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  #51  
Old 07-01-2018, 01:52 PM
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Northern Piper, you may or may not have noticed that I also responded to CelticKnot. No worries, we gave much the same answers, and it's good to reinforce the points. CelticKnot's screed bears the distinctive aroma of Republican dogma from the Holy Scripture of the American insurance lobby, a lobby that has been in mortal fear of public universal health care ever since it was first enacted in Saskatchewan and its success promoted its spread across Canada.

I wanted to point out this thread, in which a Doper is nominally just asking about getting a discount on his ambulance costs for a recent medical emergency. But what struck me rather shockingly in reading that whole story was how different the whole thing was, from a cost perspective, from my own experience in Canada with a similar medical situation.

In both cases, thankfully, the medical problem was dealt with promptly and competently after a short hospital stay. But this person -- who apparently had good insurance -- was still left with a $4000 hospital bill, and additionally, it appears, the ambulance company is billing $2000 for the ride to the hospital. I shudder to think what his hospital costs would have been if he had NOT had good insurance!

In my case, the total hospital cost was exactly zero. Not a dime. There was no ambulance involved, but if there had been, the maximum cost to the patient is $45, the rest is covered by the public plan, although in many cases there is no cost to the patient at all because the public plan covers all of it.

And this is why Canadians love their medical system, and when the American insurance lobby tries to tell everyone how terrible it is, being "socialized medicine" and all, we just laugh.

Last edited by wolfpup; 07-01-2018 at 01:54 PM.
  #52  
Old 07-01-2018, 03:58 PM
Magiver Magiver is offline
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Arguments against from conservatives generally revolve around anti-statist attitudes, combined with the idea that they don't like the idea of paying taxes to help 'unworthy' people.
We already have Medicaid for the poor. Perfect or not, nobody objects to it. Your projection of what other people think is based on your biases and not reality.

We can see the problems we've had with VA medical system in the US as well as those in other countries with UHC. The argument as I see it revolves around delays in healthcare.
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  #53  
Old 07-01-2018, 04:02 PM
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We already have Medicaid for the poor. Perfect or not, nobody objects to it. .
By nobody, I assume you mean nobody, except for leaders and members of your party?

http://thehill.com/policy/healthcare...d-cuts-in-2018

http://thehill.com/policy/finance/39...-spending-cuts

https://thinkprogress.org/paul-ryan-...-f87d810ad5b9/
  #54  
Old 07-01-2018, 04:34 PM
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Your cites don't counter what I said.
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Old 07-01-2018, 04:46 PM
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Your cites don't counter what I said.
You said that no one objects to medicaid for the poor.

I showed you citations that are your party cutting medicaid for the poor.

Yes, that counters your statement that no one objects to medicaid for the poor.
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Old 07-01-2018, 05:04 PM
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Yes, that counters your statement that no one objects to medicaid for the poor.
No it doesn't.
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  #57  
Old 07-01-2018, 05:50 PM
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No it doesn't.
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Old 07-01-2018, 06:01 PM
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No it doesn't.
Monty Python - Argument Clinic
  #59  
Old 07-01-2018, 06:03 PM
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Argument is an intellectual process ... contradiction is just the automatic gainsaying of anything the other person says.
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  #60  
Old 07-01-2018, 06:09 PM
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Budget cuts are not the same as objecting to a program. Budgets for social programs increase and decrease in relation to the economy. Right now the economy is doing better than it did 3 years ago.

My statement stands. Nobody objects to the program.
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  #61  
Old 07-01-2018, 08:48 PM
Hari Seldon Hari Seldon is offline
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Bernie's "Medicare for All Act" doesn't do that, as far as I can tell. It envisions a system with "no premiums, deductibles or copays for medical services," covers dental care, and bans providers from "dual-practice within and outside the Medicare system." Those might or might not be good ideas but they aren't how Medicare works.
Except for dental care, that is essentially what we have in Canada (in Quebec anyway, each province has its own rules). Doctors who are in the system (nearly all) have to accept what the province pays them with no copay or deductibles. Doctors outside the system (a few) cannot collect anything from the province (there is an exception in case a doctor comes on a medical emergency). There can be long wait times for elective procedures, but emergencies are treated immediately. It costs something like 47% of our provincial budget and is well worth it.

Incidentally, one province (Saskatchewan) started this on its own quite successfully and then the federal government mandated that every province do so. I doubt the US Federal government could do that, so it would have to be a national system.
  #62  
Old 07-01-2018, 09:26 PM
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I would say it's the other way, Hari - the federal government in Canada didn't mandate that the provinces provide medicare; it lacks the power to compel the provinces to do something.

Rather, the feds offered lots of money to the provinces to provide medicare. And didn't refund any taxes to provinces that didn't sign on, so if they didn't sign on, they would essentially be subsidising the health care for citizens in other provinces. The US federal government could take a similar approach, not trying to run the health care system in the 50 states, but offering them money to do it by a UHC system.
  #63  
Old 07-02-2018, 12:20 AM
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Budget cuts are not the same as objecting to a program. Budgets for social programs increase and decrease in relation to the economy. Right now the economy is doing better than it did 3 years ago.

My statement stands. Nobody objects to the program.
Nobody objects to it, but Republican governors were dead set against expanding it, and the House Republican healthcare bill would have cut Medicaid funding substantially.

Hard to find a direct quote, but here is one from here :
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For Democrats, the Senate GOP’s Better Care Reconciliation Act, which ends Medicaid’s entitlement status, is a “monstrosity.” For many Republicans, it is nirvana. “You and I have been dreaming of this since I have been around, since you and I were drinking at a keg,” House Speaker Paul Ryan told Rich Lowry, editor of National Review, earlier this year.
  #64  
Old 07-02-2018, 01:01 AM
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Sigh.

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Originally Posted by Magiver View Post
We can see the problems we've had with VA medical system in the US as well as those in other countries with UHC.
We've fought this ignorance before. The Board's motto—"It's Taking Longer Than We Thought"—is quite an understatement.

Despite its lower funding, users of the VA medical system are about as satisfied with their care as are insured customers of the U.S. private health system. One can find problems in either system; which problems you write or read about are a function of political agenda.

So I'd like a cite for the "problems we've had with VA medical system in the US". Credible cites, please — Nobody doubts that the Google search "Republicans say VA is a pile of shit born in Kenya" will get hits.
  #65  
Old 07-02-2018, 12:21 PM
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Medicare fraud is a real problem, but that's yet another reason to expand the program to cover everyone. What is fraud? It's someone trying to get something out of the system that they're not entitled to. But if everyone is entitled to it, then where's the fraud?
Medicare fraud is not people pretending to be old to get free coverage. It is people setting up clinics or using existing doctors to bill Medicare for procedures that were never performed. Medicare fraud is currently thought to be more than the combined state budgets of Virginia and Nebraska. Quadrupling the size of the program would likely make it even harder to monitor fraud and would likely mean Medicare fraud of at least $250 billion dollars a year.
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Old 07-02-2018, 02:16 PM
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Medicare fraud is not people pretending to be old to get free coverage. It is people setting up clinics or using existing doctors to bill Medicare for procedures that were never performed. Medicare fraud is currently thought to be more than the combined state budgets of Virginia and Nebraska. Quadrupling the size of the program would likely make it even harder to monitor fraud and would likely mean Medicare fraud of at least $250 billion dollars a year.
This is yet another example of what might be called the fallacy of false extrapolation that we hear so often from the American right when expounding on universal health care. The fallacy always takes the form "we have problem 'X' with the present health care system, so if we had UHC problem 'X' would be proportionately worse". The root of the fallacy, of course, is that moving to a coordinated universal system mitigates many of those problems.

The most egregious such fallacy is the one that just linearly extrapolates total costs by simply adding in the extra number of presently uninsured, completely ignoring the significant cost saving that arise, not just from savings in administrative costs, but from the opportunity to monitor and regulate provider fees. The fallacy about fraud is less egregious but similarly overlooks crucial structural differences in UHC.

There has never been any evidence, for instance, that health care billing fraud exists in Canada at anywhere even remotely close to the levels experienced in the US. There are probably many reasons for this, but arguably the most important one is that an integrated single payer that pays for all medically necessary services has unique opportunities for fraud detection by systematic analysis of billing patterns.

Most provinces use a combination of fraud control measures including random audits, verification with patients, data mining, and activity pattern analysis. The province of Ontario maintains a Provider Payment Unit responsible for this monitoring, and contracts out investigations to the health fraud unit of the provincial police force. Over the course of 15 years, between 1998 and 2013, the fraud unit investigations found only 1800 cases serious enough to secure convictions, which resulted -- over those 15 years -- in just $9 million in restitutions, out of a total Ontario health care budget that currently exceeds $55 billion a year. In the smaller province of Manitoba, health care fraud recoveries have averaged on the order of some $250K annually. With systematic detection of large-scale fraud and serious impact to a doctor's practice that discourages petty fraud, fraud just isn't that big a problem.
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Old 07-02-2018, 07:06 PM
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Sigh.

We've fought this ignorance before. The Board's motto—"It's Taking Longer Than We Thought"—is quite an understatement.
Seriously, you weren't aware of the problems with the VA? You weren't aware that Veterans Affairs Secretary Eric Shinseki was fired over it along with close to a thousand other people?
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  #68  
Old 07-02-2018, 07:10 PM
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Seriously, you weren't aware of the problems with the VA? You weren't aware that Veterans Affairs Secretary Eric Shinseki was fired over it along with close to a thousand other people?
If that's an argument against single payer, then an argument for it is the absolutely world-class care that active-duty military receive (seriously -- when I was in the Navy, making appointments and getting good quality care was incredibly easy and essentially free) is just as much, if not more, an argument for how good entirely government-run health care can be, when run well. A well run government health care system can be great. A poorly run one will be crappy.
  #69  
Old 07-03-2018, 12:39 PM
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This is yet another example of what might be called the fallacy of false extrapolation that we hear so often from the American right when expounding on universal health care. The fallacy always takes the form "we have problem 'X' with the present health care system, so if we had UHC problem 'X' would be proportionately worse". The root of the fallacy, of course, is that moving to a coordinated universal system mitigates many of those problems.

The most egregious such fallacy is the one that just linearly extrapolates total costs by simply adding in the extra number of presently uninsured, completely ignoring the significant cost saving that arise, not just from savings in administrative costs, but from the opportunity to monitor and regulate provider fees. The fallacy about fraud is less egregious but similarly overlooks crucial structural differences in UHC.

There has never been any evidence, for instance, that health care billing fraud exists in Canada at anywhere even remotely close to the levels experienced in the US. There are probably many reasons for this, but arguably the most important one is that an integrated single payer that pays for all medically necessary services has unique opportunities for fraud detection by systematic analysis of billing patterns.

Most provinces use a combination of fraud control measures including random audits, verification with patients, data mining, and activity pattern analysis. The province of Ontario maintains a Provider Payment Unit responsible for this monitoring, and contracts out investigations to the health fraud unit of the provincial police force. Over the course of 15 years, between 1998 and 2013, the fraud unit investigations found only 1800 cases serious enough to secure convictions, which resulted -- over those 15 years -- in just $9 million in restitutions, out of a total Ontario health care budget that currently exceeds $55 billion a year. In the smaller province of Manitoba, health care fraud recoveries have averaged on the order of some $250K annually. With systematic detection of large-scale fraud and serious impact to a doctor's practice that discourages petty fraud, fraud just isn't that big a problem.
This is an example of the "wishing away" fallacy. The discussion is about Medicare, not the Canadian system. Therefore what the Canadian system does is not relevant. Medicare has a huge problem with fraud and will continue to unless those running it commit to ending the fraud. The problem is not that Medicare is not big enough to monitor fraud, it is already much bigger than the Canadian system but those in charge have not changed the program to end the fraud. There is no reason to think that they would do so after the program is quadrupled in size. Ignoring this is just wishing the problem away.
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Old 07-03-2018, 01:11 PM
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If that's an argument against single payer, then an argument for it is the absolutely world-class care that active-duty military receive (seriously -- when I was in the Navy, making appointments and getting good quality care was incredibly easy and essentially free) is just as much, if not more, an argument for how good entirely government-run health care can be, when run well.
How many active-duty military are retired, or have chronic health problems? The characteristics of the populations being covered make more than a little difference.
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Originally Posted by wolfpup
The most egregious such fallacy is the one that just linearly extrapolates total costs by simply adding in the extra number of presently uninsured, completely ignoring the significant cost saving that arise, not just from savings in administrative costs, but from the opportunity to monitor and regulate provider fees.
Administrative costs for Medicare are not significantly lower than for private insurance; they are just accounted for differently.

As far as monitoring and regulating provider fees, doctors and hospitals already lose money on 65% of their Medicare patients. So if we implement MfA, we either raise taxes to cover the shortfall (if we don't allow the two-tier system against which you have already argued), or health care providers need to reduce salaries, fees, costs of equipment, pharmaceuticals, nurses and technicians' salaries, etc., by about a third, or go out of business. And we can't just raise taxes on the rich - there aren't enough rich to tax.

Of course, doctors graduate from medical school with significant debt, and reducing their compensation will mean it is that much more difficult to pay back the debt. We could subsidize medical school, which means even more taxes.

Also, Medicare as it currently stands will run out of money in 2026.

It can be done, I suppose. The problems are that it is unavoidable that taxpayers will have to pay more, health care consumers will get less, and health care providers will have to reduce what they charge. No one will be happy. And that is a best-case scenario.

Regards,
Shodan
  #71  
Old 07-03-2018, 03:15 PM
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This is an example of the "wishing away" fallacy. The discussion is about Medicare, not the Canadian system. Therefore what the Canadian system does is not relevant. Medicare has a huge problem with fraud and will continue to unless those running it commit to ending the fraud. The problem is not that Medicare is not big enough to monitor fraud, it is already much bigger than the Canadian system but those in charge have not changed the program to end the fraud. There is no reason to think that they would do so after the program is quadrupled in size. Ignoring this is just wishing the problem away.
I've noticed in the past in these discussions that all evidence that supports the benefits of universal health care is deemed irrelevant by those who oppose it. I provided a real-world example of a UHC system with very low rates of fraud, and an explanation for why an integrated universal system can have a much better handle on fraud detection than today's Medicare, which is an almost mind-bogglingly complicated system of partial coverages and intertwined shared obligations. You just continue to insist that Medicare will always have big fraud problems because it has those problems today. This is just like insisting that UHC will always have big cost problems because US health care has big cost problems today, despite the fact that UHC does a far better job of cost containment everywhere in the world without exception.

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Administrative costs for Medicare are not significantly lower than for private insurance; they are just accounted for differently.
I believe this has been shown to be false, but to the extent that Medicare's administrative costs are higher than single-payer, see above -- Medicare is an inordinately complicated system because it's inherently limited, partial, and intertwined with private insurance. Administrative costs are obviously going to be far lower with straightforward universal single-payer, unless you want to argue that an army of actuaries that assess and rate individual risk and another army of claims adjusters that scrutinize every single claim and all the paperwork associated with that gargantuan overhead comes absolutely free, because none of that exists in single-payer -- not to mention yet another army of administrative personnel in doctors' offices whose sole job is to interface with insurance companies so their employers get paid, which is also non-existent in single-payer.

As per the cite I provided earlier, the administrative overhead alone that you claim doesn't exist has been estimated to exceed $500 billion annually. To put it another way: the administrative waste in the US health care system -- the total waste that is equivalent to throwing bushels of money out the window -- is almost ten times the total Ontario health care budget that provides full health care coverage free of any extra cost for 15 million people. If I don't seem to like health insurance companies very much it's because the only word that covers that magnitude of profligate waste of national treasure is "obscene".
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As far as monitoring and regulating provider fees, doctors and hospitals already lose money on 65% of their Medicare patients. So if we implement MfA, we either raise taxes to cover the shortfall (if we don't allow the two-tier system against which you have already argued), or health care providers need to reduce salaries, fees, costs of equipment, pharmaceuticals, nurses and technicians' salaries, etc., by about a third, or go out of business. And we can't just raise taxes on the rich - there aren't enough rich to tax.
Yet another misleading argument that assumes that the costing and overhead structure in UHC would be the same as the present system, an assumption belied by the fact that every UHC system in the world has only a fraction of the per-capita cost of the broken and uncontrolled system in the US. Doctors in Canada are paid only a fraction of the fees they're paid in the US for the same services, yet far from "losing money", they manage to be about as wealthy as you'd expect doctors to be in a first-world nation. Why? Because they always get paid for services with neither hassles nor collection overhead, and they never get stiffed either by patients or their insurance companies.
  #72  
Old 07-03-2018, 03:52 PM
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Yet another misleading argument that assumes that the costing and overhead structure in UHC would be the same as the present system...
No it doesn't - I said explicitly that taxes would have to rise and/or services and overhead reduced.

Medicare currently causes health care providers to lose money most of the time, is running out of funding, it has the same administrative overhead as private insurance, but if we implement it for everybody then all those problems go away because it's bigger.

Buy at seven, sell at five, make up the difference on volume.

Regards,
Shodan
  #73  
Old 07-03-2018, 04:03 PM
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Medicare currently causes health care providers to lose money most of the time, is running out of funding, it has the same administrative overhead as private insurance, but if we implement it for everybody then all those problems go away because it's bigger.
I can't tell if you didn't understand what I said or just choose to intentionally misrepresent it. Wasteful overhead doesn't go away "because it's bigger". Wasteful overhead goes away because it's universal, and therefore structurally different.

Once you've achieved universality you have major cost control breakthroughs on many fronts and hugely streamlined the whole system. I've described all this (just above, but in fact, also many times in many threads) and I'm not going to repeat myself again. I really think you just fundamentally don't understand how single payer works. I also think that some conservatives have a kind of mental block that tells them that anything so ideologically alien to them couldn't possibly work.
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Old 07-03-2018, 04:15 PM
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One common argument for No Medicare For All:

Illness is a punishment from God.
You sinned and offended God and that is why you are sick.
I (a God-Fearing person with no interest in the well-being of others) do not want to pay for your sins.
Also, on a more dis-interested note. Many, many Americans just don't give a single solitary c#@p about their health until they need to.


I don't believe any of the above, but I find this to be a very common mindset amongst the conservative-minded folk.
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Old 07-03-2018, 04:55 PM
Textual Innuendo Textual Innuendo is offline
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It would put out of business thousands upon thousands of people who make their living devising, selling, billing and accounting for medical insurance. Perhaps such a program should include re-training and soul transplants for these people so they can function in the new system.
Or alternatively, we could just do the mirror image of the insurance industry:
Allow severely sick people to administer a program where they evaluate and choose whether a given former health-insurance employee qualifies for re-training and unemployment income.

If not, it's "oh, so sorry, I know you are going through a tough time and needed a job (kidney) to live, but your unemployment agency didn't courier form 2027G to our moonbase office in time, and we just can't cover this claim."

If the sick folk decide enough of them DON'T qualify, they get fat bonuses for being fiscally conservative and making the hard decisions that keep the enterprise afloat. It's win/win!
  #76  
Old 07-03-2018, 05:30 PM
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No it doesn't - I said explicitly that taxes would have to rise and/or services and overhead reduced.

Medicare currently causes health care providers to lose money most of the time, is running out of funding, it has the same administrative overhead as private insurance, but if we implement it for everybody then all those problems go away because it's bigger.

Buy at seven, sell at five, make up the difference on volume.

Regards,
Shodan
And it has a customer base that's vastly more healthy than the current make up.
Medicare(currently) is the ultimate in high risk groups,
  #77  
Old 07-03-2018, 08:33 PM
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Many, many Americans just don't give a single solitary c#@p about their health until they need to.
QFT. We have the attention span of goldfish.
  #78  
Old 07-04-2018, 02:04 PM
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Ají de Gallina Ají de Gallina is offline
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One common argument for No Medicare For All:

Illness is a punishment from God.
This isn't remotely a common argument. I'm sure someone actually believes it for their religious purposes but not as public policy.
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You sinned and offended God and that is why you are sick.
This isn't remotely a common argument. I'm sure someone actually believes it for their religious purposes but not as public policy.
Quote:
I (a God-Fearing person with no interest in the well-being of others) do not want to pay for your sins.
This isn't remotely a common argument. I'm sure someone actually believes it for their religious purposes but not as public policy.
Quote:
Also, on a more dis-interested note. Many, many Americans just don't give a single solitary c#@p about their health until they need to.
Most people in the world have trouble seeing 10% (for example) of their income go away for the possibility of using it maybe in 20 years, especially if money is tight now and your kid need diapers now.

Quote:
I don't believe any of the above, but I find this to be a very common mindset amongst the conservative-minded folk.
You DO believe it is a common argument.
Mops people who don't want MFA is their inability of choosing what they want and taking on themselves the risk/reward equation they want. Obama said "you can keep your plan if you like it" and then they didn't. Some people like high-deductible plans some don't. Also, the "government waste" argument is common.
"Punishment from God" is very rare.
  #79  
Old 07-04-2018, 02:34 PM
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Most people in the world have trouble seeing 10% (for example) of their income go away for the possibility of using it maybe in 20 years, especially if money is tight now and your kid need diapers now.
You are completely wrong about what "most people in the world" seem to want. If "most people" didn't want universal health care they wouldn't vote for governments that establish it and they wouldn't have it and they wouldn't be happy with it. But they do, and they are, in every civilized country in the world. Except in the US where insurance lobbyists and their Republican servants have brainwashed a significant segment of the population into believing that "socialized medicine" isn't in their best interests.
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Mops people who don't want MFA is their inability of choosing what they want and taking on themselves the risk/reward equation they want. Obama said "you can keep your plan if you like it" and then they didn't. Some people like high-deductible plans some don't. Also, the "government waste" argument is common.
Actually, complicated risk/reward "equations" isn't what anybody really wants or needs in health care. What people really want and need is to receive quality health care when they are sick, simple as that. And they want those quality services delivered efficiently, at the lowest possible cost. That's just what they get in every country in the world, where health care is delivered at a fraction of what it costs in the US. If that's "government waste", you should want some of that! The only thing your "risk/reward equations" do is make medical costs the #1 cause of bankruptcies in the US.
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Old 07-04-2018, 03:36 PM
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Used to be, the jury was still out, but widespread public health works! Even the poorest of countries benefit to the extent they are capable of implementing it. If for no other reason than one simple fact: many of the medical crises that demand massive interference start as things that demand only an informed opinion.

The investment return ratio on public health is a thing that would send the most ruthless capitalist into spasms of glee if it were money rather than people.

It is why notorious radicals like Otto von Bismarck supported it, healthy people are productive workers and better soldiers. For all of conservative's postures of being hard-nosed realists, they are markedly invulnerable to fact. It is by its very nature so positive that not even the dull thud of bureaucracy can kill it. The craven lust for profit will, or course, kill it in its tracks. Naturally, that is their preference. Thick as a brick and not as buoyant.

Last edited by elucidator; 07-04-2018 at 03:37 PM.
  #81  
Old 07-04-2018, 04:04 PM
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It's common for people to argue that Medicare for All or other government run healthcare is unconstitutional . Frankly I don't buy this argument at all.

Let's look at Article 1, Section 8, Clause 1 of the United States Constitution:

"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;"

It's blatantly stated above that Congress has authority to provide for the general welfare of the United States. I think ensuring the citizens of the United States are in good health would constitute providing for the general welfare of the United States as a whole.

And for people who argue that's not what the Founding Fathers intended, you should keep in mind George Washington himself pressured Congress to grant funds to ensure that people could get vaccinated from smallpox. The Founding Fathers were also aware of bubonic plague and that it caused almost a third of Europe's population to die in the 1400's. So it's extremely unlikely they would been opposed to government intervention in order to prevent a second occurrence of that event.
  #82  
Old 07-04-2018, 04:15 PM
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Wild idea here, folks. Do a test case where we drop the medicare age from 65 to 60. This will do two things. It will take the oldest (and likeliest of those on the private insurance market to be sick) and sickest people out of the private insurance market. And it will put them onto Medicare where they will now be the youngest and likeliest to be healthy. Seems that both private insurance and Medicaid will benefit. Evaluate in a few years. Lather, rinse, repeat.
  #83  
Old 07-04-2018, 04:34 PM
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Regarding your second question--
FDR decided that he was going to flat-out ignore the Constitution. And a great many people were happy to let him do so. The situation has not improved since.
Article I, Section 8 gives Congress the power to regulate interstate commerce.

Like it or not, we've got a very complex, interdependent society these days; FDR hadn't seen nothin' yet. If you walk into a burger joint and order a cheeseburger, chances that every part of that cheeseburger came from in state are somewhere between slim and none.
  #84  
Old 07-05-2018, 07:45 AM
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And it has a customer base that's vastly more healthy than the current make up.
Medicare(currently) is the ultimate in high risk groups,
And therefore Tricare for All is probably no more extensible to everyone than Medicare for All.

But that was part of the idea underlying Obamacare - that we would force a lot of folks who weren't insured to be insured, they would pay premiums but not use the services, and that would reduce premiums. We all know how that worked out - premiums went up (not down by $2500 a year), utilization and emergency room visits went up, not down, and yet another government program founded on lies and contempt for the American electorate founders on the rocks of actuality.

Regards,
Shodan
  #85  
Old 07-05-2018, 09:23 AM
Red Wiggler Red Wiggler is online now
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Wild idea here, folks. Do a test case where we drop the medicare age from 65 to 60. This will do two things. It will take the oldest (and likeliest of those on the private insurance market to be sick) and sickest people out of the private insurance market. And it will put them onto Medicare where they will now be the youngest and likeliest to be healthy. Seems that both private insurance and Medicaid will benefit. Evaluate in a few years. Lather, rinse, repeat.
I don't think this is crazy at all. If the Dems can win back Congress, the qualifying age of Medicare can be gradually lowered until the tipping point of general support is reached. A phase-in will also have the benefit of easing the transition on the federal bureaucracy which will be charged with administering it, and which will need to grow larger to handle the details of a universal system paying for 325 million of us.

I contend that this is the big coming issue and will face the sternest opposition since Social Security. Conservatives know that this is a battle for the nation's fundamental structure that they cannot afford to lose (well, they can, they just don't know it).
  #86  
Old 07-05-2018, 09:59 AM
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We already have Medicaid for the poor. Perfect or not, nobody objects to it. Your projection of what other people think is based on your biases and not reality.

We can see the problems we've had with VA medical system in the US as well as those in other countries with UHC. The argument as I see it revolves around delays in healthcare.
Republicans have been trying to kill Medicare and Medicaid for 60 years and Social Security for 80 years. Killing Medicaid is the wettest of all Paul Ryan dreams.
  #87  
Old 07-05-2018, 10:12 AM
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When you talk about the cost savings in Europe, it is heavily due to the fact that healthcare wages are about 2/3 of what they are here.
So are wages in general, so that argument is moot.
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  #88  
Old 07-05-2018, 10:20 AM
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Shit! That's getting right up there with the Toxic Asset Relief Program! And not even given to banks, but squandered on people!
Yea, well the banks pay it back. The government profited $15.3B from TARP. See if you get that kind of return from Medicare patients. Bonus: The economy didn't collapse.

I am no fan of banks and I don't think they were taken to task like they should have been, but blows my mind when TARP is brought up as poster boy of Government waste for the rich.
  #89  
Old 07-05-2018, 11:21 AM
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I've noticed in the past in these discussions that all evidence that supports the benefits of universal health care is deemed irrelevant by those who oppose it. I provided a real-world example of a UHC system with very low rates of fraud, and an explanation for why an integrated universal system can have a much better handle on fraud detection than today's Medicare, which is an almost mind-bogglingly complicated system of partial coverages and intertwined shared obligations. You just continue to insist that Medicare will always have big fraud problems because it has those problems today. This is just like insisting that UHC will always have big cost problems because US health care has big cost problems today, despite the fact that UHC does a far better job of cost containment everywhere in the world without exception.

You are trying to compare the current system versus a hypothetical Medicare that has fixed all its problems. It is easy to imagine a healthcare system that is better than Medicare at fraud detection, is much cheaper, and more effective. But the problem is the idea is not to create a hypothetical system from scratch or to import a better working system from abroad. The idea is to take the current actually existing Medicare and add several hundred million people to it.
A better idea would be to fix Medicare, fix the scores of billions of fraud, fix the wait times and problems with physicians not taking it, and fix its effectiveness and only then consider expanding it. After all fixing a small program should be easier than fixing a huge program.
  #90  
Old 07-05-2018, 11:30 AM
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Quoth puddleglum:

Medicare fraud is not people pretending to be old to get free coverage. It is people setting up clinics or using existing doctors to bill Medicare for procedures that were never performed.
Why would that increase at all if Medicare were expanded?
  #91  
Old 07-05-2018, 11:37 AM
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After all fixing a small program should be easier than fixing a huge program.
Except of course, when it is the very economies of scale that we are trying to take advantage of.

It's easy, prosecute the hell out of people who set up clinics for the purpose of defrauding the govt. It's not that hard to detect, really, and is only hidden at all due to the layers of bureaucracy that the private/public market hybrid causes.

If there isn't these multiple levels of coverage and care that has to be determined individually for each and every patient, then it would be much easier to see the clinic that is billing for patients, but that patients aren't actually going there.

When I hear about fraud, though, the speaker is almost invariably talking about people lying about their means or their ability to pay in order to get services that they would not be entitled to under current law. With universal coverage, this fraud is entirely eliminated.
  #92  
Old 07-05-2018, 11:42 AM
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Why would that increase at all if Medicare were expanded?
If Medicare covers more people, more people are going to try to defraud it. Same reason that Willie Sutton supposedly robbed banks - because that's where the money is.

Unless you think that those who are currently trying to defraud private insurance companies would never consider trying to defraud whatever replaces private insurance companies.

Regards,
Shodan
  #93  
Old 07-05-2018, 01:10 PM
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If Medicare covers more people, more people are going to try to defraud it. Same reason that Willie Sutton supposedly robbed banks - because that's where the money is.

Unless you think that those who are currently trying to defraud private insurance companies would never consider trying to defraud whatever replaces private insurance companies.
People defraud medicare because they are not eligible for it, so they fraudulently claim that they are in order to get medical care to save their life or increase the quality of same.

If everyone is covered, then what fraud would someone be committing in trying to get medical care?

To put it another way, the reason that people fraud medicare is because it doesn't cover them, if they are covered, then can you explain why (and how) would they commit fraud?

Last edited by k9bfriender; 07-05-2018 at 01:10 PM.
  #94  
Old 07-05-2018, 01:47 PM
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To put it another way, the reason that people fraud medicare is because it doesn't cover them, if they are covered, then can you explain why (and how) would they commit fraud?
People with good private health insurance don't go see their doctor for every minor sniffle, but 38% of Americans believe that people with government-paid health insurance will do precisely that.

I'm not sure if this is because the people government insurance would cover are "the wrong sort of people." Or if it's because the "right sort of people" will overuse Medicare as deliberate sabotage to remind us all what a Marxist monstrosity it is.
  #95  
Old 07-05-2018, 02:29 PM
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If Medicare covers more people, more people are going to try to defraud it. Same reason that Willie Sutton supposedly robbed banks - because that's where the money is.

Unless you think that those who are currently trying to defraud private insurance companies would never consider trying to defraud whatever replaces private insurance companies.

Regards,
Shodan
Who do you think is involved with Medicare fraud? Is it patients - or providers who bill for nonexistent services. Since any provider who wants to commit fraud is signed up already, why do you think more people signing up is going to change anything?
I don't think people signing up fraudulently is a big problem. First, the gummint knows your birth date (they never looked at my birth certificate when I signed up,) and identity theft would result in multiple signups for the same SSN, easy to detect.
Not to mention a 30-year old giving a Medicare card to a provider is a dead giveaway.
Medicare, btw, pays a $1,000 bounty for reporting fraud - which is getting a statement that Medicare paid for services you never got. Alas I suspect the fraudsters do this for the very old, so it might not be that effective, but putting young people in the system is not going to increase this type of fraud either.
  #96  
Old 07-05-2018, 02:30 PM
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I'm not sure if this is because the people government insurance would cover are "the wrong sort of people." Or if it's because the "right sort of people" will overuse Medicare as deliberate sabotage to remind us all what a Marxist monstrosity it is.
"I'm sitting here in this depressing waiting room surrounded by contagious people to smash the state.
Achoo!"
  #97  
Old 07-05-2018, 02:48 PM
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Except of course, when it is the very economies of scale that we are trying to take advantage of.

It's easy, prosecute the hell out of people who set up clinics for the purpose of defrauding the govt. It's not that hard to detect, really, and is only hidden at all due to the layers of bureaucracy that the private/public market hybrid causes.

If there isn't these multiple levels of coverage and care that has to be determined individually for each and every patient, then it would be much easier to see the clinic that is billing for patients, but that patients aren't actually going there.

When I hear about fraud, though, the speaker is almost invariably talking about people lying about their means or their ability to pay in order to get services that they would not be entitled to under current law. With universal coverage, this fraud is entirely eliminated.
If it is easy why hasn't it been done already?
People lying about their ability to pay is not relevant to Medicare because it is age dependent and not means tested. The three most common types of Medicare fraud are: Phantom Billing, Patient Billing, and Upcoding. None of these would be diminished by having more people sign up. Patient Billing, in which a patient provides the provider their information in exchange for some money so that the provider can make phantom charges with them, would likely increase as more people would be eligible for it and many of those would be more desperate for money than old people.
One of the reasons that fraud is so prevalent is that people doing the billing for the government are drinking from a water hose. There is so much paperwork that it is easy to hide fraud and since it is not their money no one has a reason to stop it. Quadrupling the program would mean more paperwork which would make fraud easier to hide, it would also mean hiring alot more bureaucrats would would be inexperienced and easier to fool. The reason Medicare is so vulnerable is that it pays firsts and investigates later. The so called Pay and Chase model is used because it prevents politically unpopular delay in being seen. Giving Medicare patients more political power would make reform less likely.
  #98  
Old 07-05-2018, 03:07 PM
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People with good private health insurance don't go see their doctor for every minor sniffle, but 38% of Americans believe that people with government-paid health insurance will do precisely that.

I'm not sure if this is because the people government insurance would cover are "the wrong sort of people." Or if it's because the "right sort of people" will overuse Medicare as deliberate sabotage to remind us all what a Marxist monstrosity it is.
People with insurance go to the doctor 50% more than those without insurance.
  #99  
Old 07-05-2018, 03:08 PM
k9bfriender k9bfriender is online now
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If it is easy why hasn't it been done already?
Good question. Why hasn't anyone done this already? Anyone at all?

Oh, wait, I know the answer, and it is that it has been done already, by every industrialized nation on earth except for us.
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People lying about their ability to pay is not relevant to Medicare because it is age dependent and not means tested. The three most common types of Medicare fraud are: Phantom Billing, Patient Billing, and Upcoding. None of these would be diminished by having more people sign up. Patient Billing, in which a patient provides the provider their information in exchange for some money so that the provider can make phantom charges with them, would likely increase as more people would be eligible for it and many of those would be more desperate for money than old people.
One of the reasons that fraud is so prevalent is that people doing the billing for the government are drinking from a water hose. There is so much paperwork that it is easy to hide fraud and since it is not their money no one has a reason to stop it. Quadrupling the program would mean more paperwork which would make fraud easier to hide, it would also mean hiring alot more bureaucrats would would be inexperienced and easier to fool. The reason Medicare is so vulnerable is that it pays firsts and investigates later. The so called Pay and Chase model is used because it prevents politically unpopular delay in being seen. Giving Medicare patients more political power would make reform less likely.
You are correct that I conflate the arguments against medicaid and medicare, but What is wrong with prosecuting people who commit fraud? Throw them in jail.

As Shodan said, the reason that people rob banks is because that is where the money is. Unless you are saying that that is an argument for getting rid of banks, rather than prosecuting bank robbers, then being worried about people breaking the law in regards to medicare is the same thing, just an excuse, not a reason.
  #100  
Old 07-05-2018, 03:13 PM
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People with insurance go to the doctor 50% more than those without insurance.
What's your point?

That private health insurance is just as unsustainable as Medicare?
Or that under Medicare for all, some people will get (heaven forbid!) the medical attention they need?
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