Scott Lemieux published an interesting piece in The Week today about Kirsten Gillibrand’s support for a single payer solution as the ultimate goal for healthcare reform: “Kirsten Gillibrand is serious about Medicare for all.” An excerpt:
It would have been easy for Sen. Kirsten Gillibrand (D-N.Y.) to rest on her laurels at the town hall she held at Hudson Valley Community College in Troy, New York, on Wednesday. In the wake of the narrow defeat of the Republican “skinny repeal” of the Affordable Care Act, she received two standing ovations from a packed house before she even began to speak… But she had a more ambitious agenda in mind. Before taking questions, she celebrated the defeat of ACA repeal but quickly observed that it was not enough: Too many people still couldn’t afford insurance. And making a point she would return to repeatedly for the next hour, she identified her preferred solution: Medicare for all…
While the audience was generally supportive of her advocacy for Medicare for all — some scattered booing aside — one audience member asked a practical question: What should Congress do if the votes in Congress for Medicare for all aren’t there yet? Gillibrand had a ready answer: “You get to single-payer by letting people buy in [to Medicare] now…”
[W]hat’s politically possible at a given point is a question that can be answered the next time the Democrats take over the White House and Congress. In the meantime, the Democratic Party needs to establish Medicare for all or a comparable universal program as a goal — and whether it’s Gillibrand, Sanders, or another candidate, this is almost certainly the direction the next Democratic nominee will be pushing in.
I’m grateful to Gillibrand for stating outright that a market-driven system will never achieve affordable, universal coverage, so the public aspects of the ACA will have to be expanded to move in that direction. President Obama and the Democrats who worked on healthcare reform during his first term knew that, which is why they built in Medicaid expansion nationwide, a provision the SCOTUS sabotaged.
Anyhoo, the whole thing is worth a read. Love it or hate it, I think Lemieux is correct when he says single payer is becoming a core part of the Democratic Party platform, at least as an objective. The disagreements will arise around how to get there.
rikyrah
I don’t care what she says…
She’s running in 2020.
efgoldman
The leftier-than-thous, the purity ponies, and the bros are already preparing the “but you’re doing it WRONG!” arguments.
We should ignore them, of course.
Fuckem.
germy
tobie
Betty Cracker, I tend to agree with most of your posts and always value your witty, clever writing but I have to say I find the following statement to be an article of faith not borne out by facts:
This is simply not true. There was a recent rating of the world’s healthcare systems and the two models that are said to get the most bang for the buck are the national health system in England and the 100%-privatized system in Switzerland. Germany’s healthcare system is close to the Swiss system–both rest on the pillar of employer-provided health insurance–but it does have public components. Both countries highly regulate the health insurance industry but they haven’t gone in the direction of single-payer.
Single payer has become this weird fixation on the left as if it’s the only means to achieve affordable, universal quality healthcare. I’m not opposed to it but I suspect I’m like a lot of Americans who have insurance through their employers and, if we switch to single payer, will see their taxes rise without the concomittant rise in wages, as the companies are no longer forced to pay for health benefits.
This is just my 2 cents.
kindness
I think MediCare for all is more achievable than Single Payer right now. With all due respect I hope the Bernie contingent doesn’t cough up a lung wrt this. Guess we’ll see who really wants to win elections in 2018 & 2020.
Roger Moore
And where it should be on the priority list. I agree that it’s important*, but I think it will have to take second place behind a revamped Voting Rights Act, or the Democrats’ control over Congress and the White House is likely to be short-lived.
*Though it could theoretically become a bit less important if the hoped-for bipartisan work on shoring up Obamacare actually comes to pass.
Major Major Major Major
“Single-payer” is already a shibboleth for the Sanders wing of the party, and any deviation from it is neoliberal shillery even though “Medicare for all” is not even really single-payer since Medicare as constructed is not single-payer. So embracing it as a label is smart.
As a policy, however–and David writes about this and he knows way more than me–single-payer is a stupid hill to die on, since it’s a mechanism, not a goal.
The problem is evident in statements like this:
There are some very vocal people in the party who won’t accept a comparable universal program that isn’t “single-payer”.
Baud
For the record
FlipYrWhig
How about childcare for all?
Roger Moore
@efgoldman:
They’ll shift the goalposts again and claim the goal should be a National Health System, or that we’re distracted from the real goal of reining in the banks.
elm
@tobie: Describing the Swiss system as “market-driven” is a stretch.
From Wikipedia:
There isn’t much dispute that a heavily regulated, mandated non-profit insurance model could achieve affordable universal coverage. There is no support for the Swiss system in the US.
Fake Irishman
Betty, I tend to agree with Tobie’s criticism above, but I note that you write:
“so the public aspects of the ACA will have to be expanded to move in that direction”
I’ve always appreciated how your devastating wit and ideals are leavened by hard-headed pragmatism. Looking forward to working with you to expand the Medicaid expansion, develop some sort of Medicare buy-in and/or implement some kind of public option on the ACA.
BruceFromOhio
But her emails.
clay
@germy: The House already repealed/replaced Obamacare. How would them re-voting make any difference at all?
SatanicPanic
@Major Major Major Major: Do they really know the difference though? I know some who do, but I would be curious how much of the left that is.
Baud
@Roger Moore:
That’s the thing. Assuming we control the government in 2021, we will probably have the votes for cap and trade but not for a massive carbon tax. Another important issue. Will we have a schism over best means there also?
Happy to see us keep pushing, but I don’t want to sugarcoat the challenges.
Major Major Major Major
@kindness:
Isn’t Bernie getting ready to put up a
purity testsingle-payer bill for consideration to see who signs on?@SatanicPanic:
They’ll know the difference as soon as somebody other than St. Sanders proposes legislation, and the professional splitters/purity ponies explain it to them.
And, again, it’s a shibboleth, so the name matters too.
Baud
@SatanicPanic: They’ll know whether Bernie had signed onto it or not.
retr2327
@tobie: Well, as the fortunate recipient of employer-provided health care, I can certainly understand your belief/fear that moving away from that form of health care may make things worse, not better, for those of us fortunate enough to have it.
But I have a harder time understanding your “proof” that market-driven systems can’t work. I assume you’re not relying on England, home of the government-owned and run health system, so you must be relying on Switzerland. But health care there is mandatory to have; insurers are required to provide it to everyone; and premiums beyond 8% of your income are subsidized by the Gov’t (all from wikipedia). How, exactly, is that a market-driven system?
tobie
@elm: I said “privatized,” not market driven, though I don’t see why something can’t be highly regulated and still market driven. The provisions you cite are already a part of the ACA: (1) “basic insurance to everyone, regardless of age or medical condition” = Essential Health Benefits package; and (2) “They are not allowed to make a profit off this basic insurance,” a policy which is in the same spirit as the ACA requirement that at least 80% of premium dollars have to go to actual healthcare.
You’re disagreeing with me but haven’t identified any principal difference.
SatanicPanic
@Roger Moore: This is another point I’ve been making- the ACA is probably good enough that we can limp along with it while we work on other things that are more pressing. A VRA would be very important (assuming Trump doesn’t get another SCOTUS pick), or climate change legislation would be pretty key too. Not sure it’s worth dealing with healthcare AGAIN.
kindness
@tobie: You can’t really compare Germany vs. England’s health care systems and use that as a comparison to what the US might end up with. Germany’s system isn’t what one might call a ‘Market Driven’ system. It isn’t because it is completely regulated. It isn’t free market on any level. It might not be regulated as heavily as Japan’s or Switzerland’s systems but suggesting a system with that level of regulations here in the US ignores Republicans.
Mike J
Rob in CT
@Baud: But her (neoliberal) emails!
tobie
@retr2327: The architecture of the Swiss system served as the model for the ACA. Mandatory health insurance in Switzerland = the individual mandate so vilified here; subsidies by the government there = CSR here; requirement to cover there = no exclusions for preexisting conditions here.
Can we regulate the US market more? Sure. Can we expand medicaid benefits: Yes. These are all tweaks to the existing structure that will make it better but won’t disrupt the economy in the way that single payer would and would have the same results.
Like, you’re disagreeing without really identifying any difference in structure between the Swiss model and an improved ACA.
Doc Sardonic
@tobie: Actually, unless your employer is paying 100% of your health insurance premium, which is exceedingly rare, the concomitant increase in your taxes would likely be less than your current out of pocket expenses for deductible, coinsurance and premiums.
Baud
And any debate about making health care universal is going to involve political decisions about abortion and undocumented workers, just like the ACA did. I know where this group would come out, but unfortunately not everyone is like us.
Mnemosyne
@tobie:
By criticizing Betty for saying that “market-driven” healthcare systems don’t work, you’ve put yourself in the position of defending market-driven systems. But the Swiss system is not market-driven. The insurers are very heavily regulated by the government, they are not permitted to take one penny of profit from the basic policy that they sell, and their level of profits on the supplemental policies is also tightly regulated by law.
I think you’re conflating “private insurance companies” and “market-driven systems” when those are two completely different things.
Baud
@Doc Sardonic: Depends. Single payer in other countries is more efficient than what we have, but if we decide, for example, that our single payer system will not make providers take a haircut, then it could get very costly.
Gelfling 545
@tobie: I don’t believe privatized and market-driven are the same thing. A system may be privatized and strictly regulated and not left to the whims of the invisible hand.
Elizabelle
Betty, thank you for highlighting the Lemieux article. A few Juicers had mentioned it; bookmarking this discussion thread (will scan it later).
Jeffro
@rikyrah: She’s totally running, agreed. Advocating for single-payer is smart too btw…neutralizes the Bros and unifies the party around ‘good government’?
I don’t mean to be too blasé about it, but there are at least a half dozen post-Boomer national Dems that I’d like to see on the ticket, in any order. I don’t really care that much about who it is: just give us two youngish, charismatic, positive people (hopefully women and people of color) and let’s have at it. We have a Congress and governorships and statehouses to re-take: I’m not getting all that invested in who’s at the top of the ticket.
tobie
@kindness: The auto industry is regulated but it’s still a free market. The USDA regulates most of the food I buy in stores and yet there’s a market for groceries. I don’t see any contradiction in talking about a regulated market–which is what you have in the German healthcare system, which does, by the way, have some problems. Many doctors will only take patients with private insurance because they’re reimbursed at a higher rate than from patients on public insurance. You hear a similar complaint here when doctors say they won’t take Medicare or Medicaid patients because they’re not reimbursed enough.
Baud
@Mnemosyne: Market driven to me simply means more than one company competed for customers. The level of regulation doesn’t factor into it.
FlipYrWhig
@Baud: I cannot imagine Sanders happily signing onto someone else’s healthcare proposal. Grudgingly, maybe, with a lot of harrumphing about how much it pains him to have to demean himself like this.
germy
Hoodie
Medicare for all is a smart rhetorical stance. Medicare generally has a positive reputation and it puts the GOP in the position of having to trash Medicare to oppose her. She also outflanks the Bernie contingent without fully committing to single payer. I get the sense that she would play well as a candidate. Even my generally wing nut sister likes her.
Elizabelle
PS: I don’t understand why we aren’t making more of a deal of following the Swiss system, with the heavy
regulationconsumer/patient protection.Memo to all of us: stress protection rather than using “regulation”, which is a bad word to the plutocrats and useful morons we find ourself dealing with.
Regulation protects and enhances capitalism, unless you’re into Darwinian capitalism (which is what the plutocrats want, being worthy and all …)
Baud
@FlipYrWhig: Agree.
Mnemosyne
@tobie:
I’ve suspected for quite a while that the whole point of PPACA was to get us to a Swiss-style system.
And there seems to be one other big difference in the Swiss system: their hospitals are all public, not private. Right now in the US, a majority of our hospitals are for-profit private hospitals. This is a huge driver of our increased healthcare costs.
Roger Moore
@clay:
It sounds as if this is a vote on straight repeal with no replacement. It’s pointless grandstanding, but what else did you expect from the HFC.
Baud
@Elizabelle:
Maybe call it the Patient Protection and Affordable Care Act.
Major Major Major Major
@Roger Moore:
So, not a reconciliation bill, then.
tobie
@Mnemosyne: I take your point but what I was saying that there are other options besides single payer or medicare for all that work quite well and would be less disruptive to the economy. And I deliberately described the Swiss system as “privatized” insurance, not a free market, though I still stand by the claim that a regulated market is still a market.
EDIT: You are right that for-profit hospitals are a huge driver are medical costs in the US. It’s a real problem.
@Doc Sardonic: I lived in Germany for several years and had copays and deductibles with my private German insurance. Yes, they were less than in the US but they exist there.
Baud
@Major Major Major Major: They are back to voting for bills that won’t get enacted into law.
Mnemosyne
@Baud:
IIRC, that’s not the actual definition of “market-driven.” A company that is market-driven makes changes based on what customers want and/or what the market can bear. If your company is heavily regulated by the government and limited in what it’s allowed to do by law, it can’t be market driven.
FlipYrWhig
@Mnemosyne: I would love Love LOVE to see a stronger public hospital system. VA for All!
Doc Sardonic
@Baud: Very true. To transition to “single payer” the way our system has been designed from trading the chicken to insurance with deductibles, copay, pre-existing conditions and the rest of the too numerous too list ingredients in the grand miasma stew that is our healthcare system, everybody is going to have to go to the barbershop. This includes doctors, hospitals, insurance companies, and even us the citizenry. Nobody is going to get everything they want especially the “why should I have to buy insurance because freedumb?” fuckwits.
Kent
Wait….what? What is the difference between Medicare for All and Single Payer?
Is it that Medicare for All would be just one option out of a suite of other private payer options?
I would expect that in real life, an actual Medicare for All type of program would follow a similar pattern to the existing Medicare plan for the elderly. You would have the option of “regular” Medicare which is government-run insurance and also the option of the equivalent of Medicare Advantage which would be privately-administered medicare plans run by AETNA, Blue Cross, etc. And you’d also have the option of supplemental coverage though private providers for all the things that a government-run Medicare for All doesn’t actually cover.
In practice and implementation I suspect we are really talking about a distinction without a difference.
Baud
@Mnemosyne: So how do the Swiss decide which company to go with if it’s not market driven?
germy
@Baud:
Good. Keeps them busy without actually causing too much harm.
Jim, Foolish Literalist
@FlipYrWhig: Wilmer apologists like to point out that his voting record shows a willingness to compromise, accept half a loaf while fighting for the other, etc., and there’s a lot of truth to that. The problem is his relentless, manichean sanctimony and reductive rhetoric (“there is NO reason we can’t have…. in this country”). He’s convinced a sizable chunk of should-be Dem voters that the only thing between them and Nordic utopia is the corruption and cowardice of the Democratic establishment, with their donuts and bottled water.
efgoldman
@Major Major Major Major:
We should never conflate “very vocal” with “large numbers”
Mnemosyne
@tobie:
I agree that there’s more than one way to get to universal healthcare, and being solely focused on “single payer” is a huge mistake, but it’s become the favored slogan of people who haven’t done any research, so we’re kind of stuck with it.
The problem phrase is not “market” but “market-driven.” IANAEconomist, but having a market for something and having an area of the economy that’s driven by its market are two totally different things.
Major Major Major Major
@Kent: Well, it’s not a distinction without a difference because “single-payer” has a particular policy meaning, which is relevant when we’re talking about policy. Specificity of language is very important when discussing policy, given that policy consists entirely of language. And Medicare for all is not single-payer, it’s mixed-payer/semi-private.
@efgoldman: Sufficiently vocal to fuck shit up.
Baud
Somewhat OT, I recently read this interesting Vox piece about Carter and the Dem Congress. Something to avoid if we get back control.
https://www.vox.com/policy-and-politics/2017/8/4/16075196/trump-legislative-failure-carter
Baud
@Mnemosyne: Ah, you’re making a difference better a market system and a market-driven system. I can see your point then.
Mnemosyne
@Baud:
Because the companies are limited in what they can do to influence or change the market they operate in, so they are unable to drive the market.
The problem work is not “market.” Everything has a market of some kind, but not everything is driven by that market.
trollhattan
@rikyrah:
I’m very open to her running. Running a woman two times in a row would be quite the message by Dems that we need to knock that fvcking door between women and the White House into toothpicks and to do it now, not “some convenient time in the future.” Dudes are making quite a hash of the place ATM.
elm
@tobie: The statement you originally quoted, from Mrs. Cracker, was:
That’s why I said the Swiss system isn’t market-driven, it’s not. It’s regulation-driven but uses private insurers to solve many technical matters.
Mnemosyne
@Baud:
And I think Betty was making the same point: it’s not that we can’t have a market of any kind for insurance (even the UK has supplemental insurance policies that people can buy), it’s that they don’t allow the insurance companies to drive that market.
low-tech cyclist
I think Sen. Gillibrand’s shown the Dems the way to go, not just with health care, but across the board.
1) Say, loud and proud, what we really really want. What our real goal is.
2) Say what we’ll do as a first step, if the end goal can’t be done right away.
3) Be willing to explain how the first step helps us get to the ultimate goal, and reiterate that the ultimate goal is what we want to get to.
Kent
@Major Major Major Major:
Major major. So I googled “single payer” to determine the exact difference and the top link was from the web site Physicians for a National Health Program. In the very first sentence of their definition of “single payer” I find this:
http://www.pnhp.org/facts/what-is-single-payer
So I don’t think the definitional distinctions are as well defined as you suggest.
Or, perhaps it is more accurate to say that there is a policy distinction between “public option” and “single payer” but the term “Medicare for All” seems to be used broadly enough as to apply to either type of program.
tobie
Serious question…does anyone know when and how Canada transitioned to single-payer? It would be interesting to look into how a modern economy did this, and since I’ve raised the question I suppose I should go look it up myself. My general impression is that people are willing to pay quite a bit for the general welfare if they feel there is a functioning social contract. Reagan’s “gov’t is the problem not the solution” destroyed that compact in the US.
Baud
@trollhattan:
Before you decide, make sure to read my 10 page manifesto on why no woman can be as good a president as Donald Trump.
Baud
@low-tech cyclist: I believe Obama did that when the ACA was passed. People need to hear.
rikyrah
@Jeffro:
I am with you.
Baud
@Kent:
Medicare has premiums.
Betty Cracker
@tobie: I think Gillibrand said “for profit” rather than “market driven,” but they mean the same thing in my book. A for-profit system won’t achieve universal, affordable coverage for everyone. It doesn’t anywhere in the world.
tobie
@elm: Thanks, Elm. Mnemosyne pointed that out as well, and I apologize to you, Betty Cracker, and anyone else if I took your remarks out of context. I only wanted to emphasize that systems based on employer provided healthcare can work.
rikyrah
@Hoodie:
The Poster Children for Medicare, as opposed to Medicaid, is a older WHITE couple.
Major Major Major Major
@Kent: “Medicare” contains, as a subset, Medicare Advantage and so forth; it is multi-payer. Traditional medicare is single-payer. Which are we talking about expanding? Nobody seems to say.
trollhattan
@Baud:
Will do, but It’s still down there in the bottom of my Costco Cheerios box and I can’t seem to grab it yet. [note to self: two bowls/day] Clever campaign strategery, BTW.
trollhattan
Somebody fire up the Silverman signal.
Kent
@Major Major Major Major:
Exactly. “Single Payer” seems to be a precise policy term as is “public option”. However “Medicare for All” seems to be a vague term that could apply to either or both depending on the specific proposal.
Gillibrand is proposing a “public option” form of Medicare for All”
The proposed legislation from the Physicians for a National Health Program would be a “single payer” program which they are also calling Medicare for All.
rikyrah
@trollhattan:
Amen.
I still flashback to the shudders that I get from 2008, when John Edwards was being sold as the ‘ safe White Man’.
MAN…we dodged that bullet.
zhena gogolia
I must have missed something, because I have no idea what “donuts” stand for.
The day after the election, one of my students said, “It just shows the limitations of the neoliberal vision.” I was puzzling over what the election had to do with government-private interest partnerships for urban redesign. I still don’t quite understand how they’ve decided to reinterpret “neoliberal.”
gene108
@tobie:
For a lot of folks on the Left, universal coverage without the destruction of for profit health insurers is a failure. The destruction of for profit health insurance is as important or more important than universal coverage.
The destruction of health insurers will be the first step to usher in the glorious people’s revolution, where for profit enterprise will be a thing of the past.
Yutsano
@tobie: The first province to adopt universal hospital insurance was Saskatchewan in 1947, but the actual creation of a unified health law wasn’t until 1984.
https://en.wikipedia.org/wiki/Canada_Health_Act
rikyrah
@zhena gogolia:
check this article:
Message Failure From Nina Turner and Our Revolution
http://washingtonmonthly.com/2017/08/10/message-failure-from-nina-turner-and-our-revolution/
Matt McIrvin
@Hoodie:
They could go with “more Medicare for them means less for you”, or a claim that Medicare is on the verge of collapse and expanding it will push it over the brink. Might not work, though: Bush claimed to be “saving” it by privatizing it and that didn’t fly at all.
TenguPhule
@Baud:
And not voting for bills that need to become law.
Debt Ceiling Crisis, DAMN THE TORPEDOES AND FULL SPEED AHEAD INTO THE REEF!!!
/Yes, I’m bitter about this completely unnecessary catastrophe.
Roger Moore
@SatanicPanic:
I sure as hell don’t want replacing Obamacare with Single Payer to dominate the legislative agenda to the extent passing Obamacare dominated it in 2009-2010. I’m fine with passing technical fixes, but they have to be treated as technical fixes rather than a major legislative push. There are too many other things that need attention.
Miss Bianca
@tobie: My understanding is that the Canadian system went province by province, not national all at once – and I believe it is still administered at a provincial, rather than national, level. However, IANAC, so without looking it up I am going to say that that is merely my recollection.
ETA: Just to tack on to what Yutsano said.
TenguPhule
@Roger Moore:
Single Payer doesn’t even make the top 20 in the list of things that need fixing on the existential level for the USA now.
That’s how bad its gotten.
Major Major Major Major
@Kent: One of the issues with conflating ‘medicare for all’ (which medicare?) and ‘single-payer’ is that part of why medicare is so broadly popular with beneficiaries is medicare advantage.
Ksmiami
@FlipYrWhig: hey that’s what Ive been clamoring for “kidcare” – medical/dental for all us children 0-18. then build off that. also if the biggest challenges we are facing are from technological disruption, then I think a stronger democratic platform should be America2.0 – time for an upgrade- this means a top to bottom campaign to modernize aging infrastructure, streamline the military and put the best innovators in charge of addressing climate and labor.
rikyrah
Dear Bob Mueller,
We know you’re thorough, meticulous, and cautious.
But if you could speed it up, we’d appreciate it.
Thanks,
-The World pic.twitter.com/YcgMjFu2qx
— Holly O’Reilly (@AynRandPaulRyan) August 11, 2017
rikyrah
@Ksmiami:
Kidcare, and Medicare Eligibility from age 50. Get that AARP Card and Medicare Card in the same month.
Roger Moore
@TenguPhule:
And heaven only knows how much worse it will be in 2020.
Miss Bianca
@Ksmiami: Personally, I favor the approach of tackling in pieces, from both ends of the age spectrum – lower the eligibility age for Medicare to 55 (or even age 50) as one step, then expand coverage for 0-18 (or even 0-26, in keeping with the ACA guidelines) as another step.
ETA: Cause I’m one of those damn “incrementalist” progressives – which is to say, no sort of progressive at all, according to my leftist betters.
TenguPhule
@Roger Moore:
If we make it to the end of this year without something else blowing up, I will be amazed.
tobie
@Yutsano: @Miss Bianca: Thanks for the info and also for the link to the Wikipedia page on the Canadian Health Act.
germy
rikyrah
@Miss Bianca:
Love that 0-26…makes sense.
Kent
@Major Major Major Major:
Right. Personally I think “Medicare for All” is a great campaign slogan for Democrats. The term “Single Payer” is wonky insidery language. It’s all about the framing.
Honestly based on how politics gets done in this country, under the best case scenario, any kind of next round health care reform that moves us closer to single payer is almost certainly going to contain private “Medicare Advantage” types of options contained within it. That seems the likely compromise to get the 60 votes necessary. So we would get to universal coverage but wouldn’t necessarily wring all the rent capturing out of the system. And we would end up paying more for health care at the national level than might otherwise have been the case under a perfect system. But that’s pretty much the American way.
Miss Bianca
@germy: Christ, what a weasel. Obligatory apologies to weasels. And does he go on to “say, with a smile”, how the Republicans are going to go on to tax reform *without* gutting health care?
rikyrah
@germy:
Nope.
Uh huh
No way, muthaphucka.
That vote is going to be tied around your neck like an anvil.
FlipYrWhig
@Ksmiami: I was wondering about the political feasibility of having the government will pay for all births. You’d get people whining about welfare mothers and so forth but I feel like it’d be outweighed by how popular it would be. Just say no mother should have to bring home a bill with her baby. Add the Finland baby-box thing. How expensive could that be, even for complicated births? I honestly have no idea. But it seems like we willingly pay for a lot of things that are much less ethically justifiable than that.
retr2327
@tobie: If your conception of “market-driven” is sufficiently flexible to swallow a requirement that companies not make any profit from providing insurance, then yes, I suppose I can’t identify any difference in structure that you would recognize . . .
rikyrah
That muthaphucka Lieberman…objecting to Medicare’s age being lowered to 55. If we’d already had that in place with Obamacare…the move to lower to 50 wouldn’t seem so ‘radical’.
TenguPhule
@FlipYrWhig:
Hahahaha, no.
Slutshaming is a national conservative ritual that requires all women who have the audacity to be pregnant and not white and married to a rich person to be roundly condemned as leeches on society’s tit.
I blame the Pilgrims, if they’d just had the decency to die off and not spread their rigid theology into our national identity.
FlipYrWhig
@Kent: “Single payer” is one of the WORST slogans ever created. It doesn’t even communicate WHO THE HELL PAYS, just that there’s one of them. That’s pretty much the least compelling part of the whole idea. It’d be like selling a cell phone as a Rectangle Machine. Seeing “Single Payer” get used by the same people who carp and moan about everything Democrats and liberals attempt in the way of “messaging” is mind-boggling.
raven
@FlipYrWhig: Sort of like Pro Life.
germy
@rikyrah:
Meanwhile the weasel is experiencing the most horrible nightmare a smiling republican can suffer: he’s being primaried from the right.
tobie
@retr2327: I don’t want to hog the thread with this discussion but would note that both Swiss and German private insurance companies are “not-for-profit” (as opposed to “non-profit”) companies. They can’t make money on the basic plan (i.e., our “bronze plan”) but on anything above and beyond that they can and do make money to sustain and advance the business.
FlipYrWhig
@TenguPhule: I acknowledge the popularity of slut-shaming. But that works much better as an anti-abortion argument, because having an abortion is in their eyes getting out of a deserved punishment. But becoming a mother and not getting a bill… that wouldn’t play as getting out of your well-deserved slut-punishment, because you’d still have to find a way to care for the baby. (I’m all for government-provided childcare too, but I concede that it would be a heavy lift politically because of anti-“welfare” sentiments on the right.)
Baud
@FlipYrWhig: The thing is to just do it and then it’ll be hard to take away. And unlike reforming the entire health care finance system, doing this wouldn’t be that disruptive.
VFX Lurker
My one concern with federal single-payer is the Hyde Amendment, which leads to cruel outcomes in Medicaid.
After this summer, though, I can picture this Congress using federal single-payer to also deny women access to maternity care and birth control in addition to abortion.
I used to think more highly of single-payer, but only because I saw its implementations in countries that cared about women’s health. Not sure about my own country.
FlipYrWhig
@Baud: Ivanka is working on these issues now, right? @[email protected]
Baud
@FlipYrWhig: Glad she’s there to act as a moderating force.
Cheryl Rofer
Trump is threatening Kim Jong Un again, but I’m headed to my knitting group! See y’all later!
TenguPhule
@FlipYrWhig:
“Young Bucks with their T-bone steaks.”
Facts don’t matter to the Conservative Khristians. They’re very good at demonizing by making shit up.
Major Major Major Major
@Kent: I agree that “medicare for all” is a great slogan, but I’m also aware that there are people who are very hung up on “single payer” and it’s important to know what we’re talking about.
Villago Delenda Est
A “market driven” solution will never work in something as totally fucked up and anti-market as you can get, such as health care.
raven
TenguPhule
@Cheryl Rofer:
I do not like this alternate timeline.
rikyrah
@VFX Lurker:
You do not lie.
Jim, Foolish Literalist
@FlipYrWhig: @Baud: The Princess Trumpale will be bringing Gwyneth Wannabe “Brand” to India on our behalf this fall
germy
excellent LGM comment:
?BillinGlendaleCA
@Baud: But her Emails!
rikyrah
@TenguPhule:
His voters would have to apologize until Jesus returns….and, it still wouldn’t be enough.
trollhattan
@TenguPhule:
What, we were misplaced, unlocked and empty before? Who knew?
jl
I don’t think it’s true that single payer is the only way to get good health care for US. But is one way, so good to put it up for debate.
Nothing going to happen for next few years since knaves and fools are running things right now.
Would be good to debate various forms of single payer systems, and how improvements to PPACA would compare.
rikyrah
@Jim, Foolish Literalist:
No lie told.
Don’t feel bad at all about what they’ve said.
Baud
@Jim, Foolish Literalist:
Also, an insult to the U.S., the Globe, and summits.
Kent
@retr2327:
Attaining universal coverage and wringing private profits out of the health care system are two completely separate policy objectives. And the insurance companies themselves are only one layer in a system of private hospitals, private clinics, and privately employed medical providers. Private profits are earned at every level of the system, not just at the insurance companies.
A majority of Americans is likely to support the first objective. I think it’s relatively easy to sell. I think the second objective is something of a fools errand. Pretty much every other sector of the economy: transportation, energy, environmental protection, infrastructure development, education etc. etc. has layers of participation by private entities that earn profits. I’m not sure why eliminating private profit from health care is more important than any other sector of the economy.
rikyrah
OFA targets vulnerable Republicans with a new grassroots project https://t.co/b3KyJUthvS pic.twitter.com/OuFwMuuPjO
— CNN Politics (@CNNPolitics) August 11, 2017
Frank Wilhoit
@tobie: “…Both countries highly regulate the health insurance industry…” First of all, say what you mean: for “highly” read “effectively”. Their regulation of their health insurance industries appears “high”, because it goes beyond what we could do here, not merely in degree but in kind. American industries have been above the law for so long that they simply will not consent to being regulated effectively and there is no power that can coerce them. (And Bernie Sanders and his people do not understand that problem in those terms and have no idea what to do about it, but I digress.)
The private sector has nothing to contribute — except cash, derived from skimming, to campaigns. They cannot contribute efficiency in delivery. Perhaps in other places they can; but here, even if they had the craft, they do not care about efficiency and cannot be induced to care about it. All they care about is skimming. And our problem is not that there is not enough skimming going on; it is that there is too much.
Major Major Major Major
@Kent: The second objective isn’t even something Democrats can agree they want to do, so, maybe let’s not make it our overriding goal and stick with achieving universal coverage instead.
gene108
@rikyrah:
The way Trump’s going Jesus may have to return sooner than he thought
germy
@Frank Wilhoit:
Well said.
Jim, Foolish Literalist
@raven: my post got et, but trump seems quite preoccupied with “uttering” today
he’s “getting away with” uttering.
Captain C
@Major Major Major Major:
Because it’s not Moral or Right. And being Moral and Right is more important that saving or otherwise improving actual lives.
Captain C
@Jim, Foolish Literalist:
I’m guessing this yet more projection on his part.
Jim, Foolish Literalist
@Captain C: also, virtue signaling
Captain C
@Jim, Foolish Literalist:
Well, that and “identity politics.”
Captain C
@Jim, Foolish Literalist: That too.
gene108
@Kent:
We do not interact directly with the financial ends of these industries. Roads get paved. Our taxes pay for that. We aren’t fighting with the paving company because they are directly billing us for the asphalt they laid down in front of our house.
retr2327
@Kent: I think if you review my comments from the top, you’ll find I didn’t really take a position on what the endpoint should be, or how it should be reached. I’ve just been discussing the meaning of “market-driven” with Tobie, who seems to have a different understanding of it.
FWIW, I am not, by any means, a believer in a market-driven solution to health care, but I don’t believe that it’s necessary to drive all profit out of it either. In short, smart and effective regulation is mandatory.
eclare
@trollhattan: Maybe he finally found that aircraft carrier group that he lost a few months ago.
Captain C
@rikyrah: I would say that wouldn’t be good for his spine, but based on his vote vs. his rhetoric, I’d say he already doesn’t have one.
Roger Moore
@jl:
A good point. Lets move the fucking Overton Window to the point that the discussion is about how to get everyone coverage, not whether we should let poor people die because they don’t have health insurance.
clay
@Jeffro:
I hate to say it, but I think charismatic is the key word here. I know as good liberals we’re supposed to want the best positions and policy statements, but since at least JFK, with very few exceptions, the candidate with the more natural charm has prevailed.
Kennedy, LBJ, Carter, Reagan, Clinton, Bush Jr., Obama… Nixon was propelled by dirty tricks and leftist disunity (sound familiar?), while Bush/Dukakis was a wash, charisma-wise.
Kent
@retr2327:
Retr2327: I think we are 100% on the same page. I was just sloppy in replying to your post and intended to add to your argument rather than suggest I was disagreeing.
In my former life I worked for the federal government writing environmental and fisheries regulations for NOAA. Smart and effective regulation is exactly what I agree with and how most of the rest of the modern world structures its economies.
Roger Moore
@Kent:
I don’t think we need to root out all private profit, but I strongly feel that doctors should be considered fiduciaries. The average person has no way of judging what care is appropriate, and that leaves a lot of room for doctors to make patient decisions based on their interests instead of their patients’. Of course that applies to more than just financial interests; there’s very good evidence that obstetricians have been pushing medically unnecessary c-sections because they’re good for the doctor.
trollhattan
@eclare:
Heh, stupid Aussies, stealin’ our stuff agin’.
jl
Single payer is one way to achieve better quality and more affordable health care in the US. I disagree that it is the only way. Seems like a good time to put up some ideas for single payer and similar systems. Nothing else can happen now due to the jerks in charge of WH and Congress. Would be good to debate the proposal against ideas to improve PPACA. If single payer and similar ideas continue to get good polling support, might spur some moderate GOPers and conservative Democrats to get off their butts and put forward serious proposals to fix problems in US health care system.
One thing in favor of single payer, is that going that route brings in Congressional power to tax and decide how to spend tax money, and make some other reforms easier. One example would be problems of provider market power and opaque pricing in provider markets. In a perfect world, a market oriented economist might argue would be better to address those issues directly, gut in US system, doing so might be as hard or harder than getting to the various single payer systems adopted.
Does anyone ‘hate’ this proposal? Why? I see no reason to hate it. Unless you are one of the GOP knaves and fools currently in charge.
FlipYrWhig
@clay: LBJ had no charisma, and neither did Carter. (LBJ is more of a throwback to the “machine pol” kind of character, which is weird after JFK was already the “new media celebrity” guy by 1960 standards.
I actually think the key concepts going forward for Democrats are youth, optimism, and the avoidance of corruption. “Charisma” is too hard to come by, which makes it hard to select for. (And most of what people call charisma is retrospective anyway. I was never much for Bill Clinton’s supposed charisma, and George W. Bush was far more _amiable_ than charismatic. I think we haven’t really had that many _charismatic_ per se presidents in the TV era: IMHO only JFK, Reagan, and Obama qualify. I don’t know what to do with Trump, who’s just _such an asshole_. I find it hard to define a raging, unattractive, hard-to-watch asshole as charismatic.
Captain C
@FlipYrWhig:
I still can’t figure out how they can square wanting to punish “sluts” by making them have and care for babies with being so “pro-life” (really “anti-abortion” or maybe “pro-forced-birth”) that they can’t talk about anything but how much they care about the little fetuses, which are a True Blessing from God. Or something. Seriously, we’re going to punish you for having icky sexytime fun with a little bundle of joy which is the best thing ever (as long as we don’t have to pay for any of the actual expenses associated with its upbringing).
FlipYrWhig
@Captain C: I think it’s supposed to be that it’s the kind of punishment that successfully reforms the offender. The baby teaches you responsibility in a tough-love way and then teaches you joy and tenderness in a nice way. Then again, maybe, like you’re saying, it’s just grotesquely inconsistent, like most of what they believe.
clay
@FlipYrWhig: I realize that ‘charisma’ is vaguely defined at best, and often depends on the eye of the beholder. But one must take into account the duality of the choice here. LBJ and Carter may not be movie-star-types, but they were up against Goldwater and Ford. So, comparatively, they were more charismatic. GWB was a kind of fratty asshole, but he had a relaxed, schmoozy way about him. And he went up against Gore and Kerry — two famously stiff wonks. (I recognize he didn’t beat Gore properly, but he made it close enough to steal.)
I love Hillary, but she was stiff like Gore. And Trump, goddamn him, knows showmanship and self-promotion (and little else). He’s very watchable on camera — that’s how he got famous in the first place. I thought 2016 would finally be the year of a policy-based election, but it was not to be. I have little faith that 2020 will be any different, which is why we need someone charming and telegenic. I think Gillibrand qualifies, to bring this back on topic.
VeniceRiley
What does everyone think about letting everyone buy into Medicaid as an option on their exchange in each state? That would keep it with the states, who are hell bent on controlling everything. It would strengthen Medicaid and put people with political capital in their corner. And it might be doable more than Medicare for all.
TenguPhule
@Captain C:
You’re forgetting carrying to term, labor and birth.
I assure you, they have not.
FlipYrWhig
@clay: I get that, but it’s sort of circular: knowing who won, you can go back and say, “must have been more charismatic.” That’s what makes me suspicious about it as a heuristic. It’s fixing the data around the hypothesis.
In a more general sense, though, old-pro types are NOT faring well: Humphrey, Mondale, Dole, Gore, Kerry, McCain, Hillary. I think that’s the through-line both sides are learning to avoid. The old pros who won are LBJ, Nixon, and George H.W. Bush. IMHO the common thread for Democrats who won is youth, optimism, and character (in a public sense if not a private sense). That explains Kennedy (character is questionable I suppose but it was a different media landscape then), Carter, Bill Clinton (more on the youth and optimism part than the character part), and Obama. Carter has no charisma, he’s just a good guy. Clinton I don’t find charismatic, but he’s certainly earnest.
The upside is that my list of qualities is easier to come by than “charisma.” Gillibrand would pass the test, as would the Castros, Tim Kaine, Chris Murphy, etc. A lot of them are kinda boring, but they’re decent, committed, intelligent people, and I think that’s going to go a long way against Trump, and it’s gone a long way before. (Hillary and Gore are quintessentially this type BUT they got smeared for scandal and couldn’t shake it because they’d been around too long and it became a sort of patina on them.) I suppose Warren is sort of a Carter type. She’s older than ideal. Sanders is too idiosyncratic and I don’t know what to make of him. Closest example would be Goldwater. Of the emerging contenders, I think only Boöker is charismatic per se.
Ksmiami
@rikyrah: then we use kidcare as part of the democratic party’s pro life stance. See I want to crush the GOP with their own weapons and split off the Catholic vote…
Ksmiami
@FlipYrWhig: the whole point with kidCare is to both improve the next generation, create a relatively low risk pool and challenge the GOP lie that they r the pro-life party. Imagine the ads? The Republicans hate kids, moms and puppies… see I’m not afraid of reframing the arguments
Ruckus
This may be a dead thread but I’ve seen several topics covered.
1. Medicare is not in any way free. We pay into it for decades then when we are old enough if you need it you pay a monthly cost, 3 yrs ago it was $110/month, and 20% copays. If you are on a limited budget, Medicare is far from free. How would Medicare for All differ?
2. A fixed low profit system can work but needs extreme regulation. That may not work here. How do we get rid of the for profit system and what about all those people in it now who would lose jobs?
3. Single payer, unless done correctly will still have huge medical costs, those have to change along side to make it reasonable.
4. Universal health care, like the VA. I’ve said this before and I’ll say it again, a lot of people would hate it. I know, I use it very regularly. Like today. The waiting, for appointments, the limited bed space for emergencies, the limited days your clinic has residents and attending physicians for more than routine issues, the limited number of appointments for routine care, the number of facilities available, the number of hospitals available, the locations for those…… All of these can be fixed but the fact that it would have to be the federal government doing the work and all of us paying for it, I just don’t see that playing well in huge swaths of this country. We may have gone too far down the road with profitable healthcare to reverse course.
How many countries our population size or even close have universal or single payer healthcare?
J R in WV
@retr2327:
I think making a profit from people’s misfortune (cancer, heart failure, renal failure, etc, etc) is morally evil and wrong. I’m not saying doctors and other health care professionals should not make a very good living.
I’m saying managers and executives who spend their days figuring out how to squeeze another few hundred dollars from patients suffering from terrible diseases are evil and have no moral part in health care. Like that guy, Martin Shkreli, who was just convicted for stock fraud, they are all immoral, evil scum, no other way to discuss it.
Burnspbesq
The people of Germany, France, the Netherlands, and Switzerland would like a word with you, Betty.