bluebell

Single-payer, presented without compromise or apology, is simplicity itself. And if, in the end, we're too scared to pursue it, then why should we ever expect anyone to elect us ever again? It's one thing not to stand for anything; you can at least fake convictions, then. But Democrats do have core principles, they're just afraid to fight for them. It's time they stepped back in the ring.

Amen.

My sister voted for Kerry instead of Bush because he at least offered something on health care.  One of the biggest problems for Kerry was that he chose not to campaign here in Georgia so most people probably never heard about the plan he offered.  I told my sister he had one.  She checked it out on his website.  It probably changed her vote.

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I try my best to be just like I am but everybody wants me to be just like them. -- Robert Zimmerman

While I strongly favor comprehensive reform and universal care and think it should be an 'article of faith' for Democrats to do so, I thought Kerry's plan was one of the best ideas of his campaign.  Universal single-payer coverage of all catastrophic bills (which I think was essentially his plan) would cut health insurance premiums substantially and mean that uninsured people might not be bankrupted by unexpected bills.

It's a reasonable first step, and it would alse get the 'camel's nose in the tent' for comprehensive coverage for all.

I like the idea of Medicare for all (except the current disgraceful prescription drug program) with existing insurance companies being allowed to offer supplemental coverage. My best friend has this arrangement and, interestingly, his supplemental insurance has rarely been tapped since Medicare picks up so much of the bill. As someone who has been without insurance, I find it interesting that when I tell the doctors that I don't have insurance and will be paying cash that they charge me 50% of the normal fee since they don't have the horrendous processing costs to cover. The truth is that insurance companies, regardless of the type of insurance, are simply investment companies. They do whatever they can not to pay out on a claim. Medicare has a totally different rationale: it is not intended to be a profit making enterprise.

Perhaps, this comment/observation is something of a tangent to the discussion. However, while everyone seems to recognize the urgent need for a national health program, could it be the upcoming bird flu pandemic, instead of politicians and lobbyists, which gets the ball moving?

There are a lot of folks without any insurance, and now, what happens, if this virus does actually mutate? The mortality rates at present don't look very good and from I have seen in news reports, it is a 50-50 chance even with adequate medical care.

This very well could be the national health crisis which will transform medical care for generations in this country.

"Democrats do have core principles, they're just afraid to fight for them. It's time they stepped back in the ring." ~  Exactly. ~  Todd Gitlin

With due respect, I think that's a bit simplistic, meaning too many different things to different people. A lot of people read such things as an endorsement of various mutaully exclusive pet issues.

I think the false dilemma between "triangulation" on one hand, and impassioned "principles" on the other, and the democratic tendency to oscillate between the extremes; that is the real problem, the real flip-flop, and is extremely unhelpful.

To be more specific, we need to select the principles which matter most, fight smart, and fight to win. Fighting for ideology for it’s own sake, generally not very smart, nor productive, nor enduring.

We really need to stop being afraid to stand up for what we believe in.

Except not everyone in the Democratic party or moderates actually agrees with your stated opinion. So everyone standing up for their beliefs without compromise, that's a great way to fracture the Democratic party and hand more victories to the GOP.

Thanks for repeating the GOP meme though.

What is the worst thing that happens if we stand up for single payer health care?  We lose an election.

Wow. Slick. I like the way you deride UHC to hurt morale on the issue, and simultaneously implore people to be passionate about losing.

Yea, you're a real help to Democrats and Progressive causes you are. 

Well well well ... If isn't Mr. Courtesy, the be all, end all and know all of the democratic mantra (at least the DLC mantra) who's hot on the warpath again. Now this is the kind of tactics that make everyone feel right at home in the BIG TENT for comprise...

As I’ve said before, I think bluebell is either a stealth Freeper or just a terribly simplistic person. Regardless, a saboteur to Democrats and Progressives generally.

My answer to Nick's question the other day that he never had the simple courtesy to acknowledge.

Pay special attention to that point on choice.  ... It was a political fight over whether or not Americans wanted their traditional insurance plans transformed into HMos.. They got it anyway ..

An important distinction here... One of the main things people dislike about HMO is the lack choice for doctors in plan. PPO are somewhat better but more expensive. It's important to mention that under UHC, basically every doctor's in the plan. So, UHC is actually more choice. Like a PPO or better, at the cost savings of a HMO.

Great post though.  Yes, people have a huge problem mistaking correlation with causation. The more clarification on that, the better.

That doesn't mean Mark's wrong: voters are looking for security, and nothing that can be easily demagogued or misunderstood will survive.

Very true.  Which is why I think pointing out the superiority/efficiency of UHC in blanket terms such as reducing bloat, and preserving choices is the way to go. Also important is the "narrative" explaining opposition as being basically the Big Insurance lobby. UHC is a win/win/win arguable on any level of complexity, but the message affirming it's overall superiority must come first, loud and proud. Democrats have a horrible tendancy to qualify too much in debates and over complicate things. A good debater prepares for counter arguments and makes reasonable points avoiding obvious gotchas, but doesn't try to argue every counterpoint in advance, at least not since Lincoln's day.

Lastly, the way to pass UHC is with bi-partisan support which excludes axe grinders. The perfect UHC candidate will be a left/centrist who can argue both the value of privatization and of natural monopolies. That is NOT to say UHC should be a convoluted mess.  UHC will be passed by pols who know how to compromise across a number of issues, both give and take.

UHC would greatly benefit from the support of Big Business and small business, take GM for example. Dems need to sit down to the negotiating table with GM and play hardball, using both the carrot and the stick. UHC can help GM lower it's costs, make better vehicles, increase market share, and create jobs. Research grants and tax subsidies for energy independence and competitive technology can also help GM and the national good. Credits for fuel efficiency across the auto market can help the environment and GM's bottom line. There's a nice mix of government helping business and business cooperating for the national good.

OTOH, tightening CAFE and emissions standards directly, especially in CA, or offering more tax subsidies to Toyota for the Prius and thier hybrid vehicles, that can be another way to help the environment and improve energy independence, and GM will still have it's healthcare problems.

The way to sell universal health care is to get big business on our side.  I would think that GM and Ford and others would be ready for that now.  If we can get big business (and their money) behind the idea, we can make it happen.

In my opinion, the way to do it is to give everyone acccess to basic health care and pay for it through tax dollars.  If people want more choice, they can buy supplemental insurance.

Bush et al have done such a good job at "starving the beast" that this is becoming less and less feasible. That was the plan all along I think.  There is such a huge difference between the amount of money we need to take in and the amount that tax revenue currently coming in that it is going to be hard to get anything done.

I think Dems should run on first balancing the budget and then taking on health care. 

Nick called me a "Freeper" just a couple of days ago.

To be honest, I can't tell with certainty from your posts whether you're a Freeper or just clueless. But then, a sneaky Freeper sounds like a clueless lefty, and a clueless lefty sounds like a sneaky Freeper.

They both tend to encourage Dems towards kamikaze policies to cede  victory to Republicans.

A state based system has some problems. For one thing it punishes the state offering health care if the unhealthy move there. Isn't that obvious?

National UHC is far more efficient for everyone.

this debate sounds like a political rendering of that short video on youtube showing what would happed to an IPOD if microsoft were pushing the product.  the point is that there may very well be a lot of complexity in an health policy reform package, but the key is simplicity and elegance as a marketing vehicle.  any reform worth a damn is certain to have very fine and detailed mechanics, restrictions, and particulars.  most people just want the product to work and not sweat everything else.  the key is to have them pick up the package and bring it home.

But where traditional insurance truly did offer choice and freedom that Clinton's plan would restrict, you'd have to go door-knocking in the Appalachians to find an insured American who retains traditional insurance.

Huh? This is complete nonsense. I'm someone with traditional insurance, if by that you mean I can choose my doctor and the insurance company pays the bills.  The difference nowadays is that there are bigger co-pays and deductibles, but the basic system is more or less the same.

This is a common fallacy, and it's an important point. Managed care does not have to mean that the insured person loses all control over which doctor they can see or that costs are covered differently than in traditional plans. There are plans, like the Kaiser plan in California, that operate that way. Far more common, though, is the PPO plan, which imposes penalties for going outside the network and where more care needs to go through a primary care physician. There are of course many problems with the system, not the least of which is the frequent haggling that goes on with the insurance company to get something covered. But that also happened in the days before managed care.

I also take exception to the notion that support for a single-payer system is the sine qua non for being a good Democrat. There are those of us who think the political climate is not quite ripe, despite the discontent that is out there, for such a radical change. What I think all Democrats CAN agree on is that we ought to find a way to help those who are currently uninsured.

The biggest single problem we have is that once someone loses their employer-based insurance, the cost of either a COBRA-backed continuation of their plan or purchasing a new plan is cost-prohibitive. For a family, a COBRA plan is now more than $1,000 a month in cost. And this is at a time when your income has just plummeted. To purchase a plan directly from an insurance company is even more. What's needed is a cheap way for people who lose their employer-based coverage to get covered immediately against catastrophic costs. The best way to do that that I've seen is a government risk pool. Basically, the government offers an insurance risk pool that you buy into for a lot less than if you were to buy individually. Because of the size of the risk pool, the government can afford to charge people a whole lot less for premiums.

One final point.  The political problem with a single-payer system is not that people will be afraid of losing control over their choices. It's that every single-payer system that's out there fails to cope with the rationing problem. Basically, every system in the world rations health care one way or another. Demand for healthcare outstrips supply. In our system, it's rationed by price. Certain people can't afford care. In single-payer systems, it's rationed by queueing - long waits for procedures that are non-critical (and sometimes for chronic care too). Go to Canada or Britain or any other country where the government pays for everything and that's what you see. And it causes widespread discontent.  Need that knee replacement? You'll have to wait more than a year for it. That's why Britain has moved AWAY from single-payer in the last 20 years or so as private care has expanded rapidly.  Rich people get better care than poor people.  But even poor people are covered.

No friggin' way would Americans put up with that kind of waiting. Currently, Americans that have insurance, for all the hassles they may experience getting coverage, and for all the risks they may take in losing coverage, can get care when they want it, even if it's not critical care. THAT's what the reaction would be to a full push on the part of Democrats for single-payer care. And until Democrats have a good answer, they're going to lose that argument.

bluebell

But people are more likely to die from chronic illnesses like heart disease or diabetes which require a sustained relationship with clinicians who can manage the disease.   Sure, the trauma center will treat the hugely expense heart attack but it won't treat the disease to prevent the heart attack.  That neither controls costs nor saves lives.

What's the "neo-left" stuff? I think that needs clarifying. It's not the left and moderate left generally that's the problem.

The problem is just the same unrealistic, uncompromising, screechy fringe it's always been. We just can't afford thier BS anymore becasue the country overall has moved to the right, and the right has upped the stakes incredibly high accross the board, so we can't afford F-ups.

Nick -- For those who have experienced the pain of not having a single-payer system, the issue has nothing to do with ideology and everything to do with survival. 

That worry about survival goes way beyond the usual seniors and the disabled and that forty million who have no access to health insurance.  Huge companies are faced with huge costs.  Medical partnerships, clinics, individual doctors and administrators are getting hit.  It's been enlightening to talk to some very Republican doctors here in redstatesville, clinics whose administrative costs alone have made them realize that we have to move to a national healthcare system.   I know of one partnership of 3 specialists who had 24 full and parttime administrative assistants mostly working on insurance and Medicare claims.

The dismay and disgust with the present "system" are widespread. Even those with decent coverage are appalled by the shenanigans insurance companies indulge in to avoid paying. Add all this stuff together and I think we've reached the point at which most people stop thinking in terms of political ideology. 

What we need is a really sweet piece of work laying out how government can implement a national healthcare system.  A solid plan.  A plan which could and should lower costs. That's what the Democrats have to come up with.  If we had that in hand tightly, we'd walk away with the issue.  We certainly shouldn't wait until the center-right comes up with a sleazy compromise, throwing the responsibility off onto the states, playing its usual shell-game.

(Just for fun, I wonder whether the FDA, Pharma, and the health insurance industry would rate higher or lower in polls than Blunderbuss Cheney.  Bet they're all about equally loved.)

In my view, it's a risk vs. reward question. I start from the premise that the current system is the problem. The only "people" it really works for are the insurance companies and, increasingly (as more diseases are treated by drugs), the pharmaceutical companies.

Given that premise, what are the risks of pursuing an incrementalist approach? In my view, the biggest risk is that, if we win, we simply perpetuate the problem - in perhaps a slightly mitigated form, but the current system will still be in place, helping the fewest number of people at the greatest cost. In that sense, "winning" is virtually indistinguishable from "losing" -because the risks of losing with an incrementalist approach are that the problem is perpetuated, and the reward of winning is that the problem is perpetuated - except that if we "win," we'll be complicit in that perpetuation.

What are the risks of pursuing a "UHC" approach? Well, if we lose, the system is perpstuated. That risk is absolutely cancelled out by the fact that it's the *same* risk as persuing an incrementalist approach.

But what are the rewards of pursuing a "UHC" approach? It fixes the problem AND provides the opportunity for a paradigm shift in both the way the Democratic party is perceived by the working class AND the way we as a society view government's value in solving problems.

We need not argue that government can solve *every* problem, but we can, and should, argue that government can, and should, have a role in solving problems that affect ALL of us.

In short, we won't be much worse off if we lose (and in pure partisan terms, I'd suggest we'll be better off if we lose on a UHC approach than we will be if we win on a incrementalist approach), and we'll be far, far better off - both as a country and as a party - if we win on an UHC approach.

I say we go for broke.