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  #51  
Old 03-10-2020, 04:37 AM
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Originally Posted by Hilarity N. Suze View Post
ETA: What you particularly do not need in universal health care is gatekeepers who decide whether a procedure is necessary and whether it is covered. It is the health-care providers who decide whether it's necessary and also (I would hope) whether the patient is likely to survive it and whether it's likely to be beneficial.
I think you mean "non-clinical gatekeepers second-guessing clinical judgement in every individual case". Our system works on the basis of the GP acting as both gatekeeper (other than for emergency cases) and primary health advisor. You could argue that their central gatekeeping role is the result of a money-grubbing "system capture" at the outset (preserving their existing status and income was a key stumbling block in the politics of setting it all up): but as it happens, over the decades the whole system has tended towards delegating/diverting more and more of the routine bulk of business away from the expensive specialist end towards the simpler, cheaper end, as medical needs and techniques have changed, from specialists to GPs to nurse practitioners to prescribing pharmacists. Which actually reinforces the central position in the system of the GP, to the point where they now have a key position in the local agencies that allocate the bulk of budgets for hospital and community medical services.

Plus, we do have central clinician-led agencies as well as the professional bodies for assessing clinical and cost-effectiveness, but that is to guide practice proactively for the whole system, rather than reviewing every individual case.

Last edited by PatrickLondon; 03-10-2020 at 04:40 AM.
  #52  
Old 03-10-2020, 05:23 AM
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I think you mean "non-clinical gatekeepers second-guessing clinical judgement in every individual case". Our system works on the basis of the GP acting as both gatekeeper (other than for emergency cases) and primary health advisor.
This part is identical in Canada and indeed in every country with UHC that I know of. The respected health care economist Uwe Reinhardt once wrote that every doctor in every civilized country in the world would be appalled at the degree of clinical meddling that health insurers do in the US, coming between doctor and patient and second-guessing, downgrading, or denying treatments based on costs and contractual fine print. In Canada, the Canada Health Act mandates that any procedure normally performed by any doctor or hospital must be provided at no cost to the patient if the doctor deems it medically necessary. There are no forms to fill out, and no money is involved. I was in the hospital for the first time in my life several years ago, and I was well aware of the tremendous expenses involved. The ability to just thank the doctors and nurses involved, who had literally saved my life, and walk out the door without spending a dime seemed almost unreal, even to someone like me who was accustomed to never paying for doctor's visits.
  #53  
Old 03-10-2020, 07:50 AM
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Health "insurance" is not a key part of health care.[

In the first place insurance is a business, and it's the business of maximizing returns, or in other words, making money.
So is health care. Even in a place like Canada. My doctor gets paid, and paid well. Specialists are paid well. Hospitals cost a staggering amount of money to run and any number of companies are making millions. All of it, or 99.9% of it., is paid for by health insurance, mostly the provincial single payer plan, with a little private insurance and money sprinkled in. Health insurance is a big part of delivering health care.

A system without some kind of health insurance would be catastrophically terrible. Health care where people just pay as they receive treatment simply doesn't make economic sense.

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Universal health care (or single-payer as it gets referred to) would cut out most of the hierarchy of people standing by to collect small fortunes by virtue of the money people send in to insurance companies.
UHC is a form of health insurance. The UHC plan I am covered under literally has "insurance" in the name. It is actually a UHI program. It works.

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Originally Posted by wolfpup
The respected health care economist Uwe Reinhardt once wrote that every doctor in every civilized country in the world would be appalled at the degree of clinical meddling that health insurers do in the US, coming between doctor and patient and second-guessing, downgrading, or denying treatments based on costs and contractual fine print.
This part cannot be emphasized enough. In the USA, it's often the case an accountant decided what health care you get. In Canada, it's always a doctor. I cannot imagine why anyone would prefer the former. Our system could be improved in a lot of ways but having accountants make health care decisions instead of doctors is not one of them.
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  #54  
Old 03-10-2020, 10:54 AM
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...its a fundamental difference between what you find in most parts of the world and what happens in America. Do you really not understand that the two terms are not interchangeable?

I don't have to pay any health insurance premium at all to access the healthcare system here. As outlined in the OP I pay my taxes, I pay for my GP and I pay for prescriptions. If my income was lower I'd get discounts, and there are additional layers of safety net in case my income was lower still.

I can choose to pay additional money for private health insurance. If I did this it would mean that I would probably be able to get a private room. I might be able to jump the queue for non-urgent care. But having health insurance isn't a matter of life or death here. I'm self-employed and I didn't have to liquidate my businesses to spend a week in hospital. No co-pays. No minimum payments. No bills after the fact.
I see taxes as being equivalent to a premium, sir. The lack of co-pays/deductible just means you have good insurance. I still characterize universal healthcare as a system of health insurance.

~Max
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Old 03-10-2020, 11:00 AM
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Max S's "the two terms are interchangeable in my bnook" comment is... well, amazing, to put it kindly. Confusing health insurance with health care is like confusing car insurance with a car.
The two terms I was referring to as synonymous were Banquet Bear's present system of health insurance and universal healthcare. Again, I apologize to everybody for the confusion.
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Being altogether undecided on the best system of health insurance, I am in no position to convince someone to abandon their present system. I cannot convince Banquet Bear to oppose universal healthcare.
~Max
  #56  
Old 03-10-2020, 11:05 AM
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I would suggest that you stop arguing so authoritatively over in your own thread about something you know so little about.
Pot, meet kettle... People here have been saying the exact same thing to you, but that's cool.
  #57  
Old 03-10-2020, 11:56 AM
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Pot, meet kettle... People here have been saying the exact same thing to you, but that's cool.
Set him straight then. What do you think is the flaw in his arguments?
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  #58  
Old 03-10-2020, 02:16 PM
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UHC is a form of health insurance. The UHC plan I am covered under literally has "insurance" in the name. It is actually a UHI program. It works.
....stop confusing the issue. Every country is different. Canada can reasonably say that your UHI is a form of insurance. That isn't the case here. I have stated that some countries do have insurance and that some do not: but insurance is not a requirement for a universal system. If this were a venn diagram UHC would be the big circle with health insurance a little one with overlap: not the other way around.
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Old 03-10-2020, 02:20 PM
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I would just like to note that most Americans do not have "fire insurance" but if they have a fire, a team of experts will show up and put it out. They do not have "police insurance" but if somebody is breaking into their house and they call 9-1-1 police will show up. (Eventually.)

You don't get all the "okay, here's a bill from the driver of the fire truck. And here's a bill from the guy who operated the hose. And here's another bill from the guy who busted down the door. And we used 65 gallones of water, here's the bill for that." There are things fire departments charge for, like if you buy a house and you want to know if there was ever a fire at the house. In my jurisdiction it's $15 for a report. But they don't charge you for coming out and investigating if you smell smoke.

So "insurance" is kind of the wrong word for what I envision in health care, which is much the same kind of support. Doctors get paid, but maybe they get paid per person on their roster rather than by individual procedure.

Being afraid to access health care because it will ruin you financially is not a lot better than not having health care at all.
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Old 03-10-2020, 02:26 PM
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....stop confusing the issue. Every country is different. Canada can reasonably say that your UHI is a form of insurance. That isn't the case here. I have stated that some countries do have insurance and that some do not: but insurance is not a requirement for a universal system.
New Zealand has a mixed system, though. There are, in fact, insurance elements.
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  #61  
Old 03-10-2020, 02:28 PM
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I see taxes as being equivalent to a premium, sir. The lack of co-pays/deductible just means you have good insurance. I still characterize universal healthcare as a system of health insurance.

~Max
...you are characterizing it as wrong. I can choose to pay extra for health insurance here. Its a completely different paradigm. They aren't equivalent because I can actually access health insurance if I wanted to and its a completely different thing.

In America if you want to access healthcare (unless you qualify for medicare/medicaid) you not only have to pay your taxes: you have to pay a premium as well. So you do realize that according to your characterization "you are paying a premium' then you are "paying a premium?"

You are defending a system where you pay for the same thing twice.
  #62  
Old 03-10-2020, 02:32 PM
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So "insurance" is kind of the wrong word for what I envision in health care, which is much the same kind of support. Doctors get paid, but maybe they get paid per person on their roster rather than by individual procedure.
Such an arrangement is called "capitation", meaning per-head.

~Max
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Old 03-10-2020, 02:38 PM
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...you are characterizing it as wrong. I can choose to pay extra for health insurance here. Its a completely different paradigm. They aren't equivalent because I can actually access health insurance if I wanted to and its a completely different thing.

In America if you want to access healthcare (unless you qualify for medicare/medicaid) you not only have to pay your taxes: you have to pay a premium as well. So you do realize that according to your characterization "you are paying a premium' then you are "paying a premium?"
That's right, if you opted for private insurance than I would say you are paying two premiums - a tax for the primary insurance, and a conventional premium for supplementary insurance.

I think it is clear that we are talking about the exact same thing, just that I call it insurance, and for whatever reason you do not. So be it.

~Max
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Old 03-10-2020, 02:42 PM
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New Zealand has a mixed system, though. There are, in fact, insurance elements.
..."insurance elements" is not "health insurance." If you google "health insurance new zealand" you don't get wiki pages that talk about "a mixed system" you get listing after listing of health insurance companies. I see you cribbed "insurance elements" from the wikipedia page. If you read further down to where they actually talk about health insurance:

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Originally Posted by wiki
The relatively extensive and high-quality system of public hospitals treats citizens or permanent residents free of charge and is managed by district health boards. However, costly or difficult operations often require long waiting list delays unless the treatment is medically urgent.[1] Because of this, a secondary market of health insurance organisations exists which fund operations and treatments for their members privately. Southern Cross Health Insurance, a non-profit organisation, is the largest of these at about 60% of the health insurance market and covering almost a quarter of all New Zealanders in 2007, even operating its own chain of hospitals.[2]
https://en.wikipedia.org/wiki/Health...in_New_Zealand

These "insurance elements" are elements outside of the Universal Healthcare system. They aren't part of it. I talked about this earlier. If you want faster treatment (for non-urgent care) or if you want a private room then private health insurance is an option.
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Old 03-10-2020, 02:54 PM
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That's right, if you opted for private insurance than I would say you are paying two premiums - a tax for the primary insurance, and a conventional premium for supplementary insurance.
...you don't have to pay tax to access universal healthcare in New Zealand. If you are a NZ citizen or permanent resident you can access the system even if (somehow) you never managed to pay a cent of tax. Australian citizens who have lived here for two years can access the system. Refugees or victims of trafficking can access the system without having paid a cent of tax. Paying tax here is not a requirement to access the system. Universal healthcare and health insurance are not the same thing. No matter how much you insist that they are.

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I think it is clear that we are talking about the exact same thing, just that I call it insurance, and for whatever reason you do not. So be it.
Except its clear that we aren't talking about the same thing. There is a fundamental difference.
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Old 03-10-2020, 04:02 PM
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...you don't have to pay tax to access universal healthcare in New Zealand.
I presume the doctors in New Zealand are being reimbursed for their services, and I presume such money ultimately comes from taxpayers. A line-item tax is not necessary, as I understand it New Zealand funds the healthcare system through general taxation (personal & business income tax, GST, ACC levies). You do not pay a dedicated tax such as the American social security payroll tax; healthcare is essentially funded from the general treasury.

As such, it is quite impossible for somebody to avoid paying taxes while living in New Zealand. At the very least, when one makes purchases, they pay a tax.

~Max
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Old 03-10-2020, 04:22 PM
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Well, mere visitors should purchase health insurance. Some things are covered for tourists in NZ (accidents, mostly) but some are not (illnesses and such.)

This varies a lot from place to place. In Canada tourists are not covered at all; it would be very unwise to vacation here without supplemental insurance.

I don't know of any country offhand that fully covers a tourists' health care costs.
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  #68  
Old 03-10-2020, 04:32 PM
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I presume the doctors in New Zealand are being reimbursed for their services, and I presume such money ultimately comes from taxpayers. A line-item tax is not necessary, as I understand it New Zealand funds the healthcare system through general taxation (personal & business income tax, GST, ACC levies). You do not pay a dedicated tax such as the American social security payroll tax; healthcare is essentially funded from the general treasury.

As such, it is quite impossible for somebody to avoid paying taxes while living in New Zealand. At the very least, when one makes purchases, they pay a tax.

~Max
...except I know somebody who does exactly fit that criteria, they haven't bought anything for many years now, they aren't working but still has access to our healthcare system. Its not quite as impossible as you think.

But that doesn't really matter because the principle doesn't change. Paying taxes isn't a requirement to access our healthcare system. Healthcare and healthcare insurance are two different things. The amount of tax I pay isn't determined by risk factors like obesity or pre-existing conditions. It isn't an insurance payment. Its tax. If you don't understand the difference then I'm not even sure you understand what "single payer" or what "universal healthcare" actually means.

And even if you want to personally conflate taxes with insurance payments it is extraordinarily unhelpful to do that in the context of a debate.
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Old 03-10-2020, 04:55 PM
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If you don't understand the difference then I'm not even sure you understand what "single payer" or what "universal healthcare" actually means.

And even if you want to personally conflate taxes with insurance payments it is extraordinarily unhelpful to do that in the context of a debate.
I don't understand the difference, and it is clear that you do not wish to argue over it, so we can leave it at that.

~Max
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Old 03-10-2020, 05:14 PM
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I don't understand the difference, and it is clear that you do not wish to argue over it, so we can leave it at that.

~Max
...I don't think its clear that I "do not wish to argue over it". I am quite clearly here arguing with you over it. Its clear that I'm not going to concede the argument because the definition of taxes and health insurance show they are completely different things.

Taxes: A tax (from the Latin taxo) is a compulsory financial charge or some other type of levy imposed upon a taxpayer (an individual or legal entity) by a governmental organization in order to fund various public expenditures.

Health insurance: Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

The differences: taxes are levied by a governmental organization: health insurance can be administered by government agencies, private businesses, or not-for-profit entities. Insurance works on the principle of "spreading risk": its a fundamental part of what insurance is, and the level of "risk" dictates how much premium somebody would be expected to pay. Taxes are simply a mechanism for funding public expenditure. I'm overweight. I have higher risk factors. But I don't have to pay more in tax in order to access our healthcare system. I'm not paying insurance. I'm paying my taxes.

Do you still not understand the difference, even though I've provided the two definitions that explain the differences? What is it that you don't understand?
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Old 03-10-2020, 06:19 PM
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...I don't think its clear that I "do not wish to argue over it". I am quite clearly here arguing with you over it. Its clear that I'm not going to concede the argument because the definition of taxes and health insurance show they are completely different things.
Very well, I had mistakenly drawn the inference that this line of posts had devolved into something "extraordinarily unhelpful" in the context of your debate thread, therefore it was no longer desirable to continue.
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Insurance works on the principle of "spreading risk": its a fundamental part of what insurance is, and the level of "risk" dictates how much premium somebody would be expected to pay.

[...]

Do you still not understand the difference, even though I've provided the two definitions that explain the differences? What is it that you don't understand?
Based on my extremely fresh and limited knowledge about New Zealand's healthcare system, your country still calculates risk and adjusts taxes (the premium) appropriately. This is especially conspicuous with regards to ACC earner's levies. They do not adjust an individual's tax rate according to an individual's risk, but that is not a requirement of insurance. Rather, the taxes are raised and lowered to meet budget projections, and the budget projections are based on risk - determined by looking at actual expenditure for the previous year.

Indeed, the point of insurance is to spread the risk - the most efficient risk pool would have the largest number of people, each paying the same premium, such that the sum is exactly the amount needed to handle all the claims for the upcoming period.

If you are at a high risk of needing expensive medical care, you contribute to a demographic of people who are at a high risk of needing expensive medical care. Based on previous expenditures and trends within the demographic, the government will predict the relevant portion of the next year's budget. Then they will adjust fiscal policy accordingly.

~Max
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Old 03-10-2020, 07:00 PM
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Very well, I had mistakenly drawn the inference that this line of posts had devolved into something "extraordinarily unhelpful" in the context of your debate thread, therefore it was no longer desirable to continue.
...and yet you choose to continue.

It is extraordinarily unhelpful in the context of debate to use your own personal definition of words instead of the universally accepted definitions. If you argue that "up is down" and that "left is right" then how is one supposed to reasonably argue with that?

Quote:
Based on my extremely fresh and limited knowledge about New Zealand's healthcare system, your country still calculates risk and adjusts taxes (the premium) appropriately.
It isn't a premium. It isn't "an amount of money paid to get insurance." Its tax. Its a mechanism to fund governmental services.

Quote:
This is especially conspicuous with regards to ACC earner's levies. They do not adjust an individual's tax rate according to an individual's risk, but that is not a requirement of insurance. Rather, the taxes are raised and lowered to meet budget projections, and the budget projections are based on risk - determined by looking at actual expenditure for the previous year.
Lets just be clear on what the The Accident Compensation Corporation actually is.

Quote:
Originally Posted by The ACC
The Accident Compensation Corporation (ACC) (Māori: Te Kaporeihana Āwhina Hunga Whara) is the New Zealand Crown entity responsible for administering the country's no-fault accidental injury compensation scheme, commonly referred to as the ACC scheme. The scheme provides financial compensation and support to citizens, residents, and temporary visitors who have suffered personal injuries.
https://en.wikipedia.org/wiki/Accide...on_Corporation

Quote:
Originally Posted by The ACC
Our no-fault scheme covers everyone, including visitors, who are injured in an accident in New Zealand. It includes events that result in mass casualties. The scheme covers children, beneficiaries, students, if you’re working, unemployed, or retired.
https://www.acc.co.nz/im-injured/inj...what-we-cover/

You don't need to pay taxes or pay levies to access ACC. The international visitors who were injured during the eruption of Whakaari were eligible for ACC. If they were injured their medical care was paid for. If they lost a loved one they were provided with support. They got a $6000 funeral grant and were eligible for survivors grants as well.

You have a fundamental misunderstanding of how this all works that is compounded by your insistence on conflating concepts you understand with concepts that you don't. The system you are used to operates under a completely different paradigm to universal healthcare systems. Recognizing that is the first step to understanding.

Quote:
Indeed, the point of insurance is to spread the risk - the most efficient risk pool would have the largest number of people, each paying the same premium, such that the sum is exactly the amount needed to handle all the claims for the upcoming period.
Premium has a specific definition that I've provided. It isn't helpful to continue to use the word in a way that doesn't match its definition.

Quote:
If you are at a high risk of needing expensive medical care, you contribute to a demographic of people who are at a high risk of needing expensive medical care. Based on previous expenditures and trends within the demographic, the government will predict the relevant portion of the next year's budget. Then they will adjust fiscal policy accordingly.
These words don't magically suddenly make "health insurance" equivalent to "healthcare."
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Old 03-10-2020, 07:30 PM
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It is extraordinarily unhelpful in the context of debate to use your own personal definition of words instead of the universally accepted definitions. If you argue that "up is down" and that "left is right" then how is one supposed to reasonably argue with that?
I haven't yet been convinced that the universal definition of "insurance" excludes the likes of New Zealand's healthcare system.
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It isn't a premium. It isn't "an amount of money paid to get insurance." Its tax. Its a mechanism to fund governmental services.
You say a tax cannot be a premium because a tax is not money paid to get insurance? Need I remind you, I am arguing that taxes can and do fund health insurance?
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You don't need to pay taxes or pay levies to access ACC.
That is correct, apparently, but somebody needs to pay taxes or levies for you to access ACC. An individual needs not personally pay taxes - for example those internationals you mentioned.
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These words don't magically suddenly make "health insurance" equivalent to "healthcare."
Of course not! Healthcare is the provision of health services, whereas health insurance is the pooling of money to pay for healthcare, to spread risk across a population. I had said "universal healthcare" is a "health insurance system". This is because "universal healthcare" doesn't literally mean everybody receives every health service they need (nigh impossible or nobody would die), it means everybody has access to health services they need. You know, through insurance.

~Max
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Old 03-10-2020, 07:45 PM
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I haven't yet been convinced that the universal definition of "insurance" excludes the likes of New Zealand's healthcare system.
...you haven't made a case that the likes of New Zealand's healthcare system should be regarded as insurance.

Quote:
You say a tax cannot be a premium because a tax is not money paid to get insurance? Need I remind you, I am arguing that taxes can and do fund health insurance?
I provided the definition of premium and pointed out you are using the word incorrectly. No need to remind me of anything: you are simply wrong here.

Quote:
That is correct, apparently, but somebody needs to pay taxes or levies for you to access ACC. An individual needs not personally pay taxes - for example those internationals you mentioned.
Universality is the key here. Hence the term universal healthcare. Everyone is covered. The distinction is important. Everything needs to be funded somehow. Taxes and levies are the ways that we have chosen to fund our system. But taxes and levies are not insurance payments.

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Of course not!
Concession accepted. Now that you have conceded this it would be helpful if you would stop continuing to conflate the two.
  #75  
Old 03-11-2020, 10:43 AM
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...you haven't made a case that the likes of New Zealand's healthcare system should be regarded as insurance.
Your own definition of insurance reads, "Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity."

New Zealand's healthcare system covers "the whole or part of the risk of a person incurring medical expenses". It also spreads the risk of incurred medical expenses over numerous persons, namely, the whole country. New Zealand developed a routine finance structure, in the form of taxes, to provide the money to pay for the healthcare benefits specified by law and regulations. Further, the fiscal policy of New Zealand is regularly adjusted (in part) to accommodate the changing risk of health care and system expenses over the risk pool (the entire populace). The benefit, that is, payment for medical care, is administered by a central organization.

How is that not health insurance?
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I provided the definition of premium and pointed out you are using the word incorrectly. No need to remind me of anything: you are simply wrong here.
If taxes are the sole source of the fund used to pay for insurance, then taxes are paid to get insurance. If taxes are paid to get insurance, then taxes are premiums. The New Zealand healthcare system is insurance. Taxes are the sole source of funding for the New Zealand healthcare system. Therefore, taxes are premiums.

You could say, taxes are the premium paid by the people of New Zealand to obtain health insurance coverage.

~Max
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Old 03-11-2020, 11:21 AM
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From the perspective of economics, you're correct. It's insurance. Of course it is. Banquet Bear doesn't want to call it that because it sounds bad, and it can confuse someone from the USA who's not familiar with the terms or, like you, is confused between the concepts of health care and health insurance. "Insurance" implies a direct payment for coverage; national single payer health insurance collects payments based on a country's tax policy, which is why some people don't want to call it insurance. It is, though; it's just a (usually) indirect way of doing it.

What's important, though, is not that argument. What's important is that the economic argument for universal health insurance is really, really strong. Health care is the kind of insurance that MOST benefits from being universal, because it is subject to enormous market failures that are not necessarily true of other forms of insurance.

Your reticience to accept the benefits of UHI really baffle me, to be honest, but if I can venture a guess as to why it is it may be because the big picture is being lost and the details are being too dwelt upon. Private health insurance doesn't make economic sense. It just doesn't. You cannot go totally private because the adverse selection effect causes it to instantly fail, so what happens is you will end up with a patchwork of other approaches that all have huge holes and problems. The existing American system, where a large chunk of people have government health insurance paid for by other people, another large chunk have employer-paid insurance with all the attendant problems and inequities there, and a bunch of people are screwed, is an absolutely inevitable result.

The idea that what works in every other industrialized country would not work in the USA is ridiculous. It is just so insanely preposterous; Americans are just as subject to the forces of economics as everyone else in the world, and this is fundamentally an economic question. Precisely how the details will shake out would be different in the USA of course, but that's true everywhere. The systems in Germany, France, Australia, Japan and Canada are all different, often really significantly so, and often different even within those countries depending on jurisdiction. Where they are all similar is that they address the fundamental truth that universal coverage is more economically efficient than non-universal coverage. (It's also, in my opinion, more fundamentally civilized and moral, but that is not my point here.)
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  #77  
Old 03-11-2020, 11:49 AM
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From the perspective of economics, you're correct. It's insurance. Of course it is. Banquet Bear doesn't want to call it that because it sounds bad, and it can confuse someone from the USA who's not familiar with the terms or, like you, is confused between the concepts of health care and health insurance. "Insurance" implies a direct payment for coverage[...]
I don't think I have health insurance and healthcare confused, but if insurance implies a direct payment for coverage, then I will admit that New Zealand's healthcare system is not insurance. Hopefully that puts an end to this semantic dispute.
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What's important, though, is not that argument. What's important is that the economic argument for universal health insurance is really, really strong. Health care is the kind of insurance that MOST benefits from being universal, because it is subject to enormous market failures that are not necessarily true of other forms of insurance.

Your reticience to accept the benefits of UHI really baffle me, to be honest, but if I can venture a guess as to why it is it may be because the big picture is being lost and the details are being too dwelt upon.
This thread seems to be less about convincing people to support UHC, and more about convincing people to oppose it. With my admission that I cannot convince Banquet Bear to turncoat, and with the semantic dispute resolved, without further objection I will be bowing out.

I have a thread going already to convince me to support single-payer. I won't mind if you copy-paste to that thread. Or if you really want to debate about universal healthcare (and not single-payer) in the United States, we could do that in a separate thread. Due to ignorance, absent a specific proposal I cannot hold a viable position in a debate where I have the burden of proof, as is the case in this thread.

~Max

Last edited by Max S.; 03-11-2020 at 11:50 AM. Reason: absent a specific proposal
  #78  
Old 03-11-2020, 03:50 PM
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Your own definition of insurance reads, "Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. By estimating the overall risk of health care and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity."

New Zealand's healthcare system covers "the whole or part of the risk of a person incurring medical expenses". It also spreads the risk of incurred medical expenses over numerous persons, namely, the whole country. New Zealand developed a routine finance structure, in the form of taxes, to provide the money to pay for the healthcare benefits specified by law and regulations. Further, the fiscal policy of New Zealand is regularly adjusted (in part) to accommodate the changing risk of health care and system expenses over the risk pool (the entire populace). The benefit, that is, payment for medical care, is administered by a central organization.

How is that not health insurance?
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but if insurance implies a direct payment for coverage, then I will admit that New Zealand's healthcare system is not insurance.
...concession accepted.

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If taxes are the sole source of the fund used to pay for insurance, then taxes are paid to get insurance. If taxes are paid to get insurance, then taxes are premiums.
Taxes are not premiums. Taxes are taxes. I've quoted the definition.

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The New Zealand healthcare system is insurance. Taxes are the sole source of funding for the New Zealand healthcare system. Therefore, taxes are premiums.
This is really bad logic. Fortunately you have already conceded you are wrong.

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You could say, taxes are the premium paid by the people of New Zealand to obtain health insurance coverage.
You not only could say it, you have said it. But just because you said it doesn't make it any more correct.

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This thread seems to be less about convincing people to support UHC, and more about convincing people to oppose it. With my admission that I cannot convince Banquet Bear to turncoat, and with the semantic dispute resolved, without further objection I will be bowing out.
The thread is actually about convincing people in UHC systems to abandon what we've got in favour of the system in the US. You've done a great job of convincing people that the US system is not the way to go.

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I have a thread going already to convince me to support single-payer.
That would be the thread where after four pages you had to admit you didn't actually know what single-payer actually is.
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Old 03-11-2020, 04:18 PM
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Question about the system in New Zealand (and elsewhere).

You say taxes pay for UHC.

What Particular taxes go to pay for it?

Are we just talking the payroll taxes the government takes out of a workers paycheck?

Is it sales tax on goods and services?

Is it property taxes (taxes assessed on your property like homes, land, cars, and boats) or specific taxes on a certain product. For example in the US alot of taxes are on cigarettes and alcohol that pay for things.

Or do all the taxes get collected into one huge fund and then the government of NZ or elsewhere then decide how much to spend on UHC?
  #80  
Old 03-11-2020, 05:43 PM
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Or do all the taxes get collected into one huge fund and then the government of NZ or elsewhere then decide how much to spend on UHC?

...for NZ: mainly this, but it isn't really the govt making day-to-day decisions but the DHB's. Details here.

https://www.health.govt.nz/new-zeala...system/funding
  #81  
Old 03-12-2020, 09:10 AM
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So the Great Debate here is a simple one: convince me that we've got this one wrong. Convince me that we should switch to the American system
The American system helps good people get to heaven more quickly and helps bad people get to hell more quickly. Win-win.

Yes, these advantages are more expensive, but it comes down to what a society's values are: short term temporal, or eternal spiritual.
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  #82  
Old 03-12-2020, 10:05 AM
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Or do all the taxes get collected into one huge fund and then the government of NZ or elsewhere then decide how much to spend on UHC?
That's the case in the UK. Way back, National Insurance (with compulsory employee and employer contributions) was established to fund old age pensions and rudimentary unemployment benefits, and a limited amount of support with access to medical care, but in reality both that and general taxation now go into the central government pot that all government expenditures come out of. Every now and again someone suggests a dedicated NHS tax, but the Treasury always fights tooth and nail against such "hypothecated" taxes. Naturally there's always debate/shroudwaving about how much should be spent on the NHS: historically, it's tended to go in waves of squeezes followed by splurges of catch-up spending when the clamour gets too loud for governments to ignore (and they start losing by-elections because of it).

The overall budget allocation (which may come with targets for priority investment, as it might be, mental health services or midwifery, or whatever) goes mostly to local "commissioning groups", which are governed by representatives of local GP practices, with at least a nurse as well as lay representatives with specialist financial and local knowledge. How much they get to allocate is based on a demographic formula for each area, and they decide what services to "buy" for the year, from NHS hospitals and/or outside private contractors. I may be wrong, but I think that's about 60% of the money, the rest being spent centrally on capital investment, specialist services, incentives for innovation and so on. The CCG for my area covers the local borough council area, about 260k people, and had about £420m to allocate in the most recent set of accounts.
  #83  
Old 03-12-2020, 10:20 AM
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It is difficult to reconcile the spiritual argument with the pragmatic argument.

How does one assign economic values to non-economic values? For this problem, have a look at Atif Kubursi'.

If you are looking for health and economic data, but not spiritual data, have a look at World Health Organization's annual reports on World Health Statistics, e.g. 2018, but the economic argument sans non-economic values is grossly one-sided against the spiritual argument. The WHO's data sets and reports go back for years (e.g. my post in 2004 based in part on their 2000 data).

In the United States, freedom of religion is a constitutionally protected right provided by part of the First Amendment: "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof . . . ," so one could argue that being forced into having to pay into a government medical funding system is contrary to one's constitutional right to free exercise of religion. Unfortunately, this argument has never got very far, but if the government tries to ram socialized health care down your throat, you might wish to challenge it by taking a conscientious objector approach, but don't hold your breath (well, at least if you are not ready to meet your maker quite yet), for if socialized health care to work optimally, it prefers very large / single payor base, so expect resistance to the inclusion of opting out options.
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Last edited by Muffin; 03-12-2020 at 10:24 AM.
  #84  
Old 03-12-2020, 11:37 AM
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one could argue that being forced into having to pay into a government medical funding system is contrary to one's constitutional right to free exercise of religion.
Wouldn't you have to demonstrate that there is some form of religious worship and practice that is thereby somehow prevented, inhibited or punished, in a way that does not equally apply to a government funding system for the military, fire and police services and so on? Damned if I can think of one.
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Old 03-12-2020, 01:26 PM
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I don't think I have health insurance and healthcare confused
Health care is what a patient/person receives, ranging from diagnosis and treatment to dissemination of health information.

A health care provider may be in a private practice (e.g. a family doctor) or may be publically employed (e.g. hematopathologist in a state/public hospital).

Health insurance is one, but not the only one, of the ways to pay the health care providers.

Health insurance plans can be run by the private sector or run by the public sector.

Health insurance may be funded privately by individuals/businesses, and/or publically by taxation of individuals/businesses or by some combination thereof.

There are terms that set out what a health insurance plan, be it private or public, will cover.
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Old 03-12-2020, 01:37 PM
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Wouldn't you have to demonstrate that there is some form of religious worship and practice that is thereby somehow prevented, inhibited or punished, in a way that does not equally apply to a government funding system for the military, fire and police services and so on? Damned if I can think of one.
I very much expect that you are correct, however, when it comes to the intersection of religion and the USA constitution, it's the wild west.
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  #87  
Old 03-13-2020, 08:34 AM
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I very much expect that you are correct, however, when it comes to the intersection of religion and the USA constitution, it's the wild west.
Is it? Is there a lot of precedent for this? Any examples of American courts ruling that, say, opposition to Medicare of Medicaid - which most Americans have been paying for their entire lives - is a religion? Those programs have existed for over half a century; has anyone gotten far with a lawsuit saying that paying taxes for those things violates the establishment clause?
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Old 03-13-2020, 09:47 AM
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Is it? Is there a lot of precedent for this? Any examples of American courts ruling that, say, opposition to Medicare of Medicaid - which most Americans have been paying for their entire lives - is a religion? Those programs have existed for over half a century; has anyone gotten far with a lawsuit saying that paying taxes for those things violates the establishment clause?
The exception is written into statute, 26 U.S.C. §1402(e) and (g). Paragraph (e) exempts certain religious people from the tax, if they earn income through the religion and apply for an exception. Paragraph (g) exempts certain religious people from the tax regardless of where the income comes from:
SPOILER:
"Any individual may file an application (in such form and manner, and with such official, as may be prescribed by regulations under this chapter) for an exemption from the tax imposed by this chapter if he is a member of a recognized religious sect or division thereof and is an adherent of established tenets or teachings of such sect or division by reason of which he is conscientiously opposed to acceptance of the benefits of any private or public insurance which makes payments in the event of death, disability, old-age, or retirement or makes payments toward the cost of, or provides services for, medical care (including the benefits of any insurance system established by the Social Security Act).


~Max
  #89  
Old 03-15-2020, 09:15 AM
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...

It doesn't matter what flavour of Universal Healthcare we are talking about, the basic principle is the same. The goal is healthcare for all. Nobody misses out. I won't pretend that every country gets it right every time, that there aren't flaws or problems and that we all couldn't do better than we are. But we pay less per head than you do in America for (arguably) better outcomes overall.

So the Great Debate here is a simple one: convince me that we've got this one wrong. Convince me that we should switch to the American system, and explain to me how being self-employed in such a system would make me better off. I am at a loss on how to fund the American system here. The costs are sure to be staggering because adding an entirely new infrastructure of insurance companies whom add absolutely nothing of medical value and only exist to make a profit will surely just exponentially increase our costs. Major minus.

But I'm willing to be convinced. So tell me why countries with Universal Healthcare are doing it wrong, and what we should be doing instead. And while you are at it, convince me that the American Healthcare system isn't an absolute clusterfuck, a literal dystopian nightmare and one that the coronavirus is going to expose all of the failings in one horrible swoop.
I think UHC is better than what America has. There are many ways to get to UHC, including Single-Payer like Canada, UK's NHS, Singapore's 3M system, Switzerland/Netherlands ACA-on-steroids system, etc. I think our political system in the US gets in the way of accomplishing UHC by any of the above means. We have taken steps along the way that have gotten us closer, but still have a ways to go.
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Old 03-15-2020, 09:33 AM
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..

And you've done an exceptionally poor job of explaining why you haven't gone to UHS.

But you don't have to explain it to me. I understand exactly what the problem is. America is a country that began with the subjectation of the original indigenous population, it was built off the backs of slavery, its a nation full of hypocritical values and is currently in the grips of a white supremacist regime that doesn't want to let go of any power. Most of the population has been effectively "brainwashed" by decades of propaganda that "greed is good" and "socialism is bad". There isn't any rational reason why America hasn't gone to UHS.
I think other countries that have had slavery and subjugation of indigenous populations have already accomplished UHC. So, I don't think that has anything to do with it. That's a simple-minded explanation that doesn't do anything to advance debate on why the US doesn't have UHC. If I didn't know better, I would read that as the ramblings of someone who isn't interested in understanding why we don't have UHC.

Currently, polling suggests that most Americans would support UHC:

https://www.kff.org/slideshow/public...care-coverage/

So, in spite of the brainwashing of "most" Americans that you speak of, there is majority support for UHC in this country.

There is a political system in this country that makes change difficult, hard to implement, and that puts the brakes on majorities pushing through their agenda on any topic - healthcare or any other really. So, changes over time come incrementally. Healthcare is one of those areas. And this was the case even when both parties were sane. Currently, the Republican party is not a sane party. And sometimes, we even take steps backward, which is what happened when Trump was elected, and took steps to attack the ACA.
  #91  
Old 03-15-2020, 02:44 PM
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I think other countries that have had slavery and subjugation of indigenous populations have already accomplished UHC. So, I don't think that has anything to do with it.
...it isn't just the subjugation and the slavery. That wasn't the only thing I said.

Quote:
That's a simple-minded explanation that doesn't do anything to advance debate on why the US doesn't have UHC. If I didn't know better, I would read that as the ramblings of someone who isn't interested in understanding why we don't have UHC.
And yet with your contribution here you've added nothing to the conversation. If I didn't know any better I would have read the ramblings of someone who has spent the last couple of years arguing against UHC. I'm glad you've finally come around.

Quote:
Currently, polling suggests that most Americans would support UHC:

https://www.kff.org/slideshow/public...care-coverage/

So, in spite of the brainwashing of "most" Americans that you speak of, there is majority support for UHC in this country.
You still don't have UHC. Most Americans would probably want a puppy. That doesn't mean that puppies are around the corner.

And the propaganda is daily and relentless.

Quote:
There is a political system in this country that makes change difficult, hard to implement, and that puts the brakes on majorities pushing through their agenda on any topic - healthcare or any other really. So, changes over time come incrementally. Healthcare is one of those areas. And this was the case even when both parties were sane. Currently, the Republican party is not a sane party. And sometimes, we even take steps backward, which is what happened when Trump was elected, and took steps to attack the ACA.
This doesn't dispute anything I've said.
  #92  
Old 03-18-2020, 07:00 AM
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...it isn't just the subjugation and the slavery. That wasn't the only thing I said.
I don't care if it was the only thing. You bringing up slavery is nonsense in this context.

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Originally Posted by Banquet Bear View Post
And yet with your contribution here you've added nothing to the conversation. If I didn't know any better I would have read the ramblings of someone who has spent the last couple of years arguing against UHC. I'm glad you've finally come around.
I've never argued against UHC. I've had disagreements with Bernie's Medicare for All plan, specifically the abolition of private insurance. You're mistaking one argument for the other.

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You still don't have UHC. Most Americans would probably want a puppy. That doesn't mean that puppies are around the corner.

And the propaganda is daily and relentless.
I know it's relentless. But "most" Americans as you've alleged are not brainwashed, in spite of it. That was my point.

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Originally Posted by Banquet Bear View Post
This doesn't dispute anything I've said.
But you didn't talk about it earlier. So, it needed to be said. What I said is more the reason for not having UHC than "slavery and subjugation". Your earlier post was nonsense.
  #93  
Old 03-18-2020, 08:37 AM
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I don't care if it was the only thing. You bringing up slavery is nonsense in this context.
...are you going to be bumping this thread every few days just to quibble about something I've said? Because this conversation pretty much died nearly a week ago. You are welcome to do so of course, but it was just luck that I saw this and I probably won't respond readily.

Quote:
I've never argued against UHC. I've had disagreements with Bernie's Medicare for All plan, specifically the abolition of private insurance. You're mistaking one argument for the other.
In those other discussions we talked about a generic "Medicare for all" that was a stand-in for Universal Healthcare. But it was never (always) specifically about Bernie's particular plan.

Quote:
I know it's relentless. But "most" Americans as you've alleged are not brainwashed, in spite of it. That was my point.
I used quotes around "brainwashed" for a reason. Can you guess what that reason was? And I think the evidence is clear that the propaganda has been effective. You still don't have universal healthcare. That was my point.

Quote:
But you didn't talk about it earlier.
So?

Quote:
So, it needed to be said.
Does it feel better that you got that off your chest?

Quote:
What I said is more the reason for not having UHC than "slavery and subjugation". Your earlier post was nonsense.
It was more than just "slavery and subjugation", but you've already admitted that you are going to continue to pretend that it wasn't.

You aren't doing a very good job of convincing me to stop supporting Universal Healthcare. Is there any part of the OP you would like to discuss or debate?

I'll hear from you again in about 3 or 4 days!
  #94  
Old 03-18-2020, 04:01 PM
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I'm pretty sure the standard reason to oppose UHC is because UHC means that money is going to help poor people. (And also the larger set of people who should not be helped: Everybody Who Is Not Me.) There are various other programs to help poor people, and they are also opposed by the same people who oppose UHC.

If you don't recognize the merit of wishing that poor people would suffer and die, then you don't really have the enlightened attitude necessary to support a solid philosophical opposition to UHC. You should work on that.
  #95  
Old 03-19-2020, 08:59 PM
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It was more than just "slavery and subjugation", but you've already admitted that you are going to continue to pretend that it wasn't.

You aren't doing a very good job of convincing me to stop supporting Universal Healthcare. Is there any part of the OP you would like to discuss or debate?

I'll hear from you again in about 3 or 4 days!
You seem to be taking this very personal. I'm not "pretending" on anything. You're essentially calling me a liar with that accusation. My speed of response to you is none of your business.

Post #89 is where I responded to your OP, commented on my view of UHC, which I support, and which I have supported for years. And I'm not trying to stop you from supporting UHC. I criticized your view of the reasons why we don't have UHC in the US, and I showed polling that indicates the majority of Americans are not brainwashed by the propaganda, and I offered other explanations why we don't have UHC. Don't conflate whether we have UHC with being brainwashed....those are different things.

Last edited by survinga; 03-19-2020 at 09:02 PM.
  #96  
Old 03-19-2020, 11:54 PM
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You seem to be taking this very personal.
...LOL not at all!

Quote:
I'm not "pretending" on anything.
Pretending is an apt characterization. There was a wider context to what I said. You've chosen to ignore that wider context.

Quote:
You're essentially calling me a liar with that accusation.
If I had intended to "call you a liar" I would have done so. I don't think you are a liar, I didn't intend to call you a liar, I didn't call you a liar, I didn't essentially call you a liar, calling you a liar is against the rules and I haven't done so.

I hope I've cleared that up for you.

Quote:
My speed of response to you is none of your business.
Yeah, but when you respond to a thread (especially as passionately as you have here) that died several days ago it can be hard to actually remember exactly what it was we were originally discussing. This discussion has essentially been played out. There really isn't much more that anyone can add. I'm not entirely sure what it is that you think you are adding. At best its a nitpick on a point that is entirely tangential to the OP.

Quote:
Post #89 is where I responded to your OP, commented on my view of UHC, which I support, and which I have supported for years.
You supported a system of UHC that doesn't actually guarantee universality, a cornerstone of UHC. The 3 legs of the plan you support don't deliver universality, by your own definition. This isn't UHC. Its an expanded ACA. I talked about it at length in the other thread. You refused to concede that the system you supported had gaps and wasn't universal. Now that you've bought it up again in this thread: do you concede that your system had gaps and that not everyone was guaranteed coverage? Are you now abandoning support for the expanded ACA and are you now fully behind UHC?

Quote:
And I'm not trying to stop you from supporting UHC.
But that's kinda the point of the thread

Quote:
I criticized your view of the reasons why we don't have UHC in the US, and I showed polling that indicates the majority of Americans are not brainwashed by the propaganda, and I offered other explanations why we don't have UHC. Don't conflate whether we have UHC with being brainwashed....those are different things.
I used "brainwashed" in quotes for a reason. Can you guess what that reason was? The cite doesn't say anything at all about the degree of "brainwashing": you've interpreted the data and presented a subjective conclusion, that's all.
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