"Universal healthcare now!" must be the Democratic motto in 2018

[Yank2133]

I think there will be a divide between support for a strong public option and full on single payer. I don't think the system or the country is ready for single payer. The ACA only really deals with individual market and single payer would be dealing with employer sponsored plans + individual market.

This is why I don't think single payer will ever happen in the US. Once suburban/middle-class Americans learn that a single payer may up end them from their plans, then the politicians will quickly jump ship.

[Technocracy Timmy]

It's still the home of Nixon and Reagan is loved here.

Yes; among non-Hispanic White voters. But due to the Hispanic population, Orange County had a higher Hillary margin than New Mexico last year. I think that's unlikely to totally go away.

Pence will win the County in 2020 by bringing home a lot of those college educated whites who couldn't vote for Trump.

[Shadows]

I think there will be a divide between support for a strong public option and full on single payer. I don't think the system or the country is ready for single payer. The ACA only really deals with individual market and single payer would be dealing with employer sponsored plans + individual market.

Public Option is less popular in many polls than a Single Payer/Medicare for all. The ACA in its current form will likely be dead by 2020 & Republicans will pass some compromise version protecting pre-existing & Medicaid expansion so that could kill the whole Public option debate! Besides if the Dems get 60 Senate votes, it will be foolish to not get a Single Payer, the easiest, cheapest, least complex, universal version which can NEVER be repealed by Republicans like Social Security, Medicare, Medicaid, Minimum Wage, etc!

And a public option still won't solve many problems of the ACA, the insurance attached to employer which is terrible for job mobility, entrepreneurship, creates added hassles  & even prevents some businesses to grow. You still have the same problems of cost & public option even if it gets 60 votes may likely be made optional like the Medicaid expansion (who knows what the Courts will say if the states resist n file lawsuits), we don't know what the public option looks like, how many people will get through exchanges etc.

It surely is quite a lot better than the current version of ACA but it won't guarantee universal coverage - Millions will still be uninsured & costs may or may not fall down significantly ! But if you are a conservative Democrat, public option could be an answer but progressives should push for a Single Payer !

[All Along The Watchtower]

Unfortunately, even a rhetorical commitment to any universal healthcare policy would require that campaigning Democrats admit that Obama did not already achieve universal healthcare for the United States by signing the Affordable Care Act, a common and persistent piece of confusion that that party loyalists are increasingly reluctant to acknowledge.

This is false.

Democrats admitted even during the signing of the ACA that this was just a first step towards universal coverage. 

The most honest and sophisticated discussions of the ACA cannot but admit that it does not amount to universal coverage. You may have noticed that many political discussions are not especially honest or sophisticated. A large share of the voting public does not understand the difference - e.g. multiple major newspapers have run columns clarifying that the ACA is not universal within the past several months.

We've also seen a great deal of outrage over AHCA leaving millions of people uncovered. Only a moral monster could support that, we are told. Unfortunately, the ACA also left 25M+ Americans without health insurance. That was more than before, of course, and at a higher standard of coverage, but it's not as if no one lost their coverage because of the law.

I'm not trying to be obtuse. If Democrats campaign on achieving universal coverage, this is an obvious and natural question for most voters: What the hell did you do in 2009? That's not an easy question to answer. It is not an easy appeal to clarify.

I essentially agree with all of this, but the fact that the ACA - as flawed, uneven, and needlessly complex/confusing as it is - has resulted in some undeniable benefits for a lot of people makes this a hard pill for Democrats to swallow. And unfortunately, the endless Republican demagoguing about the issue has drawn the reflexively defensive Democratic Party into an irrational excuse for a "debate" that they simply will never win.

I've noticed that Democrats are electorally punished for their failure to implement (or even campaign on, increasingly) ambitious left-wing/center-left policies that would take some real political courage within the context of the Beltway/corporate special interest bubble but would also have the potential to substantially improve the lives of everyone outside said bubble. The Republican Party doesn't get punished for that, at least, because neither they nor their political (and certainly not their economic) base of support are interested in anything even resembling a positive solution for social problems - quite the opposite, as this ghoulish pseudo-health care/really a tax cut for rich people bill demonstrates. So there's no equivalent expectation on the Right; the most "populist" that Republicans get is Donald Trump.

[Shadows]

Middle class Americans save big in Single Payer with around 400-500B $ in flat out profits & administrative costs only. Besides it is the biggest boost for middle class/suburban folks as it delinks their healthcare from job, allows them to start a new venture, shift jobs easily & this job mobility will boost the employment market, will free small companies of the 50 employee rule & additional hassles & costs ! It guaranteed covering everyone sub-urban middle class folk at a cheap cost !

It will definitely cause massive issues with the Insurance companies who will lose 100's of Billions of $ & many high paying useless fat cat jobs & they will throw everything to stop this! That will be a massive fight !

[Yank2133]

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That because the vast majority of people don't know the details of single payer/medicare for all. Both single payer/medicare for all will call for a tax increase across the board. Granted the tax increase will replace the premium hikes, but I just don't know how you can sell that to suburban Americans.

[Indy Texas]

Democrats could move the needle in this direction the next time they control WH+Congress by lowering Medicare eligibility to 55 and getting rid of the waiting period for disabled people to enroll.

[Shadows]

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That because the vast majority of people don't know the details of single payer/medicare for all. Both single payer/medicare for all will call for a tax increase across the board. Granted the tax increase will replace the premium hikes, but I just don't know how you can sell that to suburban Americans.

Firstly there's some working class & low income suburban groups here as well who are reliable Dem voters. Then there's middle class suburbans already pay very high premiums & don't get subsidies & are getting killed in this system ( the average median family income is around 50K & the 50-150 K odd range are not being benefited under ACA in terms of premiums). And some of them(200/250K) are even paying the Obamacare penalties, Obamacare taxes & are not getting anything.

So I don't know how they really benefit from this current system which hurts them even more. They people who will be negatively affected due to high payroll taxes will be the people earning above 250K or 200K at worst & most of these people will not support ACA or Universal healthcare - Around 95% of the people will be saving money in a Single Payer as will most suburban folks!

[Technocracy Timmy]

The healthcare debate isn't going away for a while but I would venture to guess that we'll follow the Netherlands/Germany/Swiss model of having a highly regulated multi payer system.

The biggest obstacle with single payer is the fact that it does lower costs considerably. Good for the consumer but bad for the producer. Right now we spend close to 18% of our GDP on healthcare and if we were to institute a single payer system that produced similar outcomes to the rest of the world it could drop to us only spending 12% of GDP on healthcare.

Sound great? Well it does come with trade offs. When 6% of your GDP is lost then it will cause a sharp recession and short term pain; a price few politicians are willing to pay. Now the economy would recover and reallocate resources fairly quickly but it wouldn't be painless. Doctors, nurses and other professionals will see their incomes decline as less money is being spent on procesdures and hundred of thousands of jobs will be lost-many of which are good paying jobs including medical device makers, insurance adjusters, marketing managers, etc.

It's just not a short term price most politicians or either Political Party is willing to pay.

[Yank2133]

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That because the vast majority of people don't know the details of single payer/medicare for all. Both single payer/medicare for all will call for a tax increase across the board. Granted the tax increase will replace the premium hikes, but I just don't know how you can sell that to suburban Americans.

I don't understand this type of thinking. Yes, taxes will be raised, but people will no longer have to pay for the vast majority of healthcare, and they are guaranteed care to the end of their lives. This is no different than Social Security or Medicare, and those are some of the most popular government programs in the United States.

It is not hard to understand, Americans hate taxes, even when they are getting a good deal out of the increase.

[henster]

The vast majority of Americans get their health insurance through their employer and are satisfied with that, it will be hard to basically kick those people off those plans onto Govt insurance. And what of the millions who work in health insurance industry do they all just lose their jobs? The reason the ACA did not deal with employer sponsored health care because of the feared backlash.

[henster]

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That because the vast majority of people don't know the details of single payer/medicare for all. Both single payer/medicare for all will call for a tax increase across the board. Granted the tax increase will replace the premium hikes, but I just don't know how you can sell that to suburban Americans.

I don't understand this type of thinking. Yes, taxes will be raised, but people will no longer have to pay for the vast majority of healthcare, and they are guaranteed care to the end of their lives. This is no different than Social Security or Medicare, and those are some of the most popular government programs in the United States.

It is not hard to understand, Americans hate taxes, even when they are getting a good deal out of the increase.

This is why a public option is a better sell, if done right it would be self sustaining and require no tax increases just people paying premiums/deductibles.

[Indy Texas]

I think there will be a divide between support for a strong public option and full on single payer. I don't think the system or the country is ready for single payer. The ACA only really deals with individual market and single payer would be dealing with employer sponsored plans + individual market.

This is why I don't think single payer will ever happen in the US. Once suburban/middle-class Americans learn that a single payer may up end them from their plans, then the politicians will quickly jump ship.

The justifiable concern is that after their employer is no longer providing them with a health insurance plan worth $10,000 a year, they won't be getting a $10,000 raise to even things out. (And then they'll have to have their taxes raised to fund single payer.) They're worried it would basically amount to a pay cut for people who get insurance through their job.

[henster]

I think eventually we will have something like the Australian healthcare system with Gov't run insurance and private insurance co-existing and competing.

[Shadows]

I think eventually we will have something like the Australian healthcare system with Gov't run insurance and private insurance co-existing and competing.

ACA was the default run system most similarity to the Australian system with a similar penalty on people not buying insurance (with a payroll kind of tax in addition) , a Medibank with a 30% share which is essentially a modified public option. The community rating basis of Pre-existing conditions was also somewhat borrowed from the Australian model. The conservatives twice pledged to sell Medibank which would have ended the public option (but lost the elections). The government also produces subsidies for all private insurance plans regardless of income now (big government subsidies for everyone) although I think conservatives are pushing for income thresholds which will increase prices for middle class. There is a lot of government support through the general budget which comes through overall taxes & there's subsidised medicines, subsidies this n that. So for the Australian system to work well, taxes have to further raises in the US in the general budget! Around 70% of the health expenditure in Australia is government investment with big chunk coming general federal revenue.

And the GOP would not only introduce means testing & but play around with income levels (beyond which there is tax/penalties/subsidies) but will play around with the coverage given too (over which you can take private plans) & reduces it to a level that makes coverage meaningless & may take away subsidies provided for everyone. The ACA without the employer healthcare issues is somewhat similar to the Australian system. And it will never be universal in US & there's 0 chance of it being permanent - It is too easy to destroy & difficult n much more complex to make it anywhere near universal & affordable in the complex setup now!

The reason FDR said he created a separate Payroll tax n account for Social security was to make it individually solvent & free from swindling & debt problems in a General budget.

[Torie]

Is universal health care the same thing as single payer? I support the former, but resist the latter, unless there is no other way to do it, that will not cost a lot more money (other than money which funds drug research).

They do not need to be the same, and universal health care can be operated with a multi-payer system. In Germany there are over 100 funds that insure most of the population, paid for by a combination of employer, employee and government contributions. The premium is fixed for individuals in these funds independent of risk. There is also an opt-out provision for qualified individuals to pay a tax and buy insurance independently of the regulated funds, but those individuals can be charged based on risk.

Thank you. Do you think the German model has merit to consider for the US?

There is no reason to condemn the German model as less likely to work well here than single payer, but neither necessarily helps when the underlying costs of delivering health care in the United State are around twice as much per capita compared to Germany, which itself is fairly expensive compared to many other rich countries. "Universal health care" is a wonderful and high-minded commitment, but it's far from a direct answer to our health care affordability problem.

The ACA has been good mostly at moving costs around to keep hospitals open, individuals out of bankruptcy, state and local governments solvent, and businesses able to afford insurance for their employees. But the costs are still there, and still growing. They are probably a major factor behind increasingly toxic politics on an issue that has always been politically toxic. Unfortunately, no one in power appears to have much interest in addressing - except maybe by cutting off some of the most basic forms of health care for the most vulnerable and powerless people.

As difficult as it to talk about health care coverage, it's much more difficult to talk about health care delivery.

Part of the problem is that the US funds drug research for the planet, because drug companies charge less to rich foreign countries than in the US due to their being a single purchaser in government run health care systems. That is why I keep harping on that the US should pass a law that drug companies should be prohibited from charging more for drugs in the US than in rich countries abroad, other than for whatever cost savings attend having just one purchaser (the volume discount concept). Doing that will reduce costs for health care in the US by a fairly large number, unless government run health systems abroad refuse to pay higher prices for expensive drugs that work better, then cheaper generic drugs, and force their citizens to do without. I tend to doubt that will happen. In the end, the idea is that rich countries abroad will pay more for drugs, and the US less.

One other thing. The health care industry private sector needs a profit to pay for the cost of capital. When the government spends money, it too has a cost of capital. It is just not on the books. It's implicit because the more the government spends, the higher the debt service. Thus the cost savings from an economic perspective from single payer are less than advertised.

[GoTfan]

That's one way to lose in 2018. 

Please stop pretending to be a liberal.

[Kingpoleon]

A century of efforts going into Universal Healthcare - Chronology

Teddy Roosevelt, Republican - "Let me add that the health and vitality of our people are at least as well worth conserving as their forests, waters, lands, and minerals, and in this great work the national government must bear a most important part.”

It wasn’t until he ran for President again in 1912 as a Progressive that his platform would include the idea of  a more nationalized healthcare idea. Roosevelt’s concept was labor based, with burden for costs shared between workers, employers and the government.   It was indeed progressive, and was not embraced by those who saw it as competition to making money with medicine. The American Medical Association (AMA) was also deeply and vocally opposed to the idea which it labeled "socialized medicine"

FDR -  In 1933, Franklin D. Roosevelt asked Isidore Falk and Edgar Sydenstricter to help draft provisions to Roosevelt's pending Social Security legislation to include publicly funded health care programs. These reforms were attacked by the American Medical Association as well as state and local affiliates of the AMA as "compulsory health insurance." Roosevelt ended up removing the health care provisions from the bill in 1935 (Social Security bill).

In January 11, 1944, in his address, Roosevelt suggested that the nation had come to recognize and should now implement, a second "bill of rights. (1 of which was guaranteed Healthcare along with education, good jobs) - The right to adequate medical care and the opportunity to achieve and enjoy good health

Harry Truman - Truman’s plan for national health insurance in 1945 was strongly committed to a single universal comprehensive health insurance plan that included all classes of society, not just the working class. The chairman of the House Committee was an anti-union conservative and refused to hold hearings. Senior Republican Senator Taft declared, “I consider it socialism. It is to my mind the most socialistic measure this Congress has ever had before it.” Taft suggested that compulsory health insurance, like the Full Unemployment Act, came right out of the Soviet constitution and walked out of the hearings. The AMA, the American Hospital Association, the American Bar Association, and most of then nation’s press hated the plan. The AMA claimed it would make doctors slaves, even though Truman emphasized that doctors would be able to choose their method of payment.

What Truman could pass - The National Mental Health Act (1946) became law on July 3, 1946. It established and provided funds for a National Institute of Mental Health (NIMH). The Act made the mental health of the people a federal priority. It was inspired by alarm at the poor mental health of some draftees and veterans, and was demanded by veterans and their families

Truman writing how AMA was sabotaging it (the Fair Deal) with lies about socialized medicine -



In 1946, the Republicans took control of Congress and had no interest in enacting national health insurance. Truman responded by focusing even more attention on a national health bill in the 1948 election. After Truman’s surprise victory in 1948, the AMA thought Armageddon had come. They assessed their members an extra $25 each to resist national health insurance, and in 1945 they spent $1.5 million on lobbying efforts which at the time was the most expensive lobbying effort in American history. They had one pamphlet that said, “Would socialized medicine lead to socialization of other phases of life? Lenin thought so. He declared socialized medicine is the keystone to the arch of the socialist state.”

JFK - Campaigned on Medical Care for the poor & old (Medicare & Medicaid essentially) but couldn't get it passed.

LBJ - Congressman Aime Forand introduced a proposal in 1958 to cover hospital costs for the aged on social security. The AMA undertook a massive campaign to portray a government insurance plan as a threat to the patient-doctor relationship. In the entire history of the national health insurance campaign, this was the first time that a ground swell of grass roots support forced an issue onto the national agenda. The AMA countered by introducing an “eldercare plan,” which was voluntary insurance with broader benefits and physician services. In response, the government expanded its proposed legislation to cover physician services, and what came of it were Medicare and Medicaid. The necessary political compromises and private concessions to the doctors (reimbursements of their customary, reasonable, and prevailing fees), to the hospitals (cost plus reimbursement), and to the Republicans created a 3-part plan, including the Democratic proposal for comprehensive health insurance (“Part A”), the revised Republican program of government subsidized voluntary physician insurance (“Part B”), and Medicaid. Finally, in 1965, Johnson signed it into law as part of his Great Society Legislation, capping 20 years of congressional debate.

1970's - In February 1970, Representative Martha Griffiths (D-MI) introduced a national health insurance bill developed with the AFL–CIO. In April 1970, Senator Jacob Javits (R-NY) introduced a bill to extend Medicare to all developed after consultation with Governor Nelson Rockefeller (R-NY) and former Johnson administration HEW Secretary Wilbur Cohen. In August 1970, Senator Ted Kennedy (D-MA) introduced a bipartisan national health insurance bill developed with the Committee for National Health Insurance founded by United Auto Workers president Walter Reuther, with a corresponding bill introduced in the House the following month by Representative James Corman (D-CA).

In January 1971, Kennedy began a decade as chairman of the Health subcommittee of the Senate Labor and Public Welfare Committee, and introduced a reconciled bipartisan Kennedy-Griffiths bill proposing universal national health insurance. In February 1971, President Richard Nixon proposed more limited health insurance reform—a private health insurance employer mandate. In October 1972, Nixon signed the Social Security Amendments of 1972 extending Medicare to those under 65 who have been severely disabled for over two years or have end stage renal disease (ESRD).

In April 1976, Democratic presidential candidate Jimmy Carter proposed health care reform that included key features of Kennedy's universal national health insurance bill. In December 1977, President Carter told Kennedy his bill must be changed to preserve a large role for private insurance companies, minimize federal spending (precluding payroll tax financing), and be phased-in so not to interfere with balancing the federal budget. Kennedy and organized labor compromised and made the requested changes, but broke with Carter in July 1978 when he would not commit to pursuing a single bill with a fixed schedule for phasing-in comprehensive coverage.


2000's - In 2001, a Patients' Bill of Rights was debated in Congress, which would have provided patients with an explicit list of rights concerning their health care. Many interest groups, including the American Medical Association (AMA) and the pharmaceutical industry came out vehemently against the congressional bill. Basically, providing emergency medical care to anyone, regardless of health insurance status, as well as the right of a patient to hold their health plan accountable for any and all harm done proved to be the biggest stumbling blocks for this bill. As a result of this intense opposition, the Patients' Bill of Rights initiative eventually failed to pass Congress in 2002.

A century of effort has gone into this - From Teddy Roosevelt to FDR to Truman to LBJ to Ted Kennedy - All fighting for Universal Healthcare !

The President who will able to get a Single Payer/Medicare for all types enacted will be by default be one of the greatest POTUS in history & will be providing the biggest tribute to all these people in their graves!

I advise you to delete this at once. It is a near-verbatim quote from here, starting in the 1930s-1950s section.

[muon2]

Is universal health care the same thing as single payer? I support the former, but resist the latter, unless there is no other way to do it, that will not cost a lot more money (other than money which funds drug research).

They do not need to be the same, and universal health care can be operated with a multi-payer system. In Germany there are over 100 funds that insure most of the population, paid for by a combination of employer, employee and government contributions. The premium is fixed for individuals in these funds independent of risk. There is also an opt-out provision for qualified individuals to pay a tax and buy insurance independently of the regulated funds, but those individuals can be charged based on risk.

Thank you. Do you think the German model has merit to consider for the US?

Health Insurance is compulsory for people living in Germany. Any1 under 50,000 Euros is forcibly provided with a public Health Insurance plan with a federally decided set of benefits. The above 50,000 Euros is around 11% odd of the population. So 90% are in a forced Single Payer within this system & the rest have to get Private Insurance. Employees pay a tax on salary if they are under 50K, similar to a pay-roll tax as under a  US government! There is around 15.5% tax (Employer + Employee) on people to finance the public insurance.

Germany has a LONG history of health insurance & conservative governments are staunch supporters of such welfare programs & are not much dissimilar to the US Democrats of today. It is also too much instability & chaos to transition into a different system when something is working for years! Multi-payer in US will also cause big tax hikes & have some of the same problems to sell to people as Single payer (Tax increases). In addition, it creates another massive problem - Government deciding an income level for people to get public healthcare which will be a massive debate (difficult to sell to people) & forced intrusion. And it will be easier to dismantle by conservative governments held by the GOP who can play around with the income level & decrease it so much to make it render non-universal. Or you can have a Multi-payer where everyone gets some insurance & the rest is through purchase of secondary plans. Now that will be even more vulnerable & will result in plans which are trash & cover little requiring everyone to purchase private Insurance. The situation in Germany is very complex & transitioning across income & plans isn't perfect. For example, let's say your income falls from 70K to 30K, you may find it difficult to immediately get a public plan. It can cause chaos if implemented not correctly in US & damn well conservatives won't support it fully.

Single-Payer is the most simplistic, universal & by far the cheapest solution & every other universal plan would require tax increase too (ACA subsidies also required some tax increase on wealthy people). USA already has a multi-payer system of sorts, a modified Single payer called Medicare & private insurance. The only difference is this multi-payer system is not universal ! Not only does Medicare not generate huge profits to increase costs, but the administrative costs of Medicare is around 2% vs 17% of Private Insurance! This is a bit of an easy choice really !

My understanding of Germany is that the public insurance system is not single-payer but it is mandatory. It is a complex system where the price and benefits are set by the government, but individuals are members of independent non-profit funds. The 2017 cost is 14.6% of income + up to 1.1% supplemental depending on the fund. There is a cost cap at a monthly income of 4350 Euros.

I personally thought that the Healthy Americans Act of 2007 and 2009 would have been a better solution than the ACA (and it was bipartisan Wyden-Bennett et al.) It has some elements similar to the German system.