# Ms. Ocasio-Cortez, on How to Pay for Medicare for All **URL:** \ **Category:** The BBQ Pit\ **Created:** [December 3, 2018, 6:43pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514 "2018-12-03T18:43:36Z")\ **Posts on this page:** 20\ **Page:** 24
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 10, 2019, 10:37pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/461 "2019-01-10T22:37:57Z")
> [@Railer13](#): > > One more time. > > Shodan has been asking for examples of countries that have reduced their health care costs by 25-40%. Several of us have pointed out, numerous times, that no other country has ever spent as much money as we are currently spending, thus there are no examples of such cost reduction. > > Now, if you’re saying that reducing our costs will be tough and the lower costs will be hard to maintain, I would agree. But I’m not at all sure that’s what you meant. 😕 What else could I mean? ---
**Author:** ![Railer13](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/railer13/32/9742_2.png) [@Railer13](https://boards.straightdope.com/u/Railer13)\ **Post date:** [January 10, 2019, 11:22pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/462 "2019-01-10T23:22:45Z")
> [@SlackerInc](#): > > 😕 What else could I mean? OK, so we agree on what you meant. Now, would you agree that no country has ever had as high of health care costs like we currently have, and thus there are no examples of any country that have reduced their costs by 25-40%? ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 11, 2019, 2:38am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/463 "2019-01-11T02:38:20Z")
> [@Railer13](#): > > OK, so we agree on what you meant. > > Now, would you agree that no country has ever had as high of health care costs like we currently have, and thus there are no examples of any country that have reduced their costs by 25-40%? Of course. That’s the exact point Shodan and I have been making. ---
**Author:** ![Railer13](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/railer13/32/9742_2.png) [@Railer13](https://boards.straightdope.com/u/Railer13)\ **Post date:** [January 11, 2019, 3:10am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/464 "2019-01-11T03:10:25Z")
> [@Shodan](#): > > Do you have any examples of countries that have reduced their healthcare spending by 25-40%? > [@Railer13](#): > > Now, would you agree that no country has ever had as high of health care costs like we currently have, and thus there are no examples of any country that have reduced their costs by 25-40%? > [@SlackerInc](#): > > Of course. That’s the exact point Shodan and I have been making. So we can stipulate that no other country has ever spent as much on health care as we currently spend. We can also stipulate that other countries currently spend substantially less than we do and achieve comparable or perhaps even better results. We can examine what these countries are doing and hopefully implement some or all of those practices in an effort to reduce our health care costs. But we cannot show an example of a dramatic reduction in costs by another country, because no other country has ever needed to do so at the level that we need to. Agreed? ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 11, 2019, 3:44am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/465 "2019-01-11T03:44:11Z")
Something that seems to have gone over people’s heads is that Shodan was quite obviously (IMO) not asking for examples of countries who have slashed medical spending this way because he thought there WERE examples of such. It was a rhetorical move to show that it is unprecedented and therefore we actually do not have any examples to follow. The U.S. is sui generis in this regard, so it’s simply unexplored territory. We should absoutely try to bend the cost curve. But the notion that since other countries kept their costs down starting 70 years ago (when President Truman tried to do the same but was unfortunately blocked by Republicans in Congress), therefore we can just suddenly slash our spending to match theirs, and we’ll instantly catch up? That’s nuts. We have developed a bloated medical sector over all these decades: if we suddenly chop it in half while expanding coverage, we’ll simultaneously mess up health care delivery AND the wider economy. 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. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 11, 2019, 4:30am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/466 "2019-01-11T04:30:41Z")
> [@SlackerInc](#): > > 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. You’re ignoring the fact that the people who don’t have coverage _are_ treated - but incredibly inefficiently, with no preventative care, going to the ER only _in extremis_. And when they can’t pay, the providers pass the cost of that treatment on to everyone else. So it’s far from a pipe dream that expanding coverage can be achieved while reducing overall spending. The way you & Shodan are talking about this is eerily reminiscent of [the Onion’s recurrent commentary](https://www.theonion.com/no-way-to-prevent-this-says-only-nation-where-this-r-1823016659) on the other major U.S. blindspot. > [@Not The Onion](#): > > No way to prevent the cost of our awful healthcare reaching 20% of GDP, says only country where healthcare costs exceed 10% of GDP. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [January 11, 2019, 6:38am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/467 "2019-01-11T06:38:52Z")
> [@Riemann](#): > > You’re ignoring the fact that the people who don’t have coverage _are_ treated - but incredibly inefficiently, with no preventative care, going to the ER only _in extremis_. And when they can’t pay, the providers pass the cost of that treatment on to everyone else. So it’s far from a pipe dream that expanding coverage can be achieved while reducing overall spending. I used to believe it would work out that way. But Medicaid expansion, including the randomized trial in Oregon, has shown that people actually do get a higher dollar amount of medical treatment when they go from uninsured to covered. Even accounting for the higher cost of ER visits. We need to get everyone at least basic coverage. But I believe that’s going to cost a shit-ton of money, and we can’t just rely on happy talk that isn’t any more believable than the Laffer Curve or “waste, fraud, and abuse”. Aren’t we supposed to be better than that? Or would you say that’s just loser talk? ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [January 11, 2019, 11:36am UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/468 "2019-01-11T11:36:14Z")
> [@SlackerInc](#): > > we can’t just rely on happy talk that isn’t any more believable than the Laffer Curve or “waste, fraud, and abuse”. Aren’t we supposed to be better than that? They’re not equivalent, because the Laffer Curve is bullshit some asshole wrote on a napkin, and the “happy talk” is what 50 countries are already doing today. I’m not expecting it to be easy, but to say it’s impossible to even approach the cost rates of other countries, without so much as attempting to develop an plan to get there, is nonsense. We’re wasting 8-10% of our GDP and half the politicians in the country don’t even want to try to get it back. It’s criminal. ---
**Author:** ![Gary\_Kumquat](https://avatars.discourse-cdn.com/v4/letter/g/4491bb/32.png) [@Gary\_Kumquat](https://boards.straightdope.com/u/Gary_Kumquat)\ **Post date:** [January 11, 2019, 12:27pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/469 "2019-01-11T12:27:10Z")
> [@SlackerInc](#): > > It’s almost like you can’t even “hear” what I’m saying. Try to keep up. It’s almost as if I was replying to Shodan, not you. Try to keep up. ---
**Author:** ![Gary\_Kumquat](https://avatars.discourse-cdn.com/v4/letter/g/4491bb/32.png) [@Gary\_Kumquat](https://boards.straightdope.com/u/Gary_Kumquat)\ **Post date:** [January 11, 2019, 12:32pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/470 "2019-01-11T12:32:50Z")
> [@Shodan](#): > > 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 In which Shodan demonstrates his capacity for analogy is as bad as his grasp of economics. ---
**Author:** ![andros](https://avatars.discourse-cdn.com/v4/letter/a/e480ec/32.png) [@andros](https://boards.straightdope.com/u/andros)\ **Post date:** [January 11, 2019, 2:07pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/471 "2019-01-11T14:07:45Z")
> [@Gary\_Kumquat](#): > > In which Shodan demonstrates his capacity for analogy is as bad as his grasp of economics. And thank ghod for it. I’ve been hoping someone will beat me out for Worst Analogy Guy for like 17 years. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [January 11, 2019, 2:36pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/472 "2019-01-11T14:36:20Z")
> [@SlackerInc](#): > > 😕 What a terrible metaphor for your case. Do you not realize that staying at 135, what someone has always weighed, is a million times easier than going from 335 to 135 and staying there? I think the best analogy is the 350 pound guy that claims it’s IMPOSSIBLE to lose 100 pounds because it’s impossible for a 150 pound guy to lose 100 pounds. My health care experiences are based on using the doctor and medical practices of a large hospital based healthcare system. IMHO, they schedule a lot of unnecessary appointments to keep their expensive to operate facilities running at full capacity. When I had my cataract surgery, I had to schedule 4 different appointments prior to the surgery and 5 follow-ups, even though there were absolutely no extenuating circumstances or complications. I felt this was ridiculous, and a waste of my time and co-pay money. But you play along because you don’t want to be deemed negligent or uncooperative in case there is a problem. Of course, that was my second cataract surgery. I only had 2 follow-ups after the first surgery, because the doctor was on vacation for a month. Now if the extra 3 follow-ups had been truly necessary they would’ve had another doctor do them. But they didn’t. But I still had to pay for 5 follow ups after the second surgery. I’m convinced my medical practice could double their patient load without compromising quality or substantially increasing their costs. As it is now, they milk their existing patients to keep the practice running at full capacity. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [January 11, 2019, 2:47pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/473 "2019-01-11T14:47:16Z")
> [@Ann\_Hedonia](#): > > I think the best analogy is the 350 pound guy that claims it’s IMPOSSIBLE to lose 100 pounds because it’s impossible for a 150 pound guy to lose 100 pounds. > > My health care experiences are based on using the doctor and medical practices of a large hospital based healthcare system. IMHO, they schedule a lot of unnecessary appointments to keep their expensive to operate facilities running at full capacity. When I had my cataract surgery, I had to schedule 4 different appointments prior to the surgery and 5 follow-ups, even though there were absolutely no extenuating circumstances or complications. I felt this was ridiculous, and a waste of my time and co-pay money. But you play along because you don’t want to be deemed negligent or uncooperative in case there is a problem. > > Of course, that was my second cataract surgery. I only had 2 follow-ups after the first surgery, because the doctor was on vacation for a month. Now if the extra 3 follow-ups had been truly necessary they would’ve had another doctor do them. But they didn’t. But I still had to pay for 5 follow ups after the second surgery. > > I’m convinced my medical practice could double their patient load without compromising quality or substantially increasing their costs. As it is now, they milk their existing patients to keep the practice running at full capacity. And that is what I have pointed out a few times. A doctor may end up making less per patient, but they will be able to see more patients, both because they have less time devoted to billing and reimbursement, and als because they don’t have to choose procedures that pay the most, they just choose the ones that the patient needs. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 11, 2019, 2:47pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/474 "2019-01-11T14:47:24Z")
> [@andros](#): > > And thank ghod for it. I’ve been hoping someone will beat me out for Worst Analogy Guy for like 17 years. His capacity for analogy is a as bad as an aardvark’s pancreas. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [January 11, 2019, 2:50pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/475 "2019-01-11T14:50:52Z")
> [@Railer13](#): > > So we can stipulate that no other country has ever spent as much on health care as we currently spend. Yes. > [@](#): > > We can also stipulate that other countries currently spend substantially less than we do and achieve comparable or perhaps even better results. Yes. > [@](#): > > We can examine what these countries are doing and hopefully implement some or all of those practices in an effort to reduce our health care costs. Yes - as long as we remember that none of those practices have reduced health care costs. So simply pointing to another country and saying that they are an example of what the US needs to do does not address the elephant in the room. > [@](#): > > But we cannot show an example of a dramatic reduction in costs by another country, because no other country has ever needed to do so at the level that we need to. > > Agreed? Yes. > [@ElvisL1ves](#): > > There are a lot of lies being told, yes. Is that not one? No, it is not a lie. It’s what the report says. It has been cited repeatedly, and **Shodan** ’s Law applies - you won’t read it or understand it or address it if it is cited again, even if it is cut and pasted in front of you. > [@](#): > > Except for almost anywhere else. :rolleyes: No, that is not an exception. Nowhere else has a country implemented dramatic cuts to health care spending. > [@](#): > > So they claim. It sounds like you don’t believe the claim. That claim has already been cited, Citing it again won’t help. Regards, Shodan ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [January 11, 2019, 2:52pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/476 "2019-01-11T14:52:35Z")
> [@k9bfriender](#): > > And that is what I have pointed out a few times. A doctor may end up making less per patient, but they will be able to see more patients, both because they have less time devoted to billing and reimbursement, and als because they don’t have to choose procedures that pay the most, they just choose the ones that the patient needs. They also won’t need a team of administrators to handle one doctor’s billing. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [January 11, 2019, 3:20pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/477 "2019-01-11T15:20:42Z")
> [@SlackerInc](#): > > What a terrible metaphor for your case. Do you not realize that staying at 135, what someone has always weighed, is a million times easier than going from 335 to 135 and staying there? Yes, it’s much easier. The other issue is that there are examples of people who have lost hundreds of pounds, and a few of them have even kept it off. It’s very difficult and unpleasant, but in theory it can be done. There are no examples of countries who have made the cuts to health care spending that are being proposed - it’s never been done. Therefore the analogy of “just deal with the problem by doing something that people do who never had the problem” misses the point. If we want to cut health care costs, we need to cut health care spending. How do we address that question? Do we lie about it, the way **Evil Economist** and Barack “the average family will see its premiums go down by $2500 a year” Obama did? Do we change the subject the way others in this thread seem to want to do? Do we do what Sanders and Ocasio-Cortez do, and say “let’s just do it”? OK - let’s see you make the case, without lying, without changing the subject, actually addressing the fact that cuts are necessary. Make the case - to liberals, to people who already have insurance, to people already covered by Medicare, to people who are going to see their taxes go up, to doctors and nurses and technicians and hospitals, to pharmaceutical companies, to conservatives and Trump voters and - most especially - to those who are not already convinced. Something for nothing sounds great. The same health care for less money overall sounds great. Maybe you can convince doctors to take one for the team and have their income reduced by a quarter, or patients to accept being told “No, you can’t see a specialist” or “sorry, the doctor isn’t accepting any new patients” or “here’s your prescription - it was manufactured in China after it went off patent. It’s probably OK”. Saying “but Canada!” doesn’t do any of those things. Regards, Shodan ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [January 11, 2019, 3:22pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/478 "2019-01-11T15:22:19Z")
> [@k9bfriender](#): > > And that is what I have pointed out a few times. A doctor may end up making less per patient, but they will be able to see more patients, both because they have less time devoted to billing and reimbursement, and als because they don’t have to choose procedures that pay the most, they just choose the ones that the patient needs. Then why do doctors lose money on Medicare patients? Regards, Shodan ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [January 11, 2019, 3:29pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/479 "2019-01-11T15:29:52Z")
> [@Shodan](#): > > Therefore the analogy of “just deal with the problem by doing something that people do who never had the problem” misses the point. Your argument is a transparent logical fallacy. Since nowhere has ever had healthcare costs this high, there is no precedent for _any_ subsequent sequence of events. Sure, there is no precedent for healthcare costs _reducing_ from 18% of GDP. There is also no precedent for healthcare costs _increasing_ from 18% of GDP. Nor is there any precedent for healthcare costs _remaining the same_ at 18% of GDP. Are we to conclude that none of these things could possibly happen? In fact, every other country in the world has the _exact_ same problem - caring for people who are sick. They _all_ do it much better, and it’s preposterous to claim that we are doomed by “lack of precedent” or something to remain the worst in the world at this. Pick a country, any country, and _do what they do_. The burden is on you to explain why on earth that’s so inconceivable. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [January 11, 2019, 3:52pm UTC](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514/480 "2019-01-11T15:52:18Z")
> [@Shodan](#): > > Yes - as long as we remember that none of those practices have reduced health care costs. Again, compared to what? They all did it long ago. Why is that so hard to grasp? > [@](#): > > So simply pointing to another country and saying that they are an example of what the US needs to do does not address the elephant in the room. The elephant in the room is the US itself. It needs to lose weight, not everyone else. > [@](#): > > No, it is not a lie. It’s what the report says. You’ve never seen a report, produced by people with an agenda, lie before? How sheltered are you? > [@](#): > > Nowhere else has a country implemented dramatic cuts to health care spending. No one else has ever been nearly as obese, have they? [Previous page](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514.md?page=23) [Next page](https://boards.straightdope.com/t/ms-ocasio-cortez-on-how-to-pay-for-medicare-for-all/825514.md?page=25)