Robamacare, Obomneycare, or Medicare for All?

Mitt Romney’s choice of Paul Ryan for running mate has set off a flurry of campaign excitement.  This could be the best news for Medicare in a long time—Ryan’s not-so-subtle Medicare killing plans might turn 2012 into the “Medicare Election” after all.  If so, privatizing Medicare could become a new 3rd rail no politician will dare to even glance towards any time in the near future.  This is a great time for people in both parties to take a strong position on Medicare—we need to let folks know we are NOT willing to let granny get shoved off the cliff. 


It’s important for Dems not to get too lulled by their own campaign ads, though.  There are other ways to ease granny off that cliff.  Some are sneaky enough that we might not be able to haul her back up by the time we realize she’s rolling.


It ought to be pretty easy to see the risks in converting Medicare to a voucher or “premium support” system, where rising costs could easily render our elderly either uninsured or unable to afford to use their insurance.  Interestingly, the idea is very similar to what the ACA does in the upcoming “exchanges”, and we will see the same problems there.  Low income families are highly likely to forgo needed care and leave that brand new insurance card in their wallets, because of the still daunting co-pays.  If you doubt that, come hang out with me at work for a few days and listen to the parents with minimum wage jobs who have employer-provided insurance.


There are FaceBook memes popping up on the pages of my intelligent friends saying Obama is using the Medicare cuts to save Medicare—that this money was cut by reducing fraud and excess payments to Medicare Advantage plans (private insurers who cover Medicare patients at higher cost than traditional Medicare), whereas the Romney/ Ryan plan would line corporate pockets.  Not exactly!  Some of the ACA cut is to hospitals, in the form of DSH reductions and value-based payment cuts to hospitals that serve the uninsured.  It is true that the ACA cut Medicare Advantage payments, which should have been just eliminated.  Then Obama’s administration (not Congress, mind you—this was an executive action) turned right around and began handing the money back as rewards to Medicare Advantage plans with only average performance.  Corporate pocket-lining is a bipartisan effort.


The ACA generally works to direct more money into the private insurance system, including taxpayer subsidy of pricey overheads.  For those who believe the ACA clearly benefits some specific groups and so is a step in the right direction, I have thought of a better metaphor than steps.  It is like global warming.  Sure, there are some chilly areas that will benefit from temperatures rising—more tourists, longer growing seasons.  The net effect is detrimental.


I have been mulling over partisanship a lot in the last few weeks.  I was raised a Democrat and even though I knew the party had problems, I made some unquestioned assumptions I now believe were incorrect.  I have decided to join the Green Party.


Between the two major parties, there are some clear differences.  The Republicans yearn to undo Roe v. Wade, bring back sexual repression, and rein in women/ minorities to their liking. They would love to end critical scientific and historical education, because the particular biases of the far right are unstable in an educated public. They worship guns and encourage the bizarre belief of some right-wingers that it would be possible to fight off an out-of-control government (complete with weapons of mass destruction) by personal armaments. The Democrats don’t so much offer improvements in those areas as they do a little more security in the status quo.


Both parties, however, have the same underlying primary purpose—to protect the interests of big money.  I doubt if this is a conscious purpose on the part of all involved—I’m not that cynical.  But in practice, in history, it doesn’t matter, because that’s what happens. The Republicans serve big money by trying to lower regulation and by cutting the “social wage” (the provision of a floor for fundamental human needs like food, shelter and medical care), so that the poor are forced into jobs they might not otherwise accept and are kept so busy scrambling for their lives that they don’t have time or energy to organize an opposition. To their base, they frame it as Personal Responsibility.


The Democrats serve money by increasing regulation to stabilize and rescue corporations when they are at risk of collapsing from their excesses and by increasing the social wages when public destabilization looms.  To their base, they frame it as a Safety Net.  The party appears to be more socially evolved for a few reasons—it is partly because they needed the progressive, socially generous block of voters (the ones Republicans bypassed in favor of Randians and religious fundamentalists).  It is also partly because some of those social policies serve particular corporate interests better, and partly because the appearance of social responsibility attracts candidates who really do believe we have a social duty to each other (even though they find, once in office, that they can’t do nearly what they hoped for).


Besides serving the interests of big money, both parties have more in common than either side would like to believe, in terms of aggression and erosions of civil liberties.  Worse, they are both creating an inexorable trend towards loss of democratic functioning in our government.  They are both making our votes count for less and less, by subverting orderly representative and judicial processes.


Most of you probably already know this—I’m saying it mainly to lay some groundwork for the rest of this post.  There are some very different possible responses to seeing this sad scenario.  One option is to say we should work within the Democratic party itself, to turn it in a better direction. This was why I stayed in the party so long.  It’s a little better reasoning than the old story that ends “with all this shit in here, there must be a pony”—and it goes like this:  “with all these great progressives in the tent, there must be hope for this party.”


After arguing this point with a new email friend, where I vigorously took the side of the Democrats, I read a book this friend recommended, and I have changed my mind.  It isn’t the repeated offenses of the Democrats, or the examples proving it is just as much a corporate party as the other, because like you, I knew that.  What got me was the history of progressive movements.  Time after time, when progressives have allowed themselves to be folded in, they lost their battles.  The only times they won any major ground—Civil Rights, for instance—were because of intense independent grassroots pressure.  I didn’t want to believe that and tried to find an exception the author forgot.  I couldn’t.  Can you?


Being scientifically minded, I just can’t ignore empirical evidence.  You should read the book—it is like watching Lucy pull the football away from Charlie Brown way too many times. 


We can’t do the significant things we need to do by working within the two party system. If we want big deal changes like real healthcare reform, not just rolling off the cliff instead of being thrown off, we need to take this seriously.  By staying under the big Democratic tent, we give those elected an easy out—they know we are terrified of the openly vicious alternative and will generally forgive them by blaming their failures on the other party, so our vote is in the bag.  This means they only have to please their corporate masters.


I saw this in action just last week, when a Democrat friend of mine heard me say some true but unpleasant things about the ACA.  She said she agreed, but that we should be careful NOT to report any of those things until after November 6, because it would give ammunition to the other side. Think hard.  If you have to lie to others or yourself to support a party, there’s a problem.


One way a third party can influence policy is by threatening or throwing elections in swing states—that could get us some important things and possibly even a change as significant as single payer health insurance.   But only if we don’t wuss out and throw darts at Ralph Nader for doing the right thing.  Another way would be if folks stuck with it and didn’t go back to the Democrats every time a small point was won, allowing the US to gradually build a true third party free of corporate control.  The time to start is now.  If we wait until it looks like an independent party can do something substantial, we will never start.  That’s an idealist point of view, I know, but it isn’t impossible.  All other developed democratic countries have some form of Labor party except us.


To succeed, we have to focus on one central objective—attaining responsive representation in government, so big money can’t rule the day.  Without that, it doesn’t really matter about the rest, because once we’ve fully lost the power of our votes, we will have only as much civil liberty as suits the most powerful big money interests.  We have to keep our focus on representation, the same way meditators deal with distractions.  If we get stronger, the efforts to distract us will intensify—be ready for it.  They’ll wave gay marriage at us, reproductive rights, maybe even changes in drug policy—don’t bite unless it comes attached to democracy.


Some folks, like Morris Berman, believe it is already too late and no road forward is possible for the United States.  If he is right, my Dem friends are probably doing the best thing.  Either one should expatriate, as Berman did, or one should at least hang with the party who won’t rape us with ultrasound probes.  It is not unreasonable, if one must go off the cliff, to choose being rolled over being thrown.


If it is NOT too late, there is only one real choice for progressives.  We must refuse to serve as arm candy that makes the Democratic party look safe.  We must stop letting Lucy hold the football.  We must stay out, and we must do our best to gather a coalition of others who will challenge the powers that be. 



Filed under Healthcare reform, Politics

15 responses to “Robamacare, Obomneycare, or Medicare for All?

  1. Chris Gamboa

    Pippa, after browsing through the Green Party’s platform, I can say I agree with several of their policies more than those of the Democratic Party. Nevertheless, I would much rather have a Democrat as President than any of the recent Republican candidates; by voting for any third party, one may make a statement, but with less than 2% of the popular vote in the 2008 presidential election going to third parties there can be no real influence. My vote is to continue working within the Democratic Party.

    I think that pockets of the country can be led by the Green Party, but for top leadership of the expansive, diverse nation that is the USA, the Democrats and Republicans will lead THE parties for the foreseeable future.

  2. Melissa

    If only the Green Party could succeed! I tell people I have been “wasting my vote” ever since the first presidential election for which i was eligible to vote. I say this because a Republican always wins this state. But still, I vote. I’m not thrilled at how “right” the Democratic party has gone but I’ll hold my nose and vote Obama anyway. Romney’s VP is enough of a right-wing scary guy to assure Obama wins, in my opinion. Dismantling MediCare for some “magic vouchers”????? My husband is 53, right at the age where he’s paid a lot into social security, etc. and is HOT about the idea he won’t get it. Oh and Ryan is against IVF-let him look at my beautiful niece and tell her she shouldn’t be here!

  3. Warm Southern Breeze

    As I see it, there is a great struggle for the future direction of this nation. And, the struggle tends toward polar opposites – Privatization & Regulation. For several reasons, I have come to conclude that the notions promulgated by the Privatization camp will do more economic damage than the notions promulgated by the Regulation camp. And for the record, I am in the latter. While I hope that I approach issues pragmatically, I understand that the complexities of the issues do not lend themselves well to 5-second sound bites, and that to fully engage any willing audience, one must patiently lay ground work for the case, and support it with fact, dispelling fallacy, and patiently explain hows, whys, and wherefores of the issues. Again, because most simply do not care, they neither care to read the Executive Summary, and therefore abandon the issue to others.

    Rationally, a significant part of why I adhere to the Regulation camp is for a simple reason. Those who assert we need less regulation, fewer rules, and smaller government are – in my simple, yet logical opinion – inherently tilting at windmills. Why? Because in a nation of 300M+, wherein we have technological advances that not even the Founding Fathers, in their wildest or most fond imaginations could ever dream of, it is preposterous to imagine that we would have fewer laws, or regulations. Analogously, I don’t wear the clothes I wore at age 6, nor 16, nor 26, nor 36 – and frankly, I never will. I have grown and matured, and am no longer fit for them, nor they for me. I need larger garments to attire myself. Similarly, our nation, with it’s myriad complexities of science, technology, innovation, commerce, and the host arrayed in practically every walk of daily life, it would be an absurdity of the highest order to imagine for even a moment that somehow, someway, our nation should revert to laws, rules and governance (or the lack thereof) for 1776, or any other age.

    Having thus expressed, in consideration for the matter about which you wrote, I would say that regulatory control is not a thing to be feared, for regulation makes things stronger, more resilient, robust, and in fact, suits the thing regulated for optimum performance. Consider the examples of our bodies, our automobiles, and sports games. Our bodies are perfectly regulated in every system, from our circulatory, respiratory and digestive. Remove or alter one or more regulatory mechanism by disease or injury, and see what happens. Similarly, the automobile spark plug is tightly confined to it’s position, where it performs subject to the regulation of timing. Liberate the spark plug by removing it – Free the spark plugs! No more regulation! – or, change the timing even 1°, and the automobile engine will be set upon a course of failure, which eventuality would be most costly to repair, or replace. And any sports game without regulation is properly called a melee.

    To the extent that we the people, by and through our governance can influence industry to do, or not to do any particular thing, any particular way, I perceive that the natural role is to require industry to operate for the greater good. And the “free market” way to influence it is to become a larger-sized customer. In essence, it’s the market philosophy that asks & receives often significant consideration in price reduction by purchasing in enormous volume.

    To be certain, we do have a balancing act, in which we encourage private enterprise while not engaging in efforts, either obtrusive or unobtrusive, to stifle growth, innovation or change. And I consider the role that our federal government has had in the same in three cases:
    1.) Eisenhower Interstate System – originally envisioned as an escape route for major cities in the event of enemy attack, it actually caused previously absent interstate commerce to develop and thrive, all in the private sector;
    2.) Global Positioning System – originally envisioned as a means of battlefield location, it has changed the way the entire world navigates, increased safety, and fostered myriad industries, enterprises and jobs, all in the private sector, and;
    3.) Internet – originally envisioned as a means and method of battlefield communication, it has literally transformed the entire globe, and the way we conduct business, and in the process, made exceedingly many billionaires and millionaires the world over, all in the private sector.

    Concluding, in practically every case – in fact, I cannot think of even one case wherein our government has ever owned the means and method of manufacture, for in every case (even during the New Deal) materials and manpower always come from the private sector – I remain a strong proponent for government spending, particularly on economic infrastructure, and that includes healthcare.

    • It is not that I disagree with regulation, it is how we are using it– and that is for the purpose of keeping big money in power. We have not used it to rein in concentrated wealth, corporate fraud, or many abuses of the environment. We are addicted to an expansionist, constant growth economy, which requires putting the good of the people second. Even socialism can screw up that way. Commerce does not have to equate to corporatism.

      We must end the two party stranglehold that is gradually taking away our voice through the vote and replacing it, as you mention, with the only path of influence in a market-based government– buying power. That is not a democracy.

      I am for a mixed economy– private commerce plus citizen ownership of key elements such as health insurance, the military, energy and transportation. I am not for a mixed control of government between citizens and big money, because the result is eventually a shutout of democracy.

      • Warm Southern Breeze

        Agreed. Our preceding generation – or, perhaps more accurately, the three prior – understood aspects of economic prosperity that seems to have been lost, even wholly reversed in their children. As my dear father – who grew up during the Great Depression – says, “‘Get all you can, can all you get, and sit on the rest’ is not a good rule of life.”

        In order for money – that abstract representation of commercial worth, or value – to do good, it must be moving. It mustn’t sit idly by. And in some way, it’s like us, for we are best when in motion.

        Granted, our nation’s population will continue to grow, and so therefore, it is incumbent upon us to practice effective size management – that is, to not merely to disallow operations to become so big that they are absolutely unwieldy, but learn how to proverbially, “eat an elephant – one bite at a time.” I perceive that such a concern – the unresponsiveness of size – to some extent, may reside within the “smaller government” ideologues. And yet, I believe it is through regulation that we can constrain the abuses inherently resident with money and influence it brings.

        Money can do good, not merely for the one whom earns it, but for many others as well. And there are examples of men now living who are allowing their wealth to do good. Two men doing that now are Bill Gates, and Sir Richard Branson.

        To illustrate instances of doing good, I heard the BBC’s 5 Minutes With” interview Richard Branson, and in response to the question “What’s it like being a billionaire?,” he said, “It’s got a lot of responsibility, but it enables me to do things, which hopefully I can feel proud of, and make a difference in the world.”

        The interviewer followed up with, “Can you ever have enough money?” Sir Richard replied, “You only need one breakfast, one lunch, one dinner. And therefore, the money aspect is not actually that important.”

        Memento mori.

        Or, as we Southerners have heard our beloved Allman Brothers Band sing, “You can’t take it with you, everybody knows. You can’t take it with you when you go.”

        Can’t Take It With You
        BMI work #177287
        By Richard Forrest “Dicky” Betts- BMI – 56772062
        Don Johnson – NA – 0
        EMI BLACKWOOD MUSIC INC – BMI – 223437493

  4. CCR

    I find the following so offensive I just can’t be bothered to read further: “The Republicans yearn to undo Roe v. Wade, bring back sexual repression, and rein in women/ minorities to their liking. They would love to end critical scientific and historical education, because the particular biases of the far right are unstable in an educated public. They worship guns and encourage the bizarre belief of some right-wingers that it would be possible to fight off an out-of-control government (complete with weapons of mass destruction) by personal armaments.”

    You are smarter than to paint half the people in this nation with such a broad stroke. If you can’t attribute intelligence and goodwill to the vast majority of those who disagree with you, then you need to get out of your liberal echo chamber and go meet a few real-life conservatives. Absolutely NOTHING of what you said there applies to me or anyone I know.

    Epic fail.

    • Was talking about the party itself and top level leadership, not the public. Thought that was understood but maybe not. I don’t know what you are seeing in your state, but everything I said is true of the party in mine! There are bills or policy efforts in place i could give as examples, but that wasnt the point of the post. Just as with the Dems, the leadership does not reflect the people but caters to a vocal but influential group. In your case, it is the Koch Brothers. Certainly there are and have been leaders in your party with much better motives and great intelligence, but your party is currently being taken over ideologically by Tea Party elements that make old guard conservatives blanch. They are being overrun by fools like Rush Limbaugh, but they aren’t doing much to stop it.

      These issues are just as superficial to the real underlying agenda– big money– as the Dem platform is to theirs– big money.

  5. Barbara Power

    I have learned that intelligence is innate and does not belong to any class of people, or political persuasion. I found, on occasion, common ground when following the career of former republican senator Chuck Hagel. I also questioned both Hagel and Biden about the Iraq war and Hagel was far more balanced and articulate. Both voted for it, but Biden just got ticked-off for being questioned. And yet, after being politically aware for most of my life, my fright level continues to increase as the decades pass. I found Reagan far worse than Nixon, the Bush’s incredibly more scary than Reagan, and Romney/Ryan make me feel like we’re on the eve of a war against our own citizens. I am more frightened than ever.
    The Dems, as Pippa correctly points out, are just as bad but finesse their way into our hearts under the guise that they care.
    As for the Green Party and gearing up all the time, $$$$, energy to get something like this off the ground, my concern is twofold: who will care enough? and so many are in such despair and financially strapped that there is no energy to do the grassroots work. Even my young sons already feel the life is being squashed right out of them as they try hard to join the adult working world and find it … not to be there for them in any meaningful way. They see the world as being run by cartels and feel they will have no choice but to “join” the mainstream just to put food on their tables.

  6. concerned cynic

    Extending Medicare to cover everyone would be administratively very simple. I propose that there be a $5000/year deductible for each family. Hence this expanded Medicare would be primarily a catastrophic policy. Medicaid would cover the 5K for the bottom 30% of families. For the remainder, partial coverage of the 5K would be negotiable with employers.
    Financing all this would probably require require raising the Medicare payroll tax from 2.9% to at least 6 or 8%.

    • Actually, the better plan, Medicare for All, would be an improved deduction with zero cost-sharing at the point of service. The estimates of payroll tax are in the 4.5 % range from employees and similar from employers, to replace the current MC tax. There would be some additional capital gains tax, but for most of us this would be all.

      • Barbara Power

        I have believed that 676 had as one of its goals a separation between the notion of receiving healthcare and being employed. If financial calculations are still being done with assumptions about employment levels then the current mathematical outcome will be wrong. 676 was conceived with employment levels that are no longer intact. This is problematic because it is still assumed that gainfully employed citizens will be the major revenue source to pay for health care.
        The suggestion of a universal $5000 “deductible” may also be a non-starter for many average citizens. It is reasonable on paper but I encounter many patients/families who would not have that $5000. This suggestion also assumes a hard-wired connection between access to health care and having a real job. I do not know one single new college grad who makes any of these assumptions or connections … they already know the lay of the land.
        If policy makers in the USA really cared about this, we would need to see a far more humane balance of wealth, and the tax structure — including tax subsidies to corporations and the wealthy — in this country. Then there would be resources for health care, education, infrastructure.

  7. Pippa,
    I just found your blog and thoroughly enjoyed reading some of your posts. Ironically, about 2 months ago, I began going through the entire Affordable Care Act, just as you did last year. I’m posting my thoughts on my website, I think that we probably agree in most of the key areas. I’ve continued to try to maintain some degree of objectivity, but it gets harder the more you go through the Act.
    I am a lifelong democrat (with a short shift to the republican party). I have actually thought of myself as a “liberal republican”, but that’s a hard place to be. Gary Johnson has caught my interest, but the extreme elements in the libertarian party tend to push me away.
    I used to give my dad a hard time for “throwing away his vote” by voting for the green party, but I have to say that I’ve come to respect the concept. How will we ever make change in this country if we stick to the status quo. What most people don’t know and republicans and democrats won’t admit, the Affordable Care Act came out of a lot of work previously done by the Senate Finance Committee, and had a ton of republican based concepts in it. Those who think that President Obama is a far left liberal don’t pay any attention to actual policy.
    This is all about politics and partisanship, and that is unfortunate. Now that I’ve found your blog, I will continue to follow it. I hope that you’ll take a look at mine.

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