> It gives Democrats a branding tool.

Yes, but to use it the Democrats would have to turn their back on the large insurance companies. Replacing their contributions with small donations perhaps? But I just don't see that happening.

Cranky

Democratic politicians are afraid to fight for it. It being a single-payer universal healthcare plan.

So all roads lead to, or more approriately start from, the same problem: the current crop of Democratic leaders are afraid to take bold positions.

It's understandable if they do so once, or may be twice, but for them to continue to adopt exactly similar stance in face of significant electoral losses resulting from such wimpiness in successive elections seems to suggest that there is much larger organic problem within the Democratic Party.

Cranky Observer: Yes, but to use it the Democrats would have to turn their back on the large insurance companies. Replacing their contributions with small donations perhaps? But I just don't see that happening.

The trick would be to get other businesses, large and small, to see UHC as being to their advantage. Either that or real campaign finance reform, but that isn't due until 2200 AD.

Cranky, you could let the large insurance companies bid for the right to administer pieces of the program. There's plenty of money in that; Ross Perot got rich off of Medicare and Medicaid. However, they would not get to make the rules as they do today.

Any change will anger someone. But there are bigger someones on the other side; at some point, the managers of Ford and GM are going to overcome their prejudices and see that single-payer care can save them a mint, and the alternative is to go out of business.

If I remember right Dean didn't have a separate public and private view. He stated in public that he was in favor of it but didn't think it could succeed politically on the national front in 2004. His pragmatic response was to move toward it incrementally -- universal healthcare for children first.

You can disagree, but it's nice when politicians have enough respect for you to spell out their thought process.

I agree with Kevin.

This is the day to push for single payer health care.

It's bold. It's clear. It has a highly popular, universally understood precedent: Medicare. Decades now after the fall of the Soviet Union, the poison has been sucked out of the most effective smear against it: that it represents "socialized medicine".

And its opponents, the special interests and their lobbyists are in disarray and in widespread disrepute.

Really, you can just feel it in the air that now is the time to strike on this issue.

I'm glad that all these think-tankers realize they better not do anything that will lead to RushCo attack them! Glad they learned their lesson!

I also think that the utter confusion induced by the Republican prescription drug coverage legislation represents still another major opportunity to push for the crystal clarity of single payer.

Is this a place for vouchers?

1. Expand Medicare or the Senate insurance plan or something to cover everyone.

2. Allow folk to get vouchers (same $ amount as above) in lieu of membership in the above. They can put these vouchers toward any of the above.

3. Fund this by taxing individuals & corporations at the rate at which they, in aggregate, currently pay for healthcare.

Yes, please gear up on this issue. It is time.

(One of the reasons hc is less efficient in Canada is the sheer size of the country--the postal system is less efficient too.)

So, how do you shift the conversation away from the relative failures of Canada, Britain, or Italy, and towards the relative successes of the Netherlands, Germany, France, and Sweden?

So, how do you shift the conversation away from the relative failures of Canada, Britain, or Italy, and towards the relative successes of the Netherlands, Germany, France, and Sweden?

By talking about the AMERICAN success of Medicare.

100% right.

Seriously, 100% right. Let's just do it. I'm so tired of being afraid of having them call us names. They call us names regardless. Let's at least make it WORTH them calling us all the names. I mean, if I'm to be burned at the stake, I'd like it to not be for something as stupid as a voucher system combined with a mandatory-buy in that costs twice as much as what we have now, delivers worse care, and STILL doesn't solve the damn problem.

Single-payer health care would be a disaster in the United States unless we rethink our attitudes toward end-of-life care. It's the nearly universal practice in this country to spare no expense in prolonging the life of an obviously dying person a little bit longer even when the chances of recovery and quality of life are both zero. I am not advocating Kevorkian-style euthanasia, just a rethinking of what is really gained by delaying the inevitable. Other countries with single-payer systems have a more realistic attitude toward life and its natural limits.
On a related note, for single-payer to work here there would have to be a vastly increased emphasis on preventative care. It's a de facto policy in America to do nothing to prevent medical problems from arising, and then spend megabucks trying to deal with the consequences.

"Big corporations are tired of healthcare and are increasingly receptive to the idea of offloading their problem to the government."

This is the one aspect of the issue that we want to be hammering. Auto companies are now blaming their layoffs directly on health care expenses. If health care costs are crippling the free market, how can free-market conservatives argue that government shouldn't have a bigger role in providing health care? UHI is good for workers, and it's good for companies; that sounds like good policy to me.

So, how do you shift the conversation away from the relative failures of Canada, Britain, or Italy, and towards the relative successes of the Netherlands, Germany, France, and Sweden?

Compared to the US status quo system, even the "relative failures" there are "relative successes"; the first thing is to be ready to underline the immense failures of the status quo system.

Then, instead of talking in vague terms about a replacement, there needs to be a specific plan, whose elements can be tied to the successes abroad and/or the values of the American voter (like choice of providers.)

2100? That's not something worth pondering.

This is.... Healthcare costs have been rising 15% (on average) for the last 5 years. This means that in the next 10 years, healthcare will cost...... 325% more than it does today....

Will anyone but the top 1% (bush's base) be able to afford it in 10, 20, 50 years with the current system (for lack of a better word)?

MOI -- what are the perceived failures of the British universal healthcare system as far as Americans are concerned? From where I sit in the UK I can't see any catastrophic failures.

There's a continuous argument in the UK about NHS funding, pay for nurses etc. but that's been true no matter which party is in power; according to the others they claim it is being underfunded.

One thing the British system doesn't do that many other single-payer universal healthcare systems do is require copayments for examinations and medical treatments; maybe that's the great failure.

Yeah Kevin! On several levels.

1) Health care is a huge issue - and a potential winner. But it involves some tough choices. The biggest one is to recognize that market based solutions don't work.

And that's primarily because markets don't work in health care. And if one thinks about the basic assumptions of free information and informed consumers that undergird micro-economic models - neither work in health care.

2) That the failure of Hillary Care was not because addressing health care was bad. It was a failure to make the hard choice. Hillary guessed that there could be a half-way compromise between single payer and the current system. She guessed wrong. Any halfway house is just too complicated and underworkable. And second, the only place to get the total savings to pay for national health care is by getting rid of the insurance intermediaries.

The second reason it failed is that they were surprised by the vehement counter-attack from the GOP and the health care industry. Who knew that industry threatened with destruction would fight hard? (and there are more....)

3) The DLC hurts Democrats. Despite Ed Kilgore's brilliance as a prognosticator and a good writer, the DLC consistently undermines the Democratic message and policies. It's just too consistent to be coincidence.

The only question really is whether they are just "useful idiots" under Stalin's old definition or whether the organization intentionally seeks to stop any progressive momentum. My vote is Ed is in the former category, and Marshall and a few others are in the latter. They are the heralds of the McCain GOP.

You make a lot of sense, Kev. I'd also add that the whole Hillarycare thing was in 1994. That's a lifetime or two in politics, and things have changed since then. People's jobs are even less secure, and so, therefore, is their healthcare. Corporations are moving in this direction.

I think this is pushing on an open door, as long as it's done properly. Grasp the nettle, Dems!

Don't call it single-payer system or anything else along those lines. Here's the position -- and the three-word slogan -- for Democrats:

Medicare for all

What can Republicans do? Accuse Democrats of supporting socialism? Well, then they'll have to explain why they support Medicare if it is socialism -- if they support Medicare, why is it not socialism for the old but socialism for everybody else? Now, if they state they don't support Medicare since it's socialism, they'll have to support the position that nobody should have it -- and they'll start losing elections big time.

I'm certain they'll try and find something to finesse the issue -- e.g. if you're retired it's not socialism, if you are not it is, etc. but then how about housewives, kids, etc. who don't work? There are many ways to respond to anything they throw out, but as long as we define the program as expanded Medicare -- something people already know about, and like and has been efficient -- voters may finally get it.

It's good for business--lower healthcare costs mean higher profits. Not having to have staff deal with insurance issues saves time, effort, and money, which means higher profits. This would help land large dometically located economic development investment projects by non-US companies as those non-US companies would not have to worry about the cost of healthcare which they usually do not need to worry about back in their home country--which means more jobs and higher profits.

I honestly do not understand why our big unions and our big employers do not jointly grasp this issue and run with it.

I'm just curious. Whatever happened to the barefoot Chinese doctors that were to provide cheap primary care? Can we import a few?

What Aris said.

"Single Payer" is a wonky term, and not terribly compelling as a brand.

Besides, some of the successful systems you cite are not truly single payer. Germany isn't. Nor is France in the strictest sense (many employers offer private supplementary insurance as a benefit).

"Medicare for every American" strikes exactly the right note: universality, a trusted system, and the possibility of a single payer without making it a logical necessity.

"Every American Saves with Medicare for Every American"

Government saves.
Business saves.
Each individual American saves (oh, and gets health care to boot).

"Medicare for every American" strikes exactly the right note: universality, a trusted system, and the possibility of a single payer without making it a logical necessity.

Maybe, before the freshest thing in most voters mind about Medicare was the prescription drug boondoggle. Now? I don't think so. I think the Republicans have poisoned that well.

"Total Choice" might be a better slogan -- after all, its basically an insurance plan where every provider of covered services is in plan.

Focus on losing the restrictions on choice imposed by competing private health plans.

Still another reason single health payer will be vastly more sellable today than in 1994: it HURTS the average voter much more today to pay for health care than it did in 1994 -- the employee insurance premiums and copays tend to be much greater (employee paid premiums for family plans have nearly doubled!).

They KNOW it's a problem, and that it's getting worse.

Once you have universal health care, you can also start bringing the cost of healthcare down (and the health of the nation up) by providing periodic health checks for all. Remember, an ounce of prevention is worth a pound of cure, and currently so many have no healthcare that the first time they hit the system is through the emergency room after their issues have reached the critical stage. After which, indigent and quite ill, they become a serious burden on society. An annual physical could nip problems in the bud.

Kevin -- bravo, bravo, bravo. You are really staking out a leadership position on this issue.

May I suggest that you take a page from Josh Marshall's playbook and "spin off" a "Medicare for every American" (I'm with Aris and JohnL) advocacy blog? You're arguing that ALL LEFTY BLOGS agree with this -- yet you're the only one talking about it (so far). If you yourself don't have the bandwidth to run it, I think you've got a ready pool of foot soldiers here from which to recruit.

But here's the thing: none of this will happen if Democratic politicians are afraid to fight for it.

You've said a mouthful there, Kevin. And as it happens, that phrase happens to be true about a lot of the progressive agenda.

Yes! Medicare for all. Aris has got it right.
Medicare is a familiar, safe, American concept. Also, anyone arguing against it will be in big trouble - it's one of the MOST popular government programs around.

I'd like to get Chris Dodd's views on UHC -- specifically whether he thinks Democrats in Connecticut can withstand the reaction of the insurance industry. Lieberman is a spineless wanker in all respects, so no point in wondering about his reaction.

...it's a long fight, and the sooner we get back in the saddle and start fighting it, the better.

Hallelujah. This could be applied to anything and everything on the progressive agenda. We were making great progress in the 20th century, and then some time in the 60's we got blindsided by Goldwater activist conservatives. We've been floundering ever since. We just need to reawaken the progressive dream(s) - it will take time, but we need to do it. We can't hope to inch towards our goals if we never acknowledge what we are and insist that they are right.

It's unclear whether all conservatives would be against this. Corporations would be delighted to be relieved from the responsibility. In fact, a big part of funding this would have to be an increase in the corporate tax rate to compensate for the expense that corporations no longer have to bear.

I think two trends are working against you. First, consider this: But we have reality on our side: good single-payer systems (France, Sweden, the Netherlands, Germany — not Canada, Britain, or Italy) work great and people love them. the trend in Europe has been to expand the opportunities for private payers (Germany has always had such opportunities.) That is, they are moving away from pure single-payers systems. Second, American businesses are threatened by businesses in countries that have next to no health care systmes (India, China) and lots of such busniness will resist having their own taxes raised to reduce the problems of GM (and others like it.)

If we can introduce the public to real world examples of how well those systems work, we can gradually overcome their fear of the unknown.

There is a concrete bill on the table in California right now, that has already passed the state senate, SB840, that would provide a universal, single-payer system for the state.

How about we put it over the top, and prove that it works in California. That way, we can vividly demonstrate that it can work in America.

Since the Democrats seem to be always so "afraid" of this or that, it is past time to make them afraid of not supporting single payer. That means those who fail to endorse it might as well go over to the Republicans and that - so far as we are concerned - this makes no difference.

This means "incremental solutions" are no solutions, and that "compromise" is a sell out. (Which accurately describes what is now happening. If incremental solutions were actually worth anything, we would already be at least halfway towards a solution by now.)

Wes Clark explicitly favors single payer, treats the incremental solutions as transition tools.

Howard Dean indicated he would sign a single payer bill in a New York minute, but didn't think it could pass Congress.

Others haven't sepped up to it, AFAIK.

I agree it can't pass, and I think there are viable transition strategies that substantially address the current underserved population.

I cannot think of a better issue with which to highlight what the Dems stand for and why our position represents a better choice. Sure, we care about people less fortunate than us, sure, we want to provide healthcare for the working poor, etc., etc. But the best reason to get behind single payer is that it benefits all of us, rich or poor, liberal or conservative, employed, self-employed or unemployed. By contrast, think of our current system as a tax on large employers and a restriction on the freedom of employees to change jobs or, heaven forbid, leave to start their own business. That's putting it in language that even Repub voters can understand.

I agree it can't pass, and I think there are viable transition strategies that substantially address the current underserved population.

Given that for several years, large majorities of the American public have supported it in survey after survey, I think it is timid to say that it can't pass. Surely, a transition period is needed, but there is no reason the transition plan can't be spelled out in a proposal that also lays out how the final system will work.

None of the points raised so far address any of the real fears concerning single payer or any government plan.

1. The existing government health care plans do not inspire trust and confidence. Take a look at the VA hospitals. Sure the top name one is good. In some of the others, patients represent lab animals for the doctors to play with.
2. How is health care going to be rationed? There is not enough money to pay for everything everyone needs let alone wants. Eventually some bureaucrat or politician will decide who gets treatment. Is it a lottery system (random)? Are we going to withhold treatment based on age or pre-existing condition (i.e. let people die)? Will there be preferential treatment for minorities (politics as usual)? This is big time politics. If you can’t answer this question stop now.
3. The government miss-spends tax revenue. Specifically the government takes tax revenue for social security and spends it on general fund items. What is to stop the government from doing exactly the same thing with a health insurance tax? It doesn’t help anyone already insured to pay a health care tax along with health insurance premiums like they are forced to do with Social Security (SS Tax and 401k/Retirment funds).

Call it the Healthcare Security and Simplification Act. Lots of commercials with "Larry and Denise" sitting at the kitchen table with a mountain of medical bills, insurance denials with cryptic codes, and dunning notices threatening bankruptcy, trying in vain to get through to the insurance co, and "Larry and Denise" worried about losing their jobs because of illness and then saying "I wish the Dem. proposal will come through before its too late".

james:

You're right. It's too hard, and the current system is too good. Let's just not bother trying to improve it.

what are the perceived failures of the British universal healthcare system as far as Americans are concerned?

Wealthy people, who want elective surgery in order to play golf or tennis, have to wait while poor people have surgery in order to go back to work. From what I understand it works that way in Canada, also. The selfishness of those with wealth and their media clout is why Americans think these systems do not work properly.

We have another single payor system in this country that works wonderfully. It is called the Military Healthcare system and Tricare. As retired Air Force member my family and I are covered by a system of healthcare that has never failed us. Tricare is made up of various insurance companies that all have to work by the same rules. This works, its overhead is as low as Medicare and we get good care.
I think it will be the AMA that fights this tooth and nail. At this time, an appendectomy can cost between $700.00 and $2400.00 depending on who does it. These designer physicians won't want a single payor or a single price.
Peter also brings up an excellent point, a single payor system will have to tackle end of life care issues. The majority of healthcare money is spent in the last month of your life.

Wealthy people, who want elective surgery in order to play golf or tennis, have to wait while poor people have surgery in order to go back to work.

That's not really it. If you have money, you can get anything done whenever you want (in the UK, I mean).

The knock is that
- your doctor has too many registered patients, and so can't see you when you'd like
- your GP has to refer you for any other problems, so you can't just book an appointment with a cardio guy if you feel a pain in your chest
- they try to avoid doing expensive tests, even if doing those early might save lives.

Now, which of those doesn't also sound like your HMO?

How is health care going to be rationed? There is not enough money to pay for everything everyone needs let alone wants.

James, what is wrong with rationing along the same lines as triage does? Those patients who are in the most life threatening conditions get treated first followed by those who's condition is less severe.

Eventually someone has to make a decision about who gets treated and how and under our present system it's still a bureaucrat that makes the decision. Whether s/he works in the government or at a private firm.

Given that for several years, large majorities of the American public have supported it in survey after survey, I think it is timid to say that it can't pass.

True, but the problem is that we don't have large majorities-- or any majority-- of American lawmakers willing to unapologetically & publicly support it, and the complaints of mere voters don't carry nearly as much weight for politicians as the threats by major contributors do. There are rank-and-file citizens who may or may not vote or pay attention to politics, and then there are important citizen-ish entities who have a helluva lot more money and pay attention to everything.

I think we should go for it anyway, because anything less is cowardly, but we probably shouldn't deceive ourselves that anything less than a tidal wave of unified public opinion will make things happen. There's a reason tbrosz & various other GOPers here like to taunt us about their side's political dominance, and it's not because their policies are actually popular among real voters, but because they have more of the super-citizens, i.e., funders. The real opposition is on that front.

By the way, the Yglesias post that Kevin links to is also worth reading, and isn't too long, for those with ADD.

There's a reason tbrosz & various other GOPers here like to taunt us about their side's political dominance

... it's because they're insecure little ninnies who are scared to death that someone might seriously consider the idea that there's a better way.

Cleek, I agree, but like most weaker sorts, they only speak up when they have a bigger bully to back them up.

The existing government health care plans do not inspire trust and confidence. Take a look at the VA hospitals. This is patently untrue. Reported in the Washington Post, for six years in a row, the VA outperforms the private sector.

http://healthypolicy.typepad.com/blog/2006/01/va_more_than_fi.html
How is health care going to be rationed? You mean its not being rationed right now? 45 million people don't even have access.

It doesn’t help anyone already insured to pay a health care tax along with health insurance premiums like they are forced to do with Social Security (SS Tax and 401k/Retirment funds). They wouldn't be paying private insurance premiums, so it wouldn't hurt. Also, the cost of medical care is inflated by having to pay for the uninsured.

No worries, Kev...Kilgore's seems to have his panties in a knot 'cause you dissed his pet progressive policy as 'feeble and ridiculous'...which it is. The only one being 'petulant' is Kilgore..and, well, kind of dumb:

PPI proposes one very simple idea...

Actually, it's more like seven ideas that sound simple, but are horribly complex to implement in the real world, if possible at all.

...making the federal employee health plan a national model...

Why not just get the Federal Government deal directly with health care providers instead of going through insurance companies as an intermediary? Then let those who wish to do so purchase supplemental health insurance, similar to Australia's system.

...but if the only definition of "universal health care" is to abolish private health insurance and cover everyone publicly...

But that's not the only definition, Ed. Stop thinking 'Canada' and look at a few other examples.

then obviously, anything short of that earns all those abusive adjectives.

'Wonkish' and 'abusive' are bad adjectives? I hear worse than that on my drive to work in the morning. Ed must be one of those overly sensitive types.

But I somehow missed the moment when single-payer became not only progressive orthodoxy, but the only way to achieve universal coverage.

Then Ed must have had a very long blink of the eye...Single payer has been shown to work; not flawlessly, but it does work.

...offered health care plans that would take the country pretty damn close to UHC without embracing a single-payer system at all...

And not a damn one could successfully explain how their plans worked. Here's single payer in a nutshell, Ed:

Everyone's covered, all the time. You can buy additional insurance if you want for additional service.

The devil is in the details, yes, but that will come across as a helluva lot clearer during a speech than 7 wordy, wonky talking points.

I'm not sure any of those plans could have been described in the seven points you consider so incredibly complex.

Who cares if they could have been?

Were they all compromising wimps?

During an election year? Quite possibly.

Did they all privately acknowledge that single-payer was the goal, and just cringe from saying it publicly?

During an election year? Quite possibly.

the big debate...is...about...the relative role of public and private insurance in getting there. That's a debate we have to have, and it's not advanced by those who deny there's anything to talk about.

IMHO, Kevin's argument is that we've pretty much debated this thing to death already...We won't get to universal coverage through some Rube Goldberg policymaking.

The stories I hear about poor healthcare in Canada have to do with waiting for surgeries. These stories come from winter tourists. What I think upper-middle class America fears is having to pay opportunity costs so that everyone else can have healthcare, too. They are correct; there are opportunity costs that will have to be paid by those who already have and can afford the kind of healthcare corporations provide for their best employees.

The existing government health care plans do not inspire trust and confidence. Take a look at the VA hospitals. Sure the top name one is good. In some of the others, patients represent lab animals for the doctors to play with.

The existing government healthcare plans, other than, in some proposals, Medicare, are not structured very much like any of the proposed universal plans.

How is health care going to be rationed?

There is no reason it couldn't be an entitlement program, with the only "rationing" being based on the reimbursement rates and the number of providers willing to provide covered services at those rates. Essentially, this is the same rationing system used in the private insurance system, only with profit taking at the level of the payment intermediary taken out.

The government miss-spends tax revenue. Specifically the government takes tax revenue for social security and spends it on general fund items.

That's not mispending, that's the whole overt declared of the SS tax hike of the 1980s, to "invest" the surplus in government debt, providing funds for current spending and avoiding current general tax increases, to be paid back out of general tax revenues.

What is to stop the government from doing exactly the same thing with a health insurance tax?

The simple way to avoid this being a problem is to fund it from general tax revenues, rather than a dedicated levy. Then the problem you raise becomes categorically impossible to arise.

It doesn’t help anyone already insured to pay a health care tax along with health insurance premiums like they are forced to do with Social Security (SS Tax and 401k/Retirment funds).

That's what people are forced to do now -- buy private insurance plus pay taxes to support Medicare, Medicaid, and other state and federal public health payment systems.

But not something that they would be forced to do under most universal models proposed, except the "mandatory, but sometimes subsidized, insurance" model.

Aris nails it -- Medicare for Everyone.

Beyond that, Single Payer Health Care misses the point, and is a sure fire loser. Why? Because it turns insurance companies into backs to the wall enemies, and even worse -- enemies with billions of dollars to oppose the shift.

Medicare for All can avoid this, with Medicare Basic for Everyone -- which can be expanded with Medicare Supplemental Insurance. Would this be as good as single payer? Probably not -- except that it is infinitely superior, because it can win. SPHC is a loser; Universal Medicare is a potential winner.

If Big Business (GM, WalMart) can be brought on board, UM is a sure fire winner.

but it's paid for by the government
No it's not, the government has no money. It's paid for by taxpayers.

All you're talking about is the mechanism that gets doctors paid. Do the users do it directly, do the users do it through insurance, or do the users do it through taxes.

You're arguing about how we pay our medical bills.

...and who doesn't enjoy a good crazed lemming fight?

Not as exciting as a crazed weasel fight, true, but still...

"Medicare for every American."

Medicare for 41 million Americans is running out of money already. I still haven't seen anyone roll out numbers on how the money is going to be effectively moved out of the existing system and into a Federal one. Not to mention real detailed numbers on health care costs around the world.

The assurances that single payer will be cheaper and more effective flies in the face of the history of every other large government program in history, including Medicare, which has far exceeded its predicted costs.

I go with Chrissy: the "Healthcare Security and Simplification Act."

Gotta get "security" in there to get the fearful peons to support it. Not that that's a BAD thing.

"Medicare" is too tainted by the drug coverage debacle.

1) Medicare for everyone is an excellent slogan.

2) Medicare is going backrupt now - thanks to that great bill that the administration passed. Without that bill, we still face a crisis, but later.

3) Notice how much the rhetoric against single payer is just asserting: a) governments don't work, and b) free markets always do. No facts, just government bad!

3) Kevin's comparison of existing single payer systems is a bit mis-leading: "But we have reality on our side: good single-payer systems (France, Sweden, the Netherlands, Germany — not Canada, Britain, or Italy)" Each one of those countries, even the "bad ones" has aggregate health care statistics that are better than the US. Longer life spans, lower infant mortality, etc.

And as a part Canadian, I can tell you that Canadians fear most the Canadian system becoming more "American". Even in that "failure" they consider ours worse.

4) There is no halfway measure on single payer. The largest problems of health care: adverse selection, excess paperwork, immense complexity just get worsened by any proposed in between system. The rest of the industrialized world has moved to single payer, because that's the model that works. And so should we.

Kevin

Your point about Democrats overtly supporting a universal, single payer plan is well made. But I take issue with one statement in this post -- "Rich people can continue to pay for service that's not covered by the government, of course."

It's not just rich people who will opt out of any public universal system. Look at public and private education -- there are lots of people of modest or less-than-modest means who send their kids to private schools and are willing to pay a much higher percentage of their income to do so because of the perceived better quality of education their children receive.

In a single-payer, there is likely to be all sorts of people -- rich and poor -- who will seek care outside the existing payment system, simply because they value healthcare more than other things.

No it's not, the government has no money. It's paid for by taxpayers.

Yes it is CN, once money has legally changed hands it becomes the recipients property.

Unless your arguing that the Federal government can own nothing and then we've got a lot of Armed Force's equipment that suddenly up for grabs.

Oh and Tbrosz, as far as predictions of Medicaid's costs, who made these predictions? At what period of time were they made? For what time period were they made for?

Clarify and you might have a point. Otherwise, there are so many unanswered assumptions in that assertion of yours to render it meaningless.

No it's not, the government has no money. It's paid for by taxpayers.

you mean the same way my employer has no money, and my salary is paid by my employer's customers?

just like i have no money and everything i buy is paid for by my employer's customers?

The assurances that single payer will be cheaper and more effective flies in the face of the history of every other large government program in history, including Medicare, which has far exceeded its predicted costs.

tbrosz, dishonest as ever, omits the uncomfortable fact that single payer will be cheaper and more effective than our current hodgepodge system in order to assert his faith that

A patchwork of private insurance providers creates a massive cost burden, leaving aside the costs of the middleman's profit. (Of course, it goes without saying that one's health care is already determined by a faceless bureaucrat, but one with a profit motive for denying care!) Too, the pool of uninsured Americans who seek treatment in ERs add to the cost.

I could go on, but tbrosz is intelligent enough to know all this. Of course, he's dishonest enough to pretend not to in order to make his assertions under his currently fashionable pose of cynicism.

As to how to pay for it, of course, Bush's tax cuts would have to go, to return us to the onerous tax burdens (not!) of the Clinton era. Of that fact tbrosz is well aware, and that explains his opposition.

We've got the most expensive health care system in the world. We could take model a replacement on the most egregious European style "failure" and still come out cheaper and expect a longer lived constituency.

QED. Americans are insane.

I go with Chrissy: the "Healthcare Security and Simplification Act."

How about "Health Security and Freedom Act"; I think "freedom" is a good word, and captures both the choice benefits of not being tied into one insurer's network and the streamlining that "simplification" alludes to.

No it's not, the government has no money.

Really, so who creates, prints, and distributes all those pieces of paper?

Fiat money is a pure product of government.

I think ABC has finally come up with a solution to health care in America. When a health disaster comes up, bring in the film crew, document the assistance, allow TV viewers to cry with the family and have the advertisers pick up the medical costs. The problem is that there are so many health disasters in this country with no insurance that the viewers will become too saturated with the stories and lose interest.

"in order to assert his faith that the program should be opposed," sorry.

Clarity and boldness is exactly the right Democratic program. To single-payer healthcare you could add, among other measures: withdrawal from Iraq by a date certain; a simpified tax code that renewed graduated taxation that soaked the rich; defict reduction; robust consumer, workplace (think mines) and environmental protections, and a commitment to phase out fossil fuels in favor of renewable energy.
Put a program like this before the public, KISS, and sell it. It will be much harder for GOP divisive demagoguery and slander to carry the day if Democrats can give voters a choice they cannot possibly misundertand.

I have a, uh, compromise, between the do-it-all and incrementalists:

Start. With. The. Kids.

If you're under 18 your basic health care plan is provided by the government. Period. People can buy add-ons for Biff and Buffy, but kids all get a card and it's paid for out of everybody's taxes.

When you turn 18 you're on your own. For now.

So it's a single-payer plan that's taken its second incremental step. We got Medicare for the old, now we have MediKid for the young. Eventually everybody in the middle will demand it.

Oh, as somebody pointed out: it's the third incremental step, as we have single payer for the military including veterans.

This Healthplan is a Production of

UNIVERSAL MEDICARE

I think we have a winner.

I *love* MediKid.

I have a, uh, compromise, between the do-it-all and incrementalists:

Start. With. The. Kids.

That's the most common incrementalist position I've seen, not a compromise between the do it alls and the incrementalists.

That being said, I don't see why the people whose position has the support of 60%+ of the American public need to compromise.

Give em hell, Kevin! This is one thread for which you have my wholehearted support.

EmmaAnne: I *love* MediKid.

Nah. I vote for:

The Marx/Engels/Lenin/Trotsky/Stalin/Mao Memorial Destroy Capitalism and Freedom and Bankrupt the Country People's Health Care System.

Is time on our side? As the health "insurance" industry gets bigger, doesn't that mean a large amount of money aligned against us?

Clarify and you might have a point
I did, try reading the whole comment. You and I are going to pay for health care whether we pay the doctor, pay the insurance company, or pay the government.

I hate people saying that "the government" will pay for something. Taxpayers pay for it.

Three points:

1) This might be an unusually good time to try this because insurance companies as a class are even more disliked than usual, given the well-publicized problems people have had with them since Katrina.

2) I don't think rationing needs to be dealt with immediately. Remember that the most-expensive, end-of-life care is mostly already paid for by Medicare. Changing to a single-payer system should save huge gobs of money, so there is no reason to think we would need any kind of stringent rationing in the near-term. It may well be a problem eventually, but it would have to be dealt with in the current system too.

3)"Medicare for all" is simple and easy for people to understand (or think that they understand). That kind of clarity is probably essential.

conspiracy nut on March 7, 2006 at 5:37 PM:

You and I are going to pay for health care whether we pay the doctor, pay the insurance company, or pay the government.

In your opinion, then, which of the three ways you've mentioned is the optimal way to pay for health insurance? Why?

tbrosz: The assurances that single payer will be cheaper and more effective flies in the face of the history of every other large government program in history, including Medicare, which has far exceeded its predicted costs.

Of course! The old "government doesn't work" wingnut talking point. The response ought to be simple: "Since the Republicans took total control of government, no program has worked and every program has far exceeded its predicted costs."

Of course! The old "government doesn't work" wingnut talking point. The response ought to be simple: "Since the Republicans took total control of government, no program has worked and every program has far exceeded its predicted costs."

As P.J. O'Rourke said, Aris, the Republicans claim that government doesn't work, then get elected and prove it.

I hate people saying that "the government" will pay for something.

c.n., your aversion to reality is a matter of record.

In your opinion, then, which of the three ways you've mentioned is the optimal way to pay for health insurance? Why?
The first. The problem with health care costs is not how we pay for those costs, the problem is the costs are high. Arguing over how we pay for rising costs does not address the fact that costs are rising.

As for why I like the first.
- Consumers of health care have incentive to keep health care costs down. I trust this is self-evident.
- Insurance companies have no incentive to keep health care costs down. They aren't paying for it. They get "paid" by the movement of money through their system. The more money that moves through, the more they make.
- The government also has no incentive to keep health care costs down. They aren't paying for it either. The more money that moves through, the more power they have. And government is in the business of more government, so this is good for them.

I think O'Roarke was stealing from someone else when he wrote this (but I don't have the book at hand to check the original on this). There are 4 ways to spend money.
1) Spend your money on you.
2) Spend someone elses money on you.
3) Spend your money on someone else.
4) Spend someone else's money on someone else.
With option 1, you care about both the cost and value of goods/services. With option 2 you do not care about the cost, but you do care about the goods/services. With option 3 you care about the cost, but you don't care about the goods/services. With option 4 you do not care about either the cost or the goods/services.

Almost all government spending falls under option 4. The best cost/benefit decisions are made under option 1. Put the buying decision in the hands of the user. Do not mask the cost of health care through insurance or taxes. Good decisions cannot be made that way.

You will say this is expensive, but here's your clue: it's already expensive. We are already paying for health care costs. You are merely arguing over how we pay for them.

Out-of-pocket medical costs are not going up, but insurance costs are skyrocketing. Let me rephrase that: The portion of health care costs that users see are stable, the portion of health care costs the user does not see are skyrocketing.

So to conclude (have I gone on long enough yet?), putting the buying decision in the hands of the consumer is how to best control costs. And when costs are controlled the service is accessible to a wider range of people. The alternative is to allow medical costs to continue to skyrocket and change the way we ration from market based to political football. But unless costs are controlled, rationing increases; regardless of the method of rationing.

I think we should start the campaign right now and right here. How about some of the commercials suggested up thread. Play them in states with real contests. Don't give Talent, DeWine and the rest a chance to breath. Don't give Rove a chance to make this election about Roe v. Wade. By the way, if you haven't figured it out, that is exactly what the South Dakota Legislature is really trying to accomplish.

The assurances that single payer will be cheaper and more effective flies in the face of the history of every other large government program in history

Except, you know, public healthcare in the rest of the developed world, which is, indeed, less expensive for better results.

Why, tbrosz, do you hate Americans so badly as to claim that they are uniquely incapable among all advanced nations of providing effective, efficient public healthcare?

conspiracy nut at 6:07 PM has absolutely nothing to say except to regurgitate right-wing dogma, and incoherently at that.

Damn Secular, I yeild to your well thought out defense of socialized medicine! Good job.

conspiracy nut at 6:07 PM has absolutely nothing to say except to regurgitate right-wing dogma, and incoherently at that.

While accurate, I'd recommend striking "at 6:07 PM" from this sentence.

The fundamental disconnect here is that what the consumer pays and what the consumer receives are unrelated. The only real, long-term way to control health costs is to give the consumer (the citizen) the responsibility for spending the money.

I am certainly not saying our current system does not have huge problems -- it does -- but a government system removes personal incentives for making the hard decisions. The costs will explode, even if we manage to obscure the money trail.

And in the defense of conspriacy nut -- government does not produce wealth. It can't. It can only extract it from those who do produce wealth.

The difference between a private insurer and the government is that in the case of the former, your handing over of $$ is voluntary and you can choose a different company if you are unsatisfied. With government, you are in the system and you pay for it, regardless of whether you want to.

The only way to sell this is to present it to citizens as something-for-nothing. You may well succeed, but I hope we are smarter than that.

The assurances that single payer will be cheaper and more effective flies in the face of the history of every other large government program in history

Is it possible to sign your paycheck with a 3" housepainting brush?

Is it possible to understand the world all you can think of are childrens cartoons and fairy-tales?

And in the defense of conspriacy nut
You don't need to do that Matt, they all love me here.

As an American who has been living in Germany for 12 years, I thought it would be helpful to the discussion to explain how health insurance works here. (With the caveat that I'm no expert, just a customer!)

The bulk of the population is covered by the public health insurance, while a small minority made up of high-income earners, the self-employed, and civil servants can opt out and purchase private insurance. There are several dozen insurance providers who make up the system, and one is mostly free to choose between them (some are regional). They all cover the same procedures, but some cover special therapies like acupuncture as well. Coverage includes medical, dental, vision, and drugs for the member and his/her dependents.

For workers, the premiums are automatically deducted from the paycheck. The rate is calculated as a percentage of gross salary, and it averages about 14% (varies according to provider). The payment is split equally between employer and employee, so what a worker sees is a 7% deduction from salary. Insurance for the unemployed and disabled, I think, is paid by some sort of public fund, but they go through the same providers like everyone else.

Physicians can be selected freely. A transfer from the family doctor is necessary to see specialists. A €10 per quarter copay has been instituted to reduce abuse of the system. For adults there is also a small copay for drugs.

I'm very impressed by the system here. The overall care is very good and is easily accessible. My step-father in the States is a doctor, and I see the chaos of all the different forms and payment methods and how much time that all costs. Here everyone has their smart card with all their insurance data stored on it, and this gets read into the doctor's computer system for billing any services and prescriptions.

And in the defense of conspriacy nut -- government does not produce wealth. It can't. It can only extract it from those who do produce wealth.

This is incorrect almost any way you slice it. One one level, government does not exist separate from people, some of whom, in their actions as part of government, are, in fact, making wealth by any reasonable definition.

On another level, the existence of government certainly is a precondition and contributing factor to many forms of wealth creation; indeed, its arguable that one of the principle functions of government is to provide coercive collective enforcement of property rights to provide incentives for the creation of stocks of wealth which it would be in no ones interest to create without the security provided by such coercive collective enforcement. That wealth is, therefore, quite naturally attributable to government, and it is quite right that those who most benefit from the security provided and the stocks of wealth enabled by government should compensate those whose cooperation in that collective project is not so richly rewarded.

The "government does not create wealth" meme is empty-headed nonsense.

And in the defense of conspriacy nut -- government does not produce wealth. It can't. It can only extract it from those who do produce wealth.

Of course gov't can produce wealth. Any entity can produce wealth if it can mobilize people to produce anything!

The gov't built the interstate highway system. That's one tiny example. Public education is wealth. Intellectual capital.

Sweep the bromides out of your brain.

Thanks, cmdicely, for making the point more thoroughly and thoughtfully.

To repeat a point frequently made by many folks: There is no possibility of a 'free market' without vigorous gov't.

Sparks, appreciate your cogent description. No doubt that our system is too complicated now.

There are great incentives for reducing the compleixity of our current system, but government ain't it. A much better solution for the US is to create incentives for this simplification, and that means allowing the health care providers to make it worthwhile. In California, I believe that Kaiser is investing somewhere around $3B in a new records system.

And, with due respect, the unemployment rate in Germany is twice what it is in the US. A welfare-based system has big social costs. It is a trade-off.

Also, again with due respect, the vast majority (but not all) of medical advances come from here in the states, attributable to our for-profit system. If we socialize it, those incentives are greatly reduced and the R&D budgets shrink in proportion. Are we willing to weigh those costs as well?

cmdicely, you are right that government can create structures that allow wealth to be produced. Property rights is a great example.

You are right that it is a necessary precondition. Absolutely. Again, though, a government does not create wealth. The highway system was created with tax money, which came from workers producing value. You can argue that the highway system was a good investment that paid off -- fair enough. But that is redistribution, not creation.

And regarding education, we have two systems in this country. One (K-12) is government run, expensive, and middling at best. The second (the university system) is probably 80% private and is the envy of the world. Which model do you prefer?

indeed, its arguable that one of the principle functions of government is to provide coercive collective enforcement of property rights to provide incentives for the creation of stocks of wealth which it would be in no ones interest to create without the security provided by such coercive collective enforcement.

It never ceases to amaze me that the loony libertarian / right-wing antigovernment cranks are ignorant of the political philosophy of Thomas Hobbes, whose treatise on this subject has been influential since the 17th Century.

But then, I suppose they'd then have to acknowledge the existence of a social contract, so they just sort of mentally edit it out and skip right to Ayn Rand.

Kevin still ignores two undeniable facts. One, that one of the Democrats' most important constituencies is the retired middle class who have been conditioned for four decades to believe the the rationing of health care services is a phenomena that other citizens should be subject to more than they, and, two, all of the systems that kevin provides as superior examples ration more severely to middle class retirees.

There is no better place than the U.S. to be a
middle class obese retiree with severe arthritis, or a heart condition, or diabetes, to say nothing of having a combination of all three afflictions. There is no better place for a retiree who desires, or whose family desires, that no expense be spared for extending life as long as possible. Democrats created this constituency, and this constituency is the biggest political obstacle to what Democrats like Kevin now want.

Kevin seems to think that this fundamental political reality can be ignored, or made irrelevant. He is incorrect.

Again, though, a government does not create wealth. The highway system was created with tax money, which came from workers producing value.

By that argument, capitalists don't produce value either, but I'm sure that isn't the point you intended to make.

Cue conspiracy nut's quaint obsession with Communism...

Matt, the reasons for the high unemployment in Germany are very complex and have little or nothing to do with the health insurance system (that I'm aware of) and a lot to do with problems integrating the former socialist states. I live in southwest Germany where we have have an unemployment rate of about 5%!

A much better solution for the US is to create incentives for this simplification, and that means allowing the health care providers to make it worthwhile.

Again, though, a government does not create wealth.

You are simply making an assertion, and a false one.

First of all, 'wealth' is simply 'anything of value.' Gov't adds value in countless ways.

You say "tax dollars financed the interstate highway system." Sure they did. But the dollars themselves are an artifact of government.

There is no reliable financial system without gov't. Dollars don't just serve as a proxy for wealth, they are a form of wealth. The highway system is not just itself a form of national wealth, it is also, as you suggested, a highly effective investment which facilitates the creation of additional wealth.

If a human being can create wealth, then an organization of human beings can create wealth. It can be a private organization or it can be a public organization. No big whoop.

Sparks, how does the incorporation of formerly socialist states affect the French unemployment rate, wh