Want to Pass Medicare For All? Make Voters Happy By Making Them Happy

By Thomas Neuburger. Originally published at DownWithTyranny!

Medicare For All is wildly popular. Why not just give the public what it wants?

An argument (or “fervent discussion”) is raging on the left about the best way to approach Medicare For All (M4A) legislation — Should the plan be proposed all at once, or piecemeal?

I recently contributed to that discussionhere: “Improved Medicare For All or Watered-Down Medicare For All?” It’s not just the program’s enemies who want to enact M4A legislation in stages, however; several of its friends have also advanced good-faith reasons why Medicare For All legislation should be tackled in chunks.

Mike Lux, who was involved in the Clinton-era health care reform battle, accurately characterizes the opposition this way. “The problem with MFA is that it takes on almost the entire industry at the same time.  Not to mention, of course, the entire big money conservative apparatus: the Koch brothers network, the Chamber of Commerce, the National Restaurant Association, the National Federation of Independent Businesses, the Wall Street banks who have made heavy investments in insurance/pharma/for-profit hospitals, all the conservative think tanks and media outlets and grassroots operations. It would also likely be opposed even by some labor unions who have great health insurance plans that they have collectively bargained for over the years, and various big businesses that have their own plans they administer.”

This leads Lux to argue for “splitting the health care industry, getting parts of them to support our side and parts of them to agree to neutrality.”

Fair enough; but look at the polling for M4A (above). The problem with this argument is that it prevents the public from having the one thing it really wants — a card on day one they can use to go to the damn doctor without paying money.

Here’s Duncan Black (Atrios) to explain this position in the simplest possible terms (emphasis mine):

I Don’t Give A Shit How You Bend The Cost Curve

“We” spend too much money on health care costs in this country, but I don’t particularly care about that. I mean, I do, it’s absurd, and we shouldn’t, but it isn’t actually my job do worry about how to fix that. It isn’t your job. It isn’t the job of voters to waste their beautiful minds worrying about what the best plan to cut health care costs is, and it’s absurd that for some reason it’s expected that voters all play Wonk for a Year and try to figure out who has the wonkiest wonko plan of all.

People are paid a lot of money to figure that shit out. Go figure it out. What kind of health plan should pass that makes voters happy and doesn’t make them upset because it doesn’t raise their taxes or upset the status quo or isn’t “moderate” or whatever the fuck? One which mails them a card on day one that they can use to go to the damn doctor without paying any money. Then the wonks and the politicians can get to work for the next 10 years fixing the engine under the hood.

Make voters happy by making them happy. Tomorrow. Eat the up front costs because we are a rich country and we can afford to eat the costs, and then spend the next 10 years clawing money back from the other “stakeholders” who have been looting the bank accounts of dying people for decades. Just don’t make us have to worry about how.

Make getting sick slightly less of a hassle than Comcast Customer Support and voters will love you. It’s that simple. The details matter, but the wonks should be working out that shit between themselves, not by writing memos on op-ed pages because none of us should have to care about them.

Note Black’s twin bottom lines:

• The best plan gives voters “a card on day one that they can use to go to the damn doctor without paying any money.”

• “Eat the up front costs because we are a rich country … then spend the next 10 years clawing money back” from the predators who’ve been looting from dead people for decades.

In other words, just get on with it and do the wonky stuff later. The public would love you for it.

Imagine if President Obama’s 2009 health care reform plan was today’s Medicare for All? Imagine how much support would he have gotten (assuming he wanted that for us in the first place, which he didn’t)? Public approval would have been instant, full-throated and universal. Remember, “Hands off my Medicare“?

A fervent supporter of all the Medicare he can get

Black’s bottom lines are wildly popular, easy to understand — and easy to love, since no one in the country is giving to the “undeserving” what they aren’t also getting for themselves.

Which tells you immediately how to frame this: “Folks, it’s called Medicare for All, not Medicare for Some. Everyone gets the new plan — free health care forever — or no one does. So pick one: Are you in or out?”

Only the predatory health care industries will say no to that. Actual voters are the plan’s best friends. All proponents have to do is make them happy by making them happy.

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  1. WheresOurTeddy

    Any society which does not provide Food, Housing, Healthcare, Employment, and Education for all who want them is a FAILED STATE.

    Any society which does not provide those Five Freedoms while allowing billionaires to exist is an IMMORAL STATE.

  2. Joe Well

    Just before I opened this, I was worrying about fighting $1000 in unexpected medical bills for a provider (largest chain of diagnostic labs in the US) who was supposedly in network but the HMO said later was out of network. It was my only attempt to get covered care with the HMO last year (I get any care I can outside the US or just go without like a normal American), because I had been assured so thoroughly it would be covered.

    I’m still going to have to call the HMO and go through that Kafkaesque vale of tears while I try not to get angry at the poor person on the other end of the line.

    But Bernie’s announcement and this article give me hope.

    Thank you, Yves.

    1. notabanker

      $1800 here. In network for an ultrasound that my Dr ordered. Had to have it to see if the 9 months of meds was working or not, which saved having to go through super expensive surgery. I’ve had health insurance for 30+ years never an ailment worse that strep throat, pay $1200 a month, $7K deductible and yet I have “recovery services” chasing me to pay full price for a mandatory test because the wonks somewhere say that it must be so.

      Don’t get me started on the ‘lifevest’ scheme that would have cost me $1K a month and could have killed me if it went off.

      What’s going on with healthcare in this country is pure criminal racketeering. Every State AG should have a 5 year docket of cases if they were doing their jobs.

      1. rc

        You are right. They are all in clear violation of 15 U.S. Code Chapter 1.

        It is preferable that the DOJ enforce the law. Why aren’t there class actions over these issues? Every person in the system is likely exploited by billing codes that are the result of collusion and restraint of trade by hospitals, insurance companies, pharma, med device manufacturers…

    2. DHG

      See if you qualify for reduced cost or even charity care. This type of stuff needs to stop right now. We should be able to refuse payment if its said to be in network then they say its not.

      1. Joe Well

        Thank you for caring. If Amazon suddenly sent me a bill for $1000 for something it had said would cost $50, would this still be your advice?

        Of course the issue of whether I can “afford” this is secondary and trying to get someone to help me will cost me $2000 worth of my time. Meanwhile I have not heard from the provider (Quest) about this and wondering what happened. Kafkaesque the whole thing.

  3. cripes

    Yes, there is a raft of ‘progressive” types chiming in across the intertubes to tell us we can’t have universal CARE health because it’s to hard or too expensive or too complicated, or some such shyte; like it’s not too hard, expensive and complicated now.

    That’s what Obama sold us ten years ago.

    Shut them down and shut them up.

    As Jimmy Dore reminds us: We Can’t Afford to have cheaper prescriptions.

    The candidate who promises and delivers on health care will win a generation. Despite his flaws, Bernie is that candidate.

    1. PlutoniumKun

      This is my favourite graph to show people who make that argument. The key thing in it is that the US actually pays more ‘tax money’ on health care than the UK on the NHS!

      There are also handy little ‘factoids’ you can thrown into the argument. For example, in 2017 the average US health expenditure was $10,224 per person. In Canada (single payer of course), its $4,826. Thats right, the Canadians have an extra $5,000+ per person due to cheaper healthcare. Thats about 8% of GNP every year saved.

      I’d really love to print a little card with figures like those for everyone to throw into their social media feeds or just coffee break conversations.

      1. Keith Newman

        Canada provides a precautionary tale for piecemeal implementation. As noted above Canada does indeed spend far less than the US on health care as does every other wealthy country (in fact P. Kun provides underestimates since in Canada, as elsewhere, 100% of the population has access whereas in the US only about 2/3rds do). In Canada doctors and hospitals are covered in the public system, HOWEVER there is still US style coverage for prescription drugs: a mix of employer coverage, public coverage for the poor and the 65+ cohort and some others, and individual coverage for those left out. Predictably this coverage is very costly, incomplete and unfair. There is a cross country coalition (unions, doctors, retirees, nurses,etc.) trying to fill this gap right now but it faces stiff opposition from big pharma, the insurance industry, and their political propagandists. The origin of the problem is the recourse to a piecemeal approach In the 1960s. Rather than implement the full program recommended in the early 1960s by a Royal Commission, one which included drugs, opposition from big pharma and the insurance industry, and their political propagandists, led to postponing the inclusion of prescription drugs to another time. Fifty years later it has still not happened. Consequently I am with those that say just do the whole thing now. If you put parts of the program off to the future they may not happen for a very long time.

        1. Dr Mike

          I fully agree with this. Our system in Canada also doesn’t cover things like physiotherapy and counselling/therapy (so people take more medications for chronic pain and mental health conditions because they lack other options) or dental care

        2. rd

          Yes. Prescription coverage in Canada is piecemeal, but it does have a huge advantage in that the prescription drug costs for non-experimental drugs are negotiated by the provincial health authorities, so even if you have to buy a prescription yourself, you get group rate pricing for it (everything is “in-network”).

          I believe the prescription drugs, including the ones you buy yourself, are included in the aggregate Canadian health care spending Plutonium Kim cites above.

          So I have a few markers for what an effective health insurance system should be, along with my grades for CAnada and US (I have personal experience with both) – ranges in grades are largely a function of variability of who is getting service and where:

          Universal coverage – Canada: “A”; US: “C”
          Cost – Canada: “B”; US: “F”
          Quality – Canada “B”; US: “B-F”
          Simplicity – Canada: “B”; US: “F”

          So, society-wide, I would give the Canadian healthcare system a solid “B”, possibly “B+” but it is improving as they use their population-wide big data to figure out how to reduce costs, reduce waits, etc. Compared to the US and Swiss systems, they have a lot of cost buffer to work with but in the end they are just average for cost across the G-20 countries. Longevity stats in Canada are typical for the G-20 countries and have been improving.

          The US healthcare system is at best a “D-“, as it very poorly serves a significant percentage of the population and is inordinately complex and expensive for the vast majority of the people it does serve. It probably serves the upper 5% to 1% very well since cost is little to no object there and you can buy access. Longevity stats in the US are the worst of any G-20 country and look like a second-world country. This is a national disgrace.

      2. beth

        PlutoniumKun, this is even better than what I have been using for years. In 2015 I looked up the CIA’s table showing heath care costs as a percentage by each country’s GDP/GNP. None of the countries with healthcare for all in Europe or Asia were paying more than 12%. We were spending 17 1/2% before Obamacare and not all of us were covered. ONE THIRD MORE.

        I could use it for Rs and Ds. If people looked at me as if I were crazy, I could tell them to look it up on the internet. The CIA has made it a little more complicated in the last couple of years.

        We could say that health care will cost less than the Wall Street crisis and certainly less than the wars we have been paying for.

  4. GramSci

    The danger with this approach is the Trump’s likely retort: “You know what those Democrats will do with this, don’t you? THEY WILL RAISE YOUR TAXES!!

    1. taunger

      Ha! But like good pols, AOC, Bernie, and Warren have already jjumped in front of that mob and stated they want to raise taxes!

    2. rob

      Yes, they already say “they will raise your taxes”. And no one ought to be able to finish their exhale after saying that rubbish, without someone chiming in ,” your taxes will be raised, a little; but you won’t be getting a health insurance bill every month anymore, and you won’t get any surprise health costs if you actually USE the health care system.”….. you decide.

      1. jrs

        and you won’t find almost no doctors take your insurance and be fiddling around trying to find a doctor you would actually be ok with seeing (doesn’t have 50 horrendous yelp reviews) that does so you can just a see a @#$# doctor already.

      2. Oh

        In his CBS interview, Bernie said that it will raise taxes but he did not emphasize that the current premium paid by the average consumer is more than what the increasee in tax will be. In effect, the consumer is already paying more to the insurance cos.

    3. johnnygl

      Correct retort to that: “You’re absolutely right. That’s what we’re going to do. And you can stop making payments to your parasitic insurance company who’s always 2nd guessing your dr. I’m also promising that you’ll never see another hospital bill in the mail again and you’ll never have to reach for your wallet when you pick up your precription meds.

      And best of all, there’s going to be more money in your pocket each month!!!

      Mr. President, why won’t you do right by the American people and solve this problem!!! Give us all Medicare for All and do it NOW!!!”

      1. redleg

        ‘And if you lose your job, or start a small business, you won’t have to work about medical insurance for you or your family.’

      1. Dwight

        I would be happy to pay premiums for a simple government program that covers all doctors and limits my out-of-pocket to $500 in any given month, and which controls costs. I’m just sick of paying premiums for complicated, limited insurance with no clear limit on out of pocket.

    4. Ramada Omar

      They will say that no matter what Dems do. Republicans cannot be negotiated with or catered to. They are literally the enemies of the human race.

  5. PlutoniumKun


    I know that sometimes incremental policy improvements are the most practical and for the best. But the experience of other countries – the formation of the NHS in the UK and the Taiwanese system (which actually is Medicare for All, they pretty much copied the Medicare system as it was in the 1990’s and made it universal) is that sometimes an all or nothing radical change is both the most politically viable, and the most practical option. The crazy complexity of health provision also ensures that incremental changes often end up doing nothing more than embedding interest groups within the system making change even harder. Countries such as Germany and the Netherlands have excellent health systems which ‘evolved’ from simpler employer based systems, but they are mind bogglingly complex to operate and are significantly more expensive that more straightforward single payer or direct provision systems.

    There is also a sociological angle – I can’t find the links right now, but years back I was looking at research into public behaviour and it strongly indicated that in many circumstances dramatic shifts in public behaviour are easier to achieve in one step rather than incrementally. People really are lemmings sometimes – in a good way. Examples would be changes in waste behaviour (putting your waste in a bin for weekly collection rather than burning it your backyard), or banning smoking in public spaces.

    1. human

      Years ago, I read of a pair of opthamologists who would send home with patients who needed saline solutions little bottles of house produced product with instructions on how to make more at home. Subsequently, patients insisted on the product made by the doctors, even offering to pay for it. The doctors went into the saline solution business.

    2. jrs

      Considering the players entering the game: Amazon, JP Morgan and Berkshire Hathaway, yea much bigger than many in the game now, change is only going to get harder to come by later.

  6. TG

    Indeed. Some other thoughts.

    1. Totally agreed, who cares how much health care costs? We spend trillions on endless pointless wars, we spend trillions bailing out Wall Street, etc.etc. We’re a rich country, why shouldn’t we spend a lot of our income on stuff people really need and want, rather than useless bailouts to rich parasites?

    2. Be very careful what you wish for. There is no decent thing that cannot be corrupted by the rich to their own ends. What if medicare for all morphs into: we tax the hell out of the middle class in order to subsidize cheap below-living-wage labor for the rich?

    1. notabanker

      I have no idea why the private sector is not waving the white flags to transfer these costs to the Federal government and do simple FICA payroll deduction instead. You’d think they would be all for it.

      I’d like to meet the person who has not received the “insurance costs are skyrocketing and we cannot afford these increases” speech from HR. As they deliver their new scheme to reduce your coverage and raise your out of pocket costs.

      1. philnc

        Traditionally many employers saw health coverage as a carrot and stick they can use to attract applicants and then control them once hired. In other words, it’s about control. Also, the reality is that American business is almost always on the trailing edge of positive societal change. They’re followers, accommodators, not leaders — although they like to fantasize about it being otherwise. There doesn’t really seem to be a big appetite for advancing causes that could subject you to the derision of your peers. That said, I’ve recently been hearing favorable comments about MFA from small business types now that word about the details of the plan is spreading. They seem to finally get that it would make things easier for them. Maybe it has always just been a matter of “make it real and they will come”.

      2. whiteylockmandoubled

        Is there a bigger line of neoliberal bullshit than “omg we can’t move everyone quickly”? Nearly every person in the damned country goes through “open enrollment” every year at their job, for the privilege of giving 20% of their Medicare and Medicaid spending to the insurance industry, whatever. Do it once more and then you’re done. It was a shitshow for obamacare because they created an entirely new useless, stupid “marketplace” for people to “comparison shop.”

        Medicare’s been enrolling people for 55 years. Just keep all the temp census workers on for an extra 8 months to bulk up the staff for a one-time push, train em up, hire Yves to oversee the IT transition and get it done. Anyone who doesn’t sign up just signs up when they go to the doctor or hospital (as with Medicaid). Done.

        The history of national health insurance programs is littered with …..success. The NHS sign up was preceded by an epidemic of elite bedwetting. 90+% of the country and the docs signed up within two weeks.

        Lux favors incrementalism for its own sake even when it’s monumentally stupid, because he’s just smarter than we are. Always has.

        1. Oh

          People like us have to tear down the BS arguments put out by the NeoLibs, Pharmas, Hospitals and the other prfiteers from the current healthcare system. We need to build a Q&A site to rebut these hollow whiners.

          I’d be willing to help in any way I can.

    2. False Solace

      > What if medicare for all morphs into: we tax the hell out of the middle class in order to subsidize cheap below-living-wage labor for the rich?

      The difference between this scenario and right now is that we’d have health care.

  7. The Rev Kev

    Agreed in fighting to get that front-end up and running is the way to go. I really don’t think that breaking the whole issue up in chunks to do one after another is that great an idea. In military history, this is how you defeat a powerful enemy – piecemeal. The opposing forces can be marshaled together to attack each and every piece as it comes up until it is compromised out of all recognition. After the first two or three chunks are done, people will get fatigued about the whole matter in the same way that the British have been fatigued with two years of Brexit talks. It may sound romantic but how about we go back to doing stuff we used to do it. Kennedy announced back in ’61 that the US intended to land a man on the moon and bring him back safe and the rest of the decade was spent working out how to do it. So wouldn’t it be great if someone stepped forward and say “We choose to pass Medicare for all”, shove the politicos aside, and let the professional decide how to go about it. Sure the Republicans will say “This will raise your taxes!” but it is time other forces grew a set and told the American people the hard truth. How many tens of thousands of their fellow Americans die each and every year because they cannot afford healthcare. How many middle class people are pushed into bankruptcy for life over one illness. How the US is a sucker as compared with other nations for paying a far higher cost and much worse results. Get brutal about it. Make the Republicans defend the annual tens of thousands of deaths and the trillions of wasted dollars. Stick it to them and pin them to the wall. I think that this is the only way to go about it.

      1. philnc

        The other question is: when the call goes out, how many of us will be willing to crowd into the Mall in the cold and rain to issue the shout that can be heard through the halls of the Capitol? Because I’m pretty sure that’s what Bernie has in mind when he says, “Not me. Us.”

      2. The Rev Kev

        Perhaps you are right as the Democrats are as determined to fight heath care reform to the death as the Republicans. I should have said so. It is true, however, that Republicans seem to have commercialized healthcare as a signature policy. Remember that Obamacare was stolen from the Republicans where it was known as Romneycare and the origins of this idea came from a conservative think tank known as the Heritage Foundation. It all falls in naturally with Republican philosophy in how government should not be involved in what they believe to be private affairs such as health care and medicine and you see this enacted out in current policy.

        1. NotTimothyGeithner

          You are right about the approach. Make the GOP defend premium, co-pays, out of networks, etc. Let Democrats like Max Baucus stand with the GOP and Trump, the party of KGB puppets.

          You don’t have to say, “you are either with us or against us,” but Democrats need to be forced into embracing the GOP ideology of cruelty or Medicare for All. Fraudulent groups supported by the ilk of Mark Warner to find compromises which embrace GOP ideology with a blue ribbon committee can’t have room to exist.

          The country already despises Republicans. Let the Democrats stand with the GOP.

      3. jrs

        because they oppose it. I mean duh, just because some Dems do as well, doesn’t mean the Republicans have stopped opposing it.

    1. False Solace

      > How many tens of thousands of their fellow Americans die each and every year because they cannot afford healthcare. How many middle class people are pushed into bankruptcy for life over one illness. How the US is a sucker as compared with other nations for paying a far higher cost and much worse results. Get brutal about it. Make the Republicans defend the annual tens of thousands of deaths and the trillions of wasted dollars.

      AOC did exactly this on The View. She turned back the question of “How can we affordddd it?” by asking “How can we afford the funerals?” For me it was shocking and quite effective.

      Naturally RCP clownishly pretended she had just proposed that M4A pay for people’s funerals.

      The video clip is much more effective than the transcript.

  8. John Beech

    Makes no difference whether I’m taxed to pay for my health care, or pay an insurance premium to pay for my health care – net zero.

    Anyway, despite voting Republican since 1980 and being very close to the promised land (Medicare age), I agree with the premise, a card right now for everybody where you don’t pay, and let the wonks work out the details . . . I’m in.

    1. human

      Being a member of the “promised land,” I can tell you that what with the myriad of plans and premiums for the ever evolving “health care” coverage provided, it still takes a Ouija board to choose wisely and achieve minimal costs with Medicare.

      1. whiteylockmandoubled

        This is why it’s called “Improved and Expanded Medicare for All” (see last year’s HR 676). Gets rid of all of that crap. No copays, no deductibles in the core Medicare program, and adds vision, mental health, dental and real Rx. If you want to choose to be part of a non-profit HMO, knock yourself out, but the current headaches? Gone. As Atrios says, card, doctor, no pay.

        The corporations and their bipartisan friends have been chipping away at Medicare for years to try to diminish people’s expectations and position the insurance industry as the savior.

    2. Big River Bandido

      It makes a huge difference to me. Government isn’t going to charge ripoff prices for tests and “procedures”, or engage me in “balance billing”, or force me to call them every month to argue and fight their latest attempt to defraud me.

      On the day that private health insurance is eliminated, millions of Americans will cheer.

  9. Donald

    I think the reason Democratic politicians oppose single payer is, for the most part, pure self interest. They like the Rube Goldberg system with the competing factions and the need for lobbyists. It’s a source of donations when they are in office and a lucrative career path when they leave I just saw the other day that AOC’s defeated opponent now works for a lobbying firm. I assume most people here take this for granted and could flesh it out with more details, but every time I hear someone argue for the incremental path I wonder if they think that centrist liberal politicians really have single payer as a goal.

    1. rob

      I think that is the “opposition” in a nutshell. The safety of the revolving door system for the political class.
      It isn’t just the funding streams to get in office and stay there. It is the jobs in lobbying,industry,academia etc, for not only yourself but your spouse, and your children, and if you do good (in the eyes of the corporate overlords),;your childrens children.

      Look at chelsea clinton, or lynn cheney or the bush family, or what will open for the obama girls, or rand paul….. these people are the children of others who have towed the party line for decades… and like all the others, whose family members are lobbyists,academics,corporate legacies,or whatever… they will never have to struggle.

      That keeps people in the political class loyal to their class, and non confrontational. It also tends to make the new boss, like the old boss….. eventually.It is what many will aspire to who get in for the first time.
      All good ideas go to die, before the political class.

      1. Mark

        “I think the reason Democratic politicians oppose single payer is, for the most part, pure self interest. ”
        Democrat or Republican. The entire political class provides as much or more resistance to change than any other stake holders. It is through their regulatory prowess that there exists a grotesque range of prices for the exact same procedure, service, device, or drug. One goal of which is to continue to shift the costs from those who have no money to those who have any money (middle and upper classes.)

        1. oh

          If you have no money they have lobbied and won programs(subsidies) where the tapayer will foot the bill for pharma or hospitalization with full clawback provisions.

          Social Security Adm actively promotions such subsidies for drugs; what’s more, you can’t go back to original Medicare unless you include a drug (Part D) policy. The pharmas sneak in all these regulations in a sneaky way, like the DimRat who snuck in the no negotiation clause into the medicare program that introduced drug coverage (thanks to Bushie and Eddie Kennedy).

    2. Big River Bandido

      I wonder if they think that centrist liberal politicians really have single payer as a goal.

      I think a lot of people probably *do* believe in their liberal Democrats, especially all those brand-new liberal Democrat members of Congress who ran last year based on M4A and are now fleeing from it. *Those* Democrats, in particular, are craven, cruel, and corrupt. They are the reason M4A will never pass in this Congress — and that’s why the Democrats will probably not be able to hold their House “majority” in 2020.

  10. Steve

    The immense difficulty of getting the Democrats to stop healthcare industry from looting the middle class can be made simple by changing an Upton Sinclair quote. -It is hard to get the Democrats to fix healthcare when their paychecks depend on them not fixing it.

    1. jrs

      they and if we’re honest a lot of middle class and not so middle class paychecks. Lots of people employed in the current system that might not be otherwise, and no there are not necessarily jobs for them otherwise, since there’s always a vast surplus army of labor anyway, capitalism 101.

  11. Fraibert

    It may be a sense that a single payer scheme actually raises business costs over the current approach. And some employees also probably fear it could be a tax increase.

    Let me explain.

    Economists believe that employers would generally be expected to increase wages if a national healthcare scheme is implemented, with such increase to approximately equal to (now unnecessary) premium costs. But if coupled with additional business taxes, this could increase overall costs more than they already are.

    There would likely be savings from employees with better health but it’s hard to quantify that when compared to cost.

    For the individual, remember that health insurance paid for by the employer is essentially exempt from income taxation even though it is clearly compensation. If additional earnings are substituted for unnecessary premiums, those are taxable. And when coupled with some kind of increased income tax and probably some kind of premium for single payer, it’s not obvious that the individual will make out better on the number side.

    In the other hand, at least for the individual the security of guaranteed coverage is good news.

    I guess I am saying is that the devil is in the details.

    1. Joe Well

      The detail that anyone who has actually tried to use private healthcare in the US knows, is that the whole thing is a giant scam with shell games like balance billing, in-network/out of network, deductibles, etc.

      So the value of private insurance is deeply questionable since it’s like Russian roulette.

      1. Bobby Gladd

        And, no amount of calling private, for-profit 3rd-party intermediated pre-payment plans “insurance” will make them so.

  12. Carolinian

    “Give the people what they want” was the default position of the Democratic party pre-Reagan and it rewarded them with decades of control over the House of Representatives. But LBJ was not wrong when he opined that Civil Rights would cause the Dems to lose the South as well as large chunks of a working class that also had to deal with the inflation and other economic problems of the 1970s. Meanwhile liberal elites grew contemptuous of wolf whistling union members with their sometimes casual racism. Watergate was the liberal high tide and it’s been downhill ever since.

    Sanders wants to change all that and good luck to him but some of us question whether he is radical enough to make history turn on a dime, particularly when a major impediment is now the leadership of your own party. A Plan B may be needed.

    1. Adam Eran

      A little quibble…Thomas Frank (Listen Liberal: Whatever happened to the party of the people) says after Eisenhower it became popular among Democrats to discard the Keynesian New Deal principles in favor of austerity. So Edmund Muskie, the guy Nixon didn’t want as an opponent, was the originator of the creditor-friendly austerity solution: “PayGo”… which haunts us still.

      The ’70s is a prime example of disaster capitalism. The disaster led to solutions that support the plutocrats, not necessarily ones that solved the problem(s). So the oil shock brought us stagflation, but the solutions proposed were higher fed funds rates and lower taxes. The conventional narrative says that Paul Volcker’s fed funds rises cured the ’70s inflation. Warren Mosler says it was really Carter deregulating natural gas. Frank notes that Carter showed Reagan how to do deregulation, starting with airlines and trucking. This threw the Democrats’ union allies under the bus, and the Teamsters endorsed Reagan in the next election.

      The price of oil in 1971: $1.75/bbl. In 1982: $42/bbl. A society built on high energy consumption–double the European and Japanese energy consumption per dollar of GDP–couldn’t help but encounter catastrophe.

  13. GERMO

    One which mails them a card on day one that they can use to go to the damn doctor OR DENTIST without paying any money.

    ‘fixed it for ya’ heh heh — but seriously, millions of lives wrecked by bad teeth, you want the working class to love you get all their teeth fixed too!

  14. thesaucymugwump

    The fools who claim they want to be uninsured have never actually been in the situation. Before the ACA, I found myself without health insurance, but not by choice. A generic prescription that Medicaid would cover today for $3 and one that my previous health insurance would have covered for $10 or so would cost around $200 from a pharmacy. Pharmacies do not negotiate, though CVS now has a cash price that is less than the uninsured rate. Surgery centers also have a cash price, which is amusingly sometimes less than what the worst health insurance policies offer. I have learned to always ask what the cash price is, even with insurance.

    I’ve always thought it amusing that the libertarian / minimal government crowd demands the right to not wear helmets when wearing motorcycles, yet they do not demand the right to be left on the side of the road to die when paramedics discover they have no health insurance.

    1. jrs

      I don’t know that many want to be uninsured, but many end up paying the full costs anyway, if they dare go out of network (no matter how narrow the network) or find their deductible isn’t reached. At a certain point it is easier to pay for doctors appointments out of pocket then deal with some of the really bad plans out there and only use them for catastrophic. But it’s not really a preference except among really bad choices (and the ACA choices, yea many of them pretty bad).

  15. Michael

    Open the existing Medicare system to all.

    I pay $135.50 per month for Parts A&B. There are copays. There are limits. There are caps. My wife pays the same. Not sure about free for everyone. Its good to have some skin in the game.

    I am constantly hounded by Ins cos wanting me to pay more for supplemental coverage incl my provider Kaiser (in CA). Eliminate that.

    Once you have seen the bills for end of life care for the elderly you recognize some services are outrageously priced. Tackle that one first.

    1. jrs

      some rare prescriptions are going to be outrageously priced regardless, so a bad medical system here isn’t the *only* problem with modern medical care. But it is the big one, maybe 80% of people’s complaints.

    2. katiebird

      I think being sick is all the skin we should have to contribute.

      And add it up… together you and your wife are paying $270 a month. Do kids pay the same if we open it to everyone. Then you have copays and deductibles…. Plus that you have to pay yourself. In the end opening the current system to everyone is not acceptable.

      1. Michael

        Eliminate the need for supplemental ins coverage now. Cover everything.
        Yes everyone pays the same. Kids free? Up to 2. Get them care from day 1.
        Lots of other details to fight over :(

        1. katiebird

          But why set up for the fights. Cover everything and pay through taxes (not that we should have to do even that) …. Your plan costs families a lot of money. $135.50 per kid adds up fast plus still all the copays and deductibles. Sounds like misery to me.

    3. beth

      Yes, I agree Medicare is not perfect entirely. I pay $240 a month and next year I will pay more. I have a plan F. If a service is covered under Medicare, then my supplement policy covers the rest, in and out of the hospital. That is IF the service provider accepts Medicare payment. After one emergency hospital visit, I did not get any bills. For another emergency visit, in another hospital I got a bill. I have not paid it since I had no control over what doctors and what services were provided.

      So far no one has put me in jail, but in my state they can’t sue me for it.

  16. Susan the Other

    Oh. Atrios. OK, got that straight. And yes. Just do it. If it is possible and congress isn’t just frantically buying time. What could possibly be the excuse? So if it is possible, why does Auerback consider a more palatable version, to ease in M4A – one that is ingenious, because it disincentives profiteering and corruption – like insurance dinosaurs manufacturing their own commodity which turns out to be paper shuffling for a goddamn fee. Their “profit”. And the medical industry – the medical industrial industry which uses technology and productivity to expand medical dystopia for profit. OK. I agree with Atrios. Just do it and stop all this legislative nonsense.

  17. Jeff W

    Mike Lux…[:] “The problem with MFA is that it takes on almost the entire industry at the same time. Not to mention, of course, the entire big money conservative apparatus: [endless list of powerful interest groups]. It would also likely be opposed even by [other groups that already “great health insurance plans” or “plans they administer”].”

    I don’t see the problem with that argument exactly as Thomas Neuburger does—that “…it prevents the public from having the one thing it really wants — a card on day one they can use to go to the damn doctor without paying money,” although that’s undoubtedly true. The problem, as I see it, is that that argument says the system is so corrupt and broken that we really can’t go against it and have a reasonable chance of prevailing—we can’t reasonably have what the majority of the population wants—and what is cheaper, simpler and, ultimately, more moral—and so tens of thousands of Americans have to die and millions more go bankrupt or face financial hardship as we inch our way piecemeal toward a solution. It embeds the constraints of the system into the process that seeks to do away with the constraints—“we can’t fix the system because those who keep the system broken and don’t want it fixed won’t allow us.”

    Of course it’s true, as Mike Lux says, that “the entire industry” and “the entire big money conservative apparatus” will fight M4A but that’s not a “problem with M4A”—that’s a problem with a system allows these big money interests to dictate policy that runs counter to the public interest. And it might actually be the better call, as a matter of strategy—although I sincerely hope not and think it isn’t—to concede that the system is so corrupt and so broken that we really can’t win—and that, as I said, tens of thousands more Americans will have to die and millions more will have to go bankrupt or face financial hardship as a result—but at least we’d be clear about what’s going on.

  18. monday1929

    If you can put in strong safe-guards against cheating the New System, and jail terms for those who do steal and cheat, you could get more on the Right to consider M4all.

    1. marym

      With M4A everyone has the right to receive the healthcare they need. There’s nothing to steal.

      If there’s a concern that some individual may have a mental or emotional problem and seek healthcare when they don’t really need it, or some healthcare providers may submit false claims, well that happens in today’s systems, public and private.

      On a practical level, at least with M4A someone with those mental issues can be referred for mental health care, which is covered; and controls like the budget process for allocating funds to hospitals and other providers, and standardized pricing will help detect cheating by providers.

      I also believe a system designed to provide for us all will strengthen our commitment to keep the system fair and functioning properly for all of us, just as most people now are protective of the current Medicare system, or providing for people with pre-existing conditions.

      We can’t legislate that perfectly a new system, any more than we can in the current system, but in the meantime we all have the healthcare we need, when we need it, free at the point of service.

  19. Tom Doak

    Is it possible that we could have a thread where everyone voluntarily posted how much they pay per year for health insurance and for health care expenses in addition to that insurance?

    I don’t mean to assign “homework” to the site, just an open thread. There are just a few numbers posted above and already I can see how amazingly variable are the costs from one person to the next. Famously, “it’s not polite to talk about money,” and that’s one reason why we can’t fix this problem . . . not many people really have a good sense of what health insurance / health care actually COST, other than their own random sample. And, of course, it’s in the best interests of the health insurance industry for pricing to be opaque.

  20. Bill Carson

    The argument I’ve been making lately (and I believe this with all my heart) is that WE PAY FOR ALL OF THE HEALTHCARE ALREADY!! As expensive as it is, WE AFFORD IT NOW! All M4A would do is change how it is paid for. In other words, M4A IS NOT GOING TO COST US A DIME MORE THAN WE PAY TODAY!

    Now, the policymakers are going to have to figure out how “THE HEALTHCARE” is going to be paid for going forward. Right now, most people in the private sector are covered through their employer. Just think of the savings to employers!! Largest line item associated with human capital is the healthcare premiums. It might be that we leave that cost in place and cover people through an employment tax, so that the employer sends a check to the Treasury instead of CIGNA. Or maybe the tax will be passed on to all taxpayers. If that is true, just think of the cost savings! Stocks would soar. So you can build that argument through some optimistic speculation, but again, it all comes around to WE CAN AFFORD TO PAY EVERY CENT OF “THE HEALTHCARE” TODAY—NOTHING IS GOING TO CHANGE THAT.

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