I don't like where all this health care "reform" is going...

[Oregone]

Mostly, because I can't figure out where it is heading at all. It seems to be all-encompassing without necessarily being focused on affordable accessible care for all. There are myriad components on boosts, cuts, changes, etc, all over the map. It seems like it is trying to be too much for too many people and there are 6 or 7 different versions of the same mixed market mess. Why does legislation have to be so convoluted and multi-faceted to accomplish simple goals (that single-payer would immediately address)?

Does anyone here really *know* that in 5 years, their health care will be cheaper or better because of this legislation?

Then there is the group ("progressive pragmatists") that believes this is the great step to single-payer health care. Well, Ill give you one thing...its a step somewhere, but by no means in the direction of single-payer (the industry is in tact with only a free market mechanism to extinguish them, that isn't guaranteed to work). Who knows where anyone is stepping, other than into the uncharted territory of the Third Way. Look, the quickest route from point A to point B is a straight line, and anyway you look at it, this reform doesn't seem to be using that morsel of knowledge. Its like scheduling a red eye-flight from LA to New York with 5 layovers across North America, just hoping no flights get canceled along the way or one of the planes isn't turned into a missile projectile and slammed into a federal building.

Half of the energy on this bill is adding enough crud to make Centrist Democrats/Republicans vote for it, without making the other Democrats drop it like a rock. But for everything you add, its possible you could be sacrificing the very purpose of the legislation in the first place. If I were to fall into the deep chasm of "pragmatism", and thereby not shoot for single-payer, I be recommending a single measure bill, streamlined, without all the controversial BS (taxing benefits/public option vs co-ops/tort reform/VATs/regulating measures of private industry/medicare cuts/mandatory purchase of private insurance). Thats right, why can't we pass but a single measure guaranteed to address this crisis, which is not watered down and balanced out by detrimental legislation?

I think what all the true "progressive pragmatists" should be shooting for to start with is a point along the path from A to B. An obvious starting point is universal, free, single-payer disaster health insurance with a high deductible. That being, a health insurance option covering everyone, which has an out-of-pocket deductible of $2500 to $10000+ dollars (depending on income levels, which counts copays on private insurance). The point? 1) For the "pragmatists", it leaves the private providers and current market completely intact (absorbing their high risk costs as a bonus), to ensure votes exist. 2) No one ever goes bankrupt again from health care costs, or dies 3) Private insurance risk models are completely redrawn from the relief of expensive exceptions, and their max expense per person is a guaranteed ceiling, thereby drastically reducing the cost of premiums. 4) This establishes a clear and straight path to single payer, just by lowering the disaster deductible in the future. 5) it wouldn't have any other measures stapled to it to cancel out its effectiveness. As long as you set the deductible a bit above the median per capita expense on health care, this would drastically reshape the market in a single step.

As of right now, who knows where this is going. Its not along that path from point A to point B, and I think that is because the "progressives" have not been allowed a seat to direct this movement (some have been told to shut-up and go along). Is it really worth it to blow your load on something that may not work, that we have no idea where it is going? Is it too late to use your heads and start recommending a true "pragmatic" solution on that line from point A to point B? Can't we just say forget it and go back to the drawing board?

I think its important to ask if you know, for a fact, the current convoluted legislation will fix the situation. And if you cannot definitely answer that, you all should be screaming for a full stop and be coming up with something simple that does.

[rockymountaindem]

1. At this point, I'd be happy if they don't actually make the situation worse

There are so many bad ideas floating around out there that if they were all to be adopted at once, such as mandatory purchasing from private insurers, forcing employers to provide care, "hardship wavers" (which are just a waver for the poor to keep suffering) and NO public option to boot, I think things have the distinct possibility of going backwards. Furthermore, if we get some "reform" out of this process that doesn't do anything at all, people will throw their hands up in frustration and we won't get anywhere else for a generation. Look at what's happened since 1993. Nothing except the Medicare Part D racket.

I'd rather they move on to the next issue than implement a lot of these concepts.

[harun]

6. The only group that wants mandatory forced insurance is the Insurance Lobby.

So we will see who is more important to the politicians.

[corpseratemedia]

11. I have the same concerns

My thinking is that they'll cut services like screening mris and lower reimbursements to physicians/hospitals somehow and people will still be left with NO public option.

Maybe they'll make Medicare unviable so they'll force even poor people to go on some totally ineffective private insurance plan that will deny everything.

It's like how privatized Medicare Part D made it impossible for my mother to continue taking the medication that has kept her cancer free for years. Now the hospitals/clinics won't give out meds, so she is screwed.

Then for the most part the Democratic Party is just a republican party and shouldn't get any financial support (except for the few true dems who are there to not represent corporate lobbyists).

[harun]

2. They seem to be moving the goal posts. I hear the politicians

from both sides talking about what is going to make the lobbyists happy, not what will get their constituents coverage.

[deaniac21]

3. The people planning it don't have any idea of where it's going either.

[Oregone]

4. Thats what I fear

[havocmom]

5. .

[baldguy]

7. Congress says it doesn't have the votes for a single-payer plan.

What they don't realize is - that doesn't mean we need a different plan, that means we need a different Congress.

[Echo In Light]

8. But only "electable" candidates matter (haha) thus ensuring things never actually change

Mission accomplished

[Oregone]

10. Good point about Congress

But what I suggested isn't true single-payer. Its hybrid, with single-payer disaster coverage. The single-payer mechanism only kicks in when an individual spends 2%-3% of their income on health care costs.

It doesn't threaten to hurt private insurance profits for the mass majority of their patients, since the majority spend under that much yearly out of pocket. It only covers expensive exceptions (which private insurers may or may not want anyway). Until the deductible is lowered, the private insurers remain viable (though cheaper), and the system isn't single-payer but just a safety net. Its "pragmatic", yet effective to reduce costs in the short term.

I lifted the idea from my PharmaCare drug plan here in BC, Canada (which lets private insurance handle inexpensive patients at LOW deductibles). It kicks in only after a certain out-of-pocket expenses to avoid having people bankrupt or die. It is different than their medical coverage which is single-payer from the start, no deductible

[BadgerKid]

21. Congress lacks balls, responsibility & wants job security.

"Doesn't have the votes" sounds like a way not to take responsibility and have Yea/Nay after names. That way, we the people have to work that much harder to vote them out.

[Cleita]

65. Howard Dean has come out and said otherwise. He says it would take

51 votes in the Senate, which we have and a majority in the House, which we have. I wish the Congressional members, who are Democrats would stop saying this. Of course they are the ones who owe the most to the industry for their campaign contributions.

[lindisfarne]

9. Can *YOU* see the future? Of course, no one *knows* anything about the future.

But programs can be set up such that they are likely to achieve certain goals.

You seem to want a level of certainty that is impossible to have with respect to anything.

[Oregone]

12. Everyone wants a "level of certainty"

I may set my threshold higher than others. Thats healthy, is it not? There is data on single-payer that doesn't need "hope".

[lindisfarne]

16. I have no "hope" that "single payer" will work. Have you thought about the chaos that

will result by throwing out everything we have now, and trying to implement single payer?

And frankly, there are many health care systems which work extremely well in developed countries which are NOT single-payer.

Frankly, from discussions, I have learned that people who are arguing for "single payer" have inadequate information about health care systems in other developed countries, as well as have different and sometimes conflicting understandings of what 'single payer' system even means. They also have failed to think about the realities of how you could implement it. I've lost a lot of respect for many of the people shouting "single payer" because quite frankly, they haven't really thought about the things they should have.

I have some sympathy for people who propose gradually moving toward a single payer system, although I don't think we'd have to have a single payer system, given that there are alternatives which work extremely well in other countries.

[Oregone]

17. An implemented single-payer is suggested effective by empirical data

But when you talk of throwing out everything, that is part of the process of implementation that may get sticky. But the plan has solid data behind it if it could ever get done. I tried to suggest a way to get there (with a disaster model put in place as a baby step along the actual pathway there, which doesn't "rock the boat" for the pragmatists).

Yes, other systems work elsewhere, but they are so drastically different with non-profit private insurance providers that it would be just as much chaos implementing those. If you want real affordable health care, getting anywhere is going to require some chaos and lines drawn in the sand.

[lindisfarne]

20. How are other systems drastically different? Germany has a public option and private

insurance. It works, very well. It provides basic coverage to everyone (unfortunately, I don't think we'll get that this year - for example, I currently have employer coverage and I doubt I'll be able to require my employer to pay my fees into the public option, rather than to private industry) and people can also buy private insurance (many don't) in a highly regulated insurance market (more regulated than anything we'll ever see in the US, unfortunately).

How does your "single payer" plan have solid data behind it? It's never been implemented on the scale required in the US. How can you be "certain" it would work - and you seem to want certainty.

I think your desire for single payer is really skewing your thinking.

[Cleita]

24. Germany's health insurances are non-profit. They are known as

the Bismarck model: http://www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php

The Bismarck Model

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system — the insurers are called “sickness funds” — usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don’t make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model — Germany has about 240 different funds — tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

I don't believe we will ever get our greedy insurers to be non-profit.

[lindisfarne]

25. 48% of US private insurance agencies are non-profit. They are as bad as the for-profits about

denying care and coverage. Rather than making "profit" they accumulate "reserves" and pay their executives as much as the for-profit industry pays their executives.

We need a lot more changes in the laws than simply making all insurance agencies non-profit.

You can also write laws to make for-profit insurance companies (and non-profit) accept everyone. In Germany, they have a mechanism whereby they assess the risk pool of each company and have a fund into which those with less risk pay, proportionate to their risk, and from which those with more risk receive funds, proportionate to their risk. That's one of the ways that the German industry is more highly regulated.

[Cleita]

30. Flip flop much? You were bragging about the German system, now it's

baaaad because they are non-profit? You are stopping to make sense.

[lindisfarne]

32. Did you read what I wrote? I said 48% of the American ins. industry is non-profit and that they are

no different from the for-profit industry in the US. This was in response to your statement "I don't believe we will ever get our greedy insurers to be non-profit."

I never made any statement about the German industry being non-profit. What I said is that the German system has a public option and a private option, and that the German insurance industry is heavily regulated.

[Cleita]

37. And the private option by law is non-profit. Have you read any of the

legislation kicking around Congress these last weeks? None of them are requiring our insurance providers to be non-profit. That's what makes their system work.

[lindisfarne]

39. First of all, your statement is not clear at all. What do you mean by the "private option by law

is non-profit". Then you say "None of them are requiring our insurance providers to be non-profit."

What exactly do you mean?

[Cleita]

41. Did you read my link at all about the Bismarck model? It's very crystal clear

as to what it means.

[lindisfarne]

45. This discussion is about the US system. Our public option will be non-profit because it is

public.

Making private insurance non-profit is not the panacea you seem to think it is, as I pointed out in a previous reply to you. I pointed out that 48% of the US insurance companies are non-profit, yet they deny care and are just as greedy as the for-profit ones.

I don't think we're going to accomplish anything with this conversation, so I'll say good bye now. But, at least be sure you've correctly read your sources and your sources have their facts correct.

[Cleita]

50. No you don't get it.

We can't have a two tiered system. It doesn't work. It kicks the poor under the bus. Only when everyone gets the same basic care is there quality care. When those who can afford Cadillac insurance can buy into it, then any public non profit program that offers the same gets eroded through underfunding and millions of cuts until anyone under those systems are getting practically no care at all because no one cares about them. These are the poor at the bottom of the class ladder.

[Oregone]

51. This is why comparing US hybrid model to Euro hybrid model is like Downs Syndrome Apples to Oranges

The mixed-market approach there is radically different, so much so, that its success cannot even be used as a basis for the proposed success of the ambiguous for-profit private/public mixed market system in the US

[Oregone]

56. "It's never been implemented on the scale required in the US"

Would it make you feel better if we regionalized it into 5 different insurance entities, such that each were the same size as comparable and existing entities in other parts of the world that are successful (though data shows that the larger the risk pool, the more money you save). A regional model allows autonomy but introduces overhead (this is Canada's approach).

At least you can point to existing systems and create similar models. The for-profit, high overhead, multi-player system with hundreds of companies in the US cannot draw an equivalent comparison anywhere on the globe. Yes, there are nations with hybrid systems, but what percent of the private providers are for-profit? What are their copays/deductibles? In these systems, do just a few exists, or are there hundreds like in the US? Open enrollment? Arbitrary denial of claims? The comparison of a US hybrid model to Germany is asinine. To replicate their system would require change as drastic and fundamental as single-payer (just a bit more complicated).

[lindisfarne]

18. Medicare is single-payer and expanding it is one way to expand the single-payer

system.

But how do you go to 100% single payer in one step?
There are lots of people who work in the insurance industry. Just what do they do when we eliminate that industry if we go to single payer with one step? I'm all for slowly reducing the insurance industry - and jobs will be lost, but gradually, and often by simply not replacing a person who retires or leaves.

Have you thought about this? Or do you see sacrificing all these workers as acceptable in the goal of achieving single payer?

[Cleita]

44. Obama could by vetoing everything Congress comes up with until they come

up with a viable plan. The Senate doesn't have a veto proof majority so he could. Of course he will make enemies with the whole health care industry lobby and lawyers and maybe he's afraid of them.

[Telly Savalas]

62. Since it's highly unlikely that Congress will pass a viable single-payer plan

in the next few years, this approach would be the equivalent of doing nothing.

[Cleita]

63. He needs to bully his blue dogs just like Johnson did when he got

Medicare passed.

[Telly Savalas]

71. What's his leverage?

Among the power brokers in the Democratic Party, folks who lack enthusiasm for a single-payer system outnumber those who support it.

[Cleita]

72. It's up to him to find it. LBJ managed to repackage what he wanted and

sell it, but it was somewhat intact from the original plan, just different ribbons on it. His repackager was a Republican. Now I know LBJ didn't do it dripping with charm. There was a lot of strong arming somewhere along the line, maybe even some blackmail. And Medicare was not the most important part of his Great Society package, but he did it. Also, he had tremendous opposition from the AMA, just like today.

[Telly Savalas]

74. So you're saying that you're not sure exactly how LBJ got things done

but whatever it was he did must certainly be applicable 40 to 45 years later, and that Obama should have no problems easily replicating it.

Sorry, I'm not buying what you have to sell.

[Cleita]

76. Whatever, but I am sure how he got things done because there is a biography

written about him that is on line now and any one including me can read it in detail how he got things done or you could go to wikipedia. Also, if something isn't broke, don't fix it. If it worked forty years ago, there's a good chance it will work again. Remember that old saying about history repeating itself? Well, that could be the things that worked as well as bad things.

[Cleita]

22. That's what they would like you to believe. The fact is that the

government already pays 60% of health care in this country through Medicare, Medicaid, the VA, CHAMPUS, SCHIPS and various other govt. programs. The bureacracy is already in place, particularly Medicare which is very efficiently administrated in spite of having to weather the holes Republican legislators have shot through it in the past twenty years and allowing the private insurance companies and pharma to enter into parts of it. So administering a single payer program would be a smooth transition with experienced staff and procedures in place. As far as the insurance companies losing their cash cows.

WHO CARES! :shrug:

[lindisfarne]

23. I don't think it's 60%. 83 million Americans get their insurance paid by the federal government

(48 million medicare, 8 million SCHIP, 11 million military; rest federal employees & other various small programs).
A considerable number - more than 1 in 4, but not 60%.

It's important to not lose our legitimacy by not using accurate numbers.

I agree a program along the lines of Medicare could expand coverage - this is essentially what the public option will do. Reimbursement rates (at least initially) are going to have to be higher than Medicare's, however.

How is an overnight shift to single payer be a "smooth" transition? Just where are all the additional employees going to come from? Training takes a long time.

What about political will? Are you willing to sacrifice any kind of reform at all? This is what we'd get if we followed the "single-payer or nothing" folks. A lot of Americans see the need for reform, for providing basic coverage to all, but MANY Americans are against losing their current coverage and going to a government option.

If you follow the "single-payer or nothing" line, you're going to end up with nothing.

[Cleita]

29. I ran across a report several years ago that said it was 60%.

However, a computer crash had me lose the information. It may be less today because of the erosion of our social programs, but we do have government run health care so we wouldn't be starting from scratch. Also, the Canadians who did start from scratch managed to do their transition with little trauma as well, so it's not like there aren't models to draw from. The additional employees will probably come from the health care industry and they would need only a little training. This never was a problem in the private sector when a company expands like Wal-Mart, why would this be different? Really, you are just making stuff up here.

As far as political will our Congress critters are selling us down the river so we are going to have to demonstrate to get their attention. Frankly, I would rather end up with nothing this time around rather than a plan that will be a huge disaster and not solve the problem.

[lindisfarne]

34. You may prefer nothing to some improvement. Most people do not, however, especially the uninsured nt

[Cleita]

36. If the improvement means the uninsured will remain uninsured if they can't

afford to buy the insurance and get a waiver for, which this bill seems to be taking shape as, I don't see it as an improvement.

[lindisfarne]

38. Are you following the proposals at all? There are provisions for people who cannot afford the cost.

You don't seem to be very informed.

[Cleita]

40. That's because I'm not agreeing with you. I am following them. I have even

posted a couple of them in another forum. The latest one is like the Massachusetts plan (which is failing) sponsored by Senator Kennedy. It requires mandates but in Massachusetts there are still uninsured who can't afford to buy into the program because they are being means tested and left behind frankly. Also, with the insurance companies having their fingers in the till, the plans are proving to be very costly. There is a provision for a waiver, but certainly this can't be universal health care by any stretch of the imagination.

[lindisfarne]

46. The uninsured in MA are a very small percentage; much smaller than was the case before it was

implemented.

There are always going to be people who choose to not spend money on health insurance, even when they can afford it. In MA, they gradually instated the program, and fines were not implemented in the first year. Once fines were implemented, more people purchased insurance. More people are covered in MA - that is a success. There are always going to be glitches, and there will always be things learned through trying to implement various programs. In fact, your objection to the MA program should be the basis for your objecting to the single payer system - what happens if it doesn't work and we've thrown out what we currently have which, flawed as it may be, does provide insurance (however unsatisfactorily) for 225 million.

In fact, I'd like to see a system where everyone is covered by the government at a basic level if they do not have the basic level through private insurance. People who choose not to pay the government program would be assessed the cost on their income taxes. There would be waivers and sliding fee scales for those without adequate income. But for those who have adequate income and choose not to pay the fee (or sliding fee), they would have a debt to the government (but would be covered). Their wages could then be garnished to cover the debt.

[Cleita]

49. Well, that makes it better doesn't it. Everyone has insurance except a few

who I guess aren't worthy of being covered for it. Experiments with health insurance around the world has proved that the successful systems are the ones that offer basic coverage, with insurance offering coverage for non-essentials but luxury items. The cannot offer the same coverage as the basic plan. When you don't you get the situation we have here, of the poor on Medicaid, and no one cares about them to give them decent coverage that medical care providers might want to accept. I had to travel a hundred miles once with a neighbor on Medicaid to get him an oral surgery he needed. He was the only oral surgeon in a hundred miles who would accept Medicaid payment because it was so underfunded, it paid too low for the procedure.

[clear eye]

57. Unsupportable argument (given the 30+ years of success in Europe)

made by a poster who doesn't deny that he works for a private health insurance co.

[bvar22]

60. Indeed.

There are many models for Government Guaranteed Health Care in the Industrialized World.
ALL of them are better than what the US currently has.

I get worried when I hear our "Democrats" say, "We are going to have a Health Care System that is uniquely American." :scared:

I would have much more confidence if they would simply borrow any one of the plans that have been proven to reduce costs and cover everybody.

[Cleita]

64. Or as Bernie Sanders said to try a different plan in each state and see

which one works best and is most cost efficient. Then it could be adopted nationally.

[zipplewrath]

13. Insurance reform

My problem, and something you kinda hint at, is a big part of this is predominately merely health INSURANCE reform.

Look, health insurance to some extent is an oxymoron in many ways. We will all get sick. Predominately, once we are talking about universal care, this is just a cost sharing, payment leveling scheme. We'll pay all our lives for our healthcare, and when we are young, we'll be paying much more than we are receiving, only to make up for it later in life. Insurance is really about things that may or may not happen. We will all get sick. We will all die. The bills we rack up will just vary between us.

But one of the most legitimate complaints I've heard from the right is that in here there really isn't the indication that any of this will particularly reduce the cost of health care. It will fill our current system with huge numbers of new customers. But the cost of health care, even for those who can get it, has been going up for decades, and that is true of military healthcare, medicare, medicaid, and for exteremly large HMO's. None of these systems has been particularly capable of reducing costs over time, merely inhibiting the rate of increase. EVEN with single payer, the cost savings will be short term, as more favorable terms are negotiated with suppliers. But in the end, all the same basic characteristics that make health care expensive and rapidly increasing in cost will be there.

[Canuckistanian]

14. I think the goal is to create maximum confusion

"Single-Payer", "Public Option", "Co-ops", "Hardship deferments"

You need a manual to keep up with all the terms being thrown around. And most of these options aren't "reform" at all, merely tinkering.

The question is simple - do the insurance companies get to KEEP their outrageous profits at the end of this process?

[asjr]

15. I have come to believe Congress is there

only to promise us the moon while patting themselves on the back. Health Care Reform--stupid nomenclature. All I want is something that works. And I do not want to bow down to them for even bringing it up. Congress is just a con game.

[Cleita]

19. Listening to Thom Hartmann today, he made the statement that

single payer health care would solve about 90% of our economic problems. If we go down the choice between private insurance and a public health care plan, it will take five years. I don't know how he came to this conclusion but Thom's a smart guy who does his homework, so if he's right we are going to need to do the torches and pitchforks approach and demand single payer. There is an organization that is organizing a rally in Washington for June 25, 2009. Here is the link:

http://www.1payer.net/action-alerts/washington-rally.html

For those who can't be there in person, a general strike is called for by calling in sick that day. There are free faxes that you can send and telephone numbers to call. Thanks to DUer clear eye for providing this information in the Single Payer Health Care Forum.

[jobycom]

26. That's a good idea, about single-payer catastrophic health care.

Well thought out post.

I think the biggest problem is that there is no general concensus on anything. If Obama had championed a single-payer, or even actual universal health care, while campaigning, he could take a strong lead right now pushing his plan, and then debate would be centered around that plan, for or against, and we'd get the proverbial "up and down" votes on the issues. But Obama's plan wasn't specific enough, and he's not now taking a strong lead demanding the plan he wants and selling it to the public. Thus, Congress gets to create something, and there are a dozen leaders in Congress all wanting something different, and all trying to protect their special interest group--whether that be insurance companies, doctors, or single-payer activists, or whatever.

And of course, not everyone wants a plan, and it's easy for them to introduce complaints and doubts into any bill to make people reject it, and a lot of that is happening.

Obama's not a leader, he's a legislator. That's been behind most of what bothers everyone so far. Legislators reach compromises, and try to build concensus, and are slaves to the status quo and legalities--like the DOMA case, where he argued an atrocity because it was the law and he didn't really know how to change that. That's been all of Obama's experience in his life so far. Leaders change the legalities and the status quo, they force concensuses by mobilizing opinion, and they compromise just enough to get the support they need, without giving away so much that they lose what they want.

Clinton was the best at that. Carter was good at that, too, though a bit dictatorial, so he didn't get his way enough. Reagan started out as a bully, but learned to compromise. Bush Daddy compromised so much he didn't know who he was by the end. W just let everyone else use his power to do what they wanted. Obama is a quick learner. If he figures it out in time, he'll get something done. But I think we all knew in the primaries that Obama didn't care about health care--it was a lesser issue for him. Since he doesn't have a plan or a goal, this is just going to go in aimless patterns until it dies or until someone takes charge of it.

The good part of that is if we can take charge of it, we have as much chance as the other side of getting it done. Obama will trend towards the liberals, even if he doesn't yet know how to marshal his forces. If he saw a rising of public support, he might turn that glorious persuasive ability of his to our fight.

That's my theory. I don't know how to do any of that, though. :(

[Oregone]

52. Catastrophic is a much better word for it

Hell, you could get it through with a huge deductible ceiling too (like 20% of income to start off). I'm not sure if the private industry would balk because it eliminates risk immediately (which they see as a good thing). The higher the deductible is the less funding it requires, but the less downward pressure it put on private premiums via market mechanisms. Anyway you cut it, its not the best solution, but at least its in the direction of single-payer, as well as clear, and not confusing as hell. It would be guaranteed to lower private premiums.

Your analysis about how this is going (legislation wise) is really accurate, IMO. Just like the stimulus bill too. Obama brought forth an idea, and stood back while the legislators bastardized it enough to reach consensus. In the end, about half of it was tax cuts that are proven to not be cost-effective stimulus. I thought he would learn from that.

Leaders with clear direction are lacking at the moment. There is no grand, cohesive vision for the people to get behind (so, its no wonder that public support is not overwhelming). We don't even know the 'minimum' requirements the legislators would possibly accept. Its just a mess. I also don't know how to do any of it at this point either.

But my first approach was to drop a simple idea ("catastrophic" single payer) and see if it picked up enough steam for someone to take notice. Probably not. Sometimes I think posting on DU is like screaming into a black hole.

[jobycom]

58. I thought that's the word you used. It's the word generally used, so I probably just

filled it in when I read your idea. You said "disaster," didn't you? (If I check now, I'll lose what I've typed!)

You're right on all your points about it. It would not be expensive, it would be palatible to most people involved, it might do some genuine good in the most dramatic health crises people face, and it would be a stepping stone, as you say. Insurance might oppose it on principle, knowing it was meant as a first move towards single payer, but it could have support from other groups, and insurance might even give it up as a compromise to get something else out of it. Part of the problem with single payer is that any dramatic change to any industry that controls as much wealth as insurance companies will create an economic ripple no one wants to see right now. This could make it less sudden.

We could build on it, lowering the deductibles, adding other types of coverage to the plan, until eventually we could become a single-payer. We might even find a unique American hybrid solution that allows people some choice on private health care options while still providing a basic single-payer system for most people. It's been said often, but America is best at advanced, complex medical treatments, and we are worst in the industrialized world at routine health care for the populace.

I like your idea, it's one of the few original ideas I've heard, that combines an ideal with a pragmatic goal. Keep talking about it, people do read this site. Maybe you could make a focused article on it and send it to some of the other liberal sites, too.

just random thoughts. I know what you mean about screaming into a black hole, but there are a lot more people who read these posts without commenting than we realize. I think you've probably influenced some thought, despite the personality battle that has emerged. I remember once having a poster randomly tell me that they remembered something I wrote several years earlier, and it affected their belief on the subject. So keep writing.

[Oregone]

59. Thanks for support

Maybe Ill see if I can get momentum going and influence people

I stole the idea from my provincial drug plan: http://www.health.gov.bc.ca/pharmacare/plani/planiindex.html

No one spends more than 2% to 4% of their income on drugs and the rest is covered 100% (they have so much cool stuff here--its fun to learn new things every day).

This leaves drug coverage as low as $25 bucks a month for an entire family via the private market.

[Lydia Leftcoast]

27. It's beginning to look a lot like the Clinton care fiasco

where the Clintons bent over backwards trying to placate the insurance companies, believing promises that "managed care" would solve the problem, and ended up with a plan that was so complicated that no one could explain what it would actually mean for the individual.

The plan needs to be revolutionary yet easy to understand, and Clinton has to go directly to the American people to sell it, just as Reagan did repeatedly. He has the political capital to do it. He only has to use the power he has instead of trying to get the Republicans on board. Instead, he should concentrate on taking his Blue Dogs to the woodshed.

[lindisfarne]

31. The majority of Americans want coverage provided to those who don't have it but want to keep their

current coverage.
If you try for a revolution (single-payer or nothing), you're going to get nothing.

Additionally, it would be a bureaucratic nightmare to move all Americans to Medicare in one shot (and even worse to try to create some other program for the 250 million who do not currently have Medicare).

Just what are your plans for everyone who works in the insurance industry? Move them to Medicare (or whatever single-payer plan you're proposing)? You can't shift jobs overnight. Training is extensive.

If you people were advocating for a gradual move toward single-payer, I'd have sympathy. I'd have more sympathy if you got your basic facts straight too. One person above isn't aware that half of the insurance companies in the US are nonprofit; another claims 60% of the US already gets coverage from the federal government. Both claims are wrong, as I pointed out in my replies.

[Lydia Leftcoast]

35. But he's not even advocating for single payer AT ALL

He's compromising before he has to.

And how many people are satisfied with their insurance? Rich people, union members, the very few who have generous and well-heeled employers. Fewer and fewer all the time.

[Cleita]

43. Every one I know complains about their health plans. No kidding. n/t

[Lydia Leftcoast]

47. One of my friends used to have superb coverage through her husband's unionized job

but about two years ago, all of a sudden the employee's premium shot way up, a hefty deductible was introduced for the first time, and copays were doubled.

According to the union, the insurance company told them to take that package or do without any coverage for their members.

As I said, fewer and fewer satisfied people all the time.

[Oregone]

53. "If you people were advocating for a gradual move toward single-payer..."

That is sort of what my OP was laying out. Currently, the "progressive pragmatists" are arguing for a course of action that isn't even on the line to single-payer, claiming this is the end goal. What I suggested, is a "catastrophic single-payer" modeled system that would only service a minority of high-risk, expensive patients a year (depending on where the out-of-pocket deductible was set). Gradually, you can turn this into single-payer by merely lowering the deductible. In the meantime, the insurance-companies would still operate (and could potentially be more profitable), and everyone could keep their own coverage.

I mentioned a single non-convoluted method of getting to point B in a straight path that doesn't alter the current structure at all or call for radical change. Its primary purpose is simply to make sure people do not die or lose their homes anymore from medical costs. Once you reach that at least, you can argue later about expanding it. No need to carry on complicated debates about mandates, VATs, taxing benefits, etc. Just a streamlined approach to absorb high-risk patients.

Once people observe a dramatic drop in premiums, its likely a public call for expansion would be imminent. Its a good dry run without destroying anything or making commitments in any direction.

[eridani]

55. That's because most don't get expensively sick. Therefore they don't know JACKSHIT

--about their insurance, any more than they really know whether their fire department is any good.

[bvar22]

61. The majority want to keep their overpriced "For Profit" Health Insurance?

You will have to provide a link to support THAT.
Everybody I know who is approaching 65 can't WAIT until the can tell their Private For Profit Health Insurance to "Kiss Off".

Try to tell a Senior that they have to give up their MediCare and purchase Private Health Insurance from the For Profit leeches. (Better bring your First Aid Kit and get your hospitalization "pre-approved" from you Private For Profit Insurance bureaucrat!)

[lindisfarne]

66. Link. People are not opposed to health care reform But they are afraid of dramatic change.

If you propose getting rid of private health insurance, you lose support. See Kaiser Family Foundation survey thread - public option which includes public option alongside private health insurance is preferred over single payer option.
http://www.kff.org/kaiserpolls/upload/7892.pdf
(And keep in mind, the KFF is completely separate from Kaiser Permanente)

http://www.healthcareforamericanow.org/site/content/public_rejects_insurance_industrys_misleading_claims_new_poll_shows

Washington, DC – A new poll conducted by Lake Research Partners on behalf of Health Care for America Now (HCAN) found there is “intense and widespread voter support” for the choice of a public health insurance plan as part of comprehensive, national health care reform even when voters hear the sharpest insurance industry attacks such as a public health insurance plan would lead to lower quality health care, more expensive health care, or big government. In paired statements supporting and attacking a public health insurance plan, a majority of voters choose the statement backing a public health insurance option every time.

For example, 62% of voters believe a public health insurance plan will spend less on profits and administration and force private insurers to compete while only 28% of voters believe the attack that a public health insurance plan would be a “big, government bureaucracy.” 60% believe that if private insurers are really more efficient than government, then they won’t have any trouble competing with a public health insurance plan. Only 23% believe a public health insurance plan would have an unfair advantage over private plans.

While recent polling has shown consistent broad support for comprehensive health care reform, this poll specifically addressed whether people want a choice of a public health insurance plan. The answer is an overwhelming yes: 73% of voters want a choice of a private or public health insurance plan, including Democrats (77%), Independents (79%), and Republicans (63%).

“Voters strongly value having a choice of private or public health insurance plans and support having the guaranteed, affordable coverage that a public health insurance plan provides. They also believe that a public health insurance plan will help contain costs in ways that private insurers have failed to do,” said Celinda Lake, President of Lake Research Partners.

[bvar22]

68. Your data proves MY point. Not yours.

If the majority of Americans want the choice of a Public Option, how can you insist that the majority want to keep their For Profit Private Insurance?

Here is another poll for you.

In recent polls by the Pew Research Group, the Opinion Research Corporation, the Wall Street Journal, and CBS News, the American majority has made clear how it feels. Look at how the majority feels about some of the issues that you'd think would be gospel to a real Democratic Party:

1. 65 percent (of ALL Americans, Democrats AND Republicans) say the government should guarantee health insurance for everyone -- even if it means raising taxes.

http://alternet.org/story/29788/

The above polls were taken in 2005.
The number of Americans supporting Government Guaranteed Plans would be even larger today.

[lindisfarne]

69. Because support for the public option is higher than support for single payer.

As I said, people want change.
But they don't want a system where there isn't a private insurance option.
Carefully reread what I said in the post you replied to.

[lindisfarne]

70. See #67 - even Dean says there's no essentially no difference between single payer & public option.

And public option is favored by more Americans and has a better chance.

[Cleita]

42. You mean Obama don't you, not Clinton?

I don't understand why they would try a repeat of Hillarycare and I don't know why Kennedy is pushing for the Massachusetts plan, which is failing. We can't have any more failed politics in these times of crisis when we are on the brink of a big crash.

[Lydia Leftcoast]

48. Sorry, yes, on this issue I'm having trouble telling the two apart

:evilgrin:

[Oregone]

54. Its not difficult

One is owned by private corporations and the other one is just being leased

[LWolf]

28. It's not going to fix the situation,

and it may make it worse.

Which comes as no surprise.

[area51]

33. K&R #4 (n/t)

[lindisfarne]

67. Dean also said that single-payer is pretty tough to differentiate from the public option.

http://www.blueoregon.com/2009/06/dean-wyden-the-public-option-single-payer-and-the-rest-of-the-kitchen-sink.html
Dean:
"Public option is like single payer. It gives consumers the choice. There's no such thing as a pure single-payer plan anywhere." Dean went on to say that there's absolutely no reason for a wedge between single payer advocates and those who support the public option. In fact, Dean said he believes that it's a recipe for disaster. "It's a mistake to drive that wedge. It's how reform has been killed in the past.", Dean said.
...
Dean and I also talked about Senator Wyden's plan. The Governor said that he will not support a plan without a public option, no matter the plan. The choice should be made by the people which option they want, public or private.

[Oregone]

73. Thats sort of a silly thing for the Dr to say on his quest to sell this

No one even knows what a public option will look like yet, whereas single-payer is a clearly defined system. Further, the public option works in a private market rather than shaping the entire market, as single-payer does. The instant savings you get from medical facilities not having to outsource billing is completely unrealized with the public option method too. Its just downright silly to suggest this, and no argument from authority will change that.

[Mimosa]

75. If Obama fails at this, he fails indeed

I support our President but I fear the big corps have so much power they can and will stop meaningful heakth care changes.