# UHC/Single Payer in the US...how would you do it? **URL:** \ **Category:** Great Debates\ **Created:** [July 3, 2017, 3:09pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433 "2017-07-03T15:09:46Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [July 3, 2017, 3:09pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/1 "2017-07-03T15:09:46Z")
Leaving aside whether we should or shouldn’t, whether it’s good or bad or stinky or sad, assume it’s something you want to do. You are President. Your party, whichever it is, has a small majority in the house and senate. The USSC is what it is. And this is key…our system is what it is. The parties are what they are. The voters are what they are. IOW, this isn’t fantasy America, nor are you god-King of the US, able to use your fiat powers to do whatever you want. You have the same real world limitations as every other US president (well, let’s say you haven’t fucked yourself as Trump, so you have a little political capital…say, Obama early first term levels). And what you want to do is get a good, affordable UHC/Single payer healthcare system passed and implemented in such a way that it becomes the new norm. And without a disruption or disconnect in the transition. (if you are completely opposed to the very idea of this then this isn’t a thread for you…move along if you can’t play along. Please). So, the question is…how would you do it? How would you get it through your own party AND through the opposition of the other party? How would you sell it to the American people so as to be meaningful to them, especially to the majority who have healthcare through their work and who are used to how it works today and for the last 50 years in the US? How would you sell it to the large number opposed to stuff like this, how would you get it through the opposition lobby groups and entrenched people who don’t think they want such a thing or have a vested interest in the old system? You have to do this within the reality of our system, of the parties and the voters as they actually are. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [July 3, 2017, 3:26pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/2 "2017-07-03T15:26:16Z")
You extend Medicare: You merge Medicaid, Veterans care and other government programs into it. You allow anyone to join. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [July 3, 2017, 3:37pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/3 "2017-07-03T15:37:50Z")
Existing thread: [http://boards.straightdope.com/sdmb/showthread.php?t=829688](http://boards.straightdope.com/sdmb/showthread.php?t=829688) ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [July 3, 2017, 4:06pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/4 "2017-07-03T16:06:08Z")
> [@PastTense](#): > > You extend Medicare: You merge Medicaid, Veterans care and other government programs into it. You allow anyone to join. Also, you add each newborn child to the program (which replaces SCHIP) but you don’t force anyone else to join. Then wait for the market to do the rest. Providers either learn to operate at Medicare rates (some do now), negotiate fairly for better rates or remain private and for-profit with those who can pay. There is even a proposed bill to do this - [Americare](https://www.vox.com/2016/2/3/10899790/single-payer-americare). ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [July 3, 2017, 6:13pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/5 "2017-07-03T18:13:51Z")
I’d like to see a tv drama series of a new President issuing a radical EO stating healthcare will be free at the point of delivery for every citizen as of 07:00am tomorrow morning. Just throw the doors open, throw the billing away - have those surplus admin staff reallocated to administrate the new lists, and slowly work through the fresh set of problems. Even have elements of the Military/National Guard help with the initial shocks and need for additional capacity. Would be an interesting watch … ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [July 3, 2017, 6:15pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/6 "2017-07-03T18:15:32Z")
[QUOTE=up\_the\_junction] I’d like to see a tv drama series of a new President issuing a radical EO stating healthcare will be free at the point of delivery for every citizen as of 07:00am tomorrow morning. [/QUOTE] The president of the US, however, doesn’t have this power, so it’s not possible. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [July 3, 2017, 6:20pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/7 "2017-07-03T18:20:09Z")
It’s a tv drama, not a documentary. But like those movies with Morgan Freeman and others as president, maybe it sows seeds … ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [July 3, 2017, 6:45pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/8 "2017-07-03T18:45:58Z")
1. Expand Medicare. 2. All healthcare free but still with deductibles, typically $10-$200, depending on procedure. 3. \*\*\*Severe \*\*\*crackdown on Medicare fraud. [($60 billion a year!)](http://www.cbsnews.com/news/medicare-fraud-a-60-billion-crime-23-10-2009/) 4. Make employers pay Medicare premiums as an employee benefit. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [July 3, 2017, 7:08pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/9 "2017-07-03T19:08:58Z")
> [@up\_the\_junction](#): > > I’d like to see a tv drama series of a new President issuing a radical EO stating healthcare will be free at the point of delivery for every citizen as of 07:00am tomorrow morning. > > Just throw the doors open, throw the billing away - have those surplus admin staff reallocated to administrate the new lists, and slowly work through the fresh set of problems. Even have elements of the Military/National Guard help with the initial shocks and need for additional capacity. > > Would be an interesting watch … > [@up\_the\_junction](#): > > It’s a tv drama, not a documentary. > > But like those movies with Morgan Freeman and others as president, maybe it sows seeds … But it doesn’t even made sense. Throw open the doors to what? Hospitals and doctors that have zero affiliation with the Federal government? There are something like 5,000 hospitals in the US. Of those, about 120 are Federally owned for veterans care, and about 80 or so are military hospitals. It makes as much sense as saying, “The food stamp program has problems, somthe President is just going to throw open the doors of grocery stores!” I think the owners of the grocery stores might have a little more say in the matter. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [July 3, 2017, 7:37pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/10 "2017-07-03T19:37:30Z")
It’d probably have to be over a lot of dead bodies which could greatly complicate the paperwork but fortunately the billings won’t increase. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [July 3, 2017, 7:39pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/11 "2017-07-03T19:39:21Z")
> [@Ravenman](#): > > But it doesn’t even made sense. Throw open the doors to what? Hospitals and doctors that have zero affiliation with the Federal government? There are something like 5,000 hospitals in the US. Of those, about 120 are Federally owned for veterans care, and about 80 or so are military hospitals. > > It makes as much sense as saying, “The food stamp program has problems, somthe President is just going to throw open the doors of grocery stores!” I think the owners of the grocery stores might have a little more say in the matter. This. Some folks see utilities such as food, healthcare, energy, etc. as something that the government turns on or off with a switch, and the only thing holding it back from the needy masses is the stingy cold hearts of those in power. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [July 3, 2017, 7:47pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/12 "2017-07-03T19:47:24Z")
> [@Ravenman](#): > > It makes as much sense as saying, “The food stamp program has problems, somthe President is just going to throw open the doors of grocery stores!” I think the owners of the grocery stores might have a little more say in the matter. Hopefully it makes more sense than this analogy! You mean the [people these guys represent.](http://www.ibtimes.com/healthcare-pharma-ceos-paid-more-top-execs-any-other-industry-analysis-finds-2374013) I’d give them a choice, the high road or strung up from the nearest lamppost. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [July 3, 2017, 7:49pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/13 "2017-07-03T19:49:05Z")
> [@Bryan\_Ekers](#): > > It’d probably have to be over a lot of dead bodies which could greatly complicate the paperwork but fortunately the billings won’t increase. Amen. You’d also get a group discount on the burials; socialised medicine is big on group discounts. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [July 3, 2017, 9:26pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/14 "2017-07-03T21:26:15Z")
> [@up\_the\_junction](#): > > Hopefully it makes more sense than this analogy! > > You mean the [people these guys represent.](http://www.ibtimes.com/healthcare-pharma-ceos-paid-more-top-execs-any-other-industry-analysis-finds-2374013) > > I’d give them a choice, the high road or strung up from the nearest lamppost. Again, you’re not making any sense at all. What does distgustingly high CEO pay have to do with the fact that the President can’t make private citizens give away health care, food, cigarettes, tattoos, weed, love, or whatever? Maybe you think I’m against UHC and for the current system? Hell no! You just seem to have no sense that the President can’t just wave a wand and give free healthcare to everyone - that scenario is just so out of touch with even a Hollywood version of how this country works. It makes Frank Underwood killing a dude look like business as usual. ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [July 3, 2017, 9:38pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/15 "2017-07-03T21:38:51Z")
> [@Ravenman](#): > > Again, you’re not making any sense at all. What does distgustingly high CEO pay have to do with the fact that the President can’t make private citizens give away health care, food, cigarettes, tattoos, weed, love, or whatever? I can see why I’m not making sense to you. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [July 3, 2017, 9:47pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/16 "2017-07-03T21:47:22Z")
> [@up\_the\_junction](#): > > I can see why I’m not making sense to you. Because he’s talking about reality and you’re not, right? ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [July 3, 2017, 9:49pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/17 "2017-07-03T21:49:43Z")
Ah, good, if you can see why you’re not making sense, then you can start making sense. ---
**Author:** ![Tee](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@Tee](https://boards.straightdope.com/u/Tee)\ **Post date:** [July 3, 2017, 11:10pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/18 "2017-07-03T23:10:15Z")
> [@XT](#): > > You have to do this within the reality of our system, of the parties and the voters as they actually are. Using this as a starting point, I have every expectation that any federal program will be rejected by half of the country. I’d rather work with state governors than Congress, and I’d much rather have the states controlling their own costs and medical facilities, so I aim to design a program that can be implemented state-by-state. I do everything possible to get the medical community on board with its architecture, which is probably the biggest “if” in the whole project. To start. This already fails your qualifications, so it goes no further. 😛 ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [July 3, 2017, 11:20pm UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/19 "2017-07-03T23:20:30Z")
> [@Tee](#): > > Using this as a starting point, I have every expectation that any federal program will be rejected by half of the country. I’d rather work with state governors than Congress, and I’d much rather have the states controlling their own costs and medical facilities, so I aim to design a program that can be implemented state-by-state. I do everything possible to get the medical community on board with its architecture, which is probably the biggest “if” in the whole project. To start. > > This already fails your qualifications, so it goes no further. 😛 Well, you at least tried to answer the question I asked. 😛 And I think yours is actually a good answer, though not sure any one state could do it this way by itself. What I was trying to get at with this OP was how difficult this would be, politically, and hoping some 'dopers would give it some thought and maybe see a way to do it. I think it’s something we SHOULD do, but I don’t see a path to get there politically. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [July 4, 2017, 12:20am UTC](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433/20 "2017-07-04T00:20:40Z")
> [@Tee](#): > > Using this as a starting point, I have every expectation that any federal program will be rejected by half of the country. I’d rather work with state governors than Congress, and I’d much rather have the states controlling their own costs and medical facilities, so I aim to design a program that can be implemented state-by-state. I do everything possible to get the medical community on board with its architecture, which is probably the biggest “if” in the whole project. To start. > > This already fails your qualifications, so it goes no further. 😛 Well that’s rather a bare bones sketch of one aspect of a plan. [Next page](https://boards.straightdope.com/t/uhc-single-payer-in-the-us-how-would-you-do-it/790433.md?page=2)