PNHP

HJM Reader Ideas

Our recent request for input from HJM readers yielded varied and rich ideas. There was some consensus on current problems (costs, complexity, & profit-taking), varied views on political context (opportunities & barriers), and a profusion of strategic and tactical ideas (both contradictory and compatible). Trump got unexpected callouts for his full-speed-ahead m.o.

HJM readers are, unsurprisingly, well-informed and articulate. Our recent solicitation of ideas yielded a profusion of cogent observations and opinions. I did my best to organize them, without judgement. Thus, HJM readers can get a sense for the range of views, both widely shared and unique.

I summarize responses by category. If you want to scan all summarized comments, see below.

More input is welcome, but I can’t guarantee that I’ll report back. If you’re eager to connect with someone expressing a specific idea, I can explore linking readers 


For Most Vexing / Motivating Current Problems, the most common views were unsurprising: high costs, for individuals and employers; complexity leading to confusion and inefficiency; and widespread profit-seeking by insurers and others. The rich are doing fine, the middle class and especially the poor not so much. Critical provider capacity suffers and improvised solutions (eg value-based payment) don’t help. It’s shameful that the US lacks state-of-the-art insurance.

Current Political Context: Harm vs Advance Single Payer elicited the the central role of economic status: the governing GOP reduces taxes for the rich and cuts government programs intended to help the middle class and poor. There is some optimism in growing condemnation of this dynamic. On broader politics, some readers are pessimistic about both parties, with huge money in politics. More upbeat, one reader noted “collectivism” counteracting the famous US “rugged individualism”. For health care, the rising sense of crisis encounters extensive anti-SP efforts by the profit-makers.

And, finally, for Strategic & Tactical Ideas 
 strategic views run the gamut: step-wise (eg expanding Medicare age and state-based single payer) to all-at-once. Tactics can be summarized as lots & varied & mutually supportive, from mass movements to fireside chats, moral suasion and technical details. Trump’s chutzpah and audacity – his disrespect for normal process, get surprise mention as a model for aggressively pursuing single payer. Framing focuses on universality, cost savings, and ending profiteering. “Premiums” is preferred to “taxes”. Finally, technical suggestions focus on fee-for-service and a tiny role for private supplemental insurance.

Many thanks to the HJM readers who chimed in so thoughtfully. These views rounded out my understanding of options and choices we face on the path to health justice.

1) Most Vexing / Motivating Current Problems

Health Insurance Failures

  • High costs – for individuals & employers (esp public) – 7
  • Un- and Under-insurance
  • Difficulty navigating insurance and care
  • Care denials
  • Inequality – poor suffer, rich do well
  • Medicaid – prove poverty now 2x / year, low payments
  • Shameful US lacks state-of-the-art insurance
  • Key provider capacity loss

Causes

  • Complexity –> confusion & inefficiency – 6
  • Profit seeking (insurance, provider groups) – 7
  • Patients seen as widgets
  • False solutions eg value-based payment

2) Current Political Context: Harm vs Advance Single Payer

Central role of economic status

  • GOP cuts: taxes for the rich & government programs
  • Wealth to rich, others losing economic stability
  • Growing perception that oligarchy = theft
  • Middle / upper class must suffer to move the needle

Other political issues

  • Govt swings between extremes
  • However, both parties fail us
  • Money in politics
  • Dems in opposition must articulate vision
  • Wide fear of taxes, esp for the common good
  • The “rugged individualism” vs “collectivism” split is shifting
  • Trump shows: Exec Branch can get stuff done if it wants

Regarding Insurance

  • Growing perception of a health care crisis
  • Relative satisfaction with Medicare (& Soc Security)
  • Inevitable strong anti-SP marketing by profit-makers
  • Dem Congress may support SP

3) Strategic / Tactical Ideas

Strategy

  • None that will work (pessimism)
  • State-by-state if fed cooperation – 3
  • Lower Medicare age to 50 – 3
  • Start with universal capitated primary care
  • All-at-once, to reveal the savings – 2
  • What would employers like?
  • Inside-Outside (legislation + mass movement)
  • Outreach + marketing, fireside chats
  • Tactic (eg moral vs technical design) tailored to constituency
  • Role of SP in the broader Left
  • Trumpian chutzpah (audacity of audacity)
  • Charismatic president “ram SP down country’s throat”

Framing

  • Universal Coverage 
 One people, one plan – 2
  • Universal coverage costs less for families than now – 3
  • Americans trained to believe govt can’t deliver – 2
  • Affordability + Abundance
  • End profiteering
  • Contrast with war spending
  • Moral imperative currently weak argument
  • “Socialized medicine” trope losing shock value
  • Govt pays for health care, not for insurance – 2
  • Delink from work
  • “Premiums” not “”taxes”

Technical

  • Fee-for-service like Trad. Medicare
  • Medicare QMB for low income
  • Private Insurance – for supplemental coverage

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