The strange insistence on Single Payer. I don't understand it.

[DanTex]

Single Payer is one of several ways to provide universal healthcare. It is far from the only way that other advanced countries have done it. It is not even what most other countries have. More common are public-private hybrid systems. And some countries like Holland have basically a better version of Obamacare -- i.e. an individual mandate.

And yet single payer is still one of the sticking points in the Democratic platform. It's one of the things Bernie is still asking for, and complaining that the rest of the committee doesn't want that particular form of universal healthcare. I do not understand why they just can't all agree that we need universal healthcare, something that Hillary and Bernie and the Democratic party all agree on, rather than fighting about the specific form that the universal healthcare will take. Why does it even matter? If you look around the world, single payer systems don't perform notably better or worse than hybrid or mandate systems. There are benefits and costs to either one, but they have all been proven, in practice, as effective ways to achieve universal healthcare.

What matters is that everyone has access to healthcare. Who cares whether we model it after the British system, the Dutch system, or the French system, or some combination of those or anything else?

[leeroysphitz]

1. I'll bet you don't n/t

[DanTex]

3. Care to explain? What's wrong with the Dutch healthcare system?

[kcjohn1]

8. Look up their premiums

And tell me its anywhere near our system. They don't have those insurer's making billions in profit.

For all practical purposes they are regulated to the point they are an extension of the government.

[DanTex]

13. They are better regulated, yes. Exactly what Hillary wants to do: improve and extend Obamacare.

But it is definitely not a single payer. Bernie's delegates are insisting on single payer, to the exclusion of systems like the Dutch/Swiss/German/etc. Which makes no sense.

Nobody is arguing for keeping the current system without improvements. Everyone wants universal coverage and better cost controls. I don't see why it has to be "single payer" specifically. Single payer may or may not be the best way to get there. Why tie ourselves down to a specific implementation, when there are others that are just as good? Why not stick to the goals, which we all agree on, and leave multiple avenues to get there available when we work out the policy details?

[kcjohn1]

19. ACA is nowhere near any European model

Is Hillary going tell these insurers that they forego billions in profits?

Majority of these countries it costs $10 to get healthcare. Current system requires people spend $5000 before their deductibles kick in. If you think we are just a regulation here and there to get to that system, I don't know what to tell you.

[DanTex]

20. Correct, which is why Hillary wants to extend and improve it.

Health insurance profits are an extremely tiny portion of healthcare costs -- less than 1% of the total. From the point of view of healthcare policy and cost control, they are irrelevant, basically rounding error. Sure, reduce their profits. Or not. Who cares? What matters is universal coverage and affordable care.

[kcjohn1]

29. So everyone else is able cover everyone

But the richest country ever is unable to cover huge chunk of the population despite spending significantly more than similar countries?

The reason is simple. Profit. You need to get rid of majority of these costs. The way you do that is through cost controls. The way you do that efficiently is for the government pool risk (insurance) and mandate though it's purchasing power price to care providers. The current system relies on many smaller insurance companies who's sole motive is profit to negotiate with deliverables who's sole motive is profit.

[DanTex]

32. Insurance profits are less than 1% of healthcare costs. Getting rid of the profit won't make any

noticeable difference.

Cost controls, yes, we need those. Single payer isn't necessary to control costs, as plenty of European countries have demonstrated. And it's also not a given that single payer actually would control provider costs. A single payer could drive a hard bargain, but that could result in hospital and clinic closures, as some providers wouldn't be able to stay in business with lower revenues, which would then result in reduced care quality and some areas without sufficient provider coverage, and so on.

It's complicated, and single payer is not a magic solution, and it's definitely not the only solution.

[KPN]

58. Insurance is just a part of it. Not sure about the 1% figure though. But you overlook the

entire story/picture: that because our system of privately provided insurance (and lets not forget at high costs to the consumers -- whether that be individuals, corporations or other entities) health providers were able to demand higher and higher fees for their services because private insurance could just raise premiums to cover those costs and still make a profit. Costs of health service spun out of control under this model.

So given the current prices, how do we effectively get a grip on health provider fees (lower them to a sustainable level that is relatively affordable for all) without single payer?

Alternatives are great -- but they have to be effective. In my view, our current system can only be roped in with a single payer system. I have not seen any other proposal that handles this dynamic. Have you? If so, I'd be interested in learning more about it.

[Gothmog]

60. The problem is that the numbers do not make sense for Sanders single payer plan

We need to move towards universal coverage at some point but Sanders plan would never work. Sanders plan relied on speculative cost savings. I trust Prof. Krugman on this http://krugman.blogs.nytimes.com/2016/01/19/weakened-at-bernies/?_r=0

On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan” isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with much lower middle-class taxes than would probably be needed in practice.

To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.

Again, as noted by Prof. Krugman this plan does not add up. The cost savings may or may not be achieved which affects the cost of these plans

[KPN]

80. And Krugman's cursory assessment was rebutted

by numerous highly regarded economists shortly after it appeared in his NY Times blog/column. Krugman is in Hillary's camp and hopes to play a role in her administration, especially after Obama snubbed him; of course, he was going to criticize Bernie's proposal -- regardless of what it was. Krugman never even ran the numbers.

Show me an alternative to single payer that can control not only insurance costs, but provider fees and prescription costs effectively such that everyone has access to adequate health care. That's the goal -- I don't care how we get there. I doubt Bernie does either, but thus far, the single payer idea meets that standard best.

[DanTex]

84. No, it wasn't. It was rebutted by one not-particularly-highly regarded economist: Gerald Friedman.

The highly regarded economists and policy analysts that chimed in (e.g. Paul and Christina Romer) all sided with Krugman. Most of the "rebuttals" were the kind of thing you are offering: ad-hominem attacks at Krugman and his supposed ulterior motives that were designed to distract from the facts and make things personal.

[KPN]

102. The Romers! God help us ... that's all I can say

when democrats defend our current economic model of deregulation, privatization, and unfettered globalism. You are defending obnoxious salaries. The CEO of my small local hospital makes half a million a year or more now. Is that necessary? Would that exist if hospitals hadn't been privatized? You are defending a parasitic system that devours the lower classes. Have you no conscience?

[DanTex]

106. Yes, the Romers. They are highly regarded economists. As is Krugman.

I have no idea what you are talking about with "deregulation, privatization, and unfettered globalism." I'm talking about the analysis of Bernie's economic projections that they and Krugman made. It's a question of whether numbers add up, and they don't.

[KPN]

111. Our health industry is one of the best examples of unfettered capitalism.

That's what I'm talking about -- something directly relevant to your statement about having no idea why some insist on single payer. And what I said was show me a system that accomplishes the goal of reducing the gross profiteering going on in health care, and making it affordable and accessible to all, and then I'll consider it. You criticize Bernie's proposal as totally unrealistic while many see it as a matter of will. You want to hang it up on the analysis of offsetting savings-costs without even giving it a chance to get fully explored. And I'm calling bullshit on that. Everything we do as a nation has a cost to somebody. In the last 4 decades, costs have been shifted in terms of growing burden on to the lower classes. To me, not recognizing that and settling for something other than single payer which by far does the best job controlling costs, is pure neoliberal thinking. I'm tired of that crap.

[DanTex]

113. The Dutch system accomplishes those things without single payer. As I mentioned in the OP.

[KPN]

161. In Holland, where admin costs were never anywhere near the gross levels

we have here in USA. Show me the numbers. You are perplexed that single payer supporters ignore alternatives given the numbers associated with single payer, show us the numbers for Holland's system applied to USA and how that accomplished the goal of AFFORDABLE (i.e., percent of GDP) here. Can you do that?

[Gothmog]

90. You are wrong but continue to believe in your fantasy

I live in the real world

[KPN]

104. Yeah, the real world of unfettered parasitic

capitalism! Bully for you. Enjoy it while you can.

[DanTex]

62. The combined profits of the 5 largest insurers were less than 0.5% of healthcare costs.

And it's a pretty consolidated market, so I doubt that the smaller insurers will push that number up much higher.
http://opinionator.blogs.nytimes.com/2011/11/03/less-than-26-billion-dont-bother/

Health insurance profits and administrative overhead are the only direct ways that single payer saves money. The rest, like you say, has to come from providers. And reducing provider costs is hard, with or without single payer. If you just pay hospitals and clinics left, some of them will have to shut down, because they have costs too.

Also, there are ways to do this without single payer. There's all-payer rate setting, an idea O'Malley was pushing, that just forces a hospital to charge the same amount for a procedure regardless of what insurance company covers it. Or the government can just step in and put in price controls.

The point is, single payer is not necessary, nor sufficient for controlling costs. It would get rid of health insurance profits, which are trivial. It would probably reduce insurance overhead costs, which are less trivial but still only a small slice of the pie, but it's arguable how much they would actually be reduced by. Beyond that, is the hard part, which is reducing the cost of care. That's the main reason we pay more than other countries, and there's no easy fix.

[insta8er]

82. Hey Dan....There are more ways to skin a cat, have a look at what is happening in my state.

http://www.al.com/news/index.ssf/2014/08/top_10_executives_at_alabamas.html

[hollysmom]

153. 1% a million % doesn't matter, I have worked for non-profit insurance companies that

manage to funnel quite a lot of money to the partners , board members and officers of the company in outrageous salaries, if you are not looking at that , you are not looking at the really money to be made in insurance. Currently there is a great misunderstanding of the therm non-profit. Just spend all your money on expenses, and you are non-profit and get all kinds of government benefits, while you can rip of people with out missing a night's sleep.
Blue cross blue shield used to be non-profit (they were talking about changing decades ago, I haven't kept up) but nicely paid all the executives working there. They weren't terribly interested in efficiency, because they needed waste to keep it non-profit. so 20 to 30 percent could be spent on executives.
this is jsut an aside.

[Exilednight]

145. 1%? I have to see a link before I believe that. Politifact puts it just under 12%

[DanTex]

147. LOL. 12%. No wonder you didn't provide a link. Truly hilarious!

http://opinionator.blogs.nytimes.com/2011/11/03/less-than-26-billion-dont-bother/

[Exilednight]

149. That would be United Health, Aetna, Cigna, Humana, and Anthem. Which makes sense. Companies that

Large make a minute amount percentage wise, but a lot of earnings are plowed into investments, thus keeping their profit margin down artificially.

[DanTex]

150. Good thing you didn't try to provide a link for that 12%. Because that would truly be funny.

Even more funny than your conspiracy theories about earnings and investments.

[Exilednight]

154. These aren't conspiracies. you can find their earnings statements

In the public domain. They take their earnings, invest them into other companies, which is not unusual for any company, and this deflates their profit line.

Too many people confuse earnings and profits.

[sufrommich]

2. There's also a strange denial that the American people

can't be frightened into voting against it. Universal healthcare won't come all at once in the U.S.,my guess is that it will start with an "opt in" choice for government sponsored healthcare.

[kcjohn1]

4. Single payer is the only way

Profit model and healthcare don't go together well.

People confuse insurance with healthcare. It is worthless to have coverage when it requires arm and leg to actually get healthcare through deductibles. This is why Obama care will ultimately fail and we will need to start from scratch.

[DanTex]

5. Why does it work in Holland and other countries then?

[kcjohn1]

12. You fundamentally don't understand the difference

In Holland insurers have to offer same rate to everyone regardless of age and health. This is essentially single payer.

They pool the risk and if one insurer has higher payouts they get subsidized by the government.

[DanTex]

15. No, you fundamentally don't understand the differences.

Single payer has a very specific meaning: a single insurer, the government. A highly regulated individual mandate is not a single payer. By definition. Nobody who studies healthcare policy would consider the Dutch system a single payer, "essentially" or otherwise. It achieves the same result -- universal coverage -- but by different means.

Insisting on single payer specifically excludes workable systems like the Dutch/German/Swiss which are not single payer.

[kcjohn1]

23. Call it whatever you want

Single payer to me = everyone has access to health care (not insurance) regardless of financial situation.

Canada has single payer. Technically the European countries might be called something else with key differences but they are much much much closer to the single payer system than whatever we have currently.

You are delusional if you think this current system is close to what they have over there. For that to happen, 100s of billion of profit in the system needs to be eliminated. That is going to be massive effort.

[DanTex]

28. Why not use the accurate terminology?

Among people who study healthcare policy, these terms have clear, unambiguous meaning:

Universal healthcare = everyone has access to health care.
Single payer = there is a single insurer, the government.

If you're going to use "single payer" to mean "universal healthcare", then we need a new word for what "single payer" used to mean. And it gets particularly confusing when people start talking about "single payer" in the Democratic platform. Because Hillary is in favor of universal healthcare, just not by means of single payer. But Bernie's people want the word "single payer" in the platform. Maybe we could have avoided this whole controversy by just sticking to the term "universal healthcare".

[kcjohn1]

31. Because that is not what politicians like Clinton mean

When they say universal care they mean everyone has insurance. Obama is always saying how many more people are insured but that is irrelevant to universal care because all this is insurance in case dramatic sickness with the exception of Medicaid which is government run program.

[DanTex]

36. Of course that's what she means. And, no, Obamacare insurance doesn't just cover catastrophic.

By law they have to cover a lot more than that, including preventative care, prescription drugs, etc. I don't know where you got that idea.

http://obamacarefacts.com/essential-health-benefits/

[BlueCaliDem]

64. It's knee-jerk Reactionaries that rant against ObamaCare without really understanding it who

are the loudest, most pro-single-payer advocates - forgetting, of course, that although we are a country, we are a country made up of 50 individual States with 50 different "presidents" in the form of Governors, and their own legislatures. These mini-governments can change a lot if they have wealthy backers - and they do.

These are the same knee-jerk Reactionaries hating on Obama's TPP, which is a very strong trade agreement - strongest ever negotiated that will protect the environment, worker's rights, the right to unionize, and protect gov'ts should a corporation lose profit and want to sue a government (as the Mexican gov't had been sued by Metaclad corporation under the old trade agreements, giving Metaclad a $15 million judgment). These provisions are outlined in Chapter 9 of the TPP. it's also why Republicans have done a 180 and now attack the TPP - although silently so that too many people still believe they're for it when they no longer are.

It's also why it's so critical for us to put more progressives on our SCOTUS so we can avoid the same b.s. lawsuits by Republican lawyers from various States in their quest to undo ObamaCare (and other progressive legal precedence) as our future Madam President works to expand and strengthen ObamaCare, women's reproductive rights, civil rights, voting rights, etc.

Personally, I would like to see a Public Option. It's what I wanted from the start. I've never been a single-payer advocate. I see the Public Option as a sound and affordable and more effective compromise between single-payer and universal healthcare.

[Nay]

67. Unfortunately, Obamacare DOES just cover catastrophic incidents, if the

insured person/family makes a middle-class income. My son and his family (wife and one kid) pay over $550 per month for a policy that begins to pay out after a $13,000 yearly deductible. Sure, they each get one free checkup per year, etc., but if anything truly goes wrong with any one of them, they'll have to come up with $13,000 first. THIS is what people are talking about when they claim that Obamacare is basically a catastrophe coverage. If you make even a middling wage, you are caught in that loop. Luckily for them, they have the bank of Mom and Dad (us) to help, but lots of people don't.

Obamacare has made it possible for totally impoverished people to go see a doc for cheap, I agree. But unless you are truly poor, you are in the catastrophic bunch.

[DanTex]

69. You're kind of describing the opposite.

It covers a lot more than catastrophic, but it has a high deductible. But usually you don't hit the deductible unless there is a catastrophe. So the high deductible means that in the event of a catastrophic event, you are out of pocket a lot of money.

But for non-catastrophic care (i.e. physicals, prescription drugs, hospital for say a broken bone, etc.), there will be copays, but you typically won't hit the deductible. If your son does have a catastrophic event (god forbid), then he/you will be out $13K, which is a lot, yes. Although you don't have to come up with it first, they'll treat you and you owe it later. But it's likely only in the event of a serious medical event that the $13K is hit.

[Nay]

70. And it means that if your injury or illness costs, say, $10,000, you get to

pay it ALL out of pocket. Obamacare won't pay a dime. That's the problem. Most families don't have $10,000 lying around.

[Lord Magus]

57. Words and terms have meanings.

You don't get to invent your own meanings and insist that everybody else should use them.

[insta8er]

77. Dan, I have lived a good deal of my adult live in Holland. I used to have single payer there...

I can tell you that you are wrong. The system used to be far better before our right wing government had to side with the insurance industry and moved to a form of a system we currently have here in the US.
In Holland we have however a government regulated healthcare that sets pricing with pharma and insurers, they also have a far larger list of insurance companies to chose from.
Dutch Healthcare insurance companies list
People in Holland all want to go back to the single payer form as the cost of healthcare is rising at an alarming rate.

[DanTex]

79. Well I went to Amsterdam on vacation. Twice. So that makes me the world's leading expert on Holland.

Kidding of course.

But are you actually saying I'm wrong? The argument in this sub-thread was about whether Holland is currently a single-payer system, I was saying that it was not. And you appear to be agreeing with me, it is no longer a single-payer system. And I would further argue that it is important to distinguish Holland's current non-single-payer system with their previous single payer system, something that other people in this discussion are reluctant to do. Some people here want to group basically all of European healthcare systems under the moniker "single payer", arguing that any sufficiently regulated private system is in principle single payer even though it is technically not.

From your comments, I would guess you disagree, since you are saying that since Holland changed from single payer to a more private mandate-based system, things have gotten worse. In order for that argument to hold meaning, it must be that case that Holland's current system should not be classified as "single payer".

I agree with you that Holland's system is different than ours, more regulated, price setting, universal, etc. But I think we can get to what Holland has much more easily that we can get to single payer. Because from here to single payer means kicking every American with private insurance off of it, despite the fact that about 60% of them are happy with their private insurance. It also means getting rid of the private insurance industry, and all the workers (don't know how many) in that industry will be looking for new jobs, and not all will find the same job in government administering the single payer.

If you say that Holland's healthcare is worse now than before, I believe you. And yet, it is much better than in the US, and according to international rankings it is competitive with the best in the world. Holland isn't the only mandate or hybrid based system, and I don't think the international comparisons support the argument that single payer is the only way to go. I feel that in the US, the myth has been sold that "everyone else has single payer", but in reality, this is not the truth. Everyone else has a lot more government involvement than the US does, true, but particularly you who have lived in Europe for so long are aware that government involvement and single payer are not the same thing.

[insta8er]

81. Dan, that it works does not mean there are no better alternatives. One of the things that has

Surprised me here on DU is the fact that people seems to have 1 position, but if their "idol" determines it is not a good one they quickly seem to be making the switch. Let's be frank, the only reason why HRC is for the current system is because it makes her friends money(and she gets "campaign contributions from them". This is something that even you cannot deny.

With a single payer system they won't be making the obscene amounts of money, even in a hybrid system they won't be able to make the kind of money that they are making now.
The reason why most people want a single payer system is because we finally will have a voice ... as the customers, and someone/something in our corner to bring down the spiraling cost of healthcare. Why someone would want to fight anything like that (we understand why the people who make money of the current system want to fight it) is beyond me.

Saying we cannot have a drawn out or "contentious" fight about it with the people on the other side (and pharma and the insurance industry) is not a valid argument in my opinion. There are currently still 23 million people without healthcare, I am willing to fight anyone to get them healthcare that is affordable.

[DanTex]

83. No, no. That's not the reason that Hillary supports extending Obamacare.

There is zero evidence for what you are saying, and it's totally absurd. She supports a more incremental approach because she understand political and policy reality. First, single payer is never going to happen politically. Second, it is a huge disruptive shift from what we have now, a ton of uncertainty, and getting to universal coverage by extending Obamacare is a lot more feasible.

You might disagree with her (and me) on that, but at least you could do it respectfully, and not insist on conspiratorial ulterior motives. The goal is to get everyone healthcare. Don't get distracted by the need to demonize Hillary.

[insta8er]

85. Dan, you are verbatim repeating her talking points. I disagree with her, looking at her past I don't

think I could not accuse her of opportunism, it is something that goes like a red line throughout her political and private live.
This is just some of the things I am talking about:

[DanTex]

86. You are verbatim repeating the most vapid anti-Hillary smears from the internet.

There is a very strong case, politically and practically, that building on Obamacare is a more fruitful avenue for reaching universal healthcare than trying to push single payer. You can disagree with that case without resorting to conspiracies and ulterior motives. I agree with that case, and I assure I don't care about insurance CEOs. And so do a lot of other people.

I see it as a weakness in the argument for single payer that its proponents can't defend it without resorting to personal smears.

[insta8er]

87. What you call "smears" are the facts, what part of the establishment wanting to keep the status quo

the status quo is a smear? It works for them, it does not work for us. HRC receiving 13 Million in "campaign contributions" from the healthcare industry is also a smear?

[DanTex]

88. They aren't facts. It is a fact that 13M of Hillary's campaign contributions came from employees

in the healthcare industry. But that means nothing. It certainly is not a "fact" that Hillary supports expanding Obamacare because she wants to protect healthcare CEOs (who can each contribute at most $2700), rather than the reason that I and millions of others support that route, which is because it makes more sense and is more likely to succeed. What you are repeating is a just a vapid internet smear.

Like I said, you should be able to disagree on the way we get to universal healthcare without resorting to these kinds of gutter tactics. And the fact that you don't seem able to (and many others as well) says a lot about the logical foundations of your argument.

[insta8er]

92. My logical foundation stems from experience, yours stems from a "can't do" that someone told

you. This country would have never come this far with that kind of an attitude, I am glad that there are millions like me and that your opinion belongs to a small minority (and the benefactors of the status quo).

Edit 80% of DEMOCRATS support SINGLE PAYER:
http://thehill.com/policy/healthcare/229959-majority-still-support-single-payer-option-poll-finds

[DanTex]

95. Well, at least you dropped that nonsense about the $13M.

But you're still going on with the personal attacks, which as I've said before, is just evidence that you can't support your case with logic. You have no idea who told me what and here you are boldly declaring that I get my logical foundation from someone telling me "can't do". Which is of course totally false.

And I'm not sure that you understand what a "minority" is. A "minority" is the people who voted for Sanders. The majority voted for Clinton. And it wasn't a small majority either, it was by 10 points. So I'm glad that there are millions more like me than there are like you. It might closer if you based your arguments on facts and not personal attacks.

[insta8er]

103. You base your attacks on ignoring polls that show that 80% of DEMOCRATS support single payer

But I guess you chose to ignore the link to the article that mentioned that poll, its all good you win(yeah, my candidate won so your argument is not valid...sounds like a very well thought out statement). And "we" the minority that voted for Bernie (forget about the rest who are declared DEMOCRATS and who support single payer 80/20) just need to shut up and conform to the "Can't do" who voted for the status quo. I hear you...

[DanTex]

107. Once people learn that they don't get to keep their current coverage and that

their taxes will go up, support for single payer plummets. What those polls show is that people don't understand what "single payer" is.

Look, we had a primary, Bernie and his platform lost, by a wide margin, to Hillary and her platform. Hillary is what most Democrats want. This isn't complicated.

[insta8er]

110. Hillary is not what most democrats want and stand for, it is just 1 of 2 choices. It might come as a

surprise to you, but not every democrat voted in the primaries. To say that because your candidate won, her platform is what every Democrat or even the majority wants is a bit of an ignorant statement. The same goes for your argument about the tax raise, which conveniently leaves out the fact that there is no insurance premium payment to be made. But I can see where your talking points are coming from. Just like the Trump Gun, the Sexist Bludgeon or the Racist white folks narrative..everything in order to make the paymasters and the status quo keep continuing their profit making market rigging way of live. I can't for the live of me understand that someone who calls themselves a Democrat would be behind something so obvious like this. The next thing I am waiting to hear from you is that fracking is good, and that we don't need clean air acts....or free college for our children...can't be done right?
But we can make war everywhere in the world, because for those things we do have money right?....did I just passed through a parallel universe where everything is the opposite from what it used to be?

[DanTex]

112. How do you figure? She's who they voted for. What kind of logic is this?

As for Dems that didn't vote, the polls showed her ahead the entire race. It's time for you to accept that you are in the minority, even among Democrats. Not a tiny minority, but a minority nonetheless.

I have no idea where the rest of your tirade comes from. I'm a liberal Dem, like you. We just have some policy differences that are relatively minor in the grand scheme of things. Hold the vitriol.

[insta8er]

114. Man you are really...NOT EVERY DEMOCRATE VOTED IN THE PRIMARIES

I put it in caps, maybe that way you can comprehend. But if you don't please..you win..your candidate has now been elevated to SUPER level. Nothing she says or does can be wrong, she is not bought and paid for by special interests. She has the infinite wisdom (just like you) to know what is best for the rest of this country.

[DanTex]

116. What makes you think those others were more Bernie than Hillary?

Polls say otherwise. I don't see the logic. You're making absurd assumptions.

[insta8er]

117. Dan...one more question...were you a republican at some point in time? maybe just a

convert to Democrat? I mean that would explain a lot...Thanks and have a nice day..we are done.

[DanTex]

121. WTF? No, I wasn't a Republican. Where is this coming from?

I believe in Democracy, and Hillary got more votes. You're trying to pretend that non-voters somehow secretly supported Bernie over Hillary even though there's no trace of evidence and the polls say otherwise. So logic fails you, and you turn to personal attacks.

[insta8er]

122. Dan no you don't you sound and act like a Republican, you just quote them use their talking points

and conveniently tells someone that shows you proof of 80% of DEMOCRATS backing a position as something ... if they knew their taxes would go up..bla bla...You don't have a point there and you try to blow smoke up .... to hide the fact that 80% of DEMOCRATS want single payer...just not you and your candidate..oh and the 20% that apparently also don't want it.

OK we are done...keep that smoke coming....just not towards me. Goodbye!

[DanTex]

123. What talking points? That Hillary got more votes? That's just a fact.

There are polls showing that people who support SP change their mind once they learn that it means giving up their current coverage and/or paying more in taxes. That is a fact.

Dems didn't vote for Bernie's agenda. A lot did, but more voted for Hillary's. That's just what happened. And trying to pretend that Bernie is "the people" when all the evidence points to the opposite is undemocratic.

[insta8er]

124. Dan..bla bla bla bla...80% of DEMOCRATS want Single Payer!

[DanTex]

125. Bla bla bla? That's it? Bernie loses, and this is what it comes to?

[insta8er]

126. Dan 80% of DEMOCRATS want Single payer!!

[DanTex]

130. Not after they learn about taxes/losing current coverage.

Do you know what happened to single payer in Vermont? Yes, Vermont, one of the most liberal states in the country, maybe the most liberal.

Google it.

[insta8er]

132. Dan 80% of DEMOCRATS! keep that smoke blowing buddy 80% you are a minority!

[DanTex]

134. You're not even listening. Some things are more complex.

SP means losing private coverage, and also tax hikes. That's why it won't happen. Google "Vermont single payer". And ignoring these facts won't make it happen.

[insta8er]

129. Whats next Dan? defend TPP?

[DanTex]

131. I'm ambivalent on TPP. I don't think it's as horrible or great as people say.

[insta8er]

133. It looks like you took the wrong door, I rest my case. LOL

[DanTex]

135. No. There are Dems both pro and anti TPP. Obama is pro-TPP.

[insta8er]

138. Yeah TPP is good, like most of the other "trade deals".........More TPP Trickery:

Keystone Pipeline Company Demands $15B Under Prior Trade Deal
This is how trade rules help corporations challenge measures that protect the environment and public health.

By Patrick Woodall
06.29.16
This week, the TransCanada pipeline company officially filed a $15 billion corporate trade lawsuit against the United States for refusing to allow the construction of the Keystone XL pipeline. After an intense grassroots campaign by environmentalists, farmers, landowners and local governments, President Obama blocked the pipeline that would have delivered high-carbon oil from Canadian tar sands because it undermined U.S. efforts to fight climate change.

But TransCanada is now using North American Free Trade Agreement (NAFTA) investment rules to sue the federal government for rejecting the pipeline, demanding $15 billion dollars in repayment for anticipated profits it expected from the project.

TPP Expands Corporate Power

The Trans-Pacific Partnership (TPP) has the same kind of investment rules that allow foreign companies to sue for damages if new laws or policies allegedly undermine their expected future earnings. These rules set up a special court for corporations to challenge measures that protect the environment and public health — effectively demanding payoffs when governments take action to safeguard the public.

Greenhouse gas polluters could use the TPP investment provisions to unravel federal, state and local efforts to fight climate change. For example, these TPP rules would empower foreign oil and gas companies with leases on public lands to sue for damages if Congress passed the Protect Our Public Lands Act, which would prohibit fracking on federal land.

https://www.foodandwaterwatch.org/news/more-tpp-trickery-keystone-pipeline-company-demands-15b-under-prior-trade-deal

[HERVEPA]

41. He understands. He has and has had a conservative agenda

[dsc]

10. tell that to France, Germany, Finland, and Holland among others

Finland's system is so good that Michael Moore left it out of Sicko for fear that no one would believe it actually existed.

[randome]

6. It's become a meme devoid of substance.

And it's not going to happen for a long time, if at all. Politicians don't typically put out plans they know will fail. Best to move toward something like single payer, improve on Obamacare and keep battling it out with the skinflints in Congress.

I think most understand this, which is why we don't see angry demonstrators in the street on this issue.

[bemildred]

7. We don't need "access to health care", we need health care. That's the difference.

With single payer everybody gets health care, paid for by the government, with taxes, and costs are strictly regulated by the government. And we think that would be much superior to the current corrupt health care system that we have.

[DanTex]

9. What about Holland, Switzerland, Germany, etc. What is wrong with their systems?

They aren't single payer, and they have universal coverage, and they provide good coverage and control costs. Why does it have to be the UK system? Those others are just as good. It's starting to take on a religious tone, the single payer obsession.

[bemildred]

11. Look, over there! nt

[DanTex]

16. What?

[bemildred]

17. +1.

Perfect.

[Alex4Martinez]

21. lol!

[7wo7rees]

22. What? Is it a shiny squirrel? 😂

Last edited Thu Jun 30, 2016, 11:02 AM - Edit history (1)

Having "access" is not health care and having access with what we have now is questionable. We are paying out nearly 750 per month through employer for the 2 of us in Tx. Co-pays, prescriptions, deductibles, all keep going up. And don't even get me started on dental care! Lack of affordability for dental care and the joke of dental insurance is killing us.

Tks bemildred for standing up.

[Silver_Witch]

35. Perfect post! N/T

[bemildred]

38. My pleasure.

[Chan790]

59. Other than the fact we can't get there from what we have?

Nothing. Mind you, those may be public-private hybrids, but they are defined care-based outcome systems. Everybody gets affordable care, insurance is universal and in exchange for not being allowed to take a profit...pretty much at all, the government subsidizes the losses. That are, factually, as much as you want to deny this, single-payer systems. ¹ The government is the entity paying for all the healthcare because the insurers never (I underlined that word for you because I do not want you to miss it) don't lose money. There is only one real payer, sometimes with a marginal co-pay or monthly fee; it's just that the recipient of the payment is the insurer who is being compensated for administering patient-care provided by private doctors.

Arguing over terms is pointless. If you're not acknowledging that we need to take a machete to the health-insurance industry to actually get to either single-payer as you're defining it or as everybody else is refining it, you're not being realistic. We're not getting to a system were everybody is guaranteed access to affordable healthcare as long as the private insurance industry within the US is allowed to stand in the way in protectionism of its profits and the individual mandate.

1: I don't give a damn how healthcare theorists classify them. I have a family full of insurance executives, having grown up in Hartford...and the industry definition of "single-payer" is: "Any defined outcome system where healthcare is primarily paid for by the government and profitability of insurers and caregivers is restricted." (Their response to any such system like the ones you're advocating for, regardless what we call it, is..."fuck no. Never. We'd rather bring the entire healthcare system to the ground than agree to those terms.&quot I realize that's not your definition...but it is the definition that everybody else, including Obama, Clinton, Sanders, their respective activist supporters, the health-insurance industry, and the general public is using for "single-payer" when referring to the US healthcare system. It may not be accurate, but it is a vernacular stand-in for the result we're advocating for and you're advocating against apparently.

[DanTex]

65. We can get there a LOT more easily than we can get to single payer.

Single payer would mean getting rid of an entire industry, causing huge job losses, or at the very least forcing huge numbers of people out of their jobs at insurance companies and into the government to administer the new single payer. Of course, if the single payer actually saves money, then some of those jobs will be lost, or at least those people will take pay cuts.

Then, it requires kicking everyone off of their current health insurance, even the people who are happy with their coverage (which is currently more than 50% of Americans). Every doctor, clinic, and hospital in America is going to have to adapt to the single payer, and again, if any costs are going to be cut there, then some of them will shut down, others will decide not to accept insurance at all and go all-cash.

Needless to say, politically this is going nowhere, because most people don't want to give up their current coverage for government coverage (for example, me), and most providers don't want to get paid at single payer rates, and the health insurance industry doesn't want to vanish.

Getting to a Dutch or hybrid system is MUCH easier. Still difficult, but it can leverage what we have now. Start with a public option. Put in all-payer rate setting. Etc. It's doable, without a huge shock to the system and all the uncertainty that comes with it. Not to mention 1000 times more politically feasible.

As far as terminology, of course it matters. Using "single payer" and "universal healthcare" interchangeably is just intellectually dishonest. Particularly when it comes to the Democratic primary and platform, because Hillary is in favor of "universal healthcare" but not "single payer". Single payer has a very clear meaning, which is that there is a single insurer -- the government -- that pays for healthcare. Nobody considers the Dutch system to be single payer because it is obviously not that. Neither Obama, nor Clinton, nor Sanders use the word "single payer" in that way.

The prototypical single-payer proposal in the US is "Medicare for all" which is nothing like the Dutch system. In fact, the amendment they wanted in the platform specified "Medicare-for-All single payer" so as to leave no ambiguity of exactly what they were talking about. It wasn't a system of tightly regulated private insurers. It was the government paying for everything. And Bernie has described it in his stump speech: everyone pays taxes, everyone gets a card from the government, you go to the doctor with that card, and it's all paid for. That is single payer.

If you want to avoid jargon, then at least be honest about it. Hillary Clinton is in favor of providing healthcare to every American. She's not in favor of getting rid of the entire private insurance system and replacing it with Medicare-for-All.

[stopbush]

42. Unless there is a government system of hospitals that's

large enough to accommodate every citizen, the gov can only control costs to a certain extent.

Most hospitals are private, not state, entities. Single-payer still pays these private hospitals. If the gov actuaries set the reimbursement rates too low, or cover too many expensive procedures, the private hospitals can simply opt out of being reimbursed directly by the government. They will then charge whatever they want directly to the patient, who then must argue with the government for reimbursement. Hip replacement? That'll be $12,000, thank you. Reimbursement from the gov? $6000. Enjoy your new hip!

Unless the government is willing to take over the entire healthcare system from private providers - imagine what THAT would cost we taxpayers! - and run said system with a systemic, chronic deficit, they cannot mandate costs and the reimbursement thereof to private entities.

[bemildred]

43. Good, let's do that. The hospitals will do what the law requires. nt

[stopbush]

45. Let's do that = trillions of $ in taxpayer expenses

Nice of you to vote for everyone else!

[bemildred]

46. Fuck yeah! nt

[Human101948]

54. Why does it cost so much less to have universal healthcare in every other developed country?

Those big numbers are part of the insurance/for profit healthcare industry, Koch brother libertarian propaganda to prevent the USA from going "socialist"

[stopbush]

55. Good question. I'm sure there's no easy, single answer.

What I do know is that in Denmark - a country that Sanders constantly pointed to as a model of successful socialism - the median tax rate is 45%. The average tax rate in countries with wide-ranging social programs is 34%.

That's "how they do it" over there. At least their numbers are reflective of the actual costs associated with providing greater social services as a right.

[Mass]

14. Allowing everybody to have access to a government insurance and not to depend of private entities

to finance their healthcare is important.

I do not know whether we need single payer (or something close to it) or whether we need a public option, but I know the democratic platform should not endorse a purely private system except for a small category of people (those private insurance are not interested in), or a employment-based insurance system.

At the very least, they should endorse craddle-to-grave insurance and subsidies for people who cannot afford an insurance. And yes, I do not mean just through the basket.

[Alex4Martinez]

25. Exactly. Any for-profit system with middlemen and high paid executives is not what we need or want.

I don't expect much progress under either administration toward that.

Obama took us a long way toward a better world, but it's not single-payer by a longshot.

We still have a highly privatized system with waste and profit and expenses that are astronomically high precisely because it is a private system. Tweaks can't fix it.

[JaneyVee]

18. UKs model is probably the worst of the EU models also.

[geek tragedy]

24. it's a shibboleth of the Common Dreams crowd nt

[MineralMan]

26. We will get universal healthcare only after we elect

a Democratic President and elect strong majorities in both houses of Congress, along with a staffing a more progressive Supreme Court.

Only then.

In 2016, we can have a Democratic President and a majority in the Senate, which will help with the SCOTUS. In 2018 or 2020, we can have a strong majority in the House.

Whenever that Democratic control over all three branches of federal government is in place, we will get universal healthcare in one form or another. Until then, we will not.

That's all the reason we should need to turn out in massive numbers in 2016, 2018, and 2020. No other requirement should be necessary.

GOTV 2016!

[hobbit709]

27. Therein lies the problem. you either cannot or will not understand it.

[KansDem]

30. This is why we need single payer...

No one should reap multi-millions from someone else's sicknesses and injuries.

[DanTex]

39. Looks like about $80M total. Who cares? Healthcare costs are like $2.5 trillion.

That amount of money changes nothing. We could take it all away from them, and it wouldn't make the slightest difference.

[stopbush]

44. Exactly.

[uponit7771]

48. So that's not even 10% of a monthly HCI payment, the rest is doctors pharma and hospital groups

... and Sanders isn't calling for those to take half of what they're getting paid today to get HCI payments on par with the rest of moral mankind

[Silver_Witch]

33. Use whatever word you like...we don't have Universal Healthcare in the US!

Provide whatever plan you have and everyone will listen. Universal means everyone has it - not the case in the US. Universal means not paying $5,000 before your plan kicks in!

Mandates don't work when you have to choose between an "insurance premium" and food for your children or rent. That is what we have now!

Not working!

[DanTex]

37. I agree. That's why we need to improve Obamacare.

[Silver_Witch]

40. The ACA is not really working for many...

I am all for improving it but because Obamacae gives states the control and therfore it is a fail in many ways. Medicare for all works I think. And as I said call it anything you want just do something thatt works! What we have now is not working!

[uponit7771]

49. its working for the plurality and it could be improved on

[TheKentuckian]

144. You could make the exact same argument for the pre-reform system, many did.

Since most folks aren't very sick they are "happy" with their coverage as long as the premium is too hellish but that tune changes quick, fast, and in a big hurry and they don't have a fuck to spare if they needed hundreds of thousands of dollars in care when they have to pay a couple grand.

Most people haven't a clue in the world how their plans work and lose their shit as soon as they have to beyond the increasingly rare copays.

[Orsino]

34. The strange, sudden need to diss Single Payer. I understand it, I believe. n/t

[uponit7771]

50. Facts matter, taking private HCI out of the picture would lower an avg HCI payment 7% due to gov...

... government taking the 3% to replace what the HCIs do.

The rest of the immorally high HCI payments are due to high pharma, doctor and hospital group cost which NO ONE is calling them to talk half if their current cost to get the US on par with the rest of the moral humankind in regards to health care

[stopbush]

47. Do people not realize that there are real expenses associated

with providing healthcare?

Under the ACA, insurance companies can spend no more than 20% of the $ they take in on overhead. The other 80% has to be spent on actual services, or they need to refund the differnce to the consumer.

That fact alone tells you that it costs real money to provide healthcare to Americans. Those expenses don't just go away if single-payer happens, or even if there's a gov takeover of the entire hospital system. Sure, there are savings to be had in both actual procedural expenses and overhead, but the savings are not so great that they would make the system self liquidating when it comes to expenses.

Single- payer is not a magic bullet. It's an option that has benefits and consequences.

[Bluenorthwest]

51. The parsing of terminologies is a tactic used to avoid discussing actual content.

Hair splitting about the Dutch Model is not really going to distract anyone. Pretending you don't understand what people mean because they don't pick all the proper industry terms is a very tawdry sort of coyness which is inadvisable in any context.

[DanTex]

56. Intentionally using incorrect terminology is a tactic used to avoid discussing actual content.

Anyone who is not thoroughly clueless knows the difference between "single payer" and "universal healthcare." And in this case the terminology is particularly important, because Hillary (along with most Dems) is in favor of universal healthcare, but not single payer.

And it especially matters for language that goes in the party platform. I get that you aren't particularly interested in policy specifics, but the people Bernie assigned to the platform committee are supposed to know about these kinds of things. This is not amateur hour. If Bernie's people meant "universal healthcare", they should just say so. Why do you think they would insist on the specific words "single payer" when the words "universal healthcare" are both more accurate and less controversial?

[Lord Magus]

89. Deliberately using incorrect terminology is also known as LYING.

This isn't "parsing", this is calling those who claim single-payer is the only way to universal heathcare out on their dishonesty.

[stopbush]

108. Those who don't understand what hairs are being split

when legislation is drafted are the people who are upset when they learn that not only the details, but the very foundation upon which the legislation was constructed is not what they imagined it was.

[Squinch]

52. People think universal coverage and single payer are the same thing. I think they

wrongly insist on single payer because they think they are rightly insisting on universal coverage.

As for BS, who can say why he does the stuff he does?

[Human101948]

53. Just as long as we trash the expensive and woefully ineffective system that the U.S. has now...

US Spends More on Health Care Than Other High-Income Nations But Has Lower Life Expectancy, Worse Health

http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations

[bemildred]

61. Indeed that is the main thing. nt

[Scuba]

63. It's not an assault rifle, it's a semi-automatic.

It's not about what you call it. But then you knew that.

[DanTex]

66. I remember a time when Bernie supporters insisted they cared about policy.

That was a long, long time ago. Because now, evidently, not just his supporters, but even his choices for the platform committee either can't or refuse to understand the difference between "single payer" and "universal healthcare", that everyone who has ever studied healthcare policy knows are different things.

[Scuba]

71. That's why "Medicare for All" is emerging as the term of choice for advocates. It best ...

... describes the policy we support.

Criticizing the ever-evolving terms rather than actual policy is an excuse not to discuss the topic.

[DanTex]

72. That's a good term. Just don't conflate that with "universal healthcare".

Because I'm in favor of universal healthcare, but I'm not in favor of Medicare for All. Surely we can agree that those are different things.

[athena]

68. I am a Hillary supporter, and I believe we need single payer.

Single-payer health care is the only way of cutting out the middleman and reducing costs. "Health insurance" is a contradiction in terms. Matters of health should not be something where the insurance industry is involved. Health care should be a right, not something you have to buy.

That being said, I don't believe that single payer has any chance of passing any time soon. When I talk to regular people out there, they are completely clueless about single payer; all they know is what they've heard from the right-wing noise machine. If we want single-payer health care, we need to do the hard work of educating the public. Attacking Hillary supporters is not going to achieve single-payer health care.

I also believe that big changes like this are best done in steps. The next step to focus on is adding a public option to Obamacare. That will go a long way toward showing people that the government does not always mess things up, and that Democrats are not out to take away their health care.

[DanTex]

73. I agree that the best way to get there (anywhere) starts with a public option.

I disagree that we need single payer. The middleman (health insurance profits and administration costs) are a very small part of why our healthcare costs are so high. The big thing is simply the cost of care itself is higher here. And those are tough costs to reduce. It's not just trimming fat.

What I see as a plausible, though difficult, way forward is to first, add a public option to Obamacare. Then make the public option the default, in an "opt-out" sense, meaning that if you're don't have private coverage, you are automatically in the public option, and you pay extra taxes to cover the premium. At that point we will basically have a single payer, with an option to use private insurance and get a tax credit to pay for it instead. We could go the whole way then and get rid of private insurance, but I don't really see the point.

A big problem with single payer is that something like 60% or more of Americans are currently happy with their coverage. Single payer means telling all those people that they can't keep it, they have to go onto Medicare, which may or may not be better, but even if it is, there's the fear of the unknown, which will cause resistance. If you go the public option route, there's none of that kicking people off of their current plans. I think people would gradually migrate to the public option, when they leave jobs, or graduate college, or whatever. Much less disruptive.

[athena]

76. I agree with your analysis.

Personally, I am fed up with health-insurance companies and have seen first-hand how much unnecessary work they create. There are many doctors I can't see because they don't accept my health insurance, even though I have good health insurance. I am also greatly turned off by the four giant billboards advertising nearby hospitals that I see every day on my way to and from work. I don't believe that insurance or advertising companies should be in any way involved in health care.

I do, however, realize that it would be extremely difficult to pass single-payer health care in this country, for the reasons you stated so clearly. I would therefore be happy with the public-option scenario you posted, as long as the law also says that all providers must accept the public option. At the very least, it would give me the option to opt out of having to support and deal with for-profit insurance companies whose CEOs make millions of dollars each year.

[insta8er]

74. Your reasoning for universal healthcare and why single payer is not such a big deal shows that you

don't understand the issue at hand. Rather than to lecture you, I would suggest you do a google search on it. Let me give you a little spoiler though....big pharma and the people who run our healthcare services (the ones that make the money) are not in favor of single payer.

[DanTex]

75. I do understand the issue. Certainly much better than anyone who doesn't know that

"single payer" and "universal healthcare" are not the same thing. It's frankly shocking that so many people appear not to know the difference.

[Vinca]

78. As long as big insurance is involved, people will get screwed over.

Healthcare shouldn't be a moneymaking opportunity. Everyone should get a card to access medical care as a right of citizenship and it should be paid for by upping taxes. A hybrid system might work perfectly fine for most people, but as we've seen with the ACA, the more complicated it gets the more people are left on the sidelines. We've still got a patchwork quilt of plans that vary according to the whims of state legislatures. One plan, everyone covered, paid through taxation, end of story. If big insurance wants to sell private plans on the side to cover cosmetic surgery or super duper hospital rooms with surround sound, let them.

[Ash_F]

93. 58% of Americans support it. Are they strange?

http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx

It is a winning position that will get Democrats more votes, come November.

[DanTex]

96. Not if you inform them that it means they can't keep their current coverage.

Or if you inform them that their taxes will go up. People don't know what single payer really entails, once they do, they don't support it.

[Ash_F]

97. Both those claims are misleading.

[DanTex]

98. That's a laugh. It's the very definition of single payer: you don't get to keep your

private coverage, you can only have medicare. And you pay for it with taxes.

Denying either of those things is a flat-out lie. Which, by the way, is the reason that it will never happen in the US. Most Americans like their current coverage, and don't want to give it up for a government single payer. A public option is plausible because it is just that: an option.

By the way, what's wrong with having the single payer be an option so the majority of us that like our current coverage can keep it?

[Ash_F]

99. Your framing was misleading

Also there is nothing wrong with private health coverage existing alongside a public system. That just creates more competition which is good.

I don't believe Sanders or any prominent lawmakers have suggested banning private health insurance. Can you explain why you went down that road?

[DanTex]

100. My framing was accurate. And if private coverage isn't banned, then it's not

a single payer, it's a public option. You get to choose, either opt in to medicare, or else keep your private coverage. That's what Hillary wants. I'm glad we agree on that.

[Ash_F]

101. Not true. Single payer can exist alongside private health insurance. Like Canada.

https://en.wikipedia.org/wiki/Single-payer_healthcare

[DanTex]

105. OK, let's just call it a "public option" then. As long as I get to keep my current coverage,

along with the majority of other Americans that like their current coverage. But anyone who wants to can buy into medicare. Which is what Hillary wants. I guess we're just arguing about words.

[Curmudgeoness]

140. That's crap.

We have already lost a lot of our current coverage over the past several decades...and I know because I have lived through the decline. Right now, the insurance that I have is restrictive of the doctors and facilities that I can use. About half of the doctors and facilities here are out of network for me, so my options are limited now. If I were to have gone with another insurance, I could have gone to the other half, but not the ones I can now. With single payer, we would not have all the angst over where we can go. All doctors and facilities would be under the same plan. Tell the people that they will no longer have to worry about being out of network and they will cheer.

And regarding taxes going up, of course they will. But a smart politician would be able to explain how it really will save people money. With income of $20,000, which is not much, a person has premiums for the worst policies at about $250 a month with rebates on ACA. That is with $2,500 deductible and $5,000 total out of pocket per year. So premiums alone are $3,000. Add the total possible out of pocket and that is $8,000. My bet is that no one will pay more in taxes than they would have to pay if they need health care. And to be honest, no one with that income would be able to pay the total cost of care, so they will still avoid going to doctors, just like before the ACA.

[DanTex]

141. Most Americans like their current coverage.

And not some metaphorical current coverage, I mean the actual coverage they have right now. Taking coverage that they like away from most Americans is pretty much a fatal political barrier to single payer. You can explain and explain to people that the single payer is going to be better, but they aren't going to believe it. Some of them might be wrong, but many will be right. Single payer will create a lot of "winners" and "losers". Frankly, I don't want to lose the coverage I have now for Medicare/single payer. It might be just as good, but once congress gets through with it, it might not, and what I have now works for me. And I'm not the only one.

As far as the taxes, just look at what happened in Vermont. They had all the same ideas that it would just balance out current premiums and out of pocket costs. Then reality set in and the balked because they saw the actual size of the tax increases needed.

[Curmudgeoness]

143. Well, as long as the system works for you, all is rainbows and puppies.

That it is not working for so many much better than pre-ACA is of no consequence. Got it.

[TheKentuckian]

146. The "like" number was just as high, maybe higher before the current reform.

So what?

All you've done is reach into the recycling bin and dusted off the same conservative excuses as we heard in 2009 and before and indeed since as well.

The keep your coverage line of crap is hard core nonsense, just see what happens when your employer (or union or retirement plan) switches plans. You ain't keeping shit like it or lump it and by the same token if I don't want my deductible based garbage I'm stuck with it.

[DanTex]

148. And part of why the current reform succeeded is that it didn't take coverage away.

I support a public option, so if you don't like the plan you have, you can opt into medicare. I like the plan I have, so do most Americans. A public option with Obamacare is the best compromise.

[TheKentuckian]

159. Sure it did, all kinds of people complained advocates just didn't care about their issues and change

It is also phony baloney, there is no magic keep your coverage clause. Your employer changes or you change and nobody gives a shit what you like you get what is served.

It is also ridiculous "want" in most cases anyway. What most people actually want is to keep their doctors and the facilities they are most comfortable with for the lowest premium and out of pocket costs that covers them for what they and their doctors decide they need and whoever comes closest to doing that they will like just fine.

Most people even before reform liked their plan because they mostly don't use it, most people who have to actually use their insurance beyond a check up and a couple of lightweight sick visits quickly learn they despise their coverage no matter how comprehensive the plan and have little idea or a vast misconception of how insurance works at all.

Too much fantasy thinking on this built on a foundation of sand, there are few "wise consumers of health care" because it is not a rational market. It isn't like you get to shop for what kind and how much sick you get first of all and most people just follow medical advice because they are short the years of medical school and practical experience to do any different.

The best people can do in reality is for non urgent procedures try to compare costs IF they can get accurate contracted rates which is dicey at best while in many cases hoping what is done is covered no matter how much they check in advance because it is all about how the claim is coded in the end and how it fits criteria they have little to no way of knowing or understanding if they do.

It is highly misleading to pitch you can keep your plan in an employer based system and it is a flat lie from any corner to say someone can keep their doctor in the current structure at all, you can't make a provider be participating they can drop out anytime they want. They can in many cases wake up with a wild hair and send your claim payments back to the carrier and send you a bill for the total charge and sometimes will get away with it too. Rare but you bet it happens.

[ismnotwasm]

94. This is an excellent point

Universal Healthcare is the goal, single payer is one way to obtain that goal. As it is, if we obtained universal healthcare tomorrow, there would not be nearly enough providers to cover care. There is also a coming shortage in nursing, which is my profession. It's actually here in many areas.

As a response to the successes of the ACA--my state of Washington is an example of such successes nursing leaders are looking at the PCP shortage and finding ways for RNs to further their education to become practitioners. So healthcare and eduction are closely entwined in this manner. No matter what direction we take to obtain the goal of universal healthcare, we are going to need enough skilled providers to provide care. This has to be factoring in for any plan, and healthcare leaders are well aware.

Nursing understands the benefits as well as the shortcomings of the ACA, and is active in developing it's improvements

[Sancho]

109. What's the elephant in the room? Paying doctors, nurses, and other providers...

The bottom line is that the US pays doctors, etc. more than most other "systems". You can debate the cost of training and insurance, but any "universal" or "single-payer" system will compensate the person with the stethoscope less $s.

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/?_r=0

It's true that for profit hospitals and insurance companies and drug companies all need to be reined in!!! Those changes plus a public option will be welcome!!

It's ALSO TRUE that someone is going to have to reduce doctors' salaries by a third to a half depending on specialty!! It's also true that the public will have accept some compromises in convenience. There may not be a drug store and MRI on every corner.

The other elephant in the room is coverage for 11 to 30 million undocumented Americans!!

[ljm2002]

115. There is an engineering principle...

...that if there is a simple way or a complicated way to solve a problem, usually (as in: almost always) the simple way is better. Fewer things to go wrong, easier to maintain, etc.

That is a big reason I am for single payer over other methods. It is a much simpler method of dealing with health care, for providers, and for patients. Other systems -- and especially anything we can expect to devise here in the US, with our demanding private sector -- tend to be complicated, and when systems are complicated, then some people get screwed because they don't know how to, or for some reason fail to play the game right.

I see no reason at all to prop up the health insurance industry. Yes I know lots of people work in that industry. I'm sure a good portion of them can still work in any new scheme we might devise. And for those who can't? Well at least they'll still have health care while they look for work in another sector. Which will make them still a hell of a lot better off than the hordes of people who lost their manufacturing jobs over the last 30, 40 years or so.

[DanTex]

119. Libertarians are big on using "simple principles" like the flat tax.

Reality is more complicated. I get that there are valid arguments both for and against single payer. I don't get why single payer specifically needs to be in the platform, as opposed to universal healthcare, which all Dems can agree on, even if we disagree on the implementation specifics.

[ljm2002]

128. While I appreciate your reply...

...I don't appreciate your implication that I am somehow Libertarian for supporting single payer. Libertarians most emphatically do NOT support single payer health care, since that means the government is doing more, not less for the people. And anyway, I told you where I got my preference for simple solutions when possible (and note, I did not claim it is always possible) -- it has nothing to do with political preference.

Single payer puts us all in a large pool and allows us to have much greater control of costs. Public private partnerships may work in other countries with stricter regulations of pricing, etc., but here in the US we can be sure that the private entities will ensure they can gouge to their hearts' content. The inability for the government to negotiate drug prices is but one illustration of that tendency.

Well no worries. There is no way in hell the Clinton contingent will allow single payer language into the platform, we all know that.

[DanTex]

139. Obviously, libertarians are against single payer.

I was comparing your appeal to simplicity in defense of single payer to libertarians' defense of simplicity in order to defend the flat tax, zero government, etc. Things are more complicated than that.

I think America's tendency towards private sector solutions is one of the reasons that a non-single-payer solution is more likely to succeed here, rather than the contrary.

[DisgustipatedinCA]

118. Is someone's insurance privilege on display?

[enid602]

120. Healthcare

I think Pres Clinton should offer (and Sen Sanders should accept) a cabinet level post as ACA Czar. While we've been fiddling, Rome is burning. New challenges to ACA have arisen from the courts and the insurance companies. We need someone who is driven, feisty, unwielding, crusty and devoted to Universal Health Care. Ironically, Sanders can do more for health care as a cabinet level executive than he could ever thought of doing as Pres. Let him make our ACA more like Denmark's! Hill's attention will be diverted in a thousand different ways after inauguration; she needs a pit bull who can live, breath and concentrate on health care and health care only. What better way to preserve Obama's legacy, and get us to where we need to be with regard to Universal Health Care.

ps: We might even unite the party.

[DemFromPittsburgh]

127. I'm single and I'm a payer

[Ken Burch]

136. It's because the healthcare system we have has been badly distorted by "market values".

We need to get away from the idea that access to medical care and pharmaceuticals should be based on a profit being made from the sale of those things.

Healthcare is an essential thing(like water, sanitation, and housing). When it is commodified, the actual provision of healthcare takes a back seat to the "need" of ceo's to receiving massive bonuses and a high short-term rate of return on investment for shareholders.

This is why most drug companies spend more on advertising than on developing medications, why medications and treatments are primarily developed to treat conditions rather than cure them, why indviduals are denied lifesaving procedures if their insurers don't cover them, and why people get kicked out of their hospital beds three days after major surgery.

[BootinUp]

137. I would like to see the public option added to Obamacare. Other than that

its like you say. Fighting battles you can't win is kind of stupid imho.

[HumanityExperiment]

142. Why are you advocating for a for profit Healthcare system?

any 'private' based aspects will always lead to a 'for profit' based model...

Not sure why you'd be advocating for that type of model here on DU

[PowerToThePeople]

151. Do you have to ask?

If you have read this board in the last week, it should be obvious. Do you see the brick wall at the back of the theater?

[silvershadow]

152. If you aren't one who could use single payer, perhaps you don't get it. nt

[Exilednight]

155. The only way to achieve 100% health care is thru a single payer system.

The ACA is a failure by that measure. There are too many loopholes for the citizenry to fall thru, which has been proven via the ACA.


How many homeless people have health insurance or access to health care without absorbing a bill they can never pay?

[Lord Magus]

156. Most of Europe achieved universal healthcare by means other than single-payer.

Should I inform France and Finland that they don't actually have universal care?

[Exilednight]

157. No they didn't.

Both have private healthcare systems outside of their national healthcare system, but that is supplemental healthcare. The difference being that if you walk in and are diagnosed with cancer and your doctor says you need chemo, the private companies will not cover it. If you want an experimental treatment your private insurance MAY cover it, but the NHS in either country will not.

[Night Watchman]

158. Saves More Lives

And costs less money!

[Dem2]

160. If a poster says there's only one solution to every problem

(and that type of poster is prolific on the internet and DU), then you're better off arguing with a wall. No actual politician who accomplishes anything thinks like this.