What I have heard to date is as watered down as the stimulus was. And it's impact will be as tepid as the stimulus currently is too.
This is not worth it. It won't be a political victory of any kind. It won't be simply because the opposing forces won't hold back on framing that just devalues whatever happens.
Literally, they will prevent it from occurring, then turn right around and say, "see? Not good enough!", or "See? It's not working, now listen to us...".
Single Payer is the goal. We know it works, we want it, we need it, and it's the right thing to do.
The most direct path is to change medicare so that it is available to anyone on a national buy-in option. Don't mandate this, just make it happen.
People without insurance can either buy in, or get a subsidy to help them buy in, and people with insurance can stick with what they've got, or buy in to the medicare, or don't buy health insurance at all, if that's what they want to do.
Nobody is going to just ignore health care when the penalties for getting sick without it are fierce. Loads of debt, potential for the wrong or substandard care, denial of access, collections calls, you name it. Get sick without insurance of some kind, and it's ugly. Always is.
Let ANYBODY buy into this thing. Doesn't matter who they are, what they do, or how they do it. They can buy in, and if they qualify for some assistance doing it, then just let them do it.
This is what is needed for robust competition with the insurance companies. This is what they fear most, because it's gonna work.
There are some who have said that medicare is a boondoggle, paying out too much money, or that the private insurers are involved with it. Who cares? Those things can be fixed easily enough, and once we give people the opportunity to buy in, they will buy in and the larger numbers then put reform on the table.
Why?
Because once we take some ownership of medicare, that it's just not the old people policy, then how it runs is an issue just like any other thing we take ownership of. We can take the idea of a commission to evaluate treatments, set rates and regulate what we cover and how we cover it, and allow for doctor exceptions. This will move us very quickly toward getting the most cost effective, high impact treatments to the largest number of people.
It will also put the burden on those that supply enabling technology to the health care industry to focus on actually adding value, not making incremental changes for profit. That will save us a ton.
So the insurers are gonna cry, "FOUL!!". The Republicans are gonna cry, "SOCIALISM!". So what? Fuck them.
Republicans have put all their cards on the table. They are backing the one percenters who don't want to pay to help everybody be healthy and productive, yet who insist on collecting most of the dollars produced every day. It's not sustainable to let them have their cake and eat it too, and they don't have the numbers to actually stop it, if we strengthen our resolve.
That is what this delay can be for. It's time to reset expectations. Frame this as a first round of discussion, determine that the direction was not one that makes any sense, and tee the debate up for medicare for all, and push it as the American alternative to single payer systems like other nations have.
Frame it right, and the nay-sayers will be forced to admit they are lucky to even get tossed a bone in terms of a medicare for all national buy in option, and not full on single payer.
We can do this! Of all the things Republicans and Corporations are good at doing, it's framing. They manage to control the scope of the debate very well, and it's time to just punch back during this nearly impossible to avoid delay.
There are groups out there doing a good job getting people active. I've been on the phones, and when I ask about the noise level, they report it being high. We need to hammer on this, run ugly ads, get on the talk shows, leverage those friendly to our cause (Ed Schultz is one big advocate and there are others), and just pound this home as the American solution.
Medicare national buy in option. That's what we need to do, that's the path toward a single payer system that will pack a punch and make a difference.
Watering this down to some exchange, or limiting reform to state by state pools, is simple divide and conquer, feel good legislation that wanna be Senators, like Wyden prefer, because they benefit and can move on and do their jobs, not actually earn their keep and make a difference.
What about private insurers?
Well, let them do all the corporate things they like to do. If the medicare public buy in program can bargain for good prices, they can too. If the medicare public buy in program offers good coverage for dental, mental health and such, they can counter with value added coverage.
Want a house call?
Into alternative medicine?
Maybe you are into lifestyle health alternatives?
Of all the most effective arguments against a medicare public buy in program, the idea of massive job loss in a bad economy is one very easily addressed.
Again, framing.
If we are really interested in getting the best health care to the people, then we need to compete. What better way to do that than have our private insurers adding value to what is our national baseline coverage? What the government provides is good, but you Mr Consumer, can get better and let us show you how!
Give them something to sell, and they will gladly go and sell it, and the jobs will be kept.
I've mentioned this before, but I think it bears a repeat. Private insurers can work with other private interests to grow the business of health in general. Insurance policies can cover lots of things in addition to that doctor visit, and can even cover the minimum co-pays required for that visit to start!
Luxery insurance policies can deliver house calls, night time services, can be tied into gym memberships and healthy lifestyle activity programs. A card carrying member of a private insurance plan can get discounts on organic food, or know that part of their premium goes to drug treatment, or to help build sustainable food production that is healthy.
The list goes on and on, but it won't happen if we continue to let the framing be such that our political expectations are we should be lucky to even get anything.
We can fix that. We need to fix that, and position the private insurers as the value added, American businesses they are supposed to be, and that you just wait and see what they've got to offer above and beyond mere health care.
Here's the deal people. I don't think the expectation that we can just apply some regulation to insurers does us any material good. That's progress, and if it must be, it must be, but failure to set expectations high, or at the least that this is the start of a multi-phase process to really reform health care, is a bloody mistake.
I wrote the kind of thing I want. That's not the only choice on the table. What isn't on the table, that should be, is the expectation that we get material change, not just some regulation.