Medicare for All?

[ESF]

What exactly is "Medicare for All"?  Is there even a policy document that explains it?

Is it just a public option so people who want to participate in Medicare can? Or do people seriously want the Democrats to abolish our entire system of private insurance completely and make everyone go on Medicare?

I hear it all the time and I do not understand what is actually being proposed. I get the sense that people have vastly different ideas of what it is.

[debatethis]

KFF has a good "summary" www.kff.org/medicare/issue-brief/medicare-for-all-and-public-plan-buy-in-proposals-overview-and-key-issues/ but really it's a collection of all eight of the major/differing policy summaries.

[WOT?*]

Here's a decent Bloomberg article from this morning that says it all: "Pretty much everyone that's going to run in 2020 is going to have to define what they think it is." www.bloomberg.com/news/articles/2018-11-07/health-politics-turn-to-medicare-for-all-as-obamacare-is-safe

[seeyalater52]

It isn't really a coherent policy. It's varying degrees of absurdity depending on which proposal you look at.

The best description that I think sums up the spirit of/commonalities of the various proposals is a national single-payer system that takes Medicare, turns it into Medicaid (so actually covering a full range of benefits, which Medicare doesn't really do) and then gives it to everyone as their health insurance. Financially in order for it to work, there would need to be large taxes on employers (to capture the money that currently goes into employer-sponsored health benefits), large taxes on individuals (either huge taxes on the wealthy or smaller taxes on people at low middle through wealthy income brackets), and people would need to give up employer sponsored coverage for this new plan or double-pay for it as supplemental insurance. Plus it would need additional expenditures from federal and state governments.

So, essentially it's a talking point that sounds really good without much, if any (depends on the plan), actual pathway to either getting it passed in the first place, or for implementing it.

I think this would all be be incredibly disruptive and expensive for an outcome I'm not sure is more desirable than lowering the threshhold for qualification for Medicaid on the lower end, increasing support for subsidizing private insurance at the federal level for those currently trapped in unaffordable marketplace or employer plans, and leaving people who are happy in the plans they currently have, with a robust safety net of options for people to choose from if they lose that coverage. Basically the ACA with maybe a private option thrown in. The only argument I've heard for why it HAS to be set up like the Medicare for all plans set things up is that it "takes for-profit insurers out of the equation" but I think that is rightfully seen as a pipe dream for anyone who is paying attention to how our current government-funded health programs function - which is to say that they are largely administered through insurance companies who contract to provide insurance benefits to consumers.

This is one reason why I feel VERY STRONGLY that election platform talking points need to become actual plans before we all get ahead of ourselves bandying promises about that can't come to fruition. And I have yet to see a single solitary "Medicare for All" branded plan federally or proposed by any state candidate that has a chance at functioning as promised. I have read every single one.

[ESF]

Thanks for the info!

seeyalater52 -- that's kind of what I thought might be happening. I think the Dems are going to have a nightmare on their hands if they all go into 2020 saying "I'm for Medicare for All" when each primary candidate has a different idea of what that actually is. They need to sort this shit out. And I agree that ending private insurance is a non-starter. Politically unpopular, logistically unfeasible, and it would tank the economy. It's got to be the ACA with a souped up public option.

[eddy]

Nov 7, 2018 12:46:39 GMT -5 ESF said:

Thanks for the info!

seeyalater52 -- that's kind of what I thought might be happening. I think the Dems are going to have a nightmare on their hands if they all go into 2020 saying "I'm for Medicare for All" when each primary candidate has a different idea of what that actually is. They need to sort this shit out. And I agree that ending private insurance is a non-starter. Politically unpopular, logistically unfeasible, and it would tank the economy. It's got to be the ACA with a souped up public option.

Very similar to the shitshow that GOP faced going into the 2016 election with their “abolish Obamacare” nonesense.

[seeyalater52]

Nov 7, 2018 12:46:39 GMT -5 ESF said:

Thanks for the info!

seeyalater52 -- that's kind of what I thought might be happening. I think the Dems are going to have a nightmare on their hands if they all go into 2020 saying "I'm for Medicare for All" when each primary candidate has a different idea of what that actually is. They need to sort this shit out. And I agree that ending private insurance is a non-starter. Politically unpopular, logistically unfeasible, and it would tank the economy. It's got to be the ACA with a souped up public option.

YUP! And we keep saying this to Dems in Congress, and they keep saying that they basically don't have time because now oversight and investigations are the only thing on the political agenda. Which is what fueled my meltdown in the results thread last night. We cannot ignore this or it's going to go dynamite all over our shot at 2020. 

[pugz]

As a former hospital/hospice social worker the idea of "medicare for all" gives me pre-emptive headaches. Granted Medicare is easier to work with in some cases because the program is so huge but a lot of people on Medicare get fucked over when they try to access their benefits due to all the government red tape. Like 85 year old people with pelvic fractures being told "sorry, you're not TECHNICALLY admitted to the hospital so you don't qualify for any kind of inpatient rehab at discharge."

that is all I have to contribute. I remain extremely skeptical about the whole idea until I see some solid hammered out details.

[msmerymac]

Well, damn. So Medicare for All is like the adult version of promising pizza for lunch every day as student council president?

[msmerymac]

seeyalater52, do you think there's any public/private hybrid system, like the NHS in Britain, that the US could move to that wouldn't completely tank the economy?

[ESF]

Nov 7, 2018 13:02:11 GMT -5 pugz said:

As a former hospital/hospice social worker the idea of "medicare for all" gives me pre-emptive headaches. Granted Medicare is easier to work with in some cases because the program is so huge but a lot of people on Medicare get fucked over when they try to access their benefits due to all the government red tape. Like 85 year old people with pelvic fractures being told "sorry, you're not TECHNICALLY admitted to the hospital so you don't qualify for any kind of inpatient rehab at discharge."

that is all I have to contribute. I remain extremely skeptical about the whole idea until I see some solid hammered out details.

One thing that is very frustrating to me about the slogan is that it reveals tremendous privilege amongst those who are spouting it. Medicare sucks. It's better than nothing, but it is truly a last resort. The people on Medicare want private insurance. 

Dems need to get their shit together on this. Whenever I see someone embracing the idea, I get hives. It's the only thing that is giving me a little bit of pause about Kamala Harris.

[ESF]

Nov 7, 2018 13:05:01 GMT -5 msmerymac said:

seeyalater52 , do you think there's any public/private hybrid system, like the NHS in Britain, that the US could move to that wouldn't completely tank the economy?

So I imagine seeyalater knows more, but the problem with this model isn't so much the economy tanking, it's that it's a non-starter and not feasible.

Politicians won't be able to resist the temptation to gut the public portion of the insurance to entice people to buy private supplementary insurance. I'm not sure how Britian keeps things in check, but I think there's more of a collective will there that results in things not getting cut too much.

Think about our higher education system right now. The GOP chips away at the edges of public higher education all the time but at the end of the day, they leave them somewhat intact. That's the balance we have and it is what it is. But it stays that way because nobody is forced to use a public university, there's enough collective will to keep public universities that transcends party lines, and because the private higher ed is still by and large almost an entirely non-profit business and they have no reason to lobby the government to kill public universities.

That's not what would happen if you divided up the health insurance market between private and public. People would be forced to use public care, and there isn't the same collective sense that that's a good thing. Plus the insurance industry would lobby for more and more of the public piece. So the entire thing would fall apart as more of the public piece is given back to the private. 

The bottom line is that the number of people in this country who actually want to be forced to use a government plan is tiny. And that number will shrink once people find out what a government plan actually is. 

I'm all for bold thinking about progressive policy, but there is a difference between thinking big and thinking stupid. 

[seeyalater52]

Nov 7, 2018 13:05:01 GMT -5 msmerymac said:

seeyalater52 , do you think there's any public/private hybrid system, like the NHS in Britain, that the US could move to that wouldn't completely tank the economy?

It is really hard for me to imagine an NHS type system here in the US mostly because the delivery systems mechanisms are SO DIFFERENT. We don't have true public systems here, everything is set up through an insurance model which is inherently privatized. And un-privatizing things is very difficult both practically and politically. 

Also our medical education system is WILDLY different than it is in Britain. As long as medical students in the US are taking on hundreds of thousands of dollars in student loans to complete their education, we will not be able to construct a public health system parallel track to the system we have now. These are larger health systems questions that can't be solved only be reforming the health system, but also thinking about how the education system and other major systems in this country function and adjusting those to fit. 

This is like 50 years worth of reforms that need to happen in multiple areas of domestic policy. 

[gretchenindisguise]

Nov 7, 2018 13:18:33 GMT -5 ESF said:

Nov 7, 2018 13:02:11 GMT -5 pugz said:

As a former hospital/hospice social worker the idea of "medicare for all" gives me pre-emptive headaches. Granted Medicare is easier to work with in some cases because the program is so huge but a lot of people on Medicare get fucked over when they try to access their benefits due to all the government red tape. Like 85 year old people with pelvic fractures being told "sorry, you're not TECHNICALLY admitted to the hospital so you don't qualify for any kind of inpatient rehab at discharge."

that is all I have to contribute. I remain extremely skeptical about the whole idea until I see some solid hammered out details.

One thing that is very frustrating to me about the slogan is that it reveals tremendous privilege amongst those who are spouting it. Medicare sucks. It's better than nothing, but it is truly a last resort. The people on Medicare want private insurance. 

Dems need to get their shit together on this. Whenever I see someone embracing the idea, I get hives. It's the only thing that is giving me a little bit of pause about Kamala Harris.

How do we help out with this as ordinary citizens? I'm in CA, Harris is my senator. What is my best way to impact her?

[ESF]

Nov 7, 2018 14:45:50 GMT -5 gretchenindisguise said:

Nov 7, 2018 13:18:33 GMT -5 ESF said:

One thing that is very frustrating to me about the slogan is that it reveals tremendous privilege amongst those who are spouting it. Medicare sucks. It's better than nothing, but it is truly a last resort. The people on Medicare want private insurance. 

Dems need to get their shit together on this. Whenever I see someone embracing the idea, I get hives. It's the only thing that is giving me a little bit of pause about Kamala Harris.

How do we help out with this as ordinary citizens? I'm in CA, Harris is my senator. What is my best way to impact her?

I'm also her constituent. I called her office the day she announced she was signing on, but I will be honest and say I've not looked into whether there's been any sort of organized attempt to get her to change her mind. That said, her decision to push it is likely a presidential campaign decision, so I'm not sure constituent calls will really impact that. Something to look into, I suppose.

[Deleted]

Nov 7, 2018 13:18:33 GMT -5 ESF said:

Nov 7, 2018 13:02:11 GMT -5 pugz said:

As a former hospital/hospice social worker the idea of "medicare for all" gives me pre-emptive headaches. Granted Medicare is easier to work with in some cases because the program is so huge but a lot of people on Medicare get fucked over when they try to access their benefits due to all the government red tape. Like 85 year old people with pelvic fractures being told "sorry, you're not TECHNICALLY admitted to the hospital so you don't qualify for any kind of inpatient rehab at discharge."

that is all I have to contribute. I remain extremely skeptical about the whole idea until I see some solid hammered out details.

One thing that is very frustrating to me about the slogan is that it reveals tremendous privilege amongst those who are spouting it. Medicare sucks. It's better than nothing, but it is truly a last resort. The people on Medicare want private insurance. 

Dems need to get their shit together on this. Whenever I see someone embracing the idea, I get hives. It's the only thing that is giving me a little bit of pause about Kamala Harris.

Is that really true though for all people?  My parents and ILs are on Medicare, and they all have substantially better, and cheaper, plans than we do on private insurance from my husband's job, and he has a government job.  They complain about their plans a lot but our private plan is like a lot worse (and it's not even the worst private plan we've had in the last 10 years).

All I know is healthcare in this country is not working, we spend basically double all developed nations per person and die earlier, we need to do something major.  I don't know what that major thing is though.

[anonymous]

Nov 7, 2018 12:58:39 GMT -5 seeyalater52 said:

Nov 7, 2018 12:46:39 GMT -5 ESF said:

Thanks for the info!

seeyalater52 -- that's kind of what I thought might be happening. I think the Dems are going to have a nightmare on their hands if they all go into 2020 saying "I'm for Medicare for All" when each primary candidate has a different idea of what that actually is. They need to sort this shit out. And I agree that ending private insurance is a non-starter. Politically unpopular, logistically unfeasible, and it would tank the economy. It's got to be the ACA with a souped up public option.

YUP! And we keep saying this to Dems in Congress, and they keep saying that they basically don't have time because now oversight and investigations are the only thing on the political agenda. Which is what fueled my meltdown in the results thread last night. We cannot ignore this or it's going to go dynamite all over our shot at 2020. 

i truly think bernie's side of the party is going to go all in for bernie and their pundits will make the false equivalency argument that any dem candidate besides bernie doesn't really want medicare for all is equally as bad as trump and the part will be split.  I don't see 2020 shaking out any other way.  even today the bernie groups and talking heads are all about how the dems don't have a chance b/c their too centrist and not acknowledging that most of the people they supported the strongest lost last night-abrams, gillum, beto, ironstache.  i'm not happy those people lost but the bernie side is not admitting to the loss and is digging in even harder this morning that berie is the only serious 2020 contender.

[ESF]

Nov 7, 2018 15:02:26 GMT -5 @lindy said:

Nov 7, 2018 13:18:33 GMT -5 ESF said:

One thing that is very frustrating to me about the slogan is that it reveals tremendous privilege amongst those who are spouting it. Medicare sucks. It's better than nothing, but it is truly a last resort. The people on Medicare want private insurance. 

Dems need to get their shit together on this. Whenever I see someone embracing the idea, I get hives. It's the only thing that is giving me a little bit of pause about Kamala Harris.

Is that really true though for all people?  My parents and ILs are on Medicare, and they all have substantially better, and cheaper, plans than we do on private insurance from my husband's job, and he has a government job.  They complain about their plans a lot but our private plan is like a lot worse (and it's not even the worst private plan we've had in the last 10 years).

All I know is healthcare in this country is not working, we spend basically double all developed nations per person and die earlier, we need to do something major.  I don't know what that major thing is though.

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Fair enough, there are a lot of shit private plans on there. It's probably more accurate to say that people want decent private plans. Given the choice between a shit private plan and Medicare, there are probably people that would choose Medicare. But it's still not a well-functioning system that the middle class aspires to have access to, and I think the romanticizing of what it is offensive and tone deaf.

[sakoro]

Nov 7, 2018 13:40:11 GMT -5 seeyalater52 said:

Nov 7, 2018 13:05:01 GMT -5 msmerymac said:

seeyalater52 , do you think there's any public/private hybrid system, like the NHS in Britain, that the US could move to that wouldn't completely tank the economy?

It is really hard for me to imagine an NHS type system here in the US mostly because the delivery systems mechanisms are SO DIFFERENT. We don't have true public systems here, everything is set up through an insurance model which is inherently privatized. And un-privatizing things is very difficult both practically and politically. 
...

This is like 50 years worth of reforms that need to happen in multiple areas of domestic policy. 

The VA is one 100% public system that is funded as an entitlement, not through insurance. (VA can bill your insurance, if you have private insurance-- though most veterans who use it don't. They can't bill medicare or medicaid.). Of course, rather than expanding VA, Congress and Trump is trying to gut it by sending veterans to private providers and taking money out of the public system. Similar tactics to charter schools. So many false promises about how much better off veterans will, even though the private system doesn't have capacity and the administrative costs will be more expensive.

If a candidate proposed "VA for all", I think it would be incredibly unpopular, even with the burners. The public has a perception of VA care being lower quality (not true, as proven through studies) and involving long waits (true in too many cases).

My health policy professor made the point that each developed country made a choice at the end of WWII about how they were going to provide health care to their citizens. US took the option of funding through large paternalistic employers. UK went public, much to the chagrin of the medical profession. It would be incredibly disruptive to undo these major decisions 60+ years later and go back and start again.

Also, for a public system to work, you need a lot of solidarity within your population for it to work in a fair, accessible way. At the end of WWII, UK was almost 100% white and the country had pulled together to win the war despite the class system. The US in 2018 does NOT fit this profile AT ALL!

[pugz]

@lindy Medicare quality really varies based on which plan people sign on to. Straight up Medicare has a lot of advantages. But the cheaper "medicare replacement plans" that you can get through companies like Humana and United Health Care and the like will dick you over when it comes to many of your benefits. They will only have contracts with the sub-par nursing homes and will make you jump through hoops to qualify for a rehabilitation stay. What sucks is many people THINK they have Medicare and will have great coverage only to find out when push comes to shove that they signed up for a replacement plan to save money and now don't get a lot of the regular Medicare benefits (like being able to go to pretty much any nursing home that accepts Medicare for rehab stays). I saw it all the time.

I advised my parents and in laws to get traditional Medicare with a good prescription plan and a secondary plan (many people get a secondary plan through a company like BCBS that will help with things not covered by Medicare). It is VERY CONFUSING when you sign up for Medicare. So many options, very little help to navigate all the policies.

Depending on what kind of plan they were on before they get Medicare it can be a step up or a step down. For us, we have amazing health insurance that we pay next to nothing for through my husband's employer. Medicare would be a step down for us.

[seeyalater52]

Nov 7, 2018 17:06:26 GMT -5 pugz said:

@lindy Medicare quality really varies based on which plan people sign on to. Straight up Medicare has a lot of advantages. But the cheaper "medicare replacement plans" that you can get through companies like Humana and United Health Care and the like will dick you over when it comes to many of your benefits. They will only have contracts with the sub-par nursing homes and will make you jump through hoops to qualify for a rehabilitation stay. What sucks is many people THINK they have Medicare and will have great coverage only to find out when push comes to shove that they signed up for a replacement plan to save money and now don't get a lot of the regular Medicare benefits (like being able to go to pretty much any nursing home that accepts Medicare for rehab stays). I saw it all the time.

I advised my parents and in laws to get traditional Medicare with a good prescription plan and a secondary plan (many people get a secondary plan through a company like BCBS that will help with things not covered by Medicare). It is VERY CONFUSING when you sign up for Medicare. So many options, very little help to navigate all the policies.

Depending on what kind of plan they were on before they get Medicare it can be a step up or a step down. For us, we have amazing health insurance that we pay next to nothing for through my husband's employer. Medicare would be a step down for us.

This is also a prime example of why when our partners in the older adult space hear “Medicare for All” they roll their eyes. Medicare is not just one standard thing. It’s incredibly complicated and in some ways limited. Many people require and purchase supplemental coverage for their Medicare plans due to gaps in coverage or unaffordable out of pocket costs. There are tons of things Medicare doesn’t cover that the average person would probably expect to receive in a primary health insurance plan as promised by Bernie and company.

The plan isn’t actually to take Medicare and give it to everyone. It’s a rhetorical device meant to capitalize on the political capital that older adults have garnered around Medicare. Disingenuous at best, purposely misleading at worst.

[seeyalater52]

Additional thoughts:

Political feasibility and cost aside, think about a federally run health program. The benefit package is set by Congress and all costs are paid directly by the federal government (that’s “single payer.”) Who is going to tell me with a straight face that this is going to be comprehensive coverage? It’s going to cover reproductive health? Birth control? Abortions? And it’s going to stay the same over the duration of the program? The the benefit package isn’t going to shift and change with every new election, disrupting the care of millions of people in the process? Won’t be subject to administrative attacks through rulemaking?

I’m not sure how that would be accomplished. The current system is a few steps removed from the government and in the course of the 10 years since the ACA passed there has only been 2 major shifts to federal power and even so the results have been incredibly disruptive for folks who rely on ACA coverage, and that is nowhere near the number of
people who would be impacted by similar shifts in a truly public system.

[pantsparty]

Nov 7, 2018 13:40:11 GMT -5 seeyalater52 said:

Nov 7, 2018 13:05:01 GMT -5 msmerymac said:

seeyalater52 , do you think there's any public/private hybrid system, like the NHS in Britain, that the US could move to that wouldn't completely tank the economy?

It is really hard for me to imagine an NHS type system here in the US mostly because the delivery systems mechanisms are SO DIFFERENT. We don't have true public systems here, everything is set up through an insurance model which is inherently privatized. And un-privatizing things is very difficult both practically and politically. 

Also our medical education system is WILDLY different than it is in Britain. As long as medical students in the US are taking on hundreds of thousands of dollars in student loans to complete their education, we will not be able to construct a public health system parallel track to the system we have now. These are larger health systems questions that can't be solved only be reforming the health system, but also thinking about how the education system and other major systems in this country function and adjusting those to fit. 

This is like 50 years worth of reforms that need to happen in multiple areas of domestic policy. 

This is what I have always wondered. Because when you look at the numbers, countries like Britain spend less per citizen to cover every citizen compared to how much the U.S. spends to not cover everyone.

I just don't know how we would undo the infrastructure. My boss, who loves talking politics, seems to think tort reform is the answer. I'm sure that's part of the equation. But we essentially need to blow up multiple industries to make this happen - which seems impossible.

[sakoro]

Nov 7, 2018 18:50:05 GMT -5 seeyalater52 said:

Additional thoughts:

Political feasibility and cost aside, think about a federally run health program. The benefit package is set by Congress and all costs are paid directly by the federal government (that’s “single payer.”) Who is going to tell me with a straight face that this is going to be comprehensive coverage? It’s going to cover reproductive health? Birth control? Abortions? And it’s going to stay the same over the duration of the program? The the benefit package isn’t going to shift and change with every new election, disrupting the care of millions of people in the process? Won’t be subject to administrative attacks through rulemaking?

That's the problem with VA. Each administration and congress has its own "pet projects" (e.g. bringing down wait times, traumatic brain injuries) that get abandoned at the next election. Do you want Congress to be your insurance company's/ health care provider's Board of Directors?

VA and Medicare currently don't provide much reproductive health services so a lot of the conservative christian anti-women stuff is kept at a distance. You bet that Chris Smith R-NJ (aka birth control is baby fertilizer) would be all over that. Not to mention they wouldn't cover assisted reproductive technologies covered by many health plan (because life begins as an embryo).

[seeyalater52]

Nov 7, 2018 19:17:07 GMT -5 sakoro said:

Nov 7, 2018 18:50:05 GMT -5 seeyalater52 said:

Additional thoughts:

Political feasibility and cost aside, think about a federally run health program. The benefit package is set by Congress and all costs are paid directly by the federal government (that’s “single payer.”) Who is going to tell me with a straight face that this is going to be comprehensive coverage? It’s going to cover reproductive health? Birth control? Abortions? And it’s going to stay the same over the duration of the program? The the benefit package isn’t going to shift and change with every new election, disrupting the care of millions of people in the process? Won’t be subject to administrative attacks through rulemaking?

That's the problem with VA. Each administration and congress has its own "pet projects" (e.g. bringing down wait times, traumatic brain injuries) that get abandoned at the next election. Do you want Congress to be your insurance company's/ health care provider's Board of Directors?

VA and Medicare currently don't provide much reproductive health services so a lot of the conservative christian anti-women stuff is kept at a distance. You bet that Chris Smith R-NJ (aka birth control is baby fertilizer) would be all over that. Not to mention they wouldn't cover assisted reproductive technologies covered by many health plan (because life begins as an embryo).

That last bit is kind of a hill to die on for me. Call me a selfish bitch but I need that shit. I live in an IVF mandate state and I went balls to the walls with a literal lawsuit to get my insurer to allow us to access that benefit as a lesbian couple (because of their shitty discriminatory policy and this is in *Massachusetts*.) Not only would there be no assisted reproduction covered in any national plan, even if by some miracle it were covered there’s no way gay couples wouldn’t be excluded.

And that’s just ONE example of a state mandate that would disappear into thin air if we nationalized health care. I’m not a fan of the patchwork of different standards by state or disparities between states in terms of what is required, but lowering everyone to the same crappy floor that 60+ Senators can agree on is not an acceptable solution to that problem.

I don’t HAVE to give up the employer plan that is working for me in order to ensure that others who don’t have equally excellent coverage options have better health care. That is a false dichotomy created by this Medicare for All or bust mentality that wants to throw away the gains we made in the ACA and substitute it for an entirely different type of health system (and education system, and legal system, tax system etc) to fix a problem that is solvable within our current system.

[sakoro]

Nov 7, 2018 19:27:52 GMT -5 seeyalater52 said:

Nov 7, 2018 19:17:07 GMT -5 sakoro said:

That's the problem with VA. Each administration and congress has its own "pet projects" (e.g. bringing down wait times, traumatic brain injuries) that get abandoned at the next election. Do you want Congress to be your insurance company's/ health care provider's Board of Directors?

VA and Medicare currently don't provide much reproductive health services so a lot of the conservative christian anti-women stuff is kept at a distance. You bet that Chris Smith R-NJ (aka birth control is baby fertilizer) would be all over that. Not to mention they wouldn't cover assisted reproductive technologies covered by many health plan (because life begins as an embryo).

That last bit is kind of a hill to die on for me. Call me a selfish bitch but I need that shit. I live in an IVF mandate state and I went balls to the walls with a literal lawsuit to get my insurer to allow us to access that benefit as a lesbian couple (because of their shitty discriminatory policy and this is in *Massachusetts*.) Not only would there be no assisted reproduction covered in any national plan, even if by some miracle it were covered there’s no way gay couples wouldn’t be excluded.

And that’s just ONE example of a state mandate that would disappear into thin air if we nationalized health care. I’m not a fan of the patchwork of different standards by state or disparities between states in terms of what is required, but lowering everyone to the same crappy floor that 60+ Senators can agree on is not an acceptable solution to that problem.

I don’t HAVE to give up the employer plan that is working for me in order to ensure that others who don’t have equally excellent coverage options have better health care. That is a false dichotomy created by this Medicare for All or bust mentality that wants to throw away the gains we made in the ACA and substitute it for an entirely different type of health system (and education system, and legal system, tax system etc) to fix a problem that is solvable within our current system.

I'm sorry to hear that you had to go through that, seeyalater52.  Why does the reproductive system have this weird "optional" status, especially for same-sex couples? Isn't it part of the body, same as your foot? I know, rhetoric question.

Think of our system of universal k-12 education system in the United States. Because we are a country that has a high tolerance for inequity and lots of racism, the education system is highly unequal. Yes, each kid is entitled to K-12 education but the quality of education and things like teacher's pay and level of experience, funding for sports and music, class size etc are very different depending on the community demographics. We all know that East Oakland schools are not the same as [name an affluent suburb]. And many people who claim to be super-progressive and support public education will go to great lengths to avoid sending their own kids to schools with low test scores and lots of minorities. And in term, those schools suffer because resources are pulled elsewhere to other schools.

You bet that universal health care would be just as unequal in quality and access. All the games people play to get their kids into the better schools and avoid the low test score schools would play out in our doctor's clinics and hospitals too. "Of course I support health care for all, but I need to go to the doctor who can spend 30 minutes with me/ hospital with cushy private rooms/ get the name brand drug when generic would suffice. If that means the providers across town run short of resources, that's too bad, but my family comes first."