Democrats Growing Skeptical Of ‘Medicare For All’

Even as candidates like Elizabeth Warren and Bernie Sanders continue to base their campaigns on it, Democrats appear to be growing skeptical of 'Medicare For All.'

Even as it continues to be the centerpiece of the campaigns of two of the top four candidates for the Democratic Presidential nomination, Democrats appear to be becoming more skeptical of the idea of “Medicare For All”:

Prominent Democratic leaders are sounding increasingly vocal alarms to try to halt political momentum for “Medicare for all,” opting to risk alienating liberals and deepening the divide in the party rather than enter an election year with a sweeping health care proposal that many see as a liability for candidates up and down the ballot.

From Michigan to Georgia, North Dakota to Texas, Democratic elected officials, strategists and pollsters are warning that the party’s commitment to the Obama-era Affordable Care Act — widely seen as critical to electoral gains in 2018 and 2019 — could slip away as a political advantage in 2020 if Republicans seize on Medicare for all and try to paint Democrats as socialists on health care.

“When you say Medicare for all, it’s a risk. It makes people feel afraid,” said Gov. Gina Raimondo of Rhode Island, who headed a successful national effort as chairwoman of the Democratic Governors Association, to win governor’s mansions in Kentucky and Louisiana this month. “We won in Kentucky and Louisiana, barely, in part, because we won on health care. I don’t think we can afford to lose on health care.”

While Democrats won the House in 2018 by decrying Republican efforts to undercut popular provisions in the Affordable Care Act, the Democratic presidential primary race has turned in large part on whether to replace that law with a more expansive, single-payer system, financed by higher taxes and linked to an end to private health insurance.

The two liberal candidates pushing Medicare for all, Senators Bernie Sanders and Elizabeth Warren, have highly energized supporters who want this form of universal health care, and collectively garner about 40 percent of the vote in most polls. More moderate leaders in the race, like Joseph R. Biden Jr., the former vice president, and Pete Buttigieg, the mayor of South Bend, Ind., support adding a public health care option to the current law. While the primary race is fluid and unpredictable, Medicare for all has steadily driven much of the Democratic discussion of health care.

A determination to shift those conversations is now spurring top Democratic officials to speak out more forcefully against Medicare for all, playing to the anxieties of Democrats who fear their party could once more lose crucial Electoral College battlegrounds like Pennsylvania, Michigan and Wisconsin to Mr. Trump if they push for a nationwide overhaul of health care coverage and benefits.

Warnings are being issued at all levels of the Democratic Party, from union members who fear losing hard-won benefits, to candidates running in swing districts, all the way up to former President Barack Obama, who offered a pointed warning about the risks of overreach at a gathering of donors in Washington, D.C., this month. People close to the former president said his remarks were rooted in his experience passing the health care law, which prompted his concerns about how willing voters would be to embrace an even more sweeping change.

House Speaker Nancy Pelosi was even more critical this month: “I’m not a big fan of Medicare for all,” she told Bloomberg Television.

Privately and publicly, party strategists focused on the nation’s most competitive House and Senate seats next cycle are frustrated that conversation in the Democratic presidential race often devolves into arcane debates about Medicare for all, rather than last year’s easier-to-grasp message about protecting people with pre-existing conditions. Many are gravely concerned about the impact that having a presidential nominee who backs Medicare for all at the top of the ticket would have on the most vulnerable Democratic candidates.

(…)

“The politics are horrible for the Democratic Party, that’s my judgment,” said Ms. Heitkamp, who lost her seat representing North Dakota last year and is now heading up an effort to win rural voters. “We’re making the issue about our plan rather than what the president has or has not done.”

Senator Sherrod Brown of Ohio, who has said it would be a “terrible mistake” for the party nominee to support Medicare for all, is urging Democrats to embrace a more unified message against Mr. Trump. That feels unlikely in the midst of a heated primary campaign where health care has emerged as a significant difference between the candidates.

“Democrats need to start talking about the contrast with Trump on this,” said Mr. Brown, who has not endorsed a candidate in the primary race. “The conversation should not be Democrats fighting over the path to universal coverage.”

The growing skepticism about Medicare for All as a mandatory program is something that has largely grown out of the debate among the candidates themselves rather than being something that was generated out of external criticism from pundits. Initially, the competing proposals by Senators Warren and Sanders, which are more similar than they are different, seemed as though they would take over the field of play. Slowly but surely, though and thanks in large part to candidates such as former Vice-President Joe Biden, Mayor Pete Buttigieg, and Senator Amy Klobuchar, the questions about the Warren and Sanders proposals began to take center stage and it became clear that neither Senator had effective responses for the criticism that was being leveled against their respective plans.

The former Vice-President was the first to openly question the “Medicare For All” idea, largely because he set himself out to be the candidate in the field was going to promote the popularity of the Affordable Care Act. Indeed, from the start of his campaign, Biden has essentially characterized Medicare For All as a plan that would undo the advances that were made with the ACA, Like Buttigieg and Klobuchar, he also pointed out that the Warren/Sanders plans would result in people currently covered by employer-provided plans that they liked losing their preferred coverage and being forced to adopt a plan that may be worse than what they might have now. Other candidates, such as Buttigieg, Harris, Klobuchar, and others have suggested that the answer is the have something akin to “Medicare for All” available as an option for those who might want it but to stop short of making it a mandatory program. This would not be dissimilar from the “public option” that was being debated at the time the ACA was being debated in Congress.

Because of all of this, critics of the Warren and Sanders plan have argued that tying the party to a mandatory “Medicare For All” plan would likely be a political disaster for the party that could result in Donald Trump once again pulling off another narrow win by exploiting fears over what, to most voters, clearly comes across as a radical idea once you get past the simplistic slogans and star looking at the details.

In addition to this political argument, several of the opponents to Warren and Sanders have brought up the issue of how such a program would be funded For their part, the two Senators have claimed that they could fund the program through a combination of increased taxes on the wealthy and taking advantage of the alleged costs savings that would result from eliminating the “middle man” of private insurance companies. As several of their opponents, most notably Senators Kamala Harris and Amy Klobuchar, have noted, the idea that a program as ambitious as what Warren and Sanders are proposing could be financed without increasing taxes on the middle class simply doesn’t add up.

One impact of this skepticism appears to be a reversal of political fortunes for Senator Elizabeth Warren:

Sen. Elizabeth Warren’s once-ascendant presidential campaign has begun to dim. And among her fellow Democrats, including those in the field, there is a universally agreed upon culprit for the stall in the polls: her embrace and handling of Medicare for All

The senator’s decision to back single-payer health care has long been considered by establishment Democrats as a self-inflicted wound, one that would prove to be a massive weight on her in a general election should she get there. One senior Democratic Party member—who is philosophically supportive of Warren’s candidacy—said he was “dumbfounded” by her decision to align herself so closely with the proposal. “She’s completely boxed herself in,” the member said. “I just don’t see why she did it or how she gets out of it.” 

Both Warren supporters and Medicare for All advocates have dismissed such prognostications as the bed-wetting cynicism of a timid—and corporate-influenced—consultant class. And through it all they’ve had an easy rejoinder to the collective freakout: Beyond the moral argument for Medicare for All, polling has continually showed it to be popular. 

But that now appears to be changing. A new national Quinnipiac University poll of the Democratic primary field showed Warren slipping dramatically, down 14 percentage points from their survey one month prior. And tucked into the survey was a possible explanation as to why. The pollsters tested support for Medicare for All and found that only 36 percent of the public said it was a good idea (52 percent said it was bad) compared to March 2019, when 43 percent said good idea, while 45 percent said bad. 

Singular polls are bad barometers for the state of elections or politics in general. But other polling paints a similar picture. The Kaiser Family Foundation, which has been tracking public opinion on health care policy closer than anyone else, has recorded a majority support for a national health care plan—styled as Medicare for All—for years. But they noted that “the level of support has narrowed in recent months.” And the most recent data found that “more Democrats and Democratic-leaning independents would prefer voting for a candidate who wants to build on [Obamacare] in order to expand coverage and reduce costs rather than replace [Obamacare] with a national Medicare-for-all plan.” 

This can be seen in a recent national poll that shows Warren’s support dropping significantly:

Sen. Elizabeth Warren’s support among Democratic primary voters nationwide plunged 50 percent over the past month, according to a new Quinnipiac University poll, signaling that the shake-ups in the primary field are far from over.

Former Vice President Joe Biden has retaken the lead in the poll after an autumn that saw him surrender his solid frontrunner status, climbing 3 points to earn 24 percent in the poll. Mayor Pete Buttigieg of South Bend, Ind., surged into second, rising 6 points to 16 percent, with Warren and Sen. Bernie Sanders not far behind at 14 and 13 percent, respectively.

But Warren’s plummet — 14 points since the previous Quinnipiac poll taken a month ago — represents a brutal dive as the first nominating contests of 2020 inch closer. Warren has come under fire over the past few months since a summertime ascendance lifted her into the top tier of the primary field. She has received particularly intense scrutiny for her “Medicare for All” plan, including how she would pay for it.

Warren’s declining fortunes can also be seen in the RealClearPolitics national poll average which shows Warren’s numbers dropping after having jumped higher earlier in the fall:

This drop, of course, has come during roughly the same time that Medicare for All has come under scrutiny. Given that, rather than boosting her campaign, it would appear that that Medicare For All is becoming Warren’s albatross:

INSERT CHART

Viewing this from outside it seems clear that what this all reflects is the fact that defeating DonaldTrump is the top priority for Democratic voters and the assessment that hitching the entire Democratic campaign to mandatory Medicare For All would be far more likely to be a losing issue than a winning one.

FILED UNDER: Bernie Sanders, Campaign 2020, Elizabeth Warren, Health Care, Joe Biden, Kamala Harris, Pete Buttigieg, Politicians, US Politics, , , , ,
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. Tony W says:

    People genuinely don’t think they are paying ~$800-1000 per month for their health insurance. They think their employer is paying for it out of the goodness of their hearts.

    The genius of the employer-based system is the duality of hiding costs and creating an unnatural dependency on your employer.

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  2. Kit says:

    Americans’ relation with healthcare reminds me of the Brits’ relation with Brexit: there’s just no talking the people out of their folly.

    People need to want change in the concrete, which they don’t. Then politicians will need to come up with a plan that can garner the necessary votes, which seems unlikely. Then the changes will need to wind their way through the inevitable court challenges, which will take years and which are facing more hostile prospects by the day. And finally, whatever is created has to withstand the eventual Republican counter offensive.

    I like Warren too much to have her die on this hill when so many other issues need her.

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  3. andros says:

    Where are the specifics essential to informed decision? Is one to understand that MFA will extend to all the same quality of care provided by the existing Medicare structure? Medicare is far from “free.” The Part B premium will be about $145 a month in 2020. And what value to assign to the 6% tax on wages since 1969?

    Medicare pays only about 80% of covered medical expense. A decent Medigap policy, including drug coverage, will cost you close to $300 a month, on top of your $145 a month Part B premium. Yes, you can go Medicare Advantage, if you are willing to accept the limitations and restrictions. Any way you jump, you will have substantial deductibles and co-pays to deal with.

    Medicare reimbursement rates are substantially less than those of private insurers — 50% less to hospitals. That’s why so many doctors aren’t accepting new Medicare patients. What happens when the government attempts to impose Medicare reimbursement rates on the provider community?

    This “discussion,” on the left, is inspired by the belief that insurer profits are huge. This, despite the fact that most group insurers are non-profits, or obliged to compete against non-profits. Professional financial analysts put the margin of profit at about 5%. Large corporations who have parted ways with insurers and gone to self-insurance programs are saving about 5%.

    One of the primary drivers of medical costs is “over-treatment,” resulting from the prudent attempt to avert accusations of malpractice. As I’ve said before, you can’t have Canadian health care costs and if you leave physicians in the position of tin ducks in a carnival shooting gallery.

    MFA, it seems to me, is simply “aspirational feelgood.”

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  4. Nightcrawler says:

    @Tony W:

    The genius of the employer-based system is the duality of hiding costs and creating an unnatural dependency on your employer.

    Additionally, if you get too sick to work — or your employer simply gets sick of you taking time off for treatments, as often happens with cancer patients — you lose your job, and your insurance is gone. If you think you can afford COBRA, you obviously don’t realize how much it costs, nor are you considering how you’re going to pay those high rates when you don’t even have a job.

    And good luck getting another one while going through, say, cancer treatment. Even Walmart won’t hire you.

    I had about a six-month period where I had at least one doctor’s appointment/lab test every week, plus two surgeries, one major, which would have required several weeks off work had I not been working for myself, from home. This in addition to four weeks of radiation treatments, which would have mandated me leaving early or coming in late every day. Keep in mind I was lucky enough to not need chemo. That makes it even worse. My rads appointments took about 20 minutes total. Infusions take several hours.

    Just for spite, all of these medical places operate only during traditional business hours, 8 a.m. to 6 p.m. or so. There is no such thing as doing this on the weekend or at night. You end up having to either take the day off work, come in late, or leave early.

    No employer would have put up with all of this. I would have been fired for excessive absenteeism, as happened to many of the patients in my cancer support groups.

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  5. Nightcrawler says:

    @Kit:

    People need to want change in the concrete, which they don’t.

    That’s why we will not have a functioning healthcare system in this country in any of our lifetimes. It may happen in the lifetimes of people who are small children right now, but only after a catastrophic event, like a 1918-style flu, that kills half the population or more. That is literally the only way change will occur.

    Here’s what will happen. Mark my words:

    * Obamacare will be abolished.
    * We’ll go back to the same system we had prior to it.
    * There will be some changes. Medicaid will be block-granted and even more difficult to get than it is now. There will be years-long waiting lists, similar to Section 8 housing waiting lists now. So, if you’ve got cancer and can’t wait 5-7 years on a list, too bad, so sad.
    * High-risk pools will go back to the way they were before Obamacare: Premiums will be astronomical, and waiting lists will be years long.

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  6. Michael Reynolds says:

    The driver of health costs are old people, and the families of old people, unwilling to be rational in the face of death. Needless to say the great majority of old people wasting fortunes clinging to an extra three weeks of misery, are Christians who claim they believe in a heavenly afterlife.

    You know what would dramatically cut how much we spend on health care? If all the people who pretend to believe in heaven actually did. No one who genuinely believed in an afterlife would bankrupt their children, or their country, in a desperate bid to hang on against the inevitable.

    I’m 65. There’s a pretty fair chance I’m dead by 75, and by 85 the odds are very long. 95? Nah. So: gonna die. As is everyone who reads this. What if we dealt with that like rational adults instead of like children telling themselves ridiculous self-soothing stories about angels? Religion blocks our ability to be reasonable, to put death into perspective. It’s a lifelong avoidance mechanism which, in the end, becomes extraordinarily expensive and generally painful and degrading, as reality peeks through the religious bullshit.

    Every story has an end. You can’t have a beginning or a middle without an end. Face that reality. The thing to fear is not death but pain and dependence. Push for a death with dignity law in your state. Realize that you will never experience death, but will experience misery. Ask why you should spend $100,000 or more to hold on long enough for more pain. Is that how you want to write the last chapter of your story?

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  7. Kurtz says:

    If labor is a market, employer based healthcare is a drag on it. It obstructs the free movement of workers via delayed benefits. If you need insurance, but cannoy afforably acquire insurance for the interim period at your new employer, you cannot change jobs.

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  8. Kurtz says:

    @andros:

    No, the discussion on the Left is not about profit margins in the insurance industry. It is about the fact that Americans spend more per capita on healthcare, yet our outcomes are worse than our counterparts in the West.

    Unfortunately, some Americans are so irrationally scared of Government that they are more than willing to allow third party, profit-driven organizations ration care.

    To quote The Rainmaker “[they] must be stupid, stupid, stupid.”

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  9. andros says:

    Ah, how delectable the flush of spiritual uplift deriving from advocating for the “most vulnerable.” But we don’t want to push it too far, do we? I mean, “if you like your doctor, you can keep your doctor” won’t even be promised here. Do you really want to risk having your providers assigned by faceless bureaucrats?

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  10. Moosebreath says:

    @andros:

    ” Do you really want to risk having your providers assigned by faceless bureaucrats?”

    You mean, like how insurance company bureaucrats choose your doctors by only having some of them within network, and charging you far more if you want to go outside the network? And sometimes you don’t even know it until you get a bill, because your in-network emergency room hires out-of-network radiologists? Is that what you are complaining about?

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  11. Gustopher says:

    One senior Democratic Party member—who is philosophically supportive of Warren’s candidacy—said he was “dumbfounded” by her decision to align herself so closely with the proposal. “She’s completely boxed herself in,” the member said. “I just don’t see why she did it or how she gets out of it.”

    Well, of course Biden would say something like that. (Is he not a “senior party leader”? I assume anonymous criticism is always self-serving)

    If she is finding it to be a drag, she can easily retool the plan — “consulting with members of the House leadership on what their caucus can support, I’m expanding my Medicare For All proposal to include Medicare Advantage….”

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  12. Gustopher says:

    @andros: Under the Sanders/Warren M4A, there would be no private insurance, so doctors would have to either forgo taking insurance, or would have to take M4A.

    So, unless your doctor retires, you would be able to keep your doctor.

    Compare that to current plans where your employer chooses the bureaucrats who choose your doctor.

    There are lots of reasons to be opposed to the Sanders/Warren M4A, but not getting to keep your doctor isn’t one of them. It shows a lack of understanding both with the proposal and with the current state of things.

    Also, if all those bureaucrats have no faces, I think we need to add plastic surgery to their health care plans. And they should stop voting for the Leopards Eating People’s Faces party.

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  13. Gustopher says:

    @Kurtz:

    If you need insurance, but cannoy afforably acquire insurance for the interim period at your new employer, you cannot change jobs.

    Or you risk it.

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  14. Bob#Youngstown says:

    @andros:
    I have to challenge you on several “specifics essential…”

    1) Decent medigap + drug policy premiums are about 180/month with no copay on medical. This is what my wife, and I pay and approximately what my three brothers and their wives pay in different locations in the country.

    2) Medicare reimbursement rates are not substantially less than private insurers. What you are asserting is a fiction cooked up by the private insurance industry. In fact, Medicare reimbursement rates are set by the American Medical Association.

    3) There is no evidence that “so many doctors are’t accepting new medicare patients”.

    4) Hospital reimbursement at 50% or so. _ When a hospital charges $140 for an arm sling, the same exact arm sling that can be purchased at retail for $30, why would you expect your insurance company to pay what the hospital charges. If a hospital charges you $9 for each tablet of coumadin, that you pay 13 cents for at retail, why would you expect your insurance company to pay what the hospital charges?

    5) Lastly ” self-insured corporations” – where I’ve had some experience, almost universally subcontract the management of health insurance programs to the same private insurer community. The only real difference is that the administration and management is shifted from the front room to the back room.

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  15. Gustopher says:

    @Michael Reynolds:

    Needless to say the great majority of old people wasting fortunes clinging to an extra three weeks of misery, are Christians who claim they believe in a heavenly afterlife.

    You repeat this over and over as if it means something profound.

    People are afraid of change, even good change. And of loss. And of hurting their loved ones. And pain. And perhaps even of meeting their maker and being judged for that time they masturbated while flipping through the Crate and Barrel catalog, or the fact that they would do it again because they really haven’t repented.

    I get it, religion is bullshit. But your claim that people clinging to life is a sign that they realize religion is bullshit is also bullshit, unless you account for all the other reasons they would be afraid and cling to life. Lots of people get scared before a big test, and what could be a bigger test than going to the pearly gates and potentially being told that you will suffer eternal damnation because you wore Crocs? They’re not only ugly, but they are manufactured in sweat shops, and were you even listening to that whole camel through the eye of a needle thing?

    (One of my problems with the Christian God Of Judgement is that everyone born in the US was born into a trap — short of living off the grid as a hunter gatherer, you’re contributing to a global system of oppression. Also, everyone raised Buddhist or Hindu would go to hell, so that’s another trap…)

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  16. Kurtz says:

    @Gustopher:

    Sure, unless of course, you have continuing care.

    My job offers pay way less than someone needs to afford even a modest rent payment, but the insurance is good. I could easily find a job that pays much more, but at the expense of decent insurance coverage. I am on medication that cannot be skipped or discontinued at the moment.

    So i am stuck for now. Of course, i don’t make the mistake of thinking that my experience is typical. However, my life is much less difficult than many people, so I am okay with it for now.

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  17. Kurtz says:

    @andros:

    Ah, how delectable the flush of spiritual uplift deriving from advocating for the “most vulnerable.”

    Maybe you should listen to the people who are telling you why they advocate for certain policies instead of imputing their motives onto them. Or, rather, not listen to swollen turd pundits who are paid highly to give people like you a weightless opinion.

    Your arguments (loosely, really you just assert) on Ukraine are so well constructed, none of us could wait to see what you think abput healthcare.

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  18. DrDaveT says:

    @andros:

    Is one to understand that MFA will extend to all the same quality of care provided by the existing Medicare structure?

    No.

    Glad I could clear that up for you.

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  19. DrDaveT says:

    @andros:

    Do you really want to risk having your providers assigned by faceless bureaucrats?

    I would rather have my providers assigned by faceless government bureaucrats than by faceless profit-motivated bureaucrats, yes.

    (You really need to get out and meet more faceless bureaucrats, dude. You have some weird notions of who and what they are.)

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  20. steve says:

    “That’s why so many doctors aren’t accepting new Medicare patients. ”

    This is not true. It is something believed by people who dont know much about health care. I run a moderate sized medical group and chair a medium sized department. I read health care policy daily. Can provide a lot of citations. There are a fair number of doctors who do not accept Medicare, but they are pediatricians and other docs who dont care for older patients. Then there are the concierge physicians, but they dont accept private insurance either so it is twisting the truth to use those docs to claim they arent accepting Medicare. Including those, less than 1% of docs have opted out of Medicare, and the largest number of those are psychiatrists. (Just so people know this is one of the markers I use to determine if someone is not serious about health care policy and just wants to make up stuff, troll or lie. I would ignore this guy.)

    https://newsatjama.jama.com/2019/10/30/jama-forum-history-suggests-that-most-physicians-likely-to-remain-as-participants-in-medicare/

    Steve

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  21. Mister Bluster says:

    I’ll build a wall and Mexico will pay for it! to me is “aspirational feelgood.”
    Promote $1 trillion infrastructure investment! to me is “aspirational feelgood.”
    Drain the swamp! to me is “aspirational feelgood.”
    Grab them by the pussy! is clear evidence of sexual perversion and a self confession of sexually molesting women!

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  22. Hal_10000 says:

    @Michael Reynolds:

    The driver of health costs are old people, and the families of old people, unwilling to be rational in the face of death.

    That’s part of it, yes. One policy I would support: everyone who enrolls in Medicare has to fill out a living will. No mandates on what’s in it. But you have to give orders. Because if you don’t, they will go to the last full measure to keep you alive to the last second. And most people don’t want that. So make them make the hard choices. It’ll be better for them, better for the country, better for their children.

    “It is about the fact that Americans spend more per capita on healthcare, yet our outcomes are worse than our counterparts in the West.”

    There are two main drivers of this (https://randomcriticalanalysis.com/2019/11/07/a-tale-of-two-covariates-why-owid-and-company-are-wrong-about-us-healthcare/) One is that we are investing a lot in diminishing returns — things that improve health outcomes are life expectancy marginally while costing a lot. The second is lifestyle. Obesity, drugs, cars, and violence explain the entire difference in life expectancy.

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  23. Kathy says:

    @Gustopher:

    Good points.

    I’d argue the attitude does not square with the belief, but this is not exclusive to Christianity or the abrahamic religions. Ancient Egyptians had a very rosy view of the afterlife, complete with judgment, especially for the Pharaoh, who was viewed as a god. Even so, mourning was both deep and ritualistic, taking weeks to play out.

    There was the judgment part, of course. More or less one’s heart was weighed against a feather. If it was lighter, great. If not, a monster whose name escapes me would eat your heart, literally, extinguishing you for all eternity, as Osiris, god of the underworld, and Toth, the divine scribe, looked passively on.

    One would argue that grief at someone’s death, then, meant they were a bad person who’d cease to exist or wind up in Hell, no? Sure, you’d miss them for the years you’ve left to live, but other than that shouldn’t you be glad? As when someone marries, or moves for a better job, or goes away to college.

    IMO, one cannot mask emotions with belief. But that doesn’t say anything about the sincerity of a belief.

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  24. Kathy says:

    @Mister Bluster:

    Not just to you.

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  25. Guarneri says:

    @Michael Reynolds:

    “No one who genuinely believed in an afterlife would bankrupt their children, or their country, in a desperate bid to hang on against the inevitable.”

    Here’s to hoping you demonstrate your conviction and adopt a leadership position, opting for closer to 65 than 75.

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  26. Guarneri says:

    @Tony W:

    Kinda like withholding taxes.

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  27. Michael Reynolds says:

    @Gustopher:

    You repeat this over and over as if it means something profound.

    Yes, in much the same way as if I saw people getting head colds a lot I’d suggest they start washing their hands. Religion is the opiate of the masses – feel free to quote me on that. Religion is a lie, a false promise that keeps people in a state of permanent childhood. It’s a bad bit of code that causes glitches throughout life, so naturally, I suggest fixing the code.

    Why wouldn’t I? Why wouldn’t anyone suggest fixing bad code?

    It wouldn’t be as much of an issue except that we live in a country where, uniquely among developed nations, ill health often means poverty, not just of the affected person, but of their family and the larger society. If these people actually believed their fantasies it wouldn’t be a problem at all, they’d live, get old, get sick and die without spending a fortune they don’t have. But faced with hypocrisy added to infantilism, I suggest that people stop hitting me up to subsidize a faith they ram down everyone’s throat while not actually believing it themselves.

    I don’t like hypocrites. Especially not when that hypocrisy is paid for at both ends – tax free churches peddling lies, followed in due course by medical bills from the very people who wouldn’t need it if they actually believed their own bullshit. I would like to suggest these people STFU about the Jesus they are evidently desperate to avoid meeting, and learn to face death the way rational people do.

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  28. Kurtz says:

    @Hal_10000:

    Thank you! I am now onto a blog that was linked in that article. I shall dive into a rabbit hole. Wish me luck!

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  29. Just nutha ignint cracker says:

    @Nightcrawler:

    Additionally, if you get too sick to work — or your employer simply gets sick of you taking time off for treatments, as often happens with cancer patients — you lose your job, and your insurance is gone.

    A friend of mine is a 5-year cancer-free survivor of stage-4 c0lon and liver cancer. He’s made it into the top 1% of survivors. He’d be dead today if it wasn’t for Medicaid, since he’d been laid off from his job just about a month before the diagnosis.

    A while ago, he had the opportunity to run into his former employer as some event related to the legal profession and his job as a paralegal. His employer, having the reputation of not being the brightest tube in the radio, said–out loud no less–something to the effect that the luckiest thing that had happened to my friend was his getting terminated, among other reasons because their company insurance would never have covered the whole cancer treatment. (The phenomenon used to be called “lifetime maximum benefit.” I know that it still exists in dental insurance but I can’t say about medical.) His employer then went on to note how nice it would be to be acknowledged for saving my friend’s life. (As I said, he’s not the brightest tube in the Philco.)

    Yeah. The status quo has more problems than we realize.

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  30. Kathy says:

    @Michael Reynolds:

    Yes, in much the same way as if I saw people getting head colds a lot I’d suggest they start washing their hands.

    But why would they do that, or rub alcohol gel on their hands, if they can take vitamin C tablets (they fizz!), and enough antibiotics to turn currently manageable pneumonia deadly in a few years?

    Seriously, since I began keeping a small bottle of alcohol gel at my desk, and using it every time after shaking hands and handling money, I stopped getting several colds every year. It helps not to touch your eyes end ears, either.

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  31. Just nutha ignint cracker says:

    @Michael Reynolds:

    You know what would dramatically cut how much we spend on health care? If all the people who pretend to believe in heaven actually did. No one who genuinely believed in an afterlife would bankrupt their children, or their country, in a desperate bid to hang on against the inevitable.

    As one of the people in the category “believe in the afterlife,” I, too, find the cognitive dissonance between what people say and what they do to be gobsmacking. My mom worked valiantly at keeping my dad alive for 5 or 6 years while his body was ravaged by shingles and general deterioration and his mind by Alzheimer’s–to the point of asking the doctors to give my dad a complete blood transfusion before he dies because their insurance would cover it. I realize that she knew that she would be lost without him (they were married for almost 70 years), but still… I always wished that she was going to find the way to be happy that he was, in the words of the spiritual “gon’ to live wit’ God,” but she never got there.

    I’ve never had much of that type of desperation about living. On the other hand, I’ve had asthma for 67 years, had pneumonia and/or bronchitis every year (some years more than once) until I was 25 or so (I had breaks for a few years but had pneumonia 5 or 6 times while I was in Korea), and have A-fib and COPD now. I’m just not as attached to this life as other people get. Take whatever comfort there is in knowing that I do what I can to keep my end-of-life health care costs down. I’m looking forward to what happens after this is done–but I know I’m the exception.

    On the other hand, that may be the clinical depression talking…

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  32. Just nutha ignint cracker says:

    @Kurtz:

    …they are more than willing to allow third party, profit-driven organizations ration care.

    THIS!!! Nobody pays attention to the reality that everything–even the “free-market” system that we don’t actually have–rations health care because there is not an infinite supply.

    It’s almost as if the real complaint is that “I’m afraid that I won’t get all I want/the biggest piece.” […sigh…] 🙁

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  33. Michael Reynolds says:

    @Just nutha ignint cracker:
    There was an article – I don’t have to hand – on end of life treatment for people with severe dementia. These are people who literally cannot understand why doctors are doing horrible things to them. From their perspective they are being tortured to death, with doctors often begging not to be forced to go on with it and ‘loved ones’ demanding they shove a tube down some nonagenarian’s throat when they’re three days away from being dead.

    The death rate for humans – indeed for all living things – is 100%. Granny’s gonna die, stop doing horrible things to her, get her a nice morphine drip, put on her favorite music, and hope that her last thought is ‘I like that song,’ not, ‘Aaaah! Aaaah!’

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  34. Gustopher says:

    @Michael Reynolds: Except you haven’t shown that the belief isn’t real, just that you don’t see it.

    The fear of death doesn’t mean a lack of belief in god. Lots of reasons to fear it. More if you believe in god, really.

    As an atheist-leaning agnostic, I’m pretty sure an eternity of damnation is not on the table for me. More sure of that than that I am a good person.

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  35. Michael Reynolds says:

    @Just nutha ignint cracker:
    BTW, I know you know this, but I hope you’re doing what you can to cope with depression. I got to a point a few years ago where I was heading there, getting close enough that it was like standing next to a very deep hole I might easily fall in. Scared the fuck out of me.

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  36. Just nutha ignint cracker says:

    “Or you risk it.”
    I don’t know why it is, but people with families–particularly those with young or college age children–tend to be more risk averse than those of us without spouses and families. Hmmm…

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  37. Just nutha ignint cracker says:

    @Michael Reynolds: My “score” is relatively low at the moment, but I do stay open to the possibility that is shapes my thinking too much. 🙂

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  38. Michael Reynolds says:

    @Gustopher:
    Nonsense. If you really believe that death is an instant transition to a state of eternal bliss it is utterly idiotic to suffer physical and mental agony and crushing expense to avoid it. Do you fight like hell to avoid turning on a game you want to watch? Do you endure agony to avoid seeing a loved one you miss?

    People avoid what they fear. If death is not really death, WTF are they afraid of? You’d rather spend 50k to hold onto another 24 hours of bone cancer when the alternative is heaven? Pure bullshit.

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  39. Just nutha ignint cracker says:

    3) There is no evidence that “so many doctors are’t accepting new medicare patients”.

    FWIW, in my area, the doctors who are not accepting new Medicare patients are not accepting new patients at all.

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  40. Scott F. says:

    @Hal_10000:

    One is that we are investing a lot in diminishing returns — things that improve health outcomes are life expectancy marginally while costing a lot. The second is lifestyle. Obesity, drugs, cars, and violence explain the entire difference in life expectancy.

    Neither of these drivers suggest that either our status quo health care system, or the status quo ante to ACA, are more effective at delivering good outcomes for the cost than other systems in developed countries.

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  41. Tyrell says:

    @andros: Not surprisingly Senator Warren’s polling numbers have gone backwards faster than that Everest Expedition coaster at Disney World. You can’t propose taking good health plans away from people and handing them Medicare without getting blow back. Medicare is not a bad plan, but many people are shocked and surprised when they find out that it does not cover a lot of things (like some necessary outpatient procedures in my case). American workers depend on a good health plan as part of their benefits package. Taking that away from them just won’t fly.
    Senator Warren has backed off her proposal.
    I remember one doctor saying that the American people are “over medicated, over tested, and over doctored”.
    “Let’s run some more tests”

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  42. Gustopher says:

    @Michael Reynolds: Maybe you need to step outside your bubble more. You’re a bright guy, and you observe people well, but sometimes your bright-guy conclusions shade your observations.

    For starters, you’re assuming good that every Christian is 100% sure that they will get eternal reward, rather than eternal torment.

    And, even for those who are convinced, you’re assuming that they can react perfectly rationally and that their logic will triumph over their emotions. Three scary things and four good things is still scary to most people.

    Here’s another example — think back to the first time you had sex. Were you scared? Most people are. But why would you be scared of something that you had wanted so much?

    Strong biological urges overwhelm rationality. And fear is as much a physical response as an emotional one. (Cognitive Behavioral Therapy for anxiety disorders involves replicating the physical sensations in a controlled environment, so you learn to deal with it and not let it control you, by the way… There may well be relevant studies with terminally ill patients)

    Your evidence (people cling to life) does not by itself lead to your conclusion (these people don’t really believe in god). You like your conclusion so much that you accept a weak, partial, inconclusive argument that you think supports it, without examining the argument enough to see the flaws.

    And, for what it’s worth, the Christian hypocrisy that bothers me most is not whether they truly believe or not, but when they clearly don’t follow any of the teachings of Jesus Christ (Superstar), such as the love thy neighbor, judge not lest you be judged, and raising the dead as a parlor game…

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  43. Gustopher says:

    @Tyrell:

    American workers…

    Why American workers and not American people, Tyrell?

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  44. Mister Bluster says:

    think back to the first time you had sex.

    Ahhh yes! No fear here. Much better than I expected!
    I don’t think it was her first time but that didn’t come up in conversation.
    Thanks for the memories.

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  45. andros says:

    The claim that Medicare reimburses providers at the same rate as group health insurers is simply untrue.

    The proponents of MFA seem to have no interest in addressing the most obvious inflators of health care costs. First among these is “over-treatment,” driven by the need to avert any possible grounds for tort liability. We must enable our physicians to exercise their independent judgment as to what is medically necessary, like their Canadian counterparts. Next, requiring emergency room to provide routine care at all hours of day and night, with little reimbursement. (That’s why you’re whacked $2000 for setting foot in one.) Then there’s simple fraud, as ably demonstrated by Dr. Atul Gawande and others.

    Did you know that Medicare contracts with Cigna and other insurers to provide administrative services?

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  46. gVOR08 says:

    @Nightcrawler: If, as our conservative brethren believe, health care could operate on a free enterprise, competition model, doctors’ offices would be open evenings.

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  47. Bob@Youngstown says:

    @andros:

    The claim that Medicare reimburses providers at the same rate as group health insurers is simply untrue.

    You previously claimed that medicare reimbursement rates were substantially less than private insurers. And I asked to see your proof.

    For a period of several years I was on medicare while my wife was on private (employee-group) insurance (Aetna PPO). When I compared the allowables between the two insurers for a wide variety of common procedure codes I found there to be a less than 5% difference.

    I am challenging you to provide independant evidence that your original assertion is valid.

    Since you incorrectly stated the premium for medicare supplement programs, I not so sure that you actually have any first-hand experience with Medicare.

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  48. andros says:

    A mere 30 seconds on Google yields MEDPAC: Even Efficient Hospitals Can’t Cover Costs with Medicare Reimbursement, Steven Porter, 3-11-19, HealthLeaders. Numerous sources claim the reimbursement rate to hospitals is only 50% of insurer rates.

    I paid $260 a month to State Farm, 5 years ago, for a Medicare supplement policy (I think they got out of that line of business.) A friend is paying $280. I assume that regional variables are in play here.

    I can attest, from personal experience, the difficulty in getting an orthopedist to accept a new Medicare patient.

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  49. andros says:

    @Bob@Youngstown:
    See reply below.

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  50. Tyrell says:

    @Gustopher: That was my fault for not reading over what I had. Any person should be able to keep the insurance they have or go with another plan if they want that. I would like to drop Medicare completely and find a private plan.

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  51. Michael Reynolds says:

    @Gustopher:
    Why would a true Christian have any doubts about going to heaven rather than hell? Don’t they understand their own doctrine? A Catholic gets last rites, a Protestant needs only to believe and accept Jesus. I was raised Christian, dude, my pastor had me in mind as a theologian. I know my doctrine.

    Scared of sex? No, actually. And I certainly would not endure agony and crushing expense to avoid it. Would you?

    Religious people don’t actually believe what they say they believe. I know it’s upsetting to have me come along all cold-bloodedly rational and point that out, but there it is. I believe the wall is solid and I never attempt to deny that solidity by walking through it. You’re accepting professions of belief as belief. Professions of belief are cheap, easy, nearly valueless. Everyone believes himself to be brave and moral and just and almost no one is. If people were what they profess we wouldn’t have to list the Righteous Among the Nations, they’d be everyone.

    Belief that is not reflected in behavior is aspirational, not actual. They want to believe, but they don’t. They wish they were not afraid, but they are. This is hypocrisy. It’s a lie told for various purposes, but a lie just the same. And this lie keeps people trapped in a permanent intellectual childhood, refusing to face reality. It’s no wonder they can’t cope with death, they’ve spent their entire lives lying to themselves about it.

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  52. DrDaveT says:

    @andros:

    I paid $260 a month to State Farm, 5 years ago, for a Medicare supplement policy (I think they got out of that line of business.) A friend is paying $280.

    Wow, 1.5% annual price growth. That’s actually lower than the national average inflation for the past 5 years, and waaaay lower than general health cost inflation.

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  53. Monala says:

    @Bob@Youngstown: I also read something about many doctors in independent practices preferring Medicare patients, because unlike private insurance, Medicare always pays in a timely fashion, without arguing about whether to do so or not.

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  54. Lounsbury says:

    Why American Lefties focus on Pie in the Sky Purity Pony solutions which any rational analysis of American political potential clearly says is completely unachievable rather escapes. I suppose it gives you lot the pleasure of going on about how stupid your fellow Americans are, indulging in your guilty pleasure of moral scold superiority, from the Left side.

    Pragmatism would have one focused on iterative development of universal coverage and looking not at government driven models (of which there are several, e.g. the French [as originally structured and currently structured, not identical, showing an evolutionary path], but ones that have at least the façade of private market with universal coverage framing. It is what will be ideologically possible in the USA although as Obamacare shows, already very difficult)

    Everything else is mere Lefty American political fantasy and idealization of other systems, sterile games which will see you lot as usual whinging on about your failures and how awful the general electorate is (or how they are duped by the Evil Opposition, using various childish nicknames for them).

    Work with reality for once.

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  55. andros says:

    O Canada! Why must your sons (that’s in a gender-neutral sense, of course) wait 9 months for an orthopedist? (Specialist Wait Times Have Doubled for Canadians, Huffington Post, 12-18-17.)

    Going to be interesting to see how eager our union members are to share their Cadillac health care with hoi polloi.

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  56. Bob@Youngstown says:

    @andros: @DrDaveT:
    My AARP USHealthcare supplement policy increased from $160/mo in 2015 to $180/mo in 2020. My brother in Research Triangle (NC) reports similar rates and increase. My other brother in TN, the same. Another brother in NV, reports slightly higher by about 15$. But no one in my family reports anything like what you are saying you paid 5 years ago.

    As well, regarding orthopedic doctors, there are 5 or 6 groups in my area, including Cleveland Clinic, all accept new medicare patients.

    So, I’m sorry that your experience in locating a specialist and finding affordable medigap policies has been so poor. Other than region, I don’t know how to explain that (all other things being equal).

    With regard to hospital “reimbursements”, I mentioned above that it makes no sense for Medicare (or anyone else for that matter) to “reimburse” a hospital at $140 for a sling that they probably purchased at wholesale from a distributor. (Considering I purchase the same item at retail for $30). So I actually looked it up in the detail accounting, and Medicare allowed 27.98 for that sling. Would you consider that to be a fair reimbursement? But if you look at the other way, comparing what the hospital charges ($140) to the actual reimbursement of 27.98, it appears like the hospital is being hosed.

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  57. Nightcrawler says:

    @gVOR08:

    If, as our conservative brethren believe, health care could operate on a free enterprise, competition model, doctors’ offices would be open evenings.

    That never occurred to me. You’re absolutely right.

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  58. andros says:

    You are assuming that all Medicare supplement (as distinguished from Medicare Advantage) policies are priced the same for everyone, everywhere. I have no idea what point you endeavor to make about hospitals. You have not disputed that the reimbursement rate of insurers is twice that of Medicare. But let’s get back to the subject at hand: the cost of Medicare. The 20% of expense not covered by Medicare can easily drive you into bankruptcy. You claim you pay $185 a month for a supplemental policy with drug coverage. The Part B premium is $145 a month. The government puts a value of $485 a month on Part A, hospital care. That comes to a total of $815 a month, with insurers having to bail out hospitals. MFA is going to be very expensive indeed, reducing, for many, exceptional to mediocre health care. It’s a loser.

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  59. Bob@Youngstown says:

    @andros:
    Your first comment at 10:42 on Friday raised a couple of red flags for me:
    1) your assertion that a good medicare supplement will “cost close to 300/mo” – I dispute that comment based on my experience and that of family members living in 4 different parts of the US. I would not quarrel, if you said that in your region of the country that you’d paid “close to 300/mo”.

    2) You went on to claim that Medicare reimbursement rates are substantially less than private, causing many doctors to not accept new Medicare patients. When I asked you to verify that claim you responded by citing MedPAC – So I looked at the MEDPAC report to Congress and I’d refer you to two summary statements made therein:
    a) “most beneficiaries continue to report that they are able to find a new doctor without a problem”.
    b) evidence suggests that the medicare payments for physicians are adequate, therefore the Commission recommends (for 2020) no update from current reimbursement rates.

    I have no opinion relative to the Medicare reimbursement to hospitals for generalized services such as a bed fee, as there are many considerations attached to that, but from a individual patient standpoint it seems to me to be entirely appropriate to reimburse a hospital at 20% level for goods (such as an arm sling) that the hospital is charging an exorbitant amount. (see my example above)

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  60. Tyrell says:

    @DrDaveT: We had a good Blue Cross private plan that was $175. Each year it went up some, then really soared. After seven years it was over $400 a month. We dropped it.

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  61. Bob@Youngstown says:

    @Tyrell: we are talking about Medicare supplement plans. Is that what you are talking about?

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