Single Payer is not an option if the Roberts Court decides to turn their back on several generations of administrative law precedent to gut PPACA in two thirds of the country.
Commenter Tripod thinks it is a viable option, and is extremely wrong:
The political answer is to start saying single payer over and over. Obama tried the Republican way, they blew it up, now they get to enjoy a socialist fisting.
My question to single payer advocates is how to get to 218 and 51 if I am being generous and if I am being an ass, 218 and 60. Progressive change is hard in this country both because of the multiple veto points in the system and the general way that representatives are elected. Building a pathway for a single payer majority is damn difficult, and I just don’t see it as a feasible choice set in under a decade and more likely single payer will happen as soon as commercial fusion will — just another thirty years.
Let’s make the following assumptions based on history.
* The overwhelming majority of Republican office holders will not vote for anything that improves health care coverage for working age adults. We saw that as a political strategy in 1993/1994, and we have seen it continuously in action since 2009.
* The Republican Party is not particularly interested in healthcare policy. What interest there is counts on expanding tax preferences for high income individuals to shelter taxable income to cover low actuarial value plans.
* There was no Democratic Party consensus for single payer in 2007/2008 as the three major “viable candidates” (Obama, Clinton, Edwards) all converged to roughly the same option space.
* Single payer would be massively disruptive to people with good employer sponsored plans
* People with good employer sponsored plans are far more likely to have their screams heard than the uninsured.
From these assumptions, I am assuming that any major health policy legislation that would be a high actuarial value coverage expansion would need 97% of the votes to come from Democrats (again, I am being generous as the non-generous assumption is 100% Democratic votes). Let’s make a couple of assumptions about the composition of Democrats in Congress:
* Post WWII, the median Congressional district leans Republican. Right now, the median district is R+3, in 2008, it was R+2, so the 218th vote in the House represents a Repbulican leaning district
* The 51st Senator probably represents a Republican leaning state, the 60th Senator definately represents a Republican leaning state
* Most politicians will see the 2010/2014 blood baths as a clear warning that disruptive healthcare reform will destroy Democrats in R+1 or worse districts
* A significant number of current Democrats don’t want single payer if there is a market based alternative available, and a decent number don’t want single payer at all.
* The PPACA majority was built on a combination of a clusterfuck of a war and a fiasco of a Presidency in 2006 with it topped off by a once in three generation financial crisis in 2008.
With those assumptions, where is the majority to vote for Medicare for All coming from?
I don’t think absolute fiascos of presidencies like the W error combined with once in three generation financial crisii are a common union set. The three big eras of progressive change (1933-1937, 1965-1966, and 2009-2010) are short bursts capitalizing on massive shocks to the system that made quite a few people who normally won’t vote for Democrats be willing to vote for Democrats.
Single payer advocates need to answer how they will build a clear voting majority for single payer with a reasonable time frame. The current alternative set for an adverse ruling in King currently is nothing not single payer or Medicare for Most, so what is the theory of change to change that alternative set and what is the time frame?
wvng
Richard, you are exactly right. The path to single payer did not exist in 2009, and it certainly does not exist now.
Villago Delenda Est
The arc of history will slowly bend to single payer. The arc, however, is very, very long in this country because we have a lot of very stupid people who can’t see beyond the current fiscal quarter and grasp the long term advantages to society as a whole, not its individual greedy little atoms, of a single payer system.
Because the long term advantages to society as a whole will, by necessity, include “those people” as beneficiaries, and “those people” must always be made to suffer.
Adam Smith weeps.
shortstop
@wvng: It exists even LESS now than it did in 2009. I seriously have no time for all this magical thinking.
ruemara
Mr. Mayhew, the battle over health insurance reform (the most accurate description of the ACA) was the first time I really looked at my fellow leftists and wondered who the hell were these people that simply were a left version of Fox viewers. The facts you stated were plain to see, but it was immaterial. The one time the fact had neither a liberal nor a conservative bias, since they were hated by everyone.
jl
Single payer may evolve slowly through natural process of disintegration of individual and employer markets. Evidence is that for health insurance, there is no competitive equilibrium given asymmetric information and heterogeneity in health risks that evolve over time as people age. Fixes that can be implemented with current state regulatory regimes and federalist BS for other insurance lines are not feasible for health insurance.
So, gradual expansion of public insurance programs. I think evidence is that every 1 percentage point expansion in coverage of a public program crowds out around 0.3 to 0.5 percentage points of private coverage.
So, after a hundred years or so, it will evolve towards mostly single payer in US. Might be a little long to wait for the oldsters in the BJ blog audience. So, get to that gym, put down the smokes and booze, so you can see that day.
SRW1
The condition that was needed in the UK to get single payer, or as they call it, the NHS, was the sentiment at the end of WW II that everybody had sacrificed in the war and everybody therefore was entitled to have a share of society. Plus, of course, the defeat of the guy who supposedly had won that war for Britain at the ballot box a mere two months after his triumph.
Botsplainer
Clearly, this would have all gone better had Obama climbed on the single payer bully pulpit in 2009. President Romney would have seen to its creation.
Splitting Image
The path to single payer is to elect Republicans in every state in the country and have them destroy not only Obamacare, but the entire safety net going back to the 1930s.
If the U.S. can do this before 2020, the voting public in Alabama, Mississippi, and West Virginia, being rational consumers, will turn against the Republicans, elect a supermajority of Democrats in Congress and every house in every state, who will then gerrymander the states into a permanent Democratic majority, which will implement single payer and give free yoga pants to every woman in Montana.
Or to put it another way, the statistical likelihood is that new civilizations will develop. There will then be lemon-soaked paper napkins. Until then there will be a short delay.
Kevin
I still can’t believe that their are people on the left who have this simplistic take on things. “It’ll be OK, we can just replace it with single payer” has to be the dumbest, most childish take on the situation. Is McConnell going to push it through? Boehner? Where are the votes? It was nearly impossible to get 60 votes when the Democrats had 60 votes. So, now in the minority in both chambers, they will suddenly get it?
What planet do people who think like this live on?
wvng
@shortstop: Ummm, that is what I said.
dr. luba
@Kevin: Happy Gumdrop Fairy-Tale Land
LongHairedWeirdo
Fuck the notion of single payer passing – the press isn’t even asking the Republicans if they’ll fix the bill to demonstrate a willingness to reach across the aisle. They know better. And so do we.
(Mind you, it does frost my balls that they won’t even *ask* to make them go on the record saying “no”. They ask similar questions to Democrats all the time.)
shortstop
@wvng: I’m agreeing with you. Enthusiastically.
CONGRATULATIONS!
THIS HORSESHIT IS MAGICAL THINKING AT IT’S CRAZY WORST.
The votes weren’t there at any point in Obama’s presidency and since 2010 they really aren’t there.
FWIW, yes, single payer is the only way to go. My nephew’s kids might see it. I certainly won’t, and the actuaries tell me I’ve got another 35-40 years left to live.
Christ, shit like this makes me want to give up on politics. The right does it every day. So, sadly, does the left.
@Kevin: Not to be a pendant, but it WAS impossible. The test votes for single payer in the Senate didn’t even get forty Senators on board.
shortstop
@LongHairedWeirdo: Why should the press ask the Republicans to fix it? Coming up with a new plan after the GOP uninsured millions is clearly Obama’s responsibility.
Roger Moore
I don’t see the fixation on single payer. As long as we’re asking for a pony, why not ask for an alicorn and NHS? It’s fairly well established that NHS is even less expensive and more equitable than single payer is, so why not ask for everything?
srv
No one could have predicted. As this site has shown over and over, nihilism is only bad if you’re nihilist before it’s hip. You will all eventually come around.
Today, the result of pandering to the right rests on what the word ‘state’ means to the honorable John Roberts.
Good is the enemy of the perfect.
Matt McIrvin
What I’m wondering is if there is even a political path to fixing the one line in the ACA that would neutralize a bad ruling in King v. Burwell.
gvg
I would agree that we can’t get single payer soon or easily, but with certain caveats I think we do need to talk about it. The damned republican conservatives have slanted all conversations too far their way. Overton window stuff. We do need to talk it back to a more reasonable middle. Shutting up about every good idea we have because they are impossible is not a good stratagy. Now holding out for only single payer or thinking losing Obamacare now in court will be all for the best…..thats nuts. Nuts in a way that is callous about real peoples pain right now.
I think in the long long run, single payer is inevitable. The structure of our needs, what medicine is, the imblance of power and knowledge, statistics of risk…everything I know about it seem to me to point to single payer National Healthcare as being what is needed.
IMO the underlying problem that causes their to be too many republicans elected compared to people who actually agree with their policies is gerrymandering. To solve a lot of problems we need laws that prevent gerrymandering even when it goes against democrats. In order to get that fixed I think we need a law proposed that specifies what does happen not just what doesn’t. Specifics about how we draw district lines based on what statistics. Remedies for when cheats are attempted. Boards of review. I don’t myself know how to do it but I want to find some ideas to advocate.
2nd problem is the media being owned by too few corporations. Enforce the anti monopoly laws etc. Banks too of course but I think its the media that is subverting the political process.
Solve those things and healthcare isn’t the only problem that might get a better solution.
jayackroyd
Single payer is a bit of a shibboleth. Richard has done a fine job illustrating the path dependence involved.
That’s why the alternative presented by the left wing coalition was a public option. As described in Richard Kirsh’s book http://www.amazon.com/Fighting-Our-Health-Rockefeller-Institute/dp/1930912242/ polling indicated that this was a feasible alternative–and one that the democratic leadership did not want a vote on, because they were committed to the private insurance model, relying on a complex regulatory regime rather than competition.
FlipYrWhig
I think Tripod is trying to use a “framing” argument, which invests a lot of hope in the idea that SAYING “single payer” wins people over, through a combination of the Bully-Overton Window-Pulpit. Problem with that is the following:
1. Virtually no one knows what “single payer” means, and the phrase in and of itself seems to mean something more like “I pay for my own health care,” which sounds like a terrible plan.
2. A fair amount of Democratic office-holders don’t support it or anything like it.
3. Single-payer without cost controls is a budgetary nightmare, and the cost control part is where the idea will start to lose support, not just from “death panels” fear-mongers but from well-paid doctors and prospective patients who worry that they’ll be deprived of the ability to try heroic, pricey longshot treatments because The Government won’t pay.
Grumpy Code Monkey
@Splitting Image:
That won’t do it either. There’s no deus ex machina that’s going to cause the ever-shrinking voting public to suddenly “wake up” and realize the Democrats were right all along. They’re exactly as awake as they care to be. They will vote for someone based on what that someone says, not what they do.
Cluttered Mind
@shortstop: I’m more confused as to why the press would ask the Republicans to fix anything. How much more blatant do they have to be in their behavior? They’re a party of destruction, not creation. They break things, they don’t fix. The Republican ideal solution to a problem is to blow it up and trust that everything will be fine when it’s gone. Their concern for what takes shape in the craters left by their policies is nonexistent. Look at Kansas! Sam Brownback has demolished every piece of Kansas government that he could get his hands on and the Republicans love him for it.
The idea that the Republicans would ever propose a new program is absurd.
FlipYrWhig
@jayackroyd: Or maybe “the Democratic leadership” knew that too few Democrats in office actually wanted to do it, despite how good an idea it was or the degree to which polling indicated support in the abstract.
jl
TPM has an article on the issue of standing of plaintiffs in upcoming ACA case.
A New Surprise Twist In The Big Anti- Obamacare Lawsuit Before SCOTUS?
http://talkingpointsmemo.com/dc/supreme-court-king-burwell-standing-obamacare
Jeremy
I agree. It’s ridiculous that some people believe that Single Payer will just happen. It took decades for Medicare to become law after FDR and Truman proposed health care for all programs, and Medicare was a scaled down compromise because it only covered people 65 and up. JFK was struggling to get enough support in congress and it wasn’t till after his death and the 1964 elections that it passed. And LBJ had to exert a lot of energy and time negotiating with key members of congress to get it passed and this was during a time when democrats had 2/3 majorities in both houses and an opposition party that had a moderate- liberal republican wing that does not exist today. The fight for health care reform has gone on for a very long time and many presidents have failed to deliver. The point I’m trying to make is that it’s not easy and it’s much harder today to get consensus, and I think the ACA foundation is the best way to achieve Single Payer healthcare.
SatanicPanic
I can see the point of hammering on the issue year after year. Play the long game. But it will be a long game. A loooooong looooooooong loooooooooooooooooooooooooooooong game. Like maybe in 2300 it’ll get passed.
Barry
@Kevin: “What planet do people who think like this live on? ”
Planet DumbF*ck.
shortstop
@Cluttered Mind: Remember when they had a fair amount of success convincing their base that Obamacare was going to rob old people of Medicare benefits, whereas the GOP plan of privatizing Medicare would keep them covered? Once again we are reminded that tribe trumps all for these folks. If anything bad happens to their people based on their own actions, they can successfully spin it as Dems’ fault because people who vote GOP truly want to hate us more than they want comfortable, secure lives.
Jeb’s current attempt to grab the big brass ring reminds me that when the whole Terri Schiavo thing came to smash for the GOP, quite a few high-profile Republicans were claiming with straight faces that the Democrats should have done more to stop them. They are fucking shameless.
pluege
it is correct that there is no political will in the US for anything that helps average people. There is ONLY political will in the US to help the rich get richer by more breaks for their businesses. Hence, the path to single payer could never be had in the US on the basis of it being the best way to help the most people – that argument is in fact counterproductive with today’s sadistic strain of republican.
What is feasible in the US politically are arguments based on policies benefitting business and the rich. Obamacare only garnered the minimal weak Democratic support because it was in fact a boon to insurance companies, Big Pharma, and hospitals, not because it would help millions of people. Thus if the case is made for single payer on the basis of unburdening business from providing healthcare and in so doing making businesses more competitive in global markets, then you could have a winner.
Tenar Darell
Yeah. One of my aunts was in the health software industry, and managed to make it clear how many stakeholders were involved in the industry. Not just hospitals, but doctors. Not just insurance companies, but they’re software infrastructure. Not just drugstore chains, but big pharma and medical devices. I might wish single payer had been part of the initial discussion, but it was traded away to get all of them to step into the negotiations. I’m certainly realist enough to understand this, even if I dislike the fact that we as a country never even talked about what could be considered the most efficient method of providing coverage for everyone. Management 101 includes getting all the stakeholders to buy-in rather than fight to the death against you. The end result may look like a kluge, but at least it will be a relatively virtuous cycle, as long as John Roberts Taney doesn’t frak it up.
burnspbesq
@srv:
Actually, it rests on the meaning of the word “such,” as used in Section 1321 (“such Exchange”).
mai naem mobile
Is Tripod a troll? Just asking because if he isn’t to me he’s an infrequent commenter.
Punchy
Where’s soothsayer eemom to share her prescient knowledge on what our SCOTUS will adjudicate?
Epicurus
Unicorns! The answer to your question is “unicorns.” Feel free to substitute another fabulous animal, like a “rational Republican” or an “honest investment banker.” None of these things exist, nor will this Congress pass anything remotely resembling single payer. But a person can dream…so long as your realize that most dreams don’t come true.
Face
@jl: That’s a nothingburger. Team Tony ultimately decides the def of standing, and I’m quite sure if there’s 5 to abort, that standing (or lack thereof) wont be the monkey wrench that derails their grand plan.
Belafon
@jl: I’m pretty sure that standing will suddenly mean “They’re standing right here, aren’t they?” when the case gets in front of Scalia.
Cacti
Single payer is a hobby horse for wine track liberals who view healthcare reform as an exercise in philosophical wankery. They are ideologically pure because they can afford to be.
Archon
I don’t see single payer happening in America for a long time, if ever. I do think health insurance companies will be looked at and treated the same way as the Department of Water and Power is treated, as a tightly regulated public utility. A public option would have fast tracked that process but I think it’s going to happen anyways.
shortstop
@Belafon: Much-needed smile there.
Cacti
@Belafon:
Pretty much.
He was one of the 5 in Bush v. Gore who said “the legal conclusions reached in this decision should never be used as precedent for any other decision anywhere because of reasons”.
Zam
Honestly even the idea of just talking about it over and over like the republicans do is absurd. Democrats and liberals, in the past, have spoken about the need for healthcare reform as well as universal coverage quite frequently. The problem is that once any concrete idea is put for the entire country focuses on every single problem (real or imagined) they can find and it dies. Hell even public opinion in the run up to these proposals have been on the side of reform, but once a real plan with all the intricacies needed to cover the entire country takes shape they turn on it like rabid dogs. This is the reality of legislation, particularly in the modern age with our endless stream of biased media, any bill put forth making drastic changes to the current system will be torn apart by various interests until the narrative becomes that this is simply a terrible plan. Like Richard said and others have pointed out, it will take a large scale collapse or disaster to usher in the environment in which this kind of change. Without that, the majority of people are simply too content with the status quo, they know it, they have worked within it their entire lives, drastic changes will seem terrifying. So we can say single payer every single day on every single morning show and in every single paper, but without something akin to a second Great Depression it will die shortly after being proposed in congress.
Cluttered Mind
@shortstop: I’m reasonably certain that the shame gene was eradicated from the right wing genome a long time ago. Charles Pierce has it right when he says that they really are the Mole People.
Tinare
Does anyone have good employer coverage anymore? I ask because I work for a very large corporation, and two years ago, citing Obamacare and not being able to offer Cadillac plans anymore (no surprise, I’m sure to any of you, but the plans they previously offered do not meet the definition of Cadillac plans…), my very large corporate employer moved to offering only high deducible plans with health savings accounts. And, of course they told us it was all a service to us to help us be better consumers of healthcare. (Just what I want to do — shop for an ultrasound.)
Anecdotally other people I know are experiencing the same thing and I just wondered if there is anyone out there that still has a good employer provided healthcare plan.
MomSense
@jayackroyd:
I disagree with Richard on the public option. First, it was not going to make it out of the Senate Finance Committee. Believe it or not Snowe was trying to come up with a compromise public option with a complicated triggering mechanism to try and preserve it. Baucus was never ever ever ever going to let it out of committee. Even if by some miracle the Senate had passed some version of the public option, the actual version that passed the House was so bad it would not work and probably “prove” in its implementation that single payer would never work. There were a bunch of problems with the public option as the house passed it. Basically it had very strict income eligibility restrictions and they wouldn’t be able to reimburse at Medicare rates making it a very expensive public option with limited chance of success. If the House version of the public option was set up to be a failure, I don’t see how we could have gotten something better out of the Senate.
Belafon
@Zam:
And history notes how many things the Conservative SCOTUS killed back then.
Fake Irishman
@SRW1: not to mention the complete overwhelming of the private health system by German bombs and overwhelming numbers of casualties — the government was already essentially running the system thanks to WWII. Atul Guwande has a great New Yorker article from 2009 or 2010 on this.
eemom
@Punchy:
Back in 2012 I said that the SCt would uphold ACA, which it did.
I have said repeatedly ever since that I will never again predict, nor put anything past those 5 robed monsters.
Off you fuck.
kd bart
“Bully Pulpit”
Roger Moore
@Zam:
FTFY. The focus on problems doesn’t happen because Americans are automatically skeptical and don’t want what’s on offer. It happens because the Republicans want to kill it and know they’re more likely to succeed in killing a generally popular idea by nitpicking it to death than by attacking it head on. Their attacks are amplified by their media enablers, and that’s what winds up doing the damage.
Fake Irishman
@Archon: This is essentially what the ACA does in part, making insurance companies into regulated utilities by capping their profits (MLR of 80 percent) and mandating minimum levels of service (tiers of plans that match minimum levels of coverage and services. Think of a bronze plan as your no-frills land-line service.
mai naem mobile
@Tinare: the only employers i know that offer good coverage are government jobs and large hospitals. I’m assuming google, apple and places like that where the companies make lots of money.
MomSense
If you really want to get pissed off, I recommend this article about how the Republicans want to “reform” food stamps.
http://www.wsj.com/articles/republicans-eye-changes-to-food-stamp-program-1423692057
Fake Irishman
@jayackroyd:
If you read Inside Health Reform, you’ll note that the Democratic leadership (Reid and Pelosi) both included versions of the public option in their floor bill. Joe Liberman and Ben Nelson were what stopped it. Blame where blame is due.
Punchy
@Tinare: I’ve been told by both the doc and the dentist that my health insurance is insanely good (United Healthcare thru Sigma-Aldrich). That it could change after Merck bought us is scaring the shit out of many people.
MomSense
And if you want something to cheer you up, I recommend President Obama’s Buzzfeed Healthcare video!
If Baud is here, he is channeling you!
https://www.youtube.com/watch?v=WvhNP3Z3pnM
Zam
@Roger Moore: Except it isn’t just republicans, the second we put up a more liberal plan, progressive purists will come in declaring various provisions unacceptable, leaving the only people willing to defend the plan publicly to be whatever administration proposes the plan. My point is that every bill in order to actually work in such a complicated economy will have millions of components. A single payer bill will have to account for all the people who work in healthcare, considering payments to doctors, pharmacies as well as all those employed in the insurance industry. It will also consider how to pay for this, which will include discussion on taxes that will likely hit all income brackets not just the top 1%.
jayackroyd
@MomSense:
“Senate passed” is actually “Reid allowed his 60 vote caucus to filibuster a Dem bill.” On an up or down vote, it passes easily.
SRW1
@Fake Irishman:
Thanks for that hint, I’ll try to locate that article.
dedc79
The only rationale I can come up with for pushing for single payer is not that it will actually get us single payer but that it might help shift the debate to safer ground.
The genius of the Republicans (I’m as surprised as anyone to be using the words “genius” and “republicans” so close together) is that they move the debate to the right even when they lose. They achieve this in part by taking outrageous positions and dragging the moderate/middle position to the right.
The Dems, by too often leading with positions that are already centrist, are enablers of the rightward lurch in our discourse.
mai naem mobile
@Fake Irishman: Joe Asshole Lieberprick didn’t want Single Payor because of the insurance cos. CT but Chuck Grassley, Barasson and every other GOPr in Baucus’ committee except for Snowe are the ones who demanded on watering down the bill to get a yay vote and then walk away. Also, Baucus was incompetent at his job.
Couldn't Stand the Weather
@shortstop:
I had forgotten about that.
A few years ago, a journalist asked Paul Ryan (or another granny starver) about g00per budgetary specifics.
The winger idiot, of course, had none. None at all.
Just Some Fuckhead
Kudos to Republicans for at least continuing to try to do something about health care. Nixon pushed for and then signed the HMO act of 1973 into law. Then Republicans passed Health Savings Accounts legislation. Then they invented a market-based health care solution that eventually got passed into law in Massachusetts. About the same time, Republicans passed Medicare Part D nationwide.
In that same time, Democrats have produced nothing except frequent circular firing squads like this post by Richard, and nationwide implementation of the Republicans market-based invention.
But keep telling us what is possible and what is not possible, Democrats. You are really awesome at that. Not much else.
Mnemosyne (iPhone)
@jayackroyd:
A public option could still be added with new legislation. Why are people complaining that it wasn’t done in 2010 instead of pushing for it to be done NOW?
ALEC writes its legislation years before they get it implemented. Where is the pre-written public option legislation that’s standing by to be put in place when/if Democrats control Congress again?
srv
@Just Some Fuckhead: We need a man like Richard Nixon again.
Kevin
@CONGRATULATIONS!: Sorry, should have been clear, meant to say “it was nearly impossible to get 60 votes for the affordable care act when they had 60 senators”.
I’m well aware that single payer was impossible at that time. I doubt they had 50 solid votes for it.
? Martin
@SRW1:
It wasn’t a sentiment. Single payer emerged because they were economically ruined – the government was the only possible entity that could provide healthcare without receiving payment. You had widespread destruction, an economy that had been transformed toward war which was no longer needed, an export economy with nobody to export to because France and the rest of Europe were as bad off or worse, and a large segment of the population returning home with no job and possibly with disabilities and other care needs.
We had the same mistake in understanding here in the US over the auto bailout – people that demanded that the private sector and not government do the bailout. Problem was, the private sector didn’t have the money to do it – even if they wanted to, they literally didn’t have the quantity of cash needed to bail the automakers out. It was the government or nobody. There was no plan B. For the UK, France, Germany, etc. there was only one possibility for a health care system, and that was for the government to own it to a very large degree. Many decisions come about because there’s only possibility. We can wrap a warm sentiment around it later to make us feel as though there was a decision to be made there and we made the most generous, most humane one, but there was no decision there.
Kylroy
@Just Some Fuckhead: When not a single Republican votes for a piece of legislation, you don’t get to claim it for Republicans.
Just Some Fuckhead
@Kylroy: Oh. Well then I submit Republican representative Joseph Cao for the right to claim it for Republicans.
Tripod
We’re getting cloobered on some
Cluttered Mind
@Mnemosyne (iPhone): ALEC can do that because they don’t care about present day conditions when they draft their legislation. It’s entirely based on ideology, not facts, so there isn’t really anything that could get them to change what’s in it. That’s fine if you’re governing based on ideology and don’t care if it works or not, but if the objective is to actually draft legislation that is going to be effective at helping the people instead of advancing an ideology, you can’t really write it in advance.
Again I’ll use the example of Brownback’s Kansas. Brownback is implementing the full wingnut agenda there and it’s demolishing the state’s ability to function. This is not a problem for him because making the government work was never his objective. ALEC is the same. The laws they write aren’t intended to actually work.
In practical terms this means that Republicans tend to be more politically effective because they always have their same old answers and plans ready to go, and they’ve spent decades working on the messaging for those ideas. The fact that they don’t work is irrelevant to them, because their objective isn’t to make the government more effective at doing its job.
Fake Irishman
@SRW1:
Aha! Found the Gunwande article. I assign this piece to my comparative politics students when we talk about comparative public policy and path dependency.
Here’s the link: http://www.newyorker.com/magazine/2009/01/26/getting-there-from-here
Kylroy
@? Martin: Excellent point. Another good point? All those European countries were *very* monoethnic when they passed that legislation. Every attempt to improve the public good in America since 1980 (hell, since 1800) has been opposed by saying it would benefit Those People.
A poster here quoted a doctor who said that modern Europe would never pass the same kinds of legislation today, being sufficiently multiethnic that they could divide people along those lines.
Tripod
Industry hack is industry hack. I don’t give a shit about single payer ponies, but we’re getting clobbered on this , and snarky nonsense about gov Goodhair and being right on the numbers isn’t going to stop these assholes from a rollback.
Archon
@dedc79:
There are definitely benefits for the Republicans in taking maximalist positions. It probably outweighs any costs to that strategy but we shouldn’t pretend there aren’t any political costs for Republicans. Obama, the most radical, extreme President EVEH! won the vote of self-identified moderates by 15 points in 2012.
True moderates understand that the GOP is much more radical then the DEMS, the real problem is there just aren’t a lot of true moderates in the electorate anymore.
Mnemosyne (iPhone)
@Tinare:
I still have good employer-provided insurance, but I work in an industry that is still heavily unionized (entertainment) so there’s only so much messing around they can do with is due to the various union contracts.
Patrick
@Kylroy:
Having lived in Europe I disagree. They very clearly do not want what we had in the US before the ACA. They couldn’t dream of living with the risk of not having the right to either health insurance or health coverage. An alternative to what we have here in the US is what they currently have in Europe.
lol
@jayackroyd:
Public option didn’t even have 45 votes in the Senate.
@Just Some Fuckhead:
Cao didn’t vote for final passage.
saysomething
As people have been saying, it’s a long, long road to single payer. But just like EVERYTHING that has ever progressed, it requires 3 elements: 1) Crisis/Chaos; 2) Immense grassroots efforts and a compelling message to activate people; 3) A visible champion (be it an individual or a powerful group.
Take the issue of gay marriage. 1) The crisis of couples not having legal rights at hospitals, in contracts, in deaths, in adoptions, etc. 2) years of concerted efforts to spread the compelling and simple message of equality 3) Strong advocacy groups formed around the country; celebs speaking for equality; media.
For single payer, #1 has been fulfilled for years. The ACA has taken this a step back as many believe the crisis has been at least partially solved. This is not true, and will become evident again. #2 depends on that happening and then will take years and years of work. There is not one, single compelling message (ala “equality”) to communicate the need for single payer. This is a huge stumbling block. As for #3, there are thousands of small, active organizations and groups fighting for single payer, but not one large, powerful group and certainly no high profile individual advocating for it. Rep. John Conyers and H.R. 676 are non-starters. Bernie Sanders is strong and people love him, but he is easily dismissible by most of the country. Paul Krugman is supportive, but just as dismissive about its chances.
It can happen, but it will have to happen state by state, like it did in Canada. And it will take a lot of time.
What Single Payer needs most is smart people working on messaging and education, not thinking of ways it will never work.
Richard Mayhew
@jayackroyd: Jay, do you believe and with what evidence that there were 51 votes on 1/5/09 in the Democratic caucus in the Senate to do away with the filibuster on legislation.
Remember, the revealed preference in 2013 was that there were those votes for a limited set of executive nominations only after four years of constant obstruction which convinced the Senate institutionalists (Leahy, Baucus, Levin etc) that the institution’s ability to function and perform a constitutionally mandated function (vet and approve or disapprove nominations) was becoming fatally compromised. The Senate did not change the filibuster rules on legislation as we are seeing this month in action.
In the 2009 Senate, you have the instituionalists (plus Byrd, plus a few others I think) plus the douchebag cacus who realized their entire political power base consisted of their ablity to extract concessions for being votes # 56, 57, 58, 59 and 60 (Nelson, Lincoln, Pryor, Lieberman) plus the cluster of Senators who thought their political survival depended on the ability to visibly hippy punch. I have a hard time seeing 51 votes to turn the Senate into a majority rules party when there was quite a bit of value (perceived or real) by the marginally decisive vote to having the Senate be a supermajority rules party.
I want to see who you think would have voted for eliminating or vastly restricting the filibuster on major legislation on 1/5/09… Convince me there were 51 votes that were either definites or highly likely. I don’t think you can get past 45
lol
@Just Some Fuckhead:
Also Romney had to be dragged kicking and screaming into do any sort of health care reform in MA. I’ll give him credit for not fucking it up though.
West is best
simple. Do it in blue states.
Professor
@jayackroyd: I quite remember that Sen Joseph Lieberman said he would filibuster the Public Option if it came to the senate floor. The reason being that some left-wingers made fun of him.
Jeremy
@dedc79: True, but the debate started with Teddy Roosevelt and we still haven’t achieved Single Payer universal health care. FDR contemplated including health care for all with the New Deal and he had the back off because their wasn’t enough support on the political level and their was a backlash among doctors. Truman pushed Medicare for all and it went no where with a democratic controlled congress. The point is that achieving universal health care is a tough task and simply having a debate will not be enough. The ACA was the last piece of major health care reform since the creation of Medicare and Medicaid in the 60’s. We should be happy that we got the ACA because it will lay the foundation for further change.
pseudonymous in nc
@SRW1:
The other condition was stuffing the mouths of specialists with gold. (That is, by allowing them to keep more lucrative private hours while on NHS contracts.)
Specialists in the US already have all their orifices stuffed with gold.
But to build on what Martin says, the split happened because the US was not bombed to bits and economically ruined after WW2, and could afford to hand out cheap mortgages and cheap college degrees and chrome-plated everything to [white] individuals, while European countries had to build social structures that were collectively beneficial.
jl
@Kylroy: Not sure ‘mono-ethnic’ explains much overseas. Belgium is not mono-ethnic and not even mono-lingual, and how long many years did they without an official parliamentary government due to infighting, and do they have one yet?. Switzerland is not, obviously: Germans, French and Italians, and the Ur-Swiss mountain people.. Sweden may seem so to us, but much of the southwest of the country sees itself as really Dane. Taiwan has three groups that make for a very contentious mix: indigenous Taiwanese, ‘old’ Chinese mainlanders who have come in since 17th century, and the refugees from Chinese communist revolution. i have seen no video clips of riots in the Taiwanese legislative chamber recently, but it is still contentious. New Zealand has a very large Maori population, and that has caused serious controversy about how a national health care system can equitably serve both.
I think racial divides may be a big factor in lack of progress in the US because of White racism. But maybe that is a unique factor.
Roger Moore
@Cluttered Mind:
This is at best a gross exaggeration. Any good legislation may require tweaks and adjustments to make it align with current conditions, but that doesn’t mean you have to start from scratch at the beginning of each legislative session. It makes perfect sense to continue drafting legislation that achieves your basic goals when you’re out of power and then use it as a starting point when you finally get control. Yes, the legislation will need to be further developed after it’s formally proposed, but at least you’ll be tweaking the details rather than the basic structure.
Richard Mayhew
@Tripod: Ok, tell me how to get a functional voting majority in both chambers of the US Congress to vote for single payer at some point in the next 10 years…. can you do that without invoking either massive pain through heighten the contradictions assertions or flying unicorns coming out of your ass…..
LongHairedWeirdo
@shortstop: I know, but like I said, it frosts me that there’s a double standard from the so-called “liberal media”. The Republicans are allowed to ignore a crisis of their making, and the people don’t even get to hear it.
Part of it is the journalism crisis, of course. Time was, if you would only give interviews to particular select people, those particular, select people, reporters would say “no – we’re not fluffers, we’re *journalists*. I like you and all, but if you’re not willing to answer meaningful, reasonable questions from any quarter, it’s not my job to provide free publicity to you. You either play ball – and deal with almost any journalist who’s fair and reasonable – or we’ll find someone else to fill that interview slot with.”
Now? If you won’t play ball with the “newsmakers” they will find someone who will. And *someone* will.
jl
@Jeremy: AMA was absolutely ruthless in trying to stamp out any departure from their dream of docs as independent professionals. Long ago the BC/BS organizations emerged as non-profits to find a way for docs to help finance patient care and guarantee revenue during Depression. Many local experiments in salaried docs and capitated plans at very local medical group level. And national health insurance reform. AMA opposed them all.
Now, many non-specialist docs are getting a bad deal from blowback and counterproductive and Luddite aspects of AMA dream. Overwork, no longer super highly paid especially considering their school bills, losing professional status, mostly employees. Specialists are doing OK. Stuffing gold into specialists mouths is more expensive for US than economically comparable countries because we have so many more of them proportionally than other countries. And because, some people say.. AMA is now catering and using its cartel power to help highly paid specialists. AMA controls rule making for reimbursement, which is a low profile aspect of market power of AMA.
Richard Mayhew
@West is best: If it was so simple, please explain to me why Vermont investigated a single payer system and then pulled back… if it was so simple, then please tell me why Massachusetts with Democratic supermajorities in both chambers decided to go the subsidized, managed competition on the individual market approach.
If it was so simple, why has it not happened yet?
Please enlighten me as to how transforming between 15% to 19% of a state’s economy with a radical restructuring is “simple” I am truly curious. None of this stuff is easy when there are already moving parts and chunks of the system that deliver real and tangible benefits to people who will scream loudly if those benefits disappear.
LongHairedWeirdo
@Tinare: I’ll tell you this much.
Used to be, anyone contracting for a certain software company in western Washington could count on getting good health insurance as part of the package. My last contract offered a (relatively) high deductible with a 60% coinsurance. I don’t know if it’s the contracting firm, or the changing nature of the business.
This isn’t a matter of “That’s one of the plans you can pick”, either.
I could (and did) buy a better plan on the exchanges.
Gin & Tonic
@West is best: Like, say, Vermont?
celticdragonchick
@eemom:
Your charm and wit are always so engaging.
Jim, Foolish Literalist
@Gin & Tonic: or Massachussetts, Maine, Illinois, Michigan, Wisconsin, New Jersey…?
Roger Moore
@SRW1:
It’s a huge mistake to conflate single payer and NHS. Single payer involves the government running the health insurance system, while NHS has it running the health care system, too. This is not a minor distinction; it’s roughly the difference between Medicare and the VA.
Mnemosyne (iPhone)
@Cluttered Mind:
Right, but we’re talking about making a desired change to existing legislation that will probably not have any significant changes made to it in the intervening time. So why not draft the public option legislation now and have it in our back pockets for the next time Democrats control Congress rather than scrambling to put it together?
And, yes, it does drive me nuts that Democrats don’t have draft legislation of their wish list ready to go as soon as they get into power. It can always be modified for current events. Instead, we always seem to have to start from zero.
eemom
@celticdragonchick:
Yes, when random assholes take swipes at me on a thread I wasn’t even participating in I am very motivated to be charming.
Richard Mayhew
@Mnemosyne (iPhone): The Dems did it too… look at how fast Lily Ledbetter got passed, look at the CHIP expansion, look at the Consumer Finance Protection Bureau that got folded up into Dodd-Frank… the 2009-2010 Congress was extremely productive for two reasons. The first is that there was a unified government where the governing party actually wanted to govern/change policy. Secondly, the shells/skeletons for quite a few big ideas had been sketched out for a very long time before hand.
Richard Mayhew
@Jim, Foolish Literalist: Hey, do you have a bright orange snowcap in your closet
:)
lol
@Richard Mayhew:
The traditionalist caucus is much smaller now and a lot have been replaced by younger Senators who see how broken the filibuster is. The next time we have a ton of Senators, I think we might be able to get 51 votes.
SRW1
@Roger Moore:
I think you are right and you are wrong. Formally, single payer does indeed mean a single body running health insurance. On the other hand it is very hard to conceive of that body not assuming an important, of not the deceicive role in how health care is being run and adapted to changing conditions. And if the single payer is a public body, aka ‘the government’, the distinction is bound to lose even more of its difference.
lol
@Professor:
He also signed off on Medicare Buy-In for people over 55 and then immediately torpedoed the idea once he saw the left supported it.
SRW1
@? Martin:
While I have little reason to doubt what you wrote, I can’t help the feeling that it actually sharpens the point I was trying to make of what extraordinary circumstances it took for the Brits to establish universal health care.
shortstop
@Couldn’t Stand the Weather: Pssst…”came to smash” is an actual expression. Maybe a bit too Britty in his context, though.
Roger Moore
@SRW1:
There really is a huge practical difference between single payer and NHS. As I said above, Medicare is single payer while VA is NHS, and they’re really quite different beasts. Single payer still has all the problems of care providers trying to bill as much as possible and the extra layers of bureaucracy involved in having all that care billed and paid for. In contrast, care providers in NHS are on a salary. There’s no payment bureaucracy, no worries about going between providers to get different services, etc. It’s really quite a different system.
pseudonymous in nc
@jl:
It’d also be counterproductive, because the people who need their mouths stuffed with gold are the med-school graduates contemplating whether general practice will pay off their loans in a reasonable timescale and provide a nice career. Or they can become dermatologists.
There need to be fewer specialists in the US. Simple as that. There need to be more and better paid general practitioners. But that’s not something that can be fixed in a year or even a decade. It involves a fundamental, incremental change in how Americans perceive and use healthcare services.
Richard Mayhew
@lol: I agree, I think if there is a Dem Caucus of 55 or greater at any point in the next decade, there are 51 votes available to kill the filibuster, but that is looking at the future and not at Jay’s point/argument that the only constraint on the public option was the 60 vote requirement that Reid insisted on with the unstated sub-argument that there were 51 votes to discard the filibuster on legislation on 1/5/09.
pseudonymous in nc
@Roger Moore:
Theoretically. GPs are independent contractors, albeit on long-term contracts, and always have been. Also, “market reforms” introduced by successive Conservative governments — autonomous regional trusts, GP budgeting — have added billing elements across components for internal accounting, and many critics see it as a path to patient billing. Whether it is or not, it means that GPs are dumped with folders and spreadsheets, and the GPs I know (who I’ve known since they were medical students) hate it. They want a seat at the table to discuss broad budgeting priorities, but they weren’t trained to propose budgets and they have much better things to do with their time.
Single payer has come up with lots of methods to address efficiency and bureaucracy in billing issues, whether it’s tariff structures for services negotiated between providers and insurers, or batch billing at agreed terms — that is, a doctor can file one claim for a bunch of visits at the agreed reimbursement amount, but if she wants to claim more than the agreed amount, each claim has to be filed separately. I once read that Ontario’s Medicare department had fewer people employed to handle billing than a single insurer in Massachusetts.
Jim, Foolish Literalist
@Professor: I think it was one of the Slate writers who said that Lieberman didn’t leave the party over the Iraq War, rather he doubled down on the War because he was bitter that the party didn’t embrace his magnificence in ’04
NCSteve
NOOOOO! PONY!!! PONY!!!!! PONY!!!!!!! I WANT MY PONEEEEEE!!!!!!!!
SRW1
@Roger Moore:
I see your point(s), though I think the second practical one is more ‘real’ than the first one. The simple fact that health care evolves all the time means that even in a system like the NHS somebody has to set and adjust the guidelines of what represents appropriate treatment regimes and supervise the adherence to these guidelines despite the absence of a profit motive. I’d freely concede, though, that the absence of the latter makes that supervision kind of a different animal
Sherparick
@SRW1: One thing to remember about the United States is that unlike the United Kingdom, and about all the rest of the democracies in the world, the U.S. is not a parliamentary democracy. In 1945, Labor won parliament on a platform of the Beveridge Report, which Churchill and the Conservatives said were nice aspirations, but not affordable. After six years of war and tremendous sacrifice, the British people turn to Labor to make their lives better than it had been in the 1920s, 30s, and 40s. http://en.wikipedia.org/wiki/United_Kingdom_general_election,_1945
And with a parliamentary system, if you have the majority of parliament (either a single party majority or coalition), you can pass any law you want that as long as your majority stays together. Obviously, this is not how the U.S. system works if you remember your after school special about “how a bill becomes a law.”
Canada’ s national health care system developed originally in the provinces and eventually was extended to the whole country by a Liberal Government in 1966. Of course Canada is parliamentary system.
So first,let’s have a Constitutional Convention to abolish the Senate, make the President a ceremonial office, and have a prime minister chosen by a majority of Congress which will be elected by popular vote, with a 5% minimum for a party to get representation, like Germany and France. Second, after the Left coalition wins a majority, we get single payer.
Because the second thing will never happen until the first happens.
Cluttered Mind
@Mnemosyne (iPhone): You and Roger Moore are both correct in your criticisms of what I said. It is indeed frustrating that the Democrats never seem to be ready to hit the ground running in the brief periods where they actually do have power. It’s a little more understandable when you realize that the Democratic Party is a coalition in the way that the Republican Party really isn’t. The Democratic Party is an alliance of a whole bunch of different groups with very different priorities, and liberals are only one of those groups. In contrast, the Republican Party can usually be counted on to fall in line with whatever the party leadership decides to do. What Bart Stupak, Ben Nelson, and Joe Lieberman did while the ACA was moving through congress is a kind of internal party dispute that only the Democrats have to deal with. Generally speaking the Republicans aren’t going to scuttle their own legislation because it didn’t cater enough to one specific group (or person, in Lieberman’s case). Nelson, Lieberman, and Stupak were all ready to kill the ACA if they didn’t get their desired changes.
pdquick
If you spent half the energy working for single-payer as you spend hand-wringing about it, we’d have it by now.
Brett
National Single-Payer is a very long ways off, but Single-Payer in some of the states may not be. The Vermont experiment failed, but that’s because they were too ambitious from the get-go. A better way to get State-Level Single Payer would be to try and set up a state-level “public option” (probably by opening up Medicaid to a far larger group of people, or everyone with sliding fees), and then let it grow from there.
In the mean-time, National Single Payer’s going to have to wait for something like the 1930s, where brutal economic conditions create a ton of labor unrest for Democrats to use to take over New Deal style. Assuming such an era ever comes – say what you will about the current leadership of the Federal Reserve and elsewhere, but they managed to keep the downturn from becoming anything more than an exceptionally bad and drawn out recession (unemployment never got much above 10% at the worst). Not so much with our friends in Europe, which is why Greece just elected Syriza and Podemos is showing considerable strength in Spain.
This. I’d apply that to the states as well – come up with some state-level model bills for health care reform.
Betty Cracker
@dedc79:
Bingo. It’s actually kind of dangerous to reflexively sneer at people who are agitating for something better because that strategy bakes into the narrative the idea that the current solution is the best possible. It’s not.
Roger Moore
@Cluttered Mind:
Not to be all disagreeable, but I think you need to pay more attention to the Republicans if you think the Democrats are the only coalition that has its own internal problems. Just look at the disagreements they’re having between the business wing and the Tea Party wing. Idiots like Ted Cruz and the people who back him are blowing stuff up on their own party leadership, and this was right after a Tea Party rebellion against John Boehner being re-elected Speaker. I think the Democrats are a bit more fractious, but the Republicans are not the lock-step, well oiled machine we think. We’re just less likely to hear “Republicans in Disarray” when they start a circular firing squad.
jayackroyd
@richardmayhew
My view is that there was a centrist consensus among democrats, and even more so among the leadership, to proceed with a Dole/Gephardt private insurance plan, that they preferred not to vote on a public option and that they used the filibuster to preclude having to take a vote. That is, Harry Reid was (least hypothesis) doing what his caucus and the president wanted him to do.
The public option, according to polls, as reported by Kirsch, would have disrupted the march toward Dole/Gephardt. The GOP threw a monkey wrench into the centrist calculations; Dole had promised them votes.
In the event, the PPACA is turning out to be considerably better than nothing, and the little technocratic gimcracks that Obama’s people got written in are, as you effectively point out in your posts, working better than expected–and, as you also point out effectively, people REALLY WANT health insurance. CMS transparency, which is actually the biggest issue in reducing the real problem–we still pay 2X what the rest of OECD for worse care–doesn’t look nearly as impossible than it did four years ago. I will continue to claim the public option would have sped this up further, and was not obviated by contrary public opinion. But, as with the Banksters, there was a centrist consensus that the status quo had to be the foundation of a truly effective solution
humanoid.panda
@srv:
Because there is no way that conservatives would not have found some silly infelicity in the design of “Healthcare for All Bill” and brought along a lawsuit hinging on the fact that conservative jurists will don’t give a crap about anything.
Jim, Foolish Literalist
Does this refer to an internet tradition of which I am unaware?
Barry
@srv: “Today, the result of pandering to the right rests on what the word ‘state’ means to the honorable John Roberts.”
Lie.
Barry
@jayackroyd:
““Senate passed” is actually “Reid allowed his 60 vote caucus to filibuster a Dem bill.” On an up or down vote, it passes easily.”
That is the stupidest thing I’ve heard today, and possibly all week.
Barry
@dedc79: “They achieve this in part by taking outrageous positions and dragging the moderate/middle position to the right.”
And in a large part by (a) favoring the rich to an incredibly degree, thereby getting vast sums of money, and the support of the corporate media, (b) going xenophobically tribal to ‘Real Americans’, and (c) being destructive and hateful – it’s far easier to be those than constructive.
Mnemosyne (iPhone)
@jayackroyd:
I still don’t understand what in the PPACA prevents a public option from being added now or in the future by amending or updating PPACA. Can you please explain why it’s impossible to add a public option?
Barry
@Just Some Fuckhead: “Oh. Well then I submit Republican representative Joseph Cao for the right to claim it for Republicans.”
Your name does not lie.
Richard mayhew
@Jim, Foolish Literalist: deaniacs in Iowa in ’04 had bright orange hats…. That is all
Richard mayhew
@Mnemosyne (iPhone): nothing prevents a public option except the lack of votes
Just Some Fuckhead
@Barry: You can do better than that, President Obama.
Barry
@LongHairedWeirdo: “I know, but like I said, it frosts me that there’s a double standard from the so-called “liberal media”. The Republicans are allowed to ignore a crisis of their making, and the people don’t even get to hear it.”
The liberal media isn’t that liberal when it comes to the economic interests of the elite, or of the Imperium.
Barry
@LongHairedWeirdo: “I’ll tell you this much.
Used to be, anyone contracting for a certain software company in western Washington could count on getting good health insurance as part of the package. My last contract offered a (relatively) high deductible with a 60% coinsurance. I don’t know if it’s the contracting firm, or the changing nature of the business.
This isn’t a matter of “That’s one of the plans you can pick”, either.
I could (and did) buy a better plan on the exchanges.”
Note that the current situation, where you could purchase on the Exchange, was far, far better than where you’d have been before Obamacare.
That is a good thing.
jayackroyd
@Mnemosyne (iPhone): nothing prevents a public option except the lack of votes.
Just Some Fuckhead
@jayackroyd: Really? Is that the new cop out?
Jim, Foolish Literalist
@Richard mayhew: ah, I was trying to figure out a hunting angle. No deaniac, I.
Just Some Fuckhead
@jayackroyd: Think about it. With majorities in the house and senate, and your guy in the White House, you idiots passed a plan written by Republicans and the health insurance lobby because nothing else was possible. Now it’s being gutted and wait for it – still nothing else is possible! This is Keystone Kops shit.
Joe Buck
Here’s how you get there: let people as well as employers buy into Medicare. It wouldn’t be “single payer” in the beginning, but eventually it will just be easier for everyone to go that way.
OGLiberal
@Tinare: My employer definitely took advantage of the Obamacare excuse to gut our health benefits. This conveniently happened after my son was diagnosed with Crohn’s disease, which requires expensive lifelong treatment. Pre-change it was covered 100 percent. Now it’s 80 percent (each bi-monthly treatment is 10k plus so not cheap) up to an annual out of pocket max. They justify this by saying the survey they did of employees said they’d prefer higher/coinsurance than higher premimums, because my selfish Wall Street fucker co-workers never think they or their family will get sick and/or are making enough money not to give a fuck.
Just fuck ’em all, as I with a seemingly comfortable salary (better than a lot of folks, i admit) go into medical debt. I’d be better off unemployed and on Medicai/SCHOP….how fucking sad is that?
Oh, and the savings they realized from these cuts resulted in nothing more than a COLA salary increase, if that. That’s with a glowing – as usual – performance review. Just fuck them all.
NobodySpecial
I’m still trying to figure out how we get to a policy if we’re never ever ever supposed to even advocate for that policy.
LongHairedWeirdo
@Barry: Um… yes?
I mean, I’m very glad that I could buy a plan. But I’m also aware that there seems to be some sense that employers don’t have to, or can keep offering crappy plans, or whatever.
My point was only that “I have also seen a deterioration of quality of health plans by employers – and I was stunned because it used to be a stone-cold given that if you were contracting with *THEM*, you’d get good health insurance.”
Obamacare is a huge improvement over the status quo, for sure. I’d like a public option and medicare buy-in at 55 and reserve the right to spit on Holy Joe Lieberman’s shoes if he ever represents himself as a centrist in my presence. And yeah, I’d have loved single-payer, and I do support the chanting of single-payer.
“Well, we know the most sensible option is something like single payer, but the Republicans would never go for an efficient system like that. So, we’re recommending…”.