August 27, 2018 at 8:19 pm #39103
So we get those things changed. Doing that is entirely possible.
What I want is a system that covers everyone and that does not require life changing amounts when things happen.
That has happened TWO TIMES in my life. What we are doing right now is completely unacceptable. I know way too many people in real trouble.
Medicare would be just fine. Better than Medicare is desirable.
What would you choose?August 27, 2018 at 9:24 pm #39104AndrewParticipant
Again, I would choose something like the French health care system if I had a magic wand.
But without a magic wand, as a pragmatist? Medicare for All isn’t happening anytime soon.
Healthcare sucks and isn’t going to get any better until at least 2021, the next time we have another chance of having a Democratic president and a Democratic legislature. Just a political reality. At that point? Let’s hope Obamacare can still be salvaged by then – probably best to stick with that. Clearly, with the way people are voting in 2018, there isn’t near the political support required to pass Medicare for All soon.
Is it possible to pass a “Medicare for All” bill that doesn’t really lower the cost of health care very much possible? Sure – but what’s the point? Is a $5,500 deductible under Medicare for All better than a $6,000 deductible under Obamacare?August 27, 2018 at 10:08 pm #39105
Ok, just wanted to be clear.
So, in reality, we are not all that far apart.
Here is what I know:
Without building for it NOW, we are not going to get a major reform no matter who may end up President.
The left has moved away from driving economic issues. It remains fairly effective at social ones, but losing over 1000 seats has brought us serious regression potential, right along with actual regressions.
Net gain, sort of, probably not, but definitely not good.
Closing the gap on economic issues will improve overall party performance, and it will improve it in ways aligned with those issues, unlike moving to the right just to score some wins will. Doing that will improve the numbers game and check the GOP somewhat, but the cost of doing it is ongoing growth of people in real trouble economically, and that is a negative in terms of recovering from that over 1000 seat lost position we struggle with right now.
At the current level of money in politics, it is difficult for ordinary people to drive ANY issue that isn’t a social issue.
This is all why progressives are doing what they are doing.
And the needle is moving. Good. More to come.
This shift to issue campaigns means setting defeatism aside. “we are not the GOP”, and or “we suck less” are not going to get the things done, and maybe not even mean getting any sort of effective control either.
Pragmatism won’t sell. Sure, in the face of Trump, it’s got legs, but only because TRUMP! The whole affair is tepid otherwise.
We just do not need tepid.
For me personally, I’ll take it. But, only when I must take it. Otherwise, it’s all about growing the issue support and linking that directly to people’s lives and their vote, advocacy, support and SMALL donations, ideally right to candidates, not the party.
Put another way?
You can pay for tepid. 😀
I won’t.August 27, 2018 at 11:07 pm #39108
…but what’s the point? Is a $5,500 deductible under Medicare for All better than a $6,000 deductible under Obamacare?
First, to people below the 25th percentile, yes! 1000 bucks matters. That’s roughly 100 a month. That is nothing to sneeze at. For people below the 50th percentile, that amount is even more meaningful.
140 million people live at poverty level or below. It’s a big deal.
We can add to that, in the passing of that legislation, we can affirm health care as a human right. That
has longer term implications worth considering.
Any reasonable restructuring will deliver better than bronze plan type coverage now. Basics like negotiating drug prices is a no brainer, and damn near criminal, given how we couple that with both prescriptions being needed, and advertising. At least Saudi Arabia permits open sales of basically everything but narcotics and a few ultra dangerous things.
There is a whole lot wrong with that, and most doctors would tell you all about it, and few of us would disagree, but that, at least, is an actual market. What we’ve got is extortion on a good day. Total mess.
We can do better on that, much, much better. And we will too. The current state of things simply is not sustainable. Not given the constant war spending we do.
Uninsured people, pre-existing condition people, “doughnut hole people”, and I’m both at present sadly, and others can benefit significantly. I’m not entirely sure the deductibles need to be that high either. One of the major league benefits of a national risk pool is being able to reduce these kinds of things.
To get the big gains, some of the money needs to come out of the system. Private insurers are going to take a big hit. They do not actually add value, unless their coverage involves things that markets actually make sense for. Other ways to get money out of the system is to reconsider treatment norms. There is a whole lot we can do and pretty much all of our peer nations are doing those things.
It’s not like we have to pioneer anything here. This is flat out undoing largesse.
Additionally, primary coverage does not make market sense. It’s needed when it’s needed, and the impact is all over the place! Planning really isn’t possible on the majority of American incomes today. Total mess.
Secondary coverage can make EXCELLENT market sense, and that’s precisely what the French do. Primary coverage is illegal, or extremely highly regulated in the rest of the world. Secondary coverage, widely available in the rest of the world, covers things like supplies, home care of various kinds, including seeing the doctor at home, better room services, and lifestyle type things. (Preventative diet, exercise…)
People, in France, who buy both, basically do not have out of pocket expenses, and as a result, nearly all of them do. People can make some basic choices. Take some risk, take very little to no financial risk. Get baseline care, or pay for luxury, where it makes sense, type care.
The market people aren’t wrong in their basic ideas. The whole problem boils down to the poor mismatches, some just an artifact of our human condition, others forced by greed buying stupid legislation. Rent seekers.
Remedies to that are a win for nearly everyone else.
And I suspect, once we get past primary care / market issues, secondary markets can make a lot of money and deliver a lot of value too. The best part about all of that is it would actually be a market, not extortion like so many experience today. Real choices, options, real value, and people weighing those things, where markets work best.
Where risk exposure can often exceed people’s net worth, inclusive, markets make no sense at all. People can’t actually participate meaningfully. That’s the issue, put another, basic way. And as they get hit, taken out of the market, the ripple effects on the rest of us, our economy are all negative.
In the USA, income does not come close to balancing personal cost and risk exposure for a solid majority of Americans. Between retirement, health care, various emergencies, and the cost of housing, utilities, food and other basics, the money just isn’t there.
Health care and living wages are issues number one and two for all those reasons.
To address them, we are going to need very large numbers of Americans working toward that end. Big money in politics opposes those goals, and in some regards, is cutting it’s nose off to spite it’s face. (demand creates jobs, and with so many unable to participate in markets, real growth is tepid, and would be painfully obvious but for the ever growing military industrial complex taking up an awful lot of slack.)
In other aspects, it’s about a “land grab” in terms of ownership and control. Things like corporate sovereignty are worth the pain involved in getting there. Big, sustained investments toward those ends could net Trillions and much greater control over policy.
I don’t blame them for it, but I do oppose all of that because the impact on the nation and far too many of it’s people, the planet exceeds any potential benefit. (and that there are benefits is being charitable on my part)
So, it has either got to actually get cheaper to live (lower cost and risk exposure)
ordinary people need more.
Flat wages and ever declining buying power associated with those wages have accumulated into a very difficult to actually avoid talking about pain point. And it’s centered on incoming generations, who also are saddled with education debt.
Many don’t care how that gets done.
My own preference is a little of both, but a greater emphasis on cost and risk exposure, but that’s just me, and I would not complain much at all should a net increase to balance actual cost and risk ended up on the table. However, centering things on lower cost and risk exposure does put some flexibility on, and reduce the need for increasing income, while at the same time, freeing a lot of liquid dollars (not consumed by risks and or costs), which would improve demand in many segments of the economy. In particular, growth in major purchases, cars, homes will improve and deliver nice returns. May even offset that which is needed to curb cost and risk exposure in the longer term.
Preferences aside, doing either will improve things, and that improvement is what this whole mess is all about.
To that end, health care has the greater momentum by far, and for the majority of Americans, packs one hell of a punch too.
All of that is why it’s issue number one, support growing by the day.August 28, 2018 at 1:45 pm #39112cbaravelliSpectator
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