General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsMedicare for all is so much cheaper and simpler than subsidizing insurance companies
That the GOP could give their wealthy lords their tax break AND provide healthcare for everyone.
And increase freedom, happiness, and joy all over this country.
and they won't do it, of course.
But to be fair, neither did the Democrats.
The obvious answer is staring us in the face, and we can't, as a country, do it.
dhol82
(9,353 posts)ChoppinBroccoli
(3,784 posts)What I don't get is that immediately after Obama was elected, Democrats controlled the Presidency, the House, AND the Senate, yet we couldn't push through single payer because the "Blue Dog" Democrats stood in the way. And why did they stand in the way? Because they were deathly afraid that if they allowed it to go through, the rubes in their districts who are afraid of buzzwords like "SO-SHUL-ISM" would vote them out of office.
Now cue to 2017. The Republicans in Congress, even the extremely vulnerable ones just hanging on by their fingertips, will stand in staunch opposition to any kind of investigation into Trump's treason, and seem to have no fear whatsoever about their upcoming re-election bids. There is virtually no such thing as a RINO or a "Red Dog Republican." They all stand in lock-step with what the Party higher-ups demand and to hell with representing their constituents.
I'm not saying that that's the way we as Democrats should behave, but damn, man, if we could just push through single payer when we have the majority (and get ready, because I have a feeling that day is coming, and right soon), the people would see how much better a system it is and will eventually embrace it. Just like Social Security and Medicare. Republicans all howled "Socialism" back when FDR passed those, but now they're the most popular governmental programs going.
Oh, I'm sure you'll find that "loyal" 20% of people who will happily defy their own best interests just to parrot the Party line. They'll sit there and go, "Yeah, I got my medical treatment for free, but I'd rather DIE as a Capitalist than live under SO-SHUL-ISM!!! First it's free healthcare; next it'll be DEATH PANELS!!!" Kinda like that Louis CK joke about the last remaining racists complaining about getting free blowjob robots from a black President.
PatSeg
(47,586 posts)I remember some of those Blue Dog Dems who relied on donations from the insurance industry. They weren't quite as bad as republicans, but they were very little help. As I recall, it cost Blanche Lincoln her seat in the senate. Then there was Max Baucus who helped write the Affordable Care Act.
https://www.washingtonpost.com/news/the-fix/wp/2013/04/24/why-max-baucus-made-democrats-angry-in-5-easy-steps/?utm_term=.61c332024333
I know there were others, but those two stick out in my memory.
Orsino
(37,428 posts)We can certainly repurpose many into billing under Medicare For All, but we need a detailed plan if we're to move more than incrementally in that direction.
I like the goal of putting more of the most vulnerable on Medicare every year, and reducing the age of qualification slowly...but even then we have to have an answer for the people whose basic incomes are at risk.
ChoppinBroccoli
(3,784 posts)There will still be just as many patients needing treatment under single payer (and some would say that once treatment becomes affordable for all, there will be even MORE demand). Demand means the need for workers/employees to treat them. We'll still need all those doctors, nurses, assistants, office personnel, etc. The only thing that changes is the way they get paid.
Under the current system, the medical office submits a bill either to the insurance company or the patient (if the patient has no insurance) and then waits to get paid. They first collect a co-pay from the patient immediately (usually), then have to figure out which insurance company to bill, submit the bill to the right insurance, negotiate for a final price, then get payment from the insurance company while the insurance company turns around and tries to get reimbursement of whatever portion they feel they're owed from the patient. That all goes out the window. Under single payer, NOTHING changes for the medical office other than WHERE they submit their bill. Every medical office submits their bill to the same place (a "single payer" and gets paid.
So the demand for treatment won't decrease, and therefore the need for medical WORKERS will not decrease either.
I happen to know that single payer works first-hand. How do I know? I work in an industry where we take single payer FOR GRANTED. It's even mandated in the Constitution. I'm an attorney who handles court-appointed cases. In the legal system, you are ENTITLED to be represented by counsel even if you can't afford one. So when people come to Court and say they can't afford an attorney, they are first screened to make sure they qualify (aka "means tested" , then someone like me gets appointed to their case. I represent them, and they don't pay a dime. However, when the case is over, I submit my bill to a single payer (in this case, the Court, who then gets reimbursement from the State's Public Defender's Office, who oversees the court-appointed attorney program for the entire State), and I get paid for my services. It's not without flaws. I get paid less for court-appointed work than I would get for private clients, and sometimes the Court is slow to pay my bill, and there are "caps" on the amount of hours I'm allowed to bill (so many times, I find myself working for free), but I always do get paid at the agreed-upon rate. And if I don't like the arrangement, I can just take myself off the Court-Appointed list. But the vast majority of attorneys I know all agree to the terms and enjoy working within the Court-Appointed system. All the horror stories about substandard care under a single payer system are bunk. In the court-appointed system, you get representation from private attorneys (and I must say that most of the best attorneys I know do court-appointed cases in addition to our private workload). And if you have the means and WANT to hire a private attorney, you can do so. I guess you could call Public Defenders and Court-Appointed attorneys a "public option." The Public Defender's Office and court-appointed attorneys are not "putting private attorneys out of business" either, so scratch another popular anti-single payer meme off the list. And this is a system that has been in place in this country since its inception (again, it's written right into the Constitution), and we as Americans simply take it for granted. I believe the same would happen if/when we finally make single payer healthcare the law of the land. Eventually.
Orsino
(37,428 posts)But there's no getting around unemployment problems when we try to collapse many private insurance companies into one government agency. Many people would find themselves redundant.
We would be eliminating some jobs, and if we want to sell the destruction of an industry, we need a detailed plan. Barring some greater genius than mine, we're going to find that such an effort will only be done incrementally.
pat_k
(9,313 posts)Work to move the ball forward, not just try to keep from going backwards. The response to Republican "ACA sucks" rhetoric is is Yes, it could be MUCH better, and here's how. Instead. we are in a losing "it sucks" v. "no it doesn't" battle.
Orsino
(37,428 posts)Let the masochists who like being robbed by insurance compnies stick with it, while making an alternate coverage available.
ChoppinBroccoli
(3,784 posts)I thought you were saying that doctors, nurses, etc. (actual healthcare workers) were going to lose their jobs. I see now that you're saying the people who work in the insurance industry will lose their jobs. Probably a valid point. But I think a large portion of them could be repurposed into doing the SAME job for the single payer. There will still be just as much paper to push around, as the demand won't decrease, but as for the bloated staffs of all the various insurance agencies, there will almost certainly need to be some trimming. Valid point.
ProfessorPlum
(11,276 posts)there is very little paperwork.
But there would still be companies providing supplemental insurance plans, as a benefit for private employers, above the basic medicare for all package.
but I imagine that there would be some loss of jobs in the healthcare insurance field.
mvd
(65,180 posts)We just need to be careful about implementation because it would be a huge change to the system. Private insurance is so entrenched. Introducing a strong public option with the intent to go to full single payer could ease the transition. I am also big on a government jobs program if we can't pass a livable income for all people.
pat_k
(9,313 posts)Get out there and make the case for it... (see post 5 below)
Demsrule86
(68,667 posts)People will die if we don't...you pick your battles. This is a waste of time.
pat_k
(9,313 posts)If Dems aren't out there actively making the case, we will NEVER generate the political will. And people will have no reason to support Dems. The opposition has successfully pushed its "ACA sucks" message. Instead of just saying "No it doesn't" the winning strategy is to say. Yes, it DOES need fixing, and here's how.
ProfessorPlum
(11,276 posts)pat_k
(9,313 posts)Let's accept the premise that people want something better than the ACA, and polling does seem to indicate "fix" leads. Introduce our own fix it bill, get out there and make the case, call on people to let their reps and Senators know the Dem replacement is what they want, and if it is blocked, call on people to elect Dems so we can do it next session. If not medicare for all, than at least add the public option. I think we CAN do it. Putting universal health care front and center now is the way to get it done in the future.
We need to be doing more than opposing. And ACA was far from the "be all, end all" fix that needs to be defended to our last breath. The way to keep from sliding back at all is to make the case to move forward, not back. You may end up in a "stalemate" (ACA stays in place), but if the only thing we do is defend ACA, not work for BETTER, what we have will be chipped, chipped, chipped away.
OnEdit: Conyers introduced a new version of medicare for all this session. Perhaps some calls to Pelosi et al to get out there and work with Conyers to Make the Case to the public?
https://www.congress.gov/bill/115th-congress/house-bill/676
yeoman6987
(14,449 posts)Everyone pay 109.00 a month into Medicare and then buy a secondary insurance to off set the 20 percent that Medicare won't pay? Would their still be a deductible?
pat_k
(9,313 posts)yeoman6987
(14,449 posts)And then tax all brackets by income by a certain percentage. It may work. I know in Italy it is done this way. A friend received 2200 euros a month but brought home 1300 but everything was free so the 1300 went towards living. What a concept? Lol. Americans don't know what living is....me included. We work to bareful survive not live.
Demsrule86
(68,667 posts)To be fair, you should not say the the GOP is the same as the Dems...I believe that is a violation. Everyone with a brain wants single payer but we won't get it with the GOP in office...oh those emails...Hillary was just unlikable( sarcasm). By not electing Hillary Clinton, we lost our best chance for single payer in the foreseeable future and now we must fight for what we have which is way better than what we had before-nothing...it only took oh a little over 100 years to get the ACA.
pat_k
(9,313 posts)see post 5
Demsrule86
(68,667 posts)Trump's small hands...millions of lives are stake...I don't understand why you don't see that.
pat_k
(9,313 posts)The way to counter the Republican ACA sucks rhetoric is to answer "Yes, and we want to make it MUCH better. Here's how..." Adding the public option is a perfect "incremental" fix that can be tied to the ultimate goal.
Tear apart their attempt to go backwards while making a case for actually moving FORWARD, as opposed to defending a status quo that 1) isn't great, 2) has been demonized by the right.
Demsrule86
(68,667 posts)Honestly...when I read some of this stuff...I wonder how we ever win. Attacking the ACA is a losing strategy...geez.
pat_k
(9,313 posts)It's about admitting it could be improved -- being honest -- and making the case for improvement. Doing that provides a stronger context for exposing "their" plan as going the wrong direction. Either we fight for what we believe because we have the best proposals, or keep silent, and keep losing because we fear what "they" will do to us if we ACTUALLY advocate for what we believe.
The only message we send when we refuse to advocate for proposals that will make a real difference in people's lives is "we're too weak to actually accomplish the things we claim we care about."
I have news, they aren't gonna "go easier on us" because we keep our mouths shut about what we actually stand for.
Demsrule86
(68,667 posts)mantra improve the ACA...not change it to single payer even though that is our larger goal...not now...time for that is during the 20 election where a public option can be championed. We will get there eventually if we save the ACA now.
pat_k
(9,313 posts)Repubs assert -- falsely -- that their bill will reduce premiums. If we introduce a competing bill with public option that actually WILL bring down rates through pooling and negotiating as does Medicaid/Medicare, we would be in a much stronger position. Now it's "We'll lower your rates" (never mind that it's a lie -- too many will be duped) v. "We want to keep everything the same." We are fighting on "their turf." We need to drag the debate over to "our turf."
I'm composing letters to my Rep and members of House leadership expressing my dismay that they aren't putting a Dem bill out there -- one with the public option; one that they mount a coordinated effort to "sell" to the public. (As opposed to their utter silence on Conyers bill.) If you agree that this is a more effective way to generate the political will to stop R bill and give an issue to run on in 2018, might want to consider doing a little "citizen lobbying" too.
ProfessorPlum
(11,276 posts)Dems never have the votes, so they never fight for anything. I get it.
Demsrule86
(68,667 posts)and lost. He went on to win as an independent and returned to the senate with a strong dislike for most Democrats...had we not primaried him we might have gotten Medicare for all...it was close Why would you primary a candidate who is popular in the polls in a safe state? The same crap is going on in Mass this year and it is nuts...we often snatch defeat out of the jaws of victory...you wanted single payer? Me too...which is why I worked my ass off for Hillary...but we lost so now we have to think of the millions who could die if the ACA is repealed...and attacking the ACA is not a winning strategy for Democrats. We will win again and can use the ACA to launch a public option. But if we don't support the ACA and call call call Congress then we will also have blood on our hands.
ProfessorPlum
(11,276 posts)It's great, as far as it goes.
But if we are looking to replace it (as the GOP is now) we should replace it with Medicare for All.
The rich get their tax cuts, everyone else gets health care. Win win.
Demsrule86
(68,667 posts)won't happen until we regain power...any alternative will be seen as Democrats admitting the ACA is not good enough...fatal at this moment.
pat_k
(9,313 posts)... mount a coordinated effort to "sell" to the public. Arguments for advantages of this approach in my other posts to this discussion.
Orrex
(63,224 posts)Despite its vocal champions, privatization is only more efficient than equivalent public programs when those public programs are attacked and undermined and under-funded by the critics who hate them the most and who stand to gain the most from funneling public money into private ventures (insurance companies, private military "contractors," "charter" schools, the list goes on).
pat_k
(9,313 posts)... responsive to "free market forces."
As I said in a post on another thread:
Orrex
(63,224 posts)And let me say for the record that I scream inside every time I hear the phrase "healthcare consumers." Fuck the evil shithead who coined that vile euphemism.
Beyond the excerpt you correctly cite, healthcare defies the market model because you can't shop around. When you're bleeding from an exposed aorta, you don't have the luxury of deciding between competing providers, and for that matter you can't assess prices in advance because hospitals don't disclose them.
Famously, an operation that costs $1000 and one hospital can easily cost $30K at another, with no difference in procedure, recovery, equipment or expertise. But you can't generally know this in advance, so you can't make an informed decision in "purchasing" your "healthcare commodity."
What other marketplace operates this way, with decisions forced upon consumers under duress and with no ability to make an informed decision? Can you imagine buying a car or a home in this way? But medical bills can routinely exceed those costs, and we're all supposed to be just fine with it?
ProfessorPlum
(11,276 posts)those costs would be known, and uniformized, across the industry.
Orrex
(63,224 posts)unblock
(52,317 posts)and some things can reasonably coexist.
there's no compelling reason for government to be in the luxury yacht business. let the private sector handle that.
there's no compelling reason for businesses to be in the business of deciding people's health insurance. if insurance is involved at all, the government should be handling it. there are advantages to having the largest pool, and having a single payer.
there are some industries where both may make sense. mail delivery, e.g. there's a compelling interest in making sure that every american can receive mail, hence the usps mandate to get mail to anyone in america, even remote areas of alaska. meanwhile, there's no reason why people who are willing to pay extra for overnight delivery can't use the private sector for that.
different objectives. the government has an interest in serving everyone, and fairly; the private sector has an interest in not serving unprofitable customers in exchange for better service for more profitable ones.
in healthcare, there's a compelling interest in making sure *everyone* gets healthcare, so government at least needs to handle things like emergency medicine, communicable diseases, etc. and it's reasonable for the private sector to handle cosmetic surgery (in cases where it's optional -- vanity vs. burn or cancer, e.g.).
the only interesting political argument, to my mind, is where to draw the line. not sure i have a good answer for that other than i would prefer the government handle more rather than less in the interest of fairness.
pat_k
(9,313 posts)Ultimately, any health care system that relies on "free market forces" to keep costs in check is doomed.
As discussed in an exchange above, health care is simply not a commodity responsive to the "free market." Nobody decides "how much" health care they need. Everybody needs a basic level of preventative care. Some get sick. Some have accidents. When they do, they need the health care they need. Period. "Buying" health care is not like buying a car. (Or, as I like to put it, no healthy person wakes up one morning and thinks, "I want to start injecting myself with Enbrel. I know it's expensive, but I'm worth it!"
Health care, like education, is one of those things that we need to figure out as a nation. We aren't dong the best job on public education, but at least it is a given that you cannot have a functional democratic government unless everyone has equal access to a basic level of education. Health care is just as fundamental, if not MORE. Education is of little use if you are dead.
We agree in principle on the need for public education, but we are still struggling with the many questions ("what is a basic level of education?" "What's a fair salaries for teachers?" and so on.) Sooner or later I think we may "get it" that paying for education primarily through local property tax is not working, and that we need to have a "broader base" if we want to ensure any level of consistency. But that is another topic.
Anyway, I firmly believe that we will reach a consensus that health care, like education, is something we must provide for ourselves through our tax dollars. We would reach that consensus a hell of a lot sooner if the Democratic Party establishment made a concerted effort to make the case. When we do finally "get it" -- that it violates the principles on which this nation was founded NOT to have a national, public, health care system, it won't necessarily be all sweetness and light. We'll struggle with all sorts of questions for a long time. "What are fair prices to pay physicians? Do we subsidize physician's education? What preventative services should be built in to help keep people as healthy as possible (and thereby save money)? What about research for drugs? Should we subsidize research at public institutions to "compete" with private pharma? What level of profit for private pharm are we willing to subsidize with our public dollars?" Fortunately, there are lots of models "out there" that we can follow. We are not starting from scratch. We can design a system that takes the best from those that already exist.
The other posts on public v. private (11, 15, 19)
Johonny
(20,888 posts)the reason for the rationing seems to be pure greed and the ability to fear superior to others. We're a society that loves artificial rationing.
ck4829
(35,091 posts)The poor have to keep in line and that means be and look poor, can't complain too loudly, and have to work for a shot at getting insurance.
If the poor didn't have the specter of disease and injury (And the extra specter of actually paying the bills associated with disease and injury) hanging over them; then that would be one less worry for them, less uncertainty, less doubt, less fear, more ability to pursue non-work/non-money related ventures, and more.
ProfessorPlum
(11,276 posts)as horrifying and dehumanizing as it is.
Give people healthcare, and they won't be cringing in abject terror all the time.
Orrex
(63,224 posts)And, I suspect, completely accurate.
Response to ProfessorPlum (Original post)
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QC
(26,371 posts)raccoon
(31,119 posts)discntnt_irny_srcsm
(18,482 posts)...if they couldn't reinvent the wheel and sell to an market without an alternative like medicare for all?