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Dems giving away store on immigration & obamacare

Races for the Senate, U.S. House, etc. and other issues of national importance.

Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Wed Mar 06, 2013 7:49 am

http://www.bizjournals.com/jacksonville ... t-are.html

Florida's state legislature has bucked Gov. Scott, and Florida will not be expanding medicaid.

But guess what (as Dennis Rodman would say) the Republicans there are now suggesting that a deal like Arkansas got would be swell.

The Arkansas deal will cost $3000 more per person to use private insurance rather than medicaid. The states don't mind, it is "free money" from the Feds.

The people who want to undermine Obamacare are dancing in the streets over the Arkansas boondoggle:
http://news.heartland.org/newspaper-art ... -expansion

As that blog makes clear, the right's strategy is to drive-up the cost of Obamacare by replacing medicaid with private insurance. Then they think congress will be forced to dial-back the subsidies, raise copays and deductibles. This (in theory) will lead to a more free market solution of self-reliant people.

Disaster. What was Obama thinking granting that waiver to AK? Didn't they see that every other redneck state would jump on it? The right's political plan is not ultimately going to work, but it certainly looks like they will be able to do tremendous harm to our health care system for years to come.
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Re: Dems giving away store on immigration & obamacare

Postby Detritus » Wed Mar 06, 2013 8:30 am

Meade wrote:
Huckleby wrote:the core mission of Obamacare - establish universal health care as our national goal

Universal health care is the core mission of obamacare. Noted. Thank you.

Wait a minute--what makes you (two) think this is true? Obama may have pushed for wider health-care coverage, but he explicitly took universal off the table before even beginning to negotiate. I see no path to universal health care from the current welter of rules and plans that 1) require each individual to be an expert in medicine and finance, and 2) privilege insurance company profits over everything else. Unless, of course, you're willing to dismantle the current system, replacing it with single payer or single provider.
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Re: Dems giving away store on immigration & obamacare

Postby Stu Levitan » Wed Mar 06, 2013 9:03 am

Sandi wrote:Everyone has equal access to education ...


No, they don't.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Wed Mar 06, 2013 12:12 pm

Detritus wrote: Wait a minute--what makes you (two) think this is true? Obama may have pushed for wider health-care coverage, but he explicitly took universal off the table before even beginning to negotiate. I see no path to universal health care from the current welter of rules and plans that 1) require each individual to be an expert in medicine and finance, and 2) privilege insurance company profits over everything else. Unless, of course, you're willing to dismantle the current system, replacing it with single payer or single provider.


"universal health care" does not require single payer or single provider, it means that everyone has some form of health insurance ( anything from medicare, to a health savings account backed by catastrophic insurance) that allows everyone affordable access to doctors.

Most countries around the world achieve universal health care with a complex mix of public and (highly regulated) private facilities & insurance. The countries that have the least private participation (Canada & Great Britain) have gotten poor value for their health care dollar, even if they are better than the U.S.'s ridiculously wasteful system. Great Britain began privatizing both insurance and providers 4 years ago, and they have seen significant gains in effectiveness. Canada is also trying to reduce the government footprint.

Obamacare is patterned a lot like Switzerland's system, which delivers universal health care with very high customer satisfaction, short wait times. They are not great with cost control, but overall a damn splendid system. None of the best performing systems in the world - Japan, Singapore, France - have a simple "medicare for all" structure. I guess Singapore is single payer, but with personal responsibility pressures. I'd be OK with medicare for all, but it is not the only way to go.

The goal of Obamacare certainly was to see that all Americans have affordable access to health care. It may be a 20 year evolutionary process, but this bill was a huge first step.

I don't know what the future holds. Hopefully Obamacare can be made to work, then improved. But Scott Walker and the DixiePubs are doing their best to sabotage it.
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Re: Dems giving away store on immigration & obamacare

Postby Detritus » Wed Mar 06, 2013 1:23 pm

Huckleby wrote:The goal of Obamacare certainly was to see that all Americans have affordable access to health care. It may be a 20 year evolutionary process, but this bill was a huge first step.

A 20-year process to provide "affordable access" is not "universal healthcare," but it is certainly "evolutionary," in the Spencerian sense.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Wed Mar 06, 2013 11:42 pm

Detritus wrote:
Huckleby wrote:The goal of Obamacare certainly was to see that all Americans have affordable access to health care. It may be a 20 year evolutionary process, but this bill was a huge first step.

A 20-year process to provide "affordable access" is not "universal healthcare," but it is certainly "evolutionary," in the Spencerian sense.


What timeline do you project for U.S. politics to evolve to the point where universal coverage via Medicare-for-All would be viable?

Obamacare, at least as the law was written and intended, could achieve about 95% coverage within a couple years. That is impressive step forward. The last 5% are harder. You aren't going to get to 100% until health care really gets broadly accepted as a right.

It ain't the system, it's the politics.

Wisconsin already had a FANTASTIC health care system in place to deal with the problem of uninsured - BadgerCare. I think BadgerCare struck an excellent balance of government subsidy and individual responsibility, it helped people all the way up to 200% of poverty.

What happened? Under a Democratic Governor, Jim Doyle, the people and government were unwilling to fund it. The legislature put caps on it, waiting lists grew longer than those to get season tickets for packer games. This a cultural problem, not a problem with a wrong health care system.

(Well, now Governor Walker has tragically blown-up Badgercare, but that is a different story.)

Any dumb fuck can come up with a theoretically beautiful health care system that theoretically will be great because pieces of the system are not profit-driven. Leaving aside the issue of whether this system will actually work so great, the hard part is finding a political path to implement it. Obamacare is genius because it threaded a nearly impossible political needle. The stars aligned briefly.
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Re: Dems giving away store on immigration & obamacare

Postby manoletters » Thu Mar 07, 2013 8:30 am

I’m disappointed, but not surprised that President Obama has been so accommodating toward the recent House Republican maneuvers aimed at further shredding our nation’s safety net. I suppose it was my own folly to have voted for the president last November. I thought it was either a choice of marking the ballot for Obama, or facing the imminent privatization of Medicaid, Medicare and Social Security under a Romney/Ryan administration.
But when The Guardian of London recently reported that the president had “attacked” the Republican position regarding the “sequester” disaster currently unfolding in the United States, I could only wonder: “What planet am I living on? I’d really like to see Barack Obama ‘attack’ Republicans, rather than collude with them, as he does on a daily basis.”
All indications are that Obama is prepared, once again, to betray his base. By now it’s become entirely futile asking him not to balance the budget on the backs of the poor and disadvantaged. Considering that nationwide, 700,000 pre-schoolers stand to lose their Head Start enrollment, we should be asking ourselves what sort of plan can succeed in thwarting congressional Republicans.

Despite Obama’s ongoing collaboration, we as a people need to find a way to mitigate the damage done by the cruel and indiscriminate Republican proponents of selective austerity.
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Re: Dems giving away store on immigration & obamacare

Postby Detritus » Thu Mar 07, 2013 9:42 am

Huckleby wrote:Leaving aside the issue of whether this system will actually work so great, the hard part is finding a political will to implement it.

Fixed that for you.

Let's troll through the relatively recent evolution "toward universal health care" for a moment, shall we?

1965 Medicare/Medicaid (partially covers a subset of the poor, elderly, disabled with government-funded insurance)
1973 HMOs (puts insurance companies into the treatment business)
1986 Emergency Medical Treatment (requires hospitals to treat emergencies)
1996 HIPPA (allows health insurance to follow job changers in some cases)
2003 Medicare Part D (lowers the cost of some drugs for some Medicare patients)
2010 Obamacare (adds more people to medicare, makes it a crime not to buy insurance)

We have gone from a system in which the insurance companies handled catastrophic illness and accident only to one in which they run all our access to medical care. Although the government-run system (which is more efficient than private insurance-based systems) has slowly added more people, the system still fails to cover millions of people, and costs have skyrocketed well beyond our peers. Insurance company profits are massive, the state of US citizens' heath is getting worse every year (particularly for the poor, who have seen a major jump in infant mortality and a major drop in life expectancy), and the "socialist" President's "evolution toward universal health care" penalizes us for not buying insurance, but does not penalize insurance companies for refusing to sell it to us.

And all this in just a little under fifty years. Impressive! Or 80 years, if you figure the beginning of the current evolution from 1935 instead of 1965.

In the time since 1965, the US has found the political will to fight three major wars and more minor ones than I care to remember. We reconstructed our entire economy around an industry (IT) that barely existed in 1965 but which now boasts many of our billionaires. We managed to erect an entire security state following 9/11 under ten years. And if we go back a little farther, I might point out that we went from no meaningful space program to astronauts on the moon in eight years.

My point: if the goal and the will was universal healthcare, we would have it by now. Rather, it seems to me that the goal is preserving the place of the insurance industry and its profits at the heart of the US healthcare system, using citizens as the pass-through for government subsidies of that business. Given that that is what has been accomplished so far, I see no reason to think that anything else was seriously considered.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Thu Mar 07, 2013 10:28 am

manoletters wrote: By now it’s become entirely futile asking him not to balance the budget on the backs of the poor and disadvantaged. Considering that nationwide, 700,000 pre-schoolers stand to lose their Head Start enrollment, we should be asking ourselves what sort of plan can succeed in thwarting congressional Republicans.

Despite Obama’s ongoing collaboration, we as a people need to find a way to mitigate the damage done by the cruel and indiscriminate Republican proponents of selective austerity.


I can't really blame Obama for the sequester, we're kinda stuck with it. Blame the American people for voting for all those congressional Republicans. Plus they voted for 30 republican governors who shepherded through redistricting.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Thu Mar 07, 2013 11:21 am

Detritus wrote:We have gone from a system in which the insurance companies handled catastrophic illness and accident only to one in which they run all our access to medical care.
Conservatives too want to return insurance companies to their former role as catastrophic insurance providers. But they want individuals to pay their regular bills, not the government.

Me, I don't care much care whether we have private insurance or not.
The private insurance model per se is not the problem, it all depends on regulation.

Detritus wrote: Although the government-run system (which is more efficient than private insurance-based systems)
In some ways, the government insurance is more efficient, in other ways it is far worse. Medicaid and Medicare are riding on the backs of private insurance through cost shifting, the tradeoffs are not as obvious as you think.
You are way too hung-up on the simple ideology of public=good, profits=bad.

Detritus wrote: the "socialist" President's "evolution toward universal health care" penalizes us for not buying insurance, but does not penalize insurance companies for refusing to sell it to us.
No, Obamacare requires insurance companies to sell insurance to us. And it explicitly caps their profit taking. And it caps the surcharge they can exact from higher risk people.

Detritus wrote:My point: if the goal and the will was universal healthcare, we would have it by now.
Yes, of course. But the holdup is not corrupt politicians or corporate greed, the problem is American culture and values.
We had a beautifully designed system in Wisconsin, BadgerCare, to sensibly help poor and low income families. Did you see Wisconsin people marching in the streets when Governor Doyle and the legislator shut-off enrollment to adults without kids?
The reason why health care reform can't happen in a couple years is that we have to make political and cultural shifts among the general population. Look at the fierce resistance to Obamacare!

Detritus wrote:Rather, it seems to me that the goal is preserving the place of the insurance industry and its profits at the heart of the US healthcare system, using citizens as the pass-through for government subsidies of that business.

The insurance industry is taking only a small slice of the profits. Insurance is the least of our problems. Most health care dollars are funneled through some form of public insurance.

There is some truth to what you are saying. Obamacare was a negotiation with the health care industries. But you miss details, like the fact that the insurance industry fought against Obamacare in its final phase. Simple ideology doesn't fit the situation.
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Re: Dems giving away store on immigration & obamacare

Postby manoletters » Fri Mar 08, 2013 9:59 am

Huckleby wrote:
manoletters wrote: By now it’s become entirely futile asking him not to balance the budget on the backs of the poor and disadvantaged. Considering that nationwide, 700,000 pre-schoolers stand to lose their Head Start enrollment, we should be asking ourselves what sort of plan can succeed in thwarting congressional Republicans.

Despite Obama’s ongoing collaboration, we as a people need to find a way to mitigate the damage done by the cruel and indiscriminate Republican proponents of selective austerity.


I can't really blame Obama for the sequester, we're kinda stuck with it. Blame the American people for voting for all those congressional Republicans. Plus they voted for 30 republican governors who shepherded through redistricting.


I basically agree with your assessment, Huckleby, as to who's more culpable re: the sequester. But but by now I completely doubt Obama's sincerity regarding the need to preserve important social programs.
http://www.commondreams.org/view/2013/03/08-2
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Re: Dems giving away store on immigration & obamacare

Postby Stebben84 » Fri Mar 08, 2013 10:09 am

manoletters wrote:But but by now I completely doubt Obama's sincerity regarding the need to preserve important social programs.
http://www.commondreams.org/view/2013/03/08-2


From the article:

Here are the facts:

Research suggests that Social Security cost-of-living increases are already inadequate. (See studies on “CPI-E” for more details on the best ways to increase them.)
Obama’s proposed chained-CPI cut would typically reduce benefits for 3 percent, and by as much as 6 percent for some recipients.
The White House’s decision to label this cut the “superlative CPI” is grotesque. It suggests that elderly women who receive an average of $950 or so per month are receiving “superlative” benefit increases each year.
The Administration’s insistence on speaking of “entitlement reform,” mixing Medicare (which has a real cost problem because of our for-profit health system) with Social Security, is a cheap trick first devised by Republican consultants.


What I don't like is when a writer says "here are the facts" yet doesn't back them up. They may all be well and true, but do we really know that? The only links he provides are of other "reporters" saying the same thing.
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Fri Mar 08, 2013 10:22 am

I've been presenting a confusing argument. On the one hand, I say that properly regulated private insurers are as good as or better than medicare for delivering universal health care. At the same time, I'm having a fit over the fact that medicaid is being turned over to private insurers in the South. The reason for the contradiction is that the devil is in the details, it depends on the goodwill of the implementer. You need strong regulation and generous subsidies.

I ran across a graph that summarizes why private insurance is unlikely to work in WI or the south for low income people:
http://www.washingtonpost.com/blogs/won ... rc=nl_wonk

Image

It shows that people earning under $25,000 are unlikely to buy health insurance even when their employer subsidizes the premiums. ( The graph shows premium burden, but increasingly it's the co-pays and deductibles that are unaffordable.) Governor Walker's claim that he is going to successfully migrate 250K low-income people to the insurance exchange is bogus.

BTW, the above graph is for single, childless adults. $25,000 is something like 250% of federal poverty level for a single person! Even those supposedly comfortable folk find subsidized private insurance unattractive. What is a family of three with 15K of income gonna do?
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Re: Dems giving away store on immigration & obamacare

Postby manoletters » Sun Mar 10, 2013 9:47 am

Huckleby, here's the best I can do at the moment, hopefully providing a better source:
http://www.youtube.com/watch?v=zxPesrGOEcc
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Re: Dems giving away store on immigration & obamacare

Postby Huckleby » Sun Mar 10, 2013 11:41 am

manoletters wrote:Huckleby, here's the best I can do at the moment, hopefully providing a better source:
http://www.youtube.com/watch?v=zxPesrGOEcc

I agree with most of Bernie Sander's point of view there. Of "the Big Three", certainly medicaid and social security need to be fiercely protected. Medicare is a somewhat different situation. People are paying-in $1 and drawing out $3, reforms are needed to control costs or raise taxes. But the fix for medicare should not include raising the eligibility age.
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