Why the top 3 candidates don't get it on true Universal Health Care...

[Solon]

First things first, I'm NOT going to say they are copying off each other, rather, I'm going to analyze why these plans are bad ideas, and, quite simply, not practical.

The biggest problem I see is that every plan subsidizes the insurance industry in some way, and at the same time, wants to slap regulations and profit margin caps on them. The biggest problem with this is that it does nothing to address the atrocious overhead costs for the insurance companies, 30 cents for every dollar you pay in premiums, nor does it address the tie in of premiums as related to the stock market. Up to 70% of employees at these insurance companies are brokers and such, not claims. To make matters worse, the government will now have to track to see if these companies are following, strictly, government guidelines, such as not paying for pre-existing conditions, stuff like that. This will further increase the total overhead cost, reducing the amount of dollars, either public or private, going into actual medical care.

The second problem is tying employers in with insurance. This is another big problem, and while it sounds good on paper, overall, it will do nothing. Employers, even big ones, already find insurance premiums to be too expensive, and are abandoning insurance plans, at least affordable ones for employees, at an astonishing rate.

Yet another objection I have is the creation of non-competitive "markets" for insurance companies to rip off customers. The problem is that the insurance companies will find as many loopholes as possible to lower costs, and maximize even legally limited profits, a lot of lawsuits in the making, but still no care.

These plans also offer an out, in odd ways, for people who don't want private insurance, but the public plan is STILL separate from Medicare, in Edward's plan at least(most detailed at the moment). So this means, that for cradle to grave coverage, we will have not one, not two, but 4 separate bureaucracies to deal with public health care in this country(Medicare, Medicaid, SCHIP, Public System). This makes absolutely no sense to me whatsoever.

In fact, the biggest problem with these plans is the fact that, if any of them are implemented as advertised, they will FAIL. They are too cumbersome, and will be called "great experiments" but will fail, and we will be back at the status quo of today in less than 5 years. They are half-measures at best, and are not even "transitional" plans.


I have a better idea, why not abolish Medicaid and SCHIP, and consolidate them under a Medicare for all system, covering everyone in the country, from cradle to grave, regardless of employment status, income, or age. Allow the government to negotiate and regulate drug prices, and negotiate for medical care as well. Don't even touch the insurance companies, just let's see them try to compete against the public system. This will be called the "transition" if you will, no need for new laws beyond establishing Medicare for all, let's just see which system, public vs. private, is cheaper and more effective for the customers.

[wildhorses]

1. i think you might be onto something here...

i am liking what i am reading.

[renie408]

2. Good luck with that.

It is a good idea, maybe a GREAT idea, but I doubt that insurance companies, the pharmeceutical industry or doctors, for that matter, will go quietly into that dark night. They all feed each other and then they feed the politicians. I am not sure it is a cycle which can be broken.

[Solon]

7. The problem is that the Edwards/Hillary/Obama plans are all designed to fail...

They will pass Congress, probably in even further watered down forms, with loopholes for insurance companies to exploit. They will end up going billions of dollars over-budget, and in a few years, the law will be repealed, and everything will be the same as before.

[renie408]

11. I think the problem is that the insurance industry has a gazillion dollar

investment in making sure that ideas like yours never see the light of day. Their idea might be destined to fail (maybe), but your idea does not stand a snowball's chance in hell of ever getting passed into law. That is regrettable and I am in no way saying it is right, but I think it is reality. We have to start with smaller reforms designed to weaken the attachment between the different factions which have made the cost of health care in the country so ridiculous. And we have to make a basic change in this country from idolizing the concept of profit to respecting the basic right of all human beings to a healthy life. Until people stop saying that insurance and pharmaceutical companies are responsible to their share holders like that excuses their behavior, NO universal health plan stands a chance.

[Dawgs]

14. Thank you renie408.

You are one of few that gets it.

[Solon]

18. I have an idea for selling the idea too, post 16. n/t

[endarkenment]

34. You are wrong about doctors.

"Proposal of the Physicians' Working Group for Single-Payer National Health Insurance
The Physicians' Working Group for Single-Payer National Health Insurance*


JAMA. 2003;290:798-805.

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care—the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least $200 billion annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage. "
http://jama.ama-assn.org/cgi/content/abstract/290/6/798

Physicians overwhelmingly endorse single-payer insurance
Nearly two-thirds (64 percent) of Massachusetts physicians favor single-payer national health insurance, far more than support managed care (10 percent) or fee-for-service care (26 percent), according to a Harvard Medical School study published Monday (Feb. 9) in the Archives of Internal Medicine. National health insurance (NHI) received majority support from physicians of virtually every age, gender, and medical specialty - even among surgeons a plurality supported NHI. The breadth of physician support for NHI was highlighted by the fact that most members of the American Medical Association (AMA) and the Massachusetts Medical Society favor the single-payer approach. Despite this high level of support, however, only about half (51.9 percent) of physicians studied were aware that a majority of their fellow physicians support NHI.
http://www.hno.harvard.edu/gazette/2004/02.12/09-singlepayer.html

Majority (57%) of Academic Medicine Physicians Favor Single-Payer
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March, 1999

Study in New England Journal of Medicine Finds Medical School Deans, Faculty, Residents and Students Favor Single-Payer 3 to 1 Over Managed Care

Managed care is bad for your health, according to the first comprehensive survey of physicians involved in research and teaching published in this week's New England Journal of Medicine. But the nation's best and brightest physicians don't want to return to the old fee-for-service system, either.

So what does this prestigious group think would make a good health system? According to the study, "all groups expressed a preference for a single-payer health care system over both managed-care and fee-for-service systems. Overall, 57.1 percent thought that a single-payer system with universal coverage was the best health care system.... A total of 21.7 percent favored managed care, and 18.7 percent preferred a fee-for-service system."

http://www.pnhp.org/news/1999/march/majority_57_of_ac.php

[Polemicist]

70. Anything short of Single Payer will fail....

You can't leave intact the private insurance system. It must be replaced totally by a single payer health insurance system that everyone is required to participate in. If this isn't done, then we will still have the problem of the healthy remaining with private coverage at lower premiums and the ill and infirm being shunted off to the government insurance programs. It's impossible for a system to succeed that allows this imbalance to continue. It will bankrupt the government insurance program every single time.

Everyone should read the links above for single payer health insurance, by the Physicians for a National Health Program. They explain why halfway measures have always failed and will always fail. Here it is again...

http://www.pnhp.org/

[endarkenment]

77. Yes but what would doctors, nurses, and other healthcare

workers know about providing healthcare service?

[Polemicist]

93. Yes, healthcare should be run only....

By Wall Street insurers and the politicians that are wholly owned subsidiaries of the same.

Doctors, Nurses, et al should restrict themselves to building....rocket ships or such.

[avrdream]

83. I agree

"Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment."

That was my experience in private practice.

I don't like the way doctors get lumped in with insurance companies as part of the problem - as sited above, there are many who want a true fix. If you look at my other posts on the subject, you will see that I am VERY interested in this issue and am reading the details of each candidate's position very carefully.

I haven't heard much about the issue from the GOP......anyone?

[Red Knight]

84. Doctors hate the current system

I can tell you that.

It's getting difficult to find one. My doctor who had been in the same place for about twenty-five years has closed up shop to become a hospitalist--citing costs and paperwork expenses associated with HMOs, etc.

I had to call five different doctors on my HMO before I could find any accepting any new patients.

Cute proposals won't work.

Serious things need to be done. I don't know what the best answer is but THIS ain't working.

[eridani]

85. Medical providers are getting sick and tired of being insurance company serfs

--and having their medical opinions overridden by bean counters.

[Jackpine Radical]

3. There is no doubt that single-payer systems are better

and more efficient. The problem is getting there. Remember Harry & Louise? The insurance industry has trillions of dollars in resources, and they will see themselves (quite accurately) as in a fight for their lives.

If the media can sell an illegal war and a retarded chimp, you oughtta see what they will be able to do when fueled with insurance-company resources.

[eridani]

86. Nevertheless, California got within TWO LOUSY VOTES of being able--

--to override the Governator's veto of single payer. It took massive community organizing to get that far, of course. All we have to do is get a functioning program in one state, and the others will fall like dominos.

[Captain Hilts]

4. They are under greater pressure to propose something plausible. nt

[Crazy Dave]

5. It's pretty bad when we live in the "richest nation" and....

...you hear so many say, "I can't afford for me or my kids to get sick". This is something that even people in a poor communist dictatorship like Cuba don't even have to say. Oh but we have it so much better than them according to the Limbaughs and the Hannitys because we have freedom of speech and we're allowed to complain about not having health care and not get arrested.
I'm looking forward to seeing Michael Moore's new movie called "Sicko" that's about how bad health care is in America and how an insurance company decides what surgeries you need, not doctors.

[Benhurst]

9. Yeah, "The World's Only Superpower."

The whole world is watching -- and laughing.

What a dump!

[doggyboy]

6. I think you're a little too pessimistic about this

I do think you've raised some very good points, and it's not my intention to dismiss your concerns. I just think you might be taking things a bit too far when you deem these plans "impractical"

For one thing, the plans emphasize cost reductions. If those cost reductions can be realized, those savings can be used to pay for increased admin costs (if any) as well as for increasing coverage.

You're right about tying health insurance to employment, but my understanding is that these plans weaken that bond by supplying insurance coverage to many who have no job. True, it's not the ultimate solutions, but these plans seems to move us further towards our goal by weakening the employment-coverage linkage.

But most importantly, as I understand it these plans are meant as a step towards getting the health insurance companies out of the actual insurance business and have them focus on claims processing. IOW, we are moving to a situation where the money paid out in claims is paid by the govt, and not from the insurance company's funds. The justification for doing this is that it is more politically feasible if the plan continues to allow insurance companies to make some profit.

[Solon]

10. We don't need them to be claims processors, that's a waste of money as well...

Why outsource a job like that to private companies? Its mostly paperwork, and the government, if anything, is really good at doing that, look to Medicare right now as an example of that.

As far as the practicalities of the plans, I don't think the "reducing in costs" which is never really detailed, will amount to much, profit caps will help, but not by enough to offset increased administrative costs. Actually, this leads to another conundrum, how to create the profit caps in the first place, if a bull market occurs, increasing profitability for the insurance companies, then do premiums go down like they do now? Or is the money just given to the government? Even worse, what happens if the market goes down, to premiums go up still, or are they capped?

These are questions that will have to be answered. As I said, this "transition" doesn't have to occur at all, cover everyone, and COMPETE with the insurance companies, instead of just writing them checks, and let the so called "market", i.e. customers decide who they want to go with. I will say that within a year after the law's effective date, most insurance companies will change over to life, home owner's, or some other insurance, and abandon health insurance altogether. That's the transition. Since all citizens would already be covered, no major fluctuations would occur in the health care industry, at least on the SERVICE side of things.

[doggyboy]

13. Technically speaking,you are 100% correct

But speaking politically, it's just not possible to completely eliminate the insurance companies from the system at this time, IMO.

"I don't think the "reducing in costs" which is never really detailed, will amount to much"

I strongly disagree with this. I think there are potentially huge savings there. Allowing Medicare to negotiate drug prices, better mgmt of chronic diseases, and preventative care are just three things that represent billions of potential savings

Of course, we're talking about politicians, so there's no garauntee that they won't fuck it up royally. But the potential is there.

"These are questions that will have to be answered."

Absolutely, and the success or failure of our efforts depends on how thse questions are answered

"As I said, this "transition" doesn't have to occur at all"

In a perfect world, I would agree with you. Even in this imperfect world, your concerns are reasonable. However, my political education suggests that a wholesale revision of the health care system is not in the political cards right now.

[Solon]

16. In Politics, perception is everything...

I never said we should ELIMINATE the insurance companies, not in the OP, not in any other post, I said for the government to compete against them in the "market". That, and eliminate any subsidies to the insurance industry.

Here's the idea, market this idea for single-payer as a free CHOICE act for patients, because that is all it is, after all, adding another choice for medical coverage for ALL Americans. Hell call it the "Patient Free Choice Act of 2009" for all I care. But market it that way, and Americans will get behind it, get enough in the grassroots, and in the constituencies of the Reps behind it, and it will pass. The Insurance industry will pay billions in TV ads trying to derail the legislation, all we have to do is ask: "Why are they afraid to compete, isn't this a free market?"

Most people in this country don't even LIKE the insurance industry, and lately they take everything the insurance industry says with a grain of salt. This idea, bill, whatever you want to call it, can have legs, and pass Congress, if we have a strong president get behind it, and a grassroots that is organized around the issue. Public pressure is needed, a LOT of it, its the job of citizens to pressure our politicians to pass laws like this to help us.

[doggyboy]

19. I don't see anything you said as flat out wrong

If one of the candidates came out with such a plan, I would certainly not oppose. When it comes to what's wrong with the system, and what actually needs to change, I don't think there's much disagreement between us. Mainly, I think we have different views the political landscape, and what might be possible in that landscape.

Basically, it seems I have less confidence in the idea that people will actively demand this from politicians. Then again, I'm a pretty cynical poster. However, I will say that expanding Medicare so that it can compete with private insurers is something I can definitely support. My posts are not in opposition to that idea. I'm just not as pessimistic as you about the potential for progress some of the other ideas contain.

Kind of odd for a cynic like, eh?

[Solon]

22. I look at the health care system, like all other systems, as machines...

Mechanical, electrical, or otherwise. Usually, the more complicated the machine, the more likely it is for things to fuck up, to put it bluntly. And to be frank, this is what happens, regardless of whether we are talking about machines or the health care system.

Call it a variation of Murphy's law, if you will.

[doggyboy]

25. I do the same

but I do recognize that it's possible to design a complex system with a lot of self-regulation built in. It may not be a fail-safe system, but they can be pretty resilient. For an example, see the US Constitution

[Solon]

28. Actually, the U.S. Constitution is quite simple, compared to most other nation's Constitutions...

That's probably why it is so resilient after all these years. I mean, compare the U.S. Constitution, at 12 pages, to the E.U.'s(not yet in effect) at 300 pages. And the E.U. Constitution isn't alone, many countries have constitutions that deal with EVERYTHING in their nations that could possibly be considered important, sometimes to absurd levels. I'm not saying the U.S. Constitution is perfect, at least we don't have to rewrite the entire damned thing every generation, regardless of what Jefferson suggested. That plus we have only added on 27 amendments in over 200 years, though at least one more should be in their(ERA). Most of them add no more than a paragraph to the document.

[doggyboy]

36. I prefer to describe it as "elegant"

A complex system need not have a lengthy list of rules. Research has shown how a simple set of rules can lead to the development of extremely complex systems. The Constitution sets the rules on how the govt works (amongst other things) but it doesn't describe the system itself. To get an idea of how complex the system (mechanism) is, one needs to analtze the entire system, and not just the rules that control the system.

Remember, the system is not just the rules; It also includes what the system is working on. In the case of the Constitution, the "what the system is working on" is us - We, The People. People are a diverse and unpredictable lot, and the fact that the relatively "simple" Constitution can deal with that unpredictability and diversity in such an effective manner is why I prefer "elegant" to "simple". Sort of like the way a poem can be short, yet profound.

However, I realized that I switched my metaphoe, and that may have confused you. I went from describing the Constitution as the "mechanism" (ie system) to describing our entire political system (Constitution plus we, the people) as the mechanism. Sorry for not being as clear as I should have

[Solon]

38. Ah, but you hit on a key here...

My system may SEEM simple, and it is, which is good, because it allows for flexibility and adaptability in implementation. This is important for future developments.

To give an example of this, let's talk about a specific set of machines, robots. In the past, programming robots was a rather complicated process, just getting them to walk involved hundreds of lines of code that involves telling every little motor in the robot to move exactly as programmed. Not surprisingly, this didn't work out too well. So, some rogue programmers sort of said "fuck it", put in an extremely simple learning algorithm in a robot, and gave it one command "learn to walk", and in a few minutes, it was walking across the table. If the programmer wants to teach the robot how to run, he simply asks it to walk faster.

The U.S. Constitution is basically the same thing, except that it affects government rather than robots. It gives the basic outline for how government can function, and the amendments refine this, as necessary, including some restrictions on government powers.

In the same way, my idea simply refines the Medicare system, removing some of the restrictions on how it can function.

[doggyboy]

43. I think the system you propose is a fine one

My main concern about your proposal is the difficulty, if not impossibility, of having Congress pass a bill that eliminates the insurance industry's profits.

Basically, there's a trade-off here. Do we go all out and hope we are successful despite the odds, or do we oursue a lesser, but more certain, goal. It's a tough call. I tend to lean towards that which is more achievable, but as a dog lover, I recognize that there's more than one way to skin a cat

[loyalsister]

29. Why wouldn't people like the insurance industry

after they have been sending them endless amount of $$$ only to be denied healthcare when they need it?

[John Q. Citizen]

21. The problem is a lack of leadership, a lack of vision. We are told we have to

settle for third best, while our so-called leaders take their contributions from the same fianacial industries we are told are just too powerful and too entrenched to overcome.

So it's no wonder that the only solutions offered use tax dollars to subsidize private insurance companies; ie corporate welfare. This is then euphemistically called a "free market solution."

There ain't no damn cat an there ain't no damn cradle.

[doggyboy]

24. Pretty much true

but I think I see "leadership" in a different way than you. Instead of seeing it as "taking principled stances", I define leadership as taking the actions needed to achieve one's goals, and like the principled stances thing, I see little of my type of leadership either. That's just one reason why I tend to see wholesale revision of the system as politically unfeasible.

[Solon]

26. I think part of the problem is that you actually consider this a wholesale revision of the system...

when, in reality, it isn't. All that would happen, on a practical level, is the elimination of the exclusions in Medicare. Consolidating Medicaid and SCHIP into Medicare could be gradual or immediate, they don't even HAVE to be in the initial free choice act bill at all.

[doggyboy]

41. You're absolutely right

The problem is not wholesale revision. I am sure that if we completely revised the system in a way that INCREASED profits for the insurance industry, it would pass in a NY minute.

The problem is the insurance industry's profits. That's what's standing in the way. Thanks for helping me clarify my thoughts.

However, though I do support your idea, I do see at least one practical (ie non-political) obstacle. It's not enough of an obstacle to make me oppose your suggestion, but it is an obstacle IMO, and needs to be addressed. Simpmly increasing access to Medicare, etc will not remove that obstacle.

The problem is the rising cost of care. Having people switch to Medicare will result in savings due to the lowered adminstrative expenses, but not enough to keep costs from rising too fast. Without such provisions (ex letting Medicare negotiate prices for drugs, improved mgmt of chronic disease, etc) costs will continue to rise, threatening the ability of the govt to offer insurance to those who cannot afford it.

However, this obstacle is far from unconquerable. If a candidate were to propose something along the lines of what you suggest (and from what I understand, some weaker forms of this have been proposed) I would support it. I just want to be clear that while I do see some obstacles for your suggestion, I still support it since ALL of the proposed ideas have these same obstacles they must overcome. My comments here were more in support of the other plans, than in opposition to yours.

[Solon]

45. Well, negotiation would mitigate some of that and I did mention it in the OP...

In another post, I also talked about increase restrictions in advertising for drug companies. Even with all the rules and regulations, and negotiations out there, some costs will continue to rise, and they aren't directly related to medical care, but energy, which, when its costs increase, the costs of EVERYTHING increase. Not to toot my own horn here, but I tackle a large amount of the problems with energy in this post:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=232796&mesg_id=233156

Also I didn't directly touch upon funding the health care system directly, partially because my response is simple, take it out of the Pentagon budget and repeal the Bush tax cuts.

[doggyboy]

50. Yes, it would and you did

While your suggestion does have some problems (like cost), I don't see any of those obstacle as insurmountable. That's why I agree with your proposal. I guess the only difference I have is that I don't see the other, weaker, proposals as "impractical". Though not the ultimate solution, I see those plans as taking us a little closer to where we want to be. As a progressive, I feel I have to support progress, and to me those plans represent progress, albeit limited.

[eridani]

87. Remind me never to ask you to advertise my used car for me

If I wanted 5K for it, but would take 3K, your ad on my behalf would read "Used car--$3000". Jeebus! Haven't you ever heard of the "if you want a kitten, ask for a pony" principle? Given that getting to universal health care will involve compromises, why in bleeding hell START OUT with a compromise?

The Repubs don't operate that way--they just repeat ridiculous lies until enough people believe them. Why Dems don't try the same tactic with the truth is utterly beyond me.

[John Q. Citizen]

54. I do know that if you don't ask for it you won't get it. I also know that you should

always ask for more than you think you might get.

So, a good starting point for a leader who is serious, would be to ask for single payer, and then except a "head to head" situation such as proposed by the OP.

Unfortunately, our three top tier candidates are starting with Gov subsidies for private insurance companies. so we will probably end up with less heath care and bigger insurance co. subsidies than proposed, and lots of loop holes to boot.

This isn't a question of principled VS pragmatic leadership, this is about how much the tax payers are going to be giving away to the insurance industry, and about how little health care we will receive.

In the early 90's I worked for a professional non-profit canvass that worked on health care reform. Over three years I spoke at the door with about 30 households a night, raising money and doing political work. In my time in the canvass, I worked in 7 states - WA, OR, CA ID, MT, MN, and MD. I spoke with over 20,000 households in that time, face to face at their door step.

One thing I can tell you with utter certainty is that Americans hate health insurance companies, with a passion. I can also tell you that most Americans (not all, by any means) would welcome a single payer fee for service universal heath care system. My bet is the number who would welcome such a system is higher now than it was in the early 90's. There is certainly a lot more support among large employers (The auto industry for example) for such a system at this point.

However, people were very skeptical that our leaders would ever actually take on the insurance industry and get such a thing passed. They felt that insurance co.s had inordinate influence over our political system. I think the public is correct in that assumption. And until a leader comes forward who will actually acknowledge the problem and offer leadership to the people and against the insurance industry to change the situation, we are going to keep getting more of the same half measures and bandaid solutions. The first step is a leader who will embrace single payer instead of running away from single payer.

I sure hope Al Gore enters the race. He has already endorsed single payer universal coverage.

[doggyboy]

56. Basically, the debate comes down to

what one thinks is politically feasible. Some think expanding coverage is as far as we can go right now. Others go a bit further and propose universal coverage, and some go even further and call for single payer UHC. I've heard many reasonable people make reasonable arguments in favor of each idea. IMO, I think SP-UHC is a bit of a stretch right now, but I recognize that it's a judgement call.

None of us really KNOW exactly how far we can go here. We all apply our own best judgement to the situation. IMO, it's the combined pressure of all of us that will result in some progress on this issue. After all, we are all on the same side, and want the same things. We just differ on how to get there.

[Solon]

61. Never been to a flea market, have you?

Its called haggling, politicians do it all the time, to give an example, let's say you go to a stand at a flea market and see a lamp you want, it may or may not have a price tag, but it is worth about 20 bucks. So you approach the seller and tell him that you'll pay 5 bucks for it, he says no way, so you haggle for a few minutes, and, for 10 bucks, you walk away with a 20 buck lamp. You do not, repeat, do not, start out with an offer to pay the full price, you try to get the price YOU think is more palatable, not what he wants out of it.

Same difference here, you start out at a compromised position, and you will end up worse off in the end than what you came in at. Out of all 3 plans, one thing that will never pass is any type of profit or price caps, no way, no how, we all know this, so let's not kid ourselves. These 3 candidates revealed their hands far too soon, much better to have asked for the sky than to ask for the dirt that's under your feet.

[doggyboy]

66. I'm not thrilled with caps either

and not because I'm a free-trader. No way.

And yes, I do know about negotiating, but I also know a bit about campaigning. Campaigning is mainly about attracting votes, and asking for the "sky" is not always the best approach. And while it is usually a good idea to ask for more than you think you can get, "how much more?" and "think you can get?" can be differing things for different people.

The answers to those question are heavily influenced by the insurance lobby's power. You look at the situation and say "what we can get away with" PLUS "how much more" EQUALS your proposal. My calculations have produced a different result because for me, "what we can get away with" appears to be less than what you seem to think.

To take your analogy, if I want the lowest price, why don't I just offer him a penny?

A: Because I know that would be a waste of time.

[BeyondGeography]

8. If we were starting from scratch, single-payer would be favored by most Dems

including the top candiadates.

Problem is, we're not.

[Solon]

12. We don't need to start from scratch, we already have a perfectly good government...

program in place that already deals with this EXACT issue. All we are doing is increasing the availability of the program(Medicare), and allowing the government to negotiate prices directly. No new bureaucracies, in fact, it will be reduced, because we will eliminate redundancy. Choice in doctors, hospitals, whatever, wouldn't be affected simply because they will have to accept patients from Medicare.

This wouldn't affect the service side of things directly, the only change would be that more patients will be on Medicare than any private insurance plan. Doctors, hospitals, etc. will not change ownership, they don't have to.

[DemBones DemBones]

15. Kucinich would cover everyone under Medicare.

It's already in place and is efficient (98% of the funds go for patient care), would merely need expansion.

Medicare premiums are far lower than private insurance premiums, too.

It's ridiculous the amount of staff that doctors have today just to file insurance claims. That would be reduced significantly.

And don't even get me started on the pharmaceutical reps camping out in doctors' offices, selling them on the latest drug -- and getting them good seats at the Super Bowl, flying them to Hawaii for "conferences" that are essentially sales pitches given by a doctor, who's paid a nice chunk of change for doing a "seminar." Doctors also get kickbacks. That's why your doctor is always pushing you to try new drugs. There was a big article in the N Y Times within the last 4-6 weeks, worth reading.

[Solon]

17. Regulating the Pharma industry is also needed...

Obviously, however, it can be passed through different legislation, preferably banning them from TV and other advertisements, and limiting their exposure in doctor's offices.

[jwirr]

20. Very good. However, When you want to abolish medicaid be sure

you are not throwing the baby out with the bath water. Medicaid funds nursing homes, foster homes, special needs and some other items that medicare does not cover. Many of the most severe medical needs are covered by first medicare and then subsidized by medicaid.

What I like about medicare is the administration: One source for claims and not three levels of government: county, state and federal. If we consolidate all the government health care programs under the best health care program's guidelines then we save money on administration. This of course does not use any insurance company. Prices could be controlled much easier this way and we would be able to see how the money is being used in order to encourage preventive care for more savings.

Providers would remain private and people would be able to select their own providers without government interference. Above all I want the doctors to be in charge of the case - not some bureaucrat.

[Solon]

23. I understand your concern....

Let's just say that I mean it quite literally that the Medicare system will take care of you from cradle to grave, including nursing homes, home care, nursing, etc.

[Bullet1987]

27. I'm let down by Obama not proposing single-payer...

but I'm not surprised. It was always 50/50 for me...

[Solon]

30. He had an opportunity to stand out, instead all the top 3 candidates...

now appear to be almost exactly the same, policy-wise. I guess now, its all up to personality.

[endarkenment]

31. I think he meant subsume.

Not abolish.

[Solon]

33. Subsume or consolidate, in the end, it means the same thing...

reducing redundancy, reducing WHO those doctors, nurses, hospices, nursing homes, and hospitals have to send the bill to, that's the goal, to save on overhead costs, so that more money can be used for actual medical care.

[endarkenment]

35. No it doesn't.

Not if all the services are incorporated under a single cradle to grave universal healthcare system, the kind that every other major industrial democracy has. This really is not that difficult.

[Solon]

37. Hey, wait a second, this is my plan, who are you to tell me what it means?!?!

Just kidding of course! :)

Actually, what I meant was that, ultimately, regardless of my inexact use of language, basically everything falls under the umbrella of Medicare. To be frank, I don't even care if its CALLED Medicare after the plan is implemented, as long as it is implemented.

[info being]

32. The only reasonable plan is the one put forth by Kucinich

[RedEarth]

39. Single-payer system is the only way to go.......

...all the others are just more of the same.

[Rydz777]

40. I despair when this issue comes up. It is fundamental to all

our well-being, but it soon gets balled up in the trees, thickets, and underbrush. In the end, few people understand the present reality or what the practical political choices are. Meantime, a huge wave of retiring Boomers with health care needs is coming like a tsunami. I don't have a lot of confidence that anything will get done before a crisis hits that all can feel.

[Colobo]

42. Anything is better than what we have now

So I applaud our 3 top candidates for actually trying to do something about health care in the USA.

[Solon]

49. I applaud the candidates at bringing the issue to the table...

They are doing more than the Republicans, and health care in this country needs to be discussed in the public sphere. That's all find and dandy, but what I care about are results, and the costs of those results. It does no good to reform the system now, in a way that we simply can't afford, and then later on claim we gave it our best shot, and just give up. We need policies that work, not half assed measures that are untested at best.

[Bullet1987]

62. The way I see it...

We're down so far on the list when it comes to countries with good healthcare for a reason. We can't just jump all of a sudden to the best there is without working our way to it first.

[Solon]

65. Uhm? Why not?

First, its not like, within a year, or even 5 years, that we are going to jump to the top of the list, but seriously, what the hell does it mean to "work up" the list? Like I said before, and I'll say again, I care about policies that work, not untested half-assed measures that, for all we know, may drop us further down the list. I don't see why we can't emulate systems that ALREADY work in other nations. Adapt them to our conditions, yes, but for crying out loud, don't go rogue on this too! Its too important.

[zulchzulu]

44. Abolish Medicare and SCHIP?

:rofl:

Yeah, that'll happen... talk about political suicide (unfortunately)...

But actually, it's good to discuss the innards of health care. Plenty of traps and gotchas. I think that if we all had the same healthcare coverage that Congress had at a very affordable rate, it would be a start. And there will NEVER be single payer coverage as long as there are insurance companies.

[Solon]

46. The whole Medicare/Medicaid/SCHIP thing is more of a consolidation...

and elimination of redundancy than any cut in benefits. It doesn't make sense to have 3 programs that deal with medical care funding, for different people, in a slightly different way, when one program, that covers all the care needs of the American people, can do the job just as well.

[Telly Savalas]

91. There are insurance companies in Canada.

A single-payer system simply cannot pay for everything that could remotely be viewed as a medical procedure. (Unless you'd like to me to get holistic crystal therapy and help foot the bill with your taxes.) There are procedures covered by the government, and private insurers provide supplemental coverage for some things not covered by the government plan. Their role is drastically smaller than it is in the U.S., but they're still there.

[Totally Committed]

47. In a nutshell, this is the reason: BIG PHARMA AND CORP. INSURANCE CAMPAIGN $$$$$$$$$$$

Single payer Universal Health Care will never happen in this country without campaign and lobby reform. Never.

TC

[Solon]

48. Isn't that a catch-22?

I mean, we will never get campaign and lobby reform as long as corporate money is in government, and we will never get single payer without campaign and lobby reform, so what should we do? Give up?

[doggyboy]

52. Here's what we do

and I think this idea of mine might be what's motivating our candidates to offer something less than SP-UHC

Weaken the insurance lobby's opposition by allowing them to continue to profit from their participation in the market, although at a lower rate than they have done so far. The lowered profits will make it harder for the insurance lobby to oppose further reforms in the future.

Basically, we may be able to loosen the grip the insurance industry has on this issue by reducing it's source of funds

[Solon]

55. Problem is that the insurance companies will fight this just as hard as if it were SP-UHC...

even though it isn't, so I don't see how one stands a greater chance against another, unless it simply comes down to bribes.

[doggyboy]

58. I'm not as sure about that as you

Reducing, and not eliminating, the industry's profits can be used to paint the industry's objections as unreasonable and motivated by greed. Of course we can always portray them as greedy, but I think it's going to be important to portray their arguments as unreasonable, and not just their motivations.

I guess I worded it wrong. It's not so much that this weakens their opposition; It's that it strengthens the arguments on our side.

[Solon]

67. The Insurance industry will not hesitate to spend billions of dollars to preserve...

as little as 1% point in profit margins. This you can bet on, and believe me, they will be shrill and loud.

[doggyboy]

68. I have no doubt

but I think, despite their money, their arguments will be weakened. The plans offered by the candidates provide no room for the insurance industry to cry about how the govt is going to decide your medical care. Expanding coverage for children is more moderate than UHC-SP, but it sure as hell is hard to argue against. Though I think you are on the right track, I do think you should give more consideration to the political dimensions of the issue.

Though SP-UHC is the ultimate goal, and though none of the candidates are offering it, they all support it and I do not think that their proposals are an indication that they don't "get it". I think that, like me, they have a different view of what is feasible than you have.

[Solon]

69. As I said before, I'm not sold on the idea, I'm afraid their plans won't work...

or worse, will backfire, and set back SP-UHC reform by a decade or more.

[doggyboy]

71. Cant say that I blame you

It's not as if we've never been screwn before.

As far as Edwards and Clinton's plans, I don't see them as having much chance of being counter-productive. Not impossible though.

I haven't seen any detail on Obama's just announced plan, but it does sound like individual mandates, which I am not pleased with, if that's what it is. I still need to see more. I do think that forcing people into a private system is a big danger. THAT would be counter-productive

[Solon]

72. Forcing people into the private system means I'll get my assed fined for living...

I think I'll just be a little pissed off at that.

[doggyboy]

74. You'll get free health care in prison

so stop your whining

[Solon]

76. You know what...

I have a pinched nerve in my left shoulder, causes constant pain, unfortunately, it manifested while I just started a new job, hence, no medical insurance. On bad days, I seriously contemplate committing a semi-serious crime, no more than a year in jail, and then try to demand the surgery I need. Like robbing a bank or something, I was thinking about doing it stupidly, the only gun I could access is my dad's muzzle loader, so I was going to walk into the bank, fire one shot into the ceiling, and then say "stick-em up!". The only thing that stops me is the fact that if they cuffed me behind my back, I'll fucking scream from the pain.

[doggyboy]

80. Bank robbery has a notoriously high close rate

You'll have much better odds with mugging.

Let me know if you're in the area. I'm also uninsured. We can work as a team, and who knows, maybe a doctor will give us the group rate

[Solon]

81. LOL, ok, how about something less violent, white collar crime, that's where its at...

rip off some faceless corporation, no one gets hurt, and you spend the time in club Fed.

NOTE: To Agent Mike, I'm KIDDING DAMMIT!!!!!

By the way, if any of these presidential plans go through, with the NO PREEXISTING condition clauses put in, and no penalty for not having insurance, then I'm going to find the cheapest insurance company, with the lowest deduct. Pay it, get my surgery, then cancel it after I recover fully. I'll have to save up just for the premiums, co-pays, and deduct, but at least I'll get ONE damned thing fixed, before I lose the use of my arm.

[doggyboy]

82. Hey, you're holding the gun

You call the shots

[eridani]

89. Don't laugh

People have deliberately committed crimes for the express purpose of getting sent to prison so they can get health care.

[geek tragedy]

51. The problem is transitioning to single payer

in a way that won't cause massive layoff or cause a significant portion of the population to change their current coverage if they like it.

[Solon]

53. I don't think the disruption would be as big as you think...

Most Health Insurance companies aren't JUST health insurance companies, many have other insurance policies they sell, like auto, home, life, and some also are mutual funds as well.

There would be layoffs, but they will be temporary, the new public system will need more claims workers to process the claims of all the new people who will use it. That will blunt most of the layoffs, the government will, after all, hire the most qualified and experienced people for the job. Not all will be hired, the overall government program will reduce the redundancy of hundreds of insurance companies, however it won't be nearly as severe as the constant layoffs at so many other companies that are partially attributed to health care costs.

[geek tragedy]

57. Very possibly. Question for you:

Of the three proposals put forth, would it be harder to transition from them to single payer than from the current system, or would it be easier to transition from those proposals once enacted?

[Solon]

63. It depends strictly on how many restrictions are placed on the public system...

if the restrictions don't change on income, employment, etc. then the transition would be no different than if it changed over now. If there are no restrictions on income, employment, etc. then its basically my plan with a bunch of expensive, unnecessary shit thrown in. The transition would be more expensive, in either case, but possible.

[endarkenment]

88. 377,480

That is the total number of people employed in the health insurance sector, as per BLS:
http://www.bls.gov/oes/2000/oesi3_632.htm#b00-0000

The entire insurance industry employs 1,451,360. http://www.bls.gov/oes/2000/oesi2_63.htm#b00-0000

The entire labor force is 152,974,000 (2007). http://data.bls.gov/cgi-bin/surveymost

I think we can manage the transition such that the 400,000 employed in health insurance have a reasonable path to other employment.

[shimmergal]

59. With Medicare you STILL get insurance co. involvement

and I don't mean just with processing claims.

The only Medicare recipients who can be confident about being able to pay their medical costs are those who buy "Medicare supplemental" policies offered by the same insurance companies. And the "filthy rich" retirees, of course.


Not that Medicare isn't better than most of what the industry. offers, it's just that there can still be some nasty surprises from unanticipated costs. Which a true single payer system should avert.

[Solon]

64. Well, I already talked about some fundemental changes to Medicare...

itself, mostly in relation to consolidating it with the other two programs I mentioned. One of the things I do NOT like is supplemental insurance when it isn't necessary. I'm using Medicare mostly as an example, it would act as the primary, publicly funded insurance agency for the American people, covering ALL necessary medical procedures. It becomes the "single payer", period. To be frank, I don't care what its called, that's the least of my worries, as long as its single payer and it works. Americare has an odd ring to it, just thought of that off the top of my head.

[Vinca]

75. Solon, your analysis is exactly right.

You could even do away with the VA system and incorporate it into the ONE health plan for everyone. It doesn't matter what the heck it's called as long as no one or no condition is excluded and there is no need to buy so-called "supplemental" insurance. Why is it our government officials see no problem in spending a half trillion dollars on a war that should never have happened, but balk at the idea of keeping all Americans healthy? So far I'm disappointed in what I've heard from Edwards and Clinton - will wait and see on Obama. Kucinich is nearer the mark, but would have a snowball's chance of winning the office.

[Solon]

79. True, the VA system could be merged in a UHC system as well...

Private insurance would only exist for cosmetic, non-medical, procedures only, like putting in gold teeth, face lifts, eye laser surgery, stuff like that. Reconstructive surgery, though, would be covered under the public system. My idea isn't that new, its basically H.R. 676, Conyer's plan, but without the provision forbidding medical insurance for the same things altogether. To be honest, I agree with Conyer's on that, however, that is my ONE compromise, besides, I don't believe they can compete anyways, let the so called market decide. ;)

[Hippo_Tron]

60. single-payer healthcare will never happen until we get money out of politics

In England, candidates for parliament are bound to a spending limit equivalent to about $40,000 depending on the size of their district. Unfortunately spending limits were ruled unconstitutional in the 1970's and that was under a much more liberal supreme court than we have today.

[NotGivingUp]

73. they're trying to con us...it's all a bunch of shit and actually makes things worse. nt

[depakid]

78. "every plan subsidizes the insurance industry in some way"

Which is why they're all destined to fail miserably.

Unless or until a candidate has the courage to cut the insurance industry out of the basic benefits package, they're promoting useless policy- and LYING about the probable results.

[Donna Zen]

90. Talked to my brother-in-law the other day:

At some point the conversation turned to health care. He said that our problems can only be solved with Single Payer.

Oh, I forgot to mention that b-i-l has a PHD in economics and teaches insurance. OK, he's just one person, but he's a very smart person who is not necessarily liberal on all issues. I was rather startled when he made his statement.

Can it be done? Yes, if we want to do it. We will need a matrix that includes cost cutting measures as we turn this around. The only people saying it can't be done are those benefiting from the current scam.

The half-measures currently being discussed are doomed because the cost will make Americans hate it. I really hear about these so-called plans because when they fall short, they will dampen the voters' current willingness to consider single payer.

[LWolf]

92. Ok. Then lets support HR 676,

and the candidate that authored it.

:thumbsup: :thumbsup: