Obama Touts Single-Payer System for Health Care

[babylonsister]

http://blogs.wsj.com/washwire/2008/08/19/obama-touts-single-payer-system/

Obama Touts Single-Payer System for Health Care

Amy Chozick reports on the presidential race from Albuquerque, N.M.


“If I were designing a system from scratch, I would probably go ahead with a single-payer system,” Obama told some 1,800 people at a town-hall style meeting on the economy.

A single-payer system would eliminate private insurance companies and put a Medicare-like system into place where the government pays all health-care bills with tax dollars.

Many liberals have long embraced the coverage plan, saying it would cover everyone, take the profit out of health insurance and allow for greater efficiencies. But Republicans cringe at such deep government involvement in the private sector, calling it socialized medicine. And many Democrats, including Obama and former rival Hillary Clinton, have taken a much more moderate approach.

Obama’s health-care plan aims for universal coverage by offering a new government-run marketplace where Americans could buy insurance, mostly from private plans. He would offer subsidies to individuals and to small business owners that offer their workers coverage. His plan also would require that parents get insurance for their kids. And he aims to lower health-care costs to make coverage more affordable. His plan includes one small step toward single payer. His new marketplace would create a new government-run plan, like Medicare, to compete against the private plans.

But Obama repeated that he rejects an immediate shift to a single-payer system. “Given that a lot of people work for insurance companies, a lot of people work for HMOs. You’ve got a whole system of institutions that have been set up,” he said at a roundtable discussion with women Monday morning after a voter asked, “Why not single payer?”

“People don’t have time to wait,” Obama said. “They need relief now. So my attitude is let’s build up the system we got, let’s make it more efficient, we may be over time—as we make the system more efficient and everybody’s covered—decide that there are other ways for us to provide care more effectively.”

[Alter Ego]

1. Cool.

[lumberjack_jeff]

2. grr. n/t

[CaliforniaPeggy]

3. I like his ideas...

I hope he can implement them.

[gateley]

4. I hope he immediately begins working on as soon as his current plan

is implemented.

[Captain Hilts]

5. But during the primaries he wanted participation to be voluntary.

How times change...

[babylonsister]

6. Did you read the article, and how his plan will slowly lead to

single-payer? How he doesn't want to see a whole bunch of people unemployed immediately? Guess not.

[Dawgs]

7. Thank you.

I am so tired of people thinking we can just start over from scratch. This is one of the big reasons I like Obama. He gets it.

Eliminating health insurance as it currently exists is just as dumb an idea as thinking we can suddenly eliminate the IRS for a "Fair" Tax system.

[Two Americas]

34. the opposition does it all the time

The Republicans have no problem making radical changes and "starting over from scratch" in all sorts of areas when it advances their agenda.

Why can very radical changes that help the wealthy and powerful few happen quickly, but things that help the people must always be incremental, slow, half-hearted and take a long time?

[lumberjack_jeff]

8. How is "voluntary" a steppingstone to "universal"?

It's gibberish.

The main attribute of his plan is that it's essentially what we have now. Voluntary, for-profit health insurance. Worse, people can opt out (and not get regular checkups or preventive care) until they get really sick, which leaves those who were insured all along holding the bag for the choices that the patient made.

It won't reduce costs at all.

I hope that congress passes something universal, but I'm not holding my breath. We'll try again in 8 years.

[babylonsister]

9. You're already convinced you're not going to like anything coming

from Obama, so I won't try to convince you. I hope that chip on your shoulder melts at some point.

[lumberjack_jeff]

21. Obama is a good candidate.

But his healthcare priorities suck.

[FatDave]

10. It's a better set up than you're going to get from McCain

Plus, did you catch the part about a government-run system similar to Medicare being among the choices? That alone has much potential to keep prices down.

I'm not saying it's definitely going to work, because only a fool speaks in absolutes. But the idea deserves a chance because his concerns are real and his ideas seem sound. If the government option ends up being the best coverage for the least money, seems like we'd pretty much have a de facto single-payer system.

As far as trying again in 8 years goes: we'll probably get many great things done after 2016. Major change happens gradually, but I would bet that an Obama victory will be the beginning of a long leftward shift in American policy.

[lumberjack_jeff]

23. This is true, and it is only one issue.

But it's a biggie for me and I feel that his plan leaves a lot to be desired.

The fact that he considers single payer a worthy goal is reason for optimism.

[ContinentalOp]

13. I could be wrong but I don't think the voluntarily uninsured are the biggest burden on the system.

What's more important is covering all of the people who want to be insured but can't afford it.

[lumberjack_jeff]

24. I've found, in many things...

... that the line between "can't" and "won't" is often fuzzy.

The key is universal. Optional is the antithesis of universal. Here on DU, many of his supporters like his plan because "it won't force me to buy insurance that I don't need".

[ContinentalOp]

30. No, I think people support his plan because...

We understand that the public perception toward Clinton's plan, helped along by the corporate media, would have overwhelmingly been "she's forcing us to buy government healthcare." I think that's an even harder sell than single payer. If everyone's taxes just go up a little, that's one thing. But to "force" people to cut a check for healthcare each month (and you know that's how they would spin it) is a losing move. She basically crafted the right's anti-health care slogan for them. It's a bad way to frame the issue in my opinion.

Obama is "forcing" people to buy healthcare for children which is much harder to argue with. Who's going to complain about that? To me, that small difference speaks volumes about the two of them, their approaches, and their ability to craft a winning message.

[Dr.Phool]

40. Single payer, regretably, won't happen in my lifetime.

And as far as, "A lot of people are employed by insurance companies", If there's ever been a bunch of people who deserve to be without jobs, it's people who deny health care claims.

[Radical Activist]

37. Crazy how Obama keeps shifting to the right now that the primary is over!

Oh wait...that old meme doesn't work in this case.

[TacticalPeek]

11. "Given that a lot of people work for insurance companies, a lot of people work for HMOs."

Therefore, 'make-work' for the healthcare buzzard corporations?

Typical: applying the worst of 'progressive' cliches for the benefit of the ruling class.

Feh.

[Qutzupalotl]

18. I think he's saying a mass layoff a million workers in this economy would be disruptive.

Which is true. Better to transition gradually, IMO. If you can find a productive use for these workers in the new system, all the better. And if any candidate can solve two problems at once, it's Obama. (Just look at his $4k scholarship/community service proposal.)

But you are right that the one problem is much more urgent than the other. I do not believe he wants to keep the current system indefinitely.

[lumberjack_jeff]

28. Right. Consumers are obligated to spend 15% of our gdp to keep paper-pushers employed. nt

[Dr.Phool]

42. Paper pushers and claim deniers.

[Two Americas]

36. Republicans never worry about that, do they?

Republicans routinely destroy jobs and industries with radical and sudden changes when it helps the wealthy and powerful few. Yet we tip toe around on things that would help the many?

[bvar22]

12. The US ALREADY HAS a Single Payer System !!!

It is efficient and effective.
The infrastructure is already in place.

We do NOT have to "build a new system from scratch" as Obama keeps insisting!!! :grr:

Simply EXPAND MEDICARE to cover all Americans.

“Given that a lot of people work for insurance companies, a lot of people work for HMOs."

Many from Middle Management on down would be absorbed by the expansion of MediCare.

The BIG FAT CEOs of the Insurance Corps and HMOs would have to find a new job :cry:


In support of Obama, he is being consistent.
He has never even pretended to be on the side of the American people on this issue.

[CTyankee]

14. And John Edwards said essentially the same thing about the gradual process to

universal coverage. The way he put it was that people would "vote with their feet" and choose the government plan because it was cheaper in the long run, thereby "starving" the for profit insurance companies and eventually forcing them to find a new line of insurance products to peddle...

[uponit7771]

15. My understanding is this is what Obama is suggesting indirectly. Either way I figure what will happe

...to big insurance companies once we do go towards what Obama is presently suggesting?

They'd fold after a while IMHO cause they wont get on the bus with the rest of us.

[DustyJoe]

17. Exdpand Medicare ?

I can't find a Dr. that will take Medicare patients now.

[lumberjack_jeff]

27. So, you're suggesting that doctors would take no one if everyone had medicare? n/t

[Dr.Phool]

43. The reason being that Bush has been gutting Medicare reimbursement rates.

AKA, the doctors pay, for several years now.

[lumberjack_jeff]

26. Exactly right.

1) Put medicaid, the VA hospital system and the public employees plans under the medicare system.
2) Make the plan available to everyone.
3) Make the plan something that every citizen and legal resident is entitled by virtue of the taxes they pay.

[ContinentalOp]

16. Unfortunately I think he's dead wrong on this issue.

I mean, "let's ease into single payer" sounds nice and logical. But the reality is that any health care reform that happens under an Obama administration will be perceived as "universal health care" by the media and most Americans and the issue will be effectively dead for decades.

If you try to bring up further reforms you'll just hear "didn't we already fix that health care thing?" Even worse, if we do a half assed job of health care reform and the new system doesn't really work or doesn't save people money, it's going to sour everyone on the very concept of universal health care.

Most people really don't understand the distinction between single payer and any of the Democratic candidates' other schemes so we need to be really careful how we approach the issue. If Obama gets elected and has a Democratic majority in both the House and Senate, it's going to be hugely disappointing if he passes up the opportunity to make some really bold changes.

[lumberjack_jeff]

31. Take a page from the shock doctrine.

Big reform (good or bad) needs to happen quickly and all at once.

[Bucky]

19. It would work better than Bush's "single-prayer" system we have now

I'm just kidding. If you don't have health coverage under Bush, you don't have a prayer.

[Lugnut]

20. Now we're getting somewhere.

Anything other than single payer is unacceptable. Insurance companies are the problem rather than the solution.

On edit: punctuation

[Abacus]

22. Precisely my view as well /nt

[Zavulon]

25. Not good.

If the federal government can't manage health care for the military, even though the numbers of active duty and reserves are known and established by said federal government, how the hell can it manage health care for the entire country?

I trust Obama's motives, but not the federal government. We should have the WH for the next eight years, but once a Republican gets it back you'll see services trimmed in a system we could all be a part of by then. Even when we have the WH, the federal government spends money more wisely than when the Repugs do, but it's still a slow-acting and wasteful behemoth.

I'd rather go into debt and be seen immediately than die on a waiting list for a routine exam. When the feds misspend money, services get cut. I've read at least thirty articles on the joys of single-payer care and none of them have come close to selling me on the idea. Once you go single-payer, there is no turning back, and that's too much responsibility to entrust to the feds - even if you could give me an absolute guarantee that we'd have the WH for the rest of my life and the lives of my loved ones.

No, not good.

Edited to add my assumption that at least one person is going to accuse me of "buying into fear tactics and / or propoganda." Go ahead, but those people who wrote articles in favor of single-payer certainly weren't trying to scare anyone.

[Solon]

32. I think the difference would be profound though...

And the reason is simple, Veteran's medical care, while extremely flawed, also affect, being honest here, a minority of Americans. A single payer health care plan, on the other hand, would cover every person in the country. If the Republicans reattain power, and try to fuck with that system, they would end up having their heads put on spikes on the White House lawn.

[Zavulon]

33. That's exactly my fear.

The feds can't cover a minority of Americans even with a ridiculously high defense budget. So why would it be reasonable to assume that they could handle the responsibility for everyone in the country?

Just because we spend money better than Repugs doesn't mean it should be overlooked that no matter who is in charge, the federal government is an absolutely shitty steward of our tax dollars no matter who is in charge. The bread may be fresher with our shit sandwiches than with GOP shit sandwiches, but the sandwiches still taste like shit.

Once the feds take over health care, there is no turning back. You really trust them that much with a responsibility as massive as this one?

[Solon]

39. Yes, simply because, overall, it would end up being a cost savings...

Right now, our health care system, using the term loosely, costs about 2 trillion dollars, 561 billion of that in Medicare and Medicaid. I'm not saying the programs are perfect, but they also only affect a minority of Americans as well. Overall, if we were do go single payer, we would just about double the budget for Medicare, and eliminate all the rest of extraneous costs associated with our private system now. In other words, we would end up with better health care at half the cost, maybe even less.

In addition, the bloated Military Budget does show exactly what is wrong with military budgets, and only a small percentage even goes to Veteran's benefits. Its largely unaccountable, that is the problem, a Single Payer system wouldn't be so unaccountable to the people, since everyone in the nation would have an interest in seeing that the system works, so that they are all adequately covered by it, the Republicans wouldn't be able to pull the shit they pull with the military budget, not if they want to continue to get elected.

Think about Social Security, the Republicans have been talking about reforming it and privatizing it since pretty much its inception, and yet it is still here. It has problems, but nothing that isn't solvable in the near future. The point is that, no matter how conservative they get, the Republicans aren't stupid, they want in power, and they can't steal all elections. This is similar to the Tories in Britain, they talk about(and exaggerate) the negatives of the NHS, and yet, even when they were in power, they didn't do much to disrupt it. Why? It is a popular system, people complain, but they don't want to go completely private either, they know that would be a disaster, and don't want to screw themselves.

[Zavulon]

41. When you say

"In other words, we would end up with better health care at half the cost, maybe even less," I respectfully disagree. We may cover more people, but we'd also increase waiting times and lower the standard as to what "quality health care" is.

I'm trying to think of any major government program that didn't come in miles over its original estimated cost, and I'm coming up empty. Maybe you can shed some light on that one; I don't claim to be an expert, but any time I hear any estimated figure I tend to multiply it by 2.5 and come a lot close to the actual cost than the original estimate is.

As for Social Security, my father's best friend showed me some old Social Security pamphlets his grandfather saved which promised that you'd NEVER have to pay more than 2%. We all know what happened there, and look at the way the Social Security surplus is spent. If the feds were to go single-payer, the original estimates would be spin control bullshit and way off base, money would be wasted, and there is no way we'd get better health care even at the current cost. Sorry, but with the federal government's track record in spending and waste, you'd really have to show me a ton to back up your assertion. The track records of tons of major programs already support mine.

[Solon]

44. Medicare has an overhead cost of around 3% and sometimes less...

Its one of the most efficient government programs ever created, the Government can and does run efficient programs, and besides that, even at their most inefficient, the Government still beats the private sector, which wastes even more money than you would think, especially when it comes to health care and insurance.

[Zavulon]

45. And where does that figure come from? Let me guess.

I wish I had the time to research the hidden costs and see what the overhead actually was.

If Medicare is so efficient, by the way, why do so many seniors have to choose between medicine and food? Is it because we haven't entrusted EVERY aspect of health care to the federal government?

[Solon]

46. Actually yes...there are two big problems with Medicare...

and the health care system in general, first is using contractors with little to no oversight, unfortunately, the Republicans thought it was a good idea to use private contractors as "middlemen" between Medicare and Doctors, Hospitals, and Patients. This is a huge problem, and these companies also are the largest contributors to Medicare fraud, yes, they outright rip the system off.

The other big problem is that, while everyone pays into Medicare, no everyone can get it, this means that, again, not a large majority of people are affected by the services provided by it, so there is little public oversight because of that. The fact of the matter is that no one is advocating for us to just expand Medicare, but also reform it, its a financing arm, first and foremost, and doesn't need private contractors to send the bills, instead of sending them directly themselves.

There are many other reforms that can be done to the system to make it more efficient, more effective at financing medical care, and also allow it to cover everyone in the nation. Its not an impossible task, and other countries are able to do, why can't we do it as well?

[Zavulon]

47. Thanks for the answer. I do appreciate being able to discuss this rationally, especially because

the last time I took this stance on DU I wasn't received so well. In the interests of full disclosure, I was a Republican until Bush 41 ran for reelection, and then sort of woke up. Been on the proper, if not "right," side for 16 years now.

My distrust for the federal government's fiscal stewardship skills still remains, however. On that note, and I do not mean this in a snide manner at all, I believe trusting the federal government's own figures regarding the effectiveness of its programs is like trusting Blockbuster's movie guide - the book will almost never trash a movie out on DVD, no matter how bad, because it wants to sell or rent it to you. The federal government has lied to us time and time again regarding what we'd pay for this and that, and I don't believe for a moment that reasonably accurate estimates weren't available when the programs in question were in their planning stages.

I, like you, want to see improvements, but the problem is that the federal government does not have a track record worth trusting in either its own performance or in reporting its own performance.

As for other countries covering everyone in the nation, the country I know the most about (this does not mean I am an expert or claiming to be one) is Canada, because I used to live there. My best friend in the entire world lives Coquitlam, British Columbia. His daughter is autistic. Some time ago, in 2005 or 2006, BC just up and arbitrarily exempted itself from covering autistic kids because it mismanaged health care funds and had to cut somewhere. Other provinces (it's a common misconception that the system is the same province to province) have done similar things. Then, of course, we've all heard the horror stories about waiting weeks or even months for an MRI (in Alberta, that is true) or the #1 hip replacement center for Canadians being in Cleveland (also true). In Quebec, things got so bad that their Supreme Court ruled that whoever can afford private care should be allowed to pursue it.

Now, we've watched our politicians waste our Social Security surplus in such a way that if it had happened in the private sector the perpetrators would have been imprisoned. What's going to stop the feds from doing the same thing with health care funds?

The reason why I brought up the BC / autism thing, BTW, is that a lot of my fear comes from the fact that we have no guarantee of holding the WH forever. If millions and millions of people depend on a system and then the Republicans steal another election in, say, 2016, 2020 or whenever, then to quote Dave Chappelle in Con Air, "We be fucked."

The problem is that once you go all federal, there is no turning back. The federal government has not done nearly enough, even when Clinton had the WH, to earn my trust on a responsibility so big. The first thing that would be done is the creation of countless program offices (waste), oversight boards (mostly waste), public outreach to make us feel warm and fuzzy about something that's a done deal (waste) including inaccurate estimates, and then the routine misappropriation of our money could commence. Then along comes a Republican president-"elect" who starts beating the drums about the nerve of those pesky North Koreans for not letting us tell them what to do, and just watch as the health care surplus (I assume one would be factored into any single-payer plan) is at least partially diverted in order to provide "much needed resources as we continue to promote hope and freedom for everyone."

I don't claim to know what the BEST solution is, but I know that all-federal isn't one that would allow me to sleep well at night if I were ill.

[endthewar]

35. Government funded not government managed I think

but could be wrong. He clarified that difference when a voter asked him about single-payer.

[Zavulon]

38. I missed that, but

I still liken it to letting a drug addict pay off my utility bills in a responsible manner without diverting some of my limited funds elsewhere to feed an addiction, such as the war machine, pork projects or whatever other wasteful bullshit we've got going on. No thanks. Besides, I refuse to believe that the government would shell out billions without lots of oversight, and I suspect that would make it even worse.

Seriously, what happens when millions of people depend on such a system and then a Republican manages to steal another election? Then what?

[Solon]

29. For once, I can actually agree with Obama about Single Payer health care...

but also disagree that the current system could "transition" to Single Payer, either painlessly or practically. The biggest problem is that the public system needs full support, and Obama's method of transitioning is extremely flawed.