Lambert here: As I’ve been saying….
By Dan Fejes, who lives in northeast Ohio. Cross posted from Pruning Shears
Here is an interesting thing about the new health care law: News stories on it sometimes conflate flaws in the existing system with those in the new one. Many complaints about Obamacare are actually complaints about America’s health care system.
The administration bears some blame for that; the White House has done some conflating of its own. Most famously, the president assured us we would be able to keep our plans. That was never a promise he was in a position to keep. The new program still goes through the private insurance market, which means they decide what customers are restricted to.
But that has always been the case. Insurers playing around with provider networks, policies etc. is a longstanding feature of the system. It’s not as though Obamacare introduced it. It was foolish, though, for the president to speak as though he was the one in charge of that. The only way to guarantee that is to prohibit insurers from altering their policies.
Here is another example of bad policy that predates Obamacare. As the saying goes, programs for the poor are poor programs. Meaning, there will never be a formidable Big Poverty lobby on K Street, so programs that are means tested will not have natural allies in the halls of power. However well intended (and effective) they are at launch, over time they will languish and get chipped away at. Universal programs are much more robust and likely to not just survive but thrive over the long term.
We have something like a controlled experiment in that when it comes to the federal government and health care. There’s a universal program (Medicare) and a means-tested one (Medicaid). Any politician who supports Medicare cuts immediately becomes an endangered species. Medicaid cuts, though, are fair game.
Washington state, for instance, expanded its Medicaid “estate recovery” provision in 2004 to include all medical expenses, not just long term care. So should your net worth not be entirely wiped out by that end-of-life nursing home stay, should you have some small amount left over that you were thinking might help your survivors defray the cost of, say, your funeral: Forget it. The state will also charge you for the aspirin you popped along the way.
But because this happened to a means tested program, not a universal one, who (that matters, anyway) was going to raise a fuss?
Fast forward to Obamacare. Medicaid expands and begins taking in people at higher incomes. Suddenly, people scraping the lower end of the middle class are eligible for benefits. While this group is not exactly calling the shots, it can create at least a little noise:
The state issued notice Monday that it will amend its estate recovery policy to avoid “unintended consequences” for people who enroll in Medicaid for health care under the expansion made possible by the Affordable Care Act.
And the state basically admitted, as diplomatically as possible, that no one really cared when only the desperately poor were getting that treatment:
The agency said the new rule was “largely non-controversial” for most of that time, but that “new concerns were raised recently due to the different population of uninsured, non-disabled adults now being served under Medicaid expansion.”
Just like with private insurance companies jerking people around, this really bad policy was only highlighted by Obamacare – not created by it. Yet fairly or not, in the popular imagination it’s all getting filed under “Obamacare sucks.” Many people discovering, as though for the first time, the shortcomings of for-profit health insurance and means-tested health care. They might therefore be especially receptive to expanding a program that shares neither of their weaknesses: Medicare.
An emerging theme on the left is that national single payer, forever praised to the skies in theory, is not achievable these days because that energy is better directed towards single payer efforts in states. Two responses to that: First, the most likely states for such efforts are still years away from achieving that goal, and in any event success is not guaranteed. Vermont has actually passed a single payer bill, but it cannot be implemented until a federal waiver is granted in 2017.
What is the advice for uninsured Vermonters for the next four years? Don’t get sick? As for the states that are supposed to follow in short(ish) order, I’ll just note that California twice passed single payer when it faced certain veto. Now that a presumably friendly governor is in office the road is apparently clear, but still nothing. States might act with what the state-by-state theory would find a curious slowness.
Second, even if states like California followed Vermont’s lead, there is no inexorable logic that would force all the other states to do so. The domino theory won’t work on health care any more than it did for communism. State-by-state single payer will improve health care in states where it passes, but it will consign those in states hostile to it to ongoing misery. Proponents of the strategy should be honest enough to acknowledge that, not pretend that Alabama is somehow obligated to ape Vermont.
We are forever told by our political betters in the church of the savvy that Medicare for all is a noble pipe dream, and only the unserious agitate for it. Of course, that was the conventional wisdom about expanding Social Security until not too long ago. Suddenly it has become acceptable to talk about it though.
There will be midterm elections in under a year. Do you know what might be savvy? To run on a Medicare For All platform – a promise to actually do something, not just belch out bromides – and jam the hell out of Republicans who are preparing to ostentatiously campaign on their love for the program. Of course, that’s provided that the party in question actually believed its rhetoric and was not simply deploying it to forever dupe the rubes.
The only way that change happens is to keep pushing. And in any event, it’s always good to favor the best actual policy. Things are impossible until they are not. Ideas are outrageous until they cease to be.
Here is the elephant in the room.
It is IMPOSSIBLE to have ‘single payer’ if we do not restrict immigration.
If every Mexican [… –lambert] who sneaks over the border […–lambert] can get total access health care, well, that can’t be sustained.
Single payer – ‘medicare for all’ – is only workable if the entire rest of the world can’t immediately access it.
Hopefully the above false statement will be removed.
Interesting that your VERY first response, Akaison, is to hope that the “false statement would be removed.” I find it really creepy when sites remove posts as a sort of “quality control.” I thought that if someone posts something one disagreed with, one debated it; one didn’t hope for its convenient disappearance. It is especially important to debate points that are not intuitively true, rather than just demanding their erasure due to “falsehood”.
The other night I was debating a political point with someone. Someone nearby came up; he was very offended by one of us. The first thing that he said was that the person he disagreed with, should NOT be making those debate points in public. Then he said that it would be better if that person were “offed,” for holding those views. Oh, BTW, this offended bystander was an ultraliberal. In the old days, it was the right wing that wanted to erase opposing viewpoints; now it’s both sides.
I know that you have now posted refutations, but your first statement and the sentiment it expresses stands.
Oh, and guess what – the person I was debating and I, each learned something, and each shifted some of our opinions.
THERE IS NO NEED TO DEBATE A LIE. IT SHOULD BE REMOVED FOR THE RACISTS BULLSHIT THAT IT IS. IGNORANT IDEALISTS NEED TO UNDERSTAND THEIR ROLE IN THE SUSTAINING THE SUPERSTRUCTURE OF LIES THAT CREATE ONGOING POLITICAL DOMINATION BY THOSE WITH PRIVILEGE AND POWER, AND MAYBE LEARN ABOUT THE SUBJECTS THEY DEMAND TO BE DEBATED!
Mexico Guarantees Universal Health Care in its Constitution
The Right to Health in Mexico: Seguro Popular
by: Hanna Jaff
During the past few years, Mexico has proven to be one of the most important advocates with regards to the notion of the right to health: through legal reforms and public program implementations, the State has proved how it is truly committed to ensuring its population’s health needs are met. By the year 2000, after a major change in the political direction and democratization of the State, Mexico was catalogued by the World Health Organization as having major issues with financial justice, with regards to healthcare, resulting in its people having little access to the health system. In other words, economic burdens were so unequally concentrated that most people did not have any access to the health system, which is why by 2003, the now famous Seguro Popular was proposed.
In 2003, most Mexican families had no access to the health system, for a number of reasons, primarily including a lack of economic resources and unemployment. Before the installment of the Seguro Popular, more than 50% of Mexico’s population was uninsured (Knaul et. al., 2003), which not only resulted in massive out-of-pocket expenses, but also less access to the health system for the entire population, reduced quality in health services, and inefficient use of resources. The creation of the Seguro Popular was a response to the lack of effectiveness of the Mexican health system, as well as the lack of access most of the population had to health insurance. It was intended to assure that the entire population was insured and could have access to healthcare, regardless of their conditions. It was specifically designed to target the population’s poorest sectors
Mexico’s public health system is quite noteworthy, which is why I will briefly explain how it works. Mexico has a history of structural inequalities and income concentration that have led to inequities in access to basic services, including the health system. Healthcare providers are both public and private, though the public system is notoriously more popular, and it includes the Instituto Mexicano del Seguro Social or IMSS (Mexican Institute of Social Security) and the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado or ISSTE (Institute of Security and Social Services for State Workers).
According to Mexican law, all workers have a right to be affiliated to the IMSS, through a system by which employers have to pay a minimum quota for each worker. This excludes workers hired on a non-contract basis that are paid only for services rendered, hence having no right to the health benefits provided by the law. The ISSSTE works in the same way, but it is only for State workers. Workers also insure their families through these public institutions. Those who are left out from any of these public providers, either because they are unemployed, or because their jobs exclude them from being affiliated, have to either purchase private health insurance, or have none at all. The latter seemed to be the majority of the cases before the Seguro Popular was instated in 2003.
By 2003, the Ley General de Salud (Health Law) was reformed so as to create the Sistema de Protección Social en Salud (System of Social Protection for Health). The Seguro Popular is implemented through the Sistema de Protección Social en Salud. The latter had anticipated that by 2010, 100% of the population would have health coverage (WHO, 2006). The Seguro Popular is in no way a mandatory insurance that all uninsured Mexicans must acquire. It is actually a voluntary public insurance for people without access to Social Security. The Seguro Popular represents the Mexican government’s compromise and obligation to provide healthcare to its entire population, regardless of each person’s particular conditions, which is reminiscent of the notion of the right to health, from a human rights perspective.
Article 4 of the Mexican Constitution stipulates that all persons have a right to the protection of their health, for which laws will provide the ways in which the federation and the states will concur to provide health services (2009). Furthermore, this article (as part of the Mexican Constitution’s Bill of Rights) establishes the right that every person has to an environment for his or her development and wellbeing, which further alludes to the human rights perspective. This shows how Mexico’s most important legal document, the Constitution, from which all other laws and treaties must derive, and under which the entire State is organized, recognizes the right to health, or at least, the right to the protection of health and the State’s obligation to provide the means by which it should be realized.
Thus, in accordance with article 4 of the Constitution, the Seguro Popular was created in 2003, but it was not until the beginning of 2004 that it was implemented on the national and state levels. As mentioned above, the Seguro Popular is not mandatory, but is intended to cover all families that have otherwise no access to the health system, which are generally lower income families. By insuring the country’s less fortunate population, combined with the public health institutions already in place, the Mexican government is surely providing the means by which to assure the right to health is respected.
I call these types the Enablers.
Their function is to navel gaze, sip tea, discuss how great it is that we can have civil debate, and do anything but understand that time wasted refuting a lie, is time wasted refuting a lie.
No, actually we’re “old fashioned liberals.”
You are claiming that refuting a lie is wasted time, but you just spent your time at it. Was it really wasted time?
You seem to be assuming that everyone you meet, already knows every bit of info you do. You are also assuming that anyone who holds an opposing view, does so for bad reasons. That no-one out there can learn anything from you, and that you can learn nothing from anyone else. That is very depressing, but fortunately I think you are incorrect in your view of Americans.
To say that there is “no need do debate a lie” begs the question. BTW, I notice that you just debated the point.
Restricting government benefits to citizens and legal residents is not only a reasonable policy, you really can’t administer universal benefits otherwise. Of course Mexico, like other countries, has a better health care program than the U.S.
The rubber hits the road, unfortunately, when a system has to deal with a lot of old and sick people. Mexico now has a constitutional right to health care for its citizens. Well, that’s nice, but alas a right doesn’t bring funding and doctors with it. Since Mexican people were starting with such a low level of availability, and their population is so young and healthy compared with the U.S., getting a GP may really mean something to someone there now, and it is very cheap to provide GP care. But I would want to see what specialists are genuinely available to them, before assessing how good it is. The only articles I have seen re the Mexican health care system have described people who had no health care, suddenly getting what you might get in a community clinic in the U.S.. Do they have a better “system” than us? Well, we don’t even seem to have a system. Do they have better actual care? I would like more info re that, if it isn’t considered “racist” (LOL) to want more info re a system we might want to try.
see, here we go. I remember this story, because it was so horrible. It is from 2010 (from the Worker’s World; heh, a notorious racist right wing rag)(actually I read it originally in the MSM): http://www.workers.org/2010/us/atlanta_0909/
Horrible story about undocumented workers in Atlanta getting no-cost to them dialysis; program shutting down; their being sent back to their countries of origin and literally dying because no dialysis was available to them there:
“However, at least nine of the ousted patients have died in the months since the clinic closed, including 23-year-old Ariana Ríos Fernández, who died on Nov. 28 in Durango, Mexico. The mother of two returned to Mexico, where each dialysis treatment cost $118. Although her father sold everything he could and borrowed money, they could only afford two sessions a week.”
Well, I hope that Mexico has gotten some free dialysis programs in place since 2010. Any updates would be appreciated.
To combat the attempt at identity politics above to block single payer, here’s some data
To combat the obvious false claims
I suppose its a sign of fear that someone felt the need to use the red herring of undocumented immigrants to try to argue against single payer
See, that was a very interesting Kaiser article. I’m not sure that the articles re Europe are really on point. If the nasty/bad/wrong post that had so offended you had been removed, no-one would have gotten to read the Kaiser article.
I love free speech. It is everything, and then everything again.
actually, VERY interesting Kaiser article. did you notice this part:
“Undocumented immigrants who seek care at health centers and clinics are typically billed on a sliding scale based on their ability to pay.
If illegal immigrants cannot pay their bills, hospitals and other providers first look to the federal government and charities for help in covering their uncompensated costs. The federal government, through the Disproportional Share Hospital program, allotted about $20 billion in 2009 to help hospitals and providers cover the costs they incurred treating uninsured patients, including citizens, legal immigrants and the undocumented.
But those government funds are generally not enough to cover the costs, and hospitals raise their fees for other patients to help provide the revenues needed to treat the uninsured.
Researchers estimate the cost of all uncompensated care was roughly $56 billion in 2008, according to a recent study published in the journal Health Affairs. However, because hospitals cannot inquire whether a patient is in the country illegally, it is difficult to tease out the cost of uncompensated care attributed to illegal immigrants.”
Well, we know that this cost shifting happened, in order to pay for the care of uninsured citizens and the uninsured undocumented. But my impression is that Obamacare is going to make cost shifting much harder; there are going to be many hospitals that have far fewer “regular pay” patients to add to their treatment slush fund, since so few of the Obamacare policies include them. There may be much less money around for the undocumented in this arrangement. I have seen reference to this issue elsewhere, but the Kaiser article was a good addition.
Health care 2.7 trillion
20 billion is less than 1 percent
In fact much less
.0007 give ir take a zero
If you look at Europe their issues there also show negligible impact on universal health care
Recheck your math. The correct answer is $20B is approx. (didn’t use calculator so small rounding error introduced) 0.75% of $2.7T. $27B would be 1%, or 1/100th of $2.7T.
How many people know that essentially all the people who would remain uninsured under the ACA, at least prior to the addition of people caused by the Supremely Political Court rule that Medicaid expansion was optional, were illegal/undocumented workers.
Its still a negligible number
Do you not understand that
Yes, that was my point. Akaison had decided that I was evil, and so she didn’t see that my point was that the undocumented were going to be newly screwed. That money that had been available to help them, would not be available. Rage doesn’t help the reading or the calculation processes; that’s why it is good to debate points with info.
Actually I think the $56 billion figure is the relevant one, not the $20 billion figure, since it is the amount in total that was spent on the uninsured (citizen and undocumented), and it is the amount whose availability is now in question: http://www.theatlantic.com/politics/archive/2013/12/obamacare-bars-illegal-immigrants-and-sticks-hospitals-with-the-bill/282444/
“The law also trims $22 billion from Medicaid charity-care reimbursements. Those cuts were approved with the reasoning that when most Americans were required to have insurance, hospitals would be stuck footing fewer bills for the uninsured. That’s generally true, but the logic falls apart in immigrant hubs such as New York, where nearly 70 percent of uninsured patients in the city’s public hospitals and clinics are also undocumented.”
The evil here is basing a discussionwhich only has as its goal to blame the problem on the Brown people.There really is such thing as “is a conversation repugnant before you even dig into the details?”
what’s evil is the acceptance of the discussion as per se valid, again my comparison is that this is equivalent of yelling “fire” in a theater becausethe poster knows it has that power. Its also increndibly easy to google all this. Like it took me minutes. What couldn’t any of you before legitimizing the exchange as valid?
Free speech isn’t everything
Like all ideas, it should be balanced with harm
Spreading false clams to incite racial or ethnic animus is about has helpful as yelling fire in a movie theater
Finally are online at a owned blog
Not the government
Free speech does not apply even if you managed ti shoehorn the attempts to incite into “free speech ”
Neither the site own nor anyone else should have to put up with people lying
Lies such as claims that the bill for the uninsured was 0.0007% of total healthcare expenses? Or that Vermont will have to wait until 2017 to get their waiver, when they plan to request the waiver this coming session for next year (unknown if will be successful, but also unknown that it won’t). Or that attempting a federal Medicare for all is preferable because there’s no confidence that other states will find any predecessor’s experience to be a compelling case to convert to single-payer, yet simultaneously so much confidence that the blogger is willing to bet the bank on a federal plan that if rejected, helps nobody.
If you recall, Medicare was implemented in steps. Initially there was only Part A coverage. Social Security and Medicare also were not implemented in the same environment where more billions of dollars have been pumped into widespread corporate lobbying and preferential treatment being accorded to private business than any other sector and any time in history, and a successful bid for national office requires large coffers with the types of campaign donations that only those who benefit from our dysfunctional system can typically afford.
Nobody has lied. Used lousy arguments, or was misinformed perhaps, but it isn’t lying.
lucy, i’m surprised to see you say vermont is planning to request the waiver ahead of this coming (u.s. congress?) session for next year (i.e. for a waiver as of 2014? 2015?). i’m in vermont with good access to state info, and i’m concerned about the wait until 2017 for the waiver and am following this issue, yet as of this writing i have not seen anything indicating such a plan regarding the vt waiver. can you direct me to your source of this info? thanks!
I don’t recall now where I originally read about moving up the request for the waiver (email newsletter from Bernie Sanders perhaps?), but here are two sources a quick search turned up.
This article states 2014 as the year the legislation to move up the waiver, though the story is a year and half old:
From October 2013, a timeline placing request for waiver in early 2015.
The implementation would still be scheduled for 2017.
I did the math in my head
A lie such as claiming that the numbers we are discussing is relevant the health care debate. Even with numerical correction, you are still enabling lies from a math stand point. My error was small. Yours is huge.
But because it makes “Liberals” feel important to argue and debate lies we go in circles.
I have not checked out the claims that were made have you? I think free-speech, particularly on sites like this are critical. When you use power to repress others rather than listening everyone suffers. Also, here, I don’t think anti-Mexican statements would incite anyone to hate Mexicans or the Mexican government. We should be free to criticize all governments and cultures. I would hope we would do it with respect and not with sweeping statements but sometimes passion gets the better of us–and sometimes that passion can be turned into something positive even if it starts out as a negative–I’ve found that to be the case in pesonal conversations where we meet face to face. On the internet such back and forth is very, very, very rare–it’s always on the level of I’m right and you’re wrong or just agreement which is very non-dynamic–nothing will change with agreement.
In closing, I think that political correctness may have been one of the most destructive movements to the left when it started in the seventies.
What I think us that yelling fire in a theater would be okay by you and there is no reasonable discussion to be had about the subject
by the way, the comment about “political correctness” underscores who you are, rather than what I have said.
If someone writes a false statement, and its knowingly false, that’s not political correctness and nor do I need to defend my position about it.
The fact you and other are so willing to enable this sort of crap is why you lose.
Banger, you’d be right — and that’s exactly why that movement came into being: to colonize and impair left criticism. Divide-et-impera, always and forever, and Westerners love to play along…
The other possibility is that its divide and conquer arguments being pushed now that the private insurers are running out of excuses
Troll, much? (Actually a badge of honor the post is targeted.)
Nah, they’ll just go to Canada. Almost makes you wish for that Trans-American Highway now doesn’t it? ;)
To broaden the scope of you comment, no less a luminary than the Founding Father of Neoliberalism, Milton Friedman, famously stated that you can have open borders, or you can have a welfare state, but you cannot over time have both. And of course, Mr. Friedman strongly and openly supported illegal immigration, particularly the low-skill variant. He was well aware that over time, flooding a wealthy country with poor people would eventually destroy the welfare state within that country. He would be well pleased to see the supposed Left / Progressives in such a tight strategic alliance with Neoliberalism in their rabid support for non-white low-skill illegal immigration.
Popular working class political parties in Europe recognize this obvious fact and in recent years have increased their support among former left-leaning voters by explicitly linking low-skill immigration restrictions to the need to protect the nation’s welfare system. The real debate is no longer between Socialist and Conservative parties but now between bourgeois-oriented Neoliberal Globalizers (Socialists and Conservatives) and native working class -oriented Nationalists.
The addition of low-skill immigrants decreases the wage levels of native low-skill citizens (who compete for the same jobs) and so welfare rolls are fatten in the process. Ideological open border Libertarians debate this but the racial taboos enforced by the Progressive Left inhibit any discussions in their camps. Corporations love it, they get lower wages and they get their payrolls subsidized by the state. But as the gulf between rich and poor widens, and as diversity destroys social cohesion, the welfare state starts to crumble. The rich gain more political power and are able to divert more of the nation’s wealth to themselves, while the poor make increasing demands on a decreasingly productive economy. The big losers the native working classes and so ideological demonization is required (union thugs on the right, racist gun nuts on the left).
And so Obamacare is an obvious manifestation of this process. While it supposedly promises to expand the welfare state, of course the real goal is to replace Medicare with a privatized caricature is this successful program and to continue the process of lowering the standard of living of the majority of Americans.
“But as the gulf between rich and poor widens, and as diversity destroys social cohesion, the welfare state starts to crumble. The rich gain more political power and are able to divert more of the nation’s wealth to themselves, while the poor make increasing demands on a decreasingly productive economy.”
please provide further info–when and where has this happened?
“…when and where…?”
Have you looked out the window lately?
sorry, i meant the bit where as a result of “the addition of low-skill immigrants,” “diversity destroys social cohesion” thus leading to the consequences i quoted. i want to know when and where these 2 specific drivers have specifically, documentedly led to these consequences.
: is it the “addition of such immigrants” and the resultant “diversity” that causes the problems described, or could it be, at least as much, due to the way the society wherein these 2 phenomena occur responds to them? and could it have more to do with power-seeking agents who stir up xenophobia and racism for their own ends?
immigration of low-skill workers has brought advantages to various societies in various times and circumstances, and more than one society has existed with great diversity for centuries with no cost to social cohesion or other ill economic or social effects.
The United States from 1978 to the present time. The change in public attitudes towards the poor, for example, have never been more toxic because the ruling class, through talk-radio and later Fox News were from one direction able to break up the working-class alliance that kept the Democratic Party as a mildly progressive party by using culture-war and racial politics. On the other side the Wall Street Democrats were able to make sure money would equal influence in the Democratic Party through the DLC and other alliances that focused strictly on middle-class issues of security, drug-war, jailing minorities and perpetual war while the upper middle-class became increasingly isolated and self-referential (the NPR-ization of middlebrow culture).
Examples of the rich looting would be the bails-outs like TARP and the decline of taxpaying among powerful corporations. Examples of the poor making increasing demands on society include food stamps payments increasing from $20 billion in 2000 to $82 billion in 2013. During the same period federal welfare payments have increased from around $600 billion to $927 billion.
As for diversity destroying social cohesion just take a look at the US states by Gini coefficient ranking; Utah, Alaska, Wyoming, New Hampshire and Iowa top the list.
Although Hawaii is obviously an outlier, most of the US states with the fairest distribution of incomes are those with low diversity. Highly diverse states, whether they be liberal wonderlands like California, Massachusetts, or New York on the one hand or conservative utopias like Texas, Alabama, or Mississippi on the other, have much more unfair distributions of income.
I think you are right on the money here. One of the interesting problems we face is a lack of true dialectic. We rarely listen to the right’s arguments on many issues we simply assume that if they are on the right they are wrong because they are either all crazy or are agents or dupes of the Koch’s and their fellow travelers. This is simply unacceptable and will only continue to ghettoize the left into utter futility.
We need more openness and more dialogue on all the issues–maybe they have a point about immigration–maybe they aren’t all racists–maybe they are observing things and not simply reacting out of fear and misinformation. I have found that almost any argument on any important subject has some basis in truth. There is a legit argument to limit immigration and there’s a legit argument for many points in between there and open-borders. These all bring up very important issues of what is a “country” or a “nation”? What do we mean by globalization? Many other such things all need definition and discussion rather than knee-jerk reaction.
If every Mexican racist who sneaks over the border (that’s not a slander: the Mexican people are OFFICIALLY racist, check out their immigration policy on wikipedia)
Leaving aside the sweeping generalization (if Bush Jr. attacks Iraq for no good reason, does that make every American citizen a warmonger?) I couldn’t find any evidence to support this statement. I did as you suggested (checked the Wikipedia page on Mexican immigration) and couldn’t find any evidence of race-based policy, or any mention of race at all.
My guess is that Brian Schweitzer will run for Prez on a national healthcare plan.
That would be excellent. It would be nice to have a Democrat dragging the Overton Window left. Of course, ObamaCare is a “national healthcare plan” of a sort.
Well, except it’s not national, not about health care, and so chaotic it’s not really a plan. But other than that….
A major problem that has been around for many years is how terrible Medicaid is, if you need a specialist. When most of the people on Medicaid were kids, it was less of an issue. Now with huge numbers of seriously sick adults on Medicaid, it will be a HUGE issue; it will be horrible. We will see a million articles re how these new Medicaid recipients are getting only GP care and are dying because there are virtually no specialists who treat Medicaid patients. However, this problem has existed all along. It is an issue that, as the post writer correctly points out, is now going to affect a better off and more vocal group of people, and the problem will come out of the shadows.
Yes, Medicaid is an even narrower network.
Because ObamaCare mandates that Medicaid reimbursements be raised to match that of Medicare reimbursements, Medicaid reimbursements aren’t small potatoes for hospitals anymore. Thanks to ObamaCare, Medicaid will soon become a significant source of corporate welfare for hospitals, particularly so-called “safety-net” hospitals. But if you think about it, hospitals wouldn’t need all of this welfare money from Medicaid if they didn’t hand out million-dollar salaries to their senior management staff and spend millions of dollars to make their facilities resemble five-star luxury hotels.
Unfortunately, hospital have no intentions of taking additional Medicaid dollars to provide better patient care for the poor and disabled. Instead, they will use this welfare money to fatten the paychecks of those who are living it up in the corporate suite and spend it on gourmet meals, crystal chandeliers, granite floors and other such frivolous and inconsequential things that contribute absolutely nothing to the goal of improving patient care and reducing hospital stay.
HR 676, our perennial single payer bill, has been is designed to cover all “residents,” not just citizens. Even then, US health care costs are cut in two. The real drivers of costs within our system are the for profit health insurance companies, for profit drug companies, fee for service billing without global budgeting, and sundry other aspects of our system.
“Single payer” is becoming a part of public discourse. The arguments are so overwhelmingly in favor of single payer over our current system that any efforts for state single payer will move single payer forward as our national health care system. The people of Vermont know a lot about single payer due to grassroots organizing on the issue. SEIU has just endorsed NYS single payer. Cigna and others: we are coming for you.
Yes … undocumented migrants come to the United States for a job. A job that one way or another includes health care services just means they will be more productive undocumented migrants. It doesn’t mean there will be a big flood of undocumented migrants coming to the United States for the health care.
Indeed, witness the single payer systems elsewhere in the world that fail to suck the entire rest of the world population into their country for the single payer health insurance coverage.
Other countries police their borders.
What ever happened to the concept of ‘Public Service?’
An uncle of mine back in Scotland was put through medical school in the way back by his church. He then had to work for several years as a medical missionary in the heart of Africa, Uganda to be exact. He and his family survived the Amin years and are, as far as I know, still there. If the Masters of the Universe, (“I have the power!”) want to treat us like Third World denizens, they’d better be prepared to accept all that that entails, including free medical in lonely outposts deep in the Urban Jungles.
FDR let slip the secret “In politics, nothing happens by accident…” Obamacare is humming along like a finely tuned automobile. There are several purposes: the end of privacy, direct access to private savings with the IRS as muscle, full regimentation of the big pharma drug paradigm, mandatory vaccines, further impoverishment of the middle class, fear of computer breaches, and simple time-wasting. Government (Federal) incompetence devolves unerringly to the common man, whilst Washington caters meticulously to our insanely rich overlords. Fifty years ago we smiled wanly at the Russkies waiting in lines for toilet paper, now we find ourselves waiting ON line in the hopes of protecting our families against medical bankruptcy.
The problem (and downfall) of by-state single payer implementation is that states have NO ABILITY to control their pool of insured. Lacking this ability, the early states that attempt to do this will be flooded by non-residents from neighboring states with poor health records and in need of continuous medical care. Even Vermont, who is determined to do this, has suddenly started to mumble about “how to pay” for their program, something that wouldn’t actually be very hard unless they’ve suddenly started to notice this pooling problem.
Governance in the United States has tons of oddities and anomalies, much like Bourbon France, and one of which is how casual the process of determining which state a citizen is a resident of is so slap-dash. I agree that one of the effects of this is to keep any state from setting up an universal benefits system notably more generous than what the federal government provides for.
Before any of you here put the onus on the doctors for healthcare cost, you might wish to check out this graph:
Medical care is the only business enterprise which claims to save money by increasing the number of middle men.
Why the sudden and eye-popping spike in the early 1990s?
Maybe Wall Street realized that medical care was virgin territory for big profits. Maybe it was the growth of “managed care”, networks and so on.
I suspect state deregulation and ending of mandates had a role to play, and the old hospital companies didn’t necessarily have boards willing to shift to parasitical operations over night.
Ted Kennedy had to brought on board, and if I recall the Nixon tapes segment on the matter, Nixon had to be confused about what they were doing. Nixon voiced the VP’s opposition to the proposed HMO Act of 1973. I suspect part of the problem was the people controlling hospitals weren’t on board.
Combined with no fear of regulators and the retirement of older board members or more accurately the dominant one who wasn’t a crook (most are there for the title), then everything was in play all of a sudden.
One other issue is crooks may be crooks, but they aren’t necessarily intelligent. Until they hear stories about people getting rich off hospitals, it may not occur to them.
Good question, Old Hickory. My guess is that the early 90s was about the time when the medical-industrial complex really started to take off in a very big way. The Cold War was coming to a close, leaving plenty of public capital as well private capital around to fill this void. Administrators and other parasites in the back office saw this as an opportune time to divert healthcare dollars away doctors and towards themelves. Monetary compensation in healthcare has become so skewed to the back office that the highest paid employee of a hospital is no longer the top surgeon, but is now the top administrator — something that was unheard of prior to the 90s.
I often hear physicians complain about this, which is perfectly understandable. After all, no one chooses to go to a particular hospital because of the quality of its administrative staff, they do so because of the quality of its medical staff. So explain to me why more and more healthcare dollars are going to those in the back office, and not to those on the front lines of care?
this book comes highly recommended by an NC commenter and by amazon reviewers:
The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry, by Paul Starr
published in the 1980s, but perhaps a good source for the deeper background we need to understand better.
Its said the racist comment still remains and is being defended.
Do you ever punch out?
When in doubt , try to distract, right?
Got anything better to argue than calls for limiting debate? I don’t even see the post as racist (though I’m not sure if Lambert edited it). I mean sure racism could be a motive behind the post, but I don’t assume mind-reading ability.
“Here is an interesting thing about the new health care law: News stories on it sometimes conflate flaws in the existing system with those in the new one. Many complaints about Obamacare are actually complaints about America’s health care system.”
As other have mentioned, this “interesting thing” is not an accident. Obamacare was designed to erode public trust in government. From the perspective of our neoliberal masters, it is brilliant policy/politics – when it “fails” by it’s own terms, it further entrenches the concept of Mr. Market ruling every aspect of our lives.
The Obamacare wreckage will be used to rationalize the dismantling of Social Security, Medicare, public education, etc.
From the perspective of an anarchist, the so-called progressive dogma on healthcare is like being sucked into the vortex of the twilight zone. Above, James Arnold gives a fairly accurate description of Obamacare. This is what government has delivered. Prior to heavy government involvement in healthcare – before Medicare, Medicaid and thousands of regulations to “help” consumers – there were lodge systems, cheap hospitalization insurance, and low-cost GP doctors and low-cost drugs. Yet, “progressives” seem to fear “Mr. Market” and greedy monopolists worse than death itself while “Mr. Market” doesn’t exist (how could it when government spent 40% of the healthcare dollars even prior to Obamacare), and while embracing Mr. Government (despite the blatant cronyism and alliance with big business). Why is there no fear of the total monopoly government would have under a single payer system? Is that because government is so pure and righteous?
The concept that government and democracy is so great based on electing the right people is not believable. I’d suggest Americans have never been able to elect the “right people” and either has any other democracy. Europe has been unable to sustain welfare states, Greece being a shining example of economic sustainability and near complete failure. And Europe isn’t trying to maintain a huge warfare state at the same time as America does.
Perhaps I could take “progressives” a little more seriously if they were not seeking half-ass reforms of the police/surveillance/warfare state that America has become, and instead lobbied for abolishing it with the same vigor as they call for a single-payer system. Maybe the Pentagon could manage the healthcare system?
But remember, the people you want to have 100% control over your healthcare are the same people that give trillions to banksters and war profiteers, and they are the same people who maintain kill lists and want to monitor every word you say and every dime you spend.
Yeah, it was pretty awesome when black male life expectancy at birth was 33:
Must have been all of that non-coercive, unregulated, government-free anarchist gifting and spontaneity.
Dan, I think you are experiencing a disconnect. Government involvement in healthcare did not begin until many years after 1900. Advancements in science and not government just might explain why life expectancy has increased for both white and black people alike. In fact, the discovery of anti-biotics may account for much longer lives as people no longer died of simple infections resulting from common injuries.
And the exploitation of antibiotics for profit has almost rendered them ineffective.
Antibiotics were over-prescribed for decades for other reasons, from initial justifiable enthusiasm at the new miracle treatment spilling into “won’t hurt, might help” prophylactic use. Parents and patients wantedantibiotics and doctors wanted to be seen as having donesomething helpful. This was the main driver of inappropriate antibiotic use, not bigPharma PR.
Antibiotics, from the best of my recollections, were not among the drugs the reps were marketing, and the vast majority of prescriptions written are for relatively old and cheap generics or lower profit brand names. They never had to promote them anyways. The drugs the companies have pushed gravitate towards the new and flashy, big profit items…… pain (large market, not including black one on scheduled items) and neurological (large profit, and can tack on a few extra indications until caught, 2-3 years probably) medications come to mind a lot.
Then how do you explain the rest of the world. Governments in other nations tend to be even more involved, or even run the healthcare system directly. They all have cheaper and better systems. Cuba is fully socialized medicine, yet they still have world class facilities at much lower cost than ours.
“Why is there no fear of the total monopoly government would have under a single payer system? Is that because government is so pure and righteous?”
Single payer systems deliver better results for less money – why do you apparently fear paying less for better health care?
A system absent of crony capitalism that involves government manipulation of healthcare delivery and artificial scarcity would also deliver better results for less money. For example, government regulation of the number of hospital beds through licensure. Or the elimination of non-profit collectives providing healthcare by government regulation. Or government price-setting for Medicare and Medicaid affecting prices. Or government created cartels such as HMO’s. Or quasi-governmental groups like the AMA being given regulatory powers (another type of cartel).
The list of how government has screwed up healthcare can fill books. Yet, “progressives” either are ignorant of these facts or are complicit with their favored political party. What passes for the left in America serves as useful idiots for the Dems just as much as the tea partiers serve as useful idiots for the GOP. Since it is impossible to read minds, there is no way to tell if people who parrot talking points actually believe the junk they peddle because they have internalized the received dogma or if they are acting with malice to create some kind of totalitarian utopia which never seems to manifest itself.
Well the thing is single payer actually has a track record, as do truely well regulated insurance markets (Switzerland). The ACA is definitely NOT the Swiss model though and even they might prefer single payer.
Other things not so much so. Besides that some of the regs like on number of beds probably actually have good reasons, like does anyone really want hosptial care to be any worse than it already is? You already hear stories of insufficient staff to even change the badpans.
“Why is there no fear of the total monopoly government would have under a single payer system? Is that because government is so pure and righteous?”
There is a little thing called elections. Crooked politicians aren’t in it for the money. They are in it for the celebrity for ugly people phenomenon. When the sheep stop being sheep and applauding pictures of Obama’s family as stand-ins for policy, politicians start to do a good job. Its really quite remarkable how that works.
Perhaps, NotTimothy. But, when will the sheep stop being sheep?
Another 100 years?
How do you know politicians will start doing a good job when the sheep have always been sheep? Each new election seems to bring a new savior who isn’t lying and will do remarkable things and every time they are worse than the last one.
This the one belief that afflicts both left and right. Along with the belief that government has the right to use guns, prisons, and the confiscation of the fruits on one’s labor to enforce whatever dogma their political cults seeks to impose on everyone else.
Yet another anti-government Libitarian that thinks he knows what progresives are thinking.
Code Name D, first I am not yet another anti-government “Libertarian”, I am an anti-government anarchist. The use of a capital “L” even indicates a libertarian of the variety that belongs to the Libertarian Party cult. Not me.
Second, I think if you take a closer look, you’ll discover that I actually wrote “since it is impossible to read minds” indicating that I don’t know what progressives are thinking. It makes little difference what progressives are thinking when one can read what they say and see what they advocate.
It is those things I question and ask about, but which progressives never seem to be able to articulate an answer.
My question to you is that in light of all the evil government does, why are progressives pro-government? Do you wave off the surveillance/police/warfare state and claim it is worth it so that a welfare state is possible, even while knowing it may not be economically sustainable?
Are wars of choice okay because suddenly women and gays have equality in the institutions of war and are empowered to kill for the state?
Do you really believe that a government that tortures, kills, spies, imprisons and impoverishes people should have a total monopoly over anything – especially your healthcare?
Do you have so much faith in politicians and voters that you are certain the day will come when the “right” people are elected and deliver your utopian dreams?
It has been my experience for many years that progressives refuse to answer these questions. The same type of glib snarky responses generally follow, much like some sort of Sean Hannity type of rhetoric – guilt by association that is almost always erroneous and name-calling. If one is lucky, a progressive might even “debate” by asserting a talking point followed by the assertion that everyone knows this talking point to be true.
Like all authoritarians, progressives insist that everyone must comply with their laws. No choices, always compliance. No exceptions other than for those who are more equal. Animal Farm writ large with violent thugs for enforcers. All I can say is you can take your government (progressive, liberal, fascist, socialist, communist, capitalist, conservative, religious, or libertarian) and shove it because it is in essence all the same and not healthy for humanity.
Tom Blanton said, “First I am not yet another anti-government “Libertarian”, I am an anti-government anarchist.”
And this is to mean… what exactly? Labels do not mean anything to me.
“Second, I think if you take a closer look, you’ll discover that I actually wrote “since it is impossible to read minds” indicating that I don’t know what progressives are thinking. It makes little difference what progressives are thinking when one can read what they say and see what they advocate.
It is those things I question and ask about, but which progressives never seem to be able to articulate an answer.”
Forgive the bluntness, but I sincerely doubt that. Based on what you have written here thus far, I suspect it far more likely your bias prevents you objectively evaluating any arguments presented to you, and that you would rather attack straw men that you stand up in place of any arguments you may have been exposed to.
“My question to you is that in light of all the evil government does…”
Evil governments? We are not going to invoke the supernatural here, are we?
“…why are progressives pro-government? Do you wave off the surveillance/police/warfare state and claim it is worth it so that a welfare state is possible, even while knowing it may not be economically sustainable?”
Why are progressives so pro “evil” government? Do progressives support the militarization of government so that the police state can protect an unsustainable welfare regime? These ARE straw men arguments! They aren’t even questions, but expressions of a paranoid fantasy regarding your perceptions of what progressive and liberals argue for. Nor are they representative of reality.
I am not going to waste time knocking down your straw men. But at this point I will assume that you intended to argue this in good faith, so I will try to address some of the misconceptions you are operating from.
Liberals and progressives are not “pro-government” in the way you imply; IE “evil-government” or as some kind of entity that operates from a will of its own. The state I/E government, is nothing more than an institution of laws that reserves itself the right to enforce those laws. Thus, by definition, any institution which holds the power to enforce its will by force – is the government. One can neither be for – or against it, any more than you can be for or against the ground you stand on.
What liberals and progressives are fighting for is an effective government that is populated by educated persons who are accountable to reason and evidence in order to set and enforce a rational policy intended to deal with the problems presented before it, to the best of its abilities and resources. Liberals and progressives also favor full enfranchisement. All persons, regardless of wealth, station, gender, race, nationality, sexual orientation, age, profusion, education, legal status, religion, or spoken language, have an inalienable right to address that government for their graveness or other issues, have a right to see those issues addressed in some manner in full public disclosure. All persons are to be treated equally under the law.
When liberals and progressives say they are “pro-government,” what they are actually saying is that they recognize that a strong central government is the only viable solution to dealing with a long raft of problems; global warming, foreign terrorism, abuses from the banking and industrial sectors, health care, public education, pollution, energy policy, public infrastructure… just to name a few.
I am well aware that anarchists do not share this position. You are at liberty to elaborate what that position is if you desire. But might recommend that you not lead with fallacious straw man arguments next time?
When liberals and progressives say they are “pro-government,” what they are actually saying is that they recognize that a strong central government is the only viable solution to dealing with a long raft of problems
I am very well aware of what progressives are actually saying. If only progressives were aware that the strong central government they cling to is complicit in many if not all of the things progressives correctly identify as problems. There is no straw man here. There is merely the failure of progressives to understand public choice theory, regulatory capture, basic economics and how the political system has functioned in America for generations. You are free to believe what you wish, and you can even blame me for your problems, but the system you cling to hasn’t functioned well for decades and more politics and more government isn’t the answer.
The only straw men are the ones you’ve invented in your own mind and the ones you continue to vote for.
By the way Code Name, it appears you are total and complete denial that you are in fact living in a police/surveillance state that is conducting overt and covert actions in approx. 70 nations. America has the highest incarceration rate in the world. Real people are being killed and great suffering is caused all over the world for the profit of a few. Trillions of dollars have been transferred to corporate interests.
And, the government who you want to strengthen and control more of our lives is responsible for these atrocities. By government, I do mean the two political parties that in fact run the government, not some straw men. If these issues are merely straw man issues, then you must be delusional.
I’m amazed that anyone can support such an institution and give it more power over their lives. I’m equally amazed that anyone still believes that voting for politicians and lobbying can make any substantive changes in the overall system.
Tom Blanton said, “By the way Code Name, it appears you are total and complete denial that you are in fact living in a police/surveillance state that is conducting overt and covert actions in approx. 70 nations. America has the highest incarceration rate in the world. Real people are being killed and great suffering is caused all over the world for the profit of a few. Trillions of dollars have been transferred to corporate interests.
And, the government who you want to strengthen and control more of our lives is responsible for these atrocities. By government, I do mean the two political parties that in fact run the government, not some straw men. If these issues are merely straw man issues, then you must be delusional.”
I am in denial about the security state? How do you draw that conclusion? I have made no statement in that regard one way or the other, or even the general state of current events at all. And if you read any of my prior works at my blog – you would know I dedicated a LOT of time investigating the Duopoly State and trying to find ways to overturn it. And I am very concerned about the security state and have absolutely no intention of legitimizing it, let alone strengthening it.
But as I warned from the beginning – you reject out of hand, actual arguments regarding the statement of their own opinion. The then dubbed down on your straw men, even after I told you they were straw men and gave you the ACTUAL position that most liberals and progressive hold about government. You are the one who is trying to tell us what we think – even after we told you are wrong! I am not the one who is deluded here.
“If only progressives were aware that the strong central government they cling to is complicit in many if not all of the things progressives correctly identify as problems.”
No. It is you who are wrong here as we do NOT have a strong central government, but a very emaciated one. Fifty years of relentless tax cuts for the wealthy have butchered the budget. The various law enforcement agencies that specialize in white collar crime and banking regulation enforcement have been systematically depopulated. Avenues of research into nearly all of the most pressing issues of our day have been blockaded by revenue bans and budget cuts, plucking out the nations eyes. The pace of legislation has been systematically accelerated, preventing deliberative public and academic debate over these bills. Legislation is conceived of in secret and passed in the dead of night. A handful of special interests have been permitted to monopolies, controlling the very perception that our legislators have of the world and current events. Industrial, commercial, banking, and even government agents are able to lie to congress with impunity. Politicians are bribed openly and in full view of the public – without consequence or censure. Persons with the lest qualifications, but extreme conflicts of interest are permitted to sail through an accelerated nomination process – closed to external comment from those best able to make an informed opinion regarding the nominee. Abuse of power becomes precedence. Whistleblowers are pursued and harassed to the ends of the earth. To prosecute the wealthy and connected requires impossible standards of evidence, and violation of the law is never established, let alone published to the record. And even then must still survive appeal after appeal after appeal.
I could easily go on, and continue for some time if pressed.
Yes, both of us agree that our current government has been wholly corrupted and captured by special interests.
Taking from your writings thus far, am I to believe you actually think that the best way to free government from this corruption is to make it weaker, to make it even MORE vulnerable to corruption? To make it less able to discharge its duties and responsibilities granted to it by the Constitution? Evidence shows that this is how we got here in the first place.
“There is merely the failure of progressives to understand public choice theory, regulatory capture, basic economics and how the political system has functioned in America for generations.”
Your understanding of the political reality has already been challenged. Our government is falling under regulatory capture because it is too weak to resist outside influence that is interested in capturing it. And given your use of the term “welfare state” causes me to suspect your understanding of “basic economics” is also questionable, and more likely populated by more ideological fantasies.
I’d like to add, Code, that when someone uses the words “sheep” or “sheeple” that is one big strike against any comment he might make. This is a person who has THE ANSWER, and anyone who might disagree is, of course, a sheep.
Only the simple minded tend to use insults in general. But it doesn’t bother me.
On the other hand, some of the best debates I have been in involved rip-roaring zingers and brutal putdowns. A clever mind will produce clever insults, and a brilliant mind will insult you without you even noticing. So I am more tolerance of insults than most. .
So? Then we will be at the mercy of random thugs for whom we don’t vote. The problem with libertarians is this is the inevitable outcome of their philosophy which means either they aren’t thinking or expect to be the random thugs.
Admittedly, you might be very young and have just decided you have found your religion, but believe or not, no one here is confused about libertarianism and its basic arguments. We were all 12 once.
NotTimothy, I’m pushing 60 and have been involved in politics for over 30 years. My first political activity was back in the 70’s and centered around anti-war, anti-racism and anti-drug war protests in DC with Yippies and getting my head bashed in at Lafayette Park in front of the White House.
I believe I plainly state I am an anarchist. Now I know that progressives consider libertarians and conservatives to be anarchists, but I think you will find that anarchists disagree. You might also be surprised to find out that anarchists don’t expect to be in charge of governments. They want to abolish governments.
I do understand that young people are very naive and I question why progressives are so naive to believe that by merely voting, great things will come from government?
Call me stupid, naive, foolish, young and inexperienced if you wish. But please enlighten me as to how progressives are to usher in an era of peace, prosperity, freedom and equality by voting for politicians to run our surveillance/police/warfare state.