Medicaid Is Not The Route To A Single-Payer Plan

Corrente is a far left blog which I generally have little interest in, but there are bound to be times when our interests overlap. Today I must say they are right while Paul Krugman and several other liberal writers/bloggers, who I would generally side with over Corrente, are wrong. Paul Krugman and some other liberal writers have been praising Medicaid expansion as if it is a path towards a single-payer plan. A writer at Corrente counters with a post saying that Paul Krugman is wrong about Medicaid.

The writer describe some of their negative experiences in a Medicaid program and concluded:

This is not the system Krugman imagines. He’s not alone; most Democrats and many people who describe themselves as progressive are celebrating the Medicaid expansion under Obamacare as an extraordinary advance. In terms of coverage, they’re right. In terms of steering the country toward health care equity, they’re wrong. Medicaid patients are too often treated as second-class citizens, and the problem is likely to worsen without the kind of drastic reform I mentioned earlier.

There are at present about 150 million Americans being served by at least a half-dozen single-payer systems. We need to take the most popular of those systems and expand it to provide cradle-to-grave coverage for everyone in the country, and improve it to achieve the health care equity that Americans deserve and that President Obama has described as a basic human right. We need Medicare for all.

Medicaid, as the author acknowledged, varies from state to state and even within different parts of states. Some people will have better or worse experience, but the fact remains that in general Medicaid patients are second-class citizens in the health care system. Access to care does vary, but is far different from the health care experiences of most Americans who have insurance or are covered by Medicare. My office receives quite a few calls each week from both people on Medicaid who do not have physicians and from those who desire to get away from the second-class care they often receive in the clinics which will see them. While better than no coverage, to those who have better coverage Medicaid would represent all the horrors of government run health care which the right has been crying about.

I bet that Krugman, and those who echo his views, would change their minds very quickly if they had to give up their private physicians and obtain all their care through Medicaid clinics.

The blogger at Corrente is also correct that, while Medicare is not perfect, Medicare for all would be a much better model for a single-payer plan. It is far better than Medicaid, while still keeping costs down.

I must conclude by also pointing out that Medicaid expansion is not without benefits. Having Medicaid is still far better than having no coverage, despite misinterpretations being spread by conservatives regarding studies of Medicaid expansion in Oregon. I previously discussed this topic here. When the Affordable Care Act was being considered in Congress while the Democrats technically had sixty votes, there weren’t sixty votes for either a pubic option or even a Medicare buy-in, due to opposition by Joe Lieberman and Ben Nelson. With limited money to expand health care coverage, and the impossibility of a single-payer system based on Medicare getting through Congress, Medicaid expansion was an understandable compromise to provide some coverage to the working poor. That does not make it a desirable model for moving to a single-payer plan.

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Quote of the Day

“Joe Lieberman is writing a book about the Jewish Sabbath called “Gift of Rest.” I hear he’s been working on it 24/6.” –Jimmy Fallon

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Clyburn Urges Democratic Votes To Revive Public Option

This is definitely a case of too little, too late (even if it is what I had suggested months ago). Back when there were not enough votes for the public option in the Senate due to the opposition of Republicans, one independent (Joe Lieberman), and one conservative Democrat (Ben Nelson) I suggested that the Democrats make this a campaign issue. The majority of the people (as well as majority of members of the Senate) were in favor. Make it a campaign issue and force Republicans to explain why they oppose this choice and go on the defensive. Instead the Democrats, after doing a poor job against the Republicans in the spin war, have been the ones on the defensive, desperately hoping voters won’t buy all the Republican misinformation being spread about the plan.

While most Democrats have tried to avoid discussing health care, there have been some exceptions. Majority Whip James Clyburn is even using the promise of a public option as a reason to keep the Democrats in control of Congress. The Hill reports:

Democrats could revive the public healthcare option if they maintain their majorities in Congress, the House Democrats’ third-ranking member said Friday.

“Reelect me, keep Democrats on the field. And when we come back next year, maybe we will get to the public option,” Majority Whip James Clyburn (S.C.) said during an appearance on the Tom Joyner Morning Show.

Clyburn has been traveling the country and making media appearances this week in an effort to drum up lagging voter enthusiasm on the Democratic side heading into the Nov. 2 midterms.

The public healthcare option was a top prize for liberal activists during the nearly two-year long debate over healthcare reform, but it was scrapped from the final legislation after support for it fell short in the Senate.

Campaigning for issues such as the public option could gain the support of many voters. At very least it would help motivate Democratic voters to turn out. Just giving Democratic voters more reason to turn out could change the outcome. Polls show that support for each party is very close, but far more Republicans than Democrats are expected to turn out to vote.

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Sarah Palin Falls To Bush Levels Of Unpopularity, With Joe Lieberman Not Far Behind

George W. Bush has the distinction of having a low approval rating of only 25 percent in the Gallup poll, just one percent above Richard Nixon who was forced to resign in disgrace. CBS News had his final approval rating even lower at 22 percent–which happens to be Sarah Palin’s current approval rating from the same organization. It appears that 22 percent might be the level of support a Republican politician can count on regardless of how incompetent they are.

More numbers from the poll:

Palin is viewed favorably by just 22 percent of Americans, according to the poll – including less than half (44 percent) of Republicans. Twenty-one percent of independents and 6 percent of Democrats view her favorably.

Forty-eight percent of Americans have an unfavorable view of Palin. That includes 73 percent of Democrats, 44 percent of independents and 22 percent of Republicans.

Another politician has seen their support fall to the same ball park as the Bush/Palin level. A survey from Public Policy Polling found that only 24 percent plan to vote for Joseph Lieberman for reelection, although his approval rating remains barely over 30 percent:

Majorities of Democrats (72%), independents (63%), and Republicans (61%) alike say it’s time to swap out Lieberman for someone new.

Lieberman is one of the most unpopular Senators in the country, with only a 31% approval rating and 57% of voters disapproving of his job performance. He’s on slightly favorable ground with Republicans at a 46/41 approval rating. But he’s lost virtually any remaining support he had with Democrats at a 20/69 approval and independents are against him as well, by a 31/56 spread.

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Democrats Up or Down, Depending Upon The Poll

More polls are conclusively showing only one thing–polls taken far in advance of an election are of little value (probably as most voters have not even given the election all that much thought). First there’s the polls on this year’s off year Congressional elections. Public Policy Polling finds that Barack Obama’s approval has hit a new low (as Obama continues to follow Ronald Reagan’s trajectory in the polls). The conventional wisdom is that off year elections are a referendum on the recently elected president. For this we’d expect that the Democrats would be falling behind the Republicans in the generic Congressional election. Instead the two are at a 43 percent tie.

Making matters even less clear. Gallup found that the Democrats have shot up to a six point lead over the Republicans in the generic poll. Perhaps some voters are starting to remember exactly why they voted against the Republicans in 2006 and 2008. No matter how bad the economy is, it makes no sense to vote for the party which caused this mess.

Yesterday, probably before these results were available, Nate Silver made some predictions based upon the finding that Republicans are more enthusiastic about voting at present than Democrats are. Nate looked at the odds of the Republicans taking control of the Senate:

Our latest Senate simulation has the chamber convening in 2011 with an average of 53.4 Democrats (counting Joe Lieberman and Bernie Sanders), 46.1 Republicans, and 0.5 Charlie Crists. This is an improvement for Republicans from our last forecast three weeks ago, which had 55.2 Democrats, 44.2 Republicans, and 0.6 Crists. The changes, however, predominantly reflect several methodological improvements we have made rather than any particular national momentum, although the dynamics of some individual contests are certainly evolving.

The model gives Republicans a 17 percent chance of taking over the Senate if Charlie Crist caucuses with them, up significantly from 6 percent three weeks ago. If Crist does not caucus with them, their chances of a takeover are 12 percent. However, the model does not account for the contingency that someone like Joe Lieberman or Ben Nelson could decide to switch parties, which makes their chances slightly better than we suggest here.

If the polls are inconclusive regarding the 2010 elections, polling on the 2012 election is even less clear.  For example, a recent PPP poll found Sarah Palin tied at 46 percent with Obama in a hypothetical 2012 match up. However a  Time Magazine Poll shows Obama leading Palin by 21 points, 55 percent to 34 percent. In other words, the polls show either a tie or landslide which might exceed Lyndon Johnson’s victory over Barry Goldwater.

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Joe Lieberman Thanks God For GOP Momentum

In a moment which might come to define him as much as kissing George Bush in 2005, Joe Lieberman made a statement today which many Democrats might never forget:

“There were a lot of people, particularly Democrats, who were declaring after the 2008 election that we were beginning a period of Democratic dominance that would go on for decades,” Lieberman said during an interview with the conservative Newsmax magazine.

“Now, all of a sudden, the momentum is with the Republicans. And that’s — thank God — that’s the way people have spoken, you know? That’s our democracy.”

Lieberman actively campaigned for the Republican presidential candidate in 2008 and now has expressed support for Republican gains in Congress. At least he did vote with the Democrats on health care reform–but only after he helped kill the public option and Medicare buy-in.

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Prospects Improving For Health Care Reform, Including Public Option

From reports over the last few days it is appearing increasingly likely that Congress will pass health care reform by having the House pass the Senate bill and making changes by budget reconciliation which only require a simple majority, a strategy frequently used to pass legislation during the Bush years.

Going from a requirement of a sixty vote super-majority to using reconciliation which only requires a simple majority vote also means that the Democrats no longer need to be concerned about compromising to obtain the votes of conservatives such as Joe Lieberman and Ben Nelson. This will allow them to pass measures supported by the majority such as a public option.

The public option is widely supported by the public, and is essential to reduce opposition to the bill created by the individual mandate. The public option would give consumers in the individual market the choice of voluntarily purchasing a government-run insurance plan modeled on the popular and highly successful Medicare program. Consumers would also have a choice of private insurance plans offered on the proposed insurance exchanges. The public option would be financed from premiums paid by those who chose the public option over private plans. Initial start up money for the public option coming from tax funds would have to be paid back.

When health care reform stalled after the lose of Ted Kennedy’s former Senate seat many on the left were urging for more immediate passage of the Senate plan. I was opposed to such immediate passage considering the political risk that this could lead to Republican gains in November, jeopardizing long term government action to reform health care delivery. Instead it appears the Democrats are following the path I favored: taking action to explain the health care plan to the voters, improve upon the Senate plan, and make clear the obstructionist policies of the Republican Party prior to passage. Both of these goals might be accomplished with the upcoming health care summit to be held prior to a final vote.

President Obama also used his weekly address to push for health care reform and it is a safe bet we will be hearing much more from him on the topic over the next several weeks. Polling over the past year has showed increases in public support for health care when discussed by Obama while support tends to decline when Republican misinformation dominates the news.  Recent double digit increases in health insurance premiums on the individual market have also highlighted how essential it is to pass health care reform this year.

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Joe Lieberman, Not a Good Old-Fashioned New England Moderate Republican

In an interview on Face the Nation, Joe Lieberman was asked if he could see himself as a Republican. Lieberman said, “it’s possible. A good old-fashioned New England moderate Republican.”

I see “a good old-fashioned New England moderate Republican” as one who would have broken with his party and opposed the Iraq war and who would have joined the Democrats in working towards health care reform without killing good ideas such as the public option and the Medicare buy-in.
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Health Care Reform Critical But Not Dead

The prognosis for health care reform is rather guarded at the moment. House majority whip James Clyburn is saying that the House will pass the Senate bill if there are assurances that fixes will be made through a separate budget reconciliation bill. It is far from certain that the Senate will be able to do this. Reports coming out of the Senate do not sound like they are prepared to make such an arrangement to pass such fixes even though only 50 votes (plus Joe Biden as tie breaker) are needed.

Two conservative Democrats, Blanche Lincoln and Evan Bayh, have already stated they will not support a reconciliation measure. The two Senators from Connecticut, Chris Dodd (Democrat) and Joe Lieberman (Schmuck) are suggesting that President Obama use the State of the Union Address to “re-invite” the Republicans back to negotiate on health care legislation. So far the Republicans have not shown any interest in negotiating, preferring to block any legislation trying make the Democrats look like failures regardless of how much they harm the country. So far their strategy might be working.

While I am extremely pessimistic about the Republicans being willing to negotiate in good faith, if they should shock us all there could even be one benefit. Perhaps a deal could be made in which the Democrats do concede one point to the Republicans and proceed with malpractice reform. This will have a far smaller impact on health care costs than Republicans typically claim but we should not overlook any source of savings such as this which does not require reductions in care provided.

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Another False Internet Rumor: Lieberman Not Endorsing Brown

There is an anonymous report on a blog claiming that Joe Lieberman is preparing to endorse Scott Brown in the Massachusetts Senate race. While this should immediately raise doubts as to its accuracy, this is being quoted elsewhere. I imagine that a story suggesting that Lieberman plans to sell out the Democrats and further attempt to block health care reform has the feeling of truth to many.

The Hill reports that Lieberman has no plans to endorse anyone in the Massachusetts race, noting that conservative bloggers are floating this rumor. It is likely that this is intentional under the assumption that this might encourage some independents to vote for Brown over Coakley.

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