I am inclined to agree with you. While I think a Medicare for All single-payer system would be ideal (as Americans living in Canada, my wife and I love the system), I think it’s going to be difficult to impossible to build the kind of support in Congress needed to adopt that system across all 50 states in one fell swoop anytime soon. A public option will facilitate universal coverage in the short-term while simultaneously enabling the system to scale up at a manageable pace, allowing government administrators to work out any kinks as the program grows. After all, the US population is nearly 10 times greater than Canada’s and Canada implemented its single-payer program when the system was far less complex than it is today in the United States. While Sanders and Warren make the transition sound easy, the fact remains it will be anything but.

I do think Buttigieg should also state that he supports Medicare for All for any state that wants it. While the next president won’t have the authority to impose Medicare for All nationwide without congressional approval, administrations can grant waivers to states willing to try it out on their own. Empowering single-payer advocates to focus their efforts on state legislatures that are more receptive than Congress is probably a more realistic way to go in the short-term as well. While sufficient political support for Medicare for All may be lacking at the national level at the moment, it might be present (or nearly so) in some states. For example, Vermont has already come close to implementing a single-payer program. Likewise, enabling states to pool their resources and form single-payer cooperatives across states lines might facilitate regional implementation and would be particularly helpful to states with small populations (i.e. small insurance pools).

US citizen residing in British Columbia, Canada. Degrees include anthropology and environmental studies. Activism, politics, science, nature.

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