The Real Obstacle to Single-Payer

Jonathan Chait: “The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all… But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.”

“That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.”

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