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  #101  
Old 08-02-2019, 07:21 PM
Wrenching Spanners is offline
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Originally Posted by k9bfriender View Post
In a world without infinite resources, there will always be some form of rationing of some kind for any good or service.

The question is not whether MFA will create an infinite supply of healthcare, the question is, will it be rationed less than it currently is by the private system? Will there be better access and better outcomes? The answer to these, as demonstrated by the examples of other countries that have done so, is yes.

Are you demanding that MFA provides infinite healthcare before you would get onboard? If not, then why do you keep harping on this? If so, then you will never be satisfied by any proposal of any kind, and therefore, your opinion need not be courted.

What rationing do you see in the current medicare system that you are concerned will be expanded if the system grows to include everyone?
I'm discussing the merits and drawbacks of supplemental insurance, and whether supplemental insurance should be banned as part of universal health care. You are apparently agreeing with my position on the drawbacks of supplemental insurance.

My statement: "The societal risk is that those at the lowest tier receiving "basic care" will be receiving insufficient care that wouldn't be acceptable to those in a higher tier."

Your statement: "If the wealthy jumping the line or getting better treatment while others are no longer able to access those resources at all, as in the current system, that is a problem."

You're apparently also agreeing my position on the merits:
My statement: "It also takes freedom away from companies that would like to offer supplemental health insurance, and from consumers who would like to purchase it."

Your statement: "That the wealthy get better treatment at only a slight detriment to others is perfectly acceptable."

The quoted statement that you're objecting to is: "If you want to make an argument that public insurance doesn't involve rationing, please make it."

Just above that statement is my initial statement: "Do you want an acknowledgement that private insurance also involves rationing? It does. Here you go. Use my quote against any statement that insurance doesn't involve rationing, whether it's public or private."

Your reaction to this was: "Are you demanding that MFA provides infinite healthcare before you would get onboard? If not, then why do you keep harping on this? If so, then you will never be satisfied by any proposal of any kind, and therefore, your opinion need not be courted." This is a reaction to one comment trying to answer the OP on why some people object to private insurance within UHC systems, and a second comment clarifying my belief that rationing occurs in both public and private insurance systems.

I'm going to simply note that any time you accuse someone in the future of strawmanning, a term that I'm unsure if you actually know what it means, I'm going to note that you're incredibly hypocritical to object to it. I'll also note that, as shown by the points where our opinions are the same, you're careless in constructing your arguments. I doubt I'll be replying one-to-one to you in the future. If you think I'm ignoring you're replies, here's why.

But hey, at least you offered one real question worth discussing:
"What rationing do you see in the current medicare system that you are concerned will be expanded if the system grows to include everyone?"
If anyone else wants to pick up that question, provided that it doesn't turn into a one-to-one argument, it might be a contribution to the thread.
  #102  
Old 08-02-2019, 07:28 PM
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I don't think k9bfriender or JohnT are actually disagreeing with you, Wrenching Spanners, unless I missed a chunk of conversation.
  #103  
Old 08-02-2019, 08:13 PM
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Under my plan, which I call "Medicare for All, sooner or later", the eligibility age would drop in 5 year increments. This would enable us to evaluate in almost real time how the thing is working as we know that real life doesn't always follow the script. Also, it would permit the insurance companies to have a "soft landing". I don't care for the companies themselves, mind you, but I would like the employees to have a chance to find honest work before the last one turns out the lights.
  #104  
Old 08-03-2019, 01:32 PM
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Quote:
Originally Posted by Wrenching Spanners View Post
I'm discussing the merits and drawbacks of supplemental insurance, and whether supplemental insurance should be banned as part of universal health care. You are apparently agreeing with my position on the drawbacks of supplemental insurance.
As am I. It is hard to tell for sure, with your jumping around on the topic, but it seems as though you are taking the position that you are for supplemental insurance, but you have also, according to your analysis, determined that anyone for MFA is against such. This analysis is what I disagree with.

The problem with the binary question of, "Do you want to abolish health insurance?" is that neither "yes", nor "no", is a sufficient answer, and it depends on the context and the assumptions that are being made by the person asking the question.

My answer would be "Yes." The reason that I would answer "yes", even though that is not a good summary of my position, is because it is a closer summary than that of "no." The healthcare insurance industry, as it stands in the United States, is not serving its purpose, and I would abolish it, if I had the power. Now abolish means to bring to an end, and I would gladly bring to an end the current system we have in place.

The problem with the answer "yes", is that it makes people start making assumptions. Assumptions like that you must also be against all forms of private insurance, as you determined in your "analysis" in post #91. That is not the case. Sure, there may be those who are against any form of private insurance, but being for MFA doesn't automatically put you into that catagory, and I think that those who would object to all forms of private insurance would be fairly rare, both in this conversation and in real life. ( I think that Canada is a special case, as they see the mess that we have down here up close, and they probably overreact in regards to private insurance as a result, but nearly all other UHC systems have the option of supplemental insurance.)

I see no reason to ban private insurance. I don't think that many people would buy it as an individual policy, but rather, it would be a perk that comes as an employer benefit. If you have the money to waste on supplemental insurance premiums, then you can probably put that money aside, and use it for room upgrades and the like if you end up needing it. Larger employers wouldn't even have to use a third party indemnity, but would be able to "self insure", as they are only paying for supplemental costs, and will not be on the hook for your multimillion dollar medical procedure.

You made an analogy to a cafeteria earlier to explain why people would be against tiered care. I disagree with that analogy on a few levels. The first is that, if I am starving, then plain and boring cafeteria food is perfectly fine. I don't care that you are eating filets in a gilded dining hall, so long as I am not suffering from malnutrition. If it is determined that the cafeteria food is lacking in some essential nutrients, and that it is necessary to get a supplemental "meal plan" in order to stave off scurvy, then that means that the lowest tier is not adequate. Anything that is deemed to be necessary should be included. Things that are nice or convenient can be allocated on a can pay basis.

The second flaw in the cafeteria analogy is that those of us eating at the lowest table still have power. We are voters. We may not mind taking the scraps, but if you take away something essential, then we will let you know that that is not acceptable.

As relates to supplemental insurance, sure, there's nothing wrong with it. Some people I know really love Aflac, and I would see no reason (other than that the salesman for it are annoying) to restrict it. I don't know all the other forms of supplemental insurance currently exist, but I would imagine that once the essentials of healthcare are taken care of, the free market will step in to fill any gaps in people's desires.

So, I am agreeing with you that supplemental insurance can and should be a part of the industry going forward, but I disagree with you that many of those for MFA are against supplemental insurance.
Quote:
The quoted statement that you're objecting to is: "If you want to make an argument that public insurance doesn't involve rationing, please make it."
To address this, I do feel that that statement is challenging the poster to make an argument that public insurance doesn't involve rationing. Given that you were replying to someone pointing out that rationing takes place in our current system, and did so by dramatically ceding to an argument that no one had made, it did seem as though you were criticizing public programs due to the fact that they would have rationing.

Now, "rationing" is a very loaded word, IMO. If I were to be asked, "Does this system ration care?" then I'd be lying if I said no, in that there is no way to create any system that can accomodate infinite demand, so there will always be some situations and edge cases you could point to as rationing, and if I said yes, then I would be admitting that my system uses rationing, a dirty word taht comes with a whole host of assumptions. Maybe the fact that I've been through that rodeo on this board before made me a bit overly sensitive to your use of the word, and was heading off that argument before you had a chance to make it.

So, I'll ask, rather than assume, what was the intent behind that line? I can only see it as either an accusation that public insurance involves actually rationing care in a way that would actually have any sort of real negative impact, or just an idle and irrelevant invitation to make an argument that no one had any reason or desire to make.

A more productive way of phrasing the question would be, "Do you think that the public system will ration care in a way that would deny anyone any reasonable access to medical care?"

And to that question, no, there is no reason that a public system should. It can take care of regular care just fine, and the expensive rare conditions are, as a poster mentioned earlier, rare. So if it costs 5 million to treat you, as long as your condition doesn't become commonplace, then it doesn't strain the system in the least.

Can I think of hypotheticals that would end up denying care based on availability? Sure, and I'm sure that many of us here can do that. Does that mean that care is rationed? Yes, in a strict technical sense, it is, but no, in a useful sense of denying people care under normal circumstances, it is not.

What is your perspective on rationing, and do you feel that a public system would lead to rationing in a useful sense?
Quote:
Just above that statement is my initial statement: "Do you want an acknowledgement that private insurance also involves rationing? It does. Here you go. Use my quote against any statement that insurance doesn't involve rationing, whether it's public or private."
And did anyone ask you for such an acknowledgement?
Quote:
Your reaction to this was: "Are you demanding that MFA provides infinite healthcare before you would get onboard? If not, then why do you keep harping on this? If so, then you will never be satisfied by any proposal of any kind, and therefore, your opinion need not be courted." This is a reaction to one comment trying to answer the OP on why some people object to private insurance within UHC systems, and a second comment clarifying my belief that rationing occurs in both public and private insurance systems.
But the thing is, is that the question of the OP was flawed in the first place. Most people do not object to private insurance within UHC. So rather than explain why people would do something that most don't do, I was explaining why most don't do that.
Quote:
I'm going to simply note that any time you accuse someone in the future of strawmanning, a term that I'm unsure if you actually know what it means, I'm going to note that you're incredibly hypocritical to object to it. I'll also note that, as shown by the points where our opinions are the same, you're careless in constructing your arguments. I doubt I'll be replying one-to-one to you in the future. If you think I'm ignoring you're replies, here's why.
Strawmanning is when you argue against a position that no one is taking, and I would say that it also includes conceding to an argument that no one has made. I may be guilty of jumping the gun a bit, and anticipating an argument that you had not yet made, because I've seen the arguments that you were making pretty much inevitably lead to them, and if that is the case, I apologize for making that assumption. But you have made quite a number of assumptions in this thread as to the motives and reasoning of the other posters. That's not a horrible thing, but it does require extra work on those who would like to answer in good faith in unpacking your assumptions and explaining why they are not valid before getting to the meat of the argument.

But, as you are making a number of assumptions here, and accusing me of hypocrisy based on these invalid assumptions, I am not sure either that engaging you is all that productive, but I don't hold things against posters, and rarely even remember prior interactions before replying.

Honestly, I cannot even tell if you are for or against MFA or any form of UHC. I do not see that you have taken a position or argued for anything at all, just against the positions that others have taken. My assumption is that you are against UHC, and see this supplemental insurance side argument as ammo against a public healthcare system. If I am incorrect on this, I apologize, but it is hard to understand where someone is coming from when they only argue against, and never for. I actually asked you where you were coming from, to try to better understand your position, and you turned around and accused me of hypocrisy for having done so.
Quote:
"What rationing do you see in the current medicare system that you are concerned will be expanded if the system grows to include everyone?"
If anyone else wants to pick up that question, provided that it doesn't turn into a one-to-one argument, it might be a contribution to the thread.
I think it is a good question, and I was disappointed that you avoided answering it.
  #105  
Old 08-04-2019, 11:44 AM
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I get the argument for Medicare for all, but what is the argument for abolishing private insurance?


Quote:
Originally Posted by UltraVires View Post
Because (and I can't believe I am taking THIS side) why should I have to wait 4 to 6 weeks for a procedure when a bed could be open sooner but for Scrooge McDuck taking up enough space in the hospital for 4 people?


YES! Ultra vires is coming over to socialism!

It's just a matter of time ...

Plus, we have cookies.

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Last edited by Northern Piper; 08-04-2019 at 11:48 AM.
  #106  
Old 08-04-2019, 12:49 PM
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Originally Posted by UltraVires View Post
This is an important point, and although this is Elections, my question here is GQ.



How do other countries deal with such a thing? Does UHC cover absolutely anything, I mean the latest and greatest, we will spare no expense to save you? I'm not talking about catered food and posh rooms. I mean a scenario where Joe Q. Citizen has a terminal illness. But there is this very expensive treatment that may save his life, may kill him, but the most recent and best studies show modest improvement. Does the government pay? Will our government pay under any of the Dem plans?



If not, where is the cutoff? Only if it doesn't cost $X? Or if you aren't older than Y? Or if your likelihood of survival is above Z? Who determines it?


Two-part answer.

First, Shodan's "little Justin" example. Yes, in a public system, there is always pressure to make the system better. If the Opposition beats up the Government in Question Period and in the news about little Justin, that is a good thing, not a bug. We want our health care system to meet the needs of the public, and if it's not working, the Government knows it could lose power.

In our public system, the public has influence over the design and delivery of health care in a way that people in a private insurance system do not. Private insurers are only accountable to their shareholders for profits. They are not generally accountable to the public at large, as the government is at every election .

So why don't we see the little Justin example causing the death of a thousand cuts, mentioned by Shodan? Because our political systems are different. In the US system, any member of the House can bring forward a spending bill. That's not the case in Canada. Only the House can authorise spending, but a spending bill can only be introduced if the Government (i.e. The PM and Cabinet) agree (technically, it's called the Royal recommendation).

That system, where both the executive and the legislature have to agree on spending, gives the government much greater control over spending and means that the Opposition can't introduce the Little Justin spending bill as a one-off that could significantly alter coverage. There can certainly be political pressure in a given case, but that doesn't mean a particular case results in a sudden systemic change in coverage and spending.

Turning to Ultra Vires' question, as I understand it from following news stories, it's a two-part process.

The first step is that the government health agency, in consultation with the Departments of Health and Finance, and the medical associations, works out the coverage list. That's extremely detailed and is meant to ensure coverage for all medical conditions and the treatment costs. It's based generally on the twin drivers of what money is available and what treatments the health professionals think are meritorious.

It can include treatment coverage for different treatment options for the same conditions, with potentially different costs and chances of success. For example, for a particular type of cancer, there might be options like surgery, or chemo, or radiation, or palliative care. But the important point is that the coverage list is done on a macro basis, not on a case-by-case basis.

Then there's the second step: the doctor and patient. The doctor treats the patient and gives them options. For the cancer example, what the doctor recommends will depend on a number of factors. Is it Stage I, or II, or III, or IV? Is it the type that responds better to chemo or radio? Is surgery an option, or is it inoperative? What is the general health of the patient? Would the patient's age or general health say that one treatment option is better than another (not an age cut-off, but medically: e.g. - given the patient's age and health, what is the chance of surviving intrusive surgery?) And, what does the patient want? That discussion of all the factors is what guides the treatment options. Once they've decided on the treatment, that's what the doctor orders, setting up the treatment at the hospital.

And there's no death panel of bureaucrats. The spending and coverage decisions are made at the first stage, at the macro level. Once a particular treatment is on the coverage list, it's the doctor, patient and hospital who make the decision for treatment. They don't need to go back to the bureaucrats for permission. That's one of the huge differences between our public system and a private system.
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  #107  
Old 08-04-2019, 01:12 PM
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Originally Posted by UltraVires View Post
Again, I was only asking and I still am. A "list of covered procedures" really doesn't answer the question because that list could be extensive or small.
These are good sensible questions that should be asked.

Again, all I know is what I've read in the papers, so I don't know the details of the coverage system. But, the Canada Health Act makes comprehensive coverage a legal requirement: to qualify for federal funding, the provinces have to provide comprehensive coverage of medical services, generally meaning services provided by a doctor or a hospital. It's very extensive.

Quote:
But having worked in government before, I see little difference between a private company wanting to save money and a government bureaucrat wanting to show his or her higher ups how frugal the agency became once he or she "cut waste" from it. I think you have that everywhere, especially when the economy goes south.
You're making an assumption there, that the payment system in a public system works the same as for a private insurance system. As mentioned in my previous post, there aren't bureaucrats who can question the doctor's treatment decision. If the doctor has recommended an approved treatment and carried it out, the agency pays the bill. Budget decisions are made at the macro level, not on the individual bills.

Quote:
I'm sure that in a UHC you would have "little white Justin" stories like Shodan discussed.

No, generally not, in my experience. I follow the news and I don't recall seeing that kind of a story, at least in my province.
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  #108  
Old 08-04-2019, 01:31 PM
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Originally Posted by PastTense View Post
Suppose you see a surgeon about whether or not you need an operation.
1. Private insurance--you see him tomorrow
2. Medicare for all--6 week delay for appointment


I think your premises are flawed here.

1. Are you saying that private health insurance in the US is so good that every American who has private health insurance can count on seeing a surgeon on a day's notice, every time, and regardless of the seriousness of the condition? That doesn't seem to match up with threads I've seen here, talking about wait lists for referrals, scarcity of specialists in particular regions, and the difficulties of finding a doctor in network in your area. Have I misunderstood?

2. You assume that that there will always be a wait list in the public system every time, regardless of the nature of the surgical need.

That's not how I understand it, and doesn't match my own personal experience. The wait lists in the Canadian system tend to be for chronic matters, while urgent matters (e.g. a heart attack or a serious injury) get immediate attention. It's the "triage" concept that is mentioned elsewhere in this thread.

Sorry, but it seems to me that you're making the best possible assumption about private insurance, and the worst possible assumption about public health systems.
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