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%?
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?
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.
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 on the other major U.S. blindspot.
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?
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.
It’s almost as if I was replying to Shodan, not you. Try to keep up.
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.
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.
His capacity for analogy is a as bad as an aardvark’s pancreas.
Yes.
Yes.
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.
Yes.
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.
No, that is not an exception. Nowhere else has a country implemented dramatic cuts to health care spending.
It sounds like you don’t believe the claim. That claim has already been cited, Citing it again won’t help.
Regards,
Shodan
They also won’t need a team of administrators to handle one doctor’s billing.
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
Then why do doctors lose money on Medicare patients?
Regards,
Shodan
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.
Again, compared to what? They all did it long ago. Why is that so hard to grasp?
The elephant in the room is the US itself. It needs to lose weight, not everyone else.
You’ve never seen a report, produced by people with an agenda, lie before? How sheltered are you?
No one else has ever been nearly as obese, have they?