Time: D H M S

UPDATE: "I've lost respect for you."

As far as I can tell, there are basically only 8 potential paths forward when it comes to the Affordable Care Act:

  • 1. It can be repealed and replaced with something worse, which is what many Republicans are proposing.
  • 2. It can be repealed and replaced with nothing at all, which is what other Republicans are proposing.
  • 3. It can be left exactly as is, which no one, to my knowledge, is proposing.
  • 4. It can be kept and mildly improved, which is what I was afraid Hillary Clinton was proposing until recently.
  • 5. It can be kept and substantially improved, which is what Hillary Clinton is now proposing.
  • 6. It can be kept and substantially improved, while also laying the groundwork for a series of gradual, longer term steps towards universal, comprehensive single payer (or similar) plan, which is what I'm proposing ("longer term" defined as 10-20 years, possibly longer).
  • 7. It can be kept in place for now (along with Medicare, Medicaid, employer-sponsored insurance, the VA/TriCare, etc.) but replaced in the short term ("short term" defined as "within the next 5 years"), which is what Bernie Sanders is proposing.
  • 8. It (along with Medicare, Medicaid, employer-sponsored insurance, the VA/TriCare, etc.) can be immediately replaced on January 20, 2017, which is what some Hillary supporters are trying to claim that Bernie Sanders is proposing, but which he isn't.

Of the above, the first 3 are completely unacceptable, as is, in my mind, the fourth. Number eight is included just to make a point about hyperbole on the Hillary side of the aisle.

So, that really boils things down to options 5, 6 and 7.

Hillary Clinton has long been publicly supporting minor improvements (#4), but a few days ago upgraded her official healthcare gameplan to #5 (substantial improvements to the ACA). Whether she intends on upping her game to #6 remains to be seen.

Bernie Sanders, in the meantime, has been solidly focused on #7. While he obviously doesn't expect to get it done on Day One (#8), or even within the first few months, it's reasonable to assume that he expects to get a comprehensive, sweeping, single payer plan at least passed sometime during his first term in office. I have no idea what his timeline for implementation of that law would be; I'm assuming it would be roughly 4-5 years, as happened with the ACA itself. Either way, no Presidential candidate I know of has the chutzpah to automatically assume that they'll win a second term before they've even won the nomination to win the first one, so I have to assume Sanders intends his Single Payer plan to be passed and signed into law no later than December 2020.

You'll note that my own views happen to fit squarely in between the two, at #6.

Now, I've repeatedly laid out my reasoning as to why I believe that a short-term move to Single Payer (#7), while theoretically more realistic than #8 (which, again, no one is proposing), is still simply not going to happen, for a bevy of economic, practical and logistical reasons, many of which have nothing to do with the sheer political resistance which Sanders and his supporters keep insisting can be overcome.

At the same time, I've also expressed serious concerns about whether Hillary's intentions are strong enough...concerns which were mostly (but not completely) allayed a few days ago. And of course, many Bernie supporters are suspicious that Hillary will retreat back from #5 to #4 as soon as she gets the nomination (if she does) or as soon as she wins the general election. I agree that this is a valid concern.

So, that's where things stand: Hillary is a definite #4 or a questionable #5 (depending on your POV) while Bernie is a solid #7. Meanwhile, I stand at a solid #6.

Bernie supporters argue that it's better to shoot for #7 even if you only end up with #6 or #5 in the end; this is the "don't start negotiating on the 50-yard line" argument.

Hillary supporters argue that #7 isn't even inside the stadium at the moment; you have to at least be on the playing field, to push the metaphor.

Me? Again, I'm somewhere in between. I want what Hillary is (now) proposing, but I also want something close to what Bernie is proposing eventually. The problem is that I also believe that those next phases will take longer than 10 years to achieve, which means that those next phases would have to happen after either one of them​ left office regardless.

That's why the question, for me, comes down to which one of these people, both of whom I have tremendous amounts of respect for in the field of healthcare, I believe is more likely to achieve whatever goals they do have in mind.

For me, it happens to be Hillary. For others, it may be Bernie...and that's perfectly fine.

And yet, while many people either support my view or oppose it using reasonable criticisms or differences of opinion, I still get this:

You are peddling false Republican talking point on DKOS now huh Charles? I lost a ton of respect for you.

...written in response to this particular point of mine (in response to the claim that "Britain switched to Socialized Medicine practically overnight!"):


I’m sorry to yell, but I get so sick of hearing this claim. Bernie isn’t just talking about building a brand new highway, he’s talking about replacing the existing highway, which happens to have 290 million people driving on it at the time.

The new highway will be faster, it will be smoother, it will hold 30 million more people...but you can’t shut down the existing highway in the meantime.

It. Will. Have. To. Be. Done. In. Phases. Over. A. Number. Of. Years.

I stated that it was a hell of a lot easier for Britain to build a socialized medicine system "practically overnight" because it wasn't replacing an existing system

Update: Or at least not nearly as elaborate of one as the U.S. in 2016...in 1948, the U.K. had only around 50 million people, and much of the healthcare infrastructure at the time, like the rest of the country, had been decimated by WWII...and even then, the NHS appears to have been the product of a nearly 30 year process:

Before the National Health Service was created in 1948, patients were generally required to pay for their health care. Free treatment was sometimes available from Voluntary Hospitals. Some local authorities operated hospitals for local ratepayers (under a system originating with the Poor Law). The London County Council (LCC) on 1 April 1930 took over from the abolished Metropolitan Asylums Board responsibility for 140 hospitals, medical schools and other medical institutions. The Local Government Act 1929 allowed local authorities to run services over and above those authorised by the Poor Law and in effect to provide medical treatment for everyone. By the outbreak of the Second World War, the LCC was running the largest public health service in Britain.[2]

...Lord Dawson was commissioned in 1919 by Lord Addison, the first British Minister of Health to produce a report on "schemes requisite for the systematised provision of such forms of medical and allied services as should, in the opinion of the Council, be available for the inhabitants of a given area". An Interim Report on the Future Provision of Medical and Allied Services[3] was produced in 1920, though no further report ever appeared. The report laid down details plans for a network of Primary and Secondary Health Centres, and was very influential in subsequent debates about the National Health Service. However the fall of the Lloyd George government prevented any implementation of those ideas at that time.

The Labour Party in 1932 accepted a resolution moved by Somerville Hastings MP calling for the establishment of a State Medical Service and in 1934 the Labour Party Conference at Southport unanimously accepted an official document on a National Health Service.[4]

(etc, etc)

I then used a metaphor to point out the gargantuan logistical task which trying to replicate this in the U.S. would be (and of course, "single payer" isn't the same thing as socialized medicine anyway; in some ways it would be easier, in other ways more diffiicult).

In response, this person stated that they I was "peddling fake GOP talking points" and that they had "lost a ton of respect for me". Someone else stated that I'm "losing credibility" for my views.

Note, again, that these are the same people who supposedly respected me immensely specificially because I've been tracking the factually accurate enrollment/related ACA data and debunking bullshit GOP/conservative talking points about the ACA on this site for the past 2 1/2 years,

Here's the thing, though: Reporting accurate information and debunking bullshit Republican/conservative talking points does not mean that every progressive claim is automatically accurate or reasonable. When I make a factual mistake, I admit it and own up to it. When I've caught the HHS Dept. or individual ACA exchanges screwing up, I've called them out for it. There was even one time that I apologized to FOX News after they made a rare truthful statement which I thought was bullshit (hey, even a broken clock...).

The point is, I'm a staunch Democrat and a solid progressive who has made a small name for myself at first by presenting accurate, factual data, and later by writing up analysis of that data in a clear, non-bullshit manner...and as I stated in my original post over a month ago, everything I've learned about the U.S. healthcare system over the past 2 1/2 years has led me to two conclusions:

  • First, I'm more certain than ever that a single payer (or similar) system is absolutely the goal we should be heading towards as a nation.
  • Second, I'm also more certain than ever that achieving that goal is absolutely not going to happen in one, two or even ten years even under the best of circumstances...but that the Affordable Care Act, for all of it's flaws (of which there are many), is the best engine to eventually get there.

In other words, I've come to the conclusion that #6 is absolutely necessary and achievable, but #7 is simply not realistic.

Now, perhaps I'll turn out to be wrong...but if I'm wrong, it's not because I've "gone to the dark side", "been corrupted by The Establishment", "sold out to The Man" or "spouting GOP talking points". If I turn out to be wrong, it'll be because I'm human, and human beings make mistakes. I don't think I'm wrong about this, but I could be, and if Bernie does get elected and somehow manages to get his universal, comprehensive, no-deductible, no-co-pay, less-expensive-for-everyone, single-payer healthcare program through the system in the next 5-9 years, I'll be absolutely elated to be proven wrong.

As I've also stated many, many times, if Bernie Sanders does win the nomination I'll do absolutely everything I can to help him win the White House, along with as many progressive Democrats as possible.

However, this doesn't change either of my conclusions above. And if that means that some people who used to respect me no longer do so because I'm not telling them what they want to hear, I guess I'll just have to accept that.