How single payer helps Republicans change the subject

[ehrnst]

The big picture: Politically, single payer — the idea of having the government pay for health care rather than private insurers — can help rally the left much like the prospect of repealing the ACA rallied the right. But it could also help Republicans, who own the problems in health care now, switch the target to the Democrats and their sweeping new health reform plan.

The pros for Democrats:

As the chart shows, single payer is popular among Democrats, with about two thirds in favor. But it has also gained popularity among independents in recent years, with over half supporting it. Republicans, not surprisingly, aren't so crazy about it.

Single payer is a big idea many Democrats can rally around. It excites the base and party activists by establishing health care as a right, achieving universal coverage, and eliminating insurance companies. This analysis is about politics, but most advocates of single payer advance the idea because they believe in it, not as a political calculation.

The cons for Democrats:

They could lose a one-time opportunity to tar Republicans with the damage their ACA replacement plan would have done to millions of people, according to the multiple analyses that showed lost coverage and higher premiums for vulnerable people.

By campaigning on their own sweeping health reform plan, Democrats could give Republicans a fighting chance to change the subject.

More targeted policy ideas, such as Medicaid buy-in options for the ACA marketplaces and a Medicare buy-in for 50-64 year olds, could also be popular on the left and the center, while offering far smaller targets than a sweeping single-payer plan would.

Reality check: Single payer is popular, but polling today doesn't tell us much about where the public will be if there is a national debate about actual single-payer legislation in the Congress. ACA repeal had the support of about half the public in Kaiser Family Foundation polling in late 2016 and early 2017, but fell to closer to 30 percent once there was an replacement plan under the microscope.

Support for single-payer falls by 10 to 20 percentage points when people are read common criticisms, such as that it will increase taxes or give the government too much control over health care. Arguments in favor, including that single payer will make health a basic right or reduce administrative costs, increase support by similar amounts.

https://www.axios.com/how-single-payer-helps-republicans-change-the-subject-2484804538.html

About Drew Altman, and the Kaiser Family Foundation (not affiliated with Kaiser Permanente):

http://www.kff.org/about-us/

[Gothmog]

1. K&R

[DemocratSinceBirth]

2. K AND R FOR EXPOSURE AND DEBATE

My goal is to see everybody gets health care when they need it and as long as they need it, regardless of ability to pay. Everything else is commentary.

[theaocp]

3. We should never talk about it.

It's like after a gun massacre; always the wrong time.

Beware gradual incrementalism. It's always the answer, so best get used to it.

[ehrnst]

5. I didn't see that at all from the post

What about the article gave you that takeaway?

[Demsrule86]

20. It is the wrong time now. Save the ACA.

[sheshe2]

4. K&R

[LexVegas]

6. Truth. nt

[leftstreet]

7. I wish everyone would call it Medicare For All, as it's named n/t

[ehrnst]

9. That is the name of a specific bill, not the term for the system.

Kaiser Family Foundation is going to use the correct terminology for a system that has had other bills with other names.

And the "Medicare for All" plan differs from Medicare in many ways, so using them interchangeably can lead people to incorrect assumptions about the bill.


http://nymag.com/daily/intelligencer/2017/07/medicare-for-all-is-a-misleading-term-for-single-payer.html

For one thing, Medicare is by design an “acute care” program. It does not cover long-term hospital stays or nursing-home care, and excludes some routine care (e.g., dental and vision care). Presumably a single-payer program designed to replace all or most private insurance would be more comprehensive than Medicare.

And therefore much more expensive and complicated than simply "expanding Medicare."

[leftstreet]

26. It's what Sanders and the co-sponsors call it

I don't know why they chose that, but I certainly think it's smart for all Democrats to use the term because it's something everyone understands and already approves of

[ehrnst]

27. I know exactly why Sanders chose it. Medicare is popular. That's good marketing. Good politics.

Sanders named it that. His co-sponsors are going to call it by name, because if they don't, they don't get the press that comes with agreeing with Bernie. And many people will be led to believe that not only is it just an "expansion" of medicare, it would cost the same, which is not the case at all.

Sanders knows what will sell, especially to a public that doesn't know just how complicated health care policy can be. He's been a politician for a long, long time.

At the same time, Medicare-for-All is really smart politics. Medicare is not only popular, it’s also familiar. Many of us have parents or grandparents who are enrolled in the program. And polls show that a significant majority of Americans now believe that it’s the government’s “responsibility to provide health coverage for all.”

But from a policy standpoint, Medicare-for-All is probably the hardest way to get there. In fact, a number of experts who tout the benefits of single-payer systems say that the Medicare-for-All proposals currently on the table may be virtually impossible to enact. The timing alone would cause serious shocks to the system. Conyers’s House bill would move almost everyone in the country into Medicare within a single year. We don’t know exactly what Bernie Sanders will propose in the Senate, but his 2013 “American Health Security Act” had a two-year transition period. Radically restructuring a sixth of the economy in such short order would be like trying to stop a cruise ship on a dime.

Harold Pollack, a University of Chicago public-health researcher and liberal advocate for universal coverage, says, “There has not yet been a detailed single-payer bill that’s laid out the transitional issues about how to get from here to there. We’ve never actually seen that. Even if you believe everything people say about the cost savings that would result, there are still so many detailed questions about how we should finance this, how we can deal with the shock to the system, and so on.”

However, when you lead people to believe that something will deliver what it will not, it can give opponents ammunition that "you lied."

“Remember how much trouble President Obama got into when he said that if you like your insurance you can keep it?” asks Pollack. “For something like 1.6 million people, that promise turned out to be hard to keep. And that created a firestorm.” Those 1.6 million people represented less than 1 percent of the non-elderly population, and most of them lost substandard McPlans which left them vulnerable if they got sick. The ACA extended coverage to almost 10 times as many people, but those who lost their policies nonetheless became the centerpiece of the right’s assault on the law. Trump and other Republicans are still talking about these “victims” of Obamacare to this day.

https://www.thenation.com/article/medicare-for-all-isnt-the-solution-for-universal-health-care/

[Demsrule86]

12. No matter what you call it...

It should never have been introduced when passage is not possible. It hurt the effort to save the ACA. Also no debate if it means pushing single payer. Save the ACA or there will be he'll to pay.

[leftstreet]

25. It's what Sanders and the co-sponsors call it n/t

[Demsrule86]

28. Honestly, I am very angry with all of them.

And the debate is a very bad idea...why give the GOP a venue to spout their lies.

[ehrnst]

32. The article uses correct terminology, as would be applied to any such bill.

And the bill is named in a way that isn't accurate in what it actually includes.

But "medicare for all" is shrewd politics. People like Medicare, and think that "medicare for all" would be easy to implement because Medicare is already in existence.

The more you look at it, the more “Medicare for all” is, well, misleading. And it is politically perilous to mislead people about sweeping new health-care programs, as Congress learned in 1988 with the Medicare Catastrophic Coverage Act of 1988, a major bipartisan initiative that had to be repealed the next year when seniors figured out it duplicated the Medigap coverage many already had instead of addressing long-term-care needs.

The scant resemblance of most single-payer proposals to the actual Medicare program is just one problem proponents have in making themselves clear. They also need to agree on what single payer itself means, other than something sorta kinda like Medicare except when it’s not. Would single payer literally outlaw private insurance, allow it on the margins, or indeed deploy private insurance companies within a framework of government-guaranteed care (as happens now with Medicare Advantage plans or Medicaid managed-care systems)? The many available variations have all sorts of pros and cons. But pretending it’s all very simple obscures these options.

http://nymag.com/daily/intelligencer/2017/07/medicare-for-all-is-a-misleading-term-for-single-payer.html

Because health care policy is complicated, and people want something that goes on a bumper sticker.

Like "Choose life - don't kill your baby!"

[Me.]

8. Thank You

Time for sanity to take hold.

KR

[Expecting Rain]

10. It is very (very) hard to take away benefits once they are established,

whether one calls them rights (as on the left) or entitlements (as on the right).

So positive incrementalism isn't a bad thing in the "turning of a battleship" that represents 25% of the US economy.

For a more dramatic change of course, it would require more fully vetted plans than we have now. I think it is true that the political winds have shifted towards a greater openness to single payer. But those gains are soft ones without hard numbers.

[ehrnst]

13. But that's not a post that will get applause.

It's not declarative enough, and doesn't quash any dissent whatsoever like "HEALTHCARE FOR ALL NOW! IF YOU'RE NOT WITH M4A, YOU ARE AGAINST HEALTHCARE AS A RIGHT!!!"

[Expecting Rain]

15. I'd make a very lousy populist demagogue.

[ehrnst]

16. Why do you hate progress?

[Demsrule86]

21. nonsense. you don't decide that.

I believe healthcare is a right. But universal coverage can take different forms.

[brer cat]

17. I agree.

I have Medicare and would love for everyone to be covered just as well as I am, but there are many stumbling blocks. Whatever we propose needs to be well thought out and presented in a way that people can understand what the costs will be and how it will operate. There are millions of people who are happy with their employer-provided insurance and they are going to be a tough sell, especially if they think their taxes are going up substantially. There are also millions of people who have been fed lies and gross exaggerations about how "terrible" healthcare is in other countries with UHC. We have to be prepared to address their concerns about physician shortages and long wait times for procedures.

Many people throw out "incrementalism" as though it is awful, yet it may be the only way we can turn that battleship, your very apt analogy.

[ehrnst]

24. True. And the "Medicare for All" bill as proposed is different than Medicare as it is.

And will cost much, much more - it includes dental, glasses, and RX.

[Demsrule86]

11. K&R

Single payer is not possible. Save what you can...the ACA. People like it. This single payer hype only helps the GOP.

[ehrnst]

14. The ACA is the farthest down the road we have ever been to UHC.

Part of the reason is that it's much harder to take target at a lot of incremental changes, than one big gutting and rebuilding in four years plan...

[Demsrule86]

29. Home now...can type better...hubs had last interview today...and they knew he had an offer so

they could have made an offer but these jobs take forever...so George accepted the offer he had. We are are off to Findley Ohio-we wanted to go there anyway but hubs promised the recruiter to take the last three interviews, but now it is over ...going to be a shit show getting the house ready for sale...but I have sold eight houses-hubs leaves for his job and I stay and get everything ready-at least this time, I am not working. We will be three hours from the kids. The youngest is in college now...not too bad.

Anyway, I am furious about the single payer bill and the debate...as your article points out, it gives the GOP cover. I cannot imagine how anyone thought this was a good idea. I will vote for none involved in this debacle in the 2020 primary...shows a lack of judgement. I would of course vote for any of them if they were the Democratic nominee- but I think the Dems felt pressured and will regret it and maybe what they thought would help their presidential chances actually will turn out to reduce them.

[Demsrule86]

18. Just heard pundit say debate bad idea. On cell

So hard to write. Single Payer is a bad idea at this moment. It can't pass, and is hurting the effort to save the ACA. The debate is dangerous. It could help Republicans kill Healthcare.

[brer cat]

19. Good article, ehrnst.

K&R

[kentuck]

22. The ACA is/was market oriented.

It was created by the Heritage Foundation.

If the market doesn't work....

[ehrnst]

23. Actually, it's a series of regulations that limits and directs the market in many ways

and expands publicly funded healthcare to many more people. It includes caps on lifetime payments for consumers, bans on pre-existing condition refusals, eliminates co-pays on checkups and meds like contraceptives - all of which would be different if determined by the market.

You could also say that Medicare is market oriented in that it uses private payers manage payments for prescription, dental eyeglasses and hearing aids.

30% of Canadian health care is paid for via private mechanisms - long term care, dental, vision, and prescription are not covered by the national plan, so you could say it's "market oriented" for those services.

I think you also forget that if the market crashes - then so does taxable income, which is the funding mechanism for single payer so it would not be immune to market forces.

See also: Medicaid, which is countercyclical in that when the economy puts less income into it, say, during a recession, the demand goes up. And then service providers are stretched, and delivery quantity slows.

[Demsrule86]

30. It could work with some tweaks and it is all we have and if goes it is all we ever had. There is no

single payer bill around the corner...it would take a super majority and that has happened three times where we had the presidency as well...as for it not working. The ACA is quite similar to Germany's coverage and could work. I just want universal coverage...it probably won't be single payer. It is GOP speak to say the ACA can't workth-that is their excuse for getting rid of it...and it should not be posted here...also not true.

[ehrnst]

31. The vast majority of countries with universal health care have Public/private hybrids

Whatever works to get more people access to affordable health care faster is what I think we should be working towards.

Not some futile loyalty to a dogma, like the GOP has to "getting rid of Planned Parenthood is the only way to stop abortion!!"

[Demsrule86]

33. Exactly. Germany has a similar system to the ACA...we would need strong price controls on

pharms, and I think non-profit insurance...they call it something else in Germany.

[LostOne4Ever]

34. And where did campaigning on a popular idea at the time get the rethugs?

It only gave them the house, the senate, the SCotUS, most governorships and state legislatures, and the presidency.

We absolutely can't have that!

The lesson of the GOP's failure (and The ACA's success) is that if we want to pass MFA or single payer we will need a large enough majority that democratic moderates won't kill the bill or we are going to have to come up with compromise bill working with GOP moderates.

This whole MFA will hurt us meme is self defeatism from conservative Dems who want compromise our position before we even begin negotiating and the vindictiveness of Sanders Derangement syndrome suffers who refuse to stop refighting the primary and have to find someway to turn ANY POSITION Bernie supports into a negative.

Supporting MFA helps us defend against the criticism that all we are about is opposing Trump and have no solutions of our own. It does something that the Democratic Party desperately needed and Bernie excels at. It gives us a positive and grand vision of what we want to do to help the country that can inspire people! That is why Dems like Booker, Warren, Harris, etc. support it!

It makes us the party of "yes we can" again! At least it would if we quit listening to those who think "no we can't" is a winning strategy...

[Demsrule86]

37. They campaigned to get rid of something...they found a common enemy.

At the time most hated the ACA even on the left left who let Obama and the country down by not voting in 10. This is different. This would be the same as what happened when we passed the ACA. We won't get this passed, but if we did, people would be angry...those who have work insurance, those who end up paying more, you still need 20% coverage from insurance so you could have high taxes and still need additional insurance...all of these things would make people angry. The demand for it is soft. Let's save the ACA , add a public option, strengthen our market and maybe lower the Medicare age to 55...also those who don't make enough to have the ACA, but make too much of Medicare able to buy into medicare for a nominal fee...or add them to the ACA for a nominal fee so there are no gaps.

[Gothmog]

35. K&R

[Hoyt]

36. A lot of stupid people are still opposed to one big government plan. A Public Option

(essentially a Medicare Buy In) is what we ought to be talking about.

If it is anywhere near as good as we think/hope, people will gravitate toward it quickly. But, it won't be cramming a single plan down the throats of those who are opposed or skeptical. They'll come around quickly enough.

[Demsrule86]

38. That is a good idea...let people buy into Medicare.

First let those who have weak exchanges and then open it up for all...so we can address some of the complications we can't name yet. Also, the 20% needs to be addressed...maybe with some sort of insurance but strictly controlled pricing.

[CherokeeFiddle]

39. This is playing right into Republican hands

I'm of the opinion that this, this whole "NO! We can't talk about single payer now!" meme is playing right into Republican hands. Completely.

The majority of American's now want a single payer health care system in America. This is factual. Look at the graphic below from Poll: Most Americans want to replace Obamacare with single-payer — including many Republicans



Here's the thing; Republicans will do ANYTHING and EVERYTHING to distract and run circles around ANY social program that benefits the American people. ANYTHING. They're backs are now truly against the wall when it comes to single payer because for the first time, the majority of American people now want that health care system in the United States.

Think about that for a second. Take that in and what that all means. It is a shot against the bow of the donor class and reps who are in the pockets of big pharma and the health care industry like nothing before. It would literally end the for-profit health care system in America which enables the deaths of people. Do you think it's coincidence that some tiny little town in West Virginia had over a millions opioids pumped into it? Drug wholesalers shipped 9 million pain pills over two years to a single West Virginia pharmacy

We are allowing the GOP to control the conversation here with NOT wanting single payer to be discussed. The more it gets shoved under the rug like it has been for decades and decades is EXACTLY what Republicans want. They are wanting the conversation to disappear, go away and be hidden in hopes of quashing any rhetoric with regards to single payer. The less it is spoken about, the more likely people will begin to forget about it.

Don't play Republican games for they lead to stupid prizes.

[ehrnst]

40. No one is stopping discussion of Single Payer & we should NOT be censoring health policy experts

The OP is discussing Single Payer and the real political ramifications (pro and con) of pushing it now. The Kaiser Family Foundation is a health policy think tank - it's their job to analyze health policy.

We need a much deeper actual discussion of it, not just yelling it as a slogan, with no real understanding of what is actually in it. The slogan yelling is what gives the GOP stupid prizes. "Medicare for all" and it's false comparison to Medicare is going to give the GOP as much ammunition as Obama did when he said, "You can keep your doctor." THAT is what is coming once they point out how different, and vastly more expensive it is than Medicare.


And about polls:

Reality check: Single payer is popular, but polling today doesn't tell us much about where the public will be if there is a national debate about actual single-payer legislation in the Congress. ACA repeal had the support of about half the public in Kaiser Family Foundation polling in late 2016 and early 2017, but fell to closer to 30 percent once there was an replacement plan under the microscope.

Support for single-payer falls by 10 to 20 percentage points when people are read common criticisms, such as that it will increase taxes or give the government too much control over health care. Arguments in favor, including that single payer will make health a basic right or reduce administrative costs, increase support by similar amounts.

So, if the GOP is able to hijack all the slogan yelling about "Medicare for All!" and turn it into "socialized medicine!!" (which it not, any more than it is Medicare) and turn public opinion against it - I highly doubt that you will think negative polls are a reason to reverse your support of it. Remember, they did that with the ACA.

So I would be cautious about using polls as a evidence that "Medicare for All" is or is not feasible.