“(I don’t know how to sell that in the US, honestly),”

I think the sell will have to come from many fronts, but one approach that might work is by appealing to great achievements in the American past (”We Americans used to believe we could improve on the best ideas out there–Kennedy didn’t look at the space race and say, “We can’t do better than the Russians”, he looked and dreamed and brought together the greatest minds in a generation and said: do it better. Surely we can do the same in health care…”) Jump-starting national pride, that sort of thing.

“Doesn’t sound like much Change or Hope to me.”

No–and Obama’s going to pay a stiff price if he doesn’t make good on the H&C promise especially when it comes to health care, because Americans are more than ready to have health care stop being something they worry about, and become something they can count on. If this admin doesn’t deliver on at least *that* promise, 2010 will be a repudiation.

True; however, he did promise to take action to fix the economy. And the elephant in the room on the economy (and frankly, it remains a mystery to me why the Big Three aren’t agitating, hard, for single-payer, especially when foreign automakers are putting plants in Canada rather than in the US because of health care costs, unless their goal is simply to break the UAW, which seems to be what a lot of the right-wing pundits want) is health care costs. Single-payer we know would be cheaper, provide better care, and would be easy enough to implement and administer because the Medicare system was designed to be extended to all.

Obama’s walked back some of his statements on Iraq because he wants to be flexible when the situation on the ground changes. But he hasn’t exhibited the same flexibility of thought on health care, even now that the economic situation has so deteriorated that it’s pretty much an imperative to Do Something Big to contain costs. And now not only is Daschle, and his really quite terrible thinking on health care going to be in charge of HHS, he’s asked for and received assurances that he will be in charge of any health care reform proposals. Doesn’t sound like much Change or Hope to me.

none of the three candidates embraced single payer, though there was some talk about how the edwards plan would have a single-payer type option available with the idea that it would outcompete the private plans and thus lay the groundwork for eventual single payer. but edwards himself never said stuff like that.

it’s true that “Presidents don’t keep their promises unless they’re relentlessly pressured to” the problem is that single payer was never one of obama’s promises. i agree that we should turn up the pressure on this issue, i just think that we’re probably going to end up with a health reform plan that includes existing health care companies and thus entrenches them in the system. the new system will be better than what we’ve got (it’s hard to do worse), but i fear that marginal improvement may make single payer less likely in the long run.

I did, however, have one small quibble (and it’s not with your piece per se, as it is with something you mention):

as a Canadian I’m really sick of this meme about long waiting times, because there doesn’t seem to be a whole lot of recognition about what got us (Canada) into that position in the first place: namely, a large cadre of conservative politicians pushing for “less government” and cutting the heck out of provincial health care budgets in order to rack up surpluses and win re-election (Ralph Klein, I’m looking at you), which have led to nursing and support staff layoffs, bed closures in hospitals, and…. longer waiting lines. Unfortunately, the free market solution to this in some provinces has been to develop a second tier of private service providers that those with the money can “opt-into” at will, thus further gutting the public system of much-needed doctors and public support.

So my point is this: also crucial to any US single-payer system would have to be a massive PR program to convince people that this might look like “more government,” but that it’s the right kind (I don’t know how to sell that in the US, honestly), and that it will only work if it’s the primary system for every person’s primary care, supported by tax dollars, and not put in place with a second level of private care that will only further create divisions between haves and have-nots. (Look at how well that worked with private vs. public schools.)

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Our health “care” system is shameful. No system is perfect, but it is inexcusable for such a wealthy, resourceful country to have a system that leaves so many people in bankruptcy and worse because they can’t afford the care they need.