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How the Democratic presidential field could unite in health care messaging

Sen. Elizabeth Warren
REUTERS/Yuri Gripas
Democrats running against Sen. Elizabeth Warren, above, and Sen. Bernie Sanders are going to argue that single-payer is too scary, and too expensive, too big a disruption.

Now that Sen. Elizabeth Warren has put out a plan to pay for her approach to providing access to health care for all Americans, the right will go ballistic with red-baiting and the more moderate left will say it’s too expensive and scary but that they prefer a less costly, less ambitious plan that reduces but doesn’t  eliminate the problem of uninsured Americans.

People will score the plan and may, for political purposes, exaggerate how much it will raise some costs and lower others. Legitimate technical quibbles may challenge whether Warren’s proposal will raise enough revenue. That’s fine, but roughly unknowable. Those unfriendly to the plan will exaggerate the costs and underestimate or completely ignore the benefits of having a plan that covers health care costs for all Americans, especially the estimated 44 million who currently have no health insurance, because their jobs don’t provide it, they’re too young for Medicare and not poor enough for Medicaid.

Others have figured it out

Quite a few countries have figured out how to cover everyone without going bankrupt. Personally, as I’ve said many times, there’s no good reason why the United States, which is among the wealthiest countries on earth, should proudly cling to the honor of having simultaneously the most expensive health care system on the planet, and one that simultaneously leaves a large portion of its residents uninsured.

My main point in this piece is to suggest how the Democrats in the presidential field should talk about this issue. But first a bit of history of the difference between the way our two major American political parties approach the issue of health insurance.


One party thinks more people should have access to health care. The other party doesn’t.

The status quo is (according to me) a scandal. If the question is posed, as it ought to be: If so many other countries can afford to cover everyone, why can’t we?, there is no good answer.

Like most of you, I find my eyes glazing a bit when trying to ingest the details of Warren’s plan. Paul Krugman writes that the math she rolled out at least passes the laugh test. That will hold me for now on the question of whether the plan is within hailing distance of balanced.

As a political matter, I understand why more moderate Democrats worry that such an ambitious and expensive plan will frighten the electorate. If, for reasons of political cowardice or caution, it is smarter for Democrats to nominate someone with a less ambitious proposal that will only cut the ranks of uninsured in half or so, I can understand that as a matter of political logic, because it is a matter approaching national emergency that Donald Trump be defeated in 2020.

Political logic

Also as a matter of political logic, Democrats running against Warren and Sen. Bernie Sanders are going to argue that single-payer is too scary, and too expensive, too big a disruption, and that too many Americans who are happy with their existing private insurance will freak out if the Democrats nominate someone who will do away with the status quo. I understand that, as a political (not a moral) argument.

I also feel confident that Warren’s universal coverage plan will not be adopted, even if she wins, and certainly won’t be adopted if, as seems likely given the map of Senate seats that are up in 2020, Republicans maintain control of the Senate. In fact, given the filibuster rules in the Senate, it’s hard to see how such a plan will be enacted unless Democrats control the White House, the House and something close to a filibuster-proof majority in the Senate.

Republicans (in general) oppose every single effort to reduce the share of Americans who lack health insurance. Ronald Reagan rose to political prominence warning in the 1960s against the adoption of Medicare as the critical step that would convert America from freedom to Socialism. Medicare! Reagan was just a washed-up actor at the time, preparing to become a Republican politician. And his argument resonated with Republicans.


When Medicare was adopted in 1965, pushed through by Democratic President Lyndon Johnson, the Senate vote for its adoption was as follows: Among Democrats: 57-7 in favor. Among Republicans 17-13 opposed. (Back then, there were more moderate and even some liberal Republicans in Congress.)

That was Medicare, a program now so popular it’s untouchable.

No Republican support in Senate for Obamacare

The Affordable Care Act (aka Obamacare) was adopted in the House with 219 votes. After Democrats voted 218-39, giving the bill enough to pass, one Republican voted “aye.” In the Senate, where 60 votes were necessary to break a Republican filibuster, the bill squeaked through with 59 Democrats and one independent voting aye. All Republicans voted no, except one who did not vote.

(As an aside, I’ll mention that Obama had supported a single-payer approach earlier in his career. But, as president, he knew that could not pass. The ACA was crafted as the approach that could increase the ranks of the insured as much as possible and still pass.)

Republicans have been trying to repeal it ever since, but have been unable to muster the 60 Senate votes necessary. In 2017, when Republicans had a three-seat majority, Majority Leader Mitch McConnell cooked up a filibuster-proof way to sort of get rid of Obamacare (called “skinny repeal”). But the three most moderate Republicans wouldn’t go along with it, ending with John McCain’s famous thumbs down.

Perhaps Democrats should remind the country of this history. If Republicans had had their way: No Medicare, no Medicaid, no Affordable Care Act. Tens of millions more American would be uninsured.

But that’s just history.

A range of Democratic ideas for insuring more

At present, most major Democrats are looking for ways to reduce the ranks of the uninsured, and most Republicans are opposed to those ways. The Democratic field ranges from those with ideas that help more Americans get coverage to those, like Warren and Sanders, who want to cover everyone.

Since Warren and Sanders are among the leaders in the current race for the Democratic presidential nomination, it makes sense that many of the others are portraying their plans as too radical or too expensive or too close to the dreaded word “socialism.” I get that, and I don’t expect it to stop. People who have private health insurance and are happy with it can perhaps be mobilized by fear of the more “radical” or “socialistic” elements of the Sanders/Warren single-payer or “Medicare for all” approach.


What I would recommend to the whole Democratic field, hard as this might be with Warren surging in the polls, is that they not use scare tactics and not demagogue the issue. I believe they could unite around a message that goes something like this:

All the Democrats in the race want more Americans, rich and poor, old and young, employed or unemployed, to be covered by health insurance. The more the better and the sooner the better.

We have a lot of ideas for making that happen. They differ in important details. Some go further and faster than others. Each of us believes we have the best and most practical plan for the next step. We’ll continue to debate the differences among our approaches.

But all of us believe that the best outcome, in the medium- and long-term, is that all Americans, rich, poor and middle class, should have guaranteed access to health care when they need it.

Lots of the other rich countries in the world have figured out how to do this, and they haven’t gone bankrupt, and in many of those places they are healthier and live longer. Why not America?

Republicans, who opposed Medicare, opposed Medicaid, opposed Obamacare, and are still try to repeal it, don’t seem to share that goal. They need to explain why. It doesn’t make sense to us.

Whoever wins the Democratic nomination will run on a plan to increase access to health care for all Americans. Donald Trump still wants to reduce the progress made toward that goal under President Obama. He needs to explain why.

Comments (107)

  1. Submitted by Gene Nelson on 11/04/2019 - 10:41 am.

    Disappointing that one political party…repubs…are unwilling to help us with affordable healthcare or affordable anything…including ignoring our crumbling infrastructure so they can cut more taxes for the wealthy and spend massively on the military.
    But…the healthcare issue is the greatest one. Disappointing that over half our populace cannot afford an extra $400 bill…so how is one going to afford any form of medical care?
    Most of the free world has affordable life, but in the US…we do not…with repubs refusing to do anything to help us with affordable life. Difficult to understand why those who vote repub cannot comprehend that this repub party does not value them.

  2. Submitted by Ray Schoch on 11/04/2019 - 10:48 am.

    “If Republicans had had their way: No Medicare, no Medicaid, no Affordable Care Act. Tens of millions more American would be uninsured.”

    Implied, but not explicitly stated: fewer, but still millions, of Americans would have gone bankrupt, lost their homes, and suffered numerous other nasty negative consequences due to a health care system based on profit rather than public service and health. Republican rhetoric and behavior is in line with this – you can get the best health care in the world here, if you can pay for it. If you’re really, really poor, we might even subsidize your health care somewhat. But if you’re in the vast middle between the extremes, the profits of our corporate donors are far more important to us than your health. We value your freedom – to die unnecessarily.

  3. Submitted by Edward Blaise on 11/04/2019 - 10:59 am.

    The Rs let their golden moment pass on Obamacare: First, it was only modest changes to the status quo, yet offered improved access and did not cause the insurance industry to melt down (literally and figuratively). It was a middle of the road approach because even with 60 D Senators you still had outliers like Joe Lieberman who would not go for a public option.

    All the R’s needed to do was declare victory: “Our Heritage Foundation conceived and Romney tested changes to our healthcare system have now been adopted by the Ds. Thank you very much.”

    Now the Ds are a long ways from 60 and outliers will likely pop up again. All of the plans of Sanders, Warren and others of radical change simply won’t happen.

    Here’s the reality I see:

    Delouse Trump effects on ObamaCare.

    Work towards adding a public option for those who elect to opt in: Buy into the Medicare system at an earlier age.

    Keep lowering that age over time.

    If it works (public acceptance), inertia will lead to MFA inevitability.

    • Submitted by Brian Simon on 11/04/2019 - 05:08 pm.

      What you propose is what I expect Warren will deliver. While she’s promoting Medicare for All, really the only way to get there would look pretty much like you describe: open the doors to opting in. Eventually as more people choose that option, private insurance will shrink to the point where we effectively have Medicare for all.

    • Submitted by Tom Crain on 11/06/2019 - 01:13 pm.

      What makes you think any changes to Obamacare would pass the Senate? Especially w/o a majority and a removal of the filibuster.

  4. Submitted by Joel Stegner on 11/04/2019 - 11:00 am.

    Universal coverage remains the common topic. That is no reason to accept a long delay in getting there. We would already much closet be there if Hillary has won, and we have lost ground due to Trump, who with Republicans are quite willing to terminate coverage for tens of millions of American, and denying tens of millions more preexisting condition coverage.

    With Bernie, one has to doubt whether he will forget his dream of single payer sacrificing millions of Americans opportunity for something that is unpopular and won’t pass. Warren could shift gears and go with Medicare for all who want it, which the large majority of Americans will support. Medicare plans with a role for private insurance for enhanced coverage is very popular, with insurers actually competing on benefits and costs, rather than our current insurance model through employment where consumers have no choice but taking a plan their employer chooses to shift costs off the balance sheets while exerting no meaningful control on prescription costs.

    • Submitted by Pat Terry on 11/04/2019 - 01:12 pm.

      This exactly.

      I do not understand why Democrats are not pursuing the public option / Medicare for anyone who wants it. That would be very popular, as opposed to replacing everyone’s employer coverage, which would be very unpopular and would invite billions spent in opposition.

      A public option would also survive judicial scrutiny, which Medicare for all never will.

      • Submitted by Paul Brandon on 11/04/2019 - 02:23 pm.

        The problem with a ‘public option’ is that it would make the system more complex, not less.
        It would increase the cost of our medical system, not reduce it.
        The only thing to be said for it is that it would be a step back that might make two steps forward (universal health care) possible.

        • Submitted by Pat Terry on 11/04/2019 - 03:26 pm.

          Why would any of those things possibly be true?

          A public means that people not currently eligible for Medicare – a a system which already exists – could buy into it. Without private insurance and its much higher overhead, costs would decrease.

          People who want Medicare would get it. People who don’t wouldn’t.

          Also, its really the only option going forward. If you have followed the ACAs trips through the court system, we are lucky its still here. The idea that a more expansive system – one that abolishes private insurance – will survive and even more conservative court is absurd. Its a dead end. But an optional program does not have that problem.

          • Submitted by Paul Brandon on 11/04/2019 - 05:15 pm.

            A public option (“Medicare for some”) does not eliminate private insurance; it adds another option to the existing ones. Thus it makes the system more complex.

            • Submitted by Pat Terry on 11/05/2019 - 02:34 pm.

              That’s not really a coherent argument. All it does is make more people eligible for Medicare. Not complex at all.

              • Submitted by Paul Brandon on 11/05/2019 - 07:03 pm.

                Since it is an additional option for people who are not currently eligible for Medicare, it will increase the number of billing options for the physicians and hospitals treating those individuals; hence more paperwork.

          • Submitted by David LaPorte on 11/04/2019 - 05:46 pm.

            The Public Option was in the original ACA but was taken out due to heavy lobbying from the private insurance companies. They were concerned that it would be too popular because it would be far less expensive since it didn’t have to make a profit or pay outrageous executive compensations.

            The Public Option (aka Medicare For Those Who Want It) would be a great starting point, since people could keep their private coverage if they wanted it. If it’s as successful as the private insurance companies fear, people would vote with their feet and it would become Medicare for All without the toxic coercion. The private insurance companies would still exist because they process the claims for Medicare and (in most states) Medicaid.

            Buttigieg, Biden and Klobuchar all support the Public Option, but they don’t get as much media attention as Sanders & Warren’s Medicare for All.

            • Submitted by Tim Smith on 11/05/2019 - 09:59 am.

              Public option is unworkable and bad policy. The providers would get paid the medicare fee schedule , 25-100 percent less than they get now from private market . They will fight that tooth and nail and they are way more powerful and profitable than insurers. If dems succeed in passing public option, providers would shift cost shortfall to those left in private insurance. That would be a disaster for middle class.

            • Submitted by Pat Terry on 11/05/2019 - 02:32 pm.

              Yes, this exactly.

  5. Submitted by joe smith on 11/04/2019 - 11:02 am.

    Two key points, first, Obamacare did not save the average family $2,500 as promised. Second, 52 TRILLION to pay for Elizabeth Warren’s plan is just absolutely absurd. I bring up these two points because the American voter has already been told by Democrats that they could save money by giving their health insurance over to the Federal Government, did not happen. 52 TRILLION is the starting point of Warren’s plan, what is the actual cost?
    Too many questions, no answers for American voters, this is a losing argument by Democrats.

    • Submitted by Paul Brandon on 11/04/2019 - 02:24 pm.

      There’s a difference between paying taxes and paying for health care.
      While Warren’s plan would increase individual tax payments, it would reduce the total that individuals spend on health care.

      • Submitted by joe smith on 11/04/2019 - 02:51 pm.

        52 TRILLION worth of savings?

        • Submitted by Paul Brandon on 11/04/2019 - 05:17 pm.

          I believe that this number is the total health insurance cost over ten years.
          It is not the amount saved through Warren’s plan.

        • Submitted by Dennis Wagner on 11/04/2019 - 05:31 pm.

          JS, please show us the math and the source. Today the US spends ~ “$3.3T about $10,348 per person” So 52/3.3= 15.7 years worth of healthcare bills W/O inflation or any other yearly adjustment. So from a financial investment perspective if we invest in short term healthcare issues, do we reduce long term healthcare outlays? That’s what business’s do calculate the ROI. Another look, “Researchers conservatively estimate that gun violence costs the American economy at least $229 billion every year, including $8.6 billion in direct expenses such as for emergency and medical care,” A 2nd example: “Smoking-related illness in the United States costs more than $300 billion each year, including: Nearly $170 billion for direct medical care for adults. More than $156 billion in lost productivity, including $5.6 billion in lost productivity due to secondhand smoke exposure” You start lining things like this up, like a well run business and it starts taking an entirely different cost benefit analysis. 2 Examples nearly $500B T a year in medical and another, $400B in lost productivity. Kind of suggests if folks open up their thinking a little bit. WE CAN ALL WIN” .

    • Submitted by Edward Blaise on 11/04/2019 - 03:57 pm.

      As Eric correctly stated:

      “Quite a few countries have figured out how to cover everyone without going bankrupt. Personally, as I’ve said many times, there’s no good reason why the United States, which is among the wealthiest countries on earth, should proudly cling to the honor of having simultaneously the most expensive health care system on the planet, and one that simultaneously leaves a large portion of its residents uninsured.”

      It’s conservatives who have proven themselves incapable to even understand, much less try, things that have worked elsewhere.

      As der leader explained:

      “Now, I have to tell you, it’s an unbelievably complex subject,” he added. “Nobody knew health care could be so complicated.”

    • Submitted by Brian Simon on 11/04/2019 - 05:14 pm.

      Criticizing Warren’s plan is easy. Proposing a better alternative is trickier. For example; Republicans still haven’t bothered to define what they’ll replace the ACA with, what, 10 years after it passed? How long will it take?

  6. Submitted by William Hunter Duncan on 11/04/2019 - 11:05 am.

    One thing we never seem to talk about when we talk about Health Care, is health.

    We subsidize the production of corn and soybeans, which are the foundation of arguably the least healthy food chain in the world. That has obvious consequences, in soil and water degradation, and ill-health in people. In addition, every day, it is pounded into us that we are consumers consumers consumers. That contributes to bad eating habits, while also creating the expectation that we should get whatever health care we want.

    In addition, there is epic bloat in the Health Care industry. The cost of executive and shareholder compensation is obscene, as is the cost of Administration. Health Care in America is less about health and more about the maintenance of profits.

    I am self-employed. My insurance, if I could afford it, would be $500 a month with a $7,000 deductible. That is the Health Care Industry treating me like a debt-serf, bleeding me until I am dead.

    The first thing in health care should be food: good, healthy food, locally produced in a way that is good for the local economy, good for people, good for pollinators/all species, good for the land and waters. Most of that exec/shareholder/admin bloat would wither on the vine if people were healthier generally. The cost of health care would collapse.

    Do we want health citizens, or ill consumers?

    • Submitted by Dennis Wagner on 11/04/2019 - 05:40 pm.

      Well WHD we agree, now the question comes up, what to do with that farming, beef, pork, fishing, milk, cheese, tobacco, sugar, etc. industries and, all the supporting agricultural business’s, John Deere, Cat etc. etc? We raised and support this monster Trump poured in $28B in welfare this year, so far. Who, how do we pick the winners and the losers a transition plan? No easy answers and a grand canyon political divide doesn’t help.

      • Submitted by William Hunter Duncan on 11/05/2019 - 09:02 am.

        DW,

        I would start from this basis: citizens, pollinators, the land and water wins; corporations, banks and billionaires lose.

        There is plenty enough brain power and muscle to work this out. It is mostly the will that is lacking.

        • Submitted by Dennis Wagner on 11/05/2019 - 12:48 pm.

          Political will? Personally I think the economics would be extremely difficult, look at the coal industry as an example, dying under its own wait, and folks talk about the loss of manufacturing jobs, well paying ones no less. Looks like Yang would have to up his $1000 a month to $5000 a month and there does not seem to be much will behind that, especially looking at the topic, health care! Folks are screaming. Just because it is rationale doesn’t make it possible, especially in the short run, example: where is America going relative to climate change, the present administration does not agree with your position about starting with the pollinators.

          • Submitted by William Hunter Duncan on 11/06/2019 - 08:28 am.

            There is no political will, and very litlle will among the people, to change economics in any fundamental way. The vast majority of people just want the system to work “better”, or “greener”, or more high techie, or more equal – but very few see our food production or consumerism generally as ecocidal, pathological really. Instead it is just normal, the pollution and species extinction of economics as we know it, it is just the way of things.

            “Radical” ideas like taxing monopoly/consolidation, pollution, automation and rentier income instead of income from labor, or mandating cover crops, soil fertility and retention, and plant diversity as pest control, or “re-zoning” most of the land around metropolitan areas to small scale, regenerative, renewable, sustainable agriculture, or even regulating corporations and banks more and small business less, are simply not allowed to be part of the conversation.

            Probably people would support such, but probably not 1 in a 1000 have heard such ideas, because those who benefit most from this society control the dialogue and the dialogue tells us, all this is inevitable, it is best, it is the only way, and most people basically believe that.

  7. Submitted by Roy Everson on 11/04/2019 - 12:16 pm.

    Eric’s 6-paragraph message Democrats could unite around is much appreciated and deserves to be reread and internalized. Universal health care is a decision every nation makes for itself. We’re very late despite mandates in 2008 and 2012 to move toward the goal. The best candidate will be someone who can capture the public’s bent toward universal coverage for all but retain the choice of status quo for the individual. Thus, Medicare for those who want it (as Mayor Pete calls it) sounds like a winning approach..

    • Submitted by Pat Terry on 11/04/2019 - 03:27 pm.

      Yes. That’s it. Medicare for those who want it. And no Medicare for those who don’t. Why every Democrat is not saying this is completely baffling.

      • Submitted by Paul Brandon on 11/04/2019 - 05:21 pm.

        Because some of them can do the numbers (see my previous posts).

      • Submitted by Connor OKeefe on 11/05/2019 - 05:46 am.

        “Why every Democrat is not saying this is completely baffling.”

        “If you like your doctor, you can keep your doctor.”

        • Submitted by Brian Simon on 11/05/2019 - 12:54 pm.

          While this criticism is valid in pointing out Obama made a promise he couldn’t keep; it is also true that the existing system makes zero guarantees about me being able to keep my doctor. If my employer changes benefits packages, I’m stuck with what they choose – I have essentially zero choice in the matter. What Republicans/conservatives never explain is why they find the status quo sacrosanct. It’s a high cost system, with middling outcomes*.

          * Yes, we have the best healthcare in the world, if you can afford it. Few can, and we somehow make this claim unashamedly while also having the highest infant mortality rate in the developed world.

          • Submitted by Paul Brandon on 11/05/2019 - 02:41 pm.

            To add to this, there are few independent pract5ice physicians left.
            So while you may be able to choose a particular group practice if it’s within your insurance3 network, they may still assign you a particular physician.

          • Submitted by Tom Anderson on 11/05/2019 - 06:38 pm.

            And in this country “infant mortality” starts at about 24 weeks unlike many other countries.

        • Submitted by RB Holbrook on 11/05/2019 - 04:13 pm.

          “​I am going to take care of everybody. I don’t care if it costs me votes or not. ​The government’s gonna pay for it.”

          “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

          “I am going to take care of everybody … Everybody’s going to be taken care of much better than they’re taken care of now.”

          Of course, when Ananias von Munchhausen makes his broken promises (English translation: outright lies), he does so in that rambling, incoherent manner he has. Obama made his infamous comment in a short, easy to remember fashion that can easily be memorized with enough repetition.

        • Submitted by kurt nelson on 11/05/2019 - 04:31 pm.

          So, you’re saying everyone that liked their physician had to make a change – cause we didn’t, we kept our very likable physician, even after the passage of the ACA. But, of course, keep on believing.

          • Submitted by Mark Kulda on 11/08/2019 - 11:12 am.

            There were many people that I saw complaining who were not able to keep their physicians. Plus we didn’t save $2500 a year like we were supposed to.

  8. Submitted by Tim Smith on 11/04/2019 - 12:47 pm.

    Single payer cannot work or be passed because to make it affordable our highest paid health care providers in the world would have to give up revenue/profits. Not happening, Obama knew it and that is why he never pursued it, or a public option.

    Add single payer to all of Warren’s other spending, (aka remake the economy) wishes, (money grabs) and there is no way you can do it all without bombarding the middle class with much higher taxes like Scandanavian countries do.

    • Submitted by Christian King on 11/04/2019 - 02:32 pm.

      We already pay an extremely high “tax,” called insurance premiums. And if mine were to go up a little, but I knew that my kids and my sister and her partner and, well, everyone, would be covered, that would be worth it. If I knew that people could leave jobs they hate (and have become terrible at) and move elsewhere and pursue other jobs and still be covered, I’d pay a little more for that, too. And finally, if I didn’t have to spend time reviewing my work’s cafeteria plan and all of its ins and outs each year, try to guess how much to put into my HSA each year, and constantly fight with the gatekeepers who hold MY MONEY and tell me what healthcare they will pay for, I would CERTAINLY pay more.

    • Submitted by RB Holbrook on 11/04/2019 - 03:52 pm.

      “Single payer cannot work or be passed because to make it affordable our highest paid health care providers in the world would have to give up revenue/profits.”

      If so, why is it that 66% of physicians now favor single payer?

      • Submitted by Tim Smith on 11/04/2019 - 08:00 pm.

        Please send me that poll and methodology and sample. We all should know by now you can get any poll result you you want by how the question is phrased. Would 66 percent really say yes if you told them what it would cost them? No.

        • Submitted by RB Holbrook on 11/05/2019 - 09:21 am.

          The exact numbers vary, but here’s a source for the 66%:

          “Majority of Healthcare Professionals Back Single-Payer System,” https://www.medscape.com/viewarticle/906703#:~:text=Sixty%2Dsix%20percent%20of%20physicians,professions%20opposed%20single%2Dpayer%20healthcare.

          Other surveys show that physicians are shifting to favor single-payer, even thought they know it would cost them:

          “Doctors favor single payer, despite likely income hit,” https://www.fiercehealthcare.com/practices/doctors-support-single-payer-system-income-would-suffer

          “A new survey says doctors are warming up to single-payer health care,” https://www.statnews.com/2017/08/17/doctors-single-payer/

          “A New Generation of Activist Doctors Is Fighting for Medicare for All,” https://time.com/5709017/medicare-for-all-doctor-activists/

          “Would 66 percent really say yes if you told them what it would cost them? No.”

          Because doctors are too boneheaded to understand that their own self-interest should come before their professional duties?

          We’ve come a long way from the “Mercedes Caravan” of doctors coming to lobby against Minnesota Care.

        • Submitted by RB Holbrook on 11/05/2019 - 09:57 am.

          For some reason, moderation deleted my actual reply, which had links to four articles. I’ll have to content myself with two:

          “Majority of Healthcare Professionals Support Single-Payer System, Poll Says,” https://www.medscape.com/viewarticle/906703#:~:text=Sixty%2Dsix%20percent%20of%20physicians,professions%20opposed%20single%2Dpayer%20healthcare.

          Yes, that’s only one poll, and it is a small, self-selected sample. It does, however, reflect common attitudes:

          “Doctors favor single payer, despite likely income hit,” https://www.fiercehealthcare.com/practices/doctors-support-single-payer-system-income-would-suffer

          Physicians, it seems, have motivations for practicing their profession other than making piles of money. We’ve come a long way from the days of the “Mercedes Caravan” of physicians opposed to Minnesota Care. We’ve come even further from the days when my Mother had to explain to me why it was funny that the witch doctor on George of the Jungle was throwing darts at a target that said “Medicare.”

          • Submitted by Tim Smith on 11/05/2019 - 11:37 am.

            Still vague and not valuable. Bottom line, docs don’t have the say they used to, few independents. They all work for big profitable systems like Mayo, Allina, etc. If you told them how much money they will lose and jobs list its a big no am sure.

          • Submitted by Connor OKeefe on 11/05/2019 - 12:22 pm.

            From your “fierce healthcare” link…

            “A multipayer system would provide more autonomy to patients, said Elizabeth Blasuci, R.N., of Toluca Lake, California.

            “Single-payer breeds dependence and strains resources that are already depleted and limited by regulations and overseeing panels,” she said.

            “One-size-fits-all is a Potemkin village on steroids,” she added.”

            I’m going to bookmark that analogy, it’s wonderful.

            In any case, neither of your links support your contention that 66% of physicians now favor single payer, sir. Perhaps it was wishful thinking…which seems to be a re-occurring theme with proponents of socialized medicine.

            • Submitted by RB Holbrook on 11/05/2019 - 04:07 pm.

              I am gratified by the thought I was able to give you a few one-liners to drop in somewhere without context.

              In any case, it looks like you didn’t read/forgot about/decided to ignore the first article.

          • Submitted by Mark Kulda on 11/08/2019 - 11:18 am.

            The Medscape poll was a very, very, very unscientific ‘reader’ poll of those subscribers who cared to go online. The 66% number is pure bunk based on that. Doctors might be somewhat ok with MFA right now but that will change dramatically once they realize how minuscule their compensation under such a plan will have to be. The only way to make MFA even barely affordable is to squeeze providers even more than they are being squeezed now. One the squeeze is fully articulated to providers, the support from the medical community will wither.

      • Submitted by Connor OKeefe on 11/05/2019 - 06:14 am.

        “…66% of physicians now favor single payer”

        92% of oil companies now favor expanding off shore drilling leases.

    • Submitted by Ray Schoch on 11/04/2019 - 04:40 pm.

      Absolutely! We want to avoid becoming socialist hellholes like Norway, Sweden and Denmark, where everyone’s health is covered by the national system, health outcomes are far better than ours at far less cost, education systems produce far better results, public transit actually works, there’s virtually no gun violence, and ordinary citizens have standards of living equivalent to ours. God forbid!

      • Submitted by Edward Blaise on 11/05/2019 - 09:57 am.

        Ray, Ray, Ray,

        Don’t you know were exceptional?

        We can’t look to inferior, outlier countries for their ideas. We have the best ideas right here, look no further.

        Just ask our conservative friends here. And while your’e at it ask them how they like that new Toyota they just bought.

        In conceptual ideas/values it is easy to claim the creative high ground.

        In areas where their are real numbers and results generated from pure competition like the auto industry, consumer electronics, aircraft construction we see that we can and do learn from others just as others learn from us: That is how things get better.

        If anyone doubts this, a meeting may be in order.

        The doubters can charter a 737 Max and the rest of get an Airbus 320 to the meeting.

      • Submitted by Paul Brandon on 11/05/2019 - 02:45 pm.

        And Switzerland (whose economy is bigger than the three Scandinavian countries combined) is an even better example. A combination of private practitioners and single payer bookkeeping. Again, cost much less than our system, and the Swiss are healthier and happier.

  9. Submitted by Andy Briebart on 11/04/2019 - 04:36 pm.

    Warren wants to DOUBLE the size of the US budget on ONE item.

    And it wont affect the middle class?

    WOW!

    • Submitted by Karen Sandness on 11/05/2019 - 03:54 pm.

      The biggest part of the U.S. budget deficit comes from just a few sources:

      1. The Bush and Trump tax cuts, which mostly benefit the upper-income brackets

      2. The costs of the numerous wars and interventions that the U.S. has been involved in, most of them completely unnecessary, since 1945, and the constant flow of money to military hardware manufacturers to build fantasy weapons that cost hundreds of billions to build with “innovations” that are about as useful as the fins on 1958 Edsel

      And I’m not even including the so-called “black budget” or the literal trillions of Pentagon dollars that even Dick Cheney recognized as being unaccounted for

      As I noted when a Portland resident complained about the then-$500 million cost of the Westside MAX (light rail) line, “That’s two B-1 bombers, and we’ll actually use the MAX.”

      But right-wingers since Reagan (and possibly before) have acted as if military spending isn’t REAL government spending.

      3. Interest on the money borrowed to fund these wars and tax cuts

      If you take the budgets of government departments and services that right-wingers love to hate and recast them in bomber-equivalents, you can see where the real waste comes from.

  10. Submitted by richard owens on 11/04/2019 - 05:10 pm.

    Health care for every person is a goal for any free society, for without it, there is no freedom.

    In order to discuss it rationally, people need to know how risk management , and actuarial science actually work.

    [Wiki]
    “Actuarial science is the discipline that applies mathematical and statistical methods to assess risk in insurance, finance and other industries and professions. … Actuarial science includes a number of interrelated subjects, including mathematics, probability theory, statistics, finance, economics, and computer science.”

    An actuarial approach does not rely on fear (e.g. “TRILLION$”), but rather pragmatic, mathematical proofs. Insurance companies do this for a living, and we the public need to do it too.

    It is possible to state the problem generally as how to allocate resources in the most efficient way in order to cover everyone. All of the world’s health systems are limited in how much they can spend, and of course the most progressive of those plans will:
    1) not spend more than is available
    2) assure prevention does not suffer and that vaccinations, drug availability and basic HEALTH itself gets the re

  11. Submitted by richard owens on 11/04/2019 - 05:18 pm.

    Health care for every person is a goal for any free society, for without it, there is no freedom.

    In order to discuss it rationally, people need to know how risk management , and actuarial science actually work.

    [Wiki]
    “Actuarial science is the discipline that applies mathematical and statistical methods to assess risk in insurance, finance and other industries and professions. … Actuarial science includes a number of interrelated subjects, including mathematics, probability theory, statistics, finance, economics, and computer science.”

    An actuarial approach does not rely on fear (e.g. “TRILLION$”), but rather pragmatic, mathematical proofs. Insurance companies do this for a living, and we the public need to do it too.

    It is possible to state the problem generally as how to allocate resources in the most efficient way in order to cover everyone. All of the world’s health systems are limited in how much they can spend, and of course the most progressive of those plans will:
    1) not spend more than is available
    2) assure prevention does not suffer and that vaccinations, drug availability and basic HEALTH itself gets the resources our populations require.

    Using the Heritage Foundation plan was a good idea, since Republicans need to be the ones who will save us all or they will spend billions to stop it. The PPACA wasn’t fought for requiring coverage, but because it took lots of funds from the wealthiest Americans in taxes.

    Once voters understand the risk pool, and the risk pool is ALL OF US, then we simply need to manage costs in the aggregate.

    Some doctors will not be able to charge as much as they do now.
    Some drug companies will refuse to make unprofitable drugs.
    Some patients will overuse the system.
    Some folks will still avoid even basic check-ups.

    Still, the problem can be made less political if we simply solve the basic actuarial problem. Implementation will take time and effort from all of us, but there are efficiencies we still ignore and prices we pay that are larcenous. A glut of money that big has lots of savings inside it already, waiting to be made better and cheaper.

  12. Submitted by cory johnson on 11/04/2019 - 07:38 pm.

    I give Bernie credit for being honest in the way to finance the plan. Warren’a plan might as well be written in crayon it’s so fantastically disingenuous. Jeff Bezos isn’t going to be forced to sell 8 billion in Amazon stock…..

    • Submitted by cory johnson on 11/05/2019 - 08:05 am.

      I should also add Bernie and the rest of the Dems lose credit for not admitting their plans will lead to rationing, reduced choices and in many cases a reduction in quality of care. And of course any honest accounting of the cost should add at least 30% to the projected costs. Just look at the MN DHS waste, fraud and abuse and make that national. Other than that it will be paradise.

      • Submitted by RB Holbrook on 11/05/2019 - 01:25 pm.

        “I should also add Bernie and the rest of the Dems lose credit for not admitting their plans will lead to rationing . . .”

        We have that now. Your care choices and options are limited by your insurance coverage. If we had a completely free market, the rationing would be even more stark.

        “reduced choices . . .”

        Again, our choices are already limited by our coverage.

        “and in many cases a reduction in quality of care.”

        Again – why? Please be specific, without any bromides about “of course it would happen.”

      • Submitted by Eric Snyder on 11/05/2019 - 02:48 pm.

        We already have heavy 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
        https://www.cnbc.com/2018/11/29/over-half-of-americans-delay-health-care-becasue-they-cant-afford-it.html

        • Submitted by Paul Brandon on 11/06/2019 - 07:05 pm.

          And there’s a hidden healthcare tax:
          People who get health care through their employers are receiving part of their wages in the form of health care. If health care were a common good paid for through taxes, employers could afford to pay higher wages. Since we’re always hearing about how hard it is for employers to attract qualified workers, one would assume that they would compete by offering the higher wages which they could now afford.
          Again, historical note: the reason that we have a unique system of providing health care through employers is that wages were frozen during WWII, and workers were in tight demand. Employers had to compete through means other than wages, such as offering health care.

  13. Submitted by Edward Blaise on 11/04/2019 - 08:29 pm.

    The next time anyone drives by the Crosstown Highway and Shady Oak road look to the SE corner and see about 1,00,000,000 sq feet of medical overhead at the United Health headquarters.

    50 Years ago doctors and clinics were entrepreneurial small businesses that allowed local docs to earn a very favorable income and provide a most valuable local service. The hospitals they worked in were often civic amenities, built and operated by the communities they served. Sometimes under the auspices of the community, sometimes by religious organizations.

    Together they provided the world leading healthcare we still enjoy. Only now all of these docs, clinics and hospitals have been swallowed up into a healthcare system with disproportionate overhead: Health care administrators used to earn a fine wage, now past heads of United Health own pro sports franchises: Richard Burke in the NHL and Bill McGuire in the MLS.

    A past pediatric doc of ours talked about starting up a new independent, small practice that focused on the pediatric needs of boys. He and his prospective partners abandoned the idea because the overhead of malpractice and medical records. Ten years of no returns in a risky long term investment.

    Our congressional leaders, as emblemized by Moscow Mitch McConnell will sell us out to the highest bidder in all aspects of life. In healthcare protect the insurance companies and kill competitive entries into the market. If anyone objects, make a lot of scary talk about the costs of change and suck in low information voters who can be convinced of the way to vote, even if it goes against their self interest in all respects:

    “Keep yo gummint hands of my Medicare”

  14. Submitted by Connor OKeefe on 11/05/2019 - 05:41 am.

    “Quite a few countries have figured out how to cover everyone without going bankrupt.”

    Correct. 40% effective tax rate and rationing.

    10 months for an MRI? No thanks.

    “Paul Krugman writes that the math she rolled out at least passes the laugh test.”

    Unfortunately for Warren, Krugman doesn’t. The reactions I’ve read suggest that endorsement from Krugman = an insurmountable lead according to the Stribpol.

    • Submitted by richard owens on 11/05/2019 - 09:07 am.

      Actuarial solutions or anecdotal arguments?

      You sound like you don’t want to cover everybody because you heard about a delayed MRI.

      Do you want to cover everybody? Your argument, if I may analyze it, says, “we can’t cover everybody or the waits for care will be too long.”

      Is that it? Anything positive at all?

      • Submitted by Connor OKeefe on 11/05/2019 - 09:30 am.

        Covering everybody in a country of 350 million isn’t economically realistic; we’ll have millions dying while waiting for treatment. The Canucks can’t do it with a population less than 1/4 the size.

        “Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish.”

        https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2017

        And Warren’s 25 Trillion plan isn’t even her worst idea.

        • Submitted by Edward Blaise on 11/05/2019 - 10:19 am.

          So much for that argument:

          “By an overwhelming margin, Canadians prefer the Canadian health care system to the American one. Overall, 82% said they preferred the Canadian system, fully ten times the number who said the American system is superior (8%)”

          By poll numbers or apocryphal stories, Canadians consistently think their approach is better than ours, which is essentially the approach they abandoned in the 1950s.

          • Submitted by Connor OKeefe on 11/05/2019 - 11:36 am.

            Declining to cite a source is always suspect, in my experience.

            “Canadians want choice in how they access health care: poll”

            “OTTAWA — The majority of Canadians support a “mixed” model of health care that would give them the option of spending their own money for care in a private system, according to the results of a new poll.

            And three-quarters of them support being able to buy private health insurance for all forms of medically necessary treatment, including cancer care and heart surgery, which they could then obtain outside of the public health care system.

            The numbers show up in a new poll conducted by Ipsos Reid for Postmedia News and Global Television…”
            http://www.canada.com/health/Canadians+want+choice+they+access+health+care+poll/6850577/story.html

            So they love them some free healthcare…but they want the right to buy real health care with what’s left after they are taxed for the free health care. Wew, sir that’s quite an endorsement.

            • Submitted by Edward Blaise on 11/06/2019 - 08:56 am.

              And if you were to carefully read and understand the content of the link you provided you would know that Canadians essentially are asking for a Medicare for all program with the option of “Medicare Advantage” options to enhance their government provided universal health coverage.

              Which is EXACTLY what we have with our current Medicare coverage.

              Nice to put this one to bed with our reaching agreement that the best path forward is simply lowering Medicare eligibility ages through a tax buy in and encouraging options for private sector enhancements through programs like “Medicare Advantage”.

              Who says compromise can’t be found????

        • Submitted by richard owens on 11/05/2019 - 10:25 am.

          The spending on Health care related industries is around 20% of GDP and much more per capita than any other developmded nation.

          A single birth costs upwards of $2000, just in malpractice premiums.

          You can’t look in a mirror and advocate for health care for only those who can afford it, can you? Have you no concern for your fellow man?

          Indifference to the plight of the uninsured is a misanthropic view- not one any responsible policy can embrace. Yours is simply a selfishness borne of austere thinking. We can afford it. WE CAN AFFORD IT.

          We are paying all the costs NOW.

  15. Submitted by Paul Udstrand on 11/05/2019 - 10:47 am.

    Aside from promoting moderation I’m actually not sure what is the point of Eric’s suggestion? As far as I can tell most of the Democratic candidates that oppose MFA have already issued this statement.

    I wouldn’t counsel Warren or Sanders’s to fall back or retreat to banality, they need keep promoting their policy.

    No one who has been supporting single payer for years and decades is under any illusions so pointing out obstacles is an exercise in the obvious pretending to be wise insight. And we should note that those who still deem MFA to be a pipe dream are same people who thought even getting on the agenda was a pipe dream just three years ago. Whatever.

    The point of putting MFA on the agenda is to put it on the agenda. Now that it’s a recognized and legitimate policy proposal, it’s a legitimate possibility. It will eventually become reality only if and when proponents overcome opposition.

    Republicans will never support MFA so we know we will simply have to defeat them at the ballot and pass it without their help. Likewise Democrats to oppose it will have to overcome. Republicans AND Democrats who prefer to leave the nation and millions of it’s citizens in the midst of a health care crises will have to explain themselves.

    Eric is correct in suggesting that it might not be constructive for Democrats to attack MFA, but this is the nature of “moderation/centrism” so I wouldn’t expect those attacks to stop until they have been defeated. These democrats gained their power and elite status by marginalizing and blocking liberal agendas and their not going to give THAT power away easily.

    Meanwhile we can now begin the actual debate and analysis of MFA that Democrats have been trying to prevent for decades, it’s on the table, and we have nothing to fear. We don’t need vague and banal statements that promise to do “something”… we have a powerful, rational, and affordable plan to promote. Hopefully we’ll see some actual discussion, analysis, and description about the actual plan in future Minnpost articles. Thus far the subject seems to be avoided at all cost outside of the comments.

    • Submitted by cory johnson on 11/05/2019 - 11:48 am.

      Even the term “Medicare for All” is an inaccurate political slogan. As people on Medicare know, they are still expected to contribute to their healthcare. What Bernie wants is a”free” government run and controlled healthcare system.

      • Submitted by Paul Udstrand on 11/06/2019 - 08:21 am.

        You’re misinformed Cory.

        MFA is exactly what is says, Medicare for All. That means every man, woman, and child in the US is covered with a nationwide irrevocable health care plan. Neither Bernie or anyone else has ever suggested that MFA could be “free” in any way. Everyone understands that health care cannot be “free”. You just won’t have the deductibles and co-pays you currently have.

        Our health care system has two basic components: the providers who actually deliver health care i.e. Dr’s, clinics, hospitals etc., and payers… i.e. insurance companies. You are mistaken when you claim MFA is a government run health system in the sense that all of the providers aside from the VA and Country hospitals will remain private, the government will run the payment side, but not the provider side. MFA takes over the payer side, but not provider side.

      • Submitted by Paul Udstrand on 11/06/2019 - 08:24 am.

        It’s also important to remember the medicare under MFA is NOT the medicare anyone is currently living with. Unlike the current Medicare MFA is universal, nationwide, and irrevocable, you can’t lose it nor can anyone take it away. For this reason many of the current limitations, coverage disputes, qualifications, etc. that current Medicare applicants and user encounter simply go away.

        • Submitted by cory johnson on 11/06/2019 - 01:46 pm.

          You say I’m misinformed in one post but then confirm that what Bernie is proposing isn’t really Medicare. It most certainly will be free for everyone since who doesn’t contribute to the system. It will also be free for every person who comes here legally or illegally from all over the world. You are sorely mistaken if you think the majority of Providers will want to participate in this system as private practitioners.

          • Submitted by Paul Udstrand on 11/07/2019 - 11:15 am.

            I suspect you think your clever Mr. Johnson but you miss the mark. Warren and Sanders are proposing that we expand the existing Medicare program to cover everyone and everything… but the nuts and bolts of the program remain the same… that’s why it’s so economical, we’re not reinventing the wheel we’re simply expanding something that already exists. Sure, it will be universal, but it will still be Medicare… like your 2019 Honda Civic may be have a lot of stuff you 2005 doesn’t… it’s still a Honda Civic.

            Your insistence that health care will be “free” is simply incoherent. We wouldn’t be talking about Warren’s plans to pay for this if it didn’t have to be paid for. If you think you’ll get health care for free when MFA is implemented you’re in for a rude awakening. You’re health care will be less expensive, universal, and irrevocable, but it won’t be free.

            You can complain about undocumented children who get health care if you wan’t, but some of us will note that 60 million American Citizens will get be getting quality affordable health care, and everyone else will get far better coverage than they have now. A net improvement for 300+ million American’s might be well the cost of treating some undocumented immigrants.

            • Submitted by cory johnson on 11/07/2019 - 11:49 am.

              You really shouldn’t compare Warren and Sanders as though there plans are the same. And it is being sold by Warren as funded only be the evil rich people. Bernie at least admits the Middle class will pay more in taxes. And of course it will cost at least 50 trillion over 10 years. One can only hope it’s run with the same efficiency of our state DHS. Open up your wallets everybody.

              • Submitted by Paul Udstrand on 11/07/2019 - 12:15 pm.

                Cory, the point is no one is promising free health care as you have repeatedly claimed.

                You’re wallet is already being drained or do you think your health care is free today? Not only are our wallets already open, but we’re paying more for less health care than we will with MFA.

                To the extent that the middle class or anyone else ends up paying a “tax” for their health care, that tax replaces you’re current more expensive private premiums, and it will provide universal, nationwide, irrevocable coverage that private insurers simply cannot offer.

                You can complain about getting vastly superior health care and coverage for less than you currently pay simply because you pay by tax rather than premium if you want. However at the end of the day your making a fundamentally irrational complaint.

  16. Submitted by Eric Snyder on 11/05/2019 - 01:29 pm.

    In addition to what kind of health care system we envision, we need a systems approach to health care, which would take into account many factors that affect cost and effectiveness. Possibilities might include:

    —Stop subsidizing the unhealthy food supply like corn and soy.
    —Do subsidize healthy agriculture and food systems.
    —Ban all agricultural chemicals that science has shown to be a threat to public health.
    —Reduce the work week to relieve stress – a significant contributor to worse health.
    —Require extensive education for doctors and nurses in nutrition.
    —Remove any barriers at the federal level to/radically expand research in anti-aging and age reversal.
    —Require businesses to make standing desks available for employees.
    —Substantially increase funding and support for public health and environmental generally: research, academic training and public outreach.
    —Update national and international guidelines on food and nutrition with the latest research and with an emphasis on optimal health, while making sure to ban the input of sleazy industry lobbyists who will inevitably want to water down and corrupt such standards.
    —Conduct a comprehensive study of water and soil contamination and appropriate all necessary funds to largely eliminate public exposure to health harming chemicals. Vastly increase the power of the EPA to deal with air, soil and water pollution, along with hazardous waste and industrial pollutants.
    —Fully fund research into gun violence and how to prevent it. Legislation should follow the evidence, and not partisan interests like those of the NRA.
    —Radically shift national priorities to combat climate change.
    —Outlaw, except in rare and obvious cases, the ability of parents to opt out of child vaccinations.
    —Offer free tuition to nursing and medical students based on the best candidates and an agreement to work for a very decent but less than market income.
    —A wholesale shift of drug research and development out of private, for-profit industry.
    —Government produced insulin and distribution at cost, along with a ban on for-profit company production.
    —Nationwide community and urban design initiatives centered around maximizing public health.
    —Make the denial of health care for any reason a human rights violation subject to criminal prosecution. An example of such a crime would be passing legislation that would knowingly take away health care coverage, as the Republicans routinely attempt to do.
    —Make it a goal to eliminate public lead exposure. This would include, among many other things, banning lead ammunition.
    —Adequately fund addiction treatment services.

    Anyway, I assume the point is obvious. If we just focus on how we’re going to increase revenue and cut costs, we’ll be missing enormous opportunities to improve our overall health.

  17. Submitted by Henry Johnson on 11/05/2019 - 10:27 pm.

    We are the only developed country in the world without universal healthcare.

    Our per capita cost for healthcare is over TWICE as high as these other countries, but our health outcome are worse, as indicated by this article, published not in a left-wing magazine, but in very firmly capitalist ‘Forbes’ magazine –

    https://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-last-compared-to-10-other-countries/#3714adae576f

    So we’re getting less than these other countries, and paying more than twice as much for it, and yet we have been brainwashed by 50 years of politicians influenced by health insurance industry campaign contributions, into believing that universal healthcare is just about the worst thing in the world – and ironically, that we can’t afford it!

    We can’t afford to save 50% per capita on healthcare costs – like that makes sense!

    Those who believe it would be the worst thing in the world might perhaps use as one of their arguments that “oh the government screws everything up”, therefore can’t be trusted to provide universal healthcare.

    But the same people will brag about how wonderful our US military is, which is, wait for it – run by the US government.

    They rely on weather forecasts made by the US government, eat food kept safe by the US government, drive on roads built by the US government – you see the double standard.

    My experience tells me that private industry screws things up at least as much as government does – when I sent half of my belongings across the country by US postal service and half by a private shipper years ago, the US postal service boxes arrived on time and undamaged, while the private shipper claimed all the boxes were lost in a traffic accident.

    We spend 25% more for healthcare just in higher administrative costs, and some who object to universal healthcare may cite as a reason because “I don’t want to pay for someone else’s health care”.

    But they should realize that many poor people use the emergency room as their doctor’s office, rarely paying their bills afterwards, which is why that hospital charges you $20 for an aspirin trying to make up for uninsured people – in other words, we are ALREADY indirectly paying for other people’s healthcare.

    And an uninsured person who has no primary care physician probably isn’t getting a yearly physical that might have detected a heart issue that could have been treated by relatively inexpensive drugs, and then may end up needing an $500,000 emergency heart operation – which they have no money to pay for – so we the public eat that cost by hospitals that then need public subsidies or need to gouge everyone else who DOES have insurance high bills to cover those freebie care given to the uninsured.

    So again, we are ALREADY paying for other people’s health care, it would be more logical to just do whatever other developed country in the world does – have universal healthcare and focus more on less costly preventative medicine.

    Yes, taxes would need to be raised, but employers no longer need to pay for health insurance and so can provide their employees with higher pay, and local hospitals don’t need to gouge insured patients to keep their doors open.

    It seems like false egotism to me that we Americans would think that we are superior to the rest of the world on something like healthcare, where in reality, the FACTS are that we have a healthcare system that costs more than twice as much, with poorer health outcomes.

    It’s not something to feel superior about as a country, as the article above indicates, we’re near the bottom of the class in healthcare.

    I would like to see the democratic party get together with some experts in the field, and put together some powerful, short, videos, which explain to the American people how the rest of the developed world gets better results for less than half the cost.

    There has been so much brainwashing against universal healthcare, that that needs to be counteracted I think by easy-to-understand video education, so that we can start to get the public to realize that they have been the victims of scare tactics, and that universal health care makes tremendous sense – for both lower overall healthcare costs and healthier lives.

    • Submitted by Eric Snyder on 11/06/2019 - 11:45 am.

      Well put, Henry.

      You may or may not have seen this PBS documentary:

      PBS Frontline: Sick Around the World
      https://www.youtube.com/watch?v=h4rg-DJBd34

      A reporter travels to 5 other countries to provide comparative perspective on the American system. What he discovers speaks for itself.

      Along these lines, I recall an interview with health care economist Uwe Reinhardt. He said that when he attended international health care economics conferences that ‘the American system’ was generally understood as a system that didn’t work very well.

    • Submitted by Karen Sandness on 11/07/2019 - 09:13 am.

      In the lead-up to the ACA, very little information was available about what it actually was.

      People who were hoping for a single-payer system could believe that Obama was promoting that. I met several people who believed this, and there was little information available to disabuse them of that notion.

      The right-wing media, acting as if Obama was working on a single-payer system, started gleaning horror stories from British and Canadian tabloids, even though the two systems are entirely different, and of course, neither one is like the ACA.

      Since so little information was available, I embarked on an online search. I finally found a description of the ACA buried in the website of the Kaiser Family Foundation, and I was horrified. While the plan had a few good points, such as the expansion of Medicaid (but only if the states wanted it) and the removal of lifetime caps and bans on refusing coverage for pre-existing conditions, it did nothing to make insurance premiums or coverage affordable for the middle class. It looked like corporate welfare for the insurance industry.

      No wonder the Establishment Democrats didn’t want the details revealed. It seemed designed to PREVENT real reform instead of advancing it.

      • Submitted by Paul Brandon on 11/07/2019 - 01:19 pm.

        Obama’s original ACA WAS a universal single payer plan.
        He quickly trimmed it back to something that he could get passed.

        • Submitted by Paul Udstrand on 11/07/2019 - 01:33 pm.

          No, Obama never promoted single payer, he did promise that there would be a public option however, and THAT was the first thing blue dog Democrats took off the table.

          Those of us who were paying attention always knew that ACA would leave millions uncovered and undercoverd and would do little or nothing to control costs. We hoped that Democrats would keep working on it, but they lost elections and then decided they could live it’s failures.

        • Submitted by Karen Sandness on 11/07/2019 - 07:02 pm.

          No, Obama let people think that he wanted single payer. But what he wanted most of all was a legislative victory.

          I got a real bad feeling when I heard that he had met in closed-door sessions with insurance company executives. The same people who screamed bloody murder when Dick Cheney met in closed-door sessions with representatives of energy companies thought it was just fine for Obama to do the same. (If I were all-powerful, I would ban closed-door sessions with representatives of any industry.)

          In his quest for a legislative victory, he offered a variation of the Heritage Foundation’s proposal for compulsory private insurance. Surely the Republicans would vote for that!

          Nope. He couldn’t even get members of his own party to agree to it until the public option was removed.

          I can imagine LBJ going to a recalcitrant Joe Lieberman type and whispering, “Nice submarine base you have there in Groton, Joe. It would be too bad if something happened to it.”

          But Obama caved in to the Blue Dogs and twisted the collective arms of the members of the Progressive Caucus to “give him a victory.”

          They did. The ACA passed without a single Republican vote, as they are fond of reminding everyone whenever the system’s shortcomings are pointed out.

          • Submitted by Paul Udstrand on 11/09/2019 - 02:31 pm.

            Very nice analysis Ms. Sandness. And that legislative victory, in tatters and rags is the ONLY thing left of the Obama “legacy” that has been otherwise torn to shreds.

            Obamacare may yet collapse due to the failure to even include a public option. I’d rather not lose Obamacare but I tend to agree the individual mandate that props it up is probably unconstitutional. I cannot think of any other instance where a universal government requirement, under penalty of law, that individuals purchase a private product. I don’ the government can compel us to buy health insurance any more than it compel us all to buy a cable TV subscription.

            If the ACA falls, MFA will be our only option.

  18. Submitted by Karen Sandness on 11/06/2019 - 09:21 am.

    Living in Japan in the 1970s was an eye-opening experience for me.

    Everything that conservatives deemed impossible was happening there: quality K-12 education for the entire population, superb public transit, universal health care, and full employment (2% unemployment at the time). Their unemployment rate didn’t rise until the U.S. succeeded in pressuring them to adopt “international” (i.e. U.S.-style oligarchic) business standards.

    Right-wingers typically have two excuses for why the U.S. can’t match other countries in quality of life issues:

    1. “They don’t have to spend any money on defense, because the U.S. is shouldering the burden.”

    If you look at military spending in the rest of the world, you’ll find that countries spend in proportion to their share of the world’s population. Although Japan does not have an official military, it has what it calls its “Self-Defense Force,” which interestingly enough, has land, marine, and air divisions. Its size and budget are proportionate to Japan’s share of the global population.

    The only outliers in this regard are the U.S., which spends more than the next several countries (including Russia and China) combined, and Britain, which seems to think it still has an empire. Interestingly enough, both countries are experiencing declining living standards.

    2. “These countries don’t have immigrants.”

    First of all, if you tell a European or Japanese that their country doesn’t have immigrants, you will be treated to the sight of said European or Japanese rolling on the floor laughing.

    Second, how are immigrants an excuse not to have a social safety net?

    Are immigrants lesser human beings than existing residents? (Sadly, some right-wingers seem to think so.)

    Are immigrants too stupid to take prudent advantage of education, health care, or other social services?

    Are immigrants more likely to cheat than existing residents?

    Or are you simply (and incomprehensibly) willing to do without universal health care, affordable college, universally high-quality K-12 education, modern infrastructure, and affordable housing as long as those people who look different from you and practice religions that you are unfamiliar with and speak languages that you don’t understand do not benefit from these amenities either?

    • Submitted by Paul Udstrand on 11/06/2019 - 11:12 am.

      I support this comment entirely but I need to point out the fact that it isn’t just Republicans or conservatives that deem all the benefits in Japan to be “impossible”… our Democrats have been declaring the impossibility of these accomplishments just as loudly. Pipe dreams and unicorns they are according to some Democrats who actually running around Iowa and New Hampshire today. The marginalization of basic programs and common sense has been a two party endeavor for decades. If you want to why, just identify the “stakeholders” who make the most money from the market neoliberal have been promoting for decades.

      • Submitted by Paul Udstrand on 11/07/2019 - 08:05 am.

        Speaking of elites and “stakeholders” you have to ask someone like Klobuchar: “Who really benefits from keeping 100 million people in their current private insurance plans?” “Why is it so important to preserve more expensive coverage that limits coverage and providers, charges co-pays and deductibles, and denies coverage?” Who benefits most from for-profit insurance?

        And I’ll just tell you right now up front, if you think that consumer “choice” is a factor or could even be a factor in health care there’s no way to avoid describing that assumption as anything but monumental ignorance. Consumer models simply don’t work when you need ten years training and education just to understand the options, and you can’t just walk away from the “deal”. You can’t just walk away from colon cancer or diabetes because you’re not happy with your “service”, and you can’t go to a different Dr. or clinic if it’s outside your network of providers with negotiated prices.

        The reason insurance companies are death on MFA is that they simply can’t compete in a truly non-profit environment. They can’t make money without denying and limiting coverage or increasing premiums, deductibles, and co-pays.

  19. Submitted by Henry Johnson on 11/06/2019 - 10:48 pm.

    One advantage to being the only developed country in the world to implement universal health care coverage is this – if we are smart we don’t have to make all the mistakes all the other systems around the world made, we can study the top 10 or 15 systems or so, and cherry-pick and incorporate the best ideas and features into a plan for the US.

    If we’re humble enough to do so (and I think that’s a real issue, given our American bias to just assume we know better than everyone else! ;- ) ) would be to consult with health officials from those countries and ask them questions like this, and in doing so learn a lot from their experience:
    1. What were your biggest problems in implementing the system initially? What programs or fixes did you put in place to reduce or eliminate those problems? What worked and what didn’t work well?

    2. What are biggest issues or problems now that you’ve been up and running for many years, and how are trying to reduce or eliminate them?

    3. Based on your experience, If you had advice for us as to how to create the best possible system, what would it be?

    I’m pretty sure that other countries, may of whom have been traditional allies, at least until the current president decided to alienate them anyway, would probably be very willing to share their hard-won experience and the lessons they’ve learned, so that maybe we don’t have to make a lot of the same rookie mistakes they did in setting up the systems their systems.

    If we played our cards right, many of these countries might even have software or other systems that they would be willing to sell to us for a reasonable price, that perhaps could be fairly easily adapted for our use here, so that we don’t have to necessarily write that code from scratch if it’s not necessary, assuming that at least some of the features of a given program or system was a proven winner, and we essentially wanted to copy it, or copy it with some modifications.

    They might also lend or lease out some of their experts, software or just process management people, to help provide some guidance as we develop our own system, so that again, we don’t have to make many of the same mistakes they did in implementing their own programs.

    By doing these things, maybe we could have a very good system up and running, and perhaps in far less time, and at a lower development cost, than if we tried to just start from scratch without taking advantage of everything all these other developed countries have learned in creating and maintaining their systems.

    • Submitted by Paul Udstrand on 11/07/2019 - 11:23 am.

      MFA is probably the best option for the US. Medicare/Medicaid is already up and running as basic program, instead of designing an entirely new or additional program we can transition the existing program into a universal one that serves everyone. The infrastructure is already there, the model is deployed, and automatic universal enrollment actually simplifies the process and saves a lot of money.

      The current application process with all it’s options and qualifications (and attending costs and administrations) simply goes away… are you breathing? You’re enrolled… done.

    • Submitted by Paul Udstrand on 11/07/2019 - 11:43 am.

      Mr. Johnson is absolutely correct to suggest that we might borrow efficiencies from other countries. Our health care system and it’s informatics systems are terribly confused and disorganized. We have thousands of systems operating at cross purposes’s with little or no coordination and it’s probably costing us billions.

      Again, an advantage to MFA is that is centralizes the program and makes simplification and organization far more possible. Simply having have one standard payer instead of hundreds with different contracts, coverage rules, and reimbursement rates simplifies the process immensely. In fact, the more universal the coverage, the easier it is to administer. Currently hundred of insurance programs spend 24 hours a day reviewing bills to find stuff they can exclude or refuse to pay for. Providers spend thousands of hours trying to collect for stuff the payers refuse to pay for. All that goes away with a universal MFA program that just pays all the bills. You still need auditing tools to keep the payments legit but you’re looking for fraud, not savings, that’s an important difference.

      • Submitted by Henry Johnson on 11/09/2019 - 10:27 am.

        Yes, you’re right to point out how INEFFICIENT our current system is Paul, and that means wasted health care dollars.

        How many times for example have you gone to the doctor, and they prescribed a drug for your condition, based on which of several drug brands and types they found worked the best based on their experience as a doctor.

        Then you get to the pharmacy and find out that particular drug “isn’t coverage” by your insurance!

        So then you have to contact your doctor again and determine which drugs your insurance covers that do apply to your condition (even if it’s not the one your doctor thinks is best, which is another problem).

        So all this wasted your time, and your doctor’s time, which means they can’t treat as many patients, which mean they have to charge more per patient to make a living.

        All of this inefficiency would be eliminated if we had a single payer system, because the doctor would know upfront what drugs were covered under that system.

        Also, with single payer now the national health service has tremendous power to negotiate lower drug costs with manufacturers, because they can buy in bulk, especially for the drugs which cover the most common health ailments.

        As you can tell, I’m actually a big fan on a universal health care system, the facts of better care for half the cost, implemented in every other developed country in the world, speak for themselves.

        I have to admit though, I’m not sure American swing-state voters, as conditioned as they are by decades of propaganda telling them universal health care is the worst thing ever, are ready to vote for candidates that are pushing it hard and I think also oversimplifying how easy it would be to implement, like Elizabeth Warren, who I think is not that electable as a candidate in general to be honest.

        I think before we get universal health care, two things have to happen – we have to convince much more of the American public on it’s benefits, and we have to carefully plan how to implement it with the least disruption during the transition from our current system to the new one, and again, hopefully seeking to learn from the experience of other developed countries who did the same thing, so we make fewer mistakes in doing so.

        I’m not at all convinced that the first thing, educating the public, can be done before the 2020 elections, and since another 4 years of Trump I think would be a disaster, I’d really like to see the candidates not making a huge fanfare for medicare-for-all as if they think it’s going to be implemented shortly after they take office.

        If too many of the swing-state voters stay with their “universal healthcare is the worst thing ever!” mentality, that could cause a Warren or Sanders to lose to Trump, and then we are really in trouble.

        I have read many national polls showing even Warren and Sanders ahead of Trump, but here’s the problem – we don’t have a popular vote system to elect our president!

        When you look at swing-state polls, Biden beats Trump by only 3 points (not double digits), and Warren and Sanders are somewhere near tied with him, or lose to him.

        And when you look at the HUGE war chest Trump has at his disposal, he can hit a “medicare-for-all will ruin your life!” ad campaign hard with saturation ads for all of 2020 probably, so this is going to be a close election IMO, and I really think the democrats should focus on winning as they did in 2018 – by taking more moderate positions and candidates to win suburban voters, including republicans, to vote for their candidate.

        Amy Klobuchar is my choice in that regard, she’s for universal healthcare, but is not on board with the idea that we should push for that to happen right away, and I think that’s just the reality of the situation anyway.

        Between the convincing of probably half or more of the public that yes, universal health care IS a good thing, and the strong political opposition to it in much of the country, and the need to really study in depth the best way to implement it, even if Warren for example pushed hard for it on day 1 of her presidency, I just don’t think it would get the votes to be done in congress, assuming that she actually got elected in the first place, which I personally think is a BIG, big if.

        On the other hand, Amy’s challenge is to win the nomination, if she could manage to convince the democrat to nominate her, I think she would win so many moderate, suburban voters especially, that she would win the general election fairly handily.

        People in general I think, minus the Trump faithful of course, are really tired of the lies, the immaturity, the non-stop bragging, the foul mouth, the impulsive decisions (e.g. – abandoning the Kurds and letting ISIS regroup), and so I think this election is the democrats to lose.

        And the way to lose I think is to promote too many programs that the swing state voters are just not going to be ready to vote for, and which provide too much attack-ad fodder for the Trump-publicans.

        The house was won in 2018 by moderate democrats who flipped red seats to blue, and to win the presidency and the senate in 2020, I think the same approach is the way to go, at least in my opinion.

        I know that doesn’t satisfy many on the board who want these progressive positions, and want them NOW, but I just think that’s betting the farm on one fairly risky roll of the dice, and not a good idea for that reason IMO.

        • Submitted by Paul Udstrand on 11/09/2019 - 04:45 pm.

          Henry,

          I don’t think anyone thinks that MFA will come easy, but it may be a lot easier that many imagine. You’re right that many have been conditioned to reject government programs, but the majority will see the advantages once their laid out clearly in head to head comparisons.

          I’m much more worried about the public option now than I was in 2008. I voted for Obama despite his failure to sign off on MFA at the time because he claimed a public option would be a required element of any health care law he signed. Then they took that off the table immediately and he didn’t seem to care… as Ms. Sandness pointed out he seemed to be ready to sign any legislation when it came down to it in order to rack up a legislative victory.

          Whereas I would have been more inclined to settle for a public option in 2008-2010, NOW that I see how invested so many “moderate” Democrats like Klobuchar are in preserving for profit insurance, I’m much less certain that a public option would ever be designed to actually insure universal coverage. It looks like just another way of delaying a national plan indefinitely. Furthermore, in 2008 NO ONE was talking about MFA at all, so a public option looked more feasible then. THAT’S changed these days. The question now is is why settle for a limited public option if we can get MFA?

          Of course “moderates” will tell us that MFA is pipe-dream we’ll NEVER get, so we should settle for the public option. We’ll see. We’ve heard claims like that before about everything from voting rights to gay marriage.

          • Submitted by Henry Johnson on 11/10/2019 - 09:11 pm.

            Paul, since having Warren as a candidate is a possible outcome, I sincerely hope you’re right, and that enough of the American public, especially the swing state public, can be convinced of the advantages of MFA for the 2020 elections, and decades of conditioning by politicians accepting campaign contributions from insurance companies to say that universal health care is the worst thing ever can be counter-acted in that short fairly short time period.

            If so, I’d be all for it. My issue is really simply based around concerns about the outlook for results of the 2020 election, as I think it would be devastating to our democracy to have another 4 years of president Trump, and almost equally bad, another 4 years of Mitch McConnell with a senate majority.

            Democrats have all kinds of plans for change, which is good, but as long as McConnell can a single person is in his current position able to control whether bill are even brought to the floor, ANY plan, even ones that 80% of even republicans would support if allowed to vote, are not just “dead on arrival”, they are pretty much “dead before arrival”.

            And like the fact that we don’t have our president elected by popular vote, our senate gives as much power to two senators from a sparsely populated state like Wyoming the same power as two senators from huge states like New York or California.

            So as with electing our president, republicans have a huge “handicap” built into our national elections, because they predominate in the sparsely populated rural states, like Wyoming, and even if a national poll for example shows MFA is favored by more than 50% or even 60% of the public, that absolutely does NOT mean that the votes are there in the senate to pass it into law.

            Or to pass ANY law actually that Democrats would want to have passed, with this bias built-in to our system which favors Republicans.

            Therefore, I really think that this isn’t just about what is the best plan for our country, it’s about how in a system which happens to favor the Republican demographics, Democrats can win the presidency, the house and very importantly the Senate – because without gaining all three, even programs far, far less hotly debated or controversial, are “dead before arrival”, sadly.

            And for that reason, I still believe that democrats and their candidates, even though they perhaps hate doing so, if they are serious about even getting “half-measures” done (regarding MFA or pretty much anything else), they need to seriously ask themselves before taking every new position – “how is this going to be received in Ohio, in Pennsylvania, in Florida, in West Virginia?” and the other swing states.

            Because without taking the Senate and the presidency, nothing of any significance at all in the Democratiic agenda is going to be passed into law, unfortunately, it’s just a simple as that, much as we hate it.

            Having said that, I would love to be wrong! I would love swing state voters to be unconvinced by all the Trump-publican attack ads that are now probably being queued-up for heavy air play, and to instead be convinced by the Democratic reasoning on some of these issues like MFA, that I do personally think is the only way to go – once it can be pulled off under our current system, with it’s republican demographic bias.

            I’ve mentioned it before, but if they haven’t already done so, I would say that in order to convince the public on some of these issues, they should connect with Hollywood film-makers who are Democrats, and have them meet with experts on things like MFA and global warming, and create some really powerful, hard-hitting, but short videos, that could then be given as much air play as possible, to try to educate and convince swing state voters especially, that some of these ideas actually make a lot of sense, and are based on sound, simple scientific principles (I’m thinking of global warming), and sound economic sense (for MFA, show graphs of how much more than other developed economies we are spending on how health care, with worse health care outcomes).

            Maybe these videos, if they were really well done and got enough air-play, could counteract the attack-ads coming our way from the Trump war-chest, and make it possible to prove me wrong, and have the house, senate and presidency go to the Democrats in 2020, even with some controversial policy positions making that more of a risk to accomplish.

    • Submitted by Karen Sandness on 11/07/2019 - 07:04 pm.

      That’s exactly what Taiwan did. Since so many of their doctors are U.S.-trained, their first impulse was to adopt an American-style system, but fortunately, they decided to study systems around the world, and they arrived at a system similar in broad outlines to the one in Canada.

  20. Submitted by Paul Udstrand on 11/07/2019 - 11:30 am.

    One of the other advantages to MFA that I don’t think has been discussed here is the fact that it frees up billions of dollars every year (actually as much a trillion-plus) for other kinds of spending. Sure, it’s a economic “hit” for the some in the health care industry, but for American Business’s, families, and individuals it puts billions of dollar on the table for alternative spending or even savings. It’s save American business hundreds of millions if not more by eliminated the current costs associated with maintaining health care plans and options for employees. It will eliminate the dilemma and crises that workers now face when they loose their jobs or want to move to a different job.

    This is actually a significant economic advantage that many of our competitors already enjoy.

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