General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsToday's ACA win does not mean the end for the push for single payer, VT and Minnesota are leading
the way.
If the SCOTUS hadn't ruled the way they did, single payer would have been on high demand. Today's ACA ruling hasn't changed the fact that SINGLE PAYER is what we want, what we need & it is INEVITABLE! It is the only way to truly cut costs & reform health care.
We should all be energized and encouraged & our eyes should be on the states that are beginning to pave the way.
joshcryer
(62,276 posts)...will cause states to be more burdened (edit!!) than if they had a single payer system.
jpbollma
(552 posts)and single-payer is the end result. This bill simply moved the ball more firmly to the Left. It was an amazing accomplishment but not the end .
joshcryer
(62,276 posts)Bolo Boffin
(23,796 posts)But 2014 will be good, too. HHS is doing all the legwork necessary to have a federal public option in all the exchanges. And the states are free to do their own, I do believe. All that's lacking is the proper authority for the Executive Branch to offer one in accordance with the standards being established by HHS.
TheKentuckian
(25,029 posts)What we need is universal access to a national exchange if any of the market forces are even going to be more than a selling point for rubes.
Two throw away issues for most folks but the only ways for the scheme to actually even have a chance to work and to bear a passing resemblance to what the bill is touted as.
Deleting the bullshit "Cadillac" tax which over time will send us all to bronze land and imposing direct cost controls would be great, maybe even impose MLR's where they can contain cost rather than acting as an incentive to increase them, like on the pharmaceutical companies, durable medical equipment, hospitals, you know where the rubber meets the road rather than just at the purse when the cartel controls the allowable charges and they are below market. The MLR is also set where the industry self reported, there is some elasticity there because there has been some clean up of the definitions and yes there will be rebates but they speak to minimal impact of the signature cost containment element (not wanting to press the other major one much, the aforementioned "Cadillac" tax which is meant to diminish care) because as a percentage of health care dollars they are insignificant.
There are elements that could make a real overhaul but they are not being applied correctly and sometimes willfully hogtied.
I also think the anti-trust exemption has to go, the ability to collude and fix prices is a legitimate threat to make a mockery of the whole effort. Any aspect they don't wish to comply with is a little unity away from being folded on. The cartel has been given too big to fail status and there is no alternative gatekeeper to keep them in line.
Some kind of effort to limit pool fragmentation is critical, any impact of systemic savings will always be minimized especially the fool's gold of the savings from the uninsured being in the system. By the time you pass the nickles through many thousands of fragmented mini-pools and groups it just isn't much bang there.
It may even sound like nit picking but these sort of little seeming adjustments actually demand some rather serious remaking of the wheel.
The biggest appeal to many is "having something to build on" and that is the essential issue the structure is essentially the same shit we have now.
I want a public option, if for no other reason than to impose a systemic check on the cartel so that we have no choice but fold to their united front but it doesn't work save for a dumping ground for undesirables as things stand.
mother earth
(6,002 posts)course. Sanders is a people's man, I've no doubt in his committment to a just and cost effective system that will ultimately pave the way and like be the template in the next stage. This is a work in progress, but we will get there.
TheKentuckian
(25,029 posts)His commitment is not at issue nor can Vermont exert much influence beyond example.
I deal with what is not what I hope.
mother earth
(6,002 posts)that includes going beyond "what is"....we, as a whole, can shape that reality...if the founding fathers felt your way, we never would have moved beyond King George. You want reform? What reform do we need? How do we change what we have and move into something sustainable and real? Leading by example is one such way.
Don't you agree that a public option can still happen and is the same as the single payer that VT will lead the way with? We are only beginning to shape an outcome. Kentuckian, the public option will get here, it's inevitable.
TheKentuckian
(25,029 posts)Single payer would mean that everyone is in a single pool with everyone required to contribute via taxes and the benefit spread to every citizen.
A public option would be a government sponsored alternative plan that one could select among the various other plans and its construction could follow any number of rules and guidelines including being forced to account for the need of other plans to promote themselves, pay dividends, and even account for the profit motive such as was being discussed before the "sliver of competition" went the way of the dinosaur the last time.
Single payer means single payer not an option of payers among several that happens to be government sponsored.
Do I agree a public option can still happen? Perhaps, it depends by what your specific definition is and how you expect it to function. I don't think it significantly matters if most people have no access to it and further believe it will have less than optimal results if it is stuck in state operated and exclusive segmented pools.
As things sit currently, a Public Option would simply serve as a dumping ground for the cartel to dispose of undesirables in the small percentage of the population allowed to participate in a system of choice and competition, even if fueled by self selection. A sick person in need would be more likely to take the government option and that means that pool would be far more expensive to operate and eventually would collapse under its own weight while the private companies would take the more healthy and less likely to use services.
As far as what reforms are needed, I have suggested several approaches including a similar approach dependant on market forces and have discussed modifications nearly constantly for years.
The founders sure as hell didn't get free from George by strengthening the crown and sending him more money or by requiring oaths of loyalty to the monarch.
We have shaped reality with this very law and that reality comes with baggage and systemic limitations and it does no good to pretend it away.
Look, optimistically you can get anywhere from anywhere. If you persevere, know where you are trying to go, have tools and/or "landmarks" to guide you, and decent fortune you can get from A to B, no matter how far apart and actually you can start in ANY direction and eventually arrive at the destination if you are okay with a longer time frame, any possible level of difficulty of terrain, and are equipped to make greater adjustments in navigation.
That is fine and dandy, but forgive me for also understanding that if I'm trying to leave my house and end up in San Francisco that going to Niagara Falls isn't in the list of best routes. I can get to San Francisco from there but I've made the trip far more expensive and long while decreasing the odds of getting there by putting the extra miles on the vehicle. I have added a huge resource burden and wasted lots of time.
We have constructed a "reform" that required remaking the damn wheel in order to make functional improvements rather than a more bare bones but solid structure to build on by amending. Well, you can't amend your way from state exchanges to a national one, the latter is a wholly new system that must be put in place and supersede what exists now, including the oppositional political forces that prevented such now.
We can amend access but you still have to have 60 votes, the House, the Presidency, revenue streams, and some serious changes to the tax code to do it and still have to overcome the same political obstacles.
The "reform" requires not additions or amendments but actual reform its self because it was designed to maintain and bolster what already exists not to replace it.
Romulox
(25,960 posts)Comrade_McKenzie
(2,526 posts)Romulox
(25,960 posts)"Single payer has been smothered in its crib."
...that like the fight to pass health care reform, there will be people (Krugman, Kucinich, Sanders, Moore and many others) who will pick up the slack for those who resign themselves to not lifting a finger for progress.
Next stops a robust public, Medicare for all or single payer.
Romulox
(25,960 posts)"Sorry. But can you put that in the form of a list? No blue links = not convincing."
I'm really happy, and you're not.
Romulox
(25,960 posts)ProSense
(116,464 posts)Romulox
(25,960 posts)ProSense
(116,464 posts)"LOL. And you seem to be out of ammunition! No links, no argument!"
...it takes to make you happy? Here: http://www.democraticunderground.com/?com=view_post&forum=1002&pid=875453
Join the celebration!
Romulox
(25,960 posts)Romulox
(25,960 posts)wrap up!