Petition to expand Medicare to be the Single Payer Healthcare System for the USA

[vertical_doug]

I may be wrong but the current Paul Ryan bill has no interstate mandate because it changes the procedural rules of the senate to pass the bill.

(Or is it the house procedure which changes)

[Doug Fattic]

My observation for the real reason Republicans want to repeal the ACA is to get rid of their taxes that pay for it. Those that can afford decent medical insurance don’t want to pay for those that can’t. The “replacement" is just blah, blah, blah to convince those that will be effected negatively by the change to support it anyway. It should be obvious to everyone that whatever free market plan replaces it will have fewer benefits (or fewer people that can benefit or both) because there will be less government money available to pay for it. That part isn’t complicated.

[Cookietruck]

^ yep.

[jclay]

I know next to nothing about health care policy or law or insurance law. Can someone who knows something give a word on the state lines thing? Aren't large insurance providers national companies? I think so. What do state borders have to do with this? This is an honest question and not something to argue about.

What would be pros and cons about larger, interstate competition?

Honest, naive question here....

Insurance products are regulated at the state level. States establish minimum requirements and other parameters of the insurance products sold within their jurisdiction. The storyline advanced by the GOP is that market competition will be increased by allowing insurance products sold in State A to be sold in State B. What will actually happen is that the company selling policies in State A, and to less rigorous minimum requirements for insurance products than those required by State B, will simply be able to circumvent State B's requirements and sell substandard products (relative to that defined, and decided upon, by State B's regulations). Note that many of the same insurance companies will be involved in both states. Sound vaguely familiar? NAFTA? Allowing corporations to export jobs and convincing a bunch of folks not to worry, the tide of competition will lift all boats and all that jazz? It's another form of a race to the bottom. With a larger, conventional KB I'd poke some more holes in the storyline but the motivated and interested folks will dig on their own. Since each of you who work in the private sector will supply well into six figures worth of private healthcare contributions over your working lives I think it's worth getting informed.

I'd like to point out that insurance isn't what we need; medical care is. Why people think we need financially disconnected, for profit (and basically term) insurance enterprises involved in the financial end of health care (which is fundamentally NOT a term insurance issue) baffles me. We need a financial component that serves us from cradle to grave, funded during our productive years, that spreads risk across the entire population and that has the largest purchasing power possible. It's called single payer and by every metric it's a hell of a lot more cost effective than what we have in the private sphere.

Other informative resources:
Physicians for a National Health Plan
Single Payer Now!

[caleb]

So, let me preface this by saying that I'm generally pretty far left economically, and I think single payer is a good idea.

That said, I'm driving home tonight listing to All Things Considered, when an interview with Atul Gawande comes on. As part of that interview he mentions that insurance systems only work when there are enough young and healthy people in the pool sharing costs with the old and sick. And that statement sort of puts the point on the simple fact that health insurance isn't like most other insurance. With most insurance, the insured internalizes the costs of known risk factors, and only the risk of the unknown is shared. But with universal but private health insurance, the idea is to get those with predictable low risk to internalize the costs of those with predictable high risk, i.e. the young and healthy are getting forced into a bargain they know that they will, in aggregate, lose in the short to medium term. I do not know of any insurance run through a private marketplace that asks or requires individuals to take that bargain. But that seems to be what the ACA has done.

While I'm generally fine with asking individuals to contribute to the common good even at a personal cost, asking millennials and gen xers to pay for the care of boomers on the verge of retirement seems like a form of redistribution from poor generations to rich generations. As a general rule, I find the redistribution of resources from relatively poor groups or individuals to relatively rich groups or individuals problematic, and groups defined by age are no exception. I don't see a moral or ethical argument in which the young and relatively poor should pay for the old and relatively well off, absent a credible commitment to reciprocation by future generations.

If we're going to use a heavily progressive income tax to cover the costs of the old and sick, then sure, let's do it. But not if the risk pool is supposed to be self sustaining.

The way I read the American Healthcare Act is as a libertarian "every man for himself" response to the feeling of intergenerational inequity I've described above (as well as a bunch of race and class issues I won't go into). It allows the young and healthy to opt out of sharing costs with those who have known risks both by going uninsured and by opting in to bare bones plans, and leaves the old and sick on their own to cover all of their own costs. It deals with the problem of intergenerational inequity (which is mostly a philosophical and ideological objection) at the expense of totally soaking the sick, poor, and older folks (a major pragmatic issue since they're still going to consume care even though they lack the ability to pay).

Whether it's the ACA or the AHCA, the major problem is that the division of incentives and interests is between the healthy and the sick. That's a division only really primitive societies have relied upon as an organizing principle. Neither of these plans makes a serious effort to use the ability to pay as a primary metric for distributing cost, which is what all of the countries with the best health outcomes do.

Anyway, we're screwed.

[caleb]

I'd like to point out that insurance isn't what we need; medical care is.

Not to quibble or even likely disagree in spirit, but I'd say what we need is health, which in may situations may not be a goal best served by increasing conventional medical care.

I'm thinking as an alternative of actually instituting the entire public health agenda, but also rethinking our approach to death and dying that is currently a massive sinkhole for resources.

So, I agree that we need less insurance, but I wonder if we couldn't all live healthier and better with even less healthcare if we focused on wellness throughout our lives, and learned to say goodbye willingly when the time comes.

[Mabouya]

Anyway, we're screwed.

From what I've read, it's mostly the older folks who are screwed. The younger and the richer folks make out OK (at least that's how interpret what the NYT says about the CBO report).

As far as Trump's campaign promise of cheaper, better health care for everyone, well, if anyone really believed that, I'm not sure what to say.

https://nyti.ms/2mDeE1g

[vertical_doug]

This is the Kaiser Family Foundation article with charts breaking down the healthcare subsidies by Age, Region and Income groups.
How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits | The Henry J. Kaiser Family Foundation

This is a link to the bill passed in the House Energy and Commerce Committee. I am pretty sure there is no interstate competition clause included in the bill.

http://docs.house.gov/meetings/IF/IF...CareAct-U1.pdf

The CBO Scoring really trashed the proposal last night. In 2018, 14mm projected to lose coverage, 2020 21 million lose coverage. But $337billion will be saved over a decade.

This $337B in savings can be used for the extra $500b in spending for the Defense budget over a decade if Trump gets his extra 50b per year.. Cutting health care for millions while spending more on the world's largest defense budget is an amoral decision. (We can already destroy the world a 4 or 5 x over, but I guess that isn't enough)

[guido]

The biggest thing the savings from killing the ACA go to is tax cuts for the well off.

[caleb]

From what I've read, it's mostly the older folks who are screwed. The younger and the richer folks make out OK (at least that's how interpret what the NYT says about the CBO report).

As individuals, sure. I suspect most all of us will be individually fine. But as a society we're still in deep trouble.

Most advanced democracies pay on the order of 10% of GDP for as good or better health outcomes than the US. The US is paying almost 20% for generally worse outcomes. That dynamic affects society from top to bottom, and I'm not seeing a thing in this bill that's really going to change that dynamic.

[jclay]

As individuals, sure. I suspect most all of us will be individually fine. But as a society we're still in deep trouble.

Most advanced democracies pay on the order of 10% of GDP for as good or better health outcomes than the US. The US is paying almost 20% for generally worse outcomes. That dynamic affects society from top to bottom, and I'm not seeing a thing in this bill that's really going to change that dynamic.

That's because there isn't any. The USA can't see the solution for the political, idealogical trees. Maybe if we cleared the underbrush on the Canadian border...

And it's (health care for our population) not a goal, never mind a priority, for people like Paul Ryan.

[guido]

A bit of history to remind us how we got to this point...

https://www.nytimes.com/2017/03/14/o...ol-left-region

[jclay]

Useful info here: Articles of Interest | Physicians for a National Health Program

[vertical_doug]

Obamacare: Share Your Story | whitehouse.gov

Do they want stories on how access to healthcare save some lives?

[vertical_doug]

I also think actions speak louder than words. Trump plasters his name on everything no matter how crap it is. Trump Tower, Trump Steaks, Trump Ties, Trump Taj Mahal...... list goes on and on.....

However, he doesn't want the AHCA to be known as Trumpcare. Why do you think that is?

D

[bcm119]

Obamacare: Share Your Story | whitehouse.gov

Do they want stories on how access to healthcare save some lives?

No, just anecdotal horror stories. The misinformation machine runs on anecdotes.

[jclay]

The good news is that Trump's healthcare stance of more & better HC for less $, and doing so without having folks who currently have HC insurance losing it, paints him into a political corner. I think the socially liberal world he's inhabited as well as his ego mitigates against Paul Ryan type approaches to some hopefully large degree. He and the less rabid GOP folks know that many who voted for them last time will be lost next go-around if they lose their ACA or end up paying significantly more.

Ryan and his cabal are obviously far more interested in his version of idealogical purity than in increasing affordable HC access to more people. He's crystal clear on that front and I look forward to the political-market-driven rejection of him and his ilk should they prevail in their HC plans.

This would be an excellent time to write letters to the editors of newspapers and magazines in support of a universal HC system....unless you particularly like flushing a couple hundred thousand dollars in lifetime HC insurance contributions down the toilet and all the other defects that are intrinsic to the way we fund HC for the ~70% that aren't already on a single payer system in the USA.

[jclay]

Given tomorrow's House vote, unless you support ACA repeal and replacement by the AHCA you'd better write AND ring your Member of Congress today...and tomorrow morning.

There is one thing I admire about the GOP and conservatives in general; they don't sit on their sanctimonious butts when it's time to fall in line, take action and come out swinging. It will be a great day when progressives and democrats match them on that score.

[guido]

Having caught the truck, the dogs have reconsidered...

https://www.nytimes.com/2017/03/24/u...T.nav=top-news

Gee maybe it was harder than it looks? Actually governing is a lot tougher than playing at it on TV... Of course Trumps blames the Democrats.

[Cookietruck]

Having caught the truck, the dogs have reconsidered...

can't help but laugh that you said that...