Fear Techniques wouldn't work nearly as well on "Medicare for all"

by: Ian Welsh

Mon Aug 10, 2009 at 19:30


Seriously, "grandma's going to be killed by Obama's healthcare plan" (whatever his plan is, even I don't know) wouldn't work on "we're just going to give medicare to everyone".

Just sayin'.

The whole "you can't sell single payer" is turning out to be, well, rather questionable.  Because the way things are going it's fairly clear you can't sell some godawful hodgepodge either and all the screaming about "you're going to take away my Medicare" indicates that a lot of the people who oppose Obamacare, love Medicare.

When you're trying to explain something, you do so by metaphor in almost all cases.  Everyone knows what Medicare is.  The majority of people with Medicare are happy with it and even people without Medicare know people (usually their parents or grandparents) who have it, and whom it's working for.

Ruling out "single payer" from the very start was an act of mind-bending incompetence on the level of disbanding Iraq's army during the occupation of Iraq.  From a policy point of view "Medicare for all" provides massive savings, and we know it works because the equivalent policies have worked for every other nation in the world who ever implemented then.  From a sales point of view it's much harder to demonize Medicare and much easier to explain it.  From a negotiation point of view pre-compromising is so stupid that anyone who has spent 5 minutes in a third world bazaar or taken even a single negotiating class knows better.

The current health reform "bills" are turning into a clusterfuck of epic proportions.  Scrap them, introduce Medicare for all, target  Senators who won't vote for it with bone-crushing ads which ask why they want 22,000 American to die every year who could be saved for less money than the Iraq war cost; explain with nice simple pictures how much money they receive from the insurance industry and note that they are willing to let Americans die in exchange for blood money from the medical industry.

I know it's difficult for Democrats to play hardball since they'd have to grow a spine, but perhaps, just perhaps, it's worth it to save lives, end 70% of all bankruptcies and make sure people who are sick get the care they need?

(Oh, and to save Obama's presidency. )

Ian Welsh :: Fear Techniques wouldn't work nearly as well on "Medicare for all"

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An even better idea...Lower Medicare eligibility age (4.00 / 2)
Push the House and Senate to lower the eligibility age for Medicare by 10 years a pop every 1-2 years for the next 5-10 years. Along with sensible Medicare reform that reduces the risk of fraud and improves outcomes (for example, paying based on results, not treatments), lowering the eligibility age seems like such an obvious no-brainer.

You don't have to create a new single payer program. Tweak and expand the current Medicare program. And provide a way to hire the drones who currently work for private insurance companies who will be put out of work.

Even better, the first two rounds, ages 55-65 and 45-55, are groups private health insurance companies could care less about because they tend to have more health problems than 20 year olds.

I've looked at the House single payer bill and, while I don't know anything about health care, it underwhelmed me. For one, fifteen years to complete the transition seems too long when you could lower the Medicare eligibility age.

Also, you wrote, "Ruling out "single payer" from the very start was an act of mind-bending incompetence..." Actually it's not incompetence. It's selfish self-interest. Medicare and single payer don't pay politicians millions for re-election, flatter politicians with trips and meals, and don't provide cushy "insta-wealth" jobs after the politician retires.


this could be done anyway, yes? (0.00 / 0)
i mean, regardless of what happens with "health insurance reform" this year. next year they could put together a bill lowering it to 55 or even just to 60. and if i understand the rules aright, that's exactly the kind of thing you can get done through budget reconciliation.

not everything worth doing is profitable. not everything profitable is worth doing.

[ Parent ]
Yes (4.00 / 2)
I like that idea a lot, have suggested it a couple time myself.  Perhaps do it from either end - reduce eligibility age, and put kids on it as well.

[ Parent ]
It was part of Hillary's planning for health CARE--extend Medicare until (4.00 / 1)
legislation can get done. It would be a buy-in, but it would still be insurance. Problem is not all could afford it, but some could.

And it was something to happen ASAP, a stop gap, stop loss of life measure.

I would have jumped at the chance. Wow! Choose my own doctors! It couldn't have been more than my Big Insurance Parasite charges.


[ Parent ]
My last sentence? That's why Obama won't do it. (4.00 / 1)
n/t

[ Parent ]
Hey, I used to be one of those drones! ;-) (4.00 / 1)
And trust me, there was absolutely NOTHING that I or anyone else I worked with did that couldn't be done by government, and done well, with proper management (which is as hard to find in the private sector as it supposedly is in the public one). It's not rocket science. Well, except for the actuarial work, which is pretty sophisticated. But the government will have no problem finding people smart and skilled enough to do such work. Oh, wait, it already DOES employ such people, in CMS, which oversees Medicare and Medicaid.

And I have to disagree in part with your point about how self-interest is what drives pols to resist single payer. After Dems completed the New Deal, they were guaranteed to be in power for several generations. If they pass a robust public option (that eventually leads to single payer), they will lock in their majority for decades. This is why the GOP is fighting tooth and nail to prevent it. It's not just about helping out their corporate buddies. It's about political survival. Which, if Dems were smart, would realize vastly trumps whatever donations they're getting from these corporations. So it's not self-interest. Not ACTUAL self-interest, at least, at the party level. Rather, it's individual self-interest, stupidity, and cowardice.

A party of George McLellans. Where are our Grants and Washingtons?

"Those who stand for nothing fall for anything...Mankind are forever destined to be the dupes of bold & cunning imposture" -- Alexander Hamilton


[ Parent ]
Slight Modification (4.00 / 4)
I really like that "Medicare for All" idea, but I think I'd do it this way to get even more positive stories into the news and to balance things between pediatricians and other medical practitioners (and to avoid provider disruptions):

* On Day 1, cover everybody born on or after January 1, 2009. That'll swat down the "he's going to euthanize my baby!" idiots. Mail every newborn's family a national Medicare card.

* Every calendar quarter, add one birth year at each end of the age spectrum. That's two additional birth years per quarter or eight per year. At that rate it'll take almost exactly 8 years for everyone to enjoy coverage. Each quarter, continue to mail all eligible Americans a national Medicare card.

* If the Republicans ever raise the slightest objection as Medicare-for-All phases in, you've got at least two birth years of very pissed Americans, young and old, united in opposition as their magic quarter approaches.

* Every quarter have a White House ceremony celebrating the accomplishments of each of the two birth years, with distinguished individuals in the cohort speaking, random ordinary Americans -- make every one a celebration of both American history and the American future. Put it on NBC, hosted by Jay Leno. (How else is he going to fill his time?) "Next up, 1958! What a wonderful year...."

* The whole thing builds to a climax as two adjacent birth years shake hands, with a December 31st birth person shaking hands with January 1st birth person -- like driving the golden spike into the final segment of the transcontinental railroad!


[ Parent ]
n/t (0.00 / 0)
The principle objection to Medicare is not "it'll kill granny" but rather "it's too expensive".  Of course we don't really know how expensive it would be because we don't have it, but just the accusation that it will bankrupt us or raise taxes is probably enough to set it back politically.  People might be willing to help pay for healthcare for grannies, but they're likely less willing to pay for it for younger, ostensibly able-bodied people.

Regardless of that, it's just as easy to lie about what's in HR676 as it is to lie about what's in HR3200.  The difference is that some people object to HR676 even without having to make up lies about it, whereas ostensibly fewer people would object to HR3200 if they knew the truth.


Just easy to lie about HR676 as HR3200? Doubtful (4.00 / 2)
HR3200 is over a thousand pages long and they're still figuring out what's going to be in it.

HR676 is only 30 pages long (single-spaced). The text; the FAQ. It's a known quantity.

Now, the Republican are going to lie about anything; that's what they do. As a corollary, it's no easier or harder for them to lie about any one thing.

The real issue, then, is whether lies about Medicare for All will stick. I'd argue no:

1. Medicare for All is simple and easy to understand (30 pages vs. 1000).

2. Medicare can be shown to work.

Even better, when Anthony Wiener gave the Republicans the chance to abolish Medicare, they didn't take him up on the offer -- so Medicare has bipartisan support!

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
HR 676 is 30 pages long (4.00 / 1)
because it hasn't been put through the amendment process in committees.  

[ Parent ]
No, HR 676 is 30 pages long because it doens't have a lot of useless cruft... (0.00 / 0)
... like health exchanges, and a firewalled and means-tested public option. Rube Goldberg machinery like that takes a lot of pages to set up.

Tell you what, though: Let's compromise. Let's make HR676 10 times as big as it is -- an entire order of magnitude.

That's 300 pages -- still under a third the size of that bloated monstrosity, HR3200.

I think it's pretty clear which bill is simpler and easier to understand.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
re (4.00 / 5)
Ruling out "single payer" from the very start was an act of mind-bending incompetence on the level of disbanding Iraq's army during the occupation of Iraq.

it's not a bug, it's a feature...


A very good rant (4.00 / 2)
and the fact you would never get a majority in the House and the Senate as currently constituted should not get in its way.

Do you know that? (4.00 / 1)
Polling indicate medicare for all would be very popular. And, as we all know, it lends itself to strong slogans, and it would be very hard for the Repubs to get the seniors they rely on so riled up about something they so love. Congress is opposed now, but Congress isn't known for having good spines, and if they did manage to stop it we'd have a great tool for thumping the obstructors, who are generally bad at other legislations too.

[ Parent ]
I'm willing to bet money (0.00 / 0)
when the CBO scores single payer, it's supporters are going to wish they hadn't.


[ Parent ]
CBO has "scored" it in the past., and GAO has also reported on it (0.00 / 0)
...back in the day, before the D leadership realized it had to prevent such reports (as well as hearings on such bills) if it was going to continue getting "contributions" from the for-profiteers.


[ Parent ]
Pelosi's having ti scored again (0.00 / 0)
I doubt she would if she knew they'd score it better than the other plans. Different situation now...the last time I've seen it scored was in 1993, when it reported that single payer would raise the baseline costs 4.8 percent in the first year and ultimately save money five years down the line.

With a deficit the size of the one we have now, a report like that would make it DOA.  


[ Parent ]
That was on Wellstone's 1993 bill. (0.00 / 0)
Conyers' bill includes taxes on the Wall Street casino as a partial funding mechanism.

Here's a compilation of statements from studies on the cost: "How Much Would a Single Payer System Cost?"

http://www.pnhp.org/facts/sing...


[ Parent ]
Which is why precompromising is bad (4.00 / 1)
you allow hearings on single-payer, you discuss it, and then you bargain down to a reasonable public option.  

Instead, we started out only arguing for a public option,a nd we're going to get bargained down to co-ops.


[ Parent ]
The Democrats unwillingness (4.00 / 1)
to make a persuasive case for what they want would not change just because they were proposing something different.  Fight the Smears is defense - there is still no offense.  This isn't, of course, limited to health care.

With a few exceptions, the Democrats seem unable to articulate why they support the positions they do. Obama can do it, but seems to be unable to sustain it.

Lies are most powerful when one side lies and the other side responds - ceding the agenda to the Republicans is a tactical error.

(On the other hand, this might make a bigger difference among activists, who would no doubt find it easier to defend a policy that made sense and existed.)  

Politics is the art of the possible, but that means you have to think about changing what is possible, not that you have to accept it in perpetuity.


although I'm a single-payer supporter (0.00 / 0)
I can't agree with you that fear techniques would not work on
"Medicare for All."

"You'll be forced to give up the coverage you have" would scare a lot of people, namely those with insurance who haven't yet gotten screwed/gone bankrupt.

Also, "the government taking over one-seventh of the U.S. economy" would be effective with a significant number of Americans. You and I know that single-payer would be the most efficient, etc., but that wouldn't be the easiest sell in the world.

A strong public option, coupled with a promise that "you'll be able to keep the coverage you have if you're happy with it" would have been the easiest sell, in my opinion. The problem is that the bills currently under consideration have only fake public options, so they are difficult to explain/defend and can't deliver what the public option is supposed to do.

Join the Iowa progressive community at Bleeding Heartland.


Forced to give up nothing (4.00 / 2)
Just as social security does not force you to give up your private pension or 401(k) or Roth IRA or whatever, a public plan that simply enrolls everyone and taxes everyone changes nothing -- all it would do is basically destroy the status quo and demand that insurance companies radically change their structures (as in France or the Netherlands) in order to survive, or die.

The most powerful version of this would be very strict tax law changes that said, "Look, company, if your employee decides to enroll in the public Medicare option, you are not allowed to just bankroll all that extra cash you were using to pay medical benefits -- you either give it to the employee as extra salary, or you get it taxes away at 100%". You would then very literally tell the public that they can keep their current coverage and network at an astronomical cost -- or, they could see their take home pay increase and see a Medicare network that covers their parents. And then a heavily regulated private network market would have to evolve to compete for customers, in a supplemental insurance market, just as the French, Dutch, and Swiss have.

And I'm pretty sure you could basically fund it all by simply fully taxing all Americans at the current payroll tax rate, but doing away with the cutoff ($105 k, or whatever it is).  


[ Parent ]
Now I'm confused (0.00 / 0)
I thought the plan was to get rid of insurance companies. You want single payer with the option of buying extra insurance?


[ Parent ]
Much of the 'single-payer' in the rest of the world (4.00 / 1)
is not a pure public plan, but a public plan plus incentivization for private spending to fill in the gap.

As far as I understand it, Britain is the closest to a pure socialized health care model, with Taiwan and Japan also being close to that. France and the Netherlands are public-private hybrids, and Switzerland is nearly a completely private model -- it also has the second highest level of spending (after the US) in terms of percentage of GDP spent on health care (it also has many pharma companies headquartered there).

The goal isn't to put health insurance companies out of business, the goal is to cover all Americans universally for preventive and catastrophic coverage, and then set up regulations to encourage innovation in ways to add supplemental coverage for additional expenses.

The current US system is the worst of all models. You almost couldn't design a worse system if you tried.  


[ Parent ]
No I know (0.00 / 0)
I'm on record as saying a lot of people around here don't understand want "universal health care" around the world really means.

I lived in Britain for 7 years, from age 7 to 14, and had experiences with the NHS, that while positive, I don't believe personally would work in this country...at least not now. I lived there during the Thatcher years and based on what I heard from family and neighbors while living there, I'm half surprised she didn't gut the system.

France/Netherlands is basically the system the House bill is trying to set up...Baucus' plan looks more like Germany, none of the plans look like Switzerland...I guess maybe the Republicans' plan does.

What you're describing is the Canadian/Australian (more Australia than Canada) system which works much like our Medicare...government single payer system is primary coverage with private insurers acting as supplemental.

Private insurance companies love that because they can scare people into buying policies they'll never use.  


[ Parent ]
Thanks (4.00 / 1)
for the interesting discussion. For silly stupid domestic political reasons, I do think saying the system we want to implement or emulate is more like the Australian system than the Canadian or French systems is probably preferable ... but that's really just because our politicians would have to choke on saying that France or Canada (or Britain) are better than the good ole U. S. of A in anything -- jingoism and all that.

Australia, Canada, France, Netherlands, even Switzerland -- these are all models that could be implemented here. I get so sick of the argument, "Well, we should study more what we can do." There are 40 different models of what works in the industrialized world, and one (1, us) that doesn't.

And I continue to be amazed by this dichotomy of Republican thinking -- we can invade random countries of brown-hued people and 'spread freedom', but we can't fund health care for our own citizens. It's a breathtaking contradiction on the role of government.  


[ Parent ]
Medicare for All...with a robust private option (0.00 / 0)
Just like Medicare is now, but hopefully, by going single payer, Medicare for All can be more comprehensive.

Saving $350-$400 Billion per year can take care of everyone from day one, dollar one. Check our Dr. David Himmelstein's interview of Bill Moyers' Journal, May 22, 2009.


[ Parent ]
..."the Expanded and Improved Medicare for All Act" (0.00 / 0)
Sponsor: Rep Conyers, John, Jr. [MI-14] (introduced 1/26/2009)      Cosponsors (86)
Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, and Natural Resources, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Lying Lies (4.00 / 1)
I find it very hard to believe that a specific policy choice would have much impact on lies as far-flung as "kill grandma".  When they are willing to make up shit based on nothing the details of the policy matter not a bit.

Remember, the whole premise behind "kill grandma" is government is going to take over Medicare.  Having government expand Medicare does nothing to immunize you from that kind of lying and confusion.  


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