It’s encouraging to see vigorous debate in the Democratic presidential primary over what our country’s healthcare system should look like. While in many ways the debate over healthcare at the national level remains focused on the Affordable Care Act, in Massachusetts we have now reached the 10th anniversary of the passage of the An Act Providing Access to Affordable, Quality, Accountable Health Care, Chapter 58 of the Acts of 2006, marking an important milestone that should push us to reflect on the state of healthcare in Massachusetts today.
It’s important to note that it was grassroots pressure that led to the passage of Chapter 58, including from labor unions, the Greater Boston Interfaith Organization, but also a signature drive by the Affordable Care Today (ACT!!) Coalition. And though it’s often forgotten, a 2004-2006 grassroots campaign to establish health care as a right in the Massachusetts constitution played a crucial role, though the constitutional amendment was sent to study (to “die,” in legislative lingo) on July 12, 2006.
While Chapter 58 did not establish universal health care as a right, by 2010 it had successfully decreased the number of uninsured Massachusetts residents from 6 % to 2%, provided free health care insurance (MassHealth) for residents earning less than 150% of the federal poverty level, restored MassHealth benefits such as dental care and eyeglasses, and established the Health Connector, among other things.
As the lead Senate sponsor of S.579 An Act Establishing Medicare for All, creating single-payer health care in Massachusetts, I’d be the first to acknowledge that there are tremendous challenges to making health care a right here. At the same time, as a legislator I see that my staff and I spend almost a quarter of our constituent services work helping people apply for MassHealth, appeal denials of health care procedures by health insurance companies, and getting the Health Connector and other state agencies that provide some form of health care to respond to constituent requests. The inefficiency and waste, and families having gaps in their health insurance coverage, are disgusting.
Furthermore, this session, as the Senate chair of the Joint Committee on Financial Services, I’ve sat in public hearings to listen to hundreds of Massachusetts families plead with the committee to pass health insurance mandates, from mental health parity to craniofacial disorders to Lyme disease to cognitive therapy for brain injuries, because health insurance companies refuse to cover these medical problems. And just last week, the committee heard from non-profit executives, including the CEO of Pine Street Inn, talk about how a growing percentage of the limited state taxpayer dollars they receive just go right to health insurance premiums that often increase 10-20% each year. Outrageous!
Finally, as the Legislature is poised to pass for the second straight legislative session an opioid abuse bill, it’s very clear that our disjointed health care system does a major disservice to people who are struggling with addiction, mental illness, and depression. While debating the Senate’s opioid abuse bill last year, one of my colleagues conceded to me, “There’s no doubt that we’ll get to single-payer,” but too many legislators are unwilling to fight for such reform.
This session, Mass-Care has launched statewide listening sessions, including patients, doctors and nurses, medical students, and small business owners, to highlight how many gaps there are in our healthcare system, the healthcare horror stories that are increasingly common, and how expensive health insurance is for the average family. While single-payer healthcare advocates and legislators wait for the Joint Committee on Health Care Finance to hold a hearing on the bill, it is clear that more organizing and conversations around the concept of universal health care, its benefits, values, and cost savings, are necessary in every community in Massachusetts. If you believe in single-payer healthcare, like I do, I hope that you will be part of these conversations.
As I have reported in other comments on Blue Mass Group, my full time employment was terminated in September of 2015 and with it, the health insurance that covered my wife and me. At the snap of a finger, we were thrust into an arcane maze of forms and 1-800 numbers, and strange sounding options. “Do you want the Gold Plan Preferred or the Platinum Premium Plus…..Or is the Golden Platinum Basic more affordable?” Furthermore, understand that while you are currently seeing one general practitioner and one specialist, know that each one may or may not accept the insurer you select and even if they do this year, they may not next year, or next month. Calls to your doctors office will reveal that the person on the other line is just as confused, angry and tired as you are.
Why are there so many plans and options for what is so very, very basic? We just want to be well and if we get sick, we want sound medical care. This is how it works in Canada, France, Germany, and on and on. Why can’t it work here? Are we “less” than the nations of the developed world?
My wife has a slight disability. Years of being a nurse have taken their toll and she has had major back surgery. She can only work part time, which is a good thing in a way because for the first two months after my job loss, my wife had a “full time job” just trying to figure out what plans we were eligible for, could afford, and were accepted by our various health care providers.
When the person on one line is a nurse and the person on the other line works in the billing department for a medical office is on the other line and THEY can’t figure this out, Houston, we have a problem.
Asking me to “shop” for health insurance is like asking me how sick I want to be, how much pain I wish to endure, how uncomfortable and miserable I can afford to be. It is more than inefficient and disgusting, it’s inhumane. We have the world’s largest military budget but we can’t afford single payer? When I hear of nations that have more bombs than hospital beds, I think if North Korea. It’s sad and embarrassing to see us on the same list.
This needs to be changed now, not later. We need people on Beacon Hill and Washington D.C. willing take a stand and announce that they are tired of this mess and we’re not going to take it anymore.
If legislators are unwilling to fight for such reform, then we need to elect those who are.
Especially when you consider MA seemed to have something that few complained about already in place?
I don’t know who you are talking about. I’ve been “complaining” about this for over 15 years and was not happy with what was in place prior to this. Who is responsible for creating the current mess? That’s easy. Anyone opposed to Universal Single Payer is responsible for creating the current mess.
Easier to complain about phantoms.
Skip down to the “plenty of satisfaction” part at the end.
http://www.factcheck.org/2011/03/romneycare-facts-and-falsehoods/
..and your link does not work either. Try this one.
Fact is that Romney Care, like Obama Care is just too little of a good thing, but at least a step in the right direction with is getting the USA to the same level of care and costs that the nations of the developed world are getting.
always seems to be an issue for me.
I think we’re all in this together.
When I started working, in 1974, I had a FABULOUS plan. I was employed by Digital Equipment Corporation, and had a card from John Hancock. When I was sick, I went to the doctor or the hospital (I remember doing each at least once). They looked at the card and said “thank you very much, you’re all set”. No deductables, no co-pays, no primary care providers, no bills, no nothing. I just went to the doctor when I got sick.
I don’t remember the specifics of when all that changed. I associate it with the Reagan administration, but it might have been the Carter years.
I think deductibles came first. Then, things just spiraled worse and worse. By the mid 1980s, I learned that EVERY communication with BCBS/MA had to be in writing and sent via certified mail. That at least eliminated issues with “we never received your …”.
By the mid-1990s, I was working for IBM doing consulting for clients in the banking, finance, and insurance industries. At that time, more than one of our clients was experiencing turnover with staff because they were hiring people with medical training, and using them to deny claims.
Our (IBM) systems were designed to maximize the “productivity” of claims processing — measured by the dollar volume of claims that were successfully denied and by the number of claims that were denied.
The staff turnover of clients was being caused by men and women got medical training because they wanted to help people, and discovered that their employer was using that training to deny coverage to people who were already suffering.
For generations we have treated health and health care as a commodity, as if the well-being of ourselves and our loved ones is something we shop for the way we shop for repairs on our automobile. I don’t know about anyone else, but the health of my children is DIFFERENT from the brake rotors on my car.
Our fundamental premise is, in my view, immoral. I think government-sponsored single-payer health care is the only system that can possibly work. I think that’s why the rest of the civilized world has chosen that.
I think that resistance today is from the GOP, from those in the 1% who benefit from today’s disparities, and from those to blinded by political dogma to actually look at what is happening today.
I think a better question than “who is responsible for creating the current mess” is:
Who is most likely to SOLVE the current problem?
It’s not just the 1%. If you’ve got a good plan, you don’t want change. As more peoples’ plans move from “good” to “not good”, more people will be interested in change. I would not point specifically at the GOP, as while they are leading the charge, they are probably reflecting a lot of independent voters as well in that regard. I might also suggest that once other nominal supporters learn details, they might be less likely to support change.
In Andover the public employee unions last year rejected a change in plans that was exactly the same plan benefits, but a different company. Would have saved the town $500K. Not sure if they would support single payer if it meant changes in their plan.
The current system is unsustainable. I worry that we will replace it with some convoluted system that everyone is unhappy with.
This is where I point out the reality that American “conservatives” are far from the definition of the term “conservative”. There is no reason to reinvent the wheel or take a liberal stand at something untried and unproven. No. A true “conservative” would look at the existing systems in place across the globe and simply and conservatively adopt a system that is already working. But no, today’s “conservatives’ in the USA are really just “orthodox capitalists”.
The GOP is so fragmented it’s unclear which wing is which to most people.
According to some Cruz is the only conservative running for president. Trump is barely a Repbublican and many people I know denounce the remainder as too liberal ( except kooky Carson, who doesn’t deserve mention).
It seems to me that an approach similar to that used by the rest of the civilized world is more likely to work than an unspecified invention cobbled together from the chaos of our current disaster.
I ask again, therefore:
Who is most likely to SOLVE the problem?
We are in a presidential campaign year. The GOP has spent most of the Obama administration attempting to repeal Obamacare, and promises to do the same if elected.
Is a GOP president going make things better? How? What candidates have offered any HINT of a solution?
Somebody will be elected President this November. A new House and Senate will take office a year from now.
Which candidates are most likely to solve the current problem?
If the question is “which candidate wants to solve it in a way you would favor, then the answer is Bernie Sanders. I think you’ve already said you’re not voting for him.
My original question was around fault, and I only put that out there because I think the general “It’s the Republicans fault” response to everything doesn’t really advance the argument.
I would suggest that “voting for a person who thinks like you, despite the fact that they will actually do nothing” is what has gotten MA it’s current legislature.
supposed to be a “+”
I see. So you your only interest is in some pointless blame game.
If Bernie Sanders is your answer, then why not just say so?
I’m sorry I bothered responding to you — you’re wasting our time.
So feel free to avoid responding to me in the future.
Funny, I started by agreeing with your observations derived from your own painful experience. I’m just saying that you seem far more eager to point fingers and seek somebody to blame than to actually solve the issue.
I don’t set the agenda or talking points of the GOP candidates. I don’t particularly like Obamacare.
The thread-starter is from a sitting state Senator who wants to move Massachusetts towards government-sponsored single-payer health care. Do you agree? If so, why not SAY SO?
It seems to me that if you or anybody else want to do anything except point fingers, it starts with saying so — then taking steps that in some way bring about constructive change.
ALL of the GOP candidates want to repeal Obamacare. Do you agree? Have any of them offered a replacement? If that’s what you want, then why not offer it?
ALL three Democratic candidates want to improve on Obamacare. Do you have a preference?
I don’t get why you so seem so more eager to attack than to move ahead.
Obamacare was the wrong solution.
If it had been pitched as this:
“People who have no insurance will now have crappy insurance and they’ll be lots of effort expended and there be an array of taxes to pay for it.” Oh and “a giant amount of money will be spent on technology to make this happen and at then at the end lots of people will still be dissatisfied” then I think it’s unlikely it would have passed. IMO it was not the right thing to force this through on a narrow vote, but “Obama won” so he could have done anything I guess.
Trump says “repeal and replace.” What’s wrong with that?
I don’t get why you’re responding to me though. You blame Republicans for almost everything and you believe their intentions are evil. That would mean that I’m either an idiot, deluded, or evil myself.
PS I can’t explain Sarah Palin either. The Republicans have many more freelancers so it’s hard to stop crazies from drifting to the forefront.
Ok. So let’s stipulate that Obamacare was the wrong solution.
“Repeal and replace” — with what?
Let’s stipulate that the intentions of Republicans are not evil. Let’s stipulate that you’re neither an idiot, deluded, or evil yourself. Please — fill the vacuum for me.
What do you SUPPORT? I get what you oppose. What do you SUPPORT?
ps: Sarah Palin hardly drifted to the forefront, she was hardly a “freelancer”, she was your party’s nominee for the Vice President for crying out loud. Your party decided that Sarah Palin was the best choice to be one heartbeat away from the Presidency.
I’m really trying here.
What do you support? Where would you have us go after you’ve dismantled what we’ve done?
is that it pre-supposes that you will be replacing it with something. To my knowledge, no Republican has suggested anything other than “repeal.”
In my view, the ACA is an improvement over what came before. It was foolish to pretend that it will be cheaper to add large numbers of people to the pool of insureds. Overall, though, having fewer people with zero insurance (even if they have poor insurance) is an improvement– as is the end to “pre-existing conditions”, lifetime caps, and the like.
I am more than willing to consider anything that might be a further improvement, but am not buying a pig in a poke, which is all that repeal and replace is at this point.
It’s mere words, No different from Sanders in that regard.
I don’t think we will have real change until things get worse. That’s just how we roll in the USA. Within 4-5 years the majority of Americans health plans will be high cost and high deductible/co-pay. The only way to lower costs will be single payer. There’s going to be huge job loss, less revenue flowing into health care and people won’t like some of the changes.
We should set the stage with discussion. I thought the ACA was done completely the wrong way and was sold at the time with misstatements (it would contain costs) and lies (if you like your plan you can keep it).
It could have been sold differently and gotten more support. When MA put in its law in 2006 they made the case that they were giving the money to hospitals anyway for free care and this would be more effective. I bought that argument.
Reduced costs will be the principle driver, but we should start talking about things like better job freedom, reduced settlements in court, and the like.
I think it’s likely that insuring adults 18-65 results in a wealthier society than not insuring them — that the benefits of insuring them outweigh the costs. The issue is cash flow. It costs more now, but we’ll see the benefits later as we avoid chronic illness, get more productivity from workers in their latter working years, etc.
I’ll agree, Obamacare was the wrong solution but it’s kind of like asking for directions in Boston. There are a few ways to get there, some better than others. So where do we want to get to?
Democrats like me want to get to a place where health care is funded by a single government agency and medical care is managed by doctors, not accountants, sales reps, and CEO’s. You know, health care as it already exists in all of the developed nations. It’s really the true conservative route, eh? It’s been tried around the world for decades and while not perfect (what is?), it’s accepted and approved by a large majority of the citizens in these developed western industrialized democracies.
Where to Republicans and Trump want us to go? Who has done it before and where has it actually worked before? Or do they want to take a liberal approach and just try something unproven, as we did with Obamacare?
…there seems to be a kneejerk opposition among some to any suggestion that the United States could learn something from other countries.
I am usually opposed to government control but one of the most important functions of government is the free education provided to the children of citizens. In conjunction with readin and writin I would be OK with clinics being attached to schools and free health care could be administered to all children. As long as they were in school, up to graduating high school care would be covered. Like the school nurse on steroids.
They would be educated about making healthy choices (show a few lungs from smokers and livers from drinkers) and then they can make their own choices as adults. It might help catching some diseases in early stages which would be cheaper. Adults would be subject to the current system, but hopefully generations to come would be healthier in the first place.
…
You do a passable job explaining why the outcome is a problem, but that’s not near enough to justify the statement “Obamacare was the wrong solution”.
Why is “Obamacare … the wrong solution”??? (hint: in a bizarre twist of circs, I agree with your statement…. I’m pretty certain I don’t agree with the path that got you to that statement…:)
Damn, is there anyone on this blog that hasn’t been canned?
I have been out since the end of July. My company was bought and they got rid of most of Finance.
And your stories are important to remember as everyone celebrates Massachusetts as the #1 innovative economy according to Bloomberg, we are also #1 in income inequality according to Forbes. Our prosperity is not being felt by all of our residents, and we have to change that.
For one I had severance until December.
In MA you can collect unemployment simultaneously if you’re forced to sign an agreement. $698/week + 2 kids under 18 @ $25/each is $748.
I’m taking a hiatus from UI and the current temp gig pays $55/hr.
I did all the heavy lifting of education/re-training when I was 30. It wasn’t easy but it worked out. I also spent the effort to keep up my professional certifications and this has paid off.
The challenge is the location of the current opportunities. While I would take a position in the Seaport, Financial District, or Cambridge, which is where a lot of the action is, all of those would represent significant quality of life costs. 93 South, Woburn to the tunnel was an hour this morning, never mind getting to Woburn and then getting to where you need to past the tunnel.
If I had stayed employed at the same company (and not had a wife to switch to her plan) my health care costs would have increased dramatically.
The other issue is the “reset.” I had to start over in a new career at 32 after graduate school. Then I had to re-invent after losing my great job at 44 and made 1/3 less on the new go (and worked a year as a temp). After ten years at that job I’m out again and there’s a good change I’ll make less and I’m working as a temp again. This is a common story these days. I have less than 11 years to 67 and financial planning becomes complicated.
All too common and getting worse, not better. You’re fortunate that you have a certification and more things that are still in demand. Not everyone (few in fact) have been born with the talents and opportunities that you (and me too an extent) have been given. I’m also not worried, not much. Unless a catastrophic illness or disaster hits, we’ll be okay.
When I meet with my representatives in government, this is a common conversation that I have with them. Politicians on the right want to raise the age of eligibility for Medicare and Social Security on the notion that we’re all living longer and able to work more. I won’t get into the statistics of this other than to say that “white males who work behind desks” are the only ones who can or will benefit from this. The rest? Not so much.
As I mentioned, my wife is an RN who has undergone back surgery. Nursing has the highest rate of back injuries. Where worked prior to getting laid off, I helped supervise as many as 35 forklift mechanics. Injuries were common, backs injured, knees and hips worn out. Raising the eligibility age for most is just going to increase medical costs all too often.
And then there is the reality of today’s American Capitalism where shareholders and shareholders alone are the focus of industry. Today, I work part time and am able to make a few bucks to supplement my unemployment income. In about another 20 weeks, that will be gone but I think we’ll still be okay. Glad to hear that you’re okay too.
So I’ve started “on again, off again” employment. Seems to break the MA system. They want you to handle things online, but I can tell I confused it. They send me “urgent messages” where the link leads to a form asking me to detail my job search (which might be audited). The site says there’s a problem with my claim (after I worked a couple weeks of temp work, then stopped) but I can’t tell what it is online. When you call UI, after about 5 minutes listening to messages, they tell you to call back on another day (you can’t even hold). The only office is Boston. Very frustrating as I could use the four weeks of UI funds, but hard to approach this (go to Boston? call at 8:00 AM hoping to hold?) when you’re at a temp job.
I had a lengthy period of unemployment before getting my current position. I went through the exact same drill as you.
My sympathies, it does truly suck.
You’re right – on again, off again seems to break the system.
I would guess that the agency is wondering if you quit your temp work job and did so for a reason that is “disqualifying” (that is, you quit or were discharged for cause). In such cases, they are allowed to continue deducting your part-time temp work wages from your grant amount.
It seems they don’t understand (1) that many temp jobs have a pre-defined end date or (2) that hours of temp jobs can vary widely from week to week.
Here’s a link to the law about this in case it’s useful. See parts 4.71 to 4.78. Good luck.
http://www.mass.gov/courts/case-legal-res/law-lib/laws-by-source/cmr/400-499cmr/430cmr.html
It just doesn’t feel like a modern site where you can click around. There’s not even any “contact us” functionality that allows you to send an e-mail or other correspondence.
I assumed when I took the temp work that I would claim the weeks I was not working, and not claim the weeks I did. It doesn’t allow for that. When you’re just plain out of work, it seems to go okay.
I have several of these related to my temp work.
Eligibility Determination
To view detailed determination, select view determination
View the Determination: Determination Not Available
I’m just going to have to call the minute they open and then wait on hold for an hour and go to work late.
The online system a couple years ago was a <a disaster when it was launched. Not quite in the league of the Health Care Connector rollout, but pretty impressively incompetent. Too bad we spent $46 million on it.
Last time I called, I was on hold for one hour and forty five minutes. You were lucky.
for some reason or another and every time you communicate with them this flag pops up and generates the “urgent messages” you’ve been getting. Something similar happened to me years ago while a resident of CT. It bothered me so much that I even considered dropping my case altogether. Luckily, I hit upon someone who recognized what was going on and removed the flag.
Looks like your experience is a lot like mine. Twice my payments were delayed for two weeks because of clerical errors that were not mine. I finally reached out to one of my state legislators and their office took care of the mess. Form what they told me, “this is one of our most common requests for assistance”. The work search requirement is stupid but required. From what I’ve been told, it’s there to appease the Republicans who think that anyone on unemployment is just living large and having a party on the dole and not looking for work. You must make at least three efforts to find work on three different days of each week. If you have three interviews on Friday, only one counts towards your search requirement. If you see four hot jobs to apply for on line first thing Monday morning, only one application counts and if you can’t come up with two more later in the week on different days, you did not meet the requirement. So, put them off and do one each day which lowers your odds of getting a job but increases your eligibility for assistance.
And then there is this: Every recruiter I have ever met or listened to has told me that once you’re over 50 (even 40 for some jobs), you can forget sending out resumes and applying to on line help wanted ads. The only way you’re going to find a job is “networking”. If you’re over 60, as I am, even “networking” gets tough because much of your network is retiring out of the system, but it’s still all you have left. But just networking won’t cut it for the requirements to receive assistance……..so you send out resumes and apply to on line help wanted ads even though you and they and we all know it’s a colossal waste of time.
For what it’s worth, I did put their paper form for Work Search on an Excel sheet so I can enter the data and store it easily. I was audited once and I brought in my sheets. The examiner looked at it for about ten seconds and said I passed.
The entire system is a bad joke.
It is counterproductive to delay contacts in order to satisfy a bullshit government requirement. Do what you have to do, and enter whatever time is needed on the form to satisfy any Vogons who may read whatever you submit.
The priority is to find a way to sustain yourself. Being employed again is better than being unemployed and in compliance with some bureaucracy.
My uncle David went through a similar process and lives up
your way and commutes to Cambridge. It’s been very difficult since he software he was an expert in became obsolete so he is retraining on new platforms while also hustling for every gig he can get on the old one. Our old middle class was built on the Fordist factory model, our new middle class includes a lot of 1099s and folks hustling between two or three jobs. It’s far less stable, albeit more lucrative for the few that can manage it well.
…it’s a bit difficult to be “canned” when you haven’t been hired in the first place:(
Martin O’Malley mentioned it during the debates, as his state was the first to implement it and it has already seen dramatic cost reductions. It has already been proposed by a ballot initiative in Massachusetts backed by the SEIU and the UIP (disclosure: my new boss).
I agree with Paul Krugman and John McDonough that it makes more sense to build on the architecture of the ACA rather than start from scratch. All payer to me is a simple way to contain the costs and help drive down the health care monopolization that Partners is attempting in Massachusetts, it should be very popular and easy to sell to voters and is something even some Republicans can get on board (though apaprently not our current Governor). Krugman and McDonough also wisely counseled for a public option, which is entirely viable in Massachusetts.
Obviously Jamie’s attempt with this bill is to drive discussion and debate forward and build critical momentum for this policy change. But we can look at the failure of the Berwick campaign to capitalize on this single issue and our neighbors to the north in Vermont on implementing a policy they actually passed, and see that the road already taken will probably be a dead end. Let’s try the road taken successfully by Maryland and the road not taken by Obama called the public option. Both seem like better next steps.
I cannot count the number of times over the years that I heard a coworker say that “I’m only here for the health insurance”. It’s been called “Job Lock”.
Of course, all the Big Guys love this. It helps retain low paid employees and lowers the competition. When I was younger, without a wife & family, I was entrepreneurial, took risks, rolled the dice. If I won, terriffic. If I lost? No big problem I’d just dust off and try again. That’s not as easy when your wife is diagnosed with breast cancer, your son has asthma and so on. Now, taking that risk and failing is putting the lives of your family on the line. So, you do as I did for too long. You put up the the abuse on the job, the poor working conditions, the realization that this is it and it will not improve…..all because you need the insurance.
I honestly felt that my insurance coverage was better under ACA and wish I hadn’t paid a penalty for switching when my current (soon to be former) employer finally offered me full time benefits. I wonder if we just dumped everyone on the exchanges with subsidy scales based on income, federalize D the Medicaid expansion and offered a public option if that would solve this issue. Keeping the employer based model is something no reformer on the left or right wants to do, but is something we sorta shrugged as a fact of life to get ACA passed. Friends in Canada find that the most appalling thing. It’s one thing to have private insurance for an individual, it’s quite another to depend on a bosses largesse and call that system “freedom”.
With the ACA in place, its really a federal issue now. Further, I think the state is ill equipped to move this issue forward in a meaningful way.
Medicare is much more reliable than Medicaid, both for patients and for providers. Medicare funding is not dependent on appropriations — the money does not run out, and the federal government can deficit spend. Medicaid routinely overspends its appropriation in the Spring, and providers are told to wait for a supp budget. Given the confiscatory rates Medicaid pays and the wait for payment, no wonder providers don’t like it.
EOHHS and the legislature have never been good stewards of the Medicaid program. For example, this year the Senate cut out needed supplemental funding for the “disproportionate share hospitals” that care for large numbers of Medicaid patients. The MassCares bill provide MassHealth for everyone. No thanks.
Start with the zero to 40 age group, and continue Medicare. This will cover transition of employees out of private insurance, and create a further transition to the 41 to 64 age group in 2 years. If people see the light and want themselves covered similarly, this can be accelerated. This is the only incremental change that would bring single payer, and bring it to fruition with wide public acceptance. And yes all would pay in like they do for Medicare for those whose present insurance is frequently in jeopardy.
Staring with zero to 40 is a major change, maybe too dramatic. The changes in our taxation, our employment, the employment in the insurance and medical sectors, etc. would be jarring, and might generate too many opponents. I’d play it differently, like this:
Hey GOP — you love unborn babies right? Me too! Let’s go ahead and put every pregnant woman on Medicare, and every child 0-6 months. Period. You can stay on your own insurance if you want, you can pay out of pocket, you can do supplemental, whatevs. But every baby deserves a great shot at being born healthy, and that means taking care of every pregnant woman and every newborn.
What’s nice about this is that you’re not overhauling every single portion of medical care — it’s focused on four (prenatal, the birth, post-birth maternal care, and newborn pediatric care). And, every new(born) American will benefit equally.
Now, here’s the kicker. You’ve got young people who today, and under my proposal, have to deal with private insurance. It’s a royal pain in the neck. Then, for fifteen months, they enjoy the benefits of Medicare. Access to health care, dramatic reduction in paperwork, not stressing about how much each prenatal visit costs, about whether or not they should wait before that hospital trip because who the hell can afford a false labor visit, and so forth. Then, once they’re finally gotten used to a more sane, more patient focused, less complex health care delivery system, Uncle Sam rips that bandage off with the intensity and flair of a professional wrestler. The young family is back on private insurance, dealing with copays, writing three checks for the same procedure because nobody in billing land can get the price correct, yadda yadda. Know what these two adults are now? They are now advocates for expanding Medicare even more.
The political problem with Medicare is that nobody knows how good it is until he or she has it for life. Once that happens, he’s content to enjoy it without working to expand it. So it seems to me that the best thing to do is to give it to young people for a short period of time. Every year that goes by more and more people will realize how terrible the private insurance system is when compared to Medicare, and either (a) the private insurance system will streamline considerably, or (b) we’ll see more and more expansions of Medicare — why take the 6 month old off of Medicare — why not at least extend the child’s benefits until he or she is older? 5 years! 12 years! 18 years! 21 years! And so forth.
And it would dramatically reduce costs without changing the status quo vis a vis insurance. It would probably help make plans cheaper for those that are choosing the fines over coverage.
I think the state doing a pilot public option for the groups stomv has identified is an intriguing idea, though I do wonder how we expect to pay for it without raising any revenue or while we devote new spending to tax breaks for casinos, Hollywood and GE. I mean all of our problems kind of go back to that central question.
if liberal Vermont was NOT able to pass single payer Medicare for all; how can Bernie’s approach work nationally ?
Fred Rich LaRiccia
I can’t find the exact number, but I am certain several well financed lobbies paid a fortune to oppose this, just as they spent a fortune in Vermont (and Massachusetts recently) to prevent any increased measures on deposits on beverage containers. The health of the environment and the health of the people be damned, they have shareholders to serve.
How can Bernie’s approach work? It works by not giving up if we don’t win the first time.
Health insurers spent big bucks on lobbying over the past year
by one of the most informed proponents of single payer:
http://goo.gl/lKnSnN
Citing those advocates is the equivalent of asking Gronk about his opinion on who will win the Superbowl and why. I admire and respect their work, but other policy experts who support single payer in theory recognize the difficult of enacting it in practice like Krugman and McDonough. An economics and public health expert, respectively.
I think the fact that the plan was 30% more expensive than projected and would’ve required drastically raising the income tax on all tax payers was the main reason the voluntarily term limited Shumlin who relied on the Progressive Party for the votes in the legislature to stay in office had to pull the plug. It was unworkable there and would likely be unworkable in any state.
By all means we should continue to support Jamie’s bill since it forces this debate and generates headlines, but realistic solutions like all payer will be on the fall ballot and a public option is a viable alternative we can begin to explore after that. I say this as someone who praised how Vermont came to pass this legislation and viewed it as an ideal test case. And the fact that it still failed has made me question it’s viability.
you have always impressed me as a virtuous man of character who believes that integrity trumps ideology.
I believe both Bernie and Hillary want universal healthcare as a birthright of every American. They share the same goal but differ in their APPROACH to reach that goal.
In the final analysis the reason I support Hillary can best be explained by her more pragmatic approach where she advocates for building on the good foundation of Obamacare by EVOLVING GRADUALLY step-by-step first by reducing costs and expanding universality to include those without coverage.
Bernie’s more REVOLUTIONARY IMMEDIATE approach is flawed, in my opinion, first and foremost because, though I share his visionary goal of universality— I don’t believe his single-payer, Medicare for all MEANS to that shared goal is politically viable nationally even if it may prove to be viable in liberal Massachusetts.
Fred Rich LaRiccia
I think Sanders and his campaign will be significantly moving the Overton window on issues ranging from police reform, to socialism/social democracy more broadly, campaign finance reform, and yes single payer healthcare.
That said, I am confident that all payer rate systems and a public option are likely next steps to build out on the ACA architecture rather than the Sanders approach which seems less implementable in the interim. And frankly after VT, those are the two next steps for Massachusetts.
Both candidates are refreshingly honest about the Republican Congress and the need for a Democratic majority to help a Democratic president achieve these reforms.
for many years. They have deeply studied single payer for over 20 years. The road block has always been the oligarchs trying to maintain the status quo. They have authored many articles with careful research on single payer.
By the way what sources do you use to promote incremental growth while people suffer? Those without insurance or inadequate insurance have excess deaths of 42,000 per year compared with those who have insurance.
Medicare has been a boon to our senior citizens, and it was passed. It took leadership, and LBJ came through. I think Bernie is capable of the same. You can look up his record as Mayor in Burlington.
Yes Drs. Himmelstein and Woolhandler are strong proponents of SP, but they came to that conclusion through careful research.
Medicare passed with overwhelming Congressional support.
Bernie has not been endorsed by a single Democratic member of Congress yet you think he is ‘capable’ of convincing them to pass socialized single payer ? What are you smoking ?
Fred Rich LaRiccia
yes, this is a thread about a single state changing health care laws, but Medicare is federal, and the GOP has power in the federal legislature but not really at the state legislative level.
I was thinking about a national expansion of Medicare.
If you have not seen the Frontline episode Sick Around the World it is well worth watching (although no longer freely available). I was introduced to it while studying for my MPH. Quick summary: the five countries discussed do healthcare better than the US, but they all do it in their own ways. I think that we need the government to take the lead at first because that’s the only way to simplify the complex IT efficiency/security/privacy/usability issues and cut out the huge amount of wasted effort. Otherwise it is a “wicked problem.” After that, we might well see some elements of choice reintroduced for a hybrid system like they use in some of these other countries. That may be more compatible with American culture in the long run, but I don’t think an incremental approach will get us there.
I heard a report on NPR a few nights ago that reported about the Cuban health care system compared to ours. We spend about $9,000 per person per year and they spend about $600 per person per year. Their life span and infant mortality rates are equal to or better than ours.
I lost two friends to pancreatic cancer a few years ago. Both lived about five years after their diagnosis. Both received quality care. But Doug lived in Denmark and was able to spend those five years with his wife and family, enjoying what time he had with them and focusing on only that. Ben lived in Chicago and during his five years, he and his wife spent a lot of time working with insurance companies, filling out forms, trying to cover co-pays, and worrying if the family would have any money left after Ben’s eventual demise.
Which five years would any of us rather have?
… with a standardized medical bill that we ALL can UNDERSTAND. Wouldn’t that be a breakthrough?