I think this is completely wrong.  It is a myth that the only thing standing between us and universal health care is corporate interests.  The fact is that for most people in this country, the present system works more or less fine.  Most (>85% or so) people are insured, most are happy with their doctors, most get the care they need.  For all the horror stories you hear about, and not to deny the very real problem of the uninsured, that is the reality.

That's one reason why the focus should be on helping the uninsured first, but leaving the bulk of the present system intact.  What's needed is a low-cost way for people to buy health insurance that's guaranteed by the government.  The other big problem, the out of control costs, should be tackled after this is solved first.

To try to remake the whole system all at once is a recipe for disaster.  We're talking about 1/6 of the entire economy.  It's too big a job to tackle all at once.

You may be right Brad but as long as we aren't changing the fundamental patient-doctor interaction, in fact making it better and more efficient, it can work.  Basically all we're talking about here is paperwork and how it is funded not a new benefit for people.  So the difficulty is convincing people that the change will result in better access and that will take some big allys, most importantly doctors, and slightly less importantly businesses.  But both can be convinced and many already have been. 

Incremental change will still leave us with a system that wastes hordes of money and offers, on average lower quality.  I'm just not willing to settle for that, but you are right that you'd have to shake the already insured out of there comfort zone.  I think you scare them with rising co-pays and premiums and the fact that if they lose their job, they are screwed.  Promise them better care at less money and just be adament that it will happen.  Cause it actually will, the numbers don't lie.  We waste so much it's ludicrous.  I'd also rely a lot on projections of the growth of healthcare costs.  "As healthcare costs continue to grow at 10% a year, by 2020 a doctor's appointment will cost $400 and your blood-pressure medication will cost $300 a month.  Somebody has to pay for that and it'll probably be you!"

Anyway, Democrats need to stand for something.  This is perfect (Energy makes sense too) because it makes Moral and Economic Sense. 

The fact is that for most people in this country, the present system works more or less fine.

No, that is a completly mistaken way to look at it. Everybody in this country is paying way too much for thier healthcare. Is there anyone who wouldn't like to get the same or more for less? Nor does UHC take away people's ability to opt for discretionary care any more than existing insurance does.

Basically UHC is just like what we have, same hospitals, same doctors, same doctor choices, only more cost efficient. The only thing missing from UHC is massive executive compensation, redundant paperwork, advertising budgets, and other bloat.

If legislation is written and framed that way to the public, it'll be a mainstream issue. Probably neither the far left or right will be perfectly happy, but it'll do a lot of good to a lot of people, from GM to small business, to the uninsured and elderly, and even young healthy people who'd like to worry less about grandma and see consumer prices fall on things like cars.

Ultimatly the consumer and citizens pay for the bloat and inneficiency in health care. We pay for the emergency room visits. We pay for the insurance companies profits and executive salaries. We pay for the advertising. We pay for the out of control spending on worthless procedures and over billing. Everybody pays for it, directly out of paychecks, out of company earnings which ultimatly effect wages, and in the prices of consumer goods manufactured by companies with inflated health care costs.

For example, GM has been complaining quite a lot that they spend more on healthcare than they do steel in thier vehicles! And that it's realy killing them because competitors in Japan for example have UHC. (GM has other competancy issues as well, but that's beside the point)

Small business would LOVE UHC. Big business would like UHC to help thier bottom line, so long as it doesn't cause too much ideological bruising. A smart pol should probably argue for balanced regulation and privitization, and try to find some other areas which would benefit from increased privitization/deregulation.

UHC is a bi-partisan, pro-bussiness, pro-quality of life issue. 

As the young and healthy that Mark referred to are squeezed more and more between paying for their parents' medical care because Medicare out-of-pocket costs are rapidly growing, and  their own out-of-pocket costs mushroom because employer-based health insurance is cost-shifting to the employee, universal health insurance will become the option of choice. 

HSAs notwithstanding, we may see a public private partnership that produces health insurance for all.  It will be characterized by high deductible catastrophic coverage... a little better but not much than the old "major medical" used to be.  The difference will be ( is already) the inclusion and expansion of prescription drug therapies.

It bears repeating that in the 1990s, the Washington Business Roundtable supported universal health coverage.  Indeed the Business Roundtable supported the Clinton health care reform effort until RNC realized that if reform passed Republicans would remain in the political wilderness for the next 40 years.

Universal coverage remains a financial investment issue in this country.  The morality of universal health care insurance is not a sufficient political imperative unless "someone you know is applying for bankruptcy protection" due to a medical catastrophe.  I do wonder if Congress will figure out that Dana, Delphi and the airlines that cite employee costs as reasons for their chapter 11 filings are "someone you know."

Perhaps the "young and healthy" -- the sandwich generation -- should pay more for their aging parents and their children's education; then universal medical insurance will turn into a "moral issue".

 I have done a few diarys on health care/medicareD in the last couple months. The way the younger people react has been mostly the same. As the time comes closer to the donut hole, and the havoc it will cause, people will begin to see this issue in a more personal way. As hospitals begin to turn away more people away because of cuts in the amount the goverment will pay, this to will make it more personal. Only when it becomes personal will the 20 and 30 somethings start to see this as their issue to. As a child or grandparent they know and love dies because of the lack of good care denied, it will become internalized. Only then will we come together. Outrage is hard to come by in this time of scandal a day reality. Outrage is one of the most important motivators, and it will have become personal in a day and age of impersonal politics. For the same reason Bush does not do a body count of collateral damage, there will be a seriuos attempt to hide the numbers of those that die from the donut hole. Choices between food and a meds will become much more real soon. The hard part will be tracking the damage. This must be done, put in the news, in the papers, on the TV. Only then, as in the days of the Nam protests, will the body count become personal.

Re: You may be right that it's impractical to do it all at once, but the cost of giving uninsured people affordable coverage

The majority of the uninsured are young and healthy and could be insured right now today for less than $150 a month.

Also, the costs of those who aren't healthy are already present in the system and would not represent any new overall spending.

Where you gettin' that 85% number, Brad?  In my experience, it's nonsense.  I have a well paying job (turbo tax tells me I'm in the top 10%), and yet, every year the large corporation I work for changes the insurance plan and every year the changes are for the worse.  Every year there's one or two things I have to pay more for or that I can't get.  This year, the new plan put my long-time doctor out-of-network.  Fortunately, my wife also has insurance and will pick up the difference, but that's more paperwork for me that I didn't have to do before.

And every year when these changes happen my coworkers and I have a little water-cooler conversation and it's the same for all of us.   Things are getting worse, not better and we all know it.  The long term trends are NOT hard to detect.  It ain't just about the "uninsured", the "poor".  Get that through your head, Brad.   And take your head out of the sand, please

 Medicare is a great idea, and it has been working for some time.  But, it is not the solution.  Under Medicare we still need private insurance plans, because Medicare does not pay 100% of our medical bills, or even close to 100% in states like California.  As long as we all are obligated to buy private insurance, and we are under Medicare, the problem remains unsolved.

This is an important problem and it deserves a good solution, not an interim half solution.

Hoppy in Sacramento

 I don't agree that our health care system provides terrific care for those who can afford it

My rich European friends are the source of my info.

I feel sure that the majority of our voters would agree with a universal care program, but I feel equally sure that the insurance industry

The evidence is that a majority won't...unless they are convinced that government would be less inefficient than our private system.  At present, they're not.

the insurance industry, as well as the medical care industries and drug industries, would fight such a change furiously, using every dirty trick known to man.

Of course.  That's what people do when their livelihoods are threatened.  Do you really think middle and lower class workers are different? 

As one of those people Brad is talking about -- insured, happy with my doctors, getting the care I need -- I think he's completely wrong. Every time I go to the doctor, or my kid or spouse requires treatment, I wonder if this is the time (really, another one of the times) that my insurance company is going to kick the claim back for some incomprehensible reason, or my doctor is going to announce they don't do business with my insurance plan any more, or a lab is going to tell me that their services aren't covered or who knows what. And then I'll get the bill for a few hundred or a few thousand or 130K dollars and have to spend a couple days or weeks tracking down who screwed up and how, and convincing them that they really need to unscrew things. (Yes, having your insurance company announce that your policy has been cancelled while your kid is in neonatal intensive care concentrates the mind wonderfully.)

 I can't imagine what life is like for the uninsured, because being insured and having access to care (at $10K a year plus deductible plus out-of-pocket plus uncovered items for a family of three) is already bad enough. Pretty much everyone I know has an insurance-company horror story that can be summed up as "They tried to get out of paying the bill, but finally they covered it as the policy said they would." Universal care would get rid of the incentive for passing the buck, and would reduce the health-related anxiety level of people in the US
enormously.

Terminally ill patients account for over 70% of health care costs in this country.  And I don't mean being born qualifies as being terminally ill.  It's very profitable for the medical industry to keep terminally ill people alive as long as possible.  If profit is taken out of the equation, as it would be in a single-payer system, the overall costs of medical care would go down considerably. 

Doing it piecemeal is how it is now.  The only way to make it work is to revamp the whole system so that we all share the risk across the board.  The young and healthy in the same program as the old and infirm.  One system with one set of paper -- or better yet -- paperless.  No one at the top trying to figure out how to decline payment in order to make profits. 

Employers could still contribute to employee's health care plan, and there could still be co-pays, but in a universal system it should be affordable to all except those who already are getting government assistance, and for them the government would pay (less than they do now, by the way).   By treating conditions early and well, serious complications would be reduced as would their expenses.

What too many people do not understand is that if you have to get insured as an individual,  (as do those whose employers do not provide insurance, or those who are not working), and you EVER had a health problem in the past (cancer, high blood pressure, depression) your premiums will be unbelievably high, and deductions and copays so expensive that insurance becomes unaffordable for those who actually need it.  That is why sharing the risk across the board is an essential part of this.  It is also why Medicaid and Medicare have so many financial  problems -- everybody is sick, so every penny (and then some) is spent.

Removing the onus of managing health care for employees would be a huge shot in the arm for industries that are now competing with such places as Canada.   

There are two big stumbling blocks to universal health care, I believe:

1.  There are those who truly believe that it is equivalent to communism, and that government should stay out of health care.  Regardless of how comfortable some may be with their empoyer provided health care, it is a system that is not working for too many.  Imagine if our education system were based on the same thing.  If we had millions of elementary - to - high school students not able to afford school because their parents' employers could not pay for those who have special needs, etc.  Would we tolerate a generation not getting educated? 

2.  Those who are in charge (Congress) of making these changes already have a gold-plated health care system...one that is better than any other, and they surely don't want to give it up.

Every other developed counry in the world has universal health care for its citizens.  We have the great opportunity of studying the best of them and taking what works and not taking what doesn't.  We don't have to re-invent the wheel; we can look at all the wheels and make a new and better one.  We just have to make the committment to do it.

Jan Knaus

Let me put out some disclaimers first. I am uninsured, and, apparently, uninsurable in Virginia, my current state of residence. It may be necessary to move from my home of 30 years to get coverage.

I also have very substantial experience in medical automation, outcomes research/evidence-based medicine, and some of the real costs and other economic factors. It becomes obvious there are no simple answers, when, for example, things that on one hand to do to improve quality of care are irrational given the realities of malpractice. It is also fairly well established that behavioral changes in physicians are the most important way to avoid suits with nothing else changing. Part of my continued survival -- and I mean that very literally -- is that I understand how to game the system from the inside, and can take a major role in my care.

OK. Enought disclaimers, and let me respond to BradtheDad's specific point. Yes, taking on the whole system at once is risky.

What lots of people miss, however, is there are several programs now in operation, involving nontrivial numbers of people, that could be expanded, in different ways, to cover the uninsured/uninsurable, and the actual results compared. Let's identify those two major alternatives in the health policy championship ring:

1. In the green trunks, is Single-payor, in the form of state-by-state authority to let people over 55 buy into Medicare


2. In the purple trunks, multipayor but not employer-based Consumer-directed Health Plan (CDHP), in the form of allowing buy-in to the Federal Employees Health Plan (FEHP), a CDHP.

did IQ's just drop sharply while I was away?

Universal health care (UHC) should be the very focus of ANY nation.

But electoral politics is not real politics. REAL politics is getting ideas out to people.

Before we can get the USA into a position to pass UHC, we need to do massive meme transmission/propaganda/education.

Why on earth progressive activists focus on electoral politics is beyond me. And that is not even dealing with the identity politics focus that has killed off American leftism....

Electoral politics is merely the REAPING of the ideas and memes that are sown much earlier. The elite and their main tool, the GOP and to a lesser degree, the Dems, have been sowing neoliberal ideas and memes for decades.

Until true leftist memes (like ULC) are sown, such memes cannot be reaped in the form of electing politicians who focus on ULC.

My documentary/book in progress is at http://www.leftwingmediamachine.blogspot.com

I think at the Great Depression's height unemployment was 25%.  Well, heck, that means 75% of people must still have jobs.  Things must not have been so bad then, right?  For all the horror stories you heard, that was reality. 

Well, no it was not.  Because those remaining 75% were underpaid, underemployed, and deeply uncertain about the future of their job.

I think something similar holds true for health insurance.  That 40 million number (which I think is an older number than the 300 million population estimate) I believe is a measure of the number of people without insurance for the entire year--so if you have insurance only part of the year, you're considered insured.  It also ignores that every insured person I know complains about how much insurance costs have gone up--even the GOP has to trot out the canard of malpractice costs to pretend they're doing something about this. And many of them are deeply uncertain about how much longer they'll hold on to that coverage--they're just one pink slip away from losing coverage.

I think you might be right that controling costs needs to be dealt with seperately from coverage and security issues--but I think you overestimate contentment with the current system.  Seems like polling would be a good idea here.  But the key thing we need to remind Americans who are fearful and uncertain about changing the system is that the current system is fear and uncertainty--both for them as individuals and for the stability of our country.

Kind of. Yes progressive memes need to be spread, yes electoral politics mostly reap what was already sown.  It's not that simple however, electoral politics also rally people to issues when there is potential, which is both sowing and reaping so to speak, and the analogy kind of breaks down there.  The point being made is that the potential for UHC, issue awareness, and real desire for UHC accross a broad swath of America, including business, already exists.

Btw, to be blunt, your documentary is going to suck if you don't take into account those complex dynamics, and simply assert that sowing and reaping are completly segregated acts. Having said that, I do agree with your basic premise that we emphasize leadership and activism too much, often seeking to skip the sowing phase. That part is good.

UHC is ready for harvesting. 

There are countless individual procedual effieciencies which can and should be adopted under any system, including UHC.

If that's true why do you follow with

UHC is a high level structural reform to cut out bloat and inneficiency that our present insurers can't, ever.

Apparently, you mean any system except our system.  Speaking of typical.... 

The statistics and facts in that post were off the top of my head, so it's entirely possible that they may be mistaken.  Certainly I'm not saying things are as bad as the Depression.  But my core point is that the current system upsets a lot more people than the 45 million uninsured--and any reform will have to go beyond the 45 million uninsured.  Not necessarily by changing the system they already have, but at least by promising that if the current system ever drops them there is always some minimum safety net of coverage to fall back on.

The thing about the employer-based insurance model is that it's kind of a compromise that's deeply unsatisfying to both sides--like an Englishman and an American compromising to drive down the middle of a busy two-way street.  Conservative Republicans, especially the anti-government wing, hate it just as much as we do.  The difference is that while we want to collectivize health risks, they want to further individualize them with HSAs or tax deductions for individually purchased health insurance and various other strange schemes they're cooking up. 

But, beyond the minimum safety net, I think there are probably a lot of things conservative and liberal ideologues might be willing to agree on.  Linking health care to employment is hampers the efficiency of the marketplace--both from the employers' side (inflating labor costs, giving an incentive to downsize and outsource) and from the employees' side (settling for a job they don't like for health insurance they do or vice-versa).  If there was some national, subsidized, standard plan all Americans could buy into (perhaps even subsidizing their current insurance if they choose to opt-out of the government plan), liberals might be willing to accept either eliminating employer tax deductions for health care or making them available to individuals.  And requiring health care providers to charge uniform prices rather than letting them negotiate cheaper prices for the insured--imagine if supermarkets would negotiate cheaper prices for wealthier customers who have "food insurance".

Obviously America will never have a health care system like Canada that prohibits private insurance--the idea that you could be forbidden from helping yourself is deeply unamerican.  The best we can do is probably a more efficient two-tier system with a more comfortable bottom tier than we have now.  But if we focus our rhetoric on improving economic security and on making the marketplace more efficien, it might make it easier to peel off moderates and conservatives.  If you just focus on the 45 million uninsured, that makes it a welfare program.  It's dangerous in the same way that means-testing Social Security pay outs is dangerous

The comparison to the Social Security debate might be misleading.  For one thing, the numbers were not on their side--Social Security will last nearly until the Robot Singularity, and to talk about an impending Social Security crisis in the face of Medicare costs, Medicaid costs, health care costs, the national debt, the current account debt, energy shortages, and numerous far scarier projections was a lie that not even Bush could maintain--eventually he admitted that private accounts wouldn't prolong Social Security's fiscal solvency and his agenda imploded.  Moreover, there was a bait-and-switch element to the whole thing--Social Security only became the center of his agenda after November 2004.  The lesson to Democrats is not to try to reform health care unless their plan is already the center of their campaign before the election.  If Democrats announce that a vote for them is a vote for universal coverage, and they still manage to acquire a majority, then the wall of opposition won't be anywhere near as solid if Republicans know that there was TRUE mandate behind the proposal.

Healthcare in Japan is completly regulated, all prices are set by government. Insurance is mandatory, most coverage terms are mandatory. The employed get it thruogh work, and the unemployed, students, etc get it through the state. Elderly have a program like medicare tailored to thier needs. Regardless, they all get the same care for the same cost.

Standardization is key. it's a big efficiency gain and allows everyone to have a higher standard of care for the price.

The employed get a basically state designed plan through work (at fixed prices which are lower than what we currently pay) because it keeps healthcare coupled to # of employees, rather than profits. Therefore, more successful companies are not taxed more for healthcare. Part is subsidized through taxes as well though, so it's progressive. Kind of a hybrid really. Also, healthcare costs are a predictable "flat" expense.

So to be clear, Japan is NOT a buy-in optionally type system. It's a universal system.

Which is why thier emergency rooms aren't filled with the uninsured, and why thier costs are lower, becasue everyone is on the same pool which is more cost efficient.

Arriving at a point where UHC is an issue that the corporate world will support is simple:  Just give KB&R an multi-billion, no-bid, negotiated-in-secret contract to 'construct' some facility or other, and the whole idea would sail through with unanim...er...universal Repugnican backing.

Of course, the finished product would be a disaster.

The drug company’s defense of high prices is the American People pay the development costs of all……. medicine.

That means we SUBSIDIZE the socialized health care of all….. other countries.

Why not only pay for ourselves.

Or may be the drug companies could offer Fair Trade Medicines to help us..