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pampango

(24,692 posts)
Wed Jul 30, 2014, 06:03 PM Jul 2014

Krugman: Liberals really should be celebrating. California shows how Obamacare can and should work..

Stealth Single Payer

So it now appears that most of California’s uninsured — 58 percent of the total, or well over 60 percent of those eligible (because undocumented immigrants aren’t covered) have gained insurance in the first year. Considering the complexity of the scheme, that’s really impressive, and it strongly suggests that next year, once those who missed out have had a chance to learn via word of mouth, California will have gotten much of the way toward universal coverage for legal residents.

But there’s something else the Kaiser report drives home: most of those gaining coverage are doing so not via the exchanges (although those are important too) but via Medicaid. And that’s important as an answer to critics of Obamacare from the left.



There have always been critics complaining that what we really should have is single-payer, and angry that subsidies were being funneled through the insurance companies. And in principle they’re right; the trouble was that cutting the insurers out of the loop would have made the plan politically impossible, both because of the industry’s power and because of the unwillingness of people with good coverage to take a leap into a completely new system. So we got this awkward public-private hybrid, which I supported because it was what we could get and despite its impurity it dramatically improves many people’s lives.

But it turns out that many of the newly insured are in fact being covered under a single-payer system — Medicaid. And as I’ve pointed out before,

Medicaid is actually the piece of the US system that looks most like European health systems, which cost far less than ours while delivering comparable results.

http://krugman.blogs.nytimes.com/2014/07/30/stealth-single-payer/?_php=true&_type=blogs&_php=true&_type=blogs&_r=1&
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Krugman: Liberals really should be celebrating. California shows how Obamacare can and should work.. (Original Post) pampango Jul 2014 OP
Krugman nails it, once again! pnwmom Jul 2014 #1
Except it is entirely based upon income. Bandit Jul 2014 #16
At least it's now based ONLY on income. stopbush Jul 2014 #17
Don't get me wrong, I am not knocking medicaid nor even ACA although we could have done better. Bandit Jul 2014 #20
OF COURSE THERE COULD BE A BETTER PLAN. Neither Krugman nor any DUer pnwmom Jul 2014 #22
That quote is generally attributed originally to Voltaire (n/t) thesquanderer Aug 2014 #31
Thank you. A lot more Americans remember it as something Kennedy used to say. pnwmom Aug 2014 #33
If you're thinking "we could have done better" back in 2009-10, you're delusional. stopbush Aug 2014 #29
Unlike anything the Rethugs would do, it's the people who need it the most. pnwmom Jul 2014 #21
Another HUGE benefit is the political payoff for Dems for the forseeable future! CTyankee Jul 2014 #24
Kick kickity kick Hekate Jul 2014 #2
How is this something to celebrate? leftstreet Jul 2014 #3
that is absurd dsc Jul 2014 #6
The success of the ACA is in fixing poverty guidelines? leftstreet Jul 2014 #7
No it upped the income you could earn and qualify for Medicaid dsc Jul 2014 #8
Right. Income below 138% FPL leftstreet Jul 2014 #10
Presuming one's definition of success is increasing the number of insured then yes dsc Jul 2014 #11
Its succeeding by giving people access to affordable health care bhikkhu Jul 2014 #27
Post removed Post removed Jul 2014 #13
Federal Government Will Assume 93 Percent of Expansion Costs Over 2014-2022 pinto Jul 2014 #14
You A Special Little Snowflake, Fella, Ain'tcha? The Magistrate Jul 2014 #15
Stealth public option for the indigent? Maybe. Stealth Single payer not at all. See SINGLE. TheKentuckian Jul 2014 #4
Medicaid and Medicare are singlr payer systems. Thinkingabout Jul 2014 #5
Wow ... 1StrongBlackMan Jul 2014 #9
Frankly, I'm sick of the Obamacare critics on the right and left. conservaphobe Jul 2014 #12
Bingo! stopbush Jul 2014 #18
Sorry...That's a pre-existing condition. Jeff In Milwaukee Jul 2014 #23
There is a personality type that lives to complain IronLionZion Aug 2014 #34
And if they fully and properly funded Medicare and MedicAid... Wounded Bear Jul 2014 #19
Exactly. The ACA greatly expands existing single payer coverage. SunSeeker Jul 2014 #25
Open Medicare to all. TIMETOCHANGE Jul 2014 #26
Medicaid is UHC for the poor. Those who care about them, should be happy. And the ACA is freshwest Jul 2014 #28
Still Serious Problems With Coverage DallasNE Aug 2014 #30
I realize it's better than nothing but... SHRED Aug 2014 #32

pnwmom

(108,925 posts)
1. Krugman nails it, once again!
Wed Jul 30, 2014, 06:06 PM
Jul 2014

"But it turns out that many of the newly insured are in fact being covered under a single-payer system — Medicaid. And as I’ve pointed out before,

Medicaid is actually the piece of the US system that looks most like European health systems, which cost far less than ours while delivering comparable results."

Bandit

(21,475 posts)
16. Except it is entirely based upon income.
Thu Jul 31, 2014, 12:17 PM
Jul 2014

We should have the same Health Care for all no matter how much money a person has.. just my $.02 worth anyway.

stopbush

(24,378 posts)
17. At least it's now based ONLY on income.
Thu Jul 31, 2014, 01:39 PM
Jul 2014

Before the Medicaid expansion under Obamacare, there was an asset test to qualify for Medicaid. In short, a family of 4 could have only $3300 in assets - including owning only one car - to qualify for Medicaid pre-Obamacare.

That test meant a family like mine - where we have some assets, but where I have been unemployed for over 3 years - was shit out of luck when it came to Medicaid. Our only option was to go into the exchanges and purchase a policy. Sure, there might have been a subsidy that made the health insurance "free," just like Medicaid, but so what? The outcome is the same. Thankfully, that asset test has been dropped under the CA MediCaid expansion.

Our family has been on MediCal since January 1. We are with Kaiser Permanente. Since starting with health care under Obamacare/Medicaid, I am being treated for a-fib (warfarin), high blood pressure and being monitored for pre-diabetes (a bit of a stretch, considering my A1C isn't that high - Rxs are always overly cautious). My wife has had two surgeries on her right breast to remove some pre-cancerous tissue. Our kids have had initial visits that included a few tests and vaccine updates and boosters.

Our out-of-pocket expenses/co-pays to date: $0. Were we on a policy through the exchanges, we might be going through dwindling assets to pay for health care.

Were it not for the Medicaid expansion in CA, none of the above would have been possible. Our COBRA had expired, and I have no idea what insurance would have cost us through the exchanges. At least I now have some peace of mind when it comes to our family's health. It's enough to have to worry about being unemployed.

Bandit

(21,475 posts)
20. Don't get me wrong, I am not knocking medicaid nor even ACA although we could have done better.
Thu Jul 31, 2014, 02:11 PM
Jul 2014

I am delighted that millions of people will now have access to real Health Care which they didn't have before Obama came to Office. I just wish it were truly a Liberal form of Health Care instead of one based upon Republican priciples. Although I doubt the Medicaid expansion was presented by Republicans to help people. They need money to exchange hands or they are not for it..

pnwmom

(108,925 posts)
22. OF COURSE THERE COULD BE A BETTER PLAN. Neither Krugman nor any DUer
Thu Jul 31, 2014, 03:32 PM
Jul 2014

I've ever seen has suggested otherwise.

But this was as good as we could do, given the current make up of the conference. Some progressives at the time thought we should reject even this because it wasn't perfect -- that we should wait for something better, no matter how long it took. Maybe you were in that camp.

I wasn't. I agreed with Ted Kennedy's famous quote. "Don't let the perfect be the enemy of the good."

pnwmom

(108,925 posts)
33. Thank you. A lot more Americans remember it as something Kennedy used to say.
Fri Aug 1, 2014, 03:41 PM
Aug 2014

But that is good to know.

stopbush

(24,378 posts)
29. If you're thinking "we could have done better" back in 2009-10, you're delusional.
Fri Aug 1, 2014, 12:01 AM
Aug 2014

Sure, it would have been great to get single payer. But the facts is that it would have been blocked by Dems. No R voted for the ACA IIRC. Ds like Max Backus were the reason we ended up with a version of Romneycare. Had Obama pushed for single payer, we probably would have got nothing, because Ds like Backus would have voted against it.

We WILL get single payer eventually. The ACA is the first major step in that direction.

pnwmom

(108,925 posts)
21. Unlike anything the Rethugs would do, it's the people who need it the most.
Thu Jul 31, 2014, 03:27 PM
Jul 2014

And he still nailed it. This is a huge expansion of single payer, and would have been bigger if the Rethug states hadn't turned it down.

CTyankee

(63,771 posts)
24. Another HUGE benefit is the political payoff for Dems for the forseeable future!
Thu Jul 31, 2014, 03:49 PM
Jul 2014

Dems fought for affordable health care and expansion of Medicaid and pukes opposed it. Dems get the advantage of having that accomplishment to all those that, like Medicare and SS in the past, make our party the one that cares about the ordinary citizen. The repukes come off looking mean, small and having NO ideas...

leftstreet

(36,078 posts)
3. How is this something to celebrate?
Wed Jul 30, 2014, 06:07 PM
Jul 2014

More and more Americans are so poor they can get Medicaid!! Yippee!

Does Krugman have any idea what the GOPers will do with this politically?

Jesus

dsc

(52,130 posts)
6. that is absurd
Wed Jul 30, 2014, 06:22 PM
Jul 2014

the income limit for Medicaid was raised thus having Medicaid cover people who otherwise weren't being covered. The number of poor people hasn't gone up.

dsc

(52,130 posts)
8. No it upped the income you could earn and qualify for Medicaid
Wed Jul 30, 2014, 06:37 PM
Jul 2014

In many states the income requirement for Medicaid was very low before the expansion. By upping that amount many people who before the expansion didn't qualify for Medicaid now do qualify for Medicaid. They weren't below the poverty level before that expansion and aren't below the poverty level now.

leftstreet

(36,078 posts)
10. Right. Income below 138% FPL
Wed Jul 30, 2014, 06:43 PM
Jul 2014

Sorry, I still don't see how expanding access to Medicaid proves the ACA (and it's much-touted affordable for-profit exchanges !!) is succeeding

Not to mention the fates of the (voting!) people in non-expansion states

dsc

(52,130 posts)
11. Presuming one's definition of success is increasing the number of insured then yes
Wed Jul 30, 2014, 07:19 PM
Jul 2014

it is a sign of the success of the ACA. In many states single people without children were pretty much ineligible for Medicaid before the expansion.

bhikkhu

(10,708 posts)
27. Its succeeding by giving people access to affordable health care
Thu Jul 31, 2014, 09:54 PM
Jul 2014

I understand the argument that it does nothing for income inequality, but it wasn't an income inequality fixing law, it was a health care expansion law. Income inequality certainly remains an issue, but the ACA is doing its job better than most people had hoped, which is a very good thing.

Response to leftstreet (Reply #3)

pinto

(106,886 posts)
14. Federal Government Will Assume 93 Percent of Expansion Costs Over 2014-2022
Thu Jul 31, 2014, 11:40 AM
Jul 2014
Federal Government Will Assume 93 Percent of Expansion Costs Over 2014-2022

Specifically, the federal government will, for the first three years (2014-2016), assume 100 percent of the costs of covering those made newly eligible by the health reform law. Federal support will then phase down slightly over the following several years (95 percent in 2017, 94 percent in 2018, and 93 percent in 2019). By 2020 and for all subsequent years, the federal government will pay 90 percent of the costs of covering these individuals.

http://www.cbpp.org/cms/?fa=view&id=3801

Center on Budget and Policy Priorities

TheKentuckian

(24,945 posts)
4. Stealth public option for the indigent? Maybe. Stealth Single payer not at all. See SINGLE.
Wed Jul 30, 2014, 06:16 PM
Jul 2014

I don't even think the former is true since being eligible means it isn't an option and if your state didn't expand you get a penalty exemption.

I guess if there are no jobs and race to the bottom wages it could become a de facto single payer but since I can't eat or seek shelter in a Medicaid card very well I'll have to cheer against that outcome.

Thinkingabout

(30,058 posts)
5. Medicaid and Medicare are singlr payer systems.
Wed Jul 30, 2014, 06:19 PM
Jul 2014

A large portion of the previously insured is in Medicare. I think one day they will get smarter and have a single payer system but I am happy we at least have something.

 

1StrongBlackMan

(31,849 posts)
9. Wow ...
Wed Jul 30, 2014, 06:38 PM
Jul 2014

While I cannot think of a issue where I have disagreed with the Good Dr. K's goal and direction ... I think this is the first time that the Good Dr. K. has acknowledged the political realities that play into what has/can be done. I completely agree (and so does the polling) with his conclusion:

the trouble was that cutting the insurers out of the loop would have made the plan politically impossible, both because of the industry’s power and because of the unwillingness of people with good coverage to take a leap into a completely new system.


And no amount of magical thinking could have moved the collect of parties to single-payer, at this point in our history.

Secondly, it almost appears that the Kaiser Report has fueled a coordinated attack ... with the Good Attorney Cummings pressing the "Why won't you expand" flank and The Good Dr. K. closing the door with "This is what we have and it's working."

 

conservaphobe

(1,284 posts)
12. Frankly, I'm sick of the Obamacare critics on the right and left.
Wed Jul 30, 2014, 07:26 PM
Jul 2014

All the news these days is overwhelmingly positive.

My personal experience is overwhelmingly positive.

They sound like broken records and they can go fuck themselves.

Wounded Bear

(58,440 posts)
19. And if they fully and properly funded Medicare and MedicAid...
Thu Jul 31, 2014, 02:08 PM
Jul 2014

things would be even better. That won't happen with Repubs blocking.

SunSeeker

(51,369 posts)
25. Exactly. The ACA greatly expands existing single payer coverage.
Thu Jul 31, 2014, 04:40 PM
Jul 2014

It is just a matter of time before we have Medicare for all (i.e. , universal single payer).

 

TIMETOCHANGE

(86 posts)
26. Open Medicare to all.
Thu Jul 31, 2014, 04:54 PM
Jul 2014

Make Medicare free to all individuals earning less than $15,000 per year. Tax ten percent of a every dollar earned in excess of $15,000 if a person elects to use Medicare. Tax an additional one percent on all income earners. It'll bring down the prices of private insurance and help get everyone covered.

freshwest

(53,661 posts)
28. Medicaid is UHC for the poor. Those who care about them, should be happy. And the ACA is
Thu Jul 31, 2014, 10:33 PM
Jul 2014

Stealth Single Payer to be made real UHC if people will vote for it in their states. It was always in the Law, which is why the GOP and the rest of them hate it. Because they did read it and knew. So they began their disinformation campaign which has trapped all sides.

DallasNE

(7,392 posts)
30. Still Serious Problems With Coverage
Fri Aug 1, 2014, 12:17 AM
Aug 2014

In nearly all of the red States, like Nebraska, where I live. My daughter is unable to work because doctors have not been able to stabilize her bi-polar condition. She is now 25. I tried using the ACA website to get her enrolled in Medicaid and while the ACA website forwarded her application to Nebraska for consideration for Medicaid coverage she was denied coverage because my retirement income is too great. For my daughter there is no safety net, even though she is now 25, as long as I have a dime to my name. She doesn't qualify under Medicaid and she doesn't qualify under Social Security disability because I am not yet destitute. In other words, there are still gaping holes in the "safety net" and those gaping holes need to be closed. The silly part is that it would be cheaper to provide coverage than to not provide coverage because the emergency room will be the only care available and that will cost the taxpayer an arm and a leg. It is, in other words, a cruel world out there and nobody seems to care. Very cruel. And that needs to change yet I don't hear any liberals pressing to close the gaping holes in our current system. None. I don't know what is going to happen when she turns 26 in a few months and my coverage expires. This dad is desperate.

 

SHRED

(28,136 posts)
32. I realize it's better than nothing but...
Fri Aug 1, 2014, 01:10 PM
Aug 2014

...isn't doctor choice and care extremely limited under Medicaid/Medical?

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