The timing alone would cause serious shocks to the

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The timing alonewould cause serious shocksto the system. Conyers’s House bill would move almost everyone in the country into Medicare within a single year. We don’t know exactly what Bernie Sanders will propose in the Senate, but his 2013 “American Health Security Act” had a two-year transition period. Radically restructuring a sixth of the economyinsuch short orderwould be like trying to stop a cruise ship on a dime. Harold Pollack, a University of Chicago public-health researcher and liberal advocate for universal coverage, says, “There
has not yet been a detailed single-payer bill that’s laid out the transitional issuesabout how to get from here to there. We’ve never actually seen that. Even ifyou believeeverything people say about the cost savingsthat would result, there arestill so many detailed questions abouthow we should finance this, how we can deal with the shockto the system, and so on.” Achieving universal coverage—good coverage, not just “access” to emergency-room care—is a winnable fight if we sweat the details in a serious way. If we don’t, we’re just setting ourselvesup for failure. Centrist Democrats will no doubt be one obstacle to universal coverage, but a more fundamental problem is that compelling theentire population to moveinto Medicare, especially over arelatively short periodof time,would invitea massive backlash. The most important takeaway from recent efforts to reshape our health-care system is that “loss aversion” isprobably the central force in health-care politics. That’s the well-established tendency of people to value something they have far more than they might value whatever they might gain if they give it up. This is one big reason that Democrats were shellacked after passing the Affordable Care Act (ACA) in 2010, and Republicans are now learning the hard way that this fear of loss cuts both ways. “Remember how much trouble President Obama got into when he said that if you like your insurance you can keep it?” asks Pollack. “For something like 1.6 million people, that promise turned out to be hard to keep. And that created a firestorm.” Those 1.6 million people represented less than 1 percent of the non-elderly population, and most of them lost substandard McPlans which left them vulnerable if they got sick. The ACA extended coverage to almost 10 times as many people, but those who lost their policies nonetheless became the centerpiece of the right’s assault on the law. Trump and other Republicans are still talking about these “victims” of Obamacare to this day. Under the current Medicare-for-All proposals, we would be forcing over 70 percent of the adult population—including tens of millions of people who have decent coverage fromtheir employer or their union, or the Veteran’s Administration, or the Federal Employees Health Benefits Program—to give up their current insurance for Medicare. Many employer-provided policies cover more than Medicare does, so a lot of people would objectively lose outin the deal. Some large companies skip the

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