The False Lure of the Sanders Single-Payer Plan

[kennetha]

http://prospect.org/article/false-lure-sanders-single-payer-plan


Can't find a single policy wonk who regards Sander's proposal as to any degree feasible.

So what exactly is the point? Surely he knows this. I assume he's not just deluded. So why is he pushing such a pie-in-the-sky proposal, one so devoid of any real details or any attempt to confront the real tradeoffs any such proposal would have to deal with?

Inquiring minds want to know.

[7wo7rees]

1. "Inquiring minds want to know".......... Not much. nt

[Maedhros]

2. The lesson is: never try. [n/t]

[kennetha]

8. The lesson is

don't try something stupid and self-defeating that has no chance of passing when you can build on what you have in place without the all out political donnybrook it would take to get this non-proposal passed.

[Maedhros]

10. I'm sorry, but I don't buy your defeatist bullshit.

/ignore list.

[riversedge]

53. There is nothin defeatist about bein practical and honest with the voters

@HillaryforNH -->*berns the house down Leaving Iowa-First woman to win Caucus … #Hillary2016

[Fawke Em]

110. Yeah, Hillary's pretty destructive, all right.

Not a good use of images, there.

[JDPriestly]

38. The choice is not between proposing something that has no chance

of passing versus building on what you have in place.

You can get single payer by building on Obamacare. You add the public option and watch it turn into single payer. You expand Medicare to cover people between 50 and 65 plus add the public option and single payer will be here even faster.

You are talking about strategy. Single payer is the goal. Bernie has been in Congress since 1992. He was mayor of Burlington for a number of years before entering Congress.

Bernie knows how to add amendments and change programs without being a bull in the china closet. You are assuming a strategy and then criticizing it. But that strategy cannot be assumed. Bernie is more likely to use a much wiser strategy than you are assuming.

Thanks for giving me the opportunity to explain this. People are assuming a lot of things about single payer that are false. I posted below my experience with single payer in four European countries. For the healthcare consumer, single payer is excellent. Maybe not so much for corporate pharmaceuticals. I think that single payer also reduces the expenses that doctors, especially private GPs incur in trying to run their practices/businesses. The billing system is necessarily simpler and less expensive to maintain. Single payer is better for everyone except the investors in private healthcare insurance companies.

I speak from experience not from guessing or reading what other people are saying -- reading the propaganda of the health insurance companies.

Feel the Bern!

[gordyfl]

31. Teddy Roosevelt

[polly7]

3. What trade offs, and why is it pie-in-the-sky?

You already have the infrastructure, the medical workers, a HUGE population pool from which to draw the necessary funding (not to mention more billionaires than any country on earth). What's the problem?

Those employed by your current insurance/health program will most likely be able to find employment with physicians in private practice or with other health provider employers - the way I see it, the only ones who will be hurt are the CEO's and possibly shareholders of billion dollar health-for-profit insurers. Do you think they might not already have enough personal wealth to tide them over?

[kennetha]

5. read the article.

[polly7]

7. No. I asked you, you made the thread and the claims. nt.

[kennetha]

11. some salient points

Sanders doesn’t just call for incremental steps toward single-payer. He’s proposing to shift all of health care to federal taxes in one fell swoop. That’s one reason for the enormous, sudden increase in taxes the plan would require—$1.38 trillion on top of existing federal spending, according to Sanders’ own estimates. As Harold Pollack has pointed out, that $1.38 trillion is just about equal to total federal income and estate tax collections in 2014—in other words, the plan would require doubling that revenue.
...
But Sanders’s estimate of the needed increase in taxation, despite its whopping size, is too low. The plan would actually cost another $1.1 trillion a year, according to an analysis by Kenneth Thorpe, a health-care economist at Emory University, who has long experience working with single-payer proponents.

....


When the Sanders campaign released its plan, it estimated $324 billion in annual savings on prescription drugs—until Thorpe noted that the United States spent only $305 billion for that purpose in 2014

....


But if the federal government did impose sufficient controls, the results would be to bankrupt many institutions that are counting on future streams of revenue to cover debt payments, meet payroll, and satisfy other obligations.

AND ON AND ON.

[polly7]

13. The U.S. spends more on health-care than any country in the developed world.

Yet 29 million people (actually, not that much less than the entire population of Canada - add in all those who do have insurance but still can't afford to be treated, and I'm sure the number would surpass our total population), if suddenly struck with illness or serious injury, could die simply because of no access to it.

Those are the 'facts'.

Those 'institutions'/insurance companies/(people with no medical background but who get to decide who gets what wrt being dx'd and treated and when) have all made their billions already. Don't you think it's time ordinary struggling people have their turn at a simple basic human right?

[JDPriestly]

43. The only way it can cost more is that it will insure more people.

Single payer is inherently cheaper in terms of the bureaucracy it reduces, the paperwork it eliminates and the negotiating power it brings.

More people will be insured. That is the only reason that single payer would be more expensive than for-profit health insurance.

There is nothing inherent in single-payer that makes it more expensive than for-profit insurance. To the contrary. Single payer streamlines a lot of the paperwork, the billing and the collection of bills (a big deal for medical billers and doctors) among other things. In Europe, dental care, vision care, etc. are covered by the single payer insurance plans. Not so here in many cases.

The problem in the US that is ignored and not discussed is the fact that even with Obamacare, many Americans have no health insurance coverage. And many of the uninsured Americans have big health problems like addiction, diabetes, high blood pressure, obesity, malnutrition, alcoholism, etc. If we insure everybody, it may cost more in that sense. But we are getting more value for our insurance dollar.

And that is what single payer will give us -- more value for our insurance dollars. That is my experience and that is why I support single payer insurance.

And collecting bills that patients cannot afford including co-payments for necessary hospital care is a big problem in our system now, a problem that critics of single-payer insurance ignore.

[Recursion]

47. You're exactly right

There is nothing inherent in single-payer that makes it more expensive than for-profit insurance.

Not inherently, no, though it is vulnerable to regulatory capture in a way private insurance isn't. (A President Ryan would appoint the former head of Eli Lilly to HHS, for instance.)

More people will be insured. That is the only reason that single payer would be more expensive than for-profit health insurance.

And that's a good goal, that I agree with. But it absolutely is going to cost more than we pay now, because we have about 80 million people skipping treatments because of costs. That's a quarter of the country. Structurally it's about 20% cheaper; but we're adding 30% to the treatment pool (it's not even clear we have enough GPs to do this).

Which, hey, I'm willing to say might well be worth it; the problem is that spending puts the rest of the safety net at risk. So now we have to weigh things.

[Erich Bloodaxe BSN]

62. Ding ding ding, we have a winner!

Yeah, that's exactly the point none of these people who hate the idea want to address. Costs only go up as actual delivery of services go up. Ie, people are actually getting the healthcare they need. And without a lot of extra 'profit' built in for insurance execs. Will it cost more? If so, that means more people are getting more healthcare they already need, but aren't getting. And it's far better both for individuals and society when you address health issues early rather than letting them go untreated until they become far more expensive and dangerous health crises.

[kennetha]

75. Again, read the article. And read other stuff that has been written about the transition costs.

It's an enormously complicated issue, both economically and politically. Sanders rhetoric is simplistic and naive in the extreme. His plan is even more so. You're being sold a bill of goods. Many people grant that if you could rewind the clock and start from scratch, it would be much preferable. But the politically and economically possible is highly path dependent, because choosing a particular path set up a structure of incentives, of winners and losers, and to unwind that is much, much trickier than you are allowing. It isn't enough to engage in magical thinking disconnected from the actual facts on the ground

[mdbl]

46. the health care industry will adjust

Maybe they won't be able to buy as many luxury cars and might even start thinking about their hippocratic oath instead of being stuck in billing quagmires with insurance companies. There is already downward pressure on the industries prices from the ACA. Single payer can work if it's not corrupted by greedy congressmen or senators and their lobbyists - some of which ended up in the ACA. Hell, maybe we can gain respect for medical science again. The reich wing has treated it with such disdain.

[jmowreader]

52. The infrastructure and medical workers are all in the private sector

According to Forbes (http://www.forbes.com/sites/danmunro/2014/02/02/annual-u-s-healthcare-spending-hits-3-8-trillion/#234212c1313d) spending on healthcare was $3.8 trillion in 2014, up from $3 trillion in 2013. Let's say the rate of increase is stable, and therefore spending on healthcare in 2015 was $4.6 trillion. Let's further assume (this one's a stretch) that between cost containment and rolling all the other federal spending on healthcare into Berniecare, he can get the bill back to an even $3 trillion.

According to http://www.usgovernmentrevenue.com/fed_revenue_2014US, in 2014 the government collected, from all taxes, fees, and anything else the not-for-profit parts of the government does to make money, $3 trillion. He will therefore have to double taxes to pay for JUST THIS ONE PROGRAM. Then there's the free college. And the government-funded family leave. And whatever the hell else Bernie wants to give away to win votes from the millennials. If he also wants to fix a couple of bridges, he'll need to triple all tax rates.

[Recursion]

54. While providing treatment to the 80 million people currently skipping treatments due to cost

Unless we cut physicians' and hospitals' reimbursements in half, it's going to absolutely take down the rest of the budget.

[polly7]

55. Medical workers are all in the private sector here, also.

As to facilities - with few exceptions, Canadian hospitals exist as not-for-profit entities.

Ownership usually resides with community-based not-for-profit corporations, religious organizations, or with municipal governments (as are ours in the more rural areas) or universities. Apart from psychiatric hospitals, provincial/territorial governments rarely own hospitals. In all cases, however, the vast majority of hospital revenues come from a single funder – the provincial/territorial department of health. This includes all hospitals approved by provincial governments providing acute care, extended and chronic care, rehabilitation and convalescent care, and psychiatric care, as well as nursing stations and outpost hospitals.


I don't know much at all about his plans for funding college, but think it's a great idea.

[jmowreader]

84. Are doctors' offices run as not-for-profit entities also?

The time to set up this kind of system was in the 1940s - BEFORE technological medicine took over.

[polly7]

85. Some run their offices in their own private buildings with other physicians and specialists,

most have offices in clinics and hospitals.

Are you saying ours don't take advantage of technological medicine? Sorry, I don't understand. My family doctor looks up my complete history on his laptop as soon as he comes in to the room to see me - every prescription I've ever had is right there, every specialist consultation, every diagnostic test and the results .. he has it instantly. Again, not understanding what you're getting at?

[jmowreader]

86. Your system was established BEFORE that kind of medicine came in

What I am referring to is a little more complex than electronic medical records: One of my county's best Democrats is an eye surgeon. He owns a big chunk of the group practice he works in. Thanks to rapid technological change and customer expectations, they spend $4 million a year just replacing equipment. Hospitals have it worse.

[polly7]

88. Our physicians and specialists also take advantage of rapid technological change

and patient needs. (We're not considered customers). I imagine our specialists have the same concerns with rising expenses as yours within their private practices. But patients are referred for dx. and treatment requiring that expensive equipment to the labs, clinics and hospitals funded by our health-care plan.

I'm still not getting your point wrt our system being established BEFORE that kind of medicine came in. (Sorry, I've got sinus infection and a killer headache.) Some of those technological advances were created right here.

Committees made up of the College of Physicians and Surgeons, First Nation representatives, physicians, nurses, etc. meet to address, province by province and territory, hospital and clinical needs - including equipment. We do have a bit of a shortage of certain things like MRI machines and CT scanners here in southeast SK. Communities raise funds to help. It's an evolving process - and it's working. The vast majority of Canadians choose to keep what we have, as do the physicians who work in it.

[jmowreader]

90. It's cheaper to upgrade than to start from scratch

Your first paragraph points out a BIG difference between your system and Bernie's plan.

The labs, hospitals and clinics funded by your system serve to centralize expensive equipment. In my county there are three eye clinics that do laser vision correction - two owned by the group my friend the surgeon is in, and a third by a different group. An excimer laser vision correction machine costs $500,000 and you pay a $2500 technology licensing fee for every patient you run through it. (And remember, they keep those machines a year and trade them in for salvage value.) There are also a LOT of supplies involved. Let's say each clinic does 20 procedures a week - which in this county is probably high. It only takes about 20 minutes in the laser room to fix one person's eyes, so 60 procedures a week on the same machine is more than feasible. If you could put one really top-shelf laser in a centralized location and refer everyone to it, you'd save a million in equipment costs plus two staffs plus everything else it takes to run three underutilized practices against one well-used one. The odds of American doctors agreeing to that kind of arrangement, unless they were forced into it, is not high.

[polly7]

91. Oh, I'm sorry. I didn't realize you were talking specifically about laser vision correction.

Most health insurance plans do not cover laser eye surgery for vision correction. I wish they did, but am not hopeful it will happen anytime soon. I believe you can claim it on your income tax though ... I just looked, yes you can. It is covered with optional private and most employment health insurance plans.

Medically required vision care is covered if provided by physicians (cataract surgery, diabetic vision care, some laser eye surgeries required as a result of disease), but not if the purpose is to replace the need for eyeglasses

Health Canada's only role in it, I guess, is to provide information on it and monitor the equipment and devices for safety and effectiveness, as well as any complaints about them. So yes, these providers would have the same concerns as to rising costs and need to replace equipment.

[Philos]

4. I'd rather he tried and failed

Than not try at all.

[kennetha]

12. He's not actually trying....

the so-called "plan" is magic pixie dust. It's there for merely rhetorical purposes.

[Philos]

14. I'm at least willing to give him the chance to prove otherwise

Before writing him off.

[Fearless]

21. You assume Bernie is like Hillary and just lying.

He isn't. He actually will work to help America.

[Recursion]

50. "Lying" is a bit harsh; he knows the "plan" he released is complete bullshit, though

I mean, he knows you can't pay a negative amount for pharmaceuticals. It's a stretch to call it a "lie"; he just is telling the base what they want to hear. It's how you win elections.

[kennetha]

74. He's not lying exactly, but he is engaging in empty demagoguery

[tecelote]

42. Pixie Dust!

'Just love it. 'Because Bernie's chances were unicorns and rainbows a few months ago.

Paint Bernie as a dreamer all you want. I'll vote for the honest dreamer over the dishonest corporatist.

[JDPriestly]

48. The magic pixie dust is in the myth that all of our healthcare is

at this time paid for.

The co-pays and deductibles are often too high for ordinary families even with Obamacare.

We need single payer. It will in the end be cheaper, more affordable for ordinary families than what we now have.

I talked to a couple with a two-year-old. They paid $2000 above and beyond their excellent healthcare plan just to have a baby. That is absurd. Many families could not afford to pay that.

Our healthcare insurance is too expensive and does not cover what we need. It does not cover our dental and vision costs in general. I had vision coverage, but still had to pay a fortune for my glasses. Thank heavens, I had cataract surgery and can now see 20/20 without glasses. But then, I now have Medicare. I have co-pays that not everyone could afford, but I have pretty good coverage.

Medicare is proof that you can cover the most expensive years of your life for less with a single payer system. Medicare is single payer. Medicare patients are in the most expensive years of their lives in terms of medical costs. (Which is why we have Medicare since the private insurance companies prefer to cover patients in the less expensive years of their lives when it comes to medical costs. They would go bankrupt covering seniors.)

The idea that single payer is an impossible boondoggle is disproved in one European country after the other, to say nothing of Canada.

[mdbl]

49. Let's hope the magic pixie dust can at least

stop your deductibles from doubling in the next couple of years. We are being soaked by the insurance companies and getting little in return. So even if you think single payer is impossible, you might at least be able to keep what you have. I need someone in office that isn't being controlled by the insurance industry lobbyists. Is that so wrong?

[Fast Walker 52]

69. is it our goal or not? Do we not speak aspirationally?

[treestar]

77. He did try as he had a bill but it went nowhere

and that apparently is preferable to getting somewhere.

[tecelote]

26. No We Can't!

'Will never get us anywhere.

"I'd rather he tried and failed than not try at all".

Exactly.

[treestar]

76. I'd rather someone succeed in doing something

What's the value of things that don't happen?

And funnily the same people complain it's not already done now.

Where were they in 2010? Maybe if Congress had not gone R there would be more progress.

[beam me up scottie]

6. The author was Bill Clinton's advisor in the 90's.

Now inquiring minds know where this is coming from.

[ebayfool]

9. LOL!

[m-lekktor]

40. American Prospect is home for DEM party hacks. nt

[beam me up scottie]

44. What a shock. ;)

[ucrdem]

15. That is the question -- So what exactly IS the point?

Of any of it? It's like he gets phrases from a marketing firm that test well for ODS and then builds bogus bills around them. "Too big to fail" for example -- that's actually the name of a Senate bill he submitted which consists of that phrase repeated about 20 times and formatted to vaguely resemble actual legislation, minus the law. And that's a cornerstone of his campaign. Talk about an optical illusion -- take away the Twitter gifs and there's nothing left.

[mhatrw]

18. Income inequility, political graft, health care costs, and student debt are all grand illusions.

Did Clinton market test this stuff, are are you just throwing it against the wall?

[ucrdem]

19. Single payer: riff on ACA. Free college: riff on Obama's CC plan. And so on.

It's a boatload of demagoguery aimed at arousing discontent among Dems. That's a hell of a way to win anything.

[polly7]

23. ACA: riff off Single Payer. And so on. nt.

[JDPriestly]

51. People are tired of being ripped off by the "too big to fail" banks

and the for-profit insurance companies.

If you deal with the "too big to fail" banks, you know what that term means. They pay not interest, charge big fees and pay their employees low wages.

They are "too big to fail." That is the reason they get bail-outs. They don't serve the public interest. It's sometimes difficult to figure out why they are still in business. They took people's homes.

We look for ways to get our money out of them. Have you seen the interest rates these banks pay savers recently? Have you seen the interest rates they charge borrowers? Where in heaven's name does their money go? The banks are certainly not run for the interests of consumers, whether savers or borrowers.

Too big to fail is a great way to express not just the reality of the big banks but our, we consumers, feelings toward them.

[Recursion]

39. Unfortunately I'm starting to think this is just how politics works now

The twitter attention span means this is what wins.

[madokie]

16. "Inquiring minds want to know"

thats the last thing you want to know, sorry

If you wanted to know you'd already know because he's laid it all out.

[mhatrw]

17. Singler payer is by far the best bet for all. One pool, everyone in it. No corporate profiteering.

Establishment wonks can nitpick it to death. I don't see anyone presenting a better single payer alternative, and I can't help but wonder why that is.

[Recursion]

36. Plenty of corporate profiteering from providers, though

It's really frustrating that people are sticking their head in the sand and pretending financing reform will fix this.

[Fearless]

20. Who cares what this person thinks. They're wrong.

[gordyfl]

22. Details?

Just mail out Medicare Cards to every American. It's not complicated as Hillary would want you to believe.

Paying for it? Cut back on our wars. That should save us $trillions.

Everyone pay into it, including employers.

Most Americans would back President Sanders on this issue. Bernie's a fighter. He's just the person to pull this off.

[Bad Dog]

24. Where's that famous American Can Do spirit?

We achieved Universal Health Care back in 1948 when we were close to bankruptcy following WW2. We had food rationing and our only commodity was coal, all the good stuff was exported meaning our power stations had to burn low quality high sulphur stuff resulting in the infamous London smogs which killed quite a few people.

Bevan complained about having to stuff the doctor's mouths with gold, but we still got it done.

It's all a case of will power and a correct mindset. Whoever came up with the term 'Single Payer' wants shooting. I had to look it up to see what it meant, and it means UHC. Calling it Single Payer focuses the mind on paying, UHC is a right, payment doesn't come into it. It's the responsibility of the state to provide it, end of. Now your constitution may not have it as a right, but it's an old document with old concepts. You need a new definition of rights in tune with today's generation. That's what amendments are for.

The real scandal is that per capita you pay more in taxes for healthcare than we do, yet we have UHC and you don't. You pay way too much for medicine, and until you drop your deferential attitude towards the rich aristocrat you'll continue to pay over the odds.

You need to dramatically revise how much drug companies can charge, clamp down on tax havens, make the aristocracy pay their fair share and probably recruit a load of doctors and nurses from overseas. You can do it, it won't be easy but with the right attitude you can.

You put a man on the moon for f***s sake.

[mwooldri]

33. I remember posting an article I found about UK healthcare before the NHS.

It read worryingly like some people's experience in America in 2016. The author was writing about the 1920's & 30's and his childhood growing up in poverty. One didn't go to the doctor - needed to pay the rent and buy food.

I'll find the link later and repost here.

[Bad Dog]

37. Harry Leslie Smith

91 year old pensioner was a star turn at the Labour Party Conference when he talked of the NHS.

A 91-year-old veteran NHS campaigner made the speech of Labour Party Conference today – to two standing ovations and a hug from Shadow Health Secretary Andy Burnham.

Describing his own childhood in Barnsley, South Yorks, before the welfare state, Harry Leslie Smith warned delegates of the dangers of losing the NHS.

“As I stand here today, my heart is with all of those people from my generation who didn’t make it past childhood, didn’t get an education, grow as individuals, marry, raise a family and enjoy the fruits of retirement because they died needlessly and too early in another era of austerity,” he said.

“But my heart is also with the people of the present, who, because of welfare cuts and austerity measures, are struggling once more to make ends meet, and whose futures I fear for.”
Harry, the Daily Mirror’s special guest at Labour conference, took to the main stage, ahead of Burnham’s big speech on health and social care.

When he described losing his sister Marion to tuberculosis at the age of 10 because his family couldn’t afford a doctor, many delegates wept.

He also described standing at the ballot box in 1945 and voting for a Labour government as a young man, just returned from WW2.

“It was the proudest day of my life,” he said. “Voting for the creation of the NHS.”

He ended with another standing ovation and rapturous applause.

“Today, we must be vigilant, we must be vocal, we must demand that the NHS will always remain an institution for the people and by the people.

"We must never ever let the NHS free from our grasp because if we do your future will be my past.

http://www.mirror.co.uk/news/uk-news/91-year-old-nhs-campaigners-storming-labour-4316044

[virgogal]

79. My father died of tuberculosis in the 30s and he HAD healthcare.

Having healthcare doesn't guarantee a cure.

This gentleman's sister may have died anyway because the disease took millions.

[Bad Dog]

83. You're more likely to get cured if you can get treated.

Full stop.

[eridani]

25. Silly bullshit. We are ALREADY PAYING for universal health care

We just aren't GETTING it. Anyone who would rather pay a $900/month "premium" than a $200/month "tax" shouldn't be running around outside without adult supervision.

The people who are still dying and going bankrupt surely appreciate your courage.

[winter is coming]

87. Actually, we're overpaying for universal healthcare.

Apparently, that's a status quo that some are eager to perpetuate.

[eridani]

94. Agreed--we could have platinum-plated care for what we are now paying n/t

[TubbersUK]

27. Actually, isn't it the status quo that's unfeasible ?

So if anything, most health policy experts believe that our current healthcare system is unsustainable for individuals, businesses, states and our federal government, and to continue this status quo is what is really unrealistic.

http://www.huffingtonpost.com/paul-y-song-md/the-real-healthcare-debat_b_9121210.html

[Fast Walker 52]

70. NAILED IT.

[pat_k]

28. So, instead of "Yes we can!" it's "No we can't!"

February 1, 2016
The big “Hillary realism” lie: Clinton supporters present a false choice — and misread our political moment
Walker Bragman

... In stark contrast to Obama’s 2008 campaign slogan “yes we can,” Hillary seems to be telling voters “no we can’t.” Of course, it might be more accurate to describe her message as “we tried, but couldn’t do it back then, so we can’t do it now—let’s settle.”...

The reality of politics today is that in order to get even half of what you want, you need to ask for the whole farm. No matter how “reasonable” and “achievable” Clinton’s policies may be on paper, she will still face as much opposition as Bernie Sanders would from Congress. So the real question for voters to decide is which of the two candidates’ watered-down policies they prefer. Bernie’s single-payer system might very well get shot down by the GOP, but we could still end up with a public option from that battle—and that’s the point. We should at least have the debate....

[mwooldri]

29. Start with an idea...

... and then go try do it.

Why can't America have a health care system where anyone can go to a health care provider of their choosing and receive service without paying for it at the time service is provided? Where declaring bankruptcy because of medical bills becomes a rarity, if not non-existent? Where every American can receive medical care with no regard for their ability to pay for it?

The rest of the "western world" does it and a lot of developing countries are going in that direction.

America. Always late to every war it doesn't start.

[nationalize the fed]

30. Inquiring minds want to know

Why do you think that Democratic Senator Max Baucus had single payer doctors and nurses arrested at a hearing when the ACA was being drafted?

Baucus's Raucous Caucus: Doctors, Nurses and Activists Arrested Again for Protesting Exclusion of Single-Payer Advocates at Senate Hearing on Healthcare

Advocates of single-payer universal healthcare — the system favored by most Americans — continue to protest their exclusion from discussions on healthcare reform. On Tuesday, five doctors, nurses and single-payer advocates were arrested at a Senate Finance Committee hearing, bringing the total number of arrests in less than a week to thirteen. We speak with two of those arrested: Single Payer Action founder Russell Mokhiber and Dr. Margaret Flowers of Physicians for a National Health Program.

http://www.democracynow.org/2009/5/13/baucus_raucus_caucus_doctors_nurses_and

What would you have thought or done if a Republican had single payer advocates arrested at a hearing?

Why do you think Obama reversed his promise to include a public insurance option in the final ACA?

[Recursion]

32. You run with the argument that brings the donations and volunteers in

Even if you know it can't work. Yeah, it's disappointing, but it's how the system works.

[jeff47]

73. No, it's aspirational and setting the starting position for negotiations.

You go into negotiations with the GOP starting with minor tweaks to improve the ACA, and you'll get minor tweaks that weaken the ACA when you compromise.

You go into negotiations with the GOP starting with single-payer, you get minor tweaks that improve the ACA.

(If you go anywhere in either scenario)

Finally, the overall plan is aspirational - this is where we want to end up, eventually. It is not intended to be done in the next two years. Just like Clinton's tweaks to the ACA are not intended to be done in the next two years - she can't get them through Congress.

[JDPriestly]

34. I lived in four European countries. They all had single-payer.

It is simple. It is easy to fund. (Take the payments out of people's paychecks, put the money in one fund and buy some kind of insurance. Take the profit out of the insurance. Pay for dental, vision, hearing, all the insurance. Longer hospital stays, more preventive medicine, overall better medical outcomes. That's what single payer does to healthcare.)

As a consumer with pregnancies, babies and early childhood diseases and conditions to deal with, it was just great. I loved it and wish we had it.

Nothing like experience to chase away the preconceptions and naysayers.

There is a reason why the nurses union is supporting Bernie and not Hillary and it does not have to do with Bernie's gender. It's about better healthcare, better hospital outcomes and a better country.

Feel the Bern!

If you listen to the Hillary supporters and her Republican-lite fans, we wouldn't have Social Security or a lot of good programs we have. We would have charter schools and means-tested everything.

Healthcare should be paid for out of our paychecks and not impoverish us when we need it most.

[Recursion]

35. Literally impossible, since there aren't 4 European countries with single payer

Arguably you could call the UK and Austria single payer, maybe, even though they aren't technically.

[Bad Dog]

41. Who cares whether or not we fit the technical definition of single payer.

It's a crap term anyway. We have Universal Health Care. I don't pay to see the doctor, I don't pay to go to hospital, and I only pay £8.20 for a prescription regardless. Kids, the unemployed and pensioners don't even have to pay that.

[Recursion]

45. I agree, which is why insisting on "single payer or nothing" is idiotic

And it's depressing as hell that Sanders's plan -- he knows perfectly well the "plan" he released is utter bullshit -- did its job by simply using those two words, because it fires up the people who support his campaign. I get it; I can't particularly blame him for throwing red meat like that, but it's still depressingly cynical.

We have Universal Health Care

And it's awesome. We need to concentrate on that rather than one particular form of financing.

[JDPriestly]

56. How do you define single-payer. I lived in UK, Austria, Germany and

France. All have single-payer. Each country has a different system. So single-payer is a broad term that allows a lot of flexibility and ingenuity in organizing healthcare coverage.

Obamacare is a move toward single payer in our country. We need to amend the bill to move it closer to single payer. Doesn't have to be an immediate move, but the goal of single payer should be where we direct our energy.

[Recursion]

59. WTF are you talking about? France has 30% copays!

That's why people need to buy insurance in France.

Single payer means one entity pays all medical claims. That's very uncommon; even in the UK doctors can bill privately (that's illegal in Canada).

[Warren Stupidity]

63. Having copays does not make a system not a universal public system.

"Single payer means one entity pays all medical claims" - no it means there is a universal public system. The Sanders proposal does not have copays, the French system does. The French system is considered one of if not the best public health systems in the world and their per-capita costs are roughly half of ours.

[Recursion]

65. Well, no, that's just not what "single payer" means

I get that people have been mislead into thinking that's what it means, but it isn't.

Single payer means one and only one entity pays all claims. It's even right there in the title. Single payer.

The Sanders proposal does not have copays, the French system does.

Which is why Sanders's proposal is single payer and France's system isn't. (Actually even Sanders's proposal isn't clear: it will only be single payer if providers are legally mandated to accept it, and he doesn't address that.)

The French system is considered one of if not the best public health systems in the world and their per-capita costs are roughly half of ours.

Which is, once again, a good example of why single payer may not be the best idea out there.

[mwooldri]

92. UK not single payer? How?

UK was single payer and single provider. Until things started getting "contracted out" that is. Started with the cleaning and the catering. Now some of the care is "contracted out" to private hospitals. A private NHS Trust was attempted but it faltered because surprise surprise you can't make lots of money in the NHS. It still is single payer, single provider at the core but the bloody Tories and the Blairites have tinkered around with it so much that a newcomer might not at first recognise this. You still have a "primary care physician" gateway, who now might have to shop around on your behalf for care. However when you start getting into the exotic stuff their choices shrink down to maybe one hospital (two if you're lucky) that specialises in that particular condition for the whole of the UK.

I can tell you this though: there has been only one occasion where a UK doctor has asked me for money. It was to pay for an urgent care clinic visit for my wife, visiting as an American citizen - and the office had no idea what to charge, so the doc said "twenty quid" (about $32) - and I parted ways with two pieces of paper with a picture of Darwin on each. The other nice thing about countries with universal single payer (or close to it) health care is reciprocity. Except for a handful of US/Canada and US/Mexico border situations, Medicare pays $0 for emergency health care abroad. The UK does have reciprocal agreements with most European countries and a handful of non-European ones.

I suppose if you compared the EU with the USA if you view each country like a US State.... then you do have a patchwork of relatively centralised health care systems with a single or low number of payers of care.

[Recursion]

93. Well, as you point out

UK was single payer and single provider. Until things started getting "contracted out" that is. Started with the cleaning and the catering. Now some of the care is "contracted out" to private hospitals.

Basically

It's legal for a doctor in the UK to have an entirely private practice and charge money for treatments offered by the NHS. That's not single payer, though like I said for practical purposes it's close to it.

If more than a single entity can be the payer for a treatment, well, that kind of says it all...

[mwooldri]

97. Generally, doctors are not NHS employees - they're contractors.

Always have been since the start of the NHS.

Basically

It's legal for a doctor in the UK to have an entirely private practice and charge money for treatments offered by the NHS. That's not single payer, though like I said for practical purposes it's close to it.

This essentially describes the set up of every GP office in the UK. Thatcher's "reforms" made it easier for a nominally private practice doctor to accept patients (generally referred to them by a NHS contracted doctor) and take payment under the NHS via a different contractual arrangement than that in place were the doctor to accept a full-time NHS contract. It also made it possible for NHS hospitals and clinics to accept patients that paid for services outside the NHS system (ie "private patients&quot .

What makes the UK single payer is simple. Every UK resident is covered. Every UK resident is entitled to be registered to a GP (primary care physician) that is contracted under the NHS. In emergency cases, an ambulance is called for, you are taken to A&E (the emergency room), you are treated, and providing all is well you are sent home. Because it's all NHS you don't see a bill. There's no doctors' office or hospital copay. The specialist who saw you will not be sending you a separate bill. The ambulance service won't bill you, nor will the medical lab who processed your tests ... and so on. That there are separate parts of the NHS system billing each other for services doesn't change things - it's all NHS to the end user. In England you might have to pay a co-pay for your prescription, though not in Wales or Scotland. Yes, subrogation exists but apart from some entity asking you about your accident it's a matter between the NHS system and the company at fault (e.g. motor vehicle accidents where insurance claims are involved... the NHS may bill the auto insurance company).

If the definition of single payer for any country's health care system is that there is only one entity that pays for all medical treatment then a communist system like Cuba or the former Soviet Union might meet that definition. However in social democratic Europe, capitalism is allowed to exist, there will be private practice doctors operating alongside a government organized health care system, and in the most part those private practice doctors will be involved in that health care system.

If the UK were ever to change its health care system by allowing people to opt out of the NHS and have private insurance companies provide payment for their health care needs in place of the NHS then the UK would no longer be a single payer system (but still be universal health care) and possibly no longer free at the point of delivery (as it is today for the vast majority of NHS services). However opt out isn't possible yet, especially not for emergency services where private hospitals don't provide these services independent of the NHS - they simply don't exist.

[TubbersUK]

96. Of course it's single payer

Last edited Thu Feb 4, 2016, 10:50 AM - Edit history (1)

It just suits some to peddle a ludicrously narrow definition of that term and thus exclude it.

If only one person out of the entire UK population once paid privately for a face-lift, they would still be trying to negate the UK as an example of single payer.

The European healthcare landscape that's portrayed in some posts is unrecognizable because of similar distortions and contortions.

[Tortmaster]

57. Senator Sanders has to be more pure than anyone in the world.

Making this an issue in 2016 would give the Republicans their most effective (and nastiest) campaign issue since desegregation. In getting to ObamaCare we've seen the rise of the Tea Party, 64 votes on it by the legislature, a Veto from the President, three major Supreme Court cases (don't forget Hobby Lobby), numerous lower court cases, a major wave against Democrats in 2010 and again in 2012, as well as Republican Governors refusing to cover their working-poor constituents, and thereby killing some, even when offered free money to care for them.!

Stupid general election strategy from Senator Sanders.

[polly7]

60. Shouldn't it be more about all the people who would benefit from

access to health-care, and not about offending Tea Partiers and Republicans?

Also, do you not believe that many of these struggling to afford health care are Tea Party members and Republicans? I think a lot of them do realize how much Obamacare has already helped and will honestly seriously consider Sanders' proposals to carry it further. 29 million people without anything - they can't all be Democrats.

[handmade34]

58. Sander's proposal are feasible

only if we change the entire dynamics of Congress and the SC... this is where all our work should be focused

[Unknown Beatle]

61. I never thought it was possible that a Democrat

would question healthcare for all US citizens. There are approximately between 33 - 40 million people uninsured in the US. Any self-described progressive would be for either universal healthcare or single payer. It's also the humanitarian thing to do. People shouldn't go broke because they need healthcare.

That's one of many reasons why Hillary is neither a progressive nor a humanitarian. She gets her marching orders from big pharma and insurance companies, she tells her supporters that healthcare for all is bad and her supporters parrot those sentiments.

Yes, we'll be taxed more, but in the end, we'll pocket more money than we paid in taxes.

Bernie is a true progressive and humanitarian.

[kennetha]

119. You confuse ends with means

We're not having a debate over ends, we're having a debate over means.

[Hoyt]

64. Yep. Sanders is going to wave arms and cut Healthcare spending from $3 Trillion to $1.38.

Why would anyone question that?

[Recursion]

66. While covering providing care to 80 million more people (nt)

[Hoyt]

67. Most folks want to do that, but he needs to be honest about the cost and

political realities.

[Jarqui]

68. I haven't got time this morning to dig them up but there are

policy wonks that support Sanders. I've posted some before.

First of all, there are entire countries who not only looked at the theory and determined it feasible, they implemented it. For example, Canada, UK and Australia (Medicare for all plus private - might be best fit for US transition) are three examples. In years gone by, Canada's system received a lot of accolades. Recently, the surveys of the UK system have been impressive. And they're all about 60% or less of what Americans pay per capita = In the longer term, would save the US hundreds of billions per year.

Usually, if you want some kind of a social program, you have to find a way to come up with the money - that's usually a prohibitive thing for something expensive. But since the US is paying far more than anyone else in the world for their healthcare, finding money to pay for it isn't a big problem. In fact, the key motivation behind single payer is to get everyone covered and healthcare costs under control.

We can bicker about whether taxes should be $500 or $1000 or whatever per person who have been relieved of paying $5,000 per year for healthcare, but anyone saying something like the concept of Sanders plan can't be done because of money is completely full of shit. When you're paying more money than anyone else, there's lots of money to reasonably do whatever.

The one added significant expense for single payer is coverage for the 29 million who don't have it. A second one would be reducing deductibles. To keep chatter simple in terms of a feasibility test, let's leave the deductibles as they are for the moment. Let's say that since the US is paying $3 trillion per yer for 300 million people that it can cover 10% more for 10% of $3 trillion = $300 billion (I think the actual estimate is about $100 billion less). So for Sanders plan to cover them without costing any more, we have to find those savings. There are two gigantic areas where single payer saves:
- don't have to pay insurance company profits anymore because the middle man has been cut out of the deal
- don't have to pay for insurance sales people, brokers, insurance adjusters, office space, etc, and doctors or hospitals save big there as well in paperwork and staff costs etc

The administration cost and profits of private healthcare is about 31% (I recently linked to that). The US spends about $1 trillion dollars on private care so there's your $300 mil savings (31% of $1 trillion) to cover those who are without coverage. The only losers are the insurance companies.

So single payer in general terms can work and not cost Americans collectively any more than they are paying right now.

Sanders wants to redistribute those healthcare costs from the middle class to the corporations and the 1% to help income inequality. His proposal example was a person in the middle class would pay $500 more in taxes and save $5,000 per year in healthcare costs. Let's say Sanders calculator is broken and he really messed up. If the reality was someone had to pay $4,000/yr in taxes instead of $500 in taxes but they still saved $1,000/yr because they didn't have to pay $5,000 per year for healthcare, will we have have to grab our pitchforks and attack Washington over that? Of course not, he will have saved the middle class taxpayer $1,000 per year.

So Sanders has a pretty big margin for error in trying to reduce income inequality and it turn out to be financially helpful.

If one wants to nitpick, I'm sure they could find flaws with Sanders plan, but the general concept makes tons of sense to me and it adds up within a large margin of error that still leaves the middle class in a better place financially.

[Autumn]

71. I pay $700 a month for my premium only. I would rather pay a $400 tax. Were you around

when Obama started talking healthcare reform, which became insurance finance reform? That was pretty short on fucking details until they started working out the details.

Inquiring minds want to know.

[jeff47]

72. God I want to buy a house from people who write this shit.

You do not start a negotiation with where you want to end up.

When it comes to health care, there will be negotiations and compromises. If you start with single-payer, you end up with minor tweaks to the ACA after those negotiations.

If you start with minor tweaks to the ACA, you get a weakened ACA.

The point of Sanders single-payer plan is not to implement it in the next year or two. The point is to set the long term goal to head towards, and to set a decent starting position in negotiations with the GOP.

[kennetha]

78. In negotiations, you don't reopen issues already settled in your favor unless you are foolish.

The issue on which Clinton disagrees with Sander re health care isn't whether we should repeal or not repeal ACA. The issue is whether to re-open, and thus try to re-litigate, a certain settled question. The settled question is what sort of health care system should we have? I mean settled in broad terms, not in detailed terms.

We have two broad options.

Broad Option A: one in which there exists a combination of more or less tightly regulated private insurer and various government provided insurance schemes for various segments of the population.

Broad Option B: one in which there are no private insurers at all and the government is the sole insurer and the insurance system is financed by some form or other of taxation.

Option A has been the reality in this country for a very long time. The ACA doesn't represent a rejection of option A. It represents a new configuration within OPTION A. It subjects private insurers to greater regulations and offers consumers within the private insurance market a new set of incentives. It also expands the reaching of the governmental portion -- though it didn't go as far as it might have in this regard, partly thanks to the Supreme Court and partly thanks to the Senate's rejection of the public option.

Though Sanders admittedly isn't proposing to directly repeal the ACA, he clearly does want re-open the debate over whether we should pursue Option A or Option B. And I assume this would entail not just polite debating points made here and there, but actual proposed legislation and political capital spent on trying to pass that legislation. In other words, he very much does want to re-litigate the fundamental question.

Though reasonable and fair-minded progressive people can differ over the wisdom of this strategy, I think any such person should start by acknowledging that the politically possible is a highly path-dependent matter. And given the paths we travel to get to this point in Option A space, it would not be at all simple. It certainly wouldn't be as simple as saying "well, we provide medicare for some, so let's just provide medicare for all."

Indeed, I think a politician who frames things that way would be being naive, or disingenuous, or at a minimum super-duper optimist, at the very minimum and would be setting those who endorse him or her for perhaps bitter disappointment.

I take Clinton's point against Sanders to be that instead taking on the massive battle it would take to shift us from broad Option A to broad Option B, however preferable B might be in an ideal world, in which the possibilities for change was not at all path dependent, let's take it as given that we live in a world deep along the path of broad Option A, and see what we can do, incrementally, to make something fitting with in that approach, more effective, more universal, etc. It could be, of course, that's there is no getting to the good enough along path A. But that seems like an empirical question, well worth the investigating, before you give yourself the burden of executing a complete paradigm shift.

[jeff47]

80. The ACA is not sustainable.

Medical expenses are going up slower than before the ACA, but they are still going up faster than inflation, and WAAAAAY faster than wages. And insurance costs are going to more-or-less go up with medical expenses.

The subsidies and Medicaid expansion in the ACA are based on federal poverty level, which will more-or-less go up with inflation.

As a result, we are going to end up with people who make too much for subsidies and expanded Medicaid, yet come nowhere close to being able to afford insurance.

The ACA always was a stopgap. It was sold to Democrats as a step towards single-payer. It never was, and can not be, the end state. Because it can not work in the long run.

As a result, we are going to have to reopen this issue. The fundamental problem of medical costs going up faster than anything else can not be fixed by minor tweaks.

[kennetha]

81. Many Countries around the world that have universal coverage operate on a similar model.

Single payer is only one way to get to Universal healthcare.


http://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/

[jeff47]

82. And using their models still requires gutting the ACA.

Because the subsidy and cost control mechanisms in the ACA are utterly unable to do what those countries do.

The ACA relies on private insurers to control costs. Yet they make more money if costs go up via the Medical Loss Ratio limit. It also ignores that virtually every private insurer's contract with providers is Medicare + X%.

Again, the ACA was a stopgap. We can not rely on it forever, because it can not work in the long run.

[TubbersUK]

121. Yes

Last edited Fri Feb 5, 2016, 11:03 AM - Edit history (1)

The French model certainly would.

Even though it's insurance based, there are some fundamental differences between it and the ACA which affect critical issues like governance and control - including cost control.

[Ferd Berfel]

89. ‘Single-payer is the only health reform that pays for itself’

http://www.pnhp.org/news/2016/january/doctors-group-welcomes-national-debate-on-%E2%80%98medicare-for-all%E2%80%99

Physicians for a National Health Program, a nonprofit, nonpartisan organization of 20,000 doctors who support single-payer national health insurance, released the following statement today by its president, Dr. Robert Zarr, a Washington, D.C., pediatrician.

Nonpartisan physicians group calls single-payer reform ‘the only effective remedy’ for nation’s continuing health care woes and urges focus on facts, not rhetoric
--------------------------------

No,we can't - and No we won't even Try are unacceptable from any American, but especially from any Democrat

[Live and Learn]

95. The lure of the CAN'T DO, CAN'T DO campaign is so much sweeter.

[AgingAmerican]

98. Yet it has been proven to work in scores of other countries

[kennetha]

99. That's not really the issue

the question is transitioning from here to there and what would be involved in bringing the change about.

[AgingAmerican]

100. Defeatist attitudes are the main roadblock

[kennetha]

102. No that's not at all the main roadblock.

the array of winners and losers, because of the incentive structures that have been built up over time are the main roadblocks. You can't just waive a magic socialist wand and change that. We don't have a political system that allows that to happen. Do you understand how many veto points are built into the American constitutional system, how many competing interests are bound to have a seat at the table? You are living in a dream world.

[AgingAmerican]

103. Defeatism is the enemy of progress

Like you are doing now

[kennetha]

104. politics as wish fulfillment

as if wanting it to be so, makes it so.

[mike_c]

105. if they can do it, why do you insist that we cannot...?

The difficulty isn't that we can't do it-- it's that we won't. We're too busy protecting the obscene profits of for-profit wealth care health care.

Have you looked at the list of countries that already provide access to universal health care for their citizens? It includes countries like Rwanda, Isreal, Cuba, Iran, Ireland, and Portugal. Do you really contend that the wealthiest nation on Earth cannot accomplish what those countries have done for some time? Really?

https://en.wikipedia.org/wiki/Universal_health_coverage_by_country

[kennetha]

106. Obviously you didn't bother to read the linked to article.

So here's a lengthy quote. See if you can respond to these arguments. I hope you are intellectually serious enough to at least try.

But what about other countries that Sanders often cites? Don’t those examples show that a system of national health insurance is cheaper and better than one with private insurance?

Here’s where I agree with that argument: If we could wind back the clock to the 1940s, when health care was just 4 percent of GDP and private insurance was just beginning to develop, we might well be able to design a national insurance program—as Harry Truman proposed—that would have kept down the growth of costs. But we can’t wind back the clock. In the mid-to-late 20th century, a very different system developed with the rise of both private, employer-based insurance and the adoption of public programs that accommodated the interests of physicians and hospitals.

This is a story I’ve told in two books—The Social Transformation of American Medicine (1983) and Remedy and Reaction (revised edition, 2013). The financing arrangements that emerged in the United States had two complementary effects: They created incentives for high-cost specialized care and protected much of the public from the full, direct cost of that system. As a result, starting from 4 percent of GDP, health care grew to 17.5 percent, far more than in any other country. That level of costs is reflected in investments in medical technology, the physical infrastructure of hospitals and other facilities, the patterns of medical training and specialization, and the size and structure of the health-care labor force. Adopting a government insurance plan won't undo a system that's been built up over decades, though it would certainly alter its future evolution.

While having the federal government take over all private health expenditures (and state and local government spending too, unless Sanders can also appoint new justices to the Supreme Court), the Sanders plan attempts to squeeze per capita health expenditures down to Canadian levels. The plan doesn’t explain how it is going to bring this about, and Thorpe’s analysis says it won’t. But if the federal government did impose sufficient controls, the results would be to bankrupt many institutions that are counting on future streams of revenue to cover debt payments, meet payroll, and satisfy other obligations.

The Affordable Care Act does not try to roll back spending levels to the share of GDP that health care represented decades ago. It has the limited, uninspiring, but ultimately more sensible goal of “bending the cost curve”—slowing the rate of growth of health-care costs, which has actually happened in the years since the law’s passage.

The ACA is far more in keeping with the lesson to be drawn from the history of health policy in other countries. Most countries have built on their existing institutions as they have pursued universal coverage and sought to control costs. The governments that instituted unified national insurance systems generally did so before private insurance had developed on a large scale. Many countries that had multiple insurance funds have maintained them; rather than centralizing all payment, they have created regulatory and negotiating arrangements that keep costs in check. This is the direction we can and should take.

[mike_c]

115. I'm sorry, but I'm not buying it....

I understand the point the author is trying to make, but again, the argument comes down to "we just cannot do what most other industrialized nations do routinely," with a big helping of "we've let the problem become so bad that we cannot even attempt to solve it." I don't buy that. If we can find a way to afford bombing people half way around the globe for years on end, we can figure out how to provide universal health care to Americans at home.

I especially don't have any sympathy for the argument that providing universal health care to all Americans undermines the profit expectations of for-profit medical and pharmaceutical industries, e.g. "the results would be to bankrupt many institutions that are counting on future streams of revenue to cover debt payments, meet payroll, and satisfy other obligations." Bankrupt the health insurance parasites that feed on the sick, injured, and elderly? Hell, I'll dance on their graves! Removing that one, single layer of obscene profit making from health care delivery will go a long way toward establishing affordable universal health care. Controlling the cost of drugs will help as well.

The absolute worst thing we can do is accept the status quo because solving problems is "too hard."

on edit: I'll bet that something as simple as providing a nonprofit publicly funded option for the ACA-- medicare for all who want it--would drive down the cost of health care in America significantly.

[kennetha]

116. Well if you were a dictator

that would be fine. But think about how democracy, especially one like ours, with many veto points and with many players having independent sources of legitimacy, would deal with the huge undertaking to shift the incentive structures, raise taxes enormously, decide on what gets covered and what doesn't.... and on and on and on.

The political system would grind to a halt.

Why not focus on improving and extending and making more fair, efficient, and just, what has already been achieved -- which actually represents an enormous, if not revolution, than at least evolution.

And also do you really believe that the House and the Senate are going to actually vote to more than DOUBLE the total revenues of the US government? Or that this could be done through taxing the rich alone?

Seriously? On the basis of what do you believe that?

Or are you refusing to acknowledge how massively taxes would have to be raised to make this happen?

[mike_c]

117. I'm happy to improve and extend what has already been achieved....

I proposed one such improvement-- a publicly funded option for the ACA, in which citizens can choose whether to sign up for free or very low cost single payer benefits, or whether to pay more for whatever benefits the private, for-profit carriers are offering. I'm betting that would drive the cost of health care down precipitously. And FAST.

The important thing is that we work to improve our current system rather than to perpetuate its worst features. If we acknowledge that one problem is the high proportion of GDP that health care costs Americans, then we need to find solutions that drive that equation in reverse. That's what our objective should be, not acceptance of the status quo because changing it is hard. We can work incrementally if we want-- but first we have to set new goals and figure out how to work toward them.

[kennetha]

118. I was all in favor the public option

Felt deeply let down by both Obama and the Senate Dems.

But the Senate wouldn't pass it. A DEMOCRATIC one, to boot.

[immoderate]

101. Yes, but they are not 'Americanly Exceptional!'

American Exceptionalismists are immune from the constraints on normal civilizations thereby becoming incapable of dealing with issues of health. Simple.

--imm

[katsy]

107. It's perfectly feasible and requires resolve.

FDR's New Deal wasn't "feasible" until it was.

Canada, England, Europe all cases that can be studied and emulated.

We should pay more in taxes to get single payer because after all is said and done, we're going to keep getting gouged in out of control skyrocketing health care costs that will dwarf the cost of implementing single payer.

[kennetha]

108. did you actually read the linked to article?

you should, if you haven't and you are intellectually serious about trying to understanding why hard-thinking committed people might disagree with you.

Consider this:

Sanders doesn’t just call for incremental steps toward single-payer. He’s proposing to shift all of health care to federal taxes in one fell swoop. That’s one reason for the enormous, sudden increase in taxes the plan would require—$1.38 trillion on top of existing federal spending, according to Sanders’ own estimates. As Harold Pollack has pointed out, that $1.38 trillion is just about equal to total federal income and estate tax collections in 2014—in other words, the plan would require doubling that revenue.

He has to DOUBLE federal revenue just to pay for his healthcare proposal.

Then add on his other priorities.

You really think that's going to happen? You really think it should happen?

[katsy]

109. I think we need to keep single payer the goal.

And im pretty sure Bernie isn't an idiot that talking out his butt about this.

I'll research other pov and compare to what I read.

[riversedge]

111. Hillary has univeral coverage as her goas since day one. Her proposal is incremental steps given

our Republican Congress

[katsy]

113. I'm all for single payer and love our candidates.

I'll research this further but I can't imagine Bernie Sanders being a liar or stupid.

I want more info.

[kennetha]

112. He is talking out of his butt. That's where you are wrong.

He's not allowing himself to be at all constrained by realities. Realities don't fuel revolutions.

And you are setting yourself up for rude and crude awakening by allowing him to get away with sweeping generalities.

[katsy]

114. I'm still researching but I am concerned

after reading a Mother Jones article.

Don't worry... I'm not setting myself up for anything. Just giving Bernie the benefit of the doubt and would welcome more details from him.

[grntuscarora]

120. So despite the fact that many countries successfully use single payer health care,

those of us that want the same here are just dumb fish, grabbing at a shiny lure.

bs.