I don't understand how you can be FOR universal heath care and AGAINST a mandate w/ public option

[HamdenRice]

I am generally against a mandate. I also have "soft" support for universal. I actually like what seems to be emerging which is public option, which I would certainly sign up for, having had a $30,000 catastrophic dispute with private insurer assholes when I had surgery.

I'm especially against a mandate with no public option which is correctly described as forcing us to buy from private insurance assholes. That would be a catastrophe because they'd have us over a barrel.

But there are people who were adamantly in favor of universal coverage who seem adamantly against mandate.

But universal IS a mandate. You will be covered whether you want to be or not in universal. The revenue will come most likely from a payroll tax, like SS and Medicaid and unemployment insurance

If there is a public option, and everyone WHO IS EMPLOYED is required to sign up for a plan, including public option, and make contributions, why would that be a bad thing?

If it's a mandate to have a payroll tax deduction, which is what they seem to be saying, why is that a bad thing?

[lindisfarne]

1. Some want single payer (with universal coverage) or nothing. They're willing to take nothing. Don't

ask me to defend that position - I'm just repeating what I've read on DU.

They are committed to the idea that any implementation of single payer is going to be better than a good implementation of public option with private insurance. Some apparently don't know there are many non-single-payer systems in Europe which provide universal health care, and at less of a per capita cost, compared to France & Canada (the 2 countries many SP-advocates (but not all) consider to be SP).

Some don't like the cut-off income levels (based on family size) for when subsidies begin phasing out (obviously, nothing set in stone, but some levels have been proposed).

Many don't know how the various systems work. For example, German has a system where people buy into heavily regulated "sickness funds" (often through an employer) and get subsidies below a certain income level. About 88% of Germans do this. But the rest purchase private health insurance. Germany now has a mandate that everyone must have some kind of coverage. The German system is NOT paid for by the tax system (except one could argue the subsidies are in some way).

In other words, Germany forces people to give money to these "sickness funds" (which are a public/private hybrid) or to private insurance companies. Similar to what is envisioned for the public option down the road (initially, who can enroll in the public option will be limited, according to the various proposals that are out there).

Many SP-advocates fail to recognize that Obama has consistently said there will be greater regulation of health insurance companies with reform. Additionally, once the public option is open to all, if the private insurance providers don't bring down their overhead, they won't be able to compete on cost, and people will vote with their wallets.

[DJ13]

2. Universal is usually paid for around the world through taxes

Mandates are paid for on an individual basis.

Using taxes in our progressive taxation system would alleviate the financial burden paying for health care by the poor.

Mandating an individual pay or be fined puts the poor in a financial bind.

[HamdenRice]

4. But isn't it usually a separate line item, like a payroll tax?

I mean, most people with insurance get it deducted just like a payroll tax. People who live in countries where there is universal also pay a payroll tax for health care, as I understand it.

Then, when the payroll taxes and income taxes are calculated, if the system is progressive, the payroll tax may be softened by income tax rebates for the poorer taxpayer.

How is that not like a mandate.

[ingac70]

3. If I am forced to give money to private insurance....

that is a no-go and a bunch of shit. oh, and Health insurance DOES NOT equal health care!

[HamdenRice]

6. I agree to that premise. Without a public option, mandate is a non starter. nt

[county worker]

5. I really think that some people think that single payer is free medical care.

That it will not cut into their current income yet they will have access to all the care they want. Or they think we will tax the rich only and provide health care for everyone.

I don't know how a single payer system will be paid for. I hear some say that if we spend on single payer what we spend on private insurance it would be paid for. The problem with that is that 40 million people are not paying for health insurance. Their health care is paid for by tax payers or they pay out of pocket if they can. If they get a single payer system do they think they can continue to pay nothing for health care?
If not what will they pay? And how will they pay it? My guess is that there will pay payroll deductions to pay for a single payer so it means less take home pay for those not paying anything now.

[HamdenRice]

8. You're exactly right

I think a lot of people here think that universal is "free" health care and they won't have to pay for it.

They will.

[customerserviceguy]

14. I agree

I'm for single-payer, and I have no illusions that it will be "free" by any means. All it will do is to provide care for the most non-controversial of procedures that currently bankrupt the families who are unfortunate enough to be afflicted with disease or accidents.

I envision it being paid for out of general tax revenues, and not merely a payroll tax. The costs of taking necessary care of all of us should not come purely from a tax on work, and a tax on people who pay people to work. It should come out of all forms of taxable income.

[mmonk]

7. A couple of reasons. I don't trust them quite frankly.

Words like co-opt and trigger come to mind. They plan to cut medicare which has only a 3% overhead for another. Many people connected to Baucus are connected to the health insurance industry and former staffers are now health insurance lobbyists and are in on the plans. "Years down the road" for the public option which hasn't been clearly defined yet.

[HamdenRice]

9. Do you think you will "pay" for single payer/universal? nt

[mmonk]

13. Yes, in some way.

However, it will truely bring down costs. To protect private insurers, I suspect the public option, whatever it is, will not be designed to be so competitive as to harm corporate profits or all the lobby money too much.

[eridani]

10. It depends whether the public option is financed like Medicare or not

If it is designed to be a dumping ground for poor and sick people with premiums mandated to be high enough to let private insurers "compete," then HELL NO! If it is single payer in every respect except that you opt into the public option, that will work. Even though it saves only 9% of what single payer would save.

[lumberjack_jeff]

11. LOL!!!

Sorry. Inside joke, I guess.

"Optional, universal" health care is exactly the platform Obama won nomination with. At the time I wondered if Columbia and Harvard had dictionaries.

[HamdenRice]

12. I think "optional, universal" means...

basically no previous conditions. Everyone can buy in, can't be refused, pays the same rate.

[truedelphi]

15. I think whether or not a person is for

The mandate with public option or not ahs a lot to do with how a person views the legislative process.

Since I have no patience or faith in the Assholes that run our nation, I gueess I belong on the side of the column with those who feel that the "SOMETHING" with public option could really end up being horrible.

Some of us agree with Lewis Black when he makes the not so funny joke:

"First the Republicans get in office, and since they don't know what they are doing, they all step forward and take one big SHIT. Then they have made such a mess of things, that the Democrats get in. And since they don't know what they are doing, they spend four years moving the SHIT around."

PS The insurance provider assholes that handled the economic (And perhaps medical) end of your 30,000 dollar procedure are also the same people that will see to it that the WITH public option wording is written to their liking. And the President has asked us progressives to shut up! Draw your own conclusions.

[HamdenRice]

16. It wasn't a $30,000 procedure

It was an attempt to stiff me with a $30,000 bill for a $60,000 procedure because of a mistake in accounting that they admitted they made internally. They said the billed they wrong account internally, and that therefore I'd have to pay.

(This was after the surgery, which prevented me from being a quadraplegic for the rest of my life.)

The gall of them was truly unbelievable. They literally said, sorry we billed our wrong internal account, so we can't cover your anasthesiologist because we paid him out of that wrong account.

I have no illusions that they are evil.

But sometimes, those forces lose. That's where we differ, I suppose.

[truedelphi]

18. Please let me know when those forces lose.

I haven't seen them lose in a long long long time.

I would love for events to prove my pessimism was a sorely inexcuseable personality trait, and not something born out by Reality.

[jannyk]

17. Seems to be a 'terminology' problem

I am for Universal Health Care and only Universal Health Care. Universal being the operative word = Health Care for ALL!!

The majority of us opposed to the current proposal of a Health Care Mandate, are opposed to the compulsory contribution to 'For Profit Insurers'. If the Public Option is an 'opt in' for everyone, with no income qualification nor any other barriers, then all is fine. Somehow I don't think that is what is being proposed.

You said...
>>If there is a public option, and everyone WHO IS EMPLOYED is required to sign up for a plan, including public option, and make contributions, why would that be a bad thing?<<

So, will the unemployed, self employed, retired and those that do not receive a paycheck, be covered? If so, that is Universal Health Care - no one is left out.

Will the bill mandate 'family coverage'? Or just for the individual employee, leaving the non working spouse and kids uninsured?

So I stand by my Universal Health Care or Nothing pledge. Unless everyone is covered by a decent Health Care Policy, they can stick the bill up their collective arses and twist it sideways!

[Coyote_Bandit]

19. Ummmm......

I am for single payer and against a mandate with a public option.

Why?

Because a single payer system can realize administrative cost savings that no private or public system can otherwise realize.

Because I believe any public option plan will eventually become a national insurer of last resort with a higher risk pool of insureds and a corresponding higher cost.

Because I know that mandates are meaningless to folks who cannot afford the mandated coverage. It is possible to be asset rich and cash poor - and be impractical to liquidate assets to fund health coverage. It is also possible to have significant cash flow and yet be unable to afford mandated coverage because of other pre-existing obligations. Those guidelines aren't going to address many of these situations.

Because I believe that everyone should be given access to a minimum level of care - and ability to pay should be irrelevant to that access. Additional services could be self-funded or insured.

Because so far as I can tell mandated coverage hasn't exactly been a resounding success where it has been implemented.

[HamdenRice]

22. You make a number of points I agree with, but...

In single payer, won't everyone's taxes go up -- either an additional payroll tax, like SSI/UI or a higher income tax?

People do have existing obligations, but I don't see how the uninsured are going to be added without both their and some others' fees, costs, etc., going up.

[Coyote_Bandit]

24. You have to compare like things

A single payer not for profit system that offers a minimum level of health care to everyone and which can be supplemented by additional private insurance cannot be compared to a for profit system with multiple competitors offerings a variety of coverages to the select few who can afford to make the premium payments (or obtain the benefit through employment).

The value of lives and the contributions they afford to society and families cannot be measured in financial terms. Ultimately the choice is whether all lives are deserving of a minimum level of care.

Every uninsured and underinsured taxpayer contributes to funding health care for others - including their elected representatives. It is cruel to require someone who is malnourished to dine with you, watch you eat, pick up your tab and yet be unable to partake. And that is exactly how we treat uninsured and underinsured taxpayers in this fucked up nation.

Folks who do not provide a minimum level of care to their animals and pets can be charged with criminal negligence and abuse. Yet we tolerate negligence and abuse toward our fellow humans. We will smile, wish them well and try to ignore their unfortunate circumstances while we know they face lifelong disability and certain death because they cannot obtain health care.

Taxes really aren't the issue. Humanity is the issue.

[mmonk]

25. Excellent post.

[HamdenRice]

28. I agree with the sentiment, but it's beside the point

Everyone should receive health care.

The question is, in the system you envision, who pays for it? Do you think doctors will diagnose and operate, orderlies push gurneys, nurses provide care, drug companies provide drugs -- all for free because it's the right thing to do?

If not, how will it be paid for?

[Coyote_Bandit]

29. Ummmm......

"In single payer, won't everyone's taxes go up -- either an additional payroll tax, like SSI/UI or a higher income tax?"



You were asking a comparative question. A question that cannot be answered. A question which is so ambigious as to be unclear whether you are concerned with initial or long term costs.

Why?

Because we are yet to determine what minimum level of care might be covered under a single payer system. A system that provides routine, preventative, emergency and pallative care is going to have a much lower cost profile than one that also includes aggressive treatment of terminal illness.

Because there are no reliable estimates of the administrative cost savings that might be realized under a single payer system. Likewise, there is no reliable system wide estimate of foregone private profits which a public not for profit system would no longer fund. Foregone profits and administrative cost savings should each offer significant savings compared to our existing system.

Because there are millions of folks who have completely foregone routine and preventative care often for decades. This means that past data is unreliable. It also means that routine and preventative care can be expected to reduce the progression of certain conditions to chronic disease and disability. That happens with treatment and preventative care you know. This suggests that initial costs might be expected to fall over time because of the provision of such routine and preventative care.

Because cost profiles will change over time and be related to a variety of factors that define the demographics and lifestyle of the population.

For whatever reason you seem to want to suggest that single payer will be a more expensive alternative. I doubt that you can offer any valid data to support that. The past is only a good predictor of the future if the same conditions hold. You simply cannot compare our current health care system to a single payer system. Available historical data is flawed and most of the variables are altered - or undefined or variable.

We have the resources to spend nearly half of our federal budget on military and national defense. We spend far far far more than other nations on such things. The real issue isn't the cost. We have the resources to fund a single payer system. The issue is whether or not we have the humanity to care for each other. My experience says that we don't. After all, it's all about MEEEEEEEEEEEEEEEE and my $$$$$$$$$$$$$$$$$$$$$$$..................

[HamdenRice]

30. And this is exactly why single payor advocates have marginalized themselves

Not of course the doctors and nurses and economists lobbying congress to advocate for it, but many members of the general public and participants here.

Universal health care, I think we agree, is a good thing and should be a human right.

Congress and the Obama administration are trying to get closer to that goal. There is no question whatsoever that it will cost more to the federal government than the current system, even if total health care costs go down.

I also deplore our country's willingness to go along with Bush in engaging us in multi-trillion dollar wars. But he did. He also stuck us with a multi-trillion dollar financial catastrophe.

We're stuck with the bill, and the current government is trying to get us out of this mess. But that's the reality. The reality is that we've reached the limit of the ability of the federal government to do things without figuring out how to pay for them. The Chinese are approaching the limit of their appetite for buying our treasury bills.

You are confirming the biggest problem in the debate here about incorporating single payer into the debate -- the refusal to address the question, how will this be paid for. It's ironic that you close your post with your accusation that people who think about cost are worrying about "Mee" because you have confirmed my fear that there are a lot of people supporting single payer because they mistakenly believe that they are going to get "free" health care without paying for it in any way, which is the ultimate "Meeee" centered fantasy. There is zero chance that would ever happen even if instead of the Obama administration it was the British Labour administration of the 1940s or the Swedish democratic socialists.

Even in European single payer systems, the public pays for the system. You may recall the very moving segment in "Sicko" in which the British Labor politician talks about the history of the public health service and reads a flyer addressed to the taxpayer from the days of its introduction. He says, essentially, this is not charity; you paid for it.

So that's the question. The system, however close it adheres to single payer, will be paid for, just like Medicare and Medicaid. And it will be paid for by the people using the system. If that's the case, then how is that any different from a mandate?

[Coyote_Bandit]

31. I'm not an actuary

If I were then maybe I could offer you several cost analysis scenarios - something which is a prerequisite to funding suggestions. I did however work in the insurance industry for nearly a decade. Part of my job responsibilities during that time period included the preparation and filing of rate and form changes for state approval in multiple states across a regional area. I am not nearly as ignorant of rating coverages as you seem to assume.

The formula used in one midwestern state to calculate a permissible loss ratio is over five single spaced pages long. The answer that is derived from that calculation represents a single factor included on one line in a much longer (20+ single space pages) calculation. And this was for minimum limit only auto coverage where there are few variables to be factored and rated.

Your utter unfamiliarity with rating insurance coverages is obvious. If you were the least bit familiar with rating practices you would acknowledge that guaranteeing that the coverages will be funded is a very complex matter that requires many actuarial assumptions and knowledge of coverages which are yet to be determined with respect to any single payer proposal.

You complain because I don't offer a simple answer. Yet there are no simple answers. Appropriately rating (and thus funding) a single payer system requires valuing a number of factors which must be estimated (usually based on a number of actuarial assessments derived from adjustments to historical data). You have yet to acknowledge these factors though I have made mention of several of them.

How single payer will be funded was ***not*** the question you asked. You asked how costs under single payer would compare to our current system. Again I've pointed out several factors that will cause significant differences in the cost profiles of these two systems. Again, you've yet to acknowledge those factors.

The question isn't whether or not we have the ability to fund a single payer system that insures everyone has access to minimum levels of health care. The question is one of priorities with respect to our expenditures. Simple fact is that our nation has the capability to spend trillions of dollars on prolonged police actions in Iraq and Afghanistan, in torture facilities in Guantanamo, on undocumented prisoner transports for purposes of torture and interrogation, on unbudgeted off the books black ops and defense expenditures. We devote nearly half our national budget to military and defense expenditures. Obviously we'd rather fight and kill than take care of our own. This unfortunate observation may well explain why we are doing so poorly taking care of our injured veterans. It would seem that it just isn't much of a priority.

If we are indeed stuck with the current proposals it is because we have not been willing to fight for single payer. We have been too willing to compromise. We are all too happy to chase after the tiny crumb thrown our way. We are a nation of selfish lazy fucks. We are not a national community. We are largely unwilling to balance the needs and interests of the many with the needs and interests of the few. Hell, some of us are so damn ignorant that we do not even recognize that these often conflict.

I did not suggest that any single payer system should make health care available without cost nor did I suggest that such a system would be more costly. You attribute that meaning because that is what you want to hear and that is apparently what you believe. Presumably a portion of all tax dollars will be used to fund any single payer system and perhaps an additional charge could be made as well. Tax collections are currently used to fund the health care which our government provides to many millions (elected officials, government employees, prisoners, the young, the old, the disabled, the poor, veterans, Native Americans, etc.). Cost will be directly related to coverages - coverages which are yet to be determined. For example, a system that includes palliative care for terminal illness will have a much lower cost profile compared to one that includes aggressive treatment for such conditions. Likewise, a system that includes a lifetime maximum benefit for each person (as for profit insurers do) will carry a much lower cost profile than one which has unlimited lifetime benefits. If a single payer system realizes administrative cost savings and has some limits on coverages it may well be less costly than our current system. And there is abso-fucking-lutely no reason why we could not have a single payer system that guarantees everyone a minimum level of care and which can be supplemented by additional private for profit coverages.

FWIW, health care reform is my line in the sand. I will not vote for any office holder to retain their position if they do not support some form of single payer affording everyone some minimum level of coverage. I'd prefer a Democratic Congress and President but I will not sacrifice my own interests and desires for their position and the personal power and prosperity they receive while ignoring my needs and interests in favor of corporate lobbyists. If that means I withhold my vote or vote for a marginal third party candidate then so be it. I'm tired of voting for the best of two bad choices. A candidate can wear the Dem label and still be nothing more than a sold out corporate lackey. Those sold out bastards need to be removed from office IMHO.

Bottom line is that this country has the resources to fund minimum coverages under a single payer system. Our citizens either lack the humanity to demand it or are too stupid to realize they do indeed have the power to do so. And our elected officials lack both the leadership ability and the intestinal fortitude to fight for a single payer system.

[area51]

32. Great post.

Wish I could nominate it for the Greatest Page.

[leftstreet]

20. Stop the terminology wars. It's either FOR-profit or NON-profit healthcare

Choose one

[inna]

21. very simple. we don't need INSURANCE. we need HEALTH CARE.

fuck for-profit insurance companies. so there.

[HamdenRice]

23. Actually we need both. Even social security is called

social security insurance. We don't need for profit insurance, but insurance is simply the term for how health care is financed.

[BlooInBloo]

26. Some of the single-payer folks demand either that or nothing at all.

[redqueen]

27. I'd love to have a single-payer system, but it's just not going to happen.

Look at how hard DEMS in Congress are fighting against just a strong public option.