Chutzpah from Hamsher: Single payer crusade is "kabuki"
Scarecrow is the person I look to in order to tell me whether something is going to be workable or not. If he says “this won’t work,” I listen to him.
We want to get something we can build out and achieve single payer. The day that becomes unworkable, and it’s just a ton of money pumped in to reinforce a bad system, that’s when I’m ready to pull the plug.
Thinking that we can wave a magic wand or click our heels and achieve single payer in an instant are just unrealistic. It would take months and months of work (if not years) to iron out all the details of the impact that single payer would have on the largest industry in America. Nobody did that. It was kabuki and people who care about single payer should be upset that people led this crusade without doing that.
First off... Scarecrow may or may not have the credentials to declare single payer unworkable, or unworkable in a short time frame. I don't know, I haven't been following FDL's take on this all that closely. I would however, need to know what Scarecrow's credentials are [at a minimum] if I'm to accept this proposition.
Two... It would take months and months of work, if not years?! Uh, helloooooo, health insurance exchanges / public option not even available until 2013, and still only 95% of the population covered even six years after that?! Just for the sake of argument, let's assume for the moment that's true, that it would take years to get all of us into Medicare, why don't we start on the process now? Why spend the next 10 years going through an inferior intermediary step?
Three... The impact that single payer would have on our largest industry? Nobody looked at that? O rly? PNHP started thinking about that impact, and all our other industries too, way back in 1989. Nor has it been ignored in the two decades since then. Search for impact on the PNHP site and you get 425 Google hits.
But let's back up to point 2 for a moment, the time line.
Medicare took 9 months to implement, back in the Dark Ages of no computers, and that was to cover 20 million old folks. We've got 45 million uninsured to to take care of right away, on that time frame we could have them covered in less than 2 years. Probably way less than 2 years, seeing as how we wouldn't be starting from scratch, building an entirely new infrastructure [health insurance exchanges would be entirely new infrastructure, for instance]. We'd just be absorbing people into an existing system, one that's already been proven to work, and work well. And health insurance exchanges work... ?
And it's not like we'd have to worry about overloading a tiny system [the financing system] Medicare covers almost 45 million people already, and Medicaid covers another 50 million, give or take. That's roughly 1/3 of the population.
Let me propose an alternate time line: 2 years to convert Medicaid beneficiaries to Medicare while simultaneously enrolling the uninsured in Medicare, and that's probably being generous. Then three more years [to borrow from PNHP's 1989 proposal] to transfer the employer-insured over to Medicare. Voila! 5 years, start to finish.
My proposed time line doesn't take into account the 15 years to convert all for-profit hospitals etc to non-profit that's allowed for in HR 676, but this part is primarily a cost control measure and can be slower. Getting everybody into the system first is more important, though just removing the
parasites insurance companies from the system and paying for everything at Medicare rates will be a nice start on cost control.
People who care about single payer should be upset that people fell for the public option kabuki without doing their homework.