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19th January 2017, 09:56 PM | #201 |
Penultimate Amazing
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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 |
19th January 2017, 10:50 PM | #202 |
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20th January 2017, 01:32 AM | #203 |
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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). |
20th January 2017, 06:56 AM | #204 |
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20th January 2017, 08:29 AM | #205 |
Penultimate Amazing
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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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20th January 2017, 09:04 AM | #206 |
Penultimate Amazing
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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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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. |
20th January 2017, 09:11 AM | #207 |
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20th January 2017, 10:21 AM | #208 |
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20th January 2017, 11:19 AM | #209 |
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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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20th January 2017, 11:35 AM | #210 |
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Myth would imply that it is widely believed. Is it?
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I agree.
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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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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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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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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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Insurance companies have made that experiences with certain types of disability insurance.
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20th January 2017, 01:40 PM | #211 |
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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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21st January 2017, 06:39 AM | #213 |
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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. |
22nd January 2017, 01:31 AM | #214 |
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1. He'd never do that. 2. Okay but he's not currently doing it. 3. Okay but he's not currently technically doing it. 4. Okay but everyone does it. 5. He's doing it, we can't stop him, no point in complaining about it. 6. We all knew he was going to do it which... makes it okay somehow. 7. It's perfectly fine that's he's doing it. |
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22nd January 2017, 04:33 AM | #215 |
Penultimate Amazing
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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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22nd January 2017, 11:32 AM | #216 |
Penultimate Amazing
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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.
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22nd January 2017, 07:56 PM | #217 |
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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. |
22nd January 2017, 08:09 PM | #218 |
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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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23rd January 2017, 03:10 AM | #220 |
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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. |
23rd January 2017, 03:22 AM | #221 |
Penultimate Amazing
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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. Hans |
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23rd January 2017, 03:33 AM | #222 |
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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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23rd January 2017, 04:11 AM | #223 |
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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 |
23rd January 2017, 06:53 AM | #224 |
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23rd January 2017, 06:55 AM | #225 |
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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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23rd January 2017, 09:42 AM | #227 |
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23rd January 2017, 09:47 AM | #228 |
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23rd January 2017, 09:47 AM | #229 |
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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. |
23rd January 2017, 09:58 AM | #230 |
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23rd January 2017, 10:39 AM | #231 |
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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.
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23rd January 2017, 11:02 AM | #232 |
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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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23rd January 2017, 11:49 AM | #233 |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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23rd January 2017, 12:15 PM | #234 |
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23rd January 2017, 12:16 PM | #235 |
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23rd January 2017, 12:41 PM | #236 |
Penultimate Amazing
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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/ |
23rd January 2017, 12:57 PM | #237 |
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23rd January 2017, 01:45 PM | #238 | ||
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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.
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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23rd January 2017, 01:48 PM | #239 |
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Suffering is not a punishment not a fruit of sin, it is a gift of God. He allows us to share in His suffering and to make up for the sins of the world. -Mother Teresa If I had a pet panda I would name it Snowflake. |
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23rd January 2017, 03:57 PM | #240 |
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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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