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The real irony of the Obama vs. Hillary (and Krugman and Baker & Hacker et al) argument over individual mandates for purchasing health insurance, is even more fundemental then they are both right and they are both wrong.

The argument against individual mandates is both political and practical. They can't really be enforced, and they are political poison.

The joke, the irony, is that individual mandates have been promoted, in part -- by the oh so moderate and well minded people on our side who should know better -- exactly because they thought this approach was more policically practical then Single Payer (which they actually do know is the only plan that actually, you know, works)!

The lesson of 1993-1994, already learned by some of us, is that no matter what is proposed, it will be attacked by the Health Insurance industry, Pharma, the Right.

It does not matter what compromies you make ahead of time.
It will be attacked afterwards, regardless.

PNHP cartoon

If it can provide affordable and universal coverage and access to care  -- which at the very least requires accepting all applicants (guaranteed issue) and moderating the variation in premiums by more effectively pooling risk (larger universal insurance pools and community rating) AND somehow controlling costs including excess profit and overhead (15-18% for the privates, 4% for Medicare) it will be attacked. If it reduces Health Insurance and Pharma corporate profits and control it will be attacked.

And, as Newt Gingrich and Bill Kristol famously pointed out back in 1993-94, if it looks like it might result in a success, it has to be attacked.

So yes... as analyzed by Clinton's advisor and respected MIT health economics Jonathan Gruber and also by our friends at the Urban Institute (and endlessly reiterated by Krugman)... in principle

absent a single payer system, it is not possible to achieve universal coverage without an individual mandate. The evidence is strong that voluntary measures alone would leave large numbers of people uninsured. Voluntary measures would tend to enroll disproportionate numbers of individuals with higher cost health problems, creating high premiums and instability in the insurance pools in which they are enrolled, unless further significant government subsidization is provided. The government would also have difficulty redirecting current spending on the uninsured to offset some of the cost associated with a new program without universal coverage.

Me... I reject the false premise.

In fact, plans depending on forced purchase of private insurance via individual mandates don't really work either. As Don McCanne, PNHP's Senior Health Policy Fellow, pointed out:

It is important to understand Professor Gruber's framing and modeling since he is an advisor for various reform efforts such as those in Massachusetts and California, and he is also providing support for the proposals of leading Democratic candidates for president.

Although this paper presents modeling of "the impact of alternative interventions to increase insurance coverage," he begins with assumptions that significantly limit the variety of options studied.  
He limits his options based on "two political constraints."

"First, it is difficult to envision a solution to the problem of the uninsured which does not involve in some way the private insurance industry... The health insurance industry in the United States has revenues of over $500 billion per year, making it a very concentrated interest that would have to be defeated to move to nationally provided health insurance."

"The second constraint is the fiscal situation of the U.S.  
government. Except for a brief window at the end of the 20th century, the U.S. government budget has been in significant deficit for thirty years, and this deficit shows no sign of abating... Given these pressures, major new expenditures to cover the uninsured are likely to engender a major political battle."

Before he has even begun his analysis, he eliminates a single payer national health program because we must involve the private insurance industry, in spite of his acknowledgment of the high administrative costs.

Also, his modeling does not look at the impact on our total health care costs, but rather he models the impact on taxpayer costs. In so doing, he has placed a very high priority on keeping the costs of the expansions of health care coverage out of our government budgets, demonstrating that the biggest "bang for the buck" is attained by those alternatives that result in the lowest taxpayer cost per each additional individual obtaining coverage, ignoring the fact that the difference must be paid by individuals and/or employers.

He discusses two "modest reforms": public insurance expansion, and non-group tax credits, which are quite inadequate compared to the need.

Then, for "more fundamental reform," he states that issues to be addressed include pooling, affordability, and mandates. He considers three options, "given the constraint that private insurance provision must be a centerpiece of any reform plan."

His first option is to ensure universal access of individuals to an affordable insurance product. He describes state-specific pools that are community rated with guaranteed issue. Voluntary participation would be encouraged by sliding scale subsidies based on income. By his modeling, this would cover about one-half of the uninsured, at a high taxpayer cost of $4500 per individual (Obama plan - per Krugman).

His second option is to add an individual mandate to this universal access approach. He makes the assumption, without supporting evidence (theorizing that strong penalties would be effective), that "95% of those who would not voluntarily choose to insure are forced to insure through the mandate." By his modeling, this would cover about 97% of the uninsured at a lower taxpayer cost of $2732 per newly insured (Clinton plan - per Krugman).

His third option is to remove the tax subsidy (regressive) for employer-sponsored insurance and use those funds for the pools in the individual mandate approach. The tax subsidy is so great ($200 billion) that this would result in a negative cost per dollar of insurance provided (individual mandate cost of $120 billion). But once again, this is a reduction in government spending (a government subsidy not granted) with a redistributive shift between employers and individuals of varying incomes.

Professor Gruber concludes, "To fundamentally control health care costs we need to actually be willing to deny care that does little for health – but which consumers now want. This would be accomplished either through government technology policy, medical standards, or global provider budgets... The fundamental insight of this round of reform is therefore to not hold the attainable goal (universal coverage) hostage to the (currently) unattainable goal, fundamental health care cost control."

But isn't that the problem? Health care costs are now so high that private insurers can no longer provide us with reasonably comprehensive plans at premiums that are affordable for middle-income individuals.

His first option of pooling (community rating and guaranteed issue) cannot make the plans affordable. His second option of an individual mandate can't work simply because the plans are not affordable, especially when he has made keeping government budgets in check a major priority. His third option corrects a tax policy injustice, but, in itself, is hardly a reason to perpetuate the inefficiencies and injustices of the private health plans.

Jonathan Gruber and Paul Krugman deserve their reputations as being amongst the most respected economists in the nation. But their fixation on individual mandates provides about the same level of insight as to what we need in the way of health financing reform as does the insight provided by the proctologist who tries to tell us our general state of health from his perspective.

But as we have seen with the relative political success of Obama's (gentle compared to what the Repugs will bring) critique, individual mandates are neither implementable and enforceable in the real world, nor somehow an a priori compromise that is politically viable.

An Overview Introduction to What We Mean By Single Payer:

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 46 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO or other group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing.

Key Features of "Pure" Single-Payer:

• Universal, Comprehensive Coverage:
   Only this ensures access, avoids a 2-class system & minimizes expense

• No out-of-pocket payments:
   Co-payments and deductibles are barriers to access, administratively
   unwieldy, and unnecessary for cost containment

• A single insurance plan, administered by a public or quasi-public agency:
   A fragmentary payment system that entrusts private firms with
   administration ensures the waste of billions of dollars on useless
   paper pushing and profits. Private insurance duplicating public
   coverage fosters two-class care and drives up costs;
   such duplication should be prohibited

• Global operating budgets for hospitals, nursing homes, HMOs and other
   providers with separate allocation of capital funds:
   Billing on a per-patient basis creates unnecessary administrative
   complexity and expense. Allowing diversion of operating funds for
   capital investments or profits undermines health planning and
   intensifies incentives for unnecessary care (under fee for service)
   or understatement (in HMOs)

• Free Choice of Providers:
   Patients should be free to seek care from any licensed health care
   provider, without financial incentives or penalties

• Public Accountability, Not Corporate Dictates:
   The public has an absolute right to democratically set overall health
   policies and priorities, but medical decisions must be made by
   patients and providers rather than dictated from afar. Market
   mechanisms principally empower employers and insurance bureaucrats
   pursuing narrow financial interests

• Ban on For-Profit Health Care Providers:
   Profit seeking inevitably distorts care and diverts resources from
   patients to investors

• Protection of the rights of health care and insurance workers:
   A single-payer national health program would eliminate the jobs of
   hundreds of thousands of people who currently perform billing,
   advertising, eligibility determination, and other superfluous tasks.
   These workers must be guaranteed retraining and placement in
   meaningful jobs.

Originally posted to DrSteveB on Thu Feb 14, 2008 at 08:19 PM PST.

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Comment Preferences

  •  tips and recs for US joining the developed world (46+ / 0-)

    In discussing this issue, the most important piece of information to hold on to, is that:

    ...has SOME form of universal health coverage for their citizens.
    Only the United States still does not.  

    They differ from each other in how they do this, and the mechanisms and details do matter... Canada is different from the U.K., is different from France is different from Germany, Japan, Austalia, Taiwan, etc... But only the United States does not have something.

    Remember that whenever somebody says, "yes... but..."

    We say, yes we can...

    •  This diary is brilliant (16+ / 0-)

      You nailed it. Absolutely nailed it.

      Words cannot convey my gratitude for this. So instead I'll just add some rather important evidence.

      "Socialized medicine" not such a bogeyman:

      "No doubt some Republicans will continue to use the words 'socialized medicine' to attack Democratic health care proposals before and after this November's elections, but these attacks are unlikely to do much damage," says Humphrey Taylor, Chairman of The Harris Poll®. "Only just over one third of adults think that socialized medicine would be worse than what we have now, and majorities associate the words with popular policies such as Medicare and a government guarantee that everyone has health insurance. Clearly socialized medicine is not the scary bogeyman it used to be."

      Too many Kossacks believe that single-payer is not possible because people will freak out at the possibility of "socialized medicine." That Republicans merely have to utter those two words, we are told, and single-payer dies.

      They are wrong.

      I'm not part of a redneck agenda - Green Day

      by eugene on Thu Feb 14, 2008 at 08:33:53 PM PST

      [ Parent ]

    •  This, DrSteveB, is one of the best diaries I have (14+ / 0-)

      seen on this subject.

      I wish I could rec it a thousand times for those people that don't understand this is a debate over "Universal Insurance Coverage" vs. "Universal Healthcare (single payer.)"

      Maybe if everybody wasn't so busy trying to piss on the other guy about the issue of "mandates" they'd realize they're dribbling on their own shoes.

      Great, great work.  Highly recommended!

      We...join arm in arm and decide we are going to remake this country block by block, precinct by precinct, county by county, state by state - that's what hope is

      by DemocraticOz on Thu Feb 14, 2008 at 08:40:13 PM PST

      [ Parent ]

      •  The list of Key Features (7+ / 0-)

        is just fantastic. A thousand times yes!

        Employer-based coverage is ridiculous. This discourages entrepreneurship and small businesses, and creates major drag on large employers (as many companies, notably auto manufacturers, have already pointed out). Besides the obvious costs of providing insurance, there's the unnecessary overhead. I worked for a 60-person company, and we had one HR employee who spent over half her time just on health insurance issues (and she was hyper-productive and over-qualified; at other small companies, it might take 1 or 2 full-time people to handle the same junk). That was a total waste for such a small company.

        Republicans will try to scare voters by saying we are taking away "choice", but what choice is there now, really? If your company provides insurance, you take the plan they offer, or you take a hike. You are also stuck with whatever provider list and formulary your plan offers. True single-payer allows people to see whatever provider they wish to.

    •  REC'D -- Excellent (6+ / 0-)

      I hope others will help this Diary be read by the community by recommending it.

      Information is power.

      Fascism ought to more properly be called Corporatism since it is the merger of state and corporate power. - Mussolini

      by Pluto on Thu Feb 14, 2008 at 08:44:32 PM PST

      [ Parent ]

    •  Excellent (6+ / 0-)

      I can unequivocally say that the HMO I retired from is ready for this and would thrive in such an environment as your describe.

      Nothing would change about how care is administered, the cost would be reduced from not having to compete with the for-profits, and the savings by elimination of Open Enrollments for their own employees and their meager outside Claims Processing (I know that is optional based on the implementation design but I'm being optimistic) would be enormous.

      HR 676 or California's SB-840 - the only health reform proposals worth my vote.

      by kck on Thu Feb 14, 2008 at 08:51:22 PM PST

      [ Parent ]

    •  We need to stop the (8+ / 0-)

      "socialized medicine" meme in its tracks. No one is proposing socialized medicine. We want universal coverage, with care still being provided privately. I am amazed at how many people unthinkingly buy the right-wing line that government will control healthcare and will control doctors' decisions.

      We need to enlighten voters about the variety of systems that can all achieve universal coverage. Ezra Klein's article The Health of Nations is a good place to start.

      This should not, in principle, be difficult. Health care is a sticky issue for most people. Many don't have it; many who do are paying rip-off prices for poor coverage. People who call themselves Christians should be appalled that we allow children to die for lack of health care (even kids whose parents have plans that they thought were good ones). Would Jesus cheer for people, or for profits?

      We need to be very clear about the party differences here. We want everyone to have quality health care. Republicans think that people are using TOO MUCH health care (their 'moral hazard' theory) and need to be discouraged by higher fees and co-pays. We don't want people to be slaves to out-of-control healthcare costs and the greed of company executives. We don't want children to die. We believe it is RIDICULOUS that anyone should have to worry, for one second, about losing their house or life savings because of a health problem.

      I don't want to turn this into a candidate thread, but I was with John Edwards precisely because he wanted to turn the system inside out, rather than letting for-profit healthcare interests dictate the outcome. I'm looking for the next best candidate. Individual mandates will just bolster insurance companies in their efforts to rip us off and delay, deny, and deceive. I can just see the cartoon dollar signs in their eyes.

    •  Excellent (1+ / 0-)
      Recommended by:
      ER Doc

      Simply the best discussion of the issue and why the only solution is single payer.  All the other "solutions" simply don't solve any problems or design the system anew, they are mere political expediency.

    •  virtual tip (1+ / 0-)
      Recommended by:
      ER Doc

      awesome diary! wish Obama would hire you for an advisor.

      -7.75, -6.10,

      by nicolemm on Thu Feb 14, 2008 at 10:12:34 PM PST

      [ Parent ]

    •  Outstanding diary on the PNHP plan... (0+ / 0-)

      I always like to see promotion of the idea that there really are doctors out there who want asubstantial change to the status quo.

      -5.12, -5.23

      We are men of action; lies do not become us.

      by ER Doc on Fri Feb 15, 2008 at 07:23:54 AM PST

      [ Parent ]

    •  Superb (0+ / 0-)

      Superb diary, best I've seen yet on the issue.

      As to "socialized medicine", perhaps it would be good to point out to its detractors that we already have socialized roads, socialized police departments, and socialized fire departments.

      Want to be a living kidney donor? I need one from someone with a bloodtype of B or O. Drop a note at

      by Kitsap River on Fri Feb 15, 2008 at 01:59:56 PM PST

      [ Parent ]

  •  it boils down to this for me (16+ / 0-)

    why spend twenty four cents on the dollar to do something you can do for three cents on the dollar, and forcing someone to do the former isnt the answer

  •  the thing that worries me about the healthcare (4+ / 0-)

    issue is that i don't really understand their plans per se.  i mean, i support a single payer plan.  in my mind, single payer is basically having everyone in the same pool, instead of having a pool for each company et cetera.  this would mean that we all participate in the same pool, and healthy folks would not necessarily need to take, while others may.  we would all benefit because in the end we are all paying anyway, right?  it's like putting a purchase on a credit card and in the end having to pay $10 for a $2 item.  we end up paying for something that costs a lot more instead of practising preventative medicine.  i know i am not making sense... it's 11:30pm here, and i need to go to bed.  LOL!

  •  It is obviously a better system. (6+ / 0-)

    I don't really understand why we have to be so stupid here.  It's a damned shame.

  •  well, single payer (3+ / 0-)

    is a hard sell because squeezing every dime out of the insured by stalling as long as possible then paying as little as possible has been siphoning direct care monies making huge, unbelievably huge profits since nixon gave it the nod when the for profit HMO was proposed to him, and they arent shy about tossing that money at our fearful leaders

  •  two things (4+ / 0-)
    Recommended by:
    jdld, kck, Leap Year, Pris from LA

    Thanks for the diary, btw.

    First, when you comment about the problem with mandating private insurance, I don't think that is a feature of either Hillary's or Edwards' mandate plans. I also don't think it's a feature of Obama's mandate for children. They all have (had) public options.

    Second, this is a general questions about single payer that I've been meaning to ask for some time. I've heard this one-third of costs are due to inefficiencies before, but it doesn't totally make sense to me why a single system would eliminate that.

    I could see some admistrative cost reductions due to economies of scale, but it's not like costs would drop thirty percent overnight, right?

    Also, if it were done incorrectly (say, by Bush), couldn't single-payer become a corporate boondoggle? Kind of like the Medicare restriction against negotiating for lower Rx prices?

    Mind you, I do not oppose single payer. Mostly, I'm just ignorant -- I'd love to support it, and welcome any thoughts.

  •  Recommend. Recommend. Recommend. (9+ / 0-)

    Brilliant diary. Put just about every point I've ever made on this topic into one comprehensive piece. Bravo.

    Health care is supposed to be about providing health care -- not generating profits for third parties who don't even provide the health care. As soon as you introduce the profit motive, you get distortions in the doctor/patient relationship, which should be about care, not $$$. Perhaps, a public health service would be too much of an overreach, creating far too much public bureaucracy, which would also get in the way. We here in the United Staes can create a different model. A single payer health care system that fully covers medical care, delivered on an essentially private level.

    Coming Soon -- to an Internet connection near you:

    by FischFry on Thu Feb 14, 2008 at 08:37:59 PM PST

  •  Of Course, If You Changed the Title (2+ / 0-)
    Recommended by:
    ER Doc, Pris from LA


    The real Irony of the Health Care Mandate Arguments


    The real Irony of the Health Care Mandate Pimping

    You might actually do some good here. Especially in defining the difference between National healthcare and Universal healthcare.

    Hint:  One type does not pay me dividends every time somebody's claim is denied.

    Fascism ought to more properly be called Corporatism since it is the merger of state and corporate power. - Mussolini

    by Pluto on Thu Feb 14, 2008 at 08:56:46 PM PST

  •  I agree with you about single payer (2+ / 0-)
    Recommended by:
    ER Doc, Pris from LA

    but that's a big jump from where we are now.  I want us to get there eventually, but I doubt that we can go from A to Z in one presidency, so I'm thinking about what is possible in the M range of advancement.

    As an intermediate step, I prefer Obama's emphasis on increasing access to high quality plans through voluntary expansion of the risk pool, and reducing premium costs, than HRC's emphasis on mandates.

    The argument against individual mandates is both political and practical. They can't really be enforced, and they are political poison.

    that pretty much covers it.

    Politics is like driving. To go backward, put it in R. To go forward, put it in D.
    give NOW to Populista's OBAMATHON!

    by TrueBlueMajority on Thu Feb 14, 2008 at 09:03:16 PM PST

    •  half measures that fail would be poison (4+ / 0-)

      If we get focused on trying to do something that appeases the for profit insurance companies and it ends up delivering significantly fewer benefits than promised and making life more complicated for patients, then we've basically taught people to distrust government solutions and poisoned the well for future reforms.  The current Medicare Plan D is heading in that direction now, as many people predicted.

      What it takes is political will and the ability to take the fight to the adversary, which are absolute requirements for the next Democratic President anyway. The hesitancy and excessive concern with bipartisanship that characterized the Carter and Clinton administrations has not gotten us results comparable to the partisan arm-twisting and big thinking of the Roosevelt and Johnson administrations. And FDR had to deal with a level of opposition (including people plotting to overthrow him) that would make most of the Democrats today faint dead away in terror.

  •  This comment... (2+ / 0-)
    Recommended by:
    ER Doc, Pris from LA

    Jonathan Gruber and Paul Krugman deserve their reputations as being amongst the most respected economists in the nation. But their fixation on individual mandates provides about the same level of insight as to what we need in the way of health financing reform as does the insight provided by the proctologist who tries to tell us our general state of health from his perspective.

    Yes this is true enough yet, in the absence of support for HR 676 or the like, Gruber and Krugman are still sounding better than Clinton's plan and more better than Obama's plan wrt to benchmarks for election analysis. No?

    DrSteveB, does PNHP have an action plan? A consolidation of activists needs to start getting organized for for Congressional challenges...etc. Any ideas? I see too many groups and not enough lobbying of corporate allies.

    HR 676 or California's SB-840 - the only health reform proposals worth my vote.

    by kck on Thu Feb 14, 2008 at 09:08:20 PM PST

  •  In Florida (1+ / 0-)
    Recommended by:
    ER Doc

    companies normally exclude people with pre-existing conditions that require expensive drugs.

    If the insurance company could legally demand and get rebates for drug expenditures that exceed half of the premiums paid, they would probably be willing to cover people with pre-existing conditions.

    In my adult life, all health insurance claims I ever filed were for pre-existing conditions.

    I always got my health insurance claims paid.

    That was in the 1980s and 1990s.

    I haven't had health insurance since 1993.

    American patent and drug approval laws place no limit on what a drug company can charge.

    Every existing condition is potentially a 20-year monthly supply of blank checks to a drug company drawn on an insurance company bank account.

  •  One use for some former insurance employees (1+ / 0-)
    Recommended by:
    ER Doc

    would be auditing billing practices for fraud. I think the only way to make single payer work and avoid massive fraud is to have every bill paid in a timely way, or at least create no disputes that would delay patient care being delivered But then have some really careful auditing of specific providers on a periodic basis, including unannounced on-site audits where there is a string suspicion of wrongdoing. And serious fraud should be prosecuted fully and result in significant jail time on conviction. But the patient should never be concerned about how their care is being billed or paid for, only that they be getting appropriate and effective care from a medical standpoint (including second opinions for confirmation on any non-standard procedures).

    •  The insurance companies help prevent fraud (0+ / 0-)

      under the current system. I believe that is their only real value.

      The government could auction off single-payer payout lists by area [Miami, Brooklyn $$$] and let former insurance companies and their clerks audit them.

      Any fraudulent provider would have to repay the government and pay a multiple to the former health insurance company as a finder's fee. A multiple of two if paid within 30 days, a multiple of four if paid after 30 days, and a multiple of eight if paid after a judge hears any part of the case, reducible to six at his discretion.

      In New York, shoplifters face the option of paying five times the cost of the merchandise to the store or face the justice system.

      My anti-fraud system could also be used for the current government payment systems.

      •  Corporate Insurance IS FRAUD (1+ / 0-)
        Recommended by:
        Hens Teeth

        They are hugely fraudulant. They say they will pay for your care just give them your money and then they do not pay for your care. This is basic Fraud 101. They have proven themselves unworthy of existance. The government couldn't do worse. At least then the people would have some control over their own care not some greedy bastards denying care.

  •  All the candidates want to go (1+ / 0-)
    Recommended by:
    ER Doc

    100% electronic I believe.

    Billing on a per-patient basis creates unnecessary administrative complexity and expense.

    Records are kept because state law requires records to be kept. Doctors need to note what they did and when they did it.

    Nurses need to note that the patient actually took a pill, got the IV, etc.

    I believe the AMA created and copyrights the medical coding system.

  •  Hospitals could set up insurance (0+ / 0-)


    The public has an absolute right to democratically set overall health policies and priorities, but medical decisions must be made by patients and providers rather than dictated from afar. Market mechanisms principally empower employers and insurance bureaucrats pursuing narrow financial interests

    Genesis of Modern Health Insurance

    It was 1929 when Dr. Justin Ford Kimball, a former school superintendent, became an administrator at Baylor Hospital in Dallas and found himself confronting some of the same problems he'd faced as an educator. Reviewing the unpaid accounts receivable of Baylor Hospital, Dr. Kimball recognized many names of Dallas schoolteachers.

    Knowing well from experience that these low-paid teachers would never be able to pay their bills, he initiated the not-for-profit Baylor Plan, which allowed teachers to pay 50 cents a month into a fund that guaranteed up to 21 days of hospital care at Baylor Hospital. The Baylor Plan — the genesis of modern health insurance — sparked interest in hospitals across the country, as they scrambled to set up similar plans. In 1944, the Baylor Plan was merged into the Texas institution we know today as Blue Cross and Blue Shield of Texas.

  •  I know I'm late to this diary but I have a plan (1+ / 0-)
    Recommended by:

    Single payer for everyone who wants it; the Republicans get a separate pay as you go plan.

    We'll see how long that lasts.

    Hillary for President John Boccieri for Ohio 16th Congressional District. ITS TIME FOR RALPH TO GO!

    by glbTVET on Fri Feb 15, 2008 at 07:06:07 AM PST

  •  Abso-freaking-lutely!!! n/t (0+ / 0-)
  •  But there is no forced purchase of private (1+ / 0-)
    Recommended by:
    p a roberson

    insurance if the plan allows for a Medicare buy-in. The trouble is, the Massachusetts system which is in many respects similiar to Hillary's plan contains a provision that disallows the choice of a government rather than a private plan...both Hillary's and Obama's plans delete this provision and allow individuals (businesses?) to choose Medicare.

    John Edwards pretty much stated explicitly, I believe, in answer to a question that the ultimate goal of his plan (the basis for many elements of Clinton's and Obama's plans) was to provide a bridge to single-payer by providing an opening for people to opt-out of private insurance and choose public insurance instead.

    The one problem now--after years of privatization pieces glommed on (Medicare Advantage and Part D), Medicare is currently a sick system that needs to be de-privatized and modernized. But if Medicare can be made more attractive and opened up to allow working age nondisabled persons to "buy in" it could simply suck the business out of private plans over time. There'd be a hell of a fight, but a UHC plan with mandates might be a good way to start that fight...because as long as it's just lefties like Michael Moore and Dennis Kucinich and his handful of Progressive Caucus members, nothing's going to happen. Americans might favor single payer in the abstract, but too many seem to believe it's not possible.

    "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

    by Alice in Florida on Sat Feb 16, 2008 at 02:06:09 PM PST

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