Thanks for the link. My understanding is that republicans are using a "fast track" procedure that has been done before (but can't be done on every bill?) and dems can't straight filibuster. They can backdoor filibuster by adding endless amendments (I guess this has been done before?) but if they do, McConnell can go nuclear and stop the backdoor filibuster(which hasn't ever been done?).

I was speaking in terms of getting public support. There's a huge difference between telling people, "Listen, we're going to start letting people buy in to Medicare" and "Everyone is going to be moved from their current plan to a Medicare-style plan." Lots of people on employer-sponsored plans will be indifferent to the former, but outraged by the latter.

Whether the consequences would end up being similar, who knows.

My understanding is repealing under reconciliation could be done with a simple majority. However creating a new bill after that could not be done under reconciliation unless they offset the total cost of a new bill with cuts elsewhere.

I don't really understand the time frame of reconciliation and the requirements of different bills equaling out individually or collectively. With straight repeal they could offer even bigger tax cuts for riches. I am not sure if new bill spending could be offset by ACA repeal or not, in reconciliation.

Can someone explain to a novice (or point to a good place to find out) how we realistically get to universal health care? What happens to those of us covered by our employers? What happens to the Anthem/Aetna/Cigna's of the world? What does this do to the caregiver (docs, nurses, hospitals, etc.) folks?

I have trouble visualizing how we get from A to B, and would appreciate any help.

You will never fully remove private pay or private insurance. Most "single-payer" countries allow additional private insurance.

You would slowly increase the Medicare eligibility age. To 60. Then 55.

You would slowly increase eligibility for Medicaid.

Make all children under the age of 18 eligible for CHIP.

Then, less and less people are covered under private insurance. If people see their children are being taken care of under CHIP, that their parents are being taken care of under Medicare 55+, then perhaps the population would be ready for Medicare for All.

You would still have Aetna et al, they would exist for supplemental policies, for private hospital room care, fancy concierge practices where the doctors start doing house calls again.

Even if you set a base of which every American is covered, the rich will still have better care. They can just privately pay for concierge practices, etc.

At least you realize that the majority of Americans are SCREAMING at the government that they want health coverage and Trump/GOP are screaming **** YOU, WE WANT MORE CASH IN OUR POCKETS back at them. And the details are missing. Such a large part of the economy that affects such a large majority of the public, yet there is very little "health" or "care" in the bill.

Study all of their policies, and you will see the same thing going on, just in different degrees.

Private healthcare exists in countries with UHC.

Depends on how fast or slow you want to take it. The slow approach is to let a government program cover children and move down the Medicare age and slowly pincer the two together. A lot of the insurance companies convert to management/ customer service oriented companies instead of gaming population groups. They deal with the organizing the bills and talking to people. Nurses or whoever stay the same, they work for the hospital. The fast approach is to simply cover everyone either by making the government program so sweet that companies will want to dump their employees on the plan (the preferred approach because it's "voluntary") or simply have the government take over all healthcare insurance. Private insurance will still exist but it will be specialized and additive, basically for whatever basic healthcare the government plan doesn't cover and/or faster access.

Here's Vox explaining an old UHC bill

I realize this goes without saying, but whenever you hear a Trumpkin say Obamacare is "in a death spiral", just ask them why they need to sabotage it if that were true.

Thanks for the input. I'll get to reading.

The implication here is what exactly? That people really like Obamacare because it is offering great access to healthcare and the Repubs are just duping people? I mean if people really are happy with Obamacare and the Repubs take it away then the Repubs will get slaughtered in the next election. Isn't that a good thing for Democrat Party election prospects?

Wouldn't a better solution be to give free healthcare to everyone except for a particular age group? Surely there are metrics out there that say e.g., ages 25-35 are the healthiest age. And we just become a society of damn that's bad luck if you get hurt at that age. Or would it be better to limit healthcare to people over the age of say 75. In order for everyone to be covered somebody will suffer, it's just a matter of who would it hurt less.

We already have that Eddy. It's called Medicare

I was gonna respond to this with a bunch of other questions you can ask, like "What study says that?" or "Why are high risk pools better?", but really the best would be to ask "What is a death spiral?"

It would be fantastic for our election prospects. It would also completely **** over 20-30 million people, Most of us aren't willing to make that trade off, even if it is short term.

Has somebody already made this joke in light of the expected 200k lives cut short from Trumpcare?

The last time conservatives killed this many Americans they were fighting to keep slavery intact.

Where did you get this number from? Also in Ohio Blue Cross - Anthem has pulled out of the exchanges and count is actually up to 20 now of the number of counties with zero insurers offering policies on the exchanges. Across the country my understanding is that there are many people that only have one insurer offering policies on the exchanges. Is it media hype that preferred provider networks for these insurers are shrinking? I can google links to stories of major insurers (like Aetna) pulling out of Obamacare due to losing a boatload of money. If I'm not mistaken the number of people using the exchanges is way below original CBO estimates. The reasons for this have been discussed in this thread. Essentially the Republicans torpedoed the "risk corridors" that would have protected insurers against losses with taxpayer money. That is my understanding anyway. The idea of the risk corridors was to help establish the markets for the exchanges over a period of time.

Perhaps a more accurate statement would be that Obamacare is in a death spiral because Republicans torpedoed the "risk corridors" that would have backed insurance companies against losses with tax payer money for a period of time to help establish the exchange marketplace. I don't know, you don't know how much money it would have taken and how long the period would really need to be. Anyway this is my take FWIW.

Wait, you're defending sabotage? I suppose you are going to tell us next that collusion with Russia is nothing more than modern day patriotism.

What I'm suggesting is pretty straightforward. Why would GOP need to help shut Obamacare down by denying funding to insurers if it were "in a death spiral" to begin with?

And again, if people can't get health insurance and they need care, who do you think ends up paying in the end anyways?

Here's a hint, it rhymes with 'flaxpayer'.

@adios: You are starting from the false premise that Obamacare is in a death spiral.

http://www.politifact.com/punditfact...-death-spiral/

https://fivethirtyeight.com/features...-death-spiral/

https://www.nytimes.com/2017/03/15/u...ther.html?_r=0

This last link talks also about the AHCA (doesn't mention the Senate version, which did not exist at the time of writing, but I'd imagine it's largely similar) making the markets less stable, but still not death spiral.

Ok not healthy then but the main points I am trying make are:

1. Obamacare has serious issues. I mean 20 counties in Ohio without an insurer and major insurance companies pulling out is at least an unhealthy situation. It is pretty well documented that there are not enough healthy people in many places paying in.

2. The Republicans torpedoing the risk corridors have at the very least exacerbated the problems and at most have completely sabotaged Obamacare.

I think that I'm being pretty fair actually. I've heard Schumer on TV indicating Obamacare has issues that need to be fixed.

FWIW Republicans are going to get slaughtered in 2018 the way they are going. I guess that would be a third point I am making .

If you are implying that I somehow think there is an easy fix well sorry I have misled you then, that wasn't my intention.

I keep hearing this number bandied about.

The "200k" number you cite is over 10 years. Just like the $800 billion cut to medicaid is over 10 years.

It is misleading because it could be much worse than that or much better than that. It totally depends on how long the uninsured are uninsured.

Assuming that the CBO is correct and 15 more million americans are uninsured next year than were insured this year, then we could expect about 18,000 more deaths as a result (at the rate of one death per 830 more people uninsured).

Also assuming that by 2026 we have 22 million more americans uninsured than were insured this year, and the rate of decline is steady (this I am guessing at) then we would have ~223,000 deaths that we wouldn't ordinarily have had in that decade (from 2017 through 2026).

By 2036 if nothing were done to rectify the situation, there would be 35 million more americans uninsured than were insured this year according to the CBO. And again assuming the decline was steady, we would have an additional ~343,000 premature deaths (from 2027 through 2036).

Also note that the rate of overdose deaths in the US is rising quickly. With severe cutbacks to medicaid that rate might even go up. Its unclear just how many more deaths will result.

The possible good news is that if Republicans get their way on medicaid cuts, then they might be swept out of office and Trump might go too. So in 2020 the medicaid expansion might be restored and possibly even expanded to include the 19 recalcitrant states... If that were the case, the net excess loss in lives by 2026 might be close to zero.

Yes well then to be clear, it's not Obamacare that's in the death spiral, it's the entire US health care system. A fully implemented ACA with congressional support could have put a halt to that, of course, but that opportunity was lost when the Reps tried actively trying to sabotage what is essentially their own health care plan.

Trump's solution to the situation was of course to promise voters literally everything, and at the same time also promise the GOP leaders that he'd support whatever plan they came up with. Shockingly those two promises are now somehow in conflict. Who woulda thunk it?

We could get a Medicare Advantage plan for all that are administered through private health insurances.

It wouldn't even cost that much more since it would be now covering younger (which equates to healthier) people. The average commercial patient visits the doctor 1.5x a year vs. 4x for Medicare.

There is more than enough money that we pay per capita to make it happen. Too many self-entrenched interests to make it happen unfortunately. Too many people just pray and wait it out to age 65 when everything become covered.