Slogans to text is a big jump: New York Single Payer Edition

New York will have a solid Democratic trifecta in 2019. The New York State Senate will have a 39-24 Democratic majority. This means any Democratic only bill can lose 7 votes or 18% of the Democratic Senate caucus and still maintain a minimal viable winning coalition. The New York House will have a 106-44 majority. Any Democrat only bill can lose 29% of the Democratic Assembly Caucus and still maintain a minimal viable coalition. As a reminder Senate Majority Leader had an effective 0% margin and Speaker Pelosi had a 14% margin within her caucus to pass the ACA.

Politico reports that one of the major bills that is being debated and prepped for a 2019 introduction is New York state single payer. It is a bill that is splitting the caucus as major internal interest groups are at loggerheads.

While public-sector unions in New York City have voiced concerns over the bill’s potential to curtail their generous health benefits, which POLITICO first reported last week, two leading health care unions are among those continuing to back the legislation….

The Municipal Labor Committee, an umbrella group of New York City unions, recently met with the bill’s sponsors — Assemblyman Dick Gottfried (D-Manhattan) and state Sen. Gustavo Rivera (D-Bronx) — in the Lower Manhattan offices of District Council 37 to express their concerns.

They worry they will lose the option to select virtually full coverage because of a provision in the legislation that passes a fraction of a proposed payroll tax onto employees. They are also concerned about losing union-controlled “welfare funds” to which the city contributes about $1,500 per member. Those accounts pay for a variety of expenses, including prescription drugs, eyeglasses and hearing aids.

The biggest challenge for national single payer is that it is massively disruptive. People who have good to very good benefits right now and who make significantly more than median income (ie high propensity voters) are going to be incredibly disrupted in the short term even if they are promised that they will be better off in the long term. The union fight in New York state is a good exemplar of how the political coalitions can be fractured.

The biggest challenge at the state level is two parts of the same problem:

  • How does this get paid for
    • How does this work in a 2008-2010 scenario?
  • How do the waivers that are not yet legal get approved by the Feds

The bill would cost an estimated $139 billion in new tax revenue each year, making its fate especially uncertain in the hands of a governor who has been reticent to raise taxes. Sponsors have argued that the price tag is misleading because the taxes displace money already being paid in co-pays and premiums…

A state-level plan would need an unprecedented federal waiver to allow for federal Medicaid, Medicare and Obamacare funds to be redirected into the new system, among other complications….

Single payer is a good slogan. Figuring out the nuts and bolts of how to implement this slogan into policy is an extraordinarily difficult political and policy act.

Is the challenge and pain worthwhile?

If the goal is to eliminate insurance companies it may be; if the goal is to make sure there is universal coverage that is good and affordable then other methods may be superior.

137 replies
  1. 1
    tobie says:

    If the goal is to eliminate insurance companies it may be; if the goal is to make sure there is universal coverage that is good and affordable then other methods may be superior.

    This was also Obama’s argument in 2008. If we were starting from scratch, single payer would be the way to go, but we’re not and massive structural changes would cause chaos for some time. Whatever period of time that is, it would be too long for the person caught in limbo who needs dialysis or regular chemotherapy. So for the umpteenth time I ask, what’s wrong with the Bismarck system (terrible name notwithstanding)?

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  2. 2
    Tom Levenson says:

    I support candidates who support universal coverage. Single payer seems to me an abstract and distant goal, and not a present policy option — and hence a unicorn farting rainbows that distracts from the actual job of making a better and more just society.

    YMMV

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  3. 3
    tobie says:

    Caught in moderation. Asking for release!

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  4. 4
    waratah says:

    Will there not always be the option for those that can afford it to have their non government insurance and their private hospitals?

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  5. 5
    Jim, Foolish Literalist says:

    I was disappointed when so many ambitious Dems blundered into the trap of accepting that SP was the only acceptable form of universal coverage. I don’t think enough people actually understand the distinction for it to be fatal, but they probably created a lot of headaches for themselves and the party down the road

    Sponsors have argued that the price tag is misleading because the taxes displace money already being paid in co-pays and premiums…

    I am deeply skeptical that the “just look at my charts!” argument is gonna cut through the risk aversion people understandably feel about health insurance,

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  6. 6
    tobie says:

    This was also Obama’s argument in 2008. If we were starting from scratch, single payer would be the way to go, but we’re not and massive structural changes would cause chaos for some time. Whatever period of time that is, it would be too long for the person caught in limbo who needs dialysis or regular chemotherapy. So for the umpteenth time I ask, what’s wrong with the Bismarck system (terrible name notwithstanding)?

    @Jim, Foolish Literalist: Gillum modified his stance on Medicare4All during his campaign but DeSantis still kept hammering that Gillum’s Medicare4All endangered Medicare for seniors. DeSantis was of course lying but I wonder if this line cost Gillum votes and whether we shouldn’t be prepared for Republicans to revive it in 2020. It’s one of the reasons why I think “universal healthcare” is a better slogan.

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  7. 7
    rikyrah says:

    I’m not against single payer.

    What I am against is the pony and unicorn aspect of its advocates.

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  8. 8
    germy says:

    The European countries with universal coverage (relying on private insurance companies) all make damn sure those private companies are heavily regulated.

    Unlike here in the wild, wild west.

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  9. 9
    the Conster says:

    @rikyrah:

    The term “single payer” has become a meaningless way for so called “progressives” to virtue signal. The terms universal health care, single payer, Medicare For All, public option, etc. are the most over-used and misunderstood terms – other than neoliberal – in current politics. Drives me crazy.

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  10. 10
    the Conster says:

    @germy:

    The ACA was designed to regulate insurance companies in similar ways. The framework of the ACA is sound, we just need to get Republicans out of the way to actually enact it as designed, and fund it so it works.

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  11. 11
    Betty Cracker says:

    @rikyrah: I agree with that sentiment, but I am also annoyed AF by the unicorn brigade’s opposite number, i.e., people who insist that if you do support single payer or any initiative bolder than the ACA, you must be a dumb fluff-head who doesn’t understand the economy. I shall call them “mules.” Down with unicorns! Down with mules!

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  12. 12
    the Conster says:

    OT – market’s down 700 points already. WEEEEEEEEEEEEEEEEE!!!!!!!!!!

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  13. 13
    Jim, Foolish Literalist says:

    @the Conster: I agree it’s a reductive buzzword, a “slogan” to stay on topic, but I think public option/Medicare buy-in is the best way to approach this from a political point of view. I have to trust to the wonks to work out the details.
    Here are some links to current expansion proposals

    A Medicare-for-all bill from Sen. Bernie Sanders
    A Medicare buy-in bill from Sens. Tim Kaine and Michael Bennet
    A Medicaid buy-in bill from Sen. Brian Schatz
    A Medicare “extra”-for-all proposal from the Center for American Progress, an influential liberal think tank that has strong ties to Clinton-land
    This new Medicare buy-in bill from Sens. Murphy and Merkley

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  14. 14
    laura says:

    I think that the Union’s concern is legitimate in that if an employer provided plan that is negotiated as part of an economic package, and a single payer plan is introduced, does the employer no longer have to provide and fund that plan, and if not, does the employer benefit from this reduction or elimination of cost, or do the Union’s negotiate that the contribution should be converted to wages, roll into the pension or other benefits -current or post employment?
    At least, that’s the type of conversation I’m having with my Union thug colleagues as we’re on the picket line this morning.

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  15. 15

    @laura: Union thugs rule! I hope it’s not too cold out there.

    ETA: When my son was small, there was a strike at the grocery store I most often used. I remember teaching him that we don’t cross picket lines. I was a member of teacher’s union at the time, but it still holds.

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  16. 16
    gene108 says:

    @Jim, Foolish Literalist:

    I am not so much worried Dems signed onto single payer – given the shit storm Bernie created around the issue and the need to get ahead of Bernie Bros – but I am worried that they are signing onto Bernie’s vision of single payer, where for a slight increase in taxes, your healthcare will be 100% free.

    Songle payer doesn’t work this way in Canada. They still have some (though considerably less than us) out of pocket expenses.

    Then there is our own single payer system, Medicare, which requires you to pay premiums for everything outside of Part A.

    Basically no one has created a single payer system that is 100% free, with no premiums and out of pocket costs.

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  17. 17
    tobie says:

    @Jim, Foolish Literalist: Thanks for this link. I heard good things about the Murphy/Merkley bill but need to look into it. Murphy’s been an incredibly powerful voice on healthcare, gun control and foreign policy.

    David, if you have time at some point, I’d love to learn more about how to reduce drug prices not just from the consumer end but the production side. It seems that the privatization of drug testing has driven up costs. Could the FDA do this? How is it done in other countries? Another question I have is about the patenting of chemical formulas produced with NIH or NSF funding. This has always bugged me. If the government funded the research that led to the new medicine, shouldn’t the medicine belong in the public domain? I know this flies in the face of the Bayh-Dole Act but maybe it’s time to reconsider the costs and benefits of this act.

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  18. 18
    Mnemosyne says:

    @Betty Cracker:

    I will repeat something I discovered during the fight over PPACA, though I don’t have the link handy:

    According to healthcare experts, South Korea switched from a for-profit system to a universal system with lightning speed. It took them 15 YEARS.

    This shit TAKES TIME. I am very impatient with the people who are mad that PPACA did not instantly transform our entire system and think that instant transformation is possible.

    It took Canada and Great Britain about 30 years and multiple pieces of legislation to plan and implement their systems. And lefties in the US think it can be done quickly and easily within a year or two by passing a single law? Get the fuck outta here.

    If you actually look at the provisions of PPACA, it’s clearly designed to slowly drive the for-profit insurance companies out of business and leave only the nonprofits behind, which would be the point where it becomes easier to switch to a single payer. But Republican fuckery is messing with that design ON PURPOSE and people are blaming the law rather than blaming the Republican fuckery.

    If people had actually PAID ATTENTION to what’s in PPACA rather than focusing on their buzzwords, we would be a lot further down the road towards single payer, but lefties are dragging their feet like sulky children because they want their way NOW NOW NOW while the actual experts try to explain that this shit TAKES TIME.

    Argh. Soapbox off, because I need to go to work.

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  19. 19
    Barbara says:

    By definition, single payer almost certainly has to be a federal effort, not a state by state effort. On the other hand, I think states could look at what Maryland has done with hospital and some other pricing policies that have effectively made hospital services “single payer” in the sense that everyone pays the same thing and all patients are equal from a financial standpoint. There are no wacky “out of network” billed charges strategies to make hospitals profitable by gouging payers and patients.

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  20. 20
    Betty Cracker says:

    @Mnemosyne: Thanks, MULE! :)

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  21. 21
    Ian G. says:

    If eliminating insurance companies is the goal, then that’s just moronic virtue signaling for Wilmer disciples and the like. The goal should be to insure as many people as cost-effectively as possible. If that involves heavily regulated insurance companies (and I don’t know if it does or not), then that’s the way we should go. “Single-payer” is quickly becoming as meaningless as “neoliberal” and just a tribal identifier.

    Full disclosure, I work for a (nonprofit) health insurer.

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  22. 22

    More generally, the states that have been smart enough to elect Democratic leadership can lead the way in multiple areas. New Mexico is one of them. A nice contrast to the scorched-earth policies Republicans are trying to put into effect in some places.

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  23. 23
    gene108 says:

    @Ian G.:

    For a lot of lefties, eliminating health insurance companies is their primary goal. This is the first step in the march towards socialist utopia. After health insurance companies are eliminated, they will have another chunk of the private sector to be taken over by the public, until socialist utopia is achieved

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  24. 24
    Betty Cracker says:

    @Ian G.: I don’t know anyone who wants to “eliminate insurance companies” just for the sake of being capitalist-hating meanies. I’m sure there are such crackpots, but most people who want to take the profit motive out of the care delivery system support that approach because for-profit healthcare generates untold waste in duplicate systems, results in fat cat executives buying yachts with money intended for patient care, etc. Full disclosure: I’ve worked for nonprofit and for-profit health insurance companies.

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  25. 25
    polyorchnid octopunch says:

    @waratah: If it’s anything like single payer in Canada, no. In Ontario, it’s illegal to accept money for any covered health services from anyone other than OHIP (Ontario Health Insurance Plan). This is the case in pretty much all provinces AFAIK. In order for single payer to work it MUST be a monopsony, otherwise it doesn’t have the market power to keep margins reasonable.

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  26. 26
    germy says:

    Maybe this is on topic:

    A tweet about the post office being closed yesterday to “pay respects” to Bush Sr.

    Lot of people criticizing this, but in fairness, the best way to honor a Republican is to deny Americans a vital government service they rely on https://t.co/K3UPHTfecZ— Jess Dweck (@TheDweck) December 4, 2018

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  27. 27
    polyorchnid octopunch says:

    @Jim, Foolish Literalist: That would be unfortunate. It will cost them significantly less money. Mind you, certain parties are really going to miss their hookers and blow budgets, but I don’t feel too bad for them.

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  28. 28
    p.a. says:

    @Mnemosyne: Yes. This. We can look to W. Europe etc for form and financing, but the politics of getting to any of those will be strictly American, given that we were apparently settled by a substantial minority of reavers who have maintainedheir ‘culture’ overtime.

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  29. 29
    01jack says:

    a governor who has been reticent to raise taxes

    I hate that use of “reticent,” but I guess words change meaning whether old men care or not …

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  30. 30
    Juice Box says:

    @waratah: No, single payer may be implemented in ways that don’t permit private insurance. For example, I believe that you can have private insurance in Canada for some incidentals, but Canada doesn’t permit the parallel public/private systems that the UK supports. There are many different ways to implement single payer, just like there are many ways to implement universal healthcare.

    I used to be a single payer supporter ten years ago, but I’m far less certain now. What’s to prevent the Eric Trump administration from slashing funding to the entire health care system in 2032? Nowdays, I kind of like the idea of having health care distributed over multiple interested parties.

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  31. 31
    daveNYC says:

    @Mnemosyne:

    If you actually look at the provisions of PPACA, it’s clearly designed to slowly drive the for-profit insurance companies out of business and leave only the nonprofits behind, which would be the point where it becomes easier to switch to a single payer. But Republican fuckery is messing with that design ON PURPOSE and people are blaming the law rather than blaming the Republican fuckery.

    Er… you got some part of the PPACA that’s supposed to muck up the insurance companies? Because the core elements of forcing them to spend X% (minimum) on benefits while using the mandate to vastly increase their customer base don’t seem like the sort of things that would drive a company out of business, much less differentiate between for-profit and non-profit. There’s nothing in there that puts much of a squeeze on the insurers, much less something that would ratchet up that pressure.

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  32. 32
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @tobie:
    Truth be told, my parents make too much money for the subsidies yet have to pay $1300/a month. Soon it’ll be $1800/month

    I’m not saying SP has to be the answer, but something needs to change

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  33. 33
    polyorchnid octopunch says:

    @gene108: In my personal opinion the right way to do this is to create a wholly publicly owned insurance company, with the power to levy payroll premiums that show up as a line item on paystubs. As it’s publicly owned, its books are public, so people can see where the money is going. In Canada, we use what are called “Crown corporations” to do this; I’m not sure exactly what the equivalent would be in the US but the overall idea is sound… for example, Canada Post is a Crown corporation, owned in this case by the federal government (i.e. the Government of Canada). We used to have the Ontario Health Insurance Corporation, which was wholly owned by the Province of Ontario, but in the early nineties Bob Rae (in what I consider his single greatest blunder) dissolved it and brought all those functions into the actual province. This was a mistake because then it creates competition within the province for funding choices from tax revenue… healthcare, roads, or schools? Given the unique nature of health care demand, it’s far better for it to be separate, imho. Also, it provides clarity to the ratepayers as to where their money’s going; they can see how much of their deductions are for health care. The OHIC administered the OHIP, which paid for services, as well as other functions related to public health like hospital planning (build, upgrade, etc) to service the population in an equitable and cost-effective manner. The board was appointed by the province’s cabinet, with the knowledge that if you appointed an incompetent crony you risked having the electorate write you off because That Shit Matters. ISTR that some of the board members were also appointed by other interested/invested parties, like the Ontario Medical Association, the Association of Ontario Municipalities, and the like.

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  34. 34
    tobie says:

    @Betty Cracker: Didn’t the PPACA require that 80% of premiums be used for actual healthcare expenses? Maybe we should up the level to 90%. France, Germany, Switzerland, etc. all have for profit, private insurers, which, as businesses, try to make money but don’t seem to have such a predatory relation to consumers. Maybe it’s because their tax codes don’t favor corporations and stock-holders like ours do. The strongest argument I’ve heard AGAINST a turbo-charged PPACA is that the US government is so in bed with business interests that whatever regulations are passed will be upended the next time Republicans gain control. Or they’ll be overturned in courts packed with the Republican appointees. It makes me sad that this level of cynicism is likely warranted.

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  35. 35

    A state-level plan would need an unprecedented federal waiver to allow for federal Medicaid, Medicare and Obamacare funds to be redirected into the new system, among other complications….

    Wait, it would replace Medicare too?

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  36. 36

    @Mnemosyne: Did you see the hit job NY Mag’s Cut did on Priyanka Chopra, casting her as a money grubbing cradle snatcher, out to steal a innocent young man for mercenary purposes?
    They took it down without so much as an apology after the furor it caused. But not before someone took screenshots for posterity.
    The woman has achieved a lot on her own steam, megastardom and critical accolades in Hindi cinema, and starting her own production company which has made many innovative movies which would have never been made otherwise. The movie made by her production company went on to win the National award (like India’s BAFTA) for direction last year for a movie called Ventilator, Its about family and friends visiting a man who is in the ICU on a ventilator after a heart attack.
    Before she was engaged to Nick Jonas I wasn’t even aware of his existence. Nick, who?

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  37. 37
    Chyron HR says:

    @Mnemosyne:

    According to healthcare experts, South Korea switched from a for-profit system to a universal system with lightning speed. It took them 15 YEARS.

    Yeah, but we’re WHITE.

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  38. 38
    MomSense says:

    I guess my preference would be to really commit to Medicaid expansion without the work requirements and private insurers bullshit. Then gradually expand Medicaid 175 % FPL and Medicare – first to age 60. I’d also like to see easing the subsidy cliff at 400. % fpl.

    But I really think it is essential to change the fee for service model in Medicare and acclimate the providers and CMS before going to single payer. There are some other issues too like what to do with all the billing specialists, how to deal with cost of medical education, need to have providers treating st the limit of their certifications etc. I’d we screw up implementation it will be 40 years before we can try again

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  39. 39
    polyorchnid octopunch says:

    @Juice Box: See my post #33 in discussion with that. That said, currently if Ontario’s bully boy premier Drug Fraud (koff koff I mean Dough Ford, er Doug… yeah that’s it Doug) were to do that it would likely mean the end of his party for a generation or two. In Canada, you fuck with the health care system at your peril, as Harper learned; once he got his majority in Parliament he started playing footsie with Health Canada transfers intended to keep service levels more-or-less equal across the provinces. It’s a large part of the reason they got pummelled by Trudeau in 2015.

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  40. 40
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @Major Major Major Major:
    You’re too young for Medicare, so what do you care ;-)

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  41. 41
    tobie says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷: I don’t disagree with you. The removal of risk corridors, the overturning of mandatory Medicaid expansion, the hollowing out of the mandate, the elimination of all cost control measures have jacked up premiums for consumers and left people like your parents in a horrible situation. A lot needs to change in our health care financing and delivery system.

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  42. 42
    goblue72 says:

    @Barbara: Single payer in Canada (which they call…Medicare) did NOT start at the Federal level. It started in the provinces – specifically in Saskatchewan in 1962, where it was opposed by the entire medical and private health insurance establishment. 10 years later, it had spread to the entire country.

    I don’t we can start single payer in the U.S. in a small population state and see it spread like that. Its going to take a big state like New York or California.

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  43. 43
    the Conster says:

    @tobie:

    The change we need in our health care system is to get rid of Republicans, or reduce their numbers so they’ll fit in a phone booth at the bottom of the ocean.

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  44. 44
    Barbara says:

    @goblue72: We aren’t Canada. More specifically, we have multiple programs already in place that would not only be disrupted, potentially, but that states don’t control and therefore might not be able to force to become integrated with a single payer initiative.

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  45. 45

    @Mnemosyne:

    According to healthcare experts, South Korea switched from a for-profit system to a universal system with lightning speed. It took them 15 YEARS.

    And even that timeline was in a military dictatorship!

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  46. 46

    @Major Major Major Major: But they didn’t have the Bird man to spread his magic pixie dust and make all your wishes come true.
    BTW what happened to Seth Moulton?

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  47. 47

    @schrodingers_cat: gosh, haven’t heard from him in a bit have we?

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  48. 48
    Betty Cracker says:

    @tobie: It does have that provision, or did — not sure what the GOP has been successful in stripping out. I agree about the danger of political turnover. We’re living it now. Consumer opposition to bringing back preexisting conditions is the only reason the PPA survives at all, IMO.

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  49. 49
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @tobie:
    It’s pretty bad and yeah, it’s mostly the efforts of Republicans trying to sabotage the law. I remember when they kept trying to say it was going to be a job-killer. That sure has been dropped, hasn’t it?

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  50. 50
    TenguPhule says:

    @schrodingers_cat:

    Before she was engaged to Nick Jonas I wasn’t even aware of his existence. Nick, who?

    Weird White guy Christian singer.

    To give you an idea of how weird, big on Male Chasity before marriage.

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  51. 51
    TenguPhule says:

    @Betty Cracker:

    Consumer opposition to bringing back preexisting conditions is the only reason the PPA survives at all, IMO.

    And even then, Republicans still are trying to strip it out anyway.

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  52. 52
    Fair Economist says:

    @gene108:

    I am not so much worried Dems signed onto single payer – given the shit storm Bernie created around the issue and the need to get ahead of Bernie Bros – but I am worried that they are signing onto Bernie’s vision of single payer, where for a slight increase in taxes, your healthcare will be 100% free.

    I don’t remember where you are, but here in Cali we got seriously f****d by the Bernie Bro types insisting unicorns would poop out perfect healthcare for free. There was a serious effort in the Cali legislature last year to do a single-payer system, but the Bernie Bro types insisted it be a gold-plated no-deductible no-copay everything covered system. Well, unsurprisingly, the result was so expensive that even taxing away the entirety of current employer healthcare payments and getting all the federal payments for Medicare and Medicaid was far short of what was needed and we would have needed to more than double current Cali taxes to pay for it.

    Result? We got nothing except reluctance on the part of the legislature to reopen the issue.

    Single-payer attempts have now failed disastrously in Vermont, Colorado, and California. If we can’t get it in those liberal states, we aren’t going to get it nationally. The problems are manyfold: Vermont foundered on the taxes, Colorado on media propaganda, and California on lefty delusions. The way forward is incremental reform – auto-enrollment for the uninsured, subsidies expanded to cover the middle class (i.e. entrepreneurs), reduction in deductible for Obamacare, etc., with the eventual outcome being a system like Germany (employer-based) or France (Obamacare-ish but much stricter regulation).

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  53. 53
    Brachiator says:

    If the goal is to eliminate insurance companies it may be; if the goal is to make sure there is universal coverage that is good and affordable then other methods may be superior.

    This is the heart of the issue. The misguided desire to eliminate insurance companies may result in a worse result.

    It is amazing that “single payer” is an article of faith among some American progressives, and yet they ignore the variety of universal health insurance programs that have actually been implemented in other countries.

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  54. 54
    TenguPhule says:

    @germy: Leave it to Donald Trump to make Christmas 2018 just a bit more miserable all around and screw with people being able to send gifts in time.

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  55. 55
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @schrodingers_cat: @Major Major Major Major:
    The reason we haven’t heard from him lately is because he phased out of existence and fused with the exterior walls of the US Capitol due to his overwhelming white fragility. Why hasn’t the same fate befallen the entire Republican Party, you ask? Well, nobody knows for certain, but some say an evil force keeps their corporeal bodies from dissipating.

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  56. 56
    TenguPhule says:

    @Brachiator: I just want government provided and regulated healthcare. The for profit model for treating human beings is a fast road to dystopia.

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  58. 58
    Fair Economist says:

    @TenguPhule:

    Weird White guy Christian singer.

    To give you an idea of how weird, big on Male Chastity before marriage.

    Based on Nick Jonas’ acting and modeling work since he left Disney, that image was about as genuine as Miley Cyrus’ clean cut image from about the same period.

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  59. 59
    TenguPhule says:

    @Major Major Major Major: Woman has a way with words, doesn’t she?

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  60. 60
    TenguPhule says:

    This week’s evidence for why we are trapped in Hell.

    Right now, in the milk in your fridge, residual streptococcus bacteria are consuming lactose to make lactic acid — which is, in turn, decreasing the pH of your milk to the point where another bacterium, lactobacillus, takes over to finish the process. As the lactic acid in your milk continues to flourish, you’ll know: Take one whiff, and you have sour, spoiled milk. It is a familiar and unpleasant surprise, especially when you haven’t performed the all-important smell test and poured it directly into your cereal.

    Or you could just buy the new Sour Patch Kids cereal from Post.

    “Sour” and “milk” are two words that food companies and consumers typically don’t want to see together. Yet somehow, Post forged ahead with this candy-flavored cereal even though the company is asking you to pay money to do to your milk what bacteria would do for free. The cereal is the same size and shape as candy Sour Patch Kids, and tastes like Froot Loops. But it’s dusted with that familiar Sour Patch sour sugar, which quickly dissolves into the milk.

    The problem with this cereal is not just that it makes the milk sour — thus depriving you of cereal milk, one of life’s simplest pleasures — but also that it opens up a portal to hell regarding What Foods Can be Other Foods.

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  61. 61
    Cintibud says:

    @TenguPhule: Does that make him a “volcel”?

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  62. 62
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @TenguPhule:

    First it was the mayo-flavored ice cream, now sour-patch kids flavored cereal. I like SP kids, but this is too much.

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  63. 63
    Amir Khalid says:

    @Cintibud:
    It’s hard to imagine Nick Jonas as any kind of celibate considering the guy just got married.

    ReplyReply
  64. 64
    Brachiator says:

    @TenguPhule:

    The for profit model for treating human beings is a fast road to dystopia.

    This would mean that every industrialized country with a health care system that is not fully government provided is a failure. This is obviously not true.

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  65. 65
    Thoroughly Pizzled says:

    David, apologies if you’ve answered this elsewhere, but what are some things that the states can do to improve healthcare that don’t require Trump’s approval?

    ReplyReply
  66. 66
    PJ says:

    @gene108:@TenguPhule: Insurance companies are almost all for-profit. This means that they are designed to make a profit, and the more profit the better. One of the most efficient ways to save on expenses is to deny claims. Insurance policies are written so that they can be read to exclude coverage whenever it is not absolutely clear that a claim is covered. In terms of general liability, homeowner, business and other forms of mostly “property” insurance, this means that many people who have legitimate claims must file expensive and time-consuming lawsuits to obtain the coverage they contracted for.

    In terms of health care, this means that policy holders receive sub-standard care and die. Assuming they can afford to bring lawsuits, they will still receive sub-standard care and many will die before those suits are resolved. Compounded with this problem is the almost complete inability for the average person to find out how much a procedure is going to cost from various providers (and the competency of those providers), so that the actual cost to the patient is a surprise. Not surprisingly, people put off caring for routine health problems until they become major. Our whole system is designed to discourage wellness. For-profit insurers are only part of the problem, but eliminating them would be a boon for this country.

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  67. 67

    @TenguPhule: Not for nothing do they say that ignorance is bliss.@Major Major Major Major: She rocks!

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  68. 68
    TenguPhule says:

    @Brachiator: Didn’t say its a failure, I’m saying that it inevitably leads to what we’re seeing today, Two tiered system that’s unsustainable over time because all of the incentives of the system work against the whole purpose of healthcare for the public.

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  69. 69
    TenguPhule says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷: Don’t forget the kale chocolate!

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  70. 70
    Brachiator says:

    @Fair Economist:

    Single-payer attempts have now failed disastrously in Vermont, Colorado, and California.

    How has the Massachusetts health care experiment been going? It is not single-payer, and has been tinkered with over the years. Also, not sure how the implementation of Obamacare affected what the state does.

    ETA: I watched the California experiment with horror. It was insane how proponents for California single payer ignored reality, all the more galling since there were a number of individuals and organizations with actual expertise in evaluating and advising on health insurance alternatives.

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  71. 71
    tobie says:

    I gather markets are tumbling world-wide because of Trump’s trade war fiasco, the Brexit fiasco, the Trump admin’s new-sanctions-against-Iran fiasco, the detention of a major Chinese telecom CEO in Canada at the FBI’s request fiasco, the riots in France fiasco, etc. Remember the good ol’ days when American Presidents were world leaders trying to put out fires world-wide?

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  72. 72
    TenguPhule says:

    ‘There Isn’t Hope for Us’: Once Dominant, California Republicans Are on the Ropes

    Warning, FTFNYT link.

    The Democratic sweep of Orange County congressional seats drew national attention on Election Day. But the Republican losses there were a symptom of the broader collapse of a storied political organization.

    Republicans now hold just seven seats in the state’s 53-member congressional delegation after what shaped up to be a devastating midterm for the party. (That number will drop to six if Representative David Valadao, a Central Valley Republican, loses to T.J. Cox in the one still undecided district, as now appears likely).

    Democrats captured three-quarters of the seats in the State Assembly, the biggest margin in over 100 years. The governor, lieutenant governor, both United States senators, the attorney general and the secretary of state are all Democrats. As of September, there were fewer registered Republican voters in California than Democrats or independents.

    The decline has been decades in the making, the result of demographic shifts, changing views toward immigration and, most recently, the rise of Trump, who lost this state by nearly four million votes to Hillary Clinton in 2016.

    The Election Day losses are being described by Republicans in cataclysmic terms. They have set off an anguished debate about what the party stands for, how to get back into the political game, and how strongly to stick by Mr. Trump.

    “This state deserves a two-party system,” said Travis Allen, a state assemblyman who ran in the primary for governor and is a candidate to become party chairman. “And that’s in jeopardy after 2018.”

    Kristin Olsen, the former Republican leader in the Assembly who is now a member of the Stanislaus County Board of Supervisors, called it “a major setback for the Republican Party.”

    “So much so that I don’t think it’s salvageable at this time,” she said.

    The results are a major political embarrassment for Representative Kevin McCarthy, the House majority leader from Central California. The Democratic sweep came despite an all-out effort by Mr. McCarthy to save his delegation, channeling money to endangered candidates and advocating a repeal of the state gas tax intended to bring Republicans to the polls.

    But Mr. McCarthy, who is a close ally of Mr. Trump, pressured his members to vote for Republican legislation — including a tax bill that hurt many California homeowners, and a repeal of President Barack Obama’s health program — that Democrats used to help topple incumbents.

    To a considerable extent, the setbacks are evidence of the burden Mr. Trump has been for Republicans in a state where Trump is viewed favorably by barely one-third of voters. Lt. Gov. Gavin Newsom, the Democratic governor-elect, rolled to an easy victory after pummeling his opponent, John Cox, a Republican, for backing Mr. Trump. (Mr. Cox drew just 38 percent of the vote and even lost to Mr. Newsom in Orange County). Similar strategies were employed by Democrats in some of the congressional seats they flipped.

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  73. 73
    Brachiator says:

    @PJ:

    Insurance companies are almost all for-profit. This means that they are designed to make a profit, and the more profit the better. One of the most efficient ways to save on expenses is to deny claims.

    Yawn. But this is not the only way to make a profit.

    It is also an interesting fantasy to suppose that a government run system will be able to ignore controlling expenses.

    Why not look at the actual results of countries that have universal health insurance and see what has worked and what has not worked?

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  74. 74
  75. 75
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @Brachiator:

    It was insane how proponents for California single payer ignored reality, all the more galling since there were a number of individuals and organizations with actual expertise in evaluating and advising on health insurance alternatives.

    Those people were neoliberal shills. Of course they were ignored /s

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  76. 76
    rikyrah says:

    @schrodingers_cat:

    Did you see the hit job NY Mag’s Cut did on Priyanka Chopra, casting her as a money grubbing cradle snatcher, out to steal a innocent young man for mercenary purposes?
    They took it down without so much as an apology after the furor it caused. But not before someone took screenshots for posterity.

    Cradle snatcher?

    Maybe

    Money Grubbing?

    I don’t know the financials, but just cause she’s from Bollywood, don’t mean that she was getting pennies.

    She’s a beautiful woman who also had a lot of endorsements.

    Now, maybe she wasn’t in Aishwarya Rai Bachchan territory, but, those top Bollywood folks GET PAID.

    It’s only American snobbery to think that she only began to work when she got Quantico.

    Did the google thing, and they say that her net worth is over $30 million….which is more than Nick Jonas.

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  77. 77
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @schrodingers_cat:
    It’s like a blue version of Texas, except it doesn’t suck.

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  78. 78
    rikyrah says:

    @TenguPhule:

    wipe them out…all of them….

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  79. 79
    Fair Economist says:

    @Brachiator: Massachusetts is up to about 98% coverage with near top in the nation outcomes, so it is a good positive support for the incremental approach. Too bad Cali couldn’t take that route instead of chasing unicorns.

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  80. 80
    TenguPhule says:

    Amazon robot sets off bear repellant, putting 24 workers in hospital

    Not the Onion.

    Twenty-four employees at an Amazon warehouse in New Jersey were taken to hospital after a robot accidentally punctured a can of bear repellant.

    The 255g can containing concentrated capsaicin, a compound in chilli peppers, was punctured by an automated machine after it fell off a shelf, according to local media.

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  81. 81
    TenguPhule says:

    @rikyrah: 33%, margin of error 6%.

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  82. 82
    TenguPhule says:

    The Senate has confirmed a controversial Donald Trump pick for an energy agency.

    The Senate voted 50 to 49 to approve Bernard McNamee for the Federal Energy Regulatory Commission, the Hill reported.

    Democrats opposed the pick because he has been a vocal defender of fossil fuels, opponent of renewable energy, and does not accept the science of climate change.

    “He has lied about how the renewable energies impact the electric grid. He has called support for clean energy ‘organized propaganda,’ and pitched the debate between fossil fuels and renewables in his words as a clash between liberty and tyranny,” Senate Minority Leader Chuck Schumer said Thursday before the vote, according to the Hill.

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  83. 83
    Doug R says:

    Single payer in Canada started in a single province, Saskatchewan in 1962 which at the time had about 5% of the Canadian population. They suffered through a doctors’ strike but with physicans pulled in from elsewhere were able to settle in about 22 days. National healthcare didn’t start until Pearson’s minority government in order to stay in power passed a bill pushed by the social democratic NDP in 1966.
    New York has about 6% of the US population, so it would seem to be a good candidate.

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  84. 84
    TenguPhule says:

    Republican senators have introduced a bill to fully fund Donald Trump’s border wall with $25 billion.

    The legislation would attempt to raise money toward the total by increasing fines for people caught crossing the border illegally, and tightening requirements to qualify for federal tax credits and welfare benefits, the Hill reports.

    Sens. Ted Cruz, John Kennedy, James Inhofe and Mike Rounds are sponsoring the legislation.

    The usual suspects. Of course.

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  85. 85
    Brachiator says:

    @TenguPhule:

    “This state deserves a two-party system,” said Travis Allen, a state assemblyman who ran in the primary for governor and is a candidate to become party chairman. “And that’s in jeopardy after 2018.”

    We Californians deserve to throw a party to celebrate the demise of the Republicans here.

    But also note that there are more Independents than Republicans:

    Independent voters now outnumber Republicans in California, according to an analysis cited by The Sacramento Bee, and have become the state’s second-biggest voting bloc.

    Political Data Inc. found that there are 4,844,803 voters in California with no party affiliation, compared to the state’s 4,771,984 Republicans.

    There are 8,436,493 registered Democratic voters in the state who make up 44 percent of the state’s electorate.

    The firm reports that independents and Republicans each make up roughly a quarter of the state’s electorate.

    Its research also shows that voters in the Democrat-dominated state have been abandoning their party affiliation at a growing rate.

    California has kicked the GOP to the curb, but this does not mean that Democrats are above reproach.

    RE: health care.
    @TenguPhule:

    Didn’t say its a failure, I’m saying that it inevitably leads to what we’re seeing today, Two tiered system that’s unsustainable over time because all of the incentives of the system work against the whole purpose of healthcare for the public.

    Show me the countries with universal health care systems where this is or has been a problem.

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  86. 86
    tobie says:

    @TenguPhule: Phuck! There are 48 Senators that caucus with the Dems, so either one Republican crossed the aisle or there were a few who switched sides. Do you know? I’m assuming Manchin stabbed his party in the back but I could be wrong.

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  87. 87
    Fair Economist says:

    @Doug R: Can NY endure a doctor’s strike like Saskatchewan? I have my doubts.

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  88. 88
    Betty Cracker says:

    @PJ: Exactly right.

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  89. 89

    @rikyrah: She has a good head over her shoulders. As I said in my comment she started her own production company, has produced critically acclaimed movies and has given many aspiring newcomers on and off the camera, a break. There is more to her than being eye candy, which she obviously is.
    PC has been far more successful than Aishwarya in Hindi movies. She has grown as an actor since she first started in movies. In the 2016 Bajirao Mastani, she overshadowed the lead pair as Bajirao’s wronged wife. She was awesome.
    There is a tendency in the American media to belittle Hindi cinema, call it Bollywood, doncha know they sing and dance and are ridiculous, undertone to it all.
    Yes that criticism is apt but there are gems too to offset the crap. Its not that every Hollywood production is meaningful cinema either. Most people who criticize including most critics know little about Indian movies.

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  90. 90

    @Brachiator: the California process went down exactly as I expected it to.

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  91. 91
    TenguPhule says:

    @tobie: Party line vote. One R Senator absent. None of the Democrats voted for him. Manchin was however the one who voted him out of committee to get him to a final vote.

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  92. 92
    Brachiator says:

    @TenguPhule:

    Republican senators have introduced a bill to fully fund Donald Trump’s border wall with $25 billion.

    The legislation would attempt to raise money toward the total by increasing fines for people caught crossing the border illegally, and tightening requirements to qualify for federal tax credits and welfare benefits, the Hill reports.

    This is total bullshit. Also, you cannot tighten the requirements for federal tax credits and welfare benefits without fucking over citizens. And you still would not be able to raise $25 billion.

    But it’s clear that the Republicans are deeply committed to the idea that non-wealthy citizens are undeserving moochers if they get any kind of benefit from the federal government.

    Sens. Ted Cruz, John Kennedy, James Inhofe and Mike Rounds are sponsoring the legislation.

    These are total bullshitters.

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  93. 93
    TenguPhule says:

    @schrodingers_cat:

    Its not that every Hollywood production is meaningful cinema either.

    Hollywood does meaningful cinema?

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  94. 94
    TenguPhule says:

    @Major Major Major Major:

    the California process went down exactly as I expected it to.

    Like the Hindenburg?

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  95. 95
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @schrodingers_cat:

    There is a tendency in the American media to belittle Hindi cinema, call it Bollywood, doncha know they sing and dance and are ridiculous, undertone to it all.

    Yes that criticism is apt but there are gems too to offset the crap. Its not that every Hollywood production is meaningful cinema either. Most people who criticize including most critics know little about Indian movies

    Based on what you’re saying, it sounds like a lazy and shallow criticism, with racism sprinkled in. Are there any Hindi movies you would recommend to someone who’s never watched any before?

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  96. 96
    Burnspbesq says:

    @Fair Economist:

    We were pretty fortunate that Anthony Rendon, unlike the BernieBros and Rose Ann DeMoro, can do third-grade arithmetic and had the guts to say that the numbers didn’t work on SB 562.

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  97. 97
    Brachiator says:

    @schrodingers_cat:

    Did you see the hit job NY Mag’s Cut did on Priyanka Chopra, casting her as a money grubbing cradle snatcher, out to steal a innocent young man for mercenary purposes?

    I saw some of the beautiful photos from her wedding. I didn’t look for or look at anything resembling gossip. I knew Chopra from the tv show Quantico, read her bio and watched a number of her YouTube clips, so I knew about her substantial entertainment career. I barely know squat about Jonas. I think one of his brothers is engaged to Sophie Turner, who is one of the stars of Game of Thrones. Otherwise, I guess that whichever Jonas married Chopra is a lucky man.

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  98. 98
    Fair Economist says:

    @TenguPhule: What is really sad about the Cali single payer fiasco is that the state is generally well governed and the legislature is usually at least heading in the right direction if not always fast enough. And sometimes it’s going pretty fast, like in energy policy.

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  99. 99
    TenguPhule says:

    @Brachiator:

    These are total bullshitters.

    No argument there.

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  100. 100

    @Brachiator: Guardian article
    Some highlights:

    Nicholas Jonas married into a fraudulent relationship against his will this past Saturday,” the author, Mariah Smith, wrote.

    “All Nick wanted was a possible fling with Hollywood’s latest It Woman, but instead he wound up staring straight at a life sentence with a global scam artist,” the piece added.

    ETA: Proof positive of the scam was a wedding that lasted for a week. She has no fucking clue that the ceremonies that precede and follow the wedding easily take a week, for a traditional Hindu wedding.

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  101. 101
    Brachiator says:

    @schrodingers_cat:

    There is a tendency in the American media to belittle Hindi cinema, call it Bollywood, doncha know they sing and dance and are ridiculous, undertone to it all.

    American media tends to belittle all cinema that ain’t Hollywood. China is “respected” only because it delivers big box office numbers for some Hollywood product.

    It is not belittling Hindi cinema to call it Bollywood. And of course, not all of Indian cinema is Hindi.

    Also, foreign movies from anywhere tend to be more highly regarded if they are closer to the American “indie” model. This is still narrow minded, but American critics have raved over the work of some Iranian and South Korean directors whose work is more “palatable” to some American critics.

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  102. 102
    Burnspbesq says:

    @PJ:

    policy holders receive sub-standard care and die

    So did i die from the cancer or the stroke? Until you clarified the situation, I would have sworn that i was alive.

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  103. 103
    HeleninEire says:

    Oh please oh please. Not a clue what I’m gonna do for health ins once I’m back. It’s all free here and a supplemental policy to cover every single thing is €1,800……a year.

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  104. 104

    @Brachiator: Bollywood makes it sound like it is a derivative of Hollywood. Indian film industry is huge and there are big budget crappy movies and innovative movies made on shoe string budgets as well. The last two entries by India at Oscars are movies like the ones you say American critics love, Newton and Court.
    Mainstream Hindi cinema is churning out some good stuff lately. One of the biggest hits last year was Raazi with Alia Bhatt as the undercover Indian spy married into Pakistani military family during the Bangladesh war of 1971. Its about how she foils Pakistani naval plans and the price she pays for it. It was directed by woman, Meghana Gulzar.

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  105. 105
    Mnemosyne says:

    @Betty Cracker:

    You know who owned mules? George Washington, that’s who!
    🤪😜

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  106. 106
  107. 107
    glory b says:

    @schrodingers_cat: Actually, I had more respect for him after hearing that she was with him.

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  108. 108

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷: I don’t know, where do you want to start? It depends on your taste in movies really.

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  109. 109
    tobie says:

    @TenguPhule: Sounds like Manchin was true to form–i.e., hypocritical and horrible.

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  110. 110
    Mnemosyne says:

    @daveNYC:

    Here’s a link that summarizes the original legislation, before the Supreme Court decided that states didn’t have to expand Medicaid:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/

    It’s not explicitly stated, but between Medicaid expansion and limiting profits for insurance companies and hospitals, for-profit insurers would have gradually decided to give up and move into more profitable insurance areas, like supplemental insurance. This squeeze would have required updates to the PPACA that would increase that 80/20 split every 5 years or so to 85/15, 90/10, etc, until it was the same as Medicaid/Medicare. Sadly, being forced to defend the very existence of PPACA meant that the regular updates and improvements that the legislators envisioned haven’t happened.

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  111. 111
    Brachiator says:

    @schrodingers_cat:

    Nicholas Jonas married into a fraudulent relationship against his will this past Saturday,” the author, Mariah Smith, wrote.

    “All Nick wanted was a possible fling with Hollywood’s latest It Woman, but instead he wound up staring straight at a life sentence with a global scam artist,” the piece added.

    Wow. I could understand it if this was a Twitter rant from an irrational Jonas fan. It’s vile and foolish. I wonder who the editor and publishers are. They are also fools.

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  112. 112
    Mnemosyne says:

    @schrodingers_cat:

    I didn’t see it, but unfortunately I’m not surprised. A big part of white supremacy is maintaining the idea that white women and white standards of beauty are the pinnacle of beauty, and a white man who marries a woman of color is a race traitor because he’s rejecting that idea. In a weird way, racists would prefer to have men of color marry white women, because it maintains that white supremacist beauty standard.

    But if white men reject the idea that only white women are worthy of marriage … well, that’s when they start muttering about “white genocide” and other stupid shit.

    I also wouldn’t be surprised if it’s a bit of a rebound reaction to Prince Harry and Meghan Markle’s wedding. The racist mutterings about that were squashed by the royal family, but the feelings are still out there. I suspect that Chopra and Jonas are getting some of that projected onto them.

    And, really, a 10-year age difference is “cradle robbing”? 🤦‍♀️

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  113. 113
    Brachiator says:

    @schrodingers_cat:

    Bollywood makes it sound like it is a derivative of Hollywood.

    It’s just a catchy short hand that has caught on. I’ve even seen the industry referred to this way in English language Indian newspapers and on Indian news sites. I don’t know that anyone really thinks that India’s movie industry somehow sprang from, or was even influenced by America.

    But I note that some people bristle at the name and see it as reductive. But I don’t see this as intentional.

    Indian film industry is huge and there are big budget crappy movies and innovative movies made on shoe string budgets as well.

    I remember reading years and years ago that India produced more films per year than Hollywood. Hmmm. Maybe Hollywood is derivative of Indian cinema.

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  114. 114
    Mnemosyne says:

    @schrodingers_cat:

    Okay, I looked at the screen shots and HOLY SHIT was that even worse than I imagined. Are we sure the writer isn’t Jonas’ ex-girlfriend? Because it was that level of crazy vitriol.

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  115. 115
    Brachiator says:

    @Mnemosyne:

    I also wouldn’t be surprised if it’s a bit of a rebound reaction to Prince Harry and Meghan Markle’s wedding. The racist mutterings about that were squashed by the royal family, but the feelings are still out there.

    Not squashed at all. They may even be intensifying as Duchess Meghan’s pregnancy becomes more observable.

    It was only recently that Piers Morgan unloaded on Meghan on some morning Brit TV show: Piers Morgan unleashes on Duchess Meghan: She’s ‘acting her way to the top’

    Morgan, Fox News, and some of the idiot UK tabloids and news sites also conspicuously defend Markle’s trashy white relatives, and can’t understand why she doesn’t “reach out to them.”

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  116. 116
    jl says:

    I don’t understand this mania for finding special big problems with single payer as opposed to other solutions. All solutions to the US health care system will be very disruptive, no matter which is chosen. There are two key things that have to be fixed in US system: prevent insurance providers from cream skimming, and preventing local insurance and provider monopolies and oligopolies from price gouging. Massive disruption is needed in other areas, but I think these two are the biggest and hardest to solve. Unless they’re solved, you will not get a good system. A single payer system will be too expensive, since it will be paying too much for services that cost much less, on average across services, in nearly every other comparable country. If you go with ‘Obama care done right’, then consumers will complain if they have to pay the tab out of deductibles and co-pays.

    So, we will have massive disruption no matter what, Single payer might be the quickest approach to inflicting that massive disruption on ruthless corporate greedheads, be easiest to get past legal challenges.

    Far too much attention is paid in the US on how the healthcare system, insurance and provision of services and goods, is financed, rather than the problems in the markets for the real services and goods themselves. IMHO.

    Look at UK, France, Germany, Netherlands, Australia, Switzerland. Extreme variation in financing methods. But all the same in beating the crap out of the US in terms of cost, access and population health. No comparison really. The US is a very corporate profit friendly killing field for both genders and all ages groups by comparison.

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  117. 117
    PJ says:

    @Brachiator: Governments are, theoretically, accountable to citizens; for-profit corporations are not. If we had serious regulation of insurers in this country, with substantial penalties for BS denials of claims, and transparency regarding costs, I would be fine with private insurance being used to organize health care, but we don’t have anything like that, and I will not be sorry to see private health insurers go out of business.

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  118. 118
    Brachiator says:

    @PJ:

    Governments are, theoretically, accountable to citizens; for-profit corporations are not. If we had serious regulation of insurers in this country, with substantial penalties for BS denials of claims, and transparency regarding costs, I would be fine with private insurance being used to organize health care, but we don’t have anything like that, and I will not be sorry to see private health insurers go out of business.

    This is irrelevant to my question. Can you show that government provided health care is superior to every other plan actually put into practice by other countries with universal health insurance?

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  119. 119
    PJ says:

    @Burnspbesq: I was generalizing about health care in this country. You may have good experiences with your insurers, many people have not. I had one insurer who repeatedly denied claims from doctors in their network even when, after obtaining a referral from my PCP, as required, I had called the insurer beforehand to make sure that they were in their network and the visits would be covered. I appealed the denials, and ultimately they covered the visits, but no one should have to spend hours fighting that kind of BS, and I am sure there are many patients with serious health problems who get overwhelmed by it and face thousands of dollars in costs they should not have to pay.

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  120. 120
    PJ says:

    @Brachiator: I am talking about the US, right now. Health care with private insurers as the gatekeepers sucks. I am for anything that is better than the status quo; if that means universal coverage via for-profit insurers that are regulated out the yin-yang with transparency of costs, fine; if that means universal coverage via single payer, fine.

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  121. 121
    jl says:

    @Brachiator: I think looking around at other countries’ experiences, evidence is that there is a problem with the profit motive, in the context of oligopoly and monopoly pricing power, in providing basic minimum coverage.

    In Switzerland, for-profit insurance companies must provide the basic federally mandated health care coverage on a nonprofit basis. They have to make profits on a separate supplemental insurance market for people who want more coverage. On the cantonal level, medical goods and services are provided using a uniform fee schedule, negotiated with industry and professional associations. I think doing that latter bit might be problematic in US and run into restraint of trade issues, but is fine in Swiss system that allows for very heavily regulated industry cartels.

    And there is a lot of publicly provided care in Switzerland, particularly for maternity, post-natal, and pediatrics.

    The Netherlands has run into milder problems of Obamacare, because that country, IMHO, left too much profit motive in the provision of the basic minimum required coverage. So you get varieties of cream skimming both between insurance companies and medical providers (who try to keep the more profitable cases to within their provider system through corrupt referrals). As a result, the risk adjustment reinsurnace system has become so complicated and all consuming, that the Netherlands system is sometimes called ‘hidden single payer’, even though on paper it is a private private competitive for-profit system.

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  122. 122
    PJ says:

    I should add that nobody wants health insurance, per se; what they want is affordable and reliable health care. Insurance is gambling on unforeseen events (it even started as literal gambling in Lloyd’s coffee shop in London.) The need for health care over a lifetime is neither unforeseen, nor should it be a gamble for patients. I am for whatever works to accomplish this, but the system we have now (much better with the ACA, I shouldn’t need to add) is woefully deficient, and I have personally not seen anything positive that for-profit insurers add to the equation.

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  123. 123
    Brachiator says:

    @PJ:

    I am for anything that is better than the status quo; if that means universal coverage via for-profit insurers that are regulated out the yin-yang with transparency of costs, fine; if that means universal coverage via single payer, fine.

    We pretty much agree on this.

    @jl: Thanks for the info and thoughts on the Swiss and Dutch systems.

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  124. 124
    jl says:

    @jl: Forgot to add that Swiss insurance companies do make cash money on their ‘non-profit’ basic health insurance policies. They get management fee, which is negotiated, and is supposed to represent the ‘normal economic profit’ that would be expected in a competitive equilibrium. I believe this is also negotiated on a cantonal basis, between government and industry association.

    And all these negotiated fees are actually soft price control bands and any company can request an exemption to charge a higher price. So, on paper, looks very free enterprise. Only problem is that if you request an exemption, you trigger an open book audit of very fart and burp committed by your company, and it could be denied. Whether denied or not, chunks of the audit will be made public. So, actually, that serves as a fairly rigorous enforcement mechanism that keeps companies inside the price bands.

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  125. 125
    laura says:

    @Dorothy A. Winsor: thank you Dorothy in Windsor. It was quite brisk, but no rain and now the sun’s shining.
    Some people are adamant about respecting the right to strike, but so many are rude in response to a minor inconvenience.
    The second pair of shoes are on and the ankles are glad of it.

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  126. 126
    jl says:

    @Brachiator: I do agree that there are trade-offs, and even if heavily regulated, keeping a for-profit conceptual framework can be useful. Swiss system is third behind US and Norway, or maybe fourth also behind Luxembourg (hard to keep track of the order behind US) most expensive system in the world. From what I have read recently, Swiss system has recently been adopting managed care systems, and they have been adopted there with fewer rip offs than in US. Swiss system, last I read is experimenting with a blended non-profit/for-profit incentive scheme for managed care.

    So, I am truly agnostic on financing system, or best way to combine for-profit and nonprofit incentives. We used to have 20 or so countries that beat the crap out of the US system. I think now there are between 25 and 30. So, plenty of models to pick and choose from, which many combination of incentive systems.

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  127. 127
    Mnemosyne says:

    @PJ:

    I was going to slightly correct you about Switzerland, but jl beat me to it: Switzerland uses private insurance companies, but the universal policies are mandated by law to be issued by a nonprofit arm of the company. The companies are only allowed to profit on supplemental policies (the kind that let you get a private hospital room, elective surgeries, etc).

    It’s not the “private” part that’s the problem. Most doctors in France are in private practice. The problem is PROFIT. That distorts the entire process of getting people covered.

    Also, a minor thing that people who work in healthcare have told me would save hundreds of man-hours: unified billing codes that all insurance companies are required to use. Right now, every company has their own system, so doctors and hospitals have to have billers who specialize in specific companies to make sure the payments get done right. That’s a dumb overhead cost that the PPACA started to try and address with electronic billing.

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  128. 128
    jl says:

    @Mnemosyne: Laura Bush (a librarian) pestered Dub into getting cracking on doing something to get the US up to international speed on electronic health records and standardization. Unfortunately it was implemented by the Dub Bushies so, watered down very much. But the US is making micro-incremental progress.

    Edit: forgot to mention that no country is perfect. One reason Switzerland has been moving to managed care for mandated and supplemental policies is that the supplemental insurance market is collapsing. Many people want the supplemental coverage, but supplemental coverage for more than amenities has become far too expensive, even for the even by European standards, very handsomely paid Swiss. I agree that the US needs to take an empirical approach and look at what can be adopted from approx 25 or 30 countries that do far better than we do, rather than go by slogans and ideology.

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  129. 129
    Sean says:

    @tobie: Still would be a lot of disruption with a hybrid private/Krankenkasse system. Some insurers would be able to adapt more quickly (Kaiser for example) but you would really want to eliminate for-profit players (it’s not so much the relatively small margins that are generated with for-profits, but more the motivators to hit those margins), even if the ACA has created some useful requirements (like medical loss ratios). And Krankenkasse cover both the employed, the unemployed, and the retired but the messy US system is so silo’d. On the other hand, the current system is closer to the German model than say the Canadian, so it would be an easier path.

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  130. 130
    Chris Johnson says:

    @Major Major Major Major: Love it. Go Pelosi!

    I am… not super amused at seeing (relatively) wealthy health insurance professionals all up in this thread telling me how unreasonable it is to have health care that isn’t primarily dedicated to the well being of insurance companies, as the only way to insure all Americans.

    I mean, go on and talk and props for the obligatory ‘full disclosure’ admissions, but like so many coal miners in today’s economy maybe you should find a line of work that’s less damaging to the country and the world.

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  131. 131
    Procopius says:

    @tobie: I think the insurance companies would fight like tigers against a Bismarck system. I don’t know much about the German system, even though I was stationed there for a total of five years in the Army, but I’ve heard glowing praise for the French system’s operation. As I understand it, though, the “insurance companies” involved are closely regulated and held to very small profits. Any insurance company executive who makes more than $100,000 a year (hahahahaha, I make the comedy) will be unwilling to take a pay cut. There is actually no reason for them to be paid so much, but they’ve grown accustomed to looting their companies

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  132. 132
    jl says:

    @Procopius: Insurance companies fight like tigers against all systems that do not allow hem to rake in maximum profits for minimum pay outs. The Swiss system is held up as a model private free enterprise system for national health insurance and medical care. But guess who hates the Swiss health insurance system and knows it is pure evil? That’s right, the Swiss insurance industry.

    Edit: but publicly, they police themselves to mainly make very helpful suggestions that just a little less regulation and maybe more profit would solve all problems. Some critics have said they have successfully done that with looser regulation on managed care plans.

    Many countries in continental Europe modeled their systems on the Bismark system, including France and early social health insurance programs in Switzerland. France came very late, so more exceptions for those in previous system, and health insurance providers organized in a simpler and more logical way (Frenchies pride themselves on system and logic). Last I read, vast majority of French insurers were non-profit associations, as in Germany.

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  133. 133
    Mnemosyne says:

    @Chris Johnson:

    Uh, the Giant Evil Corporation I work for makes movies that brainwash children into becoming lifelong consumers, which is what makes them Evil. Not sure how you got the idea I work for a health insurance company.

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  134. 134
    Adrift says:

    I work at an entity known as The New York Hotel Trades Council and Hotel Association of New York City Benefit Funds, Inc. . Our role is to provide health, dental, legal, pension and other benefits to employees of union hotels and others. We provide comprehensive medical and dental care in our four health centres at no cost to our members. We operate our own pharmacies which charge a maximum of $5 as a copay. We employ medical professionals across most specialties, including mental health. Our legal benefits are at no cost, as are our dental services. We offer a $200 yearly eye care reimbursement for eyeglasses or contact lenses to each member as well as a $200 health care card annually. All immediate family members are covered as well, including children to age 26. All of this and more at no cost to our members. How is this paid for? Our union hotels and other employers pay approximately 27% of each members wages every month to the funds. This isn’t not a payroll deduction, it is paid by the employer directly as part of the Collective Bargaining Agreement. It does not appear on any pay stub or tax document.

    We offer some of the best health care in the country, and all in one place (offered in all 4 Centers). I do not know how a single payer law in NY would affect us but I’ve a feeling it would not be good. Our members are hotel housekeepers, maintenance, front desk, security, etc. All making a good liveable wage, generally $30 plus an hour. Our work weeks are 35 hours, with overtime if you want it. You do not have to work it.

    Our system isn’t perfect but it doesn’t offer superior healthcare including hospitalisation, cancer care, transplants and coverage for our retirees at no cost whatsoever. I am truly blessed to be a part of this organisation and would love to see it rolled out on a wide scale across the country. Pipe dreams, I know, but everyone should have this level of care and security. It can be done, we prove it.

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  135. 135
    Adrift says:

    Meant to say Does offer Damn iPad

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  136. 136
    J R in WV says:

    @Betty Cracker:

    …but most people who want to take the profit motive out of the care delivery system support that approach because for-profit healthcare generates untold waste in duplicate systems, results in fat cat executives buying yachts with money intended for patient care, etc.

    I think it is immoral for companies to make fortunes supplying health care to people who will die without it. The power structure is so imbalanced that the situation is inherently immoral and unfair. People who are dying, or could die without treatment, will do anything to stay alive — and who can blame them!!

    People with all the power in that equation can do anything to remove money from the patient they want, and do just that. Immoral. These CEOs should be — I don’t know what punishment is sufficient for such a crime!

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  137. 137
    Bob Hertz says:

    Great piece, thanks, but 27% of payroll as a contribution is light years away from what most low wage employers would even consider paying.

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