The expansion is, as you say, tied to the Exchange Access Study.  The likelihood that expansion is a foregone conclusion is pretty darn high.

If there are people out there who do not have coverage equivalent to what you can get in the Exchange, then the Commissioner can open up the Exchange.  If the public plan is really so hot and public coverage is as good and affordable as single-payer advocates and other countries have maintained for years, then the answer will be an obvious, "Yes, there are people outside the Exchange who don't have coverage as good as what's offered in the Exchange," at which point it will be open to all businesses.  If the entire private insurance industry has transformed itself overnight into a universal best value for all Americans that's as good or better as what's offered in the Exchange, then the Exchange won't be opened. 

This will probably be the same year the Cubs win the World Series.

The description of the Exchange Access Study is less than a page long -- there aren't any obvious strings attached to it.

Well, we should at least call it what it is, which is a trigger.

Perfect!

We need a uniter, not a divider.

Carla, please justify your statements with concrete evidence of "cherry-picking insurance companies that masquerades as a healthcare system in this country"

My insurance paid for a $25K operation and I only paid $450 out of pocket with Pacificare.  Did you buy insurance from a bum, driving around town with stickers on his window?

I have real evidence of private insurance WORKING for me.  Where is your evidence of a majority of citezens insurance NOT working for them?

What Insurance company?  What was denied?

The single payer bill in the house (HR-676) would take 15 years to implement, so perpetrating the concept that anyone is talking about doing anything overnight is misinformation.  NO one is talking about pulling any rug out from under the health insurance industry, but the industry will contimue to shred our safety nets (for which we pay dearly) just when we need them most, in a heartbeat.

Agreed. So, how do we get the kind of rapid action on our behalf that the government took to protect the fortunes of those at the top?

BTW - My congressman wants me to know that the decision to cover everyone is a bad idea, that most Americans reject it and that the degree to which governments are involved in other countries ruins their healthcare services. That's why ours' are so much better. One of the sources of data for his arguments is in this Quinnipiac poll that suggests to me, if nothing else, that many Americans need to be treated for multiple personality disorder: http://thepage.time.com/quinnipiac-university-national-poll-on-public-insurance/

Single payer would take 15 years to implement? That's too long. Just lower the Medicare age to one hour and cover everyone overnight.

Very well said.  We give, give, give to the government which in turn gives, gives, gives to Big Business and when we want the gov't to stand up to the Fat Cats on behalf of the people, suddenly our country is too overspent, too gov't regulated, and heaven forbid we attempt to apply a 'social reform' for the health of our country because that word seems to dredge up the all fearing 'Socialistic' and (gasp!) 'Communism' ideals up for all those tormented by the cold war.  Talk about a trigger!

Your argument really only works if you ignore Austalia, New Zealand, South Korea, Japan, Taiwan, Singapore, Germany, Netherlands, Switzerland, Italy, Greece, Sweden, Denmark, France, Norway, Spain...

Here's a hint:  there are more countries in the Western World than Canada.  All of them pay less per person than we do on health care.  All of them have higher life expectancies, lower infant mortality rates, lower obesity rates, lower instances of chronic disease overall (not just picking the one type of cancer that makes your case best), higher use of primary and preventative care when they need it -- and yes, that includes just comparing those of us *with* coverage compared to those in their country with coverage.

It's a shallow argument, to say the least.  If you have to ignore most of the Western World to make your argument, it's probably not worth making.

Well, Tim, you beat me to it. Making Canada a punching bag as if that's our only alternative falls short.

I would rather boast that my country has the "best" and not just something "adequate" and I would not call the exclusion of 50 million Americans a price to pay to keep providing the rest with "adequate" care.

It would also be interesting to know the definition of "adequate" since the WHO ranks our system below Costa Rica's.

BTW - keeping government out of the private sector gave us the failures of Enron, AIG, GM, Chrysler, debt-based derivatives.

And yet Canadians voted Tommy Douglas the greatest Canadian of all time.. go figure.

http://en.wikipedia.org/wiki/The_Greatest_Canadian

And people who end up far sicker than they would/should be had they had access to preventative care cost FAR more and use FAR more medical care.

Is it smarter to treat diabetes, or wait until eyesight, limbs and kidneys are lost?  Do we stop asthma and rheumatoid arthritis in their tracks, or allow them to progress into devastatingly debilitating illnesses?  (Don't even ask me about cancer.)

How long do we want our wait persons, hair dressers, store clerks, child care workers, etc. walking around speading those nagging coughs before they are able to see a doctor?

And what if those nasty uninsured people end up taking our space in an ER with their gosh-darned preventable emergencies just when we need them most?

From my personal contacts, I can testify that Canadian system is in fact much better then what we got here.

If you (Richard F.) want to trade horror stories why not share some well documented ones from the dark human-mass alleys and 50-million-people-wide cracks of the US private insurance system? It is all well documented, books have been written about it, documentaries have been made about it, each of your neighbors has few horror stories to tell you about it. Like, can't get heath insurance once you get sick, get dropped from coverage just as you get sick, loose coverage shortly after you loose job and get sick, file for bankruptcy and loose your family because you get sick, etc. The lies about Canadian system spiced with random propaganda phrases such as: "Universal Health Care has failed throughout the western world", are just part of the propaganda war that is waged from inside on the American people. It comes right from the Health Insurance Industry Play Book.

No, we don't have to make a business opportunity from every human misery. Eliminating the middle man (private insurance) who adds nothing but takes away 30c of every health care dollar makes economic and any other sense. What we have now is not a free market, it is a free profit hunting season on peoples health, highly protected market which makes no economic or public sense because the incentives are wrong and more the "competitors" more fragmented their power is to lower the cost where the real cost comes from, and more incentives they have to cherry pick and deny the coverage as the only practical way to increase their profits.

If its about healthcare then why does the CEOs make so much money? Its by denying healthcare to the average person paying their preuims. Live long enough and you will have a preexsisting condition. Insurance dictates to the doctors how to practice medicine ask your doctor. They can give you only 15 mins at the office because they are not only seeing those in the office but hundreds throughout the day if they want to make a living. Insurance is about greed not health. Watch sicko and please don't ever get sick in america. The number one reason people file for bankruptcy medical bills.

Mary Ann Thompson- your comments are realistic and true.  But, if you have government insurance (which is definitely not free, folks) you're lucky to see the doctor for 15 seconds.

Jane Rodriquez--is that what people on Medicare tell you? The folks over 65 who are covered by government insurance (Medicare) have been very happy with it for the last 44 years. I don't think they would be pleased with it if their doctors only saw them for 15 seconds.

Hi, Carla-

Did you talk with every person over 65 who has Medicare?  If you conducted a scientific study, I would be interested to know the details.  Yes, I have talked with numerous people who have Medicare, to answer your question.  Also, I have talked with many people with disabilities and people with terminal illnesses.  I can also speak from personal experience.  The regulations probably differ between states, but where I live doctors are limited in their time (and treatments ?)provided for Medicare patients.  Many doctors have stopped taking Medicare- leaving Medicare insured people without health care- because of so many regulations and paperwork.  It's simply not worth their while.  I can not speak for all Medicare beneficiaries and neither can you, but everyone's personal experiences are valid.

On the issue of Medicare:  Some of their customers like it and some of them don't, probably.  That is likely true of any very large insurance.   But, to figure out this health care reform puzzle, I think it's important to ask ourselves this question:  Why is uncle sam cutting away at least half a trillion dollars from Medicare to finance health care reform?  Doesn't it seem contradictory that they are promising to develop a "public plan", yet drastically cutting back on an already existing "public" insurance?  Think about it.

FYI - A colonoscopy is a real-time diagnostic and screening procedure.  It is performed by a gastroenterologist and is not "read" later.  The doc performing the colonoscopy may take photos during the procedure for future reference.  And unfortunately there is a currently a large proportion of the US population opting out of getting screening colonoscopies due to lack of insurance coverage and poor public health outreach, which leads to more people with colon cancer diagnoses that may have been prevented by screening.

It's actually unusual to include an explicit timeline.  The operating assumption most of the time when you're creating a new agency or benefit is, "When it's ready..."

Hence the language on the community health insurance option includes no time determination.  When the Gateways are up, when the provider network has been created, then it gets offered.

I would just use the document from the House committees, as posted by Jon Cohn:

http://issuu.com/thenewrepublic/docs/timelineforhealthreform/3?mode=a_p

The "turn the page" interface takes some getting used to, but the document itself is very easy-to-read.

I think that both a 1000+ page bill written in language no ordinary person can understand, plus that has the support of the AMA, make me wary....but I checked and that exact phrase does not appear (yay).  From the testimony I heard on C-SPAN, it appears as if age and number within a family may be the only two reasons for paying higher rates.  One republican congressman seemed upset that "slobs who don't take care of themselves" would not have to pay more.  Another congressman pointed out that a person who takes care of himself but develops epilepsy, or has a child with diabetes, also would not have to pay more.  Ending legal discrimination against sick people (no matter why they are sick) would be a very good thing and a huge step forward.

Hello, William and Janet-

I agree with you completely.  The question is, now that the greedy big interests are drowning in debt and have looted social security, how are they going to keep feeding their greed addiction?  Think about it.

Of course, the corruption of our electoral campaign process is the root of the problem. You are 100% correct!

However, having worked very hard, myself, to get the issue of publicly funded campaigns out in front of the citizenry, I have to say it makes advocating for single-payer healthcare a relative cake-walk.

People literally say to me: "Yeah, I know you're right about campaign finance reform. And I just don't care! I can't get excited about it." Smart, educated people. They simply don't make the connection on a gut level. When their friends and relatives suffer or die for lack of healthcare, they definitely get that. But they don't understand that Americans are actually suffering and dying because we do not publicly fund our campaigns. Yet it is true.

And instant runoff voting? Dream on. Whew! I feel enough like Sisyphus as it is!

Your state's public health care arrangement sounds good according to what I have heard from you.  Maybe the rest of the country can learn from it if it really is that good.  I do wonder, though, if your relatives had gotten the same kind of medical treatment if they were elderly, poor or disabled.  Someone pays the bill and that is exactly the issue which our government is grappling with right now.  We need to look beyond the trees and see the forest.

"I never hear talk here of getting rid of our Commonwealth Care." -- That's great, I'm very glad to hear it. Maybe I can get my loved ones to move to Massachusetts with me!

Here in Ohio, things are pretty bad. We have a single payer bill in the legislature, but there's no evidence it will ever have the votes to pass. Kucinich of course is a national leader on single payer and I know about his amendment that passed the committee yesterday. But it's amended to the 1,000 page HR3200, and the overall bill is very far from being passed. It's also far from being true reform.

at least Kucinich managed to get a provision in the fed. bill that would allow states to enact universal single payer at the state level if they want it. We have one in the legislature too in Illinois, but it is not likely to get passed anytime soon. My understanding was that the Mass. plan was dropping all LEGAL immigrants from the program. How enlightened! :(

How are the "staggering deficits" of publicly/privately funded Mass. health care going to get paid?

"savings to Medicare" and "preventive care"???  I assume you are referring to the "cost savings" which are being touted by uncle sam and the big industries involved.  Do you have any REAL idea of exactly where the half a trillion dollars from Medicare are going to come from?  You see, the country has the same problems that Mass. has re: health care- namely, "staggering deficits" *in the words of Carla Rautenberg).  These "cost savings", as the big players like to call it, is also referred to as "rationing".  Can you expain, in facts, exactly how it will be implemented?  Maybe you should find out.  Re: Preventive care:  It has been proven that it would not be worth the price it would cost.  There is no justification for it.  I am not opposed to public health care, but I am in favor of fixing the present public health care system first.  It is horribly broken.  I am also in favor of fiscal responsibility on the part of every U.S citizen.  I am opposed to paying for any proposed public health care plan by cutting back existing insurance benefits to elderly, disabled and terminally ill people.

Jane claims:"Re: Preventive care:  It has been proven that it would not be worth the price it would cost.  There is no justification for it."

What exactly do you mean by "proven"? Reference please.

Jane writes: "I am also in favor of fiscal responsibility on the part of every U.S citizen. "

You mean like - you get sick, sorry pal, you are on your own, it is your fiscal responsibility to pay for it???

I do.

You seem to suggest that it's impossible to remove any money out of Medicare without a patient being denied something.  That's clearly not the case.

1.)  Reimburse Medicare Advantage plans at 100% per beneficiary cost instead of 114% (in short, stop subsidizing private insurance just because it's private.)

2.) Reducing reimbursement for digital imaging, given that the current rates presumed that the machines would only be used 50% of the time.  Similarly, change physician reimbursement rates to bring primary care into parity with specialist care.  (http://healthcare.change.org/blog/view/medicare_payments_a_second_front_on_health_reform)

3.)  Shift towards long term care and home care and away from institutionalization as a default.  Those who actually need insititutionalization should get it.  Those who don't and would prefer another, cheaper option should get that.  Also, they'd be much happier from a quality of life perspective.  (http://healthcare.change.org/blog/view/some_honest-to-god_impressive_ideas_on_funding_health_care)

4.)  Productivity adjustments in payment rates.  Not actually rationing since it's accross the board -- it's just good accounting.  (http://www.whitehouse.gov/MedicareFactSheetFinal/)

The short version -- trim back federal subsidies for large corporations, be they insurance companies, pharmaceutical companies, or medical device companies, where the subsidy isn't making us healthier -- they're just making the industry more profitable.  The majority of Medicare and Medicaid patients should not notice the difference.

You're welcome to think a larger conspiracy is at play, but the proposals do not seem to fit your theory.

Tim, politics is about competing interests.  Health care reform is a perfect example.  Your view is blatantly very limited.  You have provided an excellent example in your latest post.  I'm not sure who it was directed at, since it did not specify, but it is a laundry list of medical practitioners' opinions based strictly on their views.  It is unfortunate that in the case of health care reform, so many of the parties are so consumed with greed that they can't even consider the viewpoints of others.  I would not call the health care reform dialogue a "conspiracy" as you do, and I don't know of any one on this thread who has a "theory" as you accuse.  It's so sad that you're knowledge of this issue is so limited. 

It took me long enough to write my comment that someone popped in before me.  I was writing in answer to "Do you have any REAL idea of exactly where the half a trillion dollars from Medicare are going to come from?"

My answer was "I do" -- and I laid out the proposals that are on the table.  These aren't really my ideas -- they're the proposals that have been made by those in Congress and the White House.  I rather think most medical practitioners will wish some of these reforms won't happen -- particularly practitioners who do a lot of image scans.

Could you please clarify where you believe additional cuts to Medicare and Medicaid would come from?  And possibly provide links, as I did?  If my knowledge is so limited, please enlighten me, as well as the rest of the folks on this thread.

Peter:

It appears that you are very confused.  You directed your comment to the general audience, but then asked questions which appear to be directed to me specifically.  But, despite your confusion, I will answer your questions and hope that they will not be misinterpreted.  First, you questioned my position on single payer.  You ask if it is good or bad.  That's a very "black and white thinking" question.  Like the broader issue of health care reform, it is complex.  But, since you obviously prefer simplicity, I will say that GENERALLY I am in favor of it.  In fact, I stated that clearly in an earlier posting.  And, by the way, it is unfortunate that very often in these threads, people either take one extreme or the other instead of sharing ideas, exploring problems and discussing solutions.  Before you label me as either "Pro-public plan" or "Against public plan", let me add that I QUESTION (AS DO OUR CONGRESSPERSONS, THE GENERAL PUBLIC, ETC.) NOT ONLY HOW IT WILL BE PAID FOR, BUT THE SPECIFIC PROPOSALS WHICH HAVE BEEN PRESENTED SO FAR.  If we were given honest, detailed information in that regard, I would unquestionably support it.  However, right now, there are many unaddressed issues.  Why are we not being given the answers to the issues?  Your question re: preventive care concerns whether or not it would be cost effective.  The information I have received states that it would not.  I receive a great deal of information re: health care reform and do not always keep track of the exact source, although I'm almost positive that this was in a MSNBC article and I'm certain it was from a very credible source. So, I hope that I have cleared up at least some of your confusion.

Jane, if you want to take a position that is contrary to a common sense and sounds very much like a talking point from the Prevent-Reform-At-All-Cost-Industry Playbook, such as your claim :" Re: Preventive care:  It has been proven that it would not be worth the price it would cost.", your use of terms "rationing", "individual responsibility", "cost", etc. which are well known red-button-code-words from the above mentioned book, you need to provide a credible reference. Otherwise, your reputation will suffer. As far as your reference being some article on MSNB, are you sure it was not on FOXTV?

However, all this arguing is not important since you say that you "GENERALLY" support a Single Payer!? Ok, I got a few Single Payer petitions for you,  I am sure I will see your name there:

http://healthcare.change.org/actions/view/i_demand_congress_and_the_president_enact_single_payer_universal_health_care

http://healthcare.change.org/actions/view/join_senator_sanders_petition_supporting_single-payer_health_care

http://healthcare.change.org/actions/view/tell_congress_we_want_single_payer_health_care

Peter:  What a shame that you resort to threats and sleazy accusations.  It portrays an ugly picture of the people behind the universal health care cause.  I do not agree that my "position . . is contrary to common sense".  That doesn't make sense.  I am not familiar with the "Playbook" or FOXTV.  Apparently, you are not familiar with all of the information on health care reform which has been put out by MSNBC.  It sounds like you read a lot of propaganda.  What makes you think 1) that your extreme bullying tactics could possibly be effective, and 2) that I would sign petitions for someone who makes so many false accusations, treats others abusively and makes bizarre threats?  I am, in fact, at this point, not at all sure that I would favor universal health care.  It sounds like maybe it is promoted by a bunch of real extremist bullies.

Wow...I hope your comment was well considered.

As far as your support for universal health care, it looks like it was rather thin...

I have had Medicare reimbursed medical appointments in which I was seen by the doctor for 15 seconds, and I don't see where you folks get the idea that your claims are more valid than other people's personal experiences.  I can understand believing in  cause, but it seems that some people can not engage in constructive discourse, to put it mildly.  Shame on you.

Hi Jane--

In regards:  "I have had Medicare reimbursed medical appointments in which I was seen by the doctor for 15 seconds"

I have had private insurance reimbursed medical appointments in which I was seen by the doctor for 15 seconds.

I think that means there's a lot more to reform than who pays -- a fact I think we're all agreed upon.

Excellent point, Mary.

You mean Martin Bring isn't actually a little Viking?

Peter:  I am not familiar with the personal story in the Huff Post which you refer to.  Since, according to you, it is a personal story, and one with which I am not familiar, there is no issue of agreeing or disagreeing.  I'm not even sure what you are getting at, although there seems to be an implication by the blogger that the health care system in another country is superior to that of the U.S.  There are, I'm sure millions of personal accounts that would agree with that and millions of accounts that would disagree.  As I have stated before, I am in favor of a public plan IF IT PROVIDES EQUAL QUALITY OF CARE FOR EVERYONE.  I have not seen or heard anything which states that- and I have been very politically involved in this issue for years.  I do have reason to believe the contrary.  This is an issue which I think that we should all take a very serious look at.  It will effect each and every person in this country.  Another of your questions, Peter, was about my support of President Obama.  If you will look back at my statement, you will see that I supported and contributed to his election campaign.  As far as his health care plan, re-read this comment.  And by the way, maybe you should ask yourself why some of the big industries involved in this are in such a big hurry to push through the health care reform?  And, why the general public is not getting much information from the people who will be most effected by the health care reform (the poor, elderly and disabled).