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Forum Post: If 'Obamacare' Falls, Will 'Medicare for All' Rise?

Posted 11 years ago on April 2, 2012, 3:08 p.m. EST by Demian (497) from San Francisco, CA
This content is user submitted and not an official statement

Many observers see opening if Supreme Court kills Affordable Care Act

  • Common Dreams staff After last week's deliberations before the US Supreme Court over Obama's signature health care reform legislation, the Affordable Care Act, speculation is rampant about the political fallout if the nation's highest court knocks down some, or all, of the law.

Conservatives would see a move to throw out the law (which they derisively call 'Obamacare') as a victory, whereas Democrats and those who championed the legislation would consider it an affront to jurisprudence and a defeat of the president's largest domestic policy initiative. Progressives, however -- who only reluctantly accepted the law's passage after their preferred alternatives, either a single-payer system or a 'public option', were ruled out -- may ultimately be the ones who claim victory if the Supreme Court invalidates the 'individual mandate' or the entirety of the Affordable Care Act.

TalkingPointMemo's Sahil Kaptur reports this morning: Why Overturning ‘Obamacare’ Could Lead To Single-Payer

If the Supreme Court strikes down “Obamacare,” Republicans claim a huge short-term victory, but they may end up big losers in the long run. The future of the nation’s health care system would be thrown into disarray, and conservatives may be forced to swallow a more bitter pill.

The prospect of moving toward a more liberal, government-controlled health care system is fraught with political peril, and therefore far from inevitable, but may wind up being the only way to prevent the demise of the unsustainable, existing system from leaving many more millions without access to health care. Without a mechanism like an individual mandate to cover the uninsured and tackle the free-rider problem, health care costs are set to rise at an unsustainable rate and compel potentially drastic action from Congress.

“Conservatives may find that they weren’t careful about what they wished for in opposing ‘Obamacare,’” Adam Winkler, a constitutional law professor at UCLA School of Law, told TPM. “The economic, social and political pressure for health care reform aren’t going to just disappear. There’s a reason every major industrialized country has national health care. If the Supreme Court invalidates the Affordable Care Act, we are likely to see a government takeover of health care in the next decade.”

In that scenario, progressives could turn to two alternatives that have proven successful at lowering costs in other countries: A single-payer plan a la Medicare but for everyone, or a two-tier system in which private and public insurers compete. Both concepts are anathema to Republicans, but their constitutionality is not in doubt — and the GOP has been unable to devise a replacement plan, which could give liberals ammunition for their cause.

There’s little doubt that the idea behind the individual mandate — in which Americans either buy insurance or pay more in taxes — would be constitutional if rewritten explicitly as a “tax” as opposed to a “penalty” for not buying a product. But the political fallout of a Supreme Court decision to strike it down may well scare lawmakers away from the concept altogether.

“The defenders of federalism will be rewarded with an even bigger federal government,” Winkler said. “Wouldn’t that be ironic?” Rose Ann Demoro, executive director of National Nurses United, wrote last week:

Today Medicare remains a more efficient, cost effective, humane system for delivering healthcare, and guaranteeing it to everyone who is eligible, in a far superior manner to the broken dysfunction privatized insurance system that is based on profit and ability to pay, not on patient need.

Sure, the Affordable Care Act does have positive elements, including some restrictions on the abuses that characterize the insurance industry, and the provision that lets young adults up to 26 to remain on their parents’ health plan.

But even if Obamacare survives the court challenge – a prospect looking increasingly dim – it would leave millions of Americans out in the cold.

Despite its name the Affordable Care Act has done little to actually make healthcare affordable. Out of pocket health costs for families continue to soar. It does little to crack down on insurance companies denial of medical treatment they don’t want to pay for. It leaves 27 million Americans with no health coverage, according to a Congressional Budget office estimate in early March.

And for many who are covered, it further tethers them to a callous, insurance system that treats patients as commodities, not as individuals with individual needs. And Robert Reich, in a much cited piece, said compared to the private insurance model, "Medicare is a great deal." He continued:

Its administrative costs are only around 3 percent, while the administrative costs of private insurers eat up 30 to 40 percent of premiums. Medicare’s costs are even below the 5 percent to 10 percent administrative costs borne by large companies that self-insure, and under the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

So why not Medicare for all?




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[-] 7 points by TrevorMnemonic (5827) 11 years ago

We need real universal healthcare that cuts out the pointless middle man, the insurance companies, that pocket a bunch of the cash that should be going to the health care.

Everything would be way cheaper for everyone.

Taxes for the benefit of our society, not bombs in countries that didn't attack us.

[-] 2 points by fiftyfourforty (1077) from New York, NY 11 years ago

Trevor you are right but what we need is not going to come through the political system that is in place. for that we need #OWS type action and a long view perspective.

[-] 1 points by GypsyKing (8708) 11 years ago

Right on the mark!

[-] 1 points by factsrfun (8308) from Phoenix, AZ 11 years ago

afternoon trevor, I will have to look at the longer post later, but for now I can't see a damn thing wrong with anything you said...

[-] 1 points by Demian (497) from San Francisco, CA 11 years ago


[-] 0 points by Dell (-168) 11 years ago

you couldn't even get a public option through congress what makes you think single payer is possible?

[-] 1 points by jph (2652) 11 years ago

Easy, because the current attempt is a terrible idea, forcing people by rule of law to buy private for-profit insurance is just stupid and should be unacceptable to all. In a single payer plan everyone is covered (for basic health care) and the profits to private-insurance for 'organizing the money' is removed. It is clearly the most beneficent system, and when you have trouble paying for something the most efficient way is best.

[+] -5 points by Dell (-168) 11 years ago

just one problem - the vast majority of Americans wont stand for it. That's why the single payer idea has continued to fail. It's not efficient - look at Medicare - it's is broke. No accountability is not efficient unless you start rationing which is what eventually happens.

[-] 3 points by jph (2652) 11 years ago

Really? I think they will, in fact pools show we do!

No silly, the idea has continued to be quashed by the rich and powerful INSURANCE INDUSTRY.

"look at Medicare - it's is broke" i lov how the repugs get into gov. and then try to break every program of social uplift there is,. and then they stand back point and YELL 'look it is broken!' No surprise really.
To see single-payer in a less-broken-by-it's-opponents form you will need to look to ANY other country in western world, as they ALL have to varying degrees working systems. But yes, the opponents will keep trying to brake these too, as profits for themselves is all these sick puppies care about.

[-] -2 points by Dell (-168) 11 years ago

why do you think they didnt push for single payer ? why do you think thye didnt include a public option? why do you think the dems lost control of the house & so many seats in the senate? It is a toxic issue and no pol wants to touch it because they know that will end their career. Most people still dont like obamacare 2 - 1 want it repealed. You are in a bubble of leftists.

[-] 2 points by jph (2652) 11 years ago

Like is said (ABOVE) Obama's health plan was to make people buy private for-profit insurance, and that is a terrible idea that no one should support.

Obama is a corporatist, and a militarist (fascist), he campaigned that way and he has worked that way ever since. Don't start with the personal attacks, I did not know the 'leftist bubble' was anti-obama, perhaps when I see that I will enter it.

[-] -2 points by Dell (-168) 11 years ago

So who is going to deliver your single payer healthcare if not Obama ?

[-] 1 points by jph (2652) 11 years ago

Why leave these decisions to 'elected representatives' at all? They are always corrupted by power and money, and therefore only succeed in helping the wealthy and powerful maintain their position.

We need to take control of our collective decision-making, take it out of the hand of the few and exercise our collective will. When you take a look at good public opinion polls the majority of folks want simple and quite reasonable things, and the so called 'representatives' do not represent what the majority of people want.

There is no 'partisan' solution, the system itself is the broken element and must be replaced. NO to Obama, NO to Romney,. YES to a ground up rebuild of the political system.

[-] -2 points by Dell (-168) 11 years ago

so you want every vote to be as in the propositions in the election booth such as should the proposed school budget pas yes or no? should the town borrow x number of dollars for a highway project yes or no? Majority rules?

[-] 1 points by jph (2652) 11 years ago

No, what I would like to see, is a Consensus Based Democracy to replace the Representative Republic we have, and we clearly see does not work. (unless you are the 1% works great for them!) As long as you give your democratic power over to a 'representative', there will be corrupted representatives ruling over you.

Remember that the passing of that school budget is an issue of concern for those paying for or going to schools in that school district. Those people affected by a decision need to be involved in the decision making. Not every decision needs a vote, however when we have no consensus, and decisions are made by a 'decider', elected or otherwise we are not participating in democracy.


[-] 1 points by beautifulworld (23740) 11 years ago

You should be banned for that racist comment. Have you read the rules for posting on this forum?

[-] -3 points by hitintheheadgirl (-73) 11 years ago

You can already pay doctors and hospitals directly. No one is stopping you. But, of course, that's not what you're after. So, it isn't really the middleman you're after, it's you having to pay for it. At least be honest.

[-] 3 points by TrevorMnemonic (5827) 11 years ago

Think about roads and the police. Do you want to have to pay the police every time you report a crime? Or does the tax system take care of that really well with a tiny amount being paid by everyone every year?

Think before you speak. I'm talking about perfecting a system for everyone.

[-] -3 points by hitintheheadgirl (-73) 11 years ago

Think before you ask for a handout. You know, when you say a "tiny amount", I believe you. The bigger amounts are someone else to pay. LOL.

I guess we should collectivize everything. I hate having to pay every time I eat.

You should know too that we have thousands of jurisdictions for police that we choose by where we live. We might have two hundred or more just within one top 15 metropolitan area. We also have the freedom to hire private security and many homeowner's associations and even individuals do just that. We even have many choices for home security monitoring, making connections with neighbors to watch things, and even personal protection with firearms. So, even with police, we don't have your singular dictated collectivist solution, not even close.

[-] 3 points by TrevorMnemonic (5827) 11 years ago

What handout? I paid over 6 grand in taxes last year and I'm 25, I make a great annual income for my age in comparison to the average and I have no health problems. I haven't gone to the doctor in over 2 years because I'm in great health.

None of this means a problem doesn't exist and it doesn't mean I'm asking for a hand out either. I'm just saying the system with the police works great... why not extend it to emergency care if it can be done at a cheaper rate than the current system and for everyone?

You could have real universal healthcare and still keep the private insurance option if you wanted... just like with your relation to private security and the police. So you're entire point on that relation was pointless. Taxes for health care not bombing brown people in nations that didn't attack us.

[-] -1 points by hitintheheadgirl (-73) 11 years ago

Because it wouldn't be and police is a very poor example.

Sure, just tax people more and give it away. More taxes, more entitlements, more free shit, sounds like a plan. LOL.

[+] -4 points by aflockofdoofi2 (-66) 11 years ago

You are an idiot. Insurance means paying for massive expenses you couldnt handle yourself. Does your car insurance cover oil chsnges? Brake repairs? No.

Does your homeowners insurance pay for a broken light switch? A clogged drain? A broken refrigerstor? No.

Put $2000 in a savings account and use it for small medical bills. You buy insursnce for catastrophy, not maintainence.

[-] 3 points by TrevorMnemonic (5827) 11 years ago

We don't have police insurance. You only need the police for catastrophes.

Should I call you names now?

[-] 3 points by GypsyKing (8708) 11 years ago

I think at that point medicare for all should be a demand.

[-] 2 points by brightonsage (4494) 11 years ago

Of course Medicare for all is the best way to go, from where we are. We shouldn't lose sight of why it wasn't chosen as the way to go from the start.

One reason is they were afraid to open it up because they were afraid they would lose control and it would get screwed up for seniors. The other reason is that to Congress would lose the opportunity to be politicians, to make deals that they could cash in on (and I use the term deliberately).

They could have made it universal and the cost per person would have been lowered by 15% in the differential in administrative costs (20+% vs 5%) but raised by the high costs of those additional 30m with poorer health. I can't tell you what the net cost would have been. We may find out now.

It's the right thing to do, but can you imagine any repelicans breaking ranks to support it? 2013?

[-] -2 points by Reasonistheway (-13) 11 years ago

Medicare costs are understated by cost shifting. Medicare freeloads in part off of private pay patients which pay providers much more. It's a big hidden tax. It's not a matter if that's good or bad, it just is and if the entire system were on Medicare, these private pay patients would be squeezed away and total payments would fall. That would leave many providers insolvent and would reduce supply. So, a pure Medicare system would pay cost much more than just extrapolating current costs to the rest of the population; there'd be no one left to cost shift.

The cost shifting in Medicaid is dramatically bigger. A practice can have some Medicaid patients, but a practice built solely on them has to be a radically different practice. Medicaid is so bad, that in many cases it doesn't even cover the marginal cost of care. That's why providers are dropping Medicaid; they aren't going to, for example, give a $20 vaccine for $7 and then do that in large numbers besides. They aren't going to do an office visit for $15 and then have that patient be able to sue them all the same.

[-] 2 points by brightonsage (4494) 11 years ago

And private insurers do the coast shifting also. All forms of insurance do it. I didn't just extrapolate it. I merely pointed out that there are savings available as well as increased costs. There are others in both columns. However there are costs shifted to taxpayers by all of the uninsured who show up at ER's without insurance. It is a complicated world, total healthcare costs in the US excede17% of GDP and it is increasing much faster than inflation. Other industrialized countries get better results of half that. Tell me how you would get to comparable outcomes of even 12% of GDP?

I believe that 70-80% of medical awards involve 4% of doctors. Replacing them is a better alternative to capping the damage awards they cause.

[-] -1 points by Reasonistheway (-13) 11 years ago

But doctors get shaken down routinely by excessive claims and it get reflected in premiums. Heh, it's good news for places like Texas. Texas did tort reform and is now seeing a steady inflow of doctors that are now caring for patients, not attorneys.

But cost shifting by Medicaid and Medicare is the biggest. If they become the entire market, there's no one left to shift too and program costs would therefore have to rise considerably as this source of support would vanish.

ERs are because of the law. They can't turn people away by law. The law makes them drop their pants and it shouldn't. They should get legal cover and protection from the parasite lawyers to use judgement in turning people away. The sniffles should be shown the door without legal fear.

Yes, inflation is a problem. But there's a reason and government plans just make it worse. Inflation is being caused by too much insurance and too much government pays. They've caused people not to care about costs. Imagine what would happen to groceries if the bill went to hour homeowners' insurance and tbey took the prices off the items. Inflation. Higher deductibles and co-pays for everything would help. Health savings accouts with high deductibles are a great idea for this.

Other idea exist too like doing away with 50 state by state redundant regulation. National plans would make losing insurance less likely with moving and would eliminate small markets that more easily dominated by a single insurance company. Imagine if car companies didn't have to worry about Japanese cars and not even a car made in another state. It's nuts and should change.

We should also slow dramatically immigration of unskilled people. They immediately add to the problem of those not being able to pay their own way and raise costs for everyone else. Everyone knows that a drop out is a social problem. Just because we importing one doesn't relieve us of the negative consequences

[-] 1 points by brightonsage (4494) 11 years ago

There is this thing called simplicity. What you are describing isn't it. I would like to see 8-10% of GDP for better outcomes, much better.

[-] 0 points by Reasonistheway (-13) 11 years ago

Then skip your next doctor appointment, ban cosmetic procedures, and use other people's money less, it's inflationary. Truly, it isn't that complicated.

Border, torts, nothing for free, national policies, and rolling back the mandates to make basic policies legal.

[-] 1 points by brightonsage (4494) 11 years ago

Find a country that will allow that kind of tinkering and we will see how it works. This is an awfully big lab to start in. You seem to admire Texas, you might do it there.

Then we can judge it compared to systems in other countries.We could even compare it with Massachusetts. Right now we rank 22 and 37 among developed nations on the most common outcome measures and we are, by far, the most expensive.

Do you believe your changes will get those numbers into the top ten and cut the cost by 40+ %? Frankly, I think picking a system with an established record would entail much lower risk and get the benefits much sooner.

[-] 0 points by Reasonistheway (-13) 11 years ago

The problem in Texas is the border. Sixty percent of the births at Houston's public hospital are anchor babies. If we're going to continue to bury ourselves in imported poor people, we're going to continue an enormous pressure on healthcare. When states like Texas simply try to protect themselves, northern liberals flip and call them racists.

MA has big problems. Costs aren't getting better and access is increasing as a problem. Telling people "come get it, it's free" is inflationary. It's essentially Obamacare at it's core. Too much carefree money is chasing healthcare and too many people pay nothing at all. It causes inflation.

[-] 1 points by grapes (5232) 11 years ago

The individual mandate of the Patient Protection and Affordable Care Act is unconstitutional. It is however well within the power of the Congress to levy a tax on everyone and pay private insurers chosen by each person (or legal representative) or via Medicare to provide medical services to people. The Congress can amend the Act if it or parts of it are struck down by the Supreme Court. Universal Medicare for all who do not choose a private insurer is the best and most cost effective way to go.

[-] 1 points by bensdad (8977) 11 years ago

as long as grover is in it
as long as koch is in it
as long as alec is in it
as long as the three branches of government are not ALL Democratic
as long as citizens united is NOT overturned
we will never have medicare for all



Because of the Supreme Court's Citizens United decision,
we cannot accomplish anything significant,
without FIRST ending corporate personhood.
Because 83% of Americans already agree on it - we don’t have to explain or persuade people to accept our position – we only have to persuade them to ACT based on their own position. Pursuing this goal will prove to the world that we, at OWS, are a serious realistic Movement, with serious realistic goals.
Achieving this goal will make virtually every other goal –
jobs, taxes, infrastructure, Medicare – much easier to achieve –
by disarming our greatest enemy – GREED.
I feel that using the tactics of the NRA, the AARP an the TP – who all represent a minority – who have successfully used their voting power to achieve their minority goals - plus the Prohibition Amendment tactics – bringing all sides together - is a straight path for us to success

Our current project is developing and implementing,
a voting bloc petition to create voter support for candidates throughout the country.
We want to vote for candidates who pledge to support a Constitutional Amendment that includes:

Overturning the 2010 Citizens United Supreme Court decision which enabled the flood of secret money that is drowning our political system,
Overturning the 1976 Buckley Supreme Court decision which equates money and speech,
Eradicating the corporate personhood rights invented in the courts that
have enabled corporations to buy our democracy,
Supports campaign finance reform to level the playing field for all candidates.

The People For the American Way found 74% of Americans
want to vote for candidates who support an amendment.

Koch and the tea party and ALEC have the money –
and the government –
and they use them.

We have the people -
and the vote –
and we must use them

Join the our NYC
Corporations are not People and Money is not Speech Working Group
………….( even if you are not near NYC )


regular meetings Wednesdays 5:30-7:30PM @ 60 Wall St – The Attrium

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[-] 1 points by fiftyfourforty (1077) from New York, NY 11 years ago

Foretelling the future is risky but the experts had been saying they expected the SCOTUS to approve the Obama health plan by maybe even 7-2. The "justices'" questioning puts that in doubt. The Congress, the lobbyists, the permanent government in all its guises are against solving the real problems of the 99%, even if Obama personally would if he could. Even this law is a weak compromise to begin with and it won't really bring the kind of healthcare system that is needed.

The whole apple-cart has to be upended. Viva #OWS!

[-] 3 points by factsrfun (8308) from Phoenix, AZ 11 years ago

I think you may be right about the law being overtruned, if only we had at least gotten the public option it would have been a real start, not saying best or anything, just a lot better than what we got, and I think it might have been the thing we needed to get us there, maybe someday.

[-] 1 points by Demian (497) from San Francisco, CA 11 years ago

My own personal opinion is that Obamacare will not reduce costs in the long run and we will be having this discussion again in a decade if the law stands. Hopefully we will get single payer next time.

[-] 3 points by beautifulworld (23740) 11 years ago

I would agree with you. It is more of the same. We need universal healthcare and we could get it rather quickly by using Medicare as the foundation.

[-] 1 points by fiftyfourforty (1077) from New York, NY 11 years ago

Some medications cost ten times more in the USA than in Canada. Also we have a demographic bomb that is called "the baby boom" who are the people born from 1945 - 1964, a big demographic bulge caused by the Great Depression and WWII. these people are now getting old, some are retiring, and this is the time of life when most people get seriously ill sooner or later. It means if we are committed to preserving both human life and its quality for this generation it is going to cost. Someone.

[-] 0 points by Dell (-168) 11 years ago

oh you mean single payer? Answer - No.

[-] 0 points by Copper12 (9) 11 years ago

Obamacare prioritizes people for care based on their ability to recover, it is a lot like Englands where they will give you surgery and send you home right after. It also forces people to buy it which is unconstitutional.