Ezra, since you are (at least part time) health care policy guy, maybe you can post (or repost) some base line stuff...like what is an "INDIVIDUAL MANDATE?" Does that mean if I loose my job I will be required to pay for health insurance for myself and my family? I know a single payer system is a pipe-dream, but I am a bit confused what other options there are..open up Medicare for everyone?

I confess I am curious how the same guy who said "Hillary's health care plan forces everyone to buy insurance, even if you can't afford it" will manage to rebut his own argument.

What do you think about automatic enrollment as a way for the government to basically cover everyone without the specter of a mandate that forces people to buy coverage?

What about vouchers? They basically would achieve universal coverage without being suspect to (idiotic) cries of "socialism!" And since Zeke Emanuel is Peter Orszag's point man on health care, and has specifically advocated a voucher plan...

The devil is in the details. Without more of them this is pretty meaningless. Massachusetts has a supposed "universal" system that's a joke, and little more than a handout to private insurers.

I'm not categorically opposed to the involvement of private plans (Germany does well by them) but it matters how they're handled.

Given Obama's handling of the banking crisis, I'm worried that this will either be cosmetic and/or a handout to private insurers. Is serial incompetent Larry Summers involved in this? If so, consider a move to Canada.

Well, this is going to be one hell of a fight.

Anyone who thinks this is going to pass with "bipartisan" support is out of their mind.

I'm glad, he's starting this now though.

But even in the heat of the campaign, Obama's advisers sought to quietly signal their candidate's openness to an individual mandate.

ahh yes, those Harry & Louise ads proved a fairly quiet signal.

Oh, great, so we get forced to buy health insurance that is unaffordable, like they do in Massachusetts, in order to get insurance and health care providers onboard? Quote from friend in Mass.: "If I wasn't rich I wouldn't be able to afford the insurance they are forcing me to buy."

So he's going to pass it on to Pelosi again, in the name of not "micromanaging".

Ezra, can you track down who the uninsured would be? If it's like Germany, where rich dudes opt out and self-insure, nobody is going to complain. If it's working folks, that's another story.

Watching a recent Frontline episode on universal health care, I was astounded at how many variations there are around the world among nations that provide universal coverage. We hear about the (legion) flaws in the UK's NHS, and little else -- as if that's the only alternative out there to our present, haphazard and horrendously expensive system here in the U.S.

Of particular interest was Germany's model -- individuals are required to sign up with private, non-profit insurance programs, and get to see private physicians of their choice. There are, I believe, about 200 of these non-profit insurers, who compete with each other for clients. The downside of the German model is that physicians are not very well paid, by U.S. standards.

Might something like this work here if (say) there were subsidies for medical education (reducing new physicians' educational debt) and for malpractice insurance and other costs that effectively demand very high compensation for practicing physicians?

Why doesn't 'universal' mean the same thing now to Obama as it did six months ago? 'Universal' access, not a mandate?

Jon Cohn at TNR wrote the other day "Obama has said--quite rightly--that it's also important to create a public insurance option into which anybody could enroll."

'Could enroll' is not MUST enroll. A public pool with no penalties for not joining is not a mandate.

And administration insiders then and now emphasized that the Obama campaign didn't start the mandate fight: They felt blindsided by the attacks and compelled to respond in kind. But it was a question of politics, not of principle. In principle, they were open to a mandate if they could be convinced that it was superior policy and superior politics.

Ezra, if this is they're explanation then it is discouraging. I'm glad they're coming around to mandates, but those campaign attacks were vicious and dealt from the bottom of the deck. To reverse himself, now, reveals something deeply cynical about Obama, that I frankly did not believe was there. It's one thing to fudge on lobbyists or some such but Health care?!

Andy - Ezra wrote a really good piece on various health systems across the world. Check it out.

http://www.prospect.org/cs/articles?article=the_health_of_nations

Here's a good way to achieve UHC coverage: (1) Require businesses and other employers to either cover their employees or help finance their health insurance. (2) Make insurance affordable by creating new tax credits, expanding Medicaid and SCHIP, reforming insurance laws, and taking innovative steps to contain health care costs. (3) Create regional "Health Care Markets" to let every American share the bargaining power to purchase an affordable, high-quality health plan, increase choices among insurance plans, and cut costs for businesses offering insurance. (4) Once these steps have been taken, requiring all American residents to get insurance.

"So this is a smart, serious proposal. It addresses both the problem of the uninsured and the waste and inefficiency of our fragmented insurance system. And every candidate should be pressed to come up with something comparable." Paul Krugman

just a thought...

to dry_fish: The so-called attacks were neither vicious nor dealth from the bottom of the deck as you claim. There were other Democratic proposals on the table that included mandates well before Obama put his version out; he chose--deliberately--to reject mandates and even tried to argue that his plan should be called "universal" without mandates. That he is now signaling a willingness to accept mandates of some kind puts him more in line with the mainstream of his party, and demonstrates not cynism but growth.

I am all for universal health care, but I don't see how mandates could work. Nearly all states mandate auto liability insurance, yet in some of those states the uninsured rate is nearly 40%. Aside from a single payer system supported completely by medicare taxes, I can't see how we can make a mandate work.

the keys to the whole issue....and why germany's plan works, are: 1) No op out....you can add as much additional coverage as you like but you cannot not be a participant in the govt plan. This spreads the health risks across everyone.
2) NON PROFIT health insurance providers. Germany has a number that compete for the public to select them as administrator of the govt plan.....this keeps competition and incentives in the program while it removes the bloated salaries and marketing expenses that make US health care costs (as opposed to the phony liability stuff the gop is always moaning about)

zyxw: Oh, great, so we get forced to buy health insurance that is unaffordable, like they do in Massachusetts, in order to get insurance and health care providers onboard?

Yeah, the Obama version of "free markets", where the government causes loads of money to be handed over to entrenched private interests. Kind of like their bank rescue.

to dry_fish: The so-called attacks were neither vicious nor dealth from the bottom of the deck as you claim.

they were based on fear-mongering; that's pretty bottom-of-the-deck

I am all for universal health care, but I don't see how mandates could work. Nearly all states mandate auto liability insurance, yet in some of those states the uninsured rate is nearly 40%

Michael Johnson- I agree.
Mandates only have meaning if there is some hazard to not following the mandate. In the case of automobile insurance, if you are uninsured and cause an accident, nobody is going to fix your car.
With medical care, an uninsured person is still going to get the care they need in an emergency. That's enough incentive for a lot of people not to pay into a plan.

The key question is not will there be a mandate, but will there be a public option that any American can buy into?

A Massachusetts-style system with a mandate to buy from private insurers is unacceptable. There must be a public option for private insurers to compete with.

I'm concerned about the implications of turning over the "hammering out of the details" to congress.

Per your understanding, does this mean that congress will determine which services are covered? Or are folks thinking that a Massachusetts style connector-board will determine those coverage details?

And also, do you think this implies increased likeliness of a public plan option? As in, MA.

Unfortunately, an individual 'mandate' is going to require a whole new regulatory and enforcement structure to determine what is considered 'affordable', how subsidies are adminstered, and how the 'mandate' will be enforced. I spent 20 years working in adminstration of federal means tested programs (which is essentially what this would be), and I can assure you that they present a never ending series of basically insoluble, not the least of which is defining what is going to count as 'income' to determine if someone receives a subsidy. A voucher system seems far superior - with a little luck, it might be possible to structure it so it is basically single payer with a fig leaf, and it would more or less enforce community rating if all participating insurerers were required to accept the vouchers.

They still don't get it. I will personally refuse a "mandate," unless single-payer universal insurance is involved, because the private health insurance system is a horrible JOKE.

This will not work, period. It's insane. There will be mass refusals. Anyone who has ever dealt with a recalcitrant private insurer knows what I'm talking about.

i've always had this question in the back of my head: don't care about the executives, but what is going to happen to all the "worker bees" at the individual health insurance companies, when the switch is flipped, and we go to the univeral health care model?

One comment isn't enough: THIS IS INSANE. You can't force people to buy something that DOESN'T WORK. Private, for-profit health insurance is a sick, evil joke.

They'd better go to single-payer universal supported by taxes, or there will be blood in the streets. So far everything I've heard will have me rooting for the idiot Republicans to save us.

Ezra, I'm surprised you didn't immediately challenge the quotes about how we couldn't have universal coverage without mandates -- because we certainly could have national health insurance via a single-payor plan (and I'm sure you know this). However, it doesn't have to be a program that looks like anyone else's single-payor plan, including Canada's: we can have and need our own version. For example, we could just fold Medicare and Medicaid enrollees into the Federal Employees Health Benefit Program, then add in everybody else and let progressives taxes (in place of the premiums we and employers are already paying) fund the cost. We don't need a whole new bureaucracy to do this and could eliminate two other federal programs (Medicare and Medicaid) in the process, thereby also lifting a financial burden from the states while reining in premium increases for everyone. For details on why the individual mandate is such a bad idea and illusory promise, see this morning's post on PoliticalEye (my blog) at: http://policywonksanon.blogspot.com/2009/02/health-insurance-is-big-deal-so-take.html

M. R. Traska
independent journalist and health policy analyst
Chicago, IL

Michael Johnson/Kaybeel

If the mandate is to be anything like the Massachusetts mandate (and as Ted Kennedy was in the meetings, safe to assume it will be), the mandate will be a case of either pay now, or have a chunk of your standard deduction taken away.

Michael Johnson/Kaybeel

If the mandate is to be anything like the Massachusetts mandate (and as Ted Kennedy was in the meetings, safe to assume it will be), the mandate will be a case of either pay now, or have a chunk of your standard deduction taken away.

Look out, Mr. Klein -- Hamsher's in full on Fatwa mode now. She's gonna be on Shuster this evening, telling all the world -- well, telling Shuster and her other adoring groupies -- that you're a hapless shill for the Obama administration.
http://firedoglake.com/2009/02/24/what-we-learned-about-the-future-of-social-security-at-the-fiscal-responsibility-summit/

On behalf of the 50 million give or take of us without health insurance (doesn't sound like that includes any of the commenting commentors) the real possiblity of universal health insurance is almost too unbearable to hope for. But for a moment, I allowed myself to actually consider it coming about and was overwhelmed with tears of relief. And I'm a freaking Ironman who normally doesn't do tears of relief.

I'm hoping part of the universal thing is directly connected to completely restructuring MedicAid (not Medicare) making it essentially a federal-only program in regard to eligibility, coverage and costs (as regionally determined). SCHIP should be folded into this package.

State variances in MedicAid (and the paltry fees they pay providers) make today's MedicAid a scandal written 50 different ways.

One way universal coverage is that if you haven't private insurance or opted-in to a purely public program (MediCare-like), then you are automatically enrolled in MedicAid (and billed for the amount it costs above a voucher price if your income exceeds a threshhold.)

Result:
Over 65 = MediCare (plus Medicaid if unable to function independently or can't afford MediCare Part B and Part D)
----
Under 65 = Private employer insurance

or, Public HI Option (MediCare A,B,D-like) paid by recipient or employer

or, MedicAid (as described above)

or, VA coverage, if eligible.

or, Fed Employees Health Benefit Plan (but extended to state/local employees), if eligible.
---
Choices and Universal Coverage should be the mantra.

1. Campaigning is not governing. Obama knows this. GWB never learned.
2. No one ever one a campaign primary by saying "Elect me because I like the other guy's (gal's)plan.
3. Plans and policy statements are not law.
4. Laws are written by the legislative branch.
5. Edward de Bono quotes:
"Argument is meant to reveal the truth, not to create it."
"If you never change your mind, why have one?"
6. Insurance is cheaper for everybody when everybody is in. Only healthy people voluntarily opt out - until they aren't.
7. Mandates require everyone to participate. Subsidies guarantee everyone can afford to.

ThomasEN-
Your standard deduction on your Federal taxes?
So the IRS will be used as an enforcer of the mandate?

I can't afford health insurance and I'm never eligible for subsidies because I fall into the category of people between the very poor and the reasonably off middle class. A lot of us NEED health insurance and I would have tears like Ackermann also if I really believed that Congress or the private insurance companies would ever set up a plan I could afford to buy into. As usual, I will probably be worse off than ever. I am a huge supporter of Obama and universal health insurance or even an incremental start-off plan. But somehow I know it will just mean I will somehow have to slice more dollars off my food and gas costs. God knows how I'll do it without another job.

If anyone in Obama admin is reading these comments, PLEASE offer a plan that is fair to the in-betweeners who always get screwed. Please DON'T let all the plans be determined at the discretion of private insurance companies who will always find a loophole to exclude me with 2 chronic conditions. (E.g., a plan I can afford that has pre-existing conditions that are now called something else and won't my two chronic for legislative purposes.) I'm hoping for something and expecting the same old worst.

Probably. In Massachusetts it's the Dept. of Revenue (sort of) doing the enforcement.

I would like to add that Switzerland has a system similar to Germany. Everybody is required to purchase health insurance and is fined if they do not enroll in a plan. The low income citizens/residents are covered by the state and it affordable as the pool is universal.

No matter what the mechanism used to mandate participation you SOMEHOW have to ensure that the HEALTHY pay into insurance, not just wait until they are sick and then join. That is what spreading the risk pool is all about. Thus a mandate is neccesary if you abolish the horribly inhumane pre-exisiting condition risk rating system.

Straight funding through taxes to fund the public plan would probably be best (with a tax deduction if you choose to buy on the private market). But risk rating must be banned as well or else people buy a cheapo private plan and pocket the deduction and then drop into the public plan if they get sick.

Jon Cohn at TNR wrote the other day "Obama has said--quite rightly--that it's also important to create a public insurance option into which anybody could enroll." This would quickly go bankrupt by getting all the sick and none of the healthy unless risk rating was banned and people were SOMEHOW enticed/forced into buying in when they start that first job, not just waiting 'till they are diagnosed with cancer.

Over 1/2 of my income goes to pay my health insurance. I am self-employed so yes, I get to write off the full amount as a deduction. But trying to come up with close to $14,000 a year just for medical care is a burden that's getting harder and harder to handle as I watch most of my work being outsourced to India. I know I sound like a cliche but I'm close to having to drop my insurance after always taking care of myself. I'm on a HIPPA plan which means I have no choices. I get one "choice" of one plan, that's it. I'm considered uninsurable. It's time that people with health problems not be considered just a drain on a corporations profits. I'm sick and I'm sick of all of it!

" . . . what is going to happen to all the 'worker bees' at the individual health insurance companies, when the switch is flipped, and we go to the univeral health care model?"

Same thing that happened to the blacksmiths and buggymakers in 1900-10. Not to be so flippant, though, these companies should be able to shift to other forms of insurance--life, fire, auto, etc.

Oh - WRT my post above. If the public plan was funded out of general revenues (and maybe employer contributions from those that don't provide insurance - whatever I am not financier!) it would make sense to also ENROLL people automatically to the public plan UNLESS they choose to opt out.

My instinct is that a majority of ordinary Americans would gratefully stick with the public plan and never give it a second thought (like they do in the UK for example - I know, bad comparison 8% GDP vs. 16%... but most people dont even hate the NHS enough to drop out of it, and we spend alot more!)

Of course the whole "tax increase to fund socialized medicine" thing is never gonna fly in the US so they are gonna have to do something far more complex, and probably less effective... but that is just real life :)

Ezra,

Great post, great reporting. A couple of thoughts:

-- I suspect a lot of the haggling around "universality" vs. "aim for universality" has to do with the fact that Massachusetts doesn't have a true universal mandate out of truly liberal concerns: everyone in the state doesn't have access to affordable coverage, specifically those around the subsidy threshold, so the state allowed an affordability exception to the mandate. As you know, there's a decent number of MA citizens that fall into that bucket, so 100% universality isn't achieved. I suspect Obama, Kennedy and other Democrats are looking for a similar clause in the federal plan, hence the "aim for" caveat-- in addition to the political cover that it provides Obama given his campaign position. Which gets to...

-- I feel pretty validated about my position on the mandates debate last year which was 1) As you wrote in your first post or two on the matter, this debate really was the first/best example that Obama's politics weren't as pure as he suggested and that was pretty much what you could reasonably conclude from this little issue. 2) Obama was playing the politics more effectively on this issue (which was HRC's supposed advantage with health care) as he had the better political position for the general election; a mandate could still happen in reality, Obama was open to it and that the whole hullabaloo on the topic was overheated rhetoric on pushing candidates to pass an artificial liberal purity test that didn't have any real meaning. Given what's seems to be transpiring, that sounds about right. And its why you should've stopped posting on mandates after post #2 or 3 on the topic.

-- Between Obama beating up HRC on mandates, and McCain on tax exemptions, it is amazing that he's considering both as core elements of his actual plan. Not exactly change that you can believe in, but I think it shows that Obama can play more political hardball that we all expected/fretted about during the campaign.

-- Much better job on the sourcing. I appreciate the work you do on reporting more nuanced elements than you can read from the MSM. Keep it up.

Oh - sorry... of course NHS you cant exactly "drop out" but you can buy private health insurance (BUPA)

All the questions here are a great demonstration of why President Obama is happy to let Congress work out the details.
I don't think for one second it is a fear of micromanaging.

The plan is going to look fairly like the MA one but with a bigger expanded medicare component. In the long term this is going to squeeze private insurers as the right know only too well which is why they continue t rail against it. Basically mandate means what it says... you're going to have to have health insurance just like car insurance either employer provided or purchased from a private or public (ie. Medicare) plan. It's not single payer but it's a huge step forward and within 10 years gravity will have substantially made it one.

"Same thing that happened to the blacksmiths and buggymakers in 1900-10. Not to be so flippant, though, these companies should be able to shift to other forms of insurance--life, fire, auto, etc."

Not really that's one of the major reasons why it's not going to be a turnkey. Private insurance will shrink as it is squeezed by the govt plan.....it's the best way......no sudden shocks.......with attrition society adjusts naturally to the new system which will have some downsides for the totally starry eyed. Nevertheless it will be great progress

If the plan were any good, a mandate would not be necessary. People would wait in line to sign up.

Since it appears that a mandate IS necessary, rest assured that we will remain with the worst healthcare system in the developed world.

"Same thing that happened to the blacksmiths and buggymakers in 1900-10. Not to be so flippant, though, these companies should be able to shift to other forms of insurance--life, fire, auto, etc."

Not really that's one of the major reasons why it's not going to be a turnkey. Private insurance will shrink as it is squeezed by the govt plan.....it's the best way......no sudden shocks.......with attrition society adjusts naturally to the new system which will have some downsides for the totally starry eyed. Nevertheless it will be great progress

YES! I have always supported President Obama, but have wished he'd support universal health care. So I am very pleased to hear this news.

Everybody in the pool. Opt out if you like or can afford double digit increases every year to supply bonuses to people simply doing their job. No more 5oo million dollar men (McGuire)putting employers needs after their bonuses. Their naked greed has now killed the goose. Regulate, investigate and prosecute the thieves. People now are being forced to choose between gasoline to get to their jobs before they're shipped overseas and food in order to pay these bandits. Health care is a right not a luxury, and yes Bob Dole, there are that many sick people because they can't afford to get well so they just get sicker.

We certainly do not need another mandated program to make sure that health care costs rise while quality falls. How does Obama plan to pay for this other than raising taxes still farther than he's already proposed this week?

We rank near the top in health care costs for developed nations, but we also rank 1st in performance.

Compare to our eduction system, where we rank 1st in costs and 40th in performance.

Then ask yourselves if you want the same type of mandates placed on education to be placed on the health care system as well.

"If the plan were any good, a mandate would not be necessary".

No matter how good the plan is why not just wait to be diagnosed and THEN buy insurance from the public plan "which anyone can buy into"?

I guess there is the specter of a big emergency room bill or something, but without a mandate you just don't get enough of the healthy subsidizing the unlucky people who get REALLY sick (i.e. "insurance")

"health care costs rise while quality falls. How does Obama plan to pay for this other than raising taxes still farther than he's already proposed this week?"

If you look at the stuff coming from Orzag's office (i.e. from the Whitehouse) about how healthcare reform IS entitlement reform and key to our future fiscal solvency as a nation the WH clearly KNOWS this...

Of course what they plan to do about it, and whether they can get it done even if the have a plan, is anyone's guess.

Bill: We rank near the top in health care costs

Not near the top, at the top, and by a big margin (about 50% more per capita than any other country).

we also rank 1st in performance.

Not by a long shot - we're #37, between Costa Rica and Slovenia

I love how the Obama team is willing to change their views and policies based on new information and reasoned discussion. Just wait for the GOP to start calling him a flip-flopper and hypocrite. I bet Obama will have a good comeback for that nonsense.

Here's the punchline. "You can't win." Recently, Obama was commenting that with all of the tax cuts, he was hoping to meet the GOP "halfway", and in the end he'd not left any room for negotiation. When asked what "lessons" he'd learned, he commented that next time he'd likely lean towards giving them something to take away as a victory. Welcome to round two people. "Aim for" is a very important phrase. Clinton clearly had it right, in that "Universality" needs to be the "aim", even if you ultimately don't get there. Obama clearly had it right in so much as the ending compromise that will be accomplished.

Worth a Dean scream or two. Hang in there Marley, help is [we hope!] on the way.

6. Insurance is cheaper for everybody when everybody is in. Only healthy people voluntarily opt out - until they aren't.

What percentage of uninsured people have voluntarily opted out? Does someone have the percentages of healthy vs unhealthy currently uninsured people? And among that population, what percentage of those people can not afford insurance?
Because insurance is not cheaper if everyone is in the pool. It is cheaper if there are more healthy people in the pool, and those people pay their premiums.
It is more expensive if more unhealthy people are in the pool, or if more in the pool need to be subsidized.

7. Mandates require everyone to participate. Subsidies guarantee everyone can afford to.

Who pays the subsidies?
This money is going to come from somewhere.

New York state offers several subsizided health insurance plans that have been getting a great deal of attention (healthy NY, Child health plus, family health plus). almost all of the plans require that you fall within an income bracket lower income. All day we receive phone calls from people that are self employed indicating they just cannot afford their plan. unfortunately, those programs that are state subsidized arent available to anyone who has had insurance within the last 12 months (some exceptions). you would be hard pressed to find a good health plan in NYC under 300 per month for an individual( www.nyhealthinsurer.com )

Give me Universal Health Care or give me death!

Hillary was always right about this. If she had opposed the war when it was unpopular to do so, she would be president now.

Between Obama beating up HRC on mandates, and McCain on tax exemptions, it is amazing that he's considering both as core elements of his actual plan. Not exactly change that you can believe in, but I think it shows that Obama can play more political hardball that we all expected/fretted about during the campaign.

whew! it sure is a good thing, then, that we believed and/or discounted his lies as we should also do now by this logic...thanks!

What, Obama is no longer relying on the sage policy advice of the student editorialists at The Daily Iowan (prominently cited in his ads against mandates)? He'll never win the 2012 caucus at this rate! It's all over...

Who pays the subsidies?

The taxpayer does, through federal taxes, and the government gives DIRECT subsidies straight to the insurance companies to cover those on the lower end of the income scale.

You won't be buying into an already-established program. You'll be buying into a very skeleton policy written by the Congress with the help of insurance companies and lobbyists, and you'll help pay, in taxes, for those who can't afford it.

Who pays the subsidies?

YOU do, as a taxpayer, in addition to the cost of your own enrollment.

6. Insurance is cheaper for everybody when everybody is in. Only healthy people voluntarily opt out - until they aren't.

. . .Insurance is not cheaper if everyone is in the pool. It is cheaper if there are more healthy people in the pool, and those people pay their premiums.
It is more expensive if more unhealthy people are in the pool, or if more in the pool need to be subsidized.

I agree that the cost of insurance can go up as the pool’s health decreases, but this is not a given:
- The larger the pool, the more leverage to negotiate price reductions.
-With access to affordable health care, more problems are treated sooner, avoiding costly emergency room procedures. E.g. diabetes testing, monitoring and life changes are a lot cheaper than amputations from complications.
- With universal coverage, there needs to be a prohibition on exclusions for pre-existing conditions and a prohibition on cherry-picking the pool, or a need to tax private insurers enough to cover those who are excluded.

7. Mandates require everyone to participate. Subsidies guarantee everyone can afford to.

Who pays the subsidies?
This money is going to come from somewhere.

- A huge part of our health care costs go to insurance companies to pay for exclusion of coverage, both by person and by treatment, and to shareholders as profit.
- Medicare and the VA are substantially more efficient and spend much less money on administrative costs. For all the right-wing bashing of Medicare, and the right-wing decimation of the VA, Medicare is wildly popular among recipients, and either are a helluva lot better than nothing.
- With universal coverage, incentives could be put in place to focus on treatment, rather than procedures.

In short, a better health care system that covers everybody has the potential for substantial savings, due to better, earlier treatment, economies of scale, removal of private profit (eventually), removal of costs incurred due to administrative exclusions of coverage. If done correctly, the costs for everybody should be affordable for everybody, when everybody is paying in through employment and/or progressive taxation. At least, every other civilized country in the world is able to afford it.

Doesn’t even need to be that complicated. John Conyers introduced H.R. 676 on January 26th. Universal Healthcare in about 3 pages. It even makes special provisions for those “blacksmiths and lamp-lighers” who work for private insurance companies.
http://www.thomas.gov/cgi-bin/query/z?c110:H.R.676:

Obama's plan gives access to health INSURANCE, but not necessarily healthcare.

That skeleton plan written by Congress and its lobbyists?

Read the fine print to find out what it WON'T cover.

You'll be looking for an additional, higher-priced, supplemental. And that's exactly why the insurance companies and their lobbyists have been taking part in Kennedy's "secret" planning meetings.

This is not single-payer, universal healthcare, folks.

Read Tom Daschle's book. It's all there.

Americans need health care -- not health care insurance.

By allowing private insurance companies to skim the profits off the top by refusing to honor claims and refusing to enroll those with previous conditions, they increase their profits.

Medicare works fine for the elderly and the disabled, it would work equally well for all of us.

The way to get universal health care is by eliminating the private insurance companies all the people, while allowing the rich to buy extra coverage from private insurers to cover their special needs.

Health insurers do nothing productive for our society, except charge too much and pay for too little. They must be removed from our health care policy altogether.

Private health insurers must be eliminated from our health care policy.

The insurance companies provide nothing of value to consumers, but merely rake in huge profits while denying claims and refusing coverage to those who need it.

Medicare serves our elderly and disabled population extremely efficiently. It should be expanded and extended to all citizens.

Medicare's administrative costs are far, far lower than those of insurance companies.

Mandating that we purchase private insurance is just another subsidy for the insurance company crooks.

Go to a single payer system. The "insurance" is socialized, but the care (the doctors, hospitals, clinics) can remain private.

"What do you think about automatic enrollment as a way for the government to basically cover everyone without the specter of a mandate that forces people to buy coverage?"

During the primaries, Obama's advisor Austan Goolsbee said this was the approach Obama favored. The automatic enrollment with an opt-out option would achieve the same number of people enrolled without incurring a massive backlash as happened under Clinton's proposal.

-With access to affordable health care, more problems are treated sooner, avoiding costly emergency room procedures. E.g. diabetes testing, monitoring and life changes are a lot cheaper than amputations from complications.

I'll believe this when I see it. My personal observation is adults put off going to doctors when they think something scary is happening. They don't want to be told that wound is diabetes. They don't want to be told to lose weight or to stop drinking or smoking. So they don't go and let things fester.

Medicare serves our elderly and disabled population extremely efficiently. It should be expanded and extended to all citizens.

Medicare is currently paid for by all citizens, even though the recipients are limited. Therefore, those that use it perceive it as being an inexpensive option. And it is-- to them! Expanding it will increase the number of recipients, and will require increased payment in.
The costs of Medicare are rising along with the costs of health care in general.
Obama said just yesterday the expense of it is part of our fiscal crisis.

Medicare may work "equally well" for all of us, but it is certainly not the key to reducing costs.

Look-

I am almost 60 years old and employed at a very good job, and in the past three years, my medical bills have amounted to well over $400,000 dollars (don't ask). My share? $1,300.

I think that those respondents who question universal health care must be young and fit and single; that was me thirty years ago (no health insurance; thought I would live forever).

I can honestly say that if my taxes were raised to cover all of my brothers and sisters who need quality health care and don't have it, I would gladly pay it. There but for the grace of God, go I...

The US is the only industrial nation in which universal health care is not a given (South Africa was the last to come into the fold). Clearly, it is a matrer of profit over people, greed over good, hubrus over health. Let's stop the madness.

- Steven

I can honestly say that if my taxes were raised to cover all of my brothers and sisters who need quality health care and don't have it, I would gladly pay it. There but for the grace of God, go I...

I'm sorry, but that's obvious hyperbole. You wouldn't gladly do it, because you have the option to pay for their insurance now. If it is something you would gladly do, you wouldn't need a government mandate.
Now, maybe it is something you can't afford to do. I understand that. That's the whole argument.
I agree the system is broken, but as long as we're going to go about fixing it, let's not pretend there isn't a big black hole where "reducing health care costs" and "making health care affordable" go.

As a participant in the "mandate wars" from a different angle than wisewon, I have to say that I feel vindicated as well. On the merits, those of us who promoted mandates were right, and the arguments that said this would create requirements that individuals couldn't afford were full of sh_t.

And many of us who engaged that debate did so because we wanted to do whatever we could to ensure that mandates remained on the agenda. Obama heard us (collectively). On numerous occasions, many of us also said that we believed Obama and his team didn't believe their own rhetoric, and Congress would lead the legislative process and would want to bring a UHC bill with mandates to pass. I know I did, and I'm pretty sure Ezra did as well.

As for the folks who, insanely, think that no system with private insurers could work, there is conclusive refutation of your belief in the real and successful systems in The Netherlands, Germany, and Switzerland, and to some degree dozens of other countries.

Erm, better I can haz single-payer! (?)

jd: As for the folks who, insanely, think that no system with private insurers could work, there is conclusive refutation of your belief in the real and successful systems in The Netherlands, Germany, and Switzerland, and to some degree dozens of other countries.

Of course in Germany (and probably most of the other countries) a "private insurer" is very different from what they are here in the US. They're not-for-profit, forbidden from cherry picking, and strictly regulated in terms of what they must provide.

Contrast that with the US style of pay the CEO $X00M/yr, avoid anyone who might actually need medical care, and screw patients as much as possible to increase profits.

Calling both of the "private insurers" is highly misleading. I like the German model, but am very skeptical that our bought-and-paid-for government will regulate the "private insurers" anywhere as much as is needed. Look at Medicare Part D - it was basically a fatten the private insurers and drug companies bill. It's main sponsor in the house left shortly after its passage to take a $2M/yr job with the good buddies he'd just helped.

Do you really think future involvement of the private insurers will be different? And if so, why?

The least expensive and most universally humane method of funding health care is single payer. We in the U.S. are the laughingstock of other industrialized countries where no one goes bankrupt because of medical bills and where doctors, not insurance companies, make health decisions with their patients. Elsewhere in the world, everyone pays federal health care tax and they get quality health care with no further payments. We are told how horrible medicare-like financing is when, in truth, experience here and abroad demonstrates that it takes far less money from pockets than does our current disastrous private insurance and job-based mess. Obama and the congress should fund health care through a single 300 million person risk pool. we need to stop sacrificing millions of Americans on altar of insurance companies. Single payer and a health care trust now.
Watch PBS Frontline Sick Around the World
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Obama heard us (collectively).

jd,

There was nothing to "hear"-- he likely already agreed in principle (which you seem believe as well) which was why the whole debate was pointless. He chose a more politically expedient position (no mandates) for his campaign, Hillary saw an opening to win on the substance of mandates and tried to score points. Ezra and others got caught up in something that was pure political bloodsport, with no real substantive difference between the two. Obama said he was open to mandates during this debate and is now actually receptive to them in a mere 30 days into his presidency. There was never a difference-- that was the point.

(And as an aside-- on the merits, whether mandates are 1) politically viable 2) have affordability issues-- that's still TBD, as no legislation has been offered or passed. Given that Massachusetts has an affordability exclusion, i.e. no mandates for everyone, and the Federal Gov't will likely have the same, I have a hard time seeing how you're vindicated on the substance, particularly on the affordability point. At minimum, you need more than indications that Obama is receptive to them. Its a little premature for you to feel vindicated.)

There is a SOLUTION TO THE HEALTHCARE MESS that has been caused by the for-profit insurance companies, the pharmaceutical companies, and their lobbyists. The solution? NON-PROFIT, SINGLE-PAYER HEALTHCARE. It works well in many, many countries around the world.

Congressman John Conyers has introduced HR 676, THE UNITED STATES NATIONAL HEALTH INSURANCE ACT, to ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services. Only a single-payer approach will end the current disgraceful practice of insurance companies refusing to pay for medical treatment, denying claims, and engaging in rampant price gouging that discourages patients from going to the doctor, and has resulted in 50 million Americans without healthcare.

For more information on The National Health Insurance Bill (HR 676):
http://www.pnhp.org/publications/the_national_health_insurance_bill_hr_676.php

Health insurance companies play a major role in our current healthcare crisis. These companies make huge profits and their CEOs make millions, while the rest of us face skyrocketing healthcare costs, impossible bureaucracy, and life-diminishing insurance denials.

HEALTH INSURANCE COMPANY PROFITS IN 2007:
1. UnitedHealth Group -- $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company
2. WellPoint -- $ 3.345 BILLION. Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others
3. Aetna Inc. -- $ 1.831 BILLION
4. CIGNA Corp -- $ 1.115 BILLION
5. Humana Inc. -- $ 834 million
6. Coventry Health Care -- $626 million. Coventry owns Altius, Carelink, Group Health Plan, HealthAmerica, OmniCare, WellPath, others
7. Health Net -- $ 194 million

The huge insurance company profits—BILLIONS EACH YEAR—could provide quality healthcare for millions of people, and to pay physicians adequately for their work.

We need to get the insurance companies OUT of healthcare . The only solution is a NON-PROFIT SINGLE-PAYER HEALTHCARE SYSTEM – and the single payer should not be an insurance company or a group of insurance companies.

The solution? The United States National Health Insurance Act, H.R. 676. You can read about it here: http://www.healthcare-now.org/hr-676/

Martin Luther King said, "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane."

Congressman John Conyers has introduced HR 676, The United States National Health Insurance Act, to ensure that every American, regardless of income, employment status, or race, has access to quality, affordable health care services.
To end the inhumanity of our failed healthcare insurance system, where profits are more important than patients’ health, ask your Representatives to support John Conyer's HR 676 Bill.

HEALTHCARE SHOULD BE A RIGHT, NOT A BUSINESS.

For more information on HR 676, see:
http://www.pnhp.org/publications/the_national_health_insurance_bill_hr_676.php

WHO’S LOOKING AT THE COMPENSATION OF THE HEALTHCARE INSURANCE EXECUTIVES?

The health insurance companies have played a major role in our current healthcare crisis. They make huge profits and their CEOs make millions, while the rest of us are denied care.

ANNUAL COMPENSATION OF HEALTH INSURANCE COMPANY EXECUTIVES (2006 and 2007 figures):

• Ronald A. Williams, Chair/ CEO, Aetna Inc., $23,045,834
• H. Edward Hanway, Chair/ CEO, Cigna Corp, $30.16 million
• David B. Snow, Jr, Chair/ CEO, Medco Health, $21.76 million
• Michael B. MCallister, CEO, Humana Inc, $20.06 million
• Stephen J. Hemsley, CEO, UnitedHealth Group, $13,164,529
• Angela F. Braly, President/ CEO, Wellpoint, $9,094,771
• Dale B. Wolf, CEO, Coventry Health Care, $20.86 million
• Jay M. Gellert, President/ CEO, Health Net, $16.65 million
• William C. Van Faasen, Chairman, Blue Cross Blue Shield of Massachusetts, $3 million plus $16.4 million in retirement benefits
• Charlie Baker, President/ CEO, Harvard Pilgrim Health Care, $1.5 million
• James Roosevelt, Jr., CEO, Tufts Associated Health Plans, $1.3 million
• Cleve L. Killingsworth, President/CEO Blue Cross Blue Shield of Massachusetts, $3.6 million
• Raymond McCaskey, CEO, Health Care Service Corp (Blue Cross Blue Shield), $10.3 million
• Daniel P. McCartney, CEO, Healthcare Services Group, Inc, $ 1,061,513
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751
• Daniel Loepp, CEO, Blue Cross Blue Shield of Michigan, $1,657,555
• Todd S. Farha, CEO, WellCare Health Plans, $5,270,825
• Michael F. Neidorff, CEO, Centene Corp, $8,750,751

This executive compensation could be used to provide quality healthcare for millions of Americans! We need to get the insurance companies and their lobbyists OUT of healthcare. NON-PROFIT, SINGLE-PAYER IS THE ONLY OPTION.

If you want to learn more, go to:
http://www.insurancecompanyrules.org/learn_more/the_roster/

Who mobilized all the single payer people? It's a noble sentiment but something akin to slave reparations or giving the Native Americans back half of the US; A well-intentioned if utterly unworkable idea. Maybe 10 years after the patchwork connector is in place we'll be able to have the single payer conversation.

(feels like there must be some way to pull together a Beyonce, 'All the Single Payers' joke but he can't quite get it)

Thanks to Justina, Taneisha, and Transparency for their comments.

The Conyers single payer bill HR 676 is "fired up ready to go" in Congress.

Harvard researchers and Mass physicians know the mandate system is all smoke and mirrors. On Capitol Hill today (feb 25), Congressman Eric Massa chaired a Congressional Forum: "National Lessons from the Massachusetts Health Reform."

The truth is not pretty. Costs are rising and the insurers are still in the game. You may watch the webcast of this Forum on the pnhp.org web site:

http://www.pnhp.org/news/2009/february/national_lessons_fro.php

or at Healthcare-NOW.org

Get the facts.
Nonprofit, universal single payer will save trillions, and create health care delivery jobs.

Having just read the ThomasEN comment, I simply must respond.

Since every other free market democracy in the industrialized world has some form of single payer system, I think the health care joke might be on us.

How can the American consumer be so dumb--paying twice as much getting so little for our health care dollar, pouring trillions down the HMO rabbit hole?

God, what do many of you NOT want the government to do? I mean, do you really think the Federal Government is going to be able to efficiently control YOUR healthcare? NO! I can't believe how pathetic this country has become. The reason health care costs are so expensive now (as compared to say even the 60s, when health care was affordable for everyone) is, you guess it! Government Intervention (http://www.businessweek.com/magazine/content/06_33/b3997089.htm). Our Federal Government has become a gigantic spending blob. Both Dembots and Repugs want to control every facet of our lives, and so many of you are just sitting back and letting it happen. It's been a sad 20 years in this country, slowly seeing a lack of motivation, personal responsibility and just simple pride to achieve something with your life. Instead, we've bred two generations of lazy, entitlement-minded, whiners.

Save the country. Vote Libertarian.

Wisewon, if you are still reading despite the single payer spam:

When I said that Obama heard the mandate folks, I didn't mean that they changed his mind about whether they could work. I meant that they let him know that there was actually a strong level of support for mandates among the Democratic base as well as the policy folks on the center-left. That was not an obvious thing as recently as 1 year ago. You might argue it is not obvious today.

As for the bloodsport: you call it bloodsport, I call it making a principled stand for intellectual honesty. It was a bit of both, I think.

It does remain to be seen how affordability plays out, but we need to be clear about something: whether or not a multi-payer mandate system is affordable, either for the lower middle class specifically or the nation as a whole, is not a matter of what can be done as a matter of policy, but what can be done as a matter of politics.

It's about political will, not whether a system can be devised. What drove me nuts about the Obama folks is that they kept insinuating that there was some kind of fundamental or in-principle problem with affordability. The true-believer Obamanauts took up this line in debate and acted as though you must be crazy to have a mandate (even though plenty of other nations do it and it works fine).

But there is one part of that debate where I was probably wrong. I believed the Obama team's dissing of mandates would hurt the prospects universal health care legislation. I was on the same page with Krugman on that. Maybe we would have been right if this giant recession didn't happen, but it did, and right now it looks like we were wrong on that point.

jd,

All fair points, I'm mostly responding to let you know I read it...

On the bloodspot vs. intellectual honesty point-- this was and should have been a two or three day issue. In the grand scheme of things, relative to the type of mandate that could feasibly be passed, I don't think there is a huge difference in covered lives between Obama and HRC's plans. Obama wouldn't have required everyone to have insurance, HRC's would have ended up excluding those around the subsidy line. This issue was a legitimate one to discuss for a couple of days-- not months. In the grand scheme of things, the intellectually honest points about health care reform weren't said at the time-- blame on insurance companies and drug companies, and a focus on mandates. That's hardly an overall accurate picture of needed health reform-- by either side. This overheated rhetoric on this one issue then ended up overly serving as the debate on health care, which wasn't intellectually honest. There was a lot more to discuss, but wasn't. That's why it was bloodsport after the first two days of the debate. Same for Ezra, he's written more on that one topic than anything else in health care reform. Is that really the right balance? People got carried away...

PS On what you may be wrong-- I'd wait. Republicans will undoubtedly use Obama's own language against him in the imopending fight, and I suspect the MSM will make it tough for him to switch positions so easily. You still may be right on that one...

My mom is from England and we have family still living there. Universal health care DOES NOT work. Watch and see---it will be another debt that americans can not afford driving us into deeper recession. Stop the spending!!!

wisewon,

One last point, since this thread is now in the archives and a pain to find:

I do think this deserved more than a couple of days discussion. It is unfortunate that the fight at the time was between Obama and Clinton (and by implication Kennedy, Edwards, etc.). The fight over mandates was well worth having because given that we are going to get a multi-payer system, mandates are necessary for universal coverage. If the fight had been with the Republicans, it would have been a big part of the fight over universal health care itself. Probably still will be.

And no matter how long it dragged on, I still participated because I firmly believed I was right on the merits, and felt betrayed by the Obama team (not quite the right word, but you know what I mean). I love the guy. I really do. But that was an unacceptable position, and I didn't think he really meant it...it just grated and seemed unnecessary and counterproductive.

Whether it actually will have the impact I feared, we will soon see.

Here's the private insurers' contribution to health care: 1. The insurance industry consumes 31% of every health care dollar (necessitating a billing clerk for every bed at Duke Hospital according to a doctor there, compared to two billing clerks at Canadian hospitals) . 2. Inadequate coverage for millions of people because of exclusions and exorbitant co-pays and deductibles. 3. An insurance industry that (a) cherry picks the healthiest among us and dumps the cost of caring for the rest on federal, state and local governments and state managed high risk pools (thereby privatizing the profits from insuring the healthy and socializing the costs of caring for the sicker among us); (b) uses amorphous and ambiguous terms like "medically necessary" and "experimental" in order to deny claims even though the patients" doctors think otherwise; (c) seeks any way possible to deny coverage when a large claim arises (for example, a woman was denied coverage when she needed surgery because she failed to disclose a yeast infection when she applied for the policy years earlier); and (d) in unregulated states like Texas, raises rates often and precipitously to drive out people as they get older and their risk of getting sick increases. The government can manage a risk pool for everyone more efficiently than hundreds or thousands of private insurance plans?

Paul above: "do you really think the Federal Government is going to be able to efficiently control YOUR healthcare?"

I don't want the government to "control" my health care, Mr. Lib. I want it to manage a risk pool that includes all of us.

"The French can see any doctor or specialist they want, at any time they want, as many times as they want, no referrals or permissions needed. The French hospital system is similarly open. About 65 percent of the nation's hospital beds are public, but individuals can seek care at any hospital they want, public or private, and receive the same reimbursement rate no matter its status. Given all this, the French utilize more care than Americans do, averaging six physician visits a year to our 2.8, and they spend more time in the hospital as well. Yet they still manage to spend half per capita than we do, largely due to lower prices and a focus on preventive care."

If that is "government control," sign me up.

If health insurance is a good deal, people will buy it. You don't need a law to mandate it. How is it 'the government covering everyone'??? George Orwell would be impressed since I'd be covering MYSELF if forced to buy insurance with my own money yet the gov't would take credit for covering everyone!!! Not on your life. I'll never buy insurance by force...only if it's a fair deal. Fine me, put me in jail, whatever you want....it's never going to happen.

My Dear Ezra,

I’m heartsick. Did you get this material off of JournoList? Deep in the bowels of this site a cesspool of plagiarism is going on with it seems every faux bona fide journalist I’ve read in the last 5 years uses?

Care to elaborate here since I have wasted oh maybe two solid months of my life reading your now journalistic fodder? You had us all on the edge of our seats waiting for your next word to pop-up on the monitor only to find out it came from a gaggle of faux very well known journalists in a group think? This little journalistic tea party on the web is going to be nuked and folks will be named;

I know, I know, I don’t know who I’m messing with…..yeah right now get in line Klein and stop wasting my time.

This comes as no surprise to those who have had their eyes and ears open. Obama's whole campaign was a "bait and switch" operation presented by a slick huckster. Get ready America - Like it or not it's coming.

Beware the Bursting of the Health Care Bubble. Health Care in the USA uses /consumes some 17% of the Domestic National Product, something like $ 2.6 Trillion per year. Its growth has been at 2-5 X the rate of inflation almost every year for 30 years. Many high-income executives in health care, say, “So what”? “We earned our income”. The problem is that much of the $2.6 Trillion does not provide the medical value needed by our people. At least $400 BIllion annually is spent on unnecessary administration, competitive marketing and advertising, lobbying, large incomes, including bonuses, for CEOs and executive staff who run for-profit organizations (and many not-for-profits ) plus profits for shareholders. http://pfx.me/B4

Hopefully, Barack Obama will deliver on health care.
_______________
SCANDAL! SCANDAL! SCANDAL!

EMERGENCY! EMERGENCY! EMERGENCY!

George W. Bush continuously criminally stalked Margie Schoedinger to the point that she could not get away from it, and she committed suicide in desperation to escape: he murdered her.

“In her suit, Margie Schoedinger states that George W. Bush committed sexual crimes against her, organized harassment and moral pressure on her, her family members and close relatives and friends. As Schoedinger said, she was strongly recommended to keep her mouth shut. . . . Furthermore, she alleges that George Bush ordered to show pressure on her to the point, when she commits suicide” (blog of drizzten).

“One of those ‘very leasts’ [was] George Bush’s personal complicity in the death (murder to be precise) of my friend Margie Schoedinger in September of 2003. Determining the exact whereabouts and contacts of [then] president-elect George Bush on September 21 thru 22, 2003, should be entirely lacking in difficulty” (Leola McConnell—Nevada Progressive Democratic Candidate for U.S. Senate in 2010).

Leola McConnell is correct: Bush applying pressure (continuously criminally stalking Margie Schoedinger) purposefully to force Schoedinger to commit suicide does in fact constitute murder where it culminated in her death.

Bush is a racist hate criminal and hates black people (please feel free to see my “GEORGE W. BUSH IS THE WORST PRESIDENT IN U.S. HISTORY” blog). (Schoedinger was an African-American woman.)

BEWARE: If the president of the United States hates one—for whatever reasons—he can continuously criminally stalk one to the point that one cannot get away from it, and one ultimately commits suicide in desperation to escape. He can murder people in this way.

Bush is getting away with his murder of Schoedinger—with no sheriff, prosecutor, or court willing to uphold the rule of law.

Bush’s method of murdering Schoedinger cannot exist in a vacuum: he must have murdered other people in the same way.

Bush should confess, come out with the names of all of the people whom he murdered in the disgusting way he murdered Schoedinger, undergo execution, and accordingly find himself at the intersection where he would be free.

(There are thousands of copies of the information above on the Internet. It exists very extensively in all major search engines. Please feel free to go to any major search engine, type “George W. Bush continuously criminally stalked Margie Schoedinger to the point that she could not get away from it, and she committed suicide in desperation to escape: he murdered her” or “Bush applying pressure (continuously criminally stalking Margie Schoedinger) purposefully to force Schoedinger to commit suicide does in fact constitute murder where it culminated in her death,” hit “Enter,” and find innumerable results.)
_______________
Andrew Y. Wang
(a.k.a. “THE DISSEMINATING MACHINE”)
B.S., Summa Cum Laude, 1996
Messiah College, Grantham, PA
Lower Merion High School, Ardmore, PA, 1993

The mandate will in fact be an ENORMOUS tax on the lower and middle class.

Oops. Promise broken.

And I voted and believed in him!

Thanks for you post,It's useful to me

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