"For now, if we need a slogan, "health insurance for all" should be good enough."

Now all we need to do is to get everyone to repeat that particular slogan.

From Harold Ford and Mark Warner, to John Edwards and Hillary Clinton, to Ted Kennedy and Russ Feingold, all Democrats should be able to agree on this the way all Republicans agree on tax cuts.

Opponents of a universal, government-administered medical program, whatever its final form, are going to screw up their faces and spit out the phrase "socialized medicine" like it was an expletive. 

They will do this because it works.  It conjures up pictures of soulless insitutions staffed with beaten down, underpaid people.

Using the slogan "Medicare for all" would blunt the effectiveness of this particular form of attack.  Medicare beneficiaries and their families don't consider themselves socialists -- well, most don't --  and they aren't likely to want to give Medicare up.

Many of the details of the W Administration's Medicare deform were outlined by Ted Kennedy over the last year + on C-span.  What he notes makes it clear that when the new monstrosity kicks in the public will be horrified by the consequences (including my Medicare!).  Demonstrations should be planned now for whatever day or week it goes into effect, and groups fundraising and getting ready, so as soon as this thing hits the ground they are ready to advertise, mobilize and electioneer. 
The political nature of the scam has not been extensively dissected, however.  That's where the real bodies are buried.

     The whole purpose of the Medicare scam "reform" is precisely to alienate people enough so they are tired of further expansions of health care.  Thus, Republicans would, as happens so often, cash in on their own failures, as they do with the deficit and Social Security.     The failure of the usual enablers -- Democrats, MSM, and the 527s to confront this issue effectively is astounding morally but epistemologically boring.  They are merely playing their roles in the drama of a deeply flawed "democratic" system morphing into a wholesale imperialistic dystopia.  Health care and Social Security are slated for being assaulted, undermined fiscally, chipped away, and after some concessions are made (Social Security has been 'fixed' now at least twice) then, like some lo mein, you can be sure that another cycle of cuts is coming an election cycle or two later.

So the first priority of the Democrats must be to expose the functional AND INTENTIONAL scam of the Medicare so-called
"reform" to undermine the fiscal integrity of the system and the public's faith in it and desire for more.  "TIME TO CLEAN UP AFTER THE ELEPHANT" might be a good slogan in the coming years, especially with core working class Democratic constituencies and in 2008.  The goal of 2006, for which the Dems as usual seem unprepared, is to run strongly enough, hopefully taking back at least one House, so that a Democratic victory in 2008 would be plausible.

   After all, the longer term goals of the Democrats, other than coming up with an alternative version of the current deformation of Medicare that is workable, is to (1) extend Medicare to all minors, and (2) to have a general statement in support of NON-employer-centered single payer health coverage with parameters as to costs, and general functioning passed in Congress, which would then establish a blue ribbon Commission (not Hillary!) to draw up a plan specifically conforming to the parameters set within the range of possible non-employer-centered universal single payer health care.  These policies, of course, can only be taken seriously when the Democrats seem strong enough so that they are a possibility.
In short, it isn't evasive -- the Democrats in 2006 and probably 2008 would be running on  a program to 'CLEAN UP AFTER THE ELEPHANT'S "REFORM" '

Carl, You must have misread my earlier posts on this subject. Like Matt Yglesias, I'd greatly prefer any form of universal coverage to the status quo. There are tough, very complex trade-offs as to which universal coverage approach has the best chance of being politically enacted and which approach, if enacted, would "work" best. I lean toward a universal coverage plan that would not be "single payer." But I'd be elated if a single payer system came about. What's useful for us to try to do in forums like these is wrestle with the trade-offs involved and figure out how to get to universal coverage, in whatever guise it might take. --Greg   

Greg, perhaps you are telling the truth about your motives and you merely have a communication problem.

The posts you have made on health care--the ones I have read--emphasize "going slowly" or proceeding with caution. They have been primarily about difficulties in proceeding and the first one was argued in a sloppy manner.

You posts have not emphasized getting to universal health care, but the problems with proceeding in this direction.

So, until I see something more affirmative than cautious, I will continue to doubt you. I will continue to file you under, "Democrat paid to tell activists to expect less."

There's a lot of businesses that are realizing that universal health care is the best option for their bottom line. Corporations won't have to pay for health care costs of employees if it passes. That would make a whole lot of corporations VERY happy... especially the corporations that are tied to unionized work forces in labor-intensive industries. The next time this fight happens, there will probably be almost as much corporate money getting dumped on the pro-single payer side as there is hospital and big pharma money getting dumped into the fight against it.

I don't suppose fighting back and DEFENDING the programs and institutions we believe in is an option.

The truth is, every idea we propose will be "swiftboated". Just as every candidate. Aren't you tired of retreating yet?

No, Medicare is not perfect. But it is far more efficient and effective than the private sector.

As I said in another post, before Democrats can sell public policies that require new or expanded government services, they must first embrace and defend government as an instrument of social good. Failure to do so since Reagan declared our democratic institutions "the problem" has resulted in one of the greatest travesties our republic has endured.

Government, in a democracy, is the way we make collective decisions and solve collective problems. It is the single agent by which a free and democratic people secure the interests of the commonwealth and defend against the forces of despotism of which our founders so vociferously warned.

The Republican campaign, and lack of opposition to it, to undermine the institutions of democracy has resulted in a blanket failure of the American people to work together, in our collective interests, to solve such problems as healthcare, declining infrastructure, global warming, energy dependence, even national security.

The Republican campaign to privatize services from accountable, democratic oversight into the hands of private contractors is a threat to the principles of democratic self-government and a sure path to cronyism, corruption, and autocracy.

While Medicare certainly needs improvement, just as our beloved Postal Service once did, it also offers a testament that we, the people can work together to solve problems. That the incentive of making a better world for ourselves, our neighbors and all Americans is stronger and more effective than sheer profit motive.

And that those who don't believe in self-government, and hate the institutions of our democracy should not hold positions in those institutions.

We must first embrace and defend the will and enterprise of the American people to solve problems through their constitutionally guaranteed democratic institutions before we will deserve to hold positions in those institutions as well.

As pointed out in another post, the DNC platform still reads, "the era of big government is over."

Cowards. America is a big country with big problems. It will always have a big government as it should.

What we need to discuss is what makes government work or not work. Over-centralized, unaccountable bureaucracies vs. smart, efficient and most of all, accountable programs would be a good start.

But the party of no spine can't even defend its most basic principles, much less improve upon them. What does "big government" even mean other than code for we give up.

Does anyone here really believe that Halliburton can manage our affairs cheaper and more efficiently than we can? 

I'm all for capitalism until it replaces democracy. Medicare operates at about 3% administrative overhead as opposed to profit based insurance which is somewhere between 15-30%. 

If we can't defend that then we should find another line of work.
 

My vote goes to UHIP... Universal Health Insurance Program. It is accurately descriptive without any implied ideological bias.

If we could just get past the ideological slugfest, we might be able to garner support for the practical necessity of extending affordable health care to all Americans.

I'm sure Josh will be along any moment to slap petey for the inappropriate rating.

Can an old lady chime in?  My husband and I are pleased with Medicare.  We have our secondary insurance with our state retiree system.  Between the two we do well.  Where we live, we have not run into any doctors who do not take Medicare patients.  Most folks I know who have Medicare do not complain.

By janeboatler from a foreign computer, having forgotten my password. 

I like "LifeCare". It is in support of what many religious liberals call a consistent ethic of life. As such, if we propose LifeCare Medical Access, it is hard for Republicans to say they are Pro-Life if we they are against LifeCare. It may also force moderate Pro-Life voters to consider whether W's policies are really Pro-Life.

As I read your comment I wondered if we got employers out of the paying for healthcare would that make fighting unions less an issue or would it make unions less able to attract workers?

I support universal access through multi-payor system with competitive negotiations to create a plan such as Congress has with individuals purchasing and paying for additional coverage above the base plan which becomes an entitlement.  

Most VA docs are federal employees, Tri-Care allows patients to choose their own physicians. The Federal plan offered to members of Congress is similar to the Tri-Care plan. Not sure if that plan allows for negotiation of drugs costs though.

You're fine with a two-tier system. I'm not.

It sounds like you're a doctor who's fine with making the health care system "work for working people' as long as you are not one of the doctors who will be providing care to those working people.

If the malpractice insurance industry is the problem preventing equal patient access to doctors, then the govenment needs to start providing malpractice insurance along with offering flood insurance.

It was and is in the national interest to have a flood insurance program. Insurers got out of the flood insurance business. The government took over providing flood insurance. If the government has to do the same thing for malpractice insurance, so be it. One thing. To get those lower malpractice rates, you have to take medicare patients and medicare fee assignment.

Then, you won't have an excuse for not accepting medicare patients (or whatever the name of the next gen gov't health care program is).

"claims" hmm, I am a Democrat, and have worked diligently for Democratic party candidates locally and nationally. I did not know that there was a litmus test surrounding this issue.

I wonder why Congress offers its members various plans? Perhaps some people are willing to pay a bit more for greater access, choice of physicians or elective treatment such as various types of fertility treatment.

That seems possible, in that univeral health care would allow the Republicans' friends in monopolistic industry to become more competitive with industries in other countries, but somehow it hasn't happened yet.

One would think that big business would embrace universal care, but you're right--it hasn't happened, and won't anytime soon, IMO.  I can think of several reasons:

(1) We often talk of people voting Republican against their self-interest.  This applies to corporations as well--perhaps even more so, as they generally enjoy, shall we say, closer relationships with the power structure than do ordinary citizens.
 
(2) The number of firms that would receive real competitive benefit from universal care is limited.  Most manufacturing can be offshored, and most services can’t be, so universal care wouldn’t generally give Company A a leg up on Company B.
 
(3) Never underestimate the truism, “Better the devil you know, than the devil you don’t.”

I've thought about this quite a bit, and I think that as an organizing principle any variation on "Medicare for all" or "universal coverage for all" is deeply flawed. Before you slam me, please note that I'm not saying that universal care is a bad thing: I'm simply saying that it organizes around the wrong idea and it doesn't resonate with much of the public. In particular, it doesn't necessarily resonate with those who already have coverage. Before you propose any solution, you have to get agreement on what the problem is, and not everyone agrees the problem is lack of universal coverage. What's a problem statement that will resonate with everyone? I think it's this.

I believe that if everyone had this image in their head, they'd understand that saying that we have a coverage problem, or a cost problem, or a quality of care problem is too limiting: what we have a value problem. We get lousy bang for our buck, and whether you're lower, middle, or wealthy class, whether Democrat or Republican, whether urban, suburban, or rural, as long as you spend money you understand that poor value is a bad thing.

You can already see elsewhere in this thread that many commenters think universal care is too expensive. This graph answers that, and says that other countries are spending far less than we and getting roughly the same overall benefit. We're getting bad value for our money. Note also that this doesn't say that we're spending too much on health: I don't care if we spend 40% more than any other country on health as long as we get 40% more healthiness than any other country. I don't mind paying for improved quality if I get that quality and you shouldn't, either. However, if we aren't going to get 40% more healthiness, then we damn sure ought to look for ways to reorganize our health delivery system to give us lower cost for the same amount of healthcare. That would deliver better value. Universal care is one of the ways to get better value, along with consolidated payer, along with improved quality. You can't Harry-and-Louise bad value.

By the way, don't think that these results are specific to life expectancy: on every population-wide health indicator, we're about in the middle of other developed countries except on cost. For example, see this.

merploe wrote: "If we had a single payor, when Jenna Bush is president, will she do to everyone's healthcare what W has done to veteran's healthcare system?"

If she guts it the public can decide how it will respond to that.  I suspect she would get significant pushback from members of her own party up in the next election.

mperloe wrote: "How will annual budgets for healthcare and plan features become a political football?"

There would be fights about it.  So what?  At least they would be ones whose outcomes the public would have some opportunity to do something about if it decides their elected representatives got it wrong.

mperloe wrote: "What will happen to our healthcare coverage when J, decides to invade New Zealand?"

If she messes with it, same answer as to the first question.

I can't speak for others, but as far as I am concerned there is no litmus test on this issue of the sort CDR Adama implied. 

Having said that, opposing a single-payer approach to financing because it might make it harder for unions to organize is an argument I can't accept.  People who actually are union organizers could answer this question better than I can but it would seem to me that if single-payer helps put their employer on a sounder footing, with greater possibility of staying in business for awhile, that is something its employees would favor, no, if they have health insurance that in any case follows them wherever they go? 

And if we do get single payer, unions will hardly be left without work to do, even on health care.  They could play a powerful role in helping get the best deal possible for people covered under a universal, single-payer system--a role which I suspect would be much appreciated by both current and prospective union members. 

I agree wholeheartedly that any plan must include:

PORTABILITY: The plan is not related to employment. If you are responsible for chosing and paying for a plan. It is yours. It is not related to a specific employer.  This would do away with coverage under ERISA where an entirely different set of rules apply.

NO PRE-EXISTING CONDITION CLAUSE: I am not sure if this is statewide or national, but if you have insurance in force, you are not subject to pre-existing condition clauses. If you do not have coverage, then you're screwed. As everyone under such a plan would be covered at some level, PEC, should just not be possible.

PICK & CHOOSE: Under a congressional type plan, insurance carriers would not be able to pick and choose clients. All chronic disease coverage and medication would be covered by any plan.

I agree that the congressional plan is based on continued employment, but what I am suggesting is not employer based, rather individual based. A basic plan is provided as an entitlement to all Americans (illegals???) and people could buy up.

I really don't expect we can bring about radical change where all hospitals become federal facilities and all physicians federal employees and everyone gets care in a clinic. In Canada, there is a level of guaranteed care by government facilities, yet people can buy additional coverage to obtain care in a private facility.  

Valid point.  I think the core of the response is to say that as it is consumers pay through the nose for employer-subsidized health care as part of the cost of buying goods and services.  We propose closing down corporate welfare and/or reinstituting progressive taxation (by repealing the Bush tax cuts for the wealthy for starters) to make sure taxes on working, middle-class Americans would not go up. 

That's the core of the response.  I recognize that already with the above, you've already lost most folks.  Someone smart could figure out how to soundbite the essence of that response for public consumption.

Yes--to legitimize a sensible, well thought-out single payer universal coverage proposal as mainstream, common sense, eminently doable stuff. 

I would say we need a group of respected and committed CEOs on our side.  The way the White House treats dissident Republicans--and the way most of them have acquiesced--I don't see how we can hold out much hope of getting any sitting Republican reps or senators to come out in support of a single-payer, universal coverage approach.  Even though, as you suggest, this would be an entirely rational and smart thing to support for a pro-business elected official. 

Hoppy:

You wrote: "Both of those programs are paid by dedicated taxes, as should be the universal health insurance program. Otherwise, the program faces annual threats of budget cuts, and it would be very vulnerable to such cuts."
 
A dedicated tax might be a good way to go.   

But I'm not sure it would be necessary.  What would protect single-payer health insurance from annual threats of budget cuts is the real possibility of a backlash against the decisionmakers if the public does not accept the necessity of such cuts. 

Plus, a downside of a dedicated tax is that it would be a new tax.  Paying for single payer by repealing the Bush tax cuts on wealthy and getting rid of corporate welfare, by contrast, has more of restorative emphasis in the first case and a common sense, pro-taxpayer, good government aura in the latter case. 

You also wrote:

"California now has a bill before our state legislature to provide a California only health care insurance plan. I see this as a major mistake - we have a national problem and it requires a national program to correct it. Our efforts need to be directed to that national program and not to state programs."

Do you disagree with the counter-argument that a successful demonstration of single-payer, universal coverage in one or two states could go a long ways--and might even be politically necessary--to take the sting out of the case the doomsayers will make?  If so, why?

A shortage of physicians does not appear to be a significant factor in the cost of American health care, so increasing their number wouldn't necessarily lower costs (or raise quality, for that matter). In fact, when one controls for the type of specialty, physician charges tend to increase with the physician-to-population ratio.