As public sentiment continues to shift (in the face of ever increasing costs, inefficiencies and unfairness), Republicans are in danger of being caught on the wrong side of this issue, as they have on many others. Single payer is approaching a tipping point and the only questions left are when and how Congress catches up. Not “if.”
Once it’s done, the only campaign issues about it will be along the lines of “how can we improve our national health care system,” not “elect us and we’re going to destroy it.”
Good point. It appears that healthcare was the winning issue for Democrats in this election, and those Republicans who could be credibly accused of wanting to reintroduce the pre-existing condition denial of insurance got clobbered.
If we could get the government paying it will be hard for them to go back, since budget cuts are going to directly impact service, and they’d need to find an alternative, which they sure couldn’t do for ACA.
State oriented UHC is a non-starter. First, you’d get the uninsured from other states coming in, which would make it unaffordable. Second, many states are not big enough to have a sustainable rate base. California has talked about UHC, but it hasn’t happened yet, and I’m not sure it is feasible even for us.
Anyhow, M4A is not just a UHC, it is a more efficient single payer system. Just getting everyone insurance is not going to fix the big problems in our system.
He makes a good argument. The problem though is that we’re not going to get single-payer, because it would require a big piece of legislation, and that would require both parties, and you can forget it.
If you think the Pubs were dug in on ACA, you should see what will happen with single-payer.
The uninsured tend to be healthier than average, that is one reason they are uninsured, because they don’t feel they need insurance (because of how overpriced it is). There may be an issue with people who retired early but who are not old enough for medicare moving to California though. Someone who retires at 52 but doesn’t qualify for a subsidized ACA plan may move to California until they are 65, then move back home.
California could pull off UHC. California has a bigger population than Canada. As far as states being too small, countries like Iceland and Luxembourg both have populations of under a million and both have UHC systems.
The big issue in our system is how bloated, overpriced and inefficient it is. Unless that gets addressed, our system will be a failure. And theoretically we can lower costs w/o going to single payer. All payer rate negotiations, making it easier to go overseas for surgery and long term care, importation of Rx and medical devices, public negotiations of medical prices, streamlining administration, etc. Unless single payer includes those reforms, our system will be overpriced. But we can also get those reforms w/o single payer too.
Single-payer is also a non-starter. It’s a pipe dream in our political system. We’ll never get it. And even if we did, you can bet it would be the most kludgy messed-up horse-traded “single payer” ever. Our congress can barely agree on naming post offices. And people want them to re-engineer our health insurance system. No way.
The only way we’ll ever get UHC is incrementally through the states. It’s the political reality of the US. Single-payer is wanted by the Left, but they’re wishing for something that the other party (which controls the WH & Senate) will never allow.
Keep thinking it’s just the Right who stands in the way of affordable healthcare and you’ll definitely never get it. Big Pharma, Insurance, Hospitals, Lawyers…well everyone in healthcare has a vested interest in keeping this dysfunctional system. And you people on the Left never criticize people anyone on your side. If you Democrats had ousted Booker from office and sent him a real message that the American people want affordable healthcare, things might change.
This is what Cory Book did.
“The New Jersey senator and 12 other Senate Democrats had joined the bulk of the Republican caucus to kill a proposal aimed at lowering prescription drug prices. What made Booker’s vote all the more anguishing for the left is that the proposal won the backing of 13 Republican senators, and had a real chance of passing.”
A lot of us do blame the left. Not as much as the right, but the left refuse to do anything to make our health care system more efficient.
Anything that would’ve made health care more affordable was taken out of the ACA. A strong public option, Rx negotiations, drug importations, etc. The democrats refuse to do anything that steps on the toes of the oligarchs who own america.
And this applies on the state level too. The democrats have undisputed supermajorities in California. But they still won’t enact meaningful health reform. Forget single payer, they won’t even enact smaller scale reforms to lower costs.
Really, the only way to get genuine health reform is via ballot initiative at this point. Even in states with democratic supermajorities, we aren’t going to get legislation to actually make health care cheaper.
A large part of why your system is expensive, is all the various health care systems you’ve kludged together and all the bureaucracy that entails. Adding yet another layer won’t save you money, it’ll actually cost more.
At least at the start, its quite possible that the competition will bring down prices elsewhere over a few years. But having, Medicare, Medicaid, VHA, and a state-run UHC?
Not cheaper. Not unless you repeal Medicare etc and use the money for a state-run UHC, and I don’t think thats any easier politically than a federal UHC.
I think the key might be the Medicaid buy-in option that Nevada and New Mexico are looking at. If they implement this, and it’s successful, then I think the rest of the blue states will follow rather quickly, then the purple states. That leaves the red states, which will admittedly take a while…But all of that can occur before single-payer gets through both parties in both houses of congress and the White House.
Everyone is critical of the current system, and I get it. But single-payer is politically impossible, and will remain so for the foreseeable future.
A movement to single-payer affects not only insurance but also the delivery of healthcare itself. You can’t make a huge move like that and not affect both, which is why the “3 out of 4 like their healthcare” statistic is important.
And I would put more weight on that stat than any other stats about people’s view of the overall healthcare/health-insurance system. Most people don’t like congress either, but they like their own congressman. The average person doesn’t have a clue about the greater healthcare system, but they know a lot about their own situation.
Why does it have to affect healthcare delivery? When I went on a single payer system, mine was not affected. Most doctors and hospitals take Medicare. How would delivery be affected if they just dropped other insurances?
Now delivery would be affected in order to make healthcare less expensive - but that might be happening without single payer. Or I hope it does. And certainly expensive providers - relative to other providers - might have problems.
Are you asking that as a serious question? You don’t change how much & the source of payment over an entire system for something as large as healthcare without impacting the delivery. Some doctors will leave the field. Some clinics will close. Some treatment patterns will be impacted, based on what is paid (or not paid).
One of the reasons that the Dems pushed the ACA was that it specifically was designed to not affect the healthcare delivery of a vast majority of the population…as opposed to single-payer, which could potentially impact everyone.
As a baby step to single payer, we should make a medicare buy in option available to everyone. People who have insurance at work should have an option to buy into medicare instead, and medicare should be on the exchanges.
The public like medicare more than private insurance, and it is about 20% cheaper. So given the option a lot of people will pick medicare.
No, the average person doesn’t have a clue about the quality of their own health care, either, because most of us are healthy most of the time. When you’re healthy, it doesn’t matter if your health care sucks, because you’re not using it. It’s not until you get seriously sick that you find out how good (or bad) it is.
Here in California, ambulance companies are paid for each trip $450.00 by Medicare, $100.00 by Medical, $1800.00 by private insurance companies, and Zero dollars by people who can’t pay. The cost of an average of an ambulance trip is $750 dollars. Private insurance subsidizes government insurance and the indigent. This tells me that once private insurance is gone the actual costs to the taxpayer will be much higher.
There are a few states that are seriously considering a Medicaid buy-in option.
I don’t think the states can do it with Medicare, but only with Medicaid. So, I think that if a public option ever happens, it will be state-by-state instead of through DC.
The current states looking at this are NM & Nevada. If they’re successful, I think it will become common in many blue states quickly.
And I’m not sold on how effective it will be. But I’m just driving the point home that in the current political environment, getting toward UHC will require incremental steps at the state level. It won’t happen from DC.
I have changed the source of payment for my healthcare several times without it affecting my care.
Now I do expect that a single payer system will be able to enforce things like evidence based medicine that might affect care, but for the better overall.
Does your doctor look at your insurance before deciding on a course of action?
Or the ambulance companies can figure out how to cut the cost of a trip.
It is amazing how the free enterprise system and competition can force companies become more efficient. I started working for the Bell System, and left fifteen years later after we were no longer a monopoly. We did things a hell of a lot more efficiently at the end than at the beginning.
Some cities or counties negotiate prices with ambulance services. I think they still make money.