I don’t think anything I wrote in the OP can be reasonably described as “panicking”. I merely started a debate about whether it’s a good idea. It’s true that the amount of money involved is small compared to the federal budget. Given the size of the federal budget, that’s going to be true about almost any federal program except the real behemoths like Medicare.
You believe that the ACA has already achieved universal coverage? Really? When in the first quarter of this year 41 million Americans were still uninsured? Granted that this is better than the 50 million who were uninsured in 2010, and the corresponding 40,000 or so annual deaths from lack of health insurance is better than 45 to 48,000, but give me a break!
“Universal” doesn’t mean “available to anyone able to pay for it” nor does it mean “quality and coverage proportional to how much you pay”. “Universal” means what I said above: “… an effective health care system must be one that is universal, sustainable, regulated, and cost-controlled, and embraced as a basic human right. This engenders a view of health insurance as a common societal necessity rather than a market commodity flogged for profit.”
Here’s the reality about your “universal” health care system. US life expectancy ranks 27th out of the 34 industrialized OECD countries, and at the bottom of the list of 17 high-income countries studied by the National Institutes of Health in 2013; the Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and in a 2013 Bloomberg ranking of nations with the most efficient health care systems, the US ranks 46th among the 48 countries included in the study. Yet the US spends far more per capita, and more as a percentage of the GDP, than any other country, while leaving some 50 million residents uninsured in 2010, causing 45,000 to 48,000 unnecessary deaths every year from lack of health insurance – though both of those numbers dropped by as much as 20% as the ACA phased in. But 62% of bankruptcies are still due to medical expenses, even among the insured, and among the elderly, a 2013 study found that about 25% of all senior citizens declare bankruptcy due to medical expenses, and 43% are forced to mortgage or sell their primary residence. Cite.
So no, the ACA is nowhere even remotely close to the principles and outcomes of universal health care, and it never can be as long as private business interests dominate the health care system.
Yes, it has. Here we have more befuddlement over terminology. Are the statutory sickness funds in Germany “private insurance”? Not by any sane definition; they may be non-governmental, but they are uniformly regulated in such a way that they collectively function with all the important attributes of single-payer in terms of true universality as I defined it, including community-based rating. They are considered a de facto public system, and Germany’s private insurance system is generally referred to as, well, private insurance, and it’s distinctly different from the statuory system: it uses conventional risk-based rating, and makes up only around 10% or so of the market as an optional amenity for those who elect to use it and can afford it.
Indeed in every civilized country where private insurance exists, it covers only a tiny portion of the market and has relatively little influence on the overall health care market or its costs. In Canada, private insurance doesn’t exist at all for medically necessary procedures, and indeed it is illegal if a province accepts federal health care funding, which all do. “Extra-billing” – i.e.- any kind of co-pay – is also illegal under the same stipulation. Private insurance exists only for supplemental coverages, typically various small items and non-essential extras.
So saying that all countries have private health insurance is one of those claims that is technically true but fundamentally misleading. The central core problem with the US health care system isn’t the fact that private insurance exists, it’s the fact that the private insurance industry is front and center in the entire system, the extent to which it controls the whole health care system with virtually unregulated impunity, and the extent to which it exerts iron-fisted control over the legislative process and public perceptions to maintain its interests.
I take it that the “behemoth” reference is a sly dig at the fact that Medicare is an expensive program. Yes it is. Health care is expensive. It’s expensive in every country in the world that has a managed universal public health insurance system. The only place where it’s more expensive – outrageously more expensive – yet with poorer outcomes – is the US private system.
No. Fuck 'em. They did (and continue to do) everything in their power to avoid paying for services. Fuck them.
I’ve worked in the health insurance industry for more than 20 years and it’s disgusting. I have seen a mind-boggling array of ways they try to not pay for services – from boxes of “lost” claims for certain expensive procedures, to ever more confusing rules, to trying to retroactively avoid paying claims on any tiny reason they can dig up. The latest spin is that plans bought on the open ACA exchanges are being sued because the insurance companies have decided that for higher-risk members who need medication, they’ll only cover one generic, at the highest-tier price. All others are not covered.
All the while, the CEOs and board members of most of these companies run around in their $2000 suits on private jets, spending hundreds of millions of dollars to influence congress, the senate, and the president.
The faster we get single-payer, the better.
Well, you set it back. Now the insurance companies and the federal government are in bed together more than ever. This is the system we’ll have forever, or at least as long as any of us live.
You should be rooting for repeal. That way the system might break down and then single payer will be the only possible option.
I hadn’t appreciated that when Republicans call for the repeal of ACA, they view it as the first step towards a single-payer system. :dubious
Of course they don’t. But it does explain why many people who want it go further oppose the law. They know what the Republicans know: that if ACA gets entrenched it’s permanent. They just think that’s a bad thing for different reasons.
I think that if liberals actually knew how ACA makes single payer impossible, opposition to it would be more widespread. ACA is the very definition of a compromise that pleases no one. Well, no one other than Cigna, Blue Cross…
That’s like rooting for the southern states to secede, since that was the only possible way to end slavery.
Let’s not, eh? Let’s not have a catastrophic financial collapse, leading to tens of thousands of people losing their houses due to medical bankruptcy. Let’s not have an economic failure and recession. Let’s not have tens of thousands of us not able to get life-sustaining medical care.
There are other ways to find your car keys besides burning the house down and sifting the ashes.
And the millions of people who had no insurance before and have it now.
True. Which is why it’s staying pretty much the way it is. If it succeeds, then you’re not going to have any political support to take away people’s health insurance and promise that their new government health insurance will be better. Just won’t fly. And if it fails, no one will trust the Democrats a second time.
Personally, I just don’t see what the issue is. UHC is UHC. If consumers have choices, that’s better UHC than consumers not having choices.
Single-payer is already impossible, given the political climate that has existed ever since at least the early 60s when Ronald Reagan and the AMA fought Medicare by declaring it “socialism” and “the end of freedom in America”.
Impossible, that is, as a single bold step. That’s why baby steps like the ACA are necessary. And if the ACA had passed with the public option, it would have already had the kernel of single-payer in it – which is why the insurance companies and their Republican masters made damn sure that it didn’t. But it’s a logical extension for next time.
So by that logic, if the ACA succeeds, then people will trust the Democrats to extend it further, right?
As I already described in detail in the previous post, the ACA is nowhere even remotely close to universal health care, and no one who has a clue what universal health care is really about would make such a claim.
And this thing about “having choices” is the utter nonsense we hear from Republicans all the time about health care, and it’s meekly accepted as a wise truth because that’s how many Americans who have grown up with private insurance think of health care. No, “choice” is when I pick colors and features for a car or a washing machine. In commercialized health care, “choice” has become a euphemism for being able to pick the least bad from a set of coverages that are all inadequate and all too expensive.
What people actually need in health care isn’t “choice”, it’s to get better when they are sick, and that is achieved by having access to quality health care that is guaranteed, unconditional, and provided regardless of ability to pay. It’s fine to have a choice of providers, but in terms of insurance, all you need from them is guaranteed coverage. In the current broken system you don’t even have that – choice of providers may be limited to a defined “network”, and coverage is never guaranteed. Insurance companies don’t get to be profitable by writing checks that they don’t have to.
Gawdamnit adaher, cut the crap. You’ve already admitted in previous threads that the ACA is successful by all measurable & objective means. Your usual spin in this topic that if the law succeeds, then X, Y, & Z are bound to happen is totally baseless, given that your favorite caveat - in terms of the uncertainty of the law’s success - has already taken place (by your own admission, no doubt).
Yes, I want single player. Hell, in my perfect world, the US would nationalize the entire industry & bring our system in line with the UK. Obviously that’s politically untenable, but the ACA is objectively better than the clusterfuck joke of a HC system that preceded it.
And to those who say that the ACA makes single payer impossible, I say this: Look to Vermont. That state is using the framework & funds provided under the law to establish the first SP system in the US. Given that fact, it’s more correct to state that the ACA presents a detour to SP rather than an impassable roadblock.
It’s not a baby step, it’s a move in an entirely different direction. The end result of this is more likely to be what the Swiss have.
No, because when people like what they have, they want to keep it. People trust the Democrats on Social Security, but that doesn’t mean Democrats can say, “We’re going to take away your 401(k)s and IRAs and union retirement plans away and use the money to make SS benefits more generous!” At that point, it’s not about trust, it’s about an awful lot of people losing in the bargain. Single payer isn’t impossible due to Republicans. It’s impossible due to a faction within the Democratic Party: unions. Unions have really awesome health care plans and they aren’t about to give them up for Medicaid.
Then we’ll never have it, because there will always be a lot of people who just pay the mandate, or go without insurance and not pay the mandate tax.
One of the good things about ACA is that it makes selecting a health plan more transparent. They are easier to compare now and you can choose the plan that’s right for you. That should not change. And I don’t think those with plans on the exchanges will be willing to see that change either.
Another good thing about ACA is that it makes it much harder for insurance companies to get our of paying claims, or dropping people for getting sick.
And if we’re looking at making people better, it’s hard to beat the Swiss system of competing insurers. And while we’re talking about the Swiss, to further prove that ACA’s model is not a step on the path to single payer, the Swiss people overwhelmingly rejected single payer in a referendum just a couple of weeks ago. They like their private insurance and they want to keep it.
Okay, so you’ve gotta explain this to me: so you’re looking at all the UHC systems around the world. Why would you pick the UK’s model over the Swiss model, or Japanese model, or the German mode, or French model? Certainly not because of performance.
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First, Vermont’s single payer system isn’t even close to being off the ground. Second, it’s a state. I’m all for states trying out different systems. If the blue states want to get on board with single payer, more power to them. If we could simply agree to let states do their own thing we wouldn’t have so many contentious arguments in this country.
But sure, it makes sense that one of the most blue states in the country would try this first. If they can’t make it work, it can’t work. No excuses, either. Vermont has one of the best run, least corrupt governments in the country. If they can’t pull it off, DC sure as hell can’t.
Except, as you pointed out later, the Swiss just had referendum on single-payer. They voted no, but they could have voted yes. So much for the “ACA makes single-payer impossible” argument! And as I pointed out before, the public option could actually have been the start of it.
Now that I can agree with. You’ll never have it under present conditions, and moreover, most people won’t even understand what it is that they don’t have, and what they could have – for far less money.
I myself don’t have the opportunity to “compare health plans and choose the one that’s right for me”. Here’s what I have instead: a system that simply pays whatever health care costs I incur, without deductible, co-pay, limit, or questions asked, without forms for anyone to fill out, without bureaucratic meddling. It’s not something I ever even have to think about. I’ll take that over the ability to choose from among a bunch of overpriced inadequate bureaucratic profiteering scams, thanks very much.
If it’s not a “step on the path”, then how come it was up for a referendum?
The Swiss system is regulated in a way that progressives can only wish the US system was. One needs to be cautious of superficial comparisons. But even so, the private model makes it among the most expensive in the world after the US, which is of course completely off the chart. I suspect that cost control may make the Swiss revisit this question in time.
I don’t really think that’s the lesson to take from this. Swiss health care is expensive. It’s near the top in the rankings, but it costs more money. Single payer advocates argued that it would be cheaper to switch. It was beaten soundly. The Swiss like what they have, they aren’t interested in money-saving experiments.
In reality, it doesn’t work that way. It especially won’t work that way in the US, where bureaucratic meddling causes problems in every government agency. But even if we assume NHS-level independence in the system, you don’t just get all your medical bills paid for. You get whatever health care the government has decided to fund.
Cost concerns. Which the Swiss decided pretty overwhelmingly was not worth trading quality for. You really do get what you pay for, the US system excepted. France has superior health care too, but they spend quite a bit more than most to get there.
Cost control is possible in a multi-payer system, it’s just not as easy as in single payer, where the government can just say “no” to all comers(except important people of course). And the beauty of the government saying “no” is that they don’t say it to the patient. They say it to the doctor and he simply says, “We can try chemo, but you’re probably screwed”, knowing the proton beam therapy is unavailable.
What is more likely is that we move to a more regulated multi-payer system. The US is different culturally from the rest of the world. We’re comfortable with tiers of care. Heck, we have THREE single payer systems already of varying quality just because: Medicaid, Medicare, and the VA. In the private market, people get their health care from employers, trade guilds, as individual policy holders, as catastrophic policy holders, and as pure cash payers. Then there are the union gold plated plans which are probably the best health care in the country next to what rich people get. You certainly can’t provide that quality of care to all, so any single payer system will be a net loser for union workers, which will make it impossible for Democrats to ever do. Medicare is also superior to Medicaid, and also only possible to fund at such generous levels if we’re only covering old people. The elderly will not give up their Medicare’s quality to be placed in what amounts to Medicaid-for-all.