Urban Institute analysis of Sanders Single Payer Plan: May 2016

[ehrnst]

Summary:

We estimate that current state and local spending will be $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026. Because this would be absorbed by the federal government under the Sanders plan, some might suggest requiring states to pay maintenance-of-effort costs to offset the increased federal acute care and long-term care costs. Some dispute exists about whether maintenance-of-effort requirements are legal, however, given National Federation of Independent Business v. Sebelius; that decision may call into question whether such payments amount to coercion.

However, many other issues would be raised by a single-payer system. Providers would be seriously affected. Hospitals would see only small financial effects in the aggregate because payment rates would be increased for those otherwise insured by Medicare and Medicaid and revenue from the otherwise uninsured would increase, but they would receive less revenue for providing care to those who would otherwise be privately insured. Different types of hospitals would be advantaged and disadvantaged, depending upon their patient mix. Growth in revenues over time would be slower than under current law, however. Physician incomes would be squeezed by the new payment rates because such rates would be considerably below what physicians are paid by private insurers. Again, whether providers were financial winners or losers from the reform would depend upon their current payer mix. The pharmaceutical and medical device industries would be squeezed perhaps more than is sustainable.

Behavioral responses by the range of health care providers to such a vast change are uncertain. If provider incomes fall, additional federal investment in medical education might be necessary to achieve a sufficient level of supply. Choices would need to be made about the treatment of existing private longterm care insurance contracts and the reserves the companies that issued these policies now hold.

We assume a 6 percent administrative cost across the board; this may be too low given the many functions that would need to be carried out, including a range of care management functions, rate setting, bill paying, and oversight responsibilities for a wide variety of providers across the nation. By eliminating copayments, coinsurance, deductibles, and service limits of all types, the Sanders plan would increase demand for services. We have assumed supply constraints such that not all of the increased demand would be met. But the failure to meet all demand could lead to public outcry. Any remaining role for private health insurance would also have to be determined. If higher-income people purchase private insurance, it could give them faster access to desired providers, increasing their satisfaction with the system. Yet it could also lead to longer queues for those relying on the remaining providers,
causing dissatisfaction in other quarters.

Finally, moving to a single-payer system would be highly disruptive in the near term. When the ACA required people to give up private insurance plans that were less costly than those available in the reformed nongroup market, some vocal complaints led to quick administrative action to increase opportunities for people to keep non-ACA compliant plans longer. The ACA’s changes to the health insurance system and the number of people affected by those changes has been small compared to the upheaval that would be brought about by the movement to a single-payer system.

https://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000785-The-Sanders-Single-Payer-Health-Care-Plan.pdf

[Hoyt]

1. The Urban Institute is a creditable organization. They did much of the work establishing Medicare's

reimbursement system.

Here is an abstract of the conclusions --

Presidential candidate Bernie Sanders proposed a single-payer system to replace all current health coverage. His system would cover all medically necessary care, including long-term care, without cost-sharing. We estimate that the approach would decrease the uninsured by 28.3 million people in 2017. National health expenditures would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32.0 trillion over that period. Sanders’s revenue proposals, intended to finance all health and nonhealth spending he proposed, would raise $15.3 trillion from 2017 to 2026—thus, the proposed taxes are much too low to fully finance his health plan.

https://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-national-health-expenditures-and-federal-and-private-spending

_____________________

His current proposal is a little different from the one analyzed above, so that might help some. And, truthfully, the fact that it is going to cost more than Sanders indicates is not necessarily a reason to oppose the single payer system. But, it is going to be an issue and needs to be addressed.


Excellent find, BTW.

[ehrnst]

2. This is a topic I have some knowledge of.

So I know the reliable sources.

I think that he learned from HRC's proposal, but I still don't think it's going to change much. He's not shown that he believes he has much to learn about the topic.

In any case, anyone who has worked on a complicated project know the saying: "Cheap, fast or good - pick two."

[JCanete]

65. why does it have to be cheap? Richest nation in he world. nt

[ehrnst]

66. Not saying it does. Strawman.

I'm just saying that the reality of any project.

Sanders says quick, and way cheaper than policy experts say it actually is.

So that means "good" isn't an option.

[JCanete]

67. what? fuck that. You say some shit as if ..."it can't be all these 3 things" and you say that for

the purpose of suggesting that it is problematic. But if that isn't your meaning I never said it was anyway. I simply said that we've got the money so who cares about that issue, to which, I guess you agree.

[stevenleser]

76. It can't. This is an axiom of project management. A big & complicated project cannot be all three.

Given a project that is big and complicated enough and you will have to pick two out of

- Good
- Fast
- Cheap

If you architect the project badly, you won't even get two out of the three.

I think if you spend enough time thinking it through, you will understand this idea.

The poster to whom you responded indicated that it seems that Sanders is going for Fast and Cheap. I'm not 100% convinced of that yet but it does seem to be heading that way. If so, you know which of the three that leaves out.

[JCanete]

78. I did not see where the poster indicated that the bill was going for fast and cheap, only that it

couldn't be all 3. My question was why do we need it to be cheap? We would be fine with the other 2. There's no reason for it to be cheap. It can still be cheaper to the common American, while actually coming out of the coffers of those few who have amassed far more than is reasonable of the US's and the world's wealth.

To your point, that surprises me if Sanders is trying to make it cheap. If that ends up being your finding I'd certainly like to look at that breakdown.

[ehrnst]

79. Again...Sanders is implying that it is cheaper that experts say it is.

Last edited Mon Sep 18, 2017, 10:38 AM - Edit history (1)

Perhaps you would understand the concept better if I explained it as:

Affordable, fast or good. Pick two.

Sanders' plan is saying it's all three.

If he moved the implementation timeline to 20 years, that would fit. (fast)

If he raised the price and predictions of taxes needed to what the analysis of his 2016 plan by experts stated, that would fit. (affordable)

If he included the disruption of the health care system that the analysis of his 2016 plan by experts stated, that would fit. (good)

Here is independent analysis that talks about costs in his 2016 plan, an analysis that supporters called "an attack":

Presidential candidate Bernie Sanders proposed a single-payer system to replace all current health coverage. His system would cover all medically necessary care, including long-term care, without cost-sharing. We estimate that the approach would decrease the uninsured by 28.3 million people in 2017. National health expenditures would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32.0 trillion over that period. Sanders’s revenue proposals, intended to finance all health and nonhealth spending he proposed, would raise $15.3 trillion from 2017 to 2026—thus, the proposed taxes are much too low to fully finance his health plan.

https://www.urban.org/research/publication/sanders-single-payer-health-care-plan-effect-national-health-expenditures-and-federal-and-private-spending

[JCanete]

96. So insurance as it stands, which is gouging the fuck out of people, and granted, often has massive

holes in coverage that hopefully get closed up by the medicare for all proposal, costs about 26.4 trillion to cover over 300 million people, or without doing more than a cursory analysis, that seems to be what I'm getting from that study. Extending coverage to another 27 million people is expected to cost another 6.6 trillion? I get that some of that money is accounting for transition costs(which btw, is money likely to be taxed again and again the more people that are getting a piece of that pie), and I expect that much of it is also accounting for those holes in coverage for the whole population, and I can appreciate that an analysis might say that that 6.6 trillion isn't enough. But it is an increase in spending on healthcare of 25 percent, so I don't see how that is actually doing healthcare on the cheap, or else, so is our current system with Obamacare, which must then have sacrificed one of the other two pillars.

If more money (6.6 trillion more than what we are spending now)means it is more likely that such a system can provide better coverage or be implemented faster than what we have today, then I'd say it is an improvement.

But do they even take into account cost leveraging for services that the government would have, or the reduced costs that preventative care versus emergency or post-illness care might proffer? Or the increased productivity of a healthy workforce that might translate into more taxes, more entrepreneurial competition, etc?

[ehrnst]

99. What does this have to do with the Sanders plan lowballing the costs?

Last edited Tue Sep 19, 2017, 11:03 AM - Edit history (2)

Again - Vermont Green Mountain Care tanked in part because to continue it, Vermont had to hike taxes 160%.

Now you can talk about how a "healthy workforce will be more productive, etc," but when faced with that kind of difference between what was promised, and what became reality for people, they are going to give up thinking you know what you're doing or that you are being honest with them.


Much like when Obama said, "you can keep your doctor," when no one could guarantee that. It was used to discredit him and by extension the ACA. If you tried to tell anyone that the ACA would do this, or not do that, you would often get the response, "Well he said you can keep your doctor, and that was a lie."

Since you have questions about what the analysis says about cost leveraging, I'll supply the link again:

https://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000785-The-Sanders-Single-Payer-Health-Care-Plan.pdf

You may also find it in the UI's response to the pushback on the analysis:

https://www.urban.org/research/publication/response-criticisms-our-analysis-sanders-health-care-reform-plan

You display a familiarity with terms describing financial mechanisms in health care delivery, so I'm sure that you will be able to find answers to your questions by reading the analysis or the response.

You can get all "fucking" furious at the insurance industry that you want. Your fury doesn't make the single payer plan that UI analyzed any more affordable or less disruptive to the health care system if implemented.

The implementation costs are separate than maintenance costs - I wanted geothermal HVAC, not just because of the environmental benefits, because the costs, once installed are very low. But I could not afford the price tag for digging the hole, which would have required renting an oil derrick drill, because of the configuration of my lot. If one has a lake on one's property, it's much less expensive because you don't need to drill or dig, but I know better than to expect mine would be just as cheap. As in Europe - the circumstances surrounding their establishment of universal coverage were very different, and much cheaper, Like someone who has a lake.

It's also much, much cheaper to keep costs down from a low starting point, than it is to bring costs down from a high starting point.

[Eliot Rosewater]

4. I am not going to read the whole thing, does it relieve employers buying health insurance

and then tax them instead?

The plan put forth now, from what I see, does not relieve employers from buying health insurance, and this is a main way to get there.

Also you have to end for profit hospitals receiving payment from the plan.

[ehrnst]

6. There is a payroll tax on employers that would be limited to 6.2%

Similarly, employers that now provide coverage would pay less because their obligations under the proposed approach would be limited to the 6.2 percent payroll tax paid by employers.

In contrast, across all employers (i.e., including those who offer health insurance and those who do not), employerpaid premiums for health insurance benefits currently average 8.3 percent of total compensation. Higher-income individuals would be expected to pay considerably more toward health expenses than they do today.

[ehrnst]

8. Taxes being much higher than anticipated were part of why VT single payer failed.(n)

[George II]

22. That was the problem with the California proposal, and the Democratic Speaker....

....out there was castigated by Democrats (and Independents) for not bringing it to the floor, even though it couldn't be properly funded and would have been defeated.

[Gothmog]

102. I agree

[ismnotwasm]

3. We are facing a provider as well as a nursing shortage

I didn't see anything in the Medicare bill address this. Nursing leaders are working hard to fill the already existing gap with nurse practitioners, and nursing schools are full. There is now a preference for bachelors prepared RN's instead of the Associates, which raises the education costs--the prerequisites are mostly science based and nursing school is difficult. Established physicians have spoken out about choosing another profession rather than enduring the rigors of medical school again. And PCP's is not where the money is at--creating over-specialization.

There are a lot of things to address when we seriously discuss Medicare for all

[ehrnst]

7. This is why incremental change is neccesary - way longer than 9 years. (nt)

[ismnotwasm]

10. Yes.

Even with the ACA there are not enough providers--I see the analysis DOES mention this-- I am still reading. From a personal nursing Pov, it is, perhaps more obvious to me than to others.

[ehrnst]

13. Sanders rejects any analysis of his plan that doesn't agree with his numbers.

So I don't know that he's going to be willing or able to rework it.

[Weekend Warrior]

5. This is a political exercise by Sanders.

It's not about passing legislation now. If it were, we wouldn't have one of the least accomplished career politicians running point. More serious people with better track records will take the ball once we get closer to it being able to pass. The legislation we will eventually get will have nothing to do with what Sanders is doing. His name won't even be attached to it.

Changing hearts and minds is whats going on. No matter what, some of the deficiencies currently being noted will be hammered by the right even if they are properly addressed.

[ehrnst]

11. Yep. (nt)

[heaven05]

74. another "political exercise"

among so many---important in their consistent failure and not important or noteworthy even...

[Gothmog]

9. Interesting study

[Me.]

12. Only 1 Recce...Come Now

This is important info, especially if we want to have a real discussion about health care. "moving to a single-payer system would be highly disruptive in the near term" needs to be talked about before any decision is taken.

[ehrnst]

14. Then there's this:

https://www.urban.org/research/publication/response-criticisms-our-analysis-sanders-health-care-reform-plan

[Me.]

16. Some INteresting Bits Replying To Sanders Team Critiicisms

"The Sanders campaign and David Himmelstein and Steffie Woolhandler reacted with sharp criticisms to our recent report, The Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and Federal and Private Spending. In this brief, we discuss our key assumptions in these areas of disagreement and highlight ways in which we may have actually underestimated overall costs of the Sanders proposal. By and large our assumptions are laid out thoroughly in the original paper, but here we use them to address the specific statements made by the campaign.

Our analysis was based on detailed modeling of acute care for the nonelderly, acute care for the elderly, and long-term care services and supports. It is impossible to wholly impose a new health care system in the United States that changes the way all residents receive and finance their health care, even one that may be successful in another country, without disrupting many existing institutions, such as insurance companies, integrated health systems, hospitals, physicians, and pharmaceutical manufacturers. To be politically acceptable, compromises would have to be made, and those compromises are reflected in our assumptions.

In this brief, we discuss our key assumptions in these areas of disagreement and highlight ways in which we may have actually underestimated overall costs of the Sanders proposal. By and large our assumptions are laid out thoroughly in the original paper, but here we use them to address the specific statements made by the campaign and HW, and we provide additional reliable evidence to counter some of HW’s claims.

The increases in federal spending that we estimated ($32 trillion between 2017 and 2026) are so large because all current public and private spending would be transferred to the federal government, benefits would be expanded, and out-of-pocket costs to consumers would be eliminated."...cont...for those who are interested....

https://www.urban.org/research/publication/response-criticisms-our-analysis-sanders-health-care-reform-plan

[TCJ70]

21. $3.2 Trillion per year? That's less per year than we spend now.

Sounds like a deal to me.

[Me.]

23. Wasn't The Amount Cited 32 trillion Not 3.2

[TCJ70]

24. "The increases in federal spending that we estimated ($32 trillion between 2017 and 2026)"

$32 Trillion over 10 years = $3.2 Trillion per year

[Me.]

27. Yes, You Are Correct As To The 3.2 Trillion

As to be a bargain, I cannot attest to that

[ismnotwasm]

28. From page 20

It's a lot of info!

Consistent with our assumptions regarding acute care for the nonelderly, we assume that acute health care spending on behalf of those otherwise enrolled in Medicare would grow 0.5 percentage points more slowly under the Sanders plan than under current law.19 Still, under the Sanders plan, federal spending on acute care for those otherwise enrolled in Medicare would be $14.0 trillion from 2017 to 2026 compared with $8.2 trillion under current law. This difference of $5.8 trillion represents a relative increase in spending of 71.4 percent (table 8).

[Me.]

29. Ah, Thank You So Much

[TCJ70]

30. I'm basing that on the fact that we currently spend around $3.8 Trillion annually...

...on healthcare as a nation. The Urban Institute analysis is decent but I think it underestimates (if it considers at all) potential cost savings of an expanded Medicare or single-payer program. Our costs for things like drugs are outrageous compared to any other country at the moment. Even if we evened only that out it represents a gigantic savings overall.

[ismnotwasm]

43. Well, universal healthcare is a goal we all share

There is a lot to it--notice the analysis uses the term "non-elderly" a lot. Our aging population is already using up Medicare dollars at a high rate, with a smaller younger population paying in. A single payer would not erase that discrepancy. (Bill Clinton did something to keep Medicare solvent, and dubya spent it in his war--I could be wrong I don't remember the details)
Right now government reimbursements are tied to a numbers of factors such as HCAHPS. Government money is used as a stick and carrot for facilities such as nursing homes and rehabs to maintain quality--with various successes and failures

http://www.mghpcs.org/eed_portal/Documents/PatExp/What_is_HCAHPS.pdf

And as I said before, we are not equipped with enough healthcare providers for implementation over 10 years--this really needs to be talked about. The focus on preventative care should of course be maintained. Chronic disability illnesses, mental health dental care-Sanders Bill is covering everything and everybody from what I understand, but costs aside, I'm not sure the infrastructure is going to be ready in 10 years.?

Once government becomes the insurance policy, I'm curious as to where the people in the insurance industry will go--will they be offered a government job?

There are a number of unaddressed issues. Cost isn't the only one

[brer cat]

52. It seems to me that the cart is before the horse.

Single-payer doesn't solve the problem of not enough providers which already exists and, in fact, may make it worse. If physicians are reluctant to accept elderly Medicare patients, how will they react if the entire population is under that same fee structure? Will the cost and time requirements for a medical degree outweigh the benefits leading to even fewer people entering the field?

As to the people in the insurance industry, I am seeing a cavalier attitude that they will simply become government employees. But if one of the selling points of single-payer is reduced costs due to efficiency, will those millions of people be needed?

I support UHC but I am totally with you that there are too many unaddressed issues at this point.

[ehrnst]

59. UHC doesn't have to be Single Payer, they're not the same. (nt)

[Go Vols]

118. yep

The United States, by contrast, is very rich, and already dedicates way more than enough resources to set up the world's most generous health-care system, and a lot more besides. We spend $3.2 trillion per year — literally twice as much as the OECD average as a share of the economy. We pay enough in health-care taxes alone — that is, the government revenue that goes to Medicare, Medicaid, the VA, and a few other things — to cover a Canada-style Medicare-for-all system for the whole U.S., and then that much again in private money. In other words, if we could simply copy-paste Canada's universal health-care system into America, taxes would actually go down.

All that means is that America doesn't have to worry much about costs; it has to worry about allocating existing spending properly. We already have a gigantic pool of resources dedicated to health care — about half private and half public. We just have to adjust that spending so it can support a single-payer system.

http://theweek.com/articles/724334/why-bernie-sanders-singlepayer-push-great-policy-even-better-politics

[clu]

26. the OP link states

that the state & local gov't and private citizens could save $4 trillion over the timeframe, but doesn't (it can't legally) factor that amount into any payments to the system. lots of assumptions but a nice starting point for conversation.

[andym]

15. Sanders plan is a great start, but there is a need to flesh out the details.

For example, modest co-pays for all but those who could not afford health care should probably be incorporated, to prevent the drain on resources. Having more physicians would be a big improvement-- one of the reasons medical cost is so high is problems with the limited amount of medical training opportunities (caused by the AMA among others)-- so more training is a must. Negotiation of fees/drug costs would be key. Having a private system co-exist for a longer transition period would probably be necessary as well.

These ideas are in accord with the Urban Institute's analysis.

Senator Sanders and Rep. Conyers should be working with their colleagues and experts to flesh out the details and make this more than a symbolic exercise.

[ehrnst]

38. That would require having other people crunch the numbers...

And Sanders refuses to accept any dissent on his conclusions.

[andym]

46. Don't worry Sanders is only the sponsor/visionary-he did his part in moving the needle

It will be his co-sponsors who see this through to a detailed proposal that could be evaluated. And that will happen as they determine how to actually implement single-payer. It took thousands of hours to create the ACA and will take a lot of time to actually work out MFA.

[ehrnst]

55. And it will take 20 years to implement without huge disruption to health care

They overlooked that.

[andym]

62. MFA would radically change things, could happen quickly and would be disruptive in a good way

The conclusions that it would take 20 years to some form of MFA is not supported, since it will depend on how the plan is designed-- which is yet to be established. For example, MFA could be done very quickly, just a few years, if the old system is allowed to persist in some form at the same time, with increased regulation.

As for disruptive, it depends on what is meant mean-- "disruptive" in business is often a good thing-- that's how silicon valley innovators improve technology (the advent of DVDs meant the end or the VCR, and the advent of broadband and mobile internet meant the end of the DVD). "Disruptive" in people not having health care, won't happen, because there will be a lot of feedback about how to avoid it, since that would basically end its implementation midstream. "Disruptive" in pharmaceutical companies getting less for drugs-- very likely. Disruptive in medical professionals receiving less-- probably correct too. Disruptive to health insurance companies-- yes they would go the way of the VCR.

[ehrnst]

89. Disruption means disruption of delivery of care

which is never a good thing. Is that clearer?

Actually, those conclusions are supported.


And insurance companies are way, way larger and more baked in to the economy than VCRs were.

The majority of nations with Universal Health Coverage use multi-payer systems, and are not single payer. Even Medicare requires private insurance to pay for prescriptions, hearing aids and vision aids.

About 30 percent of all Canadian health care is financed through the private sector.

Most countries with “single-payer” systems rely on some combination of public insurance, various mixes of mandatory and voluntary private insurance (usually tightly regulated), and out-of-pocket expenditures (often with a cap). They offer free coverage for those who can’t afford it, but the exact benefits vary from country-to-country.

Germany’s “single-payer” system has 124 not-for-profit insurers participating in one national exchange. About 10 percent of Germans—the wealthiest ones—opt out of the national system and go fully private, and most of them buy plans from for-profit insurers.

The Dutch system is somewhat like Obamacare in that everyone must purchase insurance for basic services from private insurers. But the similarities end there: Insurers are barred from distributing profits to their shareholders, and a separate, entirely public scheme covers long-term care and other costly services. Premiums are subsidized, but most Dutch people purchase supplemental insurance to cover things like dental care, alternative medicine, contraceptives, and their co-payments.

The French system is often cited as the best in the world, and about a quarter of it is financed through the private sector. The French are mostly covered through nonprofit insurers in a single national pool, but most working people get their policies through their employers. Almost all French citizens either purchase government vouchers to cover things like vision and dental care, or are provided with them gratis if necessary. The system is financed through a complicated mix of general revenues, employer contributions, payroll taxes and taxes on drugs, tobacco, and alcohol.
................................................................................
We shouldn’t make promises that we aren’t going to be able to keep. “It’s not going to be easy to do,” Jacob Hacker says, “and anyone who tells you that the most expensive health-care system in the world is going to undergo a sudden shift to highly efficient and low-price medicine has not been studying American medicine.”

https://www.thenation.com/article/medicare-for-all-isnt-the-solution-for-universal-health-care/

What I’ve often said is we could have done this in the 1940s when Harry Truman proposed it,” said Starr, who has written at length on the history of American health politics. “Health care at that point was probably about 4 percent of [gross domestic product] and there existed at that time a relatively small private insurance industry.” Today health care spending in the U.S. is approaching 18 percent of the nation’s GDP and the private health insurance industry accounts for half a trillion dollars per year.

Both Starr and Pollack, however, said it would be possible to make a switch, although it would have to be carried out over a very long period of time.

“You could imagine some kind of long transition, where you gradually expanded Medicare,” said Starr, “for example moving it down to age 55” and then in later years continue to lower the age threshold.

http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

[andym]

94. Delivery of care will not be disrupted if universal healthcare is engineered carefully

By taking into account the potential problems, they can be avoided. Just like it's possible to get around the problems building electric cars that Tesla solved, when others claimed it was too difficult.

In fact, the Nation article you presented supports just this idea that universal health care can be achieved-- it clearly states that the current bill is not a detailed roadmap, which basically means it can't be analyzed accurately! Yes, the details need to be carefully crafted, but nobody is saying it can't ever work, or will require 20 years like you did. Anyone with political savvy knows that Medicare for All will look differently from how it being proposed by the 16 Democratic Senators or by Rep Conyers.

From the Nation:
"Harold Pollack, a University of Chicago public-health researcher and liberal advocate for universal coverage, says, “There has not yet been a detailed single-payer bill that’s laid out the transitional issues about how to get from here to there. We’ve never actually seen that. Even if you believe everything people say about the cost savings that would result, there are still so many detailed questions about how we should finance this, how we can deal with the shock to the system, and so on.”

Achieving universal coverage—good coverage, not just “access” to emergency-room care—is a winnable fight if we sweat the details in a serious way. If we don’t, we’re just setting ourselves up for failure."

They are not saying a successful roadmap is impossible! Nobody has said that it won't require a lot of thought and economic modeling to get it right. As I already suggested (but you ignored) one way to prevent disruption is to leave a regulated version of the current system intact while the transition is made-- I'm pretty sure that will be a real component of any proposed detailed bill-- in fact, it's not excluded that some highly regulated version of the current system continues to exist in parallel with MFA.

Given the brainpower behind the effort and the desire the succeed the problems can be worked out. As for the end result being a multipayer universal health care system like Germany, I don't think that is excluded. The absolute key as I wrote earlier is that the needle has been moved-- universal health care/single-payer is on the table, and if enough political will is exerted a universal health care plan will be enacted someday (after 2020 no doubt, given political realities). By pushing the needle to the single-payer extreme, the path to a workable solution is more probably as each potential problem is recognized and addressed and the legislaton adjusted accordingly.

[ehrnst]

103. Which as the UI analysis said, the Sanders plan would do far more than an

incremental approach on a longer timeline that what his plan says will work.

Also from the Nation article:

We shouldn’t make promises that we aren’t going to be able to keep. “It’s not going to be easy to do,” Jacob Hacker says, “and anyone who tells you that the most expensive health-care system in the world is going to undergo a sudden shift to highly efficient and low-price medicine has not been studying American medicine.”

Also you keep moving the fence on this - first you say that single payer is the same as universal health care, and anyone who doesn't support SP doesn't think healthcare is a right, or doesn't get goverment, then you say that you don't think that, and then you argue that maybe the UI analysis defintion of "disruption" isn't really the kind that's bad, then you say that there won't be any disruption if it's implemented "carefully" on a timeline that is different than what Sanders proposes, then you say that then you say that it doesn't really have to be implemented to be really good for the US.....

What is that supposed to tell me about your understanding of this thing you are "jumping on board with?"

It just sounds like you really don't care what it really involves, but won't own that you are cheerleading for this, and will simply rebut what ever real obstacles and problems someone presents to "believing" in it.

It's not dogma to me, any more than "climate change is a liberal hoax!" is.

I'm going to look at it for what it is, and not be distracted by what it claims to "represent." When Obama reassured people that "you can keep your doctor," he was trying to get people on board with the ACA. But that wasn't true, and it was used as ammunition by the GOP to discredit him for lying about the ACA.

And when the CBO numbers come out, if the bill gets that far, and they show that Sanders' bill costs way more than he says it will, that won't move the needle anywhere but backwards on how credible it is, and by extension the Democrats that have hopped on, as to how skilled they are at offering real solutions.

These are real solutions that can get more people covered way sooner than 2020:

The Solutions over Politics plan would:

Create an annual $15 billion reinsurance fund. ObamaCare had a reinsurance program for three years from 2014 to 2016 to provide payments to insurers that enroll higher-cost, sicker individuals.

Continue ObamaCare's insurer payments, which reimburse them for giving discounts to low-income patients. Insurers have blamed the uncertainty over whether these payments will continue as a reason for their proposed double digit rate increases in 2018.

Have "robust marketing strategies" to ensure that more people enroll during open enrollment periods.

Allow a buy-in option for Medicare for people nearing retirement age.

Expand tax credits by age, geography and income to help people buy insurance. Currently, about 84 percent of ObamaCare participants get a subsidy.

Expand the availability of catastrophic health plans that include essential health benefits and coverage for primary care for younger enrollees. These plans, meant to protect people from worst-scenarios, tend to have low monthly premiums and high deductibles.

http://thehill.com/policy/healthcare/341616-ten-house-democrats-propose-plan-to-fix-obamacare

[NastyRiffraff]

71. Sanders isn't good on details

So he gets the glory and everybody else does the grunt work. Nice work if you can get it!

[ehrnst]

90. But everyone is supposed to jump on board without knowing them.

Or they are "corrupt."

[andym]

95. We are jumping on board based on the principle of achieving universal health care

It's a matter of whether universal health care/single payer is a worthy goal. The details matter (see my discussion above), but first the goal needs to be set.

It's like President Kennedy declaring that within a decade the USA would land a man on the moon. He didn't know the details and neither did NASA when they started, but in less than 10 years the goal was realized.

Btw, the idea that opponents of universal healthcare are "corrupt" is counterproductive and silly, just like calling the critics of the possibility of humans flying in airplanes "corrupt." Opponents of universal healthcare may not believe in it by principle (healthcare as a privilege) or because they believe the government is incapable of such a large undertaking or they believe the current system is too complicated to ever make a transition to something better. But, for those of us who do believe in the healthcare as a Right, there is evidence that the government is more than capable (see reaching the moon as an example), and that the task is simpler than reaching the moon from a complexity viewpoint as well.

[ehrnst]

97. First off, Universal Health Care is not interchangeable with Single Payer

any more than Teacup Yorkie is interchangeable with canine, so the trope that anyone who thinks Single Payer isn't the best way, out of several, to get to universal healthcare is incorrect. Knowing something about what you are "jumping on board with," is important.

Most of the rest of the world uses multi-payer programs to achieve Universal Health Care Coverage.

The term “single-payer” is itself misleading. The truth is that many of the systems we refer to as single-payer are a lot more complicated than we tend to think they are. Canada, for example, finances basic health care through six provincial payers. Its Medicare system provides good, basic coverage, but around two in three Canadians purchase supplemental insurance because it doesn’t cover things like prescription drugs, dental health, or vision care. About 30 percent of all Canadian health care is financed through the private sector.

Most countries have mixed funding schemes that vary in complexity, and the term “single-payer” may be giving some people a false promise. Conyers’s Medicare-for-All bill promises to cover virtually everything while banishing out-of-pocket costs, but no other health-care system offers such expansive benefits. Even people living in Scandinavian social democracies face out-of-pocket expenses: In 2015, the most recent year for OECD data, the Swedes covered 15 percent of their health costs out-of-pocket; in Norway, it was 14 percent and the Finns shelled out 20 percent out-of-pocket.

So, by your definition, nearly all of the countries that have achieved universal health care, "Don't have it," "don't believe in it, "and don't see healthcare as a right." Which is clearly not the case at all.


Now that you know the difference between the terms "single payer" and "universal health care" dismissing all people who are able to distinguish between with backhanded demonization like "they don't believe health care is a right" or just don't "believe" in Universal Health Care is not only misinformed, it's insulting and counterproductive. Nearly as much as when Single Payer or bust advocates say that anyone who sees real problems with focusing on the one most expensive and hard to implement path to Universal Coverage is "corrupt," and a "stooge for big insurance."

So, are we clear on that now?

But there are several paths to universal health care coverage. Single-payer can be one of them — but it isn’t the only one. Indeed, many countries have reached the goal using methodologies other than single-payer, including varying blends of public and private coverage.

Too many progressives and others fail to distinguish between “universal coverage” and “single-payer.” The terms are used interchangeably in private conversations and in the national arena.

As we consider the most effective strategy for achieving universal coverage, progressives should keep two admonitions in mind. First, we must not conflate our foremost health care goal (universal coverage) with competing pathways toward achieving that goal. Second, recognizing that our differences are about strategy and not final goals, the dialogue should be undertaken with mutual respect.

https://www.vox.com/the-big-idea/2017/9/8/16271888/health-care-single-payer-aca-democratic-agenda

Medicare-for-All is really smart politics. Medicare is not only popular, it’s also familiar. Many of us have parents or grandparents who are enrolled in the program. And polls show that a significant majority of Americans now believe that it’s the government’s “responsibility to provide health coverage for all.”

But from a policy standpoint, Medicare-for-All is probably the hardest way to get there. In fact, a number of experts who tout the benefits of single-payer systems say that the Medicare-for-All proposals currently on the table may be virtually impossible to enact. The timing alone would cause serious shocks to the system. Conyers’s House bill would move almost everyone in the country into Medicare within a single year. We don’t know exactly what Bernie Sanders will propose in the Senate, but his 2013 “American Health Security Act” had a two-year transition period. Radically restructuring a sixth of the economy in such short order would be like trying to stop a cruise ship on a dime.

Harold Pollack, a University of Chicago public-health researcher and liberal advocate for universal coverage, says, “There has not yet been a detailed single-payer bill that’s laid out the transitional issues about how to get from here to there. We’ve never actually seen that. Even if you believe everything people say about the cost savings that would result, there are still so many detailed questions about how we should finance this, how we can deal with the shock to the system, and so on.”

https://www.thenation.com/article/medicare-for-all-isnt-the-solution-for-universal-health-care/

BTW - the space race was part of the Cold War effort to get to space and neutralize Soviet satellites, and JFK's moon shot speech was a way to get the public behind the spending on that program.

Believe me - if Universal Health Care coverage was in any way useful to neutralize ISIS, DT would be out giving speeches as to how it will Make America Great Again.

But hey, who knew health care could be so complicated?

[andym]

98. Agreed that Single payer is but one way to achieve Universal Health Care

And Universal Health Care is the goal. From my postings I thought it would be clear to you from my posting agreeing that a multipayer system may well be the final result of the Medicare for All bill after the details are worked out. I see you didn't really address my points that this bill is a good way to get the ball rolling on universal healthcare and that the details may well be very different.

As for the "stooge and corrupt" comments-- I never would agree with anyone making such remarks, but that is irrelevant to the issues at hand.

[ehrnst]

100. You wrote:

Last edited Mon Sep 18, 2017, 03:42 PM - Edit history (1)

"It's a matter of whether universal health care/single payer is a worthy goal."

You did not distinguish between them, and you judged anyone who didn't support single payer as not supporting healthcare as a right, and not thinking universal health care is a "worthy goal."

I responded to your comments in this thread, not others.

Is that clearer?

[andym]

117. Post 94 is in this thread-- and makes my meaning clear

"Given the brainpower behind the effort and the desire the succeed the problems can be worked out. As for the end result being a multipayer universal health care system like Germany, I don't think that is excluded. The absolute key as I wrote earlier is that the needle has been moved-- universal health care/single-payer is on the table, and if enough political will is exerted a universal health care plan will be enacted someday (after 2020 no doubt, given political realities). By pushing the needle to the single-payer extreme, the path to a workable solution is more probably as each potential problem is recognized and addressed and the legislation adjusted accordingly."

It is often useful to integrate the points made during an ongoing discussion, keeping track of who is saying what, in order to avoid intercommunicating and having a more fruitful discussion.

[Orsino]

87. There are other sponsors.

And if none of them are willing to discuss these matters, the bill won't get far.

We can make Sanders completely irrelevant if we want to. We can phase it in as slowly as we want, we can load it up with as many Republican amendments as are needed to pass it.

No one needs to be afraid of the result getting called SandersCare unless it passes, in which case it might be something good and therefore worth the swallowing of pride.

[ehrnst]

104. Do you see any of them dissenting with him on his bill in any way?

Do you think that Sanders will walk away from this bill that he has created?

Do you think that Sanders will tolerate being made "irrelevant" to that passing of this bill?

Do you see any sign that Sanders has considered the results of the UI crunching of the actual costs he puts forth in this 2016 plan in any way but negative?

If the assumptions on what the actual costs and affects on the health care delivery are off, no amount of filling in details will make that different.

If you say to an architect/builder: "I have a budget of $300,000 want a house with 8 bedrooms, 6 bathrooms, a state of the art kitchen, a home theatre, solar panels, geothermal hvac, and a pool in the basement. Installing those solar panels and geothermal will make this project way more affordable in the long run than other homes this size," no amount of finessing the details is going to make that a reality.

[Orsino]

105. What Sanders will "tolerate" is irrelevant.

He doesn't get to block amendments, and is only one voice in any other negotiations.

[ehrnst]

108. Sanders is the author of the bill, and what he "tolerates" in terms

of the crafting of the bill is very relevant, wouldn't you say?

Because that's what I was talking about.

Is that clearer?

[Orsino]

110. Not clearer.

What are you saying he would and could block, that you might otherwise like to see changed?

[ehrnst]

111. It didn't claim to know any of that. I think you are the one who isn't clear.

I simply said that he is someone who doesn't take criticism or change easily, and that the 2016 plan he crafted would likely not change much when presented in 2017.

The UI analysis was on the 2016 bill.

Still with me?

My understanding is that he crafted the 2017 bill and now the bill has co-sponsors. My prediction is that he would not change much from the 2016 bill. I have not seen a detailed analysis of it by health policy wonks yet, but here is a sketch of it:

https://www.theatlantic.com/politics/archive/2017/09/bernie-sanders-single-payer-health-care-legislation/539676/

But as we all know, a GOP led house and senate won't go anywhere near it, which is probably why Sanders didn't see a need to provide any details on the funding mechanisms.

You can offer the moon if you know that no one will really expect you to follow through.

[Orsino]

112. I have failed to understand you.

That Sanders himself might or might not change in some unspecified aspect doesn't have anything to do with a final form of a bill or law, does it?

[ehrnst]

113. One can discuss the personality traits of a lifelong politician

separately from the contents of their individual bills.

Yes, this trait does lead me to believe that his 2017 bill will not be substantially different than his 2016 plan.

Is that clearer?

[sheshe2]

17. Thank you for this information, ehrnst.

It will take me some time to read the rest, there is a lot to absorb.

[JHan]

18. Kicked and rec'd

Bookmarking too

[clu]

19. michael moore stated as much in sicko

they interview a UK internal med doc and he only earns $80k gbp with i'm sure a generous pension. yes this will be unpopular but consider the number of health care practitioners who still support it. if you're crafty with accounting and managing, maybe you could arrange for free airline miles or discounted vacations for providers who have to take a bath.

[ehrnst]

58. Are you on the right thread?

I have no idea what you are trying to say.

[MrsCoffee]

75. Nope.

Not even on the right message board. I guess that explains "posting privileges revoked".

[Orsino]

20. America is the only industrialized nation in the world incapable of implementing universal coverage.

...say the nay-sayers.

Of course it's disruptive. So has been leaving Americans helpless before monster insurance companies. We just have to fucking choose what sort of disruption we'd rather spend on.

My main concern has been the large segment of the population currently employed by private insurers. Wiping out their jobs with a stroke of a pen seems unwise. However, implementation of single-payer is likely to be phased in, as is any big change (as with ACA). If what comes of the current Medicare-For-All push is ultimately a compromise in which fifty-seven-year-olds are rolled in, or in which fifty-five-and-up can buy in somehow, that's a win...and the basis for more wins.

Pushing for a public option got us ACA. Who the hell wants to stop now?

[ehrnst]

25. No other nation went to single payer from the system that we have now.

...say those with the facts.

Single Payer in 8 years (which is what Sanders wanted to do in this plan) is FAR more disruptive than incrementally expanding the ACA. There are different option with different levels of disruption - to simply say all disruption is the same, or somehow is less disruptive than our current system shows a lack of understanding of the situation.

" in which fifty-seven-year-olds are rolled in, or in which fifty-five-and-up can buy in somehow, that's a win...and the basis for more wins. " - which was HRC's plan, along with pushing for a public option.

Canada didn't go single payer until all the provinces had established their own independent systems, which took nearly 20 years then a very liberal government was elected, who switched it over to federal - and it was STILL being tweaked in 1989. That's not going to happen here - especially after Vermont's failed attempt, and Coloradocare being voted down last November.

So, no they didn't go from what we have to single payer, and they didn't do it in 9 years.

The UK went from NO system in the 20's expanding to what they have now. People in the 20's were just happy to have a doctor, let alone wanting to keep their primary physician, and there wasn't the expense of major medical procedures we have now, NICUs, MRIs, etc to cover. People died earlier then, and the cost wasn't as prohibitive to cover a person. People in the US have much, much higher expectations of coverage and care than Brits did in the 20's, and accepted far less as acceptable. I loved the care I got when I was there, because I had nothing before. The local clinic looked more like a DMV office, and you know that in this "anti-government" culture, people who have insurance now are not going to like that. So, no, they didn't go to Single Payer from what we have now.

[sheshe2]

45. Thank you so much for this history.

The history of other countries and the years that it took for them to get where they are today.

[Orsino]

53. No other nation ever had what we have now.

And no other nation got to single-payer by saying they couldn't get to single-payer.

It doesn't matter how hard it is, or what HRC's plan used to be, or what anyone's bill looks like right now...because the bill just introduced isn't going to pass either house in its current form. Saying no gets us nowhere, but we can entertain a variety of "no, but" or "yes, but" positions on our way to something better.

Medicare-For-All isn't going to pass or be signed into law this year. But if we can get Medicare-For-Most, or just Medicare-For-Some-More two years from now, we win.

[ehrnst]

54. It's going to take way longer than two years

and anyone telling you it can be done in under 20 years doesn't know what they are talking about, or doesn't want you to know that they don't.

Not other nation got to single payer by saying they can't.... this is health policy in the real world, not the Little Engine that Could.

Magical thinking doesn't make something possible. And the vast majority of other developed nations got UHC with multi-payer systems, so it's not really neccessary to implement single payer.

[Orsino]

81. We already have single-payer. More than one such system.

We could expand one to take on more people without having to alter plate tectonics...though I agree the evolution to a single single-payer system is the work of decades. ACA is a step along that path, if enough of us so decide.

But I'm repeating myself. No need to complain that some bill we haven't seen yet isn't going to pass this year, or that some other bill we haven't seen won't evolve for another twenty. I want more people covered as soon as possible, and I won't complain if it happens via something we call an ACA patch.

Anything further that takes shape doesn't have to be hated just because Sanders is one of its sponsors.

[ehrnst]

82. That's what HRC proposed - incrementalism.

Expand Medicare gradually - letting 55 year olds buy in at a slightly higher premium, give it time to adjust and tweak it. Then expand CHIP to all kids through age 18, and give it time to fine tune and tweak. Add a public option for those who qualify, then expand the pool that qualifies gradually, and tweak.

Because as we all know, nothing that involves an expansion of public service is going to be perfect out the box - and the minute there is a problem (ACA website rollout, for example) it will be used as amunition by the GOP to stir public sentiment against it.

The claim that the reason that anyone wouldn't be on board with his plan is that they "hate" Sanders, isn't valid. You don't hate Sanders, and yet you see that there are some definite compromises that could be made.

That just makes people dig in and make it about defending Bernie, instead of looking at the plan with a clear eye, and accepting that independent analysis that doesn't back up the costs in Sanders' bill, or makes the case that implementing it isn't "attacking" Bernie.

[Orsino]

83. The bill ain't done yet.

We don't need to quibble over costs yet. Well, we do and will, but we don't need to say no yet.

[ehrnst]

84. Like I said

Sanders isn't known for taking criticism or disagreement with his ideas gladly.

I don't predict much of a change from the 2016 plan, but I could be wrong.

[Orsino]

86. There's no need to fixate on Sanders...

...particularly since the bill has co-sponsors willing to get behind it at this stage.

[ehrnst]

91. He is the one who introduced the bill, and is talking most about it.

His is the name that mentioned in every article on the bill, and he is certainly not telling people that crafting it was a group effort.

Just google single payer 2017.

[Orsino]

93. That's not a good reason to oppose the bill.

Unless there's some mad crush of Sanders support about to manifest out there, the heavy lifting is going to be done--if it gets done--by Dems.

[ehrnst]

101. Strawman. I never said it was.

I said that pointing out that Sanders was the author of the bill, introducer of it, and presents himself it as such isn't "fixating on Sanders."

Read that thread if you don't believe it.

[Orsino]

106. Then why is it we should care about how he takes criticism?

What would that have to do with whether or not the eventual bill is worth supporting?

[ehrnst]

107. That wasn't my point. Another strawman.

I don't care whether or not he takes criticism. That's his issue to deal with.

Someone said that the analysis was of the 2016 bill, so we didn't know what the 2017 bill would entail.

I am saying that is that the content of any previous version of any plan Sanders has authored will likely not change much in a newer version of a Sanders bill on the same topic.

Is that clearer?

[Orsino]

109. Sanders has a say in what goes into the bill, but no more than any other co-sponsor.

And nothing is going to pass without being watered down by two parties and a whiny baby of a president. Sanders would likely get a disproportionate share of the eventual credit (if he can stand to keep his name on whatever results), but no, he cannot keep the bill from getting improved/compromised/fucked over.

It's not a strawman to ask why you would bring up an alleged resistance to compromise on Sanders' part, especially if you say you don't care about it.

[ehrnst]

114. I think you don't understand what co-sponsors do.

In contrast to a sponsor, a "cosponsor" is a senator or representative who adds his or her name as a supporter to the sponsor's bill.

Sixteen Democrats — including potential 2020 presidential candidates — have lined up behind his "Medicare-for-All" bill.

https://www.cnbc.com/2017/09/14/what-sen-bernie-sanders-medicare-for-all-bill-could-mean-for-you.html

Now, Bernie is calling the bill his bill. He has not said that it's "his and Kamala Harris' bill" or any of the number who are jumping on the co-sponsor train prior to re-election campaigns beginning.

To wit:
http://www.cnn.com/2017/09/13/politics/bernie-sanders-medicare-for-all-plan-details/index.html


Are you clearer now on who is taking credit for authoring the bill?

And yes, Sanders has a reputation for not compromising, or taking counsel from anyone who disagrees with him. I personally don't think that's a trait that makes for getting a lot done with other people. There isn't any reason I find to think that he would change now - in fact quite the opposite.

If you want to say that he is sharing authorship of this bill with anyone - please provide a link, because all of the media on it is calling it his...

[Orsino]

115. News stories calling it "his" bill...

...have nothing to do with who has the power to do what with the bill after it is presented. He introduced it, and now we are at the stage where co-sponsors can jump on. It's already being fiddled with in private. If it ever makes it to committee, it will be with the support of many other senators, and if it makes it out of committee, then it'll bear more resemblance to whatever its final form is. But the process of becoming law is much more lengthy and complicated. It's going to need people from both parties willing to vote for it and a House bill, then a reconciliation, and then a president may have to be sweet-talked.

Credit for authoring the bill is irrelevant to getting some law out of it. Anyone's reputation for not compromising is also irrelevant. Many, many fingerprints will get on this thing, or it won't become law.

[ehrnst]

116. Your source for "it's being fiddled with in private?"

And I guess you haven't been reading any news on the topic, because it's all about "Bernie Sanders' Medicare for All" bill.

Sources please.

[Orsino]

119. Getting hung up on a name bandied about in the news isn't analysis.

Of course journalists need a pithy way to refer to it.

But anyone who believes that a bill in its early life isn't the subject of public or private discussion and negotiations is going to assume the burden of proof. Sponsors, with varying degrees of urgency and engagement, are on the phone discussing it with other senators. While I would hope that Sanders himself is taking the lead, we'll never know for sure who did exactly what. That's how it is with every bill, even ones produced purely for political pageantry.

[ehrnst]

120. So you have no source for "it's being fiddled with in private" at all.

"Burden of proof" is on the person making the claim.

And that is you.

[Orsino]

121. We all know how laws are made.

People who sponsor a bill might choose to do nothing, but that is unlikely. Anyone senator who truly wants something like that bill to become law is already on the job, trying to drum up support among colleagues.

Unless there's reason to believe that Sanders and all the co-sponsors have decided to abandon the concept, yes, they are negotiating.

[ehrnst]

122. Bernie is not known for drumming up support among his colleagues to write a bill.

He's known for doing things his way, on his own.

You can't back up your claim with any evidence that refutes every single statement Sanders has made about his bill. But that doesn't stop you from posting.

[Orsino]

123. That's a strange assertion.

We know of no agreement among co-sponsors that there is to be no negotiation at all, or that they imagine their bill could become law without input from the rest of the party, with the rest of the Senate, with the House, or the president.

Such a thing could happen on some other planet, but not this one.

[ehrnst]

124. Your statement that he is tweaking it with other Senators has the burden of proof

on this planet.

[Orsino]

125. Every bill on this planet is getting tweaked. n/t

[ehrnst]

127. Not having started as being co-written, like you are claiming.

Burden of proof is on you....

[Orsino]

131. Wait, what?

What started as being co-written?

[ehrnst]

132. "But anyone who believes that a bill in its early life

isn't the subject of public or private discussion and negotiations is going to assume the burden of proof."

As I said to you, the burden of proof is on you to show that Sanders didn't write the bill that he is saying is his, and included others.

Again, the Sanders campaign rejected the analysis of UI on the numbers in his 2016 plan, so I'm not seeing much evidence that he accepts outside critiques on his M4A plan.

[Orsino]

134. That's a truly weird postulate.

I don't know or care who typed the words into whatever the first form of the bill was. We are still in the bill's early life now (on any path toward becoming law). You and I both know that now that it's a bill senators will be discussing what should be done to move it forward and what might have to change. These are called negotiations, and if you believe these aren't happening, I would like to know why.

What is special about this bill that you would believe that no one beyond its first sponsor is allowed to touch it, or talk about its future? Are you saying that it is essentially a prank, never meant to get voted on?

[ehrnst]

135. So now you say who wrote and edits the bill isn't important but it DEFINITELY isn't just Bernie...

I assume that you still have no evidence to back up the claim that "it's being fiddled with in private" by many, and are trying to switch the topic.

I posited that Bernie likely won't have changed much from his 2016 iteration, because he's not known for collaborating, or accepting criticism from those that don't agree with him (as his campaign's pushback on the UI analysis illustrates), and all media mentions are that it's "Sanders' Medicare for All" bill.

You state that there are co-sponsors, so he's not just doing it himself.

I point out that co-sponsors come on after the bill is written.

You say that no, there's no reason to think that, because "everybody knows" that bills are always written by several people. And you know that it's "being fiddled with" behind the scenes by those co-sponsors.

I ask you to back that claim up.

Now you say that "you don't care who typed the words or whatever the first form of the bill was." And ignoring all that I have posted, you say "What is special about this bill that you would believe that no one beyond its first sponsor is allowed to touch it, or talk about its future? Are you saying that it is essentially a prank, never meant to get voted on?" which is a complete straw man.

You can't back up your version of who authored the bill (despite Sanders and the media telling you) except that you want to disagree with anything I say, to the point of trying to derail the topic, and throwing up strawmen.

I'm out of the discussion.

Now go ahead and post a screed about how I am wrong, yet again.

[Orsino]

136. So this is your contention?

That this bill is special, unique even, and isn't yet being worked on and renegotiated by its multiple sponsors and supporters? That nothing will ever change in its wording because Sanders won't permit it?

That's weird.

[QC]

31. Here's the Urban Institute's Sourcewatch page.

They have some interesting funding sources, like Pfizer and CIGNA.

They're also into vouchers and all that other school profitization racket.

http://www.sourcewatch.org/index.php/Urban_Institute

It's always good to check Sourcewatch when reading the work of one "think tank" or another. They all claim to be scholarly and objective and all that. Hell, ALEC calls itself an educational charity.

[clu]

32. a girlfriend's son

went to a charter school - they weren't allowed to take textbooks home

[QC]

34. The last VHS rental/tanning salon combo in my town just became a charter $chool.

So wonderfully liberal! And don't get me started on how downright leftist Pfizer and CIGNA are!!!

[ehrnst]

41. Well, that settles it then. Urban Institute can't be trusted!!!!

[Major Nikon]

48. They would have been more trustworthy had they revealed their conflict of interest in the analysis

[ehrnst]

60. So tell us - just how much of their budget is from those sources

Since you seem to have the skinny.

Please do.

Because I don't think you actually know what it is. But that would be harder than dismissing it out of hand without knowing what you are talking about.

Of course that would mean acknowledging that not everything is black and white, pure or evil. And it takes actual effort.

Proceed.

[Major Nikon]

68. I don't know what it is, nor do I really care

What I do know is they took money from CIGNA and Pfizer without disclosing that conflict of interest in a report intended to influence public policy. The amount is irrelevant. Whatever that amount was it may have influenced their outcome or maybe it didn't, but to me that makes them lest trustworthy for not disclosing it. YMMV.

[ehrnst]

69. Of course you "don't care." Facts will just burst your confirmation bias.

It's a liberal think tank, not a corporate shill. You can still read if you put your hands over your ears and yell LA LA LA, I CAN'T HEAR YOU!!!

The Urban Institute was established in 1968 by the Lyndon B. Johnson administration to study the nation’s urban problems and evaluate the Great Society initiatives embodied in more than 400 laws passed in the prior four years. Johnson hand-selected well-known economists and civic leaders to create the non-partisan,[dubious – discuss][citation needed] independent research organization. Their ranks included Kermit Gordon, McGeorge Bundy, Irwin Miller, Arjay Miller, Richard Neustadt, Cyrus Vance, and Robert McNamara.[4] William Gorham, former Assistant Secretary for Health, Education and Welfare, was selected as its first president and served from 1968-2000.

Gradually, Urban's research and funding base broadened. In 2013, federal government contracts provided about 54% of Urban's operating funds, private foundations another 30%, and nonprofits, corporations and corporate foundations, state and local governments, international organizations and foreign entities, individuals, and Urban's endowment the rest.[5] Some of Urban's more than 100 private sponsors and funders include the Annie E. Casey Foundation, the Ford Foundation, the Robert Wood Johnson Foundation, the Henry J. Kaiser Family Foundation, the Charles Stewart Mott Foundation, and the Rockefeller Foundation.[6]

[George II]

70. People have been saying that on DU over and over again - anyone know if they REALLY....

..."took money from Cigna and Pfizer"? Where did this actually come from?

Their annual report (which can't be falsified!) show that they receive 1.4% of their funding from "corporations", ALL corporations.

This false information does no good.

[ehrnst]

85. You think that Sourcewatch is trustworthy?

Their research consists of copy and paste from wikipedia, with whatever contradicts their statements edited out.

See for yourself:

http://www.sourcewatch.org/index.php/Urban_Institute

https://en.wikipedia.org/wiki/Urban_Institute

If a student turned that in as research on UI, they would be failed for plagurism...

[ehrnst]

35. They are a very reputable source in health care policy, so

Into the vouchers "racket?"

Because they are not as left wing as sourcewatch?

Because they have gotten funding from various sources? Why not list all the sources that think their work is important:

Gradually, Urban's research and funding base broadened. In 2013, federal government contracts provided about 54% of Urban's operating funds, private foundations another 30%, and nonprofits, corporations and corporate foundations, state and local governments, international organizations and foreign entities, individuals, and Urban's endowment the rest.[5] Some of Urban's more than 100 private sponsors and funders include the Annie E. Casey Foundation, the Ford Foundation, the Robert Wood Johnson Foundation, the Henry J. Kaiser Family Foundation, the Charles Stewart Mott Foundation, and the Rockefeller Foundation.[6]

Now there's a bunch of shills....

The idea that anyone, no matter how much of an expert they are, who disagrees with Sanders is corrupt is now dogma, it appears.

But hey, if it doesn't support confirmation bias, then it's not worth anything. See also, climate change deniers.

[QC]

39. You're right. CIGNA and Pfizer just want what's good for America,

Sourcewatch is a buncha commies, and policy shops are not influenced by their funding sources, not at all influenced by them.

[ehrnst]

40. Yeah, they dissed on Bernie's legislation - total corporate shills.

Can you tell me what research was funded by CIGNA and Pfizer, since you have the goods on them?

ST A T E M E N T O F IN D E P E N D E N C E
The Urban Institute strives to meet the highest standards of integrity and quality in its research and analyses and in the evidence-based policy recommendations offered by its researchers and experts. We believe that operating consistent with the values of independence, rigor, and transparency is essential to maintaining those standards. As an organization, the Urban Institute does not take positions on issues, but it does empower and support its experts in sharing their own evidence-based views and policy recommendations that have been shaped by scholarship.

Funders do not determine our research findings or the insights and recommendations of our experts. Urban scholars and experts are expected to be objective and follow the evidence wherever it may lead.

That's from the actual document, in case you couldn't get past the challenge to your confirmation bias to bother to read the link. Yeah that list that includes KFF and others are just fools. You should send them your link to let them know that they have no clue as to who they are trusting with partnerships.

Just like I tell climate change denier to give that big government shill NASA a scolding for being a shill for Obama...

[QC]

47. As shocking as this might seem,

not everyone views every issue through the lens of message board squabbles.

Crazy, I know, but please bear with me.

I'm in higher ed, so I follow the new research pretty closely, since it effects--for good or ill and lately mostly for ill--the work I do.

Much new "research" is the work not of university scholars but of policy shops. The most influential are funded by Gates, the Lumina Foundation (a front for Sallie Mae, the student loan kingpin), and Google. Not surprisingly, research funded by those outfits tends to support the agendas of their benefactors, by, for example, pushing to let people use federal financial aid for non-degree credentials (more student loans are good for Sallie Mae) or advocating greater use of technology, such as putting the children of The Teeming Unwashed Masses in MOOCs. (Gates and Schmidt, of course, will continue to send their precious little ones to real schools.)

When I read new "research," I always check out the funding sources. The fact that a given donor funded a given study doesn't mean that it's bogus, but it's always good to be aware of hidden agendas and conflicts of interest, of which there are so many as to give rise to the term "policy-based evidence making."

I also encourage my students to check their sources when writing their research papers. Knowing that the Center for Consumer Choice, which sounds all noble and freedomy and everything, is actually a lobbying outfit funded by the booze, tobacco, junk food, and puppy mill interests is important.

If you're interested in how the various "centers" and "institutes" and "foundations" and other "philanthropies" have distorted public policy research in this country, you might want to take a look at David Callahan's 'The Givers: Wealth, Power, and Philanthropy in a New Gilded Age' and Lindsey McGoey's 'No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy."

Last, it's nice that you are so pleased to have learned about confirmation bias. You might also want to look up the Dunning-Kruger Effect.

[ismnotwasm]

49. You are saying the report has bias because of source funding?

That the authors have an agenda? Am I correct?

[ehrnst]

57. So why don't you tell us what the source funding of this report is?

Since you are convinced of conflict of interest.

And I'm sure that the Kaiser Family Foundation will want to know, since they partner with the Urban Institute, and clearly don't know as much as you do about the nefarious "policy shops."

The Dunning-Kruger Effect shiv is pure projection, sweetie:

"In 2010, industry funders of the Urban Institute included CIGNA Corporation and Pfizer"

[ehrnst]

80. Do you also tell your students that a source that presents a barely edited Wikipedia copy/paste

as research is a go to for information?


http://www.sourcewatch.org/index.php/Urban_Institute


https://en.wikipedia.org/wiki/Urban_Institute

[ehrnst]

42. OMG you are totes right! Just look at this research that COMPLETELY

shills for BIG INSURANCE!!

They use MATH!!! And other "establishment corporate tools"!!!!


https://www.urban.org/sites/default/files/publication/33736/413282-Narrow-Networks-Access-to-Hospitals-and-Premiums-An-Analysis-of-Marketplace-Products-in-Six-Cities.PDF

[George II]

51. You keep bringing up Sourcewatch and their inaccurate comment about Cigna and Pfizer. Why?

[ehrnst]

56. Because it means they don't have to read or learn something they don't wanna. (nt)

[ehrnst]

37. Well, I guess that makes Al Franken a shill

His daughter is the director of extended learning at DC Prep, an organization in Washington that manages charter schools.

http://www.nytimes.com/2011/10/02/fashion/weddings/thomasin-franken-brody-greenwald-weddings.html

No wonder he won't run for POTUS. This would NEVER pass with the purity guardians if he ran against Bernie. His family would be savaged worse than Kamala Harris is.

[George II]

50. According to the Urban League's annual report only 1.4% of their funding comes from....

....corporations, ALL corporations from all industries.

That comment on your source, "In 2010, industry funders of the Urban Institute included CIGNA Corporation and Pfizer" is outdated, selective, and subjective. Most importantly it's inaccurate.

[ehrnst]

61. But that's NO FAIR!!!!

You actually looked at FACTS!!!!

STAAAAAAAAAAHHHHPP!!!

[George II]

63. They have four or five annual reports and also audited financial statements on their site....

...I'm not an accountant or anything, but it's pretty evident that they're politically neutral. In fact, there's even a page detailing their funding principles:

https://www.urban.org/support/funding-principles

[ehrnst]

64. Evident to those not suffering Dunning-Kruger Effect. (nt)

[Not Ruth]

33. Sounds like it is something worth doing

[ehrnst]

36. Even though there are options that are much less expensive and disruptive

that will get us to Universal Health Care coverage?

Why?

[murielm99]

44. K&R

[NastyRiffraff]

72. Thanks for posting this

Whether you agree or disagree with Sanders's current proposal, it's important information.

I think we can all agree on the goal of Universal Healthcare, but the Sanders bill or single payer isn't the only, or the best, way to get there. I realize this is heresy, but we need to pay attention, and get something going that can actually pass.

[heaven05]

73. puts EVERYTHING

in clear, concise unassailable perspective....why does sanderscare want to get rid of ACA so badly when the RW is already trying to assassinate a KEY program associated with a 1st class POTUS....I just don't understand the reasoning here....especially since it also would take care from 20-25 million people on ACA, proven effective as care for them and cause immense upheaval....again.

[stevenleser]

77. More evidence why I think we should be working to architect a two-tier or dual-tier system from the

get go and not Single Payer. Again the model is France which just happens to have the best health delivery outcomes of any system in the world.

I don't know why this doesn't get traction.

[ehrnst]

92. Because that's not 'hopeful' and it's not what Bernie has been

advocating for.

[GaryCnf]

126. Racking my brain here

Let me try and remember . . .

What was going on in May of 2016?

Hmmmmmmm

Oh yeah . . . the Democratic Presidential primary!!!!!!!

I knew I had seen this before!!!!

But aren't we supposed to not be re-f . . . ?

Oh never mind.

[ehrnst]

128. This may help:

Last edited Wed Sep 20, 2017, 02:34 PM - Edit history (1)

Sanders is introducing a "Medicare for All" bill. We don't know what's in it yet.

He also had a "Medicare for All" plan in 2016, and that is the one with the most recent in-depth analysis, and therefore would be relevant to discussing what might be in this bill.

Is that clearer?

[GaryCnf]

129. Here's something even clearer

If you are using the desktop version of the Democratic Underground website, type the words "urban institute sanders" (capitalization doesn't matter) in the box in the upper right hand corner of the page next to Google's trademarked image.

The results will indicate the date. Find the results from May of 2016 and click to follow the links. Evaluate: (a) whether the OP you find was made regarding a primary issue; and, (b) whether the OP was identical, or very nearly so, to the instant OP.

Because I am not here to refight the primaries, I will not be posting the reaction from public health professionals and physicians upon seeing this "in-depth analysis."

Btw, it's 96 pages long. We know what's in it.

[ehrnst]

130. Check the date on the OP.

Mea culpa, the bill had been released less than 48 hours earlier, but there was no such comparable in-depth analysis of it by any health policy wonks.

However, people had been talking about it on DU, as though it was completely feasible.

So I decided to post the most recent in depth analysis of his M4A plan, the most recent version of which was in May 2016.

Also, discussing anything prior to July 2016 does not = discussing the primary. If something related to what a candidate proposed is being discussed, then that's not refighting the primary.

I'm sure that those who are angry at me for my lack of "getting with the program!!" as the boy scouts say, and casting an eye to the actual content before accusing anyone who disagrees with Bernie as being "against health care as a human right!!" are suprised that my post hasn't been taken down for "refighting the primary" and "don't bash Democratic leaders" after what I can only guess are countless alerts.

But here it still is.

And yes, people have posted the backlash against this study. And I have posted the response of UI to that backlash.

https://upload.democraticunderground.com/10029596950#post12

[ehrnst]

133. This is the closest I've seen to an anlysis comparable to the UI analysis of the 2016 bill

However, it's still really just a summary, and not an in-depth dive into checking the numbers, timeline and consequences of the 2017 iteration:

http://healthaffairs.org/blog/2017/09/14/unpacking-the-sanders-medicare-for-all-bill/

However, this has not changed - the timeline:

"This bill establishes a federally administered Medicare-for-all national health insurance program that will be implemented over a four year period."

Which was addressed in the 2016 UI analysis:

Finally, moving to a single-payer system would be highly disruptive in the near term. When the ACA required people to give up private insurance plans that were less costly than those available in the reformed nongroup market, some vocal complaints led to quick administrative action to increase opportunities for people to keep non-ACA compliant plans longer. The ACA’s changes to the health insurance system and the number of people affected by those changes has been small compared to the upheaval that would be brought about by the movement to a single-payer system