The key thing that changed: Voters learned how gigantic and disruptive the proposal was. Previously, many voters assumed "Medicare for All" meant a public option.

Thus, most Democrats have moved to supporting a public option, as that's what the American people wanted all along.
I still support Medicare for All, but we're not going to pass anything like Sanders' or Warren's plan. No country has ever ripped out and rebuilt its entire insurance industry in 5-10 years, not even the ones that have M4A now.

They did it gradually, building on other systems.
To clarify, I'm not saying we can't do it *politically*. Let's assume we somehow got Republicans on board with M4A.

I'm saying that logistically, it is not possible to build a system that big and that comprehensive in the time frame that is being proposed.
How do you handle most people's paycheck withholding jumping 10-20% overnight?

How do you handle liquidating the big insurance companies? That would send shocks through the whole economy, cut capital investment, and smack tens of millions of people's retirement portfolios.
Then, there are the job losses? Tens of thousands of medical billers and coders would have to be retrained.

Plus, doctors' salaries would have to go down, and tons have six figures of debt from medical school.

And that's before you get into what to do about the Hyde Amendment.
None of this means Medicare for All is impossible!

But it would take, like, 50 years for the economy to restructure such that a system like that could be supportable. And we need to expand public insurance in steps and pieces to allow that restructuring to happen.
You can follow @fawfulfan.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled: