Not sure where this comes from, I certainly haven’t talked down to you. The only down talking I have seen in our conversation is your calling those who don’t favor MFA “ignorant”. I think you are partly right there, and partly wrong. Many who oppose MFA don’t understand what it entails; in my opinion many who support it don’t understand that either.
In the first place I think it unlikely that MFA will survive the inevitable legal challenges from 20 or more states and a powerful insurance industry, particularly given the 5/4 conservative split in the SCOTUS. Those suits are inevitable and it’s hard to see how the Commerce Clause can be stretched to cover the annihilation of an industry on a national scale.
This will take a year or two to work its way through the courts and there is little prospect of changing the balance on the SCOTUS. During this time the conservative states will certainly be able to get rulings that hold the law in abeyance pending a top court ruling, a ruling that will probably go their way.
In the second place, there is no current model for Medicare that is equivalent to Sanders’ MFA proposal. Medicare for seniors relies on premiums, entails, co-pays, and covers only 80% of medical expenses. There is still significant participation from private insurers; about 34% of Medicare recipients have private insurance Advantage Plans that are their payers.
This means that Medicare now only serves as the payer for about 40 million Americans, scaling up to 350 million will be an epic job. MFA could try to nationalize the existing insurance industry, which would make the bloody battle over the ACA, which is not yet settled after 10 years, look like a pillow fight. MFA could try to outlaw the insurance industry, almost certainly unconstitutional, or it could try to out compete the industry and let it die of natural causes (public option).
All of the above is probably moot unless our politics shift dramatically and MFA finds a way through congress. Meanwhile, as I said in my above post we have other huge fish that need frying. If a Democrat wins the White house in this cycle the likelihood of losing the House in the midterms is significant. The path to winning the Senate this cycle is narrow, there’s no path to winning a filibuster proof majority. If the Democrats win the Senate and White House, hold the House, end the filibuster and pass MFA they will most likely get creamed in the midterms, possibly in ’24 and MFA, which will likely still be in litigation, will end on a simple majority.
These politics do change if Bernie wins a huge victory and has long enough coat tails to hold or increase seats in the House and win a significant majority in the Senate. Seems unlikely to me but it could happen. If it does he might be able to pound the bully pulpit and pass something significant, hopefully a robust public option that can set about killing off the insurance industry without too many constitutional challenges. Clearly, the government has established national single payer systems and so far they have survived legal challenge. This would all be so much more doable if Clinton had won in ’16 and the SCOTUS now leaned left instead of right. As it stands all progressive laws and programs are at risk and if Trump stays and manages to get that sixth seat it’s “Katie bar” the door for all of them.
