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  #501  
Old 01-12-2019, 12:31 AM
SlackerInc SlackerInc is offline
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Even in Vermont, single payer ended up crashing on the shoals because all the taxes and disruption were, at the end of the day, too big a lift. Vermont. Home of Bernie Sanders (and Howard Dean for that matter). If voters in that state of all places balked, what do you think is going to happen in Ohio?


https://www.npr.org/2017/09/13/55075...led-in-vermont

Quote:
BLUMBERG: I think there's a combination of causes why it didn't work. So the lack of funding is clearly part of it because once they sat down and assessed what types of taxes they would need in order to make the plan feasible, they were, on the face of them, pretty high. And so they figured that they would not be politically palatable.
But I think part of it aside from just the sheer tax revenue that would be needed to finance a program like this - what they ran into was a real administrative and process problem also because they weren't explaining to people in a clear way over time, here's what the costs are going to be; here's what the benefits are going to be. Here's who's going to pay more. Here's who's going to pay less. This is why it's worth it for us to move from the system we're in to another one. And because this is such a big change, then when you just see the price tag, it's very shocking if you don't have an understanding of what is the core value behind doing this kind of change.

SHAPIRO: In Vermont, Governor Shumlin ultimately backed away from his signature policy after a few years. And having studied it, I wonder whether you see a way that it could easily have worked. Is there a simple fix that would have made it successful, or is the lesson that it's just really, really complicated and difficult to get something like this in place?

BLUMBERG: I think the lesson is it's very difficult. And it's not that it can't be done. We could certainly raise enough revenue to finance a program like this. But the problem is - is that any program like this has to assess what's going to be the role for private insurers? What's going to be the level of benefits and cost-sharing requirements? How are - at what level are providers going to be paid? These are political challenges at every turn.[…]

SHAPIRO: What kind of impact did the failure of this state policy in Vermont have on the national conversation around single-payer health care?

BLUMBERG: Well, I think it was a - an indication for a lot of folks who look at these issues regularly that, you know, the financing part and the face difficulty, the challenges of seeing these large tax increases is really very politically challenging. And that's aside from having a national political resistance from industries like the private insurance industry, the providers and others. So it really I think is a telling example of what the challenges are. Not that they couldn't someday be overcome, but there's a real transition issue between getting from here to there.

These are difficulties that people here, and more broadly most progressives who are rallying behind the MFA banner, just aren't honestly reckoning with.
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  #502  
Old 01-12-2019, 01:51 AM
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Originally Posted by SlackerInc View Post
Straw man.
You realize that those aren't just magic words that make an argument vanish, right? I quoted you and replied. If I misrepresented what you said (given the context that you had previously said you can't just assume two countries are the same), you'll have to explain how.

Or were you saying "straw man" to announce that you were just about to set one up [my bold]...

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Originally Posted by SlackerInc View Post
I'm adamant that we can't just adopt another country's system this late in the game and expect that it will get our costs down to parity with theirs.
The perfect is the enemy of the good.

Given that their costs are generally half our costs or less, nor do I. But you're implying that's a reason not to do it!
Surely that massive disparity is pretty fucking compelling evidence that we could at least get our costs under control by adopting UHC funded through general taxation, and eventually down maybe 10% or 20%? That's even without the moral aspect - you know, the "universal" part, that a civilized rich country shouldn't be letting many of its citizens just suffer and die.

Last edited by Riemann; 01-12-2019 at 01:56 AM.
  #503  
Old 01-12-2019, 02:10 AM
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Even in Vermont, single payer ended up crashing on the shoals because all the taxes and disruption were, at the end of the day, too big a lift.
So do you care about precedent or not? I call your Vermont precedent, and raise you the precedent of every other country in the world.

You're pulling the same nonsense as the gun lobby, conflating unwillingness to do something properly with impossibility. The fact that we may not have the political will to implement UHC sensibly at the federal level, accompanied by all the other massive reforms that are essential, does not mean it's impossible.

Last edited by Riemann; 01-12-2019 at 02:11 AM.
  #504  
Old 01-12-2019, 03:10 AM
SlackerInc SlackerInc is offline
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Of course it’s possible. If our system were like China’s, we could just implement any policy the experts recommended. Which is a true strength of theirs. But we have to treat the political hurdles as part of the landscape and adjust our ambition accordingly.
  #505  
Old 01-12-2019, 03:20 AM
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Of course it’s possible. If our system were like China’s, we could just implement any policy the experts recommended. Which is a true strength of theirs. But we have to treat the political hurdles as part of the landscape and adjust our ambition accordingly.
Fine, so are you're now following Shodan's lead, and revoking any claim that UHC is a bad idea in principle, or that it's impossible to implement in the U.S. in principle?

It was never in dispute that it's going to be extremely difficult to gain the political will to do it, to dispel the propaganda and blatant lies that have convinced the Republican working class "base" to vote against their own economic interest for decades. But just as with gun control, a lack of political consensus to change anything does not imply that the answer that is staring you in the face is "impossible".

Last edited by Riemann; 01-12-2019 at 03:20 AM.
  #506  
Old 01-12-2019, 03:36 AM
SlackerInc SlackerInc is offline
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I’m interested in what’s plausible, realistic, not just theoretically possible. I think a universal HDHP/HSA entitlement fits that bill. (And I also think single payer of the type my wives and children benefited from is bad policy, even if political hurdles were not a factor.)

Last edited by SlackerInc; 01-12-2019 at 03:38 AM.
  #507  
Old 01-12-2019, 09:04 AM
ElvisL1ves ElvisL1ves is offline
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I'm adamant that we can't just adopt another country's system this late in the game and expect that it will get our costs down to parity with theirs.
No one here, or anywhere else AFAIK, has argued that all benefits would be immediate and without other disruption. You do keep presenting that as a strawman of your own, for some reason.

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A HDHP/HSA entitlement would be far more affordable, less disruptive
And would continue to build in all the inefficiencies of the current system.

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and would not spur most people to use a lot more medical services.
Um, reducing medical care is a good thing to you? Gotta part ways with you there.

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And it would not mess with people who have more generous health coverage through their employers.
Nor would universal eligibility for Medicare. One can always decline to use it, or buy private Medicare supplemental insurance. That's the case right now.
  #508  
Old 01-12-2019, 01:06 PM
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Um, reducing medical care is a good thing to you? Gotta part ways with you there.
I think slacker's concern is that, in a market environment, healthcare is regulated by natural market forces: if it costs me money to see a doctor, I will use that service judiciously, but if it is free, I will be seeing the doctor for every faintest twinge. Presumably, medical facilities will be staffed by morons who have no ability to assess my actual level of need or implement any kind of policy that would, say, leave me waiting in the lobby for hours because the triage nurse determined that my complaint was frivolous.

Americans, after all, are notoriously stupid, wasteful and almost impossible to educate and/or train into better habits, so UHC is doomed to fail because we cannot have nice things.

Last edited by eschereal; 01-12-2019 at 01:07 PM.
  #509  
Old 01-12-2019, 02:24 PM
ElvisL1ves ElvisL1ves is offline
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Does that happen under Medicare now? No? Then why would it happen under expanded Medicare?
  #510  
Old 01-12-2019, 02:40 PM
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I think slacker's concern is that, in a market environment, healthcare is regulated by natural market forces: if it costs me money to see a doctor, I will use that service judiciously, but if it is free, I will be seeing the doctor for every faintest twinge.
The irony is that under the current system, even for those with good non-Medicaid insurance, profligacy and irrationality in treatment is rife. So much hinges on the whim of what a private insurance company will pay for, rather than the doctor's rational assessment of what treatment is appropriate and necessary. Both doctors and patients just get inured to the tiresome "game" with the insurance companies.

An example from recent personal experience, although surely everyone in the U.S. is familiar with similar nonsense. I had a serious fall in the Grand Canyon a couple of years ago. I needed a second operation on my broken arm. First conversation with the scheduler is prioritizing insurance over medical need: the doctor thinks it would be best to wait until February, but that will cost you about $3000 in copay/deductible; if you have the operation in December it will cost you nothing, because you have already exceeded your max out-of-pocket this year. Later on, I spend months going back and forth with the insurance company about whether they will pay for a rehab device that the doctor recommends. They pay for a rental for 3 months, then finally decide they will buy it. At that stage, I'm much better and probably don't need it. But I take it anyway, at a cost to the insurance company of several thousand dollars, because if I have a setback and do need it, who knows if they will agree to pay for it next time?

Last edited by Riemann; 01-12-2019 at 02:42 PM.
  #511  
Old 01-12-2019, 02:45 PM
k9bfriender k9bfriender is offline
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Originally Posted by SlackerInc View Post
and would not spur most people to use a lot more medical services.
What dos this mean here, anyway? does that mean that people will ignore chronic medical conditions, lowering the quality of life, productivity in the marketplace, and eventually leading to more expensive medical costs down the road when the condition finally becomes life threatening?

Or is this more like when my sciatica flares up, and a visit to a doctor for some muscle relaxers will clear it up in a day or so, or I can try to do the same with alcohol, which is barely effective enough to get me through the night, and lets the flare up last weeks?

People don't go to a doctor because they can go to a doctor for free. They go to a doctor because there is something wrong with them that they need professional help to address.

OTOH, if people cannot afford a doctor, then even if there is something wrong with them that they need a professional to address, they don't do so.

The entire point of a UHC is to get people to use the medical services that they need. I do not see a UHC spurring people to consume medical resources that they do not need, but I do see it as allowing people who currently are denied medical services to be able to get them.
  #512  
Old 01-12-2019, 06:00 PM
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The irony is that under the current system, even for those with good non-Medicaid insurance, profligacy and irrationality in treatment is rife. So much hinges on the whim of what a private insurance company will pay for, rather than the doctor's rational assessment of what treatment is appropriate and necessary. Both doctors and patients just get inured to the tiresome "game" with the insurance companies.
There is a related issue that I still have not gotten a proper response to, probably because it is almost impossible to answer.

One of the reasons healthcare is expensive in the US is because of malpractice insurance – I saw a table that showed it into six figures for ob/gyn practice in certain areas. But with single-payer, surely that dynamic would change. For one thing, if I am not paying money to my doctor, I might be less likely to sue him for just any little thing. And he has the government covering his backside.

So what happens there? Can doctors taking money from the UHC system also rely on it to cover their malpractice insurance (for which they might also go out and buy supplemental)? How does this fit into the UHC picture, and how does it affect the excessive orders for tests/procedures?
  #513  
Old 01-12-2019, 10:22 PM
Chisquirrel Chisquirrel is offline
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Originally Posted by eschereal View Post
There is a related issue that I still have not gotten a proper response to, probably because it is almost impossible to answer.

One of the reasons healthcare is expensive in the US is because of malpractice insurance – I saw a table that showed it into six figures for ob/gyn practice in certain areas. But with single-payer, surely that dynamic would change. For one thing, if I am not paying money to my doctor, I might be less likely to sue him for just any little thing. And he has the government covering his backside.

So what happens there? Can doctors taking money from the UHC system also rely on it to cover their malpractice insurance (for which they might also go out and buy supplemental)? How does this fit into the UHC picture, and how does it affect the excessive orders for tests/procedures?
The entire cost of malpractice is maybe $10 billion out of a $3 trillion industry, less than half of a percent. It's a relative non-issue.
  #514  
Old 01-13-2019, 12:42 AM
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Originally Posted by SlackerInc View Post
A realistic goal would be to try to stop having double-digit percentage growth in health care spending year over year. But that’s a far cry from actually reducing spending while expanding coverage. That’s a pipe dream.
In the very near term, healthcare costs may rise regardless of policy. But ...

Suppose my roof leaks. Is it better to
(a) fix the roof. with costs in the following years declining because we no longer have to keep repairing water damage; or
(b) spend the money we'd have spent on the roof to hire clowns who try to brainwash the wife into thinking we can't afford a roof.

Shodan picks (b). Which do you pick, Slacker?
  #515  
Old 01-13-2019, 11:41 AM
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Originally Posted by SlackerInc View Post
I’m interested in what’s plausible, realistic, not just theoretically possible. I think a universal HDHP/HSA entitlement fits that bill.
I know what a high-deductible health plan is. And I know what a Health Savings Account is. And I know how the two work in tandem. In fact, that was my health insurance for the last few years of my employment. It worked well for my spouse and me.

But I don't know what a 'universal HDHP/HSA entitlement' is. And a quick Google search yields no explanation.

Can you provide a cite that explains what this is?
  #516  
Old 01-13-2019, 03:09 PM
k9bfriender k9bfriender is offline
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Originally Posted by eschereal View Post
There is a related issue that I still have not gotten a proper response to, probably because it is almost impossible to answer.

One of the reasons healthcare is expensive in the US is because of malpractice insurance – I saw a table that showed it into six figures for ob/gyn practice in certain areas. But with single-payer, surely that dynamic would change. For one thing, if I am not paying money to my doctor, I might be less likely to sue him for just any little thing. And he has the government covering his backside.

So what happens there? Can doctors taking money from the UHC system also rely on it to cover their malpractice insurance (for which they might also go out and buy supplemental)? How does this fit into the UHC picture, and how does it affect the excessive orders for tests/procedures?
Part of medical malpractice is the fact that you need to pay your medical bills. If they messed up, then you not only have bills to pay for an ineffective procedure, you may have bills to pay for further corrective procedures, that may be of even greater costs. You may have a lowered standard of living, or quality of life, and need more assistance with normal activities. You may need a much longer hospital stay. There are many costs associated with a botched medical procedure that are currently borne by the patient, and therefore, would need to be covered by malpractice insurance.

If medical coverage is "free", then much of that concern is no longer an issue. Then you just have costs associated with reduced quality of life or needs for assistance, and maybe punitive for negligent acts.

There are the costs associated with doctors playing CYA to avoid a malpractice suit. If they know that they will be sued if they did not properly diagnose a condition that shows up one in a thousand times, then they will run the very expensive test on everyone.

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Originally Posted by septimus View Post
In the very near term, healthcare costs may rise regardless of policy. But ...

Suppose my roof leaks. Is it better to
(a) fix the roof. with costs in the following years declining because we no longer have to keep repairing water damage; or
(b) spend the money we'd have spent on the roof to hire clowns who try to brainwash the wife into thinking we can't afford a roof.

Shodan picks (b). Which do you pick, Slacker?
Well, it depends. If I pay the clowns the money for the roof, but they give me a kick back on part of it to fund my man cave, then my wife stops complaining about the roof, and I get a new toaster oven.
  #517  
Old 01-13-2019, 09:08 PM
Evil Economist Evil Economist is offline
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For anyone who's interested in hard numbers, here's per-capita healthcare costs and outcomes for 18 countries (from here, Table 2, with details that I haven't bothered to summarize):

PHP Code:
Country    Per-Capita Healthcare Spending    of US Spending    Avoidable deaths per 100,000
Australia    
$4,207    44.93%    62
Canada    
$4,728    50.49%    78
China    
$420    4.49%    
Denmark    $5,012    53.52%    82
France    
$4,620    49.34%    61
Germany    
$5,119    54.67%    83
India    
$215    2.30%    
Israel    $2,353    25.13%    
Italy    $3,207    34.25%    75
Japan    
$4,152    44.34%    
Netherlands    $5,227    55.82%    72
New Zealand    $4,038    43.12%    87
Norway    
$6,432    68.69%    64
Singapore    
$2,752    29.39%    
Sweden    $5,306    56.66%    69
Switzerland    
$6,787    72.48%    55
United Kingdom    
$4,094    43.72%    85
United States    
$9,364        112 
(Anyone who knows how to make that display more readable please feel free to re-post)

To summarize the above table: The US spends vastly more than any other country on healthcare, and gets worse outcomes.

More specifically, we spend almost 40% more on healthcare than the next-most-profligate spender, but have almost 30% more avoidable deaths than the next-worst performing country (though to be fair, I don't have avoidable deaths numbers for India or China, both of which spend less than 5% of what we do on healthcare).

I think there's a word for people who look at these results, throw their hands in the air, and say "how could we possibly do any better".
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  #518  
Old 01-14-2019, 06:16 AM
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Here you go:
Code:
              Per-Capita
              Healthcare   % of US   Avoidable deaths 
Country         Spending  Spending   per 100,000

Australia         $4,207    44.93%    62
Canada            $4,728    50.49%    78
China             $  420     4.49%    
Denmark           $5,012    53.52%    82
France            $4,620    49.34%    61
Germany           $5,119    54.67%    83
India             $  215     2.30%    
Israel            $2,353    25.13%    
Italy             $3,207    34.25%    75
Japan             $4,152    44.34%    
Netherlands       $5,227    55.82%    72
New Zealand       $4,038    43.12%    87
Norway            $6,432    68.69%    64
Singapore         $2,752    29.39%    
Sweden            $5,306    56.66%    69
Switzerland       $6,787    72.48%    55
United Kingdom    $4,094    43.72%    85
United States     $9,364             112
  #519  
Old 01-14-2019, 09:30 AM
ElvisL1ves ElvisL1ves is offline
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But, hey, the more morbidly obese we are, the less reason we have to do anything about it.
  #520  
Old 01-14-2019, 07:55 PM
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It’s important to have an idea of the state of play of public opinion. Here’s Gallup in 2018:

https://news.gallup.com/poll/226607/...ealthcare.aspx
Quote:
Previous Gallup research suggests:
Americans are largely positive about the quality of the healthcare they receive: Three-quarters of employed Americans (75%) said the healthcare they received was "excellent" or "good" in Gallup's last survey on the issue, in November 2017. There is little difference between U.S. workers and the overall public, among whom 77% rate their personal healthcare as "excellent" or "good."
Satisfaction on the cost of personal healthcare is mixed: Just over half of employed Americans (54%) say they are satisfied with the total cost for healthcare they pay, modestly lower than the 61% of overall Americans who say they are satisfied with their care costs.
Ratings of healthcare on a national level are substantially worse than personal: Gallup also asks Americans to rate aspects of overall healthcare in the U.S. More than half of U.S. workers (54%) and the same percentage of overall Americans rate the quality of the U.S. healthcare system as "excellent" or "good." On national healthcare costs, one in six (16%) American workers and one in five (20%) Americans in general say they are satisfied.
Most Americans say the U.S. healthcare system is troubled: Nearly three-quarters of employed Americans (73%) say the healthcare system is "in a state of crisis" or "has major problems" in Gallup's most recent survey. There is little difference between American workers' attitudes on the healthcare system and the overall U.S. public, among which 71% say the system is "in a state of crisis" or "has major problems."

So the status quo defenders will cite that first part and neglect to mention the “crisis” finding. OTOH, the MFA advocates will cherrypick just that last part as justification for why we need to blow everything up and start over. But neither approach is tenable. Most people are happy with what they have personally, so they will feel threatened if you talk about taking it away and replacing it with something else. But they do think the system overall needs change, so they will be receptive to a change that helps others as long as it doesn’t hurt them.


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Originally Posted by Riemann View Post
The irony is that under the current system, even for those with good non-Medicaid insurance, profligacy and irrationality in treatment is rife.
Uh, yeah. I don’t understand how this is ironic, or a rebuttal of the concerns I and others have. This profligacy and irrationality won’t simply disappear just because you install single payer. That’s pretty much the exact point I’ve been making over and over.


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Originally Posted by k9bfriender View Post
People don't go to a doctor because they can go to a doctor for free. They go to a doctor because there is something wrong with them that they need professional help to address.

OTOH, if people cannot afford a doctor, then even if there is something wrong with them that they need a professional to address, they don't do so.

The entire point of a UHC is to get people to use the medical services that they need. I do not see a UHC spurring people to consume medical resources that they do not need, but I do see it as allowing people who currently are denied medical services to be able to get them.

Apparently you missed my NPR cite about ambulance drivers who are constantly going on 911 calls for stuff that is far from an emergency or, often, anything that needs professional medical care at all. And you also missed my cite about the Oregon randomized experiment in which thousands of people went from having no insurance to having Medicaid, and increased their ER usage dramatically, including many visits for non-emergency issues. It found that they accessed significantly more medical care than the group that was randomized not to get Medicaid, yet other than the Medicaid group being happier, there was no significant difference in health outcomes between the groups. (That is, of course, very surprising and hard to explain.)


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Originally Posted by septimus View Post
In the very near term, healthcare costs may rise regardless of policy. But ...

Suppose my roof leaks. Is it better to
(a) fix the roof. with costs in the following years declining because we no longer have to keep repairing water damage; or
(b) spend the money we'd have spent on the roof to hire clowns who try to brainwash the wife into thinking we can't afford a roof.

Shodan picks (b). Which do you pick, Slacker?

I pick (c): Provide subsidies that help people fix their roofs, but which require those who can afford it to pay a portion of the cost. A program that allows anyone to get a free roof at any time is guaranteed to be wasteful and result in people getting new roofs prematurely.

Last edited by SlackerInc; 01-14-2019 at 07:56 PM.
  #521  
Old 01-14-2019, 08:25 PM
SlackerInc SlackerInc is offline
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Originally Posted by Railer13 View Post
I know what a high-deductible health plan is. And I know what a Health Savings Account is. And I know how the two work in tandem. In fact, that was my health insurance for the last few years of my employment. It worked well for my spouse and me.

But I don't know what a 'universal HDHP/HSA entitlement' is. And a quick Google search yields no explanation.

Can you provide a cite that explains what this is?

Sure. That’s cool that you had a good experience with your HDHP/HSA plan. What I’m advocating would be simply for the government to pay the premiums for such a plan, as well as contributing some amount (maybe matching?) to the HSA.

Here’s a plan similar to what I’ve been proposing, from Ed Dolan, who is definitely more credentialed than the undergraduate economics major referenced upthread (Dolan has a Ph.D. in economics from Yale University). He calls it UCC, for Universal Catastrophic Coverage:

https://www.vox.com/the-big-idea/201...ophic-coverage

Quote:
The exact parameters of the program would be subject to negotiation, of course, but let’s sketch some possibilities, for the sake of discussion. Suppose the deductible is set at 10 percent of the amount by which a household’s income exceeds the Medicaid eligibility level, now about $40,000 for a family of four. Under that formula, a middle-class family earning $85,000 a year would face a deductible of $4,500 per family member, with a cap of twice that amount for households of more than two people. By the same formula, the deductible for a household with $1 million of income would be $96,000.
The high-deductible policy might be provided directly by the government, as an extension of Medicare.
Quote:
People could choose among several ways to meet their out-of-pocket costs. As you can see from the examples above, for middle-class families, out-of-pocket costs would be comparable to those now faced under individual policies purchased on ACA exchanges, while for high-income families they would be substantially higher.
One option for meeting those costs would be to buy supplemental insurance to cover all or part of the UCC deductible. Such supplemental coverage would cost far less than policies now sold in the market for individual insurance, since the UCC deductible would set an automatic ceiling on claims for which the insurer would be responsible. Alternatively, consumers could pay out-of-pocket expenses from funds accumulated in a tax-deductible health savings account — yet another conservative idea, and one that is already on the books.
Very likely, many middle-income families would decide simply to cover all of their routine health care costs out of pocket. After all, as the chart shows, the healthiest 50 percent of the population accounts for less than 3 percent of all personal health care spending, and the next 20 percent of the population for only another 7 percent of spending. People on the bottom half of the spending curve could reasonably pay their routine health care costs in cash, just as they now pay for oil changes or wiper blades for their cars. (After all, no one assumes that automobile insurance covers routine maintenance.)
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Fiscal conservatives might, quite properly, ask how UCC could be financed. A large chunk of it could be paid for with another proposal favored by many on the political right — abolishing the tax deductibility of employer-sponsored insurance (ESI), which currently costs the federal budget an estimated $235 billion per year. That oddity of the US health care system is a holdover from World War II, when employers lavished in-kind benefits on scarce workers to evade wartime wage controls. Both its liberal and conservative critics say it is long overdue for repeal.
Liberals object to ESI because it’s inequitable. Suppose the cost of health insurance to your employer is $10,000 per employee. If that were taxed as ordinary income, you would pay more tax — but how much depends on your tax bracket. If your taxable income is $200,000 a year, putting you in the 33 percent bracket, the exclusion saves you $3,300 annually. At $35,000 a year, placing you the 15 percent bracket, the exclusion saves you just $1,500. The inequity is even greater for minimum wage workers.
That’s because higher-paid workers (or their unions) often negotiate compensation packages that take advantage of the tax deduction by slowing the growth of cash wages while increasing the share of health benefits. However, for workers who are already at the minimum wage, there is no room for negotiation. Wages for such workers cannot be cut (and they must rise when the legal minimum increases). As a result, the entire cost of employer-sponsored insurance falls on employers. That is one reason minimum wage jobs are less likely to include health benefits.
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And what about the poor? Liberal critics look at the way the BCRA slashes Medicaid and conclude that Republicans simply don’t care whether the poor have access to health care or not. Maybe that is true for some, but not all. Medicaid is simply not the only way to provide health care for people with low incomes.
For the poor, an alternative to Medicaid
For example, the Hagopian-Goldman variant of universal catastrophic coverage could be implemented in a way that would render Medicaid unnecessary. Suppose, as in our earlier example, the UCC deductible is set at 10 percent of the amount by which household income exceeds $40,000, roughly the Medicaid threshold for a family of four. The deductible for families below the threshold would therefore fall to zero. These families would get “first dollar” coverage from their UCC policy, so there would be no need for Medicaid as a separate program. (Such a scheme would also increase work incentives for low-income households, who would no longer have to worry that extra earnings would cause them to lose Medicaid benefits.)

I would also jack up taxes on the rich, but not on the middle class.
  #522  
Old 01-14-2019, 08:30 PM
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Most people are happy with what they have personally, so they will feel threatened if you talk about taking it away and replacing it with something else.
Most people don't realize how awful the U.S. health system is because they have no experience of a better system, of UHC that's free at the point of service. When I first came to the U.S. (as a young adult, having grown up in the U.K.), I did not know what any of these things mean:

pre-existing condition
deductible (as applied to healthcare)
co-pay
co-insurance

That's not because we have different words for these things in the U.K., like cookie vs biscuit. It's because the concepts don't exist.

I think very few people in the U.S. can imagine a healthcare system where you need healthcare, and the first thing you think about is not anxiety over money. Under the U.S. system, physical illness is immediately exacerbated by mental anguish: am I covered, how much is this going to cost me, what kind of limitations will my insurance company impose? It's quite reasonable to speculate that a major contributor to the worse outcomes shown in the statistics above may be the level of stress involved in obtaining reasonable healthcare in the U.S., even when you have good insurance.

And most people in the U.S. don't focus on the huge cost of their healthcare because they never see the money in the top line of their paycheck. It disappears, paid out directly by their employer before it hits their paycheck. But it's still a very real and very large tax tax burden that is coming out of their paycheck, just as surely as if it were income tax.

Anyone who thinks they are getting good healthcare for their money in the U.S. healthcare system is great is simply objectively wrong. Look at the statistics above. And a major element not reflected in those statistics is the drag on the economy and the constraint on personal life choices when health insurance is provided through the employer - for some people, it's a major constraint on what jobs they can consider, and may rule out self-employment or entrepreneurial ventures.

If U.S. public opinion is that "we have great healthcare, we like it", then U.S. public opinion is wrong. Those statistics don't lie. It just underlines how much work we have to do to overturn decades of propaganda by vested interests, to educate the U.S. public about how awful the system is here, and about how their government is failing them.

Last edited by Riemann; 01-14-2019 at 08:35 PM.
  #523  
Old 01-14-2019, 08:54 PM
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You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do.
  #524  
Old 01-14-2019, 08:56 PM
galen ubal galen ubal is online now
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Most people don't realize how awful the U.S. health system is because they have no experience of a better system, of UHC that's free at the point of service. When I first came to the U.S. (as a young adult, having grown up in the U.K.), I did not know what any of these things mean:

pre-existing condition
deductible (as applied to healthcare)
co-pay
co-insurance

That's not because we have different words for these things in the U.K., like cookie vs biscuit. It's because the concepts don't exist.

I think very few people in the U.S. can imagine a healthcare system where you need healthcare, and the first thing you think about is not anxiety over money. Under the U.S. system, physical illness is immediately exacerbated by mental anguish: am I covered, how much is this going to cost me, what kind of limitations will my insurance company impose? It's quite reasonable to speculate that a major contributor to the worse outcomes shown in the statistics above may be the level of stress involved in obtaining reasonable healthcare in the U.S., even when you have good insurance.

And most people in the U.S. don't focus on the huge cost of their healthcare because they never see the money in the top line of their paycheck. It disappears, paid out directly by their employer before it hits their paycheck. But it's still a very real and very large tax tax burden that is coming out of their paycheck, just as surely as if it were income tax.

Anyone who thinks they are getting good healthcare for their money in the U.S. healthcare system is great is simply objectively wrong. Look at the statistics above. And a major element not reflected in those statistics is the drag on the economy and the constraint on personal life choices when health insurance is provided through the employer - for some people, it's a major constraint on what jobs they can consider, and may rule out self-employment or entrepreneurial ventures.

If U.S. public opinion is that "we have great healthcare, we like it", then U.S. public opinion is wrong. Those statistics don't lie. It just underlines how much work we have to do to overturn decades of propaganda by vested interests, to educate the U.S. public about how awful the system is here, and about how their government is failing them.
I had the opposite experience - I moved from the States to Australia, where UHC is called Medicare. I'll call it Medicare AU to avoid confusion. I moved when I was in my late 30s. Medicare AU covers medical care, but not dental or optical. I imagine certain cosmetic and similar procedures are not covered, but I've never looked it up, and I don't have the cultural osmosis to know offhand.

You just cannot imagine how much easier everything is. A few weeks ago, I noticed a feeling of a not-quite empty bladder when urinating, like maybe some sort of blockage. I've reached that age where the prostate may be a problem, so I made an appointment with my doctor (whom I'd picked), and got in when it was convenient for me, a few days later. We talked for a bit, and he prescribed some antibiotics 'just in case' and an ultrasound at the local hospital.
The appointment cost me nothing. The pills cost me nothing. The ultrasound cost me nothing. All I needed to do was take the doctor's order, schedule the ultrasound, and turn up.

What does Medicare AU cost me?

Well, let's see. My income tax is slightly higher than it would be in the States. I've worked it out. 10.6% higher. But income tax is the only tax I have*, and no other fees. I'm not paying SS or Medicare tax on top of that. I'm not paying copays or deductibles. I'm not having insurance payments taken out of my paycheck, and I'm not paying any private insurance premiums. All in all, I'm paying less, for health care that is at least as good in theory, and much better in practice. I don't have to triage myself, wondering if I can afford the deductible.

I know I'm covered. And that's a load off my mind.

Anyone who says the US system is better is either uneducated, or profiting off the current system and/or indifferent to the problems that system causes the nation as a whole.

*Well, there's GST - sales tax - of 10% nationwide. Even that's easier than the mishmash of sales taxes in the States. The price on the shelf is what you pay, no calculations necessary to find the final cost.

Last edited by galen ubal; 01-14-2019 at 08:57 PM.
  #525  
Old 01-14-2019, 09:12 PM
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You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do.
Well, bully for you. Anecdotes are evidence, right? You'd better hope she never wants to take a different job, or start her own business or retire early to write a novel. And you'd better hope she never divorces you. Personally, I would not want the quality of my healthcare to be contingent on my partner always remaining in a particular job.

Ultimately, this is what it always comes down to when you dig down through the deflecting bullshit with the likes of you and Shodan - you are denying the statistics and the evidence.

You deny the statistics that show that U.S. healthcare is objectively dramatically worse than all other developed countries, costing twice as much for worse outcomes.

You claim that it's impossible to implement effective UHC funded out of general taxation, a model that for very obvious reasons is vastly superior the U.S. private insurance model, even when presented with the evidence that almost every other country in the world has done so.

Last edited by Riemann; 01-14-2019 at 09:14 PM.
  #526  
Old 01-14-2019, 09:13 PM
galen ubal galen ubal is online now
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Here's a simplified tax calculator for Australia, if you want to do your own comparison.
Couple notes:
*Remember to convert to and from AUD - as of 31 December 2018, the rate was 1 AUD = .7058 USD per the Reserve Bank of Aus
*Australia doesn't have filing statuses - it's all individual.

I suspect, if you account for insurance premiums you're paying or having deducted from your pay, many of you would come out better in Australia, or not very much worse off, in exchange for a much simpler system that is not tied to your employment.

Last edited by galen ubal; 01-14-2019 at 09:14 PM. Reason: many, not may
  #527  
Old 01-14-2019, 09:42 PM
Evil Economist Evil Economist is offline
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You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do.
According to health care statistics in the report I linked earlier, 33% of Americans who sought medical care experienced an access barrier because of cost. That is, 33% of Americans with a medical problem "did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care."

So, many Americans are facing a wait time of "forever", which may be slightly longer than the wait time they'll face in Canada.
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  #528  
Old 01-14-2019, 11:14 PM
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Ultimately, this is what it always comes down to when you dig down through the deflecting bullshit with the likes of you and Shodan - you are denying the statistics and the evidence.

You deny the statistics that show that U.S. healthcare is objectively dramatically worse than all other developed countries, costing twice as much for worse outcomes.

You claim that it's impossible to implement effective UHC funded out of general taxation, a model that for very obvious reasons is vastly superior the U.S. private insurance model, even when presented with the evidence that almost every other country in the world has done so.

There’s the straw man again—certainly as regards my own views (I can’t speak for Shodan).

—I do not dispute that the U.S. healthcare system overall is worse than that of other developed countries in most ways. OVERALL. What I dispute is that middle class people who have jobs that provide good healthcare plans would be better off under a Canadian-style system, including its extreme wait times.

—I don’t say “it's impossible to implement effective UHC funded out of general taxation”. I have in fact specifically advocated for a form of UHC (UCC) that would in fact be funded out of general taxation, although I would for political reasons want to confine it to taxation on the rich.

—Furthermore, if the political hurdles could be overcome, and there were not a revolt that scuttled the whole program, I don’t dispute that it would be possible economically to implement a single payer plan that would cover much more than I’m advocating. You could put every American on Medicaid, as long as you had the funding in place.

What I do dispute is that we would be able to do so while cutting costs. We would have to levy significantly higher taxes than other countries, because our health system is much more expensive than those other countries. Establishing a single payer would provide streamlining efficiencies on the bureaucratic side, but Obamacare already limits how much of health insurance premiums can be spent on overhead.

Even if single payer reduced that further, and I expect it would, it wouldn’t get the costs anywhere near as low as what those other countries pay. The only way to do that would be to pay doctors, hospitals, etc. much less, to clamp down on the number of tests and procedures performed, etc. And to do that suddenly would wreck the health system and wreck the U.S. economy.

To look at all these other countries and say “but they did it!” is simply throwing an ignorant tantrum. It’s like you live on a plot of land where your neighbors all planted hardwood trees 50-100 years ago, and now they are making handsome profits from the harvested lumber. You want those same kinds of profits, so you jump up and down and insist “they did it, so we can do it too!” When people tell you that if you wanted hardwood in 2018, you should have planted the trees in the mid-twentieth century, you just won’t listen.


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According to health care statistics in the report I linked earlier, 33% of Americans who sought medical care experienced an access barrier because of cost. That is, 33% of Americans with a medical problem "did not fill/skipped prescription, did not visit doctor with medical problem, and/or did not get recommended care."

So, many Americans are facing a wait time of "forever", which may be slightly longer than the wait time they'll face in Canada.

Again, from a utilitarian perspective it would be better for the 67% to deal with longer wait times for treatment so the 33% can shorten theirs from “forever”. But in a democracy, 67% is still quite a bit larger than 33%, not to mention that voter turnout is much higher among that 67%, multiplying their electoral advantage even further. (I’d be shocked if the 33% made up more than 20% of the electorate.)

Last edited by SlackerInc; 01-14-2019 at 11:17 PM.
  #529  
Old 01-14-2019, 11:32 PM
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There’s the straw man again...
And yet, a couple of paragraphs later...

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What I do dispute is that we would be able to do so while cutting costs.
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Old 01-14-2019, 11:57 PM
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And yet, a couple of paragraphs later...
...I said “it's impossible to implement effective UHC funded out of general taxation”? Oh wait, no: that’s what you claimed I said, but what you quoted didn’t say that at all—only that if we do so, it’s not going to involve spending less in total than we do now.
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Old 01-15-2019, 12:06 AM
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...I said “it's impossible to implement effective UHC funded out of general taxation”? Oh wait, no: that’s what you claimed I said, but what you quoted didn’t say that at all—only that if we do so, it’s not going to involve spending less in total than we do now.
Ok, then I apologize for the lack of precision in spelling out your idiocy. Let me try to do better:

Almost every other developed country in the world in the world has implemented some form of UHC funded out of general taxation; with healthcare costs 50% lower than the U.S. and better outcomes.

Yet you claim that it's impossible for the U.S. to implement a similar system with any cost saving.

Have I stated your idiocy correctly now?
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Old 01-15-2019, 12:23 AM
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It’s not idiocy, but yes: you have mostly stopped strawmanning me for the nonce—except that you go too far with that word “any”, and especially in italicizing it. I did say that we could get some marginal savings from less bureaucracy and a streamlined administration. But the cost of the healthcare itself is not going to go down any time soon, not unless we want to massively disrupt it and the economy at the same time, and not in a good way.
  #533  
Old 01-15-2019, 06:58 AM
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You will never convince me that signing up for Canada’s system and its extreme wait times would be a benefit to my family, personally, given that her teachers union has negotiated an excellent pan as part of their contract with the school system. It would of course be a net, utilitarian benefit to society overall, but that is not how I live my life and not how most people do.
I have great insurance too, I don't think I've paid more than a couple hundred in total out of pocket costs for any type of medical expenses over the past 3 years, that's including an emergency room visit followed up by in-patient surgery, and an expensive endoscopy. I recognize that I am incredibly fortunate that I'm so well covered by my company, but I understand that in other countries I wouldn't be incredibly fortunate, because that's what everyone gets. Well, they get the coverage, they don't get the dozens of bills to sort through and dispute because I should get the in-network rate instead of the out-of-network rate for that doctor I don't even remember seeing, or the "holy crap that test was 3x what I thought it was going to be and I just blew out most of my HSA on it!" They just get the coverage.

I'm reminded of the ads for St. Jude's Children's Hospital, a charitable hospital where they offer free care to children with cancer. One of the parents says "I cried when I learned I woudn't have to pay". And I always follow up to myself "just like every single parent in France". American parents are weeping at their good fortune to get this amazing opportunity for care, that is only available to the few people who St. Judes can care for every year, and the 500 million Europeans who get it by paying half what we pay for health care.
  #534  
Old 01-15-2019, 08:14 AM
Gary Kumquat Gary Kumquat is online now
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the cost of the healthcare itself is not going to go down any time soon
So just how do healthcare companies provide the same drugs, analysis and treatment elsewhere around the world for less in markets outside of the US?
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Old 01-15-2019, 09:17 AM
Evil Economist Evil Economist is offline
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Again, from a utilitarian perspective it would be better for the 67% to deal with longer wait times for treatment so the 33% can shorten theirs from “forever”. But in a democracy, 67% is still quite a bit larger than 33%, not to mention that voter turnout is much higher among that 67%, multiplying their electoral advantage even further. (I’d be shocked if the 33% made up more than 20% of the electorate.)
You're assuming that all the 67% were happy with the way things worked out, which is clearly wrong. And that the 67% don't care at all about the 33%, which is also clearly wrong.
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  #536  
Old 01-15-2019, 09:26 AM
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So just how do healthcare companies provide the same drugs, analysis and treatment elsewhere around the world for less in markets outside of the US?
Easy. There's a huge, captive, sucker market to cover all those costs, and ample executive bonuses too, right here in the Land of the Free.
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Old 01-15-2019, 09:28 AM
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The only way to do that would be to pay doctors, hospitals, etc. much less, to clamp down on the number of tests and procedures performed, etc. And to do that suddenly would wreck the health system and wreck the U.S. economy.
Who's asking to do it suddenly?
  #538  
Old 01-15-2019, 10:08 AM
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I have great insurance too, I don't think I've paid more than a couple hundred in total out of pocket costs for any type of medical expenses over the past 3 years, that's including an emergency room visit followed up by in-patient surgery, and an expensive endoscopy. I recognize that I am incredibly fortunate that I'm so well covered by my company, but I understand that in other countries I wouldn't be incredibly fortunate, because that's what everyone gets. Well, they get the coverage, they don't get the dozens of bills to sort through and dispute because I should get the in-network rate instead of the out-of-network rate for that doctor I don't even remember seeing, or the "holy crap that test was 3x what I thought it was going to be and I just blew out most of my HSA on it!" They just get the coverage.
My emphasis - although my company throws some money into my HSA, it's mostly mine - so I would consider that an out-of-pocket expense.
  #539  
Old 01-15-2019, 10:14 AM
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My emphasis - although my company throws some money into my HSA, it's mostly mine - so I would consider that an out-of-pocket expense.
Exactly right. Those who would have us believe that an HSA-based plan will solve many of these problems seem to forget that it's the individual's money that's primarily funding the HSA. It's money, that instead of paying insurance premiums, is now in a savings account that can only be used for medical-related expenses, some of which might have been paid by a lower-deductible plan.
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Old 01-15-2019, 11:28 AM
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My emphasis - although my company throws some money into my HSA, it's mostly mine - so I would consider that an out-of-pocket expense.
My company throws a LOT of money into my HSA, enough that it basically fully funds the in-network deductible, so my true out of pocket costs are very low. I can only get into real trouble if I go out of network, where a separate deductible applies.

They are exceptionally generous with these benefits, and I still don't feel that it's better overall than UHC would be. Not the least of which is the fact that it's twice as expensive for my company to offer than UHC is in other countries.
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Old 01-15-2019, 11:51 AM
Gary Kumquat Gary Kumquat is online now
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Easy. There's a huge, captive, sucker market to cover all those costs, and ample executive bonuses too, right here in the Land of the Free.
And to pay for the adverts. All $2.8 billion worth of them. Because it's important that you should be able to tell your doctor just what drug you reckon is the best for your erectile dysfunction, on the basis of a 30 second advert.
  #542  
Old 01-15-2019, 03:48 PM
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And to pay for the adverts. All $2.8 billion worth of them. Because it's important that you should be able to tell your doctor just what drug you reckon is the best for your erectile dysfunction, on the basis of a 30 second advert.
Yeah. The Big Pharma marketing budget is bigger than their R&D budget.
Plus you got the opiod makers paying some doctors tons of money for nothing to encourage them to prescribe their pills.
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Old 01-15-2019, 04:25 PM
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Yeah. The Big Pharma marketing budget is bigger than their R&D budget.
Plus you got the opiod makers paying some doctors tons of money for nothing to encourage them to prescribe their pills.
And a good chunk of their R&D doesn't go to new medications to treat diseases that currently have no treatment, or treat a disease better than other drugs currently do, but rather to develop a drug that does what another drug already does, but is different enough to get a patent.
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Old 01-15-2019, 04:36 PM
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We always have TRILLIONS for wars built on lies. (Ignore the corporate welfare and focus on the 3 cents extra out of your paycheck for a single mom's baby food)
  #545  
Old 01-15-2019, 08:03 PM
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So just how do healthcare companies provide the same drugs, analysis and treatment elsewhere around the world for less in markets outside of the US?

The question of how things cost different amounts in different countries is a complex one, that is really beyond the scope of this discussion. Take a look at this bit of data:

https://www.cbsnews.com/news/nearly-...-bank-reports/
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Extreme poverty, defined as living on less than $1.90 a day, fell from 36 percent of the world's population back in 1990 to 10 percent in 2015, the most recent year for available data.
I frequently cite this stat to illustrate the overlooked story of how much better things are getting for the global poor. But there’s something else to be gleaned here: how much cheaper many, many things (including Maslow basics like food, clothing, and shelter) obviously must be in many parts of the world. Try living on under two bucks a day in the U.S., even in a low cost of living area like rural Mississippi. Good luck!


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Who's asking to do it suddenly?

Most of the people in this thread and who support AOC, Bernie, et al. At least that has been my impression. If there is an incrementalism in here, it is not being publicized. But go ahead: tell me how you plan to make it gradual.


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Exactly right. Those who would have us believe that an HSA-based plan will solve many of these problems seem to forget that it's the individual's money that's primarily funding the HSA.

If the employer, or the government, is contributing significantly to the HSA, that doesn’t really fly. Unless you would also say that people in France aren’t getting their care for “free” because they are paying for it in taxes?


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And to pay for the adverts. All $2.8 billion worth of them. Because it's important that you should be able to tell your doctor just what drug you reckon is the best for your erectile dysfunction, on the basis of a 30 second advert.

Yes, it’s obscene and sickening. Not to mention the junkets they take doctors on, the swag “pharmaceutical reps” (a job which should not exist) ply them with, etc.


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Originally Posted by k9bfriender View Post
And a good chunk of their R&D doesn't go to new medications to treat diseases that currently have no treatment, or treat a disease better than other drugs currently do, but rather to develop a drug that does what another drug already does, but is different enough to get a patent.
Indeed, this is a major problem. I would like to see all pharmaceutical research be taken over by the government, or better yet by a coalition of all the governments of the world.

But I wonder if some here could possibly find their way to looking at this ridiculously corrupt situation with Big Pharma and start to understand why anti-vaxxers are skeptical of vaccines for this very reason. Instead, they (and I was one of “they” when my older kids were small) are treated as the most incredibly gullible idiots imaginable.

Last edited by SlackerInc; 01-15-2019 at 08:05 PM.
  #546  
Old 01-15-2019, 08:20 PM
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Riemann Riemann is offline
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Quote:
Originally Posted by SlackerInc View Post
But I wonder if some here could possibly find their way to looking at this ridiculously corrupt situation with Big Pharma and start to understand why anti-vaxxers are skeptical of vaccines for this very reason. Instead, they (and I was one of “they” when my older kids were small) are treated as the most incredibly gullible idiots imaginable.
I'm not really sure of the relevance of this to what's under debate here. But Ben Goldacre put it most succinctly:

Quote:
pharma being shit does not mean magic beans cure cancer
Do you really think that tone-policing the vaccination issue is appropriate when children's lives are at stake? Your claim is bullshit anyway, I have never seen anyone treat parents asking genuine questions as "the most incredibly gullible idiots imaginable". The people who get short shrift are the ignorant JAQing morons peddling their antivax conspiracy theories, not the people genuinely seeking advice and information.

It is not appropriate to mislead parents by acting as though there is a genuine controversy on the issue when there's not. When antivaxxers have as much evidence on their side as conspiracy theorists who claim that we didn't land on the moon, their claims should be treated with the contempt they deserve. The rule is: if you don't want your ideas treated with contempt, find some better ideas.

Last edited by Riemann; 01-15-2019 at 08:24 PM.
  #547  
Old 01-16-2019, 01:12 AM
Gary Kumquat Gary Kumquat is online now
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Quote:
Originally Posted by SlackerInc View Post
I wonder if some here could possibly find their way to looking at this ridiculously corrupt situation with Big Pharma and start to understand why anti-vaxxers are skeptical of vaccines for this very reason. Instead, they (and I was one of “they” when my older kids were small) are treated as the most incredibly gullible idiots imaginable.
No, I don't understand it - because pharma companies make less than 2% of their revenues from vaccines* and could make a fuck of a lot more money instead selling drugs to reduce the damage to people who contracted these diseases.

You'd have to be a complete fucking idiot (Hello, you) to look at companies who are clearly interested in making a profit, and conclude that they'd enable such a conspiracy, to the detriment of their own bottom line, when they could easily destroy it by just a single person out of the hundreds of thousands involved leaking any decent bit of evidence about the secret mind control drugs, etc, etc.

*https://www.skepticalraptor.com/blog...rket-Value.pdf
  #548  
Old 01-16-2019, 02:11 AM
Evil Economist Evil Economist is offline
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Originally Posted by SlackerInc View Post
The question of how things cost different amounts in different countries is a complex one, that is really beyond the scope of this discussion. Take a look at this bit of data:

https://www.cbsnews.com/news/nearly-...-bank-reports/


I frequently cite this stat to illustrate the overlooked story of how much better things are getting for the global poor. But there’s something else to be gleaned here: how much cheaper many, many things (including Maslow basics like food, clothing, and shelter) obviously must be in many parts of the world. Try living on under two bucks a day in the U.S., even in a low cost of living area like rural Mississippi. Good luck!.
You should be careful about pulling out that irrelevant little factoid. You'll pull it out like it's some startling revelation in a conversation where people are comparing costs in the US to costs in Canada*, Australia**, Switzerland***, France**** Germany*****, Norway (!)****** etc., and people will look at you like you're a fucking idiot.

You should save it for when it actually might be relevant for the point you're trying to make, like when people are comparing costs in the US to costs in Malaysia.

* 24% higher costs than the US
** 12% higher costs than the US
*** 63% higher costs than the US
**** 12% higher costs than the US
***** 13% higher costs than the US
****** 80% (!) higher costs than the US

All above based on the Economist Big Mac index
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  #549  
Old 01-16-2019, 05:44 AM
Gyrate Gyrate is offline
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Most of the people in this thread and who support AOC, Bernie, et al. At least that has been my impression. If there is an incrementalism in here, it is not being publicized. But go ahead: tell me how you plan to make it gradual.
The argument that "Sanders, AOC, etc didn't overtly say they wanted gradual implementation, therefore they must want it implemented abruptly" is no more sound than "they didn't say they wanted sudden implementation, therefore they must want it implemented gradually". Sure, in these discussions people are comparing the current US system with other systems on a "if we could wave a magic wand" basis but no one believes that an actual transition to UHC would be simple. Right now everyone is still working on the "what"; the "how" will follow.

I will, however, note that both the ACA approach and the experiment in Vermont were small steps in the direction of UHC, which suggest that a gradual approach is more likely to be the approach if ever it happens.
  #550  
Old 01-16-2019, 07:15 AM
Grim Render Grim Render is offline
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The problem is that a lot of the excess costs of healthcare in the US is due to the number of different systems and actors. It generates a massive bureaucracy. I remember a study concluding that the yearly cost of billing in the US system was just short of 500 billion $. Higher pay in the healthcare sector is pretty small-fry in terms of increased costs.

That was the problem Vermont faced: Adding yet another layer and actor to the system doesn't realize any of the savings UHC normally entails. If you had allowed the state to use Medicare, Medicaid etc funds to set up a system the cost calculation would have looked very different and far more affordable.
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