…do you still concede that 2-3% of Americans, at the very least 6 million people will not be covered by insurance with your tweaks? That 350,000 people that have to resort to using crowd-funding fit well under your 2-3% thresh-hold.
I’m taking #366 at face value. If I was having to beg for $100,000 for cancer treatment under Obamacare: how do your tweaks change things for me?
I’m asking for specifics here. Outside of a universal system (and you concede these tweaks are not universal) how do you guarantee affordable healthcare for everybody under your system? How do you stop people falling through the gaps?
I would invite anyone who thinks the US system is peachy keen aside from the minor problem of people fucking dying and millions going uninsured to read this piece on hospital prices.
Interesting but not surprising. Yep, we’ve got a real market in Medicare. Hip replacement is a good example since many or most are not emergencies, and so there should be some shopping going on.
If Amazon started opening hospitals hospital board members throughout the country would need new underwear.
And at what point do you finally give your great insight on our politics in the US? What is the nature of US politics you’re yapping about changing? And what would you do to change it? Still waiting for an answer. You brought it up. Answer the questions.
…as you have continually chosen not to answer my question: I’ll accept this as a concession.
You don’t answer the question because you can’t answer the question. You don’t have a solution for the 2-3% who can’t afford insurance, those that fall through the gaps. Because there isn’t one. Those that had to beg for money to pay for healthcare will have to beg for money to pay for healthcare even after your “tweaks”. Because your tweaks are not universal.
Stop making tradeoffs and backroom deals. Stop trying to please Republicans.
This leads to a question I was going to ask of those who propose that various little “tweaks” to the existing system is all that’s needed to fix health care. I’ll start with this statement I made earlier:
This is just one example of many serious intrinsic fundamental problems with the existing system. Others are the prevalence of uninsured, the high cost of emergency services for the uninsured, and the pervasive bureaucratic meddling in the clinical process that results in the degradation and denial of medically necessary services. Any one of these serious problems could be used as an example of the need for fundamental structural reform, not superficial tweaks.
To take the cost example just cited, for instance – how can this be fixed within the existing structure? How can you fix the fact that the US infamously has by far the highest medical costs in the world, often by many multiples?
Lord knows you could try, but any legislator who tried it would be viciously attacked by insurers and providers alike. Insurers because they essentially make their money from high provider fees, passing them on to consumers and taking a cut, and giving themselves a competitive advantage by negotiating lower fees but only within their own networks; providers because at least in part they need higher fees to offset the high costs and complexities of dealing with insurers.
None of this crap exists either in single-payer nor in multi-payer systems that are structured from the ground up to be community-rated patient-centric services rather than business-centric enterprises, enterprises whose principal focus is not the patient but Wall Street. Health care just doesn’t work that way. At some level when health insurers defend themselves against government intrusion you can see their point – they are, after all, a legitimately constituted business whose goal is to provide return on investment. But one can also see the moral and ethical imperatives of health care. This is a fundamental dichotomy that speaks to the unsuitability of the free-market model for providing medically necessary health care coverage. It can still be done but it requires the government to regulate the insurers right up the wazoo, to such an extent that they virtually all look the same and essentially become de facto agents of a uniform policy equivalent to single payer.
That’s why the whole argument against single-payer is stupid and moot. There are other ways of trying to achieve UHC but they’re either functionally similar or they don’t work – take your pick.
But single payer itself isn’t necessary to have a humane, affordable health care system. The Netherlands has a multipayer system. So do places like Germany and France, and they provide high quality health care for about 11% of GDP (which is about what Canada spends with their single payer plan).
Even the physicians for a national health program (a physician run single payer proponent organization) says single payer alone won’t fix our problems.
Our real problem is, as you said, our health care system is structured poorly. It is designed to make money, not provide quality services. So people overpay for inefficient services.
Without radical restructuring and regulation designed to lower costs and improve outcomes, we are fucked. And that won’t happen anytime soon. The GOP are full blown plutocrats, and the democrats are terrified of angering the rich and powerful.
Hopefully some state(s) will experiment with meaningful health reform, and it’ll catch on nationally someday.
It’d be nice if private providers could enter the marketplace and provide competition. Maybe walmart could build a parallel health system that was run properly, and provide services for half the cost of the mainstream health system. But I’m guessing due to regulatory capture, that won’t happen.
It’s even worse than that. You might be familiar with the New Yorker article a few years ago, by a surgeon, which found that prices for procedures varied wildly between hospitals in a single city in Texas. You can’t blame cost of living or real estate for that - it is irrational. It is kind of like airline prices, except that you don’t find the cost of your seat until after you’ve arrived at your destination.
Another thing is that doctors work as if they are in a system like yours. No doctor I’ve been to in my 66 years has ever discussed price. I’ve had good insurance, so it didn’t matter, but for someone with high deductibles or no insurance at all this could be a big problem.
It is interesting that after I gave up dental insurance my dentist has given me a discount and has been price sensitive.
If we stopped acting like we had UHC and started making prices visible it would help some - but it is no substitute for UHC, for sure.
I don’t think Amazon would do anything. People aren’t equipped to shop for care. The number of variables with health care is far greater than, say, the number of variables with a car repair. Hospitals don’t know what surgeries cost any more than patients do.
The fundamental problem is that we can’t treat things like a free market when we don’t want them to be a free market. In a free market, people with more money get more goods and services and people with less money get fewer. Free markets ration goods and services by price. There are a few people who want that in health care, but I think most people don’t, either because they think it fucking kills other people or they are afraid they will be among the population that can’t afford to stay alive.
And the argument that we can’t do single payer because the GOP would sabotage it makes no sense. They are sabotaging things now, starting from a place where fewer had coverage to begin with. Promote the idea of universality and tie the health care fortunes of everyone together. Then if the GOP wants to fuck with healthcare, they are fucking with the healthcare of everyone.
There’s a reason Republicans want Medicare to be means tested. Damage the universality and the rich stop defending the program.
No, I answered you on post #372. The fact that you didn’t read it, or didn’t like it, or won’t admit it, is your problem and not mine. I haven’t conceded anything to you. That’s in your mind only. The idea is to properly implement the ACA, and then see where we are when the dust settles, and then set the right price points (strong enough subsidies, strong enough penalties, auto-enrolls for some selected groups) so that we get full UHC. It’s not that hard to do technically. As I said before, the situation is mostly a political problem currently.
As for your “solution”, stop making tradeoffs and backroom deals…yeah, that’ll change everything (eyes roll). Let me tell that to Schumer and Pelosi, and it will completely transform America.
You live in an impenetrable fantasy world. An absolute fever-infested fantasy world. It infects your view on politics, and in your ability to admit when you’re clearly wrong.
Your last paragraph refutes your previous paragraph. Medicare is essentially a single-payer system for the age 65+. And Pubs have designs to attack it already. Means-testing, or Paul Ryan’s voucherized medicare, both will erode Medicare’s support. What you don’t understand is that Pubs see a material % of the population of this country as unworthy moochers. You give them a single-payer system, and they will go after it in order to keep “those people” from taking what is not theirs,and then you’ll see it erode. This is one good reason to keep the patchwork quilt we have.
You’re underestimating the will of the Pubs in attacking any social or welfare system, while at the same time admitting that they in fact want to attack such systems.
Of course they don’t know (could only read the first paragraph due to the paywall.) If their customers pay whatever they get asked, who cares? Something closer to a free market would make them figure this stuff out right away. And reduce costs too.
Now heart attacks are not going to be treated based on cost of course, especially since the treatment is not predictable. But hip replacements are usually not emergencies. And think if when talking to your doctor you could open an app, see the price of the treatment he recommended, see alternate treatments, and get to ask him about them. Prices would converge quickly to the lowest sustainable price.
None of this is an argument against single payer. I’m on Medicare and it is great. But it is something we can do to reduce costs without Congress getting involved
You are waving your hands and magically lowering prices and all of a sudden you’ve got full UHC. Thats despite the fact you concede earlier in the thread that 2-3% of people will remain uninsured.
This isn’t universal healthcare.
I never claimed it would be fucking easy.
No: I live in New Zealand.
A country on the ass-end of the world, a population of under 5 million people, far away from the massive economies of scale and leverage of a country like the United States of America.
I live in a country where two years ago I had a pulmonary embolism. I didn’t know I had it, when I finally went to the doctor he sent me straight to the emergency room, where they treated me for a week and a half for the embolism and pneumonia. I paid nothing out of pocket.
I had follow up visits with the cardiologist: firstly every month, then every second month, then every six months. A couple of weeks ago at my last visit my cardiologist told me that my EKG was finally looking normal. Cost of all of this? I paid nothing out of pocket.
When I went into hospital they suspected there was something wrong with my breathing and sleep patterns. They put me in overnight. They sent me home with a CPAP Machine for sleep apnea. I now wear a mask every time I go to sleep. I paid nothing out of pocket.
My dad passed away last year. The healthcare system had done an amazing job looking after him. His last month was spent in a hospital room. They allowed us to maintain a vigil. There was family by his side all the way to the end. Dignity. Every day the food service staff would leave a meal. They knew he wasn’t eating: the meal was for our family. Cost to us? Nothing out of pocket.
I don’t live in a fucking fantasy world. I pay half as much as you do before you even have to pay for fucking insurance.
If you think you can make a few tweaks to your system and suddenly get universal healthcare I’m not the one living in a fucking fantasy world. If you want universal healthcare then you have to fucking work hard to get it. You need to change the way you view your politics. You need to accept a different paradigm. You need to admit you’ve got things wrong. There is no path to universal coverage with a few tweaks.
But I suspect you don’t really want true universal coverage. Is it something you actually want?
You think that the medical community will give us an app with cost breakdowns and alternatives, as well as comparative pricing without some sort of incentive from the govt?
True, if they do them. But they get more pushback on it because it’s Medicare. What you are saying makes no damned sense. If they will go after single payer, they will go after anything but at least during the good years everyone will be covered instead of the clusterfuck we have now. You are arguing for political nihilism, that there is no point in trying to get anything real accomplished because it can be undone. Which would mean your improvements to the ACA could just be undone, and they wouldn’t have been a great starting point.
Make the goddamned starting point the best it can be and protect it as best you can rather than conceding defeat at the outset.
No, it isn’t. This was refuted before, yet you keep repeating it. This kind of misconception has to be dispensed with if we’re to make any progress on even discussing these issues.
Medicare is one of the major payers within its domain of over-65s. There are also private insurers in whole or in part, as in Medicare Advantage, personal funds, and other payers in this complicated quagmire, none of whom – either individually or collectively – has any ability to control overall system costs or provide unconditional coverage, two of the pillars of single-payer.
Single-payer means there is a single authority that negotiates all provider fees for all services for everyone, collects community-rated fees that are the same for everyone (or indexed to income), and guarantees unconditional payment in full for the covered services, no games, no meddling in the clinical process. This is essentially what all other countries have, in one form or another, even when there are multiple regulated payers. The US has nothing even close to this. You appear to be seriously misinformed about what it will take to get from this mess to true functional UHC.
You like those Medicare payments you’ve been getting?
Government could help, but I suspect an app that signed people up and doctors advertising that they used it could work too. In any case it is a far cry from de eevil socialized medicine.
The real problem would be educating users that not all treatments are amenable to cost predictions.
Medicare in the United States is a single-payer healthcare system, but is restricted to persons over the age of 65, people under 65 who have specific disabilities, and anyone with End-Stage Renal Disease
There’s a reason that when people talk about single-payer in the US, they say “Medicare for All”. I guess you didn’t get that memo.
I have people in my family with asthma, type 1 diabetes, and osteoporosis. We are dealing with all of this via my private insurance through my employer, and the co-pays are very reasonable (like $25 bucks when we visit a specialist). Our medicines are less than $10. My daughter sprained her ankle, and my ER visit net out of pocket was $0. My anecdotes mean just as much as yours.
When I say you live in a fantasy world, it’s because of your laughable, “stop making deals” nonsense. Yeah, that’ll change everything. Dems have no leverage on anything right now, because they are in the minority at every level of government.
As for your contention that the ACA won’t get us to UHC, the Netherlands and Switzerland use very similar approaches and have achieved it. It’s politics that are blocking things, not the technical details. Given where our system is at, it would be techncially much easier than implementing anything remotely like single-payer. As for you saying that you suspect that I don’t want UHC, that’s not true. You’re accusing me of lying, I guess. And I happen to think that you’re pretending when you act as if a properly adjusted and implemented ACA can’t get UHC.