Pelosi declines to endorse Single Payer bill

[ehrnst]

85. No, it's not simply enrolling everyone into Medicare - that's the actual reality.

Anyone who tells you that's all it takes doesn't know what they are talking about.

Your framing doesn't know what the reality of the health care delivery system is. The GOP learned that the hard way when suddenly they had to come up with something to "replace" the ACA.

The VA is a system designed for a population that comes to it, not it to them, and serves a limited number of people, with a limited number of health issues.

No, a solution does not already exist, and no there is no the political will to do what is incredibly complicated and won't have a quick positive outcome for them prior to 2018, and ignoring people who know more than you do doesn't make them wrong.

I think that you are also confusing socialized medicine with single payer, which explains why many other things are not clear to you.

Socialized medicine is where the government delivers the actual medical care, such as on MASH. Single Payer is a description of how medical care is paid for, not delivered..... in Medicare, private physicians deliver care, and they are paid via a federal system. This system is set up for a limited % of the population, and any expansion would need to be very gradual, over decades. Which is why the current proposal to let people buy in at 55, for a higher premium than the current participants do, let the sytem adjust, then re-evaluate what needs to happen at that time, taking into account newer medical treatments, where population centers are, etc.

Simply dismissing anyone who presents the very real obstacles that the bill doesn't address as "corporate shills" or "corporate stooges" will not change reality.

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.
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America’s unique history and politics make the successful promotion of a single-payer system an unlikely pathway to universal health coverage. There are three reasons. The first involves the inevitable strong and well-funded opposition of special-interest groups.

Since the 1930s, associations representing the pharmaceutical, insurance, hospital, physician, and medical-device industries have consistently and vehemently opposed attempts to reform health care through any approach perceived as leading to single-payer. Their only defeat on this front occurred in 1965, after President John F. Kennedy’s assassination and the Barry Goldwater electoral fiasco, when Medicare and Medicaid were enacted at a time of huge Democratic majorities (68-32 in the Senate, 295-140 in the House). Such Democratic dominance of national politics seems unlikely in the foreseeable future.

The second political impediment is the potential backlash to the cost of single-payer, and how it will be financed. Although a single-payer system would almost certainly be more efficient than the continuation of a multi-payer system, such a system would require a tax increase of a scale likely to cause the public to balk — especially when anti-tax groups mobilize.

The size of the necessary taxes cannot yet be determined, since it would depend on the precise design of the new system (such as the benefits covered and the portion of those benefits paid through consumers’ premiums, deductibles, and copayments). But the failed attempt to establish a single-payer system in Vermont, perhaps the most progressive state in the union, gives a sense of the challenges ahead.

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Incrementalism should not be considered a four-letter word. It produced numerous expansions and improvements in Medicaid, which now covers more than 70 million people. It led to the Children’s Health Insurance Program (CHIP), which resulted in historically low uninsured rates among children. It added much-needed prescription drug coverage for seniors and people with disabilities in Medicare. It added home and community-based care as an alternative to nursing homes. And it helped people with preexisting conditions combat insurance company discrimination.

As we consider the next incremental steps to promote, we should focus on expanding health coverage to the nearly 30 million who remain uninsured, and we should strive to lower health costs while improving quality of care. The following goals meet those criteria.

Expanding Medicaid in 19 states: Now that Republicans have at least temporarily lost their fight to repeal the ACA, and since extraordinarily generous federal subsidies remain to expand Medicaid, progressive advocates should renew their efforts to secure added coverage for low-income adults in the 19 states that have not yet approved the expansion. Of the 31 states that already expanded Medicaid, 18 are currently led by Republican governors. Since refusing federal money is unlikely to lead to ACA repeal at the national level, we should now expect other state Republican leaders to be more amenable to expansion, too. Activists and voters should push them in that direction.

Providing coverage for immigrants: Because of the ongoing national controversy about immigration, it is unlikely that federal legislation will extend health coverage to immigrants. But there are opportunities to do so at the state level. California, the District of Columbia, Illinois, Massachusetts, New York, and Washington already use state funds to cover undocumented children through Medicaid. In California, approximately 200,000 children have gained coverage through this expansion, and many more are eligible. Now the state is debating extending such coverage to undocumented adults. Progressives elsewhere should push their representatives to make similar efforts.

Fixing the so-called “family glitch”: People with access to affordable employer-sponsored health insurance are ineligible to receive ACA premium assistance in the individual marketplace. Unfortunately, due to an ACA drafting error, “affordability” is gauged by examining what it would cost the worker to cover him or herself at work — not the coverage costs for the worker’s family. As a result, many families who ought to be eligible for subsidies are not getting them. This is an acknowledged, unintended mistake, and activists should work to have it fixed. This would help millions.

Extending CHIP: Under current law, funding for this popular and effective program, which provides health insurance for low-income children, is only authorized through September 2017. The program was adopted on a bipartisan basis and is very popular among Republican as well as Democratic governors. Progressives should push hard to secure a funding extension as soon as possible.

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