What Form Should US Healthcare Take?

[Prophet 451]

Seems I'm posting a poll a day right now. Here are your options:

A) The current ACA plan: Everyone has to carry some form of insurance, subsidies for the poor.

B) Medicare-for-all: Everyone can buy into Medicare.

C) NHS-style single payer: I live under the NHS. It's not bad. Not perfect but not bad. There are short waiting times for some elective surgeries but that's because of not enough surgeons being available. Free at point of delivery, funded by taxes and your only co-pay is a small fee to get your prescription filled (currently about $15; young, old and poor are exempt).

D) Something else.

28 votes, 1 pass | Time left: Unlimited
	A) Current ACA plan
	1 (4%)
	B) Medicare-for-all
	9 (32%)
	C) NHS-style single payer
	17 (61%)
	D) Something else
	0 (0%)
	E) All Geminis to the raspberry hats
	1 (4%)
	1 DU member did not wish to select any of the options provided.
Show usernames Disclaimer: This is an Internet poll

[BlindTiresias]

1. NHS/single payer

Last edited Wed Dec 3, 2014, 06:30 AM - Edit history (1)

But it will never happen, the ACA has made sure of that despite what the deluded think.

[Prophet 451]

2. How so?

The impression I got of the ACA was that it was a stepping stone to, eventually, single payer.

[BlindTiresias]

7. Doubtful

It is insurance, there are no incremental steps to take to get from where we are at now to a UHC system. You also have to factor in that a UHC system would threaten the livelihoods of the now institutionally entrenched insurance companies, which puts us even further from UHC. At best those saying this was the clear path were engaging in wishful thinking.

[pnwmom]

47. Not necessarily. The ACA included funding to help states set up their own single-payer

programs, and Vermont is working on doing that.

The ACA also included support for states that want to try co-ops, and Oregon is doing that.

So the incremental aspect is state-by-state moving to single-payer.

And Vermont could lead the way, just as it did with civil unions, and then marriage equality.

[BlindTiresias]

61. Yeah, we'll see

I doubt we'll see anything on a truly national level, though.

Vermont is also having issues with figuring out how to fund and develop it, so we'll see about that too.

Don't know what to say to the optimists, the age of optimism is over.

[pnwmom]

63. You're right, Vermont is finding out how difficult this will be.

So why do you think it would be easier on a national scale?

[BlindTiresias]

67. More access to resources

Vermont isn't exactly an economic powerhouse with a large population, so projects like this tend to get easier as the scale increases and you can standardize things, so it can be more efficient. But I never said it was easier, in fact the difficulty of implementation in piecemeal or in a large national program in terms of the culture and our obsolete federalism will ensure it doesn't happen.

As I said, the age of optimism is over. We are looking at everything getting worse into the future with no solutions forthcoming, those that think we will get an adequate healthcare system are kidding themselves.

[Jamastiene]

76. America will never not be under the grip of unfettered capitalism.

That's why. If, by some miracle, the majority of the country gets smart and wakes up, it would be a stepping stone, but I don't see that happening. For one thing, our system is designed by the corporations, for the corporations, and of the corporations. We won't see a NHS in America. TPTB won't allow it.

[Recursion]

12. NHS and single payer are mutually exclusive

You can have one or the other.

[BlindTiresias]

37. I'm aware

I forgot the / between them.

I don't see the ACA as being a particularly strong contender in any incrementalist manner to either of those models.

[brooklynite]

3. Um, do you seriouy expect any divergent opinion?

i don't think anyone disputes that a more progressive health care an is desirable. It's an issue of what we could realistically get in the short term.

[Prophet 451]

4. Well, TBH

I expect a split between options B and C. I would imagine only the Obama zombies (every politician has a few zombies) are all-in for the ACA.

[fadedrose]

5. The ACA was the best Obama could get

The Senate from the red states wouldn't back it, and I don't recall how Pelozzi won over enough votes...

I always figured that ACA was training wheels on a 3-wheeler.

The 15-speed bike or a motorcycle will take a little longer.


Oh, I am an Obama zombie, and proud of it.

[Prophet 451]

6. Oh, I know

Sorry if the above gave you the impression that I thought getting single payer was possible. I know it wasn't possible at the time and probably won't be possible for many years.

And you're not a zombie. The zombies are utterly incapable of admitting that their idol has any faults or has done anything wrong ever.

[mvd]

10. I really don't even think it was the best

Surely Lieberman and others could have been pressured by the President when we had majorities. Plus Obama should have started with Single Payer and worked from there. Public Option should have been made more of a priority.

The ACA was at least better than what we had though. I don't like how it entrenched the insurance companies and that should be fixed.

Medicare buy in would be a close second for me. But I prefer the taxation of the NHS plan.

[Recursion]

15. He wasn't negotiating with the GOP and he knew it. He was negotiating with Lieberman and Baucus

That's why he started (and ended) where he did.

[mvd]

20. But the more to the right ACA gave Lieberman/Baucus control also

They could easily dismiss it. We could argue this forever because we will never know - he didn't try.

[woo me with science]

42. Nonsense. He deliberately buried the public option.

A public option was polling very well among Americans at the time.

The Third Way always wants to argue about single payer in order to try to obscure the fact that Obama sold us out on the real potential reform of a public option, which is what he campaigned on and promised to fight for.

Obama chose not to fight for a public option *after* he had promised to do so, *even when* polls showed that the country was strongly behind it, and *even though* public opinion could have been mobilized to demand it.

Not only did he make a backroom deal to kill the public option, he lied to the American people and claimed that he had never campaigned on a public option *after* the deal had been made, just as he lied to Americans that he would not support a mandate.

The truth is that, consistent with his aggressively pro-corporate appointments and proactive corporate policy agenda in virtually every other area of policy important to his corporate donors, he was working for the insurance companies' version all along.

[fadedrose]

46. Polled Americans was the wrong group

Before the nuclear option 2/3 of the Senate was needed and he didn't have it.

The only way to get it passed was to show the Republicans that private insurance companies would still be part of the health plan. You know how they love "private" stuff, like military combat troops and civilians doing government jobs, and they're trying to close the post offices, as well as do away with SS and have contributions put into the stock market...

Yeah, Obama didn't try hard enough. Maybe if he were more of an idiot he may have.

Edit: I don't think even the nuclear option would have helped in this kind of law. 60 would be needed at least because of its nature.

[joeglow3]

64. If this is a poll, why would you push for a given option?

I am not saying a disagree with most here, but a bad poll is one that explains why they think one option is good/great.

[Prophet 451]

73. Not pushing for, expecting

[elias49]

8. Aren't B. and C. pretty much the same? nt

[Prophet 451]

9. Not quite

Medicare requires you to actually buy in by paying a monthly premium. Under the NHS, that premium is included in teh taxes you pay.

[Recursion]

14. No, you're missing the huge difference. NHS means doctors work for the government.

Single payer means doctors and hospitals are not direct government employees, but the government operates a national insurance pool.

You can either be NHS or you can be single payer.

[mvd]

31. Interesting distinction

Thanks for the info. Did not know this was the official single payer position. I am for single payer but think NHS may run better - would take longer though.

[meow2u3]

39. Part C is also known as Medicare Advantage

Part B is "straight Medicare."

[C Moon]

11. Off topic a bit: I've had Kaiser for many years...

Today, I was thinking about what it is I don't like about Kaiser (they are good in many ways, so this isn't meant to be a major put down) but when I see my doctor—aka primary care physician—(I've had a few different ones over the years), it feels more like I'm seeing the insurance company. The doctors sit in front of a computer most of the visit and type and read. Then at the end of the visit they'll listen to your lungs, heart, etc.

[pnwmom]

48. That isn't Kaiser in particular. It's modern medicine in general.

Doctors don't examine patients the way they used to; it's not emphasized anymore in medical schools.

[Recursion]

13. NHS isn't single payer. You can be NHS or you can be single payer. Medicare-for-all is single payer

(And, also, Medicare-for-all is vastly more expensive than most DUers seem to think -- currently premiums are about $750 per month.)

Single payer is like Canada, where each Province runs a Medicare system which pays private hospitals and doctors.

NHS is like the UK, where the government runs the hospitals and pays the doctors' salaries.

[Prophet 451]

17. Right, now I'm with you

[Recursion]

18. Oddly enough, the closest thing to Canada's system was proposed by Baucus

Baucus wanted state-level co-ops with minimal direct political control. This is essentially what Canada's system is, because each Province runs a medical insurance program that is immune to some direct control by the Provincial government.

[Prophet 451]

19. Does that system work well?

I mean, I live under the NHS so I know it's generally pretty good. But I know jack shit about Canadian healthcare.

[Recursion]

25. People seem to like it

I've never gotten sick there so I'm not sure.

I have, however, gone to the hospital in Austria, which I remember two things of distinctly:

1. The hospitals in Austria have tobacconists next to the gift shops(!)

2. It's a two-tier system with basic health care available for free and a private insurance market for more expensive options

[Prophet 451]

28. We still have private insurers here

Some people buy it, for various reasons. Some like being able to bypass the availability lists (which usually means they get seen by an NHS doctor moonlighting on his free time). Some like brand-name drugs and luxury hospitals (the NHS tends toward generics and functionally spartan to keep costs down). Some just want the status symbol.

[Recursion]

30. Interestingly, in Canada it's illegal to bill for any covered treatment privately

That is, it is against the law to be a "personal physician" or whatever and provide somebody a treatment covered by the Provincial health insurance system and then take money directly for it. It's a little more odd than a lot of Americans seem to think; as you point out even the UK doesn't have that strict a requirement.

[mvd]

27. Haven't lived there but Canadians seem happy overall

The main difference in NHS is the delivery method not being private and government ownership. Both are loosely called single payer but NHS is more "socialized medicine" which could use a better term in the USA as to not give the wrong impression.

[Prophet 451]

32. Yeah, Americans go ballistic whenever someone mentions "socialism"

Your media seems to have trained people to see socialism as a virus that, once you give even an inch, you wake up in 1950's Moscow.

[pnwmom]

49. Where are you getting that $750 figure?

My mother pays less than $300 for her Medicare supplement policy. And basic Medicare doesn't require a premium, since you pay into it for your working career.

http://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html

[Recursion]

51. That's why the trust fund is shrinking

Medicare Part A is $426 per month if you don't have the trust fund subsidy, and Part B is $335.70 without any subsidy.

[pnwmom]

55. It's not a reflection on the Medicare system that the Fed government

shifted funds out of Medicare to plug other gaps in the budget. That's why the trust fund is shrinking.

[Recursion]

58. But I mean that's the actual cost of Medicare per beneficiary

That's what has to actually be paid in to the system to pay for it.

[pnwmom]

59. But Medicare patients aren't paying that personally. n/t

[Recursion]

60. No, it's a social insurance program. But if we expand Medicare to everyone

Either individual beneficiaries will have to come up with something in that order of magnitude (obviously the premium will go down somewhat if the insurance pool starts skewing younger) or Medicare levies will have to go up to about triple what they are. (Or some equal source of revenue will have to be found... I personally recommend either capital gains or a carbon tax.)

[pnwmom]

62. And if we went to something like NHS, we'd have to figure out how to fund that, too.

No system is free of costs, anywhere.

[Recursion]

66. Ironically, the insanity of our 2010 debate probably saved the UK NHS

The soon-to-be-in-power Tories had been salivating about scrapping it, but the invective from the American right against it was so unhinged that even they felt the need to step up to the plate for their system, and promise to maintain it.

[ellennelle]

21. so not the same!

i'm 65, and have been shocked and appalled at just how unnecessarily ungodly complicated is the medicare system.

folks like to claim everyone loves it. but let me tell you, it rivals the damn tax code.

oh, you do get plan A for free. hospital coverage. sorta.

but then you have to pay for plan B, doctor's visits.

but this is still not enough; you have to get a supplemental to pay for what A and B don't cover, and NONE of this covers drugs; that's plan D (courtesy of cantor and boehner during the bush years, remember? big gift to pharma.)

got it so far?

all that's the easy part; you then get to comb through all the myriad plans with their differing coverage and premiums, etc.

and none of this covers vision or dental - the two things that actually decline in all the elderly - until you get a supplemental, and then not in all of them; ya gotta pay extra.

sign up dates differ, depending on when you turn 65, and you can't even reject plan B; they take the premium - $104.90 - out of your SS check, or even your SSDI check!

an unbelievable scam. i intend to write bernie a long letter about how we cannot settle for medicare for all. we really have to shoot for the moon on this one; no front end compromises.

here is my scheme instead. i've offered it here before, but it's worth revisiting.

we get universal healthcare to happen by running the old harry and lois (or whatever their names were) ad, sitting at the kitchen table, complaining now about obamacare.

a neighbor comes in and asks why so glum. we're still paying too much, they whine. so here's her suggestion.

ok, say you pay a grand a month to insure your family of four.

and you pay roughly $10,000 in taxes each year.

so the solution is to increase your taxes! yours by no more than 50%, but the destitute would not get an increase, and the uber-rich would pay 75% more.

of course, the couple freaks, what?? you crazy???

she says, settle down, here's the up side. tho you're paying $5000 more a year in taxes, you're no longer paying $12,000 for healthcare. that's an automatic savings of $7000 that stays in your pocket.

moreover, you no longer have co-pays or deductibles, the insurance companies have nothing to do with any decisions about your care, that's all up to the doctors, and everyone - EVERYONE - is covered, your kids, your parents, your selves. and because the doctors are no longer fee-for-service, just salaried by the government, they cannot make their decisions based on what kind of money they'll make off your illness, or save for their insurance overlords.

and the insurance companies will no longer profit from your illness, either, because they will no longer exist! all those folks they employ? the government hires them to run this wonderful new system. except for the fat cat upper management; no need. no insurance companies, no death panels!!!

it's really quite simple. all we need is for the pigs at the trough to give up their greed, and we're good to go.

so hey, ain't that the greatest fantasy? right up until you hit that reality wall in the very last sentence, seems like it's so doable, so straightforward, so simple.

sigh.

[Recursion]

22. And Medicare still uses private insurance companies to do the actual insuring

People here always seem to forget that.

[Prophet 451]

24. In my defence, I'm British

so I don't/didn't know quite how Medicare works.

[Recursion]

26. Few Americans do, it seems

Medicare takes Medicare levies from employers and operates a trust fund. It then uses the money from that trust fund to subsidize individual retirees' premiums for a national insurance pool. This pool then contracts with private insurers (mostly Blue Cross/Blue Shield insurers) to arrange billing and payment with providers.

[Prophet 451]

29. That seems needlessly complicated

[ellennelle]

36. which?

medicare or the ad for UHC?

the only thing complicated about UHC is funding it, and as gets pointed out here, if our military budget were not so bloated, that would not be an issue at all.

the ad script is just a way of explaining to the public how simple and beneficial it would be to eliminate the insurance companies altogether.

[Prophet 451]

40. Medicare

[pnwmom]

50. What do you mean by "actual insuring"?

[Recursion]

52. Actually paying providers

They contract that out to BCBS and Cignus.

[pnwmom]

53. The money comes from the Fed govt. But yes, insurance companies

do some of the details of administration. And they must be doing it well, because Medicare has very low administrative costs.

[Recursion]

57. I agree; I'm not saying that's a bug

Just pointing out that the fact that "profit" is involved at some step in the chain doesn't make something bad.

[Prophet 451]

23. Taxes don't actually need to go up

Here, the NHS covers everyone for everything and most people pay a tax rate of about 22% and a National Insurance contribution which has an incredibly complicated system but let's say an additional 5%. So 27% for most people (the rich pay up to 45%) and you get full cover for everything.

That includes vision and dental. I'm wearing NHS glasses as I type this. You get free lenses and a selection of simple frames for free. If you want fancy, designer name frames, you pay for them yourself but my black wireframes are free. Dental is also covered. I have a cavity right now but that's because I keep forgetting to make an appointment to get it filled (my meds screw up my memory), not because of cost.

The difference is that here, we don't have such a colossal military so we aren't paying taxes to support that.

[Socal31]

33. You nailed it at the end.

Real UHC and the current US military expenditure are mutually exclusive.

[napi21]

34. I chose other because I know what the HS system is in Europe, and I'd LOVE to have theirs.

My son & DIL live in Italy, my granddaughter & her husband are both Doctors in Germany. There are NO insurance companies skimming billions being the middle-man there like we have. They NEGOTIATE with drug companies so the cost of their drugs is substantially less that in the US. The Docs are paid well, though not quite as well as some of our specialists. NO there aren't waiting lists, except for some cosmetic surgery or other electives, and I suspect that's the same here. They do have insurance companies where you can buy "extra insurance" for things like always getting a private room during a hospital stay, but nothing really necessary. All necessary care is paid for through taxes, and guess what? Their taxes aren't any higher than ours are, and in many cases, they're lower.

Of course, I'm sure that's only a dream to have a system like that here. The insurance industry not only has a very powerful lobby, but if they were facing extinction (at least in the business they are now in), I'm sure they'd literally KILL to save their asses.

[Recursion]

35. "Europe" has a lot of health care systems

The Netherlands and Switzerland have essentially what is our ACA. France, Germany, and Austria have basically a two-tier system with something like Medicare and Medicare Advantage. England has outright socialized medicine. Spain has regional and local cooperatives. Etc.

[napi21]

70. I don't know about the other countries you mentioned, but

I said when my son & his kids were visiting our step-daughter in Germany, one of the kids was taken to the ER. He was treated, given meds to take home with him, and released with a handshake and a smile. NO CHARGE!

My son who works in Sicily was in an accident, taken to the ER, kept for a few days then released with pai pills, and there was NO CHARGE!

Neither country, and I suspect none of the European countries have insurance companies in charge of everything like we do.

[Recursion]

71. Well, first off, I don't agree that insurance companies are "in charge of everything here"

if they were, all treatments would be free.

Our health care system is very complex and does not admit of simple explanations.

I said when my son & his kids were visiting our step-daughter in Germany, one of the kids was taken to the ER. He was treated, given meds to take home with him, and released with a handshake and a smile. NO CHARGE!

Well, just to point this out, having lived there: they have sent a bill to his last known address (on his visa if nothing else).

They don't refuse treatment, but they do at least try to get paid.

[napi21]

72. NO SIR. There was NO CHARGE! He asked about what he owed, and they said nothing.

They said it was a courtesy of the Country to it's visitors. This happened in June 2014, so perhaps something has changed since you lived there.

[Prophet 451]

75. Probably comes under E111 scheme

Most Euro countries are part of the E111 scheme which means they'll treat each other's citizens at no cost.

[rock]

38. OK, I'm slow; give me some help

I thought Medicare-for-all was single-payer. What'd I miss?

[Prophet 451]

41. The dumb Brit's confusion

My intention was to divide a system that paid money to insurers to cover you (which is what I thought Medicare did) from a full socialised healthcare system like we have here.

[rock]

43. No dumber than me

In the world of politics, the politicians make everything as complex as possible. Else we might figure outwhat thye're doing. Thanks.

[alarimer]

44. The more I think about it, the more I think Medicare is inadequate as well.

Because of the gaps in coverage for drugs and because of the various plans.

I favor either a Canadian-style single payer system, in which the government pays the bills or an NHS.

I think either would work, given the political will.

Of course, as someone explained above, the gaps in Medicare are wholly a result of the lack of funding. Fully funding it would make it indistinguishable from Canada's.

I also think dental and vision need to be included at some basic level, which they currently are not with Medicare.

[Prophet 451]

74. They're covered under an NHS system

I'm wearing NHS glasses as I type this. The NHS will pay for lenses and basic frames. If you want designer frames, you buy them yourself but my black wireframes are free.

[hunter]

45. Fully socialist. Public health, public education, would be federally funded by income taxes.

The "defense" budget would be funded by property taxes.

[CK_John]

54. It took about 20 yrs to get this through Congress and it will take another 20yrs to undue what the

Supreme Court has in mind for the ACA.

[pnwmom]

56. There is no perfect system. Anywhere.

There is no perfect system, anywhere.

A few stories about the NHS, Britain’s national system:

http://www.express.co.uk/news/uk/541740/NHS-plan-axe-brain-tumour-cancer-units-despite-growing-need

NHS England has launched a 12-week consultation on the proposals that could axe 19 of 25 units offering targeted treatment for tumours.
It claims this will eliminate “excess capacity” and improve efficiency and access to the service, which is expected to see a 50 per cent increase in demand over the next four years.
Last night the plans, published by NHS England’s Medical Directorate earlier this month, were branded “shocking” by Liberal Democrat MP Tessa Munt.

http://www.express.co.uk/life-style/health/521575/Diabetics-lives-are-at-risk-due-to-NHS-failure

BRITAIN is facing a public health time bomb because thousands of people with diabetes are not getting vital treatment they need, new figures reveal.

SNIP

Barbara Young said, “Test strips are the most basic of tools for day-to-day management of Type 1 diabetes and insulin-treated Type 2 diabetes, and so it is very worrying that so many people are telling us they are having their test strips rationed because of cost-saving measures.”

http://www.telegraph.co.uk/comment/telegraph-view/10639798/NHSs-bureaucratic-failures-put-lives-at-risk.html

Meanwhile, another horrific story shows how bad decision-making could be costing lives. A total of 12 families are now taking legal action against Bristol Royal Hospital, where as many as 20 children died or suffered extreme after-effects following cardiac treatment. On Friday, Sir Bruce Keogh, the country’s most senior doctor, met parents who told him that sometimes there were so few nurses available to care for their children that they were forced to clean up vomit, monitor oxygen levels and administer medicine by themselves. In one particularly distressing case, a baby boy’s operation was delayed five times in one week. Only when he was deemed an “emergency” was he operated on. He died a few hours later, following complications.

[mvd]

65. True, there's no perfect system

But overall single payer has the least problems IMO and I wish more in our party were for it. I also wonder how much the conservative government in England has affected health care over there.

[Kennah]

69. 3 darts at 10 paces

Hang up a world map with all the OECD nations highlighted. Each member of Congress gets 3 darts. They throw. Whichever country wins, we adopt their system.