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The Obamacare Challenge We Need? Improved, Expanded Medicare for All


The Obamacare Challenge We Need? Improved, Expanded Medicare for All

Robert Zarr

As a primary care pediatrician who sees children of low-income families in Washington, D.C., I am reminded every day of the vulnerability of our children’s health to the ill-informed whims of our lawmakers and courts.

Those children will be on my mind as I gather with others outside the Supreme Court today.


After we burn down the Capitol and guillotine the Supreme Court we might have a legislature intimidated enough to pass HR 676. A first step would be to get a Democratic candidate for House or Senate in a Red State run on Improved and expanded Medicare for All and win. An even humbler tactic would be to take out a State Senator or Rep who is holding it back on a State level. I nominate for ouster from the Pennsylvania State Senate, Don White who, as Head of the Finance committee bottled up the state wide initiative for Single payer in 2009, a bill which passed in the state house. He has suffered no electoral consequence for this or for limiting the expansion of Medicaid in PA. The Senator serves in rural western Pennsylvania, the vast region which Dick Morris classifies as Alabama, with an electorate as poor and in need of Medical care as anywhere else in the country. If we could win there we could win anywhere but the converse is true also if we can’t win there the reactionary forces which keep us from Improved and Expanded Medicare will be powerful enough to deny it to the rest of us everywhere.


Doctor Zarr has written an intelligent and thoughtful article, but because we don’t live in a functioning democracy, his plan is impossible to implement. “Big Pharma” has purchased almost every Democrat and Republican in the House and therefore the topic of universal healthcare is prohibited in all political arenas. Unless the Democrats seize universal healthcare as their primary election platform (extremely unlikely!), Americans require a new Party that promises exactly that. Not only do we need universal healthcare, but we need to make sure that no other option exists so that the government won’t starve the funding for such a program as they have done with the Post Office, Education and every other government run institution. Big Pharma must be permanently put to rest. Anything short of this, translates into an unconditional surrender of the 99% to corporate fundamentalism.
Unfortunately I see next years election run ups to be nothing but the usual rhetoric as the two parties argue over who can give more breaks to corporate America which politicians loosely refer to as “tax breaks for working Americans” and who can promise to increase military spending more, loosely translated into “keeping Americans safe”. No discussions about anything that corporate America approves of such as universal healthcare, raising minimum wage to $15 an hour, decreasing the military budget, ending fossil fuel dependency or tackling global warming head on will occur. Instead well dressed actors will parade in front of the cameras sticking to their carefully constructed scripts and mastering their ability to avoid any and all debates that could prove to be embarrassing to the corporate State. Flag waving, xenophobic, love the troops and hate the government political celebrities will blather on endlessly, safe in the knowledge that the game is rigged. Americans will dutifully line up on election day to reinforce the plutocracy as millions will show their approval for the two Party, one message system by checking either a Democrat or Republican in November sealing our fate for another four years of corporate servitude. Dr. Zarr and his financially challenged patients will most likely be among those who vote for our corrupt gate keepers avoiding a third party choice as being “a wasted vote” and reluctantly resign themselves to vote for one of the corporate party’s as “the lesser of two evils”.
If the human race survives to live a two hundred years from now, historians will look back on this era with astonishment at how easily the 99% surrendered to corporate fundamentalism. Essays and books will be written arguing whether Americans really lived in a democracy and debates will rage on about how successful corporate America was in brainwashing an entire country into believing that they lived in a functioning democracy.


"Regardless of how the court rules, the sad reality is that the ACA won’t be able to achieve universal coverage. It won’t make care affordable or protect people from medical bankruptcy. Nor will it be able to control costs.

The ACA is fundamentally flawed in these respects because, by design, it perpetuates the central role of the private insurance industry and other corporate and for-profit interests (e.g. Big Pharma) in U.S. health care.

In contrast, a single-payer system – an improved Medicare for All – would achieve all three goals mentioned above: truly universal/comprehensive/lifelong care, affordability, and effective cost control."

Exactly. The fact is that what’s touted as Free Market Capitalism (in this case, operating through Big Insurance) really just FREES society’s predators to mug the rest of us.

And in response to Space cadet’s statement:

“If the human race survives to live a two hundred years from now, historians will look back on this era with astonishment at how easily the 99% surrendered to corporate fundamentalism.”

Note how he turns the issue of Big Insurance’s grip over U.S. policy into an indictment of every day people.

This is another example of a “logic” that either is CODE for some think tank’s messaging–in turning the problem of Big Insurance around into that of people who merely surrendered; or that of the warrior mentality.

It is mostly the warrior that identifies with structures of power that specialize in the use of FORCE to coerce the compliance of citizens.

This is the logic that–if followed to its natural conclusion–blames the slave for being a slave, “surrendering” to slavery, and blames the rape victim for “surrendering” to the rapist, and blames the civilians defeated by overwhelming martial force, for “surrendering” to the more muscular military invaders.

Essays, genius, will not be written to blame American citizens. They will be written about the old powers using banks, courts, religious houses of worship, corporations, and politicians to enforce the WILL and WISHES of the 1% unto the 99% around the globe. And they will go on to tell the story of the chains, being wrapped too tight (Austerity) led to a global revolution with Humanity at last putting aside its long HIS-tory of pharaohs, kings, czars, presidents and other assorted tyrants.


So well said. You summed up the situation perfectly!


I think of Doctors without borders going into Whythvile VA treating the poorest and most needy as an act of charity. Then ask how those receiving that care voted. They voted Republican. They vote for those very politicians that deny them Medicare. Don’t these people have some responsibility for those choices? You know in some ways I respect these individuals more than you do. I think they should bear some consequences for your choices. I suppose that you don’t. I suppose that you think those individuals are so pitiful, ignorant and gullible that they are excused for voting against their interests and inflicting increlible pain and suffering on themselves and others. I myself think Doctors without Borders should pull out of Whythville and let them stew in their own juices. I suppose you have such pity for these imbeciles that charity should be extended to them because they are not capable of discerning their own best interests. I have to confess that my feelings about these Rednecks and Southern culture in general varies between contempt and pity. My conviction is that they have an impenetrable racism which is centered only on preserving their own white privilige. I give up on moving them toward toward a more caring and empathetic view of how others as much citizens of this country as they are should be treated. I give up on them being capable of moral advancement. I only want to separate myself from them.


Robert Zarr M.D., M.P.H., has an idea worth fighting for. Too bad no one has it in them. Guess we deserve what we get if not motivated to do anything.


Good grief - you never give up, do you, just like the other 10 SRs, whatever happened to them - lordy, there’s a whole family of you …

In a system where reps are chosen by election, and the voters keep choosing the same reps over and over, even as they keep getting screwed by those reps - your response is that essentially we are too dumb to figure out that maybe we ought to make different choices …

Hmmm, maybe you are correct, maybe we are - but somehow I don’t think folks ought to be too pleased at your “defense” of them - rather insulting, ain’t it?


T - voting Dem wouldn’t have helped much … after all the ACA was a Dem sponsored plan -


Doc, you ain’t gonna get SP as long as D/Rs are in control - i would really like to see more of an overt acknowledgement of that fact coming from you guys …


I agree with your suggestion that we need to burn down the Capital and guillotine the Supreme Court, but I am not a violent person and suggest we
might to better to stop voting for either of our two corporately funded corrupt political parties. We need to find a good honest ethical person to run in your district to replace the person who now claims to represent you, when in fact he or she as absolutely no interest in you or your family.

It would be better if your candidate did not belong to any political party but is an independent. This way he or she will not be hampered by any political party coming in between the candidate and the voters. We need a candidate that will promise to vote as directed by the living breathing people who live in the district and to ignore the advice of any big ‘donors’ or any political party. We need our Representative to be a servant of the people and vote as we direct them to vote.

Then maybe we can get single payer health care for all as well as an end to the wars, tax the wealthy, and use these funds to put people to work, fully fund our domestic programs (no austerity) and protect our environment.

Better to change our habit of choosing the lesser evil and needing to burn down the capital and guillotine the Supreme Court to get the attention of those ‘Honored Members of Congress’" who don’t heed the voice of the people.


The biggest problem is that we have the form of government where a minority can keep anything from becoming law. And thanks to the Supreme Court’s decision in “Citizens United”, there is now no longer any limit upon the amount of money that can be donated to a political campaign. This pretty much means that the candidate with the most financial backing will likely win the election.

The countries with national health care systems also have (with a few exceptions) the parliamentary type of government, often with proportional representation where it takes an agreement between political parties before legislation can be passed. Also in most of these countries a greater proportion of the citizens do vote in every election. Whereas here in the US the voter turn out for mid-term elections is a often rather small minority of those citizens eligible to vote. The Republican advocation of “Voter ID” is another way to reduce turn out in elections, since Republican voters generally are higher income and also more likely to vote regularly.


Hurrah for Dr. Zarr. I have been saying the same thing for years (retired general pediatrics), but Mr. Obala
became intimidated by big insurance and big pharma and took us down the primrose path. When I was
in the Army 1963-66, I practiced in southern Germany, and was very impressed by the efficiency of their
health service. I was sold, and still am. Sooner or later.


It might have expanded Medicaid in the poor rural counties that really need it.


Thank you for writing this. Single-payer is too often dismissed as being somehow “unaffordable” or “unrealistic” by people who are heavily invested in the current system. I can imagine how it might potentially be disastrous for the health insurance industry. Is that really a bad thing (for anyone who isn’t employed by an insurance company)? It’s always struck me that they’re primary function is to make healthcare as complicated and intimidating as possible, in order to discourage people from using it.
I keep hoping that we, as a society, are nearing the point where we accept that there are some areas of life that shouldn’t be governed by bottom lines. As more people realize how precarious their own positions are, perhaps they’ll appreciate how huge a difference a bit of security can make. We’re all subject to the vagaries of a rapidly-changing world. If we end up with single-payer, I’m sure all those out-of-work medical insurance adjusters sure will be glad to have it…


Nonsense, for two reasons.

  1. This argument is a logical fallacy called affirming the consequent. (If A, then B; B; Therefore, A)

If I am in Kansas, then I am in the US.
I am in the US.
Therefore, I am in Kansas. (Even though the premises are true, the conclusion is false because I could be in any of the other 49 states.)

If Big Pharma has purchased the government, then we won’t have single-payer health care (e.g., public insurance like Medicare and Medicaid).
We don’t have single-payer health care in the US.
Therefore, Big Pharma has purchased the government.

  1. The history of Medicare shows that our government was not bought. Medicare is single-payer (public health insurance). Why didn’t Big Pharma buy Congress and prevent the passage of Medicare? Hint: Republicans were opposed to Medicare, but LBJ and the Democrats controlled Congress, so we ended up with single-payer health insurance for geezers over 65. Ironically, Medicare Part D is just like the ACA. When you go on Medicare Parts A and B, you must purchase prescription drug coverage from a private insurance company. Not surprisingly, we got Medicare Part D from George W. Bush and a Congress controlled by Republicans.


“The ACA is fundamentally flawed in these respects because, by design, it perpetuates the central role of the private insurance industry and other corporate and for-profit interests (e.g. Big Pharma) in U.S. health care.”

Siouxrose, you are dispensing revisionist history. The ACA is not flawed by design. Barack Obama wanted a public option as part of the ACA. Medicare is public health insurance. We the people should have the choice to have public health insurance or to buy private health insurance, just as we can choose to send our kids to public schools or to pay tuition and send them to private schools.

The reason there is no public option in the ACA is because 3 Senators: Nelson (D), NE; Lieberman (I), CT; and Landrieu (D), LA, all announced they would not vote for cloture if the bill had a public option. Without a vote for cloture, bills are filibustered to death, so Harry Reid had no choice but to bring a bill to the Senate floor without a public option (a bird in the hand, so to speak).

Nelson was my Senator and he was an insurance executive before he went into politics and he is now back with the insurance industry. He sided with big Insurance and against the people. I don’t know what motivated Landrieu to oppose a public option, but a lot of insurance companies are headquartered in CT and this is why Lieberman sided against the people.


Historians still look back at Germany in the 1933 and are astonished that Hitler rose to power in such an advanced and educated society. This is not an indictment of the German people any less that Big Pharma’s grip on the insurance industry is an indictment of the American people. Nevertheless is is proof of how the population in each case was manipulated by a handful of powerful interests that led both Germans in 1933 and Americans for a couple of generations into voting for people who did not represent their best interests. Whether you accept this fact or not, most Americans buy into a mainstream corporate narrative, i.e. Muslim terrorists are our biggest threat; capitalism is the best system we have; we live in a democracy; we need to spend 1 trillion a year on the military; Democrats and Republicans are opposing forces; we have a Liberal media, etc. What historians will find difficult to understand as they did in Nazi Germany, was how so many people bought into the mainstream propaganda despite all of the signs around them that suggested that something was terribly wrong. Essays, Sioux Rose, will be written as they have been for hundreds of years by scholars who will try to determine what social factors were at play that created such a plutocracy.
Today we have a much better understanding of how Hitler was able to lead an entire country into a such colossal conflagration. My point is that in two hundred years from now scholars will also try to understand how our corporate overlords led An entire country down a similar path of destruction. And just the way students today are astonished at how Hitler rose to such heights of power, students will eventually also struggle to understand how Americans were unable or unwilling to stop the corporate subjugation of America.


Medicare or Medicaid are NOT universal healthcare. When I discuss universal healthcare, I mean ‘universal healthcare’ (covering everyone). Though those two government programs provided a medical safety net for some Americans, it was far from being universal.
Secondly, when those two programs were introduced in the U.S., “Big Pharma” did not purchase “almost every Democrat and Republican in the House” at that time. Most progressives today recognize that Nixon’s Republicans in the 60’s and 70’s would be considered left of today’s Democrats. Big Pharma in that same period did not have the money or resources to purchase out government. A lot has changed since then. Therefore I would argue that if Medicare and Medicaid were introduced for the first time today, there would not be a chance in Hell that Congress would support it. In today’s society, I don’t see how anyone can possibly argue that the U.S. government is nothing more than the extension of a handful of special interest groups. Do you really believe that our current crop of elected officials truly represent the public interest?


There was a lot of excitement in many circles in 2010 when the affordable care act passed. The excitement, unfortunately, was based on empty promises.These promises included universality, quality, affordability, and cost control, just to name a few.

But even more shocking is that the ACA not only depends upon the for-profit inefficient wasteful private insurance industry, it significantly strengthens it. Another $300 billion of taxpayer money will be handed over to the insurance companies to help pay for faulty and unaffordable health insurance.

There is good news however. Most physicians in this country support establishing national health insurance. Most Americans also support establishing national health insurance. Even our own president, in his previous career as State Sen. of Illinois, supports establishing national health insurance. In addition, many Americans have become disillusioned a lot sooner than many expected. It is my opinion that we need to harvest this discontent to organize and consolidate our influence so that we may push toward the only rational solution, Improved and Expanded Medicare for All. Right now, we have yet again another window of opportunity to solve one of our country’s blatant examples of social injustice. This is not a time to despair, but rather to use our intellect and organizing experience to create the kind of democracy where we can truly level the playing field and give every American a real chance at health and well-being, without the looming threat of bankruptcy.