What was best about the Edward's Plan, and Hillary's plan--last I checked, Obama was going to be "figuring something out" but maybe he's refined his position--was that they introduced competition between a national health care plan and the insurance companies, hoping that the national health care plan would serve as a Trojan horse for single payer. Or that was the rationale. DDay seems to agree this is a good idea:
Now, what HCAN['t] actually* favor[s] is a public option being given the ability to compete with private insurance, making gradual the transition to a national health care plan [which I assume is single payer, but maybe not]
(See the note for what HCAN't actually favors). DDay concludes:
I think that the goal ought to be single payer, but anything that helps 47 million people get health care is positive
So let me ask: If you think the goal should be single payer, then why not support it directly and explicitly, right now?
Why settle for less at the very outset, as HCAN't is doing? Why conciliate?
Because, operationally, it's the word "but" that's the killer. I mean, sheesh, you're checking into a crowded hotel and you say to the clerk "I'd like a room with broadband but any connection is a positive," do you really think you're doing to get broadband? Your flight got cancelled, and you say to the poor devil behind the podium "I'd like to get out of here tonight, but tomorrow morning is a positive," do you really think you're going to be on the next flight out? I don't.
My job isn't to help staffers do their job, or to work out what their principals want and figure out how to help them. Nor is my job to undercut the 91 sponsors of HR 676, the single payer plan. And my job especially isn't to calibrate what I think is right by what the Village and the usual suspects in the "creative class" think is possible, given the state of the art of what's possible. (Like the Village has this great track record of success over, oh, the last twenty years.) My job is to advocate forcefully for my position, and drag the Overton Window left. That's why I support the Physician's Proposal, and not the Village's.
Again I ask: If you think the goal should be single payer, then why not support it directly?
NOTE I don't know about "actually." DDay doesn't offer a link, and that's not what HCANt's About page says:
We're offering a bold new [laundry detergent-like?] solution that gives you real choice and a guarantee of quality coverage you can afford: keep your current private insurance plan, pick a new private insurance plan, or join a public health insurance plan.
We're also calling for regulation on health insurance companies.
That's a policy prescription. They're ruling out single payer from the start. I don't see anything on that page about a gradual transtion to anything, let alone a national system.
NOTE This started out as a comment, here, in a post by DCBlogger.
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Destroying another GOP/Conservative Myth
I mentioned it in the other thread. I'm not scared of putting up a single-payer system against a mixture of private options. When the single-payer system wins out, it will be a direct refutation of a conservative myth. I imagine the first years of a single payer system to be filled with challenges and deliberate efforts to weaken the system which could undermine the program and kill it before it gets to maximum efficiency.
I'm confident in the long term stability of the program when reached gradually, but not the short term stability of an all or nothing effort. And again, I just want to see another GOP myth destroyed before our very eyes. In some cases, "I told you sos" are very nice.
Talking to people
I'd also recommend talking to people. Many support the concept abstractly, but when you tell them, "you need to join this brand new system" they balk like crazy. It's understandable. You can convince about the abstract betterness of the single payer program, but when you get to implementation people freak out. Part of that is 50 years of conservatives railing against anything government.
I just don't see a reason to putz around
Can anybody point to a situation where the Trojan Horse policy worked in practice? In Saskatchewan, they went right to single payer without this complicated screwed together policy that really seems driven by talking points rather than, er, health care.
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Its not a trojan horse at all
it's direct competition. That's the point. It's all out in the open.
That said, I wouldn't oppose single-payer legislation. I just think we need to build much more direct support for the implementation rather than the abstract support. I was surprised to find the difference in people.
Since I'm a firm believer that a decent liberal program (i.e. the "public system") is almost impossible to get rid of, a competition model will inevitably lead to the single-payer system and most likely within 5 years. The payoff for kicking the crap out of a private model is worth the wait, IMO, assuming there is universal coverage from the get-go. (Of course, we have to make sure the competition model is fair, which may be a stretch.)
kicking the crap out of a private model
we don't have to wait for it, it's been done already.
35 years ago, canada and the u.s. had the same private model, and roughly the same health. after 35 years of being the control group while canada got the new experimental treatment, we here in the u.s. now live shorter lives and more of our babies die. and we spend more for those results.
1960-1970: canada's increases in health care spending paralleled ours. by 1975, canada had fully implemented their medicare program for the entire country. the british national health service began operating in 1948. and we spend more than they do.
speaking of the brits, they had some delivery problems, so they started letting privatization creep back into their system, and they're not happy with the result.
just a few examples of how well the health insurance industry is taking care of us. not.
and even if you do have insurance and your insurance company doesn't cancel your policy or deny your claims, they might just keep your doctor from telling you about all your treatment options.
The public part may not win, that's the point.
The problem is that the insurance companies and their allies are extremely powerful politically, and there's no organized, persistent opposition to them of equal weight.
We're seeing this now with Medicare. In the nineties, the Balanced Budget Act of '97 created Medicare Part C, which paid private insurance companies a flat rate per beneficiary of 95% of the average Medicare beneficiary cost. Great, you might say, let those bastards put up or shut up about being able to do it cheaper than the public plan. Well, it didn't work out so well. The companies indeed could not make a profit without cutting benefits or raising co-pays and coinsurance. Many of them withdrew their participation. Fine, you say, then the public part "won" the competition.
But of course, that's not the end of the story. Now the idea of partial Medicare privatization had come to occupy the center of the Overton window, and a Republican administration gave the insurance companies their chance. The law* passed in 2003 that gave us the prescription drug plan had another far-reaching provision, appropriately called Medicare Advantage (MA), that has been very good to the insurance companies. (Naturally, our famously free press failed to tell us much about this at the time, if I recall correctly.) This law established both a "stabilization fund" and a new way of calculating subsidies that has made privatized Medicare plans quite profitable.
The stabilization fund and method of calculating payments to MA plans have resulted in expenditures considerably higher than what it costs traditional Medicare. An analysis by the Medicare Payment Advisory Commission (MedPAC), the independent body that advises Congress on Medicare, shows that Medicare payments on behalf of enrollees in MA plans generally average 112 percent of the cost of serving the same beneficiary in traditional Medicare; PFFS plans are paid, on average, 119 percent of the cost to traditional Medicare. The Congressional Budget Office says the overpayments are a threat to Medicare’s financial future and accelerates depletion of the Medicare Trust Fund by two years.
(Source: Alliance for Retired Americans (pdf); my emphasis.)
This history suggests to me that public health insurance can't "win the competition" unless the political power of the insurance companies can be broken. And if we can do that, we might as well put through single payer.
Now, I admit, it might be that a carefully crafted incremental solution could operate so as to break that power. But that's purely hypothetical, and in fact the opposite of the way things have been working. My belief is that the chances are that the insurance companies will be allowed to help write any law defining an incremental solution, and they'll write it so they win.
Note: by definition, "single payer" rules out a mixed system, since it means one organization provides all the insurance coverage. Usually that means the government, but technically it could be a private entity.
* I originally wrote "the 2003 law" but didn't want to drag Christianity into this discussion. When I claw back my extremely modest monthly contribution to the DNC (we'll see if my third phone call did anything) I plan to turn some of it over to Correntewire; I wonder if I can earmark it for doing away with or giving commenters some control over the Biblical auto-cites.
** Sorry this is so long, but I don't have time to make it shorter.
Policy not party!
Sure. Except...
... what HCAN't does is rule certain parts of this conversation out of bounds form the outset. That doesn't start to undo the Conservative
Ascendancy. In fact, it reinforces it.
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
3 alternatives to single-payer
I completely agree with Lambert that we should be agitating for single-payer and not negotiating against ourselves.
Having said that, Obama, Hillary, and Edwards offered 3 alternatives that arguably would lead to the promised land.
Edwards offered the full-competition/"trojan horse" plan that was most likely to lead to single-payer down the road.
As far as I can tell, both Hillary's plan and Obama's plan suck, but suck in different ways. I don't trust that either would lead to single-payer in anything approximating the near to middle-term.
Hillary's plan sucked because it put universality ahead of economic efficiency; everyone would be covered but we would not have the cost savings from single-payer and it seriously risked pissing off the public as it became a massively expensive government program and slowly eroded support for single-payer.
Relative to Hillary's plan, Obama's plan is a wash. It sucks more in the short term because not everyone is covered. It is arguably better in the long term because Obama attempts to attack the unnecessary costs in the system before imposing "mandates." This is a marketing (but still real) advantage. Giving people an escape valve from the plan (even a psychological one) makes it more likely that people will feel free to "choose" single-payer and less likely to resent a government program being foisted upon them.
Make no mistake, I completely support pushing for single-payer NOW. And I agree with Gob that one way or another you are going to have to challenge the power-structure of the private insurance companies, so you might as well fight them over the best possible policy.
Space: please, more facts or linky goodness on Edwards & Obama
Can you explain how Edwards's plan (which is not single-payer) put economic efficiency ahead of universality and therefore sucks less than the other two?
Also, can you point me to how Obama's plan attacks the unnecessary costs in the system?
Not picking a fight, just hoping to cut corners on research time.
Thanks.
Policy not party!
Agreed
I got lazy on Sasketchawan because it's in the other thread, but the more linky goodness, the better.
Remember, we have to educate ourselves because nobody else well, and especially not our famously free press.
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Ummm
Hillary's plan gave people the option to keep what they have, or "choose" the government plan of their choice.
Even Erza Klein thought it was good until the Kool-Aid started to kick in.
September 2007.
Advocates v. Politicians
It made sense to me that politicians like Edwards and Clinton might propose the kinds of plans they did. They were trying to get universality into a politically sale-able package, figuring that was a big step in the right direction. Now, I think you can sell single payer, but I also think that requires a lot of time and focus on just this one issue which is hard to do while you're running for President and trying to also sell your position on many other things. And I can understand as a practical matter why a presidential candidate might not want to take that on, especially given the media and special interesst hostility. Consider Obama's ability to fearmonger Clinton's very moderate proposal.
What I don't get is why healthcare advocates like Ezra Klein would do the same thing. Afterall, they have the time to focus on this one issue and build support from the grassroots that isn't really possible in the midst of a contested presidential campaign. Moreover, while advocates should recognize the politics of their issues, their job is to try to change those politics through advocacy, not simply cave to it without a fight. It's like NARAL endorsing Lieberman. Well, of course, he's the best they're going to get if they keep rewarding his behavior.
Maybe single payer loses, but you'll never know unless you try and any compromise that starts with demands for single payer is bound to be better than one that starts with a universal mixed plan like Clinton's and Edwards' or, worse, the non-universal plan of Obama's. If you compromise before you have to, then when you have to, you're even further compromised, no?
BDBlue, is it possible for you to write
just one paragraph, even, that doesn't make me say, "wow, good point"?
Wow, good point!
Wow, good point!
Wow, good point!
Policy not party!
Maybe it's the Broder Syndrome
Meaning, "I could be the next Broder!" (and boy, when I am, things are gonna change. Just not 'til then....)
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
Play Pretend
So let us play...
Clinton instead puts forward a straight up single payer proposal and Obama(the Village and republicans) does what?
they kill it--they already have, in fact--
"... "For the rest of the year, Emanuel says, the leadership hopes to stress energy independence (with fuel-saving efficiency standards for appliances and cars) and a move toward better health care for children. And here's what Emanuel doesn't want to do: fall into the political trap of chasing overambitious or potentially unpopular measures. Ask about universal health care, and he shakes his head... Reform of Social Security and other entitlements? Too big, too woolly, too risky... The country is angry, and it will only get more so as the problems in Iraq deepen. ..." -- http://www.americanchronicle.com/article...
(we always said "make pretend" when we were little--i still do)
Think of the Children
It's great that the Democrats want to expand healthcare for children, but do you know what else could make children healthier? Having healthy parents not stressed out that if they get sick, they'll lose their jobs and lose their healthcare.
This is why people hate Congress more than they hate Bush. The Democrats claim to know what is wrong with this country - Iraq, the economy, healthcare - but are too wimpy to do anything to try to fix it. That's right, Rahm, I said you were wimpy. Because you are.
The GOP might be wrong about everything, but they aren't afraid to embrace it and fight for it.
But, go ahead, Democrats and stick with your strategy Capitulate to Victory, just don't be surprised if you don't win much except for a bunch of problems that have gotten worse and you will now be blamed for because you were too weak to deal with them earlier.
& if Obama was not a wimp, he wouldn't be where he is today--
that's why he was the safe choice for DC Dems--it's a world where even Biden is too much of a loose cannon for them--let alone Clinton and Edwards.
and Obama will just say it was "poor phrasing"
when he said he was for "universal"--or an aide's mistake, etc, just as he does for everything nowadays-- Obama says he used "poor phrasing" on Jerusalem--"... "You know, the truth is that this was an example where we had some poor phrasing in the speech. ..."
-- and note that the headline is wrong--he never takes ownership of his own words ever ever--it's "we had some poor phrasing"...
Maybe by some "overzealous staffer"?
We need better phrases, though. Definitely.
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
For the rest of the year
Emanuel was talking about the rest of this year. Even though I am sure Emanuel would be delighted to kill single payer next year I suspect that Conyers will be too many for him. We have 91 copsonsors, that is a lot of political muscle and that doesn't even count the pro-single payer challengers, some of whom are bound to win their election.
it's 91 in the House--not a lot--
and we know the Senate won't go for it--Pelosi already said stuff against it, i think.
We won't know 'til we try
And again, it's the Inside Baseball view. We shouldn't accept anything the Village says uncritically.
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
it's called the scroll bar
below the "statement of common purpose" you cited and linked is this:
You can debate the facility of the public option, but you can't really deny its existence in HCAN's conception of a plan. In essence their favored plan is the Edwards plan.
What I continue to insist is, considering that HCAN's entire budget has gone into paid media and local organizing and none of it into some lobby shop on Capitol Hill, I see no reason to assume that they are in the position to do anything but attack insurance companies and push back on the inevitable smears. If you know my history at Calitics, you'd know that I've been standing up for SB 840, the single-payer plan authored by my state Senator Sheila Kuehl, and I pushed back on the flawed AB 1x.x, brokered by Arnold and our Golden State Vichy Dems, which was a milquetoast shared responsibility proposal without a public option but a public purchasing pool that was restricted.
So I know where I stand. All I'm saying is that there's nothing inconsistent with supporting single payer and supporting an advocacy group designed to kick the shit out of opponents to health care reform.
? ... !
is there a way to actually delete replies when one posts them in the wrong place? 'cuz if there's not, i'm going to continue editing them down to &$(#.!.
Alas, not in this version
If I give you that administrative super-power, I have to give you other powers that I don't want you to have, nor would you want to have. Sorry about that.
[ ] Very tepidly voting for Obama [ ] ?????. [ ] Any mullah-sucking billionaire-teabagging torture-loving pus-encrusted spawn of Cthulhu, bless his (R) heart.
"First they ignore you, then they ridicule you, then they fight you, then you win." -- Mahatma Gandhi
i already have too many administrative superpowers irl
don't want more, actually.
It's the Tenor, Not the Timing, DCB
I don't mind that the Dems aren't going to bring up healthcare before the election, what is pissing me off is so many running from it before the election. A much stronger answer from Rahm on healthcare would've been "we're going to try to do more on children's health. We would try to do more on healthcare generally, but with this president it would be a waste of our time. Hopefully, next year, we'll have a Democratic President and more Democrats in Congress so we can address these pressing concerns." Or something like that only pithier. Instead, he gives the feeling it scares him. Just as Schumer and Rockefeller did.
Wimps!