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As Bill Maher said on Countdown;-

They should have started with single payer. I mean, even if they weren't going to get it, it is what most other western democracies have. It's the one program that makes sense. But okay, we live in a country that doesn't make sense.. But at least start with that.

During the campaign, Obama said, 'If we were starting from scratch, single-payer would make sense.' Well then, let's start from scratch - that is kinda where we are in this country right now. And if they had started from that, then the fall-back compromise position would have at least been the public option. But they didn't even start with the public option - he didn't even defend that.

and as Dr Marcia Angell said to Bill Moyer

But if you look at it as a matter of policy, the President's absolutely right that the status quo is awful. If we do nothing, costs will continue to go up. People will continue to lose their coverage. Employers are dropping health benefits. Things will get very bad.

The issue is, will this bill make them better or worse? And I believe it will make it worse.

[...]

BILL MOYERS: Well, you remind me 45 thousand people, as Wendell Potter said earlier, die every year for lack of health insurance. That should be-- they're--

MARCIA ANGELL: It's not lack of health insurance. It's lack of health care. There is a difference between health insurance and health care. You can have insurance offered that is too expensive to buy or too expensive to use. What good does it do?


 I know where you're coming from that says something, anything, is better than what you have. I can fully agree with your fury with those "progressives" who say that this bill isn't perfect, therefore it should be destroyed. A good example of the perfect driving out the good.

But what if she's right. what if it makes things worse ? I don't know, I can't judge this situation. But the fact that something that should have been easy, a perfect do something unequivocally good has been so finessed and watered down that people of good intention can seriously question if it will make things worse, makes me think somebody at the top sold you out. And I think that's what dvx is saying.


keep to the Fen Causeway

by Helen (lareinagal at yahoo dot co dot uk) on Sun Mar 14th, 2010 at 04:49:56 PM EST
[ Parent ]
I know where you're coming from that says something, anything, is better than what you have.

No, actually, that is not my stance.  While true that almost anything would be better than what we have, I'm supportive of the bill because it's a good bill.

And, I'm sorry, but 'let's start with single payer' and 'start from scratch' isn't doable just because a smug libertarian comedian says so.  

Contrary to what's being said on the blogs, this country is NOT all behind single-payer, tearing down the system, or killing the insurance industry.  A small segment is, and it's gathering steam, but the vast majority are not.  There's support for the public option, which would only require offering a service in the current 'market.'  Single payer would require actually taking over the assets of the current privately owned infrastructure - there's not broad public support for that.

And 'what if the bill makes it worse' is simple fear.  There's no evidence whatsoever that the bill will make things worse.  All impartial evidence shows the bill will be an improvement.  And I do have the experience and knowledge to be an informed judge of the situation.  The bill addresses most of our immediate problems as well as laying the foundation to get to where we want to go.

It's not lack of health insurance. It's lack of health care. There is a difference between health insurance and health care. You can have insurance offered that is too expensive to buy or too expensive to use. What good does it do?

Marcia evidently has not read the bill, which specifically addresses the problems with junk insurance policies and puts annual caps on what individual's have to pay.  In other words, it expressly prohibits these things she's worried about.  And the 'health care not insurance' talking point is meaningless -- I'm to the point of ignoring anyone who repeats it.

Right now, insurance IS our health care.  Almost our entire infrastructure is in private hands.  The bill gives us access to the health care system we currently have in place and provides for building a public system, which is currently close to non-existent.  I don't believe there's any way to get from 'private' to 'public' without taking these steps.  The 'kill the industry' 'take out the middleman' sentiments are nifty, but isn't this a goal?  How does one go about doing that right now, exactly, in one fell swoop?  

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Sun Mar 14th, 2010 at 05:26:59 PM EST
[ Parent ]
Pardon me.

Single payer would require actually taking over the assets of the current privately owned infrastructure

This statement is false.

Text of H.R. 676 (pdf) 30pp

Single-payer is a benefits financing proposal to be funded by premia collected through existing state and federal tax facilities and administered by CMMS et al. The objective of combining Medicare and Medicaid coverages and eliminating enrollment eligiblity according to age is to capitalize bargaining power of insureds in the open market for medical goods and services.

Diversity is the key to economic and political evolution.

by Cat on Sun Mar 14th, 2010 at 08:07:34 PM EST
[ Parent ]
Ok, point taken, but I meant it in the sense of an NHS type system, where government directly provides services, which is what a lot of single payer advocates want (and an idea I like as well).  In the strict sense you're addressing, it's another version of 'government insurance,' as is medicare, medicaid, the public option, etc., whether alongside private insurance or instead of it.  I don't see any broad sort of 'instead of it' support in this country, do you?  I don't see anything in the bill that's detrimental to people at the expense of industry, and nothing that rules out expansion of some sort of government insurance in some permutation.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Sun Mar 14th, 2010 at 08:47:56 PM EST
[ Parent ]
detrimental to people at the expense of industry

damn - wrong there, too!  that sentence is all fucked up.  I meant, detrimental to people and to the benefit of the industry... or something....  obviously I don't re-read or self-edit much before hitting the post button...

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Sun Mar 14th, 2010 at 08:53:26 PM EST
[ Parent ]
In my experience with the single-payer movement here in California, where I play a small but possibly growing part, it is the Canadian model that most look to as their model. The NHS is respected but even most single-payer activists believe it is unrealistic to expect Americans to support government takeover of private hospitals and to directly employ physicians, even if it is a sensible move.

And the world will live as one
by Montereyan (robert at calitics dot com) on Sun Mar 14th, 2010 at 09:37:12 PM EST
[ Parent ]
Contrary to what's being said on the blogs, this country is NOT all behind single-payer

Attitudes may have changed since 2006. You will recall at that time Mr Bush implemented a nationwide consultation steered by a DHHS commission, Citizens Healthcare Working Group, pursuant to the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014.

Following this nationwide citizen engagement, the Working Group is required to prepare and make available to the public this interim set of recommendations on ``health care coverage and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings.'' Following a 90-day public comment period on these recommendations, the Working Group will submit to Congress and the President a final set of recommendations. The law specifies that the President shall submit a report to congress on the recommendations within 45 days of receiving them, and designates five congressional committees that will hold hearings on that report and the recommendations: the Committee on Finance of the Senate, the Committee on Health, Education, Labor and Pensions of the Senate, the Committee on Ways and Means of the House of Representatives, the Committee on Energy and Commerce of the House of Representatives, and the Committee on Education and the Workforce of the House of Representatives.

Following are the interim recommendations of the Citizens' Health Care Working Group, along with descriptions of how we conducted our work and what we heard from participants in community meetings, respondents to our Web polls, and citizens who wrote in to tell us their views.

These recommendations outline a vision and a plan for achieving broad-based change in health care in America. We recognize that the issues involved are complex and challenging, and that it will take time and a great deal of technical expertise, as well as political will, to make the changes we think are necessary. Over the next three months, we will continue to actively pursue public input as we deliberate and further refine these proposals. During this process, we will provide greater detail and explanation of our recommendations, as well as further analysis of what we are hearing from the American people before issuing the final recommendations to the Congress and the President.

Some Daily Kos bloggers reported their experiences in local focus groups. I just now attempted to access Citizens Healthcare Working Group survey results, "Dialogue with America," published August, 2006, by the Bush WH, ironically. That data has been SCRUBBED. Fortunately, I copied a few data points.

  • 23% want free market competition among doctors, hospitals, other health care providers and insurance companies, rather than having government define benefits and set prices.
  • 64% want Open up enrollment in national federal programs like Medicare or the federal employees' health benefit program
  • 72% want to expand neighborhood health clinics
  • 69% agree create a national health plan, financed by taxpayers, in which all Americans would get their health insurance.
  • 63% willing to pay more in taxes to have basic health insurance coverage for all
  • 68% agree expand Medicaid and SCHIP to cover more people without health insurance.
  • 84.5% agree coverage for everyone, for a defined level of benefits
  • 92% agree  It should be public policy that all Americans have affordable health care insurance or other coverage.

re: employer assurance
  • 56% Require businesses to offer health insurance to their employees.
  • 69% Expand current tax incentives available to employers and their employees to encourage them to offer insurance to more workers and their families.
  • 42% agree income tax deductions, credits, or other financial assistance to help uninsured Americans them purchase private health insurance on their own.
  • 40% disagree (preceding prompt)
  • 11.4% agree to public funding the development of computerized health information to improve quality and efficiency of health care
  • 70% agree Doctors, hospitals, and other health care providers should invest more in computerized information systems to monitor and improve health care quality, reduce errors, and improve administrative efficiencies [electronic health records or EHRs].


Diversity is the key to economic and political evolution.
by Cat on Sun Mar 14th, 2010 at 09:03:52 PM EST
[ Parent ]
Thanks for all the data -- but it just tends to reinforce what I've been saying for years.  Yes, Americans DO support everyone having health care, paying taxes for it, and having the government involved (which they will be when the bill passes).  But they do NOT (at this point) all support, or even widely support, abolishing the private health insurance industry.  Nothing in the data contradicts this.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Sun Mar 14th, 2010 at 09:16:21 PM EST
[ Parent ]
The most recent polling I recall on this is from fall 2007, and it's from California - but "medicare for all" had majority support at the time:

Calitics: Interesting Finds on Health Care in the LA Times Poll

Extending Medicare to cover all Americans, creating a government-run system: 53% yes, 36% no

It's not public opinion that is the main obstacle - it is the vast wealth of the insurance industry, which has made both Congress and the White House reluctant to take on more fundamental and more useful reforms.

That decision can be defended. But let's be clear about what drove DC Democrats' decisions on this. It wasn't public opinion.

And the world will live as one

by Montereyan (robert at calitics dot com) on Sun Mar 14th, 2010 at 09:41:21 PM EST
[ Parent ]
Oh, I agree with you that wealth and power has driven the debate and that it's not all based on the public interest.  I also agree that many DC Democrats are working on that agenda as well.  What I'm disagreeing about is labeling either Obama separately, or together with some Democrats as a monolithic entity, as having the agenda of serving insurance rather than people.  

To call either him as an individual or The Democrats as a singular entity a sell out, to make accusations that the industry wants this bill, that it's a bailout, that they're all engaging in kabuki and serving their 'masters' is really destructive, imo, as well as being generally stupid.

What good does it do?  How does it help us reach our goals?

I think, given the political environment in general and the makeup of the current congress in particular, the bill is a really great start that will help millions.  How are we going to build on that if we keep tearing down those who've helped make it happen?

Maybe we can eventually make language a complete impediment to understanding. -Hobbes

by Izzy (izzy at eurotrib dot com) on Sun Mar 14th, 2010 at 09:54:23 PM EST
[ Parent ]
abolishing the private health insurance industry

This is an AHIP fallacy repeated to undermine popular support for public financed insurance as described in H.R. 676. That bill does not compell enrollment in the public plan; nonetheless everyone is eligible to apply for coverage. The bill does not compell persons to terminate private insurance coverage, nor does it prohibit persons from purchasing private insurance. H.R. 676 does prohibit beneficiaries duplication of coverages as do all commercial insurers; all policies contain a coordination of benefits provision to prevent over-insurance i.e. duplicate payments of claims.

Diversity is the key to economic and political evolution.

by Cat on Sun Mar 14th, 2010 at 10:51:55 PM EST
[ Parent ]
Yes, Cat, I know this and, in my view, you're proving my point.  I'm addressing overwrought rhetoric and the dialog that says because of this or that thing, Obama/The Dems are corporate sell outs and traitors to the cause.  All the options would allow our current system to stand.  All the options would require working within it to some extent.  It's ridiculous to be saying, at this point and on these details, that the whole thing is now an insurance bailout/what they wanted all along/Obama's secret master plan.

Maybe we can eventually make language a complete impediment to understanding. -Hobbes
by Izzy (izzy at eurotrib dot com) on Mon Mar 15th, 2010 at 12:21:59 AM EST
[ Parent ]

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