this post was submitted on 11 Jan 2024
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Republican obstruction and wanton destruction is responsible for the lack of progress. Refusing Medicaid expansions and then overturning the individual mandate is what gutted the plan.
And sure you could jump right into single payer without any incremental change. But you're going to put the 400,000 Americans currently working in the health insurance industry out of work, if you do that. Which is not a small consideration. (That's per a CBO analysis of the feasibility of single payer, which does conclude it would save money, but it will require a massive work transition.)
https://www.healthaffairs.org/content/forefront/congressional-budget-office-scores-medicare-for-all-universal-coverage-less-spending
The broader point that I'm making is that incrementalism as a philosophy has resulted in us going backwards. The acceptance of it as a viable strategy when it consistently fails to yield results is a serious problem.
A majority of successful social programs in the US did so in broad sweeping reforms that dramatically changed the way people interacted with systems.
Arguing that 400k jobs in an industry that is basically parasitic to the process seems Stockholm syndrome ludicrous, and yet unsurprising, because this is about the best that branded, 'Democrat with a capital D' , Democrats seem to be able to come up with.
Incrementalism sounds great on paper, it fails for two primary reasons. The first is the opponents to a program have to do far less to dismantle it, so its easy to work against. The second is that it fails to create its own proof points for why something was necessary in the first place. Obamacare is a great example of this second kind of failure. We're still utterly fucked in terms of healthcare. Most people are more fucked than they've ever been in terms of healthcare. We're worse off than we were because at least in 2008, although I didn't have healthcare, I wasn't paying several hundred dollars a month to basically not have healthcare. Incrementalism fails to make enough of a difference in peoples lives to show them that a given project is worth investing in.