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Right now, the insurance companies are salivating over the idea of mandates being put on universal health coverage. Here's a snippet of an article from the AP:

Source: Associated Press

(11-19) 08:50 PST WASHINGTON, (AP) --

The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions, but in return it wants lawmakers to mandate that everyone buy coverage.

Lawmakers have signaled their intent to craft health care legislation early next year, and the insurance industry's support would make passage easier. That legislation is expected to closely track the proposals of president-elect Barack Obama. However, Obama separated himself from his Democratic challengers by opposing an individual mandate for adults to buy health insurance.

More lawmakers may agree to a mandate if it means the insurance industry will back those efforts. They'll remember it was the industry's opposition 15 years ago that helped scuttle former President Clinton's health plan.

The board of directors for America's Health Insurance Plans agreed to the trade-off Monday night. The board endorsed the proposal after a series of hearings in various states.

Our own nyceve has written about the joke that AHIP is in a series of diaries that she's written for over close to two years.

Let me explain to you why the use of mandates would be a political killer, especially with the health care reform we need so badly. The insurance companies win if health care insurance is passed with everyone being forced to buy coverage from crappy insurance plans and the public option is only limited to the elderly aged 55 to 64, and the disabled, as was shown in the Baucus health care proposal.

The stifling of the public option as being a true competitor against the private insurance companies is what will happen in the eventual health care insurance legislation. If the public option isn't a viable player with comparable benefits and is constantly underfunded like the Massachusetts health care public option, then that means that only the sick and the elderly get shunted off onto the public option, with others being forced to stick with private insurance plans with no capped premiums, rising deductibles, and co-pays. The insurance companies still would deny claims. It'd still be murder by spreadsheet on their own terms but on a national scale.

And that's the kind of "universal health care" reform we'll see because that's what Senator Max Baucus has indicated in his legislative proposal. Remember, all health care proposals go through his committee. He also would like to see health care reform passed as separate bills. Senator Kennedy wants it to be passed in one bill. Now, why does Senator Baucus want the health care reform bill to be broken up into separate bills? To kill off the progressive elements of the plan in the Senate.

If health care reform doesn't pass due to the mandates as a political killer, then the insurance companies win anyway because they get to keep on practicing the same policies.

The only way that private health insurance companies can lower their premiums, deductibles, and co-pays is if the public option is a true competitor and allows EVERYONE to participate in the public option, not just the elderly and the disabled and the poor.

Barack Obama campaigned against the idea of mandates for universal health care. He'll likely give in on this since the insurance companies will only come to the table if they get the guarantee that Americans will be forced to buy their crappy insurance products through the use of a mandate.

And you know the only governmental oversight, as written in the Baucus proposal, is a "commission" made out of industry professionals and government officials. We all know who the industry professionals will be---insurance company officials. It's like having the fox guard the hen house.

We cannot allow the insurance companies to be on this "commission" and we must delegate oversight of the insurance industry to Congress alone. That's the only way that true oversight can work in our favor.

Seriously, say NO to mandated health care insurance!!!

Originally posted to slinkerwink on Thu Nov 20, 2008 at 05:58 AM PST.

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  •  tip jar here (172+ / 0-)
    Recommended by:
    Vince CA, Mimikatz, Chi, eugene, miasmo, irmaly, marcvstraianvs, PeterHug, TocqueDeville, ChurchofBruce, movie buff, freelunch, marjo, givmeliberty, opinionated, 88kathy, Cassandra77, Baldwiny, Time Waits for no Woman, highacidity, Xapulin, boilerman10, carolkay, David Boyle, Eddie C, wader, Maggie Swan, emmasnacker, Eddie in ME, churchylafemme, NYFM, defluxion10, alizard, bwintx, KayCeSF, Daddy Bartholomew, snowbird42, boran2, Big Tex, radarlady, tle, JanetT in MD, SherwoodB, PBen, Brooke In Seattle, reflectionsv37, fixxit, Stuart Heady, teknofyl, aaraujo, lotlizard, Joy Busey, Ozzie, empathy, dancewater, Snud, elliott, dus7, BalanceSeeker, BlueInARedState, emeraldmaiden, akasha, Alexandra Lynch, triv33, gatorcog, nilocjin, Timothy J, sarayakat, va dare, drdana, blueintheface, illusionmajik, tegrat, bigchin, One Pissed Off Liberal, dotsright, Cat Whisperer, oscarsmom, blue armadillo, karmsy, Jimdotz, horsepatsy, newpioneer, 7November, sabishi, second gen, cyncynical, willb48, MKinTN, Devsd, edg, glaser, ShadowSD, brklyngrl, karin x, Tchrldy, codeman38, golconda2, Wes Opinion, beltane, karpaty, MsWings, Serpents Sorrow, ShempLugosi, kyril, joy sinha, DixieDishrag, BYw, allie123, In her own Voice, CatJab, Design the Future, 1BQ, J Ash Bowie, cybrestrike, J M F, Mr Tentacle, ceebee7, plumcrazie, Discipline28, qmastertoo, pvlb, mrchumchum, cn4st4datrees, Yalin, TruthShark, DefendOurConstitution, Carakav, dRefractor, SteveP, johngoes, Scott Wood, paintitblue, ElizabethAM, notksanymore, Living in Gin, northernlights, Sleepwalkr, browneyes, stanjz, Lazar, seesmithrun, oohdoiloveyou, political junquie, littlezen, loper2008, Flagship, fidellio, wvmom, deboChicago, freedapeople, calichristi, sullivanst, Lady Libertine, juturna, Micheline, nycjoc, sapientgrape, Toon, nosleep4u, Its a New Day, jl4851, jeanma, derapsofphoenix, yellow cosmic seed, heart of a quince, soaquarian, medicinewoman, FightingRegistrar, free as a butterfly, giyoret, JJ Bogans
    •  What a load of crap (73+ / 0-)

      The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions, but in return it wants lawmakers to mandate that everyone buy coverage.

      These murderers have the nerve to make demands?

      I demand prosecutions for torture.

      by heart of a quince on Thu Nov 20, 2008 at 05:59:48 AM PST

      [ Parent ]

        •  They have lost their shirts on the NYSE (10+ / 0-)

          like every one else.

          What was the worst about McCain's plan was doing away with state regulation of insurance companies based in that state.

          I was surprised to learn that Baucus was holding hearings on health care. It did not seem to be where it should start in the Senate. Not all are carried on CSPAN3. Obama did not have mandates; Hillary used to point it out often.

          Deregulation of their excess, by privatization of the screw ups. Just shoot me.

          I work for a socialist, an Englishman. He had always help pay the coverage for the employee. I cover the family. When we recently moved the company across the river to another state, the rates went down. One state allowed the insurance company to rate each business as its own pool. The new one puts all business our size in a big pool. Interesting.

          Pray for the dead and fight like hell for the living~~Mother Jones

          by CA Berkeley WV on Thu Nov 20, 2008 at 07:12:10 AM PST

          [ Parent ]

          •  Baucus speaks for the Blue Dogs/bush dogs (8+ / 0-)

            Until congress comes to grips with the fact that much of the trouble in the health care area is the direct fault of the insurance companies, nothing substantive will change....Baucus knows this I think, but can't think of any other way to deal with the issue, as for him, the insurance companies handle these problems and changing that will be new untested ground and pretty scary for a survivor politician in a generally Red State.

            You can bet your last dollar the Pubbies will want Big Insurance at the negotiating table...keep the bastards far away and maybe we really will get something that is actually pretty good for the nation.

            Today, 11/19/08, 4201 Americans, and untold Iraqis are dead, tens of thousands more maimed. Bush lied; President elect Obama, it is your war now.

            by boilerman10 on Thu Nov 20, 2008 at 07:31:25 AM PST

            [ Parent ]

            •  Ezra Klein's take on it. (10+ / 0-)

              Even so, the basic foundation here -- individual mandate, guaranteed issue, some form of community rating -- is the likeliest foundation for a deal, and the political system knows that full well: That's the Baucus plan, the Wyden plan, the Clinton, plan, the Edwards plan, and probably will be the Obama plan. The insurers are recognizing that, and trying to pull the terms in their favor, dangling an easy deal where they endorse passage but have more control over the rate structure (which is to say, there's less community rating). This is the beginning of the fight, not the end of it.

              Ezra Klein

              "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 Thu Nov 20, 2008 at 08:37:00 AM PST

              [ Parent ]

              •  I'm still waiting for any private insurer model (12+ / 0-)

                that can compete with a single payer model for health care financing.

                Someone please explain to me how keeping a profit margin in health care financing is the economically responsible thing to do. Especially now.

                30+% overhead: private insurer model
                3-5% overhead: single payer

                The difference is true universal coverage.

                And yet because of a leadership deficit couched in hackneyed memes like "political infeasibility" single payer is kept out of the discussion, which, imo, seriously damages the legitimacy of the discussion.

                What is every one so afraid of?

                My belief? Mandate=corporate welfare, pure and simple, and if this is the fight we've chosen, it sure is a dumb one.

                •  I like single payer. (6+ / 0-)

                  Does Obama, the Senate, or the House?

                  That's the issue.  On blogs, people can yell for single payer, but I don't see the votes.

                  "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 Thu Nov 20, 2008 at 09:06:47 AM PST

                  [ Parent ]

                •  Too expensive to transition. (1+ / 0-)
                  Recommended by:

                  No political buy-in because most disease is not contagious.  No vested interest in reform by most people.

                  •  No vested interest? (3+ / 0-)
                    Recommended by:
                    CatJab, 1BQ, mkor7

                    I suppose 48 million uninsured isn't officially "most people",
                    but factor in all the under insured, those in possession of criminal junk insurance, any of the 473 union organizations in 49 states that have endorsed single payer, the CEOs in support of it including the former CEO of Caterpilar, the national conference of mayors who endorsed it, the numerous municipalities who have endorsed it, 50,000 physicians, 93 Congresspersons,  the Presbyterian church, and both houses of the CA legislature, and we might be getting close.

                  •  i thought the business roundtable people were at (1+ / 0-)
                    Recommended by:

                    the table on this?

                    how did those market place HMO from he 1990s work out?

                    FEDr had his veterans camping on the mall to deal with

                    we keep putting up the BS over and over expecting different results, so let take over St. E's until they get his done

                    this is part of the problem with the legacy cost of the auto industry

                    COSTA RICA and CROATIA have a longer life span

                    the pro-life people should take a look at how far down on the list we are for INFANT MORALITY

                    Pray for the dead and fight like hell for the living~~Mother Jones

                    by CA Berkeley WV on Thu Nov 20, 2008 at 09:51:06 AM PST

                    [ Parent ]

                •  Indeed, why guarantee profits for insurance cos? (2+ / 0-)
                  Recommended by:
                  churchylafemme, Ozzie

                  Get them completely out of the way. No one should be allowed to intervene between a doctor and a patient. If the doctor can cure, prevent, or treat a medical condition, no one should be allowed to interfere, especially not a company that's looking to make a profit from the "transaction."

              •  Ezra's terrible on health care policy (3+ / 0-)
                Recommended by:
                slinkerwink, MadLibrarian, Big Tex

                He has ignored the single-payer movement entirely because he does not see them passing a bill in the short-term; this political judgment of his biases his coverage, to the point where he's been sucking up to Baucus for 2 years for a plan that AHIP also loves.  I mean, God bless Ezra as a person, but he's totally undermined the American Prospect's coverage of a great American social movement.  

                •  That is the issue, isn't it? (3+ / 0-)
                  Recommended by:
                  RIP Russ, ZhenRen, carllaw

                  Reform now, which might strengthen the insurance companies and put off the say of single payer or likely lose on single payer.  People choose.  Revolution or reform.  He chose reform.

                  Good luck.

                  "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 Thu Nov 20, 2008 at 10:17:16 AM PST

                  [ Parent ]

            •  At the table, yes, but not at the head (1+ / 0-)
              Recommended by:

              Daschle at HHS is good. Medicare has about the overhead of national health service in the other industrialized countries that hare ahead of us.

              I have cringed at the auto loan debate that the entire cost of $75, which include pension and health bennies, is bantered about like it was a guy's wage. How much is health care in each car, more than the price of steel?

              Social Security was designed when most of us were dead at 65, so that should be on the table at the same time. I am way closer to this than not, and we are all in this together.

              Maybe Baucus will have to take up organic beef ranching like his junior, Tester. Wasn't it his wife that raised a ruckus at a Bethesda/DC nursery/florist two summers ago? She looked trophy.

              Pray for the dead and fight like hell for the living~~Mother Jones

              by CA Berkeley WV on Thu Nov 20, 2008 at 08:37:27 AM PST

              [ Parent ]

          •  Yup (6+ / 0-)

            One of the often overlooked elements of rising health care costs is the fact that insurers rely on playing the markets to make profits.  With the markets having gone nowhere since 2000, they've been struggling to make profits that way.  So they've had to try to wring out profits any other place they can find them.

            Overall though this whole forcing people to buy insurance is foolish.  If people can afford insurance, they buy it.  It's that simple.  Everybody gets the fact that the unexpected can happen, and that being uninsured, no matter how healthy you are, can be a risky proposition.  

            So forcing people to buy insurance means that you end up forcing people who can't afford it to buy insurance.  There's a brilliant idea.  The result is that people, in order to save money, will get whatever bare minimum coverage they can get, and the coverage will suck.  Insurers will put together highly profitable plans that provide crappy benefits and target this segment.  

            The result will be that everybody will be "insured" but that a lot of people, as we have today, will be underinsured.  You'll still have people going bankrupt because they can't afford the out-of-pocket costs.  You'll still have people getting their necessary medical treatments.  It does not fix the underlying problem, it merely covers it up, which is much worse.

            •  Profits, this just scalds me (2+ / 0-)
              Recommended by:
              Serpents Sorrow, 1BQ

              This 13% to 30% model also has an impact on your auto insurance, etc. depending on how you state handles the issue. Repugs only want to go after lawsuits, that is now that Mrs. Rick Sanctimonious has settled with her chiropractor for OVER that magic $250,000. Remember only large corporations are entitled to lawyers.

              In another life, I used to work in the business office of a small town hospital in the 1970s. A not for profit hospital. Run by the ten doctors in town. We did not sue people for past medical bills. We did not make people set up a credit card account and agree to pay interest to be able to get medical care.

              The worst accounts were two types:

              1. Divorced parents using their children's health care to try to continue to make the format parent miserable from afar.
              1. Wealthy insured who thought that only the little people had to pay that 20% the insurance did not cover after the claim was processed by BC/BS.

              The people without insurance did not want charity care. They came in every week and payed what they could. The taxi driver. The beautician. Heck, the CMA even folded in the osteopaths rather than trying to fight them. There was preventive care then, which has long term benefits. Heroic measures had to be done down in big city.

              Pray for the dead and fight like hell for the living~~Mother Jones

              by CA Berkeley WV on Thu Nov 20, 2008 at 09:41:06 AM PST

              [ Parent ]

          •  I think state (1+ / 0-)
            Recommended by:
            Skeptical Bastard

            regulations should be more uniform. Healthcare in a national market.

            •  in what world do you live in? (1+ / 0-)
              Recommended by:

              i have a local agent

              at the national level we would be guaranteed the regs would be written to the benefit of the industry not the people

              this has happened over and over

              why else would bob dole of kansas cared a hoot about a tax break for gallo wine of calif.?

              still boycott grapes and them

              i have become more a federalist on matters like this

              federal minimum, maybe

              Pray for the dead and fight like hell for the living~~Mother Jones

              by CA Berkeley WV on Thu Nov 20, 2008 at 09:44:23 AM PST

              [ Parent ]

              •  The chief problem our (0+ / 0-)

                health care system faces is that it is NOT a system.  We need to see this is a national market.  

                For example, PPMs may well have been a solution, however, they could not work nationally because some states have fee splitting and/or corporate practice laws that meant there could not be true PPms in those states.

                •  Healthcare regs are a mess (1+ / 0-)
                  Recommended by:

                  There is basically zero chance that healthcare will be regulated at the national level other than the regulations that Medicare manages to impose. Health insurance is a mixture of state regulation and federal laws that limit regulation. It's quite badly done at the moment, but I don't have much hope that any new regulations from the feds would help patients.

                  •  My mom worked at the HEW (0+ / 0-)

                    she processed the health care stuff for naval officers. This was handled there, not at DOD. This was back in the 1970s so I am a little fuzzy.

                    The bigger the rating pool the better your rates. that is a difference in a national model.

                    But McCain's idea of shopping nationally for something sucks. Face it, when you are healthy you don't think you need it. When you are sick you are too stressed to make good decisions.

                    Obama likes idea that 401(k) system changes to automatic sign up. Every one is in unless you fill out paperwork that affirms you reject savings. This is opposite of what we have now.

                    We can apply this model to health care, you are signed up for "XXXXcare for All" unless you go to the effort to opt out. With everyone getting into the pool that Sherrod Brown would be in if he were not so principled to reject it, the risk is really spread: that is my definition of insurance.

                    Pray for the dead and fight like hell for the living~~Mother Jones

                    by CA Berkeley WV on Thu Nov 20, 2008 at 11:12:08 AM PST

                    [ Parent ]

                    •  We don't need insurance (1+ / 0-)
                      Recommended by:

                      We need a health care funding mechanism.

                      Insurance happens to be the method we stumbled into. It doesn't work very well.

                      The first rating pools were community rating from the Blues. The only difference in price was related to which metropolitan or rural district you lived in. That only worked until age rating and other scoring systems were introduced so others could cherry-pick the best risks. I can guarantee you that I can find a better price for a 28-year-old male in the private market than they will get in a pool.

        •  So, what do you do about the people (6+ / 0-)

          who DON'T buy health insurance and increase the costs for those who do?  While I'm not generally in favor of mandates, I AM in favor of everyone getting coverage, mandated or not.  Yes, it is a "boon" to the health insurance industry, but that's not necessarily a good reason not to do it. Sometimes what's good for business is good for everyone.   This diary reeks with a "just because the health insurance industry wants it it MUST be bad!" vibe that I just don't agree with.

        •  Which I would actually do (0+ / 0-)

          to save the jobs of their workers... but only if they give me a car worth buying.

          Obama's campaign just transformed from "Yes, we can" to "You're fuckin'-A right we did!"

          by Eddie in ME on Thu Nov 20, 2008 at 08:48:53 AM PST

          [ Parent ]

      •  Yea imagine that... (7+ / 0-)

        lobbying from an industry group...what a surprise.../snark

        Obama/Biden'08 Winning Change for America and the Democratic Party

        by dvogel001 on Thu Nov 20, 2008 at 06:01:31 AM PST

        [ Parent ]

        •  They're killing people right now (23+ / 0-)

          Every day they kill people. And now they want to force everyone to increase their profit margins or they'll fight restrictions on their murder.

          I demand prosecutions for torture.

          by heart of a quince on Thu Nov 20, 2008 at 06:05:08 AM PST

          [ Parent ]

          •  Exactly. They'll fight HARD for mandates. (13+ / 0-)

            And guess what? The Republicans will fight just as hard against mandates as well.

            •  You're conflating issues (14+ / 0-)

              The stifling of the public option as being a true competitor against the private insurance companies is what will happen in the eventual health care insurance legislation. If the public option isn't a viable player with comparable benefits and is constantly underfunded like the Massachusetts health care public option, then that means that only the sick and the elderly get shunted off onto the public option, with others being forced to stick with private insurance plans with no capped premiums, rising deductibles, and co-pays. The insurance companies still would deny claims. It'd still be murder by spreadsheet on their own terms but on a national scale.

              This has nothing, whatsoever, to do with mandates.  

              There is absolutely nothing incompatible between mandates and an accessible, affordable public option.

              There is nothing incompatible between mandates and strict restrictions on insurers' ability to deny claims or aggressively rate.

              Nothing in your diary even addresses mandates in the form that Democrats propose them.  Yes, we all think AHIP sucks, but there's no reason mandates have to look like what they want them to look like.

              Lastly, please stop repeating the myth that mandates would hurt affordability.  It's patently obvious that bringing the young an healthy into the insurance market makes coverage MORE affordable than allowing them to skate by until they actually need care.

              •  Riiiight. (5+ / 0-)

                Lastly, please stop repeating the myth that mandates would hurt affordability.  It's patently obvious that bringing the young an healthy into the insurance market makes coverage MORE affordable than allowing them to skate by until they actually need care.

                because there's so many more young healthy professionals who go without their company benefits plans than there are poor sick people who can't afford insurance or their company doesn't offer it.

                We shouldn't be forcing the government to pay for the elderly who need more benefits while the insurance companies get the younger, healthier population. It's expensive to pay benefits for the elderly and it hurts their profits! if there's going to be a government option, it should be a life long 100% coverage option. Let the insurance companies try to compete with that (and end up selling boutique coverage for the rich, MUAHAHAHAH!).

                •  Did you forget about the subsidies? (3+ / 0-)
                  Recommended by:
                  dhonig, Clem Yeobright, chick ghandil

                  because there's so many more young healthy professionals who go without their company benefits plans than there are poor sick people who can't afford insurance or their company doesn't offer it.

                  The sick and poor would receive subsidies to make coverage affordable.  The idea of subsidies is universally supported by Democrats, and it has absolutely nothing to do with mandates.

                  We shouldn't be forcing the government to pay for the elderly who need more benefits while the insurance companies get the younger, healthier population. It's expensive to pay benefits for the elderly and it hurts their profits! if there's going to be a government option, it should be a life long 100% coverage option. Let the insurance companies try to compete with that (and end up selling boutique coverage for the rich, MUAHAHAHAH!).

                  So the perfect is the enemy of the good.  If you can't have single payer, we might as well let the 60 million uninsured Americans die.

                  And, of course, young people would be allowed to enter the public plan under Obama's plan.  

                  •  Nobody said Single payer is perfect. (7+ / 0-)

                    That is a straw man argument right there. No system is perfect.

                    If you can't have single payer, we might as well let the 60 million uninsured Americans die.

                    Again, riiiight.. because for sure those 60 million uninsured are going to love the new coverage plan they get, given the insurance companies need to skim 30% off the money they receive for 'overhead' (read as: profits and CEO salaries). Lets think about it, many plans are unaffordable now without massive employer contribution? A: All of them! Heck I make double the national median income and there is no way I could afford my family plan without my employer paying 90% of the cost. What happens to the cost of the plans once all the sick and low income who currently can't afford insurance end up covered? What kind of plans will be available to them? I hear a lot about how everyone will be covered, I don't hear crap about 'for what and how much'?

                    That said, as long as we're relying on a system that is skimming 30% off the possible benefits people could be recieving, as long as we are relying on employers to finance employees... how are we changing anything? The only real change in a mandated plan is that the companies will get massive new enrollments of people who previously couldn't pay but who's premiums (which will likely be outrageous!) will be paid by tax payers.. A direct transfer of wealth from all of us to private companies.

                  •  Couldn't agree more (5+ / 0-)

                    This diary says nothing about the issues raised by mandates at all

                    Mandates aren't some insurance industry scam to expand market share -- its a response to the obvious problem of eliminating restrictions on pre-existing conditions.

                    For those who oppose mandates, what should we do about this situation:

                    Young healthy woman opts not to buy health insurance because its $500 per month and she doesn't want to pay for it.  And she does ok -- she saves 6 grand a year, and spends less than that on the occasional out of pocket doctor visit.

                    Then, at 25, she learns she has concern.  She needs treatments that will cost around $300,000.  So she goes out and buys health insurance and the insurance company is required by law to cover her.

                    This is a classic "house on fire" insurance purchase.  

                    You may say, so what, the insurance company loses money.  But its going to price that loss into its insurance because the risk pool it has doesn't include young healthy people, but mostly sick people with big bills.  So you may need to charge $25,000 per year to break even, not $6,000 (I'm just making these numbers up) because you have so many people in the pool with huge bills, and very few people without bills.

                    So what does this mean -- what it really means is the young healthy woman already HAS FREE INSURANCE because the government has mandated that insurance companies sell her insurance when she gets sick.  Why not make her pay for that coverage instead of sticking the cost on those already sick?  

                    •  What if one chooses NOT to have health insurance (2+ / 0-)
                      Recommended by:
                      Brooke In Seattle, mkor7

                      because one doesn't believe in the medical system as it stands today?  Why should one have to pay money to insurance companies to cover one for services that one doesn't want?  The vast amount of money spent on unnecessary (and sometimes deleterious) pharmaceuticals and surgeries in this country is staggering.  This is not to say that the medical profession has no purpose, but as it stands now, a profession intricately entangled with the insurance companies and operating for profit, it is in the business of pushing disease and disability.  Is it constitutional to force those of us who choose to opt out of the conventional medical system in this country to pay for services that we don't want, especially when insurance usually doesn't cover gentler, less intrusive services which we might want?

                  •  subsidies will increase insurance profits (1+ / 0-)
                    Recommended by:

                    and suck more patient care dollars out of the system.  the taxpayer will be paying for insurance company profits; is that a good idea?

                    and the idea is that if we give all this extra medical influence to bad apple insurance companies, it will hurt our healthcare system; so it's the bad being the enemy of the good here.

                    •  Yes, we should keep people uninsured (0+ / 0-)

                      Otherwise, their money might go to insurance companies.  

                      Good point.

                      And where does this "extra medical influence come from?"  Some "socialized medicine" diatribe you heard on talk radio?

                      •  You're right about the influence- (2+ / 0-)
                        Recommended by:
                        Big Tex, CatJab

                        as the power non-physicians presently hold in denying care is horrifying enough.

                        It's about health care, not health insurance.

                        Have you a private insurance model that can compete with a single payer model?

                        How do you reconcile the 30+% overhead with a 3-5% overhead for a publicly financed, privately delivered model?

                        I'll be happy to sign on to a status quo solution if someone can crunch those numbers for me.

                        •  You enact the other reforms Democrats support (0+ / 0-)

                          How do you reconcile the 30+% overhead with a 3-5% overhead for a publicly financed, privately delivered model?

                          First, for several reasons, the contrast is not that stark.

                          But, more importantly, several key reforms endorsed by Obama and Senate leaders will drastically reduce the overhead of private insurance.  Most notably, drastically reducing the ways in which insurers can rate potential customers will cut out much of the overhead while helping to ensure that the sick can afford care.

                          •  So that just leaves profit- (0+ / 0-)

                            v. a non-profit financing system.
                            What compelling reason to choose a profit based system?
                            Political over economics?

                            I'll have to respectfully ask you for your numbers, and what you consider to be "not that stark".

                            Any monies going toward any profit overhead are wasted and diverted from care.

                            There are many many industries where a for-profit model is desirable, health care financing isn't one of them.

                          •  response (0+ / 0-)

                            v. a non-profit financing system.
                            What compelling reason to choose a profit based system?
                            Political over economics?

                            You mean why not have single payer?  I would love single payer; it's simply not politically feasible at this time.  But the next best thing is an individual mandate, IMO, accompanied by the proper reforms.

                            I'll have to respectfully ask you for your numbers, and what you consider to be "not that stark".

                            When calculating the overhead of Medicare or other public programs, some of the costs of the program is simply charged to other agencies.  For example, the physical infrastructure, the auditors, and the lawyers are often paid for by other government agencies or programs, so they don't show up on the Medicare finance sheet.  These make it seem as though public programs have less overhead than they actually do.

                            But, I agree, there will generally be less overhead in the public programs because of 1) the economy of scales, and 2) the lack of a profit motive.

                          •  I'm loathe to repeat myself- (0+ / 0-)

                            but if you're in favor of single payer, why would you insist on perpetuating the "politically infeasible" meme?

                            Need I compile those pundits decrying the election of an African American as same?

                            And I respectfully ask again for the numbers and cites comparing private and single payer models.

                            Profit is an insurance company's raison d'etre.
                            Any margin is significant and directly impacts quality and availability of care, impeding the goal of universality.

                            We should be advocating for the most fiscally responsible universal system because it's the most fiscally responsible universal system.

                            Aren't we the fact based reality community?

                          •  I think we're talking past each other a bit (0+ / 0-)

                            And I respectfully ask again for the numbers and cites comparing private and single payer models.

                            I wasn't talking about single payer versus private; I was talking about existing public programs versus existing private insurers.

                            but if you're in favor of single payer, why would you insist on perpetuating the "politically infeasible" meme?

                            Need I compile those pundits decrying the election of an African American as same?

                            It's not a "meme"; it's an undeniable truth.  Ted Kennedy introduces Medicare for All in the Senate every year, and I don't think he's gotten a co-sponsor in a decade.  

                            The reason I support a less-than-ideal system is because people are dying and going bankrupt because of what we have now, and I'd rather do something to help them than wait who-knows-how-long for single payer to become feasible.

                            As for the feasibility of it, here's a quick and dirty test: If a liberal idea is not endorsed by any of the major Democratic Primary contenders, it's not politically feasible even in a Democratic Congress.

                          •  then our congress is doing a horrible diservice (0+ / 0-)

                            to our nation, as they deny factual evidence and refuse to lead on so critical an issue.

                            I assume then, since you suggest us 'talking past each other' that you agree with my initial numbers about overhead.

                            A for-profit private insurer solution is fiscally unsustainable.

                            If we now choose the politically expedient over hard evidence we're all complicit in the resulting collateral damage.

                            What percentage of GDP are you comfortable spending on health care in this country?

                            Especially relative to every other industrialized nation?

                          •  By the way... (0+ / 0-)

                            If you want to read a more detailed account of my views on health reform, please read this.

                          •  But there could be (0+ / 0-)

                            non-profit, private insurance co-ops. Similar to what credit unions are in the banking industry, but without the eligibility requirements.

                •  Markets CAN'T do this. (0+ / 0-)

                  That's why we have Medicare.

              •  Agreed. (3+ / 0-)

                Mandates are an important, even necessary, part of any solution.  But they'd ONLY work with a number of other reforms.  Not just requiring insurance companies to cover those with pre-existing conditions (guaranteed issue), but also prohibiting them from charging more for those customers (community rating), as well as forcing them to actually pay for coverage. They should be forced to immediately pay for expenses referred by a doctor. If they suspect fraud, their remedy should be to try to recover the money from the insured later, but they could ONLY start that procedure after the patient's recovery was complete, and the burden of proof would be on the insurance company.

                There actually should be a role for private insurance companies in the system, to make positive innovations. The regulations would need to be strict enough that the insurance companies could only profit from innovations that provide care, instead of the current system where they profit by denying it. For instance, an insurance company might find that it helps their bottom line to provide free nutrition counseling and exercise programs, since it could reduce costs in the long run.

          •  The solution to me seems simple... (8+ / 0-)

            let everyone have a choice to get health insurance from an insurance company or from Medicare.  Medicare would offer a set of standard plans with high/med/low deductible coverage and premiums that are appropriate and the health insurance companies would need to offer a plan with the same benefits and then compete with Medicare for the rating would apply for rates...problem solved...premiums would be discounted on a sliding scale based on family AGI for any policy.  These discounts would be supported by a premium tax of 10% on all policyholders...

            Obama/Biden'08 Winning Change for America and the Democratic Party

            by dvogel001 on Thu Nov 20, 2008 at 06:20:31 AM PST

            [ Parent ]

            •  Or even simpler (5+ / 0-)

              give the insurance companies strict guidelines on what they MUST offer.

              1. Cover everyone. No exceptions. If they want coverage, you MUST sell it to them, and at the same rate as everybody else.
              1. Cover everything except cosmetic surgery, some alternative therapies, truly experimental treatments, and some elective surgery. Everything else, TOTALLY covered.
              1. Copays are OK, but at no more than a set amount. So your copay could be LESS, but not MORE than $XX.
              1. The insurer is liable for all payments except copays and non-covered procedures. NOT the patient, the insurer.

              The problem isn't mandates, it's INSURANCE.

              •  Even simpler (1+ / 0-)
                Recommended by:

                No choice. As long as rich people have the option of buying better health care plans, they and the insurance companies will lobby to underfund the plan available to regular people.

                •  I think that has as much chance of... (1+ / 0-)
                  Recommended by:
                  Dem partisan

                  becoming law as the plan proposed in 1993...if you have your way we will have the status quo...we need to provide choices...

                  Obama/Biden'08 Winning Change for America and the Democratic Party

                  by dvogel001 on Thu Nov 20, 2008 at 07:33:08 AM PST

                  [ Parent ]

                  •  Your current choices: (0+ / 0-)
                    1. A $5k per person tax on the people who can least afford it, with few benefits—wealth redistributed directly from the uninsured to insurance companies.
                    1. Do nothing.

                    Personally, I do not subscribe to the philosophy that when a decision desperately needs to be made in a crisis, there is any practical or moral value in choosing to "Do something, even if it's wrong."

                    •  And I personally do not subscribe... (0+ / 0-)

                      to a 1 size fits all solutions and the American people will never stand for that kind of change...what is wrong with giving people choices of different levels of coverage...why does all coverage have to be no deductible and $20 copay...makes no sense to me...if that is the plan you want then that should be one of the plans offered...others would prefer to insure for catastrophic and high medical expenses only and pay higher ou-of-pocket expenses for routine medical care...

                      Obama/Biden'08 Winning Change for America and the Democratic Party

                      by dvogel001 on Thu Nov 20, 2008 at 01:04:25 PM PST

                      [ Parent ]

                  •  good lord let's not act like (0+ / 0-)

                    everything is tied to like it's 1993.  Might as well tell all the homosexuals they can't have same-sex marriage because that was horribly unpopular in 1993.

              •  Why no more than a set amount... (0+ / 0-)

                for co-pays...I had a lot of choices for low/med and high co-pay/deductible policies and made the decision based on my health insurance needs for my size fits all is not necessary to fix the problem and is a recipe for failure of passage...not having choices is un-American...IMHO

                Obama/Biden'08 Winning Change for America and the Democratic Party

                by dvogel001 on Thu Nov 20, 2008 at 07:32:00 AM PST

                [ Parent ]

                •  Because there needs to be a ceiling (1+ / 0-)
                  Recommended by:
                  Dem partisan

                  otherwise the copays will be so much it won't be worth having the insurance at all, and we'll be right where we are now.

                  Depending on what you want, you might pay a little more to get a low/no copay policy that covers just about every drug known to man, etc. Or you might pay less and have a higher copay and a sliding drug scale (generics 100% covered, tier A $20 copay, etc.). Lots of plans already do something like that.

                  But I'd definitely cap how much the copays can be, and the max you can pay out of pocket per year.

                  •  That is short sighted and ... (0+ / 0-)

                    a 1 size fits all mentality.  I pay a $30 co-pay for interist visits and $50 for specialist and + a $3000 deductible for hospitalization.  My cap of total out-of-pocket is $7000 for the year.

                    This was the right plan for my family.  Who are you to say that my deductible/co-pay is too high?

                    One-size fits all I will personally lobby against even though I am generally for healthcare reform...

                    Obama/Biden'08 Winning Change for America and the Democratic Party

                    by dvogel001 on Thu Nov 20, 2008 at 07:50:54 AM PST

                    [ Parent ]

                    •  What about this scenario? (1+ / 0-)
                      Recommended by:

                      A family chooses the highest possible deductible/co-pays in order to get the lowest required payments because everyone is well and this is a way to make budgetary ends meet.  

                      Then one of them develops an illness that necessitates long-term, horrifically expensive pharmaceutical treatment.  Now what?

                      I worry that borderline families will choose the least amount of coverage because that is what they can afford, then get trapped by an unforeseen circumstance in some bizarro world where they can't switch to a better coverage because it's too expensive or it's not permitted, and still cannot afford the co-pays for the plan to which they are already subscribed.  

                      Many of us have options to weigh regarding sensible copay and deductible amounts v. participation fees.  Some of the people who need insurance the most are also in financial circumstances that require the cheapest way possible.  If we don't make co-pays and coverage uniform, what have we done but forced marginal clients into a situation where they pay but cannot make use?  And beyond that, would medicaid still be available to them?  

                      Does this make any sense?  To sum up, I think a scaled co-pay/deductible scheme will adversely affect borderline (not poor, but not rich) participants.

                      •  I think the coverage should be scaled.. (0+ / 0-)

                        to the max out-of-pocket per year...that is the real purpose of insurance...the rest is choices that Americans can make based on their family situation.

                        So maybe the solution is a plan cannot have a max out-of pocket over $10,000 per family per year...

                        That is how I purchased my policy focusing on the max out-of-pocket for the lowest overall cost weighing likely average healthcare costs vs premiums.

                        If the working poor, lower middle class chooses a high max out of pocket and goes bankrupt over $10,000 out of pocket costs then they will have to declare bankruptcy and the costs would be settled in a reorganization.

                        I still see no reason to make a 1 size fits all scheme...

                        Obama/Biden'08 Winning Change for America and the Democratic Party

                        by dvogel001 on Thu Nov 20, 2008 at 01:09:55 PM PST

                        [ Parent ]

                      •  The NJ system works really good and has lots... (0+ / 0-)

                        of choices for small business (2 - 50 employees)...this model is a great potential for everybody as long as there are no pre-existing conditions and community rating...with competition between a federal plan (like Medicare) and private insurance companies for standardized options...

                        Obama/Biden'08 Winning Change for America and the Democratic Party

                        by dvogel001 on Thu Nov 20, 2008 at 01:11:24 PM PST

                        [ Parent ]

                  •  Nothing should be 100% covered... (0+ / 0-)

                    except for the poor there should be at least a nominal co-pay like $5 for drugs...

                    Obama/Biden'08 Winning Change for America and the Democratic Party

                    by dvogel001 on Thu Nov 20, 2008 at 07:51:43 AM PST

                    [ Parent ]

                    •  Really? (2+ / 0-)

                      Suppose you have a child with a chronic condition that requires a lot of diagnostics and surgery. You don't think that should be 100% covered even if you make lots of money? You really feel you should basically spend a large chunk of your income for medical care under that condition, possibly causing you to lose your home, your savings, everything you've worked for?

                      Frankly, I think the exact opposite - MOST things should be 100% covered, except for relatively small copays.

                      •  "Big Rock Candy Moutain" "Drinking that (0+ / 0-)

                        free Bubble Up and eating that Rainbow Stew"

                      •  After you get to your yearly... (0+ / 0-)

                        out of pocket max then 100% after that...same as Medicare...

                        I am living proof that you do not need to have everything covered.  My plan has a $1500 deductible for hospitalization and 20% co-pay for hospitalization and a $7000 annual out-of-pocket max.

                        In addition, I pay a relatively high $30 for PCP and $50 for Specialist co-pay and prescriptions are $15/$35/$50 Generic/Regular Brand/Formulary

                        Now I ended up needing major surgery which cost over $200K.  Everything was covered after my plan ate up my $7000 but I saved $6000 on my premium.  So I lost the bet because I had major surgery which was not planned but I was protected from major costs that were not planned.

                        So I put the $6000 away and the only additional out-of-pocket was $1000...

                        So it does work and I am quite happy with that choice rather than being forced to spend the additional premium money, I take that savings and use it for co-pay and deductibles.  If I am healthy then we all win, if not that is what insurance is for.

                        Insurance is not for paying for 100% of all costs it is for protecting your assets from a major drain if you have a major medical condition that requires significant medical care.

                        I will personally lobby hard against a one-size-fits all plan...we need choices and it can still work....

                        Obama/Biden'08 Winning Change for America and the Democratic Party

                        by dvogel001 on Thu Nov 20, 2008 at 01:27:40 PM PST

                        [ Parent ]

                      •  Here is a great example that (0+ / 0-)

                        already works in NJ...


                        Obama/Biden'08 Winning Change for America and the Democratic Party

                        by dvogel001 on Thu Nov 20, 2008 at 01:44:37 PM PST

                        [ Parent ]

                    •  How many people like spending time at the doctor? (1+ / 0-)
                      Recommended by:

                      There may be a few people who will go to the doctor and waste the doctor's time because they have nothing better to do and find this entertaining, but the overwhelming majority of people actually put a little thought into whether it's worth the hassle of going to the clinic.

                      We don't need to have charges to keep people from using the services 'unnecessarily'.

                      •  It is not to ration care that we should... (0+ / 0-)

                        have choices in deductibles and co-pays it is that everybody is different and has different medical insurance order to get 100% of people covered we need to have a variety of plans that offers choice of deductible/co-pay/premium depending on your individual/family situation...

                        The only standardization should be

                        1. Selections of deductible/co-pay options
                        1. No exclusions/pre-existing conditions
                        1. Maximum out-of-pocket not extreme (nothing over $10,000 or 10% of AGI
                        1. Community rating of individual rating for premiums
                        1. Competition between a Medicare like set of plans and private insurers based on standards above...

                        6.Premiums would be supplemented somehow with federal payments based on income up to 3x the state poverty income level and gradually reduced to zero from 3x to 4x.  This would be a flat amount regardless of plan selected.

                        1. Medical expenses and premiums deducted from taxes with no limitation up to $100K AGI and then subject to the 7.5% limitation.

                        One of the plan choices should be a low co-pay/no deductible plan but that would be more expensive.

                        Obama/Biden'08 Winning Change for America and the Democratic Party

                        by dvogel001 on Thu Nov 20, 2008 at 01:37:25 PM PST

                        [ Parent ]

                  •  BTW my prescription co-pay is... (0+ / 0-)

                    $25/$35/$50 generic/regular/formulary and I am quite happy with that level of co-pay...others can select lower co-pay's

                    It is about how much do you want to insure of the you want to insure 100% of any risk...the answer is never...

                    The point of insurance is to spread the risk of catastrophic medical expenses not to insure every last medical out-of-pocket expense...

                    Obama/Biden'08 Winning Change for America and the Democratic Party

                    by dvogel001 on Thu Nov 20, 2008 at 07:53:55 AM PST

                    [ Parent ]

                  •  Co-pays encourage people to (0+ / 0-)

                    consider cost.

              •  "except cosmetic surgery" (1+ / 0-)
                Recommended by:

                People need to have cosmetic surgery after car crashes , cancer , etc etc etc

                "I don;t need to , because I don't give a shit who YOU are" MAORCA ***mean people suck***

                by indycam on Thu Nov 20, 2008 at 07:35:04 AM PST

                [ Parent ]

      •  Exactly (6+ / 0-)

        Why should we let them dictate our health care policy?

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

        by eugene on Thu Nov 20, 2008 at 06:24:08 AM PST

        [ Parent ]

      •  Accept all customers - BUT NOT ALL CLAIMS. (6+ / 0-)

        this is KEY and needs to be pointed out here.

        They can still deny claims.  They WILL still deny claims, and they'll be raking in the government-sponsored highway robbery money in the process.

        "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 Thu Nov 20, 2008 at 08:16:03 AM PST

        [ Parent ]

      •  Stop thinking in terms of health insurance (2+ / 0-)
        Recommended by:
        Brooke In Seattle, Ozzie

        It's health care reform we need, and the first thing to go is the concept of health insurance, at least any version that allows accountants to deny services.  

        We need to get to a system where doctors are on a decent salary and make decisions based on medical needs.  Take out the profit motive from health care--it doesn't belong there any more than it belongs in police or fire services.

        John McCain--he's not who you think he is.

        by Mimikatz on Thu Nov 20, 2008 at 09:10:05 AM PST

        [ Parent ]

    •  Imagine how much cost could be alleviated (27+ / 0-)

      from our health care if insurance companies were elliminated.

      I live in Nashville and there are so many huge homes in gated communities.

      When I moved here, I asked people what do these people do to make enough money to live in places like that?

      They said a lot of the money here is from "Health
      Care" and "Insurance".

      It's been the "Dawning of the Age of Aquarius" for 40 years. "Harmony and understanding," my ass.

      by Cassandra77 on Thu Nov 20, 2008 at 06:06:13 AM PST

      [ Parent ]

    •  I trust Tom Daschle to craft the right plan (14+ / 0-)

      Since hearing about his appointment, I've read about his book on healthcare and his desire to fashion a healthcare equivalent of the Federal Reserve. If I understood the proposition correctly (someone could correct me), part of that plan would require that Medicare, Medicaid, government healthcare, and those who want to buy healthcare through the government would all be pooled together, thus creating a huge pool of individuals that would drastically lower insurance plans. In addition, this Healthcare Federal Reserve would monitor what private insurers would be required to provide in terms of coverage, such as the need for preventive coverage.

      Therefore, even if there was a mandate, most individuals would probably want to choose the government option since it would be the most cost effective. I see that as a great catalyst for an eventual single payer systerm.

      •  Medicare is already cheaper than any insurance (4+ / 0-)
        Recommended by:
        tmo, Brooke In Seattle, Ozzie, kyril

        Even if we allow insurance companies to remain as players, it makes sense to let everyone buy into Medicare if they choose. Given the comparative costs of operations, insurers would have to slim down fast to compete.

        •  The (1+ / 0-)
          Recommended by:

          least expensive govt healthcare program
          is the IHS. It's even a fraction of Medicaid or Medicare., .7, .8 of the cost. Problably something Daschle is familiar with, being from South Dakota.

          •  Employee vs. Contracted services (3+ / 0-)
            Recommended by:
            sxwarren, Brooke In Seattle, kyril

            The VA is also cheaper on a health-adjusted basis, but the problem is that private clinics and hospitals (not-for-profit or for profit) don't want to be nationalized. I'm willing to let that part stay as it is.

            •  Yes. Nationalize the *insurance*, not (1+ / 0-)
              Recommended by:

              the actual health care provider.

              BTW - I wonder if anyone has calculated the contribution of malpractice and liability insurance to overall health care costs and how much that might be reduced under a single-payer, universal coverage system.

              Opposition to an ideology is not inherently another ideology. When you're at the South Pole, there's no other direction to go but north.

              by sxwarren on Thu Nov 20, 2008 at 08:00:38 AM PST

              [ Parent ]

              •  Despite the whining (1+ / 0-)
                Recommended by:

                Malpractice and other liability insurance are not that high on average, nor would the costs go away completely, even if the single payer entity didn't subrogate any medical costs to the malpractice and other liability coverage providers.

                The way to cut the cost of malpractice insurance is to cut the cost of malpractice. Improve standards. Remove incompetent doctors from areas of risk. Be consistent in procedures. Force all doctors to use electronic files. Bad handwriting is not a joke when it kills someone. Improve continuing education. Teach quality management to everyone in clinics and hospitals. Make certain that anyone there feels completely comfortable questioning a decision or procedure that isn't consistent with quality standards.

                As many organizations have found, quality can pay for itself, but only if it is built into the system. Post hoc quality control is expensive and wasteful, yet that is what too many people think about when they think about quality control. They think that checking for defectives is quality control. It may be, but it's not very good. The best quality control is the kind that is built into the system so mistakes either cannot happen or are very hard to make or are easy to recognize when they do.

                •  I agree on the quality aspect. (1+ / 0-)
                  Recommended by:

                  But that needs to be built in before switching to purely electronic systems.  If not, electronic systems will simply allow mistakes to be implemented more efficiently and make them easier to identify in post-mortem.

                  Even if malpractice and liability are only, say, 5% of costs, that still translates into billions of dollars.  And for some specialties and some regions (obstetrics in Nevada, IIRC, for example) it may be significantly higher.  Eliminating that cost entirely is, I agree, impossible.  But reducing it may be possible.  The question then becomes how to reduce it significantly without also reducing the financial incentive for doctors and hospitals to strengthen quality.

                  Opposition to an ideology is not inherently another ideology. When you're at the South Pole, there's no other direction to go but north.

                  by sxwarren on Thu Nov 20, 2008 at 08:46:28 AM PST

                  [ Parent ]

                •  Some specialties (OBs), this is a crisis. (0+ / 0-)

                  Maybe a worker's comp-type system?  NYU did some work on this that indicated that the truely injured often failed to recover, but a lot of specious claims raised costs.

                  •  It is like workers' comp (1+ / 0-)
                    Recommended by:

                    In workers' comp, the companies that have the greatest cost history pay the highest premiums, just like doctors. Obstetricians pay very high rates in some areas because they lose a lot of malpractice cases.

                    •  Getting back to that . . . (1+ / 0-)
                      Recommended by:

                      I'm wondering how many malpractice "incidents" unnecessarily escalate into relatively expensive "cases" (legal actions) simply because of the inherent opposition of the two party's insurance companies.  [Note: I'm not bashing trial lawyers here.]  How often is it that a medical error that might be easily corrected with no lasting consequences ends up in a legal action because the patient's insurance doesn't want to pay for anything and the doctor/hospital can't admit their error because of their insurance company?  

                      I mean, think about the way the auto insurance racket "works" these days.  My significant other's parents filed three small claims (total less than two grand) within two years for minor fender-benders.  ALL of these incidents were clearly the other driver's fault (police reports to back that up) and two occurred when they were legally parked and not even in the damn car.  After the third claim, their insurance company of 30-frickin'-years (never late with a premium payment) dropped them.

                      So, if the actual repairs of medical mistakes were automatically covered for the patients by a single-payer system and doctors/hospitals were simply fined/penalized commensurate with the egregiousness and consequences of their error (with some resulting patient disabilities covered as well), but the bulk of their financial liability was covered by the same system, wouldn't that tend to reduce overall costs?

                      Opposition to an ideology is not inherently another ideology. When you're at the South Pole, there's no other direction to go but north.

                      by sxwarren on Thu Nov 20, 2008 at 01:00:25 PM PST

                      [ Parent ]

                    •  But there are no (0+ / 0-)

                      damages except lost wages and medical care, which reduces the bill to the companies.  If you know there is no windfall, weak cases are not brought, ideally.

              •  The Canadian model. (1+ / 0-)
                Recommended by:
      •  Daschle (2+ / 0-)
        Recommended by:
        lrhoke, Clem Yeobright

        is on the Board of Trustees at Mayo Clinic. The Clinic's proposal IIRC was simliar to Hillary Cinton's plan. In a recent national survey Mayo provided one of the least expensive care models, but also one with either the best or one of the best out comes.

    •  Most proposals I've heard (6+ / 0-)

      Are basically carbon copies of Mittens-Care.  Why oh why do Democrats want to follow something that Mitt Romney came up with is beyond me....universal health care and universal health coverage may look the same but they are miles apart in difference.

      Hey you, dont tell me theres no hope at all Together we stand, divided we fall.

      by marcvstraianvs on Thu Nov 20, 2008 at 06:31:10 AM PST

      [ Parent ]

      •  Why? (1+ / 0-)
        Recommended by:

        First of all, Mitt Romney did not come up with the Massachusetts plan.  Ted Kennedy played a much bigger role in establishing the plan than Romney did.  Are you going to trash Ted Kennedy?

        Second, most Democrats are smart enough to realize that federal mandates would be nothing like state mandates.  The Federal government has all kinds of resources at their disposal that state governments do not have, giving the federal government the ability to ensure affordability.

        •  May as well just (1+ / 0-)
          Recommended by:

          Do health insurance through AIG since the government already owns it...

          Hey you, dont tell me theres no hope at all Together we stand, divided we fall.

          by marcvstraianvs on Thu Nov 20, 2008 at 06:38:31 AM PST

          [ Parent ]

        •  Sure (3+ / 0-)
          Recommended by:
          churchylafemme, tle, kyril

          Kennedy's history in health care isn't particularly good. His proposals helped employers self-fund which allowed them to avoid certain regulations when they did so. His proposals allowed insurance companies to create fake HMOs, hurt real ones, and avoid state consumer protection statutes.

          Is he terrible? No, but he's spent all his time improving the current system without ever appearing to consider whether it needs to be completely overhauled.

        •  US Senator Kennedy (2+ / 0-)
          Recommended by:
          ChurchofBruce, kyril

          is crafting laws for the MA State Legislature? What an ... interestingly improbable concept. Clever of him to avoid the ... credit. Cite, please.

          Not that it matters all that much. There isn't anyone in or out of government who can successfully put lipstick on that turd.

          Given that next year is when the tax penalties start getting assessed against  citizens of MA who are unable or refuse to pay extortion money to your friends at AHIP, that's when the wheels will start visibly coming off.

          If the debate about health care is delayed even to March, things should get entertaining in MA just in time to create a massive wave of bad publicity undermining the idea that mandates are a good thing for anyone not on the industry's payroll.

          Looking for intelligent energy policy alternatives? Try here.

          by alizard on Thu Nov 20, 2008 at 06:59:20 AM PST

          [ Parent ]

          •  Yes, Kennedy helped a lot. (1+ / 0-)
            Recommended by:

            Try Googling it.  Or you can start here.

            •  While I would never have believed (1+ / 0-)
              Recommended by:

              Ted Kennedy would do anything that mind-numbingly stupid, I accept his admission. People make mistakes, and a long career provides lots of opportunities for this. He's made fewer than most.

              While I won't trash him over this, I'm perfectly willing to trash his idea. However, by the time the smoke clears after the tax penalties start hitting people, I expect Kennedy to immediately repudiate mandates. He learns from experience.

              Looking for intelligent energy policy alternatives? Try here.

              by alizard on Thu Nov 20, 2008 at 07:12:57 AM PST

              [ Parent ]

      •  Cost Controls (1+ / 0-)
        Recommended by:
        James Kresnik

        The problem with the Massachusetts plan, regardless of who created it, is that it does nothing to address costs. Therefore, the plan is becoming a major cost problem for the state, which of course is facing the same economic issues as every other state.

        Any responsible plan needs to address both access and costs. The Massachusetts plan does an admirable, although not perfect, job of increasing accessing. It did so without noticeably burdening employers with additional costs as industry claimed it would. However, it did nothing to address costs. The result? Costs to the state for the subsidized plans are increasing and will require a much greater state taxpayer subsidy than projected. Also, community health centers and other frontline providers for the most at-risk populations are inundated with more people seeking services but no additional resources to provide those services.

        Overall, the Massachusetts plan had its heart in the right place, get everyone into the healthcare system, but it didn't address the critical cost elements and that is its undoing.

    •  if the goal is to make Obama (8+ / 0-)

      a one-term President and turn Congress back to the GOP in 2010, ExtortionCare appears to be ideally suited. The GOP will be happy to tell everyone paying thousands a year for junk insurance who did this to us.

      Even if they voted for it themselves.

      For health care, the choice is between fighting an extremely unpopular health insurance industry and committing political suicide with their help.

      While this should be a no-brainer, there are few people who've actually been watching the Democratic Congressional leadership who ascribes brains or integrity to them.

      Obama campaigned against mandates when HRC proposed them. Remember the Harry & Louise redux ad?

      Bending over for the insurance industry is a guarantee that the rest of Obama's program will be far more difficult to carry out.

      Looking for intelligent energy policy alternatives? Try here.

      by alizard on Thu Nov 20, 2008 at 06:46:35 AM PST

      [ Parent ]

    •  Hey, thanks for the diary. n/t (2+ / 0-)
      Recommended by:
      slinkerwink, kyril
    •  Well, if AHIP's for it (3+ / 0-)
      Recommended by:
      slinkerwink, freelunch, kyril

      I'm agin' it.  I was for mandates before, but, frankly, they changed my mind really easily.  

      If liberty means anything at all, it means the right to tell people what they do not want to hear. -- George Orwell

      by nilocjin on Thu Nov 20, 2008 at 07:13:19 AM PST

      [ Parent ]

    •  Say YES to single payer health care (3+ / 0-)

      it's the only option that saves money and guarantees coverage.

    •  Wow. A health care diary on the rec list (1+ / 0-)
      Recommended by:
      Finally.  Congratulations, and thanks.

      In TX-32, track the voting record of Pete Sessions at SessionsWatch.

      by CoolOnion on Thu Nov 20, 2008 at 08:20:24 AM PST

      [ Parent ]

    •  Some form of single payer-- (1+ / 0-)
      Recommended by:

      given where we're starting from, anything else is an almost certain disaster.

      It's the only approach that cuts out the inherently conflicted current system, where the people who are paying for the health care (the insurance companies) have a real and immediate interest in NOT paying.  And they don't care if that has an impact on quality of care or not, because it isn't them who are receiving the service.

  •  No. To mandated health care insurance. (8+ / 0-)

    and I remember during the primary that Obama said there wasn't a mandatory part in his plan.  Clinton's plan had the mandatory.  Always looking for a way to have guarantee inflow of cash.  They can't force me to have insurance.

    42.7% of all statistics are made up on the spot. A Wrightism

    by publicv on Thu Nov 20, 2008 at 06:02:02 AM PST

  •  Without mandates (14+ / 0-)

    ...there is no universal coverage.

    Certainly Obama's plan ("afforability") isn't universal coverage.

  •  What's gonna happen to you if you don't? (5+ / 0-)

    Seriously, what are the penalties if you don't get the insurance?  Fines?  Jail?

    Anybody know?

    Tiger the Tabby 1990-2008 RIP

    by browneyes on Thu Nov 20, 2008 at 06:07:06 AM PST

  •  Without "mandates", the young and healthy will (15+ / 0-)

    opt out, while the sick will pay outrageous prices. The idea behind insurance is to pool the resources.

    The hopelessly idealistic here constantly call for single-payer. We aren't going to get single-payer through this Congress and this President. We need to start focusing on the possible and making it the best we can, rather than incessantly promoting the impossible.

    •  that's stupid. I want health insurance and I'm (3+ / 0-)
      Recommended by:
      eugene, kyril, James Kresnik

      young. I'm going to be paying COBRA after I leave my current workplace for my new one because the health insurance plan at my new workplace won't take effect for 90 days.

    •  if it can't pass (3+ / 0-)
      Recommended by:
      stiela, mspicata, LaEscapee

      it will not get proposed. OTOH, the MN and GA Senate races are key here. The proposal, whatever it is, will be crafted in the Senate.

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

      by Greg Dworkin on Thu Nov 20, 2008 at 06:12:03 AM PST

      [ Parent ]

    •  With mandates, health insurance executives (13+ / 0-)

      will skim enormous profits continuing a the "reverse Robin Hood" mentality of the Bush years.

      That is why this is a thorny problem.

      •  If regulation is added, they would not, but (2+ / 0-)
        Recommended by:
        slinkerwink, Bill White

        they want mandates without regulation (i.e. corporate welfare).

        Look at the promise of mandates gere in MA:

        1.  It will bring cheap insurance to those that don't have it.
        1.  It will lower everybody's rates as ER abuse/costs will immediately go down.

        Two years in we have failed on both, the "cheap" rates are over $600/mo for individuals (much higher than national rates) and most people's insurance is still rising at double digit rates (predicted again next year).

        I am paying over $15k per year for a family of 5 with an HMO that was great, but it is getting worse by the month (copays up to $20, huge increase in outpatient costs, higher drug costs, etc.).

        I think very few people here in MA would say that mandate has improved things. Sure it is nice that we have fewer uninsured, but the deregulated insurance companies are just raking it in and (IMHO) we are not getting better health care or lower costs.

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

        by DefendOurConstitution on Thu Nov 20, 2008 at 08:58:53 AM PST

        [ Parent ]

    •  That's such a lie (6+ / 0-)

      An outright lie.

      Young people who are uninsured are that way because they cannot afford the coverage.

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

      by eugene on Thu Nov 20, 2008 at 06:31:26 AM PST

      [ Parent ]

    •  I think what people don't realize (3+ / 0-)
      Recommended by:
      stiela, ferg, lotlizard

      is that IF you force an insurance company to cover you regardless of pre-existing conditions, THEN there is an increased incentive for the young and healthy not to be insured until they have a problem.  Right now, insurance is desirable if you are young and healty because IF you develop a problem, then you can't get coverage after you develop that problem.  (Even then, studies show -- if I recall correctly, that a number of the uninsured are, in fact, young healthy adults who perhaps could afford it but choose to spend resources on other things.)  

      If you can get insurance regardless of pre-existing conditions, then, to use an extreme example, you could wait until you find out you have cancer, or heart disease, or any number of very expensive conditions, THEN go an buy insurance, and they will have to "cover you."  That really would fundamentally change the model from an "insurance" set up.  "Insurance" is buying against the risk that something will happen.  "Insurance" operates on the principle that the vast majority of people don't have that expensive catastrophe happen, and their premiums cover the costs of those who suffer a catastrophe.  If you don't have to pay in to insurance unless and until the that catastrophe has already happened, it's not really "insurance" any more.  It's like being able to pay a couple of months of flood insurance after Hurricane Katrina hit (I'm in New Orleans) and having that insurer pay the full value of the loss of your house in Katrina.  That may be helpful to those who suffer the loss, but it's not "insurance" and no economic insurance model can cover that.  

      If you don't have mandates, and you legislate that an insurance company must "cover" you no matter what pre-existing condition, you have fundamentally changed what is happening from "insurance" to something else, and you have skewered the market so that the cost of so-called "insurance" coverage -- which will be more heavily weighted toward that sick -- will not go down, because those customers that are coveted by every insurer -- the young and healthy -- will have an incentive not to buy in while they are young and healthy.  This is, I think, what Clinton and Edwards recognized during the primary season.

      If you don't have mandates, we need to be up-front that we are really not operating under an insurance system any more.  

      •  perfect explanation (0+ / 0-)

        insurance is something you buy to hedge against future risks. I have homeowners insurance not only because my mortgage requires it, but to cover the damages that might occur although I hope to heaven that nothing does happen to my house. So, if nothing does happen, I'm out many thousands of dollars - but if it does, I've come out ahead.

        There are some differences in the health care issue, however, because everyone is going to need healthcare at some point in their lives. I think that's the thing that's sort of behind some of the arguments here. Maybe the fundamental question really should be whether the private insurance model is the one we should be following.

        But as long as we are, your explanation is just spot on.

        Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - WSCoffin

        by stitchmd on Thu Nov 20, 2008 at 08:59:35 AM PST

        [ Parent ]

    •  IndySteve, this argument (3+ / 0-)
      Recommended by:
      churchylafemme, kyril, James Kresnik

      The "young and healthy will opt out"

      Reminds me of the argument that the estate tax will force heirs to sell their family farm (to my knowledge  no one has ever identified a single farm sold because the family couldn't pay the estate tax);

      And "brown people buying houses" is what crashed our economy.

      Our health care system is deeply dysfunctional.

      Collecting mandated premiums from a tiny percentage of twenty-somethings is irrelevant distraction from the core problems we face regarding health care.

      •  Young and Healthy do opt out to a degree (0+ / 0-)

        They are also the ones most likely to opt back in with mandates.

      •  Coverage for pre-existing conditions changes that (1+ / 0-)
        Recommended by:

        Think about how economic incentives will change if you mandate that health insurers must cover anyone regardless of pre-existing conditions, regardless of whether they've ever bought health insurane before, regardless of how catastrophic the illness is.

        The young and healthy essentially lose money on health insurance premiums.  They pay more in premiums than they get back.  It HAS to be that way for the economic model that we call "insurance" to work.  Someone who is young and healthy and has a health insurance policy costing say $5000 a year probably doesn't have the insurer pay back anywhere near $5000 a year.  He goes to a doctor maybe once a year for an annual checkup, if that. His premiums are far more than the payout he gets.  That's necessary so the older person who has cancer or heart disease and is still paying just the insurance premiums (maybe up to $7000 or $8000 or even $10,000 a year) can get hundreds of thousands of dollars of care.  That's the economic model of insurance -- any insurance.  

        The ONLY sound financial reason for the young and healthy to get health insurance is the "in case" scenario.  "In case" something happens, "in case" I get that catastrophic illness or injury, I will have coverage, and I will be able to pay medical bills.  

        If you mandate coverage regardless of pre-exsiting conditions, you have removed the "in case" incentive.  If you mandate coverage regardless of pre-exsiting conditions, then health insurance becaomes a very bad "bet" for the young and healthy.  If I'm young and healthy and 25, and I don't have coverage and I do get cancer say, at 40, THEN I'll start paying premiums.  I'll be covered the same at age 40 as if I had been paying premiums the last 15 years.  If I were in that situation, I'd skip health insurance, put tha $5000 a year aside, pay my own $1000 a year or so for what I use in doctors, and wait until the catastrophy happens.  My odds at 25 - 40 of not having that catastrophy are pretty good.  And, if it does happen, I can buy coverage then and get my medical bills paid.  

        It's the mandated coverage despite pre-exsiting conditions that affects the economic incentives.

        THAT'S the issue. If you can wait until you get a catastrophic illness to buy in to insurance coverage, then you have created an incentive for the young and healthy to wait until something happens to buy in.  

        •  We have not sufficiently extricated K Street (1+ / 0-)
          Recommended by:

          from the legislative process to accomplish a global and comprehensive solution to the "pre-existing condition / mandated coverage" tug of war.

          Once mandates are conceded, considerable leverage will have been expended. Therefore, 2009 is too early to concede the mandate point.

    •  Robbing from the poor to feed the industry (2+ / 0-)
      Recommended by:
      forrest, James Kresnik

      is not the answer, and that's exactly what's going to happen.


      Because the poor will only be able to scrape together enough for the worst coverage - the "coverage" that actually doesn't cover jack chit.  They will be pumping in millions (billions?) into the beast of an industry, and getting little if anything in return.

      This is not a solution.

      "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 Thu Nov 20, 2008 at 08:23:35 AM PST

      [ Parent ]

  •  Red Herring (1+ / 0-)
    Recommended by:

    Obama's plan does not require mandates.

    Same as the "reinstituting the fair use doctrine," an item NOT on Obama's agenda.

    Simply Diversionary.

    Notice: This Comment © ROGNM

    by ROGNM on Thu Nov 20, 2008 at 06:09:08 AM PST

  •  see also DrSteveB's diary (3+ / 0-)
    Recommended by:
    stiela, kyril, freedapeople for somne interesting data.

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

    by Greg Dworkin on Thu Nov 20, 2008 at 06:10:42 AM PST

    •  Great diary, Dr Steve and (6+ / 0-)


      The fact is, the insurance industry is dead and its zombie shell is taking over. And zombie shells are dangerous.

      Months before the Wall St. crash, financial news outlets were reporting that the health insurance industry was in deep shit and on the brink of collapse, if not collapsed. They were advising investors to get the hell out or stay away all together.

      Expanded Medicaid or Medicare can absorb some of the insurance industry's workers. The rest would lose their jobs anyway because of the economics of the situation.

      Also, repeat after me: Health care is not a business. Health care is not a business...

  •  Is your problem mandates, or private-sector? (5+ / 0-)

    It sounds to me like your "no to mandates" argument falls apart if there is a viable public option.

    The real political calculus no one knows how to face is that serious healthcare reform (e.g., implementation of a single-payer system that would cover at least 80% of people) would 1) probably cause the loss of a 500,000 jobs in the private sector insurance industry and 2) would play into the "government is the enemy" talking point of the right, as it would become the government denying claims.  

    Other countries fund the bulk of healthcare coverage with payroll taxes - the only reasonable way to do it - which is another step that scares the hell out of politicians.

    This doesn't mean we shouldn't do single payer, but the need for political willpower and massive organizing to help people realize they're better off is no joke...

    The McCain-Palin Campaign: a transitional medium through which Monty Python skits are transformed into SNL skits

    by Minerva on Thu Nov 20, 2008 at 06:11:54 AM PST

    •  A viable public option requires that the private (4+ / 0-)
      Recommended by:
      chuckvw, JuliaAnn, kyril, James Kresnik

      sector be undercut in the marketplace which the private sector shall continually attempt to sabotage.

      I assert that the term "viable public option" would be nothing but an illusion to fool the rubes and let Congress folk issue press releases cheering the passage of "universal coverage"

    •  We're looking at losing millions of jobs (3+ / 0-)
      Recommended by:
      lotlizard, golconda2, kyril

      if the Big 3 go down - which many republicans like Mitt are just fine with. And I suspect that if UHC were implemented, we'd probably need to hire at least 500,000 people to federally implement it.

      I have sympathy for people employed by healthcare companies just like I do auto workers. But I have no sympathy for the auto and insurance executives who got their respective companies in the pickles they are in right now and as bad as losing 500,000 healthcare insurance jobs would be, that's preferable to what's happening every day in this country: Insurance companies meting out life and death certificates based on people's ability to pay to simply survive.

      The healthcare insurance companies in this country are offering a "product" that is the equivalent of a car that gets 2 mpg. Nobody wants to buy it any more.

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

      by Snud on Thu Nov 20, 2008 at 06:21:08 AM PST

      [ Parent ]

    •  The problem is both (4+ / 0-)
      Recommended by:
      slinkerwink, chuckvw, kyril, James Kresnik

      Especially since the public option is likely to fail - the privates will dump the sick on the public option (and yes, they will evade and break the law to do so) causing the public option to either raise premiums, cut services, or seek a politically unpopular bailout.

      Taxes are the cheapest and fairest way to do this.

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

      by eugene on Thu Nov 20, 2008 at 06:35:00 AM PST

      [ Parent ]

  •  Slink's right! (8+ / 0-)

    I got a chuckle out of this:

    The health insurance industry said Wednesday it will support a national health care overhaul that requires them to accept all customers, regardless of pre-existing medical conditions, but in return it wants lawmakers to mandate that everyone buy coverage.

    I bet they will because the alternative - single-payer, universal healthcare - would put them out of business completely. So they've accepted a "lessor of two evils" (for them) - mandated, subsidized health insurance.

    Excuse my French but I say fuck healthcare insurance companies and the train they rode in on.

    Yesterday, I was listening to NPR. I can't remember who it was but they basically said they got the sense Obama was shooting for a single-payer UHC system and not mandated insurance. Why didn't he say so during the campaign? Because he probably wouldn't have gotten elected if he had. You can imagine the howls of "socialism" if he had.

    I think Dascshle's appointment is a good sign; there are very few people who can work with both houses like he can to bring this about and I think Team Obama knows that they'll have to strike while the iron's hot.

    Here we are seriously debating the demise of the Big Three automakers - and the resulting millions of lost jobs but we're going to keep throwing good money after bad to keep the health insurance industry?!?

    That's insane.

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

    by Snud on Thu Nov 20, 2008 at 06:12:37 AM PST

    •  He Actually Said The Opposite (4+ / 0-)

      Anybody who's "Sensing" that Obama is pursuing single payer is letting their "hopes" do the talking.  He explicitly said on more than one occasion that we currently do not have a viable path to single-payer in the short-medium term.

    •  And how exactly are you going to pass.... (3+ / 0-)
      Recommended by:
      stiela, ferg, Miss Blue

      single payer? Sometimes the unrealistic views of people here are astounding. The best route we have to single payer is a range of health insurance options, one of which is a gov't. plan like fed employees have. Of course, the private insurance industry will continue to exist but now we will have greater control on what they provide, who gets coverage and how much we have to pay.

      Requirements are going to be necessary.

      •  Mandated private insurance = theft (8+ / 0-)

        The core underlying problem is that too large of a percentage of every health dollar spent is paid to managers, executives and shareholders and too small a  percentage of every health dollar spent is paid to caregivers.

        The frame that healthy twenty somethings are WHY we cannot afford universal coverage is very much like the frame that unqualified brown people buying houses caused the credit default swap melt down.

        Mandates are merely a sales tactic to enrich insurance companies.

      •  How'd we put a man on the moon? (8+ / 0-)

        You may think that's a cop-out, which is fine. But I think we can do whatever we put our minds to. I for one think the bloated bureaucracy known as "health insurance" is simply insane and obsolete and plenty of other countries are doing UHC. How did they do it?

        Of course, at the moment, I don't have any health insurance - like millions of other Americans. So, I guess we should just keep this bloated, paper shoveling bunch of weasels who dole out death certificates every day ("Sorry! That bone marrow transplant is 'experimental' and we won't pay. Have a nice day!) That may be acceptable to some but not to me.

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

        by Snud on Thu Nov 20, 2008 at 06:25:42 AM PST

        [ Parent ]

      •  The only way this could pass... (0+ / 0-)

        would be with a clear cost-benefit analysis which showed cost savings to every individual now paying premiums, copayments, and deductibles. They need a plan that speaks for itself, that says, "We can't afford not to do this."

    •  It wouldn't put them out of business. (3+ / 0-)
      Recommended by:
      churchylafemme, golconda2, kyril

      Single-payer universal healthcare would likely be a humane basic level of benefits. People wealthy enough to buy gap coverage would, and employers seeking a competitive edge in attracting good employees would also offer gap coverage. This is how employer-provided health insurance started in the first place.

      Please support your local library.

      by rk2 on Thu Nov 20, 2008 at 06:24:53 AM PST

      [ Parent ]

  •  Is there consensus here at DKOS that we need (6+ / 0-)

    single-payer universal health coverage? How can we push this agenda? Is MoveOn or another group mobilizing on this? Can we give Obama and the Dems more political capital to spend?

    Please support your local library.

    by rk2 on Thu Nov 20, 2008 at 06:18:09 AM PST

    •  NO! This is an unrealistic proposal and will (2+ / 0-)
      Recommended by:
      stiela, carllaw

      relegate us to the wilderness. Please have some decent political sense...we need to deal with the realities before us.

    •  no (5+ / 0-)
      Recommended by:
      stiela, ferg, misreal, creamer, rk2

      we agree in many ways it is superior but many of us are extremely skeptical that there's an appetite for it in congress, especially the senate. Proposals are not helpful if they cannot pass.

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

      by Greg Dworkin on Thu Nov 20, 2008 at 06:26:42 AM PST

      [ Parent ]

      •  Thank you for explaining that so clearly (0+ / 0-)

        and respectfully.

        Please support your local library.

        by rk2 on Thu Nov 20, 2008 at 06:28:44 AM PST

        [ Parent ]

      •  Proposals are also not helpful (2+ / 0-)
        Recommended by:
        slinkerwink, kyril

        If they will bankrupt millions and hand control of Congress to the GOP, while endangering Obama's chances at reelection.

        The Republicans will say mandate=tax.

        Watch them.

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

        by eugene on Thu Nov 20, 2008 at 06:36:11 AM PST

        [ Parent ]

        •  Obama's plan DOES NOT include a mandate (2+ / 0-)
          Recommended by:
          stiela, mijita

          slinkerwink's diary pushing a Red Herring of an issue.

          Notice: This Comment © ROGNM

          by ROGNM on Thu Nov 20, 2008 at 06:39:38 AM PST

          [ Parent ]

          •  Obama's plan goes through Congress (2+ / 0-)
            Recommended by:
            eugene, kyril

            the health care plan will pass through Baucus's committee. Baucus favors mandated health insurance.

          •  Most Senate plans do (3+ / 0-)
            Recommended by:
            slinkerwink, mijita, kyril

            And the concern is that Obama will bow to that "political reality" as DemfromCT keeps telling us we must.

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

            by eugene on Thu Nov 20, 2008 at 06:42:42 AM PST

            [ Parent ]

            •  you're right to focus on what the senate is doing (1+ / 0-)
              Recommended by:

              chances are, that's what reform proposals will look like. The senate is the traditional place where health reform proposals are sent to die.

              Now, if you can skip insulting everyone who disagrees with you, and the condescension that only you know what you're talking about, we can get on with it.

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

              by Greg Dworkin on Thu Nov 20, 2008 at 06:48:41 AM PST

              [ Parent ]

              •  I'm not insulting everyone (4+ / 0-)
                Recommended by:
                chuckvw, mijita, churchylafemme, kyril

                Just pointing out:

                1. That mandated insurance plans ignore economic realities that suggest folks will have a hard time paying it
                1. That mandates will have a significant political cost once the cost of the mandate becomes clear and once Republicans figure out how to message against it
                1. I usually also point out that mandates typically fail - they have failed in MA
                1. Universal coverage isn't really the point here, the goal is guaranteeing access to affordable care, which mandated insurance does NOT accomplish, and I would argue it is not intended to accomplish.

                Basically, you're being selective about the realities you choose to describe.

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

                by eugene on Thu Nov 20, 2008 at 07:27:05 AM PST

                [ Parent ]

                •  basically I'm not at all being selective (1+ / 0-)
                  Recommended by:

                  because I'm, unlike you, not advocating for anything specific yet.

                  I am bringing up things others leave off and making sure this space doesn't remain hostile to those who don't think mandates are evil, and for those that think that single payer, HR 676 or Dennis Kucinich are not the only acceptable alternatives. Single payer advocates don't have to worry because they occupy most of the real estate.

                  For everyone: advocate for what you believe in. But keep your head out of the sand when you do, and don't personalize it. Advocate the plan, don't attack the poster.

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

                  by Greg Dworkin on Thu Nov 20, 2008 at 08:12:21 AM PST

                  [ Parent ]

      •  That said, DemFromCt (4+ / 0-)

        The notion that single payer is a "bridge too far" is also NOT a reason to accept mandates.

        Maybe we simply need to accept that a true comprehensive solution will be outside our grasp in 2009 and therefore we simply need to find a method of helping the most unfortunate among us.

        For example, pass S-CHIP before the end of January and get it on President Obama's desk.

        If a GOOD comprehensive solution is not politically feasible, don't exacerbate the problem by passing a BAD comprehensive solution.  

  •  What happened to the hippocratic oath? (2+ / 0-)
    Recommended by:
    JuliaAnn, kyril

    Health care wouldn't be so 'abused' if all of its' forms didn't keep getting advertised as a commodity that everyone 'must' stay on top of.  costs wouldn't be so over the top if there weren't HMO's.  Why do we live in such a 'sick' society.  What is making us so sick?

    42.7% of all statistics are made up on the spot. A Wrightism

    by publicv on Thu Nov 20, 2008 at 06:18:22 AM PST

  •  Terrible argument (3+ / 0-)
    Recommended by:
    stiela, feminatty, two roads

    This is exactly the kind of argument that killed universal health care in the 1970s.

    "Single payer" is not politically feasible. And it would indeed cause huge job losses in the insurance industry. Furthermore, it would become hated by the public, because it would occasionally deny care.

    We should accept the insurance industry's offer. Now is the time.

    •  It must go to single payer (1+ / 0-)
      Recommended by:

      to lower the costs but your concerns are spot on.  However, the solution is to go to single-payer in phases so that the insurance industry and all those employees can adapt.  Bring in one age demographic at a time and spread the change over a decade.

      One thing you forget about a huge segment of those insurance industry employees is that for many of them they have the job for one main reason - the health care benefits.  I worked with UHC for a year and can tell you that many of my coworkers were mothers in households with another working parent and their salary barely covered their child care expense.  What they got out of it was the health care benefit.  With a universal plan, they can opt to not take a job and stay home with their children.  

      Pinging on that can be a big selling point with the "Focus on the Family" crowd.

      "There are no atheists in foxholes" isn't an argument against atheism, it's an argument against foxholes. - James Morrow

      by artmartin on Thu Nov 20, 2008 at 07:46:25 AM PST

      [ Parent ]

    •  Goodness. (0+ / 0-)

      We should accept the insurance industry's offer.

      I still believe in the power of the citizenry, and corporations are there to serve us. Especially since we own a few now.

      Furthermore, it would become hated by the public, because it would occasionally deny care.

      Please support this assertion, given the present de facto denial of care to 48 million uninsured.

      Is health care a right or a class based privilege?
      And you can help guarantee its "political infeasibility" if you continue to define it as such.

      Not unlike the prospect of electing an African American as President in this generation.

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

    Mandates were always a bad idea. I think, even for children, they're a bad idea. But not covering children is worse. I think the obvious good solution is universal single-payer health care for kids, a less expansive, voluntary program from adults. With a transitional program for children w/ ongoing serious medical issues who turn 18 and need a bridge. I feel that's kind of obvious. Oh well.

    We cannot allow the insurance companies to be on this "commission"

    I sort of disagree with this. While having them on the commission may be problematic -- from a real and a PR standpoint -- I think we need to hear something from them, seeing as how they are unfortunately the providers of much of the health care coverage. I don't see how the oversight board doesn't have some of them on in an advisory role. We just need to make sure there are few of them and many critics on the board.

    We should be more worried about their role in the policy formulation phase. We don't need to give the insurance companies a detailed roadmap of how to oppose whatever plan is formulated (if they were in on all the discussions they would know every point of division for every faction and be able to divide and conquer).

    it fitfully blows, half conceals, half discloses

    by Addison on Thu Nov 20, 2008 at 06:36:10 AM PST

  •  health care reform in this country (4+ / 0-)
    Recommended by:
    chuckvw, kyril, WiseFerret, ElizabethAM

    will never happen until we kick the insurance companies to the curb.

    If the words "single payer" are not included - it is not reform, but more of the same.


    by dancewater on Thu Nov 20, 2008 at 06:37:08 AM PST

  •  Health CARE *NOT* insurance (5+ / 0-)

    Cut out these ratty greedy middlemen and we could have a top rate health CARE system for all. Let them insure 80 year olds' nips and tucks, but hands off general fundamental health CARE.

  •  I see Daschle pick as a bad sign. (1+ / 0-)
    Recommended by:

    Where is the change we need? Daschle is just more of the same from what I can tell.

  •  as govt (1+ / 0-)
    Recommended by:

    seeks to get as much blood from turnips as possible.

    After 8 years of darkness, a great nation chose to reapply power to the beacon of light America stands for.

    by FreeTradeIsYourEpitaph on Thu Nov 20, 2008 at 06:45:34 AM PST

  •  no mandates. (1+ / 0-)
    Recommended by:

    seems like a no-brainer to me...

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

    by kathleen518 on Thu Nov 20, 2008 at 06:45:56 AM PST

  •  The insurers' profits and iron control (5+ / 0-)

    of healthcare have made care unaffordable and unattentive to actual needs.  Simply delivering more victims to them hardly seems like a good solution.  And, we shouldn't expect Congress to exercise the kind of close oversight the 'solution' would need.  Congress is overwhelmed already and, for years, has been delegating its authority to federal agencies, which contract it out to the private sector and there you are.  To make any public program work requires transparency and citizen involvement in the oversight process.

  •  I had "health" insurance a couple of (4+ / 0-)
    Recommended by:
    slinkerwink, mijita, kyril, WiseFerret

    years ago. They took 35 bucks per pay period out of my check, so I still couldn't afford to see a doctor.
    I suspect that the same thing would happen with mandated coverage. I'd just be supplying more profit for the companies, and still see no benefit.
    Without having to pay for a worthless policy, at least I can get my bills paid.
    Will there be a provision that protects me in "mandated" coverage if they garnish my wages and I go belly-up bankrupt?

  •  I agree about over-sight (2+ / 0-)
    Recommended by:
    kyril, My Stupid Opinion

    No one from the insurance industry should be allowed anywhere near the over-sight entity.

    And in principle, I agree with the objections to mandated coverage because it relieves some of the pressure for single payer which I favor.

    But we are going to have to eat this if we want anything over the next eight years.  Now, it is OK to be dragged kicking and screaming into it.  This needs to be seen as a compromise from the left as well as a compromise from the right, and we are the left.  So we have to do everything that we can to make sure that what we end up with has as many elements of the single payer system that we can possibly get incorporated into this thing.

    And staking out a strong anti-mandate position at this point in time is not a bad strategy.  But ultimately there will be a mandate.  Because that is the key to making it politically possible at this point in time.

    All of this may be made moot if the economy instead of simply suffering a severe recession actually crashes in a manner similar to The Great Depression.  In that scenario, all the traditional political calculus goes out the window, and boldness counts.  Then, I say screw it, go for single payer as part of a complete restructuring of the economic system.

  •  I disagree, mandates not a bad idea. (3+ / 0-)
    Recommended by:
    stiela, two roads, My Stupid Opinion

    Insurance premiums will go down with an increase in the size of the risk pool.  Millions of people, including those with means, do not purchase coverage, then expect the system to care for them, with no intention of paying.

    There are lots of problems with our current system.  Insurance companies are not the only bogey men.  Patients need to assume some responsibiity here.

    •  Mandates with no public baseline ARE a bad idea (3+ / 0-)
      Recommended by:
      slinkerwink, churchylafemme, kyril

      Mandating that everyone buy something from the private sector is the most extreme form possible of oligopoly.

      If you want a mandate, you have to have a public option available to everyone. That way you can stop the private companies from scalping patients with obscene premiums.

      I would never die for my beliefs because I might be wrong. - Bertrand Russell
      -5.38, -6.41

      by sullivanst on Thu Nov 20, 2008 at 07:25:08 AM PST

      [ Parent ]

  •  Single payer, publically funded healthcare (2+ / 0-)
    Recommended by:
    stiela, artmartin

    (otherwise known as "socialized medicine", "Canadian-style", "British style", or "nearly everywhere in the world but the USA style" healthcare) has mandated coverage, because no distinction is made between taxes used to pay for what they call "social security" and other taxes: everyone pays, everyone is enrolled. That's what mandates are.

    Mandates are, in other words, an element of universal single-payer healthcare, and therefore in my opinion are nothing to be feared.

    Greg Shenaut

    •  There is a fundamental difference (3+ / 0-)
      Recommended by:
      churchylafemme, ceti, Toon

      economically, politically, and psychologically, between publicly tax-funded services and private individual mandates. Even if there's a public option.

      We have individual mandates to pay certain fees for certain voluntary activities (driving, gun ownership/CCW, etc) but this would effectively be a mandate to hand over a certain chunk of money just for being alive.

      •  private/public not my point (0+ / 0-)

        I'm in favor of dumping the private insurers. But it's not mandates per se that is the problem, any decent healthcare system will have them, it just won't be important. That is, "universal coverage" = "mandates", right? I mean, if you can opt out, it's not universal.

        •  But that's not the mandate we're arguing against (2+ / 0-)
          Recommended by:
          churchylafemme, sullivanst

          Equating universal tax-funded single-payer care with an individual private mandate is disingenuous. They're different functionally and politically.

          You can make the semantic argument that residents of a country with single-payer care are effectively under a "mandate," but the effect is fundamentally different. We're not making a libertarian argument against mandates; we're making a functional, economic, and political argument against mandates involving private insurers.

          Since the term "mandate" in current political debate is synonymous with individual requirements to purchase insurance (not universal plans with automatic inclusion), it's silly to try to argue the semantics. There are those who will make libertarian arguments against mandates. They're not on DKos.

          •  Well, then let's make the argument be about (0+ / 0-)

            private insurance companies versus publically funded healthcare. While it may be true that relative few people here would object to mandates in the context of publically funded healthcare, use of the word as a rallying cry is dangerous, because it is orthogonal to the relevant distinction.

            For me, since the healthcare system I prefer includes mandates, there is nothing at all scary to me about adding mandates to our present screwed-up mess; it looks like an incremental movement in the right direction to me.

            Greg Shenaut

    •  Not exactly (2+ / 0-)
      Recommended by:
      churchylafemme, kyril

      Everyone has health care as a resident, not because one pays into the system which is done by regular income tax (as a homeless person with no income you will get care the same as everyone else). It is not an outside levy that is regressive in nature.

      Mandates in the American case would be a huge budget busting subsidy for insurance companies.

      Gentlemen, you can't fight in here, this is the war room!

      by ceti on Thu Nov 20, 2008 at 07:14:46 AM PST

      [ Parent ]

    •  Single-payer is not the same (3+ / 0-)
      Recommended by:
      kyril, artmartin, Living in Gin

      If you have single payer, then yes there's a mandate.

      A mandate is not single payer though. Mandating that people hand over their money to private companies as in the Baucus plan is a terrible idea. If people are forced to buy coverage, the insurance companies will overcharge for it.

      At the very minimum, you must have a universally-available public option if you want to mandate coverage. That will set a premium level that does not gouge customers.

      Oh, and this is something that annoys me: the British system is very different from "single payer" - it's a government-operated system. There's no "insurance" in the British system, the government runs the hospitals, clinics and general practices, and doesn't charge for delivery of services. In that respect, it's like the Cuban system. Single-payer still relies on the private sector to provide actual delivery of care, and reimburses the price of the services through the insurance pool. "Socialized medicine" is too vague a term to be of use, but to my mind implies the British/Cuban system and has therefore come to be a bogeyman that the right use to scare their base.

      I would never die for my beliefs because I might be wrong. - Bertrand Russell
      -5.38, -6.41

      by sullivanst on Thu Nov 20, 2008 at 07:33:01 AM PST

      [ Parent ]

    •  The important difference between a mandate (0+ / 0-)

      and an income tax based payment system is that my health insurance premium could easily be 100% or more of my annual income.

      Fry, don't be a hero! It's not covered by our health plan!

      by elfling on Thu Nov 20, 2008 at 10:47:24 AM PST

      [ Parent ]

  •  It simply means we have to be vigilant (0+ / 0-)

    We have to watch out for the insurance industry pulling a fast one during the legislative process.

    The bottom line is that any health care reform is doomed without systemic reforms to lower health care costs.  And so, in the interests of ensuring health care reform succeeds, we need to address costs.

    That means putting a stop to speculative hospital building, requiring hospital networks to take clients from all insurers and not just those that are within the "chain", and thereby ending the wasteful underutilization of expensive facilities and equipment that dogs our system.  It also means huge reforms to the health care bureaucracy, both in hospitals and at the insurance company level.  And yes, it also means meaningful malpractice reform to bring down the cost of "strategic medicine" (i.e. unnecessary CYA procedures), although this last issue is, contrary to what Republicans and doctors would have you believe, a small part of the problem compared to the others.

    British auditing firm PriceWaterhouseCoopers recently did a good fisking of US health care.  They found that of the $2.2 trillion we spend, more than half is wasted.  Out of what is wasted, "strategic medicine" accounted for about one-sixth ($200 billion), with wasteful use of facilities and bureaucracy accounting for most of the remaining $1 trillion.

  •  Here's the problem to solve: (7+ / 0-)
    1. Insurance works best when everyone is covered.  Those who are young and healthy subsidize the sick and elderly.
    1. The young and healthy have low incentives to voluntarily participate in any insurance program and lower income so they have incentives to opt out and keep that money in their pocket and cross their fingers.
    1. Immediate single payer universal health care is politically difficult in this country.  If we push for it and succeed - great.  If we fail, as in '92, health care is dead for ten years.

    Given these facts, I think mandates may be a way to get to the next stage where moving to full universal single payer is viable.

    We elected the smart guy? How the hell did that happen?

    by nightsweat on Thu Nov 20, 2008 at 07:14:37 AM PST

  •  Mandates -- worst of both worlds (3+ / 0-)
    Recommended by:
    chuckvw, oscarsmom, kyril

    Will make the libertarians rightfully howl that big government is back, but rather than serving the public trust, will become more and more indistinguishable from big business.

    Mandates = corporatist governance. Ugh.

    Gentlemen, you can't fight in here, this is the war room!

    by ceti on Thu Nov 20, 2008 at 07:19:24 AM PST

  •  It doesn't sound like you're against mandates (1+ / 0-)
    Recommended by:

    so much as you're against the public option being more widely available - they are far from the same thing.

    Mandates would secure true universal health care, providing coverage for every single man, woman, and child in this country.  That said, I do strongly believe that the public option should be made available to people of all ages who cannot afford the private option.

    •  I want the public option to be more (2+ / 0-)
      Recommended by:
      chuckvw, kyril

      widely available. Did you not read my diary? I am very much so against mandates.

    •  Why do we need mandates to expand public option? (3+ / 0-)
      Recommended by:
      churchylafemme, oscarsmom, kyril

      Expand the public options without mandates. What is so hard about that?

      •  I agree--and reasonable people differ (2+ / 0-)
        Recommended by:
        slinkerwink, 4fx

        on whether this will actually affect people's bottom line or not.  I agree with Obama that most people WANT to be insured, they just can't afford it.  And the Massachussetts plan is proving that even WITH mandates, a certain percentage of people don't buy in, they prefer to take their chances with the fine because they can't afford the payments.

        So IMO it's a wash.  We can argue about it, but I don't think there is PROOF that one system will necessarily be more expensive than the other.

        Save the parrots: Drink shade-grown coffee!

        by oscarsmom on Thu Nov 20, 2008 at 08:59:14 AM PST

        [ Parent ]

      •  It sounds good if we could do it (0+ / 0-)

        But I doubt we can at this point.

        Mandates have to do with spreading the risk. If everyone is in the pool, young and healthy as well as older and sicker, the price for everyone drops.

        Expanding public options could be politically very difficult. From the financial point of view, it could lead to the older/sicker group going for the public option. This means that the public bears a higher cost, and the insurance companies once again get to have only the healthier (and cheaper to care for) portion of the population.

        •  This is the fallacy I am most opposed to (1+ / 0-)
          Recommended by:

          Mandates have to do with spreading the risk. If everyone is in the pool, young and healthy as well as older and sicker, the price for everyone drops.

          Yes, that is true in theory however I DENY that the number of healthy young people who choose not to buy insurance is large enough to make any actual difference in real world.

          This also provides the health insurers with a scapegoat that pits Boomers (like me) against the twenty-something generation. Dang freeloading kids!

          Remember this, our recent financial meltdown did involve a small number of unqualified people getting mortgages and the Freepers are blaming the Community Reinvestment Act ("brown people buying homes crashed our economy") which is either untrue or true to such a tiny degree as to be irrelevant.

          Calls for mandates to force foolish healthy young people to buy health insurance is merely a gimmick to distract us from the genuine reforms we need.

          Even if we fail to enact single payer, fighting for it will add cards to our poker hand when we negotiate the next health care deal.

          by Bill White on Thu Nov 20, 2008 at 09:40:23 AM PST

          [ Parent ]

          •  I'd be interested to see figures (0+ / 0-)

            Right now, the insurance companies refuse to pick up many of the older/sicker patients, but say they will if they can get everyone mandated to get coverage.

            I'd love to see figures/analysis on this issue.

            •  This is both a negotiation and a poker game (0+ / 0-)

              and there are other concessions and regulations that need consideration besides the "pre-existing conditions" issue.

              Good policy choices require transparency and that means getting the insurance companies to open their books so we can make sensible decisions on profit margins and so forth. This process is just beginning and we should not be eager to jump at the first apparent concession the insurers are willing to make.

              In the meantime, increase the pressure by working to grow support for single payer. Maybe that can be traded away - someday - or maybe not, but absolutely not yet.

              Even if we fail to enact single payer, fighting for it will add cards to our poker hand when we negotiate the next health care deal.

              by Bill White on Thu Nov 20, 2008 at 10:40:54 AM PST

              [ Parent ]

  •  We Voted for Obama, Not Clinton (7+ / 0-)

    As I recall, when Obama and Clinton were heatedly debating Clinton's #1 issue, healthcare reform, Democrats favored favored Obama, in polls and in primary elections.

    If Obama reverses his position on healthcare to give us Clinton-style mandates instead of a government single direct payer competing with private insurers, he'll have lied us into voting for him. FISA comes to mind.

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Thu Nov 20, 2008 at 07:22:05 AM PST

    •  Ummm...Reality check (1+ / 0-)
      Recommended by:

      How many votes were influenced by this distinction, much less actually determined by it?

      I'd like to see the whole thing overhauled into a single-payer system, If people want to pay for cadillac private insurance, I won't stop 'em, but everyone should be able to get their health care provided as a right, without having to pay through the nose.

      Coming Soon -- to an Internet connection near you:

      by FischFry on Thu Nov 20, 2008 at 08:26:49 AM PST

      [ Parent ]

      •  Many (0+ / 0-)

        It was the main topic of disagreement for months, while it was Democrats' top issue (before the economy topped everyone's list), while Obama's wins were increasing. The natural conclusion is that people voted for their preferred response to their top issue. If there's a convincing argument to counter that sensible deduction, I'd listen to it.

        I lived in Canada, and I want what they've got, American style. I want the Federal government to specify a minimum healthcare standard, like the minimum wage, then pay insurance through each state to cover that minium (paid by nationwide taxes). States that want to offer higher standards can do so, paid by state taxes. People who want more than their state offers can buy private insurance - but all compensation is through the state, one-stop shopping. If people want to also pay consultants to help them deal with the state, they should, or vote to make their state easy to deal with by a highschool educated American.

        I also want the US to certify at least double the number of doctors we've got, without lowering certification standards. And reduce the duration of exclusive pharmaceutical patents to recouping maybe 5x their investment. Those artifically low supplies against increasing demand are pressuring up high costs, and decreasing quality in favor of volume. When that's fixed, healthcare and insurance will become boring and reliable again.

        "When the going gets weird, the weird turn pro." - HST

        by DocGonzo on Thu Nov 20, 2008 at 09:40:29 AM PST

        [ Parent ]

        •  How people voted (1+ / 0-)
          Recommended by:

          They liked Obama and they saw him as more of a real change. Even among the select few who really understood the debate beyond a superficial level, I'd say there are very few that have a firm view.

          There's a huge flaw in your reasoning though. They did talk about this for a few weeks -- not months -- because Hillary was trying to give voters a reason to prefer her. And, in fact, they did. Obama had a lot of delegates already in the bank, and won a bunch of caucus states as the campaign went on. But, if this is your divining rod, you'd have to say voters preferred Hillary's plan. Once they started arguing about this, Hillary got more actual votes.

          Coming Soon -- to an Internet connection near you:

          by FischFry on Thu Nov 20, 2008 at 09:53:55 AM PST

          [ Parent ]

  •  Mandates only if public option for all (2+ / 0-)
    Recommended by:
    slinkerwink, mrblifil

    It would be ridiculous to force people to buy coverage if there's no public baseline against which the private companies have to compete. That's a non-starter.

    The idea of restricting it to the elderly and infirm is something that only the private insurance industry could possibly think was a good idea - it's their way of dumping the expensive-to-insure out of the market so they can make billions on the healthy young. No go.

    That's what you get when you have consultations which exclude Doctors, Nurses, and patients.

    I hope Ted Kennedy tears him a new one... behind closed doors, of course ;)

    I would never die for my beliefs because I might be wrong. - Bertrand Russell
    -5.38, -6.41

    by sullivanst on Thu Nov 20, 2008 at 07:22:57 AM PST

  •  Parasitic industry (1+ / 0-)
    Recommended by:

    The insurance companies are a bit parasitic on other businesses (unless they have merged together like GE) that have to provide employees health care services through them. Single payer will actually help their bottom lines, so I wonder why they aren't more vocal in supporting socialized medicine when it gets that huge expense off their back?

    Gentlemen, you can't fight in here, this is the war room!

    by ceti on Thu Nov 20, 2008 at 07:27:18 AM PST

    •  My therory (0+ / 0-)

      is that large corporations get the best employees through the leverage of benefits. How many employees are frozen in place because of preexisting condition clauses? How many chose a job for the benefits despite bad working conditions over all? How many delay starting their own businesses because of self insurance costs?

  •  I've had crap insurance - it's what I (3+ / 0-)
    Recommended by:
    mrblifil, churchylafemme, kyril

    have now and the jury is still out on whether I was better off with it than I was when I had nothing at all. (I'm leaning toward I was better with nothing at all, but it's really close either way. When I had major medical expenses this year, it was Medicaid that picked up the bills, which were substantial. Imagine asking taxpayers to pick up the slack after insurance has paid its share? That's what I had to do.) Mandates will lead to much more of the smelly policies like I've head, policies that will do good for anyone outside of the agents who write them and the companies, doctors and pharmaceuticals who will be kept in business because of them.

    "When fascism comes to America it will be wrapped in a flag and carrying a cross." Sinclair Lewis

    by MsWings on Thu Nov 20, 2008 at 07:28:11 AM PST

  •  Still hate mandates. (2+ / 0-)
    Recommended by:
    mrblifil, kyril

    I always thought they were an insurance company give away, and this doesn't exactly reduce my suspicions.

    However, we at least now have the insurance companies willing to bargain for them, rather than us giving away the store without them even asking. So, I guess that's a small step in the right direction.  

  •  Opposing universal coverage to slap the insurance (3+ / 0-)
    Recommended by:
    stiela, mrblifil, TomP

    industry is short-sighted and misguided.

    Right now there are people in the United States who are ill, in some cases with potentially fatal illnesses, who cannot go to the doctor because they cannot afford insurance. Waiting for the day when we can get sixty votes to jump from the system we have now to a single payer system--which could be years, decades even, considering how long it's taken us since Harry Truman's original proposal for universal health care to get to where we are now--means that people will die.

    Obama's proposal during the primary campaign--and the singleminded obsession with the word mandate obscures this--was a system of subsidized insurance. His plan differed from Edwards' and Clinton's plans primarily in that it did not require everyone to participate. But to imply Obama has been opposed to subsidized provision of private insurance as a solution to the health care crisis--which the diary surely does--is to misrepresent the debate over mandates and Obama's position.

    Now, we can have that debate about whether universal insurance coverage makes good public policy in the abstract. And we can honestly have a debate about whether subsidized universal insurance coverage is better than the system we have now (it is, by far), because those are our two options.

    When we get the votes in Congress to move to single-payer I'll support it, because that is the ultimate answer to the question. But I am not willing to accept the human cost of waiting for that to become politically viable. Moreover, the sheer expense of subsidized universal coverage may provide the most formidable lever we have to create the political constituency to demand single-payer.

    Support Obama. Support the Democratic Congress. Win universal coverage, so that people don't die.

    "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 Thu Nov 20, 2008 at 07:30:46 AM PST

    •  Offer public option to all? YES! - Mandates? NO! (4+ / 0-)
    •  I don't oppose mandates because (0+ / 0-)

      they are only half of what I what, I oppose them because they move us further from the goal not closer. They will enrich the insurance companies making their lobbies against single payer all the stronger. They are effectively a regressive tax, shifting money from the pockets of the working poor onto the bottom line of an already extremely profitable industry.  And once they are in place the political will to fix the problem will disappear until it becomes glaringly obvious that mandates didn't work any better than HMOs did. Mandates won't fix what wrong.

      •  "A regressive tax" taking money from the poor? (0+ / 0-)

        Um, no.

        Not under Obama's plan or any plan presented by last year's slate of Democratic presidential candidates. Because people with incomes beneath a certain level would have receive a graduated subsidy for the purchase of health insurance that would increase as their ability to pay decreases.

        So it's taking that money from the taxpayers. Now, if we consider the tax increases Obama has actually proposed to be the funding offset for universal health care, then actually the "tax" Toon talks about is being paid by Americans making more than $250,000 a year, not the recipient of the subsidy to purchase health insurance.

        Look again at the outline of the proposal Toon talks about. If that was what Obama had proposed to do, how could any Kossack support him? Thankfully, it's not.

        "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 Thu Nov 20, 2008 at 12:12:33 PM PST

        [ Parent ]

        •  Perhaps I was not clear. (0+ / 0-)

          When I said 'effectively a regressive tax' I did not mean a literal tax levy but rather an income drain that hits harder the less ones makes. When one mandates that every one must purchase an insurance policy then the cost as a percentage of income is highest for those making just a little too much to qualify for Medicaid or its equivalent. And what they would get for that money would be a 'junk policy' one with deductibles and co-pays so high that the policy itself might prevent them from be able to afford health care. If the goal is to be able to every one gets to see a doctor then mandates are a step backwards for the working poor.

          As an aside I have no sympathy for the argument that those making over $250,000 are paying too much in taxes. As a percentage of income those making about $100,000 are pay the most when you look at all tax liabilities. Those making a quarter of a million a year need to quit whining, lift your chins, and take some pride in this country you help make possible.

  •  Mandates are necessary to control costs. (6+ / 0-)
    Recommended by:
    stiela, TomP, two roads, carllaw, DHinIA, Kharafina

    Costs won't come down unless everyone is covered.  That's simply a fact of life in a public-private hybrid system.

    Government will likely pick up the catastrophic cases, costs for the poor.  Leveraging the Federal health insurance program will be an effective way for the government to get control of insurance and costs.

    Daschle's Federal Health Board idea can make the insurance companies play fair.  However, laws will also need to be passed that can't be undone by future health administrators (e.g., Bobby Jindal) who only like to squeeze the system for cost savings  and don't look to produce results.

    We will not have a single payer system.  So insurance in the private sector makes sense.  The real question is can we manage insurance.  Can we get control of the behemoth with all of its lobbying power.  I believe we can.

    Alternative rock with something to say:

    by khyber900 on Thu Nov 20, 2008 at 07:31:12 AM PST

    •  Actually, the Federal Health Board (2+ / 0-)
      Recommended by:
      oscarsmom, Toon

      will be comprised of industry officials (insurance company officials) and government officials, appointed by the President. It's the fox guarding the hen house in this instance.

    •  Nonsense! (7+ / 0-)

      Mandates will do NOTHING to control costs.

      The idea that there is this pool of foolish young people spending money on XBOX rather than health care, and if only we enacted mandates our problems will be solved is simply a form of scapegoating.

      The core problem is this:

      Too large a percentage of every health care dollar spent goes to managers, executives and shareholders. Too small a percentage of every health care dollar spent goes to actual caregivers.

      Mandates are entirely irrelevant to this issue.

      •  Absolutely. (2+ / 0-)
        Recommended by:
        slinkerwink, churchylafemme

        The high cost of health care is primarily due to the insurance companies engaging in a sort of reverse price gouging. They continue to underpay on bills submitted to them by healthcare providers, thus forcing the healthcare providers to raise their prices in order to get their original cost, and then the insurance companies turn around and underpay on THAT amount and so on.

        On top of that, yes... there are far, far too many people getting a piece of every health care dollar, and that's a major scam as well.

        The problem here is that we've let the insurance industry run what amounts to little more than a back-alley protection racket with regard to healthcare, and it's killing us.

        Forcing the uninsured to buy junk policies or face federal sanctions isn't going to fix a thing. Regulating the hell out of the health insurance providers is what's needed here.

        •  Regulation and new laws combined with (0+ / 0-)

          prosecution should root those problems out of the insurance system.  We've never had the laws in place or a government willint to prosecute the insurance companies.  We've done it in several industries at the state and federal level and it has had a positive impact.  I see no reason why we shouldn't be able to do it now with respect to the health insurance industry.  They are the big 'trusts' of our era (along with the oil lobby).

          If one makes the assumption that a determined Obama administration can discipline the behavior of private industry, then the issue of insurance becomes an issue of economics.  

          The costs of receiving medical care are real and most can't afford it, and that's why families will get insurance and government can help them.  However, the young and healthy will not likely buy insurance unless forced to because they don't see the risks of illness as paramount.  It is a type of moral hazard problem.  When that person does break his leg in a skiing accident he or she will push the costs onto the hospital, and those costs will trickle through the system to affect insurance rates and coverage.

          I know a lot of people on this site hate private insurance, but explain to me how you address the moral hazard and the problem of the uninsured showing up at hospitals and effectively pushing the cost of the bill to the hospitals and doctors who then pass it on to other patients who then push them on to the insurance companies (which also results in policy changes, higher deductibles, premiums and co-pays for everyone).

          Private insurance can supplement the public resources and make the provision of health care efficient for the society as a whole.  The problem we have now is that private insurance have become bloated, powerful behemoths that bilk the system for profit.  If the government breaks those practices, even breaks up some insurance companies into smaller entities, imposes restrictions and new laws, this problem can be solved.

          In other words, private insurance is not in and of itself an evil.

          Alternative rock with something to say:

          by khyber900 on Thu Nov 20, 2008 at 09:15:39 AM PST

          [ Parent ]

    •  I agree with diarist, except for the conclusion. (0+ / 0-)

      The political clout of large insurers may well increase with mandated coverage, and the plans may remain "crappy." The costs are the first concern in this economy, however.  GM's health insurance program is a major cause of their situation (but, certainly not all of it). If a better mandated plan than Baucus' can be drafted and put into operation quickly, on balance, it would be a net positive. Costs can only be lowered by insuring the largest pool of patients. That means everybody.

      I believe that Obama has an historic opportunity, though, to do something WAY better.  Employers would like to get out from under the health insurance burden, and workers (and everyone else) need health insurance that covers their needs.  Single-payer would do that if you revise and level out the tax structure to pay for it.

      Both employers and patients would benefit.  Insurance companies would be limited to covering procedures that fall out of the plan, which would be cosmetic, elective, or extremely minor treatments.

      Business taxes would be far more predictable than insurance costs for the employers, and patients would not have to worry about any significant financial liabilities coming out of unexpected health problems.

      Young people don't want to pay for insurance they believe is unnecessary, but our entire society must be on board for a comprehensive improvement to the system.

      Educate yourself. Think for yourself. Be yourself. Do for others.

      by DHinIA on Thu Nov 20, 2008 at 08:45:13 AM PST

      [ Parent ]

      •  Addendum (0+ / 0-)

        Insurance companies would be limited to covering procedures that fall out of the plan, which would be cosmetic, elective, or extremely minor treatments

        , and the inevitable copays and deductibles.  It is quite unrealistic for people to owe nothing for healthcare.  It's a right, but the responsibility must also be shared.

        That's why a mandated plan is better than the patchwork coverage created by "need" based plans.

        Educate yourself. Think for yourself. Be yourself. Do for others.

        by DHinIA on Thu Nov 20, 2008 at 08:59:09 AM PST

        [ Parent ]

  •  The real problem (2+ / 0-)
    Recommended by:
    mrblifil, kyril

    The real problem here is not mandated coverage. It's that insurance companies think they would be able to participate in a national health care program as insurers. That simply should not happen. While it's unlikely that any national plan will be able to shut down a segment of the economy as large as health insurers, their role in the plan should be limited to administrative functions (something similar to what happens under employer-sponsored self-insurance).  

    They can be allowed to adjudicate claims under tight and specific guidelines that would not allow them to have discretionary control over what is paid. This is a function that most insurance companies do pretty well. But, they should not have what would be considered a "risk-related" role in the plan. In other words, health insurers should not be allowed to assume risk under a national health program.

    The question of mandates should be debated totally separate and apart from the role of insurers in the program. The statement by the AHIP reflects a reality of health care coverage -- you can't have a pool of risk that is full of sick people. Therefore, if you want to eliminate restrictions on pre-existing conditions, you may have to force healthy risks to participate in the pool.

    These are really complicated issues. The question of mandates probably shouldn't be debated in isolation from other aspects of how the program is constructed.

  •  I would not object to mandates (3+ / 0-)
    Recommended by:
    slinkerwink, mrblifil, two roads

    if there were a public non-profit alternative available to everyone.
    A sort of creeping single-payer option.

    When civilizations clash, barbarism wins.

    by Allogenes on Thu Nov 20, 2008 at 07:44:41 AM PST

  •  If people are willing to let the auto industry go (2+ / 0-)
    Recommended by:
    4fx, Toon

    down in flames, so should go the healthcare "insurance" industry.

    There is NO need for such an industry.  All we need to do is hire more administrative employees at Medicare.  We pay monthly fees/dues to Medicare, and there ya go.  Everybody pays, everybody, but only according to what they can afford.

    As Matt Santos said, "Remove the number 65 from the Medicare laws."

    •  It's a great idea (1+ / 0-)
      Recommended by:

      and I wish it would happen, but I don't think it will. With single payer, administrative costs would go down hugely. I'm in health care, and I can tell you medical groups spend large amounts on administrative costs to game the system.

      The distinction between letting the auto industry go down and letting health insurance go down is the emotional issues attached to health care and choice of health care. Some of these objections are good points, most are not but are fueled by "they're going to take away my doctor" type scare tactics.

  •  Subsidised mandates are only option that can pass (2+ / 0-)
    Recommended by:
    jessical, two roads

    Single payer sounds great, I would love it, but I have a hard time seeing us get there. As opposed to what we have now it would seem a plan with mandates is an improvment. I'm thinking payroll taxes and fees on business's tha don't offer healthcare would pay for subsidies.(Wich would also help level the playing feild in the US for small bussiness.)
     I would also like to see a mechanism to cap insurance and pharma profits. But that might be counter-productive. If we actualy have competition that lowers cost and gives broad (universal) coverage I really don't care if they make money.

    •  The only option that can pass (1+ / 0-)
      Recommended by:

      If true, this is because the insurance industry is holding hostages.

      The discussion needs to be the pros and cons of paying ransom and whether we need a COMPREHENSIVE solution right now or whether we should stick with stop-gap measures and work to reduce the insurance industry's lobbying power.

    •  Caps on the insurance and pharma industries... (3+ / 0-)
      Recommended by:
      slinkerwink, churchylafemme, creamer the FIRST thing that has to be done, as is doing away with this despicable "pre-existing condition" crap.

      Forcing the uninsured to buy junk policies won't solve a thing, and it is EXACTLY what the insurance companies want healthcare reform to boil down to, because it'd be a major windfall for them.

  •  YES to Universal Medicare! (1+ / 0-)
    Recommended by:

    We need to go back to Kucinich's plan. Everything else is going to be a mess.

  •  Mandates are fine. (6+ / 0-)

    As long as the public insurance plans are wide open for anyone who wants to use them.

    •  that's a key component (1+ / 0-)
      Recommended by:

      whether it starts at 55 and older, or whetehr it's jmore than that (we don't know yet) it has to be robust.

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

      by Greg Dworkin on Thu Nov 20, 2008 at 08:05:53 AM PST

      [ Parent ]

      •  Unless public plans are price competitive (2+ / 0-)
        Recommended by:
        mrchumchum, Toon

        they will become the insurer of last resort and that will be a fiscal disaster for the taxpayers.

        If subsidized public plans are price competitive, and everyone switches, we will have de facto single payer.

        Therefore, the insurance industry shall NOT permit passage of a program that offers a widely available and less expensive public option.

        And if they did permit it, why not just call it single payer?

        •  you want it passed (2+ / 0-)
          Recommended by:
          stiela, mrchumchum

          or you want to argue about what to call it?

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

          by Greg Dworkin on Thu Nov 20, 2008 at 08:27:53 AM PST

          [ Parent ]

          •  The insurance companies won't be fooled (1+ / 0-)
            Recommended by:

            What we shall get is a kabuki public option that is more illusion than substance.

            Passing a bad bill and calling on everyone to sing its praises is far worse than just telling the truth, which is that America's health care delivery system is seriously screwed up and requires major surgery.

            •  you've already pre-determined (1+ / 0-)
              Recommended by:

              what will happen in a fluid area that's just getting started?

              It might happen the way you say, and it might not. But few would have predicted it would be advanced this far, this fast.

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

              by Greg Dworkin on Thu Nov 20, 2008 at 08:45:08 AM PST

              [ Parent ]

              •  Its all in the negotiation and its too early (2+ / 0-)
                Recommended by:
                slinkerwink, mrchumchum

                to declare victory and concede mandates.

                But yes, the insurance companies coming forward with this proposal is a good sign. Time to press the advantage for further concessions to make sure the public option is real and not illusory.

                BEFORE we build a consensus to accept mandates.

              •  PS - Have you already pre-determined that we MUST (2+ / 0-)
                Recommended by:
                slinkerwink, mrchumchum

                concede on mandates?

                As you say, its a fluid area just getting started and if Democrats agree to mandates the GOP will hammer on that in 2010.

                How popular is Medicare D. for example? Insanely expensive and guarantees high profit margins for Big Pharma and doesn't help people all that much.

                Therefore, I say that before we agree to mandates we need MUCH MORE than has currently been offered by the insurers

                •  no, I haven't (1+ / 0-)
                  Recommended by:

                  I actually want all the ideas on the table. i worry that too small a pool of patients without mandates would fail, but i am open to other ideas.

                  I personally favor single payor, but not if it can't pass.

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

                  by Greg Dworkin on Thu Nov 20, 2008 at 08:53:28 AM PST

                  [ Parent ]

                  •  I agree with the above comment but would add (1+ / 0-)
                    Recommended by:

                    that we need to be cautious about doing the wrong things and not be stampeded by a need to just "do something, do anything"

                    And big picture, unless we figure out how to deliver a greater percentage of every health care dollar spent to the caregivers themselves, with a lower percentage going to managers, bureaucrats, executives and shareholders, it simply will not matter what plan we pass because genuine universal CARE will remain un-affordable.

                    •  I mentioned above to heart of quince (2+ / 0-)
                      Recommended by:
                      slinkerwink, mrchumchum

                      that Ezra alos had this bit in his write-up of this.

                      Offering a public plan would almost certainly provoke a ferocious opposition campaign from the insurance industry, as will any number of smaller, more technical changes (for instance, forcing them to spend 85 percent of premiums on patient care, which is a popular idea).


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

                      by Greg Dworkin on Thu Nov 20, 2008 at 09:00:56 AM PST

                      [ Parent ]

                      •  85% of gross premiums on patient care (1+ / 0-)
                        Recommended by:

                        would get me to consider mandates. Not concede mandates but consider them. But not the measly offers the insurers have made thus far.

                        And to our Democratic advocates in Congress, I'd say that people such as slinkerwink and her diary here enhance our leverage rather than reduce it.

                        Maybe we cannot pass single payer but a grass roots upswelling in favor of single payer will give President Obama a stronger poker hand when sitting at the table with the insurance companies and Big Pharma.

                  •  What I don't get, though, is that even (0+ / 0-)

                    with a mandate and presuming people could afford it, the pool for each insurance company wouldn't grow that much would it?  I thought only way to get a really big pool that would truly give us economies of scale would be if lots of people bought into the gov't program.  In an ideal world, wouldn't it make sense to ease in mandates when that government pool gets big enough?  Am I misunderstanding the economics here?

    •  Price competitive public insurance plans, (4+ / 0-)
      Recommended by:
      tmo, two roads, mrchumchum, Toon

      Is what I hope you mean.

      But now address this aspect of all this:

      (1) If the public option is cheaper than private coverage (after doing a balance of price & quality of coverage) why wouldn't everyone leave their private plan and go public?

      Then Voila! Single payer

      (2) If the public option is more expensive than private coverage (after doing a balance of price & quality of coverage) then onlyh the least profitable people will choose public coverage as the insurer of last resort,

      Then Voila! We have privatized the profitable customers and socialized the unprofitable customers.

      Given K Street's influence, I predict Door #2

    •  What about the cost? (0+ / 0-)

      Who decides how much YOU can afford?

      That's the can of worms here--and it's exactly what is going to turn the public OFF of government involvement in health care and a single-payer system.  

      The insurance companies are probably aware of this, which is why they like the idea of mandates.

      Save the parrots: Drink shade-grown coffee!

      by oscarsmom on Thu Nov 20, 2008 at 08:54:46 AM PST

      [ Parent ]

    •  Won't work (0+ / 0-)

      People with private insurance have an incentive to see the public program underfunded.

  •  that they're really eager for mandates (4+ / 0-)

    has made me a lot more skeptical of mandated insurance.

    let's get to 60 in the senate!

    by danthrax on Thu Nov 20, 2008 at 08:15:12 AM PST

  •  I would love to see the results of a DKos survey (1+ / 0-)
    Recommended by:

    regarding who has health care insurance and what kind.

    I live in Maine and Florida, and pay for my own health care in Maine.  It costs just under $900/month for my husband, myself and daughter in college; we have a $5000 deductible before we see a dime in coverage.

    I would set up a poll myself, but I don't know how.


  •  HAHAHAHAHAHAHA! (7+ / 0-)

    Not to you specifically, Slink.

    But I've been arguing (and getting flamed for it) for at least 10 months that Obama opposed individual mandates only because he recognized that there would be intense industry pressure for them and so he knew that it was just plain stoopid to expend political capital getting them on the table upfront.  Individual mandates are one of Obama's strongest bargaining chips; he got this from day one, IMHO.

    I've been saying for ages that I was really surprised that Hillary did not appear to get this simple, basic fact, given that she had spent years working on health care reform.

    Look, folks you don't walk up to the table with your best bargaining chip in hand and lay it out there at the beginning, not when there is such a strong systemic vested interest ready to do everything it can to get that chip on the table.  I've had so many arguments with people on this site about this:  once again, the issue isn't whether mandates are "good" or "bad."  They are probably going to be necessary at some point for this system to truly run efficiently and fairly.  What is important is to figure out how best to play the mandate card.  That is what Obama has been doing all along, folks.

    Here is what I predicted many moons ago, and reading your diary today, Slink, I feel like it may turn out I was actually right for once. I predicted that at the end of the day, President Obama will sign a bill that contains a conditional individual mandate.  He will commit the federal government to work with the companies to reduce costs and to market and perform significant outreach to get everyone signed up voluntarily.  There will be a provision in the bill for an individual mandate at some future time if and only if some future milestones are not met (and even then only after a future review and some form of agency approval).  

    Mark my words.  I really believe that this is how it will shake out, and I do believe that this has been Obama's plan since day one.

    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 Thu Nov 20, 2008 at 08:18:17 AM PST

  •  What would be good is that if (0+ / 0-)

    these damn ins companies could not sell stock- period. Mandtory? Hell no! When auto went mandatory, these little knaves charge whatever they want, prices have constantly gone up ever since.

  •  Neither option helps (0+ / 0-)

    With mandates, you get the market distortions and boons to insurers that you mentioned.

    Without mandates, the costs are too high because healthy people won't bother with insurance until they get sick.

    A universal, single-payer system for everyone, paid out of general revenues (this medicare tax thing is wasteful and pointless) is the only way to go.  There could be a (low) co-pay for something like doctor's visits and a somewhat higher one for prescriptions (because some people like taking pills a little too much).  But I suppose we mostly agree on this.  So the real issue is how many Blue Dog and moderate Senate votes can we whip with what kind of plan.

    Almost no one seeks healthcare when they don't need it, so it makes sense for the cost of healthcare to be uncorrelated with the individuals contribution to the system.  And apart from the potentially crippling costs, who wants the stress and time-waste of fighting with insurance companies over the definition of "experimental" and "pre-existing"?

    Seek first and final principles at The Mean Free Path.

    by Cream Puff on Thu Nov 20, 2008 at 08:39:33 AM PST

  •  It works well here in Massachusetts (2+ / 0-)
    Recommended by:
    jessical, BDsTrinity

    A good first step to universal healthcare is making sure that everyone has insurance.  It makes the next step that much easier.

    Main Street before Wall Street! NO DEAL is better than a bad deal.

    by Subversive on Thu Nov 20, 2008 at 08:50:01 AM PST

  •  I sure hope the insurance companies' statement (5+ / 0-)

    gives the pro-mandate people here pause.  Do you need any more proof that this is BAD for our health care system?

    What is good for the insurance companies can NOT be good for the public, by definition.

    Save the parrots: Drink shade-grown coffee!

    by oscarsmom on Thu Nov 20, 2008 at 08:51:56 AM PST

  •  sorry, I disagree and think this is a terrible... (1+ / 0-)
    Recommended by:
    two roads

    ...diary.  In the Netherlands, health insurance is mandatory.  There is NOTHING wrong with mandatory health insurance...if covering everyone is a social value, then making it mandatory is perfectly fine.  The issue comes in how it is paid for.  If people who cannot afford it are given subsidies (not tax breaks)...and if that is accounted honestly...then it is a fair thing to do.  

    Sure, I'd rather have single payer.  But if we have mandatory health insurance, it will, I think, end up being regulated like any other utility -- electricity, say -- and the political pressures will be the same.

    I think the health insurance companies are playing chicken.  And I think you just bought in, and so did the recommenders of this diary...

    Donut away...

    ...j'ai découvert que tout le malheur des hommes vient d'une seule chose, qui est de ne savoir pas demeurer en repos dans une chambre.

    by jessical on Thu Nov 20, 2008 at 08:53:36 AM PST

  •  I think we are confusing health care and insu- (0+ / 0-)


    We need to make sure everyone has health care provided for.  Whether this comes from insurance, universal healthcare or another way is what we should discuss.  

    In Europe the say the have mandated insurance, but they mean mandated healcare coverage.

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

    by DefendOurConstitution on Thu Nov 20, 2008 at 09:01:58 AM PST

  •  "...the elderly aged 55 to 64" (1+ / 0-)
    Recommended by:
    two roads

    Wow, now "elderly" is 55.  As a 61 year old I am struck by your choice of words in this case.  Any of you young'uns want to join me for a nice 10 or 15 mile run this afternoon?

  •  To over-simplify, (1+ / 0-)
    Recommended by:

    discounted fee-for-service, the prevailing health care finance in most states, has caused docs and other providers to make deep cuts in their usual, customary and reasonable fees to insure volume from payors, such as Managed Care Organizations ("MCOs") and Preferred Provider Organizations ("PPOs").  

    At the same time, MCOs and PPOs have not passed these savings on to consumers, but have passed them on to shareholders and (in some cases, to a far greater degree) management.  

    The best solution would seem to be to get large numbers of patients together in affinity groups to bargain with payors to take advantage of savings in the system, with the Federal Employee Health Benefit Program ("FEHBP") playing honest broker and "messenger" (in a "messenger model" sense to keep payors proprietary data confidential).

    This is largely what Tom Dashle  suggested in his book.

  •  I opposed mandates, but only b/c (1+ / 0-)
    Recommended by:
    two roads

    I thought they were poison pills for any legislative effort to get comprehensive health care reform passed.  I don't personally understand why you are fighting so hard for those who don't want to buy it.  Your argument is confusing, b/c you seem to assume that mandates can't be accompanied by comprehensive reform of the insurance industry.

    The only thing we have to fear is fear itself - FDR. Obama Nation. -6.13 -6.15

    by ecostar on Thu Nov 20, 2008 at 09:23:45 AM PST

  •  I think we have to differentiate... (5+ / 0-)

    between mandates that require people to buy the currently existing (crappy) insurance and mandates that would require people to buy completely overhauled insurance that is affordable and comprehensive.

    Personally, I'd like to see the insurance industry put out of business.  I think it's immoral that there is an entire third-party industry that profits from our illness.  

    But I look at the way car insurance works.  It's mandated.  But I also think my car insurance is a better deal and more comprehensive than my health insurance.

    Hope you enjoyed it, Sarah, 'cause we just kicked your silly winking folksy lipsticked ass back to Alaska. For good. Also.

    by Kaili Joy Gray on Thu Nov 20, 2008 at 09:34:00 AM PST

    •  You can opt to not drive. You can't opt... (5+ / 0-)
      Recommended by:
      tmo, slinkerwink, Big Tex, jazzence, Toon not have a body.

      If you live where there's public transportation, if your spouse drives and you don't, if you're retired and don't need to drive, if you're young and just choose to bum rides off people, then it is not mandatory for you to buy auto insurance. I live in Chicago and haven't owned a car for over 15 years now. Nobody's putting me in jail or docking my tax refund for not having car insurance.

      Mandatory health insurance purchase laws would be a completely different thing. Anyone who draws breath would be forced to buy health insurance, whether they can afford it or not.

  •  Universal without mandates will not work (3+ / 0-)

    I don't really disagree with the main thesis of this diary, which is that mandating universal coverage does not solve most of the problems with the health insurance system, which is why I'd like to see us go direct to single payer.

    It is not reasonable, however, to make insurers accept all comers without a mandate.  The young and healthy would stay out of the system, paying only for their needed check-ups, until they had a medical problem needing more expensive care.  Not all would stay out, but enough would to make it much harded for insurers to turn a profit without even larger rate increases than we are currently seeing.  (Yes, insurers profit, but it is not excessive by the standards of other industries.  Yes, insurance execs, like other CEO's get way too much money, but this is not a significant contributor to overall insurance costs.

    My bottom line is that I'd like to see single payer.  Barring that, I do think that universal coverage is a step in the right direction, even if insurers still have freedom to design plans that do not do a good job of providing the coverage people really need, and we need mandates for universal coverage to work at all.

    Numbers are like people . . . Torture them enough and they'll tell you anything.

    by Actuary4Change on Thu Nov 20, 2008 at 09:37:33 AM PST

    •  yes but you'll also note that there is no limit (1+ / 0-)
      Recommended by:

      on premiums mentioned.  One need only look to Massachusetts and others before it to see that this approach will fail miserably.  The fact that AHIP is merrily jumping on board, as they did in MA, is also cause for alarm.  Sure, private insurance profits aren't "excessive", but the administrative costs on both ends of the billing cycle, advertising, enrollment upon enrollment, and on and on are all costs that eliminate rather than provide health care.

  •  Those CEO's need to start saving for their (0+ / 0-)

    rainy day, their offer is so self serving and so obviously about keeping their jobs.

    despite a federal lawsuit, diabetic kids in California still can't get a safe day at school. Shame on the ANA and CSNO.

    by foggycity on Thu Nov 20, 2008 at 09:50:04 AM PST

  •  Single / Multiple / Government / Private payer (1+ / 0-)
    Recommended by:
    two roads

    I am not aware of a country that has single payer health coverage. Every country, including Canada and the UK allow for people to pay for their own operations, doctors bills, and hospital stays. Medicare has government pay for some health care but also enables people to pay for their own extended benefits packages. The whole system is not single payer. Further, many doctors refuse to accept patients on Medicare, thus limiting Medicare's usefulness.

    The question now is how to improve our current health care so that people receive better care at less cost. Limiting health care to government employed health professionals and government run facilities is something few people would accept.

    To me the solution is fairly simple. Keep our current system for those who have insurance or who can private pay. For those who cannot, we should build a new separate set of facilities and hire government health practitioners to care for them. The cost is not what some private pay people/facilities want to charge, but rather the cost of keeping health practitioners and facilities on the government dole (for lack of a better term).

    As more people leave their health insurance plans the system will grow until a balance is reached.

    Practice tolerance, kindness and charity.

    by LWelsch on Thu Nov 20, 2008 at 10:01:19 AM PST

  •  more from that story (1+ / 0-)
    Recommended by:

    Analysts say Massachusetts is an example where the coverage guarantee has worked well, but it's also a state that requires everyone to buy health coverage or suffer a tax penalty.

    What analysts were those?  What were they smoking?  The penalties haven't even been enforced in any real way, the penalties for employers who don't comply are laughable, and most gladly laugh at them.  Massachusetts is demonstrably failing to cover everybody, and is already deep in the red.

    Of course AHIP salivates over this.  Sure, we'll agree to accept all comers - didn't say we would agree to limit their premiums now, did we?  So we just make sure we charge enough to keep our profits healthy.  And now everybody has to buy from us.  This is SWEET!

    Single-payer is what we need to start negotiations from, the private insurers should not be setting the agenda.

  •  It's not about slapping the insurance industry. (1+ / 0-)
    Recommended by:
    Big Tex

    It's about not utterly screwing over the very people that healthcare reform is supposed to be helping.

    And that is exactly what mandatory insurance purchase will do. Suddenly people who already can't afford insurance will be forced to buy it anyway, and will have to take the least expensive option to keep from breaking the law - which means they'll end up buying the same kind of junk policies that people all over Massachusetts are having to do under a similar scheme. They won't be able to afford to do anything else.

    Because let's face it... the government plan, whatever they come up with (and it won't be the same plan Congress gets, I can almost guarantee you that,) will end up being more expensive than the junk plans out there. So ultimately you'll not end up with anything like full participation in the government plan, which pretty much defeats the purpose of the mandates in the first place.

    And as for tax credits, those don't work in a situation like this because for one thing they don't kick in for a year. So again you've got people who can't afford health insurance who are forced to shell out money they don't have, and then try to muddle through for a year until they get their tax credit (whatever it may be, which may not even be a hell of a lot to begin with.)

    Plus, who gets the tax credit and who doesn't? And what happens to the people squeezed in the middle (as invariably happens) who don't qualify for the tax credit, but who also are still struggling to make ends meet?

  •  I disagree. Mandates are essential. (2+ / 0-)
    Recommended by:
    Holdek, two roads

    The combination of (1) no bans on coverage for pre-existing conditions and (2) no mandated coverage is a recipe for disaster. There will be no reason for healthy people to buy insurance, because they will be secure in the knowledge that they can always get insurance later if they need it. It is the equivalent of letting people wait until after they have an accident to buy auto insurance.  The whole system will fall apart.

    •  Forcing people to buy junk insurance plans... (3+ / 0-)
      Recommended by:
      slinkerwink, churchylafemme, Big Tex

      ...isn't going to fix a goddamned thing. It's just going to end up with people buying the cheapest plan possible and getting no real healthcare out of it.

      What you seem most concerned with is protecting the insurance companies from falling on hard times. Yeah, it's going to be a hardship on them to not be able to deny health care to as many of the people they're collecting premiums from. And yeah, some people might not buy insurance until they need it.

      But come on... do you honestly think that the healthcare system is the same thing as the health insurance system? An insurance system is not a prerequisite for a healthcare system. The reason people can't afford healthcare without insurance now is because the health insurance industry has to get rich off of people's need for healthcare. A doctor visit doesn't need to cost anywhere near what it does. But the insurance companies have to make their money, so they play this game where they only pay the doctor a portion of what he or she bills them for, which makes the doctor have to raise the on-paper cost of that same procedure, and the insurance company undercuts them even further and so on.

      Way, WAY too many people have to make their nut off of a single interaction between doctor and patient. That's the problem that needs to be solved here, and not how one keeps the health insurance companies strong.

      •  Davybaby (1+ / 0-)
        Recommended by:

        Was not arguing for strengthening insurance companies.  He's saying that if you ban pre-existing condition consideration AND do not mandate purchasing by healthy people, you ruin the market.  Then nobody gets health insurance unless you are on Medicaid or Medicare.  Get it?

        •  "Ruin the market." (1+ / 0-)
          Recommended by:

          "Nobody gets health insurance..."

          You're making my argument for me. You and Davybaby are talking primarily about the insurance industry and not about healthcare.

          Yes, if you limit the insurance companies' ability to make as much money as they can by whatever means necessary, then you do affect the health insurance market.

          But the problem with that is, it's health insurance and the bloated industry that provides it that is making healthcare so expensive in the first place. It's this notion that healthcare should be a commodity on which as many people should be making as much money as possible that has gotten us a healthcare system that's the equivalent of a $100 loaf of bread.

          It's HEALTHCARE that needs to be made more available... not health insurance. At this point the latter has gotten in the way of the former, and that's what has to be made to change.

          •  That's a different argument (1+ / 0-)
            Recommended by:

            If you want to talk about eliminating health insurance and installing a single-payer system in its place, then that's fine.  Just don't mix it in with a proposal for a market (insurance) that you obviously don't understand.

            •  Ah yes, the old "you don't understand" dodge. (0+ / 0-)

              I understand all too well the problem with applying the free market model to healthcare as though it were just another product to hawk.

              The problem is, this approach has resulted in a degraded healthcare system that fewer and fewer people can afford to use.

              The different argument here is that while we're talking about trying to fix the healthcare system so that people can actually afford to use it, you're wanting to make it all about fixing the health insurance system, which is a completely different issue altogether (though one which clearly has a negative effect on the healthcare system by making it more and more expensive.)

          •  The whole point of insurance (0+ / 0-)

            is to spread risk across as large a group as possible. Your house might not catch fire, but there is a good chance that a house in your town might burn down in the next year or two. Thus everyone pays a (relatively) small amount to protect against the slim possibility of financial disaster.

            Similarly, health also need to be spread across a large group; both healthy people and sick or injured people need to be in the insurance pool. As I said in my original post, it simply doesn't work if you eliminate pre-existing condition restrictions unless health insurance coverage is mandatory, because otherwise the only people who buy insurance will be those who have an immediate need for it. (Told you need bypass surgery? Better buy health insurance.) Economists call this "adverse selection."

            Your posts have filled with blather about "protecting the insurance companies." Obviously, this misses the point. This is about ensuring that health insurance is affordable to all.

  •  If there is an adequate & affordable public plan (2+ / 0-)
    Recommended by:
    two roads, Amber6541

    with cost based on income, I could live with mandated insurance. But only under those circumstances.

    Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius and a lot of courage to move in the opposite direction.

    by Futuristic Dreamer on Thu Nov 20, 2008 at 10:31:52 AM PST

    •  And that has to all be in place long before... (0+ / 0-)

      ...we even start talking about mandated insurance purchase.

      •  I could accept mandated insurance if the penalty (0+ / 0-)

        for not having it was being automatically added to the public plan.

        Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius and a lot of courage to move in the opposite direction.

        by Futuristic Dreamer on Thu Nov 20, 2008 at 10:44:47 AM PST

        [ Parent ]

        •  And how much does the public plan cost? (0+ / 0-)

          There's the rub.

          If the public plan costs you $200 per month, and you're not even able to squeeze out $100 per month for a junk plan, then you're basically fucked if the government automatically puts you on their plan.

          And it's not just the very poor who are in that boat. Plenty of people who make more than the poverty level on paper are still just barely making ends meet, for any of a million reasons, not all of which is that they're 20-something slackers who want to spend all their money on video games (as some here have suggested.)

          So, what becomes of these folks?

          •  The cost of a public plan should be income based (0+ / 0-)

            So if you can't afford it, you won't have to pay that much.

            Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius and a lot of courage to move in the opposite direction.

            by Futuristic Dreamer on Thu Nov 20, 2008 at 12:47:53 PM PST

            [ Parent ]

  •  The topic of mandates is a diversionary tool... (4+ / 0-)
    Recommended by:
    Big Tex, CatJab, two roads, Amber6541

    ...for the insurance companies. They is it to create controversy and division and stall reform efforts.

    What if the mandate was for Medicare? Or for a local community fund?

    Please don't fall for this again.  

  •  F* the HMOs. (1+ / 0-)
    Recommended by:
    Big Tex

    The thing we should be doing in our efforts to 'End Health Care As We Know It' is totally end the grip Insurance companies have on the "system." That is, get Health Care out of the Insurance biz. ANY Tom, Dick or Harry should be able to buy their "Health Care Plan" from any Tom, Dick or Harry. Grab a Wal-Mart Plan, or a J.C. Penney Plan or Bev's Tanning Salon Plan or Joe's Barber Shop Plan. We should be able to "buy Health Care" like we buy anything else.

    Second Life NetRoots Nation

    by winkk on Thu Nov 20, 2008 at 10:36:53 AM PST

  •  And I'm Supposed To (0+ / 0-)

    pay someone's emergency room bill with my tax dollars because they were too foolish/greedy to buy insurance, even if they could afford it?

    •  And somebody else is supposed to... (2+ / 0-)
      Recommended by:
      churchylafemme, Big Tex

      ...go bankrupt trying to pay for mandatory health insurance just to make you feel better about where your tax dollars are going?

      Hey, how about telling us the one about all of Newt Gingrich's fabled welfare queens living the high life and driving around in limos and eating caviar off of their welfare checks. That's a good one too.

      •  I know (0+ / 0-)

        Several people, personally, that live way beyond their means, buying big houses and consumer items, yet don't buy insurance and don't save for retirement.  I guess I should foot the bill for their irresponsibility?

        Nobody would go bankrupt with the mandates.  An obvious component of this would be a subsidy provided by the government to help people pay for it based on income-level.  

        •  Again, you're doing the "welfare queen" thing. (1+ / 0-)
          Recommended by:

          Yes, I know a few people who live beyond their means too. I'm not talking about them at all.

          Government subsidies for things like this generally tend to be set at very low income levels, and don't cover a lot of the people who genuinely need assistance. They also tend to come in the form of tax credits, which you generally have to initially wait a year for.

          There are PLENTY of holes for people to fall into on this thing, and it's despicable to just let them fall because you're pissed at somebody else for buying a big house they couldn't afford.

          •  You are casting your net too wide (0+ / 0-)

            You are making too many assumptions about what the subsidies would be, at what level they would be delivered, who would be left behind, etc.  

            If we can help get people insured using market economics, and personal responsibility with opportunity provided by the government, that's the best way.  Mandates could be a powerful tool in that strategy.  Look at the auto insurance industry.  They have worked there by and large.  

            •  Market economics, eh? (3+ / 0-)
              Recommended by:
              slinkerwink, churchylafemme, Toon

              Yeah, because market economics have really done right by us as far as, oh say, the financial industry goes.

              Leaving it up to the market in cases like this simply doesn't work outside of a textbook. Leaving it up to the market has gotten us the healthcare crisis we currently have. Leaving it up to the market has gotten us into bubble economy after bubble economy, to the point where our national economy is hanging by a thread.

              We need an actual solution here, and not more of the same warmed-over Reaganomics crap that's gotten us into this mess.

              •  Sorry but (0+ / 0-)

                I like markets.  It's what keeps us enjoying a standard of living higher than North Korea and Cuba.  

                •  That's fine for widgets. (0+ / 0-)

                  But making something like healthcare just another commodity on which to maximize profits is what's gotten us into this healthcare crisis.

                  And as far as our standard of living goes, it's getting worse, especially where healthcare is concerned. Hell, Cuba has us beat on healthcare at this point.

  •  I will support it (1+ / 0-)
    Recommended by:
    two roads

    I am not going to let the perfect be the enemy of the good. Yes, insurance companies add to the cost of healthcare and I'd love to see them vanish, but in today's economic climate, there will be no support for putting an entire industry out of business.

    We've got to do something. There are just too many people suffering. If mandates are the price for getting the insurance companies to cover people with pre-existing conditions, then we may just have to live with them. We should put our energies into ensuring that the insurance companies are properly regulated and there are appropriate subsidies for those who cannot afford coverage.

    "I was actually born on Krypton and sent here by my father Jor-El to save the Planet Earth."

    by lesliet on Thu Nov 20, 2008 at 10:41:43 AM PST

    •  "We've GOT to do SOMETHING!" (1+ / 0-)
      Recommended by:

      Yeah, and every time a "solution" is developed on the basis of that statement, it ends up making the problem worse.

      Solutions born of panic never work. We've seen this time and time again. It gets us shit like the Patriot Act, the Iraq invasion, the surveillance state, the financial industry bailout, yadda yadda yadda.

      Unless a healthcare reform plan is thought out thoroughly and carefully and with a very cool head, it is going to end up being of far more benefit to the insurance industry than to anyone it's supposed to be helping.

      And we'll be stuck with it.

    •  However... (0+ / 0-)

      We've got to do something. There are just too many people suffering.

      Forcing people to pay for insurance at exhorbitant rates and then not have a guarantee that their illness or their prescriptions would be covered is NOT the way to go.

      Even with three different Medicare expenditures, two of which are handled as payroll deductions (with co-pays and no guarantee that the care or the prescriptions will be covered), there's no guarantee of health care all being paid for.

      Medicare A is a payroll deduction everyone contributes to while working so that costs nothing after one goes on Social Security because it was already paid.  It covers some hospital costs, but not all, so if the co-pay is too much one can ask one's local county for assistance (state Medicaid) in paying for bills that still amount to thousands upon thousands of dollars, and even then there's a "spend down" so that the person who is sick still has a co-pay that he/she is responsible for.

      Medicare B is a Social Security deduction - mandated (forced).  It covers clinic and doctor visits with co-pays and no guarantee of coverage.  None of it covers 100% of the costs.

      Medicare D is the newest one passed during Bush's first term, it's mandated (forced) and allegedly pays for prescriptions.  When it was passed, I remember the Senate "debate" on the bill; insurance and pharmaceutical corporations wrote the legislation, not senators or reps.  I remember a couple of senators threw their hands up in the air and said they couldn't understand it... and another said "Well, this is the best we can do for now.  Let's pass this, and when we get back from break we can change it."  That's the lat mention of changing or fixing Medicare D.  To this day, no one really understands it.

      The only "choice" an individual has is between literally hundreds of insurance companies that require a monthly premium, it's the second deduction from Social Security checks, the monthly fees vary, and the types of prescriptions it pays for varies, as do co-pays, from zero co-pays to the insurance company not covering the cost of anything.

      Now, on top of that, insurance, medical, and pharmaceutical corporations want to come in and reap the profits of everyone's misfortune when they become ill, not just the disabled and senior citizens.

      See how that works?  Being offered health INSURANCE plans one is required to buy whether one is sick or not but still has to pay for is NOT a "choice."  It amounts to another tax, with the money going straight to the insurance companies (as with Medicare Part B and Medicare Part D), no guarantee of coverage, and high co-pays.  It then becomes a forced tax upon every citizen forced upon us by laws passed by our Congress, but the money goes straight to the corporations without passing through the US government as a middleman, but the US government only offers 'approved' health insurance corporations with whom to deal.

      It works kinda like forced car insurance you must buy and you must prove you have before you can renew your registration yearly (but you can avoid that if you don't own a car).  With health insurance, there's no option if "mandated" (forced) medical insurance becomes required by law.  Health care affects all of us (not just those old enough to buy cars).

      My preferred choice:  Congress Critters need to get over their knee-jerk reaction to the term Socialized Medicine, and we need to adopt a plan like the Scandinavian countries have:  EVERYONE has free medical care, cradle to grave, no exceptions.  Period.  There are very few things the private citizen has to pay for, and if they do have to pay anything (other than taxes to the government to pay for all of their health care being guaranteed free), it amounts to very tiny amounts that anyone can afford.  BTW, Scandinavians have paid leave for BOTH for a year or two at 80% salary when a new baby is born, their jobs are guaranteed when they go back to work.  They also get paid leave if a relative (spouse, child, parent, grandparent) gets sick and needs constant care and they need to stay home to take care of a chronically ill relative.  Guaranteed job when they can go back to work... where there is free daycare for children, too.

      Now... what's wrong with guaranteed free health care to every man, woman, and child, no exceptions, in the nation like they do in other nations that are civilized and have a higher standard of living than we do?  Higher taxes?  You betcha.  But how about taking away corporate tax breaks given to corporations and billionaires since Bush was installed in office, raising the tax rate on the obscene record profits to oil corporations and other military-industrial and insurance, medical, and pharmaceutical corporations have been getting for eight years to pay for it (and not let them get off tax-free for their offshore accounts)... or cutting the f***ing defense budget and divert war-making funds to free health care for everyone in the nation?  Refuse to pay for another nuclear sub, a couple of war planes, close a couple of overseas military bases.  That should take care of the majority of costs of free medical care guaranteed to everyone... with money left over.

      We've got to do something, yes.  But giving corporations more money plus tax breaks, bilking the taxpayers (AGAIN) by forcing us all to pay for medical insurance and not giving any guarantee for 100% covered costs is NOT the way to go.


      by NonnyO on Thu Nov 20, 2008 at 12:13:39 PM PST

      [ Parent ]

      •  Thoughtful comment (0+ / 0-)

        I appreciate your thoughtful comment. And I generally agree, with a few additional thoughts.

        First, your first sentence might not be the way it goes. I could imagine having government oversight to ensure that the insurance plans offered provide reasonable coverage. I have been helped with lower insurance rates in Massachusetts with a similar system, don't have to worry about pre-existing conditions, and so far have been very happy with the coverage.

        Second, when you ask what's wrong with going directly to guaranteed free government care, I thought I mentioned that in my first comment. The problem with that right now is that it would put a whole lot of companies out of business. Granted that it's a useless business that just leaches money out of the healthcare system. But there are a lot of people employed by insurance companies that would be out on the street. I just can't see that happening in the middle of an economic crisis with already soaring unemployment.

        I just don't believe it's possible politically in this economic climate to go to a government-run health care plan. There is just too much resistance. Last week I talked to a housekeeper who is struggling with health care issues. But when I mentioned a health care reform, her immediate response was "Oh no, I don't want a system like Canada where people have to wait in line for health care."

        If we reject any plan short of full government-run free health care, then I'm afraid we're going to get nothing.

        One step I would like to see is removing health insurance from the for-profit sphere. Perhaps one of the reasons I'm happy with my own health insurance is that it is offered by a non-profit company. There are several non-profit options in MA, but that doesn't seem to be equally true in other parts of the country.

        "I was actually born on Krypton and sent here by my father Jor-El to save the Planet Earth."

        by lesliet on Fri Nov 21, 2008 at 07:16:56 AM PST

        [ Parent ]

        •  I have a relative who lives in Canada (0+ / 0-)

          She has never waited in line for medical care.  I don't understand where that story comes from and why it has been promoted down in the US.

          I've never had a problem making an appointment... provided it's three months out and it's just a regular check-up to monitor my blood pressure and heart condition (both diagnosed a year ago when I went to ER and was taken by ambulance to another hospital out of town for three days of diagnostic tests).  There is a new urgent care addition to the clinic now, however, for people who are trying to avoid ER, need to see a doctor that day, but it's not an emergency enough to go to ER (altho I did see an ambulance pull up next to their door one day after my regular monitoring appointment).

          Insurance companies would still stay in business.  They have all those life insurance policies, cars to insure, not to mention things like homeowners or business insurance, etc.  Not that many people would be out of a job, if any, if they phased out medical insurance.  One of the joys of no longer having a car is that I don't have to pay exhorbitant fees for an insurance I never used except for roadside service.  That was all money wasted, IMHO (thousands, over years).

          I agree that we need to remove health care from the for-profit sphere.  That's why I liked Dennis Kucinich's not-for-profit healthcare plan.  I see no reason why insurance, medical, and pharmaceutical corporations should receive record-setting profits on the misfortune of someone's ill health.


          by NonnyO on Fri Nov 21, 2008 at 06:45:52 PM PST

          [ Parent ]

  •  Mandates should remind anyone in California (2+ / 0-)
    Recommended by:
    Big Tex, NonnyO

    of what happened with car insurance mandates years ago.

    TV commercials for car insurance stopped being about "we will cover you and fix your car" and more about "we have the power to grant you the legal status you need to drive your car without being fined or jailed."

    I feel like a Hockey mom at the state fair getting felt up by Hank Williams Jr. while fireworks go off and Jesus appears in my cotton candy. -Bill Maher

    by Dopeman on Thu Nov 20, 2008 at 10:43:13 AM PST

  •  The mandate should be for universal health care (3+ / 0-)
    Recommended by:
    churchylafemme, Wilberforce, NonnyO

    not universal health care insurance.

    Single payer is the only way this will happen.  Insurance companies are in it for the money and when you stop and think about it, what purpose do they serve?  They are nothing but a broker, a middle man who interferes between you and your doctor. Executives who dictate to you and your doctor from what surgery you can have to what antibiotic you can take.  Who gave them all this power over us?

    Health care should be a right and it should not be micro-managed by a for profit business.  

    •  You realize (0+ / 0-)

      That single-payer just replaces insurance companies with a different middle-man, right?  The government.  

      •  Is the government in the profit-maximization biz? (0+ / 0-)

        Because the insurance companies sure are. They're in the business of collecting as many premiums as possible while denying healthcare to as many policy-holders as possible.

        The government is not, on the other hand, a for-profit business. It may not always be the most efficient in the world (though that's largely been because we had a president who had a vested ideological interest in appointing as many incompetents as possible to "prove" how inefficient government is) but the government isn't trying to turn bigger and bigger profits every year the way a corporation is.

        •  Profit motive (0+ / 0-)

          Is what drives efficiencies.  That's basic econ 101.  A well-regulated free market provides the most prosperity for the most people.  That's been the history of this country, and the modern liberal consensus, since FDR.

          •  Again, it works in econ class, but... (1+ / 0-)
            Recommended by:

   the real world it simply does not.

            The healthcare crisis is a product of your free market.

            The mortgage crisis is a product of your free market.

            The economic meltdown is a product of your free market.

            If you want Econ 101, then go back to school. But the real world just doesn't work that way.  

            •  The lessons are derived from the real world (0+ / 0-)

              U.S. vs. Cuba, USSR, East Germany, North Korea, etc.  You decide what's better.  The answer is obvious to the vast majority of people.

              •  Okay, so it's a 'Murka vs. the Commies thing, eh? (0+ / 0-)

                Fine, if you want to go off into that little trip, more power to you.

                But it has absolutely nothing to do with the issue of fixing a healthcare system that's been beat to hell by the "free market" approach of treating healthcare as a commodity.

          •  Not really (1+ / 0-)
            Recommended by:

            The profit motive encourages prices to increase. Competition drives efficiencies.

            You need working competition to meet your magical free market nirvana. That does not exist in either health care or health care financing today.

            Patients are in no position to evaluate quality or price. They take their treatment on trust. They have no control over how things are paid because the tax code and insurance companies force as many people as possible into employer sponsored groups. That is why our health care costs so much more per capita than health care anywhere else in the West.

            •  Really? (0+ / 0-)

              Patients are in no position to evaluate quality or price.

              That's pretty condescending.  If they have a pair of eyeballs attached to a working brain, they should be.

              •  Really? (1+ / 0-)
                Recommended by:

                When you are told you need heart surgery, do you know who your choices are, what the price will be, and which method of surgery will be the best one for you? Can you tell me which surgeon will have the best outcomes, will be the one to handle unexpected results in the best possible way, or will be least likely to end up making a careless mistake?

                Can you tell me whether other treatment might be better? Can you tell me which treatments are dangerous? Can you tell me which teams are most skilled, most capable, most likely to have good outcomes? Can you tell me which anaesthetist is most reliable? Can you tell me which teams are most likely to be intact at the time of surgery? Which hospital has the best post-operative care?

                Now, be on vacation 500 miles from home and answer the same questions.

                I'm not being remotely condescending. There's a reason we have professional standards and regulations. Expecting a patient to select the best doctor or hospital is silly. More importantly, it's dangerous.

      •  No. It. Does. Not. (0+ / 0-)

        Yes, Medicare is modelled after insurance in some ways because it had to fit in with the system that was in place, but even if we expanded to have Medicare cover everyone, it still would not be the same as insurance companies.

        Significant differences:

        - No marketing cost. - No underwriting costs. - No investing costs. - Lower administrative costs. - No profits. - No need to set it up to continue the current pay for procedure method.

        The most efficient health care programs are those run by real HMOs like Kaiser Permanente, even they have higher overhead costs than Medicare has tody.

      •  Yes (0+ / 0-)

        It replaces 30% overhead for denying service with 2% overhead for all basic services covered.

      •  The problem with health insurance companies is (0+ / 0-)

        that they function the same way as auto insurance and home owners insurance and flood insurance, etc.  Those insurers take your money in premiums with the hope that they never have to pay out or if they do to pay out in minimum and to as few people as possible.

        Your car is not covered for maintenance, your house is not covered for normal home improvement and you are not covered if your toilet overflows.

        But, human beings need preventive and maintenance care.  You need your yearly check-ups to pick up on possible problems.  Kids need their vaccines and frequent check-ups when they are little. You need your dental cleanings so your teeth don't fall out.

        Catastrophic medical insurance is next to worthless because it will probably be too late by the time you have to file a claim. Your cancer, which you didn't know you had, may have spread everywhere or that nagging hacking cough, which you didn't have money to go see a doctor for, has turned into double pneumonia.

        Preventive care is where the savings are.  Teaching healthy behaviors and providing positive feedback is more conducive to healthier lifestyles.

        Medicare installed a process called Diagnostic Related Groups back in the 80's, DRGs.  They grouped certain diagnosis and set a price.  That is what a hospital got, no more, no less.  If the care was compromised, say a surgical wound became infected and the patient had to stay 3 days longer than allowed for that DRG the hospital ate the cost.  If the patient became more complicated then documentation had to be submitted in order to extend coverage. Private insurances jumped on that bandwagon soon enough.

        This led to losses and hospitals responded by cutting costs(no more day before admissions, they reduced length of stay and everything that could became an outpatient procedure or a 23 hour stay. You were sent home with drains and dressing changes and if you were lucky you were given adequate discharge teaching). They also decreased the biggest part of the budget, nursing. So, that increased patient to nurse ratio, the AMA pushed on care technicians, basically OJT's (on the job trainees) to make up the numbers. Patients became sicker and morbidity and mortality increased. Nurse's left the field of hospital nursing which only made everything worse.  

        I only mention all this to demonstrate how complicated and intertwined all this is.  We are facing a looming nursing shortage in the near future when nurses my age retire in great numbers.  Having sufficient nurse to patient ratio is key not only to giving quality care but to prevent complications and thereby reduce cost.

        Health insurance companies care about profit not health care.

  •  Mandates are a deal braker for me (4+ / 0-)

    Mandates will bankrupt people and make them sicker. This isn't car insurance folks, it's a ton of money.

    I'm disbled and chronically ill without health insurance. I've had tests and the doctors don't know what is wrong. My extra money goes to extra heat for my apartment and organic food and vitamins. Those things KEEP ME ALIVE!

    With mandates, the government won't give a darn about my situation, they will tell me this is what you can afford and have to buy.

    I will campaign the rest of life against the Democratic Party if they accept mandates, I human excrement you NOT!

  •  The only way we'll ever have universal (2+ / 0-)
    Recommended by:
    churchylafemme, NonnyO

    health coverage, is if we put the insurance companies out of the health care business entirely .

    "The military industrial complex not only controls our government, lock, stock and barrel, but they control our culture." - Mike Gravel

    by Wilberforce on Thu Nov 20, 2008 at 11:07:20 AM PST

  •  only come to the table? (0+ / 0-)

    He'll likely give in on this since the insurance companies will only come to the table if they get the guarantee that Americans will be forced to buy their crappy insurance products through the use of a mandate.

    I frankly don't give a flying fuck if the insurance companies come to the table. I'd be glad to decide they should be put to pasture while they're off in a huff.

    In terms of political capital, insurance companies have nothing but fear: fear that a change from the status quo will ruin what health care people do have.

    Thanks to how abysmally they've served Americans so far, that fear is dwarfed by the other problems with health care.

  •  Force people to buy Insurance Companies (1+ / 0-)
    Recommended by:

    trash and the Republican party will rule from 2010 till 2100 at least if not longer.

  •  There's a new diary about national health care (0+ / 0-)

    and the auto industry for those of you who are interested. I would post the link, but I don't want to pimp so blatantly without this diarist's permission.

    Please support your local library.

    by rk2 on Thu Nov 20, 2008 at 02:57:11 PM PST

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