Krugman: If Obamacare can work in a state of 38 million people, it can work in America as a whole

[liberal N proud]

California, Here We Come?

At a time like this, you really want a controlled experiment. What would happen if we unveiled a program that looked like Obamacare, in a place that looked like America, but with competent project management that produced a working website?

Well, your wish is granted. Ladies and gentlemen, I give you California.

Now, California isn’t the only place where Obamacare is looking pretty good. A number of states that are running their own online health exchanges instead of relying on HealthCare.gov are doing well. Kentucky’s Kynect is a huge success; so is Access Health CT in Connecticut. New York is doing O.K. And we shouldn’t forget that Massachusetts has had an Obamacare-like program since 2006, put into effect by a guy named Mitt Romney.

California is, however, an especially useful test case. First of all, it’s huge: if a system can work for 38 million people, it can work for America as a whole. Also, it’s hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured. When Massachusetts put Romneycare into effect, it already had a relatively low number of uninsured residents. California, however, came into health reform with 22 percent of its nonelderly population uninsured, compared with a national average of 18 percent.

http://www.nytimes.com/2013/11/25/opinion/krugman-california-here-we-come.html?nl=todaysheadlines&emc=edit_th_20131125&_r=0

[Fumesucker]

1. Well of course mandatory private insurance is going to make people sign up for private insurance

What remains to be seen is if it ensures access to actual medical care for ~everyone~ when people need it and if it keeps people from going bankrupt thanks to the costs of medical care.

I think the experience in MA is that the second part of that at least is doubtful.

[JoePhilly]

2. So what you mean is that people would not have signed up without the mandate, right?

[HereSince1628]

3. I read that as whether people can get care without going bankrupt

remains an open question.

With half the states refusing to expand medicaid, it's almost certain that for many millions of people below the poverty line health crises will still mean huge financial burdens if not ruin.

We'll just have to wait a few years to see what the actual numbers will be.

[JoePhilly]

7. So let's put the blame on the GOP Governors in those states ...

where it belongs.

[HereSince1628]

10. What's needed is rather more than a blame the politicians game

that comes out of such defensiveness. So you blame a governor, what does that fix? Almost Nothing.

Blame Scott Walker, for example. What does that change? Nothing; he'll use it as an indication that he is ideologically pure in his run for the presidency.

The ACA as it is may have been the best that could be accomplished. Sure blame can be assigned....I think SCOTUS poisoned it in utero, for example.

But, recognizing the ACA has limitations and has been handicapped and thereby remains an inadequate solution doesn't mean for example, that Barak Obama, -must- or is being blamed for those short comings.

It just means that progress is still necessary.

Progress requires fixing problems...which means recognizing the problems. Progress toward improvement is inhibited by being so defensive about the original work (and workers who engaged it) that the problems can't be admitted into discussion.

[JDPriestly]

30. Lovely talk. What matters is that the Republican Party does not care whether people

die because they lack access to healthcare, whether they go bankrupt because they promise to pay for care they can't afford or whether sick people just stay home and wallow in their pain and misery.

And we Democrats have a responsibility to make sure that voters know who is causing that lack of access, the bankruptcies and the pain and misery. That's why, you betcha we should blame the Republican governors and state legislators who have not done their part to help the sick and poor in America.

It is their fault. The more loudly and clearly, the better we convey that message the sooner voters will elect state legislatures and governors who do care about healthcare for everyone.

I respectfully disagree with your post. The Republicans were quick to blame Obama for the slow start with the website. Of course, we should blame those who are really responsible: The Republicans.

Let's be loud and clear about it. If you don't have healthcare, it's the fault of the insurance companies and the Republicans. No one else is to blame.

[HereSince1628]

31. I really do understand the nature of campaigning.

Blaming certainly provides psychological value and it creates targets for campaigns to rail against and for partisans to burn in effigy, etc.



It mostly doesn't actually identify or fix problems. Indeed, it making it about personalities usually diverts energy from identifying and fixing problems.

And the point in the conversation where I injected it was about the value of identifying still existing limitations and problems and getting them fixed.

[busterbrown]

37. “Identifying Problem?"

Get Profit out of healthcare... Solution? Get the money out of Politics...How? Identify what politicians support the 2 previous points and Freaking blame them in order to get em out of the picture..

The only addendum one could make to my suggestions for curing our country ills are...To slice and dice Capitalism..

[Fumesucker]

5. Some would and some wouldn't n/t

[joshcryer]

12. Under single payer if you don't you go to jail.

Assuming you were above some poverty threshold anyhow.

[Fumesucker]

34. I have family in Europe I stay in contact with

Oddly enough the incarceration rate there is a small fraction of that in the land of the free.

The one part of the ACA I'm fairly certain will be tweaked are the penalties for non compliance, they will be increased in severity until people will be going to prison for not purchasing private insurance.

That's just how America rolls.

[merrily]

23. Many people would not have. Many people never did. Many people won't sign up, even with the

mandate.

[JoePhilly]

25. You have a flare for ambiguity.

How many make most?

[merrily]

27. Most people can understand what I posted.

[JoePhilly]

28. Yes, that many people did things, or also never did them.

[Skittles]

36. YOU ARE CORRECT

[pnwmom]

8. Then why do polls show that MA residents are very happy with their insurance? n/t

[RBInMaine]

14. Yes, and there MUST be mandates to get everyone in. But most get subsidies. It is a STEP. And,

RomneyCare is VERY popular in MA.

[Tigress DEM]

4. Ain't it the truth?!

it’s hard to argue that California has had any special advantages other than that of having a government that actually wants to help the uninsured

[TBF]

6. Of course it can work -

the billionaires just don't want to pay for it.

They need to be demoted.

[pampango]

9. And Canada proves that a country of 35 million can make single-payer work; the UK that a country of

60 million can make a national health service work.

It is true that California's achievement is greater in the sense that it had to work against the history of health care in the US.

[RBInMaine]

15. Agreed. Now please tell us how you are going to get the US House to approve that.

[pampango]

21. I hope that is a rhetorical request.

All the House knows how to do is kill Obamacare. Goes to show how out of step the House is with the rest of the world.

[joshcryer]

11. But if the ACA isn't killed by SCOTUS we'll NEVER get Single Payer!

Better Believe It!

http://www.democraticunderground.com/1002476222

[RBInMaine]

16. We will not get national single payer anytime soon. End the pipedream and do what is possible.

[joshcryer]

17. We'll get it faster than Canada, I bet.

Like 40 years for Canada. It'll be 15-20 for us, I bet.

[pangaia]

18. 15-20?

JFK understood that what we now are calling 'single-payer' was the way to go.

[joshcryer]

19. That's my cynical estimate.

With any luck we'd have it by the end of the next Democratic Presidents' term.

[polly7]

26. Not quite.

Medicare was born in Saskatchewan on July 1, 1962. It would be the first government-controlled, universal, comprehensive single-payer medical insurance plan in North America. It was a difficult birth. The North American medical establishment and the entire insurance industry were determined to stop Medicare in its tracks. They feared it would become popular and spread, and they were right. Within 10 years all of Canada was covered by a medical insurance system based on the Saskatchewan plan, and no serious politician would openly oppose it.

The CMA strategy backfired. Diefenbaker appointed fellow Conservative and old seat-mate from law school, Mr. Justice Emmett Hall, to chair the Royal Commission. The Commission was intended to examine all aspects of Canadian health care. However, the public hearings overlapped with the debate then raging in Saskatchewan that was becoming a major issue in the House of Commons and beyond. Dennis Gruending, in his superb biography of Emmett Hall, describes the excitement around the hearings, which played to packed houses around the country. Labour and farm organizations, consumer groups, community associations and many churches recommended a public plan similar to the one introduced in Saskatchewan in the midst of such controversy. The CMA, the private insurance industry and their business allies wanted the government to endorse the plans already operating under the auspices of organized medicine and the insurance companies. People could pay their own premiums, with the government subsidizing the premiums of the poor based on means tests. Gruending points out that Hall examined the evidence objectively and came down on the side of public Medicare, and then convinced those who were skeptical to go along with it. The first volume of the commission report, issued in June 1964, came out in favour of a comprehensive health insurance program to be jointly financed by the federal and provincial governments. “Although he didn’t admit it in the report, Hall’s proposal was essentially the Saskatchewan model on a national scale,” Gruending wrote.

The reaction to the Hall Report could probably best be summed up with the expression “all hell broke loose.” The usual suspects mounted a rhetorical battle on a national scale, generally divided along class and ideological lines. Emmett Hall, by now elevated to the Supreme Court, threw himself into the debate in favour of public Medicare, an unprecedented move for a Supreme Court Justice and Chairman of a Royal Commission. By 1964 the pro-Medicare forces in the country were riding the crest of public opinion during a period when the political culture was moving to the left. The political alignment of national parties saw six years of minority governments over three elections between 1962 and 1968, and this favoured those political forces attempting to move the country in a more progressive direction. The NDP was growing and this strengthened left Liberals who argued that their party must protect their left flank. This in turn encouraged the red Tories within the Progressive Conservatives, who argued that the party must move left to remain electorally competitive. All of this was occurring during a minority situation when an election might occur at any time and no party wanted to be caught on the wrong side of a popular issue like public Medicare.

It took fierce struggles within both the Liberal and Progressive Conservative parliamentary parties, but in the end the party whips forced the right wing into submission. The National Medical Care Insurance Act was passed in the House of Commons on December 8, 1966, by an overwhelming vote of 177 to 2. The starting date was July 1, 1968, and the Act provided that the federal government would pay about half of Medicare costs in any province with insurance plans that met the criteria of being universal, publicly administered, portable and comprehensive. By 1971 all provinces had established plans which met the criteria. Forty-five years later, the right to universal and equitable Medicare is now in perhaps the greatest danger it has faced since 1970. The political culture has lurched dangerously to the right and the Harper government has essentially declared that it has no intention of enforcing the Canada Health Act. The popular forces which made Medicare possible will have to be revitalized if we are to preserve the achievements which took decades of struggle to accomplish.

http://canadiandimension.com/articles/4795/

[joshcryer]

29. I was more going by Tommy Douglas' hospital care.

By 1947, Saskatchewan had one of the strongest economies in Canada. After just three years as premier, Douglas made the province financially stable enough to introduce universal hospitalization for all residents of Saskatchewan for an annual fee of $5.

http://www.neatorama.com/2012/05/07/the-greatest-canadian/#!oAjgV

The Canada Health Act wasn't passed until 1984. And even still it's not a national system but one which each providence implements its own way to national standards.

That'd be 37 years of pushing hard for universal health care. Close enough.

[vinny9698]

33. Vermont has started single payer.

In Canada one province started and the others followed suit because they saw the tremendous savings and improved quality.

[frazzled]

13. It's not about not being "done right" at the federal level

It's that 36 states, with 36 different eligibility requirements and 36 different databases and software systems to tie into, decided not to set up their own exchanges. Integrating them is a nightmare beyond nightmares.

Seattle Times, on why Washington State (or California) isn't having the problems that the federal government is:

Under the Affordable Care Act, states that chose not to create their own exchanges are to use an exchange set up by the federal government — Healthcare.gov. Thirty-six states chose not to create their own exchange.

The federal system must be capable of integrating with multiple-state eligibility databases.

“It’s just the complexity of their scope vs. ours,” said Curt Kwak, chief information officer of the Washington Health Benefit Exchange, the public-private corporation that manages Healthplanfinder. “We focus on just one state, but they are having to focus on 36 states. It’s just that much more complex.”

Robert Booz, an analyst with consulting group Gartner’s health-care-industry research unit, noted that each state has different computer equipment, different software and different bureaucratic structures. Tying them all together, Booz said, “was an incredibly complex, very short-fuse situation.

>

According to Kwak, his team benefited from being able to focus solely on the issues peculiar to Washington state. That meant, of course, building a clean consumer website and preparing for integration with the federal Data Services Hub, a data center managed by CMS that provides one connection to the common federal data sources (including the Social Security Administration and the Internal Revenue Service) to verify consumer application information for income, citizenship and immigration status.

But the trickiest part, Kwak said, was integrating the state eligibility system, which tracks services — including Medicaid — that residents are eligible to receive. The state decided to build that leg of the system from scratch.

http://seattletimes.com/html/localnews/2022149296_acaexchangesxml.html

[DirtyDawg]

20. We keep...

...calling the 'rollout' a disaster...well I call it a, qualified, success. A success, that is, for the Rightwing 'hack job'. If these Republican bastards can steal a bunch of elections - including two Presidential ones - they can damn sure sabotage an already complicated internet, interfacing site - with multiple links, thirty-something different states with each one featuring multiple, all different, insurance providers with a varied array of plans ranging from low to high and all in between. These guys have surely done everything they can to circumvent, overload, attack and 'bring down' the Federal Exchange, or at least slow it down long enough for the Rightwing Big Lie Machine to do its damage. All that needs to be done is to turn the NSA loose on these bastards, track down their efforts, and nail their butts...then let em explain that.

[Jack Rabbit]

22. See what happens when you make Republicans irrelevant?

And we wouldn't dream of fucking with any one's right to vote.

[merrily]

24. Romneycare proved Obamacare CAN work. However, single payer is the goal.

[Hekate]

32. Love Dr. Krugman and his clear eyes.

[colsohlibgal]

35. Short Term It's Fine

But it is the Heritage Foundation's plan. We need to scrub profit out of health care, it does not belong there. Once again we're trying to stay well/alive, they're bottom line drives them. We're at loggerheads with our prime goals.

A health care company should be some office workers making solid middle class pay and bosses making not more than 2-3 times as much. Like it was until the 80's.

Right now it's just us among civilized countries and it's wrong that the 1st thing we now hear at a doctors office is how will you pay, can I see your insurance card, etc. I heard a lady relate that she, on a trip to Italy, broke her arm. She was treated, given a sling and some pain meds. Nobody asked for money, a card, nothing.

BTW other countries have plans that also cover vision and dental. I have dental insurance but it only plays half for anything big - which means every other year I seem to get dinged for $700-1200. It sucks but I can do it. What about others who are choosing between heat, food, and medicine?