Talk amongst yourselves.

Who cares what healthcare Bernie wants? Aren't Bernie's healthcare requirements Bernie's responsibility?

Does the Canadian government exercise that level of control in their healthcare system? I'm asking out of pure ignorance. TBH I didn't even know that the UK's healthcare was set up such.

Hysterical bullshit article. This kid would be as dead in US, only 1.6 mil later. While you found one case that could be made look bad, there is a 20 million cases that about to start looking really bad in US.

Access to Healthcare is a fundamental human right. It should be universal. This also by necessity means that limited resources are distributed based on some rational criteria, not who can pay most. People will still die, just not as much, but deaths won't be by people that could be reasonably helped, but had no insurance.

Both rich Brits and rich Canadians can travel to US for medical treatments all they want. Often they get much better deal than US citizens due to being able to negotiate with providers and pay cash.

I'm still curious how you came to that assertion.

There's a big difference between an actual right, and something you think everyone should have, or even something that would be beneficial for everyone to have.

Maslow's hierarchy of needs. How could you have democratic egalitarian society when such fundamental need is not satisfied? You are potentially putting basic survival against higher logic and altruism and counting on later to win sufficiently big to have rational and fiscally responsible government.

For example, seniors would vote for expanding medicare coverage over other convictions. They don't care about costs - they will be long since dead when debt crushes the economy. Hence "Keep government hands off my medicare" protesters. As a result you have pandering or no-integrity politicians getting elected.

Isn't Bern Dog under FBI investigation? Boy that's what I want to do trust and asshole under investigation that got fucked over by Hildawg and the Democratic party. Only to buy a third house and rumors of having a very expensive car. Ol' Bern dog got bought... he's just an old shit bag socialist.

A quick rule of thumb regarding rights. If it's something you want someone else to pay for, it's not a right.

I see what you are saying, but I still think calling it a right is a bridge too far. The difference might seem minor to you, but I think it is extremely important. Safeguarding actual rights justifies an entirely different magnitude of morally justifiable means, for starters. Rights also aren't subject to vagaries of circumstance, such as availability of resources - nor can a true right compel others to particular actions, they are negative in nature. If you accept that anything you personally feel desirable can arbitrarily be called a right, you open the door for anyone to do the same. That is an extremely dangerous line of thinking, that is antithetical to any free society - and in fact is best represented by your own example of people who want their medicare untouched despite the cost.

It would be better, and much safer to articulate a principle that it is good policy for wealthy societies to set a floor on the standard of living beneath which no citizen need descend. You can achieve similar goals, in a manner that doesn't directly draw from a line of thinking that justifies any tyranny in service to a supposed "good"

tldr; Having safety nets and social services does not necessarily preclude nor induce tyranny or other forms of social deterioration, while arbitrarily embracing things as human rights simply because you find them desirable or a utilitarian argument could be made on its behalf, will.

And has.

An academic discussion, since voters have already rejected the idea.

I acknowledge your point in rational terms. However, this discussion should not be framed in rational terms as our self-preservation imperative is not rational. It is often more economical to die, however good luck convincing anyone to act on this.

To frame it in computing terms, before we can start talking about operating system we need to establish working bootloader. The same way society operates, until you satisfy basic needs there couldn't be any talk about building just and egalitarian society. Forget that, there couldn't even be any talk about rational decision making by any individual.

Also note I didn't say unlimited healthcare, rather I framed it in terms of access.

What voters and what was exactly rejected? Be more specific.

Government health care in general is what voters have rejected. Trump in particular and Republicans in general ran against Obamacare, and for the last eight years voters have been putting Democrats out of office in historic numbers nation wide.

If voters had wanted to retain government health care, they would have elected Hillary Clinton, not Donald Trump.

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?

If you want a big reason why health care costs have gotten excessive, you've identified a big cost driver. Read that description again. How could that not serve to drive costs up?

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. Either of you please correct me if I'm wrong.

I don't want anyone stricken with crippling debt. I do want everyone to be able to have exceptional health care. I don't think anyone here would disagree with either of those statements. I think we disagree over how to provide the care without the debt.

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 only for life-threatening conditions, only insofar as stabilizing the patient, and there is no "not going to bankrupt you" rider attached to this.

For example, if you are $40K/year construction "contractor" and happen to get seriously sick, you are all but guaranteed to get bankrupted. Your income stops, your medical bills pile up... I don't think this is acceptable outcome in a country as prosperous as USA.

Exactly.

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.

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.

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.

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?

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.

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.

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"...

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.

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

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.

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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.

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.

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.

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.

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.

+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!