He is isn’t even remotely hand waving. You are just throwing out uneducated back of the envelope numbers while ignoring well documented numbers.
puddleglum, I’m afraid I have reservations that your objections are grounded in good faith beliefs. I’ll leave aside your rather amusing contention that the US is “the most diverse country in the world” for the time being.
I had to go look it up.
The United States is the 85th most racially diverse country in the world according to one analysis, 204th according to another. He’s pretty far off in his estimation.
It’s part of the “US Exceptionalism” reason why what works in other countries can’t possibly work in the US. :rolleyes:
It came up in this thread:
Norway Most, North Korea Least Democratic Country in the World.
See posts 41-48, where I was responding to the suggestion that the US is more diverse than Canada, and therefore Canadian solutions can’t work for the US. My position is that Canada is more diverse than the US, both in terms of languages and also in terms of the level of immigrants from a wide range of countries.
I note that in the wiki article linked to by Lightnin’, Canada comes in at #60, while the US is #85. I’m not surprised that at the number of African and Asian countries (particularly India) which rank ahead of Canada in terms of divesity.
It also came up here: Do any other wealthy, developed nations have the level of police violence in the US?: see posts 68-71, 79, 81.
It also came up tangentially in this thread, at post # 9: Should election district boundaries be fixed to prevent Gerrymandering?
It seems to be a standard reaction used by some to argue against the comparative experience in other countries.
ETA: I just noticed that in the wiki article on diversity, Canada is the highest-ranked “first world” country, in terms of diversity.
Which is why you have states, right? Isn’t it an article of faith that the decentralised nature of the US federal system is one of its strengths, to allow the states to function as laboratories of social policy?
So it’s hopeless, then? US ingenuity will never catch up?
What a bleak view of the US.
No argument on that point here. 
Actually, the first indice seems to be based on linguisitic diversity, not racial.
And the second ranking initially starts alphabetically, so the “204” is just the US’ place in an alphabetical order. You have to click on the little sorting arrows for each of the categories to see where the US fits in the second indice.
At least for the purposes of this discussion, I was primarily thinking of linguistic and religious diversity. I don’t see why it should be harder to administer a health system just because some of the patients are brown or whatever.
Damn, you’re right. The formatting of that second chart is kinda screwed up.
It’s labeled as cultural / ethnic as far as I can tell.
But regardless, it’s a pretty poor point of argument here. I have trouble believing Americans of Latin American origin are so radically different from European origin Americans in ways that make universal health coverage unworkable.
The table is labelled “ethnic / cultural” but in the intro, it’s clear that linguistic diversity is used as the measuring stick:
I didn’t look at that page very much, but off the top of my head, the Russian Federation, the People’s Republic of China, and India have more internal “diversity” issues than the USA does today, and sort of obviously so.
Brazil & Mexico probably have more indigenous groups that are largely un-assimilated. Don’t most Indian nations (and Yupik) in the USA have English-language education? It’s pretty unusual now to find someone from one of those groups who doesn’t speak US English, and more so for them to have no family that does.
I’d put South Africa and France ahead of the USA on the measure of “diversity” as an issue causing political difficulty, actually.
Obviously the situation was very different 160 years ago. In that timeframe, puddleglum might have had a point. But by now the USA has actually largely integrated and educated its conquered peoples enough that linguistic issues are seldom (not never, but very seldom) such a problem. :dubious:
There was a thread here a while ago started on the premise that if given 10 years and all the focus necessary - like landing a man on the moon - could the US have in place an effective UHC system?
I don’t think anyone believed it possible then.
It’s some fucked up if you achieve that in 9 years in the 1960s, and can’t do this with all the advances in technology (computing), as well as all the national UHC models available around the world now.
It depends on what is meant by diversity. Canada is 77% white, 4% Eskimo, 3% black, 2 Hispanic, and 14% Asian. The US is 64% white, 12% black, 5% Asian, 1% Indian, and 16% Latino. There are no provinces in Canada where white people are not at least 70% of the population. Whereas there are currently four states that are majority minority and twelve states where minorities make up 40% of the population.
The reason this is important for health care is two fold. First different races have radically different health outcomes and needs. There is only one country in the world, Monaco, that has a higher life expectancy than Asian Americans, yet there are 92 that have longer life expectancy than Black Americans. There are only four countries with life expectancy longer than Hispanic Americans, yet there are 45 that have longer life expectancy than White Americans.
The second and more important consideration is that there are more stakeholders for designing a system. All of the groups, not just racial groups, but age groups, regions of the country, different professions, and religions need to buy in to any change in the system. In a parliamentary system like Canada if a small group feels like they are getting the short end of the stick the government can tell them to pound sand. In the US Florida has two senators so no big changes to the Cuban policy can be made without the consent of the Cuban community in Miami. Louisiana has two senators so no changes can be made to the subsidies for sugar growers without their consent. Any change to the medical system in the US has to be signed off by the AARP, the AMA, the nurses unions, the hospitals, rural clinics, inner city hospitals, insurance groups, religious groups, the chamber of commerce, unions, and probably other groups because all of those groups have people in congress representing them.
What well documented numbers? The only well documented cost projections have been supplied by me. The US spends 1.7 trillion dollars on private healthcare. There have been four proposals how the government would spend less than that. Cutting insurance company profits, which would save 1% of that, cutting CEO pay which would save .02% of that, cutting administrative costs which would save 14% of that, and various unnamed efficiencies which are supposedly going to save the other 85% despite no one actually being able to name what they are or being able to explain why they have not already been implemented. The underpants gnomes had a more thought out plan.
What do you mean by this? What elements of Medicare does a private insurer have to comply with?
Dude, just read the link and save youself lot of trouble:
The strength of the federal system is that it allows for maximum happiness in a diverse nation. If those dirt worshiping tree huggers in California want to pay a premium for electricity so they can feel good about themselves, they can do so while the more sane states can make their own rules and pay less. UHC is not possible to implement at the state level in the US because Tiebout competition makes it impossible for the states to raise taxes enough to implement it. Thus UHC is an all or nothing proposition unless liberals want to actually put their money where the mouths are and implement it in one state and see what happens.
I think the US is the greatest country in the world, but a country is not its government or vice versa. If the US got the government out of the healthcare business then US ingenuity could give us much better outcomes for much less cost.
Great recommendations from that report, but exactly none that require switching to a Canadian style government run system. But since the way forward is now known, I look forward to the federal government implementing these recommendations and saving one third of the money currently spent on Medicaid, Medicare, and the VA. When this happens I will admit that the government is the most efficient provider of healthcare and support them taking over the rest. While I wait I think I will pass the time by translating the entire works of Tolstoy into Japanese, and my first step will be to learn Japanese.
That was poorly worded. It would be more accurate to say that the private actors in the system spend a huge portion of their budgets on Medicare compliance, but private health insurers are among them. First and foremost, private health insurers have to tailor their own billing and reporting methods to match CMS requirements because that’s the de facto standard. Employer-sponsored health insurance providers databases incorporate about three times as much data as they otherwise would to accommodate Medicare reporting. There’s a lot more to it than that, though. Medicare makes conditional payments for new beneficiaries, which may ultimately need to be covered by the insurer that provided care when the condition arose. Every civil settlement that involves an injury requiring medical care must take Medicare’s interests into account (even if the plaintiff is, say, 25).
Well, the OP is a question based on the hypothetical of the US having switched to a single payer system modeled on Canadas. You could say getting there is a bit of handwaving I guess.
Beyond that…what numbers do you feel are unsupported? Specifically? What do you require references on?
Now for the objections, I am sorry, I don’t feel you have a workable idea of what a single payer system looks like or how it works. This is what makes me think that:
Yes, Medicare C and D costs count as admistrative. More specifically, they are administrative costs that arise in the interaction between Medicare and the insurance companies. You know, that interaction which we have discussed as a large cost-adder that is unique to the US sysem. And which the hypothetical move to a Canadain style system was specifically intended to eliminate.
And about needing compliance people to deal with fraud…um, no? Here is where I have to wonder how you see a single payer system operate? In the US system, you have an extremely large number of operators, providers and patients, billing each other with no standards of billing, credit or costs, and frankly, not very intitive ones.
The US setup is uniquely well suited for fraud.
Do you know what kind of fraud we get in a single payer system? We get the occasional dirty doctor writing out disability diagnoses. Thats mostly it, and it is very rare. Were do you think there is space for fraud here?
And no, we don’t negotiate about what to cover and for how much. Thats kind of the point.
Because the medical waste and inefficiency is to a large degree an outhgrowth of the current system, and relies on it.
Two providers on the same block, each with their own set of X-rays, MR-machines, CT-scanners, techinicans, specialists and interpreters. Each with their own emergency department, maternity ward, gastrointestinal specialists etc, etc, etc. Procedures that do not improve outcomes but are very profitable. Fraud. Inflated drug costs. They are all the spawn of the system as it stands.
And that is because there are so many systems in the US. Medicare. Medicaid, VA, Indians, Childrens etc. All of them duplicating work, spending time on gatekeeping, liasing, etc.
If you run a huge corporation, and had to provide a vital in-house service, you don’t do one service for sales, a completly different one for engineering, a third one for HR, nothing at all for management, and a separate administration for each! Every other first world nation has one system for providing universal healthcare, and some private sector for filling in the cracks. One system. Some do private insurance, some NHS style, some national insrance, or a hybrid. But no-one has different systems for different groups!
Once again, do you know how single payer functions? Because, you know there are a lot of countries out there with single payer systems, where you can observe how things actually work.
More later.