by von
Matt Yglesias writes perceptively on why Democratic health care reform is failing, but – perhaps understandably — doesn't see his own role:
A disheartened Ezra Klein looks at a WSJ/NBC poll showing that people have lots of false beliefs about the president’s health care agenda and offers the following chart:
My first thought is “reform opponents are lying like crazy and it’s working.” My second thought is that three out of these four things would actually be a good idea.
…..
…. Obama gets accused of wanting a single-payer system. Then I have to say “no! no! he doesn’t! that’s a slander . . . not there’s anything wrong with single-payer.” It’s a damn dirty lie to say that the government will fund abortion services, but really the government should fund abortion services.
Yglesias concludes, in part: "I think this double-talk makes it hard to convince people that the process isn’t just being driven by people who secretly do want a government takeover of health insurance." This is true, but kinda misses Yglesias' own point a few paragraphs above. In fact, the Democratic Party's health care plans are being driven by people who want a government takeover of health care. For instance, Yglesias himself.
Yglesias, and a considerable number of others, hope that the Democrat's reform package will be the first step towards a nationalized health case system. It's the camel's nose under the tent approach; the so-called "incrementalist approach". And there's nothing wrong with letting the camel's nose into the tent if you indeed favor letting the entire camel in the tent: The sum of all the increments, after all, is government-run health care. But the "camel's nose" approach to health care reform makes it pretty much impossible to convince folks who don't much like government-run health care that the Democratic plan won't lead to government-run health care. For a considerable number of Democratic supporters, the Democratic plan absolutely does include government-run health care …. just not at this moment.
It's also crazy for Yglesias to blame "lies" for the fact that most voters have reasoned, correctly, that some of the louder folks pushing Democratic health care want "coverage for illegals," a "government takeover" of health care, and "tax-payer funded abortions,"* and to fear to some or all of these proposals are coming — if not this year, then soon. Yglesias himself wants all of those things. So do a considerable number of (although not all) liberal Democrats.** Voters aren't stupid: they see this and think that the current Democratic proposal – whatever its contents — is a just ploy to set up a future reform.
One can go on regarding all the other deficiencies in the Democratic sales job on health care reform – which are legion, and include the fact that Democratic proposals contain some stupid ideas and Democrats have largely ignored the well-reasoned, bipartisan Wyden-Bennett plan (in part because of union pressure). And I'm not typically in the job of advising the other side regarding how it can improve its arguments. Still, a significant (tho' not sole) reason for the Democratic mis-fires is that a lot of smart Democrats*** can't seem to see their own, counterproductive role in the sales job. Yglesias' post is Exhibit A in that regard.
*I should note that I support coverage for all persons, documented or not, like Yglesias. Of course, the current Democratic plans do not offer such coverage — another reason why I oppose them.
**Yglesias writes, with apparent surprise: "Interestingly, the one thing that doesn’t get a majority is the thing that’s actually a bad idea—killing grandma." I don't know why Yglesias should be surprised by this. A majority of voters correctly perceive that proponents of Democratic reform (e.g., Yglesias) don't actually want "death squads," even in their end game of a government-run health care system.
***E.g., Yglesias, whom I very much enjoy reading.
In fact, the Democratic Party’s health care plans are being driven by people who want a government takeover of health care.
Noooooo!!!!!!
Single payer INSURANCE. Not “health care.” Not, not, not, not…etc
Also, not government “take over.” Private insurance is still available!!!!
Yglesias, and a considerable number of others, hope that the Democrat’s reform package will be the first step towards a nationalized health case system.
Noooooo!!!!!!
Single payer INSURANCE. Not “health care.” Not, not, not, not…etc
Also, not government “take over.” Private insurance is still available!!!!
The sum of all the increments, after all, is government-run health care.
Noooooo!!!!!!
Single payer INSURANCE. Not “health care.” Not, not, not, not…etc
Also, not government “take over.” Private insurance is still available!!!!
It’s also crazy for Yglesias to blame “lies” for the fact that most voters have reasoned, correctly, that some of the louder folks pushing Democratic health care want “coverage for illegals,” a “government takeover” of health care, and “tax-payer funded abortions,”* and to fear to some or all of these proposals are coming — if not this year, then soon. Yglesias himself wants all of those things.
See above.
This is terrible von. You really need to do better.
I mean, in a post chiding someone for being to blame for the misinformation in the political discourse, you…spread that misinformation!
Jeez.
I agree that there’s a lack of clarity around what a desired “steady state” would be – and how we would get there over what time frame. Without that, opponents have more leeway to conflate the terms “single payer” (nationalized/socialized health insurance) and the (deliberately) ill defined terms “socialized medicine” and “government takeover”
Eric, re-read the post. I think you missed my point.
I don’t get it. Even if some Democrats want the whole schlemiel…funding for abortions, coverage for illegal immigrants, etc., it still doesn’t change the fact that none of these things are in this particular bill. I don’t think it takes great cognitive ability to reconcile these two facts: (1) some Democrats support policy x and (2) some Democrats will vote for bill y even though it doesn’t deal with policy x. The “camel” metaphor seems odd too…it’s not like if this bill is passed and the camel’s nose is let in, the other policies will just wander in of their own volition–there would have to be another bill and another vote. If people are confused about this, it seems silly to blame it on Democrats instead of people like Beck and Palin who are actively doing the confusing.
In fact, the Democratic Party’s health care plans are being driven by people who want a government takeover of health care. For instance, Yglesias himself.
Yglesias does not drive anything in the US government.
Might be helpful to point out the point he missed.
Good post, von. What’s funny is that Yglesias is sort of an instinctive neo-lib, so he’s going to be fine with any compromises.
I agreee with Eric and gwangung. You made a declarative statement which is not backed up by any sort of facts. Yglesias’ post does not supprt government takeover of health care.
You make many valid points elsewhere, but then throw this in there and do everything but use the word “socialist.”
Provide actual Democrats with power that support what you are alleging, please.
JanglerNPL, first, I’m not excusing the misinformation that’s being spread by Democratic opponents.
Second:
The “camel” metaphor seems odd too…it’s not like if this bill is passed and the camel’s nose is let in, the other policies will just wander in of their own volition–there would have to be another bill and another vote.
And of course that’s right. The point, however, is that a non-trivial number of health-care reform proponents see the current proposal as the first step towards something larger: that’s why the current plan is described as an “incrementalist approach” — i.e., the camel’s nose approach. (People who support the camel’s nose like the phrase “incrementalist approach” because “camel’s nose” generally sounds sneaky …. which is kinda is.) You’re right it’s not certain that the rest of the camel will enter. But a lot of voters will reason that, if I oppose the camel, I have to oppose the nose as well.
It’s very similar to a common Democratic response to the Republican’s attempt to reform social security. Many Democrats reasoned that Republicans ultimately wanted to destroy social security and, therefore, the current reform efforts should be resisted, whatever their merits.
Yglesias’s version of “govt takeover” means govt will pay for it, not that the govt will control the doctors/hospitals/etc.
The Republican version of “govt takeover” means the latter.
Two very different things.
Von: help me out. What’s your point?
the reason that yglesias is right to refer to lies and is right to decry the false beliefs that the polls reflect is because:
the polls show that a lot of people have false beliefs.
if you actually read the wording of the poll, the people were asked about what is contained in “the proposed health care plan”. i.e., the current plan being considered by the obama administration.
they were not asked “what might happen twenty years down the road?” or “what might some of the advocates of the plan like to do if there were no political reality to consider?”
in particular, they were not asked “what does the camel of von’s fears look like?”
instead, they were asked to comment on what they thought was contained in the current plan.
and they got it *wrong*. they had a deeply *false* picture.
and that’s because of a lot of *lies*.
like eric said, von–you’ve got to do better than this.
I agreee with Eric and gwangung. You made a declarative statement which is not backed up by any sort of facts. Yglesias’ post does not supprt government takeover of health care.
Did you miss the spot where Yglesias declares “My second thought is that three out of these four things [one of which is government takeover of health care] would actually be a good idea”?
Now, obviously, there are different degrees of government takeover of healthcare, and Yglesias hasn’t indicated which degree he wants. But, from the perspective of pushing the health-care bill, that doesn’t really matter. What matters is that Yglesias (and others) clearly want greater government control than in the current bill …. which is one of the reasons why he’s finding it so difficult to convince opponents that Democrats will stop with this reform effort. He clearly doesn’t want them to do so.
(Perhaps you and Eric are getting confused by the fact that I’m making a process rather than a policy criticism, here?)
It’s very similar to a common Democratic response to the Republican’s attempt to reform social security. Many Democrats reasoned that Republicans ultimately wanted to destroy social security and, therefore, the current reform efforts should be resisted, whatever their merits.
No, the opposite!
The Dems were complaining that the actual bill/legislation being proposed would destroy social security. Not that it wouldn’t, but would make people more willing to consider legislation decades later that would destroy social security.
Opposite.
Right, the bills not only don’t have “takeover” provisions, they bend over backwards to prevent a takeover of any kind.
I went over some of this in my “bad faith” post. There has to be like 100 different low-probability things to happen for this bill to transform into something remotely resembling single-payer.
But I keep hearing this “unions” bit, as if unions are what prevented people from adopting Wyden. What exactly do you think the GOP would say if the Dems came out with a bill that basically ended everyone’s employer-based health care? Unions may be part of it, but they are a small part — one of many.
von, I agree that there are almost certainly some voters who share your belief that incrementalism is at work here, and that is why they oppose the bill. But when 45% of people believe a reform plan will kill grandma and only an additional 10% believe a reform plan will mean coverage for illegal aliens (the response gathering the biggest “yes” response), surely the vast majority of those surveyed are not engaging in the reasoning you suggest (unless incrementalism is actually the reason for concern among the kill-grandma folks, something I don’t find likely).
Eric. Why do you want single payer so badly? (as opposed to say the government merely paying for insurance for the uninsured or subsidizing it EITC-style)?
Your arguments have seemed to focus on the idea that single payer will allow government to ram cost controls down pharma’s throat and force other cost controls down other people’s throats. I question that as a good method, but to constantly harp on “It’s just insurance” when an enormous part of the goal is to use the government’s control of the payment to reshape the system is approaching deceptive.
You want the government to be the single payer for a reason. And it isn’t just to cover the uninsured. There are lots of ways to cover the uninsured that don’t involve single payer. Furthermore, none of the current Democratic plans cover all of the uninsured (which I find very confusing). And in fact a huge majority of the legislation isn’t about the uninsured. This leads to the very reasonable inference that it isn’t mostly about the uninsured even though their plight is rightly the focus of the moral argument. It is not at all unreasonable to focus on why you think the government needs the POWER of cutting off most everyone’s standard insurance. You want that POWER to do things. It is not unreasonable, nor is it misleading to focus on what you want the government to do with that greatly increased power.
This is doubly true when some of the things you talk about using that power to do strike me as deeply unwise (see especially your repeated suggestion that lots of savings should be squeezed out of the pharmaceutical industry.)
Did you miss the spot where Yglesias declares “My second thought is that three out of these four things [one of which is government takeover of health care] would actually be a good idea”?
Now, obviously, there are different degrees of government takeover of healthcare, and Yglesias hasn’t indicated which degree he wants.
But he does! In the same piece! And you quoted him!
“I think this double-talk makes it hard to convince people that the process isn’t just being driven by people who secretly do want a government takeover of health insurance.”
What you did was seize on sloppy wording in a Matt Yglesias post (which is a given) and extrapolated way too far. You repeated the canard about government takeover of health care over and over again – even though we’re talking about insurance, not health care!!!!
What matters is that Yglesias (and others) clearly want greater government control than in the current bill
Nooooo!!!!
We want greater government participation in providing insurance.
See my original comment.
The confusion stems from the sloppy conflation of health care and health insurance, whether that sloppiness is on the part of Yglesias or you.
Either way = not helpful.
One of the points is not “government takeover of health care”. You are adding the last. Government takeover of paying for healthcare is a totally different thing. Unless you can find somewhere where he is stating the former, you are doing misinformation spreading. And additionally, please find others who are supporting government takeover of health care.
I don’t think Eric or I are confused. We both think that the process you are criticizing (or rather what you perceive to be the desired goal of the process) is not accurate.
Thank you for the response, von. I feel that the reasoning of your hypothetical “lot of voters” is flawed, and that each proposal should be evaluated on its merits rather than its potential successors’ merits–Republican plans as well as Democratic ones. I only recently started following this stuff in any detail, so I do not know whether the Social Security debate is analogous, but I’ll take your word for it.
von: First, as Eric said.
Second, So. What? Even IF the plans were for a government “takeover of health care”, that STILL wouldn’t be the lies constantly being screamed about grandmas on ice floes with Hitler and a bureaucrat. The rest of the industrialized world has universal, almost always government run health insurance or health care, and have yet to turn into illegal immigrant run death camps for grandma that cost everyone 50% of their taxes.
What is proposed is an attempt to spread health care and/or insurance to more people, and do it better, which is exactly NOT what Bush’s Social Security “reform” would have done, that would have just sucked money out of Social Security and stuck it into Wall Street, without providing any real benefits. So your example there is no good either.
Eric. Why do you want single payer so badly? (as opposed to say the government merely paying for insurance for the uninsured or subsidizing it EITC-style)?
Where did I say I want it so badly? Nowhere, actually, because I don’t. Every time you’ve suggested expanding Medicare to cover the uninsured, I’ve said I agree. We even joke about us co-sponsoring the bill. I’m OK with several alternatives, but think single payer is the best.
see especially your repeated suggestion that lots of savings should be squeezed out of the pharmaceutical industry
Seb, that’s ridiculous. We’ve discussed this topic repeatedly, and I’ve repeated that I do NOT!!! think “lots of savings” are available. I’ve said, some, and that some will help. Not sufficient, but something positive.
Also: cost savings come in vastly streamlining the recordkeeping/paperwork administrative costs.
There are lots of ways to cover the uninsured that don’t involve single payer. Furthermore, none of the current Democratic plans cover all of the uninsured (which I find very confusing). And in fact a huge majority of the legislation isn’t about the uninsured.
Right. Which makes it particularly odd to demagogue the Dem plans as “government takeovers” or even “single payer” camel noses. They are not even close. As you point out.
“The Dems were complaining that the actual bill/legislation being proposed would destroy social security. Not that it wouldn’t, but would make people more willing to consider legislation decades later that would destroy social security.”
No, the largest complaints I heard was that opt-out would undermine support for Social Security by those who opted out.
Same thing with means-testing. Whenever we go through the “It’s a pension, no it’s anti-poverty protection for old people” merry-go-round the argument goes in the following circle:
1. It is a pension
Response: It is a crappy pension
2. You can’t really judge it on that because it is really about protecting the elderly from poverty.
Response: The vast majority of the benefits don’t go to the poor or near poor. So maybe we should sliding-scale means-test.
3. *SHOCK HORROR* That would undermine the program because in the long run the middle class wouldn’t support it unless they were getting money out of it.
No, the largest complaints I heard was that opt-out would undermine support for Social Security by those who opted out.
No, the largest complaints I heard was that it would ciphon money out of Social Security, and due to the payment structure of current workers and current retirees, this would be unsustainable.
von’s failure to distinguish health care from health insurance weakens this entire post. Furthermore, the gap between the wishes of some proponents to “Likely to mean” is awfully wide.
I’ve never read Matt Yglesias previously and can’t see any reason to read him again. His noncommital and rambling piece would have been better left unwritten. I’d much rather read someone who advocated something — even if I didn’t agree with it.
If anything, this topic is the very opposite of a slippery slope. It’s among the stickiest slope imaginable. All the monied interests stand on one side and the public good on the other. The elderly would rather maintain the status quo. The bulk of the Democratic Party is ambivalent on a publicly-run insurance option, and the conservative Blue Dog caucus has disproportionate influence.
It’s easier to imagine the opposite. A future congress and President could easily kill or cripple the type of watered-down public option that the President may or may not support.
Whoops forgot the end of the merry-go-round.
4. So it is a pension.
In fact, the Democratic Party’s health care plans are being driven by people who want a government takeover of health care. For instance, Yglesias himself.
In the link Yglesias says:
And ultimately I think health insurance should be directly provided by the government.
Health insurance is not health care.
A single-payer health insurance plan does not exclude private insurance.
A publicly provided health insurance plan does not, remotely, on this or any other planet, constitute a government take over of the health care.
Weak tea, dude.
Response: It is a crappy pension
Compared to what?
My 401k is worth about 60% of what it was two years ago. I believe it’s worth less than what I put into it.
It’d be hard to compare SS to private pension plans because there aren’t many left. And most of those are hurting.
So, compared to what?
Does anything in von’s argument turn on the distinction between healthcare and health insurance? It doesn’t look like it to me.
I think the notion of interpreting legislation not on the basis of what’s in that legislation, but on the basis of what some of its supporters might like to do is bizarre. To begin with, it eliminates the possibility of any kind of compromise or negotiations. So long as the ultimate desires don’t change (and why should they?), it simply doesn’t matter what’s in the legislation.
Two other thoughts about all this…
First, as publius (and others) have pointed out, most of the versions of the public option that are being seriously discussed are specifically designed not to be the first step to single payer. The bad faith argument coming from proponents is not their denial that this is an incrementalist “government take over” (it isn’t), but rather some proponents’ continuing attempts to suggest to potential progressive supporters that it might be.
Second, as our national “debate” about healthcare indicates, any reform worthy of the name will get labelled “government takeover,” which is one of the many reasons that we should have tried for single payer. If you’re gonna win an argument over “government takeover,” you should at least get a “government takeover.” And the reason we’re not having an argument over single payer is not that it is particularly political impossible (I actually think it’s no more nor less politically possible than any other comprehensive and effective healthcare reform package) but that the leadership of the Democratic Party doesn’t want single payer.
“My 401k is worth about 60% of what it was two years ago. I believe it’s worth less than what I put into it.”
The second sentence is not likely to be true unless you have been putting money into it only in the last 3-4 years or unless you were in a very unusual 401k investment plan.
If the economy stays low enough that your 401k never comes back, I hope you don’t believe that the government will be paying out Social Security at levels comparable to the last decade (at least not post-inflation, I suppose they could just print enough money to make it appear that benefits didn’t go down).
Compared to any normal retirement plan that you would have put any similar amount of money into, Social Security is a bad deal.
Does anything in von’s argument turn on the distinction between healthcare and health insurance? It doesn’t look like it to me.
Yeah, it does.
In one case von’s claim is what we call “true”. In the other case it’s what we call “not true”.
Find all the places where von says “government-run health care”. Substitute the phrase “publicly provided health insurance”.
See if the argument has anything like the same weight.
Let us know what you discover.
von, I think you fail to distinguish between mere desire and actively striving for acquisition. I mean, I want to stop working and move to a beautiful tropical island where I live a life of leisure but I know that’s not going to happen. I’m not doing anything that could plausibly lead to the tropical island scenario. If you refused to do business with me for fear that I’d disappear one day for the island, you’d be an idiot.
There are lots of things that we want, things that we believe are “best” in some sense that we do not believe are feasible. I think the NHS is pretty awesome. I don’t plan on working to get an NHS system built in the US because I think it is completely infeasible. But that doesn’t change the fact that I think the NHS is really awesome, just like my insistence that the my tropical island plan is totally awesome remains even though I have no intention of bringing it about.
“No, the largest complaints I heard was that it would ciphon money out of Social Security, and due to the payment structure of current workers and current retirees, this would be unsustainable.”
It is already unsustainable, that is why we were having the conversation in the first place. And the whole syphoning money thing is an interesting way of framing it considering that Social Security has always been sold to the public under the blatant lie of it being like a retirement savings program. (Remember the “lock box” garbage?)
Again, I can’t see why conservatives would worry about the public option being a camel’s nose. After all, if they’re right, the public option will turn out to be an expensive, bureaucratic nightmare with crappy care that will be obvious to everyone, right? And so, you’d never get widespread support for extending it to single payer, right, since it would be political suicide?
Or are conservatives worried that it might, you know, work?
Should be “I have a bridge to sell you”. AllCaps and repeated no’s aside, there is a large number of people speaking for the progressive side of this debate who characterize every concession as a means to the ultimate single payer end. Single payer creates control, once you have control of the payment all the rest is semantics.
Asking for “people in charge” that are saying it is like saying we can discuss the debate but you can’t quote Rush or Beck (or Gingrich for that matter).
Silly stuff. At least debate the merits of the central point which is very effectively stated so I won’t repeat a word of it.
No, the largest complaints I heard was that opt-out would undermine support for Social Security by those who opted out.
Nonwithstanding that this is not what I recall (ie I recall that the proposals were a not-very-subtle attempt to destroy the system directly by diverting funds from it), this still doesn’t make it a good analogy. Von’s argument is that later legislation is likely to do something he doesn’t like even if the current legislation is unobjectionable. The SS example is of people objecting to legislation that they objected to on its own merits (or, as you say, because of the anticipated effects).
Objecting to legislation because you anticipate bad effects makes sense. Objecting to legislation because you believe that the same people will propose other legislation that you might not like in the future does not. If the first part looks good, and doesn’t create the necessity for the second part, then vote for the first part and not for the second part.
I think the distinction between health insurance/health care isn’t nearly as helpful nor as clear as Eric is asserting–especially not in the case of single payer reform.
Single payer may have some administrative advantages (possibly overstated by the fact that other government departments pay for things that can’t be hidden in a non-government’s balance sheet–i.e. tax collection and anti-fraud enforcement). But they aren’t anywhere near large enough to answer the complaint that the US spends too much on health care.
Single payer’s main theoretical advantage comes from monopoly power over providers. Using that power is an attempt to control how health care is provided for the majority of people. Proponents of single payer of course believe that such power will only be used for good. I’m more skeptical. An institution with monopoly power over providers tends to exhibit the negative characteristics of monopolies–slow responsiveness to change, active attempts to stifle competition, the propensity to get caught in dead-end ideas out of inertia.
Single payer reform wants near-monopoly power. It wants it for the purpose of doing something. That something is intended to strongly affect health care.
Yeah, I don’t quite get the connection between “here’s stuff that’s not in the proposed legislation, but that people believe is” and “I would favor some of this stuff if it were.” What are the special mind powers of Yglesias that inject his wishes into legislation, future or current or past? How should his personal preferences affect what people (who probably have never read a word he’s written) believe is in a written document containing specific proposals that Yglesias had no role in writing? Yeah, it’s Yglesias enabling Palin and Limbaugh. (I’d like a giant titanium iguana that eats old people. Now that my wishes are on the internet, will this show up in the polls as a suspected health-care reform proposal?)
And the whole syphoning money thing is an interesting way of framing it considering that Social Security has always been sold to the public under the blatant lie of it being like a retirement savings program
But the plan did siphon money out of the system, regardless of how it was sold. So, whatever.
Also, what carleton wu said.
Single payer’s main theoretical advantage comes from monopoly power over providers. Using that power is an attempt to control how health care is provided for the majority of people. Proponents of single payer of course believe that such power will only be used for good. I’m more skeptical. An institution with monopoly power over providers tends to exhibit the negative characteristics of monopolies–slow responsiveness to change, active attempts to stifle competition, the propensity to get caught in dead-end ideas out of inertia.
But it’s not monopoly power. Anyone can pay for treatments out of pocket. Anyone can buy supplemental insurance, or alternative private insurance. And, for the record, there are plenty of single payer systems in place, and yet none have succumbed to the fate you fear.
At least debate the merits of the central point
Fine.
I make this out to be the central point:
Yglesias, and a considerable number of others, hope that the Democrat’s reform package will be the first step towards a nationalized health case system.
In fact, that statement is untrue. Yglesias has said that he would favor a single-payer public health insurance plan.
Public health insurance IS NOT synonymous with government takeover of health care.
Period.
So, in a nutshell, the central and motivating claim of von’s argument is false.
Not true. False.
If we want to have a debate about whether there are some Democrats who favor single-payer health insurance, where “single-payer health insurance” means universally available publicly provided insurance for basic health care and nothing more or less than that, that’s fine with me.
It’ll just be a very short discussion. It’ll go like this:
“Some Democrats would like to see universally available public health insurance”.
“Yes, that’s correct”.
von,
But a lot of voters will reason that, if I oppose the camel, I have to oppose the nose as well.
First, I just don’t see the rationale here. If the GOP proposes a tax cut I think is good, I would support it. I wouldn’t think “they probably want other tax cuts that I don’t like, so I should oppose this as well.” The nose argument implies that the second bill has some inevitability as soon as the first bill becomes law, but I don’t see a causal force that makes single payer easier once this bill is passed. In fact, I see this as very likely reducing the possibility of single payer in the immediate future.
Second, it’s been pointed out that there is a different between what you assert- that voters anticipate future legislation- and the facts Matt cites- that voters believe that these features are in the existing proposals.
So, this isn’t about the nose at all- this is about lying about the legislative proposals currently on the table. It seems to me that you’re offering a subtle defense of the lies that have been fed to the electorate here, by misrepresenting the concerns represented by the polls as being about hypothetical future proposals. I don’t see any evidence out there to support the “nose” argument itself, nor evidence that it has any followers in the general public.
As I pointed out before (here, here, and here), there is no evidence that a substantial fraction of the Dem party leadership even wants a single payer system. Yglesias, like Eric Martin, is irrelevant. He has no power. He is not the Speaker of the House or the President or a major party bigwig. I’ve asked for evidence before and so far have gotten…nothing. I suppose von really has no evidence to support his beliefs.
I think ericblair’s point, also made by Dr. Science in the previous thread, is pretty compelling.
Whether people want single-payer or not, they’re not getting it with these bills. What anyone wants five or ten years from now will be heavily influenced by what happens between now and then. If the public option is an expensive flop single-payer wil be dead. If it’s successful, maybe the public will want to expand government’s role.
If you oppose that as a matter of principle, fine, but if you just think it’s a bad idea from a practical point of view then the camel’s nose argument doesn’t hold. Maybe what you think is a camel is really a dog, and it’s going to come in and be a loyal watchdog, and help you guard your sheep, and so forth.
It is only a camel’s nose politically. Nothing in the current bill would lead inexorably to single-payer, except that people might like the new arrangement sufficiently that the phrase “socialized medicine” might no longer scare them. Hardly a cogent argument on the merits against the current proposal.
This leads to the very reasonable inference that it isn’t mostly about the uninsured even though their plight is rightly the focus of the moral argument.
I think a wider-angle lens is called for, There is also the problem faced by those who face a significant probability of becoming uninsured for various reasons. There are also the cost issues in general, which after all drive some of the insurance problems.
It’s very similar to a common Democratic response to the Republican’s attempt to reform social security.
Not in the slightest. Total comparison fail. The supposed problem with Social Security was that it was underfunded. Bush’s proposal took more funds out of the system (by allowing contributors to take out 1/6 of their contribution and place it in a private account). It made no sense in terms of its stated intention, and only thusly was it necessary to try to infer the real intention of the proposal.
“A majority perceive that proponents of Democratic reform don’t actually want “death squads” ……….”
Well, we want “death squads”, but first the “death panels” need to meet and determine grandma’s relative productivity and then the “death squads” will be dispatched to carry out the “death panel’s” judgement.
It’s a little over-bureaucratic and duplicative for my taste buthe unionshave their work-rules and featherbedding — job creation, we call it over here in Nazi Stalinist Hillarycare land.
I would think the death panels could just push a button under their death panel table and dispense with Grandma right then and there, but government tends to fall behind in the latest technology.
I would think the death panels could just push a button under their death panel table and dispense with Grandma right then and there, but government tends to fall behind in the latest technology.
That’s OK, we’ll hire Blackwater. They’ll get it done.
“Bush’s proposal took more funds out of the system (by allowing contributors to take out 1/6 of their contribution and place it in a private account). It made no sense in terms of its stated intention, and only thusly was it necessary to try to infer the real intention of the proposal.”
No that isn’t the case, because the idea was that they also wouldn’t be able to drawn down on Social Security itself for that portion. (Which would be a greater pay out than pay in.)
“But it’s not monopoly power. Anyone can pay for treatments out of pocket. Anyone can buy supplemental insurance, or alternative private insurance.”
You mean it isn’t 100% monopoly power. Standard Oil was never a real monopoly. Microsoft has definitely never been a real monopoly. Yet the first was a target of initial anti-trust laws, and the second is often a target of anti-trust laws.
Do you deny that one of the major ‘advantages’ you see in single payer is the immense ‘market’ power it will have to cram down prices or make other changes? I’m pretty sure that in previous discussions you’ve talked about the need for government pricing power in that way (especially on drug prices). Am I confusing you with someone else?
I think that it is important to follow Dave Krugman’s lead and clearly distinguish the three health care reform options on the table.
The first option is socialized medicine, where the government runs and pays for everything. Examples are the British NHS and the military/VA system. That option has its advantages, but is impossible in the USA at this time. NOBODY is suggesting that, not even Mr. Yglesias.
The second is the single payer option (Canada, Australia, Medicare). Yglesias and most liberals (including Mr. Yglesias and yours truly ) like this. Indeed, I think that if Obama had led strongly from the beginning with a single payer proposal, under the slogan “Its like Medicare for all”, we would have gotten it this year. Unfortunately, Obama simply didn’t have the cojones for this approach.
The third option is the highly regulated private health insurance approach ( Germany, Switzerland, Netherlands). This is the approach being tried in the reform bills. Unfortunately, its complicated, difficult to understand and explain, and easy to demagogue, although its the furtherest from a “government takeover”. Indeed, that’s the tragedy. Despite the legislators bending over backward to avoid the “government takeover” smear, they are getting hit with that anyway, as in “take your government hands off my Medicare”.
I agree with Mr. Alpers. We should have gone ahead with single payer and given the demagogues some actual “government takeover”.We didn’t try that route, however. What will pass is a modified Swiss approach, with maybe a limited public option. Now if von thinks that is “government takeover”, well everyone is entitled to their own opinion, not to their own facts.
No, killer robots are definitely the way to go.
In one case von’s claim is what we call “true”. In the other case it’s what we call “not true”.
Find all the places where von says “government-run health care”. Substitute the phrase “publicly provided health insurance”.
This is kinda silly.
For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical. That’s because the vast majority of folks are unable to afford the vast majority of procedures, and the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market (assuming private insurance is even allowed).
So, please, continue to make these kinds of arguments …. and continue to be surprised why you continue to lose support for health care reform.
*Government-provided implies government-run, although, of course, one could theoretically have government-run health care/health insurance without government provided insurance.
“I think a wider-angle lens is called for, There is also the problem faced by those who face a significant probability of becoming uninsured for various reasons.”
Do you imagine that a bill covering the uninsured would be limited to the currently uninsured? If so, please let me know what the effective date is so I can be be certain to be uninsured on that date.
Eric Martin and Matt Yglesias are the liberal equivalent of Limbaugh, Beck, and Gingrich? I had no idea they had such an audience or influence!
Excuse me????????
WOULD YOU STOP DOING THAT!!!!!
“assuming private insurance is even allowed” indeed. That comment is dishonest, no two ways about it.
It is funny, von keeps writing comments but he never manages to provide any evidence showing that a substantial fraction of Democratic leaders want a single payer system. How strange.
Comparisons to the Republican-proposed overhaul of social security are, in fact, quite apt. Contra Eric, the Republican plan would not have destroyed Social Security. Social security, including a substantial government-funded safety net, would have continued to exist. The Grow accounts were purely opt in. Given the current misinformation about health care reform, however, I suppose that it shouldn’t surprise me that many Democrats believed the (false) Democratic hype regarding SS reform efforts and did not actually read the bill.
OTOH, to the extent that Democrats were legitimately concerned about “camel’s nose” type arguments …. well, that’s my point, innit?
As I pointed out before (here, here, and here), there is no evidence that a substantial fraction of the Dem party leadership even wants a single payer system. …..
I suppose von really has no evidence to support his beliefs.
Turbulence, when it was pointed out to you that substantial numbers of Democrats want some variation on a government-run system, you revised the issue to the Democratic leadership. And, you’re right, many (most?) of/in Democratic leadership is not, at this time, advocating anything like some in the grass roots are advocating. Now, why is that relevant to my point?
the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market
Von, you were asked upthread to provide something to back this prediction up. There are functioning single-payer systems in a number of countries. Where has one of them driven all supplementary private insurers out of the market?
“For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical.”
I don’t know what this means: “for the vast majority of folks,” etc. At the least, I’m unclear how you’re getting this information: mass mind-reading? Election to the Senate? But if it’s true, than, hey, let’s set up a government service that hires almost all of the doctors, and pays their salaries directly; it sounds more efficient than letting them engage in private practices. After all, you claim that the single payer proposals, which you say most Democrats approve of, “are functionally identical” to this, and Democrats are the majority, so therefore, apparently, we might as well go ahead and set up a National Health Service.
Ok.
Eric Martin and Matt Yglesias are the liberal equivalent of Limbaugh, Beck, and Gingrich? I had no idea they had such an audience or influence!
Martin and Yglesias, however, do reflect opinions held by many others.
Excuse me????????
WOULD YOU STOP DOING THAT!!!!!
“assuming private insurance is even allowed” indeed. That comment is dishonest, no two ways about it.
There are many variations on a government-run health insurance programs, and not every variation freely allows private insurance. So, no, the comment is not dishonest.
As “crazy” as it may be for Yglesias to blame Republican dishonesty for the poll results in question, it’s far, far crazier to say that “voters aren’t stupid.”
“For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical.”
von, this statement is ridiculous. As is your later statement about supplementary isnurance be driven out of the market.
Is Medicare government run health insurance? Yes. Is it functionally the same as government run health care? Not even close. Medicare rcepients have far more choice of physicians and procedures that people covered by private insurance.
Additionally, the private insurance thrives on providing supplemental isnurance to people on Medicare to cover what Medicare doesn’t such as deductibles, co-pays, etc.
This argument is going nowhere unless people actually try to represent things factually.
Turbulence, when it was pointed out to you that substantial numbers of Democrats want some variation on a government-run system,
I must have missed it. Where exactly did you point that out?
you revised the issue to the Democratic leadership. And, you’re right, many (most?) of/in Democratic leadership is not, at this time, advocating anything like some in the grass roots are advocating. Now, why is that relevant to my point?
If there is zero evidence that a substantial fraction of Dem party leaders want a single payer system, then it is not rational to believe that Dem leaders are using the current proposals as a gateway to single payer. I’m not just talking about what Dem leaders are publicly advocating right at this instant: I’m talking about party platforms, books they’ve written, interviews they’ve given in the past, speeches they’ve made, etc. Just about any evidence that rises above the group mind reading you’re relying on.
Also, Sebastian, upthread:
“The second sentence is not likely to be true unless you have been putting money into it only in the last 3-4 years or unless you were in a very unusual 401K investment plan.”
The Fidelity Spartan S&P 500 Index Mutual Fund has returned an annual average MINUS 1.19 percent over the past ten years.
Compound that and we’ll see how far ahead everyone is.
There are infinite variables to put this into context: age, prospective retirement date, etc, etc, but the investment strategies (very few people have a 401K Strategy, and the fad strategy of being fully invested in the stock market over the past decade has infinite variables as well, diversification among asset classes, etc.)
I’m willing to bet very, very few people know jacks–t about their 401K returns over the past however many years.
Also, Social Security was designed to be a “pension” with crappy returns, as opposed to the private pensions of various sorts which have had “crappy returns” during the last decade.
“”assuming private insurance is even allowed” indeed. That comment is dishonest, no two ways about it.”
I’m assuming he means private insurance for the things that the government covers. Which most likely would not be allowed under single payer.
And top-off insurance is highly controversial in some of the comparison countries, so the ‘assuming’ makes sense from that point of view too.
Also, are we positing
A) that politicians never say one thing and mean another;
and
B) that substantial numbers of Democrats definitionally have no influence on Democratic leadership?
Eric Martin and Matt Yglesias are the liberal equivalent of Limbaugh, Beck, and Gingrich?
I don’t even think Eric Martin is the equivalent of Matt Yglesias in terms of readership/notoriety/influence. Let alone either of us being in the Limbaugh/Beck/Gingrich echelon.
But color me flattered.
For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical. That’s because the vast majority of folks are unable to afford the vast majority of procedures, and the presence of government-run health insurance will drive most (all?)supplementary private health insurers out of the market (assuming private insurance is even allowed).
What on earth does that mean? If you can’t afford health insurance, and the government steps in to provide health insurance, that is still not the government taking over your health care because…you had no health care to begin with!!!!
And on what basis do you substantiate the out of business claim? Why have other nations been able to avoid that fate? What is it about a public option that would be so irresistible.
And really, it’s not the actual elements of the proposals that are turning people off. Actually, overwhelming majorities prefer SINGLE PAYER in poll after poll!!! It’s the misinformation and propaganda catapulted by a multi-hundred billion dollar industry cross-section.
Do you deny that one of the major ‘advantages’ you see in single payer is the immense ‘market’ power it will have to cram down prices or make other changes? I’m pretty sure that in previous discussions you’ve talked about the need for government pricing power in that way (especially on drug prices). Am I confusing you with someone else?
No, it’s not a cram down. There are some pricing advantages, also advantages of paperwork (administrative costs are huge, so don’t discount the effect of large savings in these areas). Those are the advantages, but I’m open to public option alternatives.
And other cost cutting measures are a separate issue, as you like to point out. But there are two tracks: insuring everyone/controlling costs.
von: Again, NO. Bush’s plan was to get money out of Social Security and give it to Wall Street. If that had happened, our current woes would be EVEN WORSE. Even leaving aside the blatant payoff to Wall Street, it was a Bad Idea that wouldn’t have worked out well for anybody. Trying to use it to destroy Social Security was just a side benefit.
But that’s a side point. The main point is that a) government run health insurance is NOT government run health care b) Why can other countries manage it without death squads and we can’t, c) NONE of those are in the damn bill being considered anyway, and d) There’s nothing wrong with government run universal insurance anyway (This chain was was the point of MattY’s original post)
“There are many variations on a government-run health insurance programs, and not every variation freely allows private insurance. So, no, the comment is not dishonest.”
No, it’s just discussing imaginary health care plans that are on the table in Airy Fairy Fantasy Land, rather than anything actually being negotiated in the Congress today.
So it’s really really relevevant.
To repeat the same question I still haven’t gotten an answer from from Sebastian when I asked him this when we had the exact same conversation in yesterday’s thread: please read this comment, this comment, and let me repeat: Let me ask a question in an attempt to clarify:
SebastianVon, how long, in your worst case, would you expect a single-payer-plan bill to pass Congress, following passage of whatever it is we will or won’t pass in this session?and: In any case,
Sebastian, von, I think that if you want to strengthen your case that passage of a bill this session — whatever it may wind up being — will inevitably lead to a single-payer system, that you’d do best to firm up that case with more specifics, rather than vague assertions that some politicians have at one time said they’d like to see it someday happen, or that a lot of ordinary Democrats say they favor it.Von, you were asked upthread to provide something to back this prediction up. There are functioning single-payer systems in a number of countries. Where has one of them driven all supplementary private insurers out of the market?
To be clear, it’s absolutely correct that many single-payer systems include private (supplemental) insurance. The UK single-payer system, for instance, has a robust (but, as a relative matter, very small) private insurance market … although it’s noteworthy that there are certain conditions where no private insurance is offered because public health insurance effectively preempts it. For example, AIDS/HIV treatment.
And this, I think, answers Gary’s complaint about my mindreading abilities. When you have a government program that effectively preempts the field, you end up with very small (or nonexistent) private insurers. It’s true that the examples of a no-private-insurer system is rare.* But it’s equally true that some elected Democratic proponents of health care reform have suggested that private insurance should be outlawed. For instance, Rep. Anthony Weiner (D-NY).
*Cuba is one, but I’m not relying on it — Rep Weiner’s quote is more relevant.
So if we make four leaps of assumptions, then we have something to worry about.
By this standard, we should all be frightened to death of almost everything, because, after all, if, if, if, if, therefore!
Von, how long, in your worst case, would you expect a single-payer-plan bill to pass Congress, following passage of whatever it is we will or won’t pass in this session?
My reasons for opposing the Democratic bill are based on the way that it further ties health care to employment, rather than any concerns regarding a single payer plan but, in answer to your question: it all depends on the public option. The public option is the nose under the tent, and thus is what’s getting all the heat (on both sides). Once you have a public plan — no matter how small — it becomes easier to expand the public plan.
But it’s equally true that some elected Democratic proponents of health care reform have suggested that private insurance should be outlawed. For instance, Rep. Anthony Weiner (D-NY).
von, that’s wonderful! You’ve managed to provide a bit of evidence for a proposition that several people had conceded yesterday, namely that there exist some Democratic congressfolk who want a single payer system. Now, do you think you can up your game and provide evidence that a substantial fraction of Dem congressman or the Dem leadership want single payer?
The UK single-payer system, for instance, has a robust (but, as a relative matter, very small) private insurance market
I would think the UK would be the wrong choice for comparison because it actually has government run health CARE not just government provided health INSURANCE.
Which is, normally, an important and essential distinction. This post notwithstanding of course.
Sebastian, von specifically used the term “supplemental” which by definition means an add-on to the public insurance. It is not meant to cover the same things the government insurance covers except as a way of covering that part of care the government doesn’t pay such as deductibles, etc.
Additionally, supplemental would include items like covering for things the government doesn’t cover like coolgen injections into the lips, etc, or private hospital room instead of the standrad.
And there is no rational reason to think that private insurance wouldn’t be allowed. To even make that statement as a question is close to irresponsible.-
von: Again, NO. Bush’s plan was to get money out of Social Security and give it to Wall Street. If that had happened, our current woes would be EVEN WORSE.
Sorry, not true. Here was the final (?) Republican proposal regarding GROW Accounts. Note that these were opt-in accounts and that did not divert SS money. Even the original Bush accounts were purely opt-in, although they left a potential shortfall in SS that would need to be filled with greater deficit spending.
How could they not divert SS money? Even if they were opt-in, wouldn’t you be opting your SS money into these new accounts and not SS?
The UK is not a single-payer system. The NHS is actual government health care. Canada is single-payer, as is France and various others. There is no plan to outlaw private supplemental insurance, and certainly no plan to eliminate out-of-pocket purchases of health care.
But to answer those who ask why people are so adamant about the single-payer system is that it is one system that has been proven to work time and again, both in other countries and in subpopulations of America. So, rather than cobble together something that is “uniquely American” (i.e. untested and quite likely to not work properly), why not go with what is proven to work, and work well? The only answers I’ve ever gotten to this question (other than the ones that flat-out deny statistics) are very religious in tone–crooning homages to the miraculous wonders of the free market in all places and times.
sebastian: “that substantial numbers of Democrats definitionally have no influence on Democratic leadership? ”
I would think the fact that single-payer was never considered by the Democratic leadership, and the way the “leadership” has been dragging their feet and/or getting played by the GOP should show this to be pretty true.
von: What, exactly, is the benefit of having a large private health insurance industry? What do they offer society, besides new and creative ways to deny people treatment and funnel money to execs?
Seriously. You’re going all out on how evil single payer is because it would kill this vital segment of industry, so what does the health insurance industry DO that makes it so worth protecting?
And there is no rational reason to think that private insurance wouldn’t be allowed. To even make that statement as a question is close to irresponsible.-
Except that Rep. Anthony Weiner (D-NY) (link above) suggested outlawing private insurance.
Again, I don’t think that Weiner’s arguments would prevail even among Democrats (indeed, even among liberal Democrats). But I don’t think that it’s irresponsible or dishonest to note that a certain number of liberal Democrats (including elected officials) are open to outlawing private insurance, so long as you provide the clarifications and caveats that I have.
I would think the UK would be the wrong choice for comparison because it actually has government run health CARE not just government provided health INSURANCE.
Eric, you are going to explain the distinction that you’re trying to draw, here. I know something about the NHS, and you can accurately characterize the NHS as either government-run health care or government-run health insurance. (It’s true that folks in the UK tend not to use the term health insurance to refer to private health insurance, but that does not mean that the NHS is not a form of health insurance.)
von, you use one quote to advance the arguments that Dems want to outlaw private insurance, which may or may not accurately reflect his thinking. How many elected Republicans have announced clearly that they want Social Security to no longer exist? I will take some time, in between work projects, to provide some. But I am pretty sure it is more than those Dems who have stated they want to get rid of private insurance.
Sorry, that should be “folks in the UK tend
notto use the term health insurance to refer to private health insurance …”I know something about the NHS, and you can accurately characterize the NHS as either government-run health care or government-run health insurance.
As the Brits would say, bollix.
Under the NHS, the government runs the hospitals, pays the salaries of the MDs etc. That might include the provision of insurance, but that is only a facet of the over all health care system that is government run.
Unlike anything that was even remotely proximately related tangentially in an off hand way associated with the Dem proposals.
Contra Eric, the Republican plan would not have destroyed Social Security.
On such complex issues, I like to hear what experts like Brad Delong say:
Given the choice between some lawyer from the midwest and an econ professor who was a former treasury dept official, I think I’ll go with Delong. Plus, Delong also occasionally admits to being wrong. That sort of thing makes it easier to trust people.
How could they not divert SS money? Even if they were opt-in, wouldn’t you be opting your SS money into these new accounts and not SS?
Eric, the original proposal from Bush on SS reform didn’t answer this question. The revised proposal from Republicans answered the question by blocking portions of the SS surplus to pay for non-SS matters.
The UK is not a single-payer system. The NHS is actual government health care.
Except that the UK system can be described as a “single payer system”. That’s one reason why I’m asking Eric to clarify what he means when he draws the distinction between providing health insurance and providing health care.
Stats for Households With Members Age 65 Years Old & Over – 2007 US Census Data The median income for said households not including government transfers was $13,807. Note that the poverty level for a household of 2 in 2007 was $13,690, so a majority of said households would have been likely have been living in poverty or near poverty were it not for the governmental transfers they received which raised the median income to a whopping $31,305. Now it could be that Social Security itself doesn’t go in equal amounts to those near poverty as to those who have had higher earnings but it seems unlikely that the roughly 70% of the households in the bottom two quintiles would receive significantly less than the 30% in the top three.
von: There’s no question on the definitions here, but let’s make it clear: government run health insurance means the government pays for procedures by independent doctors/hospitals etc, just like (most) insurance companies do now. Government run health care means the government actually employs the doctors/hospitals/etc. Which, yes, usually involves the government paying for procedures too. Can we stop playing word games now?
As for SS (which is a side point, no the main), the article you cite disagrees with you, for first, it was going to be opt-out, NOT opt-in. “Personal accounts, called “GROW” accounts, would be established for all workers under the age of 55, unless they choose not to have an account.”
The rest of it looks very…fishy. The money would have been “credited” to the SS Trust Fund (i.e. used to buy the Treasury Bonds in the Trust Fund) and then used to buy Treasury Bonds for the individuals enrolled in it somehow? Or whatever other investments were “recommended”. Then the account balances would be used to pay for part of the person’s SS benefits, with the Trust Fund making up whatever the difference was. How is that anything other than double accounting? And it doesn’t matter, because it was defeated, so we’re a few years away from having to deal with that kind of nonsense.
Camel’s noses sound a lot like slippery slopes, with the exception that we are all aware that slippery slopes are bad reasoning whereas camel’s noses are new and, as noted earlier, sound sneakier.
The odd thing about this particular slippery slope is that it has these weird things called “other bills that have to be passed” lining the slope in an interesting configuration that creates something more like a “long wide descending staircase that is fairly easy to stop along or even turn around and walk back up”. But then that turn of phrase is kind of bulky and probably doesn’t sell von’s point very well. Or sticking with von’s own camel’s nose, I will simply add, as many have above, that the camel in question has an awfully lot of extremely large humps that are going to make it very tricky indeed to sneak it into a tent without anyone noticing.
von, you use one quote to advance the arguments that Dems want to outlaw private insurance, which may or may not accurately reflect his thinking. How many elected Republicans have announced clearly that they want Social Security to no longer exist? I will take some time, in between work projects, to provide some. But I am pretty sure it is more than those Dems who have stated they want to get rid of private insurance.
You don’t need to do that, John: I’ll accept that you’re right. The point is that a lot of folks don’t want even a majority-public system (like, e.g., the UK). The only reason why I provided those quotes was to respond to arguments that I was being irresponsible (or lying) for suggesting that some percentage of Democrats really did want to eliminate all private health insurance.
“My reasons for opposing the Democratic bill are based on the way that it further ties health care to employment, rather than any concerns regarding a single payer plan but, in answer to your question: it all depends on the public option. The public option is the nose under the tent, and thus is what’s getting all the heat (on both sides). Once you have a public plan — no matter how small — it becomes easier to expand the public plan.”
The purpose of my intention is that you — and Sebastian — and anyone making this argument — be specific as to your worst case scenario: do you see, worst case, the single-payer bill being introduced next year? In 2011? 2012? 2014? 2020? 2030? What year, or range of years, specifically?
You’re making a Slippery Slope Argument. I want you to make it concrete, rather than — and I refer you to my previous two comments again — refer to vague “tendencies” and vague possible unspecified times in the future, in scenarios that depend on multiple sets of “ifs” happening. I’ll allow you one if: if the public option” passes, then in what year or range of years do you expect Democrats to begin trying to pass single-payer?
Thanks.
” why not go with what is proven to work, and work well?”
The difference in what works in the US vs Canada vs the UK or France is not limited to the construction of the healthcare system. There are many facets of those societies that are different that could make a particular healthcare solution work better or worse. The fact that all of those countries have different systems is a reason, in itself, not to just implement one here and assume it will work.
American government works differently, society is different, culture is different so why would anyone assume the healthcare system that works somewhere else would work here?
On a separate note, I can’t speak to what other people think of their social security as providing, but I find it useful to think of as this thing called a “safety net”. The idea here is that it is a guaranteed amount of money that I can count on being there when I retire. In good times, it will provide a little safety and security, peace of mind if you will. In a pinch, I can fall back on it entirely. It will be a very uncomfortable fall, because it isn’t meant to be a big cushy mattress, just a net. You know, for safety. So I can go ahead and try for bigger things with the rest of my retirement money.
Except that the UK system can be described as a “single payer system”. That’s one reason why I’m asking Eric to clarify what he means when he draws the distinction between providing health insurance and providing health care.
Oh jeez von, you are much, much, much smarter than this. You don’t really need me to do this but I will:
1. Government provides insurance but private hospitals, private doctors, private medical care professionals handle the health care.
Single payer, not government run health care.
2. Government provides insurance (even and especially if single payer), government also provides and runs hospitals, publicly employed doctors, publicly employed med care professionals.
Government run health care.
In the UK, they have single payer AND government run health care.
In other countries, such as Canada, they have single payer but NOT government run health care since the private sector still provides the actual CARE. Not the insurance, but the CARE.
Thus, you can have single payer with either model, but it’s only government provided health care where the government provides the health care.
von: You weren’t saying that “some percentage” of Democrats wanted to eliminate private health insurance, you implied it was the DIRECT RESULT of any single payer system. Which is FALSE.
Nate, where does it say that the GROW accounts were (under any version) opt-out? The original Bush plan or the second plan? If it’s there, I misread it. Sorry.
Under the NHS, the government runs the hospitals, pays the salaries of the MDs etc. That might include the provision of insurance, but that is only a facet of the over all health care system that is government run.
And how do you think insurance reimbursement works? Granted, the NHS has elements of centrality control that are not found in all single-payer insurance systems, but it’s a matter of degree — not kind.
von: You weren’t saying that “some percentage” of Democrats wanted to eliminate private health insurance, you implied it was the DIRECT RESULT of any single payer system. Which is FALSE.
Provide the quote where you think I said that.
von: The bolded part. Again, “would be established for all workers under the age of 55, unless they choose not to have an account.”” That’s the DEFINITION of opt-out.
Okay, and now you’re just being obtuse deliberately and trying to conflate the NHS with government provided insurance, which is false, and everyone has called you on so far.
In other countries, such as Canada, they have single payer but NOT government run health care since the private sector still provides the actual CARE. Not the insurance, but the CARE.
OK, so does the US have public health care? Because a large number of US hospitals fit the definition of being run by the government (e.g., New York City Health and Hospitals Corporation, which was created by the New York legislature as a public hospital.)
I really think that you’re drawing distinctions that are not particularly meaningful. You’re right that no one is seriously proposing a centralized public health care system, a la the NHS. But it’s the centralization that’s the key distinction between the NHS and the issues at hand, not the “government run” healthcare bit.
The point is that a lot of folks don’t want even a majority-public system (like, e.g., the UK).
True, to the extent that Anthony Weiner is “lots of people,” and to the extent that he is calling for anything remotely resembling the NHS, which he is not doing, and to the extent that he said that he would outlaw private insurance, which he only sort-of maybe hinted at if you squinch your eyes up just right but that’s close enough for Hot Air.
This is pathetic.
Uncle Kvetch, I think that you’ve either misread or miscontrued my point. But thanks for playing.
“Thus, you can have single payer with either model, but it’s only government provided health care where the government provides the health care.”
You can keep explaining this but, we understand your point. My point is that there is no realisti difference in single payer and single provider. The effective difference is that in one model (single provider)almost everyone is an employee, under single payer almost everyone is a contractor, the difference is primarily just in how one gets paid.
The control of healthcare is effectively the same.
von, I reread the quotes from your link. Number one: there is no point where he says that he wants to outlaw private health insurance. Number two, he specifically states he wants Medicare for all. Since Medicare allows for private health insurance and in fact many private insurers make quite a bit of money off of Medicare enrollees, he by definition is not advocating the outlawing of private insurance.
On the other hand, many Republicans have specifically advocating getting rid of the SS system, as you graciously admitted to.
And how do you think insurance reimbursement works?
Insurance reimburses the hospitals/facilities that the patient patronizes. The privately run hospital/facility, which collects money from insurance premiums and out of pocket expenditures pays salaries, dividends, and other benefits, makes corporate decisions such as reinvestment, merger, expansion, etc.
Why, how did you think it worked?
Granted, the NHS has elements of centrality control that are not found in all single-payer insurance systems, but it’s a matter of degree — not kind.
Elements? Massive understatement.
The government owns the hospitals, pays the salaries, runs the health care. That’s a huge difference.
von: The bolded part. Again, “would be established for all workers under the age of 55, unless they choose not to have an account.”” That’s the DEFINITION of opt-out.
Nate, I asked which link contained the quote you identify; I’m trying to figure out what I misread. (I am accept that you have provided an accurate quote of something I’ve linked, which means that I misread it.)
Okay, and now you’re just being obtuse deliberately and trying to conflate the NHS with government provided insurance, which is false, and everyone has called you on so far.
Oooooookaaaayyyyy. I don’t think you’re following the issue.
OK, so does the US have public health care? Because a large number of US hospitals fit the definition of being run by the government (e.g., New York City Health and Hospitals Corporation, which was created by the New York legislature as a public hospital.)
It has some! The best example is the VA. Which is part of what makes the propaganda so asinine.
And yet, no one is proposing a government take over of health care. That claim is still smarmy propaganda – even if, in actuality, it shouldn’t really scare people because there already are pockets of government run health care.
And the VA happens to be the most efficient, highest performing system we got.
The government owns the hospitals, pays the salaries, runs the health care. That’s a huge difference.
Well, among other things, the NHS doesn’t own the private UK hospitals, of course. And, since you don’t address the NYCHHC, I’m still trying to understand why this is a difference in kind rather than degree.
Alas von, I’m still waiting for your answers to the questions I raised here. Ah well, I’ve been waiting for answers since yesterday afternoon.
von: Okay, I give up. Yes, all of us evil liberals are out to create a giant government run grandma killing monster to kill off the private health insurance market and eat all the hospitals and doctors in the country, and deny health care to Republicans. You’re on to our secret plan. We’ve imported the blueprints from the UK, whose NHS is powered by the screaming torment of Stephen Hawking and all the other people who wouldn’t benefit society. And we’re going to take all the pharmaceutical companies profits and hoard the drugs so millions of people die of easily preventable diseases while we make pills to give us tons of hot sex and addict Rush Limbaugh so we can entertain ourselves by making him dance for his drugs.
Cripes, if we’re going to be accused of it anyway, even by “reasonable” Republicans, why SHOULDN’T we go for it?
The control of healthcare is effectively the same.
No it isn’t!!!
The effective difference is that in one model (single provider)almost everyone is an employee, under single payer almost everyone is a contractor, the difference is primarily just in how one gets paid.
Sweet jeebus, the government is not the only payer, even in single payer!!!!
You can still pay out of pocket, as plenty of people do. You can still buy supplemental insurance, as plenty of people do. You’re getting tripped up because single payer is actually a misnomer, not a literal arrangement.
And regardless, private entities would be free to innovate and improve services in the hope of attracting dollars. They would still make decisions with a board, shareholders, officers, etc. They would still be a privately held interest operating in a free market.
It would not be a government agency making the decisions.
For better AND for worse. But those are important differences.
And, since you don’t address the NYCHHC, I’m still trying to understand why this is a difference in kind rather than degree.
Actually, I did. I assume there was an ether delay in comment posting.
Well, among other things, the NHS doesn’t own the private UK hospitals
Yes, it’s not purely government run. Which is to say that even under the most extreme system in the West, the government doesn’t control all of health care.
I agree with that!!!
von, yes some government entities do run facilities, clincis, etc. They are mostly toto handle the poor and indigent populations. Some states still run mental hospitals. These programs were developed to provide treatment that the private sector either couldn’t or wouldn’t provide.
However, although the governmental entities runs and pays for the operation of these facilities, they also accept private insurance payments when possible.
But the most important point is that if the private sector was able to take care of these services, the services provided by the governmental entities would probably not exist.
Regarding the NHS, who pays for the services at the private hospitals. Does the government or the patient?
Von,
To follow through on your point. According to you, the UK is not government run health care, but the US is government run health care.
So I say: why the scare tactics about government run health care? We already have it, so it’s a meaningless propaganda tactic. After all, the NYCHHC exists, it’s all a matter of degree, not kind, so everyone calm down.
It’s like warning people about government run pre-college education. Right?
No it isn’t!!!
Give it up, Eric. This is the definition of a hopeless case.
Give it up, Eric. This is the definition of a hopeless case.
I think I will. My ten remaining hairs thank you Uncle K.
von: Your link to the “Final Republican Plan” here.
Not that it matters, as a) the Social Security scam was defeated, and b) isn’t the main point.
“As the Brits would say, bollix.”
I submit they’d be far more likely to say “bollocks.”
Damn you Farber!@#$!@#!@
(shaking fist in Gary’s general direction)
“No it isn’t!!!”
Is too!!!!!!!
“I really think that you’re drawing distinctions that are not particularly meaningful.”
Since we’re opining, I opine that the distinction is vital.
“You’re right that no one is seriously proposing a centralized public health care system, a la the NHS. But it’s the centralization that’s the key distinction between the NHS and the issues at hand, not the ‘government run’ healthcare bit.”
I don’t agree in the slightest, and think this is a huge obfuscation of a vital distinction.
Since we’re simply voicing opinions.
Yes, it’s not purely government run. Which is to say that even under the most extreme system in the West, the government doesn’t control all of health care.
I agree with that!!!
So do I!!!!! (Note extra exclamation points; they make my argument better than yours.)
Look, my point — which you don’t seem to want to see — is that “government run” isn’t a viable distinction of kind between the US and the UK systems. The US has government run hospitals. The UK has more. The US has private hospitals. The UK does as well, albeit fewer. This is a difference in degree, not kind.
There is a signficant distinction in kind, however, between the US and the UK health care systems with respect to who provides the health insurance. In the UK, it’s government provided via a single-payer with (rare) private supplements. In the US, it’s almost all private (save for the poor and elderly).
Anyhoo, I don’t think that you’re really focusing on my point. Perhaps beer will help. The next time I’m in NY …..
Thanks for the link, Nate.
Turb, I don’t know what you want me to agree with. Your point seems to be that the Democratic leadership is not pushing a single-payer (or government run) system. And it’s not! Indeed, that’s the premise of my post! So, since I agree with you, I don’t know what else you want me to do.
(I do point out that some democrats and democratic activists want to go much farther …. including, in some cases, to abolishing private health insurance. But I don’t take you to be disputing that point.)
NB: Yglesias sez, re his views: “— As an equally unrealistic idea, I think the National Health Service model from the UK has a lot going for it.” That seems to be second-most preferred outcome.
There is a signficant distinction in kind, however, between the US and the UK health care systems with respect to who provides the health insurance. In the UK, it’s government provided via a single-payer with (rare) private supplements. In the US, it’s almost all private (save for the poor and elderly).
I guess, but the proposal on the table is closer to the French/Canadian model of private health care and public insurance options. That’s the point. The UK does it different than other single payer systems, and no one is suggesting replicating the UK model. That is a fact.
Yes, no system is entirely pure. But, again, that only bolsters the argument that there is nothing to be afraid of. And that the scare tactics are hollow propaganda. There’s already some blend here (there’s even some government provided insurance in fact).
The exclamation points, and frustration, stems from what seems like pedantry in pursuit of a lawyer’s case building rather than a productive discussion. But maybe you see it that way too from me.
von, I do dispute that point. You have not given an example yet.
But, even if it were the point, what difference does it make? None whatsoever.
And yes, there is a difference in kind as long as you drop out the VA. Or, to take your side for just a second, the difference in degree is immense to the point of basically being a difference in kind.
I was the lead in my Senior class play. By your argument, there is no difference in kind of actor between me and Anthony Hopkins. Technically you would be correct, that there is only a difference in degree.
But this is a case were technically is irrelevant.
Under government-run health care, the doctors are government employees and the hospitals are owned by the government. How on earth is that merely a difference of degree?
Turb, I don’t know what you want me to agree with. Your point seems to be that the Democratic leadership is not pushing a single-payer (or government run) system. And it’s not! Indeed, that’s the premise of my post! So, since I agree with you, I don’t know what else you want me to do.
von, I read your post as claiming that the Dems will try to create a single payer system in the US even though they are not publicly talking about this plan. Now, even though Dem leaders are not talking about single payer, if they really want single payer as a group, then there must be some evidence of that. Like, maybe they’ve given speeches in the past. Or put a plan in the platform. Or written books where they advocated single payer. Or gave interviews. Or something. But if you can’t point to anything that happened in the real world, then you can’t really say that the Dem leadership (as a whole) wants single payer.
This seems very simple to me, so perhaps I’m confused. You’re asserting that Dems have a sekrit plan to push through single payer. Either there is real evidence to support that belief or you’re a nutty conspiracy theorist. If you’re really saying that lots of people (not you) believe this, then either those people have evidence or they’re conspiracy theorists. But if no one can provide serious evidence, then this discussion is pointless.
(I do point out that some democrats and democratic activists want to go much farther …. including, in some cases, to abolishing private health insurance. But I don’t take you to be disputing that point.)
Since I’ve explicitly conceded that point twice, yeah, I’m not disputing it. But I don’t see why the existence of individuals who support single payer tells us anything about the likelihood of the party leaders pushing single payer through congress. I mean, lots of Dems were against the war in Iraq, but lots of Dem leaders advocated for it and lots of Dem congressfolk voted for it. Right?
Von: “Your point seems to be that the Democratic leadership is not pushing a single-payer (or government run) system. And it’s not! Indeed, that’s the premise of my post!”
Von’s actual post: “In fact, the Democratic Party’s health care plans are being driven by people who want a government takeover of health care.”
But there’s no contradiction here!
“So, since I agree with you, I don’t know what else you want me to do.”
I’d suggest writing a post that actually says, and doesn’t hedge, that “the Democratic leadership is not pushing a single-payer (or government run) system.”
“So if we make four leaps of assumptions, then we have something to worry about. ”
Hmmm, apparently in your world Gary, politicians nearly always say what they mean, and the opinions of Democrats other than the top leadership don’t mean anything?
It is fascinating what counts as *leaps* of assumptions…
I’m quoting huge portions of this thread next time I hear that we can’t ban partial birth abortions because scary pro-lifers really want to ban embryo abortions. (Compare numbers of Republican ‘leaders’ who want to ban first trimester abortions to number of Democratic ‘leaders’ who want single payer…)
Man, I wish we had a Democratic party like von and Sebastian think we do, where the party activists ran things and the politicians were responsive to the desires of their constituents, rather than the one we’ve got.
Compare numbers of Republican ‘leaders’ who want to ban first trimester abortions to number of Democratic ‘leaders’ who want single payer…
Who are these Dem leaders and why do you think they want single payer? This is not a hard question. And yet I keep asking without seeing any answers.
Sure, Nate, but at least Democratic politicians always say what they mean…
But it’s equally true that some elected Democratic proponents of health care reform have suggested that private insurance should be outlawed. For instance, Rep. Anthony Weiner (D-NY).
Wow, OK, that Hot Air link . . . first of all, it completely misrepresents the context of Weiner’s comments to Scarborough, which arose in the context of Weiner pointing out that many of these disruptive and mendacious town hall jacktards are being manipulated and lied to in the service of protecting insurance company profits rather than improving health care.
That’s what prompted Weiner to ask why the concern of opponents is centered on insurance profits, and what exactly it is that insurance companies bring to the provision of health care that’s so worth protecting.
Second of all, Ed Morrissey is clearly retarded, when he gets to this:
(Bolding original to Morrissey.) He’s got a lot of balls here accusing other people of not understanding economics, because I can assure him that everything with a cost is NOT a commodity by definition.
You work with corporate clients, von. Next time you meet with a CFO or general counsel, conference up Ed Morrissey and ask your client if, next time his company has to publish its annual report and furnish its 10-K to the SEC, if he’s OK with dumping their current financial printer for Joe’s Law Shack & Disclosure Services up the street. Which, if financial printing and SEC fulfillment– which have costs — are a commodity, he should be perfectly willing to do.
Or ask ol’ Ed if he’s willing to trade in whatever he drives for a 1982 Buick LeSabre. I mean, cars cost something, so they must be commodities, right?
What about the untrue things many people believe about the current health-care proposals according to the polls? What role has Matt Yglesias played in those believes by stating his personal preferences regarding health-care reform, and how large is that role in comparison to the roles played by Palin, Limbaugh, Coulter, Malkin, Beck, Hannity in spreading misinformation? Should Matt Ygelsias not state his personal preferences for fear that some number of people might be more likely to believe Palin, Limbaugh, Coulter, Malkin, Beck, Hannity?
Hmmm, apparently in your world Gary, politicians nearly always say what they mean, and the opinions of Democrats other than the top leadership don’t mean anything?
Couldn’t we say this about almost any issue where there are varying opinions on one side or the other? Wouldn’t it be easier if we stuck to the stuff actually in writing? If you think current proposals are the camel’s nose, make the case based on the content of the current proposals, not some universally applicable generality about the nature of politics and politicians and human beings and human nature and psychology and honesty and intentions and blah, blah, blah, blah, blah….
I mean, if something is a commodity, then there’s a futures market in it. Can Ed Morrissey quote me the spot price in arthroscopic knee surgery and whether he expects it to go up or down next week? My mom’s getting it, so I might want to short some options.
at least Democratic politicians always say what they mean…
What exactly are you saying here Seb? It seems to me that you’re saying that
(1) there exists a secret Democratic party conspiracy to create a single payer system in the US, and
(2) that conspiracy counts as its members the President, a majority of Representatives and Senators and Dem party leaders, and
(3) the conspiracy members have remained silent about their goals and never written about them in the books, mentioned them in their speeches, added them to the party platform or done ANYTHING at all to reveal to the outside world their true goal.
Is that true?
Sure, Nate, but at least Democratic politicians always say what they mean…
And this means what? That single-payer is in the current proposals? That, although not in the current proposals, somehow will happen by itself because of what’s in the current proposals? That the current proposals prevent future debate on single-payer and give Democrats free reign over future health-care proposals? WTF are we talking about??? There are actual written pieces of legislation being proposed and we’re going to talk about what might or might not be in some people’s heads?
Sebastian: See above for my admission of our secret liberal plots.
American government works differently, society is different, culture is different so why would anyone assume the healthcare system that works somewhere else would work here?
Posted by: Marty | August 20, 2009 at 02:33 PM
I guess this is what is called American exceptionalism at work. In reality, US and Canada are culturally so close that most foreigners can’t tell the difference. Australia (single payer)and New Zealand(mostly government run) are a little different, but not by much. Some people indeed argue that that the USA, the UK, NZ, Australia and Canada together comprise a single culture-the Anglosphere.
http://en.wikipedia.org/wiki/Anglosphere
Thats a little controversial, though.
Let’s just say that culture should not be an argument against the USA adopting universal health insurance
Apologies to Shygetz, but the more I read the back-and-forth here and elsewhere, the more I think the healthcare reform we wind up with will be something “uniquely American.”
You can put a fig leaf over the camel’s nose and secrete your death squads inside the Trojan Horse before the cart, but never let it be said that I say it’s spinach, and to hell with it.
Ummm it isn’t secret that many Democrats, including Senators and House of Representative members would like single payer. They say so, and in the past have said so.
And we’re getting forest for the trees here. I have other problems with the House bill (assuming that is the one we are talking about, which isn’t at all clear). The camel’s nose issue isn’t my big objection.
The camel’s nose issue is about how your average your more average voter sees things. The question in THIS post was why Democrats are having so much trouble with the idea that they are for single payer when this bill (if we are talking about a particular bill, which is not clear) is not.
The answer is that many important Democrats in the past have talked about single payer (or in some cases actual government run) health care systems as if they would be a good idea. The VA is often brought up as a potential model in such discussions, and it is in fact government run health care. The long and the short of it is that your average voter associates—and rightly so—Democrats with single payer systems or systems with even more government ownership.
The average voter does NOT read a bill that has thousands of pages. He lives on the impressions he has built over the years. Those impressions—even among non-Republicans—rightly note that Democrats have long been associated with wanting health care systems that are at least single payer.
That makes it very easy to insinuate that this particular bill (which none of you have read either) might have really be a first step towards the Democrat’s ultimate goal of single payer.
Now this could be counteracted by clear statements from high level Democrats repudiating single payer (not just in this bill, but as an idea to work from) along with statements about why we should not want it. But that will not ever happen. Why is that? Because you actually want it, perhaps? I am not sure, but that is definitely the impression.
We also seem to be getting bogged down in a control/ownership distinction. Government control of something does not necessarily imply that it is technically owned by the government. Just ask people who own Lake Tahoe property.
Be honest with yourself. Are you really imagining that the majority of the savings you believe that single payer offers will come purely through administrative streamlining? Really? Because I would have sworn that I’ve seen hundreds of words over dozens of comments over multiples of years across many commenters on this blog suggesting that it will come through the increased market power of a single payer. And that is about controlling medical care, NOT just technically paying for it.
Or look at it another way. When you say that an insurance company is denying care, you really just mean that it is refusing to pay, right? No insurance company actually sends thugs to your hospital to keep the doctor from performing a surgery they don’t like, right? And that is controlling the available care to a large extent? Right?
Sure if you’re rich you can avoid that, but generally your insurance company is controlling your care, right?
Be honest with yourself. Are you really imagining that the majority of the savings you believe that single payer offers will come purely through administrative streamlining? Really? Because I would have sworn that I’ve seen hundreds of words over dozens of comments over multiples of years across many commenters on this blog suggesting that it will come through the increased market power of a single payer. And that is about controlling medical care, NOT just technically paying for it.
Being honest means admitting that single payer is not a magic bullet for costs. It will control some by increasing leverage vis-a-vis drug companies, clearing up the byzantine record keeping system necessitated by having dozens of insurance forms, use technology to improve same, and a few other niceties.
But in the end, we’ll have to think of cutting costs in other ways, including, perhaps, revamping our pay-for-procedure not outcome approach. And there are two imperatives, ensuring coverage for all Americans and lowering costs. Single payer does real well at the former, and has some advantages for the latter.
Private insurance, on the other hand, offers nothing but an additional charge as a middleman.
But even if single payer does not pay for a given procedure, it’s not controlling health care. As you said, people with means can afford it anyway. Cosmetic surgery, for example, will still largely be an out of pocket endeavor.
The camel’s nose issue is about how your average your more average voter sees things.
I’d like to reiterate this point, since von didn’t address it before: the poll he cites does not show a concern about camel noses. It shows a misunderstanding about what is contained in the current bill.
Pretending that these concerns reflect a “camels nose” concern is covering for the people who have intentionally misled the public about the actual debates and proposals occurring in Washington.
I don’t know of any evidence that the general public is concerned about future proposals, just evidence that they’re being lied to.
Ummm it isn’t secret that many Democrats, including Senators and House of Representative members would like single payer. They say so, and in the past have said so.
Can you tell me which Dem party leaders have said so? As in, which party leaders have not only said that “single payer systems have good results in other countries” but “I’d like to see single payer in the US”? Can you name names?
The answer is that many important Democrats in the past have talked about single payer (or in some cases actual government run) health care systems as if they would be a good idea.
Name them please.
The VA is often brought up as a potential model in such discussions, and it is in fact government run health care.
No, the VA is often brought up to illustrate problems in the current system, not necessarily as a model to replace the whole thing. After all, it is much easier to force healthcare providers to use open standards based electronic medical records than it is to convert the entire health care sector into a single payer system.
The long and the short of it is that your average voter associates—and rightly so—Democrats with single payer systems or systems with even more government ownership.
Cite please? And did the average voter do this before the tea baggers and their friends in the media went hog wild with their lies?
Now this could be counteracted by clear statements from high level Democrats repudiating single payer (not just in this bill, but as an idea to work from) along with statements about why we should not want it. But that will not ever happen. Why is that? Because you actually want it, perhaps? I am not sure, but that is definitely the impression.
I guess this never happened:
That’s something that both von and Sebastian haven’t answered yet, what exactly DOES the giant health insurance sector actually DO that makes it so worthy of protection from government competition? How many grandmas does private insurance kill?
And if it turns out that the government can kill more grandmas and cheaper than the private sector, and everyone ended up turning to the government for their grandma killing needs, would that be evil communist grandma killing, or red blooded capitalist grandma killing?
“Now this could be counteracted by clear statements from high level Democrats repudiating single payer (not just in this bill, but as an idea to work from) along with statements about why we should not want it. But that will not ever happen.”
This statement turns out to be extremely untrue. How many cites would you like?
von, I do dispute that point. You have not given an example yet.
I’ve lost track of which point you’re dispute, John.
And yes, there is a difference in kind as long as you drop out the VA.
That’s not true: something like 2/3rds of US hospitals are government run. The New York Hospitals that I cited above, for example, were created by and are run by the government of New York. There is a difference in that, with the notable exception of the VA, these public hospitals are run by the states …. which is why, by the bye, I was pointing out the “centrality” of the NHS as a distinction from the US system way, way, upthread.
von, I read your post as claiming that the Dems will try to create a single payer system in the US even though they are not publicly talking about this plan. Now, even though Dem leaders are not talking about single payer, if they really want single payer as a group, then there must be some evidence of that. Like, maybe they’ve given speeches in the past. Or put a plan in the platform. Or written books where they advocated single payer. Or gave interviews. Or something. But if you can’t point to anything that happened in the real world, then you can’t really say that the Dem leadership (as a whole) wants single payer.
My argument is much more Yglesias-specific. Yglesias makes a number of assertions how voters are completely crazy for thinking the Democratic plan is to do x, y, and z but then goes on to say how he’d really prefer x, y, and z and calls the Obama approach an “incrementalist” approach …. presumably towards a system that includes x, y, and z. That strikes me as a really silly on his part. Put it this way, if I tell you that I want to destroy social security and then provide a “incrementalist” plan to reform social security that doesn’t actually destroy social security but takes some steps in reducing social security’s reach, would you be “crazy” to wonder if social security destruction wasn’t part of the plan?
Now, it’s not just Yglesias who has this disconnect: as Yglesias notes in the linked posts, a lot of the loudest voices are just like him.
You’re right that virtually all leading Democrats aren’t on board with this view, but you wouldn’t expect them to be. You would, however, expect that they would be influenced by their constituents and some cynical types might think that they may share some/all of the broader, activist agenda even if they don’t voice it publicly for political reasons.
For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical.
I have no idea WTF this statement means or how to make sense of it in anything resembling the real world.
I’m not asking you to unpack it, because I doubt that can be done in any useful or sensible way. Why waste both our our time?
I’m just saying it makes no freaking sense, at all.
Having said that, I’d assert that this should not be necessary: “Now this could be counteracted by clear statements from high level Democrats repudiating single payer (not just in this bill, but as an idea to work from) along with statements about why we should not want it.”
All that’s necessary are “clear statements from high level Democrats repudiating single payer in this bill,” and then it’s up to you to demonstrate that, in fact, passing this bill will lead — somehow — to single-payer, and to explain how that will work.
I’ve already asked you for a timeline on when you expect such a change to single-payer will be proposed as a bill with a chance of passage, and I’d like to know when you think it is we should start having realistic reactions to that possibility. Thanks.
Sorry, not true. Here was the final (?) Republican proposal regarding GROW Accounts. Note that these were opt-in accounts and that did not divert SS money.
It would’ve diverted SS surpluses into private accounts. That strangles SS, since it’s paid into by current workers. The surplus was created to pay for the Boomers’ retirement, take that money away and SS cannot pay for the Boomers without becoming a huge liability on the balance sheet in the near future. Once we reached that point, the bill wouldn’t matter anyway, there would be no SS surplus to distribute. All it will have done is sequester money away from the Boomers’ retirement and force us to borrow to meet their SS payments.
In some long, long run, after the Boomers are dead, maybe this puts us on different footing (we will have borrowed a bunch of money and would have changed SS from ‘pay as you go’ to something more like a retirement account.
Much more likely, it screws SS long before we get to that point.
But it’s all irrelevant- you must admit that Dem objections such as mine, even if you feel they’re unfounded, are based on the actual bill and our perceived consequences of that bill. Even, if you like, our misperceived consequences. But *not* on the idea that there was some future bill that we had to stop by stopping this bill which we found unobjectionable on its own.
“You would, however, expect that they would be influenced by their constituents and some cynical types might think that they may share some/all of the broader, activist agenda even if they don’t voice it publicly for political reasons.”
Oh, how we wish. Oh how we wish.
“Are you really imagining that the majority of the savings you believe that single payer offers will come purely through administrative streamlining?”
No, I believe we also have to change the incentives offered to doctors and medical institutions so that they aren’t incentivized to increase costs, per Atul Gawande, as I’ve written here more than a dozen times, including directly asking you what you thought many many many times.
I’ve further stated that I believe the changes to the Medicare Payment Advisory Commission can be very helpful.
Also, are we positing
A) that politicians never say one thing and mean another
I would rather this assumption than the one where von gets his camel to put his choice of words in their mouths.
I think a dose of political reality is also in order- nothing like single-payer will pass this time around, and this set of reforms will dampen enthusiasm for reforms for the immediate future. If the camel is coming into the tent, it won’t be for a while, and it’ll be because the public wants him in based on the results of the current reforms.
Which, IMO, is the real fear here.
Once you have a public plan — no matter how small — it becomes easier to expand the public plan.
If it works and it’s popular, yeah. If it doesn’t work, I don’t see how expanding an unpopular program will be a political winner at some point in the future.
Again, I think the concern is that the camel is going to be *invited* in, because we will *like* it.
First of all, the more people covered, the lower the costs overall. That has been pointed out several times.
Secondly, single payer increases providers’ incomes while at the same time lowering over all cost. Right now, much of the reason for higher charges by providers is that they have to write off an extremely large amount of their costs. That is why many of their contracts with insurance companies are 150% of what Medicare pays and why their billed charges are 3 to 4 times what Medicare pays.
Although I could make a very good argument for increasing the Medicare level of reimbursement, and in a single payer system would definitely argue for it, it is not low Medicare reimbursement taht is driving the cost.
Rather it is insurances low reimbursements for out of network providers, both in terms of the draconian Usual and Customary repricing they do as well as the lower percent level of reimbursement.
The other factor is high administrative costs for providers to collect reimbursement from patients and insurance companies post provision of services.
With a single payer system, with a pricing such as Medicare has (which is based upon specialty and geographic area) and with almost universal coverage (thus insuring some payment for services where right now many providers see nothing)the overall cost would decrease.
This doesn’t even take into account the reduction of high cost care which takes place due to people putting off care because they can’t pay.
People talk about the administrative savings on the payers side, but neglect the adminsitrative costs on the providers side having to deal with multiple payers, trying to keep their policies and requirements correct, maintaining systems to make sure payments are accurate, etc.
In 2007 it was estimated that providersz spent 100 billion dollars just managing the submission of claims and had over 60 billion dollars in bad debt.
One thing most providers will tell you about Medicare is that they don’t have to jump through hoops. They will also tell you that reimbursement from Medicare is quicker and more accurate than through private insurers.
So yes, I want single payer, but the fact is we aren’t going to get it for a while.
BTW, Obama has declared single payer off the table and when asked specifically about the Canadian system said that that system works fine for Canada but wouldn’t work here.
I may disagree with that assessment, but you can’t a much higher Democrat that has said single payer is not a goal.
Eric, “But in the end, we’ll have to think of cutting costs in other ways, including, perhaps, revamping our pay-for-procedure not outcome approach.”
When you say “we’ll have to think of”, in a single payer system, don’t you mean that the government will decide?
Russell, “For the vast majority of folks and the vast majority of procedures, government-run* health insurance and government-run health care are functionally identical.
I have no idea WTF this statement means or how to make sense of it in anything resembling the real world.”
When an insurance company denies coverage for a procedure, for MOST people, that means that they aren’t likely to get the procedure unless they are really rich right? In that case the difference between controlling *payment* and controlling medical *care* is very small.
Are you really imagining that the majority of the savings you believe that single payer offers will come purely through administrative streamlining?
Medicare overhead is, depending on who’s doing the estimating, somewhere between 2 and 5.5%.
Private insurance is, ditto, somewhere between 15 and 25%.
That’s a lot of daylight.
Because I would have sworn that I’ve seen hundreds of words over dozens of comments over multiples of years across many commenters on this blog suggesting that it will come through the increased market power of a single payer. And that is about controlling medical care, NOT just technically paying for it.
In what meaningful way does, frex, Medicare limit access to actual medical care in ways that private insurance does not?
What can I, with my Harvard Pilgrim HMO, get that a Medicare insured cannot?
In concrete, real world terms, how do any of the existing public health insurance programs “control medical care” in detrimental ways as compared to any of the non-C-level-executive private plans?
To be honest, we’re all more or less in dancing-on-the-heads-of-pins territory. Nothing approaching anything we’re discussing here is likely to happen anytime soon. Probably not in this generation.
But it’s fun to talk about, isn’t it?
“von, I do dispute that point. You have not given an example yet.
I’ve lost track of which point you’re dispute, John.”
This point: “I do point out that some democrats and democratic activists want to go much farther …. including, in some cases, to abolishing private health insurance. But I don’t take you to be disputing that point.)”
You haven’t given an example of that (and don’t point back to that link because nowhere does he say he wants to abolish private insurance).
And would you provide a cite regarding the 2/3 of hospitals are privately run claim please. (Again, taking out of the equation VA hospitals for obvious reason, although even with VA hospitals I doubt it would come anyway near that level.)
My argument is much more Yglesias-specific. Yglesias makes a number of assertions how voters are completely crazy for thinking the Democratic plan is to do x, y, and z but then goes on to say how he’d really prefer x, y, and z and calls the Obama approach an “incrementalist” approach …. presumably towards a system that includes x, y, and z.
Yglesias has a tiny audience. 99.99% of the people in this country have no exposure to Matt Yglesias. He does not have a TV show. He does not have a radio show. He does not have a column at a big newspaper.
Now, it’s not just Yglesias who has this disconnect: as Yglesias notes in the linked posts, a lot of the loudest voices are just like him.
Who? Name them please.
You’re right that virtually all leading Democrats aren’t on board with this view, but you wouldn’t expect them to be. You would, however, expect that they would be influenced by their constituents and some cynical types might think that they may share some/all of the broader, activist agenda even if they don’t voice it publicly for political reasons.
Should I expect them to be as influenced by their constituents as they were when it came to the Iraq War? Or telecomm immunity? Or impeaching Bush?
The naivety on display here is…shocking. It is like I’m talking to a young child.
Just an aside, to illustrate the quality of the debate.
From here we have this:
So, if we exclude the fact that private insurers take a profit, the overhead cost difference isn’t that large.
Really, you have to just laugh at this stuff or you’ll go f**king nuts.
I’m quoting huge portions of this thread next time I hear that we can’t ban partial birth abortions because scary pro-lifers really want to ban embryo abortions.
Again you are making the opposite point you think you are making. People who support reproductive freedom are suspicious of bans on partial-birth abortion because they fail at their stated intention–protecting fetal life, because they only force doctors to use other procedures, possibly more dangerous to the woman carrying the fetus–which means we have to look elsewhere for their real intention.
It isn’t a slippery-slope argument when you point out that, because a proposal fails at its stated objective (or doesn’t even address it), the real reason for it must lie elsewhere. It’s an argument you may disagree with, but formally it doesn’t invoke the slippery slope at all.
von,
To be clear, I believe that your original post contained a misstatement of fact:
It’s also crazy for Yglesias to blame “lies” for the fact that most voters have reasoned, correctly, that some of the louder folks pushing Democratic health care want “coverage for illegals,” a “government takeover” of health care, and “tax-payer funded abortions,”* and to fear to some or all of these proposals are coming — if not this year, then soon.
That is not what the poll showed and that is not what Yglesias argued. He is blaming “lies” because people have been lied to, as he demonstrated.
I would appreciate you tackling this point- it seems that your entire post is based on this inaccuracy, in 1)misrepresenting Yglesias’s position, 2)creating support for your ‘camels nose’ theory where none exists and 3)implicitly pardoning those who have lied to the public about the actual contents of the current proposals.
When an insurance company denies coverage for a procedure, for MOST people, that means that they aren’t likely to get the procedure unless they are really rich right?
And do, in fact, the public providers of health insurance — Medicare, Medicaid, any of the state systems — deny access to treatment in any significant way more than private insurers do?
Or is this another theoretical “what if”?
You would, however, expect that they would be influenced by their constituents and some cynical types might think that they may share some/all of the broader, activist agenda even if they don’t voice it publicly for political reasons.
As russell said, “you” might expect it, but it would fly in the face of the evidence. Everything we have seen in Washington over the past several weeks makes it patently clear that no bill will be brought forward that threatens the profits of the health insurance industry. The public option is dead and the Progressive Caucus is being told to go sit in the corner with their hands folded and wait to be called upon. Greenwald is 100% right on this.
So, for the camel’s nose argument to be compelling, you’d have to not just posit a slippery slope–you’d have to posit a wholesale shift in the ideological moorings of the leadership of the Democratic Party. Not “some voices,” not this blogger here or that congressman over there, but the leadership. Show me how we go from a Democratic Party that panders to and then ignores the wishes of its progressive wing to one that acts on those wishes. Show me how we get a Democratic Party that is no longer beholden to money from insurance and pharmaceutical companies. Connect the dots. Show your work.
Medicare does not pay taxes and does not make a profit so any fair comparison should exclude these items.
A fair comparison of which program is more efficient, perhaps. But for a comparison of which program costs less, I would think we would want to include all of the costs that each incurs, regardless of whether it is an indictment of that program’s efficiency.
What does more or less have to do with the question? My point is that we think insurance denials as controlling health care just like we OUGHT TO think of a government plan doing the same thing as controlling health care.
You are correct that Medicare does it much like an insurance company, *which is precisely why the alleged payer/control dichotomy breaks down for most people in real life*.
My point isn’t that Medicare is worse, or that the single payer will be worse, but that it is exercising what you readily admit is control in the insurance case.
So Eric’s whole–how dare you talk about control when it is really just single payer thing–breaks down.
Well, I have a different question. von argues that the fact that many Democrats want a public option is the key to why the health care package seems to be in trouble. Yet I cannot reconcile that claim with the data I have. Such as:
Survey USA national poll sponsored by MoveOn.org Political Action, 1200 adults surveyed August 19, 2009:
Question: In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance–extremely important, quite important, not that important, or not at all important?
Extremely important….58%
Quite important……..19%
Not that important….. 7%
Not at all important…15%
Not sure…………… 1%
That poll is interesting but has a pretty serious amibiguity that you don’t see if you have been following the debate closely.
I wonder how many people saw “extremely important” as safeguarding private plans…
A fair comparison of which program is more efficient, perhaps.
Yes, and even at that the private providers do worse. When you factor in the costs that come along with — including profit, commissions, etc — the net cost is multiples of the net cost of Medicare.
My point isn’t that Medicare is worse, or that the single payer will be worse, but that it is exercising what you readily admit is control in the insurance case.
Fair enough, and in that context I’d like to offer an apology to von for dismissing his comment as I did upthread.
All of that said — the point I’d like to make is this:
The “controlling care” argument against a single payer, or any public payer, really only seems relevant to me if it ends up making care less accessible than it would otherwise be.
I don’t see any evidence for that, and in fact in many cases the public payers that currently exist in this country are (to my knowledge) less restrictive than many private providers.
If there is factual evidence to the contrary I’d be interested to know about it.
What russell said.
“The “controlling care” argument against a single payer, or any public payer, really only seems relevant to me if it ends up making care less accessible than it would otherwise be.”
Well that is where I think public payer vs. single payer is a huge difference. In single payer you extinguish most of the other payers and then you do what you want. The effect of the control happens AFTER the government gets rid of all the competitors. Then we have to trust it to get everything right.
With a public payer as an option, the government control takes place while there are still competitors, so we can weigh the savings versus the costs. They public and private plans provide a check on each other. That is why it is important that we don’t have the government ‘cheat’ (say by threatening pharma companies with breaking their patents unless they give just the government (but not private insurers) a break on price. If things like that happen (which really are just abuses of power) then we can’t see the real cost of the choices being made. That is a huge difference from a fiat single payer system.
And that is where controlling care is an important issue. Single payer destroys options first, then tells us what it intends to do to control costs. Multiple payer lets us see what controlling costs will look like, and we can decide if we like it while other options are still readily available.
I have been wondering if part of the cost issue we have is a “free rider” problem, where the US healthcare system is paying for a lot of the development of new techniques and medicines, subsidizing other developed countries.
While I recognize that many developments come from Europe, those developments still get patented and sold in the US at higher rates than other nations pay for them, presumably making the risk of R and D more palatable for the non-profit systems.
It seems similar to the cheaper meds you can get in Canada: Big Pharma can sell to Canada at a reasonable profit over manufacturing costs, since the US market is covering the cost of development.
substantial numbers of Democrats definitionally have no influence on Democratic leadership?
As was pointed out above, where the heck have you been the last 8 years? Show one point where “substatial numbers of Democrats” influenced the leadership on anything? In addition to the above, let’s add the bankruptcy bill and regulation of the credit card companies.
Sheesh.
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Uncle Kvetch, I think that you’ve either misread or miscontrued my point. But thanks for playing.
Funny how everyone but Sebastian has done so, isn’t it?
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I wonder how many people saw “extremely important” as safeguarding private plans…
Since the private plans ARE safeguaded under every single option I’ve heard, I’d say the number is “N/A”.
“Since the private plans ARE safeguaded under every single option I’ve heard, I’d say the number is “N/A”.”
Isn’t a big part of the storyline that lots of people are getting confused by Republican lies?
With a public payer as an option, the government control takes place while there are still competitors, so we can weigh the savings versus the costs. They public and private plans provide a check on each other.
You know, I’m fine with that. IMVHO, for this country a mixed public and private solution is probably going to be the best fit.
Whatever works, where the definition of “works” in this context is “people who don’t have jobs or a lot of money can go to the doctor”.
The problem is that we are highly unlikely to get even that far, because the bogeyman of Government Takeover Of The Whole Health System looms over every discussion of even more modest proposals.
Not only is it not on the table now, it has never been hinted at by anyone remotely in a position to set policy.
Von cites Yglesias as someone who looks forward to government-controlled health care. The *most radical proposal* that Yglesias has talked about is a public single-payer health insurance plan.
I get the argument about “funding equals control”, although I think it’s overstated. The purse is not the only lever involved, and the folks who would control the purse in a public approach are beholden to the end users in ways that simply don’t apply in the private model.
But even a public payer as an *option* is likely to not occur, because it’s the First Step Down The Slippery Slope To Socialism.
Public funding coexists with private actors in more parts of our economy than I can shake a stick at. In the overwhelming majority of situations, it does so effectively.
But calling for even a public *option* for health care is enough to elicit comparisons to Hitler and Stalin. Or, more modestly, here at ObWi, claims of secret (or not so secret) agendas to take over the entire health infrastructure of the nation.
Meanwhile, 15% of the people in this country — 1 out of 7, 45 million people — have no health insurance at all. Millions more have insurance that will require them to spend thousands of dollars out of pocket before anything they need is covered. Virtually anyone who is under the age of 65 and not in the military can lose whatever coverage they have immediately if they lose their job, and about a half million people a month fall in that category.
And you can stand up in public and say “Who cares, you can just go to the emergency room” and not be pelted with tomatoes and rotten fruit.
Seriously, sometimes I feel like just saying “screw it”. This country is freaking insane.
The plain truth of the matter is that there is no credible chance of the health care industry in this country being taken over by the government. None. Not in a million f**king years.
That’s fine with me, I’m not interested in having the government take over the health care industry. Neither is the government.
It’s just a stupid, fear-mongering lie that’s tossed out there to scare the sh*t out of people who don’t know better, and who don’t have the sense to find out.
So some kind of complex, ridiculous, festering turd of legislation will be coughed up by Congress, Obama will sign it, the 15% of folks who don’t have coverage may slide down to, say, 12%. The insurance companies will find a way to make sh*tloads of money off of it, and everyone will declare victory and go home.
And some number of millions of people in this country will still not be able to go to the doctor.
That’s my prediction. Anyone want to bet against it?
Thank you, Russell.
I have more, but who needs it?
Not me. I give up.
You know the scene in Batman (one of the earlier ones) with Jack Nicholsen as the Joker, when he has that ghastly smile surgically fixed to his face, or however it happens.
That’s where I am right now.
Goverbnment sucks in America because Americans suck at government.
Cackle.
I had the surgery doen in France free of charge, suckers.
Rep Rick Boucher (one of the Blue Dogs, from Coal Country, VA) gave away their real worries, “I have a problem with this government option plan,” Boucher said. “I’m troubled that the government option plan could become very popular and if it became sufficiently popular it could begin to crowd out the other” private insurance companies.” Here.
Because market competition is socialism now I guess?
“Well that is where I think public payer vs. single payer is a huge difference. In single payer you extinguish most of the other payers and then you do what you want.”
Sebastian, respectfully, wtf are you talking about? Even in Britain, with the NHS, the country is full of independent-provider healthcare companies, private hospitals, and private doctors, all of whom you are free to do business with if you don’t want to deal with the NHS.
Many decry this, but it’s impossible to know anything about health care in Britain without being acquainted with these most basic of facts about it:
Some favor and some oppose it, but it’s a fact.
Many Britons aren’t happy about aspects of increasing privatisation, but it’s a fact.
We could also go through a list of single-payer countries, none of which have exerienced what you allege will happen.
In Canada, for instance, the country is full of private doctors and private medical facilities. Doctors get to choose how to work:
Rereading von’s initial post, btw, I think this is a bit rich: “Matt Yglesias writes perceptively on why Democratic health care reform is failing, but — perhaps understandably — doesn’t see his own role….”
Matt has a significant role? We’re personalizing it at that level? By this logic, should we blame you for your “role” in health care reform “failing” from the Democratic view (personally I think that, as usual, everyone is being considerably premature in judgment as yet)?
Seriously, sometimes I feel like just saying “screw it”. This country is freaking insane.
Just now on the BBC they interviewed a woman in Mississippi who lost her health insurance when she lost her job, but doesn’t want reform, because you’ll have to stand in line, and the government will tell you what doctor you have to go to, and it “sounds like communism.” And yeah, I had a “screw it” moment. Maybe this mockery of a “system” is all we, as a country, deserve.
Howard Dean beats the drum for a far more radical reform (and has written a book about it). But I can’t say, whether he still counts as “leading Democrat”.
—
I’d say give headbands with ‘#2’ on them to all leading Republicans and their media allies and then send Samuel L. Jackson the list together with an Afro wig and a long katana.
Hartmut, Dean is beating the drum, through TV appearances and the Democracy for America group he founded, for the public option. How is that “a far more radical reform”?
“In Canada, for instance, the country is full of private doctors and private medical facilities. Doctors get to choose how to work: ”
Sure, they can charge government rates for all patients or they can go out of business. The system supports very few purely private doctors, mostly in elective specialties.
The healthcare system is controlled by the government, I think it doesn’t matter whether they can say “we aren’t doing it” or “we aren’t paying for it”, for the vast majority of people those are the same answer.
And before we get in a big circular discussion I am fully aware that both insurance companies and Medicare do the same thing today. I am just clarifying that I believe there is little effective difference between single payer and single provider. (and, for Eric, I am not confused by the terms)
Supplemental insurance in Canada primarily covers dental, eyecare and drugs.
Sebastian:
My point is that we think insurance denials as controlling health care just like we OUGHT TO think of a government plan doing the same thing as controlling health care.
Have you ever personally dealt with an insurance denial, Sebastian? Do you realize that many companies routinely *and as a matter of policy* deny *everything* over a certain dollar amount, to “weed out” the people who don’t submit a second (or third, or fourth) time? Do you know what “rescission” is? Are you aware that insurance company customer support agents get bonuses for denying claims, because every claim denied or delayed is money in the bank?
I can see how you’d get scared at the thought of a single, unavoidable government payer who acted the way insurance companies do: lying, cheating, stealing, and murdering, *and there’s no way out*. But US experience with Medicare and the VA, and that of other countries, shows that this is unlikely to be a problem. The heartless rapacity of the insurance companies is the free market in action, capitalism in a nutshell — an honestly non-capitalist system will not have to work that way.
Put it another way. Under our current system, many people become destitute because of major illness. The insurance companies have found that this is part of a good business model for them. How would you change that?
“Sure, they can charge government rates for all patients or they can go out of business.”
Marty, please give a cite to support this claim. Why would they go out of business if they simply “opts out of billing the publicly funded system altogether”?
Why is it that I know hundreds of Canadians, and they all shudder at the thought of exchanging their health care system for ours, and ditto I know hundreds of Britons, all of whom unanimously feel the same way?
The healthcare system is controlled by the government, I think it doesn’t matter whether they can say “we aren’t doing it” or “we aren’t paying for it”, for the vast majority of people those are the same answer.
In Canada the public sector pays for 70% of health care, the private sector about 30%. The public sector is legally required to pay for all medically necessary care without copays or fees, so as you note, most of the private sector money is going to dental, eye care, drugs, and discretionary care like voluntary cosmetic surgery.
Cite. And yeah, it’s wiki, but it’s a pretty good precis of the relevant facts.
I recognize that control over the purse gives the government theoretical control over what care folks have access to. Just as control over the purse gives private health insurance that same control for folks who don’t qualify for public programs in this country.
My question is: so what? Is anyone denied access to care in Canada because the government is paying for it? And if so, how does that compare to the level of access Americans have?
From the same cite, median wait times for an MRI in Canada is two weeks. I blew out my ACL a couple of years ago while building some wall, it took me more than two weeks to get an MRI on my knee.
Same cite, median wait times for a specialist in Canada is four weeks. I’ve seen specialists for ear nose & throat, GI, X-rays, physical therapy, etc etc. In my experience, four weeks is pretty normal here.
Same cite, median wait times for surgery is four weeks. Wait times for surgery here, including necessary, life-saving surgery, can easily be months.
So I don’t see the point of the “the payer has control” argument. Of course the payer has control. The question is what the payer does with the control.
If you’re wealthy enough to pay out of pocket, you can have whatever you want. Everybody else relies on insurance.
I don’t see that private insurance is any more generous than any state-run program that I’m aware of.
You can cherry-pick and find particular cases where certain kinds of treatment are more readily available in one place or another, but overall I don’t see much difference between the kinds of care available to insureds under state-run vs privately run insurance plans. At least in any nation comparable to the US.
We pay more, way more, and get average outcomes.
15% of the people here have no insurance at all, millions more have insurance requiring them to pay thousands out of pocket, and you can have health insurance in this country and still be bankrupted if you become seriously ill. It happens every freaking day.
None of that is true in any country remotely like the US. None. Only here.
We don’t have publicly provided health care in this country because we have an ideological aversion to publicly provided services. As a result, 15% or more either pays out of pocket or goes without.
You tell me why that is a good thing.
I haven’t read Dean’s book but on the occasions that I heard him he made imo clear that the public option is the minimum acceptable but far inferior to single payer in his opinion.