Will you please stop calling the public option "socialized medicine." It is "socialized insurance." To the extent that private insurers tell doctors and hospitals what they will pay for certain services and which of those services they will not pay for at all, nothing would change under a public insurance plan. Insurance companies are already coming between doctors and patients. Patients already have to find out on their own if this diagnostic test or screening or that drug, physical therapy session or medical device the doctor ordered will be reimbursed by their insurance provider and if not, they have to decide to pay for it out-of-pocket or forego it. All I want is socialized insurance with private providers. What do you call that?
62
Allowing an at cost public buy in to Medicare could solve most the problems of the healthcare exchange without increasing government spending.
The only reason not to support it is the fear that a government run program could be cheaper and more efficient than private insurance, which would undermine a core tenant of the republican platform.
The only reason not to support it is the fear that a government run program could be cheaper and more efficient than private insurance, which would undermine a core tenant of the republican platform.
54
Single payer systems are not "socialized medicine" insofar as the government does not hire and pay the workforce actually providing the medical treatment. Veteran hospitals and medical facilities might be much closer to qualifying. but such a characterization is rarely if ever applied to them insofar as mere use the the term would be be interpreted as a condemnation.
36
One notion floating around among Republicans is that private charity should be responsible for health care for the indigent; Medicaid and other government programs intrude into that private realm of responsibility.
Bake sales for cancer. It's a genuine American tradition.
Bake sales for cancer. It's a genuine American tradition.
35
You know in Australia and in the rest of the civilized world, health care is entirely uncontroversial. The Congress is in the pocket of the special interests that has been made clear. And the President is hopelessly conflicted. At a point when the country is crying out for leadership, the Congress and the President are sadly lacking. The U.S. needs a real revolution not the fake one you had in November
74
This must have been written in a alternate universe. One in which, there is no republican party or it's rapidly stinking alliance of blue dog democrats. When pigs fly, is when the GOP will let a single payer or medicare for all, come to a vote. We all know it makes perfect sense and is done throughout the world, but in the USA we have a large group of lemmings that vote against their own best interests. One cross section of it's constituency is, older White people with medicare and decent supplemental insurance policy and their mantra is.. 'I Got Mine!' The rest of the lemmings are obviously in a 50's time warp, and are waiting for a miracle rebirth of the USA in all it's glory. Then there's young people, who don't vote and who don't understand that young people get sick and die from life threatening illness's every day but they're oblivious of that fact. In reality, our quality of life is diminishing and unless there's a 60's revolution, the right wing loonies like Ayn Ryan will slowly keep chipping away at the rapidly fading American dream. It's quite simple, love thy neighbor as thyself. You know, I'm my brothers keeper. The most religious among us and the GOP, seem to have forgotten this simple ethos entirely!
41
The US is closer to single payer than it admits. When you let the private sector insure the healthy (for profit, and the public sector insure the old and the sick (so the taxpayers as suckers lose money) not surprisingly the majority of US healthcare expenditure is Medicare and Medicaid, read single payer. https://www.cms.gov/research-statistics-data-and-systems/statistics-tren...
The Republican analogy to cellphones that there should be a gazillion plans where you can buy a cheap one or an expensive one is simply poor logic. If you are sick you want to get healthy, not look for a cheaper partially sick option. If your child is sick, you will give every last cent you have to get him or her back to health. Rob a bank if you have to. Sadly, supply and demand don’t apply to healthcare.
So Health care should stay in the private sector, and great research should be rewarded with great profits. It just need for care be a single payer system.
Bob Tapscott
The Republican analogy to cellphones that there should be a gazillion plans where you can buy a cheap one or an expensive one is simply poor logic. If you are sick you want to get healthy, not look for a cheaper partially sick option. If your child is sick, you will give every last cent you have to get him or her back to health. Rob a bank if you have to. Sadly, supply and demand don’t apply to healthcare.
So Health care should stay in the private sector, and great research should be rewarded with great profits. It just need for care be a single payer system.
Bob Tapscott
7
Republicans believe healthcare is a privilege not a right unless they can make money off of cancer patients, people with heart problems or children with diabetes. The free market was found by all of the other democratic, industrialized countries to not work to keep costs down and their citizens from needlessly dying or going bankrupt. Medicare works and people love it, it's transportable state to state with no differences state to state unlike the insurance companies. We need a public option now for everyone, it would help release entrepreneurial energy everywhere and help to create jobs in the middle of the country, in fact, it would create jobs all across the country. The republicans either need to get on board or get out of the way ... Americans have decided healthcare is a right not a privilege!
37
As a Canadian, I watch with open mouth as Americans try to create a "health care system" that still costs twice as much per capita as the Canadian "system", and is no better. Our system (actually twelve provincial systems, but close enough for argument) has the advantage of being non-profit, as there are no insurance companies trying to create profits for their shareholders. Yes our single-payer system has flaws, and we are trying to correct them, but you have the advantage of being able to see all the other single payer systems, including the ones that are better than Canada's, and creating your own hybrid out of whole cloth. What an irony if a Republican government led by The Worst Man In The World, were the ones to do it!
39
As things now stand, the only way we are going to change the healthcare system is through bipartisan legislation. Heaven forbid! ! ObamaCare is here to stay, no matter what fools like Trump and Ryan try to do to it. The only way we're going to change things is to move toward a single-payer system which will require both Democrats and Republicans. Trust Me. It will happen.
14
Single payer is characterized by two things:
1. Waits. Really. Long. Waits.
2. Slow approvals.
Instead of saying Medicare for everybody, you should say, VA for everybody.
1. Waits. Really. Long. Waits.
2. Slow approvals.
Instead of saying Medicare for everybody, you should say, VA for everybody.
5
Here is a path towards Single Payer that almost no one talks about: Medicare for All Children. Open Medicare for everyone under 18. When people see it working well for their parents and their children, they will demand it for themselves.
23
Single Payer is socialized insurance not socialized medicine.
21
The real problem?
The GOP has only 1 prime directive: the ever greater concentration of wealth & power on behalf of the wealthy & powerful.
Everything else is carbon fiber.State's rights? Antiabortion? Fundamentalism? Anti-Immigatration? Just B.S. They need those noneconomic issues to attract voters to vote against their self interest to help the wealth & powerful succeed in their quest.
Anti-immigration? they use immigrants to force down wages. Abortion? They need that as an issue. They won't do anything
Same w/ single payer. What they don't like about O-care is that people don't need a job in order to get healthcare anymore. That means people who have an idea to make money on their own, like a craftsman or an artist, or have enough money saved, can walk away from their job. That shrinks the labor pool & puts upward pressure on wages.
No wonder they hate O-care.
Last week on Morning Joe, Rand Paul, THE LIBERTARIAN OF LIBERTARIANS said the best way to get healthcare is to get a good job with a big wealthy employer. My question to Paul is what happened to liberty? What he's saying is that Americans are condemned to healthcare serfdom. Thanks alot.
O-care could become identical to Japan & Korea's system by allowing a commission of insurance companies and healthcare providers set fees for procedures.
Once you have set fees you can have a centralized processing of claims.
At that point, private insurers function like banks. You make deposits, doctors make withdrawals.
The GOP has only 1 prime directive: the ever greater concentration of wealth & power on behalf of the wealthy & powerful.
Everything else is carbon fiber.State's rights? Antiabortion? Fundamentalism? Anti-Immigatration? Just B.S. They need those noneconomic issues to attract voters to vote against their self interest to help the wealth & powerful succeed in their quest.
Anti-immigration? they use immigrants to force down wages. Abortion? They need that as an issue. They won't do anything
Same w/ single payer. What they don't like about O-care is that people don't need a job in order to get healthcare anymore. That means people who have an idea to make money on their own, like a craftsman or an artist, or have enough money saved, can walk away from their job. That shrinks the labor pool & puts upward pressure on wages.
No wonder they hate O-care.
Last week on Morning Joe, Rand Paul, THE LIBERTARIAN OF LIBERTARIANS said the best way to get healthcare is to get a good job with a big wealthy employer. My question to Paul is what happened to liberty? What he's saying is that Americans are condemned to healthcare serfdom. Thanks alot.
O-care could become identical to Japan & Korea's system by allowing a commission of insurance companies and healthcare providers set fees for procedures.
Once you have set fees you can have a centralized processing of claims.
At that point, private insurers function like banks. You make deposits, doctors make withdrawals.
17
There is a good example of socialized medicine that congressional leaders should look to when writing new legislation: CHIP.
The Children's Health Insurance Program went into effect in 1997 and reduced the children's uninsured rate to 7% by 2012 (a record low). CHIP is a program for children whose family incomes are too high for them to receive Medicaid benefits. It's a state program, but the ACA requires states to "maintain eligibility standards."
For some reason, we have decided in this country that children are "deserving, poor, and innocent" until they turn 18, at which point they suddenly become independent adults, cast out into an every-man-for-himself world. What politicians, and, really, Americans have failed to recognize is that adults are just as deserving as children. And from this follows: why shouldn't these adults have the same access to government-provided healthcare that children do?
The Children's Health Insurance Program went into effect in 1997 and reduced the children's uninsured rate to 7% by 2012 (a record low). CHIP is a program for children whose family incomes are too high for them to receive Medicaid benefits. It's a state program, but the ACA requires states to "maintain eligibility standards."
For some reason, we have decided in this country that children are "deserving, poor, and innocent" until they turn 18, at which point they suddenly become independent adults, cast out into an every-man-for-himself world. What politicians, and, really, Americans have failed to recognize is that adults are just as deserving as children. And from this follows: why shouldn't these adults have the same access to government-provided healthcare that children do?
20
Opening up Medicare to people at age 60 is not going far enough. Open up Medicare to people over the age of 26. If they choose not to buy into Medicare, they can be held fully responsible for their totally out-of-pocket medical expenses, including the federal government's right to garnish wages and future Social Security payments if hospitals are not reimbursed by the patient. And the money saved by cutting out health insurance companies can be redirected toward investigating doctor and health facility Medicare fraud. Give rewards to whistleblowers and patients reporting on fraudulent billing.
8
As others have noted, taxpayers provide quality healthcare coverage to our legislators, which they seem to like, but do not seem to fully appreciate. If they cannot manage to provide the same peace of mind for us, we should reneg on that contract. You simply cannot rely on market forces in healthcare without disclosing the true cost of care. Hospitals and health providers have done a stellar job of obfuscating what a patient will pay for care. How can patients make cost-effective decisions when the information is simply not made available? We can't. Medicare has an extensive database of the cost of care by region. They base their reimbursements on it, and it includes the cost of staffing and infrastructure and builds in a modest profit. (See "Bitter Pill" by Steve Brill, Time Magazine special issue in fall 2012 or winter 2013) The answer is Medicare for all, it's tested, it works, and it's already in place. It's also the best way to ensure health care is available in rural areas. Universal coverage would also replace the VA's healthcare system, which conservatives would love, though I would not eliminate it entirely to ensure adequate care for conditions specific to veterans.
16
You left out one tiny detail; thanks to the last election, which 'donated' both the supreme court choices and the hostile takeover of congress to republicans, it's going to be a really hard lift to find democrats in control for a while - possibly a l-o-n-g while.
5
Bugs Bunny: yes
Daffy Duck: No!
Bugs: yes
Daffy: no
Bugs: no
Daffy: yes
Bugs: Have it your way
Democrats: Single Payer
Republicans: RomneyCare
Dems: Single Payer
GOP: RomneyCare
Dems: Single Payer
GOP: RomneyCare
Dems: RomneyCare (aca Obamacare)
GOP: ...er....not Obamacare, but..... wait.... er.... tax cuts for rich,...er...wait...
Still waiting.
Daffy Duck: No!
Bugs: yes
Daffy: no
Bugs: no
Daffy: yes
Bugs: Have it your way
Democrats: Single Payer
Republicans: RomneyCare
Dems: Single Payer
GOP: RomneyCare
Dems: Single Payer
GOP: RomneyCare
Dems: RomneyCare (aca Obamacare)
GOP: ...er....not Obamacare, but..... wait.... er.... tax cuts for rich,...er...wait...
Still waiting.
29
As a county medical social worker, I wish I could take a few health care denying Republicans to visit some clients of mine, small children who through no fault of their own were born into poor families that cannot afford health care for them. Or maybe they would like to meet some of my nursing home clients, people who are so debilitated, often due to lack of basic medical care when they were younger, that they can do little more than sit or lie in bed all day.
There is no excuse for this country to fail to provide medical care for all Americans. Only when we do so will we really be a great nation.
There is no excuse for this country to fail to provide medical care for all Americans. Only when we do so will we really be a great nation.
29
This statement in this article is totally incorrect: "(ObamaCare) created private insurance markets where middle-class and affluent people could buy subsidized coverage". The private insurance markets created by ObamaCare were strictly for lower income people, not for "middle class and affluent" people. The health insurance markets for the middle class and affluent already existed and became much more expensive in order to pay for the subsidized coverage program and other aspects of the law, like the requirement of insurers to cover pre-existing conditions.
5
Um, Obamacare vs. Single Payer is the Republican choice in the fantasy world where Republicans participate in good-faith politics.
What it looks like from over here is that they are starting by half-*ssing a fake attempt at health reform, and will follow up by making the existing system function less efficiently and at greater cost, for both the government and individual participants in the healthcare system.
What I cannot comprehend is why all the big business interests that keep them on such a short leash in every other major policy debate, aren't yanking Republicans hard, repeatedly, to funnel the entire healthcare system through mandatory insurance, i.e., Obamacare.
It is beyond my comprehension how distorted their train of logic has become.
What it looks like from over here is that they are starting by half-*ssing a fake attempt at health reform, and will follow up by making the existing system function less efficiently and at greater cost, for both the government and individual participants in the healthcare system.
What I cannot comprehend is why all the big business interests that keep them on such a short leash in every other major policy debate, aren't yanking Republicans hard, repeatedly, to funnel the entire healthcare system through mandatory insurance, i.e., Obamacare.
It is beyond my comprehension how distorted their train of logic has become.
12
Personally, I'm all for single-payer health care, but I don't think we should let the cat out of the bag. Once Americans hear the term, they'll make the connection to Socialism, and there's nothing Americans more unthinkingly hate than Socialism. That's why I hope you're right that the Republicans will back us into it. Progressives should cover their smiles as the Conservatives give us what they couldn't.
6
Seems to me now is the time for Democrats to reach out to republicans that opposed RyanCare. Dems also need to reach out to Trump who said he could work with democrats. The cracks in the republican party need to be exploited. If there are opportunities for new coalition building and marginalizing the freedom caucus we need to exploit them. Dems need to demonstrate what leadership and governing really looks like. Any yes, this could give Trump a win, but I as much as I dislike Trump, I would rather see Trump win than the American people lose.
2
In all the articles, discussions, advertisements etc that I have seen on healthcare costs there has always been one glaring (in my opinion) omission. That is that the business model of ALL insurance companies, whether for or not-for-profit is very simple. It is exactly the same business model as all forms of gambling - from DJT's failed casinos to the local church bingo game. Simply put it is to ""take in more money than you pay out. The first day that a gambling casino goes into the red is the day they shutter their doors. I don't recall any health insurance company declaring bankruptcy or closing their doors because they were in the red. What they do when facing lower profits is to raise rates and reduce benefits. The difference is that the gambling casino's customers can stop giving them their business without bad consequences but health care "customers" must either go without care or pony up the increased premims. While insurance companies may lose individual customers who can not afford increased premiums, this loss has no appreciable effect on the insurers.
Single payer healthcare for all citizens is the only real solution. Other counties have crafted solutions which allow the private insurance industry to maintain a role in healthcare - why our politicians don't look to these models is not a mystery either. Just follow the money......
Single payer healthcare for all citizens is the only real solution. Other counties have crafted solutions which allow the private insurance industry to maintain a role in healthcare - why our politicians don't look to these models is not a mystery either. Just follow the money......
5
Has everyone forgotten that The Heritage Foundation and Richard Nixon both proposed Universal Health Care? Had it not been for Watergate, we'd have Nixoncare. Why? Nixon in spite of his "end justify the means" mentality, paranoia, and criminal behavior, understood that to make America competitive, Americans need health insurance so they can go to work and be productive. Heritage Foundation also figured out that universal coverage drives down costs. If the GOP could just get over their need to enrich the already rich and lie to the poor and middle classes, they would embrace universal healthcare. Health costs are a leading cause of bankruptcy in the USA. How can that possibly help us be "great"? Bottom-line is in countries with universal healthcare, people die because they are sick, in America, people die because they are poor.
12
Though I like this piece, it draws a false dichotomy. Obamacare, maintained and adjusted properly, PROVIDES for a gradual transition to single payer. It includes regulations, responsibly applied, which lower the cost of health care delivery over time. It has not been responsibly maintained for six of its seven years and it's still not doing badly.
For a gradual transition to single-payer, either add a public option, gradually lower the age of Medicare eligibility, or both. Voila! Single payer in a generation. I probably don't have a generation to live, but I'm OK with that.
Insurance companies, prepare for the transition to boutique niches.
For a gradual transition to single-payer, either add a public option, gradually lower the age of Medicare eligibility, or both. Voila! Single payer in a generation. I probably don't have a generation to live, but I'm OK with that.
Insurance companies, prepare for the transition to boutique niches.
5
If we can't get for a single payer, Medicare for all, system in one step, I'd like to see the following:
1. Comprehensive catastrophic coverage paid for by a progressive tax.
2. Comprehensive preventative coverage paid for by a progressive tax.
2. Private insurance companies taking what's left of the "market" with a public option available.
1. Comprehensive catastrophic coverage paid for by a progressive tax.
2. Comprehensive preventative coverage paid for by a progressive tax.
2. Private insurance companies taking what's left of the "market" with a public option available.
1
Hey Leonhardt, quit stealing my comments! I've said that the death of Obamacare would eventually lead to single-payer in comments to nyt articles a few times now.
1
I'm all in favor of a single-payer system (I live in Canada). Just be aware of one thing. You will almost certainly need some sort of a federal sales tax (probably a value-added tax like Canada's GST) in order to fund it. If I had to go out on a limb, I'd say it would be in the order of 7-8% on most items, other than necessities like food. You can re-jig your existing tax system, but it's not going to come close to covering the cost without a new sales tax, and relying on higher income-taxes alone won't do it.
On the positive side, it would replace most (70-80%) of the present cost of your entire health-care system, and eliminate virtually all private health-care insurance premiums. In my experience, the trade-off is well worth it.
On the positive side, it would replace most (70-80%) of the present cost of your entire health-care system, and eliminate virtually all private health-care insurance premiums. In my experience, the trade-off is well worth it.
29
Death Panels = Freedom Caucus = GOP (Grossly Overcompensated Popinjays)
If you want to complain about health care being rationed all you need to do is look at our current health care (aka wealth care) system and who is truly running it and who it's run for. It's not being driven by people who care about patient health and it's not run in a way that is conducive to patients receiving the care they need when they need it. It's run in a way designed to maximize the profits of all while making sure that patients and providers are put through endless hoops in the hope that they quit and then drop dead.
If you want to complain about health care being rationed all you need to do is look at our current health care (aka wealth care) system and who is truly running it and who it's run for. It's not being driven by people who care about patient health and it's not run in a way that is conducive to patients receiving the care they need when they need it. It's run in a way designed to maximize the profits of all while making sure that patients and providers are put through endless hoops in the hope that they quit and then drop dead.
10
or, look at Kaiser... if you live in the right zip code.
2
I truly hope we can get to a single payers system in my lifetime. I'm only in my 50's but we'll see. In my opinion it's the for profit insurance companies and the greedy gargantuan hospital systems that are devouring up all the private doc practices that are largely to blame. And let's not forget big pharma and it's equally sized greed. One of my docs' office got absorbed into a big hospital system. Before when I'd see him, I'd get a reasonable bill. Less than $100. After he moved to his new office, I got a $400 facility bill just for SITTING in a room to talk to him! That was in ADDITION to his fee. When I complained to their billing department, it was explained that they are a hospital and not a private office and that their facility fee was in line with other hospitals in the area. This is highway robbery. I am lucky in that I can afford the fee. But many can't. There needs to be regulation on these conglomerates as they are ruining healthcare in this country.
8
The GOP, Grossly Overpaid Popinjays, will be in favor of health care for all when they can't afford it even with their gold plated plans. However that will be too little too late for the rest of us. And even that is no guarantee that they would institute a medical care system or plan that would help all Americans and legal residents. They'd probably put up a golden gate to which only their chosen have a key while charging the rest of us a fortune to see the gate.
5
OK but you fail to give public insurance enough credit.
It is much cheaper than private insurance. The overhead cost of Medicare is about 3%, versus about 20% for private insurers.
Also, Medicare reimbursements to providers are constrained by financial limits established by Medicare. These discounts can be as much a 50% or more.
With single payer our overall medical expenses could approach that of other industrial countries, provide, of course, that we allow Med care to negotiate prices with the drug companies.
It is much cheaper than private insurance. The overhead cost of Medicare is about 3%, versus about 20% for private insurers.
Also, Medicare reimbursements to providers are constrained by financial limits established by Medicare. These discounts can be as much a 50% or more.
With single payer our overall medical expenses could approach that of other industrial countries, provide, of course, that we allow Med care to negotiate prices with the drug companies.
9
It would be helpful if we all stopped referring to "universal single-payer coverage" as "socialized medicine."The word "socialism," widely misunderstood, is clearly a hot-button for many Americans.
We do not call car insurance "socialized vehicle accident" coverage. All insurance is, by definition, a socialization of risk. The "society" is the community of the insureds.
For medical care, the "society" is the entire nation. Rather than "socialized medicine," it much better name would be "medical risk protection."
We do not call car insurance "socialized vehicle accident" coverage. All insurance is, by definition, a socialization of risk. The "society" is the community of the insureds.
For medical care, the "society" is the entire nation. Rather than "socialized medicine," it much better name would be "medical risk protection."
10
"They create competition, which leads to innovation and lower prices. "
There is precisely zero evidence for this. Private markets actually lead to higher prices and lots of expensive, unnecessary and ineffective intervention. Stents for angina anyone?
There is precisely zero evidence for this. Private markets actually lead to higher prices and lots of expensive, unnecessary and ineffective intervention. Stents for angina anyone?
12
I believe that, outside of health care, there is much evidence that private markets create competition.
1
The end result of healthcare reform will be a single payer. It is the only thing that makes sense. So the private health insurance companies will go out of existence. The work force and executives and owners of those companies will lose their positions. The is no reason that government run programs can't be as efficient and economical as private enterprise. The basic problems with government run anything is ineffeciency and waste. Why can't these problems be fixed? Oversight and accountability would seem to be too obvious. They are possible. It takes the will and someone to enforce it. It may be asking too much, but government and congress must do their job.
6
Administrative costs for Medicare~3%. Administrative costs for private health insurers! 15-18%. Which is more efficient????
3
why can't we look at how other countries dealo with Heathcare? we know that Sweden, France, Spain all have better systems....so why not tale a look and see what works and what doesn't work for them? tha is where I would start....
7
but they have taxes!
2
MEDICARE FOR ALL SHOULD BE THE MANTRA
The challenge to providing affordable and accessible healthcare services to the entire US population is complicated to be sure. The reason that it’s complicated is not inherent in delivering quality healthcare to a deserving population. It’s a complicated system because no system was it was ever planned. The system, or rather "systems", we have is the result of competing and sometimes antagonistic public and private healthcare plans, separated by constituencies defined by age, geography, employer, socioeconomic condition, diagnosis, and more. Each plan comes with a duplicative business structure composed of buildings, systems and people resulting on a hidden tax to the American economy. This insurance machine is draining valuable resources from the American economy by depriving as much as 25% or nearly $750B a year which might otherwise be spent on actual medical care and the innovative research necessary to develop new and often cheaper therapies. And that number does not include any savings from properly negotiating with big Pharma.
The real answer is right in front of our collective noses and it's called Medicare For All.
Ask any senior if they're dissatisfied with Medicare. Doctors and hospitals have a different opinion mostly related to the very low reimbursement rates they receive for Medicare patients. The solution here: Increase their reimbursement rates by using some of the savings. This is only a start.
The challenge to providing affordable and accessible healthcare services to the entire US population is complicated to be sure. The reason that it’s complicated is not inherent in delivering quality healthcare to a deserving population. It’s a complicated system because no system was it was ever planned. The system, or rather "systems", we have is the result of competing and sometimes antagonistic public and private healthcare plans, separated by constituencies defined by age, geography, employer, socioeconomic condition, diagnosis, and more. Each plan comes with a duplicative business structure composed of buildings, systems and people resulting on a hidden tax to the American economy. This insurance machine is draining valuable resources from the American economy by depriving as much as 25% or nearly $750B a year which might otherwise be spent on actual medical care and the innovative research necessary to develop new and often cheaper therapies. And that number does not include any savings from properly negotiating with big Pharma.
The real answer is right in front of our collective noses and it's called Medicare For All.
Ask any senior if they're dissatisfied with Medicare. Doctors and hospitals have a different opinion mostly related to the very low reimbursement rates they receive for Medicare patients. The solution here: Increase their reimbursement rates by using some of the savings. This is only a start.
5
1. The house Freedom caucus killed the bill, not Trump or Ryan. The Democrats instead of crowing need to agree to come to the table. Politics is the science of the impossible.
2. While healthcare may be a right; the reality is all citizens need to realize we cannot have unlimited entitlements or we will become Greece or Spain. Such a possibility is not in the best interests of our grandchildren or great grandchildren. Ask yourselves if you are willing to be taxed for universal healthcare.
3. As a provider, medicaid does not cover the costs of practicing medicine or covering the costs of complicated care. IT is UNFAIR for hard working taxpayers to underwrite obesity, smoking, drinking, and a sedentary lifestyle.
Your day to day health should be your responsibility. Only ask your government to pay for catastrophic illness.
KM Begelman, MD, FACC, FACS
2. While healthcare may be a right; the reality is all citizens need to realize we cannot have unlimited entitlements or we will become Greece or Spain. Such a possibility is not in the best interests of our grandchildren or great grandchildren. Ask yourselves if you are willing to be taxed for universal healthcare.
3. As a provider, medicaid does not cover the costs of practicing medicine or covering the costs of complicated care. IT is UNFAIR for hard working taxpayers to underwrite obesity, smoking, drinking, and a sedentary lifestyle.
Your day to day health should be your responsibility. Only ask your government to pay for catastrophic illness.
KM Begelman, MD, FACC, FACS
2
Dr. Begelman would almost certainly make much less money under universal healthcare. I would give more credence to what he says if HE had mentioned that.
5
YES!!!!!!!! I am VERY willing to be taxed for universal health care, as evidence from EVERY nation with universal care is that it is MUCH less expensive than our system. We would all save immensely.
3
Yes, I'd rather be taxed for universal medical care and know that my fellow Americans and I, when I will need it, can receive the care when and where it's needed. Got that Doc?
Now, as far as paying for other people's obesity, smoking, drinking, and sedentary lifestyle, that's something that can be worked with. Denying them medical care because of it is foolish. Charging them more won't improve their health. However, giving them and the rest of us access to the medical care we need when and where we need it would improve their health, my health, and the health of everyone else in the country. Punishing a few to avoid paying for their "lifestyle choices" when some of them aren't choices, is more like using a nuclear bomb to smoke a beehive.
And while we're at it, what are your vices in life Doctor? Do you have perfect health? Do you never talk on a cellphone while driving or text? Do you always eat a nutritious meal, eschew sugar and salt, stand up straight, and never partake of an alcoholic beverage? When you are perfect then you can write the book on how to deal with the everyday expenses of dealing with a chronic illness or condition and how to avoid it.
Now, as far as paying for other people's obesity, smoking, drinking, and sedentary lifestyle, that's something that can be worked with. Denying them medical care because of it is foolish. Charging them more won't improve their health. However, giving them and the rest of us access to the medical care we need when and where we need it would improve their health, my health, and the health of everyone else in the country. Punishing a few to avoid paying for their "lifestyle choices" when some of them aren't choices, is more like using a nuclear bomb to smoke a beehive.
And while we're at it, what are your vices in life Doctor? Do you have perfect health? Do you never talk on a cellphone while driving or text? Do you always eat a nutritious meal, eschew sugar and salt, stand up straight, and never partake of an alcoholic beverage? When you are perfect then you can write the book on how to deal with the everyday expenses of dealing with a chronic illness or condition and how to avoid it.
4
I would like to add, that I want the same coverage as my elected federal representatives.
I know they receive coverage through the DC Exchange, but since a similar comment was an Editor's Pick in yesterday's Krugman article, I realized that I over-estimated the intelligence of the Times readership.
I guess HL Mencken's quote on the American intelligence holds water even here.
I know they receive coverage through the DC Exchange, but since a similar comment was an Editor's Pick in yesterday's Krugman article, I realized that I over-estimated the intelligence of the Times readership.
I guess HL Mencken's quote on the American intelligence holds water even here.
3
Me, I vote for those panels Republicans warned us about eight years ago, only this time for the guys doing this to us.
The lesson from Vietnam and Iraq is hearts and minds, something Trump can't ever understand. You can't rule in a democracy without the consent of the governed. Eventually the iron fist is destroyed, or you end up living like Israel does.
To try to rule the way he does in a country with more guns than people is crazy.
This is not going to end well.
Let's hope the next super hurricane targets Mar-A Lago. If it does I may reconsider a belief in God.
The lesson from Vietnam and Iraq is hearts and minds, something Trump can't ever understand. You can't rule in a democracy without the consent of the governed. Eventually the iron fist is destroyed, or you end up living like Israel does.
To try to rule the way he does in a country with more guns than people is crazy.
This is not going to end well.
Let's hope the next super hurricane targets Mar-A Lago. If it does I may reconsider a belief in God.
2
Ever since the enactment of the ACA I've been refering to it as a GIANT Corporate Welfare plan. It is what conservatives wanted until Obama got involved. It is unsustainabel and many ways outright evil. Why not pay taxes instead of premiums. Everybody pays in everybody can utilize the healthcare system. Why do Americans have to pay 5 times as much as everyone else in the developed world and still not be able to access healthcare.
11
If the Freedom Caucus were really interested in freedom, they'd be all in for single payer. That would free businesses to take care of their business, without having to devote time, energy, and money to dealing with health care insurance for their employees.. It would provide citizens with the freedom to change jobs or careers, or start their own business, without worrying about losing their health care insurance. It would free hospitals and doctors from an enormous amount of administrative cost dealing with the current market-based piecemeal system of health insurance. And the list goes on.
But no, the "Freedom Caucus" is really the "Fiefdom Caucus". They are ignorantly rooted in a rigid ideology that serves the corporate overlords, to the detriment of knowledge, science, and reason.
But no, the "Freedom Caucus" is really the "Fiefdom Caucus". They are ignorantly rooted in a rigid ideology that serves the corporate overlords, to the detriment of knowledge, science, and reason.
7
Mid terms 2018!
Single payer or vote them out.. it does not solve everything but it is a start.
The stoppage of the repeal and replace started with one raucous town hall meeting, then another, then another, then ..done.
Voters must act for their interests not vote against them.
Single payer!
Single payer or vote them out.. it does not solve everything but it is a start.
The stoppage of the repeal and replace started with one raucous town hall meeting, then another, then another, then ..done.
Voters must act for their interests not vote against them.
Single payer!
16
The only way the cost of health care insurance can come down is single payer healthcare. I suppose it could also come down with good regulation by the government of health care insurance companies...and drug companies....but hey that ain't likely to happen. So I agree. Hopefully we are headed to national single payer health care like other civilized countries.
6
People certainly want a simpler system.
5
I wish someone could explain to me we we need health insurance companies at all. These parasites are a huge drain on individual revenue with no tangible benefits - the opposite in fact when they deny treatments and limit coverage. All that money siphoned off to middlemen and stock owners, forcing the cost of treatments up up up. Absurd. Corrupt.
Why to the sheeple put up with it?
Why to the sheeple put up with it?
9
The third more probable scenario is the Administration, along with help from the GOP, will allow the ACA to "implode." The GOP currently has a case pending at the DC Appeals court, "The House v Burwell," where the Judge has already ruled the subsidies are unconstitutional, and although the case is on the Appeal docket I would not be surprised if the current administration simply withdrew the appeal.
The fact is even with the current subsidies a substantial number of Americans have either decided to pay the fine, or simply forego health coverage, which have left the exchanges with a much higher percentage of clients who require healthcare, and an insufficient number of healthy individuals to offset the medical costs resulting in the insurance companies incurring huge losses and abandoning the exchanges.
The final result may very well be the GOP claiming they were right along about the ACA's inevitable failure, which they can pin on the Democrats.
The fact is even with the current subsidies a substantial number of Americans have either decided to pay the fine, or simply forego health coverage, which have left the exchanges with a much higher percentage of clients who require healthcare, and an insufficient number of healthy individuals to offset the medical costs resulting in the insurance companies incurring huge losses and abandoning the exchanges.
The final result may very well be the GOP claiming they were right along about the ACA's inevitable failure, which they can pin on the Democrats.
If we do move to a single-payer system, there must be some way to improve the bad aspects of such a system perhaps with private competition.
1
And just what are the "bad aspects?"
What are the bad aspects when compared to out current system? Just curious.
If any argument defined the absolute absurdity of elected government this is it.
The man we elected President has no intention of serving even communicating with the citizenry and to consider for even a moment he does is to live in a dreamworld totally divorced from reality.
Who among those preceding us and those to folloow has or will live a life free of sniffles and sneezes let alone more serious medical problems?
While the Secretary of Health and Human Services, as other of Mr Trump's Cabinet appointees, may be a decent human at some level he hasn't a clue of understanding any people outside his gated mind for if so he would never have been appointed.
This administration and most of our elected officials do not in any way give a hoot about the great unwashed who elected them and to think otherwise indicates some form of kool-aid may have been passed around at their rallies.
Unfortunately this is not the joke I make it out to be it is a dead serious attack on our values promoted as alternate reality, a misuse of words which makes absolutely no sense at all.
We have elected a pack of wolves and the finest woolens cannot hide the increasingly bloodied teeth devouring what was once considered a civilized nation.
I truly fear for our children.
The man we elected President has no intention of serving even communicating with the citizenry and to consider for even a moment he does is to live in a dreamworld totally divorced from reality.
Who among those preceding us and those to folloow has or will live a life free of sniffles and sneezes let alone more serious medical problems?
While the Secretary of Health and Human Services, as other of Mr Trump's Cabinet appointees, may be a decent human at some level he hasn't a clue of understanding any people outside his gated mind for if so he would never have been appointed.
This administration and most of our elected officials do not in any way give a hoot about the great unwashed who elected them and to think otherwise indicates some form of kool-aid may have been passed around at their rallies.
Unfortunately this is not the joke I make it out to be it is a dead serious attack on our values promoted as alternate reality, a misuse of words which makes absolutely no sense at all.
We have elected a pack of wolves and the finest woolens cannot hide the increasingly bloodied teeth devouring what was once considered a civilized nation.
I truly fear for our children.
4
It'll be ironic if Republicans went for a one payer system which was what President Obama really wanted. But that would be wishful thinking. Can you ever see Republicans do what is right for the man on the street? For now, single payer health care is just a pot of gold at the end of the rainbow.
The red state and DJT voters have got to be among the dumbest people on earth - they pronounce "No Government" when they are the ones using the majority of govt. services. Its like the aristocracy in 1789 france shouting "Off with our heads".
4
Healthcare for all Part 3
• Any citizen who cannot afford insurance will get one of the policies paid for by our more affluent citizens depending on their need.
• Quasi citizens are currently illegal immigrants. They will need to sign up for health insurance. If they cannot afford insurance they get one of the policies paid for by our more affluent citizens depending on their need. Also, they must learn the English language and become citizens within 10 years. During this time they cannot be deported. After 10 years if they are not citizens, they can be deported. All new illegal immigrants will be deported to their country of origin after they are photographed and finger printed. When they are illegal immigrants 3 times, they can never legally immigrate to this country. Anyone employing or harboring an illegal immigrant will face a fine of $5,000 and 5 years in prison with no parole.
• Any citizen who cannot afford insurance will get one of the policies paid for by our more affluent citizens depending on their need.
• Quasi citizens are currently illegal immigrants. They will need to sign up for health insurance. If they cannot afford insurance they get one of the policies paid for by our more affluent citizens depending on their need. Also, they must learn the English language and become citizens within 10 years. During this time they cannot be deported. After 10 years if they are not citizens, they can be deported. All new illegal immigrants will be deported to their country of origin after they are photographed and finger printed. When they are illegal immigrants 3 times, they can never legally immigrate to this country. Anyone employing or harboring an illegal immigrant will face a fine of $5,000 and 5 years in prison with no parole.
Insurance companies had a cash cow: charging whatever they could extract from employers and insureds, cutting reimbursements to health care providers, terminating coverage on the really ill, and using the profits for marketing and executive compensation. Obamacare imposed some limits on that--in particular by limiting underwriting profit (the difference between premiums and reimbursements) and prohibiting such terminations.
The insurance companies want it back. Hospitals, doctors, and pharmacists don't. These are the two battling interests--our Congress merely does the bidding of the highest bidder.
But we have a voice ourselves. What's particularly heartening is that we used that voice effectively to defeat Trump-Don't-Care. But don't expect single-payer to happen without strong support from the public.
The insurance companies want it back. Hospitals, doctors, and pharmacists don't. These are the two battling interests--our Congress merely does the bidding of the highest bidder.
But we have a voice ourselves. What's particularly heartening is that we used that voice effectively to defeat Trump-Don't-Care. But don't expect single-payer to happen without strong support from the public.
1
• Healthcare for all Part 2
Everyone that has a gross income of $250,000 will also fund one insurance plan one level above catastrophic. For each additional $100,000 an additional one half the cost of one insurance plan one level above catastrophic will be funded.
250k-1 350k-1.5 450k-2 550k-2.5 650k-3 750k-3.5 850k-4 950k-4.5 1M-5 1.1M-5.5 1.2M-6 1.3M-6.5 1.4M-7 1.5M-7.5 1.6M-8 1.7M8.5 1.8M-9 1.9M-9.5 2M-10 3M-15 4M-20 5M and above for each 100K will fund one plan from the middle to Cadillac. 1B and above for each 100K will fund 100 plans from one step above catastrophic to Cadillac.
This will be scored by the OMB and if not enough policies for the needy are generated OMB will adjust the number of policies starting from top down (multi billions to 250k).
• When this goes into effect all other health insurance plans are void and are not allowed. This includes private, business provided and government plans. Since the government is no longer providing health insurance the amount of money the previous year that was used to pay for it now goes to paying down the national debt until it is paid off. Then an emergency fund will be built up with this money. The amount to be determined by congress. Once the debt is paid off, the country will run on a balanced budget except for emergencies or war. Then a tax cut can be given.
Everyone that has a gross income of $250,000 will also fund one insurance plan one level above catastrophic. For each additional $100,000 an additional one half the cost of one insurance plan one level above catastrophic will be funded.
250k-1 350k-1.5 450k-2 550k-2.5 650k-3 750k-3.5 850k-4 950k-4.5 1M-5 1.1M-5.5 1.2M-6 1.3M-6.5 1.4M-7 1.5M-7.5 1.6M-8 1.7M8.5 1.8M-9 1.9M-9.5 2M-10 3M-15 4M-20 5M and above for each 100K will fund one plan from the middle to Cadillac. 1B and above for each 100K will fund 100 plans from one step above catastrophic to Cadillac.
This will be scored by the OMB and if not enough policies for the needy are generated OMB will adjust the number of policies starting from top down (multi billions to 250k).
• When this goes into effect all other health insurance plans are void and are not allowed. This includes private, business provided and government plans. Since the government is no longer providing health insurance the amount of money the previous year that was used to pay for it now goes to paying down the national debt until it is paid off. Then an emergency fund will be built up with this money. The amount to be determined by congress. Once the debt is paid off, the country will run on a balanced budget except for emergencies or war. Then a tax cut can be given.
Health Care for All Part 1
• Everyone in the country is covered and is in this system. This includes the President and VP, Congress, Supreme Court, all government employees, the military, citizens and quasi citizens (discussed later). With everyone in the system the price of health insurance should be reasonable. Citizens can join groups and negotiate better prices.
• A range of policies will be available from catastrophic to Cadillac with several in between. The plans will cover 100% of the procedures included in that plan in full. There will be a review board for disputes. Pricing will be developed and a fair profit will be allowed for providers to insure solvency. Price gouging will be a criminal offence and is punishable by a fine of 25% of the previous year’s profits and all officers of the company spend a minimum of 1 year in prison.
• When income taxes are done, the first item will be to select your level of insurance. The cost is added to your tax bill. This amount will go to a special account to pay providers. Congress is barred by law from having access to this money. The level of insurance can be changed every 3 years. New insurance companies can join the system yearly. Babies are automatically covered at their parent’s level and the cost is to be paid to the insurance company within three months.
• Everyone in the country is covered and is in this system. This includes the President and VP, Congress, Supreme Court, all government employees, the military, citizens and quasi citizens (discussed later). With everyone in the system the price of health insurance should be reasonable. Citizens can join groups and negotiate better prices.
• A range of policies will be available from catastrophic to Cadillac with several in between. The plans will cover 100% of the procedures included in that plan in full. There will be a review board for disputes. Pricing will be developed and a fair profit will be allowed for providers to insure solvency. Price gouging will be a criminal offence and is punishable by a fine of 25% of the previous year’s profits and all officers of the company spend a minimum of 1 year in prison.
• When income taxes are done, the first item will be to select your level of insurance. The cost is added to your tax bill. This amount will go to a special account to pay providers. Congress is barred by law from having access to this money. The level of insurance can be changed every 3 years. New insurance companies can join the system yearly. Babies are automatically covered at their parent’s level and the cost is to be paid to the insurance company within three months.
1
It seems YOU are the one that is not listening and what has the old Soviet Union got to do with anything? Time and again it has been explained very clearly that compared to the other Western Industrialized DEMOCRACIES that have single-payer coverage in one form or another the U.S. has the most expensive health care in the world with the poorest outcomes. How much clearer can that be?
By the way, forget about Part 2.
By the way, forget about Part 2.
4
How many people today remember the Soviet Union? And what does it have to do with reforming US healthcare? A lot. Because US healthcare is a mirror image of a Soviet-style economy.
The Soviet people got fed up with endless queues for shoddy goods while the rich got the cream. Americans, too are fed up, and for similar reasons. Our health care system is unaffordable because it isn't actually designed to deliver health care. It's really just a complicated means of transferring wealth from the many payers at the bottom to the top 10%: specialist doctors, hospital administrators, manufacturers of drugs and medical equipment, and on and on.
And not just an income transfer system in the guise of health care. It's also unaccountable and corrupt. Like the Soviet system.
And here's where all you readers who want single payer and medicare for all should stick your fingers in your ears and start jumping up and down, screaming, "I'm not listening." Because the reason that the Soviet economy collapsed (and Cuba is stuck, and China is headed for a crack-up) is that they turned their back on markets.
My point is that unless we include markets in the design of our health system, we'll be left with a rigid, rule-bound, wasteful bureaucracy - like now.
Reforming US healthcare will therefore be like using "glasnost" and "perestroika." Truth and reform. It won't be easy, and it will involve markets.
You can take your fingers out of your ears now.
The Soviet people got fed up with endless queues for shoddy goods while the rich got the cream. Americans, too are fed up, and for similar reasons. Our health care system is unaffordable because it isn't actually designed to deliver health care. It's really just a complicated means of transferring wealth from the many payers at the bottom to the top 10%: specialist doctors, hospital administrators, manufacturers of drugs and medical equipment, and on and on.
And not just an income transfer system in the guise of health care. It's also unaccountable and corrupt. Like the Soviet system.
And here's where all you readers who want single payer and medicare for all should stick your fingers in your ears and start jumping up and down, screaming, "I'm not listening." Because the reason that the Soviet economy collapsed (and Cuba is stuck, and China is headed for a crack-up) is that they turned their back on markets.
My point is that unless we include markets in the design of our health system, we'll be left with a rigid, rule-bound, wasteful bureaucracy - like now.
Reforming US healthcare will therefore be like using "glasnost" and "perestroika." Truth and reform. It won't be easy, and it will involve markets.
You can take your fingers out of your ears now.
Royce Street (Seattle)
Your analogy is ridiculous. Word salad utilizing a far fetched "Red" herring.
Contrary to current sociopathic Executive Branch ideology, all aspects of nationhood are not "better" as private enterprises.
Medical Care is a Right of Citizenship. An overwhelming majority of Americans have voiced that - and loudly.
Please read the article that you commented on.
Then get back to us.
Your analogy is ridiculous. Word salad utilizing a far fetched "Red" herring.
Contrary to current sociopathic Executive Branch ideology, all aspects of nationhood are not "better" as private enterprises.
Medical Care is a Right of Citizenship. An overwhelming majority of Americans have voiced that - and loudly.
Please read the article that you commented on.
Then get back to us.
3
The free market works. The medical sector of our economy competes with all the other sectors of the economy for as much of the economic pie as it can get. Because of the unique necessity of what it provides, the medical sector has been a big winner and will continue to be one as long as free market competition determines the size of our economy's sectors. If people die from lack of medical care, the medical sector sees this as an opportunity to force further growth of its jobs and profits -- an opportunity that would be lost if everyone got medical care.
Our free market includes buying government policies that benefit one company, industry or sector against others. These benefits are bought with political contributions and the marketing of appropriate ideologies (including supporting appropriate religions and churches). The free market thus includes buying and pursuing policies (such as mergers) that reduce or eliminate competition and the free market and replace it with oligarchy or kleptocracy. Without forces that are external and artificial from its point of view, a free market naturally morphs into something else in a cycle that resembles the cycle of government types sketched by Aristotle. New technologies and military conquest will disrupt this cycle, and governments also do so occasionally, as in Japan or our antitrust laws.
Our free market includes buying government policies that benefit one company, industry or sector against others. These benefits are bought with political contributions and the marketing of appropriate ideologies (including supporting appropriate religions and churches). The free market thus includes buying and pursuing policies (such as mergers) that reduce or eliminate competition and the free market and replace it with oligarchy or kleptocracy. Without forces that are external and artificial from its point of view, a free market naturally morphs into something else in a cycle that resembles the cycle of government types sketched by Aristotle. New technologies and military conquest will disrupt this cycle, and governments also do so occasionally, as in Japan or our antitrust laws.
Single payer works in almost every developed country. Why re-invent the wheel? I agree that sooner or later we will have single payer simply because it works, our current system does not entirely work and, far worse, the recently draconian Ryan system would not work in spades. Switzerland is one country that has private insurance, but everyone is insured. The Philippines has private insurance but the uninsured must pay up front or be denied care. You cannot leave people uninsured and expect hospitals to treat them for free. Someone needs to pay. I don't believe that Americans have a taste for kicking the sick out into the street. Hence single payer.
3
Only three nations have single payer. Canada is one. I believe Japan and Taiwan are the others. NO NATION IN EUROPE HAS SINGLE PAYER.
We cannot have an intelligent discussion on this subject, when PHYSICIANS like yourself do not even know this. Switzerland has private, mandatory insurance BUT it is non-profit and strictly regulated.
What is sad is an educated, otherwise intelligent DOCTOR who does not know the definition of "single payer". Hint: it does not mean "free".
We cannot have an intelligent discussion on this subject, when PHYSICIANS like yourself do not even know this. Switzerland has private, mandatory insurance BUT it is non-profit and strictly regulated.
What is sad is an educated, otherwise intelligent DOCTOR who does not know the definition of "single payer". Hint: it does not mean "free".
1
I will read further. To me what is important is that everyone be covered. I did some work in England. Not sure how you define single payer, but National Health, I believe is available to all. The professor I worked with received only tertiary referrals under National Health, but also had a Harley Street office where those wiling to pay high fees could be seen outside of National Health with no referral from anyone. Under any system, the truly wealthy will pay to get more-- they don't matter. The problem is to provide a system that does not exclude people at the other end economically.
3
Mr. Leonhardt, Single-payer is NOT socialized medicine. I'm surprised you don't make that distinction clear.
5
I have some Republican/supply-side friends whose main screeches about single payer or a "public option" as an alternative are: 1) the government employees will mismanage it all into chaos, 2) you will not be able to get whatever drug/test/service you want when you want it, because like the NHS or Canadian Medicare, they will decide for you. What is happening now, and will only get worse, is that your insurance company (even if you are insured through your job or your spouse's job) will be the one to tell you that you cannot have that drug/test/service unless you want to pay $$$$ for it yourself -- because it is too expensive. I think some people who have never had a claim turned down will now be facing that, even from their private/employer-provided insurance. We have let the foxes run the henhouse for so long that they've driven up the costs to astronomical levels in order to pad their profits and keep their stock prices soaring. Either you will pay out of pocket or you will pay in higher taxes, but you will pay.
5
All the recent navel gazing, including this column, about Trumpcare's failure speculates on some of the things the gov't could do to destroy the ACA. None mentions that the IRS, per Trump executive order, ALREADY is no longer enforcing the ACA mandate for citizens to buy insurance.
http://www.insurancejournal.com/news/national/2017/02/16/442006.htm
News about this came out last month, but the reporting has been very scanty. So, I have 2 questions: 1) How will the ACA exchanges survive if the mandate is not being enforced? 2) How was it legal for Trump to repeal an essential provision of the ACA by executive order? Wouldn't this have to be undone by legislation? I hope the Times examines this further.
http://www.insurancejournal.com/news/national/2017/02/16/442006.htm
News about this came out last month, but the reporting has been very scanty. So, I have 2 questions: 1) How will the ACA exchanges survive if the mandate is not being enforced? 2) How was it legal for Trump to repeal an essential provision of the ACA by executive order? Wouldn't this have to be undone by legislation? I hope the Times examines this further.
1
I am a person who is independent but voted republican in the last election. When you say Medicaid works well at the end of your missive, you lost me. Medicaid typically pays physicians BELOW their cost which is passed on to others, this is not viable in the long run as the numbers of people on Medicaid explode. Should we not pay the same for Medicaid and Medicare? after all, are poor people worth less than old people? I say we have just one fee schedule for both.
2
Theodore Roosevelt was the first American President to call for national healthcare. The Republicans are elephants in all but their memories! Where is TR now that we need him?
4
Paul Ryan has reversed his Friday position that the ACA will remain the law to insisting the GOP House is readying itself to pass a bill to replace the ACA. I had thought that what happened last week was not the worst outcome for the GOP, because the worst outcome would be passage of a bill that demonstrated exactly how cruel and damaging such a bill that satisfied the Freedom Caucus would be. Perhaps Ryan et al realize that they can't "move on" from repeal and replace because it was their signature mantra for seven years. Who knows? But approving a bill that is predicated on "access" rather than the ability to obtain insurance that the ACA offers is a greater validation of the ACA than anything the Democrats have accomplished. 17% of those polled approved of what the House had concocted and less than 40% of Americans think Trump is doing a good job. Let's pass that bill and see where those numbers go!
H.R.676 Bill for single payor system before Congress many times without any progress. Never mentioned- just the vagaries of "single payor" with construction. 676 needs work but is doable - a Medicare buy in would be a start.
Legislators have little knowledge of how the healthcare industry works- after all their Medical Plan is Platinum not like the rest of us.
As to Tom Price-a shill for Big Pharma-no good will come from him.
Legislators have little knowledge of how the healthcare industry works- after all their Medical Plan is Platinum not like the rest of us.
As to Tom Price-a shill for Big Pharma-no good will come from him.
2
I simply do not understand why American politicians of ANY party cannot come out publicly and support single-payer health plans? Most of the Western World has been doing so for years, and doing it successfully. Can we not learn something from them?
7
I can see how the free market can take care of everyone's health care without intervention by government. If cancer treatment is more expensive, there will be less demand for cancer. If you cannot afford to get treatment for your heart attack, you will not go out and get a heart attack. If you can't afford to pay for being hit by a bus, then being hit by a bus will be less popular. Yes, the Invisible Hand of the Marketplace will take care of all of us, and only the rich will want to have cancer, heart attacks, or be hit by a bus.
8
An interesting and encouraging article but ultimately disappointing when one gets to the "in the long run" part. As everyone knows by now, I think, in the long run we will all be dead.
1
Well if republicans do choose single payer, when they get finished with their caveats it will be unrecognizable from the single payer other countries have. These malevolent tricksters will not do anything unless it adds more money to the rich man's coffers and takes that money out of the average citizen's pocket.
2
Wishful thinking. There's too much power in the over inflated insurance industry to get to a 'single payer' approach. So much to un-do. So many jobs will be lost.
I badly want it, but with the corruption in our political system (they don't really represent the people; just the big business $$), I don't see it happening in my lifetime. Just trying to be a realist.
I badly want it, but with the corruption in our political system (they don't really represent the people; just the big business $$), I don't see it happening in my lifetime. Just trying to be a realist.
2
I cried when I read this article; I have been waiting a lifetime to see Medicare become available to everyone in the U.S. I am 74. I hope I will live to see it.
4
I hope you live to se it too!
2
First off, they should allow Medicare and Social Security to negotiate drug prices with Big Pharma and get drug prices down to sensible levels. The protectionist attitude of Republicans toward Big Pharma is the reason Americans pay the highest drug prices in the world.
7
Every member of Congress - or at least every Republican - and the president, and their families, should be denied health care until they come up with a single payer system that covers everyone.
Not health insurance - health care. No doctor visits, no drugs, nothing (except the emergency room).
Because that's what they want to deny millions of poor, elderly and disabled Americans. And millions of middle class Americans.
Make them live as they as force those without insurance to live. Let them worry about what to do if a family member needs medical care and can't get it. They deserve nothing more until they fix this national disgrace.
Not health insurance - health care. No doctor visits, no drugs, nothing (except the emergency room).
Because that's what they want to deny millions of poor, elderly and disabled Americans. And millions of middle class Americans.
Make them live as they as force those without insurance to live. Let them worry about what to do if a family member needs medical care and can't get it. They deserve nothing more until they fix this national disgrace.
7
Obamacare was kluged together ONLY because of Rep resistance. What followed is easy criticism about the complexity. Then there were states like Texas that elected to reject Federal money that would have fully pd for coverage of an addl one million Texans (100% for 3 yrs, 80% thereafter). Rejecting the money and denying coverage was considered ok for those conservative states because it was done via a nemesis - more Medicaid for more people (in this case, many who worked full time at minimum wage.
Now we hear minimization of Obamacare because it missed its target of the number of Americans who opted into the program. It was easy to boobytrap Obamacare because States were given options of this kind.
Now we hear minimization of Obamacare because it missed its target of the number of Americans who opted into the program. It was easy to boobytrap Obamacare because States were given options of this kind.
3
I must reiterate that I have been saying for months or maybe longer, that the insurance companies will be the ones who will demand universal coverage. Republican subterfuge will force them to abandon the "market" forcing the government to take over the insurance county by county via Medicare, Medicaid, or some other name, like, let's say Medicall, Medical care for all. Canadians, English, French, Germans, Irish, Scandinavians, Scots, and southern Europeans, Like Italians, Spaniards, etc., etc., etc. have Universal, government guaranteed health care. Why can't we?
3
We are much larger than any one of those nations -- we have a much, much larger underclass of very poor minorities and rural folks -- we have to pay out of OUR pockets to defend the rest of them militarily and they don't contribute a fair share of this HUGE cost -- and we have open borders, and massive illegal immigration and liberals demand we give free care to illegal alien criminals and their anchor babies.
That's why.
That's why.
1
Hopefully, any legislative progress towards more effective national healthcare will be bipartisan. That is the good news bad the bad news. It is more likely for the changes to be responsive to people's actual needs across the socioeconomic spectrum with bipartisan sponsorship. On the other hand, Trump may try to take responsibility for the program if something finally 'gets done' on his watch. This will encourage the lunatic, fanatical Trump voters to re-elect him. After all, Trump turned a billion dollar business loss into a 'get out of paying taxes' card. The best interests of the people and the self promotion of Donald Trump should not be conflated. The Democrats should proceed with caution and conviction. Perhaps letting Trump destroy himself is the surest way of being rid of him. If he allows the death of Obamacare via a thousand cuts there is no reason to work with him at all. His pound of flesh will be paid at the polls. He will be at his seductive best in engaging the Democrats over the next few months. What we've seen, so far, is all that we'll get from this administration.
There is another possible way that single payer could come, and it could come must faster than projected by Mr. Leonhardt, who would have us waiting until Democrats take over again.
President Trump is not a conservative, and he is probably a RINO (Republican in name only). At least one of his close advisers is urging him to support a single payer (improved Medicare For All) program. Since Trump is a world class opportunist, he may well recognize that there is a real opportunity here for him. Democrats would be (I would hope) quite willing to cooperate if he came out for single payer, and he ought to be able to drag enough moderate Republicans along to make the deal.
Signs are promising, since there is more talk of collaborating with Democrats and coalitions.
A great way to promote public interest and focus the national attention would be for Trump to invite Bernie Sanders to the White House and for them to make a joint statement. Surely a decent single payer system would be very much in the interest of many Sanders and many Trump supporters.
President Trump is not a conservative, and he is probably a RINO (Republican in name only). At least one of his close advisers is urging him to support a single payer (improved Medicare For All) program. Since Trump is a world class opportunist, he may well recognize that there is a real opportunity here for him. Democrats would be (I would hope) quite willing to cooperate if he came out for single payer, and he ought to be able to drag enough moderate Republicans along to make the deal.
Signs are promising, since there is more talk of collaborating with Democrats and coalitions.
A great way to promote public interest and focus the national attention would be for Trump to invite Bernie Sanders to the White House and for them to make a joint statement. Surely a decent single payer system would be very much in the interest of many Sanders and many Trump supporters.
8
Since public policy has become swamped by marketing & branding, it is mistake to refer to a national health insurance as ' socialized medicine.'
This has been the kiss of death for sound healthcare policy since Reagan the actor proclaimed Medicare a communist subversion.
The system of hospitals & doctors that medicare supports is not a government system, it is the same network of care that for-profit insurance supports.
Medicare-for-All simply means that everyone chips in- sliding scale- so there is solvency. As with all capitalist insurance (auto, home, life)- the risk pool must include those who do not use it. This is basic economic reality.
The advantage of medicare-for-All is cost control, low overhead, maximum efficiencies of payment.
Fears of governement intrusion on healthcare decisions are foolish since they ignore the 30 years of horrendous intrusion by Managed Care. Intermediaries denied coverage, redefined benefits, and disrupted care solely to reduce insurance pay out. 'Medical necessity' was eliminated as a basis for coverage.
Under the market driven Managed Care system, premiums went up 200% - quality undermined and services reduced.
If anyone thinks the troubles began with ACA, they are ignorant of reality.
This has been the kiss of death for sound healthcare policy since Reagan the actor proclaimed Medicare a communist subversion.
The system of hospitals & doctors that medicare supports is not a government system, it is the same network of care that for-profit insurance supports.
Medicare-for-All simply means that everyone chips in- sliding scale- so there is solvency. As with all capitalist insurance (auto, home, life)- the risk pool must include those who do not use it. This is basic economic reality.
The advantage of medicare-for-All is cost control, low overhead, maximum efficiencies of payment.
Fears of governement intrusion on healthcare decisions are foolish since they ignore the 30 years of horrendous intrusion by Managed Care. Intermediaries denied coverage, redefined benefits, and disrupted care solely to reduce insurance pay out. 'Medical necessity' was eliminated as a basis for coverage.
Under the market driven Managed Care system, premiums went up 200% - quality undermined and services reduced.
If anyone thinks the troubles began with ACA, they are ignorant of reality.
2
There is no way the private sector can profitably and efficiently provide affordable universal health care.
The reason can be summed up in one word that economists are quite familiar with: externalities (Google it!).
A private insurance company expects, and rightly so, to make a profit. It receives premiums and pays out for medical and other operating expenses. The problem is that all of its income comes from premiums. Therefore, to make a profit it has to charge very high premiums (not affordable), and/or limit benefits through exclusions, preconditions, deductibles, copays, etc. (not universal), or a combination of both.
When a person gets well, that person can work at a job, make money, purchase goods and services, which create jobs, and pay taxes. But no part of those benefits accrues to the private sector insurance company. They all accrue to the state or to society in general. Thus, a public sector insurer can “profitably” afford to charge lower premiums than a private insurer, or even not charge any premiums at all.
It is not possible to have private-sector health care that is both affordable and universal. It will either not be universal or not be affordable.
The reason can be summed up in one word that economists are quite familiar with: externalities (Google it!).
A private insurance company expects, and rightly so, to make a profit. It receives premiums and pays out for medical and other operating expenses. The problem is that all of its income comes from premiums. Therefore, to make a profit it has to charge very high premiums (not affordable), and/or limit benefits through exclusions, preconditions, deductibles, copays, etc. (not universal), or a combination of both.
When a person gets well, that person can work at a job, make money, purchase goods and services, which create jobs, and pay taxes. But no part of those benefits accrues to the private sector insurance company. They all accrue to the state or to society in general. Thus, a public sector insurer can “profitably” afford to charge lower premiums than a private insurer, or even not charge any premiums at all.
It is not possible to have private-sector health care that is both affordable and universal. It will either not be universal or not be affordable.
2
The confounding of insurance with healthcare is a major source of problems in identifying the separation of government responsibility from the private sector. Insurance can be handled easily by either: in the private sector it's just a math problem of calculating the likelihood of an event and spreading the risk over those willing to share it.
Healthcare is a different matter and involves funding prevention, funding rehabilitation. supporting appropriate medical procedures, monitoring drug companies and all sorts of activities that have nothing to do with insurance and which the private sector has been shown again and again to be lousy at because a bottom-line business model is usually one that short-changes the public.
Of course, the present corporate-owned Congress is hardly the place to find a focus on healthcare, with its mantra of lower taxes, less regulation, fewer benefits, smaller government. This Congress also has the bottom-line mentality except when it comes to the 1/4%.
Healthcare is a different matter and involves funding prevention, funding rehabilitation. supporting appropriate medical procedures, monitoring drug companies and all sorts of activities that have nothing to do with insurance and which the private sector has been shown again and again to be lousy at because a bottom-line business model is usually one that short-changes the public.
Of course, the present corporate-owned Congress is hardly the place to find a focus on healthcare, with its mantra of lower taxes, less regulation, fewer benefits, smaller government. This Congress also has the bottom-line mentality except when it comes to the 1/4%.
1
The only thing we know for certain about The Donald's attitude towards government health care is that he's opposed to "Obamacare" because his predecessor's name is attached to it. If the ACA had been nicknamed "Reagancare" or even "Romneycare" he'd be fine with it. Perhaps he'll ultimately come to terms with the program and understand that it's actually helped many of the poor shnooks who voted for him. In which case, perhaps he could get the Democrats in Congress and a few sane people in his own Party to agree to a few tweaks here and there that would allow him to take credit for the whole thing. In which case perhaps we'll all be better off.
3
You know stu freeman you are quite right, as that´s how DJT sees the world - your name on stuff is all that counts, does not matter if its rotten construction or poor management. Maybe we the people can make a deal: We´ll pay for great big TRUMP letters on the White House fence in exchange for you Donald just leaving, with all your crazy friends and silly family... Then once he´s gone we can add the words - "he somehow got there then we kicked him out - beware of frauds"
2
Mr. Leonhardt writes
"But private markets in medical care tend to be more complicated and less successful.'
A look outside the US does not back this statement.
The highly rated Swiss and German Health care system are multi payer systems, based on competing not for profit companies (Krankenkasse) , that are regulated by the State, with contributions subsidized for the less well off.
The crucial difference of these successful systems to the ACA are i) not for profit health insurers and ii) very strict regulation.
"But private markets in medical care tend to be more complicated and less successful.'
A look outside the US does not back this statement.
The highly rated Swiss and German Health care system are multi payer systems, based on competing not for profit companies (Krankenkasse) , that are regulated by the State, with contributions subsidized for the less well off.
The crucial difference of these successful systems to the ACA are i) not for profit health insurers and ii) very strict regulation.
6
I think this is wishful thinking - the kind that Democrats have displayed too often. Yes, if Price undermines Obamacare it would look really bad to many people. But are those the people we really have to worry about? If Price can make Obamacare explode, I think there is a better than even chance that the GOP will be able to effectively lay the blame on Obama and the Democrats, at least with the vast majority of Republican voters. These voters don't read the NYT, they watch Fox News. Do you really think the reality will reach them?
1
Paying for universal health care for all Americans is a cost of being a member of the social compact. We all pay for police and fire departments and the judicial system. We all pay for the protection of our lives and property and our rights. We all pay for defense against foreign enemies. We all pay for the ill-advised wars we've entered since WWII. Some of us (myself included) pay more than most. That's fine with me. I'm a member in good standing of the social compact. Bring on universal health care.
19
Tom Price's investments should have kept him out of his current job. Someone will pick up where Baharra left off.
The private health insurance industry is essentially a bunch of competing casinos, gambling on their "covered lives." They don't obtain their 6-7 figure CEO salaries by being generous to those lives. No, the house always wins in the stacked game of health insurance that is funneling more and more money away from the workers in our country, while providing less and less in services.
Single-payer, preferably in the form of expanded Medicare, is the only ethical response to the havoc these insurers have wrought, and I frankly don't give a hoot how many of them lose their jobs.
The private health insurance industry is essentially a bunch of competing casinos, gambling on their "covered lives." They don't obtain their 6-7 figure CEO salaries by being generous to those lives. No, the house always wins in the stacked game of health insurance that is funneling more and more money away from the workers in our country, while providing less and less in services.
Single-payer, preferably in the form of expanded Medicare, is the only ethical response to the havoc these insurers have wrought, and I frankly don't give a hoot how many of them lose their jobs.
6
Insurance companies contribute nothing but lousy admin jobs - let them work elsewhere in something productive!
3
In 2008, when Barack Obama campaigned on the issue of health care, he defined the main problem as one of cost; health care's excessive and relentlessly growing share of the economy rendering it increasingly unaffordable. Getting coverage for the uninsured was considered a subsidiary problem that caused over use of expensive emergency room care and personal bankruptcies, although it was acknowledged that people were still getting services under EMTALA rules and charity care. In the debate over the ACA its defenders have focused on its partial success in increasing the number of covered individuals but it did little to address the cost problem. That issue remains obscured in public discourse but it will come back with a vengeance it there's a serious move toward a government-run single payer system. This is just scratching the surface of the questions that will arise, but who will decide how much income doctors can earn? Will hospitals still have a free hand in spending on beautiful but expensive construction and state-of-the-art equipment? Will patients continue to feel entitled to the best and most advanced treatments without regard to cost? We would like to think that there would be no government (read bean counter) interference but is that reasonable? To not intervene would be like allowing government employees to set their own salaries and to let government contractors set their own budgets. We will have to drastically cut cost, or drastically raise taxes.
3
It's unseemly that elected politicians, with their gold-plated health insurance guaranteed for life, would vote for lousy or nonexistent health insurance for those who voted for them.
4
Single payer is the way to go ... but we need to make sure it is adequately funded. We don't want it to become the illusory safety net that medicaid is. Doctors need to be adequately reimbursed, and the coverage provided needs to be at a level that would not drive a median wage earner to seek supplemental insurance. I'm not sure I trust anyone in our leadership in either party to come up with this. But it should be the goal.
And stop the pharma industry from pushing their latest snake oil to the public and to doctors. It is a waste of resources and undermines the doctor's best judgement.
And stop the pharma industry from pushing their latest snake oil to the public and to doctors. It is a waste of resources and undermines the doctor's best judgement.
7
Single payer is not necessarily socialized medicine. I wish the writer was more accurate in portraying what a single payer system means and does not mean. Single payer means there is one organization that pays for healthcare care. There are many variations across the global of how this is done. This can be gov't agency or a highly regulated private organization or some mixture. The key to single payer is that it negotiates with providers, drug companies and medical devise makers and due to that fact that it is the only customer in town (or the country) it is very powerful in getting prices down and lowering costs. Single payer does not mean that providers (hospitals, clinics, doctors, etc.) are owned on salary to the state. They can be private actors. In fact, this combination of gov't regulated single payer and private providers has worked extremely well in keeping cost low while providing quality care for all in many countries.
6
Very true, however, no matter how it is done, essentially, in pretty well all cases the insurance companies become a somewhat marginilized part of the system or as you describe in Switzerland kept under strict control. In a nutshell, in Canada the single-payer system is essentially a good basic plan which covers about three-quarters of all needs. It does not cover items like most dentistry and some pharmaceuticals. Insurance companies still operate in offering supplemental plans that can cover these un-served areas and in similar type employment benefit plans that will pick up that difference. All in all citizens do not have to worry about it. There are also a number of independent institutions that operate outside of the hospital system, i.e specialized types of surgeries and treatments that are still government funded, and can offer services like eye surgeries, hernias and other types. These also offer their services to out of country patients as well. At age 65, retirees, pay an annual 100 dollar upfront co-pay on all their drugs. After that pretty much everything is covered.
It was estimated that if a proper single payer system was implemented, the U.S. would be looking at a savings, over the next 10 years of approximately NINE TRILLION DOLLARS. America has been haggling about healthcare for over 60 years, it just takes the political will to do it. At present, the political will is STILL not there AND Citizens United, will not allow it.
It was estimated that if a proper single payer system was implemented, the U.S. would be looking at a savings, over the next 10 years of approximately NINE TRILLION DOLLARS. America has been haggling about healthcare for over 60 years, it just takes the political will to do it. At present, the political will is STILL not there AND Citizens United, will not allow it.
1
@Deus02: Canadian single payer does not pay for drugs AT ALL, except for patients in-hospital. You must pay out of pocket, or buy your own coverage for drugs. I have no idea what this costs! remember some people must take very costly drugs their whole lives, for specific medical conditions!
The Canadian government DOES negotiate with Big Pharma, and controls prices, which helps -- they pay about 1/3rd less than we do on most items -- but it is hardly free. I doubt it matters when you need a $20,000 a month arthritis drug that it is "only" $13,000 a month in Canada.
The Canadian government DOES negotiate with Big Pharma, and controls prices, which helps -- they pay about 1/3rd less than we do on most items -- but it is hardly free. I doubt it matters when you need a $20,000 a month arthritis drug that it is "only" $13,000 a month in Canada.
The US, with the crappiest healthcare in the developed world, prefers to lecture other countries like Germany, with a great health care system, on spending more money on weapons systems to bomb and drone the world to smithereens rather than cleaning up their own act.
Truly pathetic.
And nothing will change because Americans have been brainwashed and dumbed down for decades.
Freedom, free market, we are the greatest country on the face of the planet...
bla bla bla...
In the end, any new health care law will be intend to perpetuate the control of US health care by private, for-profit entities -- health insurance companies and large corporate heath care providers.
Truly pathetic.
And nothing will change because Americans have been brainwashed and dumbed down for decades.
Freedom, free market, we are the greatest country on the face of the planet...
bla bla bla...
In the end, any new health care law will be intend to perpetuate the control of US health care by private, for-profit entities -- health insurance companies and large corporate heath care providers.
11
David Leonhardt,
The US taxpayers are paying for most of the nation’s healthcare now. Local taxes create and support local free hospitals (ala our Harris County Hospital District taxes here in Houston, Texas) and free medical care for the poor that cannot otherwise afford medical care or have insurance.
I am a fiscal conservative, but I am now in favor of National Socialized healthcare, like the European “Nanny States,” rather than rely on local taxpayers to pay for US citizens and illegal immigrants without insurance.
Free Medical Care seems to now be considered to be a government taxpayer provided right, like Freedom of Speech and the right to life, liberty and the pursuit of happiness!
There are real limits to how much can the taxpayers afford to pay for any kind national taxpayer paid for healthcare in addition to other government activities before the US nation becomes bankrupt!
We could eliminate the costs of the Health Insurance Companies and all of their employees if the USA had National Socialized healthcare.
Government employees could be hired to limit and control the amount that is paid nationally by the government for medical care (Death Panels) at less cost that the insurance companies.
People wanting free medical treatment for sex change surgery, repeated drug overdoses, mental health issues, addictive drug treatment, cosmetic surgery, expensive experimental surgery, abortions, or fertilization treatments could pay for it themselves or not have it.
The US taxpayers are paying for most of the nation’s healthcare now. Local taxes create and support local free hospitals (ala our Harris County Hospital District taxes here in Houston, Texas) and free medical care for the poor that cannot otherwise afford medical care or have insurance.
I am a fiscal conservative, but I am now in favor of National Socialized healthcare, like the European “Nanny States,” rather than rely on local taxpayers to pay for US citizens and illegal immigrants without insurance.
Free Medical Care seems to now be considered to be a government taxpayer provided right, like Freedom of Speech and the right to life, liberty and the pursuit of happiness!
There are real limits to how much can the taxpayers afford to pay for any kind national taxpayer paid for healthcare in addition to other government activities before the US nation becomes bankrupt!
We could eliminate the costs of the Health Insurance Companies and all of their employees if the USA had National Socialized healthcare.
Government employees could be hired to limit and control the amount that is paid nationally by the government for medical care (Death Panels) at less cost that the insurance companies.
People wanting free medical treatment for sex change surgery, repeated drug overdoses, mental health issues, addictive drug treatment, cosmetic surgery, expensive experimental surgery, abortions, or fertilization treatments could pay for it themselves or not have it.
3
Mental health care is necessary and so is drug treatment. Abortions also need to be part of health care, and so does contraception.
2
Mental health issues are no different that having physical health issues.
When you are mentally ill, its not your doing. The mind is just as fragile as the body. It responds to the lack of certain chemicals the body can't produce.
Would you deny a diabetic insulin if the pancreas stop working?
Wake up and see those who are less fortunate than you, as just that.
When you are mentally ill, its not your doing. The mind is just as fragile as the body. It responds to the lack of certain chemicals the body can't produce.
Would you deny a diabetic insulin if the pancreas stop working?
Wake up and see those who are less fortunate than you, as just that.
3
nancy & Manderine: that is PRECISELY the issue that tripped up and destroyed HillaryCare in 1993. We could have had health reform 24 years ago! but she got greedy and pressured by the LIKES OF YOU, and she caved, and asked for unreasonable stuff, and the whole house of cards collapsed.
NO, you can't have everything you want! that is the first rule of adult life! To say you don't want universal health care, because it won't pay for abortion is stupid. Most women are not having abortions every year. It is (or should be) a rare lifetime event, and the cost is about $700 -- very moderate. It's an outpatient procedure. Better to exclude that -- and ALL the controversy from opponents of abortion -- than the STALL OUT on that one, small issue.
Likewise sex change surgery, drug addiction rehab (fails 90% of the time, so mostly useless), cosmetic surgery, fertilization treatment (really? with 7 BILLION people on the planet?). Get rid of that stuff, and you can really make changes. Get stuck on being "everything for everybody" and we will NEVER EVER EVER have universal health care in this country.
NO, you can't have everything you want! that is the first rule of adult life! To say you don't want universal health care, because it won't pay for abortion is stupid. Most women are not having abortions every year. It is (or should be) a rare lifetime event, and the cost is about $700 -- very moderate. It's an outpatient procedure. Better to exclude that -- and ALL the controversy from opponents of abortion -- than the STALL OUT on that one, small issue.
Likewise sex change surgery, drug addiction rehab (fails 90% of the time, so mostly useless), cosmetic surgery, fertilization treatment (really? with 7 BILLION people on the planet?). Get rid of that stuff, and you can really make changes. Get stuck on being "everything for everybody" and we will NEVER EVER EVER have universal health care in this country.
1
When I retired from the US Army Reserves after 38 years - click ! My check arrived without any hassle. When I turned 65 - click ! Medicare A - no hassles. When I retired from medical practice - click! Medicare B - no hassles. Social Security- click. ! Done no hassle. Dealing with private health insurance- tons of never ending red tape - appeals & grievances letters to write for my patients, etc. etc.
I'll take Medicare For All over our private non-system any day!
I'll take Medicare For All over our private non-system any day!
28
Why do I continue to look at photos of HHS Tom Price and think he looks like a gentleman undertaker?
3
But then what will we endlessly quarrel about? Trying to make for-profit government-subsidized private health insurance work is endless complicated. Single Payer? Not so much. It's either Yes or No. I vote Yes!
3
"So if voters like government-provided health care ...
This drives me crazy! The government provides health care FINANCING, not actual health care. when you are on Medicaid or Medicare or the plan that Congresspersons are, you dont' go see a doctor paid by the government which would be government provided health care. This is the same as saying the Russians hacked the election. No, they hacked email accounts. sheesh...
This drives me crazy! The government provides health care FINANCING, not actual health care. when you are on Medicaid or Medicare or the plan that Congresspersons are, you dont' go see a doctor paid by the government which would be government provided health care. This is the same as saying the Russians hacked the election. No, they hacked email accounts. sheesh...
4
That is correct, however, in removing the middle man, i.e the insurance companies, from the picture, the government can deal with the healthcare providers directly and in addition to funding hospitals, determine financing and procedures.
1
Private markets never lead to lower prices. It leads to less care, bigger percentage profits, and lower risks to insurance companies. Wake up. Medicaid is bare bones and admin costs for medicare are under 5% of dollars spent(that's even with insurance companies running them and still making really nice money), advantage plans admin costs are over 15%(think monster profits). Insurance companies are all about profits, government plans are about care and access. Take a couple steps away from the abyss.
4
Trump is something of a complexity-phobe as much as he is a germ-phobe and when he said a few weeks ago, "Nobody knew health care could be so complicated," it was dawning on him that this was something he didn't really want to touch. When he was then forced to, he tried to do it as quickly as possible, and right now he probably just wants to find a place to wash his hands.
It would be nice if his aversion to complexity could be harnessed as a force of good: The word 'single' in 'single-payer' might give him relief.
Unfortunately there is a large group of people in Limbaugh-land who also like to keep it simple, or have it kept simple for them, with the equation 'Single-payer' = Socialism = Next stop: the Gulag.' So getting to the simplicity of single-payer will not be simple.
It would be nice if his aversion to complexity could be harnessed as a force of good: The word 'single' in 'single-payer' might give him relief.
Unfortunately there is a large group of people in Limbaugh-land who also like to keep it simple, or have it kept simple for them, with the equation 'Single-payer' = Socialism = Next stop: the Gulag.' So getting to the simplicity of single-payer will not be simple.
2
Leonhardt calls single payer "socialized medicine." This kind of sloppy thinking we hear from many journalists trying to cover health care just creates an unnecessary barrier in peoples' minds. Maybe the NYT needs to assign him to a topic he knows something about. Single payer is "socialized insurance," it does not socialize the providers of care. The VA and local health department functions are the closest we have to "socialized medicine."
4
Yes, if Leonhardt insists on calling it that, I guess he better start naming the other government supported institutions, socialized fire and police departs, socialized medicare and social security, socialized armed forces, socialized road construction and infrastructure departments and the list goes on and on.
1
Some people shy away from calling it socialized medicine because the Republicans have conned a lot of them into thinking that socialism is a dirty word. Personally, I prefer socialism to republicanism. Take a look at all the happy Scandinavian countries with socialized medicine.
1
Single payer is the most conservative healthcare system if you are talking real conservative and the first commandment. If it ain't broke don't fix it. Over fifty years of experience tells us single payer delivers the most bang for the buck.
Unfortunately those calling themselves conservative are dogmatic neoliberals which is not an attitude but a religion and we are dealing with Jihadists a cult of neoliberal extremists.
The illogical hypothesis of the free market can do it better cannot be reconciled when there is no possible profit in insuring the sick and elderly and not mandating a pool of those who might opt out of insurance.
The inability of "Freedom Caucus" to deal with reality is a sure sign that the Republican Party has devolved from a party concerned with dealing with reality and the future into a religious cult complete with its own inviolate dogma.
Unfortunately those calling themselves conservative are dogmatic neoliberals which is not an attitude but a religion and we are dealing with Jihadists a cult of neoliberal extremists.
The illogical hypothesis of the free market can do it better cannot be reconciled when there is no possible profit in insuring the sick and elderly and not mandating a pool of those who might opt out of insurance.
The inability of "Freedom Caucus" to deal with reality is a sure sign that the Republican Party has devolved from a party concerned with dealing with reality and the future into a religious cult complete with its own inviolate dogma.
4
Moe:
You know as well as I do, that in America it is ALWAYS about the money. Americans have been haggling about what to do with healthcare for over 60 years without any real resolution and the reason for that is lobbyists and their enormous influence in Washington to maintain the status quo. Bernie Sanders proved that if you take the enormous influence of corporate money out of the picture, elect people who are committed in making the changes, it ultimately, can get done, like every other country with some form of single-payer healthcare system, it just takes the political will to do it.
At present, the big problem in America is Citizens United and billions in bribery that will not allow it.
You know as well as I do, that in America it is ALWAYS about the money. Americans have been haggling about what to do with healthcare for over 60 years without any real resolution and the reason for that is lobbyists and their enormous influence in Washington to maintain the status quo. Bernie Sanders proved that if you take the enormous influence of corporate money out of the picture, elect people who are committed in making the changes, it ultimately, can get done, like every other country with some form of single-payer healthcare system, it just takes the political will to do it.
At present, the big problem in America is Citizens United and billions in bribery that will not allow it.
2
Deus02,
I know it is all about the money but and this is a really big but my encounters with real American's tell me when they are allowed to speak the truth without fear of ridicule enough Americans are available to sweep elections if their lives might acquire some meaning.
It isn't 1992 it isn't about the economy it is about the meaning of life.
I know it is all about the money but and this is a really big but my encounters with real American's tell me when they are allowed to speak the truth without fear of ridicule enough Americans are available to sweep elections if their lives might acquire some meaning.
It isn't 1992 it isn't about the economy it is about the meaning of life.
1
The closest analogy to health-care that I can think of, are our municipal fire departments. A long time ago. in ancient Rome, fire suppression was actually a private industry (look up Marcus Licinius Crassus). If your home was on fire, you'd have to negotiate with the private fire company on a price for their services, while your home was burning. As you can imagine, you really wouldn't have much negotiating power in such a situation. Health-care needs are the same thing. The demand for both is involuntary (you would prefer not to have to buy it), coercive (if you need it, you must have it), and generally urgent, ranging from immediate to very soon. In these respects, the demand characteristics are completely different from those for almost any other goods or services, be they shoes or cars.
It was the Caesar Augustus who decided that the private model for fire-fighting wasn't working, and he started the world's first "socialized" fire department, called the Vigiles. So today, the "public option" is the only option. It's a good thing Augustus did what he did back then. Can you imagine the GOP starting municipal fire departments today? Constantly and mindlessly looking for a "market-based solution"?
It was the Caesar Augustus who decided that the private model for fire-fighting wasn't working, and he started the world's first "socialized" fire department, called the Vigiles. So today, the "public option" is the only option. It's a good thing Augustus did what he did back then. Can you imagine the GOP starting municipal fire departments today? Constantly and mindlessly looking for a "market-based solution"?
4
This a misleading opinion piece. . The normally responsible David Leonhardt is ends up with aan "on-the-one-hand/on-the-other- hand explanation of "single payer" This pepetuates g public misunderstanding of "single payer.". The phrase "government health care" the trope that the government is "running " health care. The operation of health care should be private and a ideally non-profit. Only the financing of health care, under a sngle payer system., would be public. With offhand descriptions such as "government health care," obfuscaties and confusieshe specifics of a "single-payer" health- cane financing system.
1
Yes, it is time to expand Medicare and Medicaid to cover more people. Otherwise, give me what Paul Ryan has. Why should our representative, who supposedly work for us, have better healthcare than most of their constituents? Either give American access to their healthcare exchange, or shut it down and give Congress what we have and let them tell us how great it is.
3
Every member of Congress, by law, must purchase their insurance ON THE EXCHANGES. They do not have any unique or special insurance. It's good coverage, but nothing that your mail man or any other Federal employee does not also have.
It is a myth that Congress has some unique, gold-plated insurance just for themselves.
It is a myth that Congress has some unique, gold-plated insurance just for themselves.
Why is it that, post WWII, so many western countries developed single-payer systems for healthcare yet the United States did not? I was told recently that the U.S. was so economically flush at the time that it was easier to provide healthcare insurance through the workplace. Is this so?
So what we have now is a huge layer of government and corporate bureaucracy between U.S. citizens and their healthcare. The insurance companies benefit from conservative legislation and tax advantages. Healthcare is difficult to navigate even for outspoken individuals who know enough to question what doctors provide and insurers cover as options. This reinforces and derives from inequities in access and sustains distrust that many of our poor and minorities have for western medicine.
A well-regulated single-payer healthcare system would be more efficient, simpler, and more cost-effective for citizens, providers, and easier to manage at the government level, and would achieve better population health outcomes.
So what we have now is a huge layer of government and corporate bureaucracy between U.S. citizens and their healthcare. The insurance companies benefit from conservative legislation and tax advantages. Healthcare is difficult to navigate even for outspoken individuals who know enough to question what doctors provide and insurers cover as options. This reinforces and derives from inequities in access and sustains distrust that many of our poor and minorities have for western medicine.
A well-regulated single-payer healthcare system would be more efficient, simpler, and more cost-effective for citizens, providers, and easier to manage at the government level, and would achieve better population health outcomes.
1
Only three nations in the world have single payer. None of those are in Europe or Scandinavia.
If you don't even KNOW what single payer is, or who has it -- then it becomes hopeless to have any kind of meaningful discussion about health care reforms.
If you don't even KNOW what single payer is, or who has it -- then it becomes hopeless to have any kind of meaningful discussion about health care reforms.
"Passing major social legislation is fantastically difficult...." I agree.
Beyond vested interests and lobbies a major element that makes this so difficult is the individual citizen. Here is where racism comes into play as millions of us white citizens maintain a wrong-headed notion that benefits almost exclusively go to 'takers' which in their minds are people of color. I've seen and heard this in my own family and in my peers my entire life (I'm 70).
Racism is the issue that has been used for generations to divide and conquer the workers and people of our country, and is truer than ever as we've seen with the recent national election and Trump administration. Until we fix this, we're stuck.
Beyond vested interests and lobbies a major element that makes this so difficult is the individual citizen. Here is where racism comes into play as millions of us white citizens maintain a wrong-headed notion that benefits almost exclusively go to 'takers' which in their minds are people of color. I've seen and heard this in my own family and in my peers my entire life (I'm 70).
Racism is the issue that has been used for generations to divide and conquer the workers and people of our country, and is truer than ever as we've seen with the recent national election and Trump administration. Until we fix this, we're stuck.
2
Another alternative is to mandate that only non-profit corporations can sell health insurance. What we need is the best of both worlds: both the benefit from competition in a regulated marketplace and removal of the profit motive, so corporations are not profiting from people's pain and are not motivated to deny care to make more profits.
1
The argument that Obamacare is viable with a few tweaks is ridiculous, and naive, something will have to be done. The Single payer idea with one pool for all Americans makes the most sense, but only if it is set up and regulated outside of the government control. That means no taxation, no interference, no mandates.
The idea we the people can't have a public trust for Health care is absurd. Single payer was the Obama bait and switch, that's we he started while ending up with a bill written by the insurance industry, then forced through in a budget which shut the government down.
Two years the Democrats controlled both houses, plus the executive, but could not put a bill together until the lame duck session of congress after which the republicans regained the majority as a direct result.
Democrats, you do remember Obamacare was why you lost congress don't you?...thought not. In fact the democrats have lost seats in every federal election since including this last one, including the presidency.
Government run single payer is Europe, you may want to check the tax rate over there before you get on that wagon. Privately run single payer by the American people taking the form of a tax free trust, has always been the answer. Tax breaks for corporations, employers, and private citizens who donate to this fund would be good business for everyone, and would make premiums next to nothing for the majority of people. Private single payer from the American health trust, now!
The idea we the people can't have a public trust for Health care is absurd. Single payer was the Obama bait and switch, that's we he started while ending up with a bill written by the insurance industry, then forced through in a budget which shut the government down.
Two years the Democrats controlled both houses, plus the executive, but could not put a bill together until the lame duck session of congress after which the republicans regained the majority as a direct result.
Democrats, you do remember Obamacare was why you lost congress don't you?...thought not. In fact the democrats have lost seats in every federal election since including this last one, including the presidency.
Government run single payer is Europe, you may want to check the tax rate over there before you get on that wagon. Privately run single payer by the American people taking the form of a tax free trust, has always been the answer. Tax breaks for corporations, employers, and private citizens who donate to this fund would be good business for everyone, and would make premiums next to nothing for the majority of people. Private single payer from the American health trust, now!
1
amen! the only serious discussion of health care reform now is how best to get to single payer, supplemented by the equivalent of "medigap" policies.
we agree: expand medicaid for those earning up to 150% of the poverty levels; make medicare available for those age 50 and above--and allow medicare to negotiate drug costs and private reimbursement for nursing home care; and relegate private health insurance to offering "cadillac" coverage for the the wealthy, along with a "public option" for those "gap" policies.
we agree: expand medicaid for those earning up to 150% of the poverty levels; make medicare available for those age 50 and above--and allow medicare to negotiate drug costs and private reimbursement for nursing home care; and relegate private health insurance to offering "cadillac" coverage for the the wealthy, along with a "public option" for those "gap" policies.
3
It is disgraceful that Tom Price, a Physician from Georgia, the HHS Secretary, should be so callous as to engage in undermining the health of the nation by taking retrograde steps. What did Mr. Trump, who campaigned to make healthcare better for everybody, see in Price to offer him the job of the nation's healthcare system?
I think the thinking and rationale of the President, his Secretary of HHS, and Paul Ryan is not only perverse but shows a definite intent to misguide and defraud the public by offering a fraudulent healthcare plan.
Single payer has long been considered as the most efficient and cost effective system to provide healthcare insurance, the proof of which can be seen in the efficiency of Medicare. I would go further and suggest that health insurance premiums should be replaced with a healthcare tax and everybody should be covered for healthcare from birth to death by Medicare. One great advantage of that would be that employers' resources would be freed up to create more jobs.
I think the thinking and rationale of the President, his Secretary of HHS, and Paul Ryan is not only perverse but shows a definite intent to misguide and defraud the public by offering a fraudulent healthcare plan.
Single payer has long been considered as the most efficient and cost effective system to provide healthcare insurance, the proof of which can be seen in the efficiency of Medicare. I would go further and suggest that health insurance premiums should be replaced with a healthcare tax and everybody should be covered for healthcare from birth to death by Medicare. One great advantage of that would be that employers' resources would be freed up to create more jobs.
10
Any single payer ("Medicare for all!") will need to include options such as "Medicare Advantage" and "Medicare Supplement" plans through private insurance to fully satisfy the demands of consumers who can afford them. This will give the private sector some interest in supporting such a system. For political reasons, single payer will have to include a requirement that employers contribute a certain percentage of the cost for each employee so that people currently receiving health insurance benefits through their employers do not experience the move to single payer as a decrease in net wages.
Medicare for all is a great concept but Medicare, we must remember, is not free. I paid Medicare tax for my entire working career (45 years), once I retired, I pay monthly deductions from my social security check for medicare. Additionally, my medicare advantage plan is provided by my husbands former employer with modest co payments; I love it.
The medicare advantage plan provided by my former employer, as a retirement benefit, has exorbitant copayments and co insurance.
It would be great if every citizen could have Medicare, but some one has to pay quite a bit of money to assure that medicare for all has parity; please do not disrupt my insurance; I like the employer based medicare advantage plan that I currently have.
The medicare advantage plan provided by my former employer, as a retirement benefit, has exorbitant copayments and co insurance.
It would be great if every citizen could have Medicare, but some one has to pay quite a bit of money to assure that medicare for all has parity; please do not disrupt my insurance; I like the employer based medicare advantage plan that I currently have.
2
JRS:
What happens if your job goes away then? Employers whom have substantial healthcare plans have to get the money from somewhere and usually that will come in the form of reduction in salary increases or downsizing of employees. It is an enormous cost to them, it is not free either.
What happens if your job goes away then? Employers whom have substantial healthcare plans have to get the money from somewhere and usually that will come in the form of reduction in salary increases or downsizing of employees. It is an enormous cost to them, it is not free either.
1
Deus02
Nothing is guaranteed forever; my two independent pensions could go bankrupt leaving me financially insecure, social security could fail or be disrupted by crooked politicians and I am still uneasy about the long term solvency of medicare: it is all a CHANCE.
And you bet, the cost to previous employers is not nil, but it was PROMISED, so I took the CHANCE.
Nothing is guaranteed forever; my two independent pensions could go bankrupt leaving me financially insecure, social security could fail or be disrupted by crooked politicians and I am still uneasy about the long term solvency of medicare: it is all a CHANCE.
And you bet, the cost to previous employers is not nil, but it was PROMISED, so I took the CHANCE.
There's a good reason every other country has rejected "free market" health care: It doesn't work.
It can't work because of insurers' paramount obligation to shareholders. That means they must offer coverage only to those who don't need it, until they do need it. They must price usable, comprehensive coverage at unaffordable levels to cover risk, expenses (including entitled executive compensation), and the profit shareholders demand. Affordable plans must have such high deductibles and so many exclusions that they're worse than useless, as patients pay premiums for worthless insurance on top of the full cost of care. (Republicans call that "choice" and "freedom.")
The ACA's regulation, mandates and subsidies are the only way to make the "free market" work. Republicans object to it because Obama's name is on it; and donors resent taxes that redistribute their wealth to "takers." The latter reason is why Republicans even more vehemently oppose single-payer.
The individual market may be small now. But it will soon burgeon as corporate executives aggressively "unlock shareholder value" by replacing full-time employees and their benefits with "independent contractors." All those Uber drivers and task rabbits in the Brave New Gig Economy will need health care. That will ultimately force even Republicans to accept true universal health care. But for now, it's clear they're interested only in providing donors with generous wealth care.
It can't work because of insurers' paramount obligation to shareholders. That means they must offer coverage only to those who don't need it, until they do need it. They must price usable, comprehensive coverage at unaffordable levels to cover risk, expenses (including entitled executive compensation), and the profit shareholders demand. Affordable plans must have such high deductibles and so many exclusions that they're worse than useless, as patients pay premiums for worthless insurance on top of the full cost of care. (Republicans call that "choice" and "freedom.")
The ACA's regulation, mandates and subsidies are the only way to make the "free market" work. Republicans object to it because Obama's name is on it; and donors resent taxes that redistribute their wealth to "takers." The latter reason is why Republicans even more vehemently oppose single-payer.
The individual market may be small now. But it will soon burgeon as corporate executives aggressively "unlock shareholder value" by replacing full-time employees and their benefits with "independent contractors." All those Uber drivers and task rabbits in the Brave New Gig Economy will need health care. That will ultimately force even Republicans to accept true universal health care. But for now, it's clear they're interested only in providing donors with generous wealth care.
4
The current members of congress, both Republican and Democrat, would no doubt put together the world's worst single payer system. We need to clean house - ridding ourselves of the Prices and the Pelosis - before attempting real, meaningful health care reform.
1
In 2010, on the eve of the House vote on the A.C.A. Jon McCain said it best when he said "if this bill passes, it will never be repealed."
Because nobody EVER wants to give up "Freebies" and the ACA gave 13 million more people 100% FREE Medicaid welfare.
Look at the screaming and crying when the GOP even TALKED about changing the law -- the screamers and criers were all on 100% FREE Medicaid welfare.
Fully 1 American in FIVE gets 100% FREE Medicaid welfare -- a $14,000 a year "perk" that no working class or middle class American worker can ever dream of having -- no copays, no deductibles, NO PREMIUMS, nothing, not even a $1 co-pay.
Look at the screaming and crying when the GOP even TALKED about changing the law -- the screamers and criers were all on 100% FREE Medicaid welfare.
Fully 1 American in FIVE gets 100% FREE Medicaid welfare -- a $14,000 a year "perk" that no working class or middle class American worker can ever dream of having -- no copays, no deductibles, NO PREMIUMS, nothing, not even a $1 co-pay.
1
I agree with a previous post that the loaded phrase 'socialized medicine' needs to be removed from our discussions about this. I'll use Canada as an example - health care workers do not work for the government, so it's not the medicine that's socialized. It's the insurance that is 'socialized', there is only one insurance provider and it's the government. Who can argue with getting the for-profit insurance companies out of this equation? They add zero value to the system.
3
"Single payer" is not socialized medicine. The definition of socialized medicine is when the Government owns all of the medical facilities including the hospitals, all of the medical professionals (doctors, nurses, technicians, etc) are government employees and are paid by the government, and all of the medications are dispensed from government owned pharmacies.
"Single payer" is the same system as Medicare. All of the medical services are provided at non government facilities and by civilian professionals with prices for that healthcare negotiated by and paid for by the government (the taxpayer).
However, almost no one in this country seems to be aware that we already have a large system of socialized medicine in the US, it is called the Veterans Health Care System.
"Single payer" is the same system as Medicare. All of the medical services are provided at non government facilities and by civilian professionals with prices for that healthcare negotiated by and paid for by the government (the taxpayer).
However, almost no one in this country seems to be aware that we already have a large system of socialized medicine in the US, it is called the Veterans Health Care System.
4
Leave aside the morality issue for a moment, although I know that's important. Single-payer health-care has huge macro-economic advantages over what exists presently in the US, something that's lost on the ideologues within the GOP.
Right now, about 8% of US GDP is a dead loss. The US spends 17-18% of GDP on health-care, versus 9-10% in most other OECD countries. That's a huge amount of money that's being tossed down the rabbit hole every year, with no return whatsoever. It's even worse when compared to Singapore (5% of GDP), which is the gold-standard for both efficiency, and health outcomes. Single-payer would allow the government to finally impose badly-needed cost controls, and stop this phenomenal waste.
The GOP wants freedom? Single-payer gives you freedom. Freedom from worry, freedom to move wherever you please, and to do what you wish, without having to concern yourself with health-care coverage. You are always covered. From a macro-economic viewpoint, it allocates resources much more efficiently, since people don't have to stay in dead-end jobs just for the sake of health insurance.
Last but not least, it would free US businesses from the cost of managing and paying for employee health-care, thereby making them more competitive and allowing them to hire more people. The societal problem of health-care, goes back to society, the economy improves.
So what's not to like?
Right now, about 8% of US GDP is a dead loss. The US spends 17-18% of GDP on health-care, versus 9-10% in most other OECD countries. That's a huge amount of money that's being tossed down the rabbit hole every year, with no return whatsoever. It's even worse when compared to Singapore (5% of GDP), which is the gold-standard for both efficiency, and health outcomes. Single-payer would allow the government to finally impose badly-needed cost controls, and stop this phenomenal waste.
The GOP wants freedom? Single-payer gives you freedom. Freedom from worry, freedom to move wherever you please, and to do what you wish, without having to concern yourself with health-care coverage. You are always covered. From a macro-economic viewpoint, it allocates resources much more efficiently, since people don't have to stay in dead-end jobs just for the sake of health insurance.
Last but not least, it would free US businesses from the cost of managing and paying for employee health-care, thereby making them more competitive and allowing them to hire more people. The societal problem of health-care, goes back to society, the economy improves.
So what's not to like?
2
What's not to like? It makes the wealthy pay taxes that redistribute their entitled wealth to "takers." That's offensive to ideologues in the Party of the Rich, and particularly to their donors who resent any "Big Government" intrusion into what they do with their money.
More importantly, it's anathema to the executives of insurance companies, HMOs, and the rest of the unique American medical industry, who "earn" enormous entitled compensation by making their stocks the most attractive possible investment for Wall Street. Single-payer health care would require the destruction of a lucrative industry, or at least its demotion to a secondary role in benefit administration and possibly supplemental coverage. Those executives and their lobbyists will of course wisely "invest" whatever it takes in campaign donations to preserve their profitable positions.
The fact that we have an "American Exceptional" medical industry that puts profits first and patients last-- rather than the true health care system citizens of every other advanced country enjoy as a human right-- all comes down to money. And that's because we also have an "American Exceptional" (per)version of democracy whose hallowed principle is "One Dollar, One Vote."
Last year, voters in large numbers finally recognized that our "dollar democracy" is ignoring and impoverishing them. Unfortunately, they expressed that recognition by falling for Trump's fake populism.
More importantly, it's anathema to the executives of insurance companies, HMOs, and the rest of the unique American medical industry, who "earn" enormous entitled compensation by making their stocks the most attractive possible investment for Wall Street. Single-payer health care would require the destruction of a lucrative industry, or at least its demotion to a secondary role in benefit administration and possibly supplemental coverage. Those executives and their lobbyists will of course wisely "invest" whatever it takes in campaign donations to preserve their profitable positions.
The fact that we have an "American Exceptional" medical industry that puts profits first and patients last-- rather than the true health care system citizens of every other advanced country enjoy as a human right-- all comes down to money. And that's because we also have an "American Exceptional" (per)version of democracy whose hallowed principle is "One Dollar, One Vote."
Last year, voters in large numbers finally recognized that our "dollar democracy" is ignoring and impoverishing them. Unfortunately, they expressed that recognition by falling for Trump's fake populism.
1
The Insurance companies are responsible for most of the problems, and increased, unnecessary cost.
2
Let's just cover average Americans with the same healthcare available to members of Congress. If it's good enough for the employees, it's likely good enough for their employers.
5
Since the ACA took effect on 1/1/14, Congress and its staff have been required to take ACA Gold plans. By law. So they have Obamacare plans.
1
The only people who don't care about having health insurance are those who believe they are invincible and will not need healthcare or those who have the resources to pay regardless of the cost. The rest of us want and need health insurance that we can afford. This is probably the only political topic that my Republican neighbors and I can agree on now.
2
I hope your idea comes true, really-- but
Don't forget that originally about 19 states with Republican leadership resisted medicaid expansion in the ACA -- including Mike Pence as governor of Indiana. They wanted to frustrate President Obama but they also didn't value the health of their citizens, no matter how much they pontificated.
Also don't forget that insurance companies want to make lots of money and keep lots of money. They may complain that the ACA is broken but what they are actually saying is that they can't make enough profit from the illness of unfortunate people. How Republicans will get insurance companies to pull back form that position escapes me. one thing about the Geisinger health plan is that they didn't even pay their own hospital enough for services-- the insurance company wants to keep its money for itself. That's why we needed laws to Force insurance companies to pay for more than 24 hours hospitalization after child birth--remember that?
Also remember that premiums and deductibles are going up for everyone-- not just those purchasing insurance through the ACA.
Insurance companies and pharmaceutical companies are going to go for as much money as they can until someone makes them stop. Really stop and really mean it. like it happens in the rest of the world. Will that be Republicans? Do i still believe in miracles?
Don't forget that originally about 19 states with Republican leadership resisted medicaid expansion in the ACA -- including Mike Pence as governor of Indiana. They wanted to frustrate President Obama but they also didn't value the health of their citizens, no matter how much they pontificated.
Also don't forget that insurance companies want to make lots of money and keep lots of money. They may complain that the ACA is broken but what they are actually saying is that they can't make enough profit from the illness of unfortunate people. How Republicans will get insurance companies to pull back form that position escapes me. one thing about the Geisinger health plan is that they didn't even pay their own hospital enough for services-- the insurance company wants to keep its money for itself. That's why we needed laws to Force insurance companies to pay for more than 24 hours hospitalization after child birth--remember that?
Also remember that premiums and deductibles are going up for everyone-- not just those purchasing insurance through the ACA.
Insurance companies and pharmaceutical companies are going to go for as much money as they can until someone makes them stop. Really stop and really mean it. like it happens in the rest of the world. Will that be Republicans? Do i still believe in miracles?
2
This was reasonable editorial about single-payer, with one exception. Single-payer does not have to be socialized medicine, although it can be. England has a socialized single-payer system. Canada does not. Socialism means that the government owns and controls the means of production and distribution are owned by the government, and no one has proposed that the our implementation of single-payer would be socialism.
What we seem to forget is that when it comes to promoting the general welfare, we already have socialism in this country. That is why we have police and fire departments.
Single-payer has many benefits, including covering everybody, eliminating co-payments and deductibles, allowing individuals the freedom to choose any doctor or hospital, and eventually greatly reducing the cost of health care in this country. It is past time that we move to single-payer.
What we seem to forget is that when it comes to promoting the general welfare, we already have socialism in this country. That is why we have police and fire departments.
Single-payer has many benefits, including covering everybody, eliminating co-payments and deductibles, allowing individuals the freedom to choose any doctor or hospital, and eventually greatly reducing the cost of health care in this country. It is past time that we move to single-payer.
4
"Until then, the future of socialized medicine is in the hands of Dr. Tom Price."
And what mercenary hands those are!
And what mercenary hands those are!
1
What you are describing isn't "Socialized Medicine." The system would still be in private hands but bills are paid by the government. There would still a lucrative private market for "gap" plans. We could have it inplace in a year.
July 1948 the NHS was launched to provide Britons with health services that are available to alll at point of delivery:hospitals, doctors, nurses, pharma, dental, vision, therapists. The NHS is financed entirely by taxation.which means people pay into it according to their means. It's a co-op, in which we are all stakeholders. Tom Price is no Nye Beaven and Trump no Attlee, but by July 2018 the USA might be as war weary as GB was in 1948. our country's future depends on the good health of its people, regardless of their means.
2
How is the NHS doing? Look it up
1
Mr. Or Ms. Driven, I don't need to look up NHS because my family for 5 generations, starting with my grandparents , are the NHS. we have been stakeholders since 1948 and 4 of my young cousins are doctors. You can opt for private pay. we were brought into the world by NHS doctors and midwives and our doctors today make house calls to my 96 year-old uncle who still lives independently.
1
The irony - it's so rich. Just imagine eventually thanking the Republicans for single payer health care. Can irony really be that rich? Perhaps it can.
" Politics aside, private markets in many areas of the economy have substantive advantages over a government program. They create competition, which leads to innovation and lower prices". May be that is why US has the most expensive healthcare among developed nations? May be that is why drug prices are "N-times" more here in US than in Canada?
1
Perhaps nothing reveals the heartless greed driven psyches of the Cabal of super rich individuals who would rule our nation ad the act of turning the Human Right to be healthy, guaranteed by our Constitution as in the words "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness" into a for profit business.
Just the notion that I can make money off of your sickness or broken leg, or weak heart is disgusting. The entire insurance business is a heartless Racket Driven by intense greed and lust.
The fix is to do have all of the people take care of all of the people or a single payer thing. There should be absolutely zero profit from our needs for heath care. We do not need businessmen to run our health centers. We need lots and lots more doctors/nurses/care-givers who are paid decent wages and provided with everything they need to keep us all healthy.
Imagine getting rich as people get sick, the more the merrier.
Just the notion that I can make money off of your sickness or broken leg, or weak heart is disgusting. The entire insurance business is a heartless Racket Driven by intense greed and lust.
The fix is to do have all of the people take care of all of the people or a single payer thing. There should be absolutely zero profit from our needs for heath care. We do not need businessmen to run our health centers. We need lots and lots more doctors/nurses/care-givers who are paid decent wages and provided with everything they need to keep us all healthy.
Imagine getting rich as people get sick, the more the merrier.
2
No profit, no mission. Thousands and thousands of doctors, nurses, and techs expect to make a profit.
Its all smoke and mirrors and attempts at preserving the profits of the players. If we want Health care for all then one choice ,Single Payer. Its proven it works and we can afford it.
3
In the real world there are no simple problems, but there are also no complex solutions. Obamacare is very complex and difficult to defend from the death of a thousand cuts than can be inflicted during implementation. Medicare for all is the only relatively simple solution that can be defended from sophisticated denial of service attacks mounted using the procedural details in the fine print of implementation policies.
1
When I came to this country from Europe, health care was the worst cultural shock. My scientific training was no help. Totally lost, I just asked an expert who promptly put me in a plan that covered nothing. I discovered that at first illness. In Europe, we see health care as a right similar to equal protection under the law. We all scratch our head looking at a US system that is incomprehensible, cost twice as much and produces more misery and less life expectancy. Most of my friends here (TX) who are so incensed about "socialized medicine" are Medicare beneficiaries... I guess fox news propaganda is even better than I thought. Or is it our exceptionalism?
6
What Mr. Leonhardt is talking about is not socialized medicine. It is socialized medical insurance. Health care professionals have not failed the country. They have not victimized Americans. The villains are the Health Insurance industry. When they have been put out of business, I will applaud.........
2
I don't believe any party is happy spending 17% of our GDP on healthcare, no matter who is paying. Imagine what we could do with 5% of our GDP freed up with universal coverage using 12% of our GDP (like Germany, France, Canada). Republicans want to limit our GDP healthcare spend by limiting entry of poor unhealthy citizens that drive up costs and can't pay there way. Democrats (mostly) want to solve the problem by applying market forces and efficiencies of a single-payer system (monopsony) - negotiating fair prices for goods and services from hospitals, physicians and drug companies.
I thought the idea of the ACA was to make sure people who didn't have insurance because they didn't have the resources could now have insurance. We had a way of doing that through expansion of Medicaid and Medicare. Instead Obama chose a whole new bureaucracy. It was so inefficient that it took more time to set up a workable web site than it did for us to declare war, arm the military, fight a war, and win WW II . Obama wanted a program assigned to him. The Democrats were told by their leaders to vote for it and read it later. Obama should have given congress the time to read what they were voting for. If he had, flaws would have had time to flaws and correct them before the act had passed. Trump should have decided to push for acceptance and not immediate passage. He would be wise to invite democrates in and marginalize Cruz and his cronies all together. Cruz promised to end the ACA on day one and solve the Syrian problem by carpet bombing. Trump should remember he buried Cruz and his ideas for the nomination He should also keep his promises
2
We can thank Joe Lieberman for most of the problems with the ACA.
1
As Churchill said, "You can always count on Americans to do the right thing - after they've tried everything else."
2
There is no reality at all in the idea that Republicans will create a single payer health system. That is pure fiction. If it happens, expect to see flying pigs.
Now that we have everyone's attention, including those in DC, it is time to ACT,
The real root of the issue lies in the GOP right and those of the freedom caucus.
The vast MAJORITY of the electorate view healthcare as a basic human right. The GOP simply does not. Let's not waste time trying to convert them!
It's time to identify, by name, those that do not support universal or a single payer system and subject them to the same treatment that those seeking repeal and replace experienced.
This decision whether to move to single payer is no longer up to them or they will simply be removed from office.
The freedom caucus and those like them (think bannon) must be exposed for what they are and removed from positions of influence in our government.
I'm in!
Single Payer Now.
The real root of the issue lies in the GOP right and those of the freedom caucus.
The vast MAJORITY of the electorate view healthcare as a basic human right. The GOP simply does not. Let's not waste time trying to convert them!
It's time to identify, by name, those that do not support universal or a single payer system and subject them to the same treatment that those seeking repeal and replace experienced.
This decision whether to move to single payer is no longer up to them or they will simply be removed from office.
The freedom caucus and those like them (think bannon) must be exposed for what they are and removed from positions of influence in our government.
I'm in!
Single Payer Now.
1
It will be interesting to see what the insurance companies do. Less coverage is not a good long term position for them (they make money on the # of policies sold) and as this editorial says, the alternative may be to cut them out of the equation. Prescription drugs are a similar issue. If the push comes hard, they will have to charge the same thing they charge in the rest of the world.
It would be far better for both to expand the programs with an agreed upon discount for drugs. If I were the industry, it is better to negotiate now than later if we head toward a system that will simply regulate the cost and cut out the insurance industry.
It would be far better for both to expand the programs with an agreed upon discount for drugs. If I were the industry, it is better to negotiate now than later if we head toward a system that will simply regulate the cost and cut out the insurance industry.
Maybe Republicans fear that single-payer, universal health care would be a slippery slope to other things they oppose: turning minimum wage into a true living wage, fully funded public K-12 schools and universities, consumer protections against predatory lenders and retailers. I could add more to the list but you get the idea.
3
Healthcare "insurance" is a ludicrous concept. Insurance is best for covering random risks: your house might burn down, someone might crash into your car, someone might slip and fall in your business... and so on.
We all need health care. Some a little more, some a little less. Some need more earlier in life and we all need more later in life.
To manage health care within the traditional risk paradigm of insurance - meaning millions have no health insurance - costs society money. Uninsured go to the emergency room. Family's life savings are eaten up in expensive care for problems that might have been prevented or reduced with preventative care.
It goes on and on.
Maybe Trump doesn't care or maybe Trump - who didn't want to bother to learn the complexities of Health Care for himself - just believed what Price told him. He's paying, and we're paying, the price for that.
We all need health care. Some a little more, some a little less. Some need more earlier in life and we all need more later in life.
To manage health care within the traditional risk paradigm of insurance - meaning millions have no health insurance - costs society money. Uninsured go to the emergency room. Family's life savings are eaten up in expensive care for problems that might have been prevented or reduced with preventative care.
It goes on and on.
Maybe Trump doesn't care or maybe Trump - who didn't want to bother to learn the complexities of Health Care for himself - just believed what Price told him. He's paying, and we're paying, the price for that.
1
When it comes to government assisted marketplaces, there is a very attractive marketplace available to government employees. I was able to read about it at https://www.opm.gov/healthcare-insurance/healthcare/.
I think it would be worthwhile to open this market to all Americans who lack employer-sponsored insurance.
Finally, the penalties for not purchasing health insurance should be considerably higher; for example the median price of a “Bronze” plan in the area in which a taxpayer resides.
I think it would be worthwhile to open this market to all Americans who lack employer-sponsored insurance.
Finally, the penalties for not purchasing health insurance should be considerably higher; for example the median price of a “Bronze” plan in the area in which a taxpayer resides.
1
What what can we do when a corrupt Georgia Congressman can assume a cabinet job and bring about the dismissal of the prosecutor who was close behind him.
More disturbances from the IMPERIAL RUSSIAN COURT IN THE WHITE HOUSE.
More disturbances from the IMPERIAL RUSSIAN COURT IN THE WHITE HOUSE.
I know someone, an educated and capable Republican, on Medicare, who swears that Medicare "isn't socialized medicine, because we paid for it". I think it's because she likes her socialized medicine, and can't face up to the fact that it's "socialism".
1
Everyone should watch The Untold History of the United States - it covers many of the questions people have of why we don't have expanded health insurance now and why anyone who talks of socialized medicine or anything in that manner is considered "communists" for example. Why we are at where we are at today as a society. Raises many questions in addition to see how we've been conditioned over decades.
I don't get it. Why is Obamacare or Trumpcare called a health care plan. Shouldn't it be called a medical care plan? Or so, when did medicine become medication? Just a thought.
Yup. Obama Care is a bootlegged version of Romney Care in Massachusetts. It is the maximum amalgam of corporate misfeasance and government incompetence (is that one word or two?). Clearly the only way we can migrate from the classic business model to something that works is a version of single payer.
I am philosophically pro-capitalist, but I have relectantly concluded that some businesses, based on maximizing roi, simply do not work well. For example the delivery of clean drinking water. This has to be a utility. Likewise, the provision of adequate medical services also has to be organized along the lines of a utility. Perhaps the Republicans will move in this direction.
I am philosophically pro-capitalist, but I have relectantly concluded that some businesses, based on maximizing roi, simply do not work well. For example the delivery of clean drinking water. This has to be a utility. Likewise, the provision of adequate medical services also has to be organized along the lines of a utility. Perhaps the Republicans will move in this direction.
3
Bascally Leonhardt is right in the long run. The US is not going to turn the clock back to provide tax cuts for billionaires however much smoke Republicans try to blow. There 75 million people on Medicaid, 55 million on Medicare, 6 million using the VA, and 11 million purchasing subsidized insurance on the exchanges. So 147 million or almost the same number as the 150 million with employer provided insurance (which is also government subsidized).
2
What I can't figure out is why Republican's haven't figured out that a single payer (i.e. Socialized) healthcare system like Canada's would remove a significant competitive disadvantage to American business.
As things stand much of American business is forced to pay for the healthcare of their employees. A single payer system would transfer that cost to the public sector removing a significant burden of costs to America's business sector.
Of course it would increase personal taxes somewhat, but it would also eliminate the significant quasi tax of healthcare premiums from Americans. One way or the other, you are gonna pay. Why not make it the least costly burden for everybody?
I guess that's too rational for most Republican's. I can't figure out why.
As things stand much of American business is forced to pay for the healthcare of their employees. A single payer system would transfer that cost to the public sector removing a significant burden of costs to America's business sector.
Of course it would increase personal taxes somewhat, but it would also eliminate the significant quasi tax of healthcare premiums from Americans. One way or the other, you are gonna pay. Why not make it the least costly burden for everybody?
I guess that's too rational for most Republican's. I can't figure out why.
5
Please, single-payer is not the same thing as socialized medicine. Socialized medicine is where the government hires the doctors and pays them a salary. This is the system is England and also the VA. The Single Payer (e.g. Medicare) handles the money exchange (yes, and other things) between the patient and the doctor just like the insurance companies only the Single Payer does not take obscene profits as part of the process nor does the CEO make an obscene salary. Your health care dollar goes to providing health care and not dividends for wall street.
6
One suggestion: refer to the single payer plan as "government administered" and not "government provided." The later makes it sound like there are government doctors, as opposed to having a choice.
4
"The private markets are less safe."
They are also distorted because of government involvement. Any government health care plan results in less, not more, free market solutions.
They are also distorted because of government involvement. Any government health care plan results in less, not more, free market solutions.
Yes! Conservatives who target Medicare forget that it was instituted because, even 50 years ago, the insurance companies didn't want to cover people over 65, at least not at any price the average person could afford.
When I was between ages 60 and 64, my insurance premiums skyrocketed and kept increasing every year, to the point that I actually dropped insurance for a year in order to pay off bills that my high-deductible policy didn't cover. Yes, I had to cross my fingers and choose between going without insurance and paying off the bills for necessary treatment of an injury that cost less than my deductible but was still more than I could pay at once.
I would gradually lower the age of eligibility for Medicare to avoid too much of a shock to the system. The insurance companies could continue providing supplements as they do now.
I would also utterly BAN deductibles. Their stated intention is to prevent hypochondriacs from running to the doctor for every little sniffle, but their actual effect is to make people put off necessary treatments. Copays geared to income level would be fine, but a $5,000 deductible, such as I had when I suffered my $3,500 injury, is inhumane.
I have also heard from doctors about some of the bureaucratic idiocies built into Medicare and Medicaid, and I would streamline those as well.
When I was between ages 60 and 64, my insurance premiums skyrocketed and kept increasing every year, to the point that I actually dropped insurance for a year in order to pay off bills that my high-deductible policy didn't cover. Yes, I had to cross my fingers and choose between going without insurance and paying off the bills for necessary treatment of an injury that cost less than my deductible but was still more than I could pay at once.
I would gradually lower the age of eligibility for Medicare to avoid too much of a shock to the system. The insurance companies could continue providing supplements as they do now.
I would also utterly BAN deductibles. Their stated intention is to prevent hypochondriacs from running to the doctor for every little sniffle, but their actual effect is to make people put off necessary treatments. Copays geared to income level would be fine, but a $5,000 deductible, such as I had when I suffered my $3,500 injury, is inhumane.
I have also heard from doctors about some of the bureaucratic idiocies built into Medicare and Medicaid, and I would streamline those as well.
3
Why does America have to reinvent the wheel? Wouldn't it be advantageous to look at other developed countries, i.e. Switzerland, Great Britain, Germany, etc. who have efficient medical treatment, see what we can learn and apply to our nation? Americans are decent people who care for our neighbors and don't want anyone to suffer for lack of health care. The Republican party approach to health care - and probable sabotage of "O-care" - is like Dr. Frankenstein cobbling together a monster using unworkable parts and leaving out the heart. Bottom line: does commerce exist to serve people or do people exist to serve commerce? It seems the GOP takes the latter view.
1
Government-administered single payer will be the cheapest and most efficient way to deliver health care - because the purpose of a health insurance company is NOT to provide care, but to provide profits.
The average health insurance CEO has compensation in the multiple millions of dollars per year.
The top executives controlling Medicare and Medicaid are government service employees - and make considerably less than a million. When you multiply that out through the various levels of bureaucracy, it is easy to understand why the insurance companies wept, wailed, and gnashed their teeth over Obamacare's requirement that they charge less than 15% for 'administrative overhead'.
The average health insurance CEO has compensation in the multiple millions of dollars per year.
The top executives controlling Medicare and Medicaid are government service employees - and make considerably less than a million. When you multiply that out through the various levels of bureaucracy, it is easy to understand why the insurance companies wept, wailed, and gnashed their teeth over Obamacare's requirement that they charge less than 15% for 'administrative overhead'.
4
Looks like we have another "third rail" and thank goodness.
I'm sure Social Security and Medicare weren't perfect in their honeymoon phases. C'mon Democrats and work to fix the ACA since only you can tackle those "complicated" problems. Seize the day! When you do, toot your horn as loud as possible in the deep recesses of Redville. Make believers out of 'em!
I'm sure Social Security and Medicare weren't perfect in their honeymoon phases. C'mon Democrats and work to fix the ACA since only you can tackle those "complicated" problems. Seize the day! When you do, toot your horn as loud as possible in the deep recesses of Redville. Make believers out of 'em!
4
A little precision please. It's not "socialized medicine" and "government provided health care." It's government provided health insurance. Why use the same terms the republicans use to demagogue the democrats?
8
Medicare is not perfect – What is? – but it works well for most 65+ enrollees. "The next time Democrats are in charge" (and I'm not holding my breath) I would urge them to gradually lower the enrollment age. Even VERY gradually, 1 year per year, so that the rolls don't swell too quickly and overwhelm the existing systems. Adjust Medicaid to cover the poor and near-poor, especially children, until they and the Medicare eligibility age meet. Remove income caps to Medicare contributions from earned income (and do the same for Social Security contributions while at it) so that the best-off contribute a fairer share of their total earnings to the society which benefits them so richly.
2
Seems "spiteful" is the GOP Party's middle name. Bedevilling the ACA by a thousand cuts sounds more Republican than working constructively to fix the ACA. After all these years of McConnell's scorched earth partisanship policy--does the GOP any longer even know how to do this?
If we didn't have to contend with the idea of American exceptionalism impelling us to reinvent the wheel on health care, we would already have looked at the rest of the world's conclusion that single payer universal health care is what works. We are heading that way; let's hope the journey is short and uneventful.
If we didn't have to contend with the idea of American exceptionalism impelling us to reinvent the wheel on health care, we would already have looked at the rest of the world's conclusion that single payer universal health care is what works. We are heading that way; let's hope the journey is short and uneventful.
2
By expanding Medicaid to all people in the US, we might finally have healthcare coverage and costs that are in line with other industrialized nations. Go Republicans!
2
American exceptionalism these days stands for denying American citizens the basic rights people in other advanced countries have: free government funded quality public schools and colleges, universal single payer high quality healthcare, decent minimum wages and respectful maternity/paternity leave, unemployment benefits, a pollution free environment etc.
The Republican mantra that these things hurt the economy is a lie: Countries like Germany, Denmark, the Netherlands and many more who offer these services to their citizens are at or near full employment.
I don't believe anyone who has to worry about their child's or their own health, or who is one setback away from poverty, can have a happy and productive life.
We need to fix our country now, handing the Republicans a historical defeat in 2018 is the best thing that can happen to America.
The Republican mantra that these things hurt the economy is a lie: Countries like Germany, Denmark, the Netherlands and many more who offer these services to their citizens are at or near full employment.
I don't believe anyone who has to worry about their child's or their own health, or who is one setback away from poverty, can have a happy and productive life.
We need to fix our country now, handing the Republicans a historical defeat in 2018 is the best thing that can happen to America.
2
Free school to those who have academic ability. Frankly there are not many kids in the USA that could pass the test to make it into college in other countries. How come no one ever mentions that. Not everyone gets to go to college in other countries.
2
This leg's gonna have to come off.
That's what I do.
That's what I do.
What this article leaves unsaid is that Obamacare has been rigorously studied by health economists and health provider research groups for years and that it was based on previous research that went back decades. There is a lot of information out there which would guide a serious effort to improve Obamacare. Of course many of the findings are that Obamacare has worked pretty well - which will be hard for some to stomach when they keep claiming (hoping) it will implode. If congressmen would put aside their political ideology and work together with providers, insurance companies and each other they could do good work and serve the country - not least the national budget. Is that too much to ask? Changes to the system should be based on experience based findings, not ideologues' musings - certainly not deranged tweets.
3
This Idea's time has come.
Whoever owns this slogan in the next presidential race would own the election.
I'd urge Elizabeth Warren, and Senator Sanders to run with the idea.
So should the young Congressman, Joe Kennedy. He talks about this idea with real passion.
Go Guys, GO!
Whoever owns this slogan in the next presidential race would own the election.
I'd urge Elizabeth Warren, and Senator Sanders to run with the idea.
So should the young Congressman, Joe Kennedy. He talks about this idea with real passion.
Go Guys, GO!
3
One catastrophic aspect of the insurance companies running our health care is that no price is transparent. I tried to call multiple hospitals to find out the cost of a screening mammogram. (The one that was able to tell me quoted over $900 USD btw). The NYT series of articles on cost of procedures high lighted this. One, the University of Colorado Medical Center, said they simply do not allow self pay.
As long as the insurance companies (who are there only to make money off people's ill health) can secretly negotiate prices and consumers are kept in the dark, the price of health care will continue to sky rocket. Single payer should help eliminate this.
As long as the insurance companies (who are there only to make money off people's ill health) can secretly negotiate prices and consumers are kept in the dark, the price of health care will continue to sky rocket. Single payer should help eliminate this.
3
When does government intervene? When society as a whole has a stake in the outcome. That stake overrides individual profit motives. Employment insurance, homeland defence, policing, caring for the poor are but a few examples. Healthcare is one of these. Not a privilege but a right. In Canada we recognized this more than 50 years ago--first as a major medical reimbursement and then as a first dollar reimbursement. Its paid out of general taxation with a small but affordable contribution by workers and their employers. I cannot, for the life of me, see why any party in the US would not get behind this. Seems like an election guarantee for me. However, where the insurance and drug companies rule the legislature would it be too cynical of me to suggest that they rule the roost?
2
As someone who was counting the days until my 65th birthday, I understand the support for Medicare for All, aka single payer. Still, I worry that the expectations for a Single Payer insurance system are too rosy as if difficult problems of cost and allocation will magically resolve. Medicare insurance currently has co-pays and deductibles, definitely rations medical services and isn't universally accepted by doctors who complain about too low cost reimbursements. Single payer advocates dream of a more generous program than Medicare that eliminates deductibles and co-pays and guarantees access to all medical providers. That adds to cost. Right now, young wage earners will pay into the "medicare" system with payroll taxes for on average 40 years in order to get insurance coverage for 15 to 20 years. If everyone is covered, for their lifetime, those payroll taxes will get much higher. And remember, Medicare is ONE insurance policy - and under Medicare single/payer, employment based, custom health insurance will be gone. For me, all these changes are good. But I'd like to see a more critical appreciation of what single payer can and cannot do.
2
I would like to get Leonhardt's perspective on the health insurance system that the Congress has provided for itself, and for all federal employees and their families, during careers in government service and in retirement. It's a huge system, generous in its coverage, and quite efficient. In some respects it's a single-payer system, but it also uses Blue Cross/Blue Shield bureaucracies and other insurers.
What do Republicans think of the federal employees' program? Is it not socialized medicine? And is it a solvent system, in which the premiums paid in by millions of participants cover all the costs and benefits? If not, to what extent are the nation's taxpayers supporting this fringe benefit of government employment?
Rather than 'Medicare for all,' the Federal Employees' Program might provide a model on which to base the reform of Obamacare.
What do Republicans think of the federal employees' program? Is it not socialized medicine? And is it a solvent system, in which the premiums paid in by millions of participants cover all the costs and benefits? If not, to what extent are the nation's taxpayers supporting this fringe benefit of government employment?
Rather than 'Medicare for all,' the Federal Employees' Program might provide a model on which to base the reform of Obamacare.
4
It's time for the ACA opponents to make a cogent case (or in simpler terms put up or shut up).
If you want to keep private insurance companies with a Medicare for all system, then perhaps Switzerland is your model (there - one new idea I never hear discussed). Your turn now - please come up with one NEW idea.
Just show us ONE successful market-based ('free' market) health care system in the developed world. Then maybe you may have some valid points to make.
Otherwise, give up the dream that your crony capitalist friends can continue to suck health care dollars out of the system without providing tangible benefits.
Onward Medicare for all. Thanks Tom and Don.
If you want to keep private insurance companies with a Medicare for all system, then perhaps Switzerland is your model (there - one new idea I never hear discussed). Your turn now - please come up with one NEW idea.
Just show us ONE successful market-based ('free' market) health care system in the developed world. Then maybe you may have some valid points to make.
Otherwise, give up the dream that your crony capitalist friends can continue to suck health care dollars out of the system without providing tangible benefits.
Onward Medicare for all. Thanks Tom and Don.
12
If we had single payer in our country it would not be a well funded high quality one such as in Germany or Norway. Would be worse than those in England and Canada, resembling our VA hospitals and clinics, understaffed, outdated equipment, obsolete failing computer systems and records, and rigid budgets in which unspent money, over budgeted for specific items, cannot be moved into other endeavors which were under budgeted.
2
Correct me if wrong but it seems trumpcare failed not because it wasn't liberal enough, but because it wasn't brutally lassez-faire enough for the Freedom Caucasians.
Free market extremists don't just believe in the 'magic of the market' to raise all boats, they want those drowning to be denied lifejackets. Bootstraps should be enough to keep them afloat, no boots, swim. & if they can't swim fast enough, let them trickle-drown.
The redstate constituency is trained to step on the heads of those a rung below them as they buy into the con that they can climb up the ladder & someday be on deck.
While guaranteeing basic healthcare to all by end-running around corporate insurers leaching off life & death is no doubt the best business decision, the pro-business party will fight first for corporate greed, & second for their social Darwinist solution to eradicating not poverty, but the poor themselves.
Perhaps the recent relief from waiting on line at the emergency room will prompt some 'get your government hands off my Medicaid' signs, but nothing will fix the ornery, Limbaugh-listening hardcore red-state electorate, they'll just have to die off before a new generation can understand why nations with guranteed basic healthcare are vastly happier than the 'failing' USA which doesn't even make the top 10:
https://en.wikipedia.org/wiki/World_Happiness_Report#2017_ranking
Free market extremists don't just believe in the 'magic of the market' to raise all boats, they want those drowning to be denied lifejackets. Bootstraps should be enough to keep them afloat, no boots, swim. & if they can't swim fast enough, let them trickle-drown.
The redstate constituency is trained to step on the heads of those a rung below them as they buy into the con that they can climb up the ladder & someday be on deck.
While guaranteeing basic healthcare to all by end-running around corporate insurers leaching off life & death is no doubt the best business decision, the pro-business party will fight first for corporate greed, & second for their social Darwinist solution to eradicating not poverty, but the poor themselves.
Perhaps the recent relief from waiting on line at the emergency room will prompt some 'get your government hands off my Medicaid' signs, but nothing will fix the ornery, Limbaugh-listening hardcore red-state electorate, they'll just have to die off before a new generation can understand why nations with guranteed basic healthcare are vastly happier than the 'failing' USA which doesn't even make the top 10:
https://en.wikipedia.org/wiki/World_Happiness_Report#2017_ranking
10
It is unfortunate we can not afford to follow every tenable policy to its logical conclusion. The real world is a singularity and thus following one policy eliminates all others from consideration.
But it is possible to rigorously imagine what a particular policy would result in should it be pursued.
In the case of healthcare we can be almost certain that any policy that makes it more difficult for the average Joe or Jane to buy, afford or maintain insurance will result in fewer people having insurance.
We can also predict that fewer people with insurance will mean fewer visits to doctors and hospitals.
This in turn guarantees that the medical care industry will have less business to divide between the available supply.
As with any socio-economic system less business always translates into the failure of the less viable providers. That is what competition always means.
When people can buy less food, for any reason, farmers with marginal farms or at the end of expensive transport routes go bankrupt or just plain die.
When people are forced to use less medical care, the doctors and nurses working in the poorest areas, inner cities, rural areas, will find themselves out of work. Hospitals in some areas will close. Device manufacturers will lose business. Drug companies will see profits fall and innovation will become too costly.
The ACA made medical care for the well off much better. They just don't know it.
But it is possible to rigorously imagine what a particular policy would result in should it be pursued.
In the case of healthcare we can be almost certain that any policy that makes it more difficult for the average Joe or Jane to buy, afford or maintain insurance will result in fewer people having insurance.
We can also predict that fewer people with insurance will mean fewer visits to doctors and hospitals.
This in turn guarantees that the medical care industry will have less business to divide between the available supply.
As with any socio-economic system less business always translates into the failure of the less viable providers. That is what competition always means.
When people can buy less food, for any reason, farmers with marginal farms or at the end of expensive transport routes go bankrupt or just plain die.
When people are forced to use less medical care, the doctors and nurses working in the poorest areas, inner cities, rural areas, will find themselves out of work. Hospitals in some areas will close. Device manufacturers will lose business. Drug companies will see profits fall and innovation will become too costly.
The ACA made medical care for the well off much better. They just don't know it.
1
Support the NY Health Act (Gottfried/Rivera): Universal publicly funded single payer healthcare in NYS. Passed the Assembly twice and recently reintroduced. This is the equivalent of improved Medicare for all, regardless of age, income or other status. True healthcare equality. nyhcampaign.org.
4
Republicans must be able to do math. Virtually every country that has a single payer system pays considerably less on healthcare as a percentage of their GDP and most have better results. It saves money and with a deficit in the trillions, this has to be addressed. Obamacare was originally the Republican compromise on health care. All the screaming about Obamacare, was just because they hated Obama, because he was a black guy. They knew that if they took the Eddie Munster version of health 'care', they would be caught with their pants down. He had 7 years to craft a bill and what he came up with would bump millions of Americans off insurance, cost more and actually kill people. They can gerrymander their districts all they want, but they still have constituents that rely on Obamacare, regardless of how little they understand it, and those constituents became restless when they figured out what would happen. Too bad they didn't figure it out before they voted for Trump, who promised better and cheaper care for everyone. That was pie in the sky, this was a Paul Ryan tax cut for the wealthy, plain and simple, and the Republicans didn't want to owner it.
9
Allowing people between 55-65 to buy into Medicare with their own money is a fabulous idea that will take the older people out of the insurance pool, thus making it less expensive for everyone else. Great idea. Fantastic. Clinton suggested this on the campaign trail, but apparently the voters didnt want it.
The ACA , with its emphasis on preventative health, saved a lot of people, whether or not they were in the exchanges. Bloodwork. Checkups. Mammograms. Colonoscopies. All of these, under the ACA, had no copays or deductibles. People were finally getting the tests they needed to catch things early when they were still treatable. This saved lives, which is important to Democrats, and it saved money in the long run, which is important to Republicans. I was horrified when the angry old white men tried to take this aspect of the ACA away, and I am relieved that they failed.
The ACA , with its emphasis on preventative health, saved a lot of people, whether or not they were in the exchanges. Bloodwork. Checkups. Mammograms. Colonoscopies. All of these, under the ACA, had no copays or deductibles. People were finally getting the tests they needed to catch things early when they were still treatable. This saved lives, which is important to Democrats, and it saved money in the long run, which is important to Republicans. I was horrified when the angry old white men tried to take this aspect of the ACA away, and I am relieved that they failed.
23
As a retired but career private insurance professional, I can't believe how many people love Medicare and can't wait to turn 65! Never thought any public program would out perform private plans in terms of costs and freedom to choose providers. ACA was supposed to encourage competition but affordability interfered. Medicare can offer lower prices since it has better health care cost arrangements with providers. Its admin costs, because its relatively simple, are lower too on a percent of claims basis. How can any new program compete without access lower cost health care services and a low administrative cost structure? It CANNOT. So let's at least allow those who want Medicare plans to 'buy' them and subsidize those in need who can't. Not saying that people shouldn't be able to purchase private coverage; just give them freedom to choose. I thought 'choice' was a good thing and what everyone wants? Common sense plus math works in favor of this solution.
17
@AMM Radnor PA
Choice a largely a Republican mirage. Most recipients get their healthcare covered by HMO's or PPO's. It's like whole you can keep your doctor or health insurance fictions peddled by Republicans. Most health insurance plans get re-written every year and people are continually losing doctors because of retirements, job moves, or plan changes.
Choice a largely a Republican mirage. Most recipients get their healthcare covered by HMO's or PPO's. It's like whole you can keep your doctor or health insurance fictions peddled by Republicans. Most health insurance plans get re-written every year and people are continually losing doctors because of retirements, job moves, or plan changes.
2
It is worth adding to this discussion the matter of Medicare Supplemental insurance. Medicare requires in many instances a 20% co-pay. The private market for Supplemental insurance is active and viable. Consumers have choices of insurers and whether to pay co-pays on their own, While I personally believe that a 20% co-pay may be too high for situations where individuals lack the choice of getting medical services, this model certainly can be considered and studied.
Yes, I had to choose between changing my doctor and changing my Medicare supplement this year. (I chose to change the Medicare supplement, but it was an extra layer of hassle.)
The challenge is and will always be - how to pay for it.
Germany has one less layer of government, and Health Insurance - Single Payer - requires 15% tax. And still 85% of Working Germans buy additional insurance to actually see a doctor.
Vermont tried to do it at a state level, and soon realized hat they needed an additional 11% tax to fund it at the state level.
Medicare, per the HHS budget, costs over 1,000.00 per person per month, and only covers 80% of the medical costs after the deductibles. It also does not cover outpatient medications.
btw - that 1,000 per month is that low because:
HHS and CMS wages and benefits are pushed off the HHS books to the OPM budget.
HHS and CMS facility and operational costs are pushed off the HHS books to the GSA budget.
Germany has one less layer of government, and Health Insurance - Single Payer - requires 15% tax. And still 85% of Working Germans buy additional insurance to actually see a doctor.
Vermont tried to do it at a state level, and soon realized hat they needed an additional 11% tax to fund it at the state level.
Medicare, per the HHS budget, costs over 1,000.00 per person per month, and only covers 80% of the medical costs after the deductibles. It also does not cover outpatient medications.
btw - that 1,000 per month is that low because:
HHS and CMS wages and benefits are pushed off the HHS books to the OPM budget.
HHS and CMS facility and operational costs are pushed off the HHS books to the GSA budget.
2
@John Spek Atlanta
The German system is essentially single payer but they have co-opted the insurers into the process and capped their profits. And capping is the key word here because they've also imposed caps on most of the provision of care and drugs. The US has a cost problem despite all the attention lavished on the financing side.
The German system is essentially single payer but they have co-opted the insurers into the process and capped their profits. And capping is the key word here because they've also imposed caps on most of the provision of care and drugs. The US has a cost problem despite all the attention lavished on the financing side.
7
a 15% tax is cheaper than health insurance. and if we eliminated the profit-taking and admin costs, negotiated drug and equipment prices and offset medical tuition in exchange for a period of government service, that 15% tax would be too high.
2
Healthcare spending in Germany is 11.2% of GDP, in the USA 17.1%. Economy of scale could even drive Germany's number down. The USA has the "layer" of insurance companies who take 20-30% of health care expenditures and the strange prohibition on the government negotiating drug and care prices. You also have to offset the tax for single payer (shared between employers and employees) that covers everything including co-pays and drugs, against the premiums, drugs and out of pocket here. Why would so many countries have single payer if it's so hard to pay for it?
1
Sixty two percent of the population is already on single payer. Medicare, Medicaid, the VA, the military, and numerous state plans. Single payer is also cheaper as the middleman, the insurance industry, is no longer in the equation.
We pay $3000 more per individual than any other country. The sole reason is not the cost of health care, but the costs imposed upon us by the insurance industry.
It is past time to get out of the hodge/podge way we grant healthcare and move into the 21st century with single payer.
We pay $3000 more per individual than any other country. The sole reason is not the cost of health care, but the costs imposed upon us by the insurance industry.
It is past time to get out of the hodge/podge way we grant healthcare and move into the 21st century with single payer.
3
Thank you! Research the salaries of insurance CEOs if you feel like it. Lunacy. Lock them up.
1
Make everyone of any age eligible for Medicare. The states can pay the premiums for really poor people. Rules and rates are already established. Everybody wins.
2
Sounds good to me. I've been a proponent of universal single-payer since the 1970s when I was mature enough to understand it. I just read that the CEO of Aetna pulled in $30 million in 2013. He belongs in the unemployment line, or in jail. The HHS secretary earns about 1 percent of that amount, I believe.
6
The American healthcare system which is predicated on employment-based health insurance will collapse under its own weight. There is no magic wand for the Access Fairy can wave to make healthcare affordable, as well as accessible. We must develop a system that does not depend on unlimited profits for Health Insurers or Big Pharma. The present system will continue its downward spiral until Americans say, "Enough! We want what every other developed nation has!"
4
Paul Ryan has had a such a close minded approach for years, yet has failed to deliver. most of the time. The healthcare debacle was a direct hit on the SS Ayn Rand philosophy. How we get there is not yet know but, the push back we just saw on the ACA repeal will lead to the gradual expansion of Medicare overtime. Both the income levels and age requirements will become more inclusive and it is because, as in typical fashion, the Republicans overreached. The fact they overreached so severely in their first legislative venture under Trump is what makes this debacle so astounding.
2
Mr. Leonhardt says, "private markets in many areas of the economy have ... advantages over a government program. They create competition, which leads to innovation and lower prices. But private markets in medical care tend to be more complicated and less successful."
To be blunt and specific, private markets in medical care work badlybecause they DON'T create competition. Competition requires that the customer be free to determine what he or she needs, and then compare prices and quality. In medicine, the doctor says " you're about to have a heart attack and you need quadruple bypass surgery." The frightened customer is often unable to weigh options and compare prices and outcomes (quality), though Obamacare has forced some transparency about these.
Afterwards, you or your insurance company gets a mystifying bill. Prices rise free of scrutiny. If you lack insurance, you use the emergency room at the cost of the hospital (i.e., its paying patients) or the taxpayer.
Republicans, tell me a better story about the free market in health care.
To be blunt and specific, private markets in medical care work badlybecause they DON'T create competition. Competition requires that the customer be free to determine what he or she needs, and then compare prices and quality. In medicine, the doctor says " you're about to have a heart attack and you need quadruple bypass surgery." The frightened customer is often unable to weigh options and compare prices and outcomes (quality), though Obamacare has forced some transparency about these.
Afterwards, you or your insurance company gets a mystifying bill. Prices rise free of scrutiny. If you lack insurance, you use the emergency room at the cost of the hospital (i.e., its paying patients) or the taxpayer.
Republicans, tell me a better story about the free market in health care.
5
Guess what? Single payer SAVES MONEY
Only not for the Insurance Industry. Therein lies the rub for the GOP and their Insurance industry lobbyists, providing millions in campaign donations to buy the votes of Congress.
Until we have campaign finance reform, Single Payer will never be enacted.
Only not for the Insurance Industry. Therein lies the rub for the GOP and their Insurance industry lobbyists, providing millions in campaign donations to buy the votes of Congress.
Until we have campaign finance reform, Single Payer will never be enacted.
6
Whatever health plan Congressman have should be provided to everyone in the country and at the same cost.
Any other reform, Congressmen who vote for it must be be required to enroll in the lowest cost, least coverage plan and be prohibited from using any other health insurance plan.
Do that and we'd have public, single-payer, high quality health care in a split second!
Any other reform, Congressmen who vote for it must be be required to enroll in the lowest cost, least coverage plan and be prohibited from using any other health insurance plan.
Do that and we'd have public, single-payer, high quality health care in a split second!
4
Whether Republicans (or Democrats, for that matter) care about the health of the American populace is not all that important. What does matter is the economics of it all. Single payer is less expensive, as Medicare shows. Some people are making great sums that they shouldn't be making if economics is our standard and they don't want to give it up.
2
We must appeal to the conservative mindset:
Economy--a vibrant economy does best when it encourages innovation, and more people would be free to start up their own companies, switch to a fledgling start-up, move to get a better job....
Small businesses--will be free to hire the correct number of employees for the job, not make hiring decisions based on healthcare costs per employee.
Large businesses--get rid of the headache and annoyance.
And, of course, morally-- the most successful country on this planet will be doing their duty as Christians and help others (while, of course, still really helping themselves).
If insurance companies want to stay in business, they could sell plans for services around the periphery that do not involve actual medical care;-- luxury single rooms in hospitals, at-home care when it's not medically necessary etc.
It could be a win-win!
Economy--a vibrant economy does best when it encourages innovation, and more people would be free to start up their own companies, switch to a fledgling start-up, move to get a better job....
Small businesses--will be free to hire the correct number of employees for the job, not make hiring decisions based on healthcare costs per employee.
Large businesses--get rid of the headache and annoyance.
And, of course, morally-- the most successful country on this planet will be doing their duty as Christians and help others (while, of course, still really helping themselves).
If insurance companies want to stay in business, they could sell plans for services around the periphery that do not involve actual medical care;-- luxury single rooms in hospitals, at-home care when it's not medically necessary etc.
It could be a win-win!
2
Our entertainer President promised better health insurance, and, due to his incompetence and inability to think complicated thoughts, he failed to offer his own better plan. Health insurance for all is a requirement (like car insurance) and a right. Single payer Medicare type for all is the wave of the future. Republicans ignore this to their peril.
3
stop with the personal attacks. It gets us nowhere. It only makes one side even more hard lined.
1
I think the key issue regarding the health care debate is: what do we know about the system of health care that would improve population health and reduce suffering and death? The answer given by health policy experts is clear. A single payer system would reduce suffering and death and improve our health. Single payer would allow universal access to good and timely care and mostly would do away with inequity in health care.
One of the problems I see time and time again are politicians giving their uneducated opinion about health care and these opinions getting inadvertently reinforced and emphasized when reporters discuss them. Paul Ryan's ideas on health care policy are a perfect example. This moves the discussion away from the key issue- what do the health care policy experts say would improve the health of the people of the United States. Lets move to a more enlightened age.
One of the problems I see time and time again are politicians giving their uneducated opinion about health care and these opinions getting inadvertently reinforced and emphasized when reporters discuss them. Paul Ryan's ideas on health care policy are a perfect example. This moves the discussion away from the key issue- what do the health care policy experts say would improve the health of the people of the United States. Lets move to a more enlightened age.
4
Republicans are most definitely paving the way for single payer , I have thought this all along. Obamacare is the last gasp of a private sector only solution , a noble shot at the idea but one that is going to end up demonstrating the futility of the idea.The fifty million uninsured in this country are not just people who prefer iPhones to health insurance and they no longer want to quietly live in fear along with the perilously insured. There's a reason why Bobby Jindal once said: "Republicans don't know how to talk about health care". We're seeing what he meant
4
Leonhardt's argument doesn't convince me. The failure of the Republican health care act wasn't so much a result of the outpouring of public indignation. While that happened to an extent probably greater than the White House expected, the Republican failure, I think, was more due to the Republican's not being able to agree among themselves.
2
Last week showed us the Republicans are not really interested in health policy (except the reproductive decisions of women). Their real interest is "tax policy", i.e., tax reductions for high earners financed by increases and program cuts that adversely impact the middle class and more vulnerable members of society.
Recent history has shown that as long as they thump Bibles and proclaim their commitment to "protecting the unborn" (the right to birth rather than any kind of life), millions of voters will religiously pull levers for them and then wonder why their lives are so difficult in a land of plenty.
Recent history has shown that as long as they thump Bibles and proclaim their commitment to "protecting the unborn" (the right to birth rather than any kind of life), millions of voters will religiously pull levers for them and then wonder why their lives are so difficult in a land of plenty.
5
I believe that Americans want medical care. Not access, not an insurance plan. We want what the rest of the civilized world has come to regard as a social contract between taxpayers and government. Just as we expect that education, police and fire protection and national defense are part of the infrastructure of our country, medical care needs to be the same.
6
The article makes sense, but it fails to point out an important fact about Obamacare. It actually was a Republican creation dreamed up in a hard right think tank. Its purpose was to save the private insurance companies from the threat of increasing public favor of single payer. Its purpose was not to provide health care; it was preserving insurance company profits. Obama tweaked this Republican plan a bit to make it appear palatable to Democrats, but its basic purpose remained preventing single payer. The only reason Republicans opposed it was that Obama proposed it instead of one of their own.
3
Single payer works because it's cheaper. When the government pays for everyone's healthcare costs, the negotiating table looks like this: On one side is the government, and on the other side is a hospital, or a doctor, or a drug company. And in negotiations, size makes all the difference, which is how the mammoth Wall-Mart gets lower prices when it negotiates with producers. At the negotiating table, even the largest of the health insurance companies will be dwarfed by the size of the federal government when it represents all of us. It's no coincidence that Medicare spends less than an insurance company for the same medical procedure. And it's no coincidence that we spend vastly more on healthcare than any other developed country: We spend 18% of our GDP on healthcare, while France, in second place, spends 11% of their GDP. In the midst of this, 20 million Americans have no healthcare coverage at all, our healthcare industry continues to raise prices, and we pay through the teeth or get left in the dust. It's time to change!
Joseph in Missoula
Joseph in Missoula
5
We all realize that ACA was not really a "liberal social medical program" -- as Trump, Ryan and the rest of the Republicans would have us believe -- but rather an infinitely complex and ultimately unworkable hybrid that had a built-in self-destructive element thanks to Republican obstructism during its gestation.
If Leonhardt's analysis is correct -- and I certainly hope it is -- at long last we will see how the misguided Republican strategies continue to backfire on themselves.
Of course, this is not guaranteed. Indeed, the opposite may transpire. That is, if the general gridlock among legislators persists, ACA will slowly self-destruct and it is possible that five or ten years down the road there will be NO public healthcare programs whatsoever.
If Leonhardt's analysis is correct -- and I certainly hope it is -- at long last we will see how the misguided Republican strategies continue to backfire on themselves.
Of course, this is not guaranteed. Indeed, the opposite may transpire. That is, if the general gridlock among legislators persists, ACA will slowly self-destruct and it is possible that five or ten years down the road there will be NO public healthcare programs whatsoever.
There is no free market for healthcare because there is no rational consumer. After choosing the doctor, all purchase decisions are made by professionals, whose knowledge we seek to do the right thing for us.
The same could be said for other services we have agreed to collectively pay for, like military, police and fire protection. Imagine if these indispensable services, which we consider a right of citizenship, were paid for like our current medical insurance model.
We also collectively pay for our children’s education through high school. While that level no longer provides the skills needed for an internationally competitive workforce, we do nonetheless make it available through our collectively paid taxes. And if you don’t like the public choices, there are usually multiple private options. The competition between public and private education is a free market function. In the same way, a public healthcare system provides the competitive price counterweight to private options.
As a society, we have decided that all these services are a right, not a privilege. We need to agree that healthcare is also a right. In doing so, we can begin the process of making it available to everyone. Otherwise, we get sidetracked by nonsensical, emotional discourse.
We accept socialized military, fire, police and education. Our medical care should not be considered any less important.
The same could be said for other services we have agreed to collectively pay for, like military, police and fire protection. Imagine if these indispensable services, which we consider a right of citizenship, were paid for like our current medical insurance model.
We also collectively pay for our children’s education through high school. While that level no longer provides the skills needed for an internationally competitive workforce, we do nonetheless make it available through our collectively paid taxes. And if you don’t like the public choices, there are usually multiple private options. The competition between public and private education is a free market function. In the same way, a public healthcare system provides the competitive price counterweight to private options.
As a society, we have decided that all these services are a right, not a privilege. We need to agree that healthcare is also a right. In doing so, we can begin the process of making it available to everyone. Otherwise, we get sidetracked by nonsensical, emotional discourse.
We accept socialized military, fire, police and education. Our medical care should not be considered any less important.
6
Always the stuff about what single-payer "will" do. How about what national health care systems "have done"? Sure they take away the fear factor. In it place they substitute long long waits, often substandard treatment, lack of proper facilities and equipment, exponential cost increases over time, and just for good measure, politicization of every aspect of health care from who gets what treatment where to how much everybody from the admins to the cleaners gets paid.
In the UK the NHS fakes its way through from day to day. Money goes to external private agencies because nobody who can help it wants to work directly for the govt. agency. It's budget is a significant and growing percentage of GDP.
You want that? Go ahead.
In the UK the NHS fakes its way through from day to day. Money goes to external private agencies because nobody who can help it wants to work directly for the govt. agency. It's budget is a significant and growing percentage of GDP.
You want that? Go ahead.
The NHS is different in that providers are direct employees of the British government. As such, it is subject to the whims of whichever party is in power. Yet the level of satisfaction is high, and people who have experienced both the British and the U.S. system almost always prefer the British system, and I have heard good reports from American tourists who received emergency treatment in its hospitals. It's not perfect, but British people don't go bankrupt from medical bills.
What the Progressive Caucus of the Democratic Party is advocating is something like the Canadian system, in which most providers are in private practice but the government pays the bills.
A single-payer system creates the greatest good for the greatest number. Yeah, you may have to wait for a knee replacement in Canada. Well, I know people who have had knee replacements in the U.S., and not one has been able to schedule next-day or even next-month service. More importantly, if a 45-year-old is too "rich" for Medicaid and too "poor" to pay the deductible, the wait for a knee replacement is about 20 years, i.e. till eligibility for Medicare.
What the Progressive Caucus of the Democratic Party is advocating is something like the Canadian system, in which most providers are in private practice but the government pays the bills.
A single-payer system creates the greatest good for the greatest number. Yeah, you may have to wait for a knee replacement in Canada. Well, I know people who have had knee replacements in the U.S., and not one has been able to schedule next-day or even next-month service. More importantly, if a 45-year-old is too "rich" for Medicaid and too "poor" to pay the deductible, the wait for a knee replacement is about 20 years, i.e. till eligibility for Medicare.
When the Dems are in charge again, we should expand Medicare to all. We're sick (pun intended) of all this piecemeal, half- and quarter-measures. The health care system is in turmoil and expenses are rising astronomically because there is no transparency (which we'd have with Medicare for all), no negotiation for drug prices, and questionable data to analyze the system thanks to private insurance holding the records.
1
To allow private, for-profit insurance companies in the middle of healthcare is pure lunacy. All it does is suck money and efficiency out of the system. The faster we can get rid of them the better. Medicare of all!
3
This argument assumes that by making health insurance unaffordable and unreliable, republicans will inadvertently stimulate public support for single-payer. In that scenario, I wonder how many Americans will have to die from treatable conditions before republican opposition is defeated and single-payer becomes a reality.
1
I hesitate to step into this swamp, but I wonder why some key issues aren't on the table.
Why should government pay for our health care at all, except for catastrophic coverage, say, for any health care bills in excess of, say, $25-50,000 (the exact amount is negotiable)? And an appropriate safety net.
Why should government pay for our health care at all, except for catastrophic coverage, say, for any health care bills in excess of, say, $25-50,000 (the exact amount is negotiable)? And an appropriate safety net.
1
The problem with private insurance companies are that they are businesses with allegiance to the bottom line, which means paying the least out in benefits, and maximizing profits. Health care does not lend itself to that kind of system, it isn't a commodity like pork bellies. Insurance companies are literally death panels with their power to deny coverage for whatever reason they deem feasible. They employ people looking for ways to do so. A Single-Payer system modeled after other countries is the only decent and humane way to handle health care in this country. Everyone who works contributes and the risk pool is large and diverse. A government should be for the good of all the people not just the wealthy. Everyone who lives in country should contribute to the greater good of the whole. Of course, that is only my opinion.
4
Leonhardt is restating the traditional argument from the 1950s and 1960s for subsidizing private insurance, but with a contemporary twist. The traditional argument is that it is necessary to subsidize private insurance in order to prevent a slide toward socialism.
The twist is that Leonhardt adds, with good reason, that Republicans are now unwilling or unable to act on that traditional argument. (Leonhardt has a sense of history - in a daily newspaper column. One more reason to read the NYTimes.)
I agree wholeheartedly with Leonhardt's suggestion of incremental expansion of both Medicaid and Medicare. That is the only way within the US political system both to control costs and to ensure coverage. Whether this is politically possible is of course doubtful, since it requires an old-fashioned argument.
The twist is that Leonhardt adds, with good reason, that Republicans are now unwilling or unable to act on that traditional argument. (Leonhardt has a sense of history - in a daily newspaper column. One more reason to read the NYTimes.)
I agree wholeheartedly with Leonhardt's suggestion of incremental expansion of both Medicaid and Medicare. That is the only way within the US political system both to control costs and to ensure coverage. Whether this is politically possible is of course doubtful, since it requires an old-fashioned argument.
2
I certainly agree with much of what was said in this article. Like any highly complex issue, however, there are some issues in the fine print.
First, it looks like the GOP is building a very impressive secondary defense wall as the outer ramparts crumble. Obamacare, Medicare, and Medicaid are laws that specify explicit levels of benefits. You either get particular types of medical care or you don't. The GOP alternatives mostly involve specific levels of subsidy and the insurance companies get to tell you what you can afford with that. The result of this is that the voters' negotiation with their elected representatives is only about abstract sums of money and the insurance companies have to tell you the bad news.
Second, GOP alternatives give large corporations and unions great power over the lives of their workers and by extension the workers' families. Single-payer takes the employers out of the loop. This removes a substantial burden from corporations, but it comes with a loss of control over employees.
Third, the market-based portion of the ACA is especially important for the middle class, particularly for small businesspeople and others with an entrepreneurial bent. It's ironic, but today's GOP seems to be much less interested in the middle class, especially when compared to the Democratic Party.
First, it looks like the GOP is building a very impressive secondary defense wall as the outer ramparts crumble. Obamacare, Medicare, and Medicaid are laws that specify explicit levels of benefits. You either get particular types of medical care or you don't. The GOP alternatives mostly involve specific levels of subsidy and the insurance companies get to tell you what you can afford with that. The result of this is that the voters' negotiation with their elected representatives is only about abstract sums of money and the insurance companies have to tell you the bad news.
Second, GOP alternatives give large corporations and unions great power over the lives of their workers and by extension the workers' families. Single-payer takes the employers out of the loop. This removes a substantial burden from corporations, but it comes with a loss of control over employees.
Third, the market-based portion of the ACA is especially important for the middle class, particularly for small businesspeople and others with an entrepreneurial bent. It's ironic, but today's GOP seems to be much less interested in the middle class, especially when compared to the Democratic Party.
"It’s not worth expanding health coverage in a conservative-friendly way, because Republican leaders won’t support it anyway"
The GOP motivation for enlisting Dems would not be fixing the ACA but in passing the AHCA in new robes. That is the only way the GOP gets talking points in 2018. If the "new" AHCA is really better than the good old ACA, it will be a miracle given the orientation of Ryan toward the AHCA as primarily a tax cut.
The GOP motivation for enlisting Dems would not be fixing the ACA but in passing the AHCA in new robes. That is the only way the GOP gets talking points in 2018. If the "new" AHCA is really better than the good old ACA, it will be a miracle given the orientation of Ryan toward the AHCA as primarily a tax cut.
1
We have a social security system. It seems to work and is critical as a backstop to those who have not been able to develop added retirement savings accounts. A similar fund should exist for universal medical care....with mandatory contributions. This then speaks to a 2 tier system....a backstop for those who need it; and an augmented system (private health care) for those who can afford it. To try to force people who don't have the means to participate in what is a very complex 'insurance market' is unrealistic. The sad reality is that a large proportion of our population are not prepared to address the so-called free market. These are people best served by government based medical centers/hospitals who provide the basics of good medical care. Lifestyles differ widely based on income. And it seems the level of medical care...as long as the baseline is 'good' ...is subject to the same criteria. This calls for a two tier system...one government run and one private...both with minimum necessary and sufficient care criteria. There is no reason why each cannot be run cost effectively....as long as the standards are set right. There is no one size fits all solution...and Washington does not seem to get it.
And you say that like it's a bad thing?
Arnold Kling goes to the heart of the matter.
1. The American middle class does not believe in saving up for health care expenses. The idea that you should have $10,000 – $15,000 set aside for the occasional acute medical episode is abhorrent. The idea that you should save up for the inevitable medical expenses of old age is abhorrent. We are not Singapore.
2. The American middle class does not believe in paying taxes in order to support people who are very poor or very sick. We are not Denmark.
3. Americans are not willing to say, “The proposed treatment for this problem is not worth the cost. The individual should accept lower-cost treatments and live (or perhaps not live) with the consequences.”
4. Americans, and especially health care providers, do not want to think of health care as a commodity. The providers want to be paid, but they do not want to think of themselves as selling their services, so the payment comes from third parties and the price is hidden to consumers.
5. Americans are not willing to give up being the “early adopters” of new treatments, which are often much more expensive ....
..... Put together these cultural traits and you end up, in Josh Barro’s words, with an economy that spends 1/6th of GDP on health care with nobody wanting to spend 1/6th of their income on it.
There is a bit more at http://www.arnoldkling.com/blog/the-cultural-roots-of-americas-health-ca...
1. The American middle class does not believe in saving up for health care expenses. The idea that you should have $10,000 – $15,000 set aside for the occasional acute medical episode is abhorrent. The idea that you should save up for the inevitable medical expenses of old age is abhorrent. We are not Singapore.
2. The American middle class does not believe in paying taxes in order to support people who are very poor or very sick. We are not Denmark.
3. Americans are not willing to say, “The proposed treatment for this problem is not worth the cost. The individual should accept lower-cost treatments and live (or perhaps not live) with the consequences.”
4. Americans, and especially health care providers, do not want to think of health care as a commodity. The providers want to be paid, but they do not want to think of themselves as selling their services, so the payment comes from third parties and the price is hidden to consumers.
5. Americans are not willing to give up being the “early adopters” of new treatments, which are often much more expensive ....
..... Put together these cultural traits and you end up, in Josh Barro’s words, with an economy that spends 1/6th of GDP on health care with nobody wanting to spend 1/6th of their income on it.
There is a bit more at http://www.arnoldkling.com/blog/the-cultural-roots-of-americas-health-ca...
2
Insightful- very interesting!
ACA, as shaped by the insurance company and pharmaceutical lobbies, was politically feasible at the time. It is a lifesaving dinghy attached to a leaking, rusted unbalanced ship of public healthcare funding. Our current convoluted, contorted collection of tax supported programs include employee coverage schemes, tax credits, VA care, SCHIP, Medicaid, Medicare, Obamacare, HSAs, Tricare, etc. which still do not provide universal coverage. In 2013, even prior to the ACA, the U.S. spent more public dollars on health care than all but two high-income countries. Those tax costs don't include out of pocket, for-profit insurance costs of Americans. In the ideological effort to avoid single-payer national health care, we spend, overall, almost 50% more of our GDP on healthcare (17%) than the next most expensive national program. And despite spending vastly more private dollars as well, there are fewer physician visits, the least expenditures for essential social services that improve chronic care, and poor population health outcomes. Of 13 high-income nations, the U.S. is dead last with highest infant mortality and the lowest life expectancy at birth. (OECD Health Data 2015) This is a for-profit-industry-centered system, not a patient-centered, or even “population-centered” health system.
Negotiation with Pharma is also essential - we can join developed nations which enjoy better health outcomes with less tax dollars related to efficiencies of single payer programs.
Negotiation with Pharma is also essential - we can join developed nations which enjoy better health outcomes with less tax dollars related to efficiencies of single payer programs.
1
Its called the ACA, Affordable Care Act.
MEDICARE for ALL-2020. THE winning issue for the midterms, and beyond. Seriously.
5
The republicans blew it by rushing to put a health care system that was not carefully thought out. They could have spent their time better by figuring out how to fix the minor changes which needed to be made to the ACA. They spent so much time trying to block then President Obama and now the American public from receiving adequate health care coverage. They only care for themselves because they are automatically covered by more than fabulous healthcare. What selfish, selfish people.
Don't call Single Payer Health Plan a "Socialized Medicine" when any capitalist economist will tell you that it is the most cost-effective system in any of the developed countries that care about their population. I don't know why the Wall Street is not behind such a system. All major corporations who must provide health insurance to their employees will also benefit. The losers are of course Insurance middle men who don't add anything to the GDP.
Universal Health is the most cost-effective system for a capitalist country with a heart!
Universal Health is the most cost-effective system for a capitalist country with a heart!
3
Morpheus said it best: "fate it seems is not without a sense of irony". In this case, let's hope it's true.
1
The bill HR 676 is already marked to extend Medicare to all Americans. How about the NYT putting a team up to taking a deep dive look at what that would do, what it would cost and what it would save.
It is a serious policy proposal that deserves serious consideration by the media, our Congress and the American people.
#HR676, #MedicareforAll, #Medicare
It is a serious policy proposal that deserves serious consideration by the media, our Congress and the American people.
#HR676, #MedicareforAll, #Medicare
4
Single payer health insurance is inevitable, but when the Freedom Caucus and the other far-right ideologists in Congress hear the words "socialized medicine", they always balk. They want fewer social programs, not more. This could only change if the GOP gets a good beating in the 2018 mid-terms, and a couple of new majority leaders make it clear that this is their only real choice.
1
Single payer should be the long term goal. Unfortunately, the American public will have to embrace a two tiered system. Those of means get premium care with no waiting for elective procedures and limitless new therapies; everyone else has reasonable care. Now everyone sign your end-of-life care plan!
1
I have this fantasy- my husband is concerned that I'm seriously deluded- in which Bernie Sanders calls our "president" and convinces him that single-payer Medicare for all is the way to go. He will need to put a purr in that gravelly voice of his, tell the "president" that he would see his name in lights and in every history book to be written, that his name would be added to the greatest American social program since Medicare and Social Security, that he'd be the hero of adoring millions....Come on, Bernie! You can do it! Okay, time for my meds.
1
Trump came and Trump will go. He isn't essential to the equation.
1
mindy, we also share your dream....bernie is our hero...
1
A large part of ACA are the consumer protection parts: standardized care (the 10 points that were going to be nixed), preventive care covered at 100%, no more annual cap, employers over 50 staff now have to offer insurance, and the list goes on. These pieces impact employees under their employers plan, and we seem to get so focused on those without insurance, we forget about these crucial parts. I remember the good old days (no coverage when I got pregnant, uninsurable in my 20's). There is no way I want to go back to that, or want my child or grandchild to experience that. We need to do better for our next generation. And for me the days I have left on this earth.
Wasn't the defeat of the Trumpcare plan mostly due to the scorched earth position of the Freedom Caucus who wanted nothing less than total destruction of Obamacare? So many comments here blame the defeat on how bad the Trumpcare proposal was. But that wasn't what killed the plan. It was the hardliners. My concern is that we think a better plan will win out in the future.
Our politicians don't want better coverage. That was obvious. The whole thing failed because of gerrymandering in right-wing communities, not because the Trumpcare proposal itself was bad. Again, it's about local politics.
Until we can get rid of gerrymandering we don't have a working government and future health care, tax policies, etc. are dealt body blows by over-representation of gerrymandered safe politicians who just want to throw stones instead of governing. Focus on breaking the back of local gerrymandering and we might get closer to a functional government.
Our politicians don't want better coverage. That was obvious. The whole thing failed because of gerrymandering in right-wing communities, not because the Trumpcare proposal itself was bad. Again, it's about local politics.
Until we can get rid of gerrymandering we don't have a working government and future health care, tax policies, etc. are dealt body blows by over-representation of gerrymandered safe politicians who just want to throw stones instead of governing. Focus on breaking the back of local gerrymandering and we might get closer to a functional government.
2
Most reasonable voters should be for single payer, and let's get the damned private insurance companies OUT of our lives, once and for all. Hospitals and doctors will support it, and I think we're going to see more and more demonstrations, in favor of it, in the streets. Health Care in a human right, not a way to make a profit. (DO you read me, Cory Booker?) It's time for Paul Ryan to step down, and disappear into anonymity. He's has revealed himself for the complete fraud, and crude huckster, that he truly is. Unfortunately, the Republicans probably don't have anyone better than him.
3
The premise of this article is flawed. About 175 million people obtain insurance through their employers. The rest are insured through medicare, medicaid, and the Obamacare exchanges. Obamacare insured about 30 million new people. About 20 million of those were insured through medicaid expansion. The rest -- maybe a paltry 10 million -- got insurance through the "private market" obamacare exchanges. If and when these fail, those 10 million people will lose insurance. They will fail because the insurance companies cant afford to insure those 10 million people who for the most part are probably sick and high utilization customers.
If Obamacare fails, the 175 million people with insurance will keep their insurance.
I would guess the medicaid expansion patients will keep their benefits, but states will have to scramble to pay for this -- remember the federal medicaid money was going to expire under Obamacare anyway.
Medicare isnt going anywhere.
So that leaves 10 million high risk patients who aren't eligible for medicare or medicaid.
These 10 million people aren't going to push us towards socialized medicine. The states will probably create or GO BACK TO the high risk pools that covered these people in the past. If my math is off, and there really are more people that "slip through the cracks" then politicians should go the people, explain the situation, and propose a tax increase at either the state or federal level to insure these people through medicaid or medicare.
If Obamacare fails, the 175 million people with insurance will keep their insurance.
I would guess the medicaid expansion patients will keep their benefits, but states will have to scramble to pay for this -- remember the federal medicaid money was going to expire under Obamacare anyway.
Medicare isnt going anywhere.
So that leaves 10 million high risk patients who aren't eligible for medicare or medicaid.
These 10 million people aren't going to push us towards socialized medicine. The states will probably create or GO BACK TO the high risk pools that covered these people in the past. If my math is off, and there really are more people that "slip through the cracks" then politicians should go the people, explain the situation, and propose a tax increase at either the state or federal level to insure these people through medicaid or medicare.
What is needed first and foremost is to apply antitrust powers to make the insurance industry competitive. In the Insurance Industry, we have a monopoly.
This will require legislation that currently makes insurance carriers exempt from antitrust remedies. Make this happen NOW!
This will require legislation that currently makes insurance carriers exempt from antitrust remedies. Make this happen NOW!
1
Mr. Leonhardt repeats the conservative mantra that competition between insurance companies keeps the costs of healthcare down, but if that was so, why did the costs continue to spiral upward before Obamacare when insurance companies were competing (admittedly for a smaller population)?
I'm just wondering what economic data exists which supports this proposition, i.e. competition reduces healthcare costs and increases innovation.
With respect to innovation, I am under the impression that regs under Obamacare have forced hospitals and doctors to perform more efficiently and effectively.
I'm just wondering what economic data exists which supports this proposition, i.e. competition reduces healthcare costs and increases innovation.
With respect to innovation, I am under the impression that regs under Obamacare have forced hospitals and doctors to perform more efficiently and effectively.
3
While we are waiting for the country to become sane and institute national single payer, New Yorkers could HAVE it through the NY Health Act (S04840), which has again this year passed the NYS Assembly and needs only 4 votes to pass in the NYS Senate. It would save NY State $45 billion in the first year, save employers $2 billion a year in health care plan costs, save money for local governments, lower property taxes, and provide universal comprehensive coverage with no networks, premiums, co-pays, or deductibles. California has also introduced a single payer plan.
The ACTION IS IN THE STATES. Advocate for single payer in YOUR state and we will get a national plan sooner than you think.
The ACTION IS IN THE STATES. Advocate for single payer in YOUR state and we will get a national plan sooner than you think.
5
Single payer ASAP.It's the only answer.
11
Hopefully people will wake up to what the republicans want-low taxes for the wealthy, climate and people killing deregulation and nothing for tyhe poor and middle class.
Price said on March 7, "It's not about coverage, it's about saving the government money".
3
Time to tweet #45 and tell him to dump Price.
Single payer health care is universally accepted as the solution worldwide.
4
Republicans bringing single payer to the table=pipe dream.
1
Single-payer could be a winning platform for Democrats, but only if they give up their dependence on and allegiance to the financial interests that stand to lose from it.
2
This is the GOP's and Trump's calculation. 11 or 12 million undocumented aliens, 20 million uninsured, hey presto, why do we need to give illegals insurance?
Not sure what the author was smoking, but it certainly wasn't a prescription.
right on all counts...obama caved to the insurance companies...single payer need not cut out competition for anything from insurance to aspirin, let the specs be developed by cogent medical planning and let the bids go out...and let the oversight be strict.
How about repealing the Bush tax cuts in order to pay for Medicare for all?
VA care also is in single payer group
2
You failed to mention that Bernie Sanders has already started this effort "Medicare for everyone".
1
republicans....champions for the overdog.....
2
I cannot understand why there is no discussion of repealing the McCarran Ferguson Act of 1948 and having the feds regulate insurance companies.
1
The time has come for universal single payer health care.
1
Put congress and all federal employees on medicare . then the congress would protect it.
Ain't gonna happen.
Neither was a black president, same-sex marriage, or the fall of the Berlin Wall.
For a long time I have had the suspicion that Americans want socialized medicine, but have been brainwashed in such a way, they don't even have curiosity to go beyond the caricature of political ads.
I think that Medicare for all is the answer but not sure we can afford it.The best way to find out is to lower the age of eligibility to lets say sixty and if it works then in two years down to fifty then in two years more make it available to all.I say to all the Trump doubters that a clean bill like that will be signed by the president.
1
It seems that actual health care is antithetical to the republican right wing, whereas imbedded corruption is the ruling principle.
Brilliant.
Here's my name for what will ultimately evolve: MedicALL
3
"They should open Medicare to people in their early 60s."....A better idea would be to make Medicare available for purchase as one of the options on the insurance exchanges.
13
The GOP is stuck now. Their so-called president campaigned on promises of a "better more beautiful more affordable healthcare for all Americans".
He said this because he knew how much he was able to get his supporters to hate the Kenyan Muslim in the Whitehouse (while he pushed his birther lie) who gave them the"disaster" of Obamacare.
They hated Obamacare but loved the ACA?
So they are expecting a better more beautiful and less expensive healthcare.
Only their 140 character tweeting leader threw them under the bus by threatening their republicans representatives to vote for this terrible bill or lose their seats.
This is all being played out in real time. They watch the news. Fox may blame Ryan for this but It's hard to spin a bad bill that their own leader pushed through.
So now the republicans somehow have to make good on affordable healthcare like the ACA or get blamed for not keeping their promise.
It's hard to impossible to put the toothpaste back in the tube guys.
He said this because he knew how much he was able to get his supporters to hate the Kenyan Muslim in the Whitehouse (while he pushed his birther lie) who gave them the"disaster" of Obamacare.
They hated Obamacare but loved the ACA?
So they are expecting a better more beautiful and less expensive healthcare.
Only their 140 character tweeting leader threw them under the bus by threatening their republicans representatives to vote for this terrible bill or lose their seats.
This is all being played out in real time. They watch the news. Fox may blame Ryan for this but It's hard to spin a bad bill that their own leader pushed through.
So now the republicans somehow have to make good on affordable healthcare like the ACA or get blamed for not keeping their promise.
It's hard to impossible to put the toothpaste back in the tube guys.
11
I would like to add the GOP had 7, SEVEN years to come up with a better plan while they did their repeal and replace dance, at the tax payers expense as well.
So yes, now the GOP and their tweeting leader are stuck with providing the promises HE made to them.
If it took them seven years NOT to come up with a better plan, what will they do by the midterms of 2018?
Starving Obamacare/ACA won't be blamed on the Dems because the GOP has all the cards now.
Fox will spin it for those uneducated haters.
So yes, now the GOP and their tweeting leader are stuck with providing the promises HE made to them.
If it took them seven years NOT to come up with a better plan, what will they do by the midterms of 2018?
Starving Obamacare/ACA won't be blamed on the Dems because the GOP has all the cards now.
Fox will spin it for those uneducated haters.
1
Mr. Leonhardt writes: “That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine.”
Hold on there, Mr. Leonhardt, not so fast! You do realize the implications of socialized medicine. The basis of such a scheme is socialism. Socialism is the basis of communism. Communism is the embodiment of evil.
We have enough evil, we don’t need any more it. Thank you.
Hold on there, Mr. Leonhardt, not so fast! You do realize the implications of socialized medicine. The basis of such a scheme is socialism. Socialism is the basis of communism. Communism is the embodiment of evil.
We have enough evil, we don’t need any more it. Thank you.
1
Single payer is NOT socialized medicine.
1
You do realize that many countries have single payer health care which aren't "socialists" let alone communists? Give up the right wing myth, it's already dead.
2
It's a long way from this kind of socialism to communism. Or do you want to give up Social Securith, too?
FYI, no country in the world has true communism. Russia is a ( increasingly capitalistic) dictatorship.
FYI, no country in the world has true communism. Russia is a ( increasingly capitalistic) dictatorship.
Republicans are for the single payer system. Individuals can, on their own, pay for what they can afford. And that's it. They can also HAVE ACCESS to all kinds of insurance and HAVE ACCESS to the 'greatest healthcare system' in the world....unfortunately, very few of us can afford the access. But that's a different problem to be solved by the single payer...
Like everything else in America... it's all about the money.
Like everything else in America... it's all about the money.
4
I look forward to single payer---why not nationalize all doctors
Doctors can work 8 am-3 pm for the government. Then off to private practice after 3 pm.
They will get a pension, no lawsuits for government work, and possibly a union.
Much to love.
Doctors can work 8 am-3 pm for the government. Then off to private practice after 3 pm.
They will get a pension, no lawsuits for government work, and possibly a union.
Much to love.
3
If you haven't done so, take a look at what you would be paying for insurance through one of the exchanges. Try Healthcare.gov. I was shocked to see that a single person making over $47,000. get's no subsidies and is looking at monthly premiums between $1000 - $2000 a month, plus significant deductibles, depending upon the plan and the state you are in. (I looked at CA and AZ) I now understand why middleclass folks on these plans are very angry. This is not affordable in any stretch of the imagination, except for the wealthy.
I am glad we have the ACA, as it was a big step in the right direction. But we need to fix it, or move to a universal healthcare system. I have always had employer provided health insurance at a reasonable cost, and now realize how lucky I have been. Healthcare needs to be affordable for all.
I am glad we have the ACA, as it was a big step in the right direction. But we need to fix it, or move to a universal healthcare system. I have always had employer provided health insurance at a reasonable cost, and now realize how lucky I have been. Healthcare needs to be affordable for all.
12
Finding out how much our Medicare supplement insurance costs along with required Medicare part B and D was the biggest shock in our retirement. More publicity is needed about the costs of good health insurance today. We pay approximately $1200 combined monthly just for Medicare and supplementary insurance, before any actual medical care or prescription costs.
Well said. I believe single-payer is inevitable, and has been for a long time. The mission of the GOP has been to hold it back for as long as possible. But as a first world economy, the moment we decide that we will not let people die in the street without rendering aid and comfort regardless of their ability to pay - if only in emergency circumstances - we are on an irresistible path to single-payer.
But you have to admire the greed of America that it can hold back the forces of decency for so many decades.
Property is not ownership, but stewardship. And no man is an island.
But you have to admire the greed of America that it can hold back the forces of decency for so many decades.
Property is not ownership, but stewardship. And no man is an island.
5
I don't have to admire these greedy republicans who have their gold plated healthcare for life PAID FORMBY YOU AND ME THE TAX PAYERS.
By the way, NOT the so-called president, who BRAGGED HE DOESNT PAY TAXES BECAUSE HE IS SMART.
By the way, NOT the so-called president, who BRAGGED HE DOESNT PAY TAXES BECAUSE HE IS SMART.
As every civilized nation learned long ago, a single-payer Medicare for all is the only way to cover everyone while controlling costs. Obamacare was actually a not-very-good substitute whose mandate was dreamed up by the Heritage Foundation and initiated as Romneycare in Michigan. If the GOP had adopted it as their own, even going so far as to accuse Obama of "stealing" their idea when he enacted the ACA, they would now be ahead of the game without their repeal and replace disaster. And if Trump wants to regain any of his waning popularity, he would do well to dump the Freedom Caucus and the so-called Republican "moderates" and start consulting with Democrats on how best to implement a single-payer system.
13
Romney's plan was in Massachusetts not Michigan.
1
The road to the promised land : end oligarchical rule (money talks, everyone else walks) and bring on Medicare for all ( single payer) . Sadly, however,the oligarchs have taken over both parties and big insurance, big pharma and big hospitals run the health care industry. Is there a way out of the dark age we are in ?
3
All the republicans need to do is stop calling the ACA Obamacare. It's the name Obama that incites the hatred of the bill.
5
When considering health care coverage for all, it is a huge semantic mistake to call it "socialized medicine". "Socialized" continues to carry pejorative meaning for many people in this country as it harkens back in history to times such as the Soviet period, the McCarthy era, etc . Thus there is an inclination to immediately reject the concept without an understanding what it offers. I am also dismayed that there is minimal discussion of the Kaiser model of health care so popular here in California where "members" pay a monthly "membership fee" ( technically an insurance premium) and receive the care they need for a reasonable copayment. It is a "a capitated" model where both healthy and ill people pay into the system. The model has existed here since post WWII and while it certainly has had its problems at times,but it comes closest to being a health care delivery system that works for all. It is certainly a model that should be considered at a national level.
I hope that the New York times will start to include this model of health care delivery in its articles. Caveat - this model of not popular among the private health care providers and insurance companies of the east coast, and I would anticipate negative responses, but it is an example of a viable delivery system.
I hope that the New York times will start to include this model of health care delivery in its articles. Caveat - this model of not popular among the private health care providers and insurance companies of the east coast, and I would anticipate negative responses, but it is an example of a viable delivery system.
5
and please note that Kaiser employs doctors. They are not in business to make more and more!
Please stop using the phrase "socialized medicine" to describe single payer, David. Socialism has nothing to do with it. It is simply actuarially sound and sustainable insurance, nothing more, nothing less.
7
As a country, we can not continue to not insure our population. It disables us to compete with the rest of the world that does provide proper, basic health care. Same goes with countries that offer free or low cost higher education. Being sicker and stupid does not enhance our nation as a whole.
3
Americans love to say politicians work for them. So, why don't they take the bull by the horns and lead. Tell your doofus Representatives, Senators and President what YOU want, not what they decide to "give" you.
That means becoming an active citizen. This entails reading up, doing some real research. It does not mean become entwined into the mess of the world wide web. Do not go there, fellow citizen. Go to real experts, yes, scientists, experts in the field of both hard and soft sciences. Seek them out for possible solutions to complex problems.
With health care, find out how things successfully operate in countries who are not as wealthy as the US, and who are able to provide better health care for less cost. Compare each country's plan. Which one would be most appropriate for Americans. They are many plans from which to choose. Pick one, but only one. It must be uniform to work, and it must include all, every citizen, from cradle to grave.
Then tell your Representative what YOU want. If they hem and haw, ignore it. You then demand. They get you what you want or you'll find someone who will in the next election. Do not let any politician tell it can't be done. Remind them we're Americans and can do whatever we set our hearts and minds to. I've heard Republicans say they would like the same health care Congress has, but have Congress come up with excuses for not delivering. We are the richest nation on Earth. Act like it.
DD
Manhattan
That means becoming an active citizen. This entails reading up, doing some real research. It does not mean become entwined into the mess of the world wide web. Do not go there, fellow citizen. Go to real experts, yes, scientists, experts in the field of both hard and soft sciences. Seek them out for possible solutions to complex problems.
With health care, find out how things successfully operate in countries who are not as wealthy as the US, and who are able to provide better health care for less cost. Compare each country's plan. Which one would be most appropriate for Americans. They are many plans from which to choose. Pick one, but only one. It must be uniform to work, and it must include all, every citizen, from cradle to grave.
Then tell your Representative what YOU want. If they hem and haw, ignore it. You then demand. They get you what you want or you'll find someone who will in the next election. Do not let any politician tell it can't be done. Remind them we're Americans and can do whatever we set our hearts and minds to. I've heard Republicans say they would like the same health care Congress has, but have Congress come up with excuses for not delivering. We are the richest nation on Earth. Act like it.
DD
Manhattan
2
Never forget that we have experimented long enough with 'markets' and insurance for health care. If employers like Walmart and Hilton and Burger King (essentially the bulk of the service/retail industry, to which our economy has shifted to) had provided their employees with health insurance over the last 2-3 decades, we would be in a different place today. But instead, what those employers did was pocket the money they would have spent on this benefit and kept it for themselves. The time for setting up a "Go Fund Me" or a fundraiser to help a family pay for their child's fight with cancer needs to end. Medicare4All
7
Melissa
These stalwarts of the free market, paradigms of American business and know-how, not only "pocket" the money they ought to spend on health care, they make the rest of us pay for it thorough Medicaid, etc.
Then, like virtually all businessmen, they point out their massive profits, their wisdom and wiliness as executives, their natural superiority over the working classes, and their worthiness to wield social, economic, and political power.
The system stinks. Those at top stink. But mostly, the gullible fools who keep it in place by voting Republican all the time, stink.
These stalwarts of the free market, paradigms of American business and know-how, not only "pocket" the money they ought to spend on health care, they make the rest of us pay for it thorough Medicaid, etc.
Then, like virtually all businessmen, they point out their massive profits, their wisdom and wiliness as executives, their natural superiority over the working classes, and their worthiness to wield social, economic, and political power.
The system stinks. Those at top stink. But mostly, the gullible fools who keep it in place by voting Republican all the time, stink.
1
When the Democratic Party gets its act together and comes back into power, hopefully by the time the 2020 election is all over, it will be time for payback of all sorts, including taking this country into an even more progressive space than Obama left it in--including the move to single-payer--and putting the screws to every Republican concept, and politician, and billionaire, because Obama tried "bipartisan" conciliation with them for eight long years and it never worked. The GOP/far-right monster needs to be destroyed.
1
Q: When did the majority of Americans vote to spend more of their taxes on
attacking others so that they are given greater reason to attack Americans?
A: They didn't.That is decided by their Representatives.
Q: When did the Majority of Americans vote in their Republican
Representatives to spend less of their taxes in order to make health care
coverage more expensive and debilitating as well as offering less but costing
them more?
A: They didn't. War on others, a worse environment, less consumer
protections and reduced employee benefits and opportunities are
considered a better use of their Taxes decided their Representatives.
Q: Who or what do many of the Representatives Represent?
A: Your Taxes & Money and those who want as much of it as they can rake,
make or take at your expense.
That, in a nutshell is the concept best defined as Republicans for every Single-Payer for others Wealth Care...
...or did I get this article's Headline Title wrong?
attacking others so that they are given greater reason to attack Americans?
A: They didn't.That is decided by their Representatives.
Q: When did the Majority of Americans vote in their Republican
Representatives to spend less of their taxes in order to make health care
coverage more expensive and debilitating as well as offering less but costing
them more?
A: They didn't. War on others, a worse environment, less consumer
protections and reduced employee benefits and opportunities are
considered a better use of their Taxes decided their Representatives.
Q: Who or what do many of the Representatives Represent?
A: Your Taxes & Money and those who want as much of it as they can rake,
make or take at your expense.
That, in a nutshell is the concept best defined as Republicans for every Single-Payer for others Wealth Care...
...or did I get this article's Headline Title wrong?
1
We'll have a national health service, single-payer, universal healthcare as soon as we have a ban on assault weapons and stricter limits on all guns nationwide. Except, of course, for muskets for the strict constitutionalists.
And that will be even after hell freezes over, which, due to climate change, brought to you by the Kochs of this world and the GOP, is coming sooner than we thought.
But not soon enough for the millions of Americans who need medical treatment, or for those 30,000 plus human beings killed every year by guns.
The GOP is stupefyingly locked on to the idea that freedom equals a choice of ways to suffer and die.
And that will be even after hell freezes over, which, due to climate change, brought to you by the Kochs of this world and the GOP, is coming sooner than we thought.
But not soon enough for the millions of Americans who need medical treatment, or for those 30,000 plus human beings killed every year by guns.
The GOP is stupefyingly locked on to the idea that freedom equals a choice of ways to suffer and die.
2
Republicans need to begin distancing them selves from Donald Trump before they go down with the USS Trump.. When he and Speaker Paul Ryan tried to hard to sell a health care plan that, if it were as good as they promised, it would have sold itself. But now that many Americans have realized that they cannot be trusted, the people are starting to wonder if, indeed, they can Givern.
Trump and Ryan were planning to take $1 trillion form the money they would have taken from health care premiums to provide corporate welfare to the Health Insurance Industry, and fund the huge tax cuts for the super-wealthy. Sure, they'll throw the little guy a bone; but, look for a National Sales Tax--taking it from our other pocket--as well as huge additions to there National Debt.
How much longer are the Republicans going to stick with Trump before they realize that he'll just drag them down with there USS Trump?
https://thetruthoncommonsense.com
Trump and Ryan were planning to take $1 trillion form the money they would have taken from health care premiums to provide corporate welfare to the Health Insurance Industry, and fund the huge tax cuts for the super-wealthy. Sure, they'll throw the little guy a bone; but, look for a National Sales Tax--taking it from our other pocket--as well as huge additions to there National Debt.
How much longer are the Republicans going to stick with Trump before they realize that he'll just drag them down with there USS Trump?
https://thetruthoncommonsense.com
2
Mr. Leonhardt suggests that the Democrats "should open Medicare to people in their early 60s."
What the Democrats should do is to extend Medicare to all ages. Let babies received at birth a social security card and a Medicare card and be automatically enrolled in both. The structure already is in place to do this, so the roll out will be smooth and simple. We have a single-payer system (except for the bastardized 20% that the elderly are forced to buy from profit makers) for those over 65. Simply extend it to the day of birth.
What the Democrats should do is to extend Medicare to all ages. Let babies received at birth a social security card and a Medicare card and be automatically enrolled in both. The structure already is in place to do this, so the roll out will be smooth and simple. We have a single-payer system (except for the bastardized 20% that the elderly are forced to buy from profit makers) for those over 65. Simply extend it to the day of birth.
2
Few issues have exposed how little Republicans, who tend to be beholden to a fixed ideology, know about real people's lives. It's fine to say "no government bureaucrat should come between you and your doctor," but when we all live with insurance agency burearcrats intervening it rings hollow. And on and on–the gap between the theory of what they preach (trickle down anyone?) and how it plays out in practice is massive. Governing means making things work in the real world where real people live. It's the empathy, stupid.
3
The private market =competition = lower premiums mantra the conservatives have defied for decades is a canard. The price differences are jokingly minimal at best. Please stop promoting this nonsense.
1
The article states that "Medicare is a huge success. Medicaid also works well." Indeed, both programs are huge social safety nets, and from an administrative perspective run surprisingly smoothly for a government bureaucracy. However, the dirty little secret about Medicare and Medicaid is that their reimbursement rates for doctors and hospitals are below cost. Any hospital administrator knows that if their hospital relied solely on the reimbursements rates from these programs, the hospital would run in the red no matter how many patients they served. Hospitals, both not for profit, and for profits ones, only survive financially by trying to attract as many patients with commercial insurance as possible. In some instances, the state (i.e., the taxpayer) makes up the shortfall in Medicaid revenues to cover any deficit.
If a single payer system is ever to evolve and take hold, the reimbursement rates for such a program will have to be adjusted to reflect the uncomfortable and inconvenient reality of health care costs in this country.
If a single payer system is ever to evolve and take hold, the reimbursement rates for such a program will have to be adjusted to reflect the uncomfortable and inconvenient reality of health care costs in this country.
1
Republicans are going to quickly and painfully discover "Label Politics" will be no more successful for them than "Identity Politics" was for Hillary Clinton and the Democratic Party last November.
"Free Enterprise", "Capitalism" "Socialism" or "Socialized Medicine" are meaningless words to millions of Americans who either themselves or a family member are in need medical care.
The Democrats and Republicans should have learned this lesson from Sen. Bernie Sanders unprecedented success during the Democratic primary and his widespread credibility and popularity today.
"Free Enterprise", "Capitalism" "Socialism" or "Socialized Medicine" are meaningless words to millions of Americans who either themselves or a family member are in need medical care.
The Democrats and Republicans should have learned this lesson from Sen. Bernie Sanders unprecedented success during the Democratic primary and his widespread credibility and popularity today.
The ACA was always a shaky ship with many easy ways to sink. But if it does go belly up the only real way to offer people the medical care they now expect will be as this article explains, universal health care, the only possible fix. Insurance companies will not simply rush in and fix everything, there is no certainty left!
1
Perhaps they will unwittingly end poverty, recognize global climate change, and create world peace. All the things the average American understands and wants but the right wing denies or does not care about.
Wouldn't that be lovely!!
Wouldn't that be lovely!!
3
Single payer coverage in the US will be a debacle of unprecedented proportions because unless the runaway COSTS of healthcare are addressed the tax bill for it will be ruinous. Doctors, pharmaceutical companies and the healthcare industry will never accept the lower, government mandated costs that might help single payer work. Instead, feckless politicians will let them set the costs and pass the bill on to taxpayers while they boast about what a good job they've done.
1
Even though we presently live in Panama where our health insurance is $160 a month, for both of us and private care is very good here. We do us Medicare when visiting the states. The problem is not health care but the cost for people who cannot afford insurance. This is why everyone needs to be in the same boat when it comes to health insurance and prescription drugs. We have no prescription insurance here in Panama and pay for the same price for prescription drugs that we paid for in the states with insurance. And the pills come from the same American company. We need a national program that brings the prices down so people can afford good care.
2
It was a sweet irony to see how many Republicans dared to go back to their constituents thinking they could boast about "repealing and replacing" Obamacare, only to find that those who had been so angry with "Obamacare" dearly loved the Affordable Care Act! And it's going to be impossible to rip health insurance away from so many who have now had it - - - public-option, single-payer will only begin to make more and more sense if we are to ever bring down health care costs. We spend three times as much and get so much less than other countries with single-payer systems. That picture will begin to crystallize as people pay more attention - having just about lost their coverage - and recognize the lies Republicans tell for what they are - lies!
1
I find it a big stretch that Ryan and Price would ever bring single-payer to fruition. Ryan was hoping to privatize SS and Medicare after the ACA was destroyed with Price helping Ryan do that.
Single payer would be nice and would create Goodwill on Trumps part, but I don't see Ryan ever bringing this forward unless he could make a deal with Trump to privatize SS to the extreme.
Single payer would be nice and would create Goodwill on Trumps part, but I don't see Ryan ever bringing this forward unless he could make a deal with Trump to privatize SS to the extreme.
Medicare for all is the only viable option moving forward. The GOP hates it because they resent paying for anything that benefits others - except of course for their billionaire overlords.
If it was up to the Freedom Caucus- they would repeal Medicare, Medicaid and Social Security so I doubt they will willingly embrace Medicare for all.
Universal healthcare is the right thing to do which is why the GOP will never be in favor of it.
If it was up to the Freedom Caucus- they would repeal Medicare, Medicaid and Social Security so I doubt they will willingly embrace Medicare for all.
Universal healthcare is the right thing to do which is why the GOP will never be in favor of it.
2
This is also a big supply-side problem. There need to be many more medical students in the pipeline to take care of our increasingly older population. While cities like NYC may not have as acute a need for more doctors, there are many places in the US where this is a significant issue.
The GOP only looks to the insurance companies to fix the problem. They are in a profit making business, and they make billions. The Republicans don't want to admit that allowing for-profit businesses to increase profits means cutting expenses includes life-saving procedures. Insurance companies deny life-saving services to make a profit; this will never work out well for patients.
The GOP only looks to the insurance companies to fix the problem. They are in a profit making business, and they make billions. The Republicans don't want to admit that allowing for-profit businesses to increase profits means cutting expenses includes life-saving procedures. Insurance companies deny life-saving services to make a profit; this will never work out well for patients.
2
The Republicans (house, senate, state governors) are responsible for the most significant problems with the ACA. They refused ANY involvement in crafting or supporting the legislation and/or its implementation. They built the proverbial wall to resist it in order to see it struggle to take hold. BUT it took hold anyway - at least in principle -because health care is now seen by most Americans as a right . THAT, in my opinion, is the biggest achievement of the ACA. It has changed the discussion about health care and I don't think the Republicans can in-ring that bell.
1
I really like the idea of lowering the age of Medicaid to 60. I like age 50 better. If a company realized they did not have to pay health insurance on older adults, It would make people over 50 more employable. This would also include the vast majority of people who are costly to insurance companies.
2
Besides the successful Medicare and Medicaid, the government ALSO provides single payer healthcare to millions in TriCare, serving current and retired military people...and they get care for life at amazingly low costs (even for highly-paid personnel)
Now let's just expand these programs...having people pay proportionally to their income/age. A back-door approach to get the USA caught up with all other advanced nations.
Now let's just expand these programs...having people pay proportionally to their income/age. A back-door approach to get the USA caught up with all other advanced nations.
1
Announced at a joint town hall meeting in Hardwick, Vermont this past Saturday, Bernie Sanders will soon be introducing a Medicare for All bill in the senate, and Peter Welch will do so simultaneously in the house. Right now they are signing up co-sponsors. As this process unfolds they (and we) need to keep a steel-eyed focus on a truly universal single-payer system and not a complicated mix of Medicare, Medicaid, and public option. One system, period. The practice of medicine is complicated. Paying for it should not be so.
It will be pentultimate irony if Trumpcare turns out to be a unified single-payer system crafted by the left, an ultimate slap in the face to the Clintonistas who set up the roadblocks to prevent Bernie from becoming president.
It will be pentultimate irony if Trumpcare turns out to be a unified single-payer system crafted by the left, an ultimate slap in the face to the Clintonistas who set up the roadblocks to prevent Bernie from becoming president.
2
Obama could have done more than he did. As president, he could have directed the VA or Medicare to hire actuaries and start a pilot program, to study how much it would cost to sell insurance to individuals who were either not veterans, or not 65. With the studies firmly in hand, he could have announced to the nation "I can sell you medical insurance for (insert figures from the study here)". He also could have asked for single payer then negotiated down to the public option. Yet he did neither of those things.
He was either a lousy negotiator, or he was warned off by someone with the influence to make him listen.
Fast forward to today. I work for a company that is notoriously stingy about routine raises... they don't give them. Yet on the first day of the month I became eligible for Medicare, at long last, I got a raise. Why? Maybe it was because I didn't need them as much as I did the month before. Is there a linkage here? Do large corporations continue to pay for medical insurance because of the leverage it gives them over their employees? The timing of that raise made me wonder.
He was either a lousy negotiator, or he was warned off by someone with the influence to make him listen.
Fast forward to today. I work for a company that is notoriously stingy about routine raises... they don't give them. Yet on the first day of the month I became eligible for Medicare, at long last, I got a raise. Why? Maybe it was because I didn't need them as much as I did the month before. Is there a linkage here? Do large corporations continue to pay for medical insurance because of the leverage it gives them over their employees? The timing of that raise made me wonder.
1
Our medical system is heavily regulated. Our doctors are certified by the government. They go to schools that are accredited by our government. They prescribe drugs approved by the FDA. They work with nurses that are regulated by the government. It is illegal for a health care provider to exist outside of this government regulated system. THERE IS NO FREE MARKET. Heath care has to be regulated by the government to keep it safe. So lets finish the job and regulate price with universal health care.
1
Those are unsafe hands for socialized medicine to rest in. Price, like most Republicans, but more strongly than most simply doesn't care about anything but himself. His touchstone seems to be income for orthopedic surgeons, and after than reducing access to care for anyone not qualified as rich. He is, lie Ryan, cynical and self-serving.
Otherwise the single payer argument makes a lot of sense.
Otherwise the single payer argument makes a lot of sense.
2
I was starting to feel hopeful until I read your last sentence. Sadly, this is our reality now. However, I believe Trump and his malevolent campaign to try to wipe out the progress we have made thanks to Barack Obama and the progressives before him will fail in the end.
I am grateful for the leaders who are trying every day to slow the GOP wrecking ball. Progress takes a long time to come to bear, undoing it will not be easy either if people resist and let them know it.
Republicans need to be held accountable for the suffering that will occur, there must be constant pressure on them from constituents demanding fairness. Then they must pay dearly in future elections for their lazy and regressive policies. It's only a matter of time.
I am grateful for the leaders who are trying every day to slow the GOP wrecking ball. Progress takes a long time to come to bear, undoing it will not be easy either if people resist and let them know it.
Republicans need to be held accountable for the suffering that will occur, there must be constant pressure on them from constituents demanding fairness. Then they must pay dearly in future elections for their lazy and regressive policies. It's only a matter of time.
1
" “Americans now think government should help guarantee coverage for just about everyone,” as Jennifer Rubin, a conservative, wrote.
Trump seemed to understand this during the campaign and came out in favor of universal coverage. Once elected, though, he reversed himself. "
He "understood" that he had to "pretend" like he believed people should "have" coverage. It was an important element of his faux populism that resonated with his fans.
Trump has no core beliefs other than an relentless compulsion for personal wealth acquisition and a continuous need for self aggrandizement.
It's all smoke and mirrors.
Trump seemed to understand this during the campaign and came out in favor of universal coverage. Once elected, though, he reversed himself. "
He "understood" that he had to "pretend" like he believed people should "have" coverage. It was an important element of his faux populism that resonated with his fans.
Trump has no core beliefs other than an relentless compulsion for personal wealth acquisition and a continuous need for self aggrandizement.
It's all smoke and mirrors.
1
Ironic thoughts indeed. This op-ed raised my heart rate and gave me some hope. I have never been able to figure out why single payer is such a lightning rod. I have lived in other countries where even as a foreigner I was covered.
I believe that one way or the other we, as Americans are all paying too large a price for our current system of private insurance and care. The stress, the complications, the expense, the refusals to cover care. On and on the list of what I like to call "intangible taxes" grows longer and longer. Most of it caused by for profit insurers. Our system is at odds with the end goal.
I have the means to cover my health insurance even in tougher times but, what about those that don't? I loose a lot of sleep over health insurance because I know that there are people inadvertently raising their own intangible tax rates because they do not have consistent access to proper health care and are in constant worry about the most basic of needs. Most people are struggling to "pull themselves up by their own bootstraps". Their bootstraps are stretched and broken for a multitude of reasons that many seem not to fully understand.
Personally I am happy to pay a higher monetary tax rate to get those people covered. I believe that the people in this country are suffering from a health crisis that affects every moment of their lives. This makes America weaker. Not helping people makes us weaker. We have the resources to make this part better. I hope someday we do.
I believe that one way or the other we, as Americans are all paying too large a price for our current system of private insurance and care. The stress, the complications, the expense, the refusals to cover care. On and on the list of what I like to call "intangible taxes" grows longer and longer. Most of it caused by for profit insurers. Our system is at odds with the end goal.
I have the means to cover my health insurance even in tougher times but, what about those that don't? I loose a lot of sleep over health insurance because I know that there are people inadvertently raising their own intangible tax rates because they do not have consistent access to proper health care and are in constant worry about the most basic of needs. Most people are struggling to "pull themselves up by their own bootstraps". Their bootstraps are stretched and broken for a multitude of reasons that many seem not to fully understand.
Personally I am happy to pay a higher monetary tax rate to get those people covered. I believe that the people in this country are suffering from a health crisis that affects every moment of their lives. This makes America weaker. Not helping people makes us weaker. We have the resources to make this part better. I hope someday we do.
You can't fit all the problems with the American health care system into 1 box.
First, we pay way too much for healthcare in the United States. Where do the bulk of those dollars go? Hospital care - over 80% of all dollars go there, and most of that in the final weeks of a person's life. Those costs are largely unregulated and we all pay for it in our premiums, co-pays and deductibles. If you want to seriously control costs, then create a catastrophic single payer that covers all inpatient, emergency and drug costs. We'd all pay into a tax for this, but it would force our government to actually regulate these massive costs and it would put medical bankruptcy to an end.
Once you remove the cost barrier of catastrophic care, you have a much more affordable, elective or preventative care system that can be largely private. The government can mandate that everyone buys some form of elective/preventative care plan, but the costs would be fractions of what they are now once you remove hospital and drug costs from the mix.
Overall, I suspect most would pay a lot less for health insurance. I suspect people will actually utilize preventative care once its affordable. And I think we'd be a much healthier nation. We'd all sleep better at night.
Who loses in this equation? Large hospital corporations and large private insurance companies - the very people making trillions of dollars while the rest of us pay for their excess.
First, we pay way too much for healthcare in the United States. Where do the bulk of those dollars go? Hospital care - over 80% of all dollars go there, and most of that in the final weeks of a person's life. Those costs are largely unregulated and we all pay for it in our premiums, co-pays and deductibles. If you want to seriously control costs, then create a catastrophic single payer that covers all inpatient, emergency and drug costs. We'd all pay into a tax for this, but it would force our government to actually regulate these massive costs and it would put medical bankruptcy to an end.
Once you remove the cost barrier of catastrophic care, you have a much more affordable, elective or preventative care system that can be largely private. The government can mandate that everyone buys some form of elective/preventative care plan, but the costs would be fractions of what they are now once you remove hospital and drug costs from the mix.
Overall, I suspect most would pay a lot less for health insurance. I suspect people will actually utilize preventative care once its affordable. And I think we'd be a much healthier nation. We'd all sleep better at night.
Who loses in this equation? Large hospital corporations and large private insurance companies - the very people making trillions of dollars while the rest of us pay for their excess.
Single Payer system is the only moral option at this point. Institute a VAT to pay for it. Medicare works better than anything else so just expand it and set us all FREE.
1
Any physician who is a Republican is in violation of the Hippocratic oath of Do No Harm. The Republican party does harm to the nation with its tax policies and devoted reliance to the mercies of the free market, an institution which however useful in organizing economic activities, will always fail to create a health care system which is a public, not a private, good. No advanced nation relies exclusively, save for the US, on the free market to deliver care. Measuring US health care outcomes against any other nation demonstrates how disgraceful we are.
1
Just review health care in Canada, and the Northern European countries. They all have the best care there is.
Also, how dare those congress members try to deny us anything like their health care system. You NEVER hear any members of congress wanting to change their health care provided by we the citizens who pay for it through taxes.
Why are they not willing to give us the same as they get.?
Also, how dare those congress members try to deny us anything like their health care system. You NEVER hear any members of congress wanting to change their health care provided by we the citizens who pay for it through taxes.
Why are they not willing to give us the same as they get.?
2
Employer-based health insurance might work for governments and big business but it does not work well for small business and the self-employed. And market-based health insurance is worse because the risk pool is too small. Only single-payer can address the needs of workers who are not employed by big insistitutions.
4
The Democrats will never win the health care debate until they advance sufficient & cogent arguments as to why the guarantee of universal health care should be an unalienable right of all Americans. I have been thinking for sometime about these arguments & remain baffled by why no Democrat has developed any consistent or sustained talking points. i think 3 lines of attack can be used. First, consider the right's consistent emphasis on the government's obligation to outlaw abortion. How can one truly be pro-life if one first doesn't automatically guarantee that a pregnant woman will have all the health care she needs regardless of cost to guarantee the delivery of a healthy baby? And, once the baby is born, how can one be truly pro-life if the same government doesn't see to it that that helpless baby isn't guaranteed again regardless of cost health care, food, clothing, shelter & educational opportunity until such time as it becomes a responsible adult equipped to support the government in those guarantees to newer generations? Second, the economic argument recognizes that with EMTALA legislation the health care sector cannot deny emergency care despite inability to pay. Numerous studies have shown that universal health care coverage reduces significantly to cost of this unfunded mandate. Third, those who argue that their liberty is trampled on by personal healthcare mandates should realize no citizen is free if they are threatened by bankruptcy from a healthcare crisis.
1
Medicare for all. Negotiate prices. If you don't like what you get, buy a booster policy.
3
I hope the establishment Democrats in charge of the party are smart enough to grasp the implications of the defeat of the Ryan bill. They should be proposing Medicaid expansion now. They should be promoting the inclusion of a public option in counties in which there are fewer than three insurance companies offering policies. They should fight to lower premiums by funding the risk corridors that Marco Rubio de-funded in order to cause premiums to rise just before the 2016 election. They should support Sander's Medicare-for-all proposal.
They will, of course, fail to get any of this through Congress as long as Republicans control the House and Senate. But Democrats must be in a position to argue that they had solutions to the weaknesses of the ACA and that if there is a collapse of the ACA, it is the fault of Republicans who sabotaged it.
Of course, that's assuming Democrats in Congress a have the brains and the courage to do what the public wants and what they must do to get back in control of the government.
They will, of course, fail to get any of this through Congress as long as Republicans control the House and Senate. But Democrats must be in a position to argue that they had solutions to the weaknesses of the ACA and that if there is a collapse of the ACA, it is the fault of Republicans who sabotaged it.
Of course, that's assuming Democrats in Congress a have the brains and the courage to do what the public wants and what they must do to get back in control of the government.
12
At the risk of repeating myself,
I'm angry at the politicians – whose families will have health care for the rest of their lives – that refuse to fix the problem of health care funding, but instead, cripple the very delivery system that could serve all Americans.
Notwithstanding that health care costs do need to come down, the age old debate still exists: The only way for health care to be funded, affordable and available to all, regardless of income level, is to charge EVERYONE whether they use health care or not - that is, through taxes, from DAY 1. No one should be able to "opt-out" and some sort of premium should be collected for [from] every person, starting at age 0.
In many areas, health carriers pull out because the healthy don't participate (pay premiums) in significant enough numbers to offset increasing utilization by those who pay the least and use health care the most. Consequently, MY premiums are inflated to cover when Mr. X or Ms. Y use the emergency room as their primary care physician. The other way I pay for other's health care is through my taxes that pay for local health programs. Either way, I pay twice and they don't pay.
The answer is staring us in the face. Instead of crippling ACA so it does fail, fix it! Health care should be paid for by everyone for their lifetime. For example, imagine if 172 million 65 year-olds paid $25 a month for the past 65 years (of premiums)....do the math, that’s $,$$$,$$$,$$$.$$.
Bring an end to uncompensated care!
I'm angry at the politicians – whose families will have health care for the rest of their lives – that refuse to fix the problem of health care funding, but instead, cripple the very delivery system that could serve all Americans.
Notwithstanding that health care costs do need to come down, the age old debate still exists: The only way for health care to be funded, affordable and available to all, regardless of income level, is to charge EVERYONE whether they use health care or not - that is, through taxes, from DAY 1. No one should be able to "opt-out" and some sort of premium should be collected for [from] every person, starting at age 0.
In many areas, health carriers pull out because the healthy don't participate (pay premiums) in significant enough numbers to offset increasing utilization by those who pay the least and use health care the most. Consequently, MY premiums are inflated to cover when Mr. X or Ms. Y use the emergency room as their primary care physician. The other way I pay for other's health care is through my taxes that pay for local health programs. Either way, I pay twice and they don't pay.
The answer is staring us in the face. Instead of crippling ACA so it does fail, fix it! Health care should be paid for by everyone for their lifetime. For example, imagine if 172 million 65 year-olds paid $25 a month for the past 65 years (of premiums)....do the math, that’s $,$$$,$$$,$$$.$$.
Bring an end to uncompensated care!
6
Tom Price made his deal with the dark side years ago. Why he's still in office is testament to our country's other ignored problem: an education system trounced by conservative ideologues for decades. Sack him and the world's better off.
5
I agree. I wonder at communities that continue to elect representatives that care so little for people! The only way to change Washington is to change the people who are sent there. For the first time - ever, I have contributed to a campaign in another state to help defeat Mitch McConnell. It will take all of us investing our time and money to change Washington.
1
The Republican plan was not the most conservative plan existing. The most conservative plan could work implemented properly but never will for numerous reasons. In the meantime, the ACA plan is such a Gordian Knot, that single-payer is inevitable.
1
Senator Bernie Sanders is in the process of submitting a bill for single payer. Let us hope that intelligence and what is good for the nation, rather than politics, prevails.
8
With Medicare expansion will come opportunities for private insurers to sell Medi-Gap policies, which are necessary as Medicare does not pay for everything. As this process moves forward (hopefully it will), we must be vigilant that the insurance companies don't start milking the system by pushing their HMO systems (known as Medicare Advantage plans).
2
Close to half of U.S. physicians support a single-payer system. Burn-out rates among physicians is now around 50%. One cause is the red tape burden imposed by our 1,500 profit-making health insurance companies. For example, oncologists spend some 15 or more hours per week fighting with insurance companies to get life-saving treatments approved for their patients.
20
It was seriously thought-out and proposed many years ago. Each year drop the age of Medicare eligibility by one year. Think about it.
2
The notion that 'Medicaid also works well' paints far too rosy a picture, usually by those who view it from afar, with a data driven view, and without up close, personal, or intimate knowledge of it. Yes, Medicaid is better than having no insurance. But in our evolving class/money based system of medical care it is the equivalent of steerage class on the boat or standing room in the theater.
To begin with, a huge, significant number of doctors do not accept Medicaid-try getting an appointment with a specialist in Manhattan, or, closer to home, here in Michigan where in one metropolitan area 9 of 10 specialists in one field would not accept Medicaid. Medicaid patients of course retain the 'choice' of paying cash. Looked at from the other side, that of the doctors, Medicaid payments are much less than even those of Medicare, and if patients think they have difficulty dealing with their insurer, it's even worse for doctors' offices dealing with Medicaid which has no worry about patient pushback or patients leaving their system.
The notion of expanding Medicaid seems to me like the idea of making more iron lungs for polio victims when we have a vaccine.
To begin with, a huge, significant number of doctors do not accept Medicaid-try getting an appointment with a specialist in Manhattan, or, closer to home, here in Michigan where in one metropolitan area 9 of 10 specialists in one field would not accept Medicaid. Medicaid patients of course retain the 'choice' of paying cash. Looked at from the other side, that of the doctors, Medicaid payments are much less than even those of Medicare, and if patients think they have difficulty dealing with their insurer, it's even worse for doctors' offices dealing with Medicaid which has no worry about patient pushback or patients leaving their system.
The notion of expanding Medicaid seems to me like the idea of making more iron lungs for polio victims when we have a vaccine.
2
I am a 73 year old surgeon, so I have the unique viewpoint of both a provider and a recipient of Medicare. I can tell you that is a pretty decent system. I get paid for my work without the evilness of private insurance companies, who's goal is to mimic John Grisham's "Rainmaker", taking as much money in and providing as little care as possible that they can get away with.
It is time to take as much capitalism out of health care as we can. It is amoral to be profiting from people's illness. Shame on the insurance companies, the pharmaceutical companies and the medical manufacturers.
Medical care is not like getting you car fixed. We are a nation that believes it is everyman/woman's right to life, liberty and the pursuit of happiness. That translates to a right to have our illnesses be taken care of, whether we are rich or poor.
Ryan's health plan was a farce. It was a tax scam. Take from the poor and give to the rich. And the Donald, who didn't even read it, called it "The Best".
Sad
Bad
It is time to take as much capitalism out of health care as we can. It is amoral to be profiting from people's illness. Shame on the insurance companies, the pharmaceutical companies and the medical manufacturers.
Medical care is not like getting you car fixed. We are a nation that believes it is everyman/woman's right to life, liberty and the pursuit of happiness. That translates to a right to have our illnesses be taken care of, whether we are rich or poor.
Ryan's health plan was a farce. It was a tax scam. Take from the poor and give to the rich. And the Donald, who didn't even read it, called it "The Best".
Sad
Bad
30
I am always struck by the questions around the republican agenda of taxes and the amount of money one individual should be able to keep from the fruits of their labor, inheritance, station at birth,etc. It comes down to how much is enough, how many houses, how many cars, how many jets, how many yachts, how much dry powder, how much sly pride in your war chest does a person need for the to be happy. I know many .01 percenters can give hundreds of thousands even millions at a moments notice to the charity of the moment and wry smile they have because it is in their capability to do this at any moment.However, isn't it also very important to understand which rung on the latter of opportunity you were born on, either through genetic gifts or actual hard currency inheritance and shouldn't people understand that at a certain level enough is enough?
2
Krugman demonstrated why competition does not produce better services at a better price in Health insurance; competition is who can get premiums from healthy people and dump actual patients who need to be paid for. Health care payment must be a public responsibility. Nothing else works
3
"Health Care is not to make things Right, it is a profit Opportunity"
-A.Wealth Care Provider
Truer words were never said, but are often thought by those that have the most to gain at most's expense.
The time is fast approaching and is well overdue for turning what most think they want and need into the reality it can and must be.
Single Payer Health Care for All.
Now.
-A.Wealth Care Provider
Truer words were never said, but are often thought by those that have the most to gain at most's expense.
The time is fast approaching and is well overdue for turning what most think they want and need into the reality it can and must be.
Single Payer Health Care for All.
Now.
6
So those who oppose Obamacare because it's Obama's [aka racists], will eventually support single payer, Medicare for all? Maybe by lowering the age to 60, then 50; raising the kids' coverage age to 30, and then finally giving Medicare to all, and letting Medicare negotiate drug prices like they should? Sounds like a Nixon goes to China moment! And how ironic that blatant racism led to this common sense solution that the rest of the Western world adopted decades ago! Leave the
Of course the bigger irony in all this is that "Obamacare" it modeled on the Republican plan called, "Romneycare" in Massachusetts. When Mitt Romney became governor of Massachusetts all the talk was about a single-payer system at the state level. Keeping the insurance companies in the mix was a compromise to Romney - thus, Romneycare. I do believe that was a mistake, and a single payer system would be far superior and more cost effective. What percentage of the 7%-9% of GDP difference between the expensive US system and those of the developed world with government administered single payer systems is attributable to the bureaucracy, profit margin, and inefficiency of the insurance middlemen?
5
Please! Single payer is NOT SOCIALIZED MEDICINE and you know it! It won't happen in DC until one state tries it first. Like California's SB 562!
8
Anything short of universal coverage is . . Uh . . Short. Provide healthcare, eliminate premiums, raise taxes, single risk pool. So simple, and so inevitable.
10
Unless and until healthcare is a birthright no less than the right to breathe, America will remain a second-tier nation where the welfare of its own citizens is concerned. This will not happen under Trump, who has already forgotten more than once the promises he made on the campaign trail. Secretary Price certainly has the appropriate surname for his preferred method of medical services delivery. Americans can have all they want, for a price.
4
Expanding Medicaid is a doable goal right now. Rather than storm the gates and demand single payer, Obama has shown that incremental change can push towards the worthy goal of insurance for all. Those of us who have tangled with insurance companies know what a terrible system it is. Health care should not be for profit, even in a capitalist driven economy. It isn't really working that way since so many must end up in the ER and drive up costs. But if the GOP can wrestle free from their demons and at least allow for Medicaid in all states that would in itself go a long way to at least insure families and low income citizens. It will be harder and harder to make the case to working families that they should sacrifice care so billionaires can get tax breaks.
3
A minor but essential point, essential because words matter: Single payer is not a synonym for socialized medicine. Government involvement, in itself, is not socialism. And to go a bit farther on this subject, on matters of health care there is no such thing as a viable "free market", here or elsewhere, Price notwithstanding.
2
Lowering the age to qualify for Medicare would also move a large proportion of higher cost members/patients out of the exchanges thereby reducing the cost of those plans. Meadows claims his yard stick for success is lower premiums.
2
It would also remove a disincentive for companies to hire those who are late-middle aged. As those in this age range bring up the premiums charged by health insurance companies for employers that provide health insurance to their staff, hiring or retaining older workers impacts health care costs for all of their employees in a negative way. So if perhaps those who are 60 plus can apply for and receive Medicare, this might allow more to stay employed or find employment. This in turn helps to stave off the collapse of Social Security as more continue to work.
It may be that the federal practice of keeping universal health care away from American citizens will start to suffer the same fate as the insane federal war on American citizens through including marijuana usage in its "war on drugs." States are going to engage in civil disobedience and eventually a state will pass a single payer plan of its own. As soon as that success occurs, every state will develop the courage to do the same. Colorado, first in the nation to break from the insane "war on drugs" by passing successful marijuana decriminalization and regulating its use was the first to attempt to pass a single payer plan. The referendum so panicked Republicans and yhe establishment Republican-Lite Democrats (which Leonhardt's editorials consistently fail to hold accountable) that both groups campaigned to kill it. Now, California is reaching to break Washington's strangling of decent health care. One of these initiatives is going to succeed. Unfortunately, it will not be with the support of establishment political animals. It will occur eventually in spite of anything they can do about it. Trying to move a developed country back into the status of a third-world country to have its citizens exploited by insurance companies and out-of-control pharmaceutical corporations should carry a heavy political price and perhaps even punishment in the courts for such corruption.
1
If the GOP were actually pro-business they would know that a universal single payer system would be a real boon for employers - and would arguably create jobs in large organizations that currently spend thousands of dollars per employee per year on health insurance.
Small and medium businesses would be freed of the pressure (and cost) of offering health insurance, making them more competitive and increasing their ability to attract top performers.
Universal coverage not tied to a particular job also creates a more mobile and happier workforce and by extension, boosts productivity and job satisfaction.
From a business perspective, it really is a no-brainer. And from a humanitarian perspective, it's the right thing to do.
Small and medium businesses would be freed of the pressure (and cost) of offering health insurance, making them more competitive and increasing their ability to attract top performers.
Universal coverage not tied to a particular job also creates a more mobile and happier workforce and by extension, boosts productivity and job satisfaction.
From a business perspective, it really is a no-brainer. And from a humanitarian perspective, it's the right thing to do.
17
We're not going to make much progress with socially beneficial agendas like single-payer until we start repeating the narrative that the money the wealthy have actually belongs to the people--it's the result of a tax levied by the rich on working people long before the government even gets to think about taking a cut. Therefore there is no moral dilemma in taking some of that money back to pay for the basic human right of health care.
The so-called "Freedom Causus" celebrates Americans right not to purchase healthcare. So a non-covered person gets sick - possibly with a life- threatening communicable or infections disease which can cause an epidemic - and has no money to afford treatment: does he seek medical treatment and if so, who pays?
2
Let's get this straight - a single payer system like Medicare is NOT socialized medicine. Socialized medicine is a system where the medical professionals (doctors, nurses, etc.) are all government employees, and medical clinics and hospitals are owned and operated by the government. The VA and military medical systems are examples of socialized medicine. Under Medicare and other single payer systems, medical providers are in the private sector, as are medical facilities. There should be no confusion about what is socialized medicine and what is not.
2
Why not expand Medicare to age 60? This could help ensure older Americans would stay employed until they choose to retire -- with same healthcare coverage -- rather than being pushed to retire early without.
2
We have 100 years of experience with private for-profit health insurance and one thing we know is that they will never voluntarily provide comprehensive affordable coverage for the old, the poor, or the sick. Private insurers don't compete to provide the best care at the best price. They compete to collect the most premiums and pay out the least in medical expenses by "medical underwriting" and putting up obstacles to care or outright denials. Government programs, on the other hand, are designed to provide care to satisfy clients (voters), not to make a profit. That's why they are more cost effective and have higher satisfaction rates (including the VA).
1
Back in 2003 the Republicans offered a major gift to the drug companies when it barred Medicare from negotiating drug prices. I could go on, but you get the point.
3
Expand Medicare for All (because Single-Payer is socialized medicine!)
Newsflash for those who are dead set against socialized medicine -- we already have it! We have since President Johnson signed Medicare and Medicaid into law in 1965. Even the infamous Ayn Rand ended up enrolling in Medicare (and grabbed social security, too!)
Like the word "Obamacare" scared the pants off of millions of people who actually enrolled in the ACA, the word "Single-Payer" has the same effect with millions of Americans and the media wonks who manipulate them.
In the past several years, we've all learned a whole lot about the importance of branding in the healthcare space.
Why not refer to it is as "Medicare for all"? Countless people who hate socialized medicine are already enrolled in Medicare! People accept Medicare. It has the largest network, and the best results in terms of ease of use and cost savings. The insurers will most certainly hate being massively downsized, but American and Americans would benefit both financially and physically.
Newsflash for those who are dead set against socialized medicine -- we already have it! We have since President Johnson signed Medicare and Medicaid into law in 1965. Even the infamous Ayn Rand ended up enrolling in Medicare (and grabbed social security, too!)
Like the word "Obamacare" scared the pants off of millions of people who actually enrolled in the ACA, the word "Single-Payer" has the same effect with millions of Americans and the media wonks who manipulate them.
In the past several years, we've all learned a whole lot about the importance of branding in the healthcare space.
Why not refer to it is as "Medicare for all"? Countless people who hate socialized medicine are already enrolled in Medicare! People accept Medicare. It has the largest network, and the best results in terms of ease of use and cost savings. The insurers will most certainly hate being massively downsized, but American and Americans would benefit both financially and physically.
2
Single payer healthcare would be less expensive and more effective. But it is a right-wing nightmare, not a dream.
Single payer healthcare would require higher taxes and more regulations. Most planks in the Republican Party platform are intended to lower taxes, reduce regulation and downsize government, which supports a lot of Democrats.
Tom Price has devoted his political career to undermining government healthcare programs.
Paul Ryan's only real objective is to lower taxes on the rich.
Donald Trump doesn't have a clue about healthcare and doesn't really care
Their American Health Care Act was all about, only about eviscerating single payer for the poor (i.e., Medicaid), gutting government regulations that make the Obamacare exchanges work and cutting taxes on the wealthy.
It's a bit much to expect them to do a 180 on taxes, regulations and government size.
Single payer healthcare would require higher taxes and more regulations. Most planks in the Republican Party platform are intended to lower taxes, reduce regulation and downsize government, which supports a lot of Democrats.
Tom Price has devoted his political career to undermining government healthcare programs.
Paul Ryan's only real objective is to lower taxes on the rich.
Donald Trump doesn't have a clue about healthcare and doesn't really care
Their American Health Care Act was all about, only about eviscerating single payer for the poor (i.e., Medicaid), gutting government regulations that make the Obamacare exchanges work and cutting taxes on the wealthy.
It's a bit much to expect them to do a 180 on taxes, regulations and government size.
1
Health"care" sold it's soul decades ago to the moneyplace. There is NO excuse to avoid single payer - healthcare is desperate to apply more hard and soft sciences to the practice of medicine rather than the bloated practice of money for a few.
The whole world knows single payer is the most efficient. It only shows how very dysfunctional this country has become.
4
When you mention single-payer healthcare, conservatives often come up with horror stories about such systems in other countries.
Rationing and long wait times are usually cited as the disadvantages of single-payer systems. Canada is often cited as an example. Upon close examination, however, these arguments don't hold much sway.
"5 Myths About Canadian Health Care," published by AARP, should be required reading for those who decry the single-payer system. http://tinyurl.com/7z8uuw9
Our healthcare delivery is needlessly complicated with multiple health insurance companies peddling their "plans" and an inordinate amount of time and money spent on healthcare administration.
Rationing and long wait times are usually cited as the disadvantages of single-payer systems. Canada is often cited as an example. Upon close examination, however, these arguments don't hold much sway.
"5 Myths About Canadian Health Care," published by AARP, should be required reading for those who decry the single-payer system. http://tinyurl.com/7z8uuw9
Our healthcare delivery is needlessly complicated with multiple health insurance companies peddling their "plans" and an inordinate amount of time and money spent on healthcare administration.
2
"When you mention single-payer healthcare, conservatives often come up with horror stories about such systems in other countries. "
And when they do, they are liars by omission, at best.
It may be that the best health care in the world resides in America (I somehow doubt it), but it is certainly the case that 99% of Americans will never see it. It's sequestered on special floors of hospitals and medical centers where only the rich can access it.
And, no, by 'rich' I don't mean you, who ever you are. By 'rich' I mean people who can afford to occupy an entire hospital floor and pay an inflated daily stay rate for every bed in the place. For weeks at a time.
Most importantly, though, is that our system, defended so breathlessly by those Patriots opposed to socialized medicine, pays out nearly a trillion dollars every year to a health insurance industry that offers nothing, adds nothing to the economy, creates nothing, and serves no-one other than its own executives and investors.
That amount alone would almost pay the entire cost of a single payer system. And instead of an unregulated corporate monster dedicated to denying as much service as they can without arousing the public, we would have an accountable system focused on providing service efficiently.
Right now, our treatment approvals are in the grubby hands of underpaid functionaries working for a system that, by definition, is only concerned with its own economic success.
And when they do, they are liars by omission, at best.
It may be that the best health care in the world resides in America (I somehow doubt it), but it is certainly the case that 99% of Americans will never see it. It's sequestered on special floors of hospitals and medical centers where only the rich can access it.
And, no, by 'rich' I don't mean you, who ever you are. By 'rich' I mean people who can afford to occupy an entire hospital floor and pay an inflated daily stay rate for every bed in the place. For weeks at a time.
Most importantly, though, is that our system, defended so breathlessly by those Patriots opposed to socialized medicine, pays out nearly a trillion dollars every year to a health insurance industry that offers nothing, adds nothing to the economy, creates nothing, and serves no-one other than its own executives and investors.
That amount alone would almost pay the entire cost of a single payer system. And instead of an unregulated corporate monster dedicated to denying as much service as they can without arousing the public, we would have an accountable system focused on providing service efficiently.
Right now, our treatment approvals are in the grubby hands of underpaid functionaries working for a system that, by definition, is only concerned with its own economic success.
And if the health care system in these countries was actually that bad, why would their life expectancies and infant mortality rates be betters than ours? Seems the masses aren't too capable of critical thinking.
1
What I have always wanted is a single payer National Health Policy...nothing else can come close to competing w/ the size/scale/volume of a national policy....I want THE very best deal possible, no time wasting shopping around competition so called "choices", I want THE very best deal from cradle to grave. I would like it now.
1
How about a full honest discussion of single-payer healthcare, which I am in favor of? All doctors work for the government health system, which sets their salaries! Hospitals are similarly government run! Oversupplied urban regions (too many beds per population) will see closures and under served rural areas will have healthcare practitioners assigned to them! No more unneeded medical testing (defensive medicine) as malpractice lawsuits will be prohibited!
2
We can expand Medicare for all by lowering the eligibility age for older Americans and including the youngest individuals. Over several years private insurance would eventually be eliminated. The cost should come out of general taxes and savings by streamlining delivery. Doctor's malpractice insurance could be replaced by stricter licensing and removal enforcement and some government compensation to victims. Patients can participate in their own medical monitoring with computer feedback to their physician. With innovation, scientific breakthroughs and intelligence we can make this the healthcare century.
2
Single-payer is inevitable. Price will unwittingly make it possible.
So: Lyndon Johnson - One, Donald Trump - Zero, when it comes to health care. If single-payer come to pass, it will become even more imperative than ever to see a stem-to-stern reform of the health delivery systems in the U.S. This includes Medicare, Medicaid and the VA's Tri-Care programs. It also includes some sort of controls over prescription medicine prices. The program recommended by Dr. Nortin Hadler (in his book, "By the Bedside of the Patient"), which looks to me intriguingly like the one put forward by Sen. Bernie Sanders last fall, deserves some serious attention, IMHO.
3
Elsewhere in today's Times is a story about doctors from Africa in Maine who are training to be EMTs. That's all well and good, but why can't they be DOCTORS here? I'm sure lots of places in the United States would welcome them. They shouldn't be earning $10/hour wasting their education in this land of opportunity.
1
The point of the Ryan/Trump plan was to generate a trillion dollars to fund a tax cut for the wealthy. It had only nominally anything to do with providing health care.
Republicans bitterly opposed Social Security and Medicare when they were introduced. The AMA predicted the collapse of American medical care. Now everyone loves these programs. The same will happen with Medicare for all if we can find the opportune moment to pass it.
Republicans bitterly opposed Social Security and Medicare when they were introduced. The AMA predicted the collapse of American medical care. Now everyone loves these programs. The same will happen with Medicare for all if we can find the opportune moment to pass it.
1
Only if health care workers are employed directly by the government is it socialized medicine.
The definition of socialized manufacturing is that the government owns and operates the business.
One could call it socialized payments I suppose i.e. taxes collected and paid to private physicians. Physicians who will improvise and compete.
Definitions and clarity are especially important when applied to programs that profoundly affect the well being of so many.
As an aside the difference between Socialism and Communism. In socialism workers are paid according
to productivity not to their needs.
The definition of socialized manufacturing is that the government owns and operates the business.
One could call it socialized payments I suppose i.e. taxes collected and paid to private physicians. Physicians who will improvise and compete.
Definitions and clarity are especially important when applied to programs that profoundly affect the well being of so many.
As an aside the difference between Socialism and Communism. In socialism workers are paid according
to productivity not to their needs.
Single payer health insurance would bring many benefits to the USA, such as providing reliable coverage to many more Americans, allowing expanded ability to negotiate prices with drug companies, extending preventive services to many more recipients, and making many kinds of services for both physical and mental health disorders more readily available. As Rep. Wilbur Mills was said to have remarked, however, when asking God about the prospects for such national health insurance, God replied "not in my lifetime"--it was considered that difficult!
So for now, we have the Affordable Care Act. It may be the best this nation can manage any time soon--hard to say. What we know for certain, however, is that Tom Price and minions at CMS and other parts of DHHS will do everything in their power to destroy the ACA through deliberate policies and actions intended to make it unworkable.
Price's antipathy to decent health care -- given his training and previous work experience -- is inexplicable to many, but there cannot be any question of his negative attitudes about making decent health care broadly available in this country. As with so many other Trump family and associates, he's in it for the money (particularly from drug company investments).
Perhaps the most we can hope for is that, by undermining the ACA, he will unwittingly (and certainly unintentionally) hasten the day when we can have a single payer system, and make God happy in the bargain !!
So for now, we have the Affordable Care Act. It may be the best this nation can manage any time soon--hard to say. What we know for certain, however, is that Tom Price and minions at CMS and other parts of DHHS will do everything in their power to destroy the ACA through deliberate policies and actions intended to make it unworkable.
Price's antipathy to decent health care -- given his training and previous work experience -- is inexplicable to many, but there cannot be any question of his negative attitudes about making decent health care broadly available in this country. As with so many other Trump family and associates, he's in it for the money (particularly from drug company investments).
Perhaps the most we can hope for is that, by undermining the ACA, he will unwittingly (and certainly unintentionally) hasten the day when we can have a single payer system, and make God happy in the bargain !!
1
We must write our congressman and demand single payer health care. Let's use what is successful; the Medicare model. Let's look at European nations for successful systems. Congress works for us. Tell them so.
1
Wrong, Wrong and Wrong.
Medicaid is not our savior. Medicaid is like having a shiny a new car without an engine. It doesn't take you anywhere. Our health care system is designed for PRIVATELY payed health education and providers followed by privately paid health insurance. Medicare is also a "private" insurance company. WE pay into it. Similar to a health saving account. The trouble is that its managed by the GOVERNMENT. All wasted. We have the infrastructure in our privately run health industry to make Medicare work but not Medicaid
Medicaid is a true government subsidy, an " entitlement". The trouble is that we forgot to create the infrastructure to support it. Not enough doctors, clinics, hospitals, to support the Medicaid system. It would be like using a band aid to treat gas gangrene. Obamacare is a band aid.
The same scenario applies to a single payer system. First we need to establish the infrastructure, ie clinics, Hospitals, Doctors, Nurses, tech's and most importantly health education payed for by the same " Universal" system. With our current education system, it cost over a million dollars to educate and train one doctor. It's all payed privately by the individual.
We need a comprehensive reform if a Universal Health system is the solution, otherwise we will be left with shiny new Volkswagens without engines.
Medicaid is not our savior. Medicaid is like having a shiny a new car without an engine. It doesn't take you anywhere. Our health care system is designed for PRIVATELY payed health education and providers followed by privately paid health insurance. Medicare is also a "private" insurance company. WE pay into it. Similar to a health saving account. The trouble is that its managed by the GOVERNMENT. All wasted. We have the infrastructure in our privately run health industry to make Medicare work but not Medicaid
Medicaid is a true government subsidy, an " entitlement". The trouble is that we forgot to create the infrastructure to support it. Not enough doctors, clinics, hospitals, to support the Medicaid system. It would be like using a band aid to treat gas gangrene. Obamacare is a band aid.
The same scenario applies to a single payer system. First we need to establish the infrastructure, ie clinics, Hospitals, Doctors, Nurses, tech's and most importantly health education payed for by the same " Universal" system. With our current education system, it cost over a million dollars to educate and train one doctor. It's all payed privately by the individual.
We need a comprehensive reform if a Universal Health system is the solution, otherwise we will be left with shiny new Volkswagens without engines.
It is a fitting tribute that social used medicine is in Dr.Price's hands! It is not so ironical. Ask the crossover voters in Pennsylvania, West Virginia, Michigan, Ohio and Wisconsin who gave Mr.Trump his unexpected victory! The learned doctor's medicine will be good for them. After all the failed repeal and replace goal is a temporary defeat as the battle wages. The wily doctor can easily repeal health care conservatism for socialism instead and achieve his boss's objective with a pliable and disgraced speaker's connivance to fix Congress's busy calendar.
A denial-of-care algorithm is central to Obamacare. Recall Obama's infamous: "Maybe your [elderly] mom is better off taking painkillers & forgoing the pacemaker."
Static scoring, inside-the-box thinking, Obama lies…
Despite the ACA death spiral, the Left's Pavlovian drool continues—conditioned reflex, facile punditry & picaresque prose that practically writes itself.
Were the skyrocketing premiums just days before the election bad timing or a Machiavellian plot?
The death spiral IS the plan. Ds are already pushing for the public option. Obama/Emanuel/Gruber have told how they would keep down the costs, a "complete lives system" that would allocate scarce resources by generating a priority curve favoring patients aged 15–40 w/o chronic defects.
Let's be consistent & apply this standard to fatally defective Obamacare: Replace it w/ a market-based plan that will increase quality/accessibility & reduce costs of health CARE—as opposed to illusory health INSURANCE w/ its fascistic mandate, fleeing doctors/insurers, unaffordable premiums, & stratospheric deductibles that render "health-care insurance" catastrophic only.
"Obamacare is a crazy idea"—Bill Clinton
"This bill was written in a tortured way to make sure CBO did not score the mandate as taxes…call it the stupidity of the American voter or whatever"—Jonathan Gruber
Static scoring, inside-the-box thinking, Obama lies…
Despite the ACA death spiral, the Left's Pavlovian drool continues—conditioned reflex, facile punditry & picaresque prose that practically writes itself.
Were the skyrocketing premiums just days before the election bad timing or a Machiavellian plot?
The death spiral IS the plan. Ds are already pushing for the public option. Obama/Emanuel/Gruber have told how they would keep down the costs, a "complete lives system" that would allocate scarce resources by generating a priority curve favoring patients aged 15–40 w/o chronic defects.
Let's be consistent & apply this standard to fatally defective Obamacare: Replace it w/ a market-based plan that will increase quality/accessibility & reduce costs of health CARE—as opposed to illusory health INSURANCE w/ its fascistic mandate, fleeing doctors/insurers, unaffordable premiums, & stratospheric deductibles that render "health-care insurance" catastrophic only.
"Obamacare is a crazy idea"—Bill Clinton
"This bill was written in a tortured way to make sure CBO did not score the mandate as taxes…call it the stupidity of the American voter or whatever"—Jonathan Gruber
Informed by my general practitioner at an esteemed Chicago medical institution that I needed to be scoped on both ends, I immediately pushed back when I reckoned with the price. Though I have Federal health benefits, the same ones that Paul Ryan and other members of Congress enjoy, they would pay for me to have the identical procedure at the hospital of my choice in Paris. Instead of a $22-25K cost to the benefits, we're talking in the range of $7K. The airfare and expenses on the ground, barring the purchase of $9,000 cufflinks from Hermes, would amount to a tax writeoff if they exceed 2% of my gross income for this year. Imagine the pushback from my doctor, who has "lost" my request to transfer medical records twice already. Ryan is merely the smarmy Irish undertaker presiding over the death of America's way of life, armed with the embalming fluid of plutocracy to administer to the expiring body politic. My own doctor must be a fan.
1
As a MD in my early 60s rather than give my health insurance premiums to a private insurance company whose executives are making tens of millions in salary, would gladly pay the premiums to buy into the Medicare program. Let's start by offering a public option e.g. Single payer for those over 55 to buy into. Medicare is an excellent program, with a 4 percent administrative overhead as opposed to private insurance and the 20 percent or more they keep as a loss ratio (administrative overhead). Look at the profits the private insurers make. It's obscene
Don't let the right wingers talk about Government death panels. It's pure nonsense . Time to offer a public option, Medicare to compete with the private insurers .
Don't let the right wingers talk about Government death panels. It's pure nonsense . Time to offer a public option, Medicare to compete with the private insurers .
2
The ACA is no more than a tourniquet placed on healthcare in the US. In the ACHA Republicans wanted to remove the tourniquet.
15 years ago, Donald J. Trump said the USA should join the rest of the world that handles the administration (single-payer) of health care in the US... It's the only way we will ever have real health care that invests in prevention of illness and early detection and CURE. Why? Because we have our very lives - the health and well being of our family - at the mercy of profit-driven corporations AKA insurance companies that function on an illness-management system. They collect "premiums" from people for years, and make their money via lots of paperwork to deny claims and provide little prevention and early detection because most people lose their insurance coverage and end up relying on the government (largest single-payer of health care) for end-of-life care. #Medicare4All is what we need to ever bring down the costs. We currently have legislated ourselves (the government/taxpayers) out of any ability to negotiate drug prices... That lousy piece of law was part of the Bush administration's Plan D direct payment to big pharma drug corporations on behalf of the people. We need to gradually allow people at earlier ages to join Medicare via the "public option" that Obama wanted in the Affordable Care Act -- But SURPRISE~ He couldn't get enough votes from his own Democrats to have public option. AKA MONEY FROM LOBBYISTS making those direct campaign donations to the candidates and the Democratic Party #DNC.
It wasn't Obamas democrats, it was one hold out. JOE LIEBERMANN, an independent from Connecticut who blew it.
1
It's me again..as usual I'm posting the list of countries with universal health care..all in all for our it's LESS EXPENSIVE, MORE EFFICIENT and
if I didn't have to spend so much money on health insurance , well maybe I could afford to buy meat several times a week, and even a new pair of glasses.
I'd probably sleep better too!. BTY if there are any readers living in a country on the list below who have complaints about their countries health care system..
PLEASE enlighten us Americans...see list below
Country Start Date of
Universal Health Care
Australia 1975
Austria 1967
Bahrain 1957
Belgium 1945
Brunei 1958
Canada 1966
Cyprus 1980
Denmark 1973
Finland 1972
France 1974
Germany 1941
Greece 1983
Hong Kong 1993
Iceland 1990
Ireland 1977
Israel 1995
Italy 1978
Japan 1938
Kuwait 1950
Luxembourg 1973
Netherlands 1966
New Zealand 1938
Norway 1912
Portugal 1979
Singapore 1993
Slovenia 1972
South Korea 1988
Spain 1986
Sweden 1955
Switzerland 1994
United Arab Emirates 1971
United Kingdom 1948
if I didn't have to spend so much money on health insurance , well maybe I could afford to buy meat several times a week, and even a new pair of glasses.
I'd probably sleep better too!. BTY if there are any readers living in a country on the list below who have complaints about their countries health care system..
PLEASE enlighten us Americans...see list below
Country Start Date of
Universal Health Care
Australia 1975
Austria 1967
Bahrain 1957
Belgium 1945
Brunei 1958
Canada 1966
Cyprus 1980
Denmark 1973
Finland 1972
France 1974
Germany 1941
Greece 1983
Hong Kong 1993
Iceland 1990
Ireland 1977
Israel 1995
Italy 1978
Japan 1938
Kuwait 1950
Luxembourg 1973
Netherlands 1966
New Zealand 1938
Norway 1912
Portugal 1979
Singapore 1993
Slovenia 1972
South Korea 1988
Spain 1986
Sweden 1955
Switzerland 1994
United Arab Emirates 1971
United Kingdom 1948
6
What matters?
In real estate it is
Location
Location
Location
In healthcare reform it is
Single payer
Single payer
Single payer
Resist, tom price!
In real estate it is
Location
Location
Location
In healthcare reform it is
Single payer
Single payer
Single payer
Resist, tom price!
1
Tom Price should be in jail for inside trading, Trump should be in jail for about 20 things and counting. Ryan is a pathological liar that has been caught red handed in the light of day.
THESE ARE NOT PEOPLE YOU BUILD A SOCIETY ON.
THESE ARE NOT PEOPLE YOU BUILD A SOCIETY ON.
I wonder how much it would cost to purchase all for profit health care companies in order to make single payer insurance a quicker reality? $100 billion? $200 billion? More? Doing so worth every penny!
2
Correction. Medicare For All is not socialism, it is social insurance. The providers, and para medical purveyors remain private. The pay in is through payroll taxes for the most part, but instead of waiting for Medicare it is available at every age. Regulations are slanted more to users of insurance rather than providers.
If true universal health insurance is presented so that all who have to pay in see an advantage, it can come to fruition sooner. 60% of the country and its doctors already are in favor of such a system.
How to get younger folks to buy in? They have to come to realize if they want a sterling health system when they reach an older age it is an ongoing process, not stuck at the level when they are young. It is the same anticipation that folks have presently towards Medicare. They pay the tax gladly so solid insurance will be available at age 65. For a higher payment according to income, but still affordable, they can have that peace of mind immediately and be contributing to improved care when they get older.
If true universal health insurance is presented so that all who have to pay in see an advantage, it can come to fruition sooner. 60% of the country and its doctors already are in favor of such a system.
How to get younger folks to buy in? They have to come to realize if they want a sterling health system when they reach an older age it is an ongoing process, not stuck at the level when they are young. It is the same anticipation that folks have presently towards Medicare. They pay the tax gladly so solid insurance will be available at age 65. For a higher payment according to income, but still affordable, they can have that peace of mind immediately and be contributing to improved care when they get older.
1
Solving the healthcare problem in the U.S. would be so simple if it were not for ideology and politics. A bipartisan commission formed from members of congress or one made up of members from the private sector (or both) would first examine the single-payer plans around the world which have operated successfully for many years. The features of those plans which would work best for the U.S. would be assembled into a single-payer healthcare plan to be considered and voted on by the members of congress. Unfortunately, we have in the congress a large segment whose ideology is that the federal government should never be involved in such a large social program. Never! So, in reality, nothing like this is possible until we have progressives in charge of all branches of government. Those who believe that a single-payer system is the most efficient, cost effective plan with the best health outcomes must first put the right people in charge of the federal government. That is job one!
1
Dear David
I completely agree. If Trump would actually have done what he said he would do, provide coverage for everyone, via Medicare for all with negotiated prices he would have had a huge victory with only the Freedom Caucus in opposition. It would have been a bi-partisan success that would irrevocably alter the trajectory of health care costs. Instead he listens to Ryan, Bannon, Sessions and Priebus. I hope Democratic leadership will start now to reach across the isle and get it done rather than using this failure for political gain.
I completely agree. If Trump would actually have done what he said he would do, provide coverage for everyone, via Medicare for all with negotiated prices he would have had a huge victory with only the Freedom Caucus in opposition. It would have been a bi-partisan success that would irrevocably alter the trajectory of health care costs. Instead he listens to Ryan, Bannon, Sessions and Priebus. I hope Democratic leadership will start now to reach across the isle and get it done rather than using this failure for political gain.
1
Americans have been propagandized by conservatives into thinking single payer health care in Europe brings low quality care and will bankrupt those nations. We know this is not true. So why do conservatives lie. Because they want to lower taxes on the rich. Conservative politicians talk about smaller government. That's interesting because they are working for the federal government and get sweet pensions and perks that you and I will never have. They don't turn away those perks. So they are hypocrites.
1
A few simple facts. All private insurers restrict choice of doctors. Out of network doctors have higher co-pay and deductibles. All businesses with over 5,000 employees use a single payer model through self insurance to avoid the high cost of private insurers. Medicare and Medicaid have a lower cost than private insurers. There is no free market in healthcare. A free market assumes competition. There is no price competition between doctors and hospitals. The private insurance market simply adds profit and administrative cost to the cost of care. Trump's business acumen was considered a strength. If you consider the American people shareholders of his business, any responsible businessman would chose the single payer model.
2
Bismarck was an arch conservative German Chancellor, but a pragmatist. He understood that a healthy population is a productive one. The easiest and cheapest way to chive this seemed to be the universal healthcare. It is the country’s (nation’s, Government’s) self-interest.
After all this enthusiasm on NYT about the failed republican attempt to replace ACA I went to scout the opinion of the other side. I read some of the reader’s comments on Fox News.
Seems that most people are mad at the Republicans not because they failed to replace ACA, but because they have attempted it. Their mandate was to REPEAL the act. As one of them explained it was something like this: “I want to have a decent job and I will purchase a healthcare for myself and my family. The government has no business meddling in this affair. America is a free country. Those who like the socialist universal healthcare are free to move to Europe.”
Plain and simple.
Looks like a clash of world views. Like in Medieval Europe. Protestants vs Catholics. No compromise, no prisoners. Who is right, who is wrong?
After all this enthusiasm on NYT about the failed republican attempt to replace ACA I went to scout the opinion of the other side. I read some of the reader’s comments on Fox News.
Seems that most people are mad at the Republicans not because they failed to replace ACA, but because they have attempted it. Their mandate was to REPEAL the act. As one of them explained it was something like this: “I want to have a decent job and I will purchase a healthcare for myself and my family. The government has no business meddling in this affair. America is a free country. Those who like the socialist universal healthcare are free to move to Europe.”
Plain and simple.
Looks like a clash of world views. Like in Medieval Europe. Protestants vs Catholics. No compromise, no prisoners. Who is right, who is wrong?
1
I see a different path to single payer.
I see success for the very viable single payer system proposed in california, followed by states like Oregon, Washington and hopefully my own Colorado joining the pool
This is how it happened in Canada. It could happen rapidly here, and toothless quack Tom Price and his corporatist budfies will not stop it.
I see success for the very viable single payer system proposed in california, followed by states like Oregon, Washington and hopefully my own Colorado joining the pool
This is how it happened in Canada. It could happen rapidly here, and toothless quack Tom Price and his corporatist budfies will not stop it.
1
"Until then, the future of socialized medicine is in the hands of Dr. Tom Price."
Holy Putting-the-Wolf-in-Charge-of-the-Hen House, Batman! Hard to believe that Price is actually a physician. More like he is an opportunist and puts his own well-being in front of anyone else's.
Representatives and Senators get top-tier health care in D.C. There is even a clinic at their disposal right in the capitol building should they fall ill. What hypocrites.
Holy Putting-the-Wolf-in-Charge-of-the-Hen House, Batman! Hard to believe that Price is actually a physician. More like he is an opportunist and puts his own well-being in front of anyone else's.
Representatives and Senators get top-tier health care in D.C. There is even a clinic at their disposal right in the capitol building should they fall ill. What hypocrites.
2
I think we make a huge tactical error if we assume that Tom Price can do no harm. He is a vicious ideolog and should be watched closely. Remember, the power of republican majority in the house is beyond anything the democrats, working in collaboration with a handful of republican moderates, can project legislatively. This is unlikely to change in 2018, and will merely change in 2020 but only with a lot of hard work. Until then, a record should be kept of every harmful stratagem Dr. Price employs to take us back to a time when life expectancy was 40 and health care was only for the wealthy. Professor Darwin meet Dr. Price.
The conservatives will just keep pushing for their single prayer plan. Get sick? First pray, then die.
Signing up for Medicare this year. Will have the basic, publicly funded program, and will also pay out of my own pocket for an 'advantage' package of benefits provided by a private insurance company. What a beautiful system! Should be available to every American, regardless of age. Period.
1
NYT and its columnists are averse to mentioning Bernie sanders and Liz Warren. Who are holding town hall meetings and talking to trump supporters who voted for him only because they didn't want to vote for a clinton. If well read educated and elite columnists would even bother to listen to what Bernie is addressing, you would understand what ordinary Americans are saying and thinking. Especially the ones whose grapes turned out sour an unfolding nightmare. Can we have some perspective or is it beneath NYT to mention Senators Bernie and Liz Warren?
1
The Republican Fascist Party will NEVER do anything that doesn't benefit the billionaire class and the corporate welfare nanny state. The idea that the GOP would embrace single payer is a pipe dream. It is a political mafia totally lacking in empathy and compassion for their less fortunate fellow Americans, fellow human beings. The only way American will ever become great again is for the electorate to destroy this extremist, anti-people political malignancy that is a much greater threat to the people than any external terrorist organization. It's time to stop pretending that there is even one iota of good, one shred of humanity in the GOP. It is an plague that must be eradicated before it destroys all of us. RESIST !!!
There should not be further discussion about expanding public payor systems such as Medicare or Medicaid until (1) there is a substantial change in the purchasing of services so that costs are controlled, and (2) the enrollees accept the reality that they cannot have whatever they "need." While not as dire as the "free market" system, inflation also plagues the public payor systems because of the fee for service billing and the notion that the patient should be able to get anything he or she "needs" (organ transplants for 90 year olds?). The US spends twice per capita what any other country spends for pretty lousy results. Imagine if Pres. Obama had first said we are going to slay the cost conundrum and then expand access. The political challenge is substantial but the public needs to be told that this system will be less generous and the provider community from docs, to pharmaceuticals, to gadget manufacturers told they too will get less. If done, we can have a public, single payor system yielding savings that can be invested in our younger generations (i.e., education) which are the cohorts really being screwed by our current health care system. A Chevy not a Bentley for the old, and less debt for the young.
1
"American Exceptionalism" is true in concept but false in execution. Look at where we rank in all the relevant measures of national well-being. Our conservative (non-) leaders refuse to consider, let alone adapt, proven ideas from other developed nations. I guess they think that would be "leading from behind," or some similar bogus conclusion that flies in the face of their adolescent testosterone. So sad. So immature. So plain dumb and hurtful to the American Project.
1
Argh -- why use the polarizing term "socialized medicine" twice in this article, Mr. Leonhardt? Words really matter when it comes to this issue, as evidenced by the recent revelation that many Americans who both liked and benefited from the ACA did NOT like Obamacare. Stick with the more accurate "single payer" or "universal health care," and we may just have a shot at pushing this through...finally.
239
Thank you for calling Mr. Leonhardt out on his use of this shop-worn but amazingly tenacious phase which was first used by the AMA at the suggestion of a Madison Avenue advertising agency to thwart President Truman's 1947 national health care proposal. It has since become a real bugaboo. It is time to move on.
Americans go backward every time they vote Republican. Sad but true.
286
Amazing how quickly about 46% of the voters forgot the big crash of 2008 that nearly destroyed us all. Instead, they buy one more bite at the poison apple of Republican economics disguised as "populism". When will they learn?!
1
We're not quite back to the 19th century, but we getting close.
I am a Republican and agree with those who believe there should be coverage for everyone. Catastrophic care. No one should have to go bankrupt to have life saving care. But that's it. Everything else is on your own. Either out of pocket, or through an employer who chooses to offer it. Go to the emergency room and get triaged. If you are sick enough to be admitted, you are treated and covered. If not, you are sent to urgent care where you pay or get turned away. Message: keep yourself healthy enough to avoid getting sick, and prioritize finances to pay for times you get sick anyway and need attention.
7
Jack, I'll keep what you said in mind when I'm unemployed and have to choose between food, shelter, and medical care. Guess which one wins because I'm not covered in fur or a reptile: shelter. And guess what happens when I'm ill and find that no matter how much I earn or save I can't afford medical care: I let the illness or symptom go until I can't ignore it at which point I have to use the ER but may not be admitted because I have no insurance because I'm not working.
The real answer is a single payor system that is for everyone no matter how poor or how rich they are. And everyone pays into it through taxes on the usual items or through taxes levied on their earnings with no caps on those who make more than 100K. It's the only way to make sure that every person can get the medical care they need when and where they need it. We shouldn't have to choose between the basic necessities of life or going bankrupt to get the medical care we need. In this day and age access to medical care is a more important right than owning a gun.
The real answer is a single payor system that is for everyone no matter how poor or how rich they are. And everyone pays into it through taxes on the usual items or through taxes levied on their earnings with no caps on those who make more than 100K. It's the only way to make sure that every person can get the medical care they need when and where they need it. We shouldn't have to choose between the basic necessities of life or going bankrupt to get the medical care we need. In this day and age access to medical care is a more important right than owning a gun.
8
You do know that going to the ER isn't "free"? Someone pays for it, usually the the rest of us, as by law, ERs are required to care for people. OTOH, perhaps you just think that policy is bad, and people should just suffer and die if they can't pay?
7
The overwhelming flaw in your argument is that it ignores the best possible kind of care: preventive care. You have it exactly backwards.
Keeping people healthy is the number one responsibility of health care. It keeps people working, avoids the added expense of treating sick people, and ultimately improves the economy.
Using the emergency room as a substitute for ongoing preventive care is a stupid waste of resources and a guarantee that both the cost of healthcare will continue to rise and the population will get sicker.
Keeping people healthy is the number one responsibility of health care. It keeps people working, avoids the added expense of treating sick people, and ultimately improves the economy.
Using the emergency room as a substitute for ongoing preventive care is a stupid waste of resources and a guarantee that both the cost of healthcare will continue to rise and the population will get sicker.
7
I don't understand why Republican orthodoxy is so anathema to human decency. Where's the logic? I agree someone needs to be responsible when paying the bills but that's not the Republican party anymore. Somewhere along the line Republicans became the tax cut and spend party. Worse, some Republicans aren't even respectful about giving the middle finger to everyone else. We have an aristocracy lacking taste, tact, and class.
The disregard and disrespect are utterly transparent. Hence, the Trumpcare/Ryancare failure. I'm expecting tax reform will look similar. More simple though, the AHCA failed one critical test: Do you want to spend more time and energy thinking about health care? The answer is universally no. Say goodbye to market based solutions. Now we just need to reorient the market and silence the private interests.
I also agree we need someone to push for single payer. Oh wait. Someone already did. Bernie Sanders. He and his supporters were derided as unrealistic and impossible. In today's world, that's probably true. A Sanders health care plan would likely end up looking like a Clinton compromise... BUT!!! You don't run a campaign on the compromised end result! Run on the dream and then figure out what you can pass. Example A: Obamacare.
The disregard and disrespect are utterly transparent. Hence, the Trumpcare/Ryancare failure. I'm expecting tax reform will look similar. More simple though, the AHCA failed one critical test: Do you want to spend more time and energy thinking about health care? The answer is universally no. Say goodbye to market based solutions. Now we just need to reorient the market and silence the private interests.
I also agree we need someone to push for single payer. Oh wait. Someone already did. Bernie Sanders. He and his supporters were derided as unrealistic and impossible. In today's world, that's probably true. A Sanders health care plan would likely end up looking like a Clinton compromise... BUT!!! You don't run a campaign on the compromised end result! Run on the dream and then figure out what you can pass. Example A: Obamacare.
192
The key is making sure such hard hearted greedy Republicans are clearly portrayed to their hapless voters as an anathema.
Actually, someone else pushed for single-payer: Nixon. He makes the current GOP crop look like the turds they really are, and he was no angel.
The GOP orthodoxy is really just patriarchy by the rich. Look who's in the pictures, a bunch of old white men. They feel very entitled to everything, and let the Devil take the hind-most.
This should be an interesting 4 years, because most all the guys are 70 years old, and many have not been kind to their bodies. Nature is not kind to them at this time of their live and thing can go wrong catastrophically. Hide and watch, but meanwhile work like heck to throw road blocks in their way and make their life difficult answering phone calls and appearing at Senate Committee hearings and town hall meetings.
This should be an interesting 4 years, because most all the guys are 70 years old, and many have not been kind to their bodies. Nature is not kind to them at this time of their live and thing can go wrong catastrophically. Hide and watch, but meanwhile work like heck to throw road blocks in their way and make their life difficult answering phone calls and appearing at Senate Committee hearings and town hall meetings.
If we had a public option throughout the country, the insurance companies would come to understand the truth of the assertion most recently voiced by Elizabeth Warren: "Either you have a seat at the table or you are on the menu."
If they did not want to compete, they would not be forced to do so and would "vote themselves off the island". And good riddance to them. Little has been gained by having them sucking on the teat of the sick needing care.
If I am not for me, who will be?
If I am only for me, who am I?
If not now, when?
If they did not want to compete, they would not be forced to do so and would "vote themselves off the island". And good riddance to them. Little has been gained by having them sucking on the teat of the sick needing care.
If I am not for me, who will be?
If I am only for me, who am I?
If not now, when?
2
Huh.
So yo say single payer is the way forward?
It's also the most politically realistic?
Who'd a thunk that?
Ah, that's right. Bernie.
The pie in the sky guy.
So yo say single payer is the way forward?
It's also the most politically realistic?
Who'd a thunk that?
Ah, that's right. Bernie.
The pie in the sky guy.
Having a for-profit healthcare system is the root of the problem. Perhaps many people don't know that an enormous amount of money goes into sustaining a vast and incompetent administrative infrastructure designed to make collecting on a claim feel like time spent in a Kafka novel. See;
https://www.bloomberg.com/news/articles/2013-04-10/the-reason-health-car...
As a healthcare provider in private practice, I spend an appalling amount of time just trying to get paid for the work I do. Quick example: I submitted a claim to a company ELEVEN times because they kept denying they'd received it. When finally they acknowledged the claim, it was denied due to "untimely filing". And hold times to get claims adjusted when they are denied for no apparent reason or simply to ask a basic question run up to an hour!
I would gladly accept less pay under a single payer system to be spared the maddening time suck that is inflicted by for profit insurance companies. I could serve more people and earn the same. Why isn't this obvious?
https://www.bloomberg.com/news/articles/2013-04-10/the-reason-health-car...
As a healthcare provider in private practice, I spend an appalling amount of time just trying to get paid for the work I do. Quick example: I submitted a claim to a company ELEVEN times because they kept denying they'd received it. When finally they acknowledged the claim, it was denied due to "untimely filing". And hold times to get claims adjusted when they are denied for no apparent reason or simply to ask a basic question run up to an hour!
I would gladly accept less pay under a single payer system to be spared the maddening time suck that is inflicted by for profit insurance companies. I could serve more people and earn the same. Why isn't this obvious?
17
Excellent post.
To answer your question, it IS obvious.
The problem is not the lack of wisdom about the superiority of a single payer. It's the greed of politicians who actually know better, but choose to place their own power and money over the needs of the people.
To answer your question, it IS obvious.
The problem is not the lack of wisdom about the superiority of a single payer. It's the greed of politicians who actually know better, but choose to place their own power and money over the needs of the people.
Problem from 2 years ago that explains rising rates and failing companies and co-ops:
https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-aff...
Problem in courts now:
https://www.nytimes.com/2017/03/24/upshot/trumps-choice-on-obamacare-sab...
https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-aff...
Problem in courts now:
https://www.nytimes.com/2017/03/24/upshot/trumps-choice-on-obamacare-sab...
1
"Medicare is a huge success."
Hold up there, sparky.
Medicare is hugely popular, because it handles seniors' bills with a relative minimum of hassle, but being a huge political success is different from being a huge operational success.
Medicare is also bleeding out tens of billions of dollars a year to waste, fraud and bill-padding - and if I had a nickel, or better yet, the correct Medicare billing codes for every time a promised improvement in oversight vanished, I'd be wealthy indeed.
Medicaid's got the same problems. New York got popped a few years ago for overbilling Medicaid by about $15 billion for services for the mentally disabled, over a period of 20 years. The disabled did get their care, but at a cost at least four times that of any of the other 49 states.
Where'd the rest of the money go? Ask Albany and they'll just give you the turned-out-pockets Monopoly-guy look.
A system that lets not just Florida crime operations but entire state governments skate off with billions of dollars does not meet any reasonable definition of "huge success."
Hold up there, sparky.
Medicare is hugely popular, because it handles seniors' bills with a relative minimum of hassle, but being a huge political success is different from being a huge operational success.
Medicare is also bleeding out tens of billions of dollars a year to waste, fraud and bill-padding - and if I had a nickel, or better yet, the correct Medicare billing codes for every time a promised improvement in oversight vanished, I'd be wealthy indeed.
Medicaid's got the same problems. New York got popped a few years ago for overbilling Medicaid by about $15 billion for services for the mentally disabled, over a period of 20 years. The disabled did get their care, but at a cost at least four times that of any of the other 49 states.
Where'd the rest of the money go? Ask Albany and they'll just give you the turned-out-pockets Monopoly-guy look.
A system that lets not just Florida crime operations but entire state governments skate off with billions of dollars does not meet any reasonable definition of "huge success."
1
Rick Scott, Republican governor of Florida had to step down from Hospital Corporation of America in 1997 over the biggest Medicaid fraud suit in history.
https://en.wikipedia.org/wiki/Rick_Scott#Columbia.2FHCA
Twelve years later he was elected Florida governor.
https://en.wikipedia.org/wiki/Rick_Scott#Columbia.2FHCA
Twelve years later he was elected Florida governor.
And yet Medicare is cheaper by far than private health insurance.
Still, the waste and fraud in Medicare and Medicaid, which are estimated at between 6% and 10%, would be substantially reduced in a true single payer system.
As an example, look at an existing government single payer system, Social Security, with improper payments of just 1.4%.
Nevertheless, for millions upon millions of beneficiaries, Medicare and Medicaid ARE a huge success. Those millions are alive and receiving medical care.
Still, the waste and fraud in Medicare and Medicaid, which are estimated at between 6% and 10%, would be substantially reduced in a true single payer system.
As an example, look at an existing government single payer system, Social Security, with improper payments of just 1.4%.
Nevertheless, for millions upon millions of beneficiaries, Medicare and Medicaid ARE a huge success. Those millions are alive and receiving medical care.
Scary to think this guy operated on patients. I wonder if his sense of free market dictated the quality of work he delivered: if he could extract more from a patient's insurance or wallet, the likelihood of surgical success goes up. There must be the absence of a compassion gene among Republicans since so many of them, especially those in the laughably named Freedom Caucus, show little capacity to care about their fellow Americans.
7
I was born and raised in Canada but came to the US just before universal health care (single payer) was implemented there. My family is still in Canada and have lived with their version of Medicare for 50 years. In the very early years, somey doctors left Canada for Texas, California and other states, but over time, Canadians learned to live with their medical system, and indeed a large portion of the population today never knew any other system. In their final years, my parents, each with catastrophic illness, had excellent care by excellent doctors. Granted, there can occasionally be a wait for services which are elective, but those who need immediate care, the services are immediately available, with fine medical staff and hospitals. So when our politicians play down the Canadian medical system and say it's falling apart, it's not true.
35
Excellent!
Why stop at opening up Medicare to people in their early 60s? Why not Medicare for all?
18
You may be right and I hope that political momentum works in the way you've laid out. However I wouldn't discount the GOP's will to simply undermine the system out of spite for all things Obama.
A point of word use: Please do not call it "government-provided health care". That's not what a single payer system would be. The government would provide the insurance not the care. This is an important distinction because truly "government provided health care" would remove competition where more is needed (in the provider markets) while a single-payer system would reduce competition where we have too much (in the the insurance markets). In other words, a single payer (insurer) would have a better bargaining position when negotiating reimbursement rates.
A point of word use: Please do not call it "government-provided health care". That's not what a single payer system would be. The government would provide the insurance not the care. This is an important distinction because truly "government provided health care" would remove competition where more is needed (in the provider markets) while a single-payer system would reduce competition where we have too much (in the the insurance markets). In other words, a single payer (insurer) would have a better bargaining position when negotiating reimbursement rates.
7
In Ohio, the administrative cost for managing Medicaid is four percent. There are no CEOs making millions by denying healthcare to those who have purchased their company's insurance. Medicaid is managed by bureaucrats and technicians who know what they are doing and who work for a modest salary. The Affordable Care Act placed a limit of 30% on administrative costs at insurance companies and, of course, cutback on those items, which could be denied, such as pre-existing conditions.
One would think that conservatives have forgotten basic math and frugality, but, that is not the case. Government as far as conservatives are concerned is for making the one percent and corporations wealthier. There is no caring for anyone else, regardless of basic math.
One would think that conservatives have forgotten basic math and frugality, but, that is not the case. Government as far as conservatives are concerned is for making the one percent and corporations wealthier. There is no caring for anyone else, regardless of basic math.
The USA is second to none in medical research. The thing that concerns me the most about me most about a single-payer health care is the potential disappearance of significant medical research. As it is, my doctor's and dentist's office has turned into an assembly line. Your physician no longer knows how much one procedure costs compared to another. He doesn't even know how much insurers (or the government) reimburses his employers for his services. Even the HIPAA rules are silly since the first thing your doctor's office does put on file a document you are expected to sign which waives your HIPAA rights. In the end, everyone deserves access to affordable healthcare but that doesn't mean that there needs to be an entity between you and your doctor who is profiting from both of you! People forget that the concept of insurance only works if more premiums are paid in (from healthy people) than are paid out (to sick people).
Two points. Big Pharma lies and greed have killed more Americans than even the private insurance robbers! Most basic researh is done by university labs or entrepreneurs. Under single payer, ideally, everyone is covered, but everyone pays in, according to their ability to pay. Like Medicare contributions in the form of a payroll tax. Support California's SB 562.
I would hope that a single payer system would actually improve some aspects of medical research. The more people are in the system and participating, population health data will expand dramatically providing great information, and incentive, for researchers. If we are all "in", paying taxes that support health care for all, drug companies and medical technology companies will be all in as well, because the market will expand. Actually, the government, particularly the VA has been on the leading edge of medical innovation and systems for decades. Private industry builds on their discoveries. I remain optimistic that the American desire to improve and invent will only be expanded when the burden of unsustainable health costs is relieved for all Americans.
You began with a supposed argument against single payer, but ended with an argument against private health insurance — the entity between you and your doctor — and an implied approval of single payer.
It seems immoral that insurance companies profit from the potential misfortune of American citizens. Why is there a profit built in to medical care? Because insurance companies have to make money. Get the insurance companies out of the healthcare business. I will gladly pay taxes to support single payer healthcare.
12
Single payer will ultimately prevail. The rest of the world has it. How likely is it that they are all wrong?
Trump thinks that the Democrats will come crawling to him if he lets Obamacare fail or, more likely, undermines it causing it to fail. I believe nothing that Trump says, and certainly not that Obamacare will explode. Notwithstanding, if Obamacare fails, no one will blame the Democrats. The Republicans are in charge as we all know. The blame will fall on them.
Trump will need to come crawling to the Democrats not to save Obamacare but to save himself. However, the price will be to improve Obamacare and that price as this article suggests will be to "expand Medicaid further into the working class," "open Medicare to people in their early 60s," "add a so-called public option to the private markets," and "push the United States closer to single-payer health insurance." Otherwise, Republicans will be swept out in the next election.
It is odd that during the campaign so many predicted that Trump would lose and in so doing effect the destruction of the Republican party. No one was predicting that his victory would have the same effect. Now Trump must reach out to the Democrats or doom himself to spectacular failure. But doing so might very well cause him to lose the cover from impeachment that the Republican majorities now provide him. Trump is between a rock and a hard place.
Trump thinks that the Democrats will come crawling to him if he lets Obamacare fail or, more likely, undermines it causing it to fail. I believe nothing that Trump says, and certainly not that Obamacare will explode. Notwithstanding, if Obamacare fails, no one will blame the Democrats. The Republicans are in charge as we all know. The blame will fall on them.
Trump will need to come crawling to the Democrats not to save Obamacare but to save himself. However, the price will be to improve Obamacare and that price as this article suggests will be to "expand Medicaid further into the working class," "open Medicare to people in their early 60s," "add a so-called public option to the private markets," and "push the United States closer to single-payer health insurance." Otherwise, Republicans will be swept out in the next election.
It is odd that during the campaign so many predicted that Trump would lose and in so doing effect the destruction of the Republican party. No one was predicting that his victory would have the same effect. Now Trump must reach out to the Democrats or doom himself to spectacular failure. But doing so might very well cause him to lose the cover from impeachment that the Republican majorities now provide him. Trump is between a rock and a hard place.
4
As an American currently living in the U.K., with family in Canada, I can tell you that both of their single payer systems are preferable to our own private system. Contrary to what the insurance and drug company lobbyists have said, the truth is this: In England I choose my own doctors. All of my appointments and hospital visits have been prompt, with no long waits. The standard of care is excellent. After 60, all prescriptions are completely free. I've never known a Canadian who went to the US for care, but I've known many older Canadians who have said, "I'd love to retire in Florida, but I'd never do to it because I'd have to give up my health care." Wake up, America!
6
David Leonhardt hits the nail on the head. Putting in place a national single-payer system for basic health services could indeed be a gigantic "win" and guaranteed positive posterity for Donald Trump, if he chooses to go this route and by-pass the "market-obsessed" Republicans. It won't be easy and there will be fierce resistance, with the specter of "socialized medicine" again being trotted out. The real sparks will fly when the inevitable (and welcome) lower prices for health services kick in due to the monopsony position of the single payer (gasp, the government). Providers will earn a fair profit, but no more. Private insurers would likely be contracted to administer the program (as is done in several other countries), but again with just a fair, and regulated, profit margin. But, individuals who want additional insurance to cover services not offered by the basic Medicare of All program will still be able to purchase supplemental private insurance policies, just as is the case in England, Spain, Canada, etc, etc. Can Trump rise to the occasion? If he wants to be "great," this is a good chance.
4
I think it's obvious that the title of the article is ironic.
In their selfishness and greed, and their inability to provide a health care alternative, the Republicans are inadvertently driving more people into supporting the idea of single payer.
That includes the turn of people away from the GOP and towards the Democrats. This depends, of course, on the ability of the Democrats — chronic self-defeatists — to rise to the occasion.
In their selfishness and greed, and their inability to provide a health care alternative, the Republicans are inadvertently driving more people into supporting the idea of single payer.
That includes the turn of people away from the GOP and towards the Democrats. This depends, of course, on the ability of the Democrats — chronic self-defeatists — to rise to the occasion.
Every American should have the same health insurance that is provided to Congress and the Senate. That's it.
9
Trust me, Mr. Leonhardt, I hope you are right and we do get to single payer this way. However, I don't understand why you are saying that Medicaid is safe. Is there anything in ACA that prohibits Congress from converting Medicaid to a block grant or otherwise defunding it?
2
"Until then, the future of socialized medicine is in the hands of Dr. Tom Price." Then we are truly in a game show phase in Congress of deciding who is going to pay for what and how much. Various constituencies will weigh forth with what will amount to bids of various sorts, all in attempt to placate the current barker occupying the position of Secretary of Health and Human Services and finally decide if "The Price is Right!"
7
Obamacare was a step in the right direction, and it would have taken us much farther toward a workable health care coverage system if not for all the Republican efforts to undermine it from Day 1.
And now, ironically, the Republicans' failed effort to repeal and replace Obamacare has proven that the only real "fix" for what ails our health care system is single payer.
Democrat voters have accepted this for some time. Republican voters are coming around. The political will must follow.
Single payer. Single payer. Single payer.
And now, ironically, the Republicans' failed effort to repeal and replace Obamacare has proven that the only real "fix" for what ails our health care system is single payer.
Democrat voters have accepted this for some time. Republican voters are coming around. The political will must follow.
Single payer. Single payer. Single payer.
19
Let me state first that I didn't vote for Trump and think he is proving himself the disaster that I knew he was. But just think what he could do if he really wanted to unite the country. If he reached across the aisle and worked with Democrats and moderate Republicans he could get everything he wants. Healthcare for all, infrastructure spending, tax reform. It would be bigly.
But it will never happen and I know the reason why. It's because Donald Trump is not a whole person. He is too damaged to make it work. Sad.
But it will never happen and I know the reason why. It's because Donald Trump is not a whole person. He is too damaged to make it work. Sad.
22
Donald Trump campaigned to WIN ... NOT TO LEAD. What the world needs today is a WORLD-CLASS LEADER! As a disenfranchised republican (small "r"), I voted for Obama twice, because I believed he was pragmatic enough to lead the free-world exceptionally well. Sadly he did not have the stomach for it. He simply did not want to be world leader. Perhaps he was too naïve! Perhaps the Trump presidency will force Congress to work on a bipartisan basis as they did in the 1980's and 1990's.
Yes, The easy thing for Tump to have done was to implement needed fixes and tweaks to ACA and call it victory.
Underlying principle ...
Healthcare should not be treated as a commodity in a marketplace. It fails the market test because sellers (doctors, hospitals, pharmaceuticals, insurance) and buyers (patients, the sick and injured) do not have equal bargaining power. In addition, the sellers have an inherent conflict of interest: if everyone is healthy, it eats into their profits.
Healthcare "for people", not "for profit".
Healthcare should not be treated as a commodity in a marketplace. It fails the market test because sellers (doctors, hospitals, pharmaceuticals, insurance) and buyers (patients, the sick and injured) do not have equal bargaining power. In addition, the sellers have an inherent conflict of interest: if everyone is healthy, it eats into their profits.
Healthcare "for people", not "for profit".
10
To say that Medicare is "socialized medicine" is, at least in part, error: it is a government funded fee for service system predicated on a philosophy of equal access to all services for all beneficiaries. This structure makes it ripe for underpayment of providers, over-utilization of procedures, fraud, and abuse. But, overall, it is the best "system" we have. We should look at Medicare For All but with a twist: pay the providers more and tier the system with private coverage similar to what Singapore has done.
The way to get this done is to recognize that the House is now more like the House of Commons, ie, multiple voting blocks. Yes, yes the "Freedom Caucus" -- what a joke. But if the Democrats can peel off a few rational Republicans for selected projects, they can control....
The way to get this done is to recognize that the House is now more like the House of Commons, ie, multiple voting blocks. Yes, yes the "Freedom Caucus" -- what a joke. But if the Democrats can peel off a few rational Republicans for selected projects, they can control....
2
Medical care providers in the United States are already overpaid — far more than providers in other countries.
If providers are committing fraud to increase their compensation, it's through greed, not need.
If providers are committing fraud to increase their compensation, it's through greed, not need.
As these commenters point out, only politicians make our health care system complicated. Virtually all developed countries have systems that provide health care to all of their citizens. Politicians prevent that in the United States because a bunch of them believes there should be profit in providing health care.
So what do we do? Expand Medicare to every citizen and let insurance companies sell the “Medicare Plus” policies as they do now.
Nobody on the right cares to recall that health care costs were increasing much faster than inflation before the Affordable Care Act. That trend and the failure of the system to provide health care insurance to millions of Americans led to the Democrat-led (not a single Republican supported the effort) push to pass the ACA. Yet those previously uninsured millions still received care, in emergency rooms. Hospitals and taxpayers paid those bills, not insurance companies.
The solution is to apply all of the money being spent on health insurance to providing health care instead of insurance: Medicare for everyone (single-payer system) and open the “Medicare Plus” marketplace to all of the insurance companies that want to compete for it (private profit).
If Medicare is good enough for old people like me, it’s good enough for my children, their children and my neighbors' children. Of course we have to pay for it, but some things are worth paying for. Health care for everyone is among them.
So what do we do? Expand Medicare to every citizen and let insurance companies sell the “Medicare Plus” policies as they do now.
Nobody on the right cares to recall that health care costs were increasing much faster than inflation before the Affordable Care Act. That trend and the failure of the system to provide health care insurance to millions of Americans led to the Democrat-led (not a single Republican supported the effort) push to pass the ACA. Yet those previously uninsured millions still received care, in emergency rooms. Hospitals and taxpayers paid those bills, not insurance companies.
The solution is to apply all of the money being spent on health insurance to providing health care instead of insurance: Medicare for everyone (single-payer system) and open the “Medicare Plus” marketplace to all of the insurance companies that want to compete for it (private profit).
If Medicare is good enough for old people like me, it’s good enough for my children, their children and my neighbors' children. Of course we have to pay for it, but some things are worth paying for. Health care for everyone is among them.
8
I keep hearing from the GOP that government can't manage healthcare. At the same time a Republican voters say don't take away my Medicare. Their voters are telling the GOP that government CAN manage healthcare, but the GOP takes their orders from the insurance lobbyists, not their voters. At some point, this is untenable, right? I was just in Australia. The folks there are very happy with their single payer system. If you want more coverage and can afford it, you can buy supplemental policies. I'm all for that, who wouldn't be? Oh yeah, Paul Ryan's money backers.
6
Single payer, so simple isn't it. Well we have 2 forms that could be used, VA and Indian Health Service. Oooooh, both systems are strongly criticized.
Canada has one, Ooooooh, Why do so many Canadians come here for their surgeries and hospital level care? The hospital is where the majority of medical care costs are, is severely restricted or 'controlled' and therefore creates dramatic shortages. This problem is true all over europe also.
Canada has one, Ooooooh, Why do so many Canadians come here for their surgeries and hospital level care? The hospital is where the majority of medical care costs are, is severely restricted or 'controlled' and therefore creates dramatic shortages. This problem is true all over europe also.
2
Can you support this fable of Canadians coming to the US for care? I know many Canadian coworkers who have employer provided health insurance here and go home for medical care because it cost nothing and provides superior quality.
2
This is a typical false republican response to Canadian health care. First of all "many Canadians" do not go to the US for "surgeries and hospital level care". Those that do represent a fraction of less than 1% of the Canadian population and the reason that they do is for elective surgery that they are unwilling to wait for here. Those requiring life saving treatment would typically have no longer wait times then in the US and the level of medical competence will be on par as well. Secondly, hospitals are not severely restricted or controlled with dramatic shortages. No level of government controls health care in Canada. Both levels of government (Federal and Provincial/Territorial) provide the necessary funding through taxes but they don't make any decisions based on individual treatment, hospital admittance, or surgical procedures.
2
Simple? No. Better and more humane than for profit private? Yes.
Canadians don't have to live in fear of losing their homes or savings due to an illness. We don't get medical bills if we use the public system. They are sent to the Provincial Governments and are payed for through a tax that all working Canadians pay. Do some Canadians gripe about having to pay taxes for universal coverage they rarely use? Yes. Do they sometimes have to wait longer for a test because the doctor has determined it is not urgent? Yes.
Ask these same people if they want to change our system for yours? No way!
What do you get for the taxes you pay? Your taxes may be lower, but you have to pay thousands per year in healthcare coverage that has high deductibles, co payments, high prescription drug costs etc... and you risk being denied coverage. Canadians don't get denial letters from insurance company's, unless they travel to the US and had the misfortune of getting sick while visiting. That private for profit travel insurance they bought is often a Canadians only experience in battling with a private insurer.
A majority of Canadians continue to support their Single Payer (universal healthcare) system. Living next door to the US has enabled us to watch and learn about yours. No thank you. We will keep ours and keep working to improve it.
Canadians don't have to live in fear of losing their homes or savings due to an illness. We don't get medical bills if we use the public system. They are sent to the Provincial Governments and are payed for through a tax that all working Canadians pay. Do some Canadians gripe about having to pay taxes for universal coverage they rarely use? Yes. Do they sometimes have to wait longer for a test because the doctor has determined it is not urgent? Yes.
Ask these same people if they want to change our system for yours? No way!
What do you get for the taxes you pay? Your taxes may be lower, but you have to pay thousands per year in healthcare coverage that has high deductibles, co payments, high prescription drug costs etc... and you risk being denied coverage. Canadians don't get denial letters from insurance company's, unless they travel to the US and had the misfortune of getting sick while visiting. That private for profit travel insurance they bought is often a Canadians only experience in battling with a private insurer.
A majority of Canadians continue to support their Single Payer (universal healthcare) system. Living next door to the US has enabled us to watch and learn about yours. No thank you. We will keep ours and keep working to improve it.
1
We should not limit our selves to either private or public health care. A hybrid solution would work fine. Create a public healthcare pool. Bring in public program and private company coverage options. Mandate coverage and create a reinsurance fund to backstop private health care providers until the pool of covered individuals stabilizes. Premiums could then be set based on actuarial experience and deductibles, coinsurance, and level of coverage. The larger and more diverse the pool the more fair and stable the costs. That's how insurance works. The premiums from the many pay the losses of the few.
Finally, Congress needs to keep their hand off the reserve funds created to pay losses and not rob the program to support pork barrel budget items.
Finally, Congress needs to keep their hand off the reserve funds created to pay losses and not rob the program to support pork barrel budget items.
And what are those now on Obamacare who will no longer be able to afford it (and the many who are still uninsured) to do in the meantime, while single-payer gradually becomes a reality? We cannot simply wait for the future to arrive. We must prepare for the 2018 election and reverse all these bad Trumpian moves.
Real people are in increasing danger. And we are still involved in military actions and need to be prepared for (and try to head-off) real threats around the world. Make your voices heard. When we join together we can be heard.
Real people are in increasing danger. And we are still involved in military actions and need to be prepared for (and try to head-off) real threats around the world. Make your voices heard. When we join together we can be heard.
1
"They tried to persuade the country to return to a more laissez-faire system in which if you didn’t have insurance, it was your problem. They failed, spectacularly."
I don't understand how this is a valid statement. It failed because it wasn't lasissez-faire enough. If the freedom cactus voted for it, it would have passed. Only nine or so 'moderate' Republicans voted against it. That is not a spectacular failure.
I don't understand how this is a valid statement. It failed because it wasn't lasissez-faire enough. If the freedom cactus voted for it, it would have passed. Only nine or so 'moderate' Republicans voted against it. That is not a spectacular failure.
The fundamental problem is that Americans are too stubborn and too arrogant to learn from the successes of other countries. There are two systems that are tried and true, as borne out by many years of effective and popular care. Both ensure universal coverage. In one system, health care is funded by taxes. The other system is a mixed model where everyone with the capacity to do so is required to purchase sound insurance and where those without the capacity receive government assistance funded by taxes. Obamacare made progress toward the latter system but was sabotaged by the Supreme Court, certain state governments, certain insurance companies, and certain wealthy people who do not want to pay taxes. Propaganda convinced young healthy people that they were patriots if they refused to buy health insurance.
The problem of health care has been solved in most of the developed world. Truly exceptional people do not have to solve every problem by trial and error. Only an arrogant or stupid people would close their minds to the demonstrated successes of everyone around them.
The problem of health care has been solved in most of the developed world. Truly exceptional people do not have to solve every problem by trial and error. Only an arrogant or stupid people would close their minds to the demonstrated successes of everyone around them.
5
When that hilarious sign, DON'T MESS WITH MY MEDICARE, on display at the anti Obama-care picketing-rally-demonstration, the real folk, whom seem to luv to hate the federal government as they enjoy their favorite glib Fox and talk radio political reactionaries, are eating the political-economic cake.
Populism trumps while ideologues Jordan & Ryan's fellow Ayn Randians now passively serve the contradictory cake.
I perceive
Populism trumps while ideologues Jordan & Ryan's fellow Ayn Randians now passively serve the contradictory cake.
I perceive
1
Just as Social Security keeps investment banks and money "managers" from providing private sector lifetime retirement for millions of un-rich citizens, and the Department of Defense prevents businesses from providing troops and equipment for protecting the country, Medicare as a funding and rule-setting entity would cut health insurers and service providers out of a lucrative "private sector" business model. Socialism? Not really. But Medicare for all would require changes to work. Part of the reason Medicare is less expensive on paper is that health care providers subsidize their Medicare patients by charging more for uninsured or privately insured patients. So putting all patients under the "cost controls" of Medicare will cost someone somewhere. Additionally, most Medicare clients have more than basic Medicare...they need Part B, C and D to mimic an employer-based plan in most cases. But cost control, and getting all the gimmicks out of Obamacare funding tricks to avoid calling them "taxes", and everyone is in the pool and contributes...makes sense to this Republican.
I've never seen voters get as worked up about tax cuts as they did about cutting health care spending. The challenge will be to show them, in bold relief, the trade-offs they will face: A trillion dollars in tax cuts means a trillion less for for Health Care.
Dems need a specific proposal for a trillion dollar increase in health care spending. And whenever TaxCuts is mentioned HealthCare should be looking over its shoulder, breathing down its neck.
Dems need a specific proposal for a trillion dollar increase in health care spending. And whenever TaxCuts is mentioned HealthCare should be looking over its shoulder, breathing down its neck.
3
" ... private markets in many areas of the economy have substantive advantages over a government program. They create competition, which leads to innovation and lower prices."
That's an ideological statement. But it also has a realistic problem which is that govt programs already set lower prices than any private insurer is likely to be able to compete with. I am now on Medicare and am astounded to find what Medicare pays for medical services. WAY lower than what I saw when I was covered by private insurance. No wonder in the Obamacare debates the private insurers fought to keep a "govt option" out of the game, saying "We wont be able to compete with that!!"
That's an ideological statement. But it also has a realistic problem which is that govt programs already set lower prices than any private insurer is likely to be able to compete with. I am now on Medicare and am astounded to find what Medicare pays for medical services. WAY lower than what I saw when I was covered by private insurance. No wonder in the Obamacare debates the private insurers fought to keep a "govt option" out of the game, saying "We wont be able to compete with that!!"
Private markets don't work in health care because you can't chose not to be ill. You can chose not to buy a car and take public transit. You can chose to buy an electronic vehicle rather than a gas burner. Life is full of choices but you can't. chose not to get cancer. You can't chose not to get an apendectomy.
4
David, I enjoy and respect your columns.
But please do not confuse a single-payer federal system of universal health care for all with socialized medicine.
In most single-payer systems, the patient is able to choose his physician, therapists, and his hospital. His decisions regarding medications and surgical procedures is guided by the advise of his physicians.
In a system with private insurance, the insurance companies tell the patient which physician he may go to, which therapist is available, what hospital he has access to, what surgical procedures are allowed, and which medicines he may take.
But please do not confuse a single-payer federal system of universal health care for all with socialized medicine.
In most single-payer systems, the patient is able to choose his physician, therapists, and his hospital. His decisions regarding medications and surgical procedures is guided by the advise of his physicians.
In a system with private insurance, the insurance companies tell the patient which physician he may go to, which therapist is available, what hospital he has access to, what surgical procedures are allowed, and which medicines he may take.
8
Hasn't Bernie Sanders -- the same Bernie Sanders so unfairly treated by the NYT in his run against Hillary Clinton -- introduced a Medicare for All bill in the Senate? If so, where's the coverage of that? If not, it's fake news that is completely compelling.
8
Points to ponder. Why would Price, considered a 'swine' by some, his shady business favoring his pocketbook while conflicted in public office dealings may be the least of it, as his nasty disenfranchisement of the working poor from healthcare coverage is for all to see? Price may be a physician in name only, as his business acumen takes precedence, and lacking basic decency and morals, a failing mark for the job assigned.
4
It seems to me that we give conservatives a weapon when we call it "socialized medicine." We're not suggesting a system in which hospitals are owned and doctors employed by the government. What we're talking about with single-payer or Medicare for all is "socialized insurance." Big difference.
2
What the Democrats should do and what they will do are very different things. Of course, they should have been working towards universal, single-payer for a long time. Why haven't they? Not because the idea is not popular; it is. Rather, they are beholden to corporations and insurance companies. I hope there are a few lawmakers (in both parties) who can overcome this very real obstacle.
2
Why won't the alt right accept a plan that would cut costs in half? Why doesn't the media pound that fact everyday? Why do we spend as much on our military as the next 7 countries combined? Why doesn't the media pound that fact everyday? These are questions we should be asking "fiscal conservatives" everyday!!! Healthcare is 16% of GDP and it should be 8%. The statistics are there to make the case! Do these guys really wanna save money or just move it around. Bernie getting on TV once a week ain't gonna do it! Thanks David for this one!
3
Democrats have tried for decades to get healthcare.
Senator Ted Kennedy, who fought for healthcare most of his term as Massachusetts senator tried to get single payer for all. Most people know this much.
It was Senator Joe Lieberman, an independent who was the ONE vote that wouldn't allow the single payer option in the 2009 ACA vote.
It would be a shock and might take 218 frontal lobotomies in the republican congress and 60 in the republican senate to see the single payer option back on the table. I'd vote for that.
Senator Ted Kennedy, who fought for healthcare most of his term as Massachusetts senator tried to get single payer for all. Most people know this much.
It was Senator Joe Lieberman, an independent who was the ONE vote that wouldn't allow the single payer option in the 2009 ACA vote.
It would be a shock and might take 218 frontal lobotomies in the republican congress and 60 in the republican senate to see the single payer option back on the table. I'd vote for that.
5
Dr. Price is operating far to the right of the majority of Republicans. He is of the group that seems to believe that if you can't personally pay for health care you should not receive any. Try that on the base!
He is also personally compromised because of what seem to be repeated instances of unethical behavior.
This man may well be the engineer of the next Republican train wreck. If you are a Democrat this all gets better and better!
He is also personally compromised because of what seem to be repeated instances of unethical behavior.
This man may well be the engineer of the next Republican train wreck. If you are a Democrat this all gets better and better!
Something so simple in the eyes of this retired nurse!!
Single payor system ASAP
Impeach trump and censure price.
Single payor system ASAP
Impeach trump and censure price.
1
Our culture is replete with memes like: "private markets in many areas of the economy have substantive advantages over a government program." There is no evidence for that statement with regard to healthcare, education. Collaboration is far more profitable than competition. No corporation fosters competition on the factory floor. Incentives are effective in the public sector, parasitic hoarding and executive greed is stultifying in the private sector.
Medicaid, Medicare, Social Security are not safe and have been under attack since their inception. Privatizing them is a genuine Republican goal for years, most recently by the W. Bush term. Don't be fooled. Paul Ryan has included harm to them in his budget proposal.
Bernie Sanders proposal to lower the age of eligibility for SS, raising the ceiling of the SS, Medicare taxes and offering the Public Option to those who don't have or like the exchange policies is a genuine hope for rational Americans. Yes, it is irrational for Americans to pay more for healthcare and health insurance than Canada and Europe and get worse results. Yes, it is confusing for all non-health related corporations to accept our current costly inefficient mess. Yes, it is perplexing that the foundational economists in academia do not stand as one to explain how spending more and more and getting less is unsound. The meme that may turn the tables is that "access does not equal affordable". Having access to a Masserati does not mean that you can afford a VW.
Medicaid, Medicare, Social Security are not safe and have been under attack since their inception. Privatizing them is a genuine Republican goal for years, most recently by the W. Bush term. Don't be fooled. Paul Ryan has included harm to them in his budget proposal.
Bernie Sanders proposal to lower the age of eligibility for SS, raising the ceiling of the SS, Medicare taxes and offering the Public Option to those who don't have or like the exchange policies is a genuine hope for rational Americans. Yes, it is irrational for Americans to pay more for healthcare and health insurance than Canada and Europe and get worse results. Yes, it is confusing for all non-health related corporations to accept our current costly inefficient mess. Yes, it is perplexing that the foundational economists in academia do not stand as one to explain how spending more and more and getting less is unsound. The meme that may turn the tables is that "access does not equal affordable". Having access to a Masserati does not mean that you can afford a VW.
In my opinion Mr. Leonhardt has underestimated the determination of Republicans to monetize every facet of American existence and overestimated the influence of voters on congress.
1
The Trump administration and Dr. Price are essentially saying to the American people, if the Congress won't pass our bill, let the people eat cake.
Interestingly, when Marie uttered those words, "cake" was not the sweet confection we think of, but the burned and scorched scrapings from the walls of the brick bread ovens at the end of the day. "If they don't have bread, let them eat cake" takes on an even more disdainful tone, huh? Well, she paid for it.
But here we have a President, an administration, the Secretary of Health and Human Services for god's sake, willing to not only do nothing to patch Obamacare of it's worst flaws while they devise a plan that actually solves people's problems, but willing to actively sabotage the only plan many millions of Americans have to make their partisan point.
I see that as a high crime and misdemeanor - treason against the citizens of America - Trump's own words of letting it implode and then explode - the only proof needed for impeachment - before people start dying.
Certainly we have more spine than to let him lead us, and our loved ones, meekly to the slaughter.
Interestingly, when Marie uttered those words, "cake" was not the sweet confection we think of, but the burned and scorched scrapings from the walls of the brick bread ovens at the end of the day. "If they don't have bread, let them eat cake" takes on an even more disdainful tone, huh? Well, she paid for it.
But here we have a President, an administration, the Secretary of Health and Human Services for god's sake, willing to not only do nothing to patch Obamacare of it's worst flaws while they devise a plan that actually solves people's problems, but willing to actively sabotage the only plan many millions of Americans have to make their partisan point.
I see that as a high crime and misdemeanor - treason against the citizens of America - Trump's own words of letting it implode and then explode - the only proof needed for impeachment - before people start dying.
Certainly we have more spine than to let him lead us, and our loved ones, meekly to the slaughter.
1
I feel there is another division within the Republican Party voters that their party leaders fail to see. Oddly the so-called president did see this when he was campaigning while making his wild promises of a better more beautiful health insurance for all Americans that was less expensive. He knew that was the red meat they wanted to hear.
Then there are those wealthy GOP members who don't care what others have or don't have because they have theirs, verses the rest of them who are struggling in their daily lives just to get by.
There are also those struggling to get by republican voters, who voted for this so-called president who are brainwashed into believing that "others" not like them are getting something when they shouldn't.
So there you have it.
It will be interesting to see if this can be balanced out before the 2018 midterms.
Then there are those wealthy GOP members who don't care what others have or don't have because they have theirs, verses the rest of them who are struggling in their daily lives just to get by.
There are also those struggling to get by republican voters, who voted for this so-called president who are brainwashed into believing that "others" not like them are getting something when they shouldn't.
So there you have it.
It will be interesting to see if this can be balanced out before the 2018 midterms.
2
Once Republicans realized that white
People overwhelmingly are dependent on Obamacare did they realize that their plan wouldn't survive. Go figure.
People overwhelmingly are dependent on Obamacare did they realize that their plan wouldn't survive. Go figure.
I have ventured more than once the concept that if we had less health care more folks would die earlier. That would cut down the high public cost of taking care of those useless old folks in hospitals and nursing homes. If the government didn't pay for health care, more folks would wait much longer before seeking out medical help, and they too would be more likely to die fairly promptly with minimal extra cos to the system. If you want health care, get rich like Frump and pay for it yourself! There's always prayer . .. .
The irony is that the ACA wound up being protected by those who most despise it: the Freedom Caucus. Had they not been so mule-headed, the "moderate Republicans" in the House would have been unable to stop the passage of TrumpDoesn'tCare. In fact, they probably would have gone along with the majority.
So while Americans are generallly in favor of basic social decency, they'd better not depend on Republicans for support.
So while Americans are generallly in favor of basic social decency, they'd better not depend on Republicans for support.
1
One of the reasons people like Medicare is that it's simple- -you turn 65 and you're signed up. Medicare Part B enrollment requires a yes or no answer. Done. If you want supplemental insurance, you can spend all the time you like wading through competing health plans. One of the things people found scary when Obamacare first came out was the confusing array of choices and convoluted language common to all insurance plans. Give people too many decisions to make and you have not freedom but paralysis and bewilderment. The first party to understand this will likely be the party whose health care philosophy is embraced.
1
Republicans, some Democrats can never give up their rich donors , corporations , and in this case , the Health Insurance business. Obviously when we live in a capitalist society , social programs, universal care is a Voodoo. The mean spirited republicans careless if poor citizens, eldelrly needs health care. They have their own . The Obama Care it's not a perfect for two important reasons. 1-The republican governors of some states did not expanded Medicaid , leaving many poor families without health insurance. The fault is the SCOTUS. Giving privilege of choice, for greed governors and Insurance company . 2- An insignificant penalty for private business with more than 50 employees. Obviously employers did not care about their employee's health they opted to pay the insignificant fine. ONLY IN AMERICA THIS ABSURD HAPPEN. How can we say, "One nation under God". Really! It looks like One nation under Devil. Health is basic "Human Rights", but in America, most people does not understand the meaning , because they're selfish , greed individualists, thinking that basic social programs is a disaster for the economy. I hope the people Vote against cynical republicans, also we need Trump out of the WH.
Price earlier, on camera, scorned the idea of paying for contraception for any woman. His thinking is merely another version of "welfare queen," his idea only to enrich himself. That is why he is part of the nefarious cabinet.
1
Anyone out there who wonders about single-payer and has not yet seen the movie 'Sicko,' please find it and watch it! ('Where do I pay my bill? What do you mean, 'bill?')
On March 26, 2010, Blue Cross/Blue Shield stock closed at $63.05. Yesterday it closed at $162.19. The rest of the big insurers realized similar gains. Health Care is a for-profit cash-cow and Dr. Price will make sure that the priority going forward is to increase profit margins (increase infusion from premiums, cut payouts and coverages). There's no cure in sight for the tumor called corporatism.
Our health care ratings have steadily declined for the average american who is NOT in Medicare, or Medicaid. Private Insurers take so much money out of health care that does not result in quality of care - "managing' the doctor patient relationship. Medicare and Medicaid do none of that and operate smoothly with little overhead. Its obvious - we need a single payor system and should expand on those programs -- private insurance should be 'supplemental' as it is in Medicare vs. the substance of the system. Politicians don't have to 'buy' our plans, live with them, or 'use' them and they are very, very out of touch. ALL OF THEM.
Agree mostly with your editorial...
A national health plan like the rest of the civilized world has whether single payer or something like it will eventually come to America.
The only unknowns are the time frame and how it will happen.
Since almost all Americans want it, even republicans (look at medicare), it is up to us to keep hounding the republican regime to get it.
A national health plan like the rest of the civilized world has whether single payer or something like it will eventually come to America.
The only unknowns are the time frame and how it will happen.
Since almost all Americans want it, even republicans (look at medicare), it is up to us to keep hounding the republican regime to get it.
The only thing Trump cares about is having others see him as the great leader he foolishly sees himself to be. I think Democrats, with a bit of honey, can convince him that single payer is the way to achieve his goal. With the help of moderate Republicans (the "Freedom" Caucus be damed) who curry favor with him, this could become reality. The fly in the ointment is, of course, the person who has his ear last usually wins. Hopefully, that would be Ivanka ("Daddy everyone will love you") and not Bannon.
We can only hope that Trump seizes on a single-payer, Medicare-for-all-type model, sooner or later, and in doing so winds up doing the right thing.
Arthur W. Page worked at AT&T from 1927 to 1947 as a vice president and a director. He was called “the father of corporate public relations” in promoting his own public relations heuristics, distilled into the Page Principles.
He famously said: “The fundamental way of getting public approval is to deserve it.”
Trump cannot contain his con man instincts and his deep need for public approval. His main problem is that he missed the last part of this quote.
So far Trump has lost big on immigration and health care, with the budget coming up next. If he can backtrack on health care, and show the country that he is actually capable of caring for its people, then maybe the public will eventually decide that he is deserving of their approval.
Arthur W. Page worked at AT&T from 1927 to 1947 as a vice president and a director. He was called “the father of corporate public relations” in promoting his own public relations heuristics, distilled into the Page Principles.
He famously said: “The fundamental way of getting public approval is to deserve it.”
Trump cannot contain his con man instincts and his deep need for public approval. His main problem is that he missed the last part of this quote.
So far Trump has lost big on immigration and health care, with the budget coming up next. If he can backtrack on health care, and show the country that he is actually capable of caring for its people, then maybe the public will eventually decide that he is deserving of their approval.
"ObamaCare" is a Republican idea founded on "RomneyCare". The Individual Mandate is a conservative idea, dreamt up by the Heritage Foundation. Many Republicans love their form of ObamaCare as it keeps big health insurers in the market and flush with customers and cash. On the other hand, true "ObamaCare" is "single-payer" healthcare like Canada has. This is what Barack Obama advocated for when he was a Senator in Illinois.
Republican Gov. Scott Walker himself is proposing "single payer" for Wisconsin's state employees, allowing the state to self insure, saving money on getting rid of the insurance middleman. However, his idea is born from the fact that like many Republicans, he compartmentalizes humans into those deserving, and those undeserving. Since public insurance will pay less to doctors than private insurance, his public employees will have a harder time finding a doctor to care for them.
Republican Gov. Scott Walker himself is proposing "single payer" for Wisconsin's state employees, allowing the state to self insure, saving money on getting rid of the insurance middleman. However, his idea is born from the fact that like many Republicans, he compartmentalizes humans into those deserving, and those undeserving. Since public insurance will pay less to doctors than private insurance, his public employees will have a harder time finding a doctor to care for them.
Given the fact that seeing to it that every American citizen and legal resident will need or currently needs medical care a single payor universal access health care system makes much more sense than the current fragmented system we have in place. And that universal access should cover all aspects of medical care: dental, eye, ear, rehab, skilled nursing at home or outside of the home, etc. All providers should be included unless they are guilty of a crime. It makes more sense to have access guaranteed then to force people to wait until they can afford the care they need. The latter has public health implications most of us don't want to encounter first or second hand.
If the GOP and its minions feel that they don't want to use such a system they are free to avoid medical care. The rest of us may not feel the same way. Because my father was seriously ill and then unable to work after his recovery I am firmly in favor of ensuring that every American has access to medical care and that it's universal and that we not have to worry about deductibles, co-pays, premiums, etc. If my father had fallen ill now our family would have gone bankrupt even with his insurance. In today's world being healthy is not an option only for those who can afford it especially since our country is reluctant to allow anyone on welfare. If employers want healthy workers and the GOP wants healthy citizens single payor is the way to go.
If the GOP and its minions feel that they don't want to use such a system they are free to avoid medical care. The rest of us may not feel the same way. Because my father was seriously ill and then unable to work after his recovery I am firmly in favor of ensuring that every American has access to medical care and that it's universal and that we not have to worry about deductibles, co-pays, premiums, etc. If my father had fallen ill now our family would have gone bankrupt even with his insurance. In today's world being healthy is not an option only for those who can afford it especially since our country is reluctant to allow anyone on welfare. If employers want healthy workers and the GOP wants healthy citizens single payor is the way to go.
Republican politicians see healthcare as a commodity. like cars, houses and clothing.
If you can afford it, fine.
If you can't, get a better job.
Most Americans, however, see it as a RIGHT that should be available to all.
Since this involves taxing the rich and cutting back on the healthcare industry's huge profits, Republicans resist this any way they can. They can not and will not do anything to financially hurt their corporate sponsors.
Unfortunately for them, people vote and eventually even the most hardened of Republican voters will finally see who their political idols truly care for.
Then, maybe, we will finally get the healthcare system that all other industrialized Western countries have.
Only in America.
If you can afford it, fine.
If you can't, get a better job.
Most Americans, however, see it as a RIGHT that should be available to all.
Since this involves taxing the rich and cutting back on the healthcare industry's huge profits, Republicans resist this any way they can. They can not and will not do anything to financially hurt their corporate sponsors.
Unfortunately for them, people vote and eventually even the most hardened of Republican voters will finally see who their political idols truly care for.
Then, maybe, we will finally get the healthcare system that all other industrialized Western countries have.
Only in America.
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Republican politicians don't just see cars, houses, clothing and healthcare as commodities, they also see clean water, clean air, food, K-12 education, etc. The list goes on and on.
Republicans only seem to come around on basic human decency when a catastrophe hits them or their families. Unless something affects them personally, it is not a problem.
The GOP has only one policy: tax cuts for the wealthy and corporations. That's it. After 8 years of voting to repeal Obamacare--they had to hastily cut and paste to get a semblance of a GOP health plan. And they have no crafted legislation in the pipeline either. At this point, the GOP is the party of not-Dems. And, clearly the Freedom Caucus gives herding cats a bad name.
"Preet Bharara, the federal prosecutor, was investigating Price when Trump fired Bharara this month, ProPublica reported."
Has the investigation been passed on to someone else in the office? I hope?
Has the investigation been passed on to someone else in the office? I hope?
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Last I heard, the investigation would go to none other than Jeff Sessions. How convenient is that? At least it maintains the consistency of corruption, the hallmark of this administration. Of course Mr. Sessions is supposed to be busy recusing himself from all this tawdry business....in the meantime he's busy doing nasty things.
Passed to jeff sessions I bet. That should "solve" the problem.
I'm afraid it will go nowhere with the Trump administration in charge. The administration is guilty of collusion with Russia and its running cover for all of Trump's chumps whatever their crime du jour.
I've said it before, Medicare is the best health insurance I have ever had, and I had University of California funded health insurance for 23 years. It's administratively seamless. I now have supplemental from UC, and Medicare costs me less than $200 a month. I pay a bit more than many Americans on Medicare because I have a pension and Social Security and my wife's income is included in the rate. So, I get to help Americans who through no fault of their own do not have enough funds to pay for health care. Still a bargain. Hear that Republicans?
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Yeah, but just because you directly pay $200 a month doesn't mean that's the overall cost. Surely as an employee of a world renowned university system, you can see that your argument is spurious as it fails to account for overall spending per enrollee, from all sources. There's no such thing as a free lunch.
Right! It's called single payer. Now let's make it available to everyone. It will reduce costs, save lives, boost the economy and rejuvenate the country. But oops, I forgot, the GOP/Trump/"free market" cabal have no real concerns about any of that.
We must remember that Ryancare was a tax give away to the very wealthy disguised as health care reform (promoting cutbacks in care) and the aroused public saw through the scam.
We must also remember that a scion of conservative economists, the Nobel Prize winning Kenneth Arrow, definitively demonstrated that distribution of health services was ill served in a free market system.
Finally Medicare is universally appreciated, functional, efficient and proven among the hardest and most expensive patient population.
We must also remember that a scion of conservative economists, the Nobel Prize winning Kenneth Arrow, definitively demonstrated that distribution of health services was ill served in a free market system.
Finally Medicare is universally appreciated, functional, efficient and proven among the hardest and most expensive patient population.
In thinking about a public option as a way of providing health coverage in lieu of the exchanges, I have two questions. Would a public option pose such a threat to the profits of big-time health insurers (Aetna, Humana, et al.) that they would fight it tooth and nail, and try to buy a whole passel of congressmen and women? Or, could a public option be constructed in such a way that small and medium-sized businesses, including institutions like school districts and city governments, would see its advantages and support it? From what I have seen and heard, most of the health providers are more concerned about revenue that keeps their doors open than they are about how they get paid. So, in this world of insurers, small businesses, and providers, should people like Paul Ryan and Tom Price be given any relevance? Their loyalties seem to lie only with the insurers and the investor class.
Single -payer systems work and work well to provide comprehensive "guaranteed' healthcare for the lowest possible price - can you name one insurance company offering plans for less than Medicare? Medicare offers its original plan and Medicare Advantage where private plans cover what original Medicare offers and some extra perks as well, dental, vision, gym memberships to name a few.
Where can you find such a plan for $109.00 a month outside of Medicare Advantage?
Well, their is the VA system, quality care for veterans, sure they had a few bad apples at one hospital but overall and excellent medical operation well ahead of others with specialized services for Vets that they would be hard pressed finding on their own outside the system as well as routine care and ER care.
Where can you find such a plan for $109.00 a month outside of Medicare Advantage?
Well, their is the VA system, quality care for veterans, sure they had a few bad apples at one hospital but overall and excellent medical operation well ahead of others with specialized services for Vets that they would be hard pressed finding on their own outside the system as well as routine care and ER care.
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There is no such thing as a free market as championed by the Republicans any more than there is such a thing as a free lunch. The market demands a profit, the more the better. A single payer system run by the government would eliminate the profit angle and would result in an immediate and substantial savings. The Republicans who carp endlessly about a free market argue for the benefit of the private insurance companies, not the American people.
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This is the salient point. The care of humans who are sick is not a product. Products have a manufacturer's price, a broker's or wholesale price and a retail price. I am not a chair or a Ninja or a car to be haggled over. If the price of the chair goes up, I can do without the chair. But when the price of a doctor visit goes up because another entity is in play, that's closing in on RICO act territory.
Two more reasons why Republicans should support national health care: U.S. corporations compete today in a global market against foreign companies that do NOT have to pay for their workers' health care. And, two, job-based health insurance discourages potential entrepreneurs from leaving their jobs and starting their own businesses. People with families can't risk losing their coverage.
6
Instead of taking an insurance approach why not support Healthcare systems like the do for veterans. It would create a two or more tiered system but at least everyone would have access to health care and we would simply use the tax system to make payment of it equitable - of course equality in taxes is another matter, but at least health would be more contollable.
In spite of all the apparent logical reasons to adapt single payer, it will never happen short of a grass roots revolution. The reason is as simple and logical as the single payer policy espoused here: The foundational crack that has widened in democracy, that being the rivers of private money flowing to politicians. As long as this continues, public policy decisions will quite naturally be directed at the well-being of the political donor class, a fair number of whom run insurance companies.
1
I am all for Single Payer as long as all citizens understand how it will be paid for - with a VAT on all goods? On an additional payroll tax that is applied to everyone above say $40K? And with the understanding that there are NO exclusions. All Government employees, meaning Congress too, is under the same plan. The cost for this will be huge and it will take a massive tax increase to pay for it.
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This old-fashioned republican and entrepreneur is for a single-player system.
To those who wonder why business leaders aren't for single payer, consider that while they don't like the current system, they do recognize it's a way to keep employees.
Imagine the possibilities if people could start their own business without the stress and fear of our current system.
To those who wonder why business leaders aren't for single payer, consider that while they don't like the current system, they do recognize it's a way to keep employees.
Imagine the possibilities if people could start their own business without the stress and fear of our current system.
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Everyone should be required to buy a basic HMO plan which could be supplemented by additional insurance. There would be no deductibles; however premiums would be adjusted according to income as medicare is today. Low income people would receive Medicaid assistance if they could not pay for coverage,but wealthy people would pay substantially more than they now pay for Medicare. This way rural hospitals could stay open and patients wouldn't have to live in medical care deserts. Other advanced countries promote health over profit; we can't can't afford to lag behind.
Of course single-payer basic healthcare should be provided by a civilized nation, and this does not preclude citizens from paying privately out of their own pockets for other healthcare choices. Ditto free basic public education, which does not preclude paying for private schools out of one's own pocket (not "charter schools" which divert tax $ from real public schools).
1
HRC proposed expanidng Medicare to seniors over 55 on a buy-in basis. As a private business owner who now purchases insurance on the exchanges, this would offer a lower price option, and it would reduce pressure on the insurance companies to cover a segment of the population they have no desire to cover. The result would be lower premiums for younger, healthier individual buyers. This would be a good first step to salvaging the individual buyer market and the exchanges.
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Also, what if self employed people who, I assume, make up a good part of the Individual Market, were able to "buy in" to Medicare for themselves and their families? That would add many younger, healthier people to the Medicare rolls, increasing the program's long term stability.
Medicare was initially condemned by the AMA and major insurers who claimed that it would be detrimental to quality care. Most of us have learned otherwise since those early days: almost every major medical professional and hospital organization now favors repairing the ACA. They did not want it to go away (no matter assertions from Dr. Price, who is not in the mainstream of his medical colleagues, or the so-called Freedom Caucus).
The USA can develop its own sort of "single payer." Major private insurers are already deeply involved with administration of Medicare Part C (Advantage plans). It does not seem likely that they would be thrown out of the process at this juncture. Some of their expertise will be essential to any sort of plan getting to universal access and coverage for US citizens.
The USA can develop its own sort of "single payer." Major private insurers are already deeply involved with administration of Medicare Part C (Advantage plans). It does not seem likely that they would be thrown out of the process at this juncture. Some of their expertise will be essential to any sort of plan getting to universal access and coverage for US citizens.
2
If the Democrats would just break down and strongly promote single payer instead of some compromised public-private hodgepodge they would enjoy tremendous support from the public. It's what the people want, and we're sick of waiting for "someday" or "eventually".
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We need single-payer, not-for-profit, universal healthcare for all Americans. Every other advanced nation in the world has figured this out long ago and we are very late to this party.
The simplest way would be to expand Medicare to all Americans and allow resident Aliens to buy into the system. We could cover everyone and not create a huge bureaucracy like was done with the ACA.
Senator Bernie Sanders said last Friday on MSNBC (All In with Chris Hayes) that he will be introducing legislation for Universal Coverage. It should be noted that Senator Sanders has a long history in both the House and Senate of crafting Bi-Partisan Bills & Amendments to get stuff done. Portions of the ACA that added funding for Community Health Centers were the direct result of Senator Sanders' work and he has deep knowledge and grasp of the issues surrounding health care in these United States.
From the Kaiser Foundation regarding their impact:
"Health centers are a core source of primary care in the U.S., particularly for Medicaid beneficiaries and uninsured people. In 2015, 1,375 health centers provided care to 24.3 million patients, including 1 in 12 U.S. residents and nearly 1 in 6 Medicaid enrollees. Almost three-quarters of all health center patients had income below the poverty level."
http://kaiserf.am/2jIikzG
Senator Chuck Schumer would be wise to make Bernie point man on efforts to craft a path forward so we can cover all of our people.
The simplest way would be to expand Medicare to all Americans and allow resident Aliens to buy into the system. We could cover everyone and not create a huge bureaucracy like was done with the ACA.
Senator Bernie Sanders said last Friday on MSNBC (All In with Chris Hayes) that he will be introducing legislation for Universal Coverage. It should be noted that Senator Sanders has a long history in both the House and Senate of crafting Bi-Partisan Bills & Amendments to get stuff done. Portions of the ACA that added funding for Community Health Centers were the direct result of Senator Sanders' work and he has deep knowledge and grasp of the issues surrounding health care in these United States.
From the Kaiser Foundation regarding their impact:
"Health centers are a core source of primary care in the U.S., particularly for Medicaid beneficiaries and uninsured people. In 2015, 1,375 health centers provided care to 24.3 million patients, including 1 in 12 U.S. residents and nearly 1 in 6 Medicaid enrollees. Almost three-quarters of all health center patients had income below the poverty level."
http://kaiserf.am/2jIikzG
Senator Chuck Schumer would be wise to make Bernie point man on efforts to craft a path forward so we can cover all of our people.
5
There is no evidence that a private market of competitive insurers reduces costs or covers more people than a single payer system. On the contrary, the evidence is clear that it adds marketing and administrative costs, creates a fractionalized insurance market unable to negotiate with ever larger hospital groups, and earns profits by denying care. Yet conservatives continue to mendaciously argue the opposite.
3
Let's talk about TRUE costs. I just had knee surgery. Here is what was billed to me, and what my insurance said they would pay.
I was billed $23,822.10. My insurance has agreed to pay $ 10,188.30, of which I am personally responsible for $ 2,547.09. Now of course that 23 grand did not include anesthesiology, nursing, drugs, recovery room, and facility costs. Those add up to another $6400.00. My insurance company agreed to pay $1700.00. I will pay $475.00.
So, I had a before "cost" of about $30,000.00. My insurance company said "nah way too much" and knocked it down to about half. I am paying 20% of that half.
Why can't we agree this is ridiculous. Why do we insist this makes any sense at all. To be billed outrageous sums that will never be paid? And to have to insert a middleman who doesn't care about me getting the best care for the best price. They care about their bottom line. My health should not be a profit margin for someone.
What else is ludicrous is the idea I could have shopped around. There are two systems in my area-The Cleveland Clinic and University Hospitals. When I tired to find out costs through Castlight (a website set up by my employer to help me a better consumer) every aspect of the surgery had "no value available". In the end I simply went the doctor I like the best.
I am happy with my surgery and I hope it will allow me to get back to being as active as I was before my injury. I am lucky I can afford it.
I was billed $23,822.10. My insurance has agreed to pay $ 10,188.30, of which I am personally responsible for $ 2,547.09. Now of course that 23 grand did not include anesthesiology, nursing, drugs, recovery room, and facility costs. Those add up to another $6400.00. My insurance company agreed to pay $1700.00. I will pay $475.00.
So, I had a before "cost" of about $30,000.00. My insurance company said "nah way too much" and knocked it down to about half. I am paying 20% of that half.
Why can't we agree this is ridiculous. Why do we insist this makes any sense at all. To be billed outrageous sums that will never be paid? And to have to insert a middleman who doesn't care about me getting the best care for the best price. They care about their bottom line. My health should not be a profit margin for someone.
What else is ludicrous is the idea I could have shopped around. There are two systems in my area-The Cleveland Clinic and University Hospitals. When I tired to find out costs through Castlight (a website set up by my employer to help me a better consumer) every aspect of the surgery had "no value available". In the end I simply went the doctor I like the best.
I am happy with my surgery and I hope it will allow me to get back to being as active as I was before my injury. I am lucky I can afford it.
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The ACA didn't provide markets where the middle class and affluent could buy "subsidized" insurance. The subsidies, if available at all, are paltry above 200% of the poverty level and premiums have skyrocketed. A family of 4 with an income of $100K is looking at premiums of $20K and a $12K deductible. This is unsustainable.
1
The ACA was not intended to provide such markets. Premiums have not skyrocketed in general: they have risen substantially but less fast than they had been rising before. The problem is not with the ACA; the problem is with for-profit provision of health insurance.
1
One of the benefits of living in France is the single-payer health care system. Last year my husband and I qualified to join it and now have our "cartes vitales".
Even before joining the system we found that having no insurance at all was not so bad because doctor visits and all kinds of medical tests are not expensive. But that brings me to something about single-payer that I don't hear discussed - even among left leaning people who support it. It won't work without regulation of what doctors, hospitals, pharmacies and labs can charge. Here in France a doctor visit is 23 euros, a specialist is 40 euros, and most tests are under 100 euros. I had thyroid surgery in a high quality private hospital with3 night stay for 3100 euros, and the most expensive prescription drug I ever had to use (an anti-viral against shingles) was a mere 40 euros. Most prescriptions cost around 2 euros. While I do think the US will move toward single-payer, the battle to regulate prices will be very difficult...
Even before joining the system we found that having no insurance at all was not so bad because doctor visits and all kinds of medical tests are not expensive. But that brings me to something about single-payer that I don't hear discussed - even among left leaning people who support it. It won't work without regulation of what doctors, hospitals, pharmacies and labs can charge. Here in France a doctor visit is 23 euros, a specialist is 40 euros, and most tests are under 100 euros. I had thyroid surgery in a high quality private hospital with3 night stay for 3100 euros, and the most expensive prescription drug I ever had to use (an anti-viral against shingles) was a mere 40 euros. Most prescriptions cost around 2 euros. While I do think the US will move toward single-payer, the battle to regulate prices will be very difficult...
For the individual insurance market, it seems fundamental to me. The larger the pool the lower the costs. That should be the goal for Mr. Price, the Republicans and the Democrats.
The American people want single-payer. Single-payer healthcare is more cost effective & more humane. It is the morally correct approach to treating illness. The only question is whether the Democratic Party establishment can break its addiction to corporate money, Big Pharma and the medical industrial complex. If not, then we must vote these corrupt politicians out of office and replace them with Democrats who truly represent the interests of working people in this country.
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Not only do other developed nations have health care for all, but their is evidence that their citizens are healthier and live longer. When will our representatives behave in a rationale manner, and do that is right for those they represent and stop the partisan bickering and act as statesman and not self-serving politicians? If not, they should be voted out of office in 2018.
Universal Healthcare would be an economic boon for the USA. People who can afford it could purchase private plans or employers could could offer premium plans as an incentive. But the average American would have more disposable income if they are not saving money for catastrophic illnesses or paying huge deductibles.
5
Best to leave the employer out of all of this. What does my job or boss have to do with my car insurance or homeowners insurance? Leave the company to do its business. Free the employee of the indentured servitude of job lock. Everyone wins.
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And eliminate the cost of health care to business so American companies can better compete with countries that organize their systems through the government.
2
It's called Canadian Health Care.
The propaganda that has been used to denigrate Canadian Medicare has hurt the average American .
The overwhelming acceptance by Canadians of their Health Care should tell Americans something.
The propaganda that has been used to denigrate Canadian Medicare has hurt the average American .
The overwhelming acceptance by Canadians of their Health Care should tell Americans something.
I can't understand why business is not behind a universal health plan. Just think of all the money, people, and effort they could save by going to it. What possible advantage can they think they have with the multitude of health plans and paperwork they have every October? This is one of those "no-brainers".
The term "socialized medicine" is used several times in this piece. With the exception of the few countries that have fully nationalized healthcare, i.e., where the government owns and runs hospitals and the care is delivered by government employees, single payer and socialized medicine are not synonymous.
We Americans need to stop treating healthcare as the equivalent of selling cars or real estate. By seeing medical care as a profit-making venture in which people are supposed to purchase what they can afford, we're ruining -- and taking -- lives.
We Americans need to stop treating healthcare as the equivalent of selling cars or real estate. By seeing medical care as a profit-making venture in which people are supposed to purchase what they can afford, we're ruining -- and taking -- lives.
One of the lead stories this morning recalls that Medicaid was a tiny program at the time Medicare was passed in the 1960s, but now covers 1 in 5 Americans. Herein lies the path to single payer: As our economy shrivels and we fail to address its problems and its tax code, gradually nearly all Americans will descend to the poverty line. Voila: single payer.
"Health Care" is never socialized. Societies can and should be socialized and if a society is sufficiently socialized, "Health Care" will assume it's place among all the other social activities of the society. Society will allocate the resources that it deems appropriate to keep a society healthy. One hopes that Health together with Education and the Arts will be amongst the higher priorities.
The Trump administration and its GOP enablers, like Dr. Price, see government as a playground for personal investment and privatized profit.
Let everybody age 55 - 64 add whatever years they need to get to 65 when they would be eligible for Medicare. Just like Trump added 10 non-existent floors to the Trump Tower in a fit of "truthful hyperbole".
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The American Death Panel: Price, Ryan, McConnell, Pence and T-rump, nor one of who ever had to pay half his salary for health insurance. Let's hope he is impeached, or at least over-run in 2018.
If Trump truly believed his campaign assertions that he would improve Obamacare, it's plausible he could push Single payer. But he is a liar who doesn't believe a word he says, and honestly doesn't care about helping anyone not named "Trump".
How does a "gradual shift toward a single-payer system" work? Should we support many more community health care centers? Should part of the trillion dollar infrastructure spending cover hospitals and community health care centers so that patients and insurance no longer pay for buildings? Can we stop using the label HEALTH INSURANCE and its implication of person by person responsibility and start saying HEALTH CARE implying societal responsibility. Lastly can we have an honest discussion of how to pay for this. I recommend a 10% VAT. We could DISCUSS spending LESS on the military.
The key to solving Price is in the article. He's coin operated. Make it somehow more lucrative for him to support the ACA than not. Surely insurance companies can figure something out here as it seems to be to their benefit, as the article points out, for Price to support the conservative part of the ACA.
The truth is that we are not willing to deny life-saving health care to people just because they can't pay. When health care was very limited and simple and cheap, charity could take care of it. That no longer works. But a market will not work if we are unwilling to turn away those who can't pay. Single-payer is the only solution.
Private businesses do not go to places where there is little business to be had. This includes private health insurers, who are not charities looking to help the disadvantaged. Thus, rural areas will be devoid of private insurers for the exchanges.
Medicare for all is, in my opinion, not the answer. Medicare recipients who choose traditional Medicare must not only pay the Part B/Part A premium, but also are required to purchase a private prescription drug plan, whether or not they take prescription drugs. In order to have adequate coverage, they must also purchase a private supplement plan. Or, they can choose a private Medicare Advantage plan with high deductibles, similar to an ACA exchange plan.
As another commenter said, Medicaid for all is the way to go, although different terminology should be used. We need to vociferously promote Bernie Sanders' philosophy that essential medical care is a human right. That might be the winning argument.
Medicare for all is, in my opinion, not the answer. Medicare recipients who choose traditional Medicare must not only pay the Part B/Part A premium, but also are required to purchase a private prescription drug plan, whether or not they take prescription drugs. In order to have adequate coverage, they must also purchase a private supplement plan. Or, they can choose a private Medicare Advantage plan with high deductibles, similar to an ACA exchange plan.
As another commenter said, Medicaid for all is the way to go, although different terminology should be used. We need to vociferously promote Bernie Sanders' philosophy that essential medical care is a human right. That might be the winning argument.
It is said that Americans will do the right thing, after they have tried all the others. So, finally we get to where we should have started 50 years ago, by expanding Medicaid to more and more people, and drive out the inefficient insurance middlepersons. Well, hip hip, hooray and all that.
US Health care cost is number 1 in the world ranking : the most expensive.
US health care quality rank is only 38th .
French health care cost is ranked 34th. But number 1 in quality.
Everybody is insured and health care is free for everybody since 1949.
In the US health care stock is the number 1 revenue at Wall Street,
In the US health care is not aimed at global health ...it is to make money.
US health care quality rank is only 38th .
French health care cost is ranked 34th. But number 1 in quality.
Everybody is insured and health care is free for everybody since 1949.
In the US health care stock is the number 1 revenue at Wall Street,
In the US health care is not aimed at global health ...it is to make money.
The average older Republican who voted for Trump and benefits from Medicare would argue that they don't want so much government involvement in health care! Can we keep proposing to them one thing?: Give up your government run Medicare and buy your own insurance. These folks just don't get it.
For those of us who benefit from Medicare, we wouldn't have it any other way. It's the way to go. Paul Ryan and his supporters tried to go after Medicare. That voting bloc would not let him do it.
Single payer seems to be the future. The GOP is going to have to come to grips with this. The GOP's brand of Right Wing governance is based on 1880. It needs to get with the modern world. It might run the federal government, but it does not run it well, and it is clear to Americans.
Calling single payer "socialized medicine" is a standard negative buzzword in the US of A. If the American public is giving subsidies to lower income people, THAT is socialized. So, opening the pool to all is simply the way the rest of the civilized world does it. And we can add a "capitalist medicine" private insurance option for the uber rich - and tax it at the same time.
If Obama care was repealed, or replaced by Trump care, it's true that many people would no longer have medical insurance and government expenditure would likely be reduced. But let's not confuse that with an absence of medical care and reduced medical costs.
People, largely the poor, would continue to receive a form of medical care, albeit of a poorer quality, through emergency rooms, and the costs would be the same or greater than under Obama care, just not a direct line item on the national budget.
People, largely the poor, would continue to receive a form of medical care, albeit of a poorer quality, through emergency rooms, and the costs would be the same or greater than under Obama care, just not a direct line item on the national budget.
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What happens in an ER is NOT medical care. Medical care includes things like _treatment_ -- for cancer and cardiac stents and insulin for diabetes and ... the list goes on and on. ER's do not provide treatment.
No they wouldn't.
A formula for death, Len, for many reasons. Having been in the healthcare
industry for 30 years, I've seen it.
industry for 30 years, I've seen it.
It's conservative ideology that keeps this government from creating an economical healthcare system that covers everyone. They won't allow this massive, profitable, industry to be taken out of the equation. They won't allow bargaining with the drug companies for lower prices. The "free market" hasn't worked to keep prices down, or growing slowly. It's time to face up to facts and make the obvious choice. We've wasted billions of dollars, prevented millions from getting the care they need, and have enriched people at their expense. Let's train more doctors and nurses and get people in for preventative care.
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There really is no good reason why everyone should not be covered. I went most of my life without health insurance until Obamacare. Now I can actually afford it. We should just keep moving in that direction and never go back to those terrible dark days. Families should not have to worry about cost when they or their kids get sick. This should not even be a debate.
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The government could still provide universal coverage and have a profitable private insurance system too. If the government provided catastrophic health insurance to all Americans this would greatly lower the risk the insurance companies would have to assume. They could provide buy up programs on the free market so that people who wanted benefits like well care, lower deductibles and copays, immunizations, prescription drug coverage they could buy them. Universal catastrophic coverage would also reduce bankruptcies due to unforeseen medical bills which are currently the leading cause of personal bankruptcies. The hospitals would no longer have to pass on bad debts to those of us who have insurance.
What I'm describing sounds a lot like Medicare. Virtually all of us senior citizens have 'pre-existing conditions' which would make the for profit insurance companies shun us. But the system works well and the private insurance companies must profit from it since they heavily advertise their supplements and advantage plans during open enrollment periods.
What I'm describing sounds a lot like Medicare. Virtually all of us senior citizens have 'pre-existing conditions' which would make the for profit insurance companies shun us. But the system works well and the private insurance companies must profit from it since they heavily advertise their supplements and advantage plans during open enrollment periods.
And....can we please get vision and dental care as part of everyone's healthcare? Why something so necessary for everyone is a separate policy is hard to understand. These essentials can help people stay employable.
With all this talk about taxes - its relevant to recall who's signature would ultimately be required for any change to occur. Of course I'm referring to the individual who willingly speaks at length about crowd size and hand size but has not voluntarily shared one iota of anything to do with the size of his taxes.
Sorry if this sounds a bit cynical but - good luck with that! Trumpf will always take his personal situation first and foremost - he's his own center of gravity in all things.
Sorry if this sounds a bit cynical but - good luck with that! Trumpf will always take his personal situation first and foremost - he's his own center of gravity in all things.
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It's true - and Trump will do what Steve Bannon and Robert Mercer tell him to do. The harder people to convince are the tea party members. In fact pushing for single payer is a great leverage tactic for them because it will scare the republicans enough that they want to act faster. They will not want to let go of the profit making part of health care and will fight and fight and fight to keep it. Democrats thinking they will just roll over because of town hall protests are kidding themselves. Incremental change is the way to go here - nudge left...
Trump will sign on to whatever can deliver him a win. Winning is all he cares about - well, that and adoration and attention. He doesn't give a whit about policy details or ideology. The hardest part about getting Trump to sign on will be penetrating the barrier of the cynical trickle down devotees and far-right extremists who surround him. They have his ear because they have been the most willing to cater to his pathological neediness in service of their ends.
The article does say "when [the Democrats] are next in charge". All we have to do is defeat Russia in Cold War II.
In science and math, testing theories at the extremes is a time-tested way of exposing weaknesses in those theories. Pass the test at the bounds and the theory holds. The Trump fiasco, and that's precisely the word for it, is serving one important purpose - testing GOP "theories" at the extremes. Clearly, GOP ideology since Reagan has consisted of but one element - minimize taxes on wealth. Recognizing that enables one to anticipate the GOP's every move, every position. In the case of healthcare, that predicts a tortuously long, wasteful, mean-spirited, cruel road that ultimately leads either to the adoption of universal coverage, or continuing damage to our economy. The choice is that stark.
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Trump and the GOP should careful what they wish for when they wish for the insurance exchanges to fail.
Politically, the GOP could afford to gut Medicaid -- which serves a population that Republicans have largely written off politically. But having private insurance markets melt down is another thing entirely.
The ACA exchanges serve millions of people in the core Republican demographic -- enterpreneurs, small business owners, real estate agents, contractors, people in their 50s and 60s.
Those people aren't stupid. If their premiums skyrocket this fall or insurance becomes available, Trump can blame Obama till he's blue in the face, but the electoral backlash is going to be directed against the party currently in power.
The most important thing that's happened in the last month is that the Emperor's clothes are off. Trump promised "great" health care but it turns out he was all hot air. The Ryan plan was tax cuts for the rich and a bag of empty platitudes ("freedom", "access") for everybody else.
If people lose their insurance in the next year, they know who they need to vote for if they want a real solution.
Politically, the GOP could afford to gut Medicaid -- which serves a population that Republicans have largely written off politically. But having private insurance markets melt down is another thing entirely.
The ACA exchanges serve millions of people in the core Republican demographic -- enterpreneurs, small business owners, real estate agents, contractors, people in their 50s and 60s.
Those people aren't stupid. If their premiums skyrocket this fall or insurance becomes available, Trump can blame Obama till he's blue in the face, but the electoral backlash is going to be directed against the party currently in power.
The most important thing that's happened in the last month is that the Emperor's clothes are off. Trump promised "great" health care but it turns out he was all hot air. The Ryan plan was tax cuts for the rich and a bag of empty platitudes ("freedom", "access") for everybody else.
If people lose their insurance in the next year, they know who they need to vote for if they want a real solution.
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What they found out, though, was that despite Paul Ryan's dreams, they couldn't afford to write off Medicaid entirely. Republican governors and moderate representatives knew the truth--we've broken the link between Medicaid and welfare. Now Medicaid covers your disabled niece who needs aides for everyday tasks, and your grandmother's nursing home, and kept your kids insured when you lost your job.
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@Tom if I may add, this recent republican failure of a healthcare/taxcut for the rich bill has made it crystal clear.
While there will be those who still believe (thanks to the original fake news man himself) that there was a Kenyan Muslim in the White House for 8 years who created this mess, there are many others who now see the vail has been lifted and their own Republican Party has been exposed for the greedy uncaring people that they are. Shocking!
They may not vote democratic, but they know who is pulling their much wanted health care away from them NOW.
While there will be those who still believe (thanks to the original fake news man himself) that there was a Kenyan Muslim in the White House for 8 years who created this mess, there are many others who now see the vail has been lifted and their own Republican Party has been exposed for the greedy uncaring people that they are. Shocking!
They may not vote democratic, but they know who is pulling their much wanted health care away from them NOW.
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This country needs to have a heart-felt, serious discussion about what should be done about health care: what minimal level is the "right" of all Americans and how is that right guaranteed (who pays, how is it collected). That minimal "right" should not be connected to employment.
The ACA debate has forced somewhat of a start - basically it's pushing us toward the solution: Medicaid for all and everyone gets taxed ot pay for it according to their income. Private supplementary policies are optional.
Let's get it out in the open. America is too fond of depending on simple, easy free markets to be our moral guides. Healthcare is a deep moral question/issue that must be considered in terms of what we all are willing to do for our fellow Americans. Of course costs matter. Who would have thought that it could be so complicated?
The ACA debate has forced somewhat of a start - basically it's pushing us toward the solution: Medicaid for all and everyone gets taxed ot pay for it according to their income. Private supplementary policies are optional.
Let's get it out in the open. America is too fond of depending on simple, easy free markets to be our moral guides. Healthcare is a deep moral question/issue that must be considered in terms of what we all are willing to do for our fellow Americans. Of course costs matter. Who would have thought that it could be so complicated?
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The debate is raging in comment sections. If you go to Breitbart, you'll see there's a passionate group of folks who say 'No!' to "freeloaders".
American's should be sending the message to Washington that we are willing to have our medicare tax raised, 20 dollars a month per person gets us 6.8 billion a year, a trip to McDonalds for two people or three upgraded coffee's at starbucks. I'm tired of the argument some can not afford it. If it's a healthcare system that operates like medicare all of us can afford 20 bucks a month. This entire thing has gotten stupid, get rid of insurance companies bilking us for billions and be done with it.
Bernie Sanders is already ahead on this. He is introducing a Medicare For All bill. http://www.politico.com/story/2017/03/sanders-to-introduce-single-payer-...
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Unfortunately, Bernie Sanders doesn't have a great track record on moving his proposed bills through Congress. But we appreciate the thought.
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Bernie is right! Medicare works well and the structure is there
thing we must work on is competitive bidding for prescription medications. Big Pharma has stopped that.
thing we must work on is competitive bidding for prescription medications. Big Pharma has stopped that.
Bernie Sanders is probably laying the groundwork for one more quixotic attack on Democrats for being less pure than himself. The reasons we don't have a single-payer system should be fairly obvious even to the sanctimonious left: insurance companies have tremendous economic power and, therefore, political clout. This is why Obamacare and not Medicare For All passed in 2009. That's the lay of the political land. The irony here is that if Bernie succeeds in splitting the progressive coalition yet again, you will never get to the super-majority in the US Senate you absolutely need to even entertain single payer. Republicans demonized Obamacare for two simple reasons: to kneecap Obama as much as they could, and racialize political differences to their own advantage.
Single Payer will only happen in a nation not driving itself to insanity over a racialized culture war. Trump is one manifestation of that war. The other is a subset of left-wing purists, virtually all white, who cannot understand why there's still something called identity politics in our tribalized nation.
Single Payer will only happen in a nation not driving itself to insanity over a racialized culture war. Trump is one manifestation of that war. The other is a subset of left-wing purists, virtually all white, who cannot understand why there's still something called identity politics in our tribalized nation.
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Most Americans are paying for a Corvette and getting an Edsel which still requires $5,000 of gas before you can drive it. Others don't even get a pair of shoes.
Europeans pay for a Prius and get a Prius (with a full tank).
Europeans pay for a Prius and get a Prius (with a full tank).
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Priuses need a new every every ten years. Otherwise, they are sturdy, reliable, utilitarian vehicles that get you where you want to go. Great cars. Toyota can be proud of them.
It's worse than that , Erik . Our Edsel has square wheels . It can't run smoothly by nature . We need to get rid of it . Full stop .
National single-payer , Medicare For All , is the obvious answer .
We all need to write to our Congressmen and make this clear .
National single-payer , Medicare For All , is the obvious answer .
We all need to write to our Congressmen and make this clear .
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Correction: Priuses need a new *battery* every ten years.
"Passing major social legislation is fantastically difficult. It tends to involve taking something from influential interest groups — taxing the rich, for example (as Obamacare did), or reducing some companies’ profits or hurting professional guilds."
Leonhardt correctly notes that almost all government regulations will involve some redistribution of benefits and welfare. This is the basic social contract which binds citizens and their elected officials. Most folks would like such redistribution to flow from the rich to the poor, from those who are fortunate to have resources to those who are less fortunate and have fewer resources.
However, ever since St. Reagan began his diatribe against government, many but not all Americans have come to view government regulations as a nuisance rather than a welcome intervention. Granted that many government programs are less that efficient but so are many private enterprises.
But in collectively identifying the rich as potential barriers to social reform, Leonhardt does disservice to the many rich and middle-class Americans who believe in a significant role for the government. Just look at some prominent rich folks like Bill Gates and Warren Buffet; they are more than willing to pay additional taxes if it will enhance the welfare of the less fortunate.
Leonhardt correctly notes that almost all government regulations will involve some redistribution of benefits and welfare. This is the basic social contract which binds citizens and their elected officials. Most folks would like such redistribution to flow from the rich to the poor, from those who are fortunate to have resources to those who are less fortunate and have fewer resources.
However, ever since St. Reagan began his diatribe against government, many but not all Americans have come to view government regulations as a nuisance rather than a welcome intervention. Granted that many government programs are less that efficient but so are many private enterprises.
But in collectively identifying the rich as potential barriers to social reform, Leonhardt does disservice to the many rich and middle-class Americans who believe in a significant role for the government. Just look at some prominent rich folks like Bill Gates and Warren Buffet; they are more than willing to pay additional taxes if it will enhance the welfare of the less fortunate.
Wonderful, but first the Democrats, supported one hopes by the decent people of this country, must expose and shoot down the Trump administration effort to sabotage the ACA, which the President and Dr. Price have promised to do.
If they succeed in gutting the ACA by Dr. Price's fiat, the Trump team is sufficiently clever to persuade Trump voters, including those whose lives are destroyed by the Trump administration's scuttling of the ACA, that Obamacare collapsed of its own weight. To forestall that requires a Democratic party strategy, which is not yet evident, presumably because Democrats are still celebrating.
If they succeed in gutting the ACA by Dr. Price's fiat, the Trump team is sufficiently clever to persuade Trump voters, including those whose lives are destroyed by the Trump administration's scuttling of the ACA, that Obamacare collapsed of its own weight. To forestall that requires a Democratic party strategy, which is not yet evident, presumably because Democrats are still celebrating.
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Here's one Democrat not celebrating! That's because the T administration, especially Price, can completely undermine ACA with measures, changes to the mandates, that will bring it to the "collapse" that T. & Price predict. What we have to do is urge our Democratic senators and congresspeople to work with this most unfortunate lying, hypocritical and amateur administration to bring ACA toward the single payer plan it always should have been. Who was the genius who decided that Americans' healthcare needs could best be met by working through profit-making insurance companies. THAT's the layer of healthcare costs that has made American healthcare the most costly, least effective in the world! Medicare for all, please!
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With his new motto, "Do Harm", Price is no doctor. He's not even a decent human being.
I once asked this question and the response of a second generation family business owner was that after WW II, politicians and the leaders of industry--including enterprising insurance execs--conferred upon how to stave off inflation (read: higher wage costs) in the post war boom economy. Maternity costs from the baby boom era was a small price to pay in exchange for tax deductible premiums-lower-than-wages and must have sounded like a real benefit at the time to business-naïve and relatively healthy young returning vets and their wives upon seeing those hospital maternity ward bills.
Ironically, the healthcare plan that the ACA was based on, which was proposed by Republicans in 1974, during the Nixon administration, had a public option. And, ironically, it was the Democrats, under the leadership of Ted Kennedy, who scuttled the plan. Wouldn't it by the icing on the irony cake if Republicans were the ones to restore the public option to the ACA?
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it was Max Baucus, darling of the insurance industry who took it off the table. Obama was foolish to put him in charge, but hey, Obama was a centrist not a progressive. I and my doctor husband wanted Medicare for all and maybe we'll get it.
No you are wrong. It wasn't Senator Ted Kennedy, who fought for healthcare most of his term as Massachusetts senator. Most people know this much.
It was Senator Joe Lieberman, an independent who was the ONE vote that wouldn't allow the single payer option in 2009.
Get your facts.
It would be a shock and might take 218 frontal lobotomies in the republican congress and 60 republican senators to see single payer option back on the table. I'd vote for that.
It was Senator Joe Lieberman, an independent who was the ONE vote that wouldn't allow the single payer option in 2009.
Get your facts.
It would be a shock and might take 218 frontal lobotomies in the republican congress and 60 republican senators to see single payer option back on the table. I'd vote for that.
I hope the Republicans take the opportunity now afforded them to go with a public option.
Until we think about how to destroy the United Citizens, and private donations for greed politicians , our democracy continue to be "Fake". The hypocrisy of so many is out of controle , They're destroying the basic government obrigation . Universal Care, or Medicare for all , is the right thing ., Please support Bernie, he's trying very hard to make a difference. Republicans don't care about us , and once again they proved it 100%. Why so many still vote for this party, if things a very clear.
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Yes indeed; the irony is delicious. So what next? I do hope it's single-payer for all. We need a US wide health care plan which covers everyone and is portable; you can change jobs, move to another state and you keep your health care coverage.
Should the Republicans support this, I'd hope the Democrats would join them. Health care is too important to not be a bi-partisan effort.
Perhaps a tolerable single-payer plan would be one in which basic level of service was provided to everyone; a plain vanilla plan so to speak. This would provide for preventative health care, most meds (generic when available), hospital services and catastrophic coverage. If you want more than this plan provides, you can buy extra add-on coverage. The plain vanilla coverage however would suffice for most needs and prevent medical bankruptcy. If you want concierge medicine, face lifts and 25 rounds of in-vitro attempts, it's on your or perhaps you can buy coverage for this. But mostly, the ordinary medical issues of life as well as catastrophic issues will be covered.
We can look at what works well and what doesn't in other developed countries that have health care for all and take advantage of their experience to craft a good program for the US.
Should our President wish to utilize my common-sense approach and non-partisan outlook, I'll be happy to serve.
Should the Republicans support this, I'd hope the Democrats would join them. Health care is too important to not be a bi-partisan effort.
Perhaps a tolerable single-payer plan would be one in which basic level of service was provided to everyone; a plain vanilla plan so to speak. This would provide for preventative health care, most meds (generic when available), hospital services and catastrophic coverage. If you want more than this plan provides, you can buy extra add-on coverage. The plain vanilla coverage however would suffice for most needs and prevent medical bankruptcy. If you want concierge medicine, face lifts and 25 rounds of in-vitro attempts, it's on your or perhaps you can buy coverage for this. But mostly, the ordinary medical issues of life as well as catastrophic issues will be covered.
We can look at what works well and what doesn't in other developed countries that have health care for all and take advantage of their experience to craft a good program for the US.
Should our President wish to utilize my common-sense approach and non-partisan outlook, I'll be happy to serve.
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I have some small amount of experience in this issue. First I am in favor of universal health coverage and I believe the above is interesting. However, what needs to be closely controlled are two things at least, 1.Hospitals billing the government more than is honest or legitimate ( the opposite happened to me in Florida when I went to help a relative that died in the Hospital after being there for one day and I was presented with a bill of close to 30,000 U$S and upon receiving it I almost fainted and the person giving it to me said don't worry you don't have to pay it , just sign it.) And the other thing that one needs to anticipate is Hospital overload. Sometimes when you are simply with some kind of unknown pain it can take a while to get service.
You are so correct.....awesome statement that is clear and emphatic. Thanks
Canada's system does not cover medications once you are out of a hospital.
I generally like this op ed, but there is one assertion that is just glaringly NOT ACCURATE. Leonhardt argues that private markets, "lead to ... lower prices." On the contrary, national systems of negotiated, regulated prices lead to lower prices -- the evidence in favor of this view is overwhelming.
The price of medical care and the true COST of that care is constantly referred to in this debate as though they are the same thing and, thus, interchangeable. They are not. Only when we strip health care of profit-taking and provide the care for a truly universal risk pool (as have other first world countries) will we know the actual costs. Then can we apply known methods and efficiencies to reduce those costs and provide quality care for all Americans.
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One of the fundamental problems of any government program is being able to control costs. In the normal course, it can't be done. Those, like hospitals, clinics, etc., that learn how to use the system for their own benefit treat the federal treasury like a fire hose spouting money. Open wide, here it comes.
While I don't have definitive proof, the raiding of federal money appears to be happening now with "rehabilitation centers" where patients, often elderly, are sent between hospital stays. These centers have minimal professional staffing compared to hospitals, but they rake in the dough nonetheless and profits appear to be high.
Some sort of single payer system, one that preserves or extends the ability of people to make choices about their medical care without having millions in the bank, is a goal worthy of consideration. If in encouraging the wreck of Obamacare the Republicans move us in that direction, all the better.
What will live on regardless of the chaos and inflated passions of the moment is the idea that everyone should have access to health care. That is now a permanent, fixed idea, a gift from Obamacare. There's no turning back. The sooner Republicans learn this valuable truth (a big step was made with the defeat of last week), the sooner we can move forward toward to, hey!, actually dealing with problems instead of just screaming and fighting about them.
While I don't have definitive proof, the raiding of federal money appears to be happening now with "rehabilitation centers" where patients, often elderly, are sent between hospital stays. These centers have minimal professional staffing compared to hospitals, but they rake in the dough nonetheless and profits appear to be high.
Some sort of single payer system, one that preserves or extends the ability of people to make choices about their medical care without having millions in the bank, is a goal worthy of consideration. If in encouraging the wreck of Obamacare the Republicans move us in that direction, all the better.
What will live on regardless of the chaos and inflated passions of the moment is the idea that everyone should have access to health care. That is now a permanent, fixed idea, a gift from Obamacare. There's no turning back. The sooner Republicans learn this valuable truth (a big step was made with the defeat of last week), the sooner we can move forward toward to, hey!, actually dealing with problems instead of just screaming and fighting about them.
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There is no raid like the raid now taking place with this presidency. The protection of DT for a weekend would be adequate for a month or more in many nursing homes.
Just for the record it was The Republicans who got through drug coverage part D under Bush in 2006 and overhauled Medicare M.M.A. in 2003 and it was Democrat Joe Lieberman who cast the deciding vote AGAINST the public option in the original A.C.A. Proposal, so perhaps it would be no surprise if Trump and his fellow Republicans noted the irony and took the historic opportunity to own single payer and the voting public for the foreseeable future. Let me see they would only have to dump Price, drop the tax cut for the wealthiest among us, cut defense spending, let our"allies" in the M.E. fight and pay for their own wars(that would of course require a bi partisan effort), oh and fulfilling the promise about bringing back those factory jobs, the ones where people got a paycheck, paid taxes, got benefits, health care and a pension. I don't see a problem, considering our option is to continue with an underground economy, particularly in the trades and small business where no one pays taxes and we circle the drain in a spectacular example of the short term, every man for himself, brand of capitalism that has become our defining vision.
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Joe Lieberman is a DINO. Always was when he wasn't being an "Imdependent."
We are, I believe, the only country I the world with a health care system vested in the for-profit health insurance industry. We have proved that this is just not workable-we spend 17% of our GDP on health costs. Capitalism works in many areas of the economy, but not in health care. I wonder if the GOP accept a compromise that would work: have at your capitalism in other areas, but health care for the nation can only work with a single payer system of some sort. It can be done and would improve not only the physical health but the emotional well-being of our nation.
So Price was under investigation by Preet Bharara when he was fired together with all other AGs. I hope his office continues the investigation vigorously. I imagine large health & drug industry donors got to Trump to have Bharara fired... follow the money!
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Republicans could become the party of the people rather than the party of the wealthy by developing and launching a single payer health care system that surpasses anything in the world. But they won't because they are bereft of ideas and because they do not believe government has a role in ensuring the health, safety and welfare of its people.
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Government expenditure on healthcare is already higher per capita than in other countries. Perhaps if a single payer reform was pitched as a way to reduce expenditure, to cut taxes, then it might gain traction.
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Well if republicans were so full of hate, they would have seen the FACTS that Obamacare did indeed keep the cost of health care down.
Something never mentioned is that many countries w socialized medicine have a parallel private system. British execs get fancy private health insurance and go to some very posh private hospitals. Until they're really sick. Then you want a public teaching hospital, just like here. Big Charity in New Orleans did amazing medicine until Katrina gave Republicans a chance to shutter it. Everybody went there at some point.