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When I was reading the transcript of Obama's speech on the Affordable Care Act today, two (adjacent) passages stood out to me in their disingenuousness.

And so, what we did was we chose a path that was the least disruptive to try to finally make sure that health care is treated in this country like it is in every other advanced country: That it's not some privilege that just a certain portion of people can have, but it's something that everybody has some confidence about.
First of all, the Affordable Care Act does not guarantee that health care is treated in this country as it is in other advanced countries. Because the government still has a self-imposed ban on negotiating for drug prices and because it provides outrageously long patents to pharmaceutical companies, our prescription drug prices are far higher than they are in other countries. Moreover, the ACA will still leave 30 million Americans uninsured and could end up exacerbating the problem of underinsurance. Because of such underinsurance, it will be at best a weak palliative to the problem of medical bankruptcies. Furthermore, those advanced countries that don't have a national health insurance plan, e.g. Switzerland, tend to have a market dominated by nonprofit, rather than for-profit, insurers. And that creates a completely different incentive structure.

So, does the ACA do some good? Yes, it does. Allowing children to stay on their parents' plans until age 26, the Medicaid expansion, the medical loss ratio, and the increased funding to community health centers were all good steps forward. However, it does not do enough to fix the structural problems with the American health care system and to bring it on par with those of the rest of the advanced world. It just tinkers around the edges.

And, you know, we didn't go far left and choose an approach that would have been much more disruptive. We didn't adopt some more conservative proposals that would have been much more disruptive.
Here Obama is striking his usual "adult in the room," "middle ground" posture, in which he tries to place himself above the realm of politics in this supra-partisan sensible "middle." He calls approaches further to the left of the Affordable Care Act too "disruptive." Frankly, the only thing that Medicare for All (single payer), a Medicare buy-in, or a public option would have disrupted was corporate profit.

Let's look at the first of those options, the one the administration discarded from the start: single payer, or Medicare for All.

First of all, it would provide all Americans with the same basic but robust health insurance.

Second, it would be fiscally responsible. According to the interactive Health Care Budget Deficit Calculator over at the Center for Economic and Policy Research, the U.S. could balance the budget in basically 10 years if it had adopted a health care model like that of any other advanced industrial country.

Third, it would be good for business. A single payer system would reduce labor costs and help make small businesses more competitive. By providing health security to everyone, it would promote entrepreneurship and innovation in a myriad of other sectors, by making people more willing and able to take risks.

But it would be bad for the profits of the health insurance companies and the pharmaceutical companies. And, of course, they're just too important to disrupt.

Last Congress, Sen. Bernie Sanders (I-VT) and Rep. Jim McDermott (WA-07) introduced the American Health Security Act, with the strong support of the AFL-CIO. Sam Farr (CA-20), Judy Chu (CA-27), Keith Ellison (MN-05), Raul Grijalva (AZ-03), Lacy Clay (MO-01), Jan Schakowsky (IL-09), Barbara Lee (CA-13), and Jim McGovern (MA-02) all co-sponsored the legislation as well. John Conyers's Expanded & Improved Medicare for All Act has an additional 42 extra co-sponsors.

As Congress discusses "fixing" the Affordable Care Act, I would hope that these and other progressive legislators fight to make health care reform more progressive and more universal.

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