comment: >
  
  Because we pay our Dr's and nurses far more than other countries and states cannot afford to run the hospitals like we do
context: Vermont tried, they couldn't afford it
  California also tried but ran into funding issues 
  Seems like cost is the problem mostly >
  
  Exactly.  The good old "but its free" nonsense turns out to actually have enormous costs associated with it.  Whod have thunk it?  LOL.
  Health care needs fixing in numerous ways but just chucking huge piles of money at it will NOT fix anything.  It will just facilitate the abuse, red tape, overhead & current problems even more. >
  
  No one believes health care is free. The question is who pays for it, and who (if anyone) profits from it.  Every other developed nation on earth provides better health care for less money than the United States. >
  
  Most other countries have much flatter tax systems that generate a larger portion of revenue from lower and middle income earners then the US does, in part due to VAT (which is similar to a sales tax). 
  Healthcare staff also earn significantly less, nurses in London earn about half what nurses in Mobile, Alabama do. 
  The mechanism of payment also varies greatly between “every other country”, many are closer to the US then Canada. 
  The commonality they share is they enact price controls for medical procedures to lower costs. The US could cap reimbursement at Medicaid rates tomorrow and lower costs to a far greater extent then what could be achieved by moving to single payer or multi payer a la France, Germany or a whole host of others. >
  
  You're ignoring the incredibly high transaction costs associated with our system, as well as the perverse incentives created by it.  Our system is HUGELY inefficient.  For example: we have way too many specialists and not enough general practitioners, pediatricians, and geriatricians, which are all lower-paid jobs.  Perverse incentives in a nutshell. >
  
  That’s non-sequitur to the point, the current system could be improved but the primary way other countries hold costs down is by implementing price caps. >
  
  So if you somehow doubled the number of GPS and halved the number of specialists while miraculously having no detrimental impacts to the switch you’ve saved a whopping 4% and change, taking per capita healthcare spending from $12,530 to $11,903. 
  I’d be fascinated in an explanation of how exactly you’d do that given massive political opposition, taking away peoples cardiologists and oncologists isn’t going to sit well. 
  Either way, you’re proving my point, substantial savings can’t be achieved even with relatively large tweaks. >
  
  The federal government played around with this idea -- in 1980s, with Ronald Reagan. And again in the 2010s with Bush and Ryan, and again in 2020s with McCarthy and Trump. It didn't go over well, for a few different reasons.
  The primary means by which the federal government provides states with healthcare dollars is Medicaid. Unlike Medicare, where seniors are enrolled in a federal program that pays for healthcare directly with federal dollars, Medicaid sets up a cost-sharing agreement between states and the federal government to provide healthcare.
  Medicaid provides matched funds to help states defray the costs of providing healthcare for the poor. The federal government sets baseline rules that every state must follow, but there's significant room for variance in how state determine eligibility, and which benefits they'll provide. Richer states get a lower matching rate than poorer states. Medicaid matches 84% of expenses in Mississippi, but only 56% in California.
  The problem that emerged is twofold. First, Republicans were willing to change the law so that money could be used for public healthcare plans for blue states, but only if the Democrats agreed to let red states skip other requirements. California could have public option money, but only if Texas could spend Medicaid dollars on pregnancy crisis centers or religious therapy, for example. Obviously a non-starter for the Democrats.
  Second, the states that wanted to set up public systems are also the states with the lowest matching rates, which made the public programs prohibitively expensive. Anually, California receives around $700 million in Medicaid matching dollars. The price tag for single-payer in California is estimated to be between $314 and $400 billion. Again, Republicans were willing to wiggle on those rate, if Democrats were willing to let states enforce harsh work requirements for Medicaid eligibility, or eliminate Medicaid spending on family planning services.
  Presumably, these would still be problems today. Moreso, given the toxification of the Republican base and the caliber of GOP representatives being sent to Congress. >
  
  
  What is stopping the implementation
  
  Money. They'd need Congress to pass a bill for the funding. >
  
  Colorado is the second state to launch something resembling a public option, after Washington. Nevada is ramping up a similar approach, with a 2026 start date. 
  Both states have a public option that is more of a public-private partnership: The plan was designed by the state but is offered by private insurance companies. 
  
  Cascade Care offers health insurance coverage options on the individual market through Washington's Healthplanfinder
  
  A Cascade Select plan is Washington's public option insurance coverage option on the individual market
  
  2 years after offering plans in Washington
  
  The plans are available in only 25 of the state's 39 counties,
  enrollment numbers have been underwhelming
  In the first year of the program, roughly 40% of new enrollees chose a Cascade Care plan, including 2.5% who chose a Cascade Select Public Option plan. 
  Among new enrollees, 16% chose a Cascade Care plan, including 0.8% who chose a Cascade Select Public Option plan. Enrollment was correlated with price
  and  hospitals arent signing on to accept the plans
  
  
  "The plans had a hard time getting networks put together because the hospitals wouldn't play," said state Rep. Eileen Cody, the Washington legislator who introduced the public option bill in 2019. "They're a big part of the problem."
  
  
  The public option relies on cutting payments to hospitals to control costs and ties reimbursement to Medicare rates, which don't cover hospitals' cost of providing care.
  
  In Colorado with open enrollment underway, consumers on the ACA marketplace can choose Colorado Option plans for the first time.  State officials are betting that people will look beyond the cost of the premiums. Which historically hasn't been true
  
  “People vote with their premium dollars,” said Kyle Brown, deputy commissioner for affordability programs at the Colorado Division of Insurance. 
  
  And more people are choosing not to enroll on the Public Option 
  
  “The Colorado Option isn’t going to be the cheapest because it has very rich benefits, The richer the benefit package, the more expensive it’s going to be. It’s simple math.”
  
  
  Decisions made by the Division of Insurance in creating the standard plan increased premiums.  Officials considered what benefits could help reduce health care disparities and set up the plan to address those. 
  That led to unlimited free visits for primary care, mental health care, substance use, and perinatal services, as well as coverage of diabetes supplies like glucose monitors and syringes at no cost. >
  
  The problem with a "public option" married to the current US healthcare system is that it's enormously expensive, and states can't fund via debt or printing money; they have to actually tax to pay for the services, and taxes big enough to pay for a public health care option are sufficiently big to take a big bite out of the state's economy.
  Actual socialized health care requires limiting costs - in short, you need to have doctors, nurses, hospitals, and pharma companies accept lower compensation. A nation can do that via regulation ("take the public rate or no medical license, and sell us the drugs cheap or we pirate your damn patent"). US states don't have control over IP laws and restricting doctor income enough to make a dent will just result in doctors moving to other states without similar laws. >
  
  
  What is stopping the implementation of such a plan by The Democrats,
  
  Their fealty to their corporate healthcare industry and pharma industry donors. Pelosi would never allow a pubic option to see the light of day, Jeffries is another corporate Dem so same thing. >
  
  This is the correct answer.  Big pharma controls both parties.  Remove legal bribery, fix problem.