Sobering.

https://twitter.com/NateSilver538/st...74575178010625

M4A as a slogan is a political loser but its implied policies (more money out of government to pay insurance, eventually sliding us toward the German, maybe Swiss system) are very popular.

The ship to UHC has already sailed. It's just a question of how we're going to get to UHC.

Maybe, but also when. And it looks a long way away unless there's a deluge that washes away the GOP or they get religion.

Wat

Like, it's the opposite if anything:

It's a question of who's pushing M4A: it's the Democratic Socialist types. And that makes it a political loser (in the sense it won't pass any time soon). That's why I was very specific in saying "as a slogan."

The actual underlying policies, you know, like public payer option or Medicare Part C for all or basically anything that says people can stop worrying about how much insurance is going to cost next year is popular, as long as you don't also threaten to take away how most people are actually insured today: through their employers.

It's mostly semantics. I don't think we disagree much. I actually don't think most of the country disagree. There is an emerging consensus that there is a need for UHC. Some people just don't want the government to run it and would strongly prefer something closer to what's happening in Switzerland (basically Obamacare with a real mandate).

Political loser to us usually means that it is a loser to campaign on, or that passing it gets you voted out. Things that are politically unattainable due to rules and the opposition are different.

If anything healthcare is where the range between what the median voter wants and what's politically possible is the widest. Republicans are hell bent on repealing even free market friendly policies and unleashing some version of ACism or corporate governance free of regulation healthcare, which is something no one, not even Republican voters want.

The end result of this is that there is some significant minority of people who get veto power of what kind of healthcare system we have, but also have an idea of what healthcare should look like that nobody wants.

Which means Switzerland or Canada's healthcare systems are equally out of reach.

This is definitely going back to SCOTUS (no chance the four monsters don't grant cert) and we will see how Roberts truly feels about his legacy.

Also, as always, better hope RBG/Breyer hold on because either of them go it's lights out for basically everything, including this.

I think Switzerland system has a better chance because it's easier to sneak something like a de facto mandate in disguised as a subsidy or as a way to reign in insurers' profits. Basically, we already have the framework (aka Obamacare) in place to expand into UHC by just dialing up the subsidies and/or tax/penalties to mandate coverage. I think the path of least resistance is in that direction.

The best part is we don't really need a lot of legislative work left. Just get a Democratic president and Congress elected in 2020 and they can essentially reinstate the mandate and dial up subsidies.

We already know once people get healthcare, they'll be loathe to let it go. By 2024, people's expectations would have adjusted and, as the Chinese would say, the raw rice is already a cooked meal.

The GOP knows this. They've retreated tactically from the issue already. They're just milking opposition to Obamacare for political gain but they have no interest in actually repealing Obamacare at this point.

PS: the 4 horsemen might deny cert or basically just delay the decision on the cert as long as possible because they know it's a political loser and they don't want anything to do with it. Roberts at least would not be happy to hear this case unless he knows for sure he got the vote to uphold.

We literally have the framework for Medicare for all, because we have Medicare, and it works and it's popular.

The problem with new programs is that anything that's not explicitly stated in the constitution has a chance to be struck down by the SCOTUS. It happened with many New Deal programs and almost happened with Obamacare.

Good luck passing anything that would disrupt employment based insurance.

We can't have Medicare for all. Moderates would revolt.

You can't go full racist and win the presidency. Moderates would revolt.

hmmmm

They do when that insurance is way better than Medicare and baseline Obamacare plan.

There is a reason most retirees that can afford it pay hundreds of dollars for Medicare supplement plans (I am including all kinds of supplements, not just what's known as "Medigap"). The most popular options are the Cadillac options and it's not even close. It really comes down to most Americans, (and I mean this by definition, the middle 3 quintiles), when they retire, they've already become accustomed to the high levels of care that employer-based plans provide, higher than the baseline Medicare.

If you go with Medicare Advantage/Medicare baseline model and people are free to purchase supplementals, then we're basically looking at somewhere between the German and Switzerland models.

I think we should be able to live with that considering those systems have pretty good outcomes and this is probably easier to pass for a variety of reasons (not the least of which is that it's closer to plug and play into the current overlapping regimes. The fed is just providing funding/subsidies for baseline plans.)

Politically I think Dems should campaign on it. But if they want to pass something workable, it has to be something that GOP can sell as "market based" reform or some such BS.

I don't give a **** about the GOP or moderates. Eventually the tide will be too great.

What I am more worried about is the healthcare middleman industry which is absolutely gargantuan and in a post-Citizens world counts as like 30 electoral votes or something.

If we can find some way to just slowly wind that down. So there aren't mass layoffs immediately, but eventually a lot of corporations have to adapt or disappear. Which I get how hard that's gonna be given the amounts of money and % of the economy involved.

Bleh.

Switzerland basically said:

You can't make a profit on the baseline plans but you can make money on supplementals.

US has something similar in Medicare advantage and many states already have laws limiting profit margins of health insurance companies.

This plan is convenient politically: big bad insurers cough up profits. Employer plans can stay intact (they'd have Cadillac/supplemental coverage that insurers are allowed to make money on.). Doctors and patients don't revolt because they keep coverage and salaries. You jump straight to a single-payer M4A and more than half of the country will say: "Oh, hell no."

Yeah but drug companies and providers HATE medicare because it has the temerity to negotiate reasonable prices.

All those congressmen who added the clause that the govt can't negotiate drug prices for medicare pt. D, then literally immediately quit to take cushy jobs with the big pharma? I'd be for finding some excuse to throw them in jail - as a warning to future corrupt asshats.

Yeah, the confusing thing about Medicare for all is that Medicare kinda sucks. One of my biggest charitable donations for the last couple years is for an outpatient custodial care facility for people with dementia, early stage Alzheimers etc. Basically adult daycare where someone can be dropped off in the morning and picked up at night. None of these people can/should ever be home alone and Medicare usually doesn’t pay much for stuff like that. The facility can hold like a couple hundred people and there is always a waiting list of a few hundered Medicare only patients. If you can pay your way in(which is already heavily subsidized) you can usually get in immediately. But they basically bleed money trying to keep the facility at full capacity while paying 100% for people with Medicare but no money.

This is a nightmare

Max, you and your finance bro buds can always pay for something better than Medicare. For every person in my family, it's been an absolute godsend.

My Dad has never made much money and has glaucoma. Medicare is I think the first real health insurance he's ever had - at least since his 20s/early 30s. It's incalculable how much Medicare changed his life for the better.

Moreover - I would probably be broke right now trying to help my dad if he didn't have Medicare. Which I know is what rich people want.

Douchebag, I know I’ll be isolated from practically any national healthcare changes and Medicare is great compared to no insurance. The people who are going to resist Medicare for all are middle class people with better plans who see healthcare as a large part of their overall compensation.

Switzerland is probably the closest to the US but its healthcare system is the least effecient compared to the other options, though obviously head and shoulders above ours.

Medicare 4 All isn't actually proposing Medicare as it is today, at all.

No one thinks that anymore now that everyone's deductible is $5k. Maybe where you work still gives low deductible coverage, but most people don't get that anymore.

Only pissed off people will be govt workers who still have sweet insurance. But they vote D and will support whatever.

Nah I don’t think the plans we have are any different. I was roped into the “Choosing healthcare plans for everybody” committee a couple years ago and I don’t think they had any plans with lower than 5k deductible for a family. I’ve never had problems with the out of pocket max though, like when my wife was pregnant, so I’ve been happy with it overall. Maybe my expectations were low but I always thought they would somehow get more than the max out of you.

But I disagree that people aren’t hyper sensitive about losing employer provided healthcare. I’ll be impressed if you can even get most Democrats on board. Colorado voted against a UHC plan that was 3% employee 6% employer payroll tax with no deductible 80% to 20% in 2016. I don’t think this forum has ever really bothered to understand how much work has to be done to get people on board with a semi realistic beyond slogan/talking points healthcare plan like that.