On Health Care: It's not about a legislative agenda, it's about a clear vision forward

[Tom Rinaldo]

Hillary Clinton fundamentally misreads how a debate over American Health Care now plays out with the public. It's the Republicans who call for repeal and replace (in that order) of Obamacare, not Bernie Sanders. Yes, Sanders extols the virtues of a rational health care system for America, one that would truly cover all of us while rolling back and containing the costs that are bleeding so many of us dry. He makes the case for Medicare for All because he actually believes in it and knows that when we eventually implement such a system our nation will be the better for it. That in a word is called leadership.

But Bernie Sanders never talks about rolling back any of the hard fought health care gains that we have already won. Neither has he ever claimed that in his first, second, or even fourth year in office that his administration would sign legislation into law that will replace the Affordable Care Act with Medicare for All. Bernie simply refuses to take his eye off the eventual goal, because it is a highly worthwhile one, whether it comes to fruition in 2017, 2019, 2025 or later. Bernie Sanders is behaving like a true Democrat in that regard.

But not just that, Sanders is exhibiting the type of political courage in defense of most Americans that has so set him apart in this election year from what we have all long come to expect from our mainstream political class. He will not shy away from what he knows is right simply because it temporarily is not politically viable. Hillary Clinton believes that points to a weakness in Bernie Sanders because he likely will be unable to soon deliver on this core economic premise of his platform for America when he is inaugurated as our president. Bernie Sanders has never said that he could. That is not a weakness.

Bernie Sanders combines clear eyed realism with an uplifting vision for America, he is that political rarity - the pragmatic visionary. Martin Luther King Jr. once so famously said "I've seen the Promised Land. I may not get there with you...". That wasn't an admission of defeat, it was clear headed idealism, what America at its best has always been about. If you can not articulate a goal you are unlikely to ever achieve it. The party of FDR was never timid about fighting for transformative social change. Is that still our Democratic Party?

[onecaliberal]

1. Sanders represents the party so many of us want it to be. Hillary represents

The status quo protect the monied interests at all cost.

[Tom Rinaldo]

3. It's why party labels mean less now than they used to

I get it that it is dangerous to split the center left and fragment our vote with third party candidates. Sanders immediately ruled out running as an Independent for President, he is a clear eyed idealist. We are moving toward the day when not only will Independents outnumber either the Democrats or Republicans (they do now) but they will make up a literal majority of the voting public.A political party has to stand for something to engender any sense of loyalty to it.

[Jefferson23]

2. The reason the US does not have universal health care is due to lobby control and that

is the ONLY reason. That is what Sanders highlighted, do not accept any other reason
as legitimate. Americans must decide if they want a president who speaks to
that control and will work to rally Americans to become active in the political
process AFTER they vote, not merely by voting in November.

Clinton is effectively saying, play it safe, vote for me. If one believes that
is the definition of a fighter, then your choice would obviously be Clinton.

[Punkingal]

4. Thank you for mentioning the political courage of Sanders...

He is courageous, and I respect him for it, and that is why I support him. It is long past the time when we have a politician who tells the truth.

[Tom Rinaldo]

13. It is safe to say that Bernie isn't poll group focused

Anyone who is will never convey the authenticity that he does.

[dsc]

5. It isn't courage to promise that you can have everything while paying nothing

which is what he is doing. Single payer isn't some magic talisman that by itself causes cost savings. The only way cost savings will occur is if providers are paid less money for the services they provide. And that means some people get denied care.

[Tom Rinaldo]

6. I strongly disagree

1) Those advanced nations that use some type of Single Payer system spend much less on health care with equal or better positive

2) Elimination of the need to send significant profits to corporate shareholders is a massive savings right up front

3) For the same reason why airlines and office supply chains and pharmaceutical companies seek to merge, there are efficiencies in single payer systems from elimination of duplication.

And of course your subject header is very misleading and unfair. Sanders promises nothing of the sort.

[tk2kewl]

7. xpost from my post in one of the Krugman threads...

i'm glad it's being debated in pres primary. we need to have this debate again and again...

if for no other reason than to get more and more people to realize *why* "it's not going to happen."

the simple truth is that greed prevents it from happening. the insurance industry and wall st demand to take their vig. the drug companies demand monopoly pricing.

so yeah, let's keep having "reality-based" discussions, so that reality may one day convince people that enough is enough and we aren't going to give in to the reality of greed any longer

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=7540493

[dsc]

9. Insurance companies profit is about a sixth of the savings

They take at most a 20 percent profit under Obamacare. Medicare takes 3% which is a difference of 17% Sanders needs to save at least 40% to have the numbers work. Other countries have boards which decide what will and what won't be paid for. They also pay their doctors considerably less, pay way less for drugs, and pay way less for medical devices and hospital stays. His plan implies he isn't going to have any of that happen.

[Tom Rinaldo]

11. No one, including Obama, makes a secret of the complexity of our health care system

It frequently gets described as "Rube Goldbergesque" by commentators familiar with it.

A Rube Goldberg machine is defined in Wikipedia as "a contraption, invention, device or apparatus that is deliberately over-engineered to perform a simple task in a complicated fashion, generally including a chain reaction. The expression is named after American cartoonist and inventor Rube Goldberg."

How many thousands of pages is the Affordable Care Act? What we have now, and I don't blame Obama for it, is a very imperfect system that is not affordable for millions of American and which leaves millions of others uninsured. But it is progress over what we had before. There is an argument over how to move forward. I believe that the underlying premise behind a single payer system holds the greatest long term potential for achieving a health care system in America that serves the needs of all Americans, and that is why almost all advanced nations adopt some form of it. Sanders is right to thrust it into the center of ongoing health care debates. We will end up better as a nation because of it, regardless of how the final details ultimately get resolved.

[Vincardog]

12. Single payer and NEGOTIATON is how we pay way less for drugs, and pay way less for medical devices

and hospital stays.

The Conservatives guaranteed MEDICARE part D could not even ask for a discount on drugs.
That is how the US has the HIGHTEST medical expenses and the worst results of any "modern" nation.

You say insurance profits are limited to 20% OK we can save 17% by elimination those parasites.
How much can we save by requiring pharmacy companies to struggle by with the same 20% margin?
Why should they be guaranteed 1000% profit margins? The same for medical devices and hospital stays.

Bernie's plan to provide everyone with HEALTHCARE is the only way we can negotiate and contain costs.

[dsc]

14. the clear implication of his plan is that there would be no negotiation at all

we would simply pay for any and all treatment, that is what he wrote, and that is what what he wrote means. The next pharma bro comes along with a treatment for which he wants to charge 100k and we would simply pay it. That is the meaning of the words he chose to release. No where does he talk about negotiation or anything else.

[Vincardog]

15. If you are that limited in you thinking, I can not help you understand

[dsc]

17. Here is what he says about what it means for patients.

https://berniesanders.com/wp-content/uploads/2016/01/Medicare-for-All.pdf

WHAT IT MEANS FOR PATIENTS
As a patient, all you need to do is go to the doctor and show your insurance card.
Bernie’s plan means no more copays, no more deductibles and no more fighting with
insurance companies when they fail to pay for charges.

Here is cutting costs

GETTING HEALTH CARE SPENDING UNDER CONTROL
We outspend all other countries on the planet and our medical spending continues
to grow faster than the rate of inflation. Creating a single, public insurance system
will go a long way towards getting health care spending under control. The United
States has thousands of different health insurance plans, all of which set different
reimbursement rates across different networks for providers and procedures
resulting in high administrative costs. Two patients with the same condition may get
very different care depending on where they live, the health insurance they have and
what their insurance covers. A patient may pay different amounts for the same
prescription depending solely on where the prescription is filled. Health care
providers and patients must navigate this complex and bewildering system wasting
precious time and resources.
By moving to an integrated system, the government will finally have the ability to
stand up to drug companies and negotiate fair prices for the American people
collectively. It will also ensure the federal government can track access to various
providers and make smart investments to avoid provider shortages and ensure
communities can access the providers they need.

Now go ahead and show me where he is telling us that doctors and hospitals will be making less. Go ahead and show us where he says that if a provider wants too much money his plan will just say no. Go ahead show me this. He explicitly promises that there will be no more fighting with insurance companies when they fail to pay for charges. that generally means to the vast majority of readers that if they want an MRI that costs x dollars they will get an MRI that costs x dollars. If that is what it means then just where is this savings coming from? If that isn't, isn't he being flat out dishonest.

[Vincardog]

18. "the government will finally have the ability to stand up to drug companies and negotiate fair

prices for the American people collectively".

He complains about "different reimbursement rates across different networks for providers and procedures"
Do you really believe that because he did not list every
where there would be room to negotiate, it is not implied?
You seem to impute the worst at every chance.

[dsc]

19. Negotiation means the ability to say no

he shows no such ability in his statement on patient care. Some providers are going to say no if we actually try to cut costs.

[Vincardog]

21. If as you say "some providers" are not willing to perform their health care services at a reasonable

Rate they can find some other means of making a living.
I don't see the problem.

[dsc]

22. under you live in the town where they provide the service

then you might well see the problem. My town has one hospital to take an example.

[Vincardog]

23. And in your hypothetical future that hospital would rather close than operate in a reasonable

cost environment? If so then a non profit group should take over, maybe a religion.

[Tom Rinaldo]

20. "the clear implication of his plan is that there would be no negotiation at all"

That's what you said above. But your quote from the Sanders site in the post I am replying to says this

"By moving to an integrated system, the government will finally have the ability to
stand up to drug companies and negotiate fair prices for the American people
collectively."

During the 2008 Democratic contest for the Presidential nomination neither Obama nor Clinton sp3ecified a full health care plan that turned out in many details to be the same as the Affordable Care Act that finally passed. Nor did their proposals shared with the public have the level of specificity that a legislative act of well over a thousand pages finally contained.

Like I wrote in my OP, nowhere in his campaign has Bernie Sanders said that if elected he would quickly scrap Obamacare and implement Medicare for All. At this moment it is not yet politically feasible to do so. When it does become feasible to do so no doubt the final legislation will be well over a thousand pages long and contain many specific details and modifications.

I am proud of Sanders for advocating for movement toward a Single Payer system. Someday we will join the rest of the advanced world in having one.

[KittyWampus]

8. Sanders doesn't have a "clear vision" or an actual path to achieve anything. He's an ideologue

robotically spouting off the same outdated spiel he's been doing for 50 years.

There is nothing 'clear eyed realism' in pretending single payer is going to pass Congress.

There is nothing pragmatic about the man.

Unbelievable gibberish.

Sanders is the living definition of an IDEOLOGUE.

[Tom Rinaldo]

10. That must be why he keeps winning elections

And why he has gone from being little known nationally to posing a significant threat to Hilary Clinton winning the Democratic nomination for President.

[Live and Learn]

16. Outdated speil? Health care for all is an outdated speil?

What a sad and bitter meme.

I for one believe we can accomplish what many other countries have already done. I will have none of the Can't Do campaign.