While there are some legitimate concerns that can be raised about Medicare-for-All on the merits–as opposed to on the politics–I am not convinced that it’s a problem that some people, like members of organized labor, have worked hard to negotiate good private health care plans. To me, this is a bit like arguing that we don’t need to eliminate Lyme disease because we can treat it with antibiotics. There is simply no value-added by having a profit or commercial basis to health insurance. If it is to exist at all, it should be strictly as a supplemental product.
But that’s an ideological opinion of mine and not a strategic analysis of what the Democrats should be pursuing on the health care front during the 2020 campaign. Watching the CNN debate on Tuesday night, I agreed with Warren and Sanders on the merits, but I thought the moderates had the better argument.
I have three concerns about pushing for Medicare-for-All right now. The first is that it’s obviously controversial and has big political vulnerabilities. Sanders freely admits that to pay for it will require taxes to go up on everybody who pays taxes, including the middle class. Warren is more reluctant to acknowledge this, although she doesn’t outright deny it. What they both argue, instead, is that overall costs will go down for the middle class because they will no longer have to pay premiums, co-pays, or out-of-pocket costs. This is most likely true in a general sense, although on an individual basis it might depend on how much health care someone uses in a given year. So, one problem lies in convincing people that a tax hike will benefit them, especially when it is not guaranteed that it will.
Another problem is the same one we see anytime health care reforms are proposed. People freak out about losing plans or access to doctors they like or having to wait in a queue to get treatment. This vulnerability isn’t avoidable or a good argument for not pursuing reforms but it does make it risky to propose something as disruptive as the abolishment of all private insurance. For me, this means that you should never propose something like this unless you’re serious about putting all your muscle behind it. And that gets to my third concern.
There is a basic cost-benefit error here. The chances of pushing a Medicare-for-All plan through the next Congress are almost nil. The Democrats would either have to overcome a Senate filibuster or they’d have to eliminate the legislative filibuster altogether. Let’s examine both of those scenarios.
The Democrats would need 60 votes to end a filibuster and they couldn’t get that many votes even if they won every competitive or semi-competitive Senate race next year. So, we can rule this out.
To end the legislative filibuster, they’d need 50 votes and the vice-president breaking a tie. But the Democrats will be lucky to have more than 51 or 52 seats even in a total landslide election. The problem here is that they’re unlikely to have enough unanimity in their caucus to end the legislative filibuster unless they can get closer to 55-57 seats. That’s both because senators are institutionally opposed to the change and because moderates get two valuable things out of the filibuster. First, it prevents radical legislation from passing which would endanger their political careers. Second, it puts them in the strongest negotiating position because they are the ones who can cut deals with Republicans (or so they like to think).
So, it’s not likely that the legislative filibuster will be eliminated by the next Congress. If it is, it will probably be after the first and most important year when even the moderates have to acknowledge that the rule is crippling their new president.
So, on a cost-benefit basis, there are easily identifiable downsides to proposing something that makes people apprehensive and that can be easily attacked and mischaracterized. What I can’t find is the upside. Where is the benefit in proposing something you won’t be able to enact?
And it’s not just the filibuster that makes it hard to enact. It’s also the lack of unanimity about it in the Democratic caucuses. I’m not at all certain that Nancy Pelosi could pass Medicare-for-All through the House. In the Senate, there could be a dozen or more Democratic senators who would never sign off on it. If the idea is to move the Overton Window to make Medicare-for-All more popular, that’s the job of a message candidate, not a candidate who plans on being the nominee.
This lack of unanimity was definitely on display during the debate last night when candidates like Joe Biden, Pete Buttigieg and Amy Klobuchar all attacked Warren for proposing Medicare-for-All. That footage will be manna from heaven for Donald Trump or whoever runs in his stead next year. We can be angry about Democrats echoing Republican talking points, undermining support for Medicare-for-All, prattling about budget deficits, and giving ammunition to the GOP for the 2020 campaign. But we can also be angry that we have serious potential nominees who couldn’t predict these problems and avoid them.
What’s particularly annoying is that if Sanders or Warren were to become president, they’d probably struggle to pass the plans proposed by Biden and Buttigieg and be accused of Leninism for even trying. That’s the best they could hope to do, and they’d be exceeding my expectations if they succeeded. So, all this is is a big fat political weakness that has no discernible upside at all.
And I simply can’t understand why anyone would gift a person like Donald Trump something he can grab and beat them with. It’s dumb politics and for once the moderates have the better side of an argument.
A pedantic note:
You can cure Lyme disease with antibiotics. In fact, spirochete bacteria (of which Lyme is a member, alongside syphilis) were the *first* to be cured by antibiotics. What is known as “chronic Lyme” disease is probably something else.
I should say that “eliminate.’
Still a distinction without a difference. Bacteria die when exposed to the appropriate antibiotics.
The “tax hike” framing is bullshit and Warren is correct to treat it as such. I wish she had a better response to the “throw 149 million people off their insurance” lie, but other than that, she’s been spot on.
That meme about throw people off your health care is so much bullshit. Everyone will have health care. All industrialized countries have universal health care. Time to join the party.
Also too,
Three unrelated comments about the debate/debates:
1. I completely agree with this post.
2. Am I the only one who is really worried that Biden is showing cognitive effects of aging? He seems to be struggling to get his words out (“expedentially”). If you listen carefully he often loses the thread of his argument. In his last answer of the debate, he started out saying that he could give two examples of unexpected friends, and then he only mentioned McCain before going into his prepared lines. I’m not suggesting anything beyond the normal effects of aging, but for a 78 year old man, these effects can be significant.
3. Hugh Hewitt had a column in yesterday’s WaPo giving 100 B.S. Fox-newsy reasons why the debates are unfair to Trump and how it would be a great thing for him to refuse to show up unless there were changes made to make things more fair. I didn’t really read it carefully, because the specific arguments he makes aren’t important. What’s important is that conservatives don’t want Trump to debate, and they are preparing the ground for him to decline. I assume they are scared sh*tless about what he might do if he’s put on the stage with a opponent.
I guess I am an outlier on this because few people take me seriously, but I think Trump is already seriously demented with dementia that continues to progress at a significant rate.
I don’t think who would run well against Trump is a real issue because I do not think Trump will be a plausible candidate in a year, the dementia progression will be too obvious. (Plus, of course, more scandals surfacing).
I sort of think you are right about Trump, though I think that “seriously demented” is a bit strong. He’s definitely showing signs, but it might be a while before they are so obvious that nobody can deny them. He’s also a probable adderall abuser, so that will have effects. I think he won’t be bad enough next year that he will be forced of the ticket (for that reason), but he might be bad enough that he doesn’t show up for a debate.
In any case, it is these considerations, which we both agree on to some extent, that makes me really really concerned that we pick someone whose cognitive ability is not going be a worry. If we’re right, then all we need to do is nominate someone lucid. But let’s not have two maybe-senile old men in the race. (And I speak as someone who previously thought that Biden was the ticket to 350 electoral college votes and winning Ohio. I don’t think that anymore.)
Agree with your point about Biden, it could just be relatively rapid normal aging, but he does strike me as a bit weaker cognitively, thus not a good choice against Trump who seems clearly impaired.
I have not watched all of this debate, but in September Biden noticeably ran out of steam in the third hour compared to his performance in the first, so stamina an issue as well.
Agreed about Biden. when the field does winnow down, I think the fact that the remaining candidates will have more time to answer each question in future primary debates will make Biden look even weaker as he struggles to stay coherent for more sentences in a row.
The thing that frustrates me about Biden senility discussions is that its always framed in terms of beating Trump. What about all that stuff about being fit to be president? Trump is obviously not up to the job, but Biden may not be either by virtue of diminished mental capacity or acuity.
The sad part of this inability to be strategic is that universal health care is achievable through the back door of the public option. The apple doesn’t have to be consumed in a single bite. Republicans understand this. They push their initiative step by step over many years. So many on our side turn up their noses to anything less than the revolution.
For me the unfortunate part of this is we pay half again what others pay and that’s over three trillion a year or over 10 k per capita plus we have generally worse outcomes like life span. With good management to eliminate waste and negotiate more reasonable prices for medical services and drugs and eliminate the waste from insurance we should be able to save a trillion a year.
But the real kicker for me is the bug a boo about taxes. Does no one understand we already pay for this? Every.damn.nickel. So if taxes went up other costs go down and if we save money, we keep more. We could sort of sneak up to this if we like, as let companies continue to pay and remit the money to Medicare or what ever agency will control,it. Companies could pay a percent of compensation. If savings materialize, no New taxes.
I don’t favor single payer health care on the state level. Nevertheless NY is making a stab at it. And how will they finance it? From HP
Note the use of payroll taxes. Seems companies will continue to pay for health care.
From the start of this campaign, I’ve thought that the best play, on politics and substance. would be a full-throated defense of the Patient Protection and Affordable Care Act, together with proposals to increase Medicaid expansion, strengthen the exchanges, add a public option, tighten regulation of insurance companies, etc.
I don’t understand why Medicare for all advocates get away without talking about how the program will actually be administered. Whenever Bernie is challenged he waves it off and points to the Canadian system. This ignores the fact that our healthcare infrastructure was built over 80 years of incremental change and expansion. Will 50 states set up large bureaucracies to deliver insurance to more than 300 million people overnight? Even if the states were all willing, is it even possible to do it? Health care is very, very hard. If somebody actually got some kind of bill passed – I don’t care how it is funded – the result is guaranteed to be a disaster. There is no way to wave a hand and create and staff a massive bureaucracy within any reasonable time frame.
Exactly how do Medicare for all advocates plan to deliver healthcare for everyone without private insurance companies when the private insurance companies own the infrastructure and expertise?
The goal has to be universal coverage using the existing infrastructure. There are lots of ways to do that. Talking about anything else is a waste of time and as Martin points out, hurts the cause.
Medicare is a good example of how, it will work. No insurance companies are needed to make it work.there is no doubt the government administration will expand and that may take a little time. I am on Medicare and the only “insurance “ I have is very high deductible. There is no new infrastructure if you are talking about hospitals, doctors and such. You pick your doctor and make the appointment.
Of course private insurers are needed for Medicare. They do pricing, and – unless I am mistaken – process claims on contract with the government. In Canada, our ministry of health insures everyone, collects premiums, determines what will be covered, processes claims, pays claims and negotiates fees with a variety of contractors and wages and audits the entire system. Healthcare is one of the largest and most difficult challenges for each provincial government. Oh, and controlling costs is also very hard.
Try to deliver the program from Washington. A guaranteed ongoing clusterfuck.
How do they ever handle Medicare without insurance? My doctors always know who to bill and how much minus the piece paid by Medicare. Funny that. And see the article on HP about Ny setting up single payer with no insurance help.
My family practice physician recently sold his practice to our local hospital to get out from under the cost of the administration of Medicare claims. He had a full time employee just to oversee Medicare claims. Now the hospital district will take are of all billing, including Medicare and Medicare supplements.
One of the pluses for M4A is portability. There is no such thing as pre existing conditions and you take your coverage wherever you go ,even to nursing homes, which currently are not covered for long term use.
There are many pluses to m4a. So what? You have to figure out how to make the system work despite the fact Eisenhower erred when he committed the US to employer based insurance in the fifties. Anything else is impractical.
It is Medicaid that should be made universal. Look to France, an employer based system. It is not hard to imagine getting to universal coverage moving from Obamacare to the French system.
Are you an insurance agent?
I worked for a large company that self insured. They hired insurers for the clerical end.
Have you ever been to a doctor’s office or a hospital because of an emergency? It’s a damn nightmare. I mean about getting treated due dealing with insurance companies.
I’m not an insurance agent. I’m a Canadian who has a good understanding of how healthcare services are delivered in British Columbia.
I have been to hospital emergency rooms. It usually takes a couple of weeks to get an appointment with my doctor so he is not a good option in an emergency. In any case, I would describe the care I receive as excellent. And even considering the taxes and premiums it is clearly cheaper than in the US. I would never ever trade our system for the American system. The American system is a disaster. The question is how to fix it.
Our system was built incrementally beginning in 1939 when one premier in one small province decided to have the government pick up all hospital bills. Services covered expanded slowly province by province until the 1960’s when the federal government passed a bill to standardize service and help with the funding.
Every province has a large department that basically deliver the services done in the US by private insurance companies. Tens of thousands work for these departments across the country. They have large computer systems, sophisticated software, and significant institutional expertise. We have a public service that knows how to deliver healthcare. They have been doing it for decades.
M4A advocates make it sound like the employees who work at Blue Cross are doing unnecessary work. About a million people work for healthcare insurance companies and most of them are doing things that will need to be done in M4A Somebody has to build a system and organization to do the work now done by a million people. That’s ridiculous. Laughable.
Nobody designed the Canadian system. It evolved. Somebody is going to design a system for the entire US, create a sensible bureaucracy requiring hundreds of thousands of highly trained employees, staff them, house them, train them and launch?
A clusterfuck for sure.
The equivalent of single-payer can be achieved without abolishing the filibuster and even without needing 60 votes. Just use reconciliation.
As Ezra Klein recently wrote:
I don’t get opening yourself up to slaughter by advocating what Warren is. As Martin said, why risk a political wipe out for something that can’t pass, when the equivalent of it (Medicare or Medicaid buy-in) can be done with just 50 votes in the senate (plus the VP for 51) and without handing the Repubs something to gut you with. It doesn’t make any sense.
Before I say anything else: To me, single payer is the only health care system that makes sense. I’ve felt that way since my son was born in London many years ago, and they gave us his National Health Service card. Now, he and his family live in England and are very pleased with the NHS system. But I fear that embracing the M4A bill that Bernie wrote and that Warren has co-sponsored (along with maybe 13 other senators, let it be noted) is electoral suicide in the current political environment. Of course it makes sense fiscally to save administrative costs and eliminate profit. But the cost of the M4A bill would be enormous. An article that appeared in the Atlantic today covers a lot of recent analyses of just how much it will cost, along with estimates from various sources of how much people at various income levels would save, or not. https://www.theatlantic.com/politics/archive/2019/10/high-cost-warren-and-sanderss-single-payer-plan/600166/ Here is a sample:
“The 10-year cost of $34 trillion that the [Urban Institute[ study forecasts nearly matches the CBO’s estimate of how much money the federal government will spend over that period not only on all entitlement programs, but also on all federal income support, such as the Supplemental Nutrition Assistance Program. Former Vice President Joe Biden said incorrectly at the debate that the single-payer plan would cost more annually than the total existing federal budget—it would cost less. (The CBO says Washington will spend about $4.6 trillion in 2020.) But over the next decade, the plan on its own would represent a nearly 60 percent increase in total expected federal spending, from national defense to interest on the national debt, according to CBO projections.
“The Urban Institute estimates that a single-payer plan would require $32 trillion in new tax revenue over the coming decade. That’s slightly less revenue than its projected cost, because it would generate some offsetting savings by eliminating certain tax benefits the government now provides, such as the exclusion for employer-provided health care.”
I don’t know if that Urban Institute’s estimate includes the community-based long-term services and supports that the M4A bill would move from Medicaid to Medicare. It is possible that some cost paid by Medicaid would shift to Medicare, which would transfer some of the costs of those services currently borne by states to the federal government. I’ve seen another estimate that M4A would cost less than $34 trillion, e.g. that it would cost an additional $17 trillion over 6 years because of savings on Medicaid. In any case, the price tag is so staggering that it is sure to become an issue in the general election no matter who the Republican candidate is.
I live in Phbiladelphia, and all the evidence I have seen shows that suburban voters in our state are critical to a Democratic victory. The Philadelphia suburbs are becoming more diverse and tend to be socially liberal. But many suburban voters remain fiscally conservative. They tend to worry a lot about paying more taxes. Many folks in Philadelphia and its suburbs wound up paying more taxes under the #45 tax cuts because we no longer an deduct our S&L taxes and property taxes. In addition, many folks in the suburbs already have pretty good health care coverage through their employers, so they don’t pay much in premiums and co-pays. My husband and I are Medicare-eligible, but we choose to stay on his employer’s health care plan (and associated union benefits) because the coverage is great, it is highly portable, we pay almost nothing for prescription drugs, etc. If M4A were enacted, we might save about $3,000 a year. I seriously doubt that our tax increase would be less than that amount. Judging by the impact on us of the current tax law, I’m positive it would be much, much more.
One issue I haven’t seen addressed is what will happen to the funds that currently are spent on health care by employers and states (through Medicaid). Employers who currently pay for health care will save huge amounts (some estimates are in the article I linked to). What will they do with the savings? The example of the #45 tax cuts should not be lost on any of us. having extra money does not equate to higher wages.
Similarly, what will happen to the money the states will save if costs re shifted from Medicaid to Medicare? Currently, Medicaid is the single biggest item in most state budgets. States pay about 35 to 50% of the cost of Medicaid acute and long term care services.What will they do with the extra revenue? Will they use it to invest in education and infrastructure? Or will they use the money to cut taxes?The fact that way more states have Republican legislatures and governors than Democratic legislature and governors suggests that the savings may not be used wisely.
Martin, your analysis of the legislative chances of M4A passing is very cogent and I agree with it. Sheer obstruction from Republicans, even if they are in the minority, needs to be factored in. And proposals to shift community services from Medicaid to another funding source because of the institutional bias within Medicaid have also failed in the past. (The M4A bill would keep institutional services within Medicaid, thus preserving entitlements to costly institutional services and along with it the institutional bias.)
Last time I checked, M4A had 118 co-sponsors in the House. That’s pretty good. But the 118 includes only one of the newly-elected Democratic reps from the Philadelphia suburbs, and only 2 members of Congress from New Jersey. What does that tell us? I suspect it reflects their view of how palatable the bill will be to their suburban constituents. (Note that even my Congressman from Philadelphia’s CD-3 has not co-sponsored the bill — perhaps he’s worried about affluent voters in Center City and its environs?)
A few years ago, efforts to do single payer on the state level were considered in California but went nowhere because of cost. Of course, the feds are not bound by California-style propositions and can run big deficits. Nevertheless, I think M4A is politically risky and maybe we should not try to rush into it headlong.
Interesting your mentioned what happens to the money companies now pay. I’ve said they should continue to pay it as a percent of payroll for each employee but paid to the government agency like Medicare. That would most certainly reduce whatever the tax increase will be. And since we pay so much more than other countries there is likely significant savings to be had, although the uninsured today will absorb some,of that.
There is no doubt this is a hard lift. But it is worthwhile to make the effort IMO since it has such a great benefit for all of us. In time I also think people will come to see the benefit this system offers us and now more than ever.
I like that idea, but it’s not in the bill as currently drafted. Of course, employers would resist it, as the payments would be required by law and not subject to contracts of adhesion or collective bargaining agreements. (In all the contract negotiations I am aware of at the moment, employers’ trying to reduce health care coverage or raise the employees’ contribution is a huge issue.)
BECAUSE ITS THE GOD FUCKING DAMN RIGHT THING TO DO.
Leaving aside your political concerns, I find it baffling that you fail to grasp that.
The hardest part of implementing a M4A plan is having to first untangle the underlying mess we’ve created over the years since Ike, with employer based health insurance, insurance and pharma friendly regulations and other stuff that has morphed into the basis for insurance companies siphoning off hundreds of billions of health care dollars must be untangled. Then there are the various political interests, most of them wealthy, that will be adversely impacted, that need to be dealt with somehow. Not easy.
Rather than to try to win the entire war in one battle, as Warren and Sanders are proposing, why not plan a series of skirmishes that are easier to win, with each one getting us closer to the winning the war of making sure everyone has access to healthcare?
Best way to do that IMO is open up Medicare to anyone who wants to buy in and remove the current restrictions that prevent it from bargaining for drug prices. Allow it to compete in the market with for profit insurance companies and, with better prices, access to cheaper drugs, then market forces will force the worst of the for profit health insurers forced out of business.
I agree, that is a much more winnable fight. It is all very well to preach morality and righteousness, but even if a candidate espousing M4A is elected, it cannot pass the Senate even if Dems take it back and abolish the filibuster (which, as Martin noted, is going to be difficult-to-impossible to do — heck, some progressives oppose it). In every scenario I can think of, competition between a Medicare option and more expensive private insurance will drive out the insurance companies because Medicare costs do not include a profit and Medicare administrative costs are very low. An estimate I’ve seen of the cost of a Medicare buy-in would be 1.5 trillion a year, which could be covered by repealing the True,p tax cuts.
As I’ve noted there is no guarantee we will need any new taxes if we keep employer contributions in place, especially with negotiations, reduced costs and elimination of major waste. But to your point, I’ve seen an estimate of two economists that when you add in local taxes etc. the elite actually pay less taxes than everyone else. Sort of amazing. So they can certainly afford a few dollars more if needed and that may help to reduce the extreme income inequality.
“An in-depth analysis of Fortune 500 companies’ financial filings finds that at least 60 of the nation’s biggest corporations didn’t pay a dime in federal income taxes in 2018 on a collective $79 billion in profits, the Institute on Taxation and Economic Policy said today. If these companies paid the statutory 21 percent federal tax rate, they would owe $16.4 billion in federal income taxes. Instead, they collectively received $4.3 billion in rebates.”
https://itep.org/60-fortune-500-companies-avoided-all-federal-income-tax-in-2018-under-new-tax-law/
Imagine that. Not only did they not pay a dime in federal tax on $79 billion, not in income, but profits, they also received $4.3 billion in rebates. I make a less than 6 figure salary and I pay much more of my income in taxes by percentage than these wealthy corporations. Not only is that unfair but it doesn’t make any sense. This reality becomes beyond absurd as we admonish M4A advocates with “how are you gonna pay for it” really as a way to say we can’t pay for it. And this is with the $2.1 trillion Trump tax cuts notwithstanding.
What are the income sources for private insurance, for the most part? Consumer premium and copay payments, employer sources, and the federal government. The math would add up if we were to consider that to pay for a M4A buy in, we would have consumer premium and copay payments, at a much lower rate than what is paid privately, of course; employers would have a smaller subsidy for those employees who opt for M4A vs. a private for profit plan, the federal government contribution could stay the same, e.g still collect the current Medicare tax on employee salaries as is currently done. We have it paid for without any substantial tax increases, number one. Number two, both employer and consumer realize significant out of pocket savings on smaller employer subsidies and lower out of pocket costs, respectively.
Some obvious benefits that address existing pain points:
— Insurance is portable, you don’t lose your doctor when you leave one job and go to the next and your doctor under the new insurance is “out of the network”
— You don’t lose your insurance if you lose your job. Include a “premium insurance” program to pay the premiums when a person loses a job and applies for unemployment.
— the competition with Medicare competing straight up with for profit insurance companies and hospitals will force costs down and better services. Let them stay in the market initially and force them to change when up against a powerful competitor that doesn’t have a profit motive.
The other day I say a doc on hospitals offering differing prices for the same procedures, and the head of some hospital association absurdly saying hospitals don’t have to tell patients how they arrive at their costs or what the cost will be until after they’ve had the procedure. She said, “that’s our business!” No, that is the business of the patient paying the cost, the other half of the equation. Medicare should have a rule that says any competing health care provider could not play these games with consumers.
Lastly, here’s something that the anti-M4A crowd on the left just baffles me with. Someone in this thread said: “…our healthcare infrastructure was built over 80 years of incremental change and expansion.” And yet, they bully those talking about M4A to have ALL THE ANSWERS up front, knowing by their own admission of how the current system came about, its not possible.
M4A, or some form of it, has to happen because the current state of affairs is untenable. People going bankrupt or having to die because they lose their insurance, of prescription drugs not taken because of their out sized costs, of a significant percentage of the dollars set aside for health care not going to care but going into profits that at the end of the day not only add zero value but distract from it. Its not only a cost issue but its a moral issue. (and if you have any trouble determining if it is a moral issue, consider the latest practice of exponential increases in life-saving drugs, because they know people will die without them)
The idea with M4A is, we have to start somewhere, if its ever going to happen. And I am sure it will evolve over time to a more efficient and workable state. But w.e’ll never start if we keep talking ourselves out if it before we even begin
I agree. it is time to get the show on the road and stop the ever increasing costs and death and bankruptcy associated with the current system…
Good idea. And afterwards we can deal with the increasing costs and deaths and bankruptcies that are caused by the new system. And we will not enjoy Democrats rightfully being held responsible for the disaster.
Here are a couple of the simpler questions (there are literally thousands of others):
1) Medicare fees are now set as a percentage of private sector fee schedules. Who will negotiate the fees for every possible medical service with every doctor, clinic and hospital in the country once private insurance disappears? Will you pay more, less, or the same to a doctor in New York as you do to a doctor in rural Mississippi? How do you decide?
2) Speaking of rural, how do you intend to keep rural hospitals open? They can’t make any money out in the sticks. They struggle today in the US. They will all immediately go broke without subsidies under M4A. Democrats are going to get blamed for every closure post M4A. And the government – now responsible for access to healthcare – will be expected to solve the problems of service away from major population centres. It may surprise you to know that healthcare is a major issue in our vote today. It is a major issue in every election. Why? Because it is really really fucking hard and there are always problems, rising costs, unnecessary deaths and unfair burdens.
You seem to think it is easy. You don’t seem to have a clue about what a government run healthcare system actually involves which is my point throughout this thread. I don’t think it is possible to build a system from scratch that will work remotely well enough. Landing a man on the moon was easy compared to this.
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