Yeah, one of these is not like the others. Medicare at least acts a bit like a single-payer, and drives other efficiencies in health care. Too bad there isn't a medicare-for-all option in Obamacare.
The medicare-for-all is the end game of what's happening now. All the key architects of ACA have voiced their support for single-payer as the ultimate goal.
I've been confused for years as to why that wasn't the proposed solution. We already have medicare and medicaid in place, and they are working (how well... up for debate).
"We have 17 million uninsured americans in this country!" (or whatever the number was. Well... just expand medicaid eligibility (or even allow people to pay for medicaid coverage on their own, regardless of pre-existing conditions). Problem solved (or solved a lot more broadly than this force-everyone-to-buy-private-insurance-and-make-the-insurance-companies-change-their-underwriting-practices).
> I've been confused for years as to why that wasn't the proposed solution.
It wasn't because a political concern was to get something that could pass without beign scuttled by pushback from the industry and resistance Congressional Republicans and even from conservative Democrats that met and scuttled Clinton's reform efforts (why Clinton didn't seek a simple single-payer solution is another question), and so pretty much all the proposals from the major Democratic candidates in 2008 were variations on the mandatory/subsidized insurance purchase idea that had been being pushed by the insurance industry since, IIRC, the early 00's, and had been frequently floated in Republican circles -- including being a signature accomplish for Mitt Romney in Massachussettes.)
> Medicare at least acts a bit like a single-payer
Well, several decades ago it did, before the shift to encourage purchase of private managed care plans with government subsidies through what (after several name changes) is now called "Medicare Advantage".
Medicare now is more like the ACA model plus a public option than it is like single-payer.
