Not news to some, more learning quickly. But what to do? The docs are acting. Will we?\
http://www.pnhp.org/

#BeyondACA

On May 5, 2016, an esteemed group of physicians unveiled a detailed plan for single-payer health care in the United States. To read and/or endorse the proposal, please visit www.pnhp.org/nhi. To read and view media coverage of the proposal, click here. To browse supplemental materials related to the proposal, click here.

One week after the 2016 election, PNHP members from across the country will gather in our nation's capital for our Annual Meeting and Leadership Training. We will also hold a public rally in support of single payer. For more details on these events, please click here. To register for the Annual Meeting, click here.

after he lost a Democratic primary. Democrats like Obama, Schumer and Clinton had campaigned hard for Lieberman in the primary and pretty much left Lamont twisting in the wind during the general. Oh, they politely endorsed Lamont, of course, but they were not stumping for Lamont as they had been for Lieberman during the primary, even though Lamont was no liberal, either. Some Democratic Senators even endorsed Lieberman over Lamont. Besides, undoing the damage they had already done Lamont in the primary would have been a feat. Republicans abandoned their guy, too, to the point of endorsing Lieberman.

So, Joe won in 2006. But he knew that he could not depend on the perfect storm for his election a second time. He knew he was toast with Democratic voters in Connecticut. Campaigning for McCain/Palin killed him with the Party, too, so I am guessing he knew he in 2008 that he that freedom was just another word for nothing left to lose. Being a lame duck, he agreed to be one of the scapegoats in return for who knows what. ACA finally got through Congress in March 2010 (reconciliation); in January, 2011, Lieberman announced he would not seek re-election. Obviously, this is surmise on my part, but it is not baseless speculation.

Following the election, Lieberman struck a deal with Democratic leadership allowing him to keep his seniority and chairmanship of the Governmental Affairs Committee. In return, he agreed to vote with the Democrats on all procedural matters unless he asked permission of Majority Whip Richard Durbin.[citation needed] He was free to vote as he pleased on policy matters.[citation needed] Along with Bernie Sanders, Lieberman's caucusing with the Democrats gave them a 51–49 majority in the Senate, leaving a slim one Senator majority to control the Senate in the 110th Congress.

A survey in October 2010 showed that Lieberman had an approval rating of 31% and that just 24% of Connecticut voters felt he deserved re-election.[53] Lieberman announced on January 19, 2011 that he would retire from the Senate at the end of his fourth term.[54][55] Lieberman gave his farewell address on December 12, 2012.[56] He was succeeded by Democratic representative Chris Murphy.

https://en.wikipedia.org/wiki/Joe_Lieberman

Sanders has a similar deal with, I think, Schumer as nanny. Cloture, which requires sixty votes is considered procedural. After cloture, the vote itself requires only 50 plus Lieberman. So, the idea that Lieberman by his lonesome was preventing the necessary 60th vote cannot be true, unless Durbin, Senator from Obama's home state, gave Lieberman permission to block cloture.

In reality, the ACA cake was baked before it ever got to Baucus,that nice woman from the health insurance industry and Susan Collins, who put the final kiss of death on it and then didn't even vote for it. For the ACA, thank Rahm and the other White House negotiators, the health insurance industry, the pharmaceutical industry and big health providers. They met many times before Congress got their hands on it. That's what some of the FOIA requests for the White House visitor logs were about.
https://www.google.com/#q=medical+industry+visits+to+white+house
http://www.nbcnews.com/id/32087532/ns/politics-white_house/t/after-lawsu...
https://www.publicintegrity.org/2011/04/13/4115/white-house-visitor-logs...

After the logs were requested, meetings were held at luncheonettes near the White House. I cannot find a link to that story right now, but I read it at the time.

The only ones the White House would not meet with during that period were members of the House Progressive Caucus and other advocated for Medicare for All. Obama refused meetings with the Caucus and even stood them up once. He did not meet with them until after ACA was a lock.

No one can blame Lieberman for Obama's killing the drug reimportation bill. However, continuing to forbid reimportation was part of the deal the White House had already made with PHRMA.

And if single payer came up for a vote I think it would get voted down because people think it's socialism and that's bad in their minds.
It doesn't matter to them that Medicare, Medicaid and the VA programs are run by the government, they think that any government run program is bad.
The only way it would get passed is if the Mormon church came out in favor of it.
Remember the tea party signs that said Keep the government out of my Medicare?
I don't know how to deal with people like that.

try to clarify them.

1) Re the 15% to 20%, do you agree with that part? That comes from the ACA. I assume you agree, but please confirm.

2) In order to see what I'm talking about, you need to look at things over time. Consider the following, which in some ways is contorted but I'm trying to make the point with as simple of an example as possible.

Year 1: Insurance company sells insurance to a customer for $125, after determining that the "reasonable and customary" charge for a certain service is $100. The details of how exactly they set that rate are murky to me, however one of the important factors is that premiums are set at the beginning of the year. Insurance is required by the ACA to have a medical loss ratio of no less than 80% (85% in some cases but let's ignore that for now), which means AT LEAST 80% of the premiums collected must be spent on legitimate healthcare provider expenses. In order to ensure that they themselves get their cut of the proceeds, they need to limit payments to doctors to $100 for this service (this year).

Patient goes to a doctor who charges $200 for the service. Insurance limits their charge to $100. I think that is the point you are making, and I agree: Insurance companies do limit their payments in this way. The point I am talking about is more subtle and goes into play a bit later. But for now, you are correct, doctor could charge $1000 or higher, but doctor is only going to collect $100 from insurance for that particular service. Looking at the math:

80% of $125 = $100, which will go to the doctor.

And that means that $25 will go to the insurance company. All is well for the insurance company, they collected 20% of "the take", which is what THEY care about most.

Look at what comes next. As year 1 goes along, all of the doctors are submitting their prices - so the insurance company is actually being handed a wealth of great pricing information. Doctors know that insurance company will restrict their payments, so a natural tendency will be to charge a high enough price so that they don't leave money on the table as far as the insurance company is concerned. What I mean by that is, a doctor who charges $75 for the service instead of something over than $100 does not collect the $25 extra dollars that the insurance company WOULD have paid them. It is in doctor's best financial interest to set prices that exceed the "reasonable and customary payment" so they they can collect as much money as they can from the insurance company.

Ok, I hope you are still with me ... suppose insurance folks notice that most doctors are in fact now pricing the service for $200. The insurance company recognizes an opportunity to make more money themselves, by using this information to set premiums for the next year. It is at this point that the insurance company "relents" and allows doctors to collect more for their service.

Year 2: Insurance company now sells insurance to a customer for $250 (double the price!) after determining that the "reasonable and customary" charge for a certain service will now be $200.

Patient goes to a doctor who now charges $300 for the service. Hey, they are not idiots, they know that the reasonable charges paid by insurance are going to go up, so they raise their prices in order squeeze what they can from the insurance companies. Insurance now limits their payment to $200. Looking again at the math:

80% of $250 = $200, which will go to the doctor.

And that means that $50 will go to the insurance company.. Again, all is well for the insurance company, because they collected 20% of "the take", which is what THEY care about most. Notice that as the doctors DOUBLED their prices, the insurance company similar DOUBLED the amount of money that they themselves collected. It's a win for everyone but the patients when healthcare providers raise their prices.

And here is the point: because of the way that the ACA rules are set up, it is in the best interest of the insurance companies to "allow" healthcare providers to dramatically increase their prices over time. And that is because

20% of a small number is always going to be less than 20% of a big number.

Another way of saying this is that because of the way that the ACA is set up, insurance companies actually have a financial interest to sell expensive premiums, because the ACA allows them to keep 20% of the premiums. However, and it is a big however, if less than 80% of the premiums are used to pay doctors, etc., then the insurance folks are required to issue a refund to the person who bought the insurance. The only way that they can sell expensive premiums is if they are paying 80% of that money to doctors, etc.

There is not an incentive in the system for the insurance companies to hold down healthcare costs *over the long term*.

The insurance companies make more money when healthcare costs rise. You can see this in the example. In year 1, they collected $25. In year 2, they collected $50. If doctors lower their prices, that would in turn lower the amount of money that flows to the insurance company.

Do you follow what I am trying to say? There are many flaws in price controls in the system. I got upset with the author of the article because it sounds like it is feeding the argument

"We need to do more to make the insurance companies happy in order to keep prices low.

We need to do more to give insurance companies an incentive to STAY in the exchanges.

We can only save money if they stay, so let's give them what they want."

That is flawed logic. That is the kind of logic that the insurance companies want people to be thinking, that WE will benefit the most by keeping THEM happy. I think it is propaganda. It is skewed, distorted thinking, and I actually suspect that there may have been collusion by the insurance folks in an attempt to essentially BLACKMAIL politicians and the public into giving them even more goodies. I think their decision to leave many of these markets is essentially a bluff, to see what they can squeeze out of Congress.