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ObamaCare Clusterfuck: RJ Eskow endorses Medicare for All (kinda)

Op-Ed News, all the way at the last paragraph:

I still feel the way I did in 2009 when I wrote that "progressive groupthink hindered health reform." The reflexive instinct to support a Democratic-proposed policy led to the mind-bending spectacle of liberals from Rachel Maddow to Paul Krugman cheering for an "individual mandate" policy which was designed in a conservative think tank as a boon to private corporations.

Well, that is a very charitable view. AFAIK, Hamsher is the only one in all that shameful crowd to have reflected, and changed her mind.

It's also worth noting that, whatever you think of Obamacare's merits, this story reinforces the perception that today's Democratic leaders are pretty terrible at messaging. John Boehner's spokesperson was understandably gleeful when he said "The speaker's objective is to spare the entire country from the ravages of the president's health care law. He is approached daily by American citizens, including members of Congress and staff, who want to be freed from its mandates. If the speaker has the opportunity to save anyone from Obamacare, he will."

It should've been pretty easy to see that coming, too.

The Washington Generals are fine at messaging, so fine. It's just that Eskow can't bring himself to see the kayfabe.

We argued then that it was ethically unacceptable and economically unwise to force people to buy a lousy private-sector insurance product.* The only way to mitigate that would be by offering them membership in a publicly-managed Medicare plan.** But the combination of high-pressure lobbying and presidential indifference*** made sure that didn't happen.

This doesn't mean that "Obamacare" should be repealed, although it now seems that nothing short of Medicare-For-All (or, at a minimum, all-payer) can save our broken healthcare system. But it does mean that the battle for decent health care in this country isn't over. In fact, it's only begun.

So, a couple of comments. First, it would be helpful if Eskow was just a leetle more clear-eyed about Obama, the nature of Democrats, and the truly destructive role played by career "progressives" four long years ago, when ObamaCare was passed.***** Second, it would be extremely helpful if Eskow wasn't preparing yet another pre-capitulation now that the public option, having done its bad work, is seemingly discarded. The tell is right here:

... Medicare-For-All (or, at a minimum, all-payer) ...

C'mon. Eskow's doing great, then he goes soft. All-payer is just another scam to leave the health insurance industry parasites intact while normalizing the damage they do to the host. (And I like the brand confusion of the two "____ payer" proposals. Wonderful what funding can do.) Uwe Reinhart is ON IT, so what does that tell you? PHNP:

Reinhardt discusses the effectiveness of all-payer for hospitals in the state of Maryland. In a previous response to the Maryland all-payer system, I stated, “If we can succeed in reestablishing a public service role for government, then wouldn’t it be reasonable to simply enact an all-payer system for hospitals? The problem is that it only makes one change in our fragmented, dysfunctional system of financing care, and not a complete change at that. Under all-payer, only the rates are controlled, but each service still must be accounted for and paid for independently, and the hospitals would still have multiple public and private payers with which they would have to interact.”

So what about Switzerland? Reinhardt mentions it as having successfully applied an all-payer system. In another previous message on the OECD/WHO report on Switzerland, I stated, “It is not clear why so many in the U.S. are enamored of the Swiss health insurance system when this OECD/WHO report confirms that it is highly inefficient and fragmented, with profound administrative waste, inequitably funded, with regressive financing and with wide variations in premiums, has the highest out-of-pocket costs, has an increasing prevalence of managed care intrusions, and is controlled by a private insurance industry that has learned how to game risk selection at significant cost to those on the losing end.”

Uwe Reinhardt is to be highly commended for moving us in the right direction, but…

We’ve said it before and we’ll say it again. If political feasibility is the barrier to enacting a single payer system, let’s not simply jettison single payer; let’s change the political feasibility instead! All-payer might be a modest incremental improvement (modest when compared to what needs to be done), but why settle for that when we can have it all through an improved and expanded Medicare for all?

Ya know, it's almost like "progressives" are inventing lines of defense for the health insurance industry. Weird! Or not, eh?

NOTE * I would this in a simpler and more pointed way: "ObamaCare forces people to buy a defective product."

NOTE ** That's the so-called public option, a bait and switch operation masterminded by career "progressives" running interference for Obama. That Eskow can't bring himself to name it gives me hope that somebody's finally put an axe to the Public Option Magic Zombie Sparkle Pony's head.

NOTE *** No, not indifference. Active hostility.

NOTE **** At this point, I sought, and was unable to find, posts from Ykleinias saying that ObamaCare took health care reform off the table for another thirty years or so. (Readers?) Obviously, I hope they're wrong, if only because, at the grossest possible level, somewhere between 20 and 30 million people are going to end up being denied health care for lack of insurance even after the creaky, complex, and extremely expensive Rube Goldberg device that is ObamaCare finally stumbles into motion.

NOTE ***** Let's remember that when LBJ got Medicare passed in 1965, it took one year out Medicare to the entire over-65 population, in the days before computers, too. That's because single payer is a simple and well-architected system for delivering heath care. ObamaCare has taken four years to get past the cherrypicking stage, and that's because it's a complex and confusing system designed to minimize the delivery of health care while maximizing the collection of rents. I realize that the "minimize" in "minimize the delivery of health care" is a political criterion, which is why Obama made sure that his constituencies got covered first.

NOTE "charitable organization" -> "charitable view." Not sure what's happening to my brain here...

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Comments

beowulf's picture
Submitted by beowulf on

I'm sorry but that link is the cancer.

"The VA medical system (now very well thought of, believe it or not...) announces that it will sell access, at the underwriting cost plus 10% (the profit to be used to reduce premium cost to actual veterans) to anyone who is a family member of a veteran, or a friend of one (as shown by the ability to provide the name of a veteran, dead or alive)."

The VA isn't an insurance plan, there is no underwriting nor any premium costs to actual veterans. Its a singe provider system (govt owned hospitals, doctor & nurses are federal employees) for which Congress doesn't appropriated enough money to serve our veteran population now . Even if Congress magically agreed to expand eligibility and granted an unlimited appropriation, there aren't nearly enough govt hospitals and doctors available,. It would do nothing to reimburse private doctors and hospitals, again, the VA isn't an insurance plan.

Submitted by lambert on

And it does sounds like they are selling insurance ("underwriting costs"). What am I missing? Cancer seems a little over the top.

beowulf's picture
Submitted by beowulf on

sorry, that's 4chan-ese for "that's what's wrong with America" :o)

DoD and VA are different cabinet departments.
Both have single provider systems. While the DoD does provide single payer coverage. Tricare, for servicemen, family members and retirees who see private doctors and hospitals, its funded out of the defense budget, there's no underwriting or premiums.
The VA's single payer system CHAMPVA, isn't actually veterans but for the family members of 100% disabled veterans. Likewise, no underwriting or premiums.

Now, in the sake of completeness, for the last few years Tricare has allowed reservists to buy into Tricare (Tricare Reserve Select). Since Tricare had never charged premiums before, the Pentagon wasn’t sure how to set actuarially sound premiums for the 28% of costs paid by reservists who opted in So they looked at FEHB (the insurance exchange marketplace for govt employees) premiums for a comparable plan (BCBS Standard)
An unfair comparison it would seem, to the FEHB plan since BCBS Standard has an in-network catastrophic cap of $4000 a year per family ($6000 for out of network). Tricare has a flat $1000 a year catastrophic cap. So much for “cost containment”, right? Hilariously, after a year, the Pentagon realized that they’d set its single payer premiums too high. As the GAO noted in a 2007 study, The premium for individual coverage under tier 1 was 72 percent higher than the average cost per plan of providing benefits through the program. Similarly, the premium for family coverage under tier 1 was 45 percent higher than the average cost per plan of providing benefits.
http://www.gao.gov/htext/d08104.html

That's a probably a pretty good estimate of how much more expensive an insurance marketplace would be vs a single payer system .

Aeryl's picture
Submitted by Aeryl on

The VA is more like the NHS for veterans.

It is time consuming to be seen at a VA hospital, when the Sailor tore his ACL he sat in the emergency waiting room for 11 hours before being seen my a doctor. His follow up appointment with his regular physician, was scheduled for two months later, as that was the EARLIEST availability.

Don't get me wrong, I'm happy he had access to it. But the system is underfunded and understaffed. It could not handle the influx of hundreds of thousands of new patients.

Aeryl's picture
Submitted by Aeryl on

Sure. The care he received was great, no expense, but top of line rehab gear(he got a $800 dollar knee stabilizer), and they weren't stingy with the meds. Hell, they OFFERED wellbutrin to help quit smoking, without even asking.

It would definitely need more funding. Right now, we live in a major metro area, where the only hospital for hundreds of miles is, and it's still almost an hour away. There are smaller satellite offices, but they are limited in the services that are offered.

beowulf's picture
Submitted by beowulf on

Even if a universal Medicare system is established VA hospitals should continue to be funded and veterans' families also made eligible for care there.

Since veterans and their families would also have Medicare cards, they'd vote with their vote as to whether private providers or VA providers are better. If they trend towards private then we should probably shut down separate VA system, if they trend towards VA, then we should expand VA facilities and eligibility to gradually cover everyone there.

Think of it as Medicare for All with a Public Option. :o)

letsgetitdone's picture
Submitted by letsgetitdone on

from beo, as usual. Does the above mean that you believe that switching to an enhanced Medicare for All system would lower total annual medical costs from $2.7 T to $1.86 T?

beowulf's picture
Submitted by beowulf on

If the % of population of those covered were the same before and after that'd be about right. However adding in the 84 million Americans who were uninsured or underinsured last year (out of a pop of 313 million) would eat up most of these saving.
Its pretty clear, though, Medicare for All would cut annual medical costs from where it is now even as it provided 100% population coverage.

Submitted by JuliaWilliams on

ERs are the most expensive purveyors of health care for any number of reasons, but the main one is they are designed to treat acute medical conditions and thus require gobs of expensive equipment and supplies, and need staff that are highly specialized and resources like instant access to CT scans and labs and Xrays, etc. But even more importantly if a patient presents to the ER after having "deferred" their healthcare, what we get are more seriously ill people with more complex problems that are going to cost multiples of what it would have if they had been treated in the early stages of their disease. One classic example is the undiagnosed diabetic suffering from neuropathy who presents with a septic foot that will then require surgery, most likely a series of amputations and long hospital stays since they don't heal well or quickly, not to mention the other complications, like blindness, heart disease, etc., that can arise from this neglect. In addition, let's not forget about the costs to the patients and society (the "hidden' costs) that arise when people are postponing their care and become so ill they lose their jobs and begin that well-known spiral into bankruptcy as a result of medical bills that they wouldn't have incurred if they'd received good wellness care. Not to mention the unnecessary and untimely deaths we could avoid. Even deferred dental care can, and has, killed people. Here's one study that illustrates my point on ER care vs preventive care.