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I don't know about you but I am fighting Republican fail by posting good news  about ACA on my FB page.  The d*cks will never quit, nor should we.

However, at the same time I continue to post about developments leading on the road to healthcare for all.

President Obama Bringing Single Payer

One DK post  recently gave the President credit for making the way clear for single payer in the US, and indeed his leadership will be critical.  This President has already made some tweaks and allowed some delays along as part of the 5 year rollout of ACA so he has shown flexibility and willingness to change as circumstances permit.  

Hunter's front page post  up tonight  

Thirty percent of Americans now skip some medical care

by HunterFollow for Daily Kos

   closes with this incisive comment:
   If health care reform can get the overall numbers down, it would be a godsend to both individual Americans and the wider economy. If not, we have to try again. As for the high-uninsured states that have opted out of doing anything to help their citizens because it would make certain politicians sad, I can only hope those politicians are a lot sadder after their constituents figure out just how damaging the opt-outs are going to be.

PNHP, 18,000 docs for single payer,  says essentially the same:
   Why we shouldn’t be celebrating the slowdown in health care spending    Posted by Don McCanne MD on Thursday, Nov 21, 2013
Dem. Rep. McDermott D-Seattle recently talked about the destruction of the health care system as we have known it and the growth of a 'new business model' in its place, with doctors becoming serfs in large groups, hospital closings and more.

Jim McDermott, who like Howard Dean is  a physician,  has been a tireless promoter of single payer in the House and plans to introduce a tweek to the ACA soon that will put us more firmly on the road to single payer.

In a highly reccd diary recently nyceve sounded the clarion call about costs:  

   Thu Nov 14, 2013 at 01:40 PM MST

   Shrill AHIP warnings that 2015 rates will skyrocket means single payer must be on the table
    by nyceve

Merry Christmas from Senator Sanders !

From the first it has been said the ACA was a start, a milepost on the road to single payer. Although the roll out has been long, many are already benefiting but others have been left out and Big Insurance has already signaled that they intend to keep their profits in the billions the nation be damned because capitalism.

Healthcare for All in  tie for Christmas !

On Monday Bernie Sanders, a friend of President Obama's, took the next exciting step to put us closer to healthcare for all.


Sanders and McDermott introduce bill to introduce single payer system, repeal individual mandate
HT to Clever Handle

Healthcare for all  in time for Christmas?

Sanders joked that he expected to have his bill passed by chambers of Congress and ready for President Obama’s signature by the time he returns from Nelson Mandela’s funeral in South Africa, but few proponents see much hope of gaining traction for single-payer health care in a Congress that has struggled to pass a routine budget.

Look forward to leadership from the President.

The President has shown willingness to adjust ACA  and move to the next phase.  People are hurting, and Big Insurance is gaming the system.  Time for  the milepost on the road to healthcare for all !

7:05 PM PT: Bernie Sanders celebrates protecting SS and Medicare in tonights budget deal, encourages more

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Comment Preferences

  •  Hmmm. (2+ / 0-)
    Recommended by:
    divineorder, Gooserock

    As much as I'd love him to do it, it seems pretty impossible for Obama to restructure the very foundation of the ACA for the sake of single-payer, even if he wanted to, which he doesn't.

    Because if he did, we would have heard alot more about the public option before it was washed away in backroom deals.

    Banking on the American people to be able to sort all this out and declare the adult in the room the winner is a very big bet. -Digby

    by Boogalord on Tue Dec 10, 2013 at 06:21:12 PM PST

    •  Boogalord, what about you? What do (1+ / 0-)
      Recommended by:

      you think should be the next step toward healthcare for all. You haven't given up have you ?

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Tue Dec 10, 2013 at 06:26:48 PM PST

      [ Parent ]

      •  Medicare for all. (0+ / 0-)

        It's still Medicare for all.

        But I don't see Obama personally doing much of anything to pull this. The gist of this diary is "Bernie Sanders is adding a single-payer amendment that Obama could theoretically endorse!" and no, that doesn't count.

        Banking on the American people to be able to sort all this out and declare the adult in the room the winner is a very big bet. -Digby

        by Boogalord on Thu Dec 12, 2013 at 11:28:02 AM PST

        [ Parent ]

    •  And It Really Wouldn't Matter if He Did. (0+ / 0-)

      Conservatives (meaning not only Republicans) are still enough of a majority in government that it has no chance of passing during his 2nd term, even if we had a banner year by November and took back the House.

      Commercial insurance is investment and Wall Street. We'll be damned lucky if we can keep Social Security out of their hands. Taking the health insurance market away from them? That's an idea that's been radical even through the peak liberal years between the New Deal and Great Society.

      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 Tue Dec 10, 2013 at 06:32:23 PM PST

      [ Parent ]

  •  Here's the issue. (5+ / 0-)
    Recommended by:
    divineorder, Wildthumb, valion, VClib, nextstep

    The ACA has to be seen as a success, or Democrats will not be given a second chance for a long, long time.  

    The ACA is entirely a Democratic bill.  It may have been based on conservative ideas, but since it got zero Republican support, Republicans have no stake whatseover in the ACA, which is why they are happy for it to fail.  

    If the ACA is, after everything kicks in (including the employer mandate) viewed as a big success for those who already had health insurance that they liked in 2009 (and at the time,85 people with health insurance liked it) , then yes, Democrats will have credibility with those people.  If the ACA is perceived as helping people who didn't have health insurance with no down side to that 85% of people who liked the insurance they had in 2009, THEN Democrats will have the credibility to say, "we helped some people without a down side for you.  We gave more people access to health care without hurting the people who already had access to health care.  Now trust us to do it again, and to provide even more expansion of access to health care, once again without making things worse for you.  

    However, if that group perceives the ACA as having expanded access for some but making things WORSE for them, then Democrats do not have the credibility.  That group was essentially promised by Democrats that the ACA would expand coverage at no down side for those who already had health insurance they liked.  That was the whole "if you like your plan . . . If you like your doctor . . . " thing.  If people who had health insurance in 2009 think Democrats made things worse for them with the ACA, there's no way in hell they'll trust Democrats again on health care any time soon.  Democrats can't, with any credibility, go to them and say, "We screwed some things up last time.  Give us another chance, and we'll get it right this time."  I don't think it's going to happen.  

    In other words, unlike some who think that problems with the ACA help lead to a single payer system, I see no way Democrats have any credibility in trying to push a single payer system unless the country thinks they got it right with the ACA and so trusts them when they promise to make it even better.  

    •  If we get a large (3+ / 0-)
      Recommended by:
      Jakkalbessie, divineorder, CwV

      Democratic Congress and a Dem in the White House in '16, then I think we get at least a public option or Medicare Buy in. I suspect the latter. We can sell it without ref. to the ACA simply as strengthening Medicare, both in terms of fiscal stability and expanded benefits--both true. But it also becomes a real rival to private insurance, which will do much to lower costs for everyone.

      "I was not born for myself alone, but for my neighbor as well as myself."--Richard Overton, leader of the Levellers, a17th C. movement for democracy and equality during the English Civil War. for healthcare coverage in Kentucky

      by SouthernLeveller on Tue Dec 10, 2013 at 06:33:36 PM PST

      [ Parent ]

    •  coffeetalk, absolutely right. (1+ / 0-)
      Recommended by:

      thanks for the conventional wisdom summary, very reasonably presented.

      Those in the know say ACA is now seen by the average person as a 'government' program, though  you and I know that Repubs were given quite a voice by the President in its making while bailing on the final votes.

      The President has shown flexibility already and is likely to show more as the complexity of the act and the costs driven by big insurance drive much higher costs under the ACA .  Count on it.

      The momentum is building....

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Tue Dec 10, 2013 at 06:34:37 PM PST

      [ Parent ]

    •  Right on. That's why I've fought all this pushback (0+ / 0-)

      from many "on our side," saying ACA is a failure and a disaster, etc. etc. Support the damned thing, and add to it or augment it, etc. later. It's that proverbial foot in the door.

      "The soil under the grass is dreaming of a young forest, and under the pavement the soil is dreaming of grass."--Wendell Berry

      by Wildthumb on Tue Dec 10, 2013 at 07:55:35 PM PST

      [ Parent ]

      •  "Late" lol.... Wildthumb its been 5 years! (0+ / 0-)

        Now's the time....

        Democratic Congressman McDermott nails it...

        Thanks to the Affordable Care Act, a new business model is rapidly emerging in the medical-industrial complex that, in theory, can dramatically reduce the inflated costs of healthcare while serving everyone—rich and poor, healthy and sick. But the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies. A lot of liberal Democrats, though they voted for Obama’s bill, remain skeptical.

        “In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system,” said Washington Representative Jim McDermott. “We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.” I turned to the Seattle congressman for a candid assessment because he’s the third-ranking Democrat on the House Ways and Means Committee and has been an advocate of single-payer healthcare for decades. Plus, he’s a doctor.

        The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding “integrated delivery systems”—nonprofit and profit-seeking—that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they’re hiring younger doctors as salaried employees. An  American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.

        “The medical-industrial complex is putting itself together so that the docs will be the least of our problem,” McDermott said. “They will simply be serfs working for the system.”  The AMA’s market research reports that “hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.

        Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

        by divineorder on Tue Dec 10, 2013 at 08:10:16 PM PST

        [ Parent ]

  •  Except that the ACA *ALREADY* paves the way (7+ / 0-)

    ...for individual states to go single-payer, and Vermont is well on it's way to getting there.

    California will likely be very close behind them.

    My guess is that assuming the GOP doesn't completely destroy the country before then, within about 10-15 years there should be easily a half-dozen states that are single payer...probably Washington, Oregon, Hawaii and perhaps Massachusetts in addition to Vermont and California.

    Nation-wide single payer will take another generation, though, I'm afraid.

  •  Single Payer will come eventually. (3+ / 0-)
    Recommended by:
    Wildthumb, divineorder, ybruti

    but not on Obama's watch. 1) He's invested in ACA as it stands (got his name on it, literally) and 2) even with a Democratic House and Senate after 2014, it's not going to be easy to make that transition. A sudden shift would displace over one million insurance company workers and eliminate hundreds of VERY rich companies. They will not go quietly and they have the money and clout to slow the process (as we've already seen).
    It will happen in steps. Some States will go Single Payer on their own (the Laboratory effect) and other States, the ones that refused to expand Medicaid, will face a crisis of uninsured people, the "Medicaid Gap". The public outcry from their population will be too loud for even the crassest of Republicans to ignore, specially if it starts turning Red States Blue (Texas in particular).
    As a fix for that gap, the Feds will mandate an expansion of Medicaid that withstands a court challenge and the States will by that time, need the fix.
    Expanding Medicaid as a public option/floor to the exchanges starts the process of building a national Single Payer Universal system.
    Obama will be out of office by the time any of this matures. I hope to live long enough to see this happen.

    If I ran this circus, things would be DIFFERENT!

    by CwV on Tue Dec 10, 2013 at 07:30:57 PM PST

    •  Another great summary of conventional wisdom! (0+ / 0-)
      . 1) He's invested in ACA as it stands (got his name on it, literally) and 2) even with a Democratic House and Senate after 2014, it's not going to be easy to make that transition. A sudden shift would displace over one million insurance company workers and eliminate hundreds of VERY rich companies. They will not go quietly and they have the money and clout to slow the process (as we've already seen).
      He has already made changes in the roll out so would not rule out more !

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Tue Dec 10, 2013 at 08:04:58 PM PST

      [ Parent ]

      •  Not sure how conventional this wisdom is (0+ / 0-)

        I don't hear people on either side of this issue that see it this way.
        The changes made have been tinkering at the edges, the natural adjustments that have to be made to make a new project work. Transitioning the entire thrust of the program from Private Sector partnership to Public Sector program is far more radical.
        I'd love to be wrong, I'd love to wake up next Jan1 to a British style National Health, but I doubt it.

        If I ran this circus, things would be DIFFERENT!

        by CwV on Wed Dec 11, 2013 at 07:47:36 AM PST

        [ Parent ]

  •  2015 Health Insurance rates will rocket (0+ / 0-)

    Those notices should go out just in time for the Nov 2014 midterms.  

    "let's talk about that"

    by VClib on Tue Dec 10, 2013 at 09:55:54 PM PST

  •  Let me just note that, since all dollars come (0+ / 0-)

    from the federal Treasury, there is a single payer for all goods and services in the country. The real issue is how many middlemen there are between a dollar distribution and the provider of a good or service. Medicare is direct. Medicaid, because of the interposition of the states' bureaucracies is less so. Private insurance providers are definitely a middleman whose "service" is questionable. Medicare Advantage programs proved detrimental because when real medical care was needed, the patients were dropped and sent somewhere else.
    Higher education loans have the potential of being, like unemployment compensation, direct distributions, except for the fact that the interest being charged aims to redirect a portion into another program (Medicaid). So, it's not a "clean" process.
    Federal Reserve distributions to the banks are virtually direct since the interest charges now merely cover book keeping and accounting systems. Which should lead to the question why banks are entitled to free money, regardless of whether they manage it well or poorly. And a further question -- why the dollars distributed to banks aren't programmed to be returned (as revenue) on a timely basis by being adquately taxed. Subcontracting the management of the currency to the banks has not proved particularly successful when we consider how many recessions and depressions they have had to be rescued from.

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Wed Dec 11, 2013 at 04:54:51 AM PST

  •  Single payer will have to be won on the ground (0+ / 0-)

    If progressives are smart they should be laying the ground work for a referendum to turn California's exchange into single payer system (ACA permits this starting in 2017).

    The country won't go for single payer without demonstrated success in a few (large) states.  If it is demonstrated to work in California for example, it will go a long way to convincing the entire country to go for it.

    "The Republican Party is at a crossroads. It must decide whether it wants to be the party of Lincoln or the party of apartheid." -Ted Kennedy The teabaggers have chosen to be the party of racism and apartheid.

    by TeaBaggersAreRacists on Wed Dec 11, 2013 at 05:21:47 AM PST

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