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Old 12-21-2019, 04:14 PM
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Plans for “free” college or “free” healthcare or anything of that sort


...will require MASSIVE cost cuts (IMO) resulting in LOTS of people making LOADS less money if there’s any hope of success and sustainability.

Right?

[I know nothing is “free.” Please ignore my choice of words.]


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Old 12-21-2019, 04:22 PM
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It depends on how you account for it. As a Canadian with single payer healthcare, there is a huge difference in efficiency between our system and the US. My GP shares a secretary with three other doctors - there are about a dozen doctors in the practice. She swipes my health card when I get there to ensure it is still valid (expires every 5 years) and I’m done.

There are no co-pays, in network issues, billing assistants, etc. He receives an annual fee to have me rostered as a patient and bills the province for additional office visits.
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Old 12-21-2019, 04:47 PM
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It depends on how you account for it. As a Canadian with single payer healthcare, there is a huge difference in efficiency between our system and the US. My GP shares a secretary with three other doctors - there are about a dozen doctors in the practice. She swipes my health card when I get there to ensure it is still valid (expires every 5 years) and I’m done.

There are no co-pays, in network issues, billing assistants, etc. He receives an annual fee to have me rostered as a patient and bills the province for additional office visits.
Isn't "efficiency" just a euphemism for less people getting a cut of the money moving around?
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Old 12-21-2019, 04:58 PM
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Isn't "efficiency" just a euphemism for less people getting a cut of the money moving around?
No, it means you won't need to pay who spend their days figuring out how to code all the procedures for umpy-eleven insurance companies. It means hospitals not having multiple price lists.
I'm on Medicare nd had a bunch of stuff done, and the price Medicare paid is about 1/4 the list price. I bet no insurance company pays the list price either.
We don't have employees pumping gas anymore in almost all the states. We managed the greater efficiency.
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Old 12-21-2019, 05:23 PM
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I have no qualms concerning insurance company stockholders making less money.
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Old 12-21-2019, 05:34 PM
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...will require MASSIVE cost cuts (IMO) resulting in LOTS of people making LOADS less money if there’s any hope of success and sustainability.

Right?

[I know nothing is “free.” Please ignore my choice of words.]


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No, you're exactly right in that some people will be out of work - health insurance providers and sales as well as admin staff, insurance specialists at doctors offices, debt collectors and so forth.

There's some argument that some of those will find homes in the new bureaucracy - which I believe will employ fewer people - but that's really an unknown.

But then there's the question of 'is higher employment or higher income for certain people worth lower life expectancy and worse outcomes for American citizens?' I'd say that's a fair question.

Would you or anyone you know volunteer to shave three years off your life - or see an increase in infant mortality by 1% - to provide what is essentially a jobs program? Because that's really where it is. Countries with some form of nationalized health service see longer - and healthier - lifespans while spending a smaller percentage of their GDP on healthcare in general.

All policy regards trade-offs because all policy is essentially about the allocation of scarce resources. The question becomes where does one fall?
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Old 12-21-2019, 05:44 PM
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One way free health care and free college would work well together is to remove the massive student loans required to go into high paying medical professions, which is a large part of the reason salaries have to be high--not just to recoup the cost of the education, but to account for the risk of taking those loans long before you make any money, and with no confidence that you would be able to pay them back. It boggles the mind that we say to 22 year olds "Ok, here's the deal. You take on a cool half million in debt, and then hopefully around 30 you'll start making $250K a year and paying them back. If you aren't good at this, don't like it, or for any other reason can't do this, you are pretty much screwed. Also, don't specialize in any of the areas that people actually need--they pay the worst".

Doctors wouldn't need to make "doctor salaries" if they started making real money earlier, and if they didn't have such ungodly debt loads.
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Old 12-21-2019, 05:44 PM
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That's just healthcare of course.

In terms of college - or post-high school education, at any rate - the equation is a little different.

It's pretty clear that a better-educated workforce is more productive in terms of innovation and GDP production per worker. We like those things.

The question then becomes is it worth it for the USA as a whole to encourage those things. Right now the student loan system is both unsustainable - we're already seeing private colleges fail and public ones consolidate - and, frankly, a crime against the weakest among us. It actively discourages some kids from heading to higher education or trade schools.

Is the growth in GDP - and IMHO the overall good of a better-educated population - by having a more educated workforce more than the cost of providing both trade and higher ed at low or no cost? I think it would be but I can't say for sure as I haven't looked at the numbers.

Right now, as it is, we see a massive transfer of wealth from the poorer segments of society - college students, recent grads and failed-to-grads - to banks and lenders (not quite the same thing). It also requires an enormous bureaucracy to support in it Sallie Mae. Eliminating that things would allow the young to get off to a better start, spend money, buy homes, invest and so forth and therefore both increase GDP through consumer spending AND increase it through greater productivity.

What's best? Who knows? Maybe the German system where all kids are tracked in high school toward either trade school or higher best based on performance. Maybe some other system. Who knows?

The one thing we DO know is that the current curve is unsustainable - again - and change will come either through planning or chaos. We have to make that call. Right now, the main force behind keeping the current system is only those who directly benefit from it. Lenders and those politicians to whom they give money.
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Old 12-21-2019, 06:36 PM
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Isn't "efficiency" just a euphemism for less people getting a cut of the money moving around?
Cutting out middlemen is a benefit of single payer, not a drawback.
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Old 12-21-2019, 07:03 PM
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I agree but if I were a middleman “efficiencied” out of a job I would not.


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Old 12-21-2019, 07:10 PM
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There's a phrase you don't here ever. "Why won't someone please think of the middlemen!?"
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Old 12-21-2019, 10:44 PM
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If Supply-Side economics is a thing there should be no reason those same adherents wouldn’t support Educated-Side economics.
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Old 12-22-2019, 05:40 PM
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Incentives across the board are kind of skewed. A middleman per se doesn't have to be bad or inefficient, but we have a lot of oddball incentives in the United States that make healthcare a complete and utter f'ing cluster-f. This doesn't mean single-payer must be the solution, though. That has its own negatives.
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Old 12-22-2019, 06:42 PM
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Medicare for all will, but I don't see why free public college will.

Public college is already heavily subsidized. In state students have around 60-70% of their tuition paid by the state, and that isn't even including state or federal college grants like pell grants. Free college just means the public sector pays the remaining 30% of the bill for public college, which will cost something like 80 billion a year.

Medicare for all will cost a lot more. Plus because medicare has lower reimbursement rates, yeah a lot of medical providers will suffer. But sadly our health system is 2x as expensive as any other nation, so they are going to have to learn to do more with less. Our health care system isn't sustainable, and it is starting to wreck our economy due to how much wealth it extracts and how inefficient it is.
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Old 12-23-2019, 07:47 AM
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...will require MASSIVE cost cuts (IMO) resulting in LOTS of people making LOADS less money if there’s any hope of success and sustainability.

Right?

[I know nothing is “free.” Please ignore my choice of words.]


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I don't think that offering "free" public college tuition would be all that costly, as it's already subsidized to a large extent. And it wouldn't cost jobs, and on a net basis, it would benefit the economy. There would be a tax increase, but it wouldn't be all that noticeable, IMO.

"Free" healthcare is a very different animal. The cost estimates are much more variable with some actually estimating that it would cost more, and other saying less. No one really knows the impact to costs, or the dislocation of the economy. If we went with the Sanders plan, for instance, it would essentially eliminate an industry. But we don't know if it would save money.

Of the two topics, the college side is much more simple and less disruptive than the healthcare side.
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Old 12-23-2019, 11:47 AM
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That's just healthcare of course.

In terms of college - or post-high school education, at any rate - the equation is a little different.

It's pretty clear that a better-educated workforce is more productive in terms of innovation and GDP production per worker. We like those things.

The question then becomes is it worth it for the USA as a whole to encourage those things. Right now the student loan system is both unsustainable - we're already seeing private colleges fail and public ones consolidate - and, frankly, a crime against the weakest among us. It actively discourages some kids from heading to higher education or trade schools.

Is the growth in GDP - and IMHO the overall good of a better-educated population - by having a more educated workforce more than the cost of providing both trade and higher ed at low or no cost? I think it would be but I can't say for sure as I haven't looked at the numbers.

Right now, as it is, we see a massive transfer of wealth from the poorer segments of society - college students, recent grads and failed-to-grads - to banks and lenders (not quite the same thing). It also requires an enormous bureaucracy to support in it Sallie Mae. Eliminating that things would allow the young to get off to a better start, spend money, buy homes, invest and so forth and therefore both increase GDP through consumer spending AND increase it through greater productivity.

What's best? Who knows? Maybe the German system where all kids are tracked in high school toward either trade school or higher best based on performance. Maybe some other system. Who knows?

The one thing we DO know is that the current curve is unsustainable - again - and change will come either through planning or chaos. We have to make that call. Right now, the main force behind keeping the current system is only those who directly benefit from it. Lenders and those politicians to whom they give money.
It is obvious that college educated people are more productive. It is not obvious if that is because college makes people productive or because more productive people go to college. If it is the former than sending more people to college will make the economy better, and if it is the latter than sending more people to college will make the economy worse. Likely it is somewhere in the middle where the economy would benefit from some people going to college and would benefit from other people not going to college.

The debate about free college ignores that there is already a portion of college which is very low priced, community college. The average cost of an associates degree is less than 7 grand, which could be earned working summers. Despite this less than 25% of college students are enrolled in community college. This suggests price is not what is motivating students to not go to college.
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Old 12-23-2019, 11:52 AM
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No, you're exactly right in that some people will be out of work - health insurance providers and sales as well as admin staff, insurance specialists at doctors offices, debt collectors and so forth.

There's some argument that some of those will find homes in the new bureaucracy - which I believe will employ fewer people - but that's really an unknown.

But then there's the question of 'is higher employment or higher income for certain people worth lower life expectancy and worse outcomes for American citizens?' I'd say that's a fair question.

Would you or anyone you know volunteer to shave three years off your life - or see an increase in infant mortality by 1% - to provide what is essentially a jobs program? Because that's really where it is. Countries with some form of nationalized health service see longer - and healthier - lifespans while spending a smaller percentage of their GDP on healthcare in general.

All policy regards trade-offs because all policy is essentially about the allocation of scarce resources. The question becomes where does one fall?
Not every country with free healthcare has longer lifespans. Russia has free healthcare and Americans live on average 6 years longer. What if we aim for Switzerland healthcare and end up with Russian healthcare?
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Old 12-23-2019, 12:01 PM
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It depends on how you account for it. As a Canadian with single payer healthcare, there is a huge difference in efficiency between our system and the US. My GP shares a secretary with three other doctors - there are about a dozen doctors in the practice. She swipes my health card when I get there to ensure it is still valid (expires every 5 years) and I’m done.

There are no co-pays, in network issues, billing assistants, etc. He receives an annual fee to have me rostered as a patient and bills the province for additional office visits.
There is also a huge difference in costs, the average doctor in Canada makes less than half what the average doctor in the US makes. In order to get costs down to Canadian level the salaries of doctors in the US would need to be slashed drastically.
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Old 12-23-2019, 12:57 PM
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Public college is already heavily subsidized. In state students have around 60-70% of their tuition paid by the state, and that isn't even including state or federal college grants like pell grants.
How do you figure? I just looked up two state colleges and about 20 something percent of their budget is from state appropriations.

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Old 12-23-2019, 01:59 PM
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What's best? Who knows? Maybe the German system where all kids are tracked in high school toward either trade school or higher best based on performance. Maybe some other system. Who knows?
.
I like this one - the problem in the US is all the previously blue collar workers being absolutely certain that *their* children [well, boys] will all go to college and *will* by damn have an office job, and be better than they were ... though there is absolutely nothing wrong with working with ones hands [someone needs to fix the plumbing and cars, and wait tables, sell groceries and take care of children] And admittedly, some people simply do not have the right type of 'smarts' to go to college but are mechanical whizzes. I agree that the whole cold war space race and wanting to better over the soviets was also a major part of the problem.

While I did do the tech track in high school [and apprenticed as an inside/outside mechanic] I did also go to college [and got a degree, political science with a minor in sociology that I never really used as I never went into politics like Dad wanted me to.] I would have been happy to have just gone tech the whole way, or to go college the whole way [though perhaps a different degree program, maybe accounting or something] but we never really got guided one way or the other - and some kids in high school that my brother went with were disruptive because they did the NY state minimum and had almost a full day of study hall and were *bored out of their minds* and could have benefitted by being sent off to a tech school. [NY the senior year the only required courses were phys education and English, junior as I seem to recall was Math, English and phys ed]
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Old 12-23-2019, 02:03 PM
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...will require MASSIVE cost cuts (IMO) resulting in LOTS of people making LOADS less money if there’s any hope of success and sustainability.

Right?

[I know nothing is “free.” Please ignore my choice of words.]


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In CA, Community colleges are more or less free. I think this should be nationwide.

I think that the next two years should be subsidized, but not free for all. Means tested, etc.


Too many kids go to a big 4 year college and drop out. Let's have more go to a nice two year college, and if they find academics not for them, continue as a trade school.

Lets bring Medicare to anyone up to 18 or over 55. This is a start, then for everyone. And I mean REAL Medicare, with small premiums for parts B, C, D, etc.
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Old 12-23-2019, 02:05 PM
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Medicare for all will, but I don't see why free public college will.

....

Medicare for all will cost a lot more. Plus because medicare has lower reimbursement rates, yeah a lot of medical providers will suffer. But sadly our health system is 2x as expensive as any other nation, so they are going to have to learn to do more with less. Our health care system isn't sustainable, and it is starting to wreck our economy due to how much wealth it extracts and how inefficient it is.
REAL Medicare for all can be paid for by a tax on business equal to about what they pay out in health premiums now. I mean REAL, not sanders crazy expensive plan.
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Old 12-23-2019, 03:27 PM
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REAL Medicare for all can be paid for by a tax on business equal to about what they pay out in health premiums now. I mean REAL, not sanders crazy expensive plan.


Does it have to be crazy expensive? Can’t costs be significantly reduced? Can’t billions of profit dollars currently going into certain pockets be significantly reduced? Won’t there need to be cost controls to make MCFA or single-payer work?


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Old 12-23-2019, 03:57 PM
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Does it have to be crazy expensive? Can’t costs be significantly reduced? Can’t billions of profit dollars currently going into certain pockets be significantly reduced? Won’t there need to be cost controls to make MCFA or single-payer work?


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Not only that, but the current system could be "crazy expensive" as well, perhaps more so. It's just that the cost is being hidden by being borne by the public at large as discretionary spending, rather than taxes paid.
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Old 12-23-2019, 04:09 PM
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One way free health care and free college would work well together is to remove the massive student loans required to go into high paying medical professions, which is a large part of the reason salaries have to be high--not just to recoup the cost of the education, but to account for the risk of taking those loans long before you make any money, and with no confidence that you would be able to pay them back. It boggles the mind that we say to 22 year olds "Ok, here's the deal. You take on a cool half million in debt, and then hopefully around 30 you'll start making $250K a year and paying them back. If you aren't good at this, don't like it, or for any other reason can't do this, you are pretty much screwed. Also, don't specialize in any of the areas that people actually need--they pay the worst".

Doctors wouldn't need to make "doctor salaries" if they started making real money earlier, and if they didn't have such ungodly debt loads.
Some European countries have, or in the case of the UK, had free higher education. I don't know what the restrictions were, but I've read that they didn't have that many students, and they had to perform well.

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French schooling is free and mandatory from ages six to 16, although the majority of French children start earlier. Another two years of study are required if a student is to sit the baccalauréat exam, which they must pass to enter university.
https://www.expatica.com/fr/educatio...cation-101147/

This doesn't sound very different than the American and British systems, though. In Canada, there isn't such an exam, but when I was a kid, I was told I needed an average of 83 per cent to get into university. Many children could not reach such an average.
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Old 12-23-2019, 04:34 PM
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I agree but if I were a middleman “efficiencied” out of a job I would not.
Next time you want to buy a car, call me. I’ll find the car you want, and add 10% to the cost of it for my fees.

Then if you complain that I’m charging you too much money and adding no value, I’ll remind you that you were once opposed to increasing efficiency at the cost of jobs.
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Old 12-23-2019, 05:04 PM
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One way free health care and free college would work well together is to remove the massive student loans required to go into high paying medical professions, which is a large part of the reason salaries have to be high--.
No costs is being removed here - just shifted from the med student to the taxpayer. So you aren't saving any money overall. If more doctors go into lower paying specialties, you would lose money, because they would not repay the loans in the form of higher taxes. There is no free college, and TANSTAAFL.

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Old 12-23-2019, 05:47 PM
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I agree but if I were a middleman “efficiencied” out of a job I would not.
Yup, and nobody spoke up for the poor gravediggers who were out of a job when they invented antibiotics.
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Old 12-23-2019, 05:51 PM
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...[I know nothing is “free.” Please ignore my choice of words.]
The correct wording is that a sensible primary healthcare system is free at the point of service, and funded out of general taxation.
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Old 12-23-2019, 06:48 PM
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No costs is being removed here - just shifted from the med student to the taxpayer. So you aren't saving any money overall. If more doctors go into lower paying specialties, you would lose money, because they would not repay the loans in the form of higher taxes. There is no free college, and TANSTAAFL.
Whoa, I never considered that we should keep EVERY aspect of our failed heath care system because they are all interdependent. We can’t trim the number of millionaire doctors because student loans are too expensive; we can’t make college more affordable because what about all those debt collectors who might be out of a job; we can’t make health care like fire and police service because there are struggling bankruptcy attorneys out there.

I mean, knock any leg out of that pyramid of malevolence and the whole system might get better!
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Old 12-23-2019, 10:33 PM
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Cutting out middlemen is a benefit of single payer, not a drawback.
But you're NOT cutting out middlemen with government-run healthcare. All you're doing is replacing one set of middlemen (private corporations) with another set (government bureaucrats).

At least the private ones have a reasonable chance of actually being fired from their jobs if they're not adding value somewhere to the equation. The government ones, not so much.
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Old 12-23-2019, 10:56 PM
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But you're NOT cutting out middlemen with government-run healthcare. All you're doing is replacing one set of middlemen (private corporations) with another set (government bureaucrats).

At least the private ones have a reasonable chance of actually being fired from their jobs if they're not adding value somewhere to the equation. The government ones, not so much.
Except governments are (supposed to be) looking out for your well being while corporations are definitely looking out for their bottom line.
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Old 12-23-2019, 11:25 PM
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But you're NOT cutting out middlemen with government-run healthcare. All you're doing is replacing one set of middlemen (private corporations) with another set (government bureaucrats).

At least the private ones have a reasonable chance of actually being fired from their jobs if they're not adding value somewhere to the equation. The government ones, not so much.
So, Medicare is less efficient than private insurance companies? Really?

And you would consider it more efficient for doctors to have to hire staff to navigate the many different billing policies for each insurance company? Explain to me how having to deal with a dozen or more different billing practices in order to get paid is better than one.

Shit, maybe merchants would be better served if Visa demanded that a hundred different conditions apply to any sale; MasterCard can have a very different set of 150 conditions; AmEx could have a random number of new policies; and Discover could just randomly demand proof that its customer needed to buy groceries otherwise refuse to pay the merchant.
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Old 12-24-2019, 01:14 AM
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Does it have to be crazy expensive? Can’t costs be significantly reduced? Can’t billions of profit dollars currently going into certain pockets be significantly reduced? Won’t there need to be cost controls to make MCFA or single-payer work?

Pretty much, every expert sez sanders plan is too damn expensive. One reason why Warren dropped it, she was trying to come up with some way of paying for it, and concluded it wouldnt work.
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Old 12-24-2019, 02:05 AM
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All the (western) countries that have free or heavily subsidized healthcare and college--how many of them have the US footing the bill for their national defense? Is it possible that you can have a robust national defense or free healthcare/college, but not both?

I think "free" college is going to mean free community college. The states will cover your first two years, then you'll transfer to a four-year college and will be responsible for the final leg of your Bachelor's degree and graduate school (with Pell grants and such). I don't see any proposals that guarantee a free Ivy League education for everyone.

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Old 12-24-2019, 06:37 AM
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Except all of the western countries that provide universal health care spend less, as a percentage of GDP, than does the US, with better results: universal coverage for all residents, and better indicators of health.

Here’s the wiki article health care spending by GDP. The US spends more public money on healthcare than other OECD countries, but doesn’t achieve universal coverage. As well, the public spending by US governments is roughly in line with government spending on health care in other OECD countries; again, without achieving universal coverage.

Providing “free” universal coverage is less costly than the US model, freeing up more public money in those countries for other purposes. Tying the health care spending to defence spending is a meaningless way to look at the issue.

https://en.m.wikipedia.org/wiki/List...ure_per_capita

https://www.healthsystemtracker.org/...-similar-since
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Old 12-24-2019, 06:47 AM
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But you're NOT cutting out middlemen with government-run healthcare. All you're doing is replacing one set of middlemen (private corporations) with another set (government bureaucrats).

At least the private ones have a reasonable chance of actually being fired from their jobs if they're not adding value somewhere to the equation. The government ones, not so much.
Yes, you are, at least in a single-payer system like Canada. You go to a doctor, get treatment, the doctor bills the Medicare system and gets paid.

The doctor doesn’t need to have a large staff to bill a great number of insurance plans, each with their own billing system. It’s a single billing system.

And, more significantly, there are no bureaucrats scrutinizing the doctor’s bill and substituting their views in whether it was medically necessary treatment. Cost control is handled globally, by negotiations between the Medicare officials and the doctors to establish a payment schedule. Doctors then bill for treatment provided, and get paid. They don’t have to justify their treatment choices to government bureaucrats, unlike a system of private insurance.

The only time i’ve run into a bureaucrat second-guessing my treatment is my dental insurance, which is private insurance, not part of Medicare.

A single-payer system of this type does eliminate a large bureaucracy, compared to a private insurance system where insurance bureaucrats scrutinize and question the doctor’s treatment decisions, for cost control reasons.
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Old 12-24-2019, 07:01 AM
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And, more significantly, there are no bureaucrats scrutinizing the doctor’s bill and substituting their views in whether it was medically necessary treatment. Cost control is handled globally, by negotiations between the Medicare officials and the doctors to establish a payment schedule. Doctors then bill for treatment provided, and get paid. They don’t have to justify their treatment choices to government bureaucrats, unlike a system of private insurance.
I'm not sure about the other provinces, but Ontario has some pretty dismal waiting times for things that are pretty important. Because I don't have USA data, I can't claim an advantage, but looking at some things like "imaging," I can't imagine have a wait time at all. Anecdotally, I've met multiple Canadians who cross into Buffalo or Detroit for expedited services.

I get it, our system is fucked up, albeit in in a different way. At least I can visit radiology same-day.
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Old 12-24-2019, 07:10 AM
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If you have the money to pay for it.

For individuals in the US without money or insurance, the wait time can be infinite.
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Old 12-24-2019, 07:47 AM
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Those countries with free healthcare and all also dont have the open borders being proposed.
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Old 12-24-2019, 09:10 AM
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I'm not sure about the other provinces, but Ontario has some pretty dismal waiting times for things that are pretty important. Because I don't have USA data, I can't claim an advantage, but looking at some things like "imaging," I can't imagine have a wait time at all. Anecdotally, I've met multiple Canadians who cross into Buffalo or Detroit for expedited services.

I get it, our system is fucked up, albeit in in a different way. At least I can visit radiology same-day.
Which waits are dismal? I'm looking at the CT numbers, and it says priority 1 patients ( emergency) are not included. The longest average is 37 days, for people with a target of 28 days. People with a target time of 2 days had an average wait time of 1 day.

You are very likely correct that people in the US with health insurance or the means to pay have no wait time* - but that contributes to cost. I don't regularly get MRIs- but I get a mammogram every year. No symptoms, it's a screening mammogram. And I can always get an appointment within a day or two. Which means that the center I go to has enough technicians and machines to have enough empty spaces in their schedule that they can book a non-emergency on less than two days notice. That costs money.


* And if you include the people with no insurance/poor insurance/can't afford the copay/deductible who are not going to get that scan done until the ER does it because it has now become an emergency (which could be months or years) , the average US wait would very possibly be longer than the longest Canadian wait. But somehow when Americans are talking about the lack of waiting time, they never include those people.

Last edited by doreen; 12-24-2019 at 09:11 AM.
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Old 12-24-2019, 09:52 AM
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Those countries with free healthcare and all also dont have the open borders being proposed.
This post is like a fractal of wrongness. Each individual part is wrong on it's own, and the overall impact is even more wrong than the sum of it's part. It brings a tear to my eye.
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Old 12-24-2019, 09:59 AM
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Those countries with free healthcare and all also dont have the open borders being proposed.
Again, there's no such thing as free healthcare. Sensible primary healthcare systems are free (or nearly free) at the point of service, and are funded principally out of general taxation, which guarantees that every taxpayer contributes to an implicit universal insurance pool.

But it's good to see that you've got your priorities straight. You are willing to embrace the appallingly bad U.S. healthcare system, which (below retirement age) is funded by what amounts to a massive payroll tax; a system that excludes many people without good jobs from the system entirely; a system that makes it difficult to change jobs, and makes things especially difficult for small businesses and self-employed entrepreneurs; and that costs at least twice as much as any other developed nation for worse health outcomes. You're willing to embrace it rather than take the risk of the substantials reforms that could save everyone money and make everyone healthier, because that might allow some poor people or immigrants to steal a bit of healthcare that they don't deserve. And that's the important thing.

Last edited by Riemann; 12-24-2019 at 10:02 AM.
  #44  
Old 12-24-2019, 11:05 AM
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Next time you want to buy a car, call me. I’ll find the car you want, and add 10% to the cost of it for my fees.

Then if you complain that I’m charging you too much money and adding no value, I’ll remind you that you were once opposed to increasing efficiency at the cost of jobs.
You have invented the car dealership. Dealerships allow manufacturers to sell more cars by outsourcing some marketing, inventory storage, and service. Sometimes middle men add value so eliminating them make the process less efficient.
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Old 12-24-2019, 11:21 AM
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How do you figure? I just looked up two state colleges and about 20 something percent of their budget is from state appropriations.
I just looked up tuition for my states flagship university. It's 11k a year for in state students and 36k a year for out of state students.
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Old 12-24-2019, 11:29 AM
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REAL Medicare for all can be paid for by a tax on business equal to about what they pay out in health premiums now. I mean REAL, not sanders crazy expensive plan.
Doesn't Medicare as it is have an actuarial value of around 70%?

http://newsroom.ucla.edu/releases/pu...-in-california

According to that 16% of all medical costs are paid by employers with another 12% as lost tax revenue due to employers buying private insurance. Combined that's 28% of medical spending. Around a trillion dollars.

If you assume a Medicare buy in is $6000 a year on average and you add 180 million people to it then that's 1.1 trillion dollars.

Problem is I doubt most people with employer based insurance would accept it.
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Old 12-24-2019, 11:34 AM
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All the (western) countries that have free or heavily subsidized healthcare and college--how many of them have the US footing the bill for their national defense? Is it possible that you can have a robust national defense or free healthcare/college, but not both?
The 1970s called. Who are we protecting them from again?
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Old 12-24-2019, 11:40 AM
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But you're NOT cutting out middlemen with government-run healthcare. All you're doing is replacing one set of middlemen (private corporations) with another set (government bureaucrats).
Quote:
Originally Posted by puddleglum View Post
You have invented the car dealership. Dealerships allow manufacturers to sell more cars by outsourcing some marketing, inventory storage, and service. Sometimes middle men add value so eliminating them make the process less efficient.
The issue here is in understanding where a model that's applicable for most types of private enterprise fails for healthcare. We all accept that we don't run national defense like a normal private corporation, for obvious reasons. And every country other than the U.S. understands that there are equally obvious reasons why healthcare is also an exceptional case.

For most types of insurance, it's perfectly acceptable that private insurance companies should assess prospective risk, and in competiting with one another to do this they add value. And we accept that it's reasonable for riskier drivers to pay more for car insurance, and that good drivers should not be forced to subsidize bad drivers.

But apply the Rawlsian veil of ignorance to healthcare needs. Some random selection of people will be unlucky enough to get cancer, or need a transplant, or suffer from some chronic disease. If you don't know whether you will be born as one of those people, what kind of healthcare system would you choose? Sure, there are some aspects of health that are somewhat under our control, but many are not. And even when sickness is a result of poor lifestyle choices, we generally don't believe that a civilized society should allow people to suffer and die for those choices.

So the usual insurance model where private companies continuously assess people's health prospects and exclude people who they know are likely to need healthcare doesn't work. We all know that - that's why we all agree with legislation that stops insurance companies excluding people with pre-existing conditions, it's why we won't every allow genetic screening for this purpose. But efficient assessment of prospective risk is the entire raison d'etre of private insurance in a free market economy. If we acknowledge that insurance companies should be barred from assessing prospective risk, then they have no sensible role in an efficient healthcare system at all. They are middlemen that suck money out of the system but add no value.

The sensible model for healthcare is that we all effectively buy into the principle of health insurance with a Rawlsian veil of ignorance before we are born, before we know if our individual likely healthcare needs will be above or below average, as part of our social contract. We all commit to lifelong membership of a single insurance pool to fund healthcare. And the simplest way to form a universal mandatory insurance pool is to fund the primary healthcare system from general taxation. Again, this is similar to what we all accept is necessary for funding national defense; and it's the approach taken by every country other than the U.S.

Private corporations should certainly compete for the provision of healthcare, just as they do in the defense industry. They just have no appropriate role in the funding of healthcare.

Last edited by Riemann; 12-24-2019 at 11:44 AM.
  #49  
Old 12-24-2019, 12:18 PM
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Those countries with free healthcare and all also dont have the open borders being proposed.
Do you think the Schengen Area is some type of erogenous zone?
  #50  
Old 12-24-2019, 12:21 PM
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You have invented the car dealership. Dealerships allow manufacturers to sell more cars by outsourcing some marketing, inventory storage, and service. Sometimes middle men add value so eliminating them make the process less efficient.
However, in many states, laws prohibit buying cars from anyone but a dealership. (I.e., one cannot legally buy direct from the manufacturer.) Are you in favor of such laws requiring the use of middlemen?
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