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Sanders Introducing Quixotic Medicare-for-All Bill

Bernie Sanders Speaking

Vermont Senator Bernie Sanders is introducing a bill that would create a single-payer healthcare system in the United States within four years. It has zero chance of passing in the current political climate.

Dave Weigel for WaPo:

Sen. Bernie Sanders (I-Vt.) will introduce legislation on Wednesday that would expand Medicare into a universal health insurance program with the backing of at least 15 Democratic senators — a record level of support for an idea that had been relegated to the fringes during the last Democratic presidency.

“This is where the country has got to go,” Sanders said in an interview at his Senate office. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”

Sanders’s bill, the Medicare for All Act of 2017, has no chance of passage in a Republican-run Congress. But after months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018.

The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans under 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance.

Private insurers would remain, with fewer customers, to pay for elective treatments such as plastic surgery — a system similar to Australia, which President Trump has praised for having a “much better” insurance regime than the United States.

But the market-based changes of the Affordable Care Act would be replaced as Medicare becomes the country’s universal insurer. Doctors would be reimbursed by the government; providers would sign a yearly participation agreement with Medicare to remain with the system.

“When you have co-payments — when you say that health care is not a right for everybody, whether you’re poor or whether you’re a billionaire — the evidence suggests that it becomes a disincentive for people to get the health care they need,” Sanders said. “Depending on the level of the copayment, it may cost more to figure out how you collect it than to not have the copayment at all.”

As he described his legislation, Sanders focused on its simplicity, suggesting that Americans would be happy to pay higher taxes if it meant the end of wrangling with health-care companies. The size of the tax increase, he said, would be determined in a separate bill.

“I think the American people are sick and tired of filling out forms,” Sanders said. “Your income went up — you can’t get this. Your income went down — you can’t get that. You’ve got to argue with insurance companies about what you thought you were getting. Doctors are spending an enormous amount of time arguing with insurers.”

As noted in a recent post, I both personally favor the Medicare-for-all approach and think Sanders is wrong about the preferences of the American people. Recent polling shows support for something like what he’s proposing. Alas, they also show no support for the kinds of tax hikes required to pay for it.

I do find it interesting that more Democrats are lining up behind this bill. Either they see this as a wave they want to be on or it’s simply another indicator of how polarized the two parties-in-government have become. There are precious few moderate-to-liberal Republicans or moderate-to-conservative Democrats left these days. That’s a recipe both for bolder legislative initiatives and for getting next to nothing actually passed into legislation.

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About James Joyner
James Joyner is the publisher of Outside the Beltway, an associate professor of security studies at the Marine Corps Command and Staff College, and a nonresident senior fellow at the Atlantic Council. He's a former Army officer and Desert Storm vet. He earned a PhD in political science from The University of Alabama. Views expressed here are his own. Follow James on Twitter.

Comments

  1. Argon says:

    It’s gotta start somewhere… Good for Bernie.

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    Highly-rated. Helpful or Unhelpful: Thumb up 16 Thumb down 1

  2. Richard DeMent says:

    This could easily turn into the Democratic version of “Repeal and replace”. If by some miracle the Dem’s get the House and Senate back in 2018, they won’t be able to get this bill passed anyway leading to disillusionment among the most passionate of his opponents which will trigger a swing back to Republican’s. Rinse and repeat.

    One of the biggest problems with both Sanders and Trump is their willingness to make spectacular claims about what they can achieve legislatively in a political system hostile to sweeping change. Trump is ignorant, Sander’s should know better given his lack of legislative achievements.

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  3. Moosebreath says:

    Is this more or less quixotic than the 50+ attempts to repeal ACA when Obama was still President, especially the ones between 2011 and 2014 when Republicans held the House and not the Senate?

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  4. reid says:

    As mentioned, you have to start somewhere. At least this brings it into the conversation and hopefully helps normalize the concept, rather than it forever being some unspoken, taboo thing.

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  5. Hal_10000 says:

    I criticized the Republican Trumpcare plan for being a bunch of fantastical garbage. This is lower than that. It’s not even a plan. it’s

    1) Government will pay for everything.
    2) Costs will be kept down by [vague language about efficiency]
    3) We will fund it through [to be determined]

    No country has a single payer plan that pays for everything without the consumer having to pay something. And support for single payer plunges into the 30’s the second you start talking about the taxes needed to pay for it (keeping in mind that we *already* have tens of trillions of dollars in future liabilities and will have to raise taxes just to pay for that). Hell, Vermont couldn’t do it.

    It’s not a plan. it’s a fantasy.

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  6. Jen says:

    I’m in favor of a system that disconnects employment from coverage and doesn’t bankrupt people.

    I am concerned that beating this particular drum too hard could be a problem. If it’s a starting point for reform, that’s good. If it’s a line in the sand–single payer or nothing–then it will be DOA.

    Something like the Swiss system that covers everyone but still includes private insurers is a more logical next step.

    Also–is Medicare really “single payer”? From my experience and understanding, it is not. There’s a whole decision tree of when Medicare acts as the primary versus the secondary insurer, along with Medicare gap coverage offered by private insurers. I say this not to be pedantic but to point out that if Sanders is selling this as something it is not, that will cause problems too.

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  7. Hal_10000 says:

    @Jen:

    Medicare is administered by private insurance companies under guidance from CMS. This creates problems in that bad Medicare policy is hard to change. Anytime Medicare messed up or denied coverage for something important, you had to go through the insurance company and the Medicare bureaucracy, sometimes all the way to an Administrative law judge. This is why the claims that Medicare is massively more efficiency than the private sector are not correct — people are often not counting parts of the administration. And I left long before MACRA came about, which is now a huge burden on providers.

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  8. James Pearce says:

    I do find it interesting that more Democrats are lining up behind this bill. Either they see this as a wave they want to be on or it’s simply another indicator of how polarized the two parties-in-government have become.

    Might it also be an indicator of the emptiness of modern-day Democratic rhetoric?

    I mean, I hate to rain on the parade (just kidding, I love it) but fifteen Senators? Fifteen? Bernie and Kamala and Tammy Baldwin…and…at least a dozen others! Booker and Merkley and Gillibrand and Whitehouse and Warren and Schatz and Hirono and Markey and Blumenthal. (I’m missing someone.) It’s like a wave!

    And yet, Nancy Pelosi says it’s not a litmus test. Of course not. It’s a dog and pony show. Participation trophies for everyone.

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  9. michael reynolds says:

    I think it’s an important and useful move. Won’t pass now, but it sets a direction. Not a crazy direction, either, a direction which would be inevitable if we were being rational. This helps define and crystallize the Democratic position and moves the Overton window our way.

    The choices now are:

    a) Take coverage away from 20-30 million people. (GOP Plan A.)
    b) Continue Obamacare. (GOP Plan B. also Democratic Plan B.)
    c) Medicare for all. (Democratic Plan A.)

    With (c) in the picture (a) becomes even more radical. With (c) in the picture Democrats can go to core principle – health care is a right – rather than simply having to defend a complex and flawed program. With (c) in the picture, Repeal and Replace suddenly has a potential ‘replace’ already set up and running.

    As for tax increases, they’re only really increases if taxes go up by more than the cost of premiums. Would they? I assume the CBO will tell us eventually. If the CBO scores the bill as no more costly net than what we have going on right now, then this thing becomes quite viable.

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  10. Surreal American says:

    This also represents the complete collapse of any GOP healthcare initiatives. So the only alternatives going forward are a single payer system, a strengthened-PPACA, or a hybrid compromise between the two where different healthcare models cover different age groups. All of the above are only offered through the Dems.

    The GOP had 8 years to come up with a viable plan of its own and it failed on an epic scale.

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  11. MarkedMan says:

    Bernie Sanders has never passed a significant piece of legislation in his entire career, largely due to his total inability to form a working partnership with anyone. The idea that he will do anything more than pull a Trump with this is wishful thinking.

    Oh – and another way he resembles Trump: He never released his taxes. Right up to his dropping out he played the befuddled professor whenever he was asked for them and make some vague noises about how his wife took care of all the finances and the reporters should ask her. She in turn kept saying “Oh year I forgot. As soon as we get back home to Vermont I’ll dig them out.” She never did. And is now under investigation for financial mismanagement under other matters.

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  12. al-Ameda says:

    @Jen:

    Something like the Swiss system that covers everyone but still includes private insurers is a more logical next step.

    That’s what I prefer too, but ….

    Here we go again. Hillary, in 1993 decided to ride the Third Rail and Democrats were toasted in the 2014 mid-terms. Obama rode the Third Rail in 2009 and Democrats were obliterated in the 2010 and 2014 midterms.

    Look, I’m of the opinion that if you increased the current Medicare Tax from 1.45% on employees and employers to, say 7.45% on each, many Americans would panic at the tax increase. The Right would be in a spastic drooling convulsive rage.

    I believe that having no skin in the game automatically biases many Americans against having to pay for Medicare-For-All.

    A big part of the problem we have in America is that many working Americans have a portion or all their coverage paid for by employers, and they do not write the check for their coverage. Many are unaware that prior to ACA, premium costs were increasing at annual rates ranging from about 9% to over 20%.

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  13. Tony W says:

    @michael reynolds:

    As for tax increases, they’re only really increases if taxes go up by more than the cost of premiums.

    Agreed, for some reason, the Right seems to feel like paying ‘premiums’ to the government in the form of taxes is more expensive/less desirable than paying (likely) more money to a corporation which takes a slice off the top for profits.

    There’s nothing inherently evil about taxation per-se. Regardless of to whom we write the check, the money needs to provide good value for the dollars spent.

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  14. Tony W says:

    While I applaud Sen. Sanders and his co-sponsors for moving the debate toward one of human rights vs. profits, I still regret that nobody is taking on the real problem – cost containment.

    A danger of single payer is the net effect would be to set up a duplicate healthcare system in the U.S. — the basic system that the poor would use, and the concierge system for everyone else. It’s not hard to imagine a supplemental-insurance program appearing that caters to people who want access to the providers who will figure out a way to keep charging today’s rates.

    Who knew healthcare was so complicated?

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  15. Kylopod says:

    @reid:

    As mentioned, you have to start somewhere. At least this brings it into the conversation and hopefully helps normalize the concept, rather than it forever being some unspoken, taboo thing.

    True–but it still concerns me that they’re setting up expectations that cannot be fulfilled. Every developed nation in the world besides the United States has some form of universal health care, but in most cases it is multi-payer, not single-payer. A lot of progressive activists are fuzzy about the difference and tend to use “single-payer” as a catch-all for any system of universal coverage not centered around private insurance companies.

    I worry that the project of improving the health-care system in increments has come to be viewed in negative terms, and that the activists won’t settle for anything less than a full and immediate overhaul, which is extraordinarily unrealistic.

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  16. reid says:

    @Kylopod: Understood. Who knows how this will play out. Does Bernie taint it? Is the time still too soon?

    For a long time now, it’s felt like any sort of universal coverage system is just a complete, socialist, un-American non-starter, which is bizarre. Heck, our esteemed conservative host here is for it, so some headway has been made on the topic despite it being rarely discussed in a serious way. Maybe incremental changes isn’t the way to go anymore. Maybe we need to make a quantum leap. Other things, like marriage equality, happened relatively quickly, so who knows.

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  17. MarkedMan says:

    @Tony W: I suspect one of the reason few people bring up cost containment is that most have no clue what this would entail, and those that do know that, however necessary, successful implementation will bring an immense dislocation to the American economy. Think about the millions of people employed by insurance companies to adjudicate claims. The millions more that work in local doctors offices, hospitals, clinics, care groups, walk-ins, X-ray facilities, and on and on. Think about the billions in profits the insurance companies, bill collection agencies, etc, work. In a sane system these would all be reduced by a factor of 10 or more. But that will mean millions out of work.

    Imagine this alternative: a number of years ago an American I know was living as an expat in The Netherlands. He had a nasty bike accident that required stitches. Rather than go the emergency room he went to the local clinic, which was open twenty four hours for non-serious issues. There were four people there, all of whom were health care providers. There was no billing department. No one handled insurance. When they cleaned and stitched him up, along with a prescription of antibiotics and some changes of bandages, he told them he had to pay himself. This freaked them out a bit, as they had all been trained on this procedure when they started but had never used it since. It set off a scurry as all four of them searched around for the forms and then intense discussions about how to properly fill them out and get the proper charges. In the end, he was charged less than $100.

    Now think about how much that would cost in the US and how many people would be involved in any number of billing departments and insurance companies. How much time they would have each spent on the claim. What’s covered? What’s copay? What are our specific arrangements with this insurance company for payment for this type of procedure? Make sure not to get it mixed up with anyone of the hundreds of different plans you deal with or it will screw everything up into an unholy mess. All of those people get paid. All of their bosses and bosses’ bosses, etc get paid. They use office space and computers and telephones and printers and faxes. None of that is necessary in the Dutch system. None of those people have jobs, none of those computers are sold, none of the telephones are generating charges. That is a significant shift to an economy.

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  18. Just 'nutha ig'nint cracker says:

    Of course, most corporations would probably be able to do the math and figure out that paying an increased tax for Medicare would probably be no more expensive than insurance premiums are now (and might be lower, but IANAE), save for the fact that the current GOP is touting the notion that it wants to grant people freedom and liberty from have to accept insurance that those people may never actually use and isn’t a specific match to the exact coverage that they imagine that they want at this very second in their lives. Why should corporations risk paying something when if they hold out they may be able to pay nothing?

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  19. reid says:

    @reid: By the way, I’m getting tired of saying, “No no, we can’t do it now, we’ll fail!” Always waiting for some “right time” that will never come. It seems like we’re letting the right-wing control the terms by caving in to their narrative rather than fighting the battle.

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  20. Kylopod says:

    @reid:

    Other things, like marriage equality, happened relatively quickly, so who knows.

    Oh, come on. SSM, while difficult for some people to get used to, was about as uncomplicated a policy as you can get. Just allow same-sex couples to get into the same contract as opposite-sex couples already enjoy. It’s hard to imagine a simpler proposal.

    There’s no simple solution with health care, and I fear that a lot of progressive activists don’t understand the policy details well enough to grasp that point. For example, on various blogs and websites over the years I have repeatedly encountered the phrase “single-payer public option.” Anyone who thinks the public option and single-payer are the same thing has got a lot to learn. I’ve also encountered people who mistakenly think Bill & Hillary’s 1993 plan was single-payer.

    This kind of ignorance makes them vulnerable to believing that there’s some kind of giant magical solution that will instantly make all health care affordable and easily accessed for everyone, an impression that Bernie has heavily tried to make.

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  21. MarkedMan says:

    @reid: I agree with the sentiment. The cause of universal coverage should be championed now, it shouldn’t be put off. But Bernie’s inane litmus test is a distraction. I suspect that if he championed the real goal, universal guaranteed coverage, he knows he would be just a face in the crowd with virtually every Democrat. So he shifts the talking point to single-payer and establishes anyone who disagrees with him as an enemy, so the attention is on him, which is what he really wants. No one else is ever pure enough for Bernie.

    You know, I guess I understand the desire of so many commenters here for Hillary to just shut up and go away. I don’t feel that way about her, but substitute “Hillary” for “Bernie” and my feelings are identical.

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  22. MarkedMan says:

    @Kylopod:

    makes them vulnerable to believing that there’s some kind of giant magical solution that will instantly make all health care affordable and easily accessed for everyone

    Read more: http://www.outsidethebeltway.com/sanders-introducing-quixotic-medicare-for-all-bill/#ixzz4saNigiHM

    Well said. And the frustrating thing is that there is a simple slogan that covers exactly what we want: Universal Guaranteed Coverage.

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  23. Kari Q says:

    I like the catch-22 some are putting Democrats in:

    “Democrats must show they stand for something other than opposition to Trump!”
    Democrats make symbolic move to show they stand for something.
    “That’s got no chance of passing right now. Why are Democrats wasting their time showing what they stand for?”

    Medicare for all may be one way to achieve greater coverage. I personally think that including a Medicare type option in exchanges is a more likely way to achieve this, but I don’t have a strong preference for that, or Medicare for all, or any other particular path forward. The system is broke, we all know it. In a functional government, we’d be talking about how to fix it.

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  24. MBunge says:

    While I support a move to universal coverage, I do wonder where all these preening “health care is a right” types will be when the inevitable waiting lists and outright denials of care happen.

    But the two most important factors in health care reform still go unmentioned.

    1. No health care system can survive a bad economy. The real U.S economy outside Wall Street has been sputtering and seizing for years and few in DC besides Trump even pretend to care.

    2. Most of the nations with these supposedly wonderful safet nets don’t spend one-tenth as much on their militaries as the U.S. does and a big reason they can spend so little is because we spend so much. Could Britain’s NHS survive if they had to devote a similar percentage of GDP to defense as America?

    Mike

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  25. MarkedMan says:

    @MarkedMan: I’m just curious. Why would someone down vote the post above where I talked about how much insurance and administration makes up of the US healthcare cost? Do you think I’m wrong? If so, I would love to hear why.

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  26. reid says:

    @Kylopod: I know it’s complicated. I was just giving an example of something that seemed too scary and dangerous to broach in political terms not long ago, and yet, once it was tried, it happened fairly easily. If we just listened to the right-wingers and were afraid of alienating people, marriage equality may have never happened. If you don’t even try, you’ll never win.

    And yet, I’m a libra and see all sides of things. 😉 I know there are risks, that it can backfire to fight and lose, you have to fight smart, etc.

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  27. reid says:

    @MarkedMan: I don’t actually follow Bernie all that closely. I tend to agree with him on policy, and he seems like quite a fighter. He also seems to sincerely believe in what he’s fighting for. I think that’s why he appeals to a lot of people. He may very well be “fighting stupidly” and/or be doing it to feed his ego or something, and that would be unfortunate.

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  28. Kylopod says:

    @MarkedMan:

    And the frustrating thing is that there is a simple slogan that covers exactly what we want: Universal Guaranteed Coverage.

    The problem is that a lot of progressives will call foul. They don’t want something like the Swiss system, universal but mostly private. Or at least they don’t think they do. You start talking about universal without mentioning single-payer, the Bernie Bros will just assume you’re promoting Obamacare 2.0–another incrementalist step that bills itself as universal health care but which in reality leaves many without coverage.

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  29. MarkedMan says:

    @MBunge:

    While I support a move to universal coverage, I do wonder where all these preening “health care is a right” types will be when the inevitable waiting lists and outright denials of care happen.

    Read more: http://www.outsidethebeltway.com/sanders-introducing-quixotic-medicare-for-all-bill/#ixzz4saa30bz7

    Why do you assume there will be waiting times and so forth, or at least worse waiting times than we have now?

    Those types of wait lists come in single-provider systems, not in systems with multiple providers and single payers. Virtually all systems in the developed world also allow for supplemental health coverage paid for out of pocket. It tends to be pretty reasonable too, as it doesn’t have to cover catastrophic costs.

    For all its faults, Bernie is endorsing single payer. Not single provider.

    As for denial of coverage, of course that will happen. But it happens now. Someone hears about a drug on TV that simply has to be better than what they are on now because the TV said so, but their plan doesn’t cover it because outcomes aren’t any better and it costs ten times as much.

    Republicans have this bizarro world in their mind where their $10/month employer sponsored health care plan where every single doctor is in-network, and a casual mention that your knee has been bothering you has the helpful GP scheduling for a knee surgery the next day with the most experienced surgeon in the state. But these are just Republi-facts.

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  30. James Pearce says:

    @Kylopod:

    This kind of ignorance makes them vulnerable to believing that there’s some kind of giant magical solution that will instantly make all health care affordable and easily accessed for everyone, an impression that Bernie has heavily tried to make.

    Dude, you’ve been just killing it lately.

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  31. Kylopod says:

    @MBunge:

    While I support a move to universal coverage, I do wonder where all these preening “health care is a right” types will be when the inevitable waiting lists and outright denials of care happen.

    “The mindless refusal of most in our politics, GOP and Dem, to even consider single payer.” — MBunge, 3/28/2017

    What is it with you? Do you just randomly pick out positions contrary to whatever most people are saying at the moment and then act like it suddenly makes you smarter than everyone?

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  32. Ben Wolf says:

    The Sanders’ coalition’s intent is to campaign for the bill like a campaign for the presidency. That’a why they reached out to volunteers and donors from the 2016 primary campaign for input on how to do it and how to organize. There is an actual plan here for how to make it happen.

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  33. teve tory says:

    @Moosebreath: @MarkedMan:

    All of those people get paid. All of their bosses and bosses’ bosses, etc get paid. They use office space and computers and telephones and printers and faxes. None of that is necessary in the Dutch system. None of those people have jobs, none of those computers are sold, none of the telephones are generating charges. That is a significant shift to an economy.

    Well, yeah, they get paid, but they get paid by a system that charged $10,000 to my uninsured diabetic friend when she went into ketoacidosis and had to go to the ER. It’s a terrible, shitty system, and the sooner we got on with changing it the better.

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  34. wr says:

    @MBunge:”While I support a move to universal coverage, I do wonder where all these preening “health care is a right” types will be when the inevitable waiting lists and outright denials of care happen.”

    You know what all those preening types didn’t do? They didn’t claim to support universal coverage and then vote for and publicly support Donald Trump, who is opposed even to Obamacare. I’m not sure why you believe anyone should take your advice on anything.

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  35. wr says:

    @MBunge: “2. Most of the nations with these supposedly wonderful safet nets don’t spend one-tenth as much on their militaries as the U.S. does and a big reason they can spend so little is because we spend so much. Could Britain’s NHS survive if they had to devote a similar percentage of GDP to defense as America?”

    What a wonderful example of Republican “we’re America, we can never to anything to change the status quo, as long as the status quo is making rich people richer” thinking.

    We ALREADY spend vastly more per capita on health care than any of these terrible countries who selfishly refuse to spend their money invading countries that haven’t attacked us. We are ALREADY spending far more on “health care” than we should — because we are supporting an inefficient market system that exists to derive profit from people’s suffering. Any European single-payer system costs far less than ours, so we could have that and still have plenty of cash to send young Americans to die in pointless wars in the Middle East.

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  36. Just 'nutha ig'nint cracker says:

    @MarkedMan: And, of course, if we really had a free-market system for medical care in place, there would be a single-payer option. Unfortunately, that single payer would be you–just like in the pre-insurance days of a bygone pre/early-industrial era.

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  37. DrDaveT says:

    @Tony W:

    for some reason, the Right seems to feel like paying ‘premiums’ to the government in the form of taxes is more expensive/less desirable than paying (likely) more money to a corporation which takes a slice off the top for profits.

    It’s a religious belief. One of the Golden Tickets that Adam Smith brought down from Mount Doom says that unregulated for-profit private industry is always more efficient and effective than non-profit or public or regulated utility, no matter what it’s doing. Telephones, water treatment, highways, police and military, air traffic control, education… anything.

    Because this is so clearly false, true believers have been working for decades now to make it true, by sabotaging government’s ability to do anything at all. They have nearly succeeded in many areas, and reversing that damage will be difficult and painful.

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  38. Andre Kenji says:

    Medicaid for all, basically meaning that everyone would have coverage while there would be incentives for private care, would be a great(and in some sense, PRETTY Conservative) plan.

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  39. Sleeping Dog says:

    Bernie’s single payer bill is so devoid of details that anyone could support it and fill in the details to fit their biases. Thus all the co-signers that Sanders found.

    The goal should be universal coverage, but a focus on one way to get there, single payer, is a distraction that will cause Dems to lose winnable Congressional seats in November. Pelosi and Schumer are right to hold this turd at arms length.

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  40. MarkedMan says:

    @Kylopod: FWIW I’ve been wondering if their are two MBunge’s…

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  41. HarvardLaw92 says:

    @Sleeping Dog:

    Agreed. Everybody likes the *idea*. Nobody wants to pay for it, or more typically they assume that somebody else can afford to pay for it.

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  42. Davebo says:

    @Kylopod: That’s gonna leave a mark.

    Nah, not so much..

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  43. Mikey says:

    @wr:

    We ALREADY spend vastly more per capita on health care than any of these terrible countries who selfishly refuse to spend their money invading countries that haven’t attacked us. We are ALREADY spending far more on “health care” than we should — because we are supporting an inefficient market system that exists to derive profit from people’s suffering. Any European single-payer system costs far less than ours, so we could have that and still have plenty of cash to send young Americans to die in pointless wars in the Middle East.

    This, a googolplex times this.

    We spend twice as much per capita and 50% more as a percentage of GDP than THE MOST EXPENSIVE of the universal-coverage systems, for outcomes that are comparable to worse.

    Tell me, in what other aspect of life would people consent to that? “Here’s a ham sandwich, it costs $5. Here’s another ham sandwich, identical in every aspect except for the bread being slightly stale, it costs $10.” Who the fvck is gonna say “I’ll take the $10 one.” Yet we do, and we’ve been brainwashed into thinking the $10 one is galactically superior except it’s not, it’s got stale goddamn bread.

    And Bungle’s dopey nonsense about “waiting lists and outright denials of care” would make the average German or Frenchman bust out laughing. Because it’s utter, nonsensical bullshit.

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  44. MarkedMan says:

    @teve tory: If you thought I was defending our system, then I wasn’t clear. By my reckoning at least 30% of the cost of our system provides no health care at all but simple processes paperwork. But all that processing employee people so getting from 1.5 times the most expensive system in the world to 1.0 times will have a massive impact on the economy.

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  45. Mikey says:

    @Mikey: And something else for those yelling “we can’t afford real universal coverage:” we could fund the entire U. S. military twice with the difference in per capita health care expenditures between us and the OECD average.

    What we really can’t afford is the shit way we do things now.

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  46. Monala says:

    @reid: Marriage equality could take a quantum leap because, despite the objections of many rightwingers, allowing an LGBT couple to get married has no real affect on anyone else.

    Not so a leap to a single-payer health system, which would affect everyone. Even if the overall impact is positive (which is not a sure thing), many people are adverse to change. And there are multiple changes that would need to take place:

    – What happens to all the people working for insurance companies? What happens to their jobs?
    – What happens to people with health insurance through their employer? Their taxes are going to go up, but it’s not a guarantee that their employer would increase their wages by the amount that they are saving by no longer offering health insurance.
    – What happens to health care professionals? How does this change affect their income, their number of patients, the rules and regulations they have to abide by?
    – What happens to retirees whose pensions are invested, often in large part, in insurance companies?
    – And of course, everyone’s taxes are going up significantly.

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  47. Monala says:

    @Richard DeMent: A few people joked on the blog Balloon Juice that if we want Republicans to support a single-payer system, Democrats should name it “The Obamacare Repeal and Replace Act.”

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