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Bernie is a textbook example of a Northern European Social Democrat - not a Vermont version of Che. He would be mainstream in any country in the EU.Politically, he’s no different from the politicians that have provided the highest standards of living in the world in Europe, Japan and Singapore - for decades. We should all be so lucky.As Jenell Holt pointed out, Bernie is a classic Roosevelt Democrat, which would make him mainstream in any other developed country.I voted for him in the Texas primary and I'd vote for him again. That’s how America can advance on a single payer health care system, a living wage for working people, a sensible foreign policy and a tax policy that can reduce the federal budget deficits. All the things the rest of the developed world figured out years ago - particularly a rationalized single payer health care system, and no more pointless Wag the Dog wars brought to you by the defense lobby and chickenhawk politicians, or nixonian chicanery in the Oval Office.It’s axiomatic that the pendulum swings in politics, and the more unbalanced the tweeting becomes, the more likely the pendulum will swing the other direction. HardCommandante Bernie ? Maybe not

Depending on the poll question and sample size, single-payer has received on average about 30% — 60% U.S. support…Kaiser Family Foundation (5/13–5/18): 57% favorBusiness Insider (3/13–3/14): 49% favorQuinnipiac (11/21–11/25): 36% favorThe Economist/YouGov (9/14–9/17): 45% favorCBS News (8/28–9/4): 57% favorRealClearOpinion (4/30–5/5): 55% favorAnd according to the Washington Post, a majority of House Democrats now support Medicare for All.No matter how we slice it there’s a sizable chunk of the American electorate, especially among Democrats, who support single-payer healthcare.And so if this policy is so popular among Democrats then why hasn’t it been implemented by at least one Democrat-majority state, such as California, New York, Massachusetts, or Vermont?For one, the problem with state-based single-payer healthcare is the federal government already plays a major role in providing and regulating the industry. About 17% of Americans are on Medicare, which is a federal health insurance program, but a state can work around that by filling the gap, i.e. people under 65 who aren’t disabled would be put into the state-based version.We also know a state-based single-payer can be done because it has already been done!In 2011, Vermont signed into law the first state-based single-payer healthcare system. The signing of H. 202 led to the creation of Green Mountain Care, which was described by Kaiser Health News as “a state-funded-and-managed insurance pool that would provide near-universal coverage to residents with the expectation that it would reduce health care spending.” Vermont Governor Shumlin described the plan as “a single-payer system” that he believed “will control health care costs, not just by cutting fees to doctors and hospitals, but by fundamentally changing the state’s health care system.” Vermont Representative Larson described Green Mountain Care’s provisions as “as close as we can get [to single-payer] at the state level.”But in 2014 with all the roadwork laid, the governor saw what was up ahead and decided to turn back…“Calling it the biggest disappointment of his career, Gov. Peter Shumlin said Wednesday he was abandoning plans to make Vermont the first state in the country with a universal, publicly funded health care system.Going forward with a project four years in the making would require tax increases too big for the state to absorb, Shumlin said. The measure had been the centerpiece of the Democratic governor’s agenda and was watched and rooted for by single-payer health care supporters around the country.”According to Shumlin, the plan would have required an 11.5% payroll tax and a 9.5% income tax increase. Shumlin was particularly concerned about Vermont’s small businesses going bankrupt.Putting economics aside, it’s also understandable from a political perspective why governor Shumlin threw in the surgical mask because, despite the fact Vermont consistently ranks in the top 10 most-Democratic states, Shumlin almost lost reelection to a Republican mainly on the basis of his support for single-payer in what turned out to be the closest gubernatorial election in modern Vermont history with Shumlin getting 46.4% to Milne’s 45.1%. Governor Shumlin abandoned single-payer a month later.Other states have also come close to single-payer.California passed “The California Universal Healthcare Act” in 2006 and in 2008. Both times, Governor Arnold Schwarzenegger vetoed the bill (or should I say terminated ;). In 2019, Governor Gavin Newsom appointed a commission to study the feasibility of adopting a single-payer system in the state.Colorado through a citizen-initiated constitutional amendment proposal put a state-based single-payer proposal directly on the ballot, but it was rejected by 79% of voters.Hawaii got close to a state-based single-payer healthcare system. In 2009, its legislature passed a single-payer bill, which was vetoed by Republican Governor Linda Lingle. Lawmakers overrode the veto, but Lindle refused to appoint members or release funds. She was succeeded by a Democrat who then appointed members, but ultimately decided to abandon single-payer when talks turned toward dumping private insurance.The New York State Assembly passed a state-based single-payer health plan four times: 1992, 2015, 2016, and 2017, but it has never advanced through the New York State Senate.Ultimately, state-based single-payer hasn’t been implemented because voters haven’t been enthusiastic enough about it, the business community adamantly opposes it, and politicians are risk-adverse so when Democrats don’t have the power to implement it they are more likely to vote for it, i.e. U.S. House of Representatives, California, Hawaii, New York, because their vote will play well with their base, but then when they finally do have the power to implement it, .i.e. California, Hawaii, New York they don’t put it up for a vote.For example, as soon as Democrats took the New York State Senate in 2018, The Nation wrote,“A number of new or re-elected state senators, faced with the fresh possibility that single-payer might actually become a reality, have walked back their formerly full-throated support.”Much like Governor Newsom, Governor Cuomo has proposed a commission to “look into it,” but perhaps someone should have looked into it before it was passed in the state assembly with broad Democrat support in the previous four legislative sessions.Many Democratic politicians want to be seen as progressive fighters by doing everything up until implementation, i.e. passing a bill out of committee or chamber, forming a commission to look into it, and even signing it into law. But then when it requires some unpopular moves such as eliminating private insurance or raising taxes they have thus far always backed down because they’re afraid of a repeat of 2010 when Democrats lost power after the passage of Obamacare.Overall, dark blue states' inability to implement single-payer should give Medicare-for-All’s supporters pause because, for example, if such a homogenous, Democratic, and small state as Vermont can’t implement a functional single-payer system then what hope is there for the much larger and more ideologically divided federal government to do so efficiently? As Scott Adams said, “Ideas are worthless, execution is everything.”Since Vermont’s near-miss at single-payer, the country has become much more polarized on the issue where Republicans support it less and less and Democrats support it more and more. The silver lining to this polarization is maybe Democrats and Republicans could agree to let the other be. You do you!And then if single-payer health insurance does as its supporters contend, i.e. lower costs and increase quality, in states like Vermont, New York, and California then other states would choose to follow suit. Over time, this enthusiasm could spill over into a louder, bipartisan demand for a national single-payer system, but then at that point, many Americans may prefer to “keep their plan.”

If the question is asked, “Would you like the government to supply healthcare like many other countries do?”Yes, of course. It’s not hard to see how 50% of respondents would answer in the affirmative.The problem is that almost half of those in the US do not pay income tax. If you asked the question, “Would you like the government to supply healthcare like many other countries do if almost everyone in the US had to pay income tax and even a value added tax like a sales tax for every purchase to fund it?”Many would like something granted to them and paid by others. The problem for single payer is that this isn’t 1960 anymore. Medical care is astronomically more expensive everywhere and every industrialized country is having to deal with budget stress due to the rapid rise in healthcare costs.When voters are given the choice of keeping what they have now, or paying for single payer, then you get the only poll that really counts, an election poll. This is what blue trending Colorado decided in November 2016 when the state went through the very real exercise of figuring out how much single payer would cost if implemented in the era of modern medicine.They voted 80% against single payer.How about California? There are about as many people living in California as in Canada and Californians are always touting what a great economy they have while blithely ignoring a pension crisis that some estimate to be $1 trillion. California faces a $1 trillion unfunded pension liability and lawmakers focus on foam and plastic strawsHowever when California did the recent analysis of single payer, the study funded by Democratic leadership showed that single payer in California would cost $400 billion a year. The entire state budget is $180 billion a year. Op-Ed: Democrats' single-payer health-care dream just became a nightmareLiberal economist Paul Krugman was very open about single payer in America when Bernie Sanders said he wanted Medicare for all. Krugman said that in order for it to be affordable, it would be Medicaid for all which is more like what exists in other countries.Put it this way: for all the talk about being honest and upfront, even Sanders ended up delivering mostly smoke and mirrors — or as Ezra Klein says, puppies and rainbows. Despite imposing large middle-class taxes, his “gesture toward a future plan”, as Ezra puts it, relies on the assumption of huge cost savings. If you like, it involves a huge magic asterisk.Now, it’s true that single-payer systems in other advanced countries are much cheaper than our health care system. And some of that could be replicated via lower administrative costs and the generally lower prices Medicare pays. But to get costs down to, say, Canadian levels, we’d need to do what they do: say no to patients, telling them that they can’t always have the treatment they want.Saying no has two cost-saving effects: it saves money directly, and it also greatly enhances the government’s bargaining power, because it can say, for example, to drug producers that if they charge too much they won’t be in the formulary.But it’s not something most Americans want to hear about; foreign single-payer systems are actually more like Medicaid than they are like Medicare.And Sanders isn’t coming clean on that — he’s promising Medicaid-like costs while also promising no rationing. The reason, of course, is that being realistic either about the costs or about what the system would really be like would make it a political loser. But that’s the point: single-payer just isn’t a political possibility starting from here. It’s just a distraction from the real issues.Health Reform Is Hard