We need to recognize that the ACA needs to go.

[kristopher]

Last edited Fri May 5, 2017, 08:39 PM - Edit history (1)

I believe D's will continue to drift politically until and unless we unite to propose transitioning to Medicare for everyone.

The ACHA is FUBAR.

But that doesn't mean the design created by the ACA works long term. In the area of controlling costs it leaves the public and insurance companies as price takers with the medical delivery system being virtually unchallenged price makers. We the users have virtually no power to shop and consequently effect consumer directed change on the health care delivery system.

That's why everyone else uses some form of single payer system where, by having the government act as one buyer of health care services the public can use their political voice to actually "shop" for health care services. This turns the medical delivery system into price takers.

This is a simple, easy to understand explanation of the data that Joe Walsh can't bring himself to even consider in the exchange with Ali Velshi. Note how easy it is for Joe to slide his mind around the statistics. I've found personally, that if you go a step beyond the statistics and explain (as above) WHY the stats are what they are, then it aligns perfectly with their belief about what is right and wrong.

[LuvLoogie]

1. You need to get your congressman straight.

[spanone]

20. yep, joe wilson...

[kristopher]

25. Thanks. Corrected.

Republican assholes tend to all run together over time.

[yuiyoshida]

2. So you have to be more Diverse to get better health care?

Does that mean you have to be more "White" to get better health care? What do inner cities have to do with it? What the fuck does RACE have to do with health care??? Who the fuck is this idiot?

[Hoyt]

3. Problem is explaining that to the ignorant white wing fools who elected these cretins.

[kristopher]

4. Well, Walsh (and Repubs) are trying to make it racial

And as long as the dog whistle goes unanswered that is where the beliefs of many who want low cost, dependable health care will remain.

We can't stop them from being racist but we can show them easily where the fault is and isn't. Racist beliefs (not attitudes) are often ignorance - in this case ignorance about the nature of economic markets. Once you relate the true nature of this specific problem to something intuitively understood like shopping, you'll probably succeed in changing a few minds.

Try it. It works.

[PA Democrat]

5. Taxpayers foot the bill for most of the sickest citizens (through Medicare and Medicaid)

while private insurance companies profit covering the young and the healthy. The ACA changed that a little with the elimination of preexisting conditions, but that will change back to the way it was before if Republicans have their way.

Medicare for all cuts the profits out of covering the young and healthy to help pay for people who have higher medical costs, lowering overall costs.

That's what other developed nations do.

[kristopher]

6. The impression I get initially from your comment was "Taxpayers foot the bill"

Try limiting your comments to the explanation in the OP. You aren't wrong per se, but your phrasing could produce confusion that diminishes the impact of your message.

I've had a lot of success putting just the way I presented it above.

[WinkyDink]

7. "The sickest citizens" are also tax-payers.

[PA Democrat]

15. I think I worded my post poorly.

My intent was to point out that the US has largely privatized the segments of healthcare where there is a profit to be made and socializes the rest. I think ALL health care should be paid for through taxes. I did not mean to imply that sick people do not pay taxes. Personally, I think ALL Americans are entitled to health care regardless of their income.

[WinkyDink]

30. It's a common phrasing; just a pet peeve of mine! I heard it too much as a teacher! On a

different note:

God bless our Charlie Dent! I have never in 44 years of voting voted for a Republican, but he's got me wavering.

[Hoyt]

8. White wingers do not think they are racists. I'm telling you, I know. I confronted the Aholes a

bunch, and they do not think they are racists. And even if you convince them they are, they don't care.

When I was growing up, long time ago, there was this racists who appeared on TV with a confederate flag hanging behind him and a little one in his coat pocket. He talked of "N_____s and J__s," but said he was not a racist or bigot. Said it even as they were closing the cell door on him for bombing a black church in Birmingham. They are all pretty much the same. In fact, they consider you a racist for confronting their white wing crud. Stupid Aholes.

[kristopher]

18. I agree with all you say - I grew up redneck.

But that doesn't alter the fact that they want affordable health care as much as we do so it's possible to find common ground on the topic of health care.

BTW I don't want to present myself as 'an economist'. I've studied it to advanced levels and use it as a tool, but compared to a specialist there's far more I don't know than I do know.

[HughBeaumont]

9. " . . . then he gets political . . . "

Four words that sum up the GOP's horseshit way of making everything a target.

FOR EVERY OTHER COUNTRY, RIGHTS JUST ARE, ASSHOLES.

And, while we're on the subject, "emergency care" doesn't equal "health care." When someone presents to an emergency department, the facility is required by law to see that person and treat them until they become stable. That is not the same thing as giving someone chemo for cancer, or sending someone to rehab after an injury or stroke, or any of the other THOUSANDS of conditions that aren't always preventable.

Additionally, when you give people access to basic health care, the number of people utilizing emergency departments for non-emergent conditions would decrease, which would alter costs over time. One of my FB friends worked as a medical coder for emergency departments for several years, and the number of people that go to the ED for minor ailments (sore throat, ear pain, scrapes and bruises, etc) is just plain sad. But the uninsured/underinsured treat the ED as their primary care facilities, because they have to be seen regardless of what the final diagnosis might be.

[nikibatts]

10. That's ok. It was meant to be the first step toward single-payer. Obama knew what he was doing.

He knew it would come to this and out of turmoil would come single-payer. Betcha!

[kristopher]

21. Yep!

The pure meanness of the republican sociopathic policies aren't lost on at least 75% of the public.

They just need to understand how to fix the very real problem of cost escalation.

[ucrdem]

11. Well, the Medicare for All bunch is getting half its wish at least.

Thrilling isn't it. But if you honestly think anything remotely approaching single payer, which increases the tax burden, to get passed in the next generation you're completely mistaken. ACA was our one and only chance at national subsidized healthcare and once it goes it's gone for good.

How can you not know this?

[kristopher]

24. How can I not know that?

Because I'm not as dumb as a rock.

[ucrdem]

26. If you think Obamacare will fall and from its ashes will rise a glorious Medicare for All

while this administration is in office, you might be. But more likely you're deluding yourself in a dangerous way, because a lot of people are going to get hurt when ACA goes down starting with the 24 million who will lose their health coverage.

How, how, how do you think this administration would ever agree to a single-payer plan? HOW?

[Nanjeanne]

12. I also wish morality was discussed more. And fiscal responsibility as well.

I keep going back to the issue is a MORAL one. I will never understand the concept that people buy insurance based on what they can afford. So a firefighter, a truck driver, a waiter, a social worker -- their lives are considered less important than a CEO or hedge fund manager. This is not about buying a Ford or a Tesla. This is people's lives and the idea that people go bankrupt at the same time they are dealing with serious illness -- this is not the country I want to live in. I wish there was more discussion on morality. And I believe more people who are teachers and truck drivers and coal miners and secretaries and factory workers and salespeople etc. would understand it that way and say "he'll yeah. I deserve healthCARE period. Not what I can afford based on my income". And when we approach it morally - the answer is what every other country discovered - all in means a much larger risk pool, no profit incentive, and ultimately more affordable healthcare for everyone.

Private Insurance companies will always have products to sell and rich people will always get "better" care by buying a faster MRI appointment or elective procedure coverage or private room upgrades.

But a Medicare4All system makes the baseline for all citizen good care and alleviates the fear of going bankrupt while dealing with serious illness. Unfortunately most politicians don't discuss it that way.

[smirkymonkey]

13. +1000

This!

[dmr]

17. Good post. Thank you!

[joshcryer]

14. The ACA was never designed to work long term.

It was a compromise solution for improvements over time and a political solution to incentivize voters. Start off small, things like guaranteed (free) contraceptives and medical checks and stuff like that. That's a voter base who would be annoyed if their employer took away that part of their insurance (well, stopping them from doing that). Expand Medicaid for poor people, a lot of people with ailments are then able to get taken care of, and that's a voter block who would be incentivized to help vote for more Dems to keep that in place for them.

Regan famously enumerated the anti-government idea that "I'm from the government, and I'm here to help." In fact, giving contraceptive care, pap-smears, for free, stuff like that, actually fucking helps people.

By saying this narrative that the ACA needs to be tossed shows us that we aren't able to actually get anything done. And by Republicans neutering every aspect of government it makes people, the people who need it the most in particular, allow them to continue winning elections.

We must, if we are to win, emphasize how this shit is helping people, and throw out all notions of "tossing out" any positive legislation, even if it's a hack here or there.

[kristopher]

19. "saying this narrative that the ACA needs to be tossed shows us..."

By saying this narrative that the ACA needs to be tossed shows us that we aren't able to actually get anything done. And by Republicans neutering every aspect of government it makes people, the people who need it the most in particular, allow them to continue winning elections.

No it doesn't. Explaining that Medicare for all is how we establish cost control and get quality care for everyone is an easy to understand concept when the locus of failure for the 'free market approach' is understood.

It's very much like the way free markets are a failure when providing centralized electric services.

[PatsFan87]

16. We need to be unafraid of actually having conversations about single payer.

Look at Bernie's West Virginia town hall with Chris Hayes. He got a conservative Trump voter to agree with him on universal health care.

[BainsBane]

22. It's not true that everywhere else uses single payer

Other developed nations all have universal healthcare, but they don't all have single payer. Germany and Switzerland for example, do not.

[kristopher]

23. I think you're quibbling

85% of Germans are enrolled in the public system; the same is true of Japan.

The point isn't semantics; it's that purchasing power be strong enough to shift market dynamics to the point where the medical delivery system becomes a price taker and that the public have a mechanism to replace their missing market voice. We probably won't end up with strict single payer either, but it's an easier target to shoot for than some word salad like 'semi-governmental partnering with employer provided multi-payer health care". YMMV

[BainsBane]

27. The point is universal healthcare.

We have seen people insist single payer is the only acceptable solution. Is that just semantics too?
Because a whole lot of people are focused on those semantics and have used them to express opposition to proposals and efforts to implement universal healthcare.

Germany has a multi-payer system. https://en.m.wikipedia.org/wiki/Healthcare_in_Germany
Claiming that all countries have single payer is factually false. https://en.m.wikipedia.org/wiki/Healthcare_in_Switzerland
Both Switzerland and Germany require citizens to purchase health insurance, unlike in the single payer U.K. & Canadian systems in which healthcare is payed through the national government.

I know the truth has fallen out of fashion in our current political culture and that there is an operating assumption that the less informed people are the better. I do not share that view. I believe that informed and substantive knowledge is essential to effective policy. It's one thing to examine the various systems different countries employ to deliver health care and then conclude single payer is more efficient or better in some other way. It's another to claim that they are all single payer and then chastise those who point out your claims are false.

[kristopher]

28. No, the point is GETTING universal care

My post is intended to highlight a simple argument explaining how cost control can work and which will be effective with people like Joe Walsh.

Linguistics recognizes that many words and terms have fluid meanings when viewed across the entire spectrum of their use. This is such a case. There will be a point where national discussion will need to nail down the specific format that emerges as out best cost control mechanism, but that is a pointless exercise at this time. I recognize the range of configurations that are involved in the end result, but normal language usage includes 'brand' type words such as "single payer" which is very, very often used in common vernacular to lump the range of systems achieving universal health care together. Much in the way a name like "Walkman" came to symbolize all products all the gadgets allowing people to conveniently tote around their personal selections of music.

You might not like that facet of language, but it's there no matter your preference. Medicare for all would, strictly done, be a single payer system. But if it ends up only handling 70% of the population with private, employer administered health care handling the other 30% it will still accomplish the goal of cost control and improve the country dramatically.

The point the most uninformed among us need to understand is that because of limitations in the market structure for medicine there is also a limited range of methods for for achieving cost control. Society needs a way to discuss that need smoothly - it needs a shorthand term. There is no shorthand that works to create the imagery of a good program as well as Medicare for all, and since that is also recognized as "single payer" those terms are already largely interchangeable in the public mind.

Sorry if you don't like it, but berating people on DU isn't going to change the dynamics at work in the way people use language.

[BainsBane]

29. Joe Walsh isn't reading your post

DUers are. If You think you can convince Joe Walsh, by all means, go for it. But this isn't the place that happens, which you well know. Your audience is DU, not Walsh.

We have had discussions about healthcare in this country for over 30 years. We have had seen presidential debates and countless threads in which single payer vs. ACA and other systems have been discussed. DUers are not too stupid to know the difference.

I didn't berate you. This was my response:

It's not true that everywhere else uses single payer
Other developed nations all have universal healthcare, but they don't all have single payer. Germany and Switzerland for example, do not.

You insisted my pointing out that fact amounted to "quibbling." If it is quibbling, then why are you "quibbling" about ACA vs. Medicare-for-all? Other countries do provide universal healthcare through market based systems, as the examples of Germany and Switzerland demonstrate. There are others around the world as well.

I have no objection to a single payer system. In fact, I prefer it. What I don't support is seeing people deprived of healthcare coverage because single payer can't pass. The fact is there are voters who justified refusing to vote for the Democratic nominee because she did not propose single payer. They chose to either vote for Trump or cast a third party vote that contributed to his victory because, they claimed, her plan to fix ACA was worse than Trump. People are going to die because of what you dismiss as semantics.

You seem to think that misleading Americans about the nature of universal health care systems around the world is necessary to convince them to support Medicare-for-all. I don't know why that is. American voters have never responded well to the argument that we should do what other countries do. I don't see why that would change now while the country, and much of Europe itself, is moving in an increasingly nationalist direction.

The reason why so many Republican voters oppose social programs is that they don't want black and brown people benefiting. They rather go without than see those they deem inferior benefiting as well. (Polling data from the 2016 election reveals that race was the primary motive in support for Trump.) No amount of misrepresentation about European healthcare systems is going to change that. But then, your argument wasn't meant for them, was it?

[kristopher]

31. Have it your way.

The general population doesn't routinely use words and expressions in ways that experts would consider 'wrong'.

In order to communicate with all the voters we should avoid using words and expressions in ways they are familiar with if those words and expressions aren't being used in precisely the same manner that policy experts use them.

Should such cases occur we should re-educate the populace with pedantic screeds to ensure we have their interest aroused on the topic of vocabulary.

Once we've re-educated the millions of voters we're trying to reach and established the proper common lexicon in the view of the policy experts, we can move on to a rational discussion and persuade those millions of voters that the Republican's inartful appeals to their baser emotions is a poor way to engage in decision making.

Under no circumstances should we use shorthand words and expressions from the common vernacular lest it offend policy experts; it is far more important that we follow the Oxford dictionary than it is to engage the interest of the public.

Is that about right?

I'm a Websters fan myself.