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U.S. needs to move toward single-payer health insurance

blood-pressure machine
REUTERS/Regis Duvignau
There is a national emergency here in America. I am not referring to our southern border or the impeachment inquiries or even the opioid crisis. I am talking about close to 28 million American citizens lacking health insurance. Even those with coverage struggle to afford the premiums and co-pays. Consider these statistics:

A report done by the Commonwealth Fund stated that in 2016, approximately 25% of working adults with employer-sponsored health care had such extreme out-of-pocket costs and deductibles in line with their income levels that they were not adequately insured.

A study from Harvard University revealed that 62% of bankruptcies are due to medical expenses. In a study conducted by the American Journal of Public Health found a link between 45,000 annual deaths and being uninsured.

Spending more than other nations, for little satisfaction

To add insult to injury, the United States spends more on health care than any other country in the world. Yet according to the American Consumer Satisfaction Index, satisfaction reached a 10-year low in 2015.

These are just a few of the reports I looked at. I could cite a long list of other studies and surveys that reveal much of the same. Access to affordable health care in the U.S. is at a critical stage. Even the term, “Affordable Care Act” is a misnomer. Here’s a representative example: I know of one woman who is self-employed who pays nearly one-fourth of her GROSS income for health insurance. It’s the cheapest policy available to her, and it comes with a deductible close to $7,000. Her health care costs far exceed her housing expenses. And she’s not alone. Her case is far too common.

And then there are those who have elected to go without insurance coverage because they simply can’t afford it. The tax penalty is often less than one month’s insurance premium. And so they take a gamble, going without coverage, hoping they don’t have a medical emergency.

Brent William Henry
Brent William Henry
I am an individual who is pro-life and I believe everyone has a right to — as the United States Declaration of Independence puts it — “Life, Liberty and the pursuit of Happiness.” We as a country are not currently living up to these ideals.

All Americans should be covered

In my opinion, it is morally reprehensible to make an individual’s medical necessities about maximizing monetary profitability. Someone who is unfortunately stricken with illness should be treated as a patient, not a consumer. It is time that America fully embraces the concept of universal health care coverage. The best way to achieve that, in my opinion, is to usher in a progressive single-payer system.

There are two primary ways to implement such a structure. The more left-wing approach would be public funding of public institutions. This method is used in the United Kingdom. All medical professionals work for the government. Medicare for All would be the second option, which is public funding for a single insurer. Physicians under such a system would still be able to run their own practice or work for a private group. A single-payer system like the bill introduced in the House as Medicare for All Act of 2019, H.R. 1384, would effectively eliminate the concept of co-pays and deductibles. (There are other options that would still incorporate co-pays and deductibles, but it is anticipated they would be far less than under the existing system.)

Many options for paying

The natural question is, how would we pay for all of this? The good news is we can pay for it and there are various ways of doing so. I have seen multiple reports of a single-payer system costing approximately $3 trillion annually. Economist Stephen Marks proposes ending the cap on payroll taxes and applying payroll taxes to all income, including interest and capital gains. He estimates this will raise close to $1.5 trillion. Economist Robert Pollin suggests two-thirds of the required funds could come from redirecting current spending from Medicare, Medicaid, and the Department of Veterans Affairs. Democratic presidential candidate Bernie Sanders advocates for a 70% top marginal tax rate on Americans earning over $10 million per year as a way to partially fund Medicare for All. According to an article written by oral and maxillofacial surgeon Kate de Klerk, switching to a single-payer system would end up saving America around $200 billion a year by canceling out administrative overhead expenses.

Whatever your opinion on this topic, I think we can all agree that America is in need of health-care reform, and it seems the natural evolution is to gradually shift into a single-payer model. Many countries already have such a system in place, such as Canada, Taiwan, and South Korea.

There was a survey conducted this past summer by the Morning Consult that found 55% of voters back a Medicare for All system that would decrease the role of private insurers, if people can still maintain access to their choice of providers. I can foresee Medicare for All becoming more popular as our current system continues to collapse. Please contact your local legislators and make your voice heard about the many benefits of single-payer health care.

Brent William Henry is an independent voter from Finlayson, Minnesota. 


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Comments (55)

  1. Submitted by Ron Gotzman on 11/12/2019 - 08:53 am.

    The problems you stated about healthcare, costs, premiums, deductibles -are true. However – we were told that Obamacare would solve these problems.

    I hope you were not part in the promoting of the “lies” of Obamacare.

    • Submitted by Paul Udstrand on 11/15/2019 - 08:50 am.

      Actually no, we were NOT told that Obamacare would solve cost, premium, and deductible issues. Obamacare was primarily about coverage requirements, i.e. eliminating pre-existing condition denials, allowing extended coverage for children, and requiring a variety of coverages that for profit insurance companies routinely denied.

      Some proponents claimed that increased competition would lower costs but that was always a neo-liberal/conservative fantasy. Those of us who understand the health care “market” always knew that Obamacare would not control costs. The health care exchange did create some lower premium coverage for some people, depending on the State they lived in, but it also created a lot of high deductible high co-pay plans. Many of the plans that young people ended up buying in lieu of the penalty have very high deductibles, around $10,000. These were all anticipated developments that “centrists” democrats claimed they would come back and fix later. The problem for “centrist/moderates” is that the only “fix” for these deficiencies is Medicare for All. So what ended up happening is “centrist” decided that Obamacare more less as-is was good enough.

      It was always understood that Obamacare would not contain costs, and would leave tens of millions un-insured under-insured. It was never intended to create a nation-wide universal and irrevocable insurance regime.

  2. Submitted by James Hamilton on 11/12/2019 - 09:09 am.

    Given my low estimation of American voters, I am not swayed by surveys generally, much less surveys on the still-nebulous concept of Medicare-For-All. None of the plans I have read about have more than a passing resemblance to Medicare-As-It-Is.

    Those with no experience with Medicare might be surprised to learn that we pay premiums (about $175 per month with the amount withheld from Socail Security plus my Medicare Advantage plan), have deductibles, co-pays, a prescription drug “donut hole” during which coverage drops dramatically, and are at the mercy of an insurer’s drug formulary. There are medical procedures that aren’t covered. It does not cover dental, visual, or auditory care.

    Those who label their proposals M4All should find a new, honest label.

    • Submitted by Pat Terry on 11/12/2019 - 01:25 pm.

      I just had this same discussion with my father, who has Medicare and supplemental insurance. Nobody advocating for Medicare for All seems to even understand Medicare.

    • Submitted by Paul Udstrand on 11/15/2019 - 09:10 am.

      It’s important to note that the “medicare” in Medicare For All is not simply an extension of the Medicare people already have. It’s also important to understand the costs and premiums of the Medicare regime in place now are calculated in accordance with the existing health care market.

      Medicare For All will be very different compared to the current Medicare regime. MFA is universal, nationwide, and irrevocable. It covers ALL medical costs (included medication, eye glasses, and hearing aids) without deductibles or co-pays, and it completely eliminates the doughnut hole.

      The over-cost and “premiums” will lower for three basic reasons: 1) MFA creates the largest possible “pool” of insured creating the largest possible revenue stream and dispersing costs among largest possible number of participants. 2) Universal nationwide participation gives MFA bargaining leverage. US providers currently charge several hundred percent more than any providers elsewhere in the world for the exact same health care and procedures. MFA is simply the simplest and most powerful regime to control and reign in costs. 3). Administratively the US health care regime is currently a disaster. Several hundred payers (insurance plans) currently negotiate different levels of coverage with thousands of providers and split the difference with patients. The full cost of the administrative complexity and burdens of this system are almost impossible to calculate. Conservative estimates we’re paying 20%-30% more than we should just because of this administrative nightmare.

  3. Submitted by Connor OKeefe on 11/12/2019 - 09:43 am.

    I’m sure this young fellow has the best intentions, but we all know what the road to hell is paved with.

    Proponents of socialized health care system always point to Canada…they do it, why can’t we, they ask.

    The question isn’t why can’t we; it’s shy would we.

    The only thing that is guaranteed by the Canadian socialized medical system is a spot on a waiting list. It’s a simple matter of supply and demand; everyone wants something when it “free”, but there aren’t enough people willing to work for free. The result is severe rationing.

    Last year, 3% of Canada’s population waited an average of 21 weeks for some kind of medical care; many die waiting.

    Worst of all, in order to keep socialized medicine viable at all, Canada has banned private insurance and clinics. The government is the only show in town.

    Personally, I don’t know why any rational person would opt for that in America.

    • Submitted by Eric Snyder on 11/12/2019 - 11:02 am.

      Your argument is substantially incomplete.

      For instance, if you had inquired about wait times and rationing in the US you’d discover that the American system has substantial wait times and rationing:

      Over half of Americans delay or don’t get health care because they can’t afford it—these 3 treatments get put off most:

      The problem is so bad that there are 10s of thousands of premature deaths on an annual basis:

      New study finds 45,000 deaths annually linked to lack of health coverage
      Uninsured, working-age Americans have 40 percent higher death risk than privately insured counterparts

      The Affordable Care Act improved this situation significantly, which was predictable. The above study would appear to be bolstered by this new research:
      Medicaid Expansion Has Saved at Least 19,000 Lives, New Research Finds
      State Decisions Not to Expand Have Led to 15,000 Premature Deaths

      We already have a highly rationed system that produces worse health outcomes for many relative to other countries. It kills thousands needlessly. It’s highly inefficient. It burdens many people with unacceptable financial strain.

      How could it not be obvious to conclude that our system doesn’t work?

      • Submitted by Connor OKeefe on 11/13/2019 - 07:15 am.

        Couple problems with your argument, sir.

        First is, in the US, people make the decision to postpone a visit. In Canada, not only is that decision taken from the people, they have made it illegal to buy better care unless you leave the country to do it. You see the difference? (BTW, you’re dental work, eye care and annual exams to MRI’s looking for cancer).

        Secondly, as you point out, we have Obamacare and Medicaid. People, mostly young healthy people are making the choice not to enroll. Again; choice.

        There is no rationing in the US. If people want immediate care, they can get it. Folks have no problem laying out $50,000 for a new automobile, but they balk at paying for treatment that might save their lives…it doesn’t make sense to me, but hey, it’s their choice. (There’s that word again)

        • Submitted by Eric Snyder on 11/19/2019 - 09:57 am.

          1. How does one define rationing? A quick definition might be: Constraints on availability. Thus, the ‘how’ of rationing lacks relevance to the specific point as to whether a weakness of the Canadian system is rationing.

          Here’s how you can ration health care:

          a) Structurally limit resources available relative to need.
          b) Lack of affordability.
          c) Lack of mandated universal coverage.

          2. Your point totally ignore the evidence presented.

          3. “There is no rationing in the US. If people want immediate care, they can get it.”

          The _only_ way you can argue this is if you simply ignore the evidence. You’re not even trying to seriously engage with this issue. The claim about affording a $50,000 automobile is a straw man and irrelevant.

    • Submitted by Paul Udstrand on 11/15/2019 - 09:14 am.

      The US has the most heavily rationed health care system in the world. No other country denies complete health care and basic service to 30-60 million people or such high percentages of it’s population.

      Wait times in US are just as long if not longer for most people seeking non-emergency treatment.

      Anyone who talks about the Canadian system is wasting our time. We’re not talking about adopting the Canadian plane, we’re talking about implementing Medicare For All.

      • Submitted by Connor OKeefe on 11/15/2019 - 01:10 pm.

        “we’re talking about implementing Medicare For All.”

        Many people cannot afford to pay the deductibles for Obamacare; what makes you think they will be able to afford the premiums and deductibles for Medicare?

        It’s been pointed out earlier in this thread, by another commentator, that people advocating Medicare For All don’t know anything about Medicare; I think that’s right.

        • Submitted by Paul Udstrand on 11/15/2019 - 11:19 pm.

          Connor, please pay attention. There are NO deductibles with MFA and the premiums will be far more affordable than what you’re paying now. The average family will save $3k-$5k a year.

  4. Submitted by Gerald Abrahamson on 11/12/2019 - 01:43 pm.

    What is needed is very simple: Mandatory universal health care. It does not have to be single payer, but it could be. The key points are simple:

    1. Everyone is covered.
    2. There is one set of forms for all insurance companies, with all the insurance companies using the same billing and treatment codes, etc.
    3. Pretty much every medical need is covered. NOT covered: Vanity medical procedures.
    4. Medical bills submitted to them are paid by the insurance companies within 2-3 days.

    • Submitted by Tom Anderson on 11/12/2019 - 06:20 pm.

      “Mandatory and universal” meaning that everyone must have some. OK.
      There wouldn’t be any insurance companies (for the public plan) since they would all be doing exactly the same thing, at a loss.
      #3 is what universal takes care of, and what makes things so expensive since “need” varies from person to person.
      #4 no insurance companies eliminate this, let alone the impossibility of it. Just think about your tax refund for one example.
      The missing point? How to pay for it? The author says that administrative expenses will be cut, but that is only if there are no insurance companies which means single payer. Trust me, the government costs money.

      • Submitted by Gerald Abrahamson on 11/13/2019 - 09:12 am.

        Paying for it is the part everybody loves. The cost will trend DOWN until it is in the 50% to 60% range of today’s cost, then it will stay at the level. Costs fall because major expenses (such as pharma) can be reduced by requiring commonsense stuff such as price-matching. When you buy more, the cost for each dose goes DOWN. That does not happen in the current system. So that is $500+B in cost reductions right there. The high cost of becoming a doctor is one, and then setting up and running a medical practice is another. There are HUGE costs involved. so reducing those costs substantially cuts the cost of health care over the long term. That is another $500+B saved every year after 5-10 yrs, so we are getting there. Additional savings of up to $800B are reasonable, but it will also depend on what new technologies are developed that will further reduce the cost of medical care. The US pays about *double* per capita for healthcare and gets far worse outcomes (average life expectancy is 2-3 years LESS).

        • Submitted by Connor OKeefe on 11/15/2019 - 10:05 am.

          “The cost will trend DOWN until it is in the 50% to 60% range of today’s cost, then it will stay at the level.”

          The only thing that trends DOWN with socialized medicine is the salaries of the people providing it. That is why there is a shortage of medical professionals in Canada.

          The price of the high tech equipment used in medicine today is rising, that’s why people wait 21 weeks for MRI’s and CT scans.

          You may die waiting for treatment in Canada, but hey, it don’t cost nothing!

    • Submitted by Mark Kulda on 11/13/2019 - 09:53 am.

      The one problem with your plan is that you’ve not said anything that would in any way control the costs. Once everybody is on board and get all the medical care they need, the costs won’t go down. The cost to government to pay for this care will be enormously high. There aren’t enough rich people or corporations to tax enough to do this. What would happen to control costs is that the government will set a very, very low reimbursement rate to providers, who will have to cut costs somehow and they will do so by either cheapening the care or rationing it like they do in every other country that does this. Your intent to get free care is an understandable ask….but you should know what the true impact is of what you ask for. It will be a low quality system.

      • Submitted by Gerald Abrahamson on 11/15/2019 - 11:58 am.

        Cost control is how savings are achieved. Insurance companies have no incentive to control costs because they merely pass ALL costs (marked up for company profit, of course) on to the buyers (companies and individuals).

        Savings take time to be seen because we would need to work our way down to the real cost–NOT the “marked up” prices currently charged. We all know the US pays the highest prices in the world for Pharma–so we can start cutting cots there as well. Eventually Pharma costs will drop by over $500B/yr. Why? Because the US typically buys the most of any drug, that means the cost per pill (or dose) should be the lowest (buy more = pay less for each pill/dose). Thus, Pharma savings of $500B/yr is about 27% (500B/1850B) of total savings.

        The next step is reducing the high cost of doctors. Changing to a single-form system cuts costs another 10% to 15%. Then offer low-cost/free training to become a doctor AND have more residencies available (the current bottleneck in the system). More doctors = more options for patients. Plus, new doctors can reasonably be asked to donate time or care to cover people who can’t pay. That would be part of the tradeoff for getting a “free” education.

        Overall, the change will take 5-10 years, but will be worth it in the end. Costs for healthcare drop 40% to 50%, everyone covered, taxes cut as a result (uh-oh), AND people live longer (2-3 yrs?).

    • Submitted by Paul Udstrand on 11/15/2019 - 09:19 am.

      Gerald, you’re describing Medicare For All.

      From a basic engineering perspective the infrastructure for MFA is already in place, Medicare and Medicaid already exists. It’s much easier and more economical to use existing infrastructure that it would be to build some other system from the ground up.

      All we need to do is update the coverage (i.e. cover EVERYTHING other than elective cosmetic procedures) and enroll EVERYONE in the US.

      • Submitted by Gerald Abrahamson on 11/15/2019 - 12:03 pm.

        You got it backwards. MFA is mandatory universal healthcare. I have been posting on this topic since 2011. It does NOT require single payer, but it does require all insurance companies to use the same forms, have/use the same coding, and all pay invoices in full within 2-3 days. Pharma is a related-but-similar topic, where $500+B in costs can be realized.

        • Submitted by Pat Terry on 11/15/2019 - 01:01 pm.

          I don’t think you are right on that. We wouldn’t be talking about abolishing private health insurance otherwise.

        • Submitted by Paul Udstrand on 11/15/2019 - 11:21 pm.

          I’ve been advocating Single Payer for 25 years. Simply forcing all insurance companies into the same paperwork has never been a serious proposal for a variety of reasons.

  5. Submitted by Pat Terry on 11/12/2019 - 02:27 pm.

    This guy lost me at “pro-life.” If your health care plan excludes reproductive health coverage, I’m not interested.

    • Submitted by Donna Koren on 11/15/2019 - 04:44 am.

      Something about “baby” and “bath water..” seems appropriate.

      I appreciate Mr. Henry’s contribution, here, and that we can agree on some policy areas even while strongly disagreeing on others. This all or nothing reaction is literally killing public discourse.

      • Submitted by Pat Terry on 11/15/2019 - 11:24 am.

        When single payer was on the ballot in Colorado, one of the reasons it was overwhelmingly defeated was that it would have taken away people’s private reproductive health coverage and replaced it with nothing.

        I don’t see that as a baby/bathwater issue at all. I want nothing to do with anything this guy is pushing.

        • Submitted by Paul Udstrand on 11/15/2019 - 12:17 pm.

          It’s not uncommon for initiatives to fail before they succeed, I wouldn’t read too much into the Colorado experience. And one has to remember that MFA, even on a State level threatens revenue for some of the nations most powerful corporations, they spend big bucks protecting their profits.

          People my indicate in some polls that they’re afraid of losing their private insurance but that’s not an endorsement of private insurance per se. We know that a majority of Americans are NOT happy with the cost or the coverage they get from their private insurance plans.

          From a policy perspective opponents of MFA will always have to explain why they think we need more expensive and less comprehensive private insurance plans. Why do we need plans with deductibles and co-pays, and limited coverage? Why is it so important to Klobuchar for instance that 100 million people stay in expensive private insurance plans that don’t provide complete coverage? Who benefits from that?

          • Submitted by Pat Terry on 11/15/2019 - 01:03 pm.

            They won’t have to explain anything other than MFA will take away your private health insurance and raise your taxes. And if the Democratic nominee is supporting MFA, that will be enough to re-elect Trump.

            • Submitted by Paul Udstrand on 11/15/2019 - 11:25 pm.

              Yes Pat, that’s why the candidates proposing MFA are polling at 50% and the candidate dedicated to saving private insurance is struggling to break 4%.

              That’s why centrists are panicky they’re still trying to bring new “moderate”candidates into the race.

              Again, the people who lost to Trump are NOT the electability experts in the room.

              • Submitted by Pat Terry on 11/16/2019 - 01:16 pm.

                They are panicking because they know a MFA candidate will lose. Obama – someone who actually won two elections – is warning the party of the danger. Even Warren knows its a problem and is talking about a public option now.

                • Submitted by Paul Udstrand on 11/17/2019 - 07:54 am.

                  Pat, the people who lost to Trump in 2016 are NOT the experts in the room who know how to defeat Trump in 2020. Specially when their strategy is to run the same campaign they ran in 2016 with the same kind of candidates, the same “agenda”, and the same proposals.

                  If MFA is so toxic why is one of your champions of private insurance struggling to break 4% while the other one is slipping so low that panicky “centrists” are desperately trying to find a replacement?

                  You guys are just becoming more and more incoherent. In 2016 all you could say was: “HRC won the primary” as proof her “electability”. Now you’re saying: “OMG the one’s winning the primary can’t possibly be electable!”


  6. Submitted by Dennis Tester on 11/14/2019 - 07:11 am.

    Here’s an honest proposal for my democrat friends: Convince a state, any state, to implement the “Medicare-for-all” plan on a state-wide basis. Run the program for four years, a presidential cycle, in effect, and let’s see how it goes. The plan must be paid for by the taxpayers of that state with no federal funding, replicating the model that would be expanded on a national scale should that happen.

    Surely, at least one democrat-controlled state would step up to prove their point. Why endanger the healthcare system of an entire nation on an untried model? Well, this would give us the experiment we need before diving headlong into the pool.

    Could Minnesota be the model?

    • Submitted by Paul Udstrand on 11/15/2019 - 09:29 am.

      Dennis, several States are moving in this direction, and would eventually create their own universal plans. Whether this happens before a national plan goes into effect remains to be seen.

      You need a State sufficiently large State with a sufficiently large population to make the numbers work given the price gouging among providers, but it’s perfectly doable.

      Historically there are many legislative initiatives that failed before they passed so the fact that early attempts have thus far failed doesn’t really prove anything.

      And none of this in any way actually addresses the substance of the discussion. The failure or success of any State run MFA doesn’t tell determine the reality or feasibility of a nationwide MFA proposal.

  7. Submitted by Dennis Wagner on 11/14/2019 - 09:31 pm.

    I guess the real answer is we just are just dumber than all these other countries in the world.

    • Submitted by Paul Udstrand on 11/15/2019 - 12:20 pm.

      Dennis, you’re going to want to stop worrying about other countries and focus on comprehending health care in the US and the nature of MFA.

      • Submitted by Dennis Wagner on 11/15/2019 - 02:11 pm.

        My apologies, after 30+ years of international business I get this idea that NIH (not invented here) is a bad way to run your life business whatever. If other folks can do it with reasonable success why can’t we? Again my apologies to think that there are smart people, with good ideas for solving problems and they don’t reside in good old USA,or may not even speak English.

        • Submitted by Paul Udstrand on 11/15/2019 - 11:42 pm.

          My apologies, my response overly dismissive.

          My point was that while almost every other developed nation may be decades ahead of the US in terms of their health care management, beyond simply pointing out our low ranking, a survey of other systems is simply a rabbit hole we should avoid.

          US proponents of MFA and single payer have studying other systems and nations for decades and found that replacing our system with someone else’s system is more problematic than simply expanding Medicaid to cover everyone. The advantage isn’t that it was invented here, the advantage is that the bureaucratic and administrative infrastructure is already in place.

          We HAVE a proposal, we don’t need to develop one. Decades of experience has shown us that bringing other countries and their systems into the discussion simply explodes the discourse. The more systems you bring into the discussion for comparison, the more arguments you have about who has the best system and why it is or isn’t better than the one we have.

          Stay focused, the work has been done, circling back to other comparisons is simply distracting. That’s what I meant when I said study the MFA proposal and worry less about other countries.

          • Submitted by Dennis Wagner on 11/17/2019 - 04:21 pm.

            Nothing personal. Have been on Medicare for ~ 3 years. So far a good program, No Dental no Optical, but still a good program. Like everything else, folks want perfect and can’t settle for good enough. Bad news is perfect is probably an impossibility. Therefore we will never go where we need to go because folks can’t settle for good enough and then work on making good enough better. I think many foreign countries with universal health care understand the term “good enough” it is far better than nothing!

            • Submitted by Paul Udstrand on 11/18/2019 - 08:20 am.

              “Nothing personal. Have been on Medicare for ~ 3 years. So far a good program, No Dental no Optical, but still a good program.”

              Absolutely. Look, there are undeniable problems with the current Medicare regime, but most of those problems arise from the fact that Medicare is shoe-horned into a private market environment that’s dedicated to generating profit rather than providing health care.

    • Submitted by Henry Johnson on 11/16/2019 - 09:38 pm.

      I think you hit the mail on the head Dennis.

      Every other developed country in the world has a universal health care system, which costs on average less than twice per capita what ours costs, AND which results in better health outcomes than ours as well.

      We are paying more than twice as much as those other countries, for less!

      Like anything else of importance, it should be carefully studied and planned, but given the track record of the rest of the world, those who dismiss universal health care as an awful idea from the get-go I think are on pretty weak ground, given that pretty much everyone else has already done it fairly successfully.

      Given the rising chunk of our national income spent on health care, I’d say we probably have no choice but to go for the cost savings of soe version of universal healthcare eventually.

      My own bias is to think that swing-state and rural state voters need time to be convinced on the value of universal health care, and I don’t think there’s enough time before November 2020 to do that unfortunately.

      So I’d urge democrats to pull back the reins on the medicare-for-all idea for now, since goal number 1 is to remove Donald Trump IMO, and also the senate needs to be won before any legislation of even minor significance can be passed (with Mitch McConnell simply refusing to bring even bills most republicans would favor to the floor for a vote).

      And pushing the medicare-for-all idea too hard I think is something that too many swing-state voters will not be ready for yet, so that hurts democratic chances to win the white house, and the same with rural state voters who are the key to winning back the senate.

      There should be an acceptance I think that the presidency, the house and the senate all need to be won by democrats before any major change like this has even a snowball’s chance in hell of passing.

      Also, a great deal of study of other countries universal health care systems, and how they implemented them should be done IMO, so that we can learn from their experience – i.e. – what did the do right, what did they do wrong, etc., etc, and that takes time anyway to do properly.

      There’s no reason to not try to cherrypick the best ideas,concepts and methods from the many other developed countries who’ve had universal health care for decades, to try to make a transition smoother and more efficient.

      But I’d argue that that initial study could be started now, without implying that the democratic party is arguing for a quick aggressive more to a new system, that probably 40% or more of the electorate are still convinced is just bad, bad, bad – as a result of decades of being told just that by politicians accepting campaign contributions from health insurance companies.

      Anyone studying propaganda or advertising in college learns that it is amazingly and unfortunately very effective to just repeat a simple message over and over and over again, until the audience just “knows” that it’s true – even if it’s a complete bogus lie!

      Hitler’s propaganda machine knew that, they showed film imagery of rats for 100 frames, then jews for 100 frames, then rats, then jews, and there were posters everywhere depicting jews as filthy vermin, and after a few years of doing that over and over and over and over, many if not most Germans came to believe it was true – even though it was a despicable lie.

      While not as disgusting, the American people have been sold over and over again on the idea that universal health care is just inherently bad, bad, bad, and I believe that multi-decade ‘conditioning’ needs to be overcome first before people can be convinced that it might actually be good – and that takes time to do!

      Pushing too hard before more of the public can be convinced that universal health care might be a good idea, just means jeopardizing the ability for democrats to win elections, and without that, even minor parts of the democratic platform are not going to get passed into law – not to mention risking another 4 years of the democracy-trashing Trump administration.

      • Submitted by Paul Udstrand on 11/17/2019 - 08:11 am.

        Yes, resistance an opposition needs to be overcome, but history has shown us repeatedly that opposition can collapse rather dramatically and minds can change just as dramatically.

        It’s also likely that resistance to MFA at this point is overestimated. A majority of Americans now express a desire for a national plan, that despite the fact clear proposals are only now being discussed- people wanted before they even knew what it was. The most popular candidates in the country are those who are proposing MFA. Clearly popular support for MFA is there.

        The most dangerous resistance is the push-back from the health care industry, and overcoming THAT is a matter of creating a clear and powerful narrative and sticking to it.

        One advantage to a nationwide MFA campaign is that strategically it’s more difficult to combat than a piecemeal state by state initiative.

        • Submitted by Henry Johnson on 11/17/2019 - 07:53 pm.

          I hope that you are right Paul and that I and many others are overestimating the resistance to the MFA concept, particularly in those key swing-states (to win the white house), and rural states (to win the senate) that are so necessary to win in 2020 in order to be able to carry out even much more modest goals.

          I’m just concerned and worried about anything that could reverse the momentum from the pickup of the house in 2018, and that could lead to failures to gain the white house and the senate in 2020.

          I would love to see the democratic party put together expert film and documentary makers (perhaps using democratic supporters from Hollywood) with true experts on some of these important but controversial topics, such as MFA and climate change especially, and produce some powerful, hard-hitting but short documentary films/commercials that could then receive heavy air-play – to really kick-start the process of convincing more Americans of the advantages of MFA, and the reasons we do need to be concerned about climate change.

          It’s not enough IMO to make verbal claims about MFA and climate change, people have to be shown compelling graphics, powerful facts, graphs and demonstrations, and so on, in order to combat the heavy conditioning they’ve already been exposed to that MFA is an awful idea, and that climate change is a ‘hoax’.

          Perhaps with such films/ad pieces, the more rapid collapse in resistance to new but misunderstood ideas could take place soon enough to win in 2020.

          • Submitted by Paul Udstrand on 11/18/2019 - 09:10 am.

            “I’m just concerned and worried about anything that could reverse the momentum from the pickup of the house in 2018, and that could lead to failures to gain the white house and the senate in 2020.”

            Popular candidates promoting widely demanded policies that address the largest concerns of voters are NOT a “threat” of any kind that will hand the White House to Trump again nor Congress to Republicans. “liberalism” didn’t put Trump in the White House, decades of “moderate/centrists” nothingburger Democrats put Trump in the White House and made Republicans the strongest political Party in the world. Sanders’s didn’t lose to Trump, HRC lost to Trump. I don’t know why we have to keep reminding people that fact? And now you think running a HRC clone of some kind with the same non-agenda and nothingburger policies is the ONLY WAY to defeat Trump in 2020?

            You’re worried the most popular political strategy in the history of the United States (FDR liberalism) is a pathway to electoral defeat but the “centrist” politics that delivered just one victory out of the last 6 presidential elections and lost to Trump is sure-fire path to victory in 2020?

            Dude, it might be time look for the exit in your cave.

            It’s just bizarre- When you guys put your nothingburger “moderate” candidates on the ballot you assume that we’ll all pull together and “rah rah rah” and deliver a victory by voting “blue”. But for some reason we CAN’T all pull together and “rah rah rah” vote “blue” a liberal candidate into office? This isn’t about “electability”, this is about you guys wanting to control who gets on the ballot and what the political agenda is. When you want to the 7% candidate on the ballot instead of the 20% candidate… your NOT trying to win elections.

            • Submitted by Henry Johnson on 11/18/2019 - 12:24 pm.

              Wow, I thought that was an unnecessarily harsh and insulting post – “dude”.

              Especially since unlike yourself, I’ve been acting respectful, civil and have been aggreeing with many of your points of view and even commented that I hoped you were right in assuming that MFA will not be something that could possibly hurt democratic chances in 2020!

              I see this actually as a serious problem with the very liberal – so many seem to express what seems to be virulent ANGER towards moderate democrats, and independents like myself, almost as much as towards Trump-publicans, as demonstrated by the tone of many of the rantings in this last post of yours.

              As I think you know, I’ve argued very strongly and hopefully articulately against the Trump administration and it’s assault on democracy, and I think it was just a ridiculous cheap-shot to say something like “Dude, it might be time to look for the exit to your cave”.

              I’m not a barbaric cave-man and neither are you.

              But let me address some of your assertions – first of all I’m not for an “HRC clone”, and I believe you are just wrong in asserting that HRC lost because of her ‘moderate’ policy positions.

              I believe she lost because she was perceived by many as being honesty-challenged, had a cold and unlikable personality, and because of her and Bill Clinton’s perceived ‘pay-to-play’ dealings as secretary of state, taking large amounts of money from large corporate donors for 2 hours speeches, etc.

              In other words, she as an individual had poor favor-ability ratings and republicans have hated her since the 90’s so they were going to get out the vote to defeat her.

              In talking to republicans, I can’t tell you how many said they voted for Trump not because they were necessarily all that sold on him, but because “/Well, I sure wasn’t going vote for Hillary!”.

              It wasn’t her moderate policies that cost her the election, it was the unfavorable way much of the public perceived her personally.

              On another point, you say that MFA is a “widely demanded policy”. But is that really true as I’ve pointed out before, and which you ignore over and over, in the SWING-STATES that will determine the presidential election?

              I don’t necessarily think so –

              Maybe you need to step out of your own liberal bias or “cave” in your words, where so many liberals believe that we have a presidential election system and a senate election system that is based on popular vote – dude, hate to tell you this, BUT WE DON’T!

              People quote national polls showing ‘a majority’ of people favor MFA (and that only means more than 50%), or other polices, and from that you extrapolate that it’s a ‘winning’ idea in 2020.

              But unfortunately if an idea is fairly unpopular in the not-so-liberal swing states, that means it’s a negative in the presidential election.

              And if it’s fairly unpopular in the rural states which are heavily republican, that’s a negative for winning the senate.

              I wish the presidential election was determined by national popular vote – sadly, it’s NOT.

              I wish that the representation in the senate were based on population, so that New York had far more power in the senate than Wyoming does – but that’s not the case.

              I get that you’re frustrated by moderate policies and moderate candidates and I can understand that, but I as an independent am frustrated as well that so many left-of-center liberals keep ignoring over and over and over the fact that our national election system unfortunately has a demographic bias to favor republicans, and that fact needs to be considered when candidates and policy positions are being evaluated for electability.

              You make a similar false assumption in claiming that because a democratic presidential candidate is ‘popular’ in polls among democrats, that they therefore have the best chance of any candidate of winning in the general election.

              McCarthy was very popular with democrats, but was KILLED in the general election..

              So saying someone is ‘popular’ needs to be qualified with whom and WHERE they are popular, and many left-of-center liberals keep ignoring that fact I think.

              AOC apparently has a ‘hit list’ of democrats that are too moderate for her liking, and she wants to see if she can get them replaced by more liberal democrats.

              But what she is ignoring I think is that in many areas of the country, take Missouri for example, you are either going to have a moderate democrat elected or a Trump republican. The liberal democrat has a very very poor chance of being elected.

              So her ‘hit list’ might in fact be a hit list and a game plan for democrats to lose their house majority!

              Then there’s your assertion that “This isn’t about “electability”, this is about you guys wanting to control who gets on the ballot and what the political agenda is. “.

              I’m not sure how you can say that I’m opposed to MFA being on the political agenda, when I’ve made it clear in numerous posts now that I’m pro-MFA. (I also don’t deceive myself that I can “control” anythiing!)

              My opinion was that I think more of the public needs to be educated on MFA before it’s a positive to push aggressively RIGHT NOW, and so in fact my reservations in fact are ALL about “electability”!

              Again, I suggested that some powerful educational ads might be a way to speed that process along of convincing more of the public to be pro-MFA (and maybe that could be done in time for the 2020 election?), and even said that I hope that you were right on saying that heavily emphasizing MFA is a positive now – so I’m not sure why that warranted the harsh response you had in your last post Paul.

              Here’s what I believe – NO ONE actually knows for sure what effect MFA would have in the national elections, or how various candidates would do if they became the democratic candidate, and importantly, what effect that candidate would have on the important senate and house races democrats needs to win to have a chance to enact even moderate legislative changes.

              All any of us can do is express our best GUESS in that regard, so I think it’s especially inappropriate to get nasty and personally insulting as you did in your last post – I think that’s just giving into the incivility that the current president has promoted in our culture – where you don’t respectfully debate with people who’s views differ somewhat from your own – you just bash and insult them.

              I’d like to see us be better, and act better than that, as non Trump supporters.

              • Submitted by Paul Udstrand on 11/19/2019 - 09:00 am.

                Well, I certainly hit a nerve Mr. Johnson.

                Listen, my point is rather simple, you can claim to support MFA, and you can suggest some kind of education program, but where is that support and where is that program going to come from when Democratic Party elite is dedicated to defeating MFA? Klobuchar and Biden (and the whatever other candidates “centrists/moderates” bring into the race) aren’t trying to bring us MFA in stages… they never want to see it at. If you add your voice to theirs, you’re not supporting MFA.

                Yes, I totally agree, a dedicated organized comprehensive program that explains MFA and educates the voters would absolutely succeed in eventually passing the initiative. This is NOT a new idea. But how is that campaign ever going to emerge in a scenario where Democrats are pushing back at best and outright attacking the proposal at worse? Yes, if the Democratic Party united behind the proposal they would gain the necessary seats in congress, win presidential elections, and MFA would pass. Do you see the Party uniting behind the proposal? Is THAT what Klobuchar is doing?

                This is why you have to get on the ballot. You’re NOT going to see the program you describe if anyone other than Warren or Sanders gets the nomination. You think Biden or Klobuchar will EVER launch an MFA education program?

                It’s simple, if you believe in something like MFA you fight for it (politically), you’re not afraid of it. There’s a difference between wringing concessions out of opponents and dialing back your own objectives in order to accommodate your opponents. Accommodation usually delivers failure.

                If you support MFA than support it, don’t add your voice to those who claim we’re not ready for it yet. If you want to educate people about MFA, than educate them, who’s stopping you from doing that? If you’re doing this and I’ve missed it, I apologize.

  8. Submitted by Tim Smith on 11/15/2019 - 02:02 pm.

    Never going to happen until someone stands up to the health care providers and demand thay make less money, far less, and have some regulation(rationing) of care. That is how other countries do it.

    • Submitted by Connor OKeefe on 11/15/2019 - 05:27 pm.

      “Never going to happen until someone stands up to the health care providers and demand thay make less money..”

      Start by demanding med schools lower tuitions.

      • Submitted by Karen Sandness on 11/16/2019 - 01:32 pm.

        An acquaintance who lived in Israel for a while as a consultant to the Israeli government told me that one way Israel keeps costs down is to admit everyone to medical school who is qualified, therefore none of the artificial shortages that the AMA loves, and making tuition free.

        That way, doctors cannot claim that their profession is scarce, nor can they plead high student loans as an excuse to charge high prices.

        On top of that, everyone is entitled to basic medical care at no charge, with surcharges only for elective surgery or for boutique-style hospital accommodations.

        • Submitted by Paul Udstrand on 11/18/2019 - 09:13 am.

          Listen, don’t worry about the Doc’s, they’ll be fine. The vast majority of “cuts” MFA would deliver will be health care executives and private insurance investors. Health care costs haven’t been ballooning our of all control because we pay direct care staff too much, that’s not where the savings will ever found.

  9. Submitted by Paul Udstrand on 11/16/2019 - 08:56 am.

    Regarding the “loss” of private insurance, it’s important to understand why this feature is present in the Sanders’s MFA plan.

    The elimination of private insurance isn’t an ideological attack on the private sector,it’s a nuts-n-bolts logical conclusion. One of the necessary objectives for the US health care regime is reducing costs and creating efficiencies. MFA accomplishes this goal by replacing hundreds of separate contracts with a single contract. Under an MFA regime separate and different contracts with alternate payers are simply redundant and unnecessary. Additional plans and contracts simply defeat the whole purpose.

    Another factor contributing to the elimination of private insurers is their basic obsolescence in an MFA environment. If private plans were to allowed, they would have to be required to provide the same coverage that anyone would get with MFA. Not only does that require the creation of a regulatory agency to insure private insurance (which adds to rather than reduces costs) but it’s a financially devastating requirement for private insurers. Private insurers make their profits by collecting more money than they pay out, and they control their payments by restricting coverage. No private plan can possibly provide the same coverage for a lower or even equivalent price AND earn a profit.

    There’s simply no rationale for allowing multiple duplicate plans. Multiple duplicate plans are basic violation of elementary efficiency principles, and since there’s no way private plans could offer the same coverage for less.

    Finally there’s the funding formula. In order for MFA funding to work, you need a revenue stream flowing from everyone in the country. You can’t exempt the wealthiest people in the country and pay for MFA. Since any private plans that would attempt to duplicate MFA coverage would be much more expensive than MFA, the wealthy would be the primary buyers of private plans. So do make these Americans pay their private premiums AND their MFA premiums even if they’re opting out of MFA? Most likely politicians would seek a tax deduction or exemption from MFA for those who are purchasing private plans… and the more expensive the private plan… the greater the deduction. This is a boon for tax preparation that does absolutely nothing for health care and reducing the revenue for MFA.

    One of the reasons MFA HAS to be so comprehensive (i.e. it covers everything for everyone) so it eliminates the need for any supplemental plans like those that currently fill holes in Medicare coverage. MFA brings everything under the umbrella of one single payer.

    MFA eliminates private plans because the continued existence of additional and more expensive plans simply represent additional complexity that does absolutely nothing to ensure quality health care and builds in additional and unnecessary cost. It not about being socialist, it’s just about having a rational business model.

  10. Submitted by Paul Udstrand on 11/16/2019 - 10:30 am.

    Another huge administrative savings we realize with MFA, and one more reason to abolish private plans, is automatic enrollment. Simply eliminating the application process will save hundreds of millions in administrative costs.

    Any application needs to be process and either accepted or rejected, automatic universal enrollment completely eliminates that entire regime. If we retain private insurance plans we also retain all the costs and consequences associated with processing applications and rejections.

    This is where Biden and Klobuchar fall apart in this discussion. It’s bad enough that they want to preserve the costs and inefficiencies of private plans for 100 million Americans, but they also want to send millions of Amrericans into complex and unnecessary application processes.

    Biden tried to claim that he’d create some kind of automatic enrollment in a public option or Medicare plan for people who lose their jobs, but many observers have pointed out that that’s actually impossible. There’s no way to eliminate an application process in lieu of MFA. Biden slipped when he acknowledged that “automatic” enrollment would only apply to those who “qualify”, and THAT means you need an application process to determine eligibility, therefore no “automatic” enrollment.

    Klobuchar has no plan at all aside from claiming that eliminating private insurance is a bad idea. As far I know she has not explained WHY it’s a bad idea, she just declares it.

    Currently we have thousands of people employed in the Medicare eligibility process simply because Medicare is not universal, that means you have to figure out who qualifies and who doesn’t, and how much coverage eligible enrollee’s qualify for. Switching to a universal automatic enrollment regime releases all of those personnel for other duties. MFA would require a scaling up of current Medicare administration and eliminating applications gives us thousands of employees who can be re-assigned to other duties.

    • Submitted by Tom Crain on 11/18/2019 - 07:50 pm.

      I agree with this. The admin overhead costs to maintain our current healthcare system are underestimated. Consider that the Office of Inspector General released a report in August 2014 finding that the total cost of the website had reached $1.7 billion[14] and a month later, including costs beyond “computer systems,” Bloomberg News estimated it at $2.1 billion. That doesn’t include the 15 states like MN that create their own marketplaces. That’s billions of dollars – not to deliver care- just for some of the admin.

  11. Submitted by Paul Udstrand on 11/18/2019 - 08:51 am.

    “Nothing personal. Have been on Medicare for ~ 3 years. So far a good program, No Dental no Optical, but still a good program.”

    Absolutely. Medicare has problems but most of those problem arise from the fact that it’s shoe-horned into a private market dedicated to generating profit instead of providing health care.

    Often lost in the complaints about Medicare is the fact that customer satisfaction surveys reveal just as much and frequently more satisfaction among Medicare (and VA) “customers” than those with private insurance plans. This is one reason Klobuchar’s sponsorship of private plans is so puzzling.

    I’m afraid your “good enough” observation looks like an iteration of the “don’t let the ‘perfect’ become the enemy of the ‘good’ ” rhetoric.

    No one imagines that MFA will be perfect so you’re imagining a facile choice. This facile construction of a false dilemma (i.e. “perfection” vs. less than perfection) simply ends up promoting failure. This formula doesn’t yield “good” in lieu of “perfection”, it just chronic failure.

    “Good enough” politics has not only failed politically for decades, but it’s turned perfectly manageable crises into chronic and perpetual misery for the entire Nation. In essence, “good enough” politics put Trump in the White House, I’m not sure why anyone would expect it yield a different result in 2020 than it has over the last 5 decades.

    The problem with “moderate/centrist” good-enoughism is that they never ask: “Good enough for whom?” They assume that whatever is good enough for THEM is good enough for EVERYONE. This is simply a bizarre assumption that is obviously not based in reality, but rather a product of relative affluence, privilege, and comfort levels. HRC, Kerry, Gore, Dukakis, Mondale, Carter, and Humphrey were good enough, but obviously not good enough for everyone. You can’t keep losing to Neo-Fascist and expect a good outcome for our nation.

    • Submitted by Pat Terry on 11/18/2019 - 11:28 am.

      If we are going that far back, how about McGovern? That’s what will happen if we run Sanders or anyone all-in on MFA. I’m glad to see Warren backing off.

      • Submitted by Paul Udstrand on 11/18/2019 - 12:34 pm.

        We can go as far back as you want Pat, the numbers never add up in favor of nothingburger moderates, you still got five times as many losers.

  12. Submitted by Paul Udstrand on 11/19/2019 - 09:46 am.

    Just a quick note on the “Mandatory” nature of MFA. It’s important to note the distinction between being “forced” into something as apposed to being enrolled by default. Characterizing an MFA regime that automatically enrolls everyone as an act of force of some kind is kind of weird. That’s like claiming every child born in the US is forced into being citizen. You could say for instance that we’re all “forced” into Social Security benefits but most people would find that to be a odd way of describing it.

    The Mandatory description is only coherent in a regime where private plans compete with MFA, so for instance you would have some kind of requirement that everyone either have a private plan or enroll in MFA. In this model people can be said to be “forced” into either a private plan or public option.

    Any model that doesn’t enroll everyone automatically, without exception or exclusion, is fatally flawed for a variety of reasons. You could give the option of opting out of MFA, but a system where people buy more expensive plans that cover less is incoherent. In THAT scenario you end up creating public plans to fill holes in private coverage, which just ends up being a subsidy for private plans. And a system that automatically covers everything doesn’t require any supplemental coverage.

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