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For some reason, I have a PhD in Health Policy and clinical practice, so, I'm inclined to look at the healthcare system when thinking about this question. IMO it's simple (and this is of course a common view): healthcare in the United States is a failed market. It's not about free market fundamentalism vs socialism, it's just that in this case, this market is totally broken. Costs are completely out of control, and accordingly, access, that is, access without incurring crippling debt, is a huge problem. Obama tried to address both cost and access. He went up against the insurance companies, and lost. He got somewhere on access, but even that is just access to insurance; insurance that may leave you with thousands of dollars to pay out-of-pocket if you walk into the ED with a complaint. So maybe you don't go. Socialized medicine, it seems, certainly won't fly in this country. But socialized insurance, "Medicare for all"? We, the little people, have many reasons to support a multi-decade experiment with that. There's no ideology here. It's just insane (unless you're profiting!) given history for us to continue imagine that in this case the Invisible Hand is going to fix things. |
The same endless propaganda and sloganeering brought to bear against socialized medicine in every medium and from every mainstream politician to make us think that it's obviously an impossibility in the US (because reasons), is used against Medicare for all. The possibility of changing US healthcare has never had a relationship with any potential improvement in health outcomes or lowering of costs - the chance for any new plan relies on how well it preserves the profits of an industry that consumes twice the proportion of GDP here as it does in any other country.
One of the reasons M4A is criticized has been that it doesn't directly lower anything except administrative overhead (which is massive, but trivial in comparison to the difference between US health care costs and the costs of the civilized world, which would have kept the US in budget surpluses year after year.) It relies on government to put pressure on prices. As the industry's only customer, it would obviously have the leverage, but with most individual politicians being funded by the industry, there's no expectation that it would suddenly have the will. M4A is criticized for not being socialized medicine (i.e. an NHS-like program) by interests who are also against socialized medicine.
The reason Obama passed ACA is because it preserved industry profits, stalled the growth in the rise of healthcare costs, and would hopefully delay the next mass challenge to the status quo. At the beginning of the 2020 election cycle, popular pressure led to virtually all of the early Democratic primary lineup to feign support for M4A, and by the end of the cycle it wasn't even in the platform as an aspirational goal, despite the VP-elect owing her entire initial media presence from her (later-reversed) support of Sanders' bill.
Getting M4A passed will likely be as difficult as getting socialized medicine passed, and would require immense and focused public pressure. We had the most popular candidate in the country run on it as a central issue twice, and during the second time, a new virus changed everyone's daily lives in the middle of the election. Still, through the media, it became a referendum on the personality of a reality show host, Russian spies, and secret pedophile networks. Rational healthcare policy has no hope.