Faster than you can say the word "Sicko" and turn around 3 times, the Democrats' promise of health care for all has gone from "Universal Medicare For All" to "Individual Insurance Mandate". In Monday's New York Times, Paul Krugman defends that reversal in an article entitled "Why Not Single Payer?"
The possibility, after the 2008 elections, of a Democratic-controlled Congress which could pass Medicare For All (a/k/a Universal Single Payer Health Insurance) and a Democratic President who would sign it, could bring about the best chance to enact Medicare For All since Harry Truman first proposed it in 1948.
Yet without firing a shot and with no debate, the leading Democratic Presidential Contenders--Hillary Clinton, John Edwards and Barack Obama--as well as a good part of the Washington progressive infrastructure of think tanks and lobbying groups--have given up the fight for Medicare For All. Instead they propose variations of an Individual Mandate plan developed over the past 15 years by the "moderate" corporate wing of the Republican Party, a version of which Mitt Romney enacted in Massachusetts and which Arnold Schwarzenegger is proposing in California as an alternative to the single payer plan which the Democratic California legislature passed last year that he vetoed.
The thing is, I can't quite figure out why the Democrats are in such rapid retreat from Medicare For All before the first battle has even been joined. Is it another example of the political cowardice by which the only Iraq resolutions that can pass the Democratic controlled Senate are a Republican-driven bill condemning MoveOn.Org. and praising Gen. Petraeus and another declaring the Iranian Revolutionary Guards a terrorist organization? Is it because the Democratic candidates are afraid of being accused by Republicans of supporting socialized medicine? (If so, it won't help because Giuliani, Thompson, and Romney--whose Massachusetts plan Hillary largely imitates--all quickly claimed that Hillarycare 2.0 is socialized medicine, anyway.) Is it because they've been bought off by insurance companies and drug companies or fear that too many other Congress and Senate members have?
Or is it because they think that the insurance companies and drug companies are just too politically powerful to take on: Therefore the only way to insure most Americans is to make a deal with the devil that requires profit-making insurance companies to waive pre-existing conditions and charge everyone similar premiums regardless of age or health, in exchange for Congress delivering them 50 million guaranteed new profit-making customers, partly subsidized by the government?
Paul Krugman's NY Times column is one of the first direct attempts by a liberal former supporter of single payer to try to make the case for adopting the Individual Mandate approach instead. According to Krugman, "basically it looks like something that could actually happen in the next administration, while enacting a single-payer plan...excellent as those plans are, might take a very long time."
First, Krugman argues than an Individual Mandate would not require a big tax increase, although he admits (thus defeating his own argument) that taxes which most people would pay for single payer would most likely be lower than premiums that an Individual Mandate would require them to pay out of their pockets to buy insurance. Second, he argues than an Individual Mandate won't make people feel that they're "being forced into a government plan". But the essence of an Individual Mandate plan is that the federal government forces the uninsured to buy health insurance. It involves even more government coercion than Medicare For All.
Finally, he argues that the Democrats' proposals generally include a Medicare-like public insurance alternative which individuals may buy into and which "would evolve into single-payer over time." Krugman never quite explains how this piece of alchemy will occur. Moreover, he admits that this is the part of the Democrats' plan that the insurance industry will fight "tooth and nail". If the Democrats have already surrendered on Medicare For All without firing a shot, isn't it likely that the public alternative (the "socialized medicine" part) will be the first part of the plan to be compromised away when the legislative battles start in Congress and the insurance lobby starts exercising its muscle with its hundreds of lobbyists and tens of millions of dollars in campaign contributions?
In short, I find Krugman's notion that an Individual Mandate is somehow more politically pragmatic than Medicare For All unconvincing and I don't buy his argument that it's a backdoor way to eventually get there. I even wonder how strongly he believes his own arguments. Only last January, in critiquing Schwarzeneggers's Individual Mandate plan for California as a complicated "Rube Goldberg" device, Krugman argued that "the plan requires a much more intrusive government role than a single-payer system. Instead of reducing paperwork, the plan adds three new bureaucracies: one to police individuals to make sure they buy insurance, one to determine if they're poor enough to receive aid, and one to police insurers to make sure they don't discriminate against the unwell." If you then add a public Medicare-like alternative that individuals can buy into, you need a fourth bureaucracy to administer that system.
Thus, when Hillary Clinton claims that her plan requires no new government bureaucracy, she's not being candid with the voters. That lack of candor will quickly be exploited by the Republicans and the insurance and drug lobbies. While Republicans are wrong that her plan amounts to "socialized medicine", such charges will still ring true since, in fact, her plan will require intrusive government regulation of the private insurance industry and coercive action to be sure that all citizens are obeying the individual mandate to buy health insurance. That's one of the big reasons why, once the debate really starts, an Individual Mandate will not necessarily be a popular plan with the voters--Using the political pragmatism test, it stands a better chance of being rejected by the public and meeting the same fate as Hillarycare 1.0 than does Medicare For All, for which the political arguments are simple and clean.
Whatever Clinton might claim, Hillarycare 2.0 in fact requires a highly intrusive government presence in the lives of both businesses and individuals. As with Hillarycare 1.0, this is likely to be the biggest club that Republicans and their insurance company allies will use to defeat her or another Democrat as they did in 1994, unless so many compromises are made to water down the plan that insurance and drug companies decide it's in their interest to accept the 50 million new mandatory government subsidized customers to pad their bottom lines. (Remember that with private insurance, approximately 30% of the healthcare dollar goes to administration, executive salaries and profits, compared to 2%-3% for Medicare; when all the political deals are finally cut, the private insurance and drug industries might find a new government subsidy for their bottom line an attractive deal.) If an Individual Mandate plan is more politically expedient than Medicare For All, it's not for any of the reasons which Krugman cites and not because it's likely to be more politically popular with the voters. The real reason is that with a few backroom political compromises, it could become a that plan the insurance and drug industries could learn to love.
END OF PART 1
When people start complaining about what they pay, compare the amount our employers pay, we contribute to the plan, we pay in co-pays and deductibles, and what's not covered at all... that is, if we're lucky enough to have health insurance.
The question is, why him and not you?
It is another case of government "solutions" leading to rewarding of cheaters and to punishing of those who are unable or unwilling to take advantage of blatant unfair loopholes.
crime. $100,000 per year for people sitting in wheel chairs. The patients get maybe about an hour to an hour and a half of devoted time.
Not only that - universal healthcare is such an optimistic message to spread across the country - the fact that healthcare would now come to mean prevention and cures, not paperwork and aggravation. Think of how many people would be inspired to join the healthcare apparatus: from doctors and nurses to researchers and civil service workers. Better healthcare should be our 21st Century "Moon Shot." Unfortunately, not one of the Democratic candidates has the courage to either shoot for the moon or to believe this is a fight worth losing for.
No problem giving millions in tax breaks to corporations mining companies. OR spending BILLIONS in Iraq. Or spending billions on worthless weapons systems. No problem there, but if we start talking about Medicare it's a whole different story.
COST is a red herring. Yes there is waste and fraud in Medicare. AND there always will be. Do you think that if there was ZERO waste and fraud in the system that it would be acceptible to people determined to abolish it?
IT PALES in comparison to what private companies are stealing. Right now we are subsidizing companies selling the Medicare Advantage plans to the tune of 20% so they can ration care and steal 35% profits. It's a travisty. Medicare operates at 4% overhead, even better if you take out the waste and fraud
Traditional Medicare is far more efficient than the Medicare Advantage plans but we ARE OBSESSED with privatizing everything whether it hurts us or not.
The Medicare Supplemental plans you talk about are being squeezed because we subsidizing the Adavntage plans to FORCE people out of traditional Medicare. AND the supplemntal plans were created to plaqate the insurance industry. Medicare could have been a COMPLETE PLAN.
It is truly sad that so many Americans have been brainwashed into thinking it is better to turn Medicare over to the private insurance industry because they will SAVE money. IT's a joke. But look at you, your a smart guy and EVEN you are going on about the waste and fraud in Medicare.
Answer: It doesn't.
And of course, one way to address costs is to stop putting half a trillion dollars into Defense (more than the rest of the world combined). How is it that a few thousand folks with turbins, borrowed rifles, and hand-made bombs warrant a bigger defense budget than the entire Soviet Union -- which had four million troops and tens of thousands of nukes and missiles?
Answer: It doesn't cost more to defend ourselves against them.
This is a system that doesn't pass the morality smell-test, but it is going to be hard to shut it down because of the pork involved.
It is also true that other industrialized countries pay about 60% of what the average US insured people pay.
Additionally, about half the bankruptcies in the US are due to the cost of medical care, versus ZERO bankruptcies in other countries due to medical care. One can see the desire of the right-wing to bankrupt middle class families in the Graeme Frost deal (the kid who spoke up for S-CHIP. Right wing bloggers were INCENSED they had any assests at all before they went to the state for help).
Furthermore, no one seems to bring up the point that because of the way our healthcare is structured, the US pays for almost ALL the drug R&D in the world. Most countries get their drugs at cost.
And, lastly, as Sicko points out, our system encourages the minimum care for the cheapest price. Capitalism at its finest.
If a universal health care bill is done right, the US consumer might very well pay LESS for healthcare.
EVERY other reasonably advanced country recognizes medical care as a basic human right.
And all of the yammering about private insurance won't change the fact that insurance companies are not reliable or honest. It used to be that having insurance provided some of that peace of mind, but that was before Reagan deregulated. Now having medical insurance AND a serious health problem is a guarantee of finding oneself in the middle of an adversarial relationship with a company whose main goal is investor profit.
The cost of the layers of redtape created by insurance companies trying not to honor policies, and providers of medical care trying to force them to pay up is estimated to add 30% to our already outrageous medical costs.
Not only that, but providing government-guaranteed health insurance would help our workers to be more competitive in a world labor market in which they now have to compete with workers from countries (all of them) who do have government-proved healthcare. (Why aren't the presidential candidates even mentioning this benefit? Are they THAT afraid of displeasing the private insurance companies...the ones that profiteer on people's private disasters).
What a truly sick system we.
Any troll who thinks they have THEIRS so everyhting is fine. JUST wait till you need your insurance. You might be in for a rude awakening.
50 million without health insurance is a discrace.
Another 100 million with " one claim" ( read your contract!! ) insurance is a discrace.
Why anyone would want to keep these greedy thieving corrupt insurance companies is beyond me.
Besides, the health insurance industry is a complete failure. If you consider providing services as a criterian.
Of course the trolls here think that Wall street profits are more important than keeping people healthy.
AND they think that they will always have insurnace, and they believe that a great example of personal responsibility is being 50 yrs old, loosing your job and health insurance, having a pre-existing condition so NO company will sell you individual health insurnace, getting sick and loosing your entire life savings in one two week hospital stay. AND, they believe it was YOUR FAULT for getting sick and you DESERVE to loose everything.
That's how twisted these fools are that come here and trash us for wanting Medicare for ALL.
What is going on in this country right now with rationing, private nursing homes, etc. is beyond belief. And the trolls think it is just fine. After all they have THEIRS and that is all that counts right?
Until people understand the overwehlming advantages of this type of program it will never happen. There are just too many people that now have insurnace that have been terrofied into thinking that they will LOOSE their coverage or it will be terrible.
I have yet to hear one word from any main stream nws media outlet that talks about how GREAT Medicare for ALL would be for the country.
Rationally, socialized medicine provides more care per dollar than for profit institutions. The scary thing is that people seem to believe that if physicians and nurses are not motivated by profit that they would not put in a little overtime to save a life. It is the assumption that all that is creative is only a product of the profit motive that is patently false.
The truth is that the profit motive is as destructive of creativity as it is conducive, depending on the avarice of those in charge of the creative works. Take the light bulb, the razor blade, the X-box, or the ink cartridge as examples of how industry has conspired to deny a technical advantage to the public by withholding it.
If the province of technology is innovation, the product is cost reduction in human effort, and in a perfectly reasonable world, a cost reduction for products, including healthcare. Instead, we have been feed a constant stream of assertions that the reason for healthcare being so expensive was improving technology. If this were true of technology, them the cost of the computer on which you are reading this would be going up and not down.
People will create. The more darkly craven of businesses know this and do not share the largess of their increasing profits with the people who do so create. The creative and caring professionals will not be affected in any way by socialized medicine. In fact, they may feel a sense of relief.
The first step is to resist right-wing framing of the issue. For each time someone intones "socialized medicine" or "government-run health care," at least _two_ Democrats should say loud and clear, "It is _non-profit_ health _insurance_ and _privately delivered_ health _care._" But I have yet to hear a Democrat put it this way. (Kucinich understands the issue and the proper solution, but isn't always able to articulate his policy in a way that makes it clear to people who don't share all his premises.)
It is hard to resist the conclusion that the Democrats are unable to lead _because_ they are unwilling, and that they are unwilling because of their ties to the insurance industry. But we shouldn't underestimate their sheer ineptitude, either--both at gauging the public mood and at capitalizing on it politically.
What happens to the employees of the insurance cos?
What happens to the shareholders of these companies (mutual funds, pension plans etc.)? Does the Gov't re-imburse the investors the 500+ billion in value they will lose immediately, not to mention what happens to the entire stock market in general.
Medicare is not efficient in the slightest, yes it has a 3% admin overhead compared to 20% for the insurance industry. The main reason for this is they rarely seek out, prevent or account for FRAUD!!!
Ignorance is dangerous. Impletent Medicare for everyone and welcome us to another Great Depression
Why should 45 million Americans be without health care? It is immoral that all our citizens do not have health insurance. Cut out the present 20 percent overhead and we can cover everyone.
Why should 20 percent of the money we spend on health care go to overhead to pay for insurance companies who attempt to keep down expenses by denying health care to people who are insured? Government health care programs in other countries do not deny medical care to their citizens.
These are the people that brought us FEMA, VA Hospitals, the DMV, bankrupt Social Security program, the bridge to nowhere in Alaska, AMTRAK, etc.
The list is endless.
What are you and we thinking?
Ask your relaatives over 65 what they think of Medicare.
No "must be in network" nonsense - that was invented by private insurer's tor restrict patient choices
No "get a 2nd opinion before we will pay - and still may be we won't" - that was invented by private insurers to duck paying bills
No "not pre-approved so we are not paying" - a thing invented by private insurers to even get out of paying ambulance bills for transport from an accident (though how one is supposed to get pre-approval at the scene of a traffic accident is an elusive concept.)
Medicare works and works well. he private insurers aren't spending 17-22% more on administration to "root out fraud" - they are spending the extra amounts figuring out how to duck claims and avoid covering people. And don't forget the additional 10-15% they take out of the premiums for their profit.
So yeah - a system that lets patients choose their providers and costs 3 cents out of every dollar is a LOT better than one that takes 27-37 cents out of every dollar and makes your healthcare decisions for you and does it based, not on what is best for you, but on the their bottom line profit.
Ask the old-timers at Amway or any other MLM scheme if it's a good program.
Of course it is! They're all multimillionaires. Now all you have to do it get 1,000 suckers to sign up under you and you can be a millionaire too!
When you ask the grandparent and they think it's great, and then you ask the grandkids and they think it's a disaster, you're usually talking about a ponzi scheme.
By the way, how many veterans are happy with their health insurance program? That's single payer too, right? It should be fantabulous.
And can you explain why my dad could buy 100's of different drugs at Walmart for $4 per month, but he has to pay much, much more than that at the VA pharmacy? I thought single payer plans were ALWAYS more cost effective than private entities. But you can't use a VA prescription at Walmart. You MUST get your overpriced drugs from the government pharmacy. So much for the liberal fantasy...
Two reasons: One-- because if you look at facts instead of rhetoric, they don't do a bad job (unless they're run by Bush and Co.). Best example: FEMA was highly effective under past presidents. As for social security, I'll take Greenspan's word over yours-- it needs long-term reform but is neither bankrupt nor heading towards bankrupcy anytime soon.
Two-- the private sector healthcare system is horribly inefficient at providing affordable care. Over 45 million uninsured, and ~100 million underinsured, out of a population of 300 million... that's close to 50%. Private insurance includes ~30% administrative and overhead costs, whereas medicare's is 3%. Universal healthcare would increase government spending on healthcare, but net spending for the public-- in the aggregate and for the vast majority of families-- would almost certainly drop. And, contrary to the bogus claims made about socialized medicine, a properly designed program would give doctors and patients MORE control over healthcare decisions than they have now. Insurance company "bureaucrats" make too many of those decisions now.
Perhaps it's due to the fact that that wondrous, magically efficient Medicare program is facing a 75 trillion dollar shortfall. How amazingly, astoundingly practical! I mean, all we have to do is round up everyone in the entire country, sell all of their homes and cars, empty all their bank and retirement accounts, and put all the money into a pot to set aside for Medicare. Now that's a good start, but it still wouldn't quite be enough. So then we could sell our top 500 corporations to the other countries around the world, and take all that money and dump it into the pot.
Then we can all stand back and look in fanciful awe at what a fabulous program we've funded for ourselves.
Of course, that money only covers the 'senior citizens', so we may have to put off covering the rest of society for a few hundred more years as we try to recuperate from the fire sale...
http://www.washingtontimes.com/apps/pbcs.dll/article?AID=/20070711/EDITORIAL/107110013/1013
Enough said.