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  #51  
Old 07-31-2019, 10:44 AM
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Originally Posted by UltraVires View Post
With any program that gives you free stuff, the beneficiary will love it. That says nothing about its overall desirability.

The problems with healthcare in the United States are due to the socialist aspects of it: overregulation, limitation of supply, drug laws, no price transparency because of third party payments, and the fact that the poor and the elderly already have socialized medicine.
Those aren't socialism either. Or, to put this another way, which aspects of US healthcare (or European healthcare), specially, are 'socialist'? I'm going to go with none of them, since ACTUAL socialist healthcare isn't at all what people think. Here is a hint though...check out China's healthcare system, or the system the Soviet Union had to see what it is.

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The insurance model is terrible for most healthcare items like contraception or routine doctor visits. Those things that we all need cannot be insured against anymore than buying food insurance would be a good idea such that when I go to the grocery store, I pay a co-pay, but only get the foods that an insurance company nutritionist believes is appropriate.
This is mainly because our system is broken. Basically, our system sort of straddles the line between private healthcare and public healthcare, using the very worst aspects of both. That's because our system evolved in our political system, where changes might and were made by one political faction, only to be changed or altered or, in many cases starved by the next one...only to be revised again by the next one, and changed or altered again by the next one. It's an organic system that sort of grew along with our political system through different eras. At this point, it doesn't even vaguely resemble either what it originally was or what any of the folks who have altered it in the past meant for it to be. It's also a system that people in the US are used to and have been for all their lives...hell, all their parents lives and in some cases their parents lives too.

There are some very strange and fucked up reasons why the costs are what they are...and those are mainly down to old rules, regulations, how our ridiculous insurance works and basically arbitrary and conflicting pricing that is more to 'fix' how insurance companies billed in the past. It's a broken system. And it has zero to do with socialism.

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These other first world countries are also able to afford more social programs because they enjoy living in a relatively peaceful world because the US carries the weight of having such a large military. When North Korea tests a new nuke, does Norway or Finland do anything? Nope, United States. When things flare up in the Middle East, is Canada front and center? Nope, the US.
You are conflating several things here. True, Europe as a whole and the Nordic countries specifically don't pay as much for their military as we do. And certainly that gives them bigger budgets to do social programs, knowing the US has their back. However, the US could implement similar programs, especially wrt healthcare. Our healthcare costs a lot more than anyone else in the world, and a lot of that comes down to how dysfunctional it is because of all of that historic baggage. We could streamline the system and have a much better, more comprehensive system that costs no more (and probably less) than we currently pay, but we can't all agree on how to do that. And, of course, you have vested interests who don't want any sort of large scale change. In any change, there will be winners and losers, and the losers kind of know who they are and don't want to lose.

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Also, innovations in prescription drugs and other procedures only come to fruition because these companies can recoup their R&D costs through the "private" healthcare market in the United States.

When 85+% of people in the US are happy with the current system, and there is a safety net for the poor and elderly, why scrap the system for something in the hopes of improving it?
I don't think 85+% of our citizens ARE happy with the current system...it's just that it's the only system they know, and they fear what they don't know or just basic change. But our system is broken and change IS coming, one way or another. As to R&D costs, I don't think that would necessarily change if we went to a single payer system of some kind. I think American healthcare would STILL be the most expensive on the planet...but, damn, wouldn't it be good to get everything we are paying for??

Regardless, none of this has anything to do with socialism.
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  #52  
Old 07-31-2019, 10:45 AM
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America is different, better in most ways, worse in others.
For example the US government spends more money on healthcare per capita than Canada and yet only covers half the population. Advocates of UHC would have us believe that the US government has not really been trying this whole time, and as soon as they take over the other half of the the healthcare market they will suddenly be as good as the Canadians at cost control.
Obamacare had 10 programs designed to decrease the cost of healthcare. They all failed. The Democrat controlled house just voted to repeal the Cadillac tax which is one of the few attempts to rein in healthcare costs still standing.
It seems that the best hope for America to control healthcare spending via the government would be to switch to a parliamentary system and have started 60 years ago.
This is just a long way of saying that America isn't capable of doing something that many other countries are doing right now. Too bad you don't have more confidence in your country. Maybe we could actually accomplish some great things if conservatives actually believed in America.
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  #53  
Old 07-31-2019, 10:48 AM
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“socialized healthcare” reads to me, like we are going to replace our expensive faulty healthcare system with an incredibly corrupt, more inefficient, centralized one, that will concentrate power in the hands of evil oligarchs that will use it wield arbitrary power and control over the populace turning us into slaves.
Honest question: do the people in charge of the current healthcare system resemble this remark in any way? Because as far as I see it, this is what you already have except it's not centralized.
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Old 07-31-2019, 10:48 AM
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What was the point in associating my post with wrongful conservative thinking on socialism? If you wanted to say those things you didn't need to quote me.
BECAUSE WHAT YOU SAID REMINDED ME OF THE THING I THEN SAID.

As I said.
  #55  
Old 07-31-2019, 10:51 AM
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Scylla,

The murders you reference result from centralized power in the political system, not economic policy. Our Capitalist system killed lots of it's citizens to appropriate the property of the native population and to put down the southern insurrection. And it liberally killed others during it's imperialist expansion into the Central America, the Philippines and the middle east. The socialist economy in Russia completed the emancipation of the serfs, raised literacy from 16% to 95%, industrialized the country, defeated the Nazis and put the first satellite and man in space.

The emerging problem for the US is Centralization. First the growing concentration of power away from the legislative and judicial branches toward the executive. And second the growing centralization of large industries.
  #56  
Old 07-31-2019, 10:53 AM
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Originally Posted by Scylla View Post
“socialized healthcare” reads to me, like we are going to replace our expensive faulty healthcare system with an incredibly corrupt, more inefficient, centralized one, that will concentrate power in the hands of evil oligarchs that will use it wield arbitrary power and control over the populace turning us into slaves.

Can we maybe get a proposal for a healthcare system that doesn’t borrow from Stalin?
So AFAIK, nearly every other modern industrialized nation implements a form of universal health care. While there are variations from country to country, and non of them are perfect, it's my impression that they are functional on a level comparable and often exceeding the health care system in the US.

So what I'm asking is, why do conservatives feel that a health care system funded at the national level will "turn us all into slaves" any more than any other nationally funded infrastructure like, I don't know, the interstate highway system, Medicare, Medicade, Social Security, NASA, Amtrak or the United States Armed Forces?


Nationalized infrastructure and social safety nets are not "socialism". Or at worst, it is a form of benign "socialism" practiced by nations like Canada and much of Europe. Again, hardly "perfect" but not Venezuela or Soviet Russia.


Scaremongery socialism and communism is really a form of centralized totalitarian government where a single party controls the "means of production" by nationalizing major industry sectors. They typically fail economically because control over these assets are generally based on political favor, not merit and they are usually run in a way to enrich those who control them, not based on free-market forces.
  #57  
Old 07-31-2019, 10:54 AM
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This is just a long way of saying that America isn't capable of doing something that many other countries are doing right now. Too bad you don't have more confidence in your country. Maybe we could actually accomplish some great things if conservatives actually believed in America.
We're actually pretty capable of doing good things, even good big things. But we have tens of millions of voters who are convinced that our government is destined to be inept and they keep voting for politicians who are committed to fulfilling that prophecy.
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Old 07-31-2019, 11:11 AM
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We're actually pretty capable of doing good things, even good big things. But we have tens of millions of voters who are convinced that our government is destined to be inept and they keep voting for politicians who are committed to fulfilling that prophecy.
Yes. "Government is the problem! Government can't work! Vote for us so we can prove it to you by making sure it doesn't work". And people keep falling for that over and over.
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  #59  
Old 07-31-2019, 11:12 AM
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Scylla,

The murders you reference result from centralized power in the political system, not economic policy. Our Capitalist system killed lots of it's citizens to appropriate the property of the native population and to put down the southern insurrection. And it liberally killed others during it's imperialist expansion into the Central America, the Philippines and the middle east. The socialist economy in Russia completed the emancipation of the serfs, raised literacy from 16% to 95%, industrialized the country, defeated the Nazis and put the first satellite and man in space.

The emerging problem for the US is Centralization. First the growing concentration of power away from the legislative and judicial branches toward the executive. And second the growing centralization of large industries.
See, this is the sort of thing that really drives home the miscomprehension of what is or isn't socialism, what is or isn't capitalism. On the one hand, you are glossing over the totalitarian aspects of socialism systems (I note you didn't mention China in any of this), while putting the full death toll in the Americans squarely on the US and on capitalism...despite the fact that capitalism isn't even a political system. Then you gloss over all of the really nasty aspects of socialist economics (while either intentionally misleading about the 'emancipation of the serfs' in Russia or you really don't know that millions of them starved to death or were shot...true, they died emancipated, but not sure how great that was for them) by hitting only the highest of the high points.

Socialist economic systems don't work. They have never worked. Pointing out the fact that the Soviets had a space program and managed to industrialize (over the bodies and health of their citizens) does not demonstrate that it ever worked...it actually makes the case that, despite socialism they MADE it work. Out of the barrel of a gun. And it glosses over the fact that it's dead and gone now. It also glosses over the fact that, today, most countries have abandoned it completely, and even those who still have it to one extent or another use a hybrid...and it's the socialist parts that are holding them back (I'm thinking of China here). Capitalism, for all it's flaws is still the best economic system in history. It works. But to soften it, we need social PROGRAMS. This doesn't make the system socialist, however...it is still a capitalist system with air bags and safety belts, to the extent the individual society implementing it desires those things. The very few countries who are still whole hog on socialism are the most dysfunctional on the planet currently...Venezuela and North Korea being the best examples of systems that are almost completely 100% economic and political socialism.
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  #60  
Old 07-31-2019, 11:20 AM
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This is just a long way of saying that America isn't capable of doing something that many other countries are doing right now. Too bad you don't have more confidence in your country. Maybe we could actually accomplish some great things if conservatives actually believed in America.
Do you think it would help if I closed my eyes, crossed my fingers, and chanted "I think we can"?
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Old 07-31-2019, 11:29 AM
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Do you think it would help if I closed my eyes, crossed my fingers, and chanted "I think we can"?
Currently that closing of eyes and crossed fingers is what is happening right now, the "I think we can" chant goes for the 'we have it better' or 'we can't do it better because it will turn into "socialism"' message coming from many conservatives.

https://www.theguardian.com/us-news/...rices-salaries
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Recent attempts to reform American healthcare have assigned blame for the high cost of care to nearly every sector – from drug companies to hospitals to health insurers.

However, a co-author of the new study said those arguments ignore the “800-pound gorilla”: sky-high prices everywhere.

“Most countries get to lower prices one of two ways: they either have a very strong price setter, usually a government agency, or more efficient markets,” said Dr Ashish Jha, co-author of the study by researchers at Harvard’s TH Chan School of Public Health. “The US has figured out how to do the worst of both.”

In the study, America was compared to 10 other countries: the United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, Denmark, the Netherlands and Switzerland.

Researchers used 98 indicators to compare countries across seven areas: general spending, population health, structural capacity, utilization, pharmaceuticals, access and quality and equity. The majority of the data came from international organizations, such as the Organization for Economic Cooperation and Development. What researchers found was not a single sector with high prices, but that every sector had extraordinary price tags.

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  #62  
Old 07-31-2019, 11:31 AM
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Do you think it would help if I closed my eyes, crossed my fingers, and chanted "I think we can"?
I think closing our eyes and doing nothing is much worse. Something has to be done. Our current system is broken and we need something that can replace it. Myself, I think we should take a good hard look at what other countries are doing to see what we can adapt to a new system that would work for us. And there ARE quite a lot of good aspects to single payer systems out there that we could use.
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  #63  
Old 07-31-2019, 11:35 AM
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XT,

Errr...ummmm… actually capitalist and socialist systems are a matter of degree. Russia suffered some set backs as a result of centralization, but they recovered. After WW2 Russia was a totalitarian capitalist state.

Socialism has obviously been successful in Russia, Viet Nam, Cuba and China. Even Utah, before statehood was a successful communist theocracy. South Korea and Singapore are very Capitalist, but are they also socialist?

I agree with your 'whole hog' issue. The problem with any system is optimization. Pure capitalism or socialism is degenerative.
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Old 07-31-2019, 11:42 AM
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XT,

Errr...ummmm… actually capitalist and socialist systems are a matter of degree. Russia suffered some set backs as a result of centralization, but they recovered. After WW2 Russia was a totalitarian capitalist state.

Socialism has obviously been successful in Russia, Viet Nam, Cuba and China. Even Utah, before statehood was a successful communist theocracy. South Korea and Singapore are very Capitalist, but are they also socialist?

I agree with your 'whole hog' issue. The problem with any system is optimization. Pure capitalism or socialism is degenerative.
Russia was never a capitalist state (by which I presume you mean they had a capitalist economic system, since, again, capitalism isn't a political system) until after the fall of the Soviet Union, and even today has many socialist aspects, though is at least nominally capitalism (of the crony variety). Certainly, today, systems are hybrid, as many countries (including even the US) still have some socialist (actual socialist) economic systems in place (state run and operated business, for instance, as an example).

Socialism was NOT 'obviously' successful in Russia, Viet Nam, Cuba or China. Most of those countries adopted some elements of capitalism to make their busted ass systems work, and in fact the socialist economic parts are, across the board, the parts holding them back and the most dysfunctional. In China they cost the country something like a trillion RMB at least, annually.

South Korea and Singapore are capitalist economic systems that happen to have a few socialist economic aspects still in the system. And, frankly, it's holding them back, especially South Korea. But they are not socialist economic systems by any way, shape or form...I'd go (WAG) with a 80/20 mix at most in both of those. Same goes for the Nordic countries. China, on the other hand is probably 60/40 and Vietnam is in a similar mix. NK and Venezuela are more like 10/90 or perhaps even worse.
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Last edited by XT; 07-31-2019 at 11:43 AM.
  #65  
Old 07-31-2019, 11:47 AM
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Currently that closing of eyes and crossed fingers is what is happening right now, the "I think we can" chant goes for the 'we have it better' or 'we can't do it better because it will turn into "socialism"' message coming from many conservatives.

https://www.theguardian.com/us-news/...rices-salaries
I'm pretty firmly convinced that the "more efficient markets" is what we currently lack. Insurance companies basically torpedo the whole set of market mechanisms that would allow for consumers/doctors to see or set prices. Insurance is this huge market-distorting entity inserted right into the midst of the usual market mechanism that screws up price information on the buyer and seller sides of things.

I mean, without insurance gumming up the works, things like MRIs would become a LOT cheaper, as few would pay that much for diagnostic procedures at current rates except in extreme circumstances (i.e. not for a banged-up knee), and the machines would sit idle (and not making money) until the operators dropped prices enough that people would be willing to pay.
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Old 07-31-2019, 12:11 PM
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Do you think it would help if I closed my eyes, crossed my fingers, and chanted "I think we can"?
It would help if you had any faith at all in your country. That would be a good start.
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Old 07-31-2019, 12:29 PM
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XT,

Interesting that you do not consider Russian literacy, industrialization, victory in war and first in space as success. You're expecting maybe Jesus Christ?

Russia had a brief Communist period followed by Lenin's New Economic Policy of 1923 which provided enough Capitalism for the currency to work.
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Old 07-31-2019, 12:36 PM
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XT,

Interesting that you do not consider Russian literacy, industrialization, victory in war and first in space as success. You're expecting maybe Jesus Christ?.

Don’t forget about all those wonderful technological achievements of the Nazis. Plus, they really were pioneers in medicine, breaking ground in hypothermia and trauma science.
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Old 07-31-2019, 12:45 PM
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Scylla,

Your point? Hitler was brought to power by German industrialists and was the enemy of Communism.
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Old 07-31-2019, 12:51 PM
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With any program that gives you free stuff, the beneficiary will love it. That says nothing about its overall desirability.
If you'd read my post, you would have seen that it's not 'free' - it's paid for by taxes. I paid 6% of my salary throughout my working life and my employers paid 9%.

The NHS is free when you need it.
When an ambulance arrives, it's already paid for.
When you're admitted to hospital, it's already paid for.
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Old 07-31-2019, 01:09 PM
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Agreed - taxes are fee for service.
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Old 07-31-2019, 01:13 PM
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XT,

Interesting that you do not consider Russian literacy, industrialization, victory in war and first in space as success. You're expecting maybe Jesus Christ?
I didn't say they were not successes. I was pointing out that there was more to it than just those high level bullet points.

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Russia had a brief Communist period followed by Lenin's New Economic Policy of 1923 which provided enough Capitalism for the currency to work.
Sorry, but this is a no-true-Scotsman bullshit argument. They were a socialist totalitarian and authoritarian system (both political and economic) the entire time. The fact you are trying to claim they were capitalist during that period is, frankly, laughable. We could go down the list of all the things that make the socialist, but I'd like to hear anything that demonstrated they were capitalist at all (outside of the black market which I seriously doubt you meant) indicating this. Feel free.
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  #73  
Old 07-31-2019, 01:29 PM
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XT,

I'll do you the courtesy of not demeaning your argument.

Lenin implemented the NEP in 1921 to include "a free market and capitalism, both subject to state control" and put the currency on the gold standard in 1923.

It's always a matter of degree.
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Old 07-31-2019, 01:34 PM
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XT,

I'll do you the courtesy of not demeaning your argument.

Lenin implemented the NEP in 1921 to include "a free market and capitalism, both subject to state control" and put the currency on the gold standard in 1923.

It's always a matter of degree.
It's pretty simple really. Was their economy command or market based? Answer...command. Were the majority of their companies privately owned and operated or operated by the state (i.e. who controlled the means of production)? Answer...the state. The fact that, at some point they put their currency on the gold standard (and then took it off for their own, non-market based fiat currency) does in no way make them a capitalist country, unless the converse is true and the US was a socialist economy until 1971.

True, it is a matter of degree. But the USSR was something like 95% or more socialist with a small smidgen of capitalist like things (mostly the already mentioned black market). The US was, maybe, 20-30% socialist and the rest capitalist. So, overall, USSR was predominantly socialist while the US was, overall, capitalist. Today, nearly every country is mainly capitalist with some socialist economics (almost no one uses socialist political systems outside of North Korea, some China, some Vietnam and some Venezuela...maybe a handful of others). The REALLY fucked up countries use both of course, predominantly.
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Last edited by XT; 07-31-2019 at 01:37 PM.
  #75  
Old 07-31-2019, 01:38 PM
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America is different, better in most ways, worse in others.
For example the US government spends more money on healthcare per capita than Canada and yet only covers half the population. Advocates of UHC would have us believe that the US government has not really been trying this whole time, and as soon as they take over the other half of the the healthcare market they will suddenly be as good as the Canadians at cost control.
Obamacare had 10 programs designed to decrease the cost of healthcare. They all failed. The Democrat controlled house just voted to repeal the Cadillac tax which is one of the few attempts to rein in healthcare costs still standing.
It seems that the best hope for America to control healthcare spending via the government would be to switch to a parliamentary system and have started 60 years ago.
What he said, especially the 60 years part.

It's not that America is inferior to Canada or Finland - it is that America is trying to figure out how to do something that Canada and Finland have never had to do - reduce spending. Not slow its growth, not start from a lower baseline and have it grow more slowly - actually spend less in actual dollars next year than we do now.
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In Europe, medical inflation increased by 20 percentage points in 2018 to an average of 8.1 percent...
Cite.
Quote:
The annual Medical Care Inflation Rate for the 12 months ended in June, 2018 was 2.46%.
Cite.

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Old 07-31-2019, 03:02 PM
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If you'd read my post, you would have seen that it's not 'free' - it's paid for by taxes. I paid 6% of my salary throughout my working life and my employers paid 9%.

The NHS is free when you need it.
When an ambulance arrives, it's already paid for.
When you're admitted to hospital, it's already paid for.
Maybe you paid for it and maybe someone else did. I'm not asking your salary, but you either didn't pay for it and someone else did or you paid more than needed to pay for someone else's treatment.

Society pooled its collective resources based upon ability to pay and distributed it based on need. From each according to his ability and to each according to his need. That's a catchy sentence. It's amazing nobody has tried it. What could go wrong?
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Old 07-31-2019, 03:08 PM
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Maybe you paid for it and maybe someone else did. I'm not asking your salary, but you either didn't pay for it and someone else did or you paid more than needed to pay for someone else's treatment.

Society pooled its collective resources based upon ability to pay and distributed it based on need. From each according to his ability and to each according to his need. That's a catchy sentence. It's amazing nobody has tried it. What could go wrong?
You mean like how we all pay for the fire department even if some of us never have a house fire? Or how we all pay for the police even though some of us never have had to call them? Or how we all pay for the schools even if some of us don't have any kids?

You mean like that?

I'll never understand why some conservatives have such a blind spot when it comes to health care when we do many things where we all pay for a service and only some need to use it.

Hell that is how insurance works too. I paid for car insurance last year but didn't have any accidents. Is that socialism? Jeeze.
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Old 07-31-2019, 03:09 PM
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Those aren't socialism either. Or, to put this another way, which aspects of US healthcare (or European healthcare), specially, are 'socialist'? I'm going to go with none of them, since ACTUAL socialist healthcare isn't at all what people think. Here is a hint though...check out China's healthcare system, or the system the Soviet Union had to see what it is.



Regardless, none of this has anything to do with socialism.
I agree with everything you said, even the parts I cut out. It's not pure socialism at all.

But if we agree, and even the left seems to believe that we agree, that on a continuum of things from pure free market to command control Soviet style Marxism, we believe that free markets are generally the way to go, then it would seem that we should point to special justifications as to why a government should control an entire market.

These arguments for government health care beg the question that a free market cannot function in health care because the US has a free market in health care and it is not working properly. Wouldn't the better thing to see what we can do to remove a lot of these impediments to the free market instead of throwing in the towel and say that the government must take it over?
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Old 07-31-2019, 03:12 PM
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I agree with everything you said, even the parts I cut out. It's not pure socialism at all.

But if we agree, and even the left seems to believe that we agree, that on a continuum of things from pure free market to command control Soviet style Marxism, we believe that free markets are generally the way to go, then it would seem that we should point to special justifications as to why a government should control an entire market.

These arguments for government health care beg the question that a free market cannot function in health care because the US has a free market in health care and it is not working properly. Wouldn't the better thing to see what we can do to remove a lot of these impediments to the free market instead of throwing in the towel and say that the government must take it over?
The free market in healthcare is that the insurance companies take as much in as they can in premiums and try to pay out as little as possible. Why would you rather your healthcare dollars go to rich people's pockets than helping poor people. Why is that better? How does that improve outcomes when the incentive is how to maximize profit for insurance companies?
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Old 07-31-2019, 03:21 PM
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The free market in healthcare is that the insurance companies take as much in as they can in premiums and try to pay out as little as possible. Why would you rather your healthcare dollars go to rich people's pockets than helping poor people. Why is that better? How does that improve outcomes when the incentive is how to maximize profit for insurance companies?
Did you read the prior posts? Insurance companies are a big part of the problem in most aspects of healthcare: third party payer, no price transparency, insuring against known events, etc. They distort the market and cause it not to function properly.

Most people don't know and don't care what their doctor charges for an office visit, for example. You pay your $20 co-pay and move on. Markets don't function that way. You need market suppliers and consumers knowing the price and having that price reach its true market value through competition.

ETA: In every market, a business will try to maximize its profits. That's not a unique feature to healthcare.

Last edited by UltraVires; 07-31-2019 at 03:23 PM.
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Old 07-31-2019, 03:24 PM
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Did you read the prior posts? Insurance companies are a big part of the problem in most aspects of healthcare: third party payer, no price transparency, insuring against known events, etc. They distort the market and cause it not to function properly.

Most people don't know and don't care what their doctor charges for an office visit, for example. You pay your $20 co-pay and move on. Markets don't function that way. You need market suppliers and consumers knowing the price and having that price reach its true market value through competition.

ETA: In every market, a business will try to maximize its profits. That's not a unique feature to healthcare.
Oh, are the Republicans trying to get insurance companies out of health care now? Because I've only ever heard the Democrats talk about plans that do that.
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Old 07-31-2019, 03:37 PM
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Did you read the prior posts? Insurance companies are a big part of the problem in most aspects of healthcare: third party payer, no price transparency, insuring against known events, etc. They distort the market and cause it not to function properly.
What does "proper functioning" look like?

For example, one of my in-laws had to be transported by air ambulance last month: 80 miles, hospital to hospital, in critical condition. I just saw the bill: $45K.

The thing is that they are the ONLY company doing air ambulance transports in my neck of the woods: you use them, or you don't go by air. It's a natural monopoly, because there's really not enough business locally to keep multiple fleets flying. Further, even if there were several choices, when you need them you need them right now, and calling around trying to get price quotes in an emergency just wastes valuable time. Without insurance, that bill would be absolutely devastating financially. (Actually, we're not sure yet how much the insurance might cover, so it may yet prove devastating.) So, what would be the free-market solution?
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Old 07-31-2019, 03:53 PM
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What does "proper functioning" look like?

For example, one of my in-laws had to be transported by air ambulance last month: 80 miles, hospital to hospital, in critical condition. I just saw the bill: $45K.

The thing is that they are the ONLY company doing air ambulance transports in my neck of the woods: you use them, or you don't go by air. It's a natural monopoly, because there's really not enough business locally to keep multiple fleets flying. Further, even if there were several choices, when you need them you need them right now, and calling around trying to get price quotes in an emergency just wastes valuable time. Without insurance, that bill would be absolutely devastating financially. (Actually, we're not sure yet how much the insurance might cover, so it may yet prove devastating.) So, what would be the free-market solution?
Air ambulances are something where third party payer would work. They are not customary expenses.
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Old 07-31-2019, 04:01 PM
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Right. Because that was the worst thing about Nazi Germany or the Soviet Union. Their policies on brutally efficient Universal Health Care.
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Old 07-31-2019, 04:27 PM
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Air ambulances are something where third party payer would work. They are not customary expenses.
Air ambulances, however, are typical of the kinds of big-ticket expenditures that drive up costs. Heart attack, burns, any kind of major trauma or sudden-onset illness--these all tend to yield big sudden bills. If you're having a stroke or need an appendectomy in the middle of the night, now is not the time to do comparison shopping. Every single new cancer drug brought to market in the US in 2017 cost over $100,000; the mean price was twice that. (cite) Which patients are you expecting will choose the cheapest option instead of the option recommended by their oncologist? Routine physicals are amenable to price-shopping, but routine care isn't what's driving the growth in health care costs.
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Old 08-01-2019, 01:28 AM
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Wouldn't the better thing to see what we can do to remove a lot of these impediments to the free market instead of throwing in the towel and say that the government must take it over?
The greatest impediment to the optimal working of a free market in medical care is the inherent imbalance in the exchange. The customer and provider do not have an equal command of the necessary information; but unlike other imbalances in information (say, if your car or your plumbing break down), you do not - cannot - know what the implications are of your situation, nor imagine and look for alternatives.

Your need, on one side of the exchange, is absolute: the provider's isn't. The provider can find a customer elsewhere, or some other source of income. You can't find a new healthy body.
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Old 08-01-2019, 03:48 AM
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The greatest impediment to the optimal working of a free market in medical care is the inherent imbalance in the exchange. The customer and provider do not have an equal command of the necessary information; but unlike other imbalances in information (say, if your car or your plumbing break down), you do not - cannot - know what the implications are of your situation, nor imagine and look for alternatives.

Your need, on one side of the exchange, is absolute: the provider's isn't. The provider can find a customer elsewhere, or some other source of income. You can't find a new healthy body.
Of course, in UHC systems like the NHS, the government can wield that kind of power because they negotiate on behalf of the entire population and have both the leverage to mitigate the type of gouging that goes on in the US and the scope to institute economics of scale. It evens out the balance of power quite well.
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Old 08-01-2019, 04:14 AM
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Precisely so. But it also helps if the service is accepted as a part of a broader notion of community and social contract, not just "the government" doing it. And making sure there's an arms' length relationship between the government of the day and NHS clinicians and other professionals.
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Old 08-01-2019, 05:38 AM
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A further footnote on the monopsonist power of the NHS: although there are free market enthusiasts in the Conservative Party who would like to break it up in various ways, they've stuck with it, not just because they know there'd be hell to pay if they attempted to let private providers cherry-pick the profitable bits out of it - but also because it was recognised early on as a cost control mechanism. But it's always a balancing act with public expectations.
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Old 08-01-2019, 10:08 AM
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Scylla,

Your point? Hitler was brought to power by German industrialists and was the enemy of Communism.
Ribbentrop-Molotov pact
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Old 08-01-2019, 10:13 AM
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Nazi Germany was not Socialist


XT, et al,

Hitler's Make Germany Great Again program was not Socialist. German industry was financed through banks and competed for contracts just like we do in the US. Prior to their invasion of Russia Germany purchased a large portion of it's food supply from the productive Russians. The corporations involved are the same ones we see in those countries today.

The corporate structure of Nazi Germany survived the war intact and still functions today. It was never Socialist.

So, the fantasy that Socialism leads to despotism is a myth. The converse is closer to the truth. A despotic Trump is appointing cronies to powerful government positions. They are working to narrow public access to information, substituting their propaganda instead. They are creating the world that the right wing claims to fear.

Last edited by Crane; 08-01-2019 at 10:15 AM.
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Old 08-01-2019, 10:21 AM
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Scylla,

Again your point - how about Roosevelt/Stalin and Stalin/Hirohito and Hitler/Hirohito - how do those pacts have any bearing on defining the economic structure of those countries?
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Old 08-01-2019, 10:33 AM
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Of course, in UHC systems like the NHS, the government can wield that kind of power because they negotiate on behalf of the entire population and have both the leverage to mitigate the type of gouging that goes on in the US and the scope to institute economics of scale. It evens out the balance of power quite well.
The problem with this idea is that insurance companies already have that kind of scale but cannot successfully negotiate prices down. There are 66 million people in the UK, United Health Group has 50 million people in it.
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Old 08-01-2019, 10:45 AM
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It would help if you had any faith at all in your country. That would be a good start.
I have faith America can be the richest country in the world, I have faith that America can be the most powerful country in the world, I have faith that America can lead the world in science and technology, I have faith that America can have the highest standard of living in the world.
I have faith in those because I have seen them happen.
What I don't have faith in is the Federal Government can rein in health spending, because I have seen it fail at that my entire life.
In 1969 they projected Medicare would cost about $12 billion by 1990 and it actually cost $90 billion.
In 1997 the passed a law to slow the growth of Medicare payments, not cut the payments, just slow their growth. They then passed a measure postponing that every year until they changed the law.
Obamacare was supposed to "bend the cost curve". It did not. It had 10 pilot programs to cut costs, all 10 failed and may have caused deaths. The Cadillac Tax was supposed to cut insurance costs, but it is just about to be repealed.

How blind do you think our faith should be?
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Old 08-01-2019, 10:58 AM
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I have faith America can be the richest country in the world, I have faith that America can be the most powerful country in the world, I have faith that America can lead the world in science and technology, I have faith that America can have the highest standard of living in the world.
I have faith in those because I have seen them happen.
What I don't have faith in is the Federal Government can rein in health spending, because I have seen it fail at that my entire life.
In 1969 they projected Medicare would cost about $12 billion by 1990 and it actually cost $90 billion.
In 1997 the passed a law to slow the growth of Medicare payments, not cut the payments, just slow their growth. They then passed a measure postponing that every year until they changed the law.
Obamacare was supposed to "bend the cost curve". It did not. It had 10 pilot programs to cut costs, all 10 failed and may have caused deaths. The Cadillac Tax was supposed to cut insurance costs, but it is just about to be repealed.

How blind do you think our faith should be?
Seems to me assuming that current status quo is the best we can do requires quite a bit of faith in the private healthcare industry and health insurance corporations. I don't share that particular kind of faith.
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  #96  
Old 08-01-2019, 11:14 AM
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Scylla,

Your point? Hitler was brought to power by German industrialists and was the enemy of Communism.
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Originally Posted by Scylla View Post
Ribbentrop-Molotov pact
This point from Scylla is one of the most ahistorical points ever made in this board. It is perfect example of what happens for relying on poisoned sources of information though.
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Old 08-01-2019, 11:21 AM
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The problem with this idea is that insurance companies already have that kind of scale but cannot successfully negotiate prices down. There are 66 million people in the UK, United Health Group has 50 million people in it.
That's not a particularly useful comparison, although I'll note that United Health Group certainly claim they've successfully negotiated prices down so it's also apparently not true either.

Last edited by Gyrate; 08-01-2019 at 11:26 AM.
  #98  
Old 08-01-2019, 11:29 AM
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That's not a particularly useful comparison, although I'll note that United Health Care certainly claim they've successfully negotiated prices down so it's also apparently not true either.
They seem to very successful at it, too. Certainly every statement I get shows a "real" price, and what they actually paid for the service, which is always a lot less. The only problem is that United is only negotiating for it's customers.
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Old 08-01-2019, 11:46 AM
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XT, et al,

Hitler's Make Germany Great Again program was not Socialist. German industry was financed through banks and competed for contracts just like we do in the US. Prior to their invasion of Russia Germany purchased a large portion of it's food supply from the productive Russians. The corporations involved are the same ones we see in those countries today.

The corporate structure of Nazi Germany survived the war intact and still functions today. It was never Socialist.
This post is so incoherent I'm not sure how to even answer it. First, not sure what Hitler has to do with most of this. Is it your contention that the command economy of German was capitalist? If so then we could discuss that...you would be wrong, but I suppose it IS a point. You seem to be equating having corporations with a nation state being automatically capitalist. Nazi Germany wasn't a capitalist economy, however for many of the same reasons you failed to answer when I asked you what mental torture you were using to say the USSR was capitalist.

Next up...corporations that existed during the Nazi Germany phase are still there today and that means...something? Germany is certainly not a socialist country today...that's true enough. They are a capitalist country with some small socialist elements. And so? That doesn't mean that they were capitalist when the Nazi were in charge. My only guess here is that you are seeing this all from a bi-polar perspective...things are either socialist or they are capitalist. Which completely forgets that there was another option then, namely fascist. While fascist had a lot of elements of socialism, especially the economics, it wasn't exactly socialism. But it definitely wasn't capitalism. For, again, the same reasons you didn't address when I posted about this up thread.

Quote:
So, the fantasy that Socialism leads to despotism is a myth. The converse is closer to the truth. A despotic Trump is appointing cronies to powerful government positions. They are working to narrow public access to information, substituting their propaganda instead. They are creating the world that the right wing claims to fear.
I didn't say that socialism leads to despotism. That's not a myth, that's a strawman. I said it doesn't work. That's also not a myth...it's a fact, born out over and over by history. Economic socialism sucks, it's always sucked, and it has never worked. Anywhere. Command economies work, sort of kind of, in war time. But in peacetime they suck. State owned companies sort of kind of work from a monopoly standpoint to an extent, but they are outperformed by private companies. We can see this exact dynamic today in one of the countries that still DOES have quite a bit of economic socialism...China. Or how about Venezuela? Cuba? North Korea? China is the only one of those who has at least tried to bolt on some capitalist aspects...and, surprise surprise, they are the most successful, though their socialist economic parts are really holding them back more and more.

As to socialist political systems, they don't necessarily lead to despotic regimes either...many western European nations, until the early 70's and some even later, had a lot of political socialism as well as economic socialism, and they didn't lead to despotic states. But couple those together and you get the potential for despotism...as we've seen in multiple nations in the last century or so. It doesn't have to be...but often it is. I think there are more factors than JUST socialism at play in countries that go hog wild for despotism, but I also think that socialism by it's very nature (when you couple economic with political) is a factor as well.

To me, you are trying to whitewash socialism by the use of no-true-Scotsman type arguments as well as deflection from the bad aspects to highlight the good ones...oh, and also some muddying the water with some Trump references and bad history of Nazi Germany. But the truth is, western Europe pretty much abandoned real economic and political socialism starting in the early 70's, and for good reason...it wasn't working for them. China has...well, not abandoned but definitely lowered...it's own use of socialism wrt economic at least, and tried to at least bolt on enough capitalistic economics to make their busted ass system work. It still doesn't work that great, it still has all sorts of issues mainly with the state owned and run industries dragging down the system, with the CCP still trying to do it's version of a command economy, it's market and currency manipulation, etc...but just what they have done has enabled them to push their economy to the second largest in the world, second only to the US. No other mainly socialist economy comes even close to that.
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  #100  
Old 08-01-2019, 11:51 AM
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They seem to very successful at it, too. Certainly every statement I get shows a "real" price, and what they actually paid for the service, which is always a lot less. The only problem is that United is only negotiating for it's customers.
Now imagine that the negotiations were on behalf of everyone. Just think what negotiating power could be wielded.

Even better - in the UK the pharma companies can't market directly to patients - and as, in the US, more than half the cost of drugs is due to marketing, that's a huge saving there. AND we don't have any prescription drug ads on television. I mean, if like puddleglum you're happy to pay twice as much for your prescriptions just to receive the added privilege of all those commercials, then the US system is the one for you, much in the same way that it is if you're happy to pay twice as much for healthcare per capita overall for worse outcomes.
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