It amazes me that Republican-run states are quietly voting for Medicaid expansion and hoping that they can take the Federal dollars available and avoiding notice of their hypocrisy. Don’t let it go unnoticed. Kansas, this means you.
13
Not only does the GOP work to minimize our healthcare, it also is eviscerating regulatory protections for our food, air, water, etc -- so pollution-mediated illness (from e.coli infections to cancer and asthma) is bound to increase, and dramatically in some areas and among the most vulnerable in our country. Dems need to educate voters about what they are missing -- describe the kind of healthcare available all across the developed world, everywhere but here -- and contrast it with the devastating effects (financially, emotionally, physically) we see on individuals, families, communities, and small business. Then remind voters to make a choice for the sake of your own and your family's and neighbors' health -- vote out all GOP, who over and over have shown they are committed to our ill-health.
12
"...supporters of Bernie Sanders claiming that any politician who doesn’t demand immediate implementation of single-payer health care is a corporate tool, or something."
A system that views a person receiving necessary treatment for survival in the same way as someone who wants iPhone, is a product of corporatism. A product of assigning market value to a necessity the same way it does to a commodity.
The singular goal of a health insurance company is to make profit. Every health service available through the company is centered around it's profitability. So when someone looks at that system, looks at the health insurance industry raking in billions of dollars only to turn around and deny coverage, deny life saving medicine, and throw cancer patients into bankruptcy, and then says "yeah lets keep that part!" is absolutely operating as a corporate tool.
They're defending a system designed to keep money in the pockets of huge companies and out of the pockets of sick Americans. How one can, from a moral standpoint, defend the commodification of life saving medicine as an optional good to a sick or dying child, adult, elderly person or anyone between, to me, explicitly makes them a corporate tool.
To be told that the "extreme" view is to say someone should not die because they can't afford insulin, shows how mindlessly brainwashed society has become into serving their corporate overlords who feed them misinformation so as to protect themselves from the power of your vote.
9
I wish you would reconsider saying "Trump wants this, Trump planned that." He very likely doesn't know what he is saying, doesn't remember it from one week to the next, and he is utterly incapable of planning anything. He is governed by impulse and a fragile ego, and he does not have the intelligence to have a coherent opinion on any policy.
Trump is most likely tweeting out the last things he heard on Fox or the last thing one of his handlers whispered in his ear. Those are the people who are making the decisions.
14
@Seabuscuite: Except when Trump continues to work hard at deconstructing ACA. What, for the sake of argument, he manages to succeed?
4
What's the point of singing the praises of single-payer? Ain't gonna happen. Americans prefer the devil they know, just bathed, nails trimmed, and in better clothes. Only on binary issues like same-sex marriage is revolutionary change possible. Progressives! Stop aiming at your foot and focus on winning and doing what can be done.
Gens X, Y & Z now represent over 60% of the electorate. Together, they cast more votes than Boomers & Silents in both 2016 and 2018 (yes, the boring midterms). Paul is entitled to his opinion, but political viability seems to follow the Hemingway quote about bankruptcy:
“How did you go bankrupt?"
"Two ways. Gradually, then suddenly.”
M4A might arrive sooner than you think.
3
And after they have destroyed the ACA the GOP will be coming after Medicare and Social Security, I promise you.
15
One politician, some years ago summarized the Republican health care plan: "Don't get sick, and if you do, die quickly."
13
careful Paul, your sounding a little panicky - the "Plot"! We can just imagine President Trump late at night; pacing the floor and thinking, "how can I deprive not just my supporters, but all the people, of medical coverage". Such a wicked, wicked man!
The sheer level of derangement of the US health care situation is beyond belief.
Consider:
Ridiculous, downright fraudulent prices for everything.
Many people put at serious risk.
Inaccessible services.
A truly broken, not just creaking, system.'
A parasitic system of added costs and prices.
A lunatic level of political input into basic rights to care.
Many experienced people leaving the system leaving huge gaps in skills.
America has regressed to pre-1960s basic logic on health care. You guys invented Medicare. Now everyone else has it or something like it, and millions of people are being put at serious risk for "policy" reasons.
Are sick and dying people a policy objective? Because that's what you've got. Corporate interests, that oxymoron, are the apparent goals, quite literally at the expense of people's lives and their financial conditions. You're depending on the whims of politically appointed judges, not actual law, for working principles.
600,000 plus Americans went bankrupt last year due to medical costs. It's anyone's guess how many have died or been effectively destroyed by this obscene system. You have a ridciulous, fake, demagogue actively promoting this situation and trying to make it much worse.
Health care should be free. Charging people for getting sick is like charging someone for being hit by an asteroid. The only people who need payment are the people providing the services. The whole health sector is a huge antitrust issue. Lose this mess.
9
I am in favor of universal health care, but I am really turned off by the complete lack of discussion about the problems that come with it . Consider the fact that about 20% of the citizens of European countries with universal insurance have also a private insurance, mostly through their job. In addition, there are those who pay for services out of their pocket ( suppose you need a Catscan to determine whether the pain in your stomach is due to a cancer: are you going to wait the three months it takes to get one , or will you pay the $ 600 out of your pocket and have it done tomorrow?). Anyone who has gone through a European hospital ( I have) is struck by the paucity of personnel compared to American hospitals. What we hear now from many candidates is that we will all get the best medical care, with no deductible, no copay , and dental care thrown in. This is pure propaganda,.
1
The leap from Obamacare to a single payer system a bridge too far practically speaking. And, requires a big time Senate flip in 2020. Trump remains vulnerable to this argument: he the GOP have voted on repeal with no replacement over 50 times the past 11 years of so. Trump's personal effort narrowly defeated in the Senate. He know claims his big beautiful healthcare plan will be announced after the election.
Too busy playing golf and tweeting to put together a plan the past three years?
1
The Republicans are still trying to weaken/destroy the 55-year-old Medicare and Medicaid programs, as well as the 85-year-old Social Security program. So, why would anyone think that they would ever give up on wreaking the far more recent Affordable Care Act?
5
Being opposed to Obamacare is not the equivalent of being against health care.
2
@ebmem The title is a bit off. But being opposed to Obamacare is the equivalent of believing that health care should be rationed according to wealth / personal circumstances.
You may claim this isn't your position, but the effect of Trump's & Republicans' attacks on Obamacare over the last several years has been the loss of health insurance for several million Americans, which in some cases has resulted in death for lack of health care. And you claim you're pro-life. Hahahaha!
4
Wonder how many of the 63,000,000 Americans who voted for Trump in 2016 will appreciate his ending the Affordable Care Act if he is re-elected.
5
Alert! Alert! For those that have continued to buy into the talking point "myth" of choice in private healthcare, I would refer you to the article elsewhere in the NYT today written by the former executive at Cigna Insce, "Wendell Potter" who describes exactly how the "con" was formulated to keep the public off balance and uninformed especially when comparing it to M4A.
It is very enlightening and it should be a reminder to everyone, especially those watching the debates, that any democratic primary candidate that continues to promote the "myth" of choice in private health care should be immediately disregarded as your possible nominee of choice.
1
Gradualism is unlikely to work to change Healthcare, and the courts will prosecute the Republican agenda for decades to come - brilliant strategy by a numerically inferior party.
Total healthcare spending in the US (CMS’s NationalHealthExpenditure report) was $3.6 Trillion) one plan purposed a new system at a cost of $3.0 Trillion, and even with savings over $600 Million politicians, pundits,and Nobel winning economists attacked it.
2
The lack of rationality in the U.S. political discourse is astounding. Let's hope we don't give Trump another term.
3
@Michael Cohen
Hi Michael, I believe your facts are backwards. First came Republicans and Trump, then hatred, anger and irrational politics. Trump might be reelected, by those who appointed him in 2016. With his Russian and military help, it appears the fix is in between two rich guys.
It bears repeating that Trump was an actor for N.B.C. which was owned by General Electric that is heavily involved in power plants and equipment and also medical equipment. Ponder that.
It appears the 2016 General Election was won by a man formerly with General Electric. He's making us sick with his support of coal power plants, and then we may need to be diagnosed by his former company's medical equipment. I imagine that would raise costs all around, wouldn't it?
Healthcare should not be a political divide. Universal care is the last frontier. Don’t leave it to the State. We need to be United under one system ! As self employed I pay $2000 per month to provide coverage for my family. I can guarantee that I will not pay $24,000 in taxes if we were covered by the government. Why people rather pay premium than paying taxes is beyond me. Last I had to call an ambulance for my daughter on Christmas’ eve and they just send a bill for $3000. The insurance that I am paying 24K a year said it is out of network! Free ambulance should be always the case! If you call the cops or fireman they don’t send you a bill! Or ask a credit card before you call for their services.
5
@Fred J
Your out of network extra costs expel the "myth" of choice in private healthcare further confirmed by the article elsewhere today in the NYT written by the former executive at Cigna , Wendell Potter.
1
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.
If countless videos were posted on YouTube of Americans who are benefiting from Obamacare, perhaps this could be more of the front and center topic it needs to be in the election. Republicans have a habit of criticizing programs but not offering solutions. Americans need to be reminded of this fact.
Medical care in this nation is complicated. Everyone knows it.
Someday the pharmaceutical houses will not control health care with their massive donations to "conservative" politicians. And America can join the rest of the developed world in instituting national health care.
7
People in Michigan are already being thrown off because of new work requirements.
Trump desperately needs Michigan to win and I believe he's in big trouble here. Democrats will do well on health care alone.
4
Taxpayers should be afforded the same medical insurance that is provided to our elected officials at the same cost they pay. What is good for the governed is good for the governing.
9
@Poor Richard
The politicians don't pay anything, YOU are paying for it!
3
It is discouraging that many Americans don't get this. Republicans have done nothing to improve the ACA since it was passed. They have done everything within their power to destroy it. Yet, many Americans with the most to lose, still vote for these Republicans. Are they truly so woefully not informed... or so ideologically warped that they will condemn themselves in order to refight the Civil War...
8
Healthcare is a human right and should be free at the point of use. If you disagree, debate me. If you agree, you must support repealing ACA and replacing with Medicare for all.
4
My sister -- a retired RN -- says we have the best health care system in the world, bar none. How does she know this? Because foreigners fly to this country for treatment. Saudi nationals, no less. She is a big Trump fan.
I wish I'd asked her about medical tourism; about people leaving this country to get medical care they can afford. Or about my friend, who was forced to leave the country because she was going to lose everything to pay for surprise medical bills.
Yes, we're number 1 alright.
11
The US can either do Medicare For All or Military For All. We cannot do both. I know which I would choose: Medicare For All.
5
Thank you for mentioning California. We had no coverage after I was laid off in late 2009. I also had what the medical industry calls a “pre-existing condition,” simply a lifelong condition for which I need meds. The ACA saved us: we got great coverage. We now have coverage through my wife’s employer, but plenty of people still need it.
If Republicans get their way, they’ll wipe it out, along with much more. In 2020, help your fellow Americans by voting out GOP lawmakers, whose support for Trump proves they don’t care about the rule of law. How ironic.
12
Dr. Krugman makes a valid point which I frequently discuss is why the House does not pass a penny tax for not having healthcare. Send it to the Senate then force McConnel to send it to the Senate floor for a vote. This would allow everyone to see the folk who vote against the tax and used that vote in their campaigns. Umm?
5
And how does one force Mitch McConnell to put anything to a vote, and, if possible, why hasn’t someone done this already for the multitude of legislation he has left stagnant since its arrival from the House?
3
Yes Medicare for all no time soon, however, a federal health exchange promulgating regulations for states is a start. Elimination of health insurance carriers, brokers, big Pharma would be next step. NIH funds most bomedical research so no loss getting rid of Pharma corporations. Throw dental into the medical mix also, dental procedure costs are outrageous today. I know, my father and grandfather were both DDS and neither one, as good as they're practices were, made a fortune. Not so today, $3,000 for a procedure that takes two half our visits is common-place. What we have in place today are obstacles to health, this paradigm must shift.
4
There are significant additional societal benefits of Medicare for All, rarely if ever discussed, that would result in major changes to the infamous US personal injury lawsuit industry. Medicare for All would eliminate from the damages recoverable in such suits the cost of medical care for injuries received in an accident due to the negligence. All charges for medical treatment and care are recoverable as damages in lawsuits, since under current law the injured plaintiff is legally obligated to ensure payment to medical providers for past and future expenses of care. Such medical expenses but would not be recoverable if the costs of that care are no longer the obligation of the injured party to pay, but are rather paid by the federal government as a matter of right.
Also under current law, the past and future medical expense damages paid by defendants are shared with the attorneys for the injured, with the injured receiving only 60% of those costs for care. With Medicare for All, the injured will be assured of full medical treatment without concern for having to share the recovery, or for running out of money for future care.
Personal injury lawsuits would still go forward for recovery of damages for pain and suffering, loss of quality of life, and similar claims. But without need to litigate past and future medical expenses, the cost of bringing and defending such suits would be substantially reduced. Liability insurance premiums should drop commensurately.
5
Not necessarily true, or appropriate. Why should the state be liable for people’s individual (or corporate) negligence? In Australia, we retain the right to sue for injuries caused by another, except in separately-legislated areas like car accidents and workplace injuries.
But as a taxpayer, I would not like to be on the hook for negligent or event intentional injuries.
1
@Phil Ryan - The right to sue would not be affected, other types of damage would still be recoverable in a lawsuit. And as taxpayers, the incremental cost of medical care due to negligence, if noticeable at all, could be recovered by the government directly from any negligent defendants, if there was any societal advantage to preserving that aspect of the tort claim business.
1
The quickest way to Medicare for All is NOT to build on the ACA. The quickest way to Medicare for All is to pass Medicare for All. The ACA is a steppingstone mired in quicksand.
6
@Bruce Crabtree
I am befuddled. Why would democrats and Americans in general be satisfied with the ACA, which is essentially a Mitt Romney, Republican/Heritage Foundation sponsored plan that does nothing more than line the pockets of the healthcare industry?
I would submit, why can't democrats actually come up with their own meaningful plan that takes care of ALL Americans?
4
Having lived half of my life in a universal health care system, I don't understand Americans' fear of the system. It's stress-free and no financial ruin. I won't go into details, but the US system can have a public and private combination like the UK and France. Public is for everyone, private is for folks who want to buy extra coverage or jump the queue. Although I don't like the private system, Americans are selfish and only out for themselves and would never be satisfied with a single system.
16
@Mjw
Well, the only answers I can give you is that most Americans seem to prefer private insurers whose sole purpose is to maximize profits at the expense of everything and everyone else. They also seem to prefer the reality that 89 MILLION Americans whom are under insured(with large deductibles and co-pays) including 29 MILLION of those that have no coverage at all. In three years of the Trump administration that number of uninsured has increased by SEVEN MILLION and continues to grow. It seems also that many Americans are satisfied with the idea that over 500,000 declare bankruptcy every year because of medical bills that are unpaid and 45,000 die every year because they have no healthcare at all. Americans seem to like the idea that they spend almost twice as much(with overall poorer outcomes) as any other "civilized" country that has some sort of universal coverage.
Yep, Americans must prefer the existing system, otherwise, they wouldn't continue to vote for those "corrupt, bought and paid for" politicians who continue to deny them something better.
7
"He wants to take away your health care, but he doesn’t want you to see him doing it until the election is behind him."
Every Democratic Presidential Candidate should hammer this message home every chance they get. The debate is not "medicare for all v medicare for all who want it", but rather "Obamacare v You're on your own".
19
Why is it so hard to get Paul Krugman to support Medicare for All? Private insurance companies are making huge profits while millions of people have no insurance, or can't afford the deductibles or co-pays.
Medicare for All would provide healthcare to everyone at a reasonable cost. We would be joining the rest of the developed world. The U.S. currently spends more per capita GDP on healthcare than any other country. Despite that fact, the United States has a higher prevalence of obesity and a higher infant mortality rate.
In 2018, the United States ranked 64th in the world, with an average lifespan of 78.7 years. Japan currently ranks first in the world with an average lifespan of 83.7 years as of 2018.
8
Thank God for Bloomberg's healthcare ads!
They are powerful and spot on!
Keep the running Mr Bloomberg.
America needs the truth!
14
Republicans hated FDR Social Security.
Republicans hated LBJs Medicare.
Republicans hated the ACA.
Republicans will hate whatever is next.
19
Let’s all hate Republicans out of office in November.
3
The Democrats should not be promoting the idea of medicare for all such as Canada has. Wealthy Americans will never willingly give up their gold plated health insurance and ability to buy their way to the front of the line.
What the U.S. needs and the Dems should be pushing is federal taxpayer funded and controlled medicare for all individuals who choose to opt in to the program with no co-pays and fees of any kind and include necessary drugs (something that Canada is planning to do) also. And don't allow the States or insurance company leaches into the system.
Don't eliminate private insurance, let individuals and companys who want to keep paying insurance continue to do so the same as they do now. Face up to the kind of class society that your country has become because the rich are never going to give up their privileges or willingly subsidize the poor.
Many doctors will resist and threaten to withhold service from the public system just as they did here in Canada when our medicare system was first introduced but most will have to go along to keep making money.
A two tier system like Englands should work in the U.S.
8
Just a bunch of questions:
Why should one's healthcare (and that of his/her family) depend on the place of employment?
Why are trump and his minions set against a system that would provide for all the same care that is given to those over 65? Why is it socialism if under 65?
Why can't the USA have a healthcare system that guarantees care for all for life?
Why must the US citizen pay exorbitant prices for medicines available north of the border at a fraction of the cost? (Why did our Congress forbid negotiating drug prices for Medicare D?)
13
@Francesco-in-Umbria
Why did Congress forbid negotiating drug prices?
Answer: It is referred to as bribery. In terms of dollars spent, the healthcare industry in America is now the NUMBER ONE lobbyist in Washington, D. C.
6
When I visit my doctor now he sits in front of a computer across the room and types while I speak. It feels like he is just a corporate employee checking boxes for the corporate algorithms.
I am old so I remember when you took off your shirt and the doctor would hover around you. He would listen to your heart, breathing, thump your back, palpitate your abdomen asking if you felt any pain. He was close to you he could smell you, look at your skin...etc.
You had no problem with the doctor making a "good living". You never thought of a doctor as an employee of some Byzantine greedy money extracting machine.
You were never afraid to see a doctor.
13
Trump is against anything Obama created. But that's peanuts: he his against the principles of your founding fathers and what they had in mind. Nothing new.
10
Paul Krugman is correct except in one area. Paul does not tell us that he would never accept medicine-for-all protection because he can well afford British Harley Street upscale medical care as would anyone - and this will get far worse as the multitude of Billionaires invest their funds in the most advanced genetically coupled invention and production. Yes, people will live to see, very soon, the ability to live far past 100 years and perhaps far longer. Once the brain can be synthesized the cost of creating a new perfect body for that brain will seem tiny compared to the power of hundreds of years of wisdom stored in that brain.
3
All news stories that include something Trump said should include the phrase "After 15,000 lies, Trump now said......."
15
What I find ironic is that some of the most vociferous opponents of Medicare for All, some of them my friends, are over 65, on Medicare, and like it, yet they don't want it for everybody and hate the ACA. I put this down to Fox News and its unrelenting propaganda against government involvement in health care. They never miss opportunities to run negative stories about Britain's National Health Service, stories containing half-truths and misinformation. I probably won't live to see it, but Medicare for All will happen because private health insurance will price itself out of existence.
10
I thought that Sanders and Warren were plotting to get rid of Obamacare. They propose some nebulous replacement after Obamacare is repealed by the Democrats, but have not worked out the thousands of pages of details that will determine how much more you will pay and which Democrat special interests will be take care of.
1
I will not vote for any candidate who will not support Medicare for All. My expensive for profit health insurance almost killed me.
10
@Zejee So U will sit out this election and hopefully will not die before U reach Medicare age. Why not look at the candidates with the opt in option until a Medicare like plan gets passed by congress under a Democratic president. U can let Trump get reelected and the odds of getting a Medicare type plan for all and keeping the ACA have as much chance of being around as a "Snowball in Hades:
Mr. Krugman, what I'm about to say is a serious post.
I have a congenital condition, but I look pretty normal on the outside. My ability to concentrate and remember new things is gone, and i'm pretty unstable on my feet. I'm 52. I've led a fortunate life, worked since I was 22, earned a college degree, but it has been spotty work because of my condition. Recently, things got worse, and three brain surgeries didn't remedy it. Now I'm on disability because nobody wants to hire a guy with my problems. The state police have been out ot my house six times because I was screaming at Aetna, Travelers, Hartford, BC/BS to pay the bills they contracted to pay and wouldn't. I had $6,000 in out of pocket expense in a year that I made $13,000.
How could I have done all the things Republicans want - had a job, health insurance, and three kinds of disability insurance -and yet gone a year without income and wound up $10,000 in debt with $13,000 a year in "handouts" to live on.
Can I get these Republican trolls to talk to the State Police and they can work out whether to let me go or not? Because right now I stay alive to spite them - but their demagoguery of me and my "handouts" is getting to me.
True story. Real man.
What should our country do with me? What should I do?
I am interested to see what the Republicans here will say, so I leave this here for ... the analysis of those who might see it.
16
"And while we debate the ideal health system, we mustn’t forget that Trump and his allies are as determined as ever to undo the progress we’ve made."
This is the message all the Dem candidates need to pound, instead of pounding on each other about the best plan to get to universal healthcare.
The Dems want to protect you and your family's health, while the Repubs want to take away all of your protections... in the name of freedom (emphasis on the "dumb").
Democratic candidates, please do not take the bait of debate moderators in getting down into the mud about medicare for all vs ACA expansion vs single payer, etc... Unite around the simple messaging that we are working to ensure a healthy, productive populace while the other team is working to make you less healthy and prone to bankruptcy.
It's about hope vs fear. May hope prevail!
7
People with pre-existing conditions are not a subset of humanity. All human beings have a pre-existing condition, in that something, sometime, is going to kill each of us.
Anyone who at this moment is classified as NOT having a pre-x is one slip and fall, one accident, one test result away from moving into the opposite category.
Allowing insurance companies to rake in extra-extreme profits on the backs of those already known to have a pre-x is cruel and absolutely immoral.
Perhaps evangelicals ought to focus on this, which is right in line with all the teachings of Jesus, rather than their illusory quest to ban abortion, which will never happen anyway.
8
Well said. The proverbial bottom line is this: Mister Trump simply does not care about real people and their daily lives. He cares for one thing only: Himself. And he will lie repeatedly to make that happen.
9
Thirty years as an entrepreneur left me with a clear view of "health insurers: They were the single most persistent adversary to our success. Not 'the economy' which went up, down and sidewise during our decades; not growing competition (we were early entrants);certainly not taxation... Just those every growing insurance premiums and ever expanding resistance to paying legitimate claims. Oh and the exploding deductables didn't help.
Single payer insurance would be a boon to small business and the workforce itself. It's downright stupid of America to deny itself this powerful tool.
9
Actually Trump did indeed save pre existing conditions. His incompetence in legislative dealmaking insured that his attempt to repeal the ACA failed. Yet more winning... by losing.
2
The biggest money in politics is behind destroying the ACA. Read the book Dark Money by Jane Mayer, a brilliant piece of investigative journalism. The anti-ACA effort has been driven by Koch and the gerrymandering gang, because they feel their gargantuan income/wealth should be tax exempt. (These energy barons don't care if their faulty infrastructure takes human lives. Fines are just the cost of business.) They are joined by the Mellon-Scaifes, Bradleys, Mercers (founders of Cambridge Analytica), Olins, DeVoses (yes the Sec'y of Ed), and many others who meet regularly to destroy any and all programs that benefit the rest of us, if those programs increase their taxes. Their tax free donations to the likes of Americans for prosperity, Heritage Foundation, American Enterprise Institute, Federalist Society, George Mason U, etc. are all geared to generate the propaganda that co-opts the regular working folks into their ultraconservative, self-serving politics, while surreptitiously harming those very co-opted people. Citizens United made this worse, and gerrymandering by Ed Gillespie's people in all 50 states, paid for by Koch et al, has severely damaged democracy. To see who Koch or others are mega-funding among the politicos, such as Mitch McConnell, Scott Pruitt, Tea Party, etc.. go to Maplight.org to see how the lack of campaign finance reform has fed into this perversion of democracy. If we had functional democracy for all, we would move toward Medicare for All.
7
I just love my health insurance.
3
all those movement ppl trying to "out-left" each other - look what just happened to Jeremy Corbyn. If you think your lack of enthusiasm for Hillary Clinton didn't help Trump, think again.
You will always be in the MINORITY but if you don't work hard for whoever fights the Trumpers, will be just as much to blame for wrecking democracy.
4
I am so glad that Bloomberg has said he will support any Democratic nominee with his money and the staff he has in place. We need to get this Liar in Chief out of office one way or another.
Trump's claim that he has saved pre-existing conditions laws is so profoundly and ridiculously untrue---- Bloomberg has the resources to make Trump's lies and failures generally known in all media across the country.
4
Does anyone else get the feeling that most of the first term of whichever Democrat wins the White House this Fall will spend a fair amount of time and effort simply putting Obama's legislative achievements back in place, with the ACA being merely the biggest piece?
We all know that "Little Hands" Donny wasn't treated nicely by Barack at the Correspondent's Dinner several years ago, and has been on a mission to destroy every one of his accomplishments ever since. For those of you who insist that The Donald has no strategic plan for his presidency, think again. Revenge, however base, inane and unproductive is how this guy operates, and if the country suffers as a result, he truly doesn't care. Please keep this in mind when you vote November 3, 2020.
5
Health care is the biggest concern families have. It's time we address Medicare for All. Anything else is time wasting, money wasting, and life wasting.
6
Then we've already lost, because there isn't time for incremental change.
Assuming all goes well in 2020, we have at best two years to convince the United States having decent people in the federal government leads to real, obviously positive impact on our daily lives.
Trump has shown that continually bragging about corruption through a bullhorn is still barely enough to get the American people to take notice. We will never be this mobilized again, because Republicans will never be this incompetent again. The next Republican president will be able to do Trump's "racist grandpa" song and dance for the cameras, but will not be so ignorant of how government works that he can't think of anything to do with the position other than write checks to his own hotels.
Another barely understood half-measure will not be enough to make the American people realize they benefit from it. Republicans with throw it in the garbage at the first opportunity, blame any ensuing hardship on the program itself, and half the country will go back to believing Republicans actually intend to do something for them someday.
4
The plot against health care is part of the plot against America.
6
Let's start out by removing all health care insurance from anyone named Trump or McConnell.
4
Its not just Swindler Donald, it is the GOP establishment, it goes against their smaller government philosophy. All things privatized, and profitable. They all think they are John Galt from Atlas Shrugged, and the rest of us are not worthy if we can not afford private health insurance.
You get sick, you die and are no longer a burden on them and their taxes. That is who we are dealing with, some of the most despicable politicians in history.
6
It was John McCain's plot against a reasonable Trumpcare plan that should be investigated by the NYT. Our healthcare system could by now have been functioning more effectively to get doctors and patients more in charge of care, and costs decreasing.
Peter Olsson MD
2
@Peter
Excuse me, but Trumpcare? Is THAT the long-awaited, never-seen, marvelous, health care plan that the GOP constantly promoted, but never revealed? Republicans had ten years to come up with a plan, never provided one, but were stalwart in opposing a REAL plan, like the ACA. Specifics please, Dr. Olsson?
5
"Will it be expanded coverage under a Democrat — it probably doesn’t matter much which one — or will it be tens of millions of newly uninsured Americans under Trump?"
Thank you. We need to remind ourselves that the real contrast is between ALL of the Democrats, who want fewer people uninsured, vs. the Republicans, who would leave more people uninsured. I am glad to see the pundits backing off their obsession about contrasting the details of various Democratic plans, the more radical of which would never pass anyway.
4
Thank you for laying this out so clearly. Democratic candidates, please pay attention: unify the message to make it clear that you will protect and work to improve health coverage for those who are not wealthy; stop quarreling about the finer points of the ideal, or you will hand the White House back to Trump.
1
it should be pretty obvious by now that trump lied yet again when he promised affordable health care. now it seems that he won't stop this attack on the health care system until everyone is reduced financially to organ donor status.
2
Obama Care brought access to a significant number of people who were previously denied and stifled the insurance company shenanigans associated with pre-existing conditions. These were and are laudable outcomes but fail to address the underlying complete market failure of the current healthcare finance system. In addition, touting the universal healthcare finance systems of other developed nations is also laudable but fails to recognize that many of these systems are headed towards bankruptcy, merely on a slower curve. As a personal example of that curve, we just received an approximately 7% yearly premium increase from one of the Big Blues. Seems wonderful compared with previous double digit %'s, but with inflation running in the 2-3% range even 7% yearly is not sustainable long term . Ultimately health care needs to return to the marketplace, patients paying for their own care in a competitive market. Those who can't afford need government sponsored financial coverage and even those who can on a day to day level need some sort of government sponsored catastrophic financial insurance to guard not against the inevitability of medical issues but against their power to destroy people financially. We have the finances to do this. One thing the Europeans prove is that better health care can be delivered at about half the price. As Americans I think we can do even better. Some sort of universal care/Medicare opt in/etc. is another incremental step but not the ultimate answer.
2
Mr Krugman, in your email opinion piece, you mention the incredible Uwe Reinhardt, a hero to physicians who want all persons to have health care. When you hesitate to support Medicare for All, please reread his writings.
2
The 2020 Presidential election boils down to this one question Krugman poses about health care.
"Will it be expanded coverage under a Democrat — it probably doesn’t matter much which one — or will it be tens of millions of newly uninsured Americans under Trump?"
Sadly, this reminds me of the question I thought the 2016 election boiled down to after Antonin Scalia's death.
"Will the balance of the Supreme Court change under a Democrat or be maintained and expanded under a Republican?"
I hate seeing history, if not repeating, rhyming.
2
The ACA came; we lost good coverage and low deductible plan along with our preferred family doctor. There is nothing that President Trump can do that would be worse than what the majority of us have as coverage now. The ACA ruined our Healthcare system and has led to countless shuttered community and regional hospitals. To promote as the ACA as some grand plan and boon is simply not factual. The ACA was a kick back to insurance companies and a below the belt shot to taxpayers and all citizens.
Having preexisting condition coverage would not be insurance, it would be welfare. You buy insurance to hedge against such calamity. To use that as the example to keep this amalgamation of deplorable health coverage and costs is purely political. We need universal healthcare or nothing at all. Time to bust the insurance trusts and open up national plans.
2
@Nature
Your first sentence doesn't make sense. If you already had health insurance, why did you ditch it for the ACA?
Your comment doesn't pass the smell test.
2
@Jules
They didn't 'ditch it', they lost their insurance, probably because it was 'unacceptable' under
the ACA guidelines. Lots of people lost insurance that was a good fit for their particular circumstances, and then found themselves priced out of the ACA's market. We had actual catastrophic coverage, which was affordable and worked for our needs. It was cancelled abruptly and replaced by totally unaffordable ACA 'options' which were far more catastrophic both in pricing and coverage than what we had previously.
1
There is one thing that greatly disturbs me about the health issue that no one discusses, in particular the democrats. Medicare for all would be a GIANT give away to employers especially after Trump's so called tax reform. Employers should not be let off the hook for not providing this benefit as they have been for shedding pension benefits. Given wages have been essentially flat for decades this transfer of responsibility and costs should benefit workers and/ or the new health provider, the government. I am not for any expanded medical care benefit by the government unless employers pay more taxes and give raises. why is this not part of the discussion?
4
@Lady in Green
What employers pay now to provide health insurance would be transferred to the federal government. They won't be off the hook, except for the administrative burden.
Medicare For All would streamline a lot of things.
2
Why would like to make a suggestion to your team of reporters. What researching and writing about how does universal care works in other countries? In Europe, but also in South America, specially in Brazil? We are a poor country and we do have universal health care. It doesn't always work wonderfully, but here no one dies on the street for lack of health care, or has to sell one's home to pay for medical expenses. The US are the richest nation in the world. How come you haven't sorted that one out???
10
I remember when the ACA was originally being debated, the point of view of the opposition was basically that if we don't stop this here, it will eventually lead to socialized medicine. It struck fear in the hearts of the base who militated against it. I always found it reassuring.
Aided instead of constantly crippled, the ACA would eventually lead to Universal Health Care. It is inevitable. Building on what exists and improving it is the fastest and most sure-footed way to make Republicans worst nightmare come true. The people want it. It will come to pass.
Of course if it's to happen in the near term, it means ACA's obstructionists are voted out of office and replaced with leadership that puts us on a path to immediately improving health care for all Americans, and extending it to those millions who were blocked from its benefits.
Of course it presumes a change in Leadership in the Oval Office and Senate. But it's not far fetched really. In could happen right?
3
For once, Trump apparently was confused rather than lying. When he said he was "the person who saved pre-existing conditions," he actually meant he was "the person working hard to save insurance company executives and shareholders from paying for pre-existing conditions." He probably just misread a few words on the Teleprompter and didn't notice the mistake.
5
To be fair, Trump said he is “the person who saved pre-existing conditions”, NOT that he intended to preserve insurance coverage for them.
1
The Democrats, and especially someone like Bloomberg with deep pockets, should run ads on Fox News explicitly showing Trump's contradictory statements (i.e., lies) on health care. Maybe at least some portion of the base will see the light on an issue that's vitally important to them.
2
Since private insurance cross-subsidizes medicare (the channel being the doctor who limits the number of medicare patients so the low reimbursements are offset by (upcoded) private insurance payments), medicare for all will be a no-go for doctors. End of story.
1
There are two fundamental reasons why the GOP and President Trump, no matter what they say, want to scuttle the Affordable Care Act. First, for Mr. Trump, its nickname is "Obamacare." Anything positive associated with the former president means it has a target on it for destruction by Mr. Trump.
Second, the super-wealthy, and even just the plain wealthy who support the GOP are incensed that they should in any way pay for the health of the poor, let alone the rank and file working class. If Mr. Trump prevails, and the GOP gains control of the House and Senate (not totally far-fetched), you'll see a tightening of the already meager SNAP (food stamp) program, the elimination of Obamacare, and drastic changes to Medicaid (which has already taken its lumps), Medicare, and Social Security.
And while we're at it, if the unions who support Mr. Trump and the GOP think they're going to benefit from their re-election, they're dreaming. If the Republicans had their way, unions as we know them would not exist. And, traditionally, it was unions that fought for health benefits from employers, as well as federal programs like Medicare and Social Security.
And if you think states will fill in the blanks when Obamacare is scuttled, think again. GOP legislators here in Florida promised "something better" when they refused Federal Medicaid funding. We're still waiting for that one. Only Massachusetts will have a viable healthcare system, because they had one prior to the ACA.
3
@T Norris Social Security cannot be changed unless there are 60 votes in the Senate to do so, that is written right into its law and it also cannot be included in any reconciliation bill. I dont see the Senate taking 60+ GOP seats
@DG
I don't either, and I hope they don't. But it's a long way to November. And at this time in 2016, no rational person thought Mr. Trump would be President
1
I don't understand how Universal Health Insurance can be described as 'Taking Away Private Coverage'. Instead of an Aetna Card... you would have a Medicare Card. Your employer would be unburdened. The profit motive would be removed (7 percent goes to the profit motive). Nineteen percent of all administrative costs (16 percent of the total cost of private health insurance that's HUGE)… would be largely removed as Medicare only has a 3 percent overhead. Copays and deductibles would also largely disappear.
It's not all roses - covering all the people currently not covered would come at a higher cost. The government would also be in charge of going after fraud and abuse and any efforts along those lines will be hamstringed by the right-wing 'don't regulate me' crowd.
I'm tired of reasons why we can't do something - when the reasons are based on 1) Corruption of politicians; and 2) Ignorance. Somehow the complaint that universal coverage is just not realistic - is giving in... to corruption and ignorance.
4
The only reason is money, but those of us in the lower 49 don’t get a yearly check from our state for our oil wealth so we tend to be more frugal.
As an insulin dependent diabetic, I feel targeted. For now, my insulin is covered, but it seems that for the GOP, they would just as soon allow me to go bankrupt or die. Weird, when I am not poor and could actually pay for what I need in Canada, where drug companies are not allowed to get away with a policy of "YOUR MONEY OR YOUR LIFE".
6
I get my prescriptions in Canada for 1/4 the cost. Otherwise I would be rationing my medications, as so many of my elderly friends do. But this seems to be acceptable to many Americans
4
@Caroline P. As another diabetic on Medicare with 28K a year in insulin Im gone to Mexico should they give me the shaft, I would be gone now but Medicare isnt good outside the country.
2
Americans need to get past this morbid fear of paying taxes. That seems to be the standard objection to establishing a single-payer health system. I have read many articles that point out that, at the end of the day, US citizens pay about the same out-of-pocket (taxes and deductibles etc.) as countries like Canada and those in Europe. The difference is the health care we get, and would never give up in spite of our "excessive" taxes. Don't believe anyone who tells you that the US cannot afford it. They are either sadly misinformed or flat-out lying.
6
Last night we watched the NCAA championship game in New Orleans. When Trump walked on the field with Melania the crowd roared with cheers and chants of 4 more years and USA. When Trump went to a baseball game in New York he was roundly booed. Have we ever been this divided? It’s definitely unhealthy for our country. As a never Trumper I fear for our country.
2
Of course, Trump is lying about healthcare. Lying is his default position, for one thing. In addition, Republicans have been trying to dismantle Medicare and Medicaid for years, despite the fact that they both work to keep the elderly and poor healthier than they would be otherwise.
Elimination of coverage for pre-existing conditions would be a disaster, especially for the elderly and disabled. I for one would be bankrupt if I didn't have coverage. I represent millions like me.
6
Congressional Democrats know that Medicare for All won't pass because they are prepared to stop it. highly educated, high income professionals such as yourself are prepared to accept incremental improvements in The Affordable Care Act in order to improve the coverage statistics by a few percentage points.
The people who continue to "fall through the cracks" of this overly complex, underfunded and means tested safety net wil vote for Trump or stay home.
1
That’s right. I will not vote for any candidate who will not support Medicare for All. It’s a life or death issue for me.
2
I don't think it's fair to say that progressives want the ACA to fail.
They just believe universal healthcare is better, which all the evidence (EU vs. US) suggests.
Akin to the Paris Accords with climate change, perhaps Obamacare fooled us into thinking we had something good enough. But it's too complicated and vulnerable, relying on too much support (States, funding, Courts, ...) to keep going.
Its death by a thousands stabs is evidence it's better to burn bridges and aim for MFA.
3
On a visit to southeast Ohio it became clear that there is ZERO chance of any healthcare for all solution passing Congress. The political reality is that now healthcare providers (doctors, clinics, etc.) are largely colluding with large hospitals to bargain with insurance companies. This means both groups will lobby to prevent any substantive change in the pay for service model. The best example of what this change means is cable TV where payment demands from content suppliers have become the biggest factor in the astronomical price increases for cable. But, unlike cable, most people aren't likely to become cord cutters with healthcare.
The Ohio revelation is that in many rural areas the biggest employer is likely to be a regional hospital and associated providers. The people who work in this industry vote. With the disproportionate Senate power of a vote in rural areas, real healthcare reform is about as likely as a unicorn being struck by a snowball during a fourth of July parade in Scottsdale.
Because medical costs are likely to continue to increase even faster with the new market power of the providers, this one issue could lead to a demand for a constitutional convention or worse.
2
High deductibles should be waived for people with chronic health issues. The deductibles are to keep people from overusing healthcare. But what if I have leukemia and every year I must pay my 5000 dollars or more toward deductibles and copays and pay premiums. If I have leukemia I must get the treatment or die, how I am I overusing healthcare. Its rediculas and maddening. How will taxes go up with we collectively are already paying too much?
6
This is the Republican's Plan for health care in America, if you can't pay, go straight to jail.
The sickest patients are often the most indebted, and they’re not exempt from arrest. In Indiana, a cancer patient was hauled away from home in her pajamas in front of her three children.
4
We the human beings are affected by a myriad of pre-existing conditions, germs, accidents, violent situations, and according to the statistics all persons die some day. Yes, really. In essence the human race needs doctors, remedies and hospitals. Nobody could decide that his/her health will be without any kind of suffering forever, We have not seen a sound rationale from the politicians who hate the A.C.A.
4
the argument as such is in favor of D. Trump, since the so call "OBAMA CARE" is a disaster. to begin with is a not allow to federal Gov. to negotiate with Big Pharma the medicines cost.
.
This is monopoly and price fixing.
Obamacare might be a disaster to you, but it saved my life. I had preexisting conditions and couldn’t get coverage until Obamacare came along. Now I’m healthy and all that is behind me. Thanks to ACA. Got something better? Didn’t think so. Until universal healthcare is a reality (and Im not holding my breath,) it’s the best we can do.
12
It sounds like your argument is with Mitch McConnell and Senate Republicans, not the ACA. The House passed a bill several weeks ago letting Medicare negotiate drug prices. It sits on McConnell’s desk, where he intend to let it die.
Call your senators’ offices and demand that this bill be brought to the floor.
3
The Compassionate Conservative Health Care Plan: If you are sick or injured but can't afford health insurance, our prayers are with you.
6
Maybe by Trump claiming that he "saved pre-existing conditions," he means that the people with pre-existing conditions still have those conditions because they are unable to get the needed healthcare to tackle those conditions? Note, he did not say he saved "coverage for pre-existing conditions."
8
@Dee ...good comment. You are correct -that is the literal interpretation of his words. I doubt he is that cunning or clever to have intended it. Or...maybe he is...
That would make his words so incredibly cynical. Hmmmm..........
It's nice that Mr. Krugman is wealthy and can afford the premiums and co-pays charged by the Profit Sector controlling our health care. Thus from his position of safety, he can denigrate single-payer as some sort of pipe dream (I guess Sweden, Denmark, Finland et. al. are just silly dreamers!). Alas, these expenses are budget-busters for me, so I support Bernie Sanders and Elizabeth Warren. We will be moving to single-payer, like the civilized countries of the world, as soon as one of them is elected this November, and I will be happy to support my fellow Americans via my tax dollars in providing them with the care they need.
6
Universal health care would have effects beyond health standards and costs in this country. As the status quo shifted to employer-based healthcare in the last few decades, we've seen many companies, especially those that rely on low-wage labor (i.e. Walmart), offer fewer and fewer full-time positions so as to avoid paying workers healthcare benefits. Working class people now compete in a highly precarious job market, leaving them with economic insecurity and despair. Universal healthcare would free businesses of the burden of providing healthcare to their employees, allowing them more flexibility to instead invest in their human capital and actually offer full-time jobs with living wages again. It would also free workers who are trapped in dead-end jobs simply because they would lose healthcare if they left.
As for "taxes going up", yes, they would. But guess what? Your costs would go down. England may have a higher tax rate to cover NHS expenses, but the British don't pay for premiums, deductibles, or most medications. When you add all up of those additional costs on top of taxes, the average American does in fact pay more for healthcare than the average Brit.
Sanders 2020.
6
It is simply inconceivable to the rest of the civilized world that the citizens of the USA are still arguing about universal health care. We cannot understand why your country is unable to get past the roadblocks, even though it seems the majority of Americans do want universal health care.
5
@LauraF,
Our origins and our present day reality are completely different. We fought a bloody Revolutionary War (and the a War of 1812 in which, as you well know, Canada fought against us) to win and keep our independence. Great Britain established slavery in our colonies, but not in yours (for obvious reasons). That led us to fight a bloody Civil War to rid ourselves of *that* last vestige of British rule. We have our own Head of State; you do not.
America is was not created the same way "the other civilized nations" were. We are fundamentally different and we need our own solutions. We appreciate the courtesy of others respecting that.
1
@Charles Becker Each nation has its own particular history, and yet we are among the very few countries that can't seem to provide basic health care for its populace.
I say let's get on with it and arrive at the same sensible conclusion on health care that most other nations have, regardless of what historical facts set them apart.
4
@Plashy Fen,
That is not true. Period. How many of the nations you point to 1) began as colonies, 2) had slavery established by the imperial power on their shores, 3) fought a bloody Civil War to win their freedom, 4) a generation later fought the imperial power again to retain their independence, 5) two generations later fought a horrific Civil War to eradicate the imperial legacy of slavery, and 6) is populated by post-independence immigrants?
History MATTERS. Our history is reflected today in how we, singularly and alone among civilized nations, dislike and distrust each other. History MATTERS.
2
I have been on Medicare for the past 18 years and have been very pleased with the results. Please explain why it would be so difficult to just move the age limits over four years, going from 65 to 55 to 45, etc until everyone is covered. And, kick the insurance companies out of the whole equation and have the government do the accounting process.
9
While the single payer system may be an ideal outcome there are huge problems with its implementation . A recent visit to the hospital highlighted one aspect -- for a colleague with the same procedure on medicare the reimbursement to hospitals and doctors was about half what my private insurance paid which was 70% of what was billed. Most of the hospitals will not stay solvent with the medicare reimbursement . The same procedure in other parts of the country had considerably less costs but also fewer positive outcomes . Anyone with medicare knows its problems. So to get to single payer we need to combine the systems of private insurance and medicare , figure out a way to control costs both in medicine but also drugs , deal with regional differences and continue to encourage research;it is a tall order but with a demagogue and/or fantasist in the white house from either party it will be impossible.
@Peter
The one thing you must NOT do is allow the health insurance companies to be part of a health system. Their involvement in health care is a blatant conflict of interest.
6
Every candidate who really wants to get rid of Trump needs to spend lots of time in the swing states and needs to emphasize that Trump has done absolutely nothing to improve health care, health insurance, or the cost of health care. (And don't forget his many promises not kept about so many other things, along with his thousands of undisputed lies.)
If anything, Trump's actions have made and will make the health of Americans worse.
4
If Trump has a widely beneficial, well-planned & easily executed Health Care plan that would serve the majority Americans, he needs to loudly & very specifically trumpet that plan & outline its specifics clearly to the public. And he needs to do this well before the 2020 election.
He is probably aware that Mitch McConnell (or - more accurately - the biggest GOP donors) will not pass any sort of health care reform that might raise taxes on the 0.1%. But Trump has a rabidly loyal Base that is also essential to any GOP re-election hopes. If Trump cares about ethical, just & practical health care reform, he could get any plan of his passed (even by Moscow Mitch) if he did a vigorous sales pitch to his Base.
So why doesn't he do this? It would a logical & politically wise move to make in an election year.
The enactment of the ACA undoubtedly helped many Americans. However, it’s key identifier, it’s overall accomplishment was to give corporate private health insurance control of health care delivery in this country. It’s a so called national health program administered by state making it dependent on each individual state’s political climate and access to resources. Further, it’s operationally manufactured health care into a product offered in a consumer marketplace. Health care now less about patient and doctor than it is about the rules, regulations, restrictions imposed by insurers. It was legislation crafted under the advisement of health insurance executives and lobbyists. The program’s name, the Affordable Care Act, is itself an ironical nomenclature as it’s a national health program where those that have the financial means can buy into plans with the fewest restrictions and widest access to medical providers, health services and goods. The ACA where those that can afford it get the best medical care money can buy.
Here in Canada we have universal health care for most health needs of Canadian residents. It is far from perfect, but no-one is bankrupted by illness. This system did not happen overnight. It took several decades of incremental steps by various provinces acting alone or in partnership until the national integrated single-payer system we have today matured in the 1980s. Dr. Krugman is correct. You cannot get to universal care in one glorious leap. The system in Massachusetts (Romney-care) works well and is an excellent passage towards Bernie-care. In other words, best to work with and improve the ACA.
18
@Georglen Were people in Canada put in jail when they couldn't pay their medical bills?
The sickest patients are often the most indebted, and they’re not exempt from arrest. In Indiana, a cancer patient was hauled away from home in her pajamas in front of her three children and put in jail.
2
@Jacquie How is that possible? We don't have debtors prisons here. What became of the children?
1
The main difference between modifying the Affordable Care Act and Medicare for all is that the second of these intends to cut overall healthcare costs by about $1 trillion per year. If the US proceeds with fiddles to Obama Care the health industry wins.
3
A public option would lead to a single-payer system, probably quite quickly. This is fundamental reform, not simply tweaking, and it’s hugely opposed by the insurance industry. But it’s overwhelmingly supported by voters because it’s a system they choose, not one imposed on them from D.C.
Trump shouldn't even be mentioned in this Opinion piece....8 years of the Clinton's Zero/ 8 years of Obama and a terrible plan that end up set us back to getting it right ....Now We have a Full controlled House in Congress and they have Done NOTHING on this....Trump has done more on Health Issues with the "Right to Try" which was not easy for him to do with this Politica lFarce /Shame impeachment that they knew right from the beginning was never going to end with him out of office or stop his reflection ...it's the biggest cut off your nose despite your Face Political Blunder by the Democratic Party EVER!
1
It isn’t enough to control the House, which has passed almost 300 bills, none of which were taken up in the Senate. Last month the House passed a bill for Medicare to negotiate drug prices, but few Americans have heard of it because McConnell killed it.
Democrats need to take both houses and the presidency. They need a 60 vote majority in the Senate unless that body gets rid of the filibuster.
That’s our system, and those are our challenges.
6
If impeachment hasn’t stopped the House from passing legislation—and it hasn’t—how does it affect progress on healthcare reform?
The only thing Trump has done is undermine the ACA and increase premiums. Now he’s suing to overturn the entire ACA, gutting protections.
3
@There for the grace of A.I. goes I
You do realize that the Senate is blocking all of the bills the Democrats have forwarded for a vote?
it isn't the Democrats who are screwing you over. It's the Republicans. It's just too bad that you can't see it. I feel so bad for you. You've been utterly hoodwinked.
3
We need Bloomberg and his data driven targeting machine. Messages out to the 20 million on the exchanges. 74 million on Medicaid. Vote Blue or lose your healthcare (cut to a picture of a cancer ward with a young child dying). Seriously.
5
@Shyamela
At a certain point I think you do have to be pragmatic. Bloomberg has stated that he will throw his money behind defeating Trump. At this point, nothing else really matters for the USA.
1
Republicans...at one distant time... supposedly cared about individual liberty, personal integrity, and above all else, self reliance.
Remember those folks?
Neither do I.
Who are these clowns?
3
I think Paul Krugman is a great guy and a positive force but I will never understand these kinds of comments: "There’s a sort of perverse alliance between Republicans and some progressives, both of whom are determined, albeit for different reasons, to see the Affordable Care Act as a failure."
I live in a bubble world surrounded by nothing but progressives. Warren is the extreme right in my circle. I know no one who wants the ACA to fail. I know no one who agrees with Republicans about the ACA.
This is just a weird thing to say.
6
@FF That's why he called it perverse, Neither Warren or Sanders has said anything positive about the ACA. Both are constantly boasting about the benefits of a Medicare for All Plan while ignoring the current benefits of the ACA. Republicans are doing everything to kill the ACA while Warren and Sanders are not extolling the benefits fo the ACA while working toware a single payer plan.
Thank you, Dr. Krugman, for this poignant reminder; hope you continue reminding your readers of these things because the American public has zero long-term memory.
Newscasters on CNN keep pointing out how the forthcoming impeachment trial is "low" on voters' list of priorities; that healthcare and national security rank much higher. Polls aren't always to be trusted, of course (even Nate Silver got it wrong in 2016).
But more people want Trump ousted before November than mainstream news networks let on...
Last night, for example, we learned that the Russians are now brazenly trying to help him get re-elected in 2020 (by hacking into Burisma's data base, ostensibly to find "dirt" on the Bidens). The Russians don't even bother trying to hide their U.S.-election meddling anymore.
And just this morning, we learned that Trump is diverting $7.2 billion in Congressionally-approved Pentagon funds for his border wall - a project I could actually support if it's tied to large infrastructure spending - but this again is even more blatant evidence of a rogue President flouting Congress.
In the end, impeaching Trump and making an effort to remove him from office is at least equally as important as healthcare and national security precisely because he is a threat to both. His impeachable activity will not likely cease unless and until he is removed by the Senate or the voters, or failing either of those eventualities, if both Chambers are controlled by Democrats again.
4
Exactly. The biggest threat to a Trump re-election would be if the Supreme Court sided with him and actually struck down the ACA before the election. That would put the truth out there in a way he could not refute.
This is the central issue that the Democrats should campaign on. Protecting pre-existing conditions. And making the choice between them and the GOP crystal clear on this issue. If they do they will win. If they don't...
5
But 38 % of the voters, blind as they are, will march to an early grave, supporting their liar leader: Trump.
11
Trump's problem is anything Obama!
2
Every time the Republican discuss another issue, remind them that their health care plan would have taken away coverage for more than 20 million Americans. Remind them that Trump once said, "You will all have health care, and you will like it." Over and over again.
Health care is at the top of most people's lists, because it affects every one of us, and often daily. Sure, most of us still want to be friends with Canada, Europe, aren't looking for war with Iran and North Korea, are against blatant corruption in Washington, and don't like to be the butt of the world's jokes, but it comes down to health care. The Democrats will make it better and if they have control of the government, it will be better. Period.
The day Trump/Pence are gone, the amount of national depression and anxiety will decrease immediately. On Day 1, national health will start to improve.
9
Did you know, many do I am sure that Richard Nixon started "for profit" insurance. In 1973, he signed the "Health Maintenance Organization Act of 1973". Prior to that there were NO for profit insurance companies, they were service organizations. That act also has clauses that say, "Not to cure afflictions but to prolong by treating symptoms".
1
I agree with much of this column, but the following is simply unfair:
"There’s a sort of perverse alliance between Republicans and some progressives, both of whom are determined, albeit for different reasons, to see the Affordable Care Act as a failure."
Republicans don't care if the ACA is a "failure," they just want to oppose anything that that makes government look good. This is cynicism, based on nothing but a brutal ideology and dishonesty.
Progressives see the importance of universal coverage and realize the inherent paradox of leaving part of that coverage up to for-profit companies, even when supplied by an employer. The ACA was a great step forward, but so long as profit motive remains for the middleman, the insurer, the risk remains that people will be overcharged, undercovered, or turned away one way or the other from treatment they need. This doesn't make the ACA a failure, but a stepping stone to still better methods of delivering healthcare coverage.
3
Great column.
2
The biggest lie is Republicans' use of the word "healthcare". If they were honest they'd use the term "healthwedon'tcare".
4
There are many reasons to move to a single-payer system like Medicare for All. One that isn't discussed as much as it should be is the simplicity of the system. Rather than the current Rube Goldberg Machine of Medicare, Medicaid, the ACA, individual plans, association plans, group plans, COBRA, maybe a public option, etc., there would be a single plan that covers all Americans for all required medical services. No enrollment would be required, no complex choices, no network limitations, no pre-approval processes, no claims, no billing. There would be no premiums, no deductibles, no copayments, no coinsurance.
All you do is get your health card and show it when you go to a doctor, hospital, or healthcare facility. Nothing could be easier.
288
@617to416 We do this in all 10 Provinces in Canada now!
Simple as swiping your Visa card at Walmart.
49
@617to416
Nothing could be easier except to skip the health card. Did you leave it at home before the car accident?
At an oil refinery I was treated Immediately after being hurt working there. No questions until I was patched up, bleeding stopped, given an antibiotic, and treated for serious pain.
Straighten out the 'Who is this?' stuff later!
Christ did not ask to see a health card.
25
@617to416
My only problem with our health care conversation is that whatever needs to be funded can be underfunded or completely defunded.
Telling me a personal account, a former doctor of mine cried because a friend of hers died in Sweden from cancer. The health care system decided it was too expensive to treat.
Someone needs to make decisions who lives, who dies.
Or do we all get totally unlimited care for life..
6
If Medicare for All happens I hope it is legislated well, because the first Republican president after its implementation will be looking to gut it and returning everything to the private sector. And that would really be awful with so much at stake. We would really be at the mercy of capitalists then. Republicans have been talking about eliminating medicare and social security for a long time, lets not give them an opportunity with loosely written laws.
Well enough, Paul, but here's something none of this addresses. Insurance companies have found a way to work around all of the Obamacare regulations.
Ever higher deductibles have pushed healthcare out of reach for more and more workers and their families. They are now for thousands of dollars for each and every family member with an additional total for the family as a whole before benefits kick in.
Bad enough but consider if that insurance company owns a pharmacy. It is in the interest of the pharmacy's owners to keep prices high and set high copays pocketing both the profits from both merely recirculating it's own money that is effectively a money vacuum cleaner sucking empty the pockets of it's insured.
But it goes further, people have to take the insurer imposed by their employer. What if the employer is the insurance company? Their employer has these workers by the short hairs.
This is medical Big Brother like never before possible. There are no federal regulations for self dealing in the medical industry like there are set by the FCC for corporations.
And the people backing Trump want to keep it this way. Why aren't you making this kind of blatant anti-trust that has wide and deep implications on the economy?
What's even more frightening is the unhealthy jobs these companies create that are low paid, high stress, chain workers to a chair with mandatory overtime. No wonder people are dying.
1
The Affordable Care Act is hanging on a very thin string. Lives and all manner of economic security hang with it. If a potential patient depends upon an employer, he may be threatened to lose his insurance along with his ability to work.
In order to survive under the threat of a serious illness, the right to Medical Care (which is free of cost at the point of need) must be the law of the the land. We cannot risk the potential of a single vote or the third branch of Government, as occurred in the recent past. We need voices like Mr. Krugman's to speak for us when we are desperate. That's the purpose of insurance.
1
It’s healthcare stupid. Credit to James Carville.
1
This driven by the absurdity that is racist at it's face. Poor white folks will still support Trump as they perceive that the benefit that ACA is "welfare" for people of color. There is no "color" to people that are born with diabetes or cystic fibrosis. Moreover, it is just morally wrong to deprive any human being with life saving medical care. Wake up America. The Trump voter has had their pocket picked by he Tax Cuts and know their very lives will, be shortened too.
As President Lyndon B. Johnson said in the 1960s to a young Bill Moyers: “If you can convince the lowest white man he’s better than the best colored man, he won’t notice you’re picking his pocket. Hell, give him somebody to look down on, and he’ll empty his pockets for you.”
4
Yes, Obamacare is a program worthy of preservation and improvement while the feasibility of alternatives which will provide truly universal coverage are explored.
I see Amy Kolbuchar as a practical advocate whose approach will be effective.*
Trump’s cynical hypocrisy about healthcare, like all his flaws, are part of his attractiveness to his “base”. With Trump you know you are getting a master b/s artist which is a contrast to the usual prevaricating politician. Trump may liberally spurn the truth, but his right wing adherents believe he is true to their core values.
Bernie in some way is the Trump of the left.. a demagogue appealing to the dreams and anxieties of his liberal constituency. Unlike Trump, who promises “the best healthcare ever” with no existing details or costs that could be revealed, Bernie has “written the damn law” but has not been forthright on the cost of all his proposals. That cost places Bernie’s left field ideas in the field of dreams.
Bernie should be questioned as to how “everything for all” will be paid for; I wonder if he answers that “Mexico will pay for it.”
*now that he is available, Klobuchar should form a team wih Corey Booker now and start campaigning on a platform of unity,reality, practicality, effectiveness, experience, diversity, and empathy. This is an appealing contrast to our current maniacal Divider in Chief and the members of the Democratic “dream” team of candidates.
2
After reading this article who in their right mind would vote for Trump?
3
Why is health care for human beings considered "socialist" and "bad"?
But obscene, uncessasy , additional tax cuts for the nation's wealthiest people, and "corporate welfare" are construed as "good."
PT Barnum was right - there's a sucker born every minute.
(whether that sucker will get affordable healthcare is another question)
4
Who needs health care when you can get unlimited supplies of snake oil!?
Directly from the White House, of all places.
Why is it a "plot" to oppose national health care. Why can't you just be happy with the you current insurance, which is the case for most Americans.
@Kent Kraus
Because it isn't the case for most Americans. If you have a good job that provides good insurance, then you're okay...for now. But what happens of you lose your job? And what happens to those people who can't find a decent job, and have to work three part-time jobs, none of which come with health care.
I sense from your comment that you don't care much about your fellow Americans. And that is the root of your health care problem in the USA.
4
Republicans in government don’t want Americans to have health care.
They want rich people to have more money.
Trump is just part of the con.
But people will keep voting for them because. . .
Who know!?!
2
Always struck me as ridiculous that the Republicans are pro life until you’re actually born.
Isn’t universal health care the most pro life policy ever? How can you be against that when you want every baby to live?
5
Healthcare in the rest of the developed world is:
Half the price
Just as good
Universal
Silly America!
5
Dear Paul; how is it possible that lying Trump can get away by cheating on his 'base', telling them via his big mouth that he is for protecting health care (including pre-existing conditions), when in reality he is obstinate in eliminating Obamacare (a 'racist' move, if I ever saw one, as he is clueless as to why he opposes health coverage for millions of middle class, poor the elderly, children, women, etc)? There must be a way, in real time, to not allow him continued impunity for his shameless impertinence...by insisting on the truthiness of long- ago debunked lies. How about a noisy red flashing light whenever he entertains lying as his modus operandi? Given that he lies whenever he opens his mouth, these rambunctious farcical entertainment contests may come to an end. This, to everybody's relief.
1
If Trump wins re-election he will continue to poke holes in the ACA. When it ultimately fails, death by a thousand cuts, he will blame Obama.
3
“...the votes for eliminating private health insurance won’t be there; nor will the kind of overwhelming public support that might change that calculus.”
Yeah, because people love the high deductibles and copays - not to mention going broke due to medical bills - that the private health insurance sector gives us:
https://www.google.com/amp/s/qz.com/1033336/survey-americans-hate-the-health-care-industry-even-more-than-wall-street/amp/
Just another elite, out-if-touch pundit telling the public we can’t have what we want.
https://www.google.com/amp/s/thehill.com/hilltv/what-americas-thinking/412545-70-percent-of-americans-support-medicare-for-all-health-care%3famp
1
I think Dr. Krugman supports universal healthcare, including single payer. He’s saying the structure of our federal government, with the Senate comprised of two senators from each state, means that we literally don’t have the votes to pass single payer, regardless of who is president.
We can’t have a real conversation about this issue if we dismiss every ally as an elitist.
1
@SandraH. Yeah, he uses the term, "politically impossible" when the far more accurate term would be "anti-democratic" governance applies.
We can't have a "real conversation" until you learn to read between the lines.
We are -still- waiting for the "better, cheaper, wonderful" replacement plan. Ten years - TEN YEARS - and Republicans STILL don't have a "replacement" plan.
Sure, they're still pushing, pushing, pushing for "repeal" - or "kill it in the courts". But they don't have anything, nothing, nada for "replace".
Where is the "replacement", Republicans?! Where are the details, Trump, of your "better, cheaper, wonderful" replacement plan?! Ten years, and no plan... just more lies, lies, lies.
Vote them all out!
2
There's only one group of self-righteous holier-than-thou people in American history who could manage to put-up an annoying enough candidate to lose to someone like Donald Trump once...they are called "progressive" Democrats. And they seem determined, selfish and dumb enough to do it again.
It's not only Trump lying, rural white America is lying to itself, destroying their own families, their parents and their children and grandchildren, by voting Republican. And for what? For the rich to get richer while breaking Jesus's commandments to heal the sick and feed the hungry. That's not Christian and that's not America. Enough is enough.
1
It's too bad the people who need to read this won't ... i.e. anyone considering voting for Mr. Trump
Here's two simple straight forward questions: If implemented, what does "Medicare for All" do to "Medicare for who it was designed for?" With limited cash in the pot for either one, how does it not water down the latter?
As a 30 year mom-and-pop business owner, I can tell you the #1 headache, expense and source of great anxiety has been healthcare/ health insurance. If The US wants to nurture entrepreneurship and innovation, this problem must be addressed. Many of my brilliant peers have spent their careers in low paying, dead-end jobs with health insurance, when they could have been adding to our collective innovation quotient and boosting the economy in real, tangible and sustainable ways. The ACA was a start, but now constant fear of repeal and intentional sabotage has left uncertainty, which further exasperates the issue.
It is beyond me, why "The Party of Business" GOP is dead-set on tax breaks, when what is actually needed for (most) businesses to flourish is to get the health insurance monkey off their backs.
Small business: The GOP is not on your side!
444
@John in WI I agree wholeheartedly! I operated my own business for 10 years and the biggest headache I had was selecting and managing our group healthcare insurance program. When I shared that with a Republican legislator years later, she was shocked. She was sure that a small business owner's biggest headache would be taxes. If we had universal healthcare (call it what you may) I could have been far more productive, and competitive.
69
@John in WI You ask: "Why does the GOP oppose ACA?" Well, remember that this is the same party that opposed social security, and then tried to "privatize" it - which would have been a dream-windfall for the stock market and for those who own a lot of stocks - and also tried to reduce unemployment insurance. Republicans resist every social program under the name of "creeping socialism" because they correctly fear that once the voting public has them it will like them, and will refuse to give them up. This will lessen the people's fear of dying homeless and destitute, and thereby weaken their motivation to work as hard as possible for as long as possible at the lowest possible wage that private enterprise can give them.
By the way: as owner of a small business, how do you feel about paying your workers a living wage? If the legal minimum wage were raised, all your competitors would be forced to raise their wages too, and your business would be only marginally harmed, if at all. Customers would simply pay the extra, and would have to consume a bit less - which would do most of us no harm at all.
39
@Robert Crosman And paying a living wage would give your employees and those of other employers more money to spend in your businesses.
26
The American Medical industry needs a good haircut. (in the financial sense,if the definition isn't clear.)
Moderator-for-civility, please be strict with this one, and no complaints if it vanishes into the ether; I offer it only as black humour.
What hit me is that comments about implementation by the states. Didn't Massachusetts and Hawaii already implement decent health-care plans before the ACA? So, if the ACA does fail, won't many states, where it has worked, speedily implement some sort of replacements upon outcry from their public at the loss?
If so, the main effect of the loss would be to bump off tens of thousands of late-middle-age Americans in the red states.
Those being the most-conservative voters in the nation.
Basically, Trump would be working to kill off the Tea Party.
Harvard estimated around 2010 that lack of universal health care was costing 45,000 lives a year, so "bump off" is not inaccurate, if very uncivil.
But, God help me, I spontaneously broke out laughing. Talk about poetic justice. My wife was not so amused - what a look she gave me - and I'm closing the paper now. The brush with war, followed by basically calling the other party traitors (again), has poisoned my brain; I need a break from the news.
2
Why? The meanest, the myopia, the lack of charity and concern for others? What is really gained by taking health care away from many of our most vulnerable Americans? What's wrong with Republicans? If they had an alternative worth considering, we might have good discussion. But they offer nothing that addresses the uninsured and those with limited means. Vote Democrat. Whatever the Dems come up with will be humane and better by far than the destructiveness of the Reps.
4
Obamacare is a pejorative term concocted by Republicans. Why do progressives adopt this term as well? I’ve never understood this. Let’s rescue the term Affordable care act or ACA.
2
Trump lies about absolutely everything all the time. So why would this be any different.
1
For Trump, not just eliminating, but trashing Obamacare as a supposed disaster, is all about retribution for the press-club dinner in 2015. After years of Trump's king of the birther movement attempts to take down Obama for supposedly being born out of our country, Obama got his payback in poking fun at Trump without mercy at that dinner. Everyone laughed, and Trump's hate for Obama turned to rage that continues to this day.
Trump will gladly throw half the country off health insurance coverage, if he can ruin something with Obama's name on it. Trump couldn't even fake a smidgen of humor at that dinner where he was publicly humiliated, and thin skinned self important Donald will lie about Obama, lie about preexisting condition coverage, in attempt to regain his lost stature from that night five some years ago. America pays for Trump's ego.
3
"On Monday he made the breathtakingly dishonest claim that he is 'the person who saved pre-existing conditions.'"
Everybody knows that Trump lies all the time. So we say. But perversely, the effect is that his lies, either in particular or in general, never become a major story. This particular lie should be a major story. It's as if Jim Crow white supremacists took credit for ending slavery. It's as if Trump proclaimed himself a champion of rape victims because he had been sexually assaulted by so many women.
Sometimes it feels like Trump's attacks on the media have successfully intimidated them into cutting him a big chunk of totally unearned slack.
1
The best kept secret is our primary care system works like socialized medicine already. We just won’t admit we have a terrible healthcare delivery system.
The insurance and hospital corporations did this to us. Our system is flawed on purpose for profits.
Doctors and Nurses et al make a living wage. Most are not interested in protesting and lobbying for change. They work hard and go home.
So we have only ourselves to blame when we do not pick up the phone regularly to discuss our issues with the paid aids i. Our legislators offices. And call your insurance company too. Let them know your struggles. Organize tea and conversation at the local Panera about the ills of society. Educate if you are able and listen so you know how terrible America really is under our current flock of legislators and the meanest dumbest dementia ridden president around in trump.
1
"Will it be expanded coverage under a Democrat — it probably doesn’t matter much which one — or will it be tens of millions of newly uninsured Americans under Trump?"
I'm guessing "tens of millions of newly uninsured Americans under Trump?" Why? Because the Republicans are a cult from the poorest unemployed welfare recipient among them right up to the president and they will be turning out in droves to protect their man at the top. The base has been voting against it's own interest for years and the fact that the president is a devious con-man makes no difference. The electoral college will put him back in the Oval Office. It makes me sick to my stomach.
1
Professor Krugman claims, "But the reality is that whatever its merits, universal, government-provided health insurance isn’t going to happen anytime soon."
Don't believe it. If the American people support it, it will happen. And universal, government-provided health insurance is the standard everywhere on the planet. Everywhere!
If Canada could pull it off decades ago, and if it is still going strong there, then America can do it, too. Don't believe the "it's too hard for us" nonsense.
Senators Sanders- I mean, President Sanders, or President Warren will do it. Because Americans are sick and tired of what we've got, and the ACA stinks.
We can do this.
5
I share your optimism. I think we can get there through a public option, which has overwhelming public support.
Our country is the only country in this world who does not have health care coverage for all. Our health is not as good as most other countries.
Why aren't we talking about Public Citizen's Medicare for All?
They have supported this for many years. They worked hard on developing their plan. Public Citizen is FOR WE THE PEOPLE.
https://www.citizen.org/wp-content/uploads/migration/the_case_for_medicare-for-all_-_february.pdf
2
Having grown up and having lived in Canada and now, yet again, reading through another article such as this by Krugman and by those commenting. one realizes all over again how different – foreign really – America appears to those in other countries. The contributions of America and her wonderful peoples to the world seem impossible to begin to list. Yet, there are deeply felt discussions that debate whether a level of health congruent with 21st Century America and her achievements is a “marketplace commodity”, a “right”, or akin to “Stalinism”, etc. And from these labels flows an impossible to follow acrimonious argument which seems entirely self-referentially American. It was a surprise that one did not find reference to your Founding Fathers’ opinions on universal health care and an originalist reference to health care discovered in your Constitution somewhere in the comments.
One suspects that should an economist such as Krugman valuate American health status and health care and integrate that with a Piketty-like analysis of wealth and income segregation the results would look like the days of American robber barons in the 19th Century.
Presumably, when an American goes bankrupt because of a medical bill, the wealth inequality ratio goes to infinity.
3
Want to get on the health care gravy train?
Health care mutual funds have been soaring for decades!
And the uber rich get uber richer! YAY! corporate greed...as long as my 401k is rising!
Health costs bankrupted you? Sad.
1
It seems unfortunately clear that Supreme Court Republicans plan to kill the ACA after the election. Roberts made sure it won't happen before then. The Republican Party is a slave of the 1%, which will thus no longer have to pay the special ACA tax. The immorality of this trickery is hard to believe, but we'll believe it when we see it happen, shrouded in a fog of crazy propaganda.
1
Trumpy, the Hater President, is trying to repeal the ACA along with his minions in Congress. The effort to do away with health insurance is neverending. And yes, Trumpy lies about his intentions and efforts to not pay for healthcare. He is doing a disservice to all Americans, Trumpy is destroying the lives of millions of Americans.
The Republican effort to kill attempts to provide healthcare to all Americans clearly shows who they are. I hope there is a reckoning this November.
1
And daily we are greeted by the Groundhog with an anti Trump article by Mr. Krugman. Fine. Now, what about an article in support of the Iranian dissidents for a change???
"...with some supporters of Bernie Sanders claiming that any politician who doesn’t demand immediate implementation of single-payer health care is a corporate tool, or something."
It's the time of year again, the NYT must be getting close to endorsing a candidate. I can tell because ad hominem attacks and outright false accusations hurled at Sanders and his supporters are making their usual rounds through these pages. I lived through it 4 years ago, and I'm living through it now. Whatever. However, I think I should just let columnists like Krugman know that when he makes comments like that, he just sounds scared.
Hey, Dr. K. I'm a Sanders supporter, but I vowed a long time ago that I'd vote for any Dem come November. Can the same be said about you? Or are you and your ilk more likely to write your mother's name down on the ballot come November if Sanders is the candidate, "or something"?
2
How about we the people deny their golden healthcare packages to republicans who are determine to leave people homeless and sick on the streets.
In any other country these cruelty will not be tolerated and characters like these will never get close to any position of power to implement these draconian devoid of any trace of humanity policy!
We have to fight every minute all republicans who are in power, their only goal is to suffocate our spirit and live happily ever after in the worst dictatorship where people of the country will be slaves for ever, generation after generation!
Would anyone want to live in such country.
2
Republicans are suing to have your health care taken away. djt and bill barr are orchestrating it. Don't believe their denials. Almost fits on a bumper sticker. Definitely fits in a twitter message.
1
The phony morally bankrupt con man is driven by paymasters- he is for sale and anyone can buy him. Health care is run by special interest crooks and their money machine is very powerful. Con man promised “the best health care” for everyone, in reality he has done everything to rob healthcare from the needy. As a master propaganda machine operator, he lies in a relentless manner. Unfortunately, some people start believing him after listening to his repeated lies. It is a shame and disgrace that such a worthless corrupt man is in the White House. Hope justice will serve after he gets defeated in 2020. May be “lock her up” will turn otherwise!
4
it is rather amazing that health care is thought of in some quarters as a luxury and not a necessity. The quarter that thinks it is a luxury are mostly republicans who are covered by good insurance plans and who do not know what it is to go into an emergency room having no or nearly worthless coverage. The republican myth that americans want the government to stay out of health care is one of the favorite lies.
When republicans sell the right to not be insured they are addressing people that seem to feel that all government activities and regulations are bad. They are not mentioning that the " right to be insured " already is working for people over 65 on medicare and for the very poor for whom medicaid was created. It is largely the middle class that now finds itself frequently uninsured due to the high cost of insurance or underinsured due to buying cheaper policies that offer terrible coverage.
The middle class that frequently votes independent or republican has depended on work place insurance but those that could not afford it were helped by Obama care. Today Obama-care may slip into the past however what is still hard to understand is the reluctance of the middle class to see health care as a right. it is possible that they see health care as a right leading to higher taxes or a loss of insurance that they currently have. In either case we remain a country that has yet to offer all its citizens a fundamental right recognized everywhere in the civilized world !
4
Mr. Krugman's column supports the strategy of Elizabeth Warren, who understands that universal coverage and fully breaking the stranglehold of the trillion dollar private insurance industry must be the end goal. A great deal of the controversy over Warren's strategy and tactics vs Sanders vs Buttigieg's "turnaround moderate" position on healthcare has been engineered by Big Money, anxious to stop Warren's specific proposal to clawback a tiny percentage of super wealth obtained by tax inequality. Now we have a another engineered effort by the plutocracy to this time pit Warren and Sanders against each other to the benefit of Trump. Expect this slimy strategy to continue, in no small part with the help of Zuckerberg's Facebook which makes hundreds of millions of dollars publishing anything Trump wants-no questions asked.
3
I enjoyed this article because it highlights what is at risk. Mr Krugman makes a good case for immediate incremental reform building on the ACA and “fixing” its flaws while somehow building a consensus for a better universal system. That system, however, if we look at the model provided by other countries can take many forms but all will require much more governmental input than we currently have. I think our system has multiple problems - the issue of coverage as Mr Krugman points out but also issues of costs including drugs, coverage in poorly served areas, the cost of medical school which influences doctor career choices. The government needs to be much more involved in funding for medical education and research to pay for much needed new antibiotics, immunizations and all those new and exciting treatments for “rare” diseases and genetic conditions that hold so much promise to improve so many lives. We also need high quality nutritional research, gun violence research and new paradigms in mental healthcare to address our public health issues of obesity, diabetes, suicide and substance abuse. We also may well be on the cusp of emerging infectious disease issues due to climate change. Mr Krugman is right that incremental reform is the best choice for immediate improvements but Mr Sanders and Ms Warren are also correct in that Medicare is already a pretty good system as is the rest of federal healthcare.
2
Original Obama care forced some folks to pay $1500/mo premiums $5000 deductibles..then they couldnt find a Dr taking new patients. Those advocating for government run health care are ignoring potential unintended consequences.
How is it that the costs of some medical procedures such as lasik eye surgery are going down and most everything else goes up?
1
@Lane
Studies show that that's a small minority, and that before Obamacare, things were MUCH worse.
Also, that ACA s 100% private sector based, remember? The government doesn't run anything here.
It merely changed the rules of the game, basically increasing competition among private insurers, which increased quality and overall reduced costs.
6
@Ana Luisa In some localities only 1 or 2 insurance companies are available, competition decreased and it's still not possible to buy insurance across state lines..federal mandates that women's health care, as in abortion are included is unacceptable to many.
We will not get an overhaul of healthcare for the reasons stated in the column. Sanders wants to blow the system up but that will take eighty Democratic senators, of which, 20 will lose their jobs in the next election. The same majority would be needed in the house which probably flip in the ensuing election. Then, the system which will be more socialistic than the ACA, will have to withstand legal challenges with a conservative Supreme Court.
People forget that we were just John McCain’s vote away from blowing up the system.
1
The Democrats need to start talking about this rather than sniping each other about their own healthcare plans. They need to start drawing the contrast between their approach and Trump's not their approach and those others on the stage. While they try and position themselves by undercutting everyone else on the stage the healthcare for millions hangs in the balance. Wake up Democrats. You're running against Trump. Don't destroy you chances of winning by chopping each other up into little pieces on the debate stage without highlighting what's really at stake in 2020.
8
Well said! Instead of a cohesive message, dem leaders are fighting against each other pushing pipe dreams. The election in 2020 is easy to win because of con man’s endless criminal acts. There are so many opportunities to reach out to voters. Alas, all of them want to be President with little qualification for the aspiration. They are giving the Presidency to the corrupt con man on a silver platter.
1
Trump's attacks on Affordable Health Care amount to throwing the baby out with the bath. His decision to postpone the Supreme Court case until after the Elections is a typical cop-out since he doesn't want to lose votes as others lose their health care. Meanwhile, the Democrats' platform must ensure coverage for pre-existing conditions. And with a new administration, progressive - i.e incremental-reforms such as adding a Public Option, expanding Medicare to those 55 and older, removing state obstructions to Medicaid, and, of course, negotiated price controls on medicines, are feasible.
The whole premise for adjudicating health care in the courts is ludicrous. One shouldn't have to file a lawsuit to make an appointment weeks in advance to be seen in the ER.
Every American wants health care coverage and more of us have it because of the ACA.
Politicians understand the risk of opposing that popular program.
Some Republicans, including Trump, offer to “replace” the ACA with something better. But they know it’s a hollow boast with no action plan - a shell game that fools no one.
Some Democrats can be just as misleading. The concept of “Medicare for All” is as unrealistic as the Republicans promise of replacing the ACA. Americans are telling their representatives that they like their current health coverage ... but it has become too expensive.
“Medicare for All” won’t solve that problem any time soon.. Converting a massive for-profit industry into a value-based public service is a unprecedented reform that requires vision, political support, and careful planning. I don’t find much of that around these days.
At the moment, we are better off addressing fixable problems such as jaw-dropping drug costs; antiquated billing policies; and proliferation of costly and marginally useful technology. Those challenges will test our willingness to build a new platform of health care reform.
2
The problem with certain progressives is that they don't have the guts to go standing in the mud and fight hard to achieve the next step forward to the finish line.
Instead, they prefer to stand at the sidelines and yell "not enough" to those who move on, step after step, compromise after compromise, until the end goal is reached. And then they claim that the "real" fighters are those standing at the sidelines ... .
They live as much in an alternative facts world as Trump voters, it's just that for them, the GOP doesn't exist, and a democratic legislative process doesn't exist. They seem to operate in a political void, rather than having the guts to see the situation on the battlefield, accept it, and then figure out where the next battle is, instead of putting their head in the sand and dreaming about massive victories ...
3
Quite frankly I think medical care in the US is a racket worthy of the Mafia's attention as a prospective money-maker. All my podiatrist does is clip my nails yet "surgeries" are listed on his bills! I once spent 4 days in a hospital and the room costs were $36.000. What is going on here? I understand that medical practitioners, hospitals and clinics, etc., must make up some how for the health care they provide to sick folks unable to pay for their services but the monies spent on my health care listed on my monthly reports are beyond absurd. Medicare for all is essential in any modern state but the costs of medical care in these United States most definitely is in need of attention. I am grateful that as a former civil servant in the the state of New York I have excellent medical coverage in my retirement. I am not amused, however, to see medical personnel and agencies take advantage if my benefits to enrich themselves at the tax payers' expense. After all, I am still a tax payer in my retirement.
7
Unfortunately, Americans that buy insurance through their private insurers don’t have nearly the coverage and the zero copays and deductibles provided by Medicaid. It is truly mystifying that anybody continues to support private insurers that are the primary reason that our system is failing due to their for profit status and the very high administrative cost burden that they impose upon the entire system.
5
Medicare has co-pays and deductibles. They negotiate better prices than private insurers (except for prescription drugs, where Medicare is forbidden from negotiating).
The point of the Koch Bros stealth campaign is to lower taxes on the rich and corporations. This campaign is well funded and is on track. They are winning WE are not. Health care is a top EXPENSE for rich taxpayers.
There are conservatives in office and judges on the bench whose goal is to get the federal government out of the health care business. Their support is bought and paid for- they are playing the long grift game and it IS on track.
We have the vote- but that can't take a judge off the bench. It can remove a politician. We cannot match the money they have put behind this effort. We can hand them a serious reversal this election year. YOU NEED TO KNOW OUR GAINS IN HEALTH ARE BEING REVERSED BY POLITICIANS AND JUDGES!
If health care is totally privatized everyone's costs go up and some people are going to get filthy rich.
Be aware of what deflection and distraction are and vote on this issue and make sure everyone else votes as well. This is the year of a life and death election. Choose wisely.
8
I always hear if you like your insurance you can keep it, no one likes their health ins. we put up with it because we have no choice if you own a home. $14,000 for one, just coverage is a lot, maybe if I had the ins. elected federal officials have I would like my coverage.
2
If you're not committed enough to declare Medicare for all as you goal then you're not even going to get close to providing universal healthcare in right years even if you can unseat the republican Senate, it's that simple. Bernie Sanders wants a revolution. And that's because it would take nothing short of the radical turn of a revolution to make even the slightest dent in the republican apocalypse cult agenda that has gripped this country. If you want to save lives, restore equality and prevent planetary catastrophe you better buckle up and get ready for war against the establishment of you will fail on all counts.
I have never understood Republican antipathy toward Americans having healthcare coverage. In Donald Trump the republicans have the perfect vessel of lack of empathy and compassion and a hatred of those less fortunate than he is.
3
Really, it is simple. It is all about the profit. The U.S."spends" (= loses) an enormous percentage of the healthcare dollar in coorporate management and profit compared to the other G7 countries that do provide universal coverage. Republican = private profit and wealth centralization at the expense of public well-being.
1
How can we go forward without an educated healthy public? Already our lifespan is shorter than other countries in the same tier. Maternity deaths are higher. We have men, and women, who want to control all women’s lives and bodies. People we elect and continue to elect who want to degrade healthcare. We save the large companies at the expense of the person
As far as education goes, I read the comments some people make online, including the President, and they can’t spell or even write proper grammar.
Why is this so?
1
Trump didn't run a covert stealthy subtle campaign.
Trump ran against Obama and Obamacare.
And white European American Trump nation want their republic to stay away from their private healthcare,Medicare, Medicaid and Social Security benefits.
By denying them to any one of a different color aka race, ethnicity or national origin.
2
"Beyond that, however, Trump's political health care strategy is to flat-out lie about what he has done and is trying to do."
Take a moment to recall when president Trump in 2017 encourage the president of Mexico to say that he would pay for a border wall. Trump explained to him that he didn't actually have to pay for the wall....just "say" he was going to pay for it.
There you have it: The very essence of Donald Trump, the con artist. To Trump lying is as natural and self-sustaining as breathing. That is also why he is the appropriate face of the contemporary Republican party.
3
I get the impression Trump and his Congressional cohorts don't want the weak and infirm surviving, you know, the people all Democrats care about. Gosh, I hope you don't think I'm paranoid. It's a hard impression to ignore.
In the strategies of political battles, we are the smarter ones! Republicans cater to the minority of well to do people who have private doctors, like Trump, while we care about all Americans, even the misguided. Who do you guess would have more support once that universal caring is known? That is what I call; Universal Care.
Yes, Paul, we must wake up Trump”s most systematic and devious lie that has the potential to inflict and wreak untold devastation upon the health of society’s most vulnerable and oppressed members.
Hurrah! Our columnists are so brave to "Stop Trump/GOP from coming for our health care."
But wait-- just blocking destruction can keep the inadequate status quo. We deserve better--- let's improve what we got.
Health care is an issue of life/death/financial security.
Obama understood the public duty of elected govt to ensure our right to HC--- a centrist norm in dozens of 20th C democracies that are also capitalist.
But here it's still a radical notion. Tons of money/political influence try to keep it a profit center--- no matter the destructive effects on all our lives.
The next Democratic president ---he or she-- must build on what Obama started, to improve and expand ACA to live up to standards of other democracies in citizen access and cost.
He/she must contradict the warped notion that HC for All is 'left wing' big govt interference in sacred private profit and all our 'freedom's.
He/she will have an historic duty-- post Trump---to show the stark contrast in how our parties affect all our lives in crucial ways.
He/she must bravely change our political norms, so that sociopathic exploitation of citizens is not green-lighted and rationalized, as part of “American freedom of choice and ‘independence from govt control' --- pretending to uphold our Constitution, as it contradicts it.
Trump lies? What else is new? Our Nobel economist must now write some columns with a few positive ideas--how to finance HC, like other countries do. Not as fun?
2
Healthcare for all should be the ultimate goal, as Prof Krugman points out. This must be gradual, since about 1/3 of the workers have employer insurance, 1/3 are self-insured and 1/3 have no health insurance. Getting all of these groups together is a very big undertaking. So this will take lots of time. In the meantime, a gradual improvement is necessary, as is noted in this column.
As to Trump's lies about Obamacare, I can only note that Dr Goebbels told us that big lies work better than little one, especially if these are repeated often. Trump is following this line of thought. He is also a very practiced liar.
1
The Republican party sees health care as a tax that goes directly to private, medical corporation welfare, with kickbacks flowing to the Republican party as campaign donations.
1
I wish a question about the Trump/Republican health care plan would be asked during tomorrow’s debate.
So far,because every one of the previous debates have been preoccupied with Medicare for All. It would help if Bernie would shut up and let the other candidates address this question, because every voter needs to hear the correct answer: they got nuthin.
1
On almost want Trumps supporters to be hurt and hurt hard by Trump's and the GOP's actions. They voted for him without bothering to read the fine print. Conman love people who ignore the fine print or any print. Sadly a lot of decent Americans will also be hurt.
It is my understanding that employer healthcare after WW II was generally a small bonus to get valued employees to stay. Now, it has ballooned into forcing people to stay where they work for fear of losing everything.
Healthcare claims to be 'not-for-profit'' - it is anything but.
1
Health care should be a win for the democrats. The cynical right clearly have no plan of their own and oppose it simply because that is now in their mythology. But instead of building on the ACA in terms that everybody could understand the democrats have decided to change horses in the middle of the stream and have handed the right an issue with MC4A as a socialist freebie. It’s one more example of how the democrats may yet snatch defeat from the jaws of what should be cake walk victory in 2020.
1
The tax cut that reduced the penalty for not having insurance to $0.00 severely wounded the Affordable Health Care Act because it makes it economically unsustainable. If this wound is left untreated then it will slowly die. The States Rights option was yet another clever compromise that makes it economically unsustainable.
The Republican leadership wants it to die. And when it does die they will tell us: "I told you it would not work," when they were the ones who killed it slowly.
Some Democrats, bowing to the same interest groups, have perversely twisted Medicare for All into "medicare for all for all who want it." This too would severely wound Medicare for All, making it economically unsustainable.
The reason Social Security is still around nearly a century after it was passed is that Roosevelt had the good sense to write it into the tax code. To do less than that is a sham.
Messaging is marketing. It's Trump's evil lying so we are dying, or the deliberating and cultivating Democrats getting to a good place for Americans health care. I was one of those who years back was a Medicare for All proponent, but unlike the knee jerk reacting Republicans, carefully learned about the ongoing Democrat debates. After some consideration, I am in total agreement and am coinciding with your ideas.
Once again, Messaging is Marketing. The weak mouthed Democrat leadership have lost years of really good messaging. As I've written before; The Republicans brainwashed their base so thoroughly with 50 repeal attempts and countless on camera edicts, that their base voted in droves to elect those Republicans who promised to take away their health care thus endangering their lives. Their followers actually voted to endanger themselves.
But now how do the Democrats win? Well, enough debate has occurred and most are of the consensus you described; to incrementally improve health care and coverage. So how do you compose a simple striking message that will convince all voters? You tell them often that You, as Democrats are going to give people "More Health care and coverage". More More, More. That's what they want, so tell them.
I have heard from a number of less-than-enlightened white associates an argument that follows this line of thinking: "Obama got elected and all he did was give free health care to all his black friends." It comes down to race. Working-class whites feel that black people are getting something for nothing and that it is their taxes that are paying for it. The Republicans have sold their base this lie and it works. Unless the Democrats can sell their argument in a way that counters this toxic and twisted logic Trump wins.
1
Now Trump is portraying himself as some sort of savior of health insurance when he would obviously repeal Obamacare in a New York minute if given the chance. He lies without consequence. He has become the new normal. If Trump and his minions are not removed from office, America will become a whole new place, one that nobody cares for.
1
Yes, this columnist hates "purity" but note that the compromise he promoted could now be lost entirely.
Maybe there's something to be said for making a public case for the obvious solution, the way Sanders does, instead of playing imaginary 3D chess with yourself, and then watching the opposition trash the effort?
Imagine if Democrats had fought as hard for universal coverage as Republicans have for tax cuts and deregulation.
Having lived for several decades in a country where healthcare is universal, it's hard for me to understand the motivations of Trump and the Republicans who want to sabotage the ACA and deprive people of what should be a human right. Is it sheer malevolence, like Jean Calvin's Elect enjoying the suffering of the non-Elect in eternal damnation? Is it the conviction that poor people aren't really human?
Or is it true what the old proverb says: money is the root of all evil?
“Why does Trump want to leave this court case hanging?”
Perhaps because it may actually WIN in court and then he would be seen as the Grinch who stole Health Care! Not exactly what he’d want prior to the 2020 election.
2
I am ALMOST finished being stunned by how utterly, truly Trump does not care about Americans.
Not at all.
He doesn't care if we have health insurance.
He doesn't care if an old veteran has it or a young baby or a teenager. He just doesn't care.
What he MUST have is Obama's name off health care. He cannot stand that Obama - who deep down he knows is 100 times the man that he is (isn't) - has his name on healthcare.
He wants it to say TRUMPCARE.
You're exactly right, Professor Krugman, he is putting off the healthcare vote until the day after the election, then he'll pull healthcare away and tens of millions of people will go flying off of it.
If a Democrat wins, the first thing they should do is lower medicare to age 60.
If we did that, many people who have been working and want to quit, especially those who have been working since they were teenagers, will quit. They are staying for the insurance. This will open up more jobs for younger people.
I can't stand Trump. I really, totally can't. Who takes health insurance from children?
Oh yes, the orange monster.
2
Why is everybody failing to talk about what’s really behind the health insurance debate?
If you have a walk-in emergency, before you even get to a preliminary examination station, a person behind a bullet-proof shield asks 1) if you have insurance and 2) the name of your carrier. Both questions will determine how you will be treated in the emergency room.
There are actually two queues; one for those with insurance and those without. Waits in the non-insured queue are hours longer. Those with premium insurance plans get quicker—more extensive—treatment than those with lesser plans.
People brought into emergency via 911 will have been pre-screened and their course predetermined. The problem facing 911 patients is that they could be redirected to another hospital if the first hospital indicates they have no more emergency beds.
If everybody has the same coverage (“Medicare for all”), treatment is handled by the most pressing emergency first (which includes OD’s) and then by ones’ position in line—all entries are time coded.
People frequently die in secondary emergency room queues.
Why do so many people singularly focus on Trump vs all of his enablers?
Every single one of them needs to be called out!
Hopefully Bloomberg with his wealth will blanket American media with the truth and knock Trump and McConnell off their feet and put them on the defensive with no Republican plan in sight.
Rightist leader survives only on populism devoid of substantial outcomes. Trump is one of them.
This column is an insult to the readers' intelligence. It is the height of cynicism to dismiss the high, sometimes insuperable co-payment requirements of Obamacare -- rendering health care coverage useless for too many. Also, to argue that universal health care is a goal to be achieved in some distant future is to be an expressed opponent of what all other countries have established for decades.
The cynicism, indifference, deception of this column is precisely what opens the door for the alt-right. It renders the official left feckless and a dead-end for progressive change. This disorients people into thinking that the alt-right will act to improve the lives of at least some people.
2
Everybody wants his cake (and hamburgers and beer and steak and ribs and Doritos...) and eat it, too.
1
Good question. Hopefully the Dems get the message out loud and clear.
This is what MAGA without health insurance for all except the rich...
It is difficult to believe that at the same time that he is using his Justice Department to try and get rid of protection for preexisting conditions in the Supreme Court , he is bellowing that he is the best friend of those with preexisting conditions; he is their protector. If his base weren't blinded by their stubborn acceptance of this grand liar and smooth scam artist they would realize that his promises are meaningless and that he intends to do them great harm.
1
lying has been official GOP policy since Reagan.
This has less to do with Trump wanting to take away our healthcare than it is about him wanting to end OBAMAcare.
2
If Americans still honestly believe that the so-called "public option" will be the answer to your healthcare problems, think again. This was confirmed in Congresswoman Rashida Talib's M4A Bill that it will ultimately just provide the industry with the advantage to "cherry pick" the youngest and healthiest for their customer base while leaving everyone else to the public opton which does absolutely NOTHING to reigning in costs, in fact it will make things worse.
America has been haggling about healthcare since before Truman was President, hence, the time for incrementalism is over and contrary to the proclomation in the article about private healthcare in America, ALL of the Western Industrialized Nations who have some form of universal single payer system determined decades ago, at minimum, until the private element in healthcare is brought under strict control or marginilized, America will NEVER be able to attain healthcare for all of its citizens while reigning in costs and improving efficiencies, it is just NOT possible under the current system of uncontrollable costs with increasing numbers of uninsured in America which currently stands at 29 MILLION(and growing).
Deus, if insurers can’t refuse coverage to anyone, how will they cherry-pick their members? This doesn’t make sense to me. Are you saying that protections for those with preexisting conditions will go away?
Breathtakingly dishonest. I don't think there's a better description of his lie here. And like many of his lies, it just reinforces to me that people are not paying attention.
1
Paul,
We all know that trump lies and talks nonsense about healthcare, as well as everything else. We also know that the ACA worked well within the parameters of the American distribution of healthcare monies. We know too that the Republican Party has done and will continue to do everything possible to destroy in total the ACA.
We agree on those elements, what we have is the ignorant Republican base that is in love with the circus and willingly parrot the mantra of denying healthcare for those lazy others. The other element is the most important to the Republicans, which is the Plutocracy of America that demands adherence to their agenda and they do not want to contribute one penny for healthcare for anyone. That is the reason why they have bought the Legislature, Justice, the Executive was a gift from Russia. We are teetering on the cusp of the destruction of the ACA and there will be no replacement with our current Government.
This Supreme Court is poised to strike down the ACA. The only basis for their upholding the act was the tax provision it included. The Republican Congress stripped the act of this tax provision, and not surprisingly, it was struck down by one of the federal courts. Whether or not Trump is re-elected, this Supreme Court is poised to revisit the ACA, and is prepared to strike it down.
This means that coverage for pre-existing conditions will be gone. Lifetime coverage limits will be gone. Premium limits will be gone. And Trump voters know all this. They will suffer along with the rest of us, but they don't care. They want a "president" who shares their willful ignorance and their racism, and for this, they'll see their own children die of treatable medical conditions because they can no longer afford coverage.
The fact is, it isn't Trump taking away our health care. It's Trump voters. They have channeled their racism and resentment by supporting a "president" who will gladly tear down health care coverage, in exchange for his continued expressions of racism and bigotry.
Trump voters have been given a pass for far too long. They have either been treated as playing no role in this disaster of a presidency, or as hapless dupes. They are neither. We may blame Trump all we want for the repeal of the ACA, but this is exactly what his voters want.
And the rest of us will lose much of our health coverage because of their willful ignorance, their resentment and their racism.
2
"Why does Trump want to leave this court case hanging? Partly because his side would probably lose. As I said, the lawsuit is ludicrous, although, given the partisanship of Republican-appointed judges, it might prevail anyway." The reason he doesn't want it to come up until after the election is he fears losing too much of his base if they lose their health care, or see their premiums and out of pocket rise so much they go belly up. He is likely to win in the courts and destroy our health care system once and for all. And even if he loses the election he'll claim fraud and will never give up the office without bloodshed. We are in bad shape.
How can we get Trump's lie exposed to the Fox audience?
If they never hear what Trump is trying to do and only hear his lies, they will vote for Trump again.
1
insurance is just a big coupon for healthcare.
Even through employers.
And if you change employers midyear, you retart all your deductibles and out of pocket costs from 0.
2
The Republican healthcare plan is to enrage the voters with the notion that, under any proposed Democratic plan, they will have to get up every morning and go to work to pay the medical bills of the lazy, undeserving poor--the takers who refuse to work for the things they need. People are not altruistic. This pitch has never failed.
1
I'll say it again. I cannot understand why the mental health specialists in this nation walk around looking at the ground in reaction to what President Trump is doing to our nation. Trump is a screaming, fire-breathing NARCISSIST. He doesn't have a "mood disorder." It's a "BRAIN DISORDER." Short of a brain transplant it's incurable. Donald Trump considers himself just as normal as the average John and Joan on the street - which are, of course - momentary flights of fantasy. Trump has no compassion or empathy for anyone who isn't in his cheerleader squad. He's setting this country back 75 years. And we're letting him get by with it. It is time to call a disaster a disaster. This torture must end. If it wasn't for our OUTSTANDING MILITARY...we'd all be in a deep, dark hole. At least we can still see daylight out our windows. But this cannot, and WILL NOT go on much longer.
Health care is only one of the many things Americans will loose with the re-election of Donnie. It will embolden the Repubs to dismantle more than they already have.... next up: Social Security
1
Trump seems like a lone wolf in general. He's out only for himself, but, granted, due to the nature of vulture capitalism, he needs partners in crime to help himself and his cash flow.
Is he beholden to Big Insurance? Why? I don't see a connection; for instance, he doesn't seem to be in the pockets of Big Pharma either, not from ethics, of course, but just because they're not on his tiny brain's radar. A tyrant can deal with only so much; he must pick his allies wisely, asking such pertinent questions as, How much money is in it for me? I can't appear too greedy, so I must skewer some of the Big Dogs, like Amazon, which is easy because I despise Jeff Bezos' success. Keep my critics off-balance.
Or is he just that maniacally obsessed with undoing Obamacare because it's related to Obama? (I never really bought into that theory; there's no cash-value in it, but what do I know?)
Because he's only out for himself, I would think that Trump would try to accomplish one of his campaign promises, namely, that he would create a great health plan for all Americans. It would seem to be a win-win for him, unless he's got ties to Big Insurance, which, as stated, I don't see.
What am I missing? What's his motivation here?
Republicans want wars, guns, hate and anger. Now we do have to vote for Democrats so they keep us healthy from mind to body. Anybody tracking insurance company profits as the Republicans are making us so sick? I just can't wait to see Trump's investments spelled out. I'm sure he won't be in the country as his minions are flitzing to countries opening new Trump Hotels.
1
Please use the healthcare from the Obama administration by its proper name: the Patient Protection and Affordable Care Act. Stress the protection.
2
What about the tens of millions still uninsured in 21st C America--unlike citizens of other democracies? Are they chopped liver?
What about millions of insured crushed by high medical bills, paying high premiums & copayments? What about millions who put off doctor visits due to the expense? And hit with surprise hospital bills with no warning -- even when insured?
What we see is that Trump is a gift to the moderates and cautious party Democrats, who look great deploring this lying, sociopathic, unbalanced grifter.
Many politicians, columnists & pundits can make careers now out of justifiably bashing the worst president in our history. Just 'protect' our health care from Trump/GOP destruction?
Thus they avoid the real need for great improvement in ACA, just to bring us up to the standards of dozens of other democracies--also capitalist-- where they don't make the illness of citizens into big profit centers. And don't have a dominant party equating that with protection from 'Big Govt American Freedom'.
"Coming for your coverage" … a nifty slogan, PK. So we'll fight to preserve a HC system that the citizens in dozens of countries wouldn't put up with---even if their politicians did propose it-- and called it 'great progress'.
PK, our liberal columnist makes snide cracks, saying Sanders calls anti HC for All a 'corporate tool'. Cute! But, we need columnists to please analyze pros/cons a bit further and not throw around emotional slogans-- Trump style.
1
"Some supporters of Bernie Sanders claiming that...."?
Do we play this game with all the candidates? Or just Bernie Sanders?
Didn't Dr. K. get enough of it in 2016? Or are we reverting to form now?
"Let’s talk for a minute about Obamacare."
The one thing you will never acknowledge is the ACA is unconstitutional because of the individual mandate.
"But the people who want to take away your health care haven’t given up."
Paul, who provides your health care? Do you think you have a right to it? Please explain.
But, preserving ACA from destruction is only the beginning for basic decency in our society. We deserve much more--affordable medical care as a right--- no matter income, job, health status, age or which state we live in.
Our media isn't giving voters the full discussion. Politicians can exploit us. And the Dems can look like saints for just opposing Trump, the worst president in history. Congrats.
How about discussing the organization called:
"Physicians for a National Health Program - PNHP"
Quote:
"The answer to our health care crisis is clear. We propose a publicly financed, non-profit single-payer national program that would fully cover all Americans."
Where's some publicity on this doctor group? Never see them mentioned on cable TV or NYTimes. Why wouldn't they be a very newsworthy item in the only world democracy that lacks HC for all, even with ACA?
And taxes to finance HC? Horrors. Ever heard of the group "Patriotic Millionaires" who favor higher taxes on the rich? See multi millionaire Nick Hanauer and his Ted Talk. I did see him on TV once, I think MSNBC.
Hey, US media & NYT--- 'All the News Fit to Print'? Or to discuss? Not newsworthy enough? Too 'left wing'?
Who defines 'left'? Mega donors who pay for expensive political ads that bring profit to our media? Does that keep the discussion within certain 'boundaries'?
And see Leonhardt's Dec 22 column on Centrist Bias in the media, with over 1200 comments.
Prof. Krugman,
I so often agree with you, but this article is truly gutless, the worst you have produced regarding healthcare in America. Are you saying that because many Americans may be stupid and heartless enough to re-elect Trump and his GOP enablers, that we should be afraid to vote for candidates who want our healthcare system to be the best it can possibly be?
Of course a close election (win or lose) would lead to 4 more years of gridlock and wouldn't give us improved Obamacare any more than it would give us Medicare-for-all. But it might lead to dictatorship (if Trump wins) or civil war if he doesn't, or worse. Do you really want yet another GOP lite incrementalist to be the DEM candidate this year?
Let's hope Sanders or Warren wins a landslide election and flips the Senate. But if the result is closer and the votes for medicare for all, the green new deal etc. are not there, then America will have to deal with that, in the streets if necessary. But why resign ourselves to that NOW? We're still 3 weeks away from Iowa for God's sake.
3
Once more, you tell it like it is. More power to you, Professor.
1
For the first time in a decade, the number of Americans without health insurance INCREASED — by 2 million people in 2018 — according to an annual U.S. Census Bureau report...thanks to the continued political sabotage of the ACA by the Republican Party and their healthcare expert Donald Trump.
The Census found that 8.5% of the US population went without medical insurance for all of 2018, up from 7.9% in 2017.
2018 was the first time since 2008-2009 (the Bush-Cheney Depression) that the number of uninsured increased.
https://khn.org/news/number-of-americans-without-insurance-rises-in-2018/
It's highly unusual for the number of uninsured to increase during growing economic times because it normally means more jobs and more money to buy insurance...BUT the successful Republican-Trumpian efforts to rip healthcare away from millions of Americans by making it harder for families to enroll for Medicaid coverage and demanding more paperwork are working great.
In short, the Trump-GOP has essentially been telling Americans to drop dead....because cruelty sells well in the GOP 'heartland'.
The uninsured rate, of course, was highest in radical Republican-governed -states of Texas (17.7%), Oklahoma (14.2%), Georgia (13.7%) and Florida (13%)...where an unusually cruel form of Christianity is practiced in complete contradiction and repudiation of their own Bible.
I don't know why anyone would ever vote Republican, but cruelty seems to be a major attraction.
Nice GOPeople.
Nov 3 2020
12
One of the most breathtaking aspects of Impeached 45*'s regime is his apparently limitless ability to project onto others things he is actually doing himself.
1
Every morning if you wake up healthy then you are a lucky person. Everyone is thiking about health care. It doesn't matter what the type of health care the democrats are going to give us, as long as we have coverage . Coverage is real coverage not that fake Christian coverage that doesn't cover anything
We have reached the tipping point when it comes to health care. If adylts cant figure out what coverage means then they are definielty don't need to have health care.
The facts are the GOP will allow you and your children to die on the streets or an unaccreditated hospital.
The GOP is not our friend and anyone who votes against the interest of the country to have health care is a traitor to American democracy.
I am not getting hung up on anything but ensuring that we have health care for all. I don't care about insurance companies and I don't care about the medical for profit health care and the drug companies.
The enemy to the American people
is the Russian loving GOP=Trump taking away our safety net= no health care= no food stamps= no housing= no GOP is any office and lets make sure Moscow Mitch is gone
A great start with President Obama and now. We want complete Health care coverage and when do we want it ?now no more excuses.
1
My concern is that Biden as president may try to accommodate the Republicans by cutting social programs to reduce budget deficits. Tax cuts are half of Republicans 'starve-the-beast' agenda - cuts to social programs are another.
Biden has long advocated for cuts in Social Security to ensure solvency: https://theintercept.com/2020/01/13/biden-cuts-social-security/ .
The one thing that annoys me about the Democrats is that they are arguing Obamacare+ vs. Medicare for All - the perfect being the enemy of the good - while there is still a great threat to any kind of universal coverage via Trump and a GOP congress. It's rearranging deck chairs on the Titanic.
106
@MV ; Can you please tell me what purpose the insurance companies serve? They billions going into their executives' pockets is money that could have been used to pay health care providers. And they have every incentive NOT to cover any particular treatment or screening.
27
@MV So what do you propose they argue? They are putting their health care plans out there and trying to distinguish themselves from each other. At the moment, they are running against each other, not against Trump.
Once a nominee is chosen, he or she will both put his/her plan out there AND contrast it with Trump's plan to gut the ACA.
10
@Penningtonia They don't, and I'm totally for Medicare for All. But that's not the point. The threat now is that Trump gets re-elected and destroys even the incremental improvement that Obamacare achieved. They should present a united front against what Trump is trying to do.
9
This time, I must disagree with Prof. Krugman.
Is it because he makes a very good living and has a nice plan through Princeton U? The rest of us are being bled white.
Higher premiums, copays and deductibles every year (although not THIS year, an election year. Gee, I wonder why?). So, those lucky to have coverage, get it by giving up a pound of flesh.
We must have a national healthcare system soon, or many of us simply will not be able to afford the insurance. This is the reality of most Americans.
3
There is something fundamentally obscene about profit being the primary motive for providing proper health care for all the members of our society. It is a fundamental part of "...Life, Liberty, and the pursuit of happiness..." Isn't that what we are supposed to be all about?
3
He wants to take away our healthcare coverage, but not "until the election is behind him." The same election he is intent on stealing with Russian help - again!
America's pre-existing conditions - racism, greed, supremacy (elitism), environmental destruction and deteriorating health of Americans - has all metastasized in trump-disease - a condition that has sabotaged and rendered our Constitution's anti-bodies and institutions defenseless. We now have the anti-vaxxers and vote-abstinencers letting America's trump-disease go rampant and uncheck. We need to vote, wash and disinfect our hands of foreign Russian intrusion and vaccinate our democracy by voting this deadly disease out. Voting is THE preventive care of a democracy.
While Democrats pursue healthcare for all, the GOP pursues healthcare for none except the elites, with those same elites forcing more Americans to work for punishing wages that don't include healthcare, let alone afford to feed, cloth and house their workers. Before you know it, it will take two or three jobs to qualify for food stamps as the trump engorges himself on a bucket of chicken and a second scoop of ice-cream and second slice of cake - indeed, the poor don't even get to eat cake crumbs! We have a nanny state that caters to millionaires and billionaires who claim they can't afford a society they've taken so much from and impoverished.
Perhaps we can test out GOP style healthcare, implemented strictly on Republicans. See how that works out.
3
I deeply suspect that some of the increases in health insurance costs came with the ACA, not because they were necessary, but because the ACA provided the companies with an excuse for raising costs, when what they really wanted was deeper profits.
2
The ACA limits an insurer’s margin to 20 percent above medical expenditures. It’s the first time insurance profits have been limited in U.S. history. That’s not to say the Patient Protection and Affordable Care Act is the final answer, but it’s a definite improvement.
The biggest problem with healthcare is costs, not coverage. A lack of competition among providers and pharmaceutical companies, price opacity, and price discrimination, have created perverse incentives and total chaos when it comes to pricing. The cost of an EKG shouldn’t vary by ten thousand percent from hospital to hospital and clinic to clinic and depending on whether you have insurance coverage or not.
And as far as I know, Trump is the only one talking about costs and proposing rules to increase price transparency and competition.
Until the Democrats start talking about real proposals to address costs, I refuse to take them seriously.
1
House Democrats passed a bill to have Medicare negotiate drug prices. It sits on Mitch McConnell’s desk, where he promises to kill it.
Do you take Democrats seriously now?
1
The problem with the 'health care' debate is that it's a misnomer. It's a health insurance debate that fails to address some fundamental issues in medical care. No one seems to be tackling the questions of why our costs are so wildly out of sync with the rest of the world; how we might address over-testing and over-prescribing; how we can shift to a focus on prevention and wellness; how we address nonmedical supports and treating multiple chronic condition issues for elder patients. I don't hear anyone citing guidance from those on the front lines of medical care: physicians, nurses, therapists in all categories, EMTs, even hospital administrators. That would be refreshing!
2
"But the people who want to take away your health care haven’t given up."
Krugman wants to take away your healthcare, it is part and parcel of his irrational hate-fear of Sanders and Warren.
Please remember his hysterical attacks on Sanders and "Bernie Bros" last cycle. And his lies about employer provided health care where he never and still has not acknowledged all the shortcomings such as;
High deductibles, $8K is not at all unusual. Even though employer provided health care is part of your compensation.
Change employers, kiss that insurance goodby.
Trapped in employment you'd like to change but you cannot because you or a family member is dependent on treatment of a serious health issue.
Then there are all the hurdles between you and your doctor, including that you could be forced to see someone other than your preferred doctor.
Then there are all the other lies, number one being that you will necessarily loose your present insurance. Do you seriously believe legislation would be written so that people arbitrarily lost their insurance. The new law will be complicated as the laws are right now. Which is why transition will be gradual.
1
Health care should me made available to all in this country but at a reasonable cost. Right now, even for people who have good coverage, the costs are unsustainable. I believe that controllings costs and the sheer waste of all the paperwork that has to be sent in to the insurance companies and then they get to decide who is and isn't paid. It's a mess. As for companies having to pay insurance, what on earth is that about. It stifles innovation and keeps people from being able to move in case they lose insurance. None of this makes sense which is why we need to simplify and start again. The big question however will be , does congress have the guts to do this?
2
@Sally M: The US has to try everything else before doing the obvious. Universal health care is best funded by a value added tax that everyone pays when they consume. Its rate makes public what the system costs.
1
Do bone spurs just go away, or do they require surgery? If they require surgery, shouldn't there be a medical record of djt having his massive bone spurs removed to prove he really had them? Perhaps this was a pre-existing condition that saved him for really having to serve his country.
2
@LGBrown After I had knee surgery the doctor showed me a picture of bone spurs. I asked him if he took them out and he said no. He said bone spurs always grow back. Bone spurs are only removed if they are impinging on tendons or ligaments.
@Mark Smith Thanks. So, at least, there should be a real record of a doctor's visit. But, we all know there is no such record.
If you presuppose a rhyme and reason to the evolution of healthcare worldwide and in the US, you can say that it involves the economic concept of greatest utility which gives an improvement of the human, call it, throughput of a nation (successful health for the greatest number of citizens). Which gives the best trajectory: free, easy healthcare or expensive healthcare that forces people to fear loss of their job (and hence corporation provided healthcare)?
The central economic problem is to get a precise measure of a desired equilibrium whereby a nation can make an informed decision. Free healthcare may lead to employees quitting jobs too easily and flippantly. Dearly won healthcare may lead to substandard performance and misery, keeping a job they don't like just out of fear of losing healthcare benefits. In this country, they can also be hobbled by trying to figure out what the benefits are, when they are, for how long, etc. -- 800 number calls, endless. This seems to be the weakness, for real with healthcare. It is just too (no expletive used) confusing.
What is never mentioned in these opinion pieces is the why business and the Trumps (the GOP) want dearly won, complex healthcare. They want it because big business, their donors, want to control employees with fear -- not to mention the vested interests healthcare donors.
If only an economist could put the whole thing into a mathematical relief via a pertinent, well-designed parameter. Hint, hint.
1
Actually, Trump is right. He *is* trying to "save pre-existing conditions." He just wants to eliminate the insurance that would help sufferers treat them. And he is not too skilled at speaking our rich language.
2
Oh, Dr. Krugman, too bad, you’re repeating your “incrementalism” mantra from 2016, which means many, many voters have progressed on the idea of Medicare for All, but you haven’t. That’s regrettable, but fortunately, it’s going to be much more difficult to attack progressive thinking this year because people have had four years to think about the issue, and they have a much different attitude from that of 2016...
1
I think the key factor in this debate is rarely mentioned; can any workable progress be made on health care while there is still a giant industry, flush with cash and influence, fighting it at every turn?
An unspoken rationale for true single payer is to eliminate the outsized political power of the for-profit health care industry.
Otherwise, any incremental progress on health care will just get rolled back when they buy the next election and install their paid stooges from the Republican Party.
I hate the overuse of military metaphors, but you can’t win a war if you leave a giant intact army on the field after you fight each battle. Sometimes you have to hold out for the strategic win instead of the easier skirmish.
2
@Independent
Excellent post. We're already spending enough money to provide universal coverage, but that's in theory. The trillion-plus dollar question is how to get there from here.
We are not going to suddenly convert everything into a single payer system. There are too many stakeholders (unions, people with generous private insurance, and countless people whose jobs in healthcare are threatened). There's also too much inertia and friction to quickly overcome in a very complicated system. Certainly not within one two-year congressional cycle.
And the more that voters are disappointed with a system that comes up short, the more likely Republicans take over and sabotage any progress.
Sensible measures include expanding Medicaid to every state, providing larger insurance subsidies to more people, limiting deductibles and copays, adding a public option, gov't bargaining for drug prices, limiting payouts for ineffective or overpriced care, and mandating every provider receiving federal money take a certain percentage of insured, low income patients.
By allowing the public option to compete with private insurance over time, insurance would probably come to cover mostly vanity or boutique options. Of course, any new system will need continued adjustments to control costs and improve efficiency.
I seriously doubt any candidate is going to get single payer healthcare quickly enacted and put in place. But we could get universal care that gradually gets us there and saves money.
Forcing people who can't afford to see a doctor to buy "affordable" health insurance that still doesn't allow them to see a doctor is a policy success?
I often wonder how the GOP manages to win elections despite their unpopular agenda, but then I look at the failure of Democrats to meaningfully improve people's lives and it all makes sense.
1
Republicans have done everything they can to ruin healthcare, to disrupt ACA , to destroy it, etc... if they had gone along with the plan from the beginning it would have worked out fine, don’t blame the democrats.
4
Would've worked out? These problems were baked into the bill.
It defined policies with huge deductibles as affordable and then forced people to pay premiums for those plans.
It totally ignored the fact that most Americans aren't interacting with the individual health insurance market and most Americans don't require catastrophic levels of care. They just want to be able to see a doctor if they are sick or injured.
Democrats sold it as universal health care and not only failed to deliver on that promise, but managed to make vulnerable people worse off.
The failure of many Democrats to understand this is why Democrats struggle to win elections.
@Robert Bradford - As my original statement suggested, the ACA was crippled right from the beginning by republicans. If republicans really cared about healthcare for all America citizens, they would have helped to make it all work, not destroy it in its infancy.
This is a conundrum...why do so many Americans not want some form of healthcare? Medicare is the best healthcare available. It is hassle free and I have personally not yet heard any seniors complain about it. The ACA improved my healthcare, but Medicare is even better. So far there is no republican plan other than the typical complaining, blaming, misleading buzz words and lies. Their plan depends on obstruction and includes many Americans who could really use a good healthcare plan.....go figure!
3
We're still only talking about how to finance health care spending. The costs in this country are higher than anywhere else. Other governments regulate how much providers and drug companies charge. We need to stop being so shy about taking on Big Pharma, the AMA, and the hospital industry.
4
There is no health care insurance. The reality is there is health care financing. That is a reality other advanced nations recognize by implementing universal health care coverage in various iterations. The Republicans keep promoting the idea that there is a competitive commercial market for medical services just like automobiles or cell phone service. It is also worth noting that there is increasing consolidation in the medical industry as hospital systems grow to dominate a local market. We also increasingly see independent medical practices being acquired by large medical groups and are increasingly run like corporations. While this may improve provider leverage as they negotiate with the several large insurers that dominate the payment side of the equation the idea that individual patients have any negotiation leverage as in a regular commercial transaction is nonsense. We clearly must implement some form of universal coverage.
9
Two things must and no doubt will happen that will make everyone clamoring for Medicare for All: a significant economic downturn with job losses and an acceleration in the number of jobs which turn into contract positions, making every worker an independent contractor and thus responsible for his/her own health insurance. Americans must shed this selfish attitude that permeates society ("I've got mine--today--so you figure out to get yours") and move toward, gasp, more democratic socialism,.
5
Of course he's lying. He lies as he breathes. But even his most faithful fans must find it hard to believe his claim that he is "protecting" Americans with pre-existing conditions. The ACA is flawed, yes, but getting rid of it without a replacement would return our health care system to an insurance company enrichment system.
4
The ACA may not be able to survive the current court challenge. We have to remember that most legal experts thought that the original case, NFIB v. Sibelius, would not get very far. Roberts saved the law, but on grounds both exceedingly narrow and novel. He agreed that it violated Congress's powers under the commerce clause, but justified it under the taxing power. In terms of existing precedent, that was absurd: health insurance is obviously a matter of interstate commerce and choosing to remain out of the market has an effect on interstate commerce. The case of Wickard v. Filburn already settled that private decisions could come under that rubric. Roberts won credit for saving the law when he actually did much to cripple it by removing the penalty on states for not expanding Medicaid. A long established method of federal regulation, making generous grants conditional on what the states do (cf drinking age at 21) suddenly became an affront to "states rights". That arbitrary, poorly reasoned decision is the major reason the ACA did not help millions of people. Under the rules of severability, the current case, Texas v. US, should not be difficult: as you say, this issue is supposed to be determined by congressional intent. But the fuss that has already been made in the lower courts about what should be a non-issue does not bode well for the fate of the ACA in the Supreme Court. But if we made it clear that the alternative to ACA was Medicare for all, that might focus minds.
2
The relentless attacks on healthcare are just more proof of the warfare waged against the working class. And the army of newly appointed judges will ensure victory for the billionaire class.
The first step is to admit that we have a billionaire problem. Next, we take back our government from the billionaires and their minions. Then, we work to ensure life, liberty, and justice for all, not just the few.
4
This is really simple, “If you don’t have your health, you have nothing.” If you do not have access to health care when you need it, the game’s over. If we care about our families and each other, we need to find a way to provide a health care, including medical, dental and optical, safety net for all. This includes for the rich, the middle classes and the poor of all age cohorts. As long as the coverage is affordable to all, real and comprehensive, how it is provided is just commentary. Personally, if a “Medicare For All” option were provided, I believe it would dominate the market as people would find it the easiest, most affordable, and most comfortable format and that businesses would most likely opt to focus on their core economic activities and not be a pass through for health care insurance.
8
There is one simple answer to the health insurance issues in America. Stop pitching Medicare for all to employees THE CONSUMERS and instead pitch Medicare for all who want it to the people who pay the premiums, THE EMPLOYER / COMPANIES companies.
Most healthcare is paid for by employer sponsored plans, the cost of which rises annually by on average 7%, but often is 20+% annual increases, especially in small companies in RED STATES.
Its that easy - let small companies opt in to Medicare at the same premiums they paid to the insurance company last year and fix the annual increase at 2% or the rate of inflation for the next 5 years. Small companies will jump at a deal like that, which gets rid of the volatility of a major cost, and gets rid of all sorts of administration costs, management distractions etc.
As a small company owner with 55 employees, healthcare is the only cost where I have no ability to contain or manage the cost. The local market is a monopoly for insurance and a monopoly for hospital. insurance companies and hospitals simply work together to gouge local employers the maximum possible without driving them out of business.
Give the payers not the consumers the choice. Employers will jump at Medicare for all when they see the increase in profits.
11
Is it fair to say that Trump is trying to shorten the average life span of Americans.
8
I just want to know one thing. OK, three things.
1: why can’t the US figure out how to provide healthcare for all, when it is something that all other developed nations provides its citizens. Come on, even Cuba provides national health care (such as it is) but the US cannot. It’s not as if we have to create something that’s never been done before.
2: and this goes to the Repubs: what is so terrible about a national healthcare program? (Other than needing to make sure the insurance and pharmaceutical industries are well protected.)
3: also for the Repubs: what is so bad about covering people with pre-existing conditions? I’m guessing all conservatives and Republicans are incredibly healthy and have no health concerns and that only progressives and Dems have pre-existing conditions.
8
Universal medicare is an acknowledgement that everyone has a place in our society, and “I” am willing to protect, defend, and assure everyone a safe place in it.
Many Republicans do not believe this. They believe there are excludables that live among us, that do not deserve a place in our society, and as excludables, that set of Republicans do not care to assure they live longer or more comfortably.
If they can pay their own insurance, well ok. But “I” am not paying for an excludable.
Does that help explain it?
5
Any real "policy" like this will come from GOP leadership (i.e. McConnell) after having checked with the president, not on the policy - but that it will not lead to a negative twitter barrage.
1
I believe health care should be a right. That said, I do not believe supporting a medical industry that employs more non-medically trained people than medically trained people makes much sense. Last week I got a call from a person in a medical office who told me my insurance was terminated on Dec. 31. This led to about two hours of calling people on the phone, being told if I had a medical emergency to call 9-1-1, and to listen carefully because the menu options have been changed. In the end, I talked to eight different people to learn that I really didn't have a problem -- but not one of those people was medically trained. Their job was to sit in front of a computer and answer the phone.
There is virtually no accountability. If somebody pushes a button and that screen changes, that is the way it is.
In most countries, if you go to see a doctor, you sit in a waiting room and then walk into an office and there the doctor is. In the United States, you sit in a waiting room, and are ushered into a room where you wait for the doctor to arrive. When he or she comes in, now they have a scribe who taps everything into the machine. Of course, with all of this technology, you have to proved your complete health history and medication -- because the "scribe" is not there to track medical history, but to make sure every single "fee for service" is adequately recorded.
Kill the waste, then you can fix the system.
5
Perhaps an essay on how to work on universal health care in the future while improving Obamacare is necessary. Just saying it conceals its challenges.
I'm assuming and hoping it would.
Generally, Americans only act when crisis forces them. So allowing our current system to become a greater crisis than it is might be what we have to look forward to -- unless there is some way that improving Obamacare by moderate steps will lead it to transform into a sort of Medicare-For-All system is possible.
So we need to think this through:
1) will Obamacare be able to bring down providers' fees?
2) would lower provider fees be met with free tuition for medical school?
3) will expanded health care for all lead to longer waits for care ; would it require an expanded use of physician assistants, etc.?
4) would all doctors be required to accept all Obamacare patients?
5) will Obamacare be able to negotiate drug prices and allow the use of imported medications by patients and pharmacies?
6) will doctors have to practice in rural areas, poverty areas, etc.?
I could go on, but the question boils down to what does expanding or improving Obamacare mean in practice, and how practical is it -- or will a dramatic change be required? What will prepare us all for such a dramatic change?
lowering the age for Medicare is one option. But even that has challenges.
So will an expanded Medicare-type health care at some point require major changes. Are we just putting off the inevitable?
Let's remember that one of Paul Ryan's stated policy goals was to eliminate Medicaid and that Republicans tried to repeal the ACA and install an insurance to be named later and that it is Republicans that have and are trying to get the ACA declared unconstitutional. Republicans campaigned on repealing the ACA and repealing the ACA is a plank in their party platform.
Trump does not care to improve the lives of people, but neither does the Republican Party. So often Trump gets the blamebfor things the Republican Party would be doing anyway.
3
Health care and education should be a given. Nobody should struggle for it. As you point out for health care, the goal is not short term. It does not take a rocket scientist to figure out that a very valid way to get there is by building-up on Obamacare without taking private insurance from those who have it (not even Warren talks about it anymore).
If Trump wins and if what it takes to build-up from Obamacare is to rename it to Trumpcare while in office, so be it. Trump can keep saying he saved health care for those with pre-existing conditions. Even he knows it is not true. That is the same thing he did with NAFTA. Updated and renamed the exact same agreement. Trump's signature.
4
Hey, I didn't die from cancer diagnosed weeks after his inauguration, but his repeal and replace efforts were surely going to kill more people if benefits for pre-existing conditions were denied.
5
The easiest way to transition to single player is to give people the option to buy into Medicare. Democrats are pursuing the wrong strategy with mandatory single payer up front.
5
"He wants to take away your health care, but he doesn’t want you to see him doing it until the election is behind him."
Naturally. What's left unsaid are the other 'untouchables,' senior healthcare and Social Security. Little has been made of this issue other than to repeat Trump's promises that he would never touch these entitlements.
And yet, an article a few months ago said the destruction of these entitlements was job #1 for Republicans under a second Trump administration.
So yes, let's protest Trump's attacks on the ACA and his passion to destroy any good President Obama ever did. But let's not forget Republicans true longer range plans, which are to eliminate every single entitlement program that provides a modicum of protection for seniors and the disabled.
In their book, social welfare begins and ends with aid to the rich.
15
I just read that 12 percent of American workers are in the healthcare industry. What percentage of those are at computers processing claims I have no idea. But couple this with the rising field of "healthcare coding" (those numbers on your insurance form that define the three staples that were used after your surgery), where there are even advanced degrees offered, and you can see the monstrosity of America's health care "system."
In other words, it's not merely the CEO's of Aetna and United Healthcare and all the rest that will oppose any reforms in American healthcare; it's the ever-growing number of lower-level workers sitting in their cubicles denying you your claims.
4
The ACA was a fall back after the death of Ted Kennedy to get it through the Senate. If Kennedy had lived the ACA would have been more consumer friendly. What we got was a deal with the Insurance companies to make sure they remained profitable if they gave up their more predatorial practices. Allowing people with preexisting conditions to get insurance and capping out of pocket expenses are really good. But ultimately the private companies were balking against the insurance markets. Why should they have any say. Insurance isn't a consumer item its something that should be provided everywhere to anybody. It should be paid for with premiums and the general tax system. The idea that it is good for the US to have a trillion dollar a year defense budget and the wealthiest should be encouraged by the Trump to avoid paying taxes and that national health care should be shunned is shameful.
5
I do share your view that, eventually, a single-payer plan will become a reality as it is in some form or other in many other countries including our neighbor to the north. But in the meantime incremental changes to the ACA will happen, assuming that a Democrat is elected. However if the senate remains a majority of the GOP then very little will get done of any kind.
We have an opportunity now to make a change in our country by electing a Democrat to the White House which will have lasting effects. But it will take many years to undo the damage to our democracy that has been done by the current administration.
4
Democrats need to get past each attacking each other on health care, especially using Republican's phony claims about the total cost of true universal plans. Attacking Trump on his personal scandals, failings and crimes has generally been a failure, since the 2016 campaign. The electorate should be reminded of his failed promises on health care, taxes and other things that are directly relevant to people's lives. Of course one of his promises was to disengage in the Middle East, not start WW III.
3
Apropos pre-existing conditions: One of the things that contradicts the libertarian/conservative arguments against universal health care coverage - be it through general taxation or via social health insurance – is their own belief in the miraculous powers of free markets. Anyone who has taken Economics 101 is probably aware that the conclusion that free markets are efficient and result in optimal welfare effects is ultimately based on assumptions that include the free, frictionless movement of goods, service and the factors of production.
While libertarians and free marketers are all for the freedom of movement of capital, goods and services, they have forgotten about the factor of production called labor. In the absence of fully portable health insurance coverage that doesn’t discrimate against pre-existing conditions or have waiting periods, the movement of labor is far from “frictionless”. As a result, markets are far from free and by no means efficient.
4
Our political system is so bent over backwards that even the politicians can't see what's in front of them; an economy driven by private insurers, hospital admins, and enslaving the middle and lower class via medical bills. When even the major contender in the Democratic party doesn't openly support nationalized healthcare you know that oligarchy is alive and well in America.
4
Single Payer or a multiplicity of plans crafted to make money for the insurance companies? There would be no effort to choose between the two if people were rational. Every single person that deals with making out a different form for people with different insurers to get reimbursed is money spent on health care without making the care any better. Every single time a person eventually goes to the emergency room because they do not have insurance represents money wasted, money that is paid by our taxes. Every single CEO earning a mid to high seven figure income from running a non-profit hospital system is money spent on health care without making the care better. Every single time a pharmaceutical company pays for doctors to go on a junket to entice them to prescribe their drugs is money spent on health care without making the care any better. Every single ad for prescription medicine aired on TV is money spent on health care without making the care any better.
We do not have a rational system of health care, and people making sure that continues do not help to make America great again.
5
"I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now"
Yes I have pre-exisitng conditions now and the President is making sure I continue to have them. And my health care will not take them away from me.
So comforting
2
The 8% of Californians who are left without health insurance due to its lack of affordability, would benefit from M4A. Some may die due to their difficulty in paying for healthcare. In Florida 14% are without health insurance due to the Republican's refusal to accept any ACA Medicaid funding. It says everything about Republican leadership in that the deeply red states who refuse the Medicaid expansion federal monies on principal would rather prove a political point then save lives in their respective states. Kudos to the red states that are more pragmatic like Kentucky, Arizona, Louisiana, Indiana, West Virginia, etc. Although the red states, mostly the South continue to refuse federal monies based on politics alone. If Trump wins re-election, the cruelty of Republican politics will double down in strength. Trump and his GOP cronies plan on cutting or privatizing Social Security, Medicare and Medicaid. I'm sure that people who lost up to 60% of their savings in the 2008 financial recession are skeptical about the notion of privatization. Health insurance companies do little to benefit the consumer other than skim a large % of the cost of health insurance for the cost of administration & do everything in their power to find loopholes to defend denying people coverage. This is the best argument for M4A other than it will save people's lives in the aggregate. Whoever decries the loss of jobs in the insurance field should feel the same about preventable deaths.
4
All the facts are known. We pay on average twice as much for healthcare as other countries which have some type of universal healthcare. Most health outcomes are better in countries with universal plans. Drug prices are much less expensive in other countries. There are several versions of universal healthcare which have been around for many years which could serve as a model for own plan. But all those facts and examples mean little or nothing to Republicans whose ideology trumps all facts and examples. When the business community decides that they no longer want to cover their employees with health insurance, or in the less likely event that Democrats again control all branches of government, maybe we'll get somewhere.
5
I have so had it with Democrats attacking each other's health care proposals, leading often to nasty attacks of each other. The early debates were circle firing squads with the debate moderators tossing grenades in.
The fact is, each candidate makes laudatory claims about their own plan, each candidate makes disparaging statements about the other plans. To my knowledge none of the candidates are health care experts, economists, budget analysts, or dictators. Therefore, none of them is in a position to say categorically that compared to other plans, their plan covers more, costs less and can be made law over the opposition of Republicans.
The American people should understand that unless Democrats completely control both houses of Congress, electing Sanders is not going to produce a better health care outcome than electing Warren, Buttigieg, Biden, Klobuchar, or any other Democrat. But also know that any Democrat will produce a infinitely better health care outcome than Donald Trump.
Some commenters raise the question, "What is the Republican health care plan?" Donald Trump has given us the answer: a big lie, repeated over and over and over and....
4
I've been bothered by the Medicare For All litmus test, because we are not really forward thinking nation. We are wasting time arguing about the perfect system when even our imperfect improvements are at risk.
I will not vote for Trump. But a lot will, and they just have to live in the right state to make a difference. To win, he needs a few Pennsylvanians to show and a lot of them to stay home. Our progressive / moderate rift in the party and voters can make that a reality; Democrats, unlike their GOP brethren, don't vote for party, especially if party serves up an unpalatable candidate. GOP voters will flock to the polls to elect any poor choice who is not a Democrat.
We are a nation that prefers incremental action. Open a history book and find that truth. Our radical changes have usually been in the works for ages. Healthcare will join that list - we will fix it bit by bit. But only if we get behind anyone who will not destroy it.
Vote people. Your lives may depend on it.
4
I am retired and pay for Medicare Part B coverage. As you know, Medicare Part A covering hospitalization is free for most seniors. In addition, I also pay premiums for Blue Cross supplemental coverage. As a result, I pay ZERO DOLLARS for doctors visits, medical tests and hospital care. I have had both hips replaced with NO OUT-OF-POCKET costs to me. My insurances do not cover dental care or eye glasses.
Everyone should have the coverage I have, even if not retired. On the PBS show, “Doc Martin,” none of his patients pay him. They pay small amounts for prescriptions. This is what everyone should experience- health care without the worry of deductibles, co-pays and non-coverage.
4
The reasons are simple:
1) Obama did it therefore Trump, in his sociopath's rage MUST undo it, no matter who it hurts and who suffers, because Obama's success hurts Donald Trump and that, to Trump, is the ONLY pain and suffering in the universe that matters.
2) Any moneys spent helping ordinary people with pre-existing conditions is money "stolen" that can't be funneled into Trump's own pocket.
He's helped in that Mitch McConnell and Kevin McCarthy (and Paul Ryan before him) believe to the bottom of their souls that not one dime should be spent on social welfare when it should be spent (in their warped view) on tax cuts and subsidies for corporations. (Remember, when Obama was President, McConnell fought tooth and nail to protect subsidies to some of the richest and most polluting corporations on earth: The oil industry).
The ONLY time McConnell is willing to help ordinary people it's by getting a billion dollar to a company opening a plant in Kentucky, where, despite that, he's the least popular senator up for re-election.
Republicans founded a party in 1856 to battle slavery and to help convert America from a backward agrarian 3rd world nation to a first world progressive one. I doubt Fremont, Lincoln, Grant, Hayes, or Garfield, their 1st 5 Presidential candidates would recognize ANYTHING in the party they represented in today's Get Only Power party.
10
People need to know that we are all under insured now when catastrophic injuries and illnesses strike.
There is a disingenuous insurance company ad "Only pay for what you need".
Without health care as a right as in other major, more humane, nations none of us working class Americans can pay for what we need.
10
Thank you, Mr. Krugman, for the truth. The weird aspect of the GOP plan to dismantle Obamacare is that there is no cogent reason expressed for "why". Then, of course, the very group most likely to be hurt by loss of coverage has significantly promoted this disingenuous campaign, where there is no alternative proposal.
The key crime is that for nearly 40 years, the only universal plan that tried to reduce the rate of healthcare spending and to inject the concept of "value" into the system was Obamacare. We cannot afford the care we now have. We need a plan for the future, not a destructive tantrum.
2
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.
4
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.
2
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."
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.
10
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.
1
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.
25
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.
12
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?
6
It’s because it’s one of Obama’s signature achievements.
1
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.
13
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.
1
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.
11
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.
6
@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.
1
@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.
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.
15
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.
3
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.
13
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.
2
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.
4
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.
2
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.
39
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.
11
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?
1
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.
2
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?
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.
9
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.
1
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.
2
"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.
2
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.
3
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.
1
Your boss lied to you, and you bought it. There’s no lower limit; in fact, there are ACA SUBSIDIES specifically for small biz.
1
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.
4
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.
4
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.
3
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.
@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.
@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
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.
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!
@Dave Oedel
Trump says he's for pre-existing conditions while trying to remove them, exactly as Krugman says. Do you not understand this?
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.
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.
2
@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.
ACA allowed the to find GOOD insurance? I guess it depends on definition of good.
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?
2
@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.
3
To all fairness, premiums of the ACA insurances are so high, that you are better off not buying the insurance and pay penalty.
$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.
5
@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.
12
It beats no insurance, which is what many of us had before.
9
This is very true. They have done everything they can to make the ACA work less well and cost more.
5
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.
1
Thank you, Dr. Krugman, for that dose of realism.
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.
12
@JMA
Vote BLUE. M4All
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.
5
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.
5
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.
18
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.
@Mark Keller
Well said.
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.
21
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.
6
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.
1
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?
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.
1
If it was up to the Republicans, ALL of those people would be uninsured.
@michjas
Miss statements and GOP talking points don’t solve nothin’.
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.
All Congress members should have the some insurance as us, the private citizens. Then the “ insurance industry problems” could be solved.
7
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.
1
Could they really refuse if most people were covered by Medicare? Seems like that would really limit your customer base.
2
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?
2
@Smilodon7
I agree. But I was surprised that any MD could refuse to treat people on Medicare.
1
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.
4
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.
13
@NYC expat
Will “for profit” hospitals, pharmaceuticals and medical services accept a federal plan that dramatically reduces their enormous profits?
1
@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.
2
@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.
1
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.
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.
4
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.
11
I went years without care thanks to being a preexisting condition.
2
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!
8
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!
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.
2
It's amazing to me that people object to gov't medical care over an insurance company that makes more money denying one coverage!
11
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.
2
@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.
13
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
6
@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.
5
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.
2
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.
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.
1
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.
1
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.
10
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.
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.
1
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.
2
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
1
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?
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?
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.
2
@Charles Becker
The commonality is we are all Americans. Your biased thinking doesn’t solve anything...
@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.
1
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.
3
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
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.
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.
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.
13
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?
2
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?
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.
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@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.
16
@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.
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@Charlton
I support universal healthcare. But to call it a right clouds how to make it effective.
18
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.
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@Independent
Good post
The key is to reduce costs and nobody is focused on that.
30
@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.
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@Independent
Unfortunately 1/7th of corporate American IS private health care.
That's the problem!
97
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.
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@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
27
@John Huppenthal In an economy predicated with an increasingly contingent workforce, healthcare benefits based on full-time employment is, IMHO, unrealistic.
50
@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 .
28
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?
635
@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.
162
@James Ward
Right - part of the HMO-like quality I mentioned is a limited list of providers.
55
@Anne-Marie Hislop
Medicare advantage plans cost the government 30% more than traditional medicare...
80
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.
376
@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.
27
@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.
4
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.
1404
@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.
110
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.
100
@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/
84
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.
1034
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.
27
@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.
21
@Frank F I hope he didn't pay it!!! I wouldn't!!!
10
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.
303
@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.
22
@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.
15
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.
623
@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,
23
@GUANNA And they are run by insurance companies.
11
@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.
7
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.
7
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.
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@PATRICK
How do the Republicans capitalize on the financials of healthcare if they aren't even offering a healthcare plan in the first place?
35
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.
13
@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.
20
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.
3
@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?
7
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.
15
@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.
1
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.
8
The US is not a country but a federation of loosely related states. Each state must figure it out on its own.
2
@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.
6
@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?
3
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.
4
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.
78
@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!
11
@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.
22
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.
5
@snowjs
Maybe if many Sanders's supporters voted for Clinton,we wouldn't have this mess in the White House.
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.
20
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.
9
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.
8
@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.
1
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?
5
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.
15
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.
12
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.
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.
3
@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.
2
@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.
27
@Once From Rome But we can always afford huge tax cuts for the wealthy.
23
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.
17
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.
24
@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...
5
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.
7
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.
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.
24
@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.
8
@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.
@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.
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.
10
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.
13
@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.
@Driven
No, actually, in recent years, when it comes to the healthcare industry, a good chunk of "your cash" is going to television advertising.
1
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.
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.
21
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.
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.
13
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.
81
@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.
17
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.
14
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.
104
"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.
17
@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.
3
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?
47
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.
2
@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.
1
I’ve read St. Bernie’s plan. And his legislation.
They’re both lazy tripe, without real details.
2
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.
29
@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' ...
1
I am curious what "there is policy or Peoria" means!
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.
84
@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.
4
@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!
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?)
20
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?
8
@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.
@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.
1
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.
31
@GK thanks, you said this very well.
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.
17
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.
"...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.
5
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.
63
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?
190
@Drusilla Hawke
Please site your source.
Thanks.
@Curious It's easy enough to google.
https://www.newyorker.com/news/john-cassidy/what-sort-of-man-is-donald-trump
https://www.theatlantic.com/politics/archive/2016/09/donald-trumps-cruel-streak/501554/
https://www.nytimes.com/2016/01/03/us/politics/for-donald-trump-lessons-from-a-brothers-suffering.html
1
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.
117
@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.
162
@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.
10
@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.
9
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.
25
@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.
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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.
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@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.
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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.
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@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 !
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That could be fixed by more generous subsidies.
@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.
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"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.
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"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.
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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.
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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.
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@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.
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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?
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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.
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@Larry, In other words you are an American health care refugee!
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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.
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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.
@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.
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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.
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@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.
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And Medicare for all would need these employees. Their jobs would change somewhat but they will be needed.
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"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?
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@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.......
@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.
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@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.
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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.
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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.
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@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.”
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@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.
5
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.
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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.
16
"...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.
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@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.
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@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.
13
@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
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.
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@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.
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@Pat
Actually, another $2-3 trillion on gifts to billionaires and billionaire companies.
33
@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.
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