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  #201  
Old 08-26-2019, 12:36 PM
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Originally Posted by survinga View Post
People with private health insurance have better outcomes in the US than people who are uninsured or people with Medicaid. Studies have shown this ad nauseum.
Then insure every single person in top tier private health care entirely paid for out of the government's pocket.

But of course you will not do that. Instead you will simply let people suffer and die for lack of top health care.
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  #202  
Old 08-26-2019, 01:23 PM
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Selfish, stupid, whatever you want to say: their vote counts just as much regardless. And if you follow American politics at all, you should not be surprised that it is not the most rationally presented, wonky argument that wins out.
That's where proponents of single payor health care need to spread the gospel on how people will live longer and live in a healthier condition longer (as pointed out by wolfpup up thread), while paying less for it out of their own pockets and less for it through their tax dollars, while being entirely free to go to which ever doctor or doctors that they chose.

For the most part, Americans are big on belief, such as belief in god, guns and anti-socialism. Deeply held beliefs tend to be impervious to fact and reason. Change will be generational.
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  #203  
Old 08-26-2019, 01:55 PM
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... In fact you yourself seemed to be buying in to some of this by citing how well Medicare Advantage works with the aid of private insurers, when the fact is that MA works just because capitation and outcome-based management are good ideas, and the insurers are strictly held in line by their contractual obligations ...
Perhaps I did not make myself clear if that was your takeaway.

The point was that those good ideas can and do work in an environment that uses insurance companies. Those good ideas are perhaps even more important than whether or not the system is single payer or a competitive marketplace.

And I’d quibble with a can’t get there assessment. I think public option will demonstrate its superiority and the move to single payer will be inexorable. But not overnight and gradually enough that many of the job losses will be by attrition. And by proving itself first.

But glad to see that agree on the current practical politics of it.
  #204  
Old 08-26-2019, 07:05 PM
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Then insure every single person in top tier private health care entirely paid for out of the government's pocket.

But of course you will not do that. Instead you will simply let people suffer and die for lack of top health care.
I'm all for increasing the level of subsidies in the exchanges, and for letting people with good employer coverage (that they overwhelmingly like) keep it. I'm also for expanding Medicaid, even though it's not as good as private, because Medicaid offers a good way out for people who are uninsured.

That's not letting people "suffer and die", and you're misrepresenting what I'm saying.
  #205  
Old 08-26-2019, 07:16 PM
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1. Re: insured vs uninsured outcomes: so you're surprised that having access to health care results in better outcomes than not having access to health care. Duly noted, but most of us aren't surprised by the bleeding obvious.

2. Re: insurance vs Medicaid: so you're surprised that funding top-tier ongoing health care including preventative services results in better outcomes than the care from an artificially limited substandard tier, the patients of which have typically had spotty to non-existent health care for much of their lives due to poverty. Duly noted, but again, most of us aren't surprised at all.

3. Re: all of the above, including the claim that "children in Southern California have better access to care if they have private insurance vs government-funded insurance": be prepared to be surprised again, because residents of Canada on average live longer healthier lives than Americans despite living under the yoke of evil "government-funded insurance"! In point of serious fact, better health outcomes in Canada are largely because of a lifetime of guaranteed access to health care with no monetary obstacles to such access. The same results generally hold for most European countries, too.

I have no doubt that you "can post these kinds of studies day and night" but without the proper comparative context your implied conclusions are worthless.
Well, Bernie and Warren want a plan that has no co-pays and deductibles and no premiums, but pays much less than Private. It sounds an awful lot like Medicaid for All, even though it's named (incorrectly) "Medicare for All". And in this election environment, I think we need to point out that private insurance in the US is superior in outcomes to Medicaid, hence my links, which are just a few among many. This is not worthless. This is true. And the reason I originally posted that is Muffin's point about private insurance burning money for no good cause, which flies in the face of the superior outcomes in the US for people with private insurance. You can call it worthless, but that's just nonsense.

Americans need health insurance, not self-righteous points that attack what the majority of us have, who like what we have, who are doing better than those that don't have it.
  #206  
Old 08-26-2019, 07:30 PM
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Well, get back to me when you do. People actually providing care are unlikely to lose their jobs so that number means nothing without knowing the breakdown.
How do you know people who provide care are unlikely to lose their jobs? And how do you know healthcare employment numbers mean nothing? And how do you know that no one will care if an entire industry is wiped out by Sanders/Warren version of M4A?

I think in the political campaigns, this will be far more problematic than you will admit.

This Kaiser link says that 2 million jobs could get killed, even though it says, "that's OK"....

https://khn.org/news/analysis-a-heal...-and-thats-ok/

Let's see how that holds up in an election against Republicans, and in the face of a country where 80% of Americans like their own healthcare, and 70% like their own insurance.

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  #207  
Old 08-26-2019, 07:35 PM
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People with insurance have better outcomes than people without insurance. I stand amazed.
....and better than people with Medicaid....
  #208  
Old 08-26-2019, 07:39 PM
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I'm not lamenting the fact that they're selfish, I'm lamenting the fact that they're stupid
Those kinds of attacks generally don't work in politics, and aren't persuasive. Attacking voters or attacking people who don't agree with you.... I sure hope the Dems don't do that in 2020, as it sort of reminds me of Hillary's Deplorables comment. Didn't work out for her at all - even though I voted for her - and it won't work in 2020 either.
  #209  
Old 08-26-2019, 08:02 PM
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survinga, no, Medicaid for All would also not be at all apt and making a compare and contrast with private insurance is specious at best.

Here are some facts.

1) Medicare is administered by contracted private plans now for about a third of all enrollees; Medicaid is up to about two thirds, using risk-based models. This is not the model of the proposal.

2) Medicaid is not a universal program taken by all providers. Many providers refuse to play in the space. Access to care, even to basic primary care services, is sometimes so poor as to be as unto nonexistent. Hellavu lot better than no insurance but still an issue. The Canadian-style system proposed would not have that problem. Provider access (referral for specialty care required) would be better in the proposed Canadian-style system that under the current American private insurance model.

3) Medicaid specifically takes care of population inherently different from the general pool. Poor, with all the structural challenges associated with poverty, but also sicker. It provides
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... health and long-term care for millions of America’s poorest and most vulnerable people, acting as a high risk pool for the private insurance market. ... 83% of poor children; 48% of children with special health care needs and 45% of nonelderly adults with disabilities (such as physical disabilities, developmental disabilities such as autism, traumatic brain injury, serious mental illness, and Alzheimer’s disease); and more than six in ten nursing home residents ...
To be fair Medicaid as a plan performs amazingly well given its role as a high risk pool buffer taking care of very vulnerable patients not infrequently with disabilities and complex chronic illnesses who often have very limited resources. But it usually pays crap for the work involved and many I know will only participate as a function of civic responsibility, and then only if they can limit their panel size, as they often effectively lose money in the process.

Really though, what is proposed is a Canadian-style system for All. Not Medicare for All, not Medicaid for all, at all.
  #210  
Old 08-26-2019, 08:27 PM
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survinga, no, Medicaid for All would also not be at all apt and making a compare and contrast with private insurance is specious at best.

Here are some facts.

1) Medicare is administered by contracted private plans now for about a third of all enrollees; Medicaid is up to about two thirds, using risk-based models. This is not the model of the proposal.

2) Medicaid is not a universal program taken by all providers. Many providers refuse to play in the space. Access to care, even to basic primary care services, is sometimes so poor as to be as unto nonexistent. Hellavu lot better than no insurance but still an issue. The Canadian-style system proposed would not have that problem. Provider access (referral for specialty care required) would be better in the proposed Canadian-style system that under the current American private insurance model.

3) Medicaid specifically takes care of population inherently different from the general pool. Poor, with all the structural challenges associated with poverty, but also sicker. It provides

To be fair Medicaid as a plan performs amazingly well given its role as a high risk pool buffer taking care of very vulnerable patients not infrequently with disabilities and complex chronic illnesses who often have very limited resources. But it usually pays crap for the work involved and many I know will only participate as a function of civic responsibility, and then only if they can limit their panel size, as they often effectively lose money in the process.

Really though, what is proposed is a Canadian-style system for All. Not Medicare for All, not Medicaid for all, at all.
Look, I know that Sanders plan isn't Medicaid or Medicare for All. I was just taking his comments about no premiums, deductibles, co-pays, and lower reimbursement into account in my post.

I'm not against Medicaid, by the way. Many doctors don't take it. I know people in my extended family who have Medicaid, and they are limited in the doctors that will see them or treat them. But I know that it's helped millions of people, and I wish the rest of the red states in the US would finally accept the Medicaid expansion.

But in this country, the best outcomes are associated with private insurance. I think that should be pointed out to people who post wtte that private insurance is a waste that burns money while people die, etc. In this country, the best path to UHC is to expand on what we have - which does include more government involvement - instead of throwing it out, and completely replacing it with something very different.
  #211  
Old 08-27-2019, 04:32 AM
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Well, Bernie and Warren want a plan that has no co-pays and deductibles and no premiums, but pays much less than Private. It sounds an awful lot like Medicaid for All, even though it's named (incorrectly) "Medicare for All".
It also sounds exactly like the foundational principles of health care in Canada, which is Bernie's point. It also sounds very much like UHC in most of the civilized world, which is also Bernie's point, except for the minor aspect that in many systems there is a nominal co-pay. That part is just an implementation detail -- the important thing is that public UHC systems eliminate the interference and gross inefficiencies of a useless middleman trying to profit by mediating access to something that is a basic human right.
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And in this election environment, I think we need to point out that private insurance in the US is superior in outcomes to Medicaid, hence my links, which are just a few among many. This is not worthless. This is true.
Well, pointing that out is certainly a job that you're trying to do, and Republicans along with the lobbyists at America's Health Insurance Plans™ thank you. But you're wrong, for the reasons I itemized, which you've chosen to just ignore so you can plow ahead with the same talking points again and again. Private insurance is definitely the best thing to have in the US at this time, but only because that's how skewed and broken the system has become: all forms of public insurance are relegated to being a second-rate poor cousin, and that's by design. That's not how it is in other countries, where that is NOT the design. You can go ahead and ignore that, too.
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Americans need health insurance, not self-righteous points that attack what the majority of us have, who like what we have, who are doing better than those that don't have it.
No, in the final analysis Americans don't "need" health insurance, Americans need health care. If you confuse the unnecessary and meddlesome middleman with the final product, then the next step is to argue that if Americans "need" health insurance, then what better way to provide a wide variety of "choice" than through the wonderful mechanism of the "competitive free market"? Those words would warm the heart of any free-market ideologue, and certainly bring in donations from the health insurers and their lobbyists. But as other countries have discovered -- and they discovered this a long time ago -- what people actually need is unimpeded and guaranteed access to health care.

The irony of it all, of course, is that in the name of "choice" and free-market "competition", Americans actually have far less choice in the real end product -- actual health care -- than the people of other advanced nations, because access to actual health care in America is controlled by health insurers and limited by their fiduciary duty to minimize claims, control medical payouts, and herding patients into their own provider networks. As I've often said, quoting the late health care economist Uwe Reinhardt, physicians in other countries would be horrified at the degree to which American health insurers meddle between patients and their caregivers.

How can anyone "need" health insurance when I've never had health insurance in my life, and that's just the way I and all my fellow citizens like it? I simply have lifetime access to any needed health care from any provider at any time, at no cost to me.
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Those kinds of attacks generally don't work in politics, and aren't persuasive. Attacking voters or attacking people who don't agree with you.... I sure hope the Dems don't do that in 2020, as it sort of reminds me of Hillary's Deplorables comment. Didn't work out for her at all - even though I voted for her - and it won't work in 2020 either.
Good thing I'm not a politician running for office.
  #212  
Old 08-27-2019, 06:02 AM
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Abruptly abolishing private health insurance in the early 2020s is a stupid idea, whether viewed as a matter of policy, or as a matter of electability. And Elizabeth Warren is anything but a stupid person.

We bought into Obamacare as the first step in a gradual process: increase subsidies, impose patient-friendly rules, add a public option; the problems of private health insurance would gradually wither away. I hope Elizabeth Warren clarifies that her plan is something along those lines.

Instead of "Medicare for All" I propose "VA Healthcare for Some"! Contrary to right-wing propaganda, the VA provides good health care efficiently for 9 million-plus people. How hard would it be for VA to serve 10 million-plus? With the extra million being ordinary people who volunteer to hire the VA as their insurer, at a price set by VA to make a profit.

It might be impractical to expand VA Healthcare to serve a large portion of the population, but if it served a few million it could provide a useful comparison on services and prices charged by the private sector.
  #213  
Old 08-27-2019, 08:35 AM
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The irony of it all, of course, is that in the name of "choice" and free-market "competition", Americans actually have far less choice in the real end product -- actual health care -- than the people of other advanced nations, because access to actual health care in America is controlled by health insurers and limited by their fiduciary duty to minimize claims, control medical payouts, and herding patients into their own provider networks.
And furthermore, the free market is efficient when people make informed decisions based on an analysis of the costs and benefits. The costs for health care are completely opaque, whether with insurance or not, and ironically, the system for government-run health care is more transparent.
  #214  
Old 08-27-2019, 04:04 PM
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No, in the final analysis Americans don't "need" health insurance, Americans need health care. If you confuse the unnecessary and meddlesome middleman with the final product, then the next step is to argue that if Americans "need" health insurance, then what better way to provide a wide variety of "choice" than through the wonderful mechanism of the "competitive free market"? Those words would warm the heart of any free-market ideologue, and certainly bring in donations from the health insurers and their lobbyists. But as other countries have discovered -- and they discovered this a long time ago -- what people actually need is unimpeded and guaranteed access to health care.
In terms of health outcomes, insured Americans and Canadians are very similar.

https://www.healthaffairs.org/doi/fu...haff.25.4.1133

Our main problem is people who aren't insured. If we could get them signed up via Medicaid, that would be good. If we could subsidize a private policy for them, even better...
  #215  
Old 08-27-2019, 05:43 PM
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Our main problem is people who aren't insured. If we could get them signed up via Medicaid, that would be good. If we could subsidize a private policy for them, even better...
If you ignore costs and knew these private policies wouldn't require substantial personal costs for healthcare, yes. But those are respectively wrong and unlikely assumptions. To put this thread back on track, the unlikelihood of private insurance not being a bankruptcy trap houkd be emphasized. The "pencil pushing middleman" should be emphasized as the major source of job losses, regardless of how precisely accurate that is.

Last edited by CarnalK; 08-27-2019 at 05:48 PM.
  #216  
Old 08-27-2019, 06:43 PM
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"Higher levels of inequality" in the USA? Here's how to solve it:

Put everyone, rich or poor, of every ethnic group and geographic location, into the same pool with the same medical resources and the same access to those resources.
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  #217  
Old 08-27-2019, 07:39 PM
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"Higher levels of inequality" in the USA? Here's how to solve it:

Put everyone, rich or poor, of every ethnic group and geographic location, into the same pool with the same medical resources and the same access to those resources.
Wtf is wrong with you and wolfpup? Why the hell do you think this is an "argue how awesome UHC is" thread?
  #218  
Old 08-27-2019, 07:41 PM
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If you ignore costs and knew these private policies wouldn't require substantial personal costs for healthcare, yes. But those are respectively wrong and unlikely assumptions. To put this thread back on track, the unlikelihood of private insurance not being a bankruptcy trap houkd be emphasized. The "pencil pushing middleman" should be emphasized as the major source of job losses, regardless of how precisely accurate that is.
IOW you propose lying?

To the first part ... as has been pointed out in this thread already to very significant degrees current Medicare and more so current Medicaid are in fact functionally subsidized "private policies" in which the terms of the policy coverage are standardized and very explicitly laid out by the government. They (because of the specifics of those terms) are delivering on costs and quality, value, over what the FFS model administered by government itself does.

wolfpup, you really had a point that the Canadian model has been the victim of disinformation in the United States. It is a shame that you couple that with so many falsehoods about the American one. Your doing that really weakens your position tremendously.
  #219  
Old 08-27-2019, 08:35 PM
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To put this thread back on track, the unlikelihood of private insurance not being a bankruptcy trap houkd be emphasized.
I guess a candidate could emphasize that, and get plenty of attaboys from the Sanders wing. The problem is that the number of "medical bankruptcies" is GREATLY exaggerated, and that private insurance is in fact not a bankruptcy trap.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865642/

"We calculated this estimate as follows: the graph shows that, on average, a hospitalization increases the annual probability of going bankrupt in the following 4 years by 0.004. Multiplying this figure by the annual hospitalization rate of 7.8% for our population (which we calculated using the 1999–2010 Medical Expenditure Panel Survey) reveals that 0.031% (0.004 × 7.8%) of the population goes bankrupt each year as the result of a hospitalization. Given that the annual household bankruptcy rate is 0.8% among the nonelderly,4 hospitalizations cause about 4% (0.031/0.8) of bankruptcies among nonelderly adults. A similar calculation for a subsample of uninsured adults reveals that even in that population, hospitalizations are responsible for only 6% of bankruptcies4; for this population, the effect of a hospitalization on the likelihood of bankruptcy is (not surprisingly) larger, but the hospitalization rate is lower than in the overall nonelderly population."

So, while I agree that the prescribed talking point would probably be a popular talking point in a primary, it will be shredded in an election where everyone isn't trying to "out-Bernie" each other on healthcare.

Last edited by survinga; 08-27-2019 at 08:36 PM.
  #220  
Old 08-27-2019, 11:16 PM
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Right. When I first heard Bernie talking about medical bankruptcies, I actually naïvely believed that he meant cases where people had a car accident or serious illness that bankrupted them all by itself. But the reality is that he counts every case where someone declared bankruptcy and listed medical bills as one of the many things on the pile of debt. That’s not honest.


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Then insure every single person in top tier private health care entirely paid for out of the government's pocket.

But of course you will not do that. Instead you will simply let people suffer and die for lack of top health care.

Whoa, talk about fallacy of the excluded middle! How about giving poor and low income people health plans that are much better than what they have now, but not quite as good as the coverage a wealthy or upper-middle-class person has?


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And furthermore, the free market is efficient when people make informed decisions based on an analysis of the costs and benefits. The costs for health care are completely opaque, whether with insurance or not, and ironically, the system for government-run health care is more transparent.

Yes, and if we were having that wonky policy debate, I would make a strong pitch for my preference, which is an entitlement of an HDHP/HSA plan along with transparent medical pricing and consumer choice. But no politician is proposing that, and furthermore people probably wouldn’t like it very well. The dislike is actually a necessary component, because the idea is to get people to “bend the cost curve” by shopping around and fretting a bit over their healthcare costs, but without being vulnerable to a massive financial wipeout. Therefore it is sadly a political nonstarter.


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In terms of health outcomes, insured Americans and Canadians are very similar.

https://www.healthaffairs.org/doi/fu...haff.25.4.1133

Our main problem is people who aren’t insured. If we could get them signed up via Medicaid, that would be good. If we could subsidize a private policy for them, even better...

Nice. Notice that in that study, Canadians in the fourth and fifth quintiles, 40% of the population, were slightly more likely to have an unmet healthcare need than were comparable Americans. That’s the group I have been talking about, who cannot lose even an iota of the health coverage they have now or they will freak out. And they vote and contribute to candidates in huge numbers.


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Put everyone, rich or poor, of every ethnic group and geographic location, into the same pool with the same medical resources and the same access to those resources.

SlackerInc rings in first, and Alex Trebek calls on him:

“How do you get wealthy and upper middle class people to freak out and ensure a GOP landslide in the next election?”


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So you think American voters are stupid. Well, looking at who our president is that is a hard thesis to argue against.

LOL, sad but true.


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Politically the GOP has weakness on healthcare with the unforced error of continuing to try to repeal the ACA. The ACA in fact has delivered quite a lot. Politically a Democratic candidate should be leveraging that GOP weakness, not arguing that they agree the ACA is so horrible that it should be scrapped and replaced. Politically you leverage their weakness by pointing out how many of the current issues with the ACA are a result of intentional GOP kneecapping trying to sabotage it with voters' healthcare problems as cynical political civilian casualties. Politically you remind voters that the ACA was a compromise that could pass at the time and that it should be improved upon with specific ideas of how ... ideas that are less disruptive and ones that allow them to have choices about it.

This, 1,000%.


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I do believe that Democrats should put forward a cautious transitionary approach mainly built around introducing a public option to the ACA. I understand that people are fearful of revolutionary changes, and I think Sanders' all-or-nothing proposal that would ban private insurance is a serious mistake.

Well, blow me down! We do agree. Now please tell this to the millions of people supporting Sanders and Warren.
  #221  
Old 08-27-2019, 11:41 PM
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So hospitalization causing 4% of bankruptcies is a low number? Mmm, ok. Different strokes for different folks, I guess. Wonder how high it gets with non-hospitalized medical expenses.

Last edited by CarnalK; 08-27-2019 at 11:44 PM.
  #222  
Old 08-27-2019, 11:59 PM
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It’s a much, much lower number than the one Bernie is claiming.
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Old 08-28-2019, 12:13 AM
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Where is Bernie pulling his numbers from?

Eta: and what's the medical bankruptcy rate among the elderly? Why did that cited survey not include chem?

Last edited by CarnalK; 08-28-2019 at 12:17 AM.
  #224  
Old 08-28-2019, 01:00 AM
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FWIW, 4% of all bankruptcies would be almost 31,000. (Source: https://www.uscourts.gov/news/2019/0...ntinue-decline) I just heard a soundbite from Bernie (on the highly recommended “Hacks on Tap”* podcast) telling David Axelrod this past weekend that the number “this year” will be “a half million.”

And any of the Democrats running will get rid of that 31,000.

*Mike Murphy, who masterminded McCain’s “Straight Talk Express” campaign in 2000, cohosts it with Axelrod. Murphy is one of the wittiest guys in the world. Sample: “Trump always takes defeats and declares victory. If he had been president during Pearl Harbor, he would say the Japanese lost because they used up so much aviation fuel and torpedoes.”
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Old 08-28-2019, 01:12 AM
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Well, from what I recall on earlier goes on this subject, more "robust" numbers on medical bankruptcy just want a smaller amount of total debt to be medical to count it. I suspect there's a middle ground of reality somewhere between the non-elderly hospitalizations bankruptcy numbers and the "everyone who still owes a clinic a copay".
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Old 08-28-2019, 02:37 AM
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I agree, but I really doubt it’s a six figure number, which still makes Bernie’s “half million” wildly overinflated. For a guy whose brand is supposed to be probity and forthrightness, he sure takes a lot of liberties with the truth.
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Old 08-28-2019, 02:50 AM
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Originally Posted by SlackerInc View Post
Notice that in that study, Canadians in the fourth and fifth quintiles, 40% of the population, were slightly more likely to have an unmet healthcare need than were comparable Americans. That’s the group I have been talking about, who cannot lose even an iota of the health coverage they have now or they will freak out. And they vote and contribute to candidates in huge numbers.
I was wondering where the hell that factoid came from since the principal conclusions I saw from that study -- just like from all other such studies -- is that Canadians get the same or better health care than Americans (and live longer, healthier lives) without having to pay outrageous amounts to insurance companies and have insurance bureaucrats rule on whether they're allowed to have a particular medical procedure or not. And the difference in health and medical outcomes is most dramatic for lower income groups. One must also remember that "lower income" means not just members of the middle class who may think "that's not me", but a great many retirees on fixed incomes who suddenly find themselves in that very class and with substantial health care needs (and in the US, Medicare is only a partial help).

Anyway, as I said, I was wondering where the hell that factoid came from since I never saw it mentioned in the body of the report, and it appears to be based on your microscopic examination of the bar graph in Exhibit 5. What that graph tells us is that Americans in the three lower income quintiles have overwhelmingly greater unmet medical needs than Canadians, whereas in the top two income quintiles they are statistically identical. Not only are they identical within any conceivable margin of error, but it's kind of remarkable that they are since Canada's population includes many sparsely populated northern regions where medical care is not readily available.

So the reason the report never mentions this "fact" is because it isn't a fact at all. And yet despite the report's overwhelming and clearly stated conclusions, you're trying to tell us that middle-class and rich American voters are going to rebel against UHC because they purportedly would have more "unmet medical needs" than Canadians by an amount equal to about the width of an ink molecule on a graph that they've never seen.

No, I'll tell you why rich Americans reject UHC, and it's not rocket science and it's not because of any statistical subtleties. They reject it because they know -- and this really is a fact -- that despite all of its overwhelming advantages and lower costs across the board, in any health care system that is substantially funded by taxes the rich are going to be paying more and not getting any better services than the excellent ones they already have. There are also lots of fake beliefs underlying opposition to health care, and stupid ideological ones like objecting to "the undeserving" (mostly code for "black people") getting health care for free, but the preceding is a true fact: UHC in almost all its implementations is an equalizing mechanism that requires the rich to subsidize care for the less fortunate.

So this is ultimately not a health care debate, it's a debate about the kind of society people want to live in -- it's exactly the same argument about whether poor people should die early deaths whether it's from lack of health care or from malnutrition. The argument about egregious social inequalities has been settled in most of the industrialized world since at least the middle of the 20th century -- Britain's landmark social transformations after WW2 being a great example -- but it's a tough argument to win in America. And that, my friend, is the real issue here, not some imperceptible subtlety on a bar graph. Americans need to be convinced that their broken and barbaric health care system didn't come about by accident, but reflects the values of the society they live in, and the power brokers who control it.
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Old 08-28-2019, 02:59 AM
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Would it help if I begged people to not turn this into a basic UHC thread? Yeah, we get it wolfpup, Canada is awesome . Thanks for the reminder.
  #229  
Old 08-28-2019, 03:14 AM
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Where is Bernie pulling his numbers from?

Eta: and what's the medical bankruptcy rate among the elderly? Why did that cited survey not include chem?
There seems to be very few medical bankruptcies among the over-65s.

I expect Bernies numbers are from this article in the American Journal of Medicine. As I remember, it made a splash. The figures are disputed, of course.

Its hard to pin down an exact number, because illness often leads to loss of income as well as medical bills. Also, illness and medical bills can put a financial strain on close family which can cause financial stress beyond the patient.

I expect you can get a very low number if you count only direct medical bills from hospitalizations, and only look at the patient. And you should be able to get very high ones if you count all the cases where people were too sick to work full time and bills just grew unmanageable for them or their family.
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Old 08-28-2019, 03:46 AM
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Which would still be a problem even with single-payer healthcare. But I’m sure Liz and Bernie have some other pie in the sky plan to take care of that eventuality.
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Old 08-28-2019, 06:56 AM
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Would it help if I begged people to not turn this into a basic UHC thread? ...
Doubt it. There's really no one here who is willing or able to argue that advocating for Sanders plan is smart politics for the general.

"Is it bad politically. Yes." would have been a pretty short thread.
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Old 08-28-2019, 12:37 PM
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Would it help if I begged people to not turn this into a basic UHC thread? Yeah, we get it wolfpup, Canada is awesome . Thanks for the reminder.
I guess in terms of political messaging, Bernie and now Warren have an easy set of short talking-points that they can use to demonize people who are either opposed to Medicare For All (Bernie's version of it), or people who are not fully on board with his proposal. It can sell in a Democratic primary. But in a general election, Bernie's exaggerations on things like medical bankruptcies and lack of truth on cost will get more scrutiny.

Now, on the Republican side, they basically have nothing to offer, except a pack of lies. So, this is really about how far the Dems want to take healthcare in the US, and how fast.
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Old 08-28-2019, 02:29 PM
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Would it help if I begged people to not turn this into a basic UHC thread? Yeah, we get it wolfpup, Canada is awesome . Thanks for the reminder.
No it would not. Please don’t tell other posters what they may post. If you think there’s a hijack in progress please feel free to report it and let us make that call.
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Old 08-28-2019, 05:46 PM
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I would have thought the word "begged" would keep me rather clear of junior moderator complaints.
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Old 08-28-2019, 07:47 PM
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Would it help if I begged people to not turn this into a basic UHC thread? Yeah, we get it wolfpup, Canada is awesome . Thanks for the reminder.
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Doubt it. There's really no one here who is willing or able to argue that advocating for Sanders plan is smart politics for the general.
"Is it bad politically. Yes." would have been a pretty short thread.
A major reason that 'Medicare for all' is dangerous politically is that most Americans believe things about single-payer and/or UHC that aren't true. So wolfpup has been posting some facts.

Seems relevant to me. The only way to message effectively about health-care policy positions is to get your listeners/readers on approximately the same page on the actual outcomes of UHC and single payer systems.
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Old 08-28-2019, 08:44 PM
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Really Sherrerd no. A fine discussion to have mind you. But as I stated earlier, engaging in a long discussion about why you or I believe Americans should not have a candidate's sexual orientation or religion or gender fluidity or whatever matter to their vote is not especially relevant to the question of whether or not it does matter to enough of them as to impact a candidate's chances of winning. Not a hijack worth reporting in my mind but one fair I would think to point out in progress.

I'd ask to have this discussion of whether or not it does dropped, as a further digression, but that might get me a note for telling posters what to post.
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Old 08-28-2019, 09:10 PM
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Originally Posted by wolfpup View Post

So this is ultimately not a health care debate, it's a debate about the kind of society people want to live in -- it's exactly the same argument about whether poor people should die early deaths whether it's from lack of health care or from malnutrition. The argument about egregious social inequalities has been settled in most of the industrialized world since at least the middle of the 20th century -- Britain's landmark social transformations after WW2 being a great example -- but it's a tough argument to win in America. And that, my friend, is the real issue here, not some imperceptible subtlety on a bar graph. Americans need to be convinced that their broken and barbaric health care system didn't come about by accident, but reflects the values of the society they live in, and the power brokers who control it.
And sometimes, when we have these "debates", there are candidates who will pretend to support doing something they do not actually support - such as Republicans saying "repeal and replace". But there are also candidates who will not be honest about the cost or the reasons behind their great program which they claim will address social inequalities. When I hear a candidate sell his/her policy without being honest about the cost of his program, or who exaggerates the problems in the current system, I have to wonder if he/she actually believes in what they are trying to sell. If you're cooking up something that has a big impact on 18% of our economy, and where a large majority of Americans already like what they have, we need to hear the full truth.
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Old 08-28-2019, 09:40 PM
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Doubt it. There's really no one here who is willing or able to argue that advocating for Sanders plan is smart politics for the general.

"Is it bad politically. Yes." would have been a pretty short thread.

Yet Sanders and Warren combined have more combined support in many polls than any other pair of candidates running
  #239  
Old 08-29-2019, 01:28 PM
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And sometimes, when we have these "debates", there are candidates who will pretend to support doing something they do not actually support - such as Republicans saying "repeal and replace". But there are also candidates who will not be honest about the cost or the reasons behind their great program which they claim will address social inequalities. When I hear a candidate sell his/her policy without being honest about the cost of his program, or who exaggerates the problems in the current system, I have to wonder if he/she actually believes in what they are trying to sell. If you're cooking up something that has a big impact on 18% of our economy, and where a large majority of Americans already like what they have, we need to hear the full truth.
How do you reconcile "a large majority of Americans [liking] what they have" with the fact that 70% of them are in favor of single payer in the form of Medicare for All? And only 20% are opposed to such a system.

I reconcile it by suggesting that "liking what they have" doesn't mean what you think it does. If you asked a typical middle-class American if he's satisfied with his health care, he might observe that he has a doctor who he can see if he has a medical need, likewise he has access to hospitalization should he need it, and in most cases insurance will pay for most of it. So he's more likely to say he's "satisfied" than "dissastisfied". But more and more, Americans appear to be realizing that all other comparable countries provide health care for all their citizens and that they do it more efficiently and far more economically than the US does. So there's a growing conviction that what other countries are doing is worth emulating.

As for "being honest" about cost, is there something less than honest about observing the documented real costs in all these other countries? Health care systems involve a lot of potentially complex issues, so what better way to understand their performance than to look at real-life examples of how different systems actually work and what their outcomes are, and what the public's level of satisfaction is with them. That's the most pragmatic way of arriving at the "full truth", and it's why the examples of other countries are not a hijack or irrelevant to the discussion but absolutely central to how policy proposals should be presented. I'm always astounded by how something like MfA is often represented as being a crazy and daring experiment with absolutely unknowable outcomes when variants of it exist all over the world, readily available for detailed study.
  #240  
Old 08-29-2019, 02:16 PM
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How do you reconcile "a large majority of Americans [liking] what they have" with the fact that 70% of them are in favor of single payer in the form of Medicare for All? And only 20% are opposed to such a system.
I'd say that 70% is not reliable. There is other data that shows the figure to be significantly less.
  #241  
Old 08-29-2019, 02:37 PM
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I'd say that 70% is not reliable. There is other data that shows the figure to be significantly less.
Fair enough. But, digging a bit into the details, it's worth noting that your first cite shows that support for single-payer has in fact been the position of the majority of Americans after 2016, even if it was less than 70%. And the second cite shows lack of support specifically for Bernie's plan to eliminate private insurance altogether -- which plan I always thought was unrealistic and politically a non-starter -- not lack of support for MfA itself. In fact when they present the option of "Medicare for All who choose it, allowing private insurance", the overall percentage who approve is ... exactly 70%!

So I think your additional data points are a useful clarification but the fact remains that MfA appears to be a popular policy proposal.
  #242  
Old 08-29-2019, 02:52 PM
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So I think your additional data points are a useful clarification but the fact remains that MfA appears to be a popular policy proposal.
There are so many flavors floating around, and the details are so critical to the execution, I'd say relatively few data points on a complex topic are not good fodder to base conclusions on. But I do agree that MfA is very popular policy proposal.
  #243  
Old 08-29-2019, 03:12 PM
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How do you reconcile "a large majority of Americans [liking] what they have" with the fact that 70% of them are in favor of single payer in the form of Medicare for All? And only 20% are opposed to such a system.
It's extremely easy to reconcile. First, when people are told that private insurance would be abolished under a Sanders plan, their support plummets for M4A. Second, it's the typical micro vs macro conundrum. I know if my own car is a good car. But don't ask me to evaluate the automobile industry in total. I know if my house is a good investment, but I can't accurately appraise the entire housing market across the US.

Same thing with health care and insurance. People generally are OK with what they have in the US, although yes, it is too expensive. But people generally think their own situation is good. Most of these people know alot more about their own doctors and hospitals and Rx than they know about the overall health care system.
  #244  
Old 08-29-2019, 07:30 PM
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... But as I stated earlier, engaging in a long discussion about why you or I believe Americans should not have a candidate's sexual orientation or religion or gender fluidity or whatever matter to their vote is not especially relevant to the question of whether or not it does matter to enough of them as to impact a candidate's chances of winning. ...
This analogy appears to be based on an implicit assumption that few or no Americans can or will ever learn something about a topic (in this case UHC and single-payer) that would affect their votes.

I'm not sure that's a safe assumption.

Quote:
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...But more and more, Americans appear to be realizing that all other comparable countries provide health care for all their citizens and that they do it more efficiently and far more economically than the US does. So there's a growing conviction that what other countries are doing is worth emulating.

...Health care systems involve a lot of potentially complex issues, so what better way to understand their performance than to look at real-life examples of how different systems actually work and what their outcomes are, and what the public's level of satisfaction is with them. That's the most pragmatic way of arriving at the "full truth", and it's why the examples of other countries are not a hijack or irrelevant to the discussion but absolutely central to how policy proposals should be presented. I'm always astounded by how something like MfA is often represented as being a crazy and daring experiment with absolutely unknowable outcomes when variants of it exist all over the world, readily available for detailed study.
Yes, this. Only some fraction of voters will pay attention to such information, but we can't assume that none will, nor can we assume that over time the numbers paying attention can't increase.

Thus the discussion isn't actually based on prescriptive ideas on what American voters "should" know or believe. Instead, it's based on the twin facts that useful information is worth presenting, and that polling provides evidence that opinions do change over time.

(my emphasis in the quote)

Last edited by Sherrerd; 08-29-2019 at 07:31 PM. Reason: UHC not UHB (whatever that is!)
  #245  
Old 08-29-2019, 09:43 PM
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It’s fine if you want to try to educate the electorate. But that is not a short term project to accomplish during one election cycle. Warren and Sanders are way out over their skis.


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It's extremely easy to reconcile. First, when people are told that private insurance would be abolished under a Sanders plan, their support plummets for M4A. Second, it's the typical micro vs macro conundrum. I know if my own car is a good car. But don't ask me to evaluate the automobile industry in total. I know if my house is a good investment, but I can't accurately appraise the entire housing market across the US.

Same thing with health care and insurance. People generally are OK with what they have in the US, although yes, it is too expensive. But people generally think their own situation is good. Most of these people know alot more about their own doctors and hospitals and Rx than they know about the overall health care system.

Right. People don’t approve of Congress, but they like their representative. They think “the schools” are bad, but they like their child’s school. So propose to reform other people’s health coverage, but not to replace theirs with something totally new.

Quote:
Originally Posted by wolfpup View Post
And the second cite shows lack of support specifically for Bernie's plan to eliminate private insurance altogether -- which plan I always thought was unrealistic and politically a non-starter -- not lack of support for MfA itself. In fact when they present the option of "Medicare for All who choose it, allowing private insurance", the overall percentage who approve is ... exactly 70%!

So I think your additional data points are a useful clarification but the fact remains that MfA appears to be a popular policy proposal.

But Bernie’s bill (which Warren backs to the hilt) is what is actually called MFA, inaccurate though that may be descriptively. If you add “...who
want it”, I have no problem with that. It’s what other Democrats are proposing and what I support. If anyone thinks I oppose that, we have failed to communicate.

But Warren and Sanders are two of the top three in polls, and they support precisely what you are correctly calling “unrealistic and politically a non-starter”.

The point of this thread is to oppose those two top tier candidates. Just those two. Bernie and Liz. That’s it. Not to oppose UHC in general terms, or to oppose any of the other candidates’ plans. I thought I was clear about that from the jump, but if not, my apologies.
  #246  
Old 08-29-2019, 09:45 PM
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This analogy appears to be based on an implicit assumption that few or no Americans can or will ever learn something about a topic (in this case UHC and single-payer) that would affect their votes. ...
Not by any stretch of even twisted logic.

The question of what Americans want and will want to vote for, the question of political advantage and disadvantage, is just a question very independent of arguments regarding what voters SHOULD be in support of.

Is "useful" (YMMV) information worth presenting? Sure. But "useful" information that is not useful to the question being asked is pretty useless. It is useful to a different question.
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