Scenario - It is the year 2012:
Obama and the Democratic Congress passed "health care reform" in 2009.
Maybe it passed the senate by 51 votes or maybe by 61 votes. Although at the time people thought it mattered, nobody remembers or cares anymore.
Regardless, the reform is viewed as the accomplishment of the Democrats and liberals and supporters of big government.
The good news is that the number of uninsured has been more than halved from 52 million at the peak of the recession of 2009-2010, down to 25 million. Many people who did not have affordable access to care, do now(although much of this has to do with the expansion of Medicaid and not the more publicized parts of the 2009 "reform."
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Unfortunately, many still are completely uninsured, since mandates fully don't work (10-15% of car owners don't carry auto insurance even though it is much cheaper than health insurance and presupposes you have enough money to buy and maintain a car in the first place). Just as bad, the insurance many people have been able to afford has such mediocre coverage, with high deductibles or co-pays or exceptions for what is not covered, that their out-of-pocket costs are still very high if they actually get sick. For other folks, the premiums are so high that they are angry at their mandated payments. Many folks who had insurance before are actually paying more now than they were before. And the costs to government are increasing as the for-profit private insurance companies have figured out, as they always have, how to select for the healthy and wealthy.
With the healthy and wealthy disproportionately paying into the private for-profit sector, the public sector is relatively burdened by having more and more of the sick and poor. Total costs as a percentage of GNP have continued to accelerate faster than general inflation, and faster than in Europe, Canada, Japan, Taiwan, Australia. Costs to government are rising fast. Total out of pocket costs to individuals are up too. After an initial depression in their share price, the for profit private insurance companies, pharmaceutical companies and medical equipment and supply companies are all doing very very well.
I am sure that most people here understand the difference between the mediocre compromise that is public option, and actual change of the system broken that is single payer. It may be the best we can get in 2009, but it is of critical importance that the public understands what it is and what it is not. 2009 is not the end of the fight for health care reform. We need to think strategically, not just tactically.
The reason this is important is after we get whatever reform we are going It is also a matter of who gets to win the "I told you so" argument after the next reform passes, and if it fails as Single Payer advocates believe it will. At the very least we want to be sure that after this "reform" does pass, that if it fails, the next step is forward to single-payer ("see you left the private for-profit in as wasteful cheating unneeded intermediaries"), and not backward ("see government tries to reform things and it went badly") to market fundamentalism.
Out there in the real world there is a very real danger that the distinction is lost and not understood.
Many people think what they are getting IS national health insurance.
There is a danger that the general public actually thinks that what has come to be known as public option is the progressive, liberal, left solution. Regardless of the no doubt good faith efforts of slinkerwink, HCAN, the so-called Unity Coalition and Building Blocks folks, it is not. It is a compromise kludge of a camel designed to prop up the inherent failure of the for profit private insurance model, rather than replace it. And it is predesigned to fail: it will not get us to universal coverage and actual access to care, it will not provide coverage that is comprehensive for all care necessary; it will not control total costs; it will not control individual out of pocket costs.
We are not going to get the many benefits of single payer, that go beyond just the savings of $400 Billion per year in excess administrative costs including but not limited to profit. We lose out on all the efficiencies of monospony, global planning and control.
Oh well.