Aetna to exit nearly 7 in 10 Obamacare plans
Of course the right will see this as a failure of “Obamacare” and in a way, they are correct. Now if I can only convince the left that Obamacare is, in its pedigree, a right wing plan? Back in the days when Hillary was trying to fix health care, the right wing saw that it needed fixing as well. Their solution was a mandate that all citizens not eligible for Medicare must purchase insurance from a private employer. The Heritage Foundation had this idea first. Of course, we all know that Republican Mitt Romney was the first to implement such a plan. Call it “Obama” all you want, but it’s Republican. It’s failing for a lot of reasons: too bureaucratic, splintered, complicated, and it can’t fund the big payouts to corporate shareholders. (there are other reasons as well)
Here’s the thing:
In 1900, the average American spent $100 (In today’s dollars) a year on health care. No one had health insurance, because you don’t need insurance for something that costs $100 a year. You could pass the hat in church and collect $100. But not now. Today we spend $8,845 a year.
Why?
Because back then there were no expensive medical treatments to buy.
By the late 1920s, hospitals noticed most of their beds were going empty every night. They wanted to get people who weren’t deathly ill to start coming in.
An official at Baylor University Hospital in Dallas noticed that Americans, on average, were spending more on cosmetics than on medical care. “We spend a dollar or so at a time for cosmetics and do not notice the high cost,” he said. “The ribbon-counter clerk can pay 50 cents, 75 cents or $1 a month, yet it would take about 20 years to set aside [money for] a large hospital bill.”
The Baylor hospital started looking for a way to get regular folks in Dallas to pay for health care the same way they paid for lipstick — a tiny bit each month.
Now here is an important point. The hospital in Dallas was not going to exist as it was for anyone, rich or poor unless a significant number of people could be convinced to join together and share the financial risk that one of them might need the services of that hospital. Without them, the rich lose the hospital as well. It would simply be impossible for a large hospital to exist on the small number of procedures and treatments that a handful of wealthy 1%’ers could afford. They need us more than we need them. That was the case then and it and remains true today.
If, somehow, we would all take stand, refuse to pay for private insurance and instead, send a predetermined amount to Medicare in exchange, what are the rich going to do? How can they threaten us? If we stop sending money to the insurance companies, allow them to skim their profits, and then pass the remainder to the hospitals, the hospitals will close for us, but also for the rich,because it would simply be impossible for a large hospital to exist on the small number of procedures and treatments that a handful of wealthy 1%’ers could afford.
Your reference to the origins of Employer Sponsored Insurance (ESI) in Dallas in the 1920s omits a key factor in creating today’s mess — the role that WWII-era wage and price controls played in cementing ESI as the standard delivery vehicle for health care (emphasis mine):
ESI was instituted during the unprecedented expansion of the US work force during WWII. Like it or not, at the time it was an ENORMOUSLY positive benefit provided to millions of working men and — new at the time — women.
We desperately need to replace our health care system. We urgently need single-payer government-sponsored health care. The ACA most certainly is an undeserved subsidy provided to the health insurance industry, a subsidy that none of us can afford.
The ACA is, for all its failings, MUCH better than nothing. It is MUCH better than the chaos that it replaced. I don’t know what anybody else was doing in 2008, but I was running my own business and therefore seeing the OUTRAGEOUS premiums employers were being charged for health care insurance. I hesitate to even imagine what those annual premiums would have been without the ACA.
Two straightforward provisions of the ACA are HUGELY important to working class men and especially women today:
1. Elimination of “existing conditions” for blocking coverage
2. Extending coverage to children up to age 26
Too many people don’t understand that the first was routinely used to deny maternity coverage to women. Too many people don’t understand how many young people were finally able to obtain coverage under the second.
I suggest that a necessary starting point for a constructive discussion of what must come next is an accurate history of what has come before, and an accurate characterization of what is in place today.
A necessary stance towards solving this problem includes not only accurate and correct economics, but also enthusiastic and unwavering political support for EVERY elected official that is striving to do the right thing.
That currently includes both Bernie Sanders AND Hillary Clinton.
“glaring omission”…yup. Actually, I figured everyone reading BMG would know that. But hey, it helped get your blood pumping.
Yeah, the ACA is “better than nothing”. Well put. Life boats on the Titanic were better than nothing. Does that mean the Titanic and the ACA are worth repeating?
You agree that the ACA was a much-needed step forward. Hillary Clinton agrees with your candidate that we have much still to do.
Nobody — not me, not Ms. Clinton, not Mr. Sanders — suggests that the ACA should be repeated. Hence, your final sentence is irrelevant hostility.
Your commentary still seems focused more on useless and destructive griping than on actually DOING anything constructive.
…that ACA has it’s origins on the right. Heritage came up with it and Romney implemented it (before of course campaigning against it once it became Obama’s plan). One of the biggest frustrations of Obama supporters was that it was just one proposal that GOPers liked until Obama proposed it, but opposing Obama was apparently more important than a good idea on the merits. He got plenty of criticism from the left and there are still flaws, but still better than the status quo ante.
And, still, only passed by the skin of its teeth, because big pushes for single payer tend to cost politicians elections. There wasn’t the political appetite for single payer in 1993, and there wasn’t in 2009 either, which is why certain candidates noted that single payer isn’t happening any time soon.
Maybe ACA changes that dynamic, but the dynamic has been more or less constant for decades.
I’m not sure we would have quite gotten there, but I do recall noting that some 80-odd cosponsors had signed onto Medicare for all, which seems to be a good base from which to at least campaign for it. Also, even the ACA polled better WITH the public option than without IIRC.
You had an ideal Petri dish with substantial political support, support from the business community, and even the states one health care insurer agreeing to be nationalized. And it still ballooned beyond budget projections to be unsustainable. Cost controls like an all rate payer system like Marylands and a public option are easy to add on within the ACA framework and implement federally.
That will drive costs down, and once 60-70% of the general public opts in to the public option we have a de facto single payer system. Its likely ten years away, and it wouldn’t have happened had every liberal voted down Obamacare. It’s a firm foundation, it’s definitely not the full house.
(and Republican) governor, told my dad personally that they didn’t have the money to do it before it didn’t pan out.
(Douglas’s sister used to work for my dad. She and Jim Douglas grew up in East Longmeadow).
Sure, single payer did not make it the first time in Vermont. So that’s it? Fold up the tents, retreat?
No state will be successful at implementing government-sponsored single-payer health care, because a critical mass is required that no state has.
The existing health insurance industry needs to be dissolved. As in liquidated. Parts of the existing IT infrastructure might be valuable, and so there may be some role for a new entity that addresses the staggering challenges of patient and provider information management, provider billing and payment, and so on — at least temporarily.
We spend an enormous and disproportionate share of our GDP on health care administration (as opposed to health care itself). That can be used to fund the transition. As the transition occurs, those dollars will be returned to consumers instead of being buried in health insurance company vaults.
In this case, johntmay is correct. The failure in Vermont should motivate us to make single-payer government-sponsored health care a federal program, rather than walk away from it.
Yes, so now we have to convince HRC when she returns to the White House that, in this case, johntmay is correct and her suggestion that states go the public option route is not going to happen.
Expanding Medicare is a hell of a lot better for LABOR than expanding ACA which is a gift to corporate.
…some wiggle room and the benefit of the doubt. She has been more deeply involved for longer on health care fights than just about any current politician and certainly any of us. I trust she knows exactly what she is doing both in terms of policy and politics.
Why should I give her wiggle room and just assume that she wants what I want? Sorry, I’ve been waiting for 40+ years for my government to take the side of labor. I’ve watched them wiggle and giggle at my expense. She’s been at it for years, according to you, and she has not accomplished much (yes, yes, yes we all know Children’s Health Insurance Program!!!).
That was 1993. It’s 2016.
I asked you to assume that she can get us to a good solution that is both good policy and good politics. Trust and agreement are very different things. I prefer single-payer too. Remember that in the presidential election of 1800 Alexander Hamilton, who agreed with Thomas Jefferson on almost nothing, still used his influence to hand Jefferson the presidency because he trusted him – something he could not say for Aaron Burr.
Good policy is single payer. Good politics (keeping the wealthy large donors happy) is telling people single payer will never ever happen. I don’t have the money to buy her so I have to use other means. I’d love to sit and chat with her, but at $225,000 a shot, I can’t. So I am left with BMG and other outlets to get my point across. If anyone supports single payer, they need to TELL her now and every day until we get it.
And that by saying “single payer” it will magically happen notwithstanding a Congress that very much does not support it (and the majority of which would repeal ACA and replace it with nothing if given the chance).
and saying “never ever happen” sends the wrong message to people like me, but the right message to wealthy donors.
Bernie Sanders, Hillary Clinton, and pretty much the entire rational world understands that single-payer government-sponsored health care is NOT going to happen in the next four years. It IS a priority, it MUST happen, and it will take decades, not years.
Meanwhile, expanding the ACA by providing a public option is something that CAN happen. Bernie Sanders agrees, Hillary Clinton agrees, and THAT is an attainable next step. It is especially important since the GOP majority in congress has voted to REPEAL the ACA a countably infinite number of times. The GOP has made repealing the ACA a foundation-stone of its campaign.
Like it or not, the reality is that the immediate threat from the GOP is the REPEAL of the ACA. Our party and both of our party’s primary finalists seek to EXPAND the ACA. Your relentless harping against our party and our nominee only increases the likelihood that the GOP will succeed in destroying the ACA.
You lectured me about the accuracy of my interpretation of decades and now you are telling me that “never ever” is four years time?
Expanding ACA by taking out the corporations, not adding more. What is the ACA without corporations? Medicare. We’ve already got that. Expand that.
Ms. Clinton was referring to the ill-defined and over-hyped primary campaign fantasy of Bernie Sanders. There are alternatives to that, and we must collectively find them.
If you spent nearly as much energy seeking common ground and solutions rather than sound bites to fight about, we might all get along better.
If Ms. Clinton were foolish enough to advance what you are proposing in this campaign before this electorate, the result would be the repeal of the ACA. She knows that, Bernie Sanders knows that, and in fact the overwhelming majority of Democratic primary voters (NOT caucuses) know that.
What is the ACA after your “proposals”? Dead. Gone. Buried.
in every developed nation. Calling it a “fantasy” is just a way for quasi-Democrats to say they support single payer, but……
You either support it or you don’t. If you support it, you push for it.
Or, if you’re looking to keep the big contributions coming from the big corporations (yeah, we know, the money has to come from somewhere), you give it lip service.
…the main center-right party is to the left of the DLC wing of the Democratic party in many ways. Maybe you haven’t seen my question yet, but I’ll ask again which House and Senate candidates you are actively supporting that will get single-payer to Clinton’s desk. You complain about her “never ever” comment so my challenge to YOU is to prove HER wrong on that point. I think she would sign it in a heartbeat if she had the chance.
Please … after all your shouting, I invite you to offer a link to ANY substantive and concrete national single-payer health care proposal offered by Mr. Sanders. He has spent decades in Washington — which single-payer plan has he promoted? Which legislators have supported it? What proposals has he made about how to fund it? You won’t be able to do that because he hasn’t offered one — and THAT is exactly what Ms. Clinton was accurately criticizing.
The US is NOT Finland, Germany, France, England, Austria, or even Canada. It is true that those countries all have single-payer government-sponsored health care. It is ALSO true that each of those plans are different from each other, each of those nations is VASTLY different from the US, each of those populations is vastly different from the US, and NOT ONE of those plans will work in the US without both drastic changes and without a carefully designed and managed transition plan.
Neither you nor Mr. Sanders has even touched the surface of that complexity. THAT is why Ms. Clinton correctly dismissed the fantasies spun by Mr. Sanders on the campaign trail.
In spite of your monochromatic black-and-white dystopian world view, in fact things are not NEARLY as simple as you claim.
The fact is that an overwhelming majority of those “quasi-Democrats” you disparage agreed with Ms. Clinton and voted for her. Oh, and speaking of “quasi-Democrats”, exactly how long has Mr. Sanders been a member of the Democratic Party?
Whatever your agenda is, it does not appear to be one shared by the overwhelming majority of Democratic primary voters. We (and I am proud to call myself one) enthusiastically embrace the agenda of Mr. Sanders as well as his endorsement. Some of us, including yours truly, were pushing hard for that agenda — including single-payer government-sponsored health care — while you were enthralled by Mr. Limbaugh.
Your “with us or agin us” rhetoric is, in fact, the stuff of Mr. Limbaugh, Mr. Trump, and the extreme right. Based on your commentary here, especially your frequent whining about the Democratic Party, I encourage you take a look in the mirror before you spend to much more time yelling about “quasi-Democrats”.
Wow, and all this time I thought it was. Thanks for the update. I’ll have to edit my Atlas. Tell me, is your dog really blue?
It was YOUR CANDIDATE who offered it as his model:
It was YOUR CANDIDATE who cited the “Nordic Model” when asked to provide even a little bit of detail about his health care “proposal” (emphasis mine):
It was YOUR CANDIDATE who offered the “Nordic model”. It was that groundless speculation that Hillary Clinton accurately, correctly, and devastatingly characterized as “fantasy”.
You are so busy shouting that you really aren’t paying ANY attention at all to what your own candidate says, what our nominee says, or what our campaign advocates.
You are so busy shouting that you are also utterly disconnected from the reality of US national politics, especially about health care, in 2016.
What’s the difference between a heart attack in Finland and one in the USA?
Plus I wouldn’t be surprised if Finland is healthier than we are overall.
Oh, please. Bring up Google maps. Compare the size of Finland with the US.
Even YOU can figure out that, among a countably infinite number of other differences, the transport distance alone is a HUGE difference. You do understand that ambulance costs are a significant portion of health care spending for individuals, right?
between a heart attack in Finland and one in the USA. Your reply is that the USA has more square miles. That is a geography question that I did not ask.
Let me try again.
When you have a heart attack, stroke, or similar emergency, every second counts. Providing effective emergency care for a nation the size of Finland is therefore utterly different from doing the same in the US.
If the patient is dead on arrival at the ER, the best healthcare system imaginable isn’t going to make an iota of difference.
Your argument is based on transpiration costs, I guess. Nice try but it’s not working.
Here’s a math question you also didn’t ask: how many hospitals must Finland provide, in comparison to the US?
Suppose, in order to provide a minimal level of emergency health care, a government must ensure that the maximum transport time for a given emergency is some fixed maximum (call it, for discussion, 15 minutes).
That means that the population must be served by enough ERs that a 15 minute radius around each blankets most of the population.
Suppose that the effective area of nation A is areaA and the number of ERs in A is ER-A. Suppose that the effective area of nation B is areaB and number of ERs in B is ER-B. If areaB is, say, 10 times greater than areaB, then nationB has to have ten times the number of hospitals as nationA.
The area of the US is about 3.8 million square miles. The area of Finland is 130,666 thousand square miles. The US needs AT LEAST 30 times as many hospitals because of geography (area) alone.
How big must those hospitals be? That is determined by population density. Finland is among the most sparsely populated nations in Europe, behind Iceland and Norway. The US, conversely, has a large number of densely populated areas distributed across a huge (in comparison) area.
That means in addition to 30 times as many hospitals, many of those hospitals need to be MUCH larger.
I get that you didn’t ask any geography questions. You also didn’t ask any math questions. That is sort of my point.
You aren’t asking a great many important questions.
Here’s the plan. Stop being a jerk.
https://berniesanders.com/issues/medicare-for-all/
Sorry, but that isn’t a plan. It is instead promises of fairies and unicorns.
Here’s how your cite describes “THE PLAN”:
Right. Not a word about “how”. The above is not a “plan” it is exactly as Ms. Clinton described — a fantasy, with not even hand-waving at the vast array of difficult challenges that lie between where we are today and the promised Nirvana.
…from a quick check and what I remember we did in fact land men on the moon in our first attempt to do so.
Um … not exactly. A great many important lessons were learned from that failure.
There were, in fact, many setbacks during the Apollo program.
…but broadly, it took from 1961 to 1969 to engineer the means for the first Moon flight; and three programs: Mercury, Gemini, and Apollo.
That being the case, both you and Christopher are right.