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When I was reading the transcript of Obama's speech on the Affordable Care Act today, two (adjacent) passages stood out to me in their disingenuousness.

And so, what we did was we chose a path that was the least disruptive to try to finally make sure that health care is treated in this country like it is in every other advanced country: That it's not some privilege that just a certain portion of people can have, but it's something that everybody has some confidence about.
First of all, the Affordable Care Act does not guarantee that health care is treated in this country as it is in other advanced countries. Because the government still has a self-imposed ban on negotiating for drug prices and because it provides outrageously long patents to pharmaceutical companies, our prescription drug prices are far higher than they are in other countries. Moreover, the ACA will still leave 30 million Americans uninsured and could end up exacerbating the problem of underinsurance. Because of such underinsurance, it will be at best a weak palliative to the problem of medical bankruptcies. Furthermore, those advanced countries that don't have a national health insurance plan, e.g. Switzerland, tend to have a market dominated by nonprofit, rather than for-profit, insurers. And that creates a completely different incentive structure.

So, does the ACA do some good? Yes, it does. Allowing children to stay on their parents' plans until age 26, the Medicaid expansion, the medical loss ratio, and the increased funding to community health centers were all good steps forward. However, it does not do enough to fix the structural problems with the American health care system and to bring it on par with those of the rest of the advanced world. It just tinkers around the edges.

And, you know, we didn't go far left and choose an approach that would have been much more disruptive. We didn't adopt some more conservative proposals that would have been much more disruptive.
Here Obama is striking his usual "adult in the room," "middle ground" posture, in which he tries to place himself above the realm of politics in this supra-partisan sensible "middle." He calls approaches further to the left of the Affordable Care Act too "disruptive." Frankly, the only thing that Medicare for All (single payer), a Medicare buy-in, or a public option would have disrupted was corporate profit.

Let's look at the first of those options, the one the administration discarded from the start: single payer, or Medicare for All.

First of all, it would provide all Americans with the same basic but robust health insurance.

Second, it would be fiscally responsible. According to the interactive Health Care Budget Deficit Calculator over at the Center for Economic and Policy Research, the U.S. could balance the budget in basically 10 years if it had adopted a health care model like that of any other advanced industrial country.

Third, it would be good for business. A single payer system would reduce labor costs and help make small businesses more competitive. By providing health security to everyone, it would promote entrepreneurship and innovation in a myriad of other sectors, by making people more willing and able to take risks.

But it would be bad for the profits of the health insurance companies and the pharmaceutical companies. And, of course, they're just too important to disrupt.

Last Congress, Sen. Bernie Sanders (I-VT) and Rep. Jim McDermott (WA-07) introduced the American Health Security Act, with the strong support of the AFL-CIO. Sam Farr (CA-20), Judy Chu (CA-27), Keith Ellison (MN-05), Raul Grijalva (AZ-03), Lacy Clay (MO-01), Jan Schakowsky (IL-09), Barbara Lee (CA-13), and Jim McGovern (MA-02) all co-sponsored the legislation as well. John Conyers's Expanded & Improved Medicare for All Act has an additional 42 extra co-sponsors.

As Congress discusses "fixing" the Affordable Care Act, I would hope that these and other progressive legislators fight to make health care reform more progressive and more universal.

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Comment Preferences

  •  To say that moving 300 million Americans to (6+ / 0-)

    single payer would be less disruptive than trying to get 30 million onto private insurance is simply untrue. The only way single payer will ever come to America is if it starts at the state level first.

    •  at which point you're (3+ / 0-)
      Recommended by:
      Johnny Q, TracieLynn, aliasalias

      going to be dealing with fifty different versions of it. Better to start at the top and set standards than deal with piecemeal fixes.

      (Is it time for the pitchforks and torches yet?)

      by PJEvans on Thu Nov 14, 2013 at 05:17:31 PM PST

      [ Parent ]

    •  Sanders-McDermott (6+ / 0-)

      The Sanders-McDermott single payer legislation does take a state-based approach:

    •  it took 11 months between the passage of Medicare (12+ / 0-)

      to the first recipients getting their Medicare cards. That was before the Internet, in the days when a room-sized computer had less power than a modern laptop.

      Don't tell me that Medicare for all was just too logistically cumbersome to be done. If they were really serious, they'd have found a way to do it.

      During WWII, this country went from being a pre-modern military power to having the mightiest army in the world in just five years. Don't tell me that Americans can't figure out a way to give everyone single-payer health care. That's just insulting.

      The administration did what they did because they thought it was politically easier to let the insurance companies have their way. Now that's proven to be not such a hot idea, he wants us all to know that it was everyone's fault but his that it went wrong. What a leader, huh?

      "Oh, it was the Republicans' fault. Oh, it was the insurance companies' fault." Well, who was it who was so hot to negotiate with the Republicans and the insurance companies?

      Not the Democratic base. It was Obama who said "I know better, guys, I have a better way. Let's not even consider single-payer, let's not fight for the public option, let's give the insurance companies most of the say, and even force all Americans to buy from them, and it will all turn out OK. Trust me." Well, we trusted him, and it didn't turn out OK. So it's on him.

      Obama's only defense of his policy failures is to echo the Republicans and claim that government is powerless to solve problems. Mr. "Yes we can!" has become Mr. "No we can't!"

      Obama's defenders believe that whatever Obama does is automatically the best that could possibly be done, merely by virtue of the fact that it was Obama who did it. Conversely, they believe if Obama can't do it--or even that if Obama chose not to try to do it--it can't be done.

      Look at the disruptions now--some people are being kicked off their plans, without knowing whether they'll be able to get a replacement. Some people are having their premiums raised by the insurance companies and they don't know why and can't find out why. Others are trying to navigate the websites without success. And by the way, if you choose not to get into this whole mess, you will be fined.

      And you say this is the "least disruptive" way of doing things? Pfft.

      The only way single payer will ever come to America is if it starts at the state level first.
      Do you believe in the federal government or not? Are we fifty individual states all going our separate ways, or a union indivisible? We fought a civil war over this question, you know. And we settled it in favor of the Union.

      Those who claim that a health care solution is necessarily up to the states may pay lip service to the notion of the federal government and the Union, but when it comes down to it, they are in full agreement with the teabaggers' fundamental premise: that the federal government is impotent and incapable of solving our problems.

      Well, if you accept that premise, then the teabaggers' response (i.e., destroy the federal government) is the only logical one. Maintaining a federal government is a lot of trouble and requires a lot of sacrifice on the part of Americans; if it can't even solve a basic problem like providing health care to its citizens, just what is the point of having it?

      Anyone who says they believe in the federal system but doesn't believe that the federal government can solve this federal problem is hopelessly muddled and hasn't thought his/her ideas through to their logical conclusion.

      FDR and LBJ had three things Obama doesn't: faith in the American system of federal government, and the will and courage to use the power of that federal government for the good of all Americans. That's why they're remembered as great presidents.

      Obama took the path of least resistance and continues to take it. Despite his incessant PR offensive, he won't be remembered as a great president.

      "In America, the law is king." --Thomas Paine

      by limpidglass on Thu Nov 14, 2013 at 06:35:12 PM PST

      [ Parent ]

  •  Wow! He is so sadly behind the times! (12+ / 0-)

    The "Disruptor" is the new business icon - the model that upends the status quo and provides new standards and ideals.

    And historically, "The Least Disruptive" is not and has never been a winning philosophy.

    This is the philosophy of the people investing in harness makers over the automobile manufacturers - that was "less disruptive" too.

    True leaders do not worry about being "disruptive". Did Martin Luther? Did George Washington? Teddy Roosevelt? Gandhi? FDR? Martin Luther King Jr?

    And there you have the Obama administration's philosophy a nutshell and the reason why in the fullness of time it will be deemed average at best.

    “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

    by Phoebe Loosinhouse on Thu Nov 14, 2013 at 05:24:55 PM PST

    •  You misunderstand history (2+ / 0-)
      Recommended by:
      GoGoGoEverton, MRobDC

      Just to take FDR as an example, instead of nationalizing the banking system upon taking office he decided to enact a banking rescue drawn up by bankers and Hoover Administration Treasury officials which preserved the private banking system.  Why?  Because nationalizing the banking system would've been too disruptive.

      As for Martin Luther and Martin Luther King, Jr., they weren't elected officials with official responsiblities.  They were activists whose whole purpose was to shake things up.

      Lastly, you mention Teddy Roosevelt, who did pursue a few lawsuits busting up some trusts, but here's an actual quote from TR:

      “The man who advocates destroying the trusts,” he said early in his presidency, “by measures which would paralyze the industries of the country is at least a quack and at worst an enemy to the Republic.”  Richard Hofstader, The Age of Reform, p. 246)
      In other words, although he believed in curbing some abuses of the trusts, he most definitely did not favor abolishing them because it would be too disruptive.  

      "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

      by puakev on Thu Nov 14, 2013 at 05:55:15 PM PST

      [ Parent ]

    •  Teddy R (4+ / 0-)

      I'm always uncomfortable with citing Teddy Roosevelt as a progressive hero because he was a militarist, an avid imperialist, and a defender of torture. Roosevelt was more of a Tory reformer than he was a progressive liberal. And he was quite the friend of many trusts.

      But I do agree with you that I do not like the strategy of "changing the system as little as possible," especially when the system has structural problems.

  •  More to the Point, Profit Insurance = Wall Street (8+ / 0-)

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Thu Nov 14, 2013 at 05:36:21 PM PST

  •  Single payer would be disruptive, and not only (2+ / 0-)
    Recommended by:
    MRobDC, GoGoGoEverton

    to insurance companies and pharmaceutical companies.

    The fact is that most Americans prefer a private-based health insurance system to a government-based one - a Gallup poll from November 2012 found that 57% supported a private system while 36% preferred a government-based system; the same poll found that 59% were satisfied with the cost they paid for health care.  In addition, poll after poll has shown that upwards of 80% of those coverage are satisfied with their coverage.

    I would prefer a single payer system, but let's not bullshit ourselves here, the vast majority of the American public would be overwhelmingly opposed to being told that their insurance which the vast majority of them are satisfied with would be replaced by an untested, unknown, government-run health insurance program.  You think a few million losing their junk insurance has been bad?  Imagine the uproar from tens of millions losing their plans, and millions more losing their jobs in the health insurance business.

    If you're going to advocate for single payer, you should at least be honest about the likely implications instead of pretending it's all going to be cake and balloons.

    "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

    by puakev on Thu Nov 14, 2013 at 05:47:04 PM PST

    •  The only way to achieve anything close to single (2+ / 0-)
      Recommended by:
      GoGoGoEverton, Dave925

      payer in America will be to gradual increase the income threshold for Medicaid while allowing older people to buy into Medicare. And neither of those things is going to happen for at least 10-20 years.

    •  Medicare untested and unknown? (8+ / 0-)

      Who knew? Here I thought we had had it for nearly fifty years and that it had worked far more efficiently than even the best private insurance, that it was a well-known quantity and a well-adminstered government program. I thought it was so popular that even the frickin' teabaggers, who hate all things associated with the government, loved it.

      Guess I was wrong! Learn something new every day.

      Very simple fix: lower the Medicare eligibility age to zero. There. Done.

      you should at least be honest about the likely implications instead of pretending it's all going to be cake and balloons.
      Obama's been anything but honest about the "likely implications" of the ACA, and he's been talking about nothing but "cake and balloons" when many people are being handed spoonfuls of shit and dunce caps. And yet the onus is on the single-payer advocates to be "balanced." Ridiculous.

      "In America, the law is king." --Thomas Paine

      by limpidglass on Thu Nov 14, 2013 at 06:44:02 PM PST

      [ Parent ]

    •  Untested? (7+ / 0-)

      I'd have to agree with commenter limpidglass that it's not an "untested" system. Medicare is very efficient and very popular. You could lower the eligibility age to zero. As a more moderate option, you could have allowed for a Medicare buy-in or have reduced the eligibility age to 55. Both had been talked about but were abandoned. They would have given more leverage over private insurers, which is what was sorely needed.

      When it comes to polls, it often depends on how the question is asked. Many past polls have shown high support for single payer, and the less far-reaching public option had strong support among the public throughout the health care debate.

      Few people are emotionally attached to a health insurance plan. They just don't want to pay more or get less coverage. And a single payer system doesn't even necessarily eradicate private insurance; you still would have the equivalent of supplements (e.g. Medigap) as Sanders-McDermott bill explains.

    •  However does the rest of the civilized world (2+ / 0-)
      Recommended by:
      quill, Dave925

      survive with it?

      Sometimes a little disruption is necessary.

      You may think that. I couldn't possibly comment.-- Francis Urqhart

      by Johnny Q on Thu Nov 14, 2013 at 07:37:35 PM PST

      [ Parent ]

    •  agreed let's not "bs ourselves here" where are (0+ / 0-)

      your stats about  for this?
      " American public would be overwhelmingly opposed to being told that their insurance which the vast majority of them are satisfied  ("which a vast majority are satisfied ") with would be replaced by an untested, unknown, government-run health insurance program" (yep so unlike the present deal).
      Is this a joke poll?
       To make a long story short let me say let those people you are so concerned about sooner or later experience the RESULTS of 'single payer, forget the short term excuse for the for profit industries.

      without the ants the rainforest dies

      by aliasalias on Thu Nov 14, 2013 at 10:52:07 PM PST

      [ Parent ]

  •  Americans Should have been given a public option (5+ / 0-)

    Americans should be given a choice between continuing a private Premium based health insurance program or a Public Option. Choice is goof for Americans!

    How a 'Real' Public Option Could Reduce Deficits, Create Jobs, & Save the US Economy!

  •  It is a good thing he traded the public option... (7+ / 0-)

    In exchange for the good faith cooperation of the insurance companies. I'd hate to see what everything would look like if the insurance companies weren't on board with all this ;-)

    •  The insurance companies "cooperation" (5+ / 0-)

      I know you're being sarcastic, but in my state half the insurance companies aren't participating in the exchanges.

      Those that are participating, are offering plans $60+ per month more for inferior coverage compared to what's available in the private market.

      Humana, e.g., refuses to offer coverage as good as I have at the bronze level and offers a worse plan at twice the cost I currently pay.

      They're certainly cooperating... as in, maximizing profits and hoping to cash in on federal subsidies for overpriced plans.

      •  That was always my objection.. The ACA (5+ / 0-)

        Would subsidize rising premiums from the insurance companies without a public option providing competition.

        President Obama has always assumed good faith out of his opponents, and he's been consistently made to look the fool for it...

        •  Exactly! The subsidies are messing w/the market (5+ / 0-)

          The insurance companies are artificially raising prices because they can - the difference being made up for by the subsidies.

          The only way to keep them from doing that is either to extensively regulate their pricing (which I guess isn't happening) OR to keep them honest with more competition (which certainly isn't happening, at least in my area - there's much LESS competition).

          The public option might have kept them honest. Just look at how well Medicaid enrollment is doing compared to the exchanges.

          As of now, the only reason to use the exchange is to cash in on the subsidy, and in turn, the private insurers (lacking competition) are free to capture most of that subsidy in the form of higher prices.

        •  I don't think he looks the fool to anyone but (3+ / 0-)
          Recommended by:
          Chi, SixSixSix, Dave925

          some of the electorate, ducks quack neoliberals will be neoliberals.

          I don't think it's necessary to point out that this was a Repub plan that got designed by Liz Fowler of Wellpoint (praised for it on the floor of the Senate by Sen. Baucus), but details aside it is something of, by and for corporations -aka profits.

          So whatever glitches people see now getting ironed out are just speed bumps along the way smoothing out the fleecing of customers.

          without the ants the rainforest dies

          by aliasalias on Thu Nov 14, 2013 at 11:07:45 PM PST

          [ Parent ]

        •  Good Faith (2+ / 0-)
          Recommended by:
          Chi, SixSixSix

          He also assumed the good faith of Republican governors. I think he actually thought that most Republican governors would create their own exchanges rather than putting the responsibility on the federal government.

          Regarding the original design of the Medicaid expansion, I wouldn't have been surprised if there were Republican governors who would have been willing to lose all Medicaid funding for the sake of rejecting the additional funds--for the sake of spite toward the president and hatred toward the poor. However, the Supreme Court ruling made this worse.

          Obama and the Democrats assumed the good faith of Congressional Republicans during the process of designing the bill, too. That was a waste.

          •  I can understand some of that good faith... (0+ / 0-)

            Particularly, in the beginning of his first term, before the GOP lost their minds. Traditionally, the GOP gripes about big government, but when it's their turn they line up with their hands out. I am not sure anyone expected the GOP to thoroughly screw over their own constituents or for those constituents to demand their leaders not cooperate.

            No excuse now.

  •  The only issue about single payer (0+ / 0-)

    Besides the insurance companies that'd fight tooth and nail, the major political issue with single payer is, wouldn't it require a large increase in taxes?

    Under our current system, most health insurance costs are paid by private employers and worker contributions. The government only pays for select groups (Medicare and Medicaid).

    Under single payer, the government is paying all the costs of health care. The government has to get that money through some form of taxation.

    So to pass single payer, the federal government would have to massively increase taxes. Now, it's true those costs are already in the system, but they're hidden in terms of lost wages and employee contributions, as opposed to taking the form of direct taxation.

    So the biggest political problem with single payer is people would have to accept big tax increases, and understand that these tax increases are being offset by increased wages and other cost savings.

    It'd be very easy to demonize single payer as "the biggest tax increase ever", e.g.

    •  no single payer does NOT mean "big tax increases" (2+ / 0-)
      Recommended by:
      churchylafemme, Dave925

      and no matter how much the for profit vampires would portray it it there is no match for the reality of people having single payer.

      Also to keep this short let me say your comment is boilerplate nonsense regarding single payer, almost all about the fear of 'raising taxes, ("taxes" mentioned SIX times in your short comment) "maximum" too, all while showing no experience with health 'care' where there are no gatekeepers between a patient and doctor.

      Fwiw I have lots of family in Canada and I'm so happy they don't face the 'pay for health' approach to life in this country. My daughter doesn't worry about making a choice between feeding the family , paying the mortgage or getting the needed physical therapy for  my grandson.
      They are not one medical bill away from absolute poverty and when I watched her argue with her tea party idiot cousins in New Orleans during this insurance company profit protection bill, aka ACA, she told them she was happy to pay a little more in taxes if it meant all the people around them were healthy and secure in their lives from medical bills destroying their lives, and then possibly other lives.

      without the ants the rainforest dies

      by aliasalias on Thu Nov 14, 2013 at 11:46:24 PM PST

      [ Parent ]

      •  I think you missed my point, I agree with you (0+ / 0-)

        I agree single payer is both more efficient (lower overall cost) and fairer (overall better health outcomes for more people).

        I merely pointed out that any single payer plan (either government insurance or government-run health care) shifts expenses from employers and individuals to the government.

        That necessitates government spending to replace that employer/employee/individual spending, which means taxes to finance that.

        Countries with single payer have higher taxes BUT those taxes take the place of reduced salaries that our system causes.

        I don't disagree that Canada has a better model than us, but I am just pointing out single payer necessitates higher taxes. That's simply the truth, and easy to demonize, and single payer advocates are forced to explain the complex economics of health care to voters that often seem unable to grasp that.

        •  This is why its impossible to have a rational (1+ / 0-)
          Recommended by:
          Liberal Jon

          discussion of the merits of single payer in the United States. It's biggest cheerleaders think that Congress could just snap its fingers and we'd all get medicare cards and nobody would ever have to pay to go to the doctor again. They do not look at how to pay for that coverage for 300+ million Americans. When the baby boomers are fully enrolled, we're looking at a $1 trillion/year price tag on Medicare, and thats for only about 84 million enrollees. More than triple that, and we're going to need more than a 2% tax increase to cover everyone.

          •  We are already paying far more (2+ / 0-)
            Recommended by:
            Liberal Jon, Chi

            than a 2% tax increase to the middle men corporations in the insurance industry.

            •  Exactly, but not directly to the government (0+ / 0-)

              2% to the middlemen is bad! but 2% to the government presents every opportunity to demonize. Or even it's less.

              That was the only point.

              Single-payer = paying less to private insurers

              But in any form some of that money is transferred to the government in the form of taxes. Which is easy to demonize.

              Not that we shouldn't do it, but that education is very, very necessary to push something like that.

              •  Oh I agree. We have made it almost (1+ / 0-)
                Recommended by:

                impossible for us to eliminate this middle man industry. It is very entrenched, employs tons of people and, as you can see even with a Dem President, wields tremendous political power.

                Single payer may have to come into our world in little packets of light until the whole thing can shine.

    •  Sanders-McDermott (1+ / 0-)
      Recommended by:

      Here's what the Sanders-McDermott plans says:

      It will be progressively financed through a modest employer payroll tax, a 2% tax on all incomes, a surcharge on high-income taxpayers and a financial transactions tax. Private insurance companies would be prohibited from selling coverage for any service provided by the Act. Union Funds and private insurance could continue to provide supplemental coverage.
      Employers already pay these benefits for a decent percentage of the population. Rather than paying the money to the insurers, they will pay that money in the form of a tax. And the centralization of records and, presumably, a lift on the prohibition on negotiating for drug prices would help keep down costs through efficiency.
  •  Progressives get very little media attention (3+ / 0-)

    It's all about Obama and the establishment Democrats versus the GOP these days to hear most media outlets in this country tell it.

    I'm strongly pro-public option, but, if done correctly, single-payer health care can work very well.

    My parents made me a Democrat. Scott Walker made me a progressive.

    by DownstateDemocrat on Fri Nov 15, 2013 at 01:10:37 AM PST

  •  I couldn't agree more. (1+ / 0-)
    Recommended by:

    I think we have a responsibility -- as you say -- to continue to press and advocate for single payer. I agree it won't be enough till we get the insurance companies out of healthcare. But we should see the ACA's expansion of Medicaid as an important step toward single payer, in part because it enlarges the public sector, and helps create a demand for a public, democratic healthcare system.


    by StewartAcuff on Fri Nov 15, 2013 at 04:35:33 AM PST

  •  I know we all hate Insurance Co's but... (1+ / 0-)
    Recommended by:

    Remember that some 800,000 people are employed in the insurance business.

    I believe the "disruptive" the President worries about is what happens if we go single-payer to all those employees who will cease to have a point.

    It is unfortunately part of the requirement of the design of a single-payer system (which I believe we WILL have no choice but to move to eventually) must include the mechanisms to deal with the ultimate layoff of hundreds of thousands and the collapse of an industry.

    Now, make no mistake, INSURANCE, especially health care insurance, should have NEVER EVER been a for profit business.

    The concept of Insurance is one of the most purely SOCIALIST possible.

    Everyone at risk for X should be in an insurance pool so that those who actually fall victim of X are not financially devastated by the costs of dealing with X.

    In the case of health care, every single human being is at risk from illness or accident, and could face financially fatal expense at any moment. The lottery of life as it were. For car insurance, it is only the pool of drivers, for flood insurance it is only the pool of property owners in flood risk areas. Etc, etc.

    We, as a society, let our health insurance become a massive private for profit industry, a massive mechanism for the transfer of wealth from everyone to the filthy rich, and it will be DISRUPTIVE to dismantle this system. When you talk about transitioning to single payer government operated health insurance, keep in mind just how deep into the economy the roots of this weed have gone, and how much of an impact changing the system will have on the overall economy and employment in the nation.

  •  My health care costs are doubling (0+ / 0-)

    We are on Medicare and my children do not qualify for any kind of Medicaid.  The supplemental Medigap penalizes you for being under 65, and the exchanges have such ridiculous costs, copays, and deductibles in Wisconsin I pray something changes before we go bankrupt

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