I fear for America

[Mega]

Mostly from New York..............hmm give it a few years &

Why are ALL DNC women nasty little whinney females?

[dcarrigg]

Re: I fear for America

They're not actually a very big group. They're just organized. There's about 3,100 in NYC, 1,400 in DC, 1,100 in Boston, etc. Total there's maybe 50,000 or so. Kind of surprising considering there's over 500,000 homeless and 30,000,000 with no healthcare whatsoever and another 1,000,000 with healthcare who go bankrupt due to medical bills every year.

[Mega]

Re: I fear for America

Let me be 110% clear on this one America health services are a SICK joke!
Every other 1st world nation leaves the US in the dust!

I have no problem with a level headed American left, but its NOT level headed!................

Mike

[dcarrigg]

Re: I fear for America

I think that's a large part of where it comes from. We've always got another $10 trillion for tax cuts and $10 trillion for endless wars in the middle east. Nobody asks how much those things cost. But propose a first world health system and suddenly every newscaster and politician and businessman and other assorted stuffed suits cry "How will we afford it?! Soshulism!" We're supposed to be a republic. But our working citizens can't even get basic first world services. It's obvious the lords got hold of the treasury. They've been calling the NHS etc. socialism for so long that some kids look around and say, "Well, if that's socialism, sign me up."

And by the way, the majority of the Democratic Debate stage were way to the right of Boris Johnson on this issue. Both the GOP and the DNC are. No major political party in America is openly in favor of the universal healthcare enjoyed by citizens in the rest of the developed world. Hence you get the DSA. And until and unless one party puts it in their platform, as healthcare eats up an ever-growing share of GDP, as inequality increases, and as deductibles and premiums go through the roof, the number of radicals will only grow.

I too fear for America. But this is what I fear:



Anyways, there's going to have to be a radical political upheaval. There's no way around it. If per capita income is $60k going up at 2%-3% and healthcare costs are $15k going up at 7%-9%, we could easily find ourselves in the 2030s with $75k per capita, $30k of which goes to healthcare. Add in inequality, and we're talking median personal income going entirely to healthcare by the 2030s unless something radically changes. I don't think most people realize how close we are to the economic precipice on this one. The population is aging fast. Life expectancy is dropping. Without a complete and total overhaul of the system, basic arithmetic dictates that it's going to collapse soon.

[Mega]

Re: I fear for America

If the DNC keeps going Loony left then it won't go any where............They need a level headed guy to try this..............but look what happened when "Bill & Hillary" tried in the 90's !

Mike

[dcarrigg]

Re: I fear for America

Bill and Hillary never really tried. Hillarycare was probably a bit better than Obamacare in a few respects. But it was still fundamentally a kludgy mess. It was never universal, despite what she said. It would always have left 10s of millions out. And it would have done little to control costs. I don't think a public option or a Medicare buy-in will do much to control costs either. And it definitely won't cover everyone, since we're still talking ~$10k per year, which is better than the current ~$12k per year, but which lots of people just don't have. We're going to have to stop having more coders and billers than we do doctors. But most Dems don't have plans that do anything about that. And the GOP basically has no plans at all. There are plenty of models working better in other countries we could copy. But most "level-headed" people won't even entertain them. Literally nobody in America except the "Looney Left" says, "Hey, how come Canadians pay half what we do and cover everybody?"

And until someone "level-headed" makes that conceptual leap, the "looney left" doesn't look so looney on this issue. Everyone else does.

[Mega]

Re: I fear for America

Its a shame Tip O'Neil is not about these days, he sort the DNC

[dcarrigg]

Re: I fear for America

I guess my only point was that if you want to know why there are 50,000+ dues-paying democratic socialists in America and growing, all you have to do is realize that AOC's healthcare platform is somewhere to the RIGHT of the Tories'. And everyone else is way to the right of her. That's how messed up it is. One party advocates nothing. The other advocates tinkering that doesn't address the problem. And so there's a vacuum. DSA fills that vacuum.

[Mega]

Re: I fear for America

Trouble is YOU know that the Nano second anyone tried to do this the full force & might of the other side would be thrown at them...............not sure to go from your present policy to a UK or French one?

[dcarrigg]

Re: I fear for America

No doubt. But we have about 15 years max until total chaos at status quo. And things will get exponentially worse each passing year along the way. I'm pretty sure this is not an 'if' but a 'when' problem. The other side can diet now or slim down in the coffin. Either way, they can't keep getting fatter forever.

[jk]

Re: I fear for America

2 comments:

1. re "how can we afford it?" people who ask this question appear to think that our current medical care, such as it is, is free. we are ALREADY paying a tremendous amount. the only questions are where does THAT money come from? and what will happen to THAT money if there's a gov't system. someone who thinks his employer sponsored healthcare [which probably sucks] is a free benefit doesn't seem to realize that it's coming out of his pay. the employer could pay more if not for the medical insurance cost. further, u.s. industry is saddled with the expense but must compete with foreign companies which do not have to pay this. [of course they pay taxes, etc, etc]

2. https://www.nytimes.com/2019/08/02/o...alth-care.html

[Mega]

Re: I fear for America

A Bombed out bankrupt nation did this!

But America can't.............who fight our wars for us if you no cash?
Mike

[dcarrigg]

Re: I fear for America

2 comments:

2. https://www.nytimes.com/2019/08/02/o...alth-care.html

I hear things along these lines a lot. I don't buy it:

Democrats are deeply concerned about achieving universal coverage. The simple way to do that is not through a single-payer Medicare for All plan, which faces daunting political opposition. Instead, they can get coverage for most of the remaining 28 million or so Americans with auto-enrollment. Changing some existing policies, like harmonizing the income eligibility standards for Medicaid and the insurance exchanges, would enable the government agencies, hospitals, insurers and other organizations to enroll people in health insurance automatically when they show up for care or other benefits like food stamps.

3 reasons:

1. NFIB v. Sebelius made Medicaid expansion functionally unconstitutional, so 'harmonizing' Medicaid standards at the federal level is impossible.
2. I seriously question whether the court would allow constitutional power under the commerce clause to force "auto-enrollment" in a private product. NFIB v. Seb. only allowed the mandate under the taxing power, not under the commerce clause, and they specifically say Congress can't force people to purchase a product.
3. Therefore you're never, ever going to get organizations 'enrolling' people in health insurance 'automatically.'

I don't understand what people don't get about how and why Obamacare failed. But the biggest reason for its failure was exactly ideas like this. Congress can't force people to buy products. Congress can provide benefits. But Medicaid is state funded, so Congress can't tell states what to do with it.

This is the whole rationale for turning to Medicare expansion rather than a mix of mandates to buy private insurance and Medicaid expansion in America.

It doesn't matter if something like it works in Singapore. They have a one-party dictatorship. We have a constitution. However clean it looks in the supply and demand graph of some econ wonk, the courts are Conservative, they're not going to let it fly. Hell, some smarter liberal justices won't even let it fly. As soon as Congress can force people to purchase things, you know Bezos would be hiring a thousand lobbyists to 'auto-enroll' people in Amazon Prime.

Believe it or not, I think the political fight for Medicare expansion is going to be easier than the legal fight to try to fix or tweak the existing for-profit system. And I'm pretty sure any public buy-in option is going to get knocked down by courts too. Federal government is not supposed to sell insurance products for profit quite like that. And it would certainly get challenged. Worse? States under the 10th amendment have insurance regulatory powers, not the feds. So any public option would be subject to at least the oversight of 50 state health insurance commissioners, and a bewildering array of different state laws. It will never be able to provide the same coverage in state A as state B. And state governments would get power over it.

Medicare, meanwhile, has passed constitutional muster time and again. Like the VA, it's much simpler. Federal government gives a benefit to eligible beneficiaries. No state governments involved. No forced purchasing of products necessary. No means testing required. No feds selling state-regulated products on exchanges. Just a universal benefit from Uncle Sam to the people of the United States.

Believe it or not, the low road is deceptively hard here. There are folks trying to sell Obamacare tweaking as the easier, more realistic way. But it's not more realistic. Most of what they claim they want to do is not even constitutional, at least under any interpretation likely to be supported by our current courts. The 'pragmatists' in this case are out of their minds, and so insistent on not rocking the boat of industry that they're literally proposing unconstitutional solutions right on their presidential candidate websites.

You know something else? Warren was a law professor. And she's well aware of this. Wait for this soundbite to show up at the next debate when her and Joe finally get to share a stage. His plan, if passed, would be found unconstitutional. I'm sure of it.

Worse still? What do you think would happen if somehow it was allowed and a public option went for sale on market-actuarial rates, but was free to Medicaid-eligible people in the 14 (arguably 17 for technical reasons) states that didn't expand it? All states instantly have a massive incentive to take the biggest part of their budget expenses and hoist them off on Uncle Sam. In fact, why wouldn't states pass laws restricting Medicaid eligibility to shift people onto this new 'public option' that's funded by the feds? If I were governor in that environment, I would. It makes the whole thing much more expensive for the feds than they'll admit.

And here's the real kicker: Despite all these problems, we didn't even discuss the most important one:

Nothing proposed by centrists actually does anything meaningful to control costs whatsoever. Nothing cuts administrative costs. Nothing cuts advertising and other overhead. Nothing simplifies the system. Nothing covers everybody. It's not really a solution. May as well hammer a screw into the wall with a wrench.

So the way I see it, we have 3 main choices, and each has an outcome:

Option 1: Plan GOP: Try nothing.
Result 1: Tens of millions remain uninsured. Costs spiral out of control. System collapses under its own weight in 10 to 15 years.

Option 2: Third Way: Attempt to do something like Bidencare.
Result 2: Maybe succeed. Maybe not. Either way, tens of millions remain uninsured. Costs spiral out of control. System collapses under its own weight in 10 to 15 years. Attempt burns all political capital for an entire administration. "Success" doesn't actually help anyone much.

Option 3: Looney Left: Attempt to do Medicare for All.
Result 3: Giant political fight. Unlikely to succeed. If you fail, tens of millions remain uninsured and costs spiral out of control. If you succeed, 2 or 3 million bureaucrats lose their jobs, costs come down, the system becomes sustainable, and everyone is covered.

Anyways, when I break it all down like this, and really think about it, it occurs to me that the moderate roads actually aren't safer at all. They only appear that way because of false equivalency and a crooked overton window. But in this case, the middle is really expensive and risky for almost no payoff.

And I'll ask you something else, if you'll indulge me: Does anyone here believe that passing a law allowing Congress to negotiate drug prices would really be significantly easier than just giving everyone Medicare? Either way the lobby is throwing literally everything they have against you. And either way you're going to get precisely 0 Republican votes. So why does this seem so much more plausible to so many serious people than dropping the age restriction on Medicare?

I really do think this is a case of people succumbing to fallacious thinking. Has Clintonian triangulation ever produced policies that worked well? Ever? I mean, the more that time goes by, the worse my retrospective evaluation of the Clinton administration becomes. Almost every major policy they pushed was garbage. TANF sucks compared to AFDC. The telecom act gave us monopolies everywhere. CFMA gave us the Great Recession. The criminal justice bill was hot garbage that just locked a bunch of non-violent offenders up for way too long. The trade policy destroyed industrial cities. So much hot garbage.

And these same people can't get this same kind of thinking out of their craws. Part of it's because they're corporate lackeys. There's a reason the Center for American Progress doesn't disclose its donors, and that's because Neera Tanden and John Podesta would have to admit ExxonMobil and Pfizer pay their salaries. But part of it is more earnest. I think that genuine people with moderate sensibilities tend to presume that wonky, technocratic solutions are easier. And centrists always tack to the middle. It's the whole point of the Third Way. But in this case, there is no middle ground. Not really. Not any more than Civil Unions and DOMA were a middle compromise between gay marriage or not. They seemed more reasonable. And for a hot minute, they were a thing. But the court struck all that down too.

And that's the fallacy of aiming for the middle. Not only does it seem bad in retrospect. Often times the compromise position is unconstitutional. And when people are more worried about appearing moderate and appeasing corporate America than making policy with a solid legal foundation that actually accomplishes what it set out to do effectively, we get hot garbage every time.

So this is all a longwinded way of saying that I read that NYT article, and boy do I think the good Provost is wrong as hell and totally off his rocker for 3 reasons:

1. The legal foundation of his proposals is unconstitutional
2. The political fight to get what he wants is not actually much easier, and
3. Even if we won the political fight, the prize is shitty.

So even if the odds are a little bit longer, and the up-front costs are a little bit higher, why not aim for the good prize that's built well? Why burn all your political capital (game tokens) on pushing for unconstitutional things that barely scratch the surface of the problem you're trying to address even if you get them through for a year or two before the courts knock it down? Does pulling the band-aidŽ off slow really feel that good to people after what we've seen in the last few Dem administrations?

Because when you boil it all down, there's only one serious plan on the table that addresses costs, universality, and that has a firm constitutional basis.

[jk]

Re: I fear for America

thanks dc. that was both cogent and entertaining. and you certainly convinced me. the problem i see is that not only will 0 republicans vote for it, a LOT of people with employer sponsored [mostly crappy] insurance will be frightened by it. expect to see harry and louise a LOT. [of course harry and louise were in their 40's in 1993, so they'd be on medicare now themselves, but they are ageless.]

when is the debate going to include looking at the current funds going to healthcare and what happens with them? actually if those funds were untouched it would represent an enormous windfall for every company that provides health insurance for their employees. perhaps that could prod them to organize and counter the expected insurance and pharma lobbying.

[dcarrigg]

Re: I fear for America

I don't know, jk. I've heard a lot of talking heads worry that a lot of people will be frightened by it. But none of the old timers I know are frightened by Medicare, even the current version that is far less generous than M4A. And none of the people I know IRL like their health insurance companies. I mean, none of them. Even folks who voted for Trump. We've lost our plan 2 out of the last 3 years and had it replaced with worse coverage with higher co-insurance and higher deductibles for higher premium shares coming out of our checks. And that's just going to accelerate as healthcare costs continue to outpace inflation.

So I guess maybe a lot of people will be frightened. But what's coming for them if they're too scared to change now is going to be even scarier. Even if by some miracle tinkering around the edges and leaving the massive private administrative bloat in place drops healthcare inflation from the 5.2% we're seeing this year to just 4%, we're talking $20,000 per head per year by 2030. That's the entire gross annual income of the bottom 25%. More than half gross income at the median. About 22% of GDP, a pie that's getting more mal-distributed every day.

I know I'm a broken record here. But this is a rosy scenario assuming major changes that lower healthcare price inflation below its recent and historical averages pass into law. The best-case-scenario is still total systemic collapse.

13.7% of Americans were uninsured as of the end of 2018. Up from 10.9% when Trump took office, representing over 7 million additional people who lost coverage in the last 2 years. That's the entire state of Arizona or country of Switzerland or something. And it's accelerating. I fully expect 2019 to add another 5 million uninsured. And doing nothing, just business as usual, the entire coverage impact of the ACA will be undone by 2022. We're looking at going from 30 million uninsured to 50 million uninsured by then. 2022 is not a long way away. And it's about the earliest there's any possibility of any policy change taking place whatsoever. Certainly nothing will be done between now and 2021. So that's where we are going to be.

It seems those three options I outlined are the ones shaping up. But the middle option isn't even as ambitious as the ACA. It does less. Kind of a lot less. So, like I said, even if it slows things down, the bottom quartile is 30% uninsured as of last year. By 2022 they'll be closer to half uninsured. By 2030 insuring any of them at all in the private system is totally impossible, even if spending increases slow to 4% and inequality is frozen at today's levels. We'll literally be at a point where a majority of working-aged employed people have no coverage by then. And we'll hit that point even sooner if we don't even do that.

Like I said, we barely have coverage now. They cover 70% in-network, 50% out-network, after co-pays and a $6,000 deductible. And for that we're paying more per month in premiums than we did for 100% in-network, 80% out-network, after co-pays with a $2,000 deductible just back in 2015. It's more like a 30% off coupon than insurance. And a ton of people I talk to have similar stories.

Just last year the average premium for a 42-year-old adult buying a silver plan in Worcester rose to about $444 a month, from $360 a month in 2017, according to the Connector. For that $444/mo, Tufts will cover 0% of out-of-network expenses and 80% of diagnostic tests and surgeries in-network, 70% of hospital stays in-network, 50% of prescription drug costs, there's a $2,500 deductible, and it costs $650 on top of that every time you walk into the ER. That's a "silver" plan. The bronze plans are worse. The catastrophic plans are worse still. And they ain't much cheaper. And this is Massachusetts, the single state with the best coverage and the least uninsured in the nation.

But the real point is none of them are getting any cheaper. In fact, they're gonna get more expensive. So buckle up. If we don't act decisively, soon, and I agree that it's likely we won't, we could easily wake up in 2030 with 30%+ uninsured and the rest unable to actually afford to use their insurance with a massive wave of hospital bankruptcies and people increasingly turning to black-market medical treatment and medical tourism.