Thanks Emma. Nailed it!

Medicare is the only game in town for the elderly, so they have nothing to compare it to. It does work for them, but it's also broke and will need a massive infusion of revenue to keep it solvent. Adding younger people to the plan would be a disaster, until you get it stabilized for the looming Boomer surge.

I should add that Medicare is subsidized by private insurance at about .05 to .06 for every Medicare dollar billed. Take away the private plans, and who will make up that difference? Ask any doctor, and they will tell you they cap their Medicare patients in order to keep their clinics open.

No, I am not talking about Medicare Part B or Part D. Medicare patients are a money loser for hospitals and MD's, so they make up the difference by charging younger patients with private insurance more money for the same procedures. This is the reason MD's cap their Medicare patients. Scrapping the private system would ultimately weaken the program.

Medicare for all is a very easy thing to say -- but in reality is totally impractical. We need a frank and honest discussion in this nation about what we want and what we are able to afford. You would win more converts to your argument, if you had the #'s to show us how it could be done in the current fiscal climate. Opening a bankrupt program up to more Americans is not a credible solution.

Clearthinker gets it right. This person is neither intelligent nor well educated. Let's stop suffering these fools so gently.

It's impractical, because as I'll say AGAIN -- Medicare is paying out more than it is taking in today. It's underfunded for retired Americans, which means there is no money to add more to the plan.

It's too late to talk about what we should have done 50 years ago. We have to work with what we've got, and Medicare is broke.

Only 5% of patients under 65 have medical bills > 30K in any given year. The problem is these people can be very sick and run up bills in the 7 figure range. Okay, so insurance actuaries have to allow for that 1 in 5000 person that is going to need an organ transplant, and those people mean you pay much higher premiums.

Now, the obvious solution to this problem is to have the government set up a re-insurance agency -- something similar to federal flood insurance. This agency would pick up at the 30K mark in a given year and pay 50% of the bills for that patient -- basically cutting risk for insurance companies in half. Any private company working with this agency would be required to scrap pre-ex clauses in their plans.

This solution would drop insurance premiums overnight, saving companies literally billions in costs. It would also cover everyone, and it would eliminate the nefarious cost-shifting that hospitals have been getting away with for years.

It's far more practical than Obamacare, because it doesn't require a massive government intervention, and keeps health care from becoming the political football it has now become.

If I understand you correctly, you want the government to take the risk and let the private sector profit from it? Sort of like what Fannie Mae and Freddie Mac did for the mortgage industry.

See. I got no problems with GSEs. I just think if we, the people, are going to take the risks we should get our share of the profits. And if private enterprises are going to profit from public funds, they damn sure better provide added value to a product/service.

And for the record, my bank account cannot tell the difference between a check for my insurance premium and a tax payment. The balance goes down with both.

The problem, I'm afraid, is that the curve is increasingly skewed left in the US. I don't know quite why that is, but watching the news down there leaves me quite depressed. Americans seem increasingly--and almostly willfully--stupid right now. I don't know what to do about it, but tolerating ignorance and idiocy no longer seems like an acceptable answer to me. The dumb are too abundant, too vocal . . .and too well armed . . . for me to think anything good will come from suffering them lightly.

Purple, France and Germany pay a hefty price for their public health care by punishing employers with huge taxes. For this reason, both countries have suffered from chronic double-digit unemployment, even during the 90's when the world economy was booming. That level of unemployment is unacceptable in America. Both these countries also enjoy a hefty trade surplus, which provides them with additional tax revenues on foreign capital. We have a trade deficit.

Germany holds down costs by controlling the salaries of their doctors to about 80K for a regular MD. How many doctors would work for that here?

There is no free lunch. Somebody has to pay the bill. Yes, Germany and France have great health care, but there are plenty of nations like Greece, Poland, and even Ireland where the public system does not work all that well, and you don't want to get sick there.

Public education in this country is still very good and was outstanding when we weren't trying to run it on the cheap. It can be again and most of the public universities still are. So yeah if health care were provided to Americans in the same way that education is, for most people this would be an improvement.

Compare the Medicare results (even granting your indirect subsidy) with the health care chaos of those who have not yet reached that age.

Do you really think that it is okay to provide substandard care to a baby if the parents are unemployed? That is what you are suggesting we continue to do.

The problem, I'm afraid, is that the curve is increasingly skewed left in the US. I don't know quite why that is, but watching the news down there leaves me quite depressed. Americans seem increasingly--and almostly willfully--stupid right now. I don't know what to do about it, but tolerating ignorance and idiocy no longer seems like an acceptable answer to me. The dumb are too abundant, too vocal . . .and too well armed . . . for me to think anything good will come from suffering them lightly.

I don't think it is a matter of intelligence so much as ignorance, sometimes willful, sometimes not.

A decade ago I was ripped from the standard American pop culture/infotainment milieu we are saturated in by a family health care crisis. On reentry three years later I was appalled by it.

Everything in the media seemed so juevenile and skewed heavily toward a privileged adolescent male perspective. Which it was, of course. That is the most prized marketing demographic. On reflection I realized that it had not changed; I had.

I am now a grumpy, old woman with a super strong cultural osmosis filter. There was no going back. Still I retain some sympathy for those still caught up in it.

Mis/disinformation surrounds us and seeps in unawares. We are kept busy, busy, busy and don't really notice that everything is tuned to Fox News or talk radio. Blaming NewsCorp et al for taking advantage of the situation is easy and accurate but what about Progressives. Where were they while this indoctrination was happening?

Did we make Canada the 51st (purple) state?

A big portion of the problem with Medicare is the costs incurred at the end of life, when we are spending hundreds of thousands of dollars to keep terminally ill/dieing people alive (barely) for another few days or weeks when their quality of life is terrible. People are so afraid of dieing, and we feel so badly about letting them go, that we are making terrible decisions that are costing us all an incredible amount of money. But no one wants to talk about it...death panels, kill granny...it's absurd, and we need to deal with it.

Oh don't ever ask Canadians that!!!!

No, I'm more becoming Purple Province I think . . .

Why didn't you just stop with "Yes, Germany and France have great health care"? Why is it necessary for the United States to strive to be second rate?

Hear hear.

Thanks, Olden. Lot of good stuff at that link.

As for Rick, I just figured he was either an MD or an insurance agent. Whatever. He and I are so far apart on basic economics that I see no probable way we will ever agree.

OK, criticize the majority of America for being stupid or learn to adapt your message. Some people prefer being right than winning.

Thanks for flagging everyones favorite girl economist, Emma.

If she says someone is intelligent, they likely are. I think there is such a thing known as brainwashing and it's even been documented.

Go figger.

Part of my education in Art School was the fine art of manipulation through imagery and word choice. Of course, that is hardly what they called it, but that certainly is what it was. Semantics courses were required. The GOP excels at these deceptive practices. How many words have lost their meanings since 1960, or so? Socialism is certainly one of them, and given how politicized our education system has become, it is hardly surprising that people are ripe for manipulation.

Fox is a horrible example of using images to communicate meanings other than, (and sometimes opposite of,) the stories they carry.

About 5 or 10 years ago, the powers that be in education recognized these problems and started to try and teach kids to really analyze news and broadcast. Perhaps we will start to see more savvy thinkers, but from my reckoning, it will be another 10-15 years before we even see if those methods have been successful.

"Truth in Advertising" laws do not apply to the News or to politics, and probably not even much to advertising anymore.

As far as your experience with television, I disagree with you. We all age, and programming is geared toward younger males, but it has deteriorated. Just watch a sitcom from 20 years ago and see if you think it is awful. It may be dated, and true some shows were just awful, but if you compare vocabulary and concepts, it isn't even close. The pap we're served isn't even at 4th grade level.

It's designed that way.

The only way around it is likely enforcing public interest regulation, and fining stations that promote dishonesty, that present the news falsely, and start holding the corporations to higher standards. That will not be achieved by just tossing out "Americans are dumb."

One might be tempted to think so, but really, I'd question whether that premise isn't a ploy for those that say that to think better of themselves at the expense of others, like Maxine's elderly relative.

Seems like a losing strategy to me.

No. She's dumb. As in not being a critical thinker. Especially if she was elderly, she would have had PLENTY of experience before all the nefarious techniques you discussed even got introduced 10-15 years ago.

But maybe you want to now try to explain how 1/2 of Americans are not below average intelligence?

By the way, television programming is NOT geared at young males. That would be movies. As for "awful" sitcoms, you are applying the old "damn, it's not like the good old days". It's easy to point to 30 ROCK today, and BLOSSOM or CAROLINE IN THE CITY from the 1990s.

Fact is, you are in the prime age bracket for broadcast television. Congratulations.

Good observations but I think I will stand by my conclusion that the world as we know it is of, by and for privileged adolescent males. That is not feminist drivel. It is just simply recognizing that that demographic in every society has been the one with the most education and most leisure with which to contemplate ideas. I can hardly fault them for winning the birth lottery. I am just trying to think outside their box a bit.

No, the "she" is the old woman in the interview.

Uh ... Rick . . .

You just keep talking about that calculator and no numbers whatsoever to back up your position nor real solutions other than market driven BS and I'll worry about my Baby Boomer generation.

You can postulate about the future health care system punishing the 150 million Americans who have insurance at work to cover the 10 million or so that have no coverage till the cows udders run dry. But the reality based, rational thinking people of the country will move right on into the future looking over their collective shoulders casting a wary eye on your type of fear driven dire predictions that don't solve one damn thing.

Paddlin' on . . .

~OGD~

Are you sure about Germany's higher level of unemployment relative to the US? I thought it was lower than US unemployment levels?

So, you would fund the current Medicare deficit with more debt -- then expand the program to cover everyone -- with still more debt.

Okay, well, that is a solution. It's just not a very good one, with due respect. Perhaps that is why the progressive caucus lost the single payer debate. they didn't have a credible plan to present.

No disagreement that the system needs fixing.

I used to work for a medical school, and I noticed in the mid to late 1990s that an increasing number of doctors were joining the faculty after becoming disillusioned with medical practice.
In talking to them, it seemed a common theme was their frustration with dealing with, and fighting to get paid by, insurance companies.
Many of them decided to become medical educators and thereby cut their salaries by as much as three-fourths to get out of the "business" that increasingly was giving them grief.
Their perception was that medical decision-making process had shifted from the patient and doctor -- the first and second parties in the health care team -- to the third-party payers. One doctor, a surgeon, told me how he got tired to ordering a test, only to get a call from an insurance industry employee urging him to substitute a cheaper test.
He was particularly irked that he would be subjected to such callous directives from someone who hadn't taken the Hippocratic Oath.
One woman at the medical school administers a curriculum project that exposes primary care-oriented med students to the challenges and rewards of serving in medically underserved urban and rural communities. In a prior life she worked at an HMO. She said at that time she and her colleagues were idealists who felt that they were in the vanguard of health care service delivery, working to reduce spiraling medical costs and increase patient access to medical care. She also said that after a few years at the HMO she had come to realize that the HMO model was a racket simply designed to make money by signing up subscribers and then withholding as much medical care as was legally allowed.
The old fee-for-service model was imperfect and admittedly did lead to abuses. However, under that model, the patient was scene as a profit center; someone comes in for medical care, and the doctor had an incentive to provide service and make money. Under the managed care model, the patient has become a cost center; the patient pays a fee to be in a program, and when s/he needs medical care, the provider must cut costs and limit care to stay within budget amounts defined by the patient's plan.
Also at around that same time in the 1990s, medical schools around the country were experiencing declining numbers of applications after decades of previous increases. Such has been the demoralizing influence of the insurance industry's profit motive on medical practice.

Thinking outside the box is good. But having an understanding of how we got into the box is better.

One reason that the FCC was created and things like the Fairness Doctrine and Equal Time rules were implemented is because Congress recognized just how powerful a medium television was, and understood it's potential to literally brainwash the public.

When one watches television, their brainwaves go flat, and they are very open to suggestion.

Thus, the Truth in Advertising laws. But they have been undermined, and even given the wisdom of past Congresses, I do not think they foresaw that the Nightly News would ever be subject to the same monetary commercial pressure as were the commercials that paid for it.

That came about because of the fact that our media consolidated itself into five or six corporations, most of which aren't even American owned.

The whole point of television is to enrich corporations, and after a decade or two of that relentless message, Maxines otherwise intelligent relatives reactions to her queries isn't so difficult to understand.

I was never much of a TV watcher, especially after art school, and pretty much severed my relationship with that medium in 1995 or so.

There used to be a bumper sticker that said "Shoot your Television." Perhaps that is an idea whose time has come again.

Hahahahaha . . .

Facts? You do mean the skewing of your facts the way you wish to present them ... right?

Get a tight hold of that helium filled skull of yours ...

... before you float off the orb.

~OGD~

Thanks, but i get my numbers from the GAO reports, and you will find the outline of my plan to fix the problem in a post above.

Of course, with this victim mentality....

How did you break free from the whole thing?

Why aren't you brainwashed too?

Or anyone else on TPM?

Why aren't we all Fox Zombies?

Also, you might want to check out the recent studies which pretty much show that only "stupid" dads are in sitcoms.
---------------------------------------------------

Your link doesn't show that at all. Its a survey not an analysis of sitcoms. Just because a survey shows people believe certain things doesn't mean that's an objective picture of reality. Survey results don't prove the existence of angels, or that evolution is wrong, or that Obama was born in Kenya, or that he's a muslim, and they don't prove that only stupid dads are in sitcoms.

Right now it's 7.6%, much better than in the US. From Bloomberg:

German unemployment declined for a 14th month in August after surging exports and investment fuelled record economic growth in the second quarter.

The number of people out of work declined a seasonally adjusted 17,000 to 3.19 million, the Nuremberg-based Federal Labor Agency said today. Economists forecast a decrease of 20,000, according to the median of 31 estimates in a Bloomberg News survey. The jobless rate was unchanged at 7.6 percent.

The German economy is leading Europe’s recovery as exports and investment surge, prompting companies from Daimler AG to Bayerische Motoren Werke AG to add workers. That may already be feeding through to consumer spending, which rose the most in almost two years in the second quarter.

“Looking at order books of German companies, we’ll see this miracle continue at least this year,” said Carsten Brzeski, an economist at ING Group in Brussels. “We’ll see positive surprises in the second half of the year, that’s all we need for a self-sustained recovery in Germany.”

The euro was up 0.13 cents to 1.2676 versus the U.S. dollar at 10:54 a.m. in Frankfurt, climbing from an earlier low of 1.2693.

Yeah, countries that export goods seem to be doing better than those that consume a lot without producing so much. America should have addressed this problem more seriously a few decades ago, but we've all been operating under the hypnotic spell of Reaganite ideology--and the abject helplessness it engenders as its devotees endlessly repeat their incantations of "free market" and "government is the problem."

Why is it that countries like Germany--with their workers councils, high taxes, and extensive social services--have healthier manufacturing economies than the US? That's a serious question that our pundits should be asking. But instead they chant meaningless catch-phrases about less government and lower taxes while sitting passively as jobs get shipped to China and India.

Funny. I was thinking about Pavlov and his dogs for some odd reason.

Again, for public healthcare to work, you need to do more than simply add a new payment system to the underlying expensive mess. You need to regulate the provisioning of health care. Public systems do require public control. The reason Medicare is running a deficit is:

We need Medicare like Canada's not like the US's. In other words, we don't just need a government payer, we also need to "publicize" the whole healthcare delivery system so we can control costs better.

We're not going to have a system that decides what doctors should make here. it's not realistic.

Medicare is not broke, because we don't pay enough taxes. It's broke, because it was a poorly designed program from the beginning. The same can be said for Social Security. I'm sure you're aware that Congress has been using that money as general revenue for decades. That's called embezzlement in the private sector.

Hopefully, this answers your question (why not here?) The government has failed to manage both of these programs responsibly. We can only expect more of the same, if they are put in charge of health care. They're going to have to fix what is already broken first.

So how do those of us who are scared out of our pajamas by the word "socialism" recapture the word, and remove the demon. That's a very tough thing to do. I don't think it helps to give up the word to the enemy. The left does that all the time. The right demonizes "liberal" we transform ourselves into "progressives" or we steal "populist" without realizing that word carries some baggage we might prefer not to carry around.

This paragraph deserves its own blog post.

I've toyed with the idea of doing one myself but keep putting it off because I know mine would likely generate more heat than light. It makes me so angry that there is hardly any economic left left and I have not been able yet to filter the anger out.

Hope you will give it a go.

"You know it all..." ???

I see pot meeting kettle there CT ...

Seriously. Your babbling BS gets you nowhere.

Your false front of high mindedness is a scam.

You remind me of an infomercial.

Selling nothing but hot air.

A flim-flam . . .

~OGD~