Trump’s Plot Against Health Care Continues

He is still coming for your coverage — and lying about it.

Comments: 269

  1. The only pre-existing condition Trump saved is that of the top 0.1% owning as much wealth as the bottom 90%. That grotesque reality precisely why Medicare For All is such a "tough sell." The oligarchs own our political duopoly as well as corporate media conglomerate. They spread the fear and the misinformation that make people feel nervous about losing their precarious, expensive coverage to a more equitable program covering everybody from cradle to grave with no premiums, deductibles, networks, co-pays or surprise bills from private equity vultures. One of the leading questions in polls is "do you know that Medicare For All would make your private coverage disappear?" -- the implication being that there looms a coverage gap of epic proportions. Paul Krugman does his own "there is no alternative" part by labeling those of us who demand what exists in every other advanced nation "ardent progressives" who just cannot understand that single payer is impossible even with a Democratic majority. That statement says more about the pundits and politicians in thrall to the oligarchs than it does about the "ardent progressives." In other words, if we don't adhere to the status quo of 84.2 million of our fellow citizens staying uninsured or underinsured, Trump will up the killing ante even more. It's like telling the people of Flint they're better off with the toxic water they already have, what with the uncertainty and the fear that new lead-free pipes might cause.

  2. @Karen Garcia Exactly correct. Healthcare as a consumer commodity, and one where prices are completely opaque and the providers are fighting to retain the right to hit people with "surprise medical bills," would be completely unthinkable in any other civilized country. But another trillion on ME wars and military hardware? Absolutely, no questions asked.

  3. @Pat Actually, another $2-3 trillion on gifts to billionaires and billionaire companies.

  4. @Karen Garcia As a nation, we were always set up to be profited from. As time went by and certain things could not longer be done, the setup changed to adjust to the new norms. But, at the foundation, the setup itself hasn't changed. The wealthy benefit from cheap labor and the classes underneath fight amongst each other for whatever scraps they can get. Healthcare as a human right? They will fight it tooth and nail with the judges they put in place. There are those who say that Justice Roberts will, in the end, move to the left for the sake of his legacy. I say we shouldn't count on that and, instead, elect the most steadfast, steady, loyal politician who will fight for the people's interests rather than the corporatocracy. Will the candidates who have told big donors that not much will change win? Will the candidate with the flowery language and non-committal healthcare plan sell himself to a public that doesn't get the "if you want it" part? Will the candidate who is making themselves appear as if they invented policy itself sell the public on a ten year plan even though two terms equal eight years? Or... will voters ignore the propaganda all around us and go for steady and consistent? Trump lies. That's a given. It's also a distraction from the real conversation.

  5. "...Trump’s political health care strategy is to flat-out lie about what he has done and is trying to do." Why should this be different from everything else out of his mouth? That people living in the richest, most powerful country in the world accept healthcare as a commodity instead of a right is a triumph of right-wing corporate propaganda.

  6. @Pat People in America accept healthcare as a commodity because almost everything else is: from education to politics to clean water and safe food. The root of it all is politics; until you cap election costs and make it illegal for politicians to accept donations above $1000, all the other ills will follow.

  7. @Pat -- In Republicans 'all things are transactional' world-view, we're not Citizens -- we're merely either consumers, commodities, the collaterally-damaged or canon fodder. If we're just going to strip-mine our Humanity, I say it's time for a Paradigm Shift.

  8. @Pat I think Lying is in his DNA, health care or anything else he does. Just remember he has the support of the Evangelicals, speaks volumes to me. JMO

  9. Thank you for advocating for the ACA, which was a life saver for my son from 2015 to 2017. While he has company health insurance benefits now, one can never know the future. Many people must take Rx's to stay alive. We cannot lose this safety net.

  10. This was me in 2017. Lost my job, and there is no way I would have been able to get insurance after COBRA expired (which I paid, terrified that I would go bankrupt if I got sick. I ended up needing serious surgery. ) I've paid a disproportionate part of my part time salary towards healthcare every year since.

  11. The oligarchies plot to extract every last penny from the vast majority of Americans will never end. Trump is their representative and poster boy We know he has no problem lying. He lives the way we breathe. He lies on the fly. He lies with side-by-side videos of him saying the exact opposite. He doesn’t care if he’s caught in a lie he just says so what? We need to get Trump out of the White House. The question is do we replace him with someone Will not take us all the way to full health care benefits for everyone? Will a majority of Democrats accept more compromising on health? With all of the other pressing issues we have, housing, a living wage, the environment and relax station of environmental rules, I don’t think so.

  12. The Supreme Court just ruled that the law requiring we ALL participate in “Affordable Health Care” was unconstitutional. That was not the President’s doing. That was the Supreme Court.

  13. @Julie Ireland What ruling are you referring to? Just today Trump asked the supreme court to delay any decisions until after the election. If you’re referring to the 2012 decision, then you have it backwards. Here is WaPo: “ Chief Justice John G. Roberts Jr. on Thursday joined the Supreme Court’s liberals to save the heart of President Obama’s landmark health-care law, agreeing that the requirement for nearly all Americans to secure insurance is permissible under Congress’s taxing authority. The court’s 5 to 4 ruling was a stunning legal conclusion to a battle that has consumed American politics for two years. Roberts’s compromise offered a dramatic victory for Obama and Democrats’ decades-long effort to enact a health-care law and a bitter defeat for Republicans and tea party activists, who had uniformly opposed the Patient Protection and Affordable Care Act.”

  14. @Rima Regas I don't know, Rima, as I said in my comment (above), Trump doesn't seem beholden to each and every big corporation. For instance, I don't see that he is entangled with Big Insurance or Big Pharma; he just doesn't have time and energy to be friends with every industry. He promised to fix our healthcare. It would seem a big win for him to do so, and he needs all those that he can get. (I'm predicting he'll lose in 2020.) If he made a big move on healthcare, he'd kick a big leg out from under the Democrats and please millions of voters. Of course, I don't know what he does in the White House. Maybe he has met with and sold what's left of his soul to Big Insurance.

  15. "You’re going to have such great health care, at a tiny fraction of the cost—and it’s going to be so easy.” Who was it again who promised that? Whatever happened to that?

  16. @GI Who would have thought, that being virtually Prosecuted, and Smeared, 24/7 from the date of the Inauguration, would cause such a distraction. Perhaps after the Pelosi, Schiff, and Nadler Circus, (I meant to say the Impeachement), which has turned out to be a waste of time and money, and all of The President's Existential Threats have been put to sleep, the Healthcare issues can be addressed, and resolved.......

  17. @MB - The Pelosi, Schiff, and Nadler circus as you call it started in 2018. He had two years to address healthcare with a Republican controlled House and Senate and no distractions other than golf, and the best he could do was a bill that would have gutted protections for pre-existing conditions, if it had passed. The problem isn't Democrats, it's that he doesn't have a plan.

  18. @MB The claim that the President has been wholly distracted from working on healthcare by his political enemies is disingenuous. He seems to have plenty of time for various recreational activities, vacation time, and continuous campaign rallies. I guess persecution is also keeping him from working on infrastructure, peace in the Mid East, getting Mexico to pay for a wall, and just about everything else he, at one time, promised to do.

  19. However self-interested about it's own financial health, the private health insurance industry is a major employer, and to abruptly end it would be devastating for many of its employees. While we should have Medicare and Medicaid for all who want and/or need public coverage, at least in the near term those who want, can afford and are willing to put up with private insurance limitations (and possible corruption) should be able to get it. Perhaps genuine competition with excellent public insurance will force private insurers to be less fixated on bottom line profit and give more compassionate efforts to provide better care. (Or maybe not.) It wouldn't take too long to find out.

  20. @Doug Giebel : It is better for all those employed by the health insurance business to sacrifice their jobs (most of which are low-paying) so that EVERYONE could have decent healthcare, and not worry about going bankrupt or having to commit suicide due to bankruptcy. There will be other administrative jobs to compensate for those lost. Other than the highly paid top management of health insurance companies, their employees are dismally paid. Maybe if the CEO's didn't get $25,000,000 salaries, $75,000,000 golden parachutes at retirement, and even more, this would not be the case. Health insurance companies KEEP PEOPLE FROM GETTING HEALTHCARE, AND THEY CHARGE THE PEOPLE A LOT OF MONEY FOR THE PRIVILEGE OF BEING DENIED HEALTHCARE! These predatory "businesses" should be shut down.

  21. And Medicare for all would need these employees. Their jobs would change somewhat but they will be needed.

  22. Gratitude to Obama for the ACA. Our daughter is Type 1 Diabetic, she was born in Australia where we lived until 1993 and moved back to USA. She turned 26 y.o. in 1996 and we moved back to Australia. Her health care would be a mess in USA if we were still there. In Australia, she has excellent, affordable care. We moved back because we had no confidence in Trump/McConnell and Co supporting pre-existing conditions.

  23. @Larry, In other words you are an American health care refugee!

  24. I don't know why Democrats aren't all talking about this. This is how Democrats won so many House seats in 2018. No. Instead, so many progressive Democrats are arguing for Medicare for all which has zero chance of passing. The solution to insane Republican obstructionist ideas is not to combat them with well meaning but impossible to pass progressive ideas.

  25. You don’t start bargaining from the position where you want to end up. If I wanted $20 for my bicycle I’m selling, I’d ask 30. So I’d have a chance to get 20. If I started at 20, I’d be lucky to get 15.

  26. @Smilodon7 - If you don't win the election, you're not even at the table to bargain. The whole notion that we need to start with a position far to the left so that we can arrive somewhere in between might work in a negotiation, but is a very poor campaign strategy.

  27. Excellent points made in this column. So let's start slowly. How about Medicare for all could be offered as an option with government subsidies kicking in proportionate to participation. We'll compete with private insurers and "let the market sort it out". Isn't that the Republican way? I think I know who will win out in the long run, do you?

  28. I applaud Prof. Krugman's persistent, clear-eyed coverage of this issue. Just one disagreement. He seems to assume malign intent - they simply don't want others to get health care. Based on my economics training under Prof. Blackjack Dawson at Grinnell, I posit that the goal is simply to make workers insecure. A secure workers is in a better bargaining position and an insecure one in a weaker bargaining position. Only a sociopath would want another to go without health care, but concern on losing an advantageous bargaining position could animate an entire class of Americans. It may not be "top of mind", but underneath animosity to Obamacare is fear that the balance of economic power is turning against them. They don't believe overturning Obamacare will deny health care to anyone or at least that's their comforting delusion. Unless we understand what animates those who oppose social change and stop tarring them as "bad" people, the toxic politics of our time will continue and progress will be slowed, stopped, or even reversed.

  29. Peter Quince: I have had a number of people tell me that they did not want to “pay for your” medical care. They had very strong convictions that this was completely based on their virtue and libertarian views. They also pretty much said that they did not care if we would be unable to get treatment for our medical problems. Some of it is very cold to my mind, and entirely too judgmental and unforgiving.

  30. @Betsy B Not wanting to pay for someone else's healthcare is a common Republican talking point. However, what they don't realize is that all your various insurance policies and premiums are going into a pool and are paying for other's insurance.

  31. "But the reality is that whatever its merits, universal, government-provided health insurance isn’t going to happen anytime soon." But it will happen some time in the near or more distant future, something like the Canadian model. The purity test, supporters of Bernie Sanders & Elizabeth Warren apparently seem to be performing is counterproductive. Hope they will stop that and come up with a unified approach to the govt role on healthcare, starting with a public option, which is achievable if the Democrats keep the House and win the presidency. Both have better than an even chance.

  32. "That people living in the richest, most powerful country in the world accept healthcare as a commodity instead of a right is a triumph of right-wing corporate propaganda." Pat Don't forget the millions of dollars pumped into the pockets of "our" politicians. It's a lot more than just propaganda. It's the fascist alliance of the corporate and the state for the benefit of the few. The pharmaceutical cartels and the medical industrial complex accounts for ~17% of GDP. A staggering figure that is at the heart of the problem. Yes, there will be job disruption with a shakeup of the system, but what better time to do it than now with our historically low unemployment rates.

  33. The middle class in the United States are scared of getting sick. They know that a major illness also means financial ruin. Sure we have great doctors and technology but if it's affordable, medical care is just a castle in the sky. The Affordable Care Act should be applauded for bringing the monthly premium down for middle class families. Although it doesn't address the overly bloated medical insurance racket.

  34. @Trail Runner The monthly premium only appears to be 'brought down', through subsidies, which we pay for through taxation. This is sort of dishonest because it masks the true cost. The ACA is a disaster for those of us just barely over the 'income cliff', when the full premium amount is paid for by the insured. This especially hits small business people who are modestly successful and no longer young but not yet 'Medicare worthy'. Especially since these same people are paying taxes to 'subsidize the subsidies'. And are assessed under the ACA on their pre-tax income for subsidy eligibility. It's pretty impossible to pay over half one's annual post-tax income towards ACA premiums and deductibles, but that is what many small business owners are being asked to do. Sad !

  35. That could be fixed by more generous subsidies.

  36. @Smilodon7 "More generous subsidies" does absolutely nothing to address the outrageous costs of even simple procedures. And of course we are still paying, albeit indirectly.

  37. I'm happy the ACA passed and the repeal efforts failed. When it comes to health insurance (and everything else), Republicans at all levels of government are trying to make things worse for millions of Americans. That said, the best thing about the ACA was the Medicaid expansion. The exchanges haven't really become marketplaces anyone is happy to shop at. I've been in and out of the NY marketplace for the last few years, and I've watched the deductibles rise, the provider networks shrink, and the premiums shoot up 50%. And now, regardless of who's president in 2021, the Supreme Court may strike down the whole of the ACA. That uncertainty is already affecting the markets. Saving the ACA and calming the markets would require restoring the individual mandate or passing a new law. Since the mandate remains unpopular, and passing an updated ACA would require a Democratic majority in the Senate or a bipartisan effort to save Obamacare, the ACA probably cannot be saved if the Supreme Court decides to strike it down. I'm hoping that the Democrats win the election. But I'm also hoping that, this time, they'll resist the temptation to pursue industry-backed legislation instead of popular policies that actually help people (like Medicare for All). Ten years ago, Romneycare may have been the best we could do. Now that saving it would require immense effort and result in no gains for anyone, it's time to learn our lessons and do better next time.

  38. @Adam The medicaid expansion is a good thing, but for many of us the best part of the ACA is the mandated coverage and community rating that protects pre-existing conditions. Prior to this, coverage for individuals amounted to one-use-and-gone, since anything would trigger cancellation and any future policy would exclude anything related to prior claims.

  39. Previous NYT articles have clearly shown that the central problem with health care financing in the US is the exorbitant costs of medical tests and procedures. There are models in other developed countries that suggest how to fix this problem. But so far, neither democrat nor republican politicians have significantly addressed costs, preferring instead to rearrange revenue streams, essentially perpetuating the problem of costs.

  40. @RC: "Medical tests and procedures" are the central problem of exorbitant costs? Check yourself, bro. It may be the $800+ billion/yr that for-profit health care administrators add to the system.

  41. I remain confused why Republicans and Trump want to deny people healthcare. There is lots of documentation that a healthy workforce is more employable, more productive and can earn more money which they can then spend and conspicuously consume which would only benefit the republican businesses..... i guess if we keep people poor, in ill health and only offer low paying service jobs that somehow benefits the republican ethos. Let’s be clear healthcare is a right we asked for in the Declaration of Independence - “life, liberty and the pursuit of happiness is only possible if one is healthy which only happens with affordable access to that healthcare.

  42. @BrewDoc There are a couple of reasons. First, health insurance keeps workers scared and dependent on their employers for health insurance. It keeps workers pliant, unorganized, and low paid. Second, they don’t give a rip about average Americans. Their constituency are the affluent and the big insurance companies. They will never do anything for the masses they view with total disdain or at best, ambivalence.

  43. @BrewDoc I'm sorry to be the one to break this to you, but for the modern GOP (kind of an oxymoron) the cruelty is the point. If something would cause people to suffer, it's a policy they will support.

  44. @BrewDoc Republicans don't like government programs even if millions benefit from them. It is a sad and, ultimately, sadistic philosophical position in my opinion.

  45. Just one more example—as if thinking individuals needed one—that trump cares nothing for the citizens of this country. He cares only about spitefully undoing everything President Obama did. And the more people trump can hurt, the better. What else did we expect from a man who was mean enough to cut off medical care to a nephew’s sick baby to exact revenge in a family squabble?

  46. @Drusilla Hawke Please site your source. Thanks.

  47. The health care purity test for Democrats in 2020 should be a unified message of absolute protection for pre-existing conditions, increased affordability, and an absolute commitment to moving towards universal coverage.  How best to get to universal coverage is worthy of reasoned debate -- and there will be plenty of that if the Democrats take the Senate -- but it's not worthy of ripping the party apart with exaggerations coming from either the moderates or the progressives. Intraparty "corporate tools" vs "crazy socialists" rhetoric is not going to accomplish anything besides tamping down Democratic turnout and providing fodder for Republican attack ads. The fire and brimstone should be targeted at Republicans who openly want to repeal the ACA and its protections and who have also tipped their hand in taking aim at Medicare.  The 2018 elections showed that the electorate trusts the Democrats more on health care than the Republicans.  Don't squander that trust -- save the bludgeoning for Trump and the Republicans. They earned it.

  48. "...Trump and his allies are as determined as ever to undo the progress we’ve made. It’s true that so far repeated Republican attempts to destroy the Affordable Care Act have failed...." The trump's hordes have been partially successful in destroying the Obama's ACA because it is an incomplete law, that does not touch all the people and therefore it does not have the support or interest of all the people. For the same but opposite reason it is so much more difficult, although possible!, to dismantle social security. Every law to remain in place needs the support of the majority of people and certainly medicare for all will have the same success, and for the same reasons, that medicare for elderly have now.

  49. Triage is like allocating the urgency of infrastructure construction and repair. At this point, the risk to the Metro New York economy of not building new train tunnels under the Hudson is rated moderate to low by the Trump administration.

  50. The reason Trump claims he has protected people with pre-existing conditions is that he knows that helps him in the general election. The reason he does the opposite is that it helps him with the GOP's corporate base and primary voters. If he is re-elected he will no doubt do whatever he can to destroy the ACA, and perhaps succeed. Will the majority of Americans then see he took them for a ride? The consequences could be interesting. Very interesting.

  51. Why Democrats are not capitalizing on Trump's brazen, spiteful attempts to kill the ACA is beyond me. Healthcare was a primary issue-- perhaps the primary issue--in the 2018 mid-terms. I've seen but one commercial from Mike Bloomberg that even mentions the ACA. The healthcare issue helped Democrats win control of the House. Democrats need to make it a central issue again. Mend--don't end--the ACA. Remind voters who wants to end it and who wants to mend it. There's a lot at stake.

  52. @GK thanks, you said this very well.

  53. Although I completely agree with Dr. Krugman that the gop is the people's worst enemy regarding healthcare (and many other things), congress just passed some bills recently that repealed some mechanisms that helped fund the ACA. One of the items repealed was the medical device tax, and, while not the major item, it was a help. Sad to say ,plenty of congessional Democrats voted this and nothing has been said. Why was this repealed? Why did Democratic reps vote for this?

  54. @Tim Lynch The medical devices tax was always a silly tax. When it was imposed, the producers of medical devices increased the price they charged to insurers who added 20% for profit and overhead to the numbers they used to calculate premiums. It added a pretty penny to the revenue collected by the federal treasury, because the tax was collected, not only for Medicaid expansion and Obamacare policies, but by everyone who used medical devices. For very dollar collected by the tax, somebody paid $1.20 in extra medical costs. Another of the financing mechanisms you've forgotten is that the Democrats also doubled the interest rate on federal student loans. That hasn't been repealed. But invalidating all of Obamacare would actually be a good thing for current students. It would be fun if it could be retroactively applied to all of the student loans taken out since 2011. With half of the interest already paid reversed, there would be lots of people who would be paid out and/or owed a refund.

  55. @ebmem Actually,the tax was .0213. And the lobbying industry for the device makers started lobbying for repeal from the second the ACA was enacted: They brought out the usual tripe about how it stifled innovation and affected "small" business. And,yeah, so throw all those students who were able to stay on their parents' policies off them. They can use up the little extra money for their own health insurance.

  56. Democrats and independents please jump in to save the ACA. If Trump wins, it will be gone. If Trump wins you will have no affordable coverage or protections for pre-existing conditions or from lifetime limits. The fact that, without offering an alternative, the trump administration has joined a lawsuit that - so far- has been successful in overturning the ACA in its entirety is getting little or no mention in the media or Democratic Party debates. The fact that Warren and Sanders are actually acting like medicare for all has a chance is incredibly irresponsible. (has anyone told these 2 senators that the GOP controls the Senate?)

  57. We must make this personal for Voters. Show and Tell, with real people and their Families. Show Patients that have been denied Treatment, by their Insurance Companies. Tell the Public about the numbers of Children that now have Coverage in their State, thru expanded Medicaid. Explain how Republicans want to cut regulations for Insurance Companies, providing less care at higher prices. Show, Tell and Explain. Expose the TRUTH. Don’t allow their propaganda to go unchallenged and unexposed. And last, link their VOTE to their Healthcare, and it’s Cost.

  58. @Phyliss Dalmatian You are right. We need to get Madison Avenue to put their advertising minds on this. Blitz the airwaves with poignant, funny and truthful ads. It is the only way to get people to understand.

  59. @Phyliss Dalmatian We would rather argue whether Universal Health Care is better than Medicare for All, is better than Obamacare. The point is people are dying, health care should be a right!

  60. I believe that democrats won the US House in 2018 because they ran on protecting pre-existing conditions. They were clear on this. They were repetitive on this. I give Bloomberg props for being clear and repetitive on this point for 2020 in light of the fact that his co-runners have muddied the message and not been clear on this item at all up to this time. This was such a successful talking point, even the opposition has clued in! This messaging works on the surface as effectively as it goes deep. With good reason. There’s policy and there’s Peoria. It’s quite powerful when both play well at the same time.

  61. @Jane III I agree, but docs need to include and emphasize another aspect: prevention & physical therapy. I'm fairly healthy and recently had a simple problem. The doctor prescribed a drug. I asked him if I could do pt instead. He became irritated, saying that it was hard to find people. I'm not sure if this was typical, but if so it means we are not investing in the right strategy, perhaps because it's so 'easy' to write a prescription. Later he said that many people do not want to do 10 or 20 minutes of exercise in the morning. They are too busy, they just want the drug. Too busy, or need to catch up on the next episode of 'the young and the restless' ...

  62. I am curious what "there is policy or Peoria" means!

  63. Since you despise Bernie and all he stands for, certainly his audacity to offer M4all, really we should keep pushing Obama care which is privatized to make the insurance CEOs richer than their wildest dreams, leaves many with out any insurance and people actually die because they are afraid to see a doctor anyway in case it is nothing and they have to pay thousands for the deductible. And you know that the only reason you think M4all cannot be implemented soon is because the insurance companies are paying off 80% of the Dems in congress and all the republicans to never let it happen. But if you read Bernie's plan you will see that it is cheaper to have M4all and he intends to go to the grass roots and rally them to demand it. Have you read the polls that say 81% of all registered Dems want it? And 71% of all Americans want it, so if it is cheaper and covers more, even the nefarious Koch brothers study showed it to be cheaper so with all that said the only reason it can not be done soon is because of the greedy insurance companies and their bribes. How do you plan we get around them? I guess what you are saying in order to put patches on Obama care we must give some kind of welfare to the insurance companies to sooth them first , you know like we subsidize oil companies, I say get money out of politics. Why are you supporting these insurance companies in their stranglehold of our health care and our right to have what other countries have?

  64. If you can convince 53 Republicans in the Senate to stand up to Donald Trump, a president who is so obsessed with destroying his predecessor’s legacy that he will allow nothing that even alludes to a Democrat- then I totally agree.

  65. @Reva Cooper Ah but Bernie will be going around the country after elected and ask the people to stand up and demand M4all, You know how people stood up and demanded that we keep Obama care and Medicare. We the people will do it.by popular demand. Our voices together will put fear into those senators of not being reelected or they will quit and try to work the lobby angle. There are more of us than them.

  66. I’ve read St. Bernie’s plan. And his legislation. They’re both lazy tripe, without real details.

  67. "the votes for eliminating private health insurance won’t be there" Exactly right and exactly the reason why Dem voters need to rally behind a realistic candidate like Amy Klobuchar. Health care reform WILL come, but it WILL need time to achieve. This absolutely 100% cannot be done immediately, and Dem voters need to wake up and realize that.

  68. @M.A.A Americans have been haggling about healthcare since before Truman was president. Since Americans now spend almost TWICE as much as any nation who has a universal system, still has millions under insured or not insured at all, 500,000 go bankrupt because of unpaid medical bills and as a result of it all, 45,000 die every year, it would seem the time for incrementalism is over, don't you? Since the numbers of uninsured Americans has now reached 29 MILLION(and growing), American lives are depending on it.

  69. Anyone who accepts Trump's version of anything at face value needs to have his or her head examined. So it is with the president's disingenuous assurances that he is supportive of improving, rather than eviscerating, existing health care coverage. Clearly, he isn't. A bit of warning to those who are depending upon Trump to keep his word. If you leave Trump to his own devices, and you do end up needing to have your head examined, you may end up paying for it out of your own pocket. Don't say you weren't warned.

  70. It is a tragedy that someone who lies like Trump is even allowed to run for President. He has so normalized lying as a political strategy that it makes it seem like too much to ask whether statements as absurd as his claims about pre-existing illness are proof of mental illness warranting removal. Who but Trump can make claims as detached from reality as this without begging this question? Will point out incidentally that the "unpopular" individual mandate was intended to make the requirement to cover pre-existing illness financially viable for insurance companies so they didn't go bankrupt from people buying insurance on their way to the hospital. The civil libertarians who feel that this unfairly burdens them are welcome to decline medical care if anything happens to them while uninsured. If they get sick, they destabilize the system for everyone else since the medical system has to absorb the cost of providing care to the uninsured in most cases -- i.e. it gets shifted on to people with insurance or it puts hospital at risk of not being able to pay their bills. Ordinary people do have reason to be angry about health insurance, mandated or not, however since it forces them to pay into a system artificially inflates the cost of virtually every service -- medications, laboratory services, devices, software -- to astronomical levels. Whether through taxes for Medicare/Medicaid/the VA or insurance premiums, everyone pays the cost of this.

  71. I benefitted from Obamacare and I'm grateful to those who worked to pass it, but it has many problems that can result in denial of necessary care. As long as most healthcare is in the hands of for-profit insurance companies, they continually devise new schemes to scam us. The latest I have heard is that some insurers will refuse to pay out on claims if their insure go to the emergency room and it turns out that emergency care was not needed. That is, insurers are demanding that patients diagnose themselves. We need better. With regard to campaigning against Trump, however, the Democratic nominee should just keep repeating what Mr. Krugman has said: that Trump and his Republican buddies are trying their hardest to take away Americans' healthcare, and if given the opportunity, that is exactly what they will do.

  72. @CH Americans were supposed to have "the best", "most efficient", "world-class", "least expensive", "universal" health coverage by now. Isn't that what was promised in 2016, if only we would elect him? Promises Made, Promises Broken.

  73. I am in full agreement with you Paul except for one minor point. Trump is not the culprit here. Trump knows little about anything related to health care but he is a good boy and he does what his right wing wealthy handlers tell him to do. Unfortunately those adversaries may not be purged from the political landscape even after the national Trump nightmare has long past.

  74. Single payer works. I have experienced the US system for most of my life, and the system here which is single payer. Single payer works. Perfect? Of course not. Anyone who argues against single payer because of problems in those systems is disingenuous. All systems, all models, are flawed, each in its own way. But perfect is the enemy of the good. However, the insurance industry is so entrenched financially and, most importantly, politically, in the US that it isn't going away. Advocating for single payer now now now is tantamount to nationalising the health insurance industry. Bernie Bros, do you really think that *can* happen? Not *should*, can. Everyone hates the airlines. No legroom, poor service, bad food, lack of accountability, etc. Shouldn't the US nationalise the airlines? Even if it would help, the vast majority of Americans wouldn't stand for it. The innate suspicion of government in America's DNA wouldn't allow it. They can no more nationalise airlines than they can the insurance business. Politics is the art of the possible. Work on what's possible - it's hard enough - and not lead with your ultimate fantasy, because when you lose, you lose for a very long time. The stakes are too high for that.

  75. In a negotiation, you need to ask for more than you will get. If you ask for your goal at the beginning, there’s no room to bargain. Obama should have asked for single payer, then we could have gotten the public option.

  76. I take what you say at face value. However, the progressive critique of Obamacare has value too. As Matt Taibbi writes, quoting Robert Hunter of the Consumer Federation of America, "If a bunch of construction contractors got together and decided to set the prices of bricks and mortar, they'd all go to prison. But in insurance, it's all legal." Taibbi highlights the role of the McCarran-Ferguson act, which set aside the insurance industry from federal regulation. States regulate all cases not applicable under the Sherman Antitrust Act. State regulatory officials have key relationships with hospitals and insurance companies in determining what will be covered and at what price. Yes, healthcare is a business. But this provides an incentive to drive up prices across the board. And Obamacare largely left it intact and thus was only able to slow healthcare costs instead of decrease them.

  77. @David We can lower healthcare costs by not offering the most advanced medical care unless you can pay cash for those advances. Got to make choices because we cannot have it all.

  78. @Driven No, actually, in recent years, when it comes to the healthcare industry, a good chunk of "your cash" is going to television advertising.

  79. Why not? The rest of the western world has universal health care. We get world class health care here and don't have to bankrupt ourselves to get it.

  80. Medicare for All does not begin with marginal improvements to the Affordable Care Act. It begins with a public option -- Medicare for All Who Want It. It probably will begin with coverage for persons over age fifty and then add younger people over a few years. The sweet spot for insurance companies will be through plans equivalent to Medicare Advantage Plans. That would enable Medicare to forecast and budget. The biggest hurdle to Medicare for All is Medicaid. The Southern states love the block grants that must be phased out as Medicare for All becomes a reality.

  81. Thank you for being a continuing voice of sanity, Paul Krugman. The push for Medicare for all will likely scare too many voters in November, voters who largely have their health insurance through their employers and are happy (enough) with the status quo. That is why we should rally behind Biden before it's too late. He will work to ensure that Obamacare improves and will endure. I left a full-time job with good benefits so that I could have the freedom to be self-employed. I see the option of doing that as the American dream. I have never looked back. But I could not have done it without Obamacare, despite the relatively high out-of-pocket costs. I do not want to see the ACA destroyed simply because we are determined to push universal health care prematurely in a country that is not quite ready for it. The time for (something like) Medicare for all will come. We need to be patient. Democrats must focus on winning in November, on ousting Trump. Biden can win the votes where it counts in the general election. We can move on from there. Ensuring Trump's loss is key. Moving hard left at this time is not the answer. None of us can afford four more years of this president.

  82. @Blue Moon When one considers that Trump and Republicans have NO healthcare plan and probably never will what then is the problem if a democratic candidate does offer healthcare to those who don't have it. It should be a "no brainer" not a hindrance to getting elected.

  83. @Blue Moon Bay I agree with 95 percent of this comment, but would replace "Biden" with " Bloomberg, Klobacher, Warren, Buttiege, Booker...." Trump has more dirt on Biden than the others. It's irrelevant. But it worked to make people think Hillary was a bad candidate, so it will convince them Biden is bad too. Dump Biden. Biden supporters should jump ship to Bloomberg.

  84. @Deus Yah, except the "no brainer" voters and the slave holder-demanded and derived Electoral College. Ugh. We are paying for the sins of our ancestors and those are big fn outstanding bills.

  85. In our Orwellian nation, it's 2020 and the Republican revolution is a front for the "Great" escape from the country after having pillaged it from Tax cuts to sending industry and investments to new homes in foreign lands as ready to go new fields of support and prosperity in a fog of war they started. The seeds of hate and anger have taken the smiles and happiness from our people as a means of ultimately creating that fog in which they will escape in their private jets. The wealthy are students of history and as we all know, the wealthy class comes to ultimate judgement in all nations histories. They are taking the money and running just as a hording mass of locusts would do, decimating a fertile field and moving on to the next. That means destroying health care for those left behind that might seek reprisals. The Democrats are smart. They know the game and are battling to protect us from the party of death. I'm grateful. Study Wall Street wealthy guided actions from "Globalization" defining what is a grand larceny like never before, to appointing political candidates to legislate this grand heist. Go back decades in your mind, and you may agree when you contemplate all the Republicans have done. Yes, It's the Republican Revolution, as a chaos in which to escape in. The "Party Of RED" carefully cultivated the military with money and gun owners with unbridled rights while perpetuating the gun fetish for decades to make everyone their defenders. It's a "Great" heist.

  86. I remind you that during the initial Trump campaign, negotiations occurred for building a Trump Tower in Moscow. The Negotiations were with an ethnic Russian Mayor of a major Ukranian city close to the Russian border. Timing is everything and people are creatures of time. Was it a safe house? I don't trust the Mueller Investigation.

  87. Krugman is right about the private insurance industry being so powerful that single power cannot happen over Night. But if we can manage to get Medicare extended slightly and incrementally to lower age groups, we can get started on a path that leads to the goal of universal care.

  88. @Paul W. Case Sr. Yes, that's the thing. ACA is an improvement, and the Republicans dread actually repealing it because that would do so much obvious harm... and with each step forward, people will see more of what works, and within some years, the insurance companies will have shifted their investments somewhere else, with maybe a handful of gold-plated private plans remaining as drags on the system, but we will have pretty much won...

  89. Obama-care was the Republican plan. It was Romney-care from when he was governor of Massachusetts and came from the conservative Heritage Foundation think tank. The exchanges are free market competition. The individual mandate is individual responsibility and accountability. When Obama agreed to it, Republicans called it government take over of health care and they're going to pull the plug on granny.

  90. Single payer will simply bankrupt Medicare sooner. The infatuation is understandable but the math doesn’t support it. The sooner Prof Krugman and his fellow travelers understand this, the better it will be for the rest of us.

  91. @Once From Rome Exactly, but Mr. Krugman and his followers will never believe the math. They actually think that ‘the wealthy’ will pay for all their dreams.

  92. @Once From Rome Even the libertarian Cato Institute, which does NOT like the idea of Medicare-for-All, acknowledged that it would save trillions of dollars for the nation compared to private health insurance. The idea that Medicare would go bankrupt ignores the 1/6 of our economy that would no longer be sunk into private care.

  93. @Once From Rome But we can always afford huge tax cuts for the wealthy.

  94. Americans forget that all the ACA is (and was) a Mitt Romney, Republican Party, Heritage Foundation plan that was ultimately endorsed by the Obama Administration and the corrupt members of the Senate Finance committee on its implementation whose members had, in the previous 18 months, received over $23 MILLION dollars in campaign donations from the healthcare industry. There has been little, if any, democratic policy contribution to healthcare in recent years. America can do a lot better than this.

  95. Yes, we can do better and I hope we do. Yet we can äso do worse, and in fact the situation has worseed umder Trump.

  96. Does Trump now have the ability to set the calendar for the court? He doesn’t want it heard until after the election? If that’s true then it is a kingdom and we are just the serfs.

  97. You might be right that too many members of Congress and the Senate have taken too much money from the health insurance lobby for Single Payer to be viable. That’s maybe a good thing. Imagine if Single Payer became law and the health insurers went away. Imagine if Paul Ryan then got back into politics, became President, and set about trying to destroy Single Payer like he’s said he wants to destroy Medicare. It would be catastrophic. And if Donald Trump has taught us anything, it’s that you can’t trust Republicans not to knowingly vote for a catastrophe. . That said, Obamacare was far from perfect. The mandate is onerous to working Americans who make too much for the subsidies but are still far from wealthy. Faith was put in Republican State Governors to expand Medicaid; but the faith was misplaced and premiums skyrocketed in those States. And need I remind you of the problems the exchanges had when they were rolled out? . Obamacare was legislation that had its heart in the right place - which Is much more than can be said for Donald Trump - but that had serious flaws that absolutely must be addressed. Many countries have hybrid systems, with basic government health coverage for all, and the option to buy private insurance if you want it. We currently spend $700 billion a year on Obamacare subsidies. How about dropping the Mandate; dropping the Subsidies, and using that money to establish limited coverage for all?

  98. Its more than the ACA, he is on record with several of his friends saying he will have fun gutting medicare in his second term.

  99. @DG "...saying he will have fun gutting medicare in his second term." Then thank goodness we don't have Medicare for All. Imagine having that gutted.

  100. America is in gridlock on health care as on many other issues. Dems will continue trying to shore up the public side while Republicans continue to try to undermine it. Probably neither side will make much progress. A new Democrat President alone will not change much, as Repubs will resist in Congress, the courts and at state level. To further their agenda, Dems will need to gain control of all these other institutions, which seems unlikely. In the rest of the developed world there is strong support for a public component of health care, by robust super-majorities. Only the US is different. Many Americans, apart from those with obvious vested interests, are opposed to furthering the public aspect. Many people just don't want to pay for other people's health care. This oppositional block ensures that the quagmire of US health care will not be resolved for many decades. Britain will soon celebrate the centenary of the National Health, founded in 1946. The US will not have a comparable system by then.

  101. When the history of the Trump presidency is written, it is hard to know where health care will rank on the list of Trump's most malignant policies. On one hand, it is hard to imagine an area of policy in which Trumpism has caused more American suffering--and the potential to cause so much more! On the other hand, Trump's total indifference to health care policy means that, but for the odd outburst of outright lies (like today's tweets 01/13/20), the outright demise of Obamacare has not been a policy priority. But Trump's indifference may not last long. Unshackled from the cuffs of a pending election, a re-elected Trump will surely find a way to destroy coverage in America. And he will do nothing about rising premiums in the interim. And so health care policy and outcomes, like so much else, comes down to this: there is only one chance to remove Trump from office, and it comes next November. No American can afford to be complacent.

  102. Why is it that an otherwise spot on column needs to start with what has become the obligatory slam on Bernie and his supporters? Bernie voted for Obamacare, and without his vote, I doubt it would have passed. Yes, reasonable people need to work together to expand access to healthcare and build on the successes of Obamacare. But the fact remains that Obamacare is problematic for many Americans without large incomes - with large, front-end deductions making forcing people to forgo needed care. I'm not so sure Medicare for All is the best way, or politically achievable, but staying the course is not really sustainable. A new vision is critical.

  103. @snowjs Maybe if many Sanders's supporters voted for Clinton,we wouldn't have this mess in the White House.

  104. Two things: 1) We pay for all of our own healthcare. Nobody is subsidizing us. We pay through monthly premiums, deductibles, copays, employer contributions that otherwise would have gone to our pay, and FICA taxes. All of the money that is spent on healthcare comes from us. It is all already paid for entirely by, well, us. 2) The only people who are happy with their health insurance are on Medicare. Lots of people are happy with their doctors, but I don't know anyone who loves his or her insurance plan. We need to stop arguing about where the money is going to come from for Medicare for All. We are already paying all of it for what we have right now. The question is, is this the system we want? Should your benefits be tied to what your company decides is competitive? If you lose your job, should you face losing health care, not just for you, but for your children as well? Should you be subject to surprises when you are treated by doctors outside of your plan, even when you didn't know it beforehand? We already pay a lot more than all of the other advanced nations. We can do a lot better.

  105. @Incontinental I don’t know anyone, including myself, that is on Medicare and happy! Basic Medicare has no provisions for dental, hearing aids or vision. No plan is perfect but everyone should have health insurance. Even people with pre existing conditions!

  106. @Djr1015 OK, you may be right, but for everyone I know, going on Medicare was like winning the lottery compared with what they had before turning 65. Not just the cost, but the fact that there isn't any network anymore, and there is no health insurance company to argue with constantly, since the rules are clear and consistent. I don't mean to imply that Medicare can't be improved, but it's so much better than what I had.

  107. The US is not a country but a federation of loosely related states. Each state must figure it out on its own.

  108. @Jonas Weak argument given how intertwined and interdependent the US economy and it’s citizens are across all 50 states in 2020. The current system is incredibly complex and fragmented and lacks transparency and scale — just consider Medicaid, Medicare, ACA, state programs, VA and the myriad of private plans. “Figuring it out” fifty different ways is going in the WRONG direction. Sadly, an obscene amount of money is being made today throughout the healthcare delivery (and denial) chain. That money is the biggest barrier to change.

  109. @Jonas “Every state must figure that out” Really? So how about blue states, where most wealth and medical discoveries are made, start charging the rest of the states for any new medical device they create? Just like they charge other countries?

  110. Sure. So maybe the wealthy states should keep all their own tax income instead of giving it to the poor states, many of which vote Republican.

  111. Who wins when the Affordable Healthcare Act fails other than the insurance industry? Why would anyone want to help the insurance industry? It has to be truly bizarre to be a member of the GOP. I am all for businesses running at a profit however the pre-existing condition clause is beyond wrong. The only people who are unaffected by it are the 1%. That is why any normal citizen cannot comprehend how we are even wasting our time on punishing our fellow Americans.

  112. Currently .48 cents of every Federal dollar is spent on healthcare spread between Medicare and five other federally funded programs. The cost savings promised by Obamacare has failed. That is the sad fact. Krugman has no answers. If you think healthcare is expensive now, just wait until it is free.

  113. @hawk. Factoids. Medicare payments are well below the norm. Doctors and hospitals make up the shortfall with other income. Medicaid payments are so low that ing a doc or hospital or other health care professional who will accept Medicaid payments is usually challenging. The Indian Health Service is substantially underfunded. Don't know what VA's average per patient annual cost is, and how it compares to that of similar persons other than not serving. Do you know?

  114. Actually any responsible plan would come with cost controls. I can’t tell if you support them or not, but if we are going to have health care paid for with tax dollars (not “free”) cost controls will be required.

  115. @JimPB Facts, as opposed to factoids. Hospitals complain that Medicare reimbursements only cover 90% of the cost of care, up from 80% in 2010. What that means is that they have positioned themselves politically to get 10% rate increases for Medicare if Bernie's dream comes true. Oh, but wait. Those low Medicare reimbursements are already 80% more that what a Canadian or UK hospital is paid, so we are not going to see any substantial reduction in the profits of big medicine. There are 60 million Medicare participants, retired and disabled. One third of this relatively expensive population has elected to get Medicare Advantage rather than traditional Medicaid. It offers various benefits not covered by traditional Medicare, like health club membership, hearing and vision. For the 2020 year, some plans have added home health assistance, meals on wheels, transportation to doctor appointments. Universally, the plans have out-of-pocket maximums. Many are advertised as having zero premiums, meaning there is no payment over the $140 premium for traditional Medicare. The plans are run by private insurers. It is a privatized form of Medicare, the premium support program so ridiculed when Paul Ryan suggested it. It costs the government less per participant than traditional Medicare. Traditional Medicare has price controls on services, does not allow all services, has a 20% co-pay on everything and no out-of-pocket maximum.

  116. Democrats are losing this battle for the simple fact that they are focused on the financials of Health care. The opposing side capitalized on it. It was a major mistake. You Democrats have to be right out there telling all Americans you are trying to save them from suffering and dying. Then they will listen. Tell them you want to give them more and better health care. No one wants to hear they have to spend money. It's about healthy living, not the money.

  117. @PATRICK How do the Republicans capitalize on the financials of healthcare if they aren't even offering a healthcare plan in the first place?

  118. Actually Deus, it's 10:44 pm and I just arrived back here to elaborate on the "Capitalized on it" remark; Because the Republicans quickly spotted the flaw in which Democrats focused on health care financing instead of primarily on the care itself, when they began telling the public the Democrats were forcing them to buy insurance. The truth must always be known so we can learn from it. This is why Democrats have to encourage the public to want to take care of themselves and their loved ones to be healthy and happy. Then they will find a way to pay once they realize staying alive and happy is really very good.

  119. @PATRICK But health care in the US costs twice as much as anywhere else. The Democrats should make a lot of noise about how much people will save if they go to a universal health care system like every other developed country has.

  120. If Trump wins, losing health care won’t be the biggest problem. Probably WW III will be the biggest, the environmental collapse next, loss of democracy next, then there will be another Supreme Court appointment, and a ways down will be healthcare. Of course he will destroy the ACA, but of those who read this column, maybe 10% are Trump supporters who love anything Trump does.

  121. As my friend in the mortgage business told me, the most common reason for a bankruptcy is a cancer diagnosis. Power in the hands of insurance and pharmaceutical companies will not be handed over to a better system, it will have to be forcefully wrenched from them.

  122. @Fredd R What people don't understand that there is a max amount the insurance companies. will pay out. They do not and never will cover unlimited treatment. They are only obliged to pay for the standard approved plan of care a set if treatment cycles in Oncology. After that the hospital administration and physicians can appear for more coverage. It isn't always approved. This system even exist in Canada with its national health care system. The justifications Oncology medications are extremely expensive. Sarah Palin we do have death panels,

  123. @GUANNA And they are run by insurance companies.

  124. @Fredd R Power equals dollars. The insurance companies have too much to loose if their control of the system erodes. The health care coverage dilemma is so fraught with nuances, one of which is keeping major corporations (insurance companies) in business. The concept of any transition that will hurt their bottom line is an anathema to the companies themselves and to the notion of free market capitalism itself, that we may never work this out on a national level.

  125. I have always hopes that someday we will have a single-payer system. And perhaps in the years to come that will indeed become a reality. Yet from the beginning of this debate among our top candidates I, for pragmatic reasons, have been supporting the theory that expanding the ACA should be the focus. We can not go from A to Z without working through the other 24 letters. Paul mentions the need for the government to be more generous when considering subsidies. It was indeed working before Trump got his claws into the law. I would also suggest to resurrect the public option. It did not make it through the Congress the first time around. But listening to the voices of the electorate, Republicans and Democrats alike, I would bet that it would find success the second time it is presented. Now Trump....I nearly fell out of my chair when he proclaimed that he was "the person who saved preexisting conditions." The question is does he believe that? After all, he is so lost within his deviant and ego-consumed mind, that he could live within that fantasy. My guess is that he is planting the seed for his followers to nurture and sow so that THEY will accept such trash as truth. At any rate, we have our work cut out for us leading up to November. Let us fight our battle-fatigue and win this war.

  126. @Kathy Lollock It does seem to me that Trump sincerely believes that any words that he speaks become true. Maybe he thinks there's a fairy godmother who waves a wand. The most amusing thing he's ever said was "Nobody knew healthcare was so complicated," which of course meant "I didn't know healthcare was so complicated"--and he still doesn't seem to know (or care) anything about it. But it ceases to be amusing when he's in control of the system and has the GOP loyalists helping him to crush it. "Complicated" isn't something they can handle.

  127. @Kathy Lollock The problem is his supporters believe Trump's highly publicized remarks and tweets. The fact that what he says are lies is not as highly publicized or explained as are the lies.

  128. Insurance is not "health care." In far too many cases, it's not even *insurance.* My brother, who is diabetic, went to the emergency room last year when suffering from insulin shock. Despite having already met his deductible for the year, he soon received a bill from the hospital for $86,000. His insurance company refused to pay for the emergency treatment because he'd failed to "call ahead" for approval! (As one does when falling into a coma.) Private insurers reserve the right to deny any and all claims as they see fit. What a shame that so many Americans are still forced to learn that the hard way simply because universal health care is decried as tantamount to Stalinism.

  129. Universal health care, with the option of keeping private insurance would be fine. I know of nobody except the comfortable who "likes" their private corporate insurance. It is far past the time for the US to come into the 21st century.

  130. @Frank F You need to appeal that and get a lawyer involved. Save all the correspondence. Sadly this is how our health care system works. Funny the all have computers systems but no one could tell you up front that the insurance would not cover it. They should have been able to determine that by knowing the insurance plan and the medical codes.

  131. @Frank F I hope he didn't pay it!!! I wouldn't!!!

  132. Thank you for your defense of the ACA. It's flawed, it's expensive, and infinitely inferior to a single payer system. But it's what we have. The Affordable Care Act saved my life. In the runup to the law's passage, I was facing a personal crisis. I was 23, too sick to work, about to get kicked off my student health insurance, and recently diagnosed with a severe autoimmune disease. I called every insurer in California and no one would offer me insurance of any kind, at any price. I couldn't even get a policy that excluded coverage for my pre-existing condition. I felt like the walls were closing in on me, I was so frightened. When Nancy Pelosi came out of conference and announced that she had the votes and the law would pass, I cried. I collapsed on the floor and sobbed for hours, letting out all that terror and stress that had been building inside me for months. Do we really want to go back to the days when sick people were left to die, unable to get insurance? Trump wants to send us back there, and so does the GOP. Consider - even if you're healthy now, even if you have insurance through your employer, even if you like your insurance, all of that could change in an instant. You could be me, healthy one minute and in crisis the next. Vote in 2020, because lives depend on it. Mine does, and one day yours could too.

  133. @Jennifer I had pounding in my left arm and up my neck with exertion. I had a $10K deductible and put off getting it checked out till we qualified for the expanded Medicaid. I had a 99% blockage at the top of my left descending coronary artery. It had been months, the cardiologist couldn't figure out why I was alive. The current high deductible is too high. Its what we opt for when we don't qualify for medicaid, which is off and on because of gig work.

  134. I was refused insurance for years due to a preexisting condition. It’s only luck that I didn’t come down with something bad in that time period. I’d be bankrupt or dead now.

  135. @Jennifer Thank you for sharing your story. Most people do not realize how many health conditions would be a "declinable" pre-existing condition. People with pre-existing health conditions were often denied coverage or charged higher premiums for individual market coverage before the ACA took effect in 2014. It is estimated that 27% of non elderly adults have a declinable health condition! And that number jumps to 45% for people over age 55. https://www.kff.org/health-reform/issue-brief/pre-existing-condition-prevalence-for-individuals-and-families/

  136. I cannot understand when proponents of the ACA fail to discuss the huge drop in personal bankruptcies in this country since the law passed. Is Obamacare the only reason for this decline? Of course not. But it is a big part of it. As much as Democrats discuss the numbers of uninsured, the political impetus for the bill was how the system was financially ruining those with pre-existing conditions. It was the prime topic in the Clinton and Obama 2008 campaigns. Now you are going to ignore this huge success and characterize the improvements as modest? There is nothing modest about individuals who had their retirement savings saved by this law and were not forced onto Medicaid.

  137. @Scott Mooneyham I totally agree. I received a cancer diagnosis in 2017 and would be bankrupt if it weren't for the limits on out-of-pocket maximums that are part of Obamacare. All the focus seems to be on pre-existing conditions, but for me, and I'm sure, many, many others, the cap on out-of-pocket maximums has saved my family from bankruptcy.

  138. @Scott Mooneyham Your point is well taken. I looked up the bankruptcy stats (search for "Just the Facts: Consumer Bankruptcy Filings, 2006-2017") and found that non-business bankruptcies peaked in 2010 at over 1.5 million, then fell to the present level of 767,000. Now, it should be noted that the peak came 1-2 years after the economic meltdown, but our present level is still lower than the previous low of 775,000 in 2007. There is no big drop in 2013 when Obamacare went into effect, just a steady fall in bankruptcies-- but it seems reasonable to believe that the law has contributed to that fall.

  139. The Trump administration has also been pushing Medicare Advantage plans. Now, many seniors like them (about 30% of seniors on Medicare have one). The way the plan works is that the government pays private insurance companies a fixed amount per participant for a plan which works like an HMO (limited list of docs etc.). My guess is that if more folks move to Advantage, the GOP will push to end traditional Medicare (run by the government without private insurers involved). They will want to 'get the government out of healthcare.' Like their idea to turn everything into vouchers, there is then the potential that they would plan to decrease the amount the government would pay over time. As that amount goes down, patients would have to pay more and more in fees in order to get coverage. In short, pushing folks to Medicare Advantage plans has the potential to become a way to end the Medicare program all together. Current enticements to those plans are things like health club access, rides to doctors' appointments, and eye glasses included. Sounds great to many seniors, but will the great 'extras' continue as the GOP cuts the payments?

  140. @Anne-Marie Hislop Medicare Advantage plans are great for the reasonably healthy. If you need health care, deductibles and copays can be extremely high. The plans are highly profitable for insurance companies. They also restrict choice of health care providers.

  141. @James Ward Right - part of the HMO-like quality I mentioned is a limited list of providers.

  142. @Anne-Marie Hislop Medicare advantage plans cost the government 30% more than traditional medicare...

  143. I hear all these criticisms of the Democratic plan for healthcare from Republicans. What is the Republican plan? Next time they criticize, ask them that question.

  144. @Independent The Republican Plan is a comprehensive one: No healthcare for the unemployed or minimally employed reduces their numbers. Fewer unemployed or minimally employed means less spent on the government support net

  145. @John Huppenthal In an economy predicated with an increasingly contingent workforce, healthcare benefits based on full-time employment is, IMHO, unrealistic.

  146. @cynicalskeptic The Republican plan is simple. Employers pay for the healthcare of employees in line with what the Health industry lobbyists demand from their bought and paid for GOP politicians. Health industry lobbyists spend more on lobbying than the oil industry and defense industry combined and thus are able to maintain theIr 20% stranglehold share of GDP .

  147. We pay roughly twice as much for healthcare as the other first world industrial countries. We pay $11,000 per capita versus around $5,500 per capita. We pay 18% of GDP versus 9% to 10% of GDP. They get some form of universal healthcare. We have parts of the US with infant mortality rates of a second world country. We are paying $3.5 Trillion for healthcare. We already are paying for universal healthcare, we just aren't getting it. All the money paid to private insurance would go to Medicare for All. You would think corporate America would like to get out of the business of being responsible for their employees healthcare.

  148. @Independent Good post The key is to reduce costs and nobody is focused on that.

  149. @Independent-Yes, corporate America would like nothing more than to get out from paying for their employees healthcare/benefits. They too are seeing rates go up and want to curtail costs. Right now they are doing it by age discrimination and passing on costs to employees by making care payable via a la carte plans.

  150. @Independent Unfortunately 1/7th of corporate American IS private health care. That's the problem!

  151. Health care as a human right as opposed to a marketplace commodity is not an abstract principle—it will dramatically transform our medical care system top to bottom. Doctors spend over half their time on paper-work, not for patient care but for insurance company vetting. Drug companies have licensed product monopolies with no limits on pricing. Even non-profit hospitals are organized as health-care factories, moving patients through as quickly and cheaply as possible. Rural clinics are closing, black infant morality rates are far higher than white, and American life expectancy is decreasing. Millions of Americans have experienced the inhumanity of our health care system. Health care as a product in the corporate controlled marketplace is a corrupt, expensive system where Americans are consumers with limited options, subject to profiteering by the health-industrial complex. America must commit to universal, single-payer, non-profit health system, health care as a human right, and any incrementalism and compromise is on how to make the transition.

  152. @Bruce Shigeura Healthcare is no more a right than are schools, roads, parks or Social Security. It is what our society is willing to pay for - nothing more and nothing less.

  153. @dave levy But those provisions of service in modern society are essential for operatons of the society under modern conditions. rights. As other advanced countries have proved, you have to have services like these if you want to have a sustainable a "moderrn" society.

  154. @Charlton I support universal healthcare. But to call it a right clouds how to make it effective.

  155. Since the ACA became law, US Healthcare costs increased from 16% of GDP to 18% of GDP. 'On a per capita basis, U.S. government health programs alone spend more than Canada, Australia, France and Britain each do on their entire health systems.' (WP June 2018). Please tell me again why we should continue to hold on to the current failed system?

  156. So you thought the minute the ACA passed, healthcare costs would immediately head the other direction when they have been rising for years??? Really? The rate of increase has slowed, and many more people are covered. Is that not a good thing?

  157. Just back from visiting family in Australia. Two doctor visits, an audiologist and a biopsy of a potential skin cancer; total cost? $63 after bulk billing / govt rebate. Total cost to have those 3 stitches from biopsy removed back in US? $200. WITH insurance. We have both private and govt health insurance down there. Will never understand how some Americans will die on their own bill swearing it’a not worth pursuing in the U.S.

  158. There was a time before Obamacare, I was self employed and not much extra change to throw around for health insurance but I had the best health care by paying out of pocket for preventive diseases by immunizations and not causing any self inflicted harm. I would have been very angry if at that time I had to pay a penalty for choosing to not have health insurance but managing health care within what I would have paid in deductible on top of the annual premiums. Trump is not plotting against healthcare and he is not coming for my coverage and any accusations that he is lying is patently false and fear mongering. The democrats are the ones hanging by threads thinking to make health care a big issue in 2020. Well they did get the majority in 2018 in the house of Reps. What good did that do to the health care in the country?Nothing, nada. What good will it do for them in 2020? Nothing ,nada. What happened to the only African American candidates who were talking about abolishing private health insurance? They dropped out. So what is the new game plan of the residual candidates? Try to create fear an uncertainty about what Trump will actually do and that my friends is not going to fly. Keep digging and digging and see if the Democrats can fool Americans just one more time.

  159. Well, it is true if your care consists only of immunization, pre-Obamacare was good enough, unless you had some unexpected emergencies as appendicitis or broken leg or cancer. One of these condition could really bring you down. The healthcare worries are not manufactured by Dems, it is one of top worries of American people. That's why Sanders and Warren are the top tier candidates

  160. What was your plan if you developed leukemia or were in a car crash? Your personal experience is no way to make public policy. What should concern you is that your taxes are already paying for Medicaid, Medicare, and the VA as well as uncompensated care at county hospitals and yet you have no coverage yourself. That’s pretty sad.

  161. As long as freeloaders who reject insurance are left to die when they need it and can’t pay, that’s fine with me, too. Either way, the problem is being taken care off. Unfortunately, it is the freeloaders who will be whining the most then and call for social services to save them from their own stupidity.

  162. The economic foundation of Medicare is that the system collects premiums from the individual for 30 or 40 years before it begins paying out*. "Medicare for All" is a hoax suspended by verbal sleight of hand that succeeds by stoking intergenerational jealousy. Parents pay for their children's needs for 18, 21, 26 or whatever years. Those who are physically, mentally, and emotionally able then begin paying their own way, while saving for the future so they don't become a burden on their own, or worse yet someone else's, children. We are not Scandinavians or Japanese or German; we have no thousand years of common blood to bind us to each other. They are organic nations. We are a synthetic nation; we need a different system. * Yes, clever people will point out that the trust fund will soon run out. In the context of this architectural discussion, so what?

  163. I didn't get your argument. We may not bound of blood but we all need healthcare at certain point of life, and Medicare for all it is most practical way to do so, independently of blood relation.

  164. @Charles Becker The commonality is we are all Americans. Your biased thinking doesn’t solve anything...

  165. @yuli, We do not share that deeply common bond of familial obligation to each other that helps ensure that all sacrifices are shared in common and all benefits likewise. How many Americans do you know who identify simply as "American", how many Americans have you heard state that they would like to move elsewhere, how many Americans have you heard call America an evil country? Now substitute 'Scandinavian', 'German', or 'Japanese' and answer the same questions. We Americans simply neither like nor trust each other enough to provide asocial welfare net for each other.

  166. Many of the comments here touting Medicare for All here are right on the money, but politically unworkable at this moment. if I had a magic wand I would do it in a heart beat. but as Prof. Krugman implies this is not a magical world where wishing makes it so, but a political one where the truth seems to mean nothing these days and where no one seems to want to even debate what is best only who has the power. Where will we start as democrats take back the White House and try to undo the harm that Trump and the GOP have done? Climate change and the environment? Restoring the rule of law? Getting medical coverage for the most people possible? Perhaps it is nice to think that Democrats will bring us the moon, but I myself would be happy if Medicare could be opened to everyone if they want it and every preexisting condition covered. Can we save our planet as well?

  167. Healthcare is not the lynch-pin issue that Democrats think it is. Thanks to the electoral collage, the outcome of the election will be determined by a handful of voters in rural counties in swing states. These voters are largely 55+, and either already covered by Medicare, or close to being so. The democrats keep focusing on issues that impact diverse, younger voters. However, it is older, white voters that will, once again, determine the outcome. I personally see our healthcare system as a debacle that needs urgent change, but I fear that since it has become predominantly an issue of the young, it will fail to sway the votes that count.

  168. Not necessarily. If the young people show up in the swing states, there are enough of them to win. Trump didn’t win by much.

  169. 55 is not close to Medicare. It is 10 years to go, and a lot of stuff could happen in this 10 years, considering the aging organism. I would think the healthcare is a big worry for 55 - 60

  170. Democratic candidates must make more of an issue that the Republicans and Trump not only do not have any kind of plan to improve health coverage but are actively undermining what is available today. First stop the rot and then proceed to improve the system. What is critical is to convince people that whatever happens there will not be a period when the system gets worse while trying to replace it with a better one.

  171. What frightens me the most about Trump’s comments about his saving the coverage of people with pre-existing conditions today is that there are people who will believe him.

  172. The Republican Supreme Court of the United States will be certain to delay a hearing, much less a decision, on the Affordable Care Act until November 2020 is safely in the past. The well fed, well educated, well cared for Ones in The Black Robes can then do their duty for the 1% and the Texas Republican Judge who started this whole thing, by throwing tens of millions of people to the wolves. And the malevolent mercies of Donald Trump. Can’t happen? This week Trump is campaigning In Wisconsin, and once again the Democrats will plod through Iowa, as they have for over a year. Iowa for a year, while Trump campaigns in the 6-8 states that will decide the election. The political incompetence of the Democratic Party is beyond comprehension— even Iowans must be fed up by now.

  173. Thank you for injecting this bit of realism into the discourse. I have been dismayed for the longest time because I haven't yet heard (not even in this latest column) the word transition used regarding a phase-in from no free healthcare to an eventual complete Universal Healthcare for all Americans. It seems to me that we really need to be realistic, and face a transition into this incredibly complex task. I would love to hear a Democrat articulate this with more precision. I am a Warren supporter but I understand the disbelief which many feel in this vague universe regarding the nuts and bolts of just how to achieve this transition. I like Sanders too, but how would he make this move through the snake pit of insurance companies and hospitals which make their living off this arm of Capitalism? They will fight tooth and nail to prevent it and these entities will eventually expect to be paid off, not un-like a golden parachute. This would involve tremendous sums of money. Americans need to be patiently brought into this project in a language they can understand. Years ago, Kennedy set us on the ambitious and unthinkable course to put a man on the moon. One of these Democrats needs to make the same case for Universal Heath Care for all Americans.

  174. I sometimes think Berniecrats are as much an obstacle to a Democratic win in November as the Deplorables. Sanders is not our savior, and he is as much a bomb thrower as was Newt Gingrich. And yet if he is not nominated the Berniecrats are ready to whine, stay at home, and allow the Apricot Stalin another four-reign of destruction. I wish they'd wake up and look outside their hermetically sealed political bubble at the rest of us. The world will not end if Bernie is not president. No one can or should say that about Trump.

  175. Tell the truth, your tirade is hardly good motivation for Bernie supporters to vote for moderates. I am not sure moderates can work with Reps, but they surely can not work with Progressives.

  176. It's amazing to me that people object to gov't medical care over an insurance company that makes more money denying one coverage!

  177. And what have the Democrats done Paul but sit on their hands and do nothing? What about the millions who can no longer afford insurance because their premiums have gone through the roof because of the A.C.A? How much in premiums are the illegal immigrants paying in premiums for their health care? The Affordable Care Act was a complete failure and a lie. Millions lost their primary care physician because Obama told us we could keep them when we couldn't. The rollout of the program was a total disaster and never recovered. Outside of chirping about single payer premiums, there is not a single Democratic Presidential candidate that talks about a comprehensive healthcare plan in any detail, all they can do is complain about what is.

  178. @Kurt Pickard Show me the evidence that millions lost their primary care physician. Under every insurance plan you could lose your primary care physician upon renewal. But it hardly ever happens. Plus, once you leave metropolitan areas your choice of doctors is basically whoever is around. Health care costs have been rising dramatically for 30 years. Blaming ACA is ludicrous. And please, show me that plan, that beautiful cheaper plan that Trump and the Republicans have promised.

  179. Since when do any of us get to keep our PCP? All your company has to do is change its plan-and you will have no say in that-and you get to look for a new doctor. The only way to be sure to keep your doctor is single payer. Consider yourself lucky your plan has stayed the same. Consider yourself lucky you have insurance at all

  180. @Kurt Pickard This is rich. The number of uninsured Tennesseans fell by 33% since the ACA was enacted. That must be horrible news to the red state.

  181. Dr. Krugman, you know the less than loving Republicans always focus on the economics of everything to the disadvantage of people. In a nation where most wealthy and upper middle class have ready access to health care, sometimes even having private doctors, like Trump, publicly financed health care is looked upon obviously, as an impediment to their pillaging bottom line. They don't want to pay for others health care. I venture to write that the wealthy Republicans became wealthy by focusing on themselves to the exclusion of others. It just comes naturally to them to not care and to horde treasure like the pirates they emulate. Put the "Care" back into the discussion of "Universal Care". The Democrats always cared about all Americans, but they just don't know how to verbalize it. I don't watch CSpan. Do many? Last I saw it it sounded like a therapy release for the ill. That's how bad things are now. People's happiness and smiles have gone away since Trump ascended to his throne. I don't like that Billions of campaign dollars enrich the politically coercive Television industry no matter who wins an election. How about putting money back into bumper stickers, democrat hats, and buttons again. They last for years, not a half a minute. Lets make it fun again with a message of Care for everyone.

  182. Save Obamacare for $1! Since the current legal attack on Obamacare stems from the GOP-led House zeroing out the penalty of omitting mandate -- and thereby, the claim is, undermining the taxing power of Congress that Chief Justice Roberts cited as the underlying constitutional principle justifying the mandate, why not re-instate the penalty at the level of $1? The House, with a Democratic majority, surely would pass that -- and then send it to the Senate. Mitch McConnell could squash -- a likely outcome but one with fraught political consequences -- or let it come to a vote, with serious peril for GOP senators who vote against. And if passes, a veto carries the same risk for Trump. Perhaps he would sign that sort of bill!

  183. I don't understand why the US can't learn from the European countries, where everyone is covered. In France, if you have a pre-existing condition, it's covered automatically. But private insurance companies are thriving - almost everyone has a policy to cover things the basic healthcare doesn't. I pay 80 euros a month for a top of the line plan, to supplement my National Health Care. So, national healthcare doesn't eliminate private policies - it just changes the way it works. Like Medicare + Blue Cross. But we choose our private insurance from different insurers. They also insure people who don't have their carte de séjour or citizenship. Please take the time to learn how things work - very well - in other countries!

  184. Everyone in my immediate family has some sort of pre-existing condition . This whole conversation is scary to me, and unbelievably crazy considering the money our country has. How did the US become so different than the rest of the developed world? What is wrong with us? So many Americans still don’t see universal health care as a human right. We need a true revolution in the way we think about society’s needs . We are all in this together.

  185. I went years without care thanks to being a preexisting condition.

  186. In my view, the real problem is the exorbitant costs of our med care system. Many people are blaming insurance companies but in my view they are like waiters at an expensive restaurant who get their 15%. The real culprit is the anti competitive medical establishment that limits the supply of medical care by 1) limiting the number of medical students 2) Onerous entry rules for those who studied at foreign schools 3) unnecessary restrictions on the work of nurse practitioner 4) No path for nurse practitioners to get a medical license 5) Restrictions on nearly all effective medicines that must have a dr prescription. 6) allowed scams by drug companies to extend their patents past their expiration dates.

  187. So as another wrote; we pay twice as much for health care. The Trump Wall st crowd wants that enduring profit, which is apparently a lot of money to comprehend if health care costs 11% of our Gross Domestic product. I'm thinking; are we really that sick? Consider where that extraordinary health care profit goes. New equipment is certainly a really big winner, like General Electric, deeply immersed in health care and power plants. Oops! General Electric also owned N.B.C. from where Trump came, and would you believe it, he likes power plants, some of which make us sick, but they also make medical diagnostic equipment to find problems. So are you thinking what I'm thinking? Could it be? It makes no sense to me that a Corporation would be involved in making turbines for power plants, some of which may make us sick, only to be examined for health problems.

  188. Kurgman puts the entire issue wrong. There should be 2 parallel layers of insurance, like in Europe. Universal healthcare that would offer all services at no-frills facilities, with excellent doctors and equipment. And private insurance that will offer more options at more elegant facilities. The first layer ensures that nobody is left behind. The second ensures that the people who pay more get to stay away from the Hoi Polloi in nicer medical centers. This should be noncontroversial and in everyone's interest, and it would help businesses while offering people mobility. Also, there should be NO deductibles and NO co-pays, like in Europe. The idea that people would binge on unneeded care is ludicrous, planted by the insurance industry. I am not binging on any medical services despite having no copays and no deductibles and know of nobody who does. Going to the doctor is always something unpleasant that I need to take care of. All ambulance ad EMS services should be free, covered by the universal medical system, like in Europe. None of the above is radical of socialism but normal as pie in most countries. People want something tangible in return for their taxes. As for right now, Americans get nothing....save of access to Public Libraries. Does anyone think of Public Libraries as a terrible socialist thing? Never.

  189. @NYC expat Will “for profit” hospitals, pharmaceuticals and medical services accept a federal plan that dramatically reduces their enormous profits?

  190. @Garry Read my comment above. There is NO incentive for the current monopolists to change the game. If there was a viable nationalized system to cover everyone with a modicum of medical care, everyone would flock to that system.

  191. @NYC expat Like you, I'm an expat from NYC, and agree with the consummate logic of every word you've written. Unfortunately, logic is no match for realpolitik, even with a President Sanders. As the last Democratic presidential candidate stated, "We are not Denmark!". As long as the best government that money can buy is beholden to the medical-industrial complex for campaign funding, the pay-or-die "healthcare" racket will remain in business. The United States is blinded by its arrogance and a belief in American Exceptionalism. Why would the greatest country on Earth look elsewhere to see if there's an alternative to the American Way? The current president is a stable genius, the chosen one with a big brain and the best words who is emblematic of nationalist hubris. Otto von Bismark, not known to be a raving socialist, implemented a system of universal health coverage in 1868. Had the USA been at all interested in making medical treatment a right to which its citizens are entitled, rather than a business, one example as to how to achieve that goal has been available for scrutiny for 150 years. In addition, the hostility of the corporate press, including the NYT, to government funded healthcare, plus a significant portion of the electorate who fear change, greatly undermine the likelihood of European, Canadian, Australian style medical coverage in the land of the free.

  192. I wouldn't say it's a plot. That gives him too much credit. He does whatever gives himself the most benefit politically and financially. When that immediate benefit becomes apparent, he acts on it. As for health insurance for the nation --- He doesn't care, he doesn't care, he doesn't care.

  193. You caught my attention with this statement: ". . .the A.C.A. left much of its implementation up to the states, and that national performance has been held down by states that have done their best to sabotage health reform." Because of my age, I am a long-time beneficiary of Medicare and really appreciate the peace of mind that my medical care expenses will be covered by Medicare. I was not aware that states had anything to do with either the payroll taxes or the payments. However, my wife recently experienced not being accepted as a patient because the specialist MD that she called for an appointment was told that they were sorry but they did not accept Medicare covered patients?!!! So I would guess that MDs can decline patients and still hold their license to practice in the state. I am mulling over what I should do about this kind of business practice. Somehow it seems absolutely illegal and counter to good and non-discriminatory practice. Remember we are talking about insurance and I like the idea of a government administered national health insurance for all based on a payroll contribution of all employed people paying into a trust fund that provides universal coverage. Based on the actuarial axiom that the larger the risk pool the less the risk to any of the individuals in the pool. So it would seem that we should expand Medicare. Of course, we would need to increase the payroll deduction. And there is a possibility that MD's might refuse to accept patients.

  194. Could they really refuse if most people were covered by Medicare? Seems like that would really limit your customer base.

  195. Perhaps those doctors who refuse to accept any Medicare patients can be helped along? Maybe an extra federal tax placed on their private medical business income to help pay other doctors who do accept Medicare patients?

  196. @Smilodon7 I agree. But I was surprised that any MD could refuse to treat people on Medicare.

  197. All Congress members should have the some insurance as us, the private citizens. Then the “ insurance industry problems” could be solved.

  198. The ACA, crafted by Obama and the Democrats, had, as its most optimistic goal, cutting the 50 million then uninsured by about a half. The President and his party reconciled themselves to the fact that insurance would be out of reach for 25 million Americans, the great majority of whom were working class Republicans. In fact, about 30 million working class Americans remain uninsured today. Nothing in Obamacare was ever designed to help these folks. They were just a cost of doing business. Democrats like Mr. Krugman repeatedly attack the poor Republican states that have refused to expand Medicaid. Those states have left two million poor folks uninsured. As for the 30 million unaddressed by Obamacare, Democrats don't go there. Instead, they shout about the 2 million -- naked indefensible partisanship. The simple truth is that Democrats knowingly left 30 million uninsured who were copnvenien5tly Republican, and they cast a blind eye at their fundamental unfairness. This is what I call an inconvenient truth. Explain it away all you can. Talk about the middle class and the poor who gained coverage. But the 30 million were foreseen from the start, and the party line of the Democrats has been we're sorry, not now, maybe later, maybe not.

  199. If it was up to the Republicans, ALL of those people would be uninsured.

  200. @michjas Miss statements and GOP talking points don’t solve nothin’.

  201. My comment argues that everything Krugman has ever said about Obamacare and the Republican opposition to health care is false. I demonstrate that Obamacare purposely left 25-30 million Americans uninsured, the great majority of whom are working class Republicans. I argue that Obamacare is a transparent partisan fraud because it purposefully insured poor Democrats at the expense of working class Republicans. Finally, I argue that insidious Democrats have persistently called attention to the 2 million uninsured in 14 Republican states in a nakedly partisan effort to distract attention from the ACA's indefensible strategy of insuring needy Democrats while ignoring tens of millions of Republican working class Americans. The point: Obamacare is a fraud and is nothing but partisan Democrat self-promotion at the expense of the American people. The point is that the ACA isn't just flawed it is purposely political, designed to benefit the Democrat constituency at the expense of Republicans. I state my case and I am quite certain, that it blows Krugman and ACA supporters out of the water. The ACA wasn't health care bill. It was a plan to promote the Democrats.

  202. We are deeply in debt with an ever increasing budget deficit. The last tax cuts has not done any good to the US Treasury or to the people. How can a Medicare for All, funded by government, be feasible? It is equally ludicrous to suggest that we should do away with private health care insurance. One should ask those large numbers of Medicare recipients how the plan works. The ideal situation to address the health care issue is to have a public - private sector partnership.

  203. In what form? We have somewhat of such partnership in form of employer-based insurance, individual insurance, government-subsidized insurance, Government programs as Medicare and VA. How well does it work?

  204. Yes, President Trump is coming for your coverage; and yes, he is lying about it. And, his motivation has nothing to do with the specifics of Obamacare, or with policy disagreements on how to improve healthcare. The fact is that Mr. Trump has a pathological obsession President Obama, and is consumed with tearing down his most significant accomplishments. Consider: 1) Obama inherited economic panic during his first breath as President; and, through a calm voice, keen intellect, and a steady hand at the tiller, he guided us through. (Remember the auto bailout that the Republicans reviled? Made a profit when he sold the stocks we bought, and saved Detroit. Hello.) Trump insists Obama was an economic disaster. 2) Obama persisted, through sheer force of will (with a big assist from Nancy Pelosi at a key moment) to bring our country within striking distance of an humane healthcare policy. Before that, we let people suffer and die without hope and were lying to ourselves when we claimed alignment to the core values of ethical, religious or spiritual principles. 3) Obama brought Iran into stringent Nuclear agreements that made the whole world safer and undermined the extremists in Iran. The military in Iran was fiercely opposed to the Iran Nuclear Agreement, and signing it gave power to the younger, moderate Iranians who will replace the fossilized, retrograde Ayatollahs. In the end, Trump would rather destabilize the world than give an ounce of credit to Barack Obama.

  205. Why would the health care industry want things to change? After all, those at the top of the HC food chain (the doctors, specialists, hospital administrators and suppliers and, of course the insurance industry) are making buckets of money. Doesn't it bother you that they have ALL the power, and you as "consumers" don't have a bit of power to change things? Add to your troubles the fact that Congress is beholden to all of the special interests I listed above. Don't expect help from politicians. Why do you think the Republicans have proposed no reform to the current system? As a European citizen (expat American), I can tell you that unless and until you Americans decide that seeing a doctor is a right rather than an empty-your-wallet-transaction, you will continue to be slaves to your broken system.

  206. Yes, President Trump is coming for your coverage; and yes, he is lying about it. And, his motivation has nothing to do with the specifics of Obamacare, or with policy disagreements on how to improve healthcare. The fact is that Mr. Trump has a pathological obsession with President Obama, and is consumed with tearing down his most significant accomplishments. Consider: 1) Obama inherited economic panic during his first breath as President; and, through a calm voice, keen intellect, and a steady hand at the tiller, he guided us through. (Remember the auto bailout that the Republicans reviled? Made a profit when he sold the stocks we bought, and saved Detroit. Hello.) Trump insists Obama was an economic disaster. 2) Obama persisted, through sheer force of will (with a big assist from Nancy Pelosi at a key moment) to bring our country within striking distance of an humane healthcare policy. Before that, we let people suffer and die without hope and were lying to ourselves when we claimed alignment to the core values of ethical, religious or spiritual principles. 3) Obama brought Iran into stringent Nuclear agreements that made the whole world safer and undermined the extremists in Iran. The military in Iran was fiercely opposed to the Iran Nuclear Agreement, and signing it gave power to the younger, moderate Iranians who will replace the fossilized, retrograde Ayatollahs. In the end, Trump would rather destabilize the world than give an ounce of credit to Barack Obama.

  207. I disagree with #2. ACA worked for first 2-3 years but then it became clear it didn't cure the problem. It may help to some low-income, but the rest of us still stuck with high premiums and deductibles and surprise bills. Moreover, we had to pay for having no insurance at all.

  208. @Mark Keller Well said.

  209. It's not health care per se, although Trump could not care less about national health care (if it's not about me, meh). It is about ObamaCare. As Trump has repeatedly shown, the ENTIRE basis of Trumpism is that if legislation was enacted during the presidency Barack Obama, eliminate it. RomneyCare, I suspect, would have gotten a pass.

  210. I've met more than a few people who are ardently anti-Democrat because they were hit with penalties for not having insurance. Our health care system has been a disaster since Nixon allowed it to be 'for profit' - that says it all.

  211. For a 60 year old couple who do not qualify for ACA subsidies (income in excess of aporox. $68,000) in Fairfield County, CT, the ACA options from least to most expensive (from “accesshealthCT”) are: Annual premiums $18,576 In-network out-of-pocket $16,300 Out-of-network out-of-pocket $40,000 Total catastrophic $74,876 Annual premiums $30,240 In-network out-of-pocket $16,300 Out-of-network out-of-pocket $32,600 Total catastrophic $79,140 I do not understand how Dr. K. considers this acceptable.

  212. @JMA Vote BLUE. M4All

  213. Thank you, Dr. Krugman, for that dose of realism.

  214. We're between a rock and a hard place on Health Care Cost Coverage, at least since 2010, and even since (in 2005 and earlier) we let the "foxes" (private insurance and the rest of the medical-industrial complex) into the "chicken coop" of planning in the Cinnton-era effort to have some pubic financing. Solution: Have Medicaid -level coverageusing public funds made available at the State level, as is coming in Washington State (with "Cascade Care" or "Apple Care") and in some other states. A "public option" along with private insuranlce coverage is allowed under the 2010 not going to happen n the US for the forseeable future because of the determined opposition of the Medical-Indusrial Complex of private Insurance companies and the corporate (hospitals. drug companies, etc.) scare tactics of screaming "socialism"! if any public funds (taxes) were to be used to cover health care costs.

  215. $2,000+/month for a family of four with huge individual deductibles for an Obamacare Bronze Plan. Glad you think this is good insurance, Mr. Krugman.

  216. @Erik Republicans did their best to destroy the ACA, which is why you have such high deductibles. If the ACA had been allowed to work as it was intended, it wouldn't be so expensive. Insurance needs a large pool of insured, esp healthy ones. Withe the mandate killed off, there was no reason for healthy people to buy insurance. Which leaves a smaller unhealthier group of people which drives up prices. Now these problems could be fixed, but the republicans are not going to do anything to help you. In fact what they plan is to make it worse, more costly to you. With republican control, you lose.

  217. It beats no insurance, which is what many of us had before.

  218. This is very true. They have done everything they can to make the ACA work less well and cost more.

  219. I have a question for anyone more knowledgeable than me: Republicans sabotaged the ACA be dropping the penalty for not taking insurance to zero. Does this mean that a rational, if selfish, person could drop health insurance and simply wait to buy insurance when they come down with a serious medical issue? Doesn't this risk healthy people dropping insurance and leaving a higher percentage of sick people in the insurance pool, driving up premiums?

  220. @LewisPG There is still a very limited Enrollment Period (6 weeks I think, late Nov. thru Dec.) to access ACA plans unless there are Extenuating Circumstances which are precisely described and subject to consideration by the PTB.

  221. To all fairness, premiums of the ACA insurances are so high, that you are better off not buying the insurance and pay penalty.

  222. People say Republicans have no healthcare plan. Nothing is farther from the truth. They just don’t want to say what that plan is out loud. The plan is that the system will take care of those that are deemed productive enough to warrant coverage. The rest will need to the stay healthy or die quickly plan.

  223. @Andy Makar Not correct. The Republicans don't seek to reward productivity, and you're probably the first to guess that. Sole proprietors and small businesses can be extremely productive but prior to the ACA had difficulty or were unable to get good health insurance.

  224. ACA allowed the to find GOOD insurance? I guess it depends on definition of good.

  225. Trump has consistently stated that he would support mandatory coverage for preexisting conditions, probably because that provision has been shown to be the most popular single feature of the ACA. Whether that is a principled position is doubtful, but it is not a lie for Trump to own that record. Conversely and hypothetically, whether Trump or anyone could jettison that particular feature is doubtful given its popularity. However, Trump is hardly being "breathtakingly dishonest" for noting his consistent support for the concept. The whole notion of what honesty is seems to be escaping Professor Krugman and the Times on a fairly routine basis. As a lifelong reader of the Times, this is getting more than tiresome. And I didn't even vote for Trump.

  226. Oh yes he is. All he had to do is defend the ACA, yet he’s trying to get the whole thing thrown out and he has nothing to replace it with. I go by what he DOES not by what he says because he constantly lies. Who can trust the man? Not me!

  227. @Dave Oedel Trump says he's for pre-existing conditions while trying to remove them, exactly as Krugman says. Do you not understand this?

  228. I have a preexisting condition. What you are telling me is I need to trust Trump with my financial future and my life. This is a guy who tells constant lies. There is no freaking way I’m going to trust a constant liar with something so important! You can FORGET THAT. If he wanted to be believed, he shouldn’t have squandered his credibility.

  229. What can pass is Medicare by choice. Not the ill-defined public option that was such a hot topic during the debate on the ACA, but the option to sign on to Medicare as it now exists for seniors and many others. I have been on Medicare Advantage plan for 8 years, and it is proving every bit as good as my good previous corporate plan, and much more secure. This would rapidly become the bridge to a true Medicare for All bill passing. People just need to see that it works. FDR understood and even the British conservative party understands that once people have decent, affordable health care, they are not about to let the government take it away from them.

  230. Well, clearly the premiums for Medicare could not cover the healthcare it uses. To subsidize it we pay 2.5 per cent of our salaries. You can not just open enrollment to Medicare without additional support for it, otherwise you will end up with pool of sick people and limited pool of money.

  231. @yulia But spending without tax increases is exactly what we do for all sorts of federal programs including the military, social programs, and corporate welfare. If we broaden Medicare in any large way, current medicare taxes will not cover it as they would not cover universal free health care. That does not mean we cannot meet such needs by adjusting other taxes, spending, and borrowing. Trump's tax cut is already a deficit disaster, yet most who oppose Medicare expansion still support that. They value making the rich richer over public health.

  232. @SpeakinForMyself we fund these programs with existed taxes, in order to fund Medicare expansion we have to take the money from existing programs or to tax somebody. In my view Medicare for All will be more realistically funded through some kind of income-based tax (that will replace the premiums ) and through taxes of corporations. The advantages of M4A is the diverse pool, the coverage of all population, and the great control over prices. Expansion of medicare to only 60-65, or 55-65, won't do the trick

  233. Charles Krauthammer predicted in 2017 that the US would have single payer universal health care within seven years. That's 2024. It may take that long for the public to see through the endless industry propaganda which tries to convince us we can't do what every other industrialized nation on earth has done, provide affordable universal health care, but it will happen, as Charles Krauthammer predicted. Everybody in. Nobody out.

  234. To anyone who has been seriously ill, has chronic illnesses or been badly injured, the refusal to abolish the for profit insurance and healthcare industry is as disastrous as the refusal to limit coal and fossil fuels on the climate change fiasco we are facing. You’re the best, Dr. K, but I part ways with you on this one. There are so many very sick people, no matter their finances who know this to be true.

  235. "In practice, any of the Democratic candidates — even Sanders — will, if victorious, end up building on and improving Obamacare." As an entrepreneur ACA was my only way to get healthcare, every other option was coverage offered by health insurance companies which denied most everything they could deny. This is lost on a lot of people complaining about M4A because they don't realize that there are a lot of people managing their benefits at companies that provide them with care but not available to individuals. However you above statement is more palatable if it were re-written as, "In practice, any of the Democratic candidates — even Sanders — will, if victorious, end up building on and improving "Medicare for those who want it" and not amplify the ACA's failures. I hope Sanders and Warren tweak their plans to bring along the people currently having healthcare provided by their employers until they too decide the cost is not worth keeping it against a Medicare option that gives them coverage without the "pain" of dealing with their private insurers and unexpected bills or dropped coverage.

  236. It’s not just entrepreneurs, but everyone who works at a small business who needs the ACA. My boss tried to buy coverage for us, they laughed and told him to come back when he had 50 employees. We have 6.

  237. I don't see ACA as a savior of small businesses. Premiums now are high, as well as deductibles. As matter of fact, deductibles of some plans so high that it will not cover such chronical conditions as diabetes. On the individual side, the system is complicated and require you to estimate your income for year ahead, in order to get subsidies right away. Your mistake in estimation could cause you thousands. These problems would be avoid in M4A. ACA was a (somewhat) good try, but it is clearly is not working solution.

  238. Your boss lied to you, and you bought it. There’s no lower limit; in fact, there are ACA SUBSIDIES specifically for small biz.

  239. An item-by-item comparison might show Medicare Advantage plans to be less expensive. The catch is in quality of care: some MA plans have “narrow networks” populated by medical professionals willing to accept lower compensation. Needed providers might be located miles from those with limited transportation options. And, a few plans might lack the critical specialists that some require. Further, as a volunteer Medicare counselor, I have advised enrollees that the new MA supplemental benefits can distract seniors from the primary purpose of Original Medicare and Medicare Advantage health insurance: to provide effective and affordable COVERAGE FOR MEDICAL TREATMENTS. The cost of a single major hospitalization can offset years of supplemental benefits.

  240. Dr. Krugman, You write: > In practice, any of the Democratic candidates — even Sanders — will, if victorious, end up building on and improving Obamacare. Have you considered the possibility that, come November, Obamacare will no longer be the law of the land? Technically, Obamacare has already been found to be unconstitutional by the Fifth Circuit Court of Appeals. Obamacare being found unconstitutional by the Supreme Court before the November elections is not just an academic debate at this point. There is a Supreme Court ruling coming. And it doesn't look good for Obamacare. What then? Where is the Democrats' Plan B?

  241. If the Supreme Court does that (and it’s not assured they will), it will help the Democrats immensely. Too many of us preexisting conditions vote.

  242. I think the difference is that Bernie will fight for M4A, while improving ACA, the moderates, in the best case scenario, will just improve the ACA by throwing more money.

  243. Good morning. I love the night. It's mostly peaceful allowing me to reflect on themes here. So, Trump and the Republicans are sabotaging health care. Indeed they are. So I've been mostly reserved for years now but I want to write of some of the reporting I've read, and my analysis of it, or what one would say; How I see it. Back during Trump's campaign around 2016, a little reported negotiation occurred between Trump people and an ethnic Russian Mayor of an eastern Ukraine city adjacent to the Russian border, yes, "The border". And the negotiations were about building a Trump Tower in Moscow, Russia. At the time of reading it appeared to me to be intended as a safe house. But tonight, it occurred to me to ask; was it quid pro quo for campaign assistance? I had written of it a few times over the last year or two, but now it seems starkly relevant after this past controversy over the Zelensky phone call and the claims of Biden wrongdoing in Ukraine. Are they diversions? The nagging fact was that Trump, an actor, became friends with the new Ukrainian President, also an actor on Television, and other reporting on Paul Manafort's adventures in Ukraine and his acquaintance with Russian state television. Could it be Trump and his Tribe contemplated living in the Tower in Moscow being friends with Putin? Now I want peace with Russia, but not a puppet leading our nation. There appears to be much diversion and deception portrayed for reporters.

  244. Excellent column. Obama care never had a chance to be fully implemented and, as Paul points out, building upon its foundations provides a clear and realistic path to universal coverage. Here in Wisconsin, Scott Walker and the Republican legislative majority rejected Medicaid expansion under the law (which would have covered thousands) and joined the "repeal" lawsuit. They then passed legislation preventing our new Democratic governor and attorney general, who support the ACA, from getting us out of the lawsuit. Their goal, like Trump's, is simply to destroy a program that covers millions more and protects people with pre-existing conditions while offering no viable alternative. I find it interesting that Trump and his cabal, so intent on destroying the ACA, want the courts to delay a final decision. If it's so bad, why the delay? Clearly, they know destroying the ACA and leaving millions uninsured is a loser in 2020. While I support universal coverage, we need to be realistic and build upon the ACA to get there. Progressives should not be hoping for its demise but see the ACA as a valuable tool towards the goal.

  245. No, improvement of ACA (mainly increasing subsidies) could not lead to universal healthcare, because it lacks crucial ability to control the prices. Without that healthcare will bankrupt individual and society. Doesn't New York face a budget deficit problem because of Medicaid?

  246. Except for those who live in an untouchable wealth bubble, surely there cannot be many Americans who don’t have a family member, a friend and/or an acquaintance who has not been, is, and will not inevitably be negatively impacted in the future by American style healthcare coverage - people bankrupted by even minor illnesses and accidents in a system where costs are out of control, and medical bills willfully incomprehensible. As an American living in France with its generally excellent universal health coverage, I simply cannot wrap my head around a president and political party which not only has no plans to improve the broken American system, but is actively working to make it worse. And the millions who continue to vote Republican? I can only assume they have lost any sense of self-preservation.

  247. Even with sharp differences on public healthcare aS to be seen between Bernie Sanders and other Democrats, there is definitely a concern for the common people who deserve some kind of state assistance in healthcare access. As against this public concern there is a systematic conspiracy by Trump and his Republican minions Ike Mitch McConell to deprive the Middle class and the poor of any kind of healthcsre relief from the state, and force people to go either without any healthcare acess or buy costly health insurance products from the market which is beyond the reach of the common people.

  248. I must disagree with Dr. Krugman on this one area. The reasons republicans can whittle away at Obama care is that it is too complex, and has separate parts that can be attacked and contested. We need a federally mandated system with no loopholes, and simple rules for the industry to follow. And we need it NOW. Like global warming and climate change, we've lagged all we can afford to, and the time for putting a single payer plan in place has arrived. Supplemental insurance should be available to those who can afford it, but the insurance business model is all wrong for healthcare and needs to be minimized. Your house probably won't burn down, and you very likely won't wreck your car, but you WILL get sick and old and require healthcare.

  249. The real health care question is not who will pay for it, be it Single Payer or private insurance or Public Option, but how to reduce the enormous enormous costs of health care itself. Right now, we have huge amounts of uninsured citizens and many more insured ones who have such huge deductibles, co-payments, and out of pocket expenses that they can’t afford to access their plans. Numerous studies have shown that other wealthy countries provide universal coverage at approximately half our per capita cost, regardless of what type of payment is used. We need to see why their health care delivery systems are so much more efficient than ours. The key to universal health coverage is reducing costs and maintaining quality. If a high cost of living country like Switzerland, with state of the art health care, can provide universal coverage with private Insurance at half our cost, why can’t we? For example, I am currently vacationing in France. When I had a minor issue, I was able to get a same day extended appointment with an excellent doctor in a beautiful modern office. Since I had no French insurance I had to pay in cash for the visit. The cost was 35 Euros, about $40. Compare this to the hundreds that I would have been charged at home. The four prescriptions without insurance cost a total of about $30.

  250. We pay more for everything in America. 2019 international physician compensation report shows US comp at $313k and French at $108k. We refuse to negotiate drug prices (other countries do). We could go to Medicare prices but then doctors would have to agree to take a pay cut. Drugs still a problem.

  251. I have read on The Onion of anti-socialists who want the old system where they support the right of insurers to deny them cover for serious or critical conditions. Anything is better than socialism. Americans are divided on whether the rich should pay any taxes at all, whether climate change is man made, whether health care should be affordable for the poor. It all make America and its people such an interesting country.

  252. When viewed from abroad (any European country for example) the American health care system is impossible to understand because health care in Europe is considered to be a human right not a commercial money making enterprise. In France a hybrid system exists - part private health insurance, part government subsidized and part paid for by the individual - called the three thirds system. It works perfectly well and is in effect a compromise between universal government paid health care (Medicare for all) and the present system that is causing so much suffering in the US today.

  253. ACA which we're thankful for, is flawed and expensive for-profit-system. When will our NYT columnists start criticizing it, and discuss/explain/promote a higher standard for affordable care for all that any democracy worthy of the name deserves? Why do millions abroad have that, but we don't? Why isn't that explained to voters in our esteemed media, so proud of 1st Amendment free speech? Not every country has single payer. Many have insurance mandates---but with the crucial factor of regulation of insurance premiums by the govt elected by the people. That sounds like the whole purpose of a democracy. We don't have it. 2020 will be a distorted election due to Trump/GOP extremism and the problem of which Dem to nominate, and what their platform will be--- just to get the country back to some normality. We can only hope maybe in 2024 or 28, a president and party will see fit to bring the US up to decent standards of affordable, guaranteed HC for All, similar to other democracies.

  254. @Meredith Corporations protect each other unless they are corporate rivals. The New York Times is a major corporation with a long history of hostility to socialized medicine in any form, whatever it was or is called, going back to the 2004/2008 Democratic Party presidential primaries when Dennis Kucinich was the lone advocate for a single payer healthcare plan. Kucinich was so marginalized in this paper that his name rarely appeared except in a caption under a group photo of the candidates. NYT columnists would never write in favor of a government funded medical system. That Nobel Prize winning economist Paul Krugman was too busy duking it out in these pages in defense of his neolib hero H. Clinton against his Op-Ed colleague Bob Herbert's support for B. Obama even to discuss the economic impact of Kucinich's plan. This tradition continues.

  255. @John Bacher.....you're right. As some readers said, Krugman thought a President Clinton might make him Treasury Secretary. She cited him in the debates. And he wouldn't give Sanders even the basic respect of discussing his proposals. PK's columns are repetitive and stay within narrow limits. Bash Trump/GOP --easy.

  256. I had health insurance all the way until I got on medicare and now I have medicare plus a backup. I have two concerns about medicare for all: 1. What many people don't know is that there is a 20% copay and caps on all sorts of treatments and medicare pays only for a few days of extended care. You can still go bankrupt on medicare. My backup pays all my copays but if medicare doesn't cover something, they don't pay a dime. 2. Congress is working to throttle medicare by a different method, which is reducing payments to doctors and hospitals. Many many docs won't take you if you are on medicare or medicaid - they can't pay for their office, staff, and make a living themselves. What makes anyone think that under Moscow Mitch we'd suddenly see physicians getting a reasonable reimbursement, adjusted to where you live. I.e., it is more expensive to be a doc in San Francisco than in Little Rock. Congress has been starving the payment system for as long as I remember. With no insurance companies providing better coverage, the reimbursements would go even lower. Public option is for now the only way to go until a reasonable payment schedule and increased coverage is set in stone.

  257. Trump took a solemn oath, if anything is solemn with him, to faithfully execute the office of president. That does not mean he gets to choose which laws Congress passed and the prior presidents signed that he likes or dislikes. In persistently trying to rip apart Obamacare, he violates that oath. Perhaps it should be changed to "faithlessly execute the office of president". The next president should make dealing with the high cost of medical care in America an absolute priority. We are a vastly rich and successful nation. We can afford to take care of all citizens in one way or another but million dollar weekends in the ICU or on the operating table are too much.

  258. Maybe Trump is trying to lower average life expectancy as part of a plan to reduce social security costs. Those republicans...always looking out for the tax payers.

  259. What is the underlying reasons that Trump is trying to destroy healthcare for Americans? Is he doing it to increase the profits of the insurance companies, the pharmaceutical firms and the health management firms? Is he doing it just to increase the US mortality rate? Why is his administration against people having healthcare?

  260. It’s because it’s one of Obama’s signature achievements.

  261. Healthcare is the core issue that will bring Trump down, despite his presumably 'best ever' economy. At least that what my Wisconsin absentee vote is counting on.

  262. As an RN Case Manager who worked in the recession, I dare Donald Trump to even speak to people who are in a healthcare crisis with no insurance. He wouldn’t know where to begin. When the First Lady can stay inpatient for a week at Walter Reed for an outpatient procedure, at our expense, there is no understanding about healthcare coming from the Trump’s. Keep him in office and healthcare in the US is doomed. And yes, people, millions of people, will die.

  263. Obama increased the cost of health care by a close to a trillion dollars. Result? Life expectancy fell in both 2015 and 2016. Quality of healthcare fell and the burden of that trillion on the economy reduced opportunity and jobs, leaving 12 million discouraged workers dying from alcoholism, depression and Opioid addiction. In 2018, Trump increased full-time jobs, the kind that come with healthcare benefits, by 3.1 million, 100% more than Obama did in 2016. Trump's increase was the largest such increase since 1984.

  264. Oh,sure. By all means return us to those halcyon days when insurers could deny legitimate claims, then under pressure try to get subscribers to accept half, and finally under enough pressure relent and pay the claim. I know it happened because it happened to me. DT is in the pocket of those interests and does not care about anyone but his plutocratic oligarchy. Neither he nor his minions can cite facts to prove otherwise. Follow the money and in November send him to play golf and eat cheeseburgers so the rest of us can survive his attacks on our very health.

  265. This observation may have been made before, but it is useful to repeat it because of the obtuse rhetoric of Sanders (and Warren as well) about "Medicare for All!" Current Medicare recipients do not have "Medicare for All," as defined by Sanders. Sanders notion of "Medicare for All!" means that Medicare would cover 100% of the cost and there would be no co-pays or premiums. (Taxes would absorb the cost of premiums as part of the cost of overall care.) Currently Medicare covers 80% of the cost, with no co-pays. And there are, of course, premiums. But the other 20% is the responsibility of the insured. Yes, you can buy (i.e., pay premiums for) a range of standardized supplements, called Medigap policies, which will pay some of the additional 20%, including co-pays. Beginning in 2020 you can be grandfathered to pay premiums for a Plan F Medigap policy, which truly covers all of the additional 20%, including co-pays. But you had to have been carrying this Plan as of December 31, 2019. If you had not previously been subscribing to Plan F, you cannot start buying it now. Anyway, the surge in cost for the additional 20% for current Medicare recipients themselves to have Sanders style "Medicare for All" would be enormous. 20% of a very very large number, is still a very large number. And because of their voting strength as seniors, they would be first in line to claim the incremental benefits which would flow, over time, from Sanders style "Medicare for All."

  266. A seemingly neglected feature of publicly funded health is the power over employees that it takes away from employers. How much of the lack of benefits and wage increases in the U.S. can be blamed on workers' reluctance to risk the health insurance attached to their employment? I must believe it is substantial yet little mention of it is in the press or commentary that I have read. I don't think the ACA is really very effective at addressing this issue and it needs to be fixed.

  267. I don't know if this is happening, but the democratic candidates, in addition to touting their health-care policy, should be telling the American people every single day about Trump's lies on health care.