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Image Hosted by ImageShack.usThere are a few kinds of partisan divisions on the issue of health care reform and two of them exist on our side of the spectrum. First, the Obama-Clinton divide on mandating employer based care and second, the left has a structural divide between advocates of single-payer and employer based health care.

I live in Massachusetts and as a blogger at this site I am seriously disappointed that partisans of all varieties continue to trash and defame my state's efforts to address costs by mandating coverage. I am particularly incensed when partisans don't tell the truth about my state. And I think we need to have this discussion honestly because if we can't get real national reform that works for actual people in the next administration then we'll be ready for the proverbial fork.

I read the Why Elizabeth Edwards is Wrong diary and I think the diarist owes a correction, several of them actually. But this diary is not about Mrs. Edwards as she can speak for herself. This diary is about us having an honest dialog.

Let's be honest about what is going on in Massachusetts.

We have a mandate. Why? The mandate is a necessary element of an employer based system because it's the best way to address costs for everyone. If you can't get everyone into the system then the merits of any reform should be greeted with intense skepticism. You need everybody in to pool risks and lower costs over the long-term. Cost control is the ultimate goal of health care reform, regardless of whether you support single-payer or employer based systems. Coverage for everyone, while a moral imperative, is the ancillary fruit of the tree that is planted for shade. More on this later if these statements don't persuade you, please read the rest before you go off on me.  

If anyone wants to point to MA as proof that employer based systems do not work then they need to remember two things. First, the law went into effect July 2007. Second, this is the first year that residents need to show proof of coverage. In 2007, the penalty for opting out was only 219.00. This year is the first year that the penalties can be significant.  But since significant fines have not shown up in people's budgets yet any conclusions drawn from current data showing who got what coverage because of the fine is completely erroneous at this time.

The issue is not really the mandate at all. The real issue is funding the mandate. It always has been. People concerned about the affordability of a plan should consider that fact. Today is the one year anniversary of passage of the new law. MA has signed up almost 350,000 new enrollees since then and that is solely due to: the subsidy now available for the first time to those that qualify under our new law; the mandate and/or the fine for not getting coverage. MA is a fairly wealthy state with most employers already offering health insurance to employees and that strength was a huge consideration in our state when the law was written with mandated coverage in it. That's exactly why the legislature chose to piggy back our reform on the back of the existing system. They were right about that choice. We had a lot of good employers to work with in the state.

While I fully concur with the assessment that many states do not have that luxury when looking at their choices for reform legislation, it is not honest to argue that MA chose the needs of for-profit insurance corporations over the needs of their citizens. That's the truth. Partisans arguing that MA is engaging in the worst kind of corporate welfare are lying about my state and readers of this blog should consider that when participating in these "MA sucks" diaries.  

UPDATE: From Dallasdoc in the comments.

I practiced in MA for 15 years after getting my residency training in Boston, so I know something of the state.  For-profit providers have very little presence in MA, so you don't see the worst of the insurers much.  Not-for-profits have always been the major players in MA, which actually makes it a best-case laboratory for mandates.  Experience in other states where the Uniteds and Aetnas and Cignas dominate would be significantly worse.

The blogger is a very strong proponent of single-payer and takes exception with a number of points I make in this diary. But Dallasdoc is also a very honest blogger and offers some productive comments in this thread. I'm excerpting this part as it pertains to the corporate welfare smear on my state because I think I made this point very weakly if at all. Thanks, doc.

That's the good news about MA. In the interests of honest dialog here's some of the bad news. We have a huge problem getting the money to people who need a subsidy to pay for a plan. There are many reasons for this. Right now, health care is virtually free for those at the federal poverty line and subsidies are hard to estimate but they are available for anyone earning up to 3 times the poverty rate. Some of the reasons for this shortfall in the subsidy are the following. Repeat: some of them are the following:

  • The failure of the expansion of S-CHIP which is now shelved until the next Congress comes in DC, January 2009 at the earliest, takes away vital monies my state requires to meet the needed subsidies. Did they count their chickens too soon on Beacon Hill? Maybe, but the failure of the Federal government to provide S-CHIP money to my state is a key element of the deficit we now face in the Bay State. Any short term analysis of why the MA plan is harmful to people of modest income should include that fact.
  • Our mandate is getting trashed in the media from all sides. The right wants to defeat our plan for obvious reasons, but so too MA is under assault in the media from progressive partisans of the Obama and single-payer ilk. That media trash bash makes it much harder for our leaders in this state to come up with funding. We're now looking at a sin tax on tobacco to address the shortfall, but bad media and "fear of a mandate" coverage make the job harder for Governor Patrick and the leadership to come up with an adequate funding stream. Contrary to conventional wisdom, this state is not Taxachusetts and our citizens hate taxes just the same as anyone. This negative coverage and innate inclination against taxes make a comprehensive tax hike to pay for the subsidies a total non-starter. Please consider that when trashing my state.
  • MA has always had a structural problem in our health care reform efforts in that we can't provide a truly public plan like Medicare to all our citizens. Pretty simple. No qualifications here. We are not the federal government and it is not within our power to create a Medicare type system at the state level.

And that last point brings us to the issues I would like to discuss as far as a federal health care reform package and the partisan divides I see at the national level.

Single-payer partisans.

I fully agree that single-payer is a great way to address costs which is the fundamental impetus to enacting any reform in the first place. And I would concede that single-payer is a superior framework to achieve this goal. Totally. Unreservedly. I agree.

But again here, the dialog that I see is dishonest. Let's just assume that a single-payer system will have administrative costs akin to Medicare. I think that's an assumption we can all agree upon and I think that it's probably an accurate one too, bonus. Medicare admin costs are around 2-3%. Private insurers typically run anywhere up to 20-30%. So (cost + 3%) is always less than (cost + 30%) - that's the truth. But we all have to remember that the federal government, unlike the Commonwealth of Massachusetts, has the ability to offer Medicare to everyone insured the existing system directly passing on the savings inherent in a public plan potentially to every person in this country. I never see that pointed out in these diaries and I think that omission is dishonest.

Second, I hear a lot of grief about the punitive and harmful nature of the fine in the enforced mandate. I would never suggest to someone struggling with their bills that they should just suck it up or grow up. Never. And while last year you only lost about 219.00 by opting out, this year the fines can be significant and can reach as much as half the cost of a plan. Significant fines are just starting to show up in people's budgets, so any conclusions drawn from current data in my state about who got what coverage or who got reamed on their fines are completely erroneous for this reason. There is real pain here, to be sure. But single payer advocates that use this reason as a way to promote their preferred plan should ask themselves: how would we finance a single-payer system?  

If you go by how we currently finance SS or Medicare then you would conclude that a single-payer system would be financed in large part with a payroll tax. There may be a tobacco tax as well because that's how we pay for currently S-CHIP which I think would be rolled in to the new reform. The sin tax is voluntary, for sure, but still you're not going to get enough money, especially in the long run, to pay for the new plan from a sin tax. So if you can't afford a plan that would be subsidized or a fine really hurts you for opting out then how could you afford to pay the payroll tax? See? I agree with the premise of the argument in that Elizabeth Edwards diary today, but I don't agree with the conclusions that single-payer is just pure magic just because and will represent little to no cost for people of modest income. Single-payer is going to cost people and employers too. Those of us concerned about those of us that would take a really serious hit on their budget need to consider that fact when publishing a screed against employer based systems.

Obama-Clinton partisans.

Both plans include outlawing denial of coverage for pre-existing conditions. So too, a single-payer system would have this same provision. Hopefully. So let's agree that this really important provision is a wash in all these proposals. Let's also agree that these two plans are largely similar and are far superior to anything the YOYO Republicans will run on; "YOYO" meaning here's a tax cut go figure it out in the "free" market because You're-On-Your-Own out there.  

I think this part of the diary is going to inflame discussion so allow me the opportunity to say a few things here about myself. Groan, I know, but just for purposes of defending my position. I was an Edwards supporter and I volunteered for that campaign in NH. I voted for Edwards in my primary because I could and after all that work in NH I think my choice was justified. As a democrat I will work for my nominee in the fall because it's so important that we defeat McCain. I haven't declared for either candidate at this point largely because my opinion is irrelevant, I already voted, the carnival left town months ago and MA ain't going to be a battleground state this year. I expect Obama is going to be our nominee and I have no problem with that whatsoever. He's a good choice, but from reading his UHC plan I think it's seriously flawed for two reasons. I think Clinton is a seriously flawed candidate for a variety of reasons, but I think her UHC plan is superior.

I'm not trying to cast any aspersions here or slam the candidate. I'm arguing for a little honesty here precisely because I think he will be the nominee. He's earned it because he's inspired the nation and gotten the votes where they count - at the ballot box. Since I expect him to be my nominee and I don't like certain provisions of his plan I think it's very important that liberal voices in the sphere try to challenge the candidate on his plan that we will all have to "sell" in the electorate come this fall and live with next year. This is why I think the Obama plan is flawed.

First, the Obama plan does not include a mandate for everyone. He has the mandate for children, but not for everyone. If you don't believe there's any merit to a mandate then I can see that you may not be persuaded by my argument here. But please remember that Obama includes the mandate for children because that's the best way to get the most kids covered. So if mandates work for kids then why don't they work for adults. Right?

Also in the interests of fairness let me say that I heard Kerry on Meet the Press argue against mandates because they're not going to pass in the Senate. I don't disagree that it will be an "uphill both ways" kind of a battle, but it is a fatally flawed argument for this party to stake our reform position on "can't get there from here" considerations in the general. The "we can't get anything passed with a mandate" argument is flawed because it's purely a tactical decision to get a mostly universal plan through the Congress and it doesn't reflect the will of the people in this country. I don't know about Obama, but John Kerry, who argues against mandates, has said that ultimately you need mandates to truly meet the commitment of Universal health insurance so he would support such a mandate in the 2012 time frame. I don't think that's good enough because if we screw up the reform that we need to do in 2009 then how much support can we expect from voters to fix it in 2013? People have to start seeing results in their pocket books or the whole thing goes pear-shaped real fast. And our party loses the trust of voters on this issue for a generation. I really believe that.

Mandating coverage for everyone also provides our party with an essential ingredient as far as framing goes. Without the mandate we can't argue that "we're all in this together" and it's going to be tough but the results are an investment in our future. "Most of us will get more affordable coverage" under the new plan doesn't sound as persuasive. It's all in time. It's FDR time. The country is ripe for transformational change. Obama has inspired the nation, why isn't he using his voice to make this argument? And why aren't we asking him to do so?

Besides why accommodate conservative senators by leaving out the mandate in the first iteration when those senators are not only going against the will of their own voters but don't believe in any kind of public trust in the first place? Conservatives have been trying to kill SS and Medicare forever, a position which is not supported by voters. Their completely indefensible blockage of S-CHIP was not supported in the court of public opinion either. Yet the Congress caved and Dems gave up on the issue until after the next election, see the link above. That was completely incomprehensible to me and it's outrageous that this kind of capitulation is tolerated in the liberal sphere. It was a great issue to stand and fight on. Standing for a mandate could be another great issue for the party. We do things together as a people for the public interest, they want to give you another voucher that isn't worth the paper it's written on and good luck to you.

This kind of corny crap sells itself to the nation, 80% of which think the country is seriously going in the wrong direction.

The second deficit with the Obama plan is more serious in that it does not include a truly public option. If you check the website you can see that there is a provision for the expansion of S-CHIP, cool, and Medicaid, cool too, but there is no language in that plan about providing Medicare as an option available for anyone regardless of their eligibility requirements. The "public plan" referred to is the Federal Employee Health and Benefits Program, FEHBP. This is the insurance available to federal employees like senators in DC, but it is implemented through private insurers. Blue Cross/Blue Shield. HMO's. Whatever. These are not truly public plans like Medicare is and for that reason they represent no fundamental cost savings for citizens based on administrative costs. Right?

An employer based system with a Medicare for All type option could easily turn into a single-payer system through individual choice. Today about 50 cents of every health care dollar comes out of the federal and state governments. Some of that money comes from privately implemented plans but most of it comes from good old Medicare, Medicaid and existing S-CHIP. If you put a truly public option into the reform plan and make it available to everyone regardless of eligibility then that number could go through the roof. And readers should consider that other countries like Germany and Japan now achieve universal health care through employer based systems so single-payer may be the best and easiest way to contain costs, but an employer based system can also achieve the goals of universal coverage.  

I still hope that Obama will change his offering on a universal health care plan by adding two provisions: mandated coverage and Medicare for all. I think the party needs him to make the case before voters. His voice in this dialog is going to be the governing factor in how well we do going forward. If we're not going to run on a single-payer system, and we're not - let's face it, then we're going to run on an employer based system. Subsidizing private for profit corporations without applying the right kind of downward pressure on costs through the Medicare for all option has a huge margin for error. That kind of a plan could very well turn into the worst kind of corporate welfare. I hope our party doesn't make that mistake in this cycle and I hope Obama realizes that he now bears the lion's share of the responsibility for enacting a universal health care plan and achieving the goals, all of them, of long overdue health care reform in this country.

My apologies for all the straw man arguments here. I know, I know, those really bug me too, but a lot of this diary argues for honesty in the discussion we are having about single-payer and universal health care reform. In that respect I think it's valid to include them in this diary.

Originally posted to mbair on Thu Apr 10, 2008 at 03:57 PM PDT.

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Comment Preferences

  •  Tips (24+ / 0-)

    for Massholes. The ultimate tip jar dilemma for readers that disagree with just about everything here.

    Oh and far as junk insurance goes. No questions it's a major consideration, but with federal tax dollars going directly to insurance companies and a Medicare for all option this kind of system, employee based, can adequately mandate minimum "care requirements" for all Americans.

    •  Thanks for this (13+ / 0-)

      diary.  Elizabeth is right about many things.

      "They're going to give their power away when we take their power away." John Edwards

      by TomP on Thu Apr 10, 2008 at 04:06:51 PM PDT

      [ Parent ]

      •  Your diary on this Tom, was also excellent (8+ / 0-)

        For anyone who may have missed it:

        http://www.dailykos.com/...

        •  Thanks Amy. (9+ / 0-)

          Here is Elizabeth on Olberman, from NC Dem!!

          "They're going to give their power away when we take their power away." John Edwards

          by TomP on Thu Apr 10, 2008 at 04:08:42 PM PDT

          [ Parent ]

          •  Key text. (10+ / 0-)

            I keep getting asked the difference between these two candidates and their policies and on health care, I prefer Senator Clinton‘s to Senator Obama‘s.

            The difference—more important to me is the difference between Senator McCain‘s proposed plan, I said plan, with the ideas of either of the Democratic candidates, and you‘re talking about narrower differences between the Democrats and then this gulf that I was describing earlier, a solar system of difference between what Senator McCain is suggesting for health care and what these candidates are suggesting.

            snip

            Well, I don‘t think the policies of Senator McCain have gotten—certainly his domestic policy has gotten very little attention, either from the media or the candidates, I guess in the—I was never much
            educated much by the Republican debate, but certainly now on these domestic policies, and it‘s not going to require coverage of preexisting conditions.  It‘s actually a really radical change in what we do on health care.

            For example, employer-based health care, where most of us get our coverage, that could be eviscerated and replaced with tax credits.  $5,000 tax credit may cover some people, but it won‘t cover all people, and, you know, the chances of it covering health care for a family, as the employer based coverage presently might, is pretty slim.

            People are going to find their coverage cut back if you have preexisting conditions not just cancer, a heart condition, diabetes, multiple sclerosis.  Anyway, in any preexisting conditions, you‘re very likely to find health care way out of your price range.

            snip

            I‘ve been to Senator McCain‘s Web site.  If you read the plan that‘s described on the Web site, it all sounds, you know, it‘s a great big hallmark card, all sounds great.  Cut costs, more competitive, more people will get access but that‘s not actually the way it works.

            You have to work through the details to find this out.  So the American public is going to depend on the press and the candidates who oppose Senator McCain to make it clear.

            snip

            [Re Obama and Clinton]

            But very essential ingredient is whether or, in my view, it‘s whether or not it is a universal plan, whether it covers everybody.  In order to cover everybody, it means everybody has to buy health insurance.

            Senator Clinton has suggested that she would help people buy health insurance.  In fact, Senator Obama has suggested he would help people buy health insurance if they couldn‘t afford it.  But he‘s not going to require people to buy it.  In my view, that means that we don‘t get the advantage of some cost savings, you know, you‘re still—hospitals are still, because they need to stay in the black, they‘re still going to need to charge people $25 for an aspirin or $50 for a bottle of water.  Those kinds of things have happened.

            As long as there are uninsured people, they‘re going to need to cost it (ph), they will not be able to get the costs down for everybody.  There are other reasons that are complicated I think, but related to the market and the health care pools that I think make it really important that we have this mandate, but I‘m convinced that a health care policy without the mandate is only half a policy.

            "They're going to give their power away when we take their power away." John Edwards

            by TomP on Thu Apr 10, 2008 at 04:13:11 PM PDT

            [ Parent ]

            •  "a great big hallmark card" (7+ / 0-)

              lol. That's about it.

              •  She has a great way with words. (9+ / 0-)

                If they listen to the whole interview, many Obama supporters would be less upset.

                "They're going to give their power away when we take their power away." John Edwards

                by TomP on Thu Apr 10, 2008 at 04:16:33 PM PDT

                [ Parent ]

                •  I did see the whole thing (3+ / 0-)
                  Recommended by:
                  Dallasdoc, haruki, Dougie

                  Her attacks on McCain were great, but she went off the rails when she said "everybody has to buy health insurance." That's quite simply wrong, and I'm sorry we have to call her on it - but we do. I hope she comes around on this, because I really do not enjoy criticizing her.

                  I'm not part of a redneck agenda - Green Day
                  Neither is California High Speed Rail

                  by eugene on Thu Apr 10, 2008 at 04:32:23 PM PDT

                  [ Parent ]

                  •  Oh, Eugene. (5+ / 0-)

                    I support single payer also.  I have probably for longer than you have been alive.  We used to call it nationalized health insurance.

                    Do you have the courage to write your diary and criticize Obama here for not adopting single payer?

                    You get lots of props from Obama supporter shere for critcizing Elizabeth.

                    What about those residual troops Obama may leave behind?

                    "They're going to give their power away when we take their power away." John Edwards

                    by TomP on Thu Apr 10, 2008 at 04:36:41 PM PDT

                    [ Parent ]

                    •  I've written those diaries (3+ / 0-)
                      Recommended by:
                      Dallasdoc, Hope08, batgirl71

                      here's one from September.

                      At this point my belief is the best way to move forward on health care is to enlarge the single-payer movement. And that does involve pointing out why fellow progressives who support neoliberal health care solutions are wrong.

                      I'm not part of a redneck agenda - Green Day
                      Neither is California High Speed Rail

                      by eugene on Thu Apr 10, 2008 at 04:39:48 PM PDT

                      [ Parent ]

                      •  Well (4+ / 0-)
                        Recommended by:
                        edgery, poligirl, tsunami, carllaw

                        as a neoliberal that supports an employer based system let me tell you that a diary pointing out the problem with an employer based plan like Obama's that doesn't include a truly public option is long overdue from you at this website.

                        How you can support single-payer and not criticize Obama for proposing a plan without Medicare available for everyone is just beyond me. I can't account for this contradiction. Please explain why you think Medicare should be available for everyone but have no problem with a plan that doesn't include Medicare for everyone.

                        •  When you say (0+ / 0-)

                          "most employers already offering health insurance to employees" exactly how much of the work force does that mean?  

                          •  I don't have that number (0+ / 0-)

                            I really don't. I have to copt to that. It's so hard to google stuff on this issue because I can't figure out which search terms to use and the search returns like tens of thousands of hits whatever I try.

                            So I really don't have that figure, especially as pertains to MA in comparison to other states. But I did see Patrick a lot on the campaign trail in '06. I video blogged a few of his town halls and he has said that in the Q & A. I also attended a screening of the Wal-Mart movie in Newbury last October with remarks delivered by Dukakis and he said the same thing. Basically, there was a lot to work with when the mandated was agreed upon in the run up to the vote one year ago today.

                            Now I'm pretty sure you're a single payer advocate and share my frustration that the mandate is underfunded. I have no problem with single-payer, but we're running nationally in this cycle with an employer based solution to the health care problems we face in this country. That's why I wrote the diary this way. Half and Half. Half MA, Half Obama.

                          •  Well, according to this article (0+ / 0-)

                            70% of the businesses offered benefits.  That was before they started to reduce offering insurance to get people to use the state plan.

                            Firms find ways around state health law

                            So that leaves 30% of businesses without insurance in the system you favor, before we even start.  What we don't know from that statistic is what percent of people that means.  It could be that this 30% actually represents more people, because it could be every pizza place, car repair shop, mom & pop grocery....

                            Also, it seems the estimates of the people who didn't have insurance were way off.  So I would think 70% is a high estimate to begin with, and it only gets worse as more people are dumped.  

                            So even if employer-based was a good idea (and I disagree that it is) a major chunk are left out.  And that doesn't include people who don't work.

                          •  Well your wrong here (0+ / 0-)

                            about people that don't work. Totally. If you don't have a job then you're probably retired, eligible for Medicare, covered under a family members plan or eligible for Medicaid because you're so poor anyway.

                            If you have a problem with the number and I know you do then take it up with Deval and the Duke.

                          •  No, you continue to be wrong. (0+ / 0-)

                            If you are, let's say, a stay at home mom married to an uninsured guy, you count as uninsured. But you could easily be above the poverty level.  So, if 30% of companies don't offer benefits, the number of people affected could absolutely be larger than that.  

                            I'm saying at a minimum 30% of workers are left out of your strategy, but it could be larger than that. Nice. You're a swell neighbor.

                            This doesn't even begin to address the possible large number of "independent contractors" who work for many of these large companies.

                            You are unencumbered by data, of course. That works for you.  It doesn't make your right.

                            You are ignoring large parts of the population in your favored system.  

                          •  Hey so I'm not for you clearly. (0+ / 0-)

                            I posted "probably." And let's be honest here. Most people who don't work and are retired have Medicare. Can we at least agree on that? Medicare part B that is.

                            Listen I get it. You want single-payer and you hate the new law and the what the state is trying to do to up here. Duly noted. Thanks for your comments.

                          •  Funny (0+ / 0-)

                            just heard from Lady Kestrel today about her situation.  Her husband and kids have insurance.  But not her.  
                            http://www.dailykos.com/...

                            Listen.  I get it.  You believe everything the politicians are telling you.  Actual numbers and cases of affected folks don't matter.  

                            Guess what?  Sometimes politicians aren't telling you the whole thing.  Brace yourself for the general.

                          •  Truth? (0+ / 0-)

                            One of the reasons that I wrote this diary is that bloggers aren't telling people the truth either. Look at Eugene. He'd be tickled pink if this country fails abysmally to bring any relief to ordinary people so that he could bring single-payer to this country. It's so disgusting that he uses the stories of death caused by lack of health care to block reforms that our governments in this country are undertaking to stop such unnecessary loss of life.

                            Funny? I don't think it's funny at all. So you go ahead and "marshal the evidence" with eugene against our state's efforts to address and alleviate pain. And I'll go ahead doing what I'm doing and cracking you guys up.

                          •  Are ya calling Lady Kestrel a liar? (0+ / 0-)

                            I don't think that's very nice of you.  But I can see why you are lashing out with wild claims.  The data sucks a lot.  That's gotta hurt.

                          •  No you're wrong (0+ / 0-)

                            I never said that this hurts me or that another person is not experiencing real pain or that they don't exist. My argument is this, you are hurting your state's chances to bring some needed reform and in the process alleviate the pain of another person. That's my argument. But I can see that your intense partisanship has clouded your judgment. It's just like Deval said on Boston Common, "we have to stop acting like partisans and start acting like citizens again."

                  •  In what sense is it off the rails? (2+ / 0-)
                    Recommended by:
                    lzachary, mbair

                    It might not be in the precise language you would use, but its exactly right that any solution that is going to be addressing the problem of cost shifting at hospitals requires that very close to 100% of people who arrive at the hospital have coverage.

                    Its fine to categorically reject any solution other than single-payer and then point to single-payer as the only potentially workable solution aside from those already rejected, and then move on to the political inviability of single-payer by saying that its just necessary to work toward making it politically viable.

                    But I'm in my mid-40's. What we don't get done in the next four years, while we are still in neighborhood of the Peak Oil plateau, is going to be much more easily pushed off the table in the crisis atmosphere that will hit once the downturn in global oil production starts picking up pace.

                    Even supposing we manage that transition, so that its a rough patch rather than a catastrophe, it could easily be a couple of decades before we are back in the political position to start tackling these kinds of institutional reforms. By that time I'll be over 65 and on Medicare if the system is still running.

                    So for me, a workable solution that is closer to politically viable is very appealing right now, and so I'm not going to find much appealing in efforts to undermine workable solutions on the grounds that they are not the same as the political inviable system that someone strongly prefers.

                    •  Oh man, I love you (1+ / 0-)
                      Recommended by:
                      BruceMcF

                      Its fine to categorically reject any solution other than single-payer and then point to single-payer as the only potentially workable solution aside from those already rejected, and then move on to the political inviability of single-payer by saying that its just necessary to work toward making it politically viable.

                      Here's to using your head for more than a hatrack.

                      And you're right we must seize the day and get this thing right, right now. We're running out of time and ever year we delay it just makes it that much harder to do the damn deal.

                      •  To get precise on the politics ... (1+ / 0-)
                        Recommended by:
                        mbair

                        ... there are two opportunities to improve the potential in Congress to get a universal health care plan through, or else a system through that can be moved toward a universal health care plan through a process of incremental problem solving.

                        The first is this coming November, the second is November 2010.

                        The focus this November is in the House, so that an appealing plan gets passed ... and if it has to be, then killed in the Senate by fillibuster, then with a full court press from the White House making the fillibuster stand out as blockheaded obstructionism.

                        Then leveraging that to focus in November 2010 in getting the Senate position that can break through that fillibuster.

                        Given the massive Democratic majority in the 2006 cohort coming up for re-election in 2012 (it really is massive), there is almost certainly going to be a reversion back toward a tighter Senate majority in 2012, so the next four years are the battleground.

                        •  You make some good points here (1+ / 0-)
                          Recommended by:
                          BruceMcF

                          In that it really could shape up to be a 4 year process. I just hope that we can expect voters to support good Dems out there in these elections, especially the mid-terms which you point to as key in this process. I agree that the 2010 election will be the pivotal one if we get our nominee elected this cycle.

      •  Read your diary (1+ / 0-)
        Recommended by:
        mbair

        Still not convinced.

        Mandates and fines are too nanny state for this Democrat.

        I must be from the libertarian wing of the party.

        P.S. The Massachusetts plan is NOT universal.

        •  I can understand that you are not convinced. (2+ / 0-)
          Recommended by:
          edgery, poligirl

          Really I can. Mandates are not for everyone, but the country is ready for them. The "will of the people link" in the diary goes to a recent survey from Kaiser/Harvard. I didn't quote the applicable passage because I wanted the diary to be shorter and I went down too many rabbit holes as it is. But here's what they reporte:

          Kaiser Daily Health Policy Report

          About six in 10 people support a broad approach to ensure everyone has coverage that includes a requirement for individuals to get insurance or pay a fine, subsidies for people with lower incomes, a requirement on employers to contribute towards coverage for workers and a requirement that insurers take anyone that applies. About two-thirds also support another approach to expand coverage -- a proposal that would require parents to get health insurance coverage for their children with government subsidies for lower income families. However, the public is more mixed, with about half supporting and about half opposing, on the specific question of an individual health insurance requirement that includes mentions of fines for non-compliance and subsidies for those with lower incomes, but no reference to expanded public programs and requirements on insurers and employers.

          Do we have one of those?

          I must be from the libertarian wing of the party.

          I guess you're proof that they exist. I guess the Republicans are so bad that the Democrats look like a reasonable alternative these days even though we do tend to look like the mommy party in this country. You're right here, totally.

          P.S. The Massachusetts plan is NOT universal.

          I wrote in the diary that the subsidy is a huge problem and raising taxes to pay for the needed funds are a nightmare politically for at least two reasons. Plus we can't offer a truly public plan because we're just a state and not the federal government. That kills u s on cost and puts more pressure on the subsidy that is underfunded to begin with. You're right that the MA plan is not universal. But a plan proposed by our nominee and enacted by the Congress really could be. And that's why the diary kind of reads half and half here.

      •  Please read the other diary on this topic (4+ / 0-)
        Recommended by:
        mbair, Predictor, poligirl, tsunami

        It was posted this morning.  I urge you to read and consider it.  Thanks.  Helen

        Health care is a human right.

        by Helenann on Thu Apr 10, 2008 at 05:38:05 PM PDT

        [ Parent ]

        •  link (1+ / 0-)
          Recommended by:
          mbair

          Health care is a human right.

          by Helenann on Thu Apr 10, 2008 at 06:06:52 PM PDT

          [ Parent ]

        •  Thanks for the comment (4+ / 0-)
          Recommended by:
          edgery, poligirl, tsunami, jandress

          I agree, it's a disaster if you can't afford a policy and can't qualify for enough of a subsidy. Further, it's almost like junk policies are the insurance industry equivalent of predatory lending. No argument there. It's a horrible situation with the worse kind of costs in human terms.  

          But the diary is half and half. Half about MA and our significant barriers to fully fund our mandate and half about the possibility of enacting truly universal care on the federal level. I wrote it this way because the rubber is hitting the road in this cycle. The insanity has just got to stop in this country on health care. And I really think that we sure be aware of the partisan divides and recognize that our party needs to step up and enact meaningful reform.

          Other than that I really don't have any answers. I just think this is a more important discussion than just Obama-Clinton and I hope people can realize that on this blog.  

    •  I have zero confidence that the "Medicate option" (11+ / 0-)

      will out perform the junk policies in terms of price.

      If they did no one would ever buy the junk policies in the first place and the insurance industry is too smart to fall for a transparent bait and switch like that.

      If we lack the votes in Congress to enact single payer we will also lack the votes in Congress to enact meaningful protection against junk policies that meet the letter of the law but fail to offer meaningful access to health care.  

      I want a photo of Bill Foster drinking an Oberweis milkshake.

      by Bill White on Thu Apr 10, 2008 at 04:11:05 PM PDT

      [ Parent ]

      •  That is an interesting argument (4+ / 0-)
        Recommended by:
        benny05, edgery, Predictor, poligirl

        one of the better ones that I have read.  

        •  A plan to slip a viable Medicare buy in (3+ / 0-)
          Recommended by:
          DelRPCV, benny05, poligirl

          past the unsuspecting lobbyists of the insurance industry strikes me as being patently absurd. Unless the plan is to fool us rather than them.

          If we sufficiently subsidize a Medicare buy-in how would that be different than single payer?

          I want a photo of Bill Foster drinking an Oberweis milkshake.

          by Bill White on Thu Apr 10, 2008 at 04:28:19 PM PDT

          [ Parent ]

          •  That's the whole point (1+ / 0-)
            Recommended by:
            edgery

            it wouldn't be any different than single payer. It's a voluntary backdoor to single payer. And I think there's one more element to the merit of offering Medicare to everyone in an employer based plan. If it's available to everyone without eligibility requirements like age then it puts the right kind of downward pressure on the costs of private plans. The savings on admin costs have already been demonstrated year after year. We already have the data to prove that to voters. Do you voters like their Medicare part B? I think the answer to that question has got to be a resounding Yes.

            As an aside, I went to the Edwards announcement in NH and a guy stood up and asked him about health care. He was pissed that the only real hospital in the Portsmouth area is a for-profit one. He said that he didn't mind paying his doctor for services rendered but he surely objected to paying the investors of the corporation that owns the hospital for getting sick. He was awesome.

            •  I do not trust that the Medicare buy in shall be (0+ / 0-)

              subsidized sufficiently and once we agree to support mandates it shall be game over if we've been played for fools.

              In the alternative, just offer subsidized access to Medicare WITHOUT mandates and see what happens.

              I want a photo of Bill Foster drinking an Oberweis milkshake.

              by Bill White on Thu Apr 10, 2008 at 06:36:36 PM PDT

              [ Parent ]

              •  I understand you don't have any trust (0+ / 0-)

                and frankly there is no reason at all that you should have any trust whatsoever. Really. You're not alone either. Everyone is so cynical and not due to paranoia alone. There's good reason.

                I don't know what the solution is. There's a pretty good discussion in this thread and I thank you for your comments because it's so important that we get this right at some point in this country.

                Health care is nothing but a disgrace in America today. And I hope we can all take a step back from partisanship, any kind, and talk about reform outside the Obama-Clinton axis of issues craziness. I thought we were going to have an actual discussion at some point about issue in this primary season. But it has sadly boiled down to a nothing discussion due largely to the MSM and their continued inability to cover a single issue fairly or at all really. What a disgrace they are.

                •  Single payer is the solution (0+ / 0-)

                  Anyway, trust can only come AFTER we very seriously de-fang the role played by K Street and bust open the revolving door between government and lobbyist firms.

                  Unless we reform K Street FIRST, health care "reform" shall be Emperor's New Clothes kabuki and we shall all be expected to applaud whatever screwy plan our Democratic leadership gives us, in the name of party loyalty.

                  I want a photo of Bill Foster drinking an Oberweis milkshake.

                  by Bill White on Thu Apr 10, 2008 at 08:52:12 PM PDT

                  [ Parent ]

      •  This is a very thoughtful comment (6+ / 0-)

        so thanks. The point of that statement was to argue that junk policies that are truly junk because they don't provide any useful coverage wouldn't even exist. Or at least, this kind of policy could not receive a federal subsidy. There is a very fair argument in this discussion about care and coverage. I didn't take that on in this diary. And the problems MA faces with junk policies have no parallel once you start talking about federal reform.

        I think you're wrong here, but again that's just an opinion granted:

        If we lack the votes in Congress to enact single payer we will also lack the votes in Congress to enact meaningful protection against junk policies that meet the letter of the law but fail to offer meaningful access to health care.

        "The will of the people link" in the diary is a recent survey from Kaiser/Harvard. Look at the results of a poll reported on by NPR:

        About six in 10 people support a broad approach to ensure everyone has coverage that includes a requirement for individuals to get insurance or pay a fine, subsidies for people with lower incomes, a requirement on employers to contribute towards coverage for workers and a requirement that insurers take anyone that applies. About two-thirds also support another approach to expand coverage -- a proposal that would require parents to get health insurance coverage for their children with government subsidies for lower income families. However, the public is more mixed, with about half supporting and about half opposing, on the specific question of an individual health insurance requirement that includes mentions of fines for non-compliance and subsidies for those with lower incomes, but no reference to expanded public programs and requirements on insurers and employers.

        60-40 in support of mandates and tax hikes to provide subsidies. Once you talk about garnishing peoples wages? Those number only go to 50-50. That indicates to me that it's a doable sale.

        Also, I don't have a link, sorry, for the recent story that came out citing that 59% of doctors support single-payer today. And doctors don't like Medicare generally. If you have an elderly parent then you would know that finding a doctor to accept a Medicare subscriber is really tough.  

        •  The devil shall be in the detailed regulations (2+ / 0-)
          Recommended by:
          mbair, edgery

          and lobbyists have far more influence on that topic that poor people will.

          I will OPPOSE mandates unless I see iron clad guarantees that it is not a reverse Robin Hood scheme to enrich the insurance companies while giving us the "Emperor's New Clothes" illusion of universal coverage.

          Subsidies FIRST, then we can discuss mandates down the road.

          I want a photo of Bill Foster drinking an Oberweis milkshake.

          by Bill White on Thu Apr 10, 2008 at 06:39:43 PM PDT

          [ Parent ]

          •  I don't know (0+ / 0-)

            You've got to be careful here:

            Subsidies FIRST, then we can discuss mandates down the road.

            That's what we passed with Medicare part D. And unless you're lucky and your drugs don't cost more than about 200.00 a month then you're in a really bad place. The company makes the same amount off your policy whether they cover you or not.

            I'm very skeptical of subsidies without mandated coverage and mandated care which I can see in the public plan because of Medicare Part D. True, that was passed by a Republican Congress, but lobbyists donate to both sides and they control the Congress today on both sides. That's the truth.

            •  Medicare Part D was a SELL OUT to Big Pharma (2+ / 0-)
              Recommended by:
              mbair, jandress

              and is a perfect example of why I oppose mandates until after K Street is brought under control.

              The crux of our health care crisis is that too large of a percentage of every health care dollar spent goes to managerial layers and too small of a percentage goes to people who actually provide health care.

              Unless the insurance industry LOSES all we shall be doing is re-arranging deck chairs on the Titanic.

              I want a photo of Bill Foster drinking an Oberweis milkshake.

              by Bill White on Thu Apr 10, 2008 at 08:44:58 PM PDT

              [ Parent ]

    •  You've pretty much ignored our core claims (9+ / 0-)

      That MA has failed to sign up many people, and more significantly, that its mandate has totally failed to provide affordable health care.

      The Connector DID have to rebid the "affordable" premiums several times, didn't they?

      Are the subsidies still running a deficit? As of early December they were.

      What was the % increase in premiums for 2008? Last I heard it was at least 10%.

      And what is your response to the diarist who noted he has to take out loans to pay for the mandated insurance?

      All I see in your diary is a reassertion of the talking points for mandates - whereas we who criticize mandates (I wrote the "Why Elizabeth is Wrong" diary) have marshaled evidence showing that the assumptions fail in practice.

      I'm not part of a redneck agenda - Green Day
      Neither is California High Speed Rail

      by eugene on Thu Apr 10, 2008 at 04:25:48 PM PDT

      [ Parent ]

      •  Claim away - MA failed, but (4+ / 0-)
        Recommended by:
        mbair, NCDem Amy, Predictor, poligirl

        Edwards plan was not the same as a failed state plan.

        His and Clinton's plan are on a national level with national funds not state funds for just one huge difference.

        And, you all are not addressing Obama and full mental health parity rather than just "improved coverage", what ever that may be.

        •  My argument is... (6+ / 0-)
          Recommended by:
          theran, mijita, Dallasdoc, ebbinflo, jhecht, Dougie

          ...that the MA plan failed due to basic problems with the concept of mandates, problems that WILL emerge with a national system.

          National funds for subsidized health insurance are a waste. Why would we subsidize the purchase of insurance when we can use that money to pay directly for care? It makes no sense.

          I'm not part of a redneck agenda - Green Day
          Neither is California High Speed Rail

          by eugene on Thu Apr 10, 2008 at 04:35:15 PM PDT

          [ Parent ]

          •  MA 's plan is a problem not because of mandates (6+ / 0-)
            Recommended by:
            joynow, Dallasdoc, NYFM, edgery, Predictor, poligirl

            but because they use private insurers.  All single payer insurance is a mandate.  Canada's government runs an insurance program.  The providers, e.g. doctors etc are private contractors.  They negotiate the rate of compensation with the government.  But people must pay for the insurance and some of the health care costs are paid through taxes.  Depends on the province.  

            MA was trying to do the same but keep the insurance companies happy.  That is what is wrong with both Clinton and Obama's plans.  Obama's lack of mandates does not make it any better for those who want insurance.  

            •  Nobody wants insurance (6+ / 0-)
              Recommended by:
              theran, mijita, Dallasdoc, NYFM, ebbinflo, Harkov311

              I am uninsured, because I cannot afford it. But I don't sit here thinking "gee I wish I had health insurance." Instead I think "gee I wish I could see a doctor whenever I needed to and not worry about the cost."

              The Clinton, Edwards and Obama plans were also trying to keep the insurance companies happy. The Clinton/Edwards plan reminds me a LOT of the craptacular mandate plan proposed here in CA last year, which we finally killed in January.

              I'm not part of a redneck agenda - Green Day
              Neither is California High Speed Rail

              by eugene on Thu Apr 10, 2008 at 04:44:28 PM PDT

              [ Parent ]

              •  Too bad (2+ / 0-)
                Recommended by:
                edgery, poligirl

                mandate plan proposed here in CA last year, which we finally killed in January.

                Because maybe you would lay off my state and our efforts if you had still had "marshal the evidence" against your own state's efforts to do something for their residents.

              •  Everybody wants insurance (1+ / 0-)
                Recommended by:
                mbair

                What GOOD insurance is, IS to provide you with care when you need it.

                That is what Canadians have.  It is called insurance.  

                You are betting on what you won't need and you are winning right now.  Some people lose when they don't have insurance.  That is a gambling game at the moment.

                By any true objective analysis, the Clinton or Edwards plan is better than the Obama plan.  And all of them fall short of the single payer plans other countries have.  

        •  You make a good point here (1+ / 0-)
          Recommended by:
          jandress

          A federal plan shouldn't be compared to a state plan. It's apples and oranges and Edwards had the best proposal. MA has failed to provide universal and affordable coverage to all its citizens, true. But we put 350,000 people into the system in less than one year. The significant problem we're having with the subsidy shortfall is that so many people are using subsidies now. And like I said, without a truly public plan like Medicare in the mix who knows. I am frankly shocked that Obama's plan doesn't include a public option. I really don't get that. I can understand leaving out the mandate for political reasons, but that just breeds fear of the mandate in the electorate, my opinion only.

      •  Oh thats right (4+ / 0-)
        Recommended by:
        benny05, edgery, Predictor, poligirl

        You owe a huge correction in that diary. I am shocked and extremely disappointed at the fear tactics and the worst kind of blogging on this particular passage.

        The 7% figure comes from an opinion piece in the NYTimes. You write in your diary:

        Elizabeth told Olbermann that universality is of central importance. Here I agree. So why is she backing a plan that has failed to provide universality? In Massachusetts, only 7% of uninsured residents had purchased insurance, despite possible financial penalties.

        But the link you supply to back up that claim is completely dishonest. First it goes to an opinion piece. Second the actual quote germane is this passage:

        Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.

        You imply that 93% of uninsured people in my state are going to be subject to harmful and unaffordable penalties and that's completely untrue.

        As far as this goes:

        What was the % increase in premiums for 2008? Last I heard it was at least 10%.

        Again this is the first year. The measure is not if we reduce costs as a state. It simply is not a legitimate argument to use that against the state's efforts in this country today. The measure is whether MA increases are smaller that in places without mandated, subsidized coverage.

        Okay:

        All I see in your diary is a reassertion of the talking points for mandates - whereas we who criticize mandates (I wrote the "Why Elizabeth is Wrong" diary) have marshaled evidence showing that the assumptions fail in practice.

        You get the euphemism of the day award for "marshaling evidence." Correction required on the 7% claim. Thank you.

        And I don't live in CT. I'll leave it to you to "marshal the evidence" against that state. I'm just arguing for some honesty in the dialog here.

        •  Huh? (3+ / 0-)
          Recommended by:
          theran, Dallasdoc, Crisitunity

          The 7% claim shows that the mandate fails to provide universality. I have not seen anywhere a stat that shows all uninsured Massachusetts residents have insurance. In any case, what do you want me to correct - that those 93% don't actually face penalties? That doesn't do your argument any good. The 7% claim itself, as you showed, is itself a truthful stat. Of those required to buy insurance only 7% did so. That's what the source says and I stick by what I wrote.

          And I'm sorry, I thought the point here is affordability. If MA's premiums are rising by 10% I challenge you to find any working American who would see that as "affordable." You claim in your diary "cost containment is the goal" (it's not - guaranteed access to affordable care is the goal) and yet admit that MA has totally failed to provide this?

          Game, set, match.

          I'm not part of a redneck agenda - Green Day
          Neither is California High Speed Rail

          by eugene on Thu Apr 10, 2008 at 04:48:59 PM PDT

          [ Parent ]

          •  No (4+ / 0-)
            Recommended by:
            murrayewv, benny05, Predictor, poligirl

            I just want you to be honest. That's all I'm asking for.

            Let's make this real easy and set aside your erroneous conclusions here. You claim "only 7% of uninsured residents had purchased insurance." That is not true. Only 7% of people that do not currently qualify for a subsidy have purchased insurance. But a large part of the 350,000 number includes people with a subsidy. The shortfall is due to the whole fact that the subsidy fund, that goes to people up to 3 times the federal poverty level, is being used by residents. Do you understand how dishonest your diary is in that light on this point?

            Game, set, match.

            This is a fucking game to me. We're going into a general election with an employer based system. That much is for sure. You have to ask yourself whether you want to continue to play games or affect necessary change in this country vital to our survival.

      •  Did you read that we've signed up 350,000? (2+ / 0-)
        Recommended by:
        Predictor, poligirl

        Is that evidence that we've put  a lot more people into the system that wouldn't be there without mandated coverage? I don't have a news link to this number. I've been listening to WBUR this afternoon and it's in the new round-up at the top of the hour.

        The mandate is not currently fully funded that is true. I agree with you there. But that doesn't mean that it's a failure. The Governor is proposing a tobacco tax to make up for some of the shortfall. That fact is also curiously missing from your diary about my state.

        Correction required on the 7% number in your diary. Thank you.

        •  What about the 7% number is wrong? n/t (1+ / 0-)
          Recommended by:
          mbair
          •  It's only (4+ / 0-)
            Recommended by:
            theran, benny05, Predictor, poligirl

            7% of people that don't currently qualify for a subsidy. Big difference because a lot of people in this state do qualify for the subsidy. It goes to people up to three times the poverty line. We currently have a shortfall in the subsidy funds of 1.3 or 1.6 billion not sure which. That's just the shortfall. That's not including funds already earmarked for the plan. That means that a boatload of residents are qualifying for and using subsidies to pay for policies today. I don't have the number on the percentage of the newly insured, 350,000, that qualify for subsidies. I just couldn't find that information while I was writing that diary. If I do find it through google, I'll post it here as a reply to your original question. So check your hotlist if you're interested.

            Now the subsidy is not fully funded for sure and a sin tax is being considered to make up the difference, but the subsidy is not non-existence either. The 7% claim is totally bogus in the context of that diary. That first blockquote is from the diary. That second blockquote is from the linked opinion piece backing up the diarist's assertion. I think that is very dishonest and it goes to the "fear of the mandate" negative coverage in the press and the sphere.  

            •  This is Junk Insurance Valley (1+ / 0-)
              Recommended by:
              mbair

              If you qualify for Commonwealth Care, then Romneycare is pretty nice.  But if you don't, then the available plans are outrageous.  I played around with connector a while back, and to get the health coverage I get from UMass with two grad students as a basis is completely out of reach.  The cheapest plans are more than what I actually pay and so lame that I'd be broke if I got really sick.  It does not surprise me that almost everybody who doesn't qualify for a subsidy and didn't have enough money to get good coverage---in which case they had it already---rejected the available options.

              However, the whole cost estimates of Romneycare are based on Junk Insurance Valley sponging up a bunch of money from people who won't get anything out of it.  Even with this kind of optimistic assumption, the plan is already in the red.

              There is also a second problem, which is lack of availability.  I live in Western Mass., which is a lot poorer than metro Boston.  There aren't even enough doctors around for people to easily get a check up.  (Although the NYT talks about the Valley, the situation is most dire in the Berkshires and Upper Quabbin.  This issue has been in the local press for while now.

              If Romneycare is to work out, then the subsidy needs to extend to all the people who would rather pay a fine than get useless coverage.  At the same time, there needs to be some kind of attempt to address availability (which will drive up the costs).

              In theory all of this can work.  In practice, I expect it to just be a handout to the insurance industry.

              •  "In the sleepy west (1+ / 0-)
                Recommended by:
                theran

                of the woody east there's a valley full, full of pioneers. We're not just kids to say the least. We've got ideas and to us that's dear. Like capitalists, like communists, like lots of thing you've heard about. And red-neckers they get us pissed. And stupid stuff. It makes us shout. ... It's educational ..." - The Pixies.

                You make some great points. The whole scheme for financing was total BS from the get go. No question. The surcharge for an employer who didn't offer care was 295.00. No additional dedicated funding stream, taxes, was proposed at the outset. That failure screws up the whole process for people to qualify for any help to pay for a reasonable plan that would actually work for them. That causes real pain. It's a mess.

                Thanks for your comments.

    •  Would this include a mandate for doctors (2+ / 0-)
      Recommended by:
      murrayewv, haruki

      requiring they accept ALL insurance plans, private and public? If it doesn't "universal coverage" means nothing. Why do we keep confusing coverage with care? I'm not saying that coverage is not important, just that coverage alone does very little to truly solve the deep problems in the US healthcare system.

      •  This is great point (2+ / 0-)
        Recommended by:
        Predictor, poligirl

        and a very thoughtful comment, thanks. There is a discussion in this thread about care and coverage. I didn't address that in the diary just for editorial reasons. It was not omitted to be dishonest or anything. I just had a whole school of fish to fry and I made my choices.

        As to your point, I really don't have the knowledge to address these questions to a satisfactory degree. But once you start with subsidies, and have a truly private plan on the menu for everyone, the possibilities are there to require that doctors see everyone. The pain that we are in for in reform is going to be significant. And you are right to say that doctors just won't take a patient today if the insurance the patient has is junk or even Medicare part B. My mother in law is on part B and it was really difficult to find a doctor that would accept her as a Medicare recipient in Vermont a few years ago when she got cancer. She's good now, but it was a tough situation for a while there.

        What I think is possible is this. Federal subsidy dollars can be withheld for insurers, let's call them predatory insurers, that fail to meet minimum care requirements. Remember the Patient Bill of Rights? That was about mandating care. And it passed in the Senate with much worse numbers than we have today. There is so much support for these kinds of policies out on the country because people are fearful about what can happen to them even if they have coverage and they get sick or lose a job.

        But overall, you are exactly right about the distinction between care and coverage. It's a big difference. And junk policies make money by offering almost nothing in terms of care.

        This issue of care and coverage also comes into play as far as coverage of pre-existing conditions (PEC) goes. We're good on the PEC thing because Obama's plan already has that in there. So we're running with that provision this fall. It's a great issue for us to garner votes on since as we all know: McCain's plan wouldn't even cover himself.  

        •  Thanks for your thoughtful response (0+ / 0-)

          My concern here is that the problems around the cost, availability, and delivery of health care in this country are complex.  The big elephant in this mess is the highly profitable private insurance agency.

          I think rightly or wrongly that is why you find so many individuals actually preferring Obama's plan over Hillary's while not really liking either. I know that Hillary's plan calls for a government option but it still leaves the private insurers in place.

          Secondly, both Dem candidate's plans as they are articulated now WILL BE fought tooth and nail by the aformentioned health care industry especially since they both now requiring coverage of pre-existing conditions. If we are going to have the fight now, let's atleast have it and radically change the system getting rid of for-profit providers.  So some reason, and yes I could be completely wrong and cynical, I don't buy the market option between the government Medicare plan and private plans will naturally lead through competition to the extinction of the private plans in favor of a "universal" government plan.

          Third, Medicare as it stands now has serious problems and abuses (just like the private industry) that need to be addressed. Just like the military industrial complex that feeds at the trough of our government, there are doctors who feed at the trough of Medicare, often without providing quality care.

          Given my concerns about what both plans will look like it reality after going through Congress and lobbyists, I just don't like the idea right now of telling me I'm going to have to pay for "it," an "it" which isn't cleary defined for me.

          Finally, whether under Clinton's or Obama's plan there will be individuals uninsured-- refusing the mandate or by choice. (I will graciously cede the point in this argument that both plans with be "affordable" as promised by the candidates). While we can take some guesses what those numbers will be, we don't know in actuality what they will look like. However, I don't think the small percentage of uninsured will drastically skew health costs alone. (People again are welcome to prove me wrong--I admit I very well could be.) But once again, the argument that rising health care costs are only about inadequate risk pools is highly faulty and simplifies the complexity of the problem.

          Finally, finally (I swear) the reason why I "like" Obama's plan better than Clinton's is that I feel Obama is saying to me that we're going to create a plan that all individuals will want to buy into and can afford to buy into and give me a chance to prove it to you. I don't need to force you. Like I said earlier, without knowing what that final plan will be, the idea of being told now that I must buy into it scares me tremendously.

          •  You make some great points here (0+ / 0-)

            And let's just agree that we're talking about national not MA here.

            Both plans leave private insurers in place. The problems are complex to be sure as you posted and no one in a position to win the presidency is advocating for single-payer this time around, that's a real shame.

            I too and skeptical about claims that covering more people by mandating coverage, not care, will be enough to produce enough cost savings over the long term to make plans affordable. Getting everyone insured does give people the option to see a doctor regularly and not get their care out the ER exclusively, but it's complicated. I agree. The beauty of the truly public option as defined by me in this diary is savings for real people from lower admin costs. That's where I think you'd get the biggest bang for your buck.

            You might be right here:

            So some reason, and yes I could be completely wrong and cynical, I don't buy the market option between the government Medicare plan and private plans will naturally lead through competition to the extinction of the private plans in favor of a "universal" government plan.

            It's possible we could end up with a two-tiered system. That would suck, but that goes back to the care - coverage issue too. All roads lead to care-coverage discussions. I also suspect that if we enacted a single-payer system you'd end up with supplemental insurance providers available only to the affluent and the well employed. That's the truth. Any way they can make a buck, they would. You can't trust these people.  

            I realize the "it" thing and the lack of definitions covering what "it" is are major problems too. Any your concerns are clearly shared by many voters. At least we're at the point of discussing what "it" is and not what "is" is. That's progress.

            Finally, finally (I swear) the reason why I "like" Obama's plan better than Clinton's is that I feel Obama is saying to me that we're going to create a plan that all individuals will want to buy into and can afford to buy into and give me a chance to prove it to you. I don't need to force you. Like I said earlier, without knowing what that final plan will be, the idea of being told now that I must buy into it scares me tremendously.

            Maybe that's why Obama is winning all these primaries. What do I know, I just blog for relaxation because George Bush is doing a bang job turning our country into Bangladesh. No offense to Bangladesh.

            So maybe Obama's right on the mandate and Clinton's right on the public plan. I really like the mandate for a variety of framing reasons that amount to a sales pitch. Though it is cheaper to see a doctor in their office than the ER and before you're on death's door the savings realized in the new plan go directly to care-coverage. If you've got a junk plan then you might not get in to see a doctor the cheap way anyway.

            But your point about cost savings due to mandates covering the uninsured is duly noted. It's a good point.

  •  Is there an echo in here? (0+ / 0-)

    It hurts my ears

    That's $25,000 alpaca; you blot that shit.

    by LoLoLaLa on Thu Apr 10, 2008 at 04:02:51 PM PDT

  •  Taxes are fine, in fact I'm all for them (15+ / 0-)

    The main problem with mandated health insurance is that it forces me to pay for something which ultimately doesn't give me guaranteed access to health care.

    No one wants to pay a tax, but the question really isn't "how much" it's "what are we getting in return", and unfortunately Senator Clinton's plan (which seems to be advocated by Elizabeth Edwards) doesn't solve that problem.

    •  Taxes are the only enforceable mandate (11+ / 0-)

      Taxes also give the country the ability to choose how to pay for health care.  Mandating purchase of private insurance is much less practical and flexible.

      Hanoi didn't break John McCain, but Washington did.

      by Dallasdoc on Thu Apr 10, 2008 at 04:17:31 PM PDT

      [ Parent ]

      •  Being forced to buy private insurance (0+ / 0-)

        rubs me the wrong way.  That's my big problem with this.  And when a guy like Mittens trumpets it as some big success, I am not any more persuaded.  In fact....

    •  Yes it does (3+ / 0-)
      Recommended by:
      benny05, Predictor, poligirl

      It most certainly does. Or at least it could. And let's just call it the mandated coverage plan and not the Edwards plan or Clinton plan. The party will adopt some plan in Denver, so let's keep our eyes on that prize. I think Clinton's nomination has failed at this point and Edwards is out. Obama has the field and he's going to be our guy.  

      I agree with you here that care and coverage are different. No argument from me on that and readers should be aware there's a difference.

      If the federal government does the two things I advocate for in this diary: mandate coverage and offer Medicare to everyone, then that can in effect mandate care. Right now, there is no minimum care requirement for insurance in this country outside of the public plans we currently have on the books. Remember the Patients Bill of Rights that passed the Senate oh so long ago? That's what I'm talking about here.

      If you have the power, as the federal government does, to mandate care for Medicare recipients, S-CHIP subscribers and people holding Medicaid policies then it's not impossible to mandate care in the private sector without even passing a law. People could figure out what works for them and choose the right plan for their families. If the Medicare for all option is in an employer plan then that pressures insurers to follow suit on minimum care to compete for enrollees.

      Federal subsidies to insurance companies could easily be withheld on a devastating scale to predatory insurers offering junk policies. Right? Whether the plan we adopt has mandates or not, it will have subsidies to people that qualify. That's a huge tool to affect the kind of care the average person out there gets.

  •  Unless the "for profit" middle-tier is eliminated (11+ / 0-)

    (The middleman is the traditional term) I do not see how we can possible afford universal care.

    The essence of the problem is that too little of every dollar spent on medical care goes to medical professionals and too much goes to accountants, financial analysts and managers.

    Extend Medicare coverage to EVERYONE and fund it from general tax revenues. Anything less will do more harm than good.

    I want a photo of Bill Foster drinking an Oberweis milkshake.

    by Bill White on Thu Apr 10, 2008 at 04:07:54 PM PDT

  •  Good job. But I still don't understand why we're (3+ / 0-)
    Recommended by:
    mbair, kitebro, planetclaire4

    advocating mandating universal insurance rather than health care. How do the Canadians do it?

    •  They do single-payer (4+ / 0-)
      Recommended by:
      mbair, Predictor, planetclaire4, poligirl

      The only presidential candidates this cycle to propose single payer were Gravel and Kucinich.  Unfortunately, the insurance industry won't let us get there quite yet (and, to be fair, many people are afraid of government-run healthcare).

      •  Obama and Clinton include a single payer option (3+ / 0-)
        Recommended by:
        JeremiahFP, tsunami, jandress

        Both Senators Clinton and Obama include the choice of a single payer plan (aka a public plan like Medicare) as one of the options for the people in the pool.  

        For people who work for small employers, those who are uninsured and not eligible for government programs, those who buy in the individual market and those with lousy group policies, they will be given two options in the pool.

        1. They will be given the choice of private health plans similar to those offered to members of Congress under the Federal employees health benefits program (FEHBP)

        or

        1. They can choose to enroll in the single payer plan that will operate along side the existing system.

        My research in CA suggests that within one year of enrollment 70% of the population will be in the pool and the majority will be in the single payer plan.  This will produce an ENORMOUS risk pool that can spread both risks and costs broadly, realizing the savings that we see in administering Medicare.

        Both of their plans will enable a voluntary transition to a single payer system.  THis choice is the most exciting aspect of these plans and one that the media continue to completely ignor.

        Health care is a human right.

        by Helenann on Thu Apr 10, 2008 at 05:46:24 PM PDT

        [ Parent ]

  •  Thanks for your work on this mbair (7+ / 0-)

    It's good to hear the perspective of a Mass resident.

  •  feasibility (2+ / 0-)
    Recommended by:
    oscarsmom, Dougie

    [Some] believe that Franklin D. Roosevelt succeeded by being a polarizing figure. I studied FDR for four years while writing a book about him, and this is simply untrue. It's also untrue of other successful Democratic presidents and for a simple reason: "Bitter confrontation" simply doesn't work in policy-making.

    Bear with me for a brief history lesson: The so-called "First New Deal" of 1933-34 came after Roosevelt won a landslide victory over Herbert Hoover in 1932 in a campaign devoid of any populist message despite an unemployment rate of at least 25 percent. First, FDR worked with Hoover treasury officials from the other party to rescue the banks under a conservative plan that included steep budget cuts. The rest of his famous "100 days" agenda-which included unprecedented jobs programs, agricultural reform, labor rights, and regulation of financial markets—was achieved with much more compromise than Krugman recognizes. Social Security came in 1935 after a big Democratic mandate in midterm elections and was enacted piecemeal and cooperatively (to the disappointment of many New Deal liberals) with everyone at the table.

    During and after his 1936 reelection campaign, FDR—angry at the ingratitude of the rich Americans whose fortunes he had saved—adopted class-based politics. In 1937, with a big victory under his belt, he tried confrontation with his court-packing scheme. It failed badly. So did his effort to "purge" the opposition in 1938.

    The rest of his second-term was far less productive legislatively than his first. By the end of it, he turned to foreign policy. FDR's third-term success, dominated by World II, was dependent on his unifying the country.

    Similarly, Woodrow Wilson's big legislative triumphs over entrenched interests in 1913 (for example, an income tax), Lyndon Johnson's in 1965 (Medicare and the Voting Rights Act) and Bill Clinton's in 1993 (painful tax increases) were achieved with legislative skill, not brute force and a populist message. newsweek

    a recent survey of small-business owners preferred obama's healthcare plan over clinton's and mccain's..

    obama has said he won't rule out mandates in the future, and he fully expects his plan won't be passed as-is. getting any healthcare plan passed is going to be about compromise and common ground, not rushing forward with the same dem meme of the past few decades - "universal or else!".. you know, the concept that's failed time and time again.

    not having a mandate (not having single-payer) encourages republican/independent support and creates a groundswell for actually getting something done.

    •  A recent survey? (6+ / 0-)

      What survey? That means absolutely nothing.

      A Republican lite approach, while we have a majority in Congress, is a sell out.

      Now is not the time to coddle Republicans. Americans are fed up with this economy, the struggles to maintain healthcare coverage. The support for truly UHC coverage IS there.

      •  it's not republican lite approach (2+ / 0-)
        Recommended by:
        joynow, Dougie

        republicans don't really work with democrats - and i've not seen any major healthcare plan resembling obama's from any republican, ever. but, nice try there.

        if there's so much support for HRC's plan, why don't we have it yet?

        i want healthcare as much as you, but i also have friends who don't want to be forced into a government healthcare program. too many people see this problem in black and white - some people want it, some don't. obama's plan allows for nuance - people who can't afford it are covered, people who don't want it don't have to purchase it, employers are required to provide insurance, if insurance companies can't provide adequate, inexpensive care, then the government does. it's free market ideals, like competition, that appeal to people democrats don't normally appeal to.

        if you go into this debate with the same old mantra of - we're gonna force you into a confusing, complex system of public insurance, we lose again.

        the small business survey is from here:

           *  261 respondents, or 42% said Barack Obama
           * 224 respondents, or 36% said John McCain
           * 130 respondents, or 21%, said Hillary Clinton
        http://www.earthtimes.org/...

  •  I'll give you that Obama should support (7+ / 0-)

    the "Medicare for All" option, but I still disagree with your argument for mandates.

    Cost control is the ultimate goal of health care reform, regardless of whether you support single-payer or employer based systems.

    It's good that you cleared things up by stating this bias up front, because I happen to disagree. Cost control for who? For me, the ultimate goal is for every American to be able to get the health care that they need when they need it. Everything else is a detail on the way to that goal, even the "holy grail" of health care reform -- single payer.

    I oppose the mandate because I don't even know what it is that I'd be forced to buy. Generally in life, I pay my taxes, and otherwise, if I think something's a bad deal, then I don't buy it, health care included. I think it's a significant deterioration in my position as a consumer to give up that right. However, I'd support and vote for a tax to provide health care for all Americans free of charge in a New York minute.

    I also happen to think that the mandate is a backdoor tax on the healthy to pay for the sick, which as stated above, I don't mind, but if so, make it a tax, make it progressive and don't let private industry anywhere near it.

    •  But this is not ONLY ABOUT YOU (3+ / 0-)
      Recommended by:
      benny05, poligirl, carllaw

      This is what so many kossacks fail to get.  There are things that we ALL share the cost for.....or should.
      I don't have children in school, have never had children in school.  But I did go to school..just not public. (private....not because my parents could afford it.  They could not. Our church paid for it in the heyday of catholic schooling).

      I pay for the fire department and LUCKY ME, I have never ever needed them.  I pay for the police and once I did need them.

      Health care is important for all. LUCKY people will never have to use it very much.  But sharing the costs in the largest possible pool is the way to bring down costs to all.

      But of course one has to think about more than ME.

      •  Huh? (4+ / 0-)
        Recommended by:
        joynow, Crisitunity, haruki, Dougie

        The fire department is analogous to single-payer and to single-payer alone.

        Mandated health insurance would be like closing down the public fire departments and instead forcing everyone to buy private fire insurance.

        I'm not part of a redneck agenda - Green Day
        Neither is California High Speed Rail

        by eugene on Thu Apr 10, 2008 at 04:29:36 PM PDT

        [ Parent ]

        •  Yea well until and unless (1+ / 0-)
          Recommended by:
          mbair

          you can undo the spin damage the right wing media has helped do for years, convincing people that single payer equals socialism......then going at it in steps is the best ANY one of them can do.  I believe if everyone is mandated to be involved in the system it will move us all faster toward the ultimate goal of single payer.  

          You have been proposing all or nothing all along. I do not believe anyone, not Obama, not Clinton, not Kucinich, not Edwards would be able to get this through.  People's minds have to be changed.....at least a good 50% of them

          •  There was a poll (2+ / 0-)
            Recommended by:
            joynow, mijita

            Done by Harvard a few months back, wish I had the link on me, showing that the public's support for single-payer is NOT hurt when it is framed as "socialized medicine." We need to realize that it is not 1994 any more. People's anger at the health care system trumps any fear of socialism.

            I'm not proposing all or nothing. I am proposing a movement that can, within two years, enact single-payer. We are much closer than you believe.

            In the meantime, we expand Medicare and S-CHIP. We beef up federal matching contributions to state-level programs like Medi-Cal. We slowly but steadily expand public health care provisions until we get single-payer.

            I'm not part of a redneck agenda - Green Day
            Neither is California High Speed Rail

            by eugene on Thu Apr 10, 2008 at 04:42:14 PM PDT

            [ Parent ]

          •  Hey you (0+ / 0-)

            might want to check out the link buried in in the diary under "the will of the people" text. Scroll down and you'll see the results of a survey from Kaiser/Harvard. They report that people support new taxes, mandates and subsidies by 60-40. So that's good at least. I'm just posting this because you wrote that people's minds have to change and I for one really think people are getting there. I don't have a link for this - sorry, but I've also read stuff from Pew Research, a very high quality polling outfit and bookmark worthy, and I think that people are even there on single-payer. That's just my impression from reading their stuff, again sorry I have no link.

      •  THAT'S WHY SCHOOLS AND THE FIRE DEPARTMENT (2+ / 0-)
        Recommended by:
        mbair, haruki

        ARE FUNDED WITH TAXES!!!

        Sorry for shouting, but why do we have to keep going over this.

    •  Thanks for your comment (0+ / 0-)

      Mandates are certainly not popular and you're not alone with that. It's fundamentally American to demand autonomy. Even people who have no partisanship from any angle recoil violently just on that basis alone.

      And the real issue is about trust. You post here at the end about the intense skepticism about not letting "private industry anywhere near" this. That goes to trust and I really don't see anything in the recent past that I could point to and say, "hey they got it right on this so let's just trust them on the next one." Nothing, absolutely nothing comes to mind.

      That skepticism is not based in paranoia alone. There's ample evidence on almost any issue these days to feed and nurture that suspicion. Also if you look at the poll numbers, after the new Congress got in in 2007, they were polling pretty good. Now? They're at 10-15% approval ratings? Something like that. That goes to trust too.

  •  Please stop (7+ / 0-)

    trying to talk substance in the middle of a primary fight. (Well, or even at the very tail end of a primary fight.) You think we come here for informed discussion? Troll!

    Great job. I'm an Obama supporter, and I endorse this diary.

    I want someone to quote me in their sig line - Trix

    by GussieFN on Thu Apr 10, 2008 at 04:12:04 PM PDT

  •  Please explain to me (NOT SNARK)... (8+ / 0-)

    ...why I should be mandated to get coverage. I am a single, young male in perfect health who makes just under 6 figures, but my job doesn't pay for it. I have no problem paying taxes so people who can't afford health care can have it, but why should I be forced by law to make an insurance company rich?

    Again, I am not being a smart a** and I concede at the outset that I probably don't have the firmest grasp on the nuances of this issue. It just seems to me, that if we aren't going to do true universal coverage, a la Canada or England, why should I be forced to buy it from a private entity. Children I understand some what because they have no choice.

    Personally this is not a make or break issue for me on either candidate. The candidate with the better plan will be influencial in the senate as well as the white house. And with a Democrat in the white house, and Democrats in the senate, we will get the better of the two plans (I hope).

    YES WE CAN! SI SE PUEDE! YES WE CAN! SI SE PUEDE!

    by Grant Caesar Peters on Thu Apr 10, 2008 at 04:12:15 PM PDT

    •  Well Cause You Never Know (6+ / 0-)

      what can happen. I was in a similar situation as you. I lost my care. Then got sick. Literally a 1 in 10 million thing. ICU, emergency surgery, and $67,000 later ...

      Now I had some resources and was able to set up a payment plan. If not one or two things would have happened. I would have ended up stiffing those that saved my life or I would have had to declare bankruptcy. Both very bad things.

      Now if I would have declared bankruptcy somebody had to pay those people. And the rest of the public pays for that via increased costs.

      Let us not forget New Orleans. Visit Project Katrina.

      by webranding on Thu Apr 10, 2008 at 04:16:29 PM PDT

      [ Parent ]

    •  Because you never know when you need it. (7+ / 0-)

      A car accident or a bad fall that is unexpected like happened for a friend of mine, can wipe you out when you are most vulnerable.  

      I agree about having other options other than buying from private insurers.  

      If we don't get it in the next congress, I think that all the legislators are colluding with business.  

      •  But that assumes (2+ / 0-)
        Recommended by:
        theran, Dougie

        His purchase of insurance will help with an accident or a bad fall. As we too well know, it provides NO such guarantees whatsoever.

        I'm not part of a redneck agenda - Green Day
        Neither is California High Speed Rail

        by eugene on Thu Apr 10, 2008 at 04:27:35 PM PDT

        [ Parent ]

        •  Any plan has to be regulated (5+ / 0-)
          Recommended by:
          benny05, Predictor, poligirl, carllaw, jandress

          and not be just a boondoggle for the insurance companies.  Edwards' plan limited profits to 15% of the premiums collected.  It isn't the plan that I think is best and if everyone can get Obama to go for single payer I am on board.  

          However the status quo cannot stay.  Edwards, Obama and Clinton all have been trying to get us moving towards universal health care.  The fact that the Repubs feel the need to even have a plan says that the discussion started by Edwards has made a difference.

          Obama's plan is still the weakest of the Democratic plans.  I don't want to settle for that.  I would like single payer.  Obama will win the nomination.  But we need to win the policy issues.  How do we do that on health care?  It is a crisis across the country.

          •  We make a push for single payer. (1+ / 0-)
            Recommended by:
            joynow

            I don't see why so many progressives are spending 2008 talking themselves out of doing so. The poll numbers have steadily improved on single-payer, but they won't move past 50% all by themselves. There are a LOT of activists and organizing groups out there backing single-payer. And how many cosponsors does HR 676 have? We actually passed SB 840 twice here in CA.

            We have a very, very strong starting point for a nationwide movement for single-payer. Which is what it will take, just as a nationwide movement for Social Security was needed to convince Congress and FDR to enact such a system.

            I'm not part of a redneck agenda - Green Day
            Neither is California High Speed Rail

            by eugene on Thu Apr 10, 2008 at 04:37:54 PM PDT

            [ Parent ]

          •  The current rate (0+ / 0-)

            is about eighteen percent.

            If you add one-sixth of the population and cut the percentage by one-sixth to 15%, the money the insurers get to keep stays the same.

            The Germans limit Krankenkasse overhead to less than 3% by law.

        •  Therefore what is your solution (3+ / 0-)
          Recommended by:
          benny05, Predictor, poligirl

          to that scenario?

      •  I understand the concept of insuarnce (0+ / 0-)

        I don't see why a mandate helps.

        YES WE CAN! SI SE PUEDE! YES WE CAN! SI SE PUEDE!

        by Grant Caesar Peters on Thu Apr 10, 2008 at 05:55:02 PM PDT

        [ Parent ]

    •  You are the classic free rider (4+ / 0-)
      Recommended by:
      mbair, poligirl, carllaw, jandress

      Actually, it is because of the attitude of people like you that Clinton thinks she needs a mandate.  

      Obama will let young adults up to age 25 remain on their parents policies.  

      And when you end up in the emergency room, you will wish you had health insurance.

      Health care is a human right.

      by Helenann on Thu Apr 10, 2008 at 05:48:10 PM PDT

      [ Parent ]

      •  How am I a fee ridr because I pay taxes (0+ / 0-)

        And where is the legislation that mandates the companies have to give us a better deal if I opt in.

        YES WE CAN! SI SE PUEDE! YES WE CAN! SI SE PUEDE!

        by Grant Caesar Peters on Thu Apr 10, 2008 at 05:53:28 PM PDT

        [ Parent ]

        •  Because you dont pay into the insurance system (3+ / 0-)
          Recommended by:
          mbair, poligirl, jandress

          And expect to get care without insurance.

          My proposal for folks like you is to give you a choice when you arrive at the emergency room or the doctors office with a serious injury or illness.  Enroll in insurance or sign a contract taking full financial responsibility for the costs of your care.  Me thinks you will buy the insurance.  But you will be a better citizen if you, as a health person, join the pool, and help spread both the risks and costs of health care.

          Health care is a human right.

          by Helenann on Thu Apr 10, 2008 at 06:08:55 PM PDT

          [ Parent ]

          •  Well, you are making a huge assumption about me (0+ / 0-)

            and what I expect. I have been to the emergency room for a motorcycle wreck, and a cut hand, and in both cases I paid my bill, it hurt, but it is less than premiums would be over the last 6 years.

            I see mandates, even Obama's, as at least a small hand out to the insurance companies. If we are going to mandate it, and presumably penalize those who don't get it, I would rather just pay a little more in taxes and have true universal coverage. I know eventually I need insurance, but if I have to get it from one of the insurance companies I would rather put it off until I start a family. Call me what you will.

            YES WE CAN! SI SE PUEDE! YES WE CAN! SI SE PUEDE!

            by Grant Caesar Peters on Thu Apr 10, 2008 at 07:42:57 PM PDT

            [ Parent ]

            •  None are handouts to health insurers (0+ / 0-)

              Most newly insured will get the coverage in the new pool.  In the pool people will have two choices.  One is a single payer plan like Medicare that will have NO insurance company involvement.  The other is a choice of managed care plans that will all be strictly regulated in offering policies in the pool.  

              The health insurance industry is not going to love either of the plans.

              Health care is a human right.

              by Helenann on Fri Apr 11, 2008 at 10:21:59 AM PDT

              [ Parent ]

    •  Excellent comment (0+ / 0-)

      Thanks. I guess I would say that mandates can be defending to you and your situation in two ways. You're perfectly healthy now and you're also young. That means that probably you won't get any net "bottom line" benefit to paying for health insurance. Let's be real. You're going to be like me. I have never gone without a policy, but I've been lucky, yet I've never racked up any kind of fees for services that I couldn't just pay out of pocket for. Since I've been an adult I sprained my ankle once, I needed antibiotics maybe 3-4 times and I use Birth Control. That's it for me. Other than that the only time I go to the doctor is once a year for a routine physical. Yet I pay a lot to be covered. There's no net benefit to my bottom line.

      First defense, what if I did get sick? Really sick or injured like badly in a car accident or whatever. I'm lucky that I'm not sick, but what happens when my luck runs out? What if I couldn't pay those bills over the long-term. Half of all the bankruptcies in this country are due to medical bills. That's a startling figure but 100-150K in fees for treatment can force anyone into bankruptcy and maybe even out of their home.

      Second defense, you have to pay so that others can can be covered. This sounds weird, but look at how financials do things. They pool risk. Theoretically, the mortgage meltdown crap nonwithstanding, an insurance company will put people with good credit into the same pool as people with bad credit so that on average they'll make a buck. Same thing with auto-insurance. Good drivers and bad drivers get lumped together in these risk pools. So you as a healthy, cheap, person to cover need to get pooled in with a sick, expensive, person to cover.

      I would like to point here that these analogies pertain to employer based system and profit alone. Single-payer will do the same kind of risk pooling and they also represent a kind of a mandate in that everyone is covered automatically when they're born and everyone contributes to the system throughout their lifetimes whether or not they get any net benefit from their coverage.

      Great comment thanks. Sorry the reply is so late.

  •  Thoughtful diary (13+ / 0-)

    Allow me to respond to a few points.

    Cost control is the ultimate goal of health care reform....

    No.  Universal quality health care is the ultimate goal of health care reform.  Cost control is an unavoidable feature of any health care system.

    But single payer advocates that use this reason as a way to promote their preferred plan should ask themselves: how would we finance a single-payer system?

    Any way we like.  What's important is that the tax support be a dedicated revenue stream going through an independent agency shielded from political pressure.  My model is the Social Security Administration.  Personally, for revenues I'd favor a progressive income surtax, a flat corporate tax with no loopholes exempting the smallest businesses, and increased cigarette and alcohol taxes.

    Obama-Clinton

    Neither plan is worth fighting over, in my mind, because both go down the wrong path to reform.  Health care reform will cost tremendous political capital, and if it's not successful will deeply harm the party for a generation or more.  It's crucial that we get the outlines right, and I think the mandate/no-mandate food fight which leaves the private insurers in place is precisely the wrong outline.

    I practiced in MA for 15 years after getting my residency training in Boston, so I know something of the state.  For-profit providers have very little presence in MA, so you don't see the worst of the insurers much.  Not-for-profits have always been the major players in MA, which actually makes it a best-case laboratory for mandates.  Experience in other states where the Uniteds and Aetnas and Cignas dominate would be significantly worse.

    Hanoi didn't break John McCain, but Washington did.

    by Dallasdoc on Thu Apr 10, 2008 at 04:15:44 PM PDT

    •  You've nailed the problem. (4+ / 0-)
      Recommended by:
      joynow, Dallasdoc, haruki, Dougie

      I think the mandate/no-mandate food fight which leaves the private insurers in place is precisely the wrong outline.

      You can't have a for-profit, health insurance-for-all plan and expect it to actually deliver healthcare at a reasonable cost.

      Excellent comments, Dallasdoc. As always.

      "Don't have nobody to call my own; please, please bring me a dream."

      by MrSandman on Thu Apr 10, 2008 at 04:36:58 PM PDT

      [ Parent ]

    •  Health care reform (1+ / 0-)
      Recommended by:
      Dallasdoc

      There are three ifs that must be met if we are to get a universal coverage plan in the next Congress under our new President

      1.  IF we can elect a supermajority of Democrats in the Congress to prevent Republican phllibusters.
      1. IF a bill is introduced in the first 100 days.
      1. IF we elect Senator Obama.

      The truth is that the Congress is already busy drafting Obama's plan into legislation so that it is ready to introduce shortly after the inarguration.

      Kennedy and Kerry have already stated publicly that any plan developed and passed in the Congress WILL NOT INCLUDE A MANDATE.  This idea is DOA and is a moot point.

      Obama has said this will be his priority his first year in Office.  Clinton has said she will get us universal coverage by the end of her SECOND TERM!  Say what???

      Health care is a human right.

      by Helenann on Thu Apr 10, 2008 at 05:52:14 PM PDT

      [ Parent ]

      •  I'm sorry (0+ / 0-)

        I have to disagree here.

        You might be right on 1, but don't forget blue dog Dems that might not be reliable members of a coalition. Maybe you're right on 2, "too." I have no problem with this statement at all.

        On 3, he's not running on single-payer. He's not running with a mandate, fully funded or otherwise, and he's not running with a Medicare option for all. I don't see how we get to universal health care from there, but if you read the diary I guess I'm just being redundant here. My apologies.

        As far as the DOA determination by Kennedy and Kerry, I don't know. The "will of the people link" points to a report on a survey from Kaiser/Harvard:

        Kaiser Daily Health Policy Report

        About six in 10 people support a broad approach to ensure everyone has coverage that includes a requirement for individuals to get insurance or pay a fine, subsidies for people with lower incomes, a requirement on employers to contribute towards coverage for workers and a requirement that insurers take anyone that applies. About two-thirds also support another approach to expand coverage -- a proposal that would require parents to get health insurance coverage for their children with government subsidies for lower income families. However, the public is more mixed, with about half supporting and about half opposing, on the specific question of an individual health insurance requirement that includes mentions of fines for non-compliance and subsidies for those with lower incomes, but no reference to expanded public programs and requirements on insurers and employers.

        60-40 with this kind of language looks like a doable proposal especially in light of so much negative coverage on the mandate.

        This is a good thing:

        Obama has said this will be his priority his first year in Office.

        But I still remain skeptical of subsidies without mandated care or coverage because of what happened with Medicare part D. The lobbyists are still going to control the votes in any Congress until we get to true public financing of elections. If we're going to do it right off the bat, we have to remember that we'll be working within the existing system of perfectly legal corruption.

    •  Thank you for your thoughtful comments (1+ / 0-)
      Recommended by:
      Dallasdoc

      Without cost controls then how can you get to affordability or quality in an employer based system? I guess I'll give you this one.  

      I very much agree with you here:

      Any way we like. What's important is that the tax support be a dedicated revenue stream going through an independent agency shielded from political pressure.  My model is the Social Security Administration.

      That was a meta portion in this diary. The funding stream must be independent from Medicare today too. I just wrote that because I wanted to point out that a single-payer system has costs too that will invariably be born by people of modest incomes and the well healed alike through taxes. Truly progressive taxes shield lower income people from bearing more than their fair share of pain, but there is cost here and we need to be honest about that.

      Neither plan is worth fighting over, in my mind, because both go down the wrong path to reform.  Health care reform will cost tremendous political capital, and if it's not successful will deeply harm the party for a generation or more.  It's crucial that we get the outlines right, and I think the mandate/no-mandate food fight which leaves the private insurers in place is precisely the wrong outline.

      Fair enough and I agree that a failure on this issue will damage this party for a generation. But we're going to enact some major reforms and we don't have a candidate that supports single-payer in the race. Single-payer might be the way to go, but it's not on the table in this cycle.

      Do you think that offering a truly public plan as defined in this diary, not just FEHBP, could provide a backdoor to single-payer? That's why I wrote that this omission in the Obama plan is more serious than the lack of a mandate.

      I'm also deeply concerned about subsidizing insurers with mandate coverage because of Medicare part D. That's exactly what happened there.

      And readers of this thread should remember that the care-coverage debate is a discussion that we need to have and I didn't address that in this diary. I made my choices and went with what little I could stand behind.

      This is excellent input:

      Not-for-profits have always been the major players in MA, which actually makes it a best-case laboratory for mandates. Experience in other states where the Uniteds and Aetnas and Cignas dominate would be significantly worse.

      I think I should have put in that diary, but I didn't have the sources to defend it. BC/BS a non-profit in MA, is that right? But BC/BS can be for-profit in other states, is that right? I honestly don't know the answer to this question.

  •  Agree with a Medicare for All option (6+ / 0-)
    Recommended by:
    eugene, joynow, mijita, Dallasdoc, Helenann, Dougie

    strongly disagree with mandates.  I don't want my wages garnished to fatten the profits and the salaries of an insurance company CEO.

    "The era of Scooter Libby justice, Brownie incompetence and Karl Rove politics will finally be over this year" Reject Marc Rich justice and Mark Penn politics.

    by IhateBush on Thu Apr 10, 2008 at 04:16:10 PM PDT

    •  Obama's plan (1+ / 0-)
      Recommended by:
      IhateBush

      offers the American people the CHOICE of a single payer plan and no mandate.

      I would say he is your candidate.

      Health care is a human right.

      by Helenann on Thu Apr 10, 2008 at 05:52:58 PM PDT

      [ Parent ]

      •  That's not true at all (1+ / 0-)
        Recommended by:
        jandress

        What is going on here? Did you read Obama's plan? He offers a "public plan" that is essentially FEHBP. It is not Medicare or anything like it. FEHBP is implemented through private entities. All he does is to extend eligibility to everyone in this country, but FEHBP is nothing like Medicare. You can't get to single payer with the current Obama plan. We need to change that.  

        •  Obama's plan (0+ / 0-)

          There are two choices in the pool.  And not only did I read it, I have been involved in the development.

          Both CLinton and Obama offer two major choices in the pool.

          They both offer the choice of private plans like FEHBP

          AND  they both offer a public plan option, like Medicare.

          You better go back and read Obama's plan.

          To simply things, on the stump, Obama only mentions having coverage as good as any member of Congress.  Perhaps that is where your confusion comes from.

          Health care is a human right.

          by Helenann on Fri Apr 11, 2008 at 10:24:12 AM PDT

          [ Parent ]

          •  SIngle payer (0+ / 0-)

            Both Clinton and Obama's plan enable the voluntary transition to a single payer system.

            Health care is a human right.

            by Helenann on Fri Apr 11, 2008 at 10:24:54 AM PDT

            [ Parent ]

          •  Listen I full admit (0+ / 0-)

            That I might be wrong on this but I did read the plan and nowhere does he say anything about Medicare being available to anyone. Look at the language in that page. There is no mention at all of Medicare or a Medicare type program. Now, too, I agree that he proposes a new public option available to everyone, no eligibility barriers, no BS on that with benefits just like FEHBP, but without committing to a single-payer framework to administer that new entity then how does it get delivered to people? It gets delivered through a private insurance company. If he had wanted to say that it was a single-payer option then he would have said somewhere that it would be similar to Medicare.

            Now this may be a distinction without difference and an erroneous conclusion on my part, but also he's still talking about expanding S-CHIP and Medicaid. Medicaid is a single-payer truly public plan. I'm not exactly sure about how states administer S-CHIP, but those two programs have real barriers and strict eligibility requirements.

  •  In 1987 I was able to buy (2+ / 0-)
    Recommended by:
    theran, two roads

    COBRA coverage for $57 a month from a large computer company.

    The cost of that coverage adjusted for inflation [~doubled to $114 a month] should serve as a benchmark which America's health care industry could be brought in line with.

    All the patents in effect at that time have expired, so 1987 care which offered CAT and MRI scans, bypasses, stents, and reasonable length hospital stays could be an affordable baseline for a health plan development.

    No mandates were required in 1987.

    •  1987 (0+ / 0-)

      is a whole different ballgame.

      No mandates were required in 1987.

      Yeah okay, no argument there, but costs are completely out of control today and it wasn't like this in our recent past. Even expensive ER care in those days was an order of magnitude lower, even adjusted for inflation.    

  •  Health coverage shouldn't be mandated. (6+ / 0-)
    Recommended by:
    eugene, joynow, mijita, haruki, Hope08, Dougie

    It should be a given. Forcing us to give profits to insurance companies is wrong. I live in MA. Romney forced this on us to enable him to brag about it. We need health coverage. We don't need laws forcing us to buy health insurance. On this all three major candidates have flawed plans. IMHO.

    McCain'08 - You Don't Change Horses At The Bottom Of An Abyss!

    by kitebro on Thu Apr 10, 2008 at 04:20:56 PM PDT

    •  Fair enough (1+ / 0-)
      Recommended by:
      kitebro

      Romney forced this on us to enable him to brag about it.

      And he backdoor vetoed the 295.00 dollar fee assessed on employers that don't provide coverage just so he could say he did universal health care without raising taxes. It was purely political and totally dishonest for a variety of reasons. That fee has been reinstated by the legislature.

      You get into an important point here. Care vs coverage. Junk policies do little to provide access and never fully address cost. Did you see DallasDoc's comment about non-profits in MA?

      I practiced in MA for 15 years after getting my residency training in Boston, so I know something of the state.  For-profit providers have very little presence in MA, so you don't see the worst of the insurers much.  Not-for-profits have always been the major players in MA, which actually makes it a best-case laboratory for mandates.  Experience in other states where the Uniteds and Aetnas and Cignas dominate would be significantly worse.

      So at least in MA all those dollars are not going to provide fat cats with Bentleys and vacation homes. That's a good thing. I didn't have the sources to defend that statement in the diary. That's why I left it out.

    •  It shouldn't be (0+ / 0-)

      mandated. If someone is healthy enough that paying for insurance will cost more than everything out of pocket, then I find it criminal to force the person to buy insurance.

      As far as it being a "given," there's no such thing as a free lunch

  •  Here's why you're wrong (4+ / 0-)
    Recommended by:
    eugene, joynow, loralei, Dougie

    Hillary Clinton does not say how she will enforce or impose mandates. Therefore any assumptions about how many people will actually be covered by her idea is purely speculation. Clinton has tried to make mandated health care synonymous with universal health care. It's not. Edwards plan was to mandate insurance through the filing of tax returns. That would leave millions without coverage. The only real way to affordable universal health care is to make it an entitlement.

    Incoming...it's a flying bookbag

    by jhecht on Thu Apr 10, 2008 at 04:21:00 PM PDT

    •  I agree with you here (1+ / 0-)
      Recommended by:
      jandress

      in that no one is really seriously talking about how to achieve universal coverage in an employer based system and I'm a speculator. No question on the latter.

      Do you agree that offering a truly public plan like Medicare to everyone in this country could be a backdoor to single-payer?

  •  You seem to forget.... (3+ / 0-)
    Recommended by:
    fivefouranonymous, haruki, Hope08

    that may people voted for Obama with the knowledge of  his health care plan. That suggests that whatever majority you claim for your opinion simply isn't there.

    •  Well that's a good point (1+ / 0-)
      Recommended by:
      jandress

      but you're assuming that voters by and large now the real differences between the plans and what they mean. Given the media coverage in this country, I don't think you could make that argument.

      Like in the debates. They all say universal health care and the moderator just leaves it up to the other candidates to, well, moderate the discussion. It really does boil down to a food fight with little or no context in the coverage. There's no umpires anymore. It's all about total BS and personality.

      But I guarantee that once we nominate Obama, the knives come out and he gets taken to the woodshed by the McCain loving media for deficits in the plan.  

  •  My biggest problem w/ Elizabeth Edwards (5+ / 0-)

    is she steps into the debate with the "My husbands health care plan was perfect and since Hillary's copied it, hers to is perfect"

    I would appreciate her perpective much more if she was willing to engage in an actual debate on different sides of this issue.  But that's her perspective but when she comes at the issue with hard stances like that she's going to face some blow back.  

    Secondly one diarist from yesterday talked about the crap plans she was forced to by in MA.  Is that apart of the glory of mandated private insurance coverage, crappy coverage for all?  

    I'm more interested in affordable access to care.  

    •  She has and will once her blog is up. (7+ / 0-)

      She has been on KOS more than once and answered many questions on many subjects. Sorry you missed her.

    •  Um...no, she doesn't (6+ / 0-)

      Elizabeth does debate the reasons as to why she favors mandates. She does not simply say, 'becaues her husband's plan was superior.'

      How insulting (and not true).

      •  She doesn't debate mandates (1+ / 0-)
        Recommended by:
        haruki

        She argues under the veil of "UHC" even though that's not very truthy.   Single payer is not UHC just because Edwards and Clinton say it is so.  There are people left out of both of these plans.  

        •  Yes, she does (6+ / 0-)

          Elizabeth has cited a number of reasons as to why she prefers mandates, including during the Q&A sessoin of her speech at Harvard yesterday.

          She has never said, the plan is superior because it's my husband's. That would be so out of character for Elizabeth, an exceptionally intelligent, outspoken woman.

          •  I agree she is an intelligent (0+ / 0-)

            outspoken woman and I respect her.  I didn't mean to infer that she's not well versed in the issue.  She obviously is.  

            I guess my point is that E. Edwards has an opportunity to be a spokesman that can bridge the divide across party lines.  I feel she can be more effective by pressing the mandate divide less and educating Americans on the BASICS of the issue first.  

            I think it was said after one of the debates, where Obama and Hillary spent 15 minutes debating the ins and outs of mandates.  People who watched it were like "we don't have ANYTHING right now!"  I think that pretending mandates are the holy grail of health care reform (single payer is) is going to defeat her mission before it's started.

      •  BTW (1+ / 0-)
        Recommended by:
        haruki

        On KO she said that any plan without a mandate is 1/2 a plan.  That's offensive.  That's arguing that of the 100 of thing Obama is offering in his plan including increasing the age under which children can be covered under parental insurance to 25, telling insurance cos. they can't deny coverage based on pre-existing conditions, covering all children, cutting cost, etc is only in her mind equal to 1/2 a plan and mandates equal the other.  

        This is an important debate, to go into it as HRC did in 1992 and demean other plans because of one aspect of it is not being open and fair.

        •  You're offended by Mrs. Edwards's (1+ / 0-)
          Recommended by:
          jandress

          comments duly noted.

          I agree it's an important discussion and I welcome her comments because no one is saying what she's saying. Like how McCain's plan wouldn't even cover himself. No one else is saying that and that's a devastating argument against the YOYO economics we'll be up against this year.

          She also said that media is not providing any useful analysis on this subject. I think we can agree on that.

    •  Big difference (1+ / 0-)
      Recommended by:
      jandress

      in what a federal plan and a state plan can offer. The problem is funding the mandate. And the problem with Obama is that he doesn't even have a public option in his proposal. That's not going to get us anywhere as far as affordable access goes. The subsidies in the Obama plan can easily turn into another Medicare part D fiasco.

  •  why are you defending the insurance comapnies? (2+ / 0-)
    Recommended by:
    eugene, IhateBush

    they are mass murderers.

    Put the fuckers out of buisness and the executives in jail for life.

    •  Well I'm not (1+ / 0-)
      Recommended by:
      jandress

      Really, I am not. An no where in this diary can cite evidence for your claim that I am defending insurance companies. I'm talking about what we're going to run on as a party and I'm arguing for honesty in this discussion, especially about MA and the trashing my state is getting today for our law.

  •  and yes, we need a big tax hike (2+ / 0-)
    Recommended by:
    eugene, theran

    that's one way I  know the Edwards plan sucks. It doesn't raise taxes.

  •  Nope. Here's another Mass resident. (9+ / 0-)

    I'm leaving the state this summer, and not coming back. Not due to the mandates, but I surely won't miss them. Each year my parents have to find some low-budget insurance plan to put me on for the term because we're required to have some sort of policy, to put some measure of money in the pockets of insurance companies.

    No more. I want Universal Health Care, not Wealthfare Health Insurance for Megacorporations. This perversion of UHC Edwards and Clinton keep touting is not UHC, and is not worth my parents' money.

    any inaccuracies in the above comment were almost certainly due to sniper fire.

    by haruki on Thu Apr 10, 2008 at 04:29:48 PM PDT

    •  well put... (3+ / 0-)
      Recommended by:
      theran, haruki, Dougie

      couldn't agree more...

    •  How many years? (0+ / 0-)

      You could have just taken the hit of 219 last year. That was the only penalty. Now this year is going to be different in that the fines could be significant, but see Dallasdoc's comment about MA and non-profits.

      I practiced in MA for 15 years after getting my residency training in Boston, so I know something of the state.  For-profit providers have very little presence in MA, so you don't see the worst of the insurers much.  Not-for-profits have always been the major players in MA, which actually makes it a best-case laboratory for mandates.  Experience in other states where the Uniteds and Aetnas and Cignas dominate would be significantly worse.

      Your money is not going to megacorporations.

      Any besides. If you're advocated for single-payer then that's the ultimate mandate for coverage. It also isn't free. Single payer has to be financed through taxes too.

      This perversion of UHC Edwards and Clinton keep touting is not UHC, and is not worth my parents' money.

      What about the deficits in Obama's plan?

  •  Great diary Mbair. (7+ / 0-)

    We need to keep the issues front and center.

  •  I am an Obama (5+ / 0-)
    Recommended by:
    mbair, benny05, NCDem Amy, poligirl, carllaw

    supporter who was an Edwards supporter. I voted too late to be able to vote for Edwards, and I came very close to voting for Clinton solely because of this issue. I'm gladder with every passing day that I didn't, but her health care plan is still the better of the two.

    Thanks for being brave enough to post this here.

    The only thing we have to fear is fear itself.

    by sidnora on Thu Apr 10, 2008 at 04:38:54 PM PDT

    •  How do you make that judgment? (0+ / 0-)

      She refuses to say how she will impose and enforce mandates. I know she says she'll cover everybody. Are you the last person who still takes her at her word?

      Incoming...it's a flying bookbag

      by jhecht on Thu Apr 10, 2008 at 04:47:07 PM PDT

      [ Parent ]

      •  Whatever it is (1+ / 0-)
        Recommended by:
        jandress

        it's a better plan because of the public option. I agree that without proper language in the plan about how to enforce the mandate it's harder to make the "covers more people" case, but with Medicare on the table for everyone it's a better plan.

      •  What s/he said. (1+ / 0-)
        Recommended by:
        mbair

        The analogy would be automobile insurance, if there were a government insurer of last resort for those who qualified (Medicare).

        Edwards' health insurance plan was by far the best of the three, IMO.

        The only thing we have to fear is fear itself.

        by sidnora on Fri Apr 11, 2008 at 03:25:16 PM PDT

        [ Parent ]

    •  I just had to (2+ / 0-)
      Recommended by:
      sidnora, jandress

      but I have to admit I am glad this didn't get rec'd. There's so much anti-MA, anti-mandate sentiment at this website. Some of that is truly valid like I said in the case of single-payer advocates, they've got a great issue. But we're running without single-payer this year and we need to wake up to that fact on the left. From all sides.

      I too could not vote for Clinton and I think an Obama vote is totally the way to go in the two person race. I'm so glad that Edwards was on my ballot.

      •  I hate to say this (1+ / 0-)
        Recommended by:
        mbair

        but I think that most of the opposition to a mandated plan here comes from the fact that it's Clinton's plan. As I said before, I support Obama for lots of reasons, but this isn't one of them. There are too many people here who think he walks on water, and that every position he proposes must be proven superior simply because it's his.

        The only thing we have to fear is fear itself.

        by sidnora on Fri Apr 11, 2008 at 03:28:26 PM PDT

        [ Parent ]

  •  I ate a hamburger two days ago (0+ / 0-)

    It had two hamburger patties and several slices of cheese.

    Someone took my order.

    Someone else cooked the patties.

    Someone then stacked the patties and the cheese slices on one half of a bun.

    Some ketchup was added.

    The other half of the bun was place on top.

    It was then wrapped in paper.

    They then placed the wrapped hamburger in a bag.

    I paid $1.07.

  •  Here is why I am angry at her (1+ / 0-)
    Recommended by:
    benny05

    Notwithstanding her right to be wrong on the health care issue, this makes me rethink what I thought I knew about her intelligence:

    (E. Edwards) said she saw no problem with the fight over the Democratic nomination going to the national convention. And she said she agreed with Mrs. Clinton that superdelegates should weigh in as appropriate and did not necessarily need to vote the way their state or caucus had voted.

    (from the NYT)

    •  I agree with EE on that one (3+ / 0-)
      Recommended by:
      Catesby, planetclaire4, poligirl

      I'm fine with this going down to the convention and I think superdelegates should vote the way they wish, although admittedly I wonder if such if the superdelegate category should exist anymore.  

    •  Those are the rules (5+ / 0-)

      Just like Michigan and Florida not counting (which helps Obama).  Those are the rules and everyone knew it when the contest started.  

      And the rules make sense.  Do John Kerry or Ted Kennedy have to vote for Clinton because MA went for Clinton?  Or does Evan Bayh have to vote for Obama cause he will likely win most pledged Delegates overall?  Because then what about the issue of popular vote? Isn't that a more compelling argument than pledged?  I personally think that Supers should align with Pledgeds but they don't have to.  The rules allow them to vote however they want.  

      At the end of the day, Obama and Clinton are going to have to make a pitch to the Supers and show why they are the one to take on McCain.  I give Obama a 90% chance of closing the deal. The ball's in his court and everyone knows it.  If he can't convince the Supers then it's on him, not Clinton or E. Edwards or anyone else.

      Let's hope that by the time '12 rolls around that we're wise enough to reform our primary system.

      "It is time to be patriotic about something other than war" - John Edwards

      by Valhalla on Thu Apr 10, 2008 at 05:56:30 PM PDT

      [ Parent ]

    •  This is totally off-topic (1+ / 0-)
      Recommended by:
      jandress

      Did you read anything in the diary at all? Anything? Did you just see the picture and immediately post this comment?

      Please stay on topic and don't disrupt my thread. I think it's an important issue, obviously.  

  •  That's a lovely picture and everything (1+ / 0-)
    Recommended by:
    haruki

    but she isn't right about this issue and she isn't right to be messing around with the nomination when the best she can hope to accomplish is to give more ammunition to a lost candidacy that is hurting the Democratic Party.

    I'm guessing she means well,   She's a pretty cool lady and all and again, lovely picture.  But that doesn't make her right right now.  

    •  I love the picture too (1+ / 0-)
      Recommended by:
      jandress

      she isn't right to be messing around with the nomination when the best she can hope to accomplish is to give more ammunition to a lost candidacy that is hurting the Democratic Party.

      You mean the Clinton candidacy, right?

      •  Yes, I did (0+ / 0-)

        This was used, predictably, as a quasi-endorsement by the Clinton campaign.  Aside from that result, I'm not sure what she was hoping to accomplish.  The details of the health care plan are almost an aside in terms of the effect of what she is up to right now in these interviews.  It's not going to change the Obama plan to include mandates and the best it could do for Clinton is help prolong her campaign.  That's all that Mrs Edwards could really hope to accomplish right now if she's looking at it realistically.  Otherwise it's just a tantrum of sorts.  A calmly, cooly delivered tantrum, but nothing more than that.  

  •  I would argue that the priorities should be (1+ / 0-)
    Recommended by:
    haruki

    reversed:

    Cost control is the ultimate goal of health care reform, regardless of whether you support single-payer or employer based systems. Coverage for everyone, while a moral imperative, is the ancillary fruit of the tree that is planted for shade.

    "Nothing is more powerful than an idea whose time has come." Victor Hugo

    by lordcopper on Thu Apr 10, 2008 at 05:11:22 PM PDT

    •  Fair enough (0+ / 0-)

      I won't argue this point with you, I see it as a chicken and egg problem because skyrocketing costs are really blowing a massive hole in the current system forcing people out of plans and their employers from providing good coverage. There are plenty of employers out there that might want to offer coverage for staff but can't afford to.  

  •  From today's Washington Post (0+ / 0-)

    Senate Passes Housing Bill
    Plan does not provide aid to homeowners who can't pay their mortgages and face foreclosure.

    Please tell me about those health insurance purchase subsidies.

  •  John & Elizabeth Edwards Are Right (6+ / 0-)

    John Edwards was right--He led all the Democrats this cycle in calling for universal health care.  His plan was out months before the other candidates' plans, which borrow heavily from his.  His plan was truly universal, fair, and offered financial assistance to those who cannot afford health care.  It also offered people a choice of a Medicare-type government plan.

    Obama needs to retool his plan to make it truly universal--he mandates coverage of children, why not adults?  Why not offer a Medicare-type plan as one of the choices?

    You have to wonder if this is capitulation to his donors in the pharmaceutical industry:

    http://opensecrets.org/...

    It's as Edwards said, "We can't replace corporate Republicans with corporate Democrats.  We are better than this."

    Come on, Obama...Let's make your coverage truly universal.

    •  That's why I wrote the diary (0+ / 0-)

      Come on, Obama...Let's make your coverage truly universal.

      We got to get this right. The sharks are picking up the blood in the water on the subsidies and we need to be real careful here because if we're not going to implement single-payer then we're going to get eaten alive on federal dollars going to for-profit insurance companies. It'll be the same as Part D.  Party doesn't matter. Red Blue? BS. It's all about the money, baby. And there's plenty of that to go around on both sides.

      Furthermore, straw man argument coming here - sorry, even if you believe that Obama would be squeaky clean on lobbyists as our president we will have to work within the existing system to pass reform. He's already promised the law in the first year. And I feel he has to deliver because of that promise. That's a good thing if we do the law right.  

  •  Clinton (0+ / 0-)

    Senator Hillary Rodham Clinton said in an interview on Wednesday that if elected president she would push for a universal health care plan that would limit what Americans pay for health insurance to no more than 10 percent of their income, a significant reduction for some families.

    She also said in the interview that she preferred to set the limit at a single level for all Americans rather than varying it by income.

    http://www.nytimes.com/...

  •  Huh...you seem to be missing some points (1+ / 0-)
    Recommended by:
    NYFM

    MA is a fairly wealthy state with most employers already offering health insurance to employees and that strength was a huge consideration in our state when the law was written with mandated coverage in it. That's exactly why the legislature chose to piggy back our reform on the back of the existing system. They were right about that choice.

    I don't see you addressing the employers who are messing with the system to avoid insuring people now.  

    Firms find ways around state health law

    To comply with the new state insurance law, a Burger King franchisee in Boston expanded coverage from just his salaried staff to all full-timers. To control his costs, he halved the share he pays. Only three of the 27 newly eligible employees took the insurance; others say they can't afford it....

    Another employer split his firm into separate corporations, each with fewer than 11 full-time employees, according to his insurance broker. That way he does not have to offer insurance, nor pay a fine....

    There are other stories, but in the interest of copyright you'll have to go read them yourself.  

    As expected, employers will find ways out of this.  The legislators were NOT right.  

    And in addition Romney torpedoed the whole thing by shorting the business contributions.  But that's kind of a separate issue.

    •  You're a single-payer (0+ / 0-)

      Right? And you don't support the MA plan for that reason, right?

      I don't see you addressing the employers who are messing with the system to avoid insuring people now.

      That's true I don't talk about the small business exemption per se. Is that what you mean by "messing with the system"? I chose not to do that because I had to make choices here and I didn't have the sources. Furthermore relief to employees working for a company that gets an exemption and thus don't have an option for employer subsidized coverage are addressed in this diary in that they're people needing a subsidy to afford a plan. I figure that even if they can't get coverage from their employer they're still not necessarily destitute and would be the first people fined. It's painful that is true. No question about that.

      As far as Romney goes, yes. He backdoor vetoed the damn funding mechanism assessing a 295.00 per year per employee fine for companies not offering coverage. That was total Romney sleeze, but that provision has been reinstated by the legislature in a veto override. I had a link for that source, I'll see if I can find it again and post it here as a reply to your original comment if you care at all. So it might show up on your hotlist, but as usual sometimes it takes me days to go through these threads. I too am fascinated by small shiny objects and there's plenty of them at this site.

      This is kind of a link here about that but I read a better piece that talks about how all eight of the Romney vetoes were overridden round about June 2006 - ish? I'l try and fing the link I should have that article somewhere for posterity.    

      But overall, you make an fair point about employers shirking their responsibility to provide coverage since enactment of the new law. But even if people commit out and out fraud, does that justify the throw the baby out with the bathwater argument? I don't know. Maybe.

      •  No, not small businesses only. (0+ / 0-)

        Did you read the article? Burger King is gaming the system.  Employers above the limit are fragmenting their company into smaller legal pieces to avoid it.

        We don't even have a clue how many have gone the "independent contractor" route to screw the system.

        I chose not to do that because I had to make choices here and I didn't have the sources.

        At least you admit you cherry-pick the data.  Kudos for admitting that.

        •  I wish I could say the same for you (0+ / 0-)

          Kudos that is, but sadly I can not in good conscious.

          I'm interested in having an honest discussion. You're interested in defeating the law because you're a single-payer partisan that will use the MA law to defeat any hope we have of health care reform in this country in the next generation that will work for most Americans.

          Do you agree that an employer based solution offering Medicare for everyone absent any eligibility requirements is a back-door to single-payer?

          Kudos to you if you can muster the courage to admit that just about everyone in this country could live with that kind of plan proposed and passed by the Federal government in the next Congress.  

  •  It does not matter what you say (3+ / 0-)
    Recommended by:
    mbair, benny05, poligirl

    Like with so many things that humans get their hands on, the promise of the blogosphere is ruined by a lack of communication.

    This type of venue is useless to persuade as it serves as a debating society between teams of supporters.  Only a few have open minds.

    You see, it's all about partisanship and candidates winning, come hell or high water.  It's mostly a bunch of white noise, repetition, and hot air, not very useful when it comes to information, critical thinking or decision making because of the spin that colors most of what is offered.

    And let's not forget the put downs.  Would we be progressives if they were not invariably included in the discussion?

    I applaud your effort, however, wasted though it may be in the scheme of things.  I believe that a mandate will get us closest to full coverage.  No one has explained how we will deal with those who opt out when they finally need coverage, or how much more the system will suffer because they avoid treatment so as not to get caught.

    Besides that, I'll leave this to all the self pronounced experts who seem to know better than the actual experts themselves.

    •  I know, I know (0+ / 0-)

      but I actually blog just for relaxation. And I'm no stranger to high dudgeon. That's for sure.

      No one has really explained anything. We've been in the silly season for more than a year now. It's a shame. A real shame because this is still a great country.

      Deval Patrick used to say that "we need to stop acting like partisans and start acting like citizens again". Smart guy out governor. And he supports the mandate in our state, by the way.

  •  On Medicare (0+ / 0-)

    From a new press release from The Dartmouth Institute for Health Policy & Clinical Practice:

    Chronically Ill Patients Get More Care, Less Quality, Says Latest Dartmouth Atlas
    The Fix? A Major Overhaul of Medicare

    Medicare pays many hospitals and their doctors more than the most efficient and effective health care institutions to treat chronically ill people, yet gets worse results, according to a new report from the Dartmouth Institute for Health Policy and
    Clinical Practice.

    To see the whole press release go here.

    It's not just for-profit healthcare insurance companies or small risk pools that effect high health care costs. It's also the doctors and the games doctors and private health insurers play so that everyone gets a piece of the pie.

    Just wondering--does anyone know what percentage of our economy is related to the healthcare/pharma industry?

    •  I actually can get that number for you (0+ / 0-)

      it'll take a while though. Check your hotlist. I'll eventually post it here as a reply to your original comment.

      And yes the whole thing is just a mess. I wonder how the physician side of the equation games the system. I'll take a look at the study.

      Something else here that leaps to mind from your comment and not the study is that a lot of us forget that doctors can rack up hundreds of thousands of dollars going to school. When they graduate they have to go to work for employers themselves. That limits the choices of who they see and how they treat their patients. I met a doctor at an Edwards town hall and he talks about this issue with me on tape. He's the last provider in all of Stafford County NH that will treat the indigent.

      It's another wrinkle is the discussion that no one really talks about but illustrates the uphill both ways axiom. I'll go and read that study though, thanks for the link.

  •  here's why you and Elizabeth are wrong: (1+ / 0-)
    Recommended by:
    Catesby

    a mandate w/out a cap on profits of at least 15% is simply corporate welfare to the tune of $700billion/year, for starters.  Universal care that costs 3trillion/yr is not a good thing, it is a recipe for fiscal destruction.  You mandate people are being disingenuous.  JRE's plan had a 15% cap plus an option for single-payer.

    To argue that hillarycare is better is a false dichotomy.

    ..to be healed/the broken thing must come apart/then be rejoined.

    by Zacapoet on Thu Apr 10, 2008 at 06:06:43 PM PDT

    •  Who is talking about the Edwards plan? (0+ / 0-)

      Here, not that I take your word for it anyway. I'm talking about the plan the Democratic party is going to run on this fall.

      Hillary's plan is better because she includes Medicare too. Obama's "public plan" is not the same kind of thing.

  •  Thank you for a detailed discussion (3+ / 0-)
    Recommended by:
    mbair, carllaw, jandress

    on health care that does not rely on sound bites and slogans. This is a very complex issue involving much homework.

    According to a Families USA report I read today, 3000 people between the ages of 24 and 64 in my state of Oklahoma died unnecessarily early between 2000 and 2006 because they had no health care coverage. I do not know who Families USA is, but I do know that it fits in with the 18,000 annual unnecessary deaths in the U.S. figure that has been widely quoted. We need an actuary to weigh the costs of these losses against the costs of the health care.

    Support Andrew Rice for the US Senate: link

    by tsunami on Thu Apr 10, 2008 at 06:54:51 PM PDT

    •  See? That's what I mean. (0+ / 0-)

      People dying because they can't get in to see a doctor is just ... well you know.

      Check out a conversation I had with a knowledgeable doctor at an Edwards in this comment. Pay attention to what he says about kids not going to the dentist. It's just so stupid and gross and unconscionable.

      I don't think that cost should even be a consideration exactly for the reason you posted here. We are a vastly rich nation. It ain't right. There outta be a law.

      But I'm from Taxachusetts.

  •  Who pays for the uninsured? (1+ / 0-)
    Recommended by:
    jandress

    One thing Obama needs to address is how is plan prevents cost-shifting. Right now hospitals charge $40 for a bottle of water and $15 for a bandaid to insurance companies to make up for treating the uninsured. The insurance companies then increase the cost to the consumers. In fact, I heard on the radio that it costs an extra $800 a year to the consumers. But what happens when the uninsured have to go to the Emergency room because they fell down and sprain their ankle. They do not have insurance so they have to go to the ER  which costs alot more. Who pays for it? Will Obama let the insured pay for it as they do now? That will only increase the cost of health care. How will Obama prevent hospitals from cost-shifting?

    •  I have been in that situation (0+ / 0-)

      I had an emergency eptopic pregnancy, and no insurance.

      My credit cards were completely wiped out by the hospital before they even let me in.  And I paid far higher prices because I didn't have insurance.

      Ban that.  All prices should be the same, regardless of the customer.  Charge interest on overdue accounts, sure.  But the prices should be the same across the board.

      So people who do not have insurance do not get off scott free.  They are hounded for payment, if they do not pay cash up front like I did.  And even if they pay cash, they pay far higher prices than anyone else.  Of course, then who pays for those who are hounding for payment?

      It's just really strange, when you have grown up in a country with single-payer universal health care, because it looks really sick and medieval.

      •  I know someone too (0+ / 0-)

        who got wiped out financially from the costs of a pregnancy. They didn't have an emergency situation, but those bills are taking them years to pay off.

        Medieval is charitable. I don't know whether this country needs new leadership or an exorcism. Good think Pope Benedict has committed the church to investing in "rapid response teams" to perform them.  

  •  Mandates are essential in a single payer plan (0+ / 0-)

    Then the arguments about the larger pool lowering costs hold true
    Divided up among many insurance companies? Not so clear.

    Outside of a single payer system I can't see justification and can't think of any comparable set ups. Yes we all have to have auto insurance but only to the level that it covers protecting others from loss, not ourselves.  

    But please remember that Obama includes the mandate for children because that's the best way to get the most kids covered. So if mandates work for kids then why don't they work for adults. Right?

    The difference here isn't just "will mandates work, can we enforce them" but I'll touch on that first. You can check on the health insurance status of a majority of kids through schools and daycare. Where do all adults gather?
    But the importance of the adult/child difference is children are not the ones making the choice. We will mandate the best choice for them, being insured.
    Adults are adults and have a choice. Most adults want insurance and if it is affordable or if they are subsidized they will choose to get it.
    Obama's plan lets kids stay on their parents plan through 25 and that does cover a lot of those who might chose not to.
    As far as employers I do like his reinsurance for catastrophic coverage, that will make it more affordable to many employers.

    Without the mandate we can't argue that "we're all in this together" and it's going to be tough but the results are an investment in our future.

    I can't imagine that cheer coming from this, good Lord. Again with single payer it would be something else, the all for one, one for all thing. We would not all be in this together, not in any way. It's only going to be tough on some.

    "Most of us will get more affordable coverage" under the new plan doesn't sound as persuasive.

    How about phrasing it "Everyone who wants insurance will get more affordable coverage"

    Besides why accommodate conservative senators by leaving out the mandate

    It isn't being left out to accommodate them but frankly do you think only conservatives would be against them?
    You can certainly be progressive  and feel mandates have no place in a plan that involves multiple  private insurance companies.
    I do though think it has a better chance of getting passed.

    I'm not happy with either plan but I am glad they are both doing something. My recoiling at mandates under these plans has nothing to do with being an Obama supporter...I was against them when I was still hoping for Gore and didn't much care for any of the others.

    The first thing we need to do is get things through. Plans chnage in getting through...I hope that could even be for the better. I don't know if Clinton plans to have the same open broadcast negotiations and also plans to let consumer advocates and medical personnel come and be part of it too but I think things like that even have a chance of making it better, not more watered down. Before the public and behind closed doors can bring two different results.

    Maybe mandates will turn out to be necessary but I say let things get into place, lets get it going, see how prices go, how the system works before we even think of saying everyone has to be part of it. Enforcing mandates as it's initially getting underway just adds layers of red tape and hassle

    •  I see leaving out mandates (0+ / 0-)

      because poor people might not be able to afford it even with subsidies or even free insurance akin to saying "let's just leave poor people out".

      Not very progressive in my book.  If poor people cannot afford free or subsidised care under Hillary's plan, they are going to be similarly screwed under single payer.

      •  Poor people are covered under everyone's plan (0+ / 0-)

        I have to admit to being thrown by you mentioning a couple of times not affording free care? Who can't afford free?
        It would be middle income people who didn't get free or subsidized health care.

        But here's the difference between what Obama and Hillary offer and universal single payer.

        Under Obama's and Hillary's plans the most affordable plan would likely have a high deductible and copays. If extra money is going for premiums that leaves less to be able to afford to go to the doctor.
        Now it comes in great if there is a big emergency that requires hospital care. Even if they have to pay a big sum towards it they won't have a $50,000 debt for a single event.
        What it doesn't help is getting to the doctor and getting medicine to begin with.

        Universal single payer offers everyone the same basic health insurance and the cost is much lower-we have one huge pool for risk sharing, it's non-profit and lowest administrative costs.
        They can also decide how payments are determined and what form they take. I know the Medicare system here but coverage for a nation wouldn't be done that way. Look I don't know how other countries manage their universal health care, how everyone takes part, pays their share. Is it just through taxes? Let's pretend that

        But this hypothetical middle class person who don't feel they can afford Obama/Clinton plan is certainly working (to have above free/subsidy level income) so they'd be paying their share through their proportional taxes

    •  Okay, but ... (0+ / 0-)

      The mandate is there to cover the most children because mandates cover the most people. It's pretty simple and I don't think your candidate is even making that argument anymore.

      Yes we all have to have auto insurance but only to the level that it covers protecting others from loss, not ourselves.

      Yes and if I have to pay the costs of emergency room visits through whatever cost shifting is put in place then I'm not being insured against my loss or increased costs because someone else opts out, gets sick or injured and then runs up a much larger bill then they would need to if they have insurance. People without insurance or people that opt out and never use the system cost me nothing.  

      I think someone is in charge of those children in the mandated portion of Obama plan. I also think they might be likely to need insurance since they don't cover their own kids for whatever reason. So it wouldn't really be a problem to sign them up when you sign the kids up. Right?  

      You're phrasing is much better, admittedly. I'll give you that. But either way, the current Obama plan is not going to be allowed to be sold as truly universal care once he's the nominee. The knives will come out in the media once he gets the nod. I really believe that. They'll kill him with trash and start to ask the tough questions once he is our nominee. I hope I'm wrong, really I do.

      The accommodating thing was exactly what Kerry said. He agrees that mandates do the most to get the most people covered and that mandates may be needed in the 2012 time frame. I never posted that Obama said that. I didn't mean to imply that in any way. That was not my intention.

      Maybe you're right here:

      I'm not happy with either plan but I am glad they are both doing something. My recoiling at mandates under these plans has nothing to do with being an Obama supporter...I was against them when I was still hoping for Gore and didn't much care for any of the others.

      Maybe it's a doable sale in the electorate because mandates are so unpopular in the media. But they aren't unpopular with actual people.  

      •  I'm not trying to make my candidate's argument (1+ / 0-)
        Recommended by:
        mbair

        just saying what I do or don't like about them.
        Yes you can get parents at the same time you get the kids. You can get people at many places. Most people getting it will be working, the employer can be part of reporting. There are ways.

        Hillary won't be able to sell hers as truly universal care either and would also get trashed for claiming it. No expert say mandates bring universal health care although they do agree they get more people covered. They both offer universal access breaking down many barriers

        People who refuse insurance are taking that debt on themselves and if they get emergency care they work out repayment. It definitely would have been cheaper for them to get insurance. You're talking about people who don't pay. Maybe uninsured people needing emergency care and not paying will be a problem. There will be so many fewer uninsured, in a given year so few are likely to have emergencies, those are spread out throughout the country, a portion of them will do repayment.
        As an aside the uninsured have been subsidizing the rest of us for years. They pay far more for doctors, drugs, tests and hospital care than insurance companies pay. We've been charging the most to those who can afford it least.

        You didn't imply that Obama said mandates may be needed later although Obama has said it could turn out that they are. Again I was just giving my opinion. Keep it as simple as you can, correct from there.

        I did see the post with the poll earlier. I don't know if they asked the question with mandates on their own or compared a plan with mandates to a plan without mandates. It doesn't give me a sense about how people feel about mandates.

        But again I am talking about what I think of mandates. I'm not the boss of how it will go but I can't make myself support mandates that include for profit companies as an initial step in this large undertaking. My opinion is humble but strong.

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