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Healthcare incrementalism: a practical approach

DCblogger's picture

Let's talk about a fall back position. Let's say the climate in the US will not support an all-at-once single payer system. OK. What would work?

Chuck Pennacchio argues for a state by state approach. If we can pass single payer systems in a few states, people will see its superiority. It seems that is how it was adopted in Canada, first Saskatchewan passed a single payer, then the Saskatchewan Premiere (or whatever they are called, I'm just an amateur blogger) got elected PM of Canada and passed a national system. So a states first approach does make sense.

There is single payer legislation pending in California, Ohio, and other states. We just need it to pass in one state for it's virtues to be obvious.

For that to happen we need to insist that any federal legislation not preclude the states implementing a single payer solution if they want to.

For example, the state of Maine wanted their state Medicare and Medicaid system to bargain for prescription drugs. The Pharmaceuticals and AARP sued the state of Maine and took it all the way to the US Supreme Court. The court ruled in Maine's favor and that very day Medicare part D was introduced complete with the provision that states could not bargain for prescription drugs. There is a very real danger that a federally passed health care system will include provisions that prohibit states from implementing a single payer system. At an absolute minimum we must prevent that from happening.

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BDBlue's picture
Submitted by BDBlue on

Any "incremental" plan must be universal, IMO. Without universal coverage, it becomes much easier to attack. This is my problem with Obama's plan - it isn't universal, people can opt out. Letting folks opt out of any plan, whether it's government or private or a mix, weakens it severely in two ways. First, it guarantees the costs of healthcare will be higher and strain any plan. Second, it leaves the option of controlling costs by changing who is eligible to participate in the plan. Since everyone already doesn't have to participate, you can control costs by pushing people out of the plan.

I've said this many times, but I view universal healthcare the same way I do Social Security - once it's in place, it will be impossible to take away. If insurance companies can't deliver it at acceptable costs, then folks will find other ways to control costs, including single payer, but the coverage won't be changed. It will be too popular. Which is why the health insurance companies will fight mandates or single payer or any other truly universal plan.

DCblogger's picture
Submitted by DCblogger on

Let's say California passed a single payer system. All I am saying is that any federal solution not preclude California from doing that.

Universal healthcare has to be universal, we really should insist on HR 676. 91 members of the House of Representatives is serious political muscle and tells me that this is very much doable. The people who keep telling us it is not practical tend to be bloggers and pundits. I think the politicians are better judges of what is practical.

Batocchio's picture
Submitted by Batocchio on

"If we can pass single payer systems in a few states, people will see its superiority." That's similar what some people (including Edwards) were proposing on a national level, except that in Pennacchio's proposal the competition is between states versus between the current insurance-driven model and a new national system. "There is a very real danger that a federally passed health care system will include provisions that prohibit states from implementing a single payer system." That's a legitimate concern, and the state approach definitely has merit. Thanks for following up on your earlier post, and if you missed it, you may find item #2 of this Tom Geoghegan piece interesting.

BDBlue's picture
Submitted by BDBlue on

In fact, I agree that we have to be careful that whatever federal solution there is not unnecessarily preclude the states from doing something better (this can be tricky because sometimes not having it be universal can undo the federal solution). I was just adding that, while I can get behind incremental changes (I considered Clinton's and Edwards' proposal to be these), any reform plan needs to be universal. I prefer some form of single payer, but even reform that left the insurance companies would be a step in the right direction so long as it's universal. Otherwise, there won't be the cost control pressure - that pressure will be eased by gutting coverage and forcing people out of the pool rather than by taking on the insurance companies. So you end up feeding the insurers instead of truly covering all Americans.

Hillary was, IMO, absolutely right to set the line at universal coverage. So long as we get that, I think we'll have the chance to improve any plan, even incrementalist ones.

It's only incrementalist if it actually has the ability to move the system in the right direction. My biggest fear is that the Democrats will pass something that's half-assed (and I consider Obama's plan to have all the makings of this, especially once it gets further watered down) and they end up setting back the cause of reform for a generation because people lose faith in the Government being able to address this problem.

It's astonishing to me that healthcare reform hasn't become a flagship issue for the Democratic Party* (as opposed to individual Democrats). Talk about missing a huge opportunity to do well by doing good.

* I don't consider a few lines in a platform that nobody will be held to (they never are) to say much about the party's view of healthcare. When I say flagship issue, I mean having Democrats generally run on it and identify themselves as the party of universal healthcare. With a few exceptions, they aren't doing this as far as I can see.

gqmartinez's picture
Submitted by gqmartinez on

States have budgetary restraints that the fed doesn't (running deficits). This will make it hard in CA where there are massive structural deficits as far as the eye can see--dont be fooled by the bonds that Schwarzenegger took out.

I think proceding this way poses danger if one of the states have to fail, and I wouldn't put it past the GOP to deliberately bankrupt states to make single payer look evil. Also, one of the big advantages of a national approach is that the risk pool is much bigger.

I think the debate we should be having needs to be about implemention of single payer programs. A majority wants it but those with bad insurance are scared of changing systems overnight. That's a legitimate concern that single payer advocates ignore at their peril.

Submitted by ohio on

The organized opposition to a commonsense idea like universal healthcare have already wrapped up their response. They even have a Plan B: give us just enough rope with what appears to be begrudging compromises on incremental health insurance efforts and then watch it all go to hell because it's too complicated and unworkable.

The fatal flaw of the unlearned lesson. Every gift given by the opposition carries a punch in the mouth. Beware of Greeks bearing gifts. Or gifts bearing Greeks, as the case may be.

It's time to start pitching our own commie memes.

Political will is not the issue. Packaging is. We need some snappy slogans, bumpersticker, "Got Health?" simple, easy to remember, and clever phrases that encapsulate the promise of this effort.

"If we had free healthcare, we could cure stupid."

I know it seems simplistic and dumb, but it isn't. People want a good comeback and why not be the ones to deliver it? Why not come up with the best, repeated-to-the-point-of-bleeding-ears phraseology and get it out there first?

Why in the hell are we playing defense on such a good and necessary thing?

Submitted by lambert on

1. The slogans are fun.

2. Yes, the concerns of the insured need to be addressed. I can't believe that anybody feels secure in their insurance, or feel that they'll be treated well by the health care system if they enter it. Perhaps I'm wrong.

"Will your health insurance really be there when you need it?"

Classic "take the umbrella away when its raining" situation....

[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.

gqmartinez's picture
Submitted by gqmartinez on

Here's where single payer advocates go wrong. Its not that people feel secure in their insurance--many increasingly do not--its that the insurance they have is better than nothing. Single payer is nice in principle, but it requires a massive change that could lead to risks (how the GOP frames it) people are not willing to risk. OK, you may hate your insurance, but at least your kids have something.

DCblogger's picture
Submitted by DCblogger on

that is why we have to start calling it Mediacare for All. People know what Medicare is, they like it.

Submitted by ohio on

If the program works well, then use it as the policy framework. But change the presentation. Most people don't know what Medicare is other than it's run by the government (like VA hospitals---great, rat bites for everybody), and that makes it suspect. It is already a tainted brand.

Re-brand, re-package, and re-name, and this battle is on it's way to being won. IMHO, naturally. MedicAll. AllHealth. MedicAmerica. AmeriWell. Amedica. A snappy anagram might work.

DCblogger's picture
Submitted by DCblogger on

everybody's grandma has Medicare. congress just overode a presidential veto to protect Medicare. It is a political winner.

Submitted by ohio on

"Medicare is a political winner" is not enough to get to universal healthcare. If it was, we'd already have it.

To get universal healthcare requires action on behalf of those of us who don't have Medicare---many of whom are suspicious of any government entitlement program. "My grandma has Medicare" is not a powerful enough message.

To get action on this right requires that people who want universal healthcare act. But for many of us Medicare---as a brand---is a negative. This is not a political problem---it is a marketing problem. People do not see how an entitlement program based on Medicare will solve one their most pressing needs---getting access to good healthcare without going to the poorhouse.

The politics comes in with forcing the politicians to enact universal healthcare or face serious pain---separate issue.

First things first---speak to my needs and the needs of my neighbors who are neither old nor young and inherently (and rightly) mistrust the government. Medicare is for old people, like my grandma, and I'm not old, so what's in it for me? Grandma is already taken care of---great. But what about me?

Please don't misconstrue---my needs expand beyond me, but my point is valid. Taking care of grandma is great, but if she's taken care of, then how does that ease my pain? I still have to write that check every month for health insurance I can't be sure will be there during a catastrophic personal event.

The brand and the messaging is important because it says that someone actually thought about me and the people who share this particular pain. And it also sidesteps the tainted brand of Medicare. Medicare is only a political winner because old people, who are well-organized, who are getting it will riot if anyone tries to take away their entitlement. Good for them---they should. But this is reactive and defensive---I will bite you if you touch my food bowl.

If getting the other 200-odd million of us with insurance but not Medicare onto the bandwagon is the winning tactic, then address our needs and give us a bumpersticker phrase with which to bludgeon our political representatives.

"Medicare for All"---may be you would wear it on a t-shirt. I wouldn't. "Boldly shrill"---that I'd wear on a t-shirt.

DCblogger's picture
Submitted by DCblogger on

You Grandma has Medicare? It works for her? Wouldn't it be great if you could have Medicare too? Well you can, we just pass this thing known as Medicare for All, HR 676, and we are all covered.