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  #401  
Old 01-09-2019, 04:36 PM
Railer13 Railer13 is offline
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Originally Posted by Shodan View Post
I am asking if there is any other country who has cut healthcare spending by as much as the US is being expected to do. It was asserted that many other countries have done this - which ones?
First of all, in the 5 posts since you first brought up this so-called argument, nobody 'asserted that many other countries have done this'.

Secondly, as Elvis and Economist have tried to explain to you, the other countries implemented a more economical and efficient system years ago, and thus have never spent as much as the US does on health care. Thus, they've never had the exorbitant costs that they need to cut.

This is a bizarre point you're trying to make.
  #402  
Old 01-09-2019, 04:40 PM
Shodan Shodan is offline
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Originally Posted by Evil Economist View Post
Well, question for you. If it is in fact the case that e.g. Canada spends half as much as the US on healthcare on a per-capita basis (this is in fact a fact), would you consider this as Canada reducing their healthcare costs by half relative to the US?
Do you have any examples of countries that have reduced their healthcare spending by 25-40%? By "reduce" I mean in one year they were spending $X, and then later were spending $X * .75 or * .6.

Which countries have done that?

Hell, let's make it easy. The US spends twice as much. So another country spending half as much should be able to cut its spending by, say, 12%. What country has cut its healthcare spending by 12% overall?

Regards,
Shodan
  #403  
Old 01-09-2019, 04:48 PM
Gary Kumquat Gary Kumquat is online now
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Originally Posted by Shodan View Post
Hell, let's make it easy. The US spends twice as much. So another country spending half as much should be able to cut its spending by, say, 12%. What country has cut its healthcare spending by 12% overall?
You buy a car for $50,000
I buy the same car for $25,000

You think for me to prove it's possible for you to spend less on a car, I should now be able to buy that car for $22,000.

You sir are a buffoon.
  #404  
Old 01-09-2019, 04:51 PM
Dacien Dacien is offline
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Originally Posted by Evil Economist View Post
Nope. Despite what Captain Undergraduate tells you, the only absurd assumptions are those trotted out to exaggerate the costs of medicare-for-all once the paper's authors realized it accidentally showed the opposite of what the Koch brothers paid them to show.

Here's what happened--the paper was written as proof that Medicare-for-all was more expensive than our current system. Then people actually read it and noticed that the author was misrepresenting the result and had actually showed that medicare-for-all was 2 trillion dollars cheaper than our current system. So there was a rush to invent trillions of dollars of additional costs (by people like Captain Undergraduate) to flip the result to what was initially paid for by the Koch brothers.

"Here's my paper showing that the cost of Medicare-for-all is an enormous 32 trillion dollars!"
"But we're actually paying 34 trillion dollars for healthcare. That's a 2 trillion dollar savings"
"Oh. Whoops. Wait. I just found 4 trillion dollars in costs that I 'forgot about' before. Please pay me?"
This is complete fiction. The $32 trillion number was reached by different studies, and lauded by Sanders and M4A proponents. There was no cost inflation. And the only reason they got to such a number was by assuming a 40% payment reduction. Finally the cost is what it is. You need a certain amount of taxes to raise $32 trillion over ten years.

I can't tell if you're pulling my chain at this point or not, but the facts are worth making this post.
  #405  
Old 01-09-2019, 04:52 PM
Ravenman Ravenman is offline
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Originally Posted by Shodan View Post
Do you have any examples of countries that have reduced their healthcare spending by 25-40%? By "reduce" I mean in one year they were spending $X, and then later were spending $X * .75 or * .6.

Which countries have done that?

Hell, let's make it easy. The US spends twice as much. So another country spending half as much should be able to cut its spending by, say, 12%. What country has cut its healthcare spending by 12% overall?
I would consider freezing the health care cost increases to be a win.

Why do you support a system in which costs are basically growing by 12% a year, just because you don't believe the alternative will cut costs by 12% a year? I mean, that's just stupid.
  #406  
Old 01-09-2019, 04:59 PM
Evil Economist Evil Economist is offline
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This is complete fiction. The $32 trillion number was reached by different studies, and lauded by Sanders and M4A proponents. There was no cost inflation. And the only reason they got to such a number was by assuming a 40% payment reduction. .
Think about what you said for just a second. The cost of Medicare-for-all was $32 trillion. The cost of our current system is $34 trillion. You think the only way they got from $34 trillion to $32 trillion was through a 40% cost reduction? Do you think you should maybe double-check your math?
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  #407  
Old 01-09-2019, 05:01 PM
Evil Economist Evil Economist is offline
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Finally the cost is what it is. You need a certain amount of taxes to raise $32 trillion over ten years.
Your knowledge of the thing you are discussing has reset to zero, Memento-style.
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  #408  
Old 01-09-2019, 05:05 PM
Evil Economist Evil Economist is offline
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Originally Posted by Shodan View Post
Hell, let's make it easy. The US spends twice as much. So another country spending half as much should be able to cut its spending by, say, 12%.
Just out of curiosity, are you aware of how stupid this assertion is?
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  #409  
Old 01-09-2019, 05:09 PM
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Originally Posted by Shodan View Post
Do you have any examples of countries that have reduced their healthcare spending by 25-40%? By "reduce" I mean in one year they were spending $X, and then later were spending $X * .75 or * .6.

Which countries have done that?

Hell, let's make it easy. The US spends twice as much. So another country spending half as much should be able to cut its spending by, say, 12%. What country has cut its healthcare spending by 12% overall?

Regards,
Shodan
I've joked that you seem to be drunk on Liberal tears but I'm now starting to wonder if you're just drunk.

Politicians who don't want universal care have to make obtuse arguments about the costs to argue against it. You don't. No one is voting for you, so you don't have to pretend the current system is more cost efficient. Why not just admit you don't want people getting free healthcare because it offends your capitalist sensibilities?
  #410  
Old 01-09-2019, 05:55 PM
Dacien Dacien is offline
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Originally Posted by Evil Economist View Post
Think about what you said for just a second. The cost of Medicare-for-all was $32 trillion. The cost of our current system is $34 trillion. You think the only way they got from $34 trillion to $32 trillion was through a 40% cost reduction? Do you think you should maybe double-check your math?
$32 trillion in federal spending, but the claim is that the overall spending would decrease. So the $32 trillion needs to be raised through massive taxation, that's a problem unto itself. But the way they figured that overall spending would actually slightly decrease is by assuming that every healthcare provider in America would accept 40% lower payment rates compared to what they receive through private insurers with no reduction in staff, service, or quality. This is an absurd assumption.

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You need a certain amount of taxes to raise $32 trillion over ten years.
Your knowledge of the thing you are discussing has reset to zero, Memento-style.
You're either pulling my chain or you yourself have no idea what you're talking about, and I don't think it's the latter. Federal spending would need to increase to $32 trillion over 10 years. The federal government would be in charge of paying for "Medicare for All" payments. Certainly you know this.

Last edited by Dacien; 01-09-2019 at 05:59 PM.
  #411  
Old 01-09-2019, 06:00 PM
Evil Economist Evil Economist is offline
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$32 trillion in federal spending, but the claim is that the overall spending would decrease. So the $32 trillion needs to be raised through massive taxation, that's problem unto itself. But the way the figured that overall spending would actually slightly decrease is by assuming that every healthcare provider in America would accept 40% lower payment rates compared to what they receive through private insurers with no reduction in staff, service, or quality. This is an absurd assumption.
So...you think that total costs of healthcare coverage will decrease from 34 trillion to 32 trillion because of a 40% reduction in the costs of healthcare? I agree that's absurd, but probably for different reasons than you.

Also, if we have two alternatives: 1) pay 34 trillion (what we are doing now) or 2) pay 32 trillion (the medicare-for-all plan), which of those two options do you think requires higher payments?

I asked you before, but I'll ask you again: if you had the choice of paying $32 trillion or $34 trillion, which choice would you pick, and would it really make a difference who you made the check out to?
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  #412  
Old 01-09-2019, 06:01 PM
Dacien Dacien is offline
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Edit: Okay, if you're evasively critiquing that it would technically need to increase by $21 trillion over ten years with a $1.1 trillion times ten years offset, I'll accept that. You certainly haven't explained that, but I'll accept that if that's what you're getting at.
  #413  
Old 01-09-2019, 06:10 PM
Dacien Dacien is offline
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I asked you before, but I'll ask you again: if you had the choice of paying $32 trillion or $34 trillion, which choice would you pick, and would it really make a difference who you made the check out to?
The problem is this: The lion's share of healthcare spending is private insurers, with Medicare and Medicaid close behind. So the costs to Americans is the taxation we currently have along with premiums and co-pays. These costs would be dwarfed by the increase in across-the-board taxes necessary to raise $21 trillion additional dollars. So there are certainly some people with astronomical healthcare costs due to chronic or serious ailments who would be getting a bargain, but much of the country would be paying much, much more in new taxes than they were paying previously.

You can argue that this is a sacrifice the healthy should be willing to make for their fellow Americans, that we're in this together, and it's the right thing to do. That's a conversation for another time. My only argument is that they won't. That if the average American with average healthcare needs saw the taxes that would be necessary, they'd absolutely balk. They'd balk and step back from the whole idea. They'd say, "We need a solution, but this is drastic and I can't afford it."

Last edited by Dacien; 01-09-2019 at 06:11 PM.
  #414  
Old 01-09-2019, 06:24 PM
k9bfriender k9bfriender is offline
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The problem is this: The lion's share of healthcare spending is private insurers, with Medicare and Medicaid close behind. So the costs to Americans is the taxation we currently have along with premiums and co-pays. These costs would be dwarfed by the increase in across-the-board taxes necessary to raise $21 trillion additional dollars. So there are certainly some people with astronomical healthcare costs due to chronic or serious ailments who would be getting a bargain, but much of the country would be paying much, much more in new taxes than they were paying previously.

You can argue that this is a sacrifice the healthy should be willing to make for their fellow Americans, that we're in this together, and it's the right thing to do. That's a conversation for another time. My only argument is that they won't. That if the average American with average healthcare needs saw the taxes that would be necessary, they'd absolutely balk. They'd balk and step back from the whole idea. They'd say, "We need a solution, but this is drastic and I can't afford it."
And when you show them that they won't have to pay premiums any more, and those savings are greater than the tax increase that they are looking at, will they continue to insist that they cannot afford it?

Do you think that americans are getting their healthcare for free right now?
  #415  
Old 01-09-2019, 06:33 PM
Dacien Dacien is offline
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And when you show them that they won't have to pay premiums any more, and those savings are greater than the tax increase that they are looking at, will they continue to insist that they cannot afford it?

Do you think that americans are getting their healthcare for free right now?
I'm sure for those with expensive insurance due to particular ailments, they'd see savings. But for an average American with average healthcare needs (maybe a prescription for blood pressure, a broken wrist a few years back), they would most certainly be paying more. I would guess the vast majority of people under 50 would end up paying much more in new taxes than they did on premiums or out-of-pocket costs, but I'll admit I don't have those figures. It's pretty well accepted that the healthy don't spend nearly as much on premiums or healthcare as the chronically- or seriously-ill do, obviously. This is to say nothing of those that get their healthcare through their place of employment.

But sure, if you could somehow convince tens of millions of healthy Americans with low premiums and out-of-pocket costs (or those who don't even have insurance because hey, I'm a healthy 25-year-old, what do I need that for?) that their taxes are going to increase markedly and they need to be on board, then go for it. I don't think it'll happen.

Last edited by Dacien; 01-09-2019 at 06:35 PM.
  #416  
Old 01-09-2019, 06:57 PM
k9bfriender k9bfriender is offline
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Originally Posted by Dacien View Post
I'm sure for those with expensive insurance due to particular ailments, they'd see savings. But for an average American with average healthcare needs (maybe a prescription for blood pressure, a broken wrist a few years back), they would most certainly be paying more. I would guess the vast majority of people under 50 would end up paying much more in new taxes than they did on premiums or out-of-pocket costs, but I'll admit I don't have those figures. It's pretty well accepted that the healthy don't spend nearly as much on premiums or healthcare as the chronically- or seriously-ill do, obviously. This is to say nothing of those that get their healthcare through their place of employment.

But sure, if you could somehow convince tens of millions of healthy Americans with low premiums and out-of-pocket costs (or those who don't even have insurance because hey, I'm a healthy 25-year-old, what do I need that for?) that their taxes are going to increase markedly and they need to be on board, then go for it. I don't think it'll happen.
People don't get expensive insurance due to ailments. Insurance is not based on your ailments. Not sure where you would get that from. Have you ever actually had insurance, or had anything to do with it?

Out of pocket costs can be based on your usage, but not your premiums.

Why do you say nothing of those who get their healthcare through their place of employment? Do you think that it is free to get it through your employer? Even if they cover all the premiums (which I doubt very many places do anymore), that is still part of your benefits package, resources that are being spent on you that you could be taking in cash instead.

That is not including the people who have insurance through their employer that sucks. That's quite a number of americans.

For the 25 year old that thinks he's superman, if he falls ill or gets injured, do we just leave him in the street to die? His taxes are based on his income, so he would only be paying substantially more if he makes substantially more.

I was 25 before the ACA, and I had insurance through some of my employers, and bought it on the individual market a few times as well (that sucks). I had peers that thought I was wasting money, and I was, as I've visited a doctor (other than the dentist) only 2 times in the last 20 years.

But, some of them are bankrupt now, due to medical bills they could not pay.

I get that you "guess" that the majority of people would be paying more, but your guess is contraindicated by actual economists who have studied the issue.

This is the problem with going with your gut, rather than actual facts.

Right now, a good chunk of our tax dollars go to cover the very most expensive patients. People over 55, and veterans. Throw in the fact ath people on Medicaid tend to live less healthy lives as well, and we are paying for them on our tax dollars as well.

So, what we are looking to pick up and cover are the people who have not served in combat, who are under 55, who are not poor. We are already covering the most expensive patients, covering the cheaper ones actually is a bargain.
  #417  
Old 01-09-2019, 07:05 PM
Dacien Dacien is offline
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Sorry, should have said, "high amount of healthcare costs" due to particular ailments.
  #418  
Old 01-09-2019, 07:10 PM
Dacien Dacien is offline
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I get that you "guess" that the majority of people would be paying more, but your guess is contraindicated by actual economists who have studied the issue.

This is the problem with going with your gut, rather than actual facts.
There is no economist that is contradicting that, because there's no tax scheme out proposing to pay for it, as the economist I linked earlier pointed out. They simply leave the revenue problem unaddressed. This is why we don't have those figures. We know how much it would require, but not how exactly the tax structure would be set up. As I've argued, even if you taxed everyone making a million dollars or more at 100%, it would still leave a massive shortfall. So guess what other countries with nationalized healthcare do? They tax the crap out of everybody.

Last edited by Dacien; 01-09-2019 at 07:14 PM.
  #419  
Old 01-09-2019, 07:17 PM
k9bfriender k9bfriender is offline
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Sorry, should have said, "high amount of healthcare costs" due to particular ailments.
Look, everything shows that, if we implemented a real UHC, we would spend less money on healthcare than we do now.

That some of those costs would be moved form those who can least afford them to those who can most afford them is a feature of a progressive tax structure, not a bug.

If you are middle class american, and you are in the middle 3 quintiles, then your healthcare costs will go down. If you are in the bottom, then you get healthcare when you struggled to get it before.

Only the top 20% of the population could potentially be seeing an increase, and I am actually all for that, even if not for healthcare. And, really, most of any increase would be borne by the top 1% or so.

Most people would pay more in taxes than they do now, but that would be more than offset by no longer paying premiums or out of pocket expenses. They would end up keeping more of their paycheck at the end of the year.

So, we have two arguments, one is that we shouldn't do it in any case, and the other that we cannot afford it. I think that the case that we can afford it has been pretty well made. We can afford what we are doing now, and we are doing it very efficiently, so I cannot see how making healthcare more economical would make it less affordable. Then there is the argument that, regardless of the benefits and savings, people shouldn't have to pay for other people's medical care, from an ideological standpoint. I do believe that it is largely people that hold to the second argument that keep repeating the counterfactual errors when they try to make the first.

So, for the sake of argument, let's say that we have shown that this will actually save the vast majority of americans money to your satisfaction, would you still be against it?
  #420  
Old 01-09-2019, 07:22 PM
k9bfriender k9bfriender is offline
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There is no economist that is contradicting that, because there's no tax scheme out proposing to pay for it, as the economist I linked earlier pointed out. They simply leave the revenue problem unaddressed. This is why we don't have those figures. We know how much it would require, but not how exactly the tax structure would be set up. As I've argued, even if you taxed everyone making a million dollars or more at 100%, it would still leave a massive shortfall. So guess what other countries with nationalized healthcare do? They tax the crap out of everybody.
Sure, they tax everybody, and everybody pays less in taxes towards UHC than we pay in premiums.

Your argument is a red hearing, we don't need to tax everyone that makes over $1m at 100% (though I wouldn't be against a decent hike on them). We would be increasing the taxes on the middle class, but by less than what they currently pay in premiums.

You can make up all sorts of conditions that you can claim cannot be fulfilled, but you have to show that those conditions are necessary, and you have not.
  #421  
Old 01-09-2019, 07:29 PM
Dacien Dacien is offline
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All I'm saying is if they ever get around to proposing a tax plan to pay for it sometime soon (an actual, real tax plan that satisfies the revenue requirement), people will balk. America's not ready. That's my prognostication.

Last edited by Dacien; 01-09-2019 at 07:30 PM.
  #422  
Old 01-09-2019, 07:33 PM
SlackerInc SlackerInc is online now
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First of all, in the 5 posts since you first brought up this so-called argument, nobody 'asserted that many other countries have done this'.

Secondly, as Elvis and Economist have tried to explain to you, the other countries implemented a more economical and efficient system years ago, and thus have never spent as much as the US does on health care. Thus, they've never had the exorbitant costs that they need to cut.

This is a bizarre point you're trying to make.

It’s not a bizarre point at all. And are you really serious, that you haven’t seen all the posts insisting that plenty of other countries have done this?

It’s pretty clear that Shodan and I occupy different sectors of the political spectrum. And I haven’t heard him weigh in on what I am proposing: we could probably have a good debate about that. But we agree on the point that we can’t just say “all these other countries have spent decades getting to this point while we have been doing something completely different (and pretty stupid IMO), so now we can just turn on a dime and make our system exactly like theirs”.

Think about an area where the U.S. is actually the envy of the world: our postsecondary universities, especially the major research institutions. Do you think Indonesia, or Brazil, or whatever country you want to name, can just decide “okay, we want to have the same thing” and just instantly create it? The many decades of development weren’t really important—you can play “catch up” whenever you want? No.


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So ... You're appointed legislative healthcare czar for the {you-pick-it} Party. What's your plan? What are the baby steps for the first few years?

It would be the Democratic Party, because I am a Democrat. And I already stated it several times upthread: I would push for a universal HDHP/HSA entitlement. People could get supplementary plans from their employers, or buy them themselves. But at the very least, you’d have something that would pay for preventative care and, in the case of a serious injury or illness, would limit your own financial liability to something manageable. If you rack up some medical debt that way, you could pay it off over time via an income-based repayment plan, similar to how direct federal student loans are handled.

Ideally I’d also like to end the tax exemption for health plans, but that’s probably not feasible due to the power of the top 20 percent, as I also noted upthread.
  #423  
Old 01-09-2019, 08:10 PM
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It’s not a bizarre point at all. And are you really serious, that you haven’t seen all the posts insisting that plenty of other countries have done this?
I was responding to Shodan asking for proof that other countries have drastically cut healthcare costs. Nobody has ever claimed that. Everybody has stated that under each country's current system, they pay far less per capita than the US.

The point that other countries had expensive health care and then reduced costs is bizarre, because it hasn't happened that way.
  #424  
Old 01-09-2019, 08:27 PM
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Just to note in passing, it isn't all about money anyway, even though that argument makes itself quite well. It's also about simple human decency.
  #425  
Old 01-09-2019, 08:28 PM
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America's not ready. That's my prognostication.
You have the Republican propaganda machine to thank for that, to whatever extent it exists (you might want to check the poll numbers). Rather, it seems Pelosi was right in pointing out that when people "find out what's in it", they support it.
  #426  
Old 01-09-2019, 08:37 PM
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All I'm saying is if they ever get around to proposing a tax plan to pay for it sometime soon (an actual, real tax plan that satisfies the revenue requirement), people will balk. America's not ready. That's my prognostication.
Yeah, but you're a fucking idiot.
  #427  
Old 01-09-2019, 08:45 PM
SlackerInc SlackerInc is online now
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The point that other countries had expensive health care and then reduced costs is bizarre, because it hasn't happened that way.
That was his exact point, and mine: that you can’t put the toothpaste back in the tube. We shouldn’t have foolishly squirted all that toothpaste all over the place all these years, but we did. Now our path is necessarily different from that of a country that has not gotten so much of its GDP tied up in the health care sector. (https://goo.gl/images/2ddLyG) You think 2008 was bad, try pulling the rug out from under all those companies (and the people in them) who are feeding at this trough. There needs to be a slow weaning process.

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  #428  
Old 01-09-2019, 08:49 PM
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Yeah, but you're a fucking idiot.
No, he might be right, Snowboarder. He might be right.

It's all in the timing.

Right now? Economy chugging along and unemployment at 3.9%...maybe he's right.

Wait until the house of cards, with our trillion dollar deficits and giveways to the billion dollar class, comes crashing down. We, the middle class, will be expected to pay the bill, just like we did - and we did it without questioning anything - in 2009.

There's going to come a point - it's inevitable - when we're going to have to prepare for battle. Peasants will have to strike fear in the hearts of their lords. My prophecies are correct. I guarantee it.
  #429  
Old 01-09-2019, 09:42 PM
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Your knowledge of the thing you are discussing has reset to zero, Memento-style.
Dacien? Nah; more like Groundhog Day style, but without the personal improvement.
  #430  
Old 01-09-2019, 10:52 PM
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Your knowledge of the thing you are discussing has reset to zero, Memento-style.
Great movie, by the way. In my top three.
  #431  
Old 01-10-2019, 06:10 AM
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This argument is at cross-purposes. I think Dacien et al understand that total health-care spending could decline, perhaps very steeply, if the U.S. switched to a more rational system, but there would be massive disruption; there'd be financial winners and losers.

For example, the health-insurance industry siphons off many scores of billions of dollars annually. Is that where cost savings is to come from? Laying off hundreds of thousands of health insurer employees will be disruptive. Kicking down the profits of insurance companies will be viewed as an act of sabotage against the stock market or people's 401Ks. Many employers provide insurance for employees; a sudden shift of those funds to higher salaries would be uncertain and disruptive.

And obviously taxpayer funding for the uninsured poor would necessitate tax increases on the higher-income brackets. Everyone making more than $X in salary — no, nobody knows the exact value of X — would suffer financially under UHC. Other countries happily accept this as part of the (Christian?) duty of charity. Paradoxically, such charitable instincts are absent in this, the most "Christian" of the developed democracies — our brand of Christianity often disdains love and instead teaches hatreds, esp. for government.

Quote:
Originally Posted by SlackerInc View Post
That was his exact point, and mine: that you can’t put the toothpaste back in the tube. We shouldn’t have foolishly squirted all that toothpaste all over the place all these years, but we did. Now our path is necessarily different from that of a country that has not gotten so much of its GDP tied up in the health care sector. (https://goo.gl/images/2ddLyG) You think 2008 was bad, try pulling the rug out from under all those companies (and the people in them) who are feeding at this trough. There needs to be a slow weaning process.
I asked SlackerInc for details but AFAIK he hasn't replied to me. Those who've studied the topic more than we have agreed that ACA was the best first step in the gradual way forward. But the hatreds and stupidities are so rampant in the U.S.A. that even ACA is being sabotaged. Recall that ACA was almost designed by the Republican Party! Is the best step now to re-install ACA but to rename it Trumpcare so the haters can stop hating it?

Last edited by septimus; 01-10-2019 at 06:13 AM.
  #432  
Old 01-10-2019, 06:55 AM
Gyrate Gyrate is offline
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All I'm saying is if they ever get around to proposing a tax plan to pay for it sometime soon (an actual, real tax plan that satisfies the revenue requirement), people will balk. America's not ready. That's my prognostication.
But that's a presentation issue, not a financial one. And the combination of saving a considerable amount of money, removing an enormous amount of paperwork and generally not having to worry about access to healthcare overall is a big selling point.

I live in the UK, I'm solidly middle class and got my tax statement yesterday. Turns out I pay about 8.8% of my annual income for "National Insurance" (and overall I pay about 27% of my income in tax including NI), and my employer kicks in a like amount.

But in return that covers everything - GP visits, emergency room and other hospital stays, consultants, mental health, subsidies for medicines (prescriptions in England are currently £8.80 per prescription - any prescription) and assorted other medical services. No out-of-pocket fees (apart from the £8.80), no eligibility requirements, no extensive insurance paperwork, and treatment only refused in highly extreme cases. Some years I've used the NHS a lot, some years I've barely used it at all, but overall I'm getting a freaking bargain here.

Once (if ever) we get past the first hurdle of getting people to understand that UHC will not lead to Soviet Union-style breadlines, there are indeed significant obstacles to getting from where the US is now to where it needs to be. Nye Bevan's comment about having to stuff the mouths of hospital consultants with gold to bring them around is a likely harbinger of how difficult it would be to get the US, which is both far more entrenched in its ways and with far more money sloshing around than 1940's Britain, to change. But as we can't even get over the first hurdle it remains an academic exercise.
  #433  
Old 01-10-2019, 08:31 AM
Gary Kumquat Gary Kumquat is online now
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Originally Posted by septimus View Post
obviously taxpayer funding for the uninsured poor would necessitate tax increases on the higher-income brackets.
2/3 of the cost of your current system is already raised via taxes -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880216/

You do not need to raise taxes. You just need to use these massive chunks of revenue in a vaguely sensible manner, using the sheer market power that a single purchaser has to enforce consistent and reasonable prices and achieve scale savings.

Then, if people are still concerned that the wait for non-essential treatment might be too long, you can use the money you're currently obliged to use for insurance to buy a skip the queue policy (which tend to be a a lot cheaper, when an insurer knows they're not going to be on the hook for medication for chronic ailments, etc) just to make sure you can still feel superior to poor people...which seems to be a primary concern for the US health system.

So, no new taxes, overall lower costs, everyone whose ill gets treatment, and you can still lord it over the unwashed should you so wish.
  #434  
Old 01-10-2019, 08:37 AM
SlackerInc SlackerInc is online now
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But that's a presentation issue, not a financial one. And the combination of saving a considerable amount of money, removing an enormous amount of paperwork and generally not having to worry about access to healthcare overall is a big selling point.

The problem is that people aren’t going to believe promises like that even if they might turn out to be true. As much as I generally stick up for Obama, and I still feel he was one of the best presidents in American history, he kind of screwed the pooch with his “you can keep your health plan” promises. This is not a right wing talking point: the Pulitzer Prize-winning Politifact rated this promise the Lie of the Year in 2013 (https://www.politifact.com/truth-o-m...-plan-keep-it/). So people are going to be understandably wary of promises that a subsequent and much more radical change to the health system will be win-win.

Something I haven’t seen addressed here is the question of supply. The randomized Oregon experiment showed that people who get Medicaid after previously being uninsured use significantly more medical services than they did before. How do we add tens of millions of patients to the system while simultaneously slashing payments to doctors, hospitals, clinics, and medical technology firms?
Thinking of doctors in particular, we’ll need an influx of new doctors to meet demand. How’s that going to happen at the same time we’re saying they need to take a big pay cut? Isn’t that going to reduce, rather than increase, the number of people who choose to go to medical school instead of getting an MBA or an engineering or law degree?

OTOH, if we find that it’s just untenable to try to radically “bend the cost curve” to make it like other countries, then the cost of single payer will be far greater than the optimistic estimates, which will then necessitate a much bigger hike in taxes to pay for it.


Quote:
Originally Posted by septimus View Post
This argument is at cross-purposes. I think Dacien et al understand that total health-care spending could decline, perhaps very steeply, if the U.S. switched to a more rational system, but there would be massive disruption; there'd be financial winners and losers.

For example, the health-insurance industry siphons off many scores of billions of dollars annually. Is that where cost savings is to come from? Laying off hundreds of thousands of health insurer employees will be disruptive. Kicking down the profits of insurance companies will be viewed as an act of sabotage against the stock market or people's 401Ks. Many employers provide insurance for employees; a sudden shift of those funds to higher salaries would be uncertain and disruptive.

And obviously taxpayer funding for the uninsured poor would necessitate tax increases on the higher-income brackets. Everyone making more than $X in salary — no, nobody knows the exact value of X — would suffer financially under UHC. Other countries happily accept this as part of the (Christian?) duty of charity. Paradoxically, such charitable instincts are absent in this, the most "Christian" of the developed democracies — our brand of Christianity often disdains love and instead teaches hatreds, esp. for government.



I asked SlackerInc for details but AFAIK he hasn't replied to me.
Say what? I didn’t intentionally avoid answering anything. What details?

I agree with the rest of what you said there, BTW.
  #435  
Old 01-10-2019, 08:57 AM
Shodan Shodan is offline
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Originally Posted by Railer13 View Post
I was responding to Shodan asking for proof that other countries have drastically cut healthcare costs. Nobody has ever claimed that. Everybody has stated that under each country's current system, they pay far less per capita than the US.

The point that other countries had expensive health care and then reduced costs is bizarre, because it hasn't happened that way.
As SlackerInc mentions, that's the point. The claim is that if the US implements single payer/UHC, we will reduce costs substantially, and no other country has ever done that.

Quote:
Originally Posted by Airbeck
Shodan, why is America so hapless? Why are we unable to do something that has already been done to great success in many other countries.
America is being asked to do something that has never been done with any success in any country - namely, cut health care spending very substantially.
Quote:
Originally Posted by CarnalK
I've joked that you seem to be drunk on Liberal tears but I'm now starting to wonder if you're just drunk.

Politicians who don't want universal care have to make obtuse arguments about the costs to argue against it. You don't. No one is voting for you, so you don't have to pretend the current system is more cost efficient. Why not just admit you don't want people getting free healthcare because it offends your capitalist sensibilities?
Is it your argument that, if the US implements M4A/UHC/single payer, that the US will be able to reduce health care costs and save money? If so, can you cite an example of another country that implemented single payer/UHC/M4A or its equivalent, and reduced health care costs to less than what they were before they implemented single payer/UHC?

If it's not your argument that M4A will reduce costs, then fine. But "it won't save us any money" isn't an obtuse argument.

Regards,
Shodan
  #436  
Old 01-10-2019, 09:12 AM
Shodan Shodan is offline
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Originally Posted by Gary Kumquat View Post
2/3 of the cost of your current system is already raised via taxes -
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880216/

You do not need to raise taxes.
According to the report, a doubling of the personal and corporate federal income tax would not cover the increased cost, even if
  1. We make dramatic cuts to payments to health care providers
  2. We dramatically cut drug prices
  3. We include in our calculation any projected savings on administrative costs, and
  4. We assume that there is no increased utilization of the health care system by the newly covered.
Keeping in mind that acute care hospitals currently lose money on something like three quarters of their Medicare patients. So if we implement M4A, either we raise taxes, cut spending, or that three-quarters approaches 100%.

Regards,
Shodan
  #437  
Old 01-10-2019, 09:50 AM
Ravenman Ravenman is offline
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Originally Posted by Shodan View Post
Keeping in mind that acute care hospitals currently lose money on something like three quarters of their Medicare patients.
You complain that Medicare doesn't spend enough money because of those poor, poor struggling doctors and hospitals... then in the next breath talk you will surely blather on about how Medicare costs too much and we should cut it.

How about you determine how much Medicare should pay doctors, and we'll adjust taxes to pay those bills?
  #438  
Old 01-10-2019, 09:53 AM
ElvisL1ves ElvisL1ves is offline
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Originally Posted by Shodan View Post
As SlackerInc mentions, that's the point. The claim is that if the US implements single payer/UHC, we will reduce costs substantially, and no other country has ever done that.
What other countries do you suggest we compare ourselves to as a data point? As already explained, any others you might list did it generations ago and wouldn't consider going back. Your claim that no other country has been shown to reduce costs by implementing the change is disingenuous - you might as well say no other country has increased them, either.

Quote:
But "it won't save us any money" isn't an obtuse argument.

Regards,
Shodan
Given the complete lack of substantiation for it, yes, it is.
  #439  
Old 01-10-2019, 10:19 AM
SlackerInc SlackerInc is online now
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Originally Posted by ElvisL1ves View Post
What other countries do you suggest we compare ourselves to as a data point? As already explained, any others you might list did it generations ago and wouldn't consider going back. Your claim that no other country has been shown to reduce costs by implementing the change is disingenuous - you might as well say no other country has increased them, either.

What’s disingenuous is to take statistics from countries who adopted UHC long before expensive modern medicine developed anywhere, and say “look: we just have to swtitch to their system, and our costs wil be just like theirs”. We have no evidence that we can simply put the toothpaste back in the tube.

If you want to say that skeptics don’t know what will happen either, that’s entirely fair. But for anyone who is reasonably satisfied with the status quo for their own health care, “we don’t know what will happen, but we want to try it and find out” is not enticing. (Yes, that’s selfish. Welcome to politics in America. Complaining about it isn’t going to change it or do any good for anyone.)

So on the pro-MFA side, there are surely many people who haven’t fully thought it through and don’t realize that you can’t just Xerox another country’s health system without having a major plan for the transition. But I think there are others who do understand this, but also understand that voters will balk if they are really frank about the difficulties that may arise in a transition. These people believe (with justification) that the end result will be more just. So they are willing to be disingenuous, just as Obama was, to try to push it through, and then plan to deal with any backlash when the time comes and hopefully the die is cast. But that’s a very dangerous game to play.

Last edited by SlackerInc; 01-10-2019 at 10:22 AM.
  #440  
Old 01-10-2019, 10:27 AM
Gary Kumquat Gary Kumquat is online now
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Originally Posted by Shodan View Post
Keeping in mind that acute care hospitals currently lose money on something like three quarters of their Medicare patients.
You know, constantly pointing out the failings in the current US healthcare market is not a good reason against changing it.

You might want to ask yourself why hospitals in countries with state insurance schemes, such as France, manage to make it work and still achieve higher care rankings than the US. You might want to ask why pharmaceutical companies in the US routinely charge 2 - 3 times what they do in other countries, for starters
  #441  
Old 01-10-2019, 10:31 AM
Railer13 Railer13 is offline
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Originally Posted by Shodan View Post
The claim is that if the US implements single payer/UHC, we will reduce costs substantially, and no other country has ever done that.
Sigh.

For the last time, I'll make this statement. No other country has reduced their costs substantially, because no other country has ever had the high costs that we are currently experiencing.
  #442  
Old 01-10-2019, 10:46 AM
ElvisL1ves ElvisL1ves is offline
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Originally Posted by SlackerInc View Post
What’s disingenuous is to take statistics from countries who adopted UHC long before expensive modern medicine developed anywhere, and say “look: we just have to swtitch to their system, and our costs wil be just like theirs”. We have no evidence that we can simply put the toothpaste back in the tube.
Yes, there will be one-time costs and disruptions with the change. All the people involved in our current administrative bloat will have to find other things to do, and all the executives pocketing big bonuses for denying care will have to try to make do with a bit less. But no mainstream proposal for expanding Medicare eligibility also involves banning private insurance. Even Britain has a private system alongside its beloved NHS.

Yes, claiming that one-time disruption, to any extent it actually exists, is a good reason not to do it at all is disingenuous. It's simply inventing excuses.

Quote:
But for anyone who is reasonably satisfied with the status quo for their own health care, “we don’t know what will happen, but we want to try it and find out” is not enticing.
Anyone satisfied with their current private insurance knows, or should, that it could go away at any time, and will keep costing more every year at higher than the rate of inflation. The prospect of a secure backstop certainly is enticing. Yes, many people are willing to be scared out of it, as we saw in the anti-ACA lie campaign, or in the anti-Medicare debate half a century earlier, but is that a reason not to do it? Please note that even the Republican position is "repeal and replace", never mind that they cannot define what to replace ACA with - they too know we need it, and that their voters actually know it too.

Quote:
So they are willing to be disingenuous, just as Obama was, to try to push it through,
In what way? Is that a reference to "You can keep it", which is not true either with or without ACA? Or was that some sort of bothsidesism?
  #443  
Old 01-10-2019, 11:01 AM
Evil Economist Evil Economist is offline
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Originally Posted by Shodan View Post
As SlackerInc mentions, that's the point. The claim is that if the US implements single payer/UHC, we will reduce costs substantially, and no other country has ever done that.

America is being asked to do something that has never been done with any success in any country - namely, cut health care spending very substantially.
Is it your argument that, if the US implements M4A/UHC/single payer, that the US will be able to reduce health care costs and save money? If so, can you cite an example of another country that implemented single payer/UHC/M4A or its equivalent, and reduced health care costs to less than what they were before they implemented single payer/UHC?

If it's not your argument that M4A will reduce costs, then fine. But "it won't save us any money" isn't an obtuse argument.
Whenever I read your arguments I always imagine a fat guy talking to his skinny friends.

SHODAN: "There's no way I can lose weight"
REST OF WORLD "Well, we control our portions and exercise, and we're all skinny"
SHODAN "You have no evidence that would work for me. None of you have ever needed to lose 200 lbs. I'm a special case" *stuffs his face with donuts, doesn't lose weight*
__________________
That year, according to Vanity Fair, Mary Trump asked Ivana Trump, her soon-to-be-ex-daughter-in-law, a pointed question. “What kind of son have I created?”

Last edited by Evil Economist; 01-10-2019 at 11:01 AM.
  #444  
Old 01-10-2019, 11:05 AM
Shodan Shodan is offline
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Originally Posted by Railer13 View Post
Sigh.

For the last time, I'll make this statement. No other country has reduced their costs substantially, because no other country has ever had the high costs that we are currently experiencing.
Then you understand my point, which is that saying "if the US implements UHC like Canada, we will spend much less like Canada" is not really on point.
Quote:
Originally Posted by Gary Kumquat View Post
You know, constantly pointing out the failings in the current US healthcare market is not a good reason against changing it.
One of the current ideas is to implement Medicare for All. Pointing out that a program that causes most health care providers to lose money on providing health care seems to me to be a perfectly valid point. "Buy at five, sell at three, make up the difference on volume" is not a particularly convincing argument.

Sure, let's change the US health care market. Changing it so doctors lose money by providing health care doesn't strike me as an improvement. YMMV.

Regards,
Shodan
  #445  
Old 01-10-2019, 11:25 AM
SlackerInc SlackerInc is online now
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Originally Posted by Gary Kumquat View Post
You know, constantly pointing out the failings in the current US healthcare market is not a good reason against changing it.

You might want to ask yourself why hospitals in countries with state insurance schemes, such as France, manage to make it work and still achieve higher care rankings than the US. You might want to ask why pharmaceutical companies in the US routinely charge 2 - 3 times what they do in other countries, for starters
It’s almost like you can’t even “hear” what I’m saying. Try to keep up.
  #446  
Old 01-10-2019, 01:00 PM
Shodan Shodan is offline
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Originally Posted by Evil Economist View Post
Whenever I read your arguments I always imagine a fat guy talking to his skinny friends.

SHODAN: "There's no way I can lose weight"
REST OF WORLD "Well, we control our portions and exercise, and we're all skinny"
SHODAN "You have no evidence that would work for me. None of you have ever needed to lose 200 lbs. I'm a special case" *stuffs his face with donuts, doesn't lose weight*
More like -

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

Regards,
Shodan
  #447  
Old 01-10-2019, 01:08 PM
Railer13 Railer13 is offline
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Originally Posted by Shodan View Post
More like -

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

EVERYONE ON THE SDMB: "You should lose 200 pounds. My neighbor takes spinach pills every day, and he only weighs 135."
Shodan: "What did he weigh before he started taking spinach pills?"
EVERYONE ON THE SDMB: "He's always weighed 135 pounds, and taking spinach pills is a big reason why. But somehow you cannot understand that concept."
  #448  
Old 01-10-2019, 01:35 PM
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Cheesesteak Cheesesteak is offline
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Quote:
Originally Posted by Shodan View Post
More like -

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

Regards,
Shodan
Or:

Me: "I pay $3,000 a month in rent"
Next door neighbor with identical residence: "I pay $1,500 in rent"
My wife: "Why don't we pay $1,500 in rent?"
Me: "Because we'd go broke, stupid! Anyway, look at his place, the driveway needs patching! That's way worse than our leaky roof and backed up sewer line."
  #449  
Old 01-10-2019, 01:40 PM
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Cheesesteak Cheesesteak is offline
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BTW, just in general, the question of:

How can we modify our health care system from one that consumes 20% of our GDP to one that consumes 10-12%, like all these other countries?

SHOULD be the single biggest question our lawmakers tackle every single year. It should not be ignored every year, and certainly nobody should be suggesting that 20% is BETTER than 10-12%. The idea that we can't do it is ridiculous because we have hardly even tried.
  #450  
Old 01-10-2019, 01:43 PM
Shodan Shodan is offline
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Originally Posted by Cheesesteak View Post
BTW, just in general, the question of:

How can we modify our health care system from one that consumes 20% of our GDP to one that consumes 10-12%, like all these other countries?

SHOULD be the single biggest question our lawmakers tackle every single year. It should not be ignored every year, and certainly nobody should be suggesting that 20% is BETTER than 10-12%. The idea that we can't do it is ridiculous because we have hardly even tried.
No one else has tried either.

Regards,
Shodan
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