The Hill is reporting that all of the major health industry players are orgnizing an umbrella lobbying group against single payer systems. They get a follow-up quote from Senator Sanders (I-Vt) that provides some very specific distinctions that we’ll ponder a lot on and waste an amazing number of pixels in 2021 if there is a Democratic Trifecta:
Bernie Sanders says in statement to The Hill about new industry group opposing single-payer: “Whether they like it or not, we will succeed in guaranteeing health care for all because this is an idea whose time has come.” https://t.co/EJzFtT5MmC
— Peter Sullivan (@PeterSullivan4) August 10, 2018
The critical phrase is “healthcare for all”.
- Medicare for all.
- Single Payer
- Swiss style heavily regulated private exchanges
- Singaporean style forced and subsidized savings models with owned providers models
Those are all universal coverage systems.
Is that the goal?
Or is the goal a particular economic and political arrangement?
Great Britain when they instituted their National Health Service had to stuff the mouths of the their doctors with gold to get buy in. It produced a national universal coverage system. Is that an acceptable trade-off for you?
What is the goal?
MomSense
I tried to talk about it with some rose zombies on twitter. They don’t really know anything about Medicare for all but it has become a litmus test. I also get the feeling they think it is going to happen really fast – like right after the midterm elections.
dr.bloor
The goal, of course, is universal coverage at an equitable out-of-pocket cost for the consumer.
It will die the death of a thousand online campaigns at the hands of (1) those invested in the status quo, and (2) those willing to kill the good in the name of a misguided understanding of the “perfect.”
Kay
Maybe the major “health industry players” could have dealt with some problems in their industry prior to this?
Because it isn’t just uninsured people. A lot of people hate our health care payment system. They want it 1. affordable 2. simplified and 3. with more predictable/ less volatile prices. If the “major health industry” players are running it maybe they could have attempted to improve it and address these problems? Instead they’re going to devote all their time to lobbying to keep it the same?
Cheryl Rofer
I’d like to see something from an expert on the differences between the various systems. What I want is an outcome –
– Universal coverage
– End the insurance company profiteering
– Make the system easy to use for patients and doctors
There may be more I’ll think of later, but these are primary.
And thank you for the general terms – “universal coverage” and “healthcare for all.” At my present state of relative ignorance, I have no preference among the possible systems.
Another Scott
Wilmer doesn’t understand how to actually accomplish anything in the real world. Everything is a litmus test for him, and a way to stay in the news. He doesn’t care about actually implementing policies that will make things better.
For me, the idea is to come up with a system that can be implemented quickly and improved in a step-by-step fashion to provide quasi-universal care with greater efficiency and better outcomes. Too much time and money is wasted by people fighting with their insurance companies. Too much money is wasted in people gaming the system about what drugs are paid for and by whom.
Co-pays and deductibles should be eliminated – people who need treatment shouldn’t decide between getting treated or paying the rent.
And payroll taxes for healthcare (and retirement) should be progressive.
Atrios is annoying at times, but he’s right that if you want to make the benefits universal, then just make the system universal. Putting up terms and conditions and systems for appeal and boards to decide corner cases and all the rest just adds to the cost. If you are worried that too many rich people or too many medical tourists will game a free/universal healthcare system, then tax them more.
Otherwise, I don’t much care what a new system looks like (“single payer” vs MedicareFA vs MedicaidFA vs VAFA vs NHS vs CanadaCare vs whatever). But I do know, and often say, “Purity Kills” – meaning demanding some pure system that will not get political buy-in and enough votes in Congress and elsewhere will prevent improving the system and people will die as a result. The only path forward is sustained incremental progress.
tl;dr – Simplicity, Universality, Reduced Costs and Stress for the bottom 50%, Quick Phase-in, and Incremental Improvements and Regular Review of What Works and Doesn’t.
My $0.02.
Cheers,
Scott.
low-tech cyclist
@Kay:
Bingo. And like you said, the health care execs could have used their clout to make the existing system better. They chose not to.
I want pretty much what ‘they’ want: universal health care that’s affordable, predictable, and simple to deal with. I’m good with a rallying cry of “Medicare for All,” because I figure that if the wave for M4A gets big enough, the insurance companies will be forced to go along with an affordable, predictable, and simple system just to stay in the game at all. And that’s an outcome I’d be satisfied with.
Kay
@low-tech cyclist:
Agreed. I was not a believer in the “Overton Window” but I have to say on health care it seems to work. I give Sanders and the Sandernistas credit for it, too. They brought it front and center into the debate again and if they hadn’t have pushed for the extreme it wouldn’t have gotten any media coverage.
All of the Democrats are running on health care. No one was covering it. UNTIL it became Medicare for All. Then they all rushed to the barricades.
tobie
Cheryl’s and Scott’s goals seem spot on: universal and affordable coverage, a simple system (at least from the consumer’s vantage point), and a detailed phase-in plan.
I’m glad the article gives us some hint of what the healthcare industry’s line of attack will be: single payer means dirsruption of servicee for the 55% of the Americans who receive their health insurance through their employer. I happen to think there’s some truth to that claim. So my preference is for either the Swiss model of highly regulated private exchanges or the German model of highly regulated public options and private exchanges.
As for pharmaceutical companies: they are crooks and should be regulated to kingdom come. The FDA should take over drug-testing entirely, and the NIH should start introducing some proprietary claim over the drug formulas discovered with their funding. The drug companies don’t do research and shouldn’t own the chemical formulas. I actually have more problems with pharmaceutical companies than health insurance companies, since the latter are easier to regulate.
Oh, lastly, how can be create a network of non-profit hospitals in even remote areas? My understanding is that for-profit hospitals really jack up costs for everyone.
Geoboy
@Another Scott: Scott – I second that emotion.
gene108
Well, from following DailyKos during the ACA fight, I think the goal of a lot of Bernie supporters is the obliteration of the for-profit health insurance industry, which is to be replaced with a government run system.
As far as getting to universal affordable easy to use healthcare, I am not particular on what model gets us there. But getting to affordable means putting the brakes on healthcare spending, so a good chunk of the broader healthcare industry – device makers, insurers, hospitals, pharma etc – would need to figure out how to move ahead with less money, which will likely mean lay-offs. I am not sure how to give the people in those companies a soft landing.
Baud
@Kay: The media is covering Dem bashing, not health care.
tobie
David, you’ve probably posted on this before but, if you haven’t, it would be great if you could summarize what the what the biggest drivers of healthcare costs in the US are. (I don’t know how complicated such an analysis would be.) Even some links to studies or articles on the subject would be appreciated!
Baud
@tobie: John Cole.
Kay
@gene108:
I don’t think they’re sincere in that. Everytime anyone brings up community clinics there’s a lot of pushback where people want to keep their doctor and their exact same approach to health care delivery. I think they probably have to recincile that- if the payment system changes radically the delivery will change too.
Kay
@Baud:
I don’t care who does it or how they do it at this point. They weren’t covering health care and now they are. It’s a problem for Democrats if all they cover is ranting on immigration because that’s not actually what Democrats are running on.
It bores them- it’s wonky and complicated. Medicare for All is easy and it has the added bonus of Dems in Disarray :)
Baud
@Kay: I don’t know. We’ll see how well we do with the sort of coverage the media provides.
Kay
@Baud:
I know no one likes this crazy talk but Medicare for All is a great political slogan. Three words, every one of them positive and inclusive and familiar. People already understand Medicare (as much as they need to, anyway).
Cheryl Rofer
Totally willing to add Scott’s ease/rapidity of implementation to my list.
rikyrah
Thanks for the info, Mayhew.
Will remind folks that Wilmer’s beloved VT couldn’t do single payer.
Medicare for All.
Whatever.
tobie
@Kay: I don’t know how to link to twitter, but one fellow whose new nym seems to be #This is a Sharice Davids Stan Account has a great video up where Davids answers this question in a succinct fashion. Essentially she says, sure, Medicare for All, but then goes on to talk about the problem of co-pays, drug prices, limited access to services in marginalized and rural communities. And she notes that if the problem were easy, it would have been solved ages ago. It could be me, but I find that kind of approach far more compelling than Sanders’. My fear with the latter is that Americans will be shocked at the sticker price–and there will be one if we don’t look at what’s causing sky-high healthcare costs in the US.
Eric U.
If we really went to a system like the U.K., there would be so much sabotage by so many players that Democrats would be as unelectable as Republicans are in most of California. Look at how damaged Obamacare was by a crappy website rollout and then by Republican sabotage. They don’t really care if people die or are bankrupted. Gradual change is the only way it will work. Fix Obamacare and then make it more generous and people will love it.
My family doc was going to retire because Penn State changed insurers and payments went down 20%. He sold his practice to UPMC instead, so we’ll see if we can afford to stay with him. I assume UPMC will have to take PSU insurance or his practice will go away.
low-tech cyclist
@Kay:
This.
We Dems can get too wonky for our own good at times. Wonky is fine when you’re trying to legislate and regulate: you’ve got to come up with stuff that can be implemented in the real world.
But when you’re campaigning, there’s power in simple ideas, things that can be put on a bumper sticker.
sherparick
@MomSense: I suppose you tried to explain the whole separation of powers thing and the fact that 1) you need 60 votes in the Senate to defeat filibusters (although as possible budget and tax measure you my need only 51) and 2) its not likely something President Trump is likely to sign.
Dean Baker, who is probably the best lefty economist around, and no friend of Insurance Companies, doctors, or pharma, note the problems that Progressive Left apparently thinks is just a lack of will and corruption:
“…Yet in spite of the economic and political benefits of a single-payer system, there almost certainly is no direct path that gets us to such a system from where we are today. The basic problem is that the move to single payer involves a massive shift of resources. It would imply taking an amount equal to almost 10 percent of GDP ($1.9 trillion in the economy of 2017) that is currently spent by the private sector and instead having it spent by the federal government. Furthermore, it would require the restructuring of the 7 percent of GDP that the government already spends on health care through Medicare, Medicaid, and other government health programs.
This is a massive rechanneling of resources, which is difficult to envision going smoothly. Among other things, we could not guarantee that people would be able to keep their doctors, since many may consider the compensation rate too low and opt out of the system or take relatively few patients who are in the system. While many single-payer advocates would like to prohibit doctors from practicing outside the system, it would be a huge political lift to prohibit such practices. Furthermore, the current Supreme Court would almost certainly strike down a ban on outside practices as unconstitutional. It is worth noting that even countries with universal single-payer type systems, like the United Kingdom and Denmark, have private systems that operate in parallel with the public one, although in the UK, for example, doctors must practice at least 40 hours a week in the NHS, avoiding a completely bifurcated system….”
cepr.net/publications/op-eds-columns/can-we-pay-for-single-payer
I don’t mind keeping this as ultimate goal, but as Baker suggests, progressing their through the mechanism of the ACA (first by increasing ACA’s subsidies and spreading them into higher income levels and second by adding a public option to compete with and force down the prices of the for profit insurance companies while at the same time putting pressure on drug and medical prices by replacing the patent system with a award and royalty system for drugs and medical devices and encouraging “medical tourism” by patients and “immigration to the U.S. by foreign born medical professionals.”
Matt McIrvin
I have to admit, the existence of the lobbying group against single payer makes me want to support single payer, because fuck them.
Kay
@tobie:
I would have been fine with Medicaid for all, but no one likes that because it’s associated with poor people and lower payments to providers and it’s state-level so subject to starving by GOP governors.
Medicaid is already the rural payment system. I talk to people who are on it. They love it. That’s compared with NO health care, though, which is what they had before :)
low-tech cyclist
@Kay:
Also, there’s Negotiating 101: your initial ask should be bigger than what you’re willing to settle for.
daveNYC
@Kay: Medicare For All is a real easy slogan for people to get behind. Most everyone has some idea what Medicare is, even if it’s just what Grandma and Grandpa use, and For All is pretty straightforward.
@gene108: Well pre-ACA the medical insurance industry was pretty god awful. No small part of its business model involved taking people’s premiums and then doing it’s best to not pay out for any claims. The ACA improved that but it didn’t exactly make it good. Heck, just this week Mr. Anderson ended up fielding a call from a woman who needed help navigating some issue with her insurance. Add in the general idea that things that everyone needs (like education, water, and health care) are not well suited for private industry, and the desire to burn down the insurance industry makes sense.
Kay
@low-tech cyclist:
The best evidence the Overton Window works is not Lefties, it’s Righties. They went from refusing to negotiate on immigration to seizing and imprisoning children and now we’re begging them to release the children.
Lounger
1@tobie:
The thing is, many, if not most, “non-profit” provider networks behave in practically all respects like for-profit entities.
In the Baltimore/Washington metro, one of our “non-profit” hospital networks just closed the only pediatric ER for 20 miles; during rush hour, a trip to the next closest pediatric ER could easily take an hour. The ER had a staff of 20 that handled 17,000 patient visits per year. It was also a regional teaching center for students in pediatrics. The problem wasn’t that the unit was under-utilized, just that its patients were predominantly insured by Medicaid and CHiP and therefore weren’t providing what the network’s management considered sufficient revenue.
But your point about under-served communities is spot on, and this is maybe an even greater challenge than getting everybody adequately insured. It seems that provision of healthcare is being driven not by community needs, but by where the most money is.
Joe Falco
Healthcare for All is the rallying cry and the end goal. If it gets Democrats elected then great, the slogan has done its job. We need Democrats to implement something even if it means an imperfect Affordable Care Act. Something incremental is better than the Republicans trying to pull everyone back. However I do believe what’s going to work is a system that’s as universal as possible: Carrots for doctors, rising professionals and med students along with the stated goal of providing care for all regardless of income. Tie it all together into one great Gordian Knot that can’t be untangled.
Baud
@Kay: Another way to say that is that voting moves the Overton Window. Rhetoric doesn’t do it.
low-tech cyclist
@Matt McIrvin:
I can relate to that sentiment. :^D
Also, the fact that they feel a need to form a group to lobby against M4A shows that the idea is clearly gaining traction, because if it wasn’t, they wouldn’t bother.
It’s working, let’s keep pushing.
satby
@Another Scott: well said!
@Lounger:
And this is a travesty that could and probably will cost some child’s life.
The “non-profit” health conglomerates game their revenue to look like they don’t turn a profit, but they do and it’s not a small one. The profit motive in health care needs to be eliminated.
rikyrah
@tobie:
She acknowledges complexities, which is a good thing. It helps when your opponent wants to do nothing but take people’s healthcare away.
rikyrah
@Kay:
That is true, because the poster children for Medicaid aren’t who they should be – which is Bill and Emily’s Grandma and Grandpa.
Betty Cracker
All I know is we pay more for healthcare coverage than we pay for the roof over our heads, and our coverage SUCKS. Other wealthy, developed countries have figured this shit out, and we should too. “Medicare for All” is simplistic, but apparently that’s a prerequisite for building support in a polity that possesses the level of acumen and ability to grasp nuance of a lead-painted snail. So, here we are.
beergoggles
I’d settle for not getting 4 different bills from multiple providers when my spouse goes in for a routine colonoscopy that I’ve verified with the hospital has all physicians covered by in-network providers. Or how about not having to make a list of every single possible drug and procedure we might have in the next year and then calling all the available insurance providers for coverage information, then making a spreadsheet for comparison before we sign up for the next year plan?
Honestly, going from 50 to Medicare age is going to feel like winning a marathon. So duck these people who are more interested in not providing healthcare while nickel and diming us to death.
Procopius
@Another Scott: Who is this Wilmer of whom you speak?
Gex
Somewhat health care related: Facebook memories reminded me that ten years ago today, i posted about David Frum’s response to the passing of the ACA by suggesting there are some circumstances in which it is okay to shoot the president. Because democratically elected legislators passing a law that is signed by the president is the ultimate in tyranny – if those legislators and the president are Dems.
Lest anyone get confused and think never Trumpers are on the same side as us.
schrodingers_cat
@Kay:
The only person ranting about immigration is in the WH. Why is covering that bad for the Ds? Is it because many Ds agree with the Orange Man’s nativist agenda?
schrodingers_cat
@Kay: The only person ranting about immigration is in the WH. Why is covering that bad for the Ds? Is it because many Ds agree with the Orange Man’s nativist agenda?
schrodingers_cat
@Gex: Even now most of these media favorite never Ts like Nichols bash Ds far more than they bash Agent Orange and his R minions.
tobie
@rikyrah: The video was from a candidate’s forum in the primary where they were discussing Democratic healthcare proposals.
Procopius
@Cheryl Rofer: I’ve been using “Medicare for All” as an abbreviation for truly universal health care. I think we’ve reached the point where we need to start looking at nuts and bolts. Actually, I think Medicaid buy-in for all is a better model. The minimum I need to see is:
True universal coverage. Every man, woman, and child in U.S.
territory regardless of citizenship or documentation covered.
No deductibles or co-pays. Absolutely no payment at point of
treatment or place where medicine is disbursed.
No means testing or other restrictions. It’s expensive and cruel.
From what I heard of the NHS before austerity, it was an excellent model. The people loved it, which they certainly do not now. I have read good things about the French model. I don’t know anything about the Swiss model. Anything that conforms to the points I stated above will be satisfactory, but a program based on progressive taxation is preferable. I can live with a compromise that makes substantial progress toward that outcome, but I will want follow-up efforts starting immediately. I do not believe the Democratic Centrists (or, as I call them, Moderate Republicans) will make any real effort to get this program, but I’m slightly hopeful that we’ll elect some DSA followers this year.
Doug R
When Tommy Douglas brought in socialized medicine in Saskatchewan, it wasn’t smooth sailing:
Probably one of the reasons I was born in Michigan two days before the strike.
Doug R
How about stretching Medicare to 60 and rolling in CHIP-except for all kids up to 12, then stretching 5 years every 2 years.
the Conster
You simply can’t compare the US to other countries who have universal health care without acknowledging that those countries have a single executive and a single legislature, are mostly ethnically homogeneous and are the size of one of our states. More than half our states are run by governors who petitioned SCOTUS to deny the Medicaid provision to their poorest, because they and their constituents want to stick it to “those lazy people”. The success of implementing and supporting – through high rates of taxaton – a nationalized health care system seems to be highly correlated to its ethnic homogeneity.
Shorter: we have a racism problem and whites don’t want their taxes going to people they hate.
Major Major Major Major
@MomSense: As with so many things involving this crowd, it’s the political version of this XKCD. xkcd.com/1831/
Eric U.
@Procopius: I vaguely remember that Medicare buy-in was popular at dKos during the pre-ACA bitterness. I have often thought that something like that would be a good thing, with a decent drug plan. Also, the working poor need decent insurance that doesn’t try to cost share with them. Any copay is a lot if your pay isn’t enough to feed and house your family.
I also think that “Medicare for all” is a great slogan. The only problem with it so far is pro-healthcare people that harp on the shortcomings of what they imagine that would mean.
Doug R
@gene108:
With everyone covered, there theoretically should be more business, but part of any healthcare bill should involve retraining for anyone laid off.
Gelfling 545
My feeling is that the Swiss system would be the least disruptive approach and could be more easily built on the ACA. I suspect it would also be the easiest to “sell” to the general public. The benefit of some version of “Medicare for all” would be in the greater equalzing of access. Medicaid and chip patients have a terrible time finding providers, especialy in the specialized areas. Frankly, I just want them to make a move forward.
Major Major Major Major
@Eric U.: “The only problem with it so far is pro-healthcare people that harp on the shortcomings of what they imagine that would mean.”
By ‘imagine’ are you referring to the real piece of actual legislation introduced by sanders and co-sponsored by every 2020 hopeful?
MomSense
@tobie:
The problem is that Medicare for All is a great slogan with the cohort that is the least reliable when it comes to voting. And even if we harass them until they vote, they won’t vote again if they think they were sold out when they don’t get Medicare for All without co-pays or exclusions in January of 2019.
They do not know about Parts A – D. If they don’t want private insurance companies involved than they really should be asking for Medicaid for All. Medicaid sounds like icky poor people though. I’m pretty fucking sick of letting the lowest info, least reliable voters drive the discussion.
Gelfling 545
@Major Major Major Major: Sigh. We used to get teachers like this from time to time at my school. For some strange reason they were always white. As one of my black colleagues used to say “Oh, God! Another one’s here to save the ghetto.”
tobie
@daveNYC:
I thought one of the best features of the ACA was that it forced insurance companies to use 80% of premiums for healthcare. As far as I’m concerned, we could raise the rate to 90%. Premiums rose exponentially in 2016 because Marco Rubio removed the risk corridors designed to help insurances companies cover the sick people who would sign up for insurance on the exchanges first. That, and the Supreme Court’s decision that Medicaid expansion was optional were what really hurt the ACA. It seems the GOP will stop at nothing to prevent people from getting healthcare, and I have no doubt they will take a slogan like “Medicare 4 All” and make it into an albatross around our necks. It’s harder to demonize something like “Healthcare for All” or “Universal Healthcare” but then again I could be underestimating the mendacity of GOP’s PR shop.
gene108
@Betty Cracker:
Did some canvassing for my Congressional candidate, Andy Kim, Saturday. It made it pretty clear to me that we at the B-J community are a thousand times more plugged in than “normal” people. Until people get plugged in, it will be hard to do nuance.
Sloane Ranger
@Procopius: I won’t hear anything against the NHS.I am currently recovering from a total hip replacement which I had on the NHS and, yes, I had to wait 5 months, but I ha no complaints about my treatment and it didn’t cost me a penny, even the crutches and toilet riser being provided.
Complaining about the NHS has been a British hobby for years, even before austerity but you should see us bristle if some foreigner dares to do so. Some years ago I was at a Star Trek Convention and one of our guests, who had appeared in an episode of the original series, started talking about his work supporting a hospital for actors in LA and moved on to slagging off government interference in medicine, “like you have in the NHS” and you could feel the atmosphere in the room turn frigid. His handlers got him out very quickly after that.
On a related note, there’s a really good documentary on YouTube about the difficulties in setting up the NHS, GP’s threatened to boycott it and it was really only saved by opinion polls showing solid public support for the concept, giving Bevin the political cover to continue and Churchill’s personal doctor, the head of the Consultants getting on board.
tobie
@sherparick: Thanks for the link to the Baker article. I need to read it carefully.
Another Scott
@Kay: But, as we all know, Medicare doesn’t cover everything. There’s Part A, B, D, and who knows what else. And on top of that, people need supplemental insurance to fill in the holes.
Are the MFA advocates talking about all that in a serious way? Do they want to keep all the Parts as separate entities, and supplemental insurance (and all its problems), or do they want to do away with that? What’s their plan?
There’s lots and lots of details that need to be acknowledged if we decide we (as Democrats) want to go all in on MFA. Slogans only go so far.
Cheers,
Scott.
Kay
@schrodingers_cat:
Lots and lots of GOP congressional candidates are running on it, too.
I didn’t say it was going to work, ranting about immigration. I said that’s what the GOP is running on so that’s what gets covered.
Democrats don’t rant on immigration so they don’t get covered. Medicare for All gets covered.
Democrats own health care as an issue. Any discussion of health care benefits them.
Sloane Ranger
Reference post 57, that’s Bevan, not Bevin!
schrodingers_cat
@Kay: I was not quite sure what you were trying to say there, too many pronouns, hence my confusion. So thanks for clearing it up and I mostly agree.
At this point many elected Rs and those running for office have decided to be echoes of the Orange One.
Kay
@Another Scott:
Right, but that’s a normal negotiation. Broad is “Medicare for All” and then specifics. We’ve had part of this discussion. The Medicare buy-in at 55 was wildly popular and realistic- it was actually on the table briefly in Obamacare- until Leiberman + provider lobbyists killed it.
If they start at Medicare for All and end with a buy-in at 55 that’s a very good result. That alone.
schrodingers_cat
@Another Scott: Its a shibboleth for BS followers like the Wall is for T followers.
Another Scott
@Procopius: St. Bernard of VT.
Cheers,
Scott.
Kay
@schrodingers_cat:
Democrats really are running on “kitchen table” which everyone claims to want, but really bores political media.
They prefer issues like foreign policy and immigration and national security. Manly issues. Health care is kind of..girly :)
They needed a hook to make them talk about it and Medicare For All is that hook. Bonus points! Dems in Disarray!
Kay
@Another Scott:
So this is what to me collaboration and cooperation would look like. Bernistas say “medicare for all”. They win that – now that idea is part of this- it’s the Left’s proposal. More moderate Democrats say “buy in at 55”. Buy in is wildly popular and makes a lot of sense because older people use more health care.
That’s a good result!
Robert Sneddon
@Procopius:
The British people certainly love the NHS even today. There are folks who see the British health market as a great place to reap money from if it could be privatised, turned to something like the execrable super-profitable American health system and they’ve been pushing for a gradual move to such a “pay at the bedside” model, co-pays, paying for prescription drugs, bills for visits to a doctor’s surgery or home visits etc. It’s hard work for them but they’re persevering, publishing articles in papers and blowing up every supposed failure of socialised medicine in the press because it has a payoff of billions each year in return if they succeed.
Stuff goes wrong, targets aren’t met, every individual problem in the NHS is a national crisis and failure of the system. The poor people who depend on the NHS don’t vote, the more well-off see the words “waste” and “inefficiency” paraded before them and they’re reassured that THEIR access to cheap healthcare will not be affected while their taxes will be reduced in a new efficient for-profit system.
Major Major Major Major
@Kay: it’s a good result policy-wise but to endure and grow it we need the left to realize their part in the dance. My concern is another 2010 “obama sold us out!” clusterfrak. That’s definitely getting ahead of ourselves but it’s still what I think of while I watch what’s going on.
But I agree it’s good messaging for now.
Baud
@Major Major Major Major: That also describes Trump.
@Major Major Major Major: Agree.
Major Major Major Major
@Baud: nah, trump would never get to the last panel.
Baud
@Major Major Major Major:
Huh? He’s done it several times. For example,
cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html
Major Major Major Major
@Baud: well except the last panel implies six months of actual work after which you understand the scale of the problem’s complexity.
Another Scott
@Kay: As M^4 said, we’ve been here before. And as we all know, John Cole killed the Public Option.
:-/
We’re basically in agreement, I think, but I don’t think that one can “negotiate” with someone screaming “Medicare for All” if they don’t have any idea what Medicare actually is and don’t really know what they want and how to get there.
The stylized text is my concern.
I’m all for candidates running on proposed enhancements to Obamacare, Medicare, Medicaid and all the rest. I want more than bumper-sticker slogans from them though.
:-)
Cheers,
Scott.
Baud
@Major Major Major Major: Yes, that is a distinction.
Formerly disgruntled in Oregon
@Major Major Major Major: Brilliant
NCSteve
The problem is that the Bernie wing doesn’t know or care about policy and isn’t actually all that concerned with ends and efficacy. Every complex policy matter gets reduced to a shiny bauble full of unicorns and rainbows with the power to transcend math, eliminate the TAANSTAFL principle and, if necessary, abolish the law of conservation of energy. The important thing is that the shiny bauble is delivered unto them and they’ll decide after it’s delivered whether it lives up to their expectations, which it never does and never will. They absolutely care nothing about whether it’s the best way to accomplish an end. It could be the worst way as long as they believe pain has been inflicted on corporations, blithely unaware that one corporation’s pain is another corporation’s profit.
Kay
@Another Scott:
This is better turf for us. Democrats can slaughter Republicans on health care, but not if they’re talking about a sliding scale subsidy to health insurance plans and “lowering deductibles”. This is exactly what people hate about the health care payment system, the way we talk about our plans? They hate that. Let’s not do what they hate. They have their own incredibly complex health care payment system to navigate. They don’t want to figure out the whole countrys.
L85NJGT
@sherparick:
Welp… good luck with that one kids. We’re all counting on you.
Formerly disgruntled in Oregon
@NCSteve: It’s more about identity and virtue signaling than anything else. Humility is a rare jewel in the human world at best, but these folks have nearly as little of it as the loudest Trumpettes.
goblue72
@Another Scott: You’ve just described Medicare For All.
J R in WV
@Kay:
No, federal judges are ordering them to release those children, and are finally sneaking up to contempt of court when one or another DHS agency fucks with the judge’s order, as in deporting a parent while there is a court order to reunite that parent with their child(ren). Begging would not do a thing, a court order appears to nearly almost work correctly.
I think Ms Nielsen, Secretary of DHS, should be jailed until the last child is reunited, and perhaps longer for intentional child abuse. She is below a cickroach’s belly, an inhuman monster who should not be allowed around normal people ever again.
tobie
@sherparick: @L85NJGT: “Basically, we need a way to tax people, by an amount roughly equal to what they now pay in premiums and out-of-pocket expenses.”
This is what the right is waiting to pounce on. That’s why I still prefer “Universal Healthcare” or “Healthcare for All” as mottos. Don’t box yourself in with one policy option at this stage of the debate. Hopefully in 2020, if we take the House, Senate and President and don’t need to cross the hurdle of overriding a Presidential veto, we can get a lot done fast.
goblue72
@Kay: If Sanders weren’t attached to Medicare For All and instead Clinton was promoting it, the vast majority of BJ commenters would be falling over themselves to support it. We all root for the laundry most of the time.
Americans hate health insurance companies. For obvious reasons. And Obamacare – particularly the portion that is the Exchanges and not the expanded Medicaid portion – basically takes their status quo daily experiences with private health insurance companies and slaps more forms and a website on top.
Americans LIKE Medicare. For same reason they LIKE Social Security. And for same reason voters elsewhere in the industrialized world that have social democratic welfare programs like THEIR safety net programs. Because its universal and non-means tested. Are you alive? Yes? Great – here’s your benefits. (Or, in the case of Medicare and SS: Are you alive and over X age? Yes? Here’s your benefits.) If Head Start weren’t restricted to the poor, we’d have a creche on every street corner.
Universal. Non-means tested. Easy for the public to understand. And once started, incredibly difficult to UN-do. Because every single voter has a stake in keeping those benefits. (The National Front in France are insane far-right xenophobes. But unlike their far right peers in the U.S., their platform avoids touching universal social safety net programs in France. Cuz even their angry xenophobic base wants their bennies.)
The left aren’t pushing Medicare for All out of some purity test. They are pushing it because unlike the technocrats obsessed with Rube Goldberg devices, they have a better understanding of politics. Americans already KNOW what Medicare is. They already have a really good opinion of it. They LIKE it. Getting to a universal, non-means tested public health insurance option by taking something that already exists and is broadly popular is a politically more viable and just as importantly – more DURABLE – path than creating some new 500 page plan Rube Goldberg device that involves filling out half a dozen forms and possibly have to “shop” for new health coverage every year.
Obamacare was an important step in moving the ball forward on getting the idea of universal coverage to be considered an important goal by the American public. But as an actual program – its so awesome that its taken Republicans merely a year to start breaking it into tiny little pieces. I’d rather not have fundamental social welfare program entirely dependent on which party is running the White House, thank you very much. Meanwhile, Republicans have been trying for generations to destroy Medicare and they haven’t made a dent.
The Hippies are right. The Hippies are always right.
And yes, if we have to shove $100 bills into doctors mouths to get there, fine. We already shove $100 bills into their mouths and have bupkis to show for it.
Another Scott
@goblue72: No I haven’t. And if you think that that post did, then you need to read more about Medicaid and how it actually works. Medicare.gov:
Medicare is complicated and doesn’t cover everything. There are substantial co-pays and deductibles in many cases. I think we need to find ways to eliminate co-pays and deductibles (in the vast majority of case), for reasons outlined above.
HTH.
Cheers,
Scott.
goblue72
@low-tech cyclist: Yup. Vast majority of voters do not make their voting decisions based on 50 point plans or who has the better white paper. Avid followers of politics and public policy are a minority of voters – and a strange minority at that. They are hobbyists in politics if you will – the political equivalent of people who are way too into video gaming, fantasy football or, I dunno, birding. (I don’t exclude myself from that.)
Most folks are going about their daily lives and if they think about politics its maybe a few brief moments a day when they are watching the news on TV / listening to car radio on commute / etc. They may pay a little closer attention in an election year after Labor Day. And they go into the voting booth making decisions based mostly on pre-existing tribal affiliations, personal/cultural/social/economic biases, “gut feelings” and whatever smidge of actual information seems relevant to them.
Sander’s Our Revolution, Justice Democrats, Democratic Socialists of America, et al – for most part haven’t seized M4A out of some analysis that of all possible universal healthcare programs its the most “pure” or whatever. They’ve seized on it because they see it as the best option to pushing forward a non-means tested universal program within the political context we have to work in. Which means getting the public to rally behind something they already like – and then expanding it. Because its such a loony toon idea that the late Senator Ted Kennedy proposed Medicare for All.
goblue72
@Another Scott: Sure. If you want something even more robust than Medicare but basically making Medicare even more comprehensive, I’m all for it. (And yes I am familiar with the fact that Medicare doesnt cover everything under the sun and isn’t 100% free to the patient. Forest, trees.)
But, if you want to get there through some stupid Rube Goldberg device, then NO.
We tried that shit and its already being broken into pieces. We tried that experiment. It failed.
Another Scott
@goblue72:
Any significant legislation that makes it into law would make Rube Goldberg proud. It was ever thus.
So, as I thought, St. Bernard supporters seem to want exactly what they want, or nothing. To that I say, yet again, Purity Kills.
My $0.02.
Cheers,
Scott.
Mnemosyne
@Sloane Ranger:
For comparison, I’ve waited 10 months for my ACL revision surgery to be scheduled because my HMO has been dragging their feet at every opportunity. And this is with very good employer-based health insurance. The problem is my doctor and the HMO she belongs to, not the insurance company.
When I tore the same ACL 12 years ago, I did it at work, which meant it was all taken care of by worker’s compensation, which is — gasp! — state-run here in CA. My surgery was 4 months after the injury.
John Fremont
@goblue72: And so did Ross Perot. Plenty of my GOP friends have forgotten that
L85NJGT
@tobie:
“Single payer” gets support from about 25% of RVs, “Medicare for All” around 33%.
I have significant doubts the next time Democrats control both houses and the WH they will impale themselves AGAIN on healthcare. For starters the industry is still settling out from the effects of ObamaCare’s passage.
Fix packages – closing loopholes, spending priorities, pushing the remaining Medicaid recalcitrants, expanding coverage, regulatory reform, etc. are way more likely.
Another Scott
@L85NJGT: + Eleventy Billion.
Thanks.
Cheers,
Scott.
Miss Bianca
@Kay: And as someone who is turning 55 this year and contemplating, with dismay, the amount that health insurance is going to be taking out of my meager freelancer’s pay, may I just say, “fuck Joe Liberman.” I could have really used that Medicare buy-in option right about now.
David Smith
@goblue72: Hear Hear!
Bob Smith
@Another Scott: So you could be for Medicare for All?
Another Scott
@Bob Smith: Sure, but the devil’s in the details. E.g.
Is it just today’s Medicare with everyone being eligible to join? Would it be voluntary or mandatory? What happens to the other health care systems (VA, FEHB, Medicare, etc.)? What if people don’t want to join M4A?
What’s the transition?
What about Parts A,B,C,D? Do we keep those, or just roll them all into one?
What about co-pays and deductibles?
What’s the transition period?
What do we do about doctors getting different reimbursement rates depending on the payer? Does everyone just get Medicare rates now? What do we do when doctors claim that they can’t work with that low a payment?
Etc.
The details matter.
I’m much, much happier with incremental progress than chasing after a M4A system that would be just as compromised as Obamacare is – and maybe moreso. Politics is all about compromise. Let’s get good improvements quickly, reduce costs for the bottom 50%, then worry about what to call it (M4A or whatever) later.
Cheers,
Scott.
jl
The goal is to increase population health, maybe keep US mortality rates from increasing even further and more rapidly (US life expectancy rates seem to be on long term downward trend), and lower the percentage of GDP devoted to health care.
Getting universal coverage, community rating (and elimination of individual underwriting for basic care), subsidies for low income individuals and for risk groups that have higher than average risks, and elimination of price gouging due to local insurer and provider monopoly power are the real key policy issues.
How to finance the insurance is almost a detail after you take care of the above.
I’ve been half jokingly using the slogan ‘Go Swiss’ for how Obama care can be improved. But I do have questions how easily that system can be adapted to the US. Two things about the system that will be difficult to adapt to the US are stiff deductibles before an individual reaches the stop loss and doesn’t pay anything, and price transparency. The stiff deductibles are not as big a problem for Swiss as would be for US for several reasons. One is the famously high average income for Swiss workers compared to other countries in Europe, and uniformity of benefits, and very transparent pricing. So, simple to figure out how to get care and most people can afford it. Even so, big chunks of care are provided at no cost to users. Kids get a large amount of publicly provided care in schools. Maternity care and a lot of basic preventative care is provided at no charge, Carve outs make care up to age 25 very cheap or at no charge.
Swiss legal structure eases the way because government can force doctors, pharmacies, clinics to negotiate uniform fee schedule for each canton. They have soft price controls. Providers are free to request exemption, and will get one, but only after a complete open book audit by federal government to validate reasons for exemption. Swiss system of popular national referendum vote for important legislation is a handy threat to overcome industry lobbying (Swiss insurance industry hates the Swiss health care regulations with a passion of a thousand flaming hells and works ceaselessly to weaken it).
I think Australian system of blended Medicare for all for basic care, and supplemental private insurance system is most easily adaptable to US. To some extent because using tax power to fund program overcomes a lot of legal, political, and Constitutional problems other systems face in the US.
Bottom line is that if you look at life expectancy, healthy life-expectancy for both genders and all age groups up to 80+, other measure of population health, and cost, then any reasonable person would conclude the US system is a disgrace and a horrid disaster by modern standards. Over two dozen comparable countries manage to do far better.
Another Scott
@Another Scott: Er, make that, “(VA, FEHB, Medicaid, etc.)”
Sorry.
Cheers,
Scott.
burnspbesq
@tobie:
So every publicly traded drug company commits securities fraud every quarter by publishing audited financial statements that include R&D expense?
Veddy Innnnnnteresting.
agorabum
@low-tech cyclist: Slogans first, policy later – because in reality, we already have loads of wonks working on all kinds of policy options. Policy options that generally gather dust because there aren’t enough Dems to get them passed.
Republicans ran on “repeal and replace” and when asked, would just say “we’ll replace it with something better.” If pressed, they’d say “with more freedom.” There would be a couple of flimflam plans floating around and maybe one responsible but cruel plan, and if pressed further, they’d say “yeah, something like one of those plans.”
So all Dems should say is “MFA” and if pressed “there are lots of great, exciting plan ideas – but they all result in the American citizen paying less for their healthcare and getting good coverage” and then just hand wave away the rest. Let the tough compromises arrive once there is a supermajority.