Armed Polite Society
Main Forums => Politics => Topic started by: Ben on August 04, 2017, 10:08:25 PM
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Sadly, this article hits the nail on the head IMO. At this point, the Rs have shown all they want to do is give away different free stuff, because they're afraid of what will happen to them if they take away free stuff. So as the article says, I also predict it will be a fight for the amount of free stuff in some version of Obamacare as the "conservative solution" vs single payer. The Rs have lost a free market solution.
http://hotair.com/archives/2017/08/04/poll-majority-americans-support-single-payer-heavy-majority-republicans-oppose/
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Well, the country has begun circling the drain. Dramamine, anyone? [popcorn]
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I think you're correct Ben, the "Health Care is a Right!!" narrative caught enough people that I think, for better or worse, the US will be at some crappy version of single payer in the next couple decades. It will be very hard to quantify how many cures we don't discover because we've disincentive a medical career and that genius became a lawyer or tech guy instead.
Well, the country has begun circling the drain. Dramamine, anyone? [popcorn]
The county med board has determined that you aren't in enough need and that dose has been given to someone more deserving. They were having acute motion sickness after 12 hours in a box truck for the drive up from Guadalajara.
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So we'll all be working for the Twentieth Century Motor Company. Joy.
When everyone gets the service of the VA, it'll be too late.
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http://www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/?WT.mc_id=tmg_share_fb
But the British system is so much better right? Right? Anybody?
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I think you're correct Ben, the "Health Care is a Right!!" narrative caught enough people that I think, for better or worse, the US will be at some crappy version of single payer in the next couple decades.
I think that's only half the problem. The fact that our healthcare is so ridiculously more expensive without commensurate results is also a concern.
I've mentioned it before - our healthcare is so crazy expensive that, if we could get costs down to the median of the other first world countries, that the federal government already spends enough to cover over 90% of the nation's healthcare needs. And the state governments more than cover the other 10%.
Which means that, if we could get proper cost controls in place, the feds could quite easily provide single-payer insurance without spending an extra cent.
The problem I've seen with recent health care reform proposals though, is that they do approximately jack to do that.
In no particular order:
- Ban healthcare insurance companies from making deals with providers that require providers to charge crazy rates to those paying cash.
- Adjust regulations that allow providers to get away with not being able to provide estimates for cost of their services, as well as charging drastically different rates depending on who's paying - whether government, customer paying cash, or insurance company.
- Adjust regulations to better ease insurance companies operating across state lines.
- Throw open HSPs to everybody. Make them easier to use.
- Take a chainsaw to FDA regulations - It costs way too much to comply with all the FDA rules in order to compete with the existing players, allowing existing players to both have obscene profit margins AND not practice any particular level of fiscal restraint to keep costs down
- Allow medications and equipment to be more easily imported
- Make it so that all government healthcare programs can negotiate prices on things like drugs.
- Eliminate mandates to buy drugs from specific providers(like schools and epipens)
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http://www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/?WT.mc_id=tmg_share_fb
But the British system is so much better right? Right? Anybody?
It is cheaper. We pay less per capita for the entire NHS than you pay just for Medicare and Medicaid.
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http://www.telegraph.co.uk/news/2016/09/02/obese-patients-and-smokers-banned-from-all-routine-operations-by/?WT.mc_id=tmg_share_fb
But the British system is so much better right? Right? Anybody?
Key details not mentioned by you:
Under the latest restrictions, patients in the catchment area who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight.
and
The ban will not apply to cancer patients, or those with some conditions that could becoming life-threatening, or if exceptional circumstances can be shown.
So, there are loopholes around the ban and it only applies to non-life-threatening conditions. Yeah, it sucks they're doing this, but it's not "zomg they are killing smokers and fat people!!!111!!".
Chris
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but it's not "zomg they are killing smokers and fat people!!!111!!".
Yet.
It starts by restricting the outcasts: smokers and fatties. Then druggies. Then old people who are dying anyway. Then coma patients. Then stage 4 cancer patients. Then whoever else the government deems unworthy.
The US system has many faults, but if a person can pay, that person can get treated sooner rather than later.
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I think that's only half the problem. The fact that our healthcare is so ridiculously more expensive without commensurate results is also a concern.
I've mentioned it before - our healthcare is so crazy expensive that, if we could get costs down to the median of the other first world countries, that the federal government already spends enough to cover over 90% of the nation's healthcare needs. And the state governments more than cover the other 10%.
Which means that, if we could get proper cost controls in place, the feds could quite easily provide single-payer insurance without spending an extra cent.
The problem I've seen with recent health care reform proposals though, is that they do approximately jack to do that.
In no particular order:
- Ban healthcare insurance companies from making deals with providers that require providers to charge crazy rates to those paying cash.
- Adjust regulations that allow providers to get away with not being able to provide estimates for cost of their services, as well as charging drastically different rates depending on who's paying - whether government, customer paying cash, or insurance company.
- Adjust regulations to better ease insurance companies operating across state lines.
- Throw open HSPs to everybody. Make them easier to use.
- Take a chainsaw to FDA regulations - It costs way too much to comply with all the FDA rules in order to compete with the existing players, allowing existing players to both have obscene profit margins AND not practice any particular level of fiscal restraint to keep costs down
- Allow medications and equipment to be more easily imported
- Make it so that all government healthcare programs can negotiate prices on things like drugs.
- Eliminate mandates to buy drugs from specific providers(like schools and epipens)
Your suggestions make a lot of sense. Unfortunately, they will never be adopted, so under a US single payer system, we will be stuck with the same inefficient, overpriced system with Federal bureaucracy and incompetence added, resulting in disaster.
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Key details not mentioned by you:
and
So, there are loopholes around the ban and it only applies to non-life-threatening conditions. Yeah, it sucks they're doing this, but it's not "zomg they are killing smokers and fat people!!!111!!".
Chris
You might have missed this part:
The decision, described by the Royal College of Surgeons as the “most severe the modern NHS has ever seen”, led to warnings that other trusts will soon be forced to follow suit and rationing will become the norm if the current funding crisis continues. Chris Hopson, the head of NHS Providers, which represents acute care, ambulance and community services, said: “I think we are going to see more and more decisions like this.
And:
Reports of rationing have emerged after NHS England admitted in May that its provider sector overspent by £2.45 billion in 2015-16, more than a threefold increase on the previous year.
The figure, which was described as conservative by think-tanks, prompted some hospital chief executives to question the future viability of free universal healthcare.
Mr Hopson called for a “realistic national conversation” about how much should be spent on the health service, and said that if procedures had to be restricted, the reduction should be managed on an NHS-wide basis.
The system seems to be unsustainable as it currently operates.
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The US system has many faults, but if a person can pay, that person can get treated sooner rather than later.
They can in the UK as well. Unless things have changed in the last few years, a person can buy their own private insurance, giving them access to non-NHS care. Anecdotally, most don't though. None of the Brits I know have issues with the level of care they get through the NHS.
Chris
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You might have missed this part:
Nope, I saw it. However, it doesn't materially change what I said. So far, the identified restrictions are only to non-essential procedures. When they start refusing life-saving procedures to obese or smokers, let me know.
And:
The system seems to be unsustainable as it currently operates.
No doubt there.
Chris
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Yet.
It starts by restricting the outcasts: smokers and fatties. Then druggies. Then old people who are dying anyway. Then coma patients. Then stage 4 cancer patients. Then whoever else the government deems unworthy.
The US system has many faults, but if a person can pay, that person can get treated sooner rather than later.
And then cases like Charlie Gard -- "We won't let you take your son elsewhere for treatment because we want him to be as comfortable as possible [until we let him die] while we [don't] treat him."
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The problem I've seen with recent health care reform proposals though, is that they do approximately jack to do that.
In no particular order:
- Ban healthcare insurance companies from making deals with providers that require providers to charge crazy rates to those paying cash.
- Adjust regulations that allow providers to get away with not being able to provide estimates for cost of their services, as well as charging drastically different rates depending on who's paying - whether government, customer paying cash, or insurance company.
- Adjust regulations to better ease insurance companies operating across state lines.
- Throw open HSPs to everybody. Make them easier to use.
- Take a chainsaw to FDA regulations - It costs way too much to comply with all the FDA rules in order to compete with the existing players, allowing existing players to both have obscene profit margins AND not practice any particular level of fiscal restraint to keep costs down
- Allow medications and equipment to be more easily imported
- Make it so that all government healthcare programs can negotiate prices on things like drugs.
- Eliminate mandates to buy drugs from specific providers(like schools and epipens)
One other would be to revise the guidelines that say all medications must be discarded after one year. In another classic instance of "Do as we say, and not as we do" the U.S. military has been quietly working with the FDA to test the long-term efficacy of a number of drugs commonly used by the D.o.D. and they've found that most of them are good for at least ten (and usually fifteen or more) years past the original "expiration" date. But the FDA can't admit that publicly because allowing people to keep prescription medication longer than a year would impact the profits of pharmaceutical companies.
My wife was extremely allergic to bee stings -- and our house is in the country. She always carried an epipen. I found it a year or so after she died, and I offered it to a friend whose son is also highly allergic. He declined, because it was passed the "expiration" date. I can't really blame him -- you don't want to play roulette with your son's life -- but the fact is that an epipen is probably good for several years, not just one. But the military hasn't (as far as I know) put epipens through their long-term evaluation program, so there's no way of knowing.
Any time you have a few hours to kill, look up those tests, and read the FDA and pharmaceutical companies' rationalizations for why they don't test efficacy longer than one year.
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Just getting the .gov out of healthcare would cause huge reductions in the costs.
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The system seems to be unsustainable as it currently operates.
The key bit here being "as it currently operates".
When the New Labour government came to power in 1997, it had a difficult choice to make between delivering promised investment into the NHS and delivering the promise of balanced public accounts. Like all the difficult choices that Tony Blair was faced with as PM, he cheated - in this case by adopting the "Private Finance Initiative", which basically contracted the private sector to build and/or run a hospital (or series of hospitals)*. This had the advantage of keeping the cost of building off the Blair government's books whilst ensuring that the governments that followed faced considerable cost (the final total will be around £80 billion if they aren't bought out - this is for premises that are worth £11 billion). At the moment the annual NHS PFI bill is £2 billion a year (and will rise to £2.7 billion p.a. before the costs start to taper off around 2030), which accounts for the bulk of the overspend you point to.
* "run" in this case means operate the facilities only, all the medical side of things is still provided by the NHS.
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My wife was extremely allergic to bee stings -- and our house is in the country. She always carried an epipen. I found it a year or so after she died, and I offered it to a friend whose son is also highly allergic. He declined, because it was passed the "expiration" date. I can't really blame him -- you don't want to play roulette with your son's life -- but the fact is that an epipen is probably good for several years, not just one. But the military hasn't (as far as I know) put epipens through their long-term evaluation program, so there's no way of knowing.
The problem here is that 'carried with you' is a far harsher environment than the climate controlled warehouses the DoD keeps the vast majority of its medical stockpile in.
Oh, and had another thought - set up some government supported healthcare cooperatives. Give the insurance companies some more competition.
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Oh, and had another thought - set up some government supported healthcare cooperatives.
Government supported means taxpayer funded.
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Government supported means taxpayer funded.
Sadly, yes. At least at first. Healthcare is too complicated of a mess and too expensive today for cooperatives to get their start like the USAA and Farmer's did back in the day.
And supported can mean more than straight up 'funding'. There are various means of support that don't mean giving them cash directly, but they all do have a cost.
Hell, something like favorable terms under federal law would be relatively cheap and could be a major benefit to a cooperative.
Though I'm picturing something more along the lines of the cooperative running it's own clinic to start with, eventually its own hospital.
Basically, growing out of those doctors that let you pay a monthly fee directly to a clinic and have the ability to see them as much as necessary for basic services. It can actually work out drastically cheaper than going through insurance.
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^^^This is exactly how Kaiser and Group Health Cooperative started back in the day. Kaiser recently acquired Group Health in Washington state, and now they are just another insurance company with a healthcare system attached.
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This just underscores the need to identify the worst R Senators and try to make sure they don't survive their primary next time around. Trump can help with that if he wants to.
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This just underscores the need to identify the worst R Senators and try to make sure they don't survive their primary next time around. Trump can help with that if he wants to.
just remember, if you include Murkowski in that that she managed to win by write-in. She isn't considered vulnerable.
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Sadly, yes. At least at first. Healthcare is too complicated of a mess and too expensive today for cooperatives to get their start like the USAA and Farmer's did back in the day.
And supported can mean more than straight up 'funding'. There are various means of support that don't mean giving them cash directly, but they all do have a cost.
Hell, something like favorable terms under federal law would be relatively cheap and could be a major benefit to a cooperative.
Though I'm picturing something more along the lines of the cooperative running it's own clinic to start with, eventually its own hospital.
Basically, growing out of those doctors that let you pay a monthly fee directly to a clinic and have the ability to see them as much as necessary for basic services. It can actually work out drastically cheaper than going through insurance.s
Sadly no. I've heard ads on the Radio for a Born Again Christian Heath Insurance cooperative.* They didn't need any government funding to get started. In fact, my understanding is that they were started because some folks vehemently disagreed with their government and the ACA. So they decided to "go their own way" via a loophole in the ACA.
It did kinda start like USAA, with people agreeing to insure one another. Funny that. And not using any .gov money, but thumbing their nose at the .gov instead. Again, asking the .gov for help, is allowing the camel's nose under the tent.
*- Found it. https://mychristiancare.org/medi-share/ Seems it was in response to the ACA and making people pay for coverages and treatments that contradicted their religious beliefs. Googling it also uncovered a few others as well.
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I just ran into this story this morning. It's only five people, and I think the story is slanted in favor of single payer. The couple of points that were of interest to me across the five countries were:
1) They all seem to kind of say the same thing - they like it and you can see a doctor right away, well, except for if you have an illness (preventative medicine rules) and then you may have to wait a couple of months for an MRI or whatever. I'd actually prefer to wait a couple of months for preventative medicine appointments. Having a need for an MRI or other advanced mechanism means there's a chance you have something more serious. I'm not keen on hearing, "Oh, sorry Ben. If you'd only gotten in a couple of months earlier, we might have been able to treat the cancer."
2) Even the interviewees with advanced education pull the, "It's free because the government pays for it" routine. No, you pay with your taxes, so you pay for it. To tie it in to point one, they seem to be okay waiting months for certain procedures because "it's free, so that's still a good deal". If they realized it was a service they paid for that they are not getting in a reasonable time, maybe they wouldn't be so happy with the bad service. But then it has been around so long in some of these countries that if you're born into it, you just don't see a problem. Kinda like with gun rights, where some people born into GCA 1968 don't really gripe about what was lost because they never lost it. it's just always been that way for them.
https://www.youtube.com/watch?v=siIukVsG3vs
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Sadly no. I've heard ads on the Radio for a Born Again Christian Heath Insurance cooperative.* They didn't need any government funding to get started. In fact, my understanding is that they were started because some folks vehemently disagreed with their government and the ACA. So they decided to "go their own way" via a loophole in the ACA.
It did kinda start like USAA, with people agreeing to insure one another. Funny that. And not using any .gov money, but thumbing their nose at the .gov instead. Again, asking the .gov for help, is allowing the camel's nose under the tent.
*- Found it. https://mychristiancare.org/medi-share/ Seems it was in response to the ACA and making people pay for coverages and treatments that contradicted their religious beliefs. Googling it also uncovered a few others as well.
That's who I'm with. No complaints.
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It's not that it is free - public medicine is just far cheaper and delivers better service. The wait times are no worse for the most part and can be skipped for non-emergency care with payment (payment that is well under American rates).
In America you have the worst of all possible worlds: extremely high prices for service that isn't any better, and is a royal PITA to access because you have to navigate insurers, doctors, and fifty bajillion billing codes in between.
There's a huge dollar and time efficiency gain in not having all the administration that comes with private insurance. There's no army of billing specialists when I go to the doctor, and they don't have to worry about being denied payment from entering the wrong digit in a sequence of 20.
Turning to hospital care, its publically funded so you manage a budget rather than managing a billing department.
That's why public systems can deliver equivalent service at lower prices. I've never understood why capitalism is a good thing when it causes higher prices and crappier service.
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It's not that it is free - public medicine is just far cheaper and delivers better service. The wait times are no worse for the most part and can be skipped for non-emergency care with payment (payment that is well under American rates).
In America you have the worst of all possible worlds: extremely high prices for service that isn't any better, and is a royal PITA to access because you have to navigate insurers, doctors, and fifty bajillion billing codes in between.
There's a huge dollar and time efficiency gain in not having all the administration that comes with private insurance. There's no army of billing specialists when I go to the doctor, and they don't have to worry about being denied payment from entering the wrong digit in a sequence of 20.
Turning to hospital care, its publically funded so you manage a budget rather than managing a billing department.
That's why public systems can deliver equivalent service at lower prices. I've never understood why capitalism is a good thing when it causes higher prices and crappier service.
All of which is why the Veteran's Administration is the model of patient care and service, along with medical, and fiscal efficiency when it comes to treatment and cost control.
And I managed to keep a straight face while typing that.
Holy Carp DeSelby, what the hell was in your bong today.
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*- Found it. https://mychristiancare.org/medi-share/ Seems it was in response to the ACA and making people pay for coverages and treatments that contradicted their religious beliefs. Googling it also uncovered a few others as well.
A friend of mine looked into Medi-Share. They went with Samaritan Ministries instead.
The basic principle is the same (members share each other's medical expenses), but Medi-Share is more like traditional insurance in that they tell you which providers you can use and which medical expenses can be shared. Medi-Share will not cover people whose weight is outside their parameters.
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That's why public systems can deliver equivalent service at lower prices. I've never understood why capitalism is a good thing when it causes higher prices and crappier service.
Prices aside, it seems to be a pretty common theme that there are significant wait times for more complex services in single payer in many if not most countries. These people are seeing two month wait times for an MRI as normal. Granted it was pre-ACA, but the last time I got an MRI, it was a week after I called to setup the appointment.
It was also just a $50 copay. Even if I got in for one in a week now (no idea what what times are now), on my current post-ACA plan, I'd be liable for the full cost of the MRI or the max of my $6500 annual, whichever came first.
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A friend of mine looked into Medi-Share. They went with Samaritan Ministries instead.
The basic principle is the same (members share each other's medical expenses), but Medi-Share is more like traditional insurance in that they tell you which providers you can use and which medical expenses can be shared. Medi-Share will not cover people whose weight is outside their parameters.
They do. It just costs more.
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In America you have the worst of all possible worlds: extremely high prices for service that isn't any better, and is a royal PITA to access because you have to navigate insurers, doctors, and fifty bajillion billing codes in between.
You keep saying this, and I'm not sure it's as universally true as single payer fan-boys would like it to be.
Take my family: According to this site (http://www.aihw.gov.au/australias-health/2012/spending-on-health/) Aussies spend $4319 USD per person, per year on healthcare split between gov funding, personal payments (co pays) and insurance. So a family of two (like mine) is $8638 USD/ year into health care.
We pay $230/ pay period for our insurance ($5980 USD/year) and My wife and I average about $250 in co-pays/year. (mostly dental) So we're $6230/year for the family. Cheaper than the hypothetical Aussie family.
I know there are billing inefficiencies, coding specialists and the like, but I never see them. I call, get an appointment, walk in, see the doc, give them $20 or $30 and walk out. I get great service from my docs, and if I didn't, I'd go find another. Obviously surgeons are more the luck of the draw for emergent issues, but for planned ones I shop around and ask who does good work. I have, once in the last decade, found a doc that I wanted to see that my insurance didn't have a deal with. So that can happen, but for the most part I have a lot of freedom to pick who I see for health care, and how they treat me.
Sure there are folks in the US that get just huge bills, or end up bankrupt from treatments, and their are crappier plans then mine that don't give people the choices I get, and there are huge inefficiencies in our current system. But there are MILLIONS of Americans who, like me, pay a small fee and just go to the doctor when they want, and get good, professional treatment. So when media and fan boys through out cases from the extreme of the bell curve in America and use it to try and tear down the whole system, folks like me start to get nervous. Because we were told we could keep our doc's if we liked them before, and it wasn't all roses.
You should realize, that for all it's inefficiencies, and the cases on the fringe that we 100% should work on, for the VAST majority of Americans don't live in some sort of constant anxiety about healthcare. Most of us just buy insurance, and go see a doctor whenever we want. It's not a royal PITA.
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Dogmush, I see your point on healthcare being good enough for a large swath of the population. That's certainly part of why you keep that system even in the face of its potential to bankrupt the federal govern,ent.
There are some key issues with your figures to note:
1) that figure in Australia is to cover everyone. It isn't directly comparable to your family premiums. My actual out of pocket cost for premiums is 1% of my income plus $80 a month for private cover that gives me dental, eyes, alternative medicine and access to sports injury surgeries that are much faster than public.
2) a current list (wiki but cited) sets Australia at 4420 per person, and the US at 9451. So like for like, it's pretty much impossible to make the case about affordability. For that 4420 it's impossible for cancer or heart disease to bankrupt me. That's a very realistic prospect for even insured Americans.
3) Nearly every doctor in this system is private and you can choose whoever. Having lived in both, it is far, far easier to shop around and select a doctor you want in Australia. they claim on the public benefits scheme and can choose to charge more. The existence of the public scheme and hospitals that offer major care on a public basis means that private providers are limited to some degree in what they can charge - people will just go public if the private bill is too much. Overall it yields lots of options that are excellent, easy to access, and affordable.
Insurance and us healthcare certainly do provide services people want. It's just that they aren't as good as the services in countries with a public healthcare system.
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All of which is why the Veteran's Administration is the model of patient care and service, along with medical, and fiscal efficiency when it comes to treatment and cost control.
And I managed to keep a straight face while typing that.
Holy Carp DeSelby, what the hell was in your bong today.
It sure isn't. Not sure how that's relevant to international models of public healthcare??? The VA isn't a public medical system.
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Prices aside, it seems to be a pretty common theme that there are significant wait times for more complex services in single payer in many if not most countries. These people are seeing two month wait times for an MRI as normal. Granted it was pre-ACA, but the last time I got an MRI, it was a week after I called to setup the appointment.
It was also just a $50 copay. Even if I got in for one in a week now (no idea what what times are now), on my current post-ACA plan, I'd be liable for the full cost of the MRI or the max of my $6500 annual, whichever came first.
MRI services tend to be triaged based on injury or suspected diagnosis. If you just paid out of pocket for one the price here would be far less than the difference between yearly medicine costs and an average health insurance plan in the US.
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For an expat that is so enamored of things the way they are where you are, my suggestion is for you to stay there and enjoy it. We really don't need anymore liberal/socialist/commies trying to *expletive deleted*ck things up here at home.
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1) that figure in Australia is to cover everyone. It isn't directly comparable to your family premiums. My actual out of pocket cost for premiums is 1% of my income plus $80 a month for private cover that gives me dental, eyes, alternative medicine and access to sports injury surgeries that are much faster than public.
You can't hand wave away the tax burden a gov funded system imposes. You are still paying for it.
The other issue, as RKL alludes to, is that there are cultural traditions, important to Americans, that add "cost" to just turning over healthcare to the government for us. So the difference is not as stark as you would like to portray, and there's more to the equation than JUST cost and service.
All of that doesn't touch the fact that the vast sums of money Americans spend on the edges of our bell curve subsidies medical R and D far out of proportion to our percentage of the worlds population, in much the same way as our military spending subsidies European socialism. It would be ironic if we finally cut cost enough that it's no longer worth finding new cures.
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You keep saying this, and I'm not sure it's as universally true as single payer fan-boys would like it to be.
I'm not a single payer fan-boy, I just see why so many can see it as the "solution" when all the evils of our very much NOT free-market solution are laid out. As I and others have mentioned, some of our issues wouldn't be fixed by single-payer, so it's not a "complete" solution, but when one is looking for a sound bite, it frequently wins, as a full solution takes a lot of words even as a summary.
Then, look at your family. You do realize that, given your description, you're doing the equivalent of arguing that since your Smart Car works for you, that smart cars would work for everybody? What? Don't drive a smart? You have extra needs?
The majority of healthcare costs aren't for the healthy like you. They're for people like my parents. My mom's diabetic, dad has had cancer and a screwed up spine requiring multiple surgeries.
So you're looking at the fuel use by a family with a smart4two who drives once a week for groceries while ignoring the oilfield construction contractor driving a F350 towing a trailer full of tools.
It sure isn't. Not sure how that's relevant to international models of public healthcare??? The VA isn't a public medical system.
In a sense it is. Except for inclusion requirements, it's a government medical system that could theoretically be expanded to cover the entire population. And yes, it has issues. Medicare and Medicaid are two other options where you could expand coverage.
The problem, as I see it, with supporting the current regime is that people often ignore the problems with the current system - people delaying or not getting care because they can't afford it. Medical bankruptcies that raise costs for the rest of us. Etc...
As they say - fast, cheap, good. Pick two. Maybe only one.
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You can't hand wave away the tax burden a gov funded system imposes. You are still paying for it.
The other issue, as RKL alludes to, is that there are cultural traditions, important to Americans, that add "cost" to just turning over healthcare to the government for us. So the difference is not as stark as you would like to portray, and there's more to the equation than JUST cost and service.
All of that doesn't touch the fact that the vast sums of money Americans spend on the edges of our bell curve subsidies medical R and D far out of proportion to our percentage of the worlds population, in much the same way as our military spending subsidies European socialism. It would be ironic if we finally cut cost enough that it's no longer worth finding new cures.
Sorry, to clarify - that 1 percent is the tax burden. I'm not waving it away. It's listed on your taxes.
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It sure isn't. Not sure how that's relevant to international models of public healthcare??? The VA isn't a public medical system.
It most certainly is. It's owned and paid for 100% through tax dollars. Yes, it's not "universal" but it's government run. Which is what universal healtcare systems are.
And most medicaid programs are going broke. Several States that expanded Medicaid under the ACA are having a second look and considering "contracting" medicaid. In the expansion the Feds picked up 100% the first and it declines to 90% in the year 2020. But there's no "what happens next in 2021". The feds could go to the current 57%/43% split for per ACA enrollees. And State budgets then implode.
And Univerisal Healthcare is just that. Healthcare (not insurance), you go the doc and the .gov pays. Causing an even bigger disconnect between patient, provider, and payer. Because, if Uncle Sugar is picking up the tab, then I'm headed to the doc for every little hang-nail and boo-boo.
And the other problem we have are the illegals. I've been in the ER at my hospital any number of times (me plus 2 kids in sports). 70-90% of the folks in the ER are Hispanic (West Chicago is for all practical purposes a suburb of Mexico, it often called "West Chicano") and CDH is the county hospital. And that's both the Adult and Juvenile ER's. Even though I'm constantly told they are not eligible for US welfare/food stamp and other benefits, like medicaid.)
Sorry, but there are several things we need to do to both improve the quality, but also the quantity of care. And getting the .gov out is the most important.
And sorry DeSelby, but if you want to see how univerisal healthcare, run by the fed.gov would work, then look no further than the VA.
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And sorry DeSelby, but if you want to see how univerisal healthcare, run by the fed.gov would work, then look no further than the VA.
You must be an optimist, thinking a new universal healthcare would be as well run as the VA.
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You must be an optimist, thinking a new universal healthcare would be as well run as the VA.
Yep, look no further then the disaster that was the ACA rollout and the website...
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Yep, look no further then the disaster that was the ACA rollout and the website...
The ACA and the VA are two examples of what's wrong with private health insurers capturing the field on health policy.
The ACA was supported by industry - in the end it was boon for private markets. Part of the VA's problem is that it is, like the old seaman's hospitals, a backwater to the overall healthcare market.
In short, finger pointing to them as examples of public care failing completely misses the reasons why public healthcare works well in other places.
It's very easy to shut your eyes and scream "government bad!", but that doesn't mean you'll get the right answer.
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I just don't even know how to react to that level of farktard. It wasn't private companies that botched the rollout of the Obamacare website. It was the .gov. Unlike every other website where if you go to buy something, you get to see the price first. Obama Administration Officials insisted on a last minute re-write so that you could only see and shop prices AFTER you had provided all your personal and banking information so that you would be FORCED to buy a policy. That wasn't the Insurance Companies doing, that was the Administration, and yes, they wrote the law so that if the ACA started to implode and the insurance companies were about to lose their ass as healthy people dropped coverage and only the sick remained (and you could only charge by income, not any other factors), the insurance companies would get bailed out. Yes, they took the King's shilling. I have zero sympathy for them.
And the VA, that fails it patients and kills them at a rate, that if done by any other hospital or hospital chain would see everyone from the janitors to the CEO in prison, is a malignant suckhole of death, because "private markets make it "a backwater of the healthcare market" ??
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The VA is s national wide medical system with a medical budget is $70.7 Billion. It should be a shining example and the premier healthcare system in the US, because it is yoru beloved "Single Payer". My "Backwater" Hospital system (Northwestern University Hospitals) only has 5 Hospitals (and several clinics) and budget of only $5 billion. Yet, my backwater hospital system, has managed to keep me alive about twice as long as it takes a returning veteran to register for benefits (6 years come November vs a 33 month wait to process new veterans into the system). 33 months just to register to get treatment. I guess outwaiting your patients so that they die in the mean time it a great method to control costs...
Okay, I get it. Aussie Healthcare and the British NHS are just the *expletive deleted*it when it comes to healthcare. Can you name the latest breakthrough drugs or treatments from Oz or the UK, and when they entered the market ??
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The hype in your response, and the vague shifting between obamacare, soviet housing, and then the oft repeated claim that public medicine means no breakthroughs is a telltale sign of emotional attachment to the policy, not fact based.
On the claim about breakthroughs:
Research funding, particularly by the private sector, has also shifted to later stages development and away from basic science. Guided primarily by the desire to realize short-term economic benefits, the share of spending by pharmaceutical, biotechnology, and medical device companies on phase 3 clinical trials – large studies in people that often represent the final step before regulatory approval – grew by 36 percent between 2004 and 2012. Industry spending is also now the largest component of U.S. medical R&D, increasing from 46 percent in 2004 to 58 percent in 2012.
https://www.urmc.rochester.edu/news/story/4233/u.s.-slipping-as-global-leader-in-medical-research.aspx
The Aussie and U.K. Systems both deliver a superior service at lower prices. That's what the facts support as a conclusion. The fact that you're going from public housing to wild claims about obamacare to then asserting that if Americans don't pay triple for healthcare the world will have no medicine should be illuminating enough (but I predict it won't be - facts haven't swayed this debate in an entire US generation.)
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The Aussie and U.K. Systems both deliver a superior service at lower prices. That's what the facts support as a conclusion. The fact that you're going from public housing to wild claims about obamacare to then asserting that if Americans don't pay triple for healthcare the world will have no medicine should be illuminating enough (but I predict it won't be - facts haven't swayed this debate in an entire US generation.)
Neither has the fact that the US is not the UK or Australia, and the very real differences in our governments, scale of population, and culture present some very real, and different, issues to providing better, cheaper healthcare through a single payer system in the US. But you just want to keep repeating that it works elsewhere, while poo pooing real issues.
On the R and D front, the fact is that the US healthcare market pays for more of the research and fielding of new medicine worldwide than it's population warrants. Will R and D stop? No of course not, but how do you quantify the very smart folks that in 20 years choose to work for Virgin Intergalactic instead of Pfizer? It's difficult but shouldn't just be dismissed. Much like US military power projection (another thing Australia and the UK benefit from without really paying for, come to think of it) everyone is ready to tell us we're doing it wrong, but when we stop it all goes to hell.
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....The Aussie and U.K. Systems both deliver a superior service at lower prices. That's what the facts support as a conclusion. The fact that you're going from public housing to wild claims about obamacare to then asserting that if Americans don't pay triple for healthcare the world will have no medicine should be illuminating enough (but I predict it won't be - facts haven't swayed this debate in an entire US generation.)
I won't speak about Australia, but I do wish my parents were still alive to wax eloquent, they both had experience with the British HC system, and from what they told me, I wouldn't wish it on my worst enemy. They also spoke to too many people over there about their experiences in the system, very little good was heard.
If you have some run of the mill problem, it works....sort of. Get a nasty aggressive cancer.....you're S. O. L.
It has nothing to do with competent doctors --- they're very competent. There just aren't enough of 'em, and the bureaucracy stinks.
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I have a particular rare and painful health issue (hyperacusis). There is a webboard for this disorder that I visit. A member from the UK stated that s/he had been waiting over a year for their appointment with an audiologist to get treated. There is something very, very wrong with that. =(
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Just to chime in as someone who has worked in the US healthcare system for almost four decades now: the US system could do a much better job of providing a basic level of care to all citizens. When it comes to cutting-edge care and research, the US has few peers if the patient can pay for that care. When it comes to providing basic OB, dental, pediatric or primary care to every US citizen, the US is significantly behind many other First World nations, some of which do have a health system operated by that nation's government. I recently volunteered at a local church's 'health day' in which volunteer providers came to give free medical and dental care to people in need, and it embarrasses me as a US citizen that such things are necessary in this country.
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Neither has the fact that the US is not the UK or Australia, and the very real differences in our governments, scale of population, and culture present some very real, and different, issues to providing better, cheaper healthcare through a single payer system in the US. But you just want to keep repeating that it works elsewhere, while poo pooing real issues.
On the R and D front, the fact is that the US healthcare market pays for more of the research and fielding of new medicine worldwide than it's population warrants. Will R and D stop? No of course not, but how do you quantify the very smart folks that in 20 years choose to work for Virgin Intergalactic instead of Pfizer? It's difficult but shouldn't just be dismissed. Much like US military power projection (another thing Australia and the UK benefit from without really paying for, come to think of it) everyone is ready to tell us we're doing it wrong, but when we stop it all goes to hell.
Not sure that De Selby is ignoring the real issues - especially when it comes to the NHS which demonstrably costs less per capita than the Medicare/Medicaid system does, and which demonstrably delivers far more. It isn't a perfect system by any means (though it is nowhere near as bad as painted in your media), but in terms of relatively efficient use of taxpayer's money it is streets ahead.