I had an good conversation with a new friend this past weekend. We talked about things we’d like to do and things we’d like to see and he brought up an interesting point. If you do not have a specific time, it’s just talk. When a person says “We should get together”, ask them “When”? If they can’t come up with a date or time period, they were not serious, they were just trying to be friendly, but not too friendly.
Or in the case of politics, if you do not set a time, you’re just delivering lip service to calm the opposition. President Kennedy did not just say we would go to the moon, he said “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard.”
I started to think about Single Payer Health Care. Tom from Somerville is telling me it will take decades (which I now know means thirty years), so Tom thinks that by 2046, we will have universal single payer.
Okay, so that’s my plan. I need to know from (hopefully) President Clinton when we will have health care as a human right, with a version of universal single payer.
…maybe when we have a strongly Democratic/progressive Congress in both chambers. Which candidates this year have you been volunteering for or donating to to that end? I actually don’t like timetables because when it doesn’t happen the person who proposed it is accused of breaking a promise or even lying despite many political or circumstantial issues outside of that person’s control. In the 1960s we had not only a Dem Congress to go with our Dem Presidents, but a unity of purpose and less partisanship for its own sake. We had to beat the dreaded Soviets to the punch, after all.
We’ll get to it tomorrow. Until then, we will continue to look for scapegoats, give our celebrity candidates lots of wiggle room as we post selfies with them on Facebook…
Christopher is wrong to assert that Congress is the only barrier. We had the White House, a filibuster proof Senate, and the House and single payer wasn’t even on the agenda. Where John is wrong is failing to recognize that ACA will eventually lead to de facto single payer.
As more and more insurers back out of the exchanges, as more and more states expand Medicaid, and as we eventually add a public option we will eventually see upwards of 80% of the American public on some kind of ACA exchange with a subsidy or in a public plan.
This is the backdoor way to kill off private insurance and employer insurance, it’s just going to take 20 years for that to happen. It’s why the conservatives tried so hard to kill it, since they know better than most Sanders and Berwick supporters what this policy will eventually morph into.
My guess is that you are correct, the poorly designed ACA will collapse under its own weight, but my guess is that will be in under 12 years. It’s going to be like the Berlin Wall, bit by bit, one small crack here and there and then gone in a flash.
But those Democratic majorities just didn’t support it. Heck, the Democratic minority today doesn’t support it. OK, as the question as “Medicare for all” and you can get polls showing a majority of Democratic responses in favor, but outside of a losing presidential bid, the momentum is zero. Is there any push at all in the Congress for this? No. Is there any primary pressure on Democrats in Congress to favor it? No.
The only Congressional ripple produced by the entire Sanders campaign is a primary against Wasserman-Schulz, and that has more to do with her being mean to Bernie than with single payer.
Can we foresee some big push in coming years? Dems will pick up a slew of seats this November because their opponents are hamstrung by an unusually bad top of the ticket. It still won’t be a majority. By 2018, they will be trying to preserve seats in conservative-leaning districts, and will lose ground anyway.
Kennedy made a bold promise to go to the moon because he knew it could happen. Making silly promises that cannot be backed up is just dumb.
…Democratic/PROGRESSIVE. Surely you recall that our “filibuster-proof majority” was very brief and only on paper.
I set a time, so I want it to be real.
When you want to attend, let me know and I’ll find the time.
…where CONGRESS is charged with making the laws?
…when the President keeps telling people he can rule by Executive Order.
Anybody else notice that Boehor won his suit against Obama?
So at a certain level, who cares what Hillary thinks? She can say it, John, but she can’t do it. All she can do is take credit if it happens.
They can’t create new policies out of whole cloth, especially when it comes to expenditures or taxes. They can only clarify how the executive branch will operate and how laws will be executed/enforced.
And how things really work? Or are you just interested in the official rules, the ordinary stuff?
FDR, to the left: That’s a great idea, now make me do it.
Something as radical as the abolition of the entire health insurance industry– and the medical office administration that goes with it– has to come from below, not from above.
There’s no question a President deploying the bully pulpit would help assuming said President has political capital, but Clinton knows this issue better than just about anyone. Yes, I do tend to focus on “official rules”.
“Clinton knows this issue better than just about anyone”….which is why she has failed so miserably in the past….and then quit by announcing it will never ever happen as she takes “donations” from health insurance companies. Please, spare us the drama.
Clinton learned that you can’t get everything all at once and are more likely to be successful one step at a time.
is indicative of why arguing with him is completely and utterly futile. Remember too this is the guy who cited as evidence a URL that disproved his point.
*
“Are you going to remember the part where CONGRESS is charged with making the laws?”
No, christopher, he isn’t ever going to remember this.
That’s the problem with you and christopher and wallstreettom. You say “oh’ that’s congress” when it suits you and “look what the president did” when that suits you, ignoring the reality of how things get done. But that’s how it is when you have an ideology. To quote President Clinton ” But the problem with any ideology is that it gives the answer before you look at the evidence. So you have to mold the evidence to get the answer that you’ve already decided you’ve got to have. It doesn’t work that way. “
this comment is too stupid to respond to.
It’s a fair point, but HRC (and Democrats in general) are wary of over-promising. They know there are aspects of the process they can’t control, and they don’t want to set themselves up for failure.
But your general point is right, and this is the sort of thing that frustrates a lot of us. We don’t stop thinking about tomorrow, but it would be nicer to think about today.
The end should be quality and affordable health coverage for all Americans. ACA largely achieved those ends, as more states that rejected the expansion embrace it, as more states follow Kentucky at developing smart approaches to implementation and as the public option gets added on and market pressures finally bring costs down, we will gradually see a system close to Holland’s or Germany’s. Everyone will be able to purchase a public or private plan they can afford. We are already at 93% coverage which is a huge improvement over where we were before the law.
If we were starting from scratch, single payer would be easy to create and administer. Since we are not, this made the best sense. The more I learn about health care policy and the more my friends and I use ACA plans, the more I appreciate this law. A friend who lived in Canada says ACA is easier to sign up for and use and ended up being more affordable overall, granted she had a lower tier plan as a visa holder and not a citizen. But Canada isn’t utopia, nowhere is. This plan worked within the existing fucked up ad hoc architecture of the American health care system and straightened a very crooked system. Over time it’ll be easier and easier for he government to absorb elements of it and patients that choose that kind of coverage.
Which means 57% of people who didn’t have it before still don’t have it.
Can we call that “largely?”
ACA was a step in the right direction, and would have been much more successful if not for Antonin Scalia & Co., but let’s not kid ourselves and say it was some huge success. That’s an insult to all the tens of millions of people around the country for whom it is not working, or working very poorly.
Let’s be honest about its failures and be vocal about doing better.
It’s not perfect, it’s also substantially better than its liberal critics are willing to admit. Colorado voters have a fantastic opportunity this fall to enact Colorado Care which would be the first cooperative health care system in the United States if enacted.
There will be opportunities at the state level to continue to expand Medicaid and to add on a public option. Massachusetts is ten years ahead of the curve on adopting reform and we will likely continue to lead the way on implement improvements. Obama laid the corner stone, it will be up to the next generation of leaders to finish the job. By laying that stone took six decades and eight presidencies, so let’s not kid ourselves this will be done if the next President says the magic word.
is that health insurance coverage means the individual is all set, covered, not in danger or bankruptcy if they get sick or injured.
That’s the big lie. I know from personal experience and endless conversations with my friends, that most stuff is “not covered” or the deductible or co-pay is so high that we put it off. Yeah, at our age, medical issues are an everyday conversation.
Yes, it’s a step in the proper direction and we, as Democrats, need to push the next president (assuming it is HRC) to committing herself to that end and not resting on her laurels as we simply admire her as the greatest human being in the history of the world to ever seek this office.
One of the reasons I was ambivalent about ACA from the start is that, while it was the right thing to do for the commonweal, for me, personally, it was going to mean “pay a lot more, get a lot less.” And, notwithstanding the many arguments that it would all be cheaper once all these extra people are insured, that has proved to be the case. Significantly higher premiums, combined with higher deductibles and co-pays, especially for “non-routine” things like lab work, prescriptions, and emergency room visits. The cost of family health care, for both premiums and for all of the out-of-pocket other stuff, seems to have gone WAY up since Romneycare.
I also sit on the board of a non-profit that serves low income families for certain services. It has a number of employees who are not paid anything near what they are worth. Each year the cost of the health care goes up, and each year the only way to manage that cost increase is to shift to a crappier plan. It is very depressing indeed.
I’m not overly impressed with Medicare, and am skeptical that some huge expansion of it will be anything other than pay more, get less all over again. I have had to help my own father with the the billing related to the last few months of my mother’s life,which included an extended hospital stay, all of which Medicare decided was not covered, but which should be. The process has taken dozens of hours of work, rafts of paperwork and correspondence, and is nowhere near done. It really has been health care by the DMV.
I’m not sure what the remedy is. I am heartily skeptical that “single payer” would mean anything other than saving $10 on private insurance, paying $100 more in taxes, and getting to do a tax return’s worth of paperwork for everything other than a routine checkup.
Most voters don’t know how healthcare works in this country, let alone,
policy models to adopt from other ones. Part of why ACA was poorly
designed from an implementation standpoint is how damn complicated if was to sign up for choose a plan with, IT issues not withstanding.
I think if we can design a system that is substantially easier to use and deal with, even if it’s more expensive, most voters would be for
it. I’m not sure if other systems are easier or harder. I’ve had a lot of friends say Canada’s and UK’s are complicated while France’s is easy. All anecdotal evidence, but part of what we should be pushing is an easy to use alternative to the status quo. Focus on ends and find the best means to get there. The means of delivery and payment shouldn’t be our end, affordable universal coverage with healthier outcomes should be.
Isn’t the simplest solution for the United States to just remove the age 65 minimum from Medicare?
Can anyone answer this question:
On January 26th, 2020, I will reach the age of 65 years and be eligible for Medicare. What, specifically, has changed about me that suddenly qualifies me for this? What was it about me the day before that denied me this right?
Approximately the same things that changed about you on January 26, 1973 when you became eligible to vote on your 18th birthday or January 26, 1976 when you turned 21. You did not suddenly become a better driver on January 26, 1981 when your automobile insurance rates plummeted on your 25th birthday.
In fact, like so many other things, this is not about YOU. It is about how government does things. We don’t allow children to vote, drink, smoke, or sign contracts. We set age thresholds for all kinds of things. Medicare eligibility is just one of them.
Statistically, I am an average person in many ways.
I think when Medicare was implemented (same with Soc Sec) it was with the idea that people could have maybe 5 years of rest and relaxation for the last few years of their life. In the 70’s cancer patients were sent home to die. Now chemo, transplants and hundreds of thousands of dollars later people are living past their normal expiration date.
For the record I would be OK with “death panels”, someone who smokes should not be allowed a lung transplant for example, but I doubt they would be administered honestly and the well to do would circumvent established rules.
…for raising the SS retirement age, but many of us believe that EVERYONE should have access to public health care in much the way K-12 kids have access to public education. I would think expanding eligibility downward would have a positive impact on the overall system as younger people will need it less.
I would be much more apt to support expanding eligibility from the bottom up. Clinics attached to schools (the school nurse on steroids) could be used to help teach a healthy lifestyle, monitor and catch problems early on, and encourage preventative medicine which is always cheaper.
Free for all kids who stay enrolled up till high school graduation. Cheaper program to start which has a great long term benefit. (We lose a couple generations to fuzzy care).
Your suggestion might be a simple legislative change. It is most assuredly not simple to implement.
I’m not sure how much you know about Medicare. Reimbursement schedules, schedules of approved procedures based on symptoms, care guidelines, and all the rest are heavily influenced by the demographics of the patient community being served. The health care needs of a 25 year old are very different from those of a 75 year old.
Like it or not, the economics of any proposed change have to be considered. Many or most health care providers (as opposed to insurers) who accept Medicare patients do so in the context of a balance sheet for their practice. The same is true for drug suppliers, hospital systems, and so on. Change is required. At the same time, this is an “enterprise-scale” change — an attempt to simply turn off America’s current health care system, frob some knobs, and turn on a new one is doomed to catastrophe. Especially when the new one hasn’t even been specified, never mind designed, yet.
I agree with jconway that single-payer government-sponsored healthcare is a means rather than an end. Expanding Medicare might well be an important component — still, it will almost surely be just one component of several. Most importantly, none of this will happen overnight.
It’s an unfortunate fact that the ACA really has to be graded on the curve. We’ve had a deceleration in the rise of medical costs, but that’s good but not terribly comforting. Medical costs are still rising. Hooray for the second derivative.
Some of those changes to reduce medical costs are tough. I’m reminded of the recent battle regarding dentistry in Massachusetts. It ran into the entrenched opposition of an organized group of professionals. If you think of the craziness surrounding vaccines and the flourishing industry of folk cures for cancer, the social efforts involved in getting science-based reductions in health spending look large.
I always liked the public option. Let’s have a fair choice and see who does it better. The games Aetna is playing, pulling out of the ACA because it can’t buy the company it wants to buy, are just a broad scale of its attitude toward its customers — rubes to be milked of their money.
I lived in Canada’s system for six years, and I don’t think it’s the best system to imitate.
While Canada’s system is far from perfect, our is farther.
By an overwhelming margin, Canadians prefer the Canadian health care system to the American one. Overall, 82% said they preferred the Canadian system, fully ten times the number who said the American system is superior (8%).
Canadians like their healthcare system and think it’s the best when polled. Too bad they have no bearing on American public opinion and aren’t American voters. The more interesting sample size would be Canadians who moved here and tried ours and vice a versa.
Canadians I’ve talked to so they always knew they were covered and didn’t have anxiety about paying for care, but that the quality of care and attention they received in the states was better. My friend found ACA easier to sign up for than the supplemental coverage visa holders in Canada pay into. Their immigration system is also far more strict and Byzantine than ours is and she had to move back here because of that.
The Philippines has a system far closer to single payer than we do. It’s also largely run by the Catholic Church and doesn’t allow for sex education, birth control, or abortion. Moreover the technology and training is not up to our standards. I would still rather get injured in Boston than Manila, even if I was a Filipino citizen covered by their comparatively more generous version of Medicare.
Cuba has a socialized system and some of the best trained doctors in the world. It’s infant mortality rate is the lowest in the world while ours is the highest in the developing world. It was also totally incapable of dealing with or adapting to the AIDS pandemic when it started, the US, for all its slow response, ended up doing a better job treating AIDS patients. We have better success rates with severe cancers, genetic diseases, managing diabetes and routine surgeries like knee replacements or taking it cataracts than any industrialized country.
We do specialists better than anywhere else, it’s why doctors flock to practice here. We are lousy at general practice, internal medicine and OBGYN. So by focusing on cost reduction and increasing care options we can solve for these problems. A robust public option would make it easier for more people to see a doctor on a routine basis and cut down on our bad health statistics. Generous pre and post natal care, universal coverage for children, and paid Parental leave will dramatically improve our infant and children’s health metrics.
Let’s focus on improving public health and find the best delivery mechanisms that achieve the results.
So was subati’s point functionally useless for this discussion?
He’s an American who lived there and doesn’t think their system is worth emulating here, how does respondng to that with a survey showing that Canadians who’ve largely only experienced their system like their system refute that? It doesn’t.
What matters is improving health outcomes and ensuring affordability. I am no longer convinced single payer is the means to achieve that in Massachusetts having spent a lot of time anticipating Vermont’s experiment as an ideal test case and then seeing it fail so catastrophically.
The usual liberal tropes don’t apply there. There was one HMO willing to be nationalized, leaders with courage willing to implement it, and political will to do so. It didn’t fail because of right wing opposition or liberal cowardice. It failed because it did nothing to fundamentally solve for the high costs of American care, and in fact, made those costs worse.
America’s health care problem is that it’s too expensive, and single payer is not a proven means of solving that problem. It may solve other problems, but until we tackle that one, it’s likely to be the massive budget buster it was in Vermont. A robust public option is a better way to ease people into public healthcare and it can be easily adapted to the ACA architecture. Pushing for federal single payer now requires us to start completely from scratch, and no polling you cite will account for the massive political opposition such s change will inspire and not just from the right.
This sentence nails it: “America’s health care problem is that it’s too expensive, and single payer is not a proven means of solving that problem. ”
Here’s what I think is happening today (and ACA isn’t helping). Providers must make a profit. In today’s system, even with the ACA, providers know what things insurers will and will not pay for. Providers are measured on their profits, not patient outcomes.
The result is that the role of a PCP is primarily to be a sales representative for the hospital he or she is affiliated with (and nearly every PCP is today part of “network” like BIDMC, Mass General, Mount Auburn, whatever). The PCP hears the symptoms, looks them up on a chart, and ends with a list of “diagnostic” procedures — xrays, cat scans, MRIs, etc. — those symptoms qualify the patient for. I’m picturing, perhaps apocryphally, a daily or weekly staff briefing where the providers get the current “specials” that the network wants to sell. My wife calls this the “wallet biopsy”.
What does NOT happen is an end-to-end focus on making the patient well again. A patient who presents with ankle pain from a fall is sent through thousands of dollars worth of “preventative” diagnostic procedures — each of which is defensible in the aggregate and irrelevant to that specific patient. The practice is very profitable, and patient outcomes suffer.
We speak of “personalized medicine” as if it’s some exotic outcome of very expensive “genomics”, and the industry as a whole ignores the reality that a fifteen minute dialog about family history provides better information for a tiny fraction of the cost.
Ankle pain caused by a fall is readily diagnosed and treated. That diagnosis and treatment is not nearly as profitable as the aforementioned suite of tests and procedures. That’s why, today, our providers do the latter.
The result is that we spend an ENORMOUS amount of money — and that ankle STILL hurts,, after all that, just as much as it did when the patient appeared.
Government-sponsored single-payer health care, alone, will not solve this. Medicare-for-all, alone, will not solve this. A national public option, alone, will not solve this.
There are many “moving parts” in this system — insurers, providers, patients, pharmaceuticals, equipment manufacturers, hospitals, government, even religious organizations. I strongly suspect that solutions to this (I think there are likely to be many) are going to evolve rather than be “created”. That evolution will require a constant cycle of change, measure, revise, and change again — each turn through the cycle takes time, and it will take many turns before we’ll see actual progress.
This is, in a way, a mirror of the evolution-versus-intelligent-design debate. In the real world, there is no “intelligent design” — as much as we might desire it.
The solutions we seek must EVOLVE, because that’s how complex dynamic systems like this change.
A further problem is that forces insisting on the x-rays are well-organized and forces insisting on a more judicious use of Roentgen rays are diffuse.
I suspect insurance is another factor. For ankle pain, there’s some small percentage where the pain is caused by some anomalous, more sinister cause. By not catching that on x-ray, the practitioner risks some sort of malpractice action. So the naturally risk-adverse medical professional has to make sure that the ankle pain is typical ankle pain.
So pushing for less “care” in the form of fewer x-rays is not easy politically. Too many people are sure that their ankle pain is a sign of deeper fractures, or cancer and there are enough anecdotes to make great television ads.
Cuba spends less then $1,000 per citizen on health care and their citizens have a life span equal to ours. They do it with more exercise, lots of preventative checkups, a better diet, and a supportive community.
It really is that simple, but getting to simple is not easy.
Once again, Cuba is not the US.
Cuba is a small island whose population is a tiny fraction of the US and far more homogeneous. All those things you mention are marvelous and wonderful. They’ll work wonders for portions of the US.
Cuba’s 2013 population, at 11.27 million, is less than a third that of California (at 39.1M), less than half that of Texas (@ 27.5M), and smaller than each of Florida, New York, Illinois, Pennsylvania, and Ohio.
It really is NOT as simple as you suggest.
We can’t have better health care because “we’re too big” and “we’re not homogeneous”. Neither argument holds up against logic.
I can walk into a Home Depot, Walmart, McDonalds, or any other such place all across the USA and they are all virtually the same. If the USA was the large diverse nation you need it to be for your argument, that would not be possible. Sure, the Home Depot in Marathon Florida does not sell snow blowers and the McDonalds here sells lobster rolls in the summer, but small regional exceptions do not prove your point.
Again, a heart attack in Finland, or Cuba, or the USA is the same.
For example, we might say that Vermont has a tiny, near homogeneous population, and yet Vermont’s transition to single-payer failed.
Cuba’s healthcare system can be traced to their Communist Revolution which, whatever else one might say about it, yielded some amazing results in the domain of public health.
Not even Vermont is contemplating a Communist Revolution, however.
is that they take a more “natural” approach to medicine, health, and do not consider it a “money maker” apart from the wealth generated by their doctors who are sent overseas to help others and send money back home. Doctors are an integral part of the community, more along the lines of police and fire people. Prevention plays a large part as does treating the family, not just the individual. A paradigm shift from the current USA where medical offices are grandiose and doctors are placed on pedestals and “freedom” and “individuality” are preached as virtues by the corporate media.
We could learn a lot from Cuba.
There is little evidence that taking a more “natural” approach to medicine and health produces the results seen in Cuba when applied on a larger scale. Strategies of prevention are more effective when applied to smaller more homogeneous populations — some argue that such populations are naturally healthier anyway, whatever they do.
Emulating the practices of Cuba in hopes that they will produce similar results in the US is like eating yogurt to live longer or playing the lottery to get rich quick. It’s true that people in Cuba seem to be healthier. It’s true (I think!) that Georgian citizens of the 1970s often lived long lives. It’s true that some people make a lot of money playing the lottery.
Yogurt re-entered the consumer market decades ago with a big splash when companies like Dannon cited Georgian men and women who ate yogurt and lived longer (is that Dick Cavett narrating?). It’s true that those men and women ate yogurt. It’s true that they lived longer. It does not follow that Americans who eat yogurt live longer.
We can learn a lot from a great many cultures in the world around us.
That wasn’t the claim, though. The claim was
It actually is NOT that simple. LOTS of cultures attempt to practice the “natural” and holistic approaches to medicine you advocate — with distinctly limited success. These bromides are all good things, just like eating yogurt is a good thing.
We should not kid ourselves, however, that health care policies that seemed to have worked in Cuba will work with similar effectiveness in the US.
They did not win the health lottery with luck, they won it by being smarter than us. Why would you try to downplay their success? I really can’t figure that one out.
You have got to be kidding!!! Have you ever been there? Looked at the numbers? I put Cuba in the big five of diversity with Brazil, South Africa, Malaysia and Singapore.
Cuba is not a meme nor a model for the US. It is a real place with a unique history. Anybody who tries to make policy based on Cuba without knowing the history will fail.
Cuba has invested heavily in the education of its people, which is why it punches above its weight, way above its weight, in sports, dance, music and medicine. It has produced too many physicians for its own country. Cubans have a high level of interaction with health care professionals, focused on prevention.They practice a less intensive and invasive form of medicine in a country where preventive medicine is the model.
Their diet is not great, deficient in many minerals and vitamins but low in animal fats. They walk. A lot. And dance and play sports. Obesity is a problem because of sugar consumption but not like in the US.
Let’s not pretend that Cuba will be our model. Yet let’s not lose their lessons, some of which they learned from us in the early 1900s. Public health measures in those years added more to life expectancy than any other “medical advance” we ever achieved (re-read Starr’s Social Transformation of American Medicine if you need a reminder).
And let’s not pretend there is ANYTHING to learn from the VT single payer experience. If you want to know about why single payer has failed in the US on a state level, examine former Rep John McDonough’s amazing quest to bring it to MA in the early 1990s. Or better yet, read his dispassionate treatment of the VT experience in the New England Journal of Medicine http://www.nejm.org/doi/full/10.1056/NEJMp1501050#t=article.
Canadian nationalism is very, very weak. They are aware that they live next to the preeminent cultural producer in world history. Canadians wear American clothing, listen to American music, watch American television, eat American food. For most Canadians, the only things they have to distinguish them from Americans is niceness (individual politeness and international peacekeeping)…and their health care system.
In other words, many Canadians see this poll question as “are you proud to be Canadian?” Of course they will say yes.
We shouldn’t forget the many contributions Canadians make to popular music. 🙂
“Hey, you know who else is Canadian?” is one of the most tiresome games played north of the border.
I’ve heard that complaint before, it’s one of the motivations for my smiley.
Also, in my option that song has to make the list of 100 most annoying songs ever to hit the top-10. It could have been worse, though. I could have reminded us of “These Eyes“. 🙂
Would’ve pegged you as a Neil Young or Joni Mitchell man 😉
n/m
Is/was their lead singer. I have no idea why I know that or where I learned it.
Really, what is it?
It seems that you can only frame your questions in terms of how long YOU have to wait before someone else gives you what you want.
Leaving aside the question of exactly what kind of healthcare system we should have. You know perfectly well that there is ZERO chance of some type of universal national healthcare unless we have both a Democratic President and Liberal Democrats have large majorities in both houses of Congress. So you answer the question for us: what are YOU going to do to help that come about? Because your current approach of whining isn’t likely to produce any positive results.
Yes, understood, real liberals, not the quasi types who will sell out to special interests because “the money has to come from somewhere”. I’m working on that and it’s not easy. The personal attacks from that crowd are distracting.
If you don’t want to be criticized, stop picking fights. And yes, that is exactly what you are doing, and you perfectly well know it.
Stop whining and start working positively for change.
Yeah, sure. I’m getting pummeled by wallstreettom and his sidekick and you call me out for picking fights.
I am working for change. And change will not come if Democrats continue to sell out to big money interests. You ought to know that.
“Now sit here while I shout slogans at you!” is not the way to conduct a responsible policy debate. We’ve been back and forth on single payer, and all your response is the circular logic that if it works for Canada it works here and this is the panacea progressives have been promising for decades.
Then how come it didn’t work in Vermont? How come it’s never been passed here despite progressive majorities? How come Canada is experimenting with privatization under a Liberal government? Let’s talk about actual numbers and have a real debate. Otherwise this is a waste of time, let too many of sinilar threads around here are becoming.
??
remembered it. If you want to read more, google “add image HTML.”
The code looks like this:
Check it through preview before submitting.
me post the code. It made that little picture.
In the comment editor, enter an image tag. It looks something like this:
<img src=”http://url.to.img.png” width=”123″ />
Generally you can copy the URL in your browser by right-clicking on the image you want to use. The argument to the “width” attribute is optional, but I like to provide one. It tells the browser to scale the image (both horizontally and vertically) so that width of the result is the specified number of pixels. On this site, for a comment, “400” is about as large as you want to go.
As noted, you can use “preview” to check your results.
For another copy of the image (below), I used this:
<img src=”https://englishvg1.wikispaces.com/file/view/Rainier_Wolfcastle.jpg/33665009/Rainier_Wolfcastle.jpg” width=”400″ />
Interesting that it renders the “< correctly in the preview and incorrectly when posted.
The “<” is a “less-than” sign, also called a “left corner bracket” (“”).
I see that wordpress simply does not allow a “naked” left or right corner bracket. Interesting.
Not sure what that is.
The “comment editor” is the window that opens when you click “Reply” or “Post a comment”. It is the tool that collects your text input, lets you preview it, and then posts it to the blog.
<img src=”http://url.to.img.png” width=”123″ />
We’ve stumbled on a problem that plagues too much of today’s web software — some call it the “use/mention distinction”.
What I’m attempting to do is provide the string of text that I type into the comment editor that, when rendered by the browser, produces an image. The difficulty is finding a way to enter a string so that, when rendered by the browser, it shows the string itself rather than the image produced by the string.
I’ll try a different approach and see if it works. Meanwhile, in the string you offered, if you replace the four characters “<” with a left-corner-bracket (“less-than” sign) and the four characters “>” with a right-corner-bracket (“greater-than” sign), the result will be “tag” that tells the browser to display “http://url.to.img.png” as an image, scaling it to be 123 pixels wide.
If you do the same with the string just above my version of the example image, you too should end up posting the image of Mr. Wolfcastle.
I’m trying a different way to persuade the browser to show you that string:
<img src=”https://englishvg1.wikispaces.com/file/view/Rainier_Wolfcastle.jpg/33665009/Rainier_Wolfcastle.jpg” width=”400″ />
At the bottom of my previous comment is a string you can type into a comment that, after click the “Submit” button, will cause the image of Mr. Wolfcastle to be displayed as a 400 pixel wide image in the resulting comment.
Any image available on the web can be included by providing its url as the right-hand side of the “src=” expression.
Big Money won in Vermont….this time. But we ought to keep on trying.
Note this.
Single-payer is supposedly a crucial issue for this commentator.
Supposedly.
If it were really important to any of the members here with whom I’ve been conversing for near a decade, I’d expect a researched, nuanced understanding with links, a diary, contrasting views, recommendations, etc.
Instead, what do we get? A sort of flip response of the “It’s all Wall Street’s responsibility” — as if investment bankers secretly rule absolutely everything.
Possibly single-payer isn’t so important to this person after all? At least not important enough to try and understand our most recent history with trying to implement it.
I discover that this is a rather interesting topic. It is actually not possible for a state to become the single payer because of a number of other competing laws and programs. The socialist Jacobin on-line magazine took me to a (PDF) report by Public Citizen. The Vermont attempt to surmount these obstacles was awkward — likely necessarily so.
Both the British and Canadian systems were helped immeasurably by Britain and Canada having parliamentary systems. In the British case, a Labor government swept to power in 1945 and under the leadership of the great Prime Minister Clement Attlee, the National Health Service was born in 1948. (The number of achievements of the Attlee government is actually pretty staggering.)
In the U.S. case, getting legislation like that requires not just winning a majority in a single legislative branch, but rather two legislative branches and the Presidency. Our current system prevents us from having Clement Attlees.
Nope.
And no, Wall Street does not rule everything just most of the important things.
I didn’t see any “bait” in the comment from kbusch.
I saw, instead, a gently worded request to provide “a researched, nuanced understanding with links, a diary, contrasting views, recommendations, etc.”
I saw an acknowledgement in her own follow-up that the request she has made is in fact rather difficult to fulfill, because of the complexity of the issue. She has nevertheless offered an example that models what she requested.
Your response was, as she observed, “a sort of flip response”.
Please note that this not an attack. I am attempting to describe a sequence of three successive comments here (one, two, and three).
That’s an easy question to answer, so you don’t get to use it as a straw man.
Vermont’s politicians wanted the sexy headline of starting the first single payer system in the country.
Then they realized — when the number crunchers did their crunching — that what creates the cost savings of single payer systems is using the size of the pool to force hospitals and doctors to charge less.
Doctors and hospitals — which had been on board initially, which is a big part of why Single Payer initially passed — were NOT interested in charging less, and so balked. Loudly. With their pocket books.
Vermont doesn’t have Single Payer today because the politicians were afraid to take on the hospitals and doctors — and in a small state where wages tend to be low, I’m guessing the pockets of Vermont’s doctors and hospital administrators are some of the deepest in the state.
So, Single Payer failed for many of the same reasons why many other good policies fail: rich people use campaign donations and lobbyists to kill them, because they’d rather people pay a helluva lot more for needed services than be slightly less rich.
Single Payer saves huge swaths of money over what we currently spend in America, and would have in Vermont, if designed around Single Payer systems that work all around the world. But a Single Payer system is never going to work if the single payer system is barred from using its leverage to force hospitals down on their prices.
It’s more complicated than big money opposition. The didn’t do a good job crunching the numbers and figuring out what the policy would actually look like. The states only HMO was ready to be absorbed. And the cost containment provisions were non existent. I agree with you these are incredibly important and one of the potential benefits of a single payer system, but Vermont policy makers failed to bake it into their policy.
Had they gone with a Maryland style all payer system of price controls they would’ve dramatically brought down the cost of care, and then the delivery mechanism doesn’t matter as much. The state could then more easily absorb all the costs or at least propose a public option so people could opt in to a government provider and keep the plan that they have.
Single payer has never been adopted in countries that have the kind of ad hoc messy system we have. NHS was passed in the 40s, most of the European and Canadian plans were passed in the 50s and 60s. Those systems leapt from private doctors and hospitals to a fully government system either via a national service like NHS or single payer. They never has the cacophony of middle men we have today.
Had Truman or Kennedy passed American NHS, we wouldn’t be where we are today. Instead you are talking about consolidating trillions of private dollars and private costs into a public system. That will be incredibly expensive and difficult to implement. Doing it the back door method that Obama did via ACA as the only feasible way to implement it. I agree with McDonough that in 15-20 years transitioning ACA to a fully public plan, whether universal or opt in, is inevitable. And it will have to be done federally.
So, yes, we could have single payer or a robust public option or an ‘all payer’ system or even a system similar to ours but that costs a lot less.
The problem is that if we want to have a system that costs a lot less and delivers the same or better care, hospitals and pharmaceuticals will have to be paid less. There’s no other way.
That could come in the form of single payer using market forces force hospitals to pay less, it could come in the form of a public option doing similar, or a public option statutorily based off Medicare prices, or it could be with a system similar to ours today… but with strictly regulated prices. And so on and so forth.
But it has to come in some form or another, because there’s no other way to make the system more affordable than to end capacity of hospitals, pharmaceuticals and insurers to fleece America.
Single payer would be the best and cheapest when done well, because there’s less administrative expenses, it would have the largest pool — and the most advocates, since when everyone’s in, everyone cares that it’s high quality.
But other systems can work good enough… if politicians take on the hospitals and Big Pharma.
Vermont’s pols retreated from that fight, just as other pols have done in state after state when it comes to affordability — because everyone’s afraid to take on the hospitals.
But with health care costs continuing to spike — almost as bad now as before ACA or Massachusetts’s health care reform bill — then something’s got to give, eventually, or either people will no longer be able to afford health insurance or the only way people will be able to afford health insurance is if they’re buying a product which no longer has any real value because of high deductibles, co-pays, etc.
And if being sick while owning health insurance causes someone to go bankrupt then it’s really little or no better than being sick without health insurance at all, because the end result will be the same.
Upwards of 100 million people across America are already making that decision today, BTW — either choosing no insurance, or choosing bad insurance (without the knowledge that the insurance will make them bankrupt because they haven’t had a serious health crisis or illness yet). So, for many, many people, we’re already at that point today.
It wasn’t so long ago that we didn’t have the cacophony of middle men that we have today, and most of those middle men have jobs that exist because of the insurance industry. Change the system, base it off Medicare which already has a system in place and that works, and there no longer is a cacophony of middle men.
Today’s system is what’s complicated. You’re projection today’s complications onto the cure of those complications. I’ve never seen any evidence to suggest that getting rid of those middle men by going single payer will somehow make the system more complicated. Quite the opposite, in fact. A complicated, byzantine system that’s filled with unnecessary (for care) redundancies is what we have today; a single payer system is a cure to that.
Shifting from one system may not exactly be seamless, but is something that may take a few years to work out the kinks, as opposed to the generations of complications created by our current system — complications that grow with compounding interest.
I am aware of how cause and effect work. If we pass one today, our kids won’t be in the place we are today, either. In fact, we’ll save them from those added years of grief and confusion our system has that grows with compounding interest every year, because *it doesn’t work.*
The ACA isn’t building any ‘back doors’ into a public system. Obama rejected the one idea that could have done that — a public option. The ACA instead empowers the complications and rewards the bad actors (health insurers, hospitals, Big Pharma) with more costumers without the kinds of strings attached to really grapple with the affordability issues that are plaguing our system today, never mind insuring the tens of millions who still don’t have health insurance.
1. Completely disagree. A state has a much better chance of passing it by virtue of the fact that there are more states where the party dynamics are such that they can.
2. If you were actually correct — and I don’t think you are — we are all fucked, because we’re never going to control the Presidency, control Congress with a liberal majority and control the Senate with a liberal veto-proof majority in my lifetime. We didn’t even have that in ’08.
And I refuse to believe the system is hopeless.
We elect leaders at the state level. We can elect leaders who will pass a health care bill that creates a pool that brings down prices, or forces hospitals and drug companies to charge cost + X%.
The chances of that happening are a helluva lot higher at a state level than the federal government. And if a state passes it, and it works, other states and eventually the federal government will have to follow — because there will be no other choice.
One of the things I don’t understand in all this is why hospitals appear to be such fragile things — frequently closing or consolidating, and also having difficulty achieving quality of care standards. It does not give the impression that they are huge wads of money that just require a bit of extra squeezing.
Admittedly, I haven’t done my homework here.
And the people who run them squeeze every penny they can out of them. When they fail to produce large profits, they are closed down.
If we squeeze hospitals, they’ll all close down because they’ll fail to produce large profits.
I think I expected a more worked out answer on the economics of medical care.
The medical model of the USA has its foundations in the capitalist market. Private hospitals have a goal to return a profit to the investors. Pharmaceutical companies have a responsibility to return a profit to the shareholders. Notice anything missing here? The health and well being of the patient seems to have been left out of the conversation. The working conditions of the employees, their well being and happiness is not on the list. No, they won’t all close down, they will just continue to merge as the bigger ones eat up the smaller ones.
The other thing I don’t get here is that most of our hospitals are non-profits, e.g., Mass General, Beth Israel, and Mount Auburn are non-profits. It’s not as if these organizations have shareholders or are paying dividends. To the extent that they generate money, it is likely for their management. It can’t be for “Wall Street” because, again, they are non-profit institutions.
We could imagine that hospitals are overpaid in three ways, I think:
1. They are performing a lot of useless but expensive procedures because they have an incentive to do so to increase their general fund.
2. They overpay (perhaps in aggregate) certain classes of professionals.
3. They reward their upper management in a way that is beyond generous.
As I indicated above, #1 is important to change but it is politically difficult — especially with Palin et al. whining about “death panels”. As CMD wisely points out, whenever you try to adjust professional compensation downward, you run the risk of reducing the number of available specialists in that category. That’s the effect of #2. Potentially, #2 could be addressed by turning more routine or standardized procedures over to less highly compensated personnel. It’s easy to believe that #3 could be a problem. That may be a cross-societal thing that has boosted the price of CEOing way beyond where a transparent and open market for CEOs would settle on a price.
I guess one would need to have a view of what percentage of gross revenue actually goes to upper management. If it’s 20%, well, that’s an issue; if it’s 0.5%, a reduction will have scant effect. How much?
If, on the one hand, you are expanding the heck out of the pool of patients, and on the other hand, you must “pay hospitals and pharmaceuticals” less, which means that you must pay the providers (doctors and nurses) less.
How does that not lead directly into a huge staffing shortage? Congratulations on finishing medical school, residency, fellowship. We are now capping your compensation at what we deem to be a sustainable amount; best of luck with the $400,000 of student loans.
…medical professionals in European nations aren’t exactly in the poorhouse. Of course, Europe probably subsidizes education too, so that would have to be another piece of the puzzle.
Source
My understanding was that getting the ACA passed — and it really did just squeak through narrowly — required getting conservative Democrats lined up. There were defections in the House, but the Senate defections mattered the most. Lieberman was not the only Democrat opposed to the public option either.
Obama’s stance on this had everything to do with what could and could not get passed by Congress.
There cacophony of middle men are the result of not adopting single payer 59 years ago, now that they exist, what do we do about them? They won’t go quietly and you are talking about hundreds of thousands of jobs being eliminated are rolled into a government system. The government nationalizing that monster will be incredibly expensive, even Jacobin admitted transition costs would be tremendous for the first decade or so. And that’s fine, maybe that’s the honest conversation we have to have to adopt single payer. To be honest with Americans about what this will cost and the short term sacrifices needed to have to make long term gains. The most liberal state in the union was unready to have that conversation until they were forced to in which case public support for the proposal eroded substantially.
Poll after poll show Americans prefer single payer, the same polls also show they wouldn’t want to pay for it if you attached realistic cost projections to it. That’s what happened in Vermont. It wasn’t special interest opposition but popular opposition because the Governor handled it poorly but also because most people would rather keep their shitty healthcare than pay 10% more in income taxes.
Until you change that wider political dynamic than it’s unlikely you will see it enacted, certainly in our tax averse state which couldn’t even muster more than ten communities voting for the gas tax index. I don’t see where you think single payer will suddenly find a political constituency in MA. Ask Gov. Berwick how potent it is.
I believe in the politics of the possible, and for the time being, we have a nominee likely to win in a landslide committed to a robust public option. We have a new crop of Senators who may win a majority committed to a public option. And we may have a house capable of tackling this. OR is actually a progressive state with a progressive voter base, maybe they become the first. MA isn’t there yet, but perhaps we can pass a progressive income tax and see if we can change the tax conversation to focus on revenue. If that passes, then we have a base to build support on. In the interim, I would rather we have a progressive income tax than single payer since it is a binary choice because political capital is finite.
by advocating that only the federal government can pass the necessary solutions, you are essentially ceding the ground and giving up on the issue.
While people in Massachusetts go bankrupt and/or die.
If that is the stance of the UIP, then the UIP is no better than the democrats elected today.
McDonough had the same timeframe and the same point I made, it’s going to take 15-20 years and have to be on the federal level. Vermont spent a considerable amount of political capital on a policy that couldn’t be implemented. It could’ve built on Gov. Dean’s coverage for children and done a public option, it could’ve built on ACA and expanded Medicaid. One could also a lot of sick people won’t get health care coverage because folks made the perfect the enemy of the good. There were four other options on the table and they rolled the dice on the boldest one and lost.
As for the UIP, we don’t have a litmus test on this issue. I’m sure it’s in the official DSC platform, not that many in the legislature actually have acted on it. Our policy is to adapt an all rate payer system and break up the Partners monopoly, we aren’t taking health care money like Coakley and Baker did either. One of our candidates Keri Thompson will file a single payer bill her first month in office. Jessica Lambert supports a public option.
I was speaking entirely in my own capacity as a student of public health and public policy, an admirer of the Vermont for trying this, and someone who became really disillusioned with the results. I was skeptical of Don Berwick during the campaign too, my skepticism has nothing to do with the UIP.
All the UIP $$$ is Falchuk $$$, which is health care money he made working his dad’s supplemental ins. business. This may also have something to do with why UIP solutions focus on keeping costs down only on the hospital side, but not on the insurance side.
To say UIP isn’t taking health care money is absurd.
It could have been. But Vermont didn’t do the things it would take to bring the costs down, and the Governor failed on the educating-the-public front that would have showed families making less than $150,000 a year still would have been winners (which is a vast majority of people in Vermont — their family income is much smaller than in MA).
Yes, as I’ve said, it ‘could have’ taken any number of approaches — but all of those approaches involve forcing hospitals and drug companies to charge less. And, so far, there hasn’t been the political will to do that.
And there won’t be any kind of serious health care reform that tackles cost issues until that political will changes.
A single payer system that doesn’t force hospitals or drug companies to charge less isn’t going to save much money, nor is a public option that doesn’t, and so on and so forth.
Politics is the issue. Not costs, or complications, or anything. We know how to bring the costs down. We know how to create a system that simplifies things for everyone. The question is can we elect political leaders who will enact the policies that do those things — and are willing to take on the powerful lobby of hospitals, drug companies and private insurers.
The answer, in my lifetime at least, has always been no. I hope that changes soon.
I feel we are talking past each other. I am saying the usual political caveats weren’t present Ef. Big money or major Republican or conservative Democratic opposition.
McDonoughs conclusions were thus:
1) Shumlin and the experts designed a poor policy
2) they explained the policy to voters poorly
3) Vermont is too poor to be the Guinea pig
4) Even rich states will run into implementation challenges
5) it’ll take 15-20 years for single payer to be implemented as a result of ACA not driving costs down
I don’t think you disagreed with any of these. Perhaps MA is richer. I applauded Sen. Eldridge’s bill and would’ve voted for Don Berwick in that primary. It’s a huge issue and I’d still vote for single payer as a voter or legislator, I just think we have to be very realistic about the challenges implementing it will require and less hostile to incrementalism and modifying our existing health care infrastructure rather than dismantling it and starting over to achieve an ideal system that actually brings with it challenges of its own.
But incrementalism means continued forward progress, and the candidate who just won the Democratic Primary for the POTUS certainly didn’t expend any effort to illustrate just what her incremental changes would be on the campaign trail. And I haven’t seen the state legislature expend any serious effort in pushing for incremental changes, either.
A lack of details on the stump means a lack of seriousness, IMO. These are not priorities.
Right now, we’re in a holding pattern, one that will continue until it is no longer feasible anymore, because in our government struggling families just don’t ‘count’ when it comes to politics. So, that pool of people will continue to grow and their struggles continue to deepen probably for another 20 or so years before the upper middle class and other voters who ‘count’ *really* start to feel the pinch and demand answers.
I don’t accept that kind of incrementalism. It’s been 10 years since MA passed its landmark health care reform bill. It’s time to pass a new one that seriously tackles costs.
But incrementalism means continued forward progress, and the candidate who just won the Democratic Primary for the POTUS certainly didn’t expend any effort to illustrate just what her incremental changes would be on the campaign trail. And I haven’t seen the state legislature expend any serious effort in pushing for incremental changes, either.
A lack of details on the stump means a lack of seriousness, IMO. These are not priorities.
Right now, we’re in a holding pattern, one that will continue until it is no longer feasible anymore, because in our government struggling families just don’t ‘count’ when it comes to politics. So, that pool of people will continue to grow and their struggles continue to deepen probably for another 20 or so years before the upper middle class and other voters who ‘count’ *really* start to feel the pinch and demand answers.
I don’t accept that kind of incrementalism. It’s been 10 years since MA passed its landmark health care reform bill. It’s time to pass a new one that seriously tackles costs.
We could pass an all rate payer system like Maryland to drive costs down and then pass a public option. Insurance companies dropping ACA will make a public option more likely as the only way to keep the whole system afloat, or we adopt stricter penalties for the mandates. The latter would be popular with Wall Street but disastrous to voters, and it’ll be interesting to see what choice Clinton makes. She says she’s for a public option, maybe a progressive Senate and retaking the House can accomplish this. It’s a lot more likely the new members are progressives than in the past.
No reason MA can’t pass cost containment like all rate payer, it even saves the government money if Baker was interested in that. A public option on top of that would be great. By all means push for single payer, but I’m confident those other two changes would make a real difference in the lives of working families and if they came first it would make single payer more likely down the road.
…and yes, she referred to these often in her public comments.
Our full plank titled Healthcare and Human Services reads:
The platform preamble also states, “We want healthcare to be a basic human right.”
I think it’s great that single-payer government-sponsored health care is in the Massachusetts Democratic Party platform.
What is the mechanism for making any part of this real? What is the stance of our elected Democrats in the legislature towards any part of this marvelous proposal?
We Democrats have a 160 to 34 majority in the Massachusetts House, and a 34 to 6 majority in the Massachusetts Senate. We therefore hold an overwhelming veto-proof majority of both houses, and can pass ANY LEGISLATION WE CHOOSE.
When can we expect the House and Senate leadership to bring forward legislation putting this proposal into law?
Eldridge’s bill seemed to go nowhere, just like all the other efforts over the years. Passing Romneycare was an uphill battle, and even that proposal had Democratic opposition.
And I applaud the activists and members like Christopher who have worked hard to make that platform better, I just wish there were more enforcement mechanisms. It seems that piecemeal seat by seat primaries are the way to go, and/or running credible opponents to bad incumbents in the general election. There still isn’t an infrastructure in place to run coordinated campaigns against routinely conservative legislators or the power structure itself. Anyone who doubts the UIP is that alternative is welcome to create their own, it’s incredibly difficult work.
When we start to realize that some of the Democrats in office are not the sort of Democrats that you and I think of when we use the term. Senator Wolf, at the convention two years ago that addressed wealth disparity in Democratic Massachusetts, said that the only way to put things into motion is to send elected officials keen on addressing the problem. The same can be said for health care.
The 160 Democrats in the House and 36 in the Senate will do as they please until WE speak up.
In short, the “when” is up to us, not them.
The people who called for this to be put in the platform need to lobby to get it done too. Of course, since we are not a parliamentary system this may or may not be successful. Platforms are approved in off years when mostly the most diehard activists (in terms of both ideology and level of involvement) attend conventions, whereas elections are open to all voters and even primaries include the unenrolled.
I’m glad it’s in the platform, I really am.
I think, as I’ve said before, that the Massachusetts Democratic Party needs to do a fundamental reevaluation of its vision, mission(s), purpose(s), and goals.
I say that because, and I mean this as constructive feedback, the institutional party as now formulated is a significant part of the problem. We have an overwhelming advantage of elected representatives. We enjoy an advantage in voter registrations. We have a marvelous platform that says exactly what most of us believe it should say about single-payer government-sponsored health care. We have an elected Democrat who has put forward a reasonable piece of relevant legislation.
Yet, in this like so many other urgent issues, our response to “how do we make any part of this real” is, in essence, “Not our job”. If “the people who called for this to put in the platform” have to step OUTSIDE the party to accomplish this (and I think that’s what you’re saying), then why bother to put in the platform at all?
I suggest that it is long past time for the Massachusetts Democratic Party to do whatever it must do to re-invent itself and create an entity with REAL carrots and REAL sticks. Perhaps the pursuit of such an re-invention might be more appropriate for one of those off years than cycling through another meaningless collection of words with no impact, no relevance, and no concrete consequences.
If I, as a lifelong Democrat — registered here in MA as a member of the Massachusetts Democratic Party for forty two years — struggle to rationalize why I stay, what on EARTH is the argument to attract a younger voter like any of my five children?
While johntmay and I may very different views about what needs to be done differently and in what order, I suspect we are in violent agreement about the utter irrelevance of the ONLY institutional Democratic Party presence in this state.
I think it’s long past time for the Massachusetts Democratic Party to “shit or get off the pot”. If the current leadership can’t figure this out, I suggest that new leadership is required. If that’s not possible, then I suggest that a new entity is required.
What we have now is fundamentally BROKEN, and needs to repaired or replaced.
…you would have to fundamentally alter our constitutional system, or at least many state laws. The same people who write the platform would have to have the power to vet candidates and nominees for loyalty. Even closing the primary to registered Dems would not ensure the result since there are many conservative/moderate Dems. If you move the platform to the same convention as nominating that MIGHT guarantee more adherence among endorsees for statewide office (though most who seek and get endorsement/nomination at that level already are favorably disposed to the vast majority of the platform), but even then delegates might have other priorities than platform loyalty and there is still that “pesky” primary. Conventions of course, have no leverage over legislative primaries. Again, parliamentary systems have ways of compiling party lists of acceptable candidates to make manifesto adherence much more likely, but they do it in ways that I doubt would pass the democracy test in the United States.
First, I’ll settle for something FAR short of a guarantee.
I suspect a rich variety of alternatives exist that you haven’t mentioned here. Let me try and offer some.
I see no requirement that “the same people who write the platform would have to have the power to vet candidates and nominees for loyalty”. Once the platform has been approved, it is a formal policy. We don’t require that the person who writes a policy that says “our organization does not discriminate in hiring” must then vet every candidate.
Surely there is no constitutional provision or collection of state laws that sets how much support the organization must offer a particular candidate or what penalties an organization might impose on a particular candidate.
I find it hard to believe that the organization cannot create provisions that say something along the lines of “any candidate who wishes to receive support from the Massachusetts Democratic Party must demonstrate that he or she is committed to promoting the then-current party platform”.
I strongly suspect that the Massachusetts Democratic Party can, if it chooses, create a selection of ways it is empowered to help candidates (“carrots”), a selection ways it is empowered to chastise candidates (“sticks”), and a process for administering those vehicles.
It seems to me that the Massachusetts Democratic Party can, if chooses, perform the re-invention I propose, within the limits of existing law. So far, you have offered a rationalizations for the status quo. I hope we can do better that.
If not, then sooner or later today’s Massachusetts Democratic Party — and the overwhelming advantage alleged Democrats currently hold in the legislature — will be swept away by one or more new parties that actually MEAN something.
…but that won’t be an easy consensus either. Parties are after all charged with promoting their candidates who will run the whole gambit of loyalty to the platform. DSC members come from every district and you will no doubt have members passionately defending almost every candidate/incumbent.
No profit in you and me fighting each other. Glad that’s over.
There are 126 Democrats in the House, not 160, which is the total number of members.
I was typing before coffee.
You say
McDonough says?
He also said it would have to be done at the federal level and take 15-20 years. I didn’t say there wasn’t political opposition, there should be when budget projections are done that poorly. The usual suspects didn’t apply. The states single HMO was for it, the state legislature overwhelmingly passed it and the Governor signed it. He got narrowly re-elected be because of it. There wasn’t a big money Koch brothers assault against it like JohntMay implied, the opposition was due to the poor implementation and not the other way around.
The “political” opposition was the result of poor policy implementation. Having your budget be off by 45% and requiring substantial higher than promised tax increases to pay for the program is the result of poor policy planning. Sure that made the plan politically untenable, but that’s what made the Boston Olympics untenable and what could make the GLX untenable. It’s not right wing money fueling ideological opposition, but average voters balking at taxes and budget expenditures they were promised wouldn’t occur. Either Shumlon was dishonest about the numbers or the out of state experts they hired to design the program screwed up their math. Either way, it’s not s right wing or neoliberal Democratic conspiracy as you and John are charging.
Ignore the ideology.
The CEOs of the Big Five for-profit health insurance companies all took home at least $10 million in 2014, according to each insurers’ annual filings with the Securities and Exchange Commission (SEC) (Aetna, Anthem, Cigna, Humana, UnitedHealth )
The highest-paid executive at the nonprofit insurers was Eric H. Schultz, chief executive of Harvard Pilgrim Health Care in Wellesley. He drew total compensation of $1.9 million last year, up 38.5 percent from the nearly $1.4 million he received in 2012.
Nope, not the Koch Brothers, but as my Uncle Al would say, right church, wrong pew.
Nothing about how much the CEOs make seems to have any bearing on the argument jconway is making regarding how and why single-payer didn’t make it in Vermont.
I just don’t see the need to point to them all. It’s money. It will always be about money when it comes to this issue. A few people are raking in a king’s ransom with our current system. They have so much that they can spend any amount needed to support it. Any amount.
…you still need to make the case that those CEOs donated to the campaigns of the VT politicians.
He’s a doctor, not a politician.
Making the changes at the federal level, given our political system, is even more impossible than at the state level.
The politics of it isn’t easy anywhere, but it’s easier in a state where Democrats are in charge and will be in charge regardless of whatever happens after the bill.
And a major policy advisor to governors and presidents.
If you are referring to McDonough, he is not a “doctor.” He was a politician, one of the best this state ever saw, a member of the House of Representatives during the 1980s and 1990. He earned an MPA at Harvard and a PhD in public policy at U Michigan. He currently runs a program in public health at the Harvard Medical School.
So… not that selective.
The states only insurer supported the single payer transition as did many of its largest employers. The public support collapsed when the budget projections were 45% more expensive than anticipated. Taxes would’ve gone up 11.5% for businesses and 9% for personal income. Those are massive increases and would have been politically untenable and regressive in terms of the percieved benefits.
John McDonough, a public health policy analyst and advocate was one of the architects of health care reform in MA and nationally, as well as serving as a state legislator in the 90s who pushed for single payer. He has conceded states will never be able to enact this reform, and we are likely 15-20
years away from the inevitable consolidation of the ACA and private plans into a more centralized public program. So it’s a bigger matter of economics and policy architecture, not just political will.
Scare me with a TAX bus then don’t tell me that the I won’t have to pay the $8K a year for my policy. It’s just the message of the corporations. We are closer to single payer than you think. Once my generation passes on (the old fuddy duddys that are terrified of the word “socialism”!!!) This is a slam dunk.
…that any tax increase would be more than offset by the savings in premia, copays, etc.
The savings for middle class households would not be realized for 10 years, and that’s assuming the cost containment assumptions bear out. So far the cost containment assumptions did not bear out with Obamacare. An all rate payer system like Marylands or a cooperative system like the proposed Coloradocare would likely contain costs better at the state level than leap frogging to single payer.