It infuriated me at the time when Politifact made “if you like your health care, you can keep it” the Lie of the Year in 2013. Unfortunately, that they felt comfortable making that choice is a good indication of how politically toxic it is to screw around with people’s preexisting health care plans. A small percentage of people lost their plan, but it still added up to approximately four million people. Many of them should have been grateful, since their plans were complete rip-offs, but that didn’t make it less of a headache for the Democrats.
In theory, I am very enthusiastically in favor of eliminating the private for-profit health insurance industry entirely. Yet, I know that this would cause a political firestorm unlike anything we’ve seen since George W. Bush tried to privatize Social Security. In fact, it would likely be an order of magnitude more controversial than that fiasco. To make matters worse, it’s a promise that could not be kept. To even contemplate passage of such a bill, the Democrats would need a supermajority in the Senate, and that’s not in the offing anytime soon. In truth, the Democrats would probably need eighty or ninety senators to feel comfortable about getting 60 of them to vote the health insurance industry out of existence. In addition to the staggering number of negative constituent phone calls the senators would receive, many of them would be representing states that have thousands of health insurance jobs that would be on the line.
The question, then, is why would a presidential candidate run on a platform that included the elimination of private heath insurance? It might help them win the Democratic nomination, but thereafter it would weigh on them like an albatross. As a general election candidate, they would be savaged using similar rhetoric to what caused the Tea Party revolt and the midterm wipeouts of 2010 and 2014. Only, this time, the rhetoric would largely accurate and backed up by the media. If they nevertheless won the election, which is certainly possible, they would have to abandon their promise or they’d wind up taking a huge beating much like Trump did in his effort to repeal Obamacare.
This time, I am going to have to agree with Jonathan Chait that Kamala Harris is taking a huge risk.
In which Jake asks Kamala Harris whether people would be able to keep their private insurance, if they prefer, under Medicare For All system — and she rejects that. “Let’s eliminate all of that. Let’s move on.” pic.twitter.com/A1AY2TOT4g
— Rebecca Buck (@RebeccaBuck) January 29, 2019
For the record, Chait agrees with me about the merits of the policy.
There’s no doubting the worthiness of this ambition. Financing health insurance through private firms does not add any important value. It is obviously possible to run an entire country on a single-payer basis. Lots of countries do it, and people there tend to like the experience much better than Americans do.
He’s just taking the position that it’s not a wise political choice to run on doing something that is unpopular, easy to demonize, highly disruptive, and impossible to deliver. Trump’s promise of a border wall that Mexico will pay for is an example of what can go wrong even if you win the election.
It’s true that if you ask people if they support a national health care plan like Medicare-for-All, they say that they do. If you ask them if they favor eliminated private health insurance, they are significantly more emphatic that they do not.
Now, if the the policy is the correct one and the goal is worthy, one might reasonably ask how we can ever achieve it without a presidential candidate running on it and winning. Public opposition must be overcome somehow. There used to be public opposition to gay marriage and a lot of Democrats cowered in fear rather than taking a courageous stand and leading by example. Public opinion shifted very quickly on that issue, so why couldn’t the same happen with a national health care plan?
My short answer to that is that there is too much money involved in health insurance for it to be equivalent, and too many people will feel a direct rather than an abstract threat. The U.S. Congress isn’t passing a national health care plan anytime soon regardless of how many seats the Democrats win.
This isn’t a satisfying answer to countless Democratic voters, but being set up for disappointment isn’t something people should welcome, let alone set as a litmus test for your political support. It’s an odd thing to be upset that a candidate is advocating a policy I agree with using arguments that I consider completely sound. But the same candidate is also failing to level with me about the prospects of success and the downside political risks. It’s the latter part that bothers me and that more than cancels out the former part.
In one way, convincing presidential candidates to support a national plan is definitely progress for those of us who want to reach that goal one day. I want them to argue for that goal. I just don’t want them promising to deliver it, because that’s a lie that will produce a risky backlash and just fuel cynicism when it isn’t kept.
I agree that this is not how you get private insurance abolished. However, is this how you get a public option or M4A passed?
I am glad you put this issue on the table. No one talks about it. I sometimes wonder if most even consider it. Here’s another way to look at it. Health insurance companies carry many investors money investments. One cannot simply legislate them out of business and make those investments worthless. Just can’t happen. But one could buy them out. That is a very expensive option, but the only way to get past it.
Then there are all the people who work at the insurance companies. On the one hand the elimination of them represents the real savings single payer can give us. We now pay half again what everyone else pays. Single payer could save us up to a trillion and a half a year. But that will include people who lose their jobs. That also needs to be accounted for in the plan.
Those two issues: what happens to the insurance company investments and what happens to the people working there are seldom talked about. And there are further issues. Medicare for all cannot proceed without an answer. There are ways to work through it and that is also seldom talked about. I am afraid we are years away from single payer even though AOC, Kamala Harris and others want it. I agree this will become their own border wall unless they go on to more detail.
A few thoughts:
— As I state below I think it would not be wise to make medicare for all totally free with the goal of eliminating private insurance. Instead, I’d make Medicare a competitor by charging policy holders a premium.
— Insurance companies talk all the time about their “innovation” and great service. Well, let them put that into practice with a new competitor. If they are as good as they say, they will survive. If not, why shouldn’t they be subject to the vagaries of the market?
— Insurance companies may have no choice but to lower their rates. Sure, people will lose jobs, but this made me think about something the odious Wilbur Ross recently said about the 800,000 federal employees being a third of a percent of GDP. Not sure how many health insurance employees there are, but I believe the economy is large enough to absorb them.
I think there will be many approaches to this. So perhaps one way would be to say we will study the best approach to transition to single payer. That would make it a future promise but not a border wall we need to get immediately.
Personally I favor simply buying out the insurance companies probably over some time. I doubt a for profit element in health care with all that brings including taxes and other costs is the best way. In any case much needs to be discussed.
For example, many pundits keep making points by asking how are we going to pay for it. Actually it is rather easy to answer. Since we already pay for it all – every damn nickel – we could leave that in place and just reallocate who pays what. Or we could raise taxes to handle it. Or transition to higher taxes and eliminating corporations and others over time.
I agree we should be able to find jobs for all those displaced and that should be part of the transition.
I like the idea of putting this on the national agenda. But no immediate promise until it is all flushed out.
Its good we’ve gotten beyond being bullied into not talking about it, because now we see the idea is actually popular with a clear majority of voters. Talking about it as a real possibility is the only way to move the ball forward. The question is, how best to do it?
Consider this: we are paying for it now, and in spades, with the vast majority of that money going to private insurers, and a considerable chunk of that going to profit and overhead instead of health care. Reallocating what we pay now requires that it is either taken from or not paid to, depending on the perspective, private insurers. This can either be done by force, e.g. getting rid of private insurance altogether, or by coercion, introducing a public option that is competitive. I would much rather put opponents on a playing field having to argue against why they shouldn’t have to compete in a level playing field as opposed to operating in an anti-trust free, protected market.
This is where I believe having a medicare for all that consumers can buy into (and yes, there will be taxes on premiums but I don’t believe it will make it prohibitive) will provide the leverage to get private insurers to the table, because otherwise they’re not going to agree to voluntarily give up anything they don’t have to. Study yes, but also there will need to be some trial and error, because with study alone just kicks the can down the road with respect to private insurers having any pressure to change.
Agree that is an approach. As I suggested above I would keep employers in the game by deducting a percent of payroll or other compensation from employees and paying a tax themselves on the compensation like they do today. They would pay about the equivalent as they do today. (except for those who pay nothing.) But that would end their participation unless they want to use an insurer for some higher level of care on their own nickel. The government (state and federal) now pay over forty percent I believe. They would pay the same or a little more. I would not impose any new taxes at the start since it is possible none will be needed. But it also means I don’t really support any express role for insurance companies. And I don’t want anything extraneous and no one gets to keep their current insurance, they get medicare. Bummer I guess.
Obviously, any new plan will require some very long study and debate. So no promises today. I heard Kamala last night say something like the old plan will be gone, good for her.
A big problem with the employer based insurance is the the loss of coverage if you lose your job. The job market today is very fluid; people don’t stay on jobs for years and years, and in many cases can’t even if they’d like to, as its become standard practice for employers to cut labor to goose quarterly and annual numbers. Lose your job, lose your health care. If that happens in the middle of treatment for a major health issue, your choice, if you’re “fortunate” is going bankrupt or worse, going without needed treatment. COBRA has been useless in addressing this because the cost is very high, and unaffordable especially when you no longer have a job.
I would like to see health insurance untethered from employment. If an employer wants to offer health care as a perk, then fine. Or if someone is wealthy enough to afford a Cadillac plan paid out of pocket, that’s fine too. But have a medicare for all plan as a primary option for people, with premiums low enough so that I can continue coverage and needed care if I lose my job.
Setting aside investors, there are 500K people employed in the health insurance industry. That’s a lot of jobs to write off.
Big number and that is why our health care is so expensive and those people could increase our GDP if employed elsewhere. For me the job is to get them that work.
If Wilbur Ross’ estimates are correct (and no, I’m not a fan of that cretin!), the loss of 800K jobs is the equivalent of less than one third of one percent of GDP.
And I don’t see why health insurer employees deserve any special protections that we didn’t advocate for autoworkers and others as a result of regulatory, economic and/or legislative changes that saw the loss of their jobs.
I am reacting to the idea we pay half again what our nearest competitor (Germany I believe) pays and that suggest there is well over a trillion a year we can save. (we even have worse outcomes including lower longevity.) It will not all come from employee losses I agree. But assuming that money is spent on other productive pursuits could mean an increase in GDP. It is also why I would not want to compromise a whole lot on the best way forward.
Is the money we pay into the last year of life care. Other countries simply do not go to the extraordinary lengths we do to keep someone alive, no matter the quality of life.
Another big reason is people use emergency rooms as clinics because of a lack of choice to go to an actual clinic
I’d say why we pay so much more is almost entirely because of higher prices and hospital monopolization.
I think you would find that true by looking into the cost for procedures. It is why many go to other countries for them. The sad part is we have generally worse outcomes than others and pay more. So profits eat it all up. Think drugs also.
This is not the big reason healthcare is so expensive in the United States. There will be some administrative savings, but for the most part medicine in the United States is very expensive because you pay doctors, nurses, other health care workers and hospitals a lot more than we do in Canada. Governments exercise much tighter cost controls than Blue Cross does.
Most of these workers are doing work that has to be done. If you choose to emulate Canada, then you have to set up a state run insurance company (a ministry of health) in 50 states. The ministry sells insurance, processes claims, negotiates with providers, funds hospitals along with countless other tasks. Who will do those things absent insurance companies?
It took us 80 years to gradually build the infrastructure to provide health care to all our citizens. Anybody who thinks they can design and bulid a system to deliver universal healthcare for 330 million people is nuts.
Healthcare is very, very hard and healthcare insurance is a huge undertaking. It takes bureaucracies, computer systems, software and skilled people. Build a system to deliver insurance to the entire population from scratch? That’s crazy. Rolling out Obamacare was child’s play compared to the day single payer is rolled out. It is guaranteed to be a huge fiasco. (And don’t kid yourself. We are talking about a government takeover of health care. Fuck this one up and Democrats will never get elected again.)
We have our system because one politician in one small province started paying hospital bills in 1939. We expanded from that one step at a time decade after decade. America has a stupid system because Eisenhower set the country on an employer based system in the 1950’s and you are stuck with that as your infrastructure, also built up over decades.
The goal should be univeral healthcare via private insurance companies. How do you get there? It is not too hard to imagine gradually converting Obamacare to the French system. A consortium of insurance companies contracts with the government to provide medicaid for all. and then almost everyone buys or gets supplemental insurance through their employer.
Exactly. I have family and friends who are single payer or bust, and dissuading them of its feasibility is difficult. Bernie rallied folks for this, and many Dems endorsed his Medicare for All, but I am encouraged that several less ambitious plans are being proposed that would make tangible improvements and might pass through reconciliation with 51 votes.
Democrats get criticized for not making big promises, and criticized if they do make big promises. American voters seem to like people who dream big. Asking them to be logical about it didn’t help Clinton any. So why not push for what we really want?
Hence the political conundrum…
“It’s true that if you ask people if they support a national health care plan like Medicare-for-All, they say that they do. If you ask them if they favor eliminated private health insurance, they are significantly more emphatic that they do not.”
Then why, at least in the interim, make this an either/or situation? Instead of starting out making Medicare an eliminator of private insurance, how about making it a competitor instead? Instead of making Medicare for all totally free, charge those who want to buy in a monthly premium; nothing outrageous like the private insurers charge, but something affordable that everyone can afford. Give people the choice of Medicare at say $100 month premium vs. the $500 premium for employer subsidized plans. A lot of consumers will go with Medicare, and this will put pressure on private insurers to lower rates and/or provide better coverage, or segregate themselves into a “boutique” or “Cadillac” insurance market.
In this scenario, if for whatever reason you want to stick with your employer subsidized plan, you can. If not, or if your employer doesn’t offer health insurance, you have an affordable alternative.
Of course this will have an impact on existing plans, and some who have employer subsidized plans will see them change? But when does that NOT happen anyway? In the course of three years I had to change my doctor twice, not because of the ACA but because of my employer and the insurer making changes.
Of course, the result of the competition of the sort I describe here will likely end up putting some private insurers out of business. Others will adapt to survive.
Rather than start out saying the goal is to put private insurers out of business, it would be better politically and otherwise to say the goal is to give people access to health care by making Medicare for all an affordable option.
Right, a transition from A to B is mandatory. There have already been many ideas proposed that could bridge the gap between our current system and affordable universal coverage. A national public option was proposed during the Obamacare debates (thanks for nothing Joe Lieberman). The Americare Plan offers another model for making the change.
We can do this, but it has to be done wisely and well.
I agree the transition is essential and with a good deal of wisdom to ensure we don’t set up something that won’t work long term or lead us into more insanity. . I never understood what a public option was all about. Still don’t.
This is the only practical answer given the structure of our economy, and had essentially been previewed with the the ACA “Public Option” debate, which of course every “conservative” opposed 100%.
But now the “Medicare for All” genie is out of the bottle…a wise and sensible policy, but for a capital-fundamentalist society that has basically always looked for a for-profit “solution” (or non-solution) to everything, a radical transformation, even if popular.
I was waiting for someone to point out this obvious choice. Some people get to keep their private health care if they want, but we get a public option to buy into Medicare.
But, how can we expand Medicare at all when the entire health care and insurance industry opposes it? We talk about expanding Medicare to cover all, and settle for a public option, that’s how.
We could have had a public option in 2009 if Obama hadn’t wasted a year trying to get Republicans to support it, and if they had gotten rid of Joe Lieberman when they had the chance.
They could get it now if the base forced Democrats to sign on to it, which is likely after the 2020 election.
Whichever Democrat wins in 2020 is going to be publicly committed to Medicare for Everybody – even if this is attacked as “too expensive” or “unrealistic.” So, what do Dems do if they take power? Force through the Public Option.
They will need to abandon the filibuster to do this of course, but they will need to do this anyway. If the GOP loses both Congress and the Presidency in 2020 they will simply go back to obstructing everything Dems want to do, no matter what it is. To break the log-jam they need to abandon the filibuster.
We did get rid of Joe Lieberman. Then he ran as an independent and won.
Lieberman won as an Independent with the tacit support of Obama and Democratic establishment politicians. If Obama had come out forcefully against him, he would have lost to Ned Lamont, who is now CT’s Governor.
Oh, and Hillary would be President if “bipartisan” Obama hadn’t nominated Republican James Comey to be FBI director.
You would think that these horrifically failed experiments in “bipartisanship” or “non partisanship” would have taught the Dems something but the Dem House recently opted to permit Republicans to have a say on issuance of subpoenas (restoring minority rights the Republicans stripped from the Dems) and the Reps continue to slow roll naming members to the Intelligence Committee, rendering it impotent.
The reason why Dems have been unable to get “nice things” like the public option is primarily due to self-inflicted, entirely predictable wounds. I hope they’re learning, but recent actions aren’t promising.
You’re utterly full of shit. The Democrats supported Lamont, the winner of the Democratic primary, in 2006. Former president Clinton warned Lieberman not to run as an independent. The party backed Lamont’s campaign, while Lieberman was forced to rely on his own money to run. Harry Reid and Chuck Schumer issued a statement pledging their support and the support of the DSCC to Lamont. Democratic voters backed Lamont 2-1 in the general election, while Republicans gave him nearly 80% of their votes.
This was two years before Obama was president. However, he explicitly endorsed Lamont, as did Clinton and the vast majority of Democratic officeholders.
In short, you’re simply a liar.
That is certainly possible. But why continue with a system that we know is inefficient. As a transition, of course, but permanently, it is simply wasteful.
I agree employer plans could be part of the solution, even a permanent one. But I think they would simply pay the money to the single payer (Medicare) perhaps as a payroll charge per employee like social security. Employees could also have some deducted from their pay. Employers would no longer be involved in their “own” plans and that will also save money.
I would leave Medicare to negotiate provider fees and to pay them and that should include drug costs. Nothing stops an insurance company from satisfying a need.
. . . employer subsidized plans.”
Based on my experience, that’s either really shitty insurance or a really stingy subsidy from the employer.
As for the parasitic insurance industry
I could see that working ONLY following the Medicare supplemental insurance model (i.e., doesn’t cover anything Medicare DOES cover, only things it doesn’t, like co-pays/co-insurance); but not as direct competition (i.e., covering what Medicare does cover plus “Cadillac” provisions that it doesn’t), cuz I can see no possibility of the latter ever being cost-competitive.
I was just about to jump in and say this very thing, in fact my Senator Gillibrand is already proposing a Medicare buy-in option to help with the transition and has been around through the 2009 ACA fight so would be well positioned to lay out the mechanics and know the pain points of this conversation. She would also be aided by the fact that the Dem coalition and the majority of the USA know the status quo is not working and need to know there is a well known and safe landing pad beneath them when they leap out the window.
Progressives “single payer or bust” fixation has never made political or policy sense unless you put it in the context of them having looked no further than Canada on how other countries have achieved universal coverage.
Looking past Canada most countries have multi-payer systems and and provide better healthcare coverage than Canada or current Medicare. Germany and the Netherlands to name a couple. The path to a system like Germany’s would be much more feasible for our country. It would include the following
COVERAGE SIDE
—————————————-
COST SIDE
I would go back to the “If you like your health care plan, you can keep it” trope. Even in those countries with robust government-run national health insurance agencies, private health insurance exists.
What I think Senator Harris (and others) should propose is to provide a Medicare for all “floor” such that anyone who cannot get health insurance for all the reasons that were discussed during the original ACA debate would be covered by Medicare 4 All (and that includes all Medicaid people). That way, if people wanted to remain on private health insurance, they could. But that would probably also force the private health insurance industry to be more competitive since Medicare is non-profit and has lower administrative costs.
We would do away with all the cumbersome compromises of Obamacare that were meant to appease the private health insurance industry and make the whole thing simpler. However, any Medicare 4 All bill would also need to update the existing Medicare program to make it more cost-effective.
I think Kamala Harris and others make such statements because they want to defend their left flank from the demagoguery of Bernie Sanders and his supporters. I also think a much stronger starting point for her and other candidates would be to insist upon strengthening the provisions of the Affordable Care Act, which is now popular: greater Medicaid expansion, lowering the age of eligibility for Medicare, more robust price support for insurance purchased on the exchanges, etc.
The DKos primary comes before NH and IA.
The good thing about that approach is that it’s a ratchet you can keep cranking.
She’s left the door open to someone willing to support improvements to the ACA and Medicare for America. Not sure who’s going to take that role, but in this primary every opening will be filled.
I can think of two answers to your question about why Kamala Harris is running on this platform, and they are not mutually exclusive.
1.Because sometimes presidential candidates to stake out a position in an important debate, so that it will be discussed, etc. Whether they have a chance of actually winning the nomination is secondary, evento them. A number of commenters on this thread have already noted that the issue is currently not being discussed, despite how important it is. So that’s already a plus.
2. To push the envelope and find out how much support she gets, how the debate evolves, etc., because as long as she doesn’t make it a “campaign PROMISE,” this leaves the option to her (or, as the case may be, other candidates, including the one eventually nominated) to go for a compromise that is still an advance on where we are now.
“Medicare for All” is a very vague slogan. A true single-payer plan in 2021 would be an extraordinarily difficult political lift, IMO impossible with any likely Senate composition even if we nuke the filibuster. The trick will be doing something that can be labelled “M4A” and meaningfully improves the healthcare system.
My suggestion would be a Medicare buy-in – essentially a public option.
The bill for that is currently called Medicare for America, which is sorta confusing. Here you go:
https://delauro.house.gov/media-center/press-releases/delauro-schakowsky-introduce-medicare-america
Kamala Harris came out last night for M4A She had this to say about that:
Until last night she was ok but I am now in her corner.
My family had some of what she said just there. Enough.
. . . just take Rebecca Buck’s tweeted (truncated) word for what Harris says in the clip . . . you get pretty badly misled!
You don’t need 60 votes. You need 50. As Ezra Klein put it in the following article:
https://www.vox.com/policy-and-politics/2017/6/15/15787626/mitch-mcconnell-single-payer-medicare-all
“Instead, they’ll pass what many of them wanted to pass in the first place: a heavily subsidized buy-in program for Medicare or Medicaid, funded by a tax increase on the rich. A policy like that would fit smoothly through the 51-vote reconciliation process, and it will satisfy an angry party seeking the fastest, most defensible path to restoring the Affordable Care Act’s coverage gains.
This is a very different vision than the Affordable Care Act ultimately offered. The Obama administration’s hope with their law was to create private insurance marketplaces that eventually became the coverage option of choice for most Americans. Democrats’ hope with a program based on Medicare buy-in would be that Medicare becomes the coverage option of choice for most Americans. It might not be full single-payer, but it’s a lot closer than where Obamacare was headed.”
Republicans are about to make Medicare-for-all much more likely