There is a pretty steady stream of threads here saying that even a "public option" is a cop-out and we should be fighting for a true "single player" system like the one proposed in H.R. 676. But I see at least two huge stumbling blocks to that program:

First, lots of for-profit health care businesses are public companies. Lots of people own stock in them, and often have their retirement funds invested, in part, in these health care stocks. If for-profit insurers disappear, if for-profit medical providers must close up or convert to non-profit status, what happens to all of the potentially valueless stock and the people who own it?

Now, I recognize, no one guarantees success in the stock market. And people lost tons of money when their bank stocks lost 90% of their value, or when their stock in GM lost 100% of its value on the company's way to bankruptcy. But imagine the huge outcry if the *government* makes virtually all the stock in another sector of our economy worthless (even apart from it being yet another economic blow). Alternatively, the cost to the government to "buy out" all existing health industry stock at current market value would be unfathomable even by government spending standards, even if they could convince the public that truly "nationalizing" the health care system makes sense.

This is why I think a "public option" -- something which allows a government-run system and a private system to exist side-by-side -- is probably as close as we can get. Some private companies will find ways to transition their business models to continue to be profitable, by finding ways to market better/alternative/additional coverages to various segments of the population. Other companies, perhaps most of them, will ultimately disappear (or indeed transition to non-profit operations as H.R. 676 suggests). And people will have time to consider the status of the various health care stocks in their portfolios and shift their investments accordingly.

And with the public option, those us who would otherwise prefer a "single payer" system can opt in and have something very close to what we want for ourselves, without instantly destroying a huge part of our economy, and without what I see as the second huge stumbling block: the political penalty of forcing people into a system they are scared of, don't understand, or simply don't want because of their own political beliefs. By keeping the public option optional, you allow people to be free to make their own decisions, good or bad, and that is, perhaps, what is needed. What is probably "uniquely american" is the right to make your own decisions about as much as possible, even if the decisions are bad ones. Over time, I'd expect that more people will eventually come around to the new system, but they will do it on their terms, not by having the government impose a program on them.

In short, a public option gives us most of what we want, and has the benefits of a) not destroying the economy, b) not inciting a revolution, and c) actually having a chance of being passed.

as they are their portfolio. Then there would be a fiduciary obligation to keep people alive, instead of the opposite.

I suppose you meant it facetiously, but there actually is a science fiction book that explores that concept. I'm speaking, of course, of The Unincorporated Man, a fascinating first book by Dani & Eytan Kollin. The pacing and characterization are little rocky, sometimes, but it's a fascinating read. And there occasionally seems to be "preaching" of one side of the argument... until you turn the page and the other side gets preached just as hard.

From Publishers Weekly:



I really hope they do a sequel. I can't tell you where it left off because it would spoil the read, but there's definitely room to continue the story...

I started off being satirical or whatever, but as I was writing I started thinking that if there really was a way to sell "stock" in humanity---it might just be crazy enough to work!

Books, that is, not so much the movies. The best SF makes you *think*, and lets you approach ideas without preconceptions, because it takes you out of the familiar context. You can you look at "naked ideas" - stripped of all the baggage you might have when it seems to be related to the world you already know and already have opinions about.

This isn't quite there, because it obviously bears some relation to the world today. But it's a good effort, that might lead you to some personal revelations, even so.

Can't think of anything better for maintaining corruption than making it profitable for as many people as possible.

:shrug:

Like 18 million jobs and a sector p/e of 94 are anything to sneeze at.

For god's sake!!! Won't somebody PLEASE think about those poor stock holders!?!?

Lots of middle class people own stock, even if only in (what's left of) their retirement accounts. So right there, there's an impact on an enormous part of the population, who have already had much of their retirement savings wiped out by the previous collapses. Now the government is supposed to engineer the total collapse of yet another sector of the economy? Does everyone here really thing that's desirable? (Or feasible for that matter?)

And once the health care industry disappears, the economic effect won't be only on those who owned stock. Like everything else, no segment of our economy exists in a vacuum.

If that means some shareholders' portfolios are reduced in value, so be it. The overall economic effect will be very good for the country.

Sorry, but you fail. Single payer isn't about making the health care industry disappear - and you know that. Single payer is all about making health care available to everyone, and focusing health care spending on actual health care as opposed to administrative costs, corporate profits, and greedy, corrupt middlemen in the health care insurance industry. It's about removing the burden of a bloodsucking, lying, profit whoring corporatocracy from small businesses and the self-employed so that they can thrive, taking risks without fear of literally losing their lives as a penalty for failure. It's about setting the rest of us free from the yoke imposed by fear of losing the health insurance when we walk away from the unbearable employment situation to pursue a dream, be that an advanced education or a career change.

Frankly, anyone investing in this vampiric, destructive monolith should divest from it ASAP. Before we finally manage to deal it a death blow.

Would neither destroy the economy nor incite revolution. You weaken your argument terribly by deploying such hyperbole.

A well-constructed public option will put the private health insurance racket on a course to extinction, and that is sufficient at present.

I agree with your second sentence!

:scared:

needs a little nip and tuck, but wow we all like it and it has worked for decades.

In truth, the best course is simply to extend Medicare eligibility to all citizens.

If they had planned on doing that months ago, we wouldn't be in the mess we are now.
The Obama Team looks amazingly unprepared for this battle.

The current system is unsustainable, and everyone knows it. Let's not settle for a bailout of the insurance industry. Let's insist on the eradication of it. At this point, I would rather do nothing than to pass any of the bills under consideration in Congress.

:dem:

-Laelth

though I'd offer a "friendly amendment to your statement " I would rather do nothing than to pass any of the bill under consideration except HR676."

Sadly, I just don't think it's seriously being considered ...

yet

.

I am willing to wait. :)

:dem:

-Laelth

Works in Canada, Europe and the UK. The system we have now discourages small businesses, makes talented workers beholden to a corporation no matter how bad they dislike their jobs and reinforces the situation where individual progress is tied to how gainfully one is employed.

SICK of these "can't work because of the size and job loss" arguments. You think there's not going to be administration needed in single payer? These people would transfer to the single payer processing. In France, private insurance exists alongside their govt-paid health plan. Why can't it be that way there?

re: " In France, private insurance exists alongside their govt-paid health plan. Why can't it be that way there?"

Exactly! That's what I'm saying! That's fine. It's the government plan with a government mandated *exclusion* of private plans (hence the term *single* payer) that I think would be awfully problematic in the U.S. today.

I liked the pic you posted, btw. :-)

It would still exist but it would have a smaller, tighter focus. It could be for supplemental policies, or elective type procedures or addi tonal rehabs and therapies, dental policies, wellness type stuff, etc. etc.etc. They could still make money, not just the oceans of it they have become accustomed to as they have raked in a huge percentage of all healthcare dollars spent. Too bad. So what if they can't pay millions and billions to their execs.

It is not the job of the American taxpayer to voluntarily subsidize an outmoded outdated industry that makes money by denying it's core product when the rest of the world has moved far past us.

My new litmus test for any candidate will be:

Do you support unequivocally a single payer system for American healthcare?

Industries have historically come and gone without destroying the economy. How are we know to single-payer wouldn't create economic growth in other areas?

re: "Industries have historically come and gone without destroying the economy"

Yes. But this is like talking about the entire transportation industry at once, not just horse-and-buggies. And being taken out by government mandate, not natural market forces. I don't think there is any analogy in our past to the prospect of the government forcing an entire segment of the economy to convert to non-profit.

We couldn't have that now, could we? Much better to have people die needlessly.

I'm supposed to feel bad for the poor little stock holders who make money of me getting the worst health care possible?

Your whole line of thinking is based on the fact that Health Care should be a for profit industry. That my friend is where the problem lies. No one should be making decisions on whether people live or die using their profit margin as a basis.

I also think health care *should* be non-profit. I would certainly sign up for the non-profit public option, and everyone else who thinks that way would sign up for it as well. But I think the reality is that there are serious consequences to having the government *force* people into a non-profit system they aren't ready for, and essentially instantaneously shutting down a huge chunk of the capitalist side of the economy. By making participation optional, the shift can occur at a pace that can be better handled both by the economy and by the psychology of the general population. I think it's much more realistic.

consequences of forcing people into a program it was about the poor, poor, people who would lose money when they weren't able to profit off of others misery anymore. Stockholder and CEO's.

we agree on the approach. It took the Canadian national health insurance system many decades of evolution from inception in one province to a nationwide full single payer system. They did not do it overnight and it's unrealistic to believe we can too. The 'Public Option" is a first step in the right direction.

I'm not sure that HR 676 is the answer, but single payer (or at least a form of it) can co-exist with private insurers quite well. In France, they have a single payer plan that covers very basic services. Then they have an add on option through private insurers which extends benefits. 90% of their population have a supplemental policy through a private insurer.

re: "single payer (or at least a form of it) can co-exist with private insurers quite well."

I think maybe people here just aren't using words the same way, and in fact, there's probably a lot less real disagreement here than people think.

By definition, single payer = one payer (the government). If people can choose to get other insurance, then it is some hybrid... like a public option, for example, which is what I'm supporting. I don't know about the French system, but it seems to me that if you're going to have multiple insurance companies covering essential health care, you have some kind of multiple payer system, not a single payer system.

Canada's system works in much the same way.

Put everyone on Medicare.

Some of the largest corporations in America were involved in the slave trade. It employed a large number of people and transacted millions of dollars in business.

And, just as with for-profit health insurance, the slave trade made it's money off of human suffering.

then most people will not have any insurance because the costs keep going up. this is due to a couple of things.... a for profit health insurance company has to make a profit... in the case of most industries, the profit comes from providing a service or a thing and the customer gets that service or thing and then if they feel they got a good deal and were treated right, they will come back and you have repeat customers. health insurance can't provide the service, because their profits are dependent on people NOT needing to use the service they provide. much like auto insurance or life or fire... you aren't supposed to need it. but people need to USE their health insurance. and everytime they need to use it, that is less profits for the company. therefore we see a continual rise in costs as well as an increase in copays and deductibles.... putting the cost on the person so the company doesn't have to provide the service or less service. so we are paying more for less service. Then if we become ill and require to REALLY use the insurance, then they have to try to deny covering that because that cuts into their profits. So, they can only make money by NOT providing the service.

In most areas, yes.... private entities can do just fine and thrive. But insurance by nature is basically something that you aren't supposed to ever use. And that model does not work for healthcare. Plus, the only way for health care to work really is to have the largest pool of people possible because not everyone will be sick at once... therefore we all pay in and then if we need it, it's there. Insurance companies should be relegated to INSURANCE.... that place where you most likely will not need it, but it's there if you do.... like auto or life insurance is. The insurance industry could thrive on providing supplemental insurance for those catastrophic things that most people will never go through. instead of trying to fit regular things like tests and preventative exams to ensure health into an insurance model.

It will set a record for unreccomends.

We can't have progress or humanity, because people will lose money?

should fuckin CARE about! :sarcasm:

They are running scared because they know it isn't true. They are trying to snowball people into believing it can't happen in America. It's not workable. Too many people are against it so it won't get off the ground, then you make sure it doesn't get off the ground by not allowing single payer advocates to present their ideas to the people of the United States. Funny enough, many of us are learning about it anyway. This is a very effective tactic that frankly dates back to Hitler who wrote about propaganda techniques in his book, "Mein Kampf". Please don't continue to spread that idiocy here.

That makes me sick to my stomach. :puke:

I'm not saying people have a right to profit off healthcare. If everyone chooses the public option, so be it, the health industry has no protected right of profit. But I'm not sure the government has the right to *stop* these companies from making profit, either, when doing so a) would be against the will of some of their current customers (misguided as we feel those people may be), and b) could deal a massive blow to an already precarious economy.

I do believe there should be a government non-profit program. I think that, over time, it is likely that most people will in fact sign into it, and we will end up with something close to a de facto single payer system for most essential health services. It might even happen more quickly than the 15 year period specified in H.R. 676. But I think it is preferable, less disruptive, and more realistic to allow the population to adapt at its own pace via the public option instead of having the government mandate that everyone must transition to the government program whether they want to or not. I think Obama *needs* that stump speech line, "You like your current plan? You can keep it." Let these people see the benefits of the new system before signing into it, instead of forcing them into something they believe they don't want. Let the population and the economy adjust over time. It really seems much more sensible to me, and I'm surprised at how many vehement objections I'm reading here. (Though many of those comments are, umm, not constructive!)

I heard on NPR just a few days ago that the Bill and Melinda Gates foundation dumped all their health-care related investments.

It describes perfectly the OP, and sadly most of the public debate on health care we have heard so far. We are knee-deep in twaddle.

I've said many time that Obama is a brilliant advocate, but knows his limits and the way the political process works. He believes in realistic evolution, rather than idealistic revolution. Single payer, although I agree would be a better system, is not politically feasible given the both the political divisiveness in this country and the power and influence of the health insurance industry. THOUSANDs of people work in this industry and although i think they are corrupt at the top, there are good people who would lose jobs, public stocks that would have to be de-listed, investers including your 401K that would lose money, and it would be altogether too disruptive. The better option, the one the president and you have wisely proposed, is a step process that can at least get us a public option for those that don't have insurance and some competition for an industry out of control. I think this focus on who pays is also overlooking the more comprehensive reforms being proposed: models of best practice delivery (mayo/cleveland), preventative care and wellness programs, and other cost containment. Any single payer advocate who hasn't yet read the New Yorker article, "The Cost Conundrum", i'd recommend it. It opened my eyes to other reasons why our health care is so expensive and has poor outcomes besides the health insurance industry.

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Thanks for posting the link here. And it's nice to hear from someone who agrees with my post! ;-)

are a fool.

Horseshoes, carriages, carriage wheels. It must have come as a terrible blow when autos took over the American landscape.

My friends in the for-profit health insurance industry can cry me a river -- I'm in the Big Three family, I can't begin to describe all that we've lost (and it's not over yet). When the system changes, though, you have to regroup and find another endeavor, redirect your efforts. Or die. The world can't cater to your system simply because "it has always been thus." Change happens, and you grow or die. Ask anyone in Michigan.

The government did not come to the big three and say, i'm sorry but you are not working for the American people, we have a better way and are going to shut you down and start building cars on our own to save on administative costs and profit taking. In fact as i recall, the government did the opposite and has been trying to rescue the industry. What the president is proposing is process that may eventually get us to single payer, but for now the public option is a more viable, achievable, and less disruptive step.

to the tunes of 10s of billions. And the Obama admin is currently actively running GM. Way to fact check. :eyes:

Now the same administration presumes to order all Americans to contribute to the profits of private insurers.

They were given billions of dollars on several occasions to try to assist them from going bankrupt, and unfortunately due to poor demand for their products and the severe recession, the companies had no option but to declare bankrupcy and go into federal recievership. Trying to keep our history strait here. Cash for clunkers has seemed to help restart some factories too. I just don't see the comparison with health insurance.

"They were given billions of dollars on several occasions to try to assist them from going bankrupt, and unfortunately due to poor demand for their products and the severe recession, the companies had no option but to declare bankrupcy and go into federal recievership."

Funny, AIG, Citi, et al. seemed to have other options and didn't suffer any major restructuring or even leadership shakeups while recieving far more taxpayer cash (much of which was funneled to foreign banks.) I wonder why they were treated so differently?

Also, I notice that you've attempted to ignore the point that the Obama admin is directly controlling General Motors. :hi:

the act of letting Lehman Brothers fail, nearly took down the whole world economy into a black hole. It's deplorable and not worthy of a penny of support for what those greedy,selfish, irresponsible bastards did, but letting the core financial institutions fail was risking world economic calamity. We learned that lesson in the Great Depression and given the current relative economic stabilty, I think a wise move. Obama and the administration have promised(once they get out of the car business :)to put regulation and oversight into place (missing for decades) to prevent the need for us to bail them out again. I'm going to hold him to that promise.

The immediate crisis was long over when President Obama launched his vigorous PR campaign defending the AIG bonuses under the rubric of "the sanctity of contract". President Obama promised we'd return to that issue--yet another misdirection.

Now, Ben Bernanke says we are coming out of our recession. And AIG wants to pay its new director $7, and pay another several hundred million in new bonuses. Where are these Obama administration promises you're speaking of? :rofl:

are really 1) the inevitability of accepting and adjusting to changes in your comfortable system that the outer world has deemed no longer required or necessary, and 2) loss of investments is no defense of any system. (No insurance investor can come to my house and complain about loss of entitlements and investments, believe me! The comfy future and retirement we had mapped out for ourselves is GONE at age 50.) Even the actions that the government is undertaking with the car biz is also destroying great portions of it as it is recreating it. It's not the same as it was, and the changes are not over yet. Folks in the insurance industry will just have to join the rest of us who are figuring out how to recreate ourselves, recreate our wealth, in this mess. That's all I'm saying.

Iz our chilen larnin'??

:rofl:

:spray:

So do you have the data about its failure and economic collapse so we can see?

The system only paid 50% of costs after 15 years of development, and had a very different province based structure and system evolution than our own. Obama is starting the wheels rolling with the public option. Once people see how well the it works, and doesn't kill granny or break the bank, the ground could be set for further implementation.

from Wikipedia, history of Canadian system:

The beginning of coverage
It was not until 1946 that the first Canadian province introduced near universal health coverage. Saskatchewan had long suffered a shortage of doctors, leading to the creation of municipal doctor programs in the early twentieth century in which a town would subsidize a doctor to practice there. Soon after, groups of communities joined to open union hospitals under a similar model. There had thus been a long history of government involvement in Saskatchewan health care, and a significant section of it was already controlled and paid for by the government. In 1946, Tommy Douglas' Co-operative Commonwealth Federation government in Saskatchewan passed the Saskatchewan Hospitalization Act, which guaranteed free hospital care for much of the population. Douglas had hoped to provide universal health care, but the province did not have the money.

In 1950, Alberta created a program similar to Saskatchewan's. Alberta, however, created Medical Services (Alberta) Incorporated (MS(A)I) in 1948 to provide prepaid health services. This scheme eventually provided medical coverage to over 90% of the population.<10>

In 1957, the federal government passed the Hospital Insurance and Diagnostic Services Act to fund 50% of the cost of such programs for any provincial government that adopted them. The HIDS Act outlined five conditions: public administration, comprehensiveness, universality, portability, and accessibility. These remain the pillars of the Canada Health Act.

By 1961, all ten provinces had agreed to start HIDS Act programs. In Saskatchewan, the act meant that half of their current program would now be paid for by the federal government. Premier Woodrow Lloyd decided to use this freed money to extend the health coverage to also include physicians. Despite the sharp disagreement of the Saskatchewan College of Physicians and Surgeons, Lloyd introduced the law in 1962 after defeating the Saskatchewan Doctors' Strike in July.

Healthcare is a FUNDAMENTAL HUMAN RIGHT, not a commodity. The health insurance companies are evil, pure and simple. they are like a guy that lends you an umbrella for a fee, then demands the umbrella back when it starts to rain.

Good thing we didn't do that! Imagine the injustice to the poor plantation owners if that were to happen.

buggy whip stocks. The horror or it all!

As much as I hate to admit it, my state teacher's retirement is heavily invested in insurance companies. Their well being reflects right back on me.
I don't qualify for social security. My only security is my retirement system. I would still love to have single payer. It could be the end for me, but
it is the right thing to do.

I support single payer such as what John Conyers Jr. has proposed and have written my own rep asking him to support HR 676. I do realize that converting to a single payer system would cost many their jobs and would cost others money they have invested in for profit health care companies but I believe such a conversion would be best for many now and best for every citizen in the long run. It is impossible to make most any kind of major change in this country without someone taking it on the chin.

Thanks for adding to the conversation. Much more useful than the people who just name-called and such.

but your OP was well thought out and brought up an interesting point.

If your not going to fight for the best system going like single payer, then you get the crap that's left over..

HR 676 is the best plan out there.

Then sign me up for health <b>every</b> time.