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Home Main Forums General Discussion The Democratic Establishment Is Moving Closer and Closer to Single Payer

  • UnicornOnTheCob (1769 posts)
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    The Democratic Establishment Is Moving Closer and Closer to Single Payer

    The Democratic Establishment Is Moving Closer and Closer to Single Payer, but Activists Want the Real Thing
    Zaid Jilani
    The Intercept

    With that popularity in mind, the party’s centrist wing, along with everybody else to the right of Sen. Bernie Sanders, I-Vt., has begun thinking which reforms short of single-payer might be feasible if the window of opportunity opens. Last fall, Sen. Tim Kaine of Virginia, Hillary Clinton’s running mate in 2016, teamed up with Sen. Michael Bennet, D-Colo., to introduce what they called Medicare X, a bill that would essentially create a public insurance option.

    [Center for American Progress’s] plan, called “Medicare Extra for All,” would instead offer a public plan (Medicare Extra) as a choice that Americans as individuals and employers could opt into. Unlike the Sanders plan, for most people there would be deductibles, copays, and out-of-pocket limits, but these would exist on a sliding scale that varies with income.

    Adam Gaffney, a Harvard Medical school pulmonary specialist and the president-elect of the single-payer advocacy group Physicians for a National Health Program, agreed with Lighty that the proposal represents movement by the Democratic establishment. “On the one hand I think this reflects the fact that he Democratic establishment is finally responding to its more progressive base,” he conceded, comparing it to former presidential nominee Clinton’s proposal for a modest public option. “In many ways it does much more than previous establishment proposals.”

    But he believes that the proposal would leave most of the American health care system’s problems in place — ranging from the inefficiencies of having hospitals and doctors having to deal with paperwork from hundreds of different insurers to significant our-of-pocket costs.


    I guess this is a glass half full or empty situation. You can read this as the establishment getting more comfortable with the inevitability of single payer, but I see this more as the establishment doing anything it can to prevent single payer.

    snot, glinda, Blackspade and 16 othersSalemcourt, jwirr, Stonecarver, ravensong, 99Forever, Betty Karlson, ThomPaine, OCMI, rudycantfail, djean111, elias39, xynthee, daleanime, GloriaMundi, davidthegnome, Stockholmer like this

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    • Stockholmer (4009 posts)
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      1. It is doing everything it can to stop real single payer

      They will hamstring the public option, then use the resultant cockup to squeal “We told you it was a cray idea!”

      Typical neolibcon game theory.

    • davidthegnome (2198 posts)
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      2. I agree with your view on this

      I don’t think this is a genuine shift for some, perhaps even most.  They dislike the growing popularity of Medicare for all and are throwing up what they can to prevent it.

      That said… I do believe we are going to win this particular battle.  Hopefully, in 2020, I doubt it can happen sooner.

      “There is no distinctly native American criminal class save Congress.” - Mark Twain
    • daleanime (2847 posts)
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      3. Sign me on to your theory……

      they will do everything they can do to prevent it.

      When the going gets tough, the tough take care of each other
    • Cassiopeia (3042 posts)
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      4. It's really easy for them to shift to stumping on single payer

      1. It has zero chance of passing right now.

      If push came to shove and it had any real chance of passing these new converts would suddenly find a reason it won’t work.

      If they receive a single penny from anyone related to the medical/pharma industry you can safely bet they will never vote for single payer.

      The only minority we should fear is the 1%


      I miss momcat.

    • mmonk (2740 posts)
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      5. Yes, the latter.

    • RufusTFirefly (3138 posts)
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      6. I can't help thinking of Zeno's Paradox

      They’ll keep cutting the distance to Medicare for All in half and yet somehow we’ll never manage to get there.

    • djean111 (6259 posts)
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      7. They will do everything they can to stop Single Payer. This is all just

      campaign bullshit.  I agree with you.  As a matter of fact, the Establishment does not think people who cannot afford our out-of-control health care and insurance costs should even get health care.  That is what I believe.

      • *Obligatory disclaimer - when I say "Democratic Party" I mean the DNC - the Clintons and the un-elected people and the consultants and the lobbyists and the corporations who actually run things.  The people who work and vote and are registered as "D" are no more the actual party than Trekkies are Star Trek.   Extra credit - the Democratic Party gets to actually fuck up your life. When you vote for it.
      You think the only reason that people won't vote for a warmongering Third Way fracking-enabling cluster bomb throwing H-1B increasing lying pandering corporate and Wall Street shill who says she has no problem putting abortion rights on the table is because we are mad about Bernie?  Um, nope.
      • RufusTFirefly (3138 posts)
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        8. I believe there's a bigger neoliberal theme to all of this:

        For neoliberals, who basically want to privatize everything possible, a successful public healthcare system, completely undermines their principal argument.

        The presence of Medicare and the Social Security system already sticks in their craw. This explains their continual efforts to carefully underfund and discredit both.

        They’re in a tight spot though because Americans overwhelmingly support both.

        Dramatically increasing the strength of the social safety net by instituting Medicare for All would be moving in precisely the opposite direction of where they want us to be heading. It’s their worst nightmare.

        • djean111 (6259 posts)
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          10. I agree. Horrifying how the desire to privatize and the contempt for

          those who can’t afford health care reinforce each other.

          • *Obligatory disclaimer - when I say "Democratic Party" I mean the DNC - the Clintons and the un-elected people and the consultants and the lobbyists and the corporations who actually run things.  The people who work and vote and are registered as "D" are no more the actual party than Trekkies are Star Trek.   Extra credit - the Democratic Party gets to actually fuck up your life. When you vote for it.
          You think the only reason that people won't vote for a warmongering Third Way fracking-enabling cluster bomb throwing H-1B increasing lying pandering corporate and Wall Street shill who says she has no problem putting abortion rights on the table is because we are mad about Bernie?  Um, nope.
        • closeupready (2283 posts)
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          16. While I am usually wrong on such things, my view is it's simply $$$.

          They all make money off of the broken, inefficient system of health care which we have in the US – the medical profession, insurance companies, and lobbyists and elected officials to whom they shovel many millions of $$$ per year.  No real principle to that.

          The opinions and views expressed herein are solely those of the author.
          • RufusTFirefly (3138 posts)
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            17. Mebbe so with some

            But, given that our self-destructive system hinges on perpetual growth, there is a constant, obsessive search for new markets. Speculation, extraction, privatization, and the manufacturing of needs we never realized we had are really their principal options.

        • MistaP (7729 posts)
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          21. "if we LET you have it after blocking it for half a century, it's not just

          us out on our asses but all our staffers, lackeys, groomed heirs, and proteges”

          the whole political class has relied on this shell game–even against postal banking, which was a success in other countries until privatized in the 90s because it was profitable

          they’ve attacked the whole idea of a public good (think DiFi)

          the Shinkansen’s run since LBJ was president and the TGV under Ford–and in fact most presidents except Reagan pushed for it

          http://www.salon.com/2016/11/09/the-hillary-clinton-campaign-intentionally-created-donald-trump-with-its-pied-piper-strategy/ (Third Way = Bell Curve)
      • Eleanors38 (967 posts)
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        26. The DNC's agitprop becomes more effective as time lapses before a

        sound alternative is organized to counter the DNC.

    • NV Wino (6660 posts)
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      9. Smoke and mirrors

      We will never get to single payer as long as any one of those criminals receive funds from the insurance industry.

      Resist-sm_zpswfchkz8t “As we act, let us not become the evil that we deplore.” Barbara Lee  
    • OCMI (1796 posts)
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      11. They're trying to co-opt support for Medicare-for-all in an attempt to prevent

      single payer from happening.  Anyone signing on to the Medicare Extra proposal is not on our side.

      If you dislike Trump, you should vote for him so we can change his party from within. Yes, Hillary supporters, this is how ridiculous you sound.
    • ThomPaine (5356 posts)
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      12. I agree with you. I see this as a bad sign for two reasons.

      One by them moving left (at least in appearance) it dilutes the argument of the left.  It’s the “lesser of evils” concept, like the ACA is better than nothing.

      Two and maybe more significant.  Trump won because he said stuff the base wanted to hear even if it wasn’t true.  The Neo-Lib’s hubris was so great, they didn’t think they had to lie.  They felt all they had to do was push “we are better than them”.  Maybe they learned to put their hubris in check and lie.

    • Betty Karlson (4600 posts)
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      13. Threaten them with primaries and a third party:

      they will not do the right thing out of principle or out of good will, because they have neither. Therefore they must do it out of fear and necessity.

      "Someone hacks the DNC allowing all of America to see how the DNC operates as one of the most corrupt political machines in national history. Ergo, Hillary Clinton should be installed as President by judicial fiat. And if you do not agree to this scheme you deserve to be brought up on charges of treason because fascism." - NUGrrl, december 2016 “Once a person has been determined to be an UNTRUSTWORTHY LIAR, their pretend stances on important issues are simply not relevant to rational discussion.” – Ida Briggs, September 2016
    • closeupready (2283 posts)
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      14. Not good enough. No deductibles, no co-pays. PERIOD.

      Anything else is unacceptable.

      The opinions and views expressed herein are solely those of the author.
    • INTJ (3285 posts)
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      15. IMO, Dems are motivated to want credit when it inevitably comes…

      that puts the in a place where they need to make supportive mumblins of something like medicare for all.

      But they can’t say medicare for all because  that looks to much like a Sanders campaign point.

      Consider the policy?  Hey, choosing to run on Identity Politics -IS- a policy decision.  
    • 99Forever (4424 posts)
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      18. Lying liars lie.

      Of course it’s about stopping single payer while pretending to be “helping it.”

    • ravensong (2174 posts)
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      19. It's a terrible plan, a Third Way scheme to deceive and rob the citizenry

      and ensure profit for wealthy private interests.

      Centrist incrementalism is socially and economically regressive.


      Together, together, my friends, we have begun a political revolution to transform America, and that revolution, our revolution, continues. ~ Bernie
    • jwirr (4373 posts)
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      20. That sliding fee scale probably means the rich will pay nothing and the rest of

      us will be taxed from the bottom up. That seems to be the way that they have done things since the 80s.

      What I see wrong with this is that it keeps all the different levels of execs in the plan and that means the high prices just keep getting higher.

    • doh1304 (610 posts)
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      22. Sorry for the tangent, but I had an idea worth discussing

      At the last time I looked (long story) if you itemized 7% of health out-of-pocket costs were deductable. Why not make that a refundable credit? Instant single payer (with a 7% deductable that could be reduced by the personal deduction – make that a credit too by creating a mandatory minimum income)

      As I see it the only problem would be that health care providers would have to have a steeply progressive income tax to prevent price gouging.

      • closeupready (2283 posts)
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        25. A fine idea, if helping 30% of US taxpayers is good enough.

        70% of taxpayers do not itemize.  So how do you reach them?

        The opinions and views expressed herein are solely those of the author.
        • doh1304 (610 posts)
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          28. You are assuming

          That there is some sort of law that exactly 30% of people itemize – whether they should or not. This is an obvious fallacy. But more importantly, lines 23 – 35 on the 1040 are for “common” adjustments – IRA deductions, (line 32) student loan interest, (line 33) Health savings accounts, (line 25) self employed health insurance. (line 29) See?

          • closeupready (2283 posts)
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            30. 70% do not itemize because the standard deduction results in bigger refunds

            than what they would get back from the government if they itemized their returns.

            Regardless, no, I do not support your idea on single-payer.  Though if you start another thread,  you might get a livelier discussion about its merits and demerits.

            Cheers.  :hi:

            The opinions and views expressed herein are solely those of the author.
            • doh1304 (610 posts)
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              31. I only itemized once in 40 years

              when I had $18,000 in dental bills on only $43k income. Since it was self employed income I still payed about $1900 in FICA taxes. In other years, when I only paid about $2000 in medical bills I didn’t even consider itemizing, it would have been a waste of time.

              Now then, my idea (if I’d explained it more fullly) was to have a mandatory minimum income (a refundable personal credit – not deduction, a refundable credit) and all medical costs as refundable credits (not itemized deductions, refundable credits)

              if line x on my 1040 had read “tax (from tax table)” and line xx had read “subtract personal credit” and line xxx had read “subtract all medical expenses” and then the last line had read “if line xxxx is less than 0 enter amount to be refunded to you” I would pay a lot less. (in fact, if the personal credit had been a living wage in most years I would have recieved money)

              I have tried  starting threads (on dk and c99, not here) and for some reason people kept reading “credit” and thinking “deduction”. I guess that’s because only corporations get tax credits. (in 2008 candidate Obama complained that Exxon recieved $25 billion in refundable tax credits while paying no taxes at all. Of course, after the election he stopped complaining) But maybe I should look up how to start a thread here.

    • Eleanors38 (967 posts)
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      23. But first, it must get instructions from Insurace Cos., Big Pharm, Banks, etc.

    • id-entity (2245 posts)
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      24. In other news

      Zeno tells that Achilles keeps on catching the Turtle.

      Disclaimer: You are free to reproduce, distribute, interpret, misinterpret, distort, garble, do what you like, even claim authorship, without my consent or the permission of anybody.
    • peacecorps (4789 posts)
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      27. Bernie knows that if they are 'moving closer' or ever do, they will be "kicking

      and screaming” in many cases. Many people and politicians will eventually support single-payer out of belief. Some politicians will support it because it becomes popular and they want to get re-elected.

    • Agony (150 posts)
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      29. "New Proposal Designed to Confuse Public and Prevent Medicare for All"

      as per usual, Dr Flowers, sums it up nicely…   (she is a major proponent of HR676 and National Improved Medicare for All which are in many ways better than Sanders Medicare for All proposal)


      Here are the flaws in the CAP proposal:

      1. CAP’s plan will continue to leave people without health insurance. Instead of being a universal system of national coverage like NIMA, coverage under the CAP plan relies on people’s ability to afford health insurance. Only people with low incomes would not pay, as they do now under Medicaid. Just as it is today, those who do not qualify as low income, but still can’t afford health insurance premiums, would be left out. Almost 30 million are without coverage today. There is no guarantee that health insurance premiums will be affordable.

      2. CAPS’s plan will continue to leave people with inadequate coverage. Under NIMA, all people have the same comprehensive coverage without financial barriers to care. The CAP plan allows private health insurers to do what they do best – restrict where people can seek health care, shift the cost of care onto patients and deny payment for care. This is the business model of private health insurers because they are financial instruments designed to make profits for their investors. People with health insurance will face the same bureaucratic nightmare of our current system and out-of-pocket costs that force them to delay or avoid health care or risk bankruptcy when they have high health care needs.

      3. CAP’s plan will continue the high costs of health care. NIMA has been proven over and over to have the best cost efficiency because it is one plan with one set of rules. It is estimated that NIMA will save $500 billion each year on administrative costs and over $100 billion each year on reduced prices for pharmaceuticals. As a single purchaser of care, NIMA has powerful leverage to lower the costs of goods and services. The CAP plan maintains the complicated multi-payer system that we have today. At best, it will only achieve 16% of the administrative savings of a single payer system and it will have less power to reign in the high costs of care.

      4. CAP’s plan will allow private health insurers to continue to rip off the government. NIMA is a publicly-financed program without the requirement of creating profits for investors. With a low overhead, most of the dollars are used to pay for health care. The CAP plan maintains the same problems that exist with Medicare today. Private Medicare providers cherry pick the healthiest patients and those who have or develop healthcare needs wind up in the public Medicare plan. This places a financial burden on the public Medicare plan, which has to pay for the most care, while private health insurers rake in huge profits from covering the healthy with a guaranteed payor, the government.

      5. CAP’s plan will continue to perpetuate health disparities. NIMA provides a single standard of care to all people. Because all people, rich and poor (and lawmakers), are in the same system, there are strong incentives to make it a high quality program. CAP’s plan maintains the current tiered system in which some people have private health insurance, those with the greatest needs have public health insurance, some people will have inadequate coverage and others will have no coverage at all.

      6. CAP’s plan will continue to restrict patients’ choices. NIMA creates a nationwide network of coverage and consistent coverage from year-to-year so that patients choose where they seek care and have the freedom to stay with a health professional or leave if they are dissatisfied. CAP’s plan continues private health insurers and their restricted networks that dictate where patients can seek care. Private plans change from year-to-year and employers change the plans they offer, so patients will still face the risk of losing access to a health professional due to changes in their plan.

      7. CAP’s plan does not guarantee portability. NIMA creates a health system that covers everyone no matter where they are in the United States and its territories. CAP’s plan maintains the link between employment and health coverage. When people who have private health insurance lose their job or move, they risk losing their health insurance.

      8. CAP’s plan will perpetuate physician burn-out. NIMA creates a healthcare system that is simple for both patients and health professionals to use. Under the current system, which the CAP plan will perpetuate, health professionals spend more time on paperwork than they do with patients and physician offices spend hours fighting with health insurers for authorization for care and for payment for their services. This is driving high rates of physician burnout. Suicides among physicians and physicians-in-training are higher than the general population.

      End Mass Incarceration and the Drug War - The New Jim Crow Michelle Alexander