As usual, the Doctor makes more sense than anyone else in the room, on the internet, in the news. I am halfway convinced!
3
"Moving to single-payer would mean taking away this coverage and imposing new taxes; to make it fly politically you’d have to convince most of these people both that they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old.
This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?"
You could resort to that tactics you took during the early days of Obamacare - just call these folks liars. Then when word gets out people really have lost some coverage or are paying more for the same coverage just claim they probably deserve to pay more. Then when those same folks vote against the supporters of the single-payer system, call them racists.
This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?"
You could resort to that tactics you took during the early days of Obamacare - just call these folks liars. Then when word gets out people really have lost some coverage or are paying more for the same coverage just claim they probably deserve to pay more. Then when those same folks vote against the supporters of the single-payer system, call them racists.
2
Medical prices are controlled in various ways in the rest of the developed world. In Japan, all medical care prices are listed in a book. An MRI that costs $1,200 in the USA costs $88 in Japan. Japanese insurance companies are private as are most doctors. Japan spends less than a third per capita on medical care than America. However, the Japanese are greater consumers of medical care than Americans. They visit doctors and hospitals more often, have much more diagnostic tests such as MRIs.
Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. More competition among sellers generally leads to lower prices. However, more competition among buyers leads to higher prices. In the health insurance industry the beneficial effects of more insurance companies competing for patients are far outweighed by the adverse effects of insurance companies competing for doctors and hospitals in their HMO plans. This was completely during the recent debate. With health care, more competition among insurance companies on balance results in higher prices..."
http://seekingalpha.com/article/1647632
Japan's explicit price controls are roughly emulated in other countries via the use monopsonistic systems. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopolist sets prices above free market equilibrium. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. More competition among sellers generally leads to lower prices. However, more competition among buyers leads to higher prices. In the health insurance industry the beneficial effects of more insurance companies competing for patients are far outweighed by the adverse effects of insurance companies competing for doctors and hospitals in their HMO plans. This was completely during the recent debate. With health care, more competition among insurance companies on balance results in higher prices..."
http://seekingalpha.com/article/1647632
2
Progressives and their statist policies are the reason the Democrats are dumpster diving and will continue to lose, lose. lose. Progressives want government to do their bidding with sometimes altruistic intent but always funded with OPM (re: sounds like opium, is equally addicting, stands for Other People's Money--forcibly extorted. Professor Krugman is a Keynesian, which is the only so-called school of economics that believes a nation can spend its way to prosperity. And look what 8 years of Obama progressivism gave us: unremitting deficits resulting in a national debt so large not even a Keynesian economist or a progressive politician believes it will ever be repaid--except through the dishonest slight of hand called inflation.
When the debt bangs up against the debt ceiling very soon, we may see what progressive policies have given us. If Congress and Trump kick the can down the road for the umpteenth time, America will be following the same path to perdition so many other empires no longer with us have tread.
The Professsor asks, "If Democrats regain control of Congress and the White House, what will they do with the opportunity?"
Rest assured they will endeavor to continue spending OPM, only to find the well has finally run dry.
Krugman speaks as though progressive Democrats are on the road to winning elections. He sounds like delusional Dems sounded right before Trump thumped 'em. Trump will win a second term only if the Dems run a progressive against him.
When the debt bangs up against the debt ceiling very soon, we may see what progressive policies have given us. If Congress and Trump kick the can down the road for the umpteenth time, America will be following the same path to perdition so many other empires no longer with us have tread.
The Professsor asks, "If Democrats regain control of Congress and the White House, what will they do with the opportunity?"
Rest assured they will endeavor to continue spending OPM, only to find the well has finally run dry.
Krugman speaks as though progressive Democrats are on the road to winning elections. He sounds like delusional Dems sounded right before Trump thumped 'em. Trump will win a second term only if the Dems run a progressive against him.
6
Too expensive they said. Pie-in-the-sky, they said. No, no, no you can't they still say. Krugman and the other DINOs of the party are terrified of a Single Payer system.
These people are are getting older by the day, every day in which the younger generation cares more and more about progressive virtues instead of crony capitalism.
These people are are getting older by the day, every day in which the younger generation cares more and more about progressive virtues instead of crony capitalism.
13
We all remember Obama's horrible negotiation methods with Conservatives: Start by meeting Repubs halfway and show them we're acting in good faith. Don't make the same mistake (if Dems get control of the House/Senate). START with the most extreme type of Single Payer and SETTLE for something like the Dutch system or what Dr. Krugman suggests.
17
term limits and public financing of elections. Start there.
12
Our priorities should be to overturn Citizens United and get the money out of politics, and then we can focus on healthcare without pharma and insurance calling the shots
22
Paul, it's not all or nothing.
The main advantage of Bernie Sanders' Medicare for all, is that the bureaucracy, website, laws and regulations already largely exist, therefore its establishment costs are quite limited. And, really, it's nothing new or radical, as all Americans living to 65 end up on it.
The advantage of the British system is that it is more socialist, which however makes it politically impossible in the center-right quagmire, that most Democratic politicians are entrapped in.
The disadvantage of Paul Krugman's plan to keep ACA, is that Obamacare is based on the government being a shill for the clearly corrupt insurance. As the insurance industry demands obscene profits, it must costs more than the US government itself acting as a non-profit insurance funding.
Therefore, I advocate true Single Payer medical insurance with the government being the insurer. The government can still purchase private reinsurance if necessary.
The other progressive suggestions of Krugman can also be accomplished by eliminating the FICA tax cap, taxing the upper 5% wealth at much higher rates, and creating a Democratic majority in both houses of Congress and electing a truly progressive President.
The main advantage of Bernie Sanders' Medicare for all, is that the bureaucracy, website, laws and regulations already largely exist, therefore its establishment costs are quite limited. And, really, it's nothing new or radical, as all Americans living to 65 end up on it.
The advantage of the British system is that it is more socialist, which however makes it politically impossible in the center-right quagmire, that most Democratic politicians are entrapped in.
The disadvantage of Paul Krugman's plan to keep ACA, is that Obamacare is based on the government being a shill for the clearly corrupt insurance. As the insurance industry demands obscene profits, it must costs more than the US government itself acting as a non-profit insurance funding.
Therefore, I advocate true Single Payer medical insurance with the government being the insurer. The government can still purchase private reinsurance if necessary.
The other progressive suggestions of Krugman can also be accomplished by eliminating the FICA tax cap, taxing the upper 5% wealth at much higher rates, and creating a Democratic majority in both houses of Congress and electing a truly progressive President.
24
I don't understand PK's fixation on supporting the ACA, a system designed to keep health insurance companies alive but that is likely to remain shaky. Contrary to what he assumes, single payer doesn't have to be the only insurance system in place in the country. We have it for seniors. Why don't we expand it to cover people in the individual market and leave alone employer coverage?
12
Hospitals like Obamacare. Insurance companies like Obamacare. Pharma likes Obamacare. Democrats who don't need Obamacare like Obamacare. As long as Obamacare is around, it will stoke lower middle-class resentment against those who get it for free, which suits the GOP just fine. So Obamacare is not going away any time soon.
However.
If the Dems ever hope to start winning elections again, they must appreciate just how unpopular this law is among the people whom it is supposed to be helping. Then they will be smart to campaign against Obamacare themselves, and promise to replace it with ‘something better’.
However.
If the Dems ever hope to start winning elections again, they must appreciate just how unpopular this law is among the people whom it is supposed to be helping. Then they will be smart to campaign against Obamacare themselves, and promise to replace it with ‘something better’.
3
Obamacare never had the support of even half the people.
Polling found 80% of us satisfied with our HC choices in 2009.
Polling found 80% of us satisfied with our HC choices in 2009.
2
I am stalling on the infernal references to the United States as a wealthy country. I am sure you can wow me with numbers and factual comparisons but still I wonder who are these rich Americans? They seem to be far from me. They are not my kids and I doubt they are my grand children. It do not see that shaming is going to motivate either the rich who can buy insurance or those of us who struggle to afford it into doing the right thing.
Or the rich industrial thing.
I agree we could insure all of us but only if we can agree on the meaning of WE.
I want the same deal the congress members get ....at the very least. We vote for them, they represent us ........at least that is what they claim .
Or the rich industrial thing.
I agree we could insure all of us but only if we can agree on the meaning of WE.
I want the same deal the congress members get ....at the very least. We vote for them, they represent us ........at least that is what they claim .
4
An emendation: Mr. Hume died in 1776; the Revolution to which he referred was the Glorious Revolution, not, of course, the French.
2
What's the difference between coal and healthcare?
Krugman suggests the main obstacle to Single Payer is the stranglehold healthcare and insurance cartels have on the economy. Like a metastasizing cancer, the health wholesalers have burrowed so deep into the economy, surgical removal would be lethal. And politically healthcare interests are so powerful even the faint odor of Single Payer or a Public Option triggers the lobbying equivalence of WMDs.
The best healthcare options for Americans are off the table because the middlemen would lose their livelihood and unlike coal miners can't be retrained and redeployed to more productive and less damaging jobs.
How is this remotely a marketplace that's free, fair and functioning?
Why do we even pretend ours is a democracy?
If Single Payer is a bridge too far, and our free market health system -- already heavily subsidized by taxpayers to support the middlemen but not the end users -- can't be restructured for maximum universal benefit, our body politic is in rigor mortis and we're way past triage.
There is, then, no What's Next.
We're not a free country. We're a company town. And the 1% aren't just obscenely rich, they're also the bosses.
The Beatles were prescient. We're back in the U.S.S.R.
Krugman suggests the main obstacle to Single Payer is the stranglehold healthcare and insurance cartels have on the economy. Like a metastasizing cancer, the health wholesalers have burrowed so deep into the economy, surgical removal would be lethal. And politically healthcare interests are so powerful even the faint odor of Single Payer or a Public Option triggers the lobbying equivalence of WMDs.
The best healthcare options for Americans are off the table because the middlemen would lose their livelihood and unlike coal miners can't be retrained and redeployed to more productive and less damaging jobs.
How is this remotely a marketplace that's free, fair and functioning?
Why do we even pretend ours is a democracy?
If Single Payer is a bridge too far, and our free market health system -- already heavily subsidized by taxpayers to support the middlemen but not the end users -- can't be restructured for maximum universal benefit, our body politic is in rigor mortis and we're way past triage.
There is, then, no What's Next.
We're not a free country. We're a company town. And the 1% aren't just obscenely rich, they're also the bosses.
The Beatles were prescient. We're back in the U.S.S.R.
18
I'd like to know Krugman's analysis of single-payer programs within a single state, such as the New York Health Act.
6
The title is "What's Next for Progressives?"
Independence. A separate country.
Trump and his voters have made it possible.
Time-is-wasting to move on it.
Independence. A separate country.
Trump and his voters have made it possible.
Time-is-wasting to move on it.
2
Try Canada. Please! or California without our bailout.
"This represents a huge victory for progressives..." Rather than defining them as Progressives-- simply call people who care about doing the right thing, "People who care about doing what's right."
7
If the only way I can call myself a Democrat is to endorse universal health care, then count me out.
2
What really should be next for progressives and all Americans is SECOND INCOMES! Universal Basic Incomes can be included.
The Second Income Plan originated with Louis O. Kelso, father of the Employee Stock Ownership Plan used by 11,000 companies. It does not depend upon jobs or savings.
Kelso saw automation coming. He believed it could liberate humans from toil, work we do not choose to do. He thought that by age 50, almost everyone could receive 50% of income from diversified investments.
Robert Ashford, a Professor of Law at Syracuse University has developed Louis Kelso’s Binary Economics expanding upon Kelso’s work. Unlike mainstream economics, it offers a clear plan to end poverty and expand prosperity. See Binary Economics: The economic theory that gave rise to ESOPs; or his book, BINARY ECONOMICS: The New Paradigm. (Coauthored with Rodney Shakespeare.)
A History of Economic Thought: A Concise Treatise for Business, Law, and Public Policy, Volume 1: From the Ancients Through Keynes Paperback – April 4, 2017 by Robert Ashford & Stefan Padfield
In order to provide immediate impact, combine SECOND INCOMES with a transitional Universal Basic Income. These interim funds would gradually be replaced - as growing income is derived by individuals from SECOND INCOMES. See that title at aesopinstitute.org Look under MORE.
SECOND INCOMES can unite Americans – there is only a temporary cost to the treasury! A path can open which can win elections & attack all our problems.
The Second Income Plan originated with Louis O. Kelso, father of the Employee Stock Ownership Plan used by 11,000 companies. It does not depend upon jobs or savings.
Kelso saw automation coming. He believed it could liberate humans from toil, work we do not choose to do. He thought that by age 50, almost everyone could receive 50% of income from diversified investments.
Robert Ashford, a Professor of Law at Syracuse University has developed Louis Kelso’s Binary Economics expanding upon Kelso’s work. Unlike mainstream economics, it offers a clear plan to end poverty and expand prosperity. See Binary Economics: The economic theory that gave rise to ESOPs; or his book, BINARY ECONOMICS: The New Paradigm. (Coauthored with Rodney Shakespeare.)
A History of Economic Thought: A Concise Treatise for Business, Law, and Public Policy, Volume 1: From the Ancients Through Keynes Paperback – April 4, 2017 by Robert Ashford & Stefan Padfield
In order to provide immediate impact, combine SECOND INCOMES with a transitional Universal Basic Income. These interim funds would gradually be replaced - as growing income is derived by individuals from SECOND INCOMES. See that title at aesopinstitute.org Look under MORE.
SECOND INCOMES can unite Americans – there is only a temporary cost to the treasury! A path can open which can win elections & attack all our problems.
6
I should think public healthcare, like trade policy, should be an issue driven by pragmatism rather than ideology. But of course, in the Age of Trump, everything is backwards.
Single payer is not an ideology. Nor is insurance-driven model like Obamacare. They are just different vehicles to get to the same place, and in either case the devil is in the details (which is why I do not take Trumpcare seriously, because it lacks any real details.) The facts and details is what I want to hear about. But on the whole, there is very little rational, face-based discourse about how to proceed. The discourse is dominated by sloganeering and howling social media pitchfork mobs. It's all about digging your heels in. You would think we were talking about religion, not public policy.
I look at all this and think: who are these mules that pass as people?
Single payer is not an ideology. Nor is insurance-driven model like Obamacare. They are just different vehicles to get to the same place, and in either case the devil is in the details (which is why I do not take Trumpcare seriously, because it lacks any real details.) The facts and details is what I want to hear about. But on the whole, there is very little rational, face-based discourse about how to proceed. The discourse is dominated by sloganeering and howling social media pitchfork mobs. It's all about digging your heels in. You would think we were talking about religion, not public policy.
I look at all this and think: who are these mules that pass as people?
8
Krugman: stop pretending to be practical by advocating a "modest, incremental" approach. More of the same for-profit heath care is only going to continue and worsen the present healthcare catastrophe.
Kick the can down the road to do single payer "eventually"? No! We are smarter than you think we are!
We need to catch up to the rest of the developed world. Now! People are literally dying without universal health care as we speak! Getting sick in America for too many means going bankrupt and spending one's last days in the proverbial gutter... all so some psychopathic execs can roll around in their excessive profits. It's immoral.
I have zero tolerance for those who say single payer is too politically difficult to achieve. If this paper had not infamously ignored, denigrated, and opposed Bernie Sanders, he would likely have been president now, in part because the majority of Americans want single payer. That would have made it far easier.
Are you saying all other developed countries can do what America can't? Outrageous! We can do anything we want to. And we want single payer.
Let's pay for health care by reducing military spending a bit. Let's help our own people live instead of killing innocent people around the globe. No new taxes. Forever end the draining spiral of ever increasing premiums.
You, the economist, know single payer will save us trillions in the long run. Yes, upend one sixth of the economy, ASAP. We will survive it just fine, as the other countries have!
Kick the can down the road to do single payer "eventually"? No! We are smarter than you think we are!
We need to catch up to the rest of the developed world. Now! People are literally dying without universal health care as we speak! Getting sick in America for too many means going bankrupt and spending one's last days in the proverbial gutter... all so some psychopathic execs can roll around in their excessive profits. It's immoral.
I have zero tolerance for those who say single payer is too politically difficult to achieve. If this paper had not infamously ignored, denigrated, and opposed Bernie Sanders, he would likely have been president now, in part because the majority of Americans want single payer. That would have made it far easier.
Are you saying all other developed countries can do what America can't? Outrageous! We can do anything we want to. And we want single payer.
Let's pay for health care by reducing military spending a bit. Let's help our own people live instead of killing innocent people around the globe. No new taxes. Forever end the draining spiral of ever increasing premiums.
You, the economist, know single payer will save us trillions in the long run. Yes, upend one sixth of the economy, ASAP. We will survive it just fine, as the other countries have!
15
How about single payer for children as part of this? Guaranteeing Medicare for ALL CHILDREN in the United States. How will the Republicans argue that children aren't deserving of health care? (I know. They'll try. Like Newt Gingrich recently suggesting we should bring back child labor so that poor children could work as janitors in their own schools. But insane people aside ...)
6
"time for a little pushback"? Hilarious. Read your own paper. Pushback against progressive ideals is all you guys have been doing.
7
Paul, everybody gets sick. Not everyone has a child they cannot pay for.
I am a Progressive but am more than a little tired of paying for other people's kids. If I am buying your groceries you should not have any children. This is an issue with more than just Conservatives.
I am all for an opportunity society but am tired of the cradle to grave hammock and multi-generational dependence upon public largesse.
I am a Progressive but am more than a little tired of paying for other people's kids. If I am buying your groceries you should not have any children. This is an issue with more than just Conservatives.
I am all for an opportunity society but am tired of the cradle to grave hammock and multi-generational dependence upon public largesse.
7
Great. If your house burns down i don't have to pay for the fire department to put it out. Or the road that they drive on to get there. Or the water they use to douse the flames. Or the school they went to for that matter. Your libertarian nonsense is just that. We all pay for each other. We (federal tax payers) spend more money bailing out the 'Deep Red South' than any other region. I'm not complaining about that and neither should you. We're all one America.
6
If Democrats were really progressives, they would advocate "Medicare for All" or "Single Payer". Period. Anything less would be a failure because they would have to cave to Republicans and their donors, the "for-profit-only" health insurance industry. If an inferior bill makes it out of committee for a vote, and is approved by both parties, then signed into law by Trump, you can bet your bottom dollar that if the bill receives bad reviews, Trump and the Republican leadership will place blame squarely with the Democrats. Fox News and other right wing media will stay on point for weeks that Democrats sabotaged TrumpCare to make Trump and Republicans look bad, and guess what, their viewers and listeners will gobble it all up like candy. See the risk here for Democrats?
I believe a "Single Payer" platform for Democrats going into the 2018 elections would be a win-win to voters. If Democrats want majority rule in the Senate and House this would be the route to take.
I believe a "Single Payer" platform for Democrats going into the 2018 elections would be a win-win to voters. If Democrats want majority rule in the Senate and House this would be the route to take.
10
i say if Democrats want to go with something new and cutting edge form a
coalition with the Greens and agree to advocate for the Green agenda or at least part of it. Promote alternative energy, recycling and sustainability. No hugging trees or kissing whales---too radical. Greens tend to be well educated, better off economically and very committed to their cause. Not a great number of Party members/voters---I'd guess maybe as many as 2 million---but very dedicated and energetic. Just like the Republicans tapped into the Tea Party Democrats if they play their cards right could tap into the Greens and get a jolt of energy and dedication both of which are desperately needed. And the planet would be happier too.
coalition with the Greens and agree to advocate for the Green agenda or at least part of it. Promote alternative energy, recycling and sustainability. No hugging trees or kissing whales---too radical. Greens tend to be well educated, better off economically and very committed to their cause. Not a great number of Party members/voters---I'd guess maybe as many as 2 million---but very dedicated and energetic. Just like the Republicans tapped into the Tea Party Democrats if they play their cards right could tap into the Greens and get a jolt of energy and dedication both of which are desperately needed. And the planet would be happier too.
2
I have read most of the comments. I think we desperately need a new "Age of Enlightenment". Too many of our population believe in Mother Goose and "you will get your reward in Heaven", like Wimpy saying, "I will gladly pay you on Wednesday for a hamburger today" for those who remember Popeye".
We no longer have a democracy. The last nail in our coffin was Citizens United. I recommend a peaceful divorce with those who believe in a ten thousand year old universe living in own little world of ignorant bigotry. They can have the Koch brothers, the NRA, Grover Norquist, Fox News and Ole Miss. We get to keep MIT, freedom of choice, birth control, and quality education, and progressive taxes. No more long legitty beasties and things that go bump in the night.
We no longer have a democracy. The last nail in our coffin was Citizens United. I recommend a peaceful divorce with those who believe in a ten thousand year old universe living in own little world of ignorant bigotry. They can have the Koch brothers, the NRA, Grover Norquist, Fox News and Ole Miss. We get to keep MIT, freedom of choice, birth control, and quality education, and progressive taxes. No more long legitty beasties and things that go bump in the night.
2
As a business owner, one big thing that is missing from this debate is the price that americans are already paying for health insurance, provded by employers. Krugman is right out point out that many employers (ourselves included) provide highly subsidized plans that our employees are happy with. HOWEVER, this system causes businesses like ours to pay huge amounts of money that could be better spent on higher wages, more jobs, lower prices, and disproportionately forces small businesses to compete with large corporations in a benefits race - a race that small business can ill-afford. It is a system that favors big business, drives up prices for consumers, lowers job creation, and reduces wages.
If we had some form of nationalized health care (and i'm not knowledgeable enough to say which one), we could compete on our own merits, we could pay higher wages, create more jobs, and we could lower prices. If we're good corporate citizens that is.
We pay taxes, and taxes pay for basic services that we all agree are our rights as citizens. The ACA is now an accepted basic service, as the repeal failed and we also have medicare and medicaid in addition to social security.
The question, rightly posed, is how.
If we had some form of nationalized health care (and i'm not knowledgeable enough to say which one), we could compete on our own merits, we could pay higher wages, create more jobs, and we could lower prices. If we're good corporate citizens that is.
We pay taxes, and taxes pay for basic services that we all agree are our rights as citizens. The ACA is now an accepted basic service, as the repeal failed and we also have medicare and medicaid in addition to social security.
The question, rightly posed, is how.
5
The problem with pursuing a child-focused agenda as the goal of Progressives faces one important obstacle: Millenials, the energy driving the current Progressive wave, seem very focused on identity justice issues. The first battle will be to get them to care about children's issues rather than the value of uniqueness that so motivates them.
1
This may be off topic but you did ask what Democrats should focus on if they get back congress. My suggestion is that their first act should be the 'Reapportionment Fairness Act'. The act would require that all congressional districts should have approximately the same number people represented with that number based on the number of people in the least populous state. One of the reasons our electoral college, and congress, are so out of wack with the popular vote is not only gerrymandering, but the built in advantage less populous states have in both houses when their representatives have voting power far in excess of what their constituents warrant. The House of Representatives is the peoples house. It should return to that notion. The nations priorities have been skewed towards the needs of rural and less populated states long enough. It will cause a huge increase in the number of members of congress. But that is fine. We can phase it in. But it is long past time that voters in the more populous states have their voices fairly heard and equally represented.
3
Marvelously thoughtful editorial. Congratulations; and clearly considerate of conservative thought on top of it! Good thinking for sure.
2
Progressives put the needs of the few ahead of the needs of the many, and then allow that to run into perpetuity, with no checks. That has to stop. I don't mind paying for my own healthcare, as it is not a right.
The Dems have taken up the sword for the downtrodden. Only problem is the downtrodden don't vote, even when they are able.
GOP success at the polls has occurred because they focus on what is good for the majority of Americans, and then they mobilize them to vote. The Dems could learn a lesson.
The Dems have taken up the sword for the downtrodden. Only problem is the downtrodden don't vote, even when they are able.
GOP success at the polls has occurred because they focus on what is good for the majority of Americans, and then they mobilize them to vote. The Dems could learn a lesson.
2
I actually agree with you, Mr. Krugman. And I think many Progressives would as well - at least the prudent ones, who understand that while Single Payer, Medicare for all, is a laudable goal, it might not be necessary to solve our problems, and even if it is, it will take a long time to get there.
.
I envision a series of steps that we can take to hopefully solve our nation's healthcare problems and, if they don't, put us on track to Single Payer.
.
First we allow younger, healthier people to buy into Medicare if they live in places that only have one or no private insurers on the ACA exchanges. Second, we allow people with certain preexisting conditions to buy into Medicare regardless of where they live.
.
Third, we expand Medicare to provide catastrophic coverage to all Americans (with deductibles based on income and wealth), as well as to cover regular doctors visits and vaccination.
.
These are logical, incremental changes that work in the current framework of the Affordable Care Act - as you suggested. They lift risk from the Health Insurers and put it on the Government, and they also put the insurers in a position where they compete with Medicare on the exchanges, further driving down premiums.
.
And if by themselves they don't solve our problems, we'll already have expanded Medicare. We'll be in a position, with one more push have true, Single Payer Healthcare!
.
I envision a series of steps that we can take to hopefully solve our nation's healthcare problems and, if they don't, put us on track to Single Payer.
.
First we allow younger, healthier people to buy into Medicare if they live in places that only have one or no private insurers on the ACA exchanges. Second, we allow people with certain preexisting conditions to buy into Medicare regardless of where they live.
.
Third, we expand Medicare to provide catastrophic coverage to all Americans (with deductibles based on income and wealth), as well as to cover regular doctors visits and vaccination.
.
These are logical, incremental changes that work in the current framework of the Affordable Care Act - as you suggested. They lift risk from the Health Insurers and put it on the Government, and they also put the insurers in a position where they compete with Medicare on the exchanges, further driving down premiums.
.
And if by themselves they don't solve our problems, we'll already have expanded Medicare. We'll be in a position, with one more push have true, Single Payer Healthcare!
3
I wish we could implement a single-payer system of the sort most socialists prefer, if merely for experimental purposes. Ironically, this would in all likelihood lead to a two-tiered system. When problems like undersupply, massive backups, and shoddy care start accruing, they can blame kulaks and saboteurs. Socialists never take responsibility for the failure of their ideas in practice, simply because, to them, they sound lovely in theory. Comparing the outcomes of smaller, more uniform, healthier countries, who have entirely different demographics and developmental histories, to our own dreadful statistics serves what end?
We can get universality of coverage, or at least make it affordable for all, and bring down prices throughout the system without resorting to pie-in-the-sky fantasizing, rather vapid denunciations of the profit motive in healthcare, and immensely disruptive modifications. In the real world, do recall, compromise is necessary, and progress is built on the back of what exists and what has come before. Sweeping revolutions are typically unwise.
"Extremes of all kinds are to be avoided; and though no one will ever please either faction by moderate opinions, it is there we are most likely to meet with truth and certainty." ... "Let not the ... [French] Revolution ... make us so much in love with a philosophical origin of government as to imagine all others monstrous." ~ David Hume
We can get universality of coverage, or at least make it affordable for all, and bring down prices throughout the system without resorting to pie-in-the-sky fantasizing, rather vapid denunciations of the profit motive in healthcare, and immensely disruptive modifications. In the real world, do recall, compromise is necessary, and progress is built on the back of what exists and what has come before. Sweeping revolutions are typically unwise.
"Extremes of all kinds are to be avoided; and though no one will ever please either faction by moderate opinions, it is there we are most likely to meet with truth and certainty." ... "Let not the ... [French] Revolution ... make us so much in love with a philosophical origin of government as to imagine all others monstrous." ~ David Hume
Can we talk about the costs and cost containment part of the equation, for a change? Mr Krugman cites that NY has an uninsured rate of 5%, so he considers the program a success? Progressives never seem to talk about costs. As if money grew on trees.
1
Here's a progressive who thinks about costs.
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The thing to remember is that the US already spends far more than any other modern country on healthcare, but by almost all accounts we get less. That indicates waste, and it's not hard to see where the waste is.
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It's in the massive bureaucracies of the health insurers - they employ over 500,000 people and that's just direct employment. Tens of thousands more work for doctors and spend their days just interfacing with the insurance companies trying to get their bosses paid.
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It's in the greed of the pharmaceutical companies - the fact that Medicaid can't negotiate drug prices and the insurance companies apparently won't.
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It's in the absurd cost of med school - the fact that newly minted doctors are often saddled with $250,000 in debt; sometimes much more.
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Address the waste, and we can have Universal Healthcare without breaking the bank.
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The thing to remember is that the US already spends far more than any other modern country on healthcare, but by almost all accounts we get less. That indicates waste, and it's not hard to see where the waste is.
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It's in the massive bureaucracies of the health insurers - they employ over 500,000 people and that's just direct employment. Tens of thousands more work for doctors and spend their days just interfacing with the insurance companies trying to get their bosses paid.
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It's in the greed of the pharmaceutical companies - the fact that Medicaid can't negotiate drug prices and the insurance companies apparently won't.
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It's in the absurd cost of med school - the fact that newly minted doctors are often saddled with $250,000 in debt; sometimes much more.
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Address the waste, and we can have Universal Healthcare without breaking the bank.
11
If we want to keep for-profit insurance companies in the mix, which I don't, why not just have the government contract with them to do what they're doing now but under terms and regulations set by the government? Government sets the coverage, deductibles and co-pays, the premiums, and the payments to providers, and insurance companies do the administration for a small profit. No group versus individual markets, no special deals with providers, no advertising and marketing allowed. Put the contracts out to bid and award to the lowest bidder.
4
A concrete proposal to lower the Medicare age gradually - one year every year. THAT is "incrementalism". That wouldn't scare anyone, except maybe insurance companies. Even then, the change would be gradual enough for no significant disruption of the general economy.
What is the alternative? Conceding that *any* policy that *any* donor doesn't like is "pie in the sky"? FDR would be appalled.
Calling for "single payer", is vague enough to be twisted into all kinds of political liability. Medicare age reduced one year every year? Sounds very sensible.
Rest of the platform? Anti TPP, pro Social Security (80% favor), pro higher minimum wage (70% favor), and downplaying wedge issues would be a huge winning platform - if the candidate is credible. There is huge mistrust of establishment pols. No one who takes money from the banks, or has a history of supporting bad trade deals should be considered as a presidential candidate - Not if you want to win.
What is the alternative? Conceding that *any* policy that *any* donor doesn't like is "pie in the sky"? FDR would be appalled.
Calling for "single payer", is vague enough to be twisted into all kinds of political liability. Medicare age reduced one year every year? Sounds very sensible.
Rest of the platform? Anti TPP, pro Social Security (80% favor), pro higher minimum wage (70% favor), and downplaying wedge issues would be a huge winning platform - if the candidate is credible. There is huge mistrust of establishment pols. No one who takes money from the banks, or has a history of supporting bad trade deals should be considered as a presidential candidate - Not if you want to win.
2
All valid points except for two key items:
1) The ACA was barely saved by a thumb nail--literally. Translation: there are still forces at work trying to destroy the plan for no other reason than that they can. I would work very hard to strengthen senators and congressmen who support the ACA--that means electing Democrats.
2) The ACA has a battered identity. The slogan, Medicare For All, is simple and comprehensible to everyone. It seems that only Democrats worry about the minutia; the Republicans never do.
1) The ACA was barely saved by a thumb nail--literally. Translation: there are still forces at work trying to destroy the plan for no other reason than that they can. I would work very hard to strengthen senators and congressmen who support the ACA--that means electing Democrats.
2) The ACA has a battered identity. The slogan, Medicare For All, is simple and comprehensible to everyone. It seems that only Democrats worry about the minutia; the Republicans never do.
1
Dr. Krugman, I have to tell you that I am mighty tired of insurance companies holding my life in their greedy hands.
Prior to ACA, I was excluded from coverage for a whole host of common everyday issues like flu, upper respiratory infections, ear infections, etc. because--wait for it--I once used FloNase for SIX MONTHS for allergies; I lived in fear of any major catastrophe that would be excluded. At least when I received Obamacare, I wasn't worried about preexisting conditions. BUT I did--and do--have to worry about my self-employed status and age group. I reside in the fourth largest city in the country, yet as a self-employed member of the "gig economy" (at least 20 percent of us are in this bucket), I had only THREE choices for individual insurance in 2017: all were expensive, none had decent coverage, all were "pay out of pocket" until reach $6500 (or more) deductible, only one included my primary care physician of several years, and only one had reputable hospitals--the priority for anyone seeking catastrophic health insurance. The insurance policy I chose will not be available in 2018!
So do I like Obamacare? Yes, it was a step in the right direction: no pre-existing conditions, no lifetime caps, fewer worries about personal bankruptcy. But it is not quality nor affordable; it penalizes those of us in the gig economy; and most importantly, it keeps the fat/greedy middle man insurance companies standing between all of us and the goal: HEALTH.
Single Payer Now.
Prior to ACA, I was excluded from coverage for a whole host of common everyday issues like flu, upper respiratory infections, ear infections, etc. because--wait for it--I once used FloNase for SIX MONTHS for allergies; I lived in fear of any major catastrophe that would be excluded. At least when I received Obamacare, I wasn't worried about preexisting conditions. BUT I did--and do--have to worry about my self-employed status and age group. I reside in the fourth largest city in the country, yet as a self-employed member of the "gig economy" (at least 20 percent of us are in this bucket), I had only THREE choices for individual insurance in 2017: all were expensive, none had decent coverage, all were "pay out of pocket" until reach $6500 (or more) deductible, only one included my primary care physician of several years, and only one had reputable hospitals--the priority for anyone seeking catastrophic health insurance. The insurance policy I chose will not be available in 2018!
So do I like Obamacare? Yes, it was a step in the right direction: no pre-existing conditions, no lifetime caps, fewer worries about personal bankruptcy. But it is not quality nor affordable; it penalizes those of us in the gig economy; and most importantly, it keeps the fat/greedy middle man insurance companies standing between all of us and the goal: HEALTH.
Single Payer Now.
19
The main problem with out health care system is the out-of-control pricing demanded by health care providers. Thirty years ago when most physicians were in solo or small group practices and hospitals were more numerous, large insurers could constrain prices to some extent. Now that the providers have counterattacked through unconstrained mergers and consolidation, this mechanism has broken down. A single payer in some form is the only plausible way that prices can be reined in. The current opaquely priced pay or die market mechanism will never do this.
4
Half of Americans get their health care insurance through their employers and they are happy with that? Of course that is in part government-paid through tax deductions by businesses. Like much of our bloated, graft-ridden health care system, who pays and how much is paid are craftily hidden from view. Single payer now.
3
"But the Dutch have what we might call Obamacare done right: individuals are required to buy coverage from regulated private insurers, with subsidies to help them afford the premiums."
Misleading.
Long-term treatments, especially those that involve semi-permanent hospitalization, and also disability costs such as wheelchairs, are covered by a state-controlled mandatory insurance.
For all regular (short-term) medical treatment, there is a system of obligatory health insurance, with private health insurance companies. These insurance companies are obliged to provide a package with a defined set of insured treatments.
Affordability is guaranteed through a system of income-related allowances and individual and employer-paid income-related premiums.
A key feature of the Dutch system is that premiums may not be related to health status or age.
Misleading.
Long-term treatments, especially those that involve semi-permanent hospitalization, and also disability costs such as wheelchairs, are covered by a state-controlled mandatory insurance.
For all regular (short-term) medical treatment, there is a system of obligatory health insurance, with private health insurance companies. These insurance companies are obliged to provide a package with a defined set of insured treatments.
Affordability is guaranteed through a system of income-related allowances and individual and employer-paid income-related premiums.
A key feature of the Dutch system is that premiums may not be related to health status or age.
10
Single payer has enormous advantages over a mixed system like "ACA done right": it eliminates the huge share of national health costs going to unnecessary insurance profits and what used to be called paperwork. Even small medical practices need a full time employee to handle billing. Medicare cuts administrative costs by an order of magnitude compared to private insurance. The YOOGE cost savings could go to improved coverage, more prevention and wellness programs, shorter wait times, and medical research, while still saving most people money and hassle, especially if funded by progressive taxation.
As Krugman notes, the transition is a challenge, but there are several paths to get there aside from a big bang: adding a public option to the ACA would allow gradual migration of people to the public plan, extending the medicare age downward a decade every five years and making CHIP (Child Health Plus in NY) universal would allow a smooth transition, and/or major states eg NY and CA could pass their own plans. Like Tommy Douglas's Saskatchewan single payer, successful state plans would inspire emulation and soon go national.
A national backlash against the incompetence and pig-headedness of Trump and the GOP could the create political conditions for more progressive policies than are now considered realistic.
As Krugman notes, the transition is a challenge, but there are several paths to get there aside from a big bang: adding a public option to the ACA would allow gradual migration of people to the public plan, extending the medicare age downward a decade every five years and making CHIP (Child Health Plus in NY) universal would allow a smooth transition, and/or major states eg NY and CA could pass their own plans. Like Tommy Douglas's Saskatchewan single payer, successful state plans would inspire emulation and soon go national.
A national backlash against the incompetence and pig-headedness of Trump and the GOP could the create political conditions for more progressive policies than are now considered realistic.
4
I love Krugman when he sticks to economics. But the moment he strays in policy priorities, the trouble is that doesn't understand politics. Creating a single payer system may appear too difficult and less efficient than incrementally improving Obamacare, but it will energize the democratic base. That's politics, not rationalist economics.
6
I just checked out the pay of G.P. physicians in England, who are employees of the government, not fee based. BTW, recent articles have shown how vst is the corruption among doctors on Medicare, as describing illness and treatment is still an art as much as a science.
Other than having a second doctor evaluate every patient-doctor interaction, this must be an honor system, and it's just too easy to find innocuous symptoms are more profitable when treated "aggressively" In England, a doctor is a salaried position, so such temptations don't exist.
HOWEVER, part of the reason such a system is so much cheaper than ours, is it's gone on so long. G.P.s start at only around $100K per year, while in this country it's probably at least twice that, with specialists able to make multiples of this. Most doctors accept medicare for the same reason that airlines have part of their passengers paying a fraction of others, the the aggregate of the mix that matters.
This is the catch with "medicare for all" If every one gets this special discount, the gross revenues of the businessman doctor would be dramatically lower. They will resist this with every effort, and if they can't win, those who have accrued some wealth will simply quit, or find a loophole like Concierge Practice (look it up) It's skirting Medicare laws, but not being enforced.
To change our system will take an iconoclast, but one who has the knowledge and conviction to actually, "clean out the swamp."
Other than having a second doctor evaluate every patient-doctor interaction, this must be an honor system, and it's just too easy to find innocuous symptoms are more profitable when treated "aggressively" In England, a doctor is a salaried position, so such temptations don't exist.
HOWEVER, part of the reason such a system is so much cheaper than ours, is it's gone on so long. G.P.s start at only around $100K per year, while in this country it's probably at least twice that, with specialists able to make multiples of this. Most doctors accept medicare for the same reason that airlines have part of their passengers paying a fraction of others, the the aggregate of the mix that matters.
This is the catch with "medicare for all" If every one gets this special discount, the gross revenues of the businessman doctor would be dramatically lower. They will resist this with every effort, and if they can't win, those who have accrued some wealth will simply quit, or find a loophole like Concierge Practice (look it up) It's skirting Medicare laws, but not being enforced.
To change our system will take an iconoclast, but one who has the knowledge and conviction to actually, "clean out the swamp."
5
If the Senate winds up with 60 Republicans after the 2018 election, which is highly possible, that might change this whole ballgame.
3
The only way the Republicans can end up with 60 senators is by manipulating the electronic voting machines, which they have been doing since we moved to computerized voting.
Mark Crispin Miller: Can U.S. Elections Really Be Stolen? Yes.
https://www.youtube.com/watch?v=NxXKr2hKCz0
Mark Crispin Miller: Can U.S. Elections Really Be Stolen? Yes.
https://www.youtube.com/watch?v=NxXKr2hKCz0
6
it is ridiculous that we have Medicare for old people but not Medicare for children. I suppose it's because children can't vote.
8
It is called CHIPS and is for children under Medicaid.
1
I used to hold Krugman in very high esteem, but ever since he condemned the proposal, set forth by Bernie Sanders and Elizabeth Warren, to restore Glass-Steagle, I have been wary of him.
He asks what "liberals" should do given that the right is in retreat on health care. I suspect they will do nothing. After Clinton took office he charged Hillary with formulating a plan to address health care affordability. Given Dem control of Congress, a lot could have been done.
And of course phony liberal Democrats said no. Daniel Patrick Moynihan, Dem Senator from NY, said very early in Clinton's first term, on one of the Sunday morning news shows (either Face the Nation or Meet the Press), that he would do nothing on health care until we accomplished welfare reform. And then, in 1996, when it was clear that welfare would be slashed and that his words were immaterial, he gave an impassioned address against welfare reform so he could appear liberal. Yes, the GOP savaged "Hillary Care" but the knives that hurt the most came from her fellow democrats.
In arguing that we should continue to prop up insurance companies as opposed to providing that all medical bills be paid by Washington, Krugman omits evidence that the truely progressive plan reduces costs: 96 percent of Medicare monies go to providers; only about 78 percent of insurance premiums go to providers, the rest goes to profits.
He asks what "liberals" should do given that the right is in retreat on health care. I suspect they will do nothing. After Clinton took office he charged Hillary with formulating a plan to address health care affordability. Given Dem control of Congress, a lot could have been done.
And of course phony liberal Democrats said no. Daniel Patrick Moynihan, Dem Senator from NY, said very early in Clinton's first term, on one of the Sunday morning news shows (either Face the Nation or Meet the Press), that he would do nothing on health care until we accomplished welfare reform. And then, in 1996, when it was clear that welfare would be slashed and that his words were immaterial, he gave an impassioned address against welfare reform so he could appear liberal. Yes, the GOP savaged "Hillary Care" but the knives that hurt the most came from her fellow democrats.
In arguing that we should continue to prop up insurance companies as opposed to providing that all medical bills be paid by Washington, Krugman omits evidence that the truely progressive plan reduces costs: 96 percent of Medicare monies go to providers; only about 78 percent of insurance premiums go to providers, the rest goes to profits.
9
Our spending on families is a third of the advanced-country average, putting us down there with Mexico and Turkey.
Yes but look at our budget for wars. How many countries own those bragging rights. Huh?
Yes but look at our budget for wars. How many countries own those bragging rights. Huh?
7
Krugman for president! Why not, professor? Be the Adlai who wins.
Krugman, please, don't offer a single payer system. Its simply not going to work. Also, you asked "What's next for progressives?" At this rate not much Paul. Most progressives don't have a clue. The issues are jobs, jobs, jobs and more jobs. the issue is that the middle class has literally been dissolved over 30 years and the future of the remnant is in doubt. I doubt that my grandchildren will fare as well as me or my children. The social and economic issues that divide us have not gone away. Trump triumphed based on fear. Hillary lost as her arrogance and elitism disgusted people watching their jobs and future disappear before their eyes. What's next for progressives? Hopefully a changing of the guard. Hopefully a bright, enlightened and quick on their feet new generation of leaders will come forth.
Here's a short list of what we need immediately.
1. An end to the exporting of American jobs, industry and research and development of new technology for new and better jobs.
2. Great access to affordable education.
3. Revision of bankruptcy laws to allow greater relief for a strapped middle class.
4. Access to affordable health care including eye, dental and long term care without going bankrupt.
5. An end to the gold plated benefits for Senators and Congressmen.
6. Access to and development of more affordable housing.
7. Better trade agreements with our partners and competitors and an end to stealing or purchasing of critical advanced technology by China.
And more!
Here's a short list of what we need immediately.
1. An end to the exporting of American jobs, industry and research and development of new technology for new and better jobs.
2. Great access to affordable education.
3. Revision of bankruptcy laws to allow greater relief for a strapped middle class.
4. Access to affordable health care including eye, dental and long term care without going bankrupt.
5. An end to the gold plated benefits for Senators and Congressmen.
6. Access to and development of more affordable housing.
7. Better trade agreements with our partners and competitors and an end to stealing or purchasing of critical advanced technology by China.
And more!
3
The Children of Israel did not wander 40 years in the wilderness because they did not know directions. They had to wait for the old failed leaders to fade away. Let us hope the leaders of the Hillary and Obama wing will go away before its too late for the Democratic Party and the country.
5
Okay, I disagree with your premise that universal single payer is not feasible. We already have Medicare n place. If the Democrats would get it together and put out SIMPLE messages about the ECONOMIC advantages of single payer, then everyone would be on board. These messages would have to blanket all forms of media, like campaign ads do, to the point that people get sick of hearing them and have them memorized by heart - other countries have great single payer systems in place. Taiwan is a great example of a country who took 10 years to research all of the universal healthcare plans around the world, picked the best ideas from all of them, then took another 10 years to implement the system they have now - http://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/ and the sad thing is, this video is from 2008! If Obama and the Democrats, when we had the majority, hadn't been so compromising with the ACA to Republicans, we could have had universal single payer NOW and this wouldn't even be an issue anymore. And think of all of the lives we could have saved since then. The Democrats NEED to stop talking like the nerd in school to the American public. I have a master's degree but not everyone has my higher education to understand their policy positions. Plus, get someone like Bernie, Elizabeth, and others who understand how to keep it simple, stupid, out there to explain things in simple terms to Americans and we'll have single payer tomorrow.
5
How about lowering the eligibility age for Medicare by periodic five year increments until it reaches zero?
3
Run Paul, run!
We need denttal and vision included in all healthcare. I agree that all should have the choice to buy into medicare and we must also reduce or eliminate dedutables and co pay while negotiating drug prices.
2
It's all in HR 676. https://www.congress.gov/bill/115th-congress/house-bill/676
1
Well, into our 4th week of the New Paul Krugman, and he finally leaks out his position on HealthCare. Same old, same old. Status quo, incremtalism.
Thanks for playing Paul.
We can now forget you and your "progressive" voice, and move onto someone who will advocate for the true answer.
The idea that the right thing to do is just too hard galls me. The idea of stuffing money into the pockets of insur. Co. et al, just because they have a hand out in the middle of me and my doctor galls me.
We The People got a taste of a better way with the ACA. Despite its many faults and foibles. People on the whole thought it could be better, yet was a step in the right direction. They marched, called, threatened, cajoled, and begged to keep it. Imagine what that response would have been like had they a taste of SinglePayer/Medi4All.
Yes, your stance is not what was hoped for Paul, yet it is also not unexpected. I'll glance into your columns in passing, but until you become an advocate, meh, I've got elsewhere to spend my time.
Look forward to when you are willing to be a voice for making HealthCare a Right and not just another method for Capitalism Uber Alles on the backs of the sick and dying.
Thanks for playing Paul.
We can now forget you and your "progressive" voice, and move onto someone who will advocate for the true answer.
The idea that the right thing to do is just too hard galls me. The idea of stuffing money into the pockets of insur. Co. et al, just because they have a hand out in the middle of me and my doctor galls me.
We The People got a taste of a better way with the ACA. Despite its many faults and foibles. People on the whole thought it could be better, yet was a step in the right direction. They marched, called, threatened, cajoled, and begged to keep it. Imagine what that response would have been like had they a taste of SinglePayer/Medi4All.
Yes, your stance is not what was hoped for Paul, yet it is also not unexpected. I'll glance into your columns in passing, but until you become an advocate, meh, I've got elsewhere to spend my time.
Look forward to when you are willing to be a voice for making HealthCare a Right and not just another method for Capitalism Uber Alles on the backs of the sick and dying.
7
First order of progressives to be to get rid of Trump and every single person he appointed, period. From healthcare to global warming, they are an unmitigated disaster for this country. Who on earth could support the damage except the most depraved psychopaths among us? We must beat them back badly.
1
"I have nothing against single-payer; it’s what I’d support if we were starting fresh."
What a strange thing to say at the end of an entire essay arguing against single-payer. Dr. Krugman, you are breaking my heart: you sound like someone in the pocket of Big Insurance. I think the country's rejection of GOP Deathcare should embolden us to stop thinking incrementally, cut parasitical insurers out of the loop and start building Medicare for All.
What a strange thing to say at the end of an entire essay arguing against single-payer. Dr. Krugman, you are breaking my heart: you sound like someone in the pocket of Big Insurance. I think the country's rejection of GOP Deathcare should embolden us to stop thinking incrementally, cut parasitical insurers out of the loop and start building Medicare for All.
8
Yes. The key is that we are not starting from scratch. If guns had just been invented we could make the case that they are too dangerous to have in circulation but dong this now, just because other countries are safer, is beyond imagination.
So many liberal commenters here are attacking Krugman.
What liberals should focus on are winning policy issues that will overcome their gerrymandered electoral disadvantage.
What liberals should focus on are winning policy issues that will overcome their gerrymandered electoral disadvantage.
1
B Clark,
Medicare for All is a policy that's easy to understand and would implement simple to use, affordable, truly universal care.
Compare that to the complexity of the ACA, which restricts doctor access to the provider networks of private insurances, burdens the insured with the need to yearly review the offerings to find the "best" one, threatens people with a fine if they don't enroll, and to this day leaves about 1 out of 10 Americans uninsured. Add to that the annoyance of tax payers knowing that their taxes supporting insurance subsidies don't mean better care, just richer private insurance companies.
The obvious winning choice is Medicare for All regardless of gerrymandering.
Medicare for All is a policy that's easy to understand and would implement simple to use, affordable, truly universal care.
Compare that to the complexity of the ACA, which restricts doctor access to the provider networks of private insurances, burdens the insured with the need to yearly review the offerings to find the "best" one, threatens people with a fine if they don't enroll, and to this day leaves about 1 out of 10 Americans uninsured. Add to that the annoyance of tax payers knowing that their taxes supporting insurance subsidies don't mean better care, just richer private insurance companies.
The obvious winning choice is Medicare for All regardless of gerrymandering.
2
"I'd enhance the ACA...although I would strongly support reintroducing some form of public option--a way for people to buy into public insurance--that could eventually lead to single-payer." That seems to epitomize a progressive position. Dr. Krugman is right, we can't waive a magic wand and introduce single-payer. We can, though, move towards it and use a public option to keep insurance companies honest. After all, one measure of improvement is the percentage of insured Americans, but we also have to keep an eye on the costs and coverage of private insurance, and the money that is "wasted" (from the insured's point of view) on profit.
1
Why this article now? Could it be because 115 Democrats in the House have signed on to HR 676, Improved Medicare for All? Is Krugman worried we could truly be closer than he would like?
3
I think Krugman is playing offense. Bernie plans to introduce Medicare for all legislation.
3
What's Next For Progressives ? asks Krugman.
The answer: Oblivion
Having smugly and callously overplayed their hand, they will be out of power for decades.
Things are looking up !
1
If the Progressives can't get their act together, maybe Conservatives will:
http://www.theamericanconservative.com/articles/the-conservative-case-fo...
Just a matter of time, the sooner the better.
http://www.theamericanconservative.com/articles/the-conservative-case-fo...
Just a matter of time, the sooner the better.
2
The progressive-Republican plan outlined by Dr. Krugman could very well bring affordable health-care to all by the turn of the century. Eh. Or then it may go the way of welfare when progressives joined with Republicans to repair it. Boo!Hmm. Weak beer or nothing at all. Yay, progressives and Republicans working together.
And helping kids while you foil their parents has been the liberal game plan following the Johnson years. The kids have grown up to be poor and their kids are now poor.
And helping kids while you foil their parents has been the liberal game plan following the Johnson years. The kids have grown up to be poor and their kids are now poor.
4
Progressives are anything but progressive. Perhaps, you should start by evaluating the hypocritical misnomers that you apply to yourselves. You claim to want equality. But diversity doesn't always mean equality, especially, if a more qualified candidate is passed over for someone who fits a demographic quota. You claim to be liberal. However, you ignore the minority groups (women, homosexual, Christians and other religious groups) that are being slaughtered in the Middle East. Instead, you defend the perpetrators of these actions who are radical Muslim extremists (a word you lyingly refuse to use). Your idiotic young liberal fascists are attempting to censor free speech and they will use violence, rather than ideas, to promote their agenda. Here's a novel idea. Come up with a name that is befitting of your evil political doctrine. Leftist fascists is much more fitting.
4
Medicare for All doesn't have to be an either/or choice between it and the private insurance plans currently offered under ACA. We could readily achieve a robust public option by eliminating the age restriction on Medicare and charging affordable premiums (with generous income-based subsidies and support from a combination of employer/payroll taxes).
The beauty of Medicare is that its stable, nationwide network of doctors and hospitals already exists and would not have to be created from scratch. Moreover, insurance customers who split the year between two states or who have a young adult children attending college or working in a different state could buy into Medicare in order to extend their coverage across state lines - something not likely achievable with private insurance, despite the Republican talking point. (How do you force your New York doctor to take an Arizona insurance plan?)
For those who are satisfied with their private insurance policies, they could still keep them, but competition from Medicare might induce private insurers to broaden their networks, reduce premiums or simply aim for a more affluent market, ceding the broader individual market to Medicare.
The beauty of Medicare is that its stable, nationwide network of doctors and hospitals already exists and would not have to be created from scratch. Moreover, insurance customers who split the year between two states or who have a young adult children attending college or working in a different state could buy into Medicare in order to extend their coverage across state lines - something not likely achievable with private insurance, despite the Republican talking point. (How do you force your New York doctor to take an Arizona insurance plan?)
For those who are satisfied with their private insurance policies, they could still keep them, but competition from Medicare might induce private insurers to broaden their networks, reduce premiums or simply aim for a more affluent market, ceding the broader individual market to Medicare.
2
I agree that a sweeping piece of legislation would be difficult but I think we need to start paving the path towards single payer and away from employer based coverage - because some report being "satisfied" with this coverage is not a reason to continue this system which introduces bad incentives into employment and hinders movement and start ups. To that end I would propose:
1) Remove the tax deduction from employer based coverage. Offer/require employers to pay the full amount of the coverage as salary wages, as a carrot to ease the transition allow the same tax deduction to be taken on that portion for employers.
2) Improve the subsidy formula on the exchanges, it should not be capped at income level, but should ensure that no more than x% is paid out of pocket for insurance premiums and deductibles.
3) Allow a phased in Medicare buy-in, dropping the age floor by 10 years every 5-10 years. This would start removing older people from private markets and making those markets younger and healthier (and maybe less expensive) *without* making coverage worse and less affordable for those older people (the assumption being Medicare buy ins will be < private insurance).
Private insurance can become to phase out into a supplemental service as the Medicare buy-in covers the population (or as an alternative to public Medicare). The industry doesn't need to disappear under a universal/public system, it just changes its role and form.
1) Remove the tax deduction from employer based coverage. Offer/require employers to pay the full amount of the coverage as salary wages, as a carrot to ease the transition allow the same tax deduction to be taken on that portion for employers.
2) Improve the subsidy formula on the exchanges, it should not be capped at income level, but should ensure that no more than x% is paid out of pocket for insurance premiums and deductibles.
3) Allow a phased in Medicare buy-in, dropping the age floor by 10 years every 5-10 years. This would start removing older people from private markets and making those markets younger and healthier (and maybe less expensive) *without* making coverage worse and less affordable for those older people (the assumption being Medicare buy ins will be < private insurance).
Private insurance can become to phase out into a supplemental service as the Medicare buy-in covers the population (or as an alternative to public Medicare). The industry doesn't need to disappear under a universal/public system, it just changes its role and form.
1
Insurance is the safest bet there is out there in the capitalist world -- as long as the principles of statistics remain applicable -- which they most assuredly do in the case of healthcare for some 320 million people. Just as in the case of ; national defense, provision of healthcare should be through a public agency and it should not be the source of private profits.
National defense itself is linked inextricably to the health of the population and as such personnel needs of the armed forces is another consideration that supports a public single-payer system of health insurance.
After taking the oath to execute the laws of the land, which currently includes Obamacare -- President Trump is now calling for letting the law "implode". This alone should be sufficient for impeachment and removal of mr. Trump from the presidency. Any newly hired security person at a bank found to encourage and abet bank robbery is sure to lose his job at a minimum.
National defense itself is linked inextricably to the health of the population and as such personnel needs of the armed forces is another consideration that supports a public single-payer system of health insurance.
After taking the oath to execute the laws of the land, which currently includes Obamacare -- President Trump is now calling for letting the law "implode". This alone should be sufficient for impeachment and removal of mr. Trump from the presidency. Any newly hired security person at a bank found to encourage and abet bank robbery is sure to lose his job at a minimum.
4
If it comes down to negotiating the details, then, sure, taking incremental steps towards single-payer—rather than insisting on all-or-nothing—makes sense.
But as a political strategy, Prof. Krugman's stance is a loser. Just two weekends ago, I was at a rally at the Connecticut State Capitol organized by Protect Our Care-Connecticut. Initially put together to keep up the pressure against ACA repeal, it became something of a celebration of the defeat of the GOP bills. Sens. Dick Blumenthal and Chris Murphy were there to speak and Blumenthal said—to great cheers—that the goal is single-payer. Other prominent Democrats who are not necessarily part of the Bernie wing have also moved in that direction (Kirsten Gillibrand, Jimmy Carter, Al Gore).
We should organize, educate and agitate for what we want and what makes sense—single-payer or Medicare for All, whatever you want to call it. And take the concessions as they come.
It's time for Democrats to stop taking the type of small-bore, negotiating-with-ourselves bad advice Prof. Krugman is offering here.
But as a political strategy, Prof. Krugman's stance is a loser. Just two weekends ago, I was at a rally at the Connecticut State Capitol organized by Protect Our Care-Connecticut. Initially put together to keep up the pressure against ACA repeal, it became something of a celebration of the defeat of the GOP bills. Sens. Dick Blumenthal and Chris Murphy were there to speak and Blumenthal said—to great cheers—that the goal is single-payer. Other prominent Democrats who are not necessarily part of the Bernie wing have also moved in that direction (Kirsten Gillibrand, Jimmy Carter, Al Gore).
We should organize, educate and agitate for what we want and what makes sense—single-payer or Medicare for All, whatever you want to call it. And take the concessions as they come.
It's time for Democrats to stop taking the type of small-bore, negotiating-with-ourselves bad advice Prof. Krugman is offering here.
5
Our current health care system is not unified in terms of the levels of care & cost for different services. It does more disease management than prevention and wellness. So it would seem smart to look for cost-savings and expansion to universal access in areas like prevention, wellness, and routine management of chronic diseases (e.g. vaccinations, well baby care, annual physical exams, incentives for maintainIng and improving health, patient education about self-management and good lifestyle habits to avoid health declines and emergencies like heart attack, stroke, etc., etc.). The cost for these services can be lowered when provided by nurses, nurse practitioners, and physician assistants, who can refer to an MD when necessary.
On the other hand, diagnosis and treatment of illnesses of varying degrees of severity and length requires more expensive care: more costly MDs, specialists, tests and equipment, There are probably some savings to create here too.
End of life treatment and hospice might fall somewhere in between on the cost and expertise spectra.
Finally, there is a huge amount of medical waste that inflates cost, which is rarely mentioned.
Teasing out these differences is important in reimagining where and how to cut costs while keeping quality. Publicizing how quality lower cost health care is delivered by other countries should be part of the "best practices" discussion too.
On the other hand, diagnosis and treatment of illnesses of varying degrees of severity and length requires more expensive care: more costly MDs, specialists, tests and equipment, There are probably some savings to create here too.
End of life treatment and hospice might fall somewhere in between on the cost and expertise spectra.
Finally, there is a huge amount of medical waste that inflates cost, which is rarely mentioned.
Teasing out these differences is important in reimagining where and how to cut costs while keeping quality. Publicizing how quality lower cost health care is delivered by other countries should be part of the "best practices" discussion too.
1
To me a good start for a "Medicare for all" public option would be rural countries across the country. The markets are relatively small, there are few providers and they are spread out geographically. For profit insurance companies do not want to "compete" for this business because there's not a lot of business to be had and to make matters worse, costs are much higher. Who wants to "compete" for business that may in fact not be that profitable especially if you look at it from a county to county or state by state basis.
Republicans might scream "socialized medicine" but they should be challenged to find insurance companies who want to compete for business in these areas.
I think Dr. Krugman is correct, start small with a Medicare for all public option in areas that are underserved. This would be a foot in the door, proving that it works even in poor market conditions. Once people see how it works and benefits people the model will become more accepted, just as the ACA has become more acceptable as people see how it works and how it benefits many people.
Republicans might scream "socialized medicine" but they should be challenged to find insurance companies who want to compete for business in these areas.
I think Dr. Krugman is correct, start small with a Medicare for all public option in areas that are underserved. This would be a foot in the door, proving that it works even in poor market conditions. Once people see how it works and benefits people the model will become more accepted, just as the ACA has become more acceptable as people see how it works and how it benefits many people.
3
I'm a progressive. While I was somewhat in agreement with most of Bernie Sanders positions I also recognized many of them would not work in the real world and that equally effective alternatives existed that are possible. Progressives better pay attention to what Mr. Krugman wrote in this column or be prepared to lose much more in elections still to come. Haven't we all lost enough already with Trump? This isn't about compromising principles, this is about being pragmatic and effective in delivering to America's workers a more secure and prosperous future.
2
"What’s Next for Progressives?"
Can we direct discussion to something other than healthcare?
How about a nationwide passenger rail network to rival the system the Chinese have built?
When I visited China last year, I was struck with an unprecedented notion:
THIS IS A GOVERNMENT THAT REALLY CARES FOR IT'S PEOPLE
The next thought was "How come?...Why was I seized with this peculiar notion?
The first evidence that came to mind was the rail system--cheap, fast, comfortable rides from anywhere to everywhere.
The next thing is the police. They surely have cop cars, but they are not in the sort of "get-up" that we see in USA. I saw no swashbucklers bristling with weapons and communications gear. Their primary, function is to police motorized traffic. They are just another class of public workers.
This is just a start. The Chinese have much to teach us about how to run a country. Their system is not flawless, but for 99% of the citizens it's pretty good, and likely to get better. And, all this in a place where the the per capita domestic product is a fraction of the US standard.
Can we direct discussion to something other than healthcare?
How about a nationwide passenger rail network to rival the system the Chinese have built?
When I visited China last year, I was struck with an unprecedented notion:
THIS IS A GOVERNMENT THAT REALLY CARES FOR IT'S PEOPLE
The next thought was "How come?...Why was I seized with this peculiar notion?
The first evidence that came to mind was the rail system--cheap, fast, comfortable rides from anywhere to everywhere.
The next thing is the police. They surely have cop cars, but they are not in the sort of "get-up" that we see in USA. I saw no swashbucklers bristling with weapons and communications gear. Their primary, function is to police motorized traffic. They are just another class of public workers.
This is just a start. The Chinese have much to teach us about how to run a country. Their system is not flawless, but for 99% of the citizens it's pretty good, and likely to get better. And, all this in a place where the the per capita domestic product is a fraction of the US standard.
1
Our neglect of our precious children is neglecting every one of our futures. Indeed it is time to focus on our kids and support a healthy, strong America in the future.
3
Baloney ! If towns with horses and buggies shunned the car, if whale oil was the main source of oil for heating, if going to the moon were "too difficult", if providing a tax based social security to all in the country wouldn't fly with Republicans ! ! ??
Come on Paul, incrementalism went out with the never to return Clintons. T. R. Reid spent a couple of years of his life trying to help us with our ridiculous "healthcare" system. The Healing of America was the book he did and provides a menu of options better than ours , with savings from 100 to 300 billion per year for better outcomes.
Sorry Paul, doesn't sound like the conscience of a liberal much at all.
Come on Paul, incrementalism went out with the never to return Clintons. T. R. Reid spent a couple of years of his life trying to help us with our ridiculous "healthcare" system. The Healing of America was the book he did and provides a menu of options better than ours , with savings from 100 to 300 billion per year for better outcomes.
Sorry Paul, doesn't sound like the conscience of a liberal much at all.
9
The problem with this argument is that the only way to make it work is to do what the Professor suggests makes the Dutch system work: regulation of insurance companies. And if we tried to do that in the way that would actually work, to reduce premiums and costs, and that would lead to reduced profits for providers, hospitals, etc. The political outcry that he suggests would be triggered by a push for single payer would be equally strong against real regulations with teeth. So we might as well go for the real prize.
But I agree that the best way to get there might be a graduated approach, starting with letting people buy into Medicare, maybe starting with those over 50, and then slowly moving the age range lower and lower.
But I agree that the best way to get there might be a graduated approach, starting with letting people buy into Medicare, maybe starting with those over 50, and then slowly moving the age range lower and lower.
3
What is lacking in the public healthcare debate is that everyone needs to have some "skin in the game." If we insure every person for every thing, people will say "hey, why not? As long as insurance is paying for it!" We already know they do this now. I have been involved in too many cases where families argue to save a terminally ill patient "at all costs" - because Medicare or Medicaid is paying for it. There has to be some balance, there needs to be a point where we say "just because we can, doesn't mean we should." There is a heavily advertised, very costly medication for advanced-stage lung cancer patients which claims to extend life. The ad indicates patients will live to see grandkids grow up or graduate from college. Except the average survival the drug can improve is 90 days. Let's aim for better care, better cost transparency , rewarding patients, physicians & even pharmacists for cost savings (like not over-prescribing drugs), and better outcomes. For what we currently pay for health care in this country, we should expect to see better outcomes than we are getting. And while we're at it, let's have a national conversation about the end of life - it is the most profitable time of life for the health care industry, and end of life care places a huge burden on families in many ways. There are very few ways government can touch the general public in a positive way. Healthcare should be first on the list.
2
If Progressives make a come back it will be because they will have made common cause with lots of people who may agree with some things about which they feel strongly in the same way and disagree with some things about which they feel strongly in opposite ways. Pro-life and pro-choice supporters letting that issue be while supporting universal health care at affordable costs. Thorough checks of those intending exchange firearms and court ordered seizure of firearms from people highly likely misuse them supported by people who own and use guns and those who fervently wish nobody had guns. Securing the funding to assure higher education for all and Social Security pension plans that cover everyone by increasing the wealth creation and sharing of the productivity more equitably by those who believe in the advantages of private enterprises and those who value social supports which cover basic needs for all. The cooperation of currently polarized groups by learning more about the facts of how to accomplish what is mutually desired and to end seeing those with opposite views as adversaries.
1
"Britain has true socialized medicine: The government provides health care directly through the National Health Service."
It is also worth noting that the UK has a private medical system running in parallel, funded mainly through top-up health insurance and used primarily for nice-to-have rather than essential medical care. There are private hospitals, clinics etc.
Our dental care system is more of a hybrid between the state and private care though obviously all children are automatically covered by the state system.
It is also worth noting that the UK has a private medical system running in parallel, funded mainly through top-up health insurance and used primarily for nice-to-have rather than essential medical care. There are private hospitals, clinics etc.
Our dental care system is more of a hybrid between the state and private care though obviously all children are automatically covered by the state system.
1
The Dutch healthcare system, introduced in 2006 and based on a competition of about 4 major insurance companies, has its challenges, too. Its success might be, because of the traditional strong primary health care system (GPs) serving as a gatekeeper for referrals to specialist services. Cost-containment is achieved in part by eliminating largely the fee for service as most physicians are on salary. Insurance to those who cannot pay, such as refugees, illegals and for children below 18 years is covered by a governmental health insurance paid for by income-dependent tax. An issue is the rising premiums, and the limited competition using quality criteria. Further, its introduction was associated with increased bureaucracy. Now living and working for several years in the Canadian single payer healthcare system, it is my impression that it works much more efficient in spite of a much weaker gatekeeper function of primary care and in spite of the general fee for service pay to specialists. Benefits (health and dental service) on top of the basic health care are provided by insurance companies and premiums seem reasonable, allowing excellent access to care, in spite of waiting lists for elective care.
4
Krugman is right again. There are many ways to get there. Look at the states. Vermont tried, came close, but not cigar. http://www.politico.com/story/2014/12/single-payer-vermont-113711
Instead of universal health for everyone that is hugely complicated, a first step doable alternative, is universal primary care for everyone, as the Rhode Island Neighborhood Health Station initiative is attempting.
https://www.youtube.com/watch?v=9_oAdP9r1R8
Primary health is only 5% of the healthcare costs but can lower acute costs by 1/3. Do the math. This an economic proposition hard to resist. It is the surest way to put a break to the ever rising healthcare costs resulting in a healthier population or healthier work force if you are a money man. Primary care is not only the least expensive but also most predictable healthcare costs. Leave to insurance what they do best, manage risk, while helping them reduce risk, by providing preventive medicine and supporting healthy living for all.
Neighborhood health stations can become anchors of public health while serving as sparkplugs of community economic development.
Instead of universal health for everyone that is hugely complicated, a first step doable alternative, is universal primary care for everyone, as the Rhode Island Neighborhood Health Station initiative is attempting.
https://www.youtube.com/watch?v=9_oAdP9r1R8
Primary health is only 5% of the healthcare costs but can lower acute costs by 1/3. Do the math. This an economic proposition hard to resist. It is the surest way to put a break to the ever rising healthcare costs resulting in a healthier population or healthier work force if you are a money man. Primary care is not only the least expensive but also most predictable healthcare costs. Leave to insurance what they do best, manage risk, while helping them reduce risk, by providing preventive medicine and supporting healthy living for all.
Neighborhood health stations can become anchors of public health while serving as sparkplugs of community economic development.
3
Can't fix health care unless you identify and fix the underlying problem, which is pharmaceutical medicine, pushed by MDs. 90% of pharmaceuticals do not work, according to the research, and pharmaceuticals kill over 100,000 people every year - and that is correctly prescribed drugs in a hospital setting. The actual figure is much much higher. MDs and their drugs are the 4th leading cause of death.
The 75% of healthcare that is chronic - the non communicable diseases that are at epidemic levels - cancer, heart disease, diabetes, alzheimer's have no cure according to the MDs, aka malpractice doctors. They spend their 7 minutes on average with you and "put you on" drugs for life, usually many different drugs, all of which have side effects and not one will cure. In fact most do nothing good at all, at best they cover up a symptom and cause others. This is a great business model for hospitals, doctors, and big pharma.
If you doubt any of the above, Google: "Dr Light, Safra, Harvard, pharmaceutical" and you will see the underlying cause of why the US is last in the world for health care while also being the most expensive by far.
Note that every one of those NCD listed can be prevented and cured. Just have to avoid MDs and pharmaceuticals and go to Dr. Google.
Yes, believe it or not, cancer can be cured - in spite of the so-called war on cancer since 1971 with its hundreds of millions spent and no progress at all.
Get your genome sequenced and Google from there.
The 75% of healthcare that is chronic - the non communicable diseases that are at epidemic levels - cancer, heart disease, diabetes, alzheimer's have no cure according to the MDs, aka malpractice doctors. They spend their 7 minutes on average with you and "put you on" drugs for life, usually many different drugs, all of which have side effects and not one will cure. In fact most do nothing good at all, at best they cover up a symptom and cause others. This is a great business model for hospitals, doctors, and big pharma.
If you doubt any of the above, Google: "Dr Light, Safra, Harvard, pharmaceutical" and you will see the underlying cause of why the US is last in the world for health care while also being the most expensive by far.
Note that every one of those NCD listed can be prevented and cured. Just have to avoid MDs and pharmaceuticals and go to Dr. Google.
Yes, believe it or not, cancer can be cured - in spite of the so-called war on cancer since 1971 with its hundreds of millions spent and no progress at all.
Get your genome sequenced and Google from there.
1
Once again Paul Krugman reveals his strong capitalistic bent.. I used to be a huge fan but now I mainly read his columns to see what scheme he is up to lately. Remember he is one of the elite so why would be push to help the poor and almost poor or to contain health care costs. Barack Obama, the fake liberal, worked hard to raise health care prices. So we all know America is in super trouble. We all know there is a huge conspiracy backed by huge and I mean tremendous amounts of money often from unknown very cruel and rich people. They are at least out front about wanting to kill the poor. So people are led to vote for Donald Trump, Hillary was allowed to dis Bernie and here we are. We have a crazy monster in the White House althought even the GOP doesn't want him but they know they manipulate around him for more money for the rich taken from the poor. The United States have become a Banana Republic in every way. Our country is the laughing stock of the world and there are powers who can rid our government from this the Orange Clown but it's too profitable to keep him. Just as well - I was nervous with our top notch placing with more military than we could possibly use. I wouldn't be surprised his if people start thinking about breaking up the US into smaller, more manageable entities. Why not?
2
After reading Paul today, its clear that we can probably not do much to help 85 percent of our citizens because the American decline is now speeding along the plutocracy/oligarchy road because the people are too long on the other road of the distracted, weak, ignorant and too lazy to fight.
Paul's OK with the robber drug industry, the fee for (profit) service, and un-needed crippling robber insurance industry.
Paul's OK with the robber drug industry, the fee for (profit) service, and un-needed crippling robber insurance industry.
3
The Dutch/German system probably makes the most sense as a way forward for American health care, but what Mr. Krugman fails to mention is that the health insurers in those countries are non-profit. Converting large public companies to 501(c) status would be a political bloodbath only slightly less messy than getting rid of them altogether.
5
Krugman is right about the public potion being the best way to both stabilize the ACA and to push the country towards medicare for all. An at cost buy in to Medicare would provide low cost insurance option for Americans, especially those in the areas where the exchange is failing. Additionally it could actually reduce the overall cost of medicare by spreading it's per person cost over a wider healthier population.
Too bad the republicans are afraid of it because letting medicare compete at cost would undermine their claim that private businesses are always better than government run options.
Too bad the republicans are afraid of it because letting medicare compete at cost would undermine their claim that private businesses are always better than government run options.
1
I am 68 and moved to MediCare with what I thought was very good supplemental insurance at the target age. The quality of my care diminished radically and perceptibly. Getting to a specialist is a huge lift even if you are not getting the help you need from your primary care physician.
I live in Sacramento County. Expansion of enrollment in this one county alone is is in excess of 250,000 individuals. Seeing a Doctor is now akin to being on a conveyor belt while the treating physicians stare at their algorithms and miss diagnoses that require any degree of subtlety.
The questions I want to ask in that we do not seem to be opening a lot of new med schools are:
1) Where are the doctors going to come from?
2) How will a reasonable quality of care be maintained that meets scientific/medical standards rather than the standards of a customer satisfaction surveys put out by a department store?
I live in Sacramento County. Expansion of enrollment in this one county alone is is in excess of 250,000 individuals. Seeing a Doctor is now akin to being on a conveyor belt while the treating physicians stare at their algorithms and miss diagnoses that require any degree of subtlety.
The questions I want to ask in that we do not seem to be opening a lot of new med schools are:
1) Where are the doctors going to come from?
2) How will a reasonable quality of care be maintained that meets scientific/medical standards rather than the standards of a customer satisfaction surveys put out by a department store?
2
Krugman is right in saying that it would be wrenching to try to shift everyone with employer coverage to another system quickly. But there is no reason not to shift them gradually, by allowing them to buy into a public insurance program either individually or by having employers make the contributions to such a program for them.
The truth is that providing health insurance is a headache that most employers would rather not have. In more civilized countries, they don't have it. Government is responsible for getting people covered, so employers don't have to spend a fortune paying their HR people to run insurance programs, which in most cases has nothing to do with the business they're in. Health insurance isn't a factor in recruiting, since employers don't provide it. And losing coverage doesn't stop people from changing jobs, since coverage doesn't depend on their job. Yet another example of the fact that other countries have figured out solutions to problems that still baffle us, yet we're unwilling to learn from their experience for our own benefit.
The truth is that providing health insurance is a headache that most employers would rather not have. In more civilized countries, they don't have it. Government is responsible for getting people covered, so employers don't have to spend a fortune paying their HR people to run insurance programs, which in most cases has nothing to do with the business they're in. Health insurance isn't a factor in recruiting, since employers don't provide it. And losing coverage doesn't stop people from changing jobs, since coverage doesn't depend on their job. Yet another example of the fact that other countries have figured out solutions to problems that still baffle us, yet we're unwilling to learn from their experience for our own benefit.
5
Single payer would not only be 'harder' to do - the costs are prohibitive; Vermont scuttled a single-payer program that would cost the state $500 million a year - money they don't have...ditto California whose calculation went into the billions. In the meantime, 18 counties have no 'Obamacare' exchanges and the numbering is growing. This is success??
3
A good idea and certainly more likely than single payer.
The failure of the US medical care system when it comes to children puts the US in the third world category.
However, what it does not do is change the lives of those millions of adults who are under the constant stress of having medical bills ruin their lives. Who stay in jobs they hate because it includes health coverage. Whose whole life is dominated by worries about having and keeping health coverage.
Compare that to the lives of all of the people in all other advanced economies. No one worries about being able to afford necessary medical procedures. Yes, people worry about their immediate health problems. But, no, people do not give a thought to the possibility that a serious illness among the family could bankrupt the entire family.
Americans have always had that worry and don't even know they can eliminate it and change their lives and it can reduce costs. The US already spends more per capita than any other OECD country for worse outcomes.
Cheaper, better outcomes, one major stress gone from everyone's life.
Why settle for so much less?
The failure of the US medical care system when it comes to children puts the US in the third world category.
However, what it does not do is change the lives of those millions of adults who are under the constant stress of having medical bills ruin their lives. Who stay in jobs they hate because it includes health coverage. Whose whole life is dominated by worries about having and keeping health coverage.
Compare that to the lives of all of the people in all other advanced economies. No one worries about being able to afford necessary medical procedures. Yes, people worry about their immediate health problems. But, no, people do not give a thought to the possibility that a serious illness among the family could bankrupt the entire family.
Americans have always had that worry and don't even know they can eliminate it and change their lives and it can reduce costs. The US already spends more per capita than any other OECD country for worse outcomes.
Cheaper, better outcomes, one major stress gone from everyone's life.
Why settle for so much less?
2
Unfortunately, just as Trump touted the ridiculous notion of The Wall to so many of his supporters, Single Payer was the holy grail that Sanders tossed out to his many oblivious newly involved supporters. Being a life long progressive, you definitely will not take my employee covered insurance that I worked 40 years for from me. This is something the Sanders wing forgets to talk about. And basically the only true supporters are those who have inadequate insurance or who are afraid their children will not earn enough to have it.
Howard Dean was right. Although getting him to repeat his charges was not easy. There is a band of smug newly involved "progressives" who would rather lose elections and harm those they ostensibly are wanting to help, than give up their notion of purity, the only one of whom meets this messiah like status is Bernie.
In a society where 2 parents working is a huge necessity, we need to focus on child care. In New York parents are paying $10-$12 for daycare. Who can afford that? And there is not enough adequate pre K. So let's focus on what really can help working families. And stop the starry eyed
Howard Dean was right. Although getting him to repeat his charges was not easy. There is a band of smug newly involved "progressives" who would rather lose elections and harm those they ostensibly are wanting to help, than give up their notion of purity, the only one of whom meets this messiah like status is Bernie.
In a society where 2 parents working is a huge necessity, we need to focus on child care. In New York parents are paying $10-$12 for daycare. Who can afford that? And there is not enough adequate pre K. So let's focus on what really can help working families. And stop the starry eyed
2
A single payer system always sounds like the answer to healthcare plans. With my limited knowledge of the subject maybe it is, but it should drive costs down for sure and today no one talks about the high costs of medical care. They seem to think premiums, copays, deductibles, etc. is what counts. It would be centralized, and claims streamlined, etc. like Medicare. As to PK slipping in his pro childcare reforms such that we catch up with the rest of the world, I would think one should think on that somewhat. It turns out to be another entitlement, and in our world of blaming so many problems because parents are never around to care for their children it appears what PK thinks best is to have them away from their parents more. Do we have children so we can give them to someone else for rearing. Again, don't be too fast on giving your children away, just to save a few dollars that in the long run will come back to bite you.
For Medicare-for-all to become a reality, you first must win the hearts and minds of the public. That's impossible to do if it's not even part of your platform. Start fighting for it now.
Republicans are much better at convincing people to go along with things that will do them harm than Democrats are at convincing them to believe in what will be good for them. They're miserable salespeople. They all need to get on the same page with the same talking points and answers to their critics, like Republicans do, and stop being such pushovers and wimps.
Ten years ago, gay marriage and legal marijuana seemed nearly impossible. Let's start working now toward getting public health insurance done in 10-15 years. It doesn't have to happen tomorrow, it just has to happen.
Republicans are much better at convincing people to go along with things that will do them harm than Democrats are at convincing them to believe in what will be good for them. They're miserable salespeople. They all need to get on the same page with the same talking points and answers to their critics, like Republicans do, and stop being such pushovers and wimps.
Ten years ago, gay marriage and legal marijuana seemed nearly impossible. Let's start working now toward getting public health insurance done in 10-15 years. It doesn't have to happen tomorrow, it just has to happen.
2
The thing that makes healthcare so expensive is that most of the money goes to insurance companies in the form of profits! Billions of dollars go to CEO's and stockholders. Insurance is the worst thing that ever happened to healthcare! Why does Krugman deny this basic and obvious fact? Medicare for all means no more insane prices for doctors, surgeries, drugs, hospital stays..... you name it. The taxes paid would be far, far less than insurance premiums, most of which don't even go to healthcare costs.
Single-payer is the obvious and only answer to the healthcare disaster in this country.
Single-payer is the obvious and only answer to the healthcare disaster in this country.
4
Sometimes Krugman gets it right. I think this is one of those times.
2
Paul Krugman needs to grow a spine if he's serious about "Making America America Again". First teach the whiney "progressive" and proudly use "liberal". Second, don't make the mistake of triangulating this very serious issue, as the late unlamented Democrats' Presidential candidate did, ceding the election to Trump.
Clearly a single payer or tightly regulated health delivery system is the right answer, as the rest of the civilized world knows and has demonstrated. Of course it can't happen instantaneously, but if the colossal intellects like Krugman and his liberal-minded peers get to work on it, it can and must be done.
The Democrats have politicians with spine: Sanders, Warren, Dick Durbin, Martin O'Malley (whom Krugman and the Hillary-bots studiously ignored), Sally Yates, and how about recruiting Jim Comey?
Republicans are vulnerable and should be, and should be for the fiasco they have allowed to happen, as should those in the Democratic party who allowed the only candidate who could conceivably lose to Trump, to do that.
"The times need to be changing, the old road is rapidly fading. Get out of the new one if you can't lend a hand."
Clearly a single payer or tightly regulated health delivery system is the right answer, as the rest of the civilized world knows and has demonstrated. Of course it can't happen instantaneously, but if the colossal intellects like Krugman and his liberal-minded peers get to work on it, it can and must be done.
The Democrats have politicians with spine: Sanders, Warren, Dick Durbin, Martin O'Malley (whom Krugman and the Hillary-bots studiously ignored), Sally Yates, and how about recruiting Jim Comey?
Republicans are vulnerable and should be, and should be for the fiasco they have allowed to happen, as should those in the Democratic party who allowed the only candidate who could conceivably lose to Trump, to do that.
"The times need to be changing, the old road is rapidly fading. Get out of the new one if you can't lend a hand."
1
The problem with Krugman's approach to universal health care is that he compromises with himself before the debate even begins. Negotiating with yourself, and in advance, is no way to win. No wonder Democrats keep losing, and losing, and losing. It partly explains how we lost the Public Option.
That's not to say that one shouldn't compromise with the opposition. Compromise is necessary. But compromise happens long after the fight begins, certainly not before.
Joseph in Missoula
That's not to say that one shouldn't compromise with the opposition. Compromise is necessary. But compromise happens long after the fight begins, certainly not before.
Joseph in Missoula
8
We have saved ACA for now. Where have you been? Now it's time to try to expand coverage to the millions that don't have it. Medicare for All is the best way to get there, because it is viewed favorably by most Americans. If you can't lend a hand, please at least get out of the way.
6
18 counties now have no exchanges and the will expand throughout the Fall...the Democrats have to start participating .....
That's why we need some form of universal coverage. If not Medicare for all, some sort of Medicare buy-in is the most likely way to get there. As Obama said on the campaign trail in 2007, "affordable, universal health care for every single American must not be a question of whether, it must be a question of how."
1
Single Payer System is more patient-friendly and also more cost effective for society-at large. Adding a 'Public Option" may improve Obama Care on both these counts. The German, Swiss systems of "single payer systems" are run exclusively by private industry --- but controlled like our "Utilities". But 'shoring up Obama Care' without a robust "Public Option" would become an annual chore --- which the conservatives would showcase as a failure of "socialism" again in an effort to scuttle it. Single Payer System, once established, would become unshakable --- like Medicare & Social Security!
2
Points well taken on people's health insurance through their employers and single payer and the political situation. Good enough. Most reasonable is to improve the ACA. (You're inclusion of 'government option' probably risks the political too.)
Now for the next fight: Republicans are continuing to pursue their dream--as one operative put it, "...to drag the [federal government social benefits programs] into the bathroom and drown it in the bath tub." So now we have Republican's plans for their tax bill--gutting Social Security for one thing. They've tried versions of it before. G.W.Bush tried it.
Hence, the fight. Looking further out, the Democrats/progressives slogan should be, "IT'S THE POLITICS STUPID!!" As in, that's what to keep an eagle eye on. Everything depends on preparing for 2018, 2020. Otherwise we are going to find ourselves looking at congressional Republican control continuing, and Trump winning again in 2020.
Relying on polls and presumed world-wide outrage over Trump to feel confident about U.S. elections, will cause us to lose--again.
Now for the next fight: Republicans are continuing to pursue their dream--as one operative put it, "...to drag the [federal government social benefits programs] into the bathroom and drown it in the bath tub." So now we have Republican's plans for their tax bill--gutting Social Security for one thing. They've tried versions of it before. G.W.Bush tried it.
Hence, the fight. Looking further out, the Democrats/progressives slogan should be, "IT'S THE POLITICS STUPID!!" As in, that's what to keep an eagle eye on. Everything depends on preparing for 2018, 2020. Otherwise we are going to find ourselves looking at congressional Republican control continuing, and Trump winning again in 2020.
Relying on polls and presumed world-wide outrage over Trump to feel confident about U.S. elections, will cause us to lose--again.
1
Has Paul Krugman ever spoken of the war on drug users?
2
Frankly, here are what I don't understand about Democrats and those who "feel the Bern": 1. Where is their loyalty? 2. What is wrong with their memory?
On loyalty: who worked on health care since 1990s? Who identified as Democrat and liberal since, I don't know, 1970s? Whose associates revived liberalism and Democratic party as a political force after Reagan and Neoconservative explosion?
In case you don't know the answer, it's either "Hillary Clinton" or "the Clintons." Your pick. I frankly don't know a more loyal politician than Ms. Clinton. Those voters, those short-sighted, selfish, fish-brain voters, who demand so much attention and loyalty from their politicians, pay NO LOYALTY whatsoever to those who served them.
On memory: Bernie Sanders was an INDEPENDENT until 2016; someone (Mr. Krugman?) also observed that Sanders barely made a peep when D tried to reform healthcare. What granted such person and his ilks such influence over Democratic policy stand? Seriously.
To answer the question of Bernie's supporters: have I felt the Bern? Yes I have! It burned down the culture of this country, handed the presidency to you-know-who, and made a mess out of Democratic party.
Now the Bern is trying to burn down poor ACA. Can someone throw on some water? Please? Before it burns down ACA, that is.
On loyalty: who worked on health care since 1990s? Who identified as Democrat and liberal since, I don't know, 1970s? Whose associates revived liberalism and Democratic party as a political force after Reagan and Neoconservative explosion?
In case you don't know the answer, it's either "Hillary Clinton" or "the Clintons." Your pick. I frankly don't know a more loyal politician than Ms. Clinton. Those voters, those short-sighted, selfish, fish-brain voters, who demand so much attention and loyalty from their politicians, pay NO LOYALTY whatsoever to those who served them.
On memory: Bernie Sanders was an INDEPENDENT until 2016; someone (Mr. Krugman?) also observed that Sanders barely made a peep when D tried to reform healthcare. What granted such person and his ilks such influence over Democratic policy stand? Seriously.
To answer the question of Bernie's supporters: have I felt the Bern? Yes I have! It burned down the culture of this country, handed the presidency to you-know-who, and made a mess out of Democratic party.
Now the Bern is trying to burn down poor ACA. Can someone throw on some water? Please? Before it burns down ACA, that is.
3
"Now the Bern is trying to burn down poor ACA."
I have no idea on which fringe websites this might be an issue, but as a regular reader of NYT and WaPo I have no idea why you're all worked up about Bernie Sanders and his perfidious super-powers. I doubt Mrs. Sanders devotes as much attention to him as you do.
I have no idea on which fringe websites this might be an issue, but as a regular reader of NYT and WaPo I have no idea why you're all worked up about Bernie Sanders and his perfidious super-powers. I doubt Mrs. Sanders devotes as much attention to him as you do.
2
Gosh, hello commenters, what about Krugman's call for a focus on childcare?! Do you not think improved family leave and childcare policies are as critically important as health and education? Krugman must have EXCELLENT female role models and advisors in his life, while the rest of you don't. What kind of a woman is Mrs. Sanders not recognizing the need to pivot (FOR A SECOND) and gain ground on "women's issues?" Good grief!? Never mind that the US is not kind enough to get single-payer/national healthcare right. Obama knows and Krugman is right that now it's time for a progressive flank move!
2
You have a choice whether or not to have children. Many of us don't. You don't have a choice whether or not you need health care. Everyone needs it eventually. So health care is and should be the highest priority.
1
My own personal progressive flanks are covered by Medicare, for which I am very grateful. I want all Americans to have that option.
1
If we could get to Medicare-For-All-Who-Are-Not-In-An-Employer-Plan (and with those employer plans being good, nut junk, plans), then I'd be satisfied.
I think the entire problem with ObamaRomneyHeritageCare is that folks not in employer plans are sicker than those are in such plans (i.e., employers tend to hire healthy folks, DUH!), and the individual mandate is too weak. This can be fixed by subsidizing the ORHC plans so that their cost is the same as the net cost for employer plans. Sure, some folks will take advantage of adverse selection - and perhaps some of the penalties after-the-fact that the Republicans were talking about (e.g., charging extra for buying into a plan after being without one, etc.) could be implemented to combat this.
I think the entire problem with ObamaRomneyHeritageCare is that folks not in employer plans are sicker than those are in such plans (i.e., employers tend to hire healthy folks, DUH!), and the individual mandate is too weak. This can be fixed by subsidizing the ORHC plans so that their cost is the same as the net cost for employer plans. Sure, some folks will take advantage of adverse selection - and perhaps some of the penalties after-the-fact that the Republicans were talking about (e.g., charging extra for buying into a plan after being without one, etc.) could be implemented to combat this.
1
What is next for progressives is to take back the house and senate any way they can!
3
Don't hold your breath....the Dems have not gathered their wits together yet after the 2016 whiplash.....
1
With all due respect Krugman perhaps you want to pay my family's healthcare costs as they are on the open market. This includes a monthly bill of $1800, an out of pocket $13,000, and co payments of next to nothing for my insurer....oh yeah, did I mention that Regence has informed me that they will no longer be offering individual plans next year in my state!
We need Single Payer now! I'm tired of being told to be realistic, I can't afford it and millions more as in the same boat. It's a luxury to think we can put this off. You and Congress may have awesome plans but the rest of us want to simply have a fair access to the same. We as taxpayers are tired of subsidizing the insurance companies and the CEO payouts.
Get out of our way. Single payer now!
We need Single Payer now! I'm tired of being told to be realistic, I can't afford it and millions more as in the same boat. It's a luxury to think we can put this off. You and Congress may have awesome plans but the rest of us want to simply have a fair access to the same. We as taxpayers are tired of subsidizing the insurance companies and the CEO payouts.
Get out of our way. Single payer now!
8
Single payer will start in the states. Support the NY Healthcare Act (and ask the Times why they still wont write about it!)
2
Most Americans do have access to a near perfect affordable healthcare system. My wife and I are are both on it and most everyone I know who has it, loves it. All it takes is 20 or more years of Military service. My wife has no such service, but is a military dependent. But wait, you say, doesn't the VA provide terrible service? I wouldn't know, because I have never dealt with the VA. When you achieve military retirement (20 or more years), you are covered by TriCare. Medicare pays 80%, TrICare pays the remaining 20%.
There are no TriCare hospitals, as far as I know. You see any doctor you want, when you want, with no copays, no deductibles, no caps. TriCare can negotiate with Big Pharma, so med costs are nominal, with free generics. To enable TriCare, my wife and I both pay a monthly fee that is about $100. It comes directly out our Social Security pensions.
Example: I have severe rheumatoid arthritis and require a monthly infusion of a drug called Actemra. The charge is around $2500 a month. I pay nothing. Basic TriCare does not cover routine dentistry, eye glasses or hearing aids. Staying the Air Force for 22 years was the best choice I ever made.
There are no TriCare hospitals, as far as I know. You see any doctor you want, when you want, with no copays, no deductibles, no caps. TriCare can negotiate with Big Pharma, so med costs are nominal, with free generics. To enable TriCare, my wife and I both pay a monthly fee that is about $100. It comes directly out our Social Security pensions.
Example: I have severe rheumatoid arthritis and require a monthly infusion of a drug called Actemra. The charge is around $2500 a month. I pay nothing. Basic TriCare does not cover routine dentistry, eye glasses or hearing aids. Staying the Air Force for 22 years was the best choice I ever made.
5
Sounds good!
"Staying the Air Force for 22 years was the best choice I ever made."
How clever you were to choose not to get maimed or killed in the line of duty. How sad that millions of disabled or dead veterans weren't as smart as you.
How clever you were to choose not to get maimed or killed in the line of duty. How sad that millions of disabled or dead veterans weren't as smart as you.
I served in Vietnam. I performed my duties with sufficient excellence to make colonel seven years early. My oldest daughter is a retired colonel with a husband who was a B-1B pilot who retired as a colonel. His father piloted 4 gliders landing behind German lines in WW2. My son served 27 months in Iraq as an Army captain and is now a county prosecutor. I think I did OK for a first generation American whose father started in the WV coal mines. It was not my decision to get engaged in utterly stupid wars like Vietnam and Iraq. I could have separated from the Air Force after 3 years of service in 1961. I had friends and classmates who died in combat. Are you trying to make me feel guilty because I survived? I didn't hide in France peddling magic underwear.
3
If we have health "insurance" risk has to be a criteria for setting cost. The fact is the people who are most likely to need expensive care, multiple prescription drugs, etc. are the least likely to be able to pay for the cost of their care. The poor are less healthy, they eat a less healthy diet, are overweight, are more likely to abuse alcohol and drugs, are less likely to exercise, have more stress, don't get enough sleep, and so on. Is it really fair to "share" this cost as if no responsibility lies with the individual?
Take care of yourself or pay the consequences.
Take care of yourself or pay the consequences.
If they can get the ACA to work, fine. I'm on board. But it is not time to "move on" America still has to get this right.
Personally I would get rid of state by state regulations to allow for massive and competitive national insurance markets and then let states decide how much they or the federal government will pay and what kind of plans they will offer. Sort of like auto insurance market. If a few insurers go out of business, fine... but national competitiveness should cut costs.
Also either the insurace companies or the government should be allowed to dictate pricing to the pharmaceutical companies. Think about how big retailers deal with their suppliers.
And the fed should keep track of pricing on medical procedures, and create a database so that people can see whay things cost. None of this: it costs $20 to draw blood in one place, $200 in another and $2,000 in yet a third location a block away. That kind of price gouging should potentially see people in on fraud charges.
Personally I would get rid of state by state regulations to allow for massive and competitive national insurance markets and then let states decide how much they or the federal government will pay and what kind of plans they will offer. Sort of like auto insurance market. If a few insurers go out of business, fine... but national competitiveness should cut costs.
Also either the insurace companies or the government should be allowed to dictate pricing to the pharmaceutical companies. Think about how big retailers deal with their suppliers.
And the fed should keep track of pricing on medical procedures, and create a database so that people can see whay things cost. None of this: it costs $20 to draw blood in one place, $200 in another and $2,000 in yet a third location a block away. That kind of price gouging should potentially see people in on fraud charges.
Putting aside Medicare for all, for just a moment, lowering the Medicare qualifying age, gradually, to fifty five would dramatically lower health coverage costs for everyone else. It is people fifty five to sixty four who are most endangered by Republican proposals and are also being hit hardest under Obamacare.
4
There's a lot wrong with Mr Krugman's proposal.
He advocates for following a Netherlands model for universal coverage, without detailing what that model requires. One should ask whether US private insurers would be willing to accept the amount of regulation that the Dutch accept. For example, would US private insurers be willing to see their profits squeezed as much as a Dutch model does? i'm betting not, and, just as now, insurers would walk away if their executives couldn't earn multimillions yearly. We don't need that kind of instability.
With their very powerful lobby, private insurers will dictate the terms of any "improvements" to the ACA. Those "improvements" will boil down to increasing the subsidies insurance companies get, and we, the tax payers, will be paying those subsidies.
Mr Krugman keeps saying it would be hard to get to single payer Medicare for All Well, it's getting easier as more voters think about it and more economists articulate the benefits. If we had started a discussion in 2009 about Medicare for All -- instead of removing it from consideration entirely, as Obama did -- we might be further along in getting Medicare for All, the simplest, most affordable system we could implement for universal coverage.
Let's hope Mr. Krugman starts contributing to the goal of Medicare for All, instead of resisting it.
He advocates for following a Netherlands model for universal coverage, without detailing what that model requires. One should ask whether US private insurers would be willing to accept the amount of regulation that the Dutch accept. For example, would US private insurers be willing to see their profits squeezed as much as a Dutch model does? i'm betting not, and, just as now, insurers would walk away if their executives couldn't earn multimillions yearly. We don't need that kind of instability.
With their very powerful lobby, private insurers will dictate the terms of any "improvements" to the ACA. Those "improvements" will boil down to increasing the subsidies insurance companies get, and we, the tax payers, will be paying those subsidies.
Mr Krugman keeps saying it would be hard to get to single payer Medicare for All Well, it's getting easier as more voters think about it and more economists articulate the benefits. If we had started a discussion in 2009 about Medicare for All -- instead of removing it from consideration entirely, as Obama did -- we might be further along in getting Medicare for All, the simplest, most affordable system we could implement for universal coverage.
Let's hope Mr. Krugman starts contributing to the goal of Medicare for All, instead of resisting it.
6
The Dutch system is certainly not private insurance with subsidies. I should know, I'm on it. It's nonprofit insurers with single-payer like premiums and no charges for preexisting conditions. And a public option for retirees.
Plus cost controls by forcing you to go through your family physician before you can see a specialist.
Plus cost controls by forcing you to go through your family physician before you can see a specialist.
8
Education. Education. Education. Forget Charter schools. Get rid of the property tax for funding schools and start financing all public schools in this country through a single national school income tax. Equal education for all no matter what your zip code.
3
....which would hit NYC schools and lots of minorities very hard as NY taxpayers shell out $20K per pupil - double the national rate.
1
Paul Krugman's comments are sensible and practical. I hope progressives are listening!
2
I also concluded after reading the excellent new book "White Working Class" that providing child care would be a major help to the working class.
3
What would really be progressive, but will never happen in America, is health insurance premiums that are not based on a specific amount of currency, but as a percentage of pay (with a matching percentage paid by employers), as it is done in Germany. Sure, you can shop around, but by and large everyone pays roughly 13-14% of their income for comprehensive health care as opposed to the need for separate dental insurance, vision insurance, knee insurance, elbow insurance, etc. as here in the U.S.
As for right-wing politicians, and right-leaning military service members, it never ceases to amaze me that they rail against what they see as socialist excess, while benefitting from probably the most social systems in America (e.g. in the military everyone earns 30 days paid vacation per year, the premiums for health care are based on rank, thus, those who earn more, pay more).
As for right-wing politicians, and right-leaning military service members, it never ceases to amaze me that they rail against what they see as socialist excess, while benefitting from probably the most social systems in America (e.g. in the military everyone earns 30 days paid vacation per year, the premiums for health care are based on rank, thus, those who earn more, pay more).
5
Idealism must learn to co-pilot with pragmatism to help US get through this nightmare of republican proportions.
Every American has the right to vote, and for that vote to count.
Every American has the right to health care.
Every American has the right to a good job.
Seems to me those three simple workable solutions is a good start to a political strategy.
Infrastructure. Infrastructure, Infrastructure.
Every American has the right to vote, and for that vote to count.
Every American has the right to health care.
Every American has the right to a good job.
Seems to me those three simple workable solutions is a good start to a political strategy.
Infrastructure. Infrastructure, Infrastructure.
5
This column is disingenuous. Krugman knows perfectly well that Medicare-for-All if enacted, would have to be put in place gradually, not only for political reasons, but for practical administrative reasons as well. And starting such a process is not inconsistent with keeping ACA as a bridge in the interim.
The polls on single-payer vary, depending on how the question is put, but I think it's fair to say a majority of Americans, and a plurality of Republicans, today, would accept Senator Kennedy’s original plan of Medicare-for-All.
That plan would gradually lower the eligibility age for Medicare, and allow people to "buy in" before retirement age (that is, pay up front the taxes they would have paid if they had waited until retirement age).
This would actually save the government money, because health problems associated with aging would be caught and treated sooner. It would allow many workers to retire sooner, opening up job opportunites. Lastly, as a universal program, it would be resistant to divisive political attacks.
The difficulty of transitioning quickly to single-payer is the many vested interests in the present system—including the millions of Americans who are covered by their employers, as Krugman reminds us. A plethora of legal, actuarial, medical and ethical issues would need to be resolved. http://acasignups.net/node/3085
All that said, single-payer remains a moral imperative for the Democrats if they wish to win back the House in a wave election.
The polls on single-payer vary, depending on how the question is put, but I think it's fair to say a majority of Americans, and a plurality of Republicans, today, would accept Senator Kennedy’s original plan of Medicare-for-All.
That plan would gradually lower the eligibility age for Medicare, and allow people to "buy in" before retirement age (that is, pay up front the taxes they would have paid if they had waited until retirement age).
This would actually save the government money, because health problems associated with aging would be caught and treated sooner. It would allow many workers to retire sooner, opening up job opportunites. Lastly, as a universal program, it would be resistant to divisive political attacks.
The difficulty of transitioning quickly to single-payer is the many vested interests in the present system—including the millions of Americans who are covered by their employers, as Krugman reminds us. A plethora of legal, actuarial, medical and ethical issues would need to be resolved. http://acasignups.net/node/3085
All that said, single-payer remains a moral imperative for the Democrats if they wish to win back the House in a wave election.
11
And it will start in the States! Support NY Health Act!
And it will start in the States! Support NY Health Act!
Here's an idea: Drop the age for Medicare to 60 or 55 and put all children up to age 18 on Medicaid.
There no profit to be had in a privatized medical system from the sick, the elderly or the poor. Why even try? It's why we have Medicare and Medicaid.
In the mean time, we could cover our kids for just about everything, including dental. Those older folks can keep insurance companies going by buying supplemental policies. Not near as good as single payer, but a worthwhile start.
There no profit to be had in a privatized medical system from the sick, the elderly or the poor. Why even try? It's why we have Medicare and Medicaid.
In the mean time, we could cover our kids for just about everything, including dental. Those older folks can keep insurance companies going by buying supplemental policies. Not near as good as single payer, but a worthwhile start.
6
Another option for affordable health care for families and individuals are fast-growing healthcare sharing ministries such as Christian based Liberty HealthShare, and Catholic based Solidarity HealthShare. Certified programs like these are recognized and classified by the ACA as 501(c)(3). Unlike traditional health insurance, these are exempt from State Insurance regulations and ACA's Individual Mandate. Truly innovative programs where responsible participating Christian families and individuals, or organized denominations holding common ethical/religious beliefs, pay very low monthly premiums & deductibles -their pooled funds shared for medical costs via advanced well-coordinated online electronic payment process. Rates stay unbeatable due to low admin costs ---not used like commercial insurers to pay skyrocketing HMO executive salaries! Members can access any hospital or doctor they choose, and overall, much more attractive than Insurance Exchange Marketplace.
2
http://www.pnhp.org/news/quote-of-the-day
Physicians for a National Health Program
[ I have long been surprised and disappointed that Paul Krugman never ever seemed to read the physician-scholars who write at Physicians for a National Health Program. I consider this an unfortunate turning away from the finest in scholarship on the American healthcare system. ]
Physicians for a National Health Program
[ I have long been surprised and disappointed that Paul Krugman never ever seemed to read the physician-scholars who write at Physicians for a National Health Program. I consider this an unfortunate turning away from the finest in scholarship on the American healthcare system. ]
6
Nancy,
Thanks for that link.
Representatives for Physicians for a National Health Program were excluded from congressional deliberations in 2009, when they wanted to present their case for single payer.
I too am disappointed in Mr Krugman, whom I considered a thoughtful advocate for sensible health insurance prior to the 2016 primaries and election. In 2016 he decided to turn away from advocating for the best health insurance, single payer, and became a supporter of centrist, "moderate" Democratic politics and Hillary Clinton. He then was willing to accept whatever those Clinton Democrats wanted, which didn't include single payer health insurance. For Mr Krugman in 2016, blind loyalty to something (Democratic establishment? Hillary?) replaced commitment to principles he had espoused for years.
Thanks for that link.
Representatives for Physicians for a National Health Program were excluded from congressional deliberations in 2009, when they wanted to present their case for single payer.
I too am disappointed in Mr Krugman, whom I considered a thoughtful advocate for sensible health insurance prior to the 2016 primaries and election. In 2016 he decided to turn away from advocating for the best health insurance, single payer, and became a supporter of centrist, "moderate" Democratic politics and Hillary Clinton. He then was willing to accept whatever those Clinton Democrats wanted, which didn't include single payer health insurance. For Mr Krugman in 2016, blind loyalty to something (Democratic establishment? Hillary?) replaced commitment to principles he had espoused for years.
While protecting Obamacare is extremely important, When it comes to healthcare, progressives can work for change, successfully, in narrower ways than single payer or universal healthcare. There are obvious targets begging for progressive attacks. The drumbeat over unfair drug prices is getting louder every day. Another area that is getting very little attention, so far, is non-group doctors and other providers dropping into operations and procedures then billing patients directly at inflated rates. Providers need to be obligated to deal with the overriding insurance company carried by the patient and the insurance company needs to be obligated to deal with the out of group providers. Any contention needs to be arbitrated between the provider and insurer, leaving the patient safely out of it. This could be accomplished through narrow legislation focused on this one failing in American healthcare law. It's the kind of change that progressives could push to popular acclaim.
4
Most of the people who are truly satisfied with their employer plans must have an old-fashioned plan with low deductibles and low payments because they are heavily subsidized. Even with Medicare, my employer supplement plan, which covered only 17% of my costs for Part B expenses cost more than twice as much as the 80% covered by Medicare. The difference? Insurance company profits. More than half of the people in the US think that this is the way to go. Anyone who might need convincing would not be hard to persuade, just by comparing their current cost to the taxes that they would have to pay.
4
While Krugman is right that that only 5.4 percent of New Yorkers are now uninsured - it is also true that New York State spent 59.8 Billion dollars on Medicare, more than any state except California; a state with double the population, but only paying 40% more- not exactly a success story
4
ditto education spending = NY pays $20K per student, double the national average with far less desirable outcomes.....
2
You'd "strongly support some form of public option." Only a Democrat vocally committed to doing that - as their requirement for their yes vote to prop up the ACA private insurance subsidy machine - passes my litmus test. The private insurance approach is financially and morally indefensible, to be phased out as quickly as possible. I don't trust any candidate who won't say that out loud.
4
Indeed, universal coverage should be the goal but the actual system to achieve that should be based on what is possible and should be accomplished by seriously working to model a plan after observing what works in other places. I fear that those on the left, Bernie or bust types, who do not get a single payer system will stay at home instead of voting as they have done in the past. Many on the left seem unable to accept progress if they do not get 100% of what they want.
2
I read several of the Reader's Picks comments, and I don't think they get the point of Krugman's column. It's about where to spend your political capital. He doesn't disagree with Single-Payer if we were starting from scratch with no health coverage already in place for many.
There is limited political capital. Where should we spend it?
There is limited political capital. Where should we spend it?
4
Medicare for all is politically feasible contrary to what Krugman says.
It can be framed on conservative principles.
For one thing it is simple. It takes an existing program that has wide bipartisan support and simply extends it to everyone. So the legitimate argument Republicans have about the thousands of pages of arcane rules attached to Obamacare goes away.
Medicare for all is not government run healthcare. It is government run health insurance but private healthcare delivery. Frankly Krugman and the NY Times is willfully doing its part to keep many Americans mired in ignorance on this point.
Third, under Medicare for All all, the burden of health insurance is taken off the backs of business. For smaller businesses, whom Republicans love to support, that would be a huge benefit. Not to mention state and local government employees.
If Democrats argue for Medicare for All on these points, I think it can be very feasible.
It can be framed on conservative principles.
For one thing it is simple. It takes an existing program that has wide bipartisan support and simply extends it to everyone. So the legitimate argument Republicans have about the thousands of pages of arcane rules attached to Obamacare goes away.
Medicare for all is not government run healthcare. It is government run health insurance but private healthcare delivery. Frankly Krugman and the NY Times is willfully doing its part to keep many Americans mired in ignorance on this point.
Third, under Medicare for All all, the burden of health insurance is taken off the backs of business. For smaller businesses, whom Republicans love to support, that would be a huge benefit. Not to mention state and local government employees.
If Democrats argue for Medicare for All on these points, I think it can be very feasible.
5
Progressives need to move past personalities (Sanders and Clinton) and focus on 2 I's: Ideas and Ideals. These need to be focused ideas and ideals, prioritized this way: 1) Regain Blue Collar (economic values); 2) Fairness (couched as such,not as identity oppositions); 3) Reasonable and functional compromise as long as those ideas and ideals are upheld. But who's espousing this blend, and who are the younger personalities that can package them as candidates? Now's the time.
I completely agree with Krugman, for better or worse, the politics will lead to a regulated market. I do believe that each state should be allowed to set up a government option, run by their Medicaid providers. This would give greater buying clout to Medicaid, and Medicare for that matter, so they can negotiate lower prices. The rest of the insurance market will be forced to provide similar rates. In the long run, the government provider would be backed up by the insurance market who would provide a secondary market. Employers could buy insurance as well, the add ons would be benefits to attract employees.
1
Reading between the lines, Mr. Krugman's guiding principal is to take half a loaf, rather than accepting the risk of accomplishing nothing. The phrase "the perfect is the enemy of the good" comes to mind. This mindset is also invoked by the Democratic Party's leadership on a whole slew of issues, not just healthcare. This way of thinking indirectly argues for the status quo, since change is supposedly extremely difficult or impossible, or the costs will be too high.
Fighting for half a loaf - under the guise of reasonable compromise - is a big reason why, after President Obama's transformational presidency, we continue to have an inferior healthcare system, hundreds of military bases that do not make us safe, and more income inequality. The overall impact has been gradually worsening conditions for most Americans.
By the way, it's very hard to motivate a political base, when your operative strategy is predicated on tossing a few bones to it from time to time. That's why the Democratic Party has hemorrhaged away so much of its power.
We either need a Medicare for All system, or a single payer option. Either one of these options will ensure coverage for everyone, and dramatically reduce administrative costs. If Democrats fight hard for one or both of these alternatives, America's healthcare system might substantially improve. And the Democrats' political fortunes will dramatically improve, thanks to an energized base. But wait, Mr. Krugman says that is asking for too much!
Fighting for half a loaf - under the guise of reasonable compromise - is a big reason why, after President Obama's transformational presidency, we continue to have an inferior healthcare system, hundreds of military bases that do not make us safe, and more income inequality. The overall impact has been gradually worsening conditions for most Americans.
By the way, it's very hard to motivate a political base, when your operative strategy is predicated on tossing a few bones to it from time to time. That's why the Democratic Party has hemorrhaged away so much of its power.
We either need a Medicare for All system, or a single payer option. Either one of these options will ensure coverage for everyone, and dramatically reduce administrative costs. If Democrats fight hard for one or both of these alternatives, America's healthcare system might substantially improve. And the Democrats' political fortunes will dramatically improve, thanks to an energized base. But wait, Mr. Krugman says that is asking for too much!
5
While I agree with Krugman that Medicare for all shouldn't be a litmus test, I think he underestimates - ignores, actually - its important selling point, which is we already have Medicare for many, and those many generally love it. In other words, all the scaremongering and demonization that Obamacare has been subjected to will be significantly less effective against a longstanding and effective program.
2
A public option coupled with a law preventing the Pharmaceutical Companies from being able to dictate prices would be a good start. Follow that up with Hospitals, Doctors, and Clinics having to publicly publish their fees for all services. Those in the back pockets of such groups always argue in favor of the "Free Market" and competition. They want to treat Health Care as a product? Let us know what it costs so we can shop elsewhere.
2
This is an excellent suggestion to improve the A.C.A. At least Dr. Krugman understands the concept of insurance which means you need everybody in the pool of insurance in order for it to work. The idiocy of Paul Ryan and the Republicans is to assert that the mandate to have health insurance is not like the requirement to have auto insurance or home owners, but is somehow an assault and an abrogation of our freedom. This is of course is utter nonsense, misplaced ideological claptrap not invoked in the case of cars or houses. At least this is a proposal that actually focuses on health care for real people instead of a smokescreen for a transfer of wealth to the already mega wealthy masquerading as a health care plan. All that is needed once you have the mandate and shore up the subsidies for the individual market is offer the public option on a graduated scale for all those that cannot find a reasonable commercial insurance plan in underserved areas.
2
This is what concerns me about the future of the Democrats. Why can't they endorse real reform for a change. Look Trump won promising his supporters truely ridiculous things that couldn't possibly happen like muslim bans, revitalization of the coal industry and deportation of as many immigrants as possible and he and his henchman are making them happen but for Democrats to support something that would truly benefit people; actually save lives that is too much to ask. Krugman writes "Even idealists need to set priorities, and Medicare-for-all shouldn’t be at the top of the list." but for those of us who are struggling to pay premiums, co-pays and deductables or have to visit the massive free medical clinics set up in rich cities like Seattle because even with insurance they can't get care this issue is at the top of the list. Besides what are the Democrats priorities?
5
Mr. Krugman lays out the Neoliberal Clintonian arguments against single payer health care as well as any DNC spinmeister. But aiming for what's best rather than what's "possible" led to Hillary Clinton's nomination and the loss of last year's elections.
What Mr. Krugman leaves out is the fact that what he calls 'progressive' is merely a 'Republican-lite' policy that keeps all the profits in the hands of the rapacious health care conglomerates and allows for ridiculous drug prices. A better deal- no, the same old Capitalist deal for the working class.
What Mr. Krugman leaves out is the fact that what he calls 'progressive' is merely a 'Republican-lite' policy that keeps all the profits in the hands of the rapacious health care conglomerates and allows for ridiculous drug prices. A better deal- no, the same old Capitalist deal for the working class.
2
Too bad Hillary Clinton was a flawed candidate who was successfully pilloried by the Republicans. She was the candidate who would have focused the most on children. It does seem like the welfare of children has been forgotten by the leaders of both major parties. (I don't count lip service with no policy or political commitment.)
1
The irony in all this opposition to improved healthcare, education, and other services by the business segment - largely because they fear having to pay for it - is that the more you provide people with their essential needs the more the people are free to buy all that garbage business is trying to sell them and the less business has to worry about providing them to its employees.
1
One thing you didn't mention, and I'm sure is operative in the foreign systems you mentioned, is some way to systematically control costs. That is out of control in this country, and Pharma tops the list. Many who have individual plans under the ACA are already at the limit of what they can afford due to the premiums skyrocketing from year one of its inception, and all the Republicans have to do to kill it is stop funding the subsidies. As it is, you're going to see a bunch of folks drop off these plans with the double digit increases expected for next year.
What really galls me is that these other countries have managed to work out perfectly adequate systems that deliver good care and keep their most vulnerable from penury. But the USA is too greedy, too lazy or too stupid to do the same. No one carps about their SS benefits, farm subsidies and the like, but they can't see that a healthier populace and freedom from potential medical bankruptcy are keys to increased productivity. Take a few billion from the war machine and get it done, Congress.
What really galls me is that these other countries have managed to work out perfectly adequate systems that deliver good care and keep their most vulnerable from penury. But the USA is too greedy, too lazy or too stupid to do the same. No one carps about their SS benefits, farm subsidies and the like, but they can't see that a healthier populace and freedom from potential medical bankruptcy are keys to increased productivity. Take a few billion from the war machine and get it done, Congress.
5
...it would take more than 'a few billion from the war industry' to do what you say.....
1
If Democrats want to become the equivalent of Fact Free Republicans then by all means continue ignore Paul Krugman's advice.
3
Sounds like Krugman has some good ideas.
I am on Medicare and it's not that simple at all. Not all doctors accept Medicare. To really get protection you need Medigap and prescription drug coverage, both of which are only available from, you guessed it, insurance companies. In exchange for low premiums I have to accept high deductibles. And dental is not covered at all.
When I lived in Germany there was a system similar to the Dutch one and it seemed to be working pretty well. What it did require is that all doctors see public patients as well as private ones. This would seem necessary.
A public option sounds like a great way to solve the problem of abandonment by insurance companies. It would give us a chance to experiment with a single payer system and get the kinks out, especially if implemented initially at the state level. It would also give people the option of leaving a lousy job without losing good health coverage.
He's right that most people are more or less satisfactorily covered by their work insurance, so why create a big mess and make needless enemies? If it ain't broke, don't fix it!
Finally, the fact that the ACA works pretty well already when the particular state has supported it, and works very badly when it has been opposed and subverted, needs to be repeated a lot, and loud!
I am on Medicare and it's not that simple at all. Not all doctors accept Medicare. To really get protection you need Medigap and prescription drug coverage, both of which are only available from, you guessed it, insurance companies. In exchange for low premiums I have to accept high deductibles. And dental is not covered at all.
When I lived in Germany there was a system similar to the Dutch one and it seemed to be working pretty well. What it did require is that all doctors see public patients as well as private ones. This would seem necessary.
A public option sounds like a great way to solve the problem of abandonment by insurance companies. It would give us a chance to experiment with a single payer system and get the kinks out, especially if implemented initially at the state level. It would also give people the option of leaving a lousy job without losing good health coverage.
He's right that most people are more or less satisfactorily covered by their work insurance, so why create a big mess and make needless enemies? If it ain't broke, don't fix it!
Finally, the fact that the ACA works pretty well already when the particular state has supported it, and works very badly when it has been opposed and subverted, needs to be repeated a lot, and loud!
3
"What it did require is that all doctors see public patients as well as private ones. This would seem necessary."
So coercion (a dose of fascism) is what is on order?
So coercion (a dose of fascism) is what is on order?
1
Industry lobbying organizations may have denounced the Republican plans, but that did nothing to dissuade 49 Republican senators from supporting those plans.
1
The success of the ACA is demonstrated by the recent GOP debate on healthcare and concerns expressed by some Senators about the needs of their constituents. Does anybody think that any part of the GOP would be trying to provide government support the healthcare needs of our citizens were it not for Obamacare? True, for most of GOP, the debate was in reality an anti-healthcare bill designed to reduce taxes for the wealthy and attack Medicare (not Medicare expansion - the original program). But a few GOP Senators seem actually to care about helping citizen obtain healthcare. So let's assemble a coalition of moderates from both parties who can get to work on that goal - the actual goal - of helping as many Americans as possible.
I totally agree with you Prof. Krugman, and thank you for this article. As a long-time volunteer English tutor of children in grades 1-3, I continually observe the urgent necessity for pre-school education and other training--as a nation. If we can fix the ACA, early childhood education and family care should be our top priorities. The right-wing always will howl about federal involvement in states' rights. Surely a workable nationwide plan can be devised that avoids fears of Big Brother.
Is this the very peak of the progressive and conservative thinking?
Just because there are two mainstream political parties in America, now none of them accepts any responsibility for the colossal national debt?!
Just because there are two mainstream political parties in America, now none of them accepts any responsibility for the colossal national debt?!
Not that colossal. Assets far exceed liabilities. What do you owe on your house?
U.S. national debt - outstanding treasuries held by 3rd parties - is $20 trillion, the interest of which is taking up an increasingly larger percent of the national budget, such as it is....
1
Single payer will never happen overnight
Single payer will never happen at all if we don't have the will
If we have the will, single payer can happen real soon.
All it takes is the people.
Single payer will never happen at all if we don't have the will
If we have the will, single payer can happen real soon.
All it takes is the people.
1
As a communications professional, I have learned that in order to motivate people to understand your "product" and act, you need to make it clear how what you are offering benefits them. I suggest a campaign that clearly states:
Want better health care? Vote for a democrat. Want clean air to breathe? Vote for a democrat? Want better schools for your kids? Vote for a democrat. Want job training for the unemployed? Vote for a democrat. Want clean water? Vote for a democrat. Make it easy for everyone to understand.
Want better health care? Vote for a democrat. Want clean air to breathe? Vote for a democrat? Want better schools for your kids? Vote for a democrat. Want job training for the unemployed? Vote for a democrat. Want clean water? Vote for a democrat. Make it easy for everyone to understand.
3
I encourage Dr. Krugman to read Appendix 6 of that Commonwealth Fund report, specifically line 2. Does the United States have worse health care or more people getting sick? The answer to that question can be found in the last four lines of the figure. Also, consider the report rates the United States fourth in preventative health.
I support universal health care for moral reasons and it is likely to help the overall mortality somewhat. However, these sweeping promises of reduced mortality are about as substantiated as something a Republican would say on healthcare.
I support universal health care for moral reasons and it is likely to help the overall mortality somewhat. However, these sweeping promises of reduced mortality are about as substantiated as something a Republican would say on healthcare.
If this writer were honest, he would note the bad news as well as the good. On many measures of health care outcomes, the U.S. does shamefully badly. Factor in costs (in a country that fanatically prates about costs and benefits), and the U.S. has an abysmal health care system.
If the U.S. ranks 4th on preventive care (and a cursory reading of the appendix does say that), then why is the U.S. dead last by significant margins on so many measures of outcomes.
The writer points to 4 of many measures of health care performance -- myocardial infarction, stroke, breast cancer and colon cancer. All illnesses that come later in life, which is exactly one of the problems health economists point to in the U.S. system -- disproportionate expenditure for older Americans. Note the word "disproportionate." The criticism is not that too much is spent on the elderly, but that not enough is spent on younger people.
I too, Professor, am mystified at the insistence of some from the Left that "single payer" is the SOLE legitimate approach toward universal health care and medical cost containment.
It's not just the Right that seems hopelessly parochial and unaware that while all developed nations other than the U.S. have at least a goal of universal health care only a few use a straight-forward universal health care system. (Could it be that several of these are English speaking countries and so people are unaware of what happens in other places - the Netherlands, yes, but also Germany for example?)
I am unaware of any studies showing single payer to be more cost efficient or more satisfactory to the public that other approaches toward universal coverage. Indeed, something like the German system, by preserving "inefficient" choice manages to be quite well received. All systems contain considerable angst about how to pay for everything (or pay providers v-v each other within the system) and the inevitable fringe of care as to what is/is not covered.
"Why is this type of nurse paid this when a similar nurse if paid more?" "Why is this illness only reimbursed at this level when another illness actually costs much more to treat?" "Why emphasize corrective care instead of the preventative?" "Why has my grand-dad been put off from treatment 3 times in 6 months?" "Why can't I have medicine X instead of Y?" "Why waste $1B on a medical clinic planned for only $300M?" Et cetera.
It's not just the Right that seems hopelessly parochial and unaware that while all developed nations other than the U.S. have at least a goal of universal health care only a few use a straight-forward universal health care system. (Could it be that several of these are English speaking countries and so people are unaware of what happens in other places - the Netherlands, yes, but also Germany for example?)
I am unaware of any studies showing single payer to be more cost efficient or more satisfactory to the public that other approaches toward universal coverage. Indeed, something like the German system, by preserving "inefficient" choice manages to be quite well received. All systems contain considerable angst about how to pay for everything (or pay providers v-v each other within the system) and the inevitable fringe of care as to what is/is not covered.
"Why is this type of nurse paid this when a similar nurse if paid more?" "Why is this illness only reimbursed at this level when another illness actually costs much more to treat?" "Why emphasize corrective care instead of the preventative?" "Why has my grand-dad been put off from treatment 3 times in 6 months?" "Why can't I have medicine X instead of Y?" "Why waste $1B on a medical clinic planned for only $300M?" Et cetera.
1
Dr. Krugman is forgetting one aspect of our employer-based health system. It's heading for its own price armageddon.. 25 years ago my employer gave employees a stipend from which they could choose their health insurance from a number of plans offered by private insurers. If you had any of the stipend left over after buying insurance the employer let you purchase up o a week's vacation time by essentially paying back your salary. Back then we usually had enough left over to purchase a week's vacation time and many did so. Now employees are paying thousands of dollars a year out of their pockets for the same coverage.
If our employer-based private insurer system continues on this trajectory, we may look back a few decades from now and realize we missed an opportunity to adopt a single-payer system.
If our employer-based private insurer system continues on this trajectory, we may look back a few decades from now and realize we missed an opportunity to adopt a single-payer system.
2
This is exactly the point and what Krugman fails to acknowledge. The ACA was able to pass because at the time, the majority of people were satisfied with the employee system and employers were not ready to reform it. That has changed with employers on the hunt for cheaper plans, less choices given mergers and insurers leaving the market. Give business an opportunity to untether their obligation to employee health which means a single payer, government financed system like we already have, Medicare & they'll go for it.
We spent billions insuring what is now the 7-8 million people currently receiving health care through the PPACA law who will keep their coverage once the law changes to allow people to drop health insurance. The others included in the oft-quoted 30 million say they don't want it.
There were twenty-to-thirty million uninsured when the PPACA was being written up, and the Democrats said thet knew they'd never reach most of them.
As it turned out, the law never even reached five percent of the U.S. population. I can only imagine how much will be needed to provide universal care. But if the Dems do it, then the question becomes how long the U.S. dollar remains stable.
There were twenty-to-thirty million uninsured when the PPACA was being written up, and the Democrats said thet knew they'd never reach most of them.
As it turned out, the law never even reached five percent of the U.S. population. I can only imagine how much will be needed to provide universal care. But if the Dems do it, then the question becomes how long the U.S. dollar remains stable.
I think that looking at other countries that are successfully providing health care is a good first step. But health is more complex that the provision of health care. There are underlying reasons that people in Northern Europe and, in particular, the Nordic countries, are healthy and happy. they have a government and a culture that is interested in providing benefits to its people. People, not the 1% investment class, are the main investment. This is what the progressives in the US need to be talking about. Why are the Viking countries so successful? In every area, including economically. Paul Krugman, you're an economist so please start writing about this. Thanks. !!!!
3
Single-payer is the way to go. This is similar to Medicare, as you pay the government to reimburse doctors and facilities for their service, but at a discounted rate. This system is already set up and functioning well. Why re-invent the wheel? Taxes will increase, but much less than your current premium, which you will no longer have to pay.
3
Ending the Electoral College would be a good start a national rally.
2
All of our Constitution is what has held us together all this time, counting the amendments. It made us th world's top choice for immigrants.
Rather than our ditching inconvenient parts of it that today's progressives cannot understand, I propose that the tiny number who can't deal with the Constitution proceed to travel until they find a safe little progressive country that saves them the bother of that much freedom.
While Canada beckons, the traveler might consider the countries that their own ancestors left to come here.
Rather than our ditching inconvenient parts of it that today's progressives cannot understand, I propose that the tiny number who can't deal with the Constitution proceed to travel until they find a safe little progressive country that saves them the bother of that much freedom.
While Canada beckons, the traveler might consider the countries that their own ancestors left to come here.
1
Well, one thing is certain, based on the spirited exchanges in the comments. Progressives need to do something and it is pretty clear what is currently 'exercised' by Democrats in office is seen as atrophy.
Almost all polling and post-mortem analyses indicates Sanders would have beaten Trump. So, I am baffled why, self-proclaimed, Democrats think that our next move is to move rightward. And I'm not taking an 'anti-Clinton' stance in pointing that out -spare me.
I fear too many Democrats are, perhaps unconsciously, prioritizing the needs of corporations ahead of the needs of our society and 'the commons' and the common man/woman.
The suffocating weight of Plutocracy and the simplistic world-view of the false dichotomy of 'winners and losers' is truly an error to embrace as underlying truth. It's Maya. Don't believe it. Resist. Resist.
If the foundational bedrock of Democrats is infected by catch phrases and tacit resignation to 'economic reality', 'life isn't fair', 'the richest are better, smarter, and deserve more', 'health care is a privilege', then we're in trouble not only as a party but as a nation.
What is next you ask? We need to treat our Learned Helplessness because the patients are on life-support and embracing center-right ideals will not address the vast inequality that is not only a political but a literal death sentence.
WE must appeal to our better Angels or accept nihilistic resignation & the fascists ideologues at our doorstep. That's what's next.
Almost all polling and post-mortem analyses indicates Sanders would have beaten Trump. So, I am baffled why, self-proclaimed, Democrats think that our next move is to move rightward. And I'm not taking an 'anti-Clinton' stance in pointing that out -spare me.
I fear too many Democrats are, perhaps unconsciously, prioritizing the needs of corporations ahead of the needs of our society and 'the commons' and the common man/woman.
The suffocating weight of Plutocracy and the simplistic world-view of the false dichotomy of 'winners and losers' is truly an error to embrace as underlying truth. It's Maya. Don't believe it. Resist. Resist.
If the foundational bedrock of Democrats is infected by catch phrases and tacit resignation to 'economic reality', 'life isn't fair', 'the richest are better, smarter, and deserve more', 'health care is a privilege', then we're in trouble not only as a party but as a nation.
What is next you ask? We need to treat our Learned Helplessness because the patients are on life-support and embracing center-right ideals will not address the vast inequality that is not only a political but a literal death sentence.
WE must appeal to our better Angels or accept nihilistic resignation & the fascists ideologues at our doorstep. That's what's next.
6
An excellent column, something all progressives who want to force their agenda on the people thru take-no-prisoners efforts like we've just seen with McConnell in the Senate should take note of. If the ACA is to be preserved, 3 broad goals need to be agreed to: (1) lessen bureaucratic burdens wherever possible-KISS (Keep It Simpler, Stupid) (2) admit that the ACA should have been named "the Accessible Care Act" and redouble efforts to make health care affordable (3) Redouble efforts to make it accessible and affordable with more tax money from the rich.
In the current climate, at least the last goal is pure dreaming, but these should be overall Democratic party goals. In the immediate future, why can't the Dems browbeat the frame of "repeal and replace" as a fraud and repeatedly demand the GOP/Trump stop demagoguing the CSRs as "bailouts"? Demand also that professional journalists stop providing respectability to these efforts.
It seems my party thinks it's better for Republicans to discover they own health care by allowing them to make their outrageous claims without sufficient alt-messaging and to suffer inevitable consequences. To me, it seems an inevitable consequence that if any party doesn't educate those it hopes to vote for them--necessarily independents as well as progressives--it will be the one that suffers. Pound Trump and the repeal and replace crowd relentlessly--demand reliable funding for the CSRs, at minimum.
In the current climate, at least the last goal is pure dreaming, but these should be overall Democratic party goals. In the immediate future, why can't the Dems browbeat the frame of "repeal and replace" as a fraud and repeatedly demand the GOP/Trump stop demagoguing the CSRs as "bailouts"? Demand also that professional journalists stop providing respectability to these efforts.
It seems my party thinks it's better for Republicans to discover they own health care by allowing them to make their outrageous claims without sufficient alt-messaging and to suffer inevitable consequences. To me, it seems an inevitable consequence that if any party doesn't educate those it hopes to vote for them--necessarily independents as well as progressives--it will be the one that suffers. Pound Trump and the repeal and replace crowd relentlessly--demand reliable funding for the CSRs, at minimum.
Some members of Congress are pushing forward. This just came across my screen:
Rep. Huffman Helps Introduce New Medicare Buy-In Legislation
Washington, D.C.- As the national dialogue heats up around healthcare and Americans are seeking real solutions that address their long-term needs, Reps. Jared Huffman (CA-02), Brian Higgins (NY-26), John Larson (CT-01) and Joe Courtney (CT-02) are announcing introduction of the “Medicare Buy-In and Healthcare Stabilization Act”, a bill that improves on the successes of the Medicare program and provides middle-age Americans a new option for affordable, quality healthcare. The Medicare Buy-In Act will lower the Medicare eligibility age to 50 years and offer the option to buy-in to Medicare thus avoiding the increase in premiums that older Americans often face. Additionally, working Americans who wish to buy into the program would have the option to do so, and their employers could continue to contribute to their premiums pre-tax, a win-win for those employers and employees. The buy-in option will hold down costs in both Medicare and the private market. ...
Rep. Huffman Helps Introduce New Medicare Buy-In Legislation
Washington, D.C.- As the national dialogue heats up around healthcare and Americans are seeking real solutions that address their long-term needs, Reps. Jared Huffman (CA-02), Brian Higgins (NY-26), John Larson (CT-01) and Joe Courtney (CT-02) are announcing introduction of the “Medicare Buy-In and Healthcare Stabilization Act”, a bill that improves on the successes of the Medicare program and provides middle-age Americans a new option for affordable, quality healthcare. The Medicare Buy-In Act will lower the Medicare eligibility age to 50 years and offer the option to buy-in to Medicare thus avoiding the increase in premiums that older Americans often face. Additionally, working Americans who wish to buy into the program would have the option to do so, and their employers could continue to contribute to their premiums pre-tax, a win-win for those employers and employees. The buy-in option will hold down costs in both Medicare and the private market. ...
1
If my employer-paid health insurance were to be taken away, I'd expect to get a big raise. Would I get it? You can disrupt my work-based insurance all you want as long as I get some sort of public option AND a fat raise to go with it. I think we know that the current insurance set-up has been depressing our wages for many years now.
1
Come to think of it, why couldn't an employer be allowed to cover their employee's coverage under single payer?
1
Ah, the old "If you like your insurance, you can keep your insurance" argument again.
As a Medicare recipient, my heath care costs are covered by a small reduction in my Social Security and paying about $200 a month for Part B coverage. Using the AARP approved plan, I have no copays or deductibles. My only out of pocket costs are for a couple of prescriptions because I refuse to buy into the Part D insurance which I consider a give-away to the big pharma companies. By getting prescriptions from Canada, I save 33% on one and 90% on another.
No doubt some people whose insurance is provided by their employers are fortunate and have all of their health care expenses covered. That wasn't the case in my preretirement job, where the basic cost (both to the employer and to the employee) increased nearly every year. Then came in "deductibles" and copays which also seemed to go up each year when the company renewed its policy.
Dr. Krugman, perhaps a study of employer-provided insurance would be enlightening, focusing on who is fully covered, who is partly covered (having copays/coinsurance), and the insured who can't even afford to get recommended treatment or fill prescriptions because of the out-of-pocket expenses.
My guess is that many people with employer-based health insurance are in the same boat with the Medicaid folks who really don't have full access to health care for the same reasons. Only single payer can ensure universal health care..
As a Medicare recipient, my heath care costs are covered by a small reduction in my Social Security and paying about $200 a month for Part B coverage. Using the AARP approved plan, I have no copays or deductibles. My only out of pocket costs are for a couple of prescriptions because I refuse to buy into the Part D insurance which I consider a give-away to the big pharma companies. By getting prescriptions from Canada, I save 33% on one and 90% on another.
No doubt some people whose insurance is provided by their employers are fortunate and have all of their health care expenses covered. That wasn't the case in my preretirement job, where the basic cost (both to the employer and to the employee) increased nearly every year. Then came in "deductibles" and copays which also seemed to go up each year when the company renewed its policy.
Dr. Krugman, perhaps a study of employer-provided insurance would be enlightening, focusing on who is fully covered, who is partly covered (having copays/coinsurance), and the insured who can't even afford to get recommended treatment or fill prescriptions because of the out-of-pocket expenses.
My guess is that many people with employer-based health insurance are in the same boat with the Medicaid folks who really don't have full access to health care for the same reasons. Only single payer can ensure universal health care..
2
Single payer is not going to happen overnight. The financial and political power of a well entrenched private insurance industry will absolutely fight this to the death. Like Paul Krugman, I believe single payer is the ultimate solution to health care in the US but it is reckless and delusional to approach this as an all or none political strategy. We as a country are going to have to take incremental steps toward a single payer system. I would like to see a tiered lowering approach of the age to qualify for Medicare over the next 10 to 15 years, perhaps making those who are 60 Medicare eligible next year and then lowering the age to 55 within five years and age 50 within 10 years. And yes, offering a reasonably priced and decent public option based on one's income level to anyone seems like a sound idea, too.
1
Sounds reasonable but I think we should continue to push for single payer, if for no other reason than to make conservatives nervous enough to want to fix the ACA rather than risk a major push for medicare for all one day.
1
Lots of good ideas here but it does not address the biggest hurdle, rising healthcare costs.
So long as insurance companies siphon off a large percentage of healthcare $, costs will undermine any solution. They need to be cut out of the picture. Maybe it has to be done incrementally, by starting with a public option. But it must be done.
The top 5 publicly traded health insurers have been doing extremely well since the ACA went into effect in March 2010:
United Health, up 475%
Humana, up 426%
Cigna, up 415%
Aetna, up 405%
Anthem, up 208%
For reference, the S&P500 is up 125%
Subsidizing insurance premiums is just a way for extraordinarily profitable health insurers to squeeze free money out of US taxpayers.
Of course there are other cost areas that need attention too, such as medical malpractice premiums, the cost of a medical education, and of course patented prescription drugs. Regarding the last, it's criminal that private pharmaceutical companies profit mightily from taxpayer funded research done at public educational institutions. This is another scam, another example of private for profit companies effectively stealing tax dollars.
In the end, we need a comprehensive healthCARE policy rather than health INSURANCE policy. It needs to cover:
1. healthy school lunches
2. more phys ed based on physical development rather than competitive sports
3. advertising and tax controls on junk food
4. health education for new parents and parental leave
and more
So long as insurance companies siphon off a large percentage of healthcare $, costs will undermine any solution. They need to be cut out of the picture. Maybe it has to be done incrementally, by starting with a public option. But it must be done.
The top 5 publicly traded health insurers have been doing extremely well since the ACA went into effect in March 2010:
United Health, up 475%
Humana, up 426%
Cigna, up 415%
Aetna, up 405%
Anthem, up 208%
For reference, the S&P500 is up 125%
Subsidizing insurance premiums is just a way for extraordinarily profitable health insurers to squeeze free money out of US taxpayers.
Of course there are other cost areas that need attention too, such as medical malpractice premiums, the cost of a medical education, and of course patented prescription drugs. Regarding the last, it's criminal that private pharmaceutical companies profit mightily from taxpayer funded research done at public educational institutions. This is another scam, another example of private for profit companies effectively stealing tax dollars.
In the end, we need a comprehensive healthCARE policy rather than health INSURANCE policy. It needs to cover:
1. healthy school lunches
2. more phys ed based on physical development rather than competitive sports
3. advertising and tax controls on junk food
4. health education for new parents and parental leave
and more
6
Dr. K, there's a difference between advocating for what you want and what you actually get. President Obama and the Dems' big mistake was in not advocating for something simple and easy to understand as Medicare for All. Had they done so, we would probably have now had a much more robust version of Obamacare, public option and all. Timidity is what got us where we are. I see nothing wrong with the Dems pushing Medicare for All while acknowledging that it would probably be implemented gradually, perhaps by periodically lowering the qualifying age (and raising it from birth) a few years at a time. Parties are identified by their values as well as by their policies. If you can't get there from here, at least be willing to get to "here"
4
Dr. Krugman makes a good point about the difficulty in selling single payer to much if not most of the public, but would his suggested system of regulated insurance companies be enough to contain the rapidly rising cost of medical care in the US? It would seem that the introduction of a government
option would be the best way to go. It is well established that government medical programs such as medicare, medicaid, and veteran's benefits have a much lower overhead, and would be the best bargain for consumers, including employers, eliminating one of the objections to the establishment of single payer, the loss of employer coverage. It's lower costs will allow the government option to dominate the market, giving it bargaining power with the medical industry that individual insurance companies don't have. This would minimize taxpayer subsidies to cover low income people, freeing up government funds for the child care programs he is suggesting.
option would be the best way to go. It is well established that government medical programs such as medicare, medicaid, and veteran's benefits have a much lower overhead, and would be the best bargain for consumers, including employers, eliminating one of the objections to the establishment of single payer, the loss of employer coverage. It's lower costs will allow the government option to dominate the market, giving it bargaining power with the medical industry that individual insurance companies don't have. This would minimize taxpayer subsidies to cover low income people, freeing up government funds for the child care programs he is suggesting.
1
This Progressive's first priority is a 100% Value-Added Tax for all carbon-based energy sources. Spend it however required to get it passed. My priorities for spending it would be:
1. Refundable tax credits to make the tax (on average) revenue-neutral for those under the poverty level, and modestly progressive for everyone else.
2. Shore up Obamacare (mostly by putting in a public option and lowering Medicare's eligibility age from 65 to 60).
3. Infrastructure.
1. Refundable tax credits to make the tax (on average) revenue-neutral for those under the poverty level, and modestly progressive for everyone else.
2. Shore up Obamacare (mostly by putting in a public option and lowering Medicare's eligibility age from 65 to 60).
3. Infrastructure.
2
I have had the opportunity, thru involvement in professional organizations, to view health care delivery in a number of different "first world" countries. As Dr Krugman points out, there are lots of different ways to do it - from purely "socialized medicine", as in the UK or Canada, to coverage that is almost entirely provided by private insurers, as in the Netherlands or Switzerland. But there are three common elements in all the systems that work well
1. A requirement that EVERYONE participate - that is, that everyone has some form of coverage
2. The availability of a default option - call it the public option or whatever you like - some form of catastrophic care that provides a failsafe position for those who cannot afford private insurance
3. A requirement that, not matter who is footing the bill, payment be made within some very short period of time, usually a week or ten days. If a payor disagrees with the claim, they can dispute it and try to get the money back. But the onus for assuring that payment is made falls on the payor, not the patients, who shouldn't have to deal with finances when trying to get well or stay well, or the provider, whose focus can remain on the patient and not on accounts receivable.
Obviously, the last feature doesn't occur in the US system, where insurance companies routinely deny payment for at least 90 days, and often for as much as six months. The insurers have one responsibility and one only - making payment.
1. A requirement that EVERYONE participate - that is, that everyone has some form of coverage
2. The availability of a default option - call it the public option or whatever you like - some form of catastrophic care that provides a failsafe position for those who cannot afford private insurance
3. A requirement that, not matter who is footing the bill, payment be made within some very short period of time, usually a week or ten days. If a payor disagrees with the claim, they can dispute it and try to get the money back. But the onus for assuring that payment is made falls on the payor, not the patients, who shouldn't have to deal with finances when trying to get well or stay well, or the provider, whose focus can remain on the patient and not on accounts receivable.
Obviously, the last feature doesn't occur in the US system, where insurance companies routinely deny payment for at least 90 days, and often for as much as six months. The insurers have one responsibility and one only - making payment.
4
One of the problems with single-payer is with the term itself. Does it really mean a single unique payer at the exclusion of all others? I think that's how many on the right interpret it.
I remember the look of surprise on a college professor when I told her universal government based coverage need not preclude private insurance. That other countries have safety net government coverage for all and still have private companies selling additional insurance for those who want it and can afford it. It hadn't occurred to her. She was speaking about her conservative family's opposition to universal health care in contrasts to her belief in it. Her immediate reaction was that they might feel differently if they knew they weren't stuck with what the government "forced" on them but they still had "options".
So I think progressives have to be very careful with their messaging when they fight for single-payer or they will lose out on potential allies. I think the first thing is to ditch the term single-payer and only use Medicare-for-all. People already understand it co-exists with supplemental plans so it avoids the single-unique-payer misconception.
How we get there in terms of convincing people and figuring out how to afford it is a different story. Either progressively lowering the age and/or allowing high-risk patients to buy into it should be the first step. Increasing program capacity incrementally instead of all-at-once is both politically and economically more prudent.
I remember the look of surprise on a college professor when I told her universal government based coverage need not preclude private insurance. That other countries have safety net government coverage for all and still have private companies selling additional insurance for those who want it and can afford it. It hadn't occurred to her. She was speaking about her conservative family's opposition to universal health care in contrasts to her belief in it. Her immediate reaction was that they might feel differently if they knew they weren't stuck with what the government "forced" on them but they still had "options".
So I think progressives have to be very careful with their messaging when they fight for single-payer or they will lose out on potential allies. I think the first thing is to ditch the term single-payer and only use Medicare-for-all. People already understand it co-exists with supplemental plans so it avoids the single-unique-payer misconception.
How we get there in terms of convincing people and figuring out how to afford it is a different story. Either progressively lowering the age and/or allowing high-risk patients to buy into it should be the first step. Increasing program capacity incrementally instead of all-at-once is both politically and economically more prudent.
5
Krugman is correct, we simply need to improve upon the system that we now have, not tear it down and start over. Medicare for the elderly, and Medicaid for the poor (as expanded under Obamacare), accomplish their missions. The same appies to Tricare and VA benefits. The VA needs better funding, and Medicare needs an ability to negotiate drug prices, but all of the programs are basically solid.
For those who qualify for none of those programs, I think we need to provide a Public Option on the individual market. To limit undercutting of private insurance rates, the Public Option might be constrained to a Bronze version and a Gold version, and it can be mandated to produce a five percent profit for the government. The profit would be directed to the Medicare Trust Fund to address costs that currently aren't covered by Medicare payroll taxes and instead are covered by other tax revenues.
For those who qualify for none of those programs, I think we need to provide a Public Option on the individual market. To limit undercutting of private insurance rates, the Public Option might be constrained to a Bronze version and a Gold version, and it can be mandated to produce a five percent profit for the government. The profit would be directed to the Medicare Trust Fund to address costs that currently aren't covered by Medicare payroll taxes and instead are covered by other tax revenues.
It would be a heck of a hard sell? Not really, to those of us who own homes. Just having the government as a backstop against a medical crisis that under today's system would mean bankruptcy would be convincing to me.
Perhaps we could start with a two-tier plan, with single-payer (government) insurance kicking in when expenses hit catastrophic level, perhaps $10,000, which would be catastrophic for most people. That would take care of heart surgeries, cancer treatment, strokes, and similar major medical problems. People (or their employers) could then buy supplemental insurance for the routine stuff. Purchasing supplemental insurance could be mandatory, with assistance for the truly low-income, because without the possibility of having to cover massive expenses, insurance companies would be able to charge much lower premiums for routine care. If the maximum they could have to pay out per insured is $10,000, and some insureds will cost them nothing, the risk is low and the premiums can be too. Two-tier can, and does, work, and could be another step toward where we ultimately need to go.
Perhaps we could start with a two-tier plan, with single-payer (government) insurance kicking in when expenses hit catastrophic level, perhaps $10,000, which would be catastrophic for most people. That would take care of heart surgeries, cancer treatment, strokes, and similar major medical problems. People (or their employers) could then buy supplemental insurance for the routine stuff. Purchasing supplemental insurance could be mandatory, with assistance for the truly low-income, because without the possibility of having to cover massive expenses, insurance companies would be able to charge much lower premiums for routine care. If the maximum they could have to pay out per insured is $10,000, and some insureds will cost them nothing, the risk is low and the premiums can be too. Two-tier can, and does, work, and could be another step toward where we ultimately need to go.
1
One small correction: A personal bankruptcy does not mean the loss of your home. When I declared bankruptcy, the arbitrator told me, "We don't take people's primary residence."
Interesting. I wonder whether it matters which state you're in. I also wonder whether you would be allowed to keep the proceeds from the sale of that primary residence. If I were too ill to work for an extended period, I'd be forced to sell my house or lose it to foreclosure, since I wouldn't be able to pay the mortgage. So would those proceeds then be subject to seizure by medical creditors?
That was a close one, isn't it? The vote to not repeal is a political partisan victory, but I'm not sure it'll hold mustard when the time comes for the electorate to voice and cast their votes. Once the big insurers started to pull out of their share of the ACA in the individual market, I sense that the ACA is a sinking ship, and tweaking it or making it better won't keep it afloat. This is because the ACA was designed with the insurers at the helm this time. It's like Managed Care 2.0, ACA 1.0. Managed Care 1.0 was pre-2008, with doctors groups, hospitals, and insurers (the Big 3) on one side, CMS on the other. There was minimal oversight and regulation. Cash burn was high but the economy supported that pre-2008. Money makes people myopic, and this also applies to banking and realestate, aka Greenspan. CMS was not supposed to dictate the market pricing during Managed Care 1.0. The Big 3 was supposed to get along, formulate business models under the belief that a free market can control its pricing, delivers great quality, maintain a healthy and fair competition, and regulate themselves. We now know that didn't work. Instead, market pricing was set by the CMS and lobbyists, With the ACA, the insurers is now on the federal side, lumping CMS/insurers as payers, and the others (doctors, hospitals, big pharma, biotech) as the service side. So, with Managed Care 2.0, if the insurers decide not to play along, I can assure you, there won't be an ACA 2.0. It's time for Single Payer.
1
Ironically, one issue that is sure to attract support from all parties will be repairing America's infrastructure. It's ironic because, if drumpf had tackled that instead of the based-in-hate goal of repealing and replacing Obamacare, he would have gotten a lot more support right out of the gate. It would have been easier to separate his behavioral problems from acting on a real issue. In addition, it would have provided some cover during the current investigation.
But, he didn't, and it is time for him and his loyalists to be dismissed.
But, he didn't, and it is time for him and his loyalists to be dismissed.
4
Well said! There is more than one way to skin a cat as they used to say. The issue is how to POLITICALLY achieve universal healthcare coverage. Everything else is someone with an agenda. Let the details be negotiated in Congress, but require the Congress to get on with it! Talking about pie in the sky ideas is not helpful as it does not solve problems.
This should be the beginning of a new approach. Democrats also need to address the other things they think should happen like making education better & cheaper for college, re-creating a rationale safety net, protecting our most vulnerable citizens (children, elderly, & people with disabilities), protecting the environment, and looking at the long-term impact of short-term actions (like deregulation).
With such a voice, Democrats can seize the moral and ethical high ground. Perhaps some Republicans even still remember the difference between right and wrong, which would broaden the base. Force politicians & parties to take a position to choose wrong (wealthy and corrupt taking advantage of all) or right (morally appropriate actions they would not be embarrassed to tell their children about).
This should be the beginning of a new approach. Democrats also need to address the other things they think should happen like making education better & cheaper for college, re-creating a rationale safety net, protecting our most vulnerable citizens (children, elderly, & people with disabilities), protecting the environment, and looking at the long-term impact of short-term actions (like deregulation).
With such a voice, Democrats can seize the moral and ethical high ground. Perhaps some Republicans even still remember the difference between right and wrong, which would broaden the base. Force politicians & parties to take a position to choose wrong (wealthy and corrupt taking advantage of all) or right (morally appropriate actions they would not be embarrassed to tell their children about).
3
When he wrote "if Democrats regain control of Congress," I stopped reading - because (short of a major and undeniable catastrophe like nuclear war) there's no scenario under which that happens within the next four years.
2
With regard to health care, it seems like we could actually be on the cusp of bipartisan agreement. Its broad structure would be found in combining the ACA marketplace with some of the features of the Cassidy-Collins bill released in January, which proposed auto-enrolling people in a government catastrophic insurance plan.
GOP reformers are correct when they promote competition and transparent pricing for many medical services and procedures. However, Democrats know that there is no true market for medical care when life is in danger and information is bound to be asymmetric.
So, as a hybrid model, what could be done is:
1. Auto-enrolling everyone in universal catastrophic health insurance plans, (like Cassidy-Collins) with deductible set at 10% of income, opt-out if desired
2. Expanding HSAs like in Rand Paul's plan, and allowing them to cover premiums for comprehensive insurance/gap coverage premiums and other health/wellness costs
3. Pre-funding HSAs in cash with the equivalent of the current Obamacare/ACA subsides, tax-free (so still tailored to needs based on location/income/age), HSA tax limit would be same as deductible
4. Encouraging HSA spending on direct primary care / clinic subscription models for basic wellness
5. Allowing HSA interest-free loans / negative balances for other costs within the out-of-pocket catastrophic plan amounts (gov would insure these loan balances)
6. At the end of the year, auto-transferring HSA funds to eligible IRA accounts
GOP reformers are correct when they promote competition and transparent pricing for many medical services and procedures. However, Democrats know that there is no true market for medical care when life is in danger and information is bound to be asymmetric.
So, as a hybrid model, what could be done is:
1. Auto-enrolling everyone in universal catastrophic health insurance plans, (like Cassidy-Collins) with deductible set at 10% of income, opt-out if desired
2. Expanding HSAs like in Rand Paul's plan, and allowing them to cover premiums for comprehensive insurance/gap coverage premiums and other health/wellness costs
3. Pre-funding HSAs in cash with the equivalent of the current Obamacare/ACA subsides, tax-free (so still tailored to needs based on location/income/age), HSA tax limit would be same as deductible
4. Encouraging HSA spending on direct primary care / clinic subscription models for basic wellness
5. Allowing HSA interest-free loans / negative balances for other costs within the out-of-pocket catastrophic plan amounts (gov would insure these loan balances)
6. At the end of the year, auto-transferring HSA funds to eligible IRA accounts
Proper title: "Where should corporate democrats go who don't want to reign in insurance company costs, drug costs, and are still okay with gradual expansion--operating on the belief that healthcare is not a human right in the US."
Krugman: "Moving to single-payer would mean taking away this coverage and imposing new taxes; to make it fly politically you’d have to convince most of these people both that they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old.
This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?"
Me: Yes, that might in fact be true, and it will likely lead to more positive health outcomes for more people, and lower costs for governments, hospitals, and consumer/citizens. So, so Mr. Krugman--the hard sell is a milquetoast agenda. We found that out with Hillary Clinton. Please stop abusing the word progressive. If Dems want to win the future they need a platform: i.e. Medicare for All, end the war on terror, reign in domestic police, create a federal program that matches workers up with open employment positions, and stop standing for nothing. Mr. Krugman--you were wrong to lambast the Dem leftists in the Primary a year and a half ago, and you are wrong for trying to usurp progressivism to mean incremental policy approach that still leaves millions uninsured.
Krugman: "Moving to single-payer would mean taking away this coverage and imposing new taxes; to make it fly politically you’d have to convince most of these people both that they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old.
This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?"
Me: Yes, that might in fact be true, and it will likely lead to more positive health outcomes for more people, and lower costs for governments, hospitals, and consumer/citizens. So, so Mr. Krugman--the hard sell is a milquetoast agenda. We found that out with Hillary Clinton. Please stop abusing the word progressive. If Dems want to win the future they need a platform: i.e. Medicare for All, end the war on terror, reign in domestic police, create a federal program that matches workers up with open employment positions, and stop standing for nothing. Mr. Krugman--you were wrong to lambast the Dem leftists in the Primary a year and a half ago, and you are wrong for trying to usurp progressivism to mean incremental policy approach that still leaves millions uninsured.
8
When it comes to children, no one even has to call for bipartisanship: it can happen.
1
Listen people: Dr. Krugman isn't suggesting we give up on the healthcare issue. He wasn't suggesting that what's been achieved (the defeat of Repub. fiasco legislation), was the best that could be hoped for. ALL he said was that there remain other issues -- other, important, competing priorities that merit heightened focus, and that it would be a mistake to continue to place healthcare at the top of our list. He also made great suggestions for where, at the margins, politically viable improvements might be possible to get through our Congress (here, in the real world) and bring us closer to the the goal of better, more affordable coverage for more Americans.
He makes good sense. What possesses people to think that the moral crusade for single-payer has to be our cause? Oh, yeah. That's right. It's the same idiocy that made some think a 75-year-old, non-Democrat was a good idea to be our nominee for president. And the same that suggested for some that his single-payer crusade and free-college were reasonable ideas for the party. Yes -- but yes only if you're talking about the fringe, demotratic-socialist party. But wait. Oh right.... there isn't any such animal. Bernie's been out there on the fringe tossing around provocative ideas with ZERO chance of enactment forever.
You people..... Please. Is it not finally time to give me a break? Stay calm and step away from the Bern, already.
He makes good sense. What possesses people to think that the moral crusade for single-payer has to be our cause? Oh, yeah. That's right. It's the same idiocy that made some think a 75-year-old, non-Democrat was a good idea to be our nominee for president. And the same that suggested for some that his single-payer crusade and free-college were reasonable ideas for the party. Yes -- but yes only if you're talking about the fringe, demotratic-socialist party. But wait. Oh right.... there isn't any such animal. Bernie's been out there on the fringe tossing around provocative ideas with ZERO chance of enactment forever.
You people..... Please. Is it not finally time to give me a break? Stay calm and step away from the Bern, already.
2
I believe the large impediment to a sane, rational and functional medical system are all the people who are now at the trough pigging out at the immense profits they are making. This distorts the political process by buying the politicians and putting them in their back pockets.
This has to end.
This has to end.
3
Krugman says without a hint of irony: "But single-payer, while it has many virtues, isn’t the only way to get there; it would be much harder politically than its advocates acknowledge; and there are more important priorities."
The important priorities being that Democrats need to take money from the corporations that pay them to fight single payer, despite the fact pluralities of Republicans, and overwhelming majorities of Democrats and Independents want it.
The important priorities being that Democrats need to take money from the corporations that pay them to fight single payer, despite the fact pluralities of Republicans, and overwhelming majorities of Democrats and Independents want it.
8
You make it sound so easy!
One *simple* change would make huge changes in our health care system. The basic thing that is breaking our health care system is employer subsidized health care.
Essentially, there are two separate expenses for health care. The first is regular checkups with a doctor or doctor equivalent -- health maintenance. The second is expensive remediation such as surgery. The first has real elasticity --the demand changes with the price. The second does not. Furthermore, only the second expense is something that really should be insured. The first expense is expected.
But because of employer sponsored health insurance we have the expectation that the expenses of the first type will be covered and we often care very little about how much it will cost.
For expenses of the second kind, each employer has a separate pool. So instead of all Americans being in a single pool together or all residents of a state, we have instead the employees of each employer being in a separate pool and then another separate pool for the exchanges.
If we got rid of employer provided health insurance, then everyone would have to purchase insurance on the exchanges, everyone would be in a single pool, and overall insurance costs would go down.
If in addition, we made it so that most plans do not cover expected medical expenses, then people could shop for the best value and we could also expand clinics where those of a limited means could go for insurance.
Essentially, there are two separate expenses for health care. The first is regular checkups with a doctor or doctor equivalent -- health maintenance. The second is expensive remediation such as surgery. The first has real elasticity --the demand changes with the price. The second does not. Furthermore, only the second expense is something that really should be insured. The first expense is expected.
But because of employer sponsored health insurance we have the expectation that the expenses of the first type will be covered and we often care very little about how much it will cost.
For expenses of the second kind, each employer has a separate pool. So instead of all Americans being in a single pool together or all residents of a state, we have instead the employees of each employer being in a separate pool and then another separate pool for the exchanges.
If we got rid of employer provided health insurance, then everyone would have to purchase insurance on the exchanges, everyone would be in a single pool, and overall insurance costs would go down.
If in addition, we made it so that most plans do not cover expected medical expenses, then people could shop for the best value and we could also expand clinics where those of a limited means could go for insurance.
Perfection has been the enemy of accomplishment for universal healthcare in the U.S. for decades. The ACA is established, having passed the Supreme Court, and having withstood a Republican controlled Congress. We have something solid. Scrapping this to start over again on some single payer plan would be very risky! I agree with Dr. Krugman. The best thing will be to improve the ACA. And I agree that shoring up healthcare for children would be a good place to start. I also believe that reducing the age for beginning Medicare makes a lot of sense. Many of us have observed that serious health issues show up about the time we turn 50. It is this 50+ age group that pushes up premium cost for all. If children and 50 or 55+ were covered by Medicare, the insurance industry should be able to handle everyone in between effectively. And as time goes on, everyone will demand access to a system that actually works: Medicare! Incremental growth is really the best option.
2
As a union benefits lawyer, I saw a dangerous trap in single-payer health plans that no one is discussing. Union health plans are very similar to single-payer plans: health benefits are a right (if you work enough hours), and the union trustees are elected officers. Everything works great when funds are coming in, but when there are shortages, the officers have a tough choice: 1) tell members their benefits must be cut, and be at risk of being voted out of office; or 2) pretend that there's nothing wrong and hope the plan does not go bankrupt before the next election. The more entitled the voters feel, the more likely the elected officials are to make the wrong choice.
Under the ACA, the insurance companies take the heat. Considering how entitled both the Left and the Right feel nowadays, I do not have confidence that our elected officials could or would do that. I say leave the ACA in place, and strengthen the subsidies and the regulations.
Under the ACA, the insurance companies take the heat. Considering how entitled both the Left and the Right feel nowadays, I do not have confidence that our elected officials could or would do that. I say leave the ACA in place, and strengthen the subsidies and the regulations.
2
You're making way too much sense for the single-payer fanatics. Please stop!
1
Every American ought to have access to medical care whenever and wherever they need it. We should not have to do wallet biopsies to see if we can afford the care before we receive it. We should not have to worry about going bankrupt or losing our jobs and then being unable to afford the care we need. We should not have to hold bake sales, start a Go Fund Me site, beg neighbors, raid our retirement funds, sell our houses, etc, for long term treatment for cancer, diabetes, or any other chronic illness or an accident.
The ACA did not end those problems. And if the adults can't receive care in a timely fashion children won't either because they need healthy adults to take care of them. Our current "health care" system doesn't care for the patients. It cares for the bottom lines of the wealth care industry which includes health insurance companies, pharmaceuticals, medical device companies, for profit hospitals, labs, malpractice insurers, and the CEOs of these companies. Patients are considered last in America and we are patients, not consumers.
The ACA did not end those problems. And if the adults can't receive care in a timely fashion children won't either because they need healthy adults to take care of them. Our current "health care" system doesn't care for the patients. It cares for the bottom lines of the wealth care industry which includes health insurance companies, pharmaceuticals, medical device companies, for profit hospitals, labs, malpractice insurers, and the CEOs of these companies. Patients are considered last in America and we are patients, not consumers.
3
The reason why progressives haven't made progress in winning elections is the problem that has plagued such a movement in this country since Eugene Debs through George McGovern: They are more intent on winning nominations than winning elections.
Progressive go on and on and on about the Democratic Party, about the party's base, but they never talk about the vast majority of Americans who are independents, Republicans and centrist Democrats, except to disdain them. That's not how you win elections, as Clinton's unfortunate "deplorables" remark demonstrated.
Progressive go on and on and on about the Democratic Party, about the party's base, but they never talk about the vast majority of Americans who are independents, Republicans and centrist Democrats, except to disdain them. That's not how you win elections, as Clinton's unfortunate "deplorables" remark demonstrated.
4
Krugman is correct in his pessimism about an imminent transition to single payer healthcare. The politicians advocating for single payer, such as Sanders and Warren, do not honestly set forth the cost and coverage. They are offering little more than a campaign slogan unlikely to be enacted. They vilify insurers and drug companies, but in fact all stakeholders and providers in our current system take their cut. Will doctors willingly become public hospital employees,and forego the profits from their ownership in medical imaging centers, rehab centers and chemo therapy clinics? Will suppliers subject
their profits to government control?
Obama sought to corral all those interests into a compromise program which because of such compromise was enacted. Krugman is right in urging improvement to those compromises which benefit patients.
their profits to government control?
Obama sought to corral all those interests into a compromise program which because of such compromise was enacted. Krugman is right in urging improvement to those compromises which benefit patients.
2
As a sometimes Keynesian, Krugman Paul never concerns himself with minor matters like COST. Why would he? The government can always print money if things get a little tight over at Treasury.
Who cares that NHE was $3.2Trillion in 2015, increasing 5.6% annually, and comprised 1/6 of the US economy? Who cares that NHE is projected to be $5.2Trillion in 2026 and will comprise 1/5 (at least) of the economy? Who cares that all of that increase will be rolled into the national debt, which is a meager $20Trillion today and will be approaching $30T by 2026?
No problem for the liberal conscience. Just pile on more social programs courtesy of the nanny state.
That's real progress.
Who cares that NHE was $3.2Trillion in 2015, increasing 5.6% annually, and comprised 1/6 of the US economy? Who cares that NHE is projected to be $5.2Trillion in 2026 and will comprise 1/5 (at least) of the economy? Who cares that all of that increase will be rolled into the national debt, which is a meager $20Trillion today and will be approaching $30T by 2026?
No problem for the liberal conscience. Just pile on more social programs courtesy of the nanny state.
That's real progress.
3
So you don't care if our healthcare system stinks as long as it's not "socialist."
3
GLC,
Your concern is cost, correct?
Yet a SinglePayer/Medi4All would cost half of what is being spent nationwide and give a better result and outcome.
Your concern is with the future costs. Yet you want to continue with a system that doesn't work except to for the wealthy, and costs had been growing faster than under the ACA previously. What is YOUR better way GLC? Why should an employer be in charge of my HealthCare?! Why should we/I have to pay some suit my money because he is standing between me and my doctor?! What benefit does he give me?! What business is it of his what and why my doctor prescribes or recommends actions and/or procedures?!
Get the unneeded middlemen out of my business. Isnt that the Republican way? Yet you are fighting to keep me under the thumb of someone that isn't even needed.
No problem for the conservative conscience. Just pile on more useless capitalism courtesy of the Profit over People Republicans.
Better to fleece the sick and dying than help. Right GLC?!
Your concern is cost, correct?
Yet a SinglePayer/Medi4All would cost half of what is being spent nationwide and give a better result and outcome.
Your concern is with the future costs. Yet you want to continue with a system that doesn't work except to for the wealthy, and costs had been growing faster than under the ACA previously. What is YOUR better way GLC? Why should an employer be in charge of my HealthCare?! Why should we/I have to pay some suit my money because he is standing between me and my doctor?! What benefit does he give me?! What business is it of his what and why my doctor prescribes or recommends actions and/or procedures?!
Get the unneeded middlemen out of my business. Isnt that the Republican way? Yet you are fighting to keep me under the thumb of someone that isn't even needed.
No problem for the conservative conscience. Just pile on more useless capitalism courtesy of the Profit over People Republicans.
Better to fleece the sick and dying than help. Right GLC?!
1
The first step to a rational health care system is to rehear and hopefully rescind the SCOTUS's "Citizens United" callous implementation. If that should occur then our non infected elected representatives might approach this pervasive problem, and others, with clearer heads. This is a prerequisite to restoring any semblance of "good government".
This is the crux of the matter, even as we get ready to see a return to bipartisanship in both chambers of horror, and the mud wrestling matches to be expected can only produce cockamamie mud pies of a health system.
I disagree with Dr.K, in that it is not practical to start health care discussions "fresh". We will only continue to embarrass ourselves on the world stage if a health plan does not mimic what exists and works well around the globe.
Get Citizens United off the books and we have a shot at a fresh start on just about everything. The beneficiaries of Citizens United have shown their hand and they don't have the cards. Bluffing is not governing.
This is the crux of the matter, even as we get ready to see a return to bipartisanship in both chambers of horror, and the mud wrestling matches to be expected can only produce cockamamie mud pies of a health system.
I disagree with Dr.K, in that it is not practical to start health care discussions "fresh". We will only continue to embarrass ourselves on the world stage if a health plan does not mimic what exists and works well around the globe.
Get Citizens United off the books and we have a shot at a fresh start on just about everything. The beneficiaries of Citizens United have shown their hand and they don't have the cards. Bluffing is not governing.
2
Clinton had a war chest of unprecedented size, Trump's far smaller. The term "cantored" came from the former House majority whip being defeated in a primary by a candidate who spent less than 1/10th as much.
I'm tired of blaming everything on an gullible electorate who apparently are lured by lots and lots of TV ads, direct mailings and robocalls — tired of it because I don't believe it.
I'm tired of blaming everything on an gullible electorate who apparently are lured by lots and lots of TV ads, direct mailings and robocalls — tired of it because I don't believe it.
1
Mr. Krugman use of the term "progressives" needs to be recast to "health care progressives" in this context. Many who support universal health care on the Dem side, "progressives" also support war for fun and profit, citizen surveillance, and whistleblower retaliation. It's scary when our nation's progressives are consumed by our nation's unhealthy policies.
1
Unless and until liberals realize that they need to change as much as the conservatives, we will not progress. Normally. philosophical considerations may remain in the background, silently doing their work. But when crisis come they must be brought front and center, such that a conceptual change in our public discussion may be made possible. So for example, the philosopher Rorty, a true lefty from the sixties, predicated Trump, given not just the right's positions, but also the lefts. Post Vietnam, according to him, the left lost touch with the working class, and how to help them, being now just spectators, pointing out the marginalization of various classes, women, people of color, and gays. They then, as Trump now, claimed that there is no such thing as truth, only the values of power and domination parading falsely as truth. They held that our system was corrupt, irredeemable, and just must be cast aside. The independent voter, who in their hearts would not exclude trans people, asked why bathroom use dominated the issue of jobs; Trump had the answer, according to his lies, they went for Trump. Unless the left owns this, unless the voices so active in liberal circles are asked to wait their turn, for but a moment, that they have had enough of our attention, and it is time for other voices, things will not change, and the working people will continue to turn to a conservative program, that does not have their interests at heart. Seemingly harsh truths, but truths they are.
1
Health Insurance companies came in at the last minute, when popular discontent and organizing, spearheaded by Sanders by the way, had already tipped the balance. They waited to see who was winning and then came in on the winning side.
"For now, at least, the attempt to repeal the Affordable Care Act appears dead."
The October debt ceiling limit may be another threat. They could "prioritize" payments so as not to include Obamacare Federal payments to states or insurance companies. It is not a repeal, just a failure to pay. It would have the same effect in a very short time.
The ill-will in our political system has not gone away. There is still no leadership and no vision, just in-fighting like a cage match.
The October debt ceiling limit may be another threat. They could "prioritize" payments so as not to include Obamacare Federal payments to states or insurance companies. It is not a repeal, just a failure to pay. It would have the same effect in a very short time.
The ill-will in our political system has not gone away. There is still no leadership and no vision, just in-fighting like a cage match.
4
If you are not in favor of single-payer universal health care (which could easily be done by extending Medicare/Medicaid to all) or in favor of dismantling American capitalism (ending the stock market, investment banks, hedge funds, with only employee-owned companies and corporate entities) or in favor of ending any and all special rights and benefits for all religious organizations, please do not call yourself a progressive. You are not "progressive" in your thinking but only a fan of the current systems with minor changes. An actual progressive movement in the US is nascent at best.
1
If that's what a true progressive is, then I have another name for such a movement: delusional.
2
Not at all, it will just take a very long time because there are so many ignorant people who buy into the myths of religion and capitalism. But if the wealthiest people do not completely destroy the planet, this will be part of the future. People will be educated and will learn that many current institutionalized systems do not work to their benefit.
1
We do have a British-style mini-healthcare system in the US - the VA system. It provides care through VA hospitals and clinics. "VA for all" would be a more apt comparison than Medicare for all, if you're talking about socialized/single-payer care.
1
By definition, socialized medicine includes delivery of care by government-employed care providers and government-owned hospitals with a publicly funded payment system, such as the VA and England. Medicare is a single-payer approach, a social insurance model with privately delivered care. Single-payer would NOT change the delivery of care from the prevalent model we currently experience. Physicians and other providers would retain their private practices.
Seems like Paul would prefer the Dutch model, but he says the Dutch have "regulated" insurance companies. Here the company's policies have to meet standards, but If the Dutch system is so good-and cheap-maybe the "regulation" is more than US companies would accept.
1
"It's not just about paying off the insurance industry, although getting insurers to buy in to health reform wasn't foolish, and arguably helped save the A.C.A…."
Exactly, and that's why President Obama's pragmatic strategy, which took us a major step forward, was infinitely smarter and better than a blue-sky approach destined to be DOA. Policymakers can't just ignore institutions (like the insurance industry) that, for better or worse, are built into the framework of the existing system.
At the same time, single-payer is worthy of remaining a vision if not a short-term objective. And it might be possible to wring additional constructive effect from the existing Medicare system. For example, what if the current health care law were amended so that, in markets with fewer than two competing insurers offering ACA policies, Medicare would be made available to people under 65?
I suggested that to a (seemingly) conservative pediatrician (who doesn't take Medicaid) yesterday and he wanted to know who would pay for the health care for poor people who can't pay into Medicare. This did strike me as a legitimate question from a 1+1=2 standpoint although my instinct was to argue from the broader standpoint of basic humanity. I also had a vague notion that helping people get well imposes less overall burden on society than letting them remain sick. (In the end I just grabbed another hors d'oeuvre.)
Exactly, and that's why President Obama's pragmatic strategy, which took us a major step forward, was infinitely smarter and better than a blue-sky approach destined to be DOA. Policymakers can't just ignore institutions (like the insurance industry) that, for better or worse, are built into the framework of the existing system.
At the same time, single-payer is worthy of remaining a vision if not a short-term objective. And it might be possible to wring additional constructive effect from the existing Medicare system. For example, what if the current health care law were amended so that, in markets with fewer than two competing insurers offering ACA policies, Medicare would be made available to people under 65?
I suggested that to a (seemingly) conservative pediatrician (who doesn't take Medicaid) yesterday and he wanted to know who would pay for the health care for poor people who can't pay into Medicare. This did strike me as a legitimate question from a 1+1=2 standpoint although my instinct was to argue from the broader standpoint of basic humanity. I also had a vague notion that helping people get well imposes less overall burden on society than letting them remain sick. (In the end I just grabbed another hors d'oeuvre.)
Jonathan,
You could have pretended to kick aside the sick and dying as you reached for that hors d'oeuvre.
History already shows us what a world is like without HeathCare for all. It wasn't healthy nor prosperous.
Heck, before the ACA, Medical bill where the leading cause of Bankruptcy.
Millions of our fellow citizens were/are dying because of pre-existing conditions and lack of preventative care.
But I guess in a dog eat dog world of conservativism we just step over or kick aside the dead and dying. Especially if we've gotten their last dollar off them already.
You could have pretended to kick aside the sick and dying as you reached for that hors d'oeuvre.
History already shows us what a world is like without HeathCare for all. It wasn't healthy nor prosperous.
Heck, before the ACA, Medical bill where the leading cause of Bankruptcy.
Millions of our fellow citizens were/are dying because of pre-existing conditions and lack of preventative care.
But I guess in a dog eat dog world of conservativism we just step over or kick aside the dead and dying. Especially if we've gotten their last dollar off them already.
3
Based on some of the comments here, it's clear that many people still don't realize the threat that's facing this country because of the Trump presidency. As one person wrote, the first goal is to win back the House and the Senate in 2018, The next goal is to win back the presidency in 2020. Everything is important, but nothing is more important than that. To those who suggest that the Democrats are just as bad is the Republicans: You fell for the propaganda. The goal of that propaganda is to divide the Democrats and maintain control of the government, and as a result allow authoritarianism to gain a stronger foothold. Let's address this threat first, and then build the healthcare system that we need -- whether it's making improvements to Obamacare or designing a new system.
3
The Republican Party doesn't expand its "political capital" on cutting single-payer Medicare in any serious way. Sometimes it even runs attacks against Democrats for ostensibly cutting single-payer Medicare - see 2010 & 2012. This is because the program is universal, simple to administer and politically popular, thus extracting a much higher political price from them for attempting to mess with it.
The Republican Party does, however, expend its "political capital" on targeting programs that are complex, Rube Goldberg Democratic solutions like the ACA. This is because the program is complicated, not particularly politically popular, and in large measure is a subsidy to a private, profit-making industry to deal with health care. There's a much lower political price to pay for attempting to mess with that.
If Professor Krugman doesn't think it's worth it for progressives to spend "political capital" moving for a health care system that's morally right, more cost-effective, and politically popular than the ACA, and that incrementally improving the ACA is what to shoot for... well, he didn't learn much from 2016.
The Republican Party does, however, expend its "political capital" on targeting programs that are complex, Rube Goldberg Democratic solutions like the ACA. This is because the program is complicated, not particularly politically popular, and in large measure is a subsidy to a private, profit-making industry to deal with health care. There's a much lower political price to pay for attempting to mess with that.
If Professor Krugman doesn't think it's worth it for progressives to spend "political capital" moving for a health care system that's morally right, more cost-effective, and politically popular than the ACA, and that incrementally improving the ACA is what to shoot for... well, he didn't learn much from 2016.
4
I can think of no greater national priority, Mr. Krugman, than the health of the people who comprise our nation. Seventy percent of our nation's health care expenses are currently paid by taxes. The remaining thirty percent are paid by insurance premiums paid to for-profit insurance companies. Your promotion of greater subsidies for an increasingly irrelevent industry whose free-riding existence depends upon siphoning off public dollars (ie., Medicare Advantage plans) is an intolerable breach of service for the public good. Many ordinary Americans are currently double-paying (through taxes and through health insurance premiums) for a system that doesn't come close to covering 100% of medical costs. If for no other reason than for simplicity's sake, we should go all in on a publicly-financed system. You must be receiving brownie points and accolades from your fellows in the proferssional class for cynically playing the "child card" to disguise the actual point of your argument, which by omission seems to be that the richest country in human history should tolerate 28 million people without affordablle access to health care (and an increasing number of severely underinsured). Your commentary is so out of touch with conditions on the ground in America.
8
A thoughtful and eloquent rebuttal to Krugman's callous preachings. Thank you.
1
I own a company with 18 employees. It would be better for me and my bottomline if healthcare coverage came directly from income tax revenues. I have to compete with firms that have access to socialized medicine coverage and they can out spend me. If we had single payer my employees wouldn't have to pay for deductibles they simply cannot shoulder and they'd get to take home more of their hard earned monies. It's just nuts to think we're doing the right thing by supporting an industry that stands firmly between you and your doctors so they can make a buck . . . I'm tired of businesses that make money at the expense of others. That best defines a criminal enterprise. Am I alone?
8
Why not consider a federal government plan titled "Universal Base Care" funded through a payroll tax assuring that at least some coverage is available for all by providing a floor they can not fall below? For those over 65 Medicare Part A provides something similar at no cost, but then Part B & D or supplemental insurance can be purchased if desired. Within "Universal Base Care" employers could still offer supplemental coverage as a valuable employee benefit, even so-called "Cadillac Plans" as some already offer to secure and retain talented employees.
1
More pain, failure, shrieking, melt downs, tantrums, ... I could go on. Face it, the contra-positive formulation of "Where there's a will there's a way" is, unsurprisingly enough, "Where's there's no will, there's no way". That's what "progressive" (ha!) leaders are telling us over and over. They have no will, and there's just no way. Witness Jerry Brown, exhibit A. All you faux "progressives" are failures, every last one, including Paul Krugman.
4
My mistake, the contrpositive is actually, "If there is no way (what we keep being told), then there is NO WILL". That's about the size of it. Your leaders have no will.
Note the many many comments, some quite irrational, blaming Krugman for not being "progressive" enough. Yes, I'd like to push for single payer, but that will require real change in the electorate, who severely punished the Democrats for Obamacare.
Meanwhile, practically nobody mentioned the emphasis on childcare and support for children. Guess it's a "woman's issue" just "identity politics." So boring and old-hat. Sounds just like Hillary. Remember Bernie pretending that "economic issues" trump "identity." This is a totally false dichotomy. Remember the 6 million (mainly ) women the day after the inauguration? We will NOT be sidelined again!
Meanwhile, practically nobody mentioned the emphasis on childcare and support for children. Guess it's a "woman's issue" just "identity politics." So boring and old-hat. Sounds just like Hillary. Remember Bernie pretending that "economic issues" trump "identity." This is a totally false dichotomy. Remember the 6 million (mainly ) women the day after the inauguration? We will NOT be sidelined again!
Whatever form it takes, Americans must have a public option for health care coverage. Absent this, we have already seen what happens in sparsely populated pockets of the country that are left high and dry through the random fluke of geography. Of course political knuckle-dragging doesn't help, but a national and rational public option opens the gate for all Americans, regardless of local political obtuseness.
2
i really dislike arguments that presume some industry has such a profound grip on Congress that we can't encroach on their prerogatives. We do that with gun control and health insurance and restoring a 90% top marginal tax rate.
People really want government to work for us. Instead, it works for money. and that money has grown like a strangler fig over the body politic until it's all hollowed out and something else is standing in its place. That something is totalitarian capitalism, aka fascism.
People really want government to work for us. Instead, it works for money. and that money has grown like a strangler fig over the body politic until it's all hollowed out and something else is standing in its place. That something is totalitarian capitalism, aka fascism.
8
Howsabout a staged buy-in to Medicare: 55+ now, 45+ in x yeras, 35+ in 2x years and then everybody?
4
Great question, from the columnist who endorsed the Goldwater Girl from the board of Wallmart who spent the last few years taking millions from Wall Street. Barf
5
"What’s Next for Progressives?------> move to Canada as promised?
Or to the Progressives' Paradise in Cuba or Venezuela?
Or to the Progressives' Paradise in Cuba or Venezuela?
3
Here's a challenge for all the liberals giving Krugman a standing ovation for this article. Copy/paste it into your word processor, then search for a single word: "cost"
You won't find it. An omission that was not, I suspect, accidental.
You won't find it. An omission that was not, I suspect, accidental.
5
The "cost' for single payer would be hundreds of billions less!
So 81% of democrats support Medicare for All and it's in the Democratic platform...but it shouldn't be a litmus test for democratic candidates? None of your incremental change will guarantee healthcare and save money and lives. Only Medicare for All will do that. It makes financial sense, it makes healthcare sense. Stop saying you support single payer and doing all you can to discredit it.
10
"Is this really where progressives want to spend their political capital?"
Why the heck not?? Single Payer would be your choice "if we were starting fresh" -- when does one ever "start fresh"?? -- and an effective health care system immediately addresses a host of other issues ranging from infant mortality to business competitiveness.
Why the heck not?? Single Payer would be your choice "if we were starting fresh" -- when does one ever "start fresh"?? -- and an effective health care system immediately addresses a host of other issues ranging from infant mortality to business competitiveness.
4
Hillary's message, nay, her life's work, has been about providing care for children. Yet she is viewed by many, including many democrats, as a cold hearted witch who lost to a baboon.
There are too many people who don't have kids who want a piece of the pie also. And they are getting tired of paying to raise every one else's kid.
There are too many people who don't have kids who want a piece of the pie also. And they are getting tired of paying to raise every one else's kid.
1
I favor the plan to lower the Medicare age gradually.
Politically, stated exactly like that, I believe is a political winner. Calling for "single payer", may be more of a double edged sword, so would avoid putting it that way.
Politically, being anti TPP, pro Social Security (80% favor), pro higher minimum wage (70% favor), and downplaying wedge issues would be a huge winning platform - if the candidate is credible. There is huge mistrust of establishment pols, anyone who takes money from the banks, and anyone with a history of supporting bad trade deals.
Politically, stated exactly like that, I believe is a political winner. Calling for "single payer", may be more of a double edged sword, so would avoid putting it that way.
Politically, being anti TPP, pro Social Security (80% favor), pro higher minimum wage (70% favor), and downplaying wedge issues would be a huge winning platform - if the candidate is credible. There is huge mistrust of establishment pols, anyone who takes money from the banks, and anyone with a history of supporting bad trade deals.
1
Prof. Krugman glosses over the difference between the European and American concepts of "health insurance companies."
European health insurance companies covering basic healthcare (as opposed to supplemental programs) are highly regulated; their roles are limited to administering the collection and dissemination of funds. They are not commodity purveyors. They do not exist to enrich stockholders. They do not assert the role of designing a benefits package and determining what is "medically necessary"--a flaming conflict-of-interest if ever there was one. Their officers do not receive rock star compensation and diamond-encrusted retirement packages.
European health insurance companies don't adhere to the ethos of the American insurance paradigm, which views every expenditure as a loss. They understand their role as facilitators of the provision of health care. Their function can be conceptualized as Medicare-as-public-utility.
We could not create a Dutch health care system with the health insurance companies we have now.
European health insurance companies covering basic healthcare (as opposed to supplemental programs) are highly regulated; their roles are limited to administering the collection and dissemination of funds. They are not commodity purveyors. They do not exist to enrich stockholders. They do not assert the role of designing a benefits package and determining what is "medically necessary"--a flaming conflict-of-interest if ever there was one. Their officers do not receive rock star compensation and diamond-encrusted retirement packages.
European health insurance companies don't adhere to the ethos of the American insurance paradigm, which views every expenditure as a loss. They understand their role as facilitators of the provision of health care. Their function can be conceptualized as Medicare-as-public-utility.
We could not create a Dutch health care system with the health insurance companies we have now.
5
I propose a Trojan Horse approach for implementing single-payer.
As part of stabilizing the ACA, Democrats should immediately require that a public Medicaid option be made available in counties with no insurers. How can the insurance companies complain (yes, they will howl) about offering a public option where they have deemed it unprofitable and offer no coverage?
Word will spread about how much less expensive it is when insurance company overhead is eliminated and others will demand a similar option in their states and counties. This populist approach as a better chance than fighting the insurance industry lobby directly.
As part of stabilizing the ACA, Democrats should immediately require that a public Medicaid option be made available in counties with no insurers. How can the insurance companies complain (yes, they will howl) about offering a public option where they have deemed it unprofitable and offer no coverage?
Word will spread about how much less expensive it is when insurance company overhead is eliminated and others will demand a similar option in their states and counties. This populist approach as a better chance than fighting the insurance industry lobby directly.
1
I applaud and support Krugman's assertion that we are NOT ready for single-payer. Repair the weak spots in the ACA and have it work more efficiently. Sorry, Bernie, but it's premature.
As a parent of two thirty year olds, I see them (and their friends) struggling to combine jobs, young children, and mortgages. Our society is seriously stacked against them. They are buying houses, and thus mortgages, that are huge compared to us parents, with outrageous property tax bills to match. Childcare for one daughter's 3 month old costs $1900 per month! Add the second child and one parent works just to pay for child/preschool. Staying home to care for them isn't really an option not only because kids are expected to enter kindergarten knowing more than in the past, but also because parents need to stay current in their careers to advance. The Democratic pact is that if you work hard, you can have a home and family. If that promise is not kept with our young families, they will stop being progressive and join cohort of embittered Americans.
2
I find Professor Krugman's arguments about the practicalities of near term health care solutions compelling. I would add, however, that eventually moving health care costs off of the employer would help to preserve jobs and help our competitiveness in international trade. Eliminating the costs associated with the private insurance companies might also reduce health care costs. Perhaps we should improve the ACA while also improving medicare and the VA health care system. Medicare for all or government run health care will be more appealing if it can be demonstrated that single payer health care and/or government run health care is cost effective, improves health care outcomes and is appealing to the consumer.
1
Could Krugman address the issues that the Economist brought up in regards to the Dutch system:
1) Healthcare costs rose after switching from government run single payer
2) Dutch healthcare is the costliest in the Eurozone
3) To work, it implements a regressive flat tax
https://www.economist.com/blogs/democracyinamerica/2013/10/obamacare
1) Healthcare costs rose after switching from government run single payer
2) Dutch healthcare is the costliest in the Eurozone
3) To work, it implements a regressive flat tax
https://www.economist.com/blogs/democracyinamerica/2013/10/obamacare
2
Don't like paying for health care? Don't get sick, don't grow old, and don't visit doctors.
I rarely get sick and I couldn't stop growing old, but I do visit doctors regularly to check on how well I am. For a man my age, the verdicts have been that I am in pretty good shape. But they have also been concerned about my heart.
This year a cardiologist determined I should be seen by surgeons. The verdict was that I needed a valve replacement. Four months later I am slowly getting back to the activity level I once had.
But if had to pay all the costs that have been incurred, I would probably be back in the hospital with a stroke. If I had to pay all the costs, I would probably have to sell my house.
As it is, I pay a few dollars for this, a couple hundred for that, and on and on. The max I could pay is $5,000. I'm not there yet, but I would say that lots of minimum wage workers would have a hard time making those payments.
I rarely get sick and I couldn't stop growing old, but I do visit doctors regularly to check on how well I am. For a man my age, the verdicts have been that I am in pretty good shape. But they have also been concerned about my heart.
This year a cardiologist determined I should be seen by surgeons. The verdict was that I needed a valve replacement. Four months later I am slowly getting back to the activity level I once had.
But if had to pay all the costs that have been incurred, I would probably be back in the hospital with a stroke. If I had to pay all the costs, I would probably have to sell my house.
As it is, I pay a few dollars for this, a couple hundred for that, and on and on. The max I could pay is $5,000. I'm not there yet, but I would say that lots of minimum wage workers would have a hard time making those payments.
2
The name "Medicare-for-All" doesn't always refer to a single-payer system. The most politically feasible proposal I've seen under this name is to offer a Medicare buy-in on the public exchanges alongside the private insurers. In essence, this is a resurrection of the "public option"
The objective here isn't to displace the private insurers, but to provide a safeguard against market abuses that might otherwise be tempting in states where the number of private players were too low.
The objective here isn't to displace the private insurers, but to provide a safeguard against market abuses that might otherwise be tempting in states where the number of private players were too low.
1
I know you have decided to make healthcare your "thing", but does anyone know the NAACP issued a travel warning for a state in our country? Missouri might want to get control of the situation before Wednesday night's ballgame? Or maybe we should suggest a boycott of the game?
We may not be ready for Medicare for All as Mr. Krugman suggests, but I think we, as a society, are ready for Medicare for All Children.
Providing Medicare for Children would benefit the general health of this vulnerable segment of society and make phasing in a transition to Medicare for All easier for society, the economy, and the insurance industry. Medicare for Children would be a reasonable half-step along the pathway to a single payer system.
Providing Medicare for Children would benefit the general health of this vulnerable segment of society and make phasing in a transition to Medicare for All easier for society, the economy, and the insurance industry. Medicare for Children would be a reasonable half-step along the pathway to a single payer system.
2
It is even surprising to me that pro-business Republicans do not consider a single payer public health care system. Would that not benefit businesses? Right now employers have to cover part of the healthcare plans of employees. Would they not be relieved of this "burden" and have a greater margin of profit if they did not have this cost? Could we have some analysis of this angle of the issue?
1
"A far more important consideration is minimizing disruption to the 156 million people who currently get insurance through their employers, and are largely satisfied with their coverage"
No, Paul, those people are "largely satisfied" because they have no other option! In the meantime, they are being paid less because the employer is picking up a large part of the insurance cost, keeping the insurance company profits high and adding to the cost of goods produced in the US (See- vehicles produced in Canada vs. the US). Plus, this antiquated system stifles entrepreneurship and keeps workers in jobs when they would prefer to retire or change careers. Medicare for All is a transition: add a public option & start lowering the Medicare age, plus allow Medicare to negotiate drug prices. Simple!
No, Paul, those people are "largely satisfied" because they have no other option! In the meantime, they are being paid less because the employer is picking up a large part of the insurance cost, keeping the insurance company profits high and adding to the cost of goods produced in the US (See- vehicles produced in Canada vs. the US). Plus, this antiquated system stifles entrepreneurship and keeps workers in jobs when they would prefer to retire or change careers. Medicare for All is a transition: add a public option & start lowering the Medicare age, plus allow Medicare to negotiate drug prices. Simple!
3
Please spare us with the "incrementalism" position on the health care system debate. Senator Ted Kennedy proposed single payer back in 1971 !!
He explained that “for the 15 times that I have fought on the floor of the United States Senate that we ought to have universal, comprehensive coverage, listen to the voices on the other side who HAVE universal and comprehensive coverage say ‘No, it’s not time. We can’t afford it. It is the wrong bill at the wrong time.’”
Today, the corporate Democratic Party and the GOP are making the same argument. They just can't stop taking money and say NO to the billionaire health insurance and big pharma cartels who control them.
He explained that “for the 15 times that I have fought on the floor of the United States Senate that we ought to have universal, comprehensive coverage, listen to the voices on the other side who HAVE universal and comprehensive coverage say ‘No, it’s not time. We can’t afford it. It is the wrong bill at the wrong time.’”
Today, the corporate Democratic Party and the GOP are making the same argument. They just can't stop taking money and say NO to the billionaire health insurance and big pharma cartels who control them.
5
Three points, Dr. K, from a progressive:
1. Although Bernie Sanders advocates Medicare for all as the long-range goal, he see the immediate term solution as improving the ACA to stabilize the exchanges and backs a public option as part of that effort. You're saying much the same thing here, preferring single payer but making a tactical decision not to get there in one leap. You also suggest that a public option "could eventually lead to single-payer." Your words. You and Bernie/the progressives aren't that far apart.
2. As for switching from a employer-provided insurance: I did just that in the past two years when I reached 65 and went on Medicare. My excellent employer coverage is now my Medicare supplement. And the difference in my health care, which doctors I see, what's covered? Unchanged, oh, except my premiums are lower. No complaints.
3. When talking about health care, let's be sure not to confuse principles or goals with political tactics. It seems you and I both agree single-payer is the way to go; the arguments seem to be about what is achievable in the current political context. That's a fair point, but let's be clear as we argue over the best route, that we're not arguing about the eventual destination.
1. Although Bernie Sanders advocates Medicare for all as the long-range goal, he see the immediate term solution as improving the ACA to stabilize the exchanges and backs a public option as part of that effort. You're saying much the same thing here, preferring single payer but making a tactical decision not to get there in one leap. You also suggest that a public option "could eventually lead to single-payer." Your words. You and Bernie/the progressives aren't that far apart.
2. As for switching from a employer-provided insurance: I did just that in the past two years when I reached 65 and went on Medicare. My excellent employer coverage is now my Medicare supplement. And the difference in my health care, which doctors I see, what's covered? Unchanged, oh, except my premiums are lower. No complaints.
3. When talking about health care, let's be sure not to confuse principles or goals with political tactics. It seems you and I both agree single-payer is the way to go; the arguments seem to be about what is achievable in the current political context. That's a fair point, but let's be clear as we argue over the best route, that we're not arguing about the eventual destination.
2
What's urgently next for progressives is a single payer's health insurance system that covers all Americans. I'm surprised that Prof. Krugman does not even discuss this major fundamental issue in his columns. It is time to begin discussing this issue. And for the NYT to begin publishing articles about it. It is not enough to say that all the first world countries except USA have a universal health care system. It needs to be hammered in with specific examples and comparisons to other systems. Super capitalist European countries (first and second world ones), England, Israel, Canada. Why not discuss their versions? Where is this coverage? If I were Prof. Krugman, I would not really call myself much of a Progressive.
1
As a Canadian who has enjoyed the benefits of universal Medicare for the last 50 years, I can tell you that Canada's system has always worked well for me and my family. By and large, Canadians support the system and remain wary of attempts by politicians to privatize aspects of Medicare.
The potential political strains on Canadian Confederation are considerably greater than they are over your union, despite Americans having fought a civil war because Canada has 2 official languages and 2 very distinct cultures. I have experienced 2 attempts by Quebec to separate from Canada. What I believe made the difference in holding my country together was Medicare because it gave Canadians a sense of solidarity, the sense that they care for on another and will be there for the other when needed.
The potential political strains on Canadian Confederation are considerably greater than they are over your union, despite Americans having fought a civil war because Canada has 2 official languages and 2 very distinct cultures. I have experienced 2 attempts by Quebec to separate from Canada. What I believe made the difference in holding my country together was Medicare because it gave Canadians a sense of solidarity, the sense that they care for on another and will be there for the other when needed.
2
Medicare for all as the Public Option. It won't kick people off private insurance as long as the employer/privately provided insurance provides the necessary amount of coverage. You could then roll Medicaid into the Medicare program and save on administrative costs. It's not rocket science.
The Democrats, Progressives take note, will not win unless the moderates are addressed. Wingers on either side ignores them at their peril. Both parties have lost touch with a moderate, common sense agenda. Health Care failures finally forced each side to admit to this reality.
I'm encouraged to see No Labels take this approach as well.
I'm encouraged to see No Labels take this approach as well.
1
Progressives should work to neutralize the 'income redistribution' trope of the GOP. This cry goes up any time progressives try to expand, keep, or prevent rollbacks to our tattered safety net. What the cry masks -- and very successfully -- is that there has been since 1980 a massive income redistribution in the other direction. This redistribution has been natural only if the natural state of the economy is for many or even most people to have barely enough to survive on while the very top has the rest. (Karl Marx thought this development was natural, as was the revolution it would eventually provoke.)
We need to reverse or back out or rollback or fix the broken redistribution. There are many policies that would contribute to the rollback, including expanding health care coverage, and they should all be sold as part of the great rollback that would make America great(er) again. What we need for the rollback is a name as catchy as "makers and takers" or "right to life" or "personal responsibility" or "income redistribution".
We need to reverse or back out or rollback or fix the broken redistribution. There are many policies that would contribute to the rollback, including expanding health care coverage, and they should all be sold as part of the great rollback that would make America great(er) again. What we need for the rollback is a name as catchy as "makers and takers" or "right to life" or "personal responsibility" or "income redistribution".
The Democrats are looking for a new strategy, and I think this is it: Our children's future - the new bottomline. It covers all the bases, from health care to education and the environment. I agree that, while I support single payer, there is a more pressing issue that won't wait around for an extended fight. Fix the ACA, and get serious about climate change.
1
If there was any simple way to do this, it would have been done by now. However, there isn't; are medical sector has been allowed to grow to nearly 20% of the GDP, and there is no easy way to either pay for it or cut costs.
1
There's another incremental Improvement that could eventually lead to Universal Health Care without the political difficulties of single-payer. Pass a law lowering the Medicare age from 65 to 64.
It would be impossible for anyone to claim that this would cause disaster or chaos in the system. And after a year or so, it could be done again, and the Medicare age could be lowered incrementally. This wouldn't cause a rebellion from people who get healthcare through their employers because, as today, an employed person old enough to qualify for Medicare can choose to take the health care provided by the employer instead.
Eventually, this process would lead to Medicare for all. It wouldn't be as satisfying as establishing single-payer immediately, but it would be possible to accomplish it under our present political system, as single-payer is not.
It would be impossible for anyone to claim that this would cause disaster or chaos in the system. And after a year or so, it could be done again, and the Medicare age could be lowered incrementally. This wouldn't cause a rebellion from people who get healthcare through their employers because, as today, an employed person old enough to qualify for Medicare can choose to take the health care provided by the employer instead.
Eventually, this process would lead to Medicare for all. It wouldn't be as satisfying as establishing single-payer immediately, but it would be possible to accomplish it under our present political system, as single-payer is not.
2
Oh for gods sake. The Republicans got to where they are precisely for relentlessly demanding their radical agenda. It's time to stop requesting half-way measures and demand what the country really needs. It can start with a public option, but single payer would be better. There needs to be a clear distinction between health insurance, which is simply a monetary repository with funding and payout mechanisms, and medical care delivery including services and pharmaceuticals. Set aside the latter for a moment and consider only insurance. An excellent measure of insurance quality, whether public or private, is to ask what percentage of premiums paid into the "pool" comes back in the form of actual payments for medical care. By that measure Medicare wins decisively with 95% of the money going in, coming back out for patients benefits, compared to private insurance where something like 70% comes back to be used for the patient. As to the question is overall efficiency and portability - I can only say that my private insurance is definitely NOT portable, and I have "good" insurance. So please spare me the talk about "rationing". The real cost of healthcare has little to do with insurance, and everything to do with overcharges by the pharmaceuticals, and some medical specialties and services. A public option would improve benefits and universality, but bringing down unreasonable drug prices is the key to bringing down the overall cost of healthcare.
1
What an extremely sensible article!
3
Paul, you should really stop confusing "coverage" with actual funding for health care. Or at least recognize that coverage is partial to zero in many cases for many people even with (relatively) good ACA plans. When legitimate medical needs can be deemed "not medically necessary" by a profit-based insurance company, what good is "coverage"? To really improve health insurance would require much more stringent regulation, which would sharply limit profits. You can't satisfy both shareholders and patients.
3
British NHS depends on British popular support. There are very few things (BBC being another one) that the British will allow to be debated anymore. Nothing threatens NHS more than a non-single-payer system that works in a country like the US. Nothing would secure NHS in the minds of the British more than Americans copying the system regardless of whether it works or not (Failures can always be explained away.) You will start to see more and more British effort to sell NHS-like systems to Americans. There was already a lot of evidence of that at the Democratic Socialist convention this past week. Get ready to see more. Putin will envy the British before long.
1
Unfortunately, Mr. Krugman, the grassroots, i.e. Bernie supporters, do not want to clean up the ACA. They want to start from scratch and want single payer for all. In our local Party, the single payer proponents and a very, very vocal minority. Any politician's attempt at making the ACA better, to these supporters, would be regarded as caving to the establishment, or the Hillary side of the Democratic Party. They are not going to be happy with anything less than some for of single payer. And there will be no healing of any rift in the Party unless the Democrats put on a pair of boxing gloves and start fighting for their demands. Reasonableness, which is what you are advocating, is no longer a winning strategy.
2
It's a great step forward to see this op-ed and its reader's comments. I'm grinning ear to ear. The discussion is no longer whether it is politically feasible to obtain medicare for all, or whether medicare for all is something that most people will want/benefit from. The discussion, now, is about how we should achieve medicare for all. Should we go fast (Bernie's revolution on healthcare) or slow (Clinton's reform of Obamacare)? Great to see a healthy discussion on this issue, especially because we now all assume that that medicare for all is the ultimate goal.
3
good ideas - keep moving forward and eventually you get to where you want to go -
1
I might prefer a single payer system, but I'm perfectly alright with what Krugman suggests. Making the Affordable Care Act work with a public option is the way to gain public acceptance. If people buy in to a public option and find it works well for them, the news will spread. If it is inadequate, they will be able to retain employer based insurance.
1
I have excellent health care insurance from my employer but I'd trade it any day for single-payer. I'm part of a transatlantic family so I've dealt with health care both here and in the UK. I'll take the NHS any day!
1
1) Expand Medicare to 55 years old, by letting those without employer-based health insurance buy in.
2) Reduce the overall cost of health care using the models developed by your three other nations, and more.
3) Public option on the ACA.
4) Expand the Medicaid expansion to all the states through local lobbying efforts.
2) Reduce the overall cost of health care using the models developed by your three other nations, and more.
3) Public option on the ACA.
4) Expand the Medicaid expansion to all the states through local lobbying efforts.
If winning elections is desirable, then I recommend making jobs and job training, broad support for communities facing the opioid crisis and devising localized programs to bring communities and police forces closer together very high priorities. Sure, health care, immigration and taxes are important, but I think our government wastes so much time and energy on trying to be heroes with huge legacies for us all to admire. Instead, even though there is a lot that can and should be fixed with the "big" issues, there is hardly a true crisis in any of them. Meanwhile, smaller issues like job training for the non-urban poor and middle class, opioid addiction and policing are at crisis level in many areas of the country. If that's not yet clear to you, then you're not fully aware of who was elected president in November, 2016 and how identity politics, immigration and health care were used to target and/or separate people effected by those smaller issues.
2
Any money paid for care of anyone covered by private insurance is seen as a loss. It is in their interest to not pay for anything they can avoid. Profit first,executives paid like rock stars,shareholders all must be served first...patients are far down the list.
2
The worse thing would be for progressives to do now would be to force their hand and move further left on healthcare. It might do well for them to remember that it took decades for Medicare to become the untouchable jewel that it now is – even Republicans don’t want to mess with it after seeing how Americans reacted to Speaker Gingrich’s outrageous suggestion in 1996, “But we believe it's going to wither on the vine…”
So baby steps are called for. Democrats should work with Republicans to fix the problems in Obamacare and help stabilize the system over the next few years. Once Americans become used to healthcare as a right, Medicare for All will soon follow.
So baby steps are called for. Democrats should work with Republicans to fix the problems in Obamacare and help stabilize the system over the next few years. Once Americans become used to healthcare as a right, Medicare for All will soon follow.
This column is disingenuous. Krugman knows perfectly well that Medicare-for-All if enacted, has to be put in place gradually, not only for political reasons, but for practical administrative reasons as well. And starting such a process is not inconsistent with keeping ACA, for now.
In an earlier comment, I wrote:
"Single-payer—Medicare for all—can be introduced gradually, as Senator Ted Kennedy proposed years ago. (In fact, it may only be necessary to dust off his original bill.)
"As he structured it, the eligibility age for Medicare would be lowered gradually, perhaps one year at a time, allowing the many vested interests—the public as well as insurance companies and healthcare providers—to adjust gradually.
"The real difficulty of transitioning to single-payer in this large, diverse country, is that there are so many vested interests in the existing system—including the millions of Americans under 65 who are covered by their employers, as Krugman reminds us. A plethora of legal, actuarial, medical and ethical issues must be resolved.
"To fully understand that difficulty, you need to read Charles Gaba's detailed and pellucid discussion of what's involved in moving to single-payer, and how best to go about it. I, myself, did not fully appreciate the difficulty until I read his piece. Here's the link: http://acasignups.net/node/3085"
All that said, single-payer remains a moral imperative for the Democrats if they wish to win back the House in a wave election.
In an earlier comment, I wrote:
"Single-payer—Medicare for all—can be introduced gradually, as Senator Ted Kennedy proposed years ago. (In fact, it may only be necessary to dust off his original bill.)
"As he structured it, the eligibility age for Medicare would be lowered gradually, perhaps one year at a time, allowing the many vested interests—the public as well as insurance companies and healthcare providers—to adjust gradually.
"The real difficulty of transitioning to single-payer in this large, diverse country, is that there are so many vested interests in the existing system—including the millions of Americans under 65 who are covered by their employers, as Krugman reminds us. A plethora of legal, actuarial, medical and ethical issues must be resolved.
"To fully understand that difficulty, you need to read Charles Gaba's detailed and pellucid discussion of what's involved in moving to single-payer, and how best to go about it. I, myself, did not fully appreciate the difficulty until I read his piece. Here's the link: http://acasignups.net/node/3085"
All that said, single-payer remains a moral imperative for the Democrats if they wish to win back the House in a wave election.
5
There is a lot to agree with here, but Paul Krugman still has a problem with the truth.
Thus he cites the "mon-partisan" (ha!) Commonwealth Fund for the claim that America is at the bottom when it comes to "health care performance."
How does the Commonwealth Fund study (at least its 2014 report) measure health care performance? Hint: Health care effectiveness in preventive care is measured by whether "patients [were] routinely sent computerized reminders for preventive and routine care." I don't want to knock that, but the only meaningful way to measure health care performance is by health care results.
What do those results show? Well, if you strip out deaths from fatal injuries (that have nothing to do with the health system) the US is #1. And Avik Roy tells us that Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth. It’s great that the Japanese eat more sushi than we do, …But these things don’t have anything to do with socialized medicine.”
By failing to provide that context, Krugman is misleading his readers.
Thus he cites the "mon-partisan" (ha!) Commonwealth Fund for the claim that America is at the bottom when it comes to "health care performance."
How does the Commonwealth Fund study (at least its 2014 report) measure health care performance? Hint: Health care effectiveness in preventive care is measured by whether "patients [were] routinely sent computerized reminders for preventive and routine care." I don't want to knock that, but the only meaningful way to measure health care performance is by health care results.
What do those results show? Well, if you strip out deaths from fatal injuries (that have nothing to do with the health system) the US is #1. And Avik Roy tells us that Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth. It’s great that the Japanese eat more sushi than we do, …But these things don’t have anything to do with socialized medicine.”
By failing to provide that context, Krugman is misleading his readers.
4
If only children could vote...
It is a shame Thomas Jefferson didn't pronounce that "All children are created equal" rather than all men. It would have made supporting a progressive agenda much easier. It is more difficult to accuse a child of being "lazy" or undeserving. Renewal of CHIP should not be a hard sell. Single-payer for all is another matter. Also, as you suggest, family friendly policies are more important at this time. It is also too bad that Hillary didn't mistranslate the African saying to "It takes a family to raise a child." Republicans would have had a more difficult time demonizing her.
1
I agree. It will come one day but do not waste political capital.
We do neglect our children.
And this, more than anything, is what will kill the country.
Because we are killing our future.
"When you compare the U.S. social welfare system with those of other wealthy countries, what really stands out now is our neglect of children. Other countries provide new parents with extensive paid leave, provide high-quality, subsidized day care for children with working parents and make pre-K available to everyone or almost everyone; we do none of these things. Our spending on families is a third of the advanced-country average, putting us down there with Mexico and Turkey."
And this, more than anything, is what will kill the country.
Because we are killing our future.
"When you compare the U.S. social welfare system with those of other wealthy countries, what really stands out now is our neglect of children. Other countries provide new parents with extensive paid leave, provide high-quality, subsidized day care for children with working parents and make pre-K available to everyone or almost everyone; we do none of these things. Our spending on families is a third of the advanced-country average, putting us down there with Mexico and Turkey."
1
How much did the insurance companies pay you to write this opinion?
2
What's next? Not what needs to be done...
First, lets not conflate progressivism with being a modern Democrat. A modern Democrat, in power, based on legislative agenda (removed from belief) is not a Progressive. So called 'blue dog' Ds & Neoliberals sell a Conservative agenda under the lie of 'compromise'. It's an absurd position and it is, there is no doubt, cancerous poison for the poor & middle-class. Classes which, lest you forget, represent almost all of us. Move further Left or witness our death by a thousand cuts, end the mirage of 'compromise', and be honest what our leadership as become.
There are only three, albeit related, reasons we do not have single-payer in this country. 1.) Corporate Interests. 2.) Politicians dependent on #1. 3.) A largely, and it gives me no pleasure to say this, ignorant populace.
Economics, Demography, and History all dictate, quite clearly, single-payer is the only path forward. Single-payer is not only more humane and therefore more 'Christian like' - satisfying the needs of the false (and true) Christian voters. It is also more efficient and results in cost savings, all viable data suggests, by at least 2x-3x what we now face (with or without the ACA). And, it also results in better outcomes through a preventive model of care.
There is something for everyone to ideologically support. But, there is nothing that corporations will support when it comes to their chosen business model - profiting off of the pain and suffering of humans.
First, lets not conflate progressivism with being a modern Democrat. A modern Democrat, in power, based on legislative agenda (removed from belief) is not a Progressive. So called 'blue dog' Ds & Neoliberals sell a Conservative agenda under the lie of 'compromise'. It's an absurd position and it is, there is no doubt, cancerous poison for the poor & middle-class. Classes which, lest you forget, represent almost all of us. Move further Left or witness our death by a thousand cuts, end the mirage of 'compromise', and be honest what our leadership as become.
There are only three, albeit related, reasons we do not have single-payer in this country. 1.) Corporate Interests. 2.) Politicians dependent on #1. 3.) A largely, and it gives me no pleasure to say this, ignorant populace.
Economics, Demography, and History all dictate, quite clearly, single-payer is the only path forward. Single-payer is not only more humane and therefore more 'Christian like' - satisfying the needs of the false (and true) Christian voters. It is also more efficient and results in cost savings, all viable data suggests, by at least 2x-3x what we now face (with or without the ACA). And, it also results in better outcomes through a preventive model of care.
There is something for everyone to ideologically support. But, there is nothing that corporations will support when it comes to their chosen business model - profiting off of the pain and suffering of humans.
3
My god, the Bernie Bros rise from the dead! And they ALL missed Krugman’s point. To illustrate: I have excellent, low-cost coverage through my employer, a non-profit that values providing employees with this benefit. I am also a four-time cancer survivor and an amputee who needs expensive prosthetic care. And you want to blow up the system and hope for the best? Adding a public option and instituting some price controls is an important step toward single payer without asking the 80% who are relatively happy with their employer provide insurance (and who vote, by the way) to give it up and pray. Because, guess what?: “nobody knew healthcare could be so complicated….”
1
One of Krugman's more flippant comments: [Taking 156 million people off of there current, relatively good coverage and forcing them to pay for government mandated insurance] 'might', in fact 'be just as good . . . but it would be one heck of a hard sell'.
This really is the nub of the issue. Where is the economic analysis?
This really is the nub of the issue. Where is the economic analysis?
1
The anti health care for all Gop ---the most rw party among world democracies---sets our goal posts. Then the centrist positions of Dems seems liberal by comparison. The gop wants to destroy ACA, the public be damned. They now control 3 branches and many states.
So the Dems can look good by at least keeping insurance mandates, but with no negotiation or regulation on profits—the fatal flaw of ACA. Thus we pretend the Dems are doing us a favor when our h/c is the world’s most expensive, most exploitive, and still leaves out millions. It’s over --idealized due to Gop opposition.
Dems say ACA has flaws, let’s improve it, but are vague on the methods, lest they defy the profits of big insurance/pharma election donors. What’s taken for granted as centrist in other democracies is too left wing here, and the columnists safely avoid it..
But where are we going to go? The media, so protected by the 1st amendment from govt censorship is still pressured by conformity to our political center. That center is established around the big money values set by the corporations funding our elections---and sold as protecting our American ‘freedoms’. This plants enough doubt in the public mind, that a true opposition stays weak
So the Dems can look good by at least keeping insurance mandates, but with no negotiation or regulation on profits—the fatal flaw of ACA. Thus we pretend the Dems are doing us a favor when our h/c is the world’s most expensive, most exploitive, and still leaves out millions. It’s over --idealized due to Gop opposition.
Dems say ACA has flaws, let’s improve it, but are vague on the methods, lest they defy the profits of big insurance/pharma election donors. What’s taken for granted as centrist in other democracies is too left wing here, and the columnists safely avoid it..
But where are we going to go? The media, so protected by the 1st amendment from govt censorship is still pressured by conformity to our political center. That center is established around the big money values set by the corporations funding our elections---and sold as protecting our American ‘freedoms’. This plants enough doubt in the public mind, that a true opposition stays weak
2
Krugman is right. Fix or tweak the ACA and sure up Medicare and Medicaid first. Then forget about health care. Employer based health care works well for those that have it. It will continue to work until it doesn't (especially if a republican congress succeeds to tax those benefits) and then the general population will be more inclined to consider a single payer system.
There are other battles just as important as health care to fight that will benefit working class families. Incremental victories will build a long term coalition.
There are other battles just as important as health care to fight that will benefit working class families. Incremental victories will build a long term coalition.
http://www.oecd.org/health/health-systems/oecd-health-statistics-2014-fr...
November, 2016
Organisation for Economic Co-operation and Development Health Data
Total health care spending per person, 2015 *
United States ( 9451)
OCED average ( 3814)
United Kingdom ( 4003)
Australia ( 4420)
November, 2016
Organisation for Economic Co-operation and Development Health Data
Total health care spending per person, 2015 *
United States ( 9451)
OCED average ( 3814)
United Kingdom ( 4003)
Australia ( 4420)
1
Just to address Paul Krugman's question, I think better support for child welfare is a great issue and one that needs addressing. I'm not sure that this is its time. Issues relating to taxes, wages, and jobs may be more important in the next two general elections. Although child welfare has implications in all of these areas, as it also does in healthcare.
I basically agree with Prof. Krugman's analysis, but would add this; maybe we should begin to push the Medicare eligibility age down to, say 60. It wouldn't have to be done all at once, it could be phased in over several years. If that worked out well, then look at extending the eligibility age down further in the future. I know a lot of 60-64 year olds that are in "job lock" for the medical insurance and would look at a career change or even retiring if they could obtain affordable health care.
2
This is the point of view which lost the 2016 election.
4
As I read the responses to Dr. Krugman from various Democratic Party and Progressive factions I can't help but be reminded of Will Rodger's description of his personal politics; "I belong to no organized political party...I'm a Democrat". If we want to move forward, we better start moving forward together or the United States as we know it will become a giant North American theocracy/kleptocracy the likes of which the world has never seen.
The politics of this country are NOT ones of governing coalitions but simply winners and losers. If the other party is able to get organized, vote as a discipline whole and do that from School Boards to the Presidency they will win. Look to Maine for the best example. 2 Liberal/Progressive candidates effectively gave the governorship to LePage who, like Brownback in Kansas, is an utter disaster for that state. Democrats could learn from this, they really could.
The politics of this country are NOT ones of governing coalitions but simply winners and losers. If the other party is able to get organized, vote as a discipline whole and do that from School Boards to the Presidency they will win. Look to Maine for the best example. 2 Liberal/Progressive candidates effectively gave the governorship to LePage who, like Brownback in Kansas, is an utter disaster for that state. Democrats could learn from this, they really could.
1
Strengthening O-care is obviously crucial, and we need to push hard to ensure it's done right. But I think it's going to happen anyway now that reality has beaten the GOP down to the point where they're actually thinking about the common welfare.
I would advocate instead that progressives push for a "Trump policy" (which was as much a Clinton policy, if I remember correctly): an infrastructure- renewal program. If he's still around, hold DT's feet to the fire to actually accomplish the one positive promise he made, get more people into good-paying work, and fix this country's crumbling roads, bridges, airports, etc.--many of which are "dumps," to use the corrupt argot of the day.
I travel quite a bit, and in many areas this country's skeleton is falling apart. I also see reminders everywhere of the Roosevelt-era CCC and all the fantastic work they did. We can do it again, it's well past time, and everyone's lives would be better for it.
I would advocate instead that progressives push for a "Trump policy" (which was as much a Clinton policy, if I remember correctly): an infrastructure- renewal program. If he's still around, hold DT's feet to the fire to actually accomplish the one positive promise he made, get more people into good-paying work, and fix this country's crumbling roads, bridges, airports, etc.--many of which are "dumps," to use the corrupt argot of the day.
I travel quite a bit, and in many areas this country's skeleton is falling apart. I also see reminders everywhere of the Roosevelt-era CCC and all the fantastic work they did. We can do it again, it's well past time, and everyone's lives would be better for it.
1
I think Paul's argument fails because he is making a false equivalence between the ACA and the Dutch system. The difference is that the Dutch system is not a market based system, rather the insurers function more as government contractors under a strictly controlled state system. It's more as if the UK's NHS contracted out its insurance handling work, while still setting the terms of business.
The ACA by contrast yields control to the marketplace with some government regulations added into the mix, i.e coverage of pre-existing conditions.
In the Netherlands, companies can't pull out of marketplaces and force the government's hand, insurance rates are set by the government, the overall costs of care are controlled, drug prices are negotiated by the government, etc etc etc.... it's an environment that is centrally controlled, just as the NHS, but with minor administrative differences.
So I don't think his policy suggestion is tenable unless the nature of the ACA is radically changed. This requires taking control away from the marketplace.... which is exactly the same problem in moving towards a single payer system.... so why not implement the simpler solution: single payer? Do it with a phased transition into Medicare, based on each citizen's social security number. And every citizen contributes to it via taxes (we should also reduce our military and fund health instead). Wealthy folks will pay the medicare tax but could also purchase private insurance if they want.
The ACA by contrast yields control to the marketplace with some government regulations added into the mix, i.e coverage of pre-existing conditions.
In the Netherlands, companies can't pull out of marketplaces and force the government's hand, insurance rates are set by the government, the overall costs of care are controlled, drug prices are negotiated by the government, etc etc etc.... it's an environment that is centrally controlled, just as the NHS, but with minor administrative differences.
So I don't think his policy suggestion is tenable unless the nature of the ACA is radically changed. This requires taking control away from the marketplace.... which is exactly the same problem in moving towards a single payer system.... so why not implement the simpler solution: single payer? Do it with a phased transition into Medicare, based on each citizen's social security number. And every citizen contributes to it via taxes (we should also reduce our military and fund health instead). Wealthy folks will pay the medicare tax but could also purchase private insurance if they want.
3
“single-payer; it’s what I’d support if we were starting fresh. But we aren’t”
Neither were all the other industrialized countries when they replaced what they had before with some version of single payer. Where’s that good old American can-do spirit? We don’t quit just because we see challenges ahead, especially when we also see how so many others have overcome similar challenges, giving us models of how to do it. Or do we cave when the going gets tough?
Krugman is right that we’re already within shooting distance of achieving universal coverage. Once there, or as part of the final push to get there, the inevitable pressure will be to confront the incredible and accelerating cost inefficiency of our health care delivery quagmire, streamlining, consolidating, seeking economies of scale, reducing fee-for-service paperwork, reducing unnecessary (defensive medicine) diagnostics, etc.: in short, single payer.
Now, during our time in the wilderness, is when we Dems should work on developing a viable plan for phasing in single payer. It will be our ticket back to the corridors of power.
Neither were all the other industrialized countries when they replaced what they had before with some version of single payer. Where’s that good old American can-do spirit? We don’t quit just because we see challenges ahead, especially when we also see how so many others have overcome similar challenges, giving us models of how to do it. Or do we cave when the going gets tough?
Krugman is right that we’re already within shooting distance of achieving universal coverage. Once there, or as part of the final push to get there, the inevitable pressure will be to confront the incredible and accelerating cost inefficiency of our health care delivery quagmire, streamlining, consolidating, seeking economies of scale, reducing fee-for-service paperwork, reducing unnecessary (defensive medicine) diagnostics, etc.: in short, single payer.
Now, during our time in the wilderness, is when we Dems should work on developing a viable plan for phasing in single payer. It will be our ticket back to the corridors of power.
3
Dream on... most Americans would not tolerate the levels of taxation required for this to work. It's a ticket for Democrats staying out of power.
If you think that Americans would tolerate the level of taxation that most Europeans live under, you need to get out of your echo chamber.
If you think that Americans would tolerate the level of taxation that most Europeans live under, you need to get out of your echo chamber.
1
"Other countries provide new parents with extensive paid leave, provide high-quality, subsidized day care for children with working parents and make pre-K available to everyone or almost everyone..."
Worse, the myth-based politics of righteousness attacks Planned Parenthood and abortion rights--apparently obeying the Biblical commandment to "be fruitful and multiply; " as well as sanctioning a disregard for bio-diversity and QUALITY of life in general.
As though multiplication alone is the goal--regardless of the harm done to unwanted children or their parents--especially mothers bearing the main burden of multiplication. As though the politicians are mandating a drone class to be serfs to the monied.
But even wealthy parents cannot be trusted to properly educate their children.
And worse the myth-based righteous would replace public education--SINGLE PAYER--with god story indoctrination.
Worse, the myth-based politics of righteousness attacks Planned Parenthood and abortion rights--apparently obeying the Biblical commandment to "be fruitful and multiply; " as well as sanctioning a disregard for bio-diversity and QUALITY of life in general.
As though multiplication alone is the goal--regardless of the harm done to unwanted children or their parents--especially mothers bearing the main burden of multiplication. As though the politicians are mandating a drone class to be serfs to the monied.
But even wealthy parents cannot be trusted to properly educate their children.
And worse the myth-based righteous would replace public education--SINGLE PAYER--with god story indoctrination.
The problem with you preferred plan is that the profit incentive in the private market for health care carry forward and the admin cost still break the bank.
4
Good article. There are a lot of different models/examples of health care in developed countries and everyone reading this piece should get familiar with them. Don't just dish those you may not favor. Make a short list of your ideal system...it can be as simple as maximizing health care and minimizing costs, or as detailed as you want but ask what is most important and put that at the top of your list. Examine the data from different examples; develop your opinions; discuss with others. It is not easy being a citizen, but it is important.
3
In my opinion, the best option for the next phase of a progressive agenda is to focus on improving the economy. This means things such as, for examples, minimizing college tuition and forgiving some amount of college debts, enacting immigration reform to allow sufficient immigration into various sectors of the economy, infrastructure spending increases, tax reductions on corporations and middle class individuals., finding ways to increase the supply of health care services so that prices are stabilized or even reduced, supporting ways to reduce the cost of housing in very expensive areas of the country.
1
I just want a doctor who will look at me as a human being, take care of my whole body, touch me when necessary to figure out the problem then refer me to a specialist who she/he works with if necessary, suggest "natural" remedies and only prescribe medicine when truly needed.
Are there any doctors like that left in the Seattle/Tacoma area?
Are there any doctors like that left in the Seattle/Tacoma area?
3
Really it doesn't matter what is proposed in the public interest, the vilification machine will distort it beyond all recognition. I mean, look at the assault on science, and the thesis that global warming is Chinese propaganda. One would have to mount the equivalent of a presidential campaign. The Democrats are only in the early stages of recognizing what is required to do effective policy in the face of the attacks. The ACA barely squeaked through when the Dems controlled all three branches.
If you look at the stunningly weird NRA facebook ads (what are they so riled up about? The repubs control both houses and gun control isn't on any realistic agenda) you'll see that there is a broad issue of deterioration of democratic norms. I'm not sure the U.S. political system can handle major initiatives of any kind at this point.
If you look at the stunningly weird NRA facebook ads (what are they so riled up about? The repubs control both houses and gun control isn't on any realistic agenda) you'll see that there is a broad issue of deterioration of democratic norms. I'm not sure the U.S. political system can handle major initiatives of any kind at this point.
2
I have to respectfully disagree with Dr. Krugman. The ACA is still in a precarious position. The Republicans are just laying low waiting for the protesters to take a relaxed breath and then they will pounce again.
Energy and resources are mobilized. We need to keep them mobilized and add in the other issues. This what Dems do, think they have won when they haven't and the Republicans just keep at it.
This fight needs to go to the state level and add in a opt in to Medicare at 55. Corporate America starts pushing people out at 55 who then are stuck trying to stay in industry that doesn't want them as direct hires. You can get hired as a contractor with no benefits.
This would also help with parts of the country not served by insurance companies.
Dr. Krugman seems to have a blind spot when it comes to the ACA as many have noted. This option shows some incremental acknowledgement of that, but not enough.
Energy and resources are mobilized. We need to keep them mobilized and add in the other issues. This what Dems do, think they have won when they haven't and the Republicans just keep at it.
This fight needs to go to the state level and add in a opt in to Medicare at 55. Corporate America starts pushing people out at 55 who then are stuck trying to stay in industry that doesn't want them as direct hires. You can get hired as a contractor with no benefits.
This would also help with parts of the country not served by insurance companies.
Dr. Krugman seems to have a blind spot when it comes to the ACA as many have noted. This option shows some incremental acknowledgement of that, but not enough.
4
While long a fan of what i understand to be Single Payer Krugman persuades me
of the wisdom of enhanced Obama care. Partly because i am completely philo Dutch having gotten a PhD there over fifty years ago, having a daughter and two grand kids there an having lived in Amsterdam during all of 2008.
My and my family's experience with Dutch medicine leaves us satisfied and grateful. Yes,it is much cheaper than here in "the greatest country in the history of the world,"
of the wisdom of enhanced Obama care. Partly because i am completely philo Dutch having gotten a PhD there over fifty years ago, having a daughter and two grand kids there an having lived in Amsterdam during all of 2008.
My and my family's experience with Dutch medicine leaves us satisfied and grateful. Yes,it is much cheaper than here in "the greatest country in the history of the world,"
2
The ACA is an example of incrementalism. One step at a time. Single payer would represent a leap...and making that leap isn't practical or possible. Not now. But, repairing the ACA and filling in the gaps is the right course and in keeping with an incremental approach. How to pay for those "gaps"? Taxing the healthcare benefits of those who get healthcare through their employers. That's right. Tax that benefit just like regular income. It would raise billions of dollars...hundreds of billions. Then that revenue stream can be used to shore upo the ACA make it function as seamlessly as it was envisioned in 2009....and take another step.
What if Congress passed legislation that created a Medicare for All option and let the states decide if they want to play. Sort of like what happened with ACA insurance and Medicaid? Some states opted in so they could receive fed dollars and some didn't.
Would that work?
Would that work?
2
How much did the last two wars cost? How much also goes to the Pentagon every year? How much do insurance companies and drug companies profit in the US? All that money is not treating anyone's health in any practical way. Its pure common sense to get our priorities in order. In my 57 years in the USA I have seen more death, poverty, and poor health implemented openly by our our government and many corporations. Lately we have seen Senators try to harm more innocent people again in plain public view! When did we become a country that seems to enjoy hurting our fellow citizens more than helping them? It's outrageous.
6
Mr. Krugman,
As long as we treat healthcare as a consumer good, rather than a civil right in the most prosperous nation in human history, we are doomed to millions of preventable deaths as a result of lack of insurance and healthcare justice.
This was the fatal flaw of the ACA, a Republican plan created by the Heritage Foundation and pushed by centrist democrats as a compromise that ended up being a gift to the insurance industry in the form of massive subsidies. People should't have to shop for health insurance like they shop for a new pair of shoes. Healthcare shouldn't be a market, and anyone who thinks it should be is either morally lost, in the thrall of big money or both.
I used to think you really were a progressive Dr. Krugman. As you've shown over the past year, it seems that I was sadly mistaken. Your compromise-centric approach here is exactly the type of thinking that has kept millions of impoverished Americans to remain uninsured and continued to enrich those at the top of the healthcare industry pyramid.
As long as we treat healthcare as a consumer good, rather than a civil right in the most prosperous nation in human history, we are doomed to millions of preventable deaths as a result of lack of insurance and healthcare justice.
This was the fatal flaw of the ACA, a Republican plan created by the Heritage Foundation and pushed by centrist democrats as a compromise that ended up being a gift to the insurance industry in the form of massive subsidies. People should't have to shop for health insurance like they shop for a new pair of shoes. Healthcare shouldn't be a market, and anyone who thinks it should be is either morally lost, in the thrall of big money or both.
I used to think you really were a progressive Dr. Krugman. As you've shown over the past year, it seems that I was sadly mistaken. Your compromise-centric approach here is exactly the type of thinking that has kept millions of impoverished Americans to remain uninsured and continued to enrich those at the top of the healthcare industry pyramid.
4
America cannot compete when 20% of our economy is twice as expensive as other countries who provide healthcare for all. Eventually, we lose jobs or we deal with this expense. In the short term, provide a public option. This is sorely needed in Red States that did not take the Medicare Expansion and whose citizens are paying outrageous rates. Expand the public option while putting in steps to reduce expenses, like negotiating drug prices. Allow companies to buy into the public option for their employees, which will gradually reduce the number on private insurance and will bring down costs. At some point, flipping to some kind of non-profit, single payer system will be possible because a large number of people will already be on it. This will reign in drug costs and reduce the outlandish executive salaries we see in healthcare. Yes, we need to phase this in, and yes, it should be the goal. It's that, or we watch our trade deficit grow because we can't compete on cost with other industrialized nations who have figured out how to provide healthcare for everyone at a lower price.
7
You are probably the most intelligent person writing on these subjects today. So why do you continue to use the "safety net" metaphor? Safety nets are for people who take unnecessary risks, like trapeze artists and tightrope walkers. It tacitly endorses the notion that people who need it probably don't deserve it because they made bad choices. Why can't we insist on a "floor" for everyone to stand on rather than a "safety net" to fall into? We don't have to impose a ceiling -- people can get as rich as they want -- but none of our fellow citizens should live beneath a standard of decent housing, health, food, clothing, and education. Metaphors matter. This one tilts the argument for those who claim recipients don't deserve help. You can change the conversation.
5
How about.............The Democrats will announce a new set of programs to stop the regression backwards of American society by the Republicans to assure real progress.
1
Somehow, sometime - hopefully soon, the power of the people has to trump the power of money. Has to. I often contact my representatives with this message and then get a form letter back. If you go to their websites and fill out the on-line form to address money corruption, its not even on the drop down list of topics. They're just not that interested in fixing this. $o, $trange.
1
I agree.
Republicans, for all intents and purposes, just lost the healthcare debate because people are not buying what they are selling.
Now it's time to start the family values debate. We treat families like garbage in this country. I would propose alot more than child care. What about the insanity of secondary school funding where the schools that need the most money have the least and vice versa? What about the insanity of of our higher education system, where bankruptcy is the only path to an education for many people? Where's the equality of opportunity in any of this? Let the Republicans explain how denying education, childcare, etc. to families is "family values." And focus like a laser beam on poor and middle class white people. There are alot of them, especially now, and what they need is pretty similar to what other poor/middle class people need. Why? Because I think that minorities are alot more likely to identify with the struggles of white people who are in the same boat than the converse. They've been trained to do this by our white-dominated media since birth.
Health care change is really really hard, and if you only focus on that, pretty soon you're the party of health care and not much else.
Republicans, for all intents and purposes, just lost the healthcare debate because people are not buying what they are selling.
Now it's time to start the family values debate. We treat families like garbage in this country. I would propose alot more than child care. What about the insanity of secondary school funding where the schools that need the most money have the least and vice versa? What about the insanity of of our higher education system, where bankruptcy is the only path to an education for many people? Where's the equality of opportunity in any of this? Let the Republicans explain how denying education, childcare, etc. to families is "family values." And focus like a laser beam on poor and middle class white people. There are alot of them, especially now, and what they need is pretty similar to what other poor/middle class people need. Why? Because I think that minorities are alot more likely to identify with the struggles of white people who are in the same boat than the converse. They've been trained to do this by our white-dominated media since birth.
Health care change is really really hard, and if you only focus on that, pretty soon you're the party of health care and not much else.
2
If we pay a mandatory Social Security Tax to insure the unavoidable - getting old and retired. Why shouldn't we pay a mandatory Medical Insurance to insure the unavoidable - getting old and getting sick?
4
Just because something is politically "hard" doesn't make it not worthwhile. Sure, immediately reinforce ACA with reinsurance and public option then facilitate states obtaining Medicare waivers to implement single payer. California can implement single payer, show that it works and undercut decades of fear-mongering.
2
Totally agree. Achieving Medicare was hard — and took 2 decades to overcome hysterical AMA lobbying.
Most physicians have now exited the AMA, and most support enacting a single-payer system — which would allow them to spend more time with patients, cut their expenses dramatically (fewer office staff, much lower malpractice premiums). American physicians, compared to doctors elsewhere, are among the least satisfied — why? because of all the paperwork and having private health insurers get between them and patients.
So those of us who REALLY want single-payer should get behind it at the state level (where 23+ states have bills in process) as well as supporting national legislation.
If you're in CA ... check out Healthy California Act (http://www.healthycaliforniaact.org/home/).
If you're in NY ... check out www.NYHCampaign.org/
And don't believe the hysterical voices that scream about vast increases in taxes or destroying our healthcare system. Taxes already pay for 60% of our healthcare dollars. Administrative complexity caused by private health insurance (and their profits and advertising and executive compensation packages of $100 million plus/year) add 30% to total costs ... not to mention that Americans pay 40% for drugs than our own VA and other countries (b/c volume discount savings go to insurance companies, not patients ... see today's NYT)
Most physicians have now exited the AMA, and most support enacting a single-payer system — which would allow them to spend more time with patients, cut their expenses dramatically (fewer office staff, much lower malpractice premiums). American physicians, compared to doctors elsewhere, are among the least satisfied — why? because of all the paperwork and having private health insurers get between them and patients.
So those of us who REALLY want single-payer should get behind it at the state level (where 23+ states have bills in process) as well as supporting national legislation.
If you're in CA ... check out Healthy California Act (http://www.healthycaliforniaact.org/home/).
If you're in NY ... check out www.NYHCampaign.org/
And don't believe the hysterical voices that scream about vast increases in taxes or destroying our healthcare system. Taxes already pay for 60% of our healthcare dollars. Administrative complexity caused by private health insurance (and their profits and advertising and executive compensation packages of $100 million plus/year) add 30% to total costs ... not to mention that Americans pay 40% for drugs than our own VA and other countries (b/c volume discount savings go to insurance companies, not patients ... see today's NYT)
Yes. yes. yes! Finally a really thoughtful & specific answer to Bernie's latest Don Quixote quest. Thank you!
1
Nancy, you need to read through the details of the New York Health Act that has passed the Assembly 4 times (including 2017, 2016, 2015) and has been stalled in the Senate by the IDC and special interests.
www.NYHcampaign.org.
Most physicians (generalists and specialists), nurses, unions ... it's not just Bernie Bros. And it's not a partisan issue — special interests spend lots of money on both parties, trying to keep politicians from acting in constituent (and, YES, taxpayer interests ... this bill will save New Yorkers money!) The League of Women Voters, a non-partisan group if ever this was one, is fully behind this bill.
If you don't know much about it — find out and then contact your NY Senator.
www.NYHcampaign.org.
Most physicians (generalists and specialists), nurses, unions ... it's not just Bernie Bros. And it's not a partisan issue — special interests spend lots of money on both parties, trying to keep politicians from acting in constituent (and, YES, taxpayer interests ... this bill will save New Yorkers money!) The League of Women Voters, a non-partisan group if ever this was one, is fully behind this bill.
If you don't know much about it — find out and then contact your NY Senator.
What I would do is follow Warren Buffett's lead and implement "big-time" increases in the Earned Income Tax Credit. That would relieve those over-stressed parents of the need to work two jobs. They could spend more time with their children.
Citizens of the Netherlands can afford to pay private health insurance premiums because their system provides them all with a secure retirement. According to the OECD, the Net Pension Replacement Rate (which measures the percentage of pre-retirement earnings a nation's pension system provides) in the Netherlands is 95% -- compared to a paltry 45% in the United States. Obamacare was a body blow to middle-class Americans over 50 -- many of whom have only recently come to grips with how badly they've been had by the switch from defined-benefit pension plans to 401(k)s -- and who are required to pay triple the premiums paid by younger Americans or (if that's not possible) a hefty fine.
The UK's net pension replacement rate -- at 29% -- is even worse than America's. Could that explain why they better understand the need to maintain a system that provides health-care-for-all? And when will America "get it"?
The UK's net pension replacement rate -- at 29% -- is even worse than America's. Could that explain why they better understand the need to maintain a system that provides health-care-for-all? And when will America "get it"?
2
Although this column deals essentially with healthcare, the title says what's next for "Progressives?"
For the content, what Prof Krugman says is quite accurate. For the title, however, I would say a lot to be said. Progressives need to discuss among themselves to find the best way to proceed. In the last election season, Bernie Sanders had a profound impact on the electorate, especially youngsters who often tend to be more idealistic without many hangups. Other progressive-minded people, I think ought to accept as much of Sander's idealism as possible.
I would add, Democrats ought to stop coddling black leaders the like of Al Sharpton who aren't helping blacks who really need help namely the inner-city blacks. Prominent blacks on TV are more concerned about black pride than the genuine problems of blacks, which are youth unemployment & black-on-black violence, murders.
Pre-school and public school education ought to be stressed. I would also say inner-city beatification by re-buidling dilapidated city buildings, which should employ local black youths with better than minimum wage, at least $12/hour. This would attract the youths to engage in work & away from petty crimes. It's unmentioned in the ordinary conversation that black youths lack work ethic, which is an unfortunate reality.
Greater police presence is necessary to reduce black-on-black violence. Too many carry guns. Those guns should be confiscated, by all feasible means.
For the content, what Prof Krugman says is quite accurate. For the title, however, I would say a lot to be said. Progressives need to discuss among themselves to find the best way to proceed. In the last election season, Bernie Sanders had a profound impact on the electorate, especially youngsters who often tend to be more idealistic without many hangups. Other progressive-minded people, I think ought to accept as much of Sander's idealism as possible.
I would add, Democrats ought to stop coddling black leaders the like of Al Sharpton who aren't helping blacks who really need help namely the inner-city blacks. Prominent blacks on TV are more concerned about black pride than the genuine problems of blacks, which are youth unemployment & black-on-black violence, murders.
Pre-school and public school education ought to be stressed. I would also say inner-city beatification by re-buidling dilapidated city buildings, which should employ local black youths with better than minimum wage, at least $12/hour. This would attract the youths to engage in work & away from petty crimes. It's unmentioned in the ordinary conversation that black youths lack work ethic, which is an unfortunate reality.
Greater police presence is necessary to reduce black-on-black violence. Too many carry guns. Those guns should be confiscated, by all feasible means.
Our Dutch system isn't that perfect Paul,
a large group of poor people can't afford 'the contribution' although it's obligatorily; so those people don't have a insurance.
a large group of poor people can't afford 'the contribution' although it's obligatorily; so those people don't have a insurance.
2
Are the Dutch insurance companies allowed to legally bribe the politicians that oversee them?
4
Wow, I'm so used to Krugman sounding like the Hannity of the Left that I sometimes forget he's actually a very smart guy... with a Nobel Prize no less!
1
Psul Krugman, Spare us your tired old lectures from your academic tower and comfortable position writing OPINIONS at the NYTimes. Please take a road trip through the rust belt of the upper midwest, the Latino ruffle along our southern border, largely empty stretches of the West? Eat off the Interstates, along old highways rolling through Kentucky and West Virginia.Visit some fracking sites. Attend political meetings in Missouri and Arkansas where impotent Democrats are trying to find their message. The truth is that the tired old left-right, liberal-progressive-moderate-conservative-Trumpsters (far right demogogues) spectrum is outdated and irrelevant. It doesn't account for the fact that many countries prosper with vastly different governments. And some countries fail with good democracies.
Countries which believe in and teach fact-based science (dealing realistically with the world on a factual basis) do much better than countries which are super religious (Saudi Arabia, Turkey (now), India). The United States has become a country which rejects science. In the last 40 years, our research, patents, and innovative industries and manufacturing, increasingly lag behind the rest of the world (Google Neil de GrasseTyson on this topic). Stop and talk to real folks as you travel through the interior of our grand geography. Our deeply religious, anti-intellectual, anti-education, faith-based government destroys our future. Right/left has nothing to do with it. Get relevant.
Countries which believe in and teach fact-based science (dealing realistically with the world on a factual basis) do much better than countries which are super religious (Saudi Arabia, Turkey (now), India). The United States has become a country which rejects science. In the last 40 years, our research, patents, and innovative industries and manufacturing, increasingly lag behind the rest of the world (Google Neil de GrasseTyson on this topic). Stop and talk to real folks as you travel through the interior of our grand geography. Our deeply religious, anti-intellectual, anti-education, faith-based government destroys our future. Right/left has nothing to do with it. Get relevant.
2
Prof. Krugman,
You have to stop using the metric "percentage of people with insurance", as if that's the only thing that mattered. A large number of people with ACA plans have such high deductibles and out of pocket costs that it can barely be called insurance.
Second, your comparison of the ACA with the Dutch system is dubious. I seriously doubt the Dutch allow the inferior pseudo-insurance permitted by the ACA. I'd like to see an objective comparison. There are also questions about the cost-effectiveness of the Dutch system, especially in comparison with single-payer systems.
Third, I disagree with this notion of "political capital", as if demanding our rights in one area somehow takes away our ability to demand them in another. The opposite might be true, and a victory on the single-payer front might encourage more people to get involved in the political sphere in a positive way and demand progress on other fronts.
Finally, what is the meaning of "disruption"? Among many other advantages, single-payer would mean one's heath insurance is not tied to a job. People could quit or change jobs, without ever having to worry about real disruption to their healthcare! If that is your definition of disruption, I welcome it.
You have to stop using the metric "percentage of people with insurance", as if that's the only thing that mattered. A large number of people with ACA plans have such high deductibles and out of pocket costs that it can barely be called insurance.
Second, your comparison of the ACA with the Dutch system is dubious. I seriously doubt the Dutch allow the inferior pseudo-insurance permitted by the ACA. I'd like to see an objective comparison. There are also questions about the cost-effectiveness of the Dutch system, especially in comparison with single-payer systems.
Third, I disagree with this notion of "political capital", as if demanding our rights in one area somehow takes away our ability to demand them in another. The opposite might be true, and a victory on the single-payer front might encourage more people to get involved in the political sphere in a positive way and demand progress on other fronts.
Finally, what is the meaning of "disruption"? Among many other advantages, single-payer would mean one's heath insurance is not tied to a job. People could quit or change jobs, without ever having to worry about real disruption to their healthcare! If that is your definition of disruption, I welcome it.
5
The Democrats timid approach to what is "possible" gave us Hillary, who inspired few people. This timidity continues to drive the party to the right. I find it ironic that while Trump continues to campaign against Hillary, Krugman continues to campaign against Sanders.
4
I can't find the link right now but there was an excellent article in either Bloomberg News or Reuters about many economists who are taking a new look at their economic "models". Many now realize that their top-down ideas have been VERY destructive to the middle class and poor in America and around the world.
Economists can only be taken seriously and be viable if their models include "Social Responsibility" and help strengthen every aspect of society. Otherwise they are just enablers for the rich and powerful. The models they have been using are outdated and threaten to return us to the 5th/15th centuries if not changed.
Today is a great day to get started with a serious new model, ladies and gentlemen in the economics field.
Economists can only be taken seriously and be viable if their models include "Social Responsibility" and help strengthen every aspect of society. Otherwise they are just enablers for the rich and powerful. The models they have been using are outdated and threaten to return us to the 5th/15th centuries if not changed.
Today is a great day to get started with a serious new model, ladies and gentlemen in the economics field.
2
I agree. Improving the ACA would be easier and less disruptive. The key message here is that it is working well in "states that support it". A public option would enhance it.
1
The current system doesn't offer a lot of older folks subsidies. Perhaps fixing them will help, but propping up profits of health insurers isn't a solution and it won't help lower costs.
2
Debating whether there needs to be a progressive "litmus" test on healthcare, or what is the best policy to pursue once Democrats are back in power, is highly premature.
Republicans have the WH, majorities in both chambers of Congress, and a vast majority of the governorships and state legislatures throughout the country.
So standing for "universal coverage" is enough to signal where Democrats stand. At least until the Democrats unify and win back some real political power. After that we can debate, compromise and move forward on the details of that policy principle.
Republicans have the WH, majorities in both chambers of Congress, and a vast majority of the governorships and state legislatures throughout the country.
So standing for "universal coverage" is enough to signal where Democrats stand. At least until the Democrats unify and win back some real political power. After that we can debate, compromise and move forward on the details of that policy principle.
1
The key to making "individuals are required to buy coverage from regulated private insurers, with subsidies to help them afford the premiums" work is "regulated private insures." I suspect that the reason this works in the Netherlands is that they are better able to keep the money out of their politics than we are able to keep it out of ours. This is where the focus has to be if we are to be able to make the ACA work.
3
Krugman's argument makes perfect sense. Let's take what's good enough for now and concentrate on fixing the abominable state of support for children and working parents.
Interview: Dennis Kucinich on why single payer is inevitable
https://www.counterpunch.org/2017/08/07/interview-dennis-kucinich-on-why...
https://www.counterpunch.org/2017/08/07/interview-dennis-kucinich-on-why...
Single payer has another serious problem: he who pays the piper calls the tune. Right now -- NOW -- "traditional" fee-for-service Medicare has become an HMO/managed care plan. Medicare routinely denies all sorts of very routine vanilla tests and services that would be covered under many if not most private plans. In addition, Medigap insurers are forbidden from back-filling those costs. While "appeals" exist, there is in general no way for a patient to find out exactly why a claim was denied, nor to find out in advance whether it will be permitted.
Moving to a centralized system of payments for a country the size of the US means that there will be no way for patients or providers to access decision-makers, who will be driven by top-down authority enforced entirely by computer programs designed simply to reduce costs.
Moving to a centralized system of payments for a country the size of the US means that there will be no way for patients or providers to access decision-makers, who will be driven by top-down authority enforced entirely by computer programs designed simply to reduce costs.
While Paul Krugman usually starts with a factual claim before building his case, this time he misses the mark when describing the position of progressives, and of Bernie Sanders in particular. Bernie ultimately supports a single payer system, but given the current political reality- which Krugman states guides his hesitation re single payer- Bernie is pushing for a public option and lowering the Medicare age to 55.
Single payer is a long range goal for Bernie, which will only come about with future political changes and public demand. But he puts forward a goal for the future of this country. People need a vision for the future, which single payer gives us, while fighting the current battle to save the ACA, patch up its current weaknesses, and expand its range.
And just in terms of current politics, Americans are yearning for major changes. That led to the amazing support Bernie got, coming from nowhere, and which Trump got. Hillary offered some decent programmatic changes- certainly much better for the country than Trump or his other Republican competitors- but nothing to aspire to. Or if she offered the latter, it never came across. Progressives- and Trump- offered something beyond the same old same old (though Trump's was all flimflam and appeals to bigotry and scapegoating). Neither mainstream Republicans nor Democrats gave that to people yearning for a new direction.
Single payer is a long range goal for Bernie, which will only come about with future political changes and public demand. But he puts forward a goal for the future of this country. People need a vision for the future, which single payer gives us, while fighting the current battle to save the ACA, patch up its current weaknesses, and expand its range.
And just in terms of current politics, Americans are yearning for major changes. That led to the amazing support Bernie got, coming from nowhere, and which Trump got. Hillary offered some decent programmatic changes- certainly much better for the country than Trump or his other Republican competitors- but nothing to aspire to. Or if she offered the latter, it never came across. Progressives- and Trump- offered something beyond the same old same old (though Trump's was all flimflam and appeals to bigotry and scapegoating). Neither mainstream Republicans nor Democrats gave that to people yearning for a new direction.
4
The Dutch system has much to recommend it. For conservatives, one great merit is that all of the insurances providers are private companies. A USA Dutch-type system would require, however, a national healthcare commissioner to set standards and prices. Or, perhaps, in the case of the U.S., six or seven regional commissioners. The American state insurance commissioners would be the resisters. They like their satrapies, and insurance companies like the nifty cutouts they can get away with, state by state.
From 2006 thru 2010, I worked with lots of Europeans on a variety of insurance issues.My Dutch colleagues never had any gripes about their healthcare.
From 2006 thru 2010, I worked with lots of Europeans on a variety of insurance issues.My Dutch colleagues never had any gripes about their healthcare.
Don't be misled by the presence of insurance companies in the Dutch system. They administer government-managed health care by performing the clerical functions of patient eleigibility and provider payments. Nothing lke the American health care insurers that restrict coverage and limit patient choice of providers.
Most Dutch people don't know and don't care how their health care is administered, whether by contractors in India or trained monkeys in Africa.
They get health care without hassle, and let the bureaucrats figure out the boring details.
Most Dutch people don't know and don't care how their health care is administered, whether by contractors in India or trained monkeys in Africa.
They get health care without hassle, and let the bureaucrats figure out the boring details.
1
What Krugman isn't saying is how awkward our entire health care system has become, especially the health insurance part of it. If we lose our jobs and can't pay the COBRA cost we're shunted onto the ACA where, in NY at least, it's a given that we will have probably made too much money to be eligible for a subsidy. The reasoning behind that is nonsense because once we're unemployed, even if we're getting unemployment, we don't have enough money coming in to justify paying for a plan that is, in some areas depending upon your age, over $350/month. At a time when we shouldn't have to lay out a ton of money, we're forced to. We're also forced to change doctors if our current physicians don't accept the plan.
While single payor may not be feasible now due to politics and selfishness (why should I support anyone else, especially since I take care of myself is the refrain from most people), there ought to be a better way to ensure continuity of care, access to that care, and bring down the costs, particularly when people are unemployed or in the midst of any other modern day disaster that affects the flow of money.
Even with the ACA access to health care is still a luxury. After reading the article in today's Times on generic drugs and what's happening with that it's obvious that having insurance means nothing. Other countries manage to get medical care to all their residents and citizens. Why can't we?
While single payor may not be feasible now due to politics and selfishness (why should I support anyone else, especially since I take care of myself is the refrain from most people), there ought to be a better way to ensure continuity of care, access to that care, and bring down the costs, particularly when people are unemployed or in the midst of any other modern day disaster that affects the flow of money.
Even with the ACA access to health care is still a luxury. After reading the article in today's Times on generic drugs and what's happening with that it's obvious that having insurance means nothing. Other countries manage to get medical care to all their residents and citizens. Why can't we?
5
There is one essential part of the ACA which Obama wanted and Leiberman killed: The public option. That is the only thing that will lower profits for the private health companies, and thus overall costs. When Kerry ran for president, he proposed a public option, with nothing else from ACA added. I think if we had to choose, it would be better to have a public option with no ACA, rather than ACA with no public option. ACA with public option would be even better.
3
I would like to hear more about the proposal to create a new progressive front on child care. Does that mean an insurance program with cash outlay? Who pays into the insurance pool -- everyone including those past child bearing age? Where does the money go - something like social security or something like general ledger? Tax credits do no good if working parents don't hold down a job to care for a child. What about caring for dependent adults who are as helpless as children? Nothing hits harder to home than a busy adult caring for an aging parent with ever increasing health problems and disability. At least children become healthier and more independent with age.
Yes, adopting Medicare For All is challenging, but it is the ONLY way to go. While the 156 million people who get insurance through their employer would be skeptical, there is no reason why they can't be offered as good, or better, coverage through Medicare. In fact, how many of those 156 million have marginal coverage with high premiums now? These people would love to have better coverage for less cost. And what about those employers who would see their expenses drastically drop, even if they had to pay a tax into the Medicare system? .
This column exposes Mr. Krugman as the false progressive that he is. Arguing to continue and expand a healthcare system based upon for-profit insurance and subsidies to Big Pharma is straight out of R-C orthodoxy - no surprise since the ACA was based upon a Heritage Foundation proposal in 1993. The ACA is a platypus of ideas, none of them done particularly well, whereas Medicare has a long, proven track record of success. Expanding Medicare to provide EVERYONE decent, comprehensive healthcare - including Part-B options to enable those who can afford better coverage to get it - makes so much sense that the only ones opposing it are those who make money off of the existing system (this includes Republicans and Dems who feed at the industry trough).
Medicare For All is a tough sell, but so was Social Security, and how many would give that up now?
This column exposes Mr. Krugman as the false progressive that he is. Arguing to continue and expand a healthcare system based upon for-profit insurance and subsidies to Big Pharma is straight out of R-C orthodoxy - no surprise since the ACA was based upon a Heritage Foundation proposal in 1993. The ACA is a platypus of ideas, none of them done particularly well, whereas Medicare has a long, proven track record of success. Expanding Medicare to provide EVERYONE decent, comprehensive healthcare - including Part-B options to enable those who can afford better coverage to get it - makes so much sense that the only ones opposing it are those who make money off of the existing system (this includes Republicans and Dems who feed at the industry trough).
Medicare For All is a tough sell, but so was Social Security, and how many would give that up now?
2
Improving ACA?
None of the incremental proposals would cover everyone.
None of the incremental proposals would remove financial barriers to care.
None of the incremental proposals would return choice of your physicians and hospitals.
None of the incremental proposals would recover the profound administrative waste in our health care financing system.
Single payer?
Everyone is covered for life.
Obtaining care does not create financial hardship.
Patients can choose their health care professionals and institutions.
The efficiency gains would be enough to pay for the gains in coverage.
We need to quit pretending that patching our fragmented, dysfunctional system is almost as good as single payer. It doesn’t come close.
None of the incremental proposals would cover everyone.
None of the incremental proposals would remove financial barriers to care.
None of the incremental proposals would return choice of your physicians and hospitals.
None of the incremental proposals would recover the profound administrative waste in our health care financing system.
Single payer?
Everyone is covered for life.
Obtaining care does not create financial hardship.
Patients can choose their health care professionals and institutions.
The efficiency gains would be enough to pay for the gains in coverage.
We need to quit pretending that patching our fragmented, dysfunctional system is almost as good as single payer. It doesn’t come close.
6
Hey, show up at the midterms or stop complaining. Where were the progressives when we needed them.
1
The article says about Bernie Sanders supporters, "Some even want to make support for single-payer a litmus test for Democratic candidates."
NO. The whole health care thing is just a smoke screen to keep us from focusing on the real problems. Right now the real problem is that The Con Don is trying to help his buddies start WW3.
A "litmus test" does not help the Democratic party or us. It just creates more dissidence. The Democratic Party simply needs to stand for "social and economic justice" for ALL citizens and they must simply protect OUR hard-won Constitutional rights.
WE THE PEOPLE must throw out the money-hungry political actors who have collectively thrown US under the bus. WE must demand the kind of America WE want to live in.
It starts with throwing OUT The Con Don and everyone who took office, and took over OUR government agencies. NOW.
Start here:
https://impeachdonaldtrumpnow.org/
NO. The whole health care thing is just a smoke screen to keep us from focusing on the real problems. Right now the real problem is that The Con Don is trying to help his buddies start WW3.
A "litmus test" does not help the Democratic party or us. It just creates more dissidence. The Democratic Party simply needs to stand for "social and economic justice" for ALL citizens and they must simply protect OUR hard-won Constitutional rights.
WE THE PEOPLE must throw out the money-hungry political actors who have collectively thrown US under the bus. WE must demand the kind of America WE want to live in.
It starts with throwing OUT The Con Don and everyone who took office, and took over OUR government agencies. NOW.
Start here:
https://impeachdonaldtrumpnow.org/
4
I would have to agree. Healthcare in America is not the ONLY issue under attack by Trump and the GOP. Progressives should adopt Mr. Krugman's approach to a slow and steady improve of the ACA maybe with the goal of single payer in the future. Hello, time to take some trips abroad and talk to the folks in Britain and Denmark to put together sound policy.
Progressives NEED to address the big issues of JOB JOBS JOBSS! That can include clean energy and revitalization of the EPA. That can include reinvigorating our Public School System and tuition free community colleges and job training/apprenticeships. Minimum wage too.
Progressives will also need to define an immigration policy. Failure to do so will be a catastrophe.
Since the Progressives and Democrats seem to be all over the place and have done little to move forward, it seems that trying to push too many policies and agendas all at once will go absolutely no where. FOCUS and a clear and simple message are what is needed. Let local candidates fudge a little depending upon their locale. We need seats filled not idealogical purity.
Progressives NEED to address the big issues of JOB JOBS JOBSS! That can include clean energy and revitalization of the EPA. That can include reinvigorating our Public School System and tuition free community colleges and job training/apprenticeships. Minimum wage too.
Progressives will also need to define an immigration policy. Failure to do so will be a catastrophe.
Since the Progressives and Democrats seem to be all over the place and have done little to move forward, it seems that trying to push too many policies and agendas all at once will go absolutely no where. FOCUS and a clear and simple message are what is needed. Let local candidates fudge a little depending upon their locale. We need seats filled not idealogical purity.
3
What I like about Mr. Krugman is that he cares. He is just not an "opinion" grinding you in to the ground. He is cultured and supports the growth of it, and in this cultureless den of inequities, this is what we need. He points a direction and we should consider it. Improve ACA and support for families. There's nothing wrong with that, unless it cuts in to corporate profits. Oh! If corporations could only come to understand that by supporting the culture, they will thrive themselves. It's not a winner takes all, or a zero sum game. It's about everyone winning, and if we focus on these two points, health care and support for chilren, then we will take many strides towards doing just that.
1
I definitely want to rid us of the parasitic health care insurance industry. Did you know that the CEO of UnitedHealth makes 250K a day? You read that right: a quarter of a million dollars a DAY!
We are being taken advantage of and it will continue until we demand change. Let the CEO of UnitedHealth and others like him do something useful instead of continuing to leech money that should rightfully go to medical care for American citizens.
We are being taken advantage of and it will continue until we demand change. Let the CEO of UnitedHealth and others like him do something useful instead of continuing to leech money that should rightfully go to medical care for American citizens.
4
NYT should, seriously, consider showing Krugman the door and re-directing his salary to investigative journalism. There are already, I think, plenty of worthwhile op-ed writers at NYT. Krugman, however, is a joke. His "analysis" is thin--recall he predicted on election night that the markets would crash and never recover.
Sure, he won a Nobel Prize in economics, but you can win prizes for all sorts of things and still lose whatever it was that made you great. Krugman, clearly, has lost it. This column shows, again, that he is little more than an apologist for Obama and mainstream Democrats. There are next to no facts to support his conclusions here--indeed, when he says that 5.4 percent of New Yorkers don't have insurance, he presents it as something good, even though it works out to more than 460,000 people. He claims, out of whole cloth, that most folks who have insurance through their employer are satisfied, even though recent polls show that 20 percent of such people struggle to pay medical bills, even though they have insurance.
Krugman appears to be living in some of alternative universe than the rest of us, and this is abundantly clear from the number of commenters here who point out that the system doesn't work for them, even though they have insurance that isn't via ACA. The health care system in the U.S. is fundamentally broken. A Nobel Prize winning economist should put forth an argument on how to fix it, not simply trumpet stuff that hasn't worked.
Sure, he won a Nobel Prize in economics, but you can win prizes for all sorts of things and still lose whatever it was that made you great. Krugman, clearly, has lost it. This column shows, again, that he is little more than an apologist for Obama and mainstream Democrats. There are next to no facts to support his conclusions here--indeed, when he says that 5.4 percent of New Yorkers don't have insurance, he presents it as something good, even though it works out to more than 460,000 people. He claims, out of whole cloth, that most folks who have insurance through their employer are satisfied, even though recent polls show that 20 percent of such people struggle to pay medical bills, even though they have insurance.
Krugman appears to be living in some of alternative universe than the rest of us, and this is abundantly clear from the number of commenters here who point out that the system doesn't work for them, even though they have insurance that isn't via ACA. The health care system in the U.S. is fundamentally broken. A Nobel Prize winning economist should put forth an argument on how to fix it, not simply trumpet stuff that hasn't worked.
3
The lesson we learned from the last election, despite Comey, the Russians, and massive voter suppression in Republican-run states is that the DNC has not a clue about how to motivate voters with charismatic leaders. Ninety million voters didn't bother going to the polls and unless the Democrats put some true leaders into the electoral competition, it doesn't almost doesn't matter what they say. Georgia is a case in point: choosing an out-of-district unknown Ossoff to run against Handel was a major error despite the huge number of small donations that were made to back the Democratic candidate. Leadership, leadership. leadership...DNC, not the same old, same old...generate some excitement with Bernie Sanders-class candidates - or just let Trump and the GOP continue to run the country.
4
Paul Krugman....stop being a mouthpiece for the corporate Democrats who refuse to reform the party and return it back to actually representing all working people rather than continuing to take big money from the health insurance and big Pharma billionaires.
Of course it's in your interest and the D Party's to write numerous articles and go on cable news shows like MSNBC and CNN to pick apart a Medicare For All system 3 years ahead of 2020. This is all by design folks...don't be fooled by it. It's all about money and their addiction to corporate funding. No different than the GOP.
Of course it's in your interest and the D Party's to write numerous articles and go on cable news shows like MSNBC and CNN to pick apart a Medicare For All system 3 years ahead of 2020. This is all by design folks...don't be fooled by it. It's all about money and their addiction to corporate funding. No different than the GOP.
8
Bullseye!
1
Seems like the last thing progressives want to hear is that they can't get what they want immediately. They get frustrated and go away mad.
Conservatives get mad too - but they persist. Progressives need to learn that lesson.
Conservatives get mad too - but they persist. Progressives need to learn that lesson.
1
What the healthcare/insurance argument between progressives and conservatives starkly showed isthat about 50 percent of the American population is extremely shortsighted, hates to share or support the community, believe it is better than others and is without compassion. In fact a successful selling point for Republicans is that real Americans don't need gov't help.
How the heck would childcare benefits be a better position for Democrats. Everyone could directly use healthcare but not everyone will need childcare. All those male voters hate subsidizing what they perceive to be women's issues.
How to bring that part of America into the the 21st century requires the more reasonable Republican party members to break with the Norquist Republicans and join the steady as she goes Democrats so that the choice is how far to push policy not whether it should be done at all.
The campaign funding process has to be made transparent and Citizens United overturned so the Koch brother types have less influence.
The Republican twisted logic they sell that Dems want to take away freedoms by imposing a secular state on Christian folks has to be untwisted and the country has to return to its Constitutional roots.
Most of all the US has to rethink the consumer index as the main economic growth metric.
How the heck would childcare benefits be a better position for Democrats. Everyone could directly use healthcare but not everyone will need childcare. All those male voters hate subsidizing what they perceive to be women's issues.
How to bring that part of America into the the 21st century requires the more reasonable Republican party members to break with the Norquist Republicans and join the steady as she goes Democrats so that the choice is how far to push policy not whether it should be done at all.
The campaign funding process has to be made transparent and Citizens United overturned so the Koch brother types have less influence.
The Republican twisted logic they sell that Dems want to take away freedoms by imposing a secular state on Christian folks has to be untwisted and the country has to return to its Constitutional roots.
Most of all the US has to rethink the consumer index as the main economic growth metric.
2
I wish more people would recognize that 'insurance' is the wrong model to use to discuss healthcare. I also wish that more would stop implying that 'premiums' is the appropriate metric to use. After all, you could get an extremely low premium by having a $20K deductible and a 50% copay after that with no out-of-pocket maximum, but who could afford this? Focus, instead, on the total cost to the patient...annual premium plus deductible plus copay (or alternatively annual premium plus out-of-pocket maximum) as the total potential cost per year for a person and whether that's 'affordable' or not.
Insurance only makes sense when you have a broad risk pool with a set of insureds who are likely to pay premiums and receive almost no benefits to offset those who are almost assured to max out their policies every single year. The former subsidize the latter, sure, but also have the peace of mind that should something really bad happen that they are covered. By compelling all to participate, you ensure a good risk pool.
Flood insurance is an area where the red states actually receive a huge subsidy, and get coverage for building in inadvisable locations. The people in this risk pool are almost assuredly primarily Trump/Republican supporters, and almost assuredly critical of the mandate in the ACA while benefiting hugely by federal subsidies. Hypocrisy???
Insurance only makes sense when you have a broad risk pool with a set of insureds who are likely to pay premiums and receive almost no benefits to offset those who are almost assured to max out their policies every single year. The former subsidize the latter, sure, but also have the peace of mind that should something really bad happen that they are covered. By compelling all to participate, you ensure a good risk pool.
Flood insurance is an area where the red states actually receive a huge subsidy, and get coverage for building in inadvisable locations. The people in this risk pool are almost assuredly primarily Trump/Republican supporters, and almost assuredly critical of the mandate in the ACA while benefiting hugely by federal subsidies. Hypocrisy???
1
Getting rid of the insurance companies means kicking out the middleman who profits off of each stitch and pill. Britain's single-payer system functions without the middlemen, hence they pay much less for their healthcare. Just think how hard the middlemen will fight to keep skimming off money to profit off our healthcare, and if they lose where they will go next: middlemen, like water, flow to the next available space.
4
The only thing that makes any sense at all in the medical field, if you want to provide care to everyone, is true socialized medicine. Insurance companies do not provide health care. Doctors and nurses do. Insurance companies are in businesses purely for profit. That means that they are always trying to get premiums as high as possible and to pay out as little as possible. That really is an insane system. Trying to regulate them is really pitiful. The only other possibility is to not have insurance at all in the medical field. Then prices come down to where some people can afford care, and those who still can't go without. At least you don't have a middle-man sucking out all the money. You end up with many, possibly most, not being able to afford medical care, which is just the same as when you have insurance companies provide health care. All insurance is a scam. It always has been, it always will be.
4
Paul Krugman's big lie has been equating being insured to having health care. They are NOT the same thing.
That was the lesson of Obamacare when it wad still Massachusetts' Rommeycare and people couldn't afford health care, although they were insured.
It is also the difference between the systems in other countries and here: it is not the mechanics. It's the commitment to assuring that people actually get healthcare.
Whether a system is called Medicare for All, or goes by another name, it MUST provide health care for all citizens.
That was the lesson of Obamacare when it wad still Massachusetts' Rommeycare and people couldn't afford health care, although they were insured.
It is also the difference between the systems in other countries and here: it is not the mechanics. It's the commitment to assuring that people actually get healthcare.
Whether a system is called Medicare for All, or goes by another name, it MUST provide health care for all citizens.
2
I have to congratulate the NYT editorial board on the Einstein-like theory of relativity of solving the social problems...
According to those leaders, the problems could be solved by ignoring them! If somebody offers the new solutions, let’s not pay any attention.
However, if some politicians failed to resolve the chronic crises over the last quarter of century, let’s endorse them for the White House and the Congress!
If they polarized the country, let’s give them another chance to see whether this time they could bring the country together by using the same old wrongful rhetoric...
If there is another Great Depression or even bloodier war pops up, they will be again shocked by the developments nobody reasonable could have predicted!
According to those leaders, the problems could be solved by ignoring them! If somebody offers the new solutions, let’s not pay any attention.
However, if some politicians failed to resolve the chronic crises over the last quarter of century, let’s endorse them for the White House and the Congress!
If they polarized the country, let’s give them another chance to see whether this time they could bring the country together by using the same old wrongful rhetoric...
If there is another Great Depression or even bloodier war pops up, they will be again shocked by the developments nobody reasonable could have predicted!
Single payer is the ultimate solution. It will take a while but even the ignorant, ill informed people in this country will come around.
1
The NYT editorial board has truly innovative and brilliant strategy.
The sooner they help bring the entire country to the very bottom, the sooner we will be forced to change the course!
I assume that the NYT editorial board is a part of the progressive elite...
The sooner they help bring the entire country to the very bottom, the sooner we will be forced to change the course!
I assume that the NYT editorial board is a part of the progressive elite...
"This represents a huge victory for progressives"
Progressives do not, and never have, supported ACA which, overall, is is only marginally better than what we had before it. Progressives do not support Republican efforts to repeal ACA because that would mean going back to a system that's even worse than what we have now.
To a progressive, a system that channels our health care dollars through the lecherous 20%-grabbing fingers of private insurers is reprehensible. Add to that, the fact that the private insurance system is at least partly responsible for the fact that our system is the most expensive system and provides the worst outcomes among the developed world, progressives question the motives of anyone who champions such a system.
Krugman is a pro-business liberal, which means he is able to overlook the negatives of ACA'a private insurance model because he believes that every human endeavor should provide an opportunity for private profit - even health care, a notion that progressives find unthinkable.
As a defender of pro-business liberal policy, Krugman's agenda is to convince his readers that centrism is the new "progressivism", hence his nonsensical conflation of ACA with progressive policy.
Krugman claims that his agenda includes universal coverage, but he surely knows that will never happen in a private insurance system without even bigger taxpayer subsidies to the private insurers than what ACA demands, $42.6 billion for 2017, up 28% over last year.
Progressives do not, and never have, supported ACA which, overall, is is only marginally better than what we had before it. Progressives do not support Republican efforts to repeal ACA because that would mean going back to a system that's even worse than what we have now.
To a progressive, a system that channels our health care dollars through the lecherous 20%-grabbing fingers of private insurers is reprehensible. Add to that, the fact that the private insurance system is at least partly responsible for the fact that our system is the most expensive system and provides the worst outcomes among the developed world, progressives question the motives of anyone who champions such a system.
Krugman is a pro-business liberal, which means he is able to overlook the negatives of ACA'a private insurance model because he believes that every human endeavor should provide an opportunity for private profit - even health care, a notion that progressives find unthinkable.
As a defender of pro-business liberal policy, Krugman's agenda is to convince his readers that centrism is the new "progressivism", hence his nonsensical conflation of ACA with progressive policy.
Krugman claims that his agenda includes universal coverage, but he surely knows that will never happen in a private insurance system without even bigger taxpayer subsidies to the private insurers than what ACA demands, $42.6 billion for 2017, up 28% over last year.
4
I've never gotten a cogent answer to this simple question: Why should a private, profit-making, multi-billion-dollar insurance company be involved in anyone's health care? Maybe this is the answer: Because through bribes and campaign contributions, it can.
172
For historical reasons, that is why. US got it's healthcare system through big employers, who backed insurance as a way of putting it together. And insurance is not necessarily such a bad method of proceeding. Germany's healthcare system works pretty well.
If there is no one between consumers and providers, we would be in a system like India where you pay as you go, and save a lot for healthcare. If there is only the government between the two, you have a UK like system. There is no way to bring that about given the facts as they are now.
If there is no one between consumers and providers, we would be in a system like India where you pay as you go, and save a lot for healthcare. If there is only the government between the two, you have a UK like system. There is no way to bring that about given the facts as they are now.
Single payer, universal care, Obamacare, Trumpcare, blah, blah, blah!
We already have doctors, nurses, technicians, clinics, and hospitals admirably competent at handling the really complicated aspects of health care. Setting up and managing a universal health care system for patients and providers is not complicated: it’s just a normal business process. We know because other advanced countries do it at half the price we Americans pay for our tedious, parasite-strangled, paperwork-deluged, health care coverage designed by political lobbies.
We have the elements of a health care management system that can be joined together quickly to serve as a base for continuing improvement. We have Medicare, our most satisfactory health care program, and Medicare Advantage, a program for private insurers to administer Medicare, and the Obamacare marketplace, where insurers can compete, toe-to-toe, on cost and quality.
So, let's allow private insurers to offer Medicare coverage at competitive, age-adjusted premiums in the Obamacare market place. Apply government subsidies, as needed, to Medicare Advantage plans, only.
Soon, we’ll have a Medicare-for-all, multiple-payer, comprehensive health care system. Insurance companies will be restricted to clerical functions rather than imposing coverage restrictions and limiting patient choice of providers. And, we won't have to staff a government bureau in Washington to handle the eligibility and claims processing for 200+ million people.
We already have doctors, nurses, technicians, clinics, and hospitals admirably competent at handling the really complicated aspects of health care. Setting up and managing a universal health care system for patients and providers is not complicated: it’s just a normal business process. We know because other advanced countries do it at half the price we Americans pay for our tedious, parasite-strangled, paperwork-deluged, health care coverage designed by political lobbies.
We have the elements of a health care management system that can be joined together quickly to serve as a base for continuing improvement. We have Medicare, our most satisfactory health care program, and Medicare Advantage, a program for private insurers to administer Medicare, and the Obamacare marketplace, where insurers can compete, toe-to-toe, on cost and quality.
So, let's allow private insurers to offer Medicare coverage at competitive, age-adjusted premiums in the Obamacare market place. Apply government subsidies, as needed, to Medicare Advantage plans, only.
Soon, we’ll have a Medicare-for-all, multiple-payer, comprehensive health care system. Insurance companies will be restricted to clerical functions rather than imposing coverage restrictions and limiting patient choice of providers. And, we won't have to staff a government bureau in Washington to handle the eligibility and claims processing for 200+ million people.
43
Costs won't come down if prices are allowed to be set by the for-profit free-market system. The individual healthcare consumer has no bargaining power against physicians, hospitals, drug makers, etc. Insurance companies just pass costs on and add their own overhead and profits. Whatever system is adopted - and as Krugman says there many - prices must be controlled by the government. Government must essentially act as the collective bargainer for consumers. All the other countries which have much better systems have major government control over prices.
1
I don't understand how people with Company paid health insurance can be against Medicare for all. If you get a paycheck you are ALREADY paying into Medicare AS WELL AS your own health plan (of which your Company pays the lion's share). It doesn't seem like rocket science to pay Medicare instead of private health insurance Companies (yeah, I know Medicare is administered by private Companies). So I guess 156 million people like paying for everybody else's health care anyway, so why not pay once and not have all the glorious paperwork health insurance Companies make us fill out in order to discourage us and prevent care?
you wouldn't buy into medicare for all at the rates people on it now get. you'd likely have to pay almost as much as your current private insurer costs per month. and there's still the deductible, which is 20%. i think this could all be negotiated but it would have to be by clear-headed non-partisan experts with no axes to grind.
There's an additional benefit to a single payer system that you did not include in your calculus and I think it's potentially a game changer.
With a single-payer system, that in-effect puts the government (much more) on the hook financially for the health of its citizens. By doing so, air pollution and other environmental problems, work-place safety issues, etc. that significantly impact public health become a government concern in terms of the financial bottom-line.
That's insurance against future conservative governments that wish only to cut environmental regulations (protections) to supposedly spur jobs and boost the general economy. In other words, it would add a better balance to the financial ledger by taking into the account public health in the language that conservatives value most: money.
No doubt, it will be a monumental political fight. Let's get going.
With a single-payer system, that in-effect puts the government (much more) on the hook financially for the health of its citizens. By doing so, air pollution and other environmental problems, work-place safety issues, etc. that significantly impact public health become a government concern in terms of the financial bottom-line.
That's insurance against future conservative governments that wish only to cut environmental regulations (protections) to supposedly spur jobs and boost the general economy. In other words, it would add a better balance to the financial ledger by taking into the account public health in the language that conservatives value most: money.
No doubt, it will be a monumental political fight. Let's get going.
2
Time for a universal basic income supplement, a fixed amount paid monthly to every tax payer and matched dollar-for-dollar by reductions in other entitlements. Combined with a return to a highly progressive income tax, this would allow much greater flexibility for those in need (no more losing benefits upon finding a job) and curb the excesses of the rentier class.
1
Dear Professor Krugman, the 'system' in the US has two challenges to face, and they are very different. The first is to provide some sort of formal arrangement to every citizen. That's universal health care, and Count Otto von Bismarck, hardly a socialist in any sense, was the first to effect such an arrangement. That is also the challenge Obamacare was meant to address, if not completely. (See Ronald Numbers, "Almost Persuaded"). The other challenge is the cost. The US spends 4 times what Britain spends per person per annum! The reason is that there is a difference between insurance and health care. The NHS receives roughly £10bn each month from Her Majesty; so there is no credit risk and no collection effort. The NHS merely provides care - not coverage. The primary care physicians are paid on a capitation basis, though there are some in very remote areas where there are not enough patients to make capitation realistic, where these doctors are direct employees of the NHS. Specialists are paid a salary (quite a good one). There are two features of this arrangement which are positive: primary care physicians, the family doctors, are interested in keeping their patients healthy, and specialists have nothing to gain by churning up procedures. Treatment does not involve any transactions; so the number of counter parties is at an absolute minimum. IT IS GREAT FOR PATIENTS, which is why approval and satisfaction is so nearly universal.
2
There is three big problems comparing our system with the Netherlands. First the Dutch are very responsible people. They will pay their health insurance premiums. Secondly, the Dutch are healthier than Americans. Thirdly, the Dutch do not have near the level of criminal activity and motor vehicle accidents resulting in injuries.
2
Lack of paid parental leave isn't the only way we neglect children. Low wage workers would be paying their entire paycheck for childcare to allow them to work, if they weren't lucky enough to have friends or family do it for free. Can't we do something for workers who need childcare in order to work?
1
The biggest risk I see to persons who get their insurance thru employers, if Single - Payer were to pass, is that taxes would go up , but the savings in premiums would not got to those persons, but would go to their employer. Ideally, a persons salary / take home pay would go up exactly the amount that the company would no longer have to shell out to ins. co. . But, we know, virtually for certain, based upon routine corporate behavior , that this would most certainly NOT happen. Employee would get taxed more, and corporate expenses go down, but employee would not see that pay bump, or would see a very small pay bump.
Single Payer system has a strong likelihood of being perceived as a socialist system, and to a large extent it is. In a capitalist society like ours, it will be a hard sell.
Fixing ACA is complex but doable. It is the extreme political factions sold at the hand of lobbyists representing powerful interest groups (read insurance companies, big pharma, hospitals and doctors ... enabled by legal industry) that have made it impossible.
Fixing ACA is complex but doable. It is the extreme political factions sold at the hand of lobbyists representing powerful interest groups (read insurance companies, big pharma, hospitals and doctors ... enabled by legal industry) that have made it impossible.
The Affordable Care Act will work given more time as steadily increasing enrollments continue, thus bringing down insurance rates for everyone. You're right that we are not ready for single payer after just having gone through a real threat to the ACA's existence. Democrats must be more outwardly vocal about uninsured signing up to increase enrollment. keep up the pressure to grow the ACA. the 2010 passage was not the end all of it. It's a work in continual progress needing care and feeding. It is, after all, a big program.
2
This column sounds reasonable enough, but let us not forget that we have reason to doubt Krugman's judgment. He supported the losing candidate in the democratic primaries. And it was supposedly because we had to be politically pragmatic etc.
1
this is comparing apples to oranges. in talking about economic issues krugman is on firm grounds.
"Moving to single-payer would mean taking away this coverage (for those with employment-covered health insurance) and imposing new taxes". Mr. Krugman must know that the new taxes would be imposed on everyone, where the extremely wealthy would pay a greater share of those taxes than they had heretofore, thereby reducing the overall tax required from those with lower and low income. A single-payer system will save up to 2/3 of the cost of this atrociously cumbersome system now in place, and probably would reduce total cost to make those with health insurance through employment pay even less taxes than before.
Professor Krugman makes a sound pragmatic argument for introducing a Public Option now as a possible precursor to Single-Payer down the road. In addition, I think it makes a great deal of sense to lower the Medicare age to 55 or 60. This would be a win-win. Insurance companies would be relieved of the burden of insuring more of the high risk older patients, and economies of scale would make insurance coverage more cost effective for older Americans. Everyone would benefit and there would be no threat to employer based health care. Common sense & common decency would prevail!
So Warren Buffett and Charlie Munger Sr. have a greater understanding of the economics of healthcare vs health insurance than Krugman who continues to defend the declining employee provided hc system. Employers are recognizing the burden of this system on their bottom line and employees are increasingly paying out of pocket for their care. We're finally at a tipping point where the public is understanding that insurance companies do not make money on sick people and serve no function other than to make a profit. This is a sad commentary and defense of a criminal enterprise that demeans our people and reduces our competitive edge in the world.
Progressives need to focus on expanding jobs that combat climate change. If we don't stop climate change, our children and grandchildren are going to become very unwell.
2
Employers large and small should be the strongest advocates for Medicare For All. Burdening employers to varying degrees with the responsibility of providing health insurance to their employees leads to both a patchwork system with vastly different coverages and costs for individuals (depending on who their employer is) and leaves responsible employers with a huge competitive disadvantage with foreign competitors who don't need to sound one dollar or one ounce of energy on health care issues for their workers.
Why is this so hard to understand? The US Chamber of Conference, unions, and social advocacy groups should all unite behind a push for Medicare For All.
Why is this so hard to understand? The US Chamber of Conference, unions, and social advocacy groups should all unite behind a push for Medicare For All.
1
"A far more important consideration is minimizing disruption to the 156 million people who currently get insurance through their employers, and are largely satisfied with their coverage."
Are they actually happy with their coverage or just happy to have some kind of insurance?
Are they actually happy with their coverage or just happy to have some kind of insurance?
1
I thank Dr. Krugman for discussing what we should do rather than how delusional the Republicans are, and I agree that single payer is nice in concept, but very difficult to get there from here. I like the comment about the Netherlands having "regulated" insurers, and I think that efforts to give relief to those in the middle class that still have difficulty buying insurance that actually benefits them, and equally, we need to reign in the drug companies. They should be more a utility rather than unregulated profit centers. I think that there are two main issues that should be addressed while we reinforce Obamacare and children is a good start. I think that infrastructure and jobs is a second. Creating an infrastructure that moves us into the 21st century will do much to improve the job situation, but more labor friendly legislation would help just as much. We should concentrate on making life better for the people of this country not increasing the wealth of a bunch of old men.
3
It is odd that Krugman presents the neoliberal perspective on health care in a column headed “What’s next for progressives?” In a previous comment, I noted the horrors of the current system: rising costs, premiums, deductibles, and co-pays; the in-network and out- of-network restrictions; the nightmare complexity and bureaucracy—all this imposed on patients and their families at the most difficult and vulnerable times of their lives. The health care system is supposed to alleviate suffering, not add to it. Obamacare is a temporary fix, better than nothing, but not a long-term solution.
Krugman has expended great energy explaining why we shouldn’t have single payer; why not a column protesting the cruelty and predatory nature of our current system? The reason must be that he would then have to consider seriously the merits of a Medicare for All system.
Many of the reforms that have made our country more decent and civilized—labor and civil rights legislation, for example—replaced deeply entrenched systems in which powerful interests had a stake. Should these too have been delayed for some vague future date in the interests of expediency?
Krugman has expended great energy explaining why we shouldn’t have single payer; why not a column protesting the cruelty and predatory nature of our current system? The reason must be that he would then have to consider seriously the merits of a Medicare for All system.
Many of the reforms that have made our country more decent and civilized—labor and civil rights legislation, for example—replaced deeply entrenched systems in which powerful interests had a stake. Should these too have been delayed for some vague future date in the interests of expediency?
2
Unfortunately, Krugman is afraid to take on special interests and wrong about some important things. He also has a very loud megaphone and a huge following.
Yes ! "Eventual" single payer with regulated insurers providers is the answer indeed !
BUT, what should be next for progressives are : skills, jobs and infrastructure. Using American steel and coal and labour if it can be possible.
Insurance markets for the UN-insured and insurance "assurance" ( what a contradiction in terms ! ) is also a workable idea.......
The government would insure everyone who signs on WITH pre-existing conditions, based on their age ONLY ( bad idea but an easy sell ). There would be TWO options : A full feature option and a partial option for 20/40/whatever number basic treatments.
Both would be subsidized and tax deductible as appropriate. But the full feature one would be more made appealing.
The prices would be calculated and FIXED. And all non-government insurance companies could offer them.
If you DON'T sign on, and need medical treatment beyond the basic number, then you need to pay the differential AND a penalty and move permanently into the full feature one.
That differential and penalty would be auctioned off to whichever non-government insurance company wanted it.
Which means, you can only blame yourself if you are healthy and did not use the subsidies to buy a full feature insurance, but bought a partial option and now needed more treatment.
THOUGH how EVERYONE could be assured a UNIFORM level treatment EVERYWHERE would be doubtful.
As in all things, a mixture of private and public WOULD work. People have to be persuaded to buy.
BUT, what should be next for progressives are : skills, jobs and infrastructure. Using American steel and coal and labour if it can be possible.
Insurance markets for the UN-insured and insurance "assurance" ( what a contradiction in terms ! ) is also a workable idea.......
The government would insure everyone who signs on WITH pre-existing conditions, based on their age ONLY ( bad idea but an easy sell ). There would be TWO options : A full feature option and a partial option for 20/40/whatever number basic treatments.
Both would be subsidized and tax deductible as appropriate. But the full feature one would be more made appealing.
The prices would be calculated and FIXED. And all non-government insurance companies could offer them.
If you DON'T sign on, and need medical treatment beyond the basic number, then you need to pay the differential AND a penalty and move permanently into the full feature one.
That differential and penalty would be auctioned off to whichever non-government insurance company wanted it.
Which means, you can only blame yourself if you are healthy and did not use the subsidies to buy a full feature insurance, but bought a partial option and now needed more treatment.
THOUGH how EVERYONE could be assured a UNIFORM level treatment EVERYWHERE would be doubtful.
As in all things, a mixture of private and public WOULD work. People have to be persuaded to buy.
Right and wise on all counts, (as is true more often then not for Krugman) but will anyone listen?
Krugman is approaching politics as a practical matter: How do we best build a majority and keep things moving in the direction we believe in? How do we implement policy that improves the situation without creating disruption for a populace whose lives and expectations have already been over disrupted in dozens of ways and are fed-up with it?
But in the information age, increasing numbers of people approach politics instead as a religious matter: How do we advance our holy and righteous cause over the resistance of the heretics and heathens? Once you have decided that Single Payer is utopia, you will brook no opposition, credit no dissent, and condemn any other path as appeasement, backsliding, and compromise of principle.
Krugman is approaching politics as a practical matter: How do we best build a majority and keep things moving in the direction we believe in? How do we implement policy that improves the situation without creating disruption for a populace whose lives and expectations have already been over disrupted in dozens of ways and are fed-up with it?
But in the information age, increasing numbers of people approach politics instead as a religious matter: How do we advance our holy and righteous cause over the resistance of the heretics and heathens? Once you have decided that Single Payer is utopia, you will brook no opposition, credit no dissent, and condemn any other path as appeasement, backsliding, and compromise of principle.
3
Spending 18% of nation's GDP on healthcare is crowding out allocating financial resources to building people's future. It is time for a progressive state like California to use the Federal money from ACA to adopt and improvise Britain's NHS. It is easier to model after a long time successful program than spending more money after ACA which does nothing to control the runaway medical expenditure. Lower costs and wider quality healthcare coverage should be the goal.
These issues are actually related. We now know that Adverse Childhood Experiences (ACEs) are one of the major drivers of many long-term, expensive, chronic illnesses, including obesity, heart disease and addiction. If we invest money in stronger support for families and children, our health care system will see the savings in the decades to come.
1
Krugman shoots himself in the foot really, in one breath he says single-payer system isn't easy to achieve, in the next breath he says look how every industrialized (all diverse political systems) country in the world has a single payer system. If it's so hard, how is it that every industrialized diverse eco-political country in the world has it? Can't be too hard then can it?
2
Read the article again. He explicitly says universal coverage is not the same as single payer and that not all countries have the latter (e.g., Netherlands).
Single Payer is not a panacea...I personally lived under National Health in England and witnessed some pretty bad outcomes for individuals. Primary care, checkups, etc. were great - critical care not so much. Also, here in MD, we see lots of Canadians who need critical care come to hospitals here when they either can't get the care in Canada they need in a timely fashion or at all.
So, while I fully support insurance for all, I'd sure hate for us to lose some aspects of our system - it's not all bad.
So, while I fully support insurance for all, I'd sure hate for us to lose some aspects of our system - it's not all bad.
1
Krugman conveniently ignores the fact that we have medicare, medicaid, and social security. All of them serving their purposes very well. And that health insurance for all could be grafted on without much fuss.
3
I firmly believe in that old adage that nothing is more important than ones health. Yes the Netherlands has private not government insurance. However you fail to disclose that their health care delivery system is results based and not a fee for procedure. Also insurance companies are so tightly regulated that they cannot compete on the basis of cost or benefits but on performance as an insurer. Do you really see that as a possibility here in the US when both parties are in bed with the major insurance companies, big Pharma and medical equipment manufacturers. A good start for Dems would be major campaign finance reform and an end to Citizens United. Hillary lost because she was in bed with Wall Street and Big Pharma, it's time the party cleaned up its act.
8
As a working mother whose children are now grown this makes so much sense to me. Government programs which supported the social good of having children would benefit all Americans. It was hard to cobble together childcare and I had what were considered "great" maternity benefits 6 months of unpaid leave. It was economically difficult and limited us to 2 children but we were lucky.
2
If we keep increasing the amount of immigrants, a million plus a year (legal), it will be more expensive and difficult to get healthcare for all. It will never happen if we keep doing so.
2
Wrong, young healthy immigrants contributing to a single-payer pool would lower the cost for everyone in the pool. That is precisely the advantage of single-payer.
Been into an ER or public medical clinic lately?
1
Some progressives are as rigid as the far right. It's "my way or the highway." I came across this when I was calling during the election and many Sanders supporters refused to vote. Krugman has pointed out the reality of the situation and I hope these people are listening. Part of being a mature thinking person is realizing that you can't always have it your way, you often have to compromise. Let's fix what we have.
2
Thank you for this warning. It's alarming to watch my fellow Democrats rush headlong into a losing battle. Medicare for all would be great but it's way more difficult than people suggest.
Bernie Sanders's gift is to inspire people to have higher expectations. But Mr. Sanders's approach to policy has been simplistic and impractical, lacking detailed analysis. (Witness his inability during the 2016 campaign to answer reasonable questions about regulating Wall Street.)
Yes, let's look to other models and adapt them to our situation. We need to include all players -- even overpaid pharmaceutical company execs -- in the discussion. That's exactly what Obama did and that's why we're better off now.
Bernie Sanders's gift is to inspire people to have higher expectations. But Mr. Sanders's approach to policy has been simplistic and impractical, lacking detailed analysis. (Witness his inability during the 2016 campaign to answer reasonable questions about regulating Wall Street.)
Yes, let's look to other models and adapt them to our situation. We need to include all players -- even overpaid pharmaceutical company execs -- in the discussion. That's exactly what Obama did and that's why we're better off now.
2
You cite New York as an example, but the one problem I find--and I know it's a problem nationally--is that the affordable insurance isn't particularly affordable if you need to use it. Deductibles are far too high. Additionally, 12% of your take home pay for insurance is far too high for people who are lower income. It needs to be more generous, especially to people who live in very expensive states like New York.
2
Really simple solution:
Have the government pay for primary care (to ensure everyone gets access to basic care) and catastrophic care (to keep the very sick from driving up costs for everyone else). Make private or employer-provided insurance mandatory and have it cover everything in-between primary care and catastrophic care. Subsidize the mandatory insurance for those who can't afford it (elderly, poor, etc). Expand health care savings accounts to help people to save for the cost of insurance and for any out of pocket healthcare costs.
Voila—universal coverage at affordable prices, a reduced government healthcare bureaucracy, and a continued role for a healthy insurance industry.
Have the government pay for primary care (to ensure everyone gets access to basic care) and catastrophic care (to keep the very sick from driving up costs for everyone else). Make private or employer-provided insurance mandatory and have it cover everything in-between primary care and catastrophic care. Subsidize the mandatory insurance for those who can't afford it (elderly, poor, etc). Expand health care savings accounts to help people to save for the cost of insurance and for any out of pocket healthcare costs.
Voila—universal coverage at affordable prices, a reduced government healthcare bureaucracy, and a continued role for a healthy insurance industry.
Why is cost ignored in this analysis? The Dutch may have the closest system to the ACA; but their spend per person is about 50% lower than ours. Quality is much better. That is also the case with the UK, and with Australia. So when we talk about value for money, it is not about the modality, single payer vs insurance or government provision; it is about regulation. That is the secret sauce, and that is what is missing in the ACA: cost control regulation. We have a system that doesn't regulate itself, because is not a market, it is a necessity.
2
I'm all for single payer - Medicare for all - but, how do we pay for it facing trillions upon trillions of dollars of unfunded liabilites as is. regulate insurance companies? ain't gonna happen. raise taxes? ha! no way. throw in the mix under funded local and state pensions, other economic issues, and the stew turns toxic. perhaps leadership will cobble together solutions to these problems. ooops! I only see crisis ahead and worry for my children
and other young people starting their lives - the mess we have left them. sorry for the gloom and doom...
and other young people starting their lives - the mess we have left them. sorry for the gloom and doom...
I agree. In the short term Democrats should focus on things that can be achieved, and at the same time would be broadly popular. Among those are maternity leave and subsidized day care for preschool children.
But as far as improving the ACA is concerned, perhaps moving toward a public option to cover those counties where insurance companies have opted out might be a first step. How could insurance companies complain if they are not willing to participate in those markets?
But as far as improving the ACA is concerned, perhaps moving toward a public option to cover those counties where insurance companies have opted out might be a first step. How could insurance companies complain if they are not willing to participate in those markets?
Another long list of tone deaf progressive commenters who learned nothing from Krugman. You don't have the power to make the changes you want. Until you support unity to elect Democrats, you never will. Most people support Medicare for all in theory but refuse to pay for it. Until you change the composition of Congress you will achieve nothing. You are going to have to be practical and compromise with Dem moderates to get what you want. Or you can keep the current Congress and get nothing.
3
The fact that both parties are corrupt and do not represent the the majority of voters makes Universal coverage all the more important. As important as repealing Citizen's United, getting money out of politics, reforming the voting system and creating good paying jobs by embracing green energy and spending on infrastructure. Jobs, medical care, environmental stewardship, all things that used to "mainstream" and are no considered lefty fringe. Sheesh
1
This is just more "No we can't" from a die-hard Clintonista. Enough already!
3
With his usual impeccable logic, Dr. Krugman states "there are more important priorities," but in his next paragraph, he states, "[t]he key point to understand about universal coverage is that we know a lot about what it takes, because every other wealthy country has it. How do they do it? Actually, lots of different ways.
The argument shifts from policy priorities to implementation strategies. Neat trick. The so-called "political problem is that to make universal health care work: (i) the medical-industrial complex has to be regulated to reduce costs, (2) a distinction must be made between medical and aesthetic interventions, and (3) individual expenditures have to be replaced by general taxation.
In most countries that have universal health care, there is some ethic concerning the need to care for others. Perhaps it's because in these countries, the collective culture, i.e., we are all ..., is more important than one that emphasizes "diversity" to the point in which it is difficult to see the humanity in others. Are we colour coded, gender determined, etc., etc., or are we constituent parts of a greater whole? Thanks to an excessive degree of "individuality" in American culture, we appear to be justified in feeling no real responsibility for the fortunes of other, other than paying lip service to good intentions. As the song goes "... it's your misfortune and none of my own."
The argument shifts from policy priorities to implementation strategies. Neat trick. The so-called "political problem is that to make universal health care work: (i) the medical-industrial complex has to be regulated to reduce costs, (2) a distinction must be made between medical and aesthetic interventions, and (3) individual expenditures have to be replaced by general taxation.
In most countries that have universal health care, there is some ethic concerning the need to care for others. Perhaps it's because in these countries, the collective culture, i.e., we are all ..., is more important than one that emphasizes "diversity" to the point in which it is difficult to see the humanity in others. Are we colour coded, gender determined, etc., etc., or are we constituent parts of a greater whole? Thanks to an excessive degree of "individuality" in American culture, we appear to be justified in feeling no real responsibility for the fortunes of other, other than paying lip service to good intentions. As the song goes "... it's your misfortune and none of my own."
2
Mr. Krugman makes an excellent argument. Now that we have won (at least for now) the protracted and bitter battle to save the ACA, are we really going to propose another radical remake of our health care system? Yes, repair what's wrong with Obamacare, and include the public option that was in the original proposal. The GOP fears it, because they know people will like it.
2
There's no question that young families need help and I agree with most of what you've proposed, childcare leave is a good thing. Hell even Ivanka Trump agrees with that, but even more essential for such families is medical care.
I've had the great good fortune to be covered by what passes for good employer provided insurance my entire working life. Eveen so, there are times when I've made the mistake of not asking whether a provider, was a participant in my plan. Let's face it, you're in the emergency room, face covered with blood, you have other things on your mind.
American families need the assurance that if something goes wrong they won't be socked by bills they can't pay. I don't particularly care whether it's Medicare for all, a hybrid like Obamacare with a public option that people can buy into or a British style health care service. Your right to heath care shouln't depend on who you work for or what state you lve in.
Let's get it done.
I've had the great good fortune to be covered by what passes for good employer provided insurance my entire working life. Eveen so, there are times when I've made the mistake of not asking whether a provider, was a participant in my plan. Let's face it, you're in the emergency room, face covered with blood, you have other things on your mind.
American families need the assurance that if something goes wrong they won't be socked by bills they can't pay. I don't particularly care whether it's Medicare for all, a hybrid like Obamacare with a public option that people can buy into or a British style health care service. Your right to heath care shouln't depend on who you work for or what state you lve in.
Let's get it done.
84
Even Ivanka agrees? Tell that to her sweatshop employees.
Mr. Krugman's proposed "social welfare program" is unsustainable. The wealthy countries that have this system in place have much smaller populations. This is going to cost a lot of money for America and will the taxpayers be willing to go along with such an expensive program? Highly unlikely. They are already paying a lot in taxes for reduced services and do not want to pay any more.
These parents should not expect others to have to pay for these welfare costs and that is really what it comes down to. Let them pay for these themselves if they want to have them.
These parents should not expect others to have to pay for these welfare costs and that is really what it comes down to. Let them pay for these themselves if they want to have them.
1
corporate welfare is $100 B per annum - with many paying NO TAX -
2
Krugman's point that there are many paths to universal coverage is an important one. In addition to the Netherlands, he could also have cited Switzerland and Israel, both of which have achieved universal coverage with a system featuring multiple health insurance providers and public subsidies. Both achieve excellent health outcomes. Switzerland's model, which includes an extensive private insurance component, is probably especially applicable to the United States.
As a corollary, we should not assume that single-payer would actually deliver better outcomes than these hybrid systems. I now live in Canada and have experienced both the pluses and minuses of Canadian single-payer. There's no doubt that it beats the current US model, which still leaves millions of people uninsured, but full coverage of the population isn't everything. Europeans who visit here are often struck by service delays, shortages of doctors and technology, and sometimes shoddy treatment. In short, Canadian single-payer healthcare is not the envy of the world, and Americans shouldn't assume it's the only approach to universal coverage.
As a corollary, we should not assume that single-payer would actually deliver better outcomes than these hybrid systems. I now live in Canada and have experienced both the pluses and minuses of Canadian single-payer. There's no doubt that it beats the current US model, which still leaves millions of people uninsured, but full coverage of the population isn't everything. Europeans who visit here are often struck by service delays, shortages of doctors and technology, and sometimes shoddy treatment. In short, Canadian single-payer healthcare is not the envy of the world, and Americans shouldn't assume it's the only approach to universal coverage.
4
ok paul - as an economist you forgot one very set of important numbers - healthcare expenditures as %age of GDP.
U.S, - 17%
netherlands - 12%
australia - 10%
britain - 10%
altghough the dutch system may be closest to our debacle - it costs 20% more than austrailia's - which is the direction we're headed - medicare.
U.S, - 17%
netherlands - 12%
australia - 10%
britain - 10%
altghough the dutch system may be closest to our debacle - it costs 20% more than austrailia's - which is the direction we're headed - medicare.
1
IMHO, it is high-time for anyone who is opposed to Trump and the Republicans to realize that Congressional districts are varied and unique to the people who live there, and the candidates cannot all conform to a progressive ideal.
Mis-match of Democratic candidates with the districts in which they are running next year is the most probable way that the House remains in Republican hands next year.
So you may not entirely like a candidate, but a Democrat who overlaps with 70% of your beliefs and wins is better than one who comes in at 100% but loses to a Republican whose policies are completely at odds with your beliefs.
That is the binary electoral world we live in. Keep resisting it, and you will have another round of Republican majorities in Congress, Trump in the WH until 2024, and a few more right-wing Supreme Court Justices appointed that would make Scalia proud.
Mis-match of Democratic candidates with the districts in which they are running next year is the most probable way that the House remains in Republican hands next year.
So you may not entirely like a candidate, but a Democrat who overlaps with 70% of your beliefs and wins is better than one who comes in at 100% but loses to a Republican whose policies are completely at odds with your beliefs.
That is the binary electoral world we live in. Keep resisting it, and you will have another round of Republican majorities in Congress, Trump in the WH until 2024, and a few more right-wing Supreme Court Justices appointed that would make Scalia proud.
6
Agreed, except we'd likely see Supreme Court justices who make Scalia look like a liberal.
2
Many questions and no solutions in this impasse for finding an answer to healthcare in our country reflects the confusion and chaos in our country: ACA works. No, it doesn't. Worst thing ever. Best thing ever. GOP and Democratic party miles apart on two different continents essentially. The man at the top doesn't give a damn, doesn't understand the intricacies of making it work. Where's Big Pharma? Over in yon city growing madly. Specialists, in vitro fertilization, heart surgery, success in cancer research leading to better outcomes. And yet the plan is out there to bugger the ACA and pass on "savings" to an extremely wealthy group of folks at the top. Always the example of other countries who appear civilized and caring while we stumble toward a debt ceiling debacle and a continuance of grumbles and confusion over how all this will shake out.
"When you compare the U.S. social welfare system with those of other wealthy countries, what really stands out now is our neglect of children." Precisely, Dr. Krugman. Republicans, for all their moral purity and protestations about the "Christian work ethic" are far more invested in a woman's pregnancy until the child is born then they''re on their own.
Republicans don't give a damn about anyone's children--except their own. What's prehistoric is their adamant refusal to support maternity (and paternity) leave because, they reason, absence from work reduces productivity (read: profits for the CEO's). Nothing there about raising healthy children, though, for a competitive (healthy) start in life for the unwashed.
It's interesting, Dr. Krugman, that you mentioned "the political logic that led to Obamacare," that the health industry lobbyists torpedoed the GOP at crucial junctures to weaken what was left of public support for both the House and Senate's killing plans. When Barack Obama was president, he did not begin at square one. No; he took up a working, credible model in Massachusetts, one under the auspices of a Republican governor (Mitt Romney). The basic structure of the ACA is, for all intents and purposes, a right-wing blueprint for national healthcare. President Obama inserted the mandate requirement into the law and Republicans were apoplectic--but not about "forced sign-ups." They knew the plan would be a first step toward single payer.
And Mr. Obama was black.
Republicans don't give a damn about anyone's children--except their own. What's prehistoric is their adamant refusal to support maternity (and paternity) leave because, they reason, absence from work reduces productivity (read: profits for the CEO's). Nothing there about raising healthy children, though, for a competitive (healthy) start in life for the unwashed.
It's interesting, Dr. Krugman, that you mentioned "the political logic that led to Obamacare," that the health industry lobbyists torpedoed the GOP at crucial junctures to weaken what was left of public support for both the House and Senate's killing plans. When Barack Obama was president, he did not begin at square one. No; he took up a working, credible model in Massachusetts, one under the auspices of a Republican governor (Mitt Romney). The basic structure of the ACA is, for all intents and purposes, a right-wing blueprint for national healthcare. President Obama inserted the mandate requirement into the law and Republicans were apoplectic--but not about "forced sign-ups." They knew the plan would be a first step toward single payer.
And Mr. Obama was black.
1
Dr. Krugman? I do love you sir, but you are speaking to the already converted!
How do we now push back the constant lies from Fox News, Rushbo, and Alex Jones’ Infowars? Jones has his lies in the title of his show: war against information.
In the VERY discouraging era of “alternative facts” Fox News led with Eric Bolling one of the anchors of “The Fox Specialists” stating this “fact:”
“August 2, 2017, Fox Nation:”
“Wake Up, America: "The Fox News Specialists" co-host Eric Bolling compares President Trump's record with that of former President Obama."
“Trump has fixed most of the Obama failures!"
http://nation.foxnews.com/2017/08/03/eric-bolling-trump-has-fixed-most-o...
The Trump Trolls on Twitter went nuts recommending this story! Obama Derangement Syndrome is again reaching historic high (low?)levels.
Unfortunately @ericbolling was SUSPENDED from Fox News Saturday August 5 for...Wait for it...sexual harassment! Bolling was texting (sexting?) pics of male genitalia to co-workers! Where have you gone to, Anthony Weiner?
http://money.cnn.com/2017/08/05/media/fox-news-eric-bolling-suspended/in...
With this suspension the alt-right is screaming: “Star chamber justice condemns Eric Bolling of Fox News without a trial!” This is the title of an August 7 article from a site entitled “American Thinker.”
With a minimum of 35% of America firmly believing NOTHING from the MSM, how on earth do we get FACTS into the conversation these days?
How do we now push back the constant lies from Fox News, Rushbo, and Alex Jones’ Infowars? Jones has his lies in the title of his show: war against information.
In the VERY discouraging era of “alternative facts” Fox News led with Eric Bolling one of the anchors of “The Fox Specialists” stating this “fact:”
“August 2, 2017, Fox Nation:”
“Wake Up, America: "The Fox News Specialists" co-host Eric Bolling compares President Trump's record with that of former President Obama."
“Trump has fixed most of the Obama failures!"
http://nation.foxnews.com/2017/08/03/eric-bolling-trump-has-fixed-most-o...
The Trump Trolls on Twitter went nuts recommending this story! Obama Derangement Syndrome is again reaching historic high (low?)levels.
Unfortunately @ericbolling was SUSPENDED from Fox News Saturday August 5 for...Wait for it...sexual harassment! Bolling was texting (sexting?) pics of male genitalia to co-workers! Where have you gone to, Anthony Weiner?
http://money.cnn.com/2017/08/05/media/fox-news-eric-bolling-suspended/in...
With this suspension the alt-right is screaming: “Star chamber justice condemns Eric Bolling of Fox News without a trial!” This is the title of an August 7 article from a site entitled “American Thinker.”
With a minimum of 35% of America firmly believing NOTHING from the MSM, how on earth do we get FACTS into the conversation these days?
2
Just take a look at what modern Progressives stand for--and it's obvious why the Democrat Party--as they push further to the left-- has become marginalized on the national stage.
Anti-family
Anti-achievement
Anti-military
Anti-religion
Anti-blue collar
Anti-rural (and anything below the Mason-Dixon Line).
Anti-development
Anti-energy
Anti-business
Anti-traditional values
Anti-capitalism
Anti-police
Anti-white
Anti-drug enforcement
Anti-(straight, White) men
Anti-school choice
Anti-rule of law
Anti-border enforcement
Anti-first amendment (nearly all universities)
Anti-second amendment (they would ban all guns if allowed to do so).
Anti-voter verification
Most importantly...Anti-Trump and just plain anti-American. How the hell do you build a winning platform out of that?
Answer: they haven't--and they won't. But shhhh...don't tell them.
Anti-family
Anti-achievement
Anti-military
Anti-religion
Anti-blue collar
Anti-rural (and anything below the Mason-Dixon Line).
Anti-development
Anti-energy
Anti-business
Anti-traditional values
Anti-capitalism
Anti-police
Anti-white
Anti-drug enforcement
Anti-(straight, White) men
Anti-school choice
Anti-rule of law
Anti-border enforcement
Anti-first amendment (nearly all universities)
Anti-second amendment (they would ban all guns if allowed to do so).
Anti-voter verification
Most importantly...Anti-Trump and just plain anti-American. How the hell do you build a winning platform out of that?
Answer: they haven't--and they won't. But shhhh...don't tell them.
2
Wow, someone has uncritically accepted all the right-wing radio stereotypes of the left. How do you explain the growing number of religious leftists, who base their positions on admonitions found in the Bible; small business owners who are sick of corporate control of the economy, white leftists, and others who do not fit your tidy little slander?
1
pdstran, My comment was aimed at the hard-core Left--the Bernie Sanders wing of the party--the anti-corporate, atheist, global-warming nutcases. I agree--there are many who are left of center who believe in God and who believe in free market capitalism. But since you have taken offense--thanks for confirming your position on the political spectrum.
I don't have much knowledge about American health insurance policies but here is what we have in Austria, and is failing:
a. Austria is one of the richest countries in the world, a welfare state.
b. Everybody is insured by the state and the costs are the following:
1. 51% of the GDP is spent on social benefits (health care, maternity leave, unemployment benefits, free university).
2. with a salary of about USD70 thsd a year you pay nearly 50% taxes from your gross salary meanwhile your employer also has to pay for you into the state coffers.
3. You're sick, you're going to the family doctor which will send you to a specialist. Long lines, long waiting times (your boss is angry obviously). You need a surgery which is not considered urgent (however causes a great deal of discomfort). You will get an appointment 8 months ahead. You ask yourself: why the hell am I paying so much taxes ???
c) paid maternity leave: for one year the mother can stay home and will receive about USD 1200/ months. This of course is made possible by other taxes.
d) subsidized kindergartens: great business for the owners, they get about USD 200/month from the parents and about USD 500 from the city of Vienna/ child. How is it possible: debt.
The city of Vienna (also Austria) is increasing its debt by about USD 600 million/ year.
I understand the American's frustration with their health insurance, but just FYI, overall coverage is also not a perfect, nor is it fair.
a. Austria is one of the richest countries in the world, a welfare state.
b. Everybody is insured by the state and the costs are the following:
1. 51% of the GDP is spent on social benefits (health care, maternity leave, unemployment benefits, free university).
2. with a salary of about USD70 thsd a year you pay nearly 50% taxes from your gross salary meanwhile your employer also has to pay for you into the state coffers.
3. You're sick, you're going to the family doctor which will send you to a specialist. Long lines, long waiting times (your boss is angry obviously). You need a surgery which is not considered urgent (however causes a great deal of discomfort). You will get an appointment 8 months ahead. You ask yourself: why the hell am I paying so much taxes ???
c) paid maternity leave: for one year the mother can stay home and will receive about USD 1200/ months. This of course is made possible by other taxes.
d) subsidized kindergartens: great business for the owners, they get about USD 200/month from the parents and about USD 500 from the city of Vienna/ child. How is it possible: debt.
The city of Vienna (also Austria) is increasing its debt by about USD 600 million/ year.
I understand the American's frustration with their health insurance, but just FYI, overall coverage is also not a perfect, nor is it fair.
The most important patriotic duty of the progressives is to impose the basic mathematical principles on the market economy in order to avoid the sudden collapse of the unsustainable economic system and another Great Depression!
Krugman displays two problems with the Dems in a nutshell:
(a) Near-sighted, next-election thinking. If a proposed goal isn't what gets you a win next election season, drop the goal.
(b) Making a pitch only if you think you'll succeed. If you don't see yourself obtaining the margin (again, in near term wins), don't bother with a pitch.
The result is that worthy goals, such as comprehensive guaranteed universal healthcare, are perennially put on the back burner, postponed for another day, labeled as impractical. The fallacy is obvious when you see how often Dems do it. The reasoning is like perennially giving up on saving for a vacation to Hawaii, because you can't save enough in any given year. And the GOP planning ecosystem is eons ahead of Dems in this regard: They know how to plan for the long run, and have.
Against (a), the Dems need to learn how to identify worthy goals, and then work on ways of getting there, which may take years, and many election cycles. That a goal may not play well this season is never grounds for dropping that goal. Against (b) Dems need to recognize that popular support only comes as a result of persuasion. Stop trying to persuade and you forego building support, guaranteeing lukewarm popular support next season, and the next, and the next. Dems need to stop the tactic of deciding whether to make a pitch based on the latest weathervanes, for defeatist projections do more to guarantee defeat of Dem goals than the quality of those goals.
(a) Near-sighted, next-election thinking. If a proposed goal isn't what gets you a win next election season, drop the goal.
(b) Making a pitch only if you think you'll succeed. If you don't see yourself obtaining the margin (again, in near term wins), don't bother with a pitch.
The result is that worthy goals, such as comprehensive guaranteed universal healthcare, are perennially put on the back burner, postponed for another day, labeled as impractical. The fallacy is obvious when you see how often Dems do it. The reasoning is like perennially giving up on saving for a vacation to Hawaii, because you can't save enough in any given year. And the GOP planning ecosystem is eons ahead of Dems in this regard: They know how to plan for the long run, and have.
Against (a), the Dems need to learn how to identify worthy goals, and then work on ways of getting there, which may take years, and many election cycles. That a goal may not play well this season is never grounds for dropping that goal. Against (b) Dems need to recognize that popular support only comes as a result of persuasion. Stop trying to persuade and you forego building support, guaranteeing lukewarm popular support next season, and the next, and the next. Dems need to stop the tactic of deciding whether to make a pitch based on the latest weathervanes, for defeatist projections do more to guarantee defeat of Dem goals than the quality of those goals.
What’s the next for the progressives?
What about finally awakening and returning down to the Earth from those clouds of enormous hubris and conceit?
In the market economy the market is always right, isn’t it?
That’s why we cannot preempt any Great Depression, any Great Recession, any housing bubble and any stock extravaganza...
If we live in the market economy, the market is always right?!
No, the mathematics is always correct, not the market.
The market is just a bunch of humans and the people make the most stupid mistakes.
If the progressives don’t say this sad truth, who is supposed to step forward?
The right wing gurus like Trump and Koch Brothers, the very people who would lose the billions dollars by acting in the patriotic way?!
What about finally awakening and returning down to the Earth from those clouds of enormous hubris and conceit?
In the market economy the market is always right, isn’t it?
That’s why we cannot preempt any Great Depression, any Great Recession, any housing bubble and any stock extravaganza...
If we live in the market economy, the market is always right?!
No, the mathematics is always correct, not the market.
The market is just a bunch of humans and the people make the most stupid mistakes.
If the progressives don’t say this sad truth, who is supposed to step forward?
The right wing gurus like Trump and Koch Brothers, the very people who would lose the billions dollars by acting in the patriotic way?!
I seem to recall that when the ACA went into effect it was cited as having 2,500 pages of ifs, ands, buts, nors, and God knows what else. In Canada I read that their healthcare for all consists of only 1 page. It's time America embrace HEALTHCARE FOR ALL.
If obamacare did not have 2,500 pages of if ands and buts how would all of the useless parasitic bureaucrats that infest all levels of government be able to justify their overpaid, underworked existence?
I prefer a solution of universal Medicaid for all, with no reduction of the personal and business tax deductibility for premiums paid for employer-based insurance.
Medicaid does not provide as good coverage as Medicare does (because on average, poor people and children vote at a much lower rate than old people do) and so that implies allowing the lucky majority of people who have employer-based coverage to keep it in place for better coverage than the Medicaid "safety net for all."
Because things work the way they do, over time, employer-based insurance programs would gradually shrink and the safety net would gradually grow until eventually, we'd have what is effectively Medicare for all and only a fortunate few (members of congress and other wealthy elite) with privately paid or employer-based platinum coverage on top of the universal single payer system.
That result would eventually become a hybrid of the Dutch and UK systems, and somewhere along the way, we would find the middle ground that allows people to choose for themselves how much coverage they want on top of a universal safety net that covers preventative care and keeps routine issues out of the very expense emergency room services where they now end up.
The underuse of preventative care and the overuse of emergency services in lieu of lower-cost services that could have been provided to an insured patient are two of the main drivers for our extraordinary share of GDP spent on health care in the US.
Medicaid does not provide as good coverage as Medicare does (because on average, poor people and children vote at a much lower rate than old people do) and so that implies allowing the lucky majority of people who have employer-based coverage to keep it in place for better coverage than the Medicaid "safety net for all."
Because things work the way they do, over time, employer-based insurance programs would gradually shrink and the safety net would gradually grow until eventually, we'd have what is effectively Medicare for all and only a fortunate few (members of congress and other wealthy elite) with privately paid or employer-based platinum coverage on top of the universal single payer system.
That result would eventually become a hybrid of the Dutch and UK systems, and somewhere along the way, we would find the middle ground that allows people to choose for themselves how much coverage they want on top of a universal safety net that covers preventative care and keeps routine issues out of the very expense emergency room services where they now end up.
The underuse of preventative care and the overuse of emergency services in lieu of lower-cost services that could have been provided to an insured patient are two of the main drivers for our extraordinary share of GDP spent on health care in the US.
1
Perhaps a reasonable place to start would be if we citizens better understood some of the basics, e.g., the difference between universal care and single-payer care. After reading many comments here I'm not certain that we do. We have universal care now--Medicare, Medicaid, Tricare, VA healthcare, employer-sponsored insurance, and the ACA (although needing support and tweaking). It would also be helpful to understand differences in coverage, e.g., what coverage would be offered in single-payer? Would everyone need to buy supplemental policies, if so what would they cover? And how much would they cost? It seems that many do not like incrementalism but we could end up with incrementalism in coverages to the point that it would not be much better than we have now. We might be better off if we knew what we were asking for so that we could get it. Evidence-based healthcare has a significant role here. Healthcare is indeed complex and the devil is in the details.
2
Medicare is not free! Retirees who are on Medicare pay a percentage of their income every month and Medicare only pays 80% of services, and the retiree makes up the difference and/or pays for supplemental Medicare Gap insurance which can cost quite a bit, and the retirees pay for Part D (drug coverage) which has expensive co-pays and the dreaded 'doughnut hole' where drugs are not covered.
So in many cases ACA is not that bad.
So in many cases ACA is not that bad.
2
Sorry Times. Wrong photo, wrong subjects:Two obviously well off "Moms" in San Francisco are not what Progressive agenda needs as standard bearers, these two ladies, lovely as they are, I am quite sure are among the one percent, they would no longer be living in "the city by the bay" if they weren't. We are talking about the other ninety percent who got thrown under the bus by the techies and globalization, those who used to live a pretty good life in "Baghdad by the Bay" on thirty thousand a year, that won't even cover the rent on a studio apartment now. In 2005 I was paying nine hundred and fifty a month for a charming one bedroom apartment in San Mateo, that now rents for thirty five hundred, and Paul Kugmans column says there's no inflation? Please!
2
No, that's not inflation. It's called charging "what the market will bear", living the rest of us bare of a dwelling.
1
Wanderer: I understand housing does not meet the government criteria to count in the inflation index, sometimes referred to as the "Beige Book". This goes to show how far removed from the needs of ordinary citizens those making the rules are in as much as housing for the average person makes up by far the largest part of their paycheck, healthcare, food and insurance make up the rest, none of which show up on the radar of inflation for the very simple reason that things like Social Security benefits are tied to C.O.L.A., unlike Congress' Salaries whereby they just give themselves a raise when they feel like it, ditto with their retirement plans they are not tethered to a C.O.L.A. Index. Your point however is well taken and opens up an entire other discussion around immigration,, supply and demand, housing costs and job pay. These are all tied together and no matter how progressive or liberal you might think you are in a free market society(for some) unchecked they add up to a lower standard of living for the working class. Phew, good luck with a place to live in the Bay Area, I had a very successful business there for fifty years and still had to leave as I wasn't foresighted enough to buy a house and keep it years ago, plus I had a great landlord for forty years until she died and the kids cashed out and I drifted for a few years. San Francisco nor San Mateo today bear no resemblance to the place I grew up in and frankly you couldn't pay me to move back.
When I hear complaints about the ACA it always comes out that the insurance companies' nefarious dialing for profits , conspiring to pull out of some marketplaces , are at root . The CEO's take home an obscene amount of $$$.
This must end by a government run system which suppresses the costs of the providers ; tort reform, placing physicians on salary, uncoupling health coverage from employment....all at once !
This must end by a government run system which suppresses the costs of the providers ; tort reform, placing physicians on salary, uncoupling health coverage from employment....all at once !
1
I agree with Krugman. Let's not let the perfect get in the way of something good.
Dems are going to have to be flexible.
Dems are going to have to be flexible.
95
What you're asking then is that we let the "something good" get in the way of democracy.
And to describe the private insurance system as "something good" means that you have to ignore the fact that the US is ranked 36th in health outcomes, below Costa Rica.
And to describe the private insurance system as "something good" means that you have to ignore the fact that the US is ranked 36th in health outcomes, below Costa Rica.
Yes. Steady as she goes. Slow, incremental change. Baby steps. Just like Mrs. Clinton proposed. That is the way to go...if you want to see a second Trump term. Millions of us have had more than enough. We want real change. Now.
Uh, in case you haven't noticed, the Dems can't do anything anymore.
Our Children are Our Future
or something like that might work as a slogan.
Child Care, high quality pre-K for all, and better K-12 opportunities (requires funding and good policies, not vouchers) might be sold under this banner. Even prenatal care? Some of our child poverty, morbidity, and mortality rates are third world.
The same old problem raises its head: That's for "those people" at my expense. But, maybe that could be overcome. Focus on great photos of cute kids and their potential and the fact that they will be our doctors, pilots, local public works workers, etc. Worth a try.
or something like that might work as a slogan.
Child Care, high quality pre-K for all, and better K-12 opportunities (requires funding and good policies, not vouchers) might be sold under this banner. Even prenatal care? Some of our child poverty, morbidity, and mortality rates are third world.
The same old problem raises its head: That's for "those people" at my expense. But, maybe that could be overcome. Focus on great photos of cute kids and their potential and the fact that they will be our doctors, pilots, local public works workers, etc. Worth a try.
1
Among Republicans, only Lisa Murkowski, Susan Collins, and John McCain "stood their ground." Even those who knew the Republican Health Scam Bill was a scam -- and even those who openly said as much, such as Lindsey Graham -- voted the deplorable Republican party line. Even so, the magnitude of the astonishing failure of Paul Ryan and Mitch McConnell to deliver on the Republican party's repugnant 7-year campaign against the very well-being of Americans is being underreported and underestimated. Sixty symbolic votes in the House to kill Obamacare. A Ted "Showboat" Cruz government shutdown. Seven years of NO! while developing NOTHING! That's the kicker: Seven years of NO! while developing NOTHING! The final vote -- stood up to by Murkowski, Collins, and McCain -- was a vote on what? The anorexia of McConnell's "skinny repeal," the smoke and distorted mirrors of Speaker of the Funhouse Ryan.
Lamar Alexander has now stepped forth from these shameful shadows to begin atonement for one of history's greatest political debacles -- manning-up the fact that not just that progressives, but the remainder of Alexander's deeply misguided Republican cohorts on Capitol Hill, need to fix the A.C.A. and prevent its further sabotage by an ego-bitten president.
Lamar Alexander has now stepped forth from these shameful shadows to begin atonement for one of history's greatest political debacles -- manning-up the fact that not just that progressives, but the remainder of Alexander's deeply misguided Republican cohorts on Capitol Hill, need to fix the A.C.A. and prevent its further sabotage by an ego-bitten president.
77
". . . the Republican party's repugnant 7-year campaign against the very well-being of Americans . . ."
Now THAT'S an effective phrase! First time I've heard it. Why haven't we been hearing it for the last seven years??
Now THAT'S an effective phrase! First time I've heard it. Why haven't we been hearing it for the last seven years??
Campaign finance reforms, Infrastructure. Labor and workers rights. Raise the minimum wage. Raise level where overtime pay reaches salaried workers. Job training/work skills programs. Investments in technology and innovation. Collegiate/business partnerships. Climate/air/water/wildlife protections. Strengthen Social Security/Medicare/Medicaid/Behavior Health Care/Drug Addiction Programs.
Innovations for states to address Opioid Epidemic/Addictions/Substance Abuse/Alcoholism/Other problems affecting job entry and retention.
Real criminal justice reforms. Cyber Security. National Security. Military + Defense. NASA. Volunteerism. Innovative programs for Student Loans. Housing Fairness. Disability Rights. LGBTQ Rights. Re-establish Office of Women and Girls closed by Trump Administration. Strengthen the State Dept. weakened by Trump Administration. Fair Tax System. Billionaires pay fair share. Address off-shore tax havens/excesses of corporate welfare. Continue to address poverty, school lunches, assist states for creating innovative after-school recreation/leisure programs. Innovative crime prevention programs. Innovations in Business. Veterans Programs and Health. Strengthen Affordable Care Act/ Fund the subsidies. Early Childhood Education.
Strengthen Head Start & Pre-School Access. Paid family and medical leave.
Voting rights/ease of voting/end voter suppression/address racial justice/fairness/wall street/consumer finance/rural communities issues.
Student debt.
Innovations for states to address Opioid Epidemic/Addictions/Substance Abuse/Alcoholism/Other problems affecting job entry and retention.
Real criminal justice reforms. Cyber Security. National Security. Military + Defense. NASA. Volunteerism. Innovative programs for Student Loans. Housing Fairness. Disability Rights. LGBTQ Rights. Re-establish Office of Women and Girls closed by Trump Administration. Strengthen the State Dept. weakened by Trump Administration. Fair Tax System. Billionaires pay fair share. Address off-shore tax havens/excesses of corporate welfare. Continue to address poverty, school lunches, assist states for creating innovative after-school recreation/leisure programs. Innovative crime prevention programs. Innovations in Business. Veterans Programs and Health. Strengthen Affordable Care Act/ Fund the subsidies. Early Childhood Education.
Strengthen Head Start & Pre-School Access. Paid family and medical leave.
Voting rights/ease of voting/end voter suppression/address racial justice/fairness/wall street/consumer finance/rural communities issues.
Student debt.
The more the liberal - progressives push for an increased minimum wage, the greater the incentive for companies to replace increasingly more expensive no-skill / low skill workers with increasingly less expensive and more efficient automation. The end result will be greatly increased numbers of unemployed ex-minimum wage workers.
1
I love it. Our liberal columnists who should have been discussing for years how most countries pay for h/c for all, say it's not poltiicaly practical for the US. Then readers praise these columnists for their practicaity. These readers likely have excellent h/c they can afford.
So it's accepted that It's not practical for the US to live up to intl standards of 1st world nations, in mid 20th C or before. Canada started their h/c in 1960s. (they also avoided our 08 financial crash, by keeping their prudent banking regulations that the US repealed).
What's politically practical is for the US to keep excessive profits as the main priority in health care. Excessive profits are also the main priority in our elections. The big insurance and pharma donors get good returns on their investments in our candidates. The Supreme Court calls their money 1st amendment free speech.
We are stuck. What's the way out, when even our liberals in the media and politics can't combat big profit h/c AND elections?
So it's accepted that It's not practical for the US to live up to intl standards of 1st world nations, in mid 20th C or before. Canada started their h/c in 1960s. (they also avoided our 08 financial crash, by keeping their prudent banking regulations that the US repealed).
What's politically practical is for the US to keep excessive profits as the main priority in health care. Excessive profits are also the main priority in our elections. The big insurance and pharma donors get good returns on their investments in our candidates. The Supreme Court calls their money 1st amendment free speech.
We are stuck. What's the way out, when even our liberals in the media and politics can't combat big profit h/c AND elections?
2
Rather than attempt very difficult, all-or-nothing efforts to implement single payer, I've been wondering if states like Vermont and California would be better off supplementing the federal subsidies for ACA participants. This would not only make the plans more affordable for the presently insured, but also entice more healthy people into the system and stabilize the markets. Could this lead to lower rates basic rates, before subsidies are calculated? I would love to hear an economists opinion.
Very sensible acclimation policy towards an anxiety producing goal of universal coverage. Obama was politically astute in passing the ACA without disrupting the coverage of the majority of people who were satisfied with their medical insurance. Obama was achieved a political reform at the expense of a more idealistic instinct. As he said sometimes you hit singles and doubles. One reason that HRC is not President and failed at health care reform was that she was more enamored with her intellect and not in touch with the national pulse beat.
What’s the next for the progressives?
What about finally focusing on their personal progress and education instead of blaming everybody else and lecturing the entire world what and how they should be thinking, acting, believing and living....
The only objective the progressives achieved over the last quarter of century has been to polarize and divide us by compartmentalizing the country into the tiny corrals – the Caucasians, the African Americans, the Latinos, the Asian Americans, the straights, the gays, the transgenders, the feminists, the chauvinists, the racists, the conservatives, the liberals, the xenophobes, the progressives, the misogynists, the moderates, the extreme-right wing, the pro-life, the pro-choice, the atheists, the religious, the left, the right, the affordables, the non-affordables, the hawks, the pacifists, the spenders, the savers, the exporters, the importers, the rurals, the urbans, the reds, the blues, the northerners, the southerners, the coastals, the mainlanders, the citizens, the immigrants...
The progressives diligently track down the smallest distinctions among us and try to emphasize them in order to unite us...
After the concept failed, they blamed Donald Trump for the tragic consequences. Allegedly, the hundreds of millions Americans are perfect, it’s the single guy that destroyed our freedom, liberty and democracy...
What about finally focusing on their personal progress and education instead of blaming everybody else and lecturing the entire world what and how they should be thinking, acting, believing and living....
The only objective the progressives achieved over the last quarter of century has been to polarize and divide us by compartmentalizing the country into the tiny corrals – the Caucasians, the African Americans, the Latinos, the Asian Americans, the straights, the gays, the transgenders, the feminists, the chauvinists, the racists, the conservatives, the liberals, the xenophobes, the progressives, the misogynists, the moderates, the extreme-right wing, the pro-life, the pro-choice, the atheists, the religious, the left, the right, the affordables, the non-affordables, the hawks, the pacifists, the spenders, the savers, the exporters, the importers, the rurals, the urbans, the reds, the blues, the northerners, the southerners, the coastals, the mainlanders, the citizens, the immigrants...
The progressives diligently track down the smallest distinctions among us and try to emphasize them in order to unite us...
After the concept failed, they blamed Donald Trump for the tragic consequences. Allegedly, the hundreds of millions Americans are perfect, it’s the single guy that destroyed our freedom, liberty and democracy...
Here is the wrongful economic logic of the Nobel-Prize winner professor Krugman.
During the Bush Administration the budget deficits were terrible and detrimental to the national interests.
During the Obama Administrations the budget deficits were the source of social progress, wealth and economic revival.
Under the Trump Administration the budgets deficits are again terrible and detrimental...
Don’t waste your time on looking for the Krugman’s columns advising us a dozen years ago about the imminent dangers coming from the housing bubble.
As every scientist of the utmost integrity, Professor Krugman waited on the bubble to burst to be sure we were witnessing a real bubble... The FAKE economists believed all of us could get richer by endlessly selling each other the same pieces of property because the rising sales prices indicated the sustainable trend and sound market logic...
Simply said, if we were doing it then it must have been correct because we are the market! The market is supposedly always right in the market economy! Who cares about the basic mathematical principle like the adding and the subcontracting!?
It’s called the market economy, not the mathematical economy.
That’s why we are $20 trillion in debt – to cover up all the market’s structural deficiencies! The tragic truth is the market economy cannot sustain the balanced budgets and paying our bills!
It would deflate the stock market and all those paper-based trillion dollars would suddenly disappear!
During the Bush Administration the budget deficits were terrible and detrimental to the national interests.
During the Obama Administrations the budget deficits were the source of social progress, wealth and economic revival.
Under the Trump Administration the budgets deficits are again terrible and detrimental...
Don’t waste your time on looking for the Krugman’s columns advising us a dozen years ago about the imminent dangers coming from the housing bubble.
As every scientist of the utmost integrity, Professor Krugman waited on the bubble to burst to be sure we were witnessing a real bubble... The FAKE economists believed all of us could get richer by endlessly selling each other the same pieces of property because the rising sales prices indicated the sustainable trend and sound market logic...
Simply said, if we were doing it then it must have been correct because we are the market! The market is supposedly always right in the market economy! Who cares about the basic mathematical principle like the adding and the subcontracting!?
It’s called the market economy, not the mathematical economy.
That’s why we are $20 trillion in debt – to cover up all the market’s structural deficiencies! The tragic truth is the market economy cannot sustain the balanced budgets and paying our bills!
It would deflate the stock market and all those paper-based trillion dollars would suddenly disappear!
I always love that argument: it would be so hard to do and might not work, we better not try it. Welcome to the GOP.
What’s Next for Progressives? Would you consider jumping off the bridge? Moving to Canada? Mexico? Anywhere?
I'm amazed that Paul Krugman talks about healthcare again and again and never mentions Americas out of control costs. While the healthcare industry pours millions of dollars into Congressional donations/bribes, it seems impossible that our representatives will will take any action to protect us. There is hope however. Change in healthcare costs is going to require real vibrant public outcry. Our representatives are going to need to fear voters deserting them over this issue. Right now the low hanging fruit is the prescription drug industry. Americans hate these guys. Cut them out of the healthcare herd and they will become vulnerable. Action against them is not terribly complex. Congress needs to be willing to bargain for all Americans with the simple stated goal that we are not going to pay more than the other advanced countries. The New York Times could play a role in this by asking representatives, whenever they are interviewing them "Why Congress is not bargaining with the drug companies so Americans pay what the other advanced countries pay?" Get these people on record explaining over and over why this has to be so. Public outrage will increase as Americans become more aware that our Congress is deserting us in favor of the prescription drug lords.
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YES!!!! Health care costs today are treated like a hot potato -- everyone's focused on offloading them onto somebody else to alleviate pain and minimize loss. The ONLY solution is to reduce them to the point where they're manageable. When my epipens costs $2 in parts and drugs and $600 retail, THAT's the kind of outrage we need to target.
1
If Krugman were to mention "Americas out of control costs", he'd have to get honest about a major cost-driver: the the private insurance corporations he champions.
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"Big Pharma" calls the shots because for every member of Congress, there are five or six (I forget) lobbyists registered to them.
Even if 99.9% of Americans are behind reform, it only takes 535 to ignore their will.
Even if 99.9% of Americans are behind reform, it only takes 535 to ignore their will.
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Other countries provide new parents with extensive paid leave, provide high-quality, subsidized day care for children with working parents and make pre-K available to everyone or almost every - I wholeheartedly agree Paul!
I teach a class on family stratification and my students are always floored to learn that the US doesn't have paid parental leave, subsidized day care and universal pre-Kindergarten education. Ultimately, the conversation reverts to political parties and respective policies.
I teach a class on family stratification and my students are always floored to learn that the US doesn't have paid parental leave, subsidized day care and universal pre-Kindergarten education. Ultimately, the conversation reverts to political parties and respective policies.
Once again, it's clear that if anything drives a certain segment of the Left that doesn't know anything about health care and insurances right up the wall, it's being politely told that universal health insurance doesn't have to be single-payer.
By the way, a couple things.
1. Canada's sustem requires buying private insurance for pharmacy, dental, a lot of mental health services.
2. One pays into Medicare for four or five decades before using it, which makes the airy "oh, we'll just expand medicare," stuff just...stuff.
By the way, a couple things.
1. Canada's sustem requires buying private insurance for pharmacy, dental, a lot of mental health services.
2. One pays into Medicare for four or five decades before using it, which makes the airy "oh, we'll just expand medicare," stuff just...stuff.
2
Krugman's brand of zero to half hearted progressivism and failed neoliberalism is passe. It is time for all of us to commit to single payer medicare for all. ACA leaves too many uninsured, is overly complex, doesn't address the #1 problem with private health insurance (excessive profits), and will never overtake the benefit-cost ratios of European style health statute.
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Single-payer works around the world to bring the highest quality healthcare to all at the cheapest price. Private insurance companies are merely middlemen who add about $400 BILLION to our annual healthcare bill.
Certainly we can continue the Dutch and Swiss ways, which rely on private insurance. There will come a point where we realize that wasting trillions of dollars on profits and administrative costs of healthcare that isn't much higher in quality is a fools errand.
Certainly we can continue the Dutch and Swiss ways, which rely on private insurance. There will come a point where we realize that wasting trillions of dollars on profits and administrative costs of healthcare that isn't much higher in quality is a fools errand.
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FALSE FALSE FALSE- There are only a few "single payer" systems.
As Krugman points out- all the developed nations have UNIVERSAL COVERAGE... how they get their dramatically varies.
I suggest watching "Sick around the world" a multi-part investigation on Frontline about the various health coverage methods
As Krugman points out- all the developed nations have UNIVERSAL COVERAGE... how they get their dramatically varies.
I suggest watching "Sick around the world" a multi-part investigation on Frontline about the various health coverage methods
I cannot believe this used to be my favorite column in the Times. Before the last election, that is. Professor Krugman's arguments here aren't even logical.
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Krugman is a Hayek except on mild anti-cyclical measures.
Of course, he is for single payer so long as Westchester did not have to pay more taxes. So instead of going for some reasonable step in the right direction, he wants to retain Heritagecare with enormous deductibles, mandates that much of the population cannot pay, and a payoff to the insurance companies.
Those on employer insurance are already complaining about rising premia. If health care were replaced by a corporate tax and an increase in capital gains taxes that compensated for their health expenditures and Ted Cruz's proposal of replacing the Social Security tax with a vat and sold as a removal of all employer premias and security if one loses their job.
But it means a tax increase on Westchester so obviously the Heritage plan is much better.
Of course, he is for single payer so long as Westchester did not have to pay more taxes. So instead of going for some reasonable step in the right direction, he wants to retain Heritagecare with enormous deductibles, mandates that much of the population cannot pay, and a payoff to the insurance companies.
Those on employer insurance are already complaining about rising premia. If health care were replaced by a corporate tax and an increase in capital gains taxes that compensated for their health expenditures and Ted Cruz's proposal of replacing the Social Security tax with a vat and sold as a removal of all employer premias and security if one loses their job.
But it means a tax increase on Westchester so obviously the Heritage plan is much better.
Single payer / Medicare for all is a baby that can only be born by caesarean section. My problem with an incremental approach is that as long as the insurance industry has a pulse they are going to fight to keep what they have. Lobbying, scary commercials about the evils of single payer, etc, are very effective ways to maintain things the way they are. Americans have proven to be easily led around by the noses of their screens. Remember telemarketing? Remember the doom and gloom around the loss of all those jobs? Well, they're gone and life has gone on. It could be the same way for the health insurance industry. Perhaps those unemployed health insurance workers could find jobs taking care of sick people instead of shortening their lives with paperwork, phone calls and indecipherable drug formularies.
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The Democrats must embark on a campaign of social building akin to Roosevelt's promises of a great society, which he accomplished by the same campaign. The time is long gone when piecemeal program promises won votes. An entirely new wave of progress must be put forward encompassing many ideas, not just a few.
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Pardon my possible error. I think it may have been Johnson who promised the great society.
Agree Patrick, but it will likely require another Great Depression to muster the resolve to make it happen - yet another hard lesson of history we'll be forced to re-learn.
Here's what I read in this column. Krugman thinks the USA is more likely to get to full medical coverage through improvements to the ACA and points out that The Netherlands has such a system. He proposes a government option within the ACA. He argues for improving early childhood programs, paid family leave for new parents, and universal day care.
Yet to many of those posting comments, this amounts to a betrayal of 'progressive' principles. I don't get it! Being 63 and having lived through the Vietnam war, Nixon, Reagan, Bush/Cheney/Iraq War, and now Trump, I want 'progress' and don't want to fight over the definition of 'progressive'. If we had a significantly improved ACA, day care, and paid family leave for new parents would it be a bad thing?
Yet to many of those posting comments, this amounts to a betrayal of 'progressive' principles. I don't get it! Being 63 and having lived through the Vietnam war, Nixon, Reagan, Bush/Cheney/Iraq War, and now Trump, I want 'progress' and don't want to fight over the definition of 'progressive'. If we had a significantly improved ACA, day care, and paid family leave for new parents would it be a bad thing?
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You seem to be suggesting a bargain of either single payer/Medicare for all or paid family leave, etc. Republicans won't buy into any such bargain. Instead they will fight tooth and nail to prevent ANY of it from happening and perhaps even roll back some what now exists... unless a corporation can make a bunch of money out of it, of course.
Progressives should not leave the health arena so quickly as that. True, moving to single payer would be a big leap, as politically difficult as Mr. Krugman says. But there is wide-spread public support for addressing the skyrocketing cost of prescription drugs, especially long-term maintenance drugs, which are major drivers of heath care and, therefore, heath insurance costs. It is those untamed costs that lie at the root of dissatisfaction with the ACA, that premiums and deductibles are too high, not resistance to the individual mandate, per se, nor ideological opposition to government involvement in health care. An easy start would be permitting Medicare, with its leverage, to negotiate what it pays for prescription drugs. A second, easy step would be permitting the purchase of identical, FDA approved drugs from outside the U.S. Then there is much more and more difficult work to be done revising patent law and the F.D.A. approval process, both to make it less expensive for companies to move new drugs to market and, in return, move those drugs more quickly to generic.
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Thank you for persisting on the health INSURANCE issue. You have outlined some very practical options. Commonwealth Fund report link is well worth reading. Comparing health care performance across nations is a good starting place to begin to get a handle on a path forward in health care delivery.
Your ideas for building on the A.C.A. are rational. There were also some excellent ideas in the commentary.
I believe we should accept your and other proposals to offer a public option alongside the existing systems. Where all you really need to do is ENROLL and agree to pay a certain percentage of your income to cover yourself and family members. The deduction to be determined by the actual actuarial performance probably taken from the existing Medicare/Medicaid data. The coverage should be designed for full health care: dental, eyes, hearing, mental, regular check-ups including monitoring for skin cancer and total physiological/endocrine performance.
What's next should be to delve into cost issues, and the clinical diagnostic and therapy systems that have been designed to cure dysfunctions.
I also believe more effort should be devoted to injury and disease prevention.
I specialize in transportation and strongly believe that we can cut the nearly 1 Trillion dollar annual costs of highway traffic fatalities and injuries. We can do much better in providing better mass transit. A 300 mph national Maglev network will save every American $1,000 per year for life.
Your ideas for building on the A.C.A. are rational. There were also some excellent ideas in the commentary.
I believe we should accept your and other proposals to offer a public option alongside the existing systems. Where all you really need to do is ENROLL and agree to pay a certain percentage of your income to cover yourself and family members. The deduction to be determined by the actual actuarial performance probably taken from the existing Medicare/Medicaid data. The coverage should be designed for full health care: dental, eyes, hearing, mental, regular check-ups including monitoring for skin cancer and total physiological/endocrine performance.
What's next should be to delve into cost issues, and the clinical diagnostic and therapy systems that have been designed to cure dysfunctions.
I also believe more effort should be devoted to injury and disease prevention.
I specialize in transportation and strongly believe that we can cut the nearly 1 Trillion dollar annual costs of highway traffic fatalities and injuries. We can do much better in providing better mass transit. A 300 mph national Maglev network will save every American $1,000 per year for life.
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So what if a single payer Medicare for all plan would be difficult. I expect my government to do difficult things for the American people. Instead, for the past 8 years or so, they've barely been keeping the lights on. We face a possible government shutdown this year over raising the debt ceiling and/or because Trump absolutely insists on getting his border wall. I want a win---not a draw as the Obamacare repeal failure was--for the American people. I don't need Obamacare and I'm already on Medicare, but is this too much to ask.
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Progressives are badly served by shallow political advice like this from Paul Krugman that obscures the reality working people actually face and undermines the fight for our values and program. Unlike the Right, who fight on ideological terrain for long term transformative victories (see the Powell memo of 1971), "progressives" are looking to solve problems immediately, and inevitably accommodating the status quo. As Krugman advices when it comes to healthcare, but he misses the point - health is not a commodity, it doesn't belong in the "market," it is a human right. That's what Australia, the Netherlands and the U.K. have in common. They do not conflate "coverage" with healthcare. Those countries guarantee healthcare. Having health insurance in America doesn't prevent medical bankruptcy or denied care. In the US, employer based healthcare creates great uncertainty for workers, as premiums and out of pocket costs increase, reflecting costs shifted from the company to workers to fund the profits of the insurance companies. Only 55% of employers offer coverage. 60-70% of healthcare spending comes from taxes. We 're not getting our monies worth - and wasting huge resources that could go to higher wages, child care and pensions. Single Payer is the reform that establishes health security, and enables greater equality and freedom, which are values worth fighting for.
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For true progressives everything is not measured in MONEY. The Common Good is what we need to be selling, not a nickel and dime chart to show selfish people how Healthcare for All might not hurt them in their every lovin' wallets.
The big idea behind all this is The Common Good, The New New Deal and We are all in this Together! Blow the economic arguments of selfishness out of the water with a whole new worldview.
The big idea behind all this is The Common Good, The New New Deal and We are all in this Together! Blow the economic arguments of selfishness out of the water with a whole new worldview.
Evolution is far easier than revolution. I am the age of the second year of the baby boomers. The curve in mass numbers will shift markedly as my cohort dies off .... So, let's commit to a reducing the age for Medicare by five years then repeat every third year until we get to 20--takes awhile and I guess that once the program starts we'll finally just make it universal. Or you could do it 2 years back every year. Someone with the numbers ready to hand could produce an optimal reduction time that doesn't make huge indents. As for the employer insurance, I'm guessing that the employers and insurers will actually like transferring the eldest people to medicare.
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"Evolution is far easier than revolution."
If that were true, we would all be enjoying British tea and scones right now.
If that were true, we would all be enjoying British tea and scones right now.
This is sensible, but interim. I am waiting for PK to weigh in on the two large, defining economic problems that are the real root of all the pain this issue causes. The incredible bloat of administrative expenses engendered by all the layers siphoning money between patients and their providers, no added value. And the necessity of having someone with teeth on the pay side to negotiate with Pharma et al...someone has to be able to deliver a meaningful No to medical usury.
If I were setting priorities for the Democratic party I would follow Bernie Sanders' lead on campaign contributions. He proved that, with the right message, politicians do not need to rely on big money special interests to fund a viable national campaign. (If Schultz and the DNC had not sabotaged Sanders in the primary, he may have beaten Clinton and surely would have beaten Trump).
As we have seen, the "people's work" is not going to get done as long as big money special interests control our politicians and the national agenda. (Hillary was far too beholden to her arge corporate contributors to be a viable Democratic candidate).
So, 1) get rid of big money in politics; 2) fix the ACA; 3) lower the age of eligibility for Medicare to 55; 4) fix our crumbling infrastructure, and; 5) raise taxes on the rich who have done phenomenally better than any other group of people in this country for the last 30 years. This is where I would start.
As we have seen, the "people's work" is not going to get done as long as big money special interests control our politicians and the national agenda. (Hillary was far too beholden to her arge corporate contributors to be a viable Democratic candidate).
So, 1) get rid of big money in politics; 2) fix the ACA; 3) lower the age of eligibility for Medicare to 55; 4) fix our crumbling infrastructure, and; 5) raise taxes on the rich who have done phenomenally better than any other group of people in this country for the last 30 years. This is where I would start.
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Oh, look Krugman is pushing the delusion that many people with employer based medical coverage are happy with that coverage. He's clearly never heard of high deductibles and high co-pays--things that don't exist in the Canadian system.
Oh, sure there are excellent plans for executives to whom a 10,000 dollar a year deductible is nothing, and there are some good union plans, which the workers pay for, left.
So more excuses for Hillary Clinton.
Oh, and the Dutch system doesn't use for-profit insurers and the insurers are much more highly regulated than in the USA.
Oh, sure there are excellent plans for executives to whom a 10,000 dollar a year deductible is nothing, and there are some good union plans, which the workers pay for, left.
So more excuses for Hillary Clinton.
Oh, and the Dutch system doesn't use for-profit insurers and the insurers are much more highly regulated than in the USA.
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BEFORE we seek "Medicare for all," a very good first step would be to introduce the idea that Medicare CAN cover all. This is easily accomplished, PLUS it would bolster the PPACA and fill in the insurance coverage gaps in rural states. All that is necessary is a law directing the Centers for Medicare and Medicaid Services ("CMS") to establish a community rate to allow people to sign up for Medicare who are not already eligible. It doesn't even have to be a break-even rate, they could tack on 5 or 10% and still cost at least a third less than commercial insurance. And, if they did go with the cost-plus rate, the added income would help firm up CMS's financials going forward. The point here is that a) it wouldn't cost the government a cent, b) coverage would be optional, people could sign up for it during the annual enrollment period if they want, c) we'd get some general public experience with Mediare as insurance, and d) it could even help towards defraying the operating cost of Medicare now.
I hope that sane and energetic candidates emerge soon...for local, state and national offices. We need a hungry press, while keeping us aware of the failings of our present administration, to highlight these rising stars. It is important for America to know their elected officials...look what happened when we didn't. I hear various PBS talk shows that mention or have as guests the saner voices of a new generation of Progressives hungry to serve and protect our nation. They need the help of the press because they do not have the nefarious financial backing of the GOP oligarchs and corporate interests. And I urge all voters to pay attention to local and state elections. Many states have moved toward beneficial governing and proactive productive action without a guiding hand from federal officials. If we want to save our country, then we all have to roll up our sleeves and get to work. And once again, we need the help of the media to not let viable, honest candidates fade into obscurity for lack of funding.
While ACA is a step in the right direction, single-payer is the best plan for the future. ACA will always be vulnerable to attack by GOP.
An important thing to note was the difficult start for the ACA. It was not popular until got used to it and realized the GOP really just wants to give more money back to the wealthy at the expense of everyone else. Single-payer might start down a difficult road but would most likely be so popular in a bit of time that no one, except the richest, would want it gone.
In a modern, prosperous society no one should suffer for lack of access to health care. Some fights are worth having.
An important thing to note was the difficult start for the ACA. It was not popular until got used to it and realized the GOP really just wants to give more money back to the wealthy at the expense of everyone else. Single-payer might start down a difficult road but would most likely be so popular in a bit of time that no one, except the richest, would want it gone.
In a modern, prosperous society no one should suffer for lack of access to health care. Some fights are worth having.
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{'m a progressive, but Professor Krugman is correct. If you were to initiate single payer at this point, you would likely anger a significant percentage of the populace that has all, or a large part, of their insurance premiums paid for by their employer. For these people, substituting a system where they would have to pay more than what they are now paying would not sit well. These people would be forever lost from theranks of voting Democratic again.
The biggest part of a solution to the health care crisis, is the single payer option. Private insurance companies would have competition, and if they dropped out of the market, the government option would be available.
The biggest part of a solution to the health care crisis, is the single payer option. Private insurance companies would have competition, and if they dropped out of the market, the government option would be available.
I'm one of those who get their health insurance through their employer, and I doubt I would pay more for my health care should single-payer be instituted. Even if I did, I prioritize people, especially children, the elderly, and the disabled, over money and would willingly pay my share to help provide for others. In addition, I can almost guarantee that I will never ever vote for a republican because that party quite obviously values money over people.
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Premiums are not "paid" by employers. A contribution to premiums is made as part of the overall compensation package. The employer is well aware of the cost and takes it into account setting wages.
Back in the throes of the ACA debate, I calculated the total market capitalization of all the listed major insurers and discovered that it was under $150 billion. The government could have launched a TOB with a hefty premium of, say, 40% for $210 billion.
They would then obviously be delisted and turned into non-profits. Employees would be retained but new hires frozen.
Then we would have Medicare for All through the market mechanism.
I wonder what it would cost now.
They would then obviously be delisted and turned into non-profits. Employees would be retained but new hires frozen.
Then we would have Medicare for All through the market mechanism.
I wonder what it would cost now.
Ironically, population density stress is the underlying cause of all of our current "diseases of civilization", none of which occur in contemporary hunter-gatherer societies living in their traditional manner. The otherwise prescient and honest NYT usually bans me from saying this, but the last thing we need for better health is more humans on earth. Single-child families will do more to improve our overall health than any delivery system reform, although the improved efficacy of single payer and national healthcare systems is well known world-wide. Stress R Us
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Absolutely unrestrained population growth is mankind's greatest threat. We human beings are parasites on the earth, each consuming natural resources and leaving a trail of waste that is backing up.
Birth control education should be the order of the day, starting in all third world countries where the slums of overcrowding and ignorance is at it's worst.
Taught religious ignorance around the subject is a major impediment to a sustainable population. The seas are being depleted, climate change is threatening all seaside cities in the world and ignorance seems to prevail over logic. I have small faith the world as we know it will survive unless population control begins in earnest, yet all positive economic increase is based on continued population expansion. It is a paradox of greed and ignorance that seems to prevail.
Birth control education should be the order of the day, starting in all third world countries where the slums of overcrowding and ignorance is at it's worst.
Taught religious ignorance around the subject is a major impediment to a sustainable population. The seas are being depleted, climate change is threatening all seaside cities in the world and ignorance seems to prevail over logic. I have small faith the world as we know it will survive unless population control begins in earnest, yet all positive economic increase is based on continued population expansion. It is a paradox of greed and ignorance that seems to prevail.
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The 800-pound gorilla in the US system is for-profit health insurance. For-profits have a fiduciary duty to maximize return on investment. Externalizing much of the cost of healthcare to the subscriber is a major way they do this. Denial of care, under-coverage, & limits are other ways.
BTW, the Veterans' Administration is Socialized, like the UK's NHS & a Rand study pre-ACA found it better than Medicare & MUCH better than for-profit care.
It isn't enough to cap industry profits. Our lobbyist/politician alliance will inevitably undermine them.
Medicare is NOT a single-payer system as you have to pay for private medi-gap insurance to cover what Medicare doesn't. Medicare Part D suppliers are raising their drug prices and monthly subscription payments every year by far more than the rise in the cost of living. Not all hospitals or doctors will agree to Medicare's limits & refuse it or bill for costs it doesn't cover.
Single-Payer can and has been made to work. An alternative is requiring that all private insurers be non-profit & giving subsidies for those who still can't afford it as was the practice before Nixon & HMOs.
Ford & GM have plants in Canada since they don't have to pay for employee insurance, decreasing their cost of production - single-payer's best boosters. Google "Tommy Douglas" to see how Canada's system started. He was voted "Most Popular Canadian" recently.
BTW, there is a far higher percentage of doctors in private practice in Canada than in the US.
BTW, the Veterans' Administration is Socialized, like the UK's NHS & a Rand study pre-ACA found it better than Medicare & MUCH better than for-profit care.
It isn't enough to cap industry profits. Our lobbyist/politician alliance will inevitably undermine them.
Medicare is NOT a single-payer system as you have to pay for private medi-gap insurance to cover what Medicare doesn't. Medicare Part D suppliers are raising their drug prices and monthly subscription payments every year by far more than the rise in the cost of living. Not all hospitals or doctors will agree to Medicare's limits & refuse it or bill for costs it doesn't cover.
Single-Payer can and has been made to work. An alternative is requiring that all private insurers be non-profit & giving subsidies for those who still can't afford it as was the practice before Nixon & HMOs.
Ford & GM have plants in Canada since they don't have to pay for employee insurance, decreasing their cost of production - single-payer's best boosters. Google "Tommy Douglas" to see how Canada's system started. He was voted "Most Popular Canadian" recently.
BTW, there is a far higher percentage of doctors in private practice in Canada than in the US.
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That's why the private insurers shareholders need to be bought out (see my comment above).
You seem not to have gotten his cogent point, in choosing to offer a treatise on the virtues of single-payer. The virtues of adopting single-payer given a de novo slate are clearly attractive, but we are not in de novo circumstances. What is in play is elaborate and extensive so it would be better to choose an evolutionary approach - such as Holland's - as a next stage of development of ACA, given serious political realities that make a huge incipient fight not worth the incremental advantages offered by single-payer. The great virtue of the Dutch is that they balance theory of conception with the mechanic's/tinkerer's flare for getting stuff done, sensibly and efficiently, GIVEN EXISTING CIRCUMSTANCES. Would that US would adopt the approach of shifting the balance from policy 'architects' to 'mechanics' who know how to make complex processes work robustly.
A shift to a single payer system anytime soon is a progressive fantasy, though it's what we'll hopefully eventually wind up with. There are simply too many people making too much money from the present status quo to hope that anything can change in the near future. I'm an advanced practice nurse who's worked in health care for nearly 40 years and I've seen it morph into an entirely money-driven enterprise. Most health care companies look at you, a patient, exactly the same way your local speedy lube shop looks at a 2010 Chevy Malibu coming in for an oil change. Any kind of a change to a system where people actually matter will take a very long time.
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Professor Krugman is spot on about the difficulties unraveling the employer coverage for 156 million people. Most large employers subsidize 75% of the premium cost. Moving these individuals to single payer would require raising their taxes more than their premiums currently are in order to bring those with less subsidies up to that same 75% level. Many on the exchanges are not getting a 75% subsidy, especially those who are still opting out and paying the penalty. So this would be challenging politically at the moment. Another recession where employers gut their coverage by 10% might change that political dynamic
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"single payer would require raising their taxes more than their premiums currently are"
Wrong, a single-payer system would obviously mandate that employers maintain the same level of TOTAL compensation......meaning if the employer spends $7,500/year on an employees health insurance....that $7,500 would instead be paid as additional salary/income.
Without such a mandate, single-payer would be a massive windfall for corporations/businesses.
Wrong, a single-payer system would obviously mandate that employers maintain the same level of TOTAL compensation......meaning if the employer spends $7,500/year on an employees health insurance....that $7,500 would instead be paid as additional salary/income.
Without such a mandate, single-payer would be a massive windfall for corporations/businesses.
I am tired of incremental approaches. We have been burned again and again and again. Let's take the profit out of healthcare.
2
There you again Prof. Advocating incremental change when people are ready for a little radical change such as Medicare for all. It's like riding a bike downhill and applying the brakes when there are no cross streets and you have the road to yourself. Live a little Prof. It's ok...no one will think of you less.
1
"Moving to single-payer would mean taking away this coverage and imposing new taxes"
This is the only truthful thing Krugman has every written on heath insurance. You get bet you last dollar that "they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old." Would NOT be the case.
In keeping with Krugman’s radical socialist (err, I mean liberal) agenda taxes would be high, paid for solely by the middle class, and coverage would be poor with higher out of pocket costs and degraded access. But it would be a “SUCCESS” damn it!
As for parental leave etc, I foolishly ask why parents should be paid more for the same work as those without children?
Put together the whole "liberal" package, unlimited unchecked immigration, free health care/day care/ education, housing/retirement, for the indigent all happily paid for by a minority working class. What nirvana.
This is the only truthful thing Krugman has every written on heath insurance. You get bet you last dollar that "they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old." Would NOT be the case.
In keeping with Krugman’s radical socialist (err, I mean liberal) agenda taxes would be high, paid for solely by the middle class, and coverage would be poor with higher out of pocket costs and degraded access. But it would be a “SUCCESS” damn it!
As for parental leave etc, I foolishly ask why parents should be paid more for the same work as those without children?
Put together the whole "liberal" package, unlimited unchecked immigration, free health care/day care/ education, housing/retirement, for the indigent all happily paid for by a minority working class. What nirvana.
Lady: I don't know where you learned a political lexicon, but to describe Krugman's agenda as radical socialist is straight out of the oligarchs' and plutocrats' play-book.
Wow!
Almost sounds like a reasonable, post-Twit, discussion of real issues...
Is there light at the end of the "false news", fake president tunnel?
Almost sounds like a reasonable, post-Twit, discussion of real issues...
Is there light at the end of the "false news", fake president tunnel?
1
Obamacare cares for the sickest and poorest - it will be the most expensive by default. I doubt any for profit company wants to cover them. This is the slippery slope of for profit and 'care' - like oil and vinegar. For profit insurance companies are all trying to screw people out of coverage or payments - it's how they get rich. I should know. We have a few of these in my state and I know people whose jobs are to deny coverage.
Also...
Stupid Democrats are terrible at soundbites & cutting arguments that will cut down any conservative hate-arguments. This is what the Left needs - messaging. Strong messaging that is 2 words. They ain't easy to create, but when they are good, they circle the globe in hours.
Also...
Stupid Democrats are terrible at soundbites & cutting arguments that will cut down any conservative hate-arguments. This is what the Left needs - messaging. Strong messaging that is 2 words. They ain't easy to create, but when they are good, they circle the globe in hours.
"Moving to single-payer would mean taking away this coverage and imposing new taxes"
This is the only truthful thing Krugman has every written on heath insurance. You get bet you last dollar that "they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old." Would NOT be the case.
In keeping with Krugman’s radical socialist (err, I mean liberal) agenda taxes would be high, paid for solely by the middle class, and coverage would be poor with higher out of pocket costs and degraded access. But it would be a “SUCCESS” damn it!
As for parental leave etc, I foolishly ask why parents should be paid more for the same work as those without children?
Put together the whole "liberal" package, unlimited unchecked immigration, free health care/day care/ education, housing/retirement, for the indigent all happily paid for by a minority working class. What nirvana.
This is the only truthful thing Krugman has every written on heath insurance. You get bet you last dollar that "they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old." Would NOT be the case.
In keeping with Krugman’s radical socialist (err, I mean liberal) agenda taxes would be high, paid for solely by the middle class, and coverage would be poor with higher out of pocket costs and degraded access. But it would be a “SUCCESS” damn it!
As for parental leave etc, I foolishly ask why parents should be paid more for the same work as those without children?
Put together the whole "liberal" package, unlimited unchecked immigration, free health care/day care/ education, housing/retirement, for the indigent all happily paid for by a minority working class. What nirvana.
"there are more important things to get done than Medicare for All" per Paul Krugman. People health is not that important? People who are unhealthy cost taxpayers lot of money in many little ways Paul.
You did not talk about medical expenses going thru the roof and drugs costs? What is going to drive down those costs with private for profit insurers and pharma without regulations or.....
I applaud you for bringing up the other countries that give their citizens healthcare benefits. Never heard nothing from corporate media about maybe studying other systems across the world? No republicans and democrats have to re invent the wheel in disastrously outcomes because we are so exceptional and cannot look to the rest of the world.
You did not talk about medical expenses going thru the roof and drugs costs? What is going to drive down those costs with private for profit insurers and pharma without regulations or.....
I applaud you for bringing up the other countries that give their citizens healthcare benefits. Never heard nothing from corporate media about maybe studying other systems across the world? No republicans and democrats have to re invent the wheel in disastrously outcomes because we are so exceptional and cannot look to the rest of the world.
The most important progressive agenda item is the environment. Period.
We are on a collision course to a terrible destiny if we don't change directions. 75 years from now we will be labeled "the Worst Generation" because we spent all our time rearranging deck chairs on the Titanic rather than navigating a plausible safe passage.
We are on a collision course to a terrible destiny if we don't change directions. 75 years from now we will be labeled "the Worst Generation" because we spent all our time rearranging deck chairs on the Titanic rather than navigating a plausible safe passage.
2
The ACA could have had a single payer option if it hadn't been blocked by Joe Lieberman, the Senator from United Health, Aetna & the other usual suspects.
Why do American healthcare & pharmaceuticals have unlimited profits, not to mention executive salaries? Neither provides any extra benefit to the consumer or our Republic. The overhead costs of health insurance & Big Pharma, not to mention the smirking face of Martin Shkreli, could be Exhibit "A" for what's wrong with our National Healthcare system.
Why do American healthcare & pharmaceuticals have unlimited profits, not to mention executive salaries? Neither provides any extra benefit to the consumer or our Republic. The overhead costs of health insurance & Big Pharma, not to mention the smirking face of Martin Shkreli, could be Exhibit "A" for what's wrong with our National Healthcare system.
Harkins and Mikulski, the health powers in Congress, said that Obama had the votes for single payer when he had 61 Senators, but, of course Summers, who is as conservative as Krugman, didn't want to spend the money. Obama gave him and the Citigroup team all power.
We are Liberals and proud of it.
2
Agreed, everyone is exhausted of the healthcare debate. Let's fix the ACA and move on.
Dr. Krugman is right, as usual. Democrats will only drive voters away with Medicare for All. It doesn't poll all that well. Plus, that 10-15% of overhead difference with other countries (let's call it $350 billion/year in savings) is over a million jobs eliminated, so there would be a sizable transition cost.
Let's focus on covering the rest. There are 27 million uninsured, 22 million if you exclude undocumented immigrants (we're talking about the 64 & under population). Expanding Medicaid in the remaining states would cover about 3 million. About half cite cost as the main reason they don't have insurance, so higher subsidies (and stiffer mandate) should get most of the rest into the program.
Obamacare pays about $40 billion/year in subsidies to 10 million people, so it's very affordable even at 2x that, when you consider we give $250 billion in tax breaks to the top 1% each year (i.e., deductions, exemptions, and preferential rates).
Kaiser has an excellent study on the uninsured:
http://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-po...
Let's focus on covering the rest. There are 27 million uninsured, 22 million if you exclude undocumented immigrants (we're talking about the 64 & under population). Expanding Medicaid in the remaining states would cover about 3 million. About half cite cost as the main reason they don't have insurance, so higher subsidies (and stiffer mandate) should get most of the rest into the program.
Obamacare pays about $40 billion/year in subsidies to 10 million people, so it's very affordable even at 2x that, when you consider we give $250 billion in tax breaks to the top 1% each year (i.e., deductions, exemptions, and preferential rates).
Kaiser has an excellent study on the uninsured:
http://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-po...
4
Medical care should be a human right, not an industry. I don't give a rip if 1 million people lose their jobs due to a transition to Medicare for everyone. That just underscores how bloated and inefficient our current system is.
You can sell Medicare for everyone if you pitch it properly. The math is on your side. No other nation spends as much as we do on health care and gets worse results. If you can't sell that, well, you must be stupid or on the take. Or both.
You can sell Medicare for everyone if you pitch it properly. The math is on your side. No other nation spends as much as we do on health care and gets worse results. If you can't sell that, well, you must be stupid or on the take. Or both.
93
Agreed and the coalition to get to Medicare for all is there for the taking. Really, what business really wants to have to have to pay for in-house staff or an outside firm dedicated to managing the company medical plan? What doctor's office really wants to have to have dedicated staff that do nothing except take patients' insurance information, file endless paperwork and then negotiate with the companies over what they will or will not cover? The practical economic argument for single-payer has just as much of a natural constituency as the argument for basic humanity in taking care of our people.
1
People don't trust the government, and with some reason: Recently, the president said that you can keep your doctor and your health insurance plan if you want to. He was outrageously wrong. So if 150+ million people like their current work-provided health insurance, they understandably don't want to buy a pig in a poke by throwing away their current insurance for a proposed idea.
Krugman explains even in this brief article why Medicare for all would be a tough sell.
Contra your medical care as a human right statement, I think it is the right thing do, i.e., the ethical position. But are rights carved in stone? Worthwhile benefits are granted by humane, decent societies, and thus worth striving for. I wish we all agreed to provide the benefit of medical, dental, etc., treatment to those needing it, which is all of us, sooner or later.
But if you force someone to give or participate in charity, it takes away all the beneficial aspects of compassion; it turns a warm, beautiful transaction into a cold, dead, irritating act. It's like singing "Happy Birthday" to someone you loathe.
Krugman explains even in this brief article why Medicare for all would be a tough sell.
Contra your medical care as a human right statement, I think it is the right thing do, i.e., the ethical position. But are rights carved in stone? Worthwhile benefits are granted by humane, decent societies, and thus worth striving for. I wish we all agreed to provide the benefit of medical, dental, etc., treatment to those needing it, which is all of us, sooner or later.
But if you force someone to give or participate in charity, it takes away all the beneficial aspects of compassion; it turns a warm, beautiful transaction into a cold, dead, irritating act. It's like singing "Happy Birthday" to someone you loathe.
Spoken like a man who has always enjoyed health care security. Walk a mile in my shoes, Mr. Krugman. 22+ years of a high-deductible individual policy. Never met a deductible; paid my way entirely, on top of premiums that tripled in the eight years before the ACA finally came along to limit the rise with tax subsidies. Shrinking networks. Deductible increases. Reading with horror about obscenely high pricing, especially for the wild west of prescription drugs. Trying my best to stay healthy on my own. And always, always, the fear of financial ruin from an injury or illness. Don't you understand, Mr. Krugman? In all those other countries with systems you say it's *just too difficult* to emulate, people don't have that fear. How dare you tell me to move on? How dare you bring up the 156,000,000 who cling to our employer-based system and are "satisfied" with it? I've finally reached Medicare age -- sweet relief! -- but I won't stop fighting for health care security for all Americans. P.S. Health care security and child care are not an either/or!
2
Guess we'll have to wait for Edsall's comparative stats on single payer plans before we know how the magic of healthcare works in advanced economies??
1
Unwittingly, the GOP has handed us a golden opportunity to transform our bloated, dysfunctional healthcare system that serves no one but the privileged few profit seekers and Dr. Krugman stubbornly sticks to failed pragmatism.
So what if Medicare For All is a daunting task and a heavy lift? Our system is broken beyond repair and I'll be damned if I'll sign off on handing billions and billions of additional dollars in the form of bribes and payoffs to parasites that add nothing to the equation of improving healthcare and security for our citizens.
Good luck getting insurance companies to do anything but protect their self interests but Dr Krugman, the realist, insists we have to keep them around and rely on them for our very lives and human dignity.
I really thought the election of Donald Trump , an embarrassment, an obvious fraud and phony would snap Dr Krugman out of his Neoliberal funk , but it appears he's like the Democratic Establishment, lost and unable to imagine and deliver the structural reform desperately needed.
We , emphasis we, devote vast sums on healthcare in this country and it's time we aggressively and unwaveringly disrupt the system to serve the people first . Rent seekers and parasites can hit the pike. Good riddance.
So what if Medicare For All is a daunting task and a heavy lift? Our system is broken beyond repair and I'll be damned if I'll sign off on handing billions and billions of additional dollars in the form of bribes and payoffs to parasites that add nothing to the equation of improving healthcare and security for our citizens.
Good luck getting insurance companies to do anything but protect their self interests but Dr Krugman, the realist, insists we have to keep them around and rely on them for our very lives and human dignity.
I really thought the election of Donald Trump , an embarrassment, an obvious fraud and phony would snap Dr Krugman out of his Neoliberal funk , but it appears he's like the Democratic Establishment, lost and unable to imagine and deliver the structural reform desperately needed.
We , emphasis we, devote vast sums on healthcare in this country and it's time we aggressively and unwaveringly disrupt the system to serve the people first . Rent seekers and parasites can hit the pike. Good riddance.
112
Every thing you say is true, Paul, and I am a huge fan of Medicare-For-All. I hope you are right, that the time is right to make that happen.
I also see Krugman's point. In order to make it happen, I think a party would have to focus on Medicare-For-All to the exclusion of everything else, and I believe that getting big money out of politics should be our highest priority. Lot's of good things would be possible (including Medicare-For-All) if we could just o that.
I also see Krugman's point. In order to make it happen, I think a party would have to focus on Medicare-For-All to the exclusion of everything else, and I believe that getting big money out of politics should be our highest priority. Lot's of good things would be possible (including Medicare-For-All) if we could just o that.
2
You literally have no political power. How do you suggest achieving your policy proposals? Really, what's your plan other than dreaming?
Very sage advice! (By that I mean that I agree with the contents of the column.) I would like to add that while child care is always important, we are in an era in which elder care is becoming ever more important. The Netherlands, mentioned in the article as a model for us, have a particularly compassionate and effective elder care system. I will also note that, given our electoral demographics, an enhanced elder care system, possibly along the lines of the Dutch one, might draw in voter support across party lines.
Cut out insurance billing staff in doctors offices and hospitals and the insurance company's reimbursement folks and we will end up laying off 25% of the "health" industry workers pushing paper. As Health is 1/6 of our economy we will increase unemployment by several percentage points.
1
Hillary Clinton pushed for child care. That's an important issue, but it is not going to save the Democrats from themselves, Democrats need to run on infrastructure, infrastructure, infrastructure. Every other issue connects to it: immigration, climate change, taxes, health care, and, yes, child care. And infrastructure is something everyone in America understands. It's a no-brainer. Get smart, Democrats!
1
The Republicans never hesitate to be bold. That's why they win so much of what they want.
The first rule in negotiating is never to compromise with yourself. Always fight for the utmost impossible version of what you want. Then compromise will give you most of what you want.
If Obama had gone into the 2009 negotiations fighting hard for single-payer (a bill for which already existed, by the way), then the compromise position would have been a public option, say, allowing anyone to buy into Medicare. This competition would have forced the insurance companies to shape up.
As it is, he went in trying to anticipate what the Republicans would accept (Mitt Romney's plan taken nationwide), and we ended up with a messy patchwork that has something to displease everyone.
So I don't agree with your incremental approach. We may get incremental results, but if we try to reform health care one inch at a time, the brute force of Republican stubbornness will have us ending up with one-eighth of an inch of change.
The first rule in negotiating is never to compromise with yourself. Always fight for the utmost impossible version of what you want. Then compromise will give you most of what you want.
If Obama had gone into the 2009 negotiations fighting hard for single-payer (a bill for which already existed, by the way), then the compromise position would have been a public option, say, allowing anyone to buy into Medicare. This competition would have forced the insurance companies to shape up.
As it is, he went in trying to anticipate what the Republicans would accept (Mitt Romney's plan taken nationwide), and we ended up with a messy patchwork that has something to displease everyone.
So I don't agree with your incremental approach. We may get incremental results, but if we try to reform health care one inch at a time, the brute force of Republican stubbornness will have us ending up with one-eighth of an inch of change.
1
Although I think the single-payer system is clearly the best way to provide healthcare, Krugman is right. In the current political climate, trying to enact "medicare for all" is suicidal; even if the Democrats win the house, it won't pass the Senate, and if even if it did, Trump would veto it.
Krugman is also right that even if it passed, the disruption to people who got insurance through their employers and were forced to change would make the political blowback associated with the disastrous website rollout look mild.
The way forward is to create a public option where the market is clearly failing, and (assuming that works), let it gradually take a larger and larger share. The other thing that should be done is employers should be required to show the costs of the medical coverage they provide their employees on their W-2 forms (which will let employees know how much their health insurance really costs). And if you want to get all 'market-oriented' and radical, you count that benefit as income (to level the playing field) and tax it. Maybe you provide tax credits to cover it, but gradually reduce them over time, so that people are eventually all facing the same issues. Then, if you wanted to transition to single payer, at that time you could require that employers give their employees a pay increase equal to their insurance costs (that the employer no longer has to pay, so it's cost neutral for the employer). Then they'd see clearly if they were better off.
Krugman is also right that even if it passed, the disruption to people who got insurance through their employers and were forced to change would make the political blowback associated with the disastrous website rollout look mild.
The way forward is to create a public option where the market is clearly failing, and (assuming that works), let it gradually take a larger and larger share. The other thing that should be done is employers should be required to show the costs of the medical coverage they provide their employees on their W-2 forms (which will let employees know how much their health insurance really costs). And if you want to get all 'market-oriented' and radical, you count that benefit as income (to level the playing field) and tax it. Maybe you provide tax credits to cover it, but gradually reduce them over time, so that people are eventually all facing the same issues. Then, if you wanted to transition to single payer, at that time you could require that employers give their employees a pay increase equal to their insurance costs (that the employer no longer has to pay, so it's cost neutral for the employer). Then they'd see clearly if they were better off.
6
The US has a bill of rights, that's basically no-op. Let's create the political conditions where it's not 'suicidal' to advocate medicare for all, This is centrist in dozens of other democracies which are also capitalist. They might as well be on another planet. And not all single payer either. But they don't put profits over the health of all their citizens, no matter their income, job, health status or age. Here that is radical, let's face that and discuss it.
How can the US start to create a political climate to represent the majority, if even our liberal columnists and TV pundits keep this off the table for advocacy. We can't even get 1 columnist to advocate or explain what dozens of nations have had for generations in health care. Alice in Wonderland politics, seen here as normal.
How can the US start to create a political climate to represent the majority, if even our liberal columnists and TV pundits keep this off the table for advocacy. We can't even get 1 columnist to advocate or explain what dozens of nations have had for generations in health care. Alice in Wonderland politics, seen here as normal.
Why is it that the Progressive agenda always depends on over-burdened people paying higher taxes so that people who don't pay taxes can share the wealth of those that do? There's another name for that!
Perhaps what really needs to be done is the most difficult for most people: Listening.
We-the-People no longer listen to each other. We live in our echo-chamber/silo/think tanks instead of the larger society that is actually We-the-People.
Listening is very hard. It's much easier to spend your quiet time fashioning a razor-sharp counter argument to eviscerate the other person. Listening means that you have to consider what the other is saying, regardless of how objectionable you find their statements.
While I generally disagree with the dictums of any one school of thought, I find that, when I can listen, I can find some point of understanding and occasionally common ground with those that I disagree with. That is the basis of compromise, to recognize that the other has value and to build on that.
In this post-Freudian age, we have become numb to the incessant manipulation planted in our every day language. We can no longer rely on our common humanity to bring us together.
I remember a political person who went around listening to the people from the state and was elected to the Senate. Unfortunately, when she aspired to the Presidency she only listened to the professional advisors, think tanks, and pollsters, not the ordinary people that got her in the Senate and could have launched her to the White House. She just stopped listening and finding some point of common understanding with We-the-People.
We-the-People no longer listen to each other. We live in our echo-chamber/silo/think tanks instead of the larger society that is actually We-the-People.
Listening is very hard. It's much easier to spend your quiet time fashioning a razor-sharp counter argument to eviscerate the other person. Listening means that you have to consider what the other is saying, regardless of how objectionable you find their statements.
While I generally disagree with the dictums of any one school of thought, I find that, when I can listen, I can find some point of understanding and occasionally common ground with those that I disagree with. That is the basis of compromise, to recognize that the other has value and to build on that.
In this post-Freudian age, we have become numb to the incessant manipulation planted in our every day language. We can no longer rely on our common humanity to bring us together.
I remember a political person who went around listening to the people from the state and was elected to the Senate. Unfortunately, when she aspired to the Presidency she only listened to the professional advisors, think tanks, and pollsters, not the ordinary people that got her in the Senate and could have launched her to the White House. She just stopped listening and finding some point of common understanding with We-the-People.
Why do you always forget Canada? We moved from a system that only had private insurance to a fully funded state system. We started with hospitalization: ie no charges for hospital care, and then we moved to paying doctors, etc, directly. Our plans are state by state administered ( read province by province)
What Mr. Krugman is saying is that the US must always be burdened with the extra costs that paying the middle man ( insurance companies) entails. You may get better care than at present with his plan, but you will always pay much more than is needed. Hate taxes? well, individuals pay big money with the ACA, and that won't change. A tax by any other name is what you now have. You will still be down there with Turkey when you look at the cost-benefits of staying with the present system, however you fiddle at the edges. And we are better than the UK and Australia, because they have a two-tier system that weakens the quality of care for those who cannot afford extra private coverage.
We in Canada do not know what " co-pay ' means. Deductibles apply only to car insurance . If you tell me that Americans will not be good to their fellow man, but only to their insurance company, and this is a religious tenet of Americanism, I will understand. But I will not respect it, and nor should you.
What Mr. Krugman is saying is that the US must always be burdened with the extra costs that paying the middle man ( insurance companies) entails. You may get better care than at present with his plan, but you will always pay much more than is needed. Hate taxes? well, individuals pay big money with the ACA, and that won't change. A tax by any other name is what you now have. You will still be down there with Turkey when you look at the cost-benefits of staying with the present system, however you fiddle at the edges. And we are better than the UK and Australia, because they have a two-tier system that weakens the quality of care for those who cannot afford extra private coverage.
We in Canada do not know what " co-pay ' means. Deductibles apply only to car insurance . If you tell me that Americans will not be good to their fellow man, but only to their insurance company, and this is a religious tenet of Americanism, I will understand. But I will not respect it, and nor should you.
4
I would like it if Bernie Sanders and all the progressive purists heed Professor Krugman's warning -- not just about healthcare, but about campaign positions and governing itself!
Paul Krugman is about as “progressive” as Mitch McConnell. He flatly states: “A far more important consideration is minimizing disruption to the 156 million people who currently get insurance….”
Evidently, the 30 million Americans with NO health insurance coverage just need to deal with it. It is much more important to Paul that those who ALREADY have insurance are protected.
Please Paul, join West Virginia Governor Jim Justice and make the switch to the Republican Party. Your “progressive” act is wearing thin.
Evidently, the 30 million Americans with NO health insurance coverage just need to deal with it. It is much more important to Paul that those who ALREADY have insurance are protected.
Please Paul, join West Virginia Governor Jim Justice and make the switch to the Republican Party. Your “progressive” act is wearing thin.
Focus, Krugman clearly writes that we fix the ACA. He is not saying we abandon those without health insurance. I would love to have Medicare for all, but I also would like to play center field for the Dodgers; not going to happen. Politics is the art of the possible. Climate change and jobs produced in combating climate change must be our top priority.
"It [single payer] would be much harder politically than its advocates acknowledge...getting there from here would be very hard...."
Hmm. Conventional wisdom, from the Times and elsewhere, told us it would be very hard to elect Bernie Sanders, and impossible to elect Donald Trump.
So progressives chose the "sensible" route by nominating the candidate who deserved it because she was a woman, because she was the wife of a former President. One only capable of maintaining America's failing status quo, and insulting half of America's electorate instead of inspiring them.
What's next for progressives is to stop whining about how hard life is, and nominate a leader unbeholden to special interests, with the determination to take on challenges which face all of America. It seems what's actually hard is to win an election by representing only those who can afford to write the biggest checks.
Hmm. Conventional wisdom, from the Times and elsewhere, told us it would be very hard to elect Bernie Sanders, and impossible to elect Donald Trump.
So progressives chose the "sensible" route by nominating the candidate who deserved it because she was a woman, because she was the wife of a former President. One only capable of maintaining America's failing status quo, and insulting half of America's electorate instead of inspiring them.
What's next for progressives is to stop whining about how hard life is, and nominate a leader unbeholden to special interests, with the determination to take on challenges which face all of America. It seems what's actually hard is to win an election by representing only those who can afford to write the biggest checks.
1
"Progressives" is a dirty and divisive word these days. With healthcare being such a critical issue to all, progressives are not the ones to be carrying the flag. While the alt-right is despicable, they are tiny, out of the mainstream -- and easily discountable. The self-proclaimed moral progressives are the ones preventing free speech on college campuses, pushing for the boycotting of Israel, supporting the hypocrisy of Black Lives Matter, and more.
How about "What's next for Americans?"
How about "What's next for Americans?"
1
I wish the NYT would employ a true liberal who could add to this discussion, or even get some token guest liberal economists to weigh in once in a while.
For the arguments that are missing here, I recommend The Nation magazine & any number of others:
https://www.thenation.com/
http://cepr.net/
http://www.pnhp.org/
https://nader.org/
http://robertreich.org/
For the arguments that are missing here, I recommend The Nation magazine & any number of others:
https://www.thenation.com/
http://cepr.net/
http://www.pnhp.org/
https://nader.org/
http://robertreich.org/
1
It's amazing anyone today is a "progressive" if they know the true history of progressivism.
Progressivism is regressive. It's statist. It's racist. Look at the history.
Progressives support tyranny over liberty. It's so anti-American, but it "feels good" right?
Progressivism is regressive. It's statist. It's racist. Look at the history.
Progressives support tyranny over liberty. It's so anti-American, but it "feels good" right?
1
God Bless your wit, CJ. and up is down, and order is chaos... sounds good, though.
1
What's next for the Democratic party? More squabbling between idealists and pragmatics, causing us to take our eye off the ball and blow another election that should be in the bag. Must be a great time to be a fascist. We make it so easy for them to consolidate power.
2
Yes it is the petulant so-called progressives that has given the election to both GW Bush and Donald Trump. With Bernie the idiot with his simple slogans. and Elizabeth Warren standing silently on the sidelines, playing politics until it was too late. They're the best thing that ever happened to the Republican Party.
3
Incorporate health reform with tax reform.
Put more money in the Treasury so that the money serves everyone.
Eliminate middlemen wherever possible.
Use federal buying power to drive down the cost of pharmaceuticals.
Kill the home mortgage interest deduction, which serves no social purpose and is biased toward a segment of society.
Institute a VAT.
The Treasury will find itself with money to spend money on kids.
Put more money in the Treasury so that the money serves everyone.
Eliminate middlemen wherever possible.
Use federal buying power to drive down the cost of pharmaceuticals.
Kill the home mortgage interest deduction, which serves no social purpose and is biased toward a segment of society.
Institute a VAT.
The Treasury will find itself with money to spend money on kids.
As long as the masses are convinced that the answer is less government, the idea of a government run health care system will be derided. These folk are brainwashed into thinking that less government means less taxes for them. And what I find even more ironic are the politicians who are calling for a leaner government-----fine-----quit!
3
"did you know that only 5.4 percent of New Yorkers are now uninsured?" Well, did *you* know that 19.75 million * 5.4% is over a million people?
2
Not too many numbers and data in today's column. That's the Republican way Krugman has been criticizing.
1
The Bernie Bots are pushing pie in the sky per their leader.
Politics is the art of the possible.
Single payer is not going to happen. So pick a path that will
improve the ACA.
word
Politics is the art of the possible.
Single payer is not going to happen. So pick a path that will
improve the ACA.
word
2
What ever happened to public service announcements on TV. They should be mandatory for highly rated programs. The content could be about being healthy. Americans see ads for unhealthy food and are lulled into life on the couch.
If we are to have cost effective health care, it needs to start with a public nudge into a better lifestyle. Diet and exercise can make a significant reduction in healthcare costs.
It is also possible to use smartphones and big data to keep tabs on who is out for a hike and who is on the couch.
Forgive me for being a health Nazi, but it would not hurt.
If we are to have cost effective health care, it needs to start with a public nudge into a better lifestyle. Diet and exercise can make a significant reduction in healthcare costs.
It is also possible to use smartphones and big data to keep tabs on who is out for a hike and who is on the couch.
Forgive me for being a health Nazi, but it would not hurt.
1
This Krugman half loaf thinking is what he applied to the 2016 election and he dissed Bernie and supported the republican-lite Clinton. He was wrong then and he's wrong now. Shoot for the stars, no more status quo. Health CARE, not insurance, for all.
3
Well Paul says good strategy is not to push too fast: patience folks, patience works.
Of course, Ryan/McConnell and the Freedom Caucus aren't on board and arguably without them nothing's going to happen. Although they would cheerfully get the Dems involved with their tar baby and stick them with voter ire over whatever voter rebellion ensues.
The Dems would be best served with a very clear and convincing campaign to securely stick the Republicans with their nasty little bill and the mind set behind it.
Patience indeed! Make sure 2018 puts the GOP up front and center as corporate shills and sell-outs!!
Of course, Ryan/McConnell and the Freedom Caucus aren't on board and arguably without them nothing's going to happen. Although they would cheerfully get the Dems involved with their tar baby and stick them with voter ire over whatever voter rebellion ensues.
The Dems would be best served with a very clear and convincing campaign to securely stick the Republicans with their nasty little bill and the mind set behind it.
Patience indeed! Make sure 2018 puts the GOP up front and center as corporate shills and sell-outs!!
1
I can’t blame anyone right now for wanting to promote single-payer health care as the path forward, there’s momentum for once and that’s great. As a litmus test for electable politicians, that’s too much.
Good that there is some bipartisan effort to protect the A.C.A., but it's August recess/vacation time, if in September and by a slim chance they’re successful, don’t we still need those governors who refused to expand Medicaid to get on board? All of the governors must accept and support the A.C.A. otherwise the push for single-payer can only be expected to continue.
I’d like to be pushing for family leave and elevating the safety net to a standard befitting a developed nation with an advanced economy but look at who is in charge. And if House Republicans cause a recession because they forced the United States to default in October, family leave likely won’t be a priority, unemployment will take the spotlight in 2018. This should be the best time to tackle issues like family leave and healthcare, when the economy is close to full employment, but again look at who is in charge. I would like to think that just because the Republicans are screwing things up so badly Democrats couldn’t lose in 2018, 2020… Yet Republicans wastefully shut down the government and were still rewarded with a majority.
Good that there is some bipartisan effort to protect the A.C.A., but it's August recess/vacation time, if in September and by a slim chance they’re successful, don’t we still need those governors who refused to expand Medicaid to get on board? All of the governors must accept and support the A.C.A. otherwise the push for single-payer can only be expected to continue.
I’d like to be pushing for family leave and elevating the safety net to a standard befitting a developed nation with an advanced economy but look at who is in charge. And if House Republicans cause a recession because they forced the United States to default in October, family leave likely won’t be a priority, unemployment will take the spotlight in 2018. This should be the best time to tackle issues like family leave and healthcare, when the economy is close to full employment, but again look at who is in charge. I would like to think that just because the Republicans are screwing things up so badly Democrats couldn’t lose in 2018, 2020… Yet Republicans wastefully shut down the government and were still rewarded with a majority.
A president whose every utterance is a lie, a Congress dominated by the new fascist order dedicated to structural stupidity and denial of climate change...an electorate so dumbed down by decades of Republican educational "policies" devised to turn the country into a vast herd of stupid unquestioning sheep...do these people seem ready for universal health care? They can't even understand a tax return in many cases.
2
Paul, "Incrementalism" is what got us into this mess to begin with, that and "Mr. Insurance" Joe Lieberman of Connecticut. Skip the song and dance Paul, we've been down this road already, we need single payer and the government needs the ability to negotiate with drug companies, without those two things Big Insurance and Big Pharma will continue to gouge the public at every turn and just as important for the Democrats, if they ever want to occupy the White House again they better be on board this time. Sorry, L.B.G.T. Rights and Black Lives Matter are very important issues but if you want your base back, the base that fled to Trump because they got thrown under a bus by the East and West Coast Limosine Liberals represented by H.R.C. and also still bear the tire tracks from being run over by the globalization express you really do want to push for single payer. I can't believe it Paul, that you would suggest the Danish Model with everyone buying from private insurers even a starter for Americans, how we could be confused with Little Denmark or think for one second what works in their Parlimentary System, with its snap elections and real democracy would work in America with our "single" party system involved in a charade pretending we have a choice, the armies of lobbyists behind the Healthcare Business, as well as a bloated defense budget that sucks up most of the taxpayer dollars is a mystery; as is why you as an Economist would consider supporting A.C.A. In the first place.
2
When childcare and healthcare are 'down there' with Mexico and Turkey it makes me wonder what constitutes an advanced' country? Advanced in what?
1
Krugman blowing smoke once again. I lived in the UK for years and have first hand experience with their "health system". It is a joke. Anyone with any money in the UK bypasses the public system and hires private health care. And if you need surgery, good luck on that one. The latest news is that the waiting time for surgeries in the UK is set to double. By time your turn on the list is up you might be dead. Cheers.
1
>
Heed the words of the Titan, Man's sole benefactor. Before there was your Jesus there was Prometheus. Prometheus didn't kill himself and lay down his body (" No man can take away my soul...I have power to lay it down", Jesus), but lives to fight another day
Before we get out the party hats, the Dems need to get tougher and more cunning this is a 4 quarter game against Zeus's cyclops and his bolt. Trust me I have experience with both of these. I also know who will overthrow Zeus, and I can assure you that you have quite a bit of time to wait for that. For all these I shall be punished for but it is through my intelligence and cunningness that I survive to hold court one day in the distal future
Dems are still asleep at the wheel, moreover, at the end of the day it wasn't the progressives that defeated the repeal of the ACA but, rather, the GOP's Judas, John McCain. Of course we all know what happened to Judas
Sure some day we'll have single payer, but if the Titan can be chained to this crag for 30,000 yrs before he holds court...well you see my point
"Not one scrap of an idea of ours does not originate in myth, isn’t transformed, mutilated, denatured mythology."
Bruno Schulz
Sure sometimes I get carried away; perceiving the approach of my madness, I began to experience myself as a false priest about to be disciplined for my hubris, for overstepping the boundary between mortals and the gods.
Heed the words of the Titan, Man's sole benefactor. Before there was your Jesus there was Prometheus. Prometheus didn't kill himself and lay down his body (" No man can take away my soul...I have power to lay it down", Jesus), but lives to fight another day
Before we get out the party hats, the Dems need to get tougher and more cunning this is a 4 quarter game against Zeus's cyclops and his bolt. Trust me I have experience with both of these. I also know who will overthrow Zeus, and I can assure you that you have quite a bit of time to wait for that. For all these I shall be punished for but it is through my intelligence and cunningness that I survive to hold court one day in the distal future
Dems are still asleep at the wheel, moreover, at the end of the day it wasn't the progressives that defeated the repeal of the ACA but, rather, the GOP's Judas, John McCain. Of course we all know what happened to Judas
Sure some day we'll have single payer, but if the Titan can be chained to this crag for 30,000 yrs before he holds court...well you see my point
"Not one scrap of an idea of ours does not originate in myth, isn’t transformed, mutilated, denatured mythology."
Bruno Schulz
Sure sometimes I get carried away; perceiving the approach of my madness, I began to experience myself as a false priest about to be disciplined for my hubris, for overstepping the boundary between mortals and the gods.
1
Last year Mt. Krugman relinquished his conscience of a liberal because he ain't one.
Just sayin....
Just sayin....
4
Amazing gall. Has the Nobel Prize winner learned nothing from Trump's victory? Does Professor Krugman believe he is qualified to suggest "the next step" for Progressives? The defender of the DNC? And guess what? The step he suggests is the exact same one he recommended as the best way to defeat Trump. A modest incremental approach. A modest incremental approach is the way the Republicans are destroying the A.C.A. Adopting their tactic is not the way to initiate change. And Paul Krugman is not likely to be the source for action by Progressives.
88
FDR and LBJ must be turning in their graves. As they say in Texas the middle of the road is for yellow lines and dead armadillos.
2
Clearly you were not paying attention to Republican intentions, for in no shape or form in the real world have their proposals amounted modest, incremental adjustments to the ACA. They proposed either naked wholesale repeal, or weakening of key under-girding pillars (e.g. mandated participation) that would lead to quick toppling of the whole thing. You so-called progressives must learn that there is plenty of value and virtue to be found in the territory between your most fervent dreams and your darkest nightmares. The policy world is not nearly such a high-contrast domain as you wish to make it to be, Krugman's point. Please do read and keep up more accurately with discussions actually unfolding ,rather than relying upon standard, scripted lines.
He's just tossing out ideas, giving us his perspective. Is it perfect? No. Is it even helpful? I think so, even if it allows us merely to see its shortcomings. As T pointed out: Who knew healthcare could be so difficult?
All well-intentioned ideas are welcome, I say. But as you suggest, not all ideas are good or workable; problem is, which are which? People disagree, yet insist they are right and the other fellow is full of stinky stuff. They could both be wrong, but they can't both be right as The Rise and Fall of the Mooch taught us.
All well-intentioned ideas are welcome, I say. But as you suggest, not all ideas are good or workable; problem is, which are which? People disagree, yet insist they are right and the other fellow is full of stinky stuff. They could both be wrong, but they can't both be right as The Rise and Fall of the Mooch taught us.
The Affordable Care Act would be done right if the profit motive was removed. Anything short of this is a toll which benefits stockholders thanks to the inescapable fact of illness found by everyone who travels life's often rocky path.
Someone is paying for coverage of 156 million people and, in addition, the millions who use emergency rooms for their primary health care.
We live in a nation which has enough money to afford threatening the rest of the civilized world with nuclear annihilation but still allows our own kids to go to bed hungry, our own women to die in childbirth and our own elders to do without medicine they cannot afford.
I respect your views with regard to many things but don't understand why even given "Getting there from here would be very hard", and "might not accomplish much more than a more modest, incremental approach." is the fallback position you would "support if we were starting fresh."
With all due respect, the realpolitik employed is limited and suspect.
Someone is paying for coverage of 156 million people and, in addition, the millions who use emergency rooms for their primary health care.
We live in a nation which has enough money to afford threatening the rest of the civilized world with nuclear annihilation but still allows our own kids to go to bed hungry, our own women to die in childbirth and our own elders to do without medicine they cannot afford.
I respect your views with regard to many things but don't understand why even given "Getting there from here would be very hard", and "might not accomplish much more than a more modest, incremental approach." is the fallback position you would "support if we were starting fresh."
With all due respect, the realpolitik employed is limited and suspect.
1
Medicare is great, but to make it really work, you need a Medicare Supplemental policy. So you're still stuck buying insurance.
So Medicare for All--or better yet Medicare for those who can't get insurance through their employers--would be progress, but it's far from an ideal solution.
So Medicare for All--or better yet Medicare for those who can't get insurance through their employers--would be progress, but it's far from an ideal solution.
1
I hesitate to confront Professor Krugman from long habit of not engaging in an intellectual debate with opponents who vastly outgun me, but this occasion demands that I do so. The analysis focuses on health care financing. Independent of health care outcomes and health care costs, the analysis makes sense. But, and this is a big “but,” U.S. health outcomes are weak and costs high. I went through the OECD health statistics this morning. For female 2015 mortality, only 5 of the 34 OECD countries have lower expected life spans. Only Turkey, Chile, Mexico, and Slovakia have worse infant mortality results that do we. Only Greece, Hungary, Portugal, and Turkey have lower birth weight numbers than we. These are terrible numbers. When you consider the costs we incur to produce such shabby results it is impossible not conclude that a comprehensive health reform is necessary; one that addresses not only financing, but outcomes and costs.
6
The central debate here is whether to strive for incremental improvement of the ACA or whether the simplistic call of Medicare for all is a bridge too far, politically. There is so much to unpack here.
FDR took a bold leap when he proposed Social Security. Of course, the Republicans called it Communism. Try taking that away today. When LBJ introduced Medicare, I remember videos of Ronnie Regan claiming it was the end of our democracy and evil socialism. Like the ACA, it was only a half-baked, Rube Goldberg cobbling together of what was possible at the time. As any senior will tell you, it only covers 80%, and many MDs refuse to accept Medicare patients. While politics is the art of the possible, sometimes a bold step is needed. We need to eliminate the death grip big Pharma and the for profit insurance companies have on us by buying Congress.
FDR took a bold leap when he proposed Social Security. Of course, the Republicans called it Communism. Try taking that away today. When LBJ introduced Medicare, I remember videos of Ronnie Regan claiming it was the end of our democracy and evil socialism. Like the ACA, it was only a half-baked, Rube Goldberg cobbling together of what was possible at the time. As any senior will tell you, it only covers 80%, and many MDs refuse to accept Medicare patients. While politics is the art of the possible, sometimes a bold step is needed. We need to eliminate the death grip big Pharma and the for profit insurance companies have on us by buying Congress.
4
"The first lesson for the United States is that the new (post-2006) Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?" Rosenau, Pauline; Lako, Christiaan (2008). "An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System". Journal of Health Politics, Policy and Law. 33 (6): 1031–1055. PMID 19038869. doi:10.1215/03616878-2008-033.
2
Until the '156 million people' that get insurance through their employers are affected by huge premium increases, no meaningful healthcare reform is possible.
Agreed on that point---but how quickly the public forgets that even private insurance relied on benefits lifetime caps--pre approvals, pre-existing condition clauses, etc., prior to the ACA. It's only a matter of time before the cost of private insurance increases again---people fail to realize that a premium increase is a still a net cost for them---yet call it a healthcare tax and suddenly it's unacceptable. Money out of my wallet is money out of my wallet.
Absolutely. Single payer...please.
Starting with a domestic progressive agenda of ACA Dutch style and emphasis on family and children should not neglect the searching of an international progressive agenda.
Two major international problems that can be resolved by intermingling them is the looming climate catastrophe and the unjust, unsustainable, therefore, unstable international monetary system. The conceptual, institutional, ethical and strategic dimensions of carbon-based international monetary system with its standard of a specific tonnage of CO2 per person are presented in Verhagen 2012 "The Tierra Solution: Resolving the climate crisis through monetary transformation" with updates at www.timun.net. “The further into the global warming area we go, the more physics and politics narrows our possible paths of action. Here’s a very cogent and well-argued account of one of the remaining possibilities.” Bill McKibben, May 17, 2011
Two major international problems that can be resolved by intermingling them is the looming climate catastrophe and the unjust, unsustainable, therefore, unstable international monetary system. The conceptual, institutional, ethical and strategic dimensions of carbon-based international monetary system with its standard of a specific tonnage of CO2 per person are presented in Verhagen 2012 "The Tierra Solution: Resolving the climate crisis through monetary transformation" with updates at www.timun.net. “The further into the global warming area we go, the more physics and politics narrows our possible paths of action. Here’s a very cogent and well-argued account of one of the remaining possibilities.” Bill McKibben, May 17, 2011
I rarely disagree with Prof. K, but this is one of those times. Maybe it's because I worked in the (casualty) insurance industry 30-plus years.
Medicare performs the same tasks corporate insurers perform for a tiny fraction of the cost--about 2% vs 15 or 20%. As a former policyholder and current Medicare enrollee, I have found Medicare does at least as good a job.
If single-payer delivered results merely as good as those provided by corporate insurers, the expense ratio savings would be all the evidence we'd need. But, in fact, every comparison between our system and those of single-payer systems shows those others provide better care!
Come on, Professor. Better care for less money. What's not to like?
Medicare performs the same tasks corporate insurers perform for a tiny fraction of the cost--about 2% vs 15 or 20%. As a former policyholder and current Medicare enrollee, I have found Medicare does at least as good a job.
If single-payer delivered results merely as good as those provided by corporate insurers, the expense ratio savings would be all the evidence we'd need. But, in fact, every comparison between our system and those of single-payer systems shows those others provide better care!
Come on, Professor. Better care for less money. What's not to like?
6
Why not do both? Implement something like the Dutch system while lowering the age for Medicare eligibility to 62. Employees who are happy with the coverage provided by their employers could keep it. See how that goes. If the electorate supports the lower age, then lower it again. By doing this incrementally, we eventually get medicare for all. If it stalls, let's say at age 53, at least those now feeling the most anxiety would no longer have to worry.
1
"Why not do both? "
Krugman is warming up to take on the Sanders/real progressive/Socialist/increasing leftward bent of young people. He wants no change. The deteriorating status quo has been very, very good to him and he's about psychological defense and protecting his own status and privilege.
Krugman is warming up to take on the Sanders/real progressive/Socialist/increasing leftward bent of young people. He wants no change. The deteriorating status quo has been very, very good to him and he's about psychological defense and protecting his own status and privilege.
1
"Meanwhile, progressives should move beyond health care and focus on other holes in the U.S. safety net."
Better pundits, please. Who are these "progressives" that can juggle only one ball that Krugman fancies himself speaking for?
Krugman almost has to be a consultant for that lean, mean losing machine that is the Democratic party. Because Democrats are about as inspiring (and politically effective) as a pile of dirty underwear, about the only thing Ds are now able to convince the public they're useful for is health care. (Remember, though, that it was the D party for 7 years refusing to defend the only piddly thing Ds have accomplished in 40 years that got Rs to the point they could seriously threaten it. So Ds wouldn't even be credible on health care were it not for the energy in the streets (and elsewhere) from protestors standing up to Rs. Ds certainly weren't going to until it was made completely clear to them their calculated cowardice would not stand this time). So naturally, the politically clueless Krugman wants Ds to "move on" and stop wasting time on health care. Like Obama and the rest of the worthless, passionless, self-adoring neo-liberals, there is no Overton window, there is no reason to fortify political strongholds, there is no reason for repetitive political reminding. The American right loves the current fake liberal weenies who allowed them to take over.
Christ, what passes for an establishment is brain-dead and has been for a generation.
Better pundits, please. Who are these "progressives" that can juggle only one ball that Krugman fancies himself speaking for?
Krugman almost has to be a consultant for that lean, mean losing machine that is the Democratic party. Because Democrats are about as inspiring (and politically effective) as a pile of dirty underwear, about the only thing Ds are now able to convince the public they're useful for is health care. (Remember, though, that it was the D party for 7 years refusing to defend the only piddly thing Ds have accomplished in 40 years that got Rs to the point they could seriously threaten it. So Ds wouldn't even be credible on health care were it not for the energy in the streets (and elsewhere) from protestors standing up to Rs. Ds certainly weren't going to until it was made completely clear to them their calculated cowardice would not stand this time). So naturally, the politically clueless Krugman wants Ds to "move on" and stop wasting time on health care. Like Obama and the rest of the worthless, passionless, self-adoring neo-liberals, there is no Overton window, there is no reason to fortify political strongholds, there is no reason for repetitive political reminding. The American right loves the current fake liberal weenies who allowed them to take over.
Christ, what passes for an establishment is brain-dead and has been for a generation.
No coherent discussion of the future of health coverage in the US can be made without explicit economic analysis. All the discussion has been made around the issue of who pays for it and the answer coming from all sides in government has been that a single payer (government financed) system is not appropriate for the US. The straightforward conclusion is that Obama care is the best that we can have. The republican party (mostly McCain and perhaps even Ryan) have been learning it the hard way: erase Obama care and forget about universal health care. However, all the discussion has been made ignoring the excessively high costs of American health services, exception being only Bernie Sanders and his ‘progressives’ during the democratic primaries.
All the countries with universal health coverage in the Commonwealth Fund study incorporate a two tier-system in which everybody receives “free” primary health coverage (low cost?) that can be enhanced with personal resources. The end result is that these countries spend half of what the US do in terms of GNP percentage. Without addressing the issue of high costs of health in the US promoted by well known lobbies we will not have universal health coverage. Hillary tried it two decades ago and Obama learned from it.
All the countries with universal health coverage in the Commonwealth Fund study incorporate a two tier-system in which everybody receives “free” primary health coverage (low cost?) that can be enhanced with personal resources. The end result is that these countries spend half of what the US do in terms of GNP percentage. Without addressing the issue of high costs of health in the US promoted by well known lobbies we will not have universal health coverage. Hillary tried it two decades ago and Obama learned from it.
1
I see you're already sharpening your knives to start savaging Sanders, just as you did during the last campaign.
Here's an idea: why not offer to work with him to develop a feasible plan for affordable, universal coverage. He's actively soliciting for ideas on the topic.
Would you consider that? Didn't think so...
Here's an idea: why not offer to work with him to develop a feasible plan for affordable, universal coverage. He's actively soliciting for ideas on the topic.
Would you consider that? Didn't think so...
6
I don't think you're doing Bernie any favors by ignoring the fact that he's already working with others to improve health care. He would of course like single payer by that doesn't stop him from being cooperative with others. Bernie's an adult and doesn't need his supporters picking fights in his behalf.
While I agree with the professor about the political realities, a factual reality is that insurance companies add nothing to the mechanics of healthcare than the administration of benefits, all of which is done with the profit motive looking over their backs. Medicare and the V.A. provide the same administration minus the profit motive. Preserving the insurance companies makes about as much sense as requiring cars to have buggy whip holders.
2
What is not being addressed is the people who have health care insurance, but the deductibles they have chosen are so high to keep the insurance barely affordable, they basically have catastrophic coverage. They are paying co-pays and other medical expenses out of pocket until they reach the deductible limit, and the deductible does not roll over to the next year - you start fresh. So essentially the price of the insurance premium in some cases is really doubled when the deductible is counted. How do we make insurance affordable and health care truly accessible to everyone? That is something that Congress needs to work out.
I fail to see how Medicare for all would not work out, because if there is a large pool of both healthy and those who are not, the risk is spread. It would not necessarily preclude the insurance companies from participating in partnership with the government. I keep saying if we can plunge into war, and pay trillions with no end in sight, we can spend on healthcare to save lives. It is a matter of priorities. However, if improving the ACA especially if high deductibles could be addressed as a step toward single-payer, Medicare for all, then take the steps necessary to get there.
I fail to see how Medicare for all would not work out, because if there is a large pool of both healthy and those who are not, the risk is spread. It would not necessarily preclude the insurance companies from participating in partnership with the government. I keep saying if we can plunge into war, and pay trillions with no end in sight, we can spend on healthcare to save lives. It is a matter of priorities. However, if improving the ACA especially if high deductibles could be addressed as a step toward single-payer, Medicare for all, then take the steps necessary to get there.
1
Yet another sane and sensible piece from PK. He's absolutely right on all counts. I would only add that we should encourage at the federal level the movement towards free tuition for at least community college in all the states. And one adult need: better coordination and funding of educational training and retraining for laid off workers and those regions hit hardest by economic changes in the country with particular emphasis on technical training.
1
"I would strongly support reintroducing some form of public option" Yes, for sure, and the Democrats did not have the "guts" to enact it and so we have the hybrid ACA, initiated by Heritage Foundation of Koch and to be sabotaged by Trump/GOP! It is time for Democrats to move on, so to speak, to demand single payer MEDICARE for all, period. It is not enough for Democrats to be "anti-Trump" that is easy lifting. Democrats have to re-identify with the traditional Democrat base, what is left of it. Clinton sold the Democrats to MNC Corporate America, Wall Street and the 1% and abandoned the working class with resultant gross inequality with further massive de-industrialization, off-shoring, and short-termism, all part and parcel of the continued "trickle down" insanity of Reaganomics!
It might seem that what's next for progressives is the nigh impossible task of reversing what are actually centuries of erosion of community in favor of individualism. This is shown by the fragmentation of people of good will into issues-groups, and their obstinate refusal to coalesce around a central project. Conservatives have to argue among themselves--about tactics and messaging, but not about the central issues, which are greed and the liberation of greed by the destruction of central government: flag-burning, Willie Horton,Welfare Queens, LGBTQ rights, school prayer, clean coal... whatever keeps the troops engaged. Whatever message progressives find, it must not accept the right of anyone to dictate by law that anti-choice is good, that racism is justified, that Islamophobia is acceptable, that Black Lives Don't matter, that pesky Redmen belong on the rez...
1
Why does progressive have to equal socialist? Why can't you be in favor of forward thinking environmental stewardship, separation of church and state, and individual responsibility?
Rubbish man! Follow the history of the origins of America's Anglo Saxon heritage, from the Reformation to the Glorious Reformation--step by step rejection of central authority and insistence on personal hegemony. They chopped the head off Charles I because that.
Progressive capitalist? Never heard of it. And why does social justice have to be confined to frank socialism? "Though I speak with the tongues of men and of angels, and have not charity, I am become as sounding brass, or a tinkling cymbal." But thanks for the comment. Same to @Stephen Grossman.
You say Medicare for all would impose new taxes and take away employer-provided health insurance. But employers are now spending money on insurance for their employees. Why couldn't that money be transferred to the employee salaries, thereby giving them a raise? That would help them pay the new health-care taxes.
3
One simple, logical path toward single-payer--even under our current political circumstances--would be this fix to the ACA: In markets where fewer than 2 insurers are offering policies on the exchanges, citizens are given the "public option" to buy into Medicare.
One little-discussed provision of the ACA is that, while keeping private insurance in the system, it limits the percentage of premiums spent on overhead and profit.
However, the insurance industry is still regulated by the states. The ACA also provides funds to state insurance commissioners to hire additional staff to enforce the ACA's regulations on the insurance companies. The state insurance commissions are supposed to heavily audit the insurance companies to make sure their rate increases are justified.
In states under Republican control--where there is an ideological aversion to government regulation and corporate profits are more highly valued than citizen well-being--the state insurance commissions continue to allow the "free market" to operate, and premiums go up more than they really need to.
This is a less-well-known way that red states have undermined the ACA in addition to the more obvious travesty of refusing Medicaid expansion.
If private insurers in collusion with red-state insurance commissions create their own "death spiral" of rising premiums to the point where they want to abandon a market, then who can complain when the Federal government comes in to offer a public option?
One little-discussed provision of the ACA is that, while keeping private insurance in the system, it limits the percentage of premiums spent on overhead and profit.
However, the insurance industry is still regulated by the states. The ACA also provides funds to state insurance commissioners to hire additional staff to enforce the ACA's regulations on the insurance companies. The state insurance commissions are supposed to heavily audit the insurance companies to make sure their rate increases are justified.
In states under Republican control--where there is an ideological aversion to government regulation and corporate profits are more highly valued than citizen well-being--the state insurance commissions continue to allow the "free market" to operate, and premiums go up more than they really need to.
This is a less-well-known way that red states have undermined the ACA in addition to the more obvious travesty of refusing Medicaid expansion.
If private insurers in collusion with red-state insurance commissions create their own "death spiral" of rising premiums to the point where they want to abandon a market, then who can complain when the Federal government comes in to offer a public option?
3
I am getting tired of the word "idealist" being used as if someone is out of touch who needs to be reminded of his/her place. At a time that we are behind every other industrialized country in social policy.
Both FDR and LBJ, the founders of our safety net, were idealists and not incrementalists. But they were also fighters with convictions. That's what should be next for progressives.
Both FDR and LBJ, the founders of our safety net, were idealists and not incrementalists. But they were also fighters with convictions. That's what should be next for progressives.
4
"Man's independent mind"="The prideful, greedy anti-communal false consciousness of those irredeemably committed to individualism and kleptocracy--the false consciousness exhibited by both American and Russian oligarchs, and by those objectivist wanna-be oligarchs who support them."
It's worth noting that the single-payer voices still play an important role, even if it's not realistic to obtain single-payer now. They play a counter-weight to the voices of laissez faire medical care that won't be satisfied until the ACA is dead and gone.
People like to stay in the middle. If one end of the spectrum is afraid to be heard, the middle will shift away from them.
People like to stay in the middle. If one end of the spectrum is afraid to be heard, the middle will shift away from them.
2
The only part of the ACA that isn't working well is the individual market. Let those people enroll in Medicare. It would increase the premium pool and dilute the claim pool of Medicare as younger enrollees are younger and healthier.
2
The problem is that we, as a nation, are spending far too much money on health care, and sticking with the system we have now would not fundamentally alter this situation. Whether our citizens do or not receive government subsidies to help them purchase decent insurance, we are all- in one fashion or another- paying these inflated costs. We need to demolish the health care "industry" once and for all- no one should be profiting from the poor health of their neighbors. Our government should be setting prices for medical treatment as well as for pharmaceuticals. Good doctors, good nurses and good surgeons should certainly be well paid (and good money should be made available for medical research) but Capitalism should never be key here, not when human lives are involved.
5
Medicare for all sounds good to me and those who support it.
But, imagine all the fuss over the ACA these last eight years.
There would be just as much backlash and more with added opposition from the existing insurance industry and many workers with employer-subsidized health plans.
But, imagine all the fuss over the ACA these last eight years.
There would be just as much backlash and more with added opposition from the existing insurance industry and many workers with employer-subsidized health plans.
2
One solution to the constraint of private health insurance companies is a universal coverage model based on the existing Medicare option of Medicare Advantage. Under Medicare Advantage, private health insurance companies provide health insurance to citizens over 65 based on Medicare rules.
2
If liberals had at least been discussing single payer or other options common abroad, there’d be some chance of it getting into the main stream. Other nations also use insurance mandates, but with govt regulated prices---the crucial component.
But since it’s considered impossible---it remains impossible. This vicious cycle is perpetuated by our own media---not living up to its duty to inform the public of all options on issues. It’s off limits for centrist Dems and their liberal media columnists. The rw Gop has scared them into not looking too ‘left wing’ in our distorted political culture. And who defines left wing? The Gop.
Also off limits is our need for reform of campaign finance. Big insurance/pharma are some of the major donors to both parties. The ads they pay for make profit for the media.
Notice PK and other Times columnists and TV talk shows NEVER talk about campaign finance as the underlying cause of our health care system that ranks at the bottom of intl comparisons.
In 2017, the US can’t achieve the h/c systems achieved in 20th century by dozens of nations. Canada in the 1960s. Many earlier. But that’s kept dark by our ‘liberal media’.
Now Krugman yet again makes sure to show the world that he disapproves of Bernie Sanders---who polls recently showed is our most popular politician.
We see thru the conscience of a liberal staying as safely centrist as he can, while bravely opposing the rw radical Gop. This column is only a slight improvement.
But since it’s considered impossible---it remains impossible. This vicious cycle is perpetuated by our own media---not living up to its duty to inform the public of all options on issues. It’s off limits for centrist Dems and their liberal media columnists. The rw Gop has scared them into not looking too ‘left wing’ in our distorted political culture. And who defines left wing? The Gop.
Also off limits is our need for reform of campaign finance. Big insurance/pharma are some of the major donors to both parties. The ads they pay for make profit for the media.
Notice PK and other Times columnists and TV talk shows NEVER talk about campaign finance as the underlying cause of our health care system that ranks at the bottom of intl comparisons.
In 2017, the US can’t achieve the h/c systems achieved in 20th century by dozens of nations. Canada in the 1960s. Many earlier. But that’s kept dark by our ‘liberal media’.
Now Krugman yet again makes sure to show the world that he disapproves of Bernie Sanders---who polls recently showed is our most popular politician.
We see thru the conscience of a liberal staying as safely centrist as he can, while bravely opposing the rw radical Gop. This column is only a slight improvement.
7
True single payer is pretty rare. It's used in Canada, Taiwan, Australia, and that's about it. Most rely on some sort of mix of public and private, closer to Obamacare.
In the very near future, there will not be enough work for all working-age Americans. Increases in robotics, computers and communications will allow fewer and fewer people to do most of the work that needs to be done. Before we reach that point, we need to determine how we are going to distribute all the resources of our country, not just medical insurance and care. Are we going to be a country where only those who can pay have food, housing, clothing, medical care, education, entertainment, etc? Or, will everyone be guaranteed a livable income? It's something to think about as the future comes rushing our way.
Unless of course we are all destroyed by climate change.
Unless of course we are all destroyed by climate change.
2
I'm pretty sure that in the Netherlands and other European mixed insurance systems, they also cap insurance company profits to levels that merely keep those companies in good enough financial health to do the job. Eliminating excess profit--which American insurance companies seem to regard as their primary goal--will help reduce costs.
It would also help to compare European insurance companies to American ones in their levels of overhead. American overheads, driven so much by the market and excess treatment wrangling, are said to average around 25%. Try going into a bid meeting in any business with a 25% overhead on your schedule of values. You won't be laughed out of the room, people are too polite these days. What will occur is that you will not only lose the bid, you will also be removed from the approved bidder's list.
There are a lot of different ways to reduce cost and get better service. We just have to make sure that the market does not rule every single decision we make, just because free market ideologues say so.
It would also help to compare European insurance companies to American ones in their levels of overhead. American overheads, driven so much by the market and excess treatment wrangling, are said to average around 25%. Try going into a bid meeting in any business with a 25% overhead on your schedule of values. You won't be laughed out of the room, people are too polite these days. What will occur is that you will not only lose the bid, you will also be removed from the approved bidder's list.
There are a lot of different ways to reduce cost and get better service. We just have to make sure that the market does not rule every single decision we make, just because free market ideologues say so.
8
Health insurance is not really hugely profitable... they maybe make 1%-2% profits. What they do do is they have price controls that keep the cost of medical care down.
And don't forget that with insurance companies in the mix, it is they , all too often, which make medical decisions, not the doctors. Also remember that employers are stuck with a 'tax' that negatively impacts the economy. How many people still fear unemployment as the route to losing health care? These are only some of the evils of health insurance companies ruling the roost.
1