Tulsi's Healthcare Plan: Single Payer Plus
Some extra tidbits have been becoming clear regarding Tulsi's planned healthcare initiative.
The first is that she intends to call it Single Payer Plus to differentiate it from Medicare for All, which she feels is being co-opted by a number of campaigns. She started to use the term a couple days ago while campaigning in Charleston, South Carolina (forward to 29 minutes or so):
Tulsi's South Carolina stump speech
It seems clear from her speech there that everyone would be required to pay into it (good to my mind), but that people could purchase duplicative coverage or supplemental private insurance coverage on top of that. She also makes it clear--as she has from the beginning of her campaign--that Single Payer Plus could negotiate drug and service rates to make them more affordable for everyone.
This differs from Bernie's Medicare for All plan in that his plan would not allow duplicative coverage, but only supplemental private insurance coverage for things not covered under Medicare for All.
Details have not been released for Tulsi's plan, but with what we know, hers would be more like the current Australian healthcare system, whereas Bernie's would be more like the current Canadian system.
Both types of programs would be a tremendous improvement over what we have now.
In the end, what matters would be the details about what each plan covers, and this most likely would not be evident until such a plan was actually designed and implemented by a sitting president and congress. But, generally, Bernie's plan would be more fair to everyone, whereas Tulsi's plan would allow people with money to buy additional insurance to cover things more thoroughly. Tulsi's is undoubtedly an effort to keep *some* of the current private insurance structure in place to mitigate job losses and to perhaps sway monied interests that they could pay to get extra in a way that they couldn't under Bernie's plan.
Whether you consider those aspects good or bad is up for debate. I can see advantages and disadvantages in both.
But overall--these are both great directions to go in!
Comments
Meh.
Under Tulsi's plan we pay more and get less than Bernie's - all to make sure the insurance companies can still get their vig.
To the extent that it counters the corporate media taking point about people 'losing their insurance' it works politically in the short term, but as an actual plan in the long term it's a bit of a Trojan horse.
Case in point, Trump and the Goopers just this week proposed cutting Medicare while boosting Medicare Advantage's privately adminstered insurance programs, which has the effect of cost shifting payments away from the government and onto consumers at higher rates with less coverage.
Tulsi's plan would allow similar opportunities for cost shifting and 'stealth privatization' while kneecapping universal public healthcare in favor of the same costly private Rube Goldberg insurance schemes we all currently suffer under.
One final note: during the Obamacare debate, there was a long discussion on the blogs over what to call a universal health care program. 'Single payer' was eventually rejected by most as too 'wonky' and not attractive at a retail politics level since not many people were sure what it actually meant and the term was too vague to tell people what they were really getting.
Tulsi's embrace of the old 'single payer' gives me pause because it's a bit of a weaselly term more suited as a wink and nod to insurance companies than as a rallying cry for true reform.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
The Australian System Isn't Awful Though
And as to your initial statement that we get less and pay more, there's absolutely zero evidence of either of those yet. Pure speculation on your part--especially looking at the Australian system.
Both Bernie's and Tulsi's plans need to be detailed. Will such-and-such a drug be covered for a certain cancer under Bernie's and/or Tulsi's plan? Who knows the answer to that. Maybe Tulsi's end plan would cover more options? Maybe Bernie's would? Medicare does not cover everything.
I do agree with your point about Tulsi's plan potentially allowing more stealth privatization. Is that worth potentially brining on more supporters in the early stages? I don't know the answer to that.
What I do know is that having either the Canadian or Australian systems implemented here would be a vast, vast improvement over what exists now.
Edit to add: Australian Healthcare Ranked Second in World
Better life expectancies, lower costs, better disease outcomes out of 11 countries (including the UK and USA--the USA ranked last, the UK first). Canada ranked ninth in that comparison. (Whether it is valid or not, who really knows . . . but the evaluation ranked access, process, administrative efficiency, equity of care, and health outcomes.)
'Zero Evidence'
I just explained how the Republicans are already trying to use the hybrid private/public model to soak seniors and you're saying that Tulsi's plan (which follows the same model) somehow won't?
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
And . . .
I just explained that not if it follows the Australian model.
Show me evidence how the Australian model is "soaking seniors" and then maybe you'll have a point.
All I've got from you so far is a hypothetical Republican plan, equating it to a hypothetical Tulsi plan, both of which are not really defined at all.
Australia...
is having exactly the same problem as private insurers encroach more and more on public programs under Liberal (ie Conservative) Governments' private 'reforms'.
But don't take my word for it. The Australian Medical Association agrees.
BUPA is a major private health insurer based in England.
In 1999, Australia transitioned from a public to hybrid model.
Here are the results:
Or perhaps it's merely a coincidence that with the introduction of a hybrid model, Australian health costs have skyrocketed?
Australia, with a mere 20 million people and advantageous climate and location is a poor analogy to the US when modeling health outcomes. However, its experience with hybrid privatization of its health care system is quite instructive.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
More on Australia...
Sound familiar?
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
I definitely prefer Bernie's plan
but I also think Tulsi can avoid your criticism by mandating full coverage, and the argument that her plan would risk having corporatists sabotage the coverage - they will with Bernie's plan as well - Tony Bair cut coverage in the NHS. Don't assume that one plan is definitively superior to another because the perfect implementation sounds like it is better without a fight.
On to Biden since 1973
Hybrid models add nothing.
They merely take money out of the system under the guise of administrative 'costs'.
It's simple math. The more money spent on administration, the less money there is for actual care.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
Agreed. “Health Care Industry” is a term intended
to obscure the fact that much of the money is actually going to the “insurance industry.” Oh, and shareholders and execs in the pharmaceutical industry, and the medical device industry . . ..
"The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"
'It's not a business!'
Bernie to Delaney during the second debate:
This is mentality we are dealing with here. That profiteers have some inherent right to attach a needless, inflationary, money soaking leech onto any government program they can.
Basically, if it's not already business, the catechism of Great Gods of the Market (tm) demands it must be made into one.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
States are privatizing Medicaid
I just read that DC has already started moving people in to private companies and will do the disabled next. Gee what could go wrong?
People being refused what they need from nurses that do homecare to medical equipment that they have relied on for years. And yes people have died because profits come before people. Always will.
Which AIPAC/MIC/pharma/bank bought politician are you going to vote for? Don’t be surprised when nothing changes.
Privatization of Medicaid began under 'O'--by granting
Governor's permission/waivers to utilize private insurers in return for participating in the ACA "Medicaid Expansion."
Already happened in approx 1/3 go 1/2 states (don't remember stat, exactly). If not in more states [to date], since haven't seen updated stat since DT's Admin began.
No doubt, Verma and Azar are enthusiastically supporting/expanding it.
BTW, the online Pet store I told you about (with no sales tax, or shipping costs) has constant sales. My last two orders were 20% and 15% off, respectively. Just wish they carried as many non-food products as Chewy, etc.
Mollie
Everyone thinks they have the best dog, and none of them are wrong.
Just like Obamacare
in many ways, isn't it? I was once a true believer on Obamacare until I read Matt Taibbi one day and realized what a scam that is.
And the idea that we should need to quibble over what drugs, treatments, etc will be covered is a non starter to me - it should ALL be covered, period. But we in America are content to tweak around the edges aren't we? We just never want to address a thing head on, we seem to make it more complex by the second until no one can understand the main point at all. Perhaps that is the intent.
Only a fool lets someone else tell him who his enemy is. Assata Shakur
Hey, wasn't able to follow up on DT's Medicare EO due
to mini-crisis (except to read a couple of pieces about his MA spiel at The Villages).
Anyhoo, what 'cuts' to Original/Traditional Medicare are you referring to, when you say,
Trump and the Goopers just this week proposed cutting Medicare while boosting Medicare Advantage's privately adminstered insurance programs, which has the effect of cost shifting payments away from the government and onto consumers at higher rates with less coverage.
All of the proposals 'cost shift.' One major cost shift is the ACA-Model for financing Sanders and Jayapal's plans. We've done the math--we will definitely pay more. I would suggest that folks read his bill, and figure UMFA taxes, compared to current expenditures (for Medicare, MA, Medigap, Part D, etc.).
Of course, low income folks getting financial assistance will be shielded under most of the Dem proposals. But, many who aren't getting these subsidies, will see increase in their cost of coverage. And, our increase is in spite of us being covered by 3 policies, apiece. Admittedly, we have an exceptional 'deal' regarding our (additional) RX coverage, and Medigap policy due to various affiliations/nonprofit insurer.
Thanks.
P.S. Please, if anyone has a link to Tulsi's proposal, would appreciate it if you'd post it.
Have a good one!
[Edited: 'd' replacing 's']
Mollie
I think dogs are the most amazing creatures; they give unconditional love. For me they are the role model for being alive.
~~Gilda Radner, Comedienne
Gratitude is not only the greatest of virtues, but the parent of all others.
~~Cicero
The obstacle is the path.
~~Zen Proverb
Everyone thinks they have the best dog, and none of them are wrong.
You're missing the point.
The process works like this:
1. Offer the carrot of marginally better private insurance benefits (Trump expands Medicare Advantage).
2. Behind the scenes, cut public funding for hospitals and other services that indirectly but substantially affect patient care (GOP budget). This way, Goopers can claim to not be cutting medicare benefits when what they are really cutting is the services those benefits are supposed to provide.
3. Raise rates on the Advantage plan later to makeup for the extra cost of the 'carrot'.
THAT is what I mean by cost shifting: moving the burden of funding the health care system away from the government and onto middlemen insurance companies who squeeze consumers for every last dime.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
Thanks for the reply, NHK. I understand,
and agree with your point about the expansion of MA weakening Original/Traditional Medicare. Just thought that you were referring to 'specific' new cuts that have been included in his recently signed EO (due to your wording).
I've had to be out of the loop, news-wise, for much of this week. So, gonna search for, and read, the darn thing in a minute. Learned not to depend solely upon mainstream and/or alternative media reporting on Medicare/MA, some time ago.
Mollie
Everyone thinks they have the best dog, and none of them are wrong.
Bernie’s M4A has zero premiums,
zero co-pays, zero deductibles, zero pymt at any point of service, maximum Rx annual cost of $200, covers dental, vision, hearing, DME, skilled nursing. Maybe your taxes will go up, but that increase will be less than your current out of pocket. How will you be paying more than you are now?
Hi, TB - we know because we know
exactly what we're obligated to pay annually/monthly (to the last red cent), and, for us, it's considerably less than what we'd pay under Bernie's ACA-model of financing.
It's not surprising, really. Remember, the ACA-model is not tailored for seniors (like the current Orig/Trad Medicare program is). Notice, if you pay close attention to what Bernie says, you'll find that he never claims that current Medicare beneficiaries will save money--he says "the typical Family of 4." That's for a reason. (the ACA-model of financing is a major cost shift, by its very design) Instead, when trying to appeal to Medicare beneficiaries, he mentions the addition of several benefits now offered by MA and some Medigap insurers--which Mr M and I already have.
BTW, we're currently covered at 100%, so, we have no OOP costs for medical services--including, deductibles, co-pays, co-insurance, etc. We do pay co-pays for maintenance RX's that aren't covered by Medicare Part B (instead, fall under Part D RX Plan), but, we accounted for that (down to the penny) when we calculated our current costs--which would be those co-pays, plus Medicare premiums (and Medigap).
Also, we have vision coverage, Delta Dental dental coverage, an excellent RX Discount Program, and, hearing aid coverage. (Admittedly, we're fortunate to have an exceptional deal, due to various factors. Of course, the benefits above should be added to the current Orig Medicare program, IMO.)
All that aside--our coverage is FFS, not 'managed care.' And, that's super important to us. Of course, we can see any physician, at pretty much any medical facility, anywhere, any time--without the need for specialist referral.
IMO, need to improve/add to services covered by current Orig Medicare, delete deductible/co-pays/co-insurance, and, expand to include coverage for Everyone.
What's not to like?
Mollie
Everyone thinks they have the best dog, and none of them are wrong.
My attitude toward political candidates
is to scrutinize them all with as much care as you would when buying a used car from a less than reputable outfit.
There is no justice. There can be no peace.
fans will like it
because they're fans and looking for the good.
However, it sounds to me like the beginning of the end of something that hasn't even started yet. Single Payer Plus would bring in health insurance crooks from the get-go.
The essential element
in any healthcare payment scheme, in my opinion, has to be this:
Will it require healthcare providers to accept the scheme as payment for services?
If the answer is anything other than an unqualified "yes", the scheme (whether it's called M4A, Single Payer Plus, or whatever) is no good.
Allowing providers to opt out is a mechanism by which the health insurance industry takes over and privatizes healthcare.
That's what's happening now with Medicare.
Under the current federal law, providers are allowed to refuse to accept original Medicare. Big Insurance is exerting pressure on their network providers to accept only Medicare Advantage. In some communities, this effectively shuts out people who have original Medicare.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
Providers can't be forced to participate in any
healthcare plan - public or private, including Medicare. Even the Sanders/Payapal proposal doesn't call for that. (forced participation, that) Probably, can't.
In our area/region (Southeast), it's the opposite of the handful of states that have a very heavy MA presence--like your state of Washington, IIRC. I've posted the 'map' at EB.
Strangely, the states that are pushing/selling the private Medicare plans (MA) are mostly blue states. It's the Midwest and Southern states which have retained a much higher percentage of participants in the 1965 public Orig/Trad Medicare program.
Go figure. I know that I haven't an answer for that, yet. (Unless, folks there just like managed care.)
Postscript: Actually, after reviewing some MA Plans a bit ago, I'll amend that a tad. I'm 'guessing' that it's (partly) because insurers are targeting those areas. IOW, it has to do with cherry-picking clients/beneficiaries.
Mollie
Everyone thinks they have the best dog, and none of them are wrong.
actually, because they are licensed by the state, providers
can be forced to do whatever we damn well choose to force them to do.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
Hi, UR - so far, Medicare doesn't mandate
provider participation.
Of course, prior to the ACA, beneficiary participation wasn't mandated, either.
BTW, according to Kip Sullivan, Sanders' Bill allows for ACOs. LL posted this from NC a while back.
Unless a lawmaker includes it in another proposal, there is nothing that I've seen that mandates that providers participate in their proposed MFA/public option plans/programs. And, certainly, they would be free to practice concierge medicine on cash-only basis, since it wasn't precluded in any of the proposals (that I've read).
Regarding the authority of State Insurance Commissions, it depends (to some degree) how a federal law creating a program (such as Medigap insurance) is written. That line of insurance is one which was written in such a way that it gave the states quite a bit of leeway regarding coverage (or, discretion). But, that's not true of all federal bills creating insurance programs.
Everyone thinks they have the best dog, and none of them are wrong.
oh, yes, i know the current state of things.
i just react a bit strongly when Americans lose track of certain realities about the power of government to control business in the best interests of the populace. we're so indoctrinated with the dogmas of Private Proppity that obvious truths become unimaginable fictions.
The earth is a multibillion-year-old sphere.
The Nazis killed millions of Jews.
On 9/11/01 a Boeing 757 (AA77) flew into the Pentagon.
AGCC is happening.
If you cannot accept these facts, I cannot fake an interest in any of your opinions.
Good article...
I was not aware how Bernie's bill differed from Jayapal's HR 1384 on ACO's. The author is right about that to a certain extent, although I wouldn't necessarily equate the role of ACOs in a single payer system with HMOs in a privatized one.
As I understand it, the ACOs purpose is to reign in doctors from over prescribing services, so to the extent that they can deny 'unnecessary' treatment, they act very much like HMOs. But unlike HMOs they cannot set rates for patient care or bill for patients more than what the government is willing to pay, so at least on paper their predatory role is limited.
Basically, AOC's act as a middleman between the government and heath providers, which adds another layer of administration. Whether there is any added value to having private entities manage care rather than the government itself is debatable, but they're not the same as HMOs that have free reign to bill patients whatever they like.
The current working assumption appears to be that our Shroedinger's Cat system is still alive. But what if we all suspect it's not, and the real problem is we just can't bring ourselves to open the box?
My objection is to 'managed care,' period. (Which ACOs
are the vehicle for in public programs.)
We always double-check with a physician's business office (not receptionist/scheduler) to make sure that they don't participate in an ACO. If they do--they're on our 'blacklist.'
Seriously, IMO, any system that allows capitation fees (in lieu of a FFS schedule) is likely rife with undertreatment and/or denial of necessary medical services/care.
If the PtB are so concerned about escalating medical costs, they can quit using the US as the policemen of the world (and use those monies to fund Medicare, etc.).
Plus, can't help but notice that lawmakers don't appear to be concerned about the costs of their cushy OAP medical care. The very idea that they make six figures, but, are charged a flat rate of only $600 plus change, annually (the $503 below is outdated), is sickening to me.
Have a good one.
Mollie
I think dogs are the most amazing creatures; they give unconditional love. For me they are the role model for being alive.
~~Gilda Radner, Comedienne
Gratitude is not only the greatest of virtues, but the parent of all others.
~~Cicero
The obstacle is the path.
~~Zen Proverb
Everyone thinks they have the best dog, and none of them are wrong.
I can see that I need to do some research
into this issue. Has SCOTUS ruled that requiring providers to accept Medicare is unconstitutional, and if so, on what basis? Looks like I've got my research project for the week.
With regard to Blue states, keep in mind that "blue" does not necessarily mean progressive.
I relocated to the beautiful Pacific Northwest from the Deep South, thinking that it was a progressive paradise. I've been sadly disappointed to find out that it's neoliberal. Washington State in particular is very corporate friendly. It's the home of Amazon, after all, and the former home of Boeing.
In addition, the upper West Coast, from Portland, Oregon, to the Canadian border, has a strong military presence. That includes the pristine Olympic peninsula, which is being used for military training. The State of WA seems to like being militarized. No apparent pushback.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
I want to leave this country.
Panama? Belize?
I am researching. I am too poor to go to Austria, or England, but might be welcome in Lithuania!
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
I know that feeling.
I'm thinking about it, too. Talking with expats and others who are considering doing it.
I've also known people who've retired to Thailand and liked it. Not sure I want to go that far, though.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
Hey, Centaurea, let us know what you find (as to
a possible SCOTUS ruling).
Since the Original Medicare Bill didn't require/mandate physicians and other providers to participate, not sure who would have sued (in protest). Unless a consumer advocate organization has done so. I'd be curious to know about that, as well.
Your region is beautiful, and has a lot of positives (especially, compared to the South). But, good point about the heavy military presence--it was (today's) Joint Base Lewis-McChord (Tacoma) that we medevaced to for neurological surgery at a major Army Medicare Center.
We're still looking at relocating/expatriating to SA. Uruguay's most appealing to us, at this time. But, we (and anyone) can 'buy' a entrepreneurial citizenship in another SA country for almost nothing, while spending only half-time in residence for two years. Still trying to get more details. Sounds too good to be true.
Have a good one!
Mollie
Everyone thinks they have the best dog, and none of them are wrong.
I'll keep y'all posted
on the Medicare question.
(I think the word "y'all" is the South's contribution to the world. That, and grits.)
It's comforting to know that we've got a lot of options for living abroad. Having made a big cross-country move 14 years ago, I'm not looking forward to the moving process again, but I'll do it if need be.
"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep."
~Rumi
"If you want revolution, be it."
~Caitlin Johnstone
If everyone gets on Medicare
then doctors, clinics, and so forth will have no valid reason to decline patients with Medicare.
If they decline, exactly who will they treat, and how will they earn income?
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
Good point
Very few doctors take Medicaid so it's hard to find decent ones that know what the hell they are doing. This goes for dentists too. Imagine going to one that isn't current on things. I have been lucky with the two doctors here that take it though. And so far I haven't been denied testing, treatments or medication.
Which AIPAC/MIC/pharma/bank bought politician are you going to vote for? Don’t be surprised when nothing changes.
Give a health care provider a choice,
they will choose to go for the money.
"We'll know our disinformation program is complete when everything the American public believes is false." ---- William Casey, CIA Director, 1981
VIP Medicine
I've known doctors that have transitioned to a VIP or subscription practice. People with money still get Medicare and pay their premiums, but they think of it as hospitalization insurance. They pay directty for their special doctors and VIP medicine. In cities and affluent areas, many specialities practice outside the insurance system. Psychiatrists, dermatologists, plastic surgeons, celebrity dentists. I know an anesthesiologist and a pathologist who treat medicine like a gig. Procedures paid in advance.
But those I know are avoiding the insurance companies, not the patients. And some specialties aren't generally covered by health insurance (which explains the US mental health crisis). Dentistry is still the wild west when it comes to sky high prices. They just make it up. Thus, the American mouth is not what it once was, back in the late 20th century. Something like 50 percent of American adults have periodontal disease, but only the one percent can afford to see a periodontist for treatment. Amazon now sells kits so people can do their own dentistry at home and make their own missing teeth. Some of the product reviews are crazy.
Welcome to the US, the land of poor nutrition, bad teeth, drug addiction, and a declining life expectancy. And people put up with this — along with the lack of basic human rights. They're circling the drain in a democracy — and that feels normal to them. Come to think of it, most every nation we have destroyed or tried to destroy in recent years is a Democracy; every leader we toppled was democratically elected. This has to be the tackiest Empire, ever.
/rant
____________________
The political system is what it is because the People are who they are. — Plato
All animals are equal, but some are more equal.
Any “universal” health care that leaves room for a higher level of health care for those with deeper pockets is like a patient almost cured of a raging infection. The remaining germs lie in wait for their next opportunity to proliferate. Any improvement over our current situation would be temporary at best.
Capitalism is the extraordinary belief that the nastiest of men for the nastiest of motives will somehow work for the benefit of all."
- John Maynard Keynes