Peter Schwartz:

"As a general point, it mystifies me that folks are wringing their hands about a nationwide program with inherent complexity that has only been in operation for five months during which time and before and still has been relentlessly attacked and starved of funds. This isn't excuse-making; this is being clear-eyed about what it takes to pull something like this off."

Jolly:

"Why I coulda, woulda, shoulda."

I'm only being a little snarky here because not only didn't you address what I said, you completely twisted it into something else that I wasn't saying.

Just for the record, in hindsight, Medicare For All would probably have been an easier sell only because it's so darn easy for people to "get." And they start off LOVING the program. Of course, AA will tell you about all the problems with that solution, too. So there would have been plenty for the hand-wringers to do.

VA For All...which isn't just adding paperwork in the way of Medicare...but involves adding or expanding buildings, employees at all levels, materiel like drugs and beds...in short an entire bricks and mortar and flesh and blood and administrative infrastructure...

Could have been acceptable as a place for those who were uninsurable. Put them there, and our uninsured rate goes down to just about zero. No one wants people to go without medical care, and this would have had broad support. In principle.

As long as it didn't compromise care for our vets, which I guarantee you would have been issue had this been proposed. Not to mention potential opposition from the armed services: "We're already struggling to take care of our wounded warriors. That's why Congress created this program, not to take care of Welfare Queens."

But keep in mind this would probably have dramatically increased costs for the VA insofar as the uninsured and uninsurable tend to be older and sicker. And poorer.

Remember where we showed how the per capita costs for Medicaid were substantially lower than for the VA right now? Well, get ready for VA costs to go up even more as the sick and poor and uninsurable are dumped into this system.

But, you say, "The young and healthy would also have access to this system, and they'd be paying into it." Yes, but look at the outcry--AA has shown this numerous times--at having to give up one's blessed doctor who's been like a member of the family since aught one. Well, VA For All demands that you give up your doctor. Trade him in for a "government doctor."

I'm sure you've read how panicked people are at the shortage of doctors and increased waiting times now that everyone is going to get care (at least theoretically).

Well, where the heck are all those additional VA doctors going to come from? And unless you don't want to be accused by some here of turning the American people into guinea pigs and going off half-cocked, you had best have ALL them doctors lined up the first day you open the doors and folks, who've been camping out outside since 3am, come swarming in like opening day at a new Walmart.

How many doctors, who are already straining to pay back their loans, who went into their specialties thinking they were going to be "well remunerated," are going to want to settle for a government salary, drab working conditions, and a pension at the end of the day? You are talking about a MAJOR shift in mindset for doctors, even assuming patient would be happy to switch and see a "government doctor."

So perhaps we'd pay back their loans for them...and train the new ones at no cost...do you have a calculator handy?

So here's the other point...

The public pays for the VA. They're happy to. But if you think that folks who are already paying insurance premiums and going to doctors they like at hospitals that are the best they can find are going to be happy about footing the bill for the young and healthy to go and get "free" health care...or about switching themselves...I think you're mistaken. Look at the outcry when people found out they couldn't keep the shitty plans they'd come to know and love.

And if you tell me, "No! The young and the restless will be paying into the VA," then I have to ask you, "Why is anyone then worried about them signing up for health insurance in the current plan? Why are all the hand wringers tracking the sign up numbers like hawks?" Or is this a matter of their having no choice?

And if you reply, "But the young and restless will pay for this through income or payroll taxes," then I will say, "It's almost a certainty that any tax you levy, or that anyone will allow you to levy, will not cover the cost of care at a VA hospital." Why? Because it is the sick and injured young who tend to see doctors and go to hospitals, and their care costs a lot of money.

At the end of the day, all the real problems funnel into one big one: the high cost of medical care.

You blame all the political problems of the ACA on Obama's fecklessness and naivete and airbrush away all the political potholes and booby traps one can easily see lying in the path of VA For All. Many of which, I'd argue, are the same.