Democrats Unite, But What Happened To ‘Medicare For All’?

[ehrnst]

"Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress.

“To try to do it in one fell swoop would be massively disruptive,” said Paul Starr, a professor at Princeton who was a health policy adviser to President Bill Clinton."

.....................................................................................

And it’s not just the private insurance industry (which would effectively be put out of business) that could feel the impact to the bottom line. Parts of the health care industry that lawmakers want to help, like rural hospitals, could inadvertently get hurt, too. Many rural hospitals get paid so little by Medicare that they only survive on higher private insurance payments. Yet under single-payer, those payments would go away and some could not make it financially. “You would not want to wipe out a third of the hospitals in Minnesota by accident,” Pollack said. “And you could,” if payments to hospitals end up too low.

Pollack agreed, and pointed out it’s not just the health care industry that could revolt. When the Affordable Care Act was rolled out in 2013, he said, “the people who couldn’t keep their old plans — a very tiny number as a percent of Americans” were furious. “We saw how difficult that was and how angry the public was when that promise wasn’t kept. Now imagine the major shift we’d have to do to move to a single payer system.”

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

[merrily]

1. Bull puckies. If you poll people about Medicare for All, most of them want it.

http://pnhp.org/blog/2016/03/01/kaiser-poll-suggests-support-medicare-for-all-is-more-than-two-thirds/

Close your eyes and imagine what this country would be like if we never changed anything unless we had unanimous agreement to each change.

[ehrnst]

4. Did you read the part about the consequences of implementation?

If you polled everyone, you would also find that they want lower taxes at the same time they want more services, better schools, etc.

A huge number of people also didn't support the ACA, until they were educated on what was actually in it.

What the public supports in a poll is not always possible in terms of actual policy. I don't think that the poll included being willing to pay higher taxes, the closing of many rural hospitals, and rolling out something even larger than the state exchange websites that will impact your ability to access your health care.

Here is the poll you are referring to broken down - there are those that strongly oppose it as well as some that "somewhat favor" "medicare for all"



Another Kaiser poll also found this: Looking specifically at Democrats, just 5 percent say they favor Medicare-for-all and that a candidate’s support for it will be the single most important factor in their vote.

GOP candidates would take that as reason to oppose it strongly. And we see how they have chipped away at the ACA over the years. Do you really think that there is going to be support for Medicare for All, once people understand the consequences on the health care system?

There are countries in Europe that achieve universal health care coverage without single payer.

[merrily]

5. How did implementation of Medicare go? People have plenty of experience with Medicare,

if not with themselves, than via a parent or grandparent. When polled on Medicare, they are not being polled on an unknown.

The article says both positive and negative things about implementation. As with many things, whether implementation sounds like heaven or hell depends on who is asked. From the OP article:

“We’re so used to such a complicated system in the U.S. that we envisage any change would be incredibly complicated as well,” said Steffie Woolhandler, a physician and one of the founders of the single-payer advocacy organization Physicians for a National Health Program. “But what you’re doing with single-payer is actually simplifying the system.

For example, said Woolhandler, “the latest data is U.S. hospitals are spending 25 percent of their total budget on billing and administration, and hospitals in single-payer nations like Canada and Scotland are spending 12 percent.”

Also, you are assuming higher taxes. There is no reason that has to happen. It could be simply lower health insurance premiums than the private sector charges and providers being able to lower costs because they are not dealing (or fighting) with umpteen insurers.

[ehrnst]

11. The implementation of Medicare wasn't for the whole population.

And LBJ had to lie about what it would cost - otherwise it never would have passed. We have the CBO now.

So what do you do about the rural hospitals that would close?

You can read about the process of implementing medicare on page 15 of this document:

https://www.nasi.org/usr_doc/med_report_reflections.pdf

[merrily]

12. Regardless, the implementation went fine and it's in place now. That wheel does not have to be

reinvented.

News flash: God's moving finger did not write the negative parts of your article in stone. If people want to do this, it will be done and done well. If they don't want to do this, they'll keeping reciting a parade of horribles. Same story with everything that would improve a lot of lives.

[ehrnst]

14. Regardless? Hardly.

Page 15 on in this document describes how medicare was implemented:

https://www.nasi.org/usr_doc/med_report_reflections.pdf

You would need to expand this to the whole health care system, which is way more complex, technology oriented and labor intensive than it was 45 years ago. Cancer drugs and treatments are a new issue in health care.

And my father's experience with getting his cancer treatments with Medicare was a nightmare for his physician, who had to submit paperwork three times, and be rejected three times before his regular treatments would be re-imbursed. His physician is not accepting any more Medicare patients.

"Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress."

Also I trust non-partisan health care policy analysts than I would someone who has a career advocating for a specific policy. God's moving finger doesn't get inserted so much that way.

[ehrnst]

17. And this part?

"Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress."

Can you explain how this gets through congress when a public option wasn't possible when we had a Dem House, Senate and WH?

[merrily]

20. Quoting from my Reply 12:

News flash: God's moving finger did not write the negative parts of your article in stone. If people want to do this, it will be done and done well. If they don't want to do this, they'll keeping reciting a parade of horribles. Same story with everything that would improve a lot of lives.

The U.S. Government managed to implement Social Security in the 1930s and Medicare in the 1960s using typewriters, carbon paper and mimeograph machines. Other nations managed to institute national health care before we had calculators.

[ehrnst]

23. "If people want to do this, it will be done and done well."

So why do you think the ACA was so difficult to get people on board with?

If the people want Medicare for All, why couldn't we get even a public option through with a Dem president, congress and senate?

[merrily]

25. Poster, please. What in hell does what most people want have to do with what gets through Congress?

Most people want sensible gun control. Why doesn't that legislation go through? Lobbyists. When Obama was elected, something like 75% of people polled were strongly for a public option. Why didn't that go through? Well, that's been debated on DU for years.

ACA was totally different from Medicare for All, so your question about that is out of left field.

Sorry, this has to be my last reply on this thread.

[ehrnst]

26. The public option was the part of the ACA that resembled most Medicare for All.

And it was cut out.


And if lobbyists can convince a lot of people that any gun control = "taking all our guns" then they can convince people that "socialized medicine kills," even if it's not socialized medicine. They were able to convince people that Medicare was not socialized medicine, and that they would lose medicare so that some 'undeserving lazy people' would get it for free.

The GOP convinced people that the ACA was socialized medicine - which it was not - and got the one part that was cut out.

You can say "Medicare for All" until you are blue in the face, but the minute someone says, "socialized medicine" that evokes a fear response that we clearly saw the GOP - who was a minority at the time - equated the ACA with a "Socialist president."

And that president wasn't even socialist.

(I was quoting *you* on "If the people want to do this..... Your analogy about sensible gun legislation is apt. Even if the people want something, if it's complicated, it can and will get stuck.)

[creon]

2. One way

One way to go from our current system to single payer: expand medicare.
As a matter of practical politics, that may be the best road to take.
My idea is that by expanding medicare, the medical insurance companies would lose policyholders and revenue. Eventually, they would have to get out of the business.

[Chan790]

6. The shorter path...

is to abandon Medicare and put seniors into Medicaid at the same time we keep pushing eligibility-thresholds upward, increasing income and payroll taxes to cover the cost, eliminating the clawback provision, and working towards service improvements. (Because being on Medicaid sucks in a lot of ways and is punitive in others; it needs to get better in both respects.)

The system that is best positioned to be expanded to "all" though isn't Medicare, it's Medicaid.

[creon]

30. That method

That method could work as well.

[ehrnst]

9. Incrementally, perhaps. And expand children's health care coverage.

People then get used to the idea that those are not government overreach.

It took 75 years for Social Security to be what it is. It certainly didn't start out the way it is now. It didn't cover disability until the 50's. Cost of living increases didn't come until the 70's.

[creon]

29. That

That is what I am thinking.

[NorthCarolina]

3. Is that what they're going with now...that it's "impossible"?

LOL

[ehrnst]

7. Did you read the article?

"Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress."

Yes, because we couldn't even get a public option passed when we had a Dem House, Senate and WH.

I would like abortion to be covered with no copay on all health care plans. I understand that's not going to happen.

[merrily]

8. A two thousand page bill for Obamacare--no problemo.

A three-word bill "Medicare for All"--O, the humanity!

The motives could not be more transparent.

[ehrnst]

10. Did you read the article? Medicare for All will take much more than 2000 pages

The health care system would undergo major disruptions.

"The politics of Medicare — which serves roughly 50 million Americans — already make some things difficult or impossible, he said, pointing to a current fight in which doctors and patient advocacy groups blasted a proposal to move to a more cost-effective way to pay for cancer drugs. “You already can’t do certain things in Medicare because of the politicization,” he said. ”When you cover the whole country, it would be a lot of gridlock.”


We have many physicians who are phasing out Medicare patients because of the problems in the system - having to resubmit paperwork multiple times before getting approval for procedures, etc.

And all the GOP needs to do is point to the problems with the VA to get people believing misinformation that makes "Medicare for All" would be a "three word bill," look pale by comparison.

[merrily]

13. See Replies 5 and 12. Thanks.

[ehrnst]

15. See my responses to them. Thanks.

[merrily]

16. No. Arguing is pointless. We're not going to agree, even a little.

[ehrnst]

19. You don't agree with the majority of health policy analysts

even those who favor single payer.

And there are lots of people who don't agree with the majority of climate scientists that climate change is man made, and most physicians that vaccinations are not dangerous.

[merrily]

21. Actually, I don't agree with the negative parts of your article to which you cling.

I've now said that, what? Four times or so?

[ehrnst]

24. Which is the opinion of the majority of health care policy analysts

Did you read that part of the article?

Ask the majority of health care analysts, even those that like single payer, why they "cling" to that conclusion.

[Hortensis]

31. Doesn't matter. They should at least be happy that the

media are reporting HRC's support for a small but real expansion of Medicare as a "victory for Sanders." That pleases supporters of both him and her who want more but aren't really paying attention and, far more importantly in the long run, actually is a potentially achievable step in the "Medicare for all" direction.

[Orsino]

18. Yes. We need to be moving toward single-payer models...

...but nothing we can do fast is going to end well.

[ehrnst]

22. Socialist countries in Europe have universal coverage without single payer.

We don't need to assume that it's single payer or bust. But anything we do has to be implemented slowly and with tweaks.

"Universal health care systems vary according to the degree of government involvement in providing care and/or health insurance. In some countries, such as the UK, Spain, Italy, Australia and the Nordic countries, the government has a high degree of involvement in the commissioning or delivery of health care services and access is based on residence rights, not on the purchase of insurance. Others have a much more pluralistic delivery system, based on obligatory health with contributory insurance rates related to salaries or income and usually funded by employers and beneficiaries jointly.

Sometimes, the health funds are derived from a mixture of insurance premiums, salary related mandatory contributions by employees and/or employers to regulated sickness funds, and by government taxes. These insurance based systems tend to reimburse private or public medical providers, often at heavily regulated rates, through mutual or publicly owned medical insurers. A few countries, such as the Netherlands and Switzerland, operate via privately owned but heavily regulated private insurers, which are not allowed to make a profit from the mandatory element of insurance but can profit by selling supplemental insurance.

Universal health care is a broad concept that has been implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards. Most implement universal health care through legislation, regulation and taxation. Legislation and regulation direct what care must be provided, to whom, and on what basis. Usually, some costs are borne by the patient at the time of consumption, but the bulk of costs come from a combination of compulsory insurance and tax revenues. Some programs are paid for entirely out of tax revenues. In others, tax revenues are used either to fund insurance for the very poor or for those needing long-term chronic care."

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

[Orsino]

27. We have multiple single-payer systems here, too.

What we have learned is that private insurance alone is untenable. To cover more people, we must move toward single-payer models. It's immatetial to me, though, just exactly what universal coverage would look like. If the rich want to keep a few doctors on retainer, fine...but as with school systems, they need to be taxed to support the systems that will keep the rest of us healthy.

[applegrove]

28. If there is a public option and one for people over 55 that takes the heat off Healthcare,

cause the over 55s require most of the care, and private options for young people will go down in price. Obama are will be even stronger.