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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 19th January 2017, 09:56 PM   #201
Bob001
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Originally Posted by Dr. Keith View Post
So, without reading every post, is Trump going to make sure everyone is covered or should we just disregard that statement?
The Repub position seems to be that everyone will have "access" to coverage. In practice, that would mean they can buy insurance if they can afford to pay whatever the company demands.
http://www.washingtonpost.com/blogs/...=.d6d1dc159bf5

Last edited by Bob001; 19th January 2017 at 10:02 PM.
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Old 19th January 2017, 10:50 PM   #202
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Originally Posted by Dr. Keith View Post
So, without reading every post, is Trump going to make sure everyone is covered or should we just disregard that statement?
As a rule I don't believe he's going to do anything he says until after he's done it.
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Old 20th January 2017, 01:32 AM   #203
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Originally Posted by Dr. Keith View Post
So, without reading every post, is Trump going to make sure everyone is covered or should we just disregard that statement?
It's difficult to say...

Whilst Trump may, or may not, mean that he's going to make sure everyone is covered, it seems that the GOP favour a system whereby everyone has access to be able to be covered (as long as they can afford the insurance premiums).

This will be sold as universal coverage and those who cannot afford coverage because of their poverty or the enormous expense of covering them will be vilified for being feckless.

The people who lose coverage will either complain bitterly but get nowhere (if Democratic Party voters) or somehow convince themselves that this new situation is better than the ACA (if GOP voters).
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Old 20th January 2017, 06:56 AM   #204
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Originally Posted by Dr. Keith View Post
So, without reading every post, is Trump going to make sure everyone is covered or should we just disregard that statement?
Yes.
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Old 20th January 2017, 08:29 AM   #205
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Originally Posted by Bob001 View Post
The Repub position seems to be that everyone will have "access" to coverage. In practice, that would mean they can buy insurance if they can afford to pay whatever the company demands.
http://www.washingtonpost.com/blogs/...=.d6d1dc159bf5
Yep, everyone has "access" to healthcare. Just like everyone has access to getting a yacht.

As I have said, the key to this is that it puts the blame on you. If you don't have health insurance, it is YOUR fault, not the insurance company's. Just because it would be prohibitively expensive is not their problem.
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Old 20th January 2017, 09:04 AM   #206
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Originally Posted by GnaGnaMan View Post
I am not sure where you are going with this.
Health care encompasses physical therapy and massage and psychotherapy and elective surgery and getting medicines to reduce back pain or knee pain or allergic reactions or to have sex without getting pregnant or to get an erection in order to have sex. There is so much to health care than just preventing a gunshot victim from bleeding to death. Health care spending is 17% of our GDP, and only 2% of health care spending is for emergency room treatment. It is a myth that health care spending primarily involves a tradeoff between saving a life and saving money.

Furthermore, there are many areas of the rest of the economy which do involve tradeoffs between life and health and money. A poor person who has to live in a crime-ridden neighborhood is incurring a greater risk of injury or death because of his poverty. Likewise for a poor person who can only afford a crappy, old car with bald tires and without the latest safety features. Or for a poor person who has to work a dangerous, physically exhausting job in order to make ends meet (e.g. taxi driver or coal miner). Trading health and health risk for money is far more common in our economy than most people understand. We all do it, almost all the time. There is nothing inherently special about the consumption decisions we make which are considered "health care."

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Inalienable means that it never goes away. That means one still has it in these situations you describe.
Not sure what you mean by a "right." You do not have a right to live if your body is riddled with terminal cancer. You do not have a right to live if you've been stabbed or shot, and nobody around can stop the bleeding before you succumb. You do not have a right to live if you are stuck in a blizzard without adequate shelter. As we get wealthier as a society, we feel compelled to declare more luxuries to be "rights" but it doesn't mean that they are inalienable or immutable. And it's impossible, by definition, to grant somebody a right (at least in a meaningful way) to a limited resource, when the supply of that resource is less than the demand.

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Source?
It's called logic. Either follow it or don't, but you'll have to do it on your own.

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It is unusual to ask for gratefulness for positive externalities.
Is there actual evidence that this is even the case?
It's only a positive externality because the US lets it be. If we go the same route as everybody else, it will cease to exist. And the fact that everybody else has gone the route they have has created a negative externality for us. So you can look at it either way. Either they should be grateful that we still pay absurdly more for our health care than they do, or we should be pissed about it. And, yes, it is the case. Look to some of the Obamacare threads and search for posts by me. I am already tired of repeating myself over and over again here and seeing the same posters stick their heads in the sand (not you - never seen you here before).

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I do not understand why your interpretation of the word "withheld" is important here. I think you want to say that you do not share those moral beliefs?
At some level I do, but it depends upon whether I think something is being withheld for immoral reasons. I don't think it's immoral for a BMW dealer to withhold a BMW from somebody who can't pay for it. Likewise, I don't think it's immoral for a brain surgeon to withhold 10 hours of his labor from somebody who can't pay for it. I do think it's immoral for somebody to withhold a glass of water from somebody dying of thirst (as long as you have plenty for yourself). I also think it's immoral to leave somebody to die of a heart attack in the street rather than call an ambulance. We can all disagree about the point at which certain altruistic actions transition from moral obligation to optional, but there is no question that such a point exists for each of us and for society on average, and that point is constantly moving towards more aggressive intervention as our society gets wealthier and we develop more health care resources. But it's crazy to think that somebody is entitled to consume unlimited health care resources just because he has a need. Because we have limited health care resources, his consumption inevitably means that somebody else will have to do without.

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What countries do you mean here? When I hear socialized health care I think of countries like the UK or Canada. Those countries are not known for high levels of corruption; quite the opposite, in fact. Maybe you have a narrower definition in mind.
It is inevitable that when you have a system where money is not the medium of exchange, then something else will be used. In the case of socialized economies, that becomes political clout. If you think the allocation of health care resources in countries like UK and Canada is strictly based on formula-determined need, then I might have some property in Florida to sell you. In any case, formula-determined need is a stupid way of allocating resources. It neglects the fact that each individual has a different utility curve.

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Maybe this needs to be thought through. Let's start with a think about the free market:
Say, there's a boat-load of oranges that gets put up for auction. Two juice factories make bids. The higher bid wins.
Both factories have to sell their at the same world market price. So which factory makes the higher bid?
The one that is more 'productive. That factory can afford to spend more for raw materials while still turning a profit.
No one literally measures which one that is but if you like metaphors you could say that the invisible hand measures it.

Now let's say a guy needs medical treatment to remain able to work/live. The treatment costs $X more than he has. What now?
If his potential income is high enough that he can be expected to pay back $X + interest, then lending him the money for the treatment becomes a good investment.
In this case we need someone who measure his expected income: A credit lender, investor, or insurance company. If you want to buy on credit someone will indeed measure how productive you are.
But as with the oranges, we find that the market directs the resources where they will get a good return.
You're talking about business competition. I'm talking about consumption. You don't need to be currently productive to consume. You just need to have financial resources. You might have acquired that by being productive in the past, or by being frugal. Or by being lucky. Doesn't really matter to me. What matters is that the individual makes a cost-benefit decision for himself. If you are worried that poor people won't be able to consume enough, well, we have programs for that. I would prefer to just give them money and let them make their own spending decisions. If they'd rather spend it on a new car rather than getting the knee surgery they "need," it's fine with me.

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Seems reasonable but what's your point? It sounds like you want to propose a scheme where personal utility determines what treatments someone gets. How would that work?
By allowing people to buy the health care resources they need want. You can have health insurance become what insurance is supposed to be - financial protection against a catastrophe - rather than a prepaid health care program. For poor people, you can give them money to spend as they see fit.

I think as a wealthy society, we probably could provide a guarantee of slightly less than state-of-the-art health care at the Medicaid level for everybody. Medicaid for all might work. Anybody who wants something better (and almost everybody middle class or higher would) would have to pay for that out-of-pocket.

Last edited by sunmaster14; 20th January 2017 at 09:09 AM. Reason: better word
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Old 20th January 2017, 09:11 AM   #207
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Originally Posted by The Don View Post

The people who lose coverage will either complain bitterly but get nowhere (if Democratic Party voters) or somehow convince themselves that this new situation is better than the ACA (if GOP voters).
I disagree with your prediction.

GOP voters will still complain bitterly, but they'll find a way to blame it on Obama (and Hillary for good measure).
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Old 20th January 2017, 10:21 AM   #208
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Originally Posted by Cavemonster View Post
I disagree with your prediction.

GOP voters will still complain bitterly, but they'll find a way to blame it on Obama (and Hillary for good measure).
Actually, good call, you're probably right
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Old 20th January 2017, 11:19 AM   #209
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Originally Posted by sunmaster14 View Post
Most people understand and accept that the price system works best in other areas of the economy, but for some reason rebel against the idea when it comes to health care.
I will take aside that your glorious "price system" does not work that well in "other areas of the economy", since discussion about free market miracles (or rather, lack of it) is offtopic.

Sooo... can I shop for disease that I can afford? Can I delay getting disease until better time? Can I lodge complaint about disease that is not up to my expectations to seller?

There is fundamental difference between healthcare and say, buying car. Sometimes you do not have choice. Accidents happens. Cancer happens. S**t happens that is not your fault.

You argue that it is no different than "poor person who has to live in a crime-ridden neighborhood is incurring a greater risk of injury or death because of his poverty". BS. You can still live and hope for change in this example. Health problem not only has potential to be significantly more costly than anything in one's life, but also more final.

This is why most people consider healthcare qualiatively and quantively different than "other areas of the economy".

In fact, most people don't consider deranged notion "free market is solution for all our woes" true and think that in some areas capitalism works best (or at least better than other solutions) and in some other goverment works best (or at least better than other solutions).
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Old 20th January 2017, 11:35 AM   #210
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Originally Posted by sunmaster14 View Post
Health care encompasses physical therapy and massage and psychotherapy and elective surgery and getting medicines to reduce back pain or knee pain or allergic reactions or to have sex without getting pregnant or to get an erection in order to have sex. There is so much to health care than just preventing a gunshot victim from bleeding to death. Health care spending is 17% of our GDP, and only 2% of health care spending is for emergency room treatment. It is a myth that health care spending primarily involves a tradeoff between saving a life and saving money.
Myth would imply that it is widely believed. Is it?

Quote:
Furthermore, there are many areas of the rest of the economy which do involve tradeoffs between life and health and money. A poor person who has to live in a crime-ridden neighborhood is incurring a greater risk of injury or death because of his poverty. Likewise for a poor person who can only afford a crappy, old car with bald tires and without the latest safety features. Or for a poor person who has to work a dangerous, physically exhausting job in order to make ends meet (e.g. taxi driver or coal miner). Trading health and health risk for money is far more common in our economy than most people understand. We all do it, almost all the time. There is nothing inherently special about the consumption decisions we make which are considered "health care."
I see what you are saying. The underlying motivation of health and safety and health care regulations is the same.
I agree.

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Not sure what you mean by a "right."
Let's put it in practical terms: If you have a right to something, that means that you can call in help from the government, if someone tries to deny that something to you.
For example, if someone is on your property and won't leave, then you can ask the police to remove them. They will use violence if necessary. That is because you have a right to enjoy your property.
Or say, someone will not let you vote. Then, again, you can call the police.

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You do not have a right to live if your body is riddled with terminal cancer. You do not have a right to live if you've been stabbed or shot, and nobody around can stop the bleeding before you succumb. You do not have a right to live if you are stuck in a blizzard without adequate shelter. As we get wealthier as a society, we feel compelled to declare more luxuries to be "rights" but it doesn't mean that they are inalienable or immutable. And it's impossible, by definition, to grant somebody a right (at least in a meaningful way) to a limited resource, when the supply of that resource is less than the demand.
I think you are confusing the right to do something and the means to do something.

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It's called logic. Either follow it or don't, but you'll have to do it on your own.
It does not follow from first principles that it is impossible to provide state-of-the-art medical to every citizen because of resource constraints. Obviously that depends on a variety of factors which are not constant in time.

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It's only a positive externality because the US lets it be. If we go the same route as everybody else, it will cease to exist. And the fact that everybody else has gone the route they have has created a negative externality for us. So you can look at it either way. Either they should be grateful that we still pay absurdly more for our health care than they do, or we should be pissed about it.
That's just not how it works. You could say that the US should be grateful that other countries let it shop on (dubious) credit but obviously it isn't.

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And, yes, it is the case. Look to some of the Obamacare threads and search for posts by me. I am already tired of repeating myself over and over again here and seeing the same posters stick their heads in the sand (not you - never seen you here before).
Fair enough but I can't give credit to an unsourced statement.

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At some level I do, but it depends upon whether I think something is being withheld for immoral reasons. I don't think it's immoral for a BMW dealer to withhold a BMW from somebody who can't pay for it. Likewise, I don't think it's immoral for a brain surgeon to withhold 10 hours of his labor from somebody who can't pay for it. I do think it's immoral for somebody to withhold a glass of water from somebody dying of thirst (as long as you have plenty for yourself). I also think it's immoral to leave somebody to die of a heart attack in the street rather than call an ambulance. We can all disagree about the point at which certain altruistic actions transition from moral obligation to optional, but there is no question that such a point exists for each of us and for society on average, and that point is constantly moving towards more aggressive intervention as our society gets wealthier and we develop more health care resources.
Sounds quite reasonable. Thanks for clearing that up.

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But it's crazy to think that somebody is entitled to consume unlimited health care resources just because he has a need. Because we have limited health care resources, his consumption inevitably means that somebody else will have to do without.
Any evidence for that assertion?
I can see how it is obviously true for a wide definition of health care resources. We can't have everyone praying 24/7 for someone's recovery.
But is it true for a more common sense definition?
There is only so much one can do, that is really known to be beneficial to health.

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It is inevitable that when you have a system where money is not the medium of exchange, then something else will be used. In the case of socialized economies, that becomes political clout. If you think the allocation of health care resources in countries like UK and Canada is strictly based on formula-determined need, then I might have some property in Florida to sell you. In any case, formula-determined need is a stupid way of allocating resources. It neglects the fact that each individual has a different utility curve.
Still don't get it. The UK and Canada are not socialized economies.
I also don't see how using money would prevent corruption. What do you actually mean by "money is not the medium of exchange"?

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You're talking about business competition. I'm talking about consumption. You don't need to be currently productive to consume. You just need to have financial resources. You might have acquired that by being productive in the past, or by being frugal. Or by being lucky. Doesn't really matter to me.
Yes, people win the lottery but that doesn't change the logic.
If health care is provided by the same general system as everything else then it will be focused on the most productive members of society.
Ok, as you point out above, there will be people with political clout, or connections, or luck, but those are exceptions. If that weren't the case, market economies would not work.

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What matters is that the individual makes a cost-benefit decision for himself.
The individual cost-benefit decision matters to what?

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If you are worried that poor people won't be able to consume enough, well, we have programs for that. I would prefer to just give them money and let them make their own spending decisions. If they'd rather spend it on a new car rather than getting the knee surgery they "need," it's fine with me.
Interesting idea but on second thought fatally flawed. If you offer people money for having injuries, some people will take that offer. That's probably not an intended consequence.
Insurance companies have made that experiences with certain types of disability insurance.

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By allowing people to buy the health care resources they need want. You can have health insurance become what insurance is supposed to be - financial protection against a catastrophe - rather than a prepaid health care program. For poor people, you can give them money to spend as they see fit.
You mean like a wage subsidy? Why wouldn't the employer just cut the wage until new wage+subsidy is equal to the pre-subsidy wage. After all, that is what the employee is willing to work for.

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I think as a wealthy society, we probably could provide a guarantee of slightly less than state-of-the-art health care at the Medicaid level for everybody. Medicaid for all might work. Anybody who wants something better (and almost everybody middle class or higher would) would have to pay for that out-of-pocket.
Isn't that basically how they do it in the UK?
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Old 20th January 2017, 01:40 PM   #211
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Originally Posted by GnaGnaMan View Post
Isn't that basically how they do it in the UK?
Shh! It's more likely to happen if they think it's their thing.

MEDICAID FOR ALL? HA HA WHAT IS THIS A RANDIAN DYSTOPIA
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Old 21st January 2017, 05:54 AM   #212
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Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate

President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, which might include enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

https://www.washingtonpost.com/polit...=.bf22632a84ee
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Old 21st January 2017, 06:39 AM   #213
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Originally Posted by sunmaster14 View Post
Health care spending is 17% of our GDP,

Compared to other developed nations that figure is huge. Europe spends around 11% at most of GDP on healthcare.

There's a range of models European countries use to provide basic healthcare to all citizens. Hopefully Trump will use one of these going forward to replace the ACA.

If you could "only" save 5% of GDP on healthcare, that's a hell of a lot of money freed up for better purposes.
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Old 22nd January 2017, 01:31 AM   #214
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Originally Posted by zorro99 View Post
Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate

President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, which might include enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

https://www.washingtonpost.com/polit...=.bf22632a84ee
All part of the GOP repeal and delay strategy. Millions will go without health insurance and care. Republicans don't care though, it'll mostly affect poor people. Oh, and they'll blame Obama.
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Old 22nd January 2017, 04:33 AM   #215
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Originally Posted by thaiboxerken View Post
All part of the GOP repeal and delay strategy. Millions will go without health insurance and care. Republicans don't care though, it'll mostly affect poor people. Oh, and they'll blame Obama.
If Obama hadn't made it possible for them to have health insurance, the GOP wouldn't have to take it away so they can give tax cuts to the rich. It was pretty cruel of him teasing them with such a luxury just like kids staying on their parents plan until 26 and removing the ability to deny coverage for pre-existing conditions.
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Old 22nd January 2017, 11:32 AM   #216
sunmaster14
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Originally Posted by GnaGnaMan View Post
Myth would imply that it is widely believed. Is it?
Yes, of course. The life and death, urgent care situation is the first (and only ) example any anti-free health care market people give when arguing that the health care market is fundamentally immune to free market solutions.

Quote:
I see what you are saying. The underlying motivation of health and safety and health care regulations is the same.
I agree.
No, apparently you don't see what I'm saying. What you wrote is a non sequitur.

Quote:
Let's put it in practical terms: If you have a right to something, that means that you can call in help from the government, if someone tries to deny that something to you.
For example, if someone is on your property and won't leave, then you can ask the police to remove them. They will use violence if necessary. That is because you have a right to enjoy your property.
Or say, someone will not let you vote. Then, again, you can call the police.
You claimed we have a right to life. How does that work with such a definition? Do you really think that I have a right to call in the government to expend $1 million of health care resources to keep me alive?

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I think you are confusing the right to do something and the means to do something.
They go hand in hand. If the means don't exist, then it makes no sense to talk about it as a right. And it would be really bad public policy to make laws that establish such a right.

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It does not follow from first principles that it is impossible to provide state-of-the-art medical to every citizen because of resource constraints. Obviously that depends on a variety of factors which are not constant in time.
Yes, it does. State-of-the-art means resources at the leading edge of technology, which, by definition, exists only in limited quantities.

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That's just not how it works. You could say that the US should be grateful that other countries let it shop on (dubious) credit but obviously it isn't.
I am grateful that the rest of the world wants to hold dollars and thus is willing to run a large trade surplus with us. It means we can consume more than we produce, which is a nice situation to be in. In the case of health care, though, the rest of the world benefits from us not having a single payer system. Because of the high prices we pay for health care, particularly the state of the art stuff, health care companies are incentivized to develop new diagnostic equipment, new treatments and new medicines. Which the rest of the world eventually benefits from, with a small time lag after Americans get access. If we went to single payer, we would cut back our spending, and research and development would dry up.

Quote:

<snip>

Still don't get it. The UK and Canada are not socialized economies.
I also don't see how using money would prevent corruption. What do you actually mean by "money is not the medium of exchange"?
It means that instead of rich people buying access to better health care, you have politically connected or "important" people getting access to better health care. If a bureaucrat is making the decision about which treatment is covered, don't you think that the bureaucrat is susceptible to the normal pressures? Obviously, he will be doing favors for people. Might not even see it as immoral. After all, the people he helps are visible to him, whereas the people who are screwed (by being shuffled back in the queue) are largely invisible. This is simple human nature.

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Yes, people win the lottery but that doesn't change the logic.
If health care is provided by the same general system as everything else then it will be focused on the most productive members of society.
Ok, as you point out above, there will be people with political clout, or connections, or luck, but those are exceptions. If that weren't the case, market economies would not work.
The point of free markets is to let people spend money the way they see fit. According to their own cost-benefit calculus. If somebody is too poor to afford a treatment, then, yes, it's unfortunate, although perhaps they can convince their friends to help out, or a charity, or make a public fundraising effort. The point of a free market is to allow people to express their preferences, not to weed out unproductive people. That's just cynical nonsense.

Quote:
The individual cost-benefit decision matters to what?
Do I want to spend $10,000 to get knee surgery? Do I want to spend the extra money to get the best surgeon available, or will I seek a discount and let somebody a few years out of residency operate on me? Do I need a private room, or am I willing to save a few shekels by going semi-private? Do I want generic medicines or branded? Do I want the the state-of-the-art medicine with fewer side effects, or am I willing to tolerate a little incontinence of stomach upset in order to save a few more shekels. There are literally dozens of cost-benefit decisions to make for each procedure. Or at least there would be if we had a free market in health care.

Quote:
Interesting idea but on second thought fatally flawed. If you offer people money for having injuries, some people will take that offer. That's probably not an intended consequence.
Insurance companies have made that experiences with certain types of disability insurance.
That's not what I was talking about. The government gives you the money regardless of whether you are sick. You make your health care purchasing decisions on your own, as needed. The main idea is here.

Quote:
You mean like a wage subsidy? Why wouldn't the employer just cut the wage until new wage+subsidy is equal to the pre-subsidy wage. After all, that is what the employee is willing to work for.
No, it would be a stipend outside of employment. See the link above.

Quote:
Isn't that basically how they do it in the UK?
No, they have Medicare for all. I'm talking about Medicaid, which compensates providers at a much lower rate and basically sucks. The British safety net is too high. I think we could guarantee a level of care commensurate with the state-of-the art as of 10 to 15 years prior. The British system is more like 2 years prior. Of course, they can only get away with that by relying on the US to pay the lion's share of R&D and also by having a somewhat healthier population (which is a cultural and demographic benefit rather than a consequence of policy).
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Old 22nd January 2017, 07:56 PM   #217
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Originally Posted by sunmaster14 View Post
Yes, of course. The life and death, urgent care situation is the first (and only ) example any anti-free health care market people give when arguing that the health care market is fundamentally immune to free market solutions.
Let me give you another one.

Everything that is provided in a free market system will only be provided if the provider can make a profit. To make a profit, a provider has to charge the cost of the product, plus enough of a profit margin to make it worthwhile for the provider to take the time to provide it. i.e. He has to make a living.

Medicines, health appliances (wheelchairs and such), the true cost of all the products used during surgery, never mind the actual salaries of surgeons and nurses, is more than poor people can pay. There is absolutely zero profit in providing certain forms of health care to poor people, because they don't have enough money to cover the base cost, let alone provide a profit margin to investors, or a reasonable salary for the specialized labor providing the service.

A free market system would mean that poor people don't get health care, whether that's viagra, physical therapy, or heart surgery. Whether it's improving the quality of life, or keeping someone alive another day, the free market will leave poor people out.

So you have to have subsidies of some sort, or you have to let poor people do without, and suffer the consequences, whether that means dying or leaving their wives sexually frustrated.

ETA: And that doesn't mean there is no place at all for market forces in a health care system. You are alluding to that in your own posts. I was just reacting to the idea that a "free market solution" can solve health care problems. It can't. A true free market solution means some people don't get health care.

And, once you accept the idea that a pure free market solution can't solve the problem, Obamacare is about the closest thing to a free market system there is. The better one would be to get rid of the employer as the provider. That's a really stupid thing to do, but it's engrained in our culture.
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Old 22nd January 2017, 08:09 PM   #218
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Originally Posted by The Don View Post
It's difficult to say....
No it isn't. Magical Trump is a fraud. Don't expect anything he said to actually come true.
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Old 23rd January 2017, 02:49 AM   #219
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Health-care doesn't need to be for profit - this is a false assumption.
Neither does any other kind of infrastructure.
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Old 23rd January 2017, 03:10 AM   #220
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Originally Posted by The Great Zaganza View Post
Health-care doesn't need to be for profit - this is a false assumption.
Neither does any other kind of infrastructure.
True, but there is a basic assumption in the U.S. (and increasingly in the U.K.) that a profit-based delivery system will be far more efficient, cost effective and provide a higher quality service because of the profit motive.

I personally think that analysis is flawed, not least because it makes some assumptions about the market and because it makes some flawed assumptions about people's motivation.

For example, the U.K. motor industry was attempting to operate on a "for profit" basis and yet the quality and price of the product they were producing was far inferior to vehicles elsewhere in the world, notably Japan. for market forces to work, the market has to be open.

Experience with "fore profit" operation of parts of the NHS hasn't been an unqualified success. Shifting cleaning and portering services into the private sector has resulted in a more expensive and lower quality service. In part this is because at minimum wage there wasn't any margin for saving money and making profit except by doing less cleaning - with predictably bad results.
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Old 23rd January 2017, 03:22 AM   #221
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Many people here seem to discuss healthcare systems as if they were some theoretical concept.

Numerous industrialized countries have, and have had for many decades, quite well-functioning healthcare systems that provide essential healthcare and hospital service for free or for a low, same for all cost. Prescription medicines are free or heavily subsidized. Dental care is usually subsidized.

It works, and it works well. Of course there are snags, and there is a limit to what is provided. Of course there is always the discussion of just how expensive treatments should be provided to keep certain patients alive. But we work it out.

Financing? Some have a standardized or income-dependent fee, others take it through taxes. Of course, the citizens have to pay, there IS nobody else.

Market competition? Still exists, only the healthcare authorities are the customer, not the individual patients (and a much more potent negotiator they are).

There are details. Tons of them. But this is something that can be done, is done, and should be done. All it takes is a government that wants to do it, and voters who will let them.

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Old 23rd January 2017, 03:33 AM   #222
The Great Zaganza
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For profit yields the best results if there is a reasonable expected ROI and fast amortization of the equipment.
Only then will the venture be able to procure capital at reasonable rates. And only then
can there be real competition.
Providing health-care requires massive up-front investment in equipment, personnel and training - it is next to impossible for a newcomer to break into the sector.


But the more basic question is: is it desirable to have competition when it comes to health-care (and other infrastructure-like services) ?
We don't want three different companies to build and operate three different roads between two cities - that would be massively wasteful. We don't want two sewer systems or five train tracks in parallel.
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Old 23rd January 2017, 04:11 AM   #223
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Originally Posted by The Great Zaganza View Post
But the more basic question is: is it desirable to have competition when it comes to health-care (and other infrastructure-like services) ?

We don't want three different companies to build and operate three different roads between two cities - that would be massively wasteful. We don't want two sewer systems or five train tracks in parallel.
IMO there can be competition at the point of delivery for some infrastructure services as long as there is some kind of overall management to ensure that there is sufficient capacity.

The development of the UK railways is an example of the alternative, no overall vision which meant that we ended up with some doubling-up and some areas devoid of service. Ironically once it came under central control, one of the major lines was closed because it was deemed surplus to requirement and duplicating existing lines. It's a pity now because we could use the additional capacity.

https://en.wikipedia.org/wiki/Great_Central_Main_Line
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Old 23rd January 2017, 06:53 AM   #224
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Originally Posted by Dr. Keith View Post
So, without reading every post, is Trump going to make sure everyone is covered or should we just disregard that statement?
Listen to his heart not his words.
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Old 23rd January 2017, 06:55 AM   #225
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Originally Posted by Ambrosia View Post
Compared to other developed nations that figure is huge. Europe spends around 11% at most of GDP on healthcare.

There's a range of models European countries use to provide basic healthcare to all citizens. Hopefully Trump will use one of these going forward to replace the ACA.

If you could "only" save 5% of GDP on healthcare, that's a hell of a lot of money freed up for better purposes.
That would cost hundreds of thousands of jobs though, and cause people to lose millions. You think any job killing law like that could get passed?
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Old 23rd January 2017, 09:09 AM   #226
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Republican/Ryan healthcare plan:

It will be a tax deduction for insurance paid. No websites, no enrollment. The insurance plans are handled state by state, even the "free market plans." In many states it will look like buying cable TV. Red states! "What are my choices?" Cable or satellite. Insurance or no insurance.
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And we are going right back to the Hillary/Obama progression of things once we get rid of Trump. The last Republican president this century. Face it, with population growth and more urban people, the future is more Sesame Street than Little House on The Prairie.
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Old 23rd January 2017, 09:42 AM   #227
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Originally Posted by The Don View Post
True, but there is a basic assumption in the U.S. (and increasingly in the U.K.) that a profit-based delivery system will be far more efficient, cost effective and provide a higher quality service because of the profit motive.
A belief yes, but not everyone believes it. Unfortunately the US has been fed a steady diet of that propaganda since Reagan said the government is the problem.
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Old 23rd January 2017, 09:47 AM   #228
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Originally Posted by The Great Zaganza View Post
For profit yields the best results if there is a reasonable expected ROI and fast amortization of the equipment.
Only then will the venture be able to procure capital at reasonable rates. And only then
can there be real competition.
Providing health-care requires massive up-front investment in equipment, personnel and training - it is next to impossible for a newcomer to break into the sector.
This is a rather superficial analysis of some very complex problems with free market health care efficiency. Yes, but there is a lot more too it than what you note.


Originally Posted by The Great Zaganza View Post
But the more basic question is: is it desirable to have competition when it comes to health-care (and other infrastructure-like services) ?
We don't want three different companies to build and operate three different roads between two cities - that would be massively wasteful. We don't want two sewer systems or five train tracks in parallel.
This is one of the many problems I refer to.
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Old 23rd January 2017, 09:47 AM   #229
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Originally Posted by The Great Zaganza View Post
For profit yields the best results if there is a reasonable expected ROI and fast amortization of the equipment.
Only then will the venture be able to procure capital at reasonable rates. And only then
can there be real competition.
Providing health-care requires massive up-front investment in equipment, personnel and training - it is next to impossible for a newcomer to break into the sector.


But the more basic question is: is it desirable to have competition when it comes to health-care (and other infrastructure-like services) ?
We don't want three different companies to build and operate three different roads between two cities - that would be massively wasteful. We don't want two sewer systems or five train tracks in parallel.

Many universal care systems around the world use private insurance companies. But they are regulated like public utilities as to prices, services and profits. Profit is not in itself the problem. Nobody works for free. The problem is a system that makes higher profits the primary goal and rewards insurance and hospital executives with profit-based performance bonuses.

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Old 23rd January 2017, 09:58 AM   #230
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Originally Posted by MRC_Hans View Post
Numerous industrialized countries have, and have had for many decades, quite well-functioning healthcare systems that provide essential healthcare and hospital service for free or for a low, same for all cost. Prescription medicines are free or heavily subsidized. Dental care is usually subsidized.

The usual argument is that the methods that work just fine in multiple other countries will fail miserably in the US because...reasons. It usually involves some sort of vague handwaving about the size of the population.
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Old 23rd January 2017, 10:39 AM   #231
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Originally Posted by The Great Zaganza View Post
For profit yields the best results if there is a reasonable expected ROI and fast amortization of the equipment.
Only then will the venture be able to procure capital at reasonable rates. And only then
can there be real competition.
Providing health-care requires massive up-front investment in equipment, personnel and training - it is next to impossible for a newcomer to break into the sector.
That's ridiculous. The barriers to entry in other industries are way higher: car manufacturing, airplane manufacturing, semiconductor manufacturing, computer operating systems, smartphone operating systems, cloud based computing. The list goes on and on. A new radiology group can be started with less than $2 million. How much does it cost to hang out your shingle as a family practitioner? The biggest cost is the 10 years you devote to studying medicine.

Quote:
But the more basic question is: is it desirable to have competition when it comes to health-care (and other infrastructure-like services) ?
We don't want three different companies to build and operate three different roads between two cities - that would be massively wasteful. We don't want two sewer systems or five train tracks in parallel.
By your logic, it's wasteful to have more than one car company and more than one computer software company and more than one cellular phone network. It is, at some level, of course, but the benefits of competition and choice far outweigh the duplicative effort.
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Old 23rd January 2017, 11:02 AM   #232
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Originally Posted by sunmaster14 View Post
That's ridiculous. The barriers to entry in other industries are way higher: car manufacturing, airplane manufacturing, semiconductor manufacturing, computer operating systems, smartphone operating systems, cloud based computing. The list goes on and on. A new radiology group can be started with less than $2 million. How much does it cost to hang out your shingle as a family practitioner? The biggest cost is the 10 years you devote to studying medicine.



By your logic, it's wasteful to have more than one car company and more than one computer software company and more than one cellular phone network. It is, at some level, of course, but the benefits of competition and choice far outweigh the duplicative effort.
That is not my argument at all, but thanks for giving me the chance to clarify:

I'm not saying that having multiple companies for one product is wasteful, but that sectors with very high initial investments are almost always not as competitive as those that require less investment. This is rather self-explanatory. Indeed it has long been the practice of the giants of industries to buy up any newcomer that might siphon off market share.

This is an intrinsic weakness of capitalism, in that markets become less competitive the bigger the players are.

We can easily see this when "too big to fail" companies screw up so badly that they need to be bailed out: this would never happen with smaller players because they could almost seamlessly be replaced by competitors.

And of course this becomes even worse in the case of infrastructure providers: you have to buy water and electricity at whatever price and quality (see Flint, Michigan).

I agree that most healthcare services don't require expensive equipment to start, but the big costs in healthcare do come from MRIs, cancer treatment, dialysis machines and operating theaters (plus the monitoring for Intensive Care).
That is why you hardly ever see hospitals with lots of spare capacity. Only if you did would it be a sign that actual competition is happening.
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Old 23rd January 2017, 11:49 AM   #233
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Originally Posted by Ambrosia View Post
Compared to other developed nations that figure is huge. Europe spends around 11% at most of GDP on healthcare.

There's a range of models European countries use to provide basic healthcare to all citizens. Hopefully Trump will use one of these going forward to replace the ACA.

If you could "only" save 5% of GDP on healthcare, that's a hell of a lot of money freed up for better purposes.
It is amazing that we spend more to cover fewer people and have worse health outcomes. And yet we claim our system is more efficient and any other system would be inefficient. #alternatefacts
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Old 23rd January 2017, 12:15 PM   #234
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Originally Posted by Dr. Keith View Post
It is amazing that we spend more to cover fewer people and have worse health outcomes. And yet we claim our system is more efficient and any other system would be inefficient. #alternatefacts
We don't have worse health outcomes. That's a myth. Talk about alternate facts.
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Old 23rd January 2017, 12:16 PM   #235
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Originally Posted by sunmaster14 View Post
We don't have worse health outcomes. That's a myth. Talk about alternate facts.
The problem is that they are counting the health outcomes of the proles not just those who really matter.
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Old 23rd January 2017, 12:41 PM   #236
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Originally Posted by sunmaster14 View Post
We don't have worse health outcomes. That's a myth. Talk about alternate facts.

Well, we don't have worse outcomes than everybody. But we're not at the top of any lists either.
http://www.forbes.com/sites/danmunro.../#1905fccc1b96
http://www.washingtonpost.com/news/t...=.f1c8b3c0cff0
http://www.theatlantic.com/health/ar...d-last/267045/
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Old 23rd January 2017, 12:57 PM   #237
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Kill the ACA, kill Americans:
Quote:
The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.
http://www.washingtonpost.com/postev...=.28b638ec13eb
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Old 23rd January 2017, 01:45 PM   #238
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Originally Posted by sunmaster14 View Post
We don't have worse health outcomes. That's a myth. Talk about alternate facts.
I'm sorry, as a whole we do not have the best outcomes. And we are not as good as many of our peers who pay far less. Does that help your ocular condition?

ETA: I just reread my post ...<snip>... We do have worse outcomes. Maybe not the worst, but worse. We are bested by many of our peers, not just the Danes and Swedes.
Edited by jsfisher:  Edited for compliance with Rule 0 of the Membership Agreement.
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Old 23rd January 2017, 01:48 PM   #239
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Originally Posted by Bob001 View Post
Well, we don't have worse outcomes than everybody. But we're not at the top of any lists either. . . .
http://www.washingtonpost.com/news/t...=.f1c8b3c0cff0 . . .
I should have read your links before replying:

Quote:
A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 -- as other nations did with concerted effort and significant reforms -- it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system.
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Old 23rd January 2017, 03:57 PM   #240
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Originally Posted by ponderingturtle View Post
That would cost hundreds of thousands of jobs though, and cause people to lose millions. You think any job killing law like that could get passed?
So we lose hundreds of thousands of insurance company employees. Why can't you then use some of the money saved to create jobs elsewhere.

Which people would "lose milions". Insurance company executives?

Or do you mean the people out of work collectively?

Spend a hefty chunk of the 5% of GDP you just saved on national infrastructure. Lots of building companies will need to hire lots of people. Net job loss could be zero.

No. I don't think such a bill would have a cat in hells chance of passing, particularly under a Republican Administration, because lobbyists. I can't think of any good reasons though why the USA shouldn't have a universal health care system, just about every other developed nation has.
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