There are plenty of English speaking primary care physicians in this world, countries like India and the Philipines pump them out at whatever rate one might like. The problem is the barriers to entrance maintained by the AMA and the various certifying boards that have an interest in rationing access to the profession. Break that artificial barrier and let the labor market for MDs operate fully and that access issue goes away.
The other issues Buckeye raises are important but pale in relation to the monopolies controlled by professional societies not just in medicine but in areas like law
There is a fundamental misunderstanding in that story. Nothing in the law REQUIRES employers to keep ANY insurance going prior to implementation of the Exchange and the subsidies that go with them. If MacDonald's wants to drop the admittedly minimal and overpriced plan they currently provide to their low wage workers they can. Since the cost of a family plan up to the law's new standard can easily equal the total amount of wages paid to these often part-time employees the choice for the companies is pretty obvious, without the waivers they will drop the insurance.
Now that leaves the question of whether these plans are a rip-off given the high ratio of premium to covered benefit, but that is different from the question of 'insurance yes or no'. Until subsidies kick in there was never any real question of these firms picking up the entire tab directly, the premise of the question assumes what is almost certainly in all cases a counterfactual.
People who have been complaining since the Tri-Committee Bill and Senate HELP that there were and are no cost controls simply never read the bill. They exist in the form of the MLR provisions, which in the bill that passed into law were set at the 85/80 level. If implemented effectively, and early signs are that the insurance companies weren't able to game MLR in the way they wanted too, this is an excellent and elegant way to prevent the insurers from cheating even in the absence of a public option.
But you need to know how to read and think. People who want to make an honest attempt at actually engaging the bill that was written and not the fantasy one 'explained' by the fantasists that thought HR 676 (the so-called Medicare for All Bill) was actually a seriously intended piece of legislation can start with this diary from Fall 2009, based on an actual reading of what was in the House Bill 3200 Sec 116.
If you don't understand MLR you don't understand anything about how this bill was actually designed to work by original lead authors Kennedy and Dingell. How the lefter end of the left blogosphere managed to convince themselves that those two guys simply sold them out to the insurance companies after a combined 100 years of trying to get universal health care through is beyond me. Ya think you might have given these guys a little more credit and asked WHERE the cost controls were and instead of just accepting the word of a guy at PNHP that they didn't exist?
They do. In a battle that got fought under the radar the MLR provisions were dropped from the SFC version and only partially restored in either Reid or Pelosi's final version only to be fully restored at the last minute. Which is why AHIP, who had been supporting the bill right through the Fall suddenly started squealing. THEY fully understood the importance of the MLR provisions even if BB doesn't.
Not when these very same people were happy as clams with a President who made extreme Article 2 claims based on the fact we were in a never declared, amorphous, and never ending 'War on a Tactic', er Terror. Were there any peeps from these Freedom Loving folk at the passage of the Patriot Act? At the claims that due to his dual role under the Constitution any actions of the Office of the VP were not subject to review either by the Executive Branch or Congress? The President's political operatives, who in the person of Karl Rove were elevated to almost unprecedented positions of formal power, openly set their goal as being to establish a Permanent Majority, and it that meant using the DOJ in all all out effort to suppress Democratic voter efforts ironically in the name of enforcing anti-suppression laws, well hey don't US Attorney's serve at the pleasure of the President. Add in the last Administrations constant appeals to American Exceptionalism, its outright embrace of the use of the U.S. military to establish what proponents call The New American Century (as in PNAC). From their Statement of Principles <blockquote>As the 20th century draws to a close, the United States stands as the world's preeminent power. Having led the West to victory in the Cold War, America faces an opportunity and a challenge: Does the United States have the vision to build upon the achievements of past decades? Does the United States have the resolve to shape a new century favorable to American principles and interests?</blockquote> When you put 'Arbitrary Executive' 'It's only a God Damn piece of paper' 'Permanent Majority', party control of the Courts and Prosecutor's Office, a compliant media (Fox and the WashTimes only being the tip of the iceberg), Traditional Values (both in family and religion) a 'New American Century, well lets just say you don't have Bakunin and Emma Goldman popping into mind. But other names and movements certainly do. As Colbert might say it 'all sounds better in the original German'.
But under the Rules and quite literally at dKos you are simply not allowed to do a straightforward analysis of where Bush-Cheneyism stood in relation to the political movements of the early 20th century, not even if you carefully keep your references with the bounds of the Italian Experience.
Whether Eliminationism is always and everywhere at the core of Fascism is an interesting question, after witnessing the actions of Mussolini in Abyssinia/Ethiopia and the Japanese in China, you have to conceed that certainly extreme Exceptionalism is always close to the heart. As it is quite obviously is in the case of 'We Want Our Country Back' Tea Partiers/2nd Amendment Absolutists. But we have allowed a single world historically horrific exercise of Eliminationism to define an entire movement, well sorry the 'argument' "We are not Fascists, after all we don't have any contracts out for ovens and Zyklon B" is not really a defense, or shouldn't be. Fascism is much more about a relation to Authority.
Finding some opposition to the traditional military in the ranks of the Tea Partiers doesn't mean much, there was significant tension between the S.A. and the S.S. vis a vis the Reichswehr right up until the Party came to total power in 1933, whereupon the Party aligned itself decisively with the existing organs of power and suppressed the hitherto useful S.A. Brownshirts in 1934. http://en.wikipedia.org/wiki/Night_of_the_Long_Knives
The question is whether the U.S. ''2nd Amendment Remedies" folk would drop their surface individualism for snappy identical Red-White-&Blue Shirts with Party Rank insignia under the command of a charismatic right wing leader. And the hijacking of the Tea Party Movement by party loyalists like Dick Armey and Haley Barbour and the existence of the Minutemen with their own regalia suggests that the answer is 'Yes'.
Words mean something in political history, and while terms like 'socialist', 'communist', 'anarchist' and 'fascist' don't have hard and fast lines between them and certainly people and leaders crossed back and forth at times, it is possible to identify current movements with the most historically appropriate analog. And in this case it just isn't Anarchy. In particular the social and economic doctrines associated with early 20th century Anarchy are nowhere to be seen. Yet is is considered impolitic to identify these movements for where they actually fall on the historical spectrum.
I don't have any solutions in mind, the "Mommy, the mean man called me Hitler" defense seemingly never failing in effectiveness, but somewhere there has to be a sphere for honest historical comparative analysis. Which means confronting the totality of what such terms as 'Fascism' encompass.
And odds are fairly good I will end up living in Boise by next year, and liking it. But Meridian isn't Marin (where we all come from) and Idaho north and east of downtown Boise isn't exactly, hmm, grounded in reality as we know it?
Steny has spent much of the time since the last election cozying up with early versions of the Catfood Commission including Cooper-Wolff. He may have a strong base among the New Democrats but the idea that the Progressive and Congressional Black Caucuses are going to break against Pelosi and ally with Hoyer and the Blue Dogs strikes me as absurd. Particularly after some R from fricking Black Helicopter Land weighs in in 'support'. What's next? Replacing Clyburn with Walt Minnick?
They didn't come swooping in playing Wagner's 'Flight of the Valkyries'
More seriously arguing that these were not 'war machines' because they didn't carry offensive weapons is like arguing that Custer's horses were not instruments of war because they, I guess, didn't have razors embedded in their hooves. A Blackhawk is designed to deliver armed soldiers to a battlefield just as a landing craft or an armored assault vehicle is, the presence or absence of something like a 20 MM or a door gun doesn't change that. And the same goes for the presence or absence of unit insignia from the 7th Cavalry, what is the argument supposed to be "No we are from an OTHER cavalry regiment, a one that (far as you know) WASN'T used to massacre Native Americans." I doubt many of the victims at Wounded Knee noticed or cared which guidon the soldiers were carrying during the massacre.
Union town, Harry S Truman, Gateway Arch, Beer and a Shot, and throw in Mark Twain. Missouri and St. Louis just shouts Tradition and Democratic Values at the same time.
Charlotte? Credit card companies and the Research Triangle. Big yawn.
A party and a Party on the Mississippi halfway between New Orleans and Minneapolis sounds pretty good to me. Go St. Louis!
(Indianapolis? My Mom was born and raised in Noblesville, about 18 miles north of Memorial Circle downtown, and my multi-great Grandparents started assembling the family farm in Brownsburg maybe 10 miles west back in the 1820's, with some of them immigrating before Indiana was even a State, but lets face it, excitement in Indiana is hearing the corn grow (no shit you can actually hear it on a quiet night, kind of eerie, I lived out in the corn fields for two years in High School). I am rooting like Hell for the Butler Bulldogs to pull it out tonight, but even if they win I don't expect that Hoosiers will be turning over cars and lighting dumpsters on fire, even though the Final is RIGHT THERE. Indy is just not that fun a town.)
I didn't find this funny, but then maybe I just have a stick up my ass. Because you have to be fresh fallen off the turnip truck to not be skeptical about anything you read on April Fools Day. But you know it is now April 3rd, and unless you want to triple down on that apology to Senator Nelson's staffers about the potential heartburn this could cause them maybe you could either take this down or modify the headline, or maybe put in a new lede giving people an alert that this was the day before yesterday's joke?
Speaking of Q2 fundraising totals how do you think the RNC is going to do?
If I were a big donor I am not sure what would be worse: knowing that my Chairman was spending four digits watching hot babe on babe action, OR that he was running such a loose operation that any random 'non-committee staffer' could submit a $1900 'entertainment' receipt for reimbursement? Either way it has some pretty nasty implications for cash on hand reporting next summer.
Democrats should be building a shrine to Michael Steele and keeping votive candles lit 24 hours a day, the guy is a damn miracle worker for us.
dKos poster Brainwrap organized a 4 day campaign to send roses to Nancy Pelosi and the result was that 2616 roses should be showing up at the Capitol right about now. Should be a nice photo-op. And I love the slogan: They throw rocks. We send roses.
It is not just the ban on pre-existing conditions for kid coverage that is important. Under this bill there is no cost-sharing for well-baby and well-child care, or for maternity, starting right away. The days of choosing between a $20 co-pay for a routine checkup or vaccination and buying diapers are this close to over. And hopefully so are the instances of clogging up emergency rooms with kids with sniffles. Just make an appointment at Bernie Sander's new Community Health Clinics and you can have that peace of mind that it really is just a cold.
Plus something that I will be blogging on soon. This bill changes the entire dynamic for things like Free Clinics. Maybe that indigent patient is not insured when he walks in the door, a lot of people fall through the cracks. But there is no reason he can't be fixed up with the paperwork to get coverage under Medicaid or through a subsidy on the Exchange for his next visit. The extension of Medicaid eligibility to single adults is HUGE and will totally change the structure of charity care as we know it today. Imagine how you could leverage your resources of that store-front community clinic if you knew you could actually get paid for seeing that homeless guy.
And back to the kids. All of us are familiar with those collection jars in your local store, each attached to some local story about some kid who will die without that operation. How many bake sales and community fundraisers occur ever year because as a society we can't find a way to routinely pay for needed cancer care or corrective operations for kids? Well that little piece of social injustice may have just become a fading memory, as a parent you won't have to hope to catch the eye of some local reporter so as to get your kid's story in print or on the 5 o'clock news. Certainly there will be some kids among that 6% of non-elderly Americans who are projected to remain uninsured, but it should be a pretty small fraction, and if it comes to that fund-raising to pay for an enrollment premium in an Exchange Plan comes at a tiny part of the cost of whatever that needed treatment would be.
Do Republicans really want to confront a campaign flier showing some bald-headed kid cancer-victim with the slogan "Repeal the Bill! And buy a Brownie for Kid's Cancer!!" Kids just should not have to beg for health care.
Most of the opposition to this bill from both the left and right has been to a bill that existed only in their own imaginations. But since everyone could tell you who was in the Gang of Six and no one could tell you about the significance of Sec 116 in the House Tri-Committee bill (not a random choice) this discontinuity on substance simply could not be bridged.
We have seen more coverage on what this bill actually would do in the last 48 hours than in any month over the last eight. And people are waking up. Fast. So I am not surprised at the numbers, particularly from the left. Because this bill does not actually deliver people bound hand and foot to the tender mercies of insurers, their ability to jack up prices or deny care are in fact strictly limited under the terms of the bill, something you would never get from the overheated rhetoric coming from some sites on the Left. Including at times this one.
I'll go out on a limb and predict a big swing among Indies over the next couple days. Because the question for the 'Bad Thing' people is going to be 'Which piece?' 'What part of this is Socialism?' and 'Is there really a deep pool of Americans who WANT to be uninsured?' I am uninsured and lots of people I know are uninsured (and chances are that server in your local bar or restaurant is too) and I have never met a person who was happy about that, certainly not one over thirty or who had kids. So I expect opposition to this to melt away in the coming days and weeks, except of course among the haters. Because they really have nothing concrete to point to.
"Seems it would be cheaper to pay the $750 fine and purchase insurance on my way to the operating room if it ever came to that."
Somehow I doubt that a traumatic brain injury suffered in a car crash ten minutes before you showed up at the insurance office is going to qualify as a "pre-existing condition". Or that you will be in the position of filling out even a brief sign-up form or have time to do so "on my way".
And oddly enough some people like to consult their doctor on a routine basis so that your first sign of trouble is not a massive stroke, heart attack or anal bleeding from that undiagnosed colon cancer.
And to get back to the point expressed in the subject line. The default position of the FDL folk is some form of Medicare for All. Which is for all practical purposes an individual mandate. Sure you don't have to actually enroll or utilize Medicare but if you earn wages or are self-employed you have to pay in. Which makes the Glibertarians crazy. But why on earth would self-styled progressives buy in to that logic?
hundred thousands had shown any sign of actually being willing to engage on the substance of HR676 rather than some gauzy slogans I might abjectly offer apologies. But nobody seemed to want to explain how nationalizing Walgreens and Pearle Vision Centers was actually going to be politically workable or how guaranteeing free long term care to everyone citizen or not was going to happen when that is not covered under Medicare today or how making supplementary insurance illegal or any of the other provisions of the bill made any sense at all.
HR676 proposed a National Health System far to the left of the British National Health Service or any other national health care program outside the old style Soviet bloc. Yet people still took its prime sponsor Kucinich (after its author Conyers deferred to leadership in August) seriously and held him up as some paragon of principle.
I gave the link, if anyone wants to write up a text-based defense that would explain how HR676 would ever have gotten more than 5 votes in the Senate I will be happy to post it at Angry Bear. Jerome put your political consultant hat on and read the text and tell me how you would sell unlimited free medical, dental, vision and long term care to illegal immigrants regardless of work history in any district except Barbara Lee's.
The regulars at FDL (who I don't think number in the 100's of thousands, certainly not anymore) very arrogantly took it on themselves to define who was the real liberals and who were sell-outs. And your adoption of the rather sneering 'liberal political wonks' shows you perfectly fine with that.
Well you know the old saying: "Lay down with Fire-pups---"