Lieberdouche, Medicare for All, 218, 50, 1

Jay Ackroyd laughs when I state that there is serious path dependency issues on transitioning the US health finance and health care providing systems from the current set of kludges that are based on heavy but hidden governmental involvement in both for most working age adults, and then single payer systems for the elderly, the disabled and the poor.

He thinks that path dependency can be waived away by changing the eligibility age  for Medicare.

The US has a single payer system in place already. Just change the Medicare eligibility age. Set premiums. Compete!

If my memory serves me correctly, there was a recent proposal to do just that and it failed.

New York Times December 2009:

The group of 10 senators put forward a plan to set aside the public option in favor creating at least two national health plans modeled after those offered to federal workers and allowing some people to buy coverage through Medicare beginning at age 55.

Mr. Lieberman had supported the Medicare buy-in proposal in the past — both as the Democrats’ vice presidential nominee in 2000 and in more recent discussions about the health care system. In an interview this year, he reiterated his support for the concept.

But in the interview, Mr. Lieberman said that he grew apprehensive when a formal proposal began to take shape. He said he worried that the program would lead to financial trouble and contribute to the instability of the existing Medicare program.

And he said he was particularly troubled by the overly enthusiastic reaction to the proposal by some liberals, including Representative Anthony Weiner, Democrat of New York, who champions a fully government-run health care system….

Yes, I believe Jay will agree with me that Sen. Lieberman is a douchnozzle extraordinaire, but he was not and is not categorically unique within any Democratic caucus of the past thirty years, nor is his behavioral pattern and being in-hoc to insurance and other FIRE interests unique to Democrats who represent certain states and are sponsored by certain groups.

The minimal coalition for single payer or even a break-even self-funding Medicare buy-in proposal is 218 Democratic representatives, a Democratic vice president, a friendly Senate parliamentarian and 50 Democrats.  All of the Democrats who would need to vote yes need not to be scared of being defeated by a combination of Tea baggers, insurance industry flacks and hacks and Wall Street cash.

The actual probable minimal coalition is 230 or so Democrats in the House willing to vote yes, sixty Democratic senators, and five Supreme Court justices who don’t want to invent new legal doctrine for shits and giggles.

Again, in an ideal world, a Medicare buy-in at 55 or even better, full Medicare expansion to 55 would be a significant improvement over putting the 55 to 64.999 age cohort on exchanges.  But just believing that there is an easy way to get there is Green Lanternism or belief in the power of the Bully Pulpit ™.

 

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78 replies
  1. 1
    Omnes Omnibus says:

    59-41 Senate Minority, All we want is life beyond the thunderdome, Blogospheric Navel-Gazing, Clap Louder!, Democratic Cowardice, Election 2008, Even the “Liberal” New Republic, Fools! Overton Window!, Free Markets Solve Everything, Fuck The Middle-Class, Green Lantern Pundit Corps, I Reject Your Reality and Substitute My Own, Lindsey Graham’s Fee Fees, NANCY SMASH!, Nobody could have predicted, OBAMA IS WORSE THAN BUSH HE SOLD US OUT!!, The Dirty F-ing Hippies Were Right, The Money Party, World’s Best Healthcare (If You Can Afford It)

    Awesome.

  2. 2
    JPL says:

    What surprises me are the folks who bought into the Romney plan to privatize Medicare. You can keep Medicare if you want but those that don’t, they can buy private insurance. They have no idea that would kill Medicare as we know it.
    Why would doctors agree to keep those with preexisting conditions at a lower cost? The reason Medicare works is because of the large number of people enrolled. I missed the part when the MSM explained it though, so what do I know.

  3. 3
    MomSense says:

    @Omnes Omnibus:

    So much awesome!

  4. 4
    Corner Stone says:

    I don’t know where you came from but I know where you’re going – SuperTagVille.

  5. 5
    fuckwit says:

    I bet he was eager to take the front-pager role just to be able to do tag soup like that.

  6. 6
    superfly says:

    But you’re countering a “path dependency” argument with a political argument, bit of a bait and switch, unless I’m misunderstanding what you mean by path dependency.

  7. 7
    Chyron HR says:

    Is John Cole going to have to smack a bitch cut off a finger and bitch at us for it?

  8. 8
    Warren Terra says:

    Well, gee, I am all in favor of abolishing the health insurance industry and instituting single-payer or even single provider – but since I’m not an idiot, I am aware it’s a bit of a thorny problem that something like a million people work in the industry, and not all of the money invested in the industry belongs to wealthy greed heads. Given the sort of dictatorial power to make the decision I’d still go with the change, but I’d do so recognizing the issues involved, and taking them seriously.

  9. 9
    Corner Stone says:

    But just believing that there is an easy way to get there is Green Lanternism or belief in the power of the Bully Pulpit ™.

    It’s interesting that you tag Jay and also fire off the signal flare of Lieberdouche but don’t really make any counter argument against what silly palliatives JA recommends.
    Please try again, Dick.

  10. 10
    Biff Longbotham says:

    Which one of you FPers is responsible for bringing this new guy on board? His getting to the heart of the matter, while being clear and understandable, not arch, arcane, and inside-basebally (looking at you, DougJ), is very refreshing.

  11. 11
    superfly says:

    @Warren Terra:

    Yeah, this is the second biggest problem (the biggest being the political problem), a shitload of layoffs if you flip that switch.

  12. 12
    Yatsuno says:

    No country has ever gone from private healthcare to single payer overnight. It has always been a series of steps while the government portion is expanded and improved upon. Believe it or else ACA is a big step in that direction.

  13. 13
    MikeJ says:

    @superfly:

    a shitload of layoffs if you flip that switch.

    And it’s very, very hard to explain to those people that their continued employment is harming America, even when it is true.

  14. 14
    Steeplejack says:

    @Richard Mayhew:
    Just a couple of off notes in your excellent post:

    [. . .] there is are serious path dependency issues [. . .].

    [. . .] path dependency can be waived waved away [. . .].

  15. 15
    Villago Delenda Est says:

    @MikeJ:

    This is a huge part of our economic problem in the first place.

    The perceived need to “earn” a living even if it’s in a purely parasitical position that adds nothing to the quality of life for anyone, but instead is a positive drag on progress.

  16. 16
    Mike G says:

    @superfly:

    A massive expansion of Medicare would mean lots of contracting out of services to insurance companies with experience in healthcare IT, claims processing, etc. which would mitigate a major part of the job losses; targeted aid to the laid off could help the rest. And a substantial drop in health care costs would open up many other areas of growth in the general economy.

    Besides, corporations do massive layoffs for venal, greedy reasons all the time. This would at least be in the name of a major benefit for the entire economy, not padding the option earnings of a handful of corporate sharks.

  17. 17
    MikeJ says:

    @Villago Delenda Est: There’s no need for scare quotes. The rank and file who work for the insurance companies earn their pay, even if you don’t approve of their employers.

  18. 18
    The Tragically Flip says:

    Allowing Americans of any age to temporarily buy into Medicare as part of the stimulus would have been a fantasic use of some of that money.

  19. 19
    BGinCHI says:

    Profiting off health care and profiting off education. Wrong and stupid, unless you like shitty, expensive health care and lousy education.

    Everything else is just bureaucratic noise. Important, but still not the root of the problem.

  20. 20
    RaflW says:

    The exchange in Minnesota should go live Oct 1st. I’m eager to see what options there are for me and for my partner. We each have private plans, mine is expensive and has a low(ish) deductible and out of pocket cap. His is cheaper but requires more cash for services.

    I am quite hopeful that we’ll see decent plans and prices, and when the subsidies become known, that people will finally get that what the Republican’s are warning us about is actually a good deal and a reasonable step towards health-care stability (if not outright security).

    It was fascinating for us to visit my cousins in Sweden last week. We wish we’d had a secret camera to record their various horrified looks when we told them what healthcare costs in the US, how easy its been to be denied coverage or claims, how much college costs, how shitty unemployment benefits and how non-existent our long-term safety net is.

    I realized that when Americans deride socialism, they have no working knowledge of what a (mildly) socialist/market state looks and feels like. And I realized that a lot of people abroad don’t know squat about America’s shortcomings. Sure they see “Cops” on teevee over there, but they don’t know about the social insecurity that 10s of millions of Americans experience daily, etc.

  21. 21
    handy says:

    So I just did a little playing around on the CA HEX site coveredca.com. Let me just say I don’t know what I or my family would do without my employer-sponsored coveraged. Even the Bronze 60 plan would put a serious pinch on our monthly budget, not even taking into account that God forbid one of us had to utilize services.

    We really have it ass-backwards here in the good ole US of FuckYouIGotMine.

  22. 22
    Jewish Steel says:

    @Steeplejack: But you didn’t catch in-hoc for in hock?

    Focus, man! Focus! :)

  23. 23
    catclub says:

    make it gradual by lowering the eligibility age 1 year every year.

    Accelerated method: all newborns and their families become covered by medicare, as well as lowering eligibility age.

  24. 24
    catclub says:

    @handy: My guess is that your employer is paying more than the premium for those bronze plans. Possibly a lot more. If your employer were not doing that, there is a likelihood that you would be paid substantially more ( a different world, I know) than you are now.

  25. 25
    Yatsuno says:

    @Mike G:

    A massive expansion of Medicare would mean lots of contracting out of services to insurance companies with experience in healthcare IT, claims processing, etc

    Not to mention quite a few would get hired by Medicare itself. An expansion of the coverage also means expansion of the administration.

  26. 26
    catclub says:

    @Yatsuno: Although the Medicare admin is MUCH leaner than the for profit insurance companies.

  27. 27
    handy says:

    @catclub:

    Yes they are, I know because they report it on my paystub. And yes my company is generally known for being shall we say less than “aggressively competitive” in what the salary portion of its employee contributions. Which is all fine and good. Except I know several people, highly educated, highly skilled, who have been out of work or are finding creative ways just to pay the rent. Now throw in monthly health insurance premiums and utilization. This economy just underscores how broken our system is.

  28. 28
    Jane2 says:

    At this point, it’s politically untenable, as you say. Give it a while…now that Obama has fundamentally shifted the health care landscape, incremental changes can occur.

  29. 29
    Gin & Tonic says:

    @Villago Delenda Est: Not so parasitical, actually. Most large corporate employers are, for all practical purposes, self-insured. Meaning that, actuarially, they are large enough that they don’t need to pool or share risk with anyone else. But, as with a lot of other services (payroll, janitorial, etc.) it is more cost-effective for them to farm out their claims processing. Who has the expertise to do that? United Health, Aetna, etc. Those carriers are not providing “insurance” in any traditional sense to, say, IBM, they are just providing administrative services.

  30. 30
    Gin & Tonic says:

    @Villago Delenda Est: Not so parasitical, actually. Most large corporate employers are, for all practical purposes, self-insured. Meaning that, actuarially, they are large enough that they don’t need to pool or share risk with anyone else. But, as with a lot of other services (payroll, janitorial, etc.) it is more cost-effective for them to farm out their claims processing. Who has the expertise to do that? United Health, Aetna, etc. Those carriers are not providing “insurance” in any traditional sense to, say, IBM, they are just providing administrative services.

  31. 31
    Yatsuno says:

    @Jane2:

    Give it a while…now that Obama has fundamentally shifted the health care landscape, incremental changes can occur

    Tommy Douglas didn’t just snap his fingers and Canada had health care overnight. It was a good 20+ years from the foundations in Saskatchewan (whowouldathought?) to the establishment of the Canada Health Act. But we’re getting our footings now, thanks to Vermont. Once that is a success, it will only be a matter of time.

    @Gin & Tonic: I always assume FYWP unless I have evidence otherwise.

  32. 32
    Gin & Tonic says:

    Don’t know why I keep getting those dupes. Sorry, if it’s me.

  33. 33
    Gin & Tonic says:

    Don’t know why I keep getting those dupes. Sorry, if it’s me.

  34. 34
    Steeplejack says:

    @Jewish Steel:

    True. There were a few other woolly bits in there, but it was late and I wanted to get back to Luther on the DVR. Mea culpa. Thanks for being the wingman.

  35. 35
    Roger Moore says:

    @handy:

    Bear in mind, though, that if you were out of work and struggling to pay your rent, you’d be eligible for subsidies. Try plugging in data about your real family, but put in an imaginary income assuming you were in financial distress. The subsidies are really substantial.

  36. 36
    Yatsuno says:

    @Roger Moore: Or even Medicaid eligibility, if your state expanded it. Which I expect they all will do here within a few years.

  37. 37
    magurakurin says:

    @handy:

    If they don’t have money for rent then their subsidies will probably be near 100%. They are based on income only and not assets, so if they own a house or have a 401K it won’t count against them. It might not be as bad as they think after they look closer at the details.

    And Jay A is kind of a dick. Even though most of what he says is stuff I more or less completely agree with…Medicare for all is/was/will be the obvious solution….the way he says things makes me want to disagree with things I agree with. I realize that is probably just how I react, but it is what it is.

  38. 38
    Yatsuno says:

    @magurakurin:

    Medicare for all is/was/will be the obvious solution

    Ayup. Another point in the history of single payer establishment is that it is built upon already existing systems. The NHS was born from healthcare administration for the British populace after WWII, for example. The wheel almost never gets reinvented.

    (Edited. The whell?)

  39. 39
    Roger Moore says:

    @Yatsuno:

    I think the Medicaid money is just being used for subsidies on the exchanges now.

  40. 40
    mai naem says:

    @handy: Don’t forget that even in the bronze plans you get a bigger bang for the buck. There’s just a lot more routine/preventative stuff which is free than in current crap plans.
    I figure that people in the states that choose not to expand medicaid, you might have people moving to other states. Not saying there’s going to be tons of people moving but my guess is enough to be noticed. Lots of people don’t have roots and low paying jobs that they can get almost anywhere. A decreased population can’t look good for any governor.

  41. 41
    handy says:

    @magurakurin:

    The subsidy is probably the thing that makes this program somewhat doable. Somewhat being the operative word, since even with the Enhanced Silver, out-of-pocket starts with the deductible at $500.

    ETA: Out of pocket obviously not including some of the freebies like preventitive care for kids, cancer screenings, etc.

  42. 42
    Bill E Pilgrim says:

    Ackroyd didn’t write that there was a politically easy way to get there. It’s obviously politically difficult, because we’re not there. Writing that we already have a system that could be expanded isn’t the same as saying “that would be politically easy to create”.

    This is typical misdirection, usually by by people who see everything in terms of defending Barack Obama.

    Is that really what this blog needed more of, John? Yeesh.

  43. 43
    anthrosciguy says:

    I don’t think Jay or much of anyone else is thinking it’s simple to get done, but it is simple to do and it’s a simple, easy to understand concept. So what needs to happen is just to repeatedly push it forward, in writing and in political action, over and over. This sort of repetition has worked for the rightwing in things like women’s rights to reproductive health. It takes time. Years. It can be done.

  44. 44
    Omnes Omnibus says:

    @Bill E Pilgrim: I got the impression that Mayhew, in his posts, is trying to describe where we are now. And perhaps why we are here. I think knowing this is important in order to understand how to move forward.

  45. 45
    jl says:

    I think there will always be unnecessary inefficiency when private insurance companies and providers know they will be able to hand off people to another payer at a certain age. I have heard several medical directors talk about the ‘patch ’em up and hand ’em off’ problem for enrollees in their late 50s early 60s. And there is empirical evidence for excess costs associated with the hand off.

    If Richard or anyone else has heard different, let me know.

    So, if we wish to forget about political feasibility, I would go Australian medicare and set the age for Medicare eligibility at zero years (or at conception for those yet to arrive on the scene).

    I’m not sure the current reform will result in a stable system, and suppose (or hope) it will evolve towards either a very highly regulated Swiss type system (which will perform very well but at fairly high cost, though far lower than current outrageous US costs) or some kind of single payer.

  46. 46
    PeakVT says:

    … and five Supreme Court justices who don’t want to invent new legal doctrine for shits and giggles.

    Yeah, that would be nice, wouldn’t it?

  47. 47
    magurakurin says:

    @anthrosciguy:

    this is what he wrote

    The US has a single payer system in place already. Just change the Medicare eligibility age. Set premiums. Compete!

    The word “just” and then the final exclamation point at the end make me read this as he thinks it would be simple to get done. Sorry if I got it wrong, but apparently I wasn’t the only one. The thing is I completely agree, but end up wanting to hate my own opinion after I read shit he writes. I might be batshit insane, but I’m not lying when I say that’s the way the guy makes me feel. Different strokes.

  48. 48
    Roger Moore says:

    @Bill E Pilgrim:

    Ackroyd didn’t write that there was a politically easy way to get there.

    No, because he didn’t say a damn thing about how to get there. The problem with HCR isn’t a technical problem with figuring out how to run a health care system. There are dozens of systems out there that we could model ours on, including some successful ones here in the US like Medicare and the VA. The problem is a political one about how to get enough people to support whatever proposal you make that you can actually implement it. Saying we should just make Medicare for all is ignoring that reality and pretending that the main problem is what to do, not how to get it through Congress and the Supreme Court.

  49. 49
    Yatsuno says:

    @jl: History suggests single payer or an Aussie public/private hybrid system is where we’ll end up.

  50. 50
    superfly says:

    @Mike G:

    Agree with everything you say, and to be clear, am all for opening Medicare to all, whether via premiums or taxes, either way, still would be a big upheaval, but in the end it would be for the best.

  51. 51
    Teresa says:

    America spends far too time, money and resources catering to and coddling corporate executives in the health care (and other industries), who’s performance at address a national need as been a complete failure for pure childish fairy tale believing nonsense.

    Black is correct. Expand Medicare. Our current addiction to propping up failed executives and privatization needs to be a front and center issue. It kills far too Americans and costs far too much.

  52. 52
    Teresa says:

    America spends far too much time, money and resources catering to and coddling corporate executives in the health care (and other industries), who’s performance at addressing a national need has been a complete failure, for pure childish fairy tale believing nonsense.

    Black is correct. Expand Medicare. Our current addiction to propping up failed executives and privatization needs to be a front and center issue. It kills far too Americans and costs far too much.

  53. 53
    Omnes Omnibus says:

    @Teresa: Okay, we all agree. How do you make it happen? Aye, there’s the rub.

  54. 54
    AxelFoley says:

    @Gin & Tonic:

    Don’t know why I keep getting those dupes. Sorry, if it’s me.

    @Gin & Tonic:

    Don’t know why I keep getting those dupes. Sorry, if it’s me.

    I lol’d.

  55. 55
    Baud says:

    @magurakurin:

    The thing is I completely agree, but end up wanting to hate my own opinion after I read shit he writes

    Pretty much sums up my experience with the Internet.

  56. 56
    jayackroyd says:

    I’m on the phone but will post a reply when I’m in front of a real keyboard. The short answer is that “path dependence” >< "votes in the Senate." We have an alternative policy mechanism already in place. It works better than the other two mechanisms we use (private insurance and the socialism of the VA). That same mechanism has very broad public support. Modifying it to cover everyone is way easier than implementing the PPACA. So "path dependence" can't be the problem.

  57. 57
  58. 58
    Sly says:

    @Roger Moore:

    The problem is a political one about how to get enough people to support whatever proposal you make that you can actually implement it.

    That’s half the problem. The other half is surmounting the opposition from the effected industry or industries. With respect to single payer, that means opposition from an politically-connected industry that won’t just lose money from additional regulation, but would in fact be put out of business by a state monopoly. Or, at the very least, relegated to a less profitable and much more competitive secondary insurance market that covers what the single payer policy doesn’t. They are going to fight that as if their lives depended on it, because their lives actually do depend on it. And this is before we even get to the second and third order effects such a policy would have on the other stakeholders in the current system, who will also use whatever clout they have to influence the process.

    To assume that all it takes to accomplish it is willpower is, as Richard said, Green Lanternism at its most perverse.

  59. 59
    Richard Mayhew says:

    @Omnes Omnibus: Yep, that is exactly what I have been and will be attempting to do.. describe things as they are, why they are as they are, and then identify areas where change is probable.

  60. 60
    jayackroyd says:

    @Roger Moore ( and @magurakurin):

    That’s fair enough. I was making a narrow point in that post –that the issue isn’t path dependence, that it is dishonest to claim that it is path dependence, and the Medicare for all path is an obvious counter example.

    In Eschaton speak there is only room for narrow points!

    When I say “Medicare for all,” I mean “use the Medicare system as the basis for an incremental expansion of the program, and to create a baseline for competitive alternatives.” For instance, an obvious first step in a broader Medicare role is to extend eligibility to age 55, while not requiring participation. That addresses one of the largest at risk population segments and creates an opportunity for private insurers to demonstrate the superiority of private insurance over single payer programs. (Hence “Compete!” in the eschaton post.)

    Whether you agree with that particular policy approach or not, I think you have to agree that the barrier here is not path dependence, but Something Else.

  61. 61
    rikyrah says:

    Lowering the Medicare age to 55 would set off a chain reaction. There are plenty of people in the workplace who could retire but don’t because of medical insurance. If the age was lowered, these people would retire. My sister had the years and retired at 55, but pays the equivalent of a car note for a luxury car each month for medical insurance.

  62. 62
    Richard Mayhew says:

    @jayackroyd: Jay, path dependence on the kludge of kludges that is the US health care system produced a very high number of entrenched interests that by 2009 had very significant cash flow and economic rents to protect. One of the things that they used to protect those rents is to gain influence/shills in Congress that will look out for rentier interests. A significant number of those shills are in the Democratic Party, where they were at least smart enough to get paid before and after they shill. A good number of the shills in the Republican Party do it for gratis.

    I agree with you, Medicare for All is technically simple, effective and has low intensity high popularity. However, how do we get there in 2009 with 218, 60 and 1 when there are revealed preferences that there weren’t even close to 60 in the Senate nor 200 in the House.

  63. 63
    jayackroyd says:

    @Richard Mayhew:

    I think that’s great! I’m very grateful to you for doing these posts, and to the BJ crew for giving you the forum. People don’t understand how the current systems work, and they seem to be opaque by design.

    I’ve tried to do something similar with the policy alternatives here:

    http://virtuallyspeaking.us/blog/
    2011/04/28/policy

    But when you do enter into the policy realm, I do think it’s important to recognize that “path dependence” is a euphemism for “elected officials and their staffs serving donors and future employers rather than constituents.”

  64. 64
    jayackroyd says:

    “However, how do we get there in 2009 with 218, 60 and 1 when there are revealed preferences that there weren’t even close to 60 in the Senate nor 200 in the House.”

    Yeah, and I object to calling that “path dependency.” I happen to think it’s worse than you describe–that there was 1 important participant who was committed to Dole/Daschle from the outset. But “path dependence” is not the issue here. Nor, FTM, “political reality.” That’s Beltway and Beltway media speak for “deep corruption.”

  65. 65
    Craig says:

    Preach on. I’m getting mighty tired of these people who can’t accept the biggest win we’ve had for a humane society in forty years. Did they sleep through the actual debate? Where were the votes we were going to pick up, if only the health care bill was a bit more liberal?

    Politics is the art of the possible, and I can’t for the life of me see how we could have gotten much more from a bill that barely made it through the Senate and only survived, in the end, because John Roberts disliked Antonin Scalia slightly more than Obamacare.

    And yes, my preference is to lower the Medicare age to zero, and I think we should start pushing on that. There was exactly zero possibility of such a bill passing in 2009.

  66. 66
    jayackroyd says:

    FYWP mangled the link above.

    Health care policy backgrounder

  67. 67
    Citizen_X says:

    a douchnozzle extraordinaire

    And here I was thinking you wouldn’t fit in here.

  68. 68
    KS in MA says:

    @Villago Delenda Est: Sadly, the need to make a living isn’t just a “perceived” need. It would be wonderful if there were enough jobs to go around, (a) at all, and (b) that were not in companies/industries that are basically parasitic!

  69. 69
    nellcote says:

    Aren’t individual states allowed to set up their own systems as long as they provide minimum mandated coverage? Perhaps the solution is to think of reform on the state level.

  70. 70
    Fake Irishman says:

    @handy:

    Remember, those plans are unsubsidized. If your family is less than 400 percent of the poverty line (about $85,000 for a family of four, $45,000 for a single), then you’ll get a tax subsidy to help you for a portion of a silver plan that is above a certain percentage of your income.

  71. 71
    Fake Irishman says:

    @nellcote:

    Yes. They have considerable flexibility — especially starting in 2018 when they can apply for broad waivers. Vermont has set up the basis for a single-payer system. Oregon has also made some fairly large changes on the base ACA.

    -P

  72. 72
    The Gray Adder says:

    What needs to happen is that certain Democratic agenda items must be declared inviolable – this is what we WILL do if we get the power to do it, and anyone in our caucus who dares oppose THIS LIST OF ITEMS won’t be a member of our caucus very long.

    Yes, I realize this would have hurt certain members’ precious fee fees, but I remain convinced that if Harry Reid brought the original House healthcare bill (the one containing the public option) to the floor before the August recess and dared Lieberputz or any of the other DINOs to oppose, filibuster, or otherwise screw with it, we’d still have the Congress today, only with fewer turncoats.

  73. 73
    Craig Pennington says:

    @Sly:

    [The insurance industry people] are going to fight that as if their lives depended on it, because their lives actually do depend on it.

    Well, to be pedantic their chosen livelyhoods depend on it, not their lives (Romney’s apocryphal opinion notwithstanding, nobody dies when a corporation folds.) Here is someone whose life depended on something. And that could have been any of us (quite possibly without the news coverage embarrassing the insurance company into rescinding its rescission.) We have a more visceral interest in universal coverage and we need to hammer that point home.

  74. 74
    Bloix says:

    It appears that you don’t know what “path dependency” means.

  75. 75
    e.a.f. says:

    Permitting people to “buy into” Medicare at an earlier age might actually reduce costs. As it now stands many Americans have to wait until they are much older to deal with health issues. They get worse and then they get expensive. if they were caught the first time round and dealt with, over a period of time, costs would actually come down.

    It would enable parents to provide health care coverage for their children. Over the long term, this might well catch many mental health problems and deal with them prior to them becoming front page news. You would think a civilized country, o,k. lets rephrase, a G8 country would provide health care for its children. By making them part of medicare, it will lead to a healthier country.

    yes, it might cut into the profits of the insurance business, but actually what is more important, a healthy population or the profits of a few individuals who care nothing for the general population? A country which can no care for their children, is bound to go down hill.

  76. 76
    Irony Abounds says:

    I understand the need to cover everyone, regardless of pre-existing conditions, age, etc., but in looking at California’s exchange there appears to be no benefit for being in good health. The premiums are based on age and type of plan only, so someone who makes the effort to keep in good health, has good numbers (blood pressure, heart rate, cholesterol, etc.) and therefore will likely use much less health care pays the same as some who is likely to be using doctors, hospitals and prescriptions like crazy. I thought the law allowed for some differential based on health factors, or is it just age? I don’t mind subsidizing those who can’t afford health insurance. I do have a problem subsidizing those who can afford to pay more and are clearly going to be using the system substantially more than others.

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    Pseudonymous Bosch says:

    @Irony Abounds: Good question. According to the California Pre-Existing Condition Insurance Plan website (which is consitent with my memory)

    After [December 31, 2013], there is no need for high risk pools, because federal rules do not allow insurers to reject persons with pre-existing conditions or charge them higher rates than those without such conditions.

    Being the father of a child with type 1 diabetes, I am somewhat sympathetic to this idea. I am not optimistic that the unfettered free market would result in a bunch of insurance companies fighting to offer affordable healthcare to children like mine. I have no doubt that without the regulation requiring continued coverage, my insurance company would have dropped my family like a hot rock after the diagnosis.

    And to be explicit, her condition is essentially lottery — we have no known history of the disease on either my wife’s or my side of the family. Type 1 diabetes is not lifestyle related. She was diagnosed at age 9.

    That said, her behavior now will have an outsized effect on her general health. She can control her blood glucose much more tightly when she’s exercising. This summer at the beach, when she was in the ocean every day, we gave her almost no fast acting insulin and even had to reduce her basal insulin dose to avoid hypoglycemic episodes. We have her participating in various sports year round.

    But humans are not motivated solely by money. The reward for good living is good health, regardless of other impacts. I doubt most people who live a healthy lifestyle do so because of its affect on their health insurance bill.

    If it makes you feel better, she will have to pay significantly more for her life insurance (and she will only be able to get it at all if she keeps her numbers good.) Her children, should she decide to have any, will not have quite the risk security that my wife and I have been able to give her and her brother. Hopefully, thanks to this provision of the ACA, she won’t have to forgo insulin or reuse needles because she can’t afford to buy new ones.

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