Isn't the biggest problem that the best model for a good single payer system is France, and nobody's going to get anywhere in political debates in this country by saying that we ought to emulate France?  Sigh...

What insurance companies do, in all walks of life, is risk assessment. They either exclude bad risks from the risk pool, or else price the insurance for risky cases at a sufficiently high level so as to render the risks good ones.

But risk assessment is not the ONLY thing that insurance companies do.  There are other ways of trying to deliver better service at lower cost.

On top of what I said on the weekend, one specific problem with mandate-and- subsidize plans is that the subsidy needs to be phased out somewhere along the line. This phase-out is necessarily equivalent to a very high marginal tax rate falling on the lower middle-class or the working poor depending on how you engineer it and therefore constitutes a perverse incentive toward upward mobility.

But that does not follow.  Suppose we had a system where no taxpayer would be expected to pay more than, say, 8% of income on insurance.  There is no hard phaseout threshold, nor do high-income taxpayers get off easy--8% of income for a rich oldster could amount to tens of thousands AND it is primarily the wealthy who are going to be paying the income taxes that pay for the insurance subsidies to lower-income/higher-cost people. 

Here's the bottom line.  A UK-style government system or Canadian-style single payer (where private insurance and private care are banned) are non-starters in the U.S. (in fact, Canadian-style single-payer is not even going to be around much longer in Canada given the recent court decsion up there).  So private care and private insurance are going to continue to play a role in the U.S.  Now, given that, what's the advantage of a mandate to carry insurance plus subsidies over a government insurance plan?  There may be advantages in cost and quality of care.  Or there may be disadvantages.  That's arguable.  BUT, the political advantages of mandatory insurance with subsidies are important.  First of all, it is by far the least disruptive approach.  The majority of Americans who are covered by employer plans (or Medicare) are unaffected.  Nothing changes for them.  Second, the 'personal responsibility' aspect of the plan (everybody is required to carry insurance so as not to be a burden on society) would be much more appealing to red-staters.  And it's just not going to be a political advantage to try to pass a plan by arguing that it is just like Canada's or France's.  Being able to say that this is an American plan that incorporates both market mechanisms and personal responsibility will make it much more likely to be enacted.  And lastly a proposal for a national plan to replace private insurance would bring the insurance lobby out against it in force.  But with mandatory health insurance for all it should be easy to get the insurance industry behind the proposal.

The only way any universal health coverage plan works is if the voters can see the real possiblity of an overall reduction in health care costs. That isn't going to happen if the health care insurers continue to be involved in any big way.  The one thing they know how to do is pass costs along to the users. 

Perhaps there is room for the insurance industry to provide gap coverage, but beyond that, just what services do all those superfluous insurance company bureaucrats provide.

I recently read a phrase that was something like, "Medicare for all, it's good for Americans of all ages. It's good for American business. It's good for America" in the comments section of Kevin Drum's site.  Why not?

Ron Byers

The Canadian Supreme Court decision finding that the government could not prohibit a second insurance policy was based on the fact that in a capitalist system, the "right to contract" is fundamental.  Therefore private parties such as an individual and an insurance company cannot be prohibited to contract for the guarantee of health care not covered by the government plan.  This would be the same rule in the U.S. -- even if we went to some form of National / Universal Health Care program.

This is not a problem in the U.S. because Medicare already allows for supplemental insurance plans.  Basically all that is needed is to expand Medicare and Medicaid to cover everyone and have everyone pay into the risk pool through income taxes.  With the expansion of the risk pool to all Americans (300 million of them), you get the advantages of the "economies of scale."  Furthermore, because the federal government does not need to make a profit and does not need to advertise as much, you also have instant savings of 15-25% of the cost of health care insurance right there.

There are other problems, such as the supply of medical providers in the U.S.  We already are facing a shortage of medical personnel.  The aging baby-boomers will only compound this problem.  Pressure needs to be put on the medical profession to allow more entries into medical school to deal with this known reality.  If the Republicans think that Social Security is going broke, just think of the more pressing problem of Medicare.  It is predicted to go "broke" even quicker -- say in the next 10 years or so.  (This is another reason why cutting taxes at this time is so devastating -- we needed those surplusses to make up for the foreseeable shortfalls in government programs for the elderly in the coming years.) 

Find the Truth. Do Justice.

I have to agree with the above comment (ronbyers) and the general sentiment that the insurance companies are the primary problem with the status-quo of out healthcare system as a whole.  And I feel this based on my family's personal experience, not ideology.

We experienced an unfortunate case of malpractice in the late 1980s.  It was eventually settled, more or less favorably, insofar as the potential cost of lifetime medical maintenance to address the resulting injury.  But that took nearly 15 years during which private insurance continued to pile on insult to injury, fighting us every inch of the way and denying coverage for services that could have substantially mitigated the injury from malpractice -- making it even worse and -- in effect -- committing their own form of malpractice.  The result was that the ultimate settlement cost them far more than it would have cost to do the right thing in the first place.  We imagine that this happens to others, a thousand times over, every day.  Not to mention all the other frustrations of losing insurance because of job changes and such, and then also having to fight the "pre-existing condition" battles for which a previous insurer is more responsible than the original condition and malpractice in and of itself.

Our healthcare system is a mess because of the private insurers.  No solution can work unless the first step is to get them out of the picture.

Without being too flippant:  The automobile put buggy makers out of business.  The internet put travel agents out of buisness. and on and on.

More substantionally, how mnay insurance agents actually deal with selling medical insurance?  I've had various medical plans over the last 18 years of my working life, I don't think Ihave ever dealt with an insurance agent.

I recently read a phrase that was something like, "Medicare for all, it's good for Americans of all ages. It's good for American business. It's good for America" in the comments section of Kevin Drum's site.  Why not?

But is it good politics?  Could it pass?  Would the majority of Americans be willing to trade the health coverage they already have for a government system?  Could such a proposal it survive the inevitable demagoguery and lobbyist opposition?  I say, let's get the uninsured covered first with least disruptive, most politically palatible approach and then worry about refinements down the line. 

Could it pass. Yes.

It would take massive lobbying to stop it.

What we need to do is start with our own commercials involving a couple sitting around the kitchen table worrying how they are going to pay their medical bills, how they are going to pay their COBRA payments between jobs, the effect of changing jobs on medical care they need to provide their child with some chronic illness, how they are going to fund the bills not covered by the new fangled MSA, their inability to start their own small business because they can't give up coverage, their plant closing and moving to Canada because the company can't afford medical costs. In short any one of the hundreds of real world issues millions of families face every day.

What surprises me is that there are still people like you who think a majority or even a large percentage of Americans don't worry about health care every day of their lives.  You must be a government worker. or are already on Medicare. They seem to be the only people left who haven't faced massive changes in their coverage over the last few years.  

Ron Byers

 
To persuade people, expose them to your ideasd over and over again. Suport incremental reform  when you have the chance; relieve some of the pain; mitigate the harms  But use any campaigns for  incremental reform as opportunities to educate. Let  people know that  that only single payer tackles the real problem.

1) Health care is a right. It should not be like a Mercedes, something you buy if you have the money.  We all deserve preventative care when well, such cures as exist when sick.

2) Our health care system is broken; We die younger than in other rich nations, spend more time sick while alive, and watch more of our babies die. For this we pay more than any  other nation in the world,  both in dollars and as a percent of national income.

It is an American tradition to learn from other nations; the log cabin was invented in Sweden;  hamburgers and hot dogs in Germany.  We did not hesitate to adapt the English steam engine to power our industrial revolution  at a time when Great Britain still  had ambitions to at least dominate if not reconquer the U.S.   Taking other peoples stuff is as American as apple pie (invented in ancient Egypt). Ask any American Indian.

3) The problem with our health care system is private insurers. They are why the uninsured get inadequate care; they are why most of us, insured or not get lower quality care than citizens of other rich nations. They are living proof that when it comes to medicine, private bureaucrats can produce more red  tape than public ones.

 I have a relative who sells insurance, including Medicare supplements.  You would be astonished at the percentage of the cost of those supplements and, even more so, the cost of other policies that goes to commissions for the insurance agents.  This makes all of these policies inefficient from the standpoint of service versus cost.  So, any single payer program that requires supplemental insurance policies will automatically be as ineficient as today's system.

You can bet the farm that if Republicans ever support a plan such as extending Medicare to everyone, it will only be because of this "loophole" which will be insurance for the insurance industry profits.  Protecting the profits of an industry that provides so little value to the customers should never be a part of any Democratic Party proposal.

Hoppy in Sacramento

 No, you aren't an idiot.

Those of us on Medicare now, who live in high cost of living states, know that we still have to buy health insurance, and it isn't cheap.  Medicare does not cover all medical expenses, nor does it cover the full cost of most medical expenses that it does cover.  Thus the market for Medicare supplements. 

Medicare is great, I won't deny that.  It does provide a bare basic medical coverage, without which many people would have no medical insurance at all.  But, the model we need to work towards is a plan that really does cover all medical expenses 100%, with exceptions only for the obvious  very elective medical expenses - for example sex change surgery.  If our new system is just an extended Medicare system, insurance companies will throw their biggest parties in their history, and that means really big parties.  And, over the following ten years we will see the gap insurance policies covering more and more of our expenses, until they are covering 90% or the typical person's medical costs - back to where we are today.

Hoppy in Sacramento

There's another dimension to this than government vs. private insusrance, even though that has to be the prime axis: it's federal vs. state within government. What, for example, stops red states like California or Massachusetts from introducing single-payer systems? This isn't a rhetorical question. If it has a real answer, than one incrementalist strategy that's not been discussed is to remove the obstacles to single-payer state iprogrammes, mutually recognized as in the EU, spreading steadily until they embrace the whole USA.

I suspect there's a fundamental flaw in this approach, but where? 

bluebell

Or how about an ad with a guy saying he has this terrific idea for a new business but he can't pursue his dream because it would leave his kids without health insurance?