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Democrats and single payer

Rockfish1

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Sep 2, 2001
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So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.
 
So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.

Personally, I'm pulling for California to lead the way.

It will be informative (and likely quite entertaining, for those of us who don't live there) to watch.
 
So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.
Bernie is leading by default. He had a decent sized core of voters, with Hillary out of the picture there is no one else right now. That leadership vacuum is a problem, but it will sort itself out.

As to Medicare for all, it is a problem. There are no good half measures. Healthcare reform that improves the system is hard and must be all-encompassing. We have nibbled since 1932 and the system is not greatly improved. These partial fixes create the same problem you mention, voters expect the fix to noticeably improve the system. When voters feel solutions do no improve the system, why vote Democratic.

Somehow the union guy in PA, OH, MI, and WI need to see that one of the main reasons their wages have stagnated and their jobs are in danger is because of the employer cost of healthcare. Medicare for all hits right at that issue. I don't get why we have so failed to get those union workers to understand that.
 
So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.
Very well said.
 
Hilary represents the Dem party, which no longer represents the working man, but is owned by the moneyed interests just as the GOP is.

same with Bill and Obama.

any candidate that actually represents the working man, (not just pays lip service to that end), will have the party, either party, against them.

if you allow govt to be bought, which we have, there is a 100% chance it will be, as it has been.
 
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So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.

Why is single payer better than full government-provided care? Most people think Medicare loses $60 billion, (that's with a "B") per year to fraud and waste. How much would that increase with a medicare for all approach? Having public pay for privately provided care is an invitation for significant abuse--as we now see.

I think there are better approaches to single payer, but if we end of with a single something or other, it must be single full government ownership.

Edit: Fixed link
 
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Why is single payer better than full government-provided care? Most people think Medicare loses $60 billion, (that's with a "B") per year to fraud and waste. How much would that increase with a medicare for all approach? Having public pay for privately provided care is an invitation for significant abuse--as we now see.

I think there are better approaches to single payer, but if we end of with a single something or other, it must be single full government ownership.

you kind of lost me on what exactly your point is.

but Medicare and Medicaid are not "government provided care", they are govt reimbursed care.

as to the fraud and abuse thing,

A), i have no idea what the actual dollar losses to fraud and abuse with Medicare and Medicaid are, but i'm guessing they're pretty substantial with other health insurance claims as well, so until you can give an accurate rate of fraud/abuse loss with both Medicare/Medicaid and other types of health insurance, it's impossible to make a comparison. (or are you implying there is no fraud and abuse with private health insurance)?

B), structure and oversight are 2 totally and separate concepts.

if oversight is bad, you address the oversight, not the structure.

structure is what we're discussing here.

if you wish to discuss oversight, that's a totally separate discussion, and has nothing to do with structure.


C) in any, i repeat ANY, insurance format, govt run or privately run, you effectively have "public payment for privately provided care" as you put it. (any large third party payer set up).
 
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Why is single payer better than full government-provided care? Most people think Medicare loses $60 billion, (that's with a "B") per year to fraud and waste. How much would that increase with a medicare for all approach? Having public pay for privately provided care is an invitation for significant abuse--as we now see.

I think there are better approaches to single payer, but if we end of with a single something or other, it must be single full government ownership.
Silver Streak?
 
So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.
I'm not 100% clear what you think the problem is here. Is it that there is no chance this bill will become law, and you fear for the electoral consequences of Democrats who sign on? Or are you more concerned with what happens in 2020 if the Dems take back at least one house of Congress next year, and this thing still goes nowhere? Seems to me the primary purpose of this bill is simply to shift the center of the discussion. Bernie seems like exactly the right guy to be doing that, because other Dems will always be somewhat insulated from him in the eyes of much of the public (or maybe I'm being naive on that point in a post-2016 world).
 
I'm not 100% clear what you think the problem is here. Is it that there is no chance this bill will become law, and you fear for the electoral consequences of Democrats who sign on? Or are you more concerned with what happens in 2020 if the Dems take back at least one house of Congress next year, and this thing still goes nowhere? Seems to me the primary purpose of this bill is simply to shift the center of the discussion. Bernie seems like exactly the right guy to be doing that, because other Dems will always be somewhat insulated from him in the eyes of much of the public (or maybe I'm being naive on that point in a post-2016 world).
Rock is only stating the facts, millions of employed workers have very good insurance. Union workers have top tier coverage. If you give them less than what they have you lose votes.
 
I'm not 100% clear what you think the problem is here. Is it that there is no chance this bill will become law, and you fear for the electoral consequences of Democrats who sign on? Or are you more concerned with what happens in 2020 if the Dems take back at least one house of Congress next year, and this thing still goes nowhere? Seems to me the primary purpose of this bill is simply to shift the center of the discussion. Bernie seems like exactly the right guy to be doing that, because other Dems will always be somewhat insulated from him in the eyes of much of the public (or maybe I'm being naive on that point in a post-2016 world).
In fairness to your questions, I'm still sorting out how this strikes me wrong. The first thing is Sanders himself, who isn't a Democrat and ultimately has no loyalties to anyone other than himself and his cause. The second thing is also Sanders, who only wants everything and attacks the motives of people on his side if they disagree on tactics. The third thing is also Sanders, who doesn't do any of the hard wonky work to make policy and instead encourages people do believe that no such hard work is required -- that it's all just a matter of populist consciousness-raising.

I guess it's really Sanders that's bothering me, even though I'd be happy with single-payer health care. He's effectively telling people that if only they'd get more excited about him, then their excitement would transform otherwise intractable problems. I think this is a perfect formula for a disillusioned and angry base.
 
So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.

not sure what you're beef with Bernie is, unless you're here representing the Dem party rather than yourself.

saying Bernie isn't detailed oriented is disingenuous.

he's certainly as detail oriented as anyone when speaking, and moreso than most.

as for detailing line by line on a bill that would vastly exceed a thousand pages, that would be beyond crazy, as anyone could derail the main goal just by arguing every detail to death, and never even have to address the main concept being pursued.

and just what "direction" is it that you like, that you think "many" in the Dem party want to go.
 
Rock is only stating the facts, millions of employed workers have very good insurance. Union workers have top tier coverage. If you give them less than what they have you lose votes.
The threshold problem is persuading people on the front end that you can eliminate the system they know because you'll deliver something better on the back end. People who think that's a trivial matter have apparently forgotten how hard it was to accomplish much less in Obamacare -- even though Obamacare had virtually no effect on the coverage most of us have, it was still relentlessly demagogued.
 
In fairness to your questions, I'm still sorting out how this strikes me wrong. The first thing is Sanders himself, who isn't a Democrat and ultimately has no loyalties to anyone other than himself and his cause. The second thing is also Sanders, who only wants everything and attacks the motives of people on his side if they disagree on tactics. The third thing is also Sanders, who doesn't do any of the hard wonky work to make policy and instead encourages people do believe that no such hard work is required -- that it's all just a matter of populist consciousness-raising.

I guess it's really Sanders that's bothering me, even though I'd be happy with single-payer health care. He's effectively telling people that if only they'd get more excited about him, then their excitement would transform otherwise intractable problems. I think this is a perfect formula for a disillusioned and angry base.


we get it, you represent a political party, and Bernie represents a cause that neither political party's activist investor owners represent.

anyone who's loyalties are to a political party, need to reevaluate their loyalties.
 
The fact that single payer is no longer considered crazy radical is a watershed moment. But yes, implementation is where the hard work lies.

I personally think it would not be difficult to phase it in. Make Medicare a public option, available to employers as an option to their private plans. Restrict it to older workers initially, then lower the eligibility age over time. As employers move their older workers to Medicare (while still paying much or most of the cost as they do now with their private plans), the pool of those under private plans becomes younger and healthier, offsetting any problems that might arise from the pool size becoming smaller. At some point, when the eligibility age gets low enough and/or the public is ready for it, then just drop the eligibility age to conception and make Medicare the default for all.
 
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In fairness to your questions, I'm still sorting out how this strikes me wrong. The first thing is Sanders himself, who isn't a Democrat and ultimately has no loyalties to anyone other than himself and his cause. The second thing is also Sanders, who only wants everything and attacks the motives of people on his side if they disagree on tactics. The third thing is also Sanders, who doesn't do any of the hard wonky work to make policy and instead encourages people do believe that no such hard work is required -- that it's all just a matter of populist consciousness-raising.

I guess it's really Sanders that's bothering me, even though I'd be happy with single-payer health care. He's effectively telling people that if only they'd get more excited about him, then their excitement would transform otherwise intractable problems. I think this is a perfect formula for a disillusioned and angry base.
I agree on the issues of implementation. I'm just not sure I'm where you are on the worry about a disillusioned base. Mostly because I don't think the bill will ever be voted on, and Democrats can always blame the GOP. That's why I asked about 2020. If the Dems sweep into Congress, it will be harder to blame the GOP for future failures. I'd hate to see Trump reelected on the coattails of Congressional Democratic incompetence, but...

Well, Congressional Democrats, after all.
 
I agree on the issues of implementation. I'm just not sure I'm where you are on the worry about a disillusioned base. Mostly because I don't think the bill will ever be voted on, and Democrats can always blame the GOP. That's why I asked about 2020. If the Dems sweep into Congress, it will be harder to blame the GOP for future failures. I'd hate to see Trump reelected on the coattails of Congressional Democratic incompetence, but...

Well, Congressional Democrats, after all.
Any news out of tonight's Whitehouse Dinner? I am busy with baseball.
 
Any news out of tonight's Whitehouse Dinner? I am busy with baseball.
Supposedly Trump agreed to DACA legislation as part of boarder security package, excluding the wall. Also agreed to ACA price supports. No, I am not kidding. Just reported by MSNBC Lawrence.
 
you kind of lost me on what exactly your point is.

but Medicare and Medicaid are not "government provided care", they are govt reimbursed care.

as to the fraud and abuse thing,

A), i have no idea what the actual dollar losses to fraud and abuse with Medicare and Medicaid are, but i'm guessing they're pretty substantial with other health insurance claims as well, so until you can give an accurate rate of fraud/abuse loss with both Medicare/Medicaid and other types of health insurance, it's impossible to make a comparison. (or are you implying there is no fraud and abuse with private health insurance)?

B), structure and oversight are 2 totally and separate concepts.

if oversight is bad, you address the oversight, not the structure.

structure is what we're discussing here.

if you wish to discuss oversight, that's a totally separate discussion, and has nothing to do with structure.


C) in any, i repeat ANY, insurance format, govt run or privately run, you effectively have "public payment for privately provided care" as you put it. (any large third party payer set up).


I fixed the link. Maybe you should read it. My point is that public payment for privately provided care invites deliberate fraud as well as inviting overcharging and over utilization.

A much better approach would be total public ownership of the whole shebang. That would take away the incentives to milk the system.

Medicare uses a "pay and chase" system of reimbursement. The providers love it. But it is fraud and abuse invitation. Any system of public single payer will need to address this issue. I'm not sure the providers would stand for the review that would be needed to determine payments prior fund transfers. It's a conundrum.
 
I fixed the link. Maybe you should read it. My point is that public payment for privately provided care invites deliberate fraud as well as inviting overcharging and over utilization.

A much better approach would be total public ownership of the whole shebang. That would take away the incentives to milk the system.

Medicare uses a "pay and chase" system of reimbursement. The providers love it. But it is fraud and abuse invitation. Any system of public single payer will need to address this issue. I'm not sure the providers would stand for the review that would be needed to determine payments prior fund transfers. It's a conundrum.

define "total public ownership".

you mean the docs, staff, and everyone else is a govt employee working on salary or hourly wage?

govt owns all the infrastructure and equipment? (eminent domain?)

if so, interesting concept, but an infinitely tougher sell and do, both logistically and politically, than just transitioning to single negotiator, then single payer, as i suggested in my other thread.
 
define "total public ownership".

you mean the docs, staff, and everyone else is a govt employee working on salary or hourly wage?

govt owns all the infrastructure and equipment? (eminent domain?)

if so, interesting concept, but an infinitely tougher sell and do, both logistically and politically, than just transitioning to single negotiator, then single payer, as i suggested in my other thread.

Yes, that is what I mean. The VA model or the NHS in the UK. This is not my prefereed solution. But given a binary choice between national single payer (Medicare for all) or taking everything in house and having total Government care, I think the latter would be better for a number of reasons. The former would be easier, but in the long term, I don't think it could be sustainable, and the government will end up owning the facilities and employing the providers anyway.
 
Yes, that is what I mean. The VA model or the NHS in the UK. This is not my prefereed solution. But given a binary choice between national single payer (Medicare for all) or taking everything in house and having total Government care, I think the latter would be better for a number of reasons. The former would be easier, but in the long term, I don't think it could be sustainable, and the government will end up owning the facilities and employing the providers anyway.

and no sooner would you do it, than the moneyed interests would push for "privatization" non stop.

full govt ownership might be a laudable end goal, but like i said, it would be infinitely more impossible, both politically and logistically, than even just single payer.

like i said, the most doable, both politically and logistically, is to first transition to single negotiator. (piece of cake logistically, and the only political obstacle is the moneyed interests, not the citizenry or anyone with employer distributed healthcare.

once you achieve single negotiator, you can then politically transition to single payer.

then when you achieve single payer, you can much more easily transition to full govt ownership if you still wish to.

but maybe "doable", is exactly what the powers that be wish to avoid at all costs, as that's not what the party owners are paying good money for.

as for full govt ownership, you can't get there from here, and you know it.

flat impossible.

therefore, anyone pushing even trying to get there from here is just trying to deflect away from doing something that is quite doable, now, like transitioning to single negotiator first, by deflecting the debate to something that has absolutely zero chance of happening from where we are now.

please tell me why we shouldn't pursue the road i suggested in my other thread, or does it possibly solve a problem the moneyed interests don't want solved, therefore don't want said solution even mentioned or debated.

https://indiana.forums.rivals.com/t...ansition-to-single-payer.156980/#post-2215357
 
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The fact that single payer is no longer considered crazy radical is a watershed moment. But yes, implementation is where the hard work lies.

I personally think it would not be difficult to phase it in. Make Medicare a public option, available to employers as an option to their private plans. Restrict it to older workers initially, then lower the eligibility age over time. As employers move their older workers to Medicare (while still paying much or most of the cost as they do now with their private plans), the pool of those under private plans becomes younger and healthier, offsetting any problems that might arise from the pool size becoming smaller. At some point, when the eligibility age gets low enough and/or the public is ready for it, then just drop the eligibility age to conception and make Medicare the default for all.
Democrats are shifting the Overton window, and I agree that's a good thing. But Republicans will not sit idly by as Democrats legislate a transition to the anathema of single payer. And the majority of us who are both risk averse and happy with what we've already got will be vulnerable to the inevitable demagoguery. Plus, I think Sanders himself would denounce the incremental approach you lay out.

I'd be happy with single payer, and I'd support a stepwise approach to get there over time. But that's not what I hear Bernie talking about.
 
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Democrats are shifting the Overton window, and I agree that's a good thing. But Republicans will not sit idly by as Democrats legislate a transition to the anathema of single payer. And the majority of us who are both risk averse and happy with what we've already got will be vulnerable to the inevitable demagoguery. Plus, I think Sanders himself would denounce the incremental approach you lay out.

I'd be happy with single payer, and I'd support a stepwise approach to get there over time. But that's not what I hear Bernie talking about.
Some news reports are actually describing Bernie's plan as "incremental." Could be BS, but just noting. I haven't had the time to look it over, so I have no opinion on this point.
 
Why is single payer better than full government-provided care? Most people think Medicare loses $60 billion, (that's with a "B") per year to fraud and waste. How much would that increase with a medicare for all approach? Having public pay for privately provided care is an invitation for significant abuse--as we now see.

I think there are better approaches to single payer, but if we end of with a single something or other, it must be single full government ownership.

Edit: Fixed link
From your linked article:

According to the Federal Bureau of Investigation (FBI), health care fraud costs the country an estimated $80 billion a year, or three percent of the $2.7 trillion in health care costs in 2012. This is the standard figure used to describe the amount of fraud.
Expanding Medicare would do nothing to increase the aggregate amount of fraud in the system. It would just mean that more of the fraud would occur within Medicare, and less would occur within private insurance.

Your point is a red herring. It is (if anything) an argument against any form of third-party payer insurance for anything. Nor does the existence of insurance fraud mean that the only logical policy is full on socialized medicine. That's silly.
 
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Some news reports are actually describing Bernie's plan as "incremental." Could be BS, but just noting. I haven't had the time to look it over, so I have no opinion on this point.
It's certainly incremental in the sense that he hasn't yet proposed a plan to pay for the benefits he proposes to provide.
 
I'm not 100% clear what you think the problem is here. Is it that there is no chance this bill will become law, and you fear for the electoral consequences of Democrats who sign on? Or are you more concerned with what happens in 2020 if the Dems take back at least one house of Congress next year, and this thing still goes nowhere? Seems to me the primary purpose of this bill is simply to shift the center of the discussion. Bernie seems like exactly the right guy to be doing that, because other Dems will always be somewhat insulated from him in the eyes of much of the public (or maybe I'm being naive on that point in a post-2016 world).
I agree. I think the more people hear about single payer the less radical it seems to more Americans and that can get us to single payer faster. Single payer isn't really radical and many countries have it and pay less than we do per capita. Rockfish is right that we can't get there all at once but talking about it doesn't mean that we have to get there all at once. It's normalizing the idea. Maybe the answer is to start taking other government programs and replacing them with Medicare if Medicare for all is the right way to go. Maybe replacing Medicaid with Medicare is a good first step. All the funding for Medicaid could be put into Medicare. You can take my Tricare and replace it with Medicare. Just eliminate every government healthcare program one at a time and replace it with Medicare then replace employer provided healthcare with Medicare by allowing companies to buy in to it. They would if it was a better deal for the employers. I'm not a wonk so I don't know how any of the details of this would work but it seems logical that the government could move the money its spending for an existing program to Medicare and eliminate the old program. Bottom line is I think it's great that more people think single payer is the ultimate solution now than thought it was the solution two years before now.
 
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Yes, that is what I mean. The VA model or the NHS in the UK. This is not my prefereed solution. But given a binary choice between national single payer (Medicare for all) or taking everything in house and having total Government care, I think the latter would be better for a number of reasons. The former would be easier, but in the long term, I don't think it could be sustainable, and the government will end up owning the facilities and employing the providers anyway.
The retired military I know aren't all big fans of the VA. Some like it OK but most aren't big fans. And we've all heard about the big problems they have had in recent years. I don't know if VA for all would be a popular or good solution.
 
So lots of Democrats are signing on to Bernie Sanders' new single payer bill. While I believe that universal coverage should absolutely be the Democratic Party's goal, and I think single payer would in the abstract be the best way to achieve universal coverage, I agree with Jon Chait that "Bernie Sanders's Bill Gets America Zero Percent Closer to Single Payer":

The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem.

. . . In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.

. . . There are ways around the problem. Mostly they involve boring, incremental reforms that fall well short of a real single-payer plan: lowering the age at which people can buy in to Medicare, creating a public plan on the exchanges, perhaps creating ways to encourage employers to cover their workforce through Medicare or a public plan.

Sanders is not a details person, though. He prefers to act as though the important barrier is the abstract notion of government-run insurance, turning every question about specifics into a question about values. But the concept of a government-financed insurance program has never been the controversial part. (This is why single-payer Medicare is a beloved institution Republicans swear up and down never to change, while privatized Obamacare is a detested socialist monstrosity.) The controversial part has always been the mechanics of change.

Obama himself said many times that, if he were starting a health-care system from scratch, he would prefer a single-payer system. Sanders’s single-payer bill is vague enough that the Democrats co-sponsoring it are really doing nothing more than saying the same thing Obama did: A single-payer plan would be nice, in a world that looks nothing like the one we inhabit.
This has always been my problem with Sanders, and (credit where it's due) it's also a critique Hillary Clinton makes pretty well. Bernie has some aspirational ideas, but he hasn't a clue how to make them happen. And he scorns all of the "half measures" that in our system are the only way we'll ever achieve the goal of universal coverage.

I'm with Max Weber, who described politics as "a strong and slow boring of hard boards." By all means let's have big ideas and rallies and enthusiasm. But political leaders who wave off the hard work required to actually make something happen aren't doing anyone any favors.

As much as I like the direction that many in the Democratic Party want to go, Bernie isn't leading anyone to the promised land. And if Democrats start making ill-considered promises they can't keep, they'll have all the problems that now plague the GOP.

In short, I'm not very excited that Bernie is leading this parade.


A few questions concerning the healthcare debate. what are the goals.


Insure everyone?
Get medical care for everyone?
Reduce costs?

Does single payer mean Government Run Health care?
Should the 90% of people who get good/excellent healthcare accept reduced healthcare so that the other 10% receive healthcare?
 
The retired military I know aren't all big fans of the VA. Some like it OK but most aren't big fans. And we've all heard about the big problems they have had in recent years. I don't know if VA for all would be a popular or good solution.
I think the VA problems are indicative of the Fed Gov's inability to run anything effectively.
 
From your linked article:

According to the Federal Bureau of Investigation (FBI), health care fraud costs the country an estimated $80 billion a year, or three percent of the $2.7 trillion in health care costs in 2012. This is the standard figure used to describe the amount of fraud.
Expanding Medicare would do nothing to increase the aggregate amount of fraud in the system. It would just mean that more of the fraud would occur within Medicare, and less would occur within private insurance.

Your point is a red herring. It is (if anything) an argument against any form of third-party payer insurance for anything. Nor does the existence of insurance fraud mean that the only logical policy is full on socialized medicine. That's silly.

Nope. Medicare improper payments are around 10% of total Medicare disbursements, assuming the annual $60b figure is about right. As you note, the figure for the total system is much less.

What might be worse, and is a point I haven't fully investigated, is that the improper payments are probably more concentrated in Part B, than parts A, C, or D. Part B is what people think of when they want Medicare for all to see their doctor and is where the pay and chase flourishes.
 
I think the VA problems are indicative of the Fed Gov's inability to run anything effectively.

I'm not saying the government is perfect, by any means, but there are two problems I have with this statement:

1) Our military seems to be run fairly well. We have the best universities. NASA doesn't suck. Some other agencies do a decent job.

2) There is an endless example of Big Business doing an AWFUL job so I always laugh when people say, "If only we ran the government like a business....." How many people HATE their cable company? Equifax? Wells Fargo?
 
A few questions concerning the healthcare debate. what are the goals.


Insure everyone?
Get medical care for everyone?
Reduce costs?

Does single payer mean Government Run Health care?
Should the 90% of people who get good/excellent healthcare accept reduced healthcare so that the other 10% receive healthcare?

You've nailed the political talking points. The goal not often mentioned is improving the health of Americans. Obesity is a problem. Diabetes is a problem. Hypertension is a problem. Drug abuse is a problem. All of these have strong lifestyle components. To address these issues, we need to be judgmental of people's life choices. Our politics doesn't permit that, so we instead talk about "Medicare for all!"
 
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