Employer Provided Insurance: THIRTY THREE MILLION Americans Won't Be Worrying About Losing It Anymore

ml1 said:

 if 30 million people out of work within a month doesn't sever the link to employment, nothing will.  if you're correct (and I don't have any evidence that you aren't), this country is not going to solve health care in my lifetime.  And probably not my kids' lifetime.

a depressing and demoralizing proposition, but probably true. 

 If we don't deal with the issue now, I suspect the issue will outlive the country.

drummerboy said:

I'd like to see some numbers on how many people have actually lost their insurance. I suspect it's very, very few. The people who are losing their jobs are mostly in the low-paid service industries, where they very rarely get insurance anyway.

 this may be true.  In which case the 30 million people losing their jobs are meaningless to this discussion, because they are the ones that most people didn't give a **** about anyway.

unfortunately, yes.

ml1 said:

PVW said:

 I'm not convinced it's an electoral winner, because I'm not convinced it's what the electorate actually wants. And while other solutions may be less cost-efficient or elegant, I think many have the advantage of addressing many of the concerns voters have around health care without them also trying to sell then on single payer which, much as it makes sense from a pure policy perspective, doesn't seem to be a winner politically.

Now I happen to think that as health care access expands and things like a public option get established, people will become more open to severing that link with employment entirely. But I don't think you can get there from here, without such intermediary steps. A more costly route that arrives at the desired destination is better than a cheaper route that never arrives at all.

 if 30 million people out of work within a month doesn't sever the link to employment, nothing will.  if you're correct (and I don't have any evidence that you aren't), this country is not going to solve health care in my lifetime.  And probably not my kids' lifetime.

a depressing and demoralizing proposition, but probably true. 

Depends on how you define the problem to be solved I suppose. Even countries that have universal health care systems fall short on important health care metrics and so haven't "solved" health care in some sense.

If the goal is near universal, affordable coverage, I'm optimistic that will happen, regardless of whether M4A ever does.

I'm very skeptical that any near term solution will be affordable for a large segment of the population.  The cost of deductibles and going out of network are likely to be a hurdle for many people in any health coverage that isn't similar to the Sanders or Warren plans.

ml1 said:

I'm very skeptical that any near term solution will be affordable for a large segment of the population.  The cost of deductibles and going out of network are likely to be a hurdle for many people in any health coverage that isn't similar to the Sanders or Warren plans.

And making that affordable is a goal I'd say most voters want. This is distinct from a goal of passing Warren or Sander's plan. If some other plan achieves this, M4A will probably never happen. If some other plan passes and most voters feel that this goal has not yet been satisfactorily achieved, it will remain a live issue driving further policy initiatives. Maybe at the end of these iterations we'll have something like M4A. Maybe we won't. But I'm pretty certain Democrats will continue advancing health care legislation making progress on expanding coverage and containing costs so long as this is a major issue.

PVW said:

And making that affordable is a goal I'd say most voters want. This is distinct from a goal of passing Warren or Sander's plan. If some other plan achieves this, M4A will probably never happen. If some other plan passes and most voters feel that this goal has not yet been satisfactorily achieved, it will remain a live issue driving further policy initiatives. Maybe at the end of these iterations we'll have something like M4A. Maybe we won't. But I'm pretty certain Democrats will continue advancing health care legislation making progress on expanding coverage and containing costs so long as this is a major issue.

 it's worth noting that anyone who is espousing an incremental approach is betting on hope and optimism that the country will somehow find its way to a result that would have been guaranteed by passage of some form of M4A.  I'm not as optimistic as you are because generally in anything, hope is not a good strategy for accomplishing any goal.  Usually, the best method for accomplishing a goal is to set a specific method for accomplishing it.

I'm now repeating myself to the point of ad nauseam, but if M4A is not viable now, it never will be.  And a piecemeal route to accomplishing its goals isn't likely in the end to look much like it.  The plans that people like Biden are touting are almost certain to be more expensive for both the government and patients, and almost certainly will cover less.  

ml1 said:

PVW said:

And making that affordable is a goal I'd say most voters want. This is distinct from a goal of passing Warren or Sander's plan. If some other plan achieves this, M4A will probably never happen. If some other plan passes and most voters feel that this goal has not yet been satisfactorily achieved, it will remain a live issue driving further policy initiatives. Maybe at the end of these iterations we'll have something like M4A. Maybe we won't. But I'm pretty certain Democrats will continue advancing health care legislation making progress on expanding coverage and containing costs so long as this is a major issue.

 it's worth noting that anyone who is espousing an incremental approach is betting on hope and optimism that the country will somehow find its way to a result that would have been guaranteed by passage of some form of M4A.  I'm not as optimistic as you are because generally in anything, hope is not a good strategy for accomplishing any goal.  Usually, the best method for accomplishing a goal is to set a specific method for accomplishing it.

I'm now repeating myself to the point of ad nauseam, but if M4A is not viable now, it never will be.  And a piecemeal route to accomplishing its goals isn't likely in the end to look much like it.  The plans that people like Biden are touting are almost certain to be more expensive for both the government and patients, and almost certainly will cover less.  

This view seems to go against legislative history. Even if we only look at health care, while the ACA falls short of "solving" heath care, it made substantial progress and set the stage for the next move forward -- we would not even be talking about M4A as a reach goal or a public option as the "conservative" alternative without the ACA.

In a large, diverse democracy, I think passing specific policies is less important than focusing on always advancing forward toward goals. In the 2020 presidential primary M4A was promoted, and failed to gain sufficient support. So we keep moving forward and push on with something that can find support. Then on and on. The best method for accomplishing a goal is to keep getting things passed that move us forward. Maybe next time M4A will fare better, but I don't see the value in complaining that it didn't happen this round.

If SCOTUS upholds the 5th Circuit's decision that the individual mandate in the ACA is unconstitutional does that help or hurt the push for M4A or something similar?

We must wait and see what the decision says but if all that is unconstitutional is a mandate their should be no bar to an "option". 

Of course unless they rule Medicare unconstitutional then how would M4A be unconstitutional? 

PVW said:

This view seems to go against legislative history. Even if we only look at health care, while the ACA falls short of "solving" heath care, it made substantial progress and set the stage for the next move forward -- we would not even be talking about M4A as a reach goal or a public option as the "conservative" alternative without the ACA.

In a large, diverse democracy, I think passing specific policies is less important than focusing on always advancing forward toward goals. In the 2020 presidential primary M4A was promoted, and failed to gain sufficient support. So we keep moving forward and push on with something that can find support. Then on and on. The best method for accomplishing a goal is to keep getting things passed that move us forward. Maybe next time M4A will fare better, but I don't see the value in complaining that it didn't happen this round.

I'm not complaining, I'm just observing that if a pandemic and 25% unemployment don't derail the primacy of employer-provided health insurance what on earth would?

ml1 said:

I'm now repeating myself to the point of ad nauseam, but if M4A is not viable now, it never will be.  And a piecemeal route to accomplishing its goals isn't likely in the end to look much like it.  The plans that people like Biden are touting are almost certain to be more expensive for both the government and patients, and almost certainly will cover less.  

 They may be more costly, and they may cover less, but they have a far greater chance to get done, as opposed to M4A.

The 5th Circuit in a 2-1 decision said that the mandate is unconstitutional because the Supreme Court held it as constitutional under Congress's taxing power. That is, according to CJ Roberts the penalty for not buying coverage was actually a Tax. But then the Republican Congress amended the ACA only by reducing said penalty or tax to zero. The Majority of the 5th Circuit concluded that therefore the mandate was unconstitutional.

The dissenter said that if the penalty was zero then no one would be injured by not complying with the mandate and therefore no one had "standing" to sue and the case should be dismissed. 

Now the only member of SCOTUS who found the "penalty" to actually be a "tax" was CJ Roberts. Not one of the other 8 agreed. The 4 who joined his decision that ACA was constitutional did so for different reasons and the 4 dissenters also had completely different reasons.

http://www.ca5.uscourts.gov/opinions/pub/19/19-10011-CV0.pdf

ml1 said:

I'm not complaining, I'm just observing that if a pandemic and 25% unemployment don't derail the primacy of employer-provided health insurance what on earth would?

If I was reading correctly, an answer was already posited: More incremental progress over time.

Then again, if you’re observing rather than asking, I suppose your question is rhetorical and therefore requires no answer.

DaveSchmidt said:

If I was reading correctly, an answer was already posited: More incremental progress over time.

Then again, if you’re observing rather than asking, I suppose your question is rhetorical and therefore requires no answer.

 it doesn't require an answer.  Although it seems that if one wanted to respond, the obvious answer is that nearly everyone else here thinks universal single payer cannot possibly happen in the near term under virtually any conditions.  

if this country comes out of the pandemic, with virtually no changes to the circumstances of working people regarding a living wage, income security, affordable health care, etc. it will be extremely discouraging to anyone who thought even a small measure of betterment was possible.

ml1 said:

DaveSchmidt said:

If I was reading correctly, an answer was already posited: More incremental progress over time.

Then again, if you’re observing rather than asking, I suppose your question is rhetorical and therefore requires no answer.

 it doesn't require an answer.  Although it seems that if one wanted to respond, the obvious answer is that nearly everyone else here thinks universal single payer cannot possibly happen in the near term under virtually any conditions.  

if this country comes out of the pandemic, with virtually no changes to the circumstances of working people regarding a living wage, income security, affordable health care, etc. it will be extremely discouraging to anyone who thought even a small measure of betterment was possible.

 Once again, you're turning this into a black/white choice. It's not. Restoring the ACA, with an added STRONG public option, is an incremental step that will help millions. Plus, it sets the stage for decreased reliance on employer-provided insurance. These are significant degrees of progress, and can actually be realized in the current political climate. M4A can NOT.

ml1 said:

DaveSchmidt said:

If I was reading correctly, an answer was already posited: More incremental progress over time.

Then again, if you’re observing rather than asking, I suppose your question is rhetorical and therefore requires no answer.

 it doesn't require an answer.  Although it seems that if one wanted to respond, the obvious answer is that nearly everyone else here thinks universal single payer cannot possibly happen in the near term under virtually any conditions.  

if this country comes out of the pandemic, with virtually no changes to the circumstances of working people regarding a living wage, income security, affordable health care, etc. it will be extremely discouraging to anyone who thought even a small measure of betterment was possible.

 I see two assumptions here:

- universal health care requires single payer

- we know how long this pandemic will last and its affects on our health care system

I don't think either assumption is warranted. As the pandemic continues, it might or might not shift the political opportunities for something like single payer. We're too early in to it to say for certain. Millions of Americans losing employment in a month is a different situation than millions losing employment for months at a time. We're not at "months at a time" yet; if we get there, the political situation may well look very different.

And as to single payer being the only way to get universal coverage, that's an assertion but not a known fact. The goal is universal coverage, not a particular implementation of it.

PVW said:

 I see two assumptions here:

- universal health care requires single payer

- we know how long this pandemic will last and its affects on our health care system

I don't think either assumption is warranted. As the pandemic continues, it might or might not shift the political opportunities for something like single payer. We're too early in to it to say for certain. Millions of Americans losing employment in a month is a different situation than millions losing employment for months at a time. We're not at "months at a time" yet; if we get there, the political situation may well look very different.

And as to single payer being the only way to get universal coverage, that's an assertion but not a known fact. The goal is universal coverage, not a particular implementation of it.

 I didn't mean to imply that it's necessary to get universal coverage.  It's obviously not a necessary condition.

But it's almost certainly the means to the least costly and most comprehensive coverage, without the logistical headaches of dealing with private insurance companies.

ml1 said:

PVW said:

 I see two assumptions here:

- universal health care requires single payer

- we know how long this pandemic will last and its affects on our health care system

I don't think either assumption is warranted. As the pandemic continues, it might or might not shift the political opportunities for something like single payer. We're too early in to it to say for certain. Millions of Americans losing employment in a month is a different situation than millions losing employment for months at a time. We're not at "months at a time" yet; if we get there, the political situation may well look very different.

And as to single payer being the only way to get universal coverage, that's an assertion but not a known fact. The goal is universal coverage, not a particular implementation of it.

 I didn't mean to imply that it's necessary to get universal coverage.  It's obviously not a necessary condition.

But it's almost certainly the means to the least costly and most comprehensive coverage, without the logistical headaches of dealing with private insurance companies.

 Sure, and I guess my contention is that choosing the lest costly path and getting rid of the logistical headaches of dealing with private insurance companies is not a priority for the general electorate. Maybe it'll never be. That doesn't mean universal health care is unachievable.

What did M.L.King say about the arc of the universe?

With the current jerk in the WH and the Senate run by the total a-hole nothing will get passed.

If these things change as a result of the November Election the process cannot even begin until 9-10 months from now and then will be very difficult given the rules of the Senate. So if "near future" means a year or so it will not happen in that time.

As to your lifetime, ml1, and the lifetimes of your children I am far more optimistic, perhaps as much about your longevity as about the triumph of universal healthcare. 

PVW said:

 Sure, and I guess my contention is that choosing the lest costly path and getting rid of the logistical headaches of dealing with private insurance companies is not a priority for the general electorate. Maybe it'll never be. That doesn't mean universal health care is unachievable.

 I can't see any move to M4A not being incremental.  Even if a law were passed tomorrow, I don't see how you toggle hundreds of millions of people over to public insurance immediately.  Any legislation would probably have a phase-in period of years, not months.

ml1 said:

PVW said:

 Sure, and I guess my contention is that choosing the lest costly path and getting rid of the logistical headaches of dealing with private insurance companies is not a priority for the general electorate. Maybe it'll never be. That doesn't mean universal health care is unachievable.

 I can't see any move to M4A not being incremental.  Even if a law were passed tomorrow, I don't see how you toggle hundreds of millions of people over to public insurance immediately.  Any legislation would probably have a phase-in period of years, not months.

 So we're talking about the same ending, AND a similar incremental process. The difference is that your way, passing M4A won't happen. Our way, fully restored and corrected ACA + meaningful public option, can.

Dennis_Seelbach said:

 So we're talking about the same ending, AND a similar incremental process. The difference is that your way, passing M4A won't happen. Our way, fully restored and corrected ACA + meaningful public option, can.

 how can you be so certain of this?  If the public option is expanded in a way that is perceived as too costly, it could kill any movement toward additional incremental improvements.  Especially if the expanded public option is perceived as a sort of welfare for low-income people.

No outcome is guaranteed under any of the scenarios we're discussing, regardless of how much certainty we try to express ourselves.

STANV said:

What did M.L.King say about the arc of the universe?

With the current jerk in the WH and the Senate run by the total a-hole nothing will get passed.

If these things change as a result of the November Election the process cannot even begin until 9-10 months from now and then will be very difficult given the rules of the Senate. So if "near future" means a year or so it will not happen in that time.

As to your lifetime, ml1, and the lifetimes of your children I am far more optimistic, perhaps as much about your longevity as about the triumph of universal healthcare. 

 I appreciate that.

But if this crisis doesn't start to change a lot of how we perceive what the government should be doing to "promote the general welfare" in the near term (to me, that's about 5 years, not this year).  It's not likely to happen in the next 20 or 30 years, or even the next 50.  We're in the middle of a double health and economic crisis, and if it doesn't change the way we look at the country's general welfare, what would?  Maybe if the global warming experts are right and we're looking at even bigger existential crisis in 15 or 20 years.  But absent that, I can't see it.  I find it a little puzzling that some folks here are pessimistic that the pandemic will change hearts and minds on issues like M4A, but are optimistic that somehow after the pandemic, people will come around to more progressive positions gradually.  It seems more likely to me that if attitudes toward "capitalism" and against a more activist type of government survive the pandemic, they'll be more hardened afterward.  We'll go right back to the same trajectory on wealth inequality, and antipathy toward anything labeled "socialism."

ml1 said:

STANV said:

What did M.L.King say about the arc of the universe?

With the current jerk in the WH and the Senate run by the total a-hole nothing will get passed.

If these things change as a result of the November Election the process cannot even begin until 9-10 months from now and then will be very difficult given the rules of the Senate. So if "near future" means a year or so it will not happen in that time.

As to your lifetime, ml1, and the lifetimes of your children I am far more optimistic, perhaps as much about your longevity as about the triumph of universal healthcare. 

 I appreciate that.

But if this crisis doesn't start to change a lot of how we perceive what the government should be doing to "promote the general welfare" in the near term (to me, that's about 5 years, not this year).  It's not likely to happen in the next 20 or 30 years, or even the next 50.  We're in the middle of a double health and economic crisis, and if it doesn't change the way we look at the country's general welfare, what would?  Maybe if the global warming experts are right and we're looking at even bigger existential crisis in 15 or 20 years.  But absent that, I can't see it.  I find it a little puzzling that some folks here are pessimistic that the pandemic will change hearts and minds on issues like M4A, but are optimistic that somehow after the pandemic, people will come around to more progressive positions gradually.  It seems more likely to me that if attitudes toward "capitalism" and against a more activist type of government survive the pandemic, they'll be more hardened afterward.  We'll go right back to the same trajectory on wealth inequality, and antipathy toward anything labeled "socialism."

 I'm pessimistic that as of May 1, 2020, just a little over a month in, the changes you're looking for are there. I'm saying I don't know how long the pandemic will last or what changes will occur as a result. I'm further saying that even if the public never, ever warms to M4A, real progress and real improvement in health care still are possible and, under Democratic control, even likely.

tl;dr -- I'm not pinning my hopes on M4A

PVW said:

 I'm pessimistic that as of May 1, 2020, just a little over a month in, the changes you're looking for are there. I'm saying I don't know how long the pandemic will last or what changes will occur as a result. I'm further saying that even if the public never, ever warms to M4A, real progress and real improvement in health care still are possible and, under Democratic control, even likely.

tl;dr -- I'm not pinning my hopes on M4A

I don't think I suggested that the changes have happened by today.  When I talk about the pandemic, I'm referring to it as something that is going to have long-term health and economic consequences.  Are you suggesting that the effects of this pandemic are going to be short-lived and we'll be back to normal soon?  I don't see any evidence that this isn't going to have real, long-term effects on virtually all aspects of life.  It seems really unrealistic to assume this pandemic is going to end soon, and the economy is going to bounce right back.  

If it does end soon, and the 4Q economy looks strong, then everything I'm writing here is essentially worthless rambling.

ml1 said:

I don't think I suggested that the changes have happened by today.  When I talk about the pandemic, I'm referring to it as something that is going to have long-term health and economic consequences.  Are you suggesting that the effects of this pandemic are going to be short-lived and we'll be back to normal soon?  I don't see any evidence that this isn't going to have real, long-term effects on virtually all aspects of life.  It seems really unrealistic to assume this pandemic is going to end soon, and the economy is going to bounce right back.  

If it does end soon, and the 4Q economy looks strong, then everything I'm writing here is essentially worthless rambling.

Going back to the ML quote, these things are long-term trends, you don't change that overnight. This whole Republican anti-government thing did not happen overnight either. It started with Reagan with this "government is the problem" nonsense (or maybe even before that). It is going to take decades to get back to the notion that government is a shared resource that can do good in society. But I do think that will happen, and if it does we will also be able to make sure access to high quality healthcare is a right (not some privilege). But whether all that will happen in the next few years? I am not so sure of that. But I hope I am wrong and you are right.

ml1 said:

PVW said:

 I'm pessimistic that as of May 1, 2020, just a little over a month in, the changes you're looking for are there. I'm saying I don't know how long the pandemic will last or what changes will occur as a result. I'm further saying that even if the public never, ever warms to M4A, real progress and real improvement in health care still are possible and, under Democratic control, even likely.

tl;dr -- I'm not pinning my hopes on M4A

I don't think I suggested that the changes have happened by today.  When I talk about the pandemic, I'm referring to it as something that is going to have long-term health and economic consequences.  Are you suggesting that the effects of this pandemic are going to be short-lived and we'll be back to normal soon?  I don't see any evidence that this isn't going to have real, long-term effects on virtually all aspects of life.  It seems really unrealistic to assume this pandemic is going to end soon, and the economy is going to bounce right back.  

If it does end soon, and the 4Q economy looks strong, then everything I'm writing here is essentially worthless rambling.

 I'm saying I don't know how it's going to play out, and so a thread trying to draw a straight line between the fact that the pandemic has so far put millions out of work and M4A therefore being inevitable or being forever impossible is making sweeping inferences that can't be justified.

basil said:

This whole Republican anti-government thing did not happen overnight either. It started with Reagan with this "government is the problem" nonsense (or maybe even before that).

 Read up on the American System and Internal Improvements if you're interested in trying to push this back before Reagan.

Most people on this board would probably have been Whigs.

basil said:

Going back to the ML quote, these things are long-term trends, you don't change that overnight. This whole Republican anti-government thing did not happen overnight either. It started with Reagan with this "government is the problem" nonsense (or maybe even before that). It is going to take decades to get back to the notion that government is a shared resource that can do good in society. But I do think that will happen, and if it does we will also be able to make sure access to high quality healthcare is a right (not some privilege). But whether all that will happen in the next few years? I am not so sure of that. But I hope I am wrong and you are right.

 What you're saying is pretty much central to the question I'm asking here. If this pandemic isn't a knock upside the head for a lot of people, what possibly could be?

I'd suggest almost nothing then. 

ml1 said:

 What you're saying is pretty much central to the question I'm asking here. If this pandemic isn't a knock upside the head for a lot of people, what possibly could be?

I'd suggest almost nothing then. 

In the words of Yogi Berra: "it's tough to make predictions, especially about the future"