We all know that all supporters and GOP party are morally bankrupt. When you are only for the rich and giving big tax breaks to them why would you want any one else to get government health care. The Democrats are always for the workers and poor and it showed when 29 million got on the AFC and where happy with it since it accepted pre conditions. The only people who need to vote for the GOP are the independently wealthy . The rest it is a wasted vote with no health care offered. Buy your own health care at high premiums is what the GOP offers.
4
Problem is the USA has already crossed the line of sanity on healthcare: just being "credible" is not nearly good enough anymore. Radicalism is necessary.
1
DEMOCRATS = Healthier, Fairer America! Obamacare is a success by all measures. The Democrats are committed to continuing government supported healthcare insurance for all. Meanwhile Trump is has rigged the tax system so that within the next decade, between 1.6 and 2.2 TRILLION dollars will be transferred from the 99% to the 1%. That's right folks: Trump robs the poor and middle class to enrich the rich, the very rich and the very very rich. Too bad Trump couldn't get some cut of the money laundering that the 1% allegedly use as tax dodges. What Mike Bloomberg said has also proven to be true, that Trump is a New York Con.
4
The right wing is always carping about how badly government programs are run. Fact is, ideologically they don't want government to run well. (The republican party - remember them? - had as a core value professional government management.) But whenever the right sees the spectre of a well-run program they step in and *make it* run badly. See Obamacare, see FEMA, see EPA etc. So bad government is not only a self-fulfilling prophecy, it's an agenda item. Government is messy by nature but as long as the right is in power, it won't work well. It may not be great under democrats, but it *will* be better. If that hasn't always been the case, right wing abdication of public service means that it has changed. A lot.
4
Each Krugman Opinion is like a paid political ad, namely predictable and repetitious using carefully selected facts to create a misleading and distorted picture.
Krugman was formerly a respected eonomist but is now a strongly partisan pundit lacking credibility.
The NYT Opinions should be thought provoking but his are mind numbing.
3
Those who are insured should also remember that they are paying for the uninsured who will turn up at ER, and cannot be turned away.
The ER will provide band-aid treatment which is no way to address the chronic degenerative conditions, such as diabetes or cardiovascular disease, which will affect most of the population.
The medical problems of the uninsured will not be solved or even ameliorated in the ER.
To give an example of a worst case scenario, the diabetic will turn up at ER blind, in renal failure with a gangrenous foot. Then someone can pay for his rehab after the amputation.
2
Obamacare has delivered.
Let's see what what was promised:
"If you like your health care plan, you can keep it," President Barack Obama said -- many times -- of his landmark new law."
What happened
Politifact
Lie of the Year: 'If you like your health care plan, you can keep it'
https://www.politifact.com/truth-o-meter/article/2013/dec/12/lie-year-if...
Mr. Krugman is want to accuse Republicans of lying.
Trump surely will win politifact's lie of the year award , but Obama won it fist
2
From about 1982 until 2002, I kept a family of four health-insured on a modest carpenter's income. Insurance then was reasonably affordable, even though it got harder every year, and I felt it was one's responsibility to have it.
After the crash in '08, I spent a couple of years uninsured, knowing that financial catastrophe was only a bad diagnosis or injury away. There was no work, therefore no money for sky-high premiums.
Then as soon as ACA was passed, I got insured again at a price I could afford.
This got me by for three years until I was old enough for Medicare.
Now I have serious health problems, (40 years of construction work can do this to a man), but I won't lose everything thanks to Medicare.
Think about this if you are young and not wealthy.
13
The two salient facts are 1) other countries provide better health care at half the price we pay; and 2) all of Republicans' claims about the issue have been false, as Krugman describes. Democrats should not be running "on Obamacare" because it is in fact a half-measure which has no chance of reducing overall costs by itself - they should be promising real universal care at reasonable cost. Obamacare has helped the public to realize the above facts, but it should not be the objective itself. It is clear by now that Republicans will oppose anything that Democrats do, so there is no advantage in compromise.
The common factor in other countries' successful programs is a considerable degree of price control by government - it must act as collective bargainer for health-care consumers. Democrats must give up the idea that the way to provide health-care services is by maximization of profits, which is still the unstated compromise principle behind Obamacare.
21
Thank you again, Professor. Your closing line "utterly wrong about everything and unable to admit their mistakes" describes the GOP of the last 50 years perfectly.
7
As today is 9/11
"I predict that in the years ahead Enron, not Sept. 11, will come to be seen as the greater turning point in U.S. society."
Paul Krugman , NY Times, 1/29/2012
https://www.nytimes.com/2002/01/29/opinion/the-great-divide.html
The ACA is better than nothing, but there are still -- as Mr. Krugman points out -- 29,000,000 without health insurance.
As someone who has travelled for business for much of my career, I've had many opportunities to talk with folks in other countries about their health care systems. In particular I have looked at the systems in Germany, France, UK, and Canada.
These systems share several traits:
1. Per capita, they cost less than the US system.
2. Each covers 100% of their citizens.
3. A baby born in these four countries has a longer life expectancy than in the US.
In other words, centralized, government organized systems like those in these four countries cost less and people live longer.
In Jan 2017 John Conyers (D/MI) introduced a bill (HR676) outlining a single payer system of healthcare for America. The CBO ran the numbers and said it would cost $32 trillion over ten years. Based on current spending we will spend approximately $49 trillion under the current system.
Granted these are rough numbers, but over $10 trillion in savings covers a lot of deficit.
Republicans keep saying it costs too much and it can't be done. The French, Germans, English, and Canadians prove they are wrong on both counts.
Americans deserve better. Now.
7
No it isn't clear, but "........moving beyond it to "Medicare for all," ......... seems like a logical progression to join the rest of the civilized world.
6
(Republicans)"They’ve also been utterly wrong about everything, and have learned nothing from their mistakes." Well, that is true for just about everything! However, Republicans will rely on their favorite theme, racism, to remain in office. It has worked since Nixon & Reagan through Trump to convince whites to vote against their own self-interests and will probably be effective in 2018/20!
2
What planet is Mr Krugman living on? Healthcare spending has jump from $2 billion to over $3 billion since the ACA went into effect. Consumers are paying more and more out of pocket, not just in premiums that have risen by at least 10% a year but also in obscene deductibles and out of pocket expenses. Insurers, who receive subsidies are passing more cost off to their enrollees. Hospitals have gobbled up physician practices at rates approaching monopolies and that has resulted in even higher costs to patients as well as insurers. Profits are up for virtually every aspect of the health sector, insurers, hospitals and medical supplies except for private practice or independent doctors. The ACA set in motion an unprecedented unregulated consolidation with higher costs but not better outcomes. The states that expanded MediCaid gave people insurance cards without adequate access to care. ER visits are up 50% since the ACA and most of those additional visits are MediCaid patients with no where else to go. The ACA sucked competition right out of the healthcare market and let hospitals control competition through CON, Stark laws and the ownership of doctors so squeezed by reimbursement that has decreased while operational expenses have climbed by over 5% a year. Paul Krugman must be looking at the ACA through rose colored glasses because this law has resulted in Americans spending more money for their care than ever before.
5
The CEOs of 70 of the largest U.S. health care companies cumulatively have earned $9.8 billion in the seven years since the Affordable Care Act was passed, and their earnings have grown faster than most Americans' during that time, according to an Axios analysis of federal financial documents.
Why do many Americans deny healthcare for all when a majority of advanced countries have figured out how to provide and when a .01% reduction in US defense could pay for it? Then we focus on more pressing problems. Except about 100 millionaire insurance CEOs have to find new jobs.
5
It's always about who's going to pay for it. Insurers they just don't want to be cut out of a very lucrative market, that they still get to control.
Democrats should move past this, and either make a case for a federal health insurance tax, with and opt out box for those who don't want it for whatever reason, or a federal sales tax dedicated to healthcare only. The negotiate ALL drug costs together as one government program not how it currently is. Those that "opt out" they just have to remember that they opted out, and don't have federal insurance ID card. Without the card they get the whole bill, and like school loans, set it up so the bills can't be discharged in bankruptcy.
The only people that don't seem to want universal health coverage is corporations making billions from peoples health issues, or republicans that think that some immigrant or a Mexican will get something on their dime, hence the federal sales tax.
4
Isn't that surprising that none of the politicians including the Democrats ever talk about the high middleman costs of the US health care industry?
The crisis in affordable health care is primarily rooted in administrative inefficiencies, and insatiable greed of big pharma, health care providers and insurers. A less complicated health care system can help us share the benefits of medical research more fruitfully.
3
Having had a "pre-existing condition" since the age of five, throughout my career I have wondered why Americans must struggle with healthcare costs that often burden and shorten their lives, while virtually every other country has managed to find a way to cover all citizens and keep prices far lower than we pay. I've come to realize that it's because Republicans want for-profit healthcare that makes corporations and stockholders rich, and they'll happily lie and misinform and deny and make up stories to keep their voters confused. If "Obamacare" had been allowed to develop as planned, without the sabotage of Obama's enemies, we might have a far better system now. Medicare for All is a good idea, but as currently designed, Medicare doesn't cover everything--just last week there was a news story about an 82-year-old man going back to work to help pay for his wife's medical expenses. Americans landed on the moon, but we can't seem to pay our medical expenses--because, well--Republicans.
57
It would help to broadcast Hospital Drama TV shows on US TV from countries like Australia and Britain to help to explain to Americans what health care means under Universal Health Care. Or produce a fantasy one for the American viewer! They have no idea how they would benefit. It would definately cut down on the pharmaceutical commercials that make me avoid TV whenever I am IN America. Start asking your doctor if their office charges are right for you! Start asking your insurance company why there are “out of network” providers? (You mean the ones OUTSIDE the US who charge 75% LESS than their “In Network” providers?) Pop into your local hospital and ask for the price list. Americans, you need to
work at the grass roots level to change the system. Congress is not going to do this for you. I had a CT scan last week. I didn’t even get a bill, the national health care system paid for it.
4
I appreciated your statement that Democrats talk about policy and the gop throws,basically, "red meat"; and their perpetual one trick pony, too, tax cuts. Perhaps if the Democrats came out with slogans like" The gop wants you to get sick and die", the Democrats might win more elections. Perhaps the Democrats should stop using logic and intelligence to get votes, because,as we have seen for forty years, it just doesn't work on a good portion of our citizens. The Democrats need to scare them, play on their emotions, their avarice, and fears. You know, the republican playbook.
2
At the time I thought Obama was taking a major, unnecessary risk by pushing for the ACA first, over directly fighting the recession. It turns out he was right about that. Since he decided to go that way I thought he was making a mistake by not going for the "universal coverage, single payer" program and having the "public option" as a fallback position. I still don't think he was right about that, but perhaps the jury is still out. There now seems to be growing support for "Medicare for all." Perhaps the public option will emerge as a compromise; if the Democrats take back the House we can at least halt further Republican efforts to wreck healthcare.
2
And now consider the Republican Healthcare (Deathcare) Plan.
The 'free-market' !
As you're suffering a heart attack, getting your cancer diagnosis, or breaking all your bones in a car crash...take time to shop around the healthcare supermarket...where virtually no one posts prices...as you fall in and out of consciousness.
Republicans are sticking with the greatest healthcare rip-off in the world at 17% of GDP with a Kafkaesque system that delivers middling results because they would rather have Americans drop dead rather than have to pay a little extra for a decent civilization.
It turns out that the vast majority of Americans support the core humane features of the ACA and would like it improved.
And the ones who don't like it are generally the kinds of folks who mostly like to say 'Obamacare' - which is really just a low-grade racial slur folks can get away with in public.
Only in America is healthcare treated like a luxury good.
Only in America is there a political party hacking away at healthcare for the 99% while demanding more gold paint for the toenails of the rich.
Every other rich country figured out decades ago that healthcare is not a commodity, but rather it's a public utility that demands moderate prices and regulation to ensure that everyone can reasonably access it.
The only thing holding America back from progress and good health is the Greed Over People party.
"Take two tax cuts and call me from the morgue !"
The GOP Doctor is in:
"Drop dead !"
585
@Socrates Thank you so much for your thoughts and colorful writing. This is a very serious subject but I could not help to be amused and smile as I read your comment.
15
That sums it up. Why is it so hard to do the right thing? Too many people are emotional reasoners that let
Rush and Sean do their thinking for them. Time to shut off the TV and radio, time to do your own thinking people.
2
@Socrates
May I share this response on Facebook? Thanks.
1
The real question is, "when will Democrats *really* own it, stand proud about it and crow a bit about how well it works"?
Never, or mostly never.
Trump is crowing incessantly about his booming economy, time to start the (realistic) spin Dems!
28
@Steve H
It's really not that easy you know.
Crowing is extremely easy if you just use lies (and have Fox News to sell those lies as "alternative facts"), but once it's to tout highly successful legislative progress, you need people to understand that all legislative progress is necessarily step by step progress (if not they'll blame you for touting something imperfect, and start believing that you're a liar etc.), and many people, including in the center and at the left, don't understand this.
So you also risk alienating and discouraging part of your own base.
Conclusion: imho it's time for us, ordinary citizens, to start explicitly thanking Democrats for their courage and highly competent decisions and acts, when it comes to the economy and healthcare, and tell them that they can count on our full support BECAUSE real progress is what we care about, rather than marketing/propaganda/"message" etc.
You can't ask politicians to do both: their job as lawmakers in a highly complicated DC environment, AND being their own best propaganda machine.
You want proof? Look at Trump: when he's not on the golf course he's tweeting, and as a consequence, most of his campaign agenda is still not signed into law yet ... . In the meanwhile, it's once again thanks to the hard and unified work of Democrats on Capitol Hill that Obamacare still exists today.
Enough excuses, time to vote ... !
As Churchill said, "facts" of which Krugman has aplenty "are better than dreams" or, in this matter, conservative nightmares.
However, the usually precise Krugman once again turns to jelly when it comes to "Medicare for All" saying "no one knows what it means". Well he may not know, but as a participant in Medicare I do. It means basic hospital and doctor coverage and a degree of prescription drug coverage, where you get to choose your doctor and pre-existing conditions are covered.
Need more? Medicare, run more efficiently than most private insurance, should be supplemented by a secondary policy which covers much of the Delta between Medicare and what you additionally pay. Also provides prescription coverage through co-pays wirth major pharmacy providers.
As a practical matter, I favor phased in Medicare for All. First step, everyone over 50 pays to join Medicare (with supplements for those poor ineligible for Medicaid) until age 65. Private insurance happily adds the new Medicare cohort to its Medicare Supplementary Insurance Rolls.
Every four years, say, add a new cohort (kids and adolescents next?) until it truly becomes Medicare for All. There are lots of variants of a phased approach; the point is to make the transition easier to carry out and absorb.
Why don't you, Paul Krugman, stop fleeing the issue and devise you own fact based path to Medicare for All?
9
@Frank McNeil
I'm not disrespecting Krugman, I think he's a very smart man, anyone that's won a Nobel Prize, is no idiot. But, Krugman is also not the average working from paycheck to paycheck american, so it's hard for someone like Krugman to really know what it feels like to not have access to healthcare, live paycheck to paycheck. Or in this case, what Medicare would look like.
1
ACA is a lot better than nothing. Once you or a loved one goes through a major illness the reality stares you in the face. They put on all these television ads for Neulasta which is used universally the day after chemo. After each session, you get a shot of this drug whose patent has expired, yet each shot you will get billed $10,000. Atena or some other insurer is able to get them to knock the price down to $2,500. Lack insurance? Four lousy chemo treatments will cost $40K. Get seriously sick, after 6 months your company puts you on long term disability - you lose all health insurance. What a system! And since companies are responsible for their employees health care, employing an American is expensive. As my company says when all the work goes to Poland and China, we are a "high cost region". Our health system helps make it that way.
4
@David Lisowski
Absolutely correct. So if we had a federal sales tax to fund healthcare, companies would have more money to buy their own stock back, or just stash it over seas until the next favorable Republican comes along beating the give corporate america a tax break drum.
When it should be the subsidize corporations profits with our tax money. What the GOP gave the rich and corporations would have paid for universal healthcare many times over.
1
Healthy people who know they won’t go bankrupt due to health care costs are probably happier and make better employees. American companies wantin to relocate overseas to avoid buying health insurance for their employees should choose to move t
...to states that have expanded coverage under the ACA. It is probably not safe to eat in restaurants in the states that have not expanded heath coverage. Think about that when you plan a
vacation. ( accidently hit Submit too soon on that one, need a cancel feature)
@BBB
So ask yourself, your country has universal healthcare, is it safe to eat in restaurants in Australia.
The GOP Congress is a policy vacuum led by a President who doesn’t have the attention span to read a policy, let alone write one or even comprehend one. There never was a plan in place for better health care, fixing and updating infrastructure for the 21st century, or actually creating “Clean Coal” Jobs. These 3 Core Trump Campaign Promises were all lies.
The GOP reached it’s ‘Use By’ date quite a while ago and has nothing to show for their time in office since they’ve been held for ransom
by the House Freedom Caucus.
4
No one should have to live without adequate health care. No one. This is why I loved McCain. For this one thing. He saved the lives of people at home in America even as once he was a hero in a killing combat.
1
I loved McCain, too! He saved millions of Americans with pre-existing conditions, while he was dying himself with a pre-existing condition, because HE KNEW what excellent health care looked like.
The new universal health care bill should be named after Barack Obama, Ted Kennedy and John McCain. Thank you for your service!
1
The US economy has changed and now Universal HC/insurance is needed:
- corporations and even Federal agencies have switched permanent employee hires towards using consultants.
- the gig economy needs stable HC plans in order to function consistently, including coverage for pre existing conditions
- ongoing threats via bio warfare and/or pandemics require constant preparedness as part of our National defense, this is only possible through a system built for universal care.
- families need consistent/affordable/available HC for workers to remain productive and for communities to remain vibrant
- changing demands require workers need to retrain throughout their careers to be skilled for new opportunities. Consistent HC is needed to support this.
- Federal involvement in HC costs and drivers fosters greater incentive to improve our food supply thus reducing disease and improving quality of life. Europe uses no hormonal additives for dairy nor routine spraying of chemicals on wheat. Overall health is these countries is higher with a reasonable correlation.
- Incentives for doctors+ could be based upon outcomes, not number of tests. Medicare already achieves this.
2
One of the aspects of our healthcare system that people hate the most is the network nonsense.
The "if you need a hospital, the only one your plan covers is an hour away," and "Yeah, the doctor for your procedure was covered, but the anesthesiologist wasn't."
Dems should talk more about that side of our idiotic system, as well as its out-of-line costs.
My recent hospital experiences feature doctors who spent less than ten minutes with me, while a finance person sat at my bedside for more than an hour discussing money.
I was lying there with heart failure, sixty years old, sick and exhausted, and she was battering me about how I'm going to pay the tens of thousands of dollars they were charging.
This is inhuman. But it also provides a possible explanation for why our medical results are poorer than the rest of the world.
10
@Tokyo Tea The crux of these problems is the stranglehold that the health insurance and drug industries have on health care. People in other countries decided a long time ago not to allow this.
6
More Democratic candidates should championing ACA. Instead they just ignore the accomplishments. Krugman's article should be a template going forward.
6
I would agree to universal healthcare as soon as we ditch other entitlement programs, otherwise you will inevitably bankrupt the middle class. With almost 60% of government funding already going to entitlements what do you think the new tax rates will climb to when the government has sole ownership of our medical needs?
1
You mean the entitlements going to the defense industry, big ag,
and the weekly White House golf outting, right?
5
@Mystery Lits Correction, somewhere in Russia. We will pay for this and other needed programs by reversing tax-cuts-for-the-rich enacted by Republicans under Reagan, Bush II, and Trump. This will not bankrupt the rich and certainly not the middle class.
4
@BBB. Read the numbers. We waste a lot of $ of the stuff you speak of, but the biggest part of the budget is paying off the debt and entitlements. They will soon consume the entire budget. They have to be reigned in.
It's worth pointing out that the repeal of the mandate (the penalty for not having insurance) has not actually gone into effect yet. It remains in force through tax year 2018, so taxpayers will still be paying it on their tax returns in the Spring. Its repeal is effective 1/1/2019.
So, it would seem premature to conclude that that has not affected the overall picture.
1
Universal health care would eliminate millions of jobs in the health care sector of the economy. Every medical practice could lay off the people responsible for submitting the insurance forms and resubmitting them to fix mistakes or game the system for maximum payment. All the people involved in designing, marketing, and administering health plans, fixing mistakes and arguing over who gets stuck with how much of the bill, would have to find other lines of work. Their career paths would disappear and most of their specific skills and experience would lose their value.
The health care sector will fight to preserve its current existence just as fights are waged to keep military bases open or unneeded weapons in production. As long as the country is not committed to supplying a decent job to everyone who needs one, these fights are not only inevitable but also justified, because people are on their own and have to take care of their own interests.
6
@sdavidc9
Overall, Obamacare added more than 100,000 jobs, as far as I know.
That's because with tens of millions more patients, you also need more hospitals, doctors, nurses etc.
So those who would lose their job if we'd switch to universal HC that would NOT be private sector based (contrary to Obamacare or Obamacare 2.0), would be people working for health insurance companies.
Fortunately, those who have proven to be outstanding experts when it comes to successfully adding 20 million more Americans, also now how to hire "the best people" when it comes to the economy. So thanks to Obama, we're now at full employment. That means that the tens of thousands of people working for private health insurers and who would lose their job IF we'd switch to entirely non-profit universal health insurance, should be able to find another job quite easily ...
6
Thank you Paul Krugman, another excellent and accurate story that cuts through the propaganda of the Republican/Trump noise machine.
5
Totally glosses over the fact when Obamacare was passed there was a filibuster proof majority in the Senate and the Dems had control of the House. Where was the appetite for single payer or a government option? Why did a President who ran on 'Yes, We Can' end up with a Presidency that was closer to 'But, We Didn't'? If something besides a Frankenstein Monster had been enacted when Obamacare was passed this debate would not be happening today.
3
@GregP
1. Obama ran on Romneycare and promised NOT to sign single payer into law because at the time, a majority of the American people opposed single payer.
2. His objective was to extend coverage to tens of millions of Americans, all while curbing cost increases, improving the quality of plans, ending pre-existing conditions, allowing children to stay on their parents' plan until their 26, and allowing people to switch jobs without losing their healthcare (one of the main factors keeping wages low). And that's EXACTLY what Obamacare has done.
3. Obama, as president, campaigned hard on including a public option. Result? Thanks to his hard work, a year later and for the first time in history, a majority of the American people started to support a public option too, and for the first time in history, the House passed a bill (thanks to Nancy Pelosi) that included a public option.
4. The Senate version subsequently included a public option too ... until at the version last moment, Independent Lieberman (who had been a potential VP candidate for John McCain just the year before) destroyed it.
5. Since then, Hillary and the DNC fully included it in their 2016 HC platform, so it would have been signed into law today IF millions of ordinary citizens would have informed themselves a bit better, when it comes to Obamacare, by Nov. 2016 ...
In the meanwhile, the ACA will soon have saved half a million American lives. So no, no Armageddon nor "Frankenstein Monster" here ... ;-)
5
@GregP Are you serious?
2
I've been on the ACA for two years, and it's been great. Not a word of the right wing spin has been true. Now they want us to use short term plans that don't even qualify as Continuing Coverage? Dummies..
The GOP is a direct threat to our health and finances. Vote for affordable Care. Vote for Democrats. Vote the lying, stealing GOP out!
6
"They’ve also been utterly wrong about everything, and have learned nothing from their mistakes."
The Republicans have learned nothing because they REFUSE to learn.
Who was it that has repeatedly pointed out how their living depends on their NOT learning from, or accepting, facts?
I wish the mainstream networks - CNN and MSNBC (FOX is hopeless) - would start harping on this and a couple of other weighty issues more often, instead of chasing down and analyzing every stupid Trump tweet in such excruciating detail.
3
Give us Medicare For ALL, or give us Death.
LITERALLY.
4
Believe me Mr. Krugman, we will remember the Republican liars, crooks, charlatans, obstructionists, seditionists and traitors who are so determined to deprive us of our health care. We will remember them at the ballot box, and hopefully in a court of law, where they will be sentenced to long jail terms for corruption and treason, and sent to prison where they have, for decades, rightfully belonged.
November 6, 2018
NO REPUBLICANS! NONE! NOT ONE!
4
That Krugman feels the need to write a column like this just shows how NOT credible Democrats are on Health Care!
5
No Republican has ever been credible on healthcare. Start there. Democrats have at least done something to improve access and save lives. Republicans have never had a plan save tax cuts. Care to enlighten us on the healthcare plan the GOP is running on? I thought not.
2
Yes these Repubs seem like idiots but remember they are only saying what they think their voters want to hear. And they say it "Trump" style which seems to also be what is required. Note he stays away from the "details" of policy and only uses terms like socialists, elites, Pelosi lovers, baby killers, liberals etc. These are the inflammatory words that the voters love and they have no interest in policies. Its the Texas Repub voters that set the agenda and Cruz just hopes to cash in.
3
“If you like your plan and doctor you can keep it”
Paul you clearly have never had an ACA plan
4
Love that one. If your plan was so crummy the ACA replaced it, but that miss step is the only lie the Obama haters can ever come up with. Meanwhile, we've got 5000 Trump lies and counting, including "beautiful, cheaper healthcare for everyone with no pre-existing conditions." But GOP apologists just love their lie about Obama's supposed " lie". You tell me what's better - going to another doctor with your pre -existing cancer or dying in a health-care -less Republican dystopia? Yeah, keep repeating the 10-year-old lie about the lie. It's all lying conservative hypocrites have got.
1
...Medical prices are controlled in various ways in the rest of the developed world. In Japan, the land of $100 melons and tiny $10,000 per month apartments, all medical care prices are listed in a book, thicker than the Manhattan telephone directory. The prices set in the book are usually less than a third of those in the USA. An MRI that costs $1,200 in the USA costs $88 in Japan. Japanese insurance companies are private as are most doctors. Japan spends less than a third per capita on medical care than America. However, the Japanese are greater consumers of medical care than Americans. They visit doctors and hospitals more often, have much more diagnostic tests such as MRIs. They also have better health outcomes as measured by all metrics such as life expectancy. They also wait less for treatment than Americans do as Japanese doctors work much longer hours for their much lower incomes.
Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other…” http://seekingalpha.com/article/1647632
3
The first item on the Democrats agenda, if they take power, is to immediately amend the ACA to institute a robustly funded "public option" insurance, administered by Medicare, as an alternative to private insurance on the market exchanges.
A Medicare-administered public option insurance would provide the ultimate bridge to a single payer, universal "medicare for all" system.
As you may recall, the public option was actually included in the final draft ACA legislation, but was removed at the last minute in order to get the needed vote from Joe Lieberman, the senator from the Insurance State.
It may take time, but the "arc of history" is bending toward universal health insurance, as is already the case with the rest of the industrialized world.
5
"Look at what’s happening in New Jersey, where a Democratic governor and Legislature have used their powers to undo most of the Trumpian sabotage: 2019 premiums will actually drop 9.3 percent, even as they rise modestly in the nation as a whole."
That's a clear and significant validation of the ACA. Work together on this. Available healthcare at lower costs will only help the economy. This aligns with our country's ideals and will enable more people to become entrepreneurs.
3
The reason any pitch might work is that on any given day most people don't think about their health, they don't think about health care coverage until they have a chronic illness, or a major health problem. The Medical Industrial Complex keeps healthiness on some people's minds with TV ads and NPR's human interest stories and Big hospital groups mass mailings. How come we spend so much on medical care and don't get better care than say Canada? A distorted market system oligopoly and distorted demand curves. ACA was a stopgap program with limited set of goals that worked in the oligopoly, but did not solve the cost part. The Republican plan is less costly but would remove the benefits ACA provided and so it is a step backwards, but is Medical Industrial Complex friendly so profits will persist. Politics is killing good health care models. Health care is a ball and chain on business. Tax cuts help business but cost us all. Our future better be extraordinary to pay for all this and leave some for the little people to have a decent wage.
1
The changes Trump has made to Obamacare have limited the annual increase in premiums to 5% instead of the typical 20-30% increases under Obama.
Quick summary for you.
1
@Ken
Except that all studies show the exact opposite: they increase premiums by 30% compared to where they would have been if he would have put a competent person in charge of supervising it.
Apart from that, all studies also showed that without Trump intervention, premiums would have started to stabilize this year.
But of course, who still reads studies when you can limit your knowledge to 250 character tweets ... ?
4
More lies from Fox News. Will conservatives never learn?
3
"They’ve also been utterly wrong about everything, and have learned nothing from their mistakes."
Those weren't mistakes, Paul. The Republicans were simply lying, as usual.
3
Before we give the bill to taxpayers we need to negotiate the charges. The cost is too high no matter who pays for it. Prescription drugs are over prices as well as treatments. There needs to be tort reform for medical malpractice suits so that doctors and providers no longer have to pass the sky-high costs of insurance off to patients.
4
Here in Massachusetts 100% of our Massachusetts' children and 97% of our adults have health insurance, a true Romney-Affordable Care Act success story as we have about as close to universal care as one can get. But, and this is a big but, for families and individuals that depend on getting their coverage through our version of the ACA, and have an income just above the premium subsidy cutoff and deductible subsidy cutoff, the ACA is really about as unaffordable as it gets. It really should be called the "Available" Health Care Act, not "Affordable".
3
@shend
It made insurance affordable for 20 million Americans (and would have done so for 30 million if GOP Governors and Justices wouldn't have allowed states to refuse to expand Medicaid).
For people with incomes that are just too high to get subsidies and who buy insurance on the individual market, insurance indeed sometimes is still too expensive to be affordable, studies show.
But that's easy to fix: increase those subsidies a little bit, as Democrats have already proposed (but Republicans then blocked those proposals) many times.
Obamacare was never meant to be the last health insurance reform ever. As Obama himself repeated over and over again: like all real, lasting legislative progress, it's a huge step forward and lays the foundation for the next steps to come, knowing that progress is always slow in a democracy, so you need several bills to build one on the other before you fully achieve your goal.
Unfortunately, one year later already people lost their patience and voted the Democrats out. If not, those subsidies would already have been increased eight years ago ...
2
Obama Care, to be sustainable, requires bipartisan commitment to keep it afloat with government subsidies --- not to be expected from GOP! "Medicare For All", the cheapest and most efficient system available, once established cannot be removed by another Congress. In England, Maggie Thatcher did not meddle with the National Health Services (which is genuinely Socialist and works like our Veterans Administration)! Indeed, even the "Fortune 500" companies may support it, as
the European Business does, because it relieves them of the burden of health care expenses --- -- about $10K/car to the Auto Industry, 20 yrs ago. Would be more now!
3
Much has been made of the anger and rejection of gov't's ability to solve problems. Obama though was a successful president with two solid election victories. The HCA and its market approach to health care reform provided for a hugely important circumstance, the Medicaid expansion. This has been a prime target for destruction by the Rs in Congress. The R governors have taken to it though because it makes no sense to have uninsured people to show up at ERs and bankrupt the state to pay for their medical care.
1
In the most recent edition of conservatism and libertarianism, there is the hue and cry for individualism and lifting oneself up from the bootstraps; that if a family is too poor to pay for deductable and co-pays for medical care, it is their own damned fault; that they must be of slothful and irresponsible character. Therefore they deserve to die by their own lack of economic success.
The reality is, it is a crime of unimaginable immorality when a country as rich as the USA is led by members of Congress, the White House and the United States Supreme Court, who think poor parents must decided between keeping there modest home vs. keeping their cancer-ridden child alive.
The despicables of which HRC renounced on the campaign trail are actually the Republicans in power who care more about shareholder value than moral value. McConnell, Ryan, and their power-mad ilk try to speak of "Christian values" will shoving Jesus and his teachings under the proverbial bus.
It is a dog-eat-dog world for the Repugnants in Congress. Along with their disgusting sycophancy to Trump — a "man" without a shred of empathy of compassion for anyone — they have decided to genuflect at the blood-soaked feet of Ayn Rand, than return to any civility and moral center.
Jesus tought those who listened to respect and care for the sick, the old, the dying, the homeless ... Medicare For All hasn't a chance with these miscreants. They are working for Wall Street's greedlings to pad their own retirement.
2
One of the greatest achievments in Cnada was Universal Health Care. THe proponent was voted as the greatest Canadian, Tommy Douglas. Do not listen to the lies and miss information. It works well and no bankruptcies, not pre-existing conditions. We have our own doctors and insurance companies that work within the system. We pay less and more which undermines the myth of the magic of the market. It is not free but we are glad to pay for it.
Is it perfect, no, but we look at our friends in America nad shake our heads with sadness. Such a great country but the ONLY advanced country without Universal health care.
We know you can do it every one else has....
5
The Democrats are "credible" on health care, only when compared to the neanderthal Republican Party. Compared to the rest of the developed world, the Democrat's health care policy is a mess: it causes financial strain to most Americans and its outcomes are mediocre.
But the Democratic Party refuses to honor the will of the American people, preferring to honor the will of the much-despised private health insurance industry instead - and partisan pundits try to make it all seem sane and democratic, when it is neither.
3
@Ed Watters
That's absurd.
As many ordinary citizens don't inform themselves and get their news from facebook or Fox News, the GOP can easily fire up its base using no matter what lie.
That's what they did about healthcare reform for decades, scaring the h$ll out of people, and making it much tougher for the Democratic Party to get ANYTHING done on this issue.
Obamacare was very ambitious, compared to what the alternatives at the time were, and getting it through Congress and signed into law required a level of collaboration, putting country before party/job, and expertise and negotiating competence that you rarely see in DC.
Today, it ensures 20 million more Americans, thereby saving an additional 40,000 American lives a year.
You cannot possibly claim that saving half a million American lives a decade is a "mediocre" result - and then we're even not talking about the massive attempts at destroying and sabotaging it coming from Republicans, and for years already.
As to "the will of the American people": only recently, a small majority started to support single payer.
That's NOT enough to get the votes needed to be elected and get it done in Congress.
The only way to get a government for the people, is to have a government by the people. The only reason why the GOP controls DC today is because too many ordinary citizens tend to forget this and then become cynical/discouraged and let the minority become the majority in DC.
Vote for more Dems, and HC will improve!
4
@Ed Watters "Vote for more Dems, and HC will improve!"
The key word is "improve." Sadly, some folks have no interest in that. Rage and rhetoric, undiluted by the unsatisfying imperfection of incremental progress, is an addicting drug.
4
When you think about how many people will lose their healthcare coverage, also think about how many nurses, hospitals and healthcare workers will also lose their jobs. People will die without health insurance as they show up sicker to the ER. The loss of income will also strike at blow to the economy.
3
The greatest irony of all is that the bulk of Obamacare was born in the Heritage Foundation Think Tank as a Comservative market based plan! Republicans could have gotten credit for it but they have been in objection and obstructionist mode for over three decades.
Trump is the simply the apotheosis of the efforts of Murdoch, the Koch brothers and many other super rich individuals and companies, and it has been, indeed, a vast right wing cabal. When you read Democracy in Chains by Nancy Maclean you realize sadly that like the the fighter: “[We] coulda been a contendah.” Instead, we will be the late great democracy: US of A brought down by greed, short sightedness, lack of patriotism and climate change we refused to do anything about because it reduced profits.
2
I can understand the Republicans--the Ebenezer Scrooge Party of, by, and for the rich--making it their mission to tell the struggling classes (most of us): "Now, you don't want affordable and quality health care for your fellow citizens and their children and aging parents, like all the advanced, democratic countries, do you?"
(Note: Real reasons for the GOP anti-health mission for the U.S.:
1. Because our wealthy patrons with stellar boutique health insurance plans don't want a healthy society or to pay a farthing for the well being of society and the people in it.)
2. Because private insurance corporations is where the money for health insurance needs to go, so CEOs of these companies can negotiate obscene pay packages and the administrative overhead and costs of private health care far outstrip what government charges.
Oh and those other countries with universal health insurance are socialists and have terrible cheap health care (wink wink). Pay no attention to the UN ranking of nations on health care where the U.S. ranks #1 in cost but #37 in quality of care and outcomes.
See how other countries do health care better and less costly
https://mic.com/articles/46063/7-countries-that-show-us-how-health-care-...
One political party in the U.S. actually cares about people's health care and wants to make it better and affordable. The the other party does not care about people's health or the environment and wants to make both worse.
You decide.
2
Everyone who supports universal health care access can begin by no longer calling the Affordable Care Act, Obamacare, including President Obama himself. The sad truth is that much of the opposition stems from the fact that it bears an African American man's name on it. How else to explain the fact that rural white Americans want the coverage but don't want "Obamacare?" Furthermore, calling it Obamacare suggests that President Obama is singularly the one who got a form of universal health care implemented, and that is not true -- it's a disservice to the many people who worked on it before him, and it is a disservice to the many honorable and hard working government employees that helped implement it and work on it today. We don't call Social Security "Roosevelt Pensions."
Since the days of Harry Truman, Americans have been haggling about healthcare, unfortunately, with little in the way of a concrete resolution. There is also the somewhat "minor" issue of the healthcare industry spending more on lobbying than any other major industry in America.
Coincidence? I think not.
The solution is there, especially now, in that in order to make the meaningful changes that will bring America in line with all the other "civilized" western democracies and the 21st century, start electing those that are committed to actually doing something about it and most importantly, are not beholden to the lobbyists and corporate donors that actually dictate policy. Seventy "plus" years of no solutions just confirms it.
I believe it is quite clear that when it comes to this important issue, continuing to elect "bought and paid for" politicians that continue with fear tactics and preference for the "status quo" will have America continue to haggle about healthcare for another 75 years.
3
Single payer? It’s a cosy notion for socialists, but the reality is when big government takes over healthcare, once you have factored in all the kick backs, diversion to other projects, pork, corruption, bureaucracy and plain waste that comes with that, all that will be left is pennies on the dollar going to the sharp end.
The result WILL BE a two tiered system. On the one hand, basic essential healthcare for all, free at the point Of use, but very basic. There will be long waits for procedures. Some expensive procedure or drugs might not be available. Unelected bureaucrats WILL have the power over what treatment you have and when. That is what you will get for the price you currently pay for healthcare, assuming that taxes replace our premiums and deductibles. All this coming at trillions added to the public debt.
On the other hand, assuming you want to see any doctor at the time of your choosing, a procedure no longer covered as part of the public option, or you need a life and death procedure done urgently, then you would have to take out private cover. I suspect many firms would start to provide that cover to their employees eventually. The result will be that many Americans will end up double paying to have the same standard we have today. That would be more akin to the reality of the UK where increasingly most people who can afford it have some level of private coverage.
1
I am sorry, what should we be afraid of ? High cost? But Americans are already paying twice more than votes end of the countries with the single payer. If we can afford current system, we for sure could afford one less expansive. Two-tiers? But right now we already have multi-year system that defined by ability of patients to pay. Long wait? That's really rich. Right now certain insurance have long wait list to see specialists. 6 months to see dermatologist, 8 months wait for knee replacement. And some people who could not afford the medical care had to wait for whole their life to get some procedure. So, I don't thing your scare tactics is working.
4
Why the American business community doesn't get behind a Medicare for all healthcare system this country is baffling. Every other industrialized country in the world has a single-payer healthcare system that works very well, with better outcomes than our own and at a fraction of the costs. In addition, because those countries businesses don't have to pay exorbitant insurance premiums, their operating margins are better, I bet.
The only reason I can see why our companies have not demanded Medicare for all is that if people are untethered from having to stay put in a job because of the need for health insurance coverage, then they could possibly have a stronger bargaining hand when it comes to wages and compensation.
Our current system is economically unsustainable. We pay at least twice as much as every other industrialized country in the world pays for healthcare, and with worse outcomes. Allow people to purchase a Medicare plan, using the premiums and co-pays and deductibles they now spend and they would save money and get better coverage.
3
What most Americans don't realize is that uninsured people in this country, do get health care but it's often delayed and only after patients become sicker. The care is, therefore, more expensive. And who pays for it? Everyone who has insurance. Hospitals are required by law to treat all patients in emergencies (even undocumented immigrants) and have been permitted to pass the costs along to insurers who, in turn, pass the costs along to their policyholders in the form of higher premiums. It would be far more efficient to explicitly pay for the care of uninsured and would save them from complications prevented by timely treatment.
In a large hospital where I practice, patients without insurance who are not US citizens have remained in the hospital for months receiving hemodialysis because there is no way to pay for outpatient dialysis. How much outpatient care would a year in the hospital cover?
Another thing Americans seem not to realize is that 25% of the money spent on health care through private insurance goes to administrative costs and profits. In other words, it is not providing health care. We could increase coverage by 33% if we eliminated that waste of care. Americans also do not realize the contempt for-profit insurance companies have for their health. They refer to money spent on actual medical care as the "medical loss ratio". That should tell you everything you need to know about their priorities.
5
Not sure I fully agree with Paul Krugman. This is a little too rosy of a picture for me. What happens to all of the people employed by the massive private insurance and drug industries? Private Insurance companies spend between 12 and 18 percent on administrative costs, compared to Medicare, which has administrative costs of about 2 percent. In California, Democrats are using their power to shut down single-payer legislation as they take big money from private insurance and drug companies. On the liberal East coast, it's pretty much the same story. A solidly Democratic New York, Connecticut, and New Jersey have declined to take up single payer. He who controls the money wins the game. A lot of our major social and political issues would be helped by campaign finance reform, specifically, reducing inequality and removing the ability of the rich to easily game or outright buy the political system. We need to work on reversing Citizens United and eliminating the Dark Money groups.
5
@RHS
I agree with you 100%. Unless we reform the political system completely, everything else we argue about is moot.
2
@RHS campagin finance reform has been needed for decades now. McCain-Feingold took a stab at it and the corporate Supremes shut it right down. Campaign finance reform is the key to wresting control of the government from the military-corporate complex that controls it, but it will be very difficult to do. Here's another idea: have you noticed, as everyone has gotten angrier and more polarized since the 2008 downturn, money in politics is not nearly as influential as it used to be? The minority party has, and they are doubling down on their voter control techniques. Now if we could make THAT illegal, well, that would be great.
1
@Michele Underhill I agree with you. Thanks for replying.
A better health care plan: Leave employer-sponsored insurance as is. It is both popular and working well. Expand Medicaid to cover the elderly, the poor, the working poor, and the disabled. Allow those individuals who have to have individual insurance to enroll in Medicare. It would increase the premium pool and mitigate the claims pool because those new enrollees are younger and healthier.
1
I don't know where did you get the idea that empoyer- based insurance works well. First of all, not all employers could afford insurance, with rising premiums the part is pushed on employers. Moreover, it forces employers to pick cheapest insurance with thin coverage. With more people working on contract, such arrangement became less popular.
3
@yuliaIf Do a little research which requires an open mind and a little work you will discover you're wrong. I'm not addressing small mom and pop operations but large corporations who can afford insurance for employees. For example. my daughter-in-law works for the University of Oklahoma and she has excellent insurance for her entire family.
1
What individuals pay is really not the issue. It is how you divide up the 4 trillion dollar pie which is the total cost of healthcare. Most individuals health insurance cost is subsidized by their employer or the government so they don’t understand the real cost of that insurance. My insurance is Medicare, subsidized be the government and a supplemental policy supplemented by my last employer.
2
Truth be told, about 60% of the cost of Medicare is covered by the lifetime of payroll deductions and the premiums Medicare insurers pay once they are in the program.
1
The Republican scare-mongers are starting to fight against their own base. Utah and other Republican states want Medicaid expanded.
https://www.nytimes.com/2018/09/09/us/politics/utah-medicaid-expansion.html
During a national opioid addiction crisis, which now affects rural areas more than urban ones, maybe people realize that it's hard to get someone back into an employable condition when you have them lose their job, then due to that, not have access to medical treatment. Growing up a a painful process sometimes, but the Republican leadership seems to feel it's still necessary to punish the unfortunate. But of course, they'll blame the victims or the Democrats, and then they'll remind voters that they got that extra $1.50 a week from the tax cut, and that the snipping sound as the safety net is removed under them is nothing to fear - and necessary since the tax cut has increased the deficits.
In every other country with universal healthcare, once it's established, it's politically impossible to eradicate it.
Right wing politicians in Canada, Australia, UK, EU, etc don't dare going anywhere near discussing changing their universal healthcare to an American style system.
And, per Krugman's column, you're seeing the emerging political cost in America of attacking Obamacare, which isn't quite universal healthcare.
3
Krugman never gets it and I am amazed that you guys continue to publish someone so very out of touch. College professors are generally people who have never really been successful. Anyway since Obamacare, my healthcare costs have tripled. My adult children have experience the same increase with no increase in quality or successful cure rates. Krugman continuing to talk up Obamacare masks it’s real failure. He is just part of the elite’s attempt to cover for Obama. Forget the swamp. We need to burst the elites bubble!
4
@Dan Locker
If you would calm down for a moment, you'd realize that in order to evaluate the impact of a law, you need STUDIES analyzing what happens in this country as a whole, rather than refusing to look beyond your own doorstep.
And all those studies show that before Obamacare, tripling premiums (something private sector companies will always try to do, by definition) happened MUCH more frequently before Obamacare existed.
It's sad that it happened to you this time, but if you truly care about AMERICA's greatness, you should be happy that overall, that law is making America greater (concretely, that means an additional 40,000 American lives saved a year - THAT is what happens when "the elites" do some serious healthcare studies and base new laws on proven evidence rather than personal beliefs and mere guessing).
What's even more, for years already Democrats propose measures that would solve the problem for the few people out there who indeed still have to face what your family is confronted with.
In the meanwhile, all that the GOP proposes is bills that would destroy the healthcare of 30 million Americans and increase premium costs much faster once again.
The only way to get better healthcare in this country is to learn to find out who's doing what in DC, rather than to blindly attack "the elites". Among the elites just as among ordinary citizens, there are lots of good guys, as well as lots of bad guys. And the good guy isn't always the one who yells loudest ...
2
@Dan Locker If you had Medicare for all you would pay nothing and you and your children would have the best health care on the planet. There was a guy running in 2016 who was for that...in the meantime you can blindly attack this successful professor who has accomplished much more than you ever will, or you can look at the studies he points to and you can re-evaluated your politics a little. Republicans caused all the problems you point to. Democrats tried to solve them. So your answer is what?
Just the other day, His Trumpness was heralding the complete repeal of Obamacare and its replacement by something something. (It's funny how different the volume is for the "repeal" and "replace" parts of that over-familiar mantra.)
Remember how we railed about how this election in 2016 would determine which side would select Supreme Court judges? Forward to present day, we now have the medical preconditions on the chopping block to be determined by the midterms. Can we please wake up to the reality of the importance of VOTING? If you as a citizen - registered voter or not - are going to sit on the sidelines and pout or put your hands over your ears yelling "lalalalalalala" and hope for the best, you will deserve your fate. The stakes are huge. A simple act. A responsibility. An extremely important and significant event. A citizen's vote. Just do it. Vote.
6
It's really something, watching Trumpists howl slogans about Paul Krugman's economic illiteracy and how Obamacare will "bankrupt the country."
I mean, 17% of GDP and climbing, employers stuck with trillions in premiums support, Ahura-Mazda knows how much down the drain in terms of lost productivity, and the Right's howling about OBAMACARE costs.
Cripes, guys, the PPACA really has been getting people covered, flattening the cost curves, and doing what it was spozed to do. Problems? Sure, and you're making every one of them worse.
Mwanwhile,you don't even know simple things, like the way the legislation did away with the donut hole in Part D or allos you to find out what stuff costs.
4
There were too many "compromises" in the ACA which were actually give aways for nothing. If sane people ever get control of the government we should have Medicare for all and allow the government to negotiate drug prices. We should also allow the purchase of drugs from Canada.
7
Indeed, the current crop of democrats are all in in defending the A.C.A. and, most importantly, the protection of preexisting medical conditions. Too bad it didn't happen initially, as democrats lost the Senate when shying away from Obamacare....supposedly to save their own skin. Did you know that these United States is the stingiest industrialized country in offering basic health care needs....while the most generous nation in the number of prisoners it harbors? Something is really wrong when an entire political party, the G.O.P., along with it's pseudo-republican vulgar bully in-chief, is adamant in denying to others (the poor, the sick, the elderly, women and children) what they take for granted for themselves, health care. Can't the public see that the symbiotic screwing of this democracy by cutting taxes to the corporate rich is ripe for biting us back? That we have crooks and liars in government impervious to decency, and where solidarity is a bad word?
4
@manfred marcus
You cannot possibly hold the Democrats, thanks to whom soon a whopping half a million American lives will have been saved because of Obamacare, responsible for not having campaigned hard on it after passing it, as it wasn't their fault at all that more than half of the American people didn't take the time to minimally inform themselves, whereas Republicans were throwing tons of money at spreading lies about it - and about the economic recovery.
At a certain point, people have to start accepting that we'll only have a government FOR the people if it's a government BY the people, and if we don't engage, politicians will always be powerless, in DC.
When we don't, and allow our friends and neighbors etc. to believe those lies without engaging in real, respectful debates, then the problem isn't that those Democratic Senators who voted for the ACA would lose their jobs if they boasted about it at a time when it was still highly unpopular (they KNEW they were risking their jobs when they voted for it in the first place, and decided to put country before party anyhow - something we can't thank them enough for). The problem is that the only party that would protect Obamacare would be voted out, and so would be the new law itself.
The only way to get rid of Trump and the corrupt, constantly lying GOP, is to STOP the overall cynicism that supposes that all politicians are bad, and to give credit when credit is due ... !
1
First you were not for Obama. Then you belatedly got on board. And then you started to extoll and defend Obamacare despite its flaws. Now Obama himself is talking about Medicare for All....and you are belatedly lagging behind....
3
@Petey Tonei he's been a hilldog through and through. I remember his columns criticizing Obama's ideas on healthcare in the 08 primary. He was right there. It's interesting to watch Krugman's evolution on these issues.
1
Ted Cruz, Beto O'Rourke, and the Great California Republic?
“Tofu and silicone and dyed hair.” How about "tacos, thin people and clean air?"
7
This is the hill democrats should be willing to die on. Not immigration, not gun control, not impeaching bozo the clown, all dem positions I support. THIS. IS. THE. WINNER.
9
Yes!
Republicans are running on identity politics?
And which party let that cat out of the bag? Bill Clinton started it, Obama mastered it. It blew up in Hillarys hands.
2
@Lane Actually the No Nothing Party started it. In modern politics you could make the claim Strom Thurmond started it, or perhaps George Wallace. I like to point to Richard Nixon and his "silent majority" as a good starting point, but what he did was harmless when compared to ronald reagan, he really let the cat out of the bag with the racist dog whistles. His welfare queen lies really did this country serious harm, both by destroying good public policies and by making the country more racist, and bringing identity politics out there front and center. George Bush Sr.'s despicable and racist willie horton ads were built on reagan's dog whistles. And His son's attack on John McCain's DAUGHTER was total racism to win in South Carolina. It got worse...All republicans...
Too bad the lying Republicans are trying to sabotage the health system in their zeal to make sure the poor are their slaves.
The Democrats lied about Obamacare when they forced it on the population.
Now, the Democrats lie about it when the population votes to dump it.
They are credible alright;
Just like the Saudi government is credible.
2
I keep wondering how getting elected, announcing your plans loudly, writing legislation and passing it through Congress, and signing it into law after 13 months of hearings, is forcing it on the people.
1
They don't care if you're sick and can't afford healthcare. That's the only conclusion I can come up with for Republicans. Doesn't matter to them if you're a working adult or a child. Sick people, especially the poor ones, are a burden.
Give a Republican a chance to discriminate and they'll embrace it with joy. We heard the moron Rand Paul call universal healthcare "slavery." No, Dummy, slavery is when your master says you can't go to a doctor.
4
The ACA is not perfect, but neither was insurance just a generation ago when pre-existing conditions were excluded from coverage.
Last year I was diagnosed with Stage 4 Lymphoma. Incurable but treatable. In October, after close to $1,000,000 in submitted charges, my insurer raised my rates from $1500/month to over $4000/month. I couldn’t afford that. I’d be out of pocket almost $60,000 before insurance kicked in.
I was able to get coverage via the ACA. It wasn’t quite as robust as my previous policy, but my oncological team was in network.
If Republicans continue to gut the ACA with their non-existent replacement, or seek to deny coverage for conditions over which I have no control, my decision will boil down to bankruptcy vs death.
That is the stark reality.
I’m writing about my experience, which coincided with the health care “debates” of summer 2017. It’s titled “Cancer and Me in the Early Days of Trump.” It’s about the “shock and awe” of finding myself facing potential loss of care for a disease I didn’t ask for by a government that doesn’t care. About me, about you, or about anyone but their donors. They’ve got theirs. Screw you and me.
8
I can not consider ACA as a success. Yes, people get coverage from expanding Medicaid. But that is not a reform of healthcare, it is expanding welfare. Which is fine with me, but don't call it health reform. Although the premium were low in beginning, they soured later to point it was no point to have crappy insurance for such premium. sure, insurance was unaffordable before, but now I have to pay for not having insurance. Subsidies may help some people, but it is difficult to calculate especially in this gig economy when your income varies. I am glad for people who got helped by the 'reform', but to me it was a big disappointment.
18
@yulia - right. I had Obamacare for several years and the last year was the best here in Illinois. I lowered my deductable and got a better plan than the previous year - and being able to shop over 30 options made it easy for me, a contractor during those years, to find a plan I could pay for (no subsidy, but if in the gig economy, you want to be where you don't qualify).
So make up what complaints you want, but I'm not at all convinced of your views - including the vague "it's difficult to calculate" statement. You complain about a gig economy where employers use trickery to distance themselves from people they'd otherwise offer coverage for, then complain when coverage is made available? Complain about the gig economy, not Obamacare.
Oh, and I have middle-aged hard working siblings who now have medical coverage - denied to them previously due to old, minor pre-existing conditions. Would you like to complain about that, too?
5
@yulia
I would not call the ACA "welfare" by any means, if it truly is "welfare", then the tens of millions of people who get their health insurance from their employers are "on welfare" too. And, I don't think those people consider that they are receiving "welfare", with their highly subsidized group insurance.
5
@yulia
It's covering 20 million more Americans, curbing cost increases, and saving an additional 40,000 American lives a year - which means soon a whopping half a million American lives.
If you call this "not a success", or not "healthcare", it's quite obvious why we never got a Congress that managed to improve it in the first place: too many people simply can't get their priorities right.
And only half of those 20 million got insurance through the expansion of Medicaid. The other half gets it on the individual market, thanks to the exchanges where premiums went down because of the competition they create, and through subsidies.
That you personally didn't get the insurance you wanted is sad, but Obama never promised that this bill would solve ALL problems.
And the main reason why it couldn't possibly solve all problems is because "we the people" time and again vote for Republicans who vow to destroy healthcare and social security altogether, certainly not because Democrats didn't want to adopt universal not for profit health insurance ... .
It's in THAT specific decade-long context that the ACA has been a huge and improbably success, just to get the bill through Congress and signed into law.
The only way forward now is to build on the new foundation that it laid. And that is only possible if you're able to celebrate what we already achieved. If not, if we only feel fired up AFTER ideals are 100% written into law, we'll never contribute to any progress at all.
3
It's time to move to a single payer system. Every other advanced country has done that. It isn't rocket science. Spend less on defense (which is really very much Offense - and offensive), and more on our people -- education, healthcare, environment, science, arts... Increasing military budgets, when we already spend more than practically all other nations combined, does not make us safer. But investing in our people will strengthen our economy and make us more prosperous.
6
No, every ither advanced country has NOT done that. They've moved to universal coverage, which we should.
Let's hope that facts still have influence on enough voters.
2
I'm someone who believes that Medicare for All is the ultimate goal, but in the meantime I think Medicare for More would be very popular with the electorate of both parties. Democrats need to run on a buy in for Americans over 50 or 55 and those with serious health issues. Let insurance companies cover younger and healthier people for now, it's clearly the only business they are interested in anyways because it's where the maximum profits are. We are an aging society and there is significant anxiety about health care. Democrats can be the party with a strategy to address these concerns. Republicans clearly have never had a plan beyond get a job with great benefits or please die as quickly as possible so not to be a burden.
4
The GOP is owned by the health-care/insurance, pharma and equipment industries who will never allow their politician-agents to change things much. There are just too many people in power whose wealth depends on the current system.
3
@Cowboy Marine Don't forgot how Cory Booker is owned by them too
The ACA is an insurance policy (with premiums) just like that on your house, car, life, etc. One assumes that one would prefer not to ever use any of these but they are there if/when necessary. Thus, why can we not have a progressive tax system to cover socialized medicine like so many developed countries? If one never needs serious health care then they are blessed. Your tax premiums can then help someone else. Yes the ACA is not perfect and can be improved so Congress, do so!
3
''What’s particularly impressive about Obamacare’s stabilization is that it’s happening despite desperate attempts by Trump and his allies to sabotage his predecessor’s achievement.''
Aye, imagine if all states had the medicare expansion and the extra people in the insurance groups to bring down rates even further ? - you know, how the system was designed to spread all of the costs around ?
At any rate the de-facto plank of the Democratic party is Single Payer now and that is the threshold for any new Progressive candidate - and they are winning in special elections and primaries.
Furthermore there is the provision within the ACA that any state can set up their own Single Payer system (Vermont came close) and that is in all likelihood going to be the way forward to achieve full status federally. (much like gay rights was achieved)
The republican party will continue to try and chip away away at it (much as it has done abortion rights) but the consensus is to join every other industrialized nation in making health care a human right.
It is just a matter of time and your votes.
3
I'm waiting for progressive Democrats, the FDR wing of the Democratic party Clinton abandoned, to specifically acknowledge Medicare for All is really about becoming self-insured, a well-known business model most Americans support. FDR and his advisor Harry Hopkins knew welfare traps people into poverty and tramples their dignity, something we see with Medicaid that requires people remain paupers for care or ACA subsidies that's become the bane of the gig economy, something conservatives and progressives could unwind for economic and social development.
Hospitals and medical facilities wouldn't need to overbill insurance companies to compensate for charity care or reduced fees patients pay with cash for treatment their insurance companies won't cover. American business can purchase workers compensation policies at substantially reduced rates when Medicare covers the medical portion of workplace injuries like Canada.
My wife and I operate a mom and pop shop and were forced to purchase two separate health insurance policies as employees of our company because of pre-existing conditions. We thought ACA would help until we learned our new insurance company under ACA scammed us and millions of others with fraudulent networks. Both of us are on Medicare now, and the difference between what Medicare covers and the paulty policies we could afford before is substantial. We still have time to get it right and become self-insured as Americans, so can get treatment our doctors want.
2
Yes. The Democrats are, in the main, credible on health care. Bernie Sanders and his followers are completely credible. Paul Krugman. He waffles.
2
You mean Obamacare actually worked, saved lives, and is now increasingly embraced by the poor in red srates...AS LONG AS,YOU DON'T CALL IT OBAMACARE?
Maybe if the Democrats had praised it, explained it, and embraced it after it was passed, the Republicans would have had a harder time demonizing it and strangling it, but, no, the cowards ran from it. .
So don't act surprised, all you incumbent Dems, that younger, more agressive, candidates are shoving you aside like yesterday's leftovers. The revolution is just beginning.
5
@Trakker
The very LAST thing we need at this point is the call for divisions in this party due to age, religion, gender or race -- because that's exactly what helped Republicans to get over in the last election. Now is the time for all to be on board and to get out the votes!
UNITY is POWER.
3
@Trakker
So all that you have is blaming those who had the guts and competence to get a major piece of legislation through Congress that soon, according to independent studies, will have saved an additional and whopping half a million American lives ... for not having tweeted enough about is, as we, ordinary citizens, are somehow not supposed to engage and inform ourselves ... ?
It's absurd to punish people who get real stuff done by taking their job away and replacing them with people without any congressional experience, just because the GOP decided to invest so much money in lying about Obamacare that many of its voters started to believe those lies.
Conclusion: the revolution began long ago already, and it's thanks to Democrats. You can either jump and the train and engage too, or stand at the sidelines yelling "not enough!" to those who are standing in the mud and just managed to get us one step closer to the finish line. As far as I know though, it's the latter, not the former who can be called "cowards" ...
1
It is very revealing that the Republican Party runs on tribal innuendo against immigrants, for guns and the religious right agenda and offers no meaningful policies.
It is inevitable that Donald Trump was their annointed candidate since he so perfectly fits their debasement of ideas and corruption of their principles. I feel that not only does the Republican Party needs to be defeated in the voting booth, but they need to be replaced by a new Conservative party that actually believes in democracy and intellectual honesty and is interested in formulating real policies and working with the opposition to improve our country!
5
I'm really tired of seeing right-wingers lie about the PPACA in semi-literate sentences, and almost as tired of reading the yawps about how easy and free single payer would be and how that slacker Obama coulda got it if he'd only tried.
Folks, you want single payer? Fine. Maybe start by learning what the thing even is, and try getting at least a little idea of how hard it'd be politically and what the costs would look like. Might even be good to work on that whole, "And then, everybody gets everything," fantasy.
And pretty please, stop wo the "every other industrialized nation has single payer," jazz. Because they don't. They have universal coverage, or something close to it, using one of many approaches. Usually it's some kind of mixed system.
4
Universal health care is the answer.
Come, America. Join the civilized world.
9
"The ads write themselves: just play the tape of Trump promising "terrific healthcare at a fraction of the cost" over and over." ~ Elizabeth A
Are you listening Dems?
3
Do you want health care?
Do you want clean air and water?
Do you want social security?
Do you want financial regulation to prevent another Great Recession?
Then vote Democrat
Pound this in Dems!!!
8
@Jeff Davis.to be honest, you need to include, "do you know you're going to have to pay for all this?". To be complete. There is no free lunch.
Krugman--The Fake Economist--is at it again, with more obfuscation, misdirection and mendacity than ever before.
Obamacare was great--as long as you were one of the ones getting it for free--or at a subsidized rate. Most of us were not so lucky. Here are the reasons why it was a failure:
1) It never had popular "buy-in". It was shoved up the noses of the American people--the majority of whom did not want it. Not a single Republican voted for it. The Obamacare "power-move", resulted in huge Democrat losses the year after it passed--proof of America's disaffection with the law.
2) It never held up to any of its promises.
--it did not reduce the average American's health care premiums by the $2,500 Obama promised.
--it did not expand coverage to all citizens.
--it did not allow you to keep your plan--PERIOD!
3) Costs spiraled out of control, in some cases leading to double and triple digit price increases. Most could not afford the premiums--and then suffered further indignity and harm--by being forced to pay the penalty.
4) Insurers needed heavy subsidies--in order to bribe them to offer policies. Even with that, many pulled out--leaving many states and counties with 1 insurer.
In summary, Obamacare was an unmitigated disaster--and a fraud foisted upon the American People by Progressives and the Democrat Party. The only supporters were fans of big government--and those who got it for free.
You can make anything popular--if you give it away for free.
4
Democrats have always run on policy, while Republicans run on identity politics. Sadly, running on policy is terrible politics, because most Americans don't understand policy and don't have the education levels to make rational choices on issues of even modest complexity. So, yes, Democrats have bucketloads of facts about how much it has helped Americans, and Republicans will rant about how it helped "those people" and how horrible brown immigrants are (Norwegians are ok, of course), and Republicans will win in a landslide because at the end of the day, this is America.
3
I just want the kind of healthcare the guys in Washington have (actually I want to live forever!) — but it seems if I’m asked to help contribute to theirs, they should help support mine. It’s hard to ask a man to pay for others what he cannot afford for himself. And, it is plain nonsense on the a Republican side, that the people do not want for themselves what they are providing for others — quit listening to the rich man!
111
@rebecca1048
Do you feel the same for public employee pensions?
That is, do you like paying for another's retirement when you can't afford to retire yourself?
1
@rebecca1048 They worry you will become dependent on Government. meanwhile, most have been in Government jobs for years with health care, pension, etc. They are immune to becoming dependent but are concerned for you.
@rebecca1048 Rebecca, your post reminds me of a conversation I had with my doctor some twenty-five years ago. He told me, censoriously, that what I wanted for everyone was the kind of insurance the senators and congressmen had. I replied that he was right, that eventually this was what I wanted, but immediately I wanted them to have what ordinary Americans have, constant uncertainty and the threat of bankruptcy. This would hasten the day when the rest of the citizenry had what the senators and congressmen have. Today, I stand by what I told my doctor twenty-five years ago.
Finally, thank you for your excellent post.
To moderators, I was responding to Doug below, and realized I needed to edit my comments: Hi Doug, Yes I agree with everything you say. But if you have type 2 diabetes you might be able to get well with much less medical care and much less medication, by strictly following a whole food, plant based no added oil diet. There are a number of doctors in the USA who proscribe this diet witch reduces the incidence of heart disease, diabetes and cancer. Some of the giants in this field are Caldwell Esselstyn, Neal Bernard, John McDougall, Michael Greger, Kim Williams, Joel Fuhrrman, Michael Klapper. In the Bronx there is Robert Ostfeld and in Manhattan Michelle McMacken who works in the clinic in Bellevue hospital. If you go to Bellevue insist on seeing her. You can also just read the Reversing Heart Disease Cookbook by Jane Esselstyn, the wife of Caldwell Esselstyn. The expert on diabetes among these doctors is Neal Bernard. You should read Dr. Neal Barnard's Program for Reversing Diabetes. Free information is found on NutritionFacts.org run by Michael Greger. He has a helpful book called How Not to Die. You should read The End of Diabetes by Joel Fuhrman, It is not enough to be vegan, you must follow a whole food (nothing processed), plant based (no meat, dairy, eggs, or fish), no refined grains, and no added oil. I hope this helps.
4
Three points: 1) there are no simple answers- saints-devils-miracles - on US health care politics; 2) The ( mostly Republicans) higher income participants in ACA plans don't get the subsidies - they SUBSIDIZE; 3) Most voters don't look any farther than what comes out of their pocket - not net cost - not health outcomes - not even whether they can get good insurance or not. "What does it cost me out-of-pocket?" The end.
4
@Lon Newman: that was the basis of the devastating "Harry & Louise" TV commercials that singlehandedly SUNK Hillarycare in 1993 -- setting back the cause of universal health care for a GENERATION.
Nobody else seems to remember these, but I do. A big part of it was an old gentleman patting his pocket and saying "the COST of this will come RIGHT OUT OF YOUR WALLET" -- meaning, the elderly on Medicare. He correctly predicted that any reform would take money from the old, and give it to the poor -- as indeed, Obamacare does to the tune of $700 BILLION.
Most lefties here do not realize that our American system -- with all its flaws -- generously gives very good single payer to SENIORS over 65 -- with no restrictions as they age. I just talked to a lady of 95 who had a hip replacement! and she's got dementia and is in a nursing home! in Europe....she'd be pushed to physician assisted suicide, or just left in pain in her wheelchair -- they'd NEVER spend $50,000 to replace the hip in a 95 year old!!!! -- that money is slated to go for the young and poor, especially the hordes of Muslim economic migrants who came to perch on their generous welfare systems.
1
"Almost five years after Obamacare went into full effect, the answer is a very clear yes. It hasn’t worked perfectly"
Let's also be clear that by far the biggest hurdle to the ACA has been the Nine's decision that red states could reject the Medicaid expansion if they wanted to, which has left a number of places in the country where the same people who desperately need health care the most are the ones that can't access it.
I currently live in a Medicaid-expansion state. Things are fine. I have insurance through my employer, but those times when I was between jobs, I had Medicaid to fall back on. I've also lived in a non-Medicaid-expansion state. I hope never to live there again.
7
They made a big mistake by not including a public option. It would have guaranteed that every single county would have at least one reasonably priced insurer. The plan could have been priced at the gold-level, which is the type of plan that sicker people want, and it would have served as a soft price ceiling on silver plans offered by private insurers.
Also, there should not have been a limit on profits. Profit is compensation for risk. It is risky to offer insurance in counties with higher levels of people with pre-existing conditions. So a profit-limit reduces the incentive to make insurance available to those who need it most.
Hindsight 2020
3
@Daniel Tobias
It's not "they" who took out the public option, it's Independent Lieberman.
An Hillary promised to include it as soon as she'd enter the White House.
Unfortunately, many people who support a public option preferred to stay home in Nov. 2016 instead ...
As to the limit on profits contained in Obamacare: insurers indeed must reimburse at lest 80% of what they receive in premiums, in care.
Why? Because before this mandate, it's precisely lowering this percentage that was driving massive premium increases, and those premium increase had only one cause, the fact that Wall Street strongly rewarded insurers who managed to lower it.
So this isn't about making profits or not at all. It's about taking out Wall Street as main driver for determining premium costs, so that "the market" can determine them on itself - knowing that the individual mandate gave insurers a whopping 20 million more clients ...
2
@Ana Luisa I think Hillary would have made a better president than Obama even, had she been nominated in 2008. We're going to have to agree to disagree on profit limits though.
Based on Mr. Krugman’s comments, Democrats can fix Obamacare instead of implementing single payer when they regain power. Additionally, the ACA is so well built that reinstatement of the individual mandate is unnecessary. If all of this is accurate then let’s see this as the Democrats platform for healthcare.
3
Yep. Run on putting the subsidies, mandate and advertising back in, add on trying to extend the Medicare age downward with an added buy-in equivalent to what you'd be paying into the system between when you went on Medicare and when you would otherwise have started--most of the scare stories you see about premiums and deductibles come for folks between 55-64 who live in a state that didn't expand Medicaid, and don't have employer coverage--and you're good to get started.
You'd have to tweak it some (Part D drug costs might be a prob), but a perfectly-sound foundation.
My health insurance premiums have risen 20-30% every year since Obamacare, with no change in coverage while having only one option in my state. I need to raise the price of my goods and services largely due to the increased cost of "health care" even though my family consumes very little of it. The current approach of employer-based health insurance is unsustainable. 'Medicare for all' will be even more unsustainable, but seems inevitable since our nation has no interest in compelling people to be healthy and reducing demand for disease care.
5
@JCX What Democrats dont want to tell you is the poverty they want to flood the country with to add to our own poverty will be paid for by you in a public option. You will pay even more in taxes than you pay now to pay for all the poor immigrants (their voter base) legal or not. That is the dark secret the Democrats will never tell you....until its too late.
4
I thought your choice of the phrase, "DARK secret," was nicely revealing.
1
@JCX: Americans are not on average any sicker or inclined to more medical costs than people in Canada, France, Germany, Australia, Great Britain etc. that all have universal health care. We are NOT (contrary to myth) any fatter or smoke any more than any other nation.
We have the same ordinary health problems as other nations, which DO NOT restrict care to only those who are slim and in perfect health.
2
I always thought that including a public OPTION would do the trick. Private and public health insurance would then be competing with one another, and the option that eliminates the profit motive from health insurance delivery would almost surely prove more efficient, insuring more people for less per-patient cost.
Just have a look at Germany, or Canada if you are skeptical.
7
@Martin Looking at Canada makes me more skeptical not less. Canada has far worse wait times than the US and their citizens carry more supplemental private insurance than other single payer nations.
2
@John: If Canadians need urgent care they receive it promptly and that's what counts. If the care is not needed urgently, a somewhat longer wait time is not an issue. If I need to see a specialist here for a non-urgent issue, I also have a wait time of a month or more, so what's your point? Including supplemental private insurance, health insurance in Canada is still much more affordable than in the USA, and insureres are not allowed to refuse people with pre-existing conditions. The problem here is that health insurers work from a profit motive, while in most other countries they need to be non-profit. Why do we allow 20-30% overhead costs for obscene salaries and bonuses, on top of rampant drug and medical treatment costs?
@John You are wrong. Canadian healthcare varies by province although within the well-defined limits of the Canada Health Act. The supplemental insurance is for dental and vision coverage and is usually employer provided. Wait times are for elective surgeries are fully triaged for urgency. I've had care in both the US and Canada. Give me the Canadian system each and every time.
1
The ACA needs to be discussed and modified as necessary just like: immigration, pollution laws, GW regulations or anything else. The demagoguery on this issue is the poster child for how we get nothing done anymore in this country. The fact that we, as a nation, seem to be incredibly uninformed on so many things makes it easier for people on the right and left to exploit our ignorance for their political agenda. The right is the most egregious at doing this, but the left has learned from their play book. The only solution is for the population to become educated on this like most issues so that we can call out the liars and try to move forward in spite of their efforts. Democracy is only possible with much effort on the regular citizens part. We can't depend on politicians to help.
1
"The ACA needs to be discussed and modified as necessary just like: immigration, pollution laws, GW regulations or anything else."
Exactly. This is how all government organizations, heck, all organizations, work: you're always going to have to keep making changes to keep it current. No one has a problem understanding this when discussing the military or police. It's only when we talk about welfare state or regulatory state that every glitch or need to adapt is treated by half the country as a full-blown emergency proving that the entire system can't possibly work and requiring that we shut it all down.
1
Nice how Obama and Krugman have come around on Medicare for All. Save yourself some anguish and don't google their past impressions of single payer. I wonder what would have happened if we'd had a president in 2009 with a Democratic majority in both the house and the senate who was a proponent of M4A. Hillary said single payer will never ever happen. Gee, why wasn't that boldness a reason to vote for her? Obama said we shouldn't wait for a candidate to inspire us. What a gawdawful statement. Trump, horrendous as he is, presented a message to voters that he was going to make their lives better. Hillary presented no such message and the country is suffering because of it.
3
Obamacare is a weak compromise; we need a single-payor health care system. Bernie Sanders was right, and we should continue to fight for it.
To paraphrase Patrick Henry: Give me single-payor or give me death - or as you put it: get sick, go bankrupt, and die.
Most developed countries with universal health care don't do single payer.
I have nothing AGAINST single payer, in particular. But it seems silly to focus obsessively on only one method of universal health care; leaves a lot less room for the inevitable tweaks and bargains and negotiations that all legislation needs to go through before becoming law. The goal is making sure everyone has affordable and reliable health insurance; how you get to that point shouldn't be rigidly defined.
1
So many people forget what it was like for so many without Obamacare. And those who suffered without insurance and remember shiver at the thought. The first thing a doctor's office asks before anyone will see you is do you have health insurance and what is your coverage. Heaven help you if you respond in the negative. The GOP screed against Obamacare is wearing thin even by those who focus on immigration.
Democrats almost unanimously believe that health care is a basic right and will take action to make it happen while republicans motto to the uninsured is just die, but those nasty immigrants a southern wall and must be fought at any cost, money that should be spent on health care for all.
1
I have a fundamentalist sister (not really Christian, in my book). Her son got married a few years ago at 19. Her daughter, my niece, equally ignorant due to home “schooling”, recently mentioned to me that her sister-in-law wanted to have their first child before she turns 27 because she’ll be able to do so while covered under her parents’ insurance.
“Oh, Obamacare!” I said. “How nice that it’s working for her!”
Met with sickly silence, by both my niece and my sister.
Yep, hate it, hate him, vote against it every time — but they rely on it.
Go figure.
8
“ Give us Medicare For All OR give us Death “.
LITERALLY.
5
@Phyliss Dalmatian And bankrupt the country at the same time...
1
It has taken almost a decade for people to realize just how under-handed and damaging Republican undermining and sabotage of Obamacare have been. Congressional Republicans have promised "replace and repeal" all along but have worked for "damage and destroy."
Finally, tens of millions of people, especially Republicans who have drunk the Kool-Aid, are turning against their party not only because of actions that have cost millions of people their lives and their health, but also for the consistent lying that was the tactic of party leaders.
President Trump, Liar in Chief, turns out to be a help to everyone in improving lie detection.
2
Obama was totally wrong, blindly promoting an economically and strategically infeasible program. Krugman in just wrong in contorting to build a case for this idealistic but inoperable program. The Democrats were and are as incapable as the Republicans in implementing sustainable medical program. And especially wrong are those who militate for a universal healthcare that would consume more than 50% of the resources of the country. A reasonable compromise is conceivable but impossible to implement in the current political climate.
2
Yeah... Sure, every other country in the world has somehow managed to perform the witchcraft that makes universal health care possible without consuming "more than 50%" (sic) of the national resources. But... somehow, it's impossible. Septickal from Rhode Island says so. Who you gonna believe, him or the entire developed world.
3
@CP. the rest of the world rations care. We really don't. Show up, get everything done no matter the cost. The patient gets bankrupted and so does society. Americans are going to have to get used to the reality that not everybody gets every treatment no matter what. A lot of very sick babies and old folks are going to not get expensive, futile treatment so that the greater good is achieved, just like all those countries we hold up as ideal. When Americans admit to this reality we may start to get somewhere.
Providing health care on a for profit basis is patently absurd.
2
@tbs. it's also a contradiction in terms. You make way more money by not providing health care. Your premiums HAVE to be paid. The businesses running health care don't have to provide any health care.
Norway has had Single Payer since 1912. Obama recently called it a “new” idea. Does that sound credible to you??
1
Except Norway doesn't have single-payer. It has a national health system, akin to that of England.
https://en.m.wikipedia.org/wiki/Healthcare_in_Norway
2
Credible?
“If you like your plan, you can keep your plan, period.”
“If you like your doctor, you can keep your doctor, period.”
“If you misrepresent what’s in this plan, we will call you out.”
“We can do all this without adding one dime to the deficit.”
“It is not a tax.”
“I do not believe in the individual mandate.”
Which of these were true?
7
The one where right-wingers just repeat slogans and refuse to address reality, because they're convinced that all the moochers are horning in in their mooch.
2
The GOP view on health care is another form of
voter suppression. You can't vote if you are dead.
Lying is the GOP's pre-existing condition.
3
Democrats should run both on policy AND on Trump. POLICY, because they've actually done their homework and know what they are talking about; the GOP has remained the party of 'no,' and have no ideas about anything, let alone healthcare. And they should run on TRUMP because (GOP claims to the contrary notwithstanding) Trump is the GOP and the GOP is Trump. And they are an utter misery, intent, it seems, on not only wrecking their own party but in dragging the rest of us on down with them.
Of course none of this will cut any ice with the stupid (and I do not apologize for using that word) Trump supporters.
The ones who scream about how much they hate Obamacare but who -- in the next breath -- shriek 'don't you dare take my Affordable Health Care away!" No amount of reasoning will serve to sway them. Democrats would do well not to try to 'understand' them. Democrats won't make them sane; the Trumpistas will just make the Democrats crazy.
2
The bigger question is: Do Republicans have any credibility on any issues at all?
They are not a party of ideas and policies - they are a cult of believers and deceivers, peddling comfortable lies and half-truths while running from inconvenient whole truths.
They are attempting to construct a steel bubble to live in, impervious to facts, and they want to force the entire country and the rest of the world to live in there with them. That sound you hear is them gasping for air as they run out of oxygen, using their last breaths to blame others for their predicament.
If they achieve anything positive in the public sphere, it's generally by accident, not intent.
2
Dr. Krugman got most everything right except when he said of Republicans "They’ve also been utterly wrong about everything, and have learned nothing from their mistakes.". Of course they've been wrong; as he said they've making up lies the whole time. When the lies are proved wrong, it's not a mistake, and the liars will learn nothing but move on to the next big lie.
2
Not going to harp, but Dems should have gone all in for single pay when they had the control. The Rube Goldberg system gave the Repubs too much leeway to taint the argument with the Rubes in Trumpaneseville. (Think Kentucky, which changed the name, but used the subsidies) I cannot imagine a worse world than one without decent healthcare. The people who don't have it are really cursed. Unfortunately many will scream "lock her up" at a rally and not realize what they will soon be denied. Sick world, sick country, sick people.
3
Last week, Ted Cruz, the unexpectedly endangered Republican senator from Texas, warned that Beto O’Rourke, his Democratic opponent, would turn the state into California, with “tofu and silicone and dyed hair.”
I think this statement by Cruz may seal his fate. He must have a very low opinion of his constituency.
@scott k.: all Cruz has to do is goad Beto into talking about the GIANT TAX INCREASES required for his socialist plans and then...Cruz wins again.
I hope Tom Perez, Keith Ellison, and the whole DNC mine this op-ed when crafting the Democrats' next TV ads.
2
Forgive the pettiness of this comment, but what is Ted Cruz thinking? He is insulting his constituents. I live in Dallas and have travelled all over. I have never seen so much plastic surgery, Botox, dyed hair, liposuction, breast implants, nail salons, etc.. as I have here. Although I do agree there are probably not as many tofu eaters here......
On a more serious note, Republicans seem determined to deport a large number of us, and then let most of the rest of us languish without adequate resources for proper health, education, and environmental safety while they hide behind walls and gates. At least the Democrats are trying to help people.
#medicareforall Dr. Krugman is most fiscally responsible way to deal with our "capture" by Big Pharm and Big Insurance courtesy the ObamaDems, a capture you endorse.
If "capture" means that I can afford health insurance for the first time in my life thanks to the big bad Corporate DINO Sellouts who passed the ACA, all I can say is bring on the "capture."
It's amazing how different our country would be if Republicans had decided to support their own healthcare plan of the 1990's when Obama passed it as the ACA, rather than dividing the country for partisan advantage.
Both parties should be unified in trying to cover the uninsured with affordable care. Instead we have Democrats fighting for it while Republicans obsess over Making America White Again.
“Last week, Ted Cruz, the unexpectedly endangered Republican senator from Texas, warned that Beto O’Rourke, his Democratic opponent, would turn the state into California, with ‘tofu and silicone and dyed hair.’”
Wow, this certainly smacks of desperation on the part of Cruz - using the “tofu and silicone and dyed hair” attack or what could be called “TSD” for short.
Well, Mr. Cruz may well experience “PTSD” in November when Beto O’Rourke and the voters throw him out. Can’t wait!
Krugman's predictions have all failed. Unfortunately, it appears he has become an irrational and delusional pathetic figure, against all logic and reason. Tragic.
5
The mandate that large employers must offer health insurance was going to kill the economy according to Republicans. That never happened. I am surprised that Krugman doesn't mention this.
69
@Martin
Most of them already offered health insurance anyhow ...
@Martin
Well, it applied to companies with 50 employees or more, but as just about all such companies already had employee health insurance, the effect was bound do be minimal. Apart from the fact that some of the pre-ACA coverage was junk and had to be upgraded. But the results were the same—the Publican doom-merchants were wrong.
@MartinNot Killed but wounded it. The trillions spent on health care stops many salary increases. It has been shown that the employers would save billions of dollars even if they had to increase their taxes to allow a single payer system. They would still come out way ahead and perhaps this extra money would go towards a living wage. However, the tax cut went 85% into the corporate profits and not to increase wages.
Lets clear something up right now. It is not the government that supplies the R&D for our healthcare system. It is the drug and device companies. Does the government do R&D, of course it does, but the got does not do R&D at all on the current devices currently in use, to innovate them and make them better. Is the govt spending R&D on a new knee replacement? A new plate for trauma? A new implant for calcaneal osteotomies? A new mesh for hernias?
Is the government looking to improve any and all the devices currently made by every device company?
The answer is no. The device companies conduct that R&D, with capital they get from private insurance that pays for their current devices in use. When you get a knee replacement from Stryker, or Zimmer, or Smith and Nephew, who do you think did the R&D for their implants? The government? No, Stryker and Zimmer and Smith and Nephew did. Who do you think does the R&D to make them better?To innovate? To make them less invasive, and more anatomically correct? The govt? No, those companies, and whole host of others, including smaller companies funded by investors do this. This is all ONLY paid for by private insurance. If we instituted a medicare for all, these companies would not make the extra money they need to spend on R&D. Not even close, so R&D, and with it innovation, would come to a standstill. Without the promise for a windfall profit, those investments would not be made.
This is entirely incorrect. Much of the research that is done on the most devastating diseases is done by academics, who are funded largely by government and nonprofit grants.
Pharmaceutical company research is often focused on making lucrative but unnecessary drugs like treatment for male pattern baldness, sexual enhancement, and (while absolutely necessary for some) antidepressants and anxiety pills that are only marginally different than what’s on the market already. A lot of pharma’s budget is marketing.
4
You cannot flood the country with poverty like the Democrats want to do and expect the dying American middle class to pick up the tab, which is what would happen.
5
If you believe Obamacare is a solution you do not pay health insurance premiums. While the ACA was improvement, health care is far too expensive, and bankrupts even those with insurance.
We need to move to Medicare For All. Krugman is out of touch if he thinks working people can afford this system.
5
Krugman hangs onto the "ACA success story" like a shipwreck survivor to a lifebuoy.
There are as many uninsured people now as there were in 2008, and for the rest of us insurance rates have skyrocketed.
5
@kwb
Do you have a source for that? Or is this just your opinion?
1
@kwb This is the problem of believing Republican lies. The number of uninsured under the Affordable Care Act has fallen from 46 million to 29 million. The percentage of uninsured declined from 15.1 percent in 2011 to 9.1 percent in 2015 - the first time it hit single digits. You probably will just dismiss these facts as "fake news," but here is a link to the CDC Report for people who care about the truth. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201605.pdf
3
@Charles L.
The total number of insured people under the ACA is about 3% of the total population. Who knows how many of those are self-employed prisoners of the system whose high premiums subsidize the rest.
Only in the US can the nation spend around 17% of their GDP on healthcare, yet return poorer health outcomes, than other advanced nations who spend around 11% of their GDP, on healthcare.
Despite spending 50% more on healthcare than other advanced nations, the US has a lower life expectancy and a higher infant mortality rate.
Trump continues to undermine the ACA by removing the individual mandate and allowing insurance companies to not have to accept patients with pre existing health conditions. More money for the mega rich as their taxes fall, while millions of Americans struggle with their healthcare, seems to be the Republican policy objective.
10
The GOP was in favor of an ACA-type health care plan until Obama proposed it. They had seven years to craft a "replacement" plan. Their plan? Cut health insurance for millions, while cutting taxes for the wealthiest. The GOP is a radical, broken party. Neither the US nor the planet can afford to have GOP party members in office.
Save the world. Vote on November 6.
14
It's kind of a stretch to give Democrats credit for Medicaid expansion coming in under budget. The Supreme Court edited the legislation and gave state governments the power to deny their residents the option to accept the Federal government's offer to purchase Medicaid on their behalf.
"...protect people with pre-existing conditions while also protecting and perhaps expanding Medicare."
It is personal to me. When I finished my successful cancer treatment in 2009, my oncologists informed me that I would not be able to get individual health insurance again. To me, it meant that a future serious illness would represent bankruptcy or death.
They were right until Obamacare was passed. Expensive but it doable.
To me, taking away Obamacare is criminal.
11
Dr. Krugman, you do not have Obamacare, so you apparently will NEVER EVER be able to understand intellectually why it is so lousy, worthless and detrimental to MOST Americans.
The only ones who want it -- as you point out -- are those on 100% FREE Medicaid welfare. Medicaid is not INSURANCE -- it is welfare. It is a handout. It is the OPPOSITE of insurance.
The REST OF US get stuck with high deductibles, which you REFUSE TO ACKNOWLEDGE.
4
@Concerned Citizen This is an important point. The tension and burden of the high deductible for those with insurance but who do not have the income to afford a $5-6 deductible is one of the greatest problems with our current model of health care delivery. Medicaid does not meet the costs of delivering care, and incurs further cost shifting by health care systems which leads to higher costs for those with high deductibles. Medicaid and its coverage for basic services and preventive medicine is important. However, no matter what you think about Medicaid politically, it doesn't cover the costs of delivering care. That is the vicious circle we are in. Then, if you decide not to expand Medicaid or if you remove coverage you only increase the cost shifting by creating more self pay, and underpaid patients which leads to higher deductibles. It is a terrible dilemma.
2
@Concerned CitizenWait til you get the republican plan. You'll wish you had Obamacare.
What happened to the doomsday predictions that Medicare will run out of money? Isn't it likely that Trump will try to roll back Medicare benefits as well as Obamacare? I'm getting blasted with phone spam telling me to drop Medicare and go with private health insurance.
@Richard: Medicare cannot run out of money, as Krugman and others love to tell you -- the government can just "print more money" -- and also, raise pay roll tax rates.
There has not been one bill proposed to cut or eliminate Medicare, though your St. Obama did shift away $700 BILLION from Medicare to fund his Obamacare.
The phone spam you get -- I get this too -- is to get you to sign up for Medicare Advantage, which is a legitimate form of Medicare (and IMHO, preferable to original Medicare and cheaper to boot!) -- but this is purely YOUR CHOICE.
Advantage plans are controlled and mandated by Medicare itself. They are sold by insurance companies but must comply 100% with Medicare. And you can GO BACK or change your Medicare provider EVERY YEAR during the enrollment period of October-December.....so if you try Advantage and hate it....you can GO BACK.
Dr. Krugman, once again, a well-reasoned column replete with facts and data. But that won't sway Trump voters. They don't care about the facts. And they don't care about health care, for themselves or their children.
Now I understand that we who detest Trump and this Republican Congress are in the majority. That said, it will be some time before political gerrymandering is ended (if ever), with five solid Republican votes on the Supreme Court to uphold it. We have more than half of the Senators representing a paltry 18% of our citizens, mostly white, mostly older.
And this is why Trump voters matter, because they are a minority that will hold power over the rest of us for some years, if not a decade or more. They don't want affordable health care, if it means giving up their racist screeds and a return to Jim Crow, their semi-automatic weapons, and their own personal, Biblical interpretations that women should be forced birthing vessels. These three things are all they want. Affordable health care? Not even on the list.
All the facts in the world will not change Trump voters' minds. They are drunk with power, as their "dear leader" incites their hatred of minorities, as they parade around, heavily armed at their "rallies". That semi-automatic assault rifle is what they want, not affordable medical care for their sick children.
And as long as we in the majority are held hostage by this rabid, backward minority, we will not have affordable health care in this country.
11
@Cooper Hawkes Agree with what you say. But the supporters of The Donald that I know would not be caught dead reading the NYT; so they will never read the Professor's "well-reasoned" column. NYT, NPR, Washington Post, the network news, etc., are, in the eyes of The Donald's faithful, just propaganda from the "liberal elites."
The people who dislike The Donald are in the majority, but many of our democratic friends don't bother to vote on election day. The number of voters on election day is what really counts.
I have had cancer 3 times and must purchase my own insurance as a self employed individual. I have NEVER been rejected due to preexisting conditions. However the ACA increased my premiums astronomically. I have had to pay thousands more which I consider extremely unfair. I pay for other people’s care through my taxes and for my increased premiums AND out of pocket high deductible expenses. The ACA is hype. The poor don’t even benefit as it is impossible to find doctors who accept Medicaid with its pitiful reimbursements. And as for Paul Krug’s insinuation that the Republicans have no policy points to stand on in the upcoming elections—try the ECONOMY!
22
1. "Before Obamacare, insurance companies could deny you coverage if you had a pre-existing condition. That affected 50 million people, including 17 million children. Of those with pre-existing conditions who sought private insurance, 47 percent didn't get it. They were either denied coverage, charged a higher premium, or had their condition excluded because of it.
Without health insurance, they couldn't afford treatment, which meant they wound up in the emergency room. Their expenses were either paid for by Medicaid or were absorbed by the hospitals. That resulted in higher health care costs for everyone"
https://www.thebalance.com/obamacare-pre-existing-conditions-3306072
So if you care about America's greatness, I hope you agree that you cannot possibly claim that because of the fact that you were part of the lucky 50%, a healthcare law that temporarily increased your premiums but OVERALL, as studies show, CURBED premiums increases, should be destroyed and we have to go back to the situation before Obamacare ... ?
2. A couple of million American buying insurance on the individual market indeed need subsidies to be able to buy them but have an income that is too high to get them under Obamacare. That's why Democrats want to increase subsidies, so that you get to pay lower premiums too.
3. There is NO Trump dent in ANY economical graph visible today, whereas Obama had 4% quarterly growth too, and for 5 of last 7 years had higher monthly job creation than Trump ...
38
@Deborah
I had a very different experience. I lost my job at the age of 63 and the ACA allowed me to have fairly good coverage at a reasonable price. If I had opted for COBRA, then expense would have been three times higher. When I was out of work in 2006, no one would cover me due to a history of well controlled hypertension. Finally, BCBS offered a policy for over 1000 per month, but there was a catch. Nothing related to hypertension would be covered. So, a heart attack, a stroke or renal problems wouldn't be covered. The ACA is far from perfect but it was so much better than the alternative for many of us.
11
@Deborah
Come on. Stop the lies. This President can take little or no credit for the economy. Obama did much more to get us where we are.
In the next few years we will see if Trump does more to hurt or help the economy. I bet it will be hurt. Also check out the sweetheart deal on 666 Fifth Ave for the Kushners. It stinks to high heaven !!
Ted Cruz and his staff hate Texas and make fools of themselves trying to pretend to be Texans. Ted's staff tried to poke fun at Beto by comparing him to a Whataburger. Trouble is, Texans love their Whataburgers.
https://www.elpasotimes.com/story/news/politics/elections/2018/08/22/ted...
Beto is a real Texan. If Ivy League Ted loses he will quickly move out of the state, probably to New York so his wife can be closer to her job at Goldman Sachs.
3
Dear Dr. Krugman, could you kindly explain how much Medicare for all would cost compare to the current system, and how it would be paid for? It seems to be the most reasonable and cost-effective solution to our very expensive system, but Republicans scream about the cost. Given that they just gave trillions of our tax dollars to wealthy, it seems to me that any cost of universal healthcare could just as easily be covered. One source of financing might be requiring companies which now contribute millions or billions of dollars to matching costs for health care insurance for employees to instead contribute that to a pool for universal coverage. And if we eliminate most of the administrative costs, that should drive down healthcare costs. It seems to me much of the alarmism over costs is not justified. Could you let us know if I'm wrong?
1
Universal health insurance has been an issue close to my heart since I was old enough to understand what it was. Incredibly, that was nearly fifty years ago. In the decades since, I have known even liberals who have been misled by the powerful, incessant propaganda against it: one middle-class co-worker of mine who supported Obamacare feared it would increase our taxes by five thousand dollars a year - but she remained in favor of it. We saw no tax increase, of course, just a significant improvement in our own employer-paid insurance plan.
Now, in 2018, I won't waste my vote on any Democrat who does not support single-payer, Medicare for all. Obamacare was a giant leap forward for our country. The time is coming to make the next one.
3
@Steve Surely you don't support a republican. They all want to kill Obamacare and certainly would never allow single-payer Medicare for all.
1
@Bill I would not support any Republican. I would vote for another party's candidate or else abstain altogether.
@Steve, what you say about another party's candidate is what gave us Bush instead of Gore in 2000 (please remember that on this tragic anniversary) and trump instead of Clinton this time. (and look at the sad divisions, a criminal/corrupt white house. and future exploding debt,that this has led us to) Voting all dems is the only way to go--- even if it just a place holder for a more progressive party in the future.
I am self-employed and am on the ACA. It has been a lifesaver for me since I have had a rare type of brain tumor as well as a rare chronic blood disorder classified as blood and bone marrow cancer.
I help people as best I can to sign up for the ACA, since the enrollment period has been cut in half, advertising has been slashed to next to nothing, and the number of navigators available to help people figure out how to enroll and understand the system has been reduced dramatically.
I mostly worry about all the uninsured and underinsured children and adults with serious health conditions who suffer in fear every day because we currently have inhumane politicians in charge of our government.
I keep my fingers crossed that Democrats will vote in full force this election. If we can at least flip the U.S. House, then hopefully Obamacare is saved.
If not, maybe Gary Cohn will remove the ACA paperwork from Trump's legislative folder and he won't remember that it was supposed to be there.
Such a scenario seems admittedly far-fetched, but when you're sick and dying you'll take any help you can get, for yourself and for everyone else in the same boat with you. And that's a lot of people.
While there's life there's hope. What kind of people want to take away hope? What kind of country is that?
We are the most powerful nation in the world, yet the world sees how we treat each other and looks on us with abject pity. And with fear.
So where do we go from here?
November 6.
310
@vulcanalex: And who would pay the government in taxes to enable it to provide that help? And risk sharing is the back bone of any insurance. How many people that never have a car accident pay for those that do? And car insurance is mandatory, unless you don’t need a car.
1
@vulcanalex
I can't begin to tell you how happy I would be to pay higher taxes so that @Blue Moon and others—everyone—can have decent health care.
@Blue Moon Great for you, how many healthy people are paying massive amounts for you to have your coverage? Under the old system you would have gotten help directly from the government.
3
This could have been avoided a decade ago; may Joe Lieberman's name be forever disparaged for his perfidy
5
When will our political leaders accept that their arrogance and incompetence causes real human beings -- real Americans -- to suffer and die?
When people cannot access care, they suffer and they die.
When they can't afford their meds or cut dosages in half to save money, they suffer and die.
When they put off seeing the doctor because they can't afford the visit, they suffer and die. And it is 100% preventable.
Mitch, Paul and their buddies have killed Americans through neglect. The worst part? These great "Christian" men couldn't care less.
What I would give to rip Congress' taxpayer funded healthcare out from under every single last one of them!
10
In full disclosure, each author of a comment on this column should disclose the source of their health insurance. As you all opine on the wonderful benefits of Obamacare.
Most of you have health insurance covered by your employer. Or, are on Medicare. I doubt many Medicaid recipients can afford subscriptions to the New York Times.
Krugman keeps babbling about the "Pre-existing conditions." This issue was addressed, decades ago. It was called, COBRA. If you lost your job, you could continue your health insurance until you got another job, or individual insurance. As long as you had continuous health insurance, no insurance company could deny you coverage.
A lot of people just didn't bother to do that and when they got sick, they wanted someone else to pay, for their bad decision.
To just repeat, most of you posting here do NOT have Obamacare policies. You have NO IDEA of what you are talking about.
I'm 64, I have no health insurance. I don't qualify for "subsidies." I make $45K/Year. I've just been paying the tax. That Tax is a lot cheaper than an Obamacare "Policy" at $15,000/year with a $6,000/year deductible.
No one in their right mind would sign up for that.
Although, one Silver Lining with Obamacare; the mushrooming of "Urgent Care Clinics." Places where people can go, and pay Cash and get some urgent medical need taken care of. At a fraction of the "Obamacare" price.
When government tries to oppress the free market, the free market always strikes back.
3
You might at least say thanks for the way the rest of us are forced to cover your tail for free, will be stuck with your costs if you get sick or hurt, and will be pitching in to help cover your Medicare next year.
1
@Robert No, if I get sick or hurt I will negotiate a cash price for my care. I've saved a lot of money not paying those ridiculous premiums.
I would have happily continued paying for my Catastrophic policy at $3,500/year if Obamacare hadn't made that policy illegal.
As to Medicare, I was forced to pay into this system for the past 49 years, looking forward to getting something out of it.
Ta-Nehisi Coates aptly described the lengths to which Whites will go to deny black people power in his book, "We Were Eight Years in Power".
Even when the achievement of blacks benefited whites as it did during Reconstruction when African Americans wielded political power for the first time, white people destroyed much of what they accomplished and systematically removed blacks from government office because black accomplishment was felt as a deep humiliation of whites in that it proved false the abominable myth of racial superiority.
Republicans would rather see their white constituents lose than countenance the success of an African American President whose policies benefited everyone.
8
Why are democrats running on Medicare for all (i.e. commiecare)? I thought Obamacare was going to reduce healthcare costs and insure all Americans. Isn’t it remarkable how the socialist utopia is always just beyond our reach. I guess if we like our plans we really can’t keep them.
1
The problem Repubs have with health care is one word, CARE. Simply, they don`t care, they don`t want to care, they shouldn`t have to care about anyone but themselves. If they had the slightest ability to care they would come up with a plan, but they can`t, it`s not in their DNA.
Let's face it, Obama should have instituted Medicare for all when he had the chance, when Dems controlled both houses of Congress and the White House. The ACA was a baby step, born of his desire to compromise with Republicans who brooked no compromise. Imperfect as it was, it was better than nothing. Now all Democratic office seekers can do is ask their Republican opponents: "What happened to the replace part of repeal and replace. What are you replacing Obamacare with?"
3
Let me start off by saying that I think health care is a basic human right. That being said, if we go to a Medicare for all model, how do we account for disparities caused by blatantly irresponsible health decisions? For instance, my mother-in-law is a lifelong smoker who was diagnosed with emphysema several years ago. Despite this, she (and my father-in-law, also diagnosed) continue to smoke. Because of this they are at the doctor continually, complaining of bronchitis and many, many other health problems. If either of them sneeze, once, they run for antibiotics. Despite this, they smoke like chimneys.
I quit smoking about 15 years ago, at 30. I started exercising regularly, eating better, and lost weight. I rarely get sick and rarely need to see a doctor. When it does come time for me to need the help of a doctor, should I have to wait in line behind people like my in-laws? My taxes would be paying for their care - for the care of extremely irresponsible people with regard to their health decisions. At the same time, every taxpayer would be saving money on me, because I make good health choices.
We need a way to incentivize better choices and penalize poor choices. Without that I just could not support Medicare for all.
47
Assuming people will act in accordance with their economic interests all the time is a curious assumption to make. You would think that the system we had before the ACA would have incentivized your in-laws to change their health habits. Theoretically, they would have had higher costs not covered by insurance. Because they’re still addicts, we can assume that the more expensive system didn’t do anything to change their behavior.
In fact, the cost of their care is already factored into your taxes and health care premiums. In other words, you’re already paying for their poor health choices. It doesn’t make much difference whether their costs are subsidized by more expensive health insurance premiums, higher medical fees imposed to pay for people who can’t afford their care, or by higher Medicare taxes. You will pay the same amount.
What you raise is a general problem with insurance called “moral hazard.” It occurs when people believe that others will end up bearing the costs of protecting them from the consequences of their bad behavior. But once you get rid of underwriting based on risk in order to deal with pre-existing conditions, there’s nothing you can do. You just have to make the policy judgment that a Medicare for all system would end up being a net benefit to most people after taking into account the abuses of a few.
12
@Scott
Its called the real world. You just talked yourself into why we cant have medicare for all. That and a whole host of other reasons. the 32 Trillion dollar pricetag for one.
@Scott
The core idea of universal healthcare is simple: people are in better health when they have access to healthcare.
What you're proposing is to reject that idea and see affordable healthcare as ... a reward for good health.
Don't you see that that's a "contradictio in terminis"?
And it's even not a good "investment" of your taxpayer money, as denying sick people access to decent healthcare means that they will end up in the ER, with much worse health problems, and as a consequence cost taxpayers much more.
That's why all Western countries except for the US have universal healthcare: it's because it's not only the right thing to do from a moral point of view, it's also the most selfish thing to do from a financial point of view, for each and every taxpayer.
Finally, when it comes to addiction, studies show that causes are multiple, but none of them can be understood as long as your stuck in judging people rather than investigating causes.
Most addictive substances provide chemicals that allow the brain to temporarily calm down and as such prevent worse health problems (caused by chronic high brain stress, for instance).
Studies show that brains can be taught to produce those chemicals themselves, but only if you train people in 7 crucial "self-care" skills, which develop the neuronal network needed to produce them.
What your in-laws need is such training, not more judgments (those only increases brain stress ... ). Info: see Julie D. Simon for instance.
2
No one has analyzed all the costs and inefficiencies of the current healthcare systems -- or, more accurately, systems. There are extraordinary administrative costs in maintaining 50 Medicaid systems, each with separate rules and staffs, the VA, plans for active and retired military, thousands of different individual policies with separate rules and bureaucrats who enforce them, Medicare advantage plans with separate rules and enforcers, union plans and negotiators, etc, etc, ad nauseam. And the enormous burden on doctors and hospitals of meeting data requirements, approvals and appeals of all these different plan and programs. Pity the doctors who spend much of their time coping with this insane system.
There are countless studies of all the myriad deficiencies of the current system, but like the blind men trying to understand an elephant by feeling different parts the elephant but never understanding the whole beast, no one understands the full picture.
Medicare for All, or something like that, would cut costs enormously. No more healthcare executives in HR; no more Medicaid bureaucracies; no more jungle of different policies with enforcers and "got cha" provisions. Unfortunately, in the short term, there would be significant unemployment among small army of laid off bureaucrats who are no longer needed. In the long run, we would all be much better off and the unemployed would be gradually be absorbed into the economy.
7
The Republican actions regarding health care underscores their lack of concern for people as is seen in every policy they promote. Young, middle aged, old, poor, middle class, whatever color Republicans are equal opportunity when it comes to denying help.
2
The ads write themselves: just play the tape of Trump promising "terrific healthcare at a fraction of the cost" over and over.
Maybe this great healthcare plan was secretly swiped off his desk by Alex Azar or Seema Verna.
109
@Elizabeth A
Outstanding point, Elizabeth! There are Trump ads that write themselves like the one you mentioned. In other examples, simply run his "drain the swamp" promises with ads picturing the individuals who were corrupt and forced to leave - ads that show the swamp.
If the Dems can just finally stand up to him and demonstrte his broken promises and slogans then we have done our best at creating a strong, forceful campaign.
2
If healthcare didn't carry the moniker of the first president who didn't look like the other presidents it would be the law of the land. Our resentments are so ingrained that we would rather let people die than give Obama his due. What country would deny healthcare to people because it claimed is was too costly and then turn around and give billionaires a tax cut? Can we be saved from ourselves? Guns,Race and Abortion has been used by the powerful to divide and conquer us.Healthcare should be as much a right as it is a right to buy an AK-47!
3
@Steven McCain
I 'hit' the "recommend button' -- but, while you end with "Healthcare should be as much a right as it is a right to buy an AK-47!" … I 'say' that, in a sanely 'administered' nation, the former would be a right and the latter would be prohibited (and penalized as a felony).
1
I am a medical device rep in NYC. I have scores of surgeons as clients, and am in the OR everyday when my surgeon clients use my product. I am also responsible for getting newer devices approved in hospitals. So let me say this, medicare for will destroy our current quality of care, and turn our hospitals into something that resembles your local DMV. The reason for this is, medicare, any community plan, and medicaid, does not pay for innovation. Only private insurance or cash does. For every single device or drug being used today, there is new research and development going on right at this minute to make them better. That goes from the slightest little hammertoe implant, to the joint replacement implants, to heart stents etc. Everything. R&D isnt just finding the new cure to cancer.This R&D is very expensive, takes many years, and requires a lot of input from the best surgeons in the field. That means large sums of precious capital must be spent by the drug and device companies, including paying for the best surgeons in the field to lend their expertise. This R&D doesnt always result in a new product. Sometimes it fails, and all that money goes right down the drain. That precious capital is spent by large companies and investors investing in a new company with a promising new product. These investments are made with the hope of a windfall profit. If the hope or promise of a windfall profit is not there, these investments wont be made. Innovation would come to a standstill.
@Sports Medicine
"The reason for this is, medicare, any community plan, and medicaid, does not pay for innovation. Only private insurance or cash does. For every single device or drug being used today, there is new research and development going on right at this minute to make them better"
This is hogwash. R & D happens in all of the Western democracies, even the ones that have single-payer systems. Research happens in the VA, in the National Institutes of Health, and in not for profit hospitals all over the country.
Private Insurers are not motivated to fund device or drug research. They are motivated to collect premiums and pay out as little for care as possible to return maximum profits to their shareholders.
5
That is not true. The vast majority of biomedical innovation comes out of universities and is funded by NIH. That funding stream has proved steady despite changes in administrations and political ideology. Universal Health Care will not change that. NIH spends more money on research than any similar body in the world.
3
@Renecalvo
You are both completely wrong. I know folks like yourselves think the government provides for everything, thats why I tried explaining that there is R&D spent for every single drug and device out there. Is the govt spending R&D on a new knee replacement? A new plate for trauma? A new implant for calcaneal osteotomies? A new mesh for hernias?
Is the government looking to improve any and all the devices currently made by every device company?
The answer is no. The device companies conduct that R&D, with capital they get from private insurance that pays for their current devices in use. When you get a knee replacement from Stryker, or Zimmer, or Smith and Nephew, who do you think did the R&D for their implants? The government? No, Stryker and Zimmer and smith and Nephew did. Who do you think does the R&D to make them better?Tto innovate? to make them less invasive, and more anatomically correct? The govt?
Seriously. You are off on this. No wonder Democrats get votes.
At first, the Republicans chanted "Repeal", then they decided, "Wait a minute, maybe that's not a good slogan". So, for years we heard "repeal and replace" but when it came time to say what a replacement would be...crickets.
The propaganda campaign against Obamacare was so massive and so effective that millions of people, even now, believe it was somehow the work of the devil himself. There would be death panels deciding who would get care and who would be allowed to die. There would be microchips planted in the bodies everyone who signed up. Costs would rise so much and so fast that they would eat up the entire federal budget.
Obamacare was not a comprehensive, for once and for all solution to health insurance and health care in America. That's part of the problem: it was half a loaf and it was being delivered in the middle of the worst economic crisis in our country since the Great Depression when millions of people were losing jobs or their houses to foreclosure, sometimes both at the same time.
The Democrats should make a solemn vow: don't play around with half way measures. The Great Recession plus the relentless campaign against Obama and Obamacare have delivered us into the hands of Trump and the Trumpsters. Millions of people have been helped, who knows how many lives have been saved, but how many of those voters went Republican anyway? The Democrats found a way to lose by winning. If they had delivered a more comprehensive solutions, they might have gained.
53
Let's also remember that the GOP would have a better plan. Nine years later: where is it? More GOP lies.
@Doug Terry Well, surely you know what happened. A few blue dog Democrats who live in swing states or states where health insurance companies are large employers, plus good old Joe Lieberman from Connecticut (‘the Hartford”), killed even the public option. Don’t blame all Democrats for that.
The single most fascinating thing I have learned by living in Sweden for 23 years and by watching very carefully the final 2018 pre-election debate at which leaders of 9 political parties held forth for 2 hours is this.
In Sweden, even the leader of the extreme-right Sweden Democrat (SD) party, Jimmie Åkesson, spoke forcefully for making major improvements in the Swedish Universal Health Care system. As he spoke on this subject, many of the other party leaders nodded "yes" and even smiled.
When Åkesson turned to immigration he took off his sheep's clothing and became the wolf who really would prefer that Sweden never had let even me in, Swedish last name and all.
But when it comes to health care not one party leader could dream of speaking against UHC. So as I prepare to vote in the US Midterms, I can entertain myself by picturing some Republican up for re-election saying out loud, "Yes, the people in the lower third by SES class in my district have benefited from ACA, we must preserve and extend it."
You create the scenario of what would follow for that truth teller.
Only-NeverInSweden.blogspot.com
Citizen US SE
PS Since I had a well received comment 2 days ago on Swedish voting practice I can report that about 84% of the 7,500,000 eligible to vote did so. Never in America.
5
"Pre-existing condition" is not a disease; it is a condition created by our dysfunctional health care system. Just think, all of our fellow developed nations which have universal health care coverage do not even understand what we are talking about when we mention "Pre-existing condition". When you have health care from birth to death you cannot have a "Pre-existing condition".
7
Paul is an economist. He should know that Obamacare, in its present form, could never survive. The reason being is that sick people have an advantage over healthy people, because they already know what medical bills they have. Naturally, they will select the Obamacare plan that reduces their costs the most. In other words, sick people are going to make an educated choice during enrollment. Healthy people, on the other hand, have no medical bills. So, they are just rolling the dice when choosing a plan. This puts them at a disadvantage and therefore, on average, they will pay more than sick people for coverage. As they come to realize this, naturally, they are going to start dropping out, because it's unfair. And this will just accelerate until Obamacare becomes nothing more than a national high-risk insurance pool.
1
@Mark, WHAT? "Healthy people have no medical bills." What about a 30 year-old healthy woman who gets pregnant and joyfully is in need of health care. What about a healthy 16 year-old who suddenly needs his appendix removed ? What about a 60 year-old person, who thought they were healthy, who suddenly has cancer or Parkinsons? What about a healthy person who suddenly exhibits signs of early dementia? These healthy or formerly healthy people wont have medical bills?
Why aren't ALL the Democrats out on the hustings pounding the healthcare issue? It seems very curious. Are there Democrat office holders who are beholden to the monstrous medical insurance industry, and various for profit medical providers?
Healthcare for all should be a human right not an opportunity for the greedy to take advantage of the ill.
1
To expound a little further on Socrates comment:
Only in America can a political party be wrong on everything it claims will happen if progressive laws are passed and still get elected to office.
Unleaded fuel will kill the automotive industry
Safety glass will kill the automotive industry
Seat belts will kill the automotive industry
Restrictions on smokestack emissions will drastically increase the cost of electricity
No fault insurance will destroy the insurance industry
Gays in the military will destroy moral
Gay marriage will destroy heterosexual marriage
The ACA will destroy the economy and cause hundreds of thousands of lost jobs
Add infinitum:
3
The health care debate has continued to swirl around the ACA, Obama, insurance companies, “socialism” and other such distractions. Why do we not focus on the two basic questions relating to health care?
1. Are all legal residents of the US entitled to some basic level of health care?
2. If so, what is that level and how will it be paid for?
If you think the answer to the first question is no, I question your morality and decency, but at least I know where you stand. You never get to the second question.
If your answer to the first question is yes, the problem is this: Today we have a system that is essentially run by people who are not actually providing the care—some combination of the government, insurance companies, employers, pharmacies, etc.—while the caregivers and the patients are basically passive rule followers or recipients of invoices. Pricing for services is not based on any “market” and purchasers of services have little idea what the cost will be of what they are buying until they receive the bill.
Right now, we are all indirectly paying for care that a patient cannot pay for by higher prices for our own care. We are being taxed, indirecly, to pay for inefficient, expensive care (i.e., emergency rooms as primary care clinics) because we have not solved question two.
Until we focus on and fix this disconnection between care providers and health care consumers so a rational market can form, we will never solve this problem.
1
I am convinced it is mostly about racism. We are still the nation that was built on slavery's back, and states like Virginia were established while 40% of its citizens were locked in chains.
While change is generational, the mindset of white supremacy means equality in any way is difficult, from education to health care, to voting rights.
Take away the mostly far right Republican former slave states, and America is a pretty decent place.
Hugh Massengill, Eugene Oregon
2
@Hugh Massengill There is nothing decent about injecting "race" into a problem which may have 100 other causes and issues but clearly no connection to "race."
2
I’m still waiting on that ephemeral Republican health care plan that will “increase benefits and reduce costs”. Is anyone in the GOP even working on that? The last time they tried to kill Obamacare their “replacement” for it didn’t exist and they had to make it up on the fly. Does the GOP even think about policy anymore?
1
The fact that Democrats succeeded in covering 20 million more Americans, which saves an additional 40,000 lives a year (if Obama, Pelosi, Reid and so many other Democrats who voted for this - and many lost their jobs because of the GOP lies about it - need a reason to sleep well at night, the knowledge that soon their hard work will have saved a whopping half a million American lives should help) of course proves that they are credible on healthcare.
The only reason why we don't have Obamacare 2.0 yet, which would cover the last 29 million who still don't have insurance and no longer just curb cost increases, on average, but start lowering them in absolute terms too (among other factors by including the public option that Independent Lieberman shot down but Hillary campaigned very hard on, after Obama managed to get a majority of Americans support it for the first time in history), is voter turnout.
Even GOP voters don't want what the GOP is constantly trying (but fortunately mostly failing, out of lack of real competence, when it comes to negotiating political agreements) to do, as poll after poll shows. They often just ignore WHAT the GOP is actually doing here.
The way the GOP obtains quite high voter turnout is through massively spreading lies, backed up by FN.
Democrats however need well-informed and politically literate people, and building such a civil society takes centuries. Obama made huge progress, but of course, much more work needs to be done.
Yes WE can!
1
@Ana Luisa: this is misleading.
Hillary supported a public option in 1993 -- ancient history! -- when she was FLOTUS and pushing Hillary Care.
But as a candidate in 2016...she clearly and UNAMBIGUOUSLY said "no single payer, ever" and "no public option". She ran on strengthening Obamacare, including even harsher penalties and mandates to punish those of us who have to buy lousy worthless HIGH DEDUCTIBLE policies from Big (FOR PROFIT) insurance corporations.
You know -- the ones that HIllary gave those $250,000 speeches to!
"I have a public position...and then I have a private position" -- Hillary Clinton, 2016
1
Anyone proposing to take on the entire health care industry financially is not credible nor serious.
The current US spending exceeds 3.3 trillion annually.
To put it in perspective:
Total US government spending is just over $4 trillion with revenue just about 3.7 trillion.
The government taking on such a large portion of the economy is task of monumental proportion.
The real answer is to fix Obama Care. Not abolish it. Build on it.
Think about what the medicare payroll tax would have to be to pay for medicare for all. or what tax rates would need to be to cover this expenditure.
Lowering the age to 55 needs to be addressed. How high does the Medicare tax need to be to cover the additional participants.
Pharma needs to be part of the solution not a profit center. This is a great debate to have but saying someone is right or someone is wrong at this point with the incredible size of the health spending system is literally goofy and irresponsible any all sides.
Editorials will not solve this issue nor lead to a solution. Both sides are selling snake oil and so are editorial or opinion pieces that state one side is right and the other is wrong.
Obamacare was than and is now a good start with a very strong foundation. If we were truly sincere about healthcare, for our citizens, which we are not, this could have grown into a realistic system merging Government and private initiatives.
The problem with American healthcare, is first and foremost the for profit Insurance Companies. This was a huge dynamic before we could even consider how ill-conceived this system was and continues to be.
The bigger problem, with American healthcare is that all the players learned how to milk the system to profit themselves. This includes, Healthcare Insurance Companies, Hospitals, Physicians, Pharmaceuticals, and Medical Device Manufacturers. Actual patient healthcare and access was lost in the feeding frenzy.
As a result, this perfect American creation, has nothing to do with healthcare and everything to do with Corporations and Individuals making as much money as possible.
In many ways, this is the problem with American Capitalism, profit is our only G-d. This idea, destroys the very notion that together we can do much more than we can do individually. Somehow in the charade we have lost Government involvement in balancing this two ideas, making money and doing the public good. This has destroyed much beside healthcare, such as, Education, Infrastructure, clean air and water to name a very few.
The ACA is just one, if dramatic, example of what effective government can do for ordinary citizens. And this is why the Republicans are so desperate to kill it. As soon as people realize that the government--and only the government--can be an effective instrument for improving the health of the nation, they might realize that it can also work for things like education, the environment, and housing, as well. The Republicans, however, have long been on a campaign to make the government weak and ineffective when it comes to delivering benefits, and vicious and terrifying when it comes to exercising authority. Is it any wonder that with their gangster mentality the GOP has Trump as their leader?
1
There is so much need to run as the defenders of American health care, you have to wonder why it receives such scant coverage on the front page of the NYT. With 1/3 of the workforce in gig employment, it's needed more than ever.
>
A thorough study of the history of conservatism and 20th and 21st century GOPism will show that being wrong has never stopped them before and now is no reason or time to change course.
This is all about the rich not having enough money and the poor having too much. It's pretty simple. That's their game plan and if hyper-inequality is a fact, they're winning.
“…capitalism is destroyed in its foundations, if we assume that its compelling motive is enjoyment instead of the accumulation of wealth”
Marx, Das Kapital, Vol II
2
Not clear what Medicare for All would mean? Why keep it dark, PK? We'd think an award winning economist who calls himself the conscience of a liberal would tackle what it means and how to finance it.
There are dozens of role models---
From True Cost Blog---Dates when countries started universal health care—a partial list, with varied systems.
UK 1948 Single Payer
Switzerland 1994 Insurance Mandate
Japan 1938 Single Payer
Sweden 1955 Single Payer
Netherlands 1966 Two-Tier
Australia 1975 Two Tier
Netherlands 1966 Two-Tier
Germany 1941 Insurance Mandate
France 1974 Two-Tier
Norway 1912 Single Payer
Sweden 1955 Single Payer
Austria 1967 Insurance Mandate
Italy 1978 Single Payer
In other captialist democracies, even conservative parties accept the principle of affordable health care, no matter age and income. Unlike in the US, it’s acceptable that elected govt has the right and duty to regulate the cost of insurance premium and drugs.
The pharmaceutical ads that daily flood American TV are not allowed in EU countries. They think medicine should be a matter between doctor/patient and not sold like any consumer product for profit. How about a column on that?
Here, medical industry profits are funneled to the candidates we elect for office. Our taxes help subsidize big insurance public, not our health care.
This is a blatantly obviouse cause/effect pattern. Yet it's never mentioned much less opposed by our media columnists, and TV pundits.
1
Imagine a party obsessed with depriving Americans of health care, then equally obsessed with granting billionaires unneeded tax cuts.
Would you vote for this party?
GOP R.I.P.
1
Republicans are also running on "saving Medicare" from Democrats, which shows their amazing ability to lie straight face, looking you in the eye. They are assisted on this by a political media that admires them for their tactical skill in lying and ignore the actual policies or Ryan and Trump to dismantle Medicare and Social Security for "Fiscal Restraint."
1
In May of 2017, there was the "Rose Garden Beer Party," where Republican House leaders got together with Trump and celebrated. The reason for the celebration? The House of Representatives had just repealed Obamacare for the umpteenth time, only this time they had a President who would sign their bill of repeal, prompting the celebration. Little did they know that John McCain would spoil their party soon after.
The Chicago Sun Times had on its front page the next day a picture of the celebration with the caption: "They Win, 23 million lose." The 23 million number reflected the number of people who would lose their health insurance over the next 10 years. Those in attendance at the Rose Garden party were all Republicans and all were "grinning like mules eating briars." This Sun Times front page photo I have kept and will send to all Democratic candidates for Congress in my state.
3
The GOP claims that competition will level the field. A silly notion with no proof. Trump's silly program for what he called more affordable health care policies has proved to just be another lie.
On the other hand, recent news from the steel workers union that says they may strike if USS doesn't share their windfall from the tax break, and provide better health care benefits: A labor union might be portending here.
"So are Democrats justified in running as the defenders of American health care? Yes." Yes, indeed. A winning platform.
5
Matters from health care to income distribution to war are ale entangled in the world's belief system; therefore, reasonable answers can't be found. In the near future, we are going to program the human abstract thought process in the computer, and this program will be based upon a survival algorithm. When this is done, we will have irrefutable proof about how we trick the mind with our ridiculous beliefs about just exactly what is supposed to survive - creating programs de facto for our destruction. When we see what we're doing to ourselves with our beliefs and manufactured values, we will have an opportunity to stop doing it and begin the long road back to sanity. Only then can things like health care for all be looked at with clarity. See RevolutionOfReason.com
1
Medicare for All is the correct solution; corporate Democrats will have to be forced to support it. I hope the party will field more progressive Dems and stop with the neoliberal Republicon Lite candidates.
2
Democrats put effort and study into policies that will help Americans.
Republicans put effort and study into winning elections.
4
Aside from their repeated attacks on the Affordable Health Care Act, the most glaring mistake Republicans have made is in not being able to come up with a better solution to replace it; thereby jeopardizing millions of Americans, many of whom were able to get health insurance for the first time in their lives.
A typical example of their policy of obstruction at its best.
5
Establishment Democrats are a gift to the Republicans that keep on giving. They just can't accept, or rather go against their big-money donors, a Medicare-For-All/Single-Payer system of healthcare for this country. You know, the pony that Hillary Clinton and the rest of them say we can never have. They describe it as "socialism" and a budget buster, yet every industrialized democracy in the world has it AND it would be half as expensive, covering everyone. Seventy percent of Americans support a Single-Payer system, and even a majority of Republicans back it, yet the Democrats just timidly mention it. Their behavior towards Medicare-For-All reminds me of the behavior of the apes in the movie 2001: A Space Odyssey, when they awake to find the obelisk. Afraid to touch the thing that will save them as a species, they cautiously approach and having trouble comprehending it.
It's so ironic that a society very similar to our, Canada, has figured this issue out and is doing quite well, with healthcare outcome better than ours at a fraction of the coast and coverage for all. Democrats, for your political survival, touch the obelisk.
1
@FXQ So your solution is to vote Republican? Strange. Very strange.
@Ray Clark No, of course not. Did you not understand my post? My solution is for the Democrats to grow a spine and support something a majority of Americans, even Republicans for God's sakes, want and would vote for them on.
@Ray Clark
Read the comment again. S/He never said that.
Democrats shouldn't try to run on the success of Obamacare. Yes, it is a success for those poor people who live in states that expanded Medicaid and for those who buy off the exchanges and get a big subsidy. And it is definitely better for anyone who has a preexisting condition because many of them couldn't even buy insurance before. The first year of buying unsubsidized individual insurance featured a large network, reasonable premiums but high deductibles and copays--a silver policy that was nowhere near as good as an employee plan. But these days, most of the policies offer narrow networks, fewer choices (if any choice) among plans, cover less, and cost a lot more (more than double for us). We need a public option. Medicare for All sounds nice, but I fear more of the cost would shift away from employers who often don't compensate their workers enough anyway. And Medicare, in its present form, is not good enough, which is why most seniors have to pay high prices for supplementary insurance. Anyway, if Democrats run on the success of Obamacare, too many older people who pay really high prices for lousy individual policies are not going to see a reason to vote for Democrats, although obviously the alternative is much worse.
Not that this will matter to Trump's base, but, so far, the GOP playbook---cut taxes, gut Obamacare, pollute the environment, tariffs---are becoming made to order campaign ads---e.g. Joe Manchin's is a beauty. I can't wait for the ad with methane pouring out of a stack juxtaposed to pictures of North Carolina after the coming hurricane. Really, the only campaign issue the GOP has are cultural issues---any, attempt to bring up a policy issue will backfire badly.
Why does American health care conversation always begin and end with health insurance? Are we doomed by the insurance lobby to have this as the centerpiece?
Why does a tool-and-dye maker have to learn and master the health insurance trade? Or a car manufacturer? Isn't the essence of the free market system to maximize excellence in your product to beat the competition and therefore, profit? That's what my conservative friends tell me.
Health care isn't like a car, or a cosmetic. It is a service, like a electricity provider or a sewer system. You don't have competing sewer pipes being dug to your house and competing power lines being erected in your neighborhood because that is insane.
We accept this as a given, but not with health care?
@Mjxs
You said it--it is a service--but you picked utilities to compare it to--I wonder why. It is a service like the plumber, lawn care, hair dresser, florist, etc......
See the difference
In my opinion the Democrats have completely fumbled the transition from the ACA-Obamacare to Medicare for All (MFA) as a Public Option.
First missed opportunity is recruiting current Medicare recipients, the seniors who vote. Without a brief explanation of how MFA would make Medicare more sustainable, seniors are told by Republicans they will see a dilution of benefits and loss of access. Medicare is essential a High Risk Pool which MFA would ameliorate by adding younger, healthier, at work recipients WHO WOULD PAY TO PARTICIPATE just as these workers pay for workplace health insurance now..
The second lost opportunity for MFA is a understandable explanation funding leaving a perception of MFA as another government "Giveaway" rapidly making current Medicare insolvent.
As an employee my total Healthcare costs (mine + employer) was $16K. I currently pay about $8K for A, B and Supplemental.
My guess is younger workers would be thrilled to pay $2K a year and Corporations would wet themselves at the thought of saving $6K per employee that would go straight to the bottom line.
Businesses and corporations have been silent on MFA. The US Chamber of Commerce has been silent.
I have never heard any candidate give a stump speech or an explanation why MFA (the benefit) and how MFA could be funded (the cost).
Until this changes Medicare for All or expanded Obamacare will never happen.
2
In NYC, before ObamaCare, we had Family Health Plus. It was a community plan for those folks who made too much to qualify for Medicaid, and didnt have employee sponsored health insurance. It was $450 per month for a family, no deductibles at all, and every one accepted it. It was possible because that was under the old system. The private insurance made up for the lower reimbursements from community plans like this. Now, Family Health Plus is gone, and an ObamaCare bronze family plan is $1200 per month with an $8000 deductible. That means every health care visit or expenditure you make, you are paying like you are an all cash patient until you reach $8000 in any given year - then you are "covered". No healthy family of 5 like mine would ever approach even 4k in any given year in health care spending. So Im basically paying $1200 per month for nothing - nothing which nobody accepts. I had a terrible time finding any doctor or specialist that would accept this plan. I almost felt like I was a door to door salesman. Sorry, we dont accept any ObamaCare plans, I was told, again ,and again, and again. And thats what Democrats are trying to fight for and protect. It seems they arent fighting for me, they are fighting for the folks Im paying for with my $1200 per month. So in essence, my healthcare was taken away by Obama and Democrats, and handed to folks that dont pay.
1
@Sports Medicine
Me, me, me. But it is not all about you, actually. It is about the millions of Americans who have insurance today - the net impact being quite positive.
@Sports Medicine
It is unfortunate that Family Health Plus was discontinued. But to be clear, see https://www.syracuse.com/news/index.ssf/2013/07/understanding_obamacare_...
This was an expansion of medicaid of which your family apparently qualified. It was not a success story of private insurance companies operating in a free market.
Everyone acknowledges that the ACA is imperfect and there were winners and losers.
And one more point. I do have a job, and the healthcare plan I was offered in 2013 wasn't as good as what you were able to get get with Family Health Plus. So make sure you realize that to me, you are one of those people for which healthcare was handed to (by the government through medicaid) who doesn't pay.
1
@Native Tarheel
Maybe it is all about Sports Medicine. Face the fact that Sports Medicine doesn't love you as much as you would like.
The ACA is a grand compromise that in the end gave a little to the various factions but no satisfaction to any of them. Yes, it is better than what we had before. But costs remain higher and outcomes under perform approaches adopted by other developed nations. And while the ACA is consistent with Republican proposals for healthcare reform pre-President Obama, Republicans view the ACA as an assault on freedom and democracy.
We live in sad times. Republicans tell everyone that we have the best healthcare system in the world and then work tirelessly to deny access to so many. Many believe that healthcare for all means freedom for none and therefore support healthcare for some believing that it guarantees freedom for all. Even the good Dr. Krugman undermines any hope of healthcare (Medicare) for all when he states “although it’s not clear exactly what that would mean.”
We are a selfish country composed of excessively selfish individuals and so long as we remain so we will never possess the exceptionalism required to ever completely solve our healthcare problem.
9
The formal proposals for MedicareForAll not only expand Medicare to cover all citizens , they also include dental and do away with payments at point of service . No more scraping up the money for a copay ( this often dissauades people from seeking needed care ) or fretting about an onerous deductible , which further discourages needed care . Expand these common behaviors across the system and early , easily treatable conditions become more acute and far more costly to treat .
As far as incremental approaches go the problem with that is in order to gain the maximum savings and efficiency we need to go with true MedicareForAll. It’s the only way to cut expensive overhead and take advantage of economies of scale .
A great resource for information on the current MedicareForAll proposals is PNHP.org. This is a group of physicians and healthcare professionals dedicated to establishing a Single Payer, MedicareForAll healthcare system that benefits citizens and healthcare providers while eliminating third party superfluous profit seekers from the equation.
12
Keep in mind, early on there was a 'public option' that was conceived, presumably, to offer a back stop and competitive alternative to private plans. I also assume this might have been a Medicare plan. Time to reconsider.
2
@AMM
Thanks to Obama's non stop campaigning on the public option (during the yearlong healthcare debate in Congress, he went to almost every state explaining why this was so important to include in the final bill), in the meanwhile a majority supports it.
That's how Hillary could campaign on it too, in 2016, without risking to lose crucial votes. And she did, together with thousands of other Democratic politicians.
The most logical thing to do now is to give Democrats full control of DC, so that they can sign Obamacare 2.0 into law, which would extend it to the last 29 million Americans who still don't have health insurance, curb cost increases even more, AND include the public option.
All that is needed to get there is to get most non GOP voters to vote, which will become possible once they understand that voting matters and that all change is necessarily step by step change, so they HAVE to be in it for the long run and start to vote JUST to move ONE crucial issue at the time forward (as GOP voters do, by the way ... simply having two new SC nominees is already enough for them to be fired up and turnout massively to vote ...).
I'm convinced we can do this, but we'll have to do this all together, knocking on doors, talking to our friends and neighbors etc.
Because that's how ALL progress has been made, both at home and abroad.
1
@Ana Luisa
There were a group of Democrats, bribed by insurance companies, who threatened to kill the ACA if the public option were included.
@Martin
And yet, they had the guts to not do so, AND to actively vote for a version of Obamacare that included a public option.
It's Lieberman, and he alone, who took it out.
And, once again, I've seem one comment barely touching on the reason "MFA" is a pipe dream. And I continue to be disappointed in my favorite economist for not acknowledging it.
Case 1. You make $80K and get a "$20K health insurance policy" through your employer. You pay no taxes on the $20K.
Case 2. You make $100K, and pay for your health insurance out of your earnings, whether through a Medicare tax or private and/or e.g. supplemental plan.
Duh-- you think when this is pointed out people will support MFA? Do you think medium to large employers will want to give up the benefit of locked-in workforce?
And do you think the medical establishment at all levels will want to see their slice of the economic pie cut...in...half?
That people continue to say "other countries do it and it costs half as much" without addressing why our system is so expensive just amazes me. For 60-odd years, a portion of the economy has been *sequestered* in this area-- the taxes you don't pay on health insurance could be going to infrastructure and education and on and on. Instead, the price of health care is inflated, just as any sector would be if you subsidized it in this manner.
But carry on with blaming the Democrats for not being able to change a system that has solidified like concrete over the last many decades.
4
That makes no sense. Either you don’t have the $20,000 through your employers buying your insurance...or you don’t have it because of taxes paying for your insurance. Either way...you don’t have the $20,000 in hand.
Worse if you buy your own high deductible plan on the individual market with your taxed $20,000 then paying a high portion of your healthcare costs out of the original $80,000.
The public option sounds like the best for your paycheck, honestly.
2
@arty: I don't get it. What's the difference between case 1 and case 2? In both cases you pay for health insurance. What you don't mention is that with MFA you would pay significantly less than current policies. And medium to large corporations would jump at the chance to avoid contributing to health insurance premiums.
And how in the world would "the medical establishment at all levels ... see their slice of the economic pie cut...in...half?" My billing department doesn't give a hoot how someone gets their insurance. And I can assure you, I know of NO ONE in the medical field who doesn't fervently pray for a single-payer insurance system. Oh, for a world in which we don't have to navigate over a dozen bureaucracies, each with their own procedures, standards, forms, and appeal processes, all of which change at least yearly. Give us just one bureaucracy to deal with, and you'll cut the expenses of medical offices by 20% immediately.
6
@pmbrig,
Well, all the doctors who refuse to accept Medicare and Medicaid patients don't seem attracted by the simplicity, do they?
And where are all those corporations pushing to end their tax subsidy? And to increase worker mobility? All the evidence points in exactly the opposite direction.
Sorry, unless you have some evidence that contradicts what I said, the opposition to an actual plan (rather than a slogan) will continue to be insurmountable.
And the two cases are obviously different-- in case 2, there is no guarantee that you will be able to buy "the same" policy with the after-tax dollars. It's trivially obvious economics.
In an America that is just too conservative for outright single-payer, perhaps the next step should be to lower the age for Medicare enrollment to 55. This alone would take an enormous amount of pressure off middle-aged Americans, and perhaps ease us into Medicare-for-all.
28
@Tom Hayden
This is the best, most prudent path forward - gradually lowering eligibility age for Medicare, gradually broadening Medicaid, until they meet somewhere in the middle and all Americans are eligible for one or the other.
For people who feel that the quality of care or comprehensiveness of the government run system is insufficient, they are free to purchase gap insurance or supplemental plans in the private market.
Employers could still offer better benefits by adding a layer of supplemental insurance to the existing public plan.
11
@Tom Hayden
It's not America that is too conservative for single payer, as polls now show that a majority of the American people support it.
The real problem here is voter turnout and political literacy.
Only 35% of the country supports Trump, and if you look at why they support him and the GOP, most of the time they only come up with typical Fox News fake news talking points, so IF they would have access to the truth, they would never vote for the GOP in the first place (which is of course why the GOP is investing so heavily in fake news in the first place).
The main real difference between conservatives and the rest of the country has to do with social issues, as conservatives tend to oppose abortion, homosexuals, equal rights for women and minorities, and that's about it.
If they would have access to the truth, however, they would know that what Democrats propose and do on this issue simply means allowing each individual to make his own choices, rather than imposing one philosophy on everybody else. And polls show that a whopping 80% of young conservatives (18 to 40-years old) actually agree with that position (they want to convert people by leading through example rather than through the force of government).
So all that it takes to get this signed into law is for ordinary citizens to engage in real, respectful debates with GOP voters, so that they can start to vote in a well-informed way. And then GOP fake news will lose its grip on the American people.
1
As Professor Krugman says, “many Democrats — including Barack Obama himself — are now suggesting moving beyond it to ‘Medicare for all,’ although it’s not clear exactly what that would mean.” One thing that it must mean is that it cannot be Medicare as currently configured. We cannot continue to pay Big Pharma whatever they decide to charge, and we cannot provide pharmacy benefits with a big asterisk call the donut hole in coverage because Congress wouldn’t fully fund the program. If Medicare for All is genuinely the future of healthcare in this country, the system has to have much wider and stronger controls on healthcare costs. Medicine cannot continue to become a larger and larger fraction of GDP, the ticket to vast wealth for pharma companies and their stockholders, for hospital and device executives, and for select medical specialists.
14
I support your point of view, and believe an expansion of Medicare would lead to lower prices—if that's what we want. CMS (The Centers for Medicare and Medicaid Services) has previously used its market share and ACA provisions to implement greater risk/cost-sharing along with outcomes-based reimbursement. An ever larger market share only increases its ability to do so.
This is, of course, also the source of resistance to any government role in healthcare.
But we also have to remember that the share of the population aged 65+ (and its attendant medical needs) will only continue to rise in coming years, meaning that overall spending on healthcare may not necessarily decrease. Such spending, however, would treat more people for the same cost.
2
Since the GOP wants to kill Obamacare, it's easy to idealize it. But it's the world's most expensive and profitable h/c system.
This is a pattern--- if a politician or policy is anti Trump/GOP, it must be great. But we are still putting up with mediocre policies that exploit us instead of representing our interests. Big money politics is distoring our standard of judgment.
Most other democracies that are also capitalist, like profits, but don't let corporate profits be 1st priority in health care. MIllions in other countries wouldn't put up with a complicated, costly Obamacare system. Even their rw parties support h/c for all, either single payer, or with insurance mandates but with govt regulated premium costs. Their rw parties don't run on changing to h/c American style.
When will PK an economist with the conscience of a liberal write a column or 2 with international comparisons? He sticks with the Democratic party centrism, and that is dependent on insurance co campaign donors. It's the pattern.
3
A number of comparison countries do use private payers and a mix of supports and obligations to deliver coverage. The various models can be a little dizzying in their respective approaches, but they do ultimately achieve better outcomes for less on a per capita basis.
The ACA was the only feasible approach in the US at the time. Once people experienced the effects of greater accessibility and coverage, etc., they didn't want to give it up. It was always the thin edge of the wedge. "Medicare for all" essentially means CMS sets reimbursement rates for an even larger share of the market. Make that share big enough, and private insurers have to play along.
1
Obamacare has been a great gift to tens of millions of Americans, despite it's unaffordable still to millions of Americans.
But on the way, unexpectedly something strange happened: a majority of Americans consider Medicare for All is a great idea and preferable to any other healthcare system!
Within the next 5-10 years Medicare for All is likely to be in place. Without ACA that might not have happened for quite some time.
19
Medicare for all is the answer. Medicare allows you to have whatever primary care doctor you always had. You do not have to get approval before you can see a specialist or have a procedure,
Medicare is portable, so that if you are traveling to another State and have a medical emergency you can get care without question.
And it does take care of pre-existing conditions.
Why does anyone, especially the Congress, be against such a common sense approach to Health care? Because there is nothing in it for them or the Insurance Industry.
All the more reason for others to vote for it and put pressure on those who do not support Medicare for All.
31
One of the worst things about the ACA is how its benefits were communicated--very poorly. Healthcare is complicated and the ACA was misrepresented from the get-go.
Many people, particularly in rural states, never fully understood that the Medicaid expansion, which gave them a "health card "they love and depend on is part of the hated "Obamacare" so maligned by Republican overlords.
It's the provisions of the ACA that are so popular and up to now, not destroyed by the GOP, but not for want of trying. Immediate coverage of preexisting conditions, very comprehensive coverage of illnesses, children on policies until the age of 26--there are countless benefits for people that without the ACA would have nothing except junk insurance policies.
That Joe Mansion is dong well in a red state by focusing on health insurance is good news.
Everyone needs healthcare. Everyone fears bankruptcy from not being insured. Everyone knows that dread in the pit of the stomach when a family member is diagnosed with cancer and has no health insurance.
Dems are right to run on this issue. No, the ACA isn't perfect, but it's sure preferable to the alternative, which is nothing.
19
@ChristineMcM. The tragedy of the Obama administration was the terrible job they did to implement and communicate positive policies. The much maligned stimulus did more than save banks, it actually saved jobs, started a recovery and prevented a Great Depression. Obamacare has more advantages than disadvantages but is imperfect, is a first step that should be improved, not destroyed. The current administration claims all manner of accomplishments that are actually not attributable to them and implement harmful policies cheered on by an ignorant base.
1
The irony in the Democrat health care proposal and success of the ACA is those who need it most, vote against those candidates who are trying to improve our health care. Maybe Manchin will have a shot in West Virginia because his state is poor and many need this medical coverage. For whatever reason, they voted for Trump even though he was trying to abolish the ACA. I'm not sure how much clearer Democrats can improve their messaging, but in many states voters aren't hearing it. Getting people to vote against their own self interest has been very successful for Republicans so hopefully this fall the voters will see the light and elect legislators that will fix this issue.
11
The ACA was the program that would have made national health insurance a dead issue. More people insured, a growing resolution to start to weed out the profit taking and treating health more like a utility, and stability to both providers and insurers that the bills would get paid.
Now? We have had the lure of being able to be insured after being laid off wafted under our noses, and snatched away again, and the hunger for national care is growing, as it wasn't before.
We need to act like a community. There are simply too many of us, and too few resources an opportunities for all off to thrive, and for some of us to even survive, without community. We can approach it like we did with the ACA as a public/private compromise, or we can approach it with pitchforks and flaming torches later on. Why does the GOP keep favoring the flaming torches?
10
@Cathy Because they have the guns. Lots and lots of guns.
My cousins need a gofundme page to save the life of their 14 year old daughter. I pray for her, and the our country comes to our senses about health care.
17
I wish that I could say that I am optimistic about the Democrats taking the House in the Fall and at some point taking control of the Senate, and winning the Presidency. I was looking at some figures recently about turnout at election time by republicans and democrats in recent elections. A high percentage of republicans regularly turnout and support republican candidates; but it is very hard to get many democrats to turnout. Many recent democratic losses are because of low voter turnout. The republicans have their turnout issues: guns, abortion, and racial/cultural antagonism.
The democrats can have all the bright ideas they want, but they are not going to do anything until they control state legislatures, governorships, the U. S. House, the U. S. Senate, and the Presidency. That means supporting electable candidates and showing up at the polls on election day. Do the democrats have any turnout issues?
7
While "Medicare for all" is a worthy goal I think it is strategically better to call for a Medicare "option." That is, all employers who now provide health coverage would have to allow Medicare to compete with private insurers to cover their employees. Approximately half of all Americans health care is via employer coverage. Many Americans like their existing coverage and may have fears about being forced to join Medicare. Republicans will try to take advantage of those fears. Over time most employees will see that Medicare is cheaper and better than their existing coverage thus leading to "Medicare for all."
11
@Marty
I think you may be right. Giving options and not forcing people to do things is the best way. Forcing others never turns out well--whether that is physicians, nurses, patients, taxpayers etc.....
Having others take care of you is not a right---they have to agree to take care of you.
"Obamacare has delivered.." Written by a person who has never been on Obamacare. For four years I was on Obamacare and for those same four years the costs skyrocketed and the medical plans got weaker in each succeeding year. By the fourth year my choice for plans was down to one very expensive plan. As an end user of the product called Obamacare, I can honestly say we must do better. I do not wish to put thousands of people out of work by destroying the medical insurance business. But if the government simply sold Medicare policies(and subsidized low incomes) it would provide a competitive alternative to private insurance. Would that not help to control costs throughout the industry and preserve current employer plans? Most folks are happy with their employer plans so it seems foolish to force Medicare on them. By developing this hybrid system of private and public health insurance, the taxpayers pay less than attempting to nationalize the entire medical industry.
2
Dudley, so your REAL complaint is that Ocare hasn’t worked as well as you expected NOT that Ocare is worse than the alternative(which is no insurance since private insurance is prohibitively expensive). And Ocare didn’t work as expected cause the GOP tried its best to kill it when it needed nourishment.
Universal healthcare doesn’t have to be single payer. It could be all of the above as long as every citizen and permanent resident are covered one way or another.
18
@Thought Provoking
Ocare stinks. We can and must do better. Obviously, you have never been on Ocare. It started out bad and got worse. Scrap it and start over. Democrats shoved a bad plan down America's throat. I am not opposed to universal healthcare, but I am opposed to folks who have never been on Ocare making judgments about it.
Sixteen years ago I ended up with painful post pregnancy varicose vein. I had it treated in a radiology office with a laser, wore compression stockings for two weeks and it was gone. The procedure was covered by my health insurance. Fast forward a few years... we were changing insurers and I was initially denied coverage for preexisting “vascular disease”. I fought back and got coverage but at almost double the rate of the comparable plan we were leaving. THAT is the scenario that we don’t think about when talking about the ACA. Type 1 Diabetes, cancer, heart disease etc are the kinds of illnesses we worry about most when talking preexisting conditions- as we should. I believe the insurance companies could consider almost ANYTHING a preexisting condition if they were allowed to and keep increasing rates every time time we use our plans.
14
The Democrats from the Clintons to Obama have credibility on one issue surrounding health care and that is the they both did an incredible job preserving wasteful private health insurance. Both decided against any major expansion of public health financing not because the political climate of the people were not ready for it but because the political climate of the political donor class does not want it no matter how much more efficient and ethical it would be.
3
@john f.
In real life, only recently a small majority of the American people support single payer.
THAT is why most Democrats promised to not sign it into law and to reform health insurance in such a way that it covers much more people all while at least curbing cost increases both for the federal government and individuals.
That being said, Obamacare already contains a passage allowing each and every state to immediately switch to single payer.
It's obvious that most Democratic politicians support and want single payer. In a democracy, however, you're supposed to represent your constituents, not your own personal opinions.
In the meanwhile, Democrats managed to get a bill through Congress that indeed curbs premium increases and covers 20 million more Americans, which is saving an additional 40,000 American lives a year.
Soon, thanks to "the Clintons to Obama", Obamacare will have saved half a million American lives already.
You cannot possibly claim that you care about Americans' health and then reject these results as "too little", especially not knowing that for years already, THIS is what the GOP is actively trying to destroy. If they succeed in November, WE will be responsible for hundreds of thousands of deaths, only caused by a single government decision.
Instead of blaming those who represent "we the people", we should roll up our sleeves and work hard to convince an 80% majority to support single payer, and oppose the real "bad guys" here, Republicans.
9
I am an expat living in Germany lookup in a search engine "Staying healthy in Germany-AOK" its a real eye opener.
2
Let's cut to the chase, shall we. Today's GOP, enabled and controlled by the ultra-wealthy, abetted by 24/7 right-wing media propaganda to the point of classic brainwashing, playing on latent racism and irrational fear, is the biggest scam in history. Every last "policy" position, be it "health care", taxes, military spending, foreign policy, right down the list, it's all about shoving the nation's wealth ever upward. The scam is that the "little (white) people" have been all-too-easily convinced it's all to help them, and especially to deprive The Other. And it is working like a charm. So does strychnine, and it's faster.
39
Democrats should just pass a basic income and index it to the average cost of living. It would be too popular to repeal. Republicans would need to figure out ways to lower the cost of living in order to cut taxes.
3
You state regarding Medicare for all "it’s not clear exactly what that would mean".
It would mean that the existing Medicare system and program be expanded to cover every American by replacing the myriad Federal insurance programs. Why have the massive duplication of plans, policies, claims procedures and all the rest? Medicare has an overhead far lower than any private insurance offered in the US, which means more of every Dollar spent actually goes to care- not administration, profit or marketing.
I would propose a phased in transition to Medicare for all.
Year 1: Take everyone 50-65 and move them from private policies to Medicare. Have employers pay the premiums previously paid to private coverage to the Medicare system- same for the employee part.
Year 2: Same, but add ages 35-50 to the mix.
Year 3: Same, adding 18-34 to the plan.
Year 4: Phase out CHIP and Medicaid while redirecting those funds to Medicare.
Year 5: Phase out TriCare and CHAMPUS for Military and Retired service members, transitioning the money to Medicare.
Year 6: Phase out VA healthcare and move those funds to the Medicare system.
By transitioning in phases, the private insurers can wind down their policies and close the books on a reasonable financial basis and the Medicare system can phase in the new population groups. By taking the 50-65 group in first, the highest cost people on private sector insurance go off the books and onto Medicare.
We can do this.
53
@David Gregory......why doesn't Krugman the liberal economist discuss the phase in plan you write about?
The US has divided people up into groups with varied rules for h/c access---per age, income, job status. Other countries insure all, and have tax rates that are fair and adequate to finance this. That is unAmerican per our politics. We won't find those positive examples compared in a column on this op ed page.
The Affordable Care Act was written by Insurance companies for the benefit of insurance companies. For patients who are not part of an employer sponsored health plan, the ACA remains an excessively complicated shell game. As plans incur unanticipated losses, premiums increase or plans disappear entirely requiring the patient to again go through complicated mental gymnastics to look for a new plan that is affordable. That is just plain crazy.
Other countries have figured out how to successfully do universal healthcare. Some successful foreign health plans are single payer (e.g. Great Britain). Others are run privately (e.g Germany). Still others use varying combinations of the two. They all work reasonably well.
Whether single payer or private payer, the common element to all successful foreign healthcare economics is that the government sets all prices. The sheer complexity of healthcare makes comparing prices impossible. Also, sick people are not normally disposed to shop around for the best price. That is why a free market pricing, upon which the ACA depends, will never work in healthcare.
The ACA is a poorly conceived and poorly executed morass that is collapsing under the weight of its own false assumptions and contradictions.
5
@J. T. Stasiak I am an expat living in Germany here the health care insurers are non-profit! People pay a 7.4% tax on wages that's it.
5
I fully support single payer, but you cannot possibly claim that Obamacare was "written by insurance companies for the benefit of insurance companies".
1. The law has been debated in Congress for almost a year, and both in multiple hearings and committee meetings, ALL interests groups have been fully present and their advice and objections taken into account (from patient, nurses and doctors organizations to hospitals, pharma industry and of course also insurers).
2. During the first years of implementation, insurers saw their profits go down, not up, and only now the situation is starting to stabilize for them. One of the reasons for lower profits is the fact that Obamacare includes a passage mandating insurers to invest at least 80% of what they receive in premiums, in care.
Before, lowering that percentage through massively increasing premiums was what Wall Street strongly rewarded. Now, that mechanism has been destroyed, thanks to the ACA.
2. All studies show that thanks to the ACA, today 20 million more Americans have coverage, which is saving a whopping 40,000 additional American lives A YEAR. How can you call this is "poorly conceived" law in that case?
3. As it's producing the exact results it was designed to produce, how can you call it a "poorly executed morass"?
4. Where's any evidence of "collapse"? What are its "false assumptions"?
5. It already allows any state to adopt single payer - which NOW, not in 2008, a majority of Americans supports.
11
@J. T. Stasiak.....and in the countries that are not single payer, the govt sets limits on the price of premiums. That's unacceptable in our political culture, where corporations fund our parties and candidates. . So even our liberals don't talk about it. True health care for all is actually un American in our politics.
For generations, other capitalist democracies have had h/c for all as centrist policy. Their citizens wouldn't put up with a 2nd rate plan such as ACA ---the world's most expensive for citizens and profitable for big insurance. This is what Krugman promotes--he is allied with the Democratic Party, and the party needs donations from big insurance. That's our system.
2
If Republicans can restrict access to health insurance so that it is only available through employers, they can make job searchers more willing to accept low wages in exchange for health insurance. This whole mess is all about keeping the population down, and wage suppression.
16
@Mike LaFleur
It's even worse than that.
Before Obamacare went into effect, many people would lose their health insurance if they would switch jobs, and that was the main reason to stay in the job they already had.
Employers knew this, of course, and as studies have shown, this has been an important factor in keeping wages low (after all, outstanding employees can't threaten to go away in order to negotiate and obtain higher wages from their current boss), and of course also hurts the economy, as it means that it's fear of losing health insurance that makes people work for a specific company, even though their real talents might be better used and developed in a different kind of company.
Obamacare contains a passage ending this kind of practice, and making it possible to leave a company all while keeping your insurance.
I never saw any studies on the effect of this job mobility promoting measure, but one can expect it to be quite significant.
Repealing Obamacare, of course, would also end this freedom of switching jobs, for many people ...
17
The Democrats simply need to emphasize that in the term 'health care' there is the word care, and that clearly the GOP does not care.
Because the majority of people do care, the choice should be easy.
14
Democrats are somewhat credible on Health care but not entirely credible. . Partly because universal health care is not affordable and the freedom to not have health insurance because of the lack of affordability was unfair. After the Republicans took away that mandate it is credible. Bipartisanship even though not intended has worked. Complete repeal of Obamacare by Republicans without an alternative was a non starter but removing the penalties for not having some insurance was draconian. Together both parties fixed Obamacare and Americans won.
1
@Girish Kotwal
"Partly because universal health care is not affordable..." is a lie perpetrated by the health insurance industry.
@Girish Kotwal Gee, Girish, then how does every other modern nation and not a few third world countries manage to afford universal healthcare? As Churchill observed: "The Americans always do the right thing -- after they have exhausted all the other possibilities."
Democrats need the Public Option to seal the deal. The public option will America to choose universal care. It will ease the transition and provide insurance providers time to establish a new business plan.
It could an endorsement from Paul Krugman.
3
As nearly everybody knows, Jim Carrey made most of his fortune playing various roles as an idiot. Nonetheless, if they aren't careful, Fox News viewers might actually learn something from him: They obviously don't read much, and he proves by his passionate defense of Canada's nationalized health care system near the end of this interview with Bill Maher that he is actually quite sensible and decent.
https://www.youtube.com/watch?v=ZkFUU-xJM6I
6
Medicare for all would not only provide health care, it would provide jobs. There are thousands of people in the 62-65 year old range who desperately need to retire from full time work, but can't because they need the health insurance provided by their employer.
15
Democrats should run on policy, not on Trump.
Given the present demographic of aging boomers, healthcare should be at the top of the policy agenda. Infrastructure should be second.
Trump doesn't need Democrats to help him sink the Republican Party. He can do that all by himself. So let him.
17
Amen, brother, AMEN
If the question is whether or not Democrats are credible when they say that Obamacare is working, the answer clearly is ‘Yes,’ as Paul Krugman points out.
Some people may be confused by the lies of President Trump and by well-financed ads of Republican politicians and health insurance companies, although the companies who tried to sabotage Obamacare seem to be backing down a bit.
What is very interesting and very telling in the Obamacare dispute is the fact that, with the exception of some of the more dull-witted, doctrinaire Republicans, every member of Congress – Democrat and Republican – knows that Obamacare is working.
The reality is that every Republican in the Senate and House -- other than the dimwits -- knows any American who has the facts will support Obamacare and will deeply resent the effort to remove protection for people with pre-exiting conditions.
Republican politicians dread the effect on midterm voting choices, if average Americans learn how badly they have been served by the G.O.P. on the subject of healthcare.
16
Krugman should talk about price management, because that's the key to a sane healthcare system.
The free market can't work in healthcare, where the purchaser is hurried, worried and uninformed. That's why US healthcare is such a rip-off -- and why healthcare in the rest of the developed is half the price yet gives equivalent outcomes and universal coverage.
28
@Jethro - Paul Krugman knows better than anyone that single-payer is the best way of controlling costs, and he has written on it at various times for years, but he knows it isn't politically feasible with Republicans dominating the political discourse in the US. The whole point of Medicare-For-All, which Krugman mentions in this piece, is controlling costs: He has explained in at least several articles that Medicare is far more efficient than America's private insurance system, since it has the power of government to negotiate lower prices on behalf of Medicare's elderly and disabled recipients.
13
@Gary Henscheid it is but the glaringly holes that Paul never addresses are labor costs. Are surgeons going to take the massive pay cuts like in other countries? Are nurses some whom make 6 figures? In countries where an nihs type system works the pay for staff is half of ours. Whatever going to happen is too doctors will flat out say so.
@Location01 - Ah, but governments can and do negotiate limits on doctors' and other medical professionals' fees, just as they do on reimbursements for medications. All of those out-of-control costs would be brought under much greater control by single-payer, Medicare-For-All, or any system that gave the federal government a much larger role in regulating health insurance.
Yes! Yes! and Yes! I have been saying yes since the start. I am a self-employed writer. The ACA has been key to me having health care. After the ACA passed my health insurance premium dropped by 50%. It crept up back up to where it started as opposition to the ACA increased. Now it is projected to increase another 40% next year. With income stagnant where does that come from? Someone needs to listen to us about the cost of healthcare,
33
@JEA according the Paul whom clearly doesn’t have an ACA plan your rates have stabilized and 2019 will be a “modest increase”. I love It only what an $8,000 out of placket cost! Sounds amazing! Not
When arguing whether expanding Medicare lead to a big budget hole, your argumentation isn't sound.
1. 115 billion is a lot of costs.
2. Comparing it to the Trump tax cuts achieves nothing. If anything, it will show that both parties are fiscally irresponsible.
3. In a row of three arguments about trustworthyness of Dems vs GOP you make all collapse by basically admitting that with the middle one the GOP was right.
So... were there any revenues or macroeconomic benefits outweighibg the 130 bn cost? That'd be an argument. But the tax cuts are totally unrelated and a matter of spending preference, 100% within legitimate spending priorities (lying about their positive results isnt, bzt thats another matter again).
2
@Flin: The ACA is a first step on the way to a health care system like in other civilized countries, that cost less than half to two thirds per capita than it costs here, with better outcomes. There’s your economic argument. And the ACA already led to cost reductions in insurance premiums, and expanded health care with accompanying jobs and better health outcomes in impoverished areas.
Apart from economic considerations, there is the moral argument of a civilized society taking proper care of the well fare of its most vulnerable people, in the US also supported by the Constitution.
7
@Flin No, the big argument is: should all of our citizens have health insurance? If the answer is yes, and I believe that is the correct answer, we can find a way to do it. After all almost every other country in our world does it. Instead of giving tax cuts to the rich every time a Republican is elected president, we could use that tax money to fund healthcare, infrastructure and other needed programs. It can be done.
9
While I am in favor of a possible single payer system, there are too many systemic problems inconveniently in the way. The cost of a medical school education and who bears the brunt of it, the power of the insurance lobby, the political power of the "medical industrial complex." Color me cynical, a single payer cannot happen overnight. It is a journey.
How about we start with a system that accommodates both, a single payer for those that want them, i.e. anyone can buy into Medicare?
For those who want platinum care, allow it. Ban all the corporate welfare, no tax breaks for offering all sorts of healthcare, absorb the cost of healthcare. The $200 plus billion or so corporations get in these tax breaks (look it up, its true) pay for all sorts of programs. Maybe Trump will give it to his buddies...
Dr. Krugman and the experts know all this. They also know a single payer is politically several steps too far. For now, maybe sometime in the nebulous future when all the systemic issues have been addressed logically.
4
The "problem" with ACA as well as Medicare and Medicare for All is that each program increases taxes on the rich and the rich do not want to pay these higher taxes.
*****************************
"The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness."
--John Kenneth Galbraith
39
I wish somebody would organize a nationwide "Medicare for All" march. Surely there are enough people who are sick and tired of Republicans playing politics with our and our loved ones' lives. I know I am.
37
The Affordable Care Act (ACA) was my salvation.
After I lost my good-paying job with health insurance, I was only able to find low-paying jobs with no benefits. So, I paid for COBRA with the generous severance pay I received from my former employer. After 18 months, COBRA ended so I checked out individual coverage. Most insurance companies wouldn’t cover me at all because I had a preexisting condition (diabetes). Those few that would give me a policy wanted more than I could afford to pay. So, I went for eight and a half years without health coverage. The only time I saw a doctor was if I had a severe problem or needed refills on my diabetes medications. Then the ACA came along, and I’ve been able to see doctors regularly and take better care of myself. And my fellow Republicans would like nothing better than to put me back where I was before the ACA.
That’s why we need to elect as many Democrats as possible. To ALL levels of government. Federal, state, and local.
87
Obamacare is not credible to many young adults that feel sure that they will never endure anything worse than a cold. They have been sold on the idea that they are paying exclusively as a subsidy of the middle-aged and older. The see that as an unfair burden that they resent.
In fact, Obamacare insured them to cover the medical care from auto accidents, falls, sports injuries, meningitis, STDs, etc that plague young adults more than the old. More importantly, under Obamacare, their premium buys them permanent access to health insurance without limitation for preexisting conditions. Anyone thinking that they can just wait until they get 40 years of age, say, and still have no preexisting condition, is a statistical dreamer. Then they won't be insurable until they reach the age of Medicare.
33
@cowboyabq - The same youngsters finishing vocation school or college with a mountain of debt.
What would medicare for all look like? Canada
All basic health care accessible with your Provincial Health Care Card for all visits to doctors and hospitals, including procedures and surgeries. No bill on the way out and yes, we call that basic coverage. Everyone is eligible for a Health Card regardless of income. All other health care services, eye care, dental, physiotherapy, prescriptions etc may be covered by your employer's extended health care coverage.
Simple, easy - no shopping for a plan or being denied for pre-existing conditions. No worrying about losing your life savings in your old age because of illness. A just and balanced way to provide for the health and well being of all citizens.
I'd say that's a pretty good bang for your tax buck and I live in a country that is the population of California. America can't afford universal health care? Take a little slice out of that military budget and there is more than enough to implement universal care for all.
94
@Ann except let me give you reality. I have two friends in Montreal that have been waiting over 2 years to get assigned a PCP. In British Columbia there are people that have NEVER been assigned a PCP. Canada’s healthcare ranks 1 above ours it seems triage care with long wait lists. People need to stop selling us Canada and start selling us what England has because it’s far better. Canada’s healthcare trails behind England by ever metric
@Ann: Yup, I lived in Prince Edward Island for 5 years; the system worked like a charm and I had two minor surgeries. We even had a world class oncology complex in Charlottetown, the provincial capital. I've got dual citizenship so I can go back if needed. Right now I'm on Medicare, which is NOT as good as what I had in Canada, but certainly better than any other alternative.
"So are Democrats justified in running as the defenders of American health care? Yes."
I agree, but Democrats must develop the communication skills to communicate a believable plan that will provide universal insurance to all Americans and as a result will reduce the costs of the health insurance by using it to enable use of the data from providing this universal government benefit to deliver responsive healthcare in the form of better diagnostics and therapies that will actually improve the health of Americans where ever they are located.
Meeting these goals will require thoughtful planning, organizing and controlling costs of a very complex service.
Democrats must also be aware that even though Obamacare was the creation of AEI, a conservative think tank, and the Massachusetts legislature's effort which became Romneycare, it was difficult to put in place because from birth it was strongly opposed by the existing health insurance industry and some of the major healthcare delivers. See a summary article by Norm Ornstein https://www.theatlantic.com/politics/archive/2015/07/the-real-story-of-o...
Democrats should run on the platform that costs will be brought under control and healthcare will improve. Democrats should communicate the objective that America will take the lead in good health and value. There is absolutely no reason that we can't if we agree that healthcare is outside the political debate on free enterprise vs big government.
10
@james jordan Keep the quality issues out of it. That's way too complicated and would needlessly bog things down. The main issues are covering everyone and everyone paying something they can afford on their income for the coverage.
7
If you think that the Republicans are going to bring you health care you are wrong. But Trump and his team of con men will bring you health care grief. Count on it. They have already told you that. They will destroy what is left of the ACA and we will go back to all private insurance with no government regulation. The free market will take care of all your needs as it has in the past. So vote Republican if you don't need health care---vote Democrat if you do need health care. But please vote in the November election either way. Sitting this one out is really not an option and those that do sit it out will come to regret it.
34
Those who are complaining about Obamacare in its present form, or making Republican talking points to make the case against it, fail to remember how difficult it was to get this legislation through the Congress. I remember the blue dog Democrats that withheld their support against the public option. It was a knockdown drag out fight, and the people lost. But there was always hope for future reforms, but only if the Republicans didn’t have their way to repeal it. They tried, with nothing to replace it. Now we have a second chance to do right, so vote accordingly. Your life may depend on it.
56
Yes, then-Speaker Pelosi did an amazing job to bring us the ACA.
That’s why the Rs hate her, and are working so hard to smear her — she’s a great leader who delivers for Americans. Step aside? Why should she? And who, aside from agist (misogynist?) ignoramuses, would want her to?
You don’t throw away your best arrows because your opponent complains they’re too sharp.
A major benefit of Obamacare that is rarely touted is that it has saved over 100,000 lives already and will continue to save over 30,000 lives every year going forward forever. If you went to a hospital since 2010 (hospitals starting implementing improvements in anticipation of Obamacare regulations) and didn't die from a hospital-acquired infection or other preventable condition, you might be one of those 100,000.
32
@ANdrew March where are you getting such data? https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-de...
Of course Democrats are credible on Health Care, and a whole heck of a lot of other issues, like the Economy and Education, as well. Republicans only care about the reflection they see whenever they can stomach looking into the mirror. Democrats have always been the party that advocates for the middle class by addressing middle class needs. Republicans only recognize the middle class when they look at the bottom of their shoes to see what it was they stepped on. Democrats need to do a much better job of conveying party differences in upcoming elections and not allowing themselves to be defined by the rudderless Republicans.
29
I like to say what I believe Churchill said about Democracy:"Democracy is the worst form of government, except for all the others." the ACA is the worst form of healthcare, except formal the others. Republicans got nothing on healthcare, and they live in a bubble. But, I guess if you can convince 40% of the country to vote for Trump, or to buy $240 gold coins for $430, I guess you have captured them.
17
The greatest success of the ACA was that for the first time ever in the US: (1) individuals who had a medical diagnosis or took a medication could obtain healthcare (which, prior to the ACA meant one couldn't obtain health insurance at any price, due to the 'pre-existing condition' ban) and (2) health insurance could be obtained without being an employee of a huge corporation.
Remember, prior to the ACA, there was no way of obtaining real health insurance as an individual human. If you were young, perfect and had never taken any chronic drugs, you could pay premiums for insurance that was canceled once you tried to use it.
The greatest failure was the fact that the Democrats were too chicken to include a public health buy-in, for fear it would impact insurance company campaign money. Without a real Medicare buy-in, your health is dependent upon publicly-held for-profit companies that have to have infinitely accelerating quarterly profits to impress Wall Street and (like all big public companies) spend all of their profit on massive stock buybacks and $100 million CEO compensation packages..
16
"Republicans have repealed the mandate that was supposed to induce people to sign up for coverage while still healthy..."
I like Paul's use of the word "induce." That's a nice way of saying, if you fail to sign up for coverage, you pay a penalty and get nothing. But, what was particularly sick about Obamacare was how the government was "inducing" Americans to enrich for-profit companies. You know, there are other ways we could induce Americans to do this. For instance, we could waterboard people into compliance. Now, that would surely bring down the number of uninsured even further than it is right now. And Paul could claim it to be a victory.
2
@Mark With a few exceptions (George Schultz liked to point to the example of Lasik), very little in medicine is compatible with consumer market economics ("would you like that radiation with a side-order of cisplatin"). Your beef should be with the inevitable distortions and perverse incentives that come from pretending it is.
10
@Mark No -- you pay a penalty to offset the costs paid for by my premiums and taxes when you go to the ER uninsured.
15
@Eben Espinoza There is very little about Obamacare that is compatible with American values. And that’s where the beef is. Reducing the number of uninsured by creating a system that punishes those who fail to buy insurance is simply immoral. Further complicating Paul’s argument is the fact that Democrats are suing Trump for allowing Americans to buy short-term insurance for longer periods. If the Democrats want to get steamrolled this November, all they need to do is tell the voters, “We want to induce you.”
I’m not sure about the Democrats.
Why can’t we have a single payer non profit free health care system like those enjoyed by citizens of every other first world nation?
Are campaign contributions from health insurance companies and Big Pharma more important?
15
@Zejee Thanks for bringing this issue up. I am sure it has to do with the donors not wanting us to have universal health care, that is why Nancy Pelosi says we are not ready for it.
The democrats are not as bad as the republicans but eighty percent of them still take dark money and have to serve their large donors. If we can get money out of politics that will help,
But hell, we have people like Beto and Alexandria and Bernie and other progressives who are now getting elected, who are all running on the Medicare for all platform, and they only take small donations. And they all have well thought out plans how it can realistically be done. Universal health care is polling at 70 percent now Even the republican voters are polling at 52 percent.
It is in the air now, it cannot be stopped, it is a coming! Vote for the progressives and that will hurry it up. The old white men who try to run this country are having their last gasp. Their anti life, selfish, mean ways are going to be gone soon. And good riddance to the lot of them. Love that Moonves has finally left the building!
1
I´m taking a wild guess here, but my wild guess is that Medicare for all actually means Medicare for all, including the twenty-nine milllion people residing in the United States who are uninsured and in grave danger. This is not some pie in the sky scheme, it is doable.
I have lived off and on in a European country, Spain, with a state-run single payer system, and on occasion, as when I was teaching in the public university system, I was a beneficiary of that system. In those years friends and acquaintances, some of them physicians, would ask me time and again how Americans can live without such a system. My standard answer to them was that we couldn´t, and that is still today my answer. ACA has done yoeman service but it´s time to move on to something much better. Medicare for all is that something. It won´t come cheap and it won´t come easy, but we can do it and we can afford it. Let´s get it done!
218
@Edward Baker
I'm generally with you but want to take issue with your statement "it won't come cheap". The USA pays about double per capita what Canada and the UK pay for healthcare, our outcomes are worse, and we don't cover about 9% of the population.
I'm 61 and have enough saved to retire today, the only thing stopping me is healthcare; even with 'good' insurance, if I got really sick I could lose everything. I would happily pay for Medicare between now and my 65th birthday if I was fully covered and that would make room for someone younger to move up to fill my shoes - I believe that is a major reason why young people are struggling to move up the ladder.
If you're a real Republican, you won't vote for the GOP, they are not Republicans, they are liars & grifters who don't even follow The Constitution.
Nov 6th isn't Right vs Left, it's wrong vs right.
1
It’s wonderful to hear that some people, even Republican voters, are beginning to appreciate the importance of health care coverage. Of course, the GOP has no plans nor interest in providing coverage for most Americans. The challenge is to end the for-profit motives that now inflict exorbantat prices on our health care. We cannot continue to pay huge salaries. Indeed, multi-million dollar salaries mean huge sums of our health dollars do nothing to provide direct care. Single payer insurance will have the best possible power to reduce the profiteering. The financial change for many who have taken advantage and enjoyed the substantial income will be fiercely fought. Democrats and voters must bring health care costs under control and insure wide-spread availabily. We must join the rest of the industrialized countries offering affordable, comprehensive health care to all citizens. Health care is a basic need of all. We can no longer tolerate business practices that provide wealth to some and no health coverage to millions.
31
The problem with the Republican Party, when you boil it down, is they have nothing - absolutely nothing - to offer the average American that they will do and make their lives better.
Make it easier to open a small business? Nope. Cut red tape on average taxes? Nope. Cut average taxes? Nope. Make anything easier? Nope.
They are 100% a greviance-driven party. With no plan, no idea, and even no inclination to make any voter better when they’re through.
77
@Thomas Wright
Unfortunately, Mr. Wright, you are completely right in your criticisms of the Republican Party.
There must be something decent about the Republican Party, but what, in God's name, what?
Come on Professor. What would Medicare for all mean? Er, universal coverage.
13
I don't understand why Paul and so many others keep harping on Medicare for all. Germany, Switzerland, and the Netherlands all have what could be described as Obamacare on steroids. I'd be happy with medicare for all, I've been on it for nearly 4 years now and it's great. But it might be easier to get to a Netherlands type system. At least discuss beefing up the ACA!
12
Paul, you are missing the most relevant point of all. The Republicans have discovered that, for their base, all they need to do is say something. They will be believed. Proof is irrelevant. Their minds are made up as soon as they hear their heroes such as Jim Jordan, Mark Meadows, Devin Nunes et al.
And for the White House, certainly Limbaugh and Hannity will never challenge the president's command of the fictions. I suspect that if you polled the base, a vast majority would still believe in Death Panels. Or, that Mexicans and African Americans are receiving free health care.
In essence, the Republicans know that the credo of the base is "Don't confuse me with the facts. My mind is made up."
28
This may be addressed in another comment, but has anyone calculated the net savings per person with Medicare For All?
I think the Republicans want you to believe that MFA would be “free” (as in, government picks up the whole tab) but of course that’s ridiculous.
What would a single person making, say $50000 a year, pay for MFA? Whatever it is it would be well short of what typical private insurance would cost, I would think. As you move up (and down) the wage scale , the ones that would pay more than they pay now would be the very rich. Sounds literally progressive to me.
I’m speculating but have yet to see an analysis. But I sure would love to.
18
@Dave There is a problem with changing from the current system to Medicare for All. A majority of voters have health insurance through their employers. For many of those (perhaps not a majority, but many), changing to Medicare for All would mean paying more for worse coverage. I consider myself a liberal Democrat: I am willing to pay more than I do now to support health insurance for others or for myself ... but to ask me to pay more for worse coverage is too much.
2
@Dave
My husband and I had employer-provided healthcare for nearly fifty years, and went on Medicare when we turned 65. Obamacare critics seem to think this government healthcare is free, and are surprised when I tell them what we pay out-of-pocket: $465 each per quarter for Medicare, $2500 each annually for a supplemental that covers the 20% the government doesn’t, and $25 each a month for a part D drug plan. The F.I.C.A withholding throughout our working lives was also us contributing to our future healthcare and social security.
Healthcare is too important and costly not to be universal, with the burden shared according to each’s ability to pay. It’s many of the same folks, the tax-averse, who don’t understand how a risk pool works, and complain about paying their share to support our civilization.
15
@WZ Yes, it will be easy to make an argument against "medicare for all", and although the argument,ent is phony, it will surely carry the day in congress.
That is why Hillary's plan of allowing people above a certain age, say 50, to choose medicare as their insurer, is a winner. It will be much harder to make an argument against it. And then the camel's nose will be under the tent!
1
For years now the Republicans have described Obamacare as the worst law in the history of the country but they never said exactly why that was. Not a single example that I recall. In recent years the Republicans have foisted George Bush and Donald Trump on us as presidents, two of the worst presidents ever. That alone should have told voters all they needed to know about the Republican party.
43
You count numbers. I'll be blunt..................
Democrats care about all Americans irregardless of party.
Republicans represent the wealthy individuals and businesses, which includes the high profits motivated insurance companies who created the health insurance crisis by ignoring those with preexisting conditions. Theoretically, insurance is for everyone pooled together.
In 2010 when the Affordable Care Act was debated, the Democrats tried to please the Republicans and the insurance companies by making the Act a hybrid program that coordinated the insurance companies and the Federal and State governments. That was the Democrats big-hearted "Bipartisanship" oriented objective when they held the power to institute Medicare for all. The Democrats cowered before the aggressive Republicans.
Since then the Jealous Republicans, knowing the idea was popular and in keeping with the Democrat tradition of caring such as with Social Security, have tried to destroy the great Democrat accomplishment that resulted in health care for tens of millions of Americans who were without it.
The Republicans actually convinced many millions of voters to vote for them to repeal the ACA that promised to keep them healthy and living longer lives. The Republican voters actually voted against their very lives and well being.
Next time Democrats, don't be so nice. We want people fighting for us, not appeasing the self-proclaimed enemies tearing you down for eight years.
51
@Shakinspear Democrats want the dying middle class to pick up the tab for the poverty they want to flood the country with. It cannot happen and will not work. It will put the middle class into a death spiral.
1
@MM
Haven't you been following the news? The middle class is doing well with very low unemployment and in need of health care to stay alive. Can you understand that basic fact? You are uninformed with a very vivid imagination and out of your league. Thank you for trying though. Rethink your ideas, and get health insurance. You will need it at some point, or will lose your middle class standing.
I wish someone could explain to me why the Republicans refuse to help their fellow Americans...unless they are wealthy.
33
I still think it should be referred to as the Affordable Care Act. Accuracy matters.
28
It is interesting that members of Congress are able to speak so well about curbing healthcare for the masses. By the way, all of their healthcare is free. Wait, who is paying for their healtcare? I thought so.
47
What puzzles us, meaning those countries with universal health care, is the idea that many Americans see any “social” program as borderline communism. The idea that everyone is being treated equally means that the “elites” and “the forgotten man”(Trump talk) are no longer separated by their incomes. That, and it seems that unless it has been invented/birthed/or initiated in the United States it must be an inferior concept or fundamentally flawed.
We have heard it all, the maligning of our Canadian healthcare system, but then we have heard we all live in igloos too. My two brothers have had major heart attacks, my sister has survived cancer and they are all alive today thanks to the quality care they have received.
Years ago, my mother was visiting her sister in New Jersey and had a fall was hospitalized. She called me sobbing, to get down there as quickly as I could, (she had neglected to buy out-of country health care coverage). She said, “drive quickly, they are even charging me for the Kleenex I am crying in to!”
I hope the Democrats bring this issue fully out of the closet and stand up for the idea that healthcare for all can be achieved.
62
But Bernie. That's why I won't vote for Hillary.
3
The GOP conveniently ignores the fact that white people need medical care, and insurance coverage, just as much as “ those people “. Sure, they can spew their talking points and play the blame game, and they WILL. But when it’s time to take your child to the Doctor, or even worse, the Emergency Department, Reality Bites. And reality requires decent insurance, or CASH.
Please Proceed, GOP. Demonstrate to your Base who you really work for. Seriously.
17
The hostility of some American politicians towards the idea of all citizens being able to access necessary health care is unfathomable and bleating about "socialised medicine" bizarre. Nobody talks about "socialised medicine" here in capitalist Australia. We have a two tier system and here there seems to be nothing as effective as the government for keeping costs down when they threaten to balloon out. What we pay in taxes for healthcare is low, perhaps too low, compared to some Nordic countries and we have problems as a result like long public surgery wait lists. Essential care (and rehab) for major illness or catastrophic events are free at public hospitals however. Those who want faster hip replacements or private rooms in private hospitals take out extra private health insurance. Private for profit insurance companies make enough for their investors and some specialist doctors do pretty well from our Medicare system. Prescription drug costs are negotiated by the government with drug companies and we pay a standard price per script ($39) with less ($6) for those on a pension or welfare and free for the chronically ill after an annual ceiling limit. Employers don't do health here and just manage compulsory retirement pension contributions.
Having insurance companies as main players along with drug companies charging what they like seems a perfect recipe to create escalating costs - especially when politicians undermine essential connecting parts to a system.
48
The elephant in the room is can health care actually motivate the occasional voter and the non voter to actually register and cast a ballot.
With the gerrymandering and road blocks to voting republicans have erected in recent decades it will take a full court press to overcome the tyranny of the minority we have found ourselves in.
34
I am not yet ready to breathe easy about the mid-term elections - the pain of November 2016 still is quite acute - it does seem as if the Democrats have caught on to a successful strategy: talk about preserving and protecting something that makes a difference to people regardless of their political persuasion, their healthcare. Doing so has brought attention to the emptiness of what the Republicans have to offer.
To me, this is just a start. Wouldn't it be nice if those who are running for office start listening to what voters really want, what is meaningful to them, what will make them care. My guess is it is not the creation of a divisive, hate-based and paranoid society. Neither party has yet to do this. Both have just tended to say 'this is what you want; we know what's best'. As we learned from November 2016, the party that best pretended to care was the one which won.
To win in 2018, stop pretending to care.
12
Thank you again, Mr. Krugman, for writing about healthcare policy. I strongly support a single-payer system for many reasons and one of them is to be done once and for all with government trying to force or bribe for-profit insurance companies to make health insurance affordable and available to all Americans. Why keep subsidizing insurance companies with taxpayer dollars to do what government could do just as well if not better and cheaper? I have no personal experience with Medicaid but I know first-hand that Medicare works very well. My experience with private insurers before the ACA, by comparison, was a bureaucratic headache at best and a nightmare at worst. One way or another, taxpayers will have to subsidize either the insurance or the medical care of our fellow citizens who can't afford it. We may as well do it in the simplest, most cost-effective way and cut out the middlemen and their profits.
34
Just his highly biased opinion. Obama care delivered if you don't mind a very high deductible, very high costs, and limited choices of providers.
5
@vulcanalex Not true for everyone. With Obamacare, my deductible was lower, my costs lower, and I was able to see all the doctors I had before.
63
@vulcanalex Had it not been for the ACA, I don't think my wife and I would have health insurance after my employer went bankrupt, closed shop, and thus terminated the health plan (which means no COBRA).
39
@RD not true for example I had purchased pool insurance from freelancers union it was 10x better than an ACA plan. Post ACA they union then had to sell ACA plans which were the same as the exchange abc I was trapped not being able to see my old doctors. Remember if you like your doctor you can keep your doctor? Not so much
Anyone who has ever owned a business and been tasked with providing healthcare insurance for their employees can tell you that Universal Healthcare, Medicare for Everyone, would be the greatest gift they could ever receive from Uncle Sam.
The extreme costs of health insurance is a competitive hurdle many of our exporter just can't clear. The pain and agony of choosing between health insurance or layoffs and cutbacks is one of the most agonizing decisions a business owner has to make. That is if they have the sales revenue and profitability to pay for it at all.
Health Insurance adds almost $2,000 to every automobile produced and sold in America. And, it adds to the cost of everything else we purchase in America, unless that product was made in some other country that has Universal Health Insurance.
247
@Ronny Good points. If Republicans were truly "pro-business" and in particular, small business, they would be the ones pushing a single-payer, tax-funded system that takes the heavy burden of providing and subsidizing private health insurance off the backs and bottom lines of employers. The present system is not fair to small businesses or their workers.
10
@Ronny...good points--that need explaining by the NYT op ed page. How about if we had a truly progressive columnist who is an economist interested in international trade and competition to write about it?
Health care that's guaranteed frees up a person to change jobs, start a small business, go back to school.
Health care for all regardless of job, income or health status, would be a policy in line with 'freedom and liberty' that our politicans use as slogans. But we keep the world's most expensive h/c system, that still leaves out millions. It varies from state to state--- so where you live is crucial. This is NOT Equal Protection of the Laws per our constitution.
Follow the money --- big insurance donates to our election campaigns.
1
@Ronny You are correct. Every corporation should support lobbyists for universal health care. It's a business decision, but they don't teach that in business school. They only teach midget brained asswipes to destroy companies and to monetize everything else.
2
I look at health care mostly as a consumer and based on personal experience. But I start with some statistics. However many are newly insured by the ACA, most are on Medicaid. I once looked into Medicaid and wasn’t happy with what I found. Some had stories that suggested Medicaid was great. But the big picture was different. Lawsuits by recipients were common, spending on those with Medicaid fell far short of spending on the privately insured. And the access to providers was bad. I even read somewhere that life expectancy wa less, though that may not be true.
The other issue was pre-existing conditions, where it’s hard to get the straight story. Still, it is clear that coverage is paid for by the premiums that the young and healthy pay.
Bottom line, the ACA has mostly expanded substandard Medicaid coverage and expanded coverage to those with pre-existing coditions at the expense of the middle class young. I was hoping for quality insurance for the uninsured and improvements to coverage paid for by the wealthy. I guess that was a pipe dream.
6
@michjas Pre-existing conditions. How many people in their 50's and 60's don't have some sort of pre-existing condition? So if you get thrown off your employer's health plan like I did (due to the employer's bankruptcy), where do we go when both my wife and I have high blood pressure, I have psoriasis, and my wife has had breast cancer? Pretty much you go without insurance, and then when something bad happens you end up in the poorhouse.
32
If you believe that it is unacceptable to let someone die because they can't afford healthcare, then the only logical solution to all this is single-payer universal coverage.
Congress seems to have at least partially conceded it believes this back in 1986, when it passed the Emergency Medical Treatment and Active Labor Act (EMTALA), which stipulates that any hospital which accepts federal dollars must treat any patient that comes through its emergency room doors regardless of ability to pay. We made the decision that we were going to treat somebody having a heart attack, quite possibly at enormous expense, without asking for a penny upfront. Yet if someone is diagnosed with a very treatable form of cancer (stage I prostate cancer has nearly a 100% survival rate), they will be denied treatment unless they can pay. We have arbitrarily decided that when death is imminent, treatment cannot be denied, yet we bizarrely accept a system where people with very treatable slowly-progressing fatal illnesses are routinely denied treatment solely because of ability to pay. This makes absolutely no sense as policy.
We need to look in the mirror and make a decision as a country: healthcare is either a right or it's not. If it is, then let's have single-payer universal coverage and stop this madness. If it's not, then we should prepare for the day when it becomes legal to let the uninsured die in the waiting room of the ER, because that's the direction the GOP is taking us.
105
"Last week, Ted Cruz, the unexpectedly endangered Republican senator from Texas, warned that Beto O’Rourke, his Democratic opponent, would turn the state into California, with “tofu and silicone and dyed hair.”"
Does that mean young ladies in Texas will begin to imitate the ones from Malibu, that Texans might learn to like sushi, that they might even take to drinking French style wines. As for the hail, was not there something about big hair in Texas?
Cruze is full of that air we have worked for years to get rid of, as the joke goes, the smallest thing is a Texan with all the hot air forced out of him (In more vulgar terms). We have not had a chemical plant blow up next to a school recently, and our floods consist of good clean river water, not sewage.
We do have a substate here that ha many of the characteristics of Texas, the call it the State of Jefferson, it is currently on fire. Up north there they think the rest of us do not treat them right, but we do not see them offering to pay for all the costs of the fire fighting the rest of us are paying for.
We do depend on Texas to let our most polluting industries move there, the closest Texas came to looking like California is when many of them came here to pick grapes, drill oil wells, and listen to Buck Owens. You could call Bakersfield, Texas West.
29
Most countries with universal healthcare have tax rates considerably higher than the US, usually around 50% of gross income. Doctors and nurses outside the US make half or less than their US counterparts. Try selling that to the public during the election season. Obamacare was the best they could do. Healthcare in general costs too much (my son's 5 minute visit for a prescription refill was $295!). That's his clinic price gouging because they can. Transparency and competition is desperately needed to bring costs down and quality up.
7
@Steve: yes, but the savings to households for outrageous prescription drugs and usurious medical procedures, to say nothing of getting health insurers out of the system, more than offsets the higher taxes, as almost all Western industrial nations have discovered.
28
@Steve
Why is it that those nations with Universal Healthcare pay so much less per capita than we do here; and with better quality care and outcomes?
I just can't figure out how the socialists do it?
6
@Steve. I can tell that you have surely never lived in any of the countries with universal healthcare, which includes most all developed countries (and a whole lot of developing ones, too).
I have lived in three, and my taxes were less in each of them than they are in the good old U.S.A. Moreover, the health care I received in those countries was excellent.
I can assure you that your numbers are so far from the truth as to be complete hallucinations. You should never go back to the source that provided you such misinformation and nonsense.
27
Democrats have to market their achievements on ACA more effectively, but since Trump keeps repeating the same lies and constantly inventing new ones, more focus is also needed on his miserable record. Two percent wage growth, which is break-even with inflation at the same level, is trumpeted as great success. A sugar high from a trillion dollars in additional debt, which was the direct result of handing a trillion dollars of largesse over to the wealthiest Americans,is hardly cause for anyone to celebrate, and rarely is the enormous cost even mentioned.
Worse, too many journalists attribute America's resurgence to Trump's easing of regulations – Fareed Zakaria stated that some credit may be due to him there – yet little if any reporting is done on which regulations are being cut, and just how essential most of them are. Along with Professor Krugman, Robert Reich is one of the few consistently pointing up the dangers of gutting regulations – he cited estimates by the EPA, for example, that Trump's lowering of air quality standards would result in 60,000 additional deaths per year, another cost to health scarcely mentioned.
CNN focuses almost exclusively on Mueller's investigation, but all major networks must more aggressively call out Trump and Fox, which is nothing but a completely discredited arm of the oligarchical elites. Journalists will have to do a lot better job to assure a landslide win for Democrats in November, and the rest of us must help.
60
Regarding Ted Cruz's remarks about Beto O'Rourke wanting to make Texas like California, we've had tofu and silicon breast implants in Texas for as long as I can remember, and if more Californians can afford cosmetic surgery, they are also far more likely to eat healthily than Texans are. Such remarks from Cruz are motivated by nothing but ignorance and selfishness, as was his opposition to Medicaid expansion, which others pointed out was the rejection of a direct infusion of billions of dollars into the state economy - money which sensibly governed blue states gladly accepted.
People in Texas or anywhere else who still listen to Ted Cruz on ACA or on anything else ought to consider how former Republican Speaker John Boehner described him to an audience at Stanford in April of 2016: “Lucifer in the flesh. I have Democrat friends and Republican friends. I get along with almost everyone, but I have never worked with a more miserable son of a bitch in my life.”
https://www.politico.com/story/2016/04/john-beohner-ted-cruz-lucifer-222570
14
On health care Democrats may be credible as Krugman claims. (Of course, Medicare-for-all is the the right prescription. Regardless, Krugman has no credibility until he cops to helping put Trump in the White House by knee-capping Bernie during the primaries and helping the Democratic establishment saddle the party with an unelectable nominee.
2
@Sam Rose Medicare for all would be a disaster. Many providers would decline those very low rates and therefore not only the new folks but our seniors would have few options and long waits. Just ignorant.
1
Not really clear that he was knee-capped to the tune of the nearly 3,000,000 votes Hillary beat him by.
15
@vulcanalex: If there’s Medicare for all, providers have to accept it or go out of business. That’s what “for all” means. Yes, people can have additional insurance, for non-essential cosmetic surgery for instance, or a private hospital room, or pay much more for private insurance which will kick them out if they actually use it - there’s Medicare after all - but that’s about it. Providers have to accept it or go out of business.
Healthcare is Exhibit A for Democrats to shift the national focus to what government can do for regular people every day. Guns, immigration and abortion are ugly dog whistles that don't affect the vast majority of voters on a daily basis.
Democrats need to stop playing defense and rise above it all to focus on individual needs -- healthcare, financial security for seniors, consumer protections, climate change, equitable taxation and affordable college.
Government should help everyone live better lives. If voters could tune out the noise and vote for themselves Democrats would win every time.
32
A close relative of mine had steady employment for years and a nice employer healthcare plan with reasonable costs. Always complained about Obamacare, said it was a waste of taxpayer money. Then, he lost his job and is on COBRA insurance to the tune of something around $22,500/yr.
His complaint all summer was, how come I have to wait until October to apply for the Affordable Care Act. That's what we have to deal with. Never gave it a second thought while on company insurance, but OMG where is it and how fast can I get on it.
His ACA insurance will be about a third of what he pays now.
192
@cherrylog754 So the ACA is less the cobra, it is good? Both are way too expensive.
3
@cherrylog754
Prize question: Is your relative STILL voting for GOP/Trump in the midterms?
I'll admit that I'm pessimistic, but the answer might just contain some basic truth about the conditio humana.
1
So how does he plan to vote in November?
Republicans refuse to govern. They just want government to tilt the playing field towards their wealthy benefactors.
Call it the Party of Methane and Money.
28
And, if Dems want to get votes they need to pound away on how AHCA actually works. Show the numbers. Do graphs. What ever it takes to "show" folks who don't read and bow to faux, get those numbers and facts out. Folks do want affordable health care. Not the repulsive lies about everything. Vote folks. Our lives and democracy depend on it.
25
Credible? Tell that to Nancy Pelosi who has said that should democrats win the House... they will "evaluate" universal healthcare - something democrats first proposed in 1945 when Ms. Pelosi was 5 years old.
Credible? Tell that to the people of California who saw their democrat governor kill Single-Payer through his henchmen in the government. This showed that democrats always support Single-Payer, unless it has a chance of actually happening.
Promising healthcare is the democrat version of republicans promising to end Roe v Wade. It makes them plenty of money to keep promising and promising.
Not buying the dog and pony show.
https://emcphd.wordpress.com
9
So the alternative is to vote for the other party that vows to take it all away? How does that make sense?
14
@Rev. E. M. Camarena, PhD
Yep that is the corporate democrats spin game ,
promise and then never come through, just to get
the votes. Look how dear Nancy used the Dreamers,
even stood on her little heels for hours reading their
letters, for show, ha ha. Then she left them high and dry when the Dems actually had leverage to secure the
Dreamers safety. But, the democrats who will
not take big donations, all have universal health care in their platforms, and they will deliver on what they promise, I do believe. Except for Corey Booker who says he will stop taking corporate donations, for now!
Don't vote for that fellow.
1
@Chad: Chad, if you see that as the only alternative, then you are hooked. The system has you. Think outside the box. Lesser Evilism is what got us to this point.
https://emcphd.wordpress.com
As a now 78 year-old beneficiary of Medicare, I'm glad Democrats have finally embraced Obamacare after they ran away from it in 2014 and in the process lost and turned control of the Senate to its arch-enemy in now Senate Majority Leader Mitch McConnell. If it wasn't for the eleventh hour vote of John McCain, McConnell would have succeeded in killing it. The "repeal and replace" tide has turned and the Democrats are riding a blue wave as voters finally realize that having affordable health care is actually a very good thing to have. So it's time to wash away the now anti-Constitutional Trumpublicans who only cater to Trump and his fellow oligarchs and move, as every other western nation has for decades, to "Medicare for All" even if Prof. Krugman was not especially fond of it when it was Bernie Sanders, and not Hillary Clinton, who almost washed away her fatal candidacy. A progressive wave of young women, many of color and many in same-sex relationships, are revitalizing the Democratic Party and hopefully on their way to Congress this November. It's time to put government to work for all the people all the time and affordable, quality health care is an essential part of the new progressive agenda.
31
It is always amazing to see how incredibly cheap Americans are with their tax dollars when it comes to things like education, infrastructure, and public healthcare - i.e. things that actually improve the people's quality of life and invest in the future. There are always big hues and cries of "we can't afford this, who's going to pay for it, etc." despite plenty of evidence to the contrary from other developed countries.
But when it comes to funding prestige defense projects and shadow wars around the globe, suddenly money is no object. The NYT reported an article on how Trump administration officials have been looking to supporting a military coup in Venezuela. Why is it we never hear cries of "who's going to pay for it" when it comes to that sort of nonsense?
377
@citybumpkin Exactly. www,costofwar.com
1
@citybumpkin
They want to deploy a Space Force to protect us from....?
Meanwhile, it will destroy America to provide affordable health care and roads and bridges we could actually use.
@citybumpkin
We have to save our money for granite countertops and lawns more perfectly trimmed and weedless than those of our neighbors.
Medicare for all will mean increased taxes but a greater cost savings to business and tax payers than Trump's tax cuts. I will also cause massive unemployment to overpaid paper pushers, deniers, and executives ( some making $50 mil= $5/patient) Health insurance companies have donated $160 mil to politicians yearly ($1/patient or $300,000/Congressperson.
Much medicare care without insurance leads to bankruptcy unless you are a millionaire or you prefer death or severe disability.
6
@Andrew Mitchell Your math is suspect. With medicare for all many providers won't accept it as that would mean a massive cut in their compensation. Or if you pay more people will use more and thus cost more.
1
You are confusing Medicaid (insurance for those whose income is below the poverty line), and Medicare, (insurance for those aged 65 and over) almost all doctors accept Medicare and are very happy to do so as it is a money making proposition. It’s more difficult for Medicaid patients as the visit and procedure rates are purposely set artificially low because they want to discourage its use. Punish the disadvantaged again.
6
Give the GOP credit. They did get the death panel part right. That turned out to be their own interminable attempts to destroy the ACA (and their other unhealthy policies such as environmental hazards predicted to kill and sicken thousands, closing of women's health clinics, cutting funds for health research and for international medical aid).
The ACA may have saved my brother's life last year. Diagnosed with aggressive cancer, he needed fast access to good surgery.
Young people instead of ignoring healthcare have begun championing Medicare for all. Times are changing but they may be coming full circle.
Get your government hands off of my ACA!
33
"Medicare for all" seems perfectly clear to me, as opposed to the ACA, which requires a lot of explanatory essays like this one. If you're one of the people whose premiums rose under the ACA, all the explaining in the world won't make a difference. If your strategy for achieving "credibility" rests on a Paul Krugman article, you're probably also not making any headway among the people who need convincing. There's an old saw that goes: "when you're explaining, you're losing." Seems to fit here. Maybe someone can explain to me why we don't just provide health care for everybody?
12
@Ross Krugman would be a good person to ask since he carried water for the investment bankers' darling - an opponent of Medicare-for-all - who unsurprisingly lost in the general election.
2
@Sam Rose Her loss was surprising. Bernie-supporters who didn't vote for her have a lot to answer for.
2
The Affordable Care Act was a big step forward in guaranteeing health care insurance access, subsidizing coverage for moderate income families, protecting people with pre-existing conditions, providing essential benefits, especially maternity coverage, promoting electronic medical records, evidence based and accountable care, while providing risk corridor protections for insurers to keep premiums down.
But the problem with the market based ACA, based on a Republican model, was that there are few cost controls on providers. Unlike the ACA, Medicare and Medicaid both set prices that providers can charge based on actual costs, a change implemented during the Reagan Administration.
So if you are 60ish pre-Medicare age and don't qualify for subsidies, your ACA premiums are in fact, extraordinarily high.
Democrats should be pushing for Medicare for All, requiring a higher buy-in premium than the 65+ rate. This would be a far more cost effective approach and could be phased in by age group.
13
The only real danger to Obamacare, Dr. Krugman, is the white identity politics that Republicans have waged against it since 2010. The Tea Party, and later the Freedom Caucus, was born of the hate inspired by Mitch McConnell and then-Speaker John Boehner for the black president. They didn't want it to work. It has, as you have written.
But that doesn't mean that Donald Trump and his merry band of cutthroats aren't circling the house like a pack of wolves looking for a way in. Trump won the presidency on nativism and xenophobia and, while his voters aren't looking (or listening), they're lighting the white identity fuse for all it's worth. What their voters don't understand is that when Obamacare is gone, their healthcare will be, as well. But right now, all their fixated on is...hate.
On the other side of the ledger, Democrats have to keep hitting that punching bag--not Trump--but healthcare. They have some strange sparring partners, like Joe Manchin of West Virginia. His probable vote for Judge Brett Kavanaugh, aside, he is right to make his case to the folks along the Appalachian spine. He, and the Democrats, have to tell their folks--convincingly--that if the G.O.P. holds on to its majority in both houses, their futures won't be worth a lump of coal on Christmas Day. Because that's all they'll have. And, for many, it just might be their last.
Trump's knotting his own hanging rope. Democrats would be foolish to pile on. The real work is convincing people to vote to live.
11
@Soxared, '04, '07, '13: Manchin can feel free to vote for Kavanaugh because he, too, is opposed to reproductive choice. The Democratic Party has to swallow hard in order to live with this guy- just as we did with Zell Miller and Ben Nelson, among others.
7
Every single patient on the TV show “Dr Pimple Popper” hails from a state that did not expand Medicaid
Every single one
These very fine people are reduced to pop up clinics and charity and voyeurs. They could just vote for decency and democrats. That would work too.
25
We had nothing. Obamacare if much better than nothing.
However, Obamacare is not "Democrats delivered." It is less than half way to delivered.
Worse, the establishment Democrats want us to give up with just this. They tell us no more can be done, and we should give up on trying.
They won't even talk about an effort to go the rest of the way. They fight it, as they fight everything they think comes from Bernie.
8
Agreed. But it is by no means a reason to vote for the other guys. Your role is to press for more not to expect the Republicans to do anything remotely good with healthcare.
12
@Mark Thomason: Which establishment Democrats are you referring to? Most of them have come around to the idea that Medicare eligibility needs to be extended to those 55 and above and will all be copacetic with the idea of single-payer with a government option for ALL Americans before you know it (certainly by 2020). It really doesn't take much insight to discern that there really IS a difference between our two major political parties even despite the compromises made necessary (allegedly!) by the sickness called "campaign funding."
12
The biggest flaw in the Affordable Care Act, aside from the individual mandate, was that it required too much trust be put in Republican Governors. It was on them to accept the Medicaid Expansion which prevented insurance exchange costs from skyrocketing. Democrats assumed that people like Rick Perry and Sam Brownback were honest men who work for their constituents and would accept the Medicaid expansion to improve healthcare in their states. They were proven tragically wrong.
39
The individual mandate is what creates a large enough pool of insured people - including both young and healthy, and elderly and ill - to keep premiums in check. Otherwise, no insurance will remain affordable. And yes, Obama did assume that Republican governors would eventually make the decision to do what benefited the people of their state most, and was cost-effective. And yes again, it turned out that ideology Trumped concern for costs, and for peoples’ lives, at every turn, instead. Public service GOP-style.
12
@ZAW It was unprecedented policy suicide not to accept the Medicaid Expansion. It was like not accepting money for schools because some rich donors are against public schools.
9
@Melinda Mueller Come now the elderly are on Medicare. The poor on Medicaid. Start being truthful. The ACA is a massive waste. Single payer is worse.
To get the jump on Woodward's book, the GOP is promoting a campaign of FEAR. Fear of taxes, fear of someone getting something at their expense, that those dark skinned people might have the opportunity to get medical treatment they can afford, and their kids will not have to fight ear infections, and pulmonary disease, that those others might become educated and productive citizens.
As we know, many rural emergency clinics had to close being required to treat all cases, insurance or not. Many doctors who would like top raise their families in more rural places could not make a living going into practice in smaller cities and towns, the GOP preys on those communities which see their communities as self sufficient and the ACA as some kind of Socialist plot until it is a family member that dies because they could not get to a clinic soon enough, or is forced into penury with debt.
Maybe the voters are beginning to see the light, they have seen those HMO fees, those restricted covenants, they have seen people turned down due to some previous minor aliment.
The GOP campaign of fear has worn out its welcome for the great majority. We see the Us vs. Them mentality of the GOP in Alt Right demonstrations, that is what scares us today.
All you have to do is ask, who profits if the ACA is killed? What is the real motive of the GOP and this debauchery, how can any one be so repugnant, so dissolute to be a Republican today?
42
@David Underwood
Well, I am afraid of my YUGE tax jump because of the Republican ripping away SALT deductions, which were originally promised to the states in exchange for their agreeing to the federal income tax. But of course Republicans always lie and go back on their word.
So, yes, I am afraid of the taxes enacted by Republican promise breakers.
1
The best Medicare-for-all proposal was the bill Ted Kennedy tried to pass in 2006, and again in 2007. The bill was amazing in its simplicity: every 2 years (or, in the second version, every 5 years) the eligibility for Medicare was lowered by 10 years (and raised from below by 10 years), with those under 65 being asked to check a box on their taxes if they signed up for it, so they could be charged for it (the so-called "buy-in"). http://tinyurl.com/y96paw5k
I say it was the best proposal because it was the simplest, building on the Medicare system that most Americans know and trust. Given the fanatical opposition to universal healthcare, that was, and still is, the politically most viable approach.
It avoided the big stumbling blocks: 1) no complex revisions to the tax code were required to pay for it, 2) for those below retirement age, participation was voluntary, 3) participants could keep their own doctors, and 4) it was introduced slowly enough for the government, private insurers and the public to adapt.
Furthermore, we now know that such a bill would actually save taxpayer dollars, because treatable diseases associated with aging would be caught earlier. Those newly enrolled in Medicare could receive the healthcare they had long been putting off.
Legislatively, these were brilliant proposals. All new Medicare-for-all proposals should be judged against those Kennedy put forward more than a decade ago.
194
It's just amazing how reality can often catch up with Republican lies. The ACA was billed by Republicans as the end of the world as we know it. They scared their rural base to death about the horrors of socialized medicine being rammed down their throats. The red state governors refused to allow the expansion of Medicaid. Their people suffered for it.
Guess what? The red states are beginning to accept the Medicaid expansion. Several will have ballot initiatives that will override their state's rejections. The very people that make up Trump's base, primarily rural, white people are the ones that benefit the most from the ACA. Before, they had nothing. Now they have something.
They have figured out that something is better than nothing.
Trump promised over and over again that he would deliver a fantastic, low cost healthcare system. Didn't happen. Two years on and the great promise is completely dead. Remember when Obama said you could keep your doctor and conservatives claimed that the biggest and worst lie ever spoken? It was a mistake, not a lie. Trump lied because he had nothing to replace the ACA with.
The subsidy cut off is the biggest problem the ACA has. It should gradually taper off and not abruptly end. This can be easily fixed after the Democrats take over in 2020.
Meanwhile, it would be best to run on protecting healthcare and let Trump self-destruct. He's doing a great job of that. Mueller is coming and the books are pounding him.
354
@Bruce Rozenblit
At the time Pres Obama said you can keep your doctor (the very early days of the ACA) insurance companies had agreed to that promise. Later the insurance companies backed out - not the Administration.
2
@Bruce Rozenblit
Seems like those coal miners in W. b.g.Virginia are starting to realize that black lung disease is a pre-existing condition.
"Trump lied because he had nothing to replace the ACA with. "
Nor do the Republicans. And that's because the ACA is the Republicans' best plan. It was originally called RomneyCare, remember?
The Democrats wanted something that didn't include insurance companies and covered everyone. The Republicans wanted to keep the big-business aspect. President Obama cleverly used the Republican plan to get something through Congress.
And now the Republicans are stuck because they blasted ObamaCare as evil even if it was their own, best idea.
Talk about hoist with one's own petard! What can they do now? Because we aren't going back to the bad old days pre- ACA. The country will not stand for it. He he! :)
Republicans have made no mistakes in their 'predictions' about the ACA; they have only made mistakes in their political calculations about how easily they could mislead the public, and about when and how they can get rid of the law. For them, any government program that helps the public instead of the wealthy is the problem; if the program actually works well that only makes it a more difficult problem.
26
The ACA is a black hole of funding that can’t succeed without endless public monies poured into it, and it’s a suppurating carbuncle on the backside of an equally unsustainable Medicaid. States have been cutting education and infrastructure maintenance funding for years to support the Medicaid on which the ACA is grafted. Apart from failing schools and bridges falling into rivers, we now have serious labor unrest among teachers in multiple states because they’re increasingly underpaid for what they do: states can’t afford to pay for Band-Aids AND schoolbooks. The people made it clear years ago that state and local taxes, which have been rising at horrendous rates for decades, will not be further increased, particularly in the wake of a repeal of their federal deductibility for higher earners (and a cap for everyone else who pays taxes). Even if Democrats flip the House, there is zero chance for an increase in federal taxes at least for the remainder of Trump’s term.
Every year fewer doctors even accept Medicaid because the reimbursements governments can afford to pay doctors and other providers don’t cover the cost of services. The arc of increasing demand and dwindling supply doesn’t bode well for Medicaid OR the ACA in the TACTICAL term, forget about the strategic. ObamaCare has zero support among Republicans, who aren’t about to open the floodgates on ACA or Medicaid funding to the detriment of EVERY discretionary federal priority. Insurers are abandoning markets …
3
… and where they’re not the premiums have become sky-high for anyone who DOESN’T get their healthcare free of charge. Co-pays have gone up, premiums have gone up dramatically and catastrophically rising deductibles associated with even marginally affordable plans are causing many insured basically to pay retail for their healthcare because they don’t cover their deductibles in a given year.
And Democrats are “credible” on healthcare?! Giveth me a break. All they can do is defend a failed healthcare framework for everyone who doesn’t ride free – for as long as providers are exist to offer services for free. Even those who get their health insurance from employers have been paying more (as have employers) because of the cost-busting effects the ACA has wrought.
What Democrats need to accept is that the available pie is only of a given size, and that EVERY Democratic priority can’t be allocated 100% of it. We need a completely re-imagined healthcare framework that is both effective AND strategically sustainable. But given their blind adherence to failed systems, it’s a serious question whether Democrats have ANYTHING of value to contribute to a real solution for Americans.
Are Democrats justified in running as the defenders of American healthcare? A legitimate argument is that Democrats have DESTROYED American healthcare.
1
That is the most ludicrous thing I have ever heard. Are you telling me that Republicans have a better plan for healthcare in this country? For real? Or that they even care at all? Really?! After the downright shameless moral blitzkrieg they unleashed on the public last year. Not to mention from day one they have taken a hatchet to the ACA and then blamed the Democrats for being incompetent.
I am still tired of seeing rates go up. But I do not blame Obama or the Democrats. The unease and unpredictability that pushes up rates has come from the Republican Party and their all out war against it at he cost of the public.
14
patently fawlse. not one shred of evidence to back up sweeping claims.
6
The author talks about enrollment levels. Many thousands were happy with their plans and benefits but were forced into
The ACA scheme because as a group their plans were outlawed. As a group they were relatively healthy. Of course the premiums they paid were used to subsidize the unhealthy and previously uninsured Remember if you like your insurance, you can keep your insurance. No you can't Without forcing these folks who were happily insured into the ACA scheme the whole thing collapses The Supreme Court Upheld It based on the governments ability to tax. Personally everyone should have health care. I don't want what I have to
Be diluted to give someone else care. Let's look into a public option.
2
you send to not understand the basic characteristics of insurance. Pooled risk means everyone benefits. It's not quid pro quo, rather the mass is greater than the sum of the parts. Do you believe auto insurance?
11
Pooled risk in this scheme means there are winners and losers. If you are healthy and liked your plan, in many instances you were forced into something you did not want. The auto insurance analogy doesn't fly. Auto insurance premiums are based on potential risk and past driving history. Are you suggesting we base health insurance premiums on that?
1
@Patrick You as almost everyone confuse insurance with "care". Nobody really works to improve care and increase health, they just work on insurance.
1
Let's keep it simple. Go to the polls. Vote. And we weill win the day!
39
Republicans should not be determining what works in helping people with their health insurance. Health care providers should be determining what works for people, real people.
We healthcare providers know what happened during the recession. People lost their jobs. And thus, they lost their healthcare coverage. We healthcare providers could tell disturbing stories about uninsured, uninsured who needed then and need now medical care, including expensive medical care.
How do we feel about other Americans who don’t give a rip if American citizens have access to health care? How do we feel about insurance companies non approving people because they have a pre-existing condition? How do we feel about the chance that kids who could otherwise go to college or go out on their own be covered under their parents’ healthcare policies, which may be snatched away? How do we feel about monetary caps on how much people can depend on insurance companies to pay for their healthcare treatment?
How’s do we feel about this stuff? We care. We want our patients to be able to get medical treatment and not go bankrupt. We want people to not have to live in fear they might get sick because they have no means to healthcare insurance. We want our kids with diabetes to be able to have insulin when they’re in college.
Call us Democrats then and proudly so. It should be that we can just be called Americans, caring Americans. But we know the other party does not fit that bill.
80
@MIMA
Three cheers for the actual healthcare providers! The health insurance companies and those seeking to maximize profits from healthcare - e.g. hospital billing departments - are the problem.
If you went on vacation to the UK, got in an accident, and was taken to and treated at an ER, you would not be asked to pay anything - even if you wanted to pay, the hospitals don't employ people to collect payments, they don't handle money, they just provide care.
Don't even think about raising the well worn lies that the UK has death panels and gives terrible service; I lived the first 40 years of my life in the UK and the NHS works well; the major problems it has are caused by a lack of funding by incompetent or right-wing governments. It's not free, it is funded by a contribution of about 10% of the first $30,000 of income from everyone working. Lose your job or retire, you still get service but don't pay.
8
The indisputable fact is the ACA expanded healthcare coverage for all Americans -- no American can be denied insurance based on his or her personal health. Moreover, the ACA prohibits insurers from canceling anyone's insurance if he or she becomes ill and costly to cover. The ACA also bars insurers from charging higher premiums based on personal health or preexisting conditions. Finally, the ACA made health insurance more accessible and more affordable for millions of Americans.
The fact is the ACA was working so well the GOP decided they needed to sabotage it, so they did.
Right from the outset, red states refused to expand Medicaid, throwing the poor and more unhealthy folks into the marketplace which drove premium costs and deductibles and co-pays up. The GOP (under Trump) successfully defunded marketplace-insurer, cost-sharing subsidies nationwide, which is driving premium costs and deductibles and co-pays up. The GOP (under Trump) repealed the penalty for not complying with the individual mandate through "tax reform" which will result in fewer healthy folks in every state's marketplace. This too will drive up premium costs and deductibles and co-pays. Now, the Trump Administration is pushing "junk" insurance as the solution to the problem Trump and the GOP created. This "solution" will also result in fewer healthy folks in every state's marketplace and will drive up premium costs and deductibles and co-pays for everybody else in the insurance marketplaces.
44
In the 1960s the Canadian Provinces & Federal Government created universal health care programs in each Province co-funded by the Federal Government.
The nature & scope of the delivery of medical services was simpler then &, over the years, each Province was able to adapt its program in an orderly way to better accommodate medical service delivery evolution. Arguably, if our Provinces did not have these programs in place now, then getting them running under the auspices of a public program & coordinated all administrative & delivery aspects would be a much more daunting task than was the case in the 1960s.
I'm not suggesting that establishing a single-payer universal plan would be too difficult now at the US State or Federal level, only that further years or decades delay will compound the challenges to be faced in doing so.
32
@bob adamson - Why would establishing national health care be far harder in Canada today than in the 1960s? Canada is far wealthier today, and though its population is aging, elderly people and the disabled would surely be entitled to government benefits under any system. You know Canadian society and politics far better than I, and I don't mean to say you are incorrect, but I wonder why it would be so much harder for Canadians to see the enormous benefits of a single-payer system today than in the sixties. I've heard from some Canadian friends in Japan that the right is surging in the Great White North, as it is in Europe, but surely they aren't on the verge of imposing political gridlock and sowing division there to anywhere near the extent that they have done so in the US, are they?
3
@Gary Henscheid - Each Province or Territory of Canada (Province) has its own comprehensive single-payer plan that covers services of doctors & other health care providers, hospitals & other medical facilities, etc. throughout the Province. In each case, the Province is the single payer, the plans in each Province provide its services to visitors from any other Province & the Federal Government provides cost-sharing for each plan's annual costs.
Larger Provinces have established regional boards as intermediaries to administer service delivery in its region.
Medical Practitioners & other healthcare professionals can be employed by the regional board, hospital, etc. where they work or be in private practice & bill the plan for services provided to individuals covered by the plan. Individuals can bill the plan for services for which they directly paid. Fees for private practice services are negotiated collectively between professional associations & the Province.
The foregoing skims the surface of the infrastructure that has built up in each Province. Hopefully, it suggests the unavoidable complexity of providing a full range of up-to-date health care services efficiently & effectively throughout a very large geographic area. Setting up such an infrastructure to serve all residents in the US or any State will be challenging (but very worthwhile in the end) & will become ever-more challenging if the US waits decades to make the transition.
@Gary Henscheid
Turning to the political questions in your comment:
1. Support for our medical services delivery system remains strong across the political spectrum. Some conservatives advocate that more private sector enterprises be engaged to deliver services under our plans or even that a private sector parallel system be allowed to develop. Even the conservative Federal & Provincial Parties do not embrace such changes.
2. In most Provinces & at the Federal level we have 3 or more major Parties (most centre or centre left in political orientation) vying in each General Election. Conservative Parties therefore sometimes win with well under 50% of the popular vote. To win successive General Elections conservative Parties generally govern in a moderate or centrist manner. If not, they quickly lose support in most cases.
3. Some Canadian conservative political figures have tentatively road tested populist xenophobic & other reactionary issues recently but have received, at best from their standpoint, standoffish responses within their Parties & more negative general public reactions It remains to be seen whether such views will gain more traction but 'surging' hardly describes the response to date.
"If you don't have...a job that doesn't come with good insurance..."
So, why haven't the Democrats proposed a health care minimum wage? Why haven't they recognized our "most vulnerable" citizens for a change -- the American worker.
7
@caveman007: And what exactly have the Republicans done? As far as I see it, the Democrats are the only party that has been addressing realistic health care in the last 20 years.
7
@caveman007
Maybe because they lost the House in 2010, and suddenly, American people started to blame Obama for Bush’s deficits?
1
You may well be correct, but all I know first hand comes from the policies my wife and I have had over the years. So far all the ACA did for us other than dramatically raise our premiums, increase our deductibles, and limit which doctors we can see. All in all it’s been a bad deal for us. Maybe for you it’s the best thing since sliced bread, but my guess is you don’t pay for your own insurance but don’t mind telling everyone else what they should do.
10
@TW Smith The individual market is where the problem with ACA is. People who are self-employed or early retirees and earn too to get the premium subsidies have been punished with higher premiums. But my question is, Why? Who is to blame, the law or the insurance companies? How do the companies price their group plans to employers large and small versus their individual plans? Did they decide to hold down the premiums of benefit plans to compete for that business and shift more of their costs to the individual market in higher premiums? I've never heard that anything in the ACA dictates the premiums insurance companies set to make a profit.
14
@TW Smith
TW Smith:
I am sorry to hear about your straightened circumstances regarding your health care coverage--that doesn't sound good at all--and I hope some resolution obtains for your family in the near term; nevertheless, dropping millions of Americans from the health insurance rolls does our nation no great service. And I'm afraid that's what the Republicans have in store.
9
TW Smith's comment about the ACA actually demonstrates why Medicare for All would be a politically smart move for Democrats. During Obama's first term, it may have been politically necessary to build a "kludge" which protected the economic interests of insurance companies. But the downside of this compromise was to allow insurance companies to continue many of the kinds of bad behavior that anger people like TW Smith, behavior for which Democrats and "liberal elites" are then blamed.
10
Universal health care will be a winning platform. The Democrats could go for it and win. So could the Republicans. Who will be the ones to do it? Virtually all Americans want it, rich or poor. So do businesses, large and small, who can finally no longer have to offer health insurance to their employees because everyone in the country is already amply covered. Can the U.K., Germany, France, Canada, Australia, New Zealand, Japan, etc., etc., all be wrong? No, we are wrong.
589
US failure to address public health care contributed mightily to its exodus of manufacturing..
33
@C.L.S. " Virtually all Americans want it, rich or poor."
Evidence, including comments for this op-ed, suggests otherwise. Personally, I agree the US needs to look at other developed countries and get with the program. But there is still tremendous resistance within the US. There is some fear-mongering, some navel-gazing, and just a general cultural revulsion toward anything that can even vaguely be labeled "socialism."
3
Don’t forget plain old selfishness.
8
Trump had something cheaper and better
ObamaCare? Wanted to shed her,
No plan yet did he share
It was pure Trump hot air
A bunco job in every letter.
He's sabotaged in every way
Put new junky plans into play,
His cortex is tiny
Ideas meeny miny
On Health Care Dems will win the Day.
124
“And on the other hand, if Republicans hold Congress this November....”
Republicans know how to “win” elections or, at a minimum, “minimize their losses.” Exit poll evidence has shown that election results have shifted to the right since we moved to computerized voting. Is it a coincidence when a handful of companies with ties to the far right count our votes in secret?
Reluctant whistleblower Mike Connell, Karl Rove's chief IT guru, was killed in a suspicious single person plane crash in 2008 before he was scheduled to resume testimony in open court regarding vote manipulation of the 2004 presidential election in Ohio.
Mike Connell: Man in the Middle https://tinyurl.com/yctncqr6
Harper’s Magazine: How to Rig an Election https://tinyurl.com/y9xx63f6
“It was one of Connell's websites [in Chattanooga, Tennessee] that reported the surprising (many say unbelievable) surge of votes in Ohio that handed George W. Bush the White House for the second time.
“Stephen Spoonamore, an IT specialist (and Republican) who has consulted on cybersecurity has studied the electronic ‘architecture map’ used by Ohio during the 2004 election. He speculates that SmarTech might have been able to use Connell's interface to gain access to and modify vote totals.
“In a sworn affidavit, Spoonamore said that the ‘variable nature of the story’ and ‘lack of documentation available’ would, for any of his banking clients, provoke ‘an immediate fraud investigation.’”
#HandCountedBallotsNow!
126
@RLS I agree. We needed an investigation of Bush's reelection in 2004 especially in light of John Kerry's polling numbers showing him winning Ohio. Something fishy there.
17
Jonathan Simon: “We have all these elections where you’re getting these results whether you look at exit polls, cumulative vote share analysis, individual anecdotes that we see votes flipping on touchscreen machines, poll watcher reports. All these things are very strongly probative that something significant, targeted, and directional is taking place and there is no interest in taking any further steps in reporting it or investigating it.”
Election Theft in the 21st Century with Jonathan Simon https://tinyurl.com/ydz3jcvj
More Simon interviews are at “Code Red 2014 .com”
KY Election Officials Arrested, Charged with ‘Changing Votes at E-Voting Machines [Sentenced to 156 Years] https://tinyurl.com/yb3yea8s
“Baker/Carter National Election Reform Commission: ‘There is no reason to trust insiders in the election industry any more than in other industries.’
“The best election officials in the country agree that there is no reason any citizen should ever have to simply ‘trust’ them.”
Barcodes Stir Anxiety As Georgia Eyes New Voting System https://tinyurl.com/ybut5bfu
It’s alarming that voting machine companies are pushing touchscreen machines which create “ballots” that have a “barcode.”
Top Voting Machine Vendor Admits It Installed Remote-Access Software https://tinyurl.com/ycgjv66p
“Remote-access software and modems on election equipment is the worst decision for security short of leaving ballot boxes on a Moscow street corner.”
#SayNoToFaithBasedVoting
13
@RLS
Throw in www.blackboxvoting.org - Bev found the backdoor into the Diebold voting machines online, unprotected.
She has been working to get us to outlaw voting machines since 2003 and go back to paper ballot and hand-counting votes.
I agree with her. But I will add that we need plenty of watchers of that hand-counting (both sides politically) to make sure they get counted and reported correctly.
Getting rid of the Electoral College and Citizens United would help too - get our elections back to what 'we' vote for, not what is paid for.
The ACA needs to be updated/tweaked. Subsidies end too soon. The older one is the more insurance costs. That is hurting people who have lost their jobs because of their age and who cannot find new jobs, again because of their age. We really need a single payor system for medical care. Even with the ACA patients and their families still go bankrupt, are still subject to balance billing, are hit with unexpected fees, and have to do wallet biopsies before they consider going for tests or treatment for conditions like diabetes, heart disease, pulmonary issues, cancer, etc.
We still have a wealth care system rather than a health care system in America. If you were to ask a sizable sample of Americans if they go for regular check ups, take the medicine that is prescribed for them as it's prescribed, or if they understand their coverage the answer would be no. Not because they are illiterate or don't want to be healthy but because the system is confusing, contradictory, and obstructionist.
Insurance companies deny us coverage, drop providers, and often don't know the correct answers and reverse themselves. Hospitals and other health care facilities send us incomprehensible bills, have us sign forms saying we'll pay the difference (often when we shouldn't be doing so), and threaten us with collection agencies.
This is not health care. This is stressful and unnecessary. Real medical care, for all body parts, would not be this fragmented.
205
@hen3ry
Of course it costs more if you are older. The risk increases with age. That is how insurance works. More risk, more cost. You don’t really want health insurance you want nationalized healthcare.
8
@TW Smith that's right because then all of us would be able to receive the care we need when and where we need it. Other countries manage to have nationalized health care for their citizens and residents. America can if our politicians put their minds to it and if we really want it.
What good is living in a country with the best medical care in the world if you can't afford it? Especially if it's the richest country but it chooses to subsidize and give welfare to the economic elites who don't need it while neglecting 95% of country?
If our politicians truly valued life the way they claim to we would not be in the position of having to worry about our wallets first and our health last when it comes to medical care. If our politicians had to live through what they force us to live through when it comes to medical care the system would be changed.
Again, other countries manage to have a national health care system and spend far less than we do for the privilege. Our for profit wealth care system is killing us.
@hen3ry
What if providers—all providers decide the wage you want to pay them is not worth the effort?
You can’t make others take care of you.
Though we usually like Canadians, we make an exception in Cruz's instance; native Texans don't need a furr-eh-ner like Cruz man-splaining things to us - and his mispronunciation of 'silicone' has Princeton and Harvard calling for a return of their Cruz degrees.
Lots of Beto signs down here, even in GOP'er areas, but O'Rourke has to work extra hard to overcome the 60% of Texas voters who normally vote straight ticket, lots of who are GOP'ers of course - he has to convince independents and GOP'ers to join Progressives.
Beto might even be able to lead a statewide effort to expand Medicare, like California.
Heck, we like California, as does even Rick Perry, since he wants to retire there:
https://www.nytimes.com/2014/06/22/magazine/rick-perrys-groundhog-day.html
So, if it's good enough for Rick Perry to de-camp, why does Cruz think Texas should be less like Cali ?
165
@R. Law - let's make that " whom ".
6
@R. Law-
I think it will take very heavy urban turn out to unseat Ted Cruz and I sure hope that comes to pass. It's about time average, every day Texans had representation in the Senate.
10
@R. Law: Cruz was born to an American mother, and grew up in the US -- he's as American as McCain, who was born in the Panama Canal to a military family.
Birtherism is stupid whether it is on the left or the right.
1
I have to agree and disagree. Yes, Obamacare still exists and still delivers for those who can both afford its premiums and all of the costs associated with seeing doctors, filling prescriptions, paying deductibles, copays and coinsurance. We're talking hundreds of dollars a month and tens of thousands of dollars a year, if you can even afford it. Many can't.
Democrats who support universal healthcare/Medicare for all are credible. A majority of Americans support Medicare For All. The top tier of the Democratic party doesn't support it. The centrists in Congress don't support it. Incredibly, some, like Joe Manchin who is now running on Healthcare, voted for Seema Verma's confirmation. She is the architect of the ACA's destruction!
We need to focus our priorities. There is a huge leadership vacuum in the Democratic party. The old guard is still fighting the progressive wing as it stares disaster in the face. Who are Democrats for? The voters or their corporate backers? Will the real Democrats stand up and fight for the people? Finally?
If they don't, all of these discussions we're having will become totally moot. Democrats need to retake both houses and Trump needs to be dealt with. Then, after 2020, everything will need to be rebuilt, our constitution rebooted. Failing that, we will repeat these cycles from depression to repression and back, with a few good decades in between.
--
We're Watching an Antidemocratic Coup Unfold and Other Such Writings
https://wp.me/p2KJ3H-37g
71
@Rima Regas "The old guard is still fighting the progressive wing as it stares disaster in the face."
And Krugman continues to follow the old guard into irrelevance.
12
@Rima Regas Joe Manchin has to deal with the voters he has, not the voters you would like him to have. Joe Manchin's vote did not matter for Seema Verma's confirmation (and the next nominee would have been no better in any case - witness Scott Pruitt's replacement) but it does matter for his re-election.
Joe Manchin - like every other Democratic Senator from a not-Blue state - has to pick his fights. No one you would call "progressive" would be elected to the Senate from West Virginia these days. Trump won West Virginia by 40%.
14
@WZ
In all the years Joe Manchin, Heidi Heitkamp, Jon Tester, Claire McCaskill and all the other Blue Dogs have been in office, they've made ZERO effort to inform their voters and try to bring them around to the Democratic mainstream.
Manchin and McCaskill's first vote in this Senate was to allow for pollutants in the waters adjacent to mines.
All of the Blue Dogs wrote and then voted for the rollback of Dodd Frank and that includes the roll back of protections against prejudice in lending to minorities.
With Dems like that, who needs Republicans?
Oh, and to add insult to injury, Republicans who leave the GOP are being urged to run as Democrats and then given resources that long time party members should by all rights be receiving.
Is it any wonder that the party has moved so far to the right? Is it any wonder that voters don't show up to vote?
Oh, and if you plan on replying, don't talk to me about purity. This is about principle and looking out for your constituents.
Manchin is a grifter.