Medicare for All

Democrats Are Retreating on Single Payer Health Care

It’s not just obstructionist Republicans who won't buy into Medicare for All—it’s Democrats themselves.

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A decade ago, single payer health care—the government-run health care system that Sen. Bernie Sanders (IVt.) refers to as Medicare for All—was a fringe idea in the Democratic Party. President Obama positioned his health care law as an alternative to the notion of a fully government-run system, and the few Democrats in Congress who supported single payer tended to do so softly, believing that most Americans would reject the idea. 

When former Sen. Max Baucus (D–Mont.) led negotiations over the legislation that would become the Affordable Care Act, he had one rule: All options would be up for discussion—except for single payer. As Baucus tells Robert Draper of The New York Times in a sharply reported feature on the rise of single payer as a force in Democratic politics, the senator was sympathetic to the idea, but didn't believe America was ready. Given how difficult it was to pass the comparatively less radical plan that became Obamacare, I'd say he was right.

Over the last decade, however, single payer has become a widely held policy preference on the left—what Draper describes as a "litmus test for progressives," with more than a hundred backers in the House, and multiple top-tier supporters in the race for the Democratic presidential nomination. Medicare for All, Draper writes, has gone mainstream. 

Yet in recent weeks, there are also signs that the momentum has slowed, and that some Democrats are retreating—or at least proceeding with caution. 

Most prominently, there is Sen. Kamala Harris (DCalif.), one of the original co-sponsors of Sanders' Medicare for All bill in 2017. After months of backtracking and flip-flopping on whether she supports eliminating most private health insurance, as the Sanders plan calls for, she appears to have fully reversed course, expressing discomfort with the Sanders plan and releasing her own (confused) competing plan. 

The party's old guard meanwhile, continues to think Medicare for All is a bad idea, with House Speaker Nancy Pelosi (D–Calif.) repeatedly questioning it, and former Senate Majority Leader Harry Reid (D–Nev.) saying last week that it would be a problem for Democrats to back it in the 2020 election because it couldn't pass. Former Vice President Joe Biden, who represents this wing of the Democratic Party and is the primary field's most prominent critic of Medicare for All, remains at the top of the polls.

Sanders himself, meanwhile, recently modified his plan in response to concerns from unions, suggesting that even Sanders is not completely unmoved by criticism of his plan, at least if it comes from the left. 

Meanwhile, it appears that there's little enthusiasm for single payer legislation where it matters—among the Senate Democrats positioned to exert the most influence over any future legislation. 

Ezra Klein of Vox recently spoke to a quartet of upper chamber Democrats about their health policy plans. He found that they had ambitious expansions of Obamacare in mind, and no plans to seek Republican votes, assuming that their opponents would oppose any plan Democrats put forward. So these Democrats are feeling ambitious and expansive about health policy and unburdened by the need to compromise with Republicans. Yet even now they remain wary of the sort of full-fledged single payer system called for in Sanders' plan, largely because it would abolish most private coverage:

Which isn't to say Senate Democrats are prepared to abolish private health insurance. As in Wyden's comment, the word "choices" came up a lot in my conversations.

"As a practical matter, the way we move forward on health care has to be recognizing people's current insurance system and allowing people to make choices," says Stabenow. "If everyone chose the Medicare public option, then it would be very clear what the public wanted."

"I understand the aspirational notions around Medicare-for-all, but if there's one thing that I think we still have to wrestle with, it's that Americans want to see more of their fellow citizens covered but they are very nervous about losing what they have," says Sen. Mark Warner (D-VA). "There's a huge risk aversion."

Brown, who has long supported single-payer, agreed. "I think you want people to have choice still," he says. "You don't want to take people's insurance away. A lot of people don't want government insurance. I understand that."

Single payer supporters like to argue that the energy is on their side, that the public broadly supports their plans, and that incrementalism has proven disastrous as both politics and policy. And they can point to polls like the one released this morning reporting that about two-thirds of Democratic primary voters are more likely to back a candidate who supports Medicare for All versus one who wants to expand Obamacare.

But while there's certainly truth to the notion that Medicare for All has risen in prominence and popularity, especially among the left, it also seems clear that there are limits to its rise. A separate poll from Monmouth released this week finds that less than one-quarter of Democratic voters want a system that replaces private insurance with a government-run plan—which is exactly what Medicare for All as envisioned by Bernie Sanders would do. And remember: This poll result is limited to self-described Democrats, who are almost certainly more favorable to wiping out private insurance than others. 

Even if Democrats somehow managed to win control of the White House and both chambers of Congress—which looks unlikely at this point—it would be a real struggle to pass the sort of radically disruptive plan that Sanders has called for. And it's not just obstructionist Republicans who won't stand for it; it's Democrats themselves. A decade after Obamacare, it seems that Baucus' intuition that most Americans aren't ready for single payer remains correct. 

So yes, Medicare for All has gone mainstream, and yes, it will likely remain a prominent part of the Democratic Party's policy vernacular going forward, and worthy of discussion and criticism as a result. But for the foreseeable future, at least, it will probably remain out of reach. 

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  1. Why is it Medicare for all? Why not Medicaid for all, or VA for all? Medicaid is single payer, too, and VA is a lot like the UK’s national health, with government health care facilities.

    Have any of our media watchdogs asked the Ds that?

    1. VA for all would be more accurate, if we want to do it right. Medicaid is a system where private healthcare providers are compensated by government (at pennies on the dollar) for care.

      For “medicare for all” (as Sanders describes it) the only way it’ll work is to nationalize the entire system. See my comment below.

      1. It was a rhetorical question because senior citizens like their Medicare, so that’s a safer program for the Ds to tout. They know how terrible Medicaid is and the bad rep the VA has.

        1. Try again; seniors do not like Medicare.
          We have no choice because the feds stuck a gun to our heads and forced premiums for 50 years (in my case) of our working lives, and now there is no viable alternative.
          Here is this wonderful program the Democrats claim we all need:
          Pay premiums for you entire working life, 30 to 50 years, with NO benefits.
          At 65 or so, continue to pay premiums (!) and try to get an appointment with the medical providers that will even accept Medicare.
          Pay 20% of the cost of all care, with no limit on out of pocket costs, annual OR lifetime.
          Have NO dental coverage.
          Have NO vision coverage.
          Pay an ADDITIONAL premium if you want drugs coverage.

          No wonder 110% of Medicare recipients “choose” to get supplemental coverage.

          What they mean by the political lie “medicare for all” is nationalized medicine, and the destruction of private insurance. That is, complete the plan initiated by Obamacare with even more lies and deception.

          1. “seniors do not like Medicare”

            What is the basis for this statement. Most people I know are retired or near retirement and most are eagerly waiting for Medicare. Many base their retirement date on when they can get Medicare. So I think you are very wrong about the popularity of Medicare with those receiving it.

            1. I think it was pretty clear by his statement that what you’re saying doesn’t mean seniors like Medicare. It’s that they’ve paid into it so long they expect a return on the payments they were forced to make so they’re going to use it.

              1. Precisely. Within a month of starting Medicare I had $28k operation that cost me zero. Other than the 50 years of forced payments.

                1. If you paid zero you must have had supplemental private insurance, otherwise you would have paid 20%, or about $5600

                  1. Of course. The supplemental insurance costs about 1/3 of what my previous private insurance did.

                  2. It’s common knowledge that you need a supplemental policy, but it’s still better than the alternatives.
                    My 62 year old wife purchased a policy which costs at least four times what my supplemental policy costs.

            2. Try asking people who have actually been using medicare for a while what they think of it. Half those people you know that are eagerly waiting for medicare are probably delusional about what they are going to get.

              1. So how long have you been on Medicare and based on that time what do you think?

            3. Whether or not the like MediCare, they think they are owed the benefits they had to pay into all their lives. They have something of a point except that to continue is to drive off a cliff

              1. My wife and I have accepted that we will pay Medicare (and social security) for our entire working lives, but likely not see any benefit when we retire.

                1. You shouldn’t worry.
                  The flip side of the SC decision, that FICA contributors aren’t entitled to the benefits, is that those benefits are something Congress will continue to keep flowing, even if the “trust fund” is depleted.
                  They could cut it off at any time but know it would, at least, end the political life of any politician, who did, if not start a revolution.

            4. “Eagerly waiting” seems to be the keywords.

              They may be disappointed.

          2. I would also point out that a lot of employer sponsored insurers automatically cancel your coverage at age 65. I don’t think you can even get an Obamacare policy if you’re over 65. And yeah. There is a premium for medicare that comes off the top of your SS check. And most people buy the supplemental and prescription policies if they can afford it. And you’re on your own for dental and optical. Medicare is a better deal than trying to buy a private policy in your 60s and beyond. But it ain’t the fabulous welfare scheme that a lot of people think it is.

          3. By no means am I supporting Bernie’s plan, but will say that I think most senior citizens age 65 and over are reasonably satisfied with Medicare – at least that’s what I have been hearing from my clients for 25 years or so. I’m a financial advisor in Florida – where a huge segment of the population is on Medicare. Most of them buy supplemental policies – so the 20% of costs not covered by Medicare are not a problem. Doctors in Florida must have figured out how to survive on Medicare reimbursement rates – likely because of the volume of patients on Medicare. I doubt lack of dental coverage is that big of shock to most seniors – dental coverage for people under age 65 isn’t that common, and most dental policies have limited coverage and restrictive networks. Not sure how you’re defining vision coverage – so I’ll concede that point (except I’m pretty sure Medicare covers cataract surgery – which is common for the elderly). It’s true that Medicare part D (for prescription drugs) means an extra premium, but not sure why you think that isn’t fair.

            As to your points about the way Medicare is financed – you are right, workers pay in to it for years with no benefit until they sign up at age 65. The Medicare premium for seniors is around $135 a month, plus the drug coverage, plus the supplemental policy. Add all that up and it comes to what – $350 or so a month? Seniors are mostly okay with that because many of them know that if they were 63 or 64 years old, our private insurance industry would charge them three times as much – at least (likely with higher deductibles). Yes- the younger workers are covering much of the costs of those 65 and older – and Medicare is facing serious funding issues because costs (claims paid) are so high -and getting higher – for the Medicare population.

            Politicians have certainly lied about Medicare for all. Water is wet. Both facts are widely known.

            1. It is around $135 per month until you get some higher income. My Medicare bill is rather more.

      2. Government Monopoly Health Insurance is the proper name. Use it.

      3. Three major issues: the Dutch cannot sue medical providers like the Americans (imagine 15k for amputating the wrong leg or breast!) and 1/4 of Medicare patients is already enrolled in private health insurance called Medicare Advantage (ran like an HMO). Why? Those plans are cheaper. Single payer systems require tort reform and rationing. And lead to long waiting lists to see specialists, think the NHS/Holland. VA too. https://www.theguardian.com/society/2018/jul/13/nhs-operation-waiting-lists-reach-10-year-high-at-43m-patients

        1. Medicare Advantage is not health insurance and is not an HMO. It is a supplement to Medicare that pays the 20% medicare doesn’t cover.

          1. You are incorrect. Traditional Medicare participants have parts A&B (hospitals, doctors) and often Part D (prescription drugs), then they decide whether or not to buy a supplemental policy. Those participants pay around $135 a month for Medicare (part B – there is no charge for part A), plus part D (around $60 – but I am not sure), plus the premium for their supplemental policy. In the case of Medicare Advantage, the participant gets a whole package from an insurance company, generally for less than the total of the traditional Medicare plus supplemental policy. Medicare Advantage plans are almost always HMO or PPO plans – they limit the choices of hospitals and doctors in the plan – which is why they are cheaper. Insurance companies offering Medicare Advantage plans have a contractual agreement with Medicare.

            1. blondrealist is absolutely correct

              And Medicare Advantage ( aka Medicare replacement plans) behave much like regular insurance, with prior authorizations and denials for certain services
              Medicare Advantage pays providers slightly higher than Medicare ( depending on the market and the Advantage carrier ) .
              Medicare Advantage was touted as a way to have Medicare save more money, by using the features that employer-based insurance use ( provider networks, prior-auth etc ) . I don’t think this has panned out much.

      4. More like Indian Health Service for all.

    2. “Medicaid is single payer too”.

      Huh?

  2. A lot of people don’t want government insurance. I understand that.

    That’s why we put everyone in the same pot and turn burner up slowly. We just have to resist the urge of those that want to feel the Bern too quick for the liking of others.

    1. If they ever actually inflict this on us it will be time for a civil war to stamp it, and them, out

  3. The true litmus test would be this: “Will there be an exception for federal legislators?”.
    The answer to that will tell the tale.

      1. except for the people in charge who can afford high quality health care on a cash and carry basis.

  4. Fuckers finally did the math?

    1. Nope. They just read the polls and realize they need to lie more.

      1. Or maybe they realize that the polls are saying, “We want single-payer health care, but for other people, but we want to keep our own health care system that works for us.”
        And yes, I realize that isn’t how SPHC or “Medicare for All” works.

  5. The main issue is that if Democrats pass Medicare for All, eliminating people’s private insurance and putting a bureaucrat between every American and their doctor, every time that ANYTHING goes wrong in healthcare, regardless of what it is, the American will think “Democrats did this.”

    If Democrats pass Medicare for All, they’ll be held fully responsible for Medicare for All. We all know that one thing Democrats hate more than anything is responsibility. They’ve based their entire platform on telling people “its not your fault.”

    It doesn’t matter how many “journalists” come out and blame Republicans for the ills of Medicare for All, the massive majority of Americans will blame Democrats for any of the failures that the system has.

    1. As much as I wish this was true, that hasn’t been the case for literally every Democrat program ever passed. People still blame corporations and greed for insurance premiums, not ACA, healthcare bureaucracy, Medicare/Medicaid reimbursement policy, etc. America keeps getting bluer and less white/male. The typical arguments, such as ‘make better arguments, respect individuality, they’re Catholic so they must be conservative’ and so on have been meaningless. Democrats keep trashing this country and the people blame everyone except them.

      1. What does white and male have to do with this?

        1. Because the underlying assumption of ‘let the Democrats make a stupid policy and everyone will hold them responsible’ is that people vote for rational reasons based on objective policies that affect them. That is not the unifying force behind our politics; race and sex is. Right now, if whites didn’t vote, there wouldn’t be a single Republican in Congress. If men didn’t vote, a similar outcome would occur.

      2. I can understand your pessimism, but that’s a lot harder of a position to take if Democrats go “your health insurance? Illegal. Here is your government-appointed health care insurance.”

        Obamacare is a complicated mess from the buyers perspective, so it’s easier to spread the blame around and pick your preferred guilty party. Medicare for All would also be a complicated mess, but less so on the consumer side since the most impactful part would be “oh, your current insurance? Na. You have this 1 plan and 1 plan only.”

        1. I’m just not confident that the ‘sunlight is the best disinfectant’ or ‘give them the rope by which to hang themselves’ approach works on anything Democrats say or do.

          1. “”give them the rope by which to hang themselves’ approach works on anything Democrats say or do.””

            Bed sheet is the new rope.

            1. Too soon!

              Oh, no ….. not soon enough!!

              1. I think what started as an Epstein reference ended as a Carradine regerence…

    2. Don’t be so sure. Even though not a single Republican voted for the ACA, they’re often blamed for its failure. Most on the Left say the ACA was a Republican idea, and Mitt Romney set up something similar in Massachusetts. Most people will simply believe what the mainstream press tells them–regardless of the truth.

      1. Most on the Left say the ACA was a Republican idea

        That or “not a single Republican voted for the ACA, and then they turned around and failed to implement it in good faith like they should have when they came back into power.”

      2. The argument I usually hear is that “the Republicans sabotaged it” in some unspecified way.

        1. Same way they sabotaged Flint’s water supply.

        2. Removing the penaltax would sabotage it since the money was required to keep it funded. Now I personally have not heard anyone from the left claim the ACA was sabotaged because we didn’t force people without insurance to pay up for their non-compliance. I also have not heard anyone on the left criticize anyone without insurance for not being in compliance with the ACA.

      3. Don’t let the Republicans off the hook. They conceded a Senate seat they won to give the democrats 60 votes to pass ACA. They vowed to overturn every election when Obama was in. They neglected to overturn it when they had all 3 branches of government and Trump ready and able to dump it. Useless Bush nominated SC Chief judge made not one but two convoluted nonsensical decisions to save the law.

        They would let democrats vote in medicare for all and keep their traps shut when they, the Republicans, get blamed for the failings.

        1. You are correct. the Republicans are entirely to blame for letting the Democrats inflict a horrible mistake upon the American people.

    3. >>>If Democrats pass Medicare for All, they’ll be held fully responsible for Medicare for All.

      so? all they want is the win. the rest is graft.

      1. Democrats ran from Obamacare like the plague once people lost their doctors they could keep if they liked them. Democrats care about whether or not they’ll be blamed when they ruin people’s lives. They have to have a way of blaming Republicans for shitty plans implemented by Democrats.

        1. maybe in front of cameras? behind the scenes they throw graft parties and laugh at us

      2. I don’t even think they want the win. They’d crap their pantsuits if they had to implement it.

        This is consequence free pandering.

        Haha

    4. This only applies until the next recession. It’s been the case now for 30+ years. When the economy is doing well, healthy people who are working are perfectly happy and not interested in any change. When the economy falters and people lose coverage and employers shift burden – well then things change on their own.

      ‘Medicare for All’ support and ‘the economy’ are inversely correlated. And in this case correlation IS causation. D’s understand that relationship far better than R’s seem to. Right now that means headwinds for that idea. It won’t always mean headwinds.

      1. True, support will go up in the upcoming recession/depression. I wonder if some Republicans will cave at that point and start pushing the program too.

    5. No no no. That’s not how it works. Everyone but the Democrats will be blamed for under-funding and/or sabotaging it.

      1. The Democrats are welcome to vote for raising our taxes, too. We’ll see how well the public reacts. Lol

        1. The raising taxes phase comes after we pass it and ‘realize’ that we don’t have the revenue to pay for it.

          1. Gotta read it first too.

  6. When faced with two explanations between conspiracy and stupidity; I choose the stupidity explanation every time.

    In this case it seems pretty straightforward: Telling ~200MM people that the government is taking away their private, employer-provided insurance and replacing it with Medicare-4-All (which will no doubt be modified on what it covers during the legislative process) is a sure-fire to lose an election. Somebody on Team D finally got ‘woke’. 🙂

  7. also retreating on their border stance. going w/tank the economy for the win.

    1. Part of me would love to see Sander win just to watch the look on the left’s face when he comes out for strong border control.

      1. right. lol.

  8. The journalists who cover the news and the Democrat politicians who make the headlines are both far to the left of the average Democrat voter. One of the reasons these groups feel it’s necessary to project a vision of Republicans as homophobic, racist, sexist, xenophobes is because without that fear in their hearts, average Democrat voters wouldn’t follow where progressives want them to go–but you can’t convince progressives of that.

    The first rule of progressive club is that the people want what the progressives want.

    The second rule of progressive club is that when the people don’t want what the progressives want, see the first rule of progressive club.

    1. Incredibly true. I know a lot of DINOs (usually they’re wealthier or successful doctors/lawyers) who really don’t stand with the party on anything. They want lower taxes, fewer government intrusions into their lives, often times deregulation specific to their area of expertise (but lack of understanding for the general principle, so they don’t support it for finance or corporate America), etc. The biggest hangups appear to be distrust of Republicans and 2A. A lot of them are very cosmopolitan and busy and don’t care for guns in the slightest. They have no use for them and talking about resisting the government, as legitimate a purpose as this is, sounds like militia-tier nonsense that they just cannot understand. It feeds into the distrust as well because they think we’re paranoid for believing that a government with a monopoly on force inherently makes society unfree.

    2. One of the reasons these groups feel it’s necessary to project a vision of Republicans as homophobic, racist, sexist, xenophobes is because without that fear in their hearts, average Democrat voters wouldn’t follow where progressives want them to go

      ^ So much this. My mother’s husband, who is as Team Blue as they come, hates the Medicare-for-All talk because he thinks it’s a loser with most voters. But he 100% buys the line that half of registered voters are literal Nazis and so we just have to accept whatever the Dems cough up.

      1. My uncle, a die hard union man, who proudly followed my Grandparents’ only Democrats stance finally seemed to realize how much they screwed him around about 2009. In 2008, despite being a huge gun collector, he was all for Obama. Bush was literally Hitler. We don’t need “assault rifles” and they really aren’t coming for your 2A. Now you’d think he was a lifetime Republican. They really are trying to take away our guns. Wants to leave Eastern Washington to move back to Idaho. Can’t stand any of the current candidates. And has stayed he’ll never vote for another Democrat in his life. Obama and Inslee forced that 180. Hated fracking but now supports it whole heatedly (his son works in the Bakken Oil fields on a fracking drill crew). It was all good until he realized it was actually hurting him and his family (great union insurance before the ACA, huge price increases right as the recession eliminated his company and now he does contract work for the union.

  9. A separate poll from Monmouth released this week finds that less than one-quarter of Democratic voters want a system that replaces private insurance with a government-run plan—which is exactly what Medicare for All as envisioned by Bernie Sanders would do.

    And ironically, it’s the only way it’ll work. Many (many) years ago, I used to argue that America couldn’t afford a National Health system. But I’ve since reversed that opinion. I believe that American can absolutely afford such a system given the size of our economy. However, what that system would look like would be rejected by Americans– especially those who want it most.

    We could nationalize the entire healthcare system, shut down the insurance companies, turn every healthcare worker into a government employee with a significant pay cut, shutter hundreds if not thousands of hospitals and healthcare facilities around the country, and then yes, we could afford such a system.

    1. You want us to be the U.K.?

      Haha! People would be appalled when some government apparatchik refuses their treatment, and there’s nowhere to turn.

      Why do people hate monopolies with passion, but like government monopolies? Are they really that dense?

      1. Are they really that dense?

        Yes.

      2. Right on, I lived in the UK! Americans will not tolerate a healthcare system that looks like the NHS or the Dutch (tort reform, waiting lists and rationing). OT: In the US, ludicrous amounts of medical expenses occur the last few months of life, often intubated and dire deaths (How We Die by Sherman Nuland is great).

  10. Why has not a single-state enacted a state-level version of Medicaid-for-All?

    1. Vermont did. Then abandoned it due to cost.

      NYS lower house passed it years ago but the Senate will not take it up. It kind of died because they determined that the cost of the one piece of legislation was equal to the entire NYS budget. How can you double your tax revenue when people already feel over taxed? I believe the same is true with CA and HI.

      1. I believe the same is true with CA and HI.

        I can’t speak to HI, but CA, yes. It was kicked around the legislature for a bit, but they found it would literally double the state budget.

        1. The double the budget has been a running theme. There will be no Medicare for All unless they can solve that issue.

    2. Because it’s too expensive. But when all 50 do it, it’ll be cheaper.

      1. That makes absolutely no sense.

        1. It’s sarcasm. It’s the same argument the bond rating agencies made about junk bonds circa 2006. If you put enough in a portfolio they’re no longer junk!

          1. I thought that was mortgages?

        2. Medicare for all makes sense when you don’t really think about it.

    3. Because the largest single part of the coverage pool – employees who work for ERISA employers and their dependents – would be excluded from paying. But the state would would have to pay their costs after they get sick, lose their job and lose their coverage and can’t pay.

      A state-level system (which is actually the sort of system that could solve the main problem of access) cannot coexist with an ERISA/employer system.

  11. “And they can point to polls like the one released this morning reporting that about two-thirds of Democratic primary voters are more likely to back a candidate who supports Medicare for All versus one who wants to expand Obamacare.”

    Here is how Medicare for All is described in the poll:

    “Medicare for All health care system, where all Americans
    would get their health insurance from the government”

    That’s it. Nothing in there about how it gets paid for, who does the paying or how long wait times to see a doctor or for treatment (if approved) might be, for starters. Seems like it might be nice to know some of this shit before jumping off that cliff, don’t you think?

    1. We have to pass the bill to see what’s in it!!

  12. It’s like the QWERTY keyboard and the Imperial system of measurements – they are both inferior but we are stuck with them. A more single-payer system, if built from the ground up would be much better for us but the transition would be difficult, not to mention the resistance from the GOP and the Medical-Industrial complex. It will take a catastrophe to reshape our system. A huge war for example. So I understand why voters like Medicare for All but are weary of wanting politicians to propose legislation. It’s a real conundrum for voters.

    Meanwhile, the crapified system we have in place now leaves an awful lot of space for grifters to take advantage of. No one wants to die or see their children hurt and so people will always be ripe for getting hosed.

    1. Heraclitus
      August.28.2019 at 12:19 pm
      “It’s like the QWERTY keyboard and the Imperial system of measurements – they are both inferior but we are stuck with them.”

      Fucking lefty ignoramus fell for the QWERTY bullshit.
      Keep it up; it proves how fucking stupid you are.

    2. Better for who? Some will be better off and some will be worse off. Scarce resources get allocated. Having bureaucrats do it doesn’t make the scarcity problem go away. And bureaucrats are really bad at allocating. And even if they were good at it, a single payer system would use the same values for everyone. Imagine a single payer automotive industry where bureaucrats decide what everyone gets and how much it will cost. Actually, you don’t have to imagine. That system gave the world the Trabant.

    3. The QWERTY keyboard was an elegant engineering solution to the issue of typists who were faster than the typewriters.

      1. Further, the claim that it was inferior to other arrangements was debunked at least 20 years ago.
        This is up there with “Reagan emptied the insane asylums!”

    4. The imperial system really isn’t necessarily inferior to the metric. All measuring systems are basically arbitrary. The metric system certainly has some advantages but also disadvantages. As does the imperial system. I use both, and can think in both, but I don’t consider one better then the next. It is quite common, in English speaking countries for people to use a mixture of the two. The one advantage metric does have is it is universal. That just means it is popular, not superior.

      1. The advantage of metric is that mega, kilo, milli, micro, etc have the same meaning for all types of units, so it is easier to relate to different scales when encountering an unfamiliar unit.

        1. The most important thing for people to understand about the Imperial measurement system is: it’s NOT a system, it’s a COLLECTION. Nobody designed it, individual measurement units were just adopted as needed and their values were eventually standardized by referencing a few “base” units.

  13. “Meanwhile, the crapified system we have in place now leaves an awful lot of space for grifters to take advantage of. ”

    Back in the late 1980s I interned in my state’s Medicare fraud unit. They had a dozen investigators and several lawyers, and were always busy. It’s so easy to game the system.
    One thing for sure: Medicare for all will be full employment for investigators and prosecutors, because fraud will be everywhere.

    1. No fraud once the feds take over everything.

      No way to file false claims because everyone is actually covered.
      And since the costs will prove the naysayers correct, it will become necessary to revive the draft for all medical personnel, and they can be shot for treason if they don’t play nice.

      Win/win. (politicians/bureaucrats; individuals, not so much)

      1. But their will be scandal as politically connected people get head of the line privileges.

      2. What about payments for procedures not performed?

        There’s more than one way to cheat the system.

        1. Or performing unnecessary tests to pad the margin

          1. Or doing unnecessary tests because the algorithm will allow you to admit an elderly resident with pneumonia if you diagnose them as rule out myocardial infarction but not for pneumonia. They need the hospitlazion but some bureaucrat decides you can’t admit an elderly patient for pneumonia until they fail outpatient antibiotics. But if you send them home and they die, well their family can sue you for malpractice and juries usually will reward them despite you following the rules. Just ask Johnson and Johnson how logical juries are.

    2. Fraud is already everywhere! I blew the whistle on a hospital bed that was prescribed to me while on Medicaid. The company charged Medicaid $3500, for a used bed with a used mattress. A new bed and mattress is $550 online. The government never contacted me, and I have the paper work and pictures to prove it. The Feds don’t investigate unless it’s $1 million+ of Medicare fraud. They don’t care about my used hospital bed.

      1. They charged Medicaid but the question is how much Medicaid actually paid.

        1. This is the thing about Medicare/Medicaid that rarely gets talked about. I would have charge stickers all over my scrubs after a simple dressing change. We had to sticker everything. But we rarely got reimbursed for even a third of it. And even less if we didn’t collect all those charge stickers.

  14. What Mr. Suderman is missing is the age component of support for Medicare for All (MFA). Most people at or close to age where Medicare is available look forward to the program. I suspect that young people, big supporter of Bernie and Elizabeth, want MFA as they are not yet into good employer provided healthcare. Young people also may like the transportable nature of MFA. I think the opposition is the middle aged, middleclass who have good employer based health care and would be reluctant to change. The most likely scenario here is the MFA if you choose it is also called the “public option”. Older people could chose Medicare early easing retirement worries about healthcare. Young people could chose Medicare after college as they start careers. The remainder could keep there employer based health care. While the public option stalled in 2010, it could be the time for it now.

    1. Older people could chose Medicare early easing retirement worries about healthcare. Young people could chose Medicare after college as they start careers. The remainder could keep there employer based health care.

      Yeah – that’s not going to work. That’s the exact same thing people on the left are currently complaining about regarding charter schools vs. ‘the public option.’

      ‘The public option’ will be only people who need medical care but can’t afford it (as you just pointed out). Employers will also gain a further incentive not to provide health benefits. Whether its mandated or not, eventually everyone will be on Medicare. If there’s a private insurance industry it will only be covering gaps in Medicare coverage, and we’ll quickly be right back in the same boat we’ve always been in, but with added layers of bureaucracy.

      1. “we’ll quickly be right back in the same boat we’ve always been in, but with added layers of bureaucracy.”

        You forgot about shittier service, long waits, more corruption, and more asylum seekers.

      2. “but with added layers of bureaucracy”

        The layers of bureaucracy will not change only the source of the bureaucracy as it shifts from private insurers to the government.

        1. You think shifting from private issuers to the government is going to result in less bureaucracy?

          Why would you think that?

          1. No it will be the same MFA just shifts the bureaucracy from private to government. Likely no difference.

            1. Again, you think shifting from private issuers to the government is going to result in less bureaucracy?

              Why would you think that?

              Hint: think through the incentives.

              1. S=C, perhaps you have not dealt with the bureaucracy of large health care insurance providers. I have because several years ago my son needed surgery. Now everyone from me, his doctors, and the health care insurer agreed he needed the surgery. But the health care insurance also told me it was not covered. He did get the surgery, but I also have a box of paperwork associated with the process. It took many phone calls and at least two face to face meeting (me and table full of people who wanted to deny the surgery). Why do I think that large companies and government are no different. Answer; personal experience.

                1. S=C, perhaps you have not dealt with the bureaucracy of large health care insurance providers.

                  I have, as my daughter needed emergency surgery several years ago. I have Kaiser. It really wasn’t too bad, bureaucracy-wise.

                  What do you think will happen to Kaiser under your proposed system?

                  Why do I think that large companies and government are no different. Answer; personal experience.

                  Why do you think it was so complicated? Why are for-profit companies behaving in such an inefficient manner all on their own?

                  I have my own personal-experience trump card for you: have you ever dealt with the VA? If so, I don’t see how you can say “large companies and government are no different” when it comes to bureaucracy of just the type you are lamenting.

                  1. S=C, First I hope that your daughter’s surgery went well and that she has recovered. Having a ill or injured child is always a difficult experience.

                    Bureaucracy no matter government or private are always difficult. It doesn’t have to do with the entity it is the size that matters. Many years ago a business consultant explained this to me and told me that he has as much trouble dealing with large corporations as with the government. We are encouraged to think that government is worse, but if you looked you could see as much dissatisfaction with large businesses. What we know about satisfaction with healthcare is that it affected primarily by your proximity to the provider. I live in Madison, WI and we have an abundance of providers and I am very satisfied.

                    1. Bureacracy is cancer, regardless of where it lies.

                    2. When you are dissatisfied with a business you can go to their competitors. When you are dissatisfied with government, where are you going to go?

                      Why do people hate monopolies, but like government monopolies? (which are real monopolies established by law)

      3. “Employers will also gain a further incentive not to provide health benefits. ”

        But is this not one of our goals. Employer based insurance is a remnant of a 20th century economy. We need transportability in our health insurance. The new economy will likely have people changing jobs more frequently or working as contractors.

        1. But is this not one of our goals.

          Who’s this “we?” And you said:

          Older people could chose Medicare early easing retirement worries about healthcare. Young people could chose Medicare after college as they start careers. The remainder could keep there employer based health care.

          Now you’re saying your goal is to get rid of the employer-based health insurance (which, again, is not the same thing as health care).

          To recap: in your opening salvo you say Medicare-for-All really is just Medicare for the very young and very old who can’t afford insurance, and the rest of us will remain on our employer-provided plans.

          Then, when it’s pointed out that employer-provided insurance won’t continue under this regime, you declare that getting rid of employer-provided insurance was “our” goal all along.

          Which is it? What happens to the people who lose the employer-provided plans? Do they get individual plans, or do they go on Medicare?

          1. Sorry if its confusing. What I said is that MFA is likely more popular among those close to Medicare age and young people starting out without established health care. Middle class middle aged people likely have established employer based health care they will be reluctant to give up. The ACA with a public option likely satisfies all.

            It is likely that ACA with a public option will eventually lead to an end of employer based health care. Young people starting out with a Medicare Public Option will be reluctant to transition to employer based programs. Middle age people will age into Medicare at or near retirement. This is not a bad thing because employer based health care in not transportable and this is seen as a liability across the political spectrum.

            1. The ACA with a public option likely satisfies all.

              No it doesn’t, because you’re still relying on simultaneously utilizing and eliminating employer-provided insurance.

              You’re asserting that you want to save private insurance while laying out a plan that you acknowledge will eliminate it.

              Doing that dance is exactly what has Kamala slipping in the polls.

              This is not a bad thing because employer based health care in not transportable and this is seen as a liability across the political spectrum.

              Why not eliminate the barriers to free marketplaces in healthcare and health insurance and let people make their own choices rather than you (sorry, “we”) making their decisions for them?

              1. Early you asked me to explain something, so now I will ask you to explain what is a free marketplace for health care and how does that get people coverage?

                1. A free marketplace in healthcare would involve me having the freedom to seek whatever treatment I see fit from whomever I choose to seek it from.

                  Think about my Kaiser example from above. I like Kaiser. I think it’s a great model for controlling a lot of these things you’re complaining about, because of the way its incentives are structured.

                  Medicare-for-All would quite simply be the end of Kaiser, no? Thus depriving me of my freedom to choose a healthcare provider that works for me in a way I approve of.

                  Under such a system people get coverage voluntarily from providers who can meet their needs in a way that’s tailored to them and their preferences.

                  One might even speculate that a free market in health care would make health coverage less of an urgent issue. Remember to stop conflating the two – it only confuses the issue.

                  1. I afraid that your answer has left we with a few questions. I am not familiar with Kaiser as it does not provide services in Wisconsin. We have a lot of great providers locally and I am personally very happy with my health care insurance and provider. That said I don’t really live in a free market area. Madison is a university and government center. The State of Wisconsin is the largest employer and it provides health care. Because the of the large size of the insured pool the local health insurers can supply high quality service at very reasonable rates. Non state employees and employers can get good insurance because they are in the same area and use the same insurers. In the end MFA would only be shifting the payer from State of Wisconsin to Federal Government.

  15. What cowards!
    Don’t they know Medicare for all will accelerate America’s bankruptcy?
    Don’t they know healthcare is a right guaranteed in the US Constitution?
    Don’t they know healthcare is the best way to control the unenlightened masses?
    Don’t they know how wonderful socialized medicine is in Cuba, Venezuela, North Korea and Mexico is?
    Don’t they know they’re surrendering to the nefarious capitalist concept of private healthcare and all the evils that it brings?
    These democrats should turn in their hammers and sickles!

  16. I would like affordable healthcare. It is that simple. When I was younger, before healthcare was taken over by the profiteers, I had affordable healthcare, but when I changed jobs, it did not follow me to that new job. Lot’s of paperwork. Messy for everyone. Now healthcare is starting to be difficult for everyone but very rich people to afford. Libertarians have zero answers for this serious problem. Democrats have no answer. Republicans tell us to just die. What are we to do?

    1. I had affordable healthcare right up until 2014 (when the ACA kicked in) but the truth is most people had affordable care when they are younger because young people are healthy and don’t need much care. You take a little, you pay a little, you take a lot, you pay a lot. Until the ACA that is, not everyone pays a lot and gets a little

      1. I am appalled at the out of pocket costs and the monthly premiums for working Americans. It’s criminal, especially when they are just outside subsidies range.

        1. But if they were eligible for subsidies, then it would be ok, right? Just remember, if half the canaries are flying at all times you can carry twice as many canaries…

    2. It would help if you stopped pretending you were a libertarian. Healthcare has always been run for profit. What you are subject to is the massive distortions caused by regulations and mandates. What do you think would happen to your other insurances if they had the same regulatory framework imposed upon them?

    3. When I was younger, before healthcare was taken over by the profiteers, I had affordable healthcare

      What is it that changed that allowed the ‘profiteers’ to take over a system in which they weren’t previously involved?

    4. Back when you were young there was less government involvement in healthcare. The rest is left as an exercise for the reader.

    5. TDHawkes
      August.28.2019 at 5:05 pm
      “…before healthcare was taken over by the profiteers,..”

      Fuck off, slaver.

    6. When I was younger, before healthcare was taken over by the profiteers government, I had affordable healthcare,

      FIFY.

  17. >snipendsnip<

    So was slavery…

  18. What the Dems SHOULD be “retreating” on is allowing unchecked invasion of US soil.

  19. Oh, come on: die on that hill again.

  20. The majority of people who want Medicare for All are those who think it means “Healthcare for Free”. Once they understand that taxes will go up to pay for it, support drops like a rock.

  21. “Saying last week that it would be a problem for democrats to back it in 2020 because it couldn’t pass”

    Haha. I think that’s what they like best about it. Consequence free pandering? Right in their wheelhouse.

  22. The How

    It’s not The Who. Not The What. It’s The How.

    “An error lurking in the roots of a system of thought does not become truth simply by being evolved.” -John Frederick Peifer (c.1960)

    Single-payer medical delivery (“aka/”healthcare”, a term that essentially did not exist until the 1980s) is not inherently flawed. Quite the opposite. Our current system is fatally flawed and tinkering with it — e.g., “Health Savings Accounts” — will not remedy it.

    Single payer. Universal care. Private sector. Competition. All possible.

    Healthcare Reform D.O.A. (1994) described how. The insurance-industry nominated it for two, national awards. Retribution Fever (2018) brings it up to date.

  23. The democrats still want that power and control they just don’t want to admit it now. Control the needs of the people and control the people is their ultimate goal.

  24. “and worthy of discussion and criticism as a result” — Not really!! Not unless you support the U.S. becoming the U.S.S.R. (Bernie’s old buddies).

    1) Federal Government HAS ZERO authority to be handling/meddling in your own personal health…. (PERIOD!) Its a blatant violation to the Constitution and the actual beginning of National Socialism (i.e. Nazi – yes that is an acronym for National Socialism). Funny how the left likes to embrace the very term that brought about Hitler and concentration camps.

    2) The only “Free” goods are donated by owners upon their own charity. IT DOESN’T require a Law!!!! Using law to generate “free” goods requires that Law FORCE the labor of others against their will. THAT IS SLAVERY!!!

    If you want to “pool” money to help those in need – do it!!! Start a DNC health insurance. Start a !!-LOCAL-!! charity. Become a doctor and do it for free!!! BECAUSE that what you are FORCING on others with “Medicare-for-all (unearned)”.

    Medicare-for-all = Slavery-of-the-productive

  25. No matter what they call it or how they try to frame it, the only way the medical system survives is if there are enough healthy people paying into it to cover the costs of the sick and diseased. Like every insurance Ponzi scheme…the people that rarely use it or are a lower risk must pay for the higher risk members. And if that isn’t accomplished, costs go up for everyone.

    1. The “the sick and diseased” – should be on state, city or county welfare or being cared for by loved ones.

      “cover the costs” plan in the food market wouldn’t only allow the rich and fat to eat anything they wanted at the expense of the poor but it would also limit price balance in that market and the next think you know we’d have a “food crisis”.

      People need to stop pretending that medical is some holy-grail of the service sector. There’s a thousand other life sustaining services doing just fine because they aren’t politicized as the holy-grail.

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