they already spend ~$5 billion/year on healthcare.

We have been told ad nauseum that the ACA will lead to a single-payer system in the future. After all, look what is happening in Vermont. If Vermont is now giving up, fuck it, we will not see single-payer certainly in my lifetime.

We had a change, and Obama blew it.

Ben Nelson and Joe Lieberman blew it. All Obama did was sign the Bill into Law. He did not write the Bill or even give them very much input. It was written by Congress..Unless Nelson and Lieberman were going to go along with it, it just was not going to get done...PERIOD..

Have you been living under a rock?

Clue on line one: he owns every law that passes while he's president.

Guess what - Bernie Sanders owns it too. He voted for it.

Oh wait. Let me guess, you'll let him off the hook ... but you'll also hold Hillary's feet to the fire for her Iraq Vote. Right? God. You haters are so fucking predictable.

Sanders voted for it because Obama sold him out too. During the debate he expressed extreme disappointment in the president for lying about the public option during his campaign.

http://politicalticker.blogs.cnn.com/2013/09/24/bernie-sanders-obamacare-is-a-good-republican-program/

Sanders: Obamacare is awful - http://www.sanders.senate.gov/newsroom/must-read/the-obamacare-we-deserve

And so on. You can try to revise history but it just doesn't work

As for HRC, I care little about her iwr vote, a lot about her promise to be even more accommodating to the republicans than the current appeaser in chief

And even more bullshit since Sanders has continued to express support for the ACA.

are actual quotes from Senator Sanders.

From the first link (Sep 2013)

But comity, bipartisanship and compromise for congressional shills.

Medicare, Medicaid, and the VA.

And you know the difference between those and single-payer universal health care for all Americans.

this ought to be good!

You do know that "Single-payer", even "single-payer universal health care for all Americans", is a generic term for a healthcare financing scheme where (in most cases) the government pays for healthcare services ... Right?

Which is one of the problems with Vermont. If your hospitals also accept medicare, medicaid, out of state private insurance and VA, it's not single payer.

it doesn't mean the government only pays via one system or program.

Those programs are for specific individuals. So, no, "we" don't have single payer.

I also have to pay $4400-$17,000 to private insurance companies for the privilege of getting health care.

the reason I'm making this point is for those who have no idea how to create single payer in this country --

my point is that we have numerous examples of single payer healthcare systems in this country:

Medicare
Medicaid
VA

you and I BOTH want single payer healthcare in the USA.

you WILL encounter people who will tell you IT IS IMPOSSIBLE or that nobody knows how to do it.

that is wrong.

you can tell them there are examples of single payer healthcare in the USA and they can easily be expanded or even improved and then expanded.

Everything is Obama's fault, even the fact that it rained today!!1

Obama did. And now his cheerleaders are trying to convince us that it wasn't his fault we got a corporate friendly insurance expansion instead of single-payer health care for all.

We have been told by cheerleaders such as yourself for about 2 fucking years now that this is the best he could do. The states will take it from here and you'll see, in a few years, we will have single-payer. We have been told that Vermont is the proving ground for this bullshit lie. Just you wait and see y'all promised and opined.

And now Vermont has said, sorry folks, not now, and we don't know when if ever we will try again.

So yeah, this is Obama's fault.

Look it is pretty obvious you love Obama. Go sing his praises in the threads on Cuba (hint he didn't actually end the embargo cause he can't!) and one Alaskan bay. This thread is about the fuck up that was and is the ACA.

How is that Obama's fault and what was the plan to pass single payer Nationally without 60 votes?

If Vermont can't do fucking single-payer, how the fuck do you think Obama could've pushed it through at the national level? Stop with the seething hatred of the man for one goddamn minute and realize that he can't just snap his finger and get everyone to do their thing.

Also, bud, the entire Vermont delegation voted for Obama's ACA - including Bernie Sanders. But I don't see you yapping about that. LOL

On what alternative reality planet are you living?

Single Payer was NEVER going to pass!!!

I'm not sure what part of that reality is so hard to understand.

You were NEVER going to remove the entire insurance industry in one legislative act. It was never going to happen.

The ACA ensured that Vermont and other states could try such plans.

The path to single payer still goes through the Blue states. It starts with public options being added to the state exchanges. If those are cost effective for people, they'll chase out the insurance companies.

And that's how you get to Single Payer.

You however ... are actually demanding a pony that farts glitter.

Again ... in what alternative reality do you live?

You can not construct a path to passing Single Payer ... which is why you cry "Cheerleader". Its because you have nothing of substance.

Which is probably why you revert to a right wing attack at the bottom of your response ... very telling.

You don't seem to have any more political accumen than the average right winger, and so you end up (unintentional I assume) stealing their attack lines.

Well done!!!

I'm pretty certain President Obama said that he would implement single-payer in a heart beat if it was possible and wouldn't disrupt the entire market, as We D. People, have to go from a known system to a completely unknown system.

But I could be wrong.

... of course as a candidate, he also said this ...

doing nothing.

... agree ... I think as a nation we can get there ... but the idea that we just jump to it, is sllly.

The founders of this nation made it very hard for the federal government to do what we on the left want done. That's just the reality.

Those who think it was just going to happen, need to take some civics classes.

cultures/societies that change quickly, typically, don't do so for the better ... a strong man rapes and pillages his way to the top, generally, with the promise of glorious change ... only to leave the people far worse off.

A state, with the full (majority) support of it's legislature, wanted to try and institute single-payer. After years of trying to figure out how to make it work, decides to pull the experiments plug ... and it's President Obama's fault because the nation's liberals wanted single-payer, without the support of congress (and a significant portion of the electorate) and President Obama did force Congress to vote for single-payer?

Okay!

Bernie Sanders who led the call for this said there were only 10 Senators who would vote for it - and that was when we had 60 Senators and that count likely included Harkin, Kennedy, Kerry, and Dodd, all now out of the Senate. Kerry when asked why they didn't try to change the minds of enough Senators said they were not persuadable.

The problem has always been that people are used to having insurance via their employer. This is certainly not the most efficient, but there are many people who absolutely are comfortable with that and are afraid of change. That historical reality is why it has been hard to get a majority of legislators willing to consider single payer -- though many prefer to just say they were "bought".

then.. just sounds good flying off their keyboards.. like they read it somewhere and thought they'd continue the blow hard ignorance. Nothing to do with reailty

What one has to deal with on the internet.. as you know, karyn. Thank you for your thoughtful reply. But, yeah, Blame it on Obama 'cause he's a handy punching bag.

Vermont, yet. that doesn't mean it won't happen.. they didn't say they were "giving up".. that's your take.

You people did nothing in support of either a single-payer system or a public option. I was at the supposed "single-payer" rally in D.C. Nobody was there aside from about 300 far-left activists. Not even Michael Moore could be bothered to show up (though he did send Donna Smith). These same people refused to support the Public Option Obama proposed (I was on that conference call when he urged OFA members to organize). When I suggested support for the Public Option, Tim Carpenter himself (RIP) of Democracy for America refused: "single-payer or nothing." When I returned home and asked if local activists would support a pubic option, the answer was: "single-payer or nothing" even though the general public does not now nor has it ever supported a major shift to government-financed health care. Did those spitting, snarling Tea Party protests not teach you anything? Not to mention, the whole of the GOP opposes socialized medicine, so undermining the Democratic Party with your whining simply moved the possibility of future improvements that much further into the future.

Just shut up already, you people are the reason the Tea Party now controls Congress, thanks to the constant purity trolling.

You people did nothing in support of either a single-payer system or a public option. I was at the supposed "single-payer" rally in D.C. Nobody was there aside from about 300 far-left activists. Not even Michael Moore could be bothered to show up (though he did send Donna Smith). These same people refused to support the Public Option Obama proposed (I was on that conference call when he urged OFA members to organize). When I suggested support for the Public Option, Tim Carpenter himself (RIP) of Democracy for America refused: "single-payer or nothing." When I returned home and asked if local activists would support a pubic option, the answer was: "single-payer or nothing" even though the general public does not now nor has it ever supported a major shift to government-financed health care. Did those spitting, snarling Tea Party protests not teach you anything? Not to mention, the whole of the GOP opposes socialized medicine, so undermining the Democratic Party with your whining simply moved the possibility of future improvements that much further into the future.

Just shut up already, you people are the reason the Tea Party now controls Congress, thanks to the constant purity trolling.

can now line up to smooch my pasty old cheeks. The most liberal state in the union said no.

It is the proverbial "pony that farts glitter".

but we can't have it here because it's "too radical" or some other such bullshit. We're special.

I did not say it was "too radical" ... I said it was NOT GOING TO PASS.

Some of you need to take a civics class.

Try this ... explain how, in one piece of legislation ... you make an entire industry go away.

Please ... enlighten us, and provide DETAILS of how you make it happen LEGISLATIVELY.

Well?

i did not say you said it was "too radical". Please work on your reading comprehension if you think i did.

my comment was about this nation's attitude toward single payer health care in general, legislation in particular.

I get attacked regularly for pointing out that it was never going to pass, and I get accused of claiming it is too radical, when that is not what I believe.

So to be clear, I don't think its too radical at all.

I just think it fails legislatively, because the insurance industry is not insignificant. Lots of people work in that industry. You can't just fire them all.

So, legislatively, you can't just make it go away. So any effort to "replace it" will (I think) by necessity have to happen over time.

In any case, I get attacked for my position on the political approach on this so often that I thought you reply was a similar response, I apologize.

actually, i agree with you on this, painful as it may be (the situation, not agreeing with you per se). the insurance industry and their finance sector buddies have performed a marvelous jedi mind trick on the American people, such that implementing what is seen as basic common-sense policy throughout the rest of the world is extraordinarily difficult here. to many of us, Vermont was the leader on state policy, going where others feared to tread, and now they've bowed out -- it's a tough loss. maybe after the shock & dismay ripples pass, we'll see a return to the usual fruitless political wonkery on the topic, probably just too soon now.

Other countries started from scratch and had it running in a couple years. Best hope for us is 50 years. Unbelievable.

Like I said,

We live in a democratic republic, and a sufficient number of voters and their elected representatives in the USA oppose single payer to make it politically untenable, if not electorally toxic. The PPACA passed on the smallest of margins, killed numerous Democratic political careers, and is still unpopular. What exactly is your plan to pass single payer here other than complaining about other Americans?

what about my post suggested to you that i even had a plan or was obligated to present one to you?

right now, i'm perfectly content to grouse about my fellow Americans and our bizarre voting habits. what exactly is your plan, other than complaining about other DUers?

political change in the country. No plan of yours or mine will change than in the immediate future. However, I don't believe that accusing many millions of Americans who oppose single payer as being bizarre, or far worse adjectives, is a viable political strategy to change the hearts and minds necessary to ultimately pass more liberal healthcare policies. In fact, I believe it to be very counterproductive.

More importantly and relevant to the OP, I just do not understand how so many can blame President Obama for not passing a national single payer healthcare plan or how he is in any way responsible for Vermont's inability to pay for their own single payer plan. The fact that we have the PPACA is near miraculous, and its passage cost our party so dearly that it has threatened other Democratic priorities.

the fact that the Democrats had to sacrifice so much to pass the ACA, essentially a Republican idea in the first place, astounds me to this day.

Vermont said yes to single payer healthcare, they just don't know how to pay for it. The estimated costs significantly exceed all expected revenues for the state. Even the very liberal citizens of Vermont are apparently unwilling more than double their state fees and taxes to pay for the program. If that's the case for Vermont, what would be the reaction in the rest of the country.

The "president was smart to let the states do it chorus," as you refer supporters of the PPACA, were simply trying to view the law in the best possible light. However, no matter the wisdom of single payer, the necessary support and votes in Congress for anything close to it simply did not exist. The PPACA, quite literally, passed with the smallest possible margins, and great number of those Democrats who supported the law lost elections or were essentially forced to retire, and the law is still unpopular.

Never mind. It's like trying to convince a limbecile of anything.

Please explain how it happens, in detail.

Its easy, you take the Senators who voted for the ACA ... and then explain how you get MORE of them to vote for Single Payer.

Ready .... Go!

President Obama just needed to be more FDR/LBJ-mythos-ish!

what the president could have realistically done to secure the votes for single payer healthcare at the time the PPACA was passed? It almost didn't pass as its current form, and a great many Democrats, quite presciently, believed that the PPACA compromise would result in the end of their political careers. You are certainly free to criticize the president and party all you wish, but if you want to be taken seriously, you need to demonstrate the actual political feasibility of single payer. Your belief in its wisdom or citing other countries' systems clearly did not improve the popularity of the PPACA or single payer, nor provide additional votes in Congress. Where were the potential needed votes in Congress for single payer, and how could the president secure them?

While you're at it, I wouldn't mind you explaining how Vermont, which actually supports a single payer system, can pay for it, other than doubling its state fees and taxes (and not accounting for loss of business and other revenues from such a decision), something that even very progressive Vermonters will not tolerate?

health care costs. Even on the high end you are looking at cutting systemic costs in half. The money is there, focusing on the tax receipts is completely missing the boat and gives me the impression that folks are looking for magic beans or something.

Who the hell had the slightest expectation of paying for 18% of the economy out of existing receipts? To my mind if you have the option to cut costs by half you run not walk to do so.

We don't have our heads on straight at all on this. I mean almost to the point of insanity. How does it make any sense not to reduce systematic costs by 50%? That sounds miraculous! Who would have thought it would be possible to save that much but it is going to be painted as an obstacle?

That is crazy talk. What were the expectations here?

I'm sure they tried to factor in any savings they would get.

Doing this is much more complicated than some folks here seem to realize.

and your current expenditures are 5 billion or more then we are saying that a 50% reduction is too expensive? Explain that math. "Tried like hell" nor "very progressive legislature" squares that circle.

Saving 50% is a fucking miracle. That isn't something that can't be figured out if you had any serious intent because facts on the ground absolutely dictated that this wasn't going to be a few bucks or even cost less than 100% of current tax revenue due to the systemic costs. If that was the expectations then the entire effort seems completely dishonest or quite silly.

Those revenues would add up to far less than businesses and individuals are now paying.

Both of my sons have disabilities. I'm too old to start over since Reaganomics and deregulation crashed the economy. I shouldn't have had children. I look forward to death.

Come on!

European countries that are the size of the States in the US can manage to do healthcare. What are they doing that we can't figure out how to do?

That's what our "representatives" won't do

Very liberal and progressive Vermonters can certainly enact policies that effectively "fuck corporations." However, for Vermonters who live in the real world beyond hyperbole and slogans, they know full well that their state that collects $2.7 billion in revenue cannot exact a policy that costs $2 billion without severe economic and social repercussions.

If you punitively tax Vermont businesses and citizens, they will simply leave. They needn't even go far or to red states. For instance, New Hampshire and Connecticut are close and would be quite welcoming. The end result will be fewer and poorer Vermonters and still no single payer.

Single payer healthcare and related social policies are costly. If you cannot convince Vermonters to pay the bill in their own state, I'm at a loss to how you convince the rest of the country?

However, I do hold out hope that it can be done on the national scale ... But it will take time and must be established incrementally, as the shift to single-payer will not only be a shift in business modeling; but is, more, a cultural shift.

I see the ACA as a/the first step in that, as Joephilly indicates, the state exchanges orientates the consumer to looking to a single platform to get their insurance. The next step is for states to introduce a public option into their exchanges ... from there, and once the P/O proves efficient and cost effective, it is a small step to the federal government establishing a national public option, as a cost effective alternative to the individual state-sponsored P/Os.

But to tell corporations to F themselves is tantamount to a child stomping his/her feet ... it may provide an emotional high; but in the end, accomplishes nothing.

payer". And this is also why this should have been done on a national scale, where it COULD be afforded. As to how to pay, the insurance companies are going to take in 20% more than they pay out this year, and every year, per the terms of Heritage care. So how about this - We take the money that each of us was going to pay in for-profit premiums, reduce it by 20% that we won't be giving to the death merchants, and put that in the pool! Same amount spent on healthcare, no money-grubbing CEOs. Everyone gets the same care plus a 20% lower bill! Oh, the horrors of pissing off the corporations.

I am thankful that today's news will finally put to bed the ridiculous notion that Heritage Care put us on the road to actual healthcare. That is one less idiocy we will have to battle through to get healthcare like the civilized world has.

I've only argued that it was politically impossible to enact single payer in 2009, and there was nothing the president could have done to change this reality. I also believe that the PPACA is an improvement to our old system, and numerous Americans have reaped the benefits. Although the PPACA did not solve all health care ills (and neither would socialized care), I do not let the perfect be the enemy of the good.

In any event, not only is your "plan" so simplistic as to be little more than a sloganeering and not form a real basis for discussion (e.g., many health insurers are non-profits and large sources for federal and state government tax revenue, and the insurance industries are very large and important employers), my inquiries concerned a true plan that could receive sufficient Congressional support to actually become law.

Could you kindly indicate how the president or anyone else could have convinced Congress in 2009, no less the incoming Republican Congress in 2015, to destroy the entire health insurance industry and institute a national single payer program? Complaining about how health insurers are "death merchants," noting that other countries have socialized medicine, or arguing that the PPACA may have had conservative origins, have not only proven totally and completely ineffective in change policy or opinions, such strategies have actually managed to solidify and increase opposition.

what they can or can't do. Federally run programs like Medicare can't be replaced by a state.
Even the plan Vermont was working on needed permission from the Federal Government's Health and
Human Services Department before they could implement it.

With a mix of public general care clinics and private specialist practices, with regionally-run hospitals becoming more and more important to the system as the Finnish population ages, and a mix of public and private insurance provision.

My point being that Finland also decided against single payer.

To other states since the population of Vermont couldn't buy enough weed to help with taxes.

At a minimum, the federal government is going to be another, bigger, payer.

The provinces each run and partially pay for the health care there. The Federal Government pays for part of that cost.

There are multiple provinces and yet Canada still has what is considered a single payer system.

You're getting caught up on individual words and ignoring the meaning of accepted terminology on this topic.

As I understand it, You aren't insured by the Canadian Veteran's affairs, your wife covered by Alberta public health and your kids by Canadian Medicaid.

All care for everyone living in Calgary is coordinated by AHCIP.

I think it's a distinction *with* a difference. A patchwork of overlapping government systems is still not single payer.

I disagree with the idea that "the time isn't right"; I think the concept isn't right. Fundamentally, we won't get to single payer by adding more payers - public or private.

ACA - consolidation - is a step in the right direction

the Federal Government would still be running things like Medicare.

It just means there's a single entity paying for all claims in its coverage region.

This may be an example of why single payer isn't particularly popular as a health insurance plan worldwide.

and they want to do it also but people think it would have been possible nationally where you have to deal with people who aren't as liberal as vermont.

But I suspect some states not expanding Medicaid are partially responsible.

Cutting the Pentagon budget would be a good start toward paying for it.

The fedgov has to be a huge part of it to work.

http://en.wikipedia.org/wiki/Federal_taxation_and_spending_by_state


As many have noted, you can have a war machine or an adequate social welfare system, but not both.

I read the presentation from the Green Mountain Board, but I won't claim to understand all of the underlying assumptions. It's an interesting, if short and not very detailed, presentation. It'd be good to understand what exactly this decision, aside from the obvious issue of the enormous expected cost (i.e., exactly why would there be a problem lowering the cost curve). Anyway, thanks again for posting this.

P.S. For all those continually refighting the ACA battle: give it up. It's old. It's time to get educated on what happened in Vermont and what could be done to make a single-payer, or something similar, system work. I know it sounds condescending, but I'd rather worry about what can be done in the future than spend more effort fighting the last war.

In WA State, we haven't gotten that close, but the financing pencils out just fine. Single payer would be paid for by an assessment of 1% of payroll on businesses with less than $500K income, and 10% on payroll above $500K, plus $125-$200/month for adults 18-64. For Medicare enrollees, $50-$100/year will get you B, C and D. Every single bit of this money is not now part of the state budget--it would only become so if single payer is implemented--all new money. For both buisinesses and individuals, these amounts are far less than what they are paying now.

The math works out and would take care of current medical expenditures. The rate has to be flat because our state constitution prohibits progressive income taxes, but low income subsidies would be available.

How the hell can you not be able to afford apparently cutting total costs in half or better?

You increase revenues but guess what, the money needed is already earmarked for the same purpose and all you are doing I should changing the label on the pot from fee to tax and then it would seem folks would be able to largely call it a day on medical expenses. What used to cover just premiums foots the whole bill and all the rest of that bread can go to other uses.

If we can afford almost 10% just to pay premiums we can afford around 10% for the whole ball of wax.

Now if the numbers are way off then fine but that doesn't seem to be debated so that forces me to see it as just pure "don't want to" no matter how liberal everyone involved is supposed to be.

--should probably not be allowed out in public without adult supervision.

of dealing a death blow to the single payer movement otherwise he wouldn't be presenting these numbers as a problem but a big part of the solution of reducing costs and increasing coverage, we are talking what seems to be a dramatic 50% reduction in costs and simultaneously claiming that saving billions is too expensive.

It is pure nonsensical thinking to the point where I can't see anything but a con game. Did some dumbass think this would be free?

Yes, I'm that cynical.