The noise machine can make a lot of people hate guppies, groats, or hat racks. What chance does a sensible health care program have?

It's going to take a presidential candidate who can offer a reasonable vision of national health care and then run with that mandate when he's elected.

Back when the Harry and Louise ads were running, the big scare-the-rubes line was "I don't want some faceless bureaucrat maknig decisions about my healthcare!" I was always astounded that Clinton and the rest of those pushing for expanded healthcare did not simply point out the obvious:

You already have a faceless bureaucrat makng decision about your healthcare--and that bureacrat makes those decisions solely on how it effects his employer's bottom line.

Today, if we want to get public opinion behind single-payer, I believe we MUST remind and inform the public that the current system decides your health (and perhaps survival) based on the profit motive. Single-payer would fix that.

One other theme that I think people will react to very positively is that no one wants to become a health care expert themselves they just want to go to a doctor and be taken care of until they are well.

Bush and the Republicans want us all to become health care comparison shoppers and pricing experts. Who has the time for that crap? Imagine the health care knowledge needed by a family in Bush's brave new world of "ownership". How much should we put away in our special health savings account this year? How much are we going to spend on the two kids? How much do we need for regular bills? Are we going to need glasses this year? Should I finally get that shoulder surgery I need?

Let's project it all out on a spreadsheet and try to determine how much we should put of our income into health. Assuming we have any money left let's also allocate all of our retirement money into our 401k, our IRA, and our various education accounts. Better set up a database as the spreadsheet is becoming unwieldy.

Now, which stocks and which mutual funds should I pick so that I can retire in a world where Social Security has been reduced, retirement ages have been extended, and lifespans are longer.

Frankly I don't want to become experts in all these things. What I want is to belong to a community where everyone gets health care and everyone gets taken care of when they are old. I don't want to become an expert in stocks, bonds, and medicine to do that.

Neither does anyone else in America who has a million better things to do.

How about focusing on the Republicans' alternatives? They believe the problem is people are getting too much health care already, so we need to discourage them from going to the doctor so much, as well as force them to shop around to get the best price when they're diagnosed with cancer. Doesn't that sound fun?

The waiting lines for hip replacements are due to a number of things, none of which have anything to do with the single payer system in Canada.

First of all, there is a finite number of orthopedic surgeons, partly due to the fact that its the privately run medical associations who get to accredit such specialists and like to keep the competition to a minimum.

More importantly, however, hip replacements have a limited lifespan; it isn't a case of have the surgery and you're fixed for life. Having the procedure before it's absolutely necessary actually can lead to worse problems later on.

When my father had his heart attack last year he was treated immediately, at no cost to him or his family.

When my mother was diagnosed with colon cancer last year she had her surgery a week later, spent a week in a private hospital room and had daily visits from a home care nurse for a month and a half after that. Didn't cost us a penny. No one asked how we would be paying for any of this, no bills were sent, my parents don't have to worry about losing their coverage or seeing insurance premiums go up, or having to mortgage the house to pay for their health.

Yeah, it sure is hell here in socialist Canuckistan....

What's needed is something that every American can readily relate to: a television special on universal health care.

The movers and shakers in the liberal/progressive media need to pony up and pool resources to produce a television documentary/series that seriously examines the issue, provides clear evidence of how universal health insurance mechanisms work in other countries, and demonstrates unambiguously how inefficient and broken our system is...

I know, I know...pipe dream.

Single Payer health care!

Al Gore's time has come then - time to run for President again.

Al Gore was NOT for the Iraq war know full well it would be a big mistake - was for single payer health insurance and REAL renewable energy sources. Al should run for president again however I'm quite sure Feingold would freak out if that happened.

Al Gore held so much promise for a better American - wish he'd run again. Surely Americans are alot more dispose to take a real hard look as his policies this time around as oppose to his attire.

Kevin,

Tom Brosz is a very busy person - Could you simply spare him the time of posting, by including a synopsis of his anti-universal health care with all the non-pertinent links attached? - At the bottom of your thread, you could simply say, please refer to TB's following rebuttal.

To be "fair and balanced" of course.

I fail to understand why anyone would want either a car company or the government to be master of his medical* care. It's called the veterinary model of medicine, whereby the payer determines not only how much will be paid, but also what kind of medical care the "pet" will get. To whom is your medical care more important--you or your government (just imagine what would happen with another W in charge!) or a corporation? If you think you can't afford it, then why do you think the government can afford it? If you think it's too complicated to make medical decisions, then you deserve to be a "pet." Homeownership is more expensive & almost as complicated, but we manage to do that just fine.
*Always use the word "medical" instead of "health." Heath is much more a function of genetics & lifestyle than of medicine. Turning our "health" over to the medical mafia gives them even more power over us than they already have.

Incremental steps work best. Or baby steps are better words. First step should be for single payer medical-child-care (need a better name here). The rest of us can wait.

How about ads which make the point that all Americans deserve the same kind of healthcare that their elected US representatives receive. That seems like an easy sell.

Kevin - How about telling the public how much you want to raise their taxes?

I bristle every time I read cavalier, tossed-off comments like "every time your HR department decides to switch to a cheaper health plan." Thanks, but as someone in HR, if you're company's large enough to have this dilemma, chances are this is a decision for Compensation and Benefits staff, not traditional HR (although we are all part of an administrative group, there is a difference... is all I'm saying).

But never mind the semantics, thanks for making it sound as though there's some arbitrary (although I cringed happily watching them suggest just that this week on The Office) consideration set. These decisions are complex, especially for companies doing business in several states, and have to take into account what the Insurer/Plan manager is charging the company, what kinds of benefits are included and not and how to keep costs reasonable for everyone involved. "Cheaper"? Maybe; more likely, a plan with simnilar costs to the previous year with fewer benefits and services (and probably more automation and less choice), because prices for those services are increasing faster than almost anything else in the economy.

We didn't get here exactly by accident, or by arbitrary decisions in some vacuum. It's unfair, and unwise, to make the fairly decent people who try to manage these health plans into the enemy - they're just as concerned, if not more, about how health care is administered in this country, and in a better position than most to draw some conclusions about what's realistically possible and in what time frame.

I agree, there's a massive PR job that needs to happen to educate the public, first to explain what the problems are, and then to elaborate on possible solutions, including a single payer model. I think the lefty blogosphere's biggest challenge is not rushing around trying to solve all of this by the November elections; that just ain't happening. If we're lucky, maybe a few races will have more healthcare discussions, but nationalizing it too soon is risky. I think it would be easy to try and identify some handy bad-guy bogeyman as a pinch strategy, but the truth is there are plenty of them, and at the same time none of them. The saddest part really is that everyone is trying, within these narrow, conflicted, problematic parameters to help people. And they're all part of the problem as well as part of the solution. Demonization is a cheap substitute for actually dealing with a complex issue in a thoughtful way.

Ad campaigns:

Ad Number 1: image of a doctor talking on the phone, shuffling papers on his desk. Voice over: "do you want insurance companies telling your doctor how to treat you?" It's short, truthful and to the point.

Ad Number 2: Canadians like A Hermit above telling their story, sitting at a kitchen table with a cup of coffee.

Ad Number 3: Americans telling a story of getting cancer, losing their job, going bankrupt, and saying, "healthcare savings accounts didn't do a damn thing to help me when I had no health insurance."

Ad Number 4: a round table of talking heads discussing single payer health care. The pro single payer says, "right now, we have a system where insurance executives, hospital administrators and pharmaceutical CEO's earn millions, while we have 45 million uninsured"; camera then gives a close up of an impeccably groomed, sleek executive at the table looking shifty, then saying something like "c'mon, you can't be serious! If you have single payer healthcare what would happen to us?"

I'm sure creative minds on this blog can come up with a lot better than I can...

What's needed is something that every American can readily relate to: a television special on universal health care.Posted by: Wonderin on March 25, 2006 at 11:44 AM | PERMALINK

Actually Wonderin has a good point. If we leave this subject matter to the 30 second sound byte, someone with a vested interest in keeping the status quo will come up with a killer.

What this will take is a truly informative TV special, preferrably produced by a group with established credibility. The truths about what is really going on now within the health insurance industry, within the care-giving profession, and the money and politics driving it all. Only after the blinding light of day is shining on the subject as it really is, will the general public understand that there are better choices that can be made.

Pick up on the theme in the recent Krugman piece: because employers cannot continue to foot the bill, because the bill is only going to grow, because including everybody in the coverage pool is so damned inefficient, single-payer is inevitable. It will come, it's the only feasible route to take. The sooner the better, why not now?
Attack the notion we have the best system in the world--tell people their experience shows otherwise. Each of the three weaknesses I list is experentially validated everyday. There's got to be a better way--and there is, it's coming, the only question is when.

Guys, we're not talking about drilling for oil on the moon-
there is a single payer health care system in this country, its called Medicare. We just want to lower the age of eligibility.

I am all for Universal Health Care etc., but why is it necessary for the Dems to endlessly search for new issues when the winning issues are already there in front of them?

Mendacity, incompetence, lawlessness, and immorality of the Bush administration.

If they cannot win on that, all efforts to find other strategies are doomed to utter failure, not only in November 2006 but for a generation to come.

At least this voter will never vote for democrats again.

Here is how you spin it .. more people get money out of their paychecks to pay for health insurance probably 150 to 500 a month.. since employees are shifting cost to employees.

Someone needs to do the math-- basically would the average work trade that health payment taken out of their check everymonth for a 5% tax on earnings to guarentee they ALWAYS will have healthcare whether they are at the job or not.

Another argument is that healthcare traps a worker at a job.. which stiffles people from fulfilling their potential . i am sure there are many people in this country who thought about starting own businesses but didn't do it because of losing health insurance.

I do think US would probably have to start with baby steps . Kerry had the right idea first you give health insurance to every child under 18 in US. Then you expand it to pregenant mothers etc..
as soon as people with kids realize that single payer for children is a great thing you can sell them on the rest

I think Kevin is on to something with the public opinion polls, but, if we rely on Kingdon's conception of the policy window, then that is only one, maybe two, of the three streams that are needed to pass new, innovative policy. I think it is clear to everyone that there is a health care problem, though what kind of problem this is is unclear (thus we can't claim to have a good handle on the problem stream). With regards to the political stream, that, I think, is where we can use polling data to suggest that there is some evidence that it is moving towards universal healthcare. The biggest hurdle, and I know that many in the blogosphere don't really want to hear it, is that "universal healthcare" is not a policy alternative. Universal healthcare is a panapoly of policy alternatives out of which proponents need to coalesce around a single alternative that can be acceptible to most of the American public. This isn't a simple, or quick debate, but a long drag out debate pitting moderate Democrats against liberal Democrats and exacerbating many of the tensions that already exist in the Democratic party.

I fail to understand why anyone would want either a car company or the government to be master of his medical* care. It's called the veterinary model of medicine, whereby the payer determines not only how much will be paid, but also what kind of medical care the "pet" will get. To whom is your medical care more important--you or your government (just imagine what would happen with another W in charge!) or a corporation? If you think you can't afford it, then why do you think the government can afford it? If you think it's too complicated to make medical decisions, then you deserve to be a "pet." Homeownership is more expensive & almost as complicated, but we manage to do that just fine.

I fail to understand why anyone would want the government to be master of his personal protection. It's called the veterinary model of security, whereby the payer determines not only how much will be paid, but also what kind of protection the "pet" will get. To whom is your personal safety more important--you or your government (just imagine what would happen with another W in charge!) or a corporation? If you think you can't afford it, then why do you think the government can afford it? If you think it's too complicated to make personal security decisions, then you deserve to be a "pet." Homeownership is more expensive & almost as complicated, but we manage to do that just fine.

We should, therefore, eliminate the police department, and the military, and simply make each individual citizen responsible for protecting themselves. After all, I don't want some faceless bureaucrat telling me how I am and am not allowed to protect my family, or that I shouldn't be allowed to buy a tank or a flame-thrower....

Or we could come to our senses and realize that, since we live in a society, there are some things that are easier and more efficient to by spreading out the risks and costs among society as a whole.

In Vermont, the Progressive Party started making a ruckus to have state-wide universal coverage in 2004, and the Democrats followed suit. A slogan the Dems here talk about using (though I haven't yet seen it in the press) is "Everybody pays, everybody is covered."

How much to you want to raise everyone's taxes?

Speaking as someone who pays for his own insurance, I'd say you can jack those taxes pretty fucking high and I'd still come out better. With the plan I have right now, I'm paying more than $6,000 a year in premiums and have a $12,000 deductible. So in my case, you could hit me with an additional $5,000 in taxes and I'd still come out ahead.

If I or my wife get seriously ill, you can bump my taxes up by an additional $15,000 per year and I'm still better off.

We already have universal single payer government sponsered health care. It is called Medicare. Everyone age 65 and older is covered by it.

This saves employers tons of money cause this group is the group with the highest health care cost. So anything provided by them becomes mearly supplemental to Medicare.

Drop the qualifying age down to 55. Raise payroll taxes a bit but not as much as the drop in premiums and you have a constituancy that can not be beaten.

Then just keep lowering the qualifying age for Medicare, until over time, everyone is covered.

It is as simple as that.

Why wait till you are 65 to have the benefits of the best, most effecient and most popular health benefit plan in the world?

Medicare is yours right now if we just lower the qualifying age to 55, or 45, or 35, or whatever it takes to bring you in.

You will never have to worry about doing without good health coverage ever again.

Give us your poor, your tired, your huddled masses yearning to breathe free.

No seriously. We will work them to death with no benefits. It's no problem--glad to do it!

Got to get back to church.

V/R
GOP

Here is a fine example of Hospital care in America
Alleged Skid Row Dumping Is Captured on Videotape
A patient released from a Kaiser hospital is shown wandering outside a downtown L.A. rescue mission.
By Cara Mia DiMassa, Times Staff Writer
March 23, 2006
Authorities on Wednesday released a videotape of what they say is the dumping of a 63-year-old patient from Kaiser Permanente's Bellflower hospital in gown and slippers onto the streets of skid row, eliciting an apology from hospital officials.
The videotape, recorded Monday afternoon, shows a taxicab making a U-turn and then driving out of camera view. A few seconds later, Carol Ann Reyes appears from the direction of the cab, wandering for about three minutes in busy San Pedro Street and then on the sidewalk before a Union Rescue Mission staff member escorts her inside the nearby building.
Isn't the American system of for-profit health care wonderful? It's, like, paradise to Libertarians.

I agree with you, Kevin. And if you took this on and became the single-issue blogger for single-payor health insurance, you would be my hero. Seriously. You can do it. As Somerby says, you are a superb wonk(er?).

I won't even close this comment with a snark.

"A car company should be a car company, not a healthcare supplier."

Be careful what you argue, because when you convince people of this, the next sentence out of Bush's speechwriters' pens in "Our Health Savings Accounts fixes that!"

Mike: the answer to this problem is very, very clear. Prosecute the Hell out of whoever video-taped the dumping. SOBs.

Oops! Late for church. We're handing out sample ballots.

V/R
GOP

Kevin-
I don't agree that your suggestions would be effective marketing points. The first is, sadly, probably too wonky and won't really hit home. As for the second, I just don't think pointing out over and over that France is better than the US (in anything) will go over well with most folks.

We need to sell UH in the most traditionally American manner possible- it's all about freedom.
Freedom to choose your doctor, freedom to move and not lose coverage, freedom to change jobs and not lose coverage, freedom to start your own business and not lose coverage, freedom to work part-time in order to go back to school and get a Master's degree, etc. Personal freedom. Universal Healthcare will _Liberate_ ordinary Americans. This is attractive stuff.

I think something needs to be done to inform the ignorant that in every industrialized nation with single-payer, the individual pays less, and gets more, healthcare services than in the US. Perhaps a series of ads featuring attractive healthy-looking people with charming accents describing how their darling aged mother's cancer was treated (with adorable grannie featured sitting in her comfy living room nodding agreeably).

Somehow the point needs to be hammered home that other countries have it better than us. We need to appeal to the competitive, 'we're better than everybody else' American instinct.

The Prairie Angel

I've said it before and I'll say it again: by far the most convincing argument for single payer health care with the American public is to pound on the example of Medicare.

Medicare is, to begin with, comfortably American. Moreover, it's a great popular success. I personally don't know of anyone who is covered by it who's unhappy with it. Simply suggest that the American people ask the seniors they know whether Medicare has worked for them (prescription coverage aside -- which is of course really much more of an example of the mess induced by NON single payer).

single payer, and screw all that stuff about baby steps, go for the whole enchilada. baby steps are how you fight 500 battles instead of one and get nibbled to death by ducks.

no worries about "do I qualify?", "will I lose it if I get laid off?", "will I lose it if I get fired?", "will I be able to get it at all?", "if I change jobs will I get screwed?", "I'm 50, how much will it cost me if I'm out of work and have to pay for it myself?", and so on. everybody in america either has starred in a horror story themselves or knows someone who has, why would this be a hard sell? there are only three classes of people here who don't worry about health care: the very rich, the young and healthy, and the idiots.

Just to follow up a bit on my post:

The chaos of the Republican Prescription Drug Coverage plan provides a perfect opportunity to argue for single payer: that plan demonstrates very convincingly what would happen if something OTHER than single payer were to take over.

In short, the message should be:

Medicare: single payer.

Prescription Drug coverage: non-centralized "choice" plans.

I think we need right wing "balancing" to counter this Jesus bible blogging stuff. You'll note that Kevin doesn't have a Lucifer "Red State" presence when he mentions health care reform, the environment, or ending the war.

Too many Americans are buying into helping thy neighbor and the sick. Without rebuttal!

Oops--thought this was the WashingtonPost.com

I think trying to educate the American public about the advantages of single payer (Kevin's second strategy) is going to be an uphill fight. The fear-mongers have way too long a head start. Moreover, although there are lots of Americans who find their health insurance situation increasingly dissatisfactory, there are still lots of folks who are quite content.

Far easier, unfortunately, to use fear to our advantage. LOTS of people are rightly apprehensive because of the lack of security in American life these days, and the very real possibility that they're a pink slip away from having serious difficulty paying their bills, hanging on to their house, etc.

So, the best way to get support for UHC over the top would be to keep it real simple, and use this justified fear as a tool. The stance of advocates of UHC should be something along the lines of:

Nobody should lack healthcare just because they've been laid off, or they can't afford health insurance. So, America should enact legislation making it ILLEGAL and IMPOSSIBLE for anyone to lose healthcare coverage, or to lack healthcare coverage for any reason at all.

Turn it into a personal responsibility issue. When an uninsured person gets ill they receive medical treatment which they can't pay; that means that the costs are passed on to all of us. Everyone - employers and employees - should help shoulder the burden of health care costs: affordable premiums, but no free rides.

The beauty of this approach is that it's a sort of political aikido; the right-wing catchwords and phrases are turned against them. Yeah, it can be rebutted, but not in any sort of brief, simple way.

First, I think most people don't have any idea how many of their neighbors and friends probably don't have health insurance (I just found out that one of my best friends - self employed - hasn't had it in over 15 years). I've been trying to think of a way to change that. To give people a chance to learn just how widespread and horrible the problem is.

A couple of days ago I tracked down the census reports and data on the Uninsured and where they live (by state and county). Here is the link (the data files are in the bottom half of the page). It's pretty interesting. Texas and much of the west is practically black with uninsured, while the North East has many fewer uninsured (link to the map).

My idea (and I'm willing - eager for suggestions) is to make a document that says how many people are uninsured in my state and county (In Tabloid-style shocking language). With Ask your Elected representatives what they plan to do about this problem. And contact information for each official from the Federal, State & Local levels (for that neighborhood). Also contact information for me in case they want to do this too. Oh, and links to that census page.

And just spend a couple of hours a week leafletting the neighborhoods around my house.

Senator Kennedy in his recent book said that he'd failed to convince his fellow Senators of the importance of this issue. So, I think it's time that we let his fellow Senators know how important it is to us!

(does this make sense?)

How 'bout the New England of Medicine that concluded that bad health care was not limited to the poor, but that all of us received about the same level of health care that was worse than we should expecialy considering that we pay twice as much for it as any other country.

should have been New England Journal of Medicine article

The perception of the 70% is a little unfair: the US government actually spends what most other countries would consider a very generous amount of money on healthcare. It's just that, at some point between the government and the 70% who demand the healthcare, that money is being siphoned off and distributed to CEOs as compensation and stockholders as dividends.

What a lame post.

Drum is talking about 'spinning' and 'selling' the idea. Nothing about facts, budgets, resources. Spin.

That is why I call Kevin Drum "The Harry Reid of the Blogosphere."

Some random points. 1) the "veterinary" model of care almost always ends with voluntary euthanasia; 2) medical insurance tied to employment is a huge disincentive to entrepreneurs and small business owners; the downstream impact on the economy can't be good; 3) the "support cost" differentials between private insurance and Medicare/Medicaid/VA are huge; I think it might help to know what's behind the difference. I assume (perhaps without jusification) that executive compensation is one big reason, and redundent processing meant to search for reasons to deny coverage is another, but I'm open to being educated on the subject. 4) As a single adult without dependents, currently uninsured, those baby steps look pretty sucky to me. Frankly, all the diddly little increments are just doodling in the margins. Amen to the idea of contrasting Medicare simplicity with Part D complexity.

This is a followup to my previous post. The article in question is, "Who Is at Greatest Risk for Receiving Poor-Quality Health Care?
Asch S. M., Kerr E. A., Keesey J., Adams J. L., Setodji C. M., Malik S., McGlynn E. A.
Abstract | FREE Full Text | PDF
N Engl J Med 2006; 354:1147-1156, Mar 16, 2006. This article makes you think that our problem with health care is worse that inadequate health insurance. The insurance part may be the easy part.

In my state, it's illegal to drive a car without insurance. Why not make health insurance mandatory?

We have Medicaid, so the poor do, or should, have health care coverage already. The rest of us would simply have to have proof of health insurance just as we have to provide proof that we have car insurance.

The nice thing is that non-poor people that do not currently pay into any health care system would be a huge source of income since they, in general, only consume a tiny fraction of health care costs.

I think another idea would be to have the federal government open up Medicare/Medicaid to all people in competition to our current ‘system’. People/businesses could then choose between competing services. Here we would really see how a government run single payer system could stand up in a environment of choice.

Other ideas would be to:

1. Eliminate the current government restrictions on the number of Doctors medical schools can graduate.
2. Open competition/borders for drugs.
3. Force doctors and hospitals to post their costs per standard medical procedures.
4. Force doctors and hospital to post there success ratios or other quality measures.
5. Open up immigration for doctors and nurses
6. Allow the Canadian government single payer system to compete in the US
7. Eliminate licensing and allow nurse to do more of the work of doctors, nursing assistants the work of RN’s. (see quality measures in #4 above).

And it raises a question worth asking: what's the best way of selling single-payer healthcare to the American public?

The American public, as this and other polls that have been pointed to before on this blog, don't need to be sold on single payer.

What needs to happen is that an effective demolishing counterattack on whatever scare tactic is going to be used against the actual plan when it is presented.

Hammer on the point that we already spend about as much public money on health care as many countries that do have universal coverage -- we just spend a similar amount in private funds on top of that, and don't cover everybody.

It is a sad comment on the selfishness of Americans that you feel you can’t use the argument that people die all the time because they can’t afford health insurance and that is not moral, not right and (because religion is on the rise) not Christian.

I read about a Florida boy who needed kidney surgery but had no insurance. The appeals went out from the family, as they so often do in these cases. After too long a period a rich Saudi heard the appeal and donated the money, but it was too late to save the boy.

What a travesty! A foreigner had to be the one to a save the life of a kid who lived in the richest country in the world! We may be rich in money, but not in compassion or simple humanity.

A simple summation of the Republican policy on health care: I can afford it, F everybody who can't.

Point out infant mortality rates. The US has a higher rate than Cuba for heavens sake. More babies die needlessly here than any other western country with universal care. It is a national disgrace. If the right to life folks are made aware of this maybe,just maybe they would actually do something to save babies.

re : James of DC
Right on ! I often wonder when people will realize that Mainstream Christianity and the policies of corporate politicians ("globalism", reducing the safety net in the service of "competitiveness etc) are the exact opposite of authentic religious values.

In addition to single payer being the moral or "Christ-like" thing to do, it is also the best thing that could possibly happen to the Fortune 500 or for small business. I expect this to be the rationale that eventually leads to single payer in the U.S. ... in about 2020.

I think Michael Moore is taking the first real media step: our medical system is the focus of his next movie. Check out MichaelMoore.com.

One of the conservative fallacies to watch for: They will argue "The plan will cost X billions of dollars... ." But of course, we are already paying for healthcare ourselves anyway. The real cost is of course the difference between what the government would spend and what we would have paid otherwise. Believe it or not, they actually use arguments like the above all the time, and for all kinds of issues. What's really unbelievable is that the average red-state potatoe head actually falls for that kind of stuff (well, they've been conditioned by years of Loombowel...)

I'm repeating myself - and I'm with Mark ( about 2/3 in if this is end post), here's a post of repeat :

National Health Care needs to be presented as capitalist Freedom. The freedom to have your own business, to be an entrepreneur without the baggage of who you hire. The Freedom to change jobs without the mystery or mirage of the new health insurance situation. The Freedom to go out on a limb with new ventures. The Freedom to entice Toyota to build their plants in our country. The Freedom to plan ahead. The Freedom to stay home and raise a family or care for others. The Freedom to go to school, to improve yourself. The Freedom to marry someone not in perfect health. The Freedom to live with dignity when ill. The Freedom to have medical hope no matter who you are.

This will strengthen marriages, lessen the financial strains, and eliminate half the bankruptcies. It will lower auto insurance and homeowner liabilities rates, and reduce lawsuits, since we’ll all get the care without costing each other.
It will lower public liabilities, such as schools and parks.
It will equalize the country = same basic boat = freedom to be decent
***
And, as others have noted :
Bush is out talking up “shopping” for health care value/deals - attack this flotsam on the capitalist seas. Is it best to shop for deals before your diagnoses for cancer, or after? Is a bargain diagnoses what anyone needs? Or trusts?

Universal health care is needed here; the most efficient way is to have it administered under the current public employees' health care administration (which is currently used by our president, vice president, and members of Congress as well) that had been proposed by former Democratic presidential candidate John Kerry in the 2004 presidential elections.

If it's good enough to be used by the current president, vice president, and members of Congress, it would be good enough for this country's average citizens as well--without adding another bureaucracy. I've even heard--Kevin, please confirm--that some companies such as Wal-Mart would be in favor of such a universal health care plan since it would take the burden off of companies supplying costly health care benefits to their employees.

The real question: Would our government and the citizens they are supposed to represent, be able to override the objections of the entrenched health insurance industry that is more interested in keeping its current monopoly and profits?

Some talking points:

1. Even if we do have the best healthcare in the world (which I doubt, but for the sake of argument...), that means quality of care. That is not to be confused with how efficiently it is paid for, or how costly it is etc.

2. It is actually quite unfair for people with jobs to have cheaper health insurance than those who don't (or who work for companies that don't have plans.) Don't reject arguments of freeing companies from being burdened by this mess just from reflexive anti-business sentiment.

Another talking point: why would having the government simply pick up the tab for the bill, have any effect on how long you have to wait for a hip replacement anyway? At the risk of sounding naive, I realize that there are interactive issues which contribute to how things go in the nations with national systems. Hence, I am just saying that the Socratic dialog should be undertaken to see how such a question shakes out, and the smoke out the fallacies from the opponents.

More UHC ideas:

An ad shows a $1.00 bill. THe bill is divided to show what portion goes to the doctor(s), other medical providers, the insurance company for profits, and the insurance company CEO for "compensation."

When people see that about 1/3 of their health care dollar goes for expenses other than health care, this should counteract any right-wing/libertarian arguments about waiting lines, costs, and giving the government control of your medical care.

A concept to help make a universal plan go down better: insurance companies are afraid of losing all their business, and I can't blame them for that. But, can't we come up with a universal system that they can participate in and still get a decent return?

I posed the question to a cyberpal who is a consultant in the UK, who's worked for the NHS but now does international consulting. He said this, which seems to me a good summary: "For my money, the biggest gap in the US system is primary care. Universal primary care is where risk is managed, ill-health prevented and early diagnosis made. Without it, you get a highly expensive sickness service."

The NHS recently completed an in-depth plan to upgrade and modernize the service, and the result (available in pdf) is published on the web, here in its entirety. I'm not sure how helpful this will be to us, but it's for sure it doesn't lend itself to digestion in 30 second clips.

The way I see it, existing employees of health insurance providers would be contracted en masse to do back office processing in any new UHS. I suspect the compensation picture for the executives of these companies would change, but the worker bees would be needed, and would keep on doing what they're doing now, pretty much.

Like someone above said, it's time to do the math.

Lots of people are interested. It sounds like a good deal. Now run the numbers. How much are my premiums (taxes) going to be. What's covered? What's not?

I've shopped for major medical insurance for small businesses. At this point in a discussion I would have lots of brochures and fact sheets with numbers to crunch and benefits to compare.

Why aren't there any for a single payer plan?

...

When in doubt, look at the data...

OECD on healthcare expenditure:
http://ocde.p4.siteinternet.com/publications/doifiles/012005061T002.xls

OECD data on healthcare outcomes:
http://ocde.p4.siteinternet.com/publications/doifiles/012005061T003.xls

The US spends a lot more than any other country on earth, both as a percentage of GDP and in actual dollars, on healthcare, yet, dDespite the anecdotes that rightwingers trot out, the US also does worse than most industrialized countries on measures like lifespan and child mortality. Put another way, Americans get little bang for their healthcare buck compared to countries with a socialized medical system.

I don't really see what there is to discuss.

I agree. We need single payer, NOW.

Push the "freedom" angle. Here's another example near and dear to my heart: people who are disabled who could work, but don't, because they'd lose their Medicaid. Ditto parents of disabled/ chronically ill children, who stay unemployed so their children can get Medicaid.

Use the Medicare example to drive home the message about "intermediate costs." (Although there would be massive job loss in the industry if less paper-pushing was required... whatever plan is developed would need to have some way to deal with displaced healthcare administrative workers...)

Some people could retire and do valuable but unpaid things for society if they didn't need health insurance. My husband and I are financially comfortable enough that I could stop working, **if** I didn't need health insurance due to several chronic conditions. I can't get insured on the open market, because my regular costs are too high. I love my job, but would happily trade it for volunteer work etc. if employment and health insurance were not tied together.

Side note about the HSA/major medical approach: it works great if you can put a reasonable amount into an HSA, and you don't experience any *chronic* health conditions. Major medical doesn't work too well once you're out of the hospital but still have a condition that will be with you for the rest of your life.

If the right to life folks are made aware of this maybe, just maybe they would actually do something to save babies.

BillS, no they wouldn't. They don't care about babies. The "right to life" is the positive spin the Religious Right put on "we want be the instrument of God's punishment on you for having sex." Dead babies is actually a harsher punishment for having sex than live ones, so it's all good as far as they're concerned.

...the US also does worse than most industrialized countries on measures like lifespan and child mortality. Put another way, Americans get little bang for their healthcare buck compared to countries with a socialized medical system...I don't really see what there is to discuss.

Don't be so fucking naive, Cactus. People who frequent sites like Kevin's are typically knowledgeable and wonkish by nature. Joe Sixpack ain't. The key is keeping it simple, not trotting out statistics. You can be sure the pharma-healthcare industrial complex isn't going to fight this fight on statistics. They're going to focus on anecdotes and scare tactics. Sheesh!

Annual cost of govt health care for all, $100 billion, about 6 months of spending in Iraq. For that US corporations become competitive in the global "free trade" environment and those that are actually patriotic can keep jobs in the USA instead of exporting them.

Kevin writes: The vast, vast majority of Americans would be better off under a good national healthcare system than they are now, and we need to convince them of that.

I suspect it would actually be the case that virually all Americans, not merely the vast majority, would be better off. The reason is that under any UHC plan that could possibly get through Congress, there will be plenty of scope for private healthcare that can be purchased by the affluent. You'll still be able to buy private rooms in fancy clinics, and have botox injections and boob jobs, in other words. So, with the rich being no worse off, and everybody else having lots more security, virtually everybody should enjoy healthcare delivery at least as good as today's status quo.

when Hils screwed up the Healh Care fight years ago there were 70, yes seventy, congressmen and women ready to co-sponsor single payer. could these new sort of moderate democrats that want to be so serious and stuffy, Kevin Drum on many occasions, get off the dime, stop talking about the work of years for single payer and join those of us old guys who remember where all this moderation gets us in terms of health care and demand that the US join the rest of the civilized world and move to single payer and actually believe that health care is a right of people from their governments and not a privilege to be bestowed on us by geo bush hilary clinton and blue cross. the moderation aout health care makes me sick.

99,

Respectfully, I disagree. Tell people - "You pay more and get less than everyone else in the world. If you switch to the same system as everyone else, you'll get more and pay less." I think that would sell. But, you need to actually put dollar figures on things and you need to tell people where they can check those figures, because the other side is just making stuff up, and made up magic cake always tastes better than real cake.

The more "regular" people I talk to the more I am convinced THEY don't need the convincing, especially since they are the ones being hurt by higher premiums and fewer medical care options. That is, if they haven't opted to go without because they can't afford it even tho they work fulltime.

This isn't including anyone needing to declare bankruptcy (a third of all bankruptcies--google Elizabethe Warren) because of medical costs.

To me, the real tack needs to concentrate on the "middle-man" insurance companies and HMOs because they are the ones who approve and disapprove tests and procedures and drop certain high-cost medical conditions off their "approved" list.

Not to mention the practice of "shedding lives" (see-- Health insurers getting bigger cut of medical dollars) where they increase premiums on a high-risk patient until that person can no longer afford the insurance.

So, if anyone trots out the "rationing" card, the act of "shedding lives" and not covering "pre-existing" conditions is indeed rationing care based solely on the basis of money and profit.

And we are supposed to be a "civilized" nation?

How about having the government pay for "Health" blessings from www.onlineblessings.com for everyone? It is right in their price range of what they want to pay for healthcare, $10.

I agree with Bob Kopp. I'm at a loss to figure out how universal health care would cost more money.

INSALUD costs the Spanish government 9% of GDP. It costs us around 14%. So what do we get for the additional $600B? That's not to say that the Spanish have a better system - it is to say that for a 50% premium we should have a system that much better than they do, and it seems clear that we do not.

So the question is: where is your money going? What are you really paying for?

Speaking of car companies providing only cars, just this week we see the GM effort to rid itself of providing health care and pensions. Those two items are said to add $2,500 to the price of each car produced.

At first I wondered why Republicans would fail to support an American industry through alternate ways to provide for health care and penisons, but then realized that they prefer to buy cheaper cars made abroad.

UHC has wide support already; the main concern that the public -- particularly those with good insurance now -- still has is about waiting lists and other rationing mechanisms, and provider choice.

Aside from assuring that any plan doesn't restrict provider choice (covering any eligible service at any provide legally allowed to provide that service), I think the important thing is to find a way to provide a role for private payment -- even private insurance -- to bypass any waiting lists that need to be implemented, without the complexity of our current multi-system healthcare model.

This could take the form, e.g., of a strong universal basic healthcare model wherein services that were not covered by the main system (either generally or for particular diagnoses or with waiting lists) could be covered by third-party plans where the private insurer wrote policies to a standardized set of criteria (i.e., services covered, providers allowed, diagnoses for which particular services were allowed, etc.) and collected payments, but the main healthcare plan, once the policy was "registered", actually administered the routine claim adjudication, providing an appeal system for both parties and compensating the client for any improper denials and the holding the client harmless for any improper approvals not resulting from the client's fraud.

"Universal healthcare", sure, but also hassle-free healthcare that enhances practical freedom.

We already have a single payer universal healthcare system in this country for everyone over 65 - Medicare.

I never hear anyone complaining about wait lists or inadequate care. In fact, it seems most people can't wait to qualify for Medicare because its so simple to deal with.

Instead of focusing on foreign systems, I would focus on Medicare and how well it works. Especially when virtually everyone has a family member or friend who is on Medicare.

Also Medicare's administration costs last I heard were under 2% compared to HMO and insurance company administration expenses of well over 10%.

Neil: The GOP is fearful of rationed healthcare because so many have lived in pain or did without helpful surgery that they would clog the boutiques.
Damned poor would be walking upright, lose their coughs, and have a happier outlook. Might even leave Wal-Mart.

For the record, I'll gladly wait a bit while the truly needy and hurting among us finally get the help they deserve. That is my philosophy. I'm sorry it is so controversial.

In the future, the real growth service industry will be in taking care of each other--most manufacturing and agriculture is mechanized now. But we will always need a healing hand.

However we do it, let's help America take care of its people again. Universal care is not a goal, but our raison d'etre.

1. Small businesses. Local mom-n-pop businesses are put at a significant disadvantage to large companies in hiring because the large companies are able to more effectively pool money for group healthcare plans. Pull some quotes from Dubya talking about the 'death tax' for this one.

2. Big private health care is about making money, not protecting your loved ones. With a governmental program there can be public oversight. Given the choice between the cheap procedure and the one that has a better chance of saving your spouse, profit-driven health care will choose the cheaper alternative.

3. Preventative health care is a major hidden cost. Part of our reforms should include mandatory preventative care in order to maintain eligibility, which will lower the overall number of people needing expensive care on the backend. That means when you need an unexpected heart transplant you're not stuck in line behind some guy who never got regular checkups to tell him that all those Twinkies were clogging up his arteries.

4. No matter how you slice it, our system is grossly inefficient. Show people $10,000 and how much they lose out of that for US-style health care versus how much they'd lose if they lived in any other first-world nation. Hold up the remainder and point out that all that money goes to the owners of big HMOs, not to better medical care, since ours is demonstrably worse. It's institutionalized theft.

5. If we can't get over the fearmongering about "cheaters" overusing the system, we could start by limiting universal health care to non-cheatable stuff like catastrophic emergencies and chronic illnesses -- things whose costs can be distributed easily and that ruin familes' finances for generations. This would also take a burden off the current system.

People worry about money being wasted under a public system, or people taking unfair advantage of. But these problems exist in the current model and cost untold millions yearly -- by building a new system, we can design oversight in, ensuring that we're not held hostage to our most critical medical needs. Think Enron screwing over grandmothers in California when that system was privatized -- why should we think that HMOs are any different? Accountability, accountability, accountability. It ties together everything that this administration has done wrong.

It's about making insurance companies rich...insurance lobbyists rich.....and banking interests rich.

Fighting the corporate lobbies will be very tough, won't it?

I always say that we have national health today in the US but only for veterans and retirees on Medicare. We just want the rest of us to have something similar We do need to change the Medicare prescitions drug laws to allow the gov't to negotiate with drug companies for lower prices on prescriptions, the model isn't such a bad place to start.

A point that generally makes conservatives go quiet is that small business would expand greatly if people weren't tied to employer based health coverage. The biggest hurdle is the funding mechanism.

Universal health cover is a winner in spite of all the horror stories. You get better outcomes straight away and real cash savings down the pike. While a repugnant fear campaign can make the smallest incremental reform sound like crazy and dangerous utiopionism there is a workaround. And that is the democratic socialist party that takes up this issue also panders to the libertarian's.

Thats the key to this issue. You sell it as an overall REDUCTION in the size of the state and taxes ( for the poor and middle classes) If you don't do that then the old ' Tax-and-spend' millstone will sink you again.

The rethugs have a winner with small government - less tax. The Dems can constest this terrain but will they?

I doubt that they can. Most are lumbering dinosaurs like Drum.

Spider, in your point #3 above, you should change preventive medicine to primary care. I posted this above, "Universal primary care is where risk is managed, ill-health prevented and early diagnosis made." You probably know people who play chicken with their health, married couples who've made a contest of who could be the sickest the longest before caving in and going to the doctor. I'm thinking of my parents, who grew up during the Great Depression, and my aunts and uncles, whose habit of thrift cost some of them dearly. My cohort swore we wouldn't be like that, but those of us who do without insurance don't have a choice.

Good primary care is where downstream costs are checked; people who count every penny, whose deductabile or co-pay is unmanageable do not have primary care; they only go to the doctor when they absolutely must, and the cost is inevitably much higher. The economy scales negatively; those who are very poor and have no insurance present the sickest to hospital emergency rooms, where the cost of treatment is highest. Those costs are folded back into the system and raise costs for everyone else.

I subscribe to the statement above that there's not as much resistance to a single-payer system as we've been led to believe. I certainly don't think we should settle for a crazy quilt, cobbled together system designed as a sop to the insurance industry, certainly not without putting a hard press on that common wisdom that a single payer system will never fly.

How many people have figured out that we were conned by Harry and Louise? How many have taken the "free market economics" lessons we've recently learned and now question whether something as essential as health care should properly be prey to market forces. How many are comfortable putting decisions about their care in the control of a for-profit corporation, whose model of profitability is based on exclusion: excluding people from the group they will "cover," excluding certain procedures, types of care, or medications from "coverage?"

Kevin's question was "what's the best way of selling single-payer healthcare to the American public?" Part of the answer has to be in just disenthralling ourselves with the system we have, Don't believe bullshit, and don't allow anyone within your reach to believe it.

One thing that should be stressed is how amazingly ineffecient the American healthcare anti-system is. We spend at least one-third more of our GDP on health care than any other developed nation, and still we have 45 million uncovered.

It would be good to a have a series of commercials that explained the various unique features of the American system that lead it to waste so much money. For instance, private health insurance coverage scants on preventative care, which leads to greater costs in the long-run. Another is the major added expenses of health insurance companies, such advertising, bureaucracies, and profits. And so on.

This is important to explain because the conservatives argue that the free market is always superior to the government. That is true in a lot of cases, but there are many, such as security where it isn't (would we be better of if everyone hired a private security firm, as opposed to our present system of having the police paid by taxes?). The public needs to be educated in the reasons why privatized health care is actually much more expensive than a single payer system.

My "standard" answers to the two biggest canards:

The "faceless bureaucrat from the government making decisions about my healthcare" canard:

"What, you mean as opposed to a faceless bureaucrat from the insurance company whose profit depends on denying your claim?"

I actually have two answers for the "you'll have to wait for a hip-replacement like they do in Canada" cannard, depending on who I'm talking to:

"Well, how many times are you going to need a hip replacement compared to how many times you'll have to go to the doctor for the flu?"

and

"The choice you have today is not between waiting for a hip replacement or not waiting for it. The choice is between waiting for a hip replacement or having to wait until payday to take your sick child to the doctor."

The main thing though (IMHO, and as I've argued elsewhere) is that we learn a lesson from the Dreaded Republicans. They have a mantra: "Lower taxes are better. Period." They argue and debate all the time about which taxes to reduce and how to do it, but whenever they're challenged from the "other side" they go back to the mantra.

Our "mantra" should be "Everybody's covered. Period." Not that we shouldn't debate proposals about how to get there amongst ourselves but that when attacked or challenged from the other side, we go to the mantra: Everbody's covered. Period.

The majority of the American people have a short attention span and limited interest in details. They just want somebody to recognize the problem and come across as being committed to fixing it. Look how far Ross Perot went with his "get under the hood and fix it" mantra. He didn't have policy proposals, and in fact, admitted that he didn't know how to fix it, but repeatedly said that there were people who did know how, and he'd find them and get them on it.

Even Bush used the same sort of appeal with his "MBA/CEO President" image - admitting that he wasn't an expert, but that he'd be the "CEO" that hired the experts. That went a long way towards assuaging any doubts the "muddled middle" had about his intelligence.

We who actually have an interest in policy details love to debate those details. Mr & Mrs Sixpack don't have the time to think about it. They're too busy trying to keep up with inflation on two not-so-great, stagnant incomes and hoping the kids don't get sick or the car doesn't break down, or the roof doesn't spring a leak or gods forbid one or both of their employers doesn't decide to outsource their jobs.

WE HAVE UNIVERSAL HEALTH CARE, REGRESSIVE-DEMOCRATS.

What we don't have is universal asset protection insurance in case of overwhelming medical costs. For those with assets above a very modest total, they could own less assets and afford their own health insurance. For those with few assets, that is what bankruptcy is for (not, contrary to what R-Ds think, to rip off the hard working people at credit card companies and frugal savers and investors who risk investment in them).

How many people with out health insurance (and outside Medicaid) have cable TV, long distance telephone service, a car valued at more than $7,500 in any given year, a house in middle-income neighborhood (or a rental in such), a house that is bigger than the need (or a rental); how many drink, smoke, dine out, buy lottery tickets, do drugs? Answer: 80% at least.

R-Ds: Stop trying to frame the American people; we were fooled once (1966) and you dragged us into the 1975-1980 gutter; never again.

TOH

An obvious reply to the hip-replacement-waits-in-Canada meme is: People don't have to wait for hip-replacements in the U.S., do they? Virtually all American hip-replacement patients are covered by Medicare, aren't they (this is a geriatric operation, after all)? And Medicare is a SINGLE-PAYER system!

Most Americans are already receptive to the idea that the government should take on a bigger role in healthcare.

Do none of you liberals ever bother to ask the question Which government? anymore?

I'm all for MediCal, and my local tax dollars to to help support city and county community health centers and services, but I'll be damned if I see anything in the US Constitution about a National Health System.

but I'll be damned if I see anything in the US Constitution about a National Health System.

Do you see anything in the US Constitution about a US Air Force? And yet we seem to have one....

How do you pay for it? Medicare is in much worse financila shape than Soc. Sec. We're less than 25 years to it being bankrupt and you want to extend coverage to all. Hip replacement seem sto be the term de jour about current single payer systems in other countries. But if you look at the number of Canadians coming to the U.S. for treatment, it's for much more than thier hips. There are countless anecdotal stories of people in Britain paying for private healthcare due to a variety of causes. Wait time for an appointment. The technology available between the private and public health sector is wide.
You can talk about faceless bureaucrats making decisions about your health vs a for profit corperation, but a corp. has an incentive to try and satisfy the patient.
I had to use Kaiser during the last week for a sore shoulder. I was able to make an appointment only 2 hours from the time I contacted Kaiser. I was seen at the appointed time, got an x-ray within an hour that pinpointed a problem, and had a treatment regimen set within another 30 minutes. Now compare that with the myriad stories we hear from around the world from countries with single payer care

It might be a political disaster to leap to a single payer system. It would probably be wiser to set up national health goals, than to be wedded to one possible method of implementation.

A couple of suggestions for selling universal health care:

Dad at table, head in hands, Mom with hands on shoulder: Mom says: "Jim, its the job you've always dreamed of. We have to find a way for you to take it." Dad embraces Mom: "Honey, I talked to their benefits counselor, and their health insurance won't cover Timmy's because of his diabetes. I-I have to turn it down."

Mom at table, frantic look in eyes, beseeching crestfallen looking Dad: "Tom, Dr. Smith has taken care of our family for twenty years. How can we change doctors?" Dad: "Honey, I'm sorry - but the company has gone to a new plan, and Dr. Smith isn't in the new network. We're just going to have to find someone that the company has approved."

Another possible theme is pointing out how much the drug companies rip off Americans because we don't have centralized bargainning power. Maybe commericials from with testimontials from people under Medicare about how much more freedom they have in choosing health care under Medicare than they did under restrictive company plans, and how they think all Americans should have the same choices they do.

The point is to find a way to tip the gut reactions in the direction of a single payer system. Logical arguments are not going to cut it against the right wing's talent for using fear and conflict to drown out rational discourse. We will have to find a way to drown them out in order to make progress on this and the other critical problems facing us.

I think this shows people's demand for better healthcare service rather than wanting it run by the government.

Those "countless anecdotal stories" are either generations old or refer to elective surgery. And the faceless bureaucrats at the insurance company know they're in a seller's market; they don't care about my satisfaction, they care about their profitability.

I want it run by the government because they're the only ones that'll run it without looking for profit. As soon as profit enter