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#140991 - 07/18/17 05:26 AM Re: The Healthcare Bernie Wants [Re: Sini]  
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Originally Posted by Sini
We build roads, we provide clean water, we pay for the police. How is healthcare fundamentally different than a cop or an asphalt strip?

We do have a model - universal health care. Everyone but US and some third-world countries uses it. There are many variations. We can pick the best variation and go with it, and "some people will die" will be minimized.


Good examples, as those systems you describe are all rapidly deteriorating at a noticeable rate.

Healthcare is fundamentally different because it is an order of magnitude more expensive.

Part of the problem, but far from the entire problem, of going with the universal system is that the results wont be as predictable as some like to think. Especially when it comes to both pricing and innovation. As things currently stand, US consumers currently get squeezed for the lions share of profits from new medicines and procedures. Some people favoring a universal system like to say that this wouldn't be the case under a single-payer type system, that is the gov't was negotiating one bulk price, that costs would come down, and innovation would still occur because companies would anticipate selling to the govt.

Of course this ignores political incentive, and the corrosive effects lobbying and public relations would have on the process of assigning and pricing medicine among many other things. Worse yet, you could also state the situation in the obverse: that universal systems elsewhere are basically subsidized by the US consumer, and discounted sales elsewhere are basically just value-added sales. After all, since your profit goals and ROI has been met by the US consumer, what harm could there be in peddling the products elsewhere for whatever those people were willing to pay?

People only seem willing to consider the pros, without giving honest consideration to the possible, even likely, downsides.

Not to mention our political and social fabric of accountability and principled governance has been eroding at an increasing rate for decades. Our body politic is literally rotting around us, as political and financial power centers realize that "democracy" as we practice it doesn't have to foster any sort of honest or responsive gov't. Even the world's most powerful republic can become a banana republic.

Elsewhere you said that even the most cynical vision of gov't would be better than for-profit insurance. But have you really considered that?

Imagine for a second Jeff Sessions running a single-payer program, assisted by Trump Jr and Adjit Pai as his deputies. Because that is exactly what we would get, or worse. Nevermind the inherent contradictions and systemic fragility of such a system, just imagine the people who would inevitably run it and the political and financial forces that would dominate such a system. Hopefully, dumping proven treatments in favor of whatever the best lobbyist is peddling, and instituting such scientifically rigorous health regimens such as "Prayer Faith Healing" for cancer and "tough-love forced labor boot camp" for mentally troubled teens is the type of health care you think everyone deserves. Because that's about what we would end up with.

If the USA were socially advancing, with gov't becoming steadily more sensible and responsive and open, and political advances were being made that actually realized the dreams of the social thinkers who pine for the Star Trek society, then sure, maybe I could be convinced that such a gov't run health system could work in USA, or at least work for the foreseeable future. But, this is not out situation. Our gov't and society is literally rotting out from under us, from the inside. Handing it even more power over our lives and economic well being is tantamount to suicide.

--

The details matter. Just saying "pick a system, any system" honestly shows how little someone has read into the actual consequences, because the devil is always in the details. The people who implement and oversee those details are the ones with the real power to make things a success or a failure, and in Washington DC, those people are not people with your interests at heart. Even when and if they are, that doesn't make them able to understand what they need to understand or do what they need to do.

What surprises me the most is that people who play MMOs have such a hard time with this. As we all know, people can't even get virtual worlds, where literally everything outside of player behavior is under their firm control, work properly. Easy to say " I want a fun game, with balanced PvP and conflict, and a good economy, a true virtual world" - implanting it: hard. Very hard. And despite all their shortcomings, the people who create MMOs are vastly more intelligent on the whole than people who work in govt.

If you really want a health system that worked for the poor, then best start thinking about those details. Also best take a close, and an honest, look at other systems and the nitty-gritty of where they succeed and fail, and how it might work in differing circumstances, and how they might or might not continue developing for the better or worse over time, and take principled lessons from it. Trying to treat it as an apples-to-apples situation is no different than the W Bush administration treating Iraq like Japan or Germany post-WW2, and conducting a de-Baathitization program. Hey guess what, Iraqis aren't Japanese, nor is Iraq Germany. The USA is not Briton, and Americans aren't Norwegians.

Fuck, Social Security is only projected to exist in its current state for 17 more years tops. Hand them the whole health system? Seriously?

And for anyone who thinks that other political reforms are needed, and that pressure of maintaining a functioning health system would help make said reforms a political reality - all I can say is please pull your head out of the sand. Under pressure and duress, people become more extreme and impulsive, not more rational and wise, in almost every historical example. If you think threat of impending health and economic collapse will help push through your political reforms, you best also be expecting Jefforson, Madison, Washington and Adams to rise from their cold graves to implement it for you. Because the Trumps, Bushes, Clintons and Obamas of the world sure as shit aren't.


For who could be free when every other man's humour might domineer over him? - John Locke (2nd Treatise, sect 57)
#140996 - 07/18/17 05:21 PM Re: The Healthcare Bernie Wants [Re: Derid]  
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#140997 - 07/18/17 05:59 PM Re: The Healthcare Bernie Wants [Re: Owain]  
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Originally Posted by Owain
With insurance, you know beforehand what is covered and what is not. If you are covered, you are covered.


Until they say you aren't, and force you to spend several thousand dollars to retain a lawyer and show them you are serious enough about it and have enough personal resources to be problematic. Then they will settle.

Sini's critiques of insurance aren't wrong, he just veered left off the side of the road when he said govt was better.


For who could be free when every other man's humour might domineer over him? - John Locke (2nd Treatise, sect 57)
#140998 - 07/18/17 06:38 PM Re: The Healthcare Bernie Wants [Re: Kaotic]  
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That is the risk you run with any contract, but in my experience, I have never seen it happen, which leads me to believe that it isn't as common as people fear.


To the everlasting glory of the infantry...

Owain ab Arawn
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#140999 - 07/18/17 07:18 PM Re: The Healthcare Bernie Wants [Re: Owain]  
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Originally Posted by Owain
That is the risk you run with any contract, but in my experience, I have never seen it happen, which leads me to believe that it isn't as common as people fear.


I've had it happen to me and known many it has happened to. Its really damn common. My family is friends with a great many attorneys and judges, including my godfather who took up my case when Nationwide tried to bone me hard. I know how common it is, many people build their whole careers on dealing with those issues. Aside from that, I knew many people growing up who also had to deal with it - but didn't also have the resources or background to navigate it successfully and just got hosed.

Insurance companies do a calculation for every major claim, as to whether, based on their data, it would be cheaper in aggregate to pay claims or deny. They go the cheaper route in every case.

Of course, people use insurance wrong in any case. People want to use it as a backstop against bad luck, but the true purpose of insurance is to turn intangible and random costs into tangible and fixed costs. At the end of the day, the only thing you can trust is your own savings.

Of course, the only reason we, or anyone, is even having these conversations is because the fundamentals of the health market are so incredibly broken to start with, and the overall economic outlook of many people is so abysmal.


For who could be free when every other man's humour might domineer over him? - John Locke (2nd Treatise, sect 57)
#141005 - 07/19/17 12:32 AM Re: The Healthcare Bernie Wants [Re: Derid]  
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Originally Posted by Derid
Elsewhere you said that even the most cynical vision of gov't would be better than for-profit insurance. But have you really considered that?


I considered, and acted via personal choices, on this to a much larger degree than you probably realize. I stand by my words, and unless you can demonstrate that US is somehow uniquely more corrupt than the rest, the actual numbers - costs and outcomes - indicate that the universal health care is cheaper while delivering better outcomes. You can take about any health outcome metric and US is behind other first-world countries while paying significantly more.

US 15% GDP, 7K per person per year
Canada 10% GDP, 4K per person per year
UK 8% GDP, 3K per person per year
Australia 9% GDP, 3K per person per year



#141009 - 07/19/17 03:23 AM Re: The Healthcare Bernie Wants [Re: Sini]  
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Originally Posted by Sini
Originally Posted by Derid
Elsewhere you said that even the most cynical vision of gov't would be better than for-profit insurance. But have you really considered that?


I considered, and acted via personal choices, on this to a much larger degree than you probably realize. I stand by my words, and unless you can demonstrate that US is somehow uniquely more corrupt than the rest, the actual numbers - costs and outcomes - indicate that the universal health care is cheaper while delivering better outcomes. You can take about any health outcome metric and US is behind other first-world countries while paying significantly more.

US 15% GDP, 7K per person per year
Canada 10% GDP, 4K per person per year
UK 8% GDP, 3K per person per year
Australia 9% GDP, 3K per person per year



You are missing the most important part - the human part.

Using numbers from Japan is not going to tell you how Iraq will respond to your occupation program.

If you want numbers, heres an important one - UK has a ratio of representation in Parliament of approx. 1:100,000 - where US has ratio for Congress of about 1:600,000

In any case, you are going about it backwards. Instead of thinking about how it can work, you should work backward and figure how it can't. This isn't cynicism, it's solid planning.

Another question - without US market giving ROI via current methods, and with a single payer, how do prices get set? Who determines what something is worth, using what metrics? How then will the health market respond to the new paradigm?

I doubt there is anyone who could give a satisfactory answer to the former, let alone the latter which is dependent on the former.

Which brings us back full-circle to the question of why don't we just expand Medicaid, or provide a baseline stipend to people for health use? If there is a supply of money, there will be a demand for health services, and people determined to find ways to win that business, yet still allowing individuals and their doctors a large degree of control. It wouldn't be perfect, but at least the principles would be sound, and peoples natural inclinations would be aligned in the proper direction.


For who could be free when every other man's humour might domineer over him? - John Locke (2nd Treatise, sect 57)
#141011 - 07/19/17 01:24 PM Re: The Healthcare Bernie Wants [Re: Kaotic]  
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Other countries can do as they please, but that in no way binds this country to a particular course of action.

Voters have collectively rejected this approach.


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Owain ab Arawn
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#141020 - 07/19/17 04:56 PM Re: The Healthcare Bernie Wants [Re: Brutal]  
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Originally Posted by Brutal
[suicide]

+1 Derid's post immediately preceding Brutal's.

Sini, you're ignoring Derid's point about the U.S. carrying the lion's share of developmental costs for medicines and treatments. It's all well and good for other countries to boast about how much less they spend on healthcare (ignoring that quality/availability of care are lower), but you cannot ignore the fact that the largest leaps forward (until very recently when others began climbing onto the shoulders of medical researchers in the U.S.) have been made by the profit motive in the U.S. Even the Huffpo agrees. What happens to the entire world's level of care and pace of advancement when that motive is removed? When government is in charge of advancing medicine you get this. HOORAY!


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