HR 676 !!! - Let's put Single Payer into the conversation:

[ehrnst]

97. That's a small part of the total. But HOW do you re-allocate that? You stated where from and who to.

Do you cap hospital admin salaries legislatively? Or do you simply fire a bunch of people - especially in the insurance admin? What would their severance package involve? How quickly could you eliminate a large number of positions?

What happens to all the people who need immediate health care in the meantime? Especially in rural hospitals?

This article lays it out the issues very well: http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

How would the economy be affected from those people losing their jobs, even if you gave rehired some of them lower salaries as a public employees doing even more duties.


I'm not dismissing your and your mother's experience. However, are all of those people you mention simply pointless - such as the post hospital case manager? Would you have been upset if there were fewer people involved, and you had to wait days longer for answers and care?

There have been real issues in recent years with lack of post hospitalization follow-up, ESPECIALLY for Medicare and Medicaid patients, and the ACA put incentives in place for hospitals to lower the number of people who were re-hospitalized shortly after being released. Post release case managers were part of that response.

I'm not defending the current system - it certainly has it's redundancies. What I am saying is that it is an enormous system that has been baked into our economy for over 50 years. Such a massive change will involve disruption to the economy, and that can't happen quickly.

As we have seen, it's much much harder to undo a large part of our economy than it is to build it in from the start - which would have been the Truman administration.

I would love all cars and homes to convert to fuel cell technology - that would certainly reduce our carbon footprint. Requiring it to happen in less than 30 years would be impossible.

There is this concept of the wicked problem. We expect that every problem can have a clear solution, like it does in science class.

There are some problems which sprout new tentacles in direct response to efforts to solve one part of them, and there is no solution that doesn't create more negative aspects. Health care costs on this country is one of those problems.

Saying that there is some simple solution to health care costs is not only wrong, it will create many more problems than if we address it as a very complicated issue that will have losers no matter what we do. I understand that isn't a very "hopeful" message, and I'm sure I'll be slammed for "not even TRYING!!!" and probably called a "corporate shill" for "trying to spread propaganda."


Vermont did not address all of the issues, and their plan failed. In California, they realized that their legislation was incomplete, and they did not want to make the same mistake as Vermont, and kill any hope of federal health care reform in that direction.

Now those who had the foresight to do that are being excoriated and demonized. This is our own circular firing squad.

Canada didn't go single payer federally until all the provinces had done so independently, which took nearly 20 years, then they got a very liberal federal government in. They didn't have to do what we have to do - upend 17% of their GDP, and they have 1/10th of the population to cover.


I lived in the UK and had great health care. I wish I could get what they have here in the states. I know that it's no more likely than us having the passenger train system there - for partially the same reasons. They started the infrastructure 80 years ago, and the economy grew up around it.