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[BlueTillIDie]

This message was self-deleted by its author (BlueTillIDie) on Thu Feb 27, 2020, 02:06 PM. When the original post in a discussion thread is self-deleted, the entire discussion thread is automatically locked so new replies cannot be posted.

[guillaumeb]

1. Recommended.

The current US system is a profit oriented system. That much cannot be denied.

Second, there is no reason for health insurance to exist as a product. Most developed countries use tax money to fund their healthcare systems, and do so by spending less per capita than does the US.

Third, participating in the Social Security program is mandatory, and is a tax on income.

Fourth, USA number 37 is hardly an inspiring slogan, and 37 is the ranking of the US healthcare system.

[ehrnst]

3. Sounds like you aren't asking for thoughts as much as applause. (nt)

[ehrnst]

5. OK. It sound from your headline that you don't think that there has been a 'frank discussion'

concerning this, at least here on DU.

Why is that?

[ehrnst]

10. That's interesting that you seemed to posit that there has been none

here on Democratic Underground until you came along and gave us the idea.

[ehrnst]

8. More thoughts

If we assume healthcare is a right, then we extend that to everyone equally.

That is what the ACA is addressing. Universal Health Care. We won back the house on preserving it in 2018..

Medicare for all who want it. Sure, it would be great to be able to provide health care for everyone who needs it. That's an amazing goal, and if that's ALL we can get, I'll take it!

That's not going to work, actually. There has to be a limit on who can join up, because insurers will stop subsidizing anything if they can simply tell people to go get Medicare. That's why the structure in the ACA on who could get a subsidy.

But if we ONLY do that.

Like I said, it would have to be everyone, if we did that, because it would end up that way without restrictions on who could join.

However, if we make it a right, and go with m4a under bernie or warrens plan, then we eliminate other forms of payment for medical care.

There are other options than single Payer, such as expanding the ACA. Most other industrialized countries do not use single payer to accomplish Universal Health Care, but use different, customized hybrids of programs, depending on things like the % of population concentrated in urban areas, etc.

If we go with a single system for everyone, then making improvements to that system benefit everyone. If we go with a multi-tier system, making changes to the programs that only benefit the poor becomes all that much harder.

You're unclear here - are you talking a 'system' or a 'payer' because the ACA is intended to expand to become the national health care system. We're already partway there

I see this as the difference between liberals and progressives.

You mean that no one who isn't promoting Sanders' MFA can't be a progressive? I see it as a difference between listening to non-partisan, neutral health policy experts talking about reality, and politicians running for office on promises of upending and restructuring a massive baked in system, with no interruption in health care delivery in just four years - wait, is someone else also promising M4A? - I'll promise it in TWO years, and that makes me the very most progressive!!!

Canada didn't have a national health care single payer system until all the provinces went single payer individually, over about 15 years, then a very liberal administration was elected in the 60's and added a federal layer over it, and it's been changed and tweaked to what it is over the last 50 years. Two years - and having to retrofit? Not a chance.

The same is true for almost all programs. Giving to just those in need creates unneeded divides. Giving to all eliminates those divides. FDR was very smart in this regard with social security. if it had been optional it would surely be gone by now.

Actually, SS was only available to the elderly at first. It did not cover near what it does now. It expanded incrementally to kids whose parents died, etc over 75 years. Medicare works in part because the funding mechanism requires everyone to pay in, while only a portion is eligible to use it.

Also, congress has to pass it, as does the Senate. And in the unlikely event that happens, it has to survive the inevitable challenge from the red states to SCOTUS. If the SCOTUS of 2010 refused to uphold the state mandate to expand Medicaid in the ACA, what do you think that the current SCOTUS is going to do when states refuse to participate in the administration of the expansion of Medicare?

And as we see in Canada, which has less of a population than the US, it is managed at the province level, far more like Medicaid delivery than Medicare.

You're welcome.

[ehrnst]

13. This has been discussed frankly and in depth, many times on Democratic Underground.

Universal Health Care is a plank in the Democratic party platform for years. There was an attempt at Single Payer by Democrats back in the early 70's. Ted Kennedy went to Nixon wanting to expand Medicare to everyone, and was told by Democrats to walk away from anything other than single payer. Nixon was proposing something that was to the left of the ACA, and Kennedy walked away. It was one of the biggest regrets of his career, because, as he said, we might have something much closer to what Canada does by the time the ACA was passed.

He and other Democrats let "perfect" be the enemy of "access to healthcare for millions" (and any possibility of to universal health coverage incrementally) for over 30 years.

Now we've finally gotten further down that road than we ever have, many of us actual , really truly progressive Democrats don't want to abandon the bus in hopes a plusher ride will come along, as Democrats did in 1971. Too many people are on that bus now.

The idea that one cannot be a progressive, or have a moral view of health care, and support any UHC policy other than single payer has been clearly show to be a fallacy. After all the vast majority of industrialized nations achieve UHC with other systems.

Certain politicians have made that fallacy a large part of their campaign, unfortunately.

And unfortunately MFA has become dogma for some on the left, like "the only moral way to address the abortion problem is to shut down Planned Parenthood" is on the right. Both really think that it makes perfect sense, despite what neutral health policy experts have to say on the matter.

[ehrnst]

15. "Off the top of your head" is not polling data.

See the link in my response to you here: https://www.democraticunderground.com/?com=view_post&forum=1287&pid=587711

that is polling data, and much more reliable, and evidence based than one's subjective views.

Now me personally id much rather pay more on payroll and completely eliminate co pays and deductables.

I'm sure many people would ask "how much more" which no one can honestly answer until there is much more analysis done. However, an Urban Institute analysis of Sander's 2016 MFA proposal found that it would cost more than he stated it would in taxes paid by people, and would cause more disruption to the health care delivery system than his proposal claimed. Not surprisingly, his surrogates attacked the Urban Institute as being a shill for big pharma, which they are not.

Here is a more recent analysis of different health care reform proposals.

https://www.urban.org/research/publication/incremental-comprehensive-health-reform-how-various-reform-options-compare-coverage-and-costs

Why cant we simply extend the age of medicare downward, and simply tax top incomes more to pay for it?

Downward how much? HRC proposed letting people buy into Medicare at 55, at more than if they waited, but far less than the private market. We tweak that, and let people get accustomed to it for a few years, and then popular pressure would encourage reps to lower the age more. Ted Kennedy proposed an incremental plan in 2006....

We used to have a top tax rate of 94%, so raising it to 60 would be in my mind acceptable.

If you or I were the king of the US, that wouldn't be a problem. But we don't have a king. We have reps, and they have constituencies that are influenced by social media, FoxNews and the like. Do you have any ideas on how to get around that in order to convince a vast majority to agree? This has been going on for centuries. Remember, the wealthy in the South convinced poor whites that sending their children to die to preserve the plantation was noble, and someday, they too would have the opportunity to sit up on that veranda with them, sipping cool drinks. Right now there is a social media campaign aimed at Senior Citizens telling them that Democrats want to give Medicare, what they paid into their whole working life and waited for, to people "who haven't worked a day in their lives." If you have a way to counteract that campaign, do share.

Anyone telling you that there is a simple answer to all this like "if you just elect me, that will trigger a huge uprising from both conservatives and progressives to support all I ask for, and I'll be able to threaten all the GOP congressmen and Senators that they will lose their jobs if they don't go along with this," then they are not really being realistic.

[ehrnst]

17. I don't expect a candidate completely tailored to my user preferences.

Unfortunately many see one single tactic that they don't agree with out of a huge collection of well thought out policies, and they say "that's it. I'm done." I am not so privileged as to believe that I can demand that of any human being, let alone a POTUS candidate that is always the product of compromise, for me or my country. I consider our future to be more important than any need for personal validation as a progressive.

She has people skills, emotional intelligence and the respect of her peers. This is not something that I see in other candidates that claim the "progressive" mantle. I want a candidate that can accomplish concrete progressive action, not simply promise the moon. She lapped many of the candidates before she was even elected with the Consumer Financial Protection Bureau.

She has respect for data, and is capable of changing her mind when new data emerges that challenges her assumptions. Perhaps her respect for expertise, and people who are experts who don't agree lockstep with her comes from her deep scholarship and teaching. I worked with Paul Wellstone, and saw the same in him. He was blasted not long before his untimely death as a 'sellout' because he changed his mind on how to get some things done once he got behind the wheel.

I understand that many Sanders supporters believe that kind of behavior automatically indicates "pandering" or 'weakness," but I do not.

Warren has stated that any health care reform must be approved by the people via congress, and she has been excoriated for it. I however, predicted that once she got the data from health policy experts, she would see the obstacles and drawbacks to "single payer or bust."

I hope that clarifies things for you.

[ehrnst]

19. I will never forget the morning that he died.

I worked in an advocacy org on the Hill, and the cries of OMG, NO!!! throughout the office were heartbreaking.

I remember being on a flight back to DC from Minnesota that he was on. He got up on a chair at the gate, in his red union suit, jeans and suspenders and told everyone to come visit him at his office.

He was THERE when we needed him on women's rights issues, along with Barney Frank who had NO personal skin in that game, and HRC and Elijah Cummings. I have in meetings with all of them, in different orgs, at different times in their careers. They are all the real thing when it comes to "what needs to be done NOW, to make this happen."

That's what I see in Warren, Klobuchar and Harris. I think that any combination of them in POTUS/VP/cabinet positions would get us up and running from day one to roll back the Trump damage.

[ehrnst]

22. He realized after a while that he could be a whole lot more effective at being

a Senator with some more years under his belt, so he changed his mind on only serving one term, despite running on that promise. He took the heat for it, like Warren is for moving away from single payer or bust.

He also realized that having staffers who were activists, but not experienced in a Senate office was also hindering his ability to serve, so he replaced those well meaning activists with dreaded 'beltway insiders' who had a rolodex and knew how to get people to a meeting - again, this disgusted many of his supporters around the country.

And Mother Jones tore him a new one the year before he died for "selling out."

https://www.motherjones.com/politics/2001/01/seduction-paul-wellstone/


He put service to the country and Minnesota above his own ego and political "brand" as a progressive purist. I see that in Warren, Klobuchar and Harris more than any of the others who tossed their hats in. I think Paul would have as well.

[ehrnst]

25. She's been bashed and vilified as "a cop" who was a "gleeful cog in the

school to prison pipeline" because she was a successful D.A. and was smeared with a lot of false accusations by many self-described "progressives."


I predicted that would happen the minute that she entered the race, knowing that Sanders would be too.

[ehrnst]

31. She is no longer in the race. If she was, she may have gone the way that Warren has.

She's someone who respects data as well, so "selling" her on it might not be successful. And as I laid out, Liberal does not require one bang the drum for MFA or bust. I thought you understood that..... if there is a way to get more coverage to more people sooner, then that would be the actual liberal position, wouldn't it?

I think that Bernie felt impelled to shift his promise of an overhaul of the system from eight years down to two years, because he was no longer the only candidate discussing it, and promising it sooner would somehow bestow the title of "more progressive and the least status quo" on him.

As you can imagine, that gave me the opposite impression.

Any other questions?

[Kurt V.]

28. now that's a welcome to DU post. Good grief :(

[ehrnst]

32. Do you think that our new DUer can't handle it?

What a low opinion you have of someone that had over 100 posts before my response.

[Kurt V.]

36. they handled it just fine. what a low opinion you had of them to

begin with.

[ehrnst]

45. The author of the OP asked for our thoughts, and I expressed them.

Do you think should I have been dishonest?



Perhaps you missed the ensuing discussion in your haste to scold.

[Bettie]

7. K&R

Single payer allows everyone to get care when they need it.

Our current system allows some to get care when they need it, but leaves far more wondering if they can afford the copay and out of pocket expenses to go to a doctor...because their premiums already take a hefty bite out of their paychecks.

[ehrnst]

9. A theoretical single payer system - and most countries use multiple payers, hybrids

And with more people having access to medical care there will be wait times for certain procedures - Canada experiences those.

Before you start, yes Canadians don't want our 70 year old patchwork, but one of the big issues in the national elections last year was better access to health care.

https://www.cbc.ca/news/politics/canada-votes-2019-health-care-issue-1.5279912

[ehrnst]

12. You missed this, so, I'll share:

If the public wants the ACA, which it's clear they do, then that's what Dems in Congress and the Senate will support. POTUS would be incredibly ill advised to go against what the public wants to do, and put dems in the position of either voting for what their constituents want or voting for what he wants. Obama was going to give up, but Pelosi told him she could do it, and she delivered. It's very, very doubtful the next Dem POTUS will have Dem control of the House and Senate, and anyone with Pelosi's skill working for MFA against the ACA, let alone who will work against the will of the majority, and endanger congressional seats.

https://www.democraticunderground.com/1287568051

Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage

As Medicare-for-all becomes a staple in national conversations around health care and people become aware of the details of any plan or hear arguments on either side, it is unclear how attitudes towards such a proposal may shift. KFF polling finds public support for Medicare-for-all shifts significantly when people hear arguments about potential tax increases or delays in medical tests and treatment (Figure 9). KFF polling found that when such a plan is described in terms of the trade-offs (higher taxes but lower out-of-pocket costs), the public is almost equally split in their support (Figure 10). KFF polling also shows many people falsely assume they would be able to keep their current health insurance under a single-payer plan, suggesting another potential area for decreased support especially since most supporters (67 percent) of such a proposal think they would be able to keep their current health insurance coverage (Figure 11).

KFF polling finds more Democrats and Democratic-leaning independents would prefer voting for a candidate who wants to build on the ACA in order to expand coverage and reduce costs rather than replace the ACA with a national Medicare-for-all plan (Figure 12). Additionally, KFF polling has found broader public support for more incremental changes to expand the public health insurance program in this country including proposals that expand the role of public programs like Medicare and Medicaid (Figure 13). And while partisans are divided on a Medicare-for-all national health plan, there is robust support among Democrats, and even support among four in ten Republicans, for a government-run health plan, sometimes called a public option (Figure 14). Notably, the public does not perceive major differences in how a public option or a Medicare-for-all plan would impact taxes and personal health care costs. However, there are some differences in perceptions of how the proposals would impact those with private health insurance coverage (Figure 15). KFF polling in February 2020 finds about four in ten Americans support both a Medicare-for-all plan and a public option (Figure 16). So while the general idea of a national health plan (whether accomplished through an expansion of Medicare or some other way) may enjoy fairly broad support in the abstract, it remains unclear how this issue will play out in the 2020 election and beyond.

https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/

[CrawlingChaos]

21. No one in their right mind would choose the ACA over M4A

The ACA is demeaning and unstable. My premiums more than tripled this year and I had to go down to bronze. Fortunately I'm healthy but if something happens to me I'll just have to walk it off.

The ACA is better than nothing but there's no way anyone would choose ACA over M4A. It makes no sense.

[ehrnst]

24. Whether it makes sense to you or not wasn't the point of my post.

The point is what public opinion actually as it stands for MFA and the ACA.

Is that clearer?

Your characterization of those who support the ACA as being "demeaned"might also be considered really insulting to the hundreds of thousands who had a pre-existing condition, or their kid did, and couldn't either get or afford insurance until the ACA.

Or the hundreds of thousands that didn't qualify for Medicaid until the ACA...

So there's that.

The ACA is better than nothing but there's no way anyone would choose ACA over M4A. It makes no sense.

There has never been a choice between the ACA and MFA - only a theoretical question on polls. MFA has never made it as far as the ACA did. The only choice has been the ACA or nothing. To argue as if there was an actual choice between the ACA and MFA (as you imagine it to be) right there in front of you is what "makes no sense."

[CrawlingChaos]

34. The ACA is demeaning

You have to go, hat in hand, prove that you're poor and beg for a subsidy. You go through this every year. And if you don't jump through all the required hoops, you're in trouble.

Then you never know what your premiums will be, year to year. As I said, mine skyrocketed and I had to go down to bronze.

No one who actually needs it would ever choose the ACA over M4A, unless they have been grossly misled.

The public wants it, which is why Bernie's winning big.

[ehrnst]

37. You deleted your other post that I responded to. Why?

The public wants it, which is why Bernie's winning big.

You are clearly upset at what was actually revealed in the poll here, and are now just denying it:

https://www.democraticunderground.com/?com=view_post&forum=1287&pid=587711

Your issues with the health care system are valid, but the claim that anything other than MFA will only make things worse isn't based in fact, any more than your claims that "the public wants it" are founded in data.

Shooting the messenger doesn't change the facts. The vast majority of countries that have Universal Health Care don't use single payer, let alone have Bernie telling them what to do, and they somehow manage.

https://nymag.com/intelligencer/2018/05/voters-who-like-medicare-for-all-may-not-like-single-payer.html

[CrawlingChaos]

39. I deleted because you changed the post I was responding to

And I'm not upset. Bernie's going to win.

[ehrnst]

41. You seem upset at the news about public polling on MFA.

And good luck with the Bernie thing.

I hope you learn to deal well with disappointment, because that's more useful to cultivate than magical thinking.

[CrawlingChaos]

43. You are projecting

And I think you should take your own advice.

Thanks for the thought but I won't need luck with the Bernie thing. He's winning big.

[ehrnst]

44. I have no issues dealing with disappointment. Of course, I never did take to

magical thinking.

"Clap your hands and Tinkerbelle will come back to life" or "heal yourself with the power of visualization," and that kind of thing.

Never felt I missed anything, though.

[BilltheCat]

27. rather have a frank and solid discussion on the exact mathematical details of how to oust Dottard

I'm new but it's alarming to see effectively nobody much discussing

[ehrnst]

35. I agree that the litmus test of MFA or Bust for a moral, progressive and

effective candidate is positive.

I think that "MFA is the only moral response to health care reform" is the "Getting rid of Planned Parenthood is the only moral way to reduce abortions" for the far left.

Both are dogma that requires demonizing non-partisan health policy professionals as either "shills for big pharma/big insurance" or "shills for the abortion industry."

Both prioritize punitive action towards a particular part of of the health care system over actual progress in the issue at hand.

[YOHABLO]

30. Privilege and Right are synonymous.

[ehrnst]

33. What does that have to do with the OP?

[YOHABLO]

40. You're the one who asked for my thoughts. You got it.

[ehrnst]

42. You seem in a rather unpleasant mood.

Just sayin'.

[ehrnst]

47. Hello?