At some point, you have to look at the entire industry and look at reality. If we can't afford it, what's to be done? In many areas, like my own state, they've already admitted they were wrong about single-payer. It's the salaries, the huge growth of employees and benefits.Once upon a time there were a thousand different phone companies, often with incompatible standards. Some would interconnect with others, some would not. Sometimes you had to have two phones, one to call the fire house over there, and one to call the department stores over here. Sometimes the department store would give a kickback to the phone company if the operators sent a call to Macy's when the customer asked for Gimbels.So in their infinite wisdom (and because of the approach of World War I and the military's inability to talk to itself) the government decided to change this dysfunctional system and handed it all to ... the Post Office.Within a couple years it was clear that this was no better than before, and so the government, unable to unscramble the egg, decided to hand the whole mess back to one of the original companies: AT&T, with the priviso that it be strictly regulated. It was "for profit." People could earn good salaries. But costs were strictly monitored, investor returns were capped, rates were subject to approval, and most importantly, the company was held to a standard of SERVING THE PUBLIC, not "making the most money."Single payer might be most efficient when run by the government, as we have seen with Medicare and the VA. (Not perfect, mind you, but efficient.) But I would not object if the whole thing was handed to a "for profit" company which has been in the business and knows the ropes, and which would have the ability to scale its service and tailor its products to (wait for it) SERVE THE PUBLIC as AT&T did for so many years.I'm not sure where you would find that combination of service minded public servants these days, but somewhere one must exist. I wouldn't even mind if he made a pretty big salary. I would mind if the whole thing weren't vastly more efficient than it is today, with the profit-minded insurance sector raking 30% or more off the top of health care costs.The ACA is a step forward for insuring the "previously uninsured" and in getting other things straightened out, like denying coverage after-the-fact, but we still have a long way to go. (You're still at the mercy of "in network" and "out of network" even when you don't have a choice, or only find out later, and so on.) But the ACA is not the last step, indeed I hope it's just the first in a short journey to "universal" coverage.
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