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Why not just provide Medicare for all Americans, and be done with it?Because actually no one wants it - that is in Congress - I say that becausethe proposal is not serious - it’s missing massive detailsno one is actually doing the heavy lifting to address what actually needs to be doneno one has priced out the set up costsTo put it in simpler terms for lay people -think of it as a proposal to cut the cost to maintain and live in your homewould you buy and order construction of a home based on just it’s operating costs, and give the builder a blank check, or would you look at the floor plan and layout, location, and design?would you buy and order construction of a home based on just it’s operating costs, and give the builder a blank check, or would you look at zoning regulations, if it is in a floodplain, the neighborhood, crime rates the community, local schools, etc?would you buy and order construction of a home based on just it’s operating costs, and give the builder a blank check, or would you look at construction costs as well?In a nutshell - the proposal is grossly incomplete, and not really serious as a proposal - too much is MISSING-here is the only active proposal: https://www.congress.gov/115/bills/s1804/BILLS-115s1804is.pdfstudied as written, with 3 ultimate outcomes: https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdfSo far the quibbling is not about the actual numbers in the study - just about details in the weeds, like did the private sector being phased out get fully counted into the proposaland the focus os only on the perfect enactment situation, and it possibly saving 2 trillion over 10 years compared to an old (outdated btw) national health care cost projection.The other two situations, with less than perfect outcomes - will cost more-1) It does not address -The major undisclosed flaw in Medicare payment system of Medicare for All is that Medicare only pays for the actual treatment - there is no payment or percentage added to cover the costs of the building, staff, equipment or facility. Once it is Medicare for all - the payments MUST go up to replace the costs that are now shifted to private insurers.2)The existing Dr shortage - AND If doctors choose to retire rather than accept the reduction in payment that is Medicare - 20% of the doctors are at and over retirement age, the shortage will expand at the same time the number of patients are expanded-3) to go to a single payer system, the initial one-time cost will be high.- very high as in Trillions, since the only proposed model is Medicare for allHere is a partial list of all that will need to be addressed to put in and maintain a Medicare for All systemNONE OF WHICH IS ADDRESSED FULLY in Bernie’s ProgramWe will need a NATIONAL ID number / I D card system, and the Social Security number is ILLEGAL for that purpose - which is why we have new Medicare Cards to everyone - but the cards are not designed for high and lifetime useThe Federal Government is barred from paying for Abortions - we will need to redo the abortion debateThe Single Payer debate will require a decision of how much care will be covered in end of life, as well as what medications and what treatments will be covered at a national level - EVERY OTHER NATION RATIONS MEDICAL CARE to get those lower per capita costsThe Single Payer issue requires a solution to the immigration situation FIRSTwe have 60,000 trying to enter the U S EVERY MONTH that we ACTUALLY CATCH over the U S / Mexico border. Since we know we do not catch 100% - we need a plan to add those illegals to the system, or a decision on immigrationwe need a policy - do we treat those who have no ID, or do we turn them away?we have 20 to 30 million in the U S that today can not buy coverage, because they have no legal status to be able to do sowe need to manage the enrollment of all of the homeless in the U Swe need to manage the 30 million who have chosen to not get coverage - and get them enrolledAll 57 sets of Insurance laws will have to be redoneAll 57 sets of IRS laws will have to be redoneMedicare 4 All requires NEW contracts and terms with EACH doctor - best guess - 40,000 + of themMedicare 4 All requires NEW contracts and terms with EACH doctor - all 1.1 million of themMedicare mandates use of ICD-10Medicare will have to be revised to add all it does not cover, and payment rates and structures will have to be establishedU S Governments tax medical care, devices and drugs - which adds 20% (low estimate) to the cost of care. Those taxes need to be relocated to other parts of the economy, or built into the NEW system.U S Governments mandate extra reporting on medical care - which adds 20% (low estimate) to the cost of care. Those costs need to be built into the NEW system.U S purchasing of drugs requires use of FAR systemThe FAR system is not staffed for Medication purchasing, Medical supply and equipment purchasing at a national level. This will need to be staffed up.FAR requires product descriptions to be in place for each purchased item - these need to be written and revised to stat semi-current (this is why the VA is about 10 years behind in technology)FAR requires master contracts with each provider - and there are 1000 drug makers. (this and the following is why the VA is about 10 years behind in medication technology)FAR requires sub contracts for each medication dose - so a drug in 5 mg, 10 mg, 20 mg, 100 mg and 250 mg = 5 sub contracts.FAR Purchasing contracts require quantity per shipment / contract.FAR requires contracts to be revised regularly.the U S will have to revise how Government purchased drugs get into the PUBLIC distribution system that is in place, or set up a new PUBLIC distribution systemMedicare is not set up to manage the daily Rx claims that private insurers now manageMedicare is not set up to manage the claims volume of 330 insured people - it is already failing to manage the claims for onl20 million on Original Medicare google “Medicare denies more claims” for more detailsstaff would need to be hired, certified, background checked, and put in OPM retirement systemIT systems would need to be built - Medicare IT is 20 years out of date and behind the doctor’s systemsnew claims pathways and processes would need to be set up for issues not covered by current Medicare (outpatient Rx, dental & vision processes do not exist)-4) the end results would be a lower per capita cost with universal coverage. Maybe.In how many years / decades ?Just to remind you - the U S medical condition is worse than EVERY other nation with Universal Health CareWorse medical condition = higher lifestyle induced illnesses, chronic health issues , prescribed medication use, addiction rates, obesity issues and it’s medical effects, and higher demand for advanced diagnostics and end of life deterrence medical issuesSince we are not going to kill all of those people off, and we are not going to deny them medical care - In how many years / decades will we have a lower per capita cost?

Is a single-payer healthcare system economically feasible for the U.S. right now?Depends on the systemThe devil is in the details - anyone who says yes or know, without knowing what is proposed is working on ZERO informationIf you want more understanding of why the details matter, and why many logical sounding responses are flawed, consider:an article by a well known economics expert Health Reform Is Hardand the following issuesFirst - to those who use the “if they can / we can to” or similar logic - you missed a few details that are unique to the U S - like the current actual health condition, which is documented as being worse than otherSecond - to those who use GDP as a measuring stick - keep in mind that GDP includes Government spending - so that measuring stick is flawed, since it excludes overseas profits, and adds in Government spending - per capita spending is a more accurate measureThird - the cost for care is the cost for care - so it will remain that high because our GOVERNMENT system adds more cost onto the doctors. Those who added the cost of insurance to the cost of care missed that detail in the question - if the cost for the exact same service is higher in the U S than any other nation - how do you get the cost down?-Consider - actually no one wants it - that is in Congress - I say that becausethe proposal is not serious - it’s missing massive detailsno one is actually doing the heavy lifting to address what actually needs to be doneno one has priced out the set up costsTo put it in simpler terms for lay people -think of it as a proposal to cut the cost to maintain and live in your homewould you buy and order construction of a home based on just it’s operating costs, and give the builder a blank check, or would you look at the floor plan and layout, location, and design?would you buy and order construction of a home based on just it’s operating costs, and give the builder a blank check, or would you look at zoning regulations, if it is in a floodplain, the neighborhood, crime rates the community, local schools, etc?would you buy and order construction of a home based on just it’s operating costs, and give the builder a blank check, or would you look at construction costs as well?In a nutshell - the proposal is grossly incomplete, and not really serious as a proposal - too much is MISSING-here is the only active proposal: https://www.congress.gov/115/bills/s1804/BILLS-115s1804is.pdfstudied as written, with 3 ultimate outcomes: https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdfSo far the quibbling is not about the actual numbers in the study - just about details in the weeds, like did the private sector being phased out get fully counted into the proposaland the focus os only on the perfect enactment situation, and it possibly saving 2 trillion over 10 years compared to an old (outdated btw) national health care cost projection.The other two situations, with less than perfect outcomes - will cost more-1) It does not address -The major undisclosed flaw in Medicare payment system of Medicare for All is that Medicare only pays for the actual treatment - there is no payment or percentage added to cover the costs of the building, staff, equipment or facility. Once it is Medicare for all - the payments MUST go up to replace the costs that are now shifted to private insurers.2)The existing Dr shortage - AND If doctors choose to retire rather than accept the reduction in payment that is Medicare - 20% of the doctors are at and over retirement age, the shortage will expand at the same time the number of patients are expanded-3) to go to a single payer system, the initial one-time cost will be high.- very high as in Trillions, since the only proposed model is Medicare for allHere is a partial list of all that will need to be addressed to put in and maintain a Medicare for All systemNONE OF WHICH IS ADDRESSED FULLY in Bernie’s ProgramWe will need a NATIONAL ID number / I D card system, and the Social Security number is ILLEGAL for that purpose - which is why we have new Medicare Cards to everyone - but the cards are not designed for high and lifetime useThe Federal Government is barred from paying for Abortions - we will need to redo the abortion debateThe Single Payer debate will require a decision of how much care will be covered in end of life, as well as what medications and what treatments will be covered at a national level - EVERY OTHER NATION RATIONS MEDICAL CARE to get those lower per capita costsThe Single Payer issue requires a solution to the immigration situation FIRSTwe have 60,000 trying to enter the U S EVERY MONTH that we ACTUALLY CATCH over the U S / Mexico border. Since we know we do not catch 100% - we need a plan to add those illegals to the system, or a decision on immigrationwe need a policy - do we treat those who have no ID, or do we turn them away?we have 20 to 30 million in the U S that today can not buy coverage, because they have no legal status to be able to do sowe need to manage the enrollment of all of the homeless in the U Swe need to manage the 30 million who have chosen to not get coverage - and get them enrolledAll 57 sets of Insurance laws will have to be redoneAll 57 sets of IRS laws will have to be redoneMedicare 4 All requires NEW contracts and terms with EACH doctor - best guess - 40,000 + of themMedicare 4 All requires NEW contracts and terms with EACH doctor - all 1.1 million of themMedicare mandates use of ICD-10Medicare will have to be revised to add all it does not cover, and payment rates and structures will have to be establishedU S Governments tax medical care, devices and drugs - which adds 20% (low estimate) to the cost of care. Those taxes need to be relocated to other parts of the economy, or built into the NEW system.U S Governments mandate extra reporting on medical care - which adds 20% (low estimate) to the cost of care. Those costs need to be built into the NEW system.U S purchasing of drugs requires use of FAR systemThe FAR system is not staffed for Medication purchasing, Medical supply and equipment purchasing at a national level. This will need to be staffed up.FAR requires product descriptions to be in place for each purchased item - these need to be written and revised to stat semi-current (this is why the VA is about 10 years behind in technology)FAR requires master contracts with each provider - and there are 1000 drug makers. (this and the following is why the VA is about 10 years behind in medication technology)FAR requires sub contracts for each medication dose - so a drug in 5 mg, 10 mg, 20 mg, 100 mg and 250 mg = 5 sub contracts.FAR Purchasing contracts require quantity per shipment / contract.FAR requires contracts to be revised regularly.the U S will have to revise how Government purchased drugs get into the PUBLIC distribution system that is in place, or set up a new PUBLIC distribution systemMedicare is not set up to manage the daily Rx claims that private insurers now manageMedicare is not set up to manage the claims volume of 330 insured people - it is already failing to manage the claims for onl20 million on Original Medicare google “Medicare denies more claims” for more detailsstaff would need to be hired, certified, background checked, and put in OPM retirement systemIT systems would need to be built - Medicare IT is 20 years out of date and behind the doctor’s systemsnew claims pathways and processes would need to be set up for issues not covered by current Medicare (outpatient Rx, dental & vision processes do not exist)-4) the end results would be a lower per capita cost with universal coverage. Maybe.In how many years / decades ?Just to remind you - the U S medical condition is worse than EVERY other nation with Universal Health CareWorse medical condition = higher lifestyle induced illnesses, chronic health issues , prescribed medication use, addiction rates, obesity issues and it’s medical effects, and higher demand for advanced diagnostics and end of life deterrence medical issuesSince we are not going to kill all of those people off, and we are not going to deny them medical care - In how many years / decades will we have a lower per capita cost?