Health Care: “Time For Obama to Cross the Rubicon”

By Marshall Auerback, a fund manager and investment strategist who writes for New Deal 2.0.

Many people are lamenting the apparent death of the health care bill in the aftermath of Scott Brown’s unexpected election to the Senate last week. They shouldn’t be. Congress and the President should use the opportunity afforded by the loss of Ted Kennedy’s seat to reconstruct a more sensible piece of legislation which genuinely addresses the real problems posed by our current health care system.

Senate Democrats in particular should not obsess about the number, 60. The absence of a so-called super majority of Senators does not preclude the possibility of passing significant health care reform, even the approach is ultimately more piecemeal and incremental. There is still ample opportunity to implement legislation in the Senate via reconciliation (a parliamentary maneuver which allows legislation to pass with a simple majority vote). And it’s fundamentally more democratic: 2 or 3 Senators should not be able to hold an entire piece of legislation hostage to their own narrow political interests, as Senators Lieberman and Nelson, amongst others, were cynically able to do under the previous legislation.

In response to the “incrementalists” Paul Krugman has argued that it is difficult to achieve significant health care reform via reconciliation, as this Senate procedure is basically limited to matters of taxing and spending, and therefore cannot be used to enact many important aspects of health care reform (such as the ban on pre-existing conditions) What Krugman fails to recognize is that the current incarnation of the health care bill would have done nothing to stop the abusive denial of coverage on the basis of pre-existing conditions, as Yves Smith and I have previously highlighted.

Krugman also embraces the principle flaw inherent in the whole health care reform effort. Both the House AND Senate versions of the bill entrench the centrality of private health insurance companies. But health care is not a service that should be provided by private health insurance companies, as L. Randall Wray has pointed out:

Most health “reform” proposals would somehow insure many or most of these people—mostly by forcing them to buy insurance. All of them have pre-existing conditions, many of which are precisely the type that if known would make them uninsurable if insurance companies could exclude them. While it is likely that only a fraction of the currently uninsured have been explicitly excluded from insurance because of existing conditions (many more are excluded because they cannot afford premiums)—but every one of them has numerous existing conditions and one of the main goals of “reform” is to make it more difficult for insurers to exclude people with existing conditions. In other words, “reform” will require people who do not want to buy insurance to buy it, and will require insurers who do not want to extend insurance to them to provide it. That is not a happy situation even in the best of circumstances.

Contrary to what the President suggested last week, bad salesmanship was not the main problem with this bill. There were lots of unattractive substantive elements, such as reductions in spending on Medicare to “pay” for the bill’s “reforms”, misconceived taxes on “Cadillac plans” to “reduce” health care costs and “fund” reform, a focus on costly end of life care (requiring “guidance” from an “independent group” outside of “normal political channels”), and a loophole big enough to drive a truck through in regard to the prevention of denying health insurance coverage on the basis of pre-existing conditions (which is why the 150,000 strong nurses union ultimately opposed the bill). All of this occurred against the backdrop of vague, incomprehensible talk by the President and his budget director, Peter Orszag, about “game changers” and curve-benders”, and arguments that “we’re going to have to change how doctors think about health care and how patients think about health care”. These are the sorts of things that can be happily debated in a health care symposium, but will hardly ease the fears of the average voter, whose main concerns are: “Will I get coverage?” and “How much will it cost me personally?”

Remember the Alternative Minimum Tax (AMT) which was introduced almost as a footnote to Reagan’s tax reform bill of 1986? At the time, it seemed like a relatively small item as the threshold for the AMT was set at a reasonably high level and it didn’t catch a lot of people initially. But of course, as time went on and incomes rose, more and more of the middle class got trapped by it.

The same thing would have almost certainly occurred in regard to the so-called “Cadillac tax” proposal, a tax on high cost health care premiums ran in excess of $23,000 per annum. Given that neither the House, nor the Senate, versions of the bill contained any serious proposals for cost containment, health insurance premiums likely would have continued to skyrocket, which would have likely guaranteed that an increasing number of health insurance customers would be hit by the tax as time went on. It is hard to see how pricing disclosure via national exchanges would significantly change that element, especially given the fact that the health insurance industry is an oligopoly dominated by a limited number of private companies, with no competition from a now-killed public option alternative. True, in the absence of any kind of health care reform, rising health insurance costs are still likely to remain an everyday reality, but minus the punitive taxation provisions contained in the current bill, which would simply add to the problems of a highly stressed, debt-laden American consumer.

Rapidly rising private health insurance costs are amongst the major reasons why American living standards have continued to decline over the past quarter-century. And an insurance dominated health care program is a horrible way to construct an effective health care system: the benefits of extending health insurance coverage are almost certainly overstated and are not likely to make a major dent in our two comparative gaps: we spend far more than any other nation but do not obtain better outcomes and in important areas actually get worse results. Private health insurance, in fact, represents yet another facet of the ongoing financialization of our economy – credit default swaps, instruments to facilitate speculation in vital commodities such as energy and food, exotic home mortgage products – all of which enable Wall Street gamblers to speculate and profit on outcomes with non-existent social benefit to the rest of us.

In addition to the huge rents extracted from the economy, private health insurance creates other problems, as L. Randall Wray has noted: your friendly health insurance company sells you a policy, and then denies your claim due to the existence of pre-existing conditions (of which you might have been totally unaware), or simply because denial is more profitable and you as the aggrieved victim, are likely have insufficient funding to fight your way through the courts. Bankruptcy is often the end result (according to Steffie Woolhandler, two-thirds of US bankruptcies are due to healthcare bills).

My proposal: use Senate reconciliation and expand Medicare via the Senate’s buy-in provisions. The CBO has already signed off on this as a means of saving money (“budget savings” is nonsensical concept, I know, but let’s go with it, as it provides the necessary political cover for what is essentially a budgetary procedure). More importantly, if more Americans can do a buy-in with Medicare, it creates more cost control (because there’s a genuine “public option” competitor out there against the private insurance companies). It also helps to solve the problems of pre-existing conditions, because Medicare does not deny coverage on this basis, as James Galbraith has noted in “The Predator State”:

Public health insurance entities such as Medicare do not evaluate risk because they are universal. Therefore, they save the major cost associated with private health insurance. They pay their personnel at civil servant salary scales and are under no obligation to provide a return to shareholders via dividends or meet a target rate of return. Insurance in general, therefore, strikes me as something which is intrinsically a service that the public sector can competently provide at lower cost than the private sector, and from the standpoint of the entire population, selective provision of private health insurance is invariably inferior to universal public provision. US private insurance is extraordinarily inefficient and many of the criticisms you level against your post office are replicated in spades at our insurance companies.

Allowing a Medicare buy-in to Americans under 65 would give people a genuine alternative to private health insurance and thereby render the whole issue of denying coverage on the basis of pre-existing conditions moot. It would also lower Medicare costs, by expanding the risk pool of patients (the great bulk of medical expenses are accounted for by a small number of people, mostly the elderly, requiring very expensive treatment). And it would substantially enhance the global competitiveness of American corporations. After all, in what other country in the world is health care a marginal cost of production for business?

A Medicare buy-in would also have the added benefit of getting us closer to single payer, which is a far more rational way to control health care costs, largely due to the administrative complexity associated with our current patchwork system, and the corresponding inability to bargain with suppliers, especially drug companies, for lower prices. Residents of the United States notoriously pay much higher prices for prescription drugs than residents of other advanced countries, including Canada. This proposal would also give American health care consumers far more bang for their buck than the current legislation, which looks set to go down in flames. (What is less appreciated is that both Medicaid and, to an even greater extent, the Veterans’ Administration, get discounts similar to or greater than those received by the Canadian health system – another little known secret of the Obama health care proposals is that they place considerable restrictions on the importation of generic drugs from other countries as part of the deal to get Big Pharma on board ).

Yes, what I’m proposing is politically difficult and the financial reform bill efforts have already illustrated how potently the likes of Wall Street can lobby against effective reform when their perceived vital interests are at stake. Health insurance companies are almost certain to do the same. But, as the festering populist reaction in Massachusetts demonstrates, the foes of reform can overreach and trigger a significant backlash. Hopefully, President Obama and his party will recognize this and mobilize current voter discontent if they want to deliver on real beneficial change in health care. Scott Brown’s surprising election win has bloodied the Democrats. One hopes that the President and his party recognize that, like Shakespeare’s Macbeth, they are “in blood
Stepp’d in so far that, should I wade no more,
Returning were as tedious as go o’er.”

Time to cross the Rubicon, Mr. President.

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  1. Jojo

    I could never get excited about a plan that did not take effect for 4 years.

    What was everyone w/o health insurance supposed to do until then? Everyone who would be denied coverage due to “pre-existing” conditions? Everyone who had to declare bankruptcy until then?

  2. DoctoRx

    Conceptually attractive. If Clinton had pushed for this proposal/idea of his after the big healthcare plan was shot down, perhaps he could have gotten it through.

    Would like to hear how the problem of adverse selection is handled.

    Also, is this for people of all ages? I think the Clinton proposal was for age 55 and above.

    A different point. Major legislation indeed should not obsess about the number 60. It should obsess about the number 70 or 75, so there is a broad consensus.

  3. Kevin de Bruxelles

    Far from crossing the Rubicon, the Obama Administration and their associated media hacks are tasked with shepherding the masses as far away as possible from the Rubicon of reforming health care by expanding upon the core of Medicare. I remember reading about six years ago in a French journal about the real function of Paul Krugman. I’m paraphrasing because I can no longer find the original source but they claimed his job is to protect the wealthy elite’s left flank. As a respected left-leaning opinion maker, he was to build liberal street credibility by being a rare pundit who could give voice to the truth, but only on issues where the decision was no longer in doubt (the Iraq War for example). But on issues of vital importance to the corporate elite, at the time the article was written it was primarily globalization, but since then we see this on TARP, corporate health care, TBTF, etc. his job was to cash in the political capital he had previously gained to divide liberal opinion enough to help get these elite-enriching policies past. He serves the vital purpose of setting the frontier of polite leftist opinion; any further to the left of Krugman and you are in the wilderness and in danger of being branded a radical. In any closed system of media control, he was the crucial voice to own. If any good is coming from the economic crisis and its aftermath, it is that Krugman’s power to push liberal opinion is diminishing.

    And so true to form the left is divided and sound ideas like expanding upon Medicare are considered “the enemy of the good”. The best political way forward, assuming that the Obama Administration will continue to blockade the Rubicon, is to kill the other bill and use the raising political anger to fuel a new, anti-corporatist political party. This party would not have to actually win to achieve its goal. Just the threat of losing its monopoly on power may pressure the two Corporatist parties to give way on expanding Medicare.

  4. attempter

    This is still trying to tinker with something that’s irreparably broken. If it’s politically possible to do the things described here, then it’s possible to dump the whole thing and start over with single-payer, the whole single-payer, and nothing but the single-payer.

    With this issue, just like with the SCOTUS case, and just like with everything else, the dividing line is corporatism vs. democracy. That’s the defining struggle of our time, all issues are truly defined in light of it, and all political positions are positioned according to it, whether people are aware of that or not.

    That’s why looking at anything from any kind of “process” point of view, like so many supposedly rational commentators have with the corporate speech case, is always wrong, and will always put you on the wrong side of things, because the process itself has already been hijacked.

    So with the health racket bill, the issue is simply, is any action taken a blow against the rackets, or does it further entrench them. Any action has to be one or the other.

    Given that fact, to deploy an electron microscope to discern the alleged “benefits” of this bill, and then try to argue that it’s marginally better than doing nothing, is so beside the point that it’s not even wrong.

    It’s very simple: Single payer is reform, any mandate where private rackets exist is anti-reform.

    1. Charley

      Both the House and Senate health insurance reform bill are poison pills.

      They should be killed, and kill health insurance reform, as well.

      The left will be blamed for killing health reform, and they should accept that blame. The process has been so dirtied by Washington that there is no upside to supporting it. The problem was never health insurance in the first place, It is impossible to enact any reform until Washington itself is reformed.

      After killing health insurance reform, people should fight every attempt to raise the debt ceiling for Washington until it is reformed. The left will have allies on the right who will join this fight.

  5. Greg Smith

    You are wrong about Reagan introducing the AMT. It was introduced in 1969 as part of the “Tax Reform Act”. Significant changes (arguably, some that were bad) were made under Reagan in 1986 but the AMT did not originate with him.

  6. run75441


    The Minimum Tax bill was introduced (as you said) in the late sixties as a result of a few hundred people making > $200,000 and not paying taxes.

  7. Vinny G.

    It’s not just advanced economies that guarantee health care to their citizens. Across the entire continent of Europe (Western and Eastern alike), health care is constitutionally guaranteed. Across all these nations, the medical outcomes are far better than in the US, costs are a fraction of what they are in the US, and the overall health of the population is far better than what it is in the US.

    Those here who claim that to be “communism” are clueless, clinging to antiquated ideology. I would not call Germany, France, Spain, Austria, the UK, or any other European nation to be communist.

    While the rest of the world has moved forward, he US had degenerated into a vile, putrid, and criminal capitalist society, rotten and corrupt to the core. The US now resembles a planetary cancerous tumor, bringing nothing but evil to the rest of the world. Fortunately, history has shown us that there are natural mechanisms in place to remove such malignancies from the face of the planet.

    These offensive “reforms” initiated by this castrated president and the decrepit American political system, are nothing but the last, half-baked attempts at saving the evil that this nation stands for, just before our planet’s immune system obliterates this tumor once and for all.


  8. Paul Tioxon

    Without sounding condescending, Yves, let me get this crystal clear, you, a Wall Street adviser, with a history of investment banking for decades, want to expand Medicare’s budget, funding the general population option to buy into this Federal health insurance plan, using the US Senate’s parliamentary procedure of reconciliation? Does Pelosi have a enough votes to do this? It is theoretically doable, but not what so called conservative to moderate Dems, are inclined to because of the unwanted consequence of being voted out of office as a Communist. They are not the bravest bunch out there, or the noblest.

    I agree with you, and so do Representatives in Congress from the December ’09 false alarm compromise:
    But by enlarging Medicare eligibility to Americans 55 and older, from the current 65 and older, the bill has attached itself to an existing government plan, the huge and hugely popular federal health insurance program for seniors. Potentially millions of Americans could sign up for a program that has been embraced by both parties as a safety net for the country’s retirees.

    The notion that the Senate healthcare bill might have suddenly expanded its base of political support quickly took hold Wednesday. President Obama endorsed the compromise. Many liberals who had been disappointed in the derailing of a government-run plan, or so-called public option, to compete with private insurers hailed the Medicare expansion idea.

    “Expanding Medicare is an unvarnished, complete victory for people like me,” said Rep. Anthony Weiner (D-N.Y.). “It’s the mother of all public options. We’ve taken something people know and expanded it.”

    Even Rep. Lynn Woolsey (D-Petaluma), a leader of the Congressional Progressive Caucus and a strong proponent of a government-run plan, was cautiously optimistic.

    “It doesn’t have to be a public option,” Woolsey said. What matters is that the healthcare bill increases competition, affordability and the number of people insured, she said.

    Several key centrist Democrats also endorsed the proposal.

    “It is a very good idea,” said Sen. Mary L. Landrieu (D-La.), one of the Democratic negotiators who had said that she would not vote for a bill that included an entirely new government insurance plan.

    Despite the enthusiasm, the proposal must clear at least one big hurdle: cost. The nonpartisan Congressional Budget Office has not yet analyzed the idea, and its conclusions could be a major factor — positive or negative — in determining whether the compromise opens the way for final Senate action on healthcare.

    I almost cried when I heard that this was the compromise, taking a proven government plan, that everybody knows, likes and supports, right wing capitalists not withstanding, and, I believe, as you have concluded, that it can be done through reconciliation. Other parts of the bill, the removal of the Insurance Industry exemption from the anti trust regulations, real portability and non denial of benefits because you have the nerve to be sick and have an in force policy, etc, can be sent through the other route. This stripping out the expansion of a government program from the main body of legislation is something that had to be done to appease Lieberman. Well, we don’t need him or 8 other obstructionists, there are 51 Senators who said they will vote for a public option, and this fits the bill. If you are familiar with binary compounds, each individually are almost inert, certainly safe, but combined make bombs, nerve gas etc. This binary formulation was developed by University research scientists and criticized as war contracts on campus. However, it was really a peaceful safety precaution, allowing for the harmless transportation of deadly military ordinance through populated areas where rail road tracks passed onto a final shipping point, usually a port facility in a large city, like Philadelphia, Boston etc. By breaking deadly material into two harmless parts and transporting them separately, they could be combined at a later date to create the desired effect. Let’s call Yves suggestion, the Binary Gambit: The reconciliation portion expanding an existing program, Medicare and the secondary, the non controversial but universally beneficial and relatively cost free regulation and reform of the the health insurance industry to make it socially useful. Together, reform, universal health care and cost containment are achieved. It also provides cover for those who do not want to be attached to Medicare expansion. Pelosi may have some votes held back, people who were given dispensation to vote no, because she had more than enough to pass, and vulnerable Dems needed cover. They may be called upon, if some others get weak kneed in the light of recent events. But, this is the route to go. The country needs universal health care and health care industry reform, this is the only realistic way to get both. What is being served up is thin gruel, and we may not have all the time in the world to keep going back and refining it til it’s just right. I just hope you and your associates have some traction with decision makers. More pressure is needed on the Obama administration to keep them from falling into a Beltway Stupor.

  9. run75441


    As I mentioned to a departing Senator Durbin at “Showdown In Chicago”:

    It would be nice if the Democrats, the majority of the majority, would begin to act as if they were the Party of the Majority rather than the party of the Minority they used to be.

    With that said, I am not sure the Dems could raise 50+ votes with all of the blue dog senators who are basically pretend-Dems or more right leaning as Obama appears to be at this time. In any case, Obama needs to rattle a few cages if there is to be any healthcare reform with the passage of the Senate Bill in the House or in the creation of a new healthcare bill.

    I don’t believe you are going to see any work in 2010 on a new heathcare bill as senators and reps alike who are up for election will be working towards it rather than taking on any controversial new bills. I also do not believe we will see a new healthcare proposal before 2012. With both in mind, those presently up for election will be returning to their respective states and districts with nothing to show for their efforts and a lot of explaining to do for producing “nothing.” It is here again that Obama and the Democratic Party needs to start getting tough on the issue of healthcare reform, get accurate information out amongst the population, and move forward with either a new bill or the Senate Bill in the House. Doing nothing just reinforces everything being laid at the Dems feet by the Republicans and everything thought by the constituency.

    We are pretty much left with a Glass Half Full to some and a Glass Half Empty for others. We have a Senate Bill in the House based upon private insurance and public exchanges from which people can purchase heathcare insurance. There are differences between the House and the Senate Bills; but here are some key components in the Senate Bill:

    •Primary care physicians will see increases in their Medicare and Medicaid reimbursements;
    •Insurers will not be allowed to discriminate against customers suffering from “pre-existing conditions.”
    •The legislation provides an additional $10 billion dollars over the next five years for community health centers. This funding will create centers in 10,000 communities.
    •From this point forward, children cannot be denied coverage because of pre-existing conditions.
    •Insurers in the large group market will have to spend 85% of the premiums they spend on medical care.
    •Medicaid expands.—-part-2-of-3.html Maggie Mahar, “Glass Half Full, Glass Half Full-The Senate Has a Bill”

    As far as denial of coverage for a particular ailment, there is a portion of the Senate bill that details a review board for those denials on particular ailments. With healthcare insurance, there is also a cap on how much you can pay. I didn’t see anywhere where they could cancel your entire policy as a result of pre-existing conditions.

    It is important that you separate the cost of healthcare from the cost of healthcare insurance which has a low profit margin as it is . . . 3% and 80-something nationwide in terms of profitability. The 85:1 and 80:1 ratio will force insurance companies to apply more of the premium to payouts as opposed to administrative and profit. Digging a little deeper into the cost scenario, it is the rising cost of healthcare (as opposed to insurance) being the issue. Most would tend to pin this on the aging babyboomer population which is a factor; but, the numerous innovations, new devices, and procedures are the major contributor to healthcare costs. Innovation which often has a low cost/benefit return.

  10. Seal

    We need to make sure Congress’s “Cadillac” plan is fully taxed also.

    The Rubicon? The Potomac is Petraeus’s Rubicon – 2012

  11. grayslady

    Kevin, I wish you would do a search and see if you can find that article about Krugman. Your description of the journal’s premise regarding Krugman would explain so many of his supposed inconsistencies.

  12. Costard

    “the abusive denial of coverage on the basis of pre-existing conditions”

    Insurance: “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril”. You’ll notice that “contingency” and “peril” rest in an entirely different realm of probability – they may happen – than “pre-existing condition” – has already happened. I can stomach your preference of subsidy over insurance, but not your application of “abuse” to an enterprise naturally trying to stay in business… as well accuse an uncooperative victim of abusing his robber.

    “Public health insurance entities such as Medicare do not evaluate risk because they are universal. Therefore, they save the major cost associated with private health insurance.”

    I love Galbraith. Evaluating risk is a cost, he says, but acquiring risk? Nope. I’d love to ask him A) how he would place a price tag on a federal service which, because it makes no distinctions, has potentially infinite payout and B) why is he calling this insurance when it is clear, from the get-go, that he is talking about subsidized care? In which case the question becomes, do we have a civic duty to help those who make poor health decisions (and penalize those who do not)?

    The notion of expanding Medicare would be credible if Medicare were not part and parcel of the existing problems in healthcare. We have partial reimbursement to thank for the bloated costs of treatment outside of insurance. Furthermore, medicare is a large contributor to our pill- and surgery-based (rather than preventative) status quo. In ten years we’ll be talking about medical service and product companies in the same way we currently talk about insurance. How many industries are you prepared to socialize?

    1. Hugh

      Medicare is pretty up front about what it will and will not pay for. Unlike private insurance, it has low overhead and acts to brake rising healthcare costs. It currently covers something like 70% of patient costs. This has allowed overpriced and oftern fraudulent Medicare Plus plans into the market, again on the private side.

      Your interference in health decisions is a red herring for a couple of reasons. First, Medicare currently covers those over 65. Preventative care at that stage of life has some small place but is largely beside the point. Where you get big cost saving effects from preventative care is when you start them in the teens to 40s age groups. Second, this seems a stand in for a rationed care argument. The answer to that is we already have rationed care based not someone’s bad health choices but on their ability to pay, a far less equitable and discriminatory system. Third, with seniors the vast majority of their healthcare expenses come in the last months of life. Much of the care they receive during this period is unnecessary even futile. Although much was made about “death panels”, the real issue is “death with dignity.” There is no colder, more impersonal way or place to die than in a hospital. We have many excellent hospice programs in this country that afford comfort, support, and dignity to the dying. We should build on those. (And since we were talking cost, they are far less expensive than terminal hospital care.)

      Also talking cost, expanding Medicare to 100% coverage and making it available to everyone would vastly increase their cost to government. But the cost to the country as a whole would decrease. This is what we see when we look abroad to single payer plans that produce better results than our bloated, intrinsically unfair system and at half the cost. So if government could recoup 1/2 to 2/3 of the money now going to private insurance companies, it could afford a universal system covering everyone and deliver better care in the bargain.

  13. Hugh

    Kevin de Bruxelle is right about Krugman. When push comes to shove he always opts for the Establishment. I was writing somewhere else today that he doesn’t rock the boat, he just jiggles it from time to time.

    “This is still trying to tinker with something that’s irreparably broken. If it’s politically possible to do the things described here, then it’s possible to dump the whole thing and start over with single-payer, the whole single-payer, and nothing but the single-payer.”

    attempter is exactly right. This is the flaw in all of these “reasonable fix” arguments. If the powers that be were amenable to such sense, they would never have come up with such an awful bill so in need of fixing in the first place.

  14. Econophile

    This emotional response to a complex problem is not the kind of careful analysis I would expect from Naked Capitalist. To suggest the mandated kind of top-down medical “reform” that is Medicare as a cure will only compound the problems of a failing system.

    Medicare is currently the biggest long-term debt bomb facing future generations of Americans. Some call it inter-generational theft. Why anyone would want to support socialized medical care, which is what Medicare is, in light of the huge waste and deficits it has generated? It demonstrate a failure to understand basic economics.

    If one analyzes the world’s various government-controlled health care systems it is precisely these types of top down systems that are the most inefficient, deliver the worst health care, and that are driving countries broke. Canada and the UK are at the top of this list of these systems.

    There is no real free market health care system now. What you perceive as market failures to deliver good health care are the result of government interference in the health care market. Costs are increasing for the reason of a lack of competition and other disincentives created by the government.

    1. Hugh

      You are wrong. Medicare is a payer, not a provider. If you want an example of a government provider, it would be the VA. Your comparisons with the UK are particularly inapt for this reason.

      Again most industrialized countries have some form of single payer, socialized provider, or private insurance as public utility form of healthcare. They spend on average half per capita that we do and have better health outcomes. A single payer system would only need to transfer part of the revenue flow now going to insurance companies to fund a universal system of coverage.

    2. run75441


      What we perceive as a failure of private healthcare is the result of the laissez faire market failure to provide an affordable solution to the issue of healthcare. Medicare undercuts private healthcare by percentages and you wish to tell us privately sponsored is more efficient and less costly. It isn’t. Private healthcare is running amuck with high benefit cost to actual result cost. It is this factor that is driving healthcare cost upwards.

      The long term bomb is the financing of private healthcare. Read and learn:“The Failure to Enact Healthcare Reform” The Urban Institute

  15. Steve in Philly

    The basic premise of this entire line of thinking us wrong: health care is not a right. You cannot define a “right” to be given goods or services by the government. Goods and services are not free. To define rights to goods or services is to enslave the providers of those goods and services to the needs of those who desire them. Such an act is a complete denial of real rights, namely the right to property. It is completely nonsensical to claim that one has a right to health care that requires the violation of someone else’s rights to fulfill. Either property rights exist, or health care is a right – but not both. And if you choose health care, then recognize what that means and accept that you deny property rights. You canno have both.

    1. Hugh

      This is just silly. Is education not a right? It is very much a service provided by the government, and it is universal. As for healthcare, when you take in Medicare, Medicaid, the VA, Tricare, etc. 40 to 50 cents of every healthcare dollar spent in this country is on the public side. You seem to ignore or not know that the government’s involvement in healthcare is already massive. The real question here is why private insurance which does such a shitty job should be allowed in the field at all. The public’s health is very much in the public’s interest and it is this which defines what the government’s responsibility should be in this area.

  16. joebhed

    Just like we get the best Congress that money can buy, we will get the best health care that we can afford – which is about this level.

    Our basic health has become an inane budget battle. It’s time to take a broader look than even Mr. Auerbach is willing to advance.
    A quick read of Ellen Brown’s latest proposal here just makes so much more sense, because it will end up being so much more healthy.

  17. d4winds

    The Rubicon was crossed prior to his inauguration by the Senate when it kept the filibuster rules without modification.

  18. foghorn

    Who says property is a right? Why should I have to pay taxes to provide for police to protect your property,and a legal system to adjucate title? If we decide property is a right then we can just as easily decide health care is a right.

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