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

[ericpmoss]

Here's something of interest if you want single payer. The Democratic leadership is 100% against it, so it will never happen unless they are deposed or bypassed. Here's just one taste of how ingrained the anti-single-payer attitude is: .

Short version: Dick Gephardt, who preceded Nancy Pelosi as House Dem. leader, started a consulting firm when he left Congress. His big coup in 2009 was to kill single payer. He was recorded recently on how he'll never let it happen in his lifetime. It sounds like an empty threat, but he's a DNC super-delegate, so it's not.

[jclay]

....but if we actually did it the economic displacement and reverberating effects through the economy would be so untenable as to make the shift impossible.

Certainly not technically impossible but it would require a careful design for the transition, like accomplishing it over a 10 (or more) year period by gradually lowering the Medicare age while redirecting current insurance premiums to the SPS. Doubtless there would be a lot more detail, and more options, but a gradual transition would allow the HC insurance industry (and everybody else + associated legislation) to adapt. I would think that the larger insurance companies might be good sub-contractor candidates for actually running the operational nuts and bolts of the system. Maybe not a "bumpless transfer" but reasonably close.

Not making the change to a system that's demonstrably and substantially superior in the long run because of difficulties that could be reduced to manageable levels isn't something I'll ever buy.

How to manage the transition ...seems like the great overlooked question in the discussion. I don't think the left has a plan yet for dealing with those who would end up worse off. Pareto wasn't a very good politician.

1) There isn't a meaningfully "left" party in the USA. The Democratic Party is right of center on most everything except a very limited suite of socially liberal subjects; and for many of them it consists of a fair bit of lip service. Saying you support working/poor folks and then working to repeal Glass Steagal and other associated deregulatory precursors which are going to torpedo the economy or allow textile factories to flee the country, all of which will disproportionally hurt the poor, doesn't really constitute support for them.
2) No, those who espouse SPS probably haven't worked out a detailed plan for any of this. They don't agree on moving to an SPS in general, never mind the finer points of the design of such a system. That's no surprise given the current political reality and it's no reason to fail to push for moving to an SPS. Keep pushing and eventually, hopefully, we can get some rational, informed adults in the room to figure all of that out. The good news there is that there are plenty of Western countries who's systems we can evaluate in order to make best decisions. My Papa San was fond of saying "learn from others, you won't have time to make all of the mistakes yourself". That probably comes from being a Corsair pilot in a couple of wars. It's universally good advice.

It's so contentious there that the CA nurses union is telling the Dems in no uncertain terms that if they keep sabotaging things like Prop 61 and SB 562 and people like Ellis, they should not count on support.

That's why I send Pelosi, other DNC officers and my senators frequent emails telling them not merely that they can't count on my support but that they've lost it until the Party platform includes vigorous, real world support for SPS. It's unfortunate but the country is obviously going to have to go through a protracted and painful period being run, if you can call it that (dismembered is more apt), by either the far right or the near right. I would have voted for Jill Stein, knowing full well that we might end up with a reprehensible administration (as we have) rather than a competent (operationally speaking) but still a substantially bought and paid for (by corporate America) and highly destructive administration (Clinton) except that a New York VS democrat offered to do a vote exchange with me. I voted Hill, he voted Jill. I guess that "no pain, no gain" includes the social/governmental sphere, too....a notion for which there is overwhelming historical evidence.

The Republican's have done an effective job (not difficult) of leveraging wedge issues (largely abortion and guns) to their benefit. The Democrats have assisted by supporting neo-liberal economic policy, destructive foreign policy (to sugar coat it) et al. As global economic competition grows, and our economic horizons attenuate it will only get worse. I'd suggest that's a real good reason to have maximally efficient domestic programs.

The Democratic leadership is 100% against it, so it will never happen unless they are deposed or bypassed. Here's just one taste of how ingrained the anti-single-payer attitude is: .

Short version: Dick Gephardt, who preceded Nancy Pelosi as House Dem. leader, started a consulting firm when he left Congress. His big coup in 2009 was to kill single payer. He was recorded recently on how he'll never let it happen in his lifetime. It sounds like an empty threat, but he's a DNC super-delegate, so it's not.

Didn't know that particular fact (Gephardt) but not a surprise at all. The opposite stance would have been the surprise. I rest my case.

[jclay]

Read this article. Just do it. Why insurance is the wrong model for health care

[jlyon]

I agree with the article above but I would think the first step still needs to be some alternative low priced healthcare delivery system. If the man who needed a stent knew the cost at a hospital would be $18k (If he had insurance more like $80k if he had to pay cash) or could go to stent n a box where that is all they do for $9k I bet he would have come up with the money & paid it. But todays system of unknown what the total cost will be and knowing that you will be overcharged because they can;leave people with no hope for their futures.

The current system only allows us a go overseas for services if we choose a lower quality product over the American standard of super expensive care. And nobody has any incentive now to create more or lower cost doctor alternatives because they are a powerful group.

[jclay]

Worth reading, not in terms of ceasing to demand better, but to understand the deck of cards we're using. Not unabridged, perhaps not academically accurate on all counts but from my perspective the author has a firm grasp of the essentials.

You Can Have Single-Payer When You Pry It From The Oligarchy’s Cold, Dead Hands

[sine]

Worth reading, not in terms of ceasing to demand better, but to understand the deck of cards we're using. Not unabridged, perhaps not academically accurate on all counts but from my perspective the author has a firm grasp of the essentials.

Total waste of time.

I'm being nice.

[ericpmoss]

A while back I voiced my belief that the DNC would never support single-payer because of how they are beholden to the donor class. Here is a light-hearted video I found funny in that sense: two guys pranking the DNC at PolitiCon about how they are so corporate. My favorite part is how at least one person not in on the prank was so excited about the "new direction" the pranksters were announcing on behalf of the DNC. Comic gold for the wonky types.

[jclay]

Change, cost and compassion — Selling Medicare for all | TheHill

[jclay]

Crash of Trumpcare Opens Door to Full Medicare for All | By Ralph Nader | Common Dreams

[sine]

Interesting read including some history about healthcare in Canada.

Is Canada the Right Model for a Better U.S. Health Care System?

[summilux]

That was a fairly well-balanced take on the Canadian system and they are right that waiting lists for non-life threatening issues is a problem here. When my daughter tore her ACL last year, it took one month to get an MRI appointment, a few more weeks to get the diagnosis and then three more months before surgery. That's a fairly typical timeline here and colleagues of mine wait a year or more for hip and knee replacement. Another downside of the Canadian system is that very new treatments aren't always available for Canadians. For example, the anti-cancer drug Taxol became generally available to Canadians years after it was commonly used in the US. This is because a bureaucratic process decides "standard of care", i.e. what services and drugs are available to Canadians in each province. It takes time to get new things into the system. OTOH, one big advantage of the Canadian system not mentioned in the article is that health care is independent of job status: if you retire or get laid off or move jobs or decide to work as an independent contractor you are still covered.

The article is right about how cultural and historical expectations shape what people want in a health care system. I would be appalled to receive a bill for medical attention in much the same way that my American brother-in-law is adamant that nobody should receive health care for free. There isn't a single one best solution but I have always thought that Canadian healthcare is like what Winston Churchill said about democracy: "It's the worst form of government, except for all the others."

[monadnocky]

That was a fairly well-balanced take on the Canadian system and they are right that waiting lists for non-life threatening issues is a problem here. When my daughter tore her ACL last year, it took one month to get an MRI appointment, a few more weeks to get the diagnosis and then three more months before surgery. That's a fairly typical timeline here and colleagues of mine wait a year or more for hip and knee replacement. Another downside of the Canadian system is that very new treatments aren't always available for Canadians. For example, the anti-cancer drug Taxol became generally available to Canadians years after it was commonly used in the US. This is because a bureaucratic process decides "standard of care", i.e. what services and drugs are available to Canadians in each province. It takes time to get new things into the system. OTOH, one big advantage of the Canadian system not mentioned in the article is that health care is independent of job status: if you retire or get laid off or move jobs or decide to work as an independent contractor you are still covered.

The article is right about how cultural and historical expectations shape what people want in a health care system. I would be appalled to receive a bill for medical attention in much the same way that my American brother-in-law is adamant that nobody should receive health care for free. There isn't a single one best solution but I have always thought that Canadian healthcare is like what Winston Churchill said about democracy: "It's the worst form of government, except for all the others."

Interesting - as an American it's sometimes difficult to discern if the Canadian wait times are problematic or if they are exaggerated by opponents of any form of a nationalized system. In terms of the view that nobody should receive health care for free, I just don't understand that - for me, it's like saying that nobody should receive primary education for free. "Free" (and I use that term in quotes, given that most of us pay taxes to support the common good) education is the fundamental cornerstone of civil society (of course, there are great disparities), as I would argue is "free" health care.

[caleb]

In terms of the view that nobody should receive health care for free, I just don't understand that - for me, it's like saying that nobody should receive primary education for free.

I don't understand it either, especially since that's not how the US works. In practice, nonprofit hospitals care for everyone who walks in the door. Those who can't pay themselves are paid for by others. Whether we like it or not, those of us in the US are already sharing the costs of others' health care. The main difference is that we do it through really inefficient methods of providing care (i.e. emergency instead of primary care), and opaque schemes of cost sharing (i.e. employer health insurance instead of taxes).

[summilux]

I don't really understand my brother-in-law at all when it comes to health care. We've argued long and hard about it for so long that it is basically a taboo subject when we are together. Because he is self-employed he pays a lot for health insurance and maybe he just doesn't like the idea of others getting something for free that he has paid a lot for. There is a psychological term for this but I've forgotten it.

In terms of waiting lists, it is a generally a problem only for non-life threatening illnesses like hip replacements. I had a coworker who found a lump in her breast one day and she had surgery within two weeks. For the diseases that I am familiar with, survival rates are similar to or better than the US. You might wait a little longer for treatment but that wait isn't really affecting your survival.

[sine]

I don't really understand my brother-in-law at all when it comes to health care. We've argued long and hard about it for so long that it is basically a taboo subject when we are together. Because he is self-employed he pays a lot for health insurance and maybe he just doesn't like the idea of others getting something for free that he has paid a lot for.

Nothing is free. I worked in Canada and paid the higher income taxes. Yes, when I moved to the USA and went to my first physical, it was odd paying my US$15 copay.

Anyhow, here is one take on healthcare costs in Canada.

https://www.fraserinstitute.org/site...e-2015-rev.pdf

[GrantM]

Interesting - as an American it's sometimes difficult to discern if the Canadian wait times are problematic or if they are exaggerated by opponents of any form of a nationalized system.

In the Canadian system, care is rationed, based on 'need'. If you have a critical car crash on the highway, and air ambulance picks you up and you fly to a trauma center hospital
where a team of world class trauma doctors save your life. If you have cancer, you get immediate treatment with proven outcomes to extend life to an international standard
of survival rates.

If you tear your ACL, you go sit and wait. If you live outside an urban area where you don't have local access to the best medical centres, you have to travel to get treatment.
Patients do no paperwork. Administration costs are far lower than with insurance based systems.

Canada battles with wait times the way that a baseball stadium does to get a line of people processed. It's not always about adding more entrances, but managing the ones
you have the smartest way you can. I heard one of the Canadian doctors who testified to Congress say it this way - She waited 30 minutes at the metal detector to get into
the meeting room, and across the hall were two other entrances with no lines.

I'd rather be in the situation to fix what could be improved, than at the point where the US is still arguing who and what should be covered. It's a tragedy how much money
you guys spend for the outcomes in the current system.

-g

[jclay]

In the Canadian system, care is rationed, based on 'need'. If you have a critical car crash on the highway, and air ambulance picks you up and you fly to a trauma center hospital where a team of world class trauma doctors save your life. If you have cancer, you get immediate treatment with proven outcomes to extend life to an international standard of survival rates. If you tear your ACL, you go sit and wait. If you live outside an urban area where you don't have local access to the best medical centres, you have to travel to get treatment.

Patients do no paperwork. Administration costs are far lower than with insurance based systems.

Canada battles with wait times the way that a baseball stadium does to get a line of people processed. It's not always about adding more entrances, but managing the ones
you have the smartest way you can. I heard one of the Canadian doctors who testified to Congress say it this way - She waited 30 minutes at the metal detector to get into
the meeting room, and across the hall were two other entrances with no lines.

I'd rather be in the situation to fix what could be improved, than at the point where the US is still arguing who and what should be covered. It's a tragedy how much money
you guys spend for the outcomes in the current system.

-g

Thanks for chiming in Grant. One of my brothers spent most of his career working for the Italian national health care system and retired in Italy. He has a large, extended Italian family from infants to oldsters and so has extensive first and second-hand experience with their system, and ours. He much prefers the Italian system.

Folks here don't seem to acknowledge that we have waits too, even with good insurance, and until recently about 30 million of our population didn't have coverage. Plenty of folks live far from advanced medical centers here, too.

Danielle Martin was impressive. Too bad some of the Senators, and the country for that matter, were unwilling to question their idealogical beliefs as a result of her testimony. Too many of us have this genetic predisposition to think that no other country could possibly be better at anything worthwhile than the US, that the "free market" (never mind the finer points of what that really means in practice) is best at everything and so on.

Approximately 35% of our annual health care expenditures go to administration and other non-medically productive activities (Annals of Internal Medicine data). For Canada and some Western European systems it's 12%. The approximately $250,000 in average lifetime private insurance contributions each of us will make, will cease to provide any benefit upon reaching Medicare age; that's insanity. There is no storage component either so if you lose your job and insurance, and an injury or illness is so inconsiderate as to visit you at that time, you're out of luck; that, too, is insanity. And then the whole pre-existing condition exclusion thing that we had until the ACA....that's just monumentally stupid.

We've heard, all of our lives, that we're the best at everything and that anything to which you can attach the word "socialism" (legitimately or illegitimately, doesn't matter) doesn't work, and in the main that's about as far as many people here seem to think or analyse, never mind the finer points of the "free market", "socialism" continuum and the fact that a single-payer health care system is as public financing/private service delivery mixture.

We're still wrestling with artifacts of our frontier mentality from times past. And then there are the entrenched money interests.

[jclay]

Democratic Congressional Campaign Committee advises candidates to deceive voters on healthcare. No real surprise I guess. I've noticed that numerous democratic candidates of note to me have not expressed their support for Medicare For All, offering weasely missives like "I support making health care accessible to all" or "I support affordable healthcare". More fake progressive, go corporate. Pelosi and some others are, of course, pretty straight up about keeping private, for-profit insurance as the financial basis for health care.

https://downwithtyranny.blogspot.it/...tants-are.html

[jclay]

I wrote Marco Rubio a couple of years ago to make the case that whichever party managed to transform our health care system such that it's cost was similar to that of most other first-world countries and glaring defects were rectified would hold power for quite some time. He didn't take up the challenge; surprise. Hopefully this guy will be right and the GOP, as well as the rest of the country will wake up and smell the coffee.

The Conservative Case for Universal Healthcare | The American Conservative