[apsec112]

Political operative here. If you're wondering why healthcare reform has been so hard to get and so piecemeal, even though most Americans want it, the big reasons are:

1) any reform has to get past the Senate, and the Senate gives a lot of extra weight to states with conservative electorates. In 2009, this meant the pivotal Senators were right-wing Blue Dogs, an independent (Lieberman), and a former Republican (Specter). In 2024, this means the pivotal Senator will be a conservative Republican, since Dems run fewer Blue Dogs, and liberals can't win states like North Dakota and Louisiana.

2) people don't only vote on healthcare; Democrats also support much less popular stances on other issues, especially immigration.

Lobbying etc. matters some, but is much less important than those two big ones.

[tptacek]

Single-payer proposals have failed in state referenda in non-conservative states.

[apsec112]

Yeah, the median voter position is not all the way to single payer but is still left of the status quo

[tptacek]

Is it? Where do you see the boundaries here?

[apsec112]

Polls consistently show the public supports Democrats more than Republicans on healthcare policy, even as they trust Republicans more on other issues like inflation and immigration

https://www.the-independent.com/news/world/americas/us-polit...

[tptacek]

Right, I'm a pretty engaged Democrat, but I'm asking: what reforms do you think are within the boundaries of acceptable to the median voter? Clearly single-payer is not. It couldn't even survive in Vermont.

[adgjlsfhk1]

as someone from VT, VT was way too small to do single-payer on it's own The whole point of single payer is to have a monopsony that can effectively negotiate with everyone else. For it to have a chance, they would have had to join with MA.

I think the reform that would be acceptable to the median voter is a public option for Obamacare. Just let people select Medicare as an option instead of one of the private companies (and even better, let companies provide it as an option for their employees as well).

[jmyeet]

The majority of Americans believe the Federal government should provide health care [1][2].

The current Democratic Party is essentially "Republican Lite", Republican with a happy face on it. Democrats as a whole are more interested in defeating progressives and leftists than they are in defeating Republicans.

[1]: https://news.gallup.com/poll/468401/majority-say-gov-ensure-...

[2]: https://thehill.com/policy/healthcare/351928-poll-majority-s...

[tptacek]

This is issue polling. There are lots of problems with issue polling, but even when delivered well, the fundamental problem is it's not concrete. Poll people to see if they'd like the option to stop paying for health insurance: you'll get Assad numbers. Now write a ballot initiative for single payer, where customers see the tax price tag, and have to worry about losing their current private health insurance: the numbers fall through the floor. This isn't supposition: it's happened over and over for the past several election cycles. People do not like this idea as a concrete thing.

[aodin]

I'm a Coloradan who voted for the 2016 universal healthcare (aka ColoradoCare) proposal, but I understand why the majority (79%) voted against it: there was sticker shock at the additional 10% income tax (with caveats, but people saw the 10%) and an inability of proponents to answer basic questions such as "Will I be able to keep my current doctor?", "Will I be able to get an abortion?", and "Will there be additional tax increases?".

[dehrmann]

I remember polling either done at the same time or the same pollster that found different approval ratings for Obamacare and the ACA. Its like dihydrogen monoxide vs water.

[tptacek]

Right, but the point is (I'm belaboring) we don't have to rely on issue polling at all here, because has repeatedly made it to actual ballots, which are the votes that actually count.

[s1artibartfast]

The public is very dissatisfied with the current situation. However, they reject any solution put forward.

Approval is high for "Something Else" but low for the alternatives.