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Hear that crunching sound?

It’s the eggshells that 2020 Democratic presidential hopefuls are stomping through, backing up and stomping upon all over again, as they attempt to satisfy the base’s delicate demands for Medicare-for-all.

Catherine Rampell mug

Catherine Rampell

The left-wing die-hards sometimes argue that supporting Medicare-for-all should be a litmus test for anyone seeking the 2020 nomination because it’s not only good policy but good politics, too. The entrenched establishment may claim it’s a “radical” idea, but surveys suggest it is mainstream.

“If I look at polling and 70 percent of the people support Medicare for All, if a very significant percentage of people think the rich, the very rich, should start paying their fair share of taxes,” Sen. Bernie Sanders, I-Vt., told The New York Times, “I think I’d be pretty dumb not to develop policies that capture what the American people want.”

In a sense, Sanders is right: The phrase “Medicare-for-all” polls favorably (though not always at 70 percent), and has for several years.

Here’s the problem. The things Americans are apparently envisioning when they tell pollsters they support Medicare-for-all turn out to be a different, vaguer and more varied set of ideas than the specific thing that Sanders, Rep. Alexandria Ocasio-Cortez, D-N.Y., and others in the progressive base are proposing.

Sanders, et al. want all Americans enrolled in a single, generous, government-run — or single-payer — plan with no private insurers offering their own similar, competing policies. Sanders said he envisions the role of private insurers only for “cosmetic surgery, you want to get your nose fixed.” (To be clear, this is not how Medicare currently works; the program relies heavily on privately run insurance plans.)

How does the public feel about this?

If you simply ask, “Do you favor or oppose having a national health plan, sometimes called Medicare-for-all?,” 56 percent of respondents favor it, according to a January Kaiser Family Foundation poll.

But mention that Medicare-for-all involves getting rid of private insurance companies, and support plummets to 37 percent. Which should not be that surprising. Most adults have private insurance, and most of them like it.

They’re nervous about losing it.

Sen. Kamala D. Harris, D-Calif., learned this the hard way, when the presidential candidate spelled out during a CNN town hall last week that she favored eliminating private insurance.

After a backlash, Harris’s staff walked back her comments, noting that she preferred Sanders-style single-payer but had also co-sponsored other bills that allowed existing private insurance plans to coexist alongside expanded public insurance. That, in turn, inflamed the left. A former Sanders staffer said it was equivalent to saying “you’re OK with people dying for being too poor.”

Wary of provoking the single-payer-or-bust-ers, other Democratic 2020 candidates have given incoherent or noncommittal remarks on the subject.

Pete Buttigieg, the mayor of South Bend, Ind., said he supported “single-payer” but also the use of private insurers, eventually endorsing “Medicare for all who want it.” Sen. Cory Booker (N.J.) confusingly said he supported the continued existence of “private health care,” which might mean insurers but also might simply mean providers.

Sens. Elizabeth Warren (Mass.) and Kirsten Gillibrand (N.Y.) — who, like Harris and Booker, co-sponsored Sanders’ single-payer bill — have both sidestepped the issue. Asked about private insurance, Warren said last week there were a lot of paths to get to “affordable health care for every American.”

And you know what? That’s the right answer right now.

The thing Americans want most, if you look at the polling, is not single-payer per se. They want universal, affordable coverage that doesn’t leave them begging on GoFundMe for their kids’ insulin. In that same Kaiser survey, support for “Medicare for All” was highest — 71 percent — when respondents were told it would “guarantee health insurance as a right for all Americans.”

And purity tests aside, there are many ways to achieve that outcome. Across health policy wonkland, there are vibrant debates over many alternative ideas. These include allowing non-elderly adults to buy into Medicare; allowing employers to purchase Medicare for workers; a Medicaid buy-in program; and enrolling all newborns in a government health plan.

Rather than insisting that “there’s no viable path to the Democratic nomination for someone who does not support single-payer health care,” as one progressive writer put it, Democrats should start with principles and objectives, and figure out the most effective and feasible route to them.

This is the richest country on Earth. Truly, we can figure this out. But not if we let the perfect become the enemy of the good.

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Catherine Rampell’s email address is crampell@washpost.com. Follow her on Twitter, @crampell.

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(64) comments

DMoney

I wonder what would come along with taxpayer funded Medicaid for all? Mandatory meal plans? Mandatory fitness routines? Tobacco illegal, alcohol consumption reduced? Or would the government simply let the people remain free even though bad habits result in more medical needs/costs?

PhysicsIsFun

I love the slippery slope argument. It certainly is something to rely on when you've got no good argument.

oldhomey

Exactly, Physics. But perhaps D is simply trying to make us look to Europe and Japan, advanced industrial societies like our own that have had universal healthcare for half a century, so that we can see what a nightmare it has been for those people. Those countries are constantly torn apart, I guess, be the heavy hand of government insurance banning all tobacco and alcohol sales and mandatory low-fat diets. Oh, wait! Those things have NOT transpired in those societies, and it would be political suicide now for any politician to suggest doing away with universal health insurance. But then, why would anybody make such a suggestion, when everybody has access to good healthcare and medications, provided at half the cost to the nation of what the US pays out annually for much less healthcare, leaving tens of millions without healthcare or severely substandard healthcare.

DMoney

You DO know there are opposing views on healthcare in those countries, right? If this was such a great thing for EVERYONE, why hasn't it been done yet? If it's SO great and popular, why make it mandatory? Why have no individual states started single-payer? Why wait on the federal government?

oldhomey

D, could you supply us ignoramuses with some evidence that there is strong opposition to the national healthcare plans that have been in place in Europe for the last 50 years? I don't mean people crabbing about some aspect of delivery of care, like having to wait to see specialists for a few months sometimes. It happens to people who are not in peril. But if you need immediate, timely care, you get it there. Even if you are an American tourist who has a health emergency. You will get treated, hospitalized if necessary. People always have reasons to gripe about service, sometimes legitimate gripes, but there is no groundswell in Europe to do away with national healthcare. Far from it. Of course, you, the man who makes such good decisions, may have seen some compelling evidence otherwise. Let's see it.

oldhomey

D, you DO know that you have been called out, don't you, asked to provide some back up evidence for your statement here at 5:42pm? Are we to interpret you subsequent silence for the past 30 hours to mean that you DO know that you have no evidence and evidently were wrong in your supposition?

DMoney

I was asking a question. Do you have a good answer?

oldhomey

I am not sure what question you are wanting answered, D. If it is the question as to why, if national healthcare is so great for EVERYONE, as you so eloquently put it, why hasn't it been tried here already, that is a question that the majority of Americans are wondering about. Let's get it done. A very conservative Republican governor of Massachusetts, Mitt Romney, whom I sure you remember and probably liked very much as a presidential candidate, DID implement a plan approaching universal health care just for Massachusetts. People there liked it very much, and it did not bankrupt the state. Obama liked it so much that he based Obamacare on it. The insurance companies hated it so much that the spent, spent and spent money opposing it so vociferously that even Mitt Romney opposed his own plan. Go figure. Would you join the rest of us now and campaign to get big money from billionaires and industry out of our political system?

martian2

I don't see any country in the world having demonstrations against their healthcare system and wish to have our hap hazard system instead. Not one! That should tell you volumes, unless of course you listen to the nay sayers who are always fearful of any change and whose philosophy in life is self centered.

capedcrusader

oldhomey, now that would be fake news.

DMoney

I think there ought to be some health requirements. That would be the responsible things to do. If the public is paying the health bill, would it not benefit our mutual funds to lower our mutual costs? Why should I just be healthy, active etc. if I don't receive benefit of lower cost? Why would taxes be so high to pay for people who choose to live unhealthy? If I'm paying more I'd want more say in the health of others. But...oh wait...that pesky Constitution.....

oldhomey

Yes, D, we all forget, you are the guy who makes impeccably good choices. If people just followed your recipe for a healthy life -- presumably little red meat, lots of vegetables and fruits, daily exercise, moderation in all things except for right-wing opinions -- we all would live long and healthy lives with minimal health expenses. Children, like my stepdaughter, if they would just stick to your regimen (and she generally did) would not get hit by fatal cancer, as she did before she could get on my insurance. But children are SO sloppy in their lifestyles, so why should anybody else pay for their bad habits if they come down with serious illnesses? Ditto for women like my mother, who never touched a cigarette in her life, barely touched beer or wine, but nonetheless died from cancer as she struggled with dementia, another disease she should have avoided, but probably did SOMETHING WRONG in her lifetime to cause it, so why should anybody else contribute to a system of insurance that would assure somebody like her with medical care. Fortunately, millions did through Medicare. But . . . oh wait . . . that pesky Constitution?

DMoney

Sorry for your losses. But you are going back to the zero-sum approach again. It's not all or nothing. It's obvious that good health choices will result in overall less healthcare cost. There's nothing that would argue against that, when taken over the sample size of millions of people over many years. If you so vehemently argue for the science behind global warming, surely you would support data related to health and human biology, and it's associates with medical costs. This is especially relevant when speaking on social health care, considering the astronomical costs associated. How many other countries with "successful" social health care have populations the size and diversity of ours? How many have a higher proportion of elderly and obese? How many have a higher degree of tobacco/drug users? I don't know the answer but I'm confident the answer is zero. Our freedom has a downside--and that's cultural "sloppiness". We'll pay dearly for our lifestyles when the social medical bill comes due. The billionaires are going to have their hands full.

oldhomey

Gosh, I didn't realize you were a closet sociologist, D, poring over charts of health statistics and in population size, ethnic and cultural variables contributing to differing costs and healthcare outcomes between nations. I guess if we didn't have all these African American and Hispanic people clogging up the works, it would be safe to have a cheaper, more efficient and effective healthcare system? Have you ever been to France? It is still predominately Caucasian and ethnically French, but it has a considerable minority population of people from its former Arab and African colonies and has for roughly 75 years, The French defy all medical advice by the amount of wine they consume. I haven't been here for 20 years or so, but they also smoked more heavily than any country I have ever been in. They, like other big industrial nations, spend about half what we do on healthcare, but everybody is covered and they have better health outcomes than we do. Maybe we'd do better if everybody in this country had access to healthcare and professional health counseling, avoiding catastrophic and tragic death that so many of our poor and unemployed are condemned to.

DMoney

And I didn't realize you were openly racist. Are you disagreeing with the university accepted science that a healthy lifestyle leads to lower healthcare costs (not for an individual but a society)? I gave you more credit than that... What's France's population to ours? What's their obesity rate to ours? What's their alcohol consumption to ours? Prove me wrong. Actions speak louder than words.

DMoney

*universally

oldhomey

Perhaps you could share with me and the rest of the world some evidence that I said anything racist in my comments, D. As for relative obesity in America and France, I can't find any figures, but I would assume we would be a country with more obesity. As for alcohol consumption, France is the fourth highest consumer per capita of alcohol, according to the World Health Organization, 11.4 liters per capita. The US is much lower, coming in 25th in world ranking for per capita alcohol consumption. Does that explode any of your preconceptions?

martian2

what the heck does size and diversity have to do with healthcare? Are you saying diversity drives up healthcare costs, that minorities are to blame? Is that another argument against immigration? Does being white of European descent make you healthier than all others? Wow, you are going down a slippery slope there Dman. Instead of being a nay sayer and scared of change, think of all the great things because some people weren't afraid. Why we wouldn't even have a country if over 200 years ago people thought like you, scared of their own shadow. women would of never got that right to vote. Slavery would not have ended, and we would still be in the horse and buggy days.

martian2

its my understanding that medicare as it stands now only covers 80% of health care costs. You need a private supplement insurance to cover the rest. So medicare for all does not mean no private health insurance. It has to be a combination of medicare and private insurance, with medicare being the primary insurance. So what is wrong with that scenario? Certainly medicare for all doesn't have to be some kind of litmus test for democrats, there must be other ways for covering all Americans.

PhysicsIsFun

Medicare Part B (covers doctor visits etc.) covers 80% of the bill. So yes many people purchase a supplement policy which then covers the 20% copay. Just so those of you who think Medicare is free, besides the money deducted from your paycheck throughout your working life. You need to pay the following monthly when you are on Medicare: Part B premium about $135, Supplement $150 - $200 (goes up with age), Part D $15 - $40 (depends on coverage). Then of course there are deductibles and other copays. You could get Medicare Advantage which is cheaper, but then that is private for-profit insurance and there are numerous disadvantages and traps involved in that. The non governmental aspects of Medicare are by far the most problematic. Insurance companies play gotcha with the premiums and coverage all the time. I know our Ayne Randian on here Dmoney believes private industry is always better than government, and he is right if by better he means better at making money and denying or delivering poor service.

martian2

thank you for clarifying that for us physics! We can always count on you for an honest and factual response.

DMoney

Yes, because those owners/leaders/employees/shareholders of private businesses make their paycheck no matter the level of service or efficiency......................oh wait...

oldhomey

D, your your 6:44pm post shows that your facility with humor easily matches your facility with using simplistic, ill-informed opinions. But it IS consistent, showing you holding strongly to the opinion that people with lots of money must be smart and know what is best for the rest of us.

PhysicsIsFun

Until they decide you are expendable, too old, too expensive, too problematic, or they can make more money cutting staff. It must be nice to have it all figured out. That is because you are so talented and only make good choices.

martian2

Dmoney and his boasting how smart and talented he is comes straight form talk radio. That blabber mouth Rush has been spewing that garbage for decades now. Now Dmoney wants to be just like him, a know it all-I am smarter than you, a big mouth conservative afraid to listen to experts or facts. And there are many wanna bees on talk radio like Rush, same old garbage just a different voice.

DMoney

If a private business does not generate demand, which is generated by the quality and availability of it's goods/services, it does not survive. It's employees do not stay employed. It's shareholders do not make a profit. Therefore, it is in competition with other related private businesses to offer better services or products in order to compete for demand and limited resources. The net effect is excellent consumer choices that are improving daily. How many of you use Netflix, Amazon Prime, Uber? Hello? What are public services doing to innovate and improve? Answer: nothing. Because they don't have to. Shocking this must be explained to folks who consider themselves forward thinking.

DMoney

Physics, true. The business must survive so that all employees are not unemployed. If one has experience, energy, ambition, dedication, work ethic, adaptability, etc. then one does not need to worry about one's position. Especially if they do not become reliant on the compensation offered by one's company. I'm not special, there are millions like me (and many of them are conservatives).

Are you sure you are not being a hypocrite? I recall you wintering down in Mexican resorts? Guessing that's not a byproduct of poor life choices? Also Homey/Martian have indicated solid life choices as well. I think we're all members of the massive "good choices club". I just have the courage to call it as it is.

DMoney

Yeah liberals definitely don't listen/watch liberal celebrities/activists/commentators/radio hosts/TV hosts. All of your ideas and opinions are totally unique.... just like a snowflake.

Martain, with comments like that, I don't ever need to resort to personal attacks. You self inflict them. Keep em coming.

PhysicsIsFun

I am not on a Mexican resort. I do spend the winter in Mexico. Yes I made good choices in life. Yes I worked hard, but those things which had the largest positive impact on my life were out of my control. Those include: my race, an intact family, a middle class childhood, good health, above average intelligence, athletic ability, good luck and others that escape me. Anybody who attributes their success to their own innate choice is missing the big picture. There are literally millions of people smarter and more gifted than you or I who are living in poverty and misery, not because of their choice but because of the circumstances of their birth. I couldn't put it any better than F. Scott Fitzgerald did in the opening lines of the Great Gatsby, "In my younger and more vulnerable years my father gave me some advice that I’ve been turning over in my mind ever since. 'Whenever you feel like criticizing any one,' he told me, 'just remember that all the people in this world haven’t had the advantages that you’ve had.” Do us all a favor and change your screen name from Dmoney to John Galt. It is far more representative of your selfish philosophy. Ayn Rand and Paul Ryan would be proud.

oldhomey

D, you forget that I am retired. I can't answer for anybody else, but I personally have never once availed myself of the services Netflix, Amazon Prime or Uber. I am sure you will find something in that knowledge to now attack me for it.

Your "good choices" shtick is about as silly as they come. I my not be very "with it" when it comes to digital technology and services, but I do know this (and Uber and Lyft are great examples): We now live in a distressingly rising gig economy, where employers find it convenient and cheap to not have permanent employees. You think you made a good choice in finding a job with health insurance? Talk to me in ten years (though I may well no longer be around by then) and let's see if you still have a job or if you are yourself working for the gig economy. Did I make good choices? Of course. Most of us do. And we also make plenty of poor choices, too. But coming of age when jobs were plentiful and employers were throwing benefits around to attract talent was not a product of my choice, it was my good fortune. And apparently yours, too, when so many people have no choice but must toil for a gig economy.

DMoney

Physics I don't know you, but all evidence points to you being the "bourgeois socialist":

Marx acknowledged the bourgeois industriousness that created wealth, but criticised the moral hypocrisy of the bourgeoisie when they ignored the alleged origins of their wealth: the exploitation of the proletariat, the urban and rural workers.


PhysicsIsFun

You said one correct thing. You don't know me. Get back to your libertarian baloney. Here is the best quote I have heard about libertarianism, "If you think that selfishness and cruelty are fantastic personal traits you just might be a libertarian. In the movement no one will ever call you an a$$hole, but rather, say you believe in radical individualism."

martian2

oh boy, now the name calling and desperate labeling is coming from Dmoney. Marx has nothing to do with the discussion. As a Christian society, as most republicans and conservatives believe we are, there are many examples in the new testament that show us that we need each other, we should be kind to one another. acknowledge one another's existence as critical to ours, and that we are all in this together, and we are to help the poor, disadvantaged, the sick and imprisoned. Promoting "individualism" and self centered living goes against all that.

martian2

"bourgeois" - a member of the middle class. "bourgeoisie" a social order dominated by bourgeois. So you are accusing physics of being part of the middle class there Dmoney. I think you are probably correct. Marx obviously didn't know what he was talking about.

DMoney

If I'm right, it's the most despicable form of socialism: someone that participates in, cultivates, and advances the idea of capitalism but hides under the false shadow of oppression. As long as you are not the one sacrificing, paying, being controlled--socialism is a good thing.

oldhomey

Why did you ask the question D? The answer is no, you are not right, just a right-winger.

DMoney

Why are you spending the money required to winter in Mexico when there are hungry, unfortunate people? I'd do the same thing as you. But I wouldn't then question the formula that allowed me to live such a way.

martian2

well anyone knows its cheaper to live in Mexico Dmoney? Doesn't take any brains to figure that one out. And news flash, there are hungry and unfortunate people in Mexico too. So there you go, withhold your condescending judgement till you know what you are talking about.

PhysicsIsFun

I do not know where you came up with the notion that I am the champion of the disadvantaged in LaCrosse. I merely feel that you with your pompous self congratulatory rhetoric need to take a look at the things in your life that contributed to it. How your life gave you a boost that others may not have had. Stop patting yourself on the back with regard to your talents and good choices and admit that you were lucky when others weren't. Maybe people need to work together to help each other. There are always people who take advantage of the system, but most do not. I am no socialist, but I do believe that we can achieve more if we work together. Rampant capitalism is not good for a society anymore than rampant socialism is. We need a mix of both. Public schools, public roads, many public institutions perform well and serve us all. I would gladly compare the University of Wisconsin to the University of Phoenix.

DMoney

I've never once congratulated myself. Not once, guaranteed. You are inventing that. I've congratulated you and oldhomey many times. I've called myself not special many times. So please drop that, cuz it just ain't true.

You came back to the middle there at the end. I can live with that.

PhysicsIsFun

You know they have universal healthcare in Mexico. Your premium is based on your ability to pay. Even the poorest get good healthcare. Their government is far from perfect, and they have problems, but they have that figured out. If most other western style democracies have universal healthcare why can't we in the USA have it?

DMoney

Why can't the poor/lower classes pool their money. The middle class and rich who feel so inclined can donate as much as they possibly want to. I'll chip in. Millions would chip in. Whatever money is pooled is allocated to a board who determines expenditures. I'm sure they would factor in age, potential, etc. But that way it's a co-op, 100% voluntary, constitutional.

If we must go universal, I'll agree on one condition: I get a say in the lives of those who receive benefits without paying. If I am expected to contribute my hard earned money so that others may receive good care, then I expect those who receive this care to contribute as equally as I do, within reason and ability. Deal?

martian2

trying to track what you are saying on your 5:36 post. So you want a say in what type of care someone who is poor and doesn't pay. So if someone is not currently paying into a health care system, you want to be the decider among other things, on whether they live or die. Wow that is about as arrogant and self righteous as it gets. And you call yourself a pro lifer! Wow that just blows my mind. What you don't understand Dmoney, and probably never will, those that don't currently have health insurance, and seek medical care through the emergency dept. at the hospital is currently being paid for by you whether you realize it or not. You pay for it with higher insurance premiums and out of pocket costs. Its called paying through the back door. Universal health care says let's pay through the front door, with everyone pooling their money together to pay for the costs up front. Those that can't currently afford to help pay to the pool of money, get help anyway so some day they may contribute when they are well. You got it in your head that you are in total control of your life. Only someone who is totally mad would think that. There are a million variables in life that determine where our lives are at. You would best remember that as the years go by, and you experience life changing events you have no control over. We are all in this journey together, the sooner you realize that the better off you will be.

oldhomey

D, you continually pat yourself on the back for making good choices, smugly suggesting that poor people do not. There are already plans afoot to take you up on your suggestion of poor/lower classes to pool their money for a healthcare plan, with people better off than them also kicking money into it. It's called national healthcare, it will be a cooperative effort, totally legal and 100 percent constitutional. It figures that even though who do not directly pay into it are contributing in different ways to the overall economy that makes the vast wealth of this country possible. What would be unconstitutional with your plan is your stipulation that you would have the right to have a say in the lives of anybody, not just those who are too poor to have salary deducted into the healthcare plan. What kind of nosy busybody are you, anyway?

DMoney

Physics, that's not what I was suggesting. I'm suggesting I'd want a say in how those who receive care live their lives. Alcohol intake, work habits, etc. That's the burden of receiving and not contributing. Whether they are just unlucky or made terrible choices. I want this (and by I, I mean all those who pay in) because we should have a say in where resources go and what is returned. No different than how you managed your portfolio that allowed you to be a snowbird.

DMoney

And I am in total control about how to react to the events of my life. I could get cancer tomorrow. I could lose my job tomorrow. Worse could happen. Can't control circumstances but can totally control my response. As can any living, sane human being. It's called resilience.

DMoney

Homey, I'm not patting myself on the back. I'm stating facts. I'm not especially talented, smart, attractive, disciplined. I'm an average Joe. And even I can make good decisions. A homeless guy on the street can make good decisions. That should be a thing every person can be proud of, not ashamed by. Someone with as much life experience in this country should understand that.

Regarding health care, as long as I am not coerced into paying into a plan for all, great. If I'm not forced to pay for others and some of their poor lifestyles, I don't care about the decisions they make. If I am, then I do. Because I am a contributor. Another thing, what if I pay in my entire life, hundreds of thousands of dollars, but stay healthy. One day I'm 80. Severe illness. Will I really receive the same priority as young people, despite the fact I've paid in far more? Isn't working for social security. You yourself admitted that extreme measures are necessary to ensure the viability of social security.

martian2

Dmoney you still don't get it, you are now forced to pay for those who are uninsured. Yes you are, you just don't acknowledge it. And you want to denigrate those who don't pay in to the health care system. Well then children don't pay in directly. what about the family with six kids versus two kids. Shouldn't the six kid family pay three times as much? and those with disabilities, they can't pay. You want to ration their care, or even deny it? Your scenario is backwards and inhumane. I am glad you think you are soooo resilient no matter what life throws at you. You don't need anyone's help, your bloated ego tells you. I hope life is kind to you and your family. You will learn that life has a way of changing a person's attitude and philosophy. And you may find yourself needing others to manage and survive those life changing events.

capedcrusader

Sounds to me like DMoney doesn't like being a team player. Sounds to me like DMoney remembered the "all for one" but forgot the "one for all" part.

DMoney

Martian, I have insurance. My costs might be marginally affected by people who receive care but can't pay. But that affects my insurer more than me. Universal health care would cost a heck of a lot more. Regarding the examples you listed--those are all problems we would face with universal healthcare. Parents with lots of kids SHOULD have to pay more in such a system, but they wouldn't. Society didn't tell them to have 6 kids, but we would sure be responsible for paying for them. Unfair. Handicapped, elderly, otherwise SHOULD have coverage, and I believe they currently do. But they can't possibly pay in and the elderly paid taxes their whole life. The fact is, nowhere in the Constitution does it require citizens to be coerced into paying for other citizens. You can call that inhumane. I call it liberty. Lastly, I don't think I'm resilient. I am resilient. I'm happy I am. I'm certainly not ashamed. And the only reason I brought that up was in response to being questioned about events in life happening outside of the good decisions I make. One can only control their responses. Dr. Phil has a great quote about it.

oldhomey

Bernie Sanders, of whom I am not a great fan, D, says that Medicare for All would cost about $3.2 million annually, which seems like an awful lot of money to me and has caused some conservative pundits to tsk-tsk Sanders for being such a spendthrift with such a proposal. What do you think?

crank

"Bernie Sanders, of whom I am not a great fan, D, says that Medicare for All would cost about $3.2 million annually, which seems like an awful lot of money to me and has caused some conservative pundits to tsk-tsk Sanders for being such a spendthrift with such a proposal. What do you think?"

Do you even consider these things you write? 3.2 million? That would be a bargain! But...Not even close... Not even $3.2 Billion! You liberals never quite seem to be able to calculate these things correctly.

Bernie was saying it would 'only' cost $32.6 TRILLION (with a T) additional over 10 years. So... (Go ahead...move the decimal.) $3.26 TRILLION additional dollars per year. Add that to the $1.1 TRILLION already spent annually and we get $4.36 TRILLION per year.

That number is $4,360,000,000,000 per year. Let's consider this for a moment. If you stack 1 trillion dollar bills, the height of that stack of dollar bills would reach about 67,866 miles. It would reach more than one fourth the way from the earth to the moon. #trivia #bignumbers

If you divide that number by the roughly 325 million people in the US, that's a little over $14,000 per person/year. It does seem like a good deal, yeah?

Unfortunately, we have seen how our politicians and government do math. It they say it will only cost $X, double it. When they promise a savings of $X, cut it in half. Obama, as an example, said I would save $2500/year on health care with ACA. Again, not even close... I didn't even save $1250 per year so this guidance on political math was generous.

Stick to the finding big words in your thesaurus, oldhomey. You aren't very good with big numbers.

DMoney

I just read his entire, full plan. I didn't see that number. I did see massive tax rates for the rich. If you think they'll just take that in the shorts, you are crazy.

oldhomey

Oh gosh! This IS embarrassing! I had a typo and wrote "million" when I intended "trillion". I made the mistake, crank, I accept the jacket. It was stupid and careless of me to not proof read what I sent before I sent it. You got me. You scored one on me. I deserve your scorn on this one.

Now, when you are over your paroxysms of joy on catching me on something, let me point something out to you. The estimate for Bernie Sanders' Medicare for all for the first ten years was not his estimate, but one that came out of a study group funded by the Koch Brothers, and it was something like $32 trillion for those ten years. That comes out to an average of $3.2 trillion annually. Do you know how much we spend in this country on healthcare right now?

No, it is not $1.1 trillion I don't know where you dug out that low ball figure. Americans spent $3.5 trillion on healthcare in 1017, which comes out to $10,700 for every man, woman and child. That is not a figure pulled out of a hat. That is the compilation made by the federal government. $3.5 trillion. That is roughly twice as much as any European industrialized nation spends per capita, but then they all have some form of nationalized healthcare, and they give free, tax-supported healthcare to every man, woman and child in their respective countries. Americans? We let tens of millions go uninsured and unprotected, and allow middle class families to fall into bankruptcy trying to pay for care to save loved ones seriously ill or injured. That doesn't happen in countries with national healthcare plans. Period. Full stop. And in the short and long run, they pay half of what we expend.

I have no idea if we could get our costs down to half of what they are under a similar plan, but if we get them down at all, it is an incredible benefit to the health and well being of all of us in all ways, including economically.

I notice you say you didn't get the "promised" $2,500 savings in health insurance under Obamacare, or even half that. But you conspicuously don't mention if you did, indeed get some savings out of it. Makes me think you did. But if you did, you wouldn't admit to it, because you're a crank.

But yes, you did catch me in a bad typo. I am embarrassed. Hope it makes you feel good, a little less cranky, perhaps.

oldhomey

Before you get too happy about my latest typo, crank, I will amend my latest post to say that the actual figure for annual outlay for healthcare in the U.S. was $3.5 trillion in 2017, not the year 1017.

oldhomey

Well, D, the one percenters gladly accepted huge tax cuts with the 2017 tax "reform" bill. Now that people are beginning to file their taxes this year, a lot larger percentage of ordinary schmoes like you and me are discovering that their actual tax refund is going to be smaller than in previous years because of the loss of write-offs such as state and local taxes and mortgage interest. In fact, a lot of people expecting refunds are finding that they instead owe Uncle Sam. Do you think they don't know the extremely rich got huge tax breaks, increasing their incomes by hundreds of thousands or even millions a year? How happy do you figure that is going to make them with Trump and the GOP. Paul Ryan escaped in the nick of time. Mitch McConnell did not. A few thousand billionaires and multi-multi-millionaires aren't going to take a tax increase in the shorts? They are likely going to get the biggest boot of their lives in their posteriors, considering the way this tax "reform" is written, as it is only going to get worse for the likes of scores of millions of ordinary tax-paying voting mopes like you and me:

"By 2027, more than half of all Americans — 53 percent — would pay more in taxes under the tax bill agreed to by House and Senate Republicans, a new analysis by the Tax Policy Center finds. That year, 82.8 percent of the bill's benefit would go to the top 1 percent, up from 62.1 under the Senate bill."

crank

Note again... the $32.6 Trillion was ADDITIONAL spending according to Bernie. So... ad that number to the giant number already spent and you get a lowball estimate (though a really huge sum) got what this will ACTUALLY cost. To get close, take the multi TRILLION dollar figures and double them.

This is because government is not accountable. They don’t need to operate in the black. I can’t sue them, not effectively anyway. I don’t have an army of lawyers or a war chest. Politicians rarely go to jail or are held liable for their incompetence and lies. I certainly would never be compensated if they screwed up my healthcare. The reason I don’t trust the government plans for these things can be summed up by ‘flaming water skis’.

I might feel better about our government’s abilities if they could bring drugs costs down in this country. Instead, they prohibit people from sourcing prescriptions from Canada. Start there... maybe start with insulin.

FYI: Obamacare increased my cost of healthcare. My insurance premiums went up by approx 40% and my deductible doubled.

martian2

well crank, you say government isn't accountable and it is hard to sue. Well have you ever looked at private insurance companies, they are no cake walk either. No one is held responsible there either, and they have a chest full of lawyers too. gosh they sound a lot like government. Once in a great while private insurance might have to pay a big settlement, but we all pay for that with bigger premiums and out of pocket costs. Insurance companies and their paid lobbyists are in the politicians hip pocket, forking over huge amount of money for elections. Think that doesn't influence politicians? Everyone's premiums went up during Obama care era, even those not on obama care. The argument is they went up at a slower pace than if obama care was not in place. I guess we will never know for sure. I do know the price of healthcare in this country is the highest in the world, outrageously high! The system we've had in place for decades is obviously not working.

oldhomey

Okay, crank, I admit I may not be on top of this as much as you are, so you will have to back up this assertion of yours for me before I can accept it: "the $32.6 Trillion was ADDITIONAL spending according to Bernie."

It seems to me, and of course I may be wrong, but you will have to point out to me how I am wrong, that you are assuming if we went to a national healthcare plan the money being spent already on private healthcare, $32 trillion, would still be expended, PLUS $32 trillion in additional expenditures for the new, nationalized plan. I don't think it would work that way. The very, very wealthy might continue their own private plans for more privileged care, but most of us would be on the national healthcare plan.


The government is not accountable? That was what Donald Trump thought, until the new House of Representatives was seated this January. You think it is easy to sue a gigantic insurance company? There are specialist law firms that do it, but they don't take any jamoke who walks in off the street with a beef as clients. They have to be somebody who has a really good beef that stands to win millions, if the suit is successful.

I have no idea what this business is about flaming water skis, but I will say this: If there is evidence of deep disenchantment with treatment and treatment outcomes in those rich industrialized nations that have had nationalized healthcare for more than half a century, I have not heard of any evidence of it. Are you saying Americans are less capable in this regard than they are in Europe and Japan?

As for your experience with Obamacare, you could have said that straight out instead of backing into this explanation, as you have. I guess we will just have to take your word for it that this was actually what you experienced.

crank

“No, it is not $1.1 trillion I don't know where you dug out that low ball figure.”

I guess I should have been more clear. $1.1 is the amount spent by the federal government annually. I think the figure came from 2018. That portion is part of the total you gave of $3.5 Trillion.

Source: https://www.taxpolicycenter.org/briefing-book/how-much-does-federal-government-spend-health-care

So, I added the $3.26 Trillion (additional) Bernie said it would cost annually. If you’re saying it would cost an additional $3.26 Trillion on top of the total amount you say is spent on health care (though you don’t give your source) of $3.5 Trillion, you’re actually painting an even worse picture and hurting the case you’re trying to make for single-payer government healthcare costing less.

If the US is spending a TOTAL $3.5 Trillion annually, and Bernie says adding $3.26 Trillion (almost doubling the total) would give everyone healthcare, how is that reducing the cost of healthcare? Not only that, but I contend that Bernie’s estimate is on the low end. I’d double his figure…

crank

Martian, we cannot sue the federal government. We can sue insurance companies. Since insurance companies have a profit motive, since criminal charges can be brought against insurance companies, since I people CAN get a settlement if they filed suit against an insurance company.... That provides some incentive for adhering to the rules. There is more than one insurance company. If one is skrooing their policy-holders, the government can fine them, force them to stop, arrest the execs, we can form a class and sue them (look up class action suit on Google) and therefore have some clout and some recourse against the big evil insurance company.

In contrast, we cannot form a class and sue the government. The federal government cannot be sued.
We cannot sue lawmakers for making laws and scrooing us.
We can only sue to have the laws they make invalidated and if we are harmed by those laws, we are not compensated.
Politicians live in a class by themselves and are protected. Insurance execs not as much.

"In the United States, the federal government has sovereign immunity and may not be sued unless it has waived its immunity or consented to suit. The United States as a sovereign is immune from suit unless it unequivocally consents to being sued."

crank

Let's not overlook the suggestion I had... If the aim is to reduce healthcare costs overall, politicians could demonstrate their ability and gain the faith of opponents like me by taking on a smaller issue, pharmaceuticals.

If the government can take on big pharma and make meaningful changes to reduce the cost of prescription drugs in this country to be in line with prices in other countries, I might have some confidence in their claims about reducing costs overall.

So far, basic drugs like insulin have skyrocketed even thought the technology to produce recombinant DNA insulin and biosimilar insulin hasn't changed. Those costs should be going down. Epi pens is another great example. The government has restricted the manufacture of auto-injectors for epinephrine while mandating schools and other places have them available. The manufacturer increased the price 400%. Epinephrine is pretty cheap. Coincidentally, the CEO of the company (Mylan) which makes them is the daughter of US Senator Joe Manchin.

Somehow, I don't trust them to do what's right for the 'average' Joe. Fix drug costs first, then maybe we can talk about the rest of healthcare.

capedcrusader

Guys - Bernie Sanders says a lot of things...

DMoney

Can someone logically explain how National healthcare WOULDN'T set a precedent for national anything else? Why would we stop at healthcare? I know this is the slippery slope thing, but please humor me.

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