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Old 07-31-2019, 06:19 AM
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The dangerous politics of Medicare For All


Something that is really key about this that I don’t see journalists addressing when questioning candidates, probably because they feel it will sound petty: it’s not at all just a question of whether people believe that the MFA replacement will be just as good or better than what they have now. If their union negotiated hard for this benefit or a “Cadillac health plan” was something that attracted them to take their white-collar job, equalizing everyone under the same national plan will take away their feelings of getting something significant there, unless the bill requires employers to substitute a pay raise or other benefit equal to the now redundant employer health plan—and I am sure it does not.

Sadly, behavioral economics studies show that people would rather get a five dollar an hour pay cut while their neighbors get a $10 cut, than get a five dollar raise while their neighbors get a $10 raise. (These numbers may not be exactly accurate, but the gist is there.) People care more about their relative wealth than their absolute wealth, which is why they get so upset about income inequality: if they are doing a little better and the rich are doing a lot better, they feel like they are doing worse.

So as unsatisfying as it would be for the progressive left, the best thing Democrats could do for now is to offer a universal benefit for anyone who is not insured, but make it less generous than a good union or white collar plan. Then the centrist voters we need can feel they are doing something nice for those who are struggling, without feeling like they have lost ground in terms of having something better than the “unfortunates” have.
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Old 07-31-2019, 06:45 AM
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Good post.

I'll add that Medicare-for-All is also dangerous because it reinvigorates conservatives who might be put off by Trump's personality and quietly sit this upcoming election out. There are probably a fair number of conservatives, be they Republicans or Independents, who are probably content to let someone like Joe Biden win and assume that nothing is lost by sitting the election out and forcing the Republicans to hit the reset button.

Medicare-for-All, however, is a game-changer. It gives those Republicans a reason not to sit at home, even more of a reason than voting against liberalism because of "bathrooms" or "gays" or "illegals." Medicare-for-all is a pocket-book issue, and it's one that doesn't get much traction outside of progressive utopia. But worse than that, whereas moderate, centrist Democrats might shrug and say "Not impressed, but I'll vote for Warren anyway," conservatives now have a reason to go to the polls. Progressives would be giving conservatives, even moderate conservatives, a reason to show up at the polls, to vote AGAINST something, and it's not just a social issue, but an economic and deeply personal one.

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Old 07-31-2019, 06:55 AM
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Dangerous it may be but there's no denying that popular support for a more modernized and universal health care system is growing. The issue was considered mostly a pipe dream just a few short decades ago and the accessability and affordability problems aren't improving with the free market calling the shots. Discussing the issue won't turn off the new generations of voters who will dominate US politics in the future.
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Old 07-31-2019, 06:57 AM
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Asahi: Thanks, and good points. Bracing for the revulsion from idealistic progressive ideologues…

ETA: RW, I hear this kind of argument about the future quite often. But this election will be held in 2020, not 2040.

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Old 07-31-2019, 07:08 AM
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Short answer to the OP -- private insurance could still exist, just as a "top up" to MFA. Employers could offer a private insurance plan that gives employees with Cadillac plans the bells and whistles they're used to, it would just cost them a lot less. It's true that the employers would probably end up pocketing the savings rather than passing it on, but that's capitalism for you.


I was surprised in the debate last night how everyone was talking about MFA would "ban" private insurance. Maybe I haven't been paying attention but that can't possibly be part of the proposal, right? Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right? Why did all of the candidates allow this talk of banning private insurance go unchallenged?


I gather the gist of what they were saying was that MFA would be mandatory, and therefore everyone would be kicked off of their current plan. But isn't that necessary for a single payer system to work? Aside from Warren and Sanders, everyone on stage was against MFA and in favor of a public option. But isn't a public option subject to the same issue we have right now with Medicare? That is, private insurers get to make billions in profits off relatively healthy people while government programs are forced to cover the uninsurable at taxpayer expense?

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Old 07-31-2019, 07:17 AM
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Steronz, what you are saying is logical—but while I have not read all the fine print, what I have read conveys two problems:

One is that many commentators seem to indicate that Bernie really does go further than most other countries in getting rid of private health insurance. The problem with him is that he doesn’t just want to get everyone healthcare, he wants to really stick it to corporations as much as possible.

The second problem is that his proposed plan would have so many “bells and whistles”, there would be none left to supplement. Which of course would be unworkable fiscally, but that is what he is proposing: no premiums, no deductibles, no copays even for prescriptions, any doctor, etc.

ETA: You ask about the “same problem with Medicare”, but voters don’t see Medicare as a problem. They like it, which is why Bernie (emulating a “West Wing” character named Santos) called his single payer plan that even though it’s not really like Medicare at all. (Santos had a much different and more accurate approach despite using the same name, one I’m surprised no Democrats are copying: simply delete the age requirements from Medicare laws.)

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Old 07-31-2019, 07:17 AM
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Dangerous it may be but there's no denying that popular support for a more modernized and universal health care system is growing. The issue was considered mostly a pipe dream just a few short decades ago and the accessability and affordability problems aren't improving with the free market calling the shots. Discussing the issue won't turn off the new generations of voters who will dominate US politics in the future.
Universal healthcare doesn't have to mean MFA. Germany (I think?), Switzerland (I think?) and some other northern European countries have achieved universal coverage using private insurers.

As far as I can tell, there are three ways to achieve universal coverage:

Government as provider (UK's National Health, US's VA hospital system)
Single Payer (Canada, Medicare)
Private health insurance, with mandates, coverage requirements, and subsidies (Obamacare if done right, some European countries)

They all have pluses and minuses, but if implemented properly, can all provide universal coverage with better outcomes for less money than our mess of a system.

Moving from private coverage mostly through employers to MFA would be a giant move and Sanders shouldn't require purity on that -- he and Biden can argue why their method is better without implying or saying outright that it's their way or the highway. I could see boosting Obamacare rules, while adding a public option (optional buy-in to Medicare, for example) and if people prefer that, they can go that way. If MFA really would be better, then more and more people could choose the public option and the final transition would be easier. However, if employers and unions continue to provide better coverage, as long as people are covered, it's better than we had a few years ago.
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Old 07-31-2019, 07:20 AM
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What you're saying is that some people might resent if other people got something easier than they themselves did. Which, yes, really is something that would likely happen. Jesus told of such a situation in his parables. But, as in Jesus' parable, the people who would be whining about such a thing have no reason to complain, as they got what they agreed to and deserve, and someone else benefiting doesn't in any way hurt them.
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Old 07-31-2019, 07:22 AM
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...
I gather the gist of what they were saying was that MFA would be mandatory, and therefore everyone would be kicked off of their current plan. But isn't that necessary for a single payer system to work? Aside from Warren and Sanders, everyone on stage was against MFA and in favor of a public option. But isn't a public option subject to the same issue we have right now with Medicare? That is, private insurers get to make billions in profits off relatively healthy people while government programs are forced to cover the uninsurable at taxpayer expense?
I think the way they do this in European countries that have kept private health insurers in the mix is to require insurance companies to cover everyone (like Obamacare) and require everyone to be covered (like Obamacare) so you don't have negative selection. They may have also capped profitability of private insurance, but I'm not sure. That's not as bad as it sounds -- treat them like a utility -- they get guaranteed, but modest, profits. I don't know if they've done this.

Anyway, if they all were required to cover everyone and provide some acceptable minimum standard of coverage, then they would be mostly competing on price and service and that should help keep their profits in a reasonable range anyway -- capitalism and all that.
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Old 07-31-2019, 07:35 AM
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I think the way they do this in European countries that have kept private health insurers in the mix is to require insurance companies to cover everyone (like Obamacare) and require everyone to be covered (like Obamacare) so you don't have negative selection. They may have also capped profitability of private insurance, but I'm not sure. That's not as bad as it sounds -- treat them like a utility -- they get guaranteed, but modest, profits. I don't know if they've done this.

Anyway, if they all were required to cover everyone and provide some acceptable minimum standard of coverage, then they would be mostly competing on price and service and that should help keep their profits in a reasonable range anyway -- capitalism and all that.

Completely agree. And this is actually what Obamacare does already (insurance companies must spend something like 85% of premiums on actual healthcare), but the problem is that it doesn’t extend benefits far enough. Or if you are Bernie Sanders, the problem is that they are allowed to make any profits at all. (We haven’t even mentioned how threatening his plan is to anyone who works in the health insurance industry, which is a lot of people.)


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What you’re saying is that some people might resent if other people got something easier than they themselves did. Which, yes, really is something that would likely happen. Jesus told of such a situation in his parables. But, as in Jesus' parable, the people who would be whining about such a thing have no reason to complain, as they got what they agreed to and deserve, and someone else benefiting doesn't in any way hurt them.

Yes, good point – the parable is from Matthew 20: https://www.biblegateway.com/passage...16&version=NIV

But the owner of that vineyard did not have to get the majority of votes in an election from those workers. This is politics, and although I agree with you that this kind of psychology is wrongheaded, sometimes we have to appease wrongheaded views for the greater good. And giving everyone at least basic healthcare, not to mention getting rid of the abomination that is President Trump, definitely qualifies as “greater good”.
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Old 07-31-2019, 07:41 AM
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Dangerous it may be but there's no denying that popular support for a more modernized and universal health care system is growing. The issue was considered mostly a pipe dream just a few short decades ago and the accessability and affordability problems aren't improving with the free market calling the shots. Discussing the issue won't turn off the new generations of voters who will dominate US politics in the future.
Everyone agrees that health care providers and insurance companies are failing to provide affordable healthcare, but hardly anyone agrees on what the solution is. As much as I found them to be annoying little party poopers, I kinda found myself agreeing with Ryan, Delaney, Bullock, and Hickenlooper: MFA is a structural seismic shift that's not going to be supported.

Like it or not, our political system only shifts tectonically when there's a major and obvious crisis and a complete systemic failure; otherwise, incremental change is how this country moves forward. If you don't like that, then support candidates who are going to simultaneously work on reinvigorating democracy at the national and local level.
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Old 07-31-2019, 07:46 AM
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Any plan that still allows for someone to go broke due to illness is a non-starter. This doesn't happen in Canada, UK, Germany, etc. This means no co-pays - period. (Not talking about prescriptions here, that's a separate argument).
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Old 07-31-2019, 07:48 AM
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Copays are unlikely to make people go broke. And they can always do it like federal student loans, letting people owe the copay money if necessary and slowly taking repayments out of their paychecks on a sliding income scale.

ETA: Assigning some financial responsibility to patients and incentivizing them to shop around is actually an important method to “bend the cost curve” without rationing care, which is guaranteed to provoke a political backlash.

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Old 07-31-2019, 08:05 AM
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Co-pay for my rheumatologist is $50 when I walk in the door, for my GP $25 when I walk out the door. I wonder why one guy is allowed to charge a larger co-payment.
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Old 07-31-2019, 08:29 AM
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Any plan that still allows for someone to go broke due to illness is a non-starter. This doesn't happen in Canada, UK, Germany, etc. This means no co-pays - period. (Not talking about prescriptions here, that's a separate argument).
It's the deductibles that are the killers -- deductibles, exclusions, and "out-of-network" provisions. One thing that might actually get bipartisan support is to eliminate this "out-of-network" loophole bullshit. Providers themselves should be forced to work only with approved network providers. Patients shouldn't find out that their surgeon was "in network" but their anesthesiologist or that their ambulance trip wasn't. That's just all kinds of wrong.
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Old 07-31-2019, 09:23 AM
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What you're saying is that some people might resent if other people got something easier than they themselves did. Which, yes, really is something that would likely happen. Jesus told of such a situation in his parables. But, as in Jesus' parable, the people who would be whining about such a thing have no reason to complain, as they got what they agreed to and deserve, and someone else benefiting doesn't in any way hurt them.
Yes, but Jesus' parable wasn't about votes. The disgruntled vineyard workers may have outnumbered the pleasantly-surprised workers 3-to-1 or 5-to-1, but that didn't matter in the parable.

In this MFA situation, the "disgruntled workers" do get to vote and express their annoyance.
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Old 07-31-2019, 09:57 AM
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Something that is really key about this that I don’t see journalists addressing when questioning candidates, probably because they feel it will sound petty: it’s not at all just a question of whether people believe that the MFA replacement will be just as good or better than what they have now. If their union negotiated hard for this benefit or a “Cadillac health plan” was something that attracted them to take their white-collar job, equalizing everyone under the same national plan will take away their feelings of getting something significant there, unless the bill requires employers to substitute a pay raise or other benefit equal to the now redundant employer health plan—and I am sure it does not.
I'm not following you here. Unions negotiate for better health care, and employers use "Cadillac plans" as a way of attracting better candidates. If MFA were put in place, unions and employers would throw up their hands and proclaim, "Now there's nothing we can negotiate for or offer to make our union/company more attractive to employees"?

I find that very unlikely. Unions will negotiate for and employers will offer something else. It may be higher base pay, but I think in many instances it can be more paid time off, or another benefit. Why would there need to be a requirement for employers to do something? There was no requirement for them to offer better health insurance, but there were competitive reasons for them to do so.

I've said before that I see no real reason why supplemental private insurance would not be available with a MFA system. There are a huge variety of plans available for those on Medicare now, and they have to be very profitable or insurance companies wouldn't spend the vast sums they do to market their plans.

What I've been mulling over is this: Provide MFA, allow private supplemental insurance, but make such insurance taxable compensation to employees. Those rich union plans, and Cadillac plans for the lucky few are being largely underwritten by all of us since premiums for such plans are deductible to employers and not taxable income for employees.
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Old 07-31-2019, 10:14 AM
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I think Democrats get too deep in the weeds discussing the particulars of policies in the campaigns while Republicans get away with bumper sticker platitudes. Keep it simple, say "we're on your side, we're going to build upon the ACA, expand Medicare to cover more people but still allow regulated private insurance for those that prefer it". Then fucking stop right there. Just let the voters know that Democrats are going to fight for them and get them health care as best they can, fleshing out all the details and debating potential weaknesses of each embryonic solution only plays into Republicans' hands.
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Old 07-31-2019, 10:25 AM
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I'm pleased that so many of the candidates are pushing back on the idea of abolishing private health insurance, for all the reasons stated upthread.

To emphasize the point, I suggest changing "Medicare For All" to "Medicare For Anyone." If you want to stick with your private plan, feel free. If you want Medicare, it's available.
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Old 07-31-2019, 10:44 AM
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I strongly endorse what BLD said, although he is not living up to his name.


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I'm not following you here. Unions negotiate for better health care, and employers use "Cadillac plans" as a way of attracting better candidates. If MFA were put in place, unions and employers would throw up their hands and proclaim, "Now there's nothing we can negotiate for or offer to make our union/company more attractive to employees"?

I find that very unlikely. Unions will negotiate for and employers will offer something else. It may be higher base pay, but I think in many instances it can be more paid time off, or another benefit. Why would there need to be a requirement for employers to do something? There was no requirement for them to offer better health insurance, but there were competitive reasons for them to do so.

Right, but I’m not talking about what will happen in future negotiations, but rather what was already won in previous ones. Those Cadillac health plans (which as you note are unfortunately tax deductible) will go poof when MFA takes effect, but will not necessarily be instantly replaced with a pay increase of the same size. And because of that tax deduction, if employers even give their employees the amount they were paying on their behalf in premiums (which is no guarantee), that will increase the employees’ tax hit.


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I've said before that I see no real reason why supplemental private insurance would not be available with a MFA system. There are a huge variety of plans available for those on Medicare now, and they have to be very profitable or insurance companies wouldn't spend the vast sums they do to market their plans.

But this would not be a thing under the bill Bernie wrote, and which Warren is also supporting. MFA isn’t really Medicare at all, but a “Cadillac” single payer plan (something that exists nowhere else in the world) co-opting Medicare branding. There are no premiums, no deductibles, no copays even on prescriptions, and everything under the sun is fully covered. It’s the worst of both worlds, because it could never work fiscally, and the prospect of it is damaging to Democrats.
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Old 07-31-2019, 10:52 AM
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Right, but I’m not talking about what will happen in future negotiations, but rather what was already won in previous ones. Those Cadillac health plans (which as you note are unfortunately tax deductible) will go poof when MFA takes effect, but will not necessarily be instantly replaced with a pay increase of the same size. And because of that tax deduction, if employers even give their employees the amount they were paying on their behalf in premiums (which is no guarantee), that will increase the employees’ tax hit.

But this would not be a thing under the bill Bernie wrote, and which Warren is also supporting. MFA isn’t really Medicare at all, but a “Cadillac” single payer plan (something that exists nowhere else in the world) co-opting Medicare branding. There are no premiums, no deductibles, no copays even on prescriptions, and everything under the sun is fully covered. It’s the worst of both worlds, because it could never work fiscally, and the prospect of it is damaging to Democrats.
I think whatever replaces the Cadillac plans will happen PDQ. After all, the reason for such plans will still be there. Any employer who has a need to offer such plans, will come up with an alternative quickly. And unless they want to see their best current employees jump ship for better benefits or pay from their competitors, they will provide the plan to current employees.

Whatever Bernie and Warren are supporting is only tangentially related to whatever actual legislation is proposed. I think true MFA -- that is, offering the program as it is now to everyone -- will become that proposed legislation.
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Old 07-31-2019, 10:53 AM
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If you want to stick with your private plan, feel free.
The problem with fulsomely promising that people can keep their plans is that it's not something the government, let alone a presidential candidate in the primaries, can meaningfully promise in a way that people will understand as having been kept. Any major change is going to disrupt the market, and in any case, there's no current guarantee that you can keep your plan: Health insurance policies are not permanent arrangements with unchanging costs and benefits, and beyond that, most private plans are benefits of at-will employment. Obama fell into this trap (although he may not have had much of a choice) and it was a major controversy of his administration.

Honestly, I'm just tired of hearing about specific plans for health insurance legislation at all, but I'm pretty pessimistic about the legislative side of things. 52 Democratic senators (which, to be clear, is at the good end of possible outcomes) are going to have a damn hard time finding their way to passing anything big at all (on anything, but especially health insurance reform). I realize that you can't actually campaign on that reality, but I'd like to hear more about executive policy and less about legislation, from the entire spectrum of candidates.

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Old 07-31-2019, 11:02 AM
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I think whatever replaces the Cadillac plans will happen PDQ. After all, the reason for such plans will still be there. Any employer who has a need to offer such plans, will come up with an alternative quickly. And unless they want to see their best current employees jump ship for better benefits or pay from their competitors, they will provide the plan to current employees.

Whatever Bernie and Warren are supporting is only tangentially related to whatever actual legislation is proposed. I think true MFA -- that is, offering the program as it is now to everyone -- will become that proposed legislation.

That would be a lot better, but it is much different from what they are proposing. And they defend the tax increases involved by saying there will be no premiums and copays and the plan will be better than what people already have.
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Old 07-31-2019, 01:01 PM
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The problem with fulsomely promising that people can keep their plans is that it's not something the government, let alone a presidential candidate in the primaries, can meaningfully promise in a way that people will understand as having been kept. Any major change is going to disrupt the market, and in any case, there's no current guarantee that you can keep your plan: Health insurance policies are not permanent arrangements with unchanging costs and benefits, and beyond that, most private plans are benefits of at-will employment. Obama fell into this trap (although he may not have had much of a choice) and it was a major controversy of his administration.
You're right about promises biting Obama in the ass, and this one faces the same pitfall: just because the government doesn't deny you access to your favored health plan doesn't mean your employer will still pay for it, or that the insurer will keep the same plan available.

That's why MFAnyone has to be sold, not just promised. It will be simpler. It will be seamless when you change jobs. It will unleash entrepreneurs who don't have to stay in their jobs to get affordable healthcare coverage. Etc.
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Old 07-31-2019, 03:08 PM
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I'm pleased that so many of the candidates are pushing back on the idea of abolishing private health insurance, for all the reasons stated upthread.

To emphasize the point, I suggest changing "Medicare For All" to "Medicare For Anyone." If you want to stick with your private plan, feel free. If you want Medicare, it's available.
That's the public option, letting people buy into Medicare (which includes making employers offer subsidized Medicare as an option).

I'd be open to that, but I think all uninsured should be auto enrolled in medicaid, private insurance should have all payer rate setting, elimination of networks, capping total out of pocket expenses including premiums, etc.

We don't need single payer to have a humane universal health care system. The Netherlands, Israel, Germany, Switzerland, etc do not have single payer but they all have universal health systems.
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Old 07-31-2019, 03:14 PM
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Something that is really key about this that I don’t see journalists addressing when questioning candidates, probably because they feel it will sound petty: it’s not at all just a question of whether people believe that the MFA replacement will be just as good or better than what they have now. If their union negotiated hard for this benefit or a “Cadillac health plan” was something that attracted them to take their white-collar job, equalizing everyone under the same national plan will take away their feelings of getting something significant there, unless the bill requires employers to substitute a pay raise or other benefit equal to the now redundant employer health plan—and I am sure it does not.

Sadly, behavioral economics studies show that people would rather get a five dollar an hour pay cut while their neighbors get a $10 cut, than get a five dollar raise while their neighbors get a $10 raise. (These numbers may not be exactly accurate, but the gist is there.) People care more about their relative wealth than their absolute wealth, which is why they get so upset about income inequality: if they are doing a little better and the rich are doing a lot better, they feel like they are doing worse.

So as unsatisfying as it would be for the progressive left, the best thing Democrats could do for now is to offer a universal benefit for anyone who is not insured, but make it less generous than a good union or white collar plan. Then the centrist voters we need can feel they are doing something nice for those who are struggling, without feeling like they have lost ground in terms of having something better than the “unfortunates” have.
So Crabs on a bucket, anything that makes life better for others will breed resentment? That reminds me of people who opposed gay marriage because they felt it cheapened heterosexual marriage.

Why not oppose a minimum wage hike because semi skilled workers who make $11 will be making the same as no skilled workers if the new minimum wage is $15.

Why not just phase it in to give people time to adapt.

Also what do you have against the 'left'? America's left is barely even leftist.
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Old 07-31-2019, 03:37 PM
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That's the public option, letting people buy into Medicare (which includes making employers offer subsidized Medicare as an option).
Right, I realize that's the public option. I wasn't proposing the idea so much as I was proposing the name: Medicare For Anyone. It sounds more choice-y and less impose-y.
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Old 07-31-2019, 03:46 PM
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So Crabs on a bucket, anything that makes life better for others will breed resentment? That reminds me of people who opposed gay marriage because they felt it cheapened heterosexual marriage.

Why not oppose a minimum wage hike because semi skilled workers who make $11 will be making the same as no skilled workers if the new minimum wage is $15.

Why not just phase it in to give people time to adapt.

Also what do you have against the 'left'? America's left is barely even leftist.

The minimum wage thing is an issue for that reason.

And yes, i’ve heard all about how the left here is the center-right everywhere else or whatever. It’s a lot of hyperbole. I grew up in a left-wing family and they were legit left Marxists.
  #29  
Old 07-31-2019, 04:14 PM
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Right, I realize that's the public option. I wasn't proposing the idea so much as I was proposing the name: Medicare For Anyone. It sounds more choice-y and less impose-y.
Thats fair enough. I've also heard it called 'medicare for anyone who wants it' which is the same as what you describe.

There were some good points in the debate though about how public insurance underfunds medical suppliers, and as a result there could be issues due to that. I know Washington recently passed a public option, but their reimbursement rate was 160% of medicares, which also kind of defeats the purpose.

The reason public health insurance is cheaper is due to lower reimbursement and lower overhead. If you take away the lower reimbursement, much of the financial benefit of the public plans go away. The overhead benefit is still there, I think medicare is only 2-5% overhead while private insurance can be 20%.
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Old 07-31-2019, 04:36 PM
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And yes, i’ve heard all about how the left here is the center-right everywhere else or whatever. It’s a lot of hyperbole.
Not if you're talking about the actual political roles of the different ideologies. The part of the US "left" that actually plays a significant political role advocates positions that in, say, most western European countries would be considered far more centrist or rightist than they are here.

Quote:
Originally Posted by SlackerInc
I grew up in a left-wing family and they were legit left Marxists.
But your family members weren't elected to anything, nor did their support put any other "legit left Marxists" into any significant political office.

Nobody's denying that there exists a small number of individual Americans who espouse left-wing views just as radical as any of their counterparts in Europe or wherever. The point, though, is that in the US those extreme leftist types have far less real political power and influence than their counterparts in other developed-world democracies.

Conversely, in the US the extreme right wing have much more real political power and influence than their counterparts in other developed-world democracies.
  #31  
Old 07-31-2019, 04:40 PM
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In real-life Medicare, the basic insurance is just that: basic. The private sector does a nice job with supplemental policies that have differing prescription management services, dental, eyeglasses, hearing aids and whatnot.

Give the insurance industry a chance, and they will design a Medicare-compliant, super-luxury, "not just Cadillac, but Tesla combined with Rolls Royce" level supplemental policy that even Libertarians would approve of.
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Old 07-31-2019, 04:55 PM
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Right, I realize that's the public option. I wasn't proposing the idea so much as I was proposing the name: Medicare For Anyone. It sounds more choice-y and less impose-y.
I like that. Good idea.
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Old 07-31-2019, 05:00 PM
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In real-life Medicare, the basic insurance is just that: basic. The private sector does a nice job with supplemental policies that have differing prescription management services, dental, eyeglasses, hearing aids and whatnot.

Give the insurance industry a chance, and they will design a Medicare-compliant, super-luxury, "not just Cadillac, but Tesla combined with Rolls Royce" level supplemental policy that even Libertarians would approve of.

How many times do I need to point out that Bernie’s bill is not Medicare at all but a single payer plan that is much more generous? There would be no market for the plans you describe because there is nothing left to supplement.
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Old 07-31-2019, 07:20 PM
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How many times do I need to point out that Bernie’s bill is not Medicare at all but a single payer plan that is much more generous? There would be no market for the plans you describe because there is nothing left to supplement.
Have you looked into John Dulaney's plan?

His plan seems to be more like a basic ACA plan for everyone as the public plan, then a variety of private plans on top of it you could buy as supplementals.

https://slate.com/business/2019/07/j...n-chances.html

https://www.vox.com/2019/2/11/182201...l-john-delaney

Quote:
Granted, there are a lot of details Delaney still needs to fill in, but the bones are pretty simple:
  • Every American under 65 would be enrolled in a new public plan that covers a certain set of basic medical services, comparable to the essential health services covered by Obamacare.
  • Employers and individuals could purchase supplemental insurance.
  • Medicare for people over 65 would be untouched.
  • The plan would be paid for mostly by maintaining the shared state-federal payments for Medicaid and by ending the unlimited tax break for employer health benefits.
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Old 07-31-2019, 07:28 PM
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Co-pay for my rheumatologist is $50 when I walk in the door, for my GP $25 when I walk out the door. I wonder why one guy is allowed to charge a larger co-payment.
Because one is a specialist, and one is not?
  #36  
Old 07-31-2019, 07:59 PM
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ETA: RW, I hear this kind of argument about the future quite often. But this election will be held in 2020, not 2040.
Alternatively, M4A will win, because we are living in the 21st Century, not the 20th.

M4A is the rallying cry for those who want a revolution. It's what a campaign to replace the ancient, corrupt pols in Congress will run on.

Stop acting like the Presidential election exists in a vacuum. The real fight is over Congress, and the only way to fix the USA's fiscal, environmental, & justice problems is to knock out as many corrupt "conservatives" and "centrists" as possible,

M4A is how you get the reformers into those seats.

But please, keep vocally opposing it. We need to know who our friends aren't.
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Old 07-31-2019, 08:39 PM
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How many times do I need to point out that Bernie’s bill is not Medicare at all but a single payer plan that is much more generous? There would be no market for the plans you describe because there is nothing left to supplement.
As many times as politicians keep calling it "Medicare for All."
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Old 07-31-2019, 09:32 PM
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I was surprised in the debate last night how everyone was talking about MFA would "ban" private insurance. Maybe I haven't been paying attention but that can't possibly be part of the proposal, right? Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right? Why did all of the candidates allow this talk of banning private insurance go unchallenged?
Bernie Sanders crafted the name Medicare For All during his 2016 campaign. He left open some small areas for private insurance like elective plastic surgery, at the time. Sanders introduced a Medicare For All bill in April of this year. The only allowed private insurance under that bill is for things not covered under MFA like elective plastic surgery and private hospital rooms. . The bill also prohibits cost sharing. (Cite)

Bernie Sanders created the name. He introduced a bill named Medicare For All just a couple months ago. That bill really would ban most private insurance and prohibit the two-tiered approach used in some UHC countries. MFA is not a synonym for universal health care. The problem is that many are using it as a synonym and consider possibilities that Sanders proposal explicitly prohibits. That prompts confusion.

It's also not really Medicare as we know it if implemented. Medicare is a multiplayer system that offers universal coverage for those 65+. Sanders is effectively calling for a complete repeal of the current Medicare system with a totally new replacement system. Repeal and replace is probably a bad slogan for the Democratic primary, though.

Last edited by DinoR; 07-31-2019 at 09:33 PM.
  #39  
Old 07-31-2019, 09:58 PM
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Sanders introduced a Medicare For All bill in April of this year. The only allowed private insurance under that bill is for things not covered under MFA like elective plastic surgery and private hospital rooms.
Why would private hospital rooms not be covered under MFA? It's my understanding that the trend now in new hospitals to have only private rooms, and that many existing hospitals are reconfiguring to have mostly private rooms.

There are a lot of advantages, including financial ones

Quote:
Because hospital-acquired infections are a common complication and extend inpatient stays, hospitals actually save money by building costly, single-patient rooms, according to a new study by Cornell University.
  #40  
Old 07-31-2019, 11:51 PM
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The second problem is that his proposed plan would have so many “bells and whistles”, there would be none left to supplement. Which of course would be unworkable fiscally, but that is what he is proposing: no premiums, no deductibles, no copays even for prescriptions, any doctor, etc.
No premiums - Canada - check

No deductibles - Canada - check

No copays (for doctors / hospitals) - Canada - check

Any doctor (if you mean no networks?) - Canada - check.

Doesn't seem unworkable here. And yes, there isn't much left to supplement in primary health care.
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Last edited by Northern Piper; 07-31-2019 at 11:54 PM.
  #41  
Old 07-31-2019, 11:54 PM
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As far as I can tell, there are three ways to achieve universal coverage:

Government as provider (UK's National Health, US's VA hospital system)
Single Payer (Canada, Medicare)
Private health insurance, with mandates, coverage requirements, and subsidies (Obamacare if done right, some European countries)
Canada is a mixture of government provider and single payer. Hospitals are largely publicly run. There are some not-for-profit charity ones, and the occasional private one, but most hospitals now are government provided. Doctors are primarily single payer, as are clinics for medical tests.
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Old 08-01-2019, 07:52 AM
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Canada is a mixture of government provider and single payer. Hospitals are largely publicly run. There are some not-for-profit charity ones, and the occasional private one, but most hospitals now are government provided. Doctors are primarily single payer, as are clinics for medical tests.
OK, thanks for that clarification. Even under most universal coverage plans proposed in the US, I imagine we'll still have some government run facilities in the VA and in the military.

I'm surprised you're able to reply, given the mass death and destruction that I assume happens when you have such a socialist medical system. Congrats on surviving in that, I presume, desolate wasteland.
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Old 08-01-2019, 12:28 PM
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Short answer to the OP -- private insurance could still exist, just as a "top up" to MFA. Employers could offer a private insurance plan that gives employees with Cadillac plans the bells and whistles they're used to, it would just cost them a lot less. It's true that the employers would probably end up pocketing the savings rather than passing it on, but that's capitalism for you.


I was surprised in the debate last night how everyone was talking about MFA would "ban" private insurance. Maybe I haven't been paying attention but that can't possibly be part of the proposal, right? Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right? Why did all of the candidates allow this talk of banning private insurance go unchallenged?

...
Yes, you are correct. Not only Medicare supplement plans could & would exist, but there no reason premium "cadillac" plans couldn't also. Saying MFA means the end of all private insurance is wrong.
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Old 08-01-2019, 09:04 PM
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It descends how good M4A is. Supreme Court of Canada has ruled that governments can't ban private insurance, but that doesn't mean private insurance sprang up. How many people will pay insurance premiums to get premium coverage when they can get free coverage?
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Old 08-01-2019, 09:09 PM
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Why would private hospital rooms not be covered under MFA?
I don't have a good answer but that was Sanders' aides saying that in my cite. I presume that's for hospitals that still offer both private and shared rooms but I'm just guessing.
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Old 08-01-2019, 10:05 PM
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Why would private hospital rooms not be covered under MFA? It's my understanding that the trend now in new hospitals to have only private rooms, and that many existing hospitals are reconfiguring to have mostly private rooms.

There are a lot of advantages, including financial ones
If that's only what they have , sure. But if it is a option you pay more for, like at many hospitals, then no, it wouldnt be covered.
  #47  
Old 08-02-2019, 12:34 AM
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No premiums - Canada - check

No deductibles - Canada - check

No copays (for doctors / hospitals) - Canada - check

Any doctor (if you mean no networks?) - Canada - check.

Doesn't seem unworkable here. And yes, there isn't much left to supplement in primary health care.

And as I know both anecdotally (because my mother and sister are Canadian) and from reading on the subject, Canada has lengthy delays that would cause riots if they happened here.


Quote:
Originally Posted by foolsguinea View Post
Alternatively, M4A will win, because we are living in the 21st Century, not the 20th.

M4A is the rallying cry for those who want a revolution. It's what a campaign to replace the ancient, corrupt pols in Congress will run on.

Stop acting like the Presidential election exists in a vacuum. The real fight is over Congress, and the only way to fix the USA's fiscal, environmental, & justice problems is to knock out as many corrupt "conservatives" and "centrists" as possible,

M4A is how you get the reformers into those seats.

But please, keep vocally opposing it. We need to know who our friends aren't.

Awesome strategy. Politics of subtraction rather than addition. Expelling apostates rather than seeking converts.
  #48  
Old 08-02-2019, 01:18 AM
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And as I know both anecdotally (because my mother and sister are Canadian) and from reading on the subject, Canada has lengthy delays that would cause riots if they happened here.
:
They wouldn't cause riots because the type of people who don't lengthy delays now in the U.S. aren't the type who riot. People get denied specific treatments all the time under the current system and have to fight for payment.

Lengthy delays for some procedures is a problem in Canada and that may be an inevitable result of a publicly funded health system. But it's bullshit to pretend there isn't lots of delays in the current American system except for the very rich. The next time your mom or sister complain, ask them how much they think it would cost them to buy their perfect no wait insurance in the U.S.
  #49  
Old 08-02-2019, 01:33 AM
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And as I know both anecdotally (because my mother and sister are Canadian) and from reading on the subject, Canada has lengthy delays that would cause riots if they happened here.
...rather than rely on anecdote, can you quantify what a "lengthy delay" would be, and compare that delay to someone in the United States who has no insurance and doesn't qualify for any other assistance?
  #50  
Old 08-02-2019, 01:53 AM
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It’s irrelevant to say that it’s better to have coverage with delays than to have none at all. That is obviously true, but middle class Americans who already have health coverage will not stand for having even slightly worse coverage even if it is for the greater good. Is that morally bankrupt of them? Maybe so. But this is politics, and we have to go with what the voters will actually accept. The Elizabeth Warrens of the world obviously think we should just wag our fingers and hector them to be better, but this is incredibly stupid politics and will not get anything good accomplished for anyone.


https://ottawacitizen.com/opinion/co...imes-the-worst
Quote:
Whether you ask physicians or patients, the answer is the same: Canada is failing to provide timely access to medical care.
The U.S.-based Commonwealth Fund, in conjunction with the Canadian Institute of Health Information, just published the results of itshealth policy survey of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. The results indicate that Canada is not just lagging, but is literally scraping the bottom when it comes to indicators of timely access to health care.

Notice that there are plenty of countries with universal healthcare on that list. Let’s maybe emulate them, if it is politically feasible. But definitely not Canada. Not until they get their act together.


Quote:
Originally Posted by CarnalK View Post
Lengthy delays for some procedures is a problem in Canada and that may be an inevitable result of a publicly funded health system. But it's bullshit to pretend there isn't lots of delays in the current American system except for the very rich. The next time your mom or sister complain, ask them how much they think it would cost them to buy their perfect no wait insurance in the U.S.

They don’t complain, at least not in the way you mean. They are NDP voters, true believers that their healthcare system is so superior, like everything else in the country they have adopted. I am the one side-eyeing it all as I hear about their difficulties time after time.

Meanwhile I have been consuming lots of long-deferred medical care in the past two years after a couple decades of being either uninsured or underinsured. Blue Cross/Blue Shield has taken great care of me.
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