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  #451  
Old 01-10-2019, 01:47 PM
ElvisL1ves ElvisL1ves is offline
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They all did, long ago. It worked, too.
  #452  
Old 01-10-2019, 01:56 PM
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No one else has tried either.
Nobody else had to. They got their UHC in before they had a giant problem.

We flush 8-10% of our GDP down the fucking shitter. 8-10% of the GDP thrown at health care that nobody else has to spend.

You want to talk national emergency THAT is an emergency! Hell, I'd give Trump a Great Wall of Gyna down there to get some actual action on this. 2,000 miles of stone and mortar with his fat face puckered up on every tower.
  #453  
Old 01-10-2019, 01:59 PM
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No one else has tried either.

Regards,
Shodan
Solid reason for us to not even try. Shit's broken, let's not try to fix it.
  #454  
Old 01-10-2019, 02:59 PM
Red Wiggler Red Wiggler is offline
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Wait, we can't have UHC because we can't cut the costs we'd need to? Changing to a single payer system is what cuts the fucking costs. JFC, Shodan. That's some circular reasonin' right thar, son.
  #455  
Old 01-10-2019, 03:11 PM
Evil Economist Evil Economist is offline
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Originally Posted by Shodan View Post
No one else has tried either.

Regards,
Shodan
I've said it before, and I'll say it again: the level of intellectual bankruptcy you're demonstrating in this thread is delicious. Your desire to badly argue a point that even you know is wrong has led you to take (and never abandon) the following positions:
  1. Cutting costs by two trillion dollars is somehow a bad thing. "Fiscal conservatism, except if it means I'll lose an argument"
  2. The more expenses you have the harder it is to find places to cut costs. "Cutting out the fat is harder the more fat there is because of the thickness of the fat."
  3. We shouldn't emulate the people who have done the right thing all along, because by doing the right thing they haven't had to face the problems that we have. "Sure, I'm going to jail for stealing, and Gary isn't. But Gary's not a good role model for me because by never stealing he's never had to go to jail."
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  #456  
Old 01-10-2019, 03:32 PM
Shodan Shodan is offline
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At this point it is clear that you are either lying, or engaging in premeditated stupidity, and I am not sure which is worse. Taking your foolishness out of order -

Your figure of $2T in savings is false, as has been mentioned several times. The report says so, since it also says that even a doubling of corporate and personal income tax will not cover the whole cost of M4A, but will instead increase the deficit. Increasing the deficit is not "savings". Ergo, your figure of $2T is wrong - it is a lesser but undetermined amount.

As to 3, by all means let's emulate those societies who have been able to do what the US needs to do. The unfortunate thing is that there aren't any such societies, so we have no one to emulate.

As to 2, M4A is the model currently being suggested as UHC for America. Medicare as it stands causes health care providers to lose money most of the time. Is that an example of the sort of easy cuts you want?

I recognize that you are incapable or unwilling to understand, let alone address, these points in any substantive way. That's a pity, but at least it is clear who is, and who is not, to be taken seriously.

Regards,
Shodan
  #457  
Old 01-10-2019, 03:36 PM
ElvisL1ves ElvisL1ves is offline
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Originally Posted by Shodan View Post
Your figure of $2T in savings is false, as has been mentioned several times. The report says so, since it also says that even a doubling of corporate and personal income tax will not cover the whole cost of M4A, but will instead increase the deficit.
There are a lot of lies being told, yes. Is that not one?

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As to 3, by all means let's emulate those societies who have been able to do what the US needs to do. The unfortunate thing is that there aren't any such societies, so we have no one to emulate.
Except for almost anywhere else.

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Medicare as it stands causes health care providers to lose money most of the time.
So they claim. But there are plenty of providers who do it anyway. Why, d'ya suppose?

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Is that an example of the sort of easy cuts you want?
Hell, yes. Unless your goal is to keep doctors and Big Pharma rich, instead of actually helping people.

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I recognize that you are incapable or unwilling to understand, let alone address, these points in any substantive way. That's a pity, but at least it is clear who is, and who is not, to be taken seriously.
  #458  
Old 01-10-2019, 04:03 PM
Evil Economist Evil Economist is offline
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Your figure of $2T in savings is false, as has been mentioned several times. The report says so, since it also says that even a doubling of corporate and personal income tax will not cover the whole cost of M4A, but will instead increase the deficit. Increasing the deficit is not "savings". Ergo, your figure of $2T is wrong - it is a lesser but undetermined amount.
Oh yes, your brilliant argument that "reducing costs makes the deficit go up." You should repeat it more. You'll convince someone eventually.

I'm going to open a store where we charge you less if you pay with the money in your left pocket than if you pay with the money in your right pocket. I suspect your head would explode while you tried to figure it out.
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  #459  
Old 01-10-2019, 04:59 PM
SlackerInc SlackerInc is offline
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Originally Posted by Railer13 View Post
Actually, it's more like:

EVERYONE ON THE SDMB: "You should lose 200 pounds. My neighbor takes spinach pills every day, and he only weighs 135."
Shodan: "What did he weigh before he started taking spinach pills?"
EVERYONE ON THE SDMB: "He's always weighed 135 pounds, and taking spinach pills is a big reason why. But somehow you cannot understand that concept."
What a terrible metaphor for your case. Do you not realize that staying at 135, what someone has always weighed, is a million times easier than going from 335 to 135 and staying there?
  #460  
Old 01-10-2019, 05:10 PM
Railer13 Railer13 is offline
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What a terrible metaphor for your case. Do you not realize that staying at 135, what someone has always weighed, is a million times easier than going from 335 to 135 and staying there?

One more time.

Shodan has been asking for examples of countries that have reduced their health care costs by 25-40%. Several of us have pointed out, numerous times, that no other country has ever spent as much money as we are currently spending, thus there are no examples of such cost reduction.

Now, if you're saying that reducing our costs will be tough and the lower costs will be hard to maintain, I would agree. But I'm not at all sure that's what you meant.
  #461  
Old 01-10-2019, 05:37 PM
SlackerInc SlackerInc is offline
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Originally Posted by Railer13 View Post
One more time.

Shodan has been asking for examples of countries that have reduced their health care costs by 25-40%. Several of us have pointed out, numerous times, that no other country has ever spent as much money as we are currently spending, thus there are no examples of such cost reduction.

Now, if you're saying that reducing our costs will be tough and the lower costs will be hard to maintain, I would agree. But I'm not at all sure that's what you meant.

What else could I mean?
  #462  
Old 01-10-2019, 06:22 PM
Railer13 Railer13 is offline
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What else could I mean?
OK, so we agree on what you meant.

Now, would you agree that no country has ever had as high of health care costs like we currently have, and thus there are no examples of any country that have reduced their costs by 25-40%?
  #463  
Old 01-10-2019, 09:38 PM
SlackerInc SlackerInc is offline
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OK, so we agree on what you meant.

Now, would you agree that no country has ever had as high of health care costs like we currently have, and thus there are no examples of any country that have reduced their costs by 25-40%?

Of course. Thatís the exact point Shodan and I have been making.
  #464  
Old 01-10-2019, 10:10 PM
Railer13 Railer13 is offline
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Originally Posted by Shodan View Post
Do you have any examples of countries that have reduced their healthcare spending by 25-40%?
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Originally Posted by Railer13 View Post

Now, would you agree that no country has ever had as high of health care costs like we currently have, and thus there are no examples of any country that have reduced their costs by 25-40%?
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Originally Posted by SlackerInc View Post
Of course. That’s the exact point Shodan and I have been making.
So we can stipulate that no other country has ever spent as much on health care as we currently spend.

We can also stipulate that other countries currently spend substantially less than we do and achieve comparable or perhaps even better results.

We can examine what these countries are doing and hopefully implement some or all of those practices in an effort to reduce our health care costs.

But we cannot show an example of a dramatic reduction in costs by another country, because no other country has ever needed to do so at the level that we need to.

Agreed?

Last edited by Railer13; 01-10-2019 at 10:12 PM.
  #465  
Old 01-10-2019, 10:44 PM
SlackerInc SlackerInc is offline
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Something that seems to have gone over people’s heads is that Shodan was quite obviously (IMO) not asking for examples of countries who have slashed medical spending this way because he thought there WERE examples of such. It was a rhetorical move to show that it is unprecedented and therefore we actually do not have any examples to follow. The U.S. is sui generis in this regard, so it’s simply unexplored territory.

We should absoutely try to bend the cost curve. But the notion that since other countries kept their costs down starting 70 years ago (when President Truman tried to do the same but was unfortunately blocked by Republicans in Congress), therefore we can just suddenly slash our spending to match theirs, and we’ll instantly catch up? That’s nuts. We have developed a bloated medical sector over all these decades: if we suddenly chop it in half while expanding coverage, we’ll simultaneously mess up health care delivery AND the wider economy.

A realistic goal would be to try to stop having double-digit percentage growth in health care spending year over year. But that’s a far cry from actually reducing spending while expanding coverage. That’s a pipe dream.
  #466  
Old 01-10-2019, 11:30 PM
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A realistic goal would be to try to stop having double-digit percentage growth in health care spending year over year. But that’s a far cry from actually reducing spending while expanding coverage. That’s a pipe dream.
You're ignoring the fact that the people who don't have coverage are treated - but incredibly inefficiently, with no preventative care, going to the ER only in extremis. And when they can't pay, the providers pass the cost of that treatment on to everyone else. So it's far from a pipe dream that expanding coverage can be achieved while reducing overall spending.

The way you & Shodan are talking about this is eerily reminiscent of the Onion's recurrent commentary on the other major U.S. blindspot.

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Originally Posted by Not The Onion
No way to prevent the cost of our awful healthcare reaching 20% of GDP, says only country where healthcare costs exceed 10% of GDP.

Last edited by Riemann; 01-10-2019 at 11:34 PM.
  #467  
Old 01-11-2019, 01:38 AM
SlackerInc SlackerInc is offline
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You're ignoring the fact that the people who don't have coverage are treated - but incredibly inefficiently, with no preventative care, going to the ER only in extremis. And when they can't pay, the providers pass the cost of that treatment on to everyone else. So it's far from a pipe dream that expanding coverage can be achieved while reducing overall spending.
I used to believe it would work out that way. But Medicaid expansion, including the randomized trial in Oregon, has shown that people actually do get a higher dollar amount of medical treatment when they go from uninsured to covered. Even accounting for the higher cost of ER visits.

We need to get everyone at least basic coverage. But I believe thatís going to cost a shit-ton of money, and we canít just rely on happy talk that isnít any more believable than the Laffer Curve or ďwaste, fraud, and abuseĒ. Arenít we supposed to be better than that? Or would you say thatís just loser talk?
  #468  
Old 01-11-2019, 06:36 AM
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Cheesesteak Cheesesteak is offline
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we canít just rely on happy talk that isnít any more believable than the Laffer Curve or ďwaste, fraud, and abuseĒ. Arenít we supposed to be better than that?
They're not equivalent, because the Laffer Curve is bullshit some asshole wrote on a napkin, and the "happy talk" is what 50 countries are already doing today.

I'm not expecting it to be easy, but to say it's impossible to even approach the cost rates of other countries, without so much as attempting to develop an plan to get there, is nonsense.

We're wasting 8-10% of our GDP and half the politicians in the country don't even want to try to get it back. It's criminal.
  #469  
Old 01-11-2019, 07:27 AM
Gary Kumquat Gary Kumquat is offline
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Itís almost like you canít even ďhearĒ what Iím saying. Try to keep up.
It's almost as if I was replying to Shodan, not you. Try to keep up.
  #470  
Old 01-11-2019, 07:32 AM
Gary Kumquat Gary Kumquat is offline
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Originally Posted by Shodan View Post
More like -

EVERYONE ON THE SDMB: "You should lose 200 pounds. My neighbor takes spinach pills every day, and he only weighs 135."
Me: "What did he weigh before he started taking spinach pills?"
EVERYONE ON THE SDMB: "That's not the point. Why do you hate poor people?"

Regards,
Shodan
In which Shodan demonstrates his capacity for analogy is as bad as his grasp of economics.
  #471  
Old 01-11-2019, 09:07 AM
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In which Shodan demonstrates his capacity for analogy is as bad as his grasp of economics.
And thank ghod for it. I've been hoping someone will beat me out for Worst Analogy Guy for like 17 years.
  #472  
Old 01-11-2019, 09:36 AM
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Ann Hedonia Ann Hedonia is offline
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What a terrible metaphor for your case. Do you not realize that staying at 135, what someone has always weighed, is a million times easier than going from 335 to 135 and staying there?
I think the best analogy is the 350 pound guy that claims it’s IMPOSSIBLE to lose 100 pounds because it’s impossible for a 150 pound guy to lose 100 pounds.

My health care experiences are based on using the doctor and medical practices of a large hospital based healthcare system. IMHO, they schedule a lot of unnecessary appointments to keep their expensive to operate facilities running at full capacity. When I had my cataract surgery, I had to schedule 4 different appointments prior to the surgery and 5 follow-ups, even though there were absolutely no extenuating circumstances or complications. I felt this was ridiculous, and a waste of my time and co-pay money. But you play along because you don’t want to be deemed negligent or uncooperative in case there is a problem.

Of course, that was my second cataract surgery. I only had 2 follow-ups after the first surgery, because the doctor was on vacation for a month. Now if the extra 3 follow-ups had been truly necessary they would’ve had another doctor do them. But they didn’t. But I still had to pay for 5 follow ups after the second surgery.

I’m convinced my medical practice could double their patient load without compromising quality or substantially increasing their costs. As it is now, they milk their existing patients to keep the practice running at full capacity.

Last edited by Ann Hedonia; 01-11-2019 at 09:40 AM.
  #473  
Old 01-11-2019, 09:47 AM
k9bfriender k9bfriender is offline
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I think the best analogy is the 350 pound guy that claims itís IMPOSSIBLE to lose 100 pounds because itís impossible for a 150 pound guy to lose 100 pounds.

My health care experiences are based on using the doctor and medical practices of a large hospital based healthcare system. IMHO, they schedule a lot of unnecessary appointments to keep their expensive to operate facilities running at full capacity. When I had my cataract surgery, I had to schedule 4 different appointments prior to the surgery and 5 follow-ups, even though there were absolutely no extenuating circumstances or complications. I felt this was ridiculous, and a waste of my time and co-pay money. But you play along because you donít want to be deemed negligent or uncooperative in case there is a problem.

Of course, that was my second cataract surgery. I only had 2 follow-ups after the first surgery, because the doctor was on vacation for a month. Now if the extra 3 follow-ups had been truly necessary they wouldíve had another doctor do them. But they didnít. But I still had to pay for 5 follow ups after the second surgery.

Iím convinced my medical practice could double their patient load without compromising quality or substantially increasing their costs. As it is now, they milk their existing patients to keep the practice running at full capacity.
And that is what I have pointed out a few times. A doctor may end up making less per patient, but they will be able to see more patients, both because they have less time devoted to billing and reimbursement, and als because they don't have to choose procedures that pay the most, they just choose the ones that the patient needs.
  #474  
Old 01-11-2019, 09:47 AM
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And thank ghod for it. I've been hoping someone will beat me out for Worst Analogy Guy for like 17 years.
His capacity for analogy is a as bad as an aardvark's pancreas.
  #475  
Old 01-11-2019, 09:50 AM
Shodan Shodan is offline
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So we can stipulate that no other country has ever spent as much on health care as we currently spend.
Yes.
Quote:
We can also stipulate that other countries currently spend substantially less than we do and achieve comparable or perhaps even better results.
Yes.
Quote:
We can examine what these countries are doing and hopefully implement some or all of those practices in an effort to reduce our health care costs.
Yes - as long as we remember that none of those practices have reduced health care costs. So simply pointing to another country and saying that they are an example of what the US needs to do does not address the elephant in the room.
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But we cannot show an example of a dramatic reduction in costs by another country, because no other country has ever needed to do so at the level that we need to.

Agreed?
Yes.
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Originally Posted by ElvisL1ves View Post
There are a lot of lies being told, yes. Is that not one?
No, it is not a lie. It's what the report says. It has been cited repeatedly, and Shodan's Law applies - you won't read it or understand it or address it if it is cited again, even if it is cut and pasted in front of you.
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Except for almost anywhere else.
No, that is not an exception. Nowhere else has a country implemented dramatic cuts to health care spending.
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So they claim.
It sounds like you don't believe the claim. That claim has already been cited, Citing it again won't help.

Regards,
Shodan
  #476  
Old 01-11-2019, 09:52 AM
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And that is what I have pointed out a few times. A doctor may end up making less per patient, but they will be able to see more patients, both because they have less time devoted to billing and reimbursement, and als because they don't have to choose procedures that pay the most, they just choose the ones that the patient needs.
They also won't need a team of administrators to handle one doctor's billing.
  #477  
Old 01-11-2019, 10:20 AM
Shodan Shodan is offline
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What a terrible metaphor for your case. Do you not realize that staying at 135, what someone has always weighed, is a million times easier than going from 335 to 135 and staying there?
Yes, it's much easier.

The other issue is that there are examples of people who have lost hundreds of pounds, and a few of them have even kept it off. It's very difficult and unpleasant, but in theory it can be done. There are no examples of countries who have made the cuts to health care spending that are being proposed - it's never been done.

Therefore the analogy of "just deal with the problem by doing something that people do who never had the problem" misses the point.

If we want to cut health care costs, we need to cut health care spending. How do we address that question? Do we lie about it, the way Evil Economist and Barack "the average family will see its premiums go down by $2500 a year" Obama did? Do we change the subject the way others in this thread seem to want to do?

Do we do what Sanders and Ocasio-Cortez do, and say "let's just do it"? OK - let's see you make the case, without lying, without changing the subject, actually addressing the fact that cuts are necessary. Make the case - to liberals, to people who already have insurance, to people already covered by Medicare, to people who are going to see their taxes go up, to doctors and nurses and technicians and hospitals, to pharmaceutical companies, to conservatives and Trump voters and - most especially - to those who are not already convinced.

Something for nothing sounds great. The same health care for less money overall sounds great. Maybe you can convince doctors to take one for the team and have their income reduced by a quarter, or patients to accept being told "No, you can't see a specialist" or "sorry, the doctor isn't accepting any new patients" or "here's your prescription - it was manufactured in China after it went off patent. It's probably OK".

Saying "but Canada!" doesn't do any of those things.

Regards,
Shodan
  #478  
Old 01-11-2019, 10:22 AM
Shodan Shodan is offline
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Originally Posted by k9bfriender
And that is what I have pointed out a few times. A doctor may end up making less per patient, but they will be able to see more patients, both because they have less time devoted to billing and reimbursement, and als because they don't have to choose procedures that pay the most, they just choose the ones that the patient needs.
Then why do doctors lose money on Medicare patients?

Regards,
Shodan
  #479  
Old 01-11-2019, 10:29 AM
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Therefore the analogy of "just deal with the problem by doing something that people do who never had the problem" misses the point.
Your argument is a transparent logical fallacy. Since nowhere has ever had healthcare costs this high, there is no precedent for any subsequent sequence of events. Sure, there is no precedent for healthcare costs reducing from 18% of GDP. There is also no precedent for healthcare costs increasing from 18% of GDP. Nor is there any precedent for healthcare costs remaining the same at 18% of GDP.

Are we to conclude that none of these things could possibly happen?

In fact, every other country in the world has the exact same problem - caring for people who are sick. They all do it much better, and it's preposterous to claim that we are doomed by "lack of precedent" or something to remain the worst in the world at this. Pick a country, any country, and do what they do. The burden is on you to explain why on earth that's so inconceivable.

Last edited by Riemann; 01-11-2019 at 10:34 AM.
  #480  
Old 01-11-2019, 10:52 AM
ElvisL1ves ElvisL1ves is offline
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Yes - as long as we remember that none of those practices have reduced health care costs.
Again, compared to what? They all did it long ago. Why is that so hard to grasp?
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So simply pointing to another country and saying that they are an example of what the US needs to do does not address the elephant in the room.
The elephant in the room is the US itself. It needs to lose weight, not everyone else.

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No, it is not a lie. It's what the report says.
You've never seen a report, produced by people with an agenda, lie before? How sheltered are you?

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Nowhere else has a country implemented dramatic cuts to health care spending.
No one else has ever been nearly as obese, have they?
  #481  
Old 01-11-2019, 12:56 PM
Shodan Shodan is offline
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Originally Posted by Riemann View Post
Your argument is a transparent logical fallacy.
No it isn't.
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Since nowhere has ever had healthcare costs this high, there is no precedent for any subsequent sequence of events. Sure, there is no precedent for healthcare costs reducing from 18% of GDP. There is also no precedent for healthcare costs increasing from 18% of GDP. Nor is there any precedent for healthcare costs remaining the same at 18% of GDP.
All correct.
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Are we to conclude that none of these things could possibly happen?
Incorrect. Obviously.
Quote:
In fact, every other country in the world has the exact same problem - caring for people who are sick. They all do it much better, and it's preposterous to claim that we are doomed by "lack of precedent" or something to remain the worst in the world at this.
Good thing I never said that, isn't it?

Unless you want to read "we need to cut health care costs" as saying "we can't cut health care costs", in which case there is no hope for you.
Quote:
Pick a country, any country, and do what they do.
OK, I pick Canada. How will adopting Canada's model allow the US to reduce its health care spending?

As I said above, make your case. What cuts are we going to make, where will we make them, and how will you get doctors and nurses and technicians and hospitals and drug companies and people currently on Medicare and people with private insurance and everybody else to accept them? Please be specific.

Regards,
Shodan
  #482  
Old 01-11-2019, 01:25 PM
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America is being asked to do something that has never been done with any success in any country - namely, cut health care spending very substantially.
You argue without justification that the first derivative of healthcare costs are the best predictor of their future path. Why on earth is that more relevant than the level of healthcare costs, especially when they are double what they are everywhere else in the world? Your logic is like a naive Bitcoin investor - it has always gone up in the past, so it must always continue to go up; valuation metrics are irrelevant.

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Originally Posted by Shodan View Post
Is it your argument that, if the US implements M4A/UHC/single payer, that the US will be able to reduce health care costs and save money? If so, can you cite an example of another country that implemented single payer/UHC/M4A or its equivalent, and reduced health care costs to less than what they were before they implemented single payer/UHC?
Again, an argument based on the first derivative of healthcare costs, rather than their absolute level.

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Originally Posted by Shodan View Post
As I said above, make your case. What cuts are we going to make, where will we make them, and how will you get doctors and nurses and technicians and hospitals and drug companies and people currently on Medicare and people with private insurance and everybody else to accept them? Please be specific.
I'm not going to argue specifics with you unless you justify the basis for your position that it is impossible for America to achieve an outcome that's closer to what every other country in the world has done. Pretty much every other developed nation has some form of universal healthcare at less than half the cost of the U.S., with substantially better outcomes. Yet with dozens of model systems to pick from, you think it's impossible for the U.S. to implement UHC without even (say) a 10% reduction from current total expenditure?

Why can't we do what Canada does? If you're going to throw realpolitik obstacles in the way, then it's a self-fulfilling argument that it "can't" happen. If we don't have the will to do something, then of course we won't, just like gun control. But don't conflate unwillingness to do something with impossibility.

Last edited by Riemann; 01-11-2019 at 01:27 PM.
  #483  
Old 01-11-2019, 01:40 PM
Gary Kumquat Gary Kumquat is offline
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OK, I pick Canada. How will adopting Canada's model allow the US to reduce its health care spending?
The same way it allows every other country that operates universal health care to do so. Market forces - you know, those things you're meant to be in favour of.

Right now, you're being played like an absolute fucking chump. You raise more money per head for healthcare on taxes than any other, but you don't bother to use that huge purchase power to command the best deal. Seriously, for a supposed right wing capitalist, you suck at this.

Instead you turn around to the market, and advise them that as the biggest game in town you're expecting them to sharpen their pencils if they want some of YOUR money. Buyers market, old man. This is capitalism 101 shit. It's almost embarrassing that you need a European to explain this.

Explain firmly, but gently, that advertising for pharmaceuticals aimed at the general market is banned. Honestly, why do you think that an advert is a good basis for you to suggest to your doctor the drug you need? Tell the market what you'll pay for drugs...you can even copy the pricing structures other countries have agreed that somehow Pharmco manages to turn a profit at. Have a little think about the current mechanisms where companies can evergreen patents for medication.
  #484  
Old 01-11-2019, 01:49 PM
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Seriously, for a supposed right wing capitalist, you suck at this.

Instead you turn around to the market, and advise them that as the biggest game in town you're expecting them to sharpen their pencils if they want some of YOUR money. Buyers market, old man. This is capitalism 101 shit. It's almost embarrassing that you need a European to explain this.
The Republicans would have you believe that as the largest and most diverse health care market in the world, we are simply unable to negotiate as good a deal as the smaller, more monolithic markets in Europe or Asia.

Of course, they also think Trump is a good negotiator.
  #485  
Old 01-11-2019, 02:01 PM
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Then why do doctors lose money on Medicare patients?

Regards,
Shodan
Is your claim here is that doctors expend more resources on medicare patients than they get reimbursed for? If so, please cite.

Last edited by k9bfriender; 01-11-2019 at 02:02 PM.
  #486  
Old 01-11-2019, 02:03 PM
Gary Kumquat Gary Kumquat is offline
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The Republicans would have you believe that as the largest and most diverse health care market in the world, we are simply unable to negotiate as good a deal as the smaller, more monolithic markets in Europe or Asia.
That really does appear to be Shodan's position.

"They make so much profit of us, there's no way we can stop spending so much on it"

It's right up there with the way republicans embrace socialist principles when it comes to military expenditure for sheer cognitive dissonance.
  #487  
Old 01-11-2019, 02:17 PM
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It's right up there with the way republicans embrace socialist principles when it comes to military expenditure for sheer cognitive dissonance.
Yup, socialist defense, funded out of taxes. It's the kind of thing you'd expect from Scandinavians or the French.
  #488  
Old 01-11-2019, 02:52 PM
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I'm not going to argue specifics with you unless you justify the basis for your position that it is impossible for America to achieve an outcome that's closer to what every other country in the world has done.
I don't hold that position, and have not stated that it is my position. No justification is necessary.

Now that we have cleared that up, feel free to argue specifics.

This strikes me as a dodge. You won't justify your position until I justify a position I don't hold.
Quote:
Why can't we do what Canada does?
We could indeed do what Canada does. Will this involve cuts to health care spending? Where will the cuts be made, how much will we cut, and how do you propose to persuade all the groups I mentioned to accept the cuts?

Regards,
Shodan
  #489  
Old 01-11-2019, 03:08 PM
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We could indeed do what Canada does.
Glad we got that settled.
Quote:
Will this involve cuts to health care spending?
Does Canada spend less than we do?
Quote:
Where will the cuts be made, how much will we cut, and how do you propose to persuade all the groups I mentioned to accept the cuts?
Since you have suggested that we can do what Canada does, then you should already know the answers to these questions.


The non-snarky reality is that the work effort to get us from US ---> Canada (or whatever other UHC plan we crib from) is SUBSTANTIAL.

If I suggested that we should build a new train tunnel from NYC to NJ, and we all agreed that it was a reasonable transit plan, and likely a manageable engineering project (since we have multiple tunnels already), asking me exactly where the entrances will be, and how we're going to get permission to dig is not a productive line of questioning. Those are details that need to be worked out, MUST be worked out for the plan to be successful, demanding those details before the work is done to actually plan the thing is ridiculous.

The amount of care and work that needs to be done to plan the redirection of 8% of our nation's GDP away from one industry and into other industries is HUGE. None of that work can be done until we have a consensus to do the job, and have both sides of the aisle interested in getting to the end. Right now, we have one half interested in fixing the problem, and one half interested in sabotaging whatever plan is attempted.
  #490  
Old 01-11-2019, 03:29 PM
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I don't hold that position, and have not stated that it is my position. No justification is necessary.

Now that we have cleared that up, feel free to argue specifics.
This is disingenous. If you agree that a Canadian-style system is possible, then we have no argument of principle, do we? If you're sincere about your claim that you do agree it's possible, then this debate should be restarted in a new thread entitled "We all agree that Canadian-style UHC is the objective. What's the most efficient technical implementation for a transition?".

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We could indeed do what Canada does. Will this involve cuts to health care spending? Where will the cuts be made, how much will we cut, and how do you propose to persuade all the groups I mentioned to accept the cuts?
If you agree on the principle, what are you suggesting hinges on these specifics? Of course reducing expenditure from 18% of GDP to (say) 15% would involve economic pain for vested interests who profit from the profligacy of the current system. But if, as you claim, you accept that it's perfectly possible to do what every other country does - provide better health outcomes more efficiently with UHC funded from general taxation - then the only real obstacle is the political will to do so.

Ultimately, your argument can only circle back to the same thing. We can't do what every other country on earth has proven is possible.

Last edited by Riemann; 01-11-2019 at 03:34 PM.
  #491  
Old 01-11-2019, 04:54 PM
SlackerInc SlackerInc is offline
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No one else has ever been nearly as obese, have they?

This is the point! We are talking about a metaphorical world where only one person is obese, and no one has ever been able to lose weight. So to say that the one obese person can just do what the others do does not make sense.
  #492  
Old 01-11-2019, 05:09 PM
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This is the point! We are talking about a metaphorical world where only one person is obese, and no one has ever been able to lose weight. So to say that the one obese person can just do what the others do does not make sense.
I've already pointed out the two rather obvious logical fallacies to this line of reasoning.

The first is that you are arguing that precedent for the first derivative of the value is more relevant than the value itself. Why should that be so? Even though US healthcare costs at least double what it costs in any other country (for worse results), you're arguing that the rate of change must always be positive simply because the historical rate of change has always been positive. That's analogous to arguing that Bitcoin must always continue going up because it has always gone up in the past, regardless of any valuation metric.

The second fallacy is that you're claiming that since nobody has ever been in this condition before (obsese), there is no precedent for a specific subsequent set of events (losing weight). But if nobody has been in this condition before, there is no precedent for any subsequent set of events. No country has ever spent 18% of GDP on healthcare. So there's no precedent for subsequent healthcare costs subsequently falling to 16%; but there's also no precedent for them rising to 20%, and no precedent for them remaining unchanged. Does that imply that none of these things can happen?

Last edited by Riemann; 01-11-2019 at 05:12 PM.
  #493  
Old 01-11-2019, 05:13 PM
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This is the point! We are talking about a metaphorical world where only one person is obese, and no one has ever been able to lose weight. So to say that the one obese person can just do what the others do does not make sense.
The fat person can lose weight. The skinny people cannot.

How is that an argument that the fat person should actually resist going on a diet?
  #494  
Old 01-11-2019, 05:28 PM
Evil Economist Evil Economist is offline
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Do we lie about it, the way Evil Economist ... did?
Yeah, I'm a fan of the big lie. Specifically, I like to claim that if the cost of something goes down you don't have to pay as much for it. Shodan, demonstrating his oft-discussed intellect, saw the logical inconsistency immediately.
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  #495  
Old 01-11-2019, 05:31 PM
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Yeah, I'm a fan of the big lie. Specifically, I like to claim that if the cost of something goes down you don't have to pay as much for it. Shodan, demonstrating his oft-discussed intellect, saw the logical inconsistency immediately.
Are you suggesting nobody has any Regard for Shodan's intellect?
  #496  
Old 01-11-2019, 07:00 PM
SlackerInc SlackerInc is offline
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You argue without justification that the first derivative of healthcare costs are the best predictor of their future path.

I have very specifically not argued that. I have in fact said I think we can and should reduce the rate of increase, which maps to the first derivative. You are arguing for making that first derivative not just smaller but negative, and in fact a negative number with a very large absolute value over a short period of time, and you don’t really have any evidence for what that would do to health care delivery and to the U.S. and global economy, because there is no precedent for it.

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Originally Posted by Riemann View Post
Pick a country, any country, and do what they do.

No. This is either incredibly naive, or disingenuous.

Here’s what I would consider a better analogy, in part because it actually does involve decades of growth (managed vs. not) and public policy.

Are you familiar with the Urban Growth Boundary (UGB) in Portland Oregon? The UGB was a wonderful progressive policy begun nearly a half century ago. The result has been an avoidance of the kind of sprawl seen in other metro areas. Areas outside the UGB line are still green, and the areas inside the line are more carefully utilized, avoiding the kind of “hollowing out” we see in a place like St. Louis, where there are a lot of abandoned warehouses and weedy vacant lots.

So let’s imagine the electorate of the state of Missouri became progressive enough that they wanted to emulate Oregon (this is a stretch as things currently stand, but let’s just go with it for the sake of argument). What you are doing is the equivalent of such a Missouri government declaring “We want to make St. Louis just like Portland, so we’ll just ‘do what they do’ and it will be all taken care of, simple as that.”

But of course in reality you could draw a line on the map around St. Louis and it wouldn’t magically eliminate all the subdivisions and strip malls outside that line, not to mention all the highways and surface roads and other infrastructure. Would you go in there and tear all that stuff down, bulldoze it, and start planting trees in its place? Where would all those people go? What about all the jobs at those shopping centers? Who is going to pay for the massive cost of trying to retrofit a sprawled-out metro area to make it like Portland?

What I would argue is that you can put a UGB around the extent of St. Louis’s current metro and in so doing prevent it from being even worse in another fifty years. And you can work on incentives to make people “fill in” residential space inside that UGB, maybe even slowly offer incentives for the furthest exurbs to convert to being “greener”. But you can’t just “do what Portland does” and get the same thing now that they only have as a result of a long process of making smart urban planning choices since 1973. In a way, it would be kind of unfair if you could, right? Portland and Oregon kind of deserve to have something better as a result of good foresight, don’t they?

Last edited by SlackerInc; 01-11-2019 at 07:02 PM.
  #497  
Old 01-11-2019, 08:40 PM
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...No. This is either incredibly naive, or disingenuous.

Here’s what I would consider a better analogy, in part because it actually does involve decades of growth (managed vs. not) and public policy.

Are you familiar with the Urban Growth Boundary (UGB) in Portland Oregon?...
What was the point of that diatribe? As an example of "two things that are not the same"? Good grief, what a ridiculous straw man. Why not just go with an apple and an orange, it would have been quicker.

If only one country - say Italy - had cheaper healthcare, while most other countries were similar to the U.S., then your analogy might be apt - perhaps Italy really is quite different from the U.S., and "just copy the Italy model" might be naive. But every other country has better healthcare for half the price or less - in a huge variety of countries, with many different implementations of UHC. The U.S. is certainly not so fundamentally different from every other country on earth that our healthcare must be twice as expensive for worse outcomes. We are just doing it wrong.

Of course I don't mean literally just pick any country at random and copy them naively. My comment was a rhetorical response to the constant special pleading that any kind of change in the U.S. won't work, or the ridiculous claims that UHC funded from general taxation will make healthcare more expensive. The point is - other countries have proven records of doing this better than us, and our general approach should be to study and learn from other countries, figure out how their systems work, and apply those lessons to the U.S.

Last edited by Riemann; 01-11-2019 at 08:44 PM.
  #498  
Old 01-11-2019, 09:36 PM
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I find your logic not only unconvincing but kind of bizarre. For a country to be the only one to successfully do something often only means it’s first. Someone was the first to expand suffrage to women, someone was the first to mandate a minimum wage, etc. It is THAT situation where the presumption should be that others can emulate it. Yet you say that’s the one where you might throw up your hands and say “I guess only they can do it”?!? WTF

My analogy with urban sprawl and a UGB is not apples and oranges. It is actually quite apt. Decades ago, progressives saw that a system was growing in a huge, ugly, chaotic way that had negative externalities and wasted resources. They reined it in and kept a cap on growth that has made their system quite different and superior today from one where the growth was left to go unchecked. Now, tell me: am I talking about the UGB, or the NHS? It could be either.
  #499  
Old 01-11-2019, 09:41 PM
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I find your logic not only unconvincing but kind of bizarre. For a country to be the only one to successfully do something often only means it’s first. Someone was the first to expand suffrage to women, someone was the first to mandate a minimum wage, etc. It is THAT situation where the presumption should be that others can emulate it. Yet you say that’s the one where you might throw up your hands and say “I guess only they can do it”?!? WTF.
So if only one other country had already successfully implemented UHC funded by general taxation successfuly, for half the cost and with better outcomes, you'd be willing to try it in the U.S. But when nearly all other countries have done it.... you're adamant that it won't work here?

And you claim my reasoning is bizarre?

Last edited by Riemann; 01-11-2019 at 09:42 PM.
  #500  
Old 01-12-2019, 12:13 AM
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So if only one other country had already successfully implemented UHC funded by general taxation successfuly, for half the cost and with better outcomes, you'd be willing to try it in the U.S. But when nearly all other countries have done it.... you're adamant that it won't work here?

Straw man.


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Originally Posted by SlackerInc View Post
We need to get everyone at least basic coverage. But I believe thatís going to cost a shit-ton of money

I'm adamant that we can't just adopt another country's system this late in the game and expect that it will get our costs down to parity with theirs. (If only a single country had done it, it would presumably be a fairly recent change and therefore "emulateable" in the same form.)

I'm not adamant that we can't have a universal health care entitlement here. I believe it is a human rights imperative that we do. But we need to be more realistic about the cost and therefore aim for a more modest scale. A HDHP/HSA entitlement would be far more affordable, less disruptive, and would not spur most people to use a lot more medical services. And it would not mess with people who have more generous health coverage through their employers.
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