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OpEdNews Op Eds    H3'ed 2/6/20

Will Democrats fall for the public option scam again?

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Follow Me on Twitter     Message Rick Staggenborg, MD



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When all the Establishment-backed contenders for the Democratic presidential nomination support some version of a public option, it's a safe bet that corporate interests that finance the DNC are the ones that are being served. As corporatist candidates like Harris and Biden fail to resonate, new champions of "pragmatic" approaches to reform rise to take their places. Even progressive darling Elizabeth Warren favors an incremental approach that she thinks will lead to single payer, starting with a public option. Only Sanders has consistently indicated his willingness to take the lead in a fight for a Medicare for All now.

The arguments made by the corporatists in the party are having an effect. A substantial proportion of Democrats are buying the false claim that a public option is the only viable way to establish universal access to health care. That's shown in their growing support for a public option and decreasing support for a single-payer system like Medicare for All. It's disheartening that so many supporters of a single-payer system of health care are falling for the same nonsensical arguments that were used to undermine support for it during the "health-care reform" debate in 2009.

Those of us who understood then that the call for a public option was a bait-and-switch strategy to defuse the growing movement for a single-payer system must start all over again educating progressives about why it will not lead to single payer. Instead, it will just add one more plan to a multi-payer system of access to health care that is inherently inefficient. This inefficiency is the main reason that health-care costs per capita in the US are about twice the average in countries with universal health care. Americans will not accept another expensive half-measure that won't address the root problem or assure access to all.

The reason a public option won't lead to single payer is that a Congress saturated by lobbyist cash will never create a plan that would compete with private plans. Democrats who are ready to embrace Biden, Buttigieg or any other proponent of a public option have apparently forgotten that Senator Schumer explicitly stated in 2009 that Democrats had no intention of creating such a plan. They also fail to recall that the corporate Democrats who kept single payer off the negotiating table continued to claim that people would like the plan so much that Americans would eventually all want to join it, creating a single-payer plan by default. Nothing has changed since then.

To be fair, it's theoretically possible that a public option could at least provide universal coverage. However, that's not the same as universal access to health care. Anyone who has studied the issue understands that premiums, copays and deductibles remain a significant barrier to access to care for the insured. Financial barriers to access have dramatically increased since 1998, according to a recent Harvard study published in the Journal of the AMA. That study also showed that even the much-touted Obamacare expansion, expensive as it was, has not appreciably decreased the proportion of people who experience problems with access to affordable care. That's why one in four Americans report that they or a family member have put off needed care for a serious condition because of cost. In families earning less than $40,000 per year, that figure rises to one in three.

Insurance is not the same as access to care when financial barriers to using it persist. That even applies to patients on Medicare, who also often have serious difficulty paying for their medications. That's why single-payer advocates generally prefer the term "Improved Medicare for All" when referring to the plans advocated by most advocacy groups and members of Congress who actually understand these issues and support a single-payer solution to the continuing crisis in health-care access and affordability.

Improved Medicare for All refers to a system that is more comprehensive than Medicare, with coverage for vision, dental and hearing and medications, no or minimal premiums or copays and no deductibles. Some versions include long-term care, as is provided in several European countries such as France and the Netherlands. It is also a feature of one of the bills currently in Congress. All such bills introduced in the last few Congresses are variations on Improved Medicare for All because that is the type of single-payer system that is widely acknowledged to be the most politically palatable in the US due to the generally positive views of Medicare.


I won't go into the explanations of why single-payer systems are less expensive than publicly funded and administered (single payer) systems (the basic reasons are summarized in this bullet-point document, which also points out other economic advantages). There are endless articles written on the subject for the interested reader, but the simple response to those who say we can't afford such a system is this: countries that provide universal health care to all their residents using a publicly funded and administered system provide care as good or better than the US at the least cost.

If other countries can do it, the only thing stopping the US from doing the same is the lack of political will due to Americans dithering about whether it is politically possible. It will be possible only when we demand it. A single-payer plan like Medicare for All is the only affordable way to end the crisis of health-care access and affordability in the US. Accept no substitutes.

 

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Rick Staggenborg, MD Social Media Pages: Facebook Page       Twitter Page       Linked In Page       Instagram page url on login Profile not filled in

I am a former Army and VA psychiatrist who ran for the US Senate in 2010 on a campaign based on a pledge to introduce a constitutional amendment to abolish corporate personhood and regulate campaign finance. A constitutional amendment banning (more...)
 

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5 people are discussing this page, with 12 comments


Rick Staggenborg, MD

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A lot of people who claim to want a single payer system are again falling for the argument that it is not politically feasible. Do they really want to prove it by refusing to vote for candidates who support Medicare for All and instead vote for someone repeating the same lies about how a public option will lead to a single payer system?

The public option gambit in 2009 did not fail. Corporate Dems succeeded in splintering support for single payer. Because it didn't pass, they never had to take the heat for a system that would have done nothing to improve access or control costs.

Submitted on Thursday, Feb 6, 2020 at 4:17:50 AM

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nelswight

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Thank, Rick.

Submitted on Thursday, Feb 6, 2020 at 5:39:28 PM

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John Rachel

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The public will fall for what the ruling elite wants them to fall for. Pushback? Where? From whom?

Time to stop living in a fantasy world and start planning for a deep revolution -- deep in real reform or deep in blood, that's the choice.

Submitted on Thursday, Feb 6, 2020 at 10:07:16 PM

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Rick Staggenborg, MD

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I understand your cynicism and certainly agree that ours will be a never-ending and ultimately hopeless battle if we don't eventually force fundamental change in the system, but in the meanwhile universal health care is a rallying issue where we have a good chance of winning.

The non-system as it is will eventually collapse if allowed to. The well-known death spiral of the insurance industry is where the rising costs lead to fewer customers, which leads to rising costs in order to maintain profits, which leads to less customers...I'm sure you get the point.

This is why the Democrats made "improving health care" a priority. It was really about saving the insurance industry. Despite its good qualities, Obamacare was essentially a bailout for an insurance industry which was bankrupting itself, while being packaged major "reform."

Submitted on Friday, Feb 7, 2020 at 12:20:58 AM

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John Rachel

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No cynicism here. I live in reality. You should try it. Otherwise we will never make any progress. Evidence is this article, yet another among hundreds and hundreds talking about our health care crisis. 'Public Option' has been a topic for how long? Eleven years? We're still struggling to get a health care system that's barely functional and affordable. ELEVEN YEARS, RICK! You call this progress? Wake up. Your articles are brilliant but irrelevant in the big picture. WE'RE GOING BACKWARDS. It's not cynical to point out accurately the state of things, especially the floundering efforts at reform.

Submitted on Saturday, Feb 8, 2020 at 2:52:52 AM

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David William Pear

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Here is an experiment people can try: when they do their income taxes, add to it the amount paid for health (sic) insurance and deductibles and copays.

My wife's crappy policy was raised to $7,200 this year and it is a $5,000 deductible, which she has never used, inshallah. She is not old enough for Medicare yet. A few years ago the policy cost under $4,000 per year.

Fortunately, I am covered 100% by socialized medicine; i.e. VA. The VA is the best medical care anywhere, but they are trying to destroy it with "Choice", i.e. privatization: The Veterans Health Administration is the Best Healthcare Anywhere!

Submitted on Friday, Feb 7, 2020 at 3:11:21 AM

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Rick Staggenborg, MD

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Thanks for sharing your story, David. Unfortunately, it is one among millions that I hear far too often.

Your suggestion that people calculate their current health care costs to what they would pay at point of service under a single payer system (most likely to be zero). It's true that there taxes would go up, but if they look at their current costs and ask themselves how much their taxes would have to increase to cover it, they will see just how ridiculous is the argument that their costs would raise.

That's not true for everyone, of course but under the Sanders plan (which could be improved) it is estimated that on average, 95% will come out ahead, and the rest would never have to worry about becoming bankrupted by medical bills. Of course, the fact that all their neighbors, including the working poor (about 70% of the uninsured) will have the same protection is a bonus to those who care about the less fortunate.

A big problem with getting people to take this test is that so many of those insured by work, especially those who never use their health care, have no idea of the real costs they pay through foregone wages and tax payments for subsidies to the private medical-industrial complex in order to keep their increasingly expensive employer-based plans.

Submitted on Friday, Feb 7, 2020 at 6:25:07 PM

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nelswight

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Hey, JOHN,RICK. Let's get together, you're only 7000- 8000 miles apart, and I'm over 3000 miles East.

Submitted on Saturday, Feb 8, 2020 at 1:47:13 PM

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I'm getting my canoe out of storage.

Submitted on Saturday, Feb 8, 2020 at 11:33:54 PM

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JACK DRESSER

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Referring back to your 2016 op-ed on this topic, the "real reason" we didn't get single-payer from Obama was probably this: click here It was entirely predictable. He did the same thing as an Illinois state senator. And his monstrous depredations in Libya, Syria and Honduras were equally predictabe. Unlisted on his public CV was his first job out of undergrad school with Business International Corporation, a neoliberal CIA front organization.

Submitted on Saturday, Feb 8, 2020 at 9:12:16 PM

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JACK DRESSER

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Like Ken Burns' absurdly duplicitous Vietnam whitewash that it was simply a tragic "mistake" - which in fact provided a template through the Phoenix Program for covert operations continuing still - these policy decisions are rarely if ever simple errors in judgment.

Submitted on Saturday, Feb 8, 2020 at 9:19:27 PM

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Rick Staggenborg, MD

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Absolutely right on both counts, Jack. My article was about how the scam was perpetrated, the one you shared was about why. Together, they make clear that the agenda was not about increasing access to health care as much as to assure a market for an insurance industry that was on the verge of pricing its product out of existence (see my comment above on the death spiral).

Submitted on Monday, Feb 10, 2020 at 3:31:04 AM

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