It's important to remember that Medicare is not a choice-free universal system. It's a Guaranteed Issue health plan administered by dozens of different companies. The government has set the guidelines and are responsible ultimately for bill payment, but the insurance companies play an important role in offering the standard plan, plus a lot of other options consumers may want. You can choose your Part A and B from one company and Part D from another.

So, choice doesn't seem to be a dirty word to me, when considering what needs to happen. Americans tend to like different choices.

Brook, Just to be clear: I think choice, self-reliance, and minimal bureaucracy are all lovely things as well. But the conservative movement quite consciously uses those words in order to fool people about their agenda. Those were the exact same words used to promote Social Security privatization, for example (as well as school vouchers). It's time for people to catch on about what the real agenda is, and progressives need to stop falling into the trap of debating issues on the right's terms.--Greg

ok, got the point. we already had the privatization debate. i still disagree that is a "right-wing" issue -- at least from my own personal unofficial polling. When Sweden is partially privatizing -- it's hard to argue the issue as ideological.

I agree with a lot of what you say about the Right's plan for universal healthcare non-coverage. But to even suggest that a goal of the Republican Party is smaller government is to allow the Republican Party to claim as a "virtue" something that is nothing more than a bald-faced lie.

This U.S. government is not smaller because of Republicans. It is actually much bigger than it was before the Republicans came to power. The debt is much bigger. The budget is much bigger. We have more new and bigger agencies than ever before. We "outsource" and "subsidize" and "tax credit" more of America's wealth to corporations than ever before and in more ways than most people can begin to imagine.

If by smaller government we mean as little oversight as possible into the legislation and politicisation of every branch of government from the DoD, to the EPA to the DoJ to the ED, then I agree that smaller is better where the Republicans are concerned. The smallest of all Republican governments will be a government that encourages and abets the wholesale transfer of wealth from the lower and middle classes to corporate welfare shareholders, which is exactly what we are discussing with the case in point.

Michael, I totally agree. Note that I used the word "weaker" -- as in less effective at accomplishing goals supported by the public -- not smaller. There's a huge difference. --Greg

Brooke Dataski doesn't understand how Medicare works. To explain:

Medicare FFS -- Default system in place since the beginning, offers Part A (hospital) and Part B (most other things) through a pay as you go government funded plan of benefits established by Congress. FFS program is administered by contractors but they have very limited authority to set policy and no authority at all to establish what is covered (well, there's some slippage only because they have some interpretive authority as part of administering the program).

Medicare Part C -- HMOs and PPOs etc. offered by insurers to underwrite the same benefits offered through FFS. They do not establish basic benefits, those are guaranteed by law, but if the money works out, they might be required to provide a few extra benefits.

Medicare Part D -- Rx plans offered only through private entities.

As for me, I think John Edwards' proposed plan gets just about all of the issues right -- for those who really are happy being commercially insured, they can continue. For those who aren't, they can enroll in Medicare or a parallel plan. This doesn't threaten too many interests and builds on an already existing successful program.

Not to mention that workers will then have more freedom to move from job to job based purely on pay rather than having to worry about losing their health coverage or pensions. As that would give more bargaining power to the workers, the conservatives wouldn't want to have that either.

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I've seen all sorts of reasons offered up NOT to adopt "Medicare for All" concept. Yet they all seem to reduce to one: the corporate powers-that-be in the health care industry, most especially the insurance companies, will go into a fit if it's adopted.

But that doesn't strike me as an insuperable obstacle if actual live voters in great numbers support Medicare for All.

So I ask, what would be the downside to the ordinary voter of Medicare for All? Or is there any to speak of?

Sure. Higher Medicare costs.

Right now, Congress controls Medicare costs by transferring them to private payers. That is, Congress sets Medicare reimbursement rates below costs. Providers make it up by charging everyone else more.

If we had "Medicare for All" there wouldn't be anyone left for Congress to slough the costs on. :-)

Apparently the AEI faithful don't spend much time chatting with middle aged, middle class folks who are trying to help their parents sort out prescription drug coverage.

Do these "helpful" conservatives not understand the harm the Medicare Prescription Drug Plan did to their dreams of an insurance market driven plan for health care?

Ask any senior who's discovered the donut hole about the relative virtues of "choice" versus security when it comes to health insurance.

This horror of a plan has left a real bad taste and is, I believe, one of the reasons why the idea of a single payor health insurance system is rapidly gaining political ground.

I'm not sure how much of a real problem that would represent.

Essentially, what you seem to be saying is that everybody else who is NOT in Medicare is ALREADY paying more to cover the people who ARE in Medicare.

But if the costs are distributed fairly across the board, then those who are now paying more than their share will actually pay LESS for their current health care insurance if their monies now go toward Medicare for All -- the health care costs they must cover would go DOWN under Medicare for All. Of course, the amount paid for current Medicare (as part of retirement) would have to rise to cover increased costs at that end in a fair distribution of costs. But on balance there would probably be little or no movement one way or the other under Medicare for All -- more would be paid into the retirement portion, and less into the new segment of Medicare that would cover health care services for people not yet retired.

And none of this factors into account the positive effect on costs achieved by introducing single payer over the messy bureaucracy of the insurance industry.

providers also make up the difference by setting quotas on the number of medicare patients they will see.

this indicates there must be a top down approach that addresses the problem of rising costs and brings them under control. imo, just covering everybody will not accomplish that goal.

Conservatives want to conserve their own advantages. Choice, self-reliance, and limited bureaucracy are the code words used to maintain markets that conserve those advantages. Their crucial framing is defining unregulated markets as the only real or efficient market and everything else is a step towards socialism. Variants of this framing include labeling deregulation that is written by industry lobbyists as regulation and trade agreements are said to regulate industries when in fact they regulate government.

The reality is that there are unregulated markets that benefit only the wealthy and there are well-regulated markets that benefit all AND there are portions of the economy where markets do not work to advance the general welfare. Health care, like education and journalism, is a mixed bag in this regard so public debate is particularly susceptible to bamboozlement from the right. And they have a valuable ally, the corporate media, delivering the distorted framing.

Democrats must begin all economic discussions, as you have done here, by clearly reframing the discussion in terms of corrupt markets, well-regulated markets and ineffective markets.

I always find Greg Anrig's posts refreshingly candid and rightly contemptuous of the modern conservative movement. 

The right is deluded in persisting to believe certain myths about health care, such as that our current system represents the "free market" or that single-payer systems result in reduced choice.  Conservative die-hards persist in these beliefs, in spite of all evidence, because they cannot admit that their objections to universal healthcare are ideologically based, not based on evidence that most American would find compelling.

But it may be a stretch to say that there's some sort of conscious effort to undermine universal healthcare by "subverting the process" so that the legislation that emerges is weak.  I'm always wary about claims the other side is trying to "trick" anyone.  I think the right realizes the political salience of the healthcare issue and is trying to come up with answers that don't conflict with its ideological principles.  If anything, they're tricking themselves if they expect that to be a viable long-term strategy.

It's sheer heresy to posit that the Great Invisible Hand doesn't solve all problems and cure all ills! :-)

I think the biggest thing that tying health care to employment limits is the ability to start a small business, especially if you have kids.