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  #51  
Old 12-05-2018, 08:26 AM
survinga survinga is offline
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Originally Posted by JcWoman View Post
Another issue with our current system that is under-appreciated (IMO) is what I recently had driven home - our health care insurance really REALLY needs to be disconnected from employment. I have pretty good insurance through my employer, as do many millions of people. But I recently changed jobs, which resulted in (long story short) having to go 7 FULL weeks without my doctor-prescribed medication for my arthritis. I got by, barely, with over the counter Alleve, but it was not fun and my pain levels still made it hard for me to sleep well.

We should NEVER have an interruption in our medical care simply because we change jobs.
Sorry to hear that. Did you have Cobra? I agree with you, by the way. There are a lot of holes to plug in situations where people move between states or change jobs. In your case, what exactly caused the 7 weeks? Were you without any coverage at all, or was there a problem with just your arthritis meds?
  #52  
Old 12-05-2018, 08:38 AM
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Originally Posted by Ann Hedonia View Post
Pre ACA, there was some low cost “insurance” that was sold mostly to low income hourly employees through major employers. For around $100 a month you got doctor visits with a small copay,free eye exams and glasses and all sorts of routine healthcare.

And these were among the plans that were eliminated with the ACA. And most of the people that had those plans loved loved loved them. But the catch is that these plans had a ridiculously low yearly maximum benefit of around $2000. I believe that they may have originally been designed as a bridge plan to be used in conjunction with a real insurance plan to cover the deductible.

But people that had never really gotten sick and hadn’t read the fine print honestly thought they had awesome insurance that had been taken away from them. Even though these plans weren’t even technically allowed to be called insurance. Because they didn’t provide any.
That was one of the good things about the ACA. It standardized to some extent what plans could offer. In any event, the ACA did tremendous good on many fronts, including putting limits on these small-a** plans.
  #53  
Old 12-05-2018, 08:49 AM
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Sorry to hear that. Did you have Cobra? I agree with you, by the way. There are a lot of holes to plug in situations where people move between states or change jobs. In your case, what exactly caused the 7 weeks? Were you without any coverage at all, or was there a problem with just your arthritis meds?
I didn't use COBRA because I had no gap in coverage. The delay in getting my medication was entirely dealing with the bureaucracy. The new insurance plan required a new prescription, then a prior-authorization, delays from mis-communicating with my doctor's office which I had to intervene to get corrected, and internal processing time for both of those, then they forced my medication over to their specialty pharmacy because it's on their Tier 3 list so there were more delays while the specialty pharmacy worked through it's internal bureaucracy....

...ending with a final 4-day delay because when I was finally able to schedule the shipment (they will only mail the meds to you), nobody at the specialty pharmacy informed me of that fact until I called THEM (for the seventh time).

I actually posted about this experience a couple weeks ago in the Pit forum, because I needed to rant. Several people with diabetes or diabetic family members chimed into the thread to say that they encounter this exact problem with their insulin. Going without my meds is extremely inconvenient and aggravating. Theirs is life-threatening. And this is when you have "good" insurance!

Last edited by JcWoman; 12-05-2018 at 08:51 AM.
  #54  
Old 12-05-2018, 08:52 AM
survinga survinga is offline
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No it's not. Look, the USA isnt Denmark, a tiny Euro nation. What works for many other nations doesn't work on the grand scale of the USA.

That doesnt mean we can't watch and learns but honestly saying "well, 12 other nations that I have cherrypicked out of a list of 200 do it like that, so that must be the very best way." Is just as bad.

I am in favor of single payer, but telling me Denmark has it ain't gonna win me over. What works for a nation of 5 Million, isn't necessarily a good plan for 300 million.
The one area where America is extremely different than other countries is politics. We have a political party that is against doing anything even remotely single-payer.

So, when people argue for single-payer in the US, they do so essentially by waving a magic wand in the political sphere. You can't get single-payer in this country. It will never happen. And wishing it so is basically a fantasy.

And all of the above is why we should stick with our basic system we have in place, and embrace incremental changes at the state level complimented by incremental fixes to the ACA. The authors of the ACA knew what they were doing, and put something in place that we can build on to help finalize the achievement of UHC as well as tightening on the costs front.
  #55  
Old 12-05-2018, 08:57 AM
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Originally Posted by JcWoman View Post
I didn't use COBRA because I had no gap in coverage. The delay in getting my medication was entirely dealing with the bureaucracy. The new insurance plan required a new prescription, then a prior-authorization, delays from mis-communicating with my doctor's office which I had to intervene to get corrected, and internal processing time for both of those, then they forced my medication over to their specialty pharmacy because it's on their Tier 3 list so there were more delays while the specialty pharmacy worked through it's internal bureaucracy....

...ending with a final 4-day delay because when I was finally able to schedule the shipment (they will only mail the meds to you), nobody at the specialty pharmacy informed me of that fact until I called THEM (for the seventh time).

I actually posted about this experience a couple weeks ago in the Pit forum, because I needed to rant. Several people with diabetes or diabetic family members chimed into the thread to say that they encounter this exact problem with their insulin. Going without my meds is extremely inconvenient and aggravating. Theirs is life-threatening. And this is when you have "good" insurance!
I have an insulin-dependent member in my family, and this would be deadly if it happened to us. Glad to know you got your own situation resolved. But yes. It's inexcusable to have this. I think there are situations like these that are "gaps" in the healthcare quilt of the US, that need to be dealt with.
  #56  
Old 12-05-2018, 09:56 AM
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No it's not. Look, the USA isnt Denmark, a tiny Euro nation. What works for many other nations doesn't work on the grand scale of the USA.
Scale is supposed to make things cheaper.

Is it harder to set up a a system for 300 million (USA) than it is for 300 thousand (Iceland)? Of course it is, but it's not 1,000x harder. We have 1,000x the resources at our disposal to make it happen, and 1,000x the market share to push around whoever we need to, in order to get our costs in line.

I have been involved in pricing, on the finance side, for over 20 years. Big customers ALWAYS press for better prices than small customers, and they pretty much always get it. Except here.
  #57  
Old 12-05-2018, 10:26 AM
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Originally Posted by septimus View Post
The ratio of U.S. healthcare spending per capita to Italy's is not 3 to 1; it is 3½ to 1. Cite. Per capita U.S. healthcare spending is twice that of Netherlands but Netherlands has average yearly compensation for specialists of $253,000 compared with $230,000 in U.S. Cite.

And please remember that "per capita" spending numbers reflect division by all the people in a country whether insured or not. If the denominator in the U.S. arithmetic excluded people who lack proper access to health care, the U.S. figures would be even more out-of-line with the rest of the world. (Some of the extra U.S. spending is for insurance clerks whose job is to deny healthcare to some Americans.)

Finally, is anyone talking about slashing U.S. healthcare spending by a whopping 66%? To the contrary, in another thread the worry is about a $32 Trillion increase(!). If the anti-UHC forces cannot decide whether it is a huge increase or a huge decrease in healthcare spending that most concerns them, I'm afraid it's hard to take them seriously.
The OP was talking about slashing healthcare spending by 66%. He said the only reason that US healthcare costs are not what Italy's are is leeches.
  #58  
Old 12-05-2018, 10:36 AM
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Originally Posted by Quartz View Post
Economies of scale kick in, and preventative care saves huge amounts in the long run.



Are you looking at gross salary or net income? Because under UHC nurses and doctors don't have the high insurance costs associated with practising in the US. Student loans are covered, for instance, for doctors taught in the UK. There's no need to pay for healthcare insurance either.
The US is so big that many health insurance systems are larger than other countries populations. Medicare has more recipients than the population of Canada, Medicaid has more people on it than the populations of the UK, France, or Italy. If economies of scale mattered the US would have much cheaper health care than the rest of the world.

Preventative care only saves money on an individual level, system wide preventative care costs money. One of the reasons the US spends so much on healthcare is there is so much preventative care.

Malpractice insurance costs physicians 3.2% of revenue. Switching to a system like New Zealand would be a great idea but the amount of cost saving would be small. Since doctors and nurses make well above median income, any switch to government payed healthcare would mean their taxes would skyrocket and more than make up for any savings not having to pay for health insurance.
  #59  
Old 12-05-2018, 11:06 AM
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Originally Posted by wolfpup View Post

As Grim Render notes in post #17, this first of all attributes a greatly disproportionate part of the costs to salaries. Moreover, most doctors in private practice don't generally have "salaries", they have fees which generate income, and the income comes from the difference between fees and expenses. No doctor could reasonably object to lower fees if their expenses are correspondingly lower, because they don't have to maintain an army of clerical staff to do massive amounts of insurance paperwork and chase insurance companies for payment, which often seems like trying to get blood out of stone. This is a central part of the efficiency of single payer.

No, just no. Regarding medical bankruptcies in the US, your cite is behind a paywall so provides zero information, but here is a whole set of articles on the subject including a summary of the one you cited. What one can conclude from these papers (as indeed Snopes did when they tried fact-checking some of this stuff) is, for one thing, that this is a complicated and controversial area in which each side has been trying to spin their own view of the statistics. However, it's self-evident that if you have serious health problems and your insurance won't pay (don't tell us this doesn't happen a lot), or you don't have insurance, or are faced with huge deductibles and co-pays, that you will encounter potentially major financial issues. These are things that simply can't happen under UHC, such as in Canada, notwithstanding your misleading cite.

The basic fact of the matter is that in Canada, nobody is forced to choose between treatment and bankruptcy. No one is forced to choose between health care and feeding their family. But these are constant ongoing challenges for millions in the US. As for your cite, it doesn't say what you claim it does. It says that 15% of bankruptcies in Canada for those over 55 are attributed to medical reasons -- that is, health reasons, a category which notably includes factors like the inability to work, and the costs of lifestyle changes unrelated to actual health care. This is why conservative organizations like the Fraser Institute misleadingly cite the simple statistic of higher personal bankruptcies in Canada, without mentioning that they're talking about bankruptcies from all causes, and also forgetting to mention that personal bankruptcies -- which are essentially a protective mechanism for the filer -- are much harder to get in the US than in Canada. So the whole argument you're making is just misleading spin.
I do not attribute most of the difference in spending to salaries, just said that in order to meaningfully cut healthcare spending healthcare salaries would need to cut. To get anywhere near Italy's spending they would need to be cut drastically. The idea that the only cut needed to healthcare spending is paperwork and insurance is a myth. In order to actually get healthcare costs in line with the rest of the world, there needs to be cuts in salaries, cuts in administration, less use of specialists, less use of technologies, and fewer drugs prescribed. Each of these changes will be difficult to achieve.

Here is a non gated version. Here is a summary. It finds that less than 5% of bankruptcies are due to hospital bills. Most of the bankruptcies in the US attributed to medical bills are because of a loss of work. This is the same reason as in every other country. More people go bankrupt in the US than the rest of the world mostly because we have the most generous bankruptcy laws in the world. When the rules for bankruptcies were tightened in 2005 bankruptcies fell by 90%, which is unlikely to mean everyone suddenly got healthier.
  #60  
Old 12-05-2018, 12:41 PM
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Originally Posted by puddleglum View Post
I do not attribute most of the difference in spending to salaries, just said that in order to meaningfully cut healthcare spending healthcare salaries would need to cut. To get anywhere near Italy's spending they would need to be cut drastically. The idea that the only cut needed to healthcare spending is paperwork and insurance is a myth. In order to actually get healthcare costs in line with the rest of the world, there needs to be cuts in salaries, cuts in administration, less use of specialists, less use of technologies, and fewer drugs prescribed. Each of these changes will be difficult to achieve.

Here is a non gated version. Here is a summary. It finds that less than 5% of bankruptcies are due to hospital bills. Most of the bankruptcies in the US attributed to medical bills are because of a loss of work. This is the same reason as in every other country. More people go bankrupt in the US than the rest of the world mostly because we have the most generous bankruptcy laws in the world. When the rules for bankruptcies were tightened in 2005 bankruptcies fell by 90%, which is unlikely to mean everyone suddenly got healthier.
What this tells me is that you didn't even glance at the cite I provided, and apparently didn't read what I wrote carefully enough to comprehend it, since you appear to be repeating yourself. The "Economic Consequences of Hospital Admissions" article that you think is such a decisive refutation is right there in my own cite, as the second featured article. I've already explained and cited why placing undue emphasis on those kinds of narrow micro-analyses are irrelevant spin.

The big picture is not complicated: in a very fundamental sense, the US health care system makes individuals directly responsible for the financial costs of their health care, whether it's covered by insurance or not, whether the insurance is subsidized by their employer or not; no matter how you cut it, the cost of health care one way or another comes out of individual resources because either the individual or their employer has to pay for their insurance, their insurance has to be convinced to provide coverage in each and every specific case -- which they sometimes may refuse to do -- and the individual himself has to kick in his own money. Because of this fundamental fact, it's extremely easy for an individual to become saddled with overwhelming and potentially catastrophic health care bills in the case of serious and/or chronic illness. This is not a matter of surprise or debate.

And to repeat, since you seem to have missed it, in Canada nobody is ever forced -- ever -- to choose between medical treatment and bankruptcy or financial ruin. Instead of individuals being directly responsible for the financial costs of their health care, the costs of their health care are entrenched in national policy and culture as fundamentally a shared communal responsibility, a citizen's entitlement from the common wealth. No one ever faces catastrophic medical bills because he got sick, or indeed typically any medical bills at all. No one is forced to choose between health care and feeding their family. This is not a matter of surprise or debate, either.

Last edited by wolfpup; 12-05-2018 at 12:43 PM.
  #61  
Old 12-05-2018, 02:16 PM
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Originally Posted by puddleglum View Post
T
Preventative care only saves money on an individual level, system wide preventative care costs money. One of the reasons the US spends so much on healthcare is there is so much preventative care.
From here

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According to the CDC, chronic diseases that are avoidable through preventive care services account for 75 percent of the nation’s healthcare spending and lower economic output in the US by $260 billion dollars a year. If everyone in the country received recommended clinical care, then the healthcare system could save over 100,000 lives a year.
So, if you are considering healthcare costs only, preventive care may not save a lot. If you count the economy as a whole, it does save a lot. Not counting reduction of suffering.

BTW, this blog from the UK notes that some preventive services might reduce income for providers by being cheaper.
It also notes
Quote:
We do not actually know what the whole health and social care system currently spends on prevention. A figure of 4-5% is typically quoted for England, which roughly reflects the money spent on the public health grant as a proportion of total government spending on health.
5% is hardly nothing. The blog calls for more, but along the lines of trying to reduce obesity, not basic things like checkups and vaccination. I couldn't find what we spend in the US for prevention, I did find an article saying that people don't make use of available services now.

Quote:
Malpractice insurance costs physicians 3.2% of revenue. Switching to a system like New Zealand would be a great idea but the amount of cost saving would be small. Since doctors and nurses make well above median income, any switch to government payed healthcare would mean their taxes would skyrocket and more than make up for any savings not having to pay for health insurance.
It is nice to see that you guys have given up blaming malpractice insurance for the crisis.
  #62  
Old 12-05-2018, 02:31 PM
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Cite of what? A negative?



I think you have misheard or misinterpreted what most people are saying in this context.
It's not about emulating other countries.
It's just a response to the idea that single-payer is unworkable: clearly it's very much workable as it works in all manner of countries around the globe.
Yes. You made the claim, back it up, since I know you were wrong.

Who is saying here that it is unworkable?

And again, what works in a nation that size of a state may not work in a nation 100 times are large.

Still, like i said- I am 100% in favor of single payer. But using other nations is only hurting your case.
  #63  
Old 12-05-2018, 02:34 PM
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It's that "Denmark does it better" or "Germany does it better", it's that Denmark AND Germany AND France AND the UK AND Australia AND New Zealand, and Etc., and Etc., all do it better.

You have to wonder why the US is the only one that doesn't... and it's not because we're getting better results because we aren't.
Again, this argument is specious.

And many nations dont. Look at this map:

https://www.theatlantic.com/internat...-on-it/259153/
  #64  
Old 12-05-2018, 02:44 PM
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Originally Posted by DrDeth View Post
Again, this argument is specious.

And many nations dont. Look at this map:

https://www.theatlantic.com/internat...-on-it/259153/
From your link... we are in select company

Quote:
The above map shows, in green, countries that administer some sort of universal health care plan. Most are through compulsory but government-subsidized public insurance plans, such as the UK's National Health Service. Some countries that have socialized and ostensibly universal health care systems but do not actually apply them universally, for example in poverty- and corruption-rife states in Africa or Latin America, are not counted.

What's astonishing is how cleanly the green and grey separate the developed nations from the developing, almost categorically. Nearly the entire developed world is colored, from Europe to the Asian powerhouses to South America's southern cone to the Anglophone states of Australia, New Zealand, and Canada. The only developed outliers are a few still-troubled Balkan states, the Soviet-style autocracy of Belarus, and the U.S. of A., the richest nation in the world.

Last edited by jasg; 12-05-2018 at 02:45 PM.
  #65  
Old 12-05-2018, 02:46 PM
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And again, what works in a nation that size of a state may not work in a nation 100 times are large. .
How about 3-5 times as large? We're about 4x the size of Germany. We can't learn anything from what they're doing?

Systems don't scale up just fine from 300k citizens (Iceland) to 5 million (Norway) to 85 million (Germany) to 125 million (Japan) and then just mysteriously fall apart when you go to 325 million.

Is there some magic tipping point at 200 million that makes it suddenly too hard to manage? If there is, you are the one who is going to have to explain it, and not just handwave it away.


If there's any reason why UHC isn't feasible, it's because half our government will actively sabotage it to ensure it's a failure.
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Old 12-05-2018, 03:35 PM
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If there's any reason why UHC isn't feasible, it's because half our government will actively sabotage it to ensure it's a failure.
Again, I am not arguing that Universal healthcare isnt a good idea. It is. But what I am saying is that "Hey they do it so we shoudl to" is a bad counterproductive argument. It hurts your argument, doesnt add to it at all.
  #67  
Old 12-05-2018, 04:28 PM
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You've got that backward. It's NOT "they do it, we should too" it's "if all those other people can make it work why can't we?"
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Old 12-05-2018, 04:44 PM
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Before my travels I thought very highly of the US, From my travels, I've learned that most of that is BS. Healthcare is one of the most prime examples. We are paying for nothing but to line pockets. We are scared by others who benefit from this system into believing their are long waits in other countries while ignoring there are long waits here. Our heathcare in this nation is a disgrace. Yes people do get it, but as what cost and many still go without.
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Old 12-05-2018, 04:46 PM
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Again, this argument is specious.

And many nations dont. Look at this map:

https://www.theatlantic.com/internat...-on-it/259153/
Wow, yeah. Look at how much of the world doesn't have UHC. And here I've been arguing that most of the developed world has adopted UHC and that the US of A is a pathetic exception. Apparently not. The map shows us, for instance, that no guarantee of health care exists in the Democratic Republic of the Congo or its surrounding areas -- the surrounding areas being Uganda, Rwanda, Burundi,Tanzania, Zambia, Angola, the Republic of the Congo, and the Atlantic Ocean. I think we can all acknowledge that the Atlantic Ocean has no quality health care whatsoever.

This reminds me of the argument we had regarding gun violence statistics by country, where you insisted that I was using a "selective" definition of what was meant by terms like "first world", "industrialized", or "developed country". This was apparently because it suited your purposes to cite some gang-riddled lawless shithole as an example of a fine nation that had worse gun violence than the USA. You know what? On the subjects of either gun control or health care, I have no patience for those kinds of disingenuous arguments.
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Old 12-05-2018, 05:10 PM
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Again, I am not arguing that Universal healthcare isnt a good idea. It is. But what I am saying is that "Hey they do it so we shoudl to" is a bad counterproductive argument. It hurts your argument, doesnt add to it at all.
That's a bad way to characterize the argument. It's more like "these other countries have found great success with these kinds of systems, better than our own in many ways, so we should see if we could realize even greater successes with our large throbbing American creativity and know-how."
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Old 12-05-2018, 05:11 PM
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You've got that backward. It's NOT "they do it, we should too" it's "if all those other people can make it work why can't we?"
We can, no one here is saying otherwise. But do we want to pay the price?
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Old 12-05-2018, 05:14 PM
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Wow, yeah. Look at how much of the world doesn't have UHC. And here I've been arguing that most of the developed world has adopted UHC and that the US of A is a pathetic exception. .....
This reminds me of the argument we had regarding gun violence statistics by country, where you insisted that I was using a "selective" definition of what was meant by terms like "first world", "industrialized", or "developed country". This was apparently because it suited your purposes to cite some gang-riddled lawless shithole as an example of a fine nation that had worse gun violence than the USA. ....
That's not the point. The point is that it was claimed that the USA was alone in not having Universal Health care. That is demonstrably false. In any case, this argument doesnt work- it never has worked, it never will work. It is counterproductive.

No, I cited EVERY NATION ON EARTH. You cherry picked.
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Old 12-05-2018, 05:16 PM
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That's a bad way to characterize the argument. It's more like "these other countries have found great success with these kinds of systems, better than our own in many ways, so we should see if we could realize even greater successes with our large throbbing American creativity and know-how."
It is a counterproductive argument that loses people rather than gains support. And it is usually incorrect.
  #74  
Old 12-05-2018, 05:17 PM
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.... This was apparently because it suited your purposes to cite some gang-riddled lawless shithole as an example of a fine nation that had worse gun violence than the USA. ....
You do realize you just called Mexico a "gang-riddled lawless shithole"- that sounds just like something Trump would say.
  #75  
Old 12-05-2018, 05:33 PM
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We can, no one here is saying otherwise. But do we want to pay the price?
I do. In a heartbeat. But then, I've spent the last decades watching members of my family become ill and die in our jacked up "system".

At worst it would cost no more than it does now, but cover many more people with less stress and wasted effort. More likely, we'd see some savings. I don't think we'd see some of the more dramatic savings being claimed, but we'd see some.
  #76  
Old 12-05-2018, 06:23 PM
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That's not the point. The point is that it was claimed that the USA was alone in not having Universal Health care. That is demonstrably false. In any case, this argument doesnt work- it never has worked, it never will work. It is counterproductive.

No, I cited EVERY NATION ON EARTH. You cherry picked.
Virtually every wealthy nation on earth has UHC.

Mexico implemented UHC in 2012. India and China are working on a UHC system.

The fact that the US is an outlier among wealthy nations is a factor. We tend to be an outlier among wealthy nations on various fronts.
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  #77  
Old 12-05-2018, 07:01 PM
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The point is that it was claimed that the USA was alone in not having Universal Health care.
...which particular post are you referring too?
  #78  
Old 12-05-2018, 07:02 PM
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...which particular post are you referring too?

Broomstick

"You have to wonder why the US is the only one that doesn't....."
  #79  
Old 12-05-2018, 07:03 PM
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Originally Posted by DrDeth View Post
We can, no one here is saying otherwise. But do we want to pay the price?


Dude, if the effing republicans weren’t hell bent on sabotaging UHC there wouldn’t BE a price to pay. We would SAVE money and have better care overall. I know this because every country that has implemented UHC with an actual effort to make it work pays half what we do for health care.


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  #80  
Old 12-05-2018, 07:31 PM
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Broomstick

"You have to wonder why the US is the only one that doesn't....."
...that wasn't the claim that was made.
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Old 12-05-2018, 09:21 PM
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...that wasn't the claim that was made.
Those are the exact words.
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Old 12-05-2018, 09:41 PM
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Broomstick

"You have to wonder why the US is the only one that doesn't....."
To me, it sounds like you're splitting hairs in an effort to avoid having to face the actual meat of the debate which is that the US has an overpriced, brutal system and that letting the public sector run it would make it cheaper and more humane.

I can't speak for broomstick, but it was pretty obvious she meant why the US is the only wealthy nation that doesn't. Yes the US has better healthcare than Uganda, but we have a per capita income of almost $60,000. So I'd hope we have better healthcare than Uganda.

But virtually every high income nation has better healthcare than us on various metrics (including how humane, reliable and affordable the system is). That includes nations with per capita incomes far lower than ours. Greece has a per capita income 1/3 of ours. South Korea has a per capita income 1/2 of ours. And I'm sure most people in those nations wouldn't want our health care system in their countries.

Other than the US, virtually every nation with a per capita income above 20k has a UHC system from what I can tell (and many in the 10-20k range either have a UHC system or are building one). The US is about the only outlier.
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  #83  
Old 12-05-2018, 09:49 PM
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To me, it sounds like you're splitting hairs in an effort to avoid having to face the actual meat of the debate which is that the US has an overpriced, brutal system and that letting the public sector run it would make it cheaper and more humane.

I can't speak for broomstick, but it was pretty obvious she meant why the US is the only wealthy nation that doesn't.
As I have said here a dozen times, I am 100% in favor of Universal healthcare. That's why I am against this silly argument, as it does nothing but drive people away. It's a really bad argument. It is you guys that are splitting hairs to keep using a bad argument.

She said nothing about "wealthy nations". She said the US is the only nation. No words between "only" and "nation".

Last edited by DrDeth; 12-05-2018 at 09:50 PM.
  #84  
Old 12-05-2018, 10:00 PM
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Again, I am not arguing that Universal healthcare isnt a good idea. It is. But what I am saying is that "Hey they do it so we shoudl to" is a bad counterproductive argument. It hurts your argument, doesnt add to it at all.
If all the countries that had universal healthcare were desperately trying to dismantle it because of its colossal failures, I'm guessing people would cite that as evidence that universal healthcare isn't a good idea. Do you think doing so would make for a "counterproductive" argument? Personally, I think it would be crazy to pretend actual test cases don't exist.

Yes, there are differences between the US and the countries that have universal healthcare. The way you deal with this isn't to completely ignore what those countries have done. You deal with the differences by coming up with a program that borrows the best policies from the existing systems while adding new policies that cater to American-specific issues.
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Old 12-05-2018, 10:37 PM
Wesley Clark Wesley Clark is offline
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As I have said here a dozen times, I am 100% in favor of Universal healthcare. That's why I am against this silly argument, as it does nothing but drive people away. It's a really bad argument. It is you guys that are splitting hairs to keep using a bad argument.

She said nothing about "wealthy nations". She said the US is the only nation. No words between "only" and "nation".
My mistake. I misinterpreted your criticism.

But I think most people understand the unspoken assumption that we are talking about UHC among nations with the wealth and infrastructure to provide UHC. Uganda and Syria do not have the wealth or infrastructure for UHC.

That is why the US is an outlier. Virtually every nation with the wealth and infrastructure to have UHC has a UHC plan, or is working on one. The US is about the only outlier. As I mentioned, I believe virtually every nation with a per capita income above 20k has UHC, and many nations in the 10-20k range also either have UHC or are working on a UHC plan.

So it appears pretty much every nations above 10k has UHC or is working on it (including virtually every nation above 20k), except the US. If you had to do a graph of a nations per capita income and their probability of having a UHC system, it would start out low with most poor nations not having UHC, jump dramatically at about 5-10k per capita income and be nearly guaranteed above 20k. The US is the only outlier at that level of wealth.
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  #86  
Old 12-05-2018, 11:34 PM
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Those are the exact words.
...those "exact words" are literally not the "exact words" Broomstick said.

Quote:
Originally Posted by DrDeth View Post
She said nothing about "wealthy nations". She said the US is the only nation. No words between "only" and "nation".
The "only nation" that does what?
  #87  
Old 12-06-2018, 12:09 AM
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Yes. You made the claim, back it up, since I know you were wrong.
In as far as I made a concrete claim, it was a negative one "You don't see...".
I cannot "cite" a negative.

However, let's dial it back a shade. It was just a general observation. Probably there are examples of countries saying "We aren't country X, therefore their policy Y would not work here". It's rare though, because it's just not a logical way of thinking.
It's much more logical to see that an example of policy Y working gives us reason to think it might work elsewhere, and we need good reason to believe otherwise. Not being the same country is not, in itself, good reason.

Quote:
Who is saying here that it is unworkable?

And again, what works in a nation that size of a state may not work in a nation 100 times are large.
So you are suggesting it may be unworkable. And, to be fair, at least giving a reason: that the US is very big.
So, to that point, pointing out that Canada is bigger than the United States but has UHC is absolutely relevant. Then you might say that Canada doesn't have as large a population as the US, so I might point to a populous country like Japan.

And we'd probably carry on until an excuse is found.

Quote:
Still, like i said- I am 100% in favor of single payer. But using other nations is only hurting your case.
This is a lot like the classic "I'm prepared to accept that climate change might be a problem, but you guys need to repackage your message / stop being so shrill about it". It's just an attempt -- conscious or otherwise -- to deflect from the point.

Last edited by Mijin; 12-06-2018 at 12:12 AM.
  #88  
Old 12-06-2018, 03:06 AM
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Those are the exact words.
Yeah, my exact words minus every other word in the post. Nice editing.
  #89  
Old 12-06-2018, 03:25 AM
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I think we can all acknowledge that the Atlantic Ocean has no quality health care whatsoever.
Excuse me, but I think you just offended the crews of hospital ships. Glucose bags at dawn, sir!
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  #90  
Old 12-06-2018, 12:42 PM
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Again, I am not arguing that Universal healthcare isnt a good idea. It is. But what I am saying is that "Hey they do it so we shoudl to" is a bad counterproductive argument. It hurts your argument, doesnt add to it at all.
OK, good doctor. You've made this point several times in this thread.

You've also said, several times, that you are not arguing that UHC isn't a good idea. So is it a good idea? And when somebody says it isn't a good idea and it won't work in the USA, how do YOU respond?
  #91  
Old 12-06-2018, 01:38 PM
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From here


So, if you are considering healthcare costs only, preventive care may not save a lot. If you count the economy as a whole, it does save a lot. Not counting reduction of suffering.

BTW, this blog from the UK notes that some preventive services might reduce income for providers by being cheaper.
It also notes

5% is hardly nothing. The blog calls for more, but along the lines of trying to reduce obesity, not basic things like checkups and vaccination. I couldn't find what we spend in the US for prevention, I did find an article saying that people don't make use of available services now.


It is nice to see that you guys have given up blaming malpractice insurance for the crisis.
Preventative medicine is almost always a good idea, but it will not save money.
The biggest healthcare myth is that the US can easily save money on healthcare without large disruptions in care. If you look other country's systems they are all UHC but they vary alot by country. There is no one way to control costs. The best correlation is between how rich a country is and how much they spend.

For example, Greece spends 34% less than what Italy does per capita and has longer lifespans than Italy. They spend less than one third of what Switzerland, Norway, and Luxembourg does. The reason they spend so little is not because Greece has a hyper efficient medical system but because it is the poorest country in Europe and so spends much less than the rest of Europe. Rich countries spend more on services because of Baumol's cost disease which states that efficiencies in one area of the economy push up prices in other areas of the economy. So Luxembourg and Switzerland, the two richest countries in Europe spend the most on healthcare per capita and the most on education per capita. The US is much richer than the rest of the world, actual individual consumption in the US is 16% higher than in Luxembourg and 36% higher than in Italy which is average for Europe.

Thus in order to actually save money you either have to get healthcare professionals to to agree to be paid like people in a poorer country or get people to accept a standard of care of a poorer country. The good news is that much of healthcare spending is wasted so getting less healthcare won't necessarily mean worse health. But the bad news is that we don't know what parts of healthcare are waste and thus cutting healthcare will probably mean worse health.
  #92  
Old 12-06-2018, 02:31 PM
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...those "exact words" are literally not the "exact words" Broomstick said.



The "only nation" that does what?

Originally Posted by Broomstick
It's that "Denmark does it better" or "Germany does it better", it's that Denmark AND Germany AND France AND the UK AND Australia AND New Zealand, and Etc., and Etc., all do it better.

You have to wonder why the US is the only one that doesn't... and it's not because we're getting better results because we aren't.
  #93  
Old 12-06-2018, 02:32 PM
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Yeah, my exact words minus every other word in the post. Nice editing.

Originally Posted by Broomstick
It's that "Denmark does it better" or "Germany does it better", it's that Denmark AND Germany AND France AND the UK AND Australia AND New Zealand, and Etc., and Etc., all do it better.

You have to wonder why the US is the only one that doesn't... and it's not because we're getting better results because we aren't.


So tell me how the rest of your post changes you claim that the USA is the only nation that doesnt have UHC?
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Old 12-06-2018, 02:34 PM
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OK, good doctor. You've made this point several times in this thread.

You've also said, several times, that you are not arguing that UHC isn't a good idea. So is it a good idea? And when somebody says it isn't a good idea and it won't work in the USA, how do YOU respond?
I have several times said that UHC is a good idea.

I show them the facts, without resorting to the ridiculous and counterproductive argument that Denmark has it so should we.

(And fercrickiessakes, it's Dr Deth, where did you get the idea I was a "good" Doctor? ;-) )

Last edited by DrDeth; 12-06-2018 at 02:35 PM.
  #95  
Old 12-06-2018, 02:56 PM
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Originally Posted by DrDeth View Post
Originally Posted by Broomstick
It's that "Denmark does it better" or "Germany does it better", it's that Denmark AND Germany AND France AND the UK AND Australia AND New Zealand, and Etc., and Etc., all do it better.

You have to wonder why the US is the only one that doesn't... and it's not because we're getting better results because we aren't.
...thanks for confirming that your claim and Broomstick's words are not the same. But I knew that already.

My question again: the US is the "only nation" that does what"?
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Old 12-06-2018, 02:57 PM
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ridiculous and counterproductive argument that Denmark has it so should we.
It's not "they have it, so should we", it's "they have it, so can we".

When I see that dozens of other countries were able to implement UHC, I believe that we can, too.


From a "should we" standpoint, it isn't the fact that other countries have it that suggests we should have it too, it's the comparison of their systems to ours that suggests we should have it too. They apply a far smaller percentage of their GDP to health care than we do. Their people are universally covered and are not subject to the stress, uncertainty, confusion, financial pressures, or lack of access that we have here.

Personally, I have been covered by health insurance for every moment of my adult life, over 20 years of continuous coverage. The amount of stress and confusion I have had to deal with over the financial aspect of health for me and my family has been ridiculous. Dealing with bills for things that I wasn't responsible for, or was *technically* responsible for but really shouldn't have been, or not knowing whether or not I was responsible, but I'll just pay anyway to make it go away. Uncertainty about what I was going to have to pay out of pocket, or what coverage was changing. Uncertainty about the cost for procedures, is this test my doctor recommends a $50 test or $500? Or the realization that I didn't *structure* my care smartly enough and cost myself a bundle.

It's lunacy when I think that, for all that nonsense I've had to deal with over 20 years, while having good insurance, folks across the pond have to deal with none of that, AND PAY LESS for the privilege.
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Old 12-06-2018, 03:08 PM
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I have several times said that UHC is a good idea.

I show them the facts, without resorting to the ridiculous and counterproductive argument that Denmark has it so should we.

(And fercrickiessakes, it's Dr Deth, where did you get the idea I was a "good" Doctor? ;-) )
'Good doctor' was an attempt at levity. No offense intended and it was obviously a poor choice of words.

I'm glad you think that UHC is a good idea.

But in all seriousness, what facts do you show them? I've used the 'Canada has it' argument, and it hasn't been well received. So I am genuinely curious: what facts should I be citing to back up my claim that UHC is a good idea?
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Old 12-06-2018, 03:42 PM
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Anyway, big healthcare myths that I can remember offhand:

1) US military expenses are bigger than US healthcare expenses. In fact many people in the western work think their military budgets are bigger than the healthcare speding

2) The US produces more medical research per head than other large western nations.

3) The poor US performance in infant mortality has something to do with "Different ways of recording it"

4) More people come to the US for medical care then the number of Americans that go abroad for care.

5) Many Canadians come to the US for medical care and few Americans go to Canada for health care.

6) The universal healthcare systems in the rest of the developed work are more expensive than the US system.

7) The US system has good results compared to other developed nations systems.

There are probably many others, but as far as myths go, those are the real howlers that I can think of right now.
So, let’s look at each one individually and see how big of a “howler” it is. I think #1, 6 and 7 are howlers. I think #’s 2 through 5 are either not howlers, or there’s better ways to phrase things:

1) I haven’t heard this one before. If anyone has said that, it is a howler. The attached link show the US military expenses vs US government healthcare expenses in 2015. Clearly, healthcare is larger:
https://www.nationalpriorities.org/b...-101/spending/

2) “More medical research per head”? I haven’t heard it worded that way. But here’s a better way to phrase it: The US has an outsize share of global innovation in the healthcare sector. I’m borrowing that wording from the attached column in the New York Times:

https://www.nytimes.com/2017/10/09/u...tion-edge.html

Quoting from the link:
First, let’s acknowledge that the United States is home to an outsize share of global innovation within the health care sector and more broadly. It has more clinical trials than any other country. It has the most Nobel laureates in physiology or medicine. It has won more patents. At least one publication ranks it No. 1 in overall scientific innovation.

Strong promotion of innovation in health care is one reason the United States got as far as it did in our recent bracket tournament on the best health system in the world. Though the United States lost to France, 3-2, in the semifinals, it picked up its two votes in part because of its influence on innovation, which can save lives in the United States and throughout the world.


3) Poor performance in US infant mortality is definitely not entirely due to “different way of recording it”. But it does have something to do with it. Our infant mortality has improved over time, as has the rest of the industrialized world. But we lag behind other nations. See attached links:

http://www.geoba.se/population.php?p...ype=019&page=2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856058/

From the 2nd link, it explores differential reporting of births. It appears that it does not offer a complete explanation, but it is quantitatively important, according to the authors of this study. So, #3 is not a “howler”. Quoting from the 2nd link:

This exercise yields a number of findings. First, consistent with past evidence (MacDorman and Mathews, 2009), differential reporting of births cannot offer a complete explanation for the US IMR disadvantage. However, accounting for differential reporting is quantitatively important. Compared to the average of the five European countries we analyze, limiting to a comparable sample lowers the apparent US IMR disadvantage from 2.5 deaths per 1000 births to 1.5 deaths. This finding highlights the importance of conducting cross-country comparisons in a setting where reporting differences can be addressed, which is typically not possible in the types of aggregate statistics compiled by the World Health Organization and the World Development Indicators (World Health Organization, 2006; World Bank, 2013).

4) And 5)….These are similar claims, with one focusing on Canada and the other on other countries overall, and both discussing US folks going to either Canada or somewhere else. And I don’t believe for one second that more come to the US than vice versa.

Medical tourism among Canadians has increased in recent years, but it’s not a crisis or anything:
https://www.ctvnews.ca/health/63-000...tute-1.3486635

US medical tourists are more than enough to fill a cruise boat, over a million:
https://www.amjmed.com/article/S0002...620-X/fulltext

It seems that people leaving the US for medical care are trying to save money. Very often, people coming to the US are looking for better technology or innovative treatments, and so forth. But in any event, there's not a flood of people from Canada coming to the US, nor from other countries.

6) And 7) are howlers fairly obviously. We pay alot in the US, and in many areas, our outcomes lag behind.
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Old 12-06-2018, 04:48 PM
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...thanks for confirming that your claim and Broomstick's words are not the same. But I knew that already.

My question again: the US is the "only nation" that does what"?
If you can't figure out that from context, I am at a loss.
  #100  
Old 12-06-2018, 04:49 PM
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Originally Posted by Railer13 View Post
'Good doctor' was an attempt at levity. No offense intended and it was obviously a poor choice of words.

I'm glad you think that UHC is a good idea.

But in all seriousness, what facts do you show them? I've used the 'Canada has it' argument, and it hasn't been well received. So I am genuinely curious: what facts should I be citing to back up my claim that UHC is a good idea?
It's cheaper.

It's more fair.

Fewer people go bankrupt from medical bills.

It's the Right thing to do.
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