General Discussion
In reply to the discussion: What is the "hard left"? [View all]karynnj
(59,533 posts)Even at the federally level, there is the big difficulty of the entire history of how people have been and now are insured. Unlike the other industrialized companies, we had a history where a large, but steadily declining portion of the population had employer paid or highly subsidized health insurance. Our government made this an attractive benefit by letting companies include this in their costs reducing their profits and what they paid in taxes. In essence, the government subsidized that cost. For employer's the cost of giving the benefit was less than the value to the employee.
If we tried to switch to single payer at the federal level, we would need to convince the large chunk of people with employer health insurance that they would not be big losers. Remember the huge outroar against the Cadillac tax? That tax was designed to remove the tax deduction for the excess cost of very generous plans. The first step for single payer would be to eliminate the deduction completely. Remember, you can keep your plan - not in a shift to single payer. Note, you COULD keep your doctor.
Companies would have reasons to do something in their compensation packages to keep them competitive enough.
At the state level, you have to create a very complex plan that credits people who have insurance from an employer or former employer. I know that the VT plan that did not work dealt with this. The plan also had to work with the various federal programs, ACA, Medicaid etc - so some funding came from that.
The simple fact is that if they were working from a blank canvas, it would be much easier and I doubt anyone would design what we have.