Digby asks a reasonable question:
For those who are worried about the health care reform that's being hashed out in congress right now because you believe that single payer is the only answer, I would just ask if you think that France, Holland and Germany should change their systems? They all offer universal coverage, their statistics are far superior to ours and their people would probably kill you before they'd let you change them. And none of them have what we think of as strict "single payer" plans.
No one is proposing a system similar to France, Holland, or Germany. The HELP Committee would require people to buy insurance while limiting the public option in a way that would leave many people high and dry. The public plan was never anything but an advertising slogan to divert attention.
The reason I feel so strongly about single payer is that 1.) it works, the Canadians have tried it. 2.) There is a proposal on the table, HR 676. When I call for single payer I am not advocating for some vague ideal, but a specific piece of legislation.
There is a real chance that Congress will pass something that will actually make things worse. Right now the best I hope for is specific language in the bill that will protects that states' rights to enact their own single payer system.
If you live in Pennsylvania, you have a chance to do this in your state and I encourage you to contact your state representatives.
- DCblogger's blog
- Login or register to post comments
Front page
Comments
3. it works, the americans have tried it
medicare has been working very well for longer than a lot of progressive bloggers have been alive.
yep, it's been nearly impossible to educate people on the differences between our multipayer system and all the other multipayer systems in the world. liberals seem to be quite resistant thorough research on this -- look! multiple insurance companies! just like us!
the nice thing about talking to conservatives about medicare for all is actually their preference for not straying from the familiar [the very definition of true conservatism]. i just tell them to go ask their grandma and grandpa about medicare and then compare that to what their insurance does
tofor them.Yes but don't forget
Most seniors have a "medigap" policy to pick up all of the deductibles and co-pays that Medicare has.
My mother has such a supplement and it costs her an additional $170+ per month for that.
The poor seniors have Medicaid
That pretty much covers everything, unlike people under 65 and over 18 in my state, who get nothing at all unless they do the "irresponsible" thing and have children they can't afford.
Doesn't that beat all! To get medical care as an adult, you have to reproduce, then when your children leave home and you need the care the most as you get into your late 40's, 50's and early 60's, you are cut off until you are 65, ensuring that you will likely be in bad shape by that time and really cost a lot. It's soooo not logical.
"A little knowledge is a dangerous thing. So is a lot." - Albert Einstein
based on my reading last night
two things in the HELP plan* I found interesting that I have not seen discussed yet this morning:
1) it seems to allow differential pricing of premiums based on age (but at no worse than a 2 to 1 ratio)
2) it seems to allow qualified insurers to provide plans which cover less than the usual required coverage in the case of "young adults" (that phrase is used).
Putting these two together, I see it leaving an opening for insurance companies to woo the largish group of uninsured young adults by offering cheaper plans which have less than the mandated coverage. This is still kind of a potential cash cow for the insurance companies. They've been softening up the beachhead for this in the press for awhile. (I have a post cooking on it, but I can't seem to marshal my thoughts - late night sessions with congressional bill language are not good for the brain!)
At first I thought the differential pricing thing was meant to shift more of the healthcare premium cost onto older people - and I still think it might be - but I'm moving away from that thinking because of other provisions which are meant to keep the premiums "affordable" which apply to everyone.
Another thing to discuss: "affordability" in this plan is explicitly limited to the cost of the premiums. (It's defined as 12.5% of your [adjusted gross, IIRC] income if you make at or over 400% of the poverty line, and slides down to 1% at 150% of the poverty line.) It does not take into account the amounts of deductibles and copays. However, there is also language in the plan which seems to limit the amount of out-of-pocket expenses to whatever is deductible under the IRS code for "high-deductible plans", whatever that is (I have not looked it up), and there is language which excludes yearly limits and lifetime limits on benefit payments. These are potentially good things, but it is hard for this educated lay person to figure out exactly how it is supposed to work.
I still don't understand how the fines, excuse me, what's the Orwellian language we're supposed to use? of $750 per fulltime and $375 per parttime employee for employers who do not provide insurance, or $1000 for individuals who do not buy insurance, are supposed to be an incentive to get people insured. The likely cost of insurance for most people is likely to be much higher (although, who the hell knows). In fact, I think these are just disguised taxation (and harder to collect than taxes). I've already said that I think the likely effect on employers will be to make more of the workforce into part-time or contingent (contract) workers.
One last thing: continually while reading this plan last night, I kept thinking, "Dang, what a kludge of a kludge this is!" It is complicated and hard to understand mainly because they are trying to keep the existing system pretty much intact underneath it, hence the kludginess.
*(I'm not calling this thing a "bill" because, as I said last night, we don't have the whole bill here - just this part, labeled "amendment", which the HELP-me-rhonda committee had responsibility for. There's more to come, dammit. Also, every time I go to type "bill" I end up with "bull". Hmm.)
(And yes, I am getting a little punchy. Why do you ask?)
---------------
We can't afford not to have single-payer!
One more one more thing on the kludginess...
All of this covert taxation-via-fines, and requiring this for some kinds of insurance but not this for some others, and (another thing we havene't seen discussed) some moving money around from plans with low-risk pools to plans with high-risk pools, and oh yeah, up to 4% administrative costs (explicitly so stated in the plan) for the "Gateways"...
The simple, natural thing would be to have everyone in one big pool, insured by one big plan, paid for through the tax system, with the option to purchase extra coverage if desired. What is that called again?
---------------
We can't afford not to have single-payer!
reality
it's called reality, as opposed to the faith-based belief in the power of competition and the markets that obama has.
moving money around between low- and high-risk pools is how the countries with multiple payers keep them in business. it's a less efficient and slightly more expensive way to manage the risk than having one single pool with one adminstrator, but it does add to the overall employment of the population. there's no really compelling social reason to not have a small percentage of the money going to nearly useless make-work jobs, we'd be paying them welfare payments to stay home otherwise, so why not let them push papers instead.
the problem is that this sector of the economy [in our country] is a bunch of leeches sucking resources out of everybody else and they accidentally save enough lives along the way to make themselves look not only useful, but indispensable.
Also, dental care
Not required to be covered, except (I think) for children.
Isn't that part of "preventative care", if nothing else? If you need a root canal and can't afford it, the infection can spread - to the brain. Why not take this opportunity to smuggle that into our coverage. (There may be some very questionable things being smuggled in, if I'm reading correctly, and I want to make sure that I am before I say what they are. This one is a necessity.)
(And really, that's the last comment for now. RL bangs on the door.)
---------------
We can't afford not to have single-payer!
You'd think the Maine girls...
... would get us some dental care. Maine has terrible dental care systemically.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
bingo!
Putting these two together, I see it leaving an opening for insurance companies to woo the largish group of uninsured young adults by offering cheaper plans which have less than the mandated coverage. This is still kind of a potential cash cow for the insurance companies. They've been softening up the beachhead for this in the press for awhile. (I have a post cooking on it, but I can't seem to marshal my thoughts - late night sessions with congressional bill language are not good for the brain!)
[congressional bill language should come with black box warnings.]
it's not just kind of potential cash cow for the insurance companies, it's huge. we little single payer advocates have been yelling, cassandra-like, for ages that the insurance industry will find a way to game the system, to secure for themselves the healthy and get the unlucky dumped into the public plan. plus, those 'young adult' policies are generally very high deductible plans, and these gambles work fine for a lot of youngsters because relatively few 20-somethings end up needing, oh, cancer treatment, for example. at which point it becomes junk insurance if you're a mom with small kids and a husband whose been laid off by his failing employer.
iirc, massachusetts allows those 'young adult' policies.
However, there is also language in the plan which seems to limit the amount of out-of-pocket expenses to whatever is deductible under the IRS code for "high-deductible plans", whatever that is (I have not looked it up)
i looked [very quickly] over that bit of the irs code last night -- it's in the neighborhood of $2500 for singles and $4000-5000 for families, i think, though iirc, there are policies on the market with maximum out of pocket limits that go up to something like $10,000-15,000 per family, so i don't know for sure.
there is language which excludes yearly limits and lifetime limits on benefit payments. These are potentially good things,
yes, these are very good.
but it is hard for this educated lay person to figure out exactly how it is supposed to work.
more bingo!
yes, they want this to be as clear as a brick wall for the rest of us.
large-population-wise [which we are], it's just not that hard to predict approximately how many of us are going to get expensively sick. absent any major wars or pandemics, the population grows [or shrinks] at a roughly predictable rate. absent any major depressions [and depredations by banksters], the economy chunks along, growing at a roughly predictable rate. absent any truly startling scientific breakthroughs, the human lifespan slowly inches upward.
figure out how much to pay doctors, hospitals, pharmacists, drug manufacturers, etc so they can live comfortable but not extravagant lives, figure out how much you need to tax everyone to cover those costs, and voila! problem solved, if the population is wealthy enough to pay for everything without imposing onerous taxes [and we are].
I still don't understand how the fines, excuse me, what's the Orwellian language we're supposed to use? of $750 per fulltime and $375 per parttime employee for employers who do not provide insurance, or $1000 for individuals who do not buy insurance, are supposed to be an incentive to get people insured.
my guess: this is one of those nudges. they really do seem to believe that a significant portion of the uninsured are choosing to put their money into fancy cars or big screen tvs when they should be buying health insurance instead.
nudges of course, are meant entirely for individuals. the $750/375 i would venture to guess is so that it looks [to us individuals] like they're willing to make employers share the responsibility too.
In fact, I think these are just disguised taxation (and harder to collect than taxes).
yes. one of the reasons the the cbo scored bill clinton's so high way back when was because the govt was going to have such a direct hand in controlling who got paid what, so all the collecting of premiums was pretty overtly a tax. having the health insurance exchanges mostly under state jurisdiction and having the exchanges do the premium collecting and reshuffling makes it less a tax [and therefore, by tricky definition, less spending by the federal govt] for purposes of cbo scoring, which in turn means the bill can get a more favorable score.
it seems to allow differential pricing of premiums based on age (but at no worse than a 2 to 1 ratio)
yes, the press and prominent bloggers talk up the community rating aspect a lot [we'll all pay the same thing!]. only rarely do they mention that it will be modified community rating, and that the modification will be based on age, which, with some exceptions, is actually a pretty good proxy for rating by state of health after all. i've been trying to point this [and a lot of other things] out in comments on various a-list blogs, but what do i know? i'm not an economist, i'm just a crazy cat lady.
------------
typing bull for bill... very accurate, that.
addendum
it seems to allow differential pricing of premiums based on age (but at no worse than a 2 to 1 ratio)
the modified community rating proposed by baucus' committee goes up to 7.5:1.
How's FDL coming along on their examination of it?
Similar results? Different?
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
dunno
haven't been back to fdl to look yet. jawbone's link to scarecrow suggests they're seeing roughly the same things.
Hip--Scarecrow has been something of a realist over there,
a bit of an outlier. I've found Scarecrow's analyses to be pretty good so far. I wonder whether Jane et al reads Scarecrow's posts?
There were great huzzahs when Jerrold Nadler said he would refuse to vote for any healthcare reform bill which did not have a public option; however, Commenter Ralphbon notes:
Whipping for the pledge now has 6 reps out of desired 40 making the pledge -- but the pledge is for some very abstract goals:
Check out Commernt 12, about Down With Tyranny swearing off Dems until they shape up.
yep, scarecrow is pretty good
[and is one of the fdl-ers i do read on my infrequent visits there] but was originally supporting the public option iirc [though i could be confusing scarecrow with someone else, and i'm too lazy to go look back through the archives there]. selise, ralphbon, coupla others, have pretty much been staunch single payer advocates all along.
love that 'suspending panhandling' photo, thanks for the link. whenever i get emails from any of the sellouts asking me for $$, i send them an email back, telling them i will send them some $$ only after they put their full support into single payer and only single payer [and i usually specify hr 676 since i like it better than bernie sander's bill]. i'm sure no one reads those emails, but it cost me nothing and makes me feel better to send them.
Found something by Christy Hardin Smith on the HELP bill--
She writes its the full bill with CBO scoring,but several commenters disagree. Mainly, she's writing up notes from phone call with Dodd, Whitehouse, and Brown. Posted 8:27 yesterday morning, so it's very early takes.
Selise comments discusses CBO scoring in comments 5, 11, 1--this is #12:
OMG, they're just shifting the costs onto households?
Nobody would have predicted...
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Can't know for sure-difficult to decipher. We'll be hearing lots
of claims, along with the need to trust them and The Lightbringer.
Basically, I think Bill and Hillary's plan was actually more clear.
it *is* the full version of the *help* bill
but the help committee doesn't have jurisdiction over medicare and medicaid, so they're apparently not allowed to write that part of the final bill. baucus' finance committee has jurisdiction over medicare/medicaid, so we have to wait for the version that comes out of that committee to see what the final senate bill is, and then that will be reconciled somehow with the final house bill, to give us the final final bill.
7.5 times is a complete joke
If they go higher than 2 times they will have a LOT of people opting out, and those people will be worse of than before by the $1000 fine they have to pay.
I would like to see how they arrived at their figure of 95% of Americans covered. I just don't believe it.
yes and no
7.5:1 is about what we have now.
in total numbers, a huge portion of the uninsured are 20-somethings, and $100-150/month really is something they just can't swing, so with only minimal [from the subsidizers' point of view] subsidies we could buy all of them some reasonable insurance [especially if we can dump them into medicaid, which is partially paid for by the states and only partially paid for by the federal govt]. meanwhile, the nearly-old-enough-for-medicare are a relatively small portion of the uninsured, because a lot of them do have enough earning power to pay the $750 or so they're being charged for private insurance.
mostly, though, i suspect they're arriving at the 95% figure because that's approx the [official] percentage that the massachusetts plan has managed to provide insurance for. of course, not all of the people in massachusetts who have insurance can then afford to go to the doctor after they've paid their insurance premiums. so yeah, we can, one way or another, buy insurance for 95% of the population....
hr 676 would fix those 'medigaps'
it builds on an existing framework that already works and and that has been working for decades.
if obama really believed the crap he's been spouting about keeping what works and fixing what doesn't, he'd keep medicare and throw out private insurance entirely.
we're already spending more than enough money to fix all the holes in medicare and make it financially secure far into the future and let all the rest of us in. the problem is how much of that money is being siphoned off by all the extraneous actors in the system. this money is not to pay for actual care.
Congress
can change that by allocating more funds to Medicare, specifically eliminating deductibles, co-pays, especially hospitalization co-pays. But, don't hold your breath.
What you are talking about is not a problem inherent to Medicare or any other single-payer system.
You are far kinder than I am
I would have said that Digby's question is an attempt to make single payer advocates do work that public option advocates are themselves not willing to do* -- purely a rhetorical device, a diversionary tactic, and, designed as it is to attack the credibility and intellectual integrity of those to the left of public option advocates, strategically short-sighted if the next step in the vaunted "legislative strategy" is, in fact, to push in a single payer direction. In fact, once the pressures of RL abate, I will say just that, and with more force and in considerable detail.
I mean, gee, it's not like people's lives and health are at stake, or anything.
* Are we seeing country-by-country comparisons on public option anywhere? Of course not.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
yep
every other country that ever got universal [or near-universal] health care did it by having a public option compete alongside private options.
not.
In fact, once the pressures of RL abate, I will say just that, and with more force and in considerable detail.
i look forward to that., especially the considerable detail part.
I mean, gee, it's not like people's lives and health are at stake, or anything.
well, we have kind of over-run the earth yanno, and it would be a good thing for a lot of other species [and for the remaining humans] if a lot of us do die off. enter darwinian social insurance.
4. Single-payer is less a heavy lift than
protecting the public option from political mischief (pace Robert Kuttner).
The German and French plans were instituted under political conditions very different from ours. It's quite obvious than any "public plan" that might be passed here will be attacked relentlessly and continuously by the insurance companies. (I was going to say "by the Republicans"; I'm still learning to face some political realities....)
Policy not party!
gob--when you have time, a link for your Kuttner reference?
T/U.
Kuttner links
well, here's my comment to hipparchia's post on Kuttner, Robert Reich, and Paul Starr debating the public option.
Y/W
Policy not party!
Digby
seems to be playing "good soldier" on this issue. I've noticed it for a while, and I'm not quite sure why. In fact, while France, for example, isn't' strict single payor what they are is very close to single payor - everyone is covered for X% by the government (80% for France) and then you buy top up insurance for the remaining 20%. That's rather similiar to how people have medigap insurance, actually. Does she want to argue that medicare isn't single payor?