2020 Democratic Primary

[Essence Lumin]

I am going to quote this again, because the weird Bernie worship - attributing all good things to him no matter what, while at the same time disparaging everyone else borders on the same type of delusion you see from Trump supporters.

The point is Bernie would at least like to ensure all individuals have access to health care, whereas Biden makes no mention in his policy statement of doing anything about the many uninsured who can't afford insurance but make too much for medicaid ($15000 or less I think). All he mentions are medicaid coverage for 5 million people in states that don't cover it and coverage for those below 138% of the federal poverty level which comes to $17608 for a single person in most places.

Plan to Protect and Build on Obamacare | Joe Biden

 

[Salome]

People really shouldn’t link to things they don’t read.

Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare.

The Biden Plan will help middle class families by eliminating the 400% income cap on tax credit eligibility and lowering the limit on the cost of coverage from 9.86% of income to 8.5%. This means that no family buying insurance on the individual marketplace, regardless of income, will have to spend more than 8.5% of their income on health insurance.

Biden’s plan will ensure these individuals get covered by offering premium-free access to the public option for those 4.9 million individuals who would be eligible for Medicaid but for their state’s inaction, and making sure their public option covers the full scope of Medicaid benefits. States that have already expanded Medicaid will have the choice of moving the expansion population to the premium-free public option as long as the states continue to pay their current share of the cost of covering those individuals. Additionally, Biden will ensure people making below 138% of the federal poverty level get covered. He’ll do this by automatically enrolling these individuals when they interact with certain institutions (such as public schools) or other programs for low-income populations (such as SNAP).

1. Public option available to everyone.
2. Major extension of middle class tax credits.
3. Improved baseline standards of deductibles and services.
4. Auto-enrollment for those at the poverty level who interact with other public services.

 

[Eunoli]

The point is Bernie would at least like to ensure all individuals have access to health care, whereas Biden makes no mention in his policy statement of doing anything about the many uninsured who can't afford insurance but make too much for medicaid ($15000 or less I think). All he mentions are medicaid coverage for 5 million people in states that don't cover it and coverage for those below 138% of the federal poverty level which comes to $17608 for a single person in most places.

Plan to Protect and Build on Obamacare | Joe Biden

This is disingenuous and doesn't mention that he supports a public option for medicare, as well.

 

[Essence Lumin]

This is disingenuous and doesn't mention that he supports a public option for medicare, as well.

Saying it is disingenuous is meaningless without giving any reason. It's his official website. The only public option he mentioned Is Medicare being offered for sale along with other insurance plans.

 

[Salome]

 

[Brenda Archer]

The point is Bernie would at least like to ensure all individuals have access to health care, whereas Biden makes no mention in his policy statement of doing anything about the many uninsured who can't afford insurance but make too much for medicaid ($15000 or less I think). All he mentions are medicaid coverage for 5 million people in states that don't cover it and coverage for those below 138% of the federal poverty level which comes to $17608 for a single person in most places.

Plan to Protect and Build on Obamacare | Joe Biden

So I went to look at this page and found it short on detail.

It’s better than what we have now, but it seems too focused on premiums, which are what healthy people notice, and not focused enough on deductibles, which are what low income middle aged workers with chronic conditions find to be a barrier to care. Tax credits only really help people being paid in standard wage or salary setups, who are a constantly falling proportion of workers. I’m not seeing enough here to assure me that low wage gig/temp/tip/contract workers will be able to afford chronic care.

This year is going to overturn the old health insurance paradigm because unemployment and underemployment are pushing people out of employer based healthcare. If they are allowed to buy into Medicare (and people with chronic conditions must also be allowed to buy into Part B), they’re going to need upfront subsidies and not just tax credits.

This isn’t just for the benefit of individuals, although people need to come to understand that healthcare for an aging population is also about keeping that population employed. Uncompensated care for non-COVID related conditions, at a time like this, will still push marginal hospitals out of business. We really should nationalize them, but I’m not seeing anyone who isn’t in Europe floating such ideas - yet.

 

[Salome]

Biden has said multiple times that his plan would cap all deductibles at $1000. That’s the most any plan could include. We know this because it was a huge thing when he misspoke and said “co-pay” instead of “deductible” and had to spend a week clarifying.

Low-wage/gig/self employed workers benefit enormously from tax credits because self-employment taxes are double the taxes of people who have traditional employment. Biden’s plan also doesn’t massively raise taxes on the middle and lower working like Sanders/Warren plans do. This is worth noting because raising taxes would hit gig and other self-employed persons twice as hard as everyone else.

Biden’s plan expressly states it will uphold the current law that forbids coverage limits on chronic care patients.

Obviously everyone is going to have to figure out how to integrate all their plans healthcare and otherwise, into the post-pandemic landscape.

Ponies not included.

 

[Brenda Archer]

Biden has said multiple times that his plan would cap all deductibles at $1000. That’s the most any plan could include. We know this because it was a huge thing when he misspoke and said “co-pay” instead of “deductible” and had to spend a week clarifying.

A deductible of 1000 is still a barrier to care for someone who makes $13 an hour, which is what clerical and call center workers are making in a lot of states, and that’s still more than many fast food workers.

Outpatient providers are going to want the 1000 up front, and we do not want people using the ER for chronic care (they don’t provide that type of care, anyway). They often want the money immediately.

Low-wage/gig/self employed workers benefit enormously from tax credits because self-employment taxes are double the taxes of people who have traditional employment.

Many of these people are not self-employed and are filing a 1040EZ or a 1040A. For those who are a small business, lack of insurance is a business risk.

Biden’s plan also doesn’t massively raise taxes on the middle and lower working like Sanders/Warren plans do.

This is not a net cost for people getting relief from premiums, deductibles and cost sharing.

There’s no free lunch, but if we’re going to learn anything this year, it’s that patients are not customers and healthcare cannot be priced like a luxury good. In rural and poor urban areas, hospitals fall over because healthcare is a source of unpaid consumer debt. Getting people to pay that in taxes instead of incurring it as debt is simply responsible. Or, at least, in most of the First World.

This is worth noting because raising taxes would hit gig and other self-employed persons twice as hard as everyone else.

Healthcare costs are going to be socialized onto the public one way or another. It might as well be visible, instead of becoming ruinous consumer debt. It’s not really doing anyone any favors to let them work without healthcare, facing uninsured risk of the most literal kind.

Biden’s plan expressly states it will uphold the current law that forbids coverage limits on chronic care patients.

That’s a very minimal expectation of any Democrat.

Obviously everyone is going to have to figure out how to integrate all their plans healthcare and otherwise, into the post-pandemic landscape.

Ponies not included.

It’s not ponies. It’s literally what the entire First World, except the US, and a large portion of the developing world, has managed to do. It’s especially a matter of national security. It’s just luck COVID-19 was invented by nature and not an adversary.

I’m actually arguing from your right.

 

[Salome]

A deductible of 1000 is still a barrier to care for someone who makes $13 an hour, which is what clerical and call center workers are making in a lot of states, and that’s still more than many fast food workers.

Not as big a barrier as a huge jump in taxes. And nowhere near as big a barrier as the current sustem, or having no system. Your $13/hr worker would see a $2800 burden, for example, under a 10% tax increase. A $1000 deductible would be the maximum amount allowed. The public option would likely be lower. Whatever private plans that survive would have to compete in this area, too. Bernie is saying 4% over X, most economists say it would have to be higher, and Warren’s plan was definitely higher. The reality is, in that thin range between very poor and middle class, the “working poor” are going to see a crunch from taxes or have to navigate a fixed, reasonable deductible.

Outpatient providers are going to want the 1000 up front, and we do not want people using the ER for chronic care (they don’t provide that type of care, anyway). They often want the money immediately.

The vast majority of people are not going to experience having to pay $1000 all at once. Deductibles are generally broken down across the first few incidents. Both Sanders and Biden are proposing to negotiate costs down significantly. The only time the deductible would be all at once would be in an emergency and no one’s allowed to be denied emergency care over payment.

Many of these people are not self-employed and are filing a 1040EZ or a 1040A. For those who are a small business, lack of insurance is a business risk.

Most gig workers are independent contractors and subject to self-employment tax.They and self-employed workers will be crushed the worst by any tax hikes. Low wage and part-time workers making less than approx $18k would be eligible for free coverage. Yes, things are always a little more difficult for those right at the thresholds of any system. That’s always gong to happen which is why the tax credit system is supposed to act as a buffer there.

Getting people to pay that in taxes instead of incurring it as debt is simply responsible. Or, at least, in most of the First World.

Which is what public option would provide for those that choose it. And, let’s be real, the majority of people in the nebulous middle are probably going with the public option.

But that’s going to take time to adjust to because it’s not the culture here and not something the majority of Americans are willing to accept at this time. Healthcare polls high until yiu introduce things like abolishing private insurance, making it compulsory, and raising taxes — at which point the numbers tank hard. Just like getting the ACA passed was one step, advancing healthcare to the next level in the US is the next phase to scoot the majority of the population toward accepting it as a universal right. We’ve already seen large shifts in attitude since the ACA was implemented.

Moreover, most of the ACA has weathered the bulk of its SC challenges. Tossing it aside for some pie in the sky plan is not only unlikely to pass, but will have to survive future challenges of a whole new nature under the current SC. While we’re also dealing with the aftermath of a global pandemic, a trashed economy, and staggering unemployment.

Healthcare costs are going to be socialized onto the public one way or another. It might as well be visible, instead of becoming ruinous consumer debt. It’s not really doing anyone any favors to let them work without healthcare, facing uninsured risk of the most literal kind.

That must be why every Dem has one version of UHC or another as part of their platform.

That’s a very minimal expectation of any Democrat.

Yes, it is. Which it why it was unnecessary to bring up chronic care as if there was an increased burden associated with it under anyone’s plan beyond the deductible.Limits are off the table, the max deductible is set, and pre-existing conditions cannot be denied.

It’s not ponies. It’s literally what the entire First World, except the US, and a large portion of the developing world, has managed to do.

Which is probably why Dems have been fighting for it for decades. Regardless, not all UHC systems throughout the developing world are the same or compatible to the the culture of the US. And despite what a segment if the left tries to insist, M4A is not what most of the world has.

Biden’s plan needs tweaking — and he’s tweaked it as he’s gotten input and will likely continue to tweak it, but it gets a lot of the way there. It also directly addresses women’s healthcare (something Sanders dodges too often for comfort). This fight is over very little difference in policy, but only one candidate‘s surrogates keeps insisting everyone else wants to kill poor people.

 

[Spirits Rising]

Short of a miracle, no candidate is going to be able to enact much of their campaign platform beyond doing damage control at best. Even with that miracle, no candidate should be doing more than damage control (which would hopefully include trying to put the Obama era policies back into place).

 

[Brenda Archer]

Not as big a barrier as a huge jump in taxes. And nowhere near as big a barrier as the current sustem, or having no system. Your $13/hr worker would see a $2800 burden, for example, under a 10% tax increase. A $1000 deductible would be the maximum amount allowed. The public option would likely be lower. Whatever private plans that survive would have to compete in this area, too. Bernie is saying 4% over X, most economists say it would have to be higher, and Warren’s plan was definitely higher. The reality is, in that thin range between very poor and middle class, the “working poor” are going to see a crunch from taxes or have to navigate a fixed, reasonable deductible.


The vast majority of people are not going to experience having to pay $1000 all at once.

It’s far more common than you think. A specialist visit including a routine procedure like imaging can easily run into thousands in one shot, but the imaging is required for diagnosis. All outpatient. And that’s just one example.

Deductibles are generally broken down across the first few incidents.

Sure, if you never go to a doctor except to pick up an antibiotic prescription. That’s not remotely realistic for many middle aged people or younger people with chronic illness.

Both Sanders and Biden are proposing to negotiate costs down significantly. The only time the deductible would be all at once would be in an emergency

Unrealistic and untrue.

It’s true that healthy young adults generally only experience high costs which come suddenly (this is a kind of circular truth caused by the definition of healthy), but healthcare plans have to work for the whole population, or the system will still struggle under the burden of uncompensated care while individuals get barriers to care because of underinsurance.

and no one’s allowed to be denied emergency care over payment.

This is such a Republican talking point.

The truth is that many serious illnesses are not required to be treated in an ER, for example a serious cancer, or anything else chronic. All they have to do is make sure you’re stable enough to send home.

People seeking ER care for conditions that have become serious because of lack of access to appropriate management, as a driver for uncompensated care and consumer debt, is so well-known now it’s a trope.

Most gig workers are independent contractors and subject to self-employment tax.They and self-employed workers will be crushed the worst by any tax hikes.

Yup, it’s expensive. Are you really arguing people should be allowed to go without healthcare just so they can stay in business? It’s pretty much a risky act of desperation when anybody starts working without benefits. This is not a status quo that Left people should defend. It’s also not necessary to let a new healthcare system get set up in such a way that the taxes on any low income people are so regressive they’re ruinous. Who benefits from this kind of poison pill?

Low wage and part-time workers making less than approx $18k would be eligible for free coverage. Yes, things are always a little more difficult for those right at the thresholds of any system. That’s always gong to happen which is why the tax credit system is supposed to act as a buffer there.

It’s not going to be enough without some work. There are too many low income workers to leave some fraction in the lurch and then say “tough.”

Which is what public option would provide for those that choose it. And, let’s be real, the majority of people in the nebulous middle are probably going with the public option.

But that’s going to take time to adjust to because it’s not the culture here

That was before this year.

This year, people are being shoved off employer based insurance in large enough numbers that people are going to start asking: why do I have to go without healthcare just to save old ways of doing things?

We got away with this situation because work without benefits, and unemployment, were seen as provisional, temporary circumstances. There’s too much of that now for the old system to financially survive. Either individuals or whole hospital systems are going to need a bailout.

The old system was inhumane to the losers, but Americans got used to that. What they won’t accept is watching the system go under.

and not something the majority of Americans are willing to accept at this time. Healthcare polls high until yiu introduce things like abolishing private insurance, making it compulsory, and raising taxes — at which point the numbers tank hard. Just like getting the ACA passed was one step, advancing healthcare to the next level in the US is the next phase to scoot the majority of the population toward accepting it as a universal right. We’ve already seen large shifts in attitude since the ACA was implemented.

Moreover, most of the ACA has weathered the bulk of its SC challenges. Tossing it aside for some pie in the sky plan is not only unlikely to pass, but will have to survive future challenges of a whole new nature under the current SC. While we’re also dealing with the aftermath of a global pandemic, a trashed economy, and staggering unemployment.

Universal healthcare is not on top of fixing the pandemic, it IS fixing the pandemic. Treatment for corona can’t be separated from other conditions, especially when it’s the combination of corona and pre-existing/old age sending people to the ER.

A two tiered system where people with corona can get free care and no one else can, if implemented, would not appear ethical for long. So the old ways cannot hold up in the present reality.

All these pieces are joined together.

That must be why every Dem has one version of UHC or another as part of their platform.

More necessary now than ever. Meanwhile, providing good details can be a way to nudge along decision makers and give them an idea of where the future is going.

Yes, it is. Which it why it was unnecessary to bring up chronic care as if there was an increased burden associated with it under anyone’s plan beyond the deductible.Limits are off the table, the max deductible is set, and pre-existing conditions cannot be denied.

It’s not unfair to bring up chronic care. It’s a common situation in an aging workforce that the system has to provide for so that individuals and hospitals can stay solvent.

The idea that chronic care is a special pleading is straight from the insurance industry playbook. But the workforce is aging, and hospitals (if they are not to be nationalized) need to be paid. Denial of care is not going to work after this year as a cost management method.

Which is probably why Dems have been fighting for it for decades.

This is part of why I’ve been a Democrat for decades.

We walked into this situation by allowing for-profit healthcare and have been putting out fires ever since.

Regardless, not all UHC systems throughout the developing world are the same or compatible to the the culture of the US. And despite what a segment if the left tries to insist, M4A is not what most of the world has.

Biden’s plan needs tweaking — and he’s tweaked it as he’s gotten input and will likely continue to tweak it, but it gets a lot of the way there. It also directly addresses women’s healthcare (something Sanders dodges too often for comfort). This fight is over very little difference in policy, but only one candidate‘s surrogates keeps insisting everyone else wants to kill poor people.

I’m not that much on Twitter or YouTube and don’t really care that much about self-appointed internet surrogates.

But since I can’t have Castro or Warren, anybody left standing needs to start working for the future.

The M4A meme is a function of pre-existing American systems, and it doesn’t matter what it gets called. The resistance to it is partly out of a desire to not do what those foreigners are doing. It’s time to stop catering to this self-destructive American exceptionalism.

 

[Brenda Archer]

Short of a miracle, no candidate is going to be able to enact much of their campaign platform beyond doing damage control at best. Even with that miracle, no candidate should be doing more than damage control (which would hopefully include trying to put the Obama era policies back into place).

If we elect another Republican Senate, not much can be done. But if we get a sweep, making sure this year doesn’t happen again is a very good idea.

This year: a medical system strained past the breaking point. It’s going to be impossible to cover up.

 

[Anya Ristow]

Your $13/hr worker would see a $2800 burden, for example, under a 10% tax increase.

Lies, lies and god damned lies.

Your $13 per hour worker would have zero taxes, zero out of pocket expenses under M4A. Zero. Under M4A, nobody, and I mean nobody, will pay $2800 on under $99K income. Not in premiums, not in deductibles (because there aren't any). This is simple math.

Take your income. Subtract $29K. Pay 4% of the balance.

I'm going to bet that nobody on this board, nobody, will pay $2800.

Those of you who are already on some subsidized plan or medicare or medicaid? Awesome.
Those of you who have good health insurance through your employer, can afford to use it, and think you can't lose it? Awesome.
Those of you who have some sort of socialized health care in your country? Awesome.

Your got yours. Awesome. This board sounds like fucking libertarians.

How 'bout you all stay out of arguments with people who don't already have those things?

 

[Anya Ristow]

and no one’s allowed to be denied emergency care over payment.

This is such a Republican talking point.

It's also ignorant.

The Criminalization of Private Debt
When Medical Debt Collectors Decide Who Gets Arrested
"You wouldn't think you'd go to jail over medical bills": County in rural Kansas is jailing people over unpaid medical debt
Growing Concerns Over Medical Debt Leading to Jail Time

and as if one-step thinking wasn't just dumb...

[article from 2013, you think it's gotten better?]

One in ten unemployed denied jobs due to credit checks

Employer credit checks are preventing the nation's hardest hit job seekers from entering the workforce, a new study shows.

money.cnn.com

Can you be denied a job because of bad credit?

Discredited: How Employment Credit Checks Keep Qualified Workers Out of a Job | Demos

Why employment credit checks constitute an illegitimate barrier to employment.

www.demos.org

 

[Anya Ristow]

Short of a miracle, no candidate is going to be able to enact much of their campaign platform beyond doing damage control at best. Even with that miracle, no candidate should be doing more than damage control (which would hopefully include trying to put the Obama era policies back into place).

Biden has said, even if M4A passes the House and Senate, he'd veto it.

The first step in getting the government to serve the people is to elect candidates who want the government to serve the people.

 

[Innula Zenovka]

How 'bout you all stay out of arguments with people who don't already have those things?

As someone from a country that does, indeed, have a National Health Service which is struggling heroically to protect us from the covid-19, I'm afraid I'm going briefly to decline that suggestion.

However, that's simply so I can suggest that it's already clear that, once the crisis is over and we can begin to restart our lives and pick up the pieces, there's going to have to be a major "lessons learned" exercise concerning how the NHS is planned, managed and financed, and it's bound to result in some very major changes.

That's going to be even more the case in the US, whoever wins the election, so I would suggest that any specific sets of current plans and proposals, by any candidate, are simply not going to be applicable in any detail come November, because they were drawn up before the crisis.

Everything has already changed since January, and it will have changed immeasurably more by the end of the year.

All points of detail in any discussion of funding based on plans drawn up last year, or last month even, must now be completely moot.

 

[Veritable Quandry]

Biden has said, even if M4A passes the House and Senate, he'd veto it.

No, he has not. He has expressed concerns about the transition period and said that he would have to be sure that any law passed protected people during that time. He has NOT said that he would veto any M4A plan.

 

[Anya Ristow]

No, he has not. He has expressed concerns about the transition period and said that he would have to be sure that nay law passed protected people during that time. He has NOT said that he would veto any M4A plan.

THis has happened since you got your information.

Biden suggests he would veto 'Medicare for All' over its price tag

"I would veto anything that delays providing the security and the certainty of health care being available now," Biden said.

www.cnbc.com

 

[Veritable Quandry]

THis has happened since you got your information.

Biden suggests he would veto 'Medicare for All' over its price tag

"I would veto anything that delays providing the security and the certainty of health care being available now," Biden said.

www.cnbc.com

Suggests. And yes, he has questions and has a preference for a different policy. But he did not say that he would veto a plan, especially given the number of plans on offer and a lack of sufficient detail in them.

Personally, while I want a single payer healthcare system, I believe that the tactic most likely to get us there is a public option plan. Ask yourself what it would take to get M4A through Congress, and the odds of that happening, especially if you have a President more interested in burning bridges than building a coalition.

 

[Salome]

It’s far more common than you think.

No, it isn’t. It’s about as common as I think. We’re talking about the percentage for whom $500-$1000/year is a significant barrier to health but who also make more than $18k/year. It’s not the vast majority of people.

Sure, if you never go to a doctor except to pick up an antibiotic prescription. That’s not remotely realistic for many middle aged people or younger people with chronic illness.

I‘ve been in and out of hospitals since birth. My parents are hitting their 70’s, both with chronic illness. I know exactly what we all spend and have spent and when. The idea that everyone like me drops $1k on their first doctor visit each year unless they avoid doctors except for prescriptions is wrong, even as things are now. Both Sanders and Biden and everyone else‘s UHC plans want to lower costs and coming down hard on over-billing. Working to get rid of those practices, along with the rampant fraud tied to them in the system will have huge impacts that negate many of these concerns.

Unrealistic and untrue.

Ah. Okay. If you say so.

healthcare plans have to work for the whole population, or the system will still struggle under the burden of uncompensated care while individuals get barriers to care because of underinsurance.

Putting aside the rest of everything else that is faulty in this section, the fact remains that a $1000 max deductible, even if it were the same for everyone (which it won’t be) isn’t going to cause the system to struggle. If all medical facilities had to worry about was $1k/year per patent that would be an unfathomable improvement over uncompensated care in this country. So much so that it’s hard to understand what you’re arguing.

This is such a Republican talking point.

You got me, I‘m a secret Republican. Cat‘s outta the bag.

Or, maybe, I was saying that in the most common situation where people eat up a deductible unexpectedly all in one shot (emergency) they are still guaranteed care as part of a larger point. Nah. I’ve been duped by GOP talking points. That makes more sense.

The truth is that many serious illnesses are not required to be treated in an ER, for example a serious cancer, or anything else chronic. All they have to do is make sure you’re stable enough to send home.

No one’s saying otherwise. People with pre-existing conditions will choose the plan that accommodates this best. As they do now. Which is a huge improvement over the way it used to be for people like me and many I know where being born with a pre-existing condition used to mean you had zero options.

Are you really arguing people should be allowed to go without healthcare just so they can stay in business?

No. But don’t let that stop you from building the straw man you want to argue against instead of the things I actually addressed.

It’s pretty much a risky act of desperation when anybody starts working without benefits.

No one is saying otherwise. You asserted a $1k deductible was unreasonable for people in a certain segment. I pointed out that the taxes on that segment for M4A would be higher than any $1k deductible. The rest you’re inventing to argue against yourself.

It’s also not necessary to let a new healthcare system get set up in such a way that the taxes on any low income people are so regressive they’re ruinous. Who benefits from this kind of poison pill?

Obviously there are tons of unknowns in how specifics get rolled out and implemented. But if a max $1k deductible is being labeled as “ruinous” to score political points then illustrating that tax costs would be about the same or higher under other plans is fair to highlight.

It’s not going to be enough without some work. There are too many low income workers to leave some fraction in the lurch and then say “tough.”

Accepting that some fragment always ends up in a more difficult situation than others isn’t leaving anyone in a lurch or shrugging them off and saying “tough.” It‘s acknowledging that government is always going to be a work in progress and part of that work is identifying and fixing weak links in the chain.Those links are usually where thresholds meet.

There’s too much of that now for the old system to financially survive. Either individuals or whole hospital systems are going to need a bailout.

Everyone and everything are going to need a bailout. As far as how that shifts the majority’s culture and understanding later in the year, I don’t pretend to know the future and I don’t have that kind of faith in the general electorate. I think we still have about a decade before healthcare as a human right becomes the default and everything else is considered fringe.

Universal healthcare is not on top of fixing the pandemic, it IS fixing the pandemic.

No one said otherwise and all the candidates are promoting some form of UHC, so you’re just arguing with yourself again here. My point was that the ACA has already weathered SC challenges so improving upon its framework seems safer to me than trying to implement a system that tosses out the ACA and starts over to face a whole new slate of challenges under the SC we’re going to be enduring for the next decade.

Meanwhile, providing good details can be a way to nudge along decision makers and give them an idea of where the future is going.

All the plans provide good details. No one is going to be able to provide every single detail. I‘ve read all the plans put out during the primary. All of them have some whatifs and concerns regarding implementation. Practically speaking we all know so much of it depends on down-ballot races that half of all conversations about it are moot. Which is why demonizing any candidate over details is unproductive.

The idea that chronic care is a special pleading is straight from the insurance industry playbook. But the workforce is aging, and hospitals (if they are not to be nationalized) need to be paid. Denial of care is not going to work after this year as a cost management method.

No Dem is arguing for denial of care, ffs. No Dem is calling chronic care special pleading. I’m done trying to address things you invent out of things I say.

We walked into this situation by allowing for-profit healthcare and have been putting out fires ever since.

Yes, progressing is about putting out the fires we inherited from the past. That’s Society 101.

I’m not that much on Twitter or YouTube and don’t really care that much about self-appointed internet surrogates.

How nice for you. Meanwhile, many of Sanders’ official campaign spokespeople and high profile surrogates spend their days on TV and social media saying that everyone that disagrees with their candidate‘s UHC plan is trying to kill poor people or doesn’t care about them. It’s nice that you get to opt out of how that affects the national discourse, but during an election cycle it matters. A lot. It’s how we end up with our civil rights heroes getting booed by a bunch of asshats and other problems. It hinders progress in multiple areas, not just healthcare.

But since I can’t have Castro or Warren, anybody left standing needs to start working for the future.

Every Dem candidate is doing this, except perhaps Tulsi.

The M4A meme is a function of pre-existing American systems, and it doesn’t matter what it gets called.

The idea that messaging doesn’t matter is long gone. One candidate has convinced his followers that advocating for anything anything other than M4A makes you a cartoon villain. Every Dem candidate is trying to move us into universal healthcare. The differences are who thinks which methods are more responsible and practical to get us there.

The resistance to it is partly out of a desire to not do what those foreigners are doing. It’s time to stop catering to this self-destructive American exceptionalism.

Republicans and their empire of propaganda exist. I understand none of us like it, but it doesn’t make them any less there. Acting like we just get to do whatever we want and ignore them sounds good, but it doesn’t change reality.