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Medicare For All

By Big Tent Democrat, Section Other Politics
Posted on Mon Jun 13, 2011 at 09:15:58 AM EST
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Paul Krugman:

O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.

Accepting this as true (and people like Jon Gruber and Ezra Klein who championed the Wyden-Bennett exchange reform would not accept this as true based on their writings at the time), how precisely does the "second best option" work? I'm simply not seeing it, and while Krugman keeps describing the exchanges as "the second best option" and "half a loaf," I do not understand his reasoning for expecting positive results from the exchanges. As I said at the time, any expansion of Medicaid for the less well off is a positive, and that is why I supported a positive vote for ACA. But the exchange/subsidies reform? No, that's not a "second best option" or "half a loaf." It will fail in my estimation.

Speaking for me only

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    Medicare For All | 120 comments (120 topical)

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    The real world ramifications of (5.00 / 5) (#4)
    by MO Blue on Mon Jun 13, 2011 at 09:35:47 AM EST
    Obama's decision to trade away negotiated drug prices.

    WASHINGTON (AP) -- Facing a life-and-death struggle with kidney cancer, Rita Moore took her prescription for a new kind of chemotherapy pill to her local drugstore.

    She was stunned when the pharmacist told her the cost for a month's supply would be $2,400, well beyond her income.

    Medicare drug plans that cover seniors like Moore are allowed to charge steep copayments for the latest cancer medications, whose cost can run to tens of thousands of dollars a year....
    ...
    Pills, a relatively new option, are thought to represent the future of cancer care.
    ...
    Moore decided to apply to Pfizer's prescription assistance program for patients who can't afford Sutent and other drugs the company makes. Pfizer approved a year's worth of free medication, but it took about two months to collect and review all the medical and financial paperwork.

    "They were very helpful, but it wasn't a fast process," said Moore. In the meantime, she wasn't being treated. The cancer spread and is now close to her spine and her body's main artery. link

    BTW, as stated in the article many of these medications were developed from taxpayer-funded research.

    First best legislation to further enrich the insurance, pharma and medical industries with the only real cost control being structuring the system so that the costs are controlled through making actual care is too expensive for people to afford. Death by spreadsheet.

    Second best policy for actual care? Pfft No way.  

    Have you ever heard of Propofol? (none / 0) (#32)
    by me only on Mon Jun 13, 2011 at 12:37:11 PM EST


    Parent
    I absolutely do not understand (5.00 / 2) (#5)
    by lilburro on Mon Jun 13, 2011 at 09:52:49 AM EST
    how are we still arguing about the basic facts of healthcare costs?  

    I don't know if exchanges could work or not.  The haphazard way they are being set up does not make me confident that they will work though.

    It (none / 0) (#6)
    by AngryBlackGuy on Mon Jun 13, 2011 at 10:58:19 AM EST
    is a long term process.  The exchanges as they are initially set up will look a lot different than their final resting place I think.

    The most important phrase in Krugman's piece for many here was the following:

    "Medicare for all wasn't going to pass"

    Again, we don't even have agreement on that so how are people around here ever going to agree to a basic number of assumptions which should guide our policy.

    Some here are arguing that even though the exchanges are liked and provide great coverage in Mass, that we should ignore that because in the future funding for ACA might be cut.

    And that is being argued as if it were fati accompli.  That there is no way that assumption could be completely bogus.

    You can predict anything and have it sound reasonable if you make up assumptions and declare that they are fact.

    Parent

    The most important missing phrase (5.00 / 2) (#7)
    by Big Tent Democrat on Mon Jun 13, 2011 at 11:00:34 AM EST
    How ACA will work.

    The defenders are of the school often attributed to tax cut aficionados for stimulating the economy:

    (1) Cut taxes

    (2) ?

    (3) Prosperity!

    Your argument is

    (1) ACA

    (2) ?

    (3) Success!

    Faith based advocacy is not my bag man.

    Parent

    My position (none / 0) (#13)
    by AngryBlackGuy on Mon Jun 13, 2011 at 11:47:05 AM EST
    is that we don't know how whether the exchanges will work. We can't know.  We know that they have worked in other places but we can't equate that to exchanges on a national level.  It's a big unknown.

    But we had to try something and in a world where medicare for all isn't possible (follow me and Krugman for a minute on that) it's certainly better than the status quo.

    But even if you DON'T think it was better than the status quo, what is the second best option after medicare for all? In other words, if exchanges aren't second best, what is?

    I don't remember anyone posing an answer to that question because they assume that medicare for all was possible. If we tried for medicare for all and failed, what was the preferred fall back?

    Parent

    Obama thought a public option... (none / 0) (#25)
    by Yman on Mon Jun 13, 2011 at 12:28:31 PM EST
    ... was the best alternative, ...

    ... even after caved in a backroom deal with the insurance/pharma lobbyists.

    Parent

    The problem (5.00 / 2) (#8)
    by Ga6thDem on Mon Jun 13, 2011 at 11:13:40 AM EST
    is that you are arguing that basically a crappy piece of legislation is better than nothing. This was a case where we would've been better off without passing this piece of legislation and just expanding Medicaid and passing legislation about preexisting conditions and maybe a few other parts of the bill.

    Sometimes having nothing to eat is better than being served something on the lid of a garbage can.

    This piece of legislation is likely to make things worse not better over all.

    Parent

    Yes (5.00 / 1) (#15)
    by AngryBlackGuy on Mon Jun 13, 2011 at 11:57:54 AM EST
    I am arguing that a crappy piece of legislation is better than nothing.  Why? Three reasons:

    1. Even if ACA does nothing to cost, you have millions of people who didn't have healthcare before that will afterwards.  Thousands of loves will be saved.  At the end of the day, that's my primary concern: saving lives regardless of cost impacts.  Limiting restrictions on "preexisting conditions" alone makes the legislation a win.

    2. It advances the concept of a global/government supervised healthcare umbrella and gets us a step closer to a public option.

    3. Trying something and having it fail was far preferable to another crushing defeat in passing any type of healthcare reform.


    Parent
    Gawd (5.00 / 4) (#26)
    by TeresaInSnow2 on Mon Jun 13, 2011 at 12:30:09 PM EST
    I am so sick of people like you equating health insurance to health care.

    They are NOT!!!! the same thing.

    Requiring that people buy high deductible health insurance may in many cases means that they won't be able to afford ANY health CARE because their money is being soaked up by premiums.

    Please, please, understand that.  You have the intelligence to do so, don't you?

    Parent

    I understand the difference Teresa (none / 0) (#40)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:07:36 PM EST
    I simply believe that if you have no care, having some care is better than what you had before.

    I am guessing that the guy or gal with no care thinks the same thing.

    But maybe you know better.  Maybe they'd rather stick with nothing.

    Parent

    Teresa (none / 0) (#41)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:09:44 PM EST
    as a matter of fact, how about you study up on the subsidies built into ACA and how they work and ho out of pocket costs are impacted:

    http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Apr/1493_Gruber_will_a ffordable_care_act_make_hlt_ins_affordable_reform_brief_compressed.pdf

    That study is fair and the one Krugman often references:

    Bottom line: While not perfect, ACA is clearly a net positive.

    Parent

    Who in America literally has no health care? (none / 0) (#60)
    by sarcastic unnamed one on Mon Jun 13, 2011 at 03:44:49 PM EST


    Parent
    You might just be surprised (5.00 / 1) (#101)
    by Amiss on Mon Jun 13, 2011 at 11:16:02 PM EST
    how many can not afford any health care at today's prices.

    Parent
    OK, suprise me. (none / 0) (#107)
    by sarcastic unnamed one on Tue Jun 14, 2011 at 11:34:49 AM EST
    How many Americans cannot afford any health care at today's prices?


    Parent
    Anyone (none / 0) (#62)
    by AngryBlackGuy on Mon Jun 13, 2011 at 03:47:08 PM EST
    can walk into an emergency room but that's not going to help with the stuff that really can hurt you.

    Parent
    That some people have better HC than others (none / 0) (#68)
    by sarcastic unnamed one on Mon Jun 13, 2011 at 04:24:09 PM EST
    is something I can agree on.

    Parent
    really?? (none / 0) (#64)
    by CST on Mon Jun 13, 2011 at 03:49:11 PM EST
    lots of people.

    And as for emergency room care... if you call that "care" - it's not quite the equal opportunity system it should be.  They're not supposed to turn anyone away, but that does not always translate to "care".

    Parent

    Don't disagree with that CST (none / 0) (#75)
    by AngryBlackGuy on Mon Jun 13, 2011 at 05:40:13 PM EST


    Parent
    You will have millions of people (none / 0) (#18)
    by MO Blue on Mon Jun 13, 2011 at 12:10:16 PM EST
    who may have health insurance. Whether or not they will be able to afford actual health care is debatable.

    You will have millions more who will have less  actual affordable health care because the legislation was designed to eliminate good coverage policies and lower the actuarial values of the policies. This was done so that more people will have to pay more out of pocket for actual care regardless of how high the premiums go. The way it was designed the higher the dollar amount of premiums the more the actual coverage must be lowered to avoid the excise tax.  

    Parent

    Actually (5.00 / 1) (#22)
    by AngryBlackGuy on Mon Jun 13, 2011 at 12:20:00 PM EST
    Millions of people will receive subsidies that will pay for their healthcare that had nothing of the sort before.

    Millions of people.

    In the need to ash ACA, there is this need to pretend that it was 100% evil.  At it's core, it is going to give a lot of people who couldn't afford care care that they would not have otherwise.  And they will pay little to nothing for it, as it should be.

    No fair debate can pretend that that is not the case.

    Parent

    ABG writes (2.00 / 1) (#104)
    by jimakaPPJ on Tue Jun 14, 2011 at 09:19:51 AM EST
    Millions of people will receive subsidies that will pay for their healthcare that had nothing of the sort before.

    This is similar to the mortgage reduction program. Joe and Jane Sixpack will be asking:

    "I struggle but I pay for my insurance. Why should Charles and Peggy next door get it free??"

    As of now people haven't really grasped the above. When they do class politics will reach a new level.

    Parent

    Nobody (5.00 / 2) (#105)
    by Ga6thDem on Tue Jun 14, 2011 at 09:33:50 AM EST
    is getting "free" healthcare in this country unless they are basically indigent or a minor. The neighbors aren't going to get free healthcare anymore than Joe Sixpack is.

    You know better than this. The problem is that private insurance is unaffordable for most people.

    Parent

    The comment I made was in regards to (none / 0) (#108)
    by jimakaPPJ on Tue Jun 14, 2011 at 01:16:49 PM EST
    ABG's comment re the future.

    And remember that my solution is a single payer system modeled on Medicare.

    Obamacare is not that. And in fact, Obamacare will destroy Medicare by taking funds away from it at the same time the boomers are entering into Medicare.

    Make no mistake. Obama wants to destroy Medicare and replace it with Obamacare. That's been his long range goal since day 1.

    Parent

    Once again a misstatement (none / 0) (#35)
    by MO Blue on Mon Jun 13, 2011 at 12:53:07 PM EST
    Health insurance and actual health care are not the same thing.

    Millions of people will receive subsidies that will pay for a portion of their health insurance. The majority of these subsidized policies have an actuarial value or 60 to 70%. This means that in order to get actual health care they will have to have money to pay for their share of the premium, deductibles and for 30 - 40% of the actual care.

    Romneycare is more liberal than Obama care and even there people who have insurance cannot afford actual care.

    "In Massachusetts, they put high levels of subsidies way up the income [ladder]. They made free and subsidized plans available a year before any mandate. The [individual] mandate went into effect later," Blendon said. "The impression was, 'How wonderful!' " The penalty that was eventually tied to the employer mandate was small enough not to trigger a major push-back. The law also includes a well-publicized exemption: Individuals aren't required to have insurance if the cheapest policy available costs at least 10 percent of their income.
    ...
    Recent academic studies indicate that insurance prices and the state's costs have been higher than anticipated, safety-net hospitals are struggling more than ever, doctors cannot keep up with increased demand, and some people who have insurance still can't afford care. link
     


    Parent
    No (none / 0) (#19)
    by Ga6thDem on Mon Jun 13, 2011 at 12:12:12 PM EST
    if it does nothing to cost you are going to have millions more without insurance. Do you realize how much insurance costs these days? The problem is that people with preexisting conditions can't afford the insurance so it's kind of a moot point. If it isn't affordable, you aren't "saving lives".

    There is nothing in this that will get us closer to a "public option" There is never going to be an "public option" added to this plan. That time has passed. The only way to expand that kind of coverage is to open up Medicare.

    Having this fail is preferable to not passing anything? You sound like Bush w/r/t to Iraq. It was better to go in and  have a quagmire than to do nothing.

    Like I said there are times when doing nothing is better than doing something especially if you aren't going to do it right.

    Parent

    I understand (none / 0) (#23)
    by AngryBlackGuy on Mon Jun 13, 2011 at 12:23:22 PM EST
    how much insurance costs these days (there is no need to assume that disagreement stems from ignorance).

    I simply disagree with you and believe that long term ACA will get us where we need to be in one of two ways:

    1. If insurance becomes too expensive, the threshlolds for government subsidies will be raised until it only makes sense to just have a public option that locks in rates.

    2. If it works, well, it works. Costs come down, more people are covered, etc.

    In other words, my view is that ACA either works or it pushes us towards a public option.  I understand that you disagree, but please be aware that I have read a great deal about ACA, healthcare, insurance premiums and everything else every other fairly well informed person has about the issue.

    Let's skip over the part where you believe that you have superior information and assume that we are starting from the same basic place.

    Parent

    Ha-ha-ha (5.00 / 1) (#27)
    by TeresaInSnow2 on Mon Jun 13, 2011 at 12:31:27 PM EST
    1.If insurance becomes too expensive, the threshlolds for government subsidies will be raised until it only makes sense to just have a public option that locks in rates.

    Our government, which is focused on austerity, is going to raise subsidies to match insurance premiums.  What pretend world do you live in?

    Parent

    The one (none / 0) (#38)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:05:12 PM EST
    we live in.  This is the argument over medicare and we are winning it.

    Parent
    Interesting ABG (none / 0) (#71)
    by sj on Mon Jun 13, 2011 at 04:44:58 PM EST
    Who is the "we" here that is winning the argument?*

    This is the argument over medicare and we are winning it

    As usual, you are more focused on the argument and not at all on the practical implications.  

    -------
    *My "hinky detector" just went off again.

    Parent

    This is all subject to massive fail (none / 0) (#86)
    by AngryBlackGuy on Mon Jun 13, 2011 at 07:46:17 PM EST
    But the debate is engaged in earnest now. Politicians are having to own up to wanting to cut benefits. As the polls show we win that debate handily. Now we have to handle our advantage carefully but we are winning as the NY special election showed.

    It's been silent on the budget debate for a week and I think we will see a proposal that makes cuts but keeps the core of our concerns protected.

    I could be completely wrong though. No doubt.

    Parent

    I don't think (5.00 / 1) (#42)
    by Ga6thDem on Mon Jun 13, 2011 at 01:19:11 PM EST
    you realize that you are speaking to someone who has extensive experience in the insurance industry. I know how it operates and the thing that you don't seem to realize is that as long as the main goal of insurance is to make a profit there will never be adequate care given.

    When I first moved to GA, BCBS was a nonprofit and the insurance was excellent. Since they have gone to for profit, the care and the cost has skyrocketed. Approximately 30% of the premium costs are overhead costs.

    Parent

    I don't think you realize (none / 0) (#44)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:27:42 PM EST
    1. That your name is GA6thDem and I have no idea who you are.

    2. My name is the equally ridiculous "AngryBlackGuy" and you have no idea who I am.

    3. (most important) that you have no idea what I do for a living and what my area of expertise is.  

    Let me cut to the chase. Here is your statement:

    "as long as the main goal of insurance is to make a profit there will never be adequate care given."

    Here is my response:

    Sweden.

    Parent

    My bad (none / 0) (#45)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:28:47 PM EST
    Switzerland.

    In that country you have private companies that supply certain compulsory care and also offer supplemental care at a profit.

    That's where I see us realistically ending up.

    Parent

    I don't think it's likely (none / 0) (#48)
    by lilburro on Mon Jun 13, 2011 at 01:38:28 PM EST
    that we would ever be able to regulate insurance companies as effectively as Switzerland does.  Also, Switzerland does not have a Medicare type program, or a public option.  NYT on the Swiss System.

    Parent
    No (none / 0) (#52)
    by Ga6thDem on Mon Jun 13, 2011 at 02:28:19 PM EST
    the swiss system is failing because health care costs have risen 50-60% in the last 10 years.
    link


    Parent
    fyi (none / 0) (#55)
    by CST on Mon Jun 13, 2011 at 03:10:14 PM EST
    that link is not working.

    Also... I would be carefull with that line of logic.  By that metric, the Canadian system is failing too.  As are a number of publicly funded programs, like medicare.

    Costs have gone up in the last 10 years across the board.

    Parent

    Exactly CST (none / 0) (#66)
    by AngryBlackGuy on Mon Jun 13, 2011 at 04:11:32 PM EST
    Although I think everyone here would prefer a straight public option or single payer, there are plenty of very good systems around the world that involve private insurance companies that do a good job of providing service and controlling costs.

    Parent
    Here's the thing ABG (none / 0) (#76)
    by lilburro on Mon Jun 13, 2011 at 05:44:51 PM EST
    at one point in this thread you say the ACA is good because

    It advances the concept of a global/government supervised healthcare umbrella and gets us a step closer to a public option.

    While here you suggest we will evolve into the Swiss system, which means no public options at all, including Medicare.  !!  This honestly makes no sense to me, and part of the reason why your sometime advocacy of the public option makes no sense.  BTD thinks the ACA won't work for X Y and Z reasons.  You seem to think the ACA will work, regardless of what it evolves into.  And I just do not share that faith.

    Parent

    Yes (none / 0) (#85)
    by Ga6thDem on Mon Jun 13, 2011 at 07:31:07 PM EST
    but 50 to 60%?

    I didn't say it was failing because of costs rising so much as how much they were rising.

    Parent

    Link doesn't work (none / 0) (#61)
    by AngryBlackGuy on Mon Jun 13, 2011 at 03:46:04 PM EST
    But I was able to find and read the article.

    The article does not mention our cost growth numbers. I would ask how the Swiss compare to spending in the US and the relative increase here. Healthcare costs are going to increase no matter what system we are under (every system in the world is experiencing cost growth at a fairly high rate).  Bending the curve is key and the Swiss curve looks a lot better than ours does.

    The Swiss system is failing if you see the impossibility of zero cost growth as the realistic goal.  No one really does. Here is a more realistic statement of where we are:

    "The 5.9 percent rate of spending growth in the United States is below the O.E.C.D. average of 6.6 percent, but the 30 countries in that group represent a broad continuum of economic development. Many of the nations with higher spending growth rates, like Greece and Turkey, are poorer countries that until recently spent very little on health care, said Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health. Those countries are trying to make up for their lack of investment.

    The picture looks quite different when one compares our growth rate with that in countries similar to ours, with higher incomes and higher costs but more government involvement. Health care spending in these countries -- France, Germany, Japan and Switzerland, among others -- actually grew more slowly than in the United States. "Economically competitive countries are able to control their costs better than we can," Mr. Anderson said."

    Link

    Parent

    The Swiss system is the second-most expensive in (5.00 / 1) (#99)
    by MO Blue on Mon Jun 13, 2011 at 08:56:09 PM EST
    the world. It is also one of the two with the most cost sharing and does not work in controlling costs.

    Tyler Cowen notes that the Swiss health-care system has fairly high out-of-pocket costs, suggesting that the Swiss health-care system views its patients as consumers, and yet Paul Krugman, who has derided the idea that the consumer-driven model could work for health care, has praised the Swiss system in the past. But in trying to nail Krugman, I think Cowen misses the story in his own data: The example of the Swiss system shows a) that the consumer-driven model doesn't work to control costs and b) the irrelevancy of the argument over whether individuals are consumers at all.

    If viewing patients as consumers works, and the Swiss are the best at it, then you'd presumably expect to see some large advantages to the Swiss system when you compare it to other European health-care systems. But you don't. In fact, the Swiss system is the second-most expensive in the world. They spend $3,000 less per capita than we do, but more than anyone else does. And they don't have a reputation for better outcomes, either. That the two most expensive health-care systems in the world are also the two with the most cost sharing seems to be a point for single-payer systems, not a point against them. link



    Parent
    Zero (none / 0) (#87)
    by Ga6thDem on Mon Jun 13, 2011 at 07:48:04 PM EST
    growth is a straw man argument. Costs are always going to go up but we have the most expensive healthcare system in the world and the ACA will do nothing but make it more expensive.

    The big thing that is going to make it fail large is the fact that it doesn't go into effect until 2014 and the insurance companies are going to sky rocket the prices between now and then so the majority of Americans will not be able to pay the prices in the exchanges.

    Parent

    Reading "a great deal" (5.00 / 4) (#46)
    by Anne on Mon Jun 13, 2011 at 01:30:27 PM EST
    doesn't count for much if it's all coming from OFA; propaganda is not the same as information.

    The fact that you persist in equating health insurance with health care, that you apparently think the subsidies will pay for care, as opposed to providing only a portion of premium assistance - just to name two basic elements that someone who makes claims to be informed ought not to have to be corrected about - tells me, and others, I suspect, that you really do not know what you are talking about on this issue most of the time.  

    You'd be better off to just say, "I support ACA because Obama told me to;" that would at least be more honest than the crap you keep trying to pass off as "information."

    Parent

    Anne (1.00 / 1) (#51)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:49:42 PM EST
    Let me make this idiot proof for you: The distinction you are making is stupid because even under a single payer system there is a distinction between care and insurance premium assistance. I believe that a universal system where you just walk in an get everything wrong with you paid for by the government is impossible in this country.  Any system will be based on a medicare type system where private doctors are renibursed by insurance companies.  In such a system, reimbursement and subsidies are a proxy for care.

    The only information I get from you Anne is that you have an inability to rationally discuss any topic involving Obama or anything he has done in a rational way because your hatred overwhelms your objectivity.

    As I have said before, if you don't like my stuff please feel free to ignore it, but if not, let's not pretend that you have some lock on accurate "information".  

    I could blow half of the crap you throw up here out of the water but I have too many other debates to have.

    But you know what. That's not a bad idea.  I wonder what it would be like if someone actually held your statements to the test . . .

    hmmm . . .

    Parent

    Go for it, ABG, please, let's see what (5.00 / 3) (#53)
    by Anne on Mon Jun 13, 2011 at 02:35:42 PM EST
    you've got.  I find it hard to believe that if you had something that could blow "half the crap I throw" out of the water, you wouldn't have used it by now.  With great relish, I'm sure.  Or maybe you're a catsup kind of guy - whatever.  I mean, what are you saving it for?  Do you think we're all just so blindingly stupid that, eventually, we will believe the nonsene you regularly post?  Come on, ABG, really?

    But, hey, I have a question for you: been over to Physicians for A National Health Program yet, or are you still too busy to bother?  Can't take a half hour to read their proposal, look over their FAQ's?  That's a shame. Lots of food for thought there.

    I don't think you know enough about single payer to make judgments about the stupidity or validity of my or anyone else's distinctions; if you did, you'd have more to offer than the equivalent of "that's stupid," or saying that single payer advocates wasted people's time and energy and caused the ACA to be what it is.  

    This is about more than agreeing to disagree, ABG, and I don't intend to let the gross misinformation and propaganda you regularly spout pass without comment.

    Parent

    There is nothing to believe (none / 0) (#88)
    by AngryBlackGuy on Mon Jun 13, 2011 at 07:54:23 PM EST
    If you hear someone say that they have the magic elixir that provides total care, increases no deficit and makes it all cheap you are talkin to the next Bill Gates because no one on the planet has been able to do that.

    We are looking for politically feasible solutions that don't solve every problem but address as many as we politically can.  In a world without a tea party focused on deficits much of what you say makes sense but that is not our world. As long as half the country thinks single pay or even a public option is socialist, we have to find remedies that can really pass as law.

    I agree with much of what you say but believe that your political instincts are terrible.  Elections must be won and right wing propaganda countered. Your arguments sell here but we need solutions that can grab the moderates and libertarians.  Otherwise your are just venting about fantasy.

    Note that I understand that u don't agree on likelihood of passage but I view that as your blind spot.

    Parent

    Heheheh ... "objectivity" lessons ... (5.00 / 1) (#56)
    by Yman on Mon Jun 13, 2011 at 03:14:04 PM EST
    ... from ABG.

    Gets me every time.

    BTW -

    I could blow half of the crap you throw up here out of the water but I have too many other debates to have.

    Don't bite off ABG.  Maybe start by blowing one thing she's said "out of the water".

    Heh.

    Parent

    Don't bite off ... (none / 0) (#73)
    by Yman on Mon Jun 13, 2011 at 05:16:16 PM EST
    ... "more than you can chew" ...

    Parent
    I am the focus (none / 0) (#89)
    by AngryBlackGuy on Mon Jun 13, 2011 at 07:58:12 PM EST
    Of a lot of critiques here because I am a contrarian on this and other issues. If I focused on Anne and held her statements up for the same level of scrutiny they would not survive intact.  That's my only point.  In a world of Dallas Mavericks fans, pulling for the Mavs was easy. The real test is how that fan hood holds up when your are in South Beach.

    I am bringing my talents to Texas and obviously it looks like I am doing a poor job but in the larger world, my Heat fan hood is pretty reasonable.

    Parent

    You are the focus of a lot of critique (5.00 / 2) (#94)
    by Anne on Mon Jun 13, 2011 at 08:15:51 PM EST
    not because you are a contrarian, but because your assertions largely do not hold up; they don't mesh with the facts.

    It's not like I'm the only one who counters what you say, and no one here - that I'm aware of - has any objection to having their comments subjected to scrutiny, so if you have something that actually supports your opinions, by all means, let's hear it.

    The thing is, ABG, with you it always seems to come down not to policy but to politician; put this same ACA under GOP authorship - which, considering that it is a warmed-over Bob Dole plan, it pretty much is - and I know you would be hating on it to a degree that exceeds even my own dislike.

    That's why you get a lot of the pushback you do, because most of us here are about the policy, and not so interested in supporting bad policy just because it benefits a particular politician.

    I feel like if you were to comment about the NBA finals in the same way you comment about all-things-Obama, you'd be telling us that the Heat won, that LeBron played his best games ever, and that whole thing about who actually has the trophy is meaningless.

    Parent

    Just because YOUR arguments ... (5.00 / 1) (#96)
    by Yman on Mon Jun 13, 2011 at 08:17:15 PM EST
    ... don't survive scrutiny doesn't mean Anne's arguments wouldn't survive scrutiny.  it's not about "fans" ... it's about facts and logic.

    Parent
    It's not that you're (none / 0) (#109)
    by sj on Tue Jun 14, 2011 at 04:39:43 PM EST
    "contrarian".  It's that you make stuff up and insist it's fact.

    Parent
    Third way (none / 0) (#29)
    by Yman on Mon Jun 13, 2011 at 12:33:51 PM EST
    3.  Having little to no cost control measures, it does nothing to control the rapid rise of healthcare costs and shrinking of coverage, fails miserably, and provides a convenient target for Republican to further push for even less government involvement/regulation of health care (i.e. replacing Medicare with vouchers, etc.).

    Parent
    Except (none / 0) (#39)
    by AngryBlackGuy on Mon Jun 13, 2011 at 01:06:26 PM EST
    That we would have that anyway.  The status quo was the other guys preference. The maximum that could happen is that costs goes up and we go back to what  we have right now.

    Your argument is somehow that we should stick with what we have right now to avoid ending up with what we have right now.

    Parent

    No - that's YOUR (straw) argument (5.00 / 1) (#49)
    by Yman on Mon Jun 13, 2011 at 01:44:51 PM EST
    My argument is that Obama should have fought for a plan with real cost controls, rather than the Republican plan of '94.

    Parent
    As Krugman acknowledges (none / 0) (#91)
    by AngryBlackGuy on Mon Jun 13, 2011 at 08:01:34 PM EST
    The republican plan had cost controls in mind as well.  GASP. I know people. Arguing that every GOP supported concept is evil is what you do to earn your liberal street cred but that's not me.

    The GOP is wrong about most things but they aren't wrong about everything. Claiming that Dole's crew supported the current solution isn't some kind of cursed concept for me,

    If a GOP concept gets us down the right road, give me the GOP concept.

    Parent

    BS (none / 0) (#98)
    by Yman on Mon Jun 13, 2011 at 08:20:45 PM EST
    The Republican plan "had cost controls in mind"?

    Pffffttttt ...

    BS ... not that you have a habit of repeatedly making it up as you go along, but show me the link where Krugman says that.

    Seriously.

    I'll wait.

    Parent

    And wait ... (5.00 / 1) (#102)
    by Nemi on Tue Jun 14, 2011 at 07:18:32 AM EST
    and wait ... and wait ... and ... zzzzzzz ;)

    Parent
    To be truthful, I didn't wait (5.00 / 1) (#106)
    by Yman on Tue Jun 14, 2011 at 11:01:54 AM EST
    I was distracted by a pig flying past my window and a news report of a frost-warning in he//.

    Parent
    I repeat (none / 0) (#58)
    by kmblue on Mon Jun 13, 2011 at 03:36:17 PM EST
    how will they pay the premiums?  See my real life experience above.

    Parent
    I did (none / 0) (#92)
    by AngryBlackGuy on Mon Jun 13, 2011 at 08:05:30 PM EST
    Answer you. Not everyone will be able to pay the premiums. I should have said that from the start. But many more people will be able to buy than can now. If millions can participate today that couldn't yesterday, we have done something. Not optimal but not something to sh,t on either.

    I never claimed that ACA solved everything and neither have any of it's proponents.

    Parent

    Well, sure (5.00 / 1) (#9)
    by lilburro on Mon Jun 13, 2011 at 11:26:53 AM EST
    it's a long term process.  But I am a little concerned that the process right now is "let's throw everything against the wall and see what sticks."  As far as I can tell, the exchanges if they are going to work have to be pretty well organized to allow real competition.  I guess the federal government's exchange is going to be somewhat robust from the get go, as I am sure quite a few states are going to shirk the responsibility of setting up their own exchanges.  I guess, but I still don't know, because it is unclear as to how all of this is going to work.  I do not envy Obama having to explain the ACA in the coming campaign season, because it is going to be very difficult to explain.

    Parent
    I agree (5.00 / 1) (#16)
    by AngryBlackGuy on Mon Jun 13, 2011 at 12:01:12 PM EST
    That it is going to be ridiculously complicated and messy, and very hard to explain.  However, I think a few watch words and phrases will come through:

    "pre-existing conditions"
    "your college grad kids get to stay on your healthcare when they come home because of the economy"
    "If you lose your jobs, this is a safety net"

    ACA ain't perfect, but it's massive legislation and there are a whole lot of goodies that are going to sound really good to a nation with a lot of people out of work.  We focus on the cost savings, etc., but the best thing about ACA is that if you are out of a job or broke, you are going to get taken care of in a way you weren't before.  That should resonate.

    Parent

    I agree with a lot of your comments on this (5.00 / 1) (#34)
    by CST on Mon Jun 13, 2011 at 12:41:28 PM EST
    But I disagree that the Dems will use this much during the campaign.  One of the big "misses" I thought in the legislation was starting most of it in 2014.  I realize they need time to ramp up, but it's going to be a very hard, if not impossible sell in 2012.

    In a twisted way, I hope health care is enough of a political bomb to kill Romney in the primary.  And I say that despite the fact that I'm relatively supportive of the MA healthcare plan.

    Parent

    I may be missing something (5.00 / 1) (#36)
    by lilburro on Mon Jun 13, 2011 at 01:01:47 PM EST
    but to my knowledge the ACA doesn't fundamentally offer a safety net if you are unemployed.  It's not like you automatically are eligible for Medicaid or anything.  It still comes down to the effectiveness of the exchanges and the subsidies.


    Parent
    A few tiny (none / 0) (#28)
    by TeresaInSnow2 on Mon Jun 13, 2011 at 12:33:02 PM EST
    things exist at the edges of the (un)ACA that are good, while the gist of the law is bad.  

    Keep the few good things...get rid of the rest.

    Parent

    To qualify for Georgia's (none / 0) (#57)
    by kmblue on Mon Jun 13, 2011 at 03:34:48 PM EST
    preexisting condition insurance , I would first have to go without insurance for six months.  Then the premium would be 50 bucks less than what I now pay Kaiser Permanente.  The Government plan also has a two thousand deductable to be met, plus a pharma deductible.  No deductables with my Kaiser policy.  It was the ONLY one I could get after I was laid off.  It's called a "conversion" policy.

    As much as I wince when I write my humongous check to KP every month, I am terrified to be without health insurance.  The payment is more than my mortgage, and I am out of work.

    Tell me something good about the exchanges.
    What always goes unsaid is no one can afford the premiums.  And, according to the New York Times, very few people are signing up.


    Parent

    I was directed to (none / 0) (#59)
    by kmblue on Mon Jun 13, 2011 at 03:40:38 PM EST
    the above information by your friendly FEDERAL government webpage when I asked for help.

    Parent
    one huge thing (none / 0) (#63)
    by CST on Mon Jun 13, 2011 at 03:47:16 PM EST
    that's missing here is that the plan under the ACA has not been set up yet.  Anything outhere today is just a stop-gap (catastrophic insurance).  I believe it's not until 2014 that plans are required to cover preexisting conditions on the regular plans.

    I recognize that's not very usefull to you today.  But what's happening today is not a particularly usefull metric to measure the ACA by, since most of it is not up and running yet.

    Finally, there is no federal health insurance exchange yet.  So it's not surprising that "very few people are signing up"... there are I think 4 states that have started their own, one of which is MA and has had it for ages.  And iirc one of the initial problems in MA was that there were too many people who signed up.

    Parent

    Let's keep what this is in focus (none / 0) (#65)
    by AngryBlackGuy on Mon Jun 13, 2011 at 04:00:16 PM EST
    This gets insurance to people who couldn't get ANY insurance before ACA, even if they paid twice the Kaiser premium.

    You agree?

    The program you reference disappears in 2014 to be replaced with something that will unquestionably be better from a cost perspective.

    And at that point, if you make a low enough amount, you get subsidies which keep your costs under control.  The federal government is guaranteeing that you aren't paying more than 9.8% or so of your income for your share of costs if you are below a certain income threshold. Would I like it to be 5%? Yes.  But 9.8% guarantee is better than the 0% guarantee you have right now.

    Parent

    I'm sure he will boil it all down to (none / 0) (#10)
    by Anne on Mon Jun 13, 2011 at 11:35:39 AM EST
    the usual, "if you like your doctor/the insurance you have, you can keep him/her/it;" it's worked in the past to delude people into thinking something is what it isn't, so I don't expect much deviation now.

    Given that the exchanges aren't in place, and there's no real-life experience to clutter up the discussion, Obama's going to say pretty much what he wants to - and how many people will know if it's right?

    Parent

    No real life experience works both ways (none / 0) (#11)
    by MO Blue on Mon Jun 13, 2011 at 11:39:56 AM EST
    Republicans can and will continue to frame it adversely. Unfortunately, they won't even have to lie but of course they will.  

    Parent
    Ahh, but see you and all who keep saying it (none / 0) (#110)
    by vicndabx on Tue Jun 14, 2011 at 06:13:04 PM EST
    are wrong

    Years of experience is already on the books w/an exchange.  It's why the method was agreed to by Congress.

    Wish people would stop spreading falsehoods.

    Parent

    Throughout my federal career, (none / 0) (#115)
    by christinep on Tue Jun 14, 2011 at 10:42:30 PM EST
    the exchange process was informative, transparent, and competitive. It worked--works--well.

    Parent
    Well the FEHB (none / 0) (#118)
    by lilburro on Wed Jun 15, 2011 at 08:51:17 AM EST
    has a pretty big pool of people to work with.  And the subsidy levels are going to be anywhere near what the FEHB has to offer, based on this anyway.  If I could get $428 worth of health insurance a month and only pay $100 a month out of my own pocket for it, I can tell you, I would not be complaining.  As it is when I calculate my subsidy using Kaiser's tool, it says the government will cover about $375 of my insurance over the whole year.

    Parent
    Medicare for All could've passed (5.00 / 2) (#12)
    by Dadler on Mon Jun 13, 2011 at 11:44:51 AM EST
    All it required was imagination behind it.  There is zero of that in DC, however.

    When facts are on your side, the only way you lose is by being weak and cowardly and creatively vacant.  

    All the other political b.s. is just that.  The facts and truth are on the side of Medicare.  If you can't sell that, it's no one's fault but your own.  The right would fight it hard?  Big phucking deal, they couldn't find their heads with a hat and a mirror.  You hire the best comic and satirical minds you can, you craft a campaign of unprecedented skill and entertainment value (since you MUST entertain a person's mind to engage them in anything), and you watch the right squirm like the empty nothings they are.

    But, oh no, we can't think too big or creatively.

    Jaysus, pathetic.

    Medicare for All (5.00 / 1) (#14)
    by Coral on Mon Jun 13, 2011 at 11:52:32 AM EST
    could have passed at least as a "public" option alternative (a buy-in to Medicare as one option on the exchanges for under-65, with subsidies for qualifying incomes).

    I don't think it would have needed imagination, just a really vocal and sustained campaign by Obama and more progressive Senate/House leaders.

    They capitulated from the get-go. Even the weak ACA we have now would not have passed if it had been solely up to Obama. Pelosi played a major roll in getting it through.

    As an MA resident, I was very skeptical about our plan, but it is working to get people insured who would not have insurance anywhere else in the country (not sure about a couple other states). I know several of those people, who have subsidized plans but would not be insured under Medicaid.

    So, despite my unhappiness with the outcome of the national push for health reform, I agree with Krugman that it is better than nothing. (But I wouldn't describe it as half a loaf, more like a quarter of a loaf).

    Parent

    From everything I've read, using Medicare (5.00 / 1) (#20)
    by Anne on Mon Jun 13, 2011 at 12:13:24 PM EST
    as "the public option," allowing people to buy in, would not level the playing field, or reduce costs.

    For example:

    The "public plan option" won't work to fix the health care system for 2 reasons.

    1 - It foregoes at least 84% of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even 95% of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16% of the roughly $400 billion annually achievable through single payer - not enough to make reform affordable.

    2 - A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as the single payer for seniors and has now become a funding mechanism for HMOs - and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients; with profitable ones in private plans and unprofitable ones in the public plan.

    And if you will forgive me for continuing to repeat this, everyone having insurance is no guarantee that everyone will get care they can actually afford; the goal from the start should have been on care, not insurance, and it is because the powers-that-be insisted we had to leave the insurance companies more or less in charge that we will continue to spend more and more and more, and none of the brainiacs responsible for this "reform" will understand why that is, or why we are no healthier.

    This wasn't failure of imagination, it was gross failure of Congress' and the president's civic responsibility to the people of this nation, to the benefit of those who got us to this crisis in the first place.

    Parent

    Joe Lieberman (none / 0) (#37)
    by christinep on Mon Jun 13, 2011 at 01:02:28 PM EST
    Senator Joe, as I recall, held (controlled) the deciding vote...and, he publicly pulled the rug out from under ACA expansion in that regard. (Now, Senator Joe has announced that he favors increasing the Medicare age to 67. Yep, that Senator from Connecticut...the home of so many insurance companies.)

    Really. Krugman is correct about the reality of the votes not being there at the time.

    Parent

    I believe that this is (none / 0) (#17)
    by AngryBlackGuy on Mon Jun 13, 2011 at 12:02:32 PM EST
    completely false.

    No one has anyway of proving who is right, but that is why these discussions end up at an impasse.  Where you are on ACA depends almost entirely on that question.

    I think this is what I posted in my very first comment here 4-5 months ago.

    Parent

    Of course it was impossible (5.00 / 1) (#21)
    by MO Blue on Mon Jun 13, 2011 at 12:13:35 PM EST
    because Obama made back room deals with the industries so that it would either not get on the table or pass the talking stage.

    Parent
    MO Blue (1.00 / 1) (#24)
    by AngryBlackGuy on Mon Jun 13, 2011 at 12:26:46 PM EST
    Well that's all just horsesh*t IMHO, but why even argue about it.  

    I believe people that wasted our time talking about single payer gave conservatives ammunition to distract from the real legislation and made ACA far less beneficial than it otherwise could have been.

    Prove me wrong.

    See what I mean.  It's just a silly way to think about that stuff at this point.  

    Parent

    A little horsesh*t (5.00 / 1) (#31)
    by TeresaInSnow2 on Mon Jun 13, 2011 at 12:37:03 PM EST
    for you, regarding the backroom deals with Pharma:

    Link

    You'll have to google the rest of the horse* yourself.

    Parent

    Obama's backroom deals were widely (5.00 / 2) (#43)
    by MO Blue on Mon Jun 13, 2011 at 01:26:54 PM EST
    reported. You just chose to ignore what is in the public record.  

    The fact that the Obama administration sold out reform in deals with different health care industries, like the drug companies and the hospitals, was widely reported. Senators even publicly admitted in the Senate hearings themselves that provisions were sold in exchange for campaign money.
    ..
    Given the widely reported facts, to not believe that the health care reform law (lacking a public option, providing massive subsidies for private insurance companies, and forcing people to be their customers) dramatically resembled the health insurance companies' reform proposal would require one to actively engage in willful ignorance. link

    Let's look at the back room deal with the hospitals more closely:

    In his book, Daschle reveals that after the Senate Finance Committee and the White House convinced hospitals to accept $155 billion in payment reductions over ten years on July 8, the hospitals and Democrats operated under two "working assumptions." "One was that the Senate would aim for health coverage of at least 94 percent of Americans," Daschle writes. "The other was that it would contain no public health plan," which would have reimbursed hospitals at a lower rate than private insurers.

    I think the agreement not to include any public health plan would encompass single payer, an expansion of Medicare and any real public option.

     

    Parent

    Where "backroom deal" means (none / 0) (#67)
    by AngryBlackGuy on Mon Jun 13, 2011 at 04:19:11 PM EST
    typical negotiations you have to do to come to a deal everyone can agree on.

    Take that hospital concession for example.  What happens if hospitals don't accept the $155 billion in pay reductions.  What happens if we try to pass a public health plan and the hospital industry bands together to put all of its dollars into advocating against healthcare reform.

    Answer: No healthcare reform.

    The primary fallacy of your point is that healthcare reform would have passed over the objections of the insurance industry, the hospital industry, the pension funds around the country that would have crashed after their insurance stocks lost 30% of their value, etc.

    Whenever someone says "just give us a public option" they have no idea the ripples that it would have created. It would have destroyed a massive number of jobs.  Would it have been worth it? It would have destroyed a massive amount of pension value in the middle of a recession.

    The simplistic way in which the public option and single payer are discussed ignore the ramifications of what the people actually looking at the overall economy have to deal with.


    Parent

    Oh, I see that you have changed your (5.00 / 2) (#90)
    by MO Blue on Mon Jun 13, 2011 at 08:01:28 PM EST
    tune from it was completely Horsesh!t that Obama made back room deals to eliminate any possibility of any form of a public option.  So now you agree that Obama did in fact make the back room deals that were referenced and you jump to spouting the insurance industries propaganda that it would destroy jobs and end the world as we know it. I see that CST did a good job of debunking that while I was gone.

    We will never know if real health care reform would have passed since Obama chose not to pursue actual affordable health but instead chose to make back door deals with the industries. What we do know is that prior to these deals, 70% of Americans supported implemented a public option like Medicare.

    Parent

    the pubilc option (none / 0) (#69)
    by CST on Mon Jun 13, 2011 at 04:26:56 PM EST
    would have also required new jobs to implement.  It's just trading the private sector for the public sector.  You don't necessarily eliminate work, you just change the type of job.

    Also, the public option as it was originally introduced only served a few people.  The basic premise behind support was that it would eventually be expanded to include more people.  But it would not have caused a catastrophic failure of the system.

    And in general, I think if we've learned anything over the past few year it's that the economy and government regulations can not be a complete slave to the stock market.  Because then it will always be beneficial to sell the people out.  But just because you have a 401k or a pension, doesn't mean you can afford health care.

    Parent

    It would have been a fraction of the jobs (none / 0) (#70)
    by AngryBlackGuy on Mon Jun 13, 2011 at 04:44:24 PM EST
    you never hear this argument because there was no consituency to press it, but the non-healthcare related impacts were one reason that the public option was never going to fly.  It can be summed up as follows:

    1. The elimination of thousands of jobs due to the shirkage of the insurance industry and immediate cut to profits.  This is fine from a big picture perspective but we were talking about doing it during a recession. The same arguments BTD uses to show the impact of direct stimulus, you could transfer to this scenario to see how immediate and direct the hit would be.  For years the companies would try to maintain their current profit levels by firing people and squeezing existing customers even more.

    2. Insurance company stocks, which are held by every major pension and index fund would tank.  It would have direct impact on 401K's which would ripple and strengthen itself.

    3. The cost benefits wouldn't kick in for years and that means that SS would be under even more direct attack than it is right now. The idea that we'd be able to add a massive new entitlement program and hear nothing from conservatives about cutting something else is not realistic.


    Parent
    here's the problem with everything in this comment (5.00 / 2) (#72)
    by CST on Mon Jun 13, 2011 at 04:52:54 PM EST
    you are ignoring the reality of the public option that was on the table.  It was not going to start out as a "massive new entitlement program".  It was a relatively minor inclusion that was only going to be available to a number of people.  And it was going to pay for itself by charging people a premium, just like an insurance company.  And it would have required people to run it.

    So if it is "fine in the big picture perspective" - then you have to acknowledge that it was never going to happen in the short term perspective, because in the short term the public option was a very minor benefit.  It was never more than a foot in the door, not an immediate overhaul.

    And again, it would be self funded.

    If you are that worried about the short term impact to insurance companies, but long term are okay with those changes, you have to admit that designing it to be a slowly expanding program would have worked.

    Parent

    CST (none / 0) (#74)
    by AngryBlackGuy on Mon Jun 13, 2011 at 05:38:40 PM EST
    The public option you describe would not have had the effects and benefits that are often described by ACA haters here.  It would be too small and insignificant to create a real pull on costs. For example, a self funded PO could not have been (1) cheap and (2) self funded simultaneously.

    But let me take a step back though. A limited targeted PO of the kind you suggest would have been possible I think and I'd have supported it strongly.

    But I think that if it had passed, what you would hear around here was even more anger that an across the board subsidized PO wasn't passed and that the tamer PO was just a way to avoid real change.

    It is for that reason that I don't even consider the PO you propose in discussing this with folks like Anne.

    Parent

    I think (5.00 / 1) (#77)
    by lilburro on Mon Jun 13, 2011 at 05:48:02 PM EST
    you underestimate the investment people had in the PO and the preference people had for a PO of some kind.  As far as I know Anne was never into the public option.  So you two would still be debating but you would find more supporters of the ACA here.

    Parent
    Also, it is interesting to me (5.00 / 2) (#78)
    by dk on Mon Jun 13, 2011 at 06:00:14 PM EST
    that ABG asserts the health insurance lobby's assertions regarding dramatic net employment reduction and stock market collapse as truths without even one objective shred of support, while the rapid introduction of medicare in the US, and single payer in Canada, provide analogous historical refutations of such doomsday scenarios.

    What I find interesting regarding ABGs comments in these discussions is the seamless toggling between his opposition behind real healthcare reform.  Sometimes it's "political reality" and sometimes its on the merits.  It's when he argues on the merits that the real inconsistencies come out (i.e. while claiming to really be behind single payer/public option, he gets behind the doomsday scenarios for introducing exactly such programs and touts the failed Swiss model).  At least with the political argument there is consitency, even if it's easily refutable.

    Parent

    dk, the inconsistency is the result of (5.00 / 4) (#82)
    by Anne on Mon Jun 13, 2011 at 06:27:18 PM EST
    ABG having to constantly pivot to always deliver the message that supports Obama; it's really just that simple.  Time and again, he will contradict himself not just in successive comments, but in the same comment.

    The one thing he never addresses is why, with the economy so fragile, and so in need of strong action on jobs, Obama chose to waste 18 months on a "reform" plan that isn't even going to be fully implemented until 2014.  The end result is that (1) we have sunk deeper into unemployment such that (2) people who really could use some help with their health care have been told to "just wait" - help is only three years away.

    I am a strong advocate for single-payer, and do not believe that a so-called public option would have been the answer to the problems that have been caused by the insurance industry; it was never more than a bumper-sticker and it sucked a huge amount of energy out of the entire effort to truly reform the system.  People a lot smarter than I am have spent years examining this issue, and have, over the years, come up with many of the answers to the objections raised by opponents.  I don't demand that everyone believe as I do - I understand that others have other ideas - but I have a certain level of expectation of honest engagement on the issue, and that honesty is not a possibility when those who want to argue in opposition to single-payer do not bother to educate themselves on the subject.

    I am, frankly, just completely over these people who can only tell us why we can't do something -  and don't even get me started on those who are only for or against something because of the position of the politician he or she supports; I know without a doubt that if Obama was for single-payer, none of the arguments ABG makes against it would be in evidence here.

    And I anxiously await him "blowing me out of the water;" I might have to pop some popcorn for that!

    Parent

    It's all of the above (justifications) (none / 0) (#93)
    by AngryBlackGuy on Mon Jun 13, 2011 at 08:14:33 PM EST
    And don't confuse realpolitik ABG with perfect world ABG.  Perfect world ABG agrees with almost everything said here but Real World ABG is depressingly contrarian about what could be done.

    I hate that I can't clearly distinguish the two sides in these discussions, but know that at heart I agree with what the best solution would be. I just don't think it was possible.

    And that is for reasons both political and macro economic.

    Parent

    Thanks ABG (none / 0) (#100)
    by christinep on Mon Jun 13, 2011 at 10:10:46 PM EST
    for taking the time and making the effort to be so responsive to each in your advocacy for the ACA. I agree with you, in most respects. (Right now, tho, I'm lacking the emotional energy to make the arguments for compromise, advancement, improvement, and the existence of realpolitik that you have spelled out...so, again, thank you.)

    As you stated earlier, the "preexisting conditions" changes--by itself--is worth it. The expansion to so many millions more is worth it. The attempt to subsidize is worth it. The requirement to use a stated percentage on healthcare rather than overhead is worth it.  Etc. etc.

    Where so many are now: Standing in place. Nonetheless, you must keep restating, pushing, explaining.  

    Parent

    last few thoughts on this (5.00 / 1) (#80)
    by CST on Mon Jun 13, 2011 at 06:16:17 PM EST
    you are right, some people would be annoyed still, but it would not be as many - the loudest opinions are not necessarily the most common, if you know what I mean.

    The point of a public option was that it would keep the insurance companies honest.  But in order to do that it would have to be viable - i.e. pay for itself.  The whole idea behind it is that insurance companies are taking too much off the top, and a public option would be cheaper even though it was still self funded.

    Finally, and more importantly, I think it would have been better policy, commenters here be d@mned.  A real "foot in the door" to more public health care, because it would have been popular, and then expanded upon.

    I support the ACA as it is because I believe it does significantly more good than harm.  But a public option would have made it so much stronger in the long term.

    Parent

    The argument against the (5.00 / 1) (#81)
    by dk on Mon Jun 13, 2011 at 06:26:27 PM EST
    "public option for a few" (or at least one of them) is that such a situation was designed to fail.  I.e., unless the healthy and non-poor were allowed to participate, it would not be economically viable, and thus the concern that it would not only have not kept insurance companies honest, but that it would through its economic non-viability have been used by moderate democrats (such as those who agree with ABG that the Swiss model is better...at least the ABG that made that argument, as opposed to the ABG that likes single payer) and republicans to create antipathy toward a government admnistered health insurance plan available to all that according to a New York times in June 2009 has the support of almost 70% of the U.S. population.

    Parent
    that's one opinion (none / 0) (#83)
    by CST on Mon Jun 13, 2011 at 06:39:54 PM EST
    I do not share it.

    A lot of the people that would have been "allowed to participate" were younger, poor people, that are relatively healthy.  Basically it was people who weren't insured with medicare and didn't have an employer option available.  That list includes a whole lot of rather healthy waitresses, etc...

    Parent

    Just wanted to at least (none / 0) (#84)
    by dk on Mon Jun 13, 2011 at 06:40:59 PM EST
    get the argument out there, since you had left it out in your comment.

    Parent
    CST (none / 0) (#95)
    by AngryBlackGuy on Mon Jun 13, 2011 at 08:16:09 PM EST
    Very fair position to have.  No gripes from me on what you wrote above and I agree.

    Parent
    Oh and BTW we are arguing about it since (5.00 / 3) (#47)
    by MO Blue on Mon Jun 13, 2011 at 01:35:11 PM EST
    you continually equate insurance with care and because I believe that it is important to point out the reason that we do not have an affordable system that will provide actual health care is because Obama traded real health care away for campaign contributions.

    The fact that you think it is great for Americans to pay 2 - 3 times more for health care and 35 - 50% more for prescription drugs so that Obama can get campaign contributions from his savvy friends goes way beyond silly IMO.

    Parent

    How do you disprove a fairy tale? (none / 0) (#30)
    by Yman on Mon Jun 13, 2011 at 12:36:08 PM EST
    My daughter believes Santa is real.

    Prove her wrong.

    Parent

    BTW - All of WHAT is h0r$e$hit? (none / 0) (#33)
    by Yman on Mon Jun 13, 2011 at 12:37:17 PM EST
    Obama's backroom deal with the health insurance companies?

    Seriously?

    Parent

    Please provide proof or a link to a article (none / 0) (#111)
    by vicndabx on Tue Jun 14, 2011 at 06:20:13 PM EST
    of any talk of deals.  As far as I know, there were some meetings, but no "deals" along the lines of your comments.

    Parent
    Apparently, you failed to follow the (none / 0) (#112)
    by Anne on Tue Jun 14, 2011 at 06:26:28 PM EST
    links provided in this comment by MO Blue.

    Sound like deals to me.

    Parent

    I did (none / 0) (#113)
    by vicndabx on Tue Jun 14, 2011 at 06:37:23 PM EST
    it was an opinion piece w/nary a single link to a deal w/insurance companies.

    Big pharma, medical service providers, yes, Health Insurers, no.

    Parent

    See the Frontline Program ... (none / 0) (#114)
    by Yman on Tue Jun 14, 2011 at 08:31:22 PM EST
    ... "Obama's Deal", for an example.

    Here's a relevant clip from the program.  Ignagni and the health insurance companies got him to flip on the individual mandate and kill the public option.  Pretty good deal ...

    ... for the insurance companies.

    Parent

    Obama threw insurers under the bus (none / 0) (#116)
    by vicndabx on Tue Jun 14, 2011 at 11:11:55 PM EST
    That there would be some initial discussions is no surprise.  However, the "back-room deals" were done in the Senate.  The desire for a mandate in exchange for guaranteed issue, no pre-existing conditions, expanded coverage etc. was not some new idea.

    See Chapter 5, Obama Takes Back Control


    Parent

    Further evidence (none / 0) (#117)
    by vicndabx on Tue Jun 14, 2011 at 11:39:51 PM EST
    And as far as AHIP and Ignagni, the report [PDF], when they released the report, how did the White House view that? Did that just feel like a double cross or what?

    Absolute dishonest double cross. They had never been at the table, but they'd been hovering around the table. They were in this place of not supporting health reform but not opposing it, either. But they did say if they were going to change their position that they would let us know.

    Frontline interviews Dan Pfeiffer

    Parent

    Yes, the WH Communications Director ... (none / 0) (#120)
    by Yman on Wed Jun 15, 2011 at 09:55:50 AM EST
    ... characterizes the insurance companies as "hovering around" the table versus "sitting" at the table, whatever that means.

    After Obama had caved on individual mandates with no public option in an effort to win their support - or at least keep them on the sidelines.  After Obama had made backroom deals with Pharma and providers, breaking several campaign promises.  After the Whitehouse negotiated a bill that (as Nancy Pelosi pointed out), was based on an old proposal from the Heritage Foundation and effectively identical to what AHIP, the for-profit insurance company lobby, ask for in 2008.

    Parent

    Are you seriously suggesting ... (none / 0) (#119)
    by Yman on Wed Jun 15, 2011 at 09:45:05 AM EST
    ... that the deals were only the responsibility of the Senate?  Do you think they made these deals without the involvement of the WH?

    From your own link ... "Emanuel (i.e. the Whitehouse) and Reid were now doing deals just to win over Democrats.  They killed the public option, pleasing Sen. Lieberman and others.  They lowered proposed taxes for medical device makers, for Evan Bayh..."

    The "Cornhusker Kickback", etc., etc.

    No, these deals were not finalized directly with the insurance lobbyists.  They were made to win over Senators who were advancing the interests of the insurance companies, like Lieberman.  The negotiations were, however, started with direct negotiations with the insurance companies, and were made after Obama gave them the biggest gift of all - individual mandates, an idea he previously ridiculed.  They finished with Obama breaking his promise for a public option in order to get enough votes to pass something.  All of which occurred behind closed doors, directly contrary to Obama's promise to hold the HCR negotiations in public, televised on C-SPAN.

    Yes - Obama made backroom deals with Pharma, providers, and the insurance companies.

    Parent

    This is just so dumb (5.00 / 5) (#50)
    by NYShooter on Mon Jun 13, 2011 at 01:48:14 PM EST
    All the debating, the minutia, the arguing. Ask the American public today, "what are the exchanges?"  90% wouldn't have a clue.

    Here's how this whole "health care" issue developed:
    Obama, and his team, pretended to want "affordable health care for everyone."
    The Republicans pretended to want the same thing, but do it in a fiscally responsible way.

    But the truth is, what both sides wanted was higher profits for the "health care" industry under the guise of expanding health care to everyone, and at a lower cost.

    Since the goals are directly opposed to each other the only question for both sides was, how do we market this pile of bull crap in a way that tricks the public into believing they're getting something good while, in reality, reducing care & affordability being the vehicle of increasing industry profits.

    They did it with the Bail-Outs to the Banks, why not, rinse and repeat, with "Health care?"

    Like I said above, ask anyone what an "exchange" is? They won't know. Ask them why the largest customer for drugs in the world isn't allowed to negotiate for lower prices? That, they'll know.

    It's a "rip-off," it doesn't get any simpler than that.


    Great discussion (5.00 / 1) (#97)
    by AngryBlackGuy on Mon Jun 13, 2011 at 08:17:45 PM EST
    By the way. I learned a lot. This is why I come here.  Good post BTD.

    I think his likely response is: it works in MA (none / 0) (#1)
    by andgarden on Mon Jun 13, 2011 at 09:21:03 AM EST


    Funding in MA (5.00 / 1) (#2)
    by Big Tent Democrat on Mon Jun 13, 2011 at 09:28:42 AM EST
    given the politics, is a more certain thing than funding by the federal government under ACA.

    Parent
    i think (none / 0) (#3)
    by observed on Mon Jun 13, 2011 at 09:33:51 AM EST
    Medicare for all property owners could get bipartisan support
    Health Care - Single Payer Wiil Work Fine (none / 0) (#54)
    by RootBeer on Mon Jun 13, 2011 at 02:47:15 PM EST
    Hello

    America has deep economic troubles now. Who did this to us? As I see it, America (that's all of us, the public) ought to bring those guys to Justice. There is a name for those guys and they all work for America Inc. Corporations are not the solution. Corporations are the problem. Our economic trouble was not the result of spending on our social, cultural, public health care or hot lunches for our youngsters at school or public school teachers who get paid and have earned a retirement pension.

    America Inc. are the folks who originated the battle cry: Lower Taxes. Less Spending. Clearly America Inc. is in a battle now to dismantle our U.S. Government - Federal / State / and Local. Lower Taxes: more of your money available for America Inc. Less Spending: more of your money available for America Inc. Our society and culture take your money out of the accounts of America Inc. America Inc. wants to stop all that. America Inc. wants the military / industrial / media complex to be paid with your money, along with multinational oil corporations. America Inc. has no interest in seeing your money going to public health care, PBS, hot school lunches for your children. Your Health Care money ought to go to Corporations, as America Inc. sees it. This battle is all about America Inc. taking over American life. It is not pretty. That's it. Stay Tuned.

    JOHN LONGENECKER
    The Root Beer Float Party - Founding Member
    JLemail14@GMail.com - 213 273-3661

    IIRC, Krugman has been weak (none / 0) (#79)
    by observed on Mon Jun 13, 2011 at 06:07:21 PM EST
    on acknowledging the problem of regulatory capture in the past. Isn't that the biggest issue with exchanges?

    We all know ... (none / 0) (#103)
    by Robot Porter on Tue Jun 14, 2011 at 08:16:48 AM EST
    that in poll after poll for more than a decade a majority of the public supported a "medicare for all" option.

    But in this day and age a minority of insurance companies is more valuable to pols than a majority of the public.

    Sigh.

    Medicare For All | 120 comments (120 topical)

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