Not my list, dude, so I don’t need to justify it. I told you what I want in my post, as others have done in theirs and, again, I am not seeing " “I want the best health care in the world, available to everyone, and at a reasonable cost” in these posts. If you care to respond to what I actually said, instead of your overwrought rewrite, I would be happy to continue this discussion with you.
Anyone who talks about US vs. UK is knowingly being disingenuous. How clever. You must feel so clever.
In this fashion, the line between accusing another poster of lying and not doing so is so fine as to be non-existent. This is a warning for accusing another poster of lying which is not permitted in this forum. If you feel you must, the BBQ Pit is right around the corner.
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But you’re not! Starting from a higher baseline I mean. In your own cite. Look at the graph.
In 1980, you were even with Germany and Switzerland at the top. $ 1000 per person. In 2004, you were at 7 000, Switzerland at 4 000 and Germany at 3500.
Canada, Netherlands and Australia was at 750 in 1980. In 2004 they were at 3500, 3000 and 3000. So they increased 5x and 4x where you increased 7x. The last two -New Zealand and the UK- started at 500 and ended up on 2500 and 2750.
Its blindingly obvious that the US has outpaced them all.
Yes, maybe you can cherry-pick a certain period when you didn’t grow faster but clearly, that’s a small exception. Its like saying that you shouldn’t have gained weight in the last year, you kept your diet for two whole weeks.
No, the idea is that you’ll get somewhere close to either the average OECD spending or the top three other OECD countries. Either would be a massive improvement. If you got it down to the second most expensive you’d save your military budget each year.
You’re not going to get to Uk levels, its one of the cheapest first-world setups.
Currently, thats what France has. Or a few other first world countries depending on exactly what criteria you have for “Best” But all of them has it available to everyone, at a reasonable cost, and you’re not in the top ten for results either you know. The top ten are all coutries that cover everyone at roughly half what you spend.
So I would say that your argument has the problem that doing something like that is really the norm, from your perspective.
Shodan, some of your wish list are massive money-saving measures:
One of the biggest, perhaps the biggest source of waste in your current setup is the enormous amount of bureaucracy you use, to determine who is entitled to what, who pays, how much, from where etc. Gate-keeping, credit-checking, insurance, liaising, systems that don’t interface well, in-coverage hospitals, out-coverage hospitals, insurance profits, negotiating, chasing payments, and more. And its all duplicated across your systems. You would save absolutely immense amounts of money.
That actually takes pressure off the healthcare system, and we would expect addressing things before they became emergencies would save quite a bit.
Do you know how much you spend on the last few weeks of life?
Well, thats another of your top sources of waste dealth with.
Always a good idea, but at the moment the federal government is the biggest single spender of biomedical research.
Shodan, these things are not equal in size. If you implemented your point one, you ought to be able to do all your other points from a fraction of the savings.
A. It’s not a fine line, the dictionary and thesaurus are perfectly clear
B. Lying is an irrelevant notion in the context; he was proposing a comparison that is not sensible, that is all
C. The poster was being deliberately artful, and I called him out on that.
This is poor moderating and I would like you to reconsider.
I thought of something else I’d like in a health care system. I would really love to not be whipsawed back and forth every 4-8 years about whether or not I will have available health care and in what permutation. It makes planning responsibly for my elder years almost impossible.
What can we do on the supply side?
We can train more doctors, nurses, and other workers. That will help, though there is a big lead time for such training and it has a cost. Training a doctor costs about a half million dollars to a million dollars. Residency costs the hosting institution about 100k a year, and residency is 3-5 years. Medical schools spend 50k to about 200k per year per student, for 4 years.
We can start rationing care. Thing is, the current system is “fee for service”. If a patient has coverage for a given service (aka they are still breathing and a licensed doctor can write down on a piece of paper they need the service), they get the service. Whether or not there is any point. If the patient is lying in a bed with late state Alzheimer’s, certain to stop breathing in about 3 months, but they have a heart condition, you can treat that heart condition. You the treating agency get the same fee for the treatment (and the more complex and expensive, the better) as for any other service.
So there are all kinds of low hanging fruit for rationing, where it will make absolutely zero difference in life expectancy but save billions.
We can eliminate bureaucracy. Single payer accomplishes that.
We can stop overpaying hospitals. Though, in practice, since hospital profits are not that high on the aggregate, this doesn’t help as much as it sounds.
It’s great to talk about making the system more humane on the demand side - eliminate those bankrupting medical bills that essentially give a hospital a license to steal all the assets you earned in your life - but the supply side has very real costs.
Except that “much more generous, dignified and stable” system no longer exists as they are likely remembering it.
According to this Kaiser Foundation report the average worker contribution for family coverage has gone from $2973 in 2006 to $5277 in 2016 – an increase per year (assuming my math is correct) of 5.35%. Average worker income in that time has gone up 2-2.5% per year.
Add to that the increase in plan deductibles. In 2006 only 10% of covered workers had an annual deductible of $1000 or more for single coverage. In 2016 51% of covered workers had $1000 or more deductible.
The Trumpcare vote had most of us, myself included, focusing on those who have to buy their own coverage. But employer-sponsored plans are becoming more and more unaffordable for a lot of people too.
Add to that the fact that nothing is free. These massive costs are being paid by the employer, and generally speaking they are going to choose a cheaper employee who can do the same job if they have that option. This is one reason why it’s so difficult to get a job when you are between 55 and 70 - many workers are still quite capable in that age range, but the cost to your employer for insurance skyrockets.
Yeah well, my own employer-required plans from 1994-7 was the worst and most expensive coverage I’ve ever had (a different plan each year, refusal of things for which you were mid-treatment because it was “preexisting”, the only “female care” that was covered was abortions), you really neither need nor can convince me… but my point was about perception. Perception is what propaganda is based on, after all. If y’all want to convince those guys you need to begin by changing their perceptions, their notion that healthcare being a benefit you earn after enough time of being a good boy rather than a basic right is right and proper.
If the US wants a first-class police force then that should also move to an insurance based model. Why should I in my fancy gated community subsidize people in the inner city?
And if you can’t get law enforcement insurance because you’ve previously been sexually assaulted, well, sucks to be you. You should have saved up instead of buying all those iPhones.
Yes. Because unless the US exists in an alternate universe, it’s only a matter of political will to achieve what every other first-world democracy has successfully achieved. Cost control is a challenge that will definitely have to be phased in over a period of time. The basic model that works in most other places is that providers are willing to settle for lower base fees in return for a streamlined, guaranteed payment system and knowing that they will never be stiffed either by deadbeat patients or profiteering insurance companies whose business model is closer to racketeering than honest business.
In looking at the list of wants originally produced by jsgoddess that you’ve been referencing, I’ll compare it to the system I know best, the Canadian model, which varies by province in its details but we’re speaking here in general terms. I’ve taken out those that seem US-specific or otherwise not applicable and we’re left with these, which I’ve numbered for convenience:
[ol]
[li]Universal coverage: one system for everyone paid for with strongly progressive income tax, uncapped[/li][li]Reasonable cost sharing, eliminated for low-income people[/li][li]Splitting out social services spending into appropriate safety nets rather than having it bundled into the health system[/li][li]Increasing said social safety net spending[/li][li]Increased access to HCBS[/li][li]Increased access to end of life counseling[/li][li]Pharmaceutical negotiation[/li][/ol]
Notice that (1) and (2) alone represents the fundamental transformation that everyone is looking for. (3) and (4) are not even about health care, but are a vital underpinning for a healthy society (I mean that both in a literal and metaphorical sense). (5) and (6) are important as more people enter their elderly years, and (7) benefits everyone positively.
Achieve all of these and you’ve achieved most of the important social objectives of any decent society. Other countries have done it because they believe that a decent society is pretty damn central to their existence.
I want a system that socializes the cost of healthcare access through taxes so that the difference in access is not so massively determined based on age (medicare) or abject poverty (medicaid) or inability to pay (above the income cutoff of medicaid but not enough to afford much else, especially in an economy where the TRASH model of employer based healthcare keeps tossing out ways to not have to offer employees cheaper healthcare costs.
The most basic solution to the problems want to address, is some form of universal healthcare model. I am not locked on any particular model, but I definitely want the costs socialized. Ability to pay =/= a valid reason to not get good access to care. The VAST majority of goods and services in a capitalistic economy are based on ability to pay, we can afford one exception for healthcare because the LIBERALS actually believe in some basic worth of human life.
Conservatives say they are pro life, they are only pro fetus. Once you are alive you are on your own, unless the charity fairy deigns to make an appearance. And if not, and you need care that society can provide, wither and DIE before any of them have to have any of their earnings taxed extra to make that so, for someone ELSE that is not THEM. ME and MINE is the sum total of their philosophy.
For conservatives, this harsh light I have painted is the inevitable consequence of their ideology and dogmas. They are held hostage by one of the core tenets of modern conservatism.
Anything government touches turns to ash and is inherently worse than the free market left unchecked.
If anyone believes that, and places that belief as a CORE axiom that is taken as a basic fact of the universe, then anything that undercuts that idea must be denied or ignored. This is what we see with conservatism on healthcare policy. Telling them that a pure free market is not an ideal solution for healthcare is akin to telling them their BIBLE is a LIE.
And what do we get from them in return? Holy war, arrogant conceited little men with presumed omniscience about what will and will not occur with market based healthcare vs government involved healthcare models, EVEN WITHOUT empirical examples.
This is pure theology, and if it has really come to that, than one of my goals as a liberal who DOES care about life, is to BURN that ideology to the ground. Scorched earth, Shermans march through Georgia. Step aside conservatives, there will be no quarter !!!
Many government services are not means-tested, so healthcare would not be the sole exception. I’m free to use much of the country’s infrastructure, get assistance from the fire service or police, go to a public school etc, without a dime in my pocket.
Because it’s in society’s best interest that everyone has these things, and given that, it’s also simpler and cheaper to centralize payment of these services, and remove the middlemen and paperwork.
You are right, and I’ve made a similar point about those services being “socialized” examples that even conservatives buy into for the most part. And do you know what I have heard in response? Not a god damn thing. They ignore the point, it conflicts with their dogma about government being an invalid and destructive force in society, and so they pretend the government examples they are in favor of do not contradict anything in their arguments about healthcare that rely on some eternally negative impact of government involvement.
At that point, I honestly have no idea what to say to them other than to note that they are not arguing in good faith.
Different people want different things from health care. I’m surprised how reasonable many of the responses to this thread are.
People want to feel listened to and respected. They want all necessary tests and specialist appointments. Some people want to minimize time and money spent interacting with the system. Others want to maximize it since they have dependency issues or require a lot of support.
Cheap medicine, physiotherapy, rehab, dental care, diabetes support, preventive medicine. Quick accessibility to learned professionals. Transparent discussions. Genuine compassion. Cultural sensitivity. Minimal error and misdiagnosis. Use of expensive technologies even if not superior to the tried and true.
The health professional, hospital, patient, pharmaceutical industry, HMO, lobbyist and insurance. Pmpanora have very different goals. I like single payer but it is hardly a cure all for a very difficult compromise.
Can I suggest, incidentally, that if you’re building castles in the air for an ideal system, you think again about separating non-medical social care and support into a separate wing?
It’s long been an issue in the UK that the NHS and social care come under separate organisational structures and financial rules, and that lack of co-ordination in too many individual cases imposes extra costs all round as infirm patients stay in hospital until the right arrangements for home and/or community care can be made. Time after time different attempts have been made at solutions, but somehow they never quite permeate the whole system.
Here’s one current variation (you need to know, I think, that the Clinical Commissioning Group, run by a consortium of representatives of GP practices and other local stakeholders, is the local holder of the main NHS budget for hospital and specialist services, while social care and support is the responsibility of the local council):
I’d Dispute even that, given how many Arab sheiks are coming to the UK and Germany to have procedures done. Even in those evil socalist UHS Systems, there can also be hospitals with leading edge in Research - usually University hospitals, where teaching, Research and Treatment go hand-in-Hand. E.g in Berlin the Charite Charité - Wikipedia is pretty leading.
The Advantage of a University Hospital in a big City in an UHS Country is that all unusual diseases are referred there by local and surrounding specialists. So your house doctor will either send you to a specialist to figure out what mysterious ailment you have, or if it’s clear, send you directly to the Uni Hospital. This way, you get expert care from doctors specialized in … area because they see thousands of exotic variants in this area every year and do hundreds of surgeries for that each year. The doctors meanwhile get to see a broad variety and become the best by doing a lot of procedures.
That’s why the Health Service in Germany recently changed their recommendations for hospitals: they looked at the figures, and found that specialized Areas like neonatal care, or Special procedures, like liver transplants, had a higher failure rate if the Hospital (because it was a small one in the Country side) did less than 50 per year (failure rate >50%) compared to the big City hospitals which did over 100 cases a year (failure rate <50%). So now (despite a few People complaining) small hospitals will only do Routine stuff and emergency, and everything else will go to the City (if necessary by chopper if in a hurry).
I get what you’re saying, but in the US what currently happens is that we absolutely gut social services, then our health system is forced to pick up that role, which they try to do but aren’t skilled at. And they also cost a lot more than paying for the social services at all.
A No Wrong Door approach that integrates health and social service access and cross-referral (plus legal help and referral from Medical Legal Partnerships) is probably the best way to go for the US.
Well, we’d all like that! What we have at the moment is both ends being squeezed, since they’re both depending on government decisions on tax and expenditure, but with similar problems ending up on the health service’s doorstep.