Health Care Reform with Options can succeed......Mandates will fail.

[Armstead]

Let me say first of all that I believe what we need is what Dennis Kucinich advocated for -- a single-payer, universal public healthcare system, as in expanded Medicare.

However, since neither Hillary nor Obama feels inclined to emulate Democrats of old by pushing for a fundamental liberal project like that, we are forced to choose between half-measures. So we should look at what is most likely to at least get the ball rolling in the best direction.

It is also important to recognize that neither of the candidates' plans are going to come out intact, once they enter the meat grinder of Congress, lobbying, PR campaigns, etc.

Both plans are going to get argued about, picked apart, negotiated, compromised on and politicized once they are actually put onto the table after the elections.

One of the major Achilles Heels of health care proposals in the past, including ClintonCare in the early 90's is the "socialistic Nanny State" aspect of it. That's what will rouse up people against it, and will be the battle cry of the defenders of the status quo.

"They want the government to take over a major part of the economy, and force you to buy into their plans and take away your choice."

Like it or not, that is what the debate will eventually boil down to.

Now in my own opinion, since we're going to have that fight anyway, our starting point ought to be for a straightforward and principled true Universal Coverage plan as mentioned above. So I am NOT parroting right wing talking points here.

However, if the Democrats choose to avoid that principled fight, and instead propose reforms, we should NOT include what is a poison pill without the actual benefits.

Instead, offer choices, control insurers and tale other positive measured that can be sold positively as voluntary. If, as Obama proposes, it remain voluntary to start with (except for children), we will have defused a core argument of the GOP and insurance industry. Without that argument against, it will be much more likely to get the first positive steps toward reform.

If not, we will have a weaker argument, and may well end up with another eight years of gridlock.

[drm604]

1. The problem with voluntary plans

is that, unless you allow the insurance companies to exclude preexisting conditions or charge exorbitant premiums to cover them, healthy people won't purchase them until they become sick. This will increase costs. And if we don't eliminate exclusions or increased premiums, then what exactly has been changed?

I don't see the insurance companies fighting mandatory insurance, it would be a windfall for them. I doubt that you'd see a lot of talking points against mandatory insurance.

That said, I prefer single-payer universal but I suppose that we'll have to take what we can get.

[Armstead]

2. Insurers would love mandates -- People would hate them

The details and implications of any proposal are going to be higgled over.

If the starting point is optional, with a public plan that is universally available, then IMO enough of the uninsured would sign up to reduce the problem you mentioned.

[drm604]

3. I can't see many healthy people buying insurance.

Why would they purchase it when they know that they can always buy it after they get sick? Even if it were to include preventative care, it would have to cost less then the preventative care to make if worth it to them, and that certainly wouldn't help towards lowering costs.

[Armstead]

4. A lot of healthy people buy health insurance already

If health insurance costs and access were brought down to a level that was not so unreachable or punative, more people would choose to enter the system,

As I said in my original post, the goal should be expansion of Medicare to cover everyone.

But barring that, making it more accessible to more people has to start with a plan that does not eliminate the positive aspects of universal coverage while keeping the most politically difficult aspect.

[drm604]

5. You're missing my point.

Healthy people buy it now because they know that they won't be able to buy it after they get sick. If that's changed, if the insurance companies have to accept everybody, then there is no incentive for a healthy person to buy it. They will wait until they get sick and then they will buy it.

[kristopher]

6. There are examples to settle this - we don't need to guess

In Japan, you aren't required to buy insurance. Yet it is so inexpensive, everyone DOES buy it.

In many respects, Obama's plan looks to be mirrored on the Japanese system.

[drm604]

7. But are the insurance companies in Japan required to sell to everybody

regardless of preexisting conditions? That's a very important part of the issue and everyone seems to be ignoring it.

[kristopher]

10. Yes, they are.

Large employers (I think the cut off is around 5000 employees) are required to provide insurance for their employees. Everyone else is enrolled in a program administered by the government. There are special rates for students, the elderly and the unemployed, but a working family of 4 is around $150 a month. Deductibles are about $5.
I've written a little more at my journal if you're interested.

[Ravy]

11. So, if everyone buys it, what is the problem with making it mandatory?

If everybody does it anyway, that is.

[Rosemary2205]

13. There is a HUGE difference

between being forced and choosing. And it's not just campaigning either.

[Ravy]

16. Yes, but we both know that not everyone will buy.

There will be some, probably lots, that figure out that if you can buy health insurance at any time and have existing conditions covered that it is not a good purchase until you need it, no matter how cheap it is.

But I don't mind letting people pretend until after the election.

[kristopher]

17. Have you never been to an emergency room?

Have you never taken your child to an emergency room?

The last time you came down sick and needed to visit your doctor the next day, would you have wanted to delay that cisit a couple of weeks while you filled out some forms to get enrolled in a health plan?

"Existing conditions" is hardly the only (or even the main) consideration when someone buys insurance.

[Ravy]

19. Obama has said he just wants to fine someone and make them

pay a few months back insurance if they get hurt. He has said that he thinks some will game the system. I agree with him.

[FrenchieCat]

8. You are correct. Mandating for folks to write checks to Insurance corporation

really isn't what folks should have in mind when thinking Universal Health Coverage. We should have a choice in terms of dealing with Corporations. And I agree that children, who can't make the choice, should have their coverage mandated....but not adults.

But of course, what Hillary is doing is attempting to confuse Single Payer with Universal Health care and hope no one notices.

No, Hillary, I do not want to be forced to pay money out to corporations unless that is what I have chosen to do.

She's got a real problem on her hands with this "mandate" stuff.

[BringBigDogBack]

9. That is correct.

[cooolandrew]

12. To me this illustrates Barack's reasoning well, he saw the 90s and adjusted

the plan to fit.

[WillYourVoteBCounted]

14. both remind me of Medicare D, and costs have metasticized!

Medicare D ended up increasing med costs, but the govt subsidized.

The VA's meds are much cheaper, they are the only entity allowed to negotiate med costs.


Its still expensive to seniors and many still have to do without meds.

The key to Universal Health Care might be to have a medicare (or medicaid even) for all that people can opt into,or let people keep buying private insurance.

Medicare and Medicaid are more efficient, except with Medicaid there are practically no costs to the individual.

By not trying to have the battle of completely shutting insurance companies down, it
would be easier to let Medicare for All compete with (and ultimately beat out) private insu.

I might be rehashing John Edwards plan here, not sure.

[SoCalDem]

15. if insurance and or HMOs are any part of it, it will fail..

Insurance is the PROBLEM..not the solution..

For-profit medicine is evil and if there is an money-grubbing middleman involved, we ALL lose..

Employers MUST be taken OUT of the mix..completely..

[kristopher]

18. Those are nice statements of your beliefs,

Could you perhaps include some persuasion to support them.

I think having companies involved creates a benchmark that government can be measured against. I like government to be involved but I also like systems installed to ensure the efficiency of government. That isn't going to happen on its own.

And who said anything about middlemen? Think about it a minute, what course do you think a large corporation is going to pursue? If the "middleman" takes too much then the Companies can self insure, set up their own clinics etc. They are the arm of innovation in the system, so to speak.

[UALRBSofL]

20. Armstead If that's what we have then I'll choose to opt out of healthcare

and then when I get sick and go in the hospital the bill will be paid for by the constituents that opt in to healthcare under the Obama plan. Thus, there will be millions of americans that will follow suit as I have decided to do and either the rates of the payers will go up under Obama's plan or his plan will fail due to overexpenditures and underfunding by non-payers. I know for a fact this will happen because being a nurse the past 20 years there are many people whom can't afford healthcare and they wont be able to afford Obama's plan either. Under Hillary's plan it is income based. It's prorated to what your income is. If you have no income it's free.