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Since Brian Beutler thinks the public option might make a comeback, I decided to post about something that's irked me for while...

Most of the time, when people think of "the public option," they think of it as just one key part of ObamaCare that died in the negotiation process. But the public option was much more than that. If Democrats had skipped the entire "comprehensive health reform" process and simply expanded Medicare to include a public exchange, they could have obviated the need for most of the complicated and controversial provisions in the Affordable Care Act.

I know what you're thinking: "What the hell is this guy talking about?" But keep reading, and I promise you'll understand by the end. And to be clear, I'm not trying to second-guess the President or Nancy Pelosi or anyone else. Politics is extremely complicated with lots of moving parts, and hindsight is always 20-20. But the fact that you can't change the past isn't a good reason not to reflect how different policies could have achieved similar outcomes. And as far as I know, there was NEVER any mention of the idea of passing a stand-alone public option. It was always mentioned as part of a "comprehensive" package.

Instead of a 1,000-page bill that terrified the country into "ZOMG government takeover of health care" hysteria, Democrats could have accomplished most of the same goals with a ten-page bill and even had an awesome political talking point to go with it: "we are not touching the private insurance market, we are simply offering an option for those who are locked out of it."

Contrary to popular belief, the basic crux of ObamaCare was not "universal coverage." Universal coverage would be single payer, and we can't have that, because what are we, some kinda communist dictatorship like Germany or Canada? And single payer was never gonna happen in 2010. Expanding Medicare would have been much more plausible. The politics of expanding a popular program are much more friendly than telling the country you're going to nuke their health insurance. Anyway, the main point of ObamaCare was not universal coverage, but rather to vastly expand coverage for people who needed or wanted it. That is a key difference.

The government didn't need an individual mandate or an employer mandate or a ban on preexisting conditions or even an 80/20 rule to expand coverage. And they definitely didn't need to expand Medicaid. All they needed to do was set up a "Medicare Public Exchange" in which anyone who wanted a plan could buy one, at a percentage of their income. Low-income people could get one for free, gradually eliminating the need for Medicaid altogether... more on that later.

And no, this wouldn't be some kind of "high risk pool." People predicted that the ObamaCare enrollees would skew older and sicker, and that didn't happen. With a public exchange, a death spiral would be even less likely to happen because the government would be charging much less than for-profit insurance companies, meaning "young healthies" would be even more likely to sign up than they were for ObamaCare.

Let me explain exactly what my "Medicare public option" would have looked like and what it would have accomplished:

The Medicare Public Exchange would:

1) not discriminate based on preexisting conditions or sex.
2) charge you a simple percentage of your income for a plan, because ACA's subsidy formula is a disastrous mess. I have detailed a more breakdown on that below.
3) be an arm of the Medicare program, instead of Medicaid. Medicaid is controlled by the states, which allowed the Supreme Court to gut the expansion, leaving it up to states. The federal government controls Medicare, however, meaning the high court could not have easily gutted it. Furthermore, Medicaid's reimbursement rate is so low that few doctors accept it. But almost everyone accepts Medicare.
4) include a similar "tier" system of bronze, silver, gold, platinum so people can decide how much risk they want to take.

The Medicare Public Exchange would make the following ObamaCare provisions unnecessary:

1) The "Preexisting Conditions" clause

There's no need to force insurance companies to take sick people if the government offers to take sick people. The government, unlike private companies, isn't worried about shareholders or profits. This would have been a formidable talking point ("The government has a responsibility to ALL its citizens" etc) and any claims of "government takeover" could be countered with "this bill doesn't touch the private insurance market."

2) Individual mandate.

The individual mandate was a compromise to insurance companies who knew that many of young healthy people who are necessary to avoiding a death spiral would need a strong push (the "stick") to get them to cough up $200 a month for services they may or may not need. But the public exchange bill wouldn't have touched the private market, making this provision unnecessary and saving Democrats lots of political headaches.

3) The Employer Mandate

Because of all the fear-mongering over the debt, Democrats seemed obsessed with making ACA "deficit neutral" so they included lots of controversial provisions, such as the medical device tax and cuts to Medicare overpayments (although Republicans voted for those same cuts). But one of the dumbest provisions was the employer mandate. You can see the White House fumbling with it every year. Why set up exchanges for people locked out of private insurance and then tell employers that they must provide their employees coverage? It makes no sense. It seems that it was written just as a way to collect more revenue and make the bill the "deficit neutral."

Furthermore, another headache with ObamaCare is that anyone who's offered insurance through their job is ineligible to buy an exchange plan, unless the employer plan has almost no benefits or is obscenely expensive. In many cases, this means employees are stuck in a plan that is still very stingy or moderately expensive. But they have no choice in the matter. If someone wants to deny the insurance their employer provides, and purchase government option, they should be able to do that.

The Medicare Public Exchange would have accepted everyone, even people offered insurance through their job, and made the employer mandate completely unnecessary. (As a side note, employer-provided coverage makes no sense. I don't get homeowners or health insurance through my job, so why health insurance?)

4) The 80/20 Rule

The 80/20 rule is a lesser known provision that forces insurance companies to spend at least 80% of premiums on health care rather than administrative costs and profits. It seems to be working quite well right now, but I believe that the Medicare Public Exchange would have made this provision unnecessary. Public competition would have forced insurance companies to keep their premiums low.

5) HealthCare.Gov Disaster

OK, this isn't a "provision" of the law, but rather a necessary tool to sign people up. But the website was unquestionably the biggest face plant of Obama's tenure. It was completely self-inflicted and avoidable. I could write a whole other piece on how avoidable that problem was... but I digress. The Medicare Public Exchange would still need a website to sign people up, but it wouldn't be nearly as complicated or glitchy.

One thing that really bogged down healthcare.gov was the issue of deadlines. ObamaCare mandates "enrollment periods" so that people don't just buy a health insurance plan after they break their arm or get cancer. We all saw how the rush to buy insurance before the deadlines in December and March led to outages and egregious errors. The Medicare Public Exchange has no individual mandate and thus has no enrollment period or deadlines. They could have rolled out the Medicare Public Exchange state by state, slowly working out the kinks.

Furthermore, because it's so straightforward and easy to understand, the Medicare Public Exchange would have never been named "ObamaCare" and attacked relentlessly, so there wouldn't have been any grand opening day in which political reporters who already have health insurance created accounts on a health website to see how it was working. It would have been completely uneventful and boring.

So...

You may have read all this and said to yourself, this sounds like a really sneaky way to introduce single payer... and you're right! Contrary to what many people think, ObamaCare moved us further away from single payer by moving even more money to the private health insurance industry. Just look at their profits since ObamaCare took effect. This is especially true in states like Arkansas, which has a private Medicaid program (other states like Indiana and Pennsylvania are being even more aggressive in their privatization of Medicaid). The big insurance companies love ObamaCare. That's why more insurers are jumping in this year.

Republicans are constantly badgering us about how the private sector can do everything better than the government. If a Medicare Public Exchange had been set up without any additional regulations on the private market, it would have been amazing to watch Republicans lose their minds as liberals said "OK, we didn't touch your private market, we just set up our own, and people love it."

Of course, Republicans would have said "we can't compete with socialism!" And they're right! Americans love socialized medicine. That's why Medicare is so popular. Medicare has millions of patients, low administrative costs, and doesn't spend any money on million dollar bonuses for executives. Medicare is also seeing its per-beneficiary costs drop, to the dismay of conservatives who want to dismantle it.

To be fair, ObamaCare is also socialism, but the Medicare Public Exchange would have been a much more straight-forward socialism, not a 1,000-page monstrosity full of obscure provisions and typos that can be misconstrued.

Eventually, the Medicare Public Exchange would have accomplished through approximately ten pages almost everything that ObamaCare accomplished, while bringing us closer to single payer and with a fraction of the political headaches. That is why Republicans feared it so much in 2009 and that is why they're trying to kill postal banking now. But unlike USPS having little to no experience providing loans, Medicare is extraordinarily experienced in providing health coverage.

The Medicare Public Exchange wouldn't completely kill the private market though. Wealthy people would still be able to buy supplemental plans, but wealthy Medicare enrollees can already do that! Even countries with full-blown single payer have private companies which sell supplemental plans.  

And the Medicare Public Exchange wouldn't be able to accomplish everything that ObamaCare did. There are some provisions in ObamaCare like the new Medicare readmissions policy which are working great. But that could have been added to the law and would have been very uncontroversial.

And you may be asking, "So in your imaginary world where ObamaCare never passed but the Medicare Public Exchange did, it sounds like private insurance companies can continue shameful practices like having no out-of-pocket max, charging women more, or drastically raising premiums every year." And that would be correct, but that just means that over time, more and more people would quit their private plan and join the Medicare Public Exchange, forcing private insurance companies to either adapt or go out of business. The government is writing the rules without any regulations, just through leading by example. Postal banking could achieve similar results!

So in summary, Democrats could have taken a few weeks and drafted a simple bill which would have accomplished almost everything ObamaCare did with none of the political vulnerabilities.

Would it have passed in 2010? Who knows. Is it too late to try it again if Democrats retake the House in 2016? Probably, given how entrenched ObamaCare is now. But if you're like me and you believe in simple policy which has broad, positive implications and low political risk, then the Medicare Public Option is worth fighting for. Democrats should at least make a strong push to get the Democratic 2016 platform to include a public health option as well as a public banking option.

If you're interested, check below the fold for how I would have simplified the subsidy calculation, which is currently an unholy mess.

For those interested, I have expanded on my subsidy formulations...

One of the things that is absolutely ridiculous about ObamaCare is how much the percentage of your income rises as your income rises. So someone earning $15,000/yr pays only 2%, but if someone earning $20,000 would pay over 5% of their income! And if you're an older individual earning over $47,000, you would have to pay over 15% of your income on health premiums. That is so stupid that it makes me want to scream at whoever wrote it. But I won't...

My subsidy calculation formula would replace ObamaCare's byzantine formula with a simpler one, similar to how marginal tax rates work.

Individuals/families earning under 100% FPL would pay zero. Individuals/families earning between 100-400% of FPL would pay 2% of their income after 100% FPL per enrollee. Anyone earning more than that would pay 4% of their income over 400% FPL per enrollee.  And there would be no age rating.

So, to give you an idea, here are some random examples:

An individual making $10,000/yr or a married couple making $15,000 would get free health care.
A family of four earning $30,000 per year would pay $123 per year per enrollee. That's 1.6% of their income.
A family of three earning $50,000 per year would pay $604 per year per enrollee. That's 3.6% of their income.
A family of five earning $90,000 per year would pay $1,241 per year per enrollee. That's 6.9% of their income.
A family of six earning $150,000 per year would pay $2,803 per year per enrollee. That's 11.2 % of their income.

As you can see, like income taxes, it's a progressive system. The more you make, the more you pay. This is how socialism is supposed to work.

Originally posted to YeaYouRite on Mon Aug 11, 2014 at 06:33 AM PDT.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tell Sen Nelson, and Sen Lieberman (18+ / 0-)

    Why not just say a pure national health insurance plan with no Medicare, no Medicaid, no private insurance, just a national insurance plan for all, should have been voted on in 2010.

    You simply can't ignore political realities and fantasize about something that was impossible.

    •  Because that would have been (16+ / 0-)

      even more difficult.

      It's a lot more politically realistic to expand Medicare, a program that people know, than to tell the country "we're nuking your insurance plan and the government is taking over."

      •  Neither were possibilities. Go back and recount (26+ / 0-)

        the circumstances around passing the ACA.  It's a miracle anything was accomplished.

        "Because I am a river to my people."

        by lordcopper on Mon Aug 11, 2014 at 07:01:47 AM PDT

        [ Parent ]

        •  You can't say that (26+ / 0-)

          You can't say it wouldn't have been possible because no one was even talking about doing it.

          Democrats were trying to pass a public option as one PART of a monstrosity bill.

          But there was never any suggestion of passing a stand-alone public option.

          Politically speaking, I believe it would have been possible.

          •  And while my wife is a beautiful and talented (13+ / 0-)

            woman, she can't hold a candle to my imaginary girlfriend.

            "Because I am a river to my people."

            by lordcopper on Mon Aug 11, 2014 at 07:17:42 AM PDT

            [ Parent ]

            •  well (9+ / 1-)

              if you had read all the way through, you would realize that it's still possible.

              But obviously, you're more interested in being an asshole.

              •  Now you're just being ridiculous. We can't even (10+ / 0-)

                get a Highway Bill through this House, it is impossible to pass the legislation you want with this Republican Party.  It always has been.  But call me an asshole (aka a realist) if you want, I'll where it as a badge of honour.

                "Because I am a river to my people."

                by lordcopper on Mon Aug 11, 2014 at 07:40:13 AM PDT

                [ Parent ]

                •  I know that (3+ / 0-)
                  Recommended by:
                  lunachickie, mikejay611, bnasley

                  You obviously didn't read all the way through. Every time I post something I have to deal with clowns like you who don't read the entire piece.

                  I specifically said "if we win back the House."

                  •  When are "clowns like you" going to realize that (6+ / 0-)

                    even if we "win back the house" (an extreme long shot in the next 6 years) we aren't going to have the reservoir of votes necessary to get this policy passed. I an environment where you can't even count on Democratic votes in the Senate (plus the 60 vote cloture requirement), this is a pipe dream.  The ACA was a first step. Get the public behind it, then maybe we can improve on it.

                    "Because I am a river to my people."

                    by lordcopper on Mon Aug 11, 2014 at 09:01:53 AM PDT

                    [ Parent ]

                    •  ACA is not the first step (10+ / 0-)

                      ACA is better than nothing, but in terms of where we want to go, it's a step backwards. We succeeded in giving the insurance industry MORE power. Getting to single payer is now more difficult than ever.

                      But if Democrats control all three branches of government after 2016, the only thing stopping a public option is Democrats. Period.

                      •  If that happens, you will rediscover what we (4+ / 0-)

                        learned the last time Democrats controlled all three branches of govt:

                        1.  All Democrats aren't equal.  Coming from different states and having different "political requirements" inherently decreases political reliability.

                        2. The Senate will not abandon it's traditions easily.  It will be extremely difficult to produce the legislation you want from this body.

                        There is no substitute for the popular will of voters.  Progressives need to do a better job of winning the public debate, which means persuading actual voters.  If nothing else, the ACA experience has taught us that.

                        "Because I am a river to my people."

                        by lordcopper on Mon Aug 11, 2014 at 09:21:00 AM PDT

                        [ Parent ]

                      •  The ACA is biggest expansion of single payer since (5+ / 0-)

                        Lyndon Johnson.

                        Art is the handmaid of human good.

                        by joe from Lowell on Mon Aug 11, 2014 at 10:05:43 AM PDT

                        [ Parent ]

                        •  Huh? (2+ / 0-)
                          Recommended by:
                          barkworsethanbite, aseth

                          You can support the ACA on its merits. You can, as I do, refuse to cheerlead for the ACA even though it has merits. (I personally benefit greatly from the ACA, as I qualify for medicaid now because assets no longer are considered in the qualification process, i.e. I own my home and have $325k in retirement savings, but am retired and have no income. Prior to the ACA that would have disqualified me. No longer.) But to say that the ACA is an "Expansion of single payer" is ridiculous. The ACA is the opposite of single payer.
                          I denounce the ACA because it enriches the insurance companies, who have proven themselves to be deadly enemies. I denounce the ACA because it wastes $1.2 trillion a year, while boasting that it saves $200 billion. I denounce the ACA because even with considerable subsidies the long term effect of forced premiums is impoverishing. (Had the ACA been in effect when I was working I would not have been able to qualify for a mortgage and would not have been able to save enough to retire when I had to. I would quite possibly be a very healthy person living under a bridge.) And I denounce the ACA because I believe it will make it harder for us to escape the insurance companies, not easier.

                          •  Then you Sir/Madam, are the problem. (1+ / 0-)
                            Recommended by:
                            Cedwyn

                            "Because I am a river to my people."

                            by lordcopper on Mon Aug 11, 2014 at 01:26:30 PM PDT

                            [ Parent ]

                          •  Have you never heard of the Medicaid expansion? (5+ / 0-)

                            Please tell me this was just a slip of the mind on your part, and you actually do realize the Affordable Care Act includes a massive expansion of Medicaid.

                            In point of fact - inarguable fact, which has been much reported on this very site - the Affordable Care Act includes a Medicaid expansion which is, in both dollar amounts and number of covered people, the largest expansion of federal single-payer health care since the Lyndon Johnson administration. You knew that, and just forgot about it, right?

                            Because, really, if you just wrote an entire diary presuming to educate people about the Affordable Care Act, and you don't even know enough about the law to realize that it included a Medicaid expansion, I'm going to lose what little faith I have left in humanity.

                            Art is the handmaid of human good.

                            by joe from Lowell on Mon Aug 11, 2014 at 02:03:07 PM PDT

                            [ Parent ]

                  •  Both the house and the senate (2+ / 0-)
                    Recommended by:
                    lenzy1000, Choco8

                    are littered with corporatist DLC democrats who would not agree to any plan that would exclude or in any way shape or form cut the piece of the pie reserved for the insurance companies. Lieberman, Bayh, Baucus,and a host of others are wholly owned subsidiaries of the Insurance lobby. Add to that that the Republicans require sixty votes for every senatorial bill to be able to be discussed, not to mention passed . The only ones owned and operated by corporate America are not the Republicans. A lot of Democrats are also part of that "rather exclusive" group. Maybe some day but not with the present political system where our representatives are for sale to the highest bidder

              •  Not hr-worthy (6+ / 0-)

                lc provoked the comment by calling the diarist, in essence, delusional on a point that is a matter of speculation rather than fact. lc could have kept the dialogue civil by stating his/r observations about the politics without the derogatory remark, but chose to provoke instead. But doughnuts are reserved only for those who disagree with our own pov's, right joe?

                The art of listening is the ability to pay attention to that which is most difficult to hear

                by dRefractor on Mon Aug 11, 2014 at 10:34:47 AM PDT

                [ Parent ]

                •  Everyone who lived through the fight that (2+ / 0-)
                  Recommended by:
                  Cedwyn, Catte Nappe

                  produced the ACA remembers the Public Option was a non-starter.  I'm sorry, but the diarist is delusional on this issue.  The only reason we got anything is the Senate had passed something, and we were able to use the Reconciliation process to meld the House and Senate legislation.

                  "Because I am a river to my people."

                  by lordcopper on Mon Aug 11, 2014 at 09:13:03 PM PDT

                  [ Parent ]

                  •  I think your certainty on this specific issue (0+ / 0-)

                    is delusional, but that gets us nowhere. Though I followed quite a bit of it, I didn't follow every detail of the sausage grinding the begat the ACA, but, and correct me if my memory is wrong, the powers that were did not allow a public debate on the public option in any meaningful form, did they?

                    You can claim all you want that the P.O. was DOA, that if any serious consideration was given to it that the insurance industry would have raised holy hell (privately to major donee's) that would have deep-sixed it post haste. And maybe you'd have been right. But if I were playing eleventy-dimensional chess, and was in the democratic leadership at the time (including the POTUS), I would have had the P.O. added as a last minute addition, debated, and voted on in public. It probably would have failed, but it would have been beneficial to the public to see the spectacle and to have the issue brought more out into the open. Who know's, the option might have made enough sense to get a loud enough public outcry to sneak it into law. At the very least, it would be a topic of more discussion amongst those who dislike the idea that insurance companies are big winners (along with the not insubstantial increase of insured) of the ACA.

                    Hell, I've been able to convince quite a few republicans that the P.O. would have been a good idea -- medicare is not a four letter word for most americans. So why the lack of the Dem leadership to push for it? I don't think it's just because some rogue conservadems didn't want it, I think much of the leadership didn't want to be seen opposing it as well. It's not just the lack of effort that galls some of us on this, it's the deceptive cynical process that gets buried by the voices of "reason" telling us we got all we could.

                    The art of listening is the ability to pay attention to that which is most difficult to hear

                    by dRefractor on Tue Aug 12, 2014 at 02:22:52 AM PDT

                    [ Parent ]

                    •  the house bill had a public option in it (1+ / 0-)
                      Recommended by:
                      lordcopper

                      but then teddy passed and we lost his seat, so the process of committee reconciliation (merging the senate and house versions) went right out the window.

                      since the senate had already voted on a bill, they had no choice but to adopt it in the house.

                      Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

                      by Cedwyn on Tue Aug 12, 2014 at 04:26:23 AM PDT

                      [ Parent ]

                    •  This is what I find delusional. Please review the (0+ / 0-)

                      history of the ACA, and the facts surrounding it.

                      "Because I am a river to my people."

                      by lordcopper on Tue Aug 12, 2014 at 07:07:59 AM PDT

                      [ Parent ]

                      •  It's kind of funny (0+ / 0-)

                        You recommend a comment stating that the senate passed a bill without the public option followed by some gobbledygook about how because Ted Kennedy died that no reconciliation could happen. I recall that the president went strangely silent and that there wasn't a vote on the P.O. nor even a public debate in the reconciliation committee, am I misremembering?

                        But back to my original comment, how is it that the senate leadership sanctioned a version that ignored the P.O. in the first place? Where was the leadership push for something that would have truly upset the apple cart on behalf of the public? Reid had opportunities to let the P.O. be voted on, but deferred to obstructionist procedure. Your answers as to why he deferred fail to persuade many; you sound defeatist at best, cynical and disingenuous at worst.

                        The art of listening is the ability to pay attention to that which is most difficult to hear

                        by dRefractor on Tue Aug 12, 2014 at 11:17:39 AM PDT

                        [ Parent ]

                        •  Newsflash, every Democratic Senator does not (0+ / 0-)

                          feel/vote the same about every issue. You seem to think that the PO was "entitled" to passage because 60 Senators were Democrats, or that Senate Leadership can force a Senator (running for reelection) to vote for a measure they disagree with (have decided is not in their electoral interest).  Without Republicans participating, passage would have required every Democrat to walk in lock step.   That's not the way politics work, and that's exactly the reason I say it was always a pipe dream.  It simply did not have the support in the Senate, or in the country for that matter.

                          "Because I am a river to my people."

                          by lordcopper on Tue Aug 12, 2014 at 12:37:59 PM PDT

                          [ Parent ]

                    •  Your memory is wrong (1+ / 0-)
                      Recommended by:
                      lordcopper

                      Google: debate public option for a long list of articles and reports on how that debate was faring. And those Republicans you've now been able to convince that a PO might have been a good idea would have had a very different take after being subjected to blitz of opposition ads funded by the insurance companies. As would the take of many Dems.

                      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

                      by Catte Nappe on Tue Aug 12, 2014 at 11:13:35 AM PDT

                      [ Parent ]

                      •  Yep, we gave up (0+ / 0-)

                        before the big bad insurance industry could come after us!

                         A good number of republicans are quite aware of how the net result of the ACA lines the pockets of the insurance industry even if most are indifferent or worse to the fact that many of us were able to get insurance as a result. It is by no means a fact that the insurance industry would have won the war had the P.O. been seriously pushed in the senate.

                        The art of listening is the ability to pay attention to that which is most difficult to hear

                        by dRefractor on Tue Aug 12, 2014 at 11:31:25 AM PDT

                        [ Parent ]

              •  Uprated (1+ / 0-)
                Recommended by:
                DuzT

                for bullshit HR...

                Republicans are counting on the fact that fear makes people do stupid things. Like voting Republican.. ~ Ian Reifowitz

                by mikejay611 on Mon Aug 11, 2014 at 12:09:01 PM PDT

                [ Parent ]

          •  I Could See Maybe a Formal Public Option Available (18+ / 0-)

            for a few states. Thing is, we only had 60 votes for a couple months, maybe not even 2 full months, between Al Franken being finally allowed in and Ted Kennedy going out. And even then, too many Democrats were conservatives to allow a national public option.

            I agree it should've been in the negotiating mix, it's such unconscionably bad negotiating that the only explanation is that the Admin opposes expanding public coverage as a principle.

            We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

            by Gooserock on Mon Aug 11, 2014 at 07:20:20 AM PDT

            [ Parent ]

          •  Buy you can "say that?" (0+ / 0-)

            Your entire diary is based on "assuming a can opener."

            I don't think you get to criticize this guy on the grounds that he's assuming a can opener.

            Art is the handmaid of human good.

            by joe from Lowell on Mon Aug 11, 2014 at 10:04:41 AM PDT

            [ Parent ]

          •  Would your approach have required 60 votes? (1+ / 0-)
            Recommended by:
            mikejay611

            At one point, wasn't there discussion if a bill was considered just a budgetary item it needed  just a simple majority and not 60 votes?  

            •  that's Reconciliation (0+ / 0-)

              and requires extra steps by the Congress before it can be invoked. It's how the ACA got past the Senate.

              http://en.wikipedia.org/...

              •  NO IT IS NOT how ACA got anywhere (1+ / 0-)
                Recommended by:
                Cardinal Fang

                ACA passed the senate in the normal way:  both chambers of congress passed the bill and the president signed it into law.

                the only part senate budgetary reconciliation (not to be confused with committee reconciliation between the two chambers of congress) played was in the fix bill where they removed the cornhusker kickback and made some changes to student loan financing.

                but the ACA absolutely WAS NOT passed via reconciliation.  

                Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

                by Cedwyn on Tue Aug 12, 2014 at 04:31:07 AM PDT

                [ Parent ]

                •  *ACA passed in the normal way (0+ / 0-)

                  "the senate" shouldn't be in there

                  * sips coffee *

                  Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

                  by Cedwyn on Tue Aug 12, 2014 at 07:20:01 AM PDT

                  [ Parent ]

                  •  without using the budget reconciliation (0+ / 0-)

                    that you mention, the Senate's ACA wouldn't have gotten past the House. I was a bit sloppy there and my memory wasn't as good as I thought. But my point stands. If the budget reconciliation trick hadn't been used, there probably wouldn't be an ACA.

        •  I should have read this before I posted (0+ / 0-)

          You said near the exact same thing. My bad.

          ...the GOP seems perfectly willing to hold their breath until the whole country turns Blue.

          by tommy2tone on Mon Aug 11, 2014 at 07:28:29 PM PDT

          [ Parent ]

      •  just lower the medicare eligibility age. (3+ / 0-)
        Recommended by:
        YeaYouRite, SGA, barkworsethanbite

        make it that

        TEligibility age is 59 or under 21  and increase the premium
        1%,  then, every 5 years, adjust the numbers a bit.

    •  They had a price. (1+ / 0-)
      Recommended by:
      lotlizard

      Everybody has a price.

      (And maybe if O., Clinton et al in the Party estab. had supported Ned Lamont -the people's choice--rather than Independent Lieberman...?)

      I've never left a blank space on a ballot... but I will not vote for someone [who vows] to spy on me. I will not do it. - dclawyer06

      Trust, but verify. - Reagan
      Vote, but Occupy. - commonmass

      by Words In Action on Mon Aug 11, 2014 at 09:48:20 AM PDT

      [ Parent ]

    •  Better still would be a National Health Service (0+ / 0-)

      No insurance companies needed. Everyone in the Country could go to NHS providers and receive health care, no insurance policy needed.

      Think of the savings: no insurance company overhead, along with their frequently usurious profits, because everyone could get health care without private insurance. It would kind of be like National Defense, we pay for it through our taxes. If you need it, it is there for you. Imagine the savings from preventative care obviating a lot of corrective care for preventable problems.

      Carbon dioxide in the atmosphere is now 401.25 ppm. That is "Climate Cluster Chaos". (hat tip to JeffW for CCC)

      by Zinman on Mon Aug 11, 2014 at 10:35:52 PM PDT

      [ Parent ]

  •   We can't even get the heel. (6+ / 0-)

    I was reading about the other day about a politician in the past whose approach was "half a loaf is worse than none".  I like that approach, but here I'm happy to make an exception.  I don't favor single payer - I favor a National Health Service.   But what you write about is far, far better than the gruel of today.

    Meanwhile, in the darker universe of D.C., I see HR 676 is still being introduced.  And still being ignored.  And the number of co-sponsors keeps dropping.

    I am become Man, the destroyer of worlds

    by tle on Mon Aug 11, 2014 at 06:51:07 AM PDT

  •  Medicare ALREADY HAS the Statistically Sickest (15+ / 0-)

    participants. That's why industry was willing to let it pass in the first place (or at least, not fight it to the death).

    Agewise, everyone added to Medicare should only make the pool that much less expensive for benefits, I'd have to think.

    Howard Dean had proposed Medicare Age 55 during the 08 campaign for 2 reasons. Health care of course, but also to stimulate early retirements. With 80 million boomers, Medicare 55 would've motivated at least a million or small few million to retire early, which would open up that many jobs, and maybe double the number of promotion opportunities because oldest workers tend to hold senior positions.

    My proposal had been Medicare For Microbusiness, a buy in for sole proprietors and other kinds of businesses with only a tiny number of employees (maybe under 10).

    The reason is that there are millions of people of both genders, all ethnicities and all income and job sector types who do moonlighting after work for extra income. But they can't quit their day jobs because of the need for health coverage. Ask any handy man, home seamstress or any kind of performer or artist. I figured there would be a million or few self-starters who'd be willing to leave employment and start their businesses full time; again creating job openings.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Mon Aug 11, 2014 at 07:17:14 AM PDT

    •  Medicare 55 would've also cut down on age dis- (9+ / 0-)

      crimination.  The cost of health insurance is one of the biggest reasons that the 55+'s are having such a tough time finding jobs.

      Yes yes yes to everything else you said.  

    •  Even if they'd drop Medicare enrollment age (7+ / 0-)

      to the age of eligibility to draw Social Security, that would be a win-win.  I know a woman who is now retired (she started taking SS at 62.5) but can't get Medicare till she turns 65.  This is stupid.  If you can draw your Social Security, you should be able to opt in for Medicare.  
      Of course, this would not be a problem at all, if our idiot Governor Brownback had accepted the extra Medicaid funding.  She'd be covered.  And yet, she all but worships Brownback and the Tea Party, and says "he must have a good reason for turning it down!"

      And I like your idea of Medicare for Microbusiness!  That would fit my husband to a T!  He's currently covered as my dependent, but that's over $400/month out of pocket for us.  The only thing that makes it manageable is that my employers are part of the BCBS-KS small business pool, which averages costs over all the small businesses in the state of Kansas.

      To the left, to the left....

      by CWinebrinner on Mon Aug 11, 2014 at 11:56:04 AM PDT

      [ Parent ]

    •  Expanding Medicare would be popular (0+ / 0-)

      and could make sense. However, I take issue with the diarist's proposal to not ban discrimination for pre-existing conditions for private insurance. That would guarantee that if you had significant health problems, you'd wind up in the Medicare system, and would make holding down premium costs in that system difficult.

  •  I recc'd you for making some good (4+ / 0-)

    points, but you're oversimplifying a complex issue.  For instance, who determines who's eligible?  How many months/years will that process take?  Does anyone really get it that the Medicaid expansion IS the PO, and it's doing the job in all states that utilize it, better than expected.  Has anyone considered that The Supremes gave Democrats a gift in making Medicaid expansion optional?  Do you seriously believe Republicans would have left Medicare expansion alone?  The propaganda writes itself:  The Greatest Generation squeezed out by Welfare Queens and illegals!!!!!

    It's possible we might have to accept that this was the best we could get, stop complaining and start lobbying for improvements.  It's a terrific platform to build on, just like SS and Medicare were.  Never forget that Liberals railed against both those programs, the headlines and Op-Eds could have been the Rec List at DKos.  

    I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

    by I love OCD on Mon Aug 11, 2014 at 07:57:30 AM PDT

    •  eligibility (4+ / 0-)

      Thanks for the reply.

      Everyone is eligible. I include that in the piece.

      The process wouldn't take any longer than it takes to sign up for ObamaCare.

      The Medicaid expansion is NOT the public option. You have to be ridiculously poor to qualify for Medicaid expansion.

      And Republicans wouldn't be able to touch Medicare expansion unless they took back control of all three branches of government. But they wouldn't do that. Just look at Arkansas where Republicans had the opportunity to end the Medicaid expansion and they caved. It's politically toxic to take health benefits away.

      •  minor quibble (2+ / 0-)
        Recommended by:
        I love OCD, YeaYouRite

        see my comment above - you do not have to be "ridiculously poor" to qualify for expanded Medicaid.
        Really though, I'm just taking this opportunity to thank you for an excellent diary - we must keep up the fight, now harder than ever.

      •  I had to be qualified for SSDI. The application (1+ / 0-)
        Recommended by:
        Cedwyn

        alone stops a lot of people.  Then you have to submit doctor reports.  Medicare is a secondary program I had to wait a year to be eligible for.  For your plan to work you'd have to prove regular insurance was too expensive, which will mean a lot of paperwork on pre-existings, reasonable proof you were refused care you deserved, or dropped because you got sick.  For women it would require some nebulous proof that you were charged more for being female.  Almost impossible.  

        I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

        by I love OCD on Mon Aug 11, 2014 at 02:32:01 PM PDT

        [ Parent ]

        •  no... (1+ / 0-)
          Recommended by:
          tardis10

          You wouldn't have to "prove" anything to be eligible under my plan. Citizenship, maybe. No proving you have a preexisting condition or that you are charged more as a female. None of that. You just give your name, SSN, and income and you get a quote. Simple as that.

          As for waiting periods, sure but we had to wait FOUR YEARS before ObamaCare took effect.

  •  Yes, the bigger things makes the smaller... (3+ / 0-)
    Recommended by:
    ColoTim, FG, Cedwyn

    ...thing unnecessary, but that's not necessarily an argument for the bigger thing.

    It's not the side effects of the cocaine/I'm thinking that it must be love

    by Rich in PA on Mon Aug 11, 2014 at 08:05:08 AM PDT

  •  New Name for the Public Option (14+ / 0-)

    I sent this suggestion to Sen. Sander's  and a couple of other Democrats and suggested that they do a stand alone public option bill and simply rename it "Medicare Prime."  And advertise it as Medicare for those in the prime of their life (i.e. everyone younger than 65).

  •  Compared to Public Option ACA is a Rube Goldburg (6+ / 0-)

    Machine.

    "The Democrats and the Republicans are equally corrupt where money is concerned. It's only in the amount where the Republicans excel." ~ Will Rogers

    by Lefty Coaster on Mon Aug 11, 2014 at 09:39:14 AM PDT

  •  Lieberman fucked us as payback for primarying h... (3+ / 0-)
    Recommended by:
    joedemocrat, Goingallout, Cedwyn

    Lieberman fucked us as payback for primarying him, and yes, it's just that petty. We were lucky to get what we got.

    •  That's unfair to Joe Lieberman! (4+ / 0-)
      Recommended by:
      YeaYouRite, peregrine kate, AppleP, SGA

      The man was honestly and genuinely in the pocket of the insurance companies.

      I won't stand here and watch you besmirch him like this!

      lol

      Art is the handmaid of human good.

      by joe from Lowell on Mon Aug 11, 2014 at 10:07:14 AM PDT

      [ Parent ]

    •  Nonsense. If it wasn't Liebermann or Baucus it (1+ / 0-)
      Recommended by:
      YeaYouRite

      would have been some other assholes designated to fuck things up. The party establishment didn't want to piss off their insurance industry masters. The adoption of the ACA was a classic example of rotating villains taking the fall so that others could appear to be "progressive" in their supposed battle on behalf Main Street.

      Just HOW do we get our representatives to move in a populist direction without threatening electoral consequences for their willful failure to do so? (This is the issue routinely avoided by party loyalists at the GOS.)

      by WisePiper on Tue Aug 12, 2014 at 02:12:50 AM PDT

      [ Parent ]

  •  And that roll-out disaster (3+ / 0-)
    Recommended by:
    YeaYouRite, lunachickie, BentLiberal

    Could have avoided that by just expanding what already worked...

    I've never left a blank space on a ballot... but I will not vote for someone [who vows] to spy on me. I will not do it. - dclawyer06

    Trust, but verify. - Reagan
    Vote, but Occupy. - commonmass

    by Words In Action on Mon Aug 11, 2014 at 09:45:32 AM PDT

  •  we can't have that for the same reason that the (0+ / 0-)

    Democrats were afraid to debate him and AARP wouldn't have him on their stage.

    We are all pupils in the eyes of God.

    by nuclear winter solstice on Mon Aug 11, 2014 at 09:52:23 AM PDT

  •  The public option didn't die in the process of (4+ / 0-)

    legislating Obamacare. It was taken off the table before the process had begun. That's what pissed me off the most.
    We could have tried for the ultimate cure to our healthcare woes, but it was removed from consideration before anyone sat down to haggle. At the very least, it could have been spent as a bargaining chip- a very big bargaining chip, but it was abandoned.
    I can only think that was a consideration paid for by the insurance lobbying industry.

    Lead with Love. Forgive as a reflex.

    by Gentle Giant on Mon Aug 11, 2014 at 10:01:40 AM PDT

    •  The public option was included in the debate (4+ / 0-)

      Endlessly.
      What was pulled off the table early on was single payer.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Mon Aug 11, 2014 at 11:05:43 AM PDT

      [ Parent ]

      •  No, from the beginning it was clear (0+ / 0-)

        every time Obama pitched "something like" a public option that a real public option was not to be part of the debate (except in the blogosphere, where too many deluded themselves into thinking our party's leaders were actually fighting the good fight).

        Just HOW do we get our representatives to move in a populist direction without threatening electoral consequences for their willful failure to do so? (This is the issue routinely avoided by party loyalists at the GOS.)

        by WisePiper on Tue Aug 12, 2014 at 02:17:42 AM PDT

        [ Parent ]

        •  guess Pelosi missed that memo (1+ / 0-)
          Recommended by:
          Catte Nappe

          because the house bill had a public option in it.

          Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

          by Cedwyn on Tue Aug 12, 2014 at 04:34:00 AM PDT

          [ Parent ]

        •  You have a faulty memory (1+ / 0-)
          Recommended by:
          Cedwyn

          Lots and lots of debate

          Public option at center of debate
          Democrats had little time to savor their weekend Senate health-care victory, as two of the lawmakers who voted to move the debate forward Saturday night indicated Sunday that they will not vote to pass the package if it includes a government-run insurance program.
          Despite the success in the test vote, the fragile consensus in the Democratic caucus will face its greatest test yet as the health-care debate moves to the Senate floor and Majority Leader Harry M. Reid (Nev.) struggles to stave off internal schisms. The cracks in the 60-member caucus are most obvious over the public insurance option.
          http://www.washingtonpost.com/...
          According to last week's Washington Post, the public option is the "crux" of the health-reform debate and the "greatest challenge" for Senate negotiators to overcome. That's an accurate description of the current political scene, but it's true only because so many people, including members of Congress, are responding ideologically to the idea of government involvement.
          http://prospect.org/...
          Public Option Is Next Big Hurdle in Health Debate
          As the White House and Congressional leaders turned in earnest on Wednesday to working out big differences in the five health care bills, perhaps no issue loomed as a greater obstacle than whether to establish a government-run competitor to the insurance industry.
          http://www.nytimes.com/...
          Policy Brief Examines ‘Public Option’ Debate
          A new policy brief from Health Affairs and the Robert Wood Johnson Foundation explores a key aspect of landmark health reform legislation passed by the House of Representatives: the proposal for a government-run public health insurance plan.
          http://healthaffairs.org/...
          Economists Debate 'Public Option' On Health CareAnd last week when President Obama gave his big speech to Congress on health care overhaul, Reinhardt took out a pencil and paper as he listened. Overall, he thought, the speech was impressive: A-. But then Obama brought up that idea of a "public option" — a government-run insurance plan to compete with other insurers.

          "It could provide a good deal for consumers, and would also keep pressure on private insurers to keep their policies affordable and treat their customers better," Obama said.

          Reinhardt gives Obama a C+ for that part of the speech.

          http://www.npr.org/...

          “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

          by Catte Nappe on Tue Aug 12, 2014 at 09:51:11 AM PDT

          [ Parent ]

  •  I've been using the word "simply" my whole life. (4+ / 0-)
    Recommended by:
    Catte Nappe, Goingallout, emelyn, Cedwyn

    I never knew it meant that.

    They could "simply" expand Medicare?

    I remember the politics around health care reform in 2009. I don't know what makes you think that would have been "simple."

    This idea that there wouldn't have been political headwinds is just...bizarre.

    Art is the handmaid of human good.

    by joe from Lowell on Mon Aug 11, 2014 at 10:03:30 AM PDT

    •  Simple as compared to ObamaCare. The bill would... (3+ / 0-)

      Simple as compared to ObamaCare. The bill would have been 10 pages, not 1,000. Everyone understands what Medicare is, so the idea of expanding it to anyone who wants it, without touching the private market, is VERY simple.

      •  And Congress going along? Simple? (2+ / 0-)
        Recommended by:
        Cardinal Fang, Cedwyn

        There's the problem - there's nothing "simple" about passing your proposal. It would have been an extremely heave lift, and probably would have failed, like all of the other health care reform efforts since the mid-60s.

        Art is the handmaid of human good.

        by joe from Lowell on Mon Aug 11, 2014 at 02:50:41 PM PDT

        [ Parent ]

        •  I disagree (0+ / 0-)

          I make a strong case in my diary for why it would have been EASIER to pass than ObamaCare was. Re-read the diary.

          •  Not a strong case. I have seven words for you: (1+ / 0-)
            Recommended by:
            Cedwyn

            "Keep the government's hands off my Medicare."

            Remember that?

            The success of Medicare, its popularly, does not translate into a desire to "spread the wealth" to the uninsured. Quite the opposite, it translates into a desire to "protect what I've got from them."

            Mitt Romney, with Paul Ryan himself as his running mate, won the popular vote among people of Medicare age by a healthy margin, his best outcome among any age group.

            You just can't make the jump from "Medicare is popular" to "Medicare expansion is popular."

            You also seem to think that the length of the bill is an actual concern for Congress, as opposed to just being a throwaway line used in speeches to the rubes. Congress passes longer bills than that several times a year.

            Art is the handmaid of human good.

            by joe from Lowell on Mon Aug 11, 2014 at 03:28:05 PM PDT

            [ Parent ]

            •  The length of the bill isn't as important as th... (0+ / 0-)

              The length of the bill isn't as important as the simplicity of it. Unlike explaining ObamaCare, explaining my plan to voters is very easy: "we are expanding Medicare for anyone who wants to sign up, no questions asked. Those under 65 and over the poverty level will have to pay a premium, calculated as a percentage of their income." Done.

              •  Done. Except for the half a trillion dollars (1+ / 0-)
                Recommended by:
                Cedwyn

                to pay for it, which you seem to be ignoring. (Half a trillion is just an estimate here, but your plan has everyone paying either as much as they pay now, or less, in many cases considerably less. And you give us no clue about how you plan to make up the shortfall.)

                •  What is your obsession with "paying" for it? Yo... (0+ / 0-)

                  What is your obsession with "paying" for it?

                  You think single payer is paid for? Or ObamaCare for that matter? No, they're funded through taxes. ObamaCare is full of taxes: the medical device tax, the investment tax, and yes, the employer mandate.

                  The military doesn't fund itself. Neither does health care. Get over this, it's ridiculous. You've made the same silly comment ten times already.

                  You wanna "pay for if?" Raise taxes. Period.

      •  This is kind of in the weeds but, (4+ / 0-)
        Recommended by:
        YeaYouRite, sviscusi, Cedwyn, FG

        just because an idea is simple doesn't mean a bill enacting it can be only a few pages, especially if that idea is interacting with existing law.

        The pages have a lot of whitespace, and any current law that no longer applies or has any changed wording has to be cited and changed.

        So, a bill that has a net effect of simplifying the law and reducing the number of pages of the law of the land might have quite a lot of pages in order to make those deletions.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Mon Aug 11, 2014 at 04:11:17 PM PDT

        [ Parent ]

  •  Very interesting diary.. (2+ / 0-)
    Recommended by:
    YeaYouRite, czarinakm

    I didn't know this - will have to read more

    All they needed to do was set up a "Medicare Public Exchange" in which anyone who wanted a plan could buy one, at a percentage of their income. Low-income people could get one for free, gradually eliminating the need for Medicaid altogether... more on that later.
    This would have created a definite path to Medicare For All, which is something I favor.

    Why wasn't this discussed?  I can only speculate. I think the Democratic Party was living in the past. They remembered how the "big players" like the insurance industry, the drug companies, and so on turned the public against single payer. Also, they remembered from Bill Clinton's attempt at Health Care reform, they needed some big players on board if any bill was to pass.

    The ACA has helped, but there are still too many people who are uninsured. I also believe the subsidies are not enough.

    I have always hoped ACA was a start we could build on. This would be a way to build on it. Maybe add the P.O. or even Medicare to the exchange?

  •  I like public option but anyone who thinks (5+ / 0-)

    That could've passed Congress and not get sabotaged by the industry and the GOP is fooling themselves.  In fact, In retrospect Obama should've shut down the public option debate several months earlier and pass the ACA law in 2009.  If that had happened, he would've had more time to pivot to
    The economy/jobs and might've been able to save the House.

    The success the ACA has had is because the industry is invested in its success.  That would not happen with a public option.

    Global Shakedown - Alternative rock with something to say. Check out their latest release, "A Time to Recognize": Available on iTunes, Amazon, Google Play, Spotify and other major online music sites. Visit http://www.globalshakedown.com.

    by khyber900 on Mon Aug 11, 2014 at 10:58:09 AM PDT

    •  Interesting take on the legislative process. (1+ / 0-)
      Recommended by:
      Cedwyn

      If he'd dropped the public option earlier, he would have gotten the same bill and had an even longer list of legislation in those first two years.

      I'm not entirely sold, but it makes sense. Hmm....

      Art is the handmaid of human good.

      by joe from Lowell on Mon Aug 11, 2014 at 02:48:16 PM PDT

      [ Parent ]

  •  You seem to forget (4+ / 0-)

    The powerful forces against a public option were, and would be, the insurance companies. We only got accomplished what we did because they held their fire. If you propose a system that would essentially replace them they will be out tooth and claw, with all the resources available to them to shut the idea down.

    “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

    by Catte Nappe on Mon Aug 11, 2014 at 10:58:27 AM PDT

  •  The Public Option (0+ / 0-)

    Senator Max Baucus held up the House bill while it was read and altered by the health care industry.  The Public Option was stripped out in that committee.  It would have allowed an incremental change.  "Medicare for All" would bankrupt the current bloated health care system that is 50% inflated over the rest of the world due to cost controls.  The same reason many Doctors refuse to accept medicare.
    What we are seeing is the domination of the Republicans and their friends including many physicians and all insurance companies to destroy any reform that effects their bottom-line profits.  Also we are seeing the willingness to bash the sick and poor, "disappear" them from the red states who refuse the medicaid expansion and allow the insurance industry to obstruct the ACA.  Only in dedicated ACA states is the industry held up to scrutiny.  What we know is that a large number of Americans are totally bought-in to vulture capitalism and could care less about what happens to the greater good.  We know it and the rest of the world now knows it.  The same applies to all sectors of the economy.

  •  Excellent post! (1+ / 0-)
    Recommended by:
    YeaYouRite
  •  For the record, PBO did not kill the Public Option (8+ / 0-)

    ...the Senate Finance Committee did. The term "off the table" has been attributed to Sen. Olympia Snowe.

    PBO advocated for the PO in a public address in Cincinnati  on September 7, 2009.

    "I continue to believe that a public option within the basket of insurance choices would help improve quality and bring down costs."
    On Sep-9, during the famous "You lie!" address to Congress, he advocated a PO three times. He also said
    "I believe it makes more sense to build on what works and fix what doesn't, rather than try to build an entirely new system from scratch."
    Maybe that could be construed as "no public option", but it could also indicate support for use of Medicare as a PO. Four days later he was in Minnesota saying:
    "I think one of the options should be a public insurance option. Let me be clear. It would only be an option, nobody would be forced to choose it. No one with insurance affected by it. But what it would do is provide more choice and more competition. It would keep pressure on private insurers to keep the policies affordable, to treat their customers better."

    “It is useless to attempt to reason a man out of a thing
    he was never reasoned into” - Jonathan Swift

    by jjohnjj on Mon Aug 11, 2014 at 11:27:37 AM PDT

  •  Yeah, this would have been so easy. (4+ / 0-)
    Recommended by:
    FG, emelyn, joe from Lowell, Cedwyn

    Come to think of it: I should have won the Nobel Prize by now too.  I've had some elegant ideas about how physics should work...though I have no actual training beyond high school...

    Yeah, my snark is not so great -- but really, anybody who thinks there were easy legislative options to Obamacare wasn't paying attention.

    This is not to say Obamacare was my first choice.  But sitting around dreaming for what might have been is just silly.  Others have pointed out.

    •  No, dreaming about what one wants to fight (2+ / 0-)
      Recommended by:
      YeaYouRite, tardis10

      for and then trying to convince people of its worth is not silly. It's how we make gains.

      That's what disappoints me about all these arguments. Dems compromise far too much ahead of time, instead of putting forth good evidence about why a progressive option is a better one.

      Here, FIRE won. But they do not represent the best interests of all citizens, not by a long shot.

      At this point, our best chance for improvement is on a state-by-state basis. All power to VT, MA, and CA for leading the way.

      Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

      by peregrine kate on Mon Aug 11, 2014 at 12:28:46 PM PDT

      [ Parent ]

    •  There's nothing I enjoy more than people commen... (0+ / 0-)

      There's nothing I enjoy more than people commenting without reading the post. It's my faaaavorite thing.

      If you HAD read the post (you obviously didn't), you would've read the parts where I said:

      1) I'm not second-guessing anyone and

      2) it's not too late to try again in the future

      Read posts before you comment so I don't have to waste my time

      •  A constructive suggestion: (2+ / 0-)
        Recommended by:
        Cedwyn, Cardinal Fang

        If you had used a different title that didn't suggest you thought that there was an easy alternative in the public option that had been overlooked in the original fight?  This way I'd be more motivated to imbibe the diary.

        I fought for the public option - not on these pages but in the real world, speaking at public demonstrations, etc. working to have people understand it who in some cases were openly viciously hostile to it. I was very upset at how the legislative fight went.

        I don't really have the time of day for a viewpoint that says an easy alternative was in easy reach, essentially re-fighting that fight.  Nor in the context of a diary titled that way do I have time for people that say I don't dream.

        An entirely future-looking title/approach is what attracts me, not a return to fights already fought which position it all as negative and second-guessing...

  •  I appreciate your diary; thanks for posting. n/t (1+ / 0-)
    Recommended by:
    YeaYouRite

    Support Small Business: Shop Kos Katalogue If you'd like to join the Motor City Kossacks, send me a Kosmail.

    by peregrine kate on Mon Aug 11, 2014 at 12:29:07 PM PDT

  •  very nice article, but (2+ / 0-)
    Recommended by:
    LillithMc, Cedwyn

    There are two possible challenges here.
    1. You assert that the risk pool for voluntary Medicare-purchasers would be a good one, but I'm not certain that's true or that you proved that.  Any way to substantiate that argument?

    2. Medicare's top-down management of costs of care really does put some doctors in a bind, and having a dysfunctional bipartisan "management" of medicare could well yield a product that is not worth buying.  

    Now, on the flip side you would argue that the more people who join medicare, the less Republicans can squeeze it to death by having poor doctor reimbursement rates.  

    But some of the legitimate resistence to a medicare-for-all plan is that it really would lead to a lot of doctors not taking the plan, unless congress managed the thing better than they do today.  That would lead to both problems for patients and political resistence.

    Socialism done competently is clearly the best plan, but one of the upsides of Obamacare is that is got more of the "real" political stakeholders on board and that may in fact have been an important factor.  

    To be clear, I'd want a well-run single player plan.  But it's hard when its going to be sabatoged.  i'm somewhat more hopeful about individual states doing that with a local consensus for doing it well.

    •  Thanks for the reply. As for your first questio... (0+ / 0-)

      Thanks for the reply.

      As for your first question, there is simply no question that ObamaCare got enough "young healthies" to sign up. They were shooting for 39%, but that was a totally unrealistic goal, given that 18-35 yr olds didnt make up anywhere near that high a percentage of the uninsured. They got over 27%, which health economists all agree is enough to keep premiums from going up more than a couple of percentage points. And more young people are expected to sign up as the penalty stiffens and confusion about the law subsides.

      Under a Medicare public option like the one I've devised, the premiums would be significantly lower than average ObamaCare premiums. Young people are much more likely to make less money and hence pay less for their plan. They would be part of this risk pool. We saw this year that young people WANT health insurance, but in many cases, even with the ACA subsidies, cannot afford it.

      As for your second question, doctors would be foolish to turn down a health plan that a huge percentage of the population is using. Medicare knows this and is currently using their power to do all kinds of things, like releasing payment data and tightening readmissions policy.

      •  not sure i agree (1+ / 0-)
        Recommended by:
        Cardinal Fang

        On the first point, in addition to the forecasted demand not being obvious to the crafters of the law, the current rate of demand and the mix is partly a function of the individual mandate.  So you'll need better evidence than that to convince me.

        On the second point, many doctors can and do turn down medicare patients. They want money from well-paying patients (in this case, middle and upper class folks with employer-sponsored private plans). It can be hard to medicare patients to find care that is in their area for some types of care, largely as a function of the decisions congress makes about reimbursement budget-tightening.

        •  re-read my subsidy calculations (0+ / 0-)

          Since you need more convincing, here you go:

          Here is the Kaiser Subsidy Calculator, for what a 28 year old earning $50,000 would pay under ObamaCare:

          $2,756 per year

          And under my plan:

          $899 per year

          That's a pretty HUGE difference.

          And as for the penalty, it was only $95 this year. Hardly much of an incentive.

          But we can disagree about this. Either way, it's socialized medicine, so the "risk pool" isn't really that important. The government isn't in it to make money.

  •  One of the biggest disappoinments for me... (1+ / 0-)
    Recommended by:
    tardis10

    ...of Obama's tenure has been the Public Option.  Breaking that promise was unforgivable.

    So, yes you're right, yeayouright.

    “…violence is mimetic, one act of violence sowing the seeds for the next.” Jules Fraser

    by dharmasyd on Mon Aug 11, 2014 at 02:40:39 PM PDT

  •  This would cost an obscene amount (2+ / 0-)
    Recommended by:
    Susan G in MN, sideboth

    Most people who now have insurance pay more than your cost (0-4% of income), or their employers pay more for them than your cost. Under your plan, almost everyone would immediately switch to the public option. How would you pay for it?

    •  Also, doctors would earn less (0+ / 0-)

      because private insurance pays more than Medicare reimbursements. How would you get doctors on board?

    •  No, people wouldn't immediately switch to the p... (0+ / 0-)

      No, people wouldn't immediately switch to the public option. It would take a long time for a majority of the population to be on it.

      And read the subsidy calculations. Its based on a percentage of income, so the wealthier would end up bulking the bulk of it.

      But say you're right (you're not), and the entire country suddenly was on Medicare, yes, it would cost a lot! Other countries pay a lot too. But gradually costs would go down dramatically because the entire country would be on a nonprofit system that has far more bargaining power.

      •  The wealthy would buy private insurance (0+ / 0-)

        If they could buy insurance from a private insurer cheaper than 4% of their income, they would, because they're not idiots. Nobody would spend more than 4% of income, and most would spend considerably less.

        Your plan is vastly underfunded. Notice that almost everyone who now gets subsidies would pay less under your plan. And a sizeable percentage of people who don't now get subsidies would also pay less. Your numbers don't come close to working out. Health care is expensive!

  •  It's better to have a single, simple, clear (1+ / 0-)
    Recommended by:
    YeaYouRite

    message like "Medicare for all who want it" than to have what we got, which is many parts people like, and one overwhelming impression that despite the good parts, is negative.  If "Medicare for all who want it" had been proposed as a phased in plan, with a few added things like keeping the kids on your plans until 26, the message would have been simple and clear, and the choices between Republicans and Democrats would be even clearer.  Instead we got a muddled mess that reinforced the impression that Democrats want big government and complex, "unworkable" regulations.  If we had failed with a clear message, the elections of 2010 would not have been so disastrous, and we wouldn't be in the mess we are in now because we would have certainly won majorities in 2012, especially since the 2010 elections would not have been so terrible for Democrats.  Between austerity and complexity Obama blew a once in a generation chance to really define the difference between Republicans and Democrats, and thus launch a progressive rollback of the Reagan Revolution. Instead, he reinforced most of the messages Republicans have been trumpeting for decades.  Liz Warren and Bernie Sanders have the right ideas, not Obama, and not Hillary.

    The penalty good men pay for indifference to public affairs is to be ruled by evil men. Plato Love of money is the root of all evil. Jesus Conclusion: If money rules politics, it will be dominated by evil men lining their pockets, not yours.

    by monkeybrainpolitics on Mon Aug 11, 2014 at 03:56:11 PM PDT

    •  How. Would. We. Pay. For. It. (0+ / 0-)

      Medicare is staggeringly expensive. How would we pay for a Huge Medicare expansion?

      •  You. Don't. Need. To. Pay. For. It. (0+ / 0-)

        The great part of liberalism is you don't need to "pay for" everything.

        If you want, you could increase the percentage of income I suggested to 4-6%. Or 6-8%.

        Or you could just do like ObamaCare did, and tax investments and medical devices. Or close oil loopholes. Or close big ag loopholes.

        The notion that it needs to be a self-sufficient program is silly. Does our military pay for itself? No. We pay for it through taxes, like everything.

        •  How about we just quit starting multi-trillion (0+ / 0-)

          dollar unfunded wars that are not just pointless and futile, but which actually leave things worse than they were before?  If we build a nation everyone looks up to, and wants to be like, that will be much better for us than building a military everyone fears or worse, no one fears because they see that all it can do is temporarily set back their long term goals.  How many Vietnam, Iraq, Afghanistan, Central America quagmires must we get ourselves into and out of before we learn it's just wasting all that money and those lives.  Invest it in Medicare, and eventually the VA and its costs will go down and overall the US will be a better country.

          The penalty good men pay for indifference to public affairs is to be ruled by evil men. Plato Love of money is the root of all evil. Jesus Conclusion: If money rules politics, it will be dominated by evil men lining their pockets, not yours.

          by monkeybrainpolitics on Mon Aug 11, 2014 at 08:54:46 PM PDT

          [ Parent ]

    •  Great comment My thoughts exactly. (0+ / 0-)

      Great comment

      My thoughts exactly.

  •  The per capita cost of healthcare in the US is (2+ / 0-)
    Recommended by:
    Cardinal Fang, sideboth

    over $8,000 a year.

    That means the program would need $160,000 in funding for the 20 people you outlined in your example for the program to remain solvent. (Counting the lowest income individuals as a couple.)

    At the funding levels you used, $25,327 would be collected in revenue for the population of 20 people.

    I love the idea of single-payer and the ACA includes a provision for it to be implemented as an alternative that states can choose to adopt individually. It seems no one remembers it now.

    When I talk to people about single-payer, the cost is consistently the one area where there's a huge disconnect.

    •  Great comment (1+ / 0-)
      Recommended by:
      Mark Lippman

      The per capita cost of people under 65 is less than $8K, I think, because your numbers include expensive old people whom we already cover and pay for.

      But the general argument is perfectly correct; the quoted premiums are not close to being enough to cover the costs.

    •  it's called "socialism" for a reason (0+ / 0-)

      First of all, that's a terrible example you used, because I used mainly lower-income examples. My funding levels would raise a lot more money than your example represents. But those were just levels I chose, you could always choose higher percentages.

      Secondly, my plan could be "paid for" the same ObamaCare is "paid for" or single payer is "paid for." Through taxes.

      ObamaCare is full of taxes: the medical device tax, the investment tax, and yes, the employer mandate.

      The military doesn't fund itself. Neither does health care.

      •  You still haven't addressed what would happen (2+ / 0-)
        Recommended by:
        eumaies, Cardinal Fang

        to the contributions most employers kick in to help their employees pay for their insurance premiums.

        Would those employers be let off the hook and freed from the huge financial burden they have from contributing to their employees insurance premiums? It would be a huge benefit to corporations but somebody else would have to pick up the cost. Who would that be?

        How would it be fair to employees who lose the benefit of employer contributions? The amount is technically part of the employees compensation which would be cut. That sounds like it could be another rightwing giveaway to the corporations while working people get screwed.

  •  Military Budget (1+ / 0-)
    Recommended by:
    YeaYouRite

    Americans assume that universal health care in other countries is very expensive.  It is 50% less expensive than US health care.  Our military/security agencies takes about half of our discretionary budget which is a burden not found in other countries.  IF we cared about universal health care and not being the biggest arms dealer and world policeman, we could arrange health care for everyone.

    •  Since I was a kid I have spent extended (3+ / 0-)
      Recommended by:
      Cardinal Fang, LillithMc, FG

      periods in France and I still travel there as much as possible. France is the world's standard for high quality universal health care with a per capita cost about half the US amount (you're right on the money with that) and the system produces superior outcomes.

      How do they do it?

      #1] The national debt as a percentage of GDP is lower than it is in the US so it's not funded with borrowed money.

      #2] It isn't free and if you said that it was you could be in for a sound slap across the face because French citizens pay for it with their labor. I didn't say taxes because French people expect their labor to provide a living wage (the minimum is around $11/hr), quality education, quality healthcare, and a retirement. It's not too much to ask.

      #3] There's a solid social safety net and socialism runs deep. On July 31, it was the 100th anniversary of the assassination of Jean Jaurès, the anti-war socialist revered by the French. Everywhere you go you find public places, streets, train stops, schools, named for him.  

      #4] Yes there are taxes and French culture isn't founded on greed.

      Starting in 2007, under Sarkozy, and then doubled due to the global recession, this system of a broad and prosperous middle class has come under attack. After a long tug of war, they finally passed a budget that calls for belt-tightening, the Pacte de responsabilité

      This weekend it was declared unconstitutional.

      Americans disparage and ridicule the French.

  •  I want a public option, but I still want exchanges (1+ / 0-)
    Recommended by:
    YeaYouRite

    I want to be able to compare ALL options, be they private or public, and make a choice that best suits me.  It could well be the case that a private option better suits me than whatever public option is made available.

  •  It was a major achievement to get it passed (1+ / 0-)
    Recommended by:
    Cedwyn

    and will take another to keep Robert's right wing pals from killing it.

    The public option was not an option.

    ...the GOP seems perfectly willing to hold their breath until the whole country turns Blue.

    by tommy2tone on Mon Aug 11, 2014 at 07:27:36 PM PDT

    •  read the piece (0+ / 0-)

      The public option as a part of ObamaCare was not an option, that's correct.

      But we have no idea whether a stand-alone public option could have passed because the idea was never considered.

      Don't confuse my idea (a stand-alone expansion of Medicare) with the one that was floated in 2009 (a public option to go along with a 1,000 page bill full of complicated regulations and provisions).

  •  Yeah, You (Almost) Completely Right (3+ / 0-)
    Recommended by:
    YeaYouRite, LillithMc, SGA

    I can only quibble that neither this nor ACA is "socialism". Socialism is where the workers own the means of production. In neither of these plans do we get actual socialized medicine, the gold standard for affordable, high-quality healthcare.*

    Personally, I think a plan similar to what you propose is inevitable. That's because our current system is far too expensive. It sucks up trillions of dollars for something that is arguably no better than care in other advanced countries. We're paying at least a 50% premium but we aren't getting premium care. Premium care would be where the doctor came to you when you had a health problem. A premium system would be, well, French.

    The problem with the current system is that it has a for-profit funding component. It has private healthcare insurance. Private healthcare insurance is always wrong because it makes its profits from the suffering and death of the insured. The financing of healthcare is fundamentally a government job. It is part of protecting the public from harm. It's been effectively outsourced to private companies in the U.S., which is always going to be more expensive. When a government service is outsourced, the taxpayers pay twice: once for the service and then again for the profits.

    We don't have to give up because President Obama got ACA passed. Yes, it does take us further away from the solution because it provides more profits for the insurance companies. But the cost structure for putting people into for-profit insurance is always going to be higher than putting them into a public plan. That cost differential will never go away. We need to drive that point home: a for-profit system is more expensive, and that money has to come from somewhere. It comes from other sectors of the economy: food, clothing, housing, transportation, and so on.

    And, lastly, the Republicans have paved the way for us. They've convinced a lot of people that what we have now is bad.

    So, thank heavens you've got a better solution!

    * Like the British NHS, which only costs about 11% of GDP, but covers literally everyone and has outcomes comparable to ours.

  •  Yes but the public option was to be part of ACA (0+ / 0-)

    What you are saying makes no logical sense.  Without the umbrella of ACA, a public option would have been impossible.  Go ahead and try proposing a pure single payer system and watch as a brick wall appears before your eyes.

    I do agree that the public option would have made ACA better and do think that in the right political climate it can make a comeback.

    In the meantime, we have what we have and it does solve some problems.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Riane Eisler

    by noofsh on Tue Aug 12, 2014 at 04:25:28 AM PDT

  •  The KISS principal is always better. (2+ / 0-)
    Recommended by:
    YeaYouRite, SGA

    Not only would a Public Option Medicare have been simpler, cheaper, and easier to implement than the ACA, it would have also eliminated any standing for corporations to claim for themselves religious freedom.  The problem was that what worked best for the people AND the government would cut into the profits of insurance companies.  True competition was never an intention, just fixing the profit margin among "friends."

    We got the ACA because it was impossible to pass anything that had the potential to lessen the profits of the insurance companies, and therefore lessen the amount of political donations to legislators less concerned with governing in the best interests of all, and more concerned with governing for their own personal benefit.

  •  Another thought to chew on... (0+ / 0-)

    Add just a small amount to the percentage charged per person in the Public Medicare premium, and use the funding to build Urgent Care Centers.  Job creation.  Use the funding to pay for medical education tuition a la ROTC style--education in exchange for service, providing care in the UC centers.  Reduces higher costs to ER.  Creates jobs.  Provides incentive and purpose for education.

    Use the Public Medicare Option as a jobs bill that funds itself.  

    •  "The market" is getting that done (0+ / 0-)

      Urgent Care Centers are popping up all over, some for profit others under auspices of non-profit hospitals. In the space of a few miles on my commute there have been three built in the past 18 months, and another is under construction.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Tue Aug 12, 2014 at 11:28:02 AM PDT

      [ Parent ]

  •  If we had some ham, we could have ham and eggs, (1+ / 0-)
    Recommended by:
    Catte Nappe

    ... if we had some eggs.

    I think Medicare Writ Large will be achievable after ACA succeeds and the benefits - not only in coverage for the uninsured but improvements in health care delivery - are more evident to more of the public. It may also be doable if the courts eviscerate ACA (which I think is unlikely, but not out of the question).

    Meanwhile, does any sentient person who follows politics believe it is achievable now? If not, is the lesson here to try it now and ... what?

    (This may sound editorial, but I am genuinely asking.)

    2014 is HERE. Build up the Senate. Win back the House : 17 seats. Plus!

    by TRPChicago on Tue Aug 12, 2014 at 07:34:58 AM PDT

  •  Let us also include dental, vision and hearing (0+ / 0-)

    care in the "public option" and roll Medicaid into it.  Also, no "tiers" everyone gets the best option available.....otherwise there is still discrimination in health care.  AND let's get the employer's out of paying for health care and make them pay a living wage since they won't have that excuse any longer.......

  •  4%? Do you understand how expensive healthcare is (1+ / 0-)
    Recommended by:
    Cardinal Fang

    I just moved back from the UK where I lived for seven years.  My cost for healthcare was 12% of my income.  Everyone (except the very poor) pays into the system and usually between 9-14%.

    The biggest problem of the public option isn't the idea.  It's going to be the price tag.  Americans have no idea how much healthcare really costs.

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