Two of the three state reps mentioned in this story are Democrats from Montana:
Lobbyists either helped draft or made extensive revisions to opinion columns published by three state lawmakers in a way that warned against the dangers of Medicare-for-all and other government involvement in health care, according to emails obtained by The Washington Post.
If 2020 is anything like 2016, Trump can make vague promises about providing health care for all that will never be fact checked (principally because there aren’t enough details to even check), while the Democrat will be worn down with constant picking about this detail or that about a healthcare plan that will never be enacted in the form proposed. Hell, if I were a low or even medium-information voter, I’d probably prefer Trump’s vague promise to a Medicare for Some* (* who meet certain guidelines that are carefully means tested, which doesn’t impose a tax burden on any rich people, and will be carefully engineered to fuck the middle class so we can be doubly sure that the poors don’t get anything good because they don’t deserve it and they’re only poor because they didn’t try hard enough).
I guess what I’m trying to say is that the narrative developing around M4A that it is a fairy table that crumbles at the first contact with reality is true–if you accept what insurance company lobbyists tell us via their Democratic mouthpieces.
Chief Oshkosh
Focus on the positive. TWO Montana state reps that are Democratic? Who knew?
Zinsky
Why aren’t Democrats asking the Repugnantcans how they plan to pay for the Wall or the Space Force or for upgrading the nuclear arsenal or prisons or any other pernicious government spending they get a hard-on over? The answer is they aren’t willing to pay a nickel for them but just want to put it all on our kids’ collective credit card.
Martin
I think we may be way off base on things here. Single payer healthcare has typically been ushered in following some great calamity involving mass death and destruction and the collapse of economies, and Trump is now president. I’m starting to think that single payer advocates should be pushing for a 2nd term.
Martin
@Zinsky: Trump secured Syrias oil. That and looting Greenlands wealth should cover it, no?
Baud
@Martin:
How many fascists does it take to achieve progressive Utopia?
?BillinGlendaleCA
@Martin: Nach Hitler, uns.
Martin
@Baud: I think I’ve turned into a BernieBro.
rikyrah
He could make vague promises as a candidate.
But, he’s been President for 4 years, and has an actual track record on healthcare.
Sabotaging Obamacare for 4 years.
Putting the DOJ behind that lawsuit that would get rid of Obamacare completely.
Supporting the proliferation of junk policies that are making a comeback.
No..he has an actual record that can be put forth.
The lawsuit alone should be DNC ads on an endless loop.
Baud
Ignoring the details, the three competing ideas are Medicare for All, Medicare for Those Who Want It, and Preserve and Improve Obamacare. I don’t know which the voters will like more, or which one stands up best to whatever lie Trump will put forward.
Yutsano
@Chief Oshkosh: Montana is…weird. It officially counts as a red state because it does tend to go for the Republican in Presidential yet for state offices Democrats do surprisingly well. The governor before Bullock was a Democrat.
I still want that carpetbagging journalist assaulting Gianforte to lose, but that might be too big an ask. Bullock wouldn’t go for that but maybe one of the state Dems could.
schrodingers_cat
@Baud: My neighbor who is on Medicare wants to preserve and improve Obamacare and a gradual expansion of Medicare, as in make it available for people over 60 than expand it to people over 55 etc.
ETA: Oh and BTW he is a retired factory worker that our media loves to fetishize. He is white and is personally embarrassed by the Orange One.
jl
The insurance industry, big pharmaceuticals, and corporate providers are going to attack anything that costs them a penny with equal ferocity. Some industry shills have periodically flacked the Swiss system as a model private free market health system as a model that the US should emulate. But as soon as the very strict market regulation that makes it work is proposed, that will be attacked just as ferociously as Medicare for All, or Medicare for Some, or Public Option. Edit: Krugman has said the conservative proposals to adopt the Swiss system is to steal the name and the very good results, and then gut it of everything that makes it work.
As an example, in the Swiss system, all benefits provided by the minimum federal government benefits package have to pass a cost-effectiveness test. That’s right: DEATH PANELS!.
We have to be prepared to withstand ferocious attacks, and deal with vague, empty, BS Trump and GOP feel good slogans no matter what Democratic policy proposals are eventually adopted.
NotMax
@schrodingers_cat
No idea if it is something he or she might be interested in, and it is still an expense, but shall mention in case he or she is not aware of it that Amazon Prime offers a reduced rate membership to any with a Medicare or EBT card.
BTW, you well might be able to return to the previous iteration of your nym on the new version of the B-J site.
Southern Goth
@Martin:
Let us take a moment to reflect on the dire Canadian Back Bacon Famine of 1965.
Jacel
@NotMax: I just looked the offer is for EBT and Medicaid (not Medicare). I’ve got the latter, because Old.
jl
Also, need to remember that on many major policies Trump’s actions are completely opposite of his rhetoric, or the results completely opposite. Let’s see what happens with this:
@larry_levitt
Any day now an appeals court is going to rule on a lawsuit backed by the Trump administration to invalidate the Affordable Care Act. As our new analysis shows, rolling back the ACA would affect nearly everyone in one way or another.
https://twitter.com/larry_levitt/status/1201569048821145600
jl
@Southern Goth: The Australian prawn catastrophe that depopulated the country.
PenandKey
And they’ll act like our current system of insurance company formulas making the exact same decisions, with a profit benefit thrown in, is somehow perfectly okay.
Kent
Since we are talking M4A, I’ve actually been to Warren’s web site and read her M4A information, such as it is. One question I can’t answer from a cursory review of her promotional materials:
QUESTION: How would M4A affect or change the exiting over 65 medicare system? The current medicare program has a very large private insurance component called Medicare Advantage. And it’s got all kinds of supplemental insurance plans and co-pays. Do Warren (and Sanders) propose doing away with Medicare Advantage? Or do they propose leaving it along for the oldsters but not including it for anyone under 65? I can’t figure it out.
By the way, my old-school liberal parents who are in their late 70s (retired teacher and nurse) are very happy with their Kaiser Permanente Medicare Advantage plan. They go to their nearby Kaiser clinic and get all they ever need in terms of care, one stop shopping with their Kaiser card. They would be very disinclined to support any plan that eliminated that. Yes, I know, under a M4A plan, Kaiser would still take regular Medicare if they wanted to stay in business. But would it really be as seamless as the current Kaiser model? I don’t know
If Sanders and Warren are mucking around with the existing over 65 Medicare program (even to make it “better”) they are going to run into a lot of skepticism from older voters. Guaranteed.
Jay
@Southern Goth:
North of the 49, it’s not Canadian Back Bacon, it’s just back bacon or ham,
jl
@Kent: If I understand correctly, both Sanders and Warren will eventually get to a pure Medicare for All system. Private insurance can only provide supplemental benefits, never be substitutes.
Harris envisions a mixed system, but private plans will be regulated to provide equivalent coverage that public plans provide, at least for basic minimum benefit package.
rikyrah
@schrodingers_cat:
I think the Medicare (though I am a Medicaid for All person) buy-in should happen at 55. Honestly, 50 (join AARP, Get Medicare), but, I think that would be too much of a shock to the system.
I know a number of people who would already be retired, but aren’t because of healthcare. If they had Medicare, they would be out the door.
Jay
Jim, Foolish Literalist
OT:
ellyanne Conway Verified account @ KellyannePolls
WATCH: Sleepy Joe is Creepy Joe. We need Ukraine’s help to defeat THIS guy?
George Conway @gtconway3d
Your boss apparently thought so.
MAGAts in the Conway’s replies are accusing him of emotional abuse
Kent
@jl: If that’s the case, then M4A is going to get demagogued to all hell for the over 65 crowd as about 1/3 of seniors are currently on Medicare Advantage and that crowd tilts wealthier (and therefore more likely to vote). Also, according to Kaiser Family Foundation, about 1/3 of Medicare Advantage plans are actually employer and union plans that are generally popular.
Have people actually thought this through? I know the number crunchers will say it makes sense. And I agree. I’m talking about the politics of completely overhauling existing medicare to strip out all the private options.
p.a.
I demand to be charged for the ‘right’ to breathe air. Why should it be free even for the rich!??! As long as there’s no associated carbon tax. I can, however, see my way to a cap-and-trade agreement on hair furor’s oxygen source.
Jay
@Kent:
all M4A plans and proposals are purely aspirational.
the Billionaires and Corporations are never going to let you have any form of M4A and there is a pretty damn good chance you aren’t even going to get to keep the highly degraded ACA, (1/3rd of “Americans” still don’t know that the ACA and “Obamacare” are the same program).
so don’t fret about it. The details of a pipe dream don’t matter.
Betty Cracker
@Kent: Short answer: Warren’s M4A plan would eventually eliminate Medicare Advantage, but it would also close the copay and deductible gaps in regular Medicare that make Medicare Advantage plans necessary. Not sure about Bernie’s plan.
Le Comte de Monte Cristo, fka Edmund Dantes
I’m content to withhold support for M4A until some earnest progressive explains:
1. What happens to the million people employed in health benefit administration, most of who are earning modest paychecks and have managed to scratch out decent lives in communities they were born in.
2. How to best mitigate the shock to market indices, given that nearly a third of all index funds – the pillars supporting every 401K and public/private pension in the country – are blue chip healthcare and pharmaceutical stocks.
it occurs to me that the loss of a million jobs and a third of market cap sends the country into a depression. I’ve seen the sort of analysis that Brooklyn baristas and AOC constituents have put forth, and I have my doubts that a middle aged single mom who runs a claims examination department in Dubuque has skills that could translate to property and casualty adjustment, even if the jobs existed. Nor could I imagine that a medical claims processing clerk in a rural hospital in Central Kentucky can replace her income by learning to code.
Despite the assurances of Sanderdistas and Stein acolytes, gutting police and firefighter/EMS pensions isn’t just a “price we have to pay” to get universal health coverage.
Yutsano
@rikyrah: I have zero issue getting there in steps. But every child should have at least Medicaid until 21. If that becomes Medicare with some vast improvements (How do you charge a 4 year old $137 a month?) I have zero issue with that. Let’s take Medicare for what it was originally designed for: to eventually be the single payer system for the US as a whole.
rikyrah
@Kent:
They are.
This is such an unforced error.
It really is.
They couldn’t just run on protecting Obamacare, expanding it, and protecting it?
All positions that Republicans would be on defense about?
Jay
Or does this belong in the Free College thread?
dnfree
Medicare does not cover anywhere near what is being promised. Many people have Medicare Advantage plans with lower or no premium, but again care isn’t free and I think the cost is subsidized by the government. My care is mostly free because I have a good but expensive supplement plan (but no dental or vision coverage). I have a lot of trouble figuring out how Medicare for all, and all care free of charge, would be paid for. And as an old person, I’m suspicious of anything “free”.
rikyrah
@Le Comte de Monte Cristo, fka Edmund Dantes:
Actually, it’s TWO MILLION
Miss Bianca
@Jay: So, looks like it might have been evidence of hookers and blow – or blow, at least, according to the Twitterer – that got Duncan to suddenly realize there might be consequences for criming?
Apparently the classics never go out of style!
Miss Bianca
@rikyrah:
This. This is what I’ve been wondering about all along. God damn Bernie and Co’s purity politics, they have been fucking shit up for us ever since he opened his big mouth about running for POTUS.
Betty Cracker
@Le Comte de Monte Cristo, fka Edmund Dantes: I’ll be happy to, right after you explain why you think the very real problem of potential job dislocation in the insurance industry and potential follow-on effects in the economy are more serious issues than a current reality in which tens of millions have no health coverage at all, millions more are paying gargantuan sums for shitty coverage, tens of thousands die due to lack of treatment or medication, some because they’re afraid they’ll bankrupt their families if they seek care. You first.
rikyrah
@Jay:
Hmmmmm…what happened?
Jay
@rikyrah:
1/3rd of “Americans” don’t know that Obamacare is the ACA, so how do you run on “keeping and improving Obamacare”?
the reality is, any attempt to improve health care or even health insurance, ( which isn’t healthcare) is going to face massive pushback from the billionaires and corporations, no matter what the “plan” is.
odds are that by 2022 you won’t even have ObamaCare to kick around anymore.
Yutsano
@Miss Bianca: I was gonna say the hookers part was never Duncan’s problem. What did he have like three mistresses or something like that?
germy
@Le Comte de Monte Cristo, fka Edmund Dantes:
Jay had a good answer a few days ago:
Yutsano
@germy:
It will be part of the largest expansion of government since Social Security. CMS will become the hot employer for a lot of these folks even if that means relocation. Plus the benefits of being a government employee kick in as well. These positions may not pay as well as the old ones but for what they’ll get it will work out nicely.
Just please don’t let them fucking subcontract this.
Jay
@rikyrah:
I would guess that “survey says,……”, falling on the mercy of a Judge with a guilty plea, polls a significantly lesser sentence because of “mediocre while male GrOPer privilege” than trial by Jury.
that whole, “The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”
Miss Bianca
@Yutsano: Yes, the tacky POS. Also, he apparently started ANOTHER affair, that he was spending campaign funds on, AFTER they started investigating him!
I dunno, that level of hubris maybe counts as a sort of cognitive defect. Surprised his lawyer didn’t try to pull a variation of that argument out as a defense – seems like they tried every other kind of “nuh, uh, you can’t prosecute me for *that*” BS.
Cacti
@Betty Cracker: Deflection is an acknowledgment that you have no answer.
Kent
@dnfree: Exactly. Most seniors still spend considerable savings on various health care costs from drugs, medical devices, and other things not covered by medicare to copays and such. I think one recent estimate is average annual per-capita health care costs of $3500 or so for seniors. Wipe all that out with a stroke of the pen and we are adding what $100 billion to the bill? Do Warren and Sanders have a plan to pay for that? I understand the system is far from perfect but there’s a certain element of “don’t fix what ain’t broke” here. Especially when it is all just theoretical and never going to happen in this presidency anyway.
germy
@Kent:
But it’s broken.
Jim, Foolish Literalist
M4A/BernieCare is both unpopular with most voters and dead in the water under the most hopeful 2020 scenarios so why are we having flame wars about the details of the plans?
Cacti
Bernie and Warren are the repeal and replace candidates of the Dem side.
germy
I wonder how many commenters here are employed by insurance companies.
Or have family members employed by insurance companies.
NotMax
@jacel
You are correct, and my old eyes once again betrayed me.
Plus I should have known better, having myself been on Medicare for years.
Jay
@Yutsano
if memory serves me right, lobbiests ususally pay
JohnsPoliticians,But Hunter paid for bedding the Lobbiests on his Campaign’s dime,
So whom is the hooker here and whom is the John?
BTDubs, WordPress for the 3rd time forgets my nym and login,…
Le Comte de Monte Cristo, fka Edmund Dantes
@germy:
Where are those claims clerks going to work? What happens to the communities that this brilliant progressive vision hollows out, and what are the subsidiary effects? How many people earning 35-55K per annum can afford to just “relocate” away from their support networks of family and friends? How long will they be stuck without tasks or without pay in all this salvific paradigm shifting?
Have any earnest progressives stopped to consider that the reason why Europe has a robust set of national health plans is because the entirety of the European economy had crashed due to war, and they were starting literally from scratch, and had nothing to lose by doing so?
Kent
@germy: I’m talking ONLY about the existing over-65 medicare program. And yes, it is very far from perfect. But I don’t sense any overwhelming groundswell among elderly voters to reform existing medicare. Most just plan around it and go on with their lives. And it is one hell of a lot less broke than the existing Obamacare and Medicaid system for under 65.
I’m merely pointing out the political peril of proposing to “repeal and replace” the existing medicare program as we know it. Which appears to be exactly what Warren and Sanders are proposing. No matter how good their plans might be on paper.
jonas
Any single payer plan has to be funded through a combination of revenue and cost controls. The revenue to pay for expansion will have to be raised via new taxes — Warren promises on the wealthy only, but it’s not clear if that will be enough. The other, and, quite frankly, heavier lift, will be forcing doctors and other health care workers to take huge pay cuts. Some money can certainly be saved by eliminating the for-profit insurance middleman, but the high level of compensation for medical professionals is the big elephant in the room. The NHS in Britain covers everyone, for example, but doctors in the UK make on average about half of what they do in the US. Some of that is because of the massive medical school debt many MDs have here, but reforming how med school gets paid for is a whole other policy issue that we probably need to solve before we start asking dr’s and RN’s to take a 50% pay cut.
Baud
@germy:
All of them, Katie.
Chyron HR
@Le Comte de Monte Cristo, fka Edmund Dantes:
@Cacti:
It’s going to be hilarious if “abolish ICE” really gains traction in the primary and you guys start unironically arguing that we have to save the jooooooooooooobs.
piratedan
@Le Comte de Monte Cristo, fka Edmund Dantes:
I’ll tell you where they’re going to work… they’re going to work in their home offices or the federal buildings that exist in their closest metropolitan setting be that the local county seat or urban center where all of the other government people work.
This isn’t going to be a mass fucking migration, its going to be a change in venue in where you work and it’ll be for comparable pay and quite likely a better benefit package.
or are you laboring under the belief system that every federal position is housed in the Washington DC Metro area?
jl
@Kent: “Have people actually thought this through? ”
IMHO as an economist, everyone who has offered a real plan with details on how to transition, and have a sustainable stable system, has thought it through. And for that to happen, people cannot keep their exact same current policies. The problem is health insurance companies all attempting to cherry pick and cream skim healthier people into their policies. This doesn’t happen much with current Medicaid and Medicare plans because they serve groups that are very low on a private insurance’s list of populations they want to cover, too poor or too old. But if for example, Medicare eligibility age is reduced to 55 or 50, that will change. Instead of insurance companies fighting with each other to capture healthier people, they will skim off better risks from younger Medicare eligibles.
The US health insurance system is unstable and gives ordinaty people raw deals, and denies them adequate coverage because it is severely under-regulated, even compared to other insurance lines in the US.
So, I stand by my statement that ANY plan that costs the health industry big shots a penny will be attacked with equal ferocity. I remember a corporate health industry ad campaign that swept all plans with a Medicare component (from pure M4A to public option) into one bin, and claimed they were all a ‘government takeover’ of health care.
We can go Canada, Swiss, Australia, France, Taiwan, Estonia, Spain, any direction, and any of it will be ferociously and dishonestly attacked. That is a hard fact that proponents of a better ACA and M4A just have to anticipate.
As I noted, Harris has a mixed system, and even with that, she has said private health insurance policies will have to change
Kent
Oh for fucks sake. I’m not even a M4A supporter. But I can smell out the bullshit when it comes to worry about medical billing jobs.
The single biggest health care trend over the past 20 years has been the hollowing out of much of the health care network in rural America because thousands of rural hospitals and clinics have been closing right and left and every sort of medical provider from physicians to home health aids have been abandoning rural areas. Some of this is due to Red State “own goal” obstruction to medicaid expansion. But a whole lot of it is that there simply aren’t enough people with insurance in most poor rural areas to keep hospitals and clinics profitable and open.
If we actually pumped the kinds of trillions of dollars into the US health care system that M4A is talking about it would generate tens of millions of new healthcare jobs all across the country, especially in economically depressed and rural areas that have seen their health care systems devastated. New clinics and hospitals would be popping up all over the place to take advantage of the massive new influx of M4A dollars.
But OK, let’s wring our hands and worry about all those medical coders and claims handlers who’s main job is to deny claims.
TomatoQueen
OT but in a way a propos: http://www.msn.com/en-us/lifestyle/lifestyle-buzz/viral-kitty-lil-bub-one-of-the-internets-most-beloved-pets-dies-at-8/ar-BBXFfUH?ocid=ientp
Lil Bub has crossed the Bridge. She had a large bone infection on her left cheek, visible in some recent pics.
germy
@Chyron HR:
I think I may have actually seen that argument here. I remember more than a few commenters saying “You can’t ABOLISH ICE!!!” As if ICE was invented by Ben Franklin, rather than being something younger than the Parkland students.
J R in WV
@Betty Cracker:
Betty, well said, quoted for truth.
We have to repair the health delivery system, the safety net, the education system AND the infrastructure like roads and water systems, and real soon now!
Le Comte de Monte Cristo, fka Edmund Dantes
@Betty Cracker: I can cure a whole bunch just with some bankruptcy reforms that shift the load back to providers and not blow everything up in the process.
1. I’d have a separate chapter for medical bankruptcies for minimum-level insured people who get caught with giant deductibles and copays, and would allow filing every three years, with an unlimited homestead and vehicle exemption, and no means test.
2. Nationwide prohibition on balance billing.
3. Nationwide prohibition on invisible out-of-network charges at in-network facilities.
4. Outright prohibition on all factored medical collection calls – letter or suit only.
5. Nationwide 5 year limitation period for the collection of medical debt.
Betty Cracker
@Cacti: It wasn’t a serious question — it’s form-free venting from Le Comte, followed up with dishonest wingnut talking points from you (“repeal and replace”). If either of you is the least bit interested in learning how someone who supports M4A, Warren, would address that very issue (spoiler alert: you’re not), I’ll be glad to pass along a link. Or you could Google it yourselves.
It’s fine to disagree on how to approach healthcare reform — it’s a big issue. It’s counterproductive (not to mention annoying as fuck) to throw rocks and lie about what others are proposing. You should stop.
Jay
@Kent
OK, Boomer.
Warren’s plan costs the same over 10 years as the US is/was going to pay for medical insurance over the next 10 years anyway.
The advantage of Warren’s plan is that her plan spends the money on healthcare,
The current system spends the money on health insurance, which 40% of the time, does not result in healthcare at all, and only covers some Americans.
Emily of the State notes that there is an easy way for Americans to get platinum levels of healthcare in the US for free.
Move to Germany. The free German healthcare provides full guilded coverage when people travel to the US.
And it’s funny what has to be costed out and “paid for” beforehand, and the expenses that the US just “wings”,
Healthcare, education, infrastructure,,welfare, social housing, etc,
Just put it on credit, never ending wars, tax breaks for billionaires, the Pentagon, P2P boondoggles, Wall, Incareral State, etc,……..
Baud
@germy:
No serious Abolish ICE plan to my knowledge abolishes the task of immigration enforcement. It’s more of a restructuring. Whether M4A is analogous depends on implementation details we don’t really have right now.
Martin
@rikyrah: At a minimum, Medicare should be coupled with social security as they’re administered together. It’s a bit of a kick in the neck that you can retire at 57 ½ and start drawing SS, but can’t enroll in Medicare at that time. Creates a bunch of problems.
Kent
@jl: I agree with everything you just wrote. I’m just asking how politically astute it is to open up this line of attack going into what is without a doubt the most critical election of our lifetimes. I’m not necessarily advocating a crouched cautious defensive approach. Or muddled centrist stuff. Big ideas are great. I’m just wondering if this is really the right big idea for 2020 when there isn’t a snowball’s chance in hell it will pass any Senate likely to be elected in 2020.
But then I’m not being paid the big bucks to run one of these campaigns so WTF do I know. But sheesh…the orcs are at the door (or already inside the castle) and we are messing around with overhauls of the existing medicare system that there isn’t any real groundswell of support for? What’s next? A total overhaul of social security in case seniors aren’t already suspicious enough?
chopper
@Betty Cracker:
but what about the buggy whip manufacturers?!
jeffreyw
lee
Yeah the entire ‘but…but…we have to think about the admin jobs!’ is total bullshit.
That sounds like Trump on trying to keep coal alive.
chopper
so basically we can’t have nice things because the guys who arbitrarily stamp DENIED on your claim for your kid’s chemo treatment need to keep their phony baloney jobs. that’s just fucking great.
schrodingers_cat
@rikyrah:
M4A was a BS trap and both EW and KH fell into that trap.
ETA: I live in town that’s deep blue. Registered Ds outnumber Registered Rs by a large margin. EW is my senator. I haven’t met one person who likes EW’s plan. Its anecdata make of it what you will.
germy
@chopper:
That’s the argument I keep seeing from more than a few commenters here, which is why I suspect they’re simply insurance company employees (or married to insurance company employees).
chopper
@jl:
also, no M4A type system (or anything similar) is going to just up and kick in overnight. hell, the ACA was rolled out over the course of a coupla years, this would have a loooooong rollout. people whose jorbs get displaced would have time to look for another and i’m sure the S&P will survive.
chris
@Betty Cracker:
Thank you!
Le Comte de Monte Cristo, fka Edmund Dantes
Thing is, the threat to the 401Ks and pension is real. Just 11 years ago, people were calling swaps with 85% repayment rates worthless.
what do you think happens when a third of the DJIA gets kicked in the nuts?
Baud
@chopper:
That would help address the jobs issue but both Warren and Sanders have said the transition would be four years.
Chip Daniels
@Le Comte de Monte Cristo, fka Edmund Dantes:
“What happens to the million people employed in health benefit administration, most of who are earning modest paychecks”
This is really a stunning admission, isn’t it?
That the best argument for maintaining the status quo is to keep millions of people employed doing nothing at all, like health insurance is just some massive Soviet tractor factory.
Why don’t we just reform the system, send these people home, and pay them to stay there?
That would get them out of the hair of patients and doctors, at least.
chopper
@Baud:
there’s no way anybody is gonna be able to shift that sort of system over in 4 years. warren knows that. wilmer, i dunno, he’s a nut, he believes all sorts of stupid stuff.
Le Comte de Monte Cristo, fka Edmund Dantes
@germy:
Never been employed by an insurer, got no family members with insurers, never had a lot of insurance employed clients, and I hate the industry.
Sister Machine Gun of Quiet Harmony
@Kent:
They aren’t going to just get push back from skeptical seniors. Currently, traditional medicare doesn’t pay enough to cover all the costs that hospitals incur. Without private insurance, more hospitals will close. I work for a health system. That isn’t just lobbyest blather. Private insurance makes up the difference for the costs Medicare and Medicaid don’t cover. Big changes would have to be made in compensation, in building costs, etc to change this.
Baud
@Chip Daniels:
People really need to stop asserting that people who don’t sign on to the M4A plan are supporting the status quo. There are other reform plans out there. That’s what M4A is competing against in this primary.
Baud
@chopper:
I agree. I think that time frame is not doable, even if M4A had vastly more popular support than it currently has .
Miss Bianca
@lee: There are one metric fuckton more jobs in health insurance administration than there are in coal production. Maybe several fucktons more. Take it from someone who lived in coal country.
But the real, other difference between the two situations is that coal miners are presumed to be MANLY MEN WHO MUST HAVE MANLY MEN JOBS GUARANTEED and the majority of medical coders and health office, and health insurance office, workers are women. Many, many of them women of color and who the fuck cares what happens to *their* jobs, amirite?
Sister Machine Gun of Quiet Harmony
@jonas: That is exactly right. The costs in healthcare are mostly people costs. You can’t ask someone who has HEAVILY gone into debt to pay for medical school to take a 50% pay cut and postpone paying off their student loans for another decade or two. They will fight you to death over it.
germy
@Miss Bianca: Many more women of color go without medical exams because they are either under-insured or without insurance.
ruemara
@NotMax: Oh, thank you!
Jim, Foolish Literalist
@chopper:
. wilmer, i dunno, he’s a nut, he believes all sorts of stupid stuff.
as some of his less fanatical defenders often point out, Sanders himself has often been wiling to compromise and accept half a loaf. The trouble is his weaponized sanctimony has convinced a surprising (at least to me) number of people that righteous bellowing can move political mountains, and that if Obama had thundered and bellowed, Joe Lieberman and Blanche Lincoln would have supported Single Payer, therefore Obama was a big failure if not a sell-out
Cacti
You might want to sit down for this…
Warren is a Boomer.
Miss Bianca
@germy: Are you really arguing that we shouldn’t care about the fact that for a lot of POC, the health insurance industry is one of the only jobs out there paying them a decent wage? Yes, a lot of POC can’t currently afford health insurance. But why in the world can’t we say, “yes, and the way to fix that is to *improve Obamacare to take care of that problem*”, rather than “the way to fix that is to get rid of the health insurance industry altogether!”
I’m with rikyrah on this one – I think deciding M4A was a hill to die on, or even be caught on, is a potentially disastrous own goal. It gives the Republicans a chance to start playing offense, rather than being stuck on defense, and we all know that their offense doesn’t have to be good, true, or right to be effective.
Le Comte de Monte Cristo, fka Edmund Dantes
@Miss Bianca:
Clearly, that 46 year old single mom in middle management, the one with 23 years experience earning 54K? The one with a 16 year old looking at college and an 8 year old that needs braces (and stays with grandma after school)?
She can either relocate or take a pay cut, no biggie.
Martin
None of this is wrong. But macroeconomic ‘jobs’ doesn’t equate to microeconomic ‘my job’. It’s a bit of a road to travel for a medical biller to become a nurse.
This is but an element of a larger pattern. Automation has always created more jobs than it destroyed, but it’s rare that the worker eliminated from their job can take one of the new ones. Energy transitions are similar – 500,000 clean energy jobs in CA is of little comfort for the 38,000 coal miners in Appalachia. Vertical farms in NJ doesn’t help the bankrupt dairy farmer in Wisconsin.
This is a broad problem that companies face as well. Why didn’t Nokia respond to the iPhone. They couldn’t. Their culture was built around a set of principles that the new market violated. They couldn’t get there.
Among the differences between the US economy and that of say, China, are a bunch of things that go unspoken. US worker mobility is incredibly low, keeping those coal miners from even relocating to CA. Such is the cost of high home ownership rates – it anchors you. There’s nothing stopping a coal miner or a medical biller from training to be a nurse other than pride and the entitlement that they should be able to stay in their job category until retirement like their grandparents (fictionally) did. Huge swaths of America is culturally lazy – unwilling or unable to reinvent itself, hanging onto the notion that they should be able to plow the earth they way their grandpappy did, despite the fact that the next farm over has a robotic tractor that can optimize planting based on daily satellite data.
America doesn’t have a shortage of jobs, it has a shortage of jobs that ‘I’m willing to do, at a wage that I’m willing to do it for’, and we are too eager to kowtow to that population. Nobody is seriously willing to address that. We nod at it now and then – Clinton ‘And we’re going to make it clear that we don’t want to forget those people. Those people labored in those mines for generations, losing their health, often losing their lives to turn on our lights and power our factories. Now we’ve got to move away from coal and all the other fossil fuels, but I don’t want to move away from the people who did the best they could to produce energy that we relied on.’ which got her vilified.
Part of the cultural gap, I think, is that we have these largely coastal technology based economies and these largely central extraction based economies, and the economy in the middle that would bridge the two is entirely in China now. A worker may feel like they can ladder up one or two rungs, but we have a 20 rung ladder with the middle 10 rungs almost completely missing because we fucked up and can’t admit to it.
So these big no-brainer macroeconomic decisions simply break down because there’s no way for workers to make the trip. Those millions of new healthcare jobs – we’d have to bring in a fuckton of immigrant medical professionals because the US medical education system doesn’t train enough of them, and because many states like West Virginia which have a shortage of nurses and a shortage of jobs can’t convince their residents to get that training. They have to import their nurses from North Carolina. Those problems need to be fixed, and nobody is doing that.
chopper
@Chip Daniels:
to be fair, denying people’s claims and putting them in the poor house so the insurance company doesn’t have to cough up the dough for lil’ lisa’s chemotherapy bill isn’t really ‘doing nothing’.
lee
@Le Comte de Monte Cristo, fka Edmund Dantes:
She should make the same hard choices a coal miner is having to make.
Martin
@Le Comte de Monte Cristo, fka Edmund Dantes: That’s a false choice. Median nurse salary is nearly $70K. Those jobs exist in every community in the country, and every state has a shortage. So it’s neither a pay cut nor a relocation. But it is a retraining. And that takes time not earning income.
Sister Machine Gun of Quiet Harmony
@Jim, Foolish Literalist: If Sanders had ‘often’ been willing to accept half a loaf, then his legislative record wouldn’t be so sparse.
Cacti
The youngest age that you can start collecting SS retirement benefits is 62. But you’re correct that there’s an age gap between the two programs.
Butter Emails
I guess we have no choice but to reelect Donald Trump. Think of all the people in this administration who will lose their jobs and not be qualified to work anywhere else if he loses.
Omnes Omnibus
@germy: You can abolish ICE but as long as we have immigration laws to enforce we will need someone enforce them.
Miss Bianca
@Martin: Oh, and how about thousands of dollars in schooling costs? Oh, and how about the fact that, here in CO at any rate, we just plain don’t *have* enough nursing programs for everyone who wants to retrain? I had a friend who decided to train to be a nurse after being a hairdresser for years. She had the devil of a time finding a program she could attend that she didn’t have to relocate to attend, and had thousands of dollars in debt to deal with afterwards. She loved her new job once she finally got it, but there were steep, steep costs both financial, physical, and mental to deal with.
And then…her cancer came back and killed her after only a couple of years into her new career. Not even enough time to pay off all her debt.
Butter Emails
@Omnes Omnibus:
I’m pretty sure that most individuals who are talking about abolishing ICE, expect that 50% or more aren’t getting hired back.
Cacti
At present, the demand for nursing degrees is already much higher than there are available spots in college and university nursing programs. A minimum wait time of 1 to 2-years just to get into a community college nursing program is common.
chopper
@Butter Emails:
oh come on, i’m sure there are plenty of farmers out there who could use some experienced bullshit-shovelers.
Martin
@lee: That too is a little unfair. The coal miner made a lifetime of choices. The number of coal jobs peaked in 1920 – 100 years ago. Other than a little blip in 1980 when Regan removed those solar panels from the WH, it’s been downhill the entire time.
I don’t have a huge amount of sympathy for people that can look at a 100 year trend like that and determine that they’ll be the lucky one knowing that 9 out of 10 of their coworkers will lose their job.
I’m 51 and graduated college with 3 different career options. As fate would have it, none of them panned out and I landed in unforeseen career 4, and am only now circling back to one of my original 3 options. But I’ve watched my field evolve massively. I’ve retrained constantly, expanded my skillset, expanded my domain expertise, combined those in novel ways. That’s what workers do now. I’m working on applying machine learning to my domain expertise. Machine learning is new to me but that’s where these fields are going, and either I go with it or I stagnate and get left out.
Le Comte de Monte Cristo, fka Edmund Dantes
@lee:
There ya go – that’s the sort of empathy I expect from a white progressive…
Martin
@Miss Bianca: I’m not waving away the costs of education or the availability of education slots (see my comment yesterday regarding how ‘free college for all’ advocates are glossing over that problem), merely pointing out that there are other ways to solve this problem.
The problem with the medical biller is that they have a zero value-add job. That is, every dollar spent on them is wasted as far as everyone but them is concerned. The sick individual gets nothing, the insurer gets nothing, the care provider gets nothing. The only winner is that employee. But another way, it would cost the same to move to M4A and simply hand that person a check for their old salary and ask them to do nothing. We should not look at a situation like that and proclaim ‘yeah, this is the best path’. Instead, we should look at how to migrate that individual to a value-add job. Paying to send them to school and covering their daily expenses for a 1 year intensive nursing program would be far cheaper in the long run to the economy writ large than keeping them in that job. And that would include the cost to build the nursing school to send them to.
But that needs to be part of the plan. And it’s not. And if it were, nobody would believe it possible.
D Gardner
@Le Comte de Monte Cristo, fka Edmund Dantes: Thank you for this comment, because it is the single biggest objective (non-partisan) impediment to the sudden enactment of M4A that I can think of. I am fully on board with the ultimate goal of universal health care in some sensible form, but it is dishonest to pretend that the numbers you cite don’t exist.
Chris Johnson
Why should we wait until that inevitably and immediately happens to us?
We are GOING TO crash, just as horribly, by sticking to this path and its current beneficiaries. Why not plan a little? Or is it morally necessary to just whistle while oligarchs and corporations loot EVERYTHING in America and run as far away as possible when the collapse begins in earnest?
We don’t have to do this. Back in the 30s we didn’t do this, we turned against the oligarchs and kicked them good and hard. It’s time.
David ??Booooooo?? Koch
What’s so wrong with Medicare as an option. How about automatic Medicare enrollment with an opt-out.
Why must everyone be forced into Medicare.
When did forcing people’s medical decisions become liberal?
Jim, Foolish Literalist
what leverage do y’all think Majority Leader Schumer would have, and be willing to use, to get Joe Manchin, Doug Jones, John Hickenlooper, Tom Carper and probably Chris Coons and Bob Casey to vote for this legislation we’re all het up about? And hasn’t Benet come out against it? Mark Kelly? And this is after he gets them to vote to kill the filibuster, right? And will Casey (and Jones and Manchin and maybe a couple others) demand that abortion be excluded from M4A coverage?
How many Senator Betsy Sweets can dance on the head of a pin?
JustRuss
@schrodingers_cat: According to Senator Merkley, expanding Medicare to cover age 55 and up was part of the ACA, but one senator refused to sign on until they removed that. Would love to find out who that was, I’m hoping to retire at 60 and health insurance may be a deal breaker.
Martin
@JustRuss: Probably Nelson (NE).
Martin
@Chris Johnson: It’s not that we need to wait, it’s that the transition is almost impossibly hard. That’s why it happens the way it does – the catastrophes of war render the transition moot. The bombs do the work of the politicians.
Jim, Foolish Literalist
@Martin: I was thinking Lieberman, could also have been Landrieu, Lincoln, Conrad or Dorgan. Maybe Evan Bayh
Miss Bianca
@Martin: You may not like the health insurance industry, and neither do I, but I wouldn’t argue that you can a). simply dismiss medical billing as a “zero value-added job” and b). blithely presume that everyone in that job is going to want to retrain as a nurse if you get rid of it, even also presuming that there were funds available for doing that. A lot of people do that from their homes, and unless they set up home clinics, that ain’t happening with a nursing job. For that matter, the ones I know are former nurses who wanted OUT of that profession after a certain number of years.
I agree that the sheer amount of coding is insane and that a lot of the biller’s job is centered around trying to get the insurer out of paying a claim. And like a broken record I’ll repeat: the way to deal with that is to keep improving Obamacare and putting more regulations on the insurance industry, rather than simply declaring the entire industry, and all its workers, redundant.
Jay
@David ??Booooooo?? Koch:
social services that are not universal in the US do not survive. Americans have no interest in paying into programs that they personally don’t benifit from or will benifit from.
so M4some will like Obamacare quickly die the death of a thousand cuts,
but that’s okay. Y’all ain’t getting M4A, universal medicare or any kind of universal healthcare anyway, Y’all ain’t even going to get to keep your Obamacare semi-universal medical sometimes insurance scheme.
Kathleen
@jonas: No problem. They can get part time jobs with the New Claims System to supplement their salaries.
chopper
@Miss Bianca:
but if we use ACA-type regulations to eliminate claim denial as an issue, then half of what these people do goes away. apparently it isn’t an option to get rid of any of these jobs, so i guess we just pay them to sit around for half the time?
Betty Cracker
@Jay: Sadly, you are correct. Even 30% of Democrats buy the insurance industry’s bullshit propaganda, so here we are, and here we will remain.
Omnes Omnibus
You know, we probably need to come to this discussion on this blog with certain assumptions. 1. Everyone knows the current system sucks and no one is advocating staying with it. 2. Everyone here wants the US to have universal health coverage through some mechanism. 3. Anyone ignoring 1 and 2 and slagging people’s motives for disagreeing with or supporting any method of getting to the desired goal is either misreading the audience or arguing in bad faith.
Miss Bianca
@Omnes Omnibus: Hear fucking hear. Thank you.
Le Comte de Monte Cristo, fka Edmund Dantes
What I genuinely enjoy is the fact that earnest progressives ran the ship aground in 2009 and 2010 over not getting their pony jerked off. They did it again in 2016, and damn if they’re not going to pull it off in 2020, yet again.
The campaign commercials write themselves:
Or how about this one:
Yeah.
Jay
@Omnes Omnibus:
assumption #2 is pure assumption. More than a few commenters here have expressed zero interest in any form of universal health care but instead, have cried copious tears for Sally’s job security denying benefits to customers for Dewey, Gougem and Howe LLC,
and of course, Wall Street’s and Corporate America’s continued profits.
Le Comte de Monte Cristo, fka Edmund Dantes
@Jay:
I’d love some form of universal health care, but would appreciate some honesty and genuine efforts to address all the hard consequential stuff around the margins in a realistic way.
Bernie spouting a bumper sticker slogan and waving a magic wand isn’t it. I know he’s unserious. Warren has disqualified herself in my eyes by parroting Sanders and proposing a no serious plan that also fails to address the consequences.
chopper
@Le Comte de Monte Cristo, fka Edmund Dantes:
personally i think I DENY PEOPLE’S HEALTH INSURANCE CLAIMS FOR A LIVING AND I VOTE would make a fine bumper sticker, if a bit long.
Le Comte de Monte Cristo, fka Edmund Dantes
@Jay:
By the way, given your level of empathy, can we assume that you’re a barista or dog walker in Brooklyn? Or maybe you’re an AOC constituent…
Martin
@Miss Bianca: No, it’s literally zero value-add. The service being paid for is healthcare. The billers job is to seek out a local efficiency in cost by incurring a global inefficiency in the system. That is, I’ll save my employer $3, only cost them $2 in wages in the process, forcing the care provider to make up the lost $3 by some other party – usually someone uninsured who gets to face a $20K bill for their one hour visit.
The job is providing care to the patient. Everything else is shifting dollars from one bucket to another. There’s no way for the biller to improve the quality or service of the care being provided. I’m not saying the biller isn’t profitable, I’m saying they provide no societal value beyond being an employed person.
Omnes Omnibus
@Jay: You weren’t here for the rejection of the broccoli mandate, were you?
Miss Bianca
@Jay: You know what? FUCK YOU, you sanctimonious prick, you and your “ha ha, you Americans are screeeewwwed because you just aren’t as enlightened as we are” BS. I argue for those health insurance workers because I myself live on the FUCKING EDGE OF ABJECT POVERTY – in fact, I qualify for Medicaid this year, lucky me! – not because I love the health insurance industry. So yeah – all of this “oh, it’s just so easy for these worthless people to just get another job, and who care about them anyway, they’re all just grist for the Great New Medicare Mill” crap really fucking flicks me on the raw.
Fuck.You. Take your working class hero BS and cram it up your Great White Northern Ass.
jl
@Kent: I have no clue what the best political strategy is. I just think that the corporate health care industrial complex will viciously and dishonestly attack any proposal, no matter how moderate or radical, that costs them any profit at all. Doesn’t make any difference whether mild improvement in ACA or aggressive M4A proposal. I think a mistake that one approach will face less ferocious opposition than another.
@chopper: Just my opinion, but I think problem of displacement of insurance and corporate health care administrative workers is overstated. The problem isn’t their salaries. The problem is that what they do is counterproductive. With any health care reform, many of them will stay in the industry, except that they will be doing constructive things rather than destructive things. A purist M4A would get rid of more jobs, but even there, the idea that all the administrative jobs in current health system will just disappear is just wrong.
Omnes Omnibus
@Miss Bianca: So, is he misreading the audience or arguing in bad faith? I have my theory.
Miss Bianca
@Omnes Omnibus: Damn it, you’re making me laugh. THAT will never do!
Jay
@Le Comte de Monte Cristo, fka Edmund Dantes:
I have Universal Health Care, Pharmacare and for a modest additional annual cost, ( equal to roughly the monthly cost of a Obamacare Silver Plan) I also get 100% Dental, 100% Physio and Rehab, 100% Therapy, 100% Health and Wellness, $4600 annually of cosmetic, Global Coverage, Ambulance and Evacuation.
You can attach a value to to how much a society* values a life, by how much they are willing to spend to keep them healthy, and if that value is spread universally.
*( ditto for Corporations)
based on that model, most American lives are utterly worthless.
germy
@Jay:
Yep. That’s life in these here United States.
Omnes Omnibus
@Jay: We know what you have. We know what Denmark has. Etc.
We can’t underpants gnome our way from where we are to where we want to be. As a result, there are arguments about how to get there. I can say, though, you sure as fuck aren’t helping.
germy
@Omnes Omnibus:
I wonder if they’ll eventually lose what they have, with the rise of the far right over there, plus the influx of immigrants of color.
Like here, they won’t be able to have nice things if conservatives suspect an immigrant will get the same thing.
Isn’t Boris Johnson working to tear the NHS down?
chopper
@jl:
exactly. a M4A system would eliminate a number of these jobs by reducing claim denial/recission and reducing complexity. if instead we beef up the ACA and use the heavy hand of regulation to reduce claim denial/recission and reduce complexity, then we’d be…eliminating a number of these jobs for the exact same reason. because bloat and shitty claim denials are something we want to eliminate.
germy
@chopper:
An inconvenient truth.
David ??Booooooo?? Koch
@Jay: Medicare itself is an option. As is Medicaid. While workers pay a de minimis 1.45% tax, far less than the 25% gas tax, nobody is forced into enrolling into Medicare or Medicaid.
Medicaid remains highly popular even though the vast majority of people will never enroll into the program. They like paying for an option.
If forcing people into a single payer system is so good, why did it fail in deep, deep blue Vermont just a couple of years ago.
If forcing people into single payer is so good why has Elizabeth Warren’s support plummeted. She was on course to sweep Iowa and NH and win the nomination until she turned off a huge chunk her dedicated voters. Get indignant with them, they’re the ones rejecting it.
Cacti
Like most grandiose statements, the above suffers from the familiar problem of being dead ass wrong.
First, it assumes that cost = value, which isn’t remotely true. The problem with the second part is that it makes no sense. No healthcare system has a firm universal amount that is spent per patient.
Per capita spending metrics are used as a gauge of the overall efficiency of the system, not as evidence of real time spending on every patient covered. The fact that some patients will need less care, and less expensive care than others is what makes such a system workable in the aggregate.
So, I’ll put it in a way a Canadian like yourself can understand:
Your reasoning sucks, eh.
germy
The middle man
Jay
@Omnes Omnibus:
get where?
M4A,? Nope, too many here against it in both theory and practice and how are you going to pay for it?
Enhanced Obamacare?
Medicare Advantage?
Sally’s Jobcare?
Dewey Cheatum and Howe’s Profit Care?
Before you can figure out how to get where you are going, you have to agree where you are going.
Y’all can’t even agree on where you are going, so, it’s pretty clear, you ain’t gonna get there, and when 1/4 of a comment thread on a top 10,000 lefty blog is cut and paste paid for Plutocratic objections,……….. well,……
and of course, it’s just beautiful that support for a vaguely defined, aspirational rainbow farting unicorn healthcare plan, far far far off in the future, that you are never going to get because ‘Merica!!!!!, is a dealbreaker for a Cantidate, is just poetic in an Ozimandius way.
Butter Emails
@David ??Booooooo?? Koch:
1. Vermont’s a state with a small population
2. Vermont is a state as opposed to a nation state – it doesn’t control it’s own borders which brings a whole host of issues which item one makes worse.
Jay
@David ??Booooooo?? Koch: Y’all been talking about some form of National Universal Healthcare since before Tommy Douglas got elected to office,
you are never going to get there.
Butter Emails
@Omnes Omnibus:
We also can’t wave a magic wand and keep everyone employed in their medical billing and claims filing jobs if we want to improve the system. About a quarter of the people commenting are saying no to M4A because people need to continue to be employed in their same job manufacturing buggy whips. That objection ultimately applies to most of the other systems we would want to implement – eventually a lot of these positions would be eliminated in the pursuit of efficiency.
So I guess that means 10s of millions go un- and under-insured until Amazon get’s into medical coding and eliminates 95% of those jobs without any sort of transition period or support. Then we can discuss not paying 40% more for our health care, or actually addressing the two-tiered system of care that leaves poor minorities with drastically lower life expectancy.
Gvg
I’d like to point out that people generally like to both eat and not die for preventable medical reasons….plus they prefer not to lose everything including eating money to impossible bills. The really need both life and jobs and aren’t in a good place deciding on only one. People are taking sides on this, but I think it’s a trick delimma on par with setting working class whites against minorities instead of them uniting against the rich who are actually hurting them.
some of the medical and insurance industry could lose jobs over any new health coverage plan, but not most of them, they would just be reorganized which happens all the time in every job I have ever had anyway. Even billing coders and claims denial employees….
I have concerns about these plans, I just think the jobs versus coverage argument is going around in circles here. Both things have to be considered and difficult isn’t a reason to not do something, it’s a reason to think carefully.
Omnes Omnibus
@Butter Emails: I never made any argument about insurance workers.
chopper
@Butter Emails:
ultimately it isn’t about these people’s jobs, since i’d say to a person everyone making that argument wants at the very least a more efficient, heavily regulated universal-coverage system, which means eliminating half of what those workers do anyways.
i mean there are reasons to be skeptical of a M4A system and i’m still not really sold on it myself but c’mon.
Jay
@chopper:
none of the people arguing on behalf of Wall Street or jerbs, said anything about universal coverage or healthcare, just for profit insurance and for profit insurance jerbs.
1/4 on this thread don’t believe in either healthcare or universal coverage.
Goblue72
@Le Comte de Monte Cristo, fka Edmund Dantes: I’ve seen some Fox News inspired arguments on BJ but yours about takes the cake.
”We can’t have universal healthcare because who will think of all the health insurance bureaucrats?”
JHFC.
Goblue72
@Jay: There’s a portion of regular commenters who’d sell this country out to a foreign power if it somehow meant they could stick it to Bernie Sanders.
chopper
@Goblue72:
to be fair, wilmer’s an asshole.
tam1MI
@Butter Emails: I guess we have no choice but to reelect Donald Trump
Make M4A the hill to die on for any prospective Dem candidate and you will.