"Clinton would have had a much better chance if she had followed Senator Moynihan's advice and had involved members of Congress as she was developing the plan, had made them part of the policy discussions."

You are talking about including the very Democrats who were out to kill her plan. She was trying to put together a comprehensive plan, and they were trying to tear it down. They were conservatives, out to protect big business. So she should have not put up a fight?

Everyone for the past 60 years who has tried to pass a progressive health care plan has failed, Hillary was simply the most recent one.

Even when she turned her plan into the most complex proposal imaginable, trying to make it work by including all the business interests the conservative Democrats insisted on, they still weren't satisfied, and so then the insurance industry and AMA ganged up and along with the Democrats, killed her effort outright. There was no pleasing them. Too much money involved.

"You're wrong on polls and single payer."

I am on the board of directors of Physicians for a National Health Program, the preeminent single payer organization in this country, and the polls I cite are correct, and the political impasse I describe is also correct.

"If people are asked if Medicare should cover everyone, the answer, overwhelmingly, is yes."

I know very well the polls you are referring to, and they didn't ask about single payer properly. Like the NYT poll that asked peopel, "Would you be willing to pay more in taxes to cover the uninsured?" Yes, 85 % of people favor covering the uninsured.

As soon as you explain what Medicare for All actually is, and that they will have to give up the insurance they have and pay taxes for the government single payer program, that support dips precipitously to 35% or lower.

When you just say "Medicare for All" people think, "Oh how nice, all those people who don't have health insurance will get it". But when they realize that they themselves will have to partake of the government plan, they want no part of it.

Even liberals now question single payer, because they have seen what 7 years of "starve the beast" has done to the social safety net, Medicare, and Medicaid, and they are afraid that if we had a single payer program that all had to depend on and it met the next Bush administration equivalent, we would all lose our health care. Or at least the quality would go way down. Then we wouldn't have the employer based ystem to fall back on, and we would all be at the mercy of the private health insurance industry.

"well, like most things in U.S. politics, it is a P.R. battle that the right has framed and attacked more efficiently."

If you have any idea how to drown out the private  insurance industry and Big Phrma and the AMA who's profits depend on keeping the status quo, who represent a 3 trillion dollar industry that people feel their lives depend upon please speak up. They are awful good at what they do, however.

Michael Moore tried to help with Sicko and the cacophony attacking him, CNA, and PNHP was deafening.

Give us a shout anytime you want to help.

www.pnhp.org

If people do not go for the mandate there really is no other mechanism to either lower health care costs or get to universal health care.

Yes but I don't buy the idea that even with the mandate you can actually lower health care costs and keep the plan affordable with reasonable taxes. See my comment below and this comment in the Nation

I also think that the "mandate" aspect of Hillary's plan would be easily cast in a general election as something very intrusive. Republicans could make Hillary Care II look like Big Nurse Ratchet coming after Jack and Jill Sixpack with wage garnishments and judgments on behalf of crooked health insurance companies that had paid her off -- and unfortunately they would not be completely wrong.

I heard a Yale professor (name escapes me) regarding campaign promises and she mentioned that the candidates are better aided by vague details regarding health-care. The less the plan has, the less there is to attack.

It's a sad testament to our society's inability to dissern spin from possible reward but I kind of agree with her.

so, paint a broad brush and don't dare explain it with details.

You don't sound very objective when you argue political viability on one end and then willfully ignore it on the other. The fact is that starting the process with a mandate means getting into the pool with an anchor around your neck. It's just too easy to spin it negatively, and Clinton's public image makes that spin even easier.

You already seem to agree that the best way to get universal healthcare is to phase it in. As such, you acknowledge the political viability of universal availability with a mandate in lieu of a truly universal single payer plan. However, you seem unwilling to accept the viability of first working toward universal availability, and only then adding a mandate if it's necessary to reduce costs.

Think about it. The goal is to get Americans hooked on affordable healthcare first, than see what's needed to make it universal. Obama's plan can do that, and it sells a lot better than one that includes a mandate at the front end. Once the plan is in place, you can objectively evaluate the costs. Then, if appropriate, you can have the discussion about how much the willfully uninsured are costing America. However, at that point the tone of the conversation changes entirely. Instead of "forcing you to buy healthcare" a mandate becomes "making the freeloaders pay their way." Frankly, it's a much better sell.

Please - do you never go for check ups and teeth cleanings?

And yes, Hillary's plan includes dental (and vision and psych)

"But of course SS you get back in the end. Health insurance you may never see a benefit from."

But the hospital and emergency room has got to be staffed, equipped, and ready for you whether you go there or not.

Almost 80% of health care costs are static, fixed costs: buildings, maintenance, salaries, equipment, supplies, training and retraining. That emergency room has to be kept up so that when you need it we will be there and up to speed to take care of you. In that regard we are all constantly "using" the health care system whether we ever spend a day in the hospital or not. We must all contribute toward that cost. We pay to have the fire department and police department on stand by, whether our house burns down or we get mugged or not. Same with health care.

You are getting the benefit of having a health care safety net

"Obama's plan is very similar in the sense that it starts with immediately achievable goals and can be expanded as the kinks are worked out"

But his "immediate goals" of lowering costs cannot be achieved with the means he proposes. Those are the facts. Industry has already been trying everything feasible to lower costs and they only continue to skyrocket. There is absolutely no evidence whatsoever that any of the ideas Obama puts out will lower costs one iota.

There is already a tremendous body of research done on all these proposals, and many countries have already tried all these permutations and they do not work. That is why countries that are serious about containing health care costs and having universal coverage all have either single payer or a mandate and mixed system. They all end up going down the same road.

We have already tried the "managed care" route here, and that was a failure, because companies turned it into simply denial of needed care and put the profits in their pockets. We've tried all the tinkering at the edges, and are starting to recycle the ideas that didn't work the first time because people have forgotten or dies that tried them the first time. They don't work. Obama's plan will not work.

I find that there is never a good excuse to watch Fox News.  Also, CNN seems to give Hillary great coverage, so why don't you watch CNN?

"And let's not forget that Massachusetts plan came into law under Mitt Romney. It is by no means the model for universal coverage"

Romney didn't seem to have the well being of the poor always uppermost in his mind...  :)

Even so, in Massachusetts they have achieved the extraordinary rate of providing good health insurance to 92% of their low income folks at 100% subsidy (free). That is double the rate on enrollment of any other free medical insurance program elsewhere in the US.

So for the poor, the mandate actually functions as a de facto mandate on government to provide care. They are getting people signed up like never before.  

"5% of a family's income is low???  up to 10%??"

For health insurance it is reasonable. Health insurance needs to be a priority in people's lives. Nothing else in life matters if you get sick or injured. Then you need care, in order to be able to participate in life. This is a matter of priorities. It has to budgeted in.

Right now people don't even register how much they are "spending" on health insurance if they have employer based health insurance, because the employer is paying a large portion of it. That is all money you won't see in your paycheck.

As a society we have to be realistic about what we can afford. If you get cancer, you need to have very expensive treatments for it, and your life may depend on it. Paying for insurance is the only way to be prepared (to some extent) for that catastrophic event.

The mandate works all over the world, where citizens accept it as a part of their civic responsibility to have health insurance

There may be places where it could work but I think that many Americans would find it a bitter pill to swallow, particularly when administered by Big Nurse Hillary.  Don't get me wrong, I don't see Hillary that way and I am are for civic responsibility but I just don't think "civic responsibility"  would be enough to sell this plan to a large enough percentage of Americans to make it politically and administratively practical.

Keep in mind that with the insurance companies regulated hey would have to issue insurance policies to everyone who wants it, they cannot charge more for age, sex, predisposing conditions, rates will be set according to geographic area and regional pricing.

But the problem I see with that is that there is no real mechanism to control the actual costs of health care or to keep the rates from spiraling upward for those without subsidies and vastly increasing the cost of the program for those who get subsidies.

In the end I think it would be necessary to go to a single payer plan that would permit real cost controls which is why I support such a plan even though I think it would fail in the end.  Since I think the costs would jump out of sight quickly with either plan, I don't see the point in pushing the mandates which might slow down cost increases a little bit but which would be so much political baggage that you might never be able to pass it and start down the road to the failure that might open the door for single payer.

You don't have to convince me that single payer would be better, you have to convince the public. . . .  There needs to be an interim plan to transition people over to it.

Exactly that is what we are talking about.  I am just saying that it does not make sense to trash our next candidate's transitional plan.  If they are both just placebos designed to get people use to taking their medicine the decision about how thick a sugar coating to put on the pill is a political judgment call difficult to second guess.

The only thing that will mobilize people to abandon the devil they know to reach for something better is a much greater crisis.

That seems to be the case, but it needs to be done in a way that will cause the people to blame the insurance companies rather than the gov'mint.

When people are mandated to have health insurance, and it is unaffordable, they will get up off their behinds and finally do something about it.

Or will they rebel against the mandate or worse still force congress to kill the whole program?

I am just an ageing ex-hippy myself and I don't claim to understand politics that well either, but I am able envision the Harry and Louise ads this time around and think that Obama's decision to limit mandates to families with children may well be correct. 

The brilliance of Hillary's plan is that it does offer the "Medicare for All" public option, so if enough people choose it over private insurance it could evolve into a single payer program.

But Obama offers the same thing.  The thing that could drive the evolution of this into single payer has nothing to do with the mandate. 

People won't go from  zero to a million in their trust of government to administer heath care.

I agree.  That is why -- as contradictory and likely to fail in the long run as this these very similar transitional plans are -- we need to start down the road.  But I see the mandate as being a political and administrative can of worms that will just open up a whole new area for building mistrust in government. 

If the idea is to prove government works why commit to set up some sort of Office of Mandate Enforcement that will have to individually try to track down people and collect money to give to insurance companies?  Do you really think that will turn into a government success story?

Ultimately none of the current plans being discussed will work long term, to control costs there will have to be rationing of health care, here is no other way. That is the political reality no one wants to speak about.

We see that the same way.  That is why I don't buy the that the mandate is necessary in order to make the money work.  It will not really do that but it will make the plan a bitter bitter pill.  Since it is a placebo in the long run, why not let Obama put a sugar coating on it.?

they believe in free market competition as the answer. Good luck with that. Obama was talking about it at Cooper Union here in NYC last week.

I would love to read a transcript that.  Are you really saying that the Jim Cooper controls Obama's mind and would block going farther with his plan?  I have hear this said elsewhere, but it is just not that convincing.  I would rather look at how much funding each candidate gets from health insurance lobbyists. 

"they will get up off their behinds and finally do something about it"

And that something will be to kick out the Democrats who are forcing their hands.

You made a very remarkable observation btw regarding the level of confidence we should hold in our Federal government.  We should all ask ourselves if we really do trust the Federal government, which more and more is becoming the Executive branch, to reliably oversee health care.  I'm all for a large Federal government that provides social safety nets and New Deal type economic and infrastructure development plans.  But do we really want to give Jeb Bush the power to control our health care?  It's a scary thought, and when you consider this country's history it is very much within the realm of possibility.  Hell, it could be someone even worse than Bush Co.  Never underestimate the collective stupidity of 50.1% of American voters.

More and more I'm getting the feeling that we may be barking up the wrong tree.  It might be a lot more effective to continue to push single payer at the local and state levels, where politicians are more accountable to their constituents.