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  #51  
Old 12-24-2019, 12:32 PM
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It’s not just national defence that isn’t left to the market. Governments provide a lot of services because the private market won’t, or shouldn’t, because the profit motive isn’t appropriate: Police. FireFighting. Roads. Education (K-12).

We don’t call those “free” services. We pay for them with our taxes. But they are essential for our society and best handled by government.

Health care in most countries is just another service that is better handled by government, because of moral/ethical issues, and because studies of health care economics show that the market efficiencies just don’t apply to health care decisions.
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Last edited by Northern Piper; 12-24-2019 at 12:33 PM.
  #52  
Old 12-24-2019, 12:43 PM
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Originally Posted by Horatio Hellpop View Post
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.
The US spends about 4% of gdp on military. Most other western nations spend about 1-2%.

The us spends 18% of gdp on health care, vs about 8-12% in other wealthy nations.

I believe in the US we spend about 5-6% of gdp on education, mostly via public funds. No idea what other western nations spend but I assume it's comparable.

The real issue is how expensive our health care is. If our health care was as affordable as Europe we'd save 6-8% of gdp a year.

Enough to balance the budget, offer free college to everyone, drastically increase spending on renewable energy and expand social security.

The issue isn't military spending. The US spends 1-2% more of gdp on education than other western nations but we spend 6-10% more of gdp on health care. And our health care is worse, it's just more expensive.

If we want to save costs we have to start there.

Free public college would cost about 80 billion a year. If our health care was as cost efficient as Europe and Japan we'd save 1.5 trillion a year.
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Last edited by Wesley Clark; 12-24-2019 at 12:44 PM.
  #53  
Old 12-24-2019, 12:55 PM
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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.
The US does not run health insurance like a normal private corporation. Every state has a list of rules that only apply to health insurance companies that is as long as your arm. Employer health insurance costs are given special tax advantages which is not done for any other type of insurance. Because of the rules actual health insurance is banned in most places, and what insurers provide is prepayment of health care costs.

There are also many different types of funding for health insurance around the world. In some countries like Germany there is a combination of public and private insurance companies, in some like Switzerland there is compulsory private insurance. The most efficient health insurance system in the world, Singapore, is a mix of public and private insurance with mandatory HSAs.

Insurers can provide more services than just risk pooling. They can also negotiate with providers and monitor fraud. Medicare fraud costs the government at least 90 billion a year, unless the program is changed ten making medicare for all would likely increase that to 180 to 600 billion per year.

Every country has problems with their healthcare costs, for instance if Canada's system was as efficient as South Korea's system the could cut their spending in half and still live longer. The UK could cut their spending in almost half and live longer if their system was as efficient as Greece's.
  #54  
Old 12-26-2019, 04:50 PM
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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.
I NEVER said I liked our current system. I am totally ok with a universal system like say Denmark has.

Again though, we cant have that with the current immigrant situation.
  #55  
Old 12-26-2019, 05:17 PM
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I NEVER said I liked our current system. I am totally ok with a universal system like say Denmark has.

Again though, we cant have that with the current immigrant situation.
You’re talking about Mexicans, right?
  #56  
Old 12-26-2019, 10:08 PM
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There is an interesting link between high US healthcare costs and high college costs. Lack of price elasticity. Items where the customer has little ability to reduce the purchase if the price is to high often lead to market failure.

Medically necessary healthcare is hard to refuse on cost. And in the US, parents normally see college as the ticket to success or at lest the middle class for their children, I think. Hard to refuse too. In countries with free higher education, I think theres often more rewarding non-degree life paths. So the pressure on getting a degree is less, and fewer people need to go to college.

Anyway...

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Originally Posted by Flyer View Post
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).
You seem to think they are doing the same jobs. The problem with US bureaucracy is that it generates a lot of work and jobs that other systems just don't do or do a minimal amount of.

Billing. Gatekeeping. Negotiation with insurers. Credit-checking. Liaising. Insurance bureaucracy, claims written, received, accepted or rejected, appeals. In-network and out-of-network. There is a fantastic amount of bureaucracy in the US system that won't be replaced with government bureaucracy because its unnecessary outside of the US health care ecosystem.

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Originally Posted by Horatio Hellpop View Post
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?
No. First off because there seems to be no difference in the matter between nations that have had US military support and nations that haven't. Sweden, Finland, Switzerland, doesn't seem to be much of a difference between them and NATO countries.

Second, because the savings on a UHC systems are so large they dwarf military spending. The US spends, what, 5% of GDP on defense? Versus 1-2 % from other western nations. And the US spends 18 % on healthcare versus 9-12 % for the other nations.

Third because without the US spending in the pot, the other NATO nations or the EU still grossly outspends Russia.

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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.
Actually the number of Americans filching free healthcare on forged documentation in Canada, and getting prescriptions filled in Canada vastly outnumber the people going the other way.

On the subject of waits, its a fairly complex subject. Waits to see a GP, waits to see a specialist, wait at the emergency room, waits for elective surgery, waits for urgent surgery are all different. I believe its an area where Canada does not do very well, but sitting next to a kid not doing to well does not automatically make the US good. I believe overall the US is bit above average in waits, but not in the top. I think Denmark and Switzerland are the top.

Also, the uninsured and people putting off seeing a doctor due to worries about cost is not generally counted in US waits, except emergency room ones. If they were included, it is likely US waits would increase.

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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.
What kind of value would you say the US enormous overload of middlemen adds?

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Originally Posted by puddleglum View Post
The most efficient health insurance system in the world, Singapore, is a mix of public and private insurance with mandatory HSAs.

Every country has problems with their healthcare costs, for instance if Canada's system was as efficient as South Korea's system the could cut their spending in half and still live longer. The UK could cut their spending in almost half and live longer if their system was as efficient as Greece's.
What kind of definition for "Efficient" are you using here? Because it sounds like you are only looking at costs.

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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.
Didn't you in the post just above say to aim for a system like Switzerland? Where doctors make more than in the US? How much do you think doctors salaries matter in total anyway?

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Originally Posted by Urbanredneck View Post
I NEVER said I liked our current system. I am totally ok with a universal system like say Denmark has.

Again though, we cant have that with the current immigrant situation.
Well, its a good thing you don't have the immigration of the UHC european nations then, isn't it? Nations like the UK, Germany, Belgium, Norway, Austria etc, etc... Oh and yes, Denmark. All of which have higher net migration than the US.
  #57  
Old 12-27-2019, 11:15 AM
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Originally Posted by Flyer View Post
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.
You must not be from around here, snfaulkner. "Government is always the problem" is one of the four key tenets of American political thought, along with "Gunz is good," "Tiny racially homogeneous countries like Canada or France can adopt solutions that wouldn't work in the Biggest and Bestest Country on Earth," and "I got mine already. Eat S**t, sucker!"

Note also that it is the private buying agent that will have incentives both
* to establish an inflated price scale, to expand the total cost of healthcare,
and
* to deny expensive care, as possible in individual cases.

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Those countries with free healthcare and all also dont have the open borders being proposed.
I didn't know where to begin on this. Fortunately I was immediately Ninja'ed by Babale's excellent effort:

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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.
  #58  
Old 12-27-2019, 05:03 PM
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Actually the number of Americans filching free healthcare on forged documentation in Canada, and getting prescriptions filled in Canada vastly outnumber the people going the other way.
Why does anyone need forged documentation to fill prescriptions? That's covered by employer offered private health insurance, not provincial insurance, at least in Ontario.
  #59  
Old 12-27-2019, 05:09 PM
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The forged docs are necessary to filch healthcare. All of the provinces have been upgrading the healthcards, to make it harder for non-residents to get healthcare, pretending to be Canadian residents.

Don’t need the health cards to get prescriptions.
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Last edited by Northern Piper; 12-27-2019 at 05:11 PM.
  #60  
Old 12-27-2019, 09:19 PM
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You’re talking about Mexicans, right?
Are you a racist?

Actually look it up and Mexicans are just a part of the millions of all the immigrants pouring in that then must be housed, fed, provided healthcare for, be enrolled in schools, and provide employment for.
  #61  
Old 12-27-2019, 10:01 PM
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Are you a racist?

Actually look it up and Mexicans are just a part of the millions of all the immigrants pouring in that then must be housed, fed, provided healthcare for, be enrolled in schools, and provide employment for.
Repeat after me: “Most undocumented migrants are performing work that American workers don’t want to perform for minimum wage”

If you want lettuce or berries that are grown in California, this is the only way they will ever get to market.
  #62  
Old 12-27-2019, 10:36 PM
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Are you a racist?

Actually look it up and Mexicans are just a part of the millions of all the immigrants pouring in that then must be housed, fed, provided healthcare for, be enrolled in schools, and provide employment for.
Well, your perception of all this is undercut by your assertions that there is no more room in America. Your perception that someone feeds immigrants and provides them jobs is equally not from this planet, much less this country.

And yet, somehow we manage to have universal health coverage for senior citizens, the most costly segment of society.
  #63  
Old 12-28-2019, 03:57 AM
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Are you a racist?

Actually look it up and Mexicans are just a part of the millions of all the immigrants pouring in that then must be housed, fed, provided healthcare for, be enrolled in schools, and provide employment for.
How are your Googling skills, Urbanredneck ? Try some phrasings like "Do immigrants contribute more to the tax base than they consume?" Or "Do immigrants increase or decrease the average prosperity of Americans?"

Give us a brief report when you've completed the research.

Or don't. Maybe your news source — Sean Hannity? — has already done the research, so you already know the answer.
  #64  
Old 12-28-2019, 04:08 AM
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How are your Googling skills, Urbanredneck ? Try some phrasings like "Do immigrants contribute more to the tax base than they consume?" Or "Do immigrants increase or decrease the average prosperity of Americans?"

Give us a brief report when you've completed the research.
Your points lack truthiness. What's the point of research like this when we all know that reality has a liberal bias?
  #65  
Old 12-29-2019, 06:46 AM
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Are you a racist?

Actually look it up and Mexicans are just a part of the millions of all the immigrants pouring in that then must be housed, fed, provided healthcare for, be enrolled in schools, and provide employment for.
Then how come all those European nations with more immigrants per head can do it?
  #66  
Old 12-29-2019, 12:43 PM
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Or Canada, which has a higher immigration rate than the US?
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  #67  
Old 12-31-2019, 04:26 PM
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The forged docs are necessary to filch healthcare. All of the provinces have been upgrading the healthcards, to make it harder for non-residents to get healthcare, pretending to be Canadian residents.

Don’t need the health cards to get prescriptions.
Oops, my bad. I thought you were saying Americans were using forged documentation to procure medication. I had no idea that Americans were using forged documentation to get health care. That's ballsy.
  #68  
Old 12-31-2019, 05:52 PM
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That's ballsy.
Or desperate.
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  #69  
Old 01-04-2020, 05:30 PM
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Insurers can provide more services than just risk pooling. They can also negotiate with providers and monitor fraud. Medicare fraud costs the government at least 90 billion a year, unless the program is changed ten making medicare for all would likely increase that to 180 to 600 billion per year.
But how much of that fraud is people trying to get services that they are not entitled to, because of the restrictions on who can use which program? If everyone is entitled to medical care, most of the fraud never happens.
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Old 01-04-2020, 07:59 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?
No. Think of it as an investment that increased productivity overall, rather than just some zero-game with finite resources. More college graduates means more productive citizens down the road (think of the effects of the G.I. Bill, for example) and single-payer health care means a good-sized fraction of your middle- and working-class populations will not be put on unproductive paths to bankruptcy if they have a medical emergency.

Similarly, having police departments and money-losing mass-transit systems and fire departments in large cities might appear like expenses that don't generate profits, but they and other services make the cities more livable for the residents who are generating profits, because they can live and work and spend in the city while not having to divert a large portion of their resources for personal protection (because there are no cops) and travel (because they can get around without having to maintain their own vehicles) and not losing everything (because their neighborhoods burned down). It's a libertarian fantasy that the private sector can supply all of these more efficiently and if they can't, then society will be just fine without them. That kind of short-sighted thinking decreases wealth for everyone, including the rich.
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Old 01-04-2020, 10:11 PM
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But how much of that fraud is people trying to get services that they are not entitled to, because of the restrictions on who can use which program? If everyone is entitled to medical care, most of the fraud never happens.
Actually , I believe most of the fraud is on the other end - doctors and other providers billing for services that either weren't needed or weren't provided. I am certain there are some individual people trying to use someone else's Medicare card, but it appears that sort of fraud is insignificant enough that it isn't even listed in articles about Medicare (or Medicaid or insurance fraud). Literally everything I found is about the providers and lots of it is multi-million dollar frauds. The only mention of individuals is those who get kickbacks for providing their Medicare number to providers who then use it for fraudulent billings. Universal coverage is not going to eliminate fraud on the provider end.
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Old 01-04-2020, 10:21 PM
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I have never read a comprehensive analysis of how much it would cost to have a totally uneducated population, without available health care.
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Old 01-04-2020, 10:30 PM
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Bloody hell.

a) Nothing is free if it requires resources or labor, granted

b) Many of us want to be taxed and then the tax money used to make something available in a uniform, coherent, planned fashion. The interstate highway system, the postal service, and the public school system are examples of doing it this way.

c) Not everything is better when centrally planned, I'll grant that also. I would not wish to see the apparel industry nationalized, for example. Yeah, each manufacturer seems to have a different notion of "size 12" but overall I appreciate the diversity a whole lot more than I resent the peculiarities and disparities.

d) Health insurance could conceivably have been in the same camp as the garment industry, but that's not how it has gone down. It's a sprawlingly complicated nonsystem. It's fucking awful. When I'm sick or worried about my physical health, I don't want to have to worry that the doctor isn't covered, that the facility the doctor refers me to isn't covered, or that the medication the doctor prescribes isn't covered. Even when I'm healthy and have time on my hands I don't want to wade through hundreds of self-serving descriptions of this and that health insurance policy and still not have a clear understanding of what I'd be acquiring for what price. When I'm paying my deductibles out of pocket and amassing a ludicrous pile of "THIS IS NOT A BILL" statements, and trying to sum them up and compare the latest to what I already freaking paid, I never have a single comprehensive accounting for what services I received, what the real charges were (not the imaginary charges that the insurance company denies), and how much of that I owe and when the insurance is gonna kick in and pay the rest. I end up sighing and saying "please don't cheat me" and just paying whatever they say I owe, and by the end of the year I've paid for all my medical treatment and I've also paid for health insurance and I keep wondering WHY?!?

This is not a system. I want a system. Raise my taxes. Give me health care and don't make me wade through that swamp. Don't hassle me about insurance or copayments. I'm a taxpayer. It should be like the interstate.


e) College could be like the apparel industry too, I suppose, but here in particular we don't want people to not get educated just because they can't afford it. The entire country benefits from having an educated populace. And it's not a new idea. There have been many times in history when if you qualified academically you didn't have to pay tuition at least for in-state public colleges.
  #74  
Old 01-04-2020, 11:53 PM
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I have never read a comprehensive analysis of how much it would cost to have a totally uneducated population, without available health care.
Ivanka might say, "Let them eat carrot cake."

My system doesn't like me googling, "What would lack of public education and healthcare cost the U.S.?" <time passes> Ah, five minutes later, I receive... no clear answers. A study is needed. Can we get a grant?
  #75  
Old 01-04-2020, 11:57 PM
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I have never read a comprehensive analysis of how much it would cost to have a totally uneducated population, without available health care.
I know a society like that, but the only person smart enough to write up their analysis got beat up in private school and died a month later of sepsis.
  #76  
Old 01-06-2020, 01:05 PM
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What kind of value would you say the US enormous overload of middlemen adds?
I don't know enough about the subject to offer an informed opinion but am just pointing out that the existence of a middleman does not necessarily mean that there is an inefficiency that can be rectified.

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What kind of definition for "Efficient" are you using here? Because it sounds like you are only looking at costs.
Looking at costs and life expectancy. I find it surprising that politicians in Europe are heading down to Greece to find out how to replace their systems with the better Greek one.
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Old 01-06-2020, 01:07 PM
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I have never read a comprehensive analysis of how much it would cost to have a totally uneducated population, without available health care.
The government does not provide food or cars but most people are able to get around and not starve. If the government completely abandoned healthcare and education those sectors would not go away.
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Old 01-06-2020, 02:59 PM
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The government does not provide food or cars but most people are able to get around and not starve. If the government completely abandoned healthcare and education those sectors would not go away.
Ahem. Food stamps? Public transportation?
No, the health industry and the education industry would not go away, but lots of people would no longer be able to afford any healthcare, and lots of parents wouldn't be able to send their kids to school.
That your idea of paradise?
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Old 01-07-2020, 12:08 AM
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Nobody needs health care in Libertopia because they all get good exercise walking everywhere.
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Old 01-07-2020, 01:06 AM
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Nobody needs health care in Libertopia because they all get good exercise walking everywhere.
Crosswalks. We don't need no steenkin' crosswalks.
Does keep the population down. Plus the average libertarian thinks that if a car hits him, the car will lose.
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Old 01-07-2020, 09:03 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?
Taking a slightly different tack than some in the thread...

Right!

In order for Universal Health Care to be a success, we have to cut a LOT of people out of the industry.

This is also known as "improving efficiency", something that started to happen in earnest during a little thing I like to call "The Industrial Revolution", and created the robust world economy we enjoy today.

It is not a thing to be avoided, it is a thing to be embraced, a proposition that economically minded people should be champing at the bit to dig into. It's a chance to take an industry that consumes 18% of our GDP and turn it into an equivalently effective industry that consumes 12% of our GDP. That's freeing up 6% of our GDP to do something else. Something fun, something awesome. Today, that 6% goes to administering an suboptimal healthcare system, yay.
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Old 01-07-2020, 10:50 AM
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I think a lot of the resistance to universal health care is the idea that the middle class is footing the bill for that roughly 30% of the population that "don't pull their load", and who also are more prone to doing unhealthy stuff like smoke, be obese, drink too much, get STIs, etc...

Combine that with a lot of muddling-together of socio-economic status and race, and you get a pretty powerful us-vs-them mentality. From the standpoint of a white middle-class family, it looks like the people at the bottom end of the socioeconomic ladder will be both disproportionate consumers of universal health care, as well as not paying their proportional share. In other words, they're going to use more and pay less versus their peers. And it doesn't help that in a lot of cases, the people at the bottom of the socioeconomic ladder often don't look or talk like they do either.

How do we bring the middle class around? I'd think that politicians would be good to find the cracks in the system that catch your working, middle-class white families and point out how UHC will benefit them in those cases- having their elderly retiree parents treated, for example.
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Old 01-07-2020, 12:28 PM
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The government does not provide food or cars but most people are able to get around and not starve. If the government completely abandoned healthcare and education those sectors would not go away.
The government provides the infrastructure for cars, namely the roads. And the government provides the regulatory system that ensures the food is safe.

Similarly with UHC, it doesn’t automatically mean that the government provides the entire health care system. It provides the necessary funding and organization, to ensure people can access health care.
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Old 01-07-2020, 02:20 PM
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Crosswalks. We don't need no steenkin' crosswalks.
Crosswalks? Crosswalks?! You mean like painted lines on the road? What are you, some kind of line-following commie robot?! "Beep-boop-I-am-a-slave-to-convention, beep-boop-I-only-go-where-the-collective-tells-me, beep-boop..."
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Old 01-07-2020, 03:55 PM
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Crosswalks? Crosswalks?! You mean like painted lines on the road? What are you, some kind of line-following commie robot?! "Beep-boop-I-am-a-slave-to-convention, beep-boop-I-only-go-where-the-collective-tells-me, beep-boop..."
Damn right. The only SAFE pedestrian is an ARMED pedestrian!
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Old 01-08-2020, 02:18 AM
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How do we bring the middle class around? I'd think that politicians would be good to find the cracks in the system that catch your working, middle-class white families and point out how UHC will benefit them in those cases- having their elderly retiree parents treated, for example.
Middle-class buy-in is the key to acceptance of the welfare state in western Europe. To take how that buy-in worked in my country:

1. The medical care that your doctor thinks that you need will be available to you and your family. The only restrictions on your doctor's clinical judgement relate to treatments that are not safe, or not cost-effective across the whole population. So no-one is going to second-guess your doctor and present you with an unexpected bill.

2. Your care does not depend upon your employer's insurance policy, and is entirely between you and your doctor. You will be covered in exactly the same way, whether or not you change jobs.

3. The cost to a taxpayer will probably be less than paying by private insurance premiums. Everyone will be paying according to their means, through their taxes. But what is spent on the system as a whole will be decided by your elected representatives.
(And anyone will be free to take out private insurance and/or pay for private treatment if they wish).
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Old 01-08-2020, 02:56 AM
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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.
I think you are reading this to mean that the "true" cost of tuition is $36K, that out-of-staters pay the true cost, and that in-staters are subsidized to the tune of $25K. This is false.

The actual cost is probably closer to $14-15K per student, of which the taxpayer actually subsidizes something on the order to 20-40%. Out-of-state and especially international students are profit centers; they in effect help to subsidize the in-state students because they pay vastly higher rates.
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Old 01-08-2020, 09:39 AM
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Middle-class buy-in is the key to acceptance of the welfare state in western Europe. To take how that buy-in worked in my country:

1. The medical care that your doctor thinks that you need will be available to you and your family. The only restrictions on your doctor's clinical judgement relate to treatments that are not safe, or not cost-effective across the whole population. So no-one is going to second-guess your doctor and present you with an unexpected bill.

2. Your care does not depend upon your employer's insurance policy, and is entirely between you and your doctor. You will be covered in exactly the same way, whether or not you change jobs.

3. The cost to a taxpayer will probably be less than paying by private insurance premiums. Everyone will be paying according to their means, through their taxes. But what is spent on the system as a whole will be decided by your elected representatives.
(And anyone will be free to take out private insurance and/or pay for private treatment if they wish).
I'm under the impression that sometime in the late 1940s-early 1950s (or even before), most western European countries went the UHC route in some way, while the US went the private health insurance route.

If that's actually true, that's something that might explain the seemingly outsized resistance in the US- the European countries weren't overturning an existing system, but basically building one from scratch.

To the consumer, it's a combination of "the devil you know" and some fairly deep skepticism of claims that a government-run program will be cheaper overall than what they currently have. The thing that seems to be forgotten is that for the vast majority of people, the vast majority of the time, the system works adequately. Adequately enough anyway, that people are hesitant to up-end the apple cart.

Where it falls down for most is one or a combination of a handful of situations- long-term job loss, particularly shitty coverage, or chronic disease. But again, most people aren't unemployed long-term, have terrible coverage, or are chronically ill, so it seems sort of academic for a great many people. And many that are (not all) are covered by Medicare as senior citizens anyway.

So if you were to look at someone like me, but more conservative/skeptical, you'd basically have to prove the following to get this hypothetical me on board:
  1. It will definitely cost me less to insure my family overall.
  2. I won't give up any standard of care relative to the present day.
  3. I won't give up any standard of convenience (time, scheduling, location) relative to the present day.
  4. I won't give up my current freedom of choice in terms of providers/facilities relative to today.

Most proposals concentrate on the uninsured/under-insured angle and chronic disease angles, and don't put much effort into proving how a regular family without any of that is going to benefit. Which is strange, because most voters fall in that category.
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Old 01-08-2020, 01:29 PM
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I think you are reading this to mean that the "true" cost of tuition is $36K, that out-of-staters pay the true cost, and that in-staters are subsidized to the tune of $25K. This is false.

The actual cost is probably closer to $14-15K per student, of which the taxpayer actually subsidizes something on the order to 20-40%. Out-of-state and especially international students are profit centers; they in effect help to subsidize the in-state students because they pay vastly higher rates.
This is the same reason there are high hotel taxes. Parents of out of state students don't vote in that state. No pushback for charging them more.
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Old 01-08-2020, 01:51 PM
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Taking a slightly different tack than some in the thread...

Right!

In order for Universal Health Care to be a success, we have to cut a LOT of people out of the industry.

This is also known as "improving efficiency", something that started to happen in earnest during a little thing I like to call "The Industrial Revolution", and created the robust world economy we enjoy today.

It is not a thing to be avoided, it is a thing to be embraced, a proposition that economically minded people should be champing at the bit to dig into. It's a chance to take an industry that consumes 18% of our GDP and turn it into an equivalently effective industry that consumes 12% of our GDP. That's freeing up 6% of our GDP to do something else. Something fun, something awesome. Today, that 6% goes to administering an suboptimal healthcare system, yay.
Precisely, in order for healthcare to cost less millions of people will either have to be put out of work or paid significantly less.
What gives you confidence that our government will be able to accomplish this?
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Old 01-08-2020, 02:05 PM
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Where it falls down for most is one or a combination of a handful of situations- long-term job loss, particularly shitty coverage, or chronic disease. But again, most people aren't unemployed long-term, have terrible coverage, or are chronically ill, so it seems sort of academic for a great many people. And many that are (not all) are covered by Medicare as senior citizens anyway.

So if you were to look at someone like me, but more conservative/skeptical, you'd basically have to prove the following to get this hypothetical me on board:
  1. It will definitely cost me less to insure my family overall.
  2. I won't give up any standard of care relative to the present day.
  3. I won't give up any standard of convenience (time, scheduling, location) relative to the present day.
  4. I won't give up my current freedom of choice in terms of providers/facilities relative to today.

Most proposals concentrate on the uninsured/under-insured angle and chronic disease angles, and don't put much effort into proving how a regular family without any of that is going to benefit. Which is strange, because most voters fall in that category.
You don't have to be long-term unemployed, however, to have to deal with changing your doctors and your prescriptions just because you changed jobs (never mind lost a job), or because your employer decided to change who they contracted with.

The notion that you HAVE this standard of convenience and freedom of choice right now is, for the overwhelming majority of "regular familes," an illusion. It works well enough most of the time, but most of us get our coverage through our employer (or our spouse's or parent's employer), and that employer and their contracting health insurance provider is free to decide to change the coverage, change the drug formulary, drop St. Somebody's Hospital from the network, etc. You get a divorce and you might need to change coverage, in turn changing your choice of providers; Dad goes on disability and the same thing can happen.

The goal of universal health coverage isn't (and can't be, in a resource-constrained world) to give everybody the perfect experience; it's to give everybody adequate coverage, so that no matter the circumstances of your life and no matter the changes in those circumstances, you'll still have adequate access to good providers. They may not be the most convenient providers (although in a universal environment, the majority of providers are going to accept the default coverage), but you won't have the experience of going across state lines and discovering that everything is out-of-network.
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Old 01-08-2020, 02:48 PM
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Precisely, in order for healthcare to cost less millions of people will either have to be put out of work or paid significantly less.
What gives you confidence that our government will be able to accomplish this?
If we can't do what the rest of the modern world can, then we should tell all of the "We're No. 1" people in the US to fuck off forever.
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Old 01-08-2020, 03:03 PM
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Precisely, in order for healthcare to cost less millions of people will either have to be put out of work or paid significantly less.
What gives you confidence that our government will be able to accomplish this?
It really depends on the Republicans. If they are actively sabotaging the effort, the way they actively sabotaged the ACA, it's very possibly going to fail.

The ACA has managed to remain operational, and provide at least some measure of health care protection and cost control for Americans, despite being an overly complex neutered version of UHC, avoiding any active price controls, bereft of any level of management from the legislature, and subject to ongoing attacks by half the government to destroy the very underpinnings of it's structure.

If the large majority of our government works toward a successful rollout of UHC, it'll work just fine. Many of the people being put out of work are private employees to begin with. The efficiencies can be gained in places like private hospitals, where today, 20 people can walk in with the same needs and walk out with 20 different bills, going to 20 different insurance companies, with 20 different co-pays, deductibles, and payment structures.
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Old 01-08-2020, 03:25 PM
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The notion that you HAVE this standard of convenience and freedom of choice right now is, for the overwhelming majority of "regular familes," an illusion. It works well enough most of the time, but most of us get our coverage through our employer (or our spouse's or parent's employer), and that employer and their contracting health insurance provider is free to decide to change the coverage, change the drug formulary, drop St. Somebody's Hospital from the network, etc. You get a divorce and you might need to change coverage, in turn changing your choice of providers; Dad goes on disability and the same thing can happen.
Perception is reality when we're discussing people and who they may vote for based on policy positions. People think that they have this illusory choice and convenience, which means that people trying to pitch another system have to dispel the idea that they're going to get less of each under a UHC system.

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The goal of universal health coverage isn't (and can't be, in a resource-constrained world) to give everybody the perfect experience; it's to give everybody adequate coverage, so that no matter the circumstances of your life and no matter the changes in those circumstances, you'll still have adequate access to good providers. They may not be the most convenient providers (although in a universal environment, the majority of providers are going to accept the default coverage), but you won't have the experience of going across state lines and discovering that everything is out-of-network.
Sounds like you're expecting to guilt people into voting for it apparently. That rarely works in actual real-world elections.

I mean, what you say is true and noble, but most people are satisfied with what they've currently got. So getting them to vote for something that may potentially offer less service (as they perceive it) for potentially more cost (if the increase in taxes outweighs their current premiums), and potentially less convenience is an extremely hard sell.

What I'm saying is that the politicians advocating UHC are hawking the wrong aspects of it to the public. In general, the average voter probably is most interested in how it's going to impact his wallet, how it's going to affect his ability to go to the doctors he wants, when he wants, and whether or not he'll get the same level of care he currently does. Anything about un/underinsured people, under served communities, or the like is probably way outside the realm of stuff he's going to care about, when someone says this may affect those things I mentioned above.

So the politicians need to really amp it up on the aspects that would positively affect the average American who is insured through their employer and has what they consider adequate coverage. Maybe point out the continuous aspects- no COBRA, not tied to employment. Maybe point out that drug costs would probably go down. Maybe point out that you'd have no balance billing or out-of-network woes, etc... All things that would affect that average voter, while stuff about being uninsured and having to go to the free clinic might as well be science fiction to them.
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Old 01-08-2020, 08:03 PM
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If we can't do what the rest of the modern world can, then we should tell all of the "We're No. 1" people in the US to fuck off forever.
Can you name even one country that has been able to reduce its healthcare spending by 33%?
Shouldn't be hard since rest of the modern world apparently has this ability. Maybe they just haven't done it yet and are waiting for the right time.
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Old 01-08-2020, 08:29 PM
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You know, if something grows at 8% a year and you reduce that to 5% a year, in 15 years you have a 33% difference.

I mean just as an example.
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Old 01-08-2020, 08:37 PM
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It seems to me that if we wanted to reduce health care costs, we'd outlaw insurance companies completely. End of story. Cash for services. Then you eliminate a lot of horrible incentives that drive costs up for people who pay (while, admittedly, making people who don't pay, pay).
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Old 01-08-2020, 09:00 PM
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You know, if something grows at 8% a year and you reduce that to 5% a year, in 15 years you have a 33% difference.

I mean just as an example.
Another example would be if something grows at a pace of 3.03% like the US healthcare per capita spending and you reduce that to the OECD average of 2.68%, then you would have a 33% difference in about 110 years. So it is possible that our grandchildren or great grand children will live to see it.
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Old 01-08-2020, 09:46 PM
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It seems to me that if we wanted to reduce health care costs, we'd outlaw insurance companies completely. End of story. Cash for services. Then you eliminate a lot of horrible incentives that drive costs up for people who pay (while, admittedly, making people who don't pay, pay).
Is your goal cost-cutting, or having a healthier and more productive nation? To cut costs, stop paying for medical services. Let folks buy their own funerals. For a healthier nation:

1) Establish Medicare For All, with premiums paying for basic healthcare at institutionally negotiated rates.
2) Private insurers should sell supplemental coverage to those wanting and affording anything more.

The current USA mix of private and public coverages drives huge overhead, a big factor in high costs here. I read somewhere that Duke University hospital, with 900 beds, has 1300 clerks working on compliance with every requirement. That's nuts. And private medical insurers still net nice profits, shoveled into pockets of shareholders and executives.

Cutting healthcare will lead to a sicker, weaker nation. Whose interests are served?
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Old 01-09-2020, 06:28 AM
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Can you name even one country that has been able to reduce its healthcare spending by 33%?
Can you name even one non-US country who ever spent 33% more than the OECD average on healthcare?
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