If you do this, you have to federalize Medicaid instead of having the polite fiction that it’s a state-run program. States have dropped the ball even before the financial meltdown.

Not necessarily. States would just pay as they currently do for those under the poverty level.

We’ve sort of got them by the gonads if you will in that if they force this current piece of garbage down our throats, they’re going to hand leadership back to the GOP. Period! End of story!

how do masaccio, a nice diary, I always like to post thom hartmann’s letter to obama concerning medicare for all;

Dear President Obama,

I understand you’re thinking of dumping your “public option” because of all the demagoguery by Sarah Palin and Dick Armey and Newt Gingrich and their crowd on right-wing radio and Fox. Fine. Good idea, in fact.

Instead, let’s make it simple. Please let us buy into Medicare.

It would be so easy. You don’t have to reinvent the wheel with this so-called “public option” that’s a whole new program from the ground up. Medicare already exists. It works. Some people will like it, others won’t – just like the Post Office versus FedEx analogy you’re so comfortable with.

Just pass a simple bill – it could probably be just a few lines, like when Medicare was expanded to include disabled people – that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

So it’s revenue neutral!

To make it available to people of low income, raise the rates slightly for all currently non-eligible people (like me – under 65) to cover the cost of below-200%-of-poverty people. Revenue neutral again.

Most of us will do damn near anything to get out from under the thumbs of the multi-millionaire CEOs who are running our current insurance programs. Sign me up!

This lets you blow up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with Blue Cross. Those who like it can buy into it. Simplicity itself.

Of course, we’d like a few fixes, like letting Medicare negotiate drug prices and filling some of the holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy “supplemental” insurance, but that can wait for the second round. Let’s get this done first.

Simple stuff. Medicare for anybody who wants it. Private health insurance for those who don’t…

Respectfully,

Thom Hartmann

Is this statement in a petition that I could sign?

The politics are rotted here–to put in a subsidy for the already profitable–while trying to drown Single Payer/Medicare Universal or deny the very topic of it at at the public table of discussion/consideration.

We have a priesthood here that is not going to relinquish the privilege and the money now accorded to it without a very deep fight.

A fight that the current rotted politics found in WashingtonDC — the politics of money,vested interests and K Street fixers and career gamers is not allowing to take place.

Why did President Obama take Single Payer Plan off the table?

Why is someone like Max Baucus or Chuck Grassley or Joe Lieberman allowed to frame this reform?

The political process is not addressing what needs to be done now to be in a better place in the years 2025,2045 or 2065.

Congress is in so many ways a den of ignorant know nothings perhaps but the performance Barack Obama is turning in so far on this American healthcare reform is very contrary to what he suggested in summer of 2008.

The rotted politics we are seeing far too much of now should have very real consequences for the Democrats in 2010 and this Obama WH in 2012.

If doing the right thing is too hard or not profitable in money politics to do for the current so called Democrats in Congress they should suffer for it in 2010 or 2012. The Republicans cannot be bothered with — they have gone to CrazyTown — and seem intent on staying there for a long time to come. The Democrats? Lack of spine and letting operators like Rahm Emanuel mix and deal the cards when combined with too much K Street lobby money and the current American priesthood of healthcare needs to be taken down. Taken out. Reformed? Why yes — reformed.

You are Absolutely Correct. Medicaid would have to be federalized – and then that would make it basically Medicare without the age restriction.

Medicaid is administered 50 different ways according to states. And it is constantly used as a political football (think Lucy and Charlie Brown) – by 50 different Partisan State Legislatures for their own political ends. It gets more and more ridiculous restrictions by Republican-dominated state legislatures.

Just looking at the differences in eligibility and whether states cover family planning – tells me that Medicaid would need a Complete Overhaul – in order to work as you suggest. http://www.statehealthfacts.or…..038;cat=10

Medicare for All is really the best plan.

take the average percent of income going to heathcare of the leading five countries in healthcare quality. every income private or corporate pays in that amount. mayo clinic healthcare for all.

133 percent of poverty level! Folks do not understand… if you are out there, struggling, working hard in school or a full time low paid job, or several low paid part time jobs… you do not have the time or the information to run around dealing with big government or insurance programs. Just tax these people at their paycheck.. and give them all a medical card. But give them all care when they need it.

As an alternative, the government could cover catastrophic care (say anything over $50,000 per year) and the private insurance companies could offer “wrap arounds” to pay for the “normal” expenses. This would put the majority of the costs in the hands of the federal government which would then be able to limit payment amounts in the way they do with medicare. The resulting “private” insurance should be dirt cheap and several non-profits should be set up to compete to make certain it is so. The insurance companies could offer a hundred “have it your way” alternatives and market them till the cows come home.

It’s most important to get the catastrophic cases covered- and those are the very ones the insuurance companies want to dump anyway.

The main thing is to get someone with big clout in a position to demand lower costs- and probably only the govt. can do that effectively.

The individual mandate is being pushed because the insurance companies will not submit to regulation unless they are guaranteed a universal captive customer base. What other industry would only agree to be regulated for some business practices under the condition of government mandating people patronize them? The insurance companies will not agree to end recision, exclusions for preexisting conditions, gender disparity, lifetime caps, per illness caps and the like unless the feds force us to patronize them.

This agreement also precludes any sort of price controls that one would expect as part of comprehensive regulation.

Taxes on high cost insurance policies will simply pressure insurers to drop those policies and only sell the crappiest of the crap with high deductibles and poor benefits.

All of this for an industry which has no reason to exist and which is held in low esteem amongst Americans.

But Obama’s heart is not hardened into stone, no siree. The instance when the fringe white ringers whine about their pet peeves, like reproductive services or undocumented workers, Obama springs into action, against the expressed position of a supermajority of Americans and common sense, and meets their needs. Of course, 2/3 of Americans support a public option medicare for all or single payer, yet that broad and deep sentiment is not reflected in proposed legislation.

If Obama cannot coerce the insurers to submit to honest business practices regulation without a captive customer base being enshrined into law, then the game is over, the band has left the building, and the Democrats are irretrievably captured by corporations. But that won’t matter. Conservatives will chafe over taxes masquerading as government mandates, liberals and progressive will scream over being forced under pain of fine, to patronize insurance companies whose product is dangerous to your health, and the absence of a public option will further drain Obama’s left flank. The insurers might be able to use their economic muscle to prevent common sense reform, but they are incapable of providing support for an electoral coalition in 2012.

Never negotiate with terrorists unless disarmament is a non-negotiable condition. Obama, in granting the white ringers concessions, further emboldens them, strengthens them, and flitters away his electoral coalition in the service of his governing coalition.

If you require an insurance company to cover everyone regardless of health- and then you allow people to stay uninsured, then you encourage any person with and IQ above two to forgo insurance until they get sick and THEN buy it. That’s like allowing people to buy insurance AFTER their house burns down- it makes no sense- it’s not sustainable.

I understand the rationale for your view. Medicaid is a punching bag for all states, partly because it is perceived as a welfare program.

My point here is different. I am bitterly opposed to the idea of using taxpayer dollars to subsidize the purchase of health insurance. This idea shows a clear alternative to that. If we took this step, we would force the states to treat everyone better.

Again, I don’t disagree with your points.

I’ve been thinking this for some time and your post states it in a clear coherent outline. It makes one wonder why this kind of clear thinking is not more prevalent in the nonsense being pushed on us daily.

thanks for this. Appreciate your thoughtful troubleshooting. Medicaid operates far more in the red than does Medicare. I felt it should be federalized. (Well, I think Medicare for all is where things should go.) Appreciate your focus on bloated, self-serving govt. reps and industry hogs.

“If Obama cannot coerce the insurers to submit to honest business practices regulation without a captive customer base being enshrined into law, then the game is over, the band has left the building, and the Democrats are irretrievably captured by corporations.”

Agree. That is what is so disappointing about this so-called Health Care Reform. Why is President Obama allowing Big Pharma to dictate that it is OK to charge a higher price to US consumers? Aravosis wrote that Advair asthma drug is average $300 in the US (not even discounted for Medicare) – but only about $90 in France or Canada.

I am still frustrated over the sell-out Dems.

Letsgetitdone has a diary up. It’s a list of FDLers, though, not a petition.

“I am bitterly opposed to the idea of using taxpayer dollars to subsidize the purchase of health insurance.”

I get it and you propose a good alternative. I am just very concerned about the uncooperative states being involved in this. Too many states withhold health care too.

The Demos didn’t even ask ANYTHING of big pharma, leaving Americans to submit to the highest prices for prescription drugs in the world. First, our tax system subsidized pharma R&D, which means pharma companies pay less tax and taxpayers pay more, and then the Democrats exempt pharma from any cost controls on drug price.

Spare any change you can count on, change you can believe in?

A recent study (.pdf) shows that 45,000 people die every year because they don’t have insurance.

We should frame it like this:

Our country experiences the equivalent of fifteen 9/11s each and every year that kill 45,000 innocent people, because Americans can’t get affordable health insurance. We have a moral imperative to protect and defend our citizens and stop this preventable tragedy from ever happening again.

- Tom

As I recall, Obama got some money out of the drug and insurance companies months ago. Not much given what they stand to gain, but something.

I think that providing Medicare/Medicaid for everyone would knock the part of our GDP that’s devoted to health care down to about 14%, all by itself. That’s based on the assumption that about 2/3 of Americans get their health care paid for via private insurance. The elderly, the poor, and the military are already treated on the government’s dime. Private insurance demands a profit margin of at least 20% these days. The equivalent “profit margin” for Medicare is less than 3%. That difference amounts to about 12% of the total. 0.16 * 0.12 = 0.019, or roughly 2%.

That’s the kind of money we’re wasting on the current system. If Congress wants to leave private insurers in the mix as the primary provider of financing, then it had better restrict the profit margin to a reasonable level, say 5-7%, which is about what cost-plus contracts go for at DoD.

I think that administrative expenses, marketing expenses, and profits comprise 30% of premiums. I would guess that net profit is in the two or three percent neighborhood as a percentage of premiums.

The profit margin I’m referring to is the inverse of the “medical loss ratio”. That’s the ratio of what’s actually passed on to the health care industry (IOW, “losses”) over gross receipts. Wendell Potter, the former Aetna executive, said that margin is around 80 percent, meaning that 20% goes to the insurance industry. That’s the number I’m referring to. Other sources, such as a WaPo article I referred to in this article on the subject, said a more typical ratio was 75% (25% profit margin). Take your choice, but that 20 to 25 percent is where all the money you’re referring to comes from, plus dividends and executive perks.

Will the RepublicRATS, Conservidems, DixecRATS, or whatever these pseudo Democrats call themselves vote for a Healthcare bill if it contains a public option? Why is the argument always worded by the pundits that reform will fail because the Liberals won’t take competition out of their bills? A one-sided compromise is not a negotiated give-and-take. The Blue(Yellow?)dogs continue to be rewarded for their “I will take my ball and go home” tantrums. They have taken the stance that “our morals prohibit us from budging on the public option.” Therefore, the less moral Liberals must take this option out of any bills and not be the stubborn arm of the party. The wording of the final bill will favor the Dogs and anyone voting against it will be accused of killing reform, i.e. Liberals. These Senators need to be replaced by real Democrats or at the very least, real Republicans not afraid to wear the party name.

The corollary to this is that to reduce costs further, we need to revise the American Diet. It primarily acts as a feeder – not to our digestive tracts, but to the hospital. It is no coinkydink that diabetes and heart disease figure prominently among diseases of the untreated poor and middle class as well as of the most profitable wards visited by the wealthy and the fully insured. (Congresscritters are both, the latter at taxpayer expense.)

The change in nutrition since World War Two does much to feed the health care system. Chicken soup made from today’s commercial chickens isn’t the healthy notion promoted by grandma’s recipe and bestselling books. Greater crop yields often come at the expense of lower nutrition, a bit like substituting a cardboard Delicious apple for a tasty Cox’s pippin. Government subsidies for corn and sugar make sure there are undue amounts of both in the middle two-thirds of the grocery store aisle. Not to mention the adverse public health effects of the grain-antibiotics-growth hormone trio that yields much of our commercial meat.

Mr. Obama has shown a Bushian aversion to asking corporations to reconsider their practices – Big Ag and Big Drug among them – let alone demanding it. His reluctance to hire passionate, rule-of-law regulators is nearly as tepid as his predecessor’s. He’s just better at putting two words together to sell his spin. Witness his negligent handling of Dawn Johnsen’s nomination to run the OLC.

So the route to better health lies in neutering the Blue Dogs and replacing them with progressives. We’ll need the votes to override Blue Dog ‘Bama’s predictable spiking of reform efforts – under the guise of securing bipartisanship – and/or his vetoing of reform legislation.

Will we force people to change their eating habits. ?
What about other lifestyle changes that could affect ones health?
Are we gonna start forcing people to exercise ? What about the obese? Are we gonna have fat camps where fat people are sent to lose weight?
This idea does put us on the slippery slope to socialism

I think it’s higher among the largest 5 companies, more in the range of 4-5% for 2008, but that has to be considered in light of poor investment results, and a significant increase in unrealized losses on investments. This year won’t be much better for the same reasons, but I bet it will be higher in future years.

Do you think the factors earlofhuntington cites are false? Do you think we could stop governmental actions that promote unhealthy food and living conditions?

Unfortunately, there’s nothing in the Baucus bill that represents any kind of meaningful regulation of the health insurance industry, in exchange for gaining a massive new (captive) customer base. In fact, in exchange for dropping “preexisting conditions”, they will be allowed to dramatically increase premiums on older Americans. Over 50’s beware! This psudo “reform” is just a bailout of the industry.

And please, Masaccio, people aren’t dying because they lack health INSURANCE, they’re dying because they lack health CARE. The people pushing this massive insurance bailout want us to confuse the two!

rwcole, we really don’t know the insurance companies’ finances well enough to know what kind of regulation they can and can’t tolerate and still produce a reasonable profit. We only have their word. Do you trust their word?

Middle class folks are going to be soaked for 10% or so of their earnings that will go to crappy insurance policies, a total of $140b over 10yr. Insurance companies stand to make higher profits due to this mandated market. Insurers pledged Obama less than $100b, similar with pharmaceuticals. This puts the burden of maintaining insurer supremacy on the middle class in exchange for marginal health insurance.

And we still get to fund pharma research through the federal government, offer up tax subsidies and exempt them from competition as they sell to a captive audience that facilitated their patents.

The insurers are superfluous to the provision of health care and are going to great pains to ensure their relevance irrespective. In any democratic society the business practices in which insurers engage would be criminal. But in a country where the FIRE economy–Finance, Insurance and Real Estate–produces nothing but paper and credit but controls everything, we are required to mediate every aspect of our lives through the financial system. They don’t just let go.

Obama made promises before the election and approached the table already compromised from his promises. He has now given away the compromise of a weak public option and offers up a politically suicidal individual mandate which will tank the Democrat Party once and for all. All because the insurers demand for overhead and profit requires them to take in as many premium dollars as possible while delivering as little health care as possible.

For-profit insurers do not pool risk by any means, they pool profits.

-marc

If the Dem’s want to rule congress for the next 40 years like after FDR then all they have to do if the Repuks won’t play is pass a Health Care bill without a public Option and instead insert SINGLE PAYER. But I don’t think they have the Balls to lead what a bunch of wimps

This may answer a few questions about the way Obama is “thinking”:
Australian PhD economist Steve Keen points out a huge gap in the thinking of Summers – and all neoclassical economists.

Now that Obama’s done pretty much what Hoover did in the first great depression, do you really think he’s on the side of the people…or the “supply”?
Makes one wonder just how much of this country is already conquered…

Thanks Loo Hoo. In effect, however, if you put your name on this list by responding to the post, you’re signing on to advocacy for Medicare for All.

We could cover half the uninsured by raising Medicaid to 150% FPL. Makes you wonder why they are forcing people into private insurance do achieve what they could by doing that, and nationalizing and funding Medicaid.

Hi Cujo, I think your figures are off a bit. The margin of overhead + profits for private insurers is more like 30% while Medicare is 2.5%, and 160 million are covered. Also, the percentage of GDP is more like 17 to 17.5%. So, I think we’re looking at a reduction of a bit more than 2%, perhaps as much as 3% or 4%. In addition, we know what public programs such as Medicare are capable of when it comes to saving money in other countries. Giving us a few years with people of all ages being covered by Medicare is there any reason why we can’t just as well as Canada when it comes to costs. If so, that would give us enormous savings of 7% of GDP eventually.

I’ve looked at the 10-Ks of the 10 largest health insurance companies and at the financials of Michigan Blue Cross for 2008. The medical loss ratios run in the range of 80-84% for the for-profits and a bit higher for the BCBS company. This doesn’t take investment income into account, and doesn’t account for their screwing around with their reserves, which are an adjustment to income. Here is the Wellpoint 10-K. It says on page 43 that their benefit loss (”The benefit expense ratio represents benefit expenses as a percentage of premium revenue.”) ratio was 83.6% for 2008.

That would be a remarkable achievement. I wonder how much it would cost.

Implementing Medicare For All would mean absolving employers of the burden and raising wages and taxing everyone an amount significantly less than the cost of employer based insurance premiums and existing Medicare payments.

It would also absolve states and localities of the need to spend local resources on health care.

It would also beef up Medicare’s finances with an influx of younger workers’ premiums which would make the system more secure for seniors and available for the young.

It needs to be a bit shorter.

A broken healthcare system costs America 15 catastrophic 9/11-like events a year.
If lobbyists want to fight reform then I say, “Bring it on!”

Republicans have it RIGHT! We need Health Care Competition with Internet Exchange so we can all compare 1,300 Insurers on Total Cost, deductibles, coverage, co-pays, etc. 100% of Citizens the Internet Exchange that shows Private and Public Plans ranked by cost, benefits, deductibles, or co-pays to select best plan for them!

Democrats have it RIGHT! We need a STRONG Medicare Public Option as part of that Internet Exchange!

Baucus has it WRONG! Isolates 180 Million people from having a CHOICE of employer Coverage or buying through the Internet Exchange!

If 0BAMA agrees with Baucus then 0BAMA is also WRONG!

If Medicare is ranked with the 1,300 Insurers by ANNUAL COST then Medicare will more frequently than NOT be the Best Plan (Top in the Sorted List) so competition will be the key to having a market!
_______________

COMPETITION with Private & Public Options = Lower COST Health Care for ALL

Insurers will have to lower prices and increase coverage to compete! That will be the best way to insure Innovation and lower costs!

NO Rejections of any kind!

One problem with interstate competition is that insurance regulators are state-based, implementing state insurance laws, and when an insurer does wrong across state lines, the insurance regulators have to cobble together an investigation and enforcement process tailored to that event. There would need to be some sort of federal framework to provide guidance to state regulators if insurance companies were allowed to operate across state lines as the Republicans suggest.