Most Americans would not be okay with the rationing that comes with that zero deductible system.
And the National Review talking points come out.
Until we fix the supply problems, rationing is inevitable. The question is whether you get rationed care, or you get to pay through the nose to get to the front of the line.
So what you’re really saying is that “most” Americans want to deny care to the working poor at the cost of bankrupting themselves. Ah, yes, that’s a classic American demand, just like, “I insist that you punch me in the kidneys until I die, and then go and call that Mexican over there a bastard.” :rolleyes:
And the National Review talking points come out.
Until we fix the supply problems, rationing is inevitable. The question is whether you get rationed care, or you get to pay through the nose to get to the front of the line.
So what you’re really saying is that “most” Americans want to deny care to the working poor at the cost of bankrupting themselves. Ah, yes, that’s a classic American demand, “Do me harm for the promise of not helping that smelly peon.” :rolleyes:
It’s just like, “I insist that you punch me in the kidneys until I die, and then go and call that Mexican over there a bastard.”
Or that old favorite, “I’ll let you stick my hand in that blender if you knock that kid’s lollipop in the dirt! Heck, I’ll just stick my hand in the blender anyway!”
ETA: Sorry for the semi-dupe post, internet glitch.
I noted yesterday that I wasn’t offended by being called “weird” or “cognitively strange”. I am however offended by being characterized as a National Review Republican. Please take that back, because I don’t think I deserve it whatsoever.
I don’t want to constantly repeat myself, but it may be that you missed where I described how I used to believe, just like any other good liberal Democrat, that the Canadian system was completely peachy keen. Then my sister got kind of screwed by it, and subsequently my mother almost did, before someone clued her into a backdoor way to work the system.
It should be noted that neither of them has any interest in Canada reverting to a U.S.-style patchwork. But that’s because they are way over on the NDP/Green left (yes, I am the black sheep of the family, LOL). They would not want to cause millions of Canadians to become uninsured altogether. Which is absolutely admirable, and it is where my heart is as well. But the political reality is that blocking the change to single payer would not be bad for everyone, as you try to characterize it.
For starters, I guarantee you doctors don’t want to switch, except for a few whose conscience pulls them way left. But beyond that, the system as it is is good for anyone who has a decent plan through their employer. And that’s a lot of people. It’s not everyone, it’s not even the vast majority, but I think it is a majority — at least, a majority of voters. And most of those people do not want to trade down a bit so that a bunch of working poor people they don’t know will get healthcare. It’s harsh, but that’s the reality. And it’s not as though people who would take the trade-off can style themselves as morally pure either. Everyone (except a very few extreme outlier individuals) chooses to put some of their money toward things they don’t one hundred percent need, which implicitly is money they could have given to a group that saves children’s lives in the developing world. So we all have blood on our hands.
I will repeat myself in wondering why it would be so bad to just give everyone a catastrophic single payer benefit. Poof: the chance that you will lose your house, or leave crushing debt to your family after you die of cancer, is eliminated. And it would be so much cheaper than this zero-deductible full coverage concept. Add sliding scale tax credits to fund health savings accounts for the poor and low income segments of the population, and you’ve got a pretty good, affordable system that doesn’t change anything for the white-collar set.
In your system, those sliding-scale credits are just a tax-funded kludge for some patients, while you avoid admitting that commercial insurance isn’t a real solution for everyone. And as in states today that still refuse to expand Medicaid, those credits will presumably eventually go unfunded, because they don’t have buy-in from the middle income quintile. To have a stable system that covers the poor, it’s better to get a majority of voters on the same system as the smelly peons, so it’s their system too.
“Programs for the poor are poor programs.”
I don’t remember hearing about your sister’s problems with Canadian single-payer. While I’d be interested to hear that story, I also know* it won’t change my mind.* The USA non-system has more cracks, and more people fall through them. The USA has price variance from one customer (not supplier) to another, which continues to deny many patients care, in that while they are insured, they’re insured in the “wrong” way. Even if we changed that by mandating a standard price schedule, there would still be patients insured by no one, and the comical process of trying to collect on a bill the patient can’t pay and no one has reason to pay.
Complaining about “rationing,” as if care isn’t denied to many Americans now, is silly and NR-like. The present non-system denies care to the poorer classes, and imposes financial strain on others. The privileged do all right under it, yes.
It’s like complaining that the voting system in egalitarian democracy “rations” influence instead of allowing votes to be bought with money.
I would have thought by now you’d get that I’m describing *political *problems, not ethical problems. I’m not disputing that the Canadian system is *ethically *superior to the U.S. system. But Bernie is selling it as a free lunch, that would have drawbacks for no one, and that is BS. This is why I say he too is dishonest. I’m okay with dishonesty from politicians if (a) it is for the greater good, and (b) it isn’t going to come back to bite you in the ass politically. You can definitely make the argument for (a). But as soon as people started to have the kinds of problems my family members did, the scenario in (b) would go nuclear, we’d have a massive political backlash, we’d be worse off than before, and we’d be set back for decades at least in terms of trying to get any sort of universal coverage. We are much better off adding a patch at a time, as inefficient and “kludgy” as that admittedly is, while not disturbing the health plans of the privileged set.
Here, in their own words, is what happened to my sister and my mother, both naturalized Canadian citizens. These are copied verbatim (though slightly condensed in my sister’s case, with nothing germane removed) from email exchanges, with of course pseudonyms used to protect privacy:
First, in July 2013:
That was where we left it at that time. I asked my mother what she thought about this, and at that point she said she thought it was not a problem in Ontario where she lives, but just a case of the BC government being conservative and starving the system. She changed her tune somewhat later on, as you will see.
Then came this exchange in December 2014:
So it looks to me like they already have the “poor people’s health care” issue in Canada, with these two tiers.
Just a couple weeks ago, I asked my mom to email me details about the problem she had. She knew what purpose I intended to use it for (debates like these), and she is a big Bernhead and still an advocate for single payer, so she loaded it up heavily with caveats. I will be fair and include all of her advocacy; but again, I think these kinds of issues would practically lead to riots if they came about in the U.S. So if Bernie pushes for a single payer system here, at the very least he cannot pretend it will cost the same as the Canadian system has been costing in recent years, especially when you add in the fact that you’re not going to get all these doctors to massively slash their pay. They really might “go Galt” if you tried that. Anyway, with no further ado, here’s SlackerMom:
Let’s note too that we can’t just shrug and say that everyone could use my mom’s workaround. If they have a six week waiting period, they clearly don’t have the resources to see everyone in a timely manner. What she did essentially pushed the next caller back to six weeks and one day.
I’m not happy with the rationing that comes with the free market system. My wife needed a stem cell transplant, but the death panel at Blue Cross/Blue Shield said no. She’s dead now.
Of course universal health care isn’t a free lunch. There Ain’t No Such Thing, after all. But it’s a cheaper lunch, and if we’re going to have to eat lunch anyway, it might as well be the cheap one instead of the expensive one.
Universal health care keeps some people healthier than Capitalism Care, and it’s cheaper for everyone. It’s win-win.
Ugh, I’m so sorry to hear that. 
The problem in political terms is that if we go to single payer, every single denial or delay of coverage will be blamed on the change, even if it might well have happened with private insurance as well. We already see that with Obamacare: I have a shirttail relative who works at a factory and his company pulled some kind of fast one in terms of either reducing their employees’ health coverage, raising their premiums, or maybe both. They told their workers it was the fault of Obamacare.
I am hazy on the details now, but at the time I researched it and it seemed pretty clear that it was total bullshit, pure scapegoating. But of course these rural, blue-collar Missourians ate that excuse up with a spoon. The company got away with a scam that added to their bottom line, while turning their workforce even more against Democrats. It’s enraging, but pretty hard to combat.
Which, again, is why I lean more and more toward adding patchwork coverage to people who don’t have it now. We did exactly that with SCHIP (which is how all my kids get their healthcare), and I don’t recall anyone ever blaming any of their insurance problems on that program. The Medicaid expansion is a good example of this too. I think it’s some of the other aspects of the ACA that are vulnerable to this kind of scapegoating.
Chronos, what you are calling “win-win” I agree with on the merits, but do you really not see what a political dead duck that is? I don’t think it’s any coincidence that Otto von Bismarck, the originator of socialized medicine way back in the 19th century, said that “politics is the art of the possible, the attainable — the art of the next best”.
ETA: Mulling your “cheaper lunch” analogy makes it even clearer: if your average white collar type was given the option to trade in their daily lunch of chopped salad with artisinal lettuce for a sack lunch of a PB&J or turkey and cheese on supermarket sliced bread, with the payoff being that all the hungry people in the world would now be fed, I just don’t think they’d go for it. Do you?
It should be noted that a lot of private insurance denials are also scapegoating. In many cases it’s procedures that don’t make a whole lot of sense. If a procedure is not indicated for a particular condition, then it’s not going to be approved, whether it’s private insurance or government insurance. The same goes for high priced procedures. Inherent in single payer, as well as insurance, is that either party to the price negotiations can walk away from the table. Which means the procedure in question is not covered. There is no law that says that an agreement HAS to be reached on Drug A or Test B or Procedure X. Except in North Korea maybe.
Greed can’t be written off of course, greed is certainly a reason why some things get denied, but the government equivalent is not as different as advocates would like to claim. Bureaucrats need to meet their bottom lines and budget targets the same way companies have to hit profit targets. The taxpayers aren’t willing to write the government a blank check and get pretty ornery when the health care budget comes in $100 billion over and they have to pony up.
Wait, your sister could get FREE ACL surgery but she only had to wait a year or two? And if she’d had money she could have jumped to the head of the line?
Compare that to the USA system again.
And your mom, by learning to work the system, got totally free care in a timely fashion,* from an Emergency Department.*
Compare that to the USA system again.
You just argued *for *Canadian single-payer, on the merits. Congratulations.
Every province runs its own health care system - the Canada Health Act is only about six pages long. So some provinces offer more private services than others. There are some treatments that are simply not available here, or that are only available on long waiting lists.
Canada is pretty good at life-saving medicine, cancer treatment, etc. But if you are 60 years old and need a hip or knee replacement, good luck. My grandmother walked with a cane for years while waiting in a queue for a knee replacement. It pretty much ruined her retirement plans, and by the time she got the knee she had other issues that prevented her from doing the things she wanted. That really, really sucked.
My kid needed some surgery that was deemed optional but who had major problems without it. The waiting list for that surgery was 2-3 years, which is an eternity to a child. We took him to the US and had it done there and paid $8,000 out of pocket, plus the travel and hotel expenses. And there’s no insurance available to cover that.
When you travel across the border near us, on the U.S. side there are billboards advertising various medical procedures. Enough Canadians travel to the U.S. to skip waiting lines or seek better doctors that it’s profitable to do this.
The way our health system pays doctors leads to poor front line care and assembly line medicine. Doctors get paid a flat rate for a visit, so they will often be seeing five or six patients at the same time. The doc will walk into the room, tell you to get undressed or ask you to fill out a form, then while you are doing that he’ll go to another patient. The doc comes and goes repeatedly during the visit unless it’s something that takes a very short time. And because they are incentivized to treat so many people, your chance of getting a bad diagnosis or having the doc miss a condition is really high.
It can be very hard to get a family doctor here in Alberta now. If you need to see specialists, it can be time consuming and take forever. If your family doctor refers you to a specialist, it can take anywhere from a month to six months to get in. And once you do, if you want a second opinion or need to see a second specialist, be prepared to wait months more. Along the way, expect errors, bureaucratic snafus like losing referrals, etc.
Also, our health care is neither free nor universal. As I said, some provinces have privatized various treatments and procedures to take a load off the public system. In addition, ancilliary medical services like dentistry and podiatry are completely private. In a lot of provinces you pay a monthly fee to help pay for the health care system. And of course the rest of the money comes from taxes - which you also pay. There are no free lunches.
Finally, prescription drugs are not covered by the public health care system. If my wife and I didn’t have good health care insurance through our employers we would be paying close to $2,000/mo for our prescription drugs.
Yes, lets. Canada free-rides on your system in a number of ways, which is one of the reasons our health care costs are lower. Our wealthiest people also travel to the U.S. for the very expensive treatments that are either not here at all or only available after waiting a long time. That also lowers the strain on our system.
We also benefit from lower drug prices because Americans are wealthier and therefore pay more and help amortize the cost of drug R&D.
Finally, because our serious medical procedures are a state monopoly and price controlled, we rely on the U.S. heavily for innovation in treatments and medical devices. The first artificial hearts cost millions and millions of dollars. Eventually they’ll figure them out and the cost will come down, but without rich people acting as early adopters and willing to pay the huge money for new development, those things wouldn’t exist at all.
As an analogy, if the price of cars was capped at the price of a Chevy Cruz so they were affordable to all, do you think we’d have seen the kinds of innovation in safety, emissions, and performance that we have today? Almost all of the advanced features that are widespread today were initially designed and built for luxury cars, and eventually the technology trickled down to everyone else. Airbags, nav systems, stability control, rear view cameras, ABS brakes… All of this stuff was way too expensive for the mainstream market when it was first developed. Good thing Mercedes, BMW, and others had wealthy people as customers who were willing and able to pay high premiums for those devices, or it’s likely that none of us would get to enjoy them today.
In health care, CAT scans, heart surgery, stents and shunts and such were once extremely expensive and their development was funded in large part by wealthy people willing to pay whatever it took. Now they’re available to everyone. Good thing those rich people didn’t have all their money taxed away, or that the medical procedures available weren’t limited by government fiat.
So thanks, US. Without you our system would be a lot more expensive and expensive new treatments would never be developed.
Incidentally, if you think the U.S. health care market can be brought under control and the prices lowered significantly with single payer, ask yourself why your current single payer system (Medicare) still costs way more than ours? You don’t suppose there might be other factors at play here?
Canada has a fine health care system. It’s maybe on balance better than the U.S. system today for the average person. But it’s not a panacea and lots of people fall through the cracks. Our system looks good statistically because the statistics revolve around lifespan and treatments of life-threatening issues. We focus our limited resources on those. But if you gathered stats on quality of life issues, waiting lists, availability of more expensive treatments and the like, we won’t look nearly so impressive.
Notice that the people kept re-electing him and still keep re-electing his party. There must be something in the Bolivarian Revolution that they like. Think about that.
It helps when you suppress the opposition press while using state media to campaign.
Except, of course, for the states that don’t approve SCHIP or Medicaid expansion, and so their citizens that should be covered by it can’t be covered by it.
And that’s different than the U.S. system how?
And that’s different than the U.S. system how? Last summer, I had to wait 3 months to get a neurologist lined up because of various bureaucratic snafus and whatnot. While trying to figure out what was causing muscle weakness and pain in my arm.
Jesus. How many times do I have to reiterate that I am in favor of such a system “on the merits”, at least if the only choices are that system or the one we have now? I’m talking about the politics. And you can’t force Americans into a system which, for teachers, cops, firefighters, and college-educated professionals, will be more of a hassle than the one they have now. Not without major political blowback.
What states don’t do SCHIP? I live in Missouri, which was terrible about Medicaid in general even before the expansion that they didn’t join, and they have a perfectly robust SCHIP system.
All you have to do is call it “expanding Medicare eligibility”. The system is already in place, and works extremely efficiently, and has near-universal approval too. Nothing new need be created and no blowback from anybody outside Big Insurance need be expected.
I enjoyed those last couple seasons of TWW too. But are you saying that people who are comfortable with their current scenario could just continue without joining Medicare?