Healthcare Jujitsu: A Path to Medicare for All by Robert Reich

[Better Believe It]

Healthcare Jujitsu: A Path to Medicare for All
by Robert Reich
March 27, 2012

So why not Medicare for all?

Because Republicans have mastered the art of political jujitsu. Their strategy has been to demonize government and seek to privatize everything that might otherwise be a public program financed by tax dollars (see Paul Ryan’s plan for turning Medicare into vouchers). Then they go to court and argue that any mandatory purchase is unconstitutional because it exceeds the government’s authority.

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

If they did this the public will be behind them — as will the Supreme Court.

[ProSense]

1. Here's the

link: http://robertreich.org/post/19972321637

Americans don’t mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new health care law.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits. But requiring citizens to buy something from a private company is different because private companies aren’t directly accountable to the public. They’re accountable to their owners and their purpose is to maximize profits. What if they monopolize the market and charge humongous premiums? (Some already seem to be doing this.)

<...>

Obama and the Democrats should do the reverse. If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions.

When this happens, Obama and the Democrats should say they’re willing to remove that requirement – but only if Medicare is available to all, financed by payroll taxes.

I thought insurance companies loved the mandate? So the trade off is to drop pre-existing conditions for Medicare for all?

This assessment does not sound realistic.

[Selatius]

6. I believe the insurance companies didn't want ACA to pass originally.

Yes, requiring a purchase does generate what is known as a "captive audience" in the business world, but it also imposes restrictions upon them that they'd rather do without if they could get away with it. They still want to discriminate based upon pre-existing conditions. They still want to impose a lifetime cap on individual insurance policies, and they still want the freedom to determine how much money actually goes toward health care costs vs. "administrative costs."

[ProSense]

9. That

Yes, requiring a purchase does generate what is known as a "captive audience" in the business world, but it also imposes restrictions upon them that they'd rather do without if they could get away with it. They still want to discriminate based upon pre-existing conditions. They still want to impose a lifetime cap on individual insurance policies, and they still want the freedom to determine how much money actually goes toward health care costs vs. "administrative costs."

...really doesn't support Reich's argument. The fact is that the insurance companies and the right are figthing the mandate. The other thing is why would they agree to Medicare for all as a condition for dropping pre-existing conditions?

If the law is a boon for them, why would they agree to a system than ensures their doom? If Medicare for all is enacted, the pre-existing condition provision and the current law are moot.

The arguments are simply not making sense.

[Selatius]

13. No, it doesn't.

And the whole notion that they'd go ahead and support expanding Medicare to cover everybody is a bit laughable. Medicare, after all, doesn't donate to politicians for re-election campaigns like the insurance cartels. As imperfect as ACA is in the eyes of the health insurance companies, it's a far more liveable arrangement than being driven into extinction by Medicare. The only more livable arrangement they'd deal with is repealing the aforementioned parts of ACA reform. Even if Obama did try that route, he'd have no support from right-wing Democrats in the Senate and House. It'll make Obama look to the peanut gallery but little else.

[zbdent]

2. I find it ironic that the Republicans, conservatives, and Teahadists are the ones leading the charge

for people to get FREE healthcare ...

[still_one]

4. They are not, and it isn't free. Emergency room treatment is the most expensive /nt

[zbdent]

10. it is the most expensive, and it's the last resort ... which is spread to all ...

when the person can't (or won't) pay their bills.

If "Obamacare" didn't have a provision which covers people using something without any financial consequence to the user, then you'd be hearing Repubs/Teahadists/Conservatives screaming about how Obama was giving it away for free.

[Better Believe It]

5. They aren't. The Republicans are opposed to a single payer health care system.

[zbdent]

11. Too bad "single payer health care" was not on the table ...

[still_one]

3. Nice thought but it won't even get to that. If the court rules down the mandate, it is over. Obama

will lose the election

This will be used by the MSM and the repukes to demonize the Democrats

As far as the public will demand it, that won't cut it either. The repukes who control the house will not allow it, and they do not care what helps the people or what they want

In fact, if the HCR goes down in the court, I suggest that Medicare and Social Security will be next

The right wing has been trying to eliminate those safety nets for decades

It doesn't look good, and the balance is in the hands of Kennedy, and based on the "corporations are people" decision, I pretty dismayed

[zbdent]

12. heard today it's a "win-win" situation for Repugs ...

SCOTUS shoots it down, Repugs claim victory, ride into November with that as their banner.

SCOTUS upholds it, Repugs run on shutting it down entirely - repeal and ... oh, wait, "replace"? Riiiiiight ...

[Motown_Johnny]

25. Backward

If SCOTUS repeals the entire law then everyone who has their 18-25 year old child on their policy is going to be told their child no longer has insurance. Also every senior who fell into the "doughnut hole" for their prescription drug coverage is going to be told that their costs are going back up. The backlash for these, and other clauses already in effect, will be enormous.


If SCOTUS upholds the entire law then we just keep bashing the (R)s with the fact that they were wrong all along and are just unable to grasp reality. Only the RW nut jobs will still be on their side after that.

[still_one]

26. I hope the court upholds it, but I don't think it looks good /nt

[Better Believe It]

7. Obama and Democratic party leaders could make it clear they are opposed to any cuts in Medicare and

Social Security.

Gimmicks to cut benefits such as increasing the retirement age for Social Security or changing the cost of living formula can only be passed if President Obama and leading Democratic politicians support such "reforms".

A prediction.

They will lead the campaign for such reforms .... right after the election.

And I bet we might find a few people on Democratic Underground who will try to justify and defend such cuts in the name of protecting such benefits.

[Dragonfli]

20. A Few? We are lousy with apologists for every right wing idea adopted by so called Democratic pols

[mother earth]

8. Single payer is the future, it's the only way to end the grip and give power back to the people,

(and providers) to stop skyrocketing costs in medical care, insurances, etc. It's completely out of hand because we've handed the corporations the right to dictate law. The GOP lies and obstructionism must be stopped! They've allowed corporations to have the rights of people, which trumps the best interest of citizens.

Get profits for insurance co.'s out of health care! Doctors want to practice medicine, they are tired of the intrusion into their practices & patients have lost what was once the best care, over to rationed care.

I worry that people misunderstand Medicare for all.
SINGLE PAYER is to the point, it takes out the middleman & it will happen, because it must, it's the only way to go.

When we say Medicare for all, we want a plan that has gov't protections & does not seek to profit, its a system that is cost effective & ends the mountains of paperwork for providers & patients....it SIMPLIFIES.

Why shouldn't people with pre-existing conditions be allowed medical care? Do we let them all die? This is what the GOP has in mind, who exactly are they working for? They are working for the corporations that have bought them!

PAUL RYAN's PLAN IS DEATH CARE!

[Jim Lane]

14. Reich's scenario is why the Court will NOT rule that way

The conservative Justices might vote to leave the whole Act intact. They might strike down the mandate and declare that the ban on excluding pre-existing conditions, being inextricably tied to the mandate, must also fall. They might even go whole hog and strike down the entire Act. (That would be an unusual result, but that's because most bills include a severability clause, under which striking one part of the bill doesn't affect the other parts. Someone on DU said that the ACA lacks such a clause.)

The one thing I'm sure they won't do is to strike the mandate but leave in place everything else (including the ban on excluding pre-existing conditions). On that result, people would game the system by not buying insurance until they get the cancer diagnosis or whatever. Every private insurance company in the country would be facing bankruptcy in short order. All we would need would be 41 Democrats in the Senate to filibuster any repeal of the ban, and single payer would be the only way out. (Reich says "Obama and the Democrats" but it wouldn't even reach Obama's desk. The only repeal scenario would be a Republican takeover of the Senate, plus their abolition of the filibuster rule, plus a Republican beating Obama -- an unlikely parlay.)

The conservative Justices can figure all this out for themselves and simply won't go that route, regardless of what the merits of the legal arguments might be.

[mother earth]

15. So, it's a keep it all or strike it all? And striking it all is unlikely since it will open the

door to single payer?

[Jim Lane]

28. No, maybe strike the mandate and the ban on excluding pre-existing conditions, keep the rest.

There's a reasonable argument that the mandate is essential to the ban on excluding pre-existing conditions, but is not essential to, for example, the provision about keeping students on their parents' policies. That provision could be left in place even if the mandate were scrapped.

[mother earth]

29. Either way, if they strike it, the fall-out may just tip the scales against the GOP led farce.

This time, it won't only be about women, it'll be about once again doing nothing to help anything but corporations.

Thanks for your reply.

[mainer]

17. If mandate goes, the whole program collapses anyway.

So you're right. This is all about the mandate, which is the linchpin of the program.

[mother earth]

18. Perhaps collapse, isn't a bad thing then? Correct me if I'm wrong, but then the only option is

in reality the best thing that could happen? Single Payer? I'm hard pressed to believe it won't come to that anyway.
There's so much money at stake, the costs are so high that the only way to rein them in and end this is to go single payer.
It doesn't mean the end of insurance co's it only means their role would change.

Those who have enjoyed a measure of health care thanks to health care reform are not going to want to give it up easily.

[pnwmom]

16. As I understand it, the Supreme Court could also strike down the pre-existing conditions clause.

Where would our leverage be then?

[SidDithers]

19. So Obama should throw those with pre-existing conditions under the bus...

in order to get Medicare for everyone else?

Sid

[Dragonfli]

21. Medicare does not exclude pre-existing conditions, it's like Canada care, so no need for any bus

Unlike the Insurance care you champion every chance you can here.

Tell me, how is the campaign going back home to replace what you have there with an ACA run by insurance companies?
Are you a voice in the wilderness arguing for Insurance control or are they finaly coming around to your way of thinking?

[SidDithers]

22. ROFL...

Sid

[Dragonfli]

23. Do you come here just to laugh at us that have been bankrupted and lost a

loved one to insurance companies (like I have)?

What is so funny about life or death issues in general?

You never did answer my question, I imagine because you appear to come here mostly to laugh at Americans.
Try answering, this is a discussion board, not your own personal "Americans are so funny" site.

How is the selling of an Insurance company controlled ACA as a replacement for Canada's current socialized system going?
Are you a voice in the wilderness or are you starting to convert more Canadians to your way of thinking?

[Dragonfli]

24. I take it by your answer you think our Medicare system refuses to treat those with pre-existing

conditions.

You are incorrect, no one has ever been denied their Medicare due to a pre-existing condition.

Humor is great, but ignorance is not quite that funny, at least not IMHO. Next time if you don't know something about our system, try just asking nicely for answers rather than ridicule everyone you meet here.

[Uncle Joe]

27. Kicked and recommended.

Thanks for the thread, Better Believe It

[KharmaTrain]

30. Pipe Dreaming...

I usually agree with Dr. Reich but he's dreaming on this one. If the SCOTUS strikes down the AHCA there's no going back...any form of universal healthcare will be dead for at least 20 years or longer. There will be no political will in either party to go near this thing no matter how great the proposal or even if President Obama decided to start over with a single payer system. It's not up to him it's to the 535 congresscritters and there weren't the votes for Single payer two years ago and there won't be now...even less if the SCOTUS cuts this thing to shreads.

This is an extremely selfish country that's gotten moreso in recent years. Few are willing to share what they have with others and this is especially the problem with healthcare. Sadly the AHCA was the best that could have been passed and about to get thrown out by an administration that did a horendous job selling this thing in the first place and activist judges who are just one rushpublican vote away from turning back the clock on a century of social legislation and progress...