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Originally Posted by Brutal
Originally Posted by Kaotic
Originally Posted by Sini
Also note I didn't say unlimited healthcare, rather I framed it in terms of access.

Can you define the limits of "access"?

In my conversations, I find that many people do not know that it is now, and has been since 1986, the law that no hospital can turn away a patient based on their citizenship, legal status, or ability to pay. How much access should we provide in order to establish the footing for egalitarianism?


I think the difference is that Sini's viewpoint advocates "Access to healthcare that is not proceeded by crippling debt" while the law prohibiting hospitals from turning away patients simply affords "Access to healthcare" which may or may not be followed by said crippling debt.


Exactly.


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Originally Posted by Sini
Originally Posted by Kaotic

Can you define the limits of "access"?


Typically, countries where universal health care is practiced use some variation of "healthy years per $" metric. Similar approach should be used here. For example, I don't want to see multi-million dollar end-of-life treatments for seniors, but kidney transplant for a young adult might be reasonable ask. Personally, I want to see two-tier system - basic medicare-like system for everyone, then premium insurance or fee based medicine for people willing to pay.


This is where we disagree. I think that opening up insurance markets across state lines will foster competition thereby bringing down the costs of insurance for everyone. Sini thinks it is the government's responsibility to provide that coverage for each citizen, thereby forcing those who pay taxes to cover everyone who doesn't.

I'm actually not completely against Sini's idea of basic health care provided by the government, but don't we already provide that in the form of medicaid (let's pretend for a minute that I'm completely ok with how that is run)? Can the impoverished not apply for and receive medicaid? Wouldn't that cover the basics?

I think we've all seen just exactly how that works with the ACA (note, the first "A" is for affordable) which has increased premiums by over 140% for the average family. All those healthy people who were supposed to prop up the system have decided that it's cheaper to pay the penalty than to get insurance. Who can blame them? I am a 40 year old non-smoking male with no medical conditions and so far this year I have paid $2,168.14 for my health insurance. Compared to ~$1,800 this time last year and ~$1,600 to this date in 2015. Why wouldn't a 20 something choose to pay the fine? I probably would have when I was younger and invincible. It's also worth noting that I have had health insurance (other than my parents') since I was 19 and started one of my first jobs at Wal-Mart. Yes, great big evil Wal-Mart offered health insurance to a peon making minimum... Oh wait, they also never paid me minimum wage. I started there making a couple dollars above minimum wage. At which time I was living with two roommates, completely independent of my parents and paying for college (while choosing as a rational human not to have children). But I think I'm heading down the "living wage" road and getting distracted.


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Insurance across state laws will probably not rusult in savings. Health insurance in Nevada, for example may be cheaper than insurance in Utah, but that might be because Utah requires more coverage by law. For a Nevada company to sell insurance in Utah, they have to comply with Utah laws, and their insurance may be more expensive since they have higher costs to know the laws in multiple states that a company that specializes in Utah requirements.


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I agree with Owain, I don't think "opening up insurance markets across state lines" would make difference. The system is not price conscious and is not driven by supply and demand.

Anecdote: A while ago I worked for a place that had "Cadillac insurance". Anything you could imagine, it was covered. Seeing everything was covered, I decided to go to a doctor to complain about poor memory. It was related to getting up at 5am to get to work, but I wanted to see if there was something else. I was prescribed 1 on 1 assessment with a memory specialist and MRI when in my opinion simple blood work would have done the trick. More so, I wanted to turn down MRI but no less than 3 different MRI companies in town called me and offered to send me a limo to my work. Really. A limo. So I ended up having MRI. Not only I had no incentive to be frugal, there is psychological (e.g. but what if?) incentive to over-consume. Out of curiosity, I tried to find out how much this costs. Couldn't - nobody I could talk to really knew. Insurance sorted this out.

Meanwhile some folks going without and/or getting bankrupt.

Now tell me how this is market-rational system when not only consumers don't directly pay, but it is often impossible to find out prices.

When I eventually moved on from that place, I found out that COBRA payments for that plan was about $2500 a month. For 100% healthy adult with no preexisting conditions.


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Originally Posted by Sini
I agree with Owain, I don't think "opening up insurance markets across state lines" would make difference. The system is not price conscious and is not driven by supply and demand.
I also intend for the consumer to have to purchase the product rather than your employer. Why in the world should employers be paying for people's health insurance? Does your employer offer to cover your homeowner's policy?

Originally Posted by Sini
Now tell me how this is market-rational system when not only consumers don't directly pay, but it is often impossible to find out prices.
Not being able to find the price is intentional. As is the fact that when you do get a price it won't be anywhere close to the "negotiated" price that insurance actually pays. It is a racket and the only solution is for us to have to feel the pain for the expense enough that the market is forced to compete for our dollars. The problem with that is, some people will die due to lack of care. If there was an easy solution we'd have it already, but I don't think that robbing Peter to pay for Paul's healthcare is the solution.


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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.


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Originally Posted by Sini
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.

Unless you're too young or too old to speak for yourself, or if the doctors just decide your "quality of life isn't worthwhile"...


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The government cannot be trusted with these decisions, medical decisions made for non medical reasons.


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Originally Posted by Owain
The government cannot be trusted with these decisions, medical decisions made for non medical reasons.

For-profit insurance corps that have financial interest and shareholder obligation to minimize insurance payouts should be trusted A LOT LESS than even the cynic's version of US Gov't.


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With insurance, you know beforehand what is covered and what is not. If you are covered, you are covered.


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