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In the midst of the euphoria over the Supreme Court ruling on the Affordable Care Act, it's easy to forget how frustrating it is that the law requires individuals to purchase health insurance but does not include an option for them to purchase public health insurance.

That is not to say we would be better off without the Affordable Care Act—far from it. This is simply a reminder that the fight to improve the bill goes on.

This week at Daily Kos we endorsed five new candidates. All five are in battleground House districts held by Republicans, and all five are on record in favor of "The Medicare You Can Buy Into Act," which would allow all citizens or permanent residents of the United States to buy into Medicare. Here is how they all responded when we asked them if they supported the bill:

The Republican-controlled House is not going to improve on the Affordable Care Act. As we saw in 2009-2010, quite a few Democrats won't improve on it either. But if we replace Republicans with strong, people-powered Democrats, then we absolutely have a shot at things like Medicare for all.

Please contribute $1 to each of our newly endorsed House candidates who have explicitly endorsed "The Medicare You Can Buy Into Act." Today is the last day of the quarter, and that's why it's especially important to donate now. We won a great victory this week, and we can do more than just defend it.

Originally posted to Chris Bowers on Fri Jun 29, 2012 at 04:36 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  thanks for the update on endorsed House candidates (12+ / 0-)

    good stuff.

    An ambulance can only go so fast - Neil Young

    by mightymouse on Fri Jun 29, 2012 at 04:49:40 PM PDT

  •  Working people ... (3+ / 0-)
    Recommended by:
    elwior, slowbutsure, mightymouse

    pay into Medicare for 40+ years before getting access to benefits; the accumulation of contributions and interest earned over the years builds up a sizable fund.  That's why it's workable and not bankrupt.  How would a public option be able to survive if people have immediate access?

    "Two things are infinite: the universe and human stupidity, and I am not sure about the universe." -- Albert Einstein

    by Neuroptimalian on Fri Jun 29, 2012 at 04:56:48 PM PDT

    •  By expanding the pool. (6+ / 0-)

      If younger, healthier people buy into the system individually, in small groups, or through work, they are now paying for coverage which they may not need for years to come.
         And this is not just a small paycheck deduction, but the actual cost for a quality insurance policy.
          The thing is though, that policy will cost less than a private policy because there would be no profit involved, no need for advertisement, no huge bonuses for executives, etc.
         Further, the size of the program allows for decreased costs when purchasing/negotiating for high volume items like meds and medical equipment.

         These additions will actually improve the solvency picture for Medicare, save money for employers/employees who buy into it, and exert the needed cost-control into the system.
         It's a plan that is chock-full of WIN!

      "We the People of the United States...." -U.S. Constitution

      by elwior on Fri Jun 29, 2012 at 05:40:40 PM PDT

      [ Parent ]

      •  Right you are elwior, excellent comment, and this (4+ / 0-)
        Recommended by:
        slowbutsure, eglantine, JesseCW, elwior

        is why Chris Bowers post is so important. He gives us a chance at helping elect better Democrats who can make this happen!

      •  But much more theft. Have you been (0+ / 0-)

        paying attention to all the medical crime rings being rolled up by Holder?

        About 10% has been ripped off each year — before Obama, far outstripping the insurers take for private insurers.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Sat Jun 30, 2012 at 06:24:06 PM PDT

        [ Parent ]

        •  The insurers are taking 18-25%. (1+ / 0-)
          Recommended by:
          elwior

          Double or more what medicare loses to fraud.

          It's also important to remember - not every medicare fraud involves PT's getting nothing.  I know that seems like some fine hair to split, but I've worked in the industry.

          It's not "10% fraud".  It's 10% or so which turns out on audit not to have been covered.

          That doesn't mean fraud.   Sometimes it means that a provider can't find the medical records they were supposed to have.

          Now, those providers should have to pay back what they owe.  It's like not being able to find proper receipts to support some of your tax deductions - it doesn't mean you committed fraud but it does mean you have to pay back the cash and some penalties.

          Actually fraud is only 2-3% of total spending, and it's roughly the same in the private market.

          Thinking the "food stamp challenge" teaches you about being poor is like thinking a camping trip will give you insight into being homeless.

          by JesseCW on Sat Jun 30, 2012 at 07:24:52 PM PDT

          [ Parent ]

    •  you are wrong.n The only thing (0+ / 0-)

      the medicare tax pays into it the hospital fund, Medicare A. And it is going out faster than it is going in — although thanks to Obamacare and the hard work of Eric Holder that is slowing.

      For all the rest — excluding dental, nursing homes, eye care, prescriptions — Medicare B is used. It is totally paid out of premiums, 25% by each person, 75% from general funds.

      Prescription coverage is by compulsory private insurance.

      Oh a few more details you utopian people don't seem to realize. The copay on Medicare is 20% rather than the usual 10% and there is NO stop loss. ObamaCare includes a requirement of a stop loss on insurance come 2014. Your costs could mount quite high.

      Furthermore the copay for hospitalization is $1100 whether for one day or up to 60 days, iirc then it's some large amount for excess days up to a limit.

      Oh and the premium is progressive and considerably higher at higher incomes.

      The premium is per person. A couple pays 2 times; add in children ???

      Oh and if you haven't worked for ten years there is a premium for part A also.

      Be careful what you wish for!

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jun 30, 2012 at 06:21:33 PM PDT

      [ Parent ]

      •  Part D is not compulsory. (0+ / 0-)

        Many many seniors do not have Part D plan.

        10% copays are not "The Usual".  20% is much more common.  Silver Plans on the exchange only have 70% Actuarial Value, so Medicare will still be a better deal.

        Thinking the "food stamp challenge" teaches you about being poor is like thinking a camping trip will give you insight into being homeless.

        by JesseCW on Sat Jun 30, 2012 at 07:27:26 PM PDT

        [ Parent ]

    •  Over 65's absorb a huge proportion of (0+ / 0-)

      all healthcare spending.

      Everyone else is really pretty cheap to cover.

      Thinking the "food stamp challenge" teaches you about being poor is like thinking a camping trip will give you insight into being homeless.

      by JesseCW on Sat Jun 30, 2012 at 07:19:44 PM PDT

      [ Parent ]

  •  Chris I have a question (2+ / 0-)
    Recommended by:
    elwior, slowbutsure

    Does this ruling help? I mean doesn't this ruling actually codify that corporations are people i.e citizens united and might be argued against as infringement on rights when we ask for single payer/medicare for all?

    There are no sacred cows.

    by LaEscapee on Fri Jun 29, 2012 at 05:08:18 PM PDT

  •  Medicare For All: YES! (7+ / 0-)

    Candidates who support MFA: YES!!!

    "We the People of the United States...." -U.S. Constitution

    by elwior on Fri Jun 29, 2012 at 05:53:02 PM PDT

    •  Is it possible for us to take the House? (0+ / 0-)

      I'm not trying to be a downer, but with the spanking the GOP gave us in redistricting combined with the retirement of several vestigial Southern Dems that managed to survive 2010, is it really possible to win a net +25? The GOP's gerrymandering really hit us hard.

      I'm just wondering if it's realistic. If not, we would probably be better focused on winning the Presidency and holding the Senate.

    •  Nancy HAD the gavel (0+ / 0-)

      When this Mitt Romney, Heritage Foundation inspired piece of shit passed the Congress. Are you saying she'd do better this time around? I don't believe that either.

      "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

      by MargaretPOA on Sun Jul 01, 2012 at 06:02:18 AM PDT

      [ Parent ]

  •  Recalls, that's the key. (2+ / 0-)
    Recommended by:
    divineorder, Matt Z

    Whatever we do, let's not engage in direct action.  That might offend twelve "uncommitteds" in Kenosha!

  •  While everybody is celebrating (6+ / 0-)

    It's important to remember that the mandate was the Heritage Foundation's alternative to "Hillary care" back in the 90s. A mandate without medicare for all or at least a very strong public option is a Republican's wet dream. The only reason they are acting all apocalyptic is because they can't get past that "D" on the end of Obama's name and, I'm sorry to say, the only reason many left leaning people are celebrating the Supreme Court ruling is also because of that "D". The mandate is going to devastate a whole lot of working poor and that's not partisanship, that's arithmetic.

    "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

    by MargaretPOA on Sat Jun 30, 2012 at 04:07:15 PM PDT

    •  I don't know... (0+ / 0-)

      What do you think the chances are that people that cannot afford health insurance from any source won't be helped by Uncle Sam?

      What you're saying isn't going to happen.  It's just not.  Now, there might be a whole lot of hollering and screaming about taxpayer dollars being used because of the mandate...but, there will be provisions, you can take that to the bank.

      The truth is sometimes very inconvenient.

      by commonsensically on Sat Jun 30, 2012 at 04:41:44 PM PDT

      [ Parent ]

      •  You're not thinking about what you're saying. (1+ / 0-)
        Recommended by:
        JesseCW

        Many working poor live paycheck to paycheck. Their budgets are so tight that they have to do things like put off buying food to repair the car or delay the electric bill because the water heater started leaking all over the floor. How are they going to afford another monthly expenditure that will be a minimum of 200 bucks a month, (for a family of four say. It's more expensive than that but let's guess low), for crappy, bare bones insurance with a high deductible? And what about working families in red states whose governors will opt out of medicare expansion funds? Millions of Americans raise children on less than 30,000 a year but don't qualify for assistance. Clearly something will have to give and the ACA does not cover them. Period. 2,400 dollars a year from an earner who grosses 30,000 is eight percent of their gross earnings and we're not even addressing that what they take home is considerably less. That's a huge bite. You don't know what you're saying.

        "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

        by MargaretPOA on Sat Jun 30, 2012 at 04:55:37 PM PDT

        [ Parent ]

        •  It will go on a % of poverty (0+ / 0-)

          I'm thinking about it and I believe that these folks you're talking about will be afforded credits and availability to health care through government efforts.

          Just my opinion, of course, but pretty sure that's how it's gonna work.

          The truth is sometimes very inconvenient.

          by commonsensically on Sat Jun 30, 2012 at 05:46:25 PM PDT

          [ Parent ]

          •  You should actually look at the details (1+ / 0-)
            Recommended by:
            MargaretPOA

            instead of "believing".

            There's a reason there was such a knock down fight among Democrats about this bill.  There's a reason the Progressive Caucus held out so long for something better.

            It's not because they're "stupid purists".

            It's because the subsidies are no where near high enough for people between 140 and 250% of FPL.

            Thinking the "food stamp challenge" teaches you about being poor is like thinking a camping trip will give you insight into being homeless.

            by JesseCW on Sat Jun 30, 2012 at 07:30:15 PM PDT

            [ Parent ]

          •  The maybe you ought to read the effing thing (0+ / 0-)

            Before you simply assume that you're right and I'm wrong. I have read it. It's past time for you and the rest of the left leaning people who support this piece of shit to get to KNOW what it says, rather than believing your own construct of what you think it might say.

            "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

            by MargaretPOA on Sun Jul 01, 2012 at 05:57:20 AM PDT

            [ Parent ]

    •  I agree with what you say - and yet... (1+ / 0-)
      Recommended by:
      mightymouse

      am still glad it was upheld because it would have been struck down for the wrong reasons.  And would have provided a massive boost to the ultra-right.  I got to do a couple of press interviews on Thursday and I told them, it was better upheld than overturned, but it's still not the answer to our nation's health care crisis.  

      "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

      by Chico David RN on Sat Jun 30, 2012 at 04:46:38 PM PDT

      [ Parent ]

      •  A Pyrric victory at best (0+ / 0-)

        If I cared more about partisanship than policy, I would agree with you. The entertainment factor of right wing heads exploding was wonderful to me but that's not going to enable poor people to buy insurance. It's the people on the bottom of the ladder who work hard every day and only squeak by barring unforeseen emergencies each month that are going to suffer.

        "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

        by MargaretPOA on Sat Jun 30, 2012 at 05:00:22 PM PDT

        [ Parent ]

      •  Read through the titles of the whole bill (0+ / 0-)

        rest of the ACA. Without the rest of the ACA Medicare itself would collapse. Single payer by itself won't do much to help.

        And you fools need to go to the Medicare site and read it. See also http://www.dailykos.com/...

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Sat Jun 30, 2012 at 06:52:54 PM PDT

        [ Parent ]

    •  Even "buying into Medicare"... (2+ / 0-)
      Recommended by:
      MargaretPOA, JesseCW

      ...was brought up by George Bush (you know, George Bush) in a debate in 1988, as a way of countering the Democratic proposal that employers be required to carry health insurance.  "Great idea", I thought.  "We'll never hear about it again."

      The '60s were simply an attempt to get the 21st Century started early....Well, what are we waiting for? There's no deadline on a dream!

      by Panurge on Sat Jun 30, 2012 at 04:57:47 PM PDT

      [ Parent ]

      •  Yep. I remember (1+ / 0-)
        Recommended by:
        JesseCW

        As an example of how far the entire conversation in this country has shifted to the right, Daily Kos is cheering the fact that the Heritage Foundation's "health care" proposal has been upheld by SCOTUS. Crazy times indeed.

        "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

        by MargaretPOA on Sat Jun 30, 2012 at 05:07:16 PM PDT

        [ Parent ]

        •  Oh, I don't mind that. (0+ / 0-)

          It's plain that holding out for something better has NOT worked, to say the very least.  Get your slice of the loaf now, and consider it the setting of a trend.  That's how you normally get to something better (unless things happen that we really wouldn't want to happen).  The conservative movement understands the value of baby steps--the Overton Window technique, if you like.  We keep thinking the world is lost if we don't get all we want NOW--and then we don't get all we want and we decide the world is lost.  What good has that attitude done us?

          The '60s were simply an attempt to get the 21st Century started early....Well, what are we waiting for? There's no deadline on a dream!

          by Panurge on Sun Jul 01, 2012 at 09:16:40 PM PDT

          [ Parent ]

  •  About that photo caption...... (2+ / 0-)
    Recommended by:
    mightymouse, JesseCW

    I've kind of gotten the idea that the front page doesn't like to mention us all that much, due to the relationship with SEIU, but those folks in the picture are nurses from National Nurses United, and any connection to the DC metro Labor Council is pretty incidental.  Their being there was organized by NNU, not by the labor council.

    "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

    by Chico David RN on Sat Jun 30, 2012 at 04:49:42 PM PDT

    •  what is the relationship w/SEIU? (1+ / 0-)
      Recommended by:
      JesseCW

      all ears - thx.

      I like NNU.

      An ambulance can only go so fast - Neil Young

      by mightymouse on Sat Jun 30, 2012 at 05:38:24 PM PDT

      [ Parent ]

      •  The polling partnership and likely more (1+ / 0-)
        Recommended by:
        mightymouse

        We have the SEIU/Daily Kos poll, and there may be more things that don't show on the surface.  SEIU hates NNU and CNA - despite being officially in a state of peace at the moment - so one has to think that to whatever extent they have any influence it is not friendly to us.  And despite that official state of peace, the head of the largest SEIU local in the west, Dave Reagan, is partnering with the hospital association in a major attack on the nurse staffing ratio law that we treasure deeply.  
        This sums that last part up pretty well.

        And maybe I'm overly sensitive, but it has seemed to me that some of our major initiatives and fights - the very creative (and highly successful) efforts vs Arnold in 2005, Whitman in 2010, The push for the Financial Transaction Tax currently - all of them major national and international stories - have gotten essentially no mention on the front page here, while comparable stories of lesser magnitude have been well covered.  But I may have a slanted view of that.

        "Wouldn't you rather vote for what you want and not get it than vote for what you don't want - and get it?" Eugene Debs. "Le courage, c'est de chercher la verite et de la dire" Jean Jaures

        by Chico David RN on Sat Jun 30, 2012 at 07:33:44 PM PDT

        [ Parent ]

  •  important point when folks say, "where's the repub (2+ / 0-)
    Recommended by:
    mightymouse, samddobermann

    "where's the republican healthcare plan?"
    remind them, that Romneycare and Obamacare is THE REPUBLICANS' PLAN, goldurnit.

    Romney is the Bain of MY existence...

    by stagemom on Sat Jun 30, 2012 at 04:52:18 PM PDT

  •  Affordable care is impossible (1+ / 0-)
    Recommended by:
    JesseCW

    As long as healthcare costs are approximately 20% of GDP.  For-profit insurers make about 5% net.  Of course there are non-profit insurers, but they aren't stunningly cheaper.  A case can be made that for-profit insurers do a better job of curbing fraud.  No one makes money by curbing Medicare fraud, lots of people make millions by perpetrating it.  Focusing on profit distracts from the continuous increase in costs.  That's where the real problem lies.

    I suppose the government can provide insurance i.e. "Medicare for all", at an affordable charge because they can simply pay more than they take in, unlike private entities which eventually run out of money.

    The real answer is to make actual health care affordable -- i.e. lower the actual cost of providing it.  We are still stuck with the paradigm of the doctor with the black bag.  Our system, dominated by the AMA, forces everyone to go to an expensive doctor to get 'health care'.  Technology has revolutionized our lives.  It's time that it do the same to health care.

    The day will come when your primary physician is an AI software agent which is available 24/7 and is free.  Routine care will be handled at virtually no cost, freeing up physicians for serious problems.

    •  It's not enough to be non-profit (0+ / 0-)

      Insurers need to actually represent the insured.    We might be able to do this, for example, by requiring a transition to a case where at least 60% of shares are distributed in equal fashion to policy holders.

      Corporations are not goin to negotiate better prices for customers unless they can make more money by doing it.  If profits are capped at a precentage of revenue, this means more incentive to pay out more money, and this is one of my big complaints with the PPACA.

      •  You negotiate better prices (0+ / 0-)

        To get higher market share.  You can make more money if you do.

        •  I still think the incentives are all wrong (0+ / 0-)

          The insurers here don't represent the insured in negotiations.  They represent their own interests which you just hope are aligned.  Require that they be aligned by being owned by policy holders and the problems go away.

          •  As long as purchasers have a choice (0+ / 0-)

            then the insurance companies selling the coverage have an incentive to keep the cost down.  Insurance is a big-ticket item, close to 20% of payroll at my company.  I look at price and coverage to determine what to purchase.  The carriers compete to get our business.

            Of course they are looking out for their own interest, but their interest is to get me to buy their policy instead of the competition.  Your profit margin on a sale you don't make is meaningless.

            •  But price and coverage don't tell you anything (0+ / 0-)

              The dirty secret is that the allegedly independent firms that tell insurance companies what is reasonable and customary to charge are, in fact, owned by the insurance companies.

              In essence health insurance contracts are opaque and include (even under the PPACA) enough clauses that an insurer who doesn't want to pay can simply refuse and invoke some clause or another in the contract.  And since you are buying it for your employees, you probably don't get a lot of feedback when this happens.  I have heard of this happening more times than I can count.

              When my second child was born, I went back the next year and figured out how much we paid out of pocket for tax purposes.  Note there was nothing unusually complicated about the pregnancy or delivery....  We paid out of pocket $11k even after insurance largely because of clauses like these.  We cancelled our insurance at that point and have been uninsured since.  I fully plan, under the PPACA to pay the penalty rather than give it to an insurance company, and only buy insurance if/when we need it.  If they can play that game, I can play it too.

              This would be different if the insurance company was owned and operated by the insured.  Then the insurance union would represent me.  That's not the system we have though, and what they say they cover doesn't always reflect what they actually cover.

            •  In case you are wondering (0+ / 0-)

              My third child was born in Indonesia.  Total cost without insurance?  $3000.  Including plane tickets?  about $8k.  Prenatal care?  Not significant expense-wise.

    •  You are almost right but (0+ / 0-)

      nurse practitioners are taking over more and more of primary care — sometimes on their own.

      They will be the mainstay of Community Health Centers — in fact already are.

      The ACA has provisions for change. They are being tried now.

      And pay attention: Holder and his merry men are rounding them up apace. They have recovered over $5 billion but have stopped. prevented, multi billions more.

      Doctors do what rewards them most — but idealists here are demanding whatever a doctor orders — even if it kills them or the program itself.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Sat Jun 30, 2012 at 06:59:36 PM PDT

      [ Parent ]

      •  The FDA is actually thinking about this (0+ / 0-)

        I've been beating the 'technology' drum for some time but this spring there was a speculative meeting on the subject.  The Federal Register description includes:

        "FDA is aware that industry is developing new technologies that consumers could use to self-screen for a particular disease or condition and determine whether a particular medication is appropriate for them. For example, kiosks or other technological aids in pharmacies or on the Internet could lead consumers through an algorithm for a particular drug product.  Such an algorithm could consist of a series of questions that help consumers properly self-diagnose certain medical conditions, or determine whether specific medication warnings contraindicate their use of a drug product. In addition, for some drug products that require an initial prescription, the product could be made available as a nonprescription product with a condition of safe use for the purpose of product refills."

        A modest step, and only speculation, but real savings can be found down that path.

  •  Republicans not only want to keep us from moving (1+ / 0-)
    Recommended by:
    JBraden

    forward, they want to put us in reverse. They want to cut Medicaid, not expand it. The only way to preserve the gains we have made and make more gains is to GOTV and beat the Republicans.

    •  "[They] want to put us in reverse." (1+ / 0-)
      Recommended by:
      JesseCW

      EXACTLY.  Which is why I'm sick and tired of hearing Democrats described as "liberal" and Republicans as "conservative."  Crap on a cracker, America has NO liberal major party--Democrats are the conservatives, and Republicans are REGRESSIVE.

  •  Incremental Change and Reality (1+ / 0-)
    Recommended by:
    Micheline

    Ideally, we would have a single payer system which could be achieved if we enacted the public option.  However, we also need to recognize that according to a number of polls, the United States is a center right country.  We can’t just cram this stuff down people’s throats without recognize the makeup of the electorate.  One idea is to kill the individual mandate and replace it with an open enrollment period.  Offer each American 30 days after their birthday each year to enroll in a healthcare plan.  If they fail to do so, their own choice mind you, then they are not covered and risk the consequences.  Keep the rest of ACA intact.

    We also have to realize that while the Democrats will probably pick up some seats in the House it is highly unlikely that they will actually take the House.  Even if they do, many of the Democrats that win will mostly likely be conservative and anti, “Big Government”.  Democrats will also most likely lose the Senate given the electoral math but it is also doubtful that the Republicans will obtain a filibuster proof 60 seats.

    Folks, this is what we have to work with and needless to say, there is not enough aluminum foil to line the three cornered hats of the Republican base.

  •  Medicare should be like education (1+ / 0-)
    Recommended by:
    JBraden

    Everybody pays into it and you are free to pay more for a private provider.  Simple, sustainable and cost effective.  

  •  Rather to hear some congressional candidates (0+ / 0-)

    giving unequivocal answers rather than the usual ambiguous "I support access to affordable health care, blah blah blah" blather.

    We MUST work to get these candidates elected to Congress--not just because of the odious incumbents they will knock off (good luck, young Mr. Murphy!), but because they are also outstanding candidates in their own right.

  •  Very depressing! (1+ / 0-)
    Recommended by:
    samddobermann

    A prediction today that we won't retake the House.

    This is do-able, and totally dependent on shoe-latex. House districts (other than North Dakota, I guess) are small and local. They have local issues.

    I live in MI1--a district that by any statistic is heavily red. Abortion, guns, abortion and guns...But in fact, it's Medicare and unemployment...medicare and unemployment. I've been contributing to the Dem here because he seems to get it, but his messages aren't yet really simple enough. I've got two bumper stickers (Obama Cares and Women for Obama) at the risk of having my "second childhood" convertible keyed in some bar at night.

    My point is that we need to REALLY focus on the House. When you get the votes out there for the local candidate, you get the votes for Obama and for SCOTUS (indirectly) out there as well. The trick is to get the middle of the road guys who get home from work at 6 O clock off of their couches and down to the township hall.

  •  I think we need a different approach (0+ / 0-)

    Ok, before I start, I get a whole lot of flack from both left and right on this issue.   But let's start with the facts:

    1)  The United States has the highest public sector, per capita rate of spending on health care of any country in the world.  Our health care costs are so high our governments spend more on health care per resident than do the governments of places like Canada or the UK.  People who complain about waiting lists in Canada or the UK need to remember they are covering everyone for around what we spend on Medicare and Medicaid alone.

    2)  The way other countries get away with so little is that they aggressively control costs, particularly with regard to hospitals, pharmaceuticals, and medical devices.  Single payer systems thus work essentially by giving patients collective bargaining on this sort of thing.  I don't see this congress (indeed a significant number of congressmen of either party) being willing to take this on.

    3)  Existing, working single payer systems are relatively local.  For example, many countries that have them are small compared to even our largest states.  Lest you say, "What about Canada?"  Canada does not have a national single payer system but rater a series of single payer systems run by the provinces and supported by provincial sales tax.  Indeed, Canada has traditionally had less national coordination of medicine than the US has and the lack of a Canadian equivalent to the CDC was a big reason why Ontario had such big problems with SARS.

    Bigger isn't necessarily better.  What you gain in actuarial predictability, you lose in a lack of representation.

    So I humbly suggest two directions we could go.  The first would be a step towards state-by-state single payer systems, and the second would be an improved version of the PPACA.

    First, we could block-grant all Medicare and Medicaid funds to the states.  It's worth noting that federal taxes would still probably at least partly support single payer systems in this cases, but they would be block granted to the states who would then have near total freedom as to how to structure their programs.

    The conditions would be simple:  In the first year of the grant, the funds must cover the poorest f their residents and those over 65.  Any money they have left over can be rolled over into a general health program fund which can be used to pay for covering others in subsequent years.  If states want to aggressively control costs, they can probably use these funds to set up single payer systems with no added taxes.  Some states might want to raise taxes and provide premium care for their residents, but I don't think many states will choose dysfunctional spending when others are doing well with single payer approaches.

    The second approach would be to improve the measurs of the PPACA and take on other areas of cost.  The first thing to require is that all insurance programs that qualify as minimum essential coverage must be patient-run and owned insurance cooperatives.  People must participate in insurance that directly represents them and which they own a part of the company.  We can then remove the existing rebate rules, etc. because the patients are the stockholders and can decide on rebates as they want.  This way, the coops can provide real, single-payer-style collective bargaining over costs.

    But I don't think you can stop there.  I think one also would have to bring prices down in a lot of areas.  This means compulsatory licensing of patents for medicines and medical devices, and the second is thinking about how doctor licensing approaches currently drive up costs and drive down quality.  One approach to this latter view is to charter multiple medical guilds per region.  A guild would be responsible for setting criteria of licensing for their members, but would also stand in as a med-mal insurance pool.  This would mean physician on physician review of med-mal claims on the defense side, and doctors who make inexusable mistakes would be forced out of practice by the fellow members of their guilds.  Because the guild as a whole would be responsible for the malpractice of their members, guilds which would have better standards of professionalism and outcomes would have lower overheads.

    So the second proposal is your free market solution.

    Unfortunately I don't see either party getting behind reforms that might work, either imposing tried-and-true principles of local single payer systems or distributed free market systems that learn from single payer systems.  The Republicans are too much into making big business bigger, and the Democrats haven't adequately explained how, if they can't control costs regarding Medicare, how they can control costs in a Medicare for All plan.  But maybe if we organize and demand changes, we can get something that doesn't make the system worse.  I think the PPACA does make the system worse, but maybe witht he above changes it can be a foundation for something better.

  •  THANK YOU! (0+ / 0-)

    Thinking the "food stamp challenge" teaches you about being poor is like thinking a camping trip will give you insight into being homeless.

    by JesseCW on Sat Jun 30, 2012 at 07:18:45 PM PDT

  •  I think the real way we are going to (0+ / 0-)

    get to single payer is through medicaid, like Canada did.  While I would prefer medicare for all, the states will now be set up to very quickly go to single payer for a number of reasons.

    Individuals below 133% will already be in medicaid, as will many others.  I think the number of people on the subsidies will increase much more than they budgeted for, and will cost far more than the way the CBO scored them.  The federal budget will be very tight for the foreseeable future.  A decision time will come in which the federal government will be looking to further close the deficit.  Due to medicaid's far lower cost than private insurance, and that the federal government is paying the difference between the small percentage payed by those with subsidies and the actual cost of coverage, moving all people receiving subsidies onto medicaid would save the federal government a great deal of money over 10 years.  The other options are to cut services, drop people's coverage, or raise taxes.  These options are not politically tenable.  If those receiving subsidies are placed on medicaid, then all individuals below 400% of the poverty line would be on medicaid.  The last step is just to open up medicaid to all consumers and, presto, state-based single payer.  Then the states coordinate and it will morph into national single payer.  

    This is similar to how Canada did it.  My wife is from Canada and I am somewhat familiar their program.  Ontario residents do not have a national health insurance plan, they have the Ontario Health Insurance Plan(OHIP).  But since all provinces now basically have the same coverage, share all information, are partially funded by themselves and the federal government, it works out to be single payer.  Canada's single-payer began in the provinces and I think our's will start in the states.

  •  Carol Shea-Porter ! (0+ / 0-)

    I think she has a real chance to oust the teabagger Giunta.  I donate to her regularly.   Teabaggers have overplayed their hand in New Hampshire, but a lot depends on turnout.  

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