Which do you Favor and Why: Medicare for All or ACA expansion?

[kennetha]

I’ll go first. ACA expansion.

Reason: Medicare for All is a political loser and ACA Expansion is a potential big winner.

Given the political difficulty of starting from scratch in the American political system, given how heavy a lift the ACA was already ... what with the blue dogs causing the Democrats to lose nerve on the public option, and the Supreme Court dealing the ACA a serious blow on Medicaid expansion. ... and given that the ACA is now broadly supported, and given the public option seems now like it can be easily framed as the moderate sensible alternative in comparison with Medicare for All, and given the added fact that Medicaid expansion has actually gained some momentum, the public option would be much less of a political lift than Medicare for All and together with a renewed push on Medicaid expansion would get us to universal coverage from where we are now much more quickly, with far less division and disruption.

And remember the public option was once derided by the right as a stealth way of moving us toward “socialized medicine.” And even some on the left explicitly saw it as a foot in the door for single payer. It was in fact that combination that caused the blue dogs to lose their nerve and torpedo it.

It is a measure of political progress that the public option can now be sold not as the “radical” proposal of the burn it all down and start over Sanders-Warren left, but as a sensible, centrist, mainstream proposal that even a blue dog could love and embrace!

Politics is the art of the (really) possible, not the merely conceivable. The (really) possible is highly path dependent. Public Option, given our path, is really possible, perhaps even likely. Medicare for All is not.

Finally at least for Sanders and to a much lesser extent perhaps Warren as well, part of what seems to drive them to Medicare for All is a distaste for corporations and profit and wealth. Sanders in particular seems to be deeply personally offended that corporations make profits and obscene profits off selling health insurance. But it is still much easier to regulate corporations than to just eliminate them. In ACA the corporate share of the total health insurance “market” is limited and regulated. And in ACA+ you still get the best aspects of markets ... competition and innovation. Especially if the Public Option has to and gets to compete with private insurers for business both the private insurers and the Publuc Option would be forced to try to be more efficient and cost effective.

Ask yourself whether you preferred the old US Postal Service when it was the only game in town or the new US Postal Service that has to compete on all but first class mail with the likes of UPS and Federal Express and you’ll see what I mean.

[dem4decades]

1. I favor which ever one is most popular and will win us the election. Then get to work on the best

[HopeAgain]

2. Medicare for all

People who want an ACA expansion have never had to deal with an exchange plan for serious illnesses. Calling our best ideas "political losers" is why the political right is now center.

[kennetha]

3. Care to elaborate

I am looking for a serious exchange of ideas

[DemocracyMouse]

52. She just gave you a serious argument.

I've heard the same from many others, including a nurse inside the health care system. Her private insurer stuck her with an insurmountable bill of $6,000. A for-profit health care system provides no incentive for the insurers to NOT stiff the public.

Warren has been great at explaining how Medicare for all will provide better insurance at less cost across the board. We Americans like the sound of thst and we're not as stupid as you think.

Why not help the public get their information straight instead of gaslighting them?

[OneGrassRoot]

5. Not in my case...

Having been self-employed for decades, I could never afford insurance once I got divorced. I finally got Obamacare coverage in 2017 -- turns out, the same year I was diagnosed with cancer.

My coverage has been excellent. Very affordable in comparison to anything else I've ever looked at (I'm a paycheck-to-paycheck person). Can make payments on the large bills (MRI, PET scans) which were part of the deductible. Premium and out-of-pocket are both very reasonable. Granted, my plan is a BCBS plan that is regional, and if you select a certain network, it's a very affordable plan. It turns out all my providers are part of that network, so it works for me.

[HopeAgain]

36. Affordable for you, maybe

but not for many, especially young people. Healthcare should be a right for all, regardless of income.

[OneGrassRoot]

44. I absolutely agree it should be a right for all...

I'm just saying that ACA has been demonized a lot, but it has done a lot of good. My premium is $52/month, btw.

[yellowdogintexas]

16. ACA expansion would work better if EVERY state takes the Medicaid

expansion $$$ Texas has the highest uninsured rate in all 50 states. We did not take the expansion dollars. This is the result.

[kennetha]

20. Right that was the law!

Until the Supreme Court stepped in and said you cannot mandate Medicaid expansion without rewriting the Medicaid law from scratch!

[Gothmog]

53. How will you pay for it-societal savings are not tax revenues and cannot be used to pay for MFA

Such a plan in theory may generate societal savings but such savings would not pay for a program. Governments can only spend tax revenues and/or borrowings. This study does not say how one would pay for such a program in the real world. I note that Prof. Krugman like the concepts of such a plan in theory but notes that taxes will have to be raised a great deal to pay for such a plan
Back in 2016, here is his position Prof. Krugman compares Sanders hoped for health care savings to the GOP tax cuts. http://krugman.blogs.nytimes.com/2016/01/19/weakened-at-bernies/?_r=0

On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan” isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with much lower middle-class taxes than would probably be needed in practice.

To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.

Today, Prof. Krugman says that such a plan is feasible if you are willing to pay a great deal more in taxes
https://www.alternet.org/news-amp-politics/paul-krugman-explains-why-single-payer-health-care-entirely-achievable-us-and-how

If we went to government provision of all insurance, we’d pay more in taxes but less in premiums, and the overall burden of health spending would probably fall, because single-payer systems tend to be cheaper than market-based."

The amount of higher taxes are not quantified in this article by Krugman. To pay for any such plan will require massive tax hikes

Again sanders has utterly failed in his attempts to get Vermont to adopt his magical single payer plan because the state of Vermont cannot use hypothetical societal saving to pay for this plan. Even Krugman admits that much higher taxes are needed

[Eko]

85. My mom was on ACA when she got cancer.

It was literally a life saver for a long time. I helped her with this when she was not able to so I have firsthand knowledge of "dealing" with it. I'm for expanding the ACA. As for the last sentence I can only shake my head. Have you dealt with ACA with a serious illness?

[Prosper]

4. ACA has too many short falls.

Co-pays and deductibles are ACA problem. Different plans having poor people subsidizing rich people is an ACA problem.

[kennetha]

6. Poor people subsidizing rich people???

Where do you get that? Co pays and deductibles aren’t intrinsically bad. They help ration consumption by not masking the true cost. Otherwise the true cost is hidden and borne by someone else.

[yellowdogintexas]

15. Traditional Medicare has copays and deductibles too but they are

very very small. I think my deductible is $145 for medical services. Part A (facility services) has $1000 per confinement (unless it is a readmission for the same dx within a certain number of months)

[dflprincess]

33. In 2019 the maxmium deductible allowed by the ACA is

$7,900 for individual and $15,800 family.

The average 2019 deductible for a "bronze" plan is $5,900 for a single. If the deductible is so high it keeps a person from seeking care, it makes the "coverage" worthless.

[Prosper]

38. Almost half of the members can't afford co-pays

and deductibles. Their premiums and unused services keep costs down for people that can afford the co-pays and deductibles. So that is people unable to use services subsidizing those that can.

CNN.com › money
Web results
40% of Americans can't cover a $400 emergency expense
May 22, 2018 · Four in ten Americans can't, according to a new report from the ... That's an improvement from half of adults being unable to cover such an ...

Covering Pre-existing Conditions Isn’t Enough
Too often, even patients who have coverage can’t afford their medications

https://www.google.com/amp/s/www.nytimes.com/2019/02/25/opinion/pre-existing-conditions-aca.amp.html

[Prosper]

42. Underinsured means having insurance and can't use it.

“Since the ACA, Fewer Adults Are Uninsured, but More Are Underinsured” *

Underinsured means they can’t use insurance because of high deductibles and/or copays. Underinsured are subsidizing those financially able to afford copays, deductibles and medicine.

The way to rectify this is to have only one plan ascribing deductibles and copays by a means test.

*https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca

[Prosper]

41. See 38

[wasupaloopa]

9. It is so easy to knock something with made up assumptions when what you support isn't even defined.

My guess is you are one of those who believes in free healthcare.

[Prosper]

31. Nothing made up about ACA.

20 million with no insurance and millions more can’t afford co-pays, deductibles and medicine.

Nothing is free in a country where you can be called upon to give your life to defend that country.

[wasupaloopa]

51. This whole debate is about adding a public option. With that all your points are null and void

I think the M4A is a phony idea that everyone defines it as they would want it to be. It doesn’t even exist. You can attack the ACA all day and say your pipe dreams are better.

[Hortensis]

22. Completing the ACA would allow anyone who wanted it to sign

up for public option coverage. MfA coverage would eventually be virtually identical but take years longer to become available. I fully intended to sign up for the public option back in 2009, before the Republicans forced it to be left out of the initial stage. I also fully expected then and expect again that the vast majority of people will eventually decide for it.

As for that last, no. And if anyone's been suggesting MfA would somehow be more "socialist" than the ACA, they're trying to deceive. Medical care, devices, and services would all be provided by for-profit corporations and other private business entities, the same as the ACA and Medicare are. No difference: ALL for-profit medicine that is government regulated, but none even slightly socialized.

Now, the VA is socialized medicine because it owns and/or controls the means of production and takes no profit: the facilities, labs, and employee personnel are all the government-owned and run VA.

[Pantagruel]

7. Good ideas posted 9/14

McCamy Taylor posted on 9/14
Talking Points for Medicare 4 All from a Public Health Physician

Hi. You may or may not remember that in addition to being a primary care physician working in a not for profit publicly funded health care system (not saying which one), I also have a Master's Public Health. So, here are some talking points to help sell Medicare 4 All.

Talking Points for the General Public:

1. Number one--it will save money in the long run. How? Because once Americans have cradle to grave coverage with the same insurer, that insurer (Medicare) will have a tremendous financial incentive to invest in disease prevention. Current Medicare, which only covers you once you are old and sick, gains nothing by investing in disease prevention. Medicare is too busy scrambling like crazy to pay for the consequences of decades of health neglect to take time to invest in disease prevention. And your private insurance, which only covers you until you are old/sick (and get on Medicare), also gains nothing from disease prevention.

2. All this investment in disease prevention to save money down the road (and we are not talking next century here, we are talking in the next two to three decades) will also make Americans healthier. And healthier means less pain, more happiness, longer lives, better quality of life.

Right now the only "cradle to grave" single payer in this country is the VHA--the Veterans Health Administration. And it is not really cradle to grave. It is honorable discharge to grave. But that is close enough for the purposes of this essay. Because the VA promises to take care of veterans health forever, it invests in disease prevention. The VA studied aspirin's effects in preventing heart attack. No Big Pharm would have done that--aspirin is a cheap generic. The VA developed the shingles vaccine. It developed the new injectable alternative to statins for those who can not take statins. It supplies diabetic socks because it would rather prevent the diabetic foot ulcer than amputate your foot. It pays for vitamins and nutritional supplements, because it would rather keep you well nourished than try to put you back together once malnutrition wrecks your health. When the VA comes up with a cheap and easy way to prevent disease( and suffering), the VA reaps a direct economic benefit which allows it to stay solvent.

Ever wonder why West Europeans/Canadians pay half per year of what we do in this country for health care and yet are so much healthier? It is because their cradle to grave single payer health plans have an economic incentive to invest pennies in disease prevention now to avoid paying gazillions of dollars down the line to treat horrible disease like heart failure and cancer.

Ever wonder why the VA is under attack? Because the VA model, even more than Medicare is the winning health care model. The one that gives the greatest benefits for the least cost. But Big Pharm all over the world makes a killing in the US. The manufacturers of durable medical goods including artificial joints all over the world make a killing in the US. Hospitals make a killing in the US. Literally. They are killing us with preventable disease so they can make money.

This is the same reason that the UK's National Health is under attack. These are the world's two biggest single payer __to grave plans. Don't be fooled by Twitter trolls. People in the UK love their guaranteed health care. Veterans love their guaranteed health care. Why? If a veteran is told that he has heart disease and needs surgery or cancer and needs chemotherapy, the first words out of his mouth are not "Will I have to put a second mortgage on my house to pay for this?" For the veteran, sickness does not equal bankruptcy and poverty.

So, when talking M4A, remember these two key points 1) It will keep you healthier and 2) After an initial start up investment, it will save this country about 1-2 trillion dollars a year once it is up and running. (Based upon current annual US health care spending) And this is not even factoring in increase worker productivity.

Talking Points for Targeted Audiences:

For 20 somethings who think that they are immortal and invincible, selling disease prevention is not easy. However, there is actually an easy way to get their attention. Point out how overweight and unhealthy their parents and grandparents are. Ask them "Do you want to end up like them? Wouldn't you rather be better than your parents and grandparents?" (Young people always want to believe that they can change the world for the better) Sell the 20 somethings on better health.

For seniors who love their Medicare to death and who are afraid that if they have to share it with younger folks there will not be enough Medicare left over for them remind them that this will keep Medicare solvent. Everyone will pay (small compared to traditional insurance) premiums. People coming into the system will be healthier and stay healthier. More people in the system means that the system will be self sustaining. Old folks ought to be worried as hell that if something is not done now to increase Medicare enrollment, eventually Medicare will be so crowded with high utilizers that it will collapse. Sell the seniors on Medicare solvency.

For middle aged people who have fairly decent private insurance through their jobs or that they purchase for themselves, remind them that their out of pocket on Medicare will be lower than even the most platinum plated private insurance. Including the monthly premiums, the average Medicare patients pays around $7000 a year out of pocket (not counting medications that is a whole other issue). (For comparison, I have platinum plated federal health insurance and for two folks it averages to around $8000 per year per person out of pocket.) M4A means every American will have out of pocket that is actually less than Congressional Insurance! Yippee!

For middle aged people who do not have insurance, M4A sells itself. They are putting off their hysterectomy or mammogram or heart surgery because they cannot afford these things. They lost their jobs because they were too sick to work and now they run a cash register at 7-11 and are praying they live long enough to get Medicare.


1. In states that took the Medicaid expansion, small towns were able to open new clinics and hospitals (compare rural Colorado and New Mexico to rural Texas). Medicare 4A would have an even greater effect on small towns. And once there are doctors and hospitals then companies and jobs could relocate to small towns. So M4A is great for rural America!

2. M4A will mean more emphasis on disease prevention meaning a greater demand for primary care physicians. We can either continue to import them from other countries where the cost of going to medical school does not put you half a million dollars in debt. Or, we can do medical school debt forgiveness for docs who go into primary care. Primary care is much more fun than specialty care. But many medical students give up their dream of being an all around doctor (think Marcus Welby) because it would take them too long to pay back their loans on what a pediatrician or family doctor makes. So M4A means more primary care doctors. Meaning it will no longer be easier to find an orthopedist to replace your knee (next day) versus a primary care doctor to treat your diabetes (never in some areas where primary care is no longer accepting new diabetic patients)<--- this is an absolutely true story. As a nation we ought to be scared that it is easier to get a new knee than to get your blood sugar under control.

[kennetha]

8. Private insurance gains nothing from disease prevention ??

You lost me right there. How could you say that with a straight face? Do you even know how insurance works?

[wasupaloopa]

10. This is rediculous. Desease prevention starts and ends with the individual. You can't force

people to take care of themselves just because there is some cradle to grave health care. The opposite will be the case.

[yellowdogintexas]

18. Offering important screenings without deductible or copay

is a giant step and is a key element in the ACA and in Medicare Part B

Screening mammograms, PAP, PSA antigen, colonoscopies, bone densities, annual physical exam are all covered at 100% of contracted rate with no copay or deductible. No out of pocket cost is a huge incentive to have these screenings. The # obstacle to obtaining these services is $$$$$

Medicare also covers flu shots and pneumonia vaccines without copay or deductible.

When I was a claims examiner for Part B services back in the 70s, there were NO screening services covered except mammograms and PAP smears (not the whole well woman visit, just the PAP) and no preventative coverage either (I must have denied a zillion flu shots and Pneumovax in the 5 years I processed claims)

I have worked for many other small group and individual plans which do not cover any thing other than screening Mammograms and Paps IF their state of residence had a state mandate to cover it. This also goes for well child care. ACA covers well child universally. If Medicare is opened to anyone who wants it, it would need to be updated to include services currently not addressed in Medicare.

[dflprincess]

34. Offering the screening with copays & deductibles is great

but what happens when the PAP or the mammogram comes back showing you need follow up & you can't afford the copays and/or deductibles that kick in then?

I support a single payer plan but it needs to be better than Medicare as it exists now. Currently, I only have Medicare A as I'm still on my employer's plan and, from what I've seen of Medicare, I'm not as impressed as I expected to be. It will actually cost me more out of pocket than what I have now and cover less.

Medicaid For All would be a better plan.

[Prosper]

56. Thank you.

Opposition to M4A comes from greed.

[YOHABLO]

11. So are you, or are you not, a Blue Dog Democrat? Could we clarify that?

I will refrain from expressing my opinion on 'Blue Dog' Democrats. For now.

[kennetha]

12. No

[TCJ70]

13. Why did you give two of the same option?

They’re the same thing as far as I’m concerned. It’s a bullshit argument that M4A people are somehow disrespecting Obama and the ACA by promoting moving to M4A. The ACA was supposed to be a stepping stone to universal healthcare if I remember right...at least, that was one of the selling points at the time.

[kennetha]

14. Universal Coverage is the end

Single payer vs ACA are different means to that end with very different structures and very different costs and benefits.

I think you mistakenly think Universal Coverage = Single Payer

[DemocratSinceBirth]

17. Medicare For All Who Want It.

[DemocratSinceBirth]

19. Vote

https://www.democraticunderground.com/1287280519

[yellowdogintexas]

21. Offer both. Seriously.

Just put Medicare out there as the public option as was originally intended in the writing of the ACA (Thanks to Joe Liebermann we do not have public option) Update it to include services needed by young families (like well child care).

here is the deal. Every employer offering insurance coverage should be required to include the Public Option in their choices. Let the employees choose what they want. This has two advantages: the folks who choose Public Option and are happier will tell their co workers and more will opt in. The employer ends up with lower costs too.
The other advantage is that people are phased in to Medicare gradually. Trust me, we don't want 10 million people dumped into the system at once!!! The administrative costs would skyrocket and the claims backlog would explode.

None of the folks who are in favor of employee/individuals choosing what they want are addressing the best reason to go gradually - dumping everyone in at once would destroy the system.

Also, somehow the Medicaid expansion needs to be made mandatory - I do not know how we can accomplish this but surely there is a way... If we can revoke an amendment (prohibition) is there a way to revoke a SCOTUS decision if there are enough votes in COngress?

[kennetha]

23. The Supremes said the law authorizing Medicaid would have to be rewritten!

in order to make expansion mandatory... fat chance of that!

[Politicub]

24. Yes. Anything that leaves no Americans without healthcare coverage is

fine with me.

I use a plan from the Exchange and I’m happy with it. My husband has Medicare and he is happy with it.

But what is most important is that we are covered.

But there’s nothing special about us. There is nothing that makes us more deserving of coverage than anyone else.

Healthcare should be thought of as a human right and made available to all, including those who do not have money to pay for it. I don’t care if the ACA is bolstered to enable this or if Medicare for all gets us there.

The most equitable system is the Medicare for All plan from Sanders. All Americans will have the same access to care. There is no discrimination on ability to pay because there are no co-payments.

The ACA can be used, too. It was created as a platform on which to build. The result will be a hodgepodge solution, with some having more advantages and coverage than others. But as long as everyone is covered, that will be better than the status quo.

[Baked Potato]

25. ACA Expansion

I trust President Obama and his administration did the right thing and we were on the right path. The ACA wasn’t allowed to flourish and become the helpful program it was meant to be. The republicans *had* to kill the ACA lest it become a successful government program. That was their horror. A generation of Americans would trust the Democrats on healthcare. They had to stop that momentum.

The bugs needed to be worked out and it needed fine tuning. Imagine if we could simply re-engineer the program, and add a public option. The Supreme Court has already ruled for the ACA in some instances. It would be a huge win for the Democrats and could spark a generational change to our direction. It’s all about trust.

Americans know the republicans don’t give a shit if people live or die. Our candidates should get on the same sheet of music and quit bombarding us with minute details of their plans. That’s dividing us. Just tell Americans:

We are Democrats! We care about you! Get us a majority and we’ll fix healthcare and we’ll fix every other damn mess the republicans have gotten us into.

[bitterross]

26. Medicare for all - we need to nationlize healthcare

The for-profits have to be taken out of the picture.

[Nanjeanne]

27. Medicare For All because it is immoral to make profits from denying people healthcare.

And M4All is the only cost effective way to go. It must be all in for effective cost sharing. And I do not like the idea of my tax dollars going to profitable insurance companies in the form of subsidies. But first and foremost it is a morality issue for me.

[KPN]

28. Medicare for All. Why?

Starting the legislative lift at "a public option" pretty much guarantees that we end up with a seriously imperfect public option that can easily be punctured at State levels and by the SCOTUS so that the GOP can shit-can it.

Starting with the goal of MFA on the other hand gives us at least more negotiating turf, more leverage with the insurance and pharmaceutical industries, and a greater chance therefore of actually creating a public option that might thrive.

In the end, I want MFA for a lot of reasons, but principally because everyone should have access to good health care in the wealthiest nation on earth and I see it as being the most effective and efficient way of doing that.

[Joe941]

29. Medicare for all. ACA really was unaffordable for too many.

[Gothmog]

30. Warren and Sanders say Americans don't like their health insurance. Polls don't back that up.

Link to tweet

[elocs]

32. MFA is a pipe dream & promises everything but has little to no chance

of ever being passed into law and if those who support it were honest they would say so.
The ACA is still the law of the land for now and it can be made better although Republicans will try and prevent it.

[wellst0nev0ter]

35. I'm not in favor of leaving 10 million people uninsured

That's what the best ACA expansion would do.

[krawhitham]

37. Medicare buy in option for the ACA exchanges

[Gothmog]

43. Speaker Pelosi-There's no need to reinvent health care -- just improve Obamacare

I agree with Speaker Pelosi https://www.cnbc.com/2019/09/17/nancy-pelosi-no-need-to-reinvent-health-care-improve-obamacare.html?__source=sharebar|twitter&par=sharebar

Democrats should focus on making improvements to Obamacare instead of trying to reinvent the wheel with “Medicare for All,” House Speaker Nancy Pelosi said Tuesday.

“God bless” 2020 Democratic presidential candidates putting forth Medicare for All proposals, Pelosi said in an interview with “Mad Money” host Jim Cramer. “But know what that entails.”

Pelosi’s thoughts on how to improve the nation’s health-care laws appear to align with those of former Vice President Joe Biden, who in his 2020 presidential bid is calling for building on provisions of Obamacare, formally known as the Affordable Care Act.

“I believe the path to ‘health care for all’ is a path following the lead of the Affordable Care Act,” Pelosi told Cramer. “Let’s use our energy to have health care for all Americans, and that involves over 150 million families that have it through the private sector.”

[Gothmog]

45. Buttigieg tells Medicare-for-all proponents to show their cards

Against my better instincts, I am slowly beginning to like Mayor Pete.

Link to tweet

Now, I’d like to get more detail on those “cost savings” and the “corporate tax reform” (and why aren’t Democrats promising to raise the capital gains tax rate to equal or nearly equal the rates for salary income, a much bigger revenue-generator?). Buttigieg also promises “additional plans to address issues such as drug pricing, innovation and health equity,” which will need to come with funding mechanisms.

Nevertheless, Buttigieg has a compelling argument: Candidates are obligated to offer bold ideas that are doable. He argues, “Rather than flipping a switch and kicking almost 160 million Americans off their private insurance, including 20 million seniors already choosing private plans within Medicare, my plan lets Americans keep a private plan if they want to.” The latter is a reference to Medicare
Advantage, which would go away under a strictly single-payer system.

The approach favored by Buttigieg, Biden, Sen. Amy Klobuchar (D-Minn.) and other moderates would be cheaper and allow people to gradually migrate to Medicare (if that is what they want). Moreover, if Democrats want to accomplish anything, it likely will require a Democratic majority in the Senate and use of reconciliation; they would at least need a majority. There is not, as we speak, a majority of Democrats in both houses who support Medicare-for-all.

Part of the problem with this discussion is that the Medicare-for-all advocates are adept at deflecting pesky questions about cost, logistics and political feasibility. They shouldn’t be allowed to skate by on ad hominem attacks (That’s a Republican talking point!) or non sequiturs (Let me tell you how great Medicare-for-all is!) or platitudes (We’re going to fight!).

[emmaverybo]

55. +10000

[Zaphod42]

46. Interesting thread...

I'm very much the newbie here at DU; I've seen more actual discussion on this thread than on any other that I've read (so far)....It seems that most of what I see here at DU consists of people posting links to articles from HuffPost or DKos, etc... and trading snarky comments.

Anyhoo, I digress...

Insurance, of any sort, has always confounded me. I carry insurance because it's stupid not to, but gawd!, the terms/conditions/limitations/exclusions, et al, are just almost indecipherable!

To your question...I think that M4A is the most desirable path, but is it politically doable? The ACA was a huge step forward, but obviously not a perfect fit for everyone. It seems like no one is talking about the actual cost of healthcare...I think that any discussion about healthcare needs to start there. WHY is healthcare in this country so much more expensive than almost anywhere else in the world? I don't know, but it's quite clear that "for profit" healthcare has failed most of the people who most need it.

[Blue_true]

48. Why is healthcare more expensive here?

We are pretty much the most obese country in the world, yet our life expectancy is pretty decent. There are people in poorer countries that are thinner because they do more intense physical labor and have less to eat, but many of those people die fairly young.

What we can do here. I am not going to double talk. We need to attack obesity the way that we attacked smoking cigarette and driving under the influence (which killed or seriously injured many people). We shy away from talking about weight and health because lots of people get bent out of shape over that focus. I was in a busy public place yesterday and I only saw FOUR people that were not overweight (other than me). Most of the people that I saw were young and morbidly obese. We need to get Physical Education and nutrition classes back in schools and not have them taught by clueless assholes, get skilled educators in those functions. Students should be required to take PE and nutrition classes until the 11th grade (by then the training should be a life choice). We should not allow fat shaming of people, but neither should we tolerate overeating and no exercise. Diabetes and cardiovascular disease combined are our number one killer by a large margin, both have a strong correlation to obesity (though both can be due to genetics at a lower level).

[Blue_true]

47. I favor ACA expansion if the following are met.

1. People that are in insurance plans that they like are allowed to keep them.

2. The expansion covers the large number or working people that now fall through a donut hole, people that can't afford quality healthcare and make too much to qualify for ACA assistance now (I think allowing them to buy into a massive group plan would lower their costs and provide high quality low deductible, no cap health insurance to them).

3. Short term unemployed people get high quality plan options that can be handled with unemployment payments and some premium assistance.

4. A plan exists for unemployed people on the 50-65 age range. Because of ageism, those people have a hard time finding a job.

5. Small companies be allowed to buy into large group plans that cross state borders. We simply must attack the state by state health insurance regulation market, health insurance should be like auto and homeowners insurance, companies can offer insurance across state lines, as long as those plans meet the standard of being high quality, with low deductibles and no coverage cap.

[SKKY]

49. Medicare for all, but I absolutely believe that the ACA, if allowed...

...to mature, would have turned into Medicare for all at some point in the not-too-distant future. What I DO NOT agree with is getting rid of private insurance. In my personal experience having lived in Spain for almost 18 years, that type of hybrid system can and does work.

[comradebillyboy]

50. The ACA actually exists in the real world. People are much more

accepting of it, especially the preexisting conditions protections. Expanding on that is a much more productive way to insure more people without another political blood bath like 2010.

[Midnightwalk]

54. It's not completely a binary choice

What is best is immaterial. How you deliver a new product, idea, program is often as important as the content.

We have to win the presidency and the senate to get anything.

Then figure it’ll take close to two years to get a bill fully written, debated and enacted. That’s just un time for midterms in 2022. If we don’t keep the house and senate making any tweaks we need as we move to implement the new law won’t be possible.

I’ll guess it will take another 2 years before some of the benefits show up. There are always glitches in big roll outs. That puts us up to the next presidential election in 2024. If we don’t win that the new law will be sabotaged or may be revoked if we lose congress.

That’s true for either approach.

I think medicare for all is the best plan when fully implemented and people would eventually recognize the benefits.

At the same time I think “democrats want to throw 130 million people off their insurance plans” is a devastating attack. As a country we have been conned into believing that government is horrible and never works as good as the private sector. I don’t believe that myself, but I think too many do.

The ACA was villainized after it passed and I think it was a factor in our big losses in 2010. It was clearer by 2012 that it wasn’t as horrible as republicans made it out to be and we didn’t lose the presidency. By 2018, people finally recognized the benefits and we got the house back.

Many other factors were at play but healthcare was a big factor in those elections.

I think it is much easier to win the arguments and elections by adding a benefit than by being seen taking away an employee benefit.

For that reason I think it is better to take a longer path through a public option and grow that as much as we can into a form of medicare for all.

I hate that people will suffer and die unnecessarily until we have a system that covers everyone affordably. I don’t dispute that adding a public option does not do enough, just whether we can win elections when people are told that they will lose their employers insurance and we answer “yes you will and here’s why that’s good”. Not enough will listen to and believe the explanation.

In the meantime I wish we would raise a bigger stink about prescription price gouging. That is more easily framed as Americans are being cheated by pharmaceutical companies. We ought to be able to cut a lot of cost out of the system and win elections on that issue.

[IronLionZion]

57. Start with Medicare for all and compromise down to ACA/public option

Just like Beto should start with gun grabbing and compromise down to better background checks and closing loopholes

That's how Republicans do it. They run circles around us.

[Gothmog]

58. NBC/WSJ poll shows Biden's healthcare stance (optional Medicare buy-in) much more popular

Link to tweet

Link to tweet

[Demsrule86]

59. The ACA...MFA will never happen and why would we start over? Americans like the ACA and would

toss us out should we do this...I can only shudder to think what it would take in taxes and the glitches in the implementation...No No.

[madville]

60. Voters will not tolerate an additional 10 or 15% paycheck deduction to fund M4A

None of the proponents will admit peoples' paychecks will go down even if there is a net savings. They simply can't sell that argument to the general electorate.

[brooklynite]

61. I'd like to go to Medicare for all; I don't think you can sell it in this election.

[Blue_true]

62. ACA expansion. nt

[trueblue2007]

63. I'll go first. ACA expansion.

[andym]

64. MFA with an optional opt-out

and a transition period to MFA that looks a lot like a public option grafted onto the ACA.

[Gothmog]

71. Why Elizabeth Warren won't talk about the cost of 'Medicare for All'

Link to tweet

The elephant in the waiting room remains the staggering cost of this new system. There's a reason why Warren avoids the conversation about how we're going to pay for Medicare for All. In fact, anyone with a pencil and paper and third-grade math skills would quickly figure out that this proposal simply cannot work.

Depending on whom you ask, cost estimates range from $2.5 trillion to $4.7 trillion per year. It's important to keep in mind that the entire federal budget for fiscal year 2020 is $4.7 trillion (including a $1.1 trillion-dollar deficit). Basically, we would have to double the size of the government through higher taxes on every American employee and fundamentally alter the structure of the American economy.....

Medicare for All fans propose to demolish our current health care system that certainly needs streamlining, more competition between insurance companies and plans and new and better technology. Other issues that must be addressed are drug manufacturing and distribution networks and hospital consolidation.

While we desperately need reform, any realistic policy proposal would recognize that 90 percent of Americans currently have health insurance. Instead, reasonable politicians should focus on how to cover those who are uninsured or underinsured in our current system.

[andym]

87. She now has. She claims it will put 11 trillion dollars of savings in the pocket of the middle class

Sounds like a winning issue to me. Her plan would essentially end paying for premiums and paid for by business (which already pays private insurers anyways) and the billionaires subject to the wealth tax.
https://elizabethwarren.com/plans/paying-for-m4a?source=soc-WB-ew-tw-rollout-20191101

[Algernon Moncrieff]

65. I'm tired, and I could (really) write a short book on this, so I'll keep it short

Americans want medical coverage; they want it as cheaply as they can get it, but they also have very different needs/wants/preferences. Some love and trust a specific family doctor for all but the most specialized needs. Others have no use for Internal Medicine/Family Practice types and want to head straight to specialists. Others don't care who they see, and will happily see ARNPs or PAs at big multispecialty practices - they just want to be seen right away. Rural patients are thrilled if they don't have to drive 2 hours + to be seen by anyone. So I say expand the ACA. Every American is part of a group and can get group rates, and select coverage options that suit their preferences and budget.

MFA should serve as a public option for those who cannot get coverage in the private markets - particularly those between 50 and Medicare age. There should be a buy-in.

Unlike most DUers, I do not see the insurance industry as the villain. There are plenty of dastardly deeds being performed by medical practices, hospitals, pharma, DME retailers, and third-party administrators. There is a need for supervision and audit at every level of the system.

I'll also point out the obvious: having the government running healthcare for all represents an additional huge sacrifice of privacy to government authority. I get that we sacrifice the same privacy to a number of private actors now, but having that level of personal knowledge entrusted to the State rightly troubles some people.

At the end of the day, any plan that reduces or eliminates unpaid medical debt and allows all Americans to get treatment is a good thing.

[Eric J in MN]

66. Medicare for All

People are afraid to take ambulances because of the cost.

People at hospitals are afraid that if an out-of-network doctor talks to them they'll get huge bills.

People are rationing their insulin.

Enough. Time to replace this ridiculous system with a straightforward system which serves people:
Single Payer Medicare-for-All.

[TreasonousBastard]

67. Improve BOTH Medicare and Obamacare and begin phasing out the patchwork...

we now have.

After the trouble we had trying to pass Obamacare, and the ongoing attempts to destroy it, I cannot believe that we could possibly enact a complete reorganization of our health care system of coverage.

Two things are important-- reducing the ridiculously high cost of delivering health services (including drugs) and increasing coverage to include everyone. How we get there is less important than getting there.

[Gothmog]

68. Obamacare Has Made People Healthier

Getting rid of Obamacare is a bad move https://politicalwire.com/2019/09/30/obamacare-has-made-people-healthier/

Washington Post: “Poor people in Michigan with asthma and diabetes were admitted to the hospital less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.”

“Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.”

[Gothmog]

69. 73% of people favor [the] public option that would keep private insurance in place

Link to tweet

[Gothmog]

70. Support for a public option has been increasing, and for Medicare-for-All has been decreasing

Link to tweet

[Gothmog]

72. Choices for Financing Medicare for All: A Preliminary Analysis

This is from a non-partisan think group that is well respected http://www.crfb.org/papers/choices-financing-medicare-all-preliminary-analysis

Proposals to adopt single-payer health care in the United States have grown in popularity in recent years, as numerous lawmakers and presidential candidates have embraced Medicare for All. However, few have grappled with how to finance the new costs imposed on the federal government. By most estimates, Medicare for All would cost the federal government about $30 trillion over the next decade. How this cost is financed would have considerable distributional, economic, and policy implications.

In the coming months, the Committee for a Responsible Federal Budget will publish a detailed analysis describing numerous ways to finance Medicare for All and the consequences and trade-offs associated with each choice. This paper provides our preliminary estimates of the magnitude of each potential change and a brief discussion of the types of trade-offs policymakers will need to consider.

We find that Medicare for All could be financed with:

A 32 percent payroll tax
A 25 percent income surtax
A 42 percent value-added tax (VAT)
A mandatory public premium averaging $7,500 per capita – the equivalent of $12,000 per individual not otherwise on public insurance
More than doubling all individual and corporate income tax rates
An 80 percent reduction in non-health federal spending
A 108 percent of Gross Domestic Product (GDP) increase in the national debt
Impossibly high taxes on high earners, corporations, and the financial sector
A combination of approaches

Each of these choices would have consequences for the distribution of income, growth in the economy, and ability to raise new revenue. Some of these consequences could be balanced against each other by adopting a combination approach that includes smaller versions of several of the options as well as additional policies.

[Hoyt]

77. If those projection are anywhere close, MFA ain't gonna happen without big changes. That's unlikely.

[Act_of_Reparation]

73. I favor not being lectured to about what's "possible"

I understand certainty. I understand probability. I understand what outcomes are or are not likely at present.

What's possible ain't necessarily what's right.
What's popular ain't necessarily what's ethical.
What "people want" ain't necessarily what people deserve.

That's why I support what I support.

[Autumn]

74. MFA. There is really nothing else that will work. nt

[Gothmog]

75. A dose of reality for Medicare-for-all

Link to tweet

Now we have two more data points. The quite credible think tank, Committee for a Responsible Federal Budget, comes up with some options assuming a cost of $30 trillion over the next decade (a midway point in the range of estimates):

We estimate the cost could be covered with a 32 percent payroll tax, a 25 percent income surtax, a 42 percent value-added tax, or a public premium averaging $7,500 per capita or more than $12,000 per individual who wouldn’t otherwise be enrolled in Medicare, Medicaid, or CHIP. Medicare for All could also be paid for by more than doubling individual and corporate income tax rates, reducing federal spending by 80 percent, or increasing the national debt by 108 percent of GDP. Tax increases on high earners, corporations, and the financial sector by themselves could not cover much more than one-third of the cost of Medicare for All.

But you say, none of that is remotely feasible politically and would have all sorts of negative economic consequences.

Warren actually has an even harder task since CFRB does not exempt the middle class. Therefore, Warren cannot use “a 32 percent payroll tax, a 25 percent income surtax, a 42 percent value-added tax, or a public premium averaging $7,500 per capita” if they are going to hit the middle class to such an extent that it wipes out savings from removing insurance premiums, co-pays, deductibles, etc. This is the equivalent of trying to balance on elephant on the head of a pin.

[Hoyt]

78. That's depressing. But why Vermont, Colorado and Cal abandoned consideration of single-payer quickly

[Gothmog]

79. Vermont was unable to adopt a single payer plan

A deep-blue state’s failure to enact a single-payer system shows why a national version is unlikely to succeed. www.nytimes.com/2019/10/09/opinion/bernie-sanders-single-payer.html

Link to tweet

The first problem for any single-payer push would be political support: Mr. Shumlin campaigned on a promise to build a single-payer system in Vermont, but the public never quite bought in. An April 2014 survey showed 40 percent support, 39 percent opposition and 21 percent undecided — a lukewarm result for such a major undertaking. That year, Mr. Shumlin barely won the popular vote against an anti-single-payer Republican. As John E. McDonough of Harvard wrote in a perceptive New England Journal of Medicine analysis of the plan’s collapse, “a clear public mandate” for Mr. Shumlin’s health care agenda “was nowhere in evidence.”

One reason the plan lacked strong support was lawmakers were cagey about how to pay for it. The 2011 proposal included no specific financing mechanism, because Mr. Shumlin’s team worried that might kill its chances.

Initial cost estimates were far too optimistic. A 2011 study led by William Hsiao of Harvard found that single-payer could reduce state health care spending by 8 percent to 12 percent immediately and more in later years, resulting in about $2 billion in savings over a decade. But by the time Mr. Shumlin ditched the plan, internal government estimates showed a five-year savings of just 1.6 percent.....

The Vermont plan was done in by high taxes, distrust of government and lack of political support. Any effort by a Sanders administration to enact a single-payer system at a national level would probably be doomed by similar problems.....

But if it couldn’t work in Vermont, with a determined governor, an accommodating legislature and progressive voters, Mr. Sanders will have a tough time explaining why it will somehow succeed on a vastly larger scale. Vermont represents a practical failure on friendly turf, and that is what makes it such a powerful counter to Mr. Sanders’s proposal.

“If Vermont can pass a strong single-payer system and show it works well, it will not only be enormously important to this state, it will be a model,” Mr. Sanders said in 2013.

As it turns out, it was a model. But instead of showing us how it would work, it showed us why it would fail.

[Hoyt]

81. Yep. I figured the legislators in all those states just didn't have the guts to tell voters what it

would cost in increased taxes, even if the tax increase supposedly replaces premiums and out-of-pocket costs we are paying now.

I do believe the new study you provided is a bit high. I can't see it requiring a 16 percentage point increase in payroll taxes, but some credible organization -- like CBO -- would have to prove those figures wrong. Haven't seen it yet, all we've gotten is "we are already spending it" BS.

[redstatebluegirl]

76. ACA Expansion

This country is not ready for MFA and may never be. Plus it is not FREE, I am getting ready for Medicare and am looking at how much it costs, and how much the other policy you need costs. Some of the people I have talked to who love MFA think it will be free of charge, no it won't. Either taxes will go up a ton to cover it, or there will be a cost like there is now.

We can't sell it and win, that is the bottom line. We go that far left and we get 4 more years of trump or pence.

[lamp_shade]

80. ACA expansion. nt

[Voltaire2]

82. MFA: everyone should have comprehensive health care.

Nobody should be dependent on the benevolence of their employer.
Private insurance companies should not act as the gatekeepers, their motivation is their bottom line, not your health.

[JT45242]

83. Based on tax revenue

I would roll back taxes to the Reagan era bipartisan tax cut. I would remove all caps on FICA and social security to fund expanded services.

If that would pay for Medicare for all, then do it. If it would make subsidies and Medicaid expansion of the ACA then do that.

[redqueen]

84. Honestly not sure.

I see positives and negatives for both.

I think ACA expansion is more realistic, but I hope it can be paired with something that prevents the for-profit companies from foisting the highest risk individuals off onto the public option, thereby again socializing the risk while they reap the rewards. Not sure how to do that.

Yang is going to be releasing details on his plan soon and I'm really looking forward to it. He seems to focus on finding the best possible solutions with the best chance of getting through Congress.

[Gothmog]

86. A good rule of thumb: Don't get to Pelosi's left

Link to tweet

She is openly dubious of the left’s top priority in 2020: the push to establish a single-payer health-care system that will replace private health insurance. It would be better for Democrats to “begin with where we have agreement,” she said. “Let’s not start with: ‘You have private insurance—forget about it.’” She wants to begin by bolstering the Affordable Care Act, adding a public competitor to private insurance, and restoring provisions in the law that Trump has weakened. “Maybe Medicare for All is a destination,” Pelosi said. “But it’s certainly not a starting point.”

[scheming daemons]

88. ACA expansion. Because it is feasible in any congress makeup we could imagine in 2021

And M4A isn't.