Is This Healthcare Reform Or Just Assistance To Health Corps?

I have a busy morning here, but want to draw attention to an article this morning in the New York Times by Robert Pear on the ongoing discussions of healthcare reform for the United States:

Since last fall, many of the leading figures in the nation’s long-running health care debate have been meeting secretly in a Senate hearing room. Now, with the blessing of the Senate’s leading proponent of universal health insurance, Edward M. Kennedy, they appear to be inching toward a consensus that could reshape the debate.

Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance.

“There seems to be a sense of the room that some form of tax penalty is an effective means to enforce such an obligation, though only on those for whom affordable coverage is available,” said the memorandum, prepared by David C. Bowen, a neurobiologist who is director of the health staff at the Senate Committee on Health, Education, Labor and Pensions.

The proposal for an individual mandate was one of the few policy disagreements between Mr. Obama and Hillary Rodham Clinton in their fight for the Democratic presidential nomination. She wanted to require everyone to have and maintain insurance. He said he wanted to “ensure affordable coverage for all,” but would initially apply the mandate only to children.

The 20 people who regularly attend the meetings on Capitol Hill include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce.

"Many of the parties, from big insurance companies to lobbyists for consumers, doctors, hospitals and pharmaceutical companies, are embracing the idea that comprehensive health care legislation should include a requirement that every American carry insurance." Yeah, no one could have anticipated that I guess. It suggests that those allowed in these discussions are overwhelmingly tied to the current system; few if any represent alternative approaches. So what is Kennedy’s staff doing? And why are people sworn to secrecy? Surely this deserves more light. With regards to "mandate," the mandate they’re talking about is everyone required to purchase insurance. That does little to control total costs, which is the macro issue that drives the long-run insolvency claims about Medicare/Medicaid and the fact that US costs are higher than elsewhere.

If everyone must have PRIVATE insurance, that’s full employment and industry expansion beyond that for the insurance industry. OTOH, if we move to universal care and single-payer, that cuts the throat of the private health insurance industry. I know which seems more palatable to me. I’ll be honest, I had to struggle to find anything positive to say at all about the things laid out in Pear’s article. There is maybe some help in this for the truly poor. Pretty clear though that for the rest of the country, they are going to keep getting raped as usual on healthcare; perhaps even more so. This doesn’t do squat for anybody in my family, nor anybody I know. I understand that is not the overriding criteria of judgment, but it does matter to me. But we are going broke paying for medical insurance because we all have to buy individual policies that don’t provide that great of coverage and cost a fortune.

We only need the mandate because we refuse to consider true national health insurance. Obama was focussed on bringing costs down during the campaign–the best way to get costs down, despite his protestations, is to get the ones who use the service least to pay into the pot.

If the gov’t was going to offer a program that undercut the private plans (which it easily could because of efficiency), it would theoretically drive private costs down or drive private insurers out of business. . . which would mostly be fine with me. However, with a medicare-for-all model as a competitor, we could make that mandate seem much less burdensome to individuals (and less expensive to the federal gov’t). . . and those that wanted to keep private insurance or demand supplemental plans from the market could do that. . . which sounds like a much freer market solution than the one we have, or the patchwork I expect to get.

As I have said for a long time now, the proper way to craft and pitch a doable healthcare reform is to make it "Medicare For Everyone!"

[The thoughts expressed in this post, aside from the Pear NYT quote, are an amalgamation of those from a discussion I had online with a few extremely bright good friends]

84 replies
  1. Alison says:

    This is nuts. Compulsory purchases without a public alternative, kind of like the Medicare pharmacare doughnut hole.

    Really ugly, really cowardly.

  2. oldtree says:

    The meatbags are starting to feel the heat. Kennedy must be laughing at them now that he realizes his time is short and he has a chance to give all of us the same care he gets. I guess things will be different after the fall of Romerica. Imagine paying for healthcare? How absurd.

  3. jdmckay says:

    The only reason Biz Roundtable & industry groups are getting on board now: a recognition that they’ve drained so many unproductive $$ from an economy which now can’t afford to pay for any of this stuff, their only alternative is to plug into the federal trough.

    Any compromise support from these guys will last only until some recovery takes hold, at which time their “free market” genes will once again take over. Unless, of course, some kind of fundamental change is forced upon how they conduct themselves.

    • bmaz says:

      Yeah, contrary to folks who think that hard reform cannot be done in these times of economic failure, I think now is the perfect time to do it. And make it single payer, or close thereto. Let’s use the shock doctrine to our benefit for once.

    • readerOfTeaLeaves says:

      “Fundamental change”, indeed. This issue has been held hostage by the lobbying class.
      And doctors have to spend too much time doing paperwork for insurance companies who are calling the shots on quality of care.

  4. readerOfTeaLeaves says:

    But we are going broke paying for medical insurance because we all have to buy individual policies that don’t provide that great of coverage and cost a fortune.

    The ‘market’ is good for many things.
    But not for health care.
    And we’ve just been through 28 years of ‘market fundamentalism’ in which stupid, fallacy-riddled economic ideology was applied to health care delivery.

    The fact that these people are meeting is a good thing if it moves us toward solving a very complicated set of problems. One of those is separating health care, research, and education from the false ideology of market fundamentalism.

  5. Loo Hoo. says:

    Wow. I just went online for insurance for my 20 year old daughter. I’ve covered her through work, but soon she’ll be ineligable. Checking out Kaiser Permanente costs online. (I love Kaiser)

    The Deductible 20/500 plan offers higher monthly rates and moderate, fixed copayments for preventive care services. Additional services are subject to the deductible. $195.00

    She’s a student and works at Blockbuster…One week of every month’s wages would go for healthcare. Oh, and it’s an extra $25 per month for dental.

    • jdmckay says:

      Oh, and it’s an extra $25 per month for dental.

      I can tell you from experience w/them that Delta Dental “insurance” charge is going to cost more for dental work than w/out.

    • conniptionfit says:

      Loohoo, she should be eligible for coverage under your plan as long as she’s going to school, I think. My 20 yr old is.

  6. laurastrand says:

    Geez . . . ask anyone seriously ill and insured just how good their coverage and care are.
    My personal opinion is that a really good plan would either look like – or preferrably be the plan designed by former CA Senator Sheila Keuhl – SB 840 – a comprehensive, single payer plan for all, covering the uninsured by using the funds that currently go to the industry. The details include all kinds of metric for determining outcomes and best practices. That it completely gets rid of the industry (who consider actual care as a loss – of profits) is the part that makes me the happiest. The immediate cost savings to employers is significant.

    • aine says:

      You describe the solution clearly. The obvious way to pay for single payer is to use the money people like me are already paying in insurance premiums; instead of paying for “insurance” I would be investing in the nations health care. Like any good investment, the health care would be available to me when I need it.

      Health insurance is just the opposite. You pay for health insurance when you are healthy and able to work, but you build no future right to health care with your insurance premiums. If an illness or injury keeps you from working for an extended period of time and you can’t pay your premiums, you lose your access to health care at the point you stop paying your premiums.

      Try getting chemotherapy when you are sick and have no way to pay and you don’t meet the severe level of poverty needed to qualify for SSI and Medicaid. You can get social security disability if you face extended time unable to work, but then you have to wait two years to qualify for Medicare. During those two years you have to find a way to pay for insurance or health care with your limited income.

      To me it makes more sense to invest in “singe payer for all” which keeps my health care investment dollars in a system dedicated to maximize health care for all Americans with well documented efficiency in administering health care dollars: and most importantly to know that the investment in healthcare I am making in my healthy years will yield quality health care for me when I need it.

  7. Hugh says:

    Is This Healthcare Reform Or Just Assistance To Health Corps?

    It’s just welfare for the health corps. This has been another case of simple answers to . . .

  8. amilius says:

    I would imagine that this article was leaked by someone from the health insurance industry to circulate the idea that a national program without Universal Single Payer Healthcare is even plausible. Think of how much the industry could score in even a short run failed experiment at this. Insurance companies have figured out how to go out with a very profitable bang! This is obvious to those of us considered ‘uninsurable’.

  9. hychka says:

    Insurance is abslutely the wrong way to go.

    There is no need for insurance, or insurance profit, or insurance overhead, or insurance paperwork, or insurance payments, or anything to do with an inurance IF we are willing to accept the responsibility for ALL health care. Whatever the bill comes to, we pay it centrally.

    Drs won’t have to bill huge amounts to make up for what they are forced to give away or get ripped apart on. Drs won’t have to charge a huge amount to make up for the 6 to 9 month average wait time for their money.

    The savings from EXCLUDING insurance companies from the health care feeding frenzy is estimated at around 70%!!!!

  10. WilliamOckham says:

    Here’s another interesting bit from that article. The Republicans aren’t participating. No surprise, but look at the ‘why’:

    But so far Republican aides have stayed away from the sessions, saying they felt they would be relegated to a secondary role, with no opportunity to set the agenda or choose the outside participants.

    Think about that for a minute. Those guys haven’t figured out that they lost the last two election cycles. Or they think that setting the agenda is their birthright. But the part that really seems insane is the part about choosing outside participants. They can’t be pissed because their allies aren’t at the table. They’re all there (Chamber of Commerce, Big Pharma, Health Insurers). They must be pissed because somebody got invited to the party that they don’t like. Can somebody please explain to the Republicans in Congress that life is not like middle school; we don’t have time to waste on useless puppet shows.

      • MarkH says:

        That whole “we weren’t at the table” whine has gotten them so much sympathy over the stimulus bill.

        Why should they be at that table when they’ve got their lobbyist friends there. What is the matter with Congress (or is it Kennedy) that this plan would be written by the lobbyists. If we were okay with that we’d have voted for Republicans. [ Remember Cheney’s energy meetings were all with lobbyists. ]

        I think we need legislators, including Republicans, talking this over.

  11. foothillsmike says:

    Costs for medicare for all will need to be covered. I would reccommend putting a tax on boob jobs, face lifts and other voluntary & unnecessary procedures.

  12. wmd1961 says:

    I wonder if I’d be considered in the affordable class?

    I’m paying monthly bills from retirement savings. Looking for employment – I have pretty specific experience and qualifications that make it a long term proposition.

    I had been paying COBRA premiums of about $500 a month up until December 2008. I applied with Blue Cross in December for an underwritten policy at about $350 per month, was turned down due to four health factors:
    1) Overweight
    2) Osteo Arthritis in one hip
    3) Allergy to hornet stings that requires an Epipen.
    4) Tendonitis in August 2008.

    A guaranteed issue policy for me through Blue Cross is about $720 per month.

    • bobschacht says:

      When I was “between jobs” back in 2003-2004 I took COBRA and was glad for it. Any other form of health insurance, with the same coverage, would have cost me much more. For example, I compared it to the health coverage I could get from my AZ Retirement connection, and that was way more expensive.

      IIRC, COBRA funding survived in the Stim package. That’s a very good thing, IMHO.

      Bob in HI

  13. Blub says:

    this health debate needs to be fully integrated into the national response to our economic emergency. I saw something yesterday that fully 66% of young adults above 18 and below 30 are now uninsured… no access to healthcare beyond the emergency room. This is a crisis, not a policy disagreement.

    • Blub says:

      Sorry.. got that switched around.. 36% are completely uninsured. 66% are either uninsured or at risk of being uninsured (because they’re about to finish school or expect their jobs are in danger). But still, my point remains.

  14. Praedor says:

    I prefer single-payer for basic, necessary healthcare. People would be free to buy insurance to cover purely elective procedures.

    See, there IS still a place for private insurance companies in healthcare. They just don’t get to be in a position of murdering people by saying “NO” to any lifesaving treatments.

  15. bmaz says:

    I have just about the same problems. I had childhood asthma and allergies. Not much now, maybe use an albuterol puffer once a week or so; could live without that just fine. They freaking treat me like I have terminal cancer or something. Simply amazing.

    • Watt4Bob says:

      I had childhood asthma and allergies.”

      You had a childhood!

      Of course they’re afraid of insuring you, who wouldn’t be?

  16. conniptionfit says:

    You know, I have yet to hear anyone other than a Republican politician or a conservative pundit say that health insurers deserve a bite at the apple.

  17. Praedor says:

    So, when an economy melts down like ours has, what is the penalty for all those people who USED to have insurance (forced upon them by the government in the reichwing “healthcare reform” giveaway to insurance companies) letting their insurance drop because they don’t have, you know, AN INCOME?

    The very idea of these clowns thinking that they can FORCE me to give money to a private, for profit, company for ANY reason PISSES ME OFF! This makes MY money an entitlement for insurance companies – a government guarantee for maximized shareholder value, bonuses for CEOs, extra mansions, etc.

    FUCK. NO.

    No profit motive in healthcare decisions!

  18. GrandmaSheila1 says:

    This is getting really tedious, other countries can manage universal health care, but America acts like it’s trying to invent the damned thing.
    It’s simple, cover everyone, drawn from taxes.

    If America can afford to spend 51% of its GDP on the military, it can afford to cover everyone. Means test it if need be, if you are unemployed you are covered, if you’re rich, you pay more tax. Frivolous surgery, such as cosmetic surgery, you pay for, or get private insurance that is happy to co-pay for boob jobs, nose jobs, wrinkle lifts, stomach stapling yada yada.

    It’s a fucking joke that America claims it can’t do this because of cost or it’s too hard or whatever other pathetic excuse comes down the pike.
    Stop lying to us.

    • eCAHNomics says:

      If America can afford to spend 51% of its GDP on the military

      Decimal point error. It’s more like 4-5% of GDP.

        • eCAHNomics says:

          U.S. spends half again as much on per capita medical care than the next nearest country, which is Canada, and gets worse outcome. The economics are pretty transparent.

            • eCAHNomics says:

              I said the economics were transparent. That doesn’t mean vested interests paying off pols won’t prevent it from happening. It’s not about dogma, it’s about creating appealing lies to hide the obvious. Like the Iraq war.

          • bigbrother says:

            “U.S. spends half again as much on per capita medical care than the next nearest country, which is Canada, and gets worse outcome. The economics are pretty transparent.”

            That 50% is exactly what insured will save in a single payer plan like

            • eCAHNomics says:

              The way that other countries get medical care for less is by price controls. THAT is why the resistence from providers is so extreme. Their livelihoods will be greatly diminished.

              • EvilDrPuma says:

                Oh, well, if it’s a matter of keeping a bunch of fat cats in the lifestyle of sybaritic excess to which they’re accustomed, I say fuck ‘em all.

                • eCAHNomics says:

                  That’s not the point. To instate change, you’ll have to think of productive ways to fight the fat cats.

                  • bigbrother says:

                    If dems have the Governor’s office it is a done deal in CA…after the the industry referendum goes down in flames.

              • bigbrother says:

                Please read the bill before judging…..rolled.pdf The bill is 96 pages and I hope Conyers staff of Leg analyst read it.
                The Leg summary is 3 small an easy read. My dentist who has been involved since 2003 says it will expand the healthcare industry in order to provide services.
                I am not an expert by any means but this is bodaciously good news for everyone except insurance companies and others that are extorting us. They have let so many people go untreated and died that they have earned universal single payer.

    • Badwater says:

      It cannot be done now because Republics still have too much power and still have way too much credibility with the news media.

    • Margot says:

      It is that simple. It’s not like we have to build hospitals and train doctors from scratch–that would actually be hard. We just have to sign paper and it’s done.

  19. bmaz says:

    Wonder how much better off he will be there. What will the Brits do with him and how will they treat him? They have ill motives behind them too.

    • skdadl says:

      The last lines of that story say that British officials say that Binyam Mohamed faces no charges there and will be released on his return.

      I have worries about what will happen to our child soldier, Omar Khadr, when your people and our people finally figure out that they have to repatriate him. His lawyers (American and Canadian) have sensible ideas about how to reintegrate him here, but there are too many other interested parties (politicians and psychologists) who sound as though they want to continue the clockwork-orange experimentation for their own sakes.

    • WilliamOckham says:

      From the article:

      Officials in Britain have said Mohammed faces no charges there and will be released upon his return.

  20. bigbrother says:

    Thank you Al!!! I’ve forwarded this email to Ali Bay, our press relations person in Senator Leno’s office. She’s very enthusiastic about the possibility of connecting to firedoglake. I’m also very enthused by your clear understanding of single-payer healthcare and your willingness to spread the word. Educating the public, both business and private sectors, on how single-payer healthcare will affect and improve the quality of their lives is the biggest challenge facing single-payer healthcare reform. The more we can inform them before the massive health and pharmaceutical industries begin spreading their disinformation campaign, the better we’ll be. Ali’s information is [email protected] and her phone number is (916) 651-4003.

    Let’s keep in touch, and thank you again!


    Carole Simon Mills

    District Representative

    Senator Mark Leno

    3501 Civic Center Drive, Suite 425

    San Rafael, CA 94903

    (415) 479-6612 (phone)

    (415) 479-1146 (fax)

    [email protected]

    —–Original Message—–
    From: al barrow [mailto:[email protected]]
    Sent: Friday, February 20, 2009 12:04 AM
    To: Mills, Carole
    Cc: suin fdl; al barrow
    Subject: health care for all…a post series for fdl

    Hi Carole;

    Meet Suin the media manager at firedoglake.

    Suin meet carole at Ca Senator Mark Leno’s office. Please keep me in the loop and let Jane Hamsher know what we are proposing to help promote single payer health care for all.

    I posted this in the FDL comments tonight. I think a series scheduled in parallel with your campaign might be worth considering. They have a book salon that hosts authors maybe get Michael Moore and others to schedule a book salon could be hosted by Senator Leno or a knowledgeable individual. It is gracious and people are asked to stay on topic. It will be hugely popular we have a Dr, Kirk Murphy a frequent poster on health subject who might also be a great host. It will also help affordable housing by taking that burden away. Many medical professional do not take Medical (share of cost has ballooned) or Medicare. My dentist is interested and mentioned Insurance Director Garamandi’s support he was at a leg conference in Sac 2003 and has good connects in the Dental associations.

    Here is what I posted tonight;

    Senate Bill No. 840
    Passed the Senate August 31, 2008
    Secretary of the Senate
    Passed the Assembly August 29, 2008
    Republican Governor Arnold Swarznegger vetoed it. In other words this health care bill was supported across the board, It will save a medium income family of six $10,000.00 a year.
    A new effort by CA Senator Mark Leno is in the legislative birthing process. Senator Leno’s office says he wants to do a Post with Firedoglake (he may not know it yet). bu this staff does. They referred me to one of the leads on publicity and I iowe them an email. So need a conract here.
    If Ca gets single payer it will lead the nation to it. Can anyone help me here Suz? (including immigrant families).
    This means noone has to go without care noone has to lose their home because they got sick. It cuts medical costs in half fo Californians and employers. Creates disposable income to stimulate the economy.

    • bigbrother says:

      California has approved single payer 4% of income over $7,000.00 income for dental/medical no deductible the bill CA SB840 is on the state website. They are rewriting it at Senator Mark Leno’s SF office not publicised but will take suggestions.
      If CA gets single payer the rest of the country is likely. A stimulus to the economy as a family of 4 earning $50K would sqave $10K…that is disposable income. Migrant families are covered. What do you think about a post by Senator Leno?

      • hipparchia says:

        i would love to see a post by senator leno. it’s probably hopeless to get the florida legislature to do anything sensible like single payer, but i’d still like to have an in their own words kind of writeup by another state legislator to point mine to.

  21. dcblogger says:

    Meanwhile Pennsylvania and Minnesota are passing state based single payer systems. We would have it in California, but for the Gropinator’s veto.

    • Badwater says:

      Republics need to protect the wealthy. How can they feel good about being rich if everyone has access to healthcare like they do?

  22. TomThumb says:

    There is no one in the meetings to represent The People.
    I want healthcare not health insurance.
    Where is there mention of setting costs/prices for providers?
    If health insurance companies don’t want to compete with guaranteed healthcare with no middlemen, who cares?
    Everyone in/No one left out!
    No separate and unequal tiers for the poor, the middlings and the rich.
    HR 676 Single payer or bust!

  23. foothillsmike says:

    CO has a bill up for single payer. Hearing on it will be 3/4. My state house member is the sponsor. Keep your fingers crossed for us.

  24. otchmoson says: and (physicians for national healthcare) are two good sites to visit for additional information. As I’ve followed the healthcare discussion, one item that I find remarkable yet is rarely mentioned is this. Physicians pay huge malpractice insurance premiums. When a malpractice suit wends it way through the court system, there is usually a dual component to any award . . . (pardon the non-legalese): pain-and-suffering award PLUS past/future medical costs awards. If/when EVERYONE is covered by a universal, single-payer healthcare system, the medical costs that now accrue to the physician and/or his insurer are no longer necessary within the parameters of malpractice insurance.

    With so many other problems and expenses facing all of us in the healthcare arena, this is perhaps insignificant . . . but nevertheless is a part of the healthcare equation. (Incidentally, another high cost for physicians is having to employ a bevy of office staff to prepare insurance claims, and required familiarity with dozens of individual insurer idiosyncracies).

    And as for the chief “conservative” meme . . that we will have to wait in long lines and government will determine who gets treated, and how. The response should be that we already wait (the lines are invisible, but still present). Whether you call for an appoint with a dermatologist and secure an appoint 2-3 weeks in the future, or you go to an emergency room, and spend hours waiting for non-emergency treatment . . . there IS a waiting line. And as for government determining who/what gets treated . . . is that any worse than a cubicle-contained cleric, reading from company-prepared ‘rulebook’, telling us if we can or cannot be treated?

  25. bigbrother says:

    A second benefit is it makes it frees up money to pay for housing cost. I am an affordable housing advocate and many people have to chose between med or housing.Now the new unemployed are joining the army of unemployed at the food banks which can’t keep up. USA is literally running out of food! Is that stunning? see NYT.

  26. JoeBuck says:

    What if we said that everyone must have insurance, and one of the options, that would be available to everyone, would be to buy into Medicare, and that private insurance companies can’t pick and choose who they take, and refuse to put in any subsidies for the private insurers? Then they can try to compete, but the deck will be stacked against them. They can be pushed into the role of supplemental insurance that you often see in Europe.

  27. SouthernDragon says:

    OT – There is a convoy of vehicles filled with aid getting ready to cross the border from Morocco into Algeria, the first time that land border has been opened in about 20 years. Started by our old friend George Galloway, MP, it has a British red fire truck in the lead followed by numerous ambulances and other vehicles. The plan is to travel to Egypt then into Gaza. You can go to to hear a discussion with one of the participants on True Talk. The link to the archive should be up a little later. Just click on today’s date when it finally shows up on the archive list. They’re apparently a little slow today.

    Sorry for the interruption. Carry on.

  28. Synoia says:

    Here’s an analysis of Wellpoint’s 2007 P&L…..20Care.htm

    We can save 35% by elimination overhwad.

    If you send me more urls, I’ll do the analysis on any P&L statement to make the point. Also, feel free to question my assumptions.

  29. JohnLopresti says:

    There is a lot of vision and principle involved in getting universal health care right. The post is on target, the vested capital interests are engaged in the current deliberations. I wonder who is thought to be the nominee at HHS. My work in the field has led to an impression something like: if HRClinton could condense her first study to 1,100 pages, that is about the size of the document required to cover some of the specious and disorganized parts of the current system. My program would incorporate population control, however, somewhat at a tangent to what properly is the topic of health. I also understand the best programs in other countries are part of a social safetynet which in aggregate consumes noticeably less than half of personal income, but approaching that. Since 911, and the CDS swap insurance industry revelations, the insurance world has been in turmoil. Global warming’s effects on natural disasters, and resource extraction rapine creating environmental calamaties only will add to insurer costs.

  30. foothillsmike says:

    Then after investors would have the opportunity to draw dividends from these corporations receiving welfare they will bitch to high heavens if they have pay capital gains tax.

  31. i4u2bi says:

    Health care for chillin sound real good…don’t we all have mommies and daddies? Ain’t we all God’s chillin?

  32. BargainCountertenor says:

    Studies have shown that the people in the United States who are most satisfied with their health care are those on (wait for it):


    Yeah. Medicare. Medicare’s administrative costs run about 2%. Your health plan is more like 8%, pushing 15% if you include their need for profit. There is something vaguely distasteful about making money from someone’s misery (divorce attorneys, health care workers, etc.), although these people also work in a preventive fashion.

    There is something immoral about investing money and earning a return on the misery of others. And worse, deriving profit by failing to provide (or not providing in a timely fashion) the services agreed. We need hospitals and health care professionals. But deriving income for investors is simply immoral. They should be operated as not-for-profit entities: any profits made should be used to improve the services available.

  33. earlofhuntingdon says:

    George Bush mandated lots of things. Like everything else in his life, he paid for none of it. This sounds a lot like that.

    Mandating “insurance” is driving in a circle. It says nothing about the cost of that insurance, whether it is public or private, or how inclusive or limited that insurance would be. It gets us nowhere.

    The primary issue should be medical care. Insurance payments are merely a means to pay for it, or partially pay for it, best when associated with one-size-fits-all pooling of risk. Private insurance is a possible, credible, but limited alternative. But each insurance dollar spent for private insurance inevitably provides less medical care than a quality government-sponsored plan. Those who want private insurance and can pay for it, great, go for it. Nearly fifty million medically uninsured Americans are testimony to that way bringing needless loss, needless cost, and needless pain for many.

    For most Americans, some version of Medicare for All — a luxury version of which is basically what CongressCritters get — will inevitably be the route most Americans take. Democrats should start cutting the trail.

    • BargainCountertenor says:

      You’re exactly correct, in that the problem is not health insurance, it’s health care finance.

      The model we have now generates tremendous capacity to provide care for those with (access to) deep pockets. We know this is horribly unfair, and so we come with laws intended to ameliorate the problem. Women are being kicked out of the maternity ward after less than a day in-hospital? People are being discharged from emergency departments before their condition is stable? We’ll fix that! And we got EMTALA (Emergency Medical Treatment and Active Labor Act) as a result.

      This approach amounts to treating the symptoms rather the underlying problem. The underlying problem is a focus on insurance, rather than finance.

      When finally get around to treating the underlying problem, some things are going to change. We will see more emphasis on prophylaxis rather than treatment, for one thing. We will likely see less effort spent on prolonging the inevitable: people are going to be allowed to die (comfortably!) rather spend weeks (or months) in incredibly expensive ICU beds.

      But it’s a finance problem, not an insurance problem. Associated with the finance problem is a maldistribution problem. Addressing the finance issue should allow the distribution issue to be managed too.

      • earlofhuntingdon says:

        Sadly, treating the symptoms is a defining characteristic of the medical model.

        Your characterization is more precise: the problem is health care finance. The current system rewards withholding of medical care for the many and its intensive, expensive application for the few. In the third world, that would be like hiring a top cardiologist for el presidente, whose cost would pay for fifty nurse practitioners whose care could reach thousands.

        As I see it, the biggest stumbling block for both Dems and the GOP is that changing the current model requires government — acting as the representative of its citizenry, not lobbyists — to take an active role in allocating resources. They do that now, but in a manner similar to defense procurement: they fund the private sector and consequently pay for absurdly priced weapons, air and naval craft. (Some of the latter won’t even float; how ’bout them apples?)

        The GOP’s public face is that further government involvement is “socialism. Priately, it’s about whose voice government listens to in allocating scarce tax dollars: select private corporations or David Brooks’ hated expert technocrat, who might spend in order to do the most good rather than generate the most profit. It’s not about socialism; its about citizenry taking responsibility for how their government spends their money. To date, they’ve relied on private companies to order priorities. Time to wake up.

        Apart from health care finance, a more wide awake citizenry might demand more rational priorities from, e.g., the FDA and HHS. For example, testing for BSE, food processing inspections, food import inspections, and more critical drug trials and approvals, with shorter patent protections.

  34. ffein says:

    Also see John Conyers & Dennis Kucinich’s bill HR696 United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act. They have an organization trying to get the word out

  35. PJEvans says:

    Considering how many times most of these big health insurers have been fined for cancelling policies to avoid paying for treatment or other illegal activities (IIRC, Kaiser got nailed for their transplant program), trying to make coverage mandatory without providing a low-cost public option is just plain stupid.

    I’d sign up for one of the group plans where I work, but the choices are not appealing, and the information provided needs an insurance lawyer attached to explain what it really covers. (90 page PDF file written in insurance-legalese? You have to be kidding.)

  36. TarheelDem says:

    Tell me how forcing more people into the same crappy system (A) brings costs down or (B) doesn’t dictate treatments to physicians.

    I think the fly in the ointment is the fee-for-service system. The way it runs now required immense IT resources. The feds don’t necessarily want to pick up the responsibility for doing this for everybody. Indeed they have contracted out Medicare claims processing to — ta da — insurance companies.

    To have single payer, you have to figure out how to control for fraud, abuse, and overcharging without having a fee-for-service system.

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