[velcrovan]

From another good review of the book:

> “One of the personally amusing aspects of reading Abundance is that it kept reminding me of a two-hour discussion I had with Ezra Klein in 2019 about Medicare for All. […] In our discussion, Klein balked at making Medicare for All the centerpiece of a Democratic health care agenda because he thought it was not politically practical. […] At one point in the discussion, he asks how would I overcome employer opposition to the change, and I responded that we will just have to beat it, which he clearly did not find persuasive.

> “It’s not hard to imagine having the same conversation about Abundance but with the roles reversed. Whatever the merits of their proposals, Klein and Thompson are pushing an agenda that requires direct confrontation with many powerful, entrenched constituencies.”

https://www.peoplespolicyproject.org/2025/03/24/the-abundanc...

[tptacek]

And I mean, again, here's the crux of the opposition Abundance gets from the left.

The project of the Progressive movement is a decisive takeover of the state and national Democratic parties, which is what they'd need in order to get single payer, their signature policy, passed.

The notion that there's an alternative long game for the Democrats to play, that instead of enacting a massive (and controversial) change to the health care system, the party can instead just build a track record of demonstrable competency, is a problem for their movement. Why pay attention to whether the party governs well where it holds power today (that is: in essentially every major population center in the country)? That's just a distraction from the real goal, which is reworking the entire system.

Breunig is saying the quiet part loud, which is pretty typical for him.

[velcrovan]

Except that Bruenig isn’t opposed to Abundance (neither am I). In the conclusion to the review he says the book is fine and that people who are upset about it are blowing things out of proportion. What quiet part is being said loud in this review, again?

[nradov]

The focus on "Medicare for All" or single payer healthcare in general is so misguided. Commercial insurers are like the smallest problem in the whole messed up US healthcare system. Putting everyone on Medicare wouldn't solve any of the more fundamental problems.

https://www.sensible-med.com/p/the-entire-healthcare-system-...

[HDThoreaun]

One of the most fundamental problems with the US healthcare system is the fee for service payment system. Another closely realted one is the abundance of bureaucrats and administrators. Obamacare created a pilot program to move medicare off fee for service and toward fee per patient, and m4a would likely expand that program. Combined with some sort of pharma reform and 3 of the biggest problems healthcare face could be solved. Then congress needed to expand residency funding and the next biggest problem(lack of physicians, they currently make 9% of healthcare spending in the US) would be easily solved as well.

[nradov]

Commercial insurers are also moving from fee-for-service to value-based care payment models (with capitation being one approach). That isn't something unique to Medicare.

Increasing residency funding is a good idea, but I'm skeptical that it would reduce overall costs. With an aging population, demand for healthcare services is effectively infinite. The shortage of physicians is, paradoxically, one of the factors holding costs down today. If you can't see your doctor because appointments are backlogged for months then no insurance claim will be generated.

[HDThoreaun]

Abundance's main thesis isnt about policy at all, as the OPs author points out. Their main thesis is that democrats have lost the trust of the voters because they are too focused on process instead of results. Klein and co call for incremental policy change but even beyond that they call for a reorganization of the bureaucratic state which would require no policy change at all.