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obamacare
Does Anyone Even Remember Trump Once Favored Medicare for All?
Who's going to pay for covering everybody, including the currently uninsured? "The government's going to pay for it," Trump said in a 2015 interview.
Nov 25, 2025
When asked what they like most about Trump, fervent supporters often say, “He says what he thinks.” Well, not always. Donald Trump has long supported government-run universal healthcare—well before he had to deal with a crazed Congressional GOP in his first term. The controlling Republicans repealed Obamacare dozens of times in the House of Representatives (repeal was blocked in the Senate)—without offering any alternative.
President Trump also denounced Obamacare in vitriolic expletives, but he offers no alternatives.
However, let’s look back at a time when Trump, before his first term, was not tongue-tied about Medicare for All.
In a little-noticed Washington Post article (May 5, 2017), headlined “Trump’s forbidden love: Single-payer health care,” Aaron Blake reports that “in his heart of hearts, [Trump] wants single-payer health care. Indeed, it seems to be his forbidden fruit.”
Blake goes back to 2000 when “he [Trump] advocated for it as both a potential Reform Party presidential candidate and in his book, “The America We Deserve,” to wit:
“We must have universal health care. Just imagine the improved quality of life for our society as a whole,” he wrote, adding: “The Canadian-style, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms, and deductibles)…helps Canadians live longer and healthier than Americans…Just before the 2016 campaign, Trump appeared on David Letterman’s show and held up Scotland’s socialist system as the ideal.”
Then, in April 2017, a law professor argued in the New York Post that Trump should just go for it. Universal Healthcare would be great for the Republican Party, as it would challenge the Democrats’ claim that it is the compassionate party. Moreover, Trump’s supporters would actually like better, less costly healthcare.
“A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in trouble, and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge,’” Trump said. “Not only that, he said it was like great doctors, great care. I mean, we could have a great system in this country.”
Then, early in the 2016 campaign, he again praised the single-payer systems in Scotland and Canada—while also arguing that the United States needed to have a private system.
Asked on “Morning Joe” whether he supported single-payer, he said: “No, but it’s certainly something that in certain countries works. It actually works incredibly well in Scotland. Some people think it really works in Canada. But not here, I don’t think it would work as well here.”
He said two days later at a GOP debate: “As far as single-payer, it works in Canada. It works incredibly well in Scotland. It could have worked in a different age, which is the age you’re talking about here.”
Later on, Trump would repeatedly push for universal health care without specifically subscribing to the words “single-payer.”
“Everybody’s got to be covered. This is an un-Republican thing for me to say,” Trump said in a September 2015 “60 Minutes” interview. “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”
He added when asked who is going to pay for it: “The government’s gonna pay for it.”
[…]
Law professor F.H. Buckley argued in the New York Post last month that, in the face of defeat for the Republican health-care bill, Trump should just go for it. He argued that it would be a great thing for the Republican Party because it would eliminate Democrats’ claim to being the party of compassion and that Trump’s supporters would actually like it.
“Leave behind all the people who hated you, who curse when you succeed,” Buckley wrote. “Reach out to the people who voted for you. Challenge the Democrats by offering them what they’ve always said they wanted.”
Fast forward, and Buckley’s words are even more timely. In a few weeks, the Republicans have promised a vote on extending the Obamacare subsidies to 22 million Americans. The Grand Old Plutocrats are in a bind. If they reject these subsidies, they give the Democrats a huge and decisive winning campaign issue for the 2026 elections. If they accede and keep the prices from skyrocketing, they hand a victory to the Democrats in defiance of their past rejections of universal healthcare and look weak.
My sister Claire Nader suggests that this is a great opportunity for Trump’s sense of grandiosity. Knowing the Congressional Republicans’ bind and disarray, he can announce his single-payer universal health care—everybody in, nobody out—and cite how much more efficient such a system is in Scotland, Canada, Australia, and other countries.
Then Trump could tout the political advantages—sweeping aside all the media coverage coming about the loss of Medicaid coverage by tens of millions of Americans, including Trump voters. Gone would be the huge inflationary price increases, continued inscrutable bills, with their overcharges and fraud. Getting healthcare would be far less aggravating than today. Imagine no more giant health insurance companies with their denials of benefits, rip-offs, suffocating fine print, and prior authorization requirements that enrage physicians. All people would need to show is their Medicare card.
Trump could pluck H.R. 676 out of its obscurity (about 140 House Democrats signed on in 2019). He would get support for this bill from all the Democrats plus a hefty slice of GOP lawmakers, especially those running for re-election in 2026.
Trump is running out of distractions, and running out of the gas that kept his opponents in shock and awe. His polls are dropping. A recession is on the horizon. Inflation is here. His campaign promises are papier-mache. Government health insurance for all, with private (and some public, as with the VA) delivery of health care, comes close to the Canadian healthcare system that has worked for some 50 years, with better health outcomes.
As Claire wryly reminded me, Trump could become the Tommy Douglas of the United States. Douglas started Canadian Medicare in Saskatchewan in 1962 and is a hero in Canada.
Any Democrats holding back support for “Medicare for All” for fear of making Trump look good should think of the tens of millions of Americans who would feel good in so many ways, shorn of the anxiety, dread, and fear produced by our current broken, gouging healthcare system.
Trump’s past, present, and future will still give the Dems plenty of fodder for their loathing of the president’s policies and actions.
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As Dr. Oz Helps Prove 'There Is No Republican Health Care Plan,' Democrats Have Solution Most Refuse to Embrace: Medicare for All
"Healthcare is becoming unsustainable under Trump," says one progressive politician running for US Senate. "Medicare for All would fix it."
Nov 16, 2025
The Trump administration came under fire on Sunday after sending Dr. Mehmet Oz, the Administrator of the Centers for Medicare and Medicaid Services, onto CNN's weekend news show to try to explain the Republican Party's elusive "solution" to the nation's healthcare crisis, a topic of much interest in recent weeks amid the longest government shutdown in the nation's history and growing fears over massive premium increases or loss of coverage for tens millions of Americans.
Asked during his appearance to explain what Republicans are considering to address the surging cost of healthcare, Oz talked about direct cash payments—something Trump himself has floated in recent weeks—as well as the idea of health saving accounts (or HSAs) which allow for personalized accounts set up to help pay for out-of-pocket medical needs, though not premium payments.
"If you had a check in the mail, you could buy the insurance you thought was best for you," Oz stated without explaining in what way that is different from people who received tax credits to purchase plans on the insurance exchanges established by the Affordable Care Act signed into law by former President Barack Obama.
Pushing such empty ideas while claiming them as viable solutions to soaring costs is partly what led critics like Sen. Patty Murray (D-Wash.) this week to issue a public service announcement which stated flatly: "There is no Republican health care plan"—despite repeated claims to the contrary by GOP lawmakers, including Speaker of the House Mike Johnson (R-La.).
Dr Oz: "If you had a check in the mail, you could buy the insurance you thought was best for you" pic.twitter.com/rLoMdxhNPV
— Aaron Rupar (@atrupar) November 16, 2025
"Dr. Oz a few years ago was pitching Medicare Advantage for All—a scheme to put every person on the corporate health insurance plans he used to sell," said Andrew Perez, a politics editor for Zeteo, in response to the interview. "Now, he’s saying let’s take away insurance from millions and give them a few bucks for their health care instead. Insane."
In a blog post published last week, Nicole Rapfogel, a senior policy analyst with the Center on Budget and Policy Priorities (CBPP), a nonpartisan policy think tank, explained why expanded HSAs, backed by the government or otherwise, would do little to nothing to improve access or lower costs for healthcare.
"Expanding HSAs has been a consistent theme, including in the House-passed version of the Republican megabill, though those provisions didn’t pass the Senate," explained Rapfogel. "But these policies are misguided and would do little to preserve access to affordable, comprehensive coverage."
She further explains that HSAs generally are better for wealthier people who have spare income to direct into such accounts, but of little use to poorer Americans who are already struggling to make ends meet each month. According to Rapfogel:
Most people do not have spare cash to set aside in HSAs; an estimated 4 in 10 people are in debt due to medical and dental bills.
People in lower tax brackets also benefit less from HSA tax savings. For example, a married couple making $800,000 saves 37 cents for each dollar contributed to an HSA, more than three times the 12 cents per dollar a married couple making $30,000 would save.
Further, HSAs do not promote efficient use of health care services. Research has shown that HSAs do not reduce health care spending, but rather shield more of that spending from taxes.
Given that understanding of the well-known limitations of HSAs or other avenues of government backstopping of private insurance, the level of bullshitting or straight up ignorance by Oz on Sunday morning, for many, was hard to take.
It's "pretty amazing," said economist Dean Baker on Sunday, "that Dr. Oz doesn't know that people choose their insurance under Obamacare, but no one ever said Dr. Oz knew anything about healthcare."
In an interview with Newsmax earlier this month, Johnson—who has argued that the GOP has reams of policy proposals on the topic—accused Democrats of having no reform solutions to the nation's healthcare crisis other than permanently fighting to save the status quo, including the "subsidizing the insurance companies" which is at the heart of the Affordable Care Act.
Taxpayer subsidies for private insurance giants "is not the solution," Johnson admitted at the time, though his party has refused to offer anything resembling a departure from the for-profit model which experts have demonstrated is the central flaw in the US healthcare system, one that spends more money per capita than any other developed nation but with the worst outcomes.
Meanwhile, as Republicans show in word and deed that they have nothing to offer people concerned about healthcare premiums in the nation's for-profit system, only a relative handful of Democratic Party members have matched renewed focus on the nation's long-simmering healthcare crisis with the popular solution that experts and economists have long favored: a single-payer system now commonly known as Medicare for All.
Sen. Bernie Sanders, the Independent from Vermont who caucuses with the Senate Democrats, made the demand for Medicare for All a cornerpost of his two presidential campaigns, first in 2016 and then again in 2020. On the heals of those campaigns, which put the demand for a universal healthcare system before voters in a serious way for the first time in several generations, a growing number of lawmakers in Congress embraced the idea even as the party's establishment leadership treated the idea as toxic.
While a 2018 study by the Political Economy Research Institute (PERI) at the University of Massachusetts at Amherst detailed why it is "easy to pay for something that costs less," people in the United States exposed to the arguments of Medicare for All over the last decade a majority have shown their desire for such a system in poll after poll after poll.
A single-payer system like Medicare for All would nullify the need for private, for-profit insurance plans and the billions of dollars in spending they waste each year in the form of profits, outrageous pay packages for executives, marketing budgets, and administrative inefficiences.
Despite its popularity and the opportunity it presents to show the working class that the Democratic Party is willing to turn its back on corporate interests by putting the healthcare needs of individuals and families first, the party leadership continues to hold back its support.
Lawmakers like Rep. Ro Khanna (D-Calif.), who served as national co-chair to Sanders' second presidential run, has been arguing in recent weeks, amid the government shutdown fight, that Democrats should be "screaming" their support for universal healthcare "from the rooftops" in order to seize on a moment in which voters from across the political spectrum are more atuned than usual to the pervasive and fundamental failures of the for-profit system.
Rep. Pramila Jayapal (D-Wash.), lead sponsor of the Medicare for All Act in the US House, on Thursday reiterated her support for universal coverage by saying, "Instead of raising premiums for millions, how about we just get rid of them? Medicare for All!!"
As former Ohio state senator and progressive organizer Nina Turner said on Saturday, "This is a moment to mobilize for Medicare for All."
I went on Fox News to make the case for national health insurance & Medicare for All.
Democrats need to be screaming this from the rooftops. pic.twitter.com/eq9VO0pAxw
— Ro Khanna (@RoKhanna) November 15, 2025
Dr. Abdul El-Sayed, another former Sanders surrogate now running for the Democratic nomination in Michigan's US Senate race, has been another outspoken champion of Medicare for All in recent weeks.
"While MAGA slowly suffocates our healthcare system, we’re watching corporate health insurance choose profits—and corporate Democrats capitulating," El-Sayed said last week, expressing frustration over how the shutdown fight came to end. "Who suffers? The rest of us. It’s time for a healthcare system that doesn’t leave our insurance in the hands of big corporations—but guarantees health insurance for all of us."
Following Dr. Oz's remarks on Sunday, El-Sayed rebuked the top cabinet official as emblematic of the entire healthcare charade being perpetrated by the Republican Party under President Donald Trump.
"They think we're dumb," said El-Sayed of Oz's convoluted explanation of direct payments. "They know that no check they send will cover even a month of the healthcare Trump bump we can’t afford—but they think we’re not smart enough to know the difference. Healthcare is becoming unsustainable under Trump. Medicare for All would fix it."
In Maine on Sunday, another Democratic candidate running for the US Senate, Graham Platner, also championed the solution of Medicare for All.
After watching Oz's peformance on CNN, Tyler Evans, creative director who works for Rep. Alexandria Ocasio-Cortez (D-N.Y.) declared in a social media post: "If we had Medicare for All, you could simply go to the doctor."
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The Republican Health Care Apocalypse
The only people in America whose health care isn’t about to get much worse are billionaires, who can hop into their private helicopters to see their private doctors. The rest of us? It's time for us to fight like hell.
Nov 14, 2025
Republicans are obsessed with taking your health care away. This spring, they cut $1 trillion from Medicaid, all to give massive tax handouts to billionaires. For the last month and a half they shut down the government rather than prevent premiums from doubling on average for 24 million people in the Affordable Care Act marketplace. And they “won.”
The number of uninsured Americans is about to skyrocket, which is exactly what Republicans want. It is what they fight for every day; to steal your health care.
These cuts are devastating for seniors, who rely on Medicaid to pay for nursing homes and other long-term care (which typically isn’t covered by Medicare). They are also disastrous for Americans aged 50-64, many of whom are in the ACA marketplaces and will have the largest premium increases. Many will have no choice but to drop their health insurance and pray they don’t get too sick before they turn 65 and become eligible for Medicare—literally gambling with their lives.
Even if you’re not on Medicaid or the ACA, the Republican cuts will make your health care worse. Without the Medicaid dollars they need to survive, hospitals and nursing homes across the country are already closing their doors. Far more will close in the next few years, with rural areas and inner cities hit hardest.
Republicans are ideologically committed to destroying health care at the behest of their billionaire donors.
The hospitals that remain open will have to cut staff due to lower revenue—even as their ERs are flooded with newly uninsured patients who have nowhere else to go. That means if you get hit by a car, you’ll likely have to go to a hospital further away and wait longer to see a doctor. All thanks to Republicans.
The only people in America whose health care isn’t about to get much worse are billionaires, who can hop into their private helicopters to see their private doctors.
Democrats are demanding that Republicans back off their draconian health care cuts. That’s what the just-concluded government shutdown was all about—Democrats refusing to vote for a budget that doesn’t fix the coming health care apocalypse.
Some Democrats thought that Republicans would come to the negotiating table and figure out a health care fix, if only out of political self-interest. But Republicans are ideologically committed to destroying health care at the behest of their billionaire donors.
House Republican Leader Mike Johnson is refusing to bring an extension of the ACA subsidies, which would prevent premiums from skyrocketing, up for a vote.
This refusal is why House Democratic Leader Hakeem Jeffries has put forward a discharge petition to obtain a three-year extension of the ACA subsidies. If the petition gets 218 signers, it forces a floor vote which also needs 218 to pass. There are 214 Democrats in the House.
Republicans are betting that by dividing Americans against each other, they can duck the blame for the health care apocalypse they created. Let’s prove them wrong.
That means we need only FOUR Republicans to cross the aisle and we can get the subsidies to pass the House, putting pressure on the Senate.
It comes down to these 25 Republicans, who are in extremely tight races and whose constituents are getting hammered by spiking premiums and disastrous Medicaid cuts:
Juan Ciscomani (AZ-06)
Kevin Kiley (CA-03)
David Valadao (CA-22)
Darrell Issa (CA-48)
Gabe Evans (CO-08)
Cory Mills (FL-07)
María Elvira Salazar (FL-27)
Mariannette Miller-Meeks (IA-01)
Zach Nunn (IA-03)
Bill Huizenga (MI-04)
Tom Barrett (MI-07)
Nicole Malliotakis (NY-11)
Tom Kean Jr. (NJ-07)
Mike Lawler (NY-17)
Mike Turner (OH-10)
Brian Fitzpatrick (PA-01)
Ryan Mackenzie (PA-07)
Rob Bresnahan (PA-08)
Scott Perry (PA-10)
Andy Ogles (TN-05)
Monica De La Cruz (TX-15)
Rob Wittman (VA-01)
Jen Kiggans (VA-02)
Bryan Steil (WI-01)
Derrick Van Orden (WI-03)
Republicans are betting that by dividing Americans against each other, they can duck the blame for the health care apocalypse they created. Let’s prove them wrong. That starts with flooding the phone lines of these Republicans and protesting outside their offices, to demand they save our health care.
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'Nothing Short of Catastrophic': Federal Judge Strikes Down ACA Preventative Care Provision
"Another reason why we need Medicare for All—the milquetoast ACA is being dismantled before our eyes," said one critic.
Mar 30, 2023
A ruling handed down by a U.S. district judge on Thursday will threaten a range of lifesaving preventative healthcare services for more than 150 million people, legal experts and advocates said, as the decision challenged the legality of a federal task force that enforces coverage for the services.
Judge Reed O'Connor, a Bush appointee who sits on the U.S. District Court for the Northern District of Texas, ruled that insurance companies do not have to comply with preventative care recommendations made by the U.S. Preventive Services Task Force (USPSTF), which was established by a key provision in the Affordable Care Act (ACA), also known as Obamacare.
O'Connor ruled that the appointments of members of the task force violate the Appointments Clause in the U.S. Constitution and said that violation "invalidates its power to enforce anything against anyone nationwide," according to Slate journalist Mark Joseph Stern.
The USPSTF has issued recommendations for a wide range of preventative care services, including screenings for breast cancer, colorectal cancer, cervical cancer, and diabetes; interventions and tests for pregnant patients; anxiety screenings for children and adolescents; and pediatric vision tests.
Under the ACA, insurance companies are required to cover those services, but following O'Connor's ruling coverage will no longer be mandated.
The decision is "nothing short of catastrophic to the U.S. healthcare system," said Stern.
The ruling stemmed from a lawsuit filed in 2020 by Christian employers who objected to paying for services such as contraceptives and preexposure prophylaxis (PrEP), to prevent HIV transmission.
In September, O'Connor ruled that coverage for PrEP violated the companies' religious freedom in a decision that one doctor who specializes in HIV treatment condemned as "disgusting and inhumane" and likely "driven solely by homophobia and transphobia."
The companies are being represented by Texas attorney Jonathan Mitchell, who helped develop the state's abortion ban that allows private citizens to sue anyone who "aids or abets" a person who obtains abortion care.
More than 150 million Americans who have private health insurance have coverage for preventative care under the ACA, as well as approximately 20 million Medicaid and 61 million Medicare recipients.
Last July, as O'Connor was considering the case, titled Braidwood Management Inc., vs. Xavier Becerra, national health organizations including the American Medical Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists warned that a ruling in the plaintiffs' favor would "reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable."
"With an adverse ruling, patients would lose access to vital preventive healthcare services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia, and hearing, as well as access to immunizations critical to maintaining a healthy population," the organizations wrote. "Our patients cannot afford to lose this critical access to preventive healthcare services."
The Biden administration is expected to appeal O'Connor's ruling, and since insurance coverage contracts typically run through the end of the year, coverage will likely not change for many before 2024.
If upheld, the ruling will deal "a devastating blow to American public health," said University of California law professor Jennifer Oliva.
Last year, a Morning Consult poll found that at least 2 in 5 Americans were not willing to pay out-of-pocket for preventative services currently covered by the ACA.
O'Connor previously ruled in 2018 that the ACA should be struck down in its entirety, but that ruling was overturned by the U.S. Supreme Court.
The judge's latest ruling offers "another reason why we need Medicare for All," said the Debt Collective. "The milquetoast ACA is being dismantled before our eyes. There is no reason not to fight for real solutions when the non-solutions stand no better chance."
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Does Mitch McConnell Really Give a Damn About the Supreme Court?
Ideology has never been as important to the Senate majority leader as power.
Feb 26, 2016
Many years ago, I worked on a documentary about the how and why of political TV ads. The primary focus was on two media consultants: the late Bob Squier, a Democrat, and Bob Goodman, a Republican.
One ad of which Goodman was incredibly proud was for a fellow in Kentucky running against Todd Hollenbach, Sr., the incumbent judge/executive of Jefferson County. Produced in 1977, the spot featured a farmer complaining about taxes that he claimed Judge Hollenbach had raised and then lied about.
As he mucked out a barn and his faithful horse whinnied, the farmer declared, "Maybe Hollenbach ought to have my job, because in my business, I deal with that kind of stuff every day."
Then he threw a shovel of manure right at the camera.
Hollenbach lost to the candidate who approved this message: Mitch McConnell.
McConnell has been shoveling it ever since, but perhaps never as stunningly as on Tuesday when he spoke from the floor of the US Senate. The now-majority leader of the so-called greatest deliberative body in the world blustered, as he has several times in the last couple of weeks, that Senate Republicans would never, ever consider an appointment by President Obama to replace the still-dead Supreme Court Justice Antonin Scalia.
The president, McConnell, said, "has every right to nominate someone, even if doing so will inevitably plunge our nation into another bitter and avoidable struggle."
Excuse me, Senator, the bitter and undeniably avoidable struggle was created by you on the Saturday that Scalia's corpse was found. The body was barely cold when you crassly announced that the duly elected President of the United States should not name the judge's successor but must leave it to the next president - more than 300 days from now.
McConnell continued, "Even if he never expects that nominee to be actually confirmed but rather to wield as an election cudgel, he certainly has the right to do that." Again, Senator, it's you who is wielding the blunt object.
And then the majority leader had the chutzpah, as they say down home in his Bluegrass State, to add that "Obama also "has the right to make a different choice. He can let the people decide and make this a legacy-building moment rather than just another campaign roadshow."
Oh, brother, look who's talking. Of all the pompous, insincere bloviation, ignoring courtesy, tradition - let alone the US Constitution - in the name of Senator McConnell's misbegotten ambitions.
Psychiatrists call this "projection," the defensive method by which people take their own negative beliefs or feelings and attribute them to someone else - otherwise known as shifting blame. In McConnell's case, add to it a megadose of the cynical manipulation and crass opportunism characteristic of most of his political career.
Not that it was always so. McConnell began his political life as a liberal Republican - remember them? -- interning for legendary Kentucky senator and statesman John Sherman Cooper. He supported the Equal Rights Amendment and collective bargaining. Friends say he was pro-Planned Parenthood, and he even wrote an op-ed piece in the Louisville Courier-Journal favoring campaign finance reform. Former McConnell press secretary Meme Sweets Runyon told Jason Cherkis and Zach Carter at The Huffington Post, "He was kind of a good-government guy. He thought the government could do good and could be a solution."
But once Mitch McConnell got to Washington as an elected senator, the mood of the Republican Party shifted right, and so did he. Delay and obstruction became stepping stones. At the same time, the man who New York Times columnist Gail Collins famously described as having "the natural charisma of an oyster" developed a Jekyll-and-Hyde style of self-serving pragmatism - bashing government from Capitol Hill but using all of its perks to bolster support among his constituents.
In 2013, Cherkis and Carter wrote:
Up until the tea party-led ban on earmarks a few years ago, McConnell played out this dichotomy across Kentucky. In Washington, he voted against a health care program for poor children. In Kentucky, he funneled money to provide innovative health services for pregnant women. In Washington, he railed against Obamacare. In Kentucky, he supported free health care and prevention programs paid for by the federal government without the hassle of a private-insurance middleman. This policy ping-pong may not suggest a coherent belief system, but it has led to loyalty among the GOP in Washington and something close to fealty in Kentucky. It has advanced McConnell's highest ideal: his own political survival.
"McConnell's hold on Kentucky is a grim reminder of the practice of power in America -- where political excellence can be wholly divorced from successful governance and even public admiration," the Huffington Post reporters continued. "The most dominant and influential Kentucky politician since his hero Henry Clay, McConnell has rarely used his indefatigable talents toward broad, substantive reforms. He may be ruling, but he's ruling over a commonwealth with the lowest median income in the country, where too many counties have infant mortality rates comparable to those of the Third World. His solutions have been piecemeal and temporary, more cynical than merciful."
And so it goes. "He privileges the scoreboard above all," The New Yorker's Evan Osnos wrote in 2014. "Asked about his ideological evolution, he explained simply, 'I wanted to win.'"
Tailoring his positions to adjust to the shifting seasons, what sets Mitch McConnell apart is that his motives aren't ideological but so baldly about holding onto personal power. His opposition to Obama's naming of a Scalia replacement puts the majority leader in solid with the far-right Republicans he purportedly so dislikes but who have threatened his job security over the last few years, both at home and in DC.
Moreover, McConnell is desperate to keep a conservative majority on the Court to preserve the unbridled flow of campaign cash that the Citizens United decision let loose and that he so successfully has tapped for himself and the GOP. Unlike the young man who penned that campaign finance reform op-ed back in Louisville, fundraising has become his favorite thing, and he's scary good at it. As his former Republican Senate colleague Alan Simpson said, "When he asked for money, his eyes would shine like diamonds. He obviously loved it."
And even if a Democrat holds onto the White House next year, chances are McConnell - the man who once said that the most important thing was to make Barack Obama a one-term president -- will still play a power broker role in determining which Supreme Court candidate will successively run the 60-vote supermajority gauntlet needed for Senate approval. It's good to be king.
But if he wants us all to wait for a Republican president to choose the next appointment to the Court, he might want to think twice. Donald Trump bows before no man - just ask him -- and he shovels muck even better than that farmer who helped Mitch McConnell win his first public office.
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Clinton's 'Public Option' is a Diversion: We Need Single Payer, Medicare for All
Feb 24, 2016
You remember the public option. During the drafting of the Affordable Care Act (ACA), efforts were made to include a public option - a government-run plan that would compete with private health plans in the insurance marketplace.
If the private plans proved that they could provide greater value, then they would prevail. If the government could do a better job, then the public option could expand by demand and eventually become the single payer for the nation, so supporters believed.
"Clinton is now showing us how the public option is a diversion from the reform we really need - single-payer."
The original concept for the public option was to allow individuals to buy into the Medicare program instead of purchasing private insurance. There were some obvious problems. Medicare lacked some important features required of private plans, such as catastrophic coverage, which establishes a maximum out-of-pocket responsibility for paying for health care. Also, the existing Medicare pool was composed of the elderly and those with long-term disabilities - expensive groups to insure. The exorbitant premium that would have to be charged could not be competitive with the private plans.
It was then decided to establish a new public insurance program that was designed like the private plans and that would have to follow the same rules. The insurance industry immediately opposed this since it would be "unfair" competition considering the government resources backing up the public plan, and the inherently higher administrative costs that the private insurers face, not to mention the need to profit from their operations - profit not being a feature of a publicly owned insurer. Several (anti-competitive) features were proposed for the public option which would give the private insurers a "fair" playing field.
The insurers were still concerned that they could not compete against even a restricted government plan, and thus they continued to oppose it. There is a basis for that concern since the private Medicare Advantage plans are able to "compete" with the traditional Medicare program only because of the overpayments that are being made to the private plans. If they were in the same playing field, the private plans would perish.
Nevertheless, the issue of the public option became moot when Sen. Joseph Lieberman, with no votes to spare, threatened to kill the entire Affordable Care Act if the public option were included.
We were left with the co-ops as a substitute for the public option. The co-ops are nonprofit organizations in which the insured members are the owners. Congress, under the Republicans, has refused to provide promised funds, and half of them have collapsed. They are now being used by opponents of single-payer to "prove" that the government would be incapable of running a single-payer system - an obvious non sequitur.
Since the enactment of ACA there have been endless calls to add a public option. Single-payer failed to gain traction because of the pervasive meme that single-payer was not politically feasible. But if we could just get a public option, that would automatically evolve into a single-payer system, they said.
Then along came Bernie Sanders. He carried the message that not only was single payer politically feasible, it was a moral imperative to achieve health care justice for all.
To the surprise of Hillary Clinton and her campaign staff, Bernie Sanders came out of nowhere and gained traction carrying the single-payer banner, and, as a result, has become a genuine challenge to her candidacy.
Hillary Clinton has always been an opponent of single-payer and instead has supported the private insurance industry. Some misinterpreted a statement of hers from many years ago as supporting the fact that we would have a single-payer in the United States. But that statement was not in support of single-payer but rather was her threat to us that if we did not accept her managed-competition model of reform, we would have single-payer.
So what was her campaign to do? They decided to bring back the concept of a public option to appease those who were turning to Sanders because of his advocacy of single-payer. They are relying on the meme that the public option is our door to single-payer (even though it is not true). But what is her version of the public option?
She says we should build on ACA. She has proposed no new federal public option legislation but she is merely suggesting that the states look at Section 1332 of ACA which authorizes waivers for limited innovations on a state level.
Imagine the difficulties that states would have, within the confines of Section 1332, in building their own intra-state public plan. Unless they used private insurance innovations such as high deductibles, narrow provider networks, and tiered services, the premiums would be unaffordable to most. A single-payer system would be funded equitably through progressive taxes, but you could not do that with a public option since that is only one plan in a multi-payer system.
In 2009, David Himmelstein and Steffie Woolhandler explained in very brief terms why the public option is a flawed concept:
The "public plan option" won't work to fix the health care system for two reasons.
1. It forgoes at least 84 percent of the administrative savings available through single-payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians' offices, and nursing homes, which would still contend with multiple payers and hence still need the complex cost-tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer - not enough to make reform affordable.
2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry-picked healthier seniors and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan - which started as the single-payer for seniors and has now become a funding mechanism for HMOs - and a place to dump the unprofitably ill. A public plan option does not lead toward single-payer but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.
Hillary Clinton is now showing us how the public option is a diversion from the reform we really need - single-payer. It is up to us, the people, to convince our politicians that single-payer is what we want. It will not happen without us.
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Downton Abbey, Obamacare, and the Road to Socialized Healthcare
Feb 19, 2016
As the rightly acclaimed television series Downton Abbey unspools its final episode, some fans have criticized the producer's decision to devote so much time to a debate about the future of Downton's Cottage Hospital. The show makes the issue mostly personal with delightfully snippy exchanges between Violet, Dowager Countess of Grantham, who speaks for a way of life that is passing, and her cousin Isobel, widow and daughter of physicians and trained as a nurse during WWI, who is the voice of modernity. But underneath the repartee lies a serious and persistent issue: what should be the relationship of the community to the emerging age of high-tech, highly capitalized, and highly specialized medical system?
As Mary Kay Clunies-Ross, Senior Vice President of the Washington State Hospital Association, who has taken a keen interest in the show, told me, "They're asking the right questions. Who will be in charge? Will someone tell me what to do? Will we be able to continue to provide free care?"
The US and British health systems, while dramatically different, have had to grapple with these same questions. And in their exploration they've discovered that case can be made for big and for small but the weight of evidence suggests that the optimum medical configuration is when high tech and specialization is in service to responsible and accountable community hospitals.
In 1859, in real life, Albert Napper opened the first cottage hospital in Cranley. As Doctor Irvine Loudon at Oxford University observed, it was "built explicitly as a warm, clean idealized version of the farm laborer's cottage in order to reassure patients." A familiar doctor would treat people in a familiar atmosphere. Communities rallied around the concept. Hundreds of cottage hospitals sprang up and over the decades evolved into relatively sophisticated operations, often with state-of-the-art medicine and surgery.
In a very early episode in the series a farmer John Drake was admitted to the hospital with a terminal case of Dropsy. Isobel suggested to a Dr. Clarkson they use a very new technique. He reluctantly agreed and Drake promptly revived. By 1925, the year in which the final season of the tv series is set, voluntary hospitals constituted about 40 percent of all hospitals. They were largely supported by contributions and staffed with volunteers. There were also government hospitals: The infirmaries that grew out of the much-despised workhouses of the 19th century. But to many people these remained unwelcome venue.
In 1913 the liberal/labour coalition passed a law that gave a cash benefit to workers ages 16-70 who earned below the poverty level and the right to receive medical treatment at no cost. (These benefits did not extend to their spouses or children.)
Early in the series Isobel asks Robert, Earl of Grantham, how the Downton Cottage Hospital was financed. He notes that his father had given the land and building and established an endowment and then he adds, "Mr. Lloyd George's new insurance measures will help." Violet is aghast. "Please don't speak that man's name, we are about to eat," she archly announces.
In 1925, despite the federal money cottage hospitals were still suffering losses. Demand was up while charitable contributions were stagnating, in part the result of the decline of the landed aristocracy. Meanwhile, the price of medical equipment was climbing.
Most hospitals filled the financial hole by introducing subscription medicine, a form of local and self-insurance. Many of these were based in the workplace. Some doubled down on their efforts to gain contributions. The Granthams have responded by opening their castle to paying visitors as a benefit for the hospital.
Some cottage hospitals merged with bigger regional hospitals. That is the focus of the ongoing debate in Downton Abbey. Will their cottage hospital merge with the larger Royal Yorkshire Hospital?
Some communities converted their voluntary hospital into a municipal hospital. That is what happened in real life when the city council of Bradford, located about 30 miles south of Downton's village of Ripon took over the running of hospital services in 1920.
Socialized Medicine and Community Hospitals
A Gallup poll in July 1944 found that 85 percent of former patients were satisfied with their hospital treatment. Two-thirds of these had been patients in voluntary hospitals. But the question of sustainable financing remained. Over 71 percent of Britishers said they would prefer a state-financed hospital system to one supported by contributions. At the stroke of midnight on July 4, 1948 they got their wish. The National Health Service came into operation. Hospitals became government hospitals. Doctors became employees or contractors. It was Violet's worst nightmare. In the series she declared another reason why she wants to maintain local control of Downton's Cottage Hospital, "For years, I've watched government take control of our lives. And their argument is always the same--fewer costs, greater efficiency. But the result is the same too--less control by the people, more control by the state. Until the individual's own wishes count for nothing. That is what I consider my duty to resist...Your great-grandchildren won't thank you when the state is all-powerful because we didn't fight."
That the NHS began operation on the American day of Independence would probably have struck Violet as a cruel joke. For to her it was a declaration of slavery, a sentiment that would make her at home with current Tea Party philosophy. Indeed, in 1961 Ronald Reagan opposed Medicare with a rant that would have made Violet proud, "One of the traditional methods of imposing statism or socialism has been by way of medicine....If you don't do this (oppose Medicare), one of these days you and I are going to spend our sunset years telling our children and our children's children what it was like in American when men were free."
The NHS made it possible for cottage hospitals to survive. But it didn't make that survival inevitable. Health policymakers were unsure about community hospitals. At almost every turn they undervalued their benefits and overvalued the benefits of centralization. In the 1990s the NHS announced a wave of closures. Communities fought back with equal resolve, writing petitions, packing public meetings, marches. Some were successful. Others were not. In Odiham a four-year battle against the closure of its community hospital resulted in its becoming financially independent. The town of Rye, East Sussex, after discovering that its pleadings fell on deaf ears in Whitehall, took matters into its own hands, bought the local hospital and land, improved it and managed it. That protest had the benefit of being led by a local resident named Sir Paul McCartney, who gave a million pounds to the community's initiative. "My mother was a nurse," McCartney told the Independent. "I've got a lot of time for nurses and doctors because of what I saw her go through. The NHS is something our tax money buys. It's like education. That was the deal, I always thought. We're finding now that it isn't quite the deal...."
British support for community hospitals has waxed and waned and waxed. In 2006 an Independent headline reported "Cottage hospitals to make a comeback." Eight years later a headline in the Guardian announced, "NHS must end mass centralization, says new boss"
But even while criticizing large, impersonal institutions for robbing people of "dignity and compassion" the Conservative government cut another 20 percent from the NHS budget. Dr. Mark Porter, the Chair of the British Medical Association's hospital consultants committee worries that the happy talk about reviving community hospitals is simply a justification for turning the clock back and not in a good way. "Very deliberately the government wishes to turn back the clock to the 1930s and 1940s, when there were private, charitable and co-operative providers. But that system failed to provide comprehensive and universal service for the citizens of this country. That's why health was nationalised."
Community Hospitals in the United States
The United States hospital system began much as it had in the United Kingdom--as a charitable, often church-related institution governed locally and staffed by volunteers.
A bill for national health insurance made significant headway in Congress about the same time the British Parliament enacted their first worker-based health insurance benefit, but ultimately failed when WWI made all things German, Kaiser, distasteful and after WWI the Red Scare undermined any further efforts. In 1946 Republicans took control of Congress in 1946, in part by charging that Truman's proposal for a single egalitarian medical system that included all classes (and races) was socialism. After Truman's surprise victory in 1948, he doubled down on national health insurance. The American Medical Association assessed its members an extra $25 each and launched the most expensive lobbying effort in American history. One of its pamphlets echoed Violet's warning, "Would socialized medicine lead to socialization of other phases of life? Lenin thought so. He declared socialized medicine is the keystone to the arch of the socialist state." If you think that sounds an awful lot like Ronald Reagan's rhetoric 13 years later it should. The AMA wrote his speech too.
At the same time the British were rolling out the world's first free universal health system that was based on citizenship, not premiums or payroll taxes, Truman's plan died in Committee. No political party in America ever again embraced a universal, national health insurance system.
After World War II Congress appropriated billions of dollars to build hundreds of mostly rural community hospitals. Many of these are now threatened. Since 2010 more than 50 rural hospitals have closed and over 280 across 39 states are vulnerable to closure.
In big cities, Community hospitals built a century before are closing. Detroit boasted dozens of hospitals in the 1960s. It now has four. Since 1988, Milwaukee County has lost its public hospital and five city hospitals. Since 1990 New York has lost more than 20 hospitals even as its population has grown.
From 1999 to 2008, according to the American Hospital Association the number of independent hospitals fell by 290 by mergers and bankruptcies.
Adding insult to concentration, most closures are occurring in poorer communities and in communities of color even while new fully equipped hospitals continue to open in the wealthier suburbs.
Federal rules are complicit in undermining the financial stability of community hospitals. The original health care law required states to expand Medicaid and the law reduced federal payments to hospitals that had been used to cover their costs of providing care to the indigent because the federal government believed many of those poor patients would now be under Medicaid. Tragically, the Supreme Court declared that provision unconstitutional and almost half the states have refused to expand Medicaid. The result is that in 2016 their hospitals will begin to lose federal revenues, putting a significant strain especially on many fragile rural hospitals. In states that had expanded Medicaid 8.5 percent of rural hospitals are vulnerable to closure, nearly doubled in non-expansion states, where 16.5 percent of rural hospitals are vulnerable to closure, according to iVantage Health Analytics.
Hospital administrators complain about too low reimbursement rates from federal health care programs. As one administrator told USA Today, "Commercial insurers reimburse the hospital $1.33 for every $1 spent on a patient, on average, while Medicare pays about 83 cents for every dollar spent, and Medicaid pays 80 cents for every dollar spent."
Many independent hospitals lack the clout to get higher payments from insurers and steeper discounts from suppliers because they aren't part of larger hospital systems, another peculiar aspect of the U.S. medical system.
The Benefits of Local
Some argue that the closure of community hospitals has not negatively affected health outcomes but those working in these hospitals vehemently disagree. One community hospital physician responded that the study "does not resemble my real world." The medical profession talks about the "golden hour" after heart attacks, trauma and stroke in which treatment is needed to prevent loss of heart muscle and brain tissue. Closing community hospitals often eliminates the ability to provide critical medical care within that hour.
The anecdotal information about the health impacts of closing community hospitals is not insignificant. Stewart-Webster Hospital had served the small town of Richland Georgia and surrounding farms for more than six decades. With only a week's notice it shut its doors in 2013.
A month after it closed Farmer Buren "Bill" Jones, 52, died of a heart attack. His family had to wait about 15 minutes for an ambulance to take him to a hospital 22 miles away, where doctors couldn't revive him. The closed hospital was 9 miles from his house, a distance his wife or daughter -- who performed CPR on him at home -- might have driven.
"I have heard our little hospital called a Band-Aid station, but that little Band-Aid station saved my father's life two times after heart attacks," says Mike Pryor, judge-executive of Nicholas County Ky., which lost its small, rural hospital a few months before.
Six days after a nearby hospital closed in Bellhaven, North Carolina Portia Gibbs died while waiting to be airlifted to a big-city hospital 80 miles away. A rural hospital that recently closed in Nevada moves the nearest hospital 100 miles away.
Empirical evidence suggests that smaller and more localized institutions increase operating efficiencies while not reducing quality. In 1976 one British doctor commonsensically addressed the economics of centralization, "If the small hospitals are closed it means that the district hospital will have to cope with all the patients suffering from ordinary uncomplicated complaints and needing comparatively simple operations. The district hospital is geared to deal with the most complicated type of case. It has sophisticated diagnostic and therapeutic equipment which may be totally unnecessary and wasted upon such patients. The cost per bed in the district hospital is vastly greater than that in the cottage hospital. There will be no economy."
To which one might add that new clinical and technological developments mean that services such as kidney dialysis, ultrasound and MRI scanning can be offered in small hospitals.
Studies that have looked at the comparative efficiency of big and small hospitals ignore the direct and indirect economic impact of a community hospital. Directly it tends to be one of the largest employers in town, especially in rural areas. Indirectly, economic development is hurt because of the negative image to businesses of communities lacking a hospital.
Studies also ignore the substantial community-wide out-of-pocket savings of more localized medical attention. (e.g. extra driving time and expense) And they ignore the also substantial collateral damage of community hospital closures. In 2005 University of California researchers looked at hospital closures in L.A. County between 1997 and 2002. Joe R. Hicks, Vice President of Los Angeles based Community Advocates Inc. writes, "They found that the closures overwhelmed staff and facilities at the county's four general hospitals. The closures triggered a stampede of patients to doctor's offices, clinics and emergency rooms. They increased the time and distance that patients had to travel to get to a healthcare provider. That meant that fewer patients saw doctors, fewer children had checkups, patients were less likely to seek and get preventive care, and there was a jump in the number of deaths from injuries and heart attacks. This virtually guaranteed that the number of people who suffered from acute illnesses would climb. These ailments are more costly to treat."
And then there is the unquantifiable satisfaction from the peace of mind of having a medical facility nearby where you know the personnel.
Doctors too have lost their independence and autonomy. Hospitals have been on a buying spree of physician practices for a decade. Why? Federal rules allow an office visit with a physician in a hospital outpatient department to be reimbursed at a rate 80 percent higher than the same procedure performed in a physician's office. In May 2013, the Denver Post reported on a patient who received the same cardiac stress test twice from the same cardiologist. The first time the physician was independent. The test cost about $2,100. The second test, performed a year later after the practice was purchased by a local hospital, cost more than $8,000, mostly because of an added facility fee by the hospital.
"Hospital acquisition of physician practices leads to higher prices," the Robert Wood Johnson Foundation concluded in 2012, and had not improved quality. It also concluded that physician-hospital consolidation has not led to either improved quality or reduced costs. Consolidations are undertaken "primarily for the purpose of enhanced bargaining power with payers."
"Doctors really don't want to sell their practices," says H. Christopher Zaenger, CHBC, chief executive officer of Z Management Group in Barrington, Illinois. "They do it kicking and screaming." Nevertheless, so many did that as of 2012, the majority of physicians were employees instead of owners.
In 2014 Medical Economics magazine intriguingly asserted, "Put simply, fighting to preserve physician autonomy may be one key to help rein in America's enormous medical bills,"
Obamacare and Community Hospitals
All of this brings back the key question: what is the optimum configuration of a medical system? Most might embrace the vision of a network of well-equipped and locally owned or controlled hospitals that are part of regional networks of larger more capital-intensive hospitals that focus on specialized treatments.
The new buzzword in the medical community is "affiliation." The key, as both Violet and Isobel might agree, is how to affiliate in a way that maintains local control and patient intimacy while adding the access to specialized treatments and expensive technologies. Cooperative agreements come in hundreds of varieties. Mary Kay Clunies-Ross of the Washington Hospital Association notes a common joke among health policymakers, "If you've seen one affiliation you've seen one affiliation."
One of the key strategies the Affordable Care Act has embraced to reduce healthcare costs is by encouraging Accountable Care Organizations (ACO), networks of doctors and hospitals that share financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. The focus is on Medicare because it is a single-payer insurance program where the government can establish the rules directly. Each ACO has to manage the healthcare needs of a minimum of 5,000 Medicare beneficiaries for at least three years. At the heart of each patient's care is a primary care physician.
While ACOs are touted as a way to help fix an inefficient payment system that rewards more, not better, care, some economists warn they could lead to greater consolidation in the healthcare industry, which could allow some providers to charge more if they're the only game in town.
Kaiser Health News observes, "ACOs have become one of the most talked about new ideas in Obamacare." Some applaud it as a way to help fix an inefficient payment system that rewards more, not better care. But as Kaiser notes, "some economists warn they could lead to greater consolidation in the health care industry, which could allow some providers to charge more if they're the only game in town."
It is clear that Downton Abbey's cottage hospital will merge with Royal Yorkshire Hospital. Viewers will never discover what happens then. When a hospital is taken over by a system, the parent company typically replaces local board members. Physicians may end up with less say. "If you have a strong parent, they make all the decisions," says Donald Thieme, executive director of the Massachusetts Council of Community Hospitals. When the depression hits Britain, where will the Royal Yorkshire Hospital cut expenses first? Will the Downton Cottage Hospital survive?
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Rejecting Right-Wing Attack, US Supreme Court Upholds Obamacare Subsidies
Experts had warned that a finding in favor of the plaintiffs would eviscerate the healthcare law
Jun 25, 2015
Handing a victory for President Barack Obama and the Affordable Care Act--as well as millions of people who gained more affordable healthcare under the law--the U.S. Supreme Court on Thursday ruled that individuals who get their health insurance through an exchange established by the federal government will continue to be eligible for tax subsidies.
The "ALEC-fueled" case, King v. Burwell, dealt with whether the Affordable Care Act provides subsidies to everyone in the country who qualifies for them on the basis of income level, regardless of whether they get their insurance through a state-run exchange or an exchange run by the federal government. Basing their argument on just four words buried in the massive legislation, the plaintiffs claimed that subsidies were supposed to be only for those purchasing health care through state-run health exchanges--not the federal one.
Experts warned that a finding in favor of the plaintiffs would eviscerate the healthcare law.
Affirming the decision of the Fourth Circuit, the justices voted 6-3 to uphold the subsidies. Chief Justice John Roberts, as well as Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor, and Elena Kagan were in the majority.
Here's how SCOTUS Blog described "the core of the dispute:"
[T]o ensure that everyone can afford the health insurance that they are now required to buy, the ACA also provides for subsidies for people who buy their health insurance through an exchange. But one provision of the ACA indicates that subsidies are only available if you purchase your health insurance on an exchange "established by the State." The plaintiffs in this case argue that subsidies are therefore not available if you are one of the roughly seven million people who buy their health insurance on an exchange established by the federal government, because the federal government is not a "State." Defending the subsidies, the federal government argues that, if you look at the entire ACA and its history, it is clear that the subsidies are available to everyone who purchases insurance on an exchange, no matter who created it - including because the plaintiffs' reading could mean the end not just of the subsidies, but the entire health-insurance system created by the ACA.
About 6.4 million people are receiving subsidies in more than 30 states where the marketplace is run by the federal government. In a piece published Thursday, the New York Times asked one simple--but critical--question: "Have the subsidies succeeded?"
"By many measures, the answer is yes," wrote Times journalists Margot Sanger-Katz and Robert Pear. "More than seven million people are enrolled in the federal health insurance marketplaces, and a majority of them--87 percent--receive subsidies in the form of tax credits to help pay their premiums, the government says. Without subsidies, many would be unable to buy insurance."
They continued: "The subsidies also appear to have drawn substantial numbers of younger, healthier Americans into the new insurance markets, stabilizing premiums, even for people who pay the full cost themselves."
Of course, they add, "The effectiveness of the subsidies is separate from the question of whether they are legal."
Speculating on the potential impact of a ruling for the plaintiffs--against the ACA subsidies--Sanger-Katz and Pear wrote:
The effects would be felt around the country, but disproportionately in the South. More than three million people are receiving subsidies in four states that use the federal exchange: Florida, Georgia, North Carolina and Texas. In Florida alone, 1.3 million people -- more than 8 percent of the population under 65 -- receive subsidies to buy insurance.
However, some have maintained all along that King v. Burwell merely underscored the need for a single-payer system.
"Because of the ACA's administrative complexity and flaws--largely reflecting its accommodation to the private health insurance industry and other corporate, profit-oriented interests in U.S. health care--it is particularly vulnerable to the kind of legal challenge we saw today," said Physicians for a National Health Program president Robert Zarr.
"In contrast," he continued, "a single-payer system--an improved Medicare for All--would achieve truly universal care, affordability, and effective cost control. It would put the interests of our patients--and our nation's health--first."
And while he praised the Supreme Court ruling for not throwing millions off health insurance, Sen. Bernie Sanders (I-Vt.) added: "What the United States should do is join every other major nation and recognize that health care is a right of citizenship. A Medicare-for-all, single-payer system would provide better care at less cost for more Americans."
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The Mind-Boggling Libertarian Legal Game Plan to Repeal Obamacare
Jul 23, 2014
Dave Weigel explains something that I had not fully understood before --- the Obamacare repeal legal game plan:
At least 4 million people, who signed up for Obamacare in states that chose not to set up exchanges (or in the case of Oregon, tried and failed to set up their own), are currently panicking about the threat of erased subsidies and higher payments. Why do I attribute this to libertarians? Like I wrote in 2013, and like Alec MacGillis has been writing, the Halbig case's chief advocate was Michael Cannon, a Cato Institute scholar who had previously campaigned to stop states from setting up their own exchanges.
Cannon's goal, stated bluntly and frequently, was that Obamacare had to be brought down by any means necessary. States that did not set up exchanges were in a better position to sue the government. Fewer people in the exchanges meant higher overall costs. To insurers, the "death spiral" was an apocalypse scenario; to Cannon, it meant freedom.
"A victory for the Halbig plaintiffs would not increase anyone's premiums," he wrote Monday.* "What it would do is prevent the IRS from shifting the burden of those premiums from enrollees to taxpayers. Premiums for federal-Exchange enrollees would not rise, but those enrollees would face the full cost of their 'ObamaCare' plans."
This is the Leninism I'm referring to in my headline. Cannon's no socialist--quite the opposite!--but he saw a solution to the Republican crisis of watching people grow used to new entitlements. Rip the entitlement away, weaken the system, and a painful short term would give Congress no choice but to undo the law. Take away some of the beams, and what do you know? The roof collapses.
An what "undoing" the law means in this context is removing the requirements for pre-existing conditions and the basic package of coverage --- which means that people affected will go uncovered or pay an unaffordable price for an inadequate policy. You know, like it used to be. Which in their minds was a great system apparently.
Remember, this is how they really feel about this:
Teaparty: Just Let Uninsured People Die (CNN GOP debate, Ron Paul)https://24ahead.com/s/tea-parties (Super special note for Ron Paul fans below) Teapartiers shout out "yeah!" when Wolf Blitzer ...
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Healthcare: Let's Have People Over Profits Once And For All
Jun 18, 2014
There are some things in this world that shouldn't be turned into profit-making machines, and healthcare is definitely one of them. Believe it or not, there was a time in America when in almost every state health insurance companies and hospitals were required to be non-profits. Back then, Americans could actually get the healthcare and treatment they needed at affordable prices. But then Ronald Reagan came to Washington, and you guessed it, everything changed.
Suddenly, there was money to be made off of healthcare in America, and a lot of it. Banksters realized that these once-nonprofit hospitals, health insurers, and nursing homes had the potential to become absolute gold mines. Former Senator Bill Frist's family, for example, made billions in the 1980s and 1990s privatizing formerly county and city hospitals, slashing salaries, busting unions, and raising prices.
Slowly but surely, corporations and the wealthy elite took over our healthcare system, and have left us with a healthcare nightmare. That's why according to a new study by a prominent think-tank, the United States ranks dead last in a review of healthcare in the industrialized world. For the fifth time in a row, the U.S. has been ranked last in the Commonwealth Fund's annual review of healthcare in developed nations.
The review looked at healthcare access, efficiency and equity in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K. and the U.S. Of the nations included in the review, the United States had the highest percentage of citizens who didn't get medical care because they couldn't afford it.
A staggering 37% of Americans said they didn't get a prescription, see a doctor, or seek out other medical care, because they were worried about the costs. On the flip side, just four percent of people in the United Kingdom said they skipped out on healthcare because of cost concerns. So why such a large disparity?
The United Kingdom has universal health care. In fact, every country the Commonwealth Fund looked at has universal healthcare, except the U.S. The U.S. is the ONLY free-market country in the world without a universal healthcare system, and - not coincidentally - the only one with such a large involvement of for-profit companies in the healthcare marketplace.
Countries with universal nonprofit healthcare don't have millions of people struggling to afford healthcare. And they don't have millions of people skipping out on prescriptions because they cost too much money. From Switzerland to Italy, and Norway to France, healthcare is considered a basic human right. No one questions the notion that everyone, no matter who they are, is entitled to lifesaving and affordable healthcare.
But the differences in healthcare outcomes in the U.S. and in Europe go beyond just universal healthcare. You see, healthcare isn't a profit-making machine in Europe the way it is in the U.S.
In fact, in Switzerland, not only is there universal healthcare, but health insurers are FORBIDDEN from making a profit on basic health insurance coverage, because the Swiss realize, and accept, that healthcare and ballooning profits don't go together. They realize that profit incentives have to be removed if a healthcare system is going to work for everyone.
Since it went into effect, Obamacare has done tremendous things for healthcare in America. It's allowed millions of Americans to get the healthcare and treatment they wouldn't have gotten otherwise. An April Gallup study found that as many as 9.9 million Americans have gotten new health insurance under Obamacare, and more than 4 percent of Americans have gotten health insurance for the first time in their lives.
But Obamacare is just one piece of the puzzle. If we truly want to have a healthcare system that works for all, than we need to go back to the days before Reagan, when healthcare wasn't a cash cow for Wall Street bankers. Unless we take Wall Street's skin out of the game, healthcare in America will never work for everyone. It's time to put people over profits once and for all, and require hospitals and health insurance companies to once again become non-profits.
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