Yes, it is single payer, but the framework itself is problematic for the US. Part of the reason it works in Canada is because the provinces and territories have considerable discretion over what is covered; would this be applied to the states? It doesn't take too much imagination to foresee the consequences of that sort of framework, with some states choosing to cover beyond the 'medically necessary' - things like prescription drugs and dental care - and others choosing not to cover those things. It's one thing to have that sort of disparity of coverage between ten broad areas, but it would be patchwork nightmare if applied to the 52 states.
But assuming that could be worked out - it still begs the question of how the US is going to reach that point from where it stands now. Private, for-profit insurance companies are part and parcel of the ACA - and the regulation over those companies is minimal and far from ironclad. There has to be a recognition that some things are not negotiable - and that just isn't in the fine print of the ACA.
How does the US move from the ACA to anything remotely akin to 'universal care'? The ACA does not provide for a system of health CARE - it provides a system of loose controls over the currently completely out-of-control private, for-profit heath insurance industry. And insurance is not health care - nor does it necessarily provide access to that care, as many, many people in this country can attest.
The ACA is better than nothing - but it really isn't a road to socialized health care. In order to be a road to that, there has to be a point of intersection where one can move from the rocky path of insurance coverage to the tarmac of universal care. Where is that intersection? Where, even, is the will to consider it?
Canada started to move to a system of universal coverage in the 1940s, province by province, starting with hospital care. I admittedly have not done much research into the rationale behind this move, but I suspect that Canada was looking at the changes instituted in the UK in the twenty years before the NHS was formally introduced (1948) and borrowing ideas from what they saw.
In other words, there is a background and history; an early recognition that pay-for-service and for-profit health insurance were not the best option for the nation. The United States has never made much of an attempt beyond Medicare and Medicaid to promote the idea that health care should be a right of citizens, not a hopeful goal to be achieved through the 'Protestant work ethic'.
It took Canada twenty-five years (if you count from 1946, when Saskatchewan began to provide hospital coverage) to reach the point of universal 'Medicare' for all the provinces and territories - and they were not starting from a position of firm belief in free-market capitalism and a desire to 'protect' the for-profit companies that serve as barriers, not facilitators to health care in the US.
We don't even have a consensus among liberals that universal health care is the right answer . . .
As for the 'private insurance companies' in Europe - can you name one country (that uses private health insurance companies to manage primary care) that does not strictly - strictly - regulate those companies?
Yes, there are private insurance companies, but they are strictly regulated to avoid the 'for profit' part of the equation - some with percentages; most with flat fee structures, regardless of age, gender, and state of health. Most of the countries in Europe do allow individuals to purchase supplemental insurance if they want it - that part, I am sure, is where the insurances companies profit - but the key word there is 'supplemental'.
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