It is not about fiscal responsibility. Or the filibuster where the minority party in the Senate can obstruct. Or when Pubs do it X and when Dems do it Y.
The sticking point is that people need subsidies to pay the premiums on the most basic health care plans. How is it that we are at a point that the insurance plan itself is too expensive let alone the fact that we have to actually pay most of the medical costs ourselves because they don’t cover it. I don’t agree that shutting down the government over one aspect of the medical costs cluster is the right move. We (the people) need to burn down the current system and rebuild it from scratch. When single payer came up in Colorado (a blue state), 70% of the voters voted against it.
I would argue trying a system more like the one in Germany or the Netherlands might be a good place to start. You could get costs even lower by using a system like the UK or Japan, but that might be too radical a departure.
So, what does the German system look like? This is pretty easily researched, but it’s basically a multi-payer hybrid system with public insurers that have to accept all applicants and additional private options on top. Public options have to meet government-set requirements for coverage and insurance premiums are set based on income (so you can’t pay more than a specific percentage of your income in a a given year to be covered). If this sounds familiar, the core ideas are what “Obamacare” was all about: mandatory coverage, guaranteed issue/community rating, and subsidies for affordability.
The right will block all rebuilding, and people will die in the meantime. Destruction is easy, fast and mindless-building is hard, slow and takes a lot of thought. We definitely aren’t missing what you are pushing here, but we are certainly tired of this non-”help”.
Well, there are definitely some sweeping, but probably not mind-breaking changes that could be made. Some folks might end up with slightly worse coverage, others with slightly better.
Typically the ones that might get gored the worst are the ones that get platinum-level coverage from their employer with a relatively small employee contribution. They don’t realize (or believe, perhaps) that this is just part of their compensation.
One such change would be that any plan an insurer offers must accept all applicants at the same cost (considering only age and perhaps smoking status or other government-approved factors). So if United Healthcare wants to negotiate to get Boeing’s business, for example, then that plan must be available to folks at the small auto body shop down the road, or the independent contractor, or the Uber driver. No more breaks for big employers that have leverage over the insurers.
This is the guaranteed issue part of the ACA, but expanded to include coverage that isn’t on the exchanges.
The next step, of course, is that all “public” insurance is just ACA exchange insurance, with premiums set by the market and subsidized by the government. Decouple insurance from having a job, and don’t hide the costs inside of an overall compensation package.
ETA: If you’re asking more broadly “who gets less money or less health care from the system?”, I would say it’s largely two categories. One is insurance companies (either in the form of profits or just dead-weight jobs). The other is high-cost specializations with tend to be significantly over-compensated in the US compared to other developed countries. And perhaps a third group which is the one I pointed out above - the ones that have on-demand high-quality coverage with no to minimal wait times because they get it from their job.
Have enough citizens with brains who will never vote Republican Fascist. Then we can begin an era where considerations larger than stopping fascism have some room to breath.
We are IMO a century away from being in the comfortable spot of being even able to have a dialog on affordable health care for all, much less a solution.
The Titanic is dead in the water, with the bow down 20 degrees and you’re proposing we discuss redecorating the steerage class lounge? Color my mystified about this topic.
It is a bit odd… we’ve had these debates for decades now. No intelligent person that has spent more than a few hours reading about it doesn’t know the basic outline of what a sane, workable, and humane system would look like. Hell, a law that said “just do what Germany does” would be better than what we have now.
We spent most of the early 2000’s debating it, and only got the bare minimum level of improvements over the line. Then spent the next decade or two fighting to keep the husk of it alive and functional, while one party worked tooth-and-nail to repeal it without even the outline of a plan to replace it. The current POTUS has run for president 3 times (winning twice) without ever formulating even a template of a plan for health care.
It gets even worse. In California we tried to have single payer and it was killed in committee by our Democratic state legislature. It was never even brought to the attention of the people. Our health care system exists for the benefit of the people that make money off of it (rather than the patients) and our politics are so corrupt that you can’t find enough people of any party to do the right thing. The lobbyists will always pay who they need to pay make sure the required changes are not made. Fixing this problem requires fixing the problem that causes money to be the deciding factor in who wins elections. That same money is almost certainly why 70% of people in Colorado voted against it. Money rules politics.
I know you think it is always the Fascist Republican’s fault, but that doesn’t explain how in Colorado 70% voted against single payer. Some of themwere Democrats and even Progressives.
We have a Democratic legislature here in Colorado and they won’t even discuss it. Of course maybe that is to keep their job when almost 3/4 of the state oppose it. I wouldn’t mind paying high premiums if it meant my medical bills were paid. That’s how car insurance works. My issue is that I pay high premiums AND a significant amount of my medical bills That is my objection to ACA being so great .. it may make the insurance cheaper but it never addressed the fundamental problem of outrageous medical costs to begin with along with insurance failing to protect the consumer except in maybe the most extreme cases.
It’s not really that hard to explain. Of the possible workable and humane health-care systems (as defined by those that are used by developed nations around the world while providing health-care outcomes similar to or better than the ones the US achieves), single-payer is the biggest departure from our existing system. It is not at all surprising that such a dramatic change would be rejected at the ballot box.
I would further argue that the inability of the public at large to reasonably assess the merits and shortcomings of various health-care regimes is one of the reasons we have a representative democracy rather than a direct democracy.
Do you have any inputs as to the merits of the possible changes I outlined above?
I also don’t really think that the Fascist/Socialist framework is really helpful when talking about health care since a highly authoritarian fascist state is perfectly in alignment with a public-private multi-payer socialized healthcare system (or even a single-payer one, potentially). You see some of this is Trump (an authoritarian at heart) arm-twisting Pfizer and others to provide drug pricing breaks to US buyers. Using the power of the government to reward and punish private industries fits nicely with a publicly-managed health-care system. That doesn’t mean the government should stay out of health care. It just means we shouldn’t elect fascists.
Exactly. Coloradans hate paying taxes for anything even if (in this case) it would save them money. We complain about the roads but at the same time vote to reduce our SIT. And TABOR My point to LSLGuy was that there is a lot more here “Facists!”.
The solution is not to make insurance cheaper (although that helps). It is to protect the insured from the out-of-control medical costs. Look at car insurance. I pay a lot per month but if I wreak my car, I pay my $250 deductible and my car is fixed no matter the real repair cost. That is a model that health insurance should follow.
A large portion of Americans hate helping people, even if they themselves are helped in the process. Demonstrably, many of them would prefer their own death over helping other people. Thus, people opposing single player; the fact it would help other people than themselves makes it unacceptable. They’d rather be sick.
But that’s the same problem… ultimately the cost of insurance is just the risk-adjusted cost of the potential claims divided by the number of insured.
There are two related issues: the total cost of all medical care, typically expressed in per-capita terms, and the cost each individual person must bear through insurance premiums, deductibles, and out-of-pocket expenses.
Car insurance is affordable because cars are cheap to fix compared to the cost of keeping a sick human alive. You can’t really analogize between the two.
If you want to cut overall costs down you either (a) allow the government to set limits on what medicine can cost (drugs, procedures, visits, etc) or (b) ration care either by making it unaffordable for most or having some other entity (insurance, government, etc) decide who gets care or not. The free market won’t work because if the choice is pay or die almost everyone will pay. So that’s it - those are your choices.
If you want to make the insurance affordable you have to take from those that have resources to pay the risk-adjusted premiums (the rich) and give it to those that don’t (the poor) via taxation and subsidies. Or you just say if you are poor tough shit you can’t be insured. Again, those are your only choices.
The problem here is just getting everyone to buy into the shared risk pool. Everyone. That’s essentially what Obamacare aimed to do it in its own “free market” way.
There are lots of different ways to do this, all of which can work, but the fundamental road block is -isms. Mostly racism, which is the underlying issue with most of our attempts at making things better for Americans.
See, if a nice, white, evangelical family looks around their church and thinks, “We should all chip in for a communal heath care plan,” they’ll get behind that. And, in fact, there are LOTS of Christian health sharing programs. See, socialism is OK as long as it’s not helping the wrong people.
So your 70% in Colorado is probably 100% of Republicans, who would rather be buried deep in the cold cold ground before their tax dollars go to support whatever race or ethnic group they happen to hate, and 40% of Democrats who are also probably racist.
Until we can get Americans to start thinking about health care as a human right, there’s no solving the problem.
Ultimately, whether funded by direct self-pay, private insurance, or taxes, the total amount every individual pays for medical care has to somehow pay for everyone’s bills.
The problem is that number, over a lifetime, is more than a hefty fraction of Americans can afford to pay. Heck, their “fair share” is more than a hefty fraction of Americans earn over a lifetime.
Even if we wring the administrative & profit overhead of commercial insurance out of the equation, the total cost of all care provided (if provided to everyone without limitation) is in excess of what the country can afford to spend. Not as a matter of political will, but as a matter of economics.
So we need to make the product cheaper, as well as find a way to get enough of everyone to agree that helping pay for other people’s care is in fact the right thing to do.
I actually think a different approach might be better, politically.
One of the big motivators of the MAGA movement is resentment that others are getting an unfair advantage. I would lean into that and point out how unfair it is that folks that work for big companies get great insurance while entrepreneurs and small-business owners have to pay for their own insurance. Why should government employees and Senators get platinum insurance while you’re stuck on a shitty ACA plan? Everybody should have access to the same great plans that the fat cats get, right?
Emphasize the unfairness of the system and talk about how everybody should be able to get the same plan, and see the same doctors, for the same price as everybody else. It’s not “you helping your neighbor”, it’s “not letting your neighbor screw you anymore”.
The simplest solutions would be to either have Medicare have a minimum age of zero or Medicaid have a maximum income of infinity. Then anyone that wants free government insurance can apply for it and be granted it and anyone that wants to continue their current coverage could do so (though I expect all insurance companies to eventually fail when their competition is free). Figuring out how to pay for it would be another matter, but once the free government option exists it would be difficult to change it back so we would likely find a way to keep it. I don’t think it would be impossible to get the people to agree to these solutions, but getting the representatives of any party to vote against their lobbyists is the hard part.
I know we get a lot of endless Republican bashing on this forum, but few Democrats are any better on this issue. We need people willing to lose their jobs in order to do the right thing. We need representatives that will vote for universal healthcare even though it will almost certainly be the end of their career. People like that rarely get elected to begin with because you need to kiss up to the big donors even to make it in to office the first time (with a small handful of exceptions).
My point to LSLGuy was that there is a lot more here “Facists!”.