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Just a quick diary here. Senator Max Baucus (D. Mont.), chairman of the Senate Finance Committee, which is the committte with jurisidiction over a universal health care plan, says we need mandated health insurance.  While I prefer single payer, so long as the eventual plan has a means to migrate to single payer, I think this is progress.  And this plan has a government option.

Paul Krugman indicates that Barack Obama may not oppose a plan with mandates:

This is very big news.


But now Max Baucus — Max Baucus! — is leading the charge on a health care plan that, at least at first read, is more like Hillary Clinton’s than Barack Obama’s; that is, it looks like an attempt at full universality

(The word I hear, by the way, is that Obama’s opposition to mandates was tactical politics, not conviction — so he may well be prepared to do the right thing now that the election is won.)

Paul Krugman, Hopeful signs on health care

More, after the poll. (Obama spokesman update at end of diary)  (Kennedy comments in Update II)

It looks like the Democrats are not going to settle for baby steps:

Baucus of Montana, chairman of the Senate Finance Committee, said in a health-care blueprint released today that only a mandate could ensure people didn't wait until they were ill to buy health insurance, forcing up the price for everyone.

The 89-page proposal revives a debate from the Democratic presidential primaries about how to overhaul the U.S. health- care system. Obama supported requiring coverage only for children, saying adults would buy coverage voluntarily if it were affordable. Senator Hillary Clinton of New York said insurance must be mandated for everyone.

``Requiring all Americans to have health coverage will help end the shifting of costs of the uninsured to the insured,'' Baucus said today in his plan. The requirement ``would be enforced possibly through the U.S. tax system or some other point of contact between individuals and the government,'' he said, without spelling out possible penalties.

Senate Finance Chief Calls for Making Health Coverage Mandatory

The Baucus plan has a government option:

Echoing Obama's campaign proposals, Baucus said the exchange should include a new government plan, similar to Medicare, that would compete with private insurance, as well as subsidies to make coverage more affordable. Except for small businesses, employers that don't offer insurance to their workers would have to contribute to a fund to help cover others.

``Once affordable, high-quality, and meaningful health insurance options are available to all Americans through their employees or through the Exchange, individuals would have a responsibility to have health coverage,'' he wrote in his plan.

Senate Finance Chief Calls for Making Health Coverage Mandatory

I hope Krugman is right that Obama's anti-mandate proposal was more tactical than deep conviction.  At one time, Obama favored single payer.  I suspect he will sign a bill with mandates or without mandates, so long as it has a government plan that will compete with private insurance and could migrate to single payer.

Other big players in the Senate will be Teddy Kennedy and Hillary Clinton.  Baucus says this 89-page proposal is a ``vision for health-care reform,'' not a legislative proposal.  And Teddy Kennedy wants Democrats to agree on a single bill first and then work together to pass it.  

The big news is that universal health care is on the agenda.  If we cannot get single payer, this is a real step forward.

(Just a note: the Clinton universal health care plan (on which the Baucus plan is somewhat based) was extremely similar to the plan announced by John Edwards in early 2007, months prior to the Clinton plan:

Feb 5, 2007

Chapel Hill, North Carolina – Senator John Edwards today released a bold plan to transform America's health care system and provide universal health care for every man, woman and child in America. Under Edwards' plan, families without insurance will get coverage at an affordable price, families with insurance will pay less and get more security and choice, it will be cheaper and easier for businesses and employers to insure their workers.

"The American health care system today is broken for far too many of our families," said Edwards. "To fix this crisis, we don't need an incremental shift, we need a fundamental change. We need universal health care in this country—not only access to insurance as some politicians say—so every American is insured and we bring down costs for middle and working-class families."

Edwards Announces Plan for Universal Health Care

John Edwards had some personal failings, but he placed universal health care on the agenda last year, leading to the announcement of universal health care plans by Obama and Clinton months later.  At the time Edwards made the announcement of his plan in February 2007, and said he was willing to pay for it by repealing Bush's tax cuts for those who make over $200,000, most Democrats thought that universal health care was years away.  The failure of the Clinton administration in 1994 to get its plan passed took universal health care off the table for years.  Dr. Dean supported it in 2003 and 2004, but incrementalism was the policy.  Many Democrats were afraid of being called "socialists" or being accused of favoring "socialized medicince." Hillary Clinton spoke of doing it at the end of her second term, and Barack Obama had no plan for months in 2007.  Edwards, as he did with many issues, pushed the agenda leftward, and that was a good thing. (I'm glad Obama won the nomination and he was clearly the right choice, but I'm also glad Edwards ran and pushed these issues.  It was a win/win for all of us.)

Hillary and Bill Clinton also tried to reform health care in 1993 and 1994. Many have fought for this, but I wanted to thank John Edwards here).  

Update I:  The Office of Barack Obama provides a non-committal comment:

"President-elect Obama applauds Chairman Baucus’s work to draw attention to the challenges of the health system and looks forward to working closely with the Chairman and other Congressional leaders, as well as the American public, to make quality, affordable health care a reality for all Americans."

Ben Smith, quoting Obama spokesman spokesman Tommy Vietor:

Whether you agree or disagree with mandates or even an insurance plan, this is good because it keeps health care as a priority.  

Update II:

Teddy Kennedy comments on Senator Baucus' proposal:

"Senator Baucus’s white paper is a major contribution to the debate on health reform. It provides an important analysis of the urgent need for significant improvements in our health care system, and thoughtful recommendations for reform. I look forward to working with Senator Baucus, our colleagues in Congress on both sides of the aisle, and the Obama Administration to see that we at last achieve the goal of quality, affordable health care for all Americans. Senator Baucus's white paper brings us closer to that goal."

Quoted by Ezra Klein

Ezra Klein has more:

Baucus also addressed Kennedy directly in his opening statements:

The fact is I did not write an actual bill that is legislation because I want to work with Senator Kennedy, the HELP committee, and senators on both sides of the aisle. I've spoken with Senator Kennedy three times over the last few weeks about this, and we're very much on the same page.

Quoted by Ezra Klein

Originally posted to TomP on Wed Nov 12, 2008 at 06:48 AM PST.

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  •  Tips for universal health (350+ / 0-)
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    "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

    by TomP on Wed Nov 12, 2008 at 06:48:31 AM PST

  •  Karen Ignagni on C-Span (8+ / 0-)

    Washington Journal this morning. Watch her try to save her dying industry.

  •  I don't support the use of mandates (36+ / 0-)

    It's going to be a huge political fight with mandates on health care coverage. The public will easily be duped into believing they're forced to buy health care coverage they can't afford. The insurance companies pushed for the mandates in Baucus's plan because they know it'll kill the plan in Congress.

  •  It's morning in America (10+ / 0-)

    That's great news about Baucus! Just broaching the subject of mandates is a quantum leap, IMO.

    There is no reason Congress should not move expeditiously in this area in parallel with whatever other priorities are thrust upon them.

    You kids behave or I'm turning this universe around RIGHT NOW! - god

    by Clem Yeobright on Wed Nov 12, 2008 at 06:54:59 AM PST

  •  From a party building standpoint, (14+ / 0-)

    I can't think of a better issue to get through than universal health care. The leadership will be too gun shy to push single payer right now, so a plan with a "path" is good enough for now.

    Good catch.

    If Liberals hated America, we'd vote Republican.

    by ord avg guy on Wed Nov 12, 2008 at 06:55:26 AM PST

    •  I can't think of a single issue (8+ / 0-)

      that would drive people to vote Republican more than "mandates."  America is broke.  Do you think it wants to be given a medical insurance bill it can't pay, from a government which just revised the bankruptcy laws to create a class of permanent debt peons?

      "If they can get you asking the wrong questions, they don't have to worry about the answers" -- Thomas Pynchon

      by Cassiodorus on Wed Nov 12, 2008 at 07:46:38 AM PST

      [ Parent ]

      •  Mandates are not a solution (4+ / 0-)

        Repubs will become popular by abolishing the mandates, and then we're back to where we started.  People will start hating the idea of universal health care if they are punished for not buying into it.  People should want universal health care.  On the other hand, if we do this right, the democrats will be thanked for generations to come.

        We need to focus on preventative care, reducing unnecessary costs, providing more primary care to more people, and ensuring that anyone that needs treatment can get it.  
        Mandates don't do any of this. They just transfer the problem to the patient.  Hospitals, when confronted by sick people without insurance, will then have an additional reason to throw them out the door.

        "Nothing in biology makes sense except in the light of evolution" - Theodosius Dobzhansky

        by science nerd on Wed Nov 12, 2008 at 10:38:56 AM PST

        [ Parent ]

        •  Also -- (2+ / 0-)
          Recommended by:
          cynndara, science nerd

          We need to make it cheaper to be a doctor, and not weigh the doctors down with huge student loan bills, so that doctors will find it easier to care about more than money...

          "If they can get you asking the wrong questions, they don't have to worry about the answers" -- Thomas Pynchon

          by Cassiodorus on Wed Nov 12, 2008 at 11:12:44 AM PST

          [ Parent ]

          •  More medical schools. (2+ / 0-)
            Recommended by:
            Cassiodorus, TomP

            As long as it takes heroic efforts just to get IN to medical school, and then even more heroic efforts to pay for it, doctors are going to have to demand high salaries when they get out, and we are all going to have to pay them. And they're still going to be paying as much attention to keeping their finances straight as they are to practicing medicine. The medical schools -- even the NURSING schools -- practice "occupational birth control" by making sure there are lines, lists, and waiting applications years long.  So start more schools.  And spike them with "community medical service" scholarships that take the financial worry off the young doctor's shoulders -- you get the scholarship, they pay for your degree, then you work for them for the next thirty years ... you have a decent salary and you practice medicine.  You don't get rich, but you don't have to pay back loans.  You can work at any registered "community medical" facility -- and the list of those should be continually expanded until they include everything except snooty posh places that only take Private Patients.

    •  Mandates are political suicide for Dems (10+ / 0-)

      Mandates would force people to pay for something without guaranteeing them anything.  Other than the insurance companies — who needs that?  I don't make enough money to even consider buying health insurance.  I wouldn't comply with a mandate like this unless I first receive a guarantee that I'm going to get something of real value in return for it.

  •  As long as there is some government (23+ / 0-)

    option that is similar to medicare, I am happy with mandates. My concern about mandates was forcing people to purchase private insurance. This would be a windfall for the industry. Medicare is simply much more cost efficient because it spends much less on overhead.

    •  auto insurance (9+ / 0-)

      Think mandated auto insurance with penalties.  It was absolutely a bonanza for auto insurance companies.

      Yet the prices of auto insurance are now so high that many simply gamble driving without auto insurance.  Of course, the lower class can't afford the penalties either of an accident or a police stop either.

      •  Is there a government (5+ / 0-)

        option and Medicaid for auto insurance?  Poor analogy.

        "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

        by TomP on Wed Nov 12, 2008 at 07:14:12 AM PST

        [ Parent ]

      •  Auto insurance is slightly different (6+ / 0-)

        In Massachusetts (at any rate) you are obligated to carry insurance for damage YOU might do to OTHERS with your vehicle, but your own health and vehicle is optional. I support that mandate.

        I do not support a mandate that requires me to spend money with a private company simply because I exist.

        •  But Do You Believe That If You Opt Out (0+ / 0-)

          That is to say if you say, "I will not send money to this company because I exist," and then you fall sick or greviously injured, everybody else should have to take care of you?

          I'm trying to figure out if this is based on principle or just hatred of private companies.

          --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

          by TooFolkGR on Wed Nov 12, 2008 at 07:42:03 AM PST

          [ Parent ]

          •  This is what government is FOR (9+ / 0-)

            To step in an make possible those things which private enterprise cannot do.  It's eminently clear that private health insurance in this country = massive fail.  

            It's one thing to create a system whereby tax revenues are used to pay the health care costs of all.  It's quite another simply to require citizens to patronize a for-profit insurance racket.

            •  But IS That True? (1+ / 0-)
              Recommended by:
              Clem Yeobright

              I think it's eminently clear that private health insurance in this country = "not great" but a massive failure?  When my appendix ruptured my private insurance paid for $12,000.00 of the bills... without it I would have been bankrupt.  We hear horror stories about preexisting conditions and basic coverage denials, and those are serious issues that need addressing... but to pretend that those anecdotes prove we need to tear everything down and start from scratch is, I think, a stretch.

              --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

              by TooFolkGR on Wed Nov 12, 2008 at 07:56:25 AM PST

              [ Parent ]

              •  48 million uninsured and rising... (3+ / 0-)

                If that isn't "massive fail", I would hate to see your definition of "success".

                I think it's great that you have health insurance.  Really, good for you.

              •  How much have you paid in (3+ / 0-)
                Recommended by:
                Jagger, cynndara, science nerd

                premiums over the years, compared to how much they've paid out for you?  And what if you factor in the interest that money could have made over the years?

                You'd have been bankrupt if you'd simply not done anything, but would you be ahead or behind the game now, if you'd just put the same amount into a savings account earning low interest all along?  On average, supposedly 30% of the money that goes into insurance simply goes to the insurance companies, not healthcare.

                It's a scam.  If we had a gov't run 'big pool o cash' into which everyone paid, that didn't require giving profits to shareholders, your premiums would be roughly 30% lower.

                Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

                by drbloodaxe on Wed Nov 12, 2008 at 08:35:02 AM PST

                [ Parent ]

            •  I think that can fall under: (2+ / 0-)
              Recommended by:
              cynndara, science nerd

              We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. That to secure these rights, Governments are instituted among Men, deriving their just Powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

              McCain, Republican Party, Palin = Captain, Sinking Ship, Anchor.

              by Pescadero Bill on Wed Nov 12, 2008 at 08:51:51 AM PST

              [ Parent ]

              •  An addendum to this. (1+ / 0-)
                Recommended by:
                science nerd

                If insurance companies are interfering with our Safety and Happiness, we the people must direct our government to do something about it. If that government fails to do so, we have the right, authority, and the mandate to abolish it.

                We must always keep that in mind.

                McCain, Republican Party, Palin = Captain, Sinking Ship, Anchor.

                by Pescadero Bill on Wed Nov 12, 2008 at 08:56:32 AM PST

                [ Parent ]

    •  Can we make the "medicare" option the best, most (9+ / 0-)

      affordable option?

      Low ball the insurance companies out of business.

      The only people who are happy with their health insurance plan, haven't used it yet.

      by Hens Teeth on Wed Nov 12, 2008 at 07:23:20 AM PST

      [ Parent ]

      •  Bingo. (1+ / 0-)
        Recommended by:
        Hens Teeth

        "You can't teach an old dogma new tricks." Dorothy Parker

        by AnnCetera on Wed Nov 12, 2008 at 08:07:07 AM PST

        [ Parent ]

      •  Not necessarily in the near term (2+ / 0-)
        Recommended by:
        slinkerwink, Big Tex

        (1) the insurance companies are going to dump all the "high risk" people into the government program. Premiums for smokers, or for those with a past history of cancer or hear disease, for example, will suddenly become astronomical so that smokers will be forced on to the government plan.  

        (2) in order for government insurance to be affordable for the working class, the rich are going to have to pay premiums high enough to subsidize premiums for the working class.  That means the rich will pay premiums for themselves and a some of the premiums for the working poor.  No one in their right mind would opt to do this. The healthiest rich people are all going to opt out of the government system if they can.  They will satisfy the "mandate" by buying private insurance for healthy people.    

      •  How about making it the default option... (3+ / 0-)
        Recommended by:
        tmo, Hens Teeth, science nerd

        We don't fine people who don't buy insurance, we just automatically assign them to the government plan, and assess the corresponding tax. People who have employer benefits are fine. Others end up on the government plan unless they prefer to buy from the thieves.

        All that is required for evil to flourish is for good people to stand by and do nothing.

        by davewill on Wed Nov 12, 2008 at 09:47:42 AM PST

        [ Parent ]

    •  The government option will fail (5+ / 0-)

      Here is why:

      The for-profit insurers will find ways to dump the sick onto the public rolls. The government option will have to take them. That in turn increases the cost of providing the government option. That means one of three options:

      1. Increase premiums
      1. Cut services
      1. Taxpayer bailout

      None of which will be popular, all of which will be used by opponents of single-payer and even of government involvement in health care to say "see! the system sucks!"

      Nobody, anywhere, should be forced to purchase ANY insurance. It is a tax on the poor.

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

      by eugene on Wed Nov 12, 2008 at 07:41:52 AM PST

      [ Parent ]

      •  Look at the rest of the world (1+ / 0-)
        Recommended by:
        Pescadero Bill

        people pay taxes in order to have healthcare at minimal cost.

        There are arguments about socialized medicine with the lines, etc. but most citizens of countries who have done this (=all but the US) are alright with that. In Canada, further health insurance coverage can be bought, at reasonable cost per month.

        Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

        by riverlover on Wed Nov 12, 2008 at 08:09:15 AM PST

        [ Parent ]

    •  Why not start by expanding medicare? (2+ / 0-)
      Recommended by:
      cynndara, princess k

      Perhaps by covering all children, for instance, as well as raising the income limits for medicaid.  Personally, I would love to see all children have free care, no questions asked, at least as a start.  Plus, it's harder for repubs to argue against that.  

      "Nothing in biology makes sense except in the light of evolution" - Theodosius Dobzhansky

      by science nerd on Wed Nov 12, 2008 at 10:33:35 AM PST

      [ Parent ]

  •  I still don't think mandates are a good idea (8+ / 0-)

    that's not what makes coverage universal-- universal means everyone gets it. If you can't afford the coverage or the fee, how do you have coverage? I think the issue isn't "shifting costs of the uninsured to the insured" it's shifting costs from those who can't afford enough coverage back onto their own shoulders. We're all in this together, and we all need better healthcare. This could be a start, but Obama needs allies on the Hill.

    President-elect Barack Obama.

    by noabsolutes on Wed Nov 12, 2008 at 06:59:28 AM PST

    •  Read. The. Plan. (0+ / 0-)

      I'm continually blown away by this kind of comment. Have you read it? Any of it? I can't believe you have, because you wouldn't have this question.

      Do people making 10k/year pay income tax? Why do you immediately assume that the big bad government is going to force the little guy to shell out? The whole point here is that it'll be a progressive cost system. The rich will pay for the poor.

      Seattle Transit Blog

      by Bensch on Wed Nov 12, 2008 at 07:57:43 AM PST

      [ Parent ]

  •  I am so tired of listening to politicians (41+ / 0-)

    talk about health insurance. I don't want health insurance, I want health care. Insurance is a joke.

    "...and will to the best of my Ability, preserve, protect and defend the Constitution of the United States." --Barack Obama, January 20, 2009

    by jiordan on Wed Nov 12, 2008 at 07:00:33 AM PST

  •  tip'd/rec'd (8+ / 0-)

    Important diary and needs more attention...

    "When the power of love overcomes the love of power, the world will know peace.-- Jimi Hendrix (1942-1970)

    by ebbinflo on Wed Nov 12, 2008 at 07:02:06 AM PST

  •  I'm torn on this issue (15+ / 0-)

    Considering the state of the economy and the fact that it WILL get worse long before it gets better I'm confused as to how people that are losing their jobs and homes can possibly afford to buy insurance.  I know I can't afford it even if it's very reasonable at this point because my husband has been laid off for two months now and we are barely keeping our heads above water NOW.  I truly want healthcare but I'm not sure now is a good time to be pushing it while we are facing a Depression.

    ~War is Peace~Freedom is Slavery~Ignorance is Strength~ George Orwell "1984"

    by Kristina40 on Wed Nov 12, 2008 at 07:02:25 AM PST

      •  You assume there is no subsidy (6+ / 0-)

        for those without money.  That is not correct.

        "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

        by TomP on Wed Nov 12, 2008 at 07:09:21 AM PST

        [ Parent ]

        •  so, how would it work for a single person (7+ / 0-)

          who makes 35k a year? A couple? A family of four on 45K? What would the subsidies look like? Would the fee for not going without health care be cheaper than the premiums themselves?

          •  Again, those things will be sketched out. (3+ / 0-)

            I suspect such a family will pay very little.  Any plan that did not would not work.  Please give Senators Baucus and Clinton (and Teddy Kennedy) some credit for having brains.  Any plan would not be designed for failure.  

            I prefer single payer where taxation from all on aprogresisve basis pays for health care for all, but this is a steep forward.

            Most people here liked universal health insurance with mandates and a public plan/government component competing with insurance companies until Obama released his plan without mandates.  Then support for Obama drove a few into opposition to mandates.  If Obama does not make mandates a big issue, accepting a plan with or without, then many people here will not.

            "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

            by TomP on Wed Nov 12, 2008 at 07:17:58 AM PST

            [ Parent ]

            •  That's a bit of revisionist history, Tom (4+ / 0-)

              Regarding your comment about "Most people here liked universal health insurance with mandates.....until Obama released his plan without mandates." Show the proof that a majority of Kossacks supported the mandated health care version until Obama released his health care plan.

              •  I was here and you were here. (7+ / 0-)

                Edwards won every Dkos monthly vote until late in January.

                Obviously I don't have time to poll all comments, but I can say that even after Obama released his plan, most people here still supported the Edwards plan, and even some Obama people supported Obama, but liked the Edwards plan better.

                It's my subjective view.  Yours may be different.

                But it is not revisionist history.

                How many Nyceve diaires hit the Rec List all the time?  And how many Obama health care plan diaries?    

                "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

                by TomP on Wed Nov 12, 2008 at 07:22:27 AM PST

                [ Parent ]

                •  Internet polls are not that reliable, Tom, and (1+ / 0-)
                  Recommended by:

                  you know it.

                  •  This is Foolish (3+ / 0-)
                    Recommended by:
                    MontanaMaven, nicolas, ZhenRen

                    A poll of DailyKos to figure out the opinions of the nation would be extremely unreliable, but suggesting that the dKos straw poll was an unreliable way of guaging support of active dKos people is just dishonest.  That's all he was saying was that Edwards was the favorite candidate at dailyKos, and that's not even disputable.

                    --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

                    by TooFolkGR on Wed Nov 12, 2008 at 07:53:52 AM PST

                    [ Parent ]

                •  Nyceve is an opponent of mandates (5+ / 0-)

                  At least that's how I recall it. She is at least skeptical of them, and isn't the cheerleader for the concept that you are.

                  Besides, your inner Edwards supporter is showing.

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

                  by eugene on Wed Nov 12, 2008 at 07:44:53 AM PST

                  [ Parent ]

                  •  and look how great Edwards turned out to be. (3+ / 0-)
                    Recommended by:
                    eugene, blueocean, science nerd

                    Cheating on his wife who has terminal cancer, and lying to us about it. He's a real 'champion' of the working people, all right.

                    •  Go Tuck Yourself In (6+ / 0-)

                      This shit belongs at Redstate.

                      --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

                      by TooFolkGR on Wed Nov 12, 2008 at 07:48:49 AM PST

                      [ Parent ]

                    •  That is a total bullshit (7+ / 0-)

                      comment.  Attacking John Edwards as you just did reveals to me that you cannot argue rationally.  Edward had an affair before she had a relapse.  That really is betwqeen him and Elizabeth.  I thanked John Edwards here for placing the issue on the agenda.

                      An affair has nothing to do with whether he supports working people, and you know it.  MLK Jr. had many affairs and he was a good amn who supported working people, the poor, and civil rights for African Americans.  

                      Moreoever, playing primary wars where we are talking issues shows me that you are unable to debate issues rationally.  

                      Attacking John Edwards cannot make your position correct.

                      Your comment is disgusting.

                      I no longer will be communicating with you or responding to any comments.  Good bye.

                      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

                      by TomP on Wed Nov 12, 2008 at 07:54:36 AM PST

                      [ Parent ]

                      •  Ok. What did Edwards accomplish in Senate? (2+ / 0-)
                        Recommended by:
                        Big Tex, science nerd

                        He's now charging 35K to give speeches about poverty. What a stand-up guy.

                        •  This is the last time (4+ / 0-)

                          I will speak to you.  I have lost all respect for you.

                          You are trying to attack John Edwards because you cannot defend your position.  But that is not what this is about.

                          Good bye.  

                          "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

                          by TomP on Wed Nov 12, 2008 at 08:02:57 AM PST

                          [ Parent ]

                          •  I have defended my position. You just refuse to (1+ / 0-)
                            Recommended by:
                            science nerd

                            get the political reality.

                          •  Which is What Again Exactly? (4+ / 0-)
                            Recommended by:
                            Clem Yeobright, benny05, TomP, ZhenRen

                            That internet polls are unreliable?  That John Edwards misused his penis?  That BECAUSE nobody who disagrees with you can give you a detailed breakdown of how every penny would be spent for a couple making $45,000 a year with two kids it MUST be a bad idea?  

                            Tom's never speaking to you again.  Good for Tom.  I'll speak to you.  You're full of shit.

                            --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

                            by TooFolkGR on Wed Nov 12, 2008 at 08:08:22 AM PST

                            [ Parent ]

                          •  heh. I've said over and over again in this thread (1+ / 0-)
                            Recommended by:
                            science nerd

                            that mandates won't work politically. TomP refuses to understand that political reality. Eugene has constantly provided examples as to why mandates don't work, and TomP's ignored him.

                          •  Yes Constantly (3+ / 0-)
                            Recommended by:
                            Clem Yeobright, benny05, TomP

                            He's said, "Massachusetts," when nobody is suggesting taking Massacusetts plan nationwide and "Auto Insurance," which is only mandatory to protect the health and property of others in case YOU cause an accident (thus protecting yourself from expensive lawsuits).

                            Tom has not ignored Eugene, rather he has pointed out (like I just did) that the examples he's "constantly providing" are not the last word for the reasons I listed.

                            --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

                            by TooFolkGR on Wed Nov 12, 2008 at 08:20:46 AM PST

                            [ Parent ]

                          •  Yawn (6+ / 0-)

                            Concurring Opinion

                            Lots of claims are being made about John Edwards' apparent endorsement of "mandatory preventive care" in a speech. First, let's look at his exact language:

                            [Edwards said his universal health care proposal] "requires that everybody be covered. It requires that everybody get preventive care. . . If you are going to be in the system, you can't choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK."

                            Now, if I understand the Edwards health plan correctly, that "If you are going to be in the system" qualifier is very important. Note this cornerstone of his proposal:

                            Health Care Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price

                            And as far as there being no other comparative system other than states, check this out.

                            Edwards' plan for "Health Care Markets" mirrors something the critics of universal coverage never seem to mention--that other systems that do offer universal coverage also routinely let their citizens supplement the state-run program with private insurance. Consider the case of France, detailed in Paul Dutton's Differential Diagnoses: A Comparative History of Health Care Problems and Solutions in the United States and France:


                            The French share Americans' distaste for restrictions on patient choice and they insist on autonomous private practitioners rather than a British-style national health service, which the French dismiss as "socialized medicine." . . . French legislators also overcame insurance industry resistance by permitting the nation's already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market.

                            Let's just say this doesn't sound like totalitarianism to me.

                            Now, if Edwards really meant mandatory preventive care for everyone, sure, that is a big change and worth debating. But anyone who's panicking about it might also want to worry about this bottom-line demand from the former Senator: "Does your plan cover every single American?"

                            It's not that hard.

                        •  About As Much As Any Other Democrat (2+ / 0-)
                          Recommended by:
                          benny05, TomP

                          ...when they were mostly in the minority.  He tried to roll back mandatory sentencing and was the first person to introduce privacy-protecting anti-spyware legislation.

                          But I'm guessing you don't actually give two shits about that because your'e just going to reply with a strawman like you do whenever you post anything.

                          --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

                          by TooFolkGR on Wed Nov 12, 2008 at 08:04:03 AM PST

                          [ Parent ]

                    •  I don't understand the petty comment (4+ / 0-)

                      You recommended this diary.  Why are you attacking Edwards for a good plan he came out with in 2007?  Because of an indiscretion?  A good plan is a good plan.  If you disagree with the plan or the concept of mandated health insurance, then give your reasons.  

                      You might as well attack Ted Kennedy while you are at it, even though he has been a leader on health care issues for a long time.

                    •  Mean spirited, ill-informed and counter (1+ / 0-)
                      Recommended by:

                      productive. What good is to be done by making a personal and subjective attack on a person who, though flawed like all of us, put forth very progressive, dare I say, very social democratic ideas for a former moderate Senator?

                      We desperately, and I mean desperately need a national health care plan.  I know people who are not getting treatment because of the cost.  I know people who are ill and dragging themselves to work because they need coverage. Joseph Stiglitz recently said that the people who say "it will take time" aren't dealing with the real life problems of many, if not most, Americans who don't have time.

                      Let's keep focused on the good stuff.  I am shocked that my Senator has moved in this direction at all.  This is a man who slept with "The World is Flat" under his pillow.  That Max has been moved to contemplate any kind of health care reform other than the old yada  yada of laundry list liberal "let's insure all the children" is a minor miracle.  

                      I still don't trust this, but I will start a letter writing campaign of my own to Max's offices here.

                      "It is not be cause things are difficult that we do not dare; it is because we do not dare that they are difficult." Seneca

                      by MontanaMaven on Wed Nov 12, 2008 at 02:48:06 PM PST

                      [ Parent ]

                  •  What Does That Mean "Inner Edwards Supporter?" (5+ / 0-)

                    Tom has given (again and again and again) GOOD reasons for supporting the plan.  What's the sniping all about?

                    --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

                    by TooFolkGR on Wed Nov 12, 2008 at 07:48:23 AM PST

                    [ Parent ]

                  •  Not completely correct. (7+ / 0-)

                    Nyceve supported the Edwards plan as a road to single payer.

                    Your other comment is quite assine.  

                    I also supported the Edwards plan as a road to single payer.

                    You assume that it was about Edwards.  It was about issues.

                    "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

                    by TomP on Wed Nov 12, 2008 at 07:49:11 AM PST

                    [ Parent ]

          •  It would be graduated, like a reverse income tax. (2+ / 0-)
            Recommended by:
            Clem Yeobright, TomP

            Those at the bottom of the scale would have subsidies equal to 100% of the insurance cost, and it would decrease as a percentage as the ability to pay increases compared to the expense of the cost for the household in question. Whole branches of economics and public policy have been devoted to these question, and so they're not new or without answers.

            "It's like we weren't made for this world, But I wouldn't really want to meet someone who was." --Of Montreal

            by andydoubtless on Wed Nov 12, 2008 at 08:45:15 AM PST

            [ Parent ]

            •  That works for single payer, of course (0+ / 0-)

              but not for the kind of system Obama promied.  That system has the rich subsidizing the poor by paying higher health insurance premiums -- by paying for themselves and part of the poor.  If, as Obama promised, the rich can keep their own insurance -- where they pay health insurance premiums just for themselves -- how many rich people are going to opt in to the government program?  

              The only way to guarantee that the rich subsidize the health insurance premiums for the poor is through a tax, where you pay it whether you are part of the government program or not.  

        •  I understand they want subsidies (1+ / 0-)
          Recommended by:

          I'm just not sure where they'll get it from.  Paulson quietly shoveled 2Trillion with a T through the Fed window while pushing for another trillion in bailout money.  Be careful not to look behind the curtain,  Treasury and Fed are BROKE.  

          ~War is Peace~Freedom is Slavery~Ignorance is Strength~ George Orwell "1984"

          by Kristina40 on Wed Nov 12, 2008 at 07:15:52 AM PST

          [ Parent ]

        •  The subsidies will be inadequate (2+ / 0-)
          Recommended by:
          tmo, slinkerwink

          As shown in Massachusetts.

          Besides, it is horribly inefficient to use insurance subsidies to pay for health care. Waste of money.

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

          by eugene on Wed Nov 12, 2008 at 07:44:02 AM PST

          [ Parent ]

        •  the subsidies are never sufficient (1+ / 0-)
          Recommended by:

          Study the "Massachusetts option," once again...

          "If they can get you asking the wrong questions, they don't have to worry about the answers" -- Thomas Pynchon

          by Cassiodorus on Wed Nov 12, 2008 at 07:49:16 AM PST

          [ Parent ]

    •  The Health Insurance Industry Profitability Act (13+ / 0-)

      That's basically what this is.  Mandating that everyone buy health insurance merely mandates profits for health insurance companies.  It does not, in any way, guarantee that every American has access to top-quality, affordable health care.

      •  Exactly. There you go. (8+ / 0-)

        And the lack of mandates basically would force insurance companies to offer better coverage in competition with the government model.

        •  Not really. (2+ / 0-)
          Recommended by:
          cynndara, science nerd

          The lack of mandates would simply leave younger Americans deciding not to buy insurance they can't afford and hope they won't need.

          But mandating health insurance would basically put us in the same place as does mandatory auto insurance: the insurance companies get rich, coverage is iffy at best, and the ininsured (or insured through the state plan) are people you hope not to meet on the road....

      •  Top Quality? (11+ / 0-)

        Nobody in America gets top quality healthcare with or without insurance.  The system is broken, I know, I watched what it did to my Mother may she rest in peace.  She had the best healthcare available and it didn't save her from their incompetence.  I'd rather go to a vet.

        ~War is Peace~Freedom is Slavery~Ignorance is Strength~ George Orwell "1984"

        by Kristina40 on Wed Nov 12, 2008 at 07:17:17 AM PST

        [ Parent ]

      •  Not true (7+ / 0-)

        A good plan would include a Medicare type option to provide people with an alternative to private insurance. You've not read much on the plans, apparently.

        •  This exists in Germany. (6+ / 0-)

          This is basically the health care model that exists in Germany.  German citizens are required by law to buy health insurance, either through the government agency or through a private agency.

          The government agency has the same rates regardless of age, while the private agencies are cheaper than the government plan for young adults but far more expensive when you get older.  The government agency provides a pretty good "basic" package - better than most private insurance in the U.S., in fact - but the private agencies have better coverage.  If you buy private insurance, once you're an adult, you can't switch over to the government insurance later - once out, never back.

          The government plan costs about 20% of employee income - 10% from your paycheck, 10% from your employer - or 25% if you're self-employed.  For the unemployed, it's free.  I assume the reason for the 5% self-employment penalty is that self-employed people are more likely to be unemployed at times.

          How well does it work?  In terms of per-capital cost and life expectancy, Germany ranks better than the U.S., but not as high as France (single-payer).

          But it's worth noting that in Germany there are a lot of other social welfare programs in place, so that paying 5000€ from a 20,000€ income - your plus your employer's payments - is quite as dire as it would be in the U.S.  Lacking those programs, that 5000€ could be the difference between a roof over your head and living in your car.

          •  Just checked. (3+ / 0-)
            Recommended by:
            tmo, Clem Yeobright, TomP

            The "government agencies" I referred to in Germany are not owned by the government.  They are Ersatzkassen, private companies that agree to premiums and coverage set by government rules.

            The private agencies - Private Krankenkassen - set their own premiums and coverage, and while the premiums are lower for young adults, they are much more expensive for older adults.

      •  So You Do Both (3+ / 0-)
        Recommended by:
        Clem Yeobright, TomP, NCrissieB

        The plan has strings attached for the health insurance companies that accept subsidies.

        Why do we have to PRETEND that there are only two options and zero overlap?

        --- It's SPELLED "TooFolkGR" but it's pronounced "Throat-Warbler Mangrove."

        by TooFolkGR on Wed Nov 12, 2008 at 08:06:42 AM PST

        [ Parent ]

  •  Hill-tality (2+ / 0-)
    Recommended by:
    slinkerwink, Real STE

    I think this will be Obama's finishing move on Clinton.  The GOP knows that healthcare reform is on its way and I don't think that mandates are as popular or good as Hillary would like.  

    If he so much as blinks on mandates the GOP can jump all over it, he wont lose any face, he will get what he wants, and Clinton will for the last time discover how tough Obama really is.  

    I do not think he will be out politicked into doing anything he doesn't want to do.  

    •  Wow. The primary wars really have you. (14+ / 0-)

      This is about governing, not some silly spat.

      No one is forcing Obama to do anything.  I suspect he wil sign a bill with or without mandates.

      This is about solving problems for real people, not some simple game where Obama is good guy and Hillary Clinton the bad guy. Your comment relects all that is wrong in the politics of personality.

      Fortunately, Obama is about solving problems and not playing silly games.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 07:11:25 AM PST

      [ Parent ]

      •  This is about governing in America (1+ / 0-)
        Recommended by:

        Do we ignore a central tenant of American life: freedom?  Hillary is only relevant in that she was wrong in 1993 and still wrong now.

        Barack understands that American life is simultaneously about the common good and individual freedom/self-reliance.  Any policy that completely ignores one or the other is doomed to failure.

        The repubs for years have ignored the common good to their detriment.  Dems have ignored the individual which is why we have been in the wilderness for the last 28 years.  

      •  Uhh I do live in America don't I?? (0+ / 0-)

        Before you pseudopsychoanalyze my comments, I suggest you take a look at the last 250 years of American politics.

        Getting things done and playing political games are not and have never been exclusive of each other.

        I voted for the guy too, but if you think for one second that he is so far above the fray that he wont take the opportunity, to show her who the boss is after almost two years of the crap he took from her, you might be disappointed.

        These are politicians, they have egos as big as their budgets.  

        And the simple fact is that Healthcare funded by the government is an issue that the GOP would love to take a stand on and there are some democrats that probably don't like it either.  With mandates it gives them that much more to fight against.  

        Politicians politicize everything, it is their job.  Obama is no different, I was as happy as the next person to see him elected, but I have no illusions, you don't rise through the ranks like he did without putting a few people in their place.

    •  Congress will lead the charge (4+ / 0-)
      Recommended by:
      RichM, Terra Mystica, TomP, CatJab

      Obama only has to sign the bill. That's how he deals with the Republicans.

  •  There is only ONE way I would support madatory (27+ / 0-)

    health insurance: health insurance companies MUST be non-profit.

  •  how do u force me to buy something that (16+ / 0-)

    I can't afford? that's the crux of it!

    "Nov. 12 (Bloomberg) -- Senator Max Baucus, presenting the first Democratic health plan since President-elect Barack Obama's victory, said all Americans should be required to have insurance once coverage is made affordable.

    how we get to 'affordable' is above my pay grade ;)

    •  There is no such thing as affordable health ins (20+ / 0-)

      if you're making under $30,000 in this country.

      "Greatest weakness, it's possible that I'm a little too awesome." --Barack Obama

      by SneakySnu on Wed Nov 12, 2008 at 07:09:14 AM PST

      [ Parent ]

    •  Answer: Write into the legislation (3+ / 0-)
      Recommended by:
      Bensch, Terra Mystica, TomP

      a progressive insurance fee structure that makes it affordable. Hillary and Edwards both provided for subsidies to make health care affordable. As an uninsured person, I'm all for mandates, so long as they are structured with subsidies.

      •  In my experience (8+ / 0-)

        the government has never been good at determining what regular people can afford.

        •  It depends on who is in government (3+ / 0-)
          Recommended by:
          Terra Mystica, TomP, CatJab

          The government is us! We just proved that in the election. Just look at the success of Social Security. Do you also want that not mandated? And do you want SCHIP to not be mandated?

          •  There is a difference between mandating (3+ / 0-)
            Recommended by:
            slinkerwink, cynndara, kathleen518

            parents to insure their children, and mandating adults to insure themselves.  As President-elect Obama said during the primaries, people want health insurance.  I want health insurance.  But I barely get by as it is.  And as a returning adult student I am currently struggling with a broken system where the government is deciding what I can afford.  My experience as a student gives me zero confidence in the government on issues like these.  How can I trust a government that thinks I can afford to spend 30% of my income on tuition, when I'm barely making more than my meager life costs, to make the right choices about what I can afford in any other area?  What if they are wrong?  Maybe on paper it will look like I can afford something that I can't.  Then what?  How will a fine help me, or anyone, in that situation?

            •  As I said... (0+ / 0-)

              We just changed the government. The argument that government can't be trusted is an old conservative argument. Democrats tend to assert that we are the government. By structuring the health care mandates with a progressive rate, and by providing subsidies, and with eliminating wastes in the medical system, there is plenty of money to make health care affordable. Our entire economy will adjust. As an uninsured person, I'm all for mandates because that is the only way to get everyone into the pool to bring down costs. So long as significant portions of the population are left out of the health care system, the costs will remain too high, because less people paying in means less money available.

              •  You see, that just doesn't make sense to me (2+ / 0-)
                Recommended by:
                zeke L, science nerd

                how does having higher demand bring down prices?

                •  Everyone will be paying into the sytem (1+ / 0-)
                  Recommended by:

                  As it is now, many people wait until they have an illness before they think about how to pay for health care. With everyone on board, more money will be available in the pool. By using better preventative care, cutting expensive waste out of they system, reigning in the drug and insurance industries, and providing a medicare type plan as an option to compete with the insurance industry, we can bring down the cost. We spend double per capita for health care than do the Europeans, and have lower quality health care. The money is there.

          •  The government ISN'T us (3+ / 0-)

            It's an arm of the owning class.

            "If they can get you asking the wrong questions, they don't have to worry about the answers" -- Thomas Pynchon

            by Cassiodorus on Wed Nov 12, 2008 at 07:53:26 AM PST

            [ Parent ]

      •  Big question: (0+ / 0-)

        How do you pay for that?

        •  This is how: (4+ / 0-)
          Recommended by:
          beans, TomP, CatJab, kathleen518

          With all the waste in the medical industry, restructuring would save a huge amount of money. The money is already there, it just needs to be redirected in a better way that doesn't all go to the insurance industry and drug companies. Americans spend more for health care than other Western countries, yet receive less care. The money is there.

          Look at Social Security. Do you also want to remove the mandates for that? Ahem...that's what the Republicans keep saying: We don't have the money. But that's not true.

          •  After years of promises by both parties, (0+ / 0-)

            no one has ever managed to put their hands on substantial amounts of money by promising to "eliminate waste."

            With all the waste in the medical industry, restructuring would save a huge amount of money. The money is already there, it just needs to be redirected in a better way that doesn't all go to the insurance industry and drug companies. Americans spend more for health care than other Western countries, yet receive less care. The money is there.

            And exactly how much do you think is going to be raised through this?  Are there any solid estimates that you can point to that say that this whole thing can be financed simply by "restructing costs and eliminating waste"?  More importantly, is that what Baucus plans to do?? Does Baucus' plan say that we can pay for this whole thing by "eliminating waste"?  Frankly, I don't think that is going to have a whole lot of credibility in the Congress.

            •  That's the argument the Republicans make (2+ / 0-)
              Recommended by:
              kathleen518, science nerd

              "You can't trust the government to spend your money."

              But we have all seen the success of Social Security, and how many Americans want us to eliminate Medicare and SCHIP? We can do this in a fair way, with the right structure. It's time every American had health care. With everyone paying into the pool a sum that they can afford, the money will be there. If you exclude the healthy, that will drive up costs. The only way to bring down costs is to get everyone on board, paying into the system. It's the only enlightened way to proceed.

              •  Then you almost have to mandate a system (0+ / 0-)

                where everybody participates in the government system and you eliminate private insurance entirely.  Essentially, you are proposing that the wealthy pay more for the same health care coverage that the poor and middle class are getting.  That means that the wealthy pay a premium that is above the market price for what they are getting.  If you are wealthy, why on earth would you do that? You would "opt out" and keep your present insurance and pay the market price for what you are getting.  

                Now, while I know that the concept would be popular here, how do you think the country will react when they are told that the government is going to eliminate what the opponents call "your choice" and mandate that everybody participate in a government program like Medicaid?  Do you think that is going to pass Congress?  I know that Dems from red states (Like Landrieu here in Louisiana) would get crucified for voting for that.

                •  "government system" (1+ / 0-)
                  Recommended by:

                  in this thread seems to equate w/"inferior".
                  as if by requiring everyone to participate in the "government system" they're getting less.
                  if it's done right, they'll be getting more.
                  i think that was the point zhen ren was trying to make about waste - the entire system, as we know it, needs a massive overhaul.  you do that, provide everybody with a superior product, who the hell cares if it's a "government system".

                  "I aimed at the public's heart, and by accident I hit it in the stomach." - Upton Sinclair

                  by kathleen518 on Wed Nov 12, 2008 at 08:25:40 AM PST

                  [ Parent ]

                •  You've made a lot of assumptions (2+ / 0-)
                  Recommended by:
                  TomP, cynndara

                  I think we can bring down the cost of health care for everyone, including the wealthy. We absolutely must reign in costs, no matter what else we do. By reigning in the insurance and drug industries, and eliminating waste, and similar measures, we can get the costs down. As it is, the high cost of health care is strangling this country. Either way, we need to get this under control. I would like single payer if there is support, but barring that, the hybrid system gets us close, with single payer as a goal.

                  And yes, the entire system needs an overhaul to make this work.

                  •  Color me a bit skeptical (1+ / 0-)
                    Recommended by:

                    about paying for anything substantial through "eliminating waste."  I've heard it for decades from both parties, and I've never seen it actually work.

                    Anyway, what are the estimates as to what can be "saved," as compared to what this will cost?  Then take what will be "saved" and cut it in half (not counting all the costs for the special intests lobbying to show that their program is not "waste"), and take what it will cost, and double it, and I think you might have accurate estimates (given our history over the last 50 years or so).  

        •  Progressive structure... (0+ / 0-)

          Same as income tax.

          Seattle Transit Blog

          by Bensch on Wed Nov 12, 2008 at 07:53:07 AM PST

          [ Parent ]

          •  Like I said above, (0+ / 0-)

            the only way that works is if you force the wealthy to participate and eliminate their option to buy private insurance instead.  You are essentially mandating that they pay more than "market value" for what they get, because they subsidize others.  No one in their right mind would opt for that if he/she has the option to buy private insurance at market value rates.  

            •  That's why there's a mandate. (1+ / 0-)
              Recommended by:

              Having a couple of years where everyone realizes we can't pay for this plan without universal single payer is the only way we actually get universal single payer.

              Seriously. Trust the people trying to make this happen. You know Obama, Clinton, Edwards, all want single payer. They're going to work together to make it happen. It might not be great for a few years - but this is how we'll get there.

              Seattle Transit Blog

              by Bensch on Wed Nov 12, 2008 at 08:06:30 AM PST

              [ Parent ]

              •  I understand that you want single payer (0+ / 0-)

                and I understand that mandating that everyone -- rich and poor -- participate in the government program instead of private insurance is the only way economically to make this work.

                However, that would be breaking a HUGE campaign promise by Obama, where he promised everyone that "you can keep your own insurance if you want to."  I also think that Senators like Landrieu (here in Louisiana) would be committing political suicide to vote for something that forced people into a government program INSTEAD of private insurance.  

                •  Single payer is still the only thing that works. (3+ / 0-)

                  At least, for everyone.

                  I don't know if this will resonate for you, but this is the same issue as with schools. Inner city public schools suck because there's enough of a critical mass of richer people that they opt out of the system. Sure, they still pay a bit, but because they don't have to use the public schools for their kids, they don't bring expertise for improvement. They don't have a vested interest.

                  Suburban US districts tend to be better not because they get more money, but because the income range they serve is more homogeneous. There's much less demand for private schools.

                  The big reason that many European primary and secondary schools are better is that there's less of a split between rich and poor in the core countries. You don't have that critical mass, so there are many fewer private school students per capita, and a larger portion of the population participates in improvement.

                  So, in healthcare, because it's at a national level, this discussion will get traction. We will see a 'public school' system of healthcare at first with this program - just like people have 'mandated' property taxes and schooling already - and we'll have the discussion in the open, guided by effective leadership.

                  Public opinion will change because people actually get it, and then we'll get single payer.

                  Seattle Transit Blog

                  by Bensch on Wed Nov 12, 2008 at 08:25:08 AM PST

                  [ Parent ]

    •  There always were subsidies (7+ / 0-)

      in the plan for poor people.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 07:11:53 AM PST

      [ Parent ]

    •  well PhillyGal (0+ / 0-)

      one option is to garnish wages. Pretty shitty, huh?

      John McCain, 100 years in Iraq "fine with me"

      by taylormattd on Wed Nov 12, 2008 at 08:40:32 AM PST

      [ Parent ]

  •  Medical care is already "Socialized." (19+ / 0-)

    It is rationed by class, and wealth status of the consumer.
    We need to change the fundamental meme that the traditional media has been ordered to run with in order to protect investor profits.
    Investors need to return to job creation instead of making a buck on human misery.
    Debushify all areas of our government!

    St. Ronnie was an asshole.

    by manwithnoname on Wed Nov 12, 2008 at 07:08:26 AM PST

  •  Politically, this is a complete winner (7+ / 0-)

    Healthcare is one of Obama's big 4 initiatives, but it has seemed for the last couple of days that his administration's major push in the first few weeks will be on energy independence and economic stimulus/tax reform. Having Baucus, the Senator whose committee any healthcare proposal must go through, set out his preferences early is a big deal. Remember how Moynihan in the same position killed the Clinton health plan?

    This is how it seems to me. Obama doesn't care who gets the credit, as long as something effective is passed that meet his major objectives. He'll let the Senate hash it out. Luckily, it appears that quite a few influential Senators have decided that now is the time. Obama gets to focus on his most important priorities, and still be there for the final push on healthcare.

  •  ...and not a moment too soon! (5+ / 0-)
    Recommended by:
    Bensch, beans, Hens Teeth, TomP, ZhenRen

    from my admittedly-subjective (read: uninsured) point of view...

    "the people have the power to redeem the work of fools" --Patti Smith

    by Immigrant Punk on Wed Nov 12, 2008 at 07:16:53 AM PST

  •  Tipping and rec-ing (3+ / 0-)
    Recommended by:
    Cali Scribe, RunawayRose, TomP

    Although I've been abstaining from tipping since you ate my mojo a few weeks ago by jumping my tip jar (I got mine up in under a minute of posting).  You have won absolution by posting about Universal Healthcare and getting THAT on the rec list.  Thank you.  ;-)

    ...there is the bottom of the ocean --Talking Heads

    by MsGrin on Wed Nov 12, 2008 at 07:17:28 AM PST

  •  How is requiring people do buy insurance (7+ / 0-)

    a progressive step?  If they could buy it, wouldn't they have done so already?

  •  one needs a job (8+ / 0-)

    to pay for insurance to start with.
    I wonder how long it will be till the job market improves.
    unemployeed welder here.

  •  Terrible frame job: Socialism vs. Choice (2+ / 0-)
    Recommended by:
    slinkerwink, Cool Blue Reason

    Obama won by emphasizing choice.  Mandates are the opposite of choice.  Fortunately we have Rahm to beat this fool into submission.  If Barack let's this go through we lose the whitehouse, congress or both.

    •  there you go. Mandates would kill this plan (0+ / 0-)

      immediately in Congress.

    •  Socialism attack failed on Nov 4. 47 million (1+ / 0-)
      Recommended by:

      Americans are without health care. Many more have seen their costs go up and their coverage go down. I think that many people switched parties or voted for Obama because of this issue. People at the DNC Convention on Day 4 and in the Barack Infomercial were examples.  

      The statistics show the burden is increasing. We know the impact it is having.

      Therefore, the standard 90's Republican reply just won't work anymore.

  •  wha? (7+ / 0-)

    The word I hear, by the way, is that Obama’s opposition to mandates was tactical politics, not conviction — so he may well be prepared to do the right thing now that the election is won.

    Opposition to mandates IS the right thing so I don't get this sentence.  Don't punish the sick for failing to afford healthcare.

  •  I think Obama will sign ... (2+ / 0-)
    Recommended by:
    Terra Mystica, TomP

    ... whatever gets to his desk -- mandate or no mandate.  As an actuary, I personally favor mandates, but as a political observer, I understand how difficult it would be to get 60 votes for cloture on mandates.

  •  Here's the nut: (6+ / 0-)

    Health insurance is a sub-optimal choice for a certain segment of the population: healthy 20-sumpins. Without mandates, their rational interest is to go bare or to carry only a high-deductible restricted catastrophic-care policy.

    But without their contributions, the cost of insuring the remainder of the population is prohibitive. And as costs go up, more and more people fall into the category where the insurance is a sub-optimal selection.

    Only with mandates can we have a system that is sustainable.

    You kids behave or I'm turning this universe around RIGHT NOW! - god

    by Clem Yeobright on Wed Nov 12, 2008 at 07:26:40 AM PST

  •  Mandates = terrible (9+ / 0-)

    Ask Mass!

    The only real solution for universal health care is a national single-payer system. The amount of rate reduction achieved by universal coverage with no uninsured sick people pales in comparison to the amount we'll save when people's health and their lives are not controlled by a profit-driven business!

  •  Great diary, Tom! (8+ / 0-)

    This really is excellent news.

    It was also encouraging to hear Rahm, last Sunday, indicate that Obama will not hesitate moving forward on a number of issues, including health care.

    It sounds like this may all come together!

  •  Debate will lead to Medicare for All (14+ / 0-)

    Medicare for All is the only real solution. Hearings and a national debate on the subject will demonstrate that.

    For a guide to how Obama will play it, look at how he moved universal health care for children through Illinois legislature but creating a commission to lay out the facts and alternatives.

    Pay particular attention to Obama's comment that "if the facts lead to a Canada type national health care, then so be it".

    Obama's technique is not for him to propose it but for the facts and experts to propose it as the best solution. Obama then explains the facts and choices and works to build a coalition around the best choice based on the facts.  Medicare for All always wins that debate.

  •  Mandates are only the first step to single payer (4+ / 0-)


    Obama's plan intends to set private insurers in competition with government provided insurance that will provide better coverage at a lower rates because it doesn't have the huge overhead (advertising, CEO compensation) that private insurance carries.  I think Krugman pointed this out in another column.

    This is also his single strongest mandate from the American people.  Healthcare's time has finally come...

    Although, come to think of it, I am the beneficiary of military medical health care which is an outstanding example of how well the federal government can provide care, and how successful the "socialization" of healthcare can be.

    Piffle crack eat monkey snow. Really. Leonard Pitts, Miami Herald

    by Susan Grigsby on Wed Nov 12, 2008 at 07:30:55 AM PST

    •  They are a step AWAY from single-payer (7+ / 0-)

      Mandated insurance is the policy equivalent of privatizing Social Security.

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

      by eugene on Wed Nov 12, 2008 at 07:48:35 AM PST

      [ Parent ]

      •  Automobile liability insurance is mandated in (1+ / 0-)
        Recommended by:

        the state of California for much the same reason that mandates are necessary in the health insurance field: if mandates don't exist, those who do pay for insurance pay for those who don't in the form of higher rates.

        The difference in Obama's plan is that the private insurers have to compete with Medicare/FEHB.  There is no way that with their overhead they can successfully compete.

        If private business can provide the same guaranteed benefits of Social Security at the same price, why shouldn't they?  The fact is that they can't.  They can only offer a gamble on the stock market as "privatization."  

        There is a world of difference between mandates for insurance and privatization of Social Security as each are currently defined.

        Piffle crack eat monkey snow. Really. Leonard Pitts, Miami Herald

        by Susan Grigsby on Wed Nov 12, 2008 at 07:59:40 AM PST

        [ Parent ]

    •  Well... (0+ / 0-)

      ...if there is a cheap Medicare option available to all, then I don't mind the mandate quite as much. In fact, it's downright clever.

      •  That is what Obama has been saying, (1+ / 0-)
        Recommended by:

        not that it is clever, but that those who can't obtain affordable health care will be offered a government Medicare option.  Actually he said that everyone should be able to have the same type of health care insurance that he has as a US Senator.

        It is a wide open back door into single payer health care.

        Piffle crack eat monkey snow. Really. Leonard Pitts, Miami Herald

        by Susan Grigsby on Wed Nov 12, 2008 at 09:56:43 AM PST

        [ Parent ]

  •  Can't afford to do universal healthcare now... (0+ / 0-)

    ...but we also can't afford NOT to do something about it.

    That is the dilemma the Democrats are in.

    •  No one seems to be concerned about the cost (3+ / 0-)
      Recommended by:
      nedog, Cassiodorus, Neglected Duty

      and I am really puzzled by that.  Everyone assumes that some form of universal health care "will make health insurance/care affordable for me," but you can't possibly lower the costs for most people, provide subsidies for the 40 million who can't afford it now, and not have some huge huge cost associated with the program.   What's the plan to pay for this?

      •  No one seems concerned about the cost of (16+ / 0-)

        the war in Iraq or Afghanistan. Or the cost of supporting a military that has a budget greater than all the rest of the world combined.

        If we need money to blow somebody up, nobody ever asks "Gee, where will we get the money?"

        If we need money to heal the sick or repair our infrastructure, there's plenty of hand-wringing about how to pay for it.

        I have an idea: Slash the f***ing military budget by about a quarter and get the hell out of both Iraq and Afghanistan.

        If we also funded sustainable energy we wouldn't have to worry about fighting wars on the other side of the planet anyway.

        This ain't no party. This ain't no disco. This ain't no foolin' around!

        by Snud on Wed Nov 12, 2008 at 07:43:19 AM PST

        [ Parent ]

        •  Just like it wasn't right (3+ / 0-)

          to start two wars without considering the cost and who is going to pay for it, I don't think it's right to restructure the health care system in this country without any thought of who is going to pay for it.  What happened to Dem promises of "pay-go"?  What happened to Dem criticism of the Republicans for their "borrow and spend" practices?  Didn't that mean anything?  I guess I just believed some of that, and for them to completely abandon it would be a big disappointment for me.  

          •  We all pay for healthcare now! (15+ / 0-)

            You either pay for the uninsured through higher premiums and failed hospitals, or you do it through a non-profit government entity which, as we see in every other advanced nation, controls costs.

            But you are already paying. You just aren't getting your money's worth.

            Barack Obama is a noble-hearted patriot and humble Christian, and he has my full faith and support.

            by benheeha on Wed Nov 12, 2008 at 07:57:06 AM PST

            [ Parent ]

            •  very well said. (5+ / 0-)

              as someone about to lose her insurance, and who has consequently sat down and really studied this, done the math, i'd venture to say that in the not-too-distant-future, we're going to save a ton of money.
              there is SO much waste right now in this ridiculously inefficient system we've got that it makes me gag.
              i'm a fan of single payer, have been for a long time, just because when you study this, it makes the most sense.  anybody who says otherwise hasn't really looked.
              i'll take an easily morphed universal system for now. it's a beginning, but the point is that very few people are getting what they're paying out the nose for right now, and the longer we wait on this, the more good money is gonna get thrown after bad.

              "I aimed at the public's heart, and by accident I hit it in the stomach." - Upton Sinclair

              by kathleen518 on Wed Nov 12, 2008 at 08:12:09 AM PST

              [ Parent ]

              •  I'd like single payer but don't think its... (2+ / 0-)
                Recommended by:
                nedog, TomP

                ...politically feasible.  Not because the public doesn't want it, but because there are too many monied interests who are lined up against it.  The insurance industry, the drug companies, the AMA, small businesses...

                I think first we have to establish the principle of universal coverage and if that means retaining private insurance in the short-term or long-term, I'm all for it because I think it is the best we can do.

                •  It will be Obama's big test. (1+ / 0-)
                  Recommended by:

                  He has said he likes single-payer. He says he is against special interests.

                  Let's see if he is willing to take a stand on the most obvious, sensible plan, or if he will become mired in trying to please everyone. I see both tendencies in Obama, a real tension, and of course it depends if he can rally support in that corporatist country club called the US Senate.

                  That's a big "if." My gut is that unless Obama hits the airwaves and specifically pushes his supporters for a big, bold plan, we are going to end up with an unworkable hodgepodge that will become the GOP's new reason to live, and we will lose. Big time.

                  Barack Obama is a noble-hearted patriot and humble Christian, and he has my full faith and support.

                  by benheeha on Wed Nov 12, 2008 at 11:15:34 AM PST

                  [ Parent ]

                •  politically feasible, in my mind, is (0+ / 0-)

                  what the public wants.  or it better become that way real soon.
                  i am tired of talking to people i know who live in other countries, who roll their eyes and sigh and wonder why we americans can't get our shit together where health care is concerned.
                  it's not like there isn't a model, or a practical way to do it.
                  settling for "the best we can do" is why our auto industry is in the shitter.  it's why we kissed goodbye to 350 ppm ages ago.  it's why we're never gonna get really good health care - not health insurance, health CARE - in this country.
                  sorry if i sound riled, but we - the people - need to say screw what some politician thinks is feasible.  do what's right, what's practical, what's most efficient, the most bang for the buck.
                  which is what single payer is, and i will proclaim that loud and long until i drop dead of some untreated illness.

                  "I aimed at the public's heart, and by accident I hit it in the stomach." - Upton Sinclair

                  by kathleen518 on Wed Nov 12, 2008 at 12:35:32 PM PST

                  [ Parent ]

            •  Not only that - we DO pay for UAW healthcare (6+ / 0-)

              through the new government bailout plan.  1/2 of the proposed 50bn package, or 25bn, is going to pay for existing and retired union worker healthcare.

              25 bn.

              I have lost track of how much money we the people have given the auto companies in my lifetime because they are "too important to fail".

              So yeah, we need single payer.  Because not only are you paying into the Medicare and Medicaid systems, your tax dollars keep going to unionized companies to keep their benefits systems afloat.

              I don't begrudge these people their benefits, but since the taxpayer is paying for them now, a cost/benefit analysis of whether our tax dollars should continue buying them private insurance, or whether they should be considered government workers and get Medicare/aid and essentially go single-payer makes a whole lot of sense to me.

          •  Dean had a way to pay for it in 2004. (2+ / 0-)
            Recommended by:
            TomP, sethtriggs

            Bring his plan back to the table, and you'll see some solutions develop.

            "You only live once. Let's keep trucking. If we don't do that, who's going to do it for us? We have to be happy. Why hate?" - Anthony Acevedo, WWII veteran

            by Black Leather Rain on Wed Nov 12, 2008 at 08:32:07 AM PST

            [ Parent ]

      •  Cost control: look overseas. (6+ / 0-)

        Or just over the Canadian border.

        Every other developed country provides universal health care at far less cost per person. The US spends about 50% more per person than the next highest-cost country -- not per covered person, but per person in the population.

        Whatever the other developed countries are doing to hold costs down, we can do that. This may mean delays in some treatments, but that's a worthwhile tradeoff.

        One hitch: drug prices. With our inflated drug prices, the USA is paying for most of the world's drug R&D. Our prices need to come down to world levels, but world levels may have to come up somewhat to fund continued R&D. This probably means government deciding what a fair profit margin is for drug companies. I can live with that.

        "The true strength of our nation comes not from the might of our arms or the scale of our wealth, but from the enduring power of our ideals." - Barack Obama

        by HeyMikey on Wed Nov 12, 2008 at 08:21:52 AM PST

        [ Parent ]

      •  Single-payer universal would save money (7+ / 0-)

        Insurance and healthcare costs are hugely inflated by a corrupt, bloated, adversarial insurance cartel which skims a third of the healthcare dollars off the top. Making them compete with something like medicare, with 3% overhead, would force them to live up to their professed ideology. Saying we can't afford a working healthcare system ignores the huge costs to our productivity of our current collapsing system, as well as the vast parasitic healthcare-denial cartel.

        •  Nobody in Congress is willing to go near (0+ / 0-)

          single payer.  It would be directly contrary to Obama's campaign promises, and would be political suicide for a lot of people in Congress.  

          •  maybe not immediately. (0+ / 0-)

            maybe not right out of the gate.
            but it's coming.

            "I aimed at the public's heart, and by accident I hit it in the stomach." - Upton Sinclair

            by kathleen518 on Wed Nov 12, 2008 at 08:28:44 AM PST

            [ Parent ]

            •  Obama essentiallly ran against single payer (3+ / 0-)
              Recommended by:
              nedog, Neglected Duty, kathleen518

              When he kept promising "you can keep your private health insurance if you want to."  

              How soon do you expect him to abandon that, and what will be the political fallout?

              •  i'm not sure. (1+ / 0-)
                Recommended by:

                i believe he's a secret fan of single payer.  he obviously couldn't run on that, so he toned it down, but i suspect he's got a much more liberal streak embedded in that conciliatory nature of his than he lets on.
                my thing is that if - and granted, it's a big if, but he's a very smart, shrewd guy and if anybody can pull it off, he can - they can restructure the whole kit and kaboodle so that what has passed for years as quality "private" health insurance doesn't look any better than what you can get through a "government" program, we are well on our way to single payer.
                which is, as anybody who has looked at this from all angles, in depth, the most cost-effective, efficient way to go.
                you'll never convince me otherwise.  i've spent too much time studying.

                "I aimed at the public's heart, and by accident I hit it in the stomach." - Upton Sinclair

                by kathleen518 on Wed Nov 12, 2008 at 09:19:46 AM PST

                [ Parent ]

                •  Gee, the McCain campaign would have loved you (2+ / 0-)
                  Recommended by:
                  nedog, Neglected Duty

                  had you posted this prior to the election.  

                  I believe he's a secret fan of single payer.  he obviously couldn't run on that, so he toned it down, but i suspect he's got a much more liberal streak embedded in that conciliatory nature of his than he lets on.

                  McCain kept saying over and over that he's all talk, he doesn't mean what he says, he's secretly more liberal than he is telling you, when you elect him, he's suddenly going to be way more "left" than you thought.  McCain kept saying, You can't believe him.  

                  The public didn't buy that. They believed him on all his campaign positions -- no new taxes on anybody under $250,000; he would consider offshore drilling; etc.  They believed him and that's why they voted for him. They believed him when he promised "no socialzed medecine" (the "code" for single payer) and "you can keep your private insurance."  The voters believed him.  They had every right to believe him.  They voted for him because they believed him.  I am really surprised that people are suggesting that he now say to the voters, "Remember all that stuff I promised during the campaign?  Well, never mind.  McCain was right -- I really AM more to the left than the positions I took during the campaign."  

                  Frankly, I, like millions of voters, expect him to keep his campaign promises.  I don't expect him to do a complete reversal just because the election is behind him.  

                  •  relax. (1+ / 0-)
                    Recommended by:

                    if he can keep his campaign promise re: healthcare in a BETTER way, why not?
                    you REALLY want to keep what we've got?
                    you really think that our current system, with the huge profits that private insurers, pharm, etc. are raking in, and will continue to rake in, is good?  
                    have you looked at this issue, studied single payer?

                    thinking that BO isn't further left than we thought he was is kinda naive.  you say it as if it were a bad thing.
                    of course, you're talking to somebody who's way far left, in favor of that "socialized" medicine that people in every other developed nation on the planet have been benefitting from for ages.
                    go left, young man.  do it slowly, but go ahead and do it.

                    "I aimed at the public's heart, and by accident I hit it in the stomach." - Upton Sinclair

                    by kathleen518 on Wed Nov 12, 2008 at 09:40:27 AM PST

                    [ Parent ]

      •  Medicare is paid for by payroll taxes (1+ / 0-)
        Recommended by:

        that max out at $107K/yr.  Remove this limit and reduce the rate to something like 4% for everyone, and I'll bet there'll be enough to cover almost everyone.  Fiddling around with the retirement age for SS would probably cover the rest.

        •  There already is no cap on Medicare payroll taxes (5+ / 0-)

          From Wiki:

          Social security and Medicare taxes, also known as FICA taxes, must be withheld from the employee's wages. The employer must also pay a matching amount of FICA taxes for employees.

          1. Social Security Tax: As of 2007, the employer must withhold 6.2% of an employee's wages and pay a matching amount in social security taxes until the employee reaches the wage base for the year. The combined total for the employee and the employer is equal to 12.4% of gross compensation. The wage base for social security tax in 2007 is $97,500. Once that amount is earned for a given year, neither the employee nor the employer owe any additional social security tax for that year.
          1. Medicare Tax: As of 2007, the employer must withhold 1.45% of an employee's wages and must pay a matching amount for Medicare tax. The combined total for the employee and the employer is equal to 2.9% of gross compensation. Unlike the Social security tax, there is no maximum wage base for the Medicare portion of the FICA tax. Both the employer and the employee continue to incur and pay Medicare tax on each additional amount of gross compensation, with no limit on the amount of gross compensation on which the tax is imposed.

          Try again?

      •  Right now in the US (0+ / 0-)

        we already have the highest per capita healthcare costs in the world.  We are paying as I recall, in excess of $6k per year per person. Costs per capita in European nations runs around $4k, and the European countries tend to do better in many aggregate measures of overall health (lower infant mortality, higher life expectancy, etc.).

        A nationalized, single payer program would potentially reduce the healthcare burden to the national economy, not increase it.

        First they ignore you,
        then they laugh at you,
        then they fight you,
        then you win <-- YOU ARE HERE

        by Irony Raygun on Wed Nov 12, 2008 at 09:03:40 AM PST

        [ Parent ]

      •  What's the plan to pay for the enormous (0+ / 0-)

        "bailouts" going on now?

        For years, we have heard that health care is unaffordable.  But universal health care for the USA certainly was NEVER estimated to cost over $700 Billion dollars.  That amount was recently just tossed into the breeze over Wall Street and it hasn't even done anyone any good.

        So, if we're going to be throwing money around like irresponsible kids, let's throw some toward the health care of the poor and the middle class and the unemployed and the people who are hurting and suffering and cannot even get a damned doctor.

        But no. That's TOO Expensive!  AIG execs can burn our tax money over and over at luxury resorts, but treat a child or take care of someone's pain and suffering?  Oh hell. THAT is too expensive.

        Priorities in this nation are just F-d up and that's all there is to it.

        droogie6655321 lives!

        by YucatanMan on Wed Nov 12, 2008 at 11:07:26 AM PST

        [ Parent ]

    •  There are some things they can do (11+ / 0-)

      immediately which, while not good for insurance companies, drug companies, and the Dow, will be good for the American people:  price caps on ins premiums and drugs.  Enforce coverage.  Make it illegal for coverage to be denied based on pre-existing conditions.  That won't cost our government anything.

      "Greatest weakness, it's possible that I'm a little too awesome." --Barack Obama

      by SneakySnu on Wed Nov 12, 2008 at 07:36:53 AM PST

      [ Parent ]

    •  If we want to bail out the auto industry (7+ / 0-)

      (and other industries as well) one of the best ways to do it is to put in universal health care. That will enable US industries to be more competitive with those located in countries that do provide national health care to their workers, and also reduce/eliminate the need for those companies to administer multiple health plans.

      Putting forward universal health care as a pro-business move, as well as pro-American, could be a good way of selling it to voters and causing them to put pressure on their (Republican) reps to back it.

      I always felt that eventually Obama's plan would take on the best parts of all proposals out there -- I'm still doubtful about mandates right off the bat but once we have plans that people can afford and that don't have those stinky "pre-existing conditions" clauses, I can deal with them.

      "Once you choose hope, anything's possible." ~Christopher Reeve

      by Cali Scribe on Wed Nov 12, 2008 at 07:59:28 AM PST

      [ Parent ]

    •  Can not "afford" to do health care reform... (3+ / 0-)
      Recommended by:
      rincewind, YucatanMan, Floja Roja

      can't not do it either. It is pushing 20% of GNP as an industry and a basic drain on the system, expenses you must cover or die. Out of wack, imbalanced as compared to every other system in the world.

      The recovery in the larger economy won't happen without freeing up some funds that are basically profiteering and skimming from the health care system.  Those funds are redeployed and transformative to extend coverage and reach. That also increases gainful employment and helps in the recovery. There is where the "large added costs" come from.

      Cutting back and making health care worse in various ways adds to the downward spiral in our economy.

      More copays adding more insurance dollars to their premiums. Dropping more health care plans as a tactic to survive in business. Passing on and upwards more expense thru pharmaceutical monopoly pricing . No. Those are the wrong answers that are business as usual.

      It has to be addressed, doing it via creative financing, nationalizing or taking out of business most of the insurers or whatever else it takes.

      It has to be a staged plan to single payer coverage for the vast majority of Americans. A default option has to be in place for those refusing to join in this care, sort of an "assigned risk pool" as exists in auto insurance with a dollar amount that gets charged to the opt out individual. The wealthiest can afford that, and their own boutique care or private physician on retainer.

      There are no partial choices that work, only those partial solutions ending up making the situation even worse.

      That's single payer/universal no exceptions  or our situation just continues to get worse.

      cast away illusions, prepare for struggle

      by Pete Rock on Wed Nov 12, 2008 at 08:53:28 AM PST

      [ Parent ]

  •  Having Baucus, a red state Dem, support mandates (7+ / 0-)

    gives an indication of how popular the issue is with working class white americans, the constituency that the GOP thinks it owns.  During the primary, I never thought Obama believed as much in his health care plan as he did in his plan to get out of Iraq.  This plan will have Hillary's support it, and with it the support of the white working class.  I like it. Can Bush leave early so we can get started?

    Alternative rock with something to say:

    by khyber900 on Wed Nov 12, 2008 at 07:32:05 AM PST

  •  Not to be pissy, but I spent God-knows how (11+ / 0-)

    much time arguing in comments sections during the primary that Obama had pretty clearly signaled that he would not oppose mandates vigorously.  Remember that he always consistently maintained that he was open to the idea of mandates at some future point in time once the need for them had been shown.

    I argued - over and over and over again - that it is the health insurance industry which, first and foremost, has a strong interest in seeing individual mandates under a universal coverage system such as the one Obama proposed.  I argued (correctly, I believe), that Clinton was foolish to push for mandates as an initial matter because the vested interest to push for them already existed.  The thing you need to push for is regulation on industry profits and coverage restrictions, not for mandates.  The mandates will follow whether anyone likes it or not.  Obama got this.  I was very surprised that Clinton did not.

    I also argued, and we will see if this pans out, that what was most likely to happen is that - under pressure from insurers- Obama would ultimate sign a bill that contained provisions for a future, conditional mandate if certain goals relating to voluntary coverage are not met within some time frame, say 3-5 years of something.  Now what remains to be seen is whether I was right.

    But here comes the pissy.  I was flamed over and over and over again for daring to suggest these things, including, I believe, by the diarist.  So, glad you've seen the light TomP!  There IS a place for progressively-inclined strategery in our politics.  It's not unprincipled to decline to show all your cards on the table from square one, especially when you are contemplating taking on  powerful vested interest in the name of universal coverage.

    There, I've had my pissy say, and now I'll go away.

    The festive scenes of liberation that Dick Cheney had once imagined for Iraq were finally taking place -- in cities all over America -- Frank Rich

    by Mother of Zeus on Wed Nov 12, 2008 at 07:36:27 AM PST

    •  i agree with Mother of Zeus... thing long-term... (1+ / 0-)
      Recommended by:
      Mother of Zeus

      with what mother of zues said.  people have to remember that this i a HUGE political undertaking and these sorts of things need a plan.

      let's call it a slippery slope plan...

      step 1: require private insurers to cover all  pre-existing conditions and to have an unlimited out of pocket yearly maximum for all (i.e. real catastrophic coverage)

      step 2: step 1 will cause fewer people to go into bankruptcy which is good for the economy and job creation, but step 1 will also make it dificult for private insurers to provide affordable insurance

      step 3: private insurers will be motivated to increase the size of their pool in order to take in enough $ to comply with step 1's requirements.  the gov't then makes available the largest pool of insurees (i.e. the "exchange") to compete with the private insurers, making the private insurers reduce costs and make their coverage more efficient.

      step 4: eventually the "Exchange" pool continues to grow, earned income credits are offered to low-income participants in the "exchange" program to ensure affordability and to comply with a positively enforced mandate (not a fine system, but a reward system) and private insurers are relegated to "upgrade" insurance provider status like in Canada.

      step 5: when the next wave of political will hits, we then offer the "Exchange" insurance as an automatic coverage for all (medicare for all), with upgrades purchased from private insurers for cosmetic surgery, experimental procedures, etc.

      Never separate the life you live from the words you speak.

      by jrdigre on Wed Nov 12, 2008 at 09:11:18 AM PST

      [ Parent ]

  •  I'm ambivalent (2+ / 0-)
    Recommended by:
    Floja Roja, TomP

    I fully support a single payer model.  I would support an additional tax to pay for it.  

    However, I don't  know how everyone else sees this.  

    I might lean towards requiring children be covered, offering a government plan for businesses to buy into, and then as children grow into adults, have them continue being mandated to have healthcare.  

    I'm sure there are problems with that, but it seems like a nice way to slowly put a system into place.  

    •  I support (3+ / 0-)

      a single payer system where everyone is automatically insured at birth.  It would be the most rational system.  Anything less than that is someone slicing off a cut of the money for  unnecessary expenses, admin overhead, etc.

      Single payer medicare uses approximately 3% of the premiums for admin overhead.  Private insurers use upwards of 20%.

  •  insurance mandates, car insurance, poor people. (11+ / 0-)

    You know I really have a problem with the idea of mandating health care. I would much rather see a system like France's which is the best in the world.

    Poor people get the short end of the stick, here. They get criminalized for not having the money. We all know that the gov't will then decide for them whether or not they should have paid for health care or bought christmas gifts, bought a new suit hoping to land a job, or paid the health care bill. I just think that without truly understand the plight of those in poverty this could be a real boon for the insurance industry and a bust for the poor.

    I just think that what has happened with mandated car insurance is a good view into some of the potential problems of mandated health care. In car insurance they tried to use credit to determine car insurance costs. Will they charge you more if you live in poverty? I just think this has too much potential to victimize the poor and the ignorant.

    The greatest gift you can contribute to the goal of world peace is to heal.

    by wavpeac on Wed Nov 12, 2008 at 07:38:31 AM PST

    •  You are VERY correct. Here's an example: (4+ / 0-)
      Recommended by:
      slinkerwink, rincewind, AnnCetera, CatJab

      Here in IL, they recently passed a law forcing us to take our children to dentists about 4 years ago. I looked at the new requirement from our school, to show my daughter's dental records for grade 2, and said, wth does my daughter's dental health have to do with her learning? Anyways, I told the public school system to shove it, as I didn't have the money to take her in for a dental visit.

      A year later, after many low income families said the same to the state, they made sure Medicare/Medicaid covered dental visits for kids, including routine cleaning, fillings, extractions and so on. Virtually everything other than braces is covered for children.

      Now... here's where it gets icky for me as an adult with Medicare/Medicaid. Two years ago I had to have one of my molars pulled, I was stressed out and was grinding my teeth, and had finally cracked it in 6 places. I went to a dentist nearby and paid out $280 to have it pulled.

      I went to a dentist covered by Medicare/Medicaid recently when one became available finally in my area. My fillings are covered. That's it. Nothing else. If I want my Wisdom tooth pulled, which is also cracked and now broken in one area, I need to see one of 3 oral surgeons who accept Medicare/Medicaid.  So I called the closest one. I was told it would cost me $300 for a local anesthetic copay, or $500 for a complete knockout while they extract it copay.  Yes, that's called a copay. When I could go BACK to the original dentist who pulled my other tooth and pay less for whole darn thing including a local. So I either pay MORE for this lovely Medicare/Medicaid copay, or I leave the tooth in, or pay less for a quick pull.

      •  Yep, If you are poor you pay more. (5+ / 0-)

        That's our slogan at our house. It just seems that the rich corporations find ways to basically victimize the poor.

        They just started charging co-pays for healthcare in our state for those on medicaid. Now it's only a buck a visit, but for some of my clients, that buck is the choice between a bus ride or not.

        I just think we don't really understand how hard it is to live on 600 to 1000 dollars a month. We like to think that in American it's easy to work our way to the top but many people are not aware of the number of pitfalls for those in poverty.

        The greatest gift you can contribute to the goal of world peace is to heal.

        by wavpeac on Wed Nov 12, 2008 at 08:06:40 AM PST

        [ Parent ]

  •  Medicare Not All Its Cracked Up To Be (3+ / 0-)

    I keep hearing the phrase "Medicare for All" in conjunction with how we reform our health care system.

    1. WE HAVE TO REFORM OUR HEALTH CARE SYSTEM. It is beyond broken and people suffer and die every day because of it.
    1. Medicare may be good but it's not great.  It's biggest problem is the much vaunted Prescription drug coverage plan passed by the Bush Administration with the drug companies fingers on the scale and no sense of what people really need. Most people don't know about Part D. If you buy a plan you get sort of decent coverage until you (in the form of co-pays) and your insurance company have spent around $2500 in a year. THEN THE COVERAGE STOPS UNTIL YOU YOURSELF HAVE PAID CLOSE TO FIVE GRAND OUT OF POCKET.  Then it picks up again. I, like many seniors have very expensive medications which means I will hit what is known as the "Doughnut Hole" but should be known as the "Black Hole" every year.  Last year even with a Part D plan I spent close to $4000 on medication. This year it will be more.  I am fortunate and so far have been able to afford this (although it means I am spending into my retirement savings to do it).  MANY CANNOT.  As far as I can tell this program was designed by sadists and lunatics. Any overhaul of health care in the US needs to address this travesty and soon.  Coverage during the "black hole" could probably be added without too much additional expense if the government negociated directly with the Big Pharmaceuticals to get decent prices for drugs. Instead, they can run amok and charge more or less whatever they want. So at this point the winners on part D are the drug companies and the insurance companies with seniors coming in a distant third.
  •  If It Looks Anything Like Auto Insurance - (11+ / 0-)

    It will be a huge win for the insurance companies -
    And, quite possibly, a big loss for ordinary Americans.

    I didn't work 40 years for this.

  •  Penalty for failing to meet "mandate?" (5+ / 0-)

    What exactly does "mandatory" mean in this context?

    Seriously, I'm not trying to be a jerk. But I don't understand. We throw your ass in jail or something if you don't purchase health care insurance? Fines?

    I know that auto insurance is "mandatory" here in Illinois. Still plenty of people driving around without it.

    •  The Massachusetts model uses tax penalties (0+ / 0-)
    •  Here's what John Edwards suggested (1+ / 0-)
      Recommended by:
      Clem Yeobright

      wage garnishment:

      The newly covered individual would not only have access to health benefits but would also be responsible for making monthly payments with the help of a tax credit.

      The exact size of the financial obligation would vary according to a person's income (lower-income Americans would receive larger tax credits).

      If a person did not meet his or her monthly financial obligation for a set period of time (perhaps a year, perhaps longer) the Edwards plan would empower the federal government to garnish an individual's wages for purposes of collecting "back premiums with interest and collection costs."

      The process, according to the Edwards campaign, would resemble the process used to collect money from Americans who are delinquent on federal student loans or child support payments.

      John McCain, 100 years in Iraq "fine with me"

      by taylormattd on Wed Nov 12, 2008 at 08:44:47 AM PST

      [ Parent ]

  •  Jan 20 can't come soon enough n/t (2+ / 0-)
    Recommended by:
    TomP, An Affirming Flame
  •  AIG, our newest branch of government, (5+ / 0-)

    could be instrumental in such an exchange and a segue into single-payer.  We own it, let's use it.  Sell "top-up" insurance to cover the cost of basic, single-payer insurance.

    It takes a movement to change the world, and the Oval Office just can't hold all of us --- me, in a moment of pithy pique.

    by oxon on Wed Nov 12, 2008 at 07:48:43 AM PST

  •  Great comments here, but don't forget (1+ / 0-)
    Recommended by:

    ...the children

    at the very least, mandated insurance for kids should be a priority

    ...there's a rose in the fisted glove and the eagle flies with the dove - Stephen Stills

    by NuttyProf on Wed Nov 12, 2008 at 07:51:21 AM PST

    •  No (6+ / 0-)

      We should ALL be the priority.  Why would a child be worth more than an adult?  If you begin excluding certain people (in this case, based on age), then it becomes easier for those against it to continue to resist this right of health.

      A child is not more important than the adult who is self employed who cannot afford health care right now, is she?  After all, is it not the self employed parent who will feed and provide clothing for that child?  Why should the adult be left out?

      This is an all-in situation.  Either fix the problem all at once, and have people become used to the fact that the government will provide health insurance for ALL, or don't.  Any half measures will become a stumbling block for real heath care for all.  No exceptions.

  •  I hope we have TRUE universal HC in the USA (6+ / 0-)

    We deserve it.  

    I read once that it would actually cost LESS for the average American and/or their employers if we had universal healthcare vs paying for it out of pocket.  
    Something like the average person has around 13% of their paycheck devoted to health insurance and under a UHC plan it could be as low as 10%.
    Does anyone have a link to something like that?  I can't find anything on Goooooooogle!

    But yeah.  Obama's healthcare plan was one of the things I REALLY didn't like about him.  It's destined to fail.  You CAN'T let the insurance companies in on this.  They are the problem!

    While universal healthcare may have it's failings and problems, it is FAR superior to the broken, expensive system we have in America now.

    My style is impetuous.
    My defense is impregnable.

    by samfish on Wed Nov 12, 2008 at 07:51:40 AM PST

  •  want to sink obama's administration? (5+ / 0-)
    Recommended by:
    eugene, slinkerwink, VClib, mim5677, NuttyProf

    push for healthcare mandates after he campaigned (and won) both the primary and the general based on his opposition to them. dont you just love how we democrats take control and push the self destruct button almost immediately?

  •  I agree with the diarist here: (2+ / 0-)
    Recommended by:
    Clem Yeobright, TomP

    Edwards, as he did with many issues, pushed the agenda leftward, and that was a good thing. (I'm glad Obama won the nomination and he was clearly the right choice, but I'm also glad Edwards ran and pushed these issues.  It was a win/win for all of us.)

    Hillary and Bill Clinton also tried to reform health care in 1993 and 1994. Many have fought for this, but I wanted to thank John Edwards here).  

    To say my fate is not tied to your fate is like saying, "Your end of the boat is sinking."--Hugh Downs

    by Dar Nirron on Wed Nov 12, 2008 at 07:54:22 AM PST

    Recommended by:

    Our debt is very large , so and i know this health care program will coast a large sum of money every year....

    As Obama come up with the money to pay for this thing?

    •  They just print the money -- (1+ / 0-)
      Recommended by:

      eventually it, like "mandatory" health insurance, becomes worthless.

      "If they can get you asking the wrong questions, they don't have to worry about the answers" -- Thomas Pynchon

      by Cassiodorus on Wed Nov 12, 2008 at 08:00:29 AM PST

      [ Parent ]

      •  what do you mean (0+ / 0-)

        by just print the money and "mandantory" being worthless?

        If the fed prints more , it means the dollar's value decreases and our debt grows larger?

        I dont know whether this is good news.

        I think Obama should think about bringing the Tax thing to zero and watch the market rebound quickly.

        Do it for one year.

        •  No and yes. (0+ / 0-)

          If the fed prints more, it means the dollar's value decreases and our debt grows larger?

          With dollar hegemony, the banks prop up the dollar's value as the national debt grows larger.  Otherwise the $10 trillion national debt would already have sunk the dollar.

          The insurance, however, will become worthless simply by virtue of the fact that the health insurance industry exists to prop up the insurers, without granting America adequate access to real health care.

          "If they can get you asking the wrong questions, they don't have to worry about the answers" -- Thomas Pynchon

          by Cassiodorus on Wed Nov 12, 2008 at 08:23:07 AM PST

          [ Parent ]

  •  Look, Obama is in the POCKET of (1+ / 0-)
    Recommended by:

    the PEOPLE.

    Not the insurance scammers.

    Oh how sweet it is.....

    •  Yeah and I traveled to Mars yesterday (0+ / 0-)

      Sorry Brando I just don't believe that anything will get done regarding health care. They are all toooooo corrupt. Look at the kid glove treatment that Lieberman is getting.

  •  Question: Mandated insurance for children (3+ / 0-)
    Recommended by:
    TomP, carllaw, sethtriggs

    Is there someone here who does not support that mandate? Do parents have the right to let their children go bare?

    And, if mandates for children are proper and necessary and can be enforced, why not everyone?

    You kids behave or I'm turning this universe around RIGHT NOW! - god

    by Clem Yeobright on Wed Nov 12, 2008 at 07:58:18 AM PST

    •  its pretty much accepted (1+ / 0-)
      Recommended by:

      at least among dems that there should be mandated coverage for children because they cannot decide for themselves what plan (if any) they should or should not have. adults, on the other hand, have the capacity to decide their healthcare fate and should not be forced by mandate to accept govt healthcare if they dont want it.

      people, especially americans, like options - not forced realities. it's a no brainer - the people who we are trying to insure (the poor, the sick, etc) will taking the f***ing healthcare mandate or no mandate. those who dont want it or want to use their own will do that. its pretty simple.

    •  I don't support it. (5+ / 0-)

      I support gov't paid for healthcare for kids.
      And for adults.

      If you want to 'mandate' my healthcare 'insurance', take it out of my taxes and give it directly to the healthcare providers.  Don't 'mandate' that I buy 'insurance' that takes 30% of the money I pay and gives it to for-profit companies to give to their shareholders.

      Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

      by drbloodaxe on Wed Nov 12, 2008 at 08:21:00 AM PST

      [ Parent ]

  •  Same old arguments I see (6+ / 0-)

    I find it utterly laughable when people argue against something without understanding the facts of the situation. Of course it will be a fight for any type universal health care. It wouldn't matter if they tried to push McBush's plan through you would have some who just wouldn't support it.

    TomP your first mistake was giving any praise either to Hillary for essentially adopting the Edwards plan, the second was pointing out he pushed the issues. The same crew will fight tooth and nail against any issue that might involve their ideas. What's new?

    Good diary, and BTW Hi.

    •  LOL!! (4+ / 0-)

      Thanks, La Escapee.  It was amazing.  Two folsk in particlar attacked Edwards about his affair instead of debating rationally.  

      The funny thing is that Edwards is not running for anything anymore and Obama is President-elect.  It showed me a fundamental inability to discuss issues by those people.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 08:10:06 AM PST

      [ Parent ]

    •  "More Obama than Obama" they are (4+ / 0-)
      Recommended by:
      TomP, poligirl, LaEscapee, carllaw

      Notice that Krugman is getting read out of the Democratic Party again here!

      Even a Nobel Prize doesn't get you any cover here. Tough audience!

      You kids behave or I'm turning this universe around RIGHT NOW! - god

      by Clem Yeobright on Wed Nov 12, 2008 at 08:33:37 AM PST

      [ Parent ]

  •  I think Obama is going to surprise allot (1+ / 0-)
    Recommended by:

    people, he did what he had to do to get into office.  Okay I am fine with that.

    He is going to be so radical in change that he will amaze all of his followers.  Obama is great, I love him, I love his family, and he will not go into the night without making a difference for the American people.

    Please hush hush about any kind critism, he will be a great President, he will make FDR look like a moment of change obsolite. Obama is going to make history of change.

    You betcha, let him get past these 68 days now, and BOOM its going to hit.  Shhh I'm not going to say anything else, what did Michele say, "He gets it."

    Support him stand behind him. He is going to make a huge difference.  Hallelujah for a great Presdent that he will be.

  •  I hate the thought of being forced to buy private (7+ / 0-)

    insurance.  I am looking at retiring next year and I also hate that I am forced to purchase some plan in the rotten drug insurance scam system.

    National single payer health care is the only way to reduce costs and provide all with treatment.  Anything less is pandering to the insurance corporations. the elites...actually believe that society can be destroyed by anyone except those who lead them? - John Ralston Saul -

    by Silverbird on Wed Nov 12, 2008 at 08:04:29 AM PST

  •  I don't like mandates (4+ / 0-)
    Recommended by:
    slinkerwink, GN1927, rolandzebub, CatJab

    Mandates do NOT equal Universal, unless we're planning to haul people into court to ensure they pay.

    And "mandate" is a terrible word politically.

    "This union may never be perfect, but generation after generation has shown that it can always be perfected." - Barack Obama (3.18.08)

    by lapis on Wed Nov 12, 2008 at 08:05:00 AM PST

  •  MA has done a good job (3+ / 0-)
    Recommended by:
    kenlac, CatJab, DefendOurConstitution

    in getting the uninsured into the system. Mandates are part of that.

    However, what they have NOT done a good job with is helping people who have shitty insurance that costs too much. You are not eligible for the subsidized plans if your employer offers insurance.

    It's not just about the uninsured, and it can't just be about the uninsured if we want real reform, and blabbing about "mandates" makes it...all about the uninsured.

    I'm sick of paying a fortune for shitty coverage.

    What do you call a parent that believes in abstinence only sex ed? A Grandparent.

    by ChurchofBruce on Wed Nov 12, 2008 at 08:05:02 AM PST

    •  My family plan is over $14k in MA and (2+ / 0-)
      Recommended by:
      slinkerwink, ChurchofBruce

      current plan does not seem like it will stop the crazy growth.

      Keep in mind that my $14k+ for a family of 5 is the cheapest HMO I can find in MA that still covers everything my wife and I dem critical. It is also a plan w/$20 co-pays and other significant out of pocket expenses.

      The MA plan was supposed to help everyone, but it sure does not seem to be helping me.

      Then they came for me - and by that time there was nobody left to speak up.

      by DefendOurConstitution on Wed Nov 12, 2008 at 08:19:16 AM PST

      [ Parent ]

      •  If you take into account (1+ / 0-)
        Recommended by:

        that my employer pays 75% of mine, mine would be about that. And it's not an HMO, it's a PPO, and I have crazy high deductibles. (and a 15 dollar copay).

        As I said, my employer pays 75%. I pay about 4K a year. However, when you only make 17K a year....

        That math, however, points out how screwed up our system is. My employer is paying half of my annual salary for my health insurance. Of course, since I work in retail, and most retail workers below the management level are 1) kids, or 2) married to someone that makes more, only a minority of people there take the health insurance.

        What do you call a parent that believes in abstinence only sex ed? A Grandparent.

        by ChurchofBruce on Wed Nov 12, 2008 at 08:26:01 AM PST

        [ Parent ]

  • I get mandatory health insurance (4+ / 0-)

    but that does not guarantee affordable health care. If I have to think several times whether I can afford to visit a doctor then that's no good. Reduce the cost of health`care along with health insurance.  

    Rabindranath Tagore-"Bigotry tries to keep truth safe in its hand with a grip that kills it."

    by joy sinha on Wed Nov 12, 2008 at 08:05:14 AM PST

  •  Oh great... (7+ / 0-)

    at a time when I'm employed 3 hrs a day and not even making enough to cover all of my existing bills, I'm going to be legally forced to buy health insurance I can't afford, as opposed to the government simply becoming the single-payer?

    Just fricking great.

    Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

    by drbloodaxe on Wed Nov 12, 2008 at 08:06:16 AM PST

    •  And you assume that (2+ / 0-)
      Recommended by:
      ZhenRen, dle2GA

      there wil be no subsidies for poor people?  Please think.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 08:07:53 AM PST

      [ Parent ]

      •  I'm not technically 'poor' (1+ / 0-)
        Recommended by:

        I just have high expenses that I was able to cover when fully employed, that I cannot cover on 3 hrs of work a day until I finish studying up to take my stwate licensing test to actually get another job that does pay what my current hourly is.

        Is the answer truly to cause me to pay even more, to force me to become poor first, so that I can then qualify for such subsidies?

        That seems backwards.

        I've worked hard for a decade, paid off over half my sensible 4.75% mortgage on a modest house, which now I'm having trouble keeping up with, and it makes more sense to load me up with enough extra burden to tip the scales and make me lose the house so that THEN I can get subsides for being poor?

        Got a problem with my posts? Quit reading them. They're usually opinions, and I don't come here to get in arguments.

        by drbloodaxe on Wed Nov 12, 2008 at 08:27:35 AM PST

        [ Parent ]

      •  Yeah, tax credits - which do no good... (0+ / 0-)

        ...when you still have to pay up front and then get the tax credit to cover it at the end of the year.

        And we're not just talking about "poor people" either. We're also talking about people with fluctuating income levels, and in this economy there are more and more folks in that situation.

        Which means that plenty of folks are going to end up paying for insurance on the front end, have their income change just enough to raise beyond where they qualify for the tax credit, end up not getting the tax credit on the back end, and be stuck trying to catch up.

        If everyone's suddenly forced to shell out money for health insurance, an awful lot of people are going to end up getting screwed if they don't have a relatively steady income level (even if it's a relatively steady LOW income level.)

        And it's not like government health plans like Medicare (to which UHC is being compared) are exactly cheap. I know retirees not exactly rolling in dough who are getting socked for $400 per month for their Medicare coverage.

        If all Americans are suddenly forced by law to drop $400 a month when they already can't afford health insurance, and then have to sweat their way through the year until they can get their tax credit (if they qualify for one) you're going to see an awful lot more hardship for an awful lot more people before this thing is done.

        If Obama's seriously considering the Clinton/Edwards/Romney gun-to-the-head approach to health insurance, he'd goddamned well better think it through a lot better than those others have done.

  •  The mandate leads to single payer. (5+ / 0-)

    Subsidise the government option so its simply the best deal. Force insurance companies to run as low profit clearinghouses. As more people opt in to the government plan, insurance companies lose their profitability and go away.
    The mandate will get us there.

  •  Mandates can be dangerous. (2+ / 0-)
    Recommended by:
    GN1927, An Affirming Flame

    I'm all for cutting out the insurance middle-man, but what happens when the hospitals and nursing homes start putting beds in the hallways to comply with mandates on the number of patients allowed in a room, for example, as happened in the UK?

    We have to be very careful about unintended consequences. Mandates set by bureaucrats can be just as bad as those set by for-profit health insurance companies. People will play with the numbers and find loopholes in the regulations to get that promotion and avoid those penalties. Are mandates the best solution to this problem? I'm not so sure.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." -- Groucho Marx

    by rolandzebub on Wed Nov 12, 2008 at 08:10:54 AM PST

    •  When people begin manipulating the system (1+ / 0-)
      Recommended by:

      by working around and through the "loop holes", then you shut those loop holes.  This is going to be a new venture for this country and there will be mistakes.  When those mistakes arise, you fix the problem and move forward.  This will not be perfect from the onset, and that imperfection should not provide pause for UHC to be pushed through.

  •  Obama ran against universal insurance (6+ / 0-)

    The word I hear, by the way, is that Obama’s opposition to mandates was tactical politics, not conviction — so he may well be prepared to do the right thing now that the election is won.

    That's not how politics works in this country.

    He ran against "government-run health care and higher taxes" (quote from TV ad), against mandates, and in favor of "keeping your employer-provided healthcare" and "affordability." Also, he ran on the plank of insuring all children (SCHIP).

    As Rahm Emmanuel said yesterday:

    "[T]he lesson is to do what you got elected to do," said Mr. Emanuel. "Do what you talked about on the campaign. If you got elected, that's what people expect. Don't go off on tangents where part of your party is demanding an ideological litmus test."

    If he had campaigned on universal healthcare (e.g., single payer) and still won, then he would have a mandate to try for it. As it stands, the contract is to not have "government-run healthcare."

    You gets what you votes for.

    •  Obama has a history of workig "well"... (2+ / 0-)
      Recommended by:
      FightTheFuture, TomP

      ...with the ins cos in Ill.

      The voice of the public needs to be loud, impossibe to misstake, relentless, and focused on the prize.

      We need to regulate pricing at cost plus 3%. We can't move off of that Medicare model.

      If in the end, that becomes 5%, I will be very happy. If in the end there is no regulation or cap, we lose. Any plan without a cap will be gamed.

      For ins cos to endure after a good reform, the whole structure of public insurance holdings either needs to be replaced or a new one added that is similar to a utility with regulated costs and profits caps.

    •  two issue (1+ / 0-)
      Recommended by:

      you are merging two issues.

      He ran against a single payer system
      His plan did not include mandates.

      Ran against a single payer system
      Her plan DID include mandates.

      Single payer will eventually win because it is cheaper than insurance and employer based care.  I don't have the figures in front of me, but overhead as a % of dollars spent on care, and number of employees as a % are both LOWER for medicare than for the private insurance industry.  

      President-Elect Obama's job is to lead, not to stick with every word of his plan.  The directions will and should change as voices are heard, and the needs are balanced against the ability to get the thing through Congress.  The "contract" is for Obama to provide us leadership through the many challenges we face.

    •  I am astonished that people here (3+ / 0-)
      Recommended by:
      Clem Yeobright, VClib, NuttyProf

      think that they are going to be able to push for single payer any time soon.  As jmknapp says, Obama ran against single payer, and promised not to implement single payer.

      Campaign promises mean something. People voted for him because of those promises.  People did not vote for him because they expected him to completely reverse himself once the election was behind him.  

    •  We elected him to solve problems. If it looks (0+ / 0-)

      like Universal Health Care, like almost every other developed country in the world has in some form, is the real answer here, then he has a "mandate" to do it.

      Really, don't let Rahm "My lips are around Wall Street's Dick" Emanual confuse the issue!

      The 4 boxes of Democracy: The soap box, the ballot box, the jury box and the ammo box. The 4 G's of survival: Gold, Grub, God and Guns.

      by FightTheFuture on Wed Nov 12, 2008 at 11:10:23 AM PST

      [ Parent ]

  •  Taxes, taxes, taxes (1+ / 0-)
    Recommended by:

    A Republican meme for so long that we turn it off. Most of us all ready pay into to SS, etc., money you never see in your paycheck.

    For those of us who have employer-sponsored healthcare, it is the same thing: money disappears before the taxable amount, so it is Totally Good. If you are lucky, your employer pays the other 70-80% of your healthcare "insurance". McCain had the good idea to tax that tax dodge and look where he ended.

    Betcha that little goodie will go the way of self-supporting Big Three in the US.

    Obama proposed as I see it, a short evolution to single payer, without saying it, and without having to deal with yet more millions of people who would lose their job because (insert healthcare Insurance CO name here) just went under.

    Americans, while occasionally willing to be serfs, have always been obstinate about being peasantry. F. Scott Fitzgerald, the Great Gatsby

    by riverlover on Wed Nov 12, 2008 at 08:20:56 AM PST

    •  How does promising you can keep private insurance (0+ / 0-)

      which is what Obama did, equate to this:

      Obama proposed as I see it, a short evolution to single payer.

      Obama was very emphatic that he was not proposing single payer, or (using the somewhat misleading term) "socialized medecine."  Very emphatic.  I know a lot of people here wish he was on the side of single payer, but that's not what he campaigned on.  Millions and millions of people heard him say "no" to single payer -- "you can keep your own private insurance if you want to" and they rightfully understood that he was NOT going to support a single payer system.

  •  reality check - Its not possible w/o mandates (2+ / 0-)
    Recommended by:
    TomP, sethtriggs

    Without mandates, the math doesn't work.  If I can get coverage even if I was sick and there was no mandate I would of course immediately cancel my insurance which is $1100 a month.  Coverage for pre-existing conditions is only possible if there is some incentive to get insurance while you are healthy.

    If I can't get coverage even if I am already sick, its just not universal.

    Obama knows this; the lack of mandates was a tactical white lie for which he has my forgiveness.

    Universal, by definition, means mandated.  There is no other way.

    •  I slightly disagree with your definition: (1+ / 0-)
      Recommended by:

      Universal, by definition, means mandated.  There is no other way.

      Universal means everyone is covered. Period. People pay for it through their taxes.  If you dont work, then you get the benefit without having to pay for it (at least until you begin working).  Unemployed or retired people still have the right to coverage, even if they are not paying for it.  It is time we begin thinking of health care as a "right" which is owed to us from birth, rather than something that is forced upon us by the government.

  •  "without spelling out possible penalties" (2+ / 0-)
    Recommended by:
    slinkerwink, GN1927

    Nobody ever does because nobody likes to hear what the penalties are for failing to enroll.

    John McCain, 100 years in Iraq "fine with me"

    by taylormattd on Wed Nov 12, 2008 at 08:26:21 AM PST

  •  At his point I'll take ANYTHING that is... (4+ / 0-)
    Recommended by:
    TomP, Goose for Obama, sethtriggs, dle2GA

    ....progress from what we have now.

    There are NO countries that already have some form of universal healthcare that (1) wish to get rid of it and (2) wish to trade their system for a more "American style" one.

    If I am wrong, please tell me, especially the right-wingers out there that constantly pooh-pooh the idea of universal healthcare. We need to do SOMETHING and fast.

    "...if my thought-dreams could be seen, they'd probably put my head in a guillotine...." {-8.13;-5.59}

    by lams712 on Wed Nov 12, 2008 at 08:27:17 AM PST

    •  "But we HAVE to do SOMETHING!" Yeah, right... (0+ / 0-)

      ...because that approach always ends up with well-thought-out, rational, and ultimately beneficial solutions put in place.

      I guarantee you, if that's the attitude we go into this with, we are going to get fucked.

      •  We will not get fucked. (0+ / 0-)

        There are plenty of examples out there (i.e., the rest of the civilized world) that we can analyze and see what works and what doesn't.  We are not inventing the wheel here, folks.  We get to see which design of the wheel works best and use that.

        The "we are fucked" mentality is decades and decades of Republican scare tactics that have sunk into our mindset and is viewed as "truth" by many Americans.  

        The rest of the world is doing it and doing it successfuly.  Why cant "The Greatest Nation in the World" not get on board?

        •  If we rush into it in a panic... (0+ / 0-)

          ...saying things like "I'll take ANYTHING!" then yes, we will get fucked.

          I didn't say we ARE fucked. I said that if we don't take a cool-headed, reasoned approach to the problem, then we'll end up with a slapdash solution that will end up making the problem worse... a'la the Patriot Act, the recent bailout package, etc, and (as with "solutions" like those) we will GET fucked.

          No solution arrived at in a panic is ever worth two shits. And the healthcare crisis is far too serious to approach that way.

          •  I agree (0+ / 0-)

            that we cannot rush into it.  Thankfully, we have a cool headed President that will lend his even hand in this.  We cannot, however, go into this half-assed, either.  We need to get this in, full forced, from the get go.  Once we get the nay-sayers used to the idea and they see that we (Americans) won't turn into France (whatever that means, anyway) if we adopt a universal solution, then there won't be any turning back...just like the mention of privatizing social security now will never be stood for.

            Once we as a country get over this "fear", all will be long as we go all in from the beginning.

  •  Mandates give me headaches. (3+ / 0-)

    It's a shame I can't go see my doctor about these mandate headaches, though, since the company-sponsored $200/month health insurance I enjoy has told me that it doesn't need to pay for anything else that goes wrong for the rest of the year.

    Ah, the joy of health care.

    "You only live once. Let's keep trucking. If we don't do that, who's going to do it for us? We have to be happy. Why hate?" - Anthony Acevedo, WWII veteran

    by Black Leather Rain on Wed Nov 12, 2008 at 08:28:18 AM PST

  •  I think what Republicans will find (4+ / 0-)

    is that the American people think "socialized medicine" is better than "no medicine at all".

    Some say we need a third party. I wish we had a second party. -- Jim Hightower

    by joe m on Wed Nov 12, 2008 at 08:28:32 AM PST

    •  Exactly! Most of the 300K people who lost their (2+ / 0-)
      Recommended by:
      TomP, carllaw

      jobs last month also lost their coverage -- if you assume that somebody who just lost their income can't afford COBRA coverage.

      Add that 300K to the hundreds of thousands who previously lost their jobs in this fucking economy and, well, universal, guaranteed, affordable health care starts too look pretty damn good! No matter what your political party.!

      Seize the moment

      $700 Billion would fund 10 years of Obama's universal health plan!!

      by pmcmscot on Wed Nov 12, 2008 at 08:33:35 AM PST

      [ Parent ]

  •  Contrary to these indications. . . (1+ / 0-)
    Recommended by:

    Sam Nunn working to advise President-elect Obama?

    He killed Universal Health Care in 1993, in my opinion.

    The victorious strategist only seeks battle after the victory has been won, whereas he who is destined to defeat first fights and afterwards looks for victory.

    by Pacifist on Wed Nov 12, 2008 at 08:31:36 AM PST

  •  Here's why we HAVE to have universal (3+ / 0-)
    Recommended by:
    pmcmscot, Albatross, TomP

    health care.

    Maybe this should be a diary, but it's going to be pretty short.

    Right now the second biggest crisis facing the economy after the banking/insurance industry meltdown is the automotive sector. One of the big reasons why GM, Ford and Chrysler are hemorrhaging cash, apart from designing big dumb cars that no one wants to buy, is their health care costs. They are on the hook for at least all of their unionized workers, and probably non-unionized workers as well, to the tune of billions of dollars a year. Someone else probably has better ststistics than I have.

    Shifting the those health care costs over to a single-payer system would be cheaper than a bailout, or at least reduce the size of any bailout that would still be required. True, the American taxpayer would end up footing the bill -- but I have no doubt that if intelligently designed, this would end up saving money in the long run. It might even result in cheaper cars that Americans can actually afford, especially if the auto industry gets behind Obama's promise to kickstart the alternative energy industry.

    And I doubt the auto industry would be the only one to benefit from a single-payer system.

    We have done the impossible, and that makes us mighty.

    Now the real work begins.

    by Omir the Storyteller on Wed Nov 12, 2008 at 08:32:08 AM PST

    •  I've been saying this same thing all over Kos, (0+ / 0-)

      throughout this campaign.

      Our current system of employer-provided health insurance is killing our ability to be competitive in the new economy.

      But I've asked this before, and I'll ask again: WHY aren't the Big 3 and the rest of the manufacturing sector pushing harder for this? Or pushing at all?

      $700 Billion would fund 10 years of Obama's universal health plan!!

      by pmcmscot on Wed Nov 12, 2008 at 08:40:01 AM PST

      [ Parent ]

    •  the argument for making health care first (0+ / 0-)

      not only the auto makers but many people who are going to be laid off are going to need help with health care.

      Frankly, all this talk of bail out makes me sick and fearful. The Democratic agenda should be to create a decent safety net- unemployment insurance, health care, job training etc. but allow businesses to fail as they must if the free market is to have any meaning at all.

  •  Thank you, Tom. (4+ / 0-)
    Recommended by:
    Clem Yeobright, mommyof3, TomP, RadioGirl

    We need more than nyceve's heroic leadership for this phase of national health care reform dialog. Things will be happening fast and so much education has to be done, really starting from square 1

    We do need to be so skeptical and reframe everything to our benefit. Assume AHIP and the ins cos have billions in place to defeat the common good. Let's use Cal Prop 8 as a model and get in front of the bad guys...

    And  am not a ins-cos-hater. I worked in ins and HMOs and believe me, the cos will fight to the death but the people...well, we're all in this together imho. They know what's going on.

    My worst fear is that the uninsureds will be covered, by the same ins cos we are all familiar with, and the urgency is gone and reform is considered an accomplishment.

    If we lose this one shot, the status quo will persist for 30 years.

    •  Thanks. I think you may be right. (4+ / 0-)
      Recommended by:
      Clem Yeobright, kck, mommyof3, RadioGirl

      There is an opening for real progress right now.  It's why I've been willing to compromise on single payer, provided there is a road to it in a plan.  I respect those who disagree, but I do not see a road to single payer and I suspect that if it is single payer or nothing, we'll get nothing.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 09:00:29 AM PST

      [ Parent ]

      •  I am going to on what is needed and not... (0+ / 0-)

        ...what is or isn't possible or what is or isn't a good idea. In fact, what has or hasn't been tried is only partially relevant because something may not have resulted as well within an incremental framework yet within an integrated, architected reform plan it could be beneficial.

        If we dwell on "mandates" or my personal gold standard, single-payer, then we have the status quo. It's time for progress and a systematic way forward.

        By the time Congress starts hearings, on CSPAN as Pres-elect Obama promised, we should be clear on high level requirements such as, as these are merely my examples:

        1. Decouple ins from employment
        1. Decouple ability to pay from clinical decisions
        1. End "pre-existing"
  •  GM should be lobbying heavily for (9+ / 0-)

    universal medicare. Its health insurance bills are one reason it's going under, and why other US companies don't compete as well as they should internationally. NO other industrialized nation has this problem.

  •  FWIW, here's a letter I wrote yesterday (1+ / 0-)
    Recommended by:

    to Bacus and Kennedy:

    I would like to propose my  method of gradually phasing in universal healthcare.  It's quite simple, really:  

    Change the age limit for Medicare to 10 and below, leaving it at 65 and above for awhile until our economy gets back on its feet.  It could be funded by a removal of the $107,000 FICA ceiling.  This should essentially fund the SCHIP program.  

    To fulfill Pres. Elect Obama's promise to reduce taxes on the working, middle class,  the FICA taxes could be reduced across the board to something like 4%, and still garner more income to the trust fund because of the $107K ceiling lift.

    How much these taxes would need to be reduced and still provide the necessary income to fund Medicare could be adjusted as the costs are better known, but one thing is certain:

    This would be certainly better than what we have now, and less painful to implement than a whole new program, in my opinion...

  •  Mandates will morph into single payer (2+ / 0-)
    Recommended by:
    mommyof3, TomP

    my requirement for mandates is that they not become a terrible burden on people who can't afford it. The subsidies would need to be very generous.

  •  I'm never sure... (2+ / 0-)
    Recommended by:
    jkb246, sethtriggs

    ...what people mean when they say "universal health."  If it means "universal health insurance for everyone, working through private insurers," then I think this is not such a good idea.  such a system just adds a layer of management and retains the profit motive that denies significant numbers of people health care.

    If the term means "single payer," however, where the government acts as insurer, this is an idea I can get behind.  Particularly if the burden on businesses to provide health coverage is reduced or eliminated.  The private health insurance industry needs to be aborted, to put it entirely bluntly, as they have increased not only the cost of health care for individuals, but of running businesses that provide health care for employees.

    If a single-payer, universal health care plan were positioned as friendly to both voter and employer, it would stand a much better chance of passage than a plan working through private insurers.

    The America I knew and loved is finally dead at the hands of bipartisanship.

    by TheOrchid on Wed Nov 12, 2008 at 08:47:23 AM PST

  •  Reposting image lost in margin (2+ / 0-)
    Recommended by:
    jkb246, TomP

    as the health industry lobbyists have no appetite for profit contraint...

    I did grow up in the UK though before immigrating to the US in the mid 90s, and I can attest that I never had any problems with the UK service.

    One-third of patients with health problems in the U.S. report experiencing medical, medication, or test errors, the highest rate of any nation in a new Commonwealth Fund international survey. Assessing health care access, safety, and care coordination in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, the survey found that while no one nation was best or worst overall, the U.S. stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs leading to barriers to access to care.

    Here is a handy chart, comparison of medical malpractice in major industrialized countries :


    source article

    Government for the people, by the people

    by axel000 on Wed Nov 12, 2008 at 08:51:46 AM PST

    •  and further - cost differential (1+ / 0-)
      Recommended by:


      The U.S. was an outlier for its financial burdens on patients:

      Half (51%) of the U.S. adults reported they had gone without care because of costs in the past year.
      In contrast, just thirteen percent of U.K. adults reported not getting needed care because of cost.
      One–third (34%) of U.S. patients reported out-of-pocket expenses over $1,000 in the past year.
      U.K. patients were the most protected from high cost burdens, with two-thirds (65%) having no out-of-pocket expenses. The variations were notable given the study design focus on sicker adults with recent intensive use of medical care.

      Government for the people, by the people

      by axel000 on Wed Nov 12, 2008 at 09:13:40 AM PST

      [ Parent ]

      •  and even more shocking - access data (1+ / 0-)
        Recommended by:

        Access—including after-hours access—and waiting times to see a doctor when sick differed markedly across the countries:

        Canadian and U.S. adults who needed medical care were the least likely to report fast access (same day) to doctors (30% or less of U.S. or Canadian patients).
        In contrast, majorities of patients in New Zealand (58%) and Germany (56%) reported they were able to get same-day appointments, as did nearly half of patients in Australia (49%) and the U.K. (45%).
        Majorities of patients in Germany (72%), New Zealand (70%), and the U.K. (57%) also reported that after-hours (nights, weekends, or holidays) access to a doctor was easy.

        In contrast, majorities of patients in the U.S. (60%), Australia (58%), and Canada (53%) said it was very or somewhat difficult to get after-hours care.

        The four countries with comparatively more rapid access to physicians—Australia, Germany, New Zealand, and the U.K.—also had significantly lower rates of emergency room use, with Germany having the lowest rates.

        One–fifth of Canadians and one–fourth of U.S. patients who reported going to the ER said it was for a condition that could have been treated by their regular doctor if available.

        Government for the people, by the people

        by axel000 on Wed Nov 12, 2008 at 09:15:38 AM PST

        [ Parent ]

  •  Is there evidence Baucus is working with Obama? (1+ / 0-)
    Recommended by:

    Would be useful to confirm...

    The McCain-Palin Campaign: a transitional medium through which Monty Python skits are transformed into SNL skits

    by Minerva on Wed Nov 12, 2008 at 08:53:50 AM PST

    •  Don't know. (1+ / 0-)
      Recommended by:
      Clem Yeobright

      It would be interesting to know.  He may have done this on his own to get the debate moving.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 08:58:15 AM PST

      [ Parent ]

    •  there's a statement from Tommy Vietor (1+ / 0-)
      Recommended by:

      "President-elect Obama applauds Chairman Baucus’s work to draw attention to the challenges of the health system and looks forward to working closely with the Chairman and other Congressional leaders, as well as the American public, to make quality, affordable health care a reality for all Americans."

      Doesn't sound like a warm embrace of Baucus's proposal.

  •  We need to keep the pressure on (0+ / 0-)

    I've also heard talk that Obama will move first to expand SCHIP and will "wait" on universal health care.  I find that to be completely unacceptable.  It's to our national shame that we -- alone among the developed world -- do not provide health care to all of our citizens.  

    Together with the economic rescue plan, this needs to be priority number one.  And it is related to economic prosperity, as employers now pay too much for to ensure their employees and Obama's plan will bring those costs down.

    But it won't get done without pressure from us.  Call your congresspeople.  Call the President-elect.  We can't let Obama backslide on this fundamental right that American have been denied too long.

  •  Baucus needs to remember: (2+ / 0-)
    Recommended by:
    paintitblue, Real STE

    only a mandate could ensure people didn't wait until they were ill to buy health insurance, forcing up the price for everyone.

    Another thing that could keep people from buying health insurance is that they don't have an extra $12,000 a year.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Wed Nov 12, 2008 at 08:58:08 AM PST

  •  Red flag (3+ / 0-)

    If Max Baucus is pushing it, that's a red flag right there.

    •  hence Obama's spokesman's lukewarm statement (1+ / 0-)
      Recommended by:

      "President-elect Obama applauds Chairman Baucus’s work to draw attention to the challenges of the health system and looks forward to working closely with the Chairman and other Congressional leaders, as well as the American public, to make quality, affordable health care a reality for all Americans."

  •  Individual mandate = (1+ / 0-)
    Recommended by:
    Big Tex

    Big Republican gains in 2010.

  •  Health insurance mandates are unequivocally wrong (3+ / 0-)
    Recommended by:
    bumblebums, Big Tex, Alice Marshall

    I absolutely will not support insurance mandates without certain conditions:

    1. there is a well-defined time line detailing a transition to single-payer, universal health care (not health "insurance");
    1. premiums are capped on a graduated, highly-progressive basis, with a cap of $0/yr for the poorest;
    1. pre-existing condition clauses are either nixed entirely or else highly restricted to the point that explicit, specific conditions must be spelled out on an itemized, individual basis (i.e. no vague, all-encompassing language like  "pre-existing conditions include conditions for which symptoms would cause a 'reasonable person' to seek treatment");
    1. a minimum level of coverage is required for every insurance policy issued, to include bi-annual physicals and regular checks for various well-known conditions based on appropriate demographics and recommendations by medical professionals (e.g. breast/prostate cancer exams), and reasonable allowances for medications for temporary maladies (e.g. anti-biotics, pain medications for broken limbs, etc.)

    These basic needs must be met by any plan before I'd consider mandates. Mandates in and of themselves are useless to, or even harmful to, the very segments of the population that need the "insurance" in the first place. Without these basic protections, no mandate plan is good.

  •  Screw the baby steps (4+ / 0-)
    Recommended by:
    Big Tex, TomP, Goose for Obama, dle2GA

    We need single payer NOW. Great Britain, in the aftermath of WWII instituted their health insurance plan. If they could do it after suffering through a war that left much of the country in ruins, physically and financially, then we can too.
    Screw the naysayers, screw the insurance companies. let's have a plan that is as good as (if not better than) Canada, France and the UK.
    I mean, if the USA is so gosh darn terrific then we should be able to have the best plan in the world. Time to git er done.

    Electing conservatives is like hiring a carpenter who thinks hammers are evil.

    by MA Liberal on Wed Nov 12, 2008 at 09:13:00 AM PST

  •  My only comment............. (1+ / 0-)
    Recommended by:

    IT'S ABOUT TIME!!!!!!

    "Virtus Junxit Mors Non Separabit"

    by Fuzzy5150 on Wed Nov 12, 2008 at 09:14:29 AM PST

  •  Realistically, I don't think Obama (2+ / 0-)
    Recommended by:
    jkb246, TomP

    could get enough people in Congress to vote for a single payer system.  Unfortunately, I don't think he could get enough people in Congress to vote for a universal insurance system that included sufficient subsidies for mandated insurance.  

    I think we may end up with a system that is implemented in three steps over time.

    First, the children's health program that Bush vetoed.

    Second, the Obama plan without mandates, but also without subsidies.

    Third, either adding in mandates and subsidies or increasing the number of poor people who just get health care outright.

    The challenge in implementing step two is trying to make it work in a way that encourages healthy people to join and include no discrimination against people with pre-existing conditions.

    During the debates, Obama dodged the question about what programs he was going to cut.  He's going to have to answer that question soon because there's going to be a lot of spending going on, and a lot of people in Congress are going to be tired of just printing more money to pay for stuff.

    •  Good points. (0+ / 0-)

      Tyhere are political realities.

      Baucuses plan helps, because it makes the original Obama plan much more in the middle.  There is sinmgle payer, then Baucus, then Obama,then nothing.    

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 09:29:05 AM PST

      [ Parent ]

  •  Request: what is single payer? (2+ / 0-)
    Recommended by:
    TomP, CatJab

    I find myself confused by this, even when looking it up.  Seems like it might be worth adding to dKOSopedia.

    Anyone willing to take a swing at it?

    •  Basically it is Medicare for (3+ / 0-)
      Recommended by:
      jkb246, Alice Marshall, martini


      The government raises money by taxation and pays for all health care needed by citizens.  It would end private insurance, although some might buy supplements.  Something like the National Health in UK, which they have had since 1948.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 09:27:51 AM PST

      [ Parent ]

    •  Think in terms of Medicaid for everybody (1+ / 0-)
      Recommended by:

      Instead of you on Blue Cross, and me on Cigna, and somebody else on an AARP plan; all with different requirements and conditions. Requiring your doc to have 3 people in his office just to handle the various types of claim forms and coverages.

      "Rosa sat so Martin could walk. Martin walked so Obama could run. Obama runs won so our children can fly."

      by Catte Nappe on Wed Nov 12, 2008 at 09:59:16 AM PST

      [ Parent ]

    •  it would end FOR PROFIT Insurance (1+ / 0-)
      Recommended by:

      and would save billions of dollars on FOR  PROFIT insurance waste...administrative costs, advertising, billing...
      Illinois alone would save 18 billion
      and the scary word 'taxes' is brought up...
      when we would simply be pulling out of  a regressive tax spiral...and put an end to the rising premiums...
      the average annual premium for a family  12,680 dollars not including out of pocket and co-pays...

  •  Single payer or nothing (2+ / 0-)
    Recommended by:
    Big Tex, CatJab

    I have insurance and it's crappy.  No more "nibbling around the edges."  Give us real universal health care, with no more pandering to the insurance industry.

    In TX-32, track the voting record of Pete Sessions at SessionsWatch.

    by CoolOnion on Wed Nov 12, 2008 at 09:28:05 AM PST

    •  You likely will get nothing then. (2+ / 0-)
      Recommended by:
      LaEscapee, carllaw

      Elect people to the presidency and Congress who support single payer.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 09:42:35 AM PST

      [ Parent ]

      •  Then we'll march on Washington (1+ / 0-)
        Recommended by:

        I'm ready.

        In TX-32, track the voting record of Pete Sessions at SessionsWatch.

        by CoolOnion on Wed Nov 12, 2008 at 10:15:39 AM PST

        [ Parent ]

        •  You lack the numbers. (0+ / 0-)

          Build numbers.

          Who was elected to the Senate on the issue of single payer?

          People here are blowing smoke up their own asses.  The plan passed likely will be weaker than even Obama's plan.  That's the reality.  

          "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

          by TomP on Wed Nov 12, 2008 at 10:36:55 AM PST

          [ Parent ]

  •  asdf (3+ / 0-)
    Recommended by:
    jdld, Catte Nappe, TomP

    Once again it is being assumed that the reason people do not have health insurance is because they don't want to buy insurance rather than no insurance company will sell them insurance.  If we are going to have mandates part of the mandates should be that health insurers should be mandated they have to be willing to sell insurance to anyone.

    •  BradMajors (0+ / 0-)

      Obama's plan will require health insurance companies to sell insurance to anyone with a pre-existing condition. I'm not sure if he will make that a requirement for all health insurance companies, or only the ones that are included in his National Health Insurance Exchange. But this is my number one concern, too. My husband has a pre-existing condition.

      But I was concerned that people would wait until they got sick to buy insurance under Obama's plan. That is why I thought there needed to be a mandate. I have been reading the comments here and I agree that a mandate for people to buy something unaffordable won't work.

      I thought I was over the top in my interest in health care. It makes me very happy to see the discussion here, and the high level of knowledge and interest in the topic.

      My first choice would be single payer. This thread has inspired me to write letters to my senators and reps.

  •  Mandate? (2+ / 0-)
    Recommended by:
    slinkerwink, Big Tex

    Ohz nohz ya don't.

    I don't have health insurance.


    Not because I choose not to, Barack.
    Because I'm unemployed and I can't fuckin' afford it.

    I swear I heard you say this during the primary.

    Go ahead and try to push for a mandate for me to buy the heatlh insurance I can't afford, or be punished.

    I'll be sure to push for your punishment by making sure your mandate lasts four years, and four years only.

    •  Why should I pay for your health care (2+ / 0-)
      Recommended by:
      carllaw, Neglected Duty

      if you get sick because you wish to free ride?

      We pull our own weight here.  If you can't afford insurance and are poor, there is Medicaid.

      The madate is exactly for people who try to free ride.

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 10:31:09 AM PST

      [ Parent ]

      •  Why should we pay for your roads, (1+ / 0-)
        Recommended by:

        fire departments, police coverage, food safety regulations, etc??

        Why?  Because we are ALL in this together. We can act to raise all boats or let many boats flounder while the huge boats crush even more. The right answer is:

        Today, everyone is paying for everyone's health care anyway.  

        Except, some people get denied over and over and end up in Emergency Rooms.  Those of us with coverage and all of us who pay taxes (and that IS all of us-- even the poor pay property taxes through their rent), pay for that Emergency Room to operate.

        The problem today is that between the people who need healthcare and the doctors wanting to treat them, there is a huge profit-making bureaucracy shuffling papers around in the most inefficent ways possible.  This bureaucracy is called "health insurance."  And it is entirely unnecessary.  

        Single payer. No for-profit companies between the patient and the doctor. Period.

        droogie6655321 lives!

        by YucatanMan on Wed Nov 12, 2008 at 11:15:20 AM PST

        [ Parent ]

        •  This is why the issues have to be discussed in a (2+ / 0-)
          Recommended by:
          YucatanMan, TomP

          big way. People really don't understand that the neighborhood hospital closing is because of uninsured patients and high overhead. They really think that everything will be great if something happens to them. The reality is that they are going to get denied  and denied no matter what they paid for that coverage.

        •  Not my point at all. (1+ / 0-)
          Recommended by:

          I am probably more left wing than you are.

          I understand we are all in it together.  But when a person opts out and sticks others with the costs, and can afford to do otherwise, then we all are hurt.  If he really was too poor to pay for insurance, then Medicaid would cover him.  He's talking about taking a chance and then letting the system pay.

          A free rider like him makes a choice that he will stick others with costs if anything happens.

          Real socialsim means we are all in it together: we pay according to our means and get according to our needs.

          People think single payer is "free."  Wrong, we'll pay for it in taxes.  I'm for that.  

          So don't feed me this bs about highways. Duh.

          I'm talking about a free rider problem in a univeral insurance regime.  People who choose to put themselves first.  

          Unfortunately, we are far too weak to create single payer now.

          "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

          by TomP on Wed Nov 12, 2008 at 01:14:39 PM PST

          [ Parent ]

          •  So people who already can't afford health ins. (0+ / 0-)

            ...would be forced to buy it anyway.

            I've heard the Medicare comparison plenty, and Medicare is NOT cheap for retirees. Suddenly having to pony up about $400 extra dollars per month is a seriously big deal for a lot of people, particularly those who are already uninsured because of insurance costs.

            What we have to do is to get costs under control and put an end to this "$100 loaf of bread" scam that our healthcare system has become. Simply forcing the uninsured to come up with hundreds of extra dollars per month to buy health insurance is only going to make the problem worse.

            Regulate the shit out of the healthcare industry and force them to cap prices and bring down costs so people can actually afford it and THEN maybe talk about forcing them to buy insurance when it's not going to break people.

            •  No. People who cannot affford it (0+ / 0-)

              would get subsidies. Poor folks likely will pay little to nothing.

              Health care has to cost someone.  Raise taxes to 50% on high incomes is fine with me, but you show me how we get that through.

              If someone is that poor, they will get free care.  

              Why on earth would I want to charge people who cannot afford it?  That's absurd.

              I have no problems with regulation.  In fact, I favor it.  

              And I prefer single payer.

              Frankly, I think the opposition to mandates is really weird.  if you have insurance now, you'll buy it.  If you don't have it now, you'll be able to get it much, much cheaper. And if you are so poor you cannot afford it, then you'll likely get it virtually for nothing.

              Mandates affect only those with money who choose to take their chances and put their costs on those who work hard and pay for insurance.  If a person really cannot afford it, then it will be subsidized.

              But, hey, the system now works so well.  I guess we'll just keep it, because the doable isn't good enough for ideologues. Cool.

              The people who cannot afford it will just suffer.  

              That's the choice as I see it.

              "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

              by TomP on Wed Nov 12, 2008 at 01:50:52 PM PST

              [ Parent ]

          •  I agree with you up to this point: (0+ / 0-)

            We shouldn't be forced to "buy" health INSURANCE.

            We should pay taxes and along with everything else they cover, we should receive health CARE.

            Insurance does not equal care.

            I've had what is supposed to be excellent insurance for a long time.  But actually RECEIVING health CARE under than insurance has been a constant and significant battle.

            There's a problem with mandated coverage because it is all about Insurance.  Insurance is about making a for-profit company money. NOT about providing health care.

            droogie6655321 lives!

            by YucatanMan on Wed Nov 12, 2008 at 02:35:28 PM PST

            [ Parent ]

    •  I agree completely... (0+ / 0-)

      Pushing mandates on the American public would be suicide for the Dems. Health Care needs to be socialized. You can't just force people to hand their money over to the insurance cartel.

  •  Universal (3+ / 0-)
    Recommended by:
    jdld, Big Tex, TomP

    Employers pay a 1.2% EHT (Employer Health Tax) based upon the salary of the employee to provide universal coverage up here. Every citizen is covered, not just employees. I get so upset when the American MSM carps about our wait times for some procedures. Yeah - you may have to wait a few weeks for a hip replacement, but it's all covered except for hospital parking for your visitors.

    Canada - where a pack of smokes is ten bucks and a heart transplant is free.

    by dpc on Wed Nov 12, 2008 at 10:22:21 AM PST

    Recommended by:
    Big Tex, princess k, dle2GA

    Employer mandates and penalties and all this convoluted red tape is not the way to lead with Health Care issue. This is a failure.

    What we should all be getting behind is the Conyers-Kucinich H. R. 676 "Medicare For All" bill.

    It's simple.
    It's cost effective.
    It is merely an extension of the existing Medicare system (which people understand).
    There are no new business burderns or taxes, etc.
    It provides true gauranteed Health Care (universal) without putting the burden on employer-employee relationships (which are transient and insecure anyway).

    The Democratic Party will be hurt politically and will once again fail if they repeat the whole "Hillary-Care" approach to the Health problem all over again.  This is not the answer.

    Just support and pass H. R. 676

  •  I hope... (2+ / 0-)
    Recommended by:
    Big Tex, TomP

    that Congress decides to go ROGUE, and gets all MAVERICKY in there, and PASSES...

    *** Single Payer Health Insurance ***

    That's what I hope, you betcha!

  •  The mandate I'd start with... (3+ / 0-)
    Recommended by:
    jkb246, YucatanMan, TomP

    is having everyone in the US watch Michael Moore's "Sicko" documentary.  

    Now, before your shorts get in a wad, I know that there was talk that he only showed the good parts of the other country's systems.  I don't know if that is true or not, but my husband and I agreed that if even half of what he showed was true, we'd take it in a heartbeat.

    As I mentioned in a comment in another diary, I am one of the people totally screwed by the current system.  We're self-employed with a modest, average income, and we just got a letter saying our monthly insurance premium will now be $1400/month, before copays, deductables, and non-covered expenses (of which we have many-they don't pay for certain things my daughters needs for their medical conditions).  Oh, and those "medical conditions" are also pre-existing conditions, so no chance of shopping around for a different deal.

    So, you can imagine what I think of the "for profit" insurers.

  •  Universal Health care (2+ / 0-)
    Recommended by:
    Big Tex, Cat Whisperer

    What we need is universal health care, not universal health insurance.  Insurance may be a means, but universal health care is the goal.  A single-payer system appears to be the best alternative, but universal affordable health insurance could be a first step, as long as it doesn't get in the way of universal health care.  Insurance companies are not my concern, making & keeping people healthy are.

    •  My concern is that mandated (1+ / 0-)
      Recommended by:
      Big Tex

      health insurance will not be affordable.  I can't see employers carrying health insurance if it is mandated.  I just see the insurance companies benefiting from all of us having to purchase insurance --- no matter what the cost.  I want a single-payer system.  

      Speak softly and carry a big can of tuna.

      by Cat Whisperer on Wed Nov 12, 2008 at 11:20:31 AM PST

      [ Parent ]

      •  That's the big problem. (1+ / 0-)
        Recommended by:
        Cat Whisperer

        Talking mandates up front absolutely puts the cart before the horse. If the uninsured are suddenly going to have to pay hundreds of dollars a month for mandated health insurance, then it's no solution at all.

        Bring prices down, make healthcare truly affordable for those who currently have trouble affording it, and then maybe start talking mandatory buy-ins.

        But to simply force people up front to buy into a prohibitively expensive, essentially broken healthcare system is ridiculous, and that'd probably kill Obama's presidency.

  •  There is now a 'crack in the door' (Single Payer) (0+ / 0-)

    Even if it is premature, Obama and Congress should just blast on through it.  Some one recently said God had told her that's what SHE should do with open or cracked doors!

    OT.  I sure hope that 'crack' for a possible Senate run for HER (the one who is to remain namesless) seals shut with Mr. Six Felonies loses his race.

    Oh, and remember one of Bart Simspon's unforgetable truthinesses:  "Crack Kills, man".  <g>

    Barack Obama can inspire Americans to get involved!

    by davekro on Wed Nov 12, 2008 at 11:18:53 AM PST

  •  I oppose mandates. (0+ / 0-)
    Why?  Because I don't WANT healthcare in the enormously wasteful, expensive, and patronizing American medical system.  I was tormented by doctors as a small child, and when asked to enter my allergies on healthcare forms, DOCTORS is always the first one on the list.  

    I resent the idea that the government might force me to pay thousands of dollars for "coverage" to partake of services I never want to use.  I have been to a doctor exactly twice in twenty years, both times for acute infections I could have easily treated myself if I didn't need a Permission Slip from the Doctor, known as a Prescription, to purchase a drug that I knew was appropriate, in a dose I could look up in my own library.  I have dealt with everything from sprained ankles to broken bones and cracked ribs on my own, and that's the way I prefer it.  I would like to be able to purchase a codeine-based painkiller without a Permission Slip, because they work better for me with fewer side effects than the NSAIDS available OTC.  However, it's not worth the irritation of having to beg a stranger for permission to treat my body the way it needs treating, especially after I've been told before that said strangers "can't justify" the use of a good drug instead of a mediocre one for a level of pain they can't gauge because, excuse me, it's MY body, not theirs, and they haven't lived with it for twenty or forty years.  

    Anyway, for the rare occasions when I seriously need serious painkillers, there IS a black market.  For basic antibiotics, there are veterinary supplies.  For tranquilizers, antidiabetics, preliminary heart failure and common infections, there's an herb store in town and plenty of vitamins.  I'd prefer being able to go to the local pharmacy legally, but if the People & Senate of the Imperium insist on being assholes, I can keep going behind their backs.  I can manage my health.  I don't need to pay money I don't have to someone to "insure" me for expenses I am NEVER going to run up because I'll slit my wrists before I put myself in the hands of the Medical Profession again.

    There are actually plenty of people who "underconsume" healthcare because they have either personal or philosophical objections to the current system.  JWs who shouldn't have to pay for blood transfusion coverage, because they don't ever want a blood transfusion.  Catholics who shouldn't have to pay for abortion coverage, because they're fundamentally opposed to abortion.  And people who don't want to pay the ghastly sky-high costs of insuring against being placed on machines and having tubes run into their stomachs, because that is not something they intend to allow to have done to them.  We need an "opt-out" option on this "mandate" business.  It's not because we don't think we can get sick and die.  It's because we prefer doing it our way, to the alternative.

  •  if nothing else, this can move the overton window (1+ / 0-)
    Recommended by:

    to make single payer seem more possible, and make Obama's proposal seem like common sense and bipartisanship.

    we have honest disagreements about tactics, compromise, and what kinds of shortcomings are acceptable...

    but we all agree that Americans have the right to basic health.

    let's get to 60 in the senate!

    by danthrax on Wed Nov 12, 2008 at 11:40:59 AM PST

  •  As I asked NYCEVE a few weeks ago (1+ / 0-)
    Recommended by:

    Where should our money go to? the reality is that nothing is going to get done without public pressure. Ads should be running 24 hours a day explaining why single payer is the best solution. Michael moore should chip in something to run Sicko on the major networks. The Big_____fill in the blank are going to spend whatever it takes to not be put out of business.

    I'm tired of hearing about this topic here on Kos. We need on central site run by someone that we can back.  only then will we see something meaningful come out of this.

  •  There are some many things we have to do (0+ / 0-)

    we have to bailout the financial systemetc I don't want to HAVE to pay for health Insurance. President Elect promised no mandates and that is one thing I am definately holding him to. NO Way No How No Mandates.

    The entire health system has to be reformed, right down to what these people charge for services. I have a two year old daughter. She fell and hit her head. The doctor told us to take her into the ER just to make sure. She was doing fine, they looked at her, they did not give her ANYTHINg and said she looked fine, then the doctor said he wanted to give her a CTSCAN just to make sure, we said no because they said they were going to tranqualize her to do it. The doctor said they would not tranqualize her and we would just have to hold her down so we did. He said everything was fine.

    Now the doctor did nothing to her at all he did not even give her tylenol. We don't have insurance, you know what the bill came it at over $2000.00 dollars. That's a real problem. We will not be able to reform the health care system if we don't dig deep and that means charges. WE can fix this but we need to do it right.

    Working for a more perfect union

    by amoreperfectunion on Wed Nov 12, 2008 at 11:53:10 AM PST

  •  Excellent Diary (3+ / 0-)
    Recommended by:
    3goldens, TomP, princess k

    BTW, I read where Obama's Health Care plan is estimated to cost $75 Billion.  That sounds like a lot at first glance, but when you compare it to $700 Billion for bailing out the Wall St. Bankers, it sounds like one hell of a deal to me!  At least some of us "regular folks" would get something out of it.

  •  Mandatory private insurance (2+ / 0-)
    Recommended by:
    defluxion10, edg

    is not universal health care.  And if we push this crap, the Republicans are going to clean our clocks in 2010 and 2012.  They're probably already preparing new Harry and Louise ads as we speak.

  •  It's "CIVILIZED MEDICINE, Stupid. " (1+ / 0-)
    Recommended by:

    Many Democrats were afraid of being called "socialists" or being accused of favoring "socialized medicince."

    We need to face down this propaganda by making it clear that A CIVILIZED SOCIETY does not let members fall by the wayside because they are poor.  Don't let them trump moral issues with financial ones!!

    ...Former candidate for Congress.

    by Steve Love on Wed Nov 12, 2008 at 01:20:31 PM PST

  •  If it has Mandates Obama will be one term and (0+ / 0-)

    Republicans will win for 50 years.

  •  Is there any GOOD reason (0+ / 0-)

    we shouldn't take the whole leap to single payer?
    There's not economically; so it must be political. I say a pox upon incrementalism!! Where are the balls? We won! They are terrified! Let's make anvils by the thousands!

    •  You go do that. (1+ / 0-)
      Recommended by:

      I have bene hearing that bullshit for 30 yyears and single payer never happens.  Meanwhile, people suffer.

      Yes, it's political.  We lack the votes in Congress and Barack Obama opposes single payer.  

      "What we've seen the last few days is nothing less than the final verdict on an economic philosophy that has completely failed." -- Barack Obama

      by TomP on Wed Nov 12, 2008 at 02:15:39 PM PST

      [ Parent ]

  •  I look at my neighbors and wonder what (1+ / 0-)
    Recommended by:

    "affordable" means.  Some of them would have difficulty squeezing another dime out of their "budgets" --  too often the choice now is between heat or food.  How do you mandate something that is absolutely NOT affordable to a certain percentage of the population?  

    "The world is too dangerous for anything but truth and too small for anything but love." ~~ William Sloane Coffin

    by puddleriver on Wed Nov 12, 2008 at 02:03:51 PM PST

  •  However important this, I'll not settle for (0+ / 0-)

    anything less than single payer.

    One can not legislate competence and there is no oversight forceful enough to stop the insurers from their scam:  denial of service.

    It's all well and good that the insurers won't be able to deny policies for "pre" conditions  but it means nothing if they are allowed to continue to deny payments for health care to those already insured.

    Obama is right to be skeptical.  

    "History is a tragedy, not a melodrama." - I.F.Stone

    by bigchin on Wed Nov 12, 2008 at 03:38:30 PM PST

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