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Because private run insurance will always involve trying to pass the buck to someone else. We don't need universal insurance. We need universal health care.
Even insured patients find themselves without care at critical times like when they get cancer and need advanced treatment.
"It's the planet, stupid."
by FishOutofWater on Fri Apr 11, 2008 at 06:05:05 AM PDT
[ Parent ]
and I was wondering myself why Krugman used this language.
We don't need universal insurance. We need universal health care.
Maybe he's throwing in the towel in some fashion, he's conceding that we will have to accept private health insurance (as opposed to single-payer), at least at the beginning. I don't know.
I also don't understand why he has a knife out for Obama?
Tell your healthcare and insurance horror stories at Guaranteed Healthcare
by nyceve on Fri Apr 11, 2008 at 06:12:39 AM PDT
However, free riders, generally healthy young people cause a tiny fraction of the costs of the health system. Economists want healthy young people to pay for the sick.
The only fair solution is single payer, because mandated insurance will cause the insurance companies to design their plans to get those healthy young people and keep away the old and sick.
In reality, none of the candidate's plans were very different. They are all starting points for a legislative effort.
by FishOutofWater on Fri Apr 11, 2008 at 06:18:15 AM PDT
Krugman is in the camp of single payer would be best in principle, but cannot be acheived politically. Therefore, he argues, since private insurers are with us even if we wish they were not, then only to get to 100% coverage is mandates. Therefore, Obama is fudging it when he claims his plan is universal and his ads that mimicked Harry & Louise were too much like Repuglican talking points. Similar to Obama's brief rhetoric against Edwards and "trial lawyers." And that from pure economist analysis (no politics, no real world analysis of what insurance companies actually do) mandate are only way to get to 100% coverage, if not single payer or some other automatic enrollment.
Obamist argument would be that mandates are political poison. His plan is step in right direction. And if it turns out we need more later on, and privates have further proven to be bad, then we can take next step from a stronger position.
Need to remember that Clinton's rhetoric and stated plans on many domestic issues IS more liberal then Obama. It's just that we don't trust her to follow through (plus on international & war she is to his right).
click to learn about Single Payer Health Care
by DrSteveB on Fri Apr 11, 2008 at 06:22:40 AM PDT
more in the Obama or Clinton camp?
I recognize PNHP must detest both plans, but since you're tied into them, what's the word, if any, on the inside? Of course, if you're at liberty to say.
by nyceve on Fri Apr 11, 2008 at 06:47:39 AM PDT
really. The organization has NO leanings for either! Individual members all over the place...
by DrSteveB on Fri Apr 11, 2008 at 07:17:07 AM PDT
PNHP doesn't like any of the candidates and for good reason... the incremental step reform strategy has a history of falling on its face.
What about incremental reform of the health system? As a matter of policy, PNHP expressly opposes many so-called gradual steps towards single-payer. Many well-meaning supporters often push these bills as "feasible steps" to move us towards single-payer, but the history of these kinds of health reform efforts - Hawaii in 1974, Massachusetts in 1988, Oregon in 1989, Tennessee in 1992, Minnesota in 1992, Maine in 2003, etc. - shows that despite their claims of pragmatism, incremental reforms have consistently failed for more than three decades. Incremental reforms cannot garner administrative savings and redirect them to care. Hence they always founder on the shoals of cost. In addition, these reforms distract attention from the economically realistic, if politically challenging, option of single-payer reform.
http://www.pnhp.org/...
A Kossack by the name of Dallas Doc, I believe, made the point that under Obama's or Clinton's plan the government plan will wind up being for the poor and those with preexisting conditions and will provide much lower quality care.
I think he described as a "medical apartheid" and given the current state of medicaid, I'm inclined to agree with him.
PNHP makes the same argument:
Why shouldn’t we let people buy better health care if they can afford it? Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important. Moreover, when the wealthy jump the queue, it results in longer waits for others. Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system for the wealthy means the creation of a permanent lobby for underfunding public care. Such underfunding increases the demand for private care.
Why shouldn’t we let people buy better health care if they can afford it?
Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded.
Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important.
Moreover, when the wealthy jump the queue, it results in longer waits for others. Studies in New Zealand and Canada show that the growth of private care in parallel to the public system results in lengthening waits. Additionally, allowing the development of a parallel, private system for the wealthy means the creation of a permanent lobby for underfunding public care. Such underfunding increases the demand for private care.
Analysis of 2008 candidates: http://www.pnhp.org/...
Single-Payer FAQ http://www.pnhp.org/...
After spending thousands of hours going over countless studies and the history of single payer systems around the globe, I'm inclined to agree with them.
Reform efforts will be a band aide approach and the rich will buy off the rethugs and DINOs in congress and they will ultimately fail.
I know in business that if I walk into a negotiation knowing that my business needs X to survive and thrive, but I don't believe that I can get it... so I ask for half of X... what I usually will wind up with will even be less than that.
Which ever candidate gets elected, ultimately it will take the efforts of the American people to keep spreading information and hammering on the politicians to get what they need.
Ultimately, to me, it makes little difference if it is Obama or Clinton who gets elected. Any efforts that they make are going to have to be run through the gauntlet of congress and the lobbyist.
This may be a time of sea change and congressional reform may be possible too... certainly the situation is dire enough to warrant it and the fund raising models have changed forever.
Politicians can see that candidates can raise vast sums of money with populist campaigns across the net that far exceed what the lobbyist contribute. Open secrets.org shows that while Obama's campaign is 99% funded through individual donors, Hillary, who accepts lobbyist donations, is 88% funded by small donors.
The old model of peddling influence inside the beltway ultimately doesn't produce as much cash as going to the people with a populist campaign. The question is... can the American people realize their own power, can they get organized and informed enough to get what they want and need?
Those are open questions... but one thing I do know is that if you start with the belief that you can't get what you want... you probably aren't going to get it.
by Flint on Fri Apr 11, 2008 at 10:27:45 AM PDT
Thanks for correctly explaining why Krugman is saying this. I'm angry that both Dem candidates' health care plans do not go far enough - but so far what I hear and read is that Clinton's plan is pushing for more than Obama's plan. It is not attacking a candidate - it is attacking their health care plan.
I'm still looking for the candidate who takes a stand like Elizabeth Edwards did. I know that I am only one illness away from bankruptcy and I think it sucks that I will lose everything because of something that cannot be helped.
47 million Uninsured in the U.S. Why aren't more Americans outraged?
by PAbluestater on Fri Apr 11, 2008 at 07:55:55 AM PDT
Recently there have been some news items about how the mandated insurance program in Massachusetts is working out. I don't know how unexpected they were, but there have been problems. In particular, the cost of subsidies given to those who can't afford market rates for insurance is projected to skyrocket over the next several years.
Ergo, by the time Obama is in the White House (humor my optimism) and puts a health care plan on the table, say early 2010, the relative success or failure of mandates may be a lot more apparent.
Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read. - Groucho Marx
by Joe Bob on Fri Apr 11, 2008 at 08:13:42 AM PDT
but about the willingness to fund subsidies and pay them to for-profit insurance companies. And whether the regulations contain the profit margins.
All other western countries have mandates. Everyone is required to be covered. In Canada the government is the only insurer for the basic needs. Private insurers supply the frills like a private room, etc. It IS universal health insurance. Doctors and healthcare providers bill the government agency, not dozens of insurance companies. And profits are a non-issue.
But mandates are part of the system.
What will be apparent in MA is whether private insurance can actually provide the healthcare needed at a reasonable cost.
Visit EENR blog for Progressives
by pioneer111 on Fri Apr 11, 2008 at 08:56:24 AM PDT
But without the strict regulations required to turn that into universal health care.
At least, that seems to be how the term is used here in the U.S.
Doesn't John McCain look tired?
by SciVo on Sat Apr 12, 2008 at 08:55:14 AM PDT
To get single payer, we have to wipe out the health insurance industry. With universal single payer coverage, there will be no place for them in our economy, unless they want to start offering discount plans for cosmetic surgery or somesuch.
The only way we can get the health care savings we need is to eliminate their profits and admin costs. As long as they're getting their 20%, we won't have the resources to cover everyone.
The health insurance industry will fight single payer and fight it hard because they are literally fighting for survival.
They have not done these awful things because they are bad conservatives; they have done them because they are good conservatives. -- Thomas Frank
by sagra on Fri Apr 11, 2008 at 08:19:40 AM PDT
45% of our medical dollars are already from the government, and the murder by spreadsheet industry already claims more than half of the other 55%(!)
We face terrible economic times and it is going to be deeply unpopular to gut that industry, but they're as much a parasite as a tapeworm and they're killing us, slowly but surely.
by Stranded Wind on Fri Apr 11, 2008 at 09:50:26 AM PDT
Period. If that causes the demise of these health insurance companies, well, too bad. I am sorry for the employees involved, but all this mess is due to pure and simple greed by the owners and upper, upper management. The employees do not share in the ever increasing millions taken home each year by the CEOs, CFOs, etc. as salary and bonuses. These heads of companies are not about to take any less..they just want more.
I don't see how having the present insurance companies involved could possibly work. The companies will just raise their rates to make up for any disparity in their bottom line. The government (our tax dollars)will just get charged exhorbitant prices to cover as-now-uninsurable folks and those who cannot afford basic coverage. Guess who still pays? We do. We will never be able to compete with the greed of corporatism.
The guys at the top do not care one whit about the good of the people. As long as they are in charge, We the People are sunk. Both candidates need to come up with a more workable plan to cover everyone. I am a rabid Obama supporter but he needs to come up with a better plan. And...Yes, He. Can.
"What, Me Worry?"...King George Walker Alfred Eusless Newman Bush
by RantNRaven on Fri Apr 11, 2008 at 09:57:13 AM PDT
The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered. This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered.
This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
http://www.pnhp.org/
You can not get around those figures... the private for profit health care insurance industry must go.
by Flint on Fri Apr 11, 2008 at 10:42:07 AM PDT
THE PRIVATE FOR PROFIT HEALTH CARE INDUSTRY MUST GO!!!!
by Yearn For Liberty on Fri Apr 11, 2008 at 11:07:46 AM PDT
a great assessment. Thanks.
by mbair on Fri Apr 11, 2008 at 09:08:19 AM PDT
There is a big difference between care and coverage. While there are many strengths to a single-payer system this is one of them. Single-payer systems mandate minimum care requirements for subscribers. You have a right to certain services and that right extends across the boards to everyone in the system.
Krugman is not happy with Obama and has been attacking him since early last fall on health care. He's decidedly partisan for Clinton now and often gives her the "more progressive policy" award. I recall reading about the mortgage crisis speeches from all three majors. Clinton got the Krugman nod in that column on that issue as well.
I don't know what Krugman trying to do, if he's got an ulterior motive or not. He's written disparagingly of Obama supporters too and not in a subtle way either. Even in this column he slams them.
And though I think that single-payer is a great choice for health care reform, I think we should recognize as a party that we're not running on that this year. We're going with the Obama or Clinton plan this time and neither are even remotely a true single-payer delivery system for care.
by mbair on Fri Apr 11, 2008 at 09:01:42 AM PDT
himself. He may mean universal health care but also fell into the trap of calling it universal insurance/coverage.
If he shows vision, he lacks substance. If he gives details, he's wonky. If he walks on water, he can't swim. DBunn at DKos
by TexDem on Fri Apr 11, 2008 at 12:03:16 PM PDT
Right the fuck on!
"The truth shall set you free - but first it'll piss you off." Gloria Steinem
Iraq Moratorium
by One Pissed Off Liberal on Fri Apr 11, 2008 at 06:17:46 AM PDT
Step 1: Put EVERYONE on Medicare.
Step 2: Any doctors who don't want to accept Medicare can operate cash-only. I doubt there'd be too many.
Rubus Eradicandus Est.
by Randomfactor on Fri Apr 11, 2008 at 08:17:30 AM PDT
I remember going to see Michael Moore's "Sicko" and being livid, as were the other people in the packed movie theatre. But, as we can see, nothing has changed. It gets worse every day. It's about U.S. attitude--we worry about ourselves and to hell with our brothers and sisters. Where there is universal health care, that attitude is different. The disparity in America between the rich and everyone else is striking. I consider my husband and I to be fairly smart when it comes to our future finances. He would like to retire next year, and we would have a good income, but because he's not yet 65 and eligible for Medicare (which costs almost $300 a month if you want good coverage) he would have to pay at least $700 for COBRA from his company, and that's just for him, not me. That eats way into our income. I'm not complaining--we are very lucky. I cannot imagine the pain of those who are not so lucky--we ought to be ashamed, but alas, those at the top don't give a rat's ass.
by lutznancy on Fri Apr 11, 2008 at 06:59:58 AM PDT
I wish more people would watch this movie, then I wonder if any major network CBS, NBC, ABC would have the guts to televise this.
by PAbluestater on Fri Apr 11, 2008 at 08:00:09 AM PDT
Just watch an evening of TV on any channel and note the number of ads for pharmaceuticals and HMOs.
These corporate rats will band together until the ship sinks.
by Ammo Hauler on Fri Apr 11, 2008 at 11:14:37 AM PDT
No matter how you look at it, the purpose of an INSURANCE policy is to spread risk among a large group. Everyone pays a little bit into the fund, and the fund pays for the catastrofic costs to the few.
That's how insurers work, and that's how a healthcare system works. You can fund it through taxes and administer through a federal bureaucracy, or you can fund it through private insurance premiums and administer through private insurers, or the mix of the two. It's six on one and half a dozen on the other if you remove the incentive and the ability to weed out the sick and stiff providers.
If under the healthcare legislation any provider must accept any application - cancer or not - for a nominal fee common in a geographic area with a mandated level of coverage AT LEAST equal to Medicare, then you could go with a federal agency as the default insurer or let private carriers compete based on their customer service and perks that they wish to provide.
You also need to revoke their ability to decline claims, except through the review by a federal appeals board (to make that point stick, require that the payment be made on demand and allow chargebacks if the appeal succeeds).
However, to be successful, you must not allow healthy people to opt out. Anyone getting income must pay into the fund, just like Medicare. You can do it via mandates, or you can do it via taxes - except that it is difficult to coordinate the latter with private carriers, which will probably be required in one way or another to make this politically possible.
by mgoltsman on Fri Apr 11, 2008 at 07:08:00 AM PDT
because you limit so many overhead costs - profit to insurers - cost to healthcare providers (additional staff which knowledge to process - and reprocess claims)
At least that's how it seems to me. There is so much additional overhead with insurance companies in the fray - and even more so because there are so many different insurers.
If you love Bush, Vote John McCain '08
by biscobosco on Fri Apr 11, 2008 at 08:40:14 AM PDT
but because of the way they are allowed to operate - they are allowed to cherry-pick subscribers and then toss them to the curb when they actually need services, they are allowed to stiff providers left and right, and they have a constrained enough market to engage in implicit price-fixing.
If regulations prevent cherry-picking, aggressively protect providers from being stiffed, and dictate a competitive environment, private players can be just as efficient as public ones. For instance, making Medicare an available option for everyone at a nominal cost will prevent any insurance carrier from charging much more without offering significant value-add.
by mgoltsman on Fri Apr 11, 2008 at 12:16:17 PM PDT
support your claims. You do not in any way address the problem of health care providers having to deal with a dizzying array of insurers, all with different requirements, procedures, covered expenses, etc, etc.
Medicare part D is an example of what you mention, and it has been an abysmal failure. It has been bloated and expensive, complicated and terrible.
Participating Insurers must cover medicare part D clients - but there is such a proliferation of insurers, all with differing plans it is terrible for the customers, who are, by definition sick and elderly people. Insurers may not "kick people off plans" - But they can and do change the formulary in mid-stream, have customer help lines which are understaffed, have confusing sign up procedures, delay payment to providers, and in short, engage in all the tricks of the trade which keep their costs low and profits high.
Federally mandated private insurance is a boondoggle. It causes more waste, because now you have two layers of administration instead of one.
You have understaffed federal government attempting oversight and regulation, and you have insurance companies trying to push the rules to the limit to make a profit.
The "free market" has been shown over and over to be an expensive and inefficent means for providing health care for an entire nation.
That is because health care is a complex "system" not a set of packaged goods or commodities which are interchangable.
by biscobosco on Fri Apr 11, 2008 at 12:48:54 PM PDT
That's a set of regulations written by the industry. By definition, anything passed under Bush administration and Republican Congress cannot be an example of a good public policy.
Medicare D would be an OK system (I think - not an expert by any stretch) if the insurers were required to pay up and appeal instead of denying and forcing clients/providers to beat money out of them at considerable expense; if the formularies remained fixed; if there were some standardized procedures for interaction between providers, users and isnurers; and, most importantly, if the Medicare were allowed to compete against private insurers to make sure they don't get too greedy lest everyone defect to Medicare next year. Like I said, private providers can be functional when appropriately regulated, but please don't bring up anything signed by Bush's crayon as even an attempt at meaningful regulation.
by mgoltsman on Fri Apr 11, 2008 at 09:05:31 PM PDT
...because of activist judges creating corporate personhood and turning the influence of corporate money in our politics into constitutionally protected speech. The fox has a key to the henhouse. Either we take away the key or we shoot the fox; anything else is ultimately doomed to fail.
by SciVo on Sat Apr 12, 2008 at 09:05:09 AM PDT
the burden is exactly as progressive as the tax. The poor get coverage even if they are unable to pay or pay very little tax. The 20-something making $25,000 a year is paying more, but not much.
If you use a mandate, the poor are given help, which feels like a handout. The 20ish, $25,000 guy is probably getting NO help, and the mandate is forcing him to pay money he can't afford, or be a criminal and face penalties. Penalties that no one wants to talk about. If there's no direct penalty, then the mandate is toothless. Penalty or no, the poor schmuck is a crook, and feels like one.
Hardly six of one, half dozen of another.
In 2000, a criminal became President. In 2004, we failed to remove him.American Democracy, 1787-2004, RIP
by davewill on Fri Apr 11, 2008 at 12:19:51 PM PDT
This is the care-coverage debate that we really need to be having. And as far as the uninsured or underinsured, paying a junk policy, just look at the one issue of pre-existing conditions. The fact that denial of coverage due to a PEC is legal is one of the biggest disgraces we have in this country.
by mbair on Fri Apr 11, 2008 at 09:05:37 AM PDT
wide narrow
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