Can you still be in favor of single payer but support ACA as a step to get us there?

[nobodyspecial]

Is it perfect? No. Will it help everyone? No. Is it being implemented less effectively in some (GOP) states? Yes.

But what about the people it has helped and will help? Do their lives not matter? I just don't get why it has to be so black and white.

[Daniel537]

1. Absolutely.

But that doesn't mean we shouldn't point out the problems the ACA doesn't fix. Single payer itself won't be perfect either, but its sure as hell a much saner system than for-profit health insurance.

[Jackpine Radical]

4. Yes, I agree.

ACA is better than what we had, in that more people get somewhat better coverage. I hope it is a waystation on the path to Single Payer. At the same time I note with dismay that it does nothing to rein in costs, and entrenches the parasitic insurance companies even further. It was a Heritage Foundation plan, and it still bears many of the faults one might expect of a plan hatched in a right-wing think tank.

[Loudly]

9. I don't think ACA takes the profit out of health insurance.

To the contrary, I think it tries to preserve profit while introducing some modicum of conscience.

Medicare for All is the ideal, of course, and the sooner the better.

[Daniel537]

13. Indeed it does not.

Single payer is the only thing that will get rid of profit in the health care industry. Personally i think Medicaid for All is even more ideal. I wish congress would have just made it a strictly federal program when it passed the ACA and gotten rid of the States as the middleman, something for which i and millions of others will now pay the price for since we live in States refusing to expand Medicaid.

[gopiscrap]

2. Yes

[kestrel91316]

3. Yep. I am one of those evil people. I see ACA as a stepping stone to something even better

and more just.

But ACA itself will make a HUGE difference for me, and will help me avert catastrophe between now and when I qualify for Medicare. Of course by that time I hope we have Single Payer/Medicare for All/Universal Healthcare, lol.

[liberal_at_heart]

5. Good luck getting the insurance companies out of the health care system. we should have addressed

this issue from the beginning. Now they will never leave. It will take a huge leap to get to single payer. That's why those of us who wanted him to take that leap wanted him to take it from the very beginning. There is no nice, easy, glide from ACA to single payer. Whenever it is that we finally decide to go for single payer we will see the same fight from the insurance companies that we saw when Hillary tried to introduce the idea of universal health care. It will not be easy. That is why we need someone who is willing to fight for it. Obama is not willing to fight for it.

[KG]

14. it's a meme taken like gospel, but nobody ever wants to explain how it happens.

[nobodyspecial]

30. Yeah, and explain to me

how you just ban insurance companies overnight and how exactly that happens. And let's just forget about all of those people, particularly the low-level paper pushers, coders, billers, etc., who suddenly don't have jobs. They were part of an evil system anyway.

[Enthusiast]

21. Lets agree to take that huge leap.

How about we take our nation back.

[jeff47]

33. Yes, there is a nice and extremely easy glide to single payer

Via the exchanges and "government options".

Implement a "government option" insurance in California and other blue states. With no need to turn a profit, it will be cheaper than the insurance companies. That will attract your initial buyers. Who won't die from "government healthcare", which destroys the ammunition the Republicans have tried to use against single-payer. That will get more "government option" customers, Eventually displacing the insurance companies. You now have de-facto single-payer in California.

That will be relatively easy-to-do in the blue states. The purple states will see the positive results in the blue states, and get on board. This massive loss of customers will start the collapse of the insurance industry, making a national solution far easier to pass.

Think it's bullshit? Well, the above is exactly how Canada got single payer. We know it can work because it has worked extremely well.

You propose that there is some magic way to "fight for it" that would somehow eliminate the political power of the insurance industry and Republican party, yet fail to lay out any specific steps. You just claim that fighting will somehow stop them. Sorry, but I was very much alive when the Clinton administration took that plan, and the subsequent utter failure....which is now blamed on not "fighting for it" in a classic, No-True-Scotsman defense.

[IronLionZion]

46. Start at the state level

Some states are more open to it than others. See Vermont's efforts. It may be possible in California once their economy gets better and they have enough liberal Dems supporting it again.

[SidDithers]

6. It's the first step in a long process...

That will eventually lead to national single payer.

Sid

[PowerToThePeople]

7. Can you? Sure, you can think what ever you want.

I do not agree with this thought though. Any mandate to support a for profit industry such as the insurance industry is wrong. I will agree to the ACA once the insurance industry is nationalized.

[VanillaRhapsody]

28. companies are going to abandon insurance for the market place...then the insurance companies

will abandon the market place...then the govt rolls all of those already into the market place into Medicare. Single Payer Healthcare in 3 easy steps!

[PowerToThePeople]

39. One can hope. n/t

[bluestate10]

73. You throw out declarative statements, then immediately dismiss any statement or listing

of facts that counter your claims.

[PowerToThePeople]

75. All I declared was my opinion on the ACA

Then I was countered with, "Hey look this plan (ACA) will get things where you would like them (single payer) to be. How? Magic." So I said "One can Hope." I see nothing wrong with anything I have done here.

edit - and, it may have not been a counter at all. it could very well have been sarcasm in support of my statement. Either way, my response of "One can hope" is valid. Remember this?

[bravenak]

8. Yep.

I think it's putting us on track to single payer. We will definitely get there in my lifetime.

[appleannie1]

10. It is one step in the right direction. The way to achieve most goals is one step at a time.

[KG]

11. how is ACA a step toward single payer?

[pnwmom]

61. It provides waivers so that states can take the funding and use it to set up single payer.

Vermont and other states are already taking steps toward this.

[Recursion]

12. Why did single payer become the gold standard? There are tons of better ways

I wish we'd look more at a national health system. I think the FQHC expansion in ACA could be a start towards that...

[CTyankee]

18. national health service IS single payer. What they have in some western european countries is just a

variation, but the whole idea of single payer is that the government collects the funding via the tax system to pay for health care and each country comes up with its own plan to implement. There can be, and there are, private organizations in some countries that implement the health care, but there is a requirement that they must be non-profit. I don't have a problem with that...

[Recursion]

22. No. "Single payer" describes a specific kind of insurance arrangement

With a central single insuring body (generally the government). e.g. what Medicare is, but expanded nationwide. A national health system would be what the VA health system is, expanded nation wide; "single operator" if we want to adopt the same politically tone-deaf sort of language we got stuck with for "single payer".

I'm aware that in the blogosphere it's become synonymous with "a government run universal healthcare program", but in fact it's one very specific thing, and not necessarily the best option.

[CTyankee]

24. Well, Medicare is accepted in private insurance coverage. I don't go to special Medicare docs.

I have both Medicare and private insurance coverage for a supplement.

So with the right system in place, the health care systems they have in France or Germany or Switzerland, etc. have universal health care paid for through the central government's taxation. It works because everyone pays in and everyone is covered.

[leftstreet]

25. Exactly. Medicare is NON PROFIT

That's the thing the anti-single payer people don't like to talk about

[CTyankee]

26. well, we've seen the general ignorance about that fact among low information voters that the RW

relentlessly exploits and distorts. They are gonna lose; it's only a matter of time...

[jeff47]

34. Pedantic: Switzerland doesn't.

Switzerland has a system very much like the ACA - health insurance is private, but subsidized and the "basic" plans are very highly regulated - for example the private insurance companies can only make no-or-trivial profit off them. The insurance companies in Switzerland make their money selling add-on insurance products to people who can afford it.

[Recursion]

74. Switzerland has basically what we will have in 2 years (with lower profit caps)

Though they have basically a cartel of a few insurance networks (which will be what most people predict we end up with) that are regulated like utilities and make their profit selling "plus" plans.

[CTyankee]

78. by single payer I was referring to the government collecting taxes to

pay for the universal health care that everyone pays into. The Swiss private organizations providing basic health care cannot make a profit off of providing it (they can for the services that are not considered basic, unlike OUR private insurance companies.)THAT was the difference I was talking about.

[Recursion]

79. Right. Switzerland is not single payer. We won't be either

At least not for a while. But Switzerland shows what we're getting can have a good outcome.

The Swiss private organizations providing basic health care cannot make a profit off of providing it

Not exactly. The government works with them to figure out what they can charge to limit profit to a politically acceptable level; it's closer to what cities and counties in the US do with power and gas companies. (They're sort of "half for-profit&quot . I would say that only works because they have sane campaign finance, but it turns out their campaign finance system is in some ways worse than ours, so it's not that.

[Bunnahabhain]

91. Most folks cannot even name the four basic healthcare delivery models

let alone discuss them intelligently. Glad to see you're injecting some nuance here.

[Warren Stupidity]

15. Sure, have been from day one. But aiming low was the wrong way to go.

[CTyankee]

16. Oh, this definitely a GOOD thing for single payer down the road.

People will get used to having this coverage and anyone who tries to take it away from them will have their faces ripped off by the voters. Expanding ACA to real single payer will then be a reality...the repubukes know this and that is why they are in near hysteria over ACA's implementation in 2014...

[IronLionZion]

51. Plus having payments in place would support more health providers

This country is sorely in need of more general/family doctors, nurses, clinics, hospitals, etc. The ACA now provides for a funding mechanism to support expanding providers. Private equity has already been investing heavily in retail clinics and urgent care centers to better accomodate some of the new patients seeking checkups and screenings and lab tests for the first time. I'm seeing tons of them pop up here in MD. There's certainly a need for more of this whether its public or private, and insurance provides a reliable payment stream.

Once there are more health providers, these A-holes can stop whining about "rationing health care" and we can work on switching the payment model towards single payer. Make no mistake. Republicans piss their pants in fear of this future where the people in our country are healthy (and educated, successful, and confident) due to the policies of the other party. Once everyone gets coverage, there is no going back. See their efforts to gut Medicare and Social Security. If everyone pays into it and everyone benefits, it is so much harder for them to kill it.

If you want to see efforts to kill existing single payer systems, see the conservative governments in single payer countries try desperately to cut funding but their people won't allow it.

[Enthusiast]

17. That's my position.

But we shouldn't have accepted a ban on discussing single payer.

It was wrong, they know it was wrong and it is another example of the erosion of democracy in the nation.

We preserved a terrible health insurance industry for no good reason. While the corporatist assholes were fine with sending our good paying manufacturing jobs overseas, they balk at losing their lucrative paper shuffling insurance jobs. It's total bullshit!

Let all just decide that we will have single payer, the insurance and pharmaceutical industries be damned.

[Proud Liberal Dem]

19. It was regrettably the best we could get at the time

but I still hope that eventually we'll get to a SP system. I tend to think that it is inevitable but will take some time and some states implementing it first.

[Aristus]

20. Yes.

And I do.

[Bluenorthwest]

23. Of course you can, but to do so righteously you must feel as stongly about those

who as you say will not be helped as you do about those who will. That is if you in any way count the fight as over, your position is not 'taking a step' but accepting a less than best status quo.
Justice delayed is in fact justice denied, no matter how many preach about the glories of slow change what they are advocating is continued injustice, and that's not cool.

[nobodyspecial]

29. I live in a GOP state that is opting out of Medicaid expansion

and pretty sure I'm screwed in the deal, so, yeah, I'm still VERY concerned about the people it is not helping. That doesn't mean I don't want all those who will be helped to be forced to wait for the perfect solution because this doesn't personally benefit me. I think I may benefit from the new federally funded clinics. We'll see.

[pnwmom]

62. The better ACA works in the blue states, the more pressure there will be on governors like yours. nt

[The Magistrate]

27. Certainly, Sir: That Is Pretty Much My Own View

And I suspect millions more share it.

I favor single-payer, and see this law as giving far too much leeway to insurance profiteers.

But the last thing I would want to see done is the law repealed, or even delayed in going into full effect.

[sheshe2]

31. Yes

[treestar]

32. Of course. Nt

[Bunnahabhain]

35. I understand the desire to believe the ACA is a step towards a true universal health system

But I think the ACA only entrenches the same fatally flawed system even more. If nothing else alone the ACA has mandated 10s of millions of new customers for the insurance companies.

Know what the real first step towards universal was? Disconnecting employer paid premiums from the income tax code. Why should premiums get different tax treatments if I pay for my premiums myself or if my employer decides who I have to buy insurance from and then pays some (or all) of the premium for me?

[jeff47]

86. The ACA actually does what you're asking for.

Know what the real first step towards universal was? Disconnecting employer paid premiums from the income tax code.

The tax on "Cadillac" health plans is poorly indexed. Intentionally. In about 10 years, virtually any employer-based insurance will hit it. Which will result in companies "dumping" their employees onto the exchanges.

Which is actually a good thing. Because those exchanges are how we get single-payer. Blue states have/are likely to implement "government options" in those exchanges. With no need to profit, they will be cheaper than the private insurance companies. Resulting in people switching to the government options. When they don't die, more will switch for the cost savings. Since insurance is all about risk pool, the private companies will get more and more expensive until they are driven out of those markets. Creating a de-facto single-payer system.

Just annihilating the insurance companies was not going to happen - too many Democrats in Congress were scared of making that large a leap. And Joe Lieberman is an asshole. So the ACA sets up a system that will gradually transition away from employer-based and private insurance to single-payer. The beauty is we don't have to do a single thing at the federal level to do so. The battle moves to the states, where it will be much easier for us to fight.

[Bunnahabhain]

88. People will think what they want to think

I don't argue with them. I'm correct 99 times out of 100.

Here, I'll toss one out to you: your ten year plan will never happen. Either the next POTUS will be Repub, who is sure to strike that component of the ACA, or the next POTUS will be Dem and that person will be forced by the unions to exempt them thus eroding that component. From there it will be easy for the Repubs to come along and finish the job the next Dem POTUS starts.

I also find it specious to just assume a government run program will be cheaper. I could be wrong though because government run programs would never cook the books, pander to special interest groups and drive costs up, mismanage risk, etc. Right? I mean look at what a great job they did with Social Security and life expectancies.

The only way a government program is actually cheaper is how Canada does it. Set a budget and when the money runs out you close things up. I'll never forget about 12 years ago a friend had to go have her kid in Detroit as Windsor closed down hospital pharmacy and labs from MD-6a and she was a high risk delivery.

[jeff47]

89. I severely doubt your accuracy

Either the next POTUS will be Repub, who is sure to strike that component of the ACA, or the next POTUS will be Dem and that person will be forced by the unions to exempt them thus eroding that component

Doesn't particularly matter. It's a bonus that speeds up the transition. The penalty for a company not covering their employees isn't indexed. So it won't take too long for that penalty to cost much less than covering employees.

I also find it specious to just assume a government run program will be cheaper. I could be wrong though because government run programs would never cook the books, pander to special interest groups and drive costs up, mismanage risk, etc.

Or instead of snark, you could notice that Medicare, Medicaid and the VA cost a lot less than equivalent private insurance. And that the government-run insurance in every other advanced country costs much less than private insurance in the US.

But nah, it must just be a guess pulled out of my ass. Has nothing to do with that massive track record.

I'll never forget about 12 years ago a friend had to go have her kid in Detroit as Windsor closed down hospital pharmacy and labs from MD-6a and she was a high risk delivery.

Ah yes, the magical friend who just happens to fit the story you want to tell. I'm totally sure they exist. And I'm equally as sure as it was only the budgetary constraints that caused her to go to Detroit. Had nothing to do with any other aspect of a high-risk pregnancy.

[Bunnahabhain]

90. You are proving my accuracy

As I said people will think what they want.

Medicare is bankrupting the US. The unfunded liability is in the trillions. Not sure how you can compare that to traditional insurance that has to fund itself. Also the much vaunted "low overhead" it is a bit artificial. I could talk about practically non-existent utilization review, having fiscal intermediaries do the bulk of processing (basically Medicare pays insurance companies to do the claims hence that is an not an overhead line item but rather a business expense), and other stuff but I'm not going to change a single mind.

As to other advanced country costs...being a Canuck, as I'm trying to tell you, it's easy to limit costs when you just cease to provide services when the money runs out, cut out services, etc. Here's a link to the Ontario website that shows wait time for surgeries by geographic location. I picked a CABG (coronary artery bypass graft) for Windsor, the city across from Detroit. http://www.waittimes.net/Surgerydi/en/Data.aspx?view=0&Type=0&Modality=4&ModalityType=8&city=Windsor&pc=&dist=0&hosptID=0&str=&period=0&expand=0 Notice the result? This MSA of a million people in an advanced country cannot get a simple CABG! They have to travel to London. Also notice provincial wait times...42 days! For a simple CABG! Yanks that favour single payer do not want to hear the reality about Canadian healthcare and it's all unicorn farts. Does Canada's system have some advantages? Sure it does. Is it something I think the majority of Americans would really want when reality sets in? Nope. Even your comment where you feel I'm lying about my friend's pregnancy...you don't see the problem if your answer is correct? That Windsor was just plain unable to handle her pregnancy? The real reason was, as I said, labs and pharmacies were shut down overnight and the OB did not want to be hours without stat labs if things went south.

Additionally the advanced Euro democratic socialists countries have different tax structures. VATs are all over the place in Europe and are needed to fund the social safety net. Americans seem singularly against VATs both on the right and on the left. I just do not see how people expect to have the expense side and not the revenue side.

[NCTraveler]

36. I support single payer and don't think the ACA is a step to get us there.

I also think the ACA has some great provisions in it. You are correct, it does not need to be black and white. Nothing about the enormous bill that is the ACA is black and white.

[Liberal_Stalwart71]

37. Yes, you can. Even the Brits didn't get their NHS overnight. The story of the NHS

is long and varied. It didn't happen overnight. It took time to get the NHS.

I live in the BLUE state of Maryland and the implementation of our health care exchanges under Obamacare is a step in the right direction. Maryland, California, New York...all these states that have implemented the ACA exchanges are witnessing a decline in premiums starting this year.

Obamacare is far from perfect, but it is a step in the right direction. We will eventually work towards the Public Option--just like Congress has right now, and most federal government employees like myself. It will take some time, though.

[1-Old-Man]

38. No, at least I don't think so. Reason is that stopgap measures prolong a bad system.

I don't see the ACA as a first step to anything. What I see it as is appeasement of the medical and insurance industries enshrined into law which makes it about as solid as a rock when it comes time to move on to the real target. In short we have given those who profit immensely from our shitty health care system a benchmark bit of legislation that they will not let us get past.

The Right may hate the ACA now, but they will come to defend it as a perfect system if anyone tries to move on to Step-2 and their defense of it will be even harder to get past than it was to put the ACA in place in the first place. In short they will think they gave us enough and fight tooth and nail to stop any further improvements. So to my mind the ACA will have the effect of killing any chance for Single Payer, which is the only rational system for us.

[Hoyt]

40. I look at this as huge step toward single payer, with private insurers taking much of the risk of

insuring millions more people. That is something our current Congress would never accept. And the risk is huge.

I think middle class people come out better than they were before.

I think a number of the poor will benefit from Medicaid expansion, but others -- with slightly higher income -- will have difficulty with deductibles/copays. That latter group is the one I worry about most.

Again, many of them will find easier access to Medicaid. And, those facing big expensive care, will probably come out in reasonable shape. I don't think a hospital is going to refuse care for a transplant because you can't pay your out-of-pocket cap ($3000 - $6000), when the procedure reimburses in the hundreds of thousands of dollar.

Clearly it is better than before.

[Orsino]

41. It's not necessarily a step to get us there.

Isn't it enough to know, though, that defending it against he GOP will preserve health care for millions?

[tabasco]

42. That's me.

The historic ACA will improve health care in America, but we still have work to do.

[bvar22]

43. As soon as someone shows me HOW...

...we move from:

[font size=3]*Every American MUST BUY Health Insurance from private Corporations

TO

*A Publicly Owned, Government Administered NATIONAL Health Care Program,[/font]
I will be willing to listen to the Step in the Right Direction crowd.


So what exactly is the next step?

Some states MAY try to start their own Public Option,
but the thing that makes Insurance work is a LARGE risk pool.
By diluting the collective POWER by a factor of 50X , I really don't see how
a State Run Public Option is going to offer that much of a cost advantage,
especially when the "private" plans on the 50 individual State Run Exchanges will have ALL the Corporate Resources of their Conglomerate National Power to make SURE that small, State Run Public Options fail.

It will be like Mom & Pop Insurance trying to start a new business in a small town that directly competes with Wall Mart,
and Mom & Pop MUST AT LEAST BREAK EVEN OR FAIL their 1st Year (and EVERY year), while the Wal-Marts of Health Insurance can run
[font color=firebrick]In-the-Red[/font] in those states for as long as it takes to UNDERCUT & KILL Mom & Pop Public Options before jacking their prices back up.

Every State has always had the right to have non-profit, sliding scale Community Health Centers. The ACA did NOT give states that right, though that hasn't stopped the salesmen from taking the credit.
We did NOT have to trade away The MANDATE to BUY Insurance to get this CHC benefit. It already existed.

It looks to me like we are going to be STUCK with the Republican Dream of A MANDATE to BUY INSURANCE from Private Corporations with NO Public Option for a LONG time,
and that REAL Health Care Reform like that taken for granted in civilized nations where the term "Medical Bankruptcy" is unknown
has been delayed by at least a generation.


They have THIS insurance scam figured out.
But it IS The LAW now,
so we only have to Wait & See.
2014, when The MANDATE kicks in
will be an interesting year.

One thing we DO know,
the Health Insurance Cartel is overjoyed with the ACA.
The Insider Smart Money believes that it will be a Gold Mine for the private Health Insurance Industry.
Their stock has more than DOUBLED since ACA was passed.





You will know them by their [font size=3]WORKS.[/font]

[Hoyt]

48. We could have defeated it like Hilliary care and waited another 15/20 years to debate it again.

I think it's a lot easier to improve from here, than from where we were in 2009.

[bvar22]

52. If we lived in a Binary World,

you would have an Either/Or point.
But we don't, and there were better options available that would have actually been a Step in the Right Direction.

In an uncharacteristic moment of honesty,
Obama's Chief-of-Staff Rahm Emanuel let the Cat Out of the Bag while addressing his "base" at the Chamber of Commerce:

"In a Thursday interview, White House chief of staff Rahm Emanuel argued that business leaders should be grateful for ... the fact that the overhaul of health care preserved the private delivery system"

http://dyn.politico.com/printstory.cfm?uuid=B2F85DDF-18FE-70B2-A835FE1E7FA8D74C

Opportunities like we had in 2008 for genuine reform don't come along very often.... once a generation if we are lucky.
This one was wasted "preserving the private delivery system."

Incrementally Expanding Medicare was an EASY sell, even in conservative rural America.
That is why is was taken OFF the Table from the very start.



You will know them by their [font size=3]WORKS.[/font]

[IronLionZion]

55. See Canada's path to single payer,

Started with one rural midwestern province and spread through proven success and popularity. Also it is still administered by each province.

See the beginning of coverage
http://en.wikipedia.org/wiki/Health_care_in_Canada#The_beginning_of_coverage

It was fought with the same arguments the Repubs are using now. And federal efforts were unsuccessful so they went province by province.

Even in our country we have reforms at the state level for things like gun control and gay marriage and taxes and loads of other stuff. We're a big country with a long history of state level autonomy. Its harder for Repubs to fight it in liberal states.

[lumberjack_jeff]

68. As of Oct 1, health coverage isn't something that is doled out at the sole discretion of the insurer

If the insurer is obliged to take all applicants, it is hard to argue that health care is not now considered a right.

Since health care is now a fundamental right (although not free as in beer), the remaining issue is one of cost.

Medical loss ratios among private insurers are now capped at 20%. As competitive pressures (since the public can now compare apples to apples) drive costs down, and more low-income people become comfortable with Medicaid, the pressure to further reduce costs will lead to opening up Medicare for open enrollment.

The private sector can't compete with the public, so medicare will grow and private insurance will shrink. At some point, private insurance only is useful in fringe kinds of supplementary insurance.

[jeff47]

87. Not really

"Blue Cross" can't run an insurance company in NY. "Blue Cross of NY" can, which is actually a different company. Because most states have regulations that require a unique company for insurance in their state.

Yes, the big "Blue Cross" could send money to keep "Blue Cross of NY" afloat. But it's not as easy as shuffling funds within a single company.

Plus, the state "public option" doesn't have to be in the black at all. The legislature could easily support it until it really gets up-and-running. Which is why we should be targeting blue states first - their legislatures are likely to fund the start-up phase.

Finally, these public options don't have to start from nothing. Each state already runs a massive insurance company called Medicaid. Tweak reimbursement rates and let people buy in, and you suddenly have a mature public option.

[JoePhilly]

44. Blasphemer!!!! Either you hate the ACA as much as the House GOP ...

or you're a BAD liberal!!!!

[ProSense]

45. Single Payer movement in the era of Obamacare

Single Payer movement in the era of Obamacare

by Shockwave

If you believe that healthcare is a basic human right and understand why Single Payer IS the final destination of healthcare reform and you want to get it done as soon as possible, read on.

<...>

If you are involved in the Single Payer movement in California this diary may help you understand what we face and whet we can do to get things done.

I am one of those Single Payer activists who understands that Obamacare will benefit many and it is truly amazing that this effort, that President Obama should get full credit for, is the best that could come from a dysfunctional and extremely polarized DC.

And I support those who keep up the fight to prevent its sabotage by all the Republicans in red states and in DC.

I consider the ACA a giant first step towards an America where healthcare is recognized as a basic human right and there is a system that allows ALL who live here to have access to affordable medical attention without the fear of going bankrupt.

And I understand that California is leading the country in the implementation of Obamacare. But it's not about being better than other states like Texas and Georgia where Obamacare is being sabotaged or ignored. It's about joining Vermont to help lead the country to a place where ALL are covered, where the private insurance blood suckers are gone, where medical results and costs are in line with other developed nations, where if you need to see a doctor (or a dentist) you make an appointment and you don't worry whether you will be able to pay the rent (given that 76% of all Americans live paycheck to paycheck).

So how do we get it done? <...>

Bill Zimmerman has just published an article that sets the tone;

Why California can lead the way to Single Payer in the U.S.

Recently Public Citizen, a member of California’s AllCare Alliance, released a report entitled, “A Roadmap to Single-Payer: How States Can Escape the Clutches of the Private Health Insurance Industry.” “We’re looking for a few pioneering states with the courage and fortitude to let common sense prevail over the insanity of our current patchwork system, “said Lisa Gilbert, director of Public Citizen’s Congress Watch division. “Once they succeed, we expect most opposition to single-payer and our reliance on privately insured health care to become historical relics.”

By the time California votes to move to a single payer system – the earliest date possible is 2017 when the Affordable Care Act allows states to set up their own systems – Congress will have gone through two more election cycles. Voters will be less white, and probably less conservative, and the changing composition of the House of Representatives may allow for passage of single-payer waiver legislation for states, perhaps even with “state’s rights” support from a few Republicans.

California, Vermont and possibly other states moving to single-payer will put increasing pressure on Congress to grant other state waivers. Once subject to such pressure, Congress could theoretically pass a federal bill to give (improved) Medicare to all, but it is politically far more likely that they will simply let the states set up their own systems, which can then become models for a larger federal program. California, once again, could be the engine driving national change.

One of the features of Obamacare is the "waiver". The idea is that states can apply for this "waiver" and implement their own plan starting 2017 if this new plan covers more people and is affordable.

So lets take a look at what the ACA says about the "innovation waiver";

SEC. 1332 ø42 U.S.C. 18052¿. WAIVER FOR STATE INNOVATION.
(a) APPLICATION.—
(1) IN GENERAL.—A State may apply to the Secretary for the waiver of all or any requirements described in paragraph
(2) with respect to health insurance coverage within that State for plan years beginning on or after January 1, 2017. Such application shall—
(A) be filed at such time and in such manner as the Secretary may require;
(B) contain such information as the Secretary may require, including—
(i) a comprehensive description of the State legislation and program to implement a plan meeting the requirements for a waiver under this section; and
(ii) a 10-year budget plan for such plan that is budget neutral for the Federal Government; and
(C) provide an assurance that the State has enacted the law described in
subsection (b)(2).

So this is the milestone that any state has to go through. The Vermont single payer activists lead the way. Even Vermont will apply for the "innivation waiver" to get federal funds starting in 2017 to help pay for their Single Payer system.

Here in California the Single Payer organizations (linked logos below) will announce soon the plan to achieve the "waiver" milestone by January 1st 2017. The Single Payer plan that will be proposed will be based mostly on SB 810, which was approved by SEnate and Assembly twice and vetoed twice by Arnold Schwarzenegger and in 2012 it was stopped by 6 blue dogs in the Senate before it could get to Jerry Brown's desk.

In California, one of the key issues is that Obamacare will leave out over 3,000,000 undocumented workers. These 3,000,000 are an integral part of our society and mostly but not all are Latinos. And as Joan McCarter pointed out, Latino organizations worry about funding for Obamacare outreach efforts;

Hispanic health centers and community organizations say they don’t have the funding or resources to carry out the complicated sign up process for the 10 million Latinos who will be eligible for new public and subsidized health coverage options.

Latino organization outreach is a key to success.

And we should coordinate the efforts around the country.

So here in California we need to work with Sacramento at all levels. It will be a lot of hard work but there are thousands of committed activists.

One way you can help is by joining one of the Single Payer organizations and help us organize and direct the grassroots movement that will be instrumental in convincing Sacramento to go along.

And this week on Thursday August 1st you can join other activists to watch The Healthcare Movie in Santa Monica at 7:30PM and celebrate the 48th anniversary of Medicare. You can buy tickets here.

- more -

http://www.dailykos.com/story/2013/07/30/1226609/-Single-Payer-movement-in-the-era-of-Obamacare

Great stuff!







Note:

Kos Media, LLC Site content may be used for any purpose without explicit permission unless otherwise specified

http://www.democraticunderground.com/10023372091

Bottom line: Obamacare really is for the 99%
http://www.democraticunderground.com/10023441345

Under Obamacare, Millions Of Americans Will Pay Less Than $100 Per Month For Health Insurance
http://www.democraticunderground.com/10023683018

[TBF]

47. It's a giveaway to the insurance companies -

we need Medicare for ALL.

[Hoyt]

49. Of course, insurance companies administer Medicare at local level, and 25% of Medicare beneficiaries

voluntarily sign up for Medicare Advantage Plans which are sold by private insurers.

Believe me, I don't like private insurers, but they have their greedy hands in everything including Medicare and Medicaid.

[TBF]

54. I know exactly what the insurance companies do -

and it's time to remove the middle man and particularly the profit motive from health care in the US. YMMV.

[IronLionZion]

56. Its not giving away shit

it creates a functional and regulated marketplace for individual insurance plans. The greedy ones like Aetna who don't want to pay for the flood of new preventive checkups and screenings by bypassing state exchanges will also not get any of the premium payments from those exchanges. The companies who choose to operate in the exchanges and are willing to pay for care of the inevitable flood of new patients seeking care for pre-existing conditions are the ones who will benefit from the premium payments and subsidies, and possible customer loyalty going forward as people keep the plans that work.

No, its far from ideal. But it is a drastic improvement to what we had before where so many were left out with no access to care. Don't sacrifice good in the hope of pursuing perfect down the road. Many folks won't live that long. I have friends who work in nonprofit or small business or self-employed who are counting down the days until they can purchase plans on the exchanges.

[TBF]

80. Did I say that we shouldn't do it? No.

What I did is point out the obvious - insurance companies are still in the middle taking profit off every bit they can - collecting premiums, denying claims. Until we get profit out of the system this will continue. Your "friends" will purchase plans and then they too can experience what the rest of us do - insurance companies trying their best to overrule doctors, refusing to pay for prescriptions, refusing to pay claims ... it will not end until we have a single-payer system.

[Uncle Joe]

50. There are some things I like about the ACA but I believe it's actually taking us away from

"single payer" health coverage aka Universal Health Coverage.

The ACA mandate strengthens the for profit health insurance industry by giving them tens of millions of captured customers.

These increased profits by the for profit health insurance industry will be used to bribe/lobby future Congresses and administrations to fight against instituting universal single payer coverage.

The for profit health insurance industry is already a powerful lobby in its' current manifestation, just look at what they did in defeating even a strong national or regional public option as evidence.

As time goes by they will become wealthier and even more powerful.

Thanks for the thread, nobodyspecial.

[IronLionZion]

57. Those new customers are not pure profit

they include folks with pre-existing conditions and those who are getting free preventive screenings that will uncover expensive conditions like cancer. Insurance companies expect high costs for the first few years.

And the reliable insurance payments for treatment will provide one way to increase the supply of healthcare providers which we desperately need with any sort of universal coverage especially single payer.

[Uncle Joe]

60. I know it's not pure profit but with an estimated 40 million new customers coming on board,

you can bet the for profit insurance corporations profits will increase.

The economy of scale will for a lack of better words "insure" it.

[IronLionZion]

63. Anything over 20% gets paid back

80% of premiums have to be paid in healthcare or reimbursed.

[Uncle Joe]

65. 20% of tens of millions in premiums is still a lot of profit. n/t

[IronLionZion]

66. You don't want companies to make profit they don't "deserve"

just like Republicans don't want people to get any kind of benefits we don't "deserve". Why does it matter what someone else gets?

[Uncle Joe]

67. Not in regards in health insurance, anymore than I believe there should be for profit prisons or

hired mercenaries.

For profit prisons corrupt the judicial system and erode the Bill of Rights while hired mercenaries ie: Blackwater/Xe or whatever their name is now weaken the nation's defense by avoiding accountability, being loose cannons and leeching from the armed forces.

For profit health insurance corporations actually work against health care due to inefficiency and self-interest.

There are some things government is far better suited to do.

[Romulox]

83. Twenty percentage is a HUGE profit margin in most industries, especially when guaranteed in law. nt

[IronLionZion]

84. Not profit margin, its administrative costs like staff salaries

80% of premiums have to be paid out in claims for treatment or paid back

Of course Medicare does it for less. Once most everyone is covered under the ACA, we can move forward towards single payer with the administrative cost savings being our primary benefit.

[Romulox]

85. Nope. Admin costs and *profit*. These are *for-profit* insurers.

"80% of premiums have to be paid out in claims for treatment or paid back "

The more paid out in premiums, the larger the insurers' 20% will be.

[grahamhgreen]

53. Yes but I'd like a national address on a public option.

[FredStembottom]

58. Yes.

I hope for what is stated above. That a migration begins towards single-payer-esque options.
Also, just getting coverage to all puts a nail in the coffin of anti-Obama-care wing nuttery.
Once all the brain-washed lunatics in Dumbassistan get some help for their teeth, joints, chronic pain, diabetes, etc., etc., they will hopefully consider not demonstrating against 1+1 equalling 2 anymore.

[PoliticAverse]

59. Some people think the ACA will make single-payer more likley to happen. n/t

[Lifelong Dem]

64. People complain about what we have with ACA

Especially the Republicans.

[Maven]

69. That's a bit like asking if adding worcestershire to your chuck steak is a step toward filet mignon

fundamentally two totally different things, and one ruins your appetite for the other

[devils chaplain]

70. I am. n/t

[Kingofalldems]

71. Yes

[bluestate10]

72. Yes. That is the only path that will work. nt

[NoOneMan]

76. No. Its not single payer. It wont be. Its its own "uniquely American" thing.

The consequences of which we really can't judge yet. In 5 years it may either bolster the case for a true overhaul of the health insurance system or a collapse. Who really knows

[roamer65]

77. Here's why it will be the first big step toward single payor Medicare.

The ACA will begin to break the link between employment status and health insurance availability. It shifts the paradigm away from the employer to the actual person(s). This is the biggest mindset change that needs to happen in America for the acceptance of an eventual single payor system.

[Demo_Chris]

81. Support what you like, but ACA is not a step toward single payer...

It is a step away.

All it does is transfer more wealth and power into the hands of private corporations and billionaires. Now, thanks to Obamacare not only will the poor not have healthcare, they will be hammered with a fine for being poor.

[Romulox]

82. It's fantasy to believe mandatory private insurers will ever give up the power they've been given.