It seems like M4A/single-payer has displaced the public/government option (aka Medicare for Anyone, Medicare for All Who Want It) in terms of mindshare and chatter. Why is that?
There seems to be this fallacy on the Left that if you force the wealthy and privileged into the same systems as everyone else, they will use their wealth and privilege to improve that system. It seldom actually works that way; it seems naive to think that.
I would think that a public option that anyone could buy into at a reasonable price, taking into account personal resources (that is, means-tested premiums) and taking those who are actuarially uninsurable at reasonable rates, would solve a host of problems.
You wouldn't want the public option to become a "high risk pool" (although it wouldn't be the worst thing vs. the status quo if it did), and while you'd want the premiums to be competitive with private insurance where possible (one, to improve the risk pool with healthier people and two, keep Big Insurance on their toes and economically efficient), you wouldn't want to run private insurance out of business, to maintain that choice and also so private insurers can help to carry the load. There might need to be some regulation requiring private insurers to take on a certain number of higher risks to prevent dumping all of the high risks into the public option.
One other big benefit would be to combine Medicare, Medicaid, SCHIP, and everything else into one system (call it Americare) and reduce the overhead costs from separate administration.
Unfortunately the government already has become the high-risk pool; that ship has sailed. Case in point: Seniors (Medicare), 40% of pregnant women (Medicaid), Native Americans (IHS) and veterans (VHA).
The other thing about combining everything (which does have its merits!) is figuring out what the model will be. Insurance like Medicare/Medicaid, or direct delivery like VHA and IHS?
Yeah, the public plans are already a high-risk pool and would become even more of a higher risk pool--of course, it can't get that much riskier as a result and *by design* it would pick up the remaining actuarially uninsurable risks.
What I would not want to see is the private sector using this as an excuse to cherry-pick better risks even more than they do today. Health insurers need to operate more like a public utility--private ownership and investors and profits, but pretty strictly regulated.
What would be great is if there could be some kind of hybrid model combining private sector providers with direct delivery. I wouldn't want one or the other, nor the parallel systems they have in the UK with the NHS and private providers + private insurance that seem to operate completely separately. A direct-delivery option in some locations could increase accessibility in rural and other underserved areas.
What would be the point of the public option in this scenario. If it is not gonna be significantly better then private insurance, why would anyone switch over?
What I appreciated most of all about this piece is the futility of trying to chimera M4A as meaning whatever vibes-based position one would like it to mean in a given moment. I’m a public-option supporter because I generally don’t love to subsidize demand. But it’s amazing to talk to e.g. GenZs who view healthcare exclusively through a moral lens. Inevitably you start to get into policy details and and either a) the impression of what the policy does becomes self-contradictory, or b) rests on pillars of a bunch of things that poll at ~30%.
I think what your investigations have revealed is that (1) due to the efforts of the rebubs, Americans are distrustful of government in general and (2) most are too busy, unwilling, or incapable of understanding complex health care policy issues. The only way this is going to be resolved is via a national debate in which the various options are thoroughly discussed. The basic point that Dems should communicate is that because of its capitalistic underpinnings, a fundamental adversarial relationship exists between the motivations of insurance providers and the health care needs of the population. The second point should be that if you want to continue to pay for insurance, so be it, but tax payers will fund the single payer coverage regardless. The third point should be that the money to pay for the single payer coverage will come out of the current subsidies for the "defense" industry and increased taxes on the 1%.
This is a point that has to be made over and over, because M4A advocates just don't want to believe it: Americans like the idea of government-run healthcare for other people, but they really like *their* private health insurance. There's a natural way to avoid the backlash, which is to gradually lower the eligibility age for Medicare. But M4A is overwhelmingly advocated by young people who are specifically angry at old people. So I don't see them signing on for an incremental approach that initially benefits 60-year-olds.
The real choice is not between government healthcare and the system we have today. The real choice is between political allocation and a genuine free market in medicine—where doctors, hospitals, insurers, charities, and patients are free to contract without government interference. The market should be judged only after it has actually been allowed to exist.
America's healthcare system is already one of the most heavily regulated and subsidized sectors of the economy. Employer tax preferences, licensing laws, certificate-of-need regulations, Medicare, Medicaid, the FDA, and countless mandates have distorted prices and reduced competition for decades.
This is a bad faith take. And people proposing it know it. The goal is to muddy the waters and entrench the current unworkable system. Primary care isn’t where cost in healthcare are. Anyone who knows anything about this topic knows that mathematically, costs are mainly in catastrophic or chronic illnesses. Some are preventable. Many are not. Free direct primary care is a token policy that does nothing to make healthcare actually affordable. Expensive things are high-value innovative drugs, especially for life threatening conditions, surgeries, and advanced imaging/diagnostics. This is where costs that bankrupt families are. So this centrist proposal does Jack squat. Continuously lying to Americans all the time. But you ghouls can’t run away from math. Employer insurance system has run out of the dollars to extract from the working class. They got no more money to feed this broken system. They simple reality is that people on the medical system who make a ton of money off of ill people… whether in insurance, hospitals, or Pharma… need to make less money. Their revenues need to go down. Medicare for all actually does this. Which is why all pundits and think tanks funded by special interests are opposed to it. If they actually wanted to build a workable multi-payer system… they would propose regulating profiteering out of the system, the way Germany does. But none of them propose this. And it reveals everything about the intent. The reality is simple. Policy is about winners and losers. Picking winners and losers. And fixing the system requires the current winners to become the losers. But better to lie, confuse and mislead Americans into an early grave…
Next time you should ask only current Medicare recipients whether they prefer Medicare or private health insurance. I don't know what the result would be, but it seems valuable to demarcate people who possess a basis for comparison.
It seems like M4A/single-payer has displaced the public/government option (aka Medicare for Anyone, Medicare for All Who Want It) in terms of mindshare and chatter. Why is that?
There seems to be this fallacy on the Left that if you force the wealthy and privileged into the same systems as everyone else, they will use their wealth and privilege to improve that system. It seldom actually works that way; it seems naive to think that.
I would think that a public option that anyone could buy into at a reasonable price, taking into account personal resources (that is, means-tested premiums) and taking those who are actuarially uninsurable at reasonable rates, would solve a host of problems.
You wouldn't want the public option to become a "high risk pool" (although it wouldn't be the worst thing vs. the status quo if it did), and while you'd want the premiums to be competitive with private insurance where possible (one, to improve the risk pool with healthier people and two, keep Big Insurance on their toes and economically efficient), you wouldn't want to run private insurance out of business, to maintain that choice and also so private insurers can help to carry the load. There might need to be some regulation requiring private insurers to take on a certain number of higher risks to prevent dumping all of the high risks into the public option.
One other big benefit would be to combine Medicare, Medicaid, SCHIP, and everything else into one system (call it Americare) and reduce the overhead costs from separate administration.
Unfortunately the government already has become the high-risk pool; that ship has sailed. Case in point: Seniors (Medicare), 40% of pregnant women (Medicaid), Native Americans (IHS) and veterans (VHA).
The other thing about combining everything (which does have its merits!) is figuring out what the model will be. Insurance like Medicare/Medicaid, or direct delivery like VHA and IHS?
Yeah, the public plans are already a high-risk pool and would become even more of a higher risk pool--of course, it can't get that much riskier as a result and *by design* it would pick up the remaining actuarially uninsurable risks.
What I would not want to see is the private sector using this as an excuse to cherry-pick better risks even more than they do today. Health insurers need to operate more like a public utility--private ownership and investors and profits, but pretty strictly regulated.
What would be great is if there could be some kind of hybrid model combining private sector providers with direct delivery. I wouldn't want one or the other, nor the parallel systems they have in the UK with the NHS and private providers + private insurance that seem to operate completely separately. A direct-delivery option in some locations could increase accessibility in rural and other underserved areas.
What would be the point of the public option in this scenario. If it is not gonna be significantly better then private insurance, why would anyone switch over?
What I appreciated most of all about this piece is the futility of trying to chimera M4A as meaning whatever vibes-based position one would like it to mean in a given moment. I’m a public-option supporter because I generally don’t love to subsidize demand. But it’s amazing to talk to e.g. GenZs who view healthcare exclusively through a moral lens. Inevitably you start to get into policy details and and either a) the impression of what the policy does becomes self-contradictory, or b) rests on pillars of a bunch of things that poll at ~30%.
I think what your investigations have revealed is that (1) due to the efforts of the rebubs, Americans are distrustful of government in general and (2) most are too busy, unwilling, or incapable of understanding complex health care policy issues. The only way this is going to be resolved is via a national debate in which the various options are thoroughly discussed. The basic point that Dems should communicate is that because of its capitalistic underpinnings, a fundamental adversarial relationship exists between the motivations of insurance providers and the health care needs of the population. The second point should be that if you want to continue to pay for insurance, so be it, but tax payers will fund the single payer coverage regardless. The third point should be that the money to pay for the single payer coverage will come out of the current subsidies for the "defense" industry and increased taxes on the 1%.
This is a point that has to be made over and over, because M4A advocates just don't want to believe it: Americans like the idea of government-run healthcare for other people, but they really like *their* private health insurance. There's a natural way to avoid the backlash, which is to gradually lower the eligibility age for Medicare. But M4A is overwhelmingly advocated by young people who are specifically angry at old people. So I don't see them signing on for an incremental approach that initially benefits 60-year-olds.
The real choice is not between government healthcare and the system we have today. The real choice is between political allocation and a genuine free market in medicine—where doctors, hospitals, insurers, charities, and patients are free to contract without government interference. The market should be judged only after it has actually been allowed to exist.
America's healthcare system is already one of the most heavily regulated and subsidized sectors of the economy. Employer tax preferences, licensing laws, certificate-of-need regulations, Medicare, Medicaid, the FDA, and countless mandates have distorted prices and reduced competition for decades.
Calling this a free market is a fiction.
This is a bad faith take. And people proposing it know it. The goal is to muddy the waters and entrench the current unworkable system. Primary care isn’t where cost in healthcare are. Anyone who knows anything about this topic knows that mathematically, costs are mainly in catastrophic or chronic illnesses. Some are preventable. Many are not. Free direct primary care is a token policy that does nothing to make healthcare actually affordable. Expensive things are high-value innovative drugs, especially for life threatening conditions, surgeries, and advanced imaging/diagnostics. This is where costs that bankrupt families are. So this centrist proposal does Jack squat. Continuously lying to Americans all the time. But you ghouls can’t run away from math. Employer insurance system has run out of the dollars to extract from the working class. They got no more money to feed this broken system. They simple reality is that people on the medical system who make a ton of money off of ill people… whether in insurance, hospitals, or Pharma… need to make less money. Their revenues need to go down. Medicare for all actually does this. Which is why all pundits and think tanks funded by special interests are opposed to it. If they actually wanted to build a workable multi-payer system… they would propose regulating profiteering out of the system, the way Germany does. But none of them propose this. And it reveals everything about the intent. The reality is simple. Policy is about winners and losers. Picking winners and losers. And fixing the system requires the current winners to become the losers. But better to lie, confuse and mislead Americans into an early grave…
Next time you should ask only current Medicare recipients whether they prefer Medicare or private health insurance. I don't know what the result would be, but it seems valuable to demarcate people who possess a basis for comparison.