The lesson to take away from that is not "WE CAN GET AWAY WITH ANYTHING IF WE PASS IT".
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Vox: Bernie Sanders outlines his single payer bill
- Thread starter The Technomancer
- Start date
ErasureAcer
Banned
balladofwindfishes
Member
Medicare for all doesn't mean outlawing private insurance...
Your own link shows only a third want single payer. Which isn't really enough support to make an entire industry that employs millions, illegal.
Aaronrules380
Member
This isn't the same as outlawing any form of private insurance
Shake Appeal
Member
I would guess the latter. I think what the language is trying to do is saying you can't "price match" or undercut the benefits provided by the federal government (not that any private insurer would be able to match that buying/negotiating power): any supplemental private insurance has to be for superior services/coverage, etc.
This would be the same kind of hybrid model as most of Europe.
The Technomancer
card-carrying scientician
It seems to work pretty well, but did 30+% of the Canadians have healthcare plans through their employers that they were then told would be replaced by government plans?
If Medicare for all works out it will be more attractive to people to swap anyway, there's no reason to literally hand the GOP their absolute favorite ammo right out of the gate like this
I don't really see anyone decrying the end result, but rather how the implementation is being proposed to migrate the current system to this. Let's not even get into the handwaving away of how to pay for any of it and how to keep employers from just pocketing the money they save not having to provide plans rather than passing it on to workers.
But hey, I guess nowadays if you have any criticism of anything Sanders does and don't embrace it whole cloth then you're a dirty Republican beholden to rich elitists.
https://en.wikipedia.org/wiki/Health_care_in_France
France still has universal coverage while maintaining employer-based plans.
I'd prefer to get rid of them in the long run, but I'm not sure if we can actually pull that off any time in the near future.
All-Payer rate setting is really important.
I mean, it's called a single-payer plan for a reason...
The Technomancer
card-carrying scientician
Oh yeah sorry I should be clear, I also want employer based healthcare to go, its just literally the single most touchy aspect of this entire thing for a huge chunk of the country
Phrozenflame500
Member
I do actually, Canada's system still ranks worse then most European mixed public/private systems. It's better then the US for sure, but considering the US is already moving from a primarily private system I'm not sure a blanket nationalization of the health insurance industry is a good idea.
Hey, you know how the 20+ million people on Obamacare exchange became a third rail?
Here's another third rail SEVEN TIMES THE SIZE.
Doc Holliday
SPOILER: Columbus finds America
He was President at this point with an overwhelming majority in congress. tactically, he should have gone for single payer. You don't start with the compromise when dealing.
Well, yeah.
Many times, state and employer plans are considerably better than Medicare. I can assure you, in NY, the quality of healthcare you get from the state is far greater than federal. And that includes those who work for the IRS/Post Office, etc.
I would be pissed if I had to turn in my insurance for something that would likely be inferior.
Not seeing the difference between Chait and Breitbart is itself kind of a big problem. If your goal is to create the leftist Tea Party, intolerant of all critique, hostile to heterodoxy within the coalition, unable to think coherently about policy arguments, and trapped in a closed information system by their own ideological fragility, this line of discussion would make you quite pleased at your progress.
I think Chait is wrong about all the things you guys think he's wrong about. But he is neither incoherent nor a mouthpiece. Do you intend to respond to everybody who says Bernie has not thought through the difficulty of transitioning employer-based health insurance by accusing them of supporting the Iraq War? Because I'm not sure the strategy scales.
brianmcdoogle
Member
I didnt know Chait was so reviled around here. Its like I posted a David Brooks column over at Free Republic or something. Ill take note and wont do it again. Sorry.
That was not the tactical mistake. The reason we do not have the Public Option is because he and Reid did not nuke the fillibuster, mandating a 60-vote requirement instead of a 51-vote requirement, letting Lieberman/Baucus/Nelson/etc. be the ones gatekeeping what was in and what was out of the bill rather than a less conservative member of the caucus.
The negotiations on a bill like this are intra-party, not extra-party. There is no reason to "start from the extreme" when the position is a non-starter due to a lack of sizable support within your coalition.
LegendofJoe
Member
That's why any funding plan HAS to place most of the burden on businesses. A shared payroll tax that companies pay the majority of. So, exactly how Social Security and Medicare are funded today except the employer would pay a higher portion.
This is just not how legislation works. Obama had all the votes in his caucus. The problem wasn't some kind of horse trading. The problem was that the 60th Democratic senator didn't want to vote for a public option. Starting with single-payer doesn't change where you end up if that's your limiter.
I mean, I think you should do it. People need to be exposed to arguments they disagree with from people who are in their party!
My only point was that it's perfectly acceptable to dismiss certain writers based on their past. Breitbart was the first thought that came to my head, and I didn't imply that they were similar.
No?
Zoe
Member
And that's how it worked in his original plan. Except people misconstrued it and characterized the additional payroll tax as a tax coming directly out of the employee's check.
Beyond funding in general, I'd be very interested in hearing how any single-payer system intends to handle reimbursement negotiations with hospitals. If you retain for-profit hospitals, there's going to be a conflict of interest between the hospital wanting maximum reimbursement and the government wanting to minimise it.
How does the bill intend to prevent for-profit hospitals from basically scalping the government, and causing costs to explode out of control? They can't do that in in a multi-payer system because insurers might exclude them from the coverage (or simply force the patient to pay) But if the government uses the same tact, that would instantly bankrupt the hospital, which I doubt is something anyone wants. Will there be government administrators determining what parts of a bill are justified, and which are not? By which criteria? How much are hospital staff allowed to earn? How deep is the micro-management intended to go, and is that actually what people want?
In a sense, going all-out on single-payer and nationalising all hospitals and clinics would be easier. That way, the government could manage all parts of the system and eliminate conflicts of interest. Bernie's proposed hybrid system would be much more complex, and have that many more potential pitfalls.
That's mostly semantics. Payroll taxes are still indirectly payed by the employee because the employer will simply end up taking it out of their potential pay, one way or the other. Either that, or hire fewer workers, or raise prices on produced goods. All costs filter down.
How does the bill intend to prevent for-profit hospitals from basically scalping the government, and causing costs to explode out of control? They can't do that in in a multi-payer system because insurers might exclude them from the coverage (or simply force the patient to pay) But if the government uses the same tact, that would instantly bankrupt the hospital, which I doubt is something anyone wants. Will there be government administrators determining what parts of a bill are justified, and which are not? By which criteria? How much are hospital staff allowed to earn? How deep is the micro-management intended to go, and is that actually what people want?
In a sense, going all-out on single-payer and nationalising all hospitals and clinics would be easier. That way, the government could manage all parts of the system and eliminate conflicts of interest. Bernie's proposed hybrid system would be much more complex, and have that many more potential pitfalls.
That's mostly semantics. Payroll taxes are still indirectly payed by the employee because the employer will simply end up taking it out of their potential pay, one way or the other. Either that, or hire fewer workers, or raise prices on produced goods. All costs filter down.
Frankly, this country will never have affordable care until you remove the needless, toxic middlemen insurance companies that drive up the prices.
They are holding us back and one of the big differences we have with other countries.
That's where most all of our costs are going. These businesses are no longer serving a purpose that's needed and are just a drain on our society.
Whompa02
Member
Susan Collins, Lisa Murkowski and jk nobody will vote for this.
He doesn't even have Pelosi on board yet.
So then what would be the response to that? Because that's the criticism Chait is making.
Aaronrules380
Member
Pelosi's situation is different. She's not on board because a good amount of other democrats aren't on board, regardless of her personal stance on single payer healthcare
This is an argument for implementing all-payer rate setting in a multi-payer system. All-Payer rate setting means that Hospitals negotiate for a singular rate w/ all providers. Nothing is done individually, it's a collective negotiation.
Here in the states, Maryland has already implemented it, and its in many Euro countries as well.
Or--stick with me here--the question remains what benefit it serves in an ornamental bill that you've isolated from "how to pay for it" to make it less controversial. The assumption that the only reason to find Bernie's latest bill to nowhere a little inconsistent is youth or ignorance is unsurprising, but: There is a shitload of political baggage associated with destroying the private healthcare industry, and it will have real economic impact if it comes to pass. If supporters are being shielded from the economic impact of how the hell to pay for this, why not also shield them from the blowback from blowing up the private sector?
That's my point. The bill is only interesting as an act of political theater, because nobody believes it will pass. In practice the bill would have to be paid for, but they hand-Wave that because the ideological point takes precedence and it makes it easier to support. Not handwaving the removal of employer insurance leaves a massive scare-tactic in about the economic angle, which seems unnecessary for a bill that has about as much chance of becoming law as the Obama-era ACA appeals the GOP passed. This proposal is not ideologically pure, it's not practical to apply, and it's not a pathway of least blowback. It's an odd combination.
Shake Appeal
Member
A singlepayer system is entirely compatible with the existence of private insurance companies. Something like one-tenth of people in the UK pay for private health insurance despite the existence of the NHS, for example.
Rentahamster
Rodent Whores
Don't apologize. Post whatever you want. Don't be shamed into silence. This is a discussion board.
As I see it, Chait has two main points:
1. Single-payer will never happen because Americans don't like taxes or change
2. This bill doesn't help anything anyway
My response would be:
1. Single-payer will happen because Americans like health care
2. No one thinks this bill will pass, but it may bring visibility to the issue and a commitment by the Democratic Party to health care as a human right, both of which are immensely valuable
The second this is actually viable with a Democrat president and Democrat controlled House/Senate, Pelosi will jump on board and whip up the votes.
Until then it's counterproductive for her to endorse it.
The Technomancer
card-carrying scientician
Exactly
LegendofLex
Member
This generally wasn't the case, from my experience. Lots of people concluded that the added payroll tax costs would be passed on to workers, but this can take the form of reduced benefits and lower wages (and lower employment in general) in addition to tax withheld. And of course those costs are offset by reductions in direct healthcare spending.
LegendofJoe
Member
It was a problem of presentation. The cost should be presented in percentages: the company you work for pays 80% of the payroll tax and you pay the remaining 20% for example.
Figuring out the rate of the tax to cover what is needed is the tricky part. Because we badly need price controls, that largely don't exist right now, to truly get this to work. These controls need to be in place from day one to mitigate sticker shock. As soon as big businesses see that they would pay a lower rate than they do now legislators will have gained the allies they need to make this possible.
Zoe
Member
The organization that did the analysis had to release a statement and revise their findings because of how they reported it and how people interpreted it.
(xposting from the other, closed thread)
Some stuff from Vox:
General overview of the possible issues w/ Single Payer and the altenatives - https://www.vox.com/the-big-idea/2017/9/8/16271888/health-care-single-payer-aca-democratic-agenda
Alternative "Medicare available to all" proposal - https://www.vox.com/policy-and-politics/2017/8/22/16171160/schatz-health-care-medicaid
Using Medicare as the public option might be workable. Medicaid runs into serious issues on that front because its payouts to providers are about half the level and it makes availability of care a problem, especially when trying to expand it.
edit: Here's a decent article arguing for it- http://washingtonmonthly.com/2017/04/27/the-case-against-single-payer/ w/ a relevant Obama quote
Looking for it, I'm running into the same issue you are w/ the search results being... quite slanted.
Some stuff from Vox:
General overview of the possible issues w/ Single Payer and the altenatives - https://www.vox.com/the-big-idea/2017/9/8/16271888/health-care-single-payer-aca-democratic-agenda
Alternative "Medicare available to all" proposal - https://www.vox.com/policy-and-politics/2017/8/22/16171160/schatz-health-care-medicaid
Using Medicare as the public option might be workable. Medicaid runs into serious issues on that front because its payouts to providers are about half the level and it makes availability of care a problem, especially when trying to expand it.
edit: Here's a decent article arguing for it- http://washingtonmonthly.com/2017/04/27/the-case-against-single-payer/ w/ a relevant Obama quote
I think it's an error to think of this bill as a gesture or ornamental. This bill is a mission statement. When the Democrats get power, the plan is to pass a bill that is, at the very least, some subset of this, possibly modified.
It should be critiqued for what it is. But it's not just a bill to throw away, or at least, it shouldn't be.
It should be critiqued for what it is. But it's not just a bill to throw away, or at least, it shouldn't be.
brianmcdoogle
Member
Its not so much being shamed into silence rather than just wondering what the point is in doing so. If no one discusses the contents of the article because of past viewpoints hes had or because he isnt sufficiently liberal enough, then all it seems to do is entrench people into not discussing the issue. Its like the study that once showed arguing online doesnt really change people's viewpoints but either makes them more concrete or extreme, and considering how the discussion last year has faired and continuing into this year, especially with our far left, European, and Wikileaks supporting posters, I guess I wonder why bother. So maybe if I find an editorial or article I find interesting, regardless of its landing on the political spectrum, I might post it and leave it at that.
I guess Ill just reiterate I found the Chait aritcle interesting in the first place since he is a moderate liberal with a critique being published on a semi-large moderate liberal website.
How is it even legal to put out a huge bill like this that will need lots of funding and then not include any ideas on how it will be paid within said bill. Just a; 'well that's someone else's problem after this is signed.'
This is not a little thing like building a park or creating a new federal holiday. It's a huge chunk of the economy. But hey, I guess that's someone else's problem. This is exactly what the pony analogy was talking about. Everyone wants a pony but nobody wants to discuss how to pay for the pony or it's upkeep. :|
But I guess Saint Bernard has personally done the calligraphy on the gold parchment so we better not question his holiness.
Till these bills can start answering these questions they are a waste of time and resources. Dems need to get it the fuck together and come out with a knock it out of the park Universal Healthcare bill. Not for now but if they ever in the unlikely event take control of the White House and Congress again, they can fast track a reasonable responsible bill through and not some vanity project of Bernie's.
This is not a little thing like building a park or creating a new federal holiday. It's a huge chunk of the economy. But hey, I guess that's someone else's problem. This is exactly what the pony analogy was talking about. Everyone wants a pony but nobody wants to discuss how to pay for the pony or it's upkeep. :|
But I guess Saint Bernard has personally done the calligraphy on the gold parchment so we better not question his holiness.
Till these bills can start answering these questions they are a waste of time and resources. Dems need to get it the fuck together and come out with a knock it out of the park Universal Healthcare bill. Not for now but if they ever in the unlikely event take control of the White House and Congress again, they can fast track a reasonable responsible bill through and not some vanity project of Bernie's.
Rentahamster
Rodent Whores
Yes. A lot of us were making fun of Republicans for shitting on Obamacare for 8 years but then getting caught with their pants down and their asses exposed because in all their protest they didn't actually craft an alternative for when they did get back into power.
Bernie's strategy avoids this sort of thing.
I'm leaning towards the Dutch system being the best universal healthcare option, and a quick Wiki read suggests they're one of the nations using this strategy. It could definitely be a good idea, but I'm not seeing anything like it (or anything else, for that matter) in the Vox outline. I'm also a bit unsure if that level of government control will go over well with most Americans.
Full disclosure; I work as a doctor in Sweden. Our system is basically the complete opposite of the US system. I follow the American healthcare debate with interest. We're a single-payer, government run system with extremely limited truly private options. What private options we have are mostly smaller clinics that are run for-profit, but with the government footing the bill according to a standardised reimbursement scheme based on things like number of patients and procedures done. Incidentally, our government run system uses the "new management" system where it's basically "buying" services from itself, so the distinction between private and public clinics are minimal. Come to think of it, it might actually function similarly to an all-payer rate setting.
Our system works well, but it definitely has flaws. Major ones, in some cases. I'd say that chief among them is how politicians aren't really held accountable for the shortcomings, which in turn breeds mismanagement and incompetence.
A primary problem is many people on the left don't see this as a work in progress. But a 'agree with what is here or else'
A long term development of a Democratic healthcare plan is good, just don't expect everyone to agree with the first couple drafts. Especially when the initial questions haven't even been answered yet.
It's also possible that a large number of people are enthusiastic about the policy, and it's not really about Bernie at all
StarCreator
Member
I said it in another thread - there's no way insurance companies will just idly sit by and let themselves be literally outlawed out of a job. Any bill will have to either work out a way for them to continue existing, or get lobbied to death.
Rentahamster
Rodent Whores
Then that means they're getting bent out of shape over an imaginary problem.
Zoe
Member
Good thing that's not what's happening.
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