Establishment looks to crush liberals on Medicare for All

[Phys251]

Hopefully they can explain how they will pull it off this time around and keep the premiums from skyrocketing all over again.

Faeries, unicorns, and pixie dust will cover the multi-trillion-dollar price tag. /s

 

[Phys251]

If that is true, why do you think Republicans are so against it?

Because how dare people who work two or three jobs gain affordable healthcare. What's next, they want clean drinking water, good public schools, and other horrible things?

 

[Surrealistik]

They would have to charge equally and account for it, is my guess. Right now it seems to be a bit more for profit to make up for the ones who can't pay. What people, esp those who are against a single payer system, don't understand is that they are already paying for the next guy.
We need to have this settled once and for all.

For the OP, establishment...as in keeping both sides of the aisle important and in power?

Establishment in this case is more the 'old guard' of the Democratic party, the corporatists, the Pelosis and Clintons, the Third Way/New Democrats; the guys who convincingly took the party over from FDR progressives sometime around the mid 80s: https://en.wikipedia.org/wiki/Third_Way | https://en.wikipedia.org/wiki/New_Democrats

The cynical and/or conspiracy theory level reactions to mainstream Democrats not throwing their support behind vague Medicare For All ideas is pretty tiresome.

Time to resurrect an important thread on this subject, started by Greenbeard.

https://www.debatepolitics.com/gene...all-isn-t-solution-universal-health-care.html

It's not a conspiracy theory if it's actually happening, and establishment figures in the party are leveraging or are in the process of leveraging warchests filled by the insurance and other industries that stand in opposition.

I've hashed out this debate with Greenbeard countless times, and it always comes down to him either over-dramatizing the economic impact of the transition, playing up this asinine notionn it'll happen overnight as opposed to being phased in gradually over a period of years (in fact, I haven't seen a contemporary proposal that purports such an instantaneous switch), or alternately trying to argue that cost savings will be minimal which even ideologically hostile thinktanks (Mercatus) didn't really conclude, despite having notably high estimates that deviate from more reasonable ones by over $8-10 trillion:

https://www.scribd.com/doc/29683169...sis-of-Bernie-Sanders-s-single-payer-proposal

https://berniesanders.com/wp-content/uploads/2016/01/friedman-memo-1.pdf

He has however raised one singular good point though: lobbyists will work like mad to pervert the course and rollout of MFA; this does legitimately concern me.

The problem there is the damn lobbying. So many dems are up to their eyeballs in it and unfortunately the ACA just gave strength to the insurers. They dont want UHC and will fight it. No doubt there will be huge money spend in 2020 so nobody that wants it will get near the finish line. I think those that want MFA will either have to wait 30 years or so or try to find a third party way forward. Neither of the two parties is going to dare take this up. They talk about it but then come time its all "pie in the sky."

Agreed, that they will fight hard, though whether we wait 30 years or have it in 4 depends its proponents. True, Republicans won't touch it, but Dems are quickly getting on side; from "it'll never happen" ala Hillary to main stream discussion and overwhelming popularity; what a difference 2 years makes.

Faeries, unicorns, and pixie dust will cover the multi-trillion-dollar price tag. /s

Nah, more like taxes and economy of scale predicated negotiating power that lowers the bill in the first place, of which the US federal government's is supreme; y'know, the stuff that pays for it in every other developed country that runs SP.

If there's anything fantastical about it, it's overcoming the powerful vested interests that stand in opposition, but that's more a problem with corruption and the undue influence of money in politics than anything else.

Further, TYT, does indeed have its political bias, but unlike Fox, they're honest about it, and don't knowingly commit to lies of omission (or just straight up lies). Either way, the analysis here is accurate.

 

[Xelor]

Reimbursements for medicare is low. Reimbursement for private insurance is much higher.

And yet hospitals are willing to accept both rates for the goods and services they provide.

Are you familiar with the economic behavior of profit maximizing perfect monopolists? Health care providers, like airlines, are among the few firm types that routinely behave so.

 

[Neomalthusian]

Establishment in this case is more the 'old guard' of the Democratic party, the corporatists, the Pelosis and Clintons, the Third Way/New Democrats; the guys who convincingly took the party over from FDR progressives sometime around the mid 80s: https://en.wikipedia.org/wiki/Third_Way | https://en.wikipedia.org/wiki/New_Democrats

It's not a conspiracy theory if it's actually happening, and establishment figures in the party are leveraging or are in the process of leveraging warchests filled by the insurance and other industries that stand in opposition.

This is us vs. them rhetoric.

I've hashed out this debate with Greenbeard countless times, and it always comes down to him either over-dramatizing the economic impact of the transition, playing up this asinine notionn it'll happen overnight as opposed to being phased in gradually over a period of years (in fact, I haven't seen a contemporary proposal that purports such an instantaneous switch), or alternately trying to argue that cost savings will be minimal which even ideologically hostile thinktanks (Mercatus) didn't really conclude, despite having notably high estimates that deviate from more reasonable ones by over $8-10 trillion:

There's no over-dramatization required. The Medicare for All ideas and advocacy often leaves major questions unanswered. And how much it will cost vs. save depends on a lot of the questions that remain unanswered. If cost control mechanisms are brutal, it will disrupt access and put a lot of clinics and providers out of business (because they've built businesses around rates negotiated with insurance companies which are higher than Medicare reimbursement rates). Or if cost control mechanisms are grossly inadequate, then there isn't significant cost savings and it defeats a major underlying purpose of even doing single payer. There can either be minimal disruption and maximum upward pressure on the federal budget, or there can be rapid savings via austere cost controls and major disruption of the U.S. health care system. Proposals tend to vastly oversimplify, obfuscate, and sugarcoat those difficult questions.

Nah, more like taxes and economy of scale predicated negotiating power that lowers the bill in the first place, of which the US federal government's is supreme; y'know, the stuff that pays for it in every other developed country that runs SP.

The other developed countries that "run SP" still often rely heavily on supplemental private insurance, in most cases I've seen, to assuage the problems with access that their global budgeting and other cost-control mechanisms create. Even our own existing Medicare incorporates additional coverage to be purchased by beneficiaries. This becomes one of the cruxes of any MFA proposal here. What is to become the role of the insurance industry? Some presumably minimally-informed proponents of MFA seem to think there won't be insurance companies anymore because the government will do everything, including suddenly be responsible for and capable of administering benefits and UR for 200 million more people.

Also, federal price controls are not an example of "economies of scale."

If there's anything fantastical about it, it's overcoming the powerful vested interests that stand in opposition, but that's more a problem with corruption and the undue influence of money in politics than anything else.

It's entirely possible that a single payer scheme could be so inadequately thought through that anyone who understands the complexities baked into our health care delivery systems would be rational to oppose it. This doesn't always mean corruption in politics and lobbyists controlling Congress. It could just mean that it's actually not a complete and workable policy.

 

[Phys251]

Establishment in this case is more the 'old guard' of the Democratic party, the corporatists, the Pelosis and Clintons

 

[Surrealistik]

This is us vs. them rhetoric.

If there's a conflict, it's not 'us vs them' to define the actors in that conflict, or their actions/underlying motives.

There's no over-dramatization required. The Medicare for All ideas and advocacy often leaves major questions unanswered. And how much it will cost vs. save depends on a lot of the questions that remain unanswered. If cost control mechanisms are brutal, it will disrupt access and put a lot of clinics and providers out of business (because they've built businesses around rates negotiated with insurance companies which are higher than Medicare reimbursement rates). Or if cost control mechanisms are grossly inadequate, then there isn't significant cost savings and it defeats a major underlying purpose of even doing single payer. There can either be minimal disruption and maximum upward pressure on the federal budget, or there can be rapid savings via austere cost controls and major disruption of the U.S. health care system. Proposals tend to vastly oversimplify, obfuscate, and sugarcoat those difficult questions.

Again, he assumes essentially a worst case scenario, and moreover that the rollout is instantaneous as opposed to graduated; it is not an honest representation of currently proposed MFA rollouts, though I agree that any rollout of MFA would be complex and fraught with difficulty, which I don't believe a single person disputes. It'll be a challenging, but ultimately rewarding and necessary change; no one sane said this would be easy.

The other developed countries that "run SP" still often rely heavily on supplemental private insurance, in most cases I've seen, to assuage the problems with access that their global budgeting and other cost-control mechanisms create. Even our own existing Medicare incorporates additional coverage to be purchased by beneficiaries. This becomes one of the cruxes of any MFA proposal here. What is to become the role of the insurance industry? Some presumably minimally-informed proponents of MFA seem to think there won't be insurance companies anymore because the government will do everything, including suddenly be responsible for and capable of administering benefits and UR for 200 million more people.

First of all, it depends on the country/SP system as to the extent of supplementation; I believe the proposals (and cost assessments) that are currently on the table assume a totality of coverage which is actually more generous than some SP systems like Canada (where I live more often than not) that has 70/30 public to private coverage.

Second, I don't think anyone really believes that private insurance will just straight up vanish; of course some degree of private supplemental coverage will remain; that's fine. The key thing is making vital healthcare practically accessible to all, not squeezing private insurers out of existence.

Also, federal price controls are not an example of "economies of scale."

I said economy of scale predicated, as in retooling towards standardization and elimination of administrative chaos/expense, lower margins are at least partially compensated for by volume, while the federal govt has considerable power to negotiate prices given the business it would represent in this case; in SP, it's not that the government just straight up pulls a price out of its ass, and says that's it; it consults with providers, suppliers and so on, consults with its own experts, and arrives at something that's workable and economically tenable for all parties.

It's entirely possible that a single payer scheme could be so inadequately thought through that anyone who understands the complexities baked into our health care delivery systems would be rational to oppose it. This doesn't always mean corruption in politics and lobbyists controlling Congress. It could just mean that it's actually not a complete and workable policy.

Well yes, I agree that it is certainly possible that people legitimately oppose it on the basis of there not being a suitably developed plan, but that's generally not the case per many of these politicos that have adopted a generally reflexive stance, or a rationale that has nothing to do with under-thought proposals: they always cite cost, rather than complexity or lack of detail, some nebulous absurdity about 'consumer choice' and keeping government out of healthcare, and of course, never make support contingent on a more nuanced and detailed blueprint, which they of course would if they opposed it on the basis of good faith reasons as you allege they might. Anthony Rendon is a notorious recent example, having spiked the SP proposal in California without even attempting to explore ways to fund it which was his job.

 

[Neomalthusian]

If there's a conflict, it's not 'us vs them' to define the actors in that conflict, or their actions/underlying motives.

Us vs. Them goggles.

Again, he assumes essentially a worst case scenario, and moreover that the rollout is instantaneous as opposed to graduated; it is not an honest representation of currently proposed MFA rollouts, though I agree that any rollout of MFA would be complex and fraught with difficulty, which I don't believe a single person disputes. It'll be a challenging, but ultimately rewarding and necessary change; no one sane said this would be easy.

Most proponents are glossing over the critical details. Big questions remain unanswered. Ideologues are just insistent, essentially saying "sure, fine, tough questions, but we must! WE MUST!"

First of all, it depends on the country/SP system as to the extent of supplementation; I believe the proposals (and cost assessments) that are currently on the table assume a totality of coverage which is actually more generous than some SP systems like Canada (where I live more often than not) that has 70/30 public to private coverage.

Second, I don't think anyone really believes that private insurance will just straight up vanish

Well, you think wrong about that.

"The employer-based insurance that now covers 156 million people would be eliminated."

"[Sanders'] plan would also have big effects on the health care industry, since it would eliminate private health insurance..."

How Medicare for All Would Affect You - NY Times

I said economy of scale predicated, as in retooling towards standardization and elimination of administrative chaos/expense (yadda yadda)

I was merely pointing out that monopsony price-setting is not the same as economies of scale.

But coming full circle, Medicare For All enjoys tons of support from ordinary people whose understanding of the complexities of our health care system is apparently very weak. Medicare For All sounds great to people whose understanding of this is surface-level at best. Even in this back-and-forth, we see two contrasting ideas about how MFA would work, just between your assumption that private insurance would retain an important role, and the NYT article that apparently thinks private health insurance will be eliminated.

This article articulates some important, consideration-worthy concerns about just wiping away our current system and planting Medicare For All on the nation.

The Risks of Medicare for All

And if you don't like it because of the author's conservative bias, refer to this one from The Nation, whose author is liberal.

Medicare-for-All Isn’t the Solution for Universal Health Care

 

[year2late]

And yet hospitals are willing to accept both rates for the goods and services they provide.

Are you familiar with the economic behavior of profit maximizing perfect monopolists? Health care providers, like airlines, are among the few firm types that routinely behave so.

Yes, but we have not been in a world where it is only Medicare reimbursement. There is a lot of fat to trim, but it has to be done in an intelligent manner.

 

[Surrealistik]

Us vs. Them goggles.

Again, I see no problem in recognizing the blatant reality of a policy conflict and distinguishing between participants.

Most proponents are glossing over the critical details. Big questions remain unanswered. Ideologues are just insistent, essentially saying "sure, fine, tough questions, but we must! WE MUST!"

Well sure, you've first got to build the momentum before it's worth the time to draft discrete and specific policy for an obviously complex and involved transiiton; the former is largely done, though there is pushback as per the subject of the thread. I'm all for hashing out the latter, and agree that now is the time to start getting serious about the details.

Well, you think wrong about that.

"The employer-based insurance that now covers 156 million people would be eliminated."

"[Sanders'] plan would also have big effects on the health care industry, since it would eliminate private health insurance..."

I think that's obvious alarmism; there's a difference between that and what people actually believe. Put it this way: the people who imagine that there will be no private insurance period are an unrealistic minority; unless a healthcare plan is drafted that covers virtually everything under the sun, or there is some legislated restriction against it (highly doubtful) you will have some form of supplemental private insurance available.

I was merely pointing out that monopsony price-setting is not the same as economies of scale.

But coming full circle, Medicare For All enjoys tons of support from ordinary people whose understanding of the complexities of our health care system is apparently very weak. Medicare For All sounds great to people whose understanding of this is surface-level at best..

To be clear, I'm not sure of the exact role private insurance would take, but it would invariably be a minority one, whether or not it continues to play an important role. As stated, current drafts of MFA look to be far more comprehensive in terms of care provision than Canadian SP, so the actual end importance of private insurers is likely to be small, but it's impossible to say how things would permute after the considerable debate and negotiation that would be involved at the federal level, even with a painstakingly detailed proposal in hand. Suffice to say that some level of private supplemental is sure to exist; what that % actually is is unknown and contingent on the breadth and depth of final coverage. A substantial part of what feeds into this ambiguity is this inevitable change and evolution of any input, such that we won't know the exact nature of the output.

Overall though, I agree that people could stand to be better educated on the nature of MFA, and the existing system, and that both sides of the debate are too prone to settle for buzz words and soundbites.

This article articulates some important, consideration-worthy concerns about just wiping away our current system and planting Medicare For All on the nation.

The Risks of Medicare for All

Medicare-for-All Isn’t the Solution for Universal Health Care

And if you don't like it because of the author's conservative bias, refer to this one from The Nation, whose author is liberal.

I'm familiar with the critiques of the first article that are essentially predicated on the idea that MFA wouldn't/couldn't actually result in greater efficiencies, which is half the point of the transition, and unlikely at best. Yes, it is difficult for the government to extract efficiency on a piecemeal basis from a healthcare system that has calcified in a state of overbilling and excess compensation with a considerable layer of administrative inefficiency and bloat; MFA isn't exactly a piecemeal half-measure approach, hence the savings which even Mercatus is forced to acknowledge.

The second is a quality read that contains many good points I actually agree with. Personally I agree that any MFA rollout, if that is the direction we indeed go in, should be absolutely gradual, and moreover, that the solution doesn't necessarily need to be SP; if more centrist Democrats want to propose a workable, convincing alternative that borrows from the solutions of non-SP UHC countries, I'm very open to it, but let's actually have that conversation and get a sign back/counter offer on MFA, rather than what I've seen thus far which is has been overwhelmingly straight up denial and resistance, offering no alternatives save unacceptably unambitious increments of ACA that don't even provide a public option.

 

[Neomalthusian]

the people who imagine that there will be no private insurance period are an unrealistic minority

Based on what evidence?

To be clear, I'm not sure of the exact role private insurance would take

Few are, apparently. The New York Times has told its millions of readers in no uncertain terms that private health insurance will be eliminated. That whole notion is a big part of single payer's conceptual appeal for a lot of lay people who have decided in their own heads that insurance companies are evil or greedy or unnecessary. But for those who work in the industry or in higher levels of government, when something this important remains unknown and unclear, why would they throw support behind such a nebulous idea?

The second is a quality read that contains many good points I actually agree with. Personally I agree that any MFA rollout, if that is the direction we indeed go in, should be absolutely gradual,

How does one gradually replace private health coverage of 200 million people with single payer government coverage?

and moreover, that the solution doesn't necessarily need to be SP; if more centrist Democrats want to propose a workable, convincing alternative that borrows from the solutions of non-SP UHC countries, I'm very open to it, but let's actually have that conversation and get a sign back/counter offer on MFA

H.R. 5155 would fix critical glitches in Obamacare that could end up effectively enabling employers in high-cost states to start to transition away from employer-sponsored coverage (ESL), opting to pay a shared responsibility payment (tax) instead and having employees purchase their own coverage. A gradual transition away from ESL where people instead purchase their own coverage and share considerably in the cost of their care (which has cost-containment elements) would be an important step in the general direction of other relatively similar developed countries (e.g., Canada, Germany, Australia).

 

[RAMOSS]

The public support/movement definitely wasn't there for MFA at the time Dems controlled all chambers of govt, so I can understand Obamacare's drafting and passage then. In the end sadly, Obamacare couldn't even deliver on the much desired (and talked about) public option thanks to the insurance lobby's influence, particularly with regards to that snake Joe Lieberman.

These days, yes, despite the overwhelming popular support, we will need to take back all the other chambers to make MFA a possibility, but that's besides the point that establishment interests are actively working to get Dems to collectively backpedal and abandon it as a long term ambition, and are otherwise attempting to erode the momentum and foundation required for its passage if/when the party ends up in a position to enact it.

I don't like to call it 'medicare for all'. Single payer option is better terminology. What I want is for health care to be divorced from employers. I know too many cases where people had good health insurance via their employer, got sick, could not work and got fired, and didn't have the resources to pay for cobra and their health expenses.

 

[Surrealistik]

Based on what evidence?

Anecdotal largely, as no polling has been done (to my knowledge at least)

That said, the idea is couched in the fact that a legitimate, honest to god belief in absolutely no private insurance at all post MFA is a pretty high bar to clear.

Few are, apparently. The New York Times has told its millions of readers in no uncertain terms that private health insurance will be eliminated. That whole notion is a big part of single payer's conceptual appeal for a lot of lay people who have decided in their own heads that insurance companies are evil or greedy or unnecessary. But for those who work in the industry or in higher levels of government, when something this important remains unknown and unclear, why would they throw support behind such a nebulous idea?

I mean everyone has a pretty good general sense of where things are going to wind up: if any kind of MFA gets passed, it will mean an obvious, vast and substantial shrinkage of the private market, likely to 30% or under per the example of other developed countries with SP. We don't know the exact ratio, but we certainly have a pretty good idea that it will be reduced to a clear minority of the overall market; the rest is determining where on that sliding scale between the low single digits and ~30% we end up, and that's something that's of course fundamentally impossible to know until the legislation goes through doubtlessly many drafts and amendments. In otherwords, there's uncertainty of specific numbers, relative certainty of the general bounds/ballpark.

How does one gradually replace private health coverage of 200 million people with single payer government coverage?

Graduated age-indexed rollout as per some current proposals (though they have IMO too aggressive a time table; I believe Bernie's proposal is tabled at 4 years); MFA is expanded over a period of years to cover an age bracket that expands annually.

H.R. 5155 would fix critical glitches in Obamacare that could end up effectively enabling employers in high-cost states to start to transition away from employer-sponsored coverage (ESL), opting to pay a shared responsibility payment (tax) instead and having employees purchase their own coverage. A gradual transition away from ESL where people instead purchase their own coverage and share considerably in the cost of their care (which has cost-containment elements) would be an important step in the general direction of other relatively similar developed countries (e.g., Canada, Germany, Australia).

It's a start at best, and were we in a position to pass major healthcare reform, to pass it alone would be a squandering of that power. A persuasive public option I feel would be a good, definitive offer that centrists might be able to commit to, and would substantially improve the health care coverage situation, particularly if the public insurer was given the authority to aggressively negotiate.

I don't like to call it 'medicare for all'. Single payer option is better terminology. What I want is for health care to be divorced from employers. I know too many cases where people had good health insurance via their employer, got sick, could not work and got fired, and didn't have the resources to pay for cobra and their health expenses.

MFA as a name is generally adopting for ease of understanding the general thrust/concept, but I get you, as it doesn't fully encompass the exact nature of what is being proposed.

And yes, that is one of the primary goals of MFA, and indeed any UHC system/implementation, and a definite minimum for an acceptable proposal.

 

[Greenbeard]

I've hashed out this debate with Greenbeard countless times, and it always comes down to him either over-dramatizing the economic impact of the transition, playing up this asinine notionn it'll happen overnight as opposed to being phased in gradually over a period of years (in fact, I haven't seen a contemporary proposal that purports such an instantaneous switch), or alternately trying to argue that cost savings will be minimal which even ideologically hostile thinktanks (Mercatus) didn't really conclude, despite having notably high estimates that deviate from more reasonable ones by over $8-10 trillion:

The economic impact is the savings. I don't know why this needs to be hammered home again and again. These are two sides of the same coin. You either argue the economic impact (savings) will be substantial, or that it won't. If you're going to argue economic disruption as a merit of single-payer, then you have to own that. If you're going to argue that it won't be disruptive, then you need to own and account for those costs. What I take issue with is arguing mutually contradictory points simultaneously and presenting them both as arguments in favor of the same concept. That kind of sophistry and bogus salesmanship what gives single-payer a bad name.

As for timing, H.R 676 has been the premier single-payer legislation for the past decade and a half with by far the most co-sponsors. It completely phases in single-payer in 1-2 years. So I don't know how you "haven't seen a contemporary proposal" that flips a switch to implement single-payer when the most famous single-payer proposal in existence does just that.

 

[The Mark]

Obamacare was a compromise because it was the only plan that could pass. It’s actually a conservative plan formed by the Heritage Foundation in the 1990s.

Given that the GOP controls the Senate and the WH, Medicare for all has no chance of passage. However, since the House is now controlled by Democrats, efforts to kill Obamacare are dead too.

Technically the republicans still control both houses until January.

But it's unlikely they'll do much?

 

[Bassman]

I don't like to call it 'medicare for all'. Single payer option is better terminology. What I want is for health care to be divorced from employers. I know too many cases where people had good health insurance via their employer, got sick, could not work and got fired, and didn't have the resources to pay for cobra and their health expenses.

Then what we're left with is **** selection at over inflated taxation. Sorry, but I prefer the pre-Obamacare system myself.

 

[Surrealistik]

The economic impact is the savings. I don't know why this needs to be hammered home again and again. These are two sides of the same coin. You either argue the economic impact (savings) will be substantial, or that it won't. If you're going to argue economic disruption as a merit of single-payer, then you have to own that. If you're going to argue that it won't be disruptive, then you need to own and account for those costs. What I take issue with is arguing mutually contradictory points simultaneously and presenting them both as arguments in favor of the same concept. That kind of sophistry and bogus salesmanship what gives single-payer a bad name.

I have repeatedly said that with a graduated schedule, the disruption though significant, will be manageable as opposed to catastrophic, not that it will be non-existent or negligible; I'm not sure exactly what kind of double speak it is that you are choosing to remember, but it's definitely not what I've purported or argued.

As for timing, H.R 676 has been the premier single-payer legislation for the past decade and a half with by far the most co-sponsors. It completely phases in single-payer in 1-2 years. So I don't know how you "haven't seen a contemporary proposal" that flips a switch to implement single-payer when the most famous single-payer proposal in existence does just that.

The more contemporary bill authored by Sanders ( S.1804 - Medicare for All Act of 2017 ) is what I'm referring to, and has a four year rollout, which, while significantly faster than my preference, is not at all a switch flip: https://www.npr.org/2017/09/14/550768280/heres-whats-in-bernie-sanders-medicare-for-all-bill | https://www.congress.gov/bill/115th-congress/senate-bill/1804/text

Further, H.R. 676 does have provisions to help the private sector readjust, including displaced employees. I don't at all agree with the rapidity, but it must be acknowledged that it specifically attempts to compensate for this.

 

[Neomalthusian]

I have repeatedly said that with a graduated schedule, the disruption though significant, will be manageable as opposed to catastrophic, not that it will be non-existent or negligible; I'm not sure exactly what kind of double speak it is that you are choosing to remember, but it's definitely not what I've purported or argued.

It's not double-speak. The disruption we're both talking about does not center around "how fast" as much as what would invariably be required for single payer to result in significant savings in terms of the country's total health expenditures. We can't significantly reduce the country's health expenditure without major disruptions to actual patient care (quality or access or both).

The more contemporary bill authored by Sanders ( S.1804 - Medicare for All Act of 2017 ) is what I'm referring to, and has a four year rollout, which, while significantly faster than my preference, is not at all a switch flip: https://www.npr.org/2017/09/14/550768280/heres-whats-in-bernie-sanders-medicare-for-all-bill | https://www.congress.gov/bill/115th-congress/senate-bill/1804/text

Further, H.R. 676 does have provisions to help the private sector readjust, including displaced employees. I don't at all agree with the rapidity, but it must be acknowledged that it specifically attempts to compensate for this.

On Sanders' own page about this (Medicare for All: Leaving No One Behind), he claims the following:

Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.

Notice there is zero indication from Sanders that the average working family will continue to spend anything on health insurance under this system, rather he says straight away there will be a 92% savings to that family. That clearly suggests this plan will eliminate private health insurance, which opens a can of worms to a litany of additional critically important questions about how this is all really supposed to work.

 

[pilot16]

It's not double-speak. The disruption we're both talking about does not center around "how fast" as much as what would invariably be required for single payer to result in significant savings in terms of the country's total health expenditures. We can't significantly reduce the country's health expenditure without major disruptions to actual patient care (quality or access or both).



On Sanders' own page about this (Medicare for All: Leaving No One Behind), he claims the following:

Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.

Notice there is zero indication from Sanders that the average working family will continue to spend anything on health insurance under this system, rather he says straight away there will be a 92% savings to that family. That clearly suggests this plan will eliminate private health insurance, which opens a can of worms to a litany of additional critically important questions about how this is all really supposed to work.

People have to realize that with a single payer or MFA plan, its typical that all other insurance fades away. There will be no more VA, Medicare, Medicaid, COBRA etc. Most other countries pay a percent of taxes to cover healthcare and thats the plan. Other private insurance covers supplemental stuff (plastic surgery, dentistry etc) that isnt required. Some countries are better than others and cover more. But it would be a massive change for the US which is why some want to put down the age of Medicare by 5 years every so many years until it gets down to the 20s or so and then cover everyone. To do it too quickly would be massively disrupting and why we heard in 2009 AARP and seniors yelling "dont touch my Medicare." They feared their coverage would be diminished or changed.

The real can of worms is that for many health insurance is a lot like defense, in that every state employs so many in that industry and the representation is nervous about all those jobs lost in their district. Its similar to the cries to cut the defense budget but when it comes down to it, it never happens. Many fear the same will happen with the insurance industry, they will never vote to cut those jobs.

 

[Surrealistik]

It's not double-speak. The disruption we're both talking about does not center around "how fast" as much as what would invariably be required for single payer to result in significant savings in terms of the country's total health expenditures. We can't significantly reduce the country's health expenditure without major disruptions to actual patient care (quality or access or both).

But it does.

The speed of the phase in determines exactly the rate of economic shock and the amount of time the economy has to readjust and recalibrate; there is an obvious and egregious difference between say, a 10 year phase in and an overnight flip switch; how could anyone reasonably dispute this? You will never be able to completely eliminate the fallout and disruption of such a transition, even with a lengthy phase in time, but you will be able to significantly reduce it, which is the fundamental basis of my argument.

Moreover, it is absolutely possible to achieve at least comparable levels of care and health outcomes despite spending significantly less money; again, that's half the reason for a transition to an SP/UHC system. If you're talking about short term degradation during the messiness of transition/readjustment, that's a possibility, but in the long run the idea, and indeed the conclusion of every study thus far produced on the issue, including from ideological vantages that are hostile to SP, is we pay significantly less for approximately the same level of care in the end.

On Sanders' own page about this (Medicare for All: Leaving No One Behind), he claims the following:

Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.

Notice there is zero indication from Sanders that the average working family will continue to spend anything on health insurance under this system, rather he says straight away there will be a 92% savings to that family. That clearly suggests this plan will eliminate private health insurance, which opens a can of worms to a litany of additional critically important questions about how this is all really supposed to work.

Basically what pilot said; of course there will be supplemental insurance in the end, at the bare minimum for cosmetic procedures and certain perks like private rooms, etc. Further, I have no doubt the final draft of the bill won't cover everything under the sun, and may feature stuff like small means adjusted co-pays (which I support as it helps reduce over-utilization).

 

[Neomalthusian]

But it does.

The speed of the phase in determines exactly the rate of economic shock and the amount of time the economy has to readjust and recalibrate; there is an obvious and egregious difference between say, a 10 year phase in and an overnight flip switch; how could anyone reasonably dispute this? You will never be able to completely eliminate the fallout and disruption of such a transition, even with a lengthy phase in time, but you will be able to significantly reduce it, which is the fundamental basis of my argument.

Moreover, it is absolutely possible to achieve at least comparable levels of care and health outcomes despite spending significantly less money; again, that's half the reason for a transition to an SP/UHC system. If you're talking about short term degradation during the messiness of transition/readjustment, that's a possibility, but in the long run the idea, and indeed the conclusion of every study thus far produced on the issue, including from ideological vantages that are hostile to SP, is we pay significantly less for approximately the same level of care in the end.

I'm not talking about short-term messiness of readjusting and recalibrating, I'm talking about long-term and permanent changes to the availability of health care which has evolved over decades of fees-for-services negotiated with private insurers. Replacing fee-for-service with global budgeting does not just result in laying off or re-purposing some redundant billing clerks. It could result in huge swaths of private practices and clinics closing because their budget no longer comes close to working.

Basically what pilot said; of course there will be supplemental insurance in the end, at the bare minimum for cosmetic procedures and certain perks like private rooms, etc.

Private insurance serves a much more important purpose in numerous UHC systems than just things like cosmetic surgery and perks. It exists to smooth out systemic access problems that would exist because of global budgeting replacing fee-for-service, and perhaps other cost-containment measures. We see this in other countries with mixed-system UHC.

Further, I have no doubt the final draft of the bill won't cover everything under the sun, and may feature stuff like small means adjusted co-pays (which I support as it helps reduce over-utilization).

Your confidence here again seems faith-based that the bill will do things that directly contrast with what is being proposed. So I really don't think you can expect everyone to throw support behind something based on faith that the final version will significantly differ from the proposal, nor is it reasonable to accuse skeptics and opponents of just being corrupt political whores for lobbyists because they're not on board. A lot of people are gung-ho about Medicare For All precisely because they've been led to believe it will eliminate private insurance, and eliminate all deductibles, co-insurance and co-pays.a

I think Greenbeard really nailed it when he said "What I take issue with is arguing mutually contradictory points simultaneously and presenting them both as arguments in favor of the same concept. That kind of sophistry and bogus salesmanship what gives single-payer a bad name."

 

[Surrealistik]

I'm not talking about short-term messiness of readjusting and recalibrating, I'm talking about long-term and permanent changes to the availability of health care which has evolved over decades of fees-for-services negotiated with private insurers. Replacing fee-for-service with global budgeting does not just result in laying off or re-purposing some redundant billing clerks. It could result in huge swaths of private practices and clinics closing because their budget no longer comes close to working.

It could, and no doubt there may be some clinics that have become reliant on excess margins and may not be able to recalibrate at all, and that there will be short term issues as the system adjusts, but in the end, in the long term and relative to the bigger picture, I don't see how we're overall getting to a point where we actually have compromised access and outcomes. If anything de facto access is likely to improve due to the universality and affordability of coverage.

Private insurance serves a much more important purpose in numerous UHC systems than just things like cosmetic surgery and perks. It exists to smooth out systemic access problems that would exist because of global budgeting replacing fee-for-service, and perhaps other cost-containment measures. We see this in other countries with mixed-system UHC.

It depends on the system of course. I'm saying that at a minimum, this is the role of private insurance, even relative to the most inclusive and comprehensive public healthcare.

Your confidence here again seems faith-based that the bill will do things that directly contrast with what is being proposed. So I really don't think you can expect everyone to throw support behind something based on faith that the final version will significantly differ from the proposal, nor is it reasonable to accuse skeptics and opponents of just being corrupt political whores for lobbyists because they're not on board. A lot of people are gung-ho about Medicare For All precisely because they've been led to believe it will eliminate private insurance, and eliminate all deductibles, co-insurance and co-pays.a

As previously stated, even if I know what's going into the sausage machine, I don't know what's coming out. It just seems probable to me, or even nigh certain that there will be certain compromises and scalebacks on the way (not to be confused with some kind of sea change or wholesale inversions in the legislation). Personally I'm not at all chagrined if we get a completely comprehensive MFA outcome as advertised that leaves little space for the private sector; I don't really care what happens to private insurers so long as they have sufficient time/resources to recalibrate so that the economic shock of the transition and run on effects aren't too significant.

And yes, I believe there's plenty of basis for accusations that people who oppose it and also happen to have substantial political funding from vested interests which are also in opposition, are corrupt political whores/shills; that's precisely how Washington has worked for a long time, particularly given the nature of their objections which in fact typically have little to do with the specifics of implementation and how it might mutate (this is really more the concern of MFA purists who aren't okay with any deviations) as previously stated.

I think Greenbeard really nailed it when he said "What I take issue with is arguing mutually contradictory points simultaneously and presenting them both as arguments in favor of the same concept. That kind of sophistry and bogus salesmanship what gives single-payer a bad name."

I think this is more a reflection of your confirmation bias and his chronic disingenuity and misrepresentation vis a vis SP proponents and my own arguments than anything accurate or poignant. There is absolutely nothing internally contradictory or paradoxical about my stance which is that A: SP would save the country considerable resources and expense without having an averse impact on overall care in the long run and B: the economic shock of its implementation can be substantially limited (but not eliminated entirely) with a proper phase in period and contingencies for helping those displaced by such changes.

 

[Neomalthusian]

It could, and no doubt there may be some clinics that have become reliant on excess margins

That comment doesn't even make sense. If a business model is reliant on it, it's not an "excess margin."

and may not be able to recalibrate at all, and that there will be short term issues as the system adjusts, but in the end, in the long term and relative to the bigger picture, I don't see how we're overall getting to a point where we actually have compromised access and outcomes. If anything de facto access is likely to improve due to the universality and affordability of coverage.

That is just nonsensical. Take one specific hypothetical example, outpatient mental health care. Countless solo private practitioners and small group practices have business models based on $100-120 an hour for psychotherapy. Those costs pay for facility rent, utilities, provider and administrative support wages. Those businesses plenty of times have relatively thin margins. Medicare and Medicaid typically pay way less than that. Like at least 30% less than that. These practitioners and group practices are not currently sitting on 30%+ in pure profit that they can just surrender and keep going. If those reduced rates become universal, countless private practitioners and small group practices will just stop. They won't shrug and operate at a loss until they're bankrupt. They'll stop immediately. Why can I predict this so confidently? Because they already don't accept Medicare or Medicaid, and the reason they don't is because it's a losing endeavor. So when those practitioners and clinics stop providing, there becomes a shortage of available mental health therapists. Access and quality suffers because of shortages. Or alternatively, a single payer bureaucracy can take over but then realize it lacks the spine to actually follow through with cuts that would result in shortages/access problems and they maintain very similar reimbursement rates, but then in that case, where's the savings, and why did we even bother to flip the entire nation's health system in the first place?

You started out in this thread making very sweeping suggestions that anyone in Congress opposing this still-completely-nebulous MFA concept must be in bed with lobbyists, calling Lieberman a snake because he killed the public option (which by the way, that wouldn't have come even close to addressing our problems either), and so forth. But now you're dancing around this issue acting like it will save substantial costs while improving access and quality despite having faith that the "final" bill will starkly contrast with what's currently being proposed and articulated in public.

It sounds to me that you've decided first that Medicare For All would be wonderful, and now are working hard to build a coherent rationale around it that was never fully formulated before your mind was made up (and still isn't).

 

[Surrealistik]

That comment doesn't even make sense. If a business model is reliant on it, it's not an "excess margin."

I had more meant the idea of gross margin which must necessarily be high to compensate for other inefficiencies further down the balance sheet when other expenses factor; you might need that higher gross margin because you're complacent/incompetent/wasteful (in which case, you deserve to go out of business when you lose gross margin due to MFA rollout), or perhaps say because something like administrative costs are high which is something SP aims to correct via consolidation of payers.

That is just nonsensical. Take one specific hypothetical example, outpatient mental health care. Countless solo private practitioners and small group practices have business models based on $100-120 an hour for psychotherapy...

Right, and here's the fundamental thing you're missing: many things in the current supply chain and expense column for providers are inflated, from labour to drugs prices, to medical supplies, to huge swaths of administration due to Byzantine billing complexities/insurer market fragmentation, middle men markups and so on; all things MFA aims to tackle. The reason other countries can manage to spend half of what we do is because the cost of all of these inputs is kept down. That having been said, the government must absolutely work, as virtually every developed country with SP does, to make sure that the impact of cost reductions are shared between both providers and suppliers, so that everyone can still come away solvent, and that there is a reason to retain capacity. Again, I have no doubt that there will be interim fallout as the system and markets adjust to the new normal, and certain clinics, facilities and such fail to adjust, but I see nothing that evinces long term, permanent averse impacts to health care capacity or access. Even if we were to cut spending by the order of 30%, we would still be leading the developed world in health expenditures; healthcare in America would still be a relatively sweet deal as compared to every other wealthy nation. Why should it be impossible for us to even achieve that much of a reduction without a permanent and significant loss in capacity?

That having been said, if the government cannot manage to engage in systemic control of such costs, or if the burden of cuts fall in a disproportionate way, yes, I fully admit there could be trouble; you can't for example, squeeze a provider's margins on one end without helping to alleviate his expenses on the other.

You started out in this thread making very sweeping suggestions that anyone in Congress opposing this still-completely-nebulous MFA concept must be in bed with lobbyists...

#1: Lieberman was absolutely a snake, a shill and a blatant insurance industry hatchetman. Moreover the public option would have been a much more substantive step forward than what we got in the final draft of ACA.

#2: Yes, I would surmise again that between the reasons given (which often has little to do with a lack of detail; in general they stand against it as a matter of principle, again the usual empty platitudes of choice, keeping govt out of healthcare, etc and so forth), and their sources of political funding, many if not most of the Congressional opposition is generally predicated in donor money and industry lobbyist influence; it is a very reasonable assumption, particularly given the significant amount of money spent by vested interests that have a great deal to lose per SP/MFA.

#3: What I've actually said is that it is probable that a bill of such sweeping immensity and complexity will undoubtedly face changes and mutations when it is actually being hashed out; I don't think this can be at all reasonably disputed; it is simply a point of fact. Anyone who thinks for a second that MFA will make it through the entire legislative process without a single substantive change is obviously disconnected from reality. That having been said, as long as the soul and core goals of MFA are achieved, i.e. a substantial reduction in healthcare costs and affordable universal healthcare, I, and most of its supporters will be happy.

It sounds to me that you've decided first that Medicare For All would be wonderful, and now are working hard to build a coherent rationale around it that was never fully formulated before your mind was made up (and still isn't).

Um, my positions on this have been consistent start to finish, long before I'd even posted in this thread, and haven't really changed at all. It is the same consistent viewpoint I had when I debated this exact issue with Greenbeard several times.

 

[Media_Truth]

It's not double-speak. The disruption we're both talking about does not center around "how fast" as much as what would invariably be required for single payer to result in significant savings in terms of the country's total health expenditures. We can't significantly reduce the country's health expenditure without major disruptions to actual patient care (quality or access or both).



On Sanders' own page about this (Medicare for All: Leaving No One Behind), he claims the following:

Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.

Notice there is zero indication from Sanders that the average working family will continue to spend anything on health insurance under this system, rather he says straight away there will be a 92% savings to that family. That clearly suggests this plan will eliminate private health insurance, which opens a can of worms to a litany of additional critically important questions about how this is all really supposed to work.

If Bernie's numbers are even near-correct, it will be in the best interest of our country. Either patients can continue to line the pockets of insurance company billionaire CEOs, are they can pay the doctors and nurses.