The Bernie Bill: Medicare for All

[Tiassa]

​

This is going to get complicated.

As the 2016 Democratic also-ran preps a Medicare-for-all bill with no apparent funding mechanism, and four much-murmured presidential A-listers sign on as cosponsors, the Senate Democratic Leader is hedging his position:

Senate Minority Leader Charles Schumer (D-N.Y.) is staying on the sidelines on a single-payer health care bill being rolled out this week by Sen. Bernie Sanders (I-Vt.).

"Democrats believe that health care is a right for all, and there are many different bills out there. There are many good ones," Schumer told reporters during a weekly leadership press conference.

Schumer was asked what he would "say" about the legislation being unveiled Wednesday by the Independent senator.

He didn't say if he would be co-sponsoring the "Medicare for all" bill. A spokesman didn't immediately respond to a request for comment about Schumer's position.

(Carney↱)​

Sen. Schumer can easily be a problem for Democrats. In a transition when voters clearly want changes of direction, institutional consistency as Senate Democratic Leadership does not really qualify as leadership. We might wait and see how the Minority Leader breaks when he gets off the bench, but if we need a microcosm of the Democrats' problem, waiting for others to prove the case before jumping up to lead makes a very intriguing model. It would probably help a great deal if Mr. Schumer would throw in and set the Democratic Party institution about figuring out how to make this work.
____________________

Notes:

Carney, Jordain. "Schumer noncommittal on Sanders's 'Medicare for all' bill". The Hill. 12 September 2017. TheHill.com. 12 September 2017. http://bit.ly/2wZ6BT4

 

[mathman]

I believe all people should have medical insurance. However, Sanders's bill may or may not be the best solution., so I can sympathize with Schumer.

 

[superstring01]

Americans are going to have to be eased into it.

The next step is to do what the Dutch do: have you pick your insurance company every November. You get a base amount to buy your insurance (which by law has to cover catastrophic care with no limit). But the basic care means you share rooms, etc. You can buy the equivalent of "gold" and "platinum" plans either by adding your own money deducted from your paycheck or an employer can contribute.

 

[iceaura]

Americans are going to have to be eased into it.

They are currently farther away than forty years ago, and continuing to ease in the wrong direction.

The next step is to do what the Dutch do: have you pick your insurance company every November.

First you would have to get rid of the Republican Congress and President - because the Dutch plan, like all working plans, imposes cost controls (including heavy income taxes on insurance company executives, drug price curbs, etc) and forbids profiting on basic medical care.

I believe all people should have medical insurance. However, Sanders's bill may or may not be the best solution., so I can sympathize with Schumer.

Schumer's had decades to come up with something better. And plenty of opportunity.
Anybody revisiting Wellstone's plan - the one the Clintons (and Schumer et al) helped kill?

 

[Xelor]

It's long been obvious that health care costs too much for most people to afford paying for it as they might a home repair -- outright or on credit. That means that health insurance is not going away, but to anyone who understands economics, it's not hard to see that health insurance is better provided as natural monopoly goods.

https://kellyandjenny.wordpress.com/2012/01/15/natural-monopoly/

[Either click on the pic or click on the "natural monopoly" link if you don't understand the economics of natural monopoly.]​

Single-payer, economically speaking, is natural monopoly applied to health insurance , which makes sense because in health insurance it's necessary that insurers be able to fully benefit from the cost minimization impact of economies of scale when paying for various care regimens needed by populations of varying states of health. There are a variety of "basic" structural models that can be considered, though I haven't crunched the numbers to discern for myself which of them is most economically efficient.

• Postal services model --> A baseline of coverage is offered by a self-supporting government insurer and private concerns can compete with it as they see fit -- offering fully competing insurance and/or offering supplemental insurance -- and feel able to differentiate their product delivery to customers.
  • Variations:
    • Baseline insurance provided by state government
    • Baseline insurance provided by local (county) government
    • Baseline insurance provided by federal government
• Water model --> Single, regional private sector insurers who have a monopoly on health insurance provision in their region.
  • Variation: government rather than private entity provides the insurance.
• Electricity model --> Single, regional insurers have a monopoly on certain aspects of coverage, with competition for other types of coverage.
  • Variations: the insurers can be either private sector or governments. Obviously, there are too many combinations for how this approach might be structured for me to list.

 

[Tiassa]

Landscaping

​

Democratic enthusiasm, per Steve Benen↱:

It raised more than a few eyebrows last week when Baucus – whom Bernie Sanders once said wouldn't support single-payer "in a million years" – announced his belief that "the time has come" for a single-payer system.

This wasn't an isolated fluke. As the Washington Post reported yesterday, the "dam is breaking when it comes to the Democratic Party embracing government-funded health care."

Sen. Cory Booker (D-N.J.) became the fourth co-sponsor of Sen. Bernie Sanders's (I-Vt.) "Medicare for all" health-care bill Monday. In doing so, he joined Sens. Elizabeth Warren (D-Mass.) and Kamala D. Harris (D-Calif.).

What do those four senators have in common? Well, they just happen to constitute four of the eight most likely 2020 Democratic presidential nominees, according to the handy list I put out Friday.​

Soon after the story was published, Sen. Kirsten Gillibrand (D-N.Y.), who's also rumored to be interested in the 2020 presidential race, announced her support for the legislation, as did Sens. Jeff Merkley (D-Ore.) and Sheldon Whitehouse (D-R.I.).

I'm going to go out on a limb and predict the list of co-sponsors for Bernie Sanders' bill, which is due to be released this week, isn't done growing.

Sen. Chris Murphy (D-Conn.), meanwhile, is moving forward with a separate bill that would allow American consumers and business to buy into the Medicare system. As we discussed last week, this isn't single-payer, but because Medicare is a socialized system, it'd be a significant step in a progressive direction – and offer an interesting alternative to lawmakers who aren't yet on board with Sanders' model. Vox added last week Murphy "casts his bill as an on-ramp to single-payer."

Sen. Brian Schatz (D-Hawaii), meanwhile, has an alternative of his own, which would allow Americans to buy into Medicaid. (Remember, "Medicaid for All" is an approach with plenty of champions, too.)​

And in the question of leadership, the msnbc blogger recalls marriage equality, when "support for the idea within the party was broad, but fears of a political backlash kept most Democratic officials quiet". Perhaps the greatest significance is Democratic willingness to pursue universal health care.

But this is also what makes the Party institution nervous; Steven Rosenfeld↱ considers the point for AlterNet:

The good news is Bernie Sanders and other senators will introduce "Medicare-for-all, single-payer healthcare" legislation this week. The bad news is their proposal won't say how to pay for universal health care for all Americans.

"Unless something changes, which I'm [still] hoping, this confirms the two nastiest judgments of critics of single-payer," said Gerald Friedman, a University of Massachusetts economist and expert on financing universal healthcare coverage. "The liberals are saying, 'The single-payer community doesn't know how to do policy, so they need to come to us, the wonks, and we'll tell them how to do it'—and in the process, we won't do single payer, we'll do something else. And the conservatives who say, 'Single payer will be so expensive that even its supporters are scared to talk about how much it will cost and how much it will raise your taxes.'"

"If you fill in the blanks [on how to pay for universal care], then you are going to have an argument," Friedman continued. "You are going to have an argument with people about how much this will go up; how much that will go up; how much you will be able to control this cost or that cost. You'll have an argument. And if you don't fill in the blanks on the financing, then you're going to just leave the whole space to them [opponents]. They'll say whatever they want."

Friedman's warning, call it loyal opposition, comes at a poignant moment. Progressives have long sought a national health care system, long before Sanders ran for president and popularized the idea. It was sidelined in 2017 over GOP threats to destroy Obamacare and gut Medicaid, the state-run health plan for the poor.​

Such adventures on the horizon. There is a lot here that is hard to gauge, such as what will happen to the latest version of a Republican plan needing a lot of procedure if it intends to make a 30 September parliamentary deadline. But for Democrats the question is simple enough: If the task is nothing more than finding the Holy Grail, someone please tell me there is a plan for that part of the plan.
____________________

Notes:

Benen, Steve. "On single-payer, the Democratic floodgates have opened". msnbc. 12 September 2017. msnbc.com. 12 September 2017. http://on.msnbc.com/2wZpaGA

Rosenfeld, Steven. "Bernie's Big Healthcare Solution Has a Major Flaw … and It's an Open Invitation for Critics to Sabotage the Movement". AlterNet. 11 September 2017. AlterNet.org. 12 September 2017. http://bit.ly/2y1uU1f

 

[Tiassa]

"Massive Party Shift"

​

The summary from Talking Points Memo↱:

Though the bill introduced this week has no chance of passing in a Republican-controlled Congress, and is more of a blueprint than a fully fleshed-out plan, the proposal and its reception show just how far the party’s base has moved to the left on health care in just a few years.

In introducing the legislation on Wednesday during a Capitol Hill press conference, Sanders lamented that the U.S. health care system is “woefully behind every other major country.” He called for a four-year transition to a fully public model that would cover hospital visits, primary care, lab services, maternity care, most prescription drugs, and vision and dental care—without any co-pays.

Though the bill does not say how the government would pay for the implementation of universal health care, Sanders released a list of populist suggestions, including raising the estate and capital gains taxes, creating a new tax on the wealthiest 0.1 percent of earners, and taxing Wall Street banks and other large financial institutions.

Sander promised Wednesday that any increase in individual taxes would be “more than offset” by the health care spending savings people would enjoy.

This lack of detail did not bother co-sponsors like Sen. Richard Blumenthal (D-CT), who told reporters that the message of the bill is what’s important.​

How big a party shift is this? The answer will emerge as Senate Democratic Leadership gets on board and starts leading. Until then, what we see is a shiny bauble in progress; we all want it, but can Democrats carry it to 2018 without resoloving the funding questions? Crowdsourcing the Sanders movement didn't help during the primary; Democrats have more time, though, and a particular range of questions to answer.

It really does seem possible, but the Democratic Party institution and its leadership in elected office will need to step up and actually do some work that doesn't involve mitigating promises as fundraising.
____________________

Notes:

Ollstein, Alice. "In Massive Party Shift, Democrats Line Up Behind Sanders' Medicare-For-All Bill". Talking Points Memo. 13 September 2017. TalkingPointsMemo.com. 13 September 2017. http://bit.ly/2eWvFQS

 

[iceaura]

Though the bill introduced this week has no chance of passing in a Republican-controlled Congress, and is more of a blueprint than a fully fleshed-out plan, the proposal and its reception show just how far the party’s base has moved to the left on health care in just a few years.

The Dems - and the rest of the country - were farther left than this debate forty years ago.

Wellstone's proposals were on the table in the 90s - and meeting with solid "base" approval, everywhere they were heard. (Also approved by "the base" more locally: John Marty's proposals, decades old now. And others.)

The large majority of the American citizenry (60% +) has been on board with this stuff for the entire adult life of almost everyone here.

The "base" has never been the problem.

 

[Tiassa]

[#onceuponatime]​

​

I wonder how far this particular emerging theme will go, or how badly it will come back to hurt. Can Congressional Democrats be memewhipped back into line, or will they finally stand up and say, "Well, yeah, since everyone is either complaining that we are liberal or electing us to be liberal, we thought maybe we should give this liberalism thing a try."

Just like marriage equality.

There's a "third alternative" punch line having to do with the Democratic Party framework and the idea of burying the ACA in order to establish it, among other potential bargains to strike with problematic swing blocs, but the important thing is that if come-lately Democratic leadership still has any viability, this is not the only issue that could use some waking coffee.

 

[joepistole]

Americans are going to have to be eased into it.

The next step is to do what the Dutch do: have you pick your insurance company every November. You get a base amount to buy your insurance (which by law has to cover catastrophic care with no limit). But the basic care means you share rooms, etc. You can buy the equivalent of "gold" and "platinum" plans either by adding your own money deducted from your paycheck or an employer can contribute.

Welcome back String.

What you describe is a lot like Obamacare. It sounds like an expanded version of Obamacare.

 

[joepistole]

[#onceuponatime]​

​

I wonder how far this particular emerging theme will go, or how badly it will come back to hurt. Can Congressional Democrats be memewhipped back into line, or will they finally stand up and say, "Well, yeah, since everyone is either complaining that we are liberal or electing us to be liberal, we thought maybe we should give this liberalism thing a try."

Just like marriage equality.

There's a "third alternative" punch line having to do with the Democratic Party framework and the idea of burying the ACA in order to establish it, among other potential bargains to strike with problematic swing blocs, but the important thing is that if come-lately Democratic leadership still has any viability, this is not the only issue that could use some waking coffee.

I think it's a good move for Democrats. But, Bernie needs to develop a plan to pay for it. He needs more detail. Specifics and details are not Bernie's strong points. Democrats need to be bold, but they need to have their ducks in a row too. Bernie's got the bold thingy down, but he needs to work on the other stuff: the details.

 

[Tiassa]

I think it's a good move for Democrats. But, Bernie needs to develop a plan to pay for it. He needs more detail. Specifics and details are not Bernie's strong points.

The thing about it being a good move for Democrats is that they're announcing a hell of an obligation to voters. Crowdsourcing funding solutions isn't the worst idea in the world; it's just really, really risky. I mean, maybe I'm making too much of it, but there is to the one a seeming tendency in the market to play close to the vest in case one figures out how to profit from their solution, and that might be stifling some information exchange, while to the other I also live in a world verging on idiocracy because six is greater than one, and it's green, yellow, red, just like a traffic light, which makes it so easy.

Don't get me wrong; I'm not going to knock the idea of a broad-application antihistamine, or an easy to use color-coded digital sphygmomanometer. But we're pitching to morons. Soon enough I expect to be reminded that my breakfast cereal stays crunch because crunchy is better than soggy, unless, well, you happen to only eat breakfast cereals at all because soggy Cinnamon Toast Crunch or Golden Grahams are food experiences unto themselves. I had a political discussion some months ago in which, trying to figure why a voter would vote against one's own interests, the other was so determined to ward off arrogant presumption and judgment of another's interests that we could not agree that dead is a better human condition than alive. (I'm sorry, but the signs simply didn't read, "No socialist takeover of healthcare! Hands off my Medicare! Just let me die!" You know, because dead is better than alive. Or something.)

Oh, right. Democrats. Look, they can't run this in the midterm without a decent sketch toward funding.

 

[Tiassa]

About on Schedule

​

Via Howard Fineman↱ for Huffington Post:

Beshear implemented Obamacare in his state more sweepingly and effectively than almost anywhere else in the country—so effectively, in fact, that the big-talking tea party Republican who succeeded him, Matt Bevin, hasn't followed through on his gaudy campaign promise to dismantle it ....

.... Sen. Bernie Sanders (I-Vt.) and a bundle of Democratic senators on Wednesday announced their commitment to replace Obamacare with a "single-payer" government plan for all Americans modeled on Medicare.

But in an interview in Washington, Beshear suggested that single-payer was politically unrealistic and that Obamacare can still be made to work the way it has in Kentucky.

"The problem with Obamacare is not the program itself but the uncertainty about the program," he said. "We were able to minimize that uncertainty in Kentucky, which is why we had nine different insurance companies come in and participate, where before we had had basically only two."

It's not that Beshear opposes single-payer in theory.

"If we were starting from scratch, I would be for single-payer, too," he said. "But we aren't starting from scratch. There are too many stakeholders to be able to sweep them away and begin all over again. It won't work."

Democrats can be forgiven such idealism, Beshear said, but Republicans and Trump administration officials who are deliberately undermining the existing program cannot.

"It'll work if we support it the way we did in Kentucky," the former governor said.​

To the one, yes, this is the shape of the institutional pushback. To the other, Beshear has a ridiculous amount of credibility when it comes to threading the line. But that's the question; if the ACA is how we thread the line, are Democrats safe simply holding the line?

Democratic safety, in this aspect, will perpetually posit a juxtaposition 'twixt holding unsatisfactory ground in fear of losing it for risking an advance to something better. And we can think back to Pat Boone making robocalls↗ against candidate Steve Beshear in a time when many conservatives expected the attack to work against a Kentucky Democrat. It's hard to imagine↱ homophobia in Kentucky↱, isn't it? And yet, throughout, he held the line.

Yeah. And it's true, this is the sort of ally Minority Leader Schumer is going to want in the great out-there.

Watch this fault line running through the Democratic Party. It's going to be important.
____________________

Notes:

Fineman, Howard. "A Key Southern Democrat Says Let’s Stick With Obamacare". The Huffington Post. 13 September 2017. HuffingtonPost.com. 13 September 2017. http://bit.ly/2wXDH6P

 

[superstring01]

Welcome back String.

What you describe is a lot like Obamacare. It sounds like an expanded version of Obamacare.

Thanks Joe.

Fuck. What we have is so totally and insufferably broken that it would surprise no one. It should make people take up arms -- it's that bad. Remind me to tell you about my spine surgery two years ago. Yeah. 36 hours in the hospital. C5/6 arthroplasty. C6/7 fusion. $136,000.

 

[origin]

We can expect to start seeing commercials about the horrors of single payer from the insurance companies.

 

[iceaura]

What you describe is a lot like Obamacare. It sounds like an expanded version of Obamacare.

The differences are critical - they are the core of the US clusterfuck. They are as significant as the differences between ACA and single payer.

The US probably cannot adopt something like the Netherlands model, because it would cost people too much.

The necessary government control of cost is the central economic obstacle to universal health care in the US (racial matters being the central social one). Lack of cost controls is what dooms Obamacare.

We have working single payer setups in the US, that can be expanded. Single payer is probably easier for us.

 

[superstring01]

Legally, I think it would be easier to just say, "Everybody gets medicare as an option." Effectively, Americans are drunk on choice, believing that somehow having insurance companies compete for your business makes things better. Even Australia admitted that quality went down when they went to a Dutch style model. The problem is that we're not going to magically get rid of Republicans and not in sufficient numbers to make those Democrats who win their seats feel safe with a decision that will cost them the seat down the road (never mind redistricting). What is the easiest sell is giving people choices in insurance companies.

But Iceaura is right. When we create a system that encourages layers and layers of profit margin, if we went to a Dutch model, it wouldn't suddenly control costs or fix our clusterfuck of problems. We'd need to immediately reign in costs, control what prescriptions can be charged, limit the patent protection to just seven years (and not the infinite expansions they get), etc. etc.

 

[Bells]

Even Australia admitted that quality went down when they went to a Dutch style model.

We don't have a Dutch style model.

Private health insurance here is not compulsory like the Dutch model, but is something people can choose to join. The Dutch system demands that everyone have private health insurance.

Australia has a Medicare system, which we pay for with a Medicare levy in our tax. That covers everyone's hospital visits if they choose to go public that is. Those who have private health insurance can opt for a private hospital or private care in a public hospital (which doesn't really equate to much, you just pay the excess and the insurer covers the rest - the level of care is the same).. Most GP's bulk bill - meaning that there are no out of pocket expenses to the patient, and it is covered by Medicare. GP's that do not bulk-bill will charge a fee and if one does not have private health insurance, they have to pay the out of pocket expenses for their GP visit. GP's will often bulk bill for patients they know are elderly, unemployed, low income. And you can then take that receipt for the doctor's bill to Medicare and get a refund for a large portion of it. The same applies with specialists. If you go through the public system to see a specialist for a non-emergency issue, it can be a bit of a wait. Or you can see one privately and Medicare will refund 75% of the bill (mostly) if you do not have private health insurance.

We kind of like our Medicare system. Is it perfect? Hell no. But we all contribute to it and if one's case is an emergency, there are no calls to insurers for scans, tests and whatnot. If it isn't an emergency and you need to see a specialist, then it can be a bit of a wait and elective surgery does have a long wait time. That is the only downside to our healthcare system.. The wait for elective surgery and to see a specialist in the public system (as an outpatient at the nearest hospital).. That can be a long while. But if there is an emergency or someone has something like cancer or the GP suspects cancer, then the care is immediate and frankly, brilliant. My father prior to being diagnosed.. When they suspected he had bowel cancer, he was referred through the public system and was seen in a week, they booked him for scans and a colonoscopy within the next week, and he started radiotherapy and chemo within a week of his diagnosis. The same with me. Didn't even have time to actually process what was happening before it was already happening, it was that quick. In that, the Australian healthcare system, to me from what I have seen and experienced, is brilliant.

Scans, tests, surgery were free. As was the treatment. Even get free car parking in some hospitals for radio and chemo patients.

Would such a system work in the US? I don't know. Everyone contributes to it, whether they use it or not. It's there as a safety net for just about everyone. And it covers everything, every test, scan, hospital stay, surgery. Medication is cheaper for low income and pensioners if they have a Government healthcare card (which means GP appointments will generally be bulk billed for them regardless and specialist appointments also for some and/or cheaper).. The impression I get with healthcare in the US is a level of selfishness from so many on the right.. The idea that they object to paying more tax, for example, for others to use these sorts of services that they themselves might not feel they need. Here it's just a thing we all pay through our tax and we know it's there. Sure, some grumble about it, but when push comes to shove, we all know it's there no matter what.

 

[superstring01]

Would such a system work in the US? I don't know. Everyone contributes to it, whether they use it or not. It's there as a safety net for just about everyone. And it covers everything, every test, scan, hospital stay, surgery. Medication is cheaper for low income and pensioners if they have a Government healthcare card (which means GP appointments will generally be bulk billed for them regardless and specialist appointments also for some and/or cheaper).. The impression I get with healthcare in the US is a level of selfishness from so many on the right.. The idea that they object to paying more tax, for example, for others to use these sorts of services that they themselves might not feel they need. Here it's just a thing we all pay through our tax and we know it's there. Sure, some grumble about it, but when push comes to shove, we all know it's there no matter what.

I'm not knocking it. My friend is a lawyer living in Brisbane and she said that there was a noticeable shift in the speed of service when the system was reformed (I'd have to ask her the date). Because she makes over a certain amount, she has to carry private insurance. I would LOVE the Australian system -- hell, even our fuckwit of a president acknowledged the Australian as being the/one of the best systems on the planet.

 

[Bells]

I'm not knocking it. My friend is a lawyer living in Brisbane and she said that there was a noticeable shift in the speed of service when the system was reformed (I'd have to ask her the date). Because she makes over a certain amount, she has to carry private insurance. I would LOVE the Australian system -- hell, even our fuckwit of a president acknowledged the Australian as being the/one of the best systems on the planet.

Huh?

There is no requirement for any Australian to have private health insurance, even if you make over a certain amount of salary. We are encouraged to, but there is no requirement for it. There are incentives or some incentives, particularly depending on one's age and when they sign up. But that's it really.