Tulsi's Healthcare Plan: Single Payer Plus

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  • #218799

    Voltairine
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    @voltairine

    Some extra tidbits have been becoming clear regarding Tulsi’s planned healthcare initiative.

    The first is that she intends to call it Single Payer Plus to differentiate it from Medicare for All, which she feels is being co-opted by a number of campaigns. She started to use the term a couple days ago while campaigning in Charleston, South Carolina (forward to 29 minutes or so):

    Tulsi’s South Carolina stump speech

    It seems clear from her speech there that everyone would be required to pay into it (good to my mind), but that people could purchase duplicative coverage or supplemental private insurance coverage on top of that. She also makes it clear–as she has from the beginning of her campaign–that Single Payer Plus could negotiate drug and service rates to make them more affordable for everyone.

    This differs from Bernie’s Medicare for All plan in that his plan would not allow duplicative coverage, but only supplemental private insurance coverage for things not covered under Medicare for All.

    Details have not been released for Tulsi’s plan, but with what we know, hers would be more like the current Australian healthcare system, whereas Bernie’s would be more like the current Canadian system.

    Both types of programs would be a tremendous improvement over what we have now.

    https://caucus99percent.com/content/tulsis-healthcare-plan-single-payer-plus

    IMO the major argument on the side of single payer plus is that if you have good healthcare provided by employer, union, university etc. tailored for the needs of specific group, great, you don’t need to resort to the already overburdened universal health care providers who get paid through government. In Bernie’s plan health care providers can opt out from the single payer system and work only for private insurers (forcing all providers to work for government is a no go), and supply side reality on the ground is already bad and would get worse, if duplicative insurances were banned.

    Aloha!

  • #218803

    RufusTFirefly
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    @rufustfirefly

    As long as private insurance exists as an alternative, it will seek out and destroy public insurance.

    With both public and private options, many hospitals and doctors will simply choose not to accept public patients. This will perpetuate a two-tiered system where the wealthy and healthy can get care easily, while the poor and the sick will have to scramble to find help. Meanwhile, with both systems operating concurrently, certain members of Congress will actively seek to gut funding for public insurance in order to “prove” that private solutions are superior to government-run ones.

    • #218814

      Voltairine
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      @voltairine

      To my understanding duplicative coverage does not mean only for profit private insurances, but especially and most importantly health care organized by large employers to their employees, by universities to students, etc. Nordic countries allow duplicative coverage.

      Any case, too early to make detailed comparisons, but from what I hear, Tulsi has in mind holistically preventive health care, instead of just sick care.

      Aloha!

      • #218896

        Ohio Barbarian
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        @ohiobarbarian

        @voltairine Your understanding seems to be incorrect. Bernie’s single payer plan prohibits any kind of duplicative insurance of anything covered by the single payer system. This is necessary, for if private for profit health insurance companies are allowed to compete with single payer, they’ll offer lower rates to healthy people and some bells & whistles stuff to rich ones, forcing poorer and sicker people onto single payer and eventually bankrupting it.

        No, for single payer health insurance to work in the United States, it needs to be mandatory universal coverage without private competition. It’s the only way to make it economically feasible, and it’s the only way to insure its survival against any future “private enterprise friendly” government. The private health insurance companies need to be relegated to things like optional cosmetic surgery not covered by the new Medicare, and if they can’t survive, most Americans will not miss them.

        We know now that Government by organized money is just as dangerous as Government by organized mob.--Franklin Delano Roosevelt

        With Bernie Sanders, we have the receipts. --Nina Turner

        • #218969

          Voltairine
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          @voltairine

          I was speaking about Tulsi plan, which apparently will allow duplicative coverage on top of single payer universal coverage. It’s not public option, people can’t opt out from single payer system and choose only private insurance, so there’s not the kind of competition you speak about.

          I can’t see what the problem is with employers etc. offering better quality health care than the providers of single payer universal health care can offer. Different professional groups etc. have different needs from firefighters to university students etc., and one shoe does not fit all. You get baseline and ability to improve.

          No system is fool proof against political adversaries gaining power and ruining health care. That’s not convincing argument, and on the other hand total ban of all duplicative systems, no matter how they are funded and by whom, is tough and near impossible to get through legislative branch and general public support.

          Aloha!

          • #219094

            Yanath
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            @yanath

            @voltairine

            There shouldn’t be any “higher quality” insurance than a publicly funded system. If rich people want to pay for extra shit, they should be forced to pay for it themselves. For-profit healthcare insurance provides no service of any kind to our society and no one has a moral imperative to profiteer from illness and injury.

            • #219111

              Voltairine
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              @voltairine

              So you want to allow rich people to pay extra shit themselves?

              To be honest, this discussion has made me only more confused, I have no idea anymore what “duplicate coverage” is supposed to mean.

              Aloha!

              • #219128

                Yanath
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                @yanath

                @voltairine

                It should be illegal to profiteer from illness and injury. For-profit healthcare insurance should not even exist.

              • #219185

                Mr. Mickeys Mom
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                @mrmickeysmom

                Let’s keep it simple, Voltairine… The single payer system is funded under the government (which is what we have thus far invested in through our paycheck deductions for Medicare – promised when we are eligible). We can under Bernie’s plan fund everyone at a lower cost only if that set aside payment system is not gutted by Congress, which is what a two tier system would do, should we allow another tier via financed private insurers. Bernie’s system is NOT allowing the robbing of this funding to go on. Everyone’s insurer is Medicare.

                Under Bernie’s plan, the Veterans Health Administration and Indian Health Service would remain. Current Medicare benefits would be expanded, since they don’t include dental, hearing or vision coverage now. Also, Sanders’ bill calls for virtually no out-of-pocket costs at the point of service for these benefits. There would be no copays, deductibles or premiums, with the exception of prescription drugs and biologics (such as vaccines and gene therapy), which could carry copays totaling no more than $200 a year per person, indexed for inflation.

                Hell, no... I'm not giving up...

          • #219133

            Ohio Barbarian
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            @ohiobarbarian

            @voltairine You do not understand. Tulsi’s plan will allow private health insurance companies to exist and offer plans that compete with the government-run single payer plan. This is just another public option. It won’t work. The private health insurance companies must be destroyed in order for it to work in this country.

            We’ve seen this sort of crap before. It’s like letting people invest in stock portfolios with a portion of the money they otherwise would have paid into Social Security. That weakened the whole Social Security system.

            IOW, additional plans that do not cover the same illnesses and conditions as the New Medicare coverage are fine, but competition is verboten, except maybe in some very narrowly defined situations. And nearly all doctors will accept the New Medicare payments or they’ll go out of business because it’s the only game in town.

            If you go into medicine to get filthy rich, you really have no business practicing medicine, anyway. You’re the wrong sort of person to practice that trade.

            We know now that Government by organized money is just as dangerous as Government by organized mob.--Franklin Delano Roosevelt

            With Bernie Sanders, we have the receipts. --Nina Turner

            • #219554

              Voltairine
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              @voltairine

              I understand your argument. I also understand that even if Sanders wins, his plan is not going to pass Congress.

              Aloha!

    • #218893

      Cold Mountain Trail
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      @coldmountaintrail

      +++++

      and both the australian and canadian systems are under attack from the forces of capital.

      CANBERRA, Australia—Australia’s government is considering a multibillion-dollar privatization of public health and welfare payments, as conservatives look for new ways to refill budget coffers emptied by an economic slowdown and collapsing prices of the country’s resource exports.

      In a move that would be risky in a charged election year, due to the popularity among voters of the country’s generous health and welfare system, Prime Minister Malcolm Turnbull said on Tuesday the conservatives were looking at outsourcing a range of government payments worth up to 50 billion Australian dollars (US$35.43 billion).

      “The government is as always totally committed to Medicare,” Mr. Turnbull told Parliament. “What we are looking at…is improving the delivery of government services, looking at ways to take the health and aged care payment systems into the 21st century.”

      Treasurer Scott Morrison may test market appetite for a deal soon after the next national budget statement in May, which could clarify the future of several privatization offers being looked at by the conservatives.

      I don’t trust tulsi on this.
      and the “plus” = leaving a wedge for the forces of capital to keep on doing what they do; a two-tier system right out of the box.

       

  • #218806

    incognito
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    @incognito

    Duplicative coverage gives a lifeline to the bloodsucking greedy insurance companies and every freakin’ one of them needs to be DESTROYED and NEVER given the ability to be a part of our healthcare system again! THEY destroyed the system. In the 70s, we had an incredible healthcare system until the insurance vultures were given free reign to charge as much as they wanted. Until They played doctor denying coverage so the money they saved denying that coverage could go into THEIR pockets. Their greed has spiked costs across the board. They MUST BE ELIMINATED FROM THE SYSTEM COMPLETELY.

    There is no other way to make the system work the way we need it to work. It’s imperative insurance companies are not included at all. They get no foot in the door.

  • #218810

    a little weird
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    @alittleweird

    This is the main reason I can’t back Tulsi.  She’s spot on when it comes to stopping regime change wars but she lost me the first time I heard her talk about health care.

  • #218812

    game meat
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    @gamemeat

    A misleading name, to say the least, and kind of weaselly. Tulsi is great on foreign policy, not so much on domestic problems.

    She calls it single payer, but it really isn’t single payer; it’s a hybrid single payer/private insurance system. I assume that is where the ‘plus’ comes from. lol. Single payer minus, tbh. And more Buttiegieg than Bernie.

    The whole “if you like your insurance provided by your employer, etc.” is an insurance company talking point. No one likes their providers, but they may like their doctors, and that’s a big difference.

    I’m not a fan of plans that give so much leverage to private insurance. They will just use their capital and influence to lobby to get the plan watered down, sabotage it from within, or work to under fund it later on, using that as proof that the public plan doesn’t work. No, the insurance companies must be done away with, if not entirely, then they should be limited to handling the market for frivolous stuff like cosmetic surgery.

     

    • #218874

      Voltairine
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      @voltairine

      It’s single payer, as government provides universal health care for all. That’s what the term “single payer” means. If you go to the details, M4A is not public monopoly either, but complex system of federal state, states and certain private insurance systems.

      Aloha!

      • #218891

        game meat
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        @gamemeat

        That’s true, single payer systems may not monopolize everything and still have supplemental coverage, etc., but that’s not what she’s proposing. What she seems to be proposing is closer to a public option because private insurance can still compete with the public plan. That’s not really single payer, but more of a hybrid system.

        • #218900

          Cold Mountain Trail
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          @coldmountaintrail

          yep, its public option — you can ‘choose’ the insurance your job pays for, you can buy your own, or you can choose the publicly-paid option.

          can you see the immediate class divide there?

          and “weasely” is exactly what it is.

           

          • #218986

            Voltairine
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            @voltairine

            What is your source claiming that Tulsi plan is not single payer but public option? Are you accusing her of lying?

            She says it’s single payer, meaning that it’s not optional but everybody pays and everybody gets it. “Plus” means that you can have also additional coverage, instead of government outright banning that.

             

            Aloha!

        • #218976

          Voltairine
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          @voltairine

          I’m sure that if Tulsi was suggesting public option, she would say so. She says single payer, meaning that duplicative coverage is not alternative to single payer universal coverage, it’s on top of it, additional option, single payer plus. People have asked her campaign, and they have confirmed this.

          Aloha!

          • #219000

            game meat
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            @gamemeat

            It’s a lot closer to a public option than single payer because it allows duplicative coverage. The whole point of duplicative coverage is to leave the door open for the insurance companies to be able to walk right in and ruin the public plan.

            Yes, it is on top of the public plan, and that’s the problem, not the same thing as supplemental insurance. It allows those privileged enough to have it to be able get preferential treatment and jump to the front of the line. That’s literally the only function it serves. This exacerbates inequality and furthers the class divide.

            • #219026

              Voltairine
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              @voltairine

              We don’t know the details of Tulsi’s model yet. So how do you claim to know what you claim to know about duplicate coverage being closer to public option?

              If I understand correctly, Sanders plan allows supplemental coverage for medical issues that universal care does not cover. That entails very detailed red tape bureaucracy to define various qualities and functions of health care that supplemental is either allowed or not allowed to cover. I suppose the worry is that without such red tape, health care providers would be free to prioritize supplemental insurances over universal. That would be bad, I agree.

              There is, however, no evidence that that is what Tulsi would be suggesting – no evidence except malicious imagination. There can be many other ways to guarantee equal treatment for all patients by health care providers other that Sanders model, some perhaps much better. For example, making sure that providers charge only based on treatment they provide, regardless of who gets the bill.

               

               

              Aloha!

              • #219110

                game meat
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                @gamemeat

                I don’t have to know all of the details of her plan to know that allowing private companies and employers to sell duplicate plans for things already covered by the public plan is a gift to the insurance companies compared to Sanders’ plan which proposes to ban them from doing so. The only reason for anyone to want such a plan is for preferential treatment (shorter waiting times, etc.), which is why it increases inequality while keeping private insurance in the game for no practical reason. Can you not see how that is a bad thing?

                Yes, Sanders allows supplemental plans to be sold to cover non-essential services like cosmetic surgery. That doesn’t lead to the same problems as allowing duplicative coverage because the supplemental plans only cover non-essential services which are not already covered through the government plan.

                That being said, you are correct in stating that there will be issues when it comes down to deciding what is/isn’t covered through the government plan, and what can/can’t be covered with supplemental insurance. That’s a fight that will be certain to happen no matter what. Allowing duplicative coverage won’t change that.

                • #219112

                  Voltairine
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                  @voltairine

                  I checked the wiki on Australian system, and there people with more money can buy preferential treatment in hospitals. If that’s what this means, I don’t like it.

                  If Sanders plan means that employers, unions etc. can’t provide free health care payed by the employer or other institution to employees, members, students etc, in addition to what universal health care offers, that’s not OK either.

                  Aloha!

                  • #219187

                    Ohio Barbarian
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                    @ohiobarbarian

                    @voltairine Our unions and employers haven’t paid 100% for our health care through our and their contributions for over a generation now. We don’t trust them to provide our health care coverage, and we know they will eventually rip us off and then start going after Medicare again if they are given the chance. Yes, our unions are often corrupt, too.

                    We want both employers and unions completely out of the health care picture, for very good historical reasons.

                    We know now that Government by organized money is just as dangerous as Government by organized mob.--Franklin Delano Roosevelt

                    With Bernie Sanders, we have the receipts. --Nina Turner

                    • #220777

                      Voltairine
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                      @voltairine

                      Taking away from veterans their current health care, and replacing it with something probably much worse, as the Sanders plan is very thin on supply side, is not the best campaign promise a politician can make.

                      Aloha!

  • #218871

    retired liberal
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    @retiredliberal

    Has anyone else noticed the current problem with the name “Medicare for All”?
    1. The problem is, Medicare already exists. Because of that there are already gaps and loop holes in its coverage.
    2. Have you been watching the “Medicare” commercials on TV and in your mail lately? All this “free” coverage for Medicare Advantage plans, provided by the private health insurance companies, calling themselves Medicare insurance? Implying this Medicare is somehow government?
    3. Bernie should have gone with the name “Single Payer, Universal Health Care”, or some such, from the start to differentiate from the current government Medicare. But because he didn’t, the name “Medicare” is being co-opted by the health insurance companies, calling themselves Medicare Advantage, to muddy the waters and confuse people as to what Bernie is selling.
    4. Now Tulsi is jumping into the fray with Single Payer Plus, further confusing the issue.

    But no matter what we do, we absolutely must put the health insurance companies out of business, period. We should have done so back in 1948. We didn’t and so here we are today, fighting an uphill battle, with rocks and sling shots against barricaded, heavily financed, big artillery

    We are an arrogant species, believing our fantasy based "facts" are better than the other person's fake facts.

    If you are wrong, it will be because you are not cynical enough.

    Both major political parties are special interest groups enabling each other for power and money, at the expense of the people they no longer properly serve…

  • #218872

    Babel 17
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    @babel17

    It will all come down to how resolute and skilled either Sanders or Gabbard were at negotiating, once elected.

    Even Bernie, with a Democratic majority in the House, and Senate, won’t be getting Medicare for all into law just by fiat. As Bernie has said in the past, and I think he had President Obama, and other Democrats, in mind, when you negotiate you don’t start from where you think you might end up.

    Gabbard is not Sanders, and she’s coming across on this as the epitome of reason. That way she’d never have to concede on any points of her plan as being too bold or ambitious. She could get a large majority of Democrats on board with her plan, and she’d have as cover some saying it wasn’t bold enough.

    Sanders has a reputation as a high stakes negotiator, Gabbard does not. So moderates know that Sanders will be very tough, but to get a good deal passed he won’t view his plan as having been written in stone. When Sanders lays out his plan, key Democratic insiders know that if a deal was close to being approved, Sanders would allow some wiggle, like, for example, in temporarily grandfathering some union plans (he already said he would with those), and imo if the final impediment was allowing multi-millionaires to keep platinum coverage on top of Medicare for all which they’d still pay for, he’d cut a deal that allowed it. He just wouldn’t use it as chip, they’d have to come to him with a done deal that had that in it. Bernie would be using the bully pulpit while his surrogates worked to get the needed votes.

    Gabbard has to negotiate differently, and that would involve how she’d build an actual majority in both houses that would vote for it, after House and Senate leaders allowed it to get out of committee, and to the floor for a vote. It would never get near being voted on if it polled badly, and looked to be the kiss of death for Democrats election chances.

    This election will mostly/also be a referendum on Trump, and not/not just on Medicare for all.

    Warren is showing cracks in her facade over her version, and imo that’s because she’s not Bernie, and she has no idea of how to ram home her revolutionary proposal to fund her version of Medicare for all. Gabbard knows she’s not Bernie, and she knows that for her to get elected President she can’t campaign like Bernie. For her to get a health care bill passed that even Bernie would approve of, she’s going to have to do it her way.

    Gabbard is not running an aspirational campaign as such, but rather she’s running as a moral and ethical pragmatist, and as veteran of the Sanders led movement (which is aspirational, in its own way). We don’t need a mini-me of Bernie in the race, one who happens to be a woman who isn’t white, and who is a combat veteran.

    Only Bernie is Bernie, and if he wins the primary, great, he’ll do the best job possible in getting his platform made a reality.

    And if Gabbard wins the primary she’ll be 100% ready to work to deliver on what she ran on, and she won’t already have one eye on how she can pull off the bait and switch that was baked into her campaign.

    Have we forgotten 2008?

    https://www.tulsi2020.com/

    • #218884

      Voltairine
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      @voltairine

      From what I’ve seen, Gabbard is very talented result oriented legislator, who studies issues first holistically on root level and makes the details serve the whole of actual needs in most common sense, pragmatic no-nonsense manner possible that can win common sense support from fellow legislators regardless of partisan divides.

      Aloha!

  • #218888

    eridani
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    @eridani

    No duplicate coverage period!  This is just a way go get government to take care of the sick people, and private insurers can continue to insure the healthy 85% majority at huge profits.  If private insurance continues to exist, it should be allowed to cover only those things that are not in Medicare for All.  BTW, seniors benefit from this also, as it would eliminate co-pays and deductibles.

    Given that 215% of the population of every demographic accounts for 85% of that demographic’s health care expenses, the comparatively healthy 85% don’t know jackshit about whether their employer’s plan is any good.  Just like I really don’t know if my fire extinguisher is any good.  Sure, the brand got an acceptable rating from Consumer Reports, but I’ve never tried to use it on an actual fire.

    Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #218994

      Voltairine
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      @voltairine

      Duplicate means providers in addition to universal health care, not alternative. Duplicate coverage and public option are totally different things.

      Aloha!

      • #219027

        eridani
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        @eridani

        No, it does not.  Duplicate means duplicating coverage for procedures.  M4A of course means you can choose any qualified provider.

        Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

        • #219092

          Voltairine
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          @voltairine

          Procedures?

          M4A is not obligatory to providers, they can opt out.

          Aloha!

          • #219188

            Mr. Mickeys Mom
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            @mrmickeysmom

            What are you talking about?

            Hell, no... I'm not giving up...

          • #219189

            Ohio Barbarian
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            @ohiobarbarian

            @voltairine Then they’ll also opt out of practicing medicine, and good riddance to them!

            If single payer is the only game in town, doctors will accept it, just like they do in Canada. If they don’t like it, they can try their luck at a hedge fund or something.

            We know now that Government by organized money is just as dangerous as Government by organized mob.--Franklin Delano Roosevelt

            With Bernie Sanders, we have the receipts. --Nina Turner

          • #220642

            eridani
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            @eridani

            Yes, they can opt out.  But  very few do.  It isn’t really possible to sustain  a practice consisting only of very rich people.

            Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

  • #218899

    Ohio Barbarian
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    @ohiobarbarian

    Anything that allows companies like Blue Cross Blue Shield, University Hospitals, and up here the Cleveland Clinic insurance companies to continue to exist will not work. To borrow from Cato: The private health insurance companies must be destroyed!

    And some of their executives imprisoned for crimes against humanity.

    We know now that Government by organized money is just as dangerous as Government by organized mob.--Franklin Delano Roosevelt

    With Bernie Sanders, we have the receipts. --Nina Turner

    • #218912

      incognito
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      @incognito

      @ohiobarbarian

      “And some of their executives imprisoned for crimes against humanity.”

      Exactly. The greedy CEOs who profited from denying coverage to people who desperately needed it, need to go to jail, but that will never happen.

      At least with Bernie in the WH, their ilk will cease to exist.

      Their companies are going down. Personally, I can’t wait until that happens and it can’t happen soon enough! Thousands more people will die in the meantime… Because of their greed.

  • #219197

    Yanath
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    @yanath

    If our society truly regards healthcare as a human right, it would allow no profiteering from it. Everyone would have the best that’s available.

  • #219840

    xyzse
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    @xyzse

    Thanks for the clarification.

    I prefer Bernie’s plan, but objectively speaking, I know both plans have a steep up-hill battle to come to fruition.  I can see why Tulsi would go with such a thing, considering that this is probably what she thinks she can fight for.

    So here’s the thing.  The reason Tulsi’s plan is not a deal breaker for me, is because I actually trust her to fight in comparison to Obama.  Beyond that, I consider Bernie’s plan to be a much better starting point.  I think it is better to start beyond what is best, and what you think can be accomplished, so as negotiation goes on, you can reach an acceptable level.  Obama went immediately Right-Wing Heritage Foundation, and even conceded more from that, only to have no/none of the Republicans voting for it.

    As for the branding.  Depending on where you fall, people do like Medicare but know it is not enough.  So saying Medicare for All makes sense due to familiarity, but Bernie’s expands on it, so those that think Medicare does not cover enough and inefficient might balk on the naming.  Either way, that’s for those who don’t really look in to things that deeply.

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