Medicare For All? Or For All Who Want It?

Elizabeth Warren and Bernie Sanders have made “Medicare for All” a centerpiece of their campaigns. Pete Buttigieg has offered “Medicare for All Who Want It.” Both proposals have generated criticism, and in my opinion, most criticism of both is misplaced, because the discussion fails to distinguish between two very separate issues: 1) what would a sensible system look like, and 2) how do we get there?

I was prompted to revisit the issue because my cousin–the cardiologist I often cite on this blog–has done his own analysis of the current state of healthcare in this country, and concluded that a single-payer system is both preferable and inevitable. (Those who want to get “into the weeds” of that analysis should follow the link.)

In my most recent book, I also make the case for single-payer–and point out that a fully-implemented single-payer system would be much less costly than our current patchwork, dysfunctional approach. Virtually every economist who has analyzed the situation agrees. That doesn’t necessarily mean that taxes wouldn’t go up, but any increase would be more than offset by savings on premiums, co-pays and other costs currently borne by individuals and employers.

At any rate–I’m in full agreement that a single-payer system is needed. I depart from the “vote for me and I’ll change the system” approach being taken by Warren and Sanders because there is an enormous mountain to climb between where we are and where we need to be, and the suggestion that all we have to do to get a single-payer system is elect a Democratic president (or perhaps a Democratic president and Senate) is ludicrous.

It isn’t simply that politically powerful insurance and pharmaceutical  companies would throw everything they have into that debate. Voters rebel when they are told they will be forced into a new system, no matter how demonstrably better off they would be. Just getting the Affordable Care Act through Congress took enormous political capital, and that was after numerous (unfortunate but necessary) concessions.

In a recent column for the New York Times, political scientist Jacob Hatcher writes that we shouldn’t lose sight of what Ms. Warren is trying to do.

She’s making an evidence-based case for shifting the debate away from the perilous place it’s now in. Rather than “Will taxes go up?” or “Will private insurance be eliminated?” she wants us to ask a more basic question: How can we move from a broken system — a system that bankrupts even families who have insurance and produces subpar health outcomes despite exorbitant prices — to one that covers everyone, restrains prices and improves results?

I actually don’t see Warren asking (or answering) that very important question–she seems to be making the case for an immediate change that would eliminate all private insurers, and if my impression is correct, it is a politically fraught case.

Nevertheless, “how” is the most important question. As Hacker writes,

Getting to affordable universal care has always been a problem of politics, not economics. Given that the United States spends much more for much less complete coverage than any other rich democracy, it’s easy to come up with a health care design that’s much better than what we have. The problem is figuring out how to overcome three big political hurdles: financing a new system, reducing disruptions as you displace the old system and overcoming the backlash from those the old system makes rich.

Yep. And that brings me to an interesting paragraph in my cousin’s post. Dismissing the “public option” (which is what “Medicare for All Who Want It” really is), he writes,

Even now, given our current healthcare pricing, a medicare type program, operating with lower administrative costs, would be far cheaper than those offered by their private counterparts. This would allow employers to willingly relinquish expensive private plans in favor of the cheaper public option that would reduce the cost burden of extra employee benefits. This means that the public option would likely supplant the present private plans completely in short order. (Emphasis mine.)

Yes. That’s the point.

“Medicare for All Who Want It ‘ isn’t the answer to the “what” question. It’s the answer to the “how” question.



  1. This is only true if the public option is made available to employers, not just those uninsured at work. That’s a leap nobody has made yet, but is the one that must be made to flip the Chamber to the side of change. To date, we’ve never talked about more than half the population, those without employer insurance. The result? Those who get their insurance at work see it as a giveaway to “them,” and the chamber-types see only a cost, not a benefit.

  2. Remember that many employers consider health care benefits as part of “compensation” whenever employees want to negotiate hourly wage or salary.

    Also, health care benefits are an enticement to retention. Anyone who has had to use COBRA when transitioning to a different job knows how costly and difficult that can be.

    Even in this time with high employment stats, there are often very specialized skills required for a higher wage job. Employees who are training themselves and paying the high costs and want to keep coverage have an incentive to keep the job they have.

    As for concerns about private insurers and pharma, those jobs will still be there, just in different market conditions. The real losers will be the overpaid execs/stock holders as well as the hedge fund giants who profit so excessively from current conditions. And there is the rub. Those who have the wealth and access to more wealth and the power it facilitates, will use all of that power to keep what they have and more.

    Progressive though I may be, I recognize the pragmatism of incremental moves represented by Pete and others. Talking the talk is not walking the walk. Even then, a packed SCOTUS may make any attempts to change anything a moot point, nice to contemplate but purely hypothetical.

  3. Sheila’s 2nd issue has been my first question for quite a while now; the super powered, mega health care insurance and Big Pharma are not going to give up their ridiculous profit margin to this government and this government cannot afford to buy them out. About the raise in taxes “…but any increase would be more than offset by savings on premiums, co-pays and other costs currently borne by individuals and employers.”; health care providers come into the picture with specialists the biggest winners at this time due to primary physicians no longer allowed to “practice medicine”. These specialists are not going to give up their profit margin and will primary physicians willingly return to “practicing medicine” rather than providing information and referral services? Thanks to Nixon the entire health care system is one huge corporation as we pay for health care we often do not seek due to the deductibles and co-pays at this time. Will funeral homes and crematoriums become the newest corporate recipient due to the failure of health care being provided due to current cost?

    David Honig; regarding your comment, “Those who get their insurance at work see it as a giveaway to “them,”; while working for the City of Indianapolis I chose their offer of Metro Health option. Being promised a specific percentage wage increase, the amount seemed low to me; I was told the City’s cost of health care was considered part of my raise in salary.

  4. While the pace of change to the problem of how to better provide medical care in the United States is important, of more importance to me is the DIRECTION of that change. Is the country ready to really commit to health care for all? Or are we going to allow special interests to dictate the terms of providing health care to some but not all?

    In choosing the future leadership of the country I’m looking hard at candidates who have the skills, the knowledge and the political experience to point us in the direction of “good for all” change. I’m looking hard at candidates who have demonstrated ethical behavior in their business and public service rolls in the past. I’m looking at candidates who know what they stand for and are not afraid to stand.

  5. Economicalky it’s not viable. It’s not inevitable. When people see what Medicare for all really is, we see only less than 30 % wanting it. I see it as a big break for the wealthy who if they want better employees thru benefits can’t use it to attract them. I already lost a fantastic plan to the big lie that you can keep your plan or your doctor which was false. Instead of my employer paying for my insurance I’m going to pay to wait longer for a doctor because its rationed if this goes thru. People will also lose that part of the incentive equation to have to work.
    Even Democrat Senators recognize that we need to ease into this. Nothing bipartisan happened with the ACA. You would think that Washington is a place that represents everyone, but it proved under Obama they weren’t interested in a plan that all sides could agree upon. Half of the people weren’t represented as it was passed.
    Union democrats see it as a wealthy mans ploy to get the small guy to dive up part of their wages. Cadillac plans are gone wouldn’t you know and the union rank and file sees it the way it is.

  6. Our small local nonprofit monopolistic hospital became the target of our local university economics professor because they made almost half a billion in profits and paid nothing to the local government.

    Meanwhile, how many people went bankrupt or choked on medical bills?

    Companies claim market rules for extending high deductible plans to workers. As a social worker, my employer offers a healthcare plan with a $4,000 deductible. Not sure how they can offer this with a straight face. I’ve heard them claim the market dictates health care options. If you buy this explanation, you are part of the ignorant ones.


  7. I’d like to bring up the idea of changing the way pharmaceuticals renew patents. Instead of renewing a patent when they find a new use for the drug, they are only allowed to renew when they significantly change the formula (and not by adding benign ingredients). Easy renewal of patents keeps some drug prices ridiculously high.

  8. Who would have thought that people actually liked having insurance that didn’t cover much at all? President Obama sure didn’t. That’s why he made his infamous you’ll be able to keep…statement. The ACA actually required insurers to cover many things that only the so-called Cadillac plans had covered until then. The bill as it was passed was really pretty good. Since I’m one of the few Americans who actually had to read it before it passed, I’m in a position to say that. Well that statement caused an uproar, mostly because, as I’ve said before on this blog, Republicans are masters at marketing. So instead of fixing what didn’t work well, Republicans spent the next seven years filing lawsuits to decimate the bill. And, since the ACA was so unpopular that it cost the Dems first the House and later the Senate (not to mention the myriad statehouses that turned bright red), the Dems weren’t in any position to do anything about it.

    Now we may be faced with the same dilemma. Do we go for the ultimate plan that will eventually prove beneficial to all Americans or do we work at it incrementally? Remember that the European countries implemented national health care programs after WWII. At that same time, they were rebuilding their entire infrastructures. Those countries had been devastated so they required bold moves to go forward at all. We’re not there. The smart move is Medicare for all who want it and if Medicare is improved , all will want it soon enough.

    Those who warn about not being able to get care or having long delays to get surgeries under national health programs, that is mostly myth. I’m not saying it doesn’t happen, but it also happens here in our current system. You can only have the health care your insurer says you can have, despite what your doctor thinks you need.

    Before I sign off: A great big thank you to all who have served our country in uniform. I love all of you.

  9. It will be an enormous uphill battle to get rid of our For-Profit health insurance in this country.

    The right wing media likes the money that insurance and pharmaceutical companies pay them to post advertisements full of false information that is meant to frighten the public. They certainly don’t want to lose those millions/billions of dollars in revenue.

    We, the public, have been forced to pay for this media onslaught via the astronomical premiums that we are charged. It will take massive amounts of advertising dollars to fight back at those lies by paying for advertising that shows the proof that single payer insurance will enable us to receive better health care with fewer dollars. The public needs to be repetitively reminded about that and no longer having to fight their insurance company that refuses to allow your physician to provide the care that they need. They will no longer have to fight with their insurance company to pay for care that they already received either. Finally, eliminating co-pays and vastly reducing or eliminating deductibles will far outweigh any potential tax increase.

    Essentially, we need to fight fire with fire by educating the public about the actual benefits of single payer by showing a side by side comparison of the pitfalls, huge expenses and massive waste of the current system next to a list of the benefits and true costs of single payer. The public must be shown actual dollar comparisons between the two systems – the increase in taxes that is still much less than the premiums, deductibles and co-pays that they currently pay.

    The positive changes can only be brought about by having the money to pay for a continuous media onslaught until the public actually recognizes the benefits and demands the change be made.

  10. I think the public option will win, eventually. Having competition in insurance will allow the public option to be the best option to purchase. Private insurance will be for those that want specific things like Naturopathic medicine to treat their autoimmune conditions like I have.

    The first thing we Must do is remove the profit from health care. Nothing works until that is resolved.

  11. I was impressed with Sheila’s thumbnail sketch of Jacob Hatcher’s excellent analysis. I, too, have been a single payer aficionado for ages and have voted yes on every plan put forth by politicians on the road to that end. I only favor these interim “plans” one by one in the hope that they will take us to the ultimate answer – single payer. I don’t care about pride of authorship in this connection; I care only about the end product whether sponsored by Bernie, Warren, or even (gasp!) Trump. Whoever. I am totally result-oriented on this issue.

    As I see it, the right to healthcare is not about insurance which, after all, is a rather late development in this brawl, having only started when Nixon gave his California buddies (Kaiser) entrance into its financing in the 1970s. How it has developed since then represents a study in privatization of financing (and even policy) of the public’s right to healthcare, and Big Pharma and Big Insurance and their campaign contribution-loving buddies in the Congress have propagandized many of us into believing that the status quo should be maintained because of fears of “big government” and “socialism” and other such myths that keep executive salaries and bonuses and dividends to insurance companies’ shareholders humming and the rest of us subject to the fine print of their so-called policies, policies they write and interpret which have resulted in patchwork coverage and medical bankruptcies that at last count amount to forty one percent of all bankruptcies filed.

    It is in this connection that I determined to agitate for single payer after reading a study which showed that twenty five to thirty percent of the premium dollar paid to “health” insurance companies wound up in dividends to shareholders and executive compensation. That amounts to an enormous sum which under single payer could be instead applied to real healthcare for all of us. I even wondered what insurance companies were doing in the healthcare business at all before coming to understand that Nixon had let the foxes roam free in our health hen house, like, who needs ’em, as in, what’s next? Are we going to invite insurance companies into the financing and administration of our Social Security program? Who needs ’em (and the additional costs)? Are we going to open every public program to corporate taint and profiteering and, if so, why?

    I think single payer is at last (and irrespective of corporate propaganda) gaining traction and that perhaps soon the only question remaining will be its financing, and while that will be fiercely contested by some employers, Big Pharma and Big Insurance, I consider it a detail that can be worked out via underwriters and spread sheets. Imagine a healthcare system where literally everyone is fully covered for any thing medical and at a cheaper cost – such as that of France, widely acknowledged to have the best health care system in the world and at something over half of what we pay for a patchwork system where public control has been hijacked by profiteers who value profits over the nation’s health.

    All we need to bring single payer into fruition is political control and agitation for its adoption, so let’s have at it.

  12. David Honig,

    There would not be a need to offer the public option to employers because every citizen would automatically be insured, including those who are company owners/employers. Employers would no longer be involved in providing health insurance coverage. They would not have to negotiate with insurance companies to provide coverage for their employees. Employers would no longer deal with annual increases to their cost of providing employee coverage. Employers would save money by not having to pay an employee or multiple employees to manage health insurance coverage.

    Your statement that we’ve only talked about half of the population (those who are uninsured) is not accurate. The savings to those who are employed has been repeatedly pointed out by those who are in favor of single payer. It has been pointed out that employees would no longer face annual premium increases from their employers and would no longer face ‘In Network” provider restriction coverage placed on them by the for-profit insurance company chosen by their employer. Everyone would be free to choose their medical providers and free to seek care at any hospital.

  13. Immediately after World War II ended, Great Britain made their National Health Service law. Their reasoning was that EVERYONE, including Lords and Labour had sacrificed equally for saving their country and helping to win the war. The least the government could do, they reasoned, was provide single payer health care. Period. They saw it as a social right.

    As Gerald mentioned, Republicans decided to make health care insurance a market. Kaiser had just made countless billions building ships for the world war. His greed and corruption played right into the Nixon/Republican meme of “free-market” economics. The economics point is that health care insurance companies charge between 25% – 60% OVERHEAD on their premiums. The Medicare system costs about 7% in overhead. After all, the stockholders must be kept happy. The sick and injured who need medical care? Not so much. What this wonderful Republican “strategy” has provided is: “HOW MUCH ARE YOU WILLING TO PAY TO LIVE A LITTLE LONGER OR NOT HURT?” Once again, unbridled capitalism comes to the rescue of humanity.

    Single payer, universal health care by any name anyone wants to pin on it, is the HUMANITARIAN solution to keeping our society healthy, productive and solvent. Republicans and capitalists have no room in their playbooks for such notions. Hey! If virtually every other civilized nation can provide single-payer health care and be successful, why should we. We’re the United States. We’re dumber, more callous and greedier than anyone else. That’s what makes us great.

  14. The United States already has several excellent “universal” health care programs in existence, The Federal Employees Health Benefits (FEHB) Program, the Medicare and Medicaid programs, TriCare and the Veterans Health Administration. These programs should combine in some way and become the basic groundwork for our National Health Care Plan.
    We currently pay about $10K for 2 people for our health insurance. Those who already contribute to their coverage and supplemental health insurance should continue to pay a reasonable annual fee for their coverage. There should be a graduated premium according to the family income level. Those below a specific annual income would pay nothing.
    No one is expecting totally FREE health care. Call it an insurance premium or a tax, but those who are able should pay something into the program — especially to get it going!!

  15. Medicare for all would be an enormous undertaking and a massive economic upheaval unparalleled in U.S. history. Why?

    Medicare is a small fraction of the health care industry, representing only 9% of expenditures and coverage for 17% off the population. Two-thirds of citizens (200M) have coverage through private employer provided insurance with which they are generally satisfied. This would present extraordinary scalability and conversion challenges.

    Financing would also be extremely challenging because half of the current $3.3 trillion dollars in health care costs are privately funded. And what would you do with the other federal and State programs such as Medicaid, Obamacare, CHIPS etc. Conversion to a totally or mostly tax based funded program would dramatically increase federal taxes and have currently unknowable effects throughout the economy. For example, how would the 500,000 employees in the health care industry be affected?

    There are also enormous gaps in health care provided under Medicare; 35% of participants rely on supplemental private insurance plans to manage these coverage and financing shortfalls. Medicare in its current iteration does not provide comprehensive benefits. It too needs to be fixed.

    The point being, candidates for the Presidency have to be held accountable to more than a slogan and the scanty plans we have seen thus far.

  16. Nancy @ 9:12 am, excellent points. Corporatism, is losing the intellectual battle of improving ACA, as any “improvements” require more subsidies and tangled bobbing and weaving to maintain profitability to the Health Care Industry.

    Now the campaign is another bogus scenario of Medicare for all that want it. What you end up with is a two tier system. The people who are pushing Medicare for all that want it are slim to non-existent on details. Anyone who has and relies on Medicare now, understands you must buy supplements in order to receive “complete coverage”.

    Naturally, the McMega-Media, advertising companies, health insurance and big pharma are doing their best to torpedo, Universal Health Care or Single Payer, imagine all the advertising revenue that will be lost to them.

    I am on Medicare now and everyday I am bombarded with phone calls and mailers about various supplements, plus the TV advertisements. All of these advertisements cost money. The money comes from those people who pay the premiums.

    As far as Employer provided Health Care, it is only as good as the employer can afford, and it is only applies while you are employed.

  17. Sounds like this is in line with Pete. From Pete’s page: “Through Pete’s Medicare for All Who Want It plan, everyone will be able to opt in to an affordable, comprehensive public alternative. This affordable public plan will incentivize private insurers to compete on price and bring down costs. If private insurers are not able to offer something dramatically better, this public plan will create a natural glide-path to Medicare for All. “

  18. To me there is no ultimate answer for affordable health care other than socialized medicine. Capitalism only works in markets full of competition and there is none in the health care delivery market. There is no form of insurance that can cure that.

    The question of transition is an absolutely essential one though. No matter who is promising what at this point what will happen is both political and economical compromise considering how to make such a profound change and that has to lead from current Medicare, to adding those who have no real insurance alternative now, to sometime in the future changing the entire structure of the market to eliminate insurance all together by tax payers owning the means of delivery of health care services themselves. I’ll bet that takes at least a decade no matter who replaces Trump.

    It will never happen if Trump replaces Trump.

  19. In other words, start by returning Obamacare but for those who have no affordable insurance option fund it through Medicare rather than through a private insurance regulated market.

  20. Americans pay approximately twice as much for health care than other developed countries. The cost of health care is a significant barrier to more people having access. Cost of healthcare is also a burden on business and governments that is unsustainable. Reducing the cost of healthcare by 50% is a goal we should all get behind. In my view, the only way to get there is through a single payer system.

    That said, I can’t support a “Medicare for All” approach as envisioned by Warren and Sanders.
    Politically it’s unobtainable, even with a Democratic Senate. The political fights, legal challenges, etc. would certainly delay needed reform for a decade or more. In my view, “Medicare for all who want it” is exactly the right approach.

    It’s very easy to negotiate with people who mostly agree with you – not so much when folks are vehemently opposed. The backlash to a Warren/Sanders plan would be certain and fierce. Politically, it turns an issue that is an “asset” for Democrats (healthcare) into a liability. “Medicare for All” is being politically stupid for the sake of ideological purity. Democrats who think that a Warren/Sanders health care plan is a winning issue for Democrats need to get out of their ideological bubble more – seriously. I was astounded that Elizabeth Warren thought she could duck the issue of how to pay for her plan – Republicans will be more than happy to do that for her in a general election.

    A decade has passed since signing Obamacare. Look at it– and look at John’s comments: The ACA was a big deal, but it’s been gutted in many ways by legal challenges, political opposition, and arguably the failure to cut the underlying cost of health care. Never mind that I disagree with many of the things that John assumes to be true – the fact is that there are a lot of people who believe the same way John does. The overhaul and disruption brought about by the ACA is peanuts compared to what Warren/Sanders are proposing.

    If such a large transition is attempted on almost 20% of the US economy and it doesn’t go well (and it most certainly won’t), it would doom needed health care reform for another decade, easily. The people who feel that universal coverage is a justice issue should understand the inherent risk of an attempt at a sudden transition. The desire for “purity” would likely delay real reform and greater coverage for far longer than if we took an approach that provided a transition – especially if that change is driven by consumer choice rather than political dictate.

  21. Two comments…

    From 30 years of consulting in complex change to giant corporations, I can assure you that moving quickly to a single-payer system would bring the county to its knees – complex change is incredibly difficult.

    One more wrinkle to throw in – hundreds of thousands of employees in the current system with jobs and no college degree thrown out of work.

  22. John –

    Regarding your statement “Instead of my employer paying for my insurance I’m going to pay to wait longer for a doctor because its rationed if this goes thru.”

    You have fallen for the propaganda the insurance companies have been spewing since they began their battle to stop the ACA from becoming law.

    But what really bothers me about your statement is that it reveals you to be one of those selfish people who is content to watch others go without health care and suffer because they can’t afford it as long as you are taken care of.

    The old Ayn Rand selfish belief of “I’ve got mine, to hell with you” certainly applies to you based upon your statement of having to wait in line for care if those who are currently uninsured become insured in the future.

  23. My guess is that the 70% who think they don’t want Medicare for All, and who will have to be weaned, over time, off their accustomed systems, will be persuaded by the following ten facts which roll off the keyboard like water over Niagara Falls:

    1. In the end, a single giant customer of Big Pharma will be such a powerful client that it will be able to secure fair and sensible prices for drugs (please refer to the insulin pricing saga)
    2. Paying private firms for nothing more than shuffling paper and forbidding care never made any sense and contributes almost nothing to achieving acceptable levels of health (refer to Rick Scott’s fortune)
    3. Instead of paying more for American pharmaceutical products than any other country, America will pay less
    4. Legislators, not lobbyists, will assume a bigger roll in deciding practices, policies, and prices
    5. The possibility of a nationwide medical records system, with all of an individual’s data on a single, portable thumb drive, will become a reality and will save billions
    6. Hospital systems will stop suing to keep other systems from what they consider to be impinging on their God-given markets
    7. Uniform standards will be imposed that reflect equal, nationwide healthcare for all as a replacement for the best care for the richest people
    8. Doctors will experience simplified billing procedures
    9. Emergency rooms will cease having to serve as the provider of last resort
    10. A national healthcare program will introduce the possibility of providing acceptable levels of care in all geographical areas, not just the most profitable markets.

    This tiny, partial list of predictable improvements make a single-payer system inevitable. That doesn’t mean it will be easy. It will require time, patience, salesmanship, determination, scrupulous planning and careful execution to bring the 70% to an understanding of their own self-interest. Lobbyists and their employers will pay billions to slow or stop such progress. Politicians and their handlers will dedicate themselves to obstructionism. Anyone who suggests that this is achievable over night is an enemy of getting there. People despise change more, if that’s possible, than they do Trump, but Henry Ford proved it was possible.

  24. Let’s face it, insurance is only a financial service that takes money from all of its customers and pays it out to those who have the worst luck in preserving what’s insured. They have no ability to change what goes wrong or how to fix it. They just pay for fixing whatever they cover when it goes wrong.

    There is no path through health care insurance that fixes health care delivery.

    Having all of us own the means of production of health care means that our taxes are our insurance. We all pay for our fair share of the costs of fixing everything that’s necessary to keep all of us healthy from the ones who need the most care to the ones that need the least.

    Socialized medicine eliminates the health care insurance business altogether.

    It’s just not possible politically and economically and emotionally to get directly from here to there.

    Obamacare was a wonderful first step in a long necessary journey.

  25. I agree with Pete that Insurance companies add very little value to the process and extract a considerable cost in terms of overhead, profit and administrative burden on employers and providers as well as consumers. They have been miserable failures at constraining costs.

    I disagree with Nancy. “I’ve got mine…” is a political reality. Getting the public to support something that isn’t in their personal interest is tricky (although Republicans have been pretty good at it). Shaming people isn’t going to work.

    Having a plan that cuts costs and simplifies delivery is the way to win converts over time.

  26. A public option was one of the choices originally contained in the Affordable Care Act when it was first presented. I thought it was necessary for the ACA to work. I thought it made a lot of sense, but it was quickly erased. There were squawks of “that’s socialism” that helped erase it, along with lobbying by big pharma and big insurance. I seriously doubt that a majority of people even know what socialism is, there is just a Randian opposition to anything that benefits somebody else. Medically based bankruptcies do not benefit the country, nor do legions of sick people who are poverty stricken. I think the public option for those who want it is a practical approach.

  27. Terry; for me it isn’t not wanting Medicare for all, it isn’t feasible at this time. It could have been implemented years ago before corporations took over the system and lobbyists and Citizens United cemented the system in place we now have. Medicare for all will take years to become a reality; to provide health care now requires bipartisan agreement to fix the current system so that people are getting health care they can afford to pay for. President Obama and Congress were very open about the fact that ACA needed work but it brought health care to those who had been denied due to meeting the insurance company requirements to qualify. President Obama was also open about the fact that much of the ACA had been written by Republicans under George W’s administration by Democrats blocked it. Now; we are watching the Republicans try to destroy many of the health care provisions their own party members tried to provide and blocked application to ACA by state health care systems with ridiculous requirements. Along with the outrageous costs of health care insurance premiums, sky high annual deductibles and co-pays for treatment, we have that stone wall of partisan government blocking any progress. We will never reach agreement on the health care system which will be a perfect system for all or which will please everyone.

  28. A lot of differing perspectives means there is a possibility to move forward by limiting profits and building on the ACA.
    There needs to be guarantees for the first $2000 to have no deductible followed by a doughnut that can be covered by a part B type of coverage whether that’s covered by government or private insurance.
    15% profit limits would allow for lowered deductibles and better overall coverage. All larger companies should be required to cover within 3 months of hire both full and part time employees.
    Competition by companies accross state lines should be allowed to lower costs. Profits from companies above 15% should go to those caught with payments in the doughnut.
    The ACA was meant to fail to bring about a national plan insurance should be usable

  29. Sen coons made it clear. You shouldn’t take away from what unions have done for the rank and file who are willing to strike and bargain for better benefits. Along came “The Greatest President of all Time” winning a purlitzer for being elected, ha, who blew up the national debt to pay his chronies and with partisan support by only one party turned his back on unions by lying to them about the fact that they could keep their Cadillac plans. Now unions lost bargaining power and workers lost their benefits.
    It seems that when someone like me pays out an additional $10000 in lost coverage and tax exemptions that if I complain about not being able to take care of my family in the same fashion big league socialists act like they’re Behar on The View.
    It’s simple, don’t turn your back and lie to those that put you in power and they might not be forced to vote against a party that they can’t trust

  30. For all the nay saying and profits of “no can do” melted like wicked witch when SOCIAL SECURITY AND MEDICARE actually went into effect. Whatever finally transpires single payer is inevitable response rising billing and administration costs. We have a “two tiered ” system now. Private health insurance is really never likely to be effective cost wise. Unless they heavily regulated like the Netherlands. One key to why this so? Current MEDICARE ADVANTAGE policies are a prime example. A private insurance coverage, claiming to be even better than Medicare . It is funded by Medicare recipients signing over their premium and monthly Medicare cost coverage. I tried it for one year. It is a scam. They start denying claims and playing the appeal scam. Claims traditional Medicare does not deny. Like bad money and good or the slower, non-digital, monaural VHS drove out high speed, digital video and stereo sound. The bad will drive out the good in health. Because you can sell anything you can convince Americans is cheaper, just as good, and not government. Private can make huge profits, set the hook on the con, and PT Barnum find his sucker every minute. Two tiered system only if people are given one chance only to opt in or out government program. Opt out , stay out for good. Varying actuaries and private undercutting price until they monopolize can never be allowed. A one time option. If private wins then regulate the in the public interest.

  31. Politically, telling business that their employee health insurance costs would decrease would greatly increase the chances of getting public option or single payer through. Also getting people to understand ownership of insurance pool, and ridding the profiteering middle men would enhance policy holders responsibility. Single payer would reduce costs per increased negotiating power, and streamline paperwork that would save healthcare personnel thousands of hours & dollars. Tri-care is a good Federal Model. Quality of care would be upheld by hospitals competing for the business. Some people would want to feel special & they could buy “extra” insurance where they could be put on the top floor of the hospital, and pay more for the same care.

  32. A great post, Sheila, and to the point. You get input from your cousin the cardiologist and I get input from my brother who moved from law to head up an Accountable Care Organization (ACO)under Medicare for his former clients (physicians). Our sources seem to agree with each other.

    I will mention this again – back when Obama was trying to figure out a healthcare plan, Greater Indianapolis for Change (which I co-founded) called together all of the groups that had been working for healthcare reform in Indiana for the past many years. Surprisingly, they all came together for this meeting set up by someone they never heard of from an organization that they also had never heard of.

    We met and all agreed on three things: (1) we needed to lobby, but also to do it in a coordinated and harmonious fashion – one voice, (2) we all thought that a single payer system was the right way to deal with healthcare, and (3) we all understood politics and believed that if we pushed hard for a single payer system, it would be compromised down to a strong public option (or even a weak one) and that this would be a victory, because this seemed like the most viable path to what we all wanted. We, those good-hearted, but foolish liberals that Obama thought should be ignored believed in compromise.

    We should also remember how life and politics don’t follow straight paths. The ACA is a Heritage Foundation product (motto – the answer is laissez-faire free markets, now what was the question?) – under the ACA, insurance companies are entrenched as is the notion that healthcare is a commodity and not a right — funny how now most people are viewing healthcare as a right and not a commodity.

    Lester is right about the difficulty of merging systems. My previous employer was an IT firm formed by the merger of two large companies. Two years in and they hadn’t merged their HR or their help desks and were just setting up a single standard computer system for their 130,000 employees. On the average, each employee was unable to work for 1-2 weeks while they were trying to reconfigure their computers. Imagine what merging everyone into Medicare in one year would do.

    For various reasons, many unions have opted to pursue better healthcare benefits over better wages. I know when my sister-in-law was negotiating for her teachers’ union, it was a well reasoned strategy. Those unions are not going to want to drop their benefit all at once. (We all know that the corporations will let the workers have a tiny raise, pocket the rest, and hand out big bonuses to the CEOs for saving the corporations money). Also remember the resistance to change that is part of human nature. That all is fine. Realistically, the transition from ACA to ACA with a public option (Medicare for those who want it) to a single payer system will take at least a decade and maybe more to complete. Remember – it took from FDR/Truman to Obama to get the healthcare improvement we have now. Burn it all down and build from scratch sounds great, but I wouldn’t want to live through it unless forced.

    Monotonous – I will keep tabs this year, but my “back of the envelope” calculations suggest that I will be better off with my Medicare/Supplemental/Part D that if I chose my employer’s healthcare plan. Of course this varies with your medical needs.

    One last point – A co-worker insisted that his Canadian friend said that all of the Canadians are coming to Buffalo for healthcare because of the long waits for critical care. That is balderdash. If a Canadian comes to the US for healthcare, they are going to pay “retail”. Canada does allow for private healthcare, so they could buy it in Canada without having to travel to the US.

    However, there is rationing. Americans want to see their doctor the same day for a bad case of hangnail. In Canada, (as under an American single payer system), they have to wait. Serious cases do not get delayed; what the patient thinks is urgent — that is another issue.

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