The Money Mustache Community
Other => Off Topic => Topic started by: gentmach on January 30, 2019, 08:48:08 AM
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
I don't know how you can exclude morality from the debate when your questions are about the morality of forcing people to behave in a particular way. Were you to enact laws and such to address the issues you mention, you would be fulfilling the wildest nightmares of some people who think socialized healthcare is a way to control how we live.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
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I don't have answers to any of your questions. However, I can tell you how these things work in Canada (specifically BC, because "Universal healthcare" is run provincially). Most of the answers boil down to the fact that universal health care doesn't replace personal responsibility or personal agency. No morality is attached to any health issue.
1. No morality or extra tax is attached to being overweight. If you have medical problems that stem for being overweight, they'll get treated, but otherwise it's up to you to lose weight; if you want. Surgical procedures like lap band, stomach stapling, etc are extremely hard to get. You must have a very high BMI and then wait years for the actual procedure. This is because OR and hospital time is prioritized for life saving procedures like cancer surgeries, cardiac issues, etc.
2. No one makes sure you take your meds properly. If you have medical issues stemming from improper use of meds, they'll get treated.
3. Addiction treatment is in extremely short supply. Addicts are lucky if they can get into a treatment program at all. Google "BC fentanyl crisis" for a graphic look at how this is a big issue here.
Universal health care doesn't solve all problems. It doesn't make for some kind of utopian paradise. All it does is make basic health care affordable for the masses. It also means that everyone deserves health care and very, very few people go bankrupt due to medical expenses. However, they may still go bankrupt if they're not able to work because they're too sick.
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Doesn't group insurance work similarly when you get down to it? I understand group insurance is voluntary, but I don't really understand how the argument changes when it becomes universal healthcare. Life isn't fair, no system is perfect, and ultimately, we do have Medicare which is working, even if imperfectly.
I have to point out that there's a fucking problem when I walk into a doctor's office lined in marble and filled with iPads but 20%+ of the population can't even get a checkup.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
That's what death panels are for.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
That is not an evidence-based statement. It's a preconceived notion, based on a moral stance. I'll repeat, creating a system that functions on reality and evidence, not on people's preconceptions, is the key.
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I'm not concerned about the truly sick people getting treatment. I'm concerned about the hypochondriacs bogging down the system. I guess they would get mental health treatment for that too, though.
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I'm not concerned about the truly sick people getting treatment. I'm concerned about the hypochondriacs bogging down the system. I guess they would get mental health treatment for that too, though.
How do we in America handle hypochondriacs right now? If they don't have coverage, they go to the ER. Is that better or worse than in a universal care system?
How do the many universal care systems around the world handle hypochondriacs?
Does the US have more hypochondriacs than, say, France or Germany?
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TrMama's reply would be pretty much the same for Ontario. There are walk-in clinics (helpful if you are away from home), clinics (for your GP and specialties like sports medicine), medical centers (for tests) and ERs for crises. And of course hospitals if you are really sick If you go to the ER for something trivial you will be referred to a clinic. If you really need an ER the ER will not turn you away. If you are sick you will be treated, urgent cases quickly, non-urgent cases not as quickly. But you will be looked after, and your OHIP will cover it. "Extras" (like prescription drugs, physiotherapy) get covered by personal insurance. People do fall through cracks, I have no idea how someone who is homeless gets an OHIP card. But getting that is a matter of residency, not money. We all pay for it, through our taxes (I am sure every Canadian will be happy to point out that this is not "free" health care, the cost is simply distributed over the whole population). Some years an individual may not need the system at all, other years they may use it a lot. Mental health care is not as good as physical health care, and addiction health care is in really short supply. Sadly, dental care is not covered, except for some dental surgeries done in a hospital.
There are 2 3 obvious advantages to this: 1. People are more likely to see a doctor before something gets so serious they are really sick and need hospitalization, and 2. they are not held hostage by an employer because how will they get insurance coverage otherwise? and I remembered 3. People get their immunizations easily - flu shots are provided at clinics and pharmacies, all children's immunizations are covered, most adult immunizations are covered.
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S That's what death panels are for.
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I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.
Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost. I routinely care for morbidly obese patients. We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient. As far as I can see under the current system there is no penalty for non compliance.
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S That's what death panels are for.
I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.
Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost. I routinely care for morbidly obese patients. We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient. As far as I can see under the current system there is no penalty for non compliance.
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Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
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I'm not concerned about the truly sick people getting treatment. I'm concerned about the hypochondriacs bogging down the system. I guess they would get mental health treatment for that too, though.
I had a relative go to the emergency room too many times in a certain time period with nothing wrong with him. The hospital wound up sending him to the psych ward involuntarily.
So the system does have methods available.
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S That's what death panels are for.
I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.
Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost. I routinely care for morbidly obese patients. We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient. As far as I can see under the current system there is no penalty for non compliance.
Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
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I don't understand your question. 99% of the patients in the hospital are on at least low dose blood thinners. I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify. We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday. She had only 3 months to go.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
That is not an evidence-based statement. It's a preconceived notion, based on a moral stance. I'll repeat, creating a system that functions on reality and evidence, not on people's preconceptions, is the key.
My brother had a girlfriend who was a heroin addict. Her mother died of a heroin overdose. One year later the daughter was dead of a heroin overdose.
The particular heroin addict I was talking about has been doing heroin for 12 years at this point. She gets arrested. They kick her to "drug court." Drug court sends her to rehab. After rehab she moves in with her mother who is toxic and the whole process starts over again.
Fun fact, that addict owes me 1365 dollars. And that is never coming back.
So I have "walked the walk" that you are asking me to do with helping people. I have found that people will strip you to the bone if you allow them. Jamming the government into these people's self destructive cycles seems like a bad idea.
To be clear, I agree that we need to find systems that work. Problem is the system needs to be more comprehensive (job training, life skills and keeping them away from the wrong people).
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
That is not an evidence-based statement. It's a preconceived notion, based on a moral stance. I'll repeat, creating a system that functions on reality and evidence, not on people's preconceptions, is the key.
My brother had a girlfriend who was a heroin addict. Her mother died of a heroin overdose. One year later the daughter was dead of a heroin overdose.
The particular heroin addict I was talking about has been doing heroin for 12 years at this point. She gets arrested. They kick her to "drug court." Drug court sends her to rehab. After rehab she moves in with her mother who is toxic and the whole process starts over again.
Fun fact, that addict owes me 1365 dollars. And that is never coming back.
So I have "walked the walk" that you are asking me to do with helping people. I have found that people will strip you to the bone if you allow them. Jamming the government into these people's self destructive cycles seems like a bad idea.
To be clear, I agree that we need to find systems that work. Problem is the system needs to be more comprehensive (job training, life skills and keeping them away from the wrong people).
I literally don’t know what you’re talkng about when you say I’m asking you to walk some sort of walk. I’m not. I don’tcare, for the purposes of this conversation, about helping people put of anything.
I am saying, if we want to construct a universal health care system that actually works, we have to start with evidence based studies of what actually works. Not, “I knew a heroin addict once and she just kept relapsing until she died.”
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
@gentmach, I think your wording might be throwing the debate off.
If you're asking for the actual mechanism of making decisions on who receives treatment, and the level of treatment they receive, then 'panels' are the correct answer. Somewhere, probably at multiple levels - federal, state, center - groups would get together and make standards. People do tend to get histrionic over the idea, but such decision making groups already exist. Transplant boards, premie care teams, oncologists; they're already holding such decision making panels.
If you're asking for how those groups would reach agreement on standards, that's definitely morality. Since you said you're now sold on universal healthcare, I'm guessing what you'd really prefer is for everyone to avoid rehashing the morality argument against universal healthcare.
Do I have it correct?
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I don't understand your question. 99% of the patients in the hospital are on at least low dose blood thinners. I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify. We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday. She had only 3 months to go.
That is so sad. Unless she still had a great quality of life, too many families keep their loved ones alive because they don't want to let go....I knew my brother would have trouble, so we had the conversation with my mother about a DNR when she was very healthy and in her early 90s. When she got really sick last summer, he knew what her wishes were and was comforted by that. I'm happy to say she rallied (3 times), and we had her 97th birthday party a few weeks ago.
Back to universal health care - as some else said, it isn't free, we're still paying for it. And because I'm a higher income worker, I get to pay 'extra' for that free health care. What I've always seen as a huge short-coming of health care in general, whether it's my 'free' provincial health care, or employer offered health care, they will spend thousands on the disease, but little to nothing on prevention. ie $1000s on bypass surgery or prescription drugs, but nothing on cease smoking or heart healthy eating or exercise plans.
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S That's what death panels are for.
I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.
Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost. I routinely care for morbidly obese patients. We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient. As far as I can see under the current system there is no penalty for non compliance.
Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
I don't understand your question. 99% of the patients in the hospital are on at least low dose blood thinners. I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify. We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday. She had only 3 months to go.
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You got it right. What is the work load treating the 900 pound patient versus an "average" adult? Do you require a lifting machine (https://medmartonline.com/advance-e-340-portable?utm_source=google_shopping&gclid=EAIaIQobChMIy_jGlcOW4AIVV_7jBx1aCAsjEAQYASABEgJcp_D_BwE) or do you assist them?
My dad had one knee replaced and the other should have been done. Unfortunately his weight has probably done no favors to that device so it's lifetime has probably been shortened significantly.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
@gentmach, I think your wording might be throwing the debate off.
If you're asking for the actual mechanism of making decisions on who receives treatment, and the level of treatment they receive, then 'panels' are the correct answer. Somewhere, probably at multiple levels - federal, state, center - groups would get together and make standards. People do tend to get histrionic over the idea, but such decision making groups already exist. Transplant boards, premie care teams, oncologists; they're already holding such decision making panels.
If you're asking for how those groups would reach agreement on standards, that's definitely morality. Since you said you're now sold on universal healthcare, I'm guessing what you'd really prefer is for everyone to avoid rehashing the morality argument against universal healthcare.
Do I have it correct?
Yes. I wanted to get beyond the "universal health Care is bad" debate. I wanted to know how the system would actually run.
And it didn't occur to me that those would be called "panels". Thank you.
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S That's what death panels are for.
I'm not sure what your stance on "death panels" are, but I think people need to spend a few days in my ICU (ICU nurse) and see what they think about death panels after a few days there.
I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
Your questions are all about morality.
Looking at solutions that work, rather than who "deserves" health care, should be the focus.
I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Right.
You are injecting a "personal responsibility" morality argument into the question. You want a system that limits care based on the fact you think "self-destructive" people are the thing that would bring the entire system to a halt.
Curious how Canada treats what I would consider to be futile care.
Currently, if a patient is readmitted within 30 days to the hospital for the same diagnoses (could be non compliance/ could be the hospital discharged them too early), the hospital eats the cost. I routinely care for morbidly obese patients. We had one who weighs 900 pounds. He got treated the same, medicaide paid the same as any other patient. As far as I can see under the current system there is no penalty for non compliance.
Do they use extra resources (I.e blood thinning medicine, specialized equipment) in order to be treated?
I don't understand your question. 99% of the patients in the hospital are on at least low dose blood thinners. I'm talking ventilators, pressors, dialysis, blood transfusions, if that's what you mean about specialized equipment. If that's not what you mean, please clarify. We had a family point blank say they wanted all of the the above so that their 99 year old mother could get a telegram from the president on her 100th birthday. She had only 3 months to go.
You got it right. What is the work load treating the 900 pound patient versus an "average" adult? Do you require a lifting machine (https://medmartonline.com/advance-e-340-portable?utm_source=google_shopping&gclid=EAIaIQobChMIy_jGlcOW4AIVV_7jBx1aCAsjEAQYASABEgJcp_D_BwE) or do you assist them?
My dad had one knee replaced and the other should have been done. Unfortunately his weight has probably done no favors to that device so it's lifetime has probably been shortened significantly.
It may be a bit of a diversion, but my understanding was that morbidly obese patients and others who refuse to be responsible for their own care outside of in-patient facilities end up costing the system the least, mostly because they die quickly and early before expensive long-term geriatric care is required. Now whether or not that's relevant to any discussion regarding universal health care is debatable.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
1. There is an argument out there that the obese actually end up consuming less healthcare on average due to shortened life span. People with a BMI >30 live 3 years shorter, people with BMI >40 live 10 years shorter. That difference tends to balance out the lifetime costs. So I don't think it's obese adults we'd need to worry about, it's the growing epidemic of obese children. So what are some major policy changes that should happen:
- End sugar subsidies/ tax sugar - sugar is probably the single biggest driver of obesity. It needs to stop being added to absolutely every single product. Add taxes on sugar until manufacturers find it a better choice to remove it from their products. (ie people will prefer to pay less, rather than buy the sweeter product)
- Provide good SNAP benefits and end food deserts. - A lot of obesity is in poor rural areas. Access to good nutritional food is low. People need a grocer that can supply them the products and benefits that will allow them to afford it.
2. You can't. Sounds like he's on the wrong anti-depressants. With universal healthcare, maybe he'd feel more able to get a second opinion.
3. I don't think heroin addicts choose to go to therapy willy-nilly. Usually they have to be pressured and incentivized by their family to go in the first place. Not because they're bad people, just because that's the power of the addiction. I think rehab done right does not have to be an expensive operation. And the government is going to have to come to terms with this in the current opioid epidemic. We need a top-down clear manual on how to operate and fund these facilities. As far as I know, there are no guidelines that lawmakers can follow. It's still the wildwest out there on what constitutes a reasonable rehab facility.
Overall though the major benefit of universal healthcare is that it creates a driving force for us to collectively improve how our communities function. Remove major waste in the system. Rethink some of our current policies. (Like why are we subsidizing sugar when it's part of what's driving our insane healthcare costs.) It simplifies health care administration, source of funding, medical debt management and losses, buy batch amounts of pharmaceuticals, have a huge risk pool, removes a need for profit, reduces hospital admin complexity, and can possibly lead to some other potential health improvements such as community analyses that are difficult to implement without a central system/database.
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
My opinions:
1. Mantadory service for everyone from age 18-21. Minimum 2 years for military, and 3 years for civilian service. Both routes will have exercise requirements, inside which slacking is highly and deeply discouraged. It won't fully fix the problem, but it will instill discipline, as well as a national identity as fit and sporty people. Or, at the very least it will delay the inevitable slide into massive weight gain by a few years. If people become obese, despite this excellent societal shift towards exercise, they should continue to be provided care. Weight doesn't reduce someone's humanity.
2. There's possibly no solving for this one. Though, making sure children are raised in loving and protective environments will probably save a great portion of the next generation. It would probably also help if we could get over our societal squeamishness about sexuality and identity.
3. Intransigent recidivists should be shunted towards houses in which their basic needs are provided for. Three hots, and a cot in which to safely shoot up. They could be staffed by such 18-21 year olds that score high on empathy, and low on abusing the desperate. Given such succor, some might choose to return to rehab, and have a better chance of success. Research the "Rat Park Studies." Of course, some will still overdose and die, and we as society should grieve our failure of anyone in that much pain. Particularly if their doctors are the ones that hooked them in the first place. Heroin often comes once someone can no longer afford oxy...
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I have come around to the idea of universal health care. But as I was researching it, I couldn't find answers to the questions I have.
I'm not worried about the morality of it so if you would kindly stash those arguments for the time being, it would be appreciated.
It seems to me the success of such a system will depend on everyone who can be healthy, being healthy. So using that framework, consider these scenarios.
Scenario 1: My family has been obese all our lives. No amount of cajoling from our doctors have gotten us to lose weight. Nothing is seriously wrong with us, we just don't do it. So should there be an incremental "fat tax" to convince people to get in shape?
Scenario 2: A friend of mine is on anti-depressants. However, the anti-depressants cause him have emotional problems, which he gets blackout drunk to handle, counteracting his antidepressants. How would we make sure that people are taking their medications properly?
Scenario 3: How many times should we allow a heroin addict to go through rehab? Should it be capped at 5 times?
What will be the benchmarks for considering the system a success? Will it be measured by quantity of people treated or a blend of quality and quantity? And if the need arises, what would be the conditions to "pull the plug" on the system?
1. There is an argument out there that the obese actually end up consuming less healthcare on average due to shortened life span. People with a BMI >30 live 3 years shorter, people with BMI >40 live 10 years shorter. That difference tends to balance out the lifetime costs. So I don't think it's obese adults we'd need to worry about, it's the growing epidemic of obese children. So what are some major policy changes that should happen:
- End sugar subsidies/ tax sugar - sugar is probably the single biggest driver of obesity. It needs to stop being added to absolutely every single product. Add taxes on sugar until manufacturers find it a better choice to remove it from their products. (ie people will prefer to pay less, rather than buy the sweeter product)
- Provide good SNAP benefits and end food deserts. - A lot of obesity is in poor rural areas. Access to good nutritional food is low. People need a grocer that can supply them the products and benefits that will allow them to afford it.
2. You can't. Sounds like he's on the wrong anti-depressants. With universal healthcare, maybe he'd feel more able to get a second opinion.
3. I don't think heroin addicts choose to go to therapy willy-nilly. Usually they have to be pressured and incentivized by their family to go in the first place. Not because they're bad people, just because that's the power of the addiction. I think rehab done right does not have to be an expensive operation. And the government is going to have to come to terms with this in the current opioid epidemic. We need a top-down clear manual on how to operate and fund these facilities. As far as I know, there are no guidelines that lawmakers can follow. It's still the wildwest out there on what constitutes a reasonable rehab facility.
Overall though the major benefit of universal healthcare is that it creates a driving force for us to collectively improve how our communities function. Remove major waste in the system. Rethink some of our current policies. (Like why are we subsidizing sugar when it's part of what's driving our insane healthcare costs.) It simplifies health care administration, source of funding, medical debt management and losses, buy batch amounts of pharmaceuticals, have a huge risk pool, removes a need for profit, reduces hospital admin complexity, and can possibly lead to some other potential health improvements such as community analyses that are difficult to implement without a central system/database.
1. That's interesting.
2. Actually he said "the anti-depressants leave me with fucked up thoughts." It sounds like he gets trapped obsessing over the bad things in his life. So the anti-depressants are working properly, he may need to see a therapist to work out some of his issues.
3. The heroin problem is people are fine as long as they are within the system. However upon release from the system they are often put in the same environment that caused them to pick up the needle in the first place. Thus begins a cycle of relapse and rehab.
The system would have to be expanded to provide skills training and allow new habits to form. But if someone keeps returning to a bad environment then we need to have an option to say stop.
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3. Intransigent recidivists should be shunted towards houses in which their basic needs are provided for. Three hots, and a cot in which to safely shoot up. They could be staffed by such 18-21 year olds that score high on empathy, and low on abusing the desperate. Given such succor, some might choose to return to rehab, and have a better chance of success. Research the "Rat Park Studies." Of course, some will still overdose and die, and we as society should grieve our failure of anyone in that much pain. Particularly if their doctors are the ones that hooked them in the first place. Heroin often comes once someone can no longer afford oxy...
This actually sounds like a solution.
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The Scandinavian model is to treat healthcare as a part of the larger picture. We don't address the obesity issue by denying/increasing the co-pay of healthcare, but by taxing unhealthy choices and making it easier to choose to live healthy. The same goes for tobacco and alcohol (yes, the expensive alcohol in Norway is a feature, not a bug). We spend state money on electric cars partly because bad air quality is very expensive for the healthcare budget.
As for the hypochondriachs and people misusing their medication; everyone has a "house doctor", the one that you book your regular appointments with, and who receives all your papers. If you choose to go to a different doctor, or the ER, they will send you back to the house doctor. The house doctors are quite strict, and will often tell people to take a paracetamol and see if gets better, if not; come back in two weeks. There is no system for sueing doctors. If things go seriously wrong, you might get a compensation from the state. But it is very rarely blamed on individual doctors. Due to this, the system as a whole saves a shitload of money on unnecessary tests, medication, and operations. We have some of the lowest use of antibiotics in the world (and do not have a lot of multi-resistant bacteria).
My kid has Erb's palsy. In the facebook groups about the diagnosis, it looks like most of the US kids with this diagnosis (who have insurance) have several operations before they are 5, and often need to re-operate later in life. Long term physical therapy is rarely covered by the insurance. My kid only had physical therapy and training (swimming lessons paid by the state) until the age of 8. By then we had been able to retrain 90 % of the muscles, but one movement was still missing. So she got an operation for that, before going back to physical therapy. Her arm and shoulder blade moves a bit differently, and they told us there is a possibility to operate to make it look more normal, but they recommended not to do it since it was purely cosmetical and could cause other problems. If everything continues as now, and she keeps up the stretching and training, she won't need any more operations. Better life for her, cheaper for the state.
We have a panel for medicines, where the recommended limit is 275 000 NOK/extra year of life, adjusted for quality. That means that some of the more expensive treatments available in the US for well insured people, are not offered by the state universal health care here. Now and then the panel gets a lot of heat in the media for "denying people life saving treatment", and sometimes the politicians give new orders based on the outrage. But usually, the decisions by the panel make sense.
But: our system is built on an acceptance of a strong state, that tells us what is best for us.
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But: our system is built on an acceptance of a strong state, that tells us what is best for us.
Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.
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"But: our system is built on an acceptance of a strong state, that tells us what is best for us"
Wow - Kris is right. We have two generations now brainwashed on Ronald Reagan stuff:
"The most terrifying words in the English language are: I'm from the government and I'm here to help."
"In this present crisis, government is not the solution to our problem; government is the problem.”
Lots of hypochondriacs out there who go to the doctor for every little ache and pain. They will cost a public healthcare system money. There's got to be a minimum charge per visit say twenty dollars. If you can't afford the twenty dollars, then you are really hard up and I guess you'll get in free.
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"But: our system is built on an acceptance of a strong state, that tells us what is best for us"
Wow - Kris is right. We have two generations now brainwashed on Ronald Reagan stuff:
"The most terrifying words in the English language are: I'm from the government and I'm here to help."
"In this present crisis, government is not the solution to our problem; government is the problem.”
Lots of hypochondriacs out there who go to the doctor for every little ache and pain. They will cost a public healthcare system money. There's got to be a minimum charge per visit say twenty dollars. If you can't afford the twenty dollars, then you are really hard up and I guess you'll get in free.
Or their medical history states that they're likely a hypochondriac, doctor perscribes a placebo and we all move on...
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For all its faults the Australian universal healthcare system works well too, much the same as Canada.
Two points I'd make:
1) We don't have the culture of popping pills and drugs for everything under the sun. Partly because pharmaceutical companies cannot by law advertise to the general public.
This is interesting reading:
https://www.consumerreports.org/prescription-drugs/too-many-meds-americas-love-affair-with-prescription-medication/
An incredibly large proportion of America is on prescription medication, which generally leads to more medication to treat the side effects of the initial pills.
2) People accept their taxes will be a little bit higher than otherwise. In return, we know that we won't die or suffer major life setbacks due to minor health issues for want of being poor.
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Declaring that a healthcare system has failed and should be shut down sounds like something possible only in a society that does not view healthcare as a human right. I am guessing that in places with public HC, obesity, hypochondria and addictions (to cite your examples) tend to be considered more like diseases to be treated than bad personal choices.
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Declaring that a healthcare system has failed and should be shut down sounds like something possible only in a society that does not view healthcare as a human right. I am guessing that in places with public HC, obesity, hypochondria and addictions (to cite your examples) tend to be considered more like diseases to be treated than bad personal choices.
I consider whatever system we put in place an experiment. As such we should have metrics to compare to see if it doing better or worse.
I would have preferred to have each state to its own system so we would have a set of data to compare and contrast. But we will go national and see what happens.
It has nothing to do with it being a human right. If a system is not living up to its promises then it should be abandoned.
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Personally, the health care system in Canada works very well for me and I am very grateful for our system that doesn't cost an arm and a leg to each user, but may cost a bit more in taxes. Overall, we spend way less per capita on health care than the US does, and we have better outcomes (longer lifespan at least, I'd have to research other metrics). Since the taxes are progressive, people who can afford to pay more do so, and people who can't afford to pay still get access.
Fundamentally, I believe that all people should have access to health care, and that access should not rely on how much money that person has.
Our system does have some flaws, but for the most part, people who need health care can receive it without risking their financial future, going bankrupt or having to choose to postpone or discontinue care because they can't afford it. The exceptions here are eye care, dentists, and prescription meds, and personally I would love to see an all-encompassing system, but we aren't there yet.
Honestly, I am willing to accept that there are a few people who might abuse the system or not do all they can to live as healthily as possible, as long as the vast majority of people who get sick for reasons beyond their control can still be cared for. The extra cost and effort of trying to deny care to some people isn't worth it, in human or monetary cost. I don't think it's useful to judge whether a person is truly "deserving" of care, because
1. Fat is not necessarily automatically unhealthy, and BMI is a poor indicator of overall health
2. Even if fat does cause a health problem, doesn't make someone unworthy of health care
3. Fat people already get discriminated against and judged by the health care system, so any attempt to deny them care on that basis is wrong.
4. Until all people have equal access to education, money, healthy food, and the ability and time to live the most healthy life possible, we cannot fault people for ending up with less than optimal health.
5. Nobody judges skinny or rich people for eating the "wrong" foods or drinking and smoking too much, so lets just not judge people when it has almost no impact on our own lives.
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Declaring that a healthcare system has failed and should be shut down sounds like something possible only in a society that does not view healthcare as a human right. I am guessing that in places with public HC, obesity, hypochondria and addictions (to cite your examples) tend to be considered more like diseases to be treated than bad personal choices.
I consider whatever system we put in place an experiment. As such we should have metrics to compare to see if it doing better or worse.
I would have preferred to have each state to its own system so we would have a set of data to compare and contrast. But we will go national and see what happens.
It has nothing to do with it being a human right. If a system is not living up to its promises then it should be abandoned.
Well, I made assumptions. I meant the human right thing in the context of the US, where leaving a large part of the population without access to healthcare seems to be a realistic alternative to a system "not living up to its promises".
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But: our system is built on an acceptance of a strong state, that tells us what is best for us.
Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.
The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.
I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.
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But: our system is built on an acceptance of a strong state, that tells us what is best for us.
Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.
The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.
I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.
I agree. There's a fundamentally barbaric mindset in this country that is prevalent enough to make me sick to my stomach pretty often.
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Here is an interesting article on health care costs in Canada. Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal. The Feds basically coordinate and subsidize.
https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
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In my region of Italy, they recently brought in a system in the ER where if you go there for something which is not an emergency you have to pay a (small) fee. I think that's fair.
Plenty of people here eat junk, use drugs, don't comply with doctor's orders etc and they are treated just the same by hospitals and doctors. I don't think there is any other moral way of doing it and universal healthcare doesn't effect this morality.
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Here is an interesting article on health care costs in Canada. Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal. The Feds basically coordinate and subsidize.
https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
That's actually super interesting. Clicking through, it looks like the US actually has a higher share of public spending (82%) than canada (70%). I didn't expect that.
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Here is an interesting article on health care costs in Canada. Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal. The Feds basically coordinate and subsidize.
https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
That's actually super interesting. Clicking through, it looks like the US actually has a higher share of public spending (82%) than canada (70%). I didn't expect that.
From what I understand (could easily be off), the cost savings by provinces buying in bulk for hospitals, and the savings in paperwork because OHIP (or other provincial equivalents) paperwork is much less time-consuming than dealing with insurance companies at both the hospital and doctor's clinic (and therefore less staff time used) both add up to a lot of savings. I would guess good vaccination programs help too, although not everyone uses them - I know seniors who have not had their flu shots this year, for example, and they are free.
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Here is an interesting article on health care costs in Canada. Remember that health care is a provincial responsibility (@gentmach wondered about state versus federal administration, here is is state=province management), not federal. The Feds basically coordinate and subsidize.
https://www.cihi.ca/en/health-spending/2018/national-health-expenditure-trends
That's actually super interesting. Clicking through, it looks like the US actually has a higher share of public spending (82%) than canada (70%). I didn't expect that.
From what I understand (could easily be off), the cost savings by provinces buying in bulk for hospitals, and the savings in paperwork because OHIP (or other provincial equivalents) paperwork is much less time-consuming than dealing with insurance companies at both the hospital and doctor's clinic (and therefore less staff time used) both add up to a lot of savings. I would guess good vaccination programs help too, although not everyone uses them - I know seniors who have not had their flu shots this year, for example, and they are free.
That makes a lot of sense. It would be funny if it weren't so sad that many Americans have been convinced that socialized medicine will bankrupt their country, and at the same time they spend more money, both public and private, for worse outcomes. The savings of "medicare for all" or whatever form takes would far outweigh the cost of any hypochondriacs, obese people or drug addicts who might abuse the system.
Not to mention, those people are still using the private medical system, which still increases premiums for everyone, so either way, those costs are baked into the system.
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But: our system is built on an acceptance of a strong state, that tells us what is best for us.
Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.
The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.
I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.
I think you make us sound too nice. A major motivation for a lot of politicians and economists in Norway is that healthy people pay more taxes than sick people. We have detailed calculations showing how much the state will get in increased revenues for each additional person we can get to finish school, stay healthy, and be employed. These calculations include reduction in teenage pregnancies, less crime, etc.
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The problem is both parties need to be on board and that is not going to happen. Republicans would sabotage any universal system at the first opportunity. They would purposefully under fund it and then say look it doesn't work.
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I think you make us sound too nice. A major motivation for a lot of politicians and economists in Norway is that healthy people pay more taxes than sick people. We have detailed calculations showing how much the state will get in increased revenues for each additional person we can get to finish school, stay healthy, and be employed. These calculations include reduction in teenage pregnancies, less crime, etc.
I don't know if anyone has done the calculations for Canada, but it makes sense - if people are healthy they are more productive. And happy. And the government is carrying out its mandate of peace, order and good government (well, that's the federal mandate, not sure what the provincial mandate is in the BNA Act, except to look after everything not specifically allocated to the federal government, which therefore includes health care).
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But: our system is built on an acceptance of a strong state, that tells us what is best for us.
Right. And unfortunately in the US, we have this really strong thread of moralistic puritanism mixed with a fetishization of "bootstrapper" mentality. Both of which combined lead "us" to reflexively balk at anything like this, because the people who yell loudest tend to be the ones who think their successes are 100% because of their hard work, and everyone else is just lazy and doesn't deserve help.
The other thing countries with universal healthcare have in common is a belief that all people deserve healthcare. It's a recognition that we're fundamentally all the same and we're all worthy of being treated the same. This means that even the downtrodden get healthcare and that "successful" people don't get special treatment. It's an acceptance that when we're sick, we're all the same and we accept the same level of care.
I honestly don't think the US will ever get to that point and will therefore continue to endlessly argue about whether and how to implement a system that'a already been adopted by nearly every other developed country.
I think you make us sound too nice. A major motivation for a lot of politicians and economists in Norway is that healthy people pay more taxes than sick people. We have detailed calculations showing how much the state will get in increased revenues for each additional person we can get to finish school, stay healthy, and be employed. These calculations include reduction in teenage pregnancies, less crime, etc.
It's not just taxes. Healthy people are also contributing to the economy much more effectively than sick people. Everybody wins.
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Yes. I wanted to get beyond the "universal health Care is bad" debate. I wanted to know how the system would actually run.
To be a bit glib, it depends on how the system is set up.
I think the fear is health care becomes "free" and then too many people try to take too much out of the system and it leads to long lines and a lot of taxes. And that's definitely a possibility.
But it doesn't have to be that way. For instance, in Japan the government sets the prices at hospitals, but then people are expected to pay 30% of that out of pocket, which acts as a rationing mechanism. I don't think the US medical establishment would allow the government that much control over pricing, but the concept could still be employed. One possibility I've come up with is for the government to establish a "should cost" value of a procedure (which it already has done for Medicare) and then the government covers a percentage of that price, but the health care providers are able to charge whatever they want, with the patient responsible for the difference. And there's a lot of ways to tinker with it from there... do you set one price for the entire country or do you set up regional prices to account for the cost of living? Is it a flat percentage, or do people pay a larger percentage for common procedures like going to the family physician when you've sprained a wrist and a smaller percentage for more serious (and probably more expensive) issues like cancer?
The big problem with that concept is that this maintains the pay-for-service system which is really one of the roots of the health care expense problem. There's some thought that the entire system has to change so that it is focused on wellness/overall health. Because right now the providers increase profits by performing more procedures and charging as much as they can for them, while the insurance companies increase profits by increasing premiums and minimizing the number and cost of procedures. But what if you merge a hospital with an insurance company, as is already starting to happen? Now the hospital has a an incentive to perform fewer procedures and be more honest about the pricing since they are essentially charging themselves.
But if we go to a system focused on wellness that's funded mostly by annual premiums rather than fee-for-service, does the money to pay the premium come entirely from the government, or does the government just provide a portion of the premium and the customer/patient is still expected to pay at least some for various reasons (i.e. tailoring coverage and instilling competition)?
Are you allowed to pay more to get a procedure done at your convenience, or will you be forced to essentially get in line and the you'll be seen whenever they get around to you?
Will medical tourism be encouraged or even allowed?
How I think the system should be set up is different from how other people think the system should be set up, and it's going to come down to who is able to implement their plan.
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My only request as a tall person: If we're going to have some type of "fat tax" can we please fix the BMI calculation such that it stops insisting we're two-dimensional beings? Seriously, my three-dimensional self would have to be unhealthily thin to be within current BMI guidelines.
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If you're asking for the actual mechanism of making decisions on who receives treatment, and the level of treatment they receive, then 'panels' are the correct answer. Somewhere, probably at multiple levels - federal, state, center - groups would get together and make standards. People do tend to get histrionic over the idea, but such decision making groups already exist. Transplant boards, premie care teams, oncologists; they're already holding such decision making panels.
Another existing decision-making group is the insurance companies. Among other things, they decide whether certain procedures are covered, declare providers as in-network or out-of-network, and determine how many alternative solutions you must try before getting back surgery or expensive medication.
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Many countries with government-managed healthcare systems have criteria used to justify medications and procedures based on value per quality-adjusted life-year (QALY). Essentially it looks at how many extra years of non-dependent life a procedure or drug provides. For example, if a chemotherapy agent provides a overall survival benefit of 12 months, but half the patients in the trial had a poor quality of life (unable to perform any tasks independently), then the QALY would be 0.5. This is obviously a simplification of the calculations.
The main point is that many countries have used this method to say to drug companies "we will approve this drug for this disease if you provide it at this price." That has been effective at managing costs. The US does this in an ad-hoc way (insurance denials mostly). This is the major reason our costs are going nuts:
US health spending went from 5% to 18% of GDP from 1960 to 2010, compared to 4% to 8% for UK and 5% to 10% for Germany. I would say for the vast majority of illnesses, outcomes in the latter two are on par with the US.
Other interesting facts, comparing US and UK systems:
the UK spends a larger fraction of total budget on mental health (14 vs 9%)
US spends more on heart disease, hypertension, diabetes (22 vs 14%)
US spends twice as much on orthopedic issues (9 vs 4.5%)
Cancer spending is the same (5.5 vs 5.5%) - I was surprised by this.
Everything else was fairly similar (1-2% difference).
Interestingly, none of these countries' systems particularly reward people for healthy behavior, and this shows in the majority determinants of health: weight, smoking, diabetes and cancer.
- Obesity rates are higher in the US (34%) than UK (28%) and Germany (24%), but not dramatically.
- The US has lower smoking rates (14%) than UK (20%) and Germany (24%)
- Diabetes rates are similar: 10%, 6% and 8%
- Cancer rates are much higher in UK (608 per 100k annually) than US (440) and Germany (313)
So overall the US population isn't that much more unhealthy than in Europe, we just suck at controlling costs. The solutions are cultural changes that are hard to implement, so no good solutions on my end (other than the cost effectiveness evaluation).
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If we wanted to move to socialized medicine, we could just use the VA as a model and slowly offer service to Medicare patients, and then as the system builds lower the age for Medicare overtime. Everyone that isn't in range of a Medicare hospital could continue to use the insurance, and the system could have the proper time to on board doctors and such.
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If we are on the fat shaming bandwagon how would a fat tax work?
1) Person 1 is obese but regularly exercises. Cholesterol, diabetes, blood pressure numbers are good.
2) Person 2 has a normal BMI but never exercises, eats like crap, and has numbers that are all in the danger zone.
So, the fat person gets taxed in this case? I am overweight but have had 2 different doctors tell me they wish they had my low numbers in terms of cholesterol, sugar, blood pressure, kidney function, etc. Not all overweight people are unhealthy, and not all thin people are healthy.
I worry much less about hypochondriacs and repeat admissions to rehab sucking a universal health care system dry than I would the massive grift and price gouging that happens in the current system in the United States. Many medical supplies, pharmaceutical companies, device makers, etc. literally charge as much as they can get away with and reap massive profits. Since there often is really is no choice in buying most of these products, it is price gouging people at their most vulnerable. Case in point - my son takes a drug that costs $11,000 per month. The bulk of the research for this drug was funded by the US taxpayer. The CEO of the company that makes this drug got $18 Million in compensation for just the year 2017. Strict price caps would have to be in place for any universal system to work. Just like we have a public utilities commission that makes sure the utility companies don't rob you blind for electricity, a government panel should do the same to make sure you don't get robbed blind for chemo or surgery or other health care needs.
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Cindy - it's amazing to me how much less the same exact pharmaceuticals cost here in Italy than in the US. I had to take a drug during pregnancy that cost less than 10 euros a month full sticker price here (and only a couple of Euros after the national health care system paid its share of the cost) but in the US it costs hundreds. I've been told that drugs are so expensive in the US as individuals and individual health insurance companies have a lot less bargaining power than, say, the national healthcare system of Italy or Canada.
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I support treating everyone equally and would not support a fat tax. I would support better education of the population regarding what healthy food actually is. I would also support getting the cattle/dairy and chicken industry out of making government policy decisions so that they aren't being subsidized by tax payers. Subsidies on things like corn and soybeans have probably done more to ruin the health of America than anything else.
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Read this interesting op-ed:
https://www.washingtonpost.com/opinions/2019/01/30/media-is-badly-botching-medicare-all-debate
" You have to compare what a universal system would cost to what we’re paying now.
It isn’t easy to be perfectly precise about this, because there are multiple forms a universal system might take. But there have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.
That’s a lot of money. But you can’t understand what it means until you realize that last year we spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade." [bolds mine]
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Read this interesting op-ed:
https://www.washingtonpost.com/opinions/2019/01/30/media-is-badly-botching-medicare-all-debate
" You have to compare what a universal system would cost to what we’re paying now.
It isn’t easy to be perfectly precise about this, because there are multiple forms a universal system might take. But there have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.
That’s a lot of money. But you can’t understand what it means until you realize that last year we spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade." [bolds mine]
This is the part so many seem to miss. It's the worst, most expensive option, except for all the others.
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Read this interesting op-ed:
https://www.washingtonpost.com/opinions/2019/01/30/media-is-badly-botching-medicare-all-debate
" You have to compare what a universal system would cost to what we’re paying now.
It isn’t easy to be perfectly precise about this, because there are multiple forms a universal system might take. But there have been some recent attempts to estimate what it would cost to implement, for instance, the single-payer system that Sen. Bernie Sanders (I-Vt.) advocates; one widely cited study, from a source not favorably inclined toward government solutions to complex problems, came up with a figure of $32.6 trillion over 10 years.
That’s a lot of money. But you can’t understand what it means until you realize that last year we spent about $3.5 trillion on health care, and under current projections, if we keep the system as it is now, we’ll spend $50 trillion over the next decade." [bolds mine]
This is the part so many seem to miss. It's the worst, most expensive option, except for all the others.
Exactly. People get all up in arms about how "They'll have to raise taxes!!!1! OMG F-NO!!!" Well, last year my health insurance premiums cost $14,000 (that's how much it costs to insure my family of 6 with zero actual spending) and I spent $10,000 in out-of-pocket costs (because we have a special needs child who requires expensive care). That's more than a quarter of my annual income right there. The federal government could literally triple my effective tax rate and I'd still pay half as much for health care as I do right now. Oh, and don't even get me started on the numbers of hours my wife and I spend sorting, paying, and fighting for corrections to our medical bills. If the government actually tallied lost productivity due to our byzantine healthcare system, publicly-funded healthcare would look like a steal.
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Exactly. People get all up in arms about how "They'll have to raise taxes!!!1! OMG F-NO!!!" Well, last year my health insurance premiums cost $14,000 (that's how much it costs to insure my family of 6 with zero actual spending) and I spent $10,000 in out-of-pocket costs (because we have a special needs child who requires expensive care). That's more than a quarter of my annual income right there. The federal government could literally triple my effective tax rate and I'd still pay half as much for health care as I do right now. Oh, and don't even get me started on the numbers of hours my wife and I spend sorting, paying, and fighting for corrections to our medical bills. If the government actually tallied lost productivity due to our byzantine healthcare system, publicly-funded healthcare would look like a steal.
We still have to do the paperwork for some of the costs incurred out of system* that are covered by private insurance, but it is nothing like this.
*My pharmacy has my insurance information and I only do co-pay on prescriptions, I don't have to submit the bill to my insurance, they do. I have to handle my physiotherapy bills.
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Exactly. People get all up in arms about how "They'll have to raise taxes!!!1! OMG F-NO!!!" Well, last year my health insurance premiums cost $14,000 (that's how much it costs to insure my family of 6 with zero actual spending) and I spent $10,000 in out-of-pocket costs (because we have a special needs child who requires expensive care). That's more than a quarter of my annual income right there. The federal government could literally triple my effective tax rate and I'd still pay half as much for health care as I do right now. Oh, and don't even get me started on the numbers of hours my wife and I spend sorting, paying, and fighting for corrections to our medical bills. If the government actually tallied lost productivity due to our byzantine healthcare system, publicly-funded healthcare would look like a steal.
We still have to do the paperwork for some of the costs incurred out of system* that are covered by private insurance, but it is nothing like this.
*My pharmacy has my insurance information and I only do co-pay on prescriptions, I don't have to submit the bill to my insurance, they do. I have to handle my physiotherapy bills.
I don't have any paperwork for the medical part. Some of the welfare system runs on forms, but not the medical one. We have an annual maximal co-pay of about $200, and when we hit the limit, they automatically stop charging us at the doctors', physical therapists' and pharmacies. Even the transport refunds have been automated now. If I have to take the kids to a hospital in a different city, the state will cover the travel costs. It used to be a form to fill out, and you had to send in the receipts. Now we can choose to let them calculate everything automatically, and you only click one box that says "please send the money to my bank account #XXXX". There is no co-pay for the kids, so doctors visits are very easy with them.
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Exactly. People get all up in arms about how "They'll have to raise taxes!!!1! OMG F-NO!!!" Well, last year my health insurance premiums cost $14,000 (that's how much it costs to insure my family of 6 with zero actual spending) and I spent $10,000 in out-of-pocket costs (because we have a special needs child who requires expensive care). That's more than a quarter of my annual income right there. The federal government could literally triple my effective tax rate and I'd still pay half as much for health care as I do right now. Oh, and don't even get me started on the numbers of hours my wife and I spend sorting, paying, and fighting for corrections to our medical bills. If the government actually tallied lost productivity due to our byzantine healthcare system, publicly-funded healthcare would look like a steal.
We still have to do the paperwork for some of the costs incurred out of system* that are covered by private insurance, but it is nothing like this.
*My pharmacy has my insurance information and I only do co-pay on prescriptions, I don't have to submit the bill to my insurance, they do. I have to handle my physiotherapy bills.
I don't have any paperwork for the medical part. Some of the welfare system runs on forms, but not the medical one. We have an annual maximal co-pay of about $200, and when we hit the limit, they automatically stop charging us at the doctors', physical therapists' and pharmacies. Even the transport refunds have been automated now. If I have to take the kids to a hospital in a different city, the state will cover the travel costs. It used to be a form to fill out, and you had to send in the receipts. Now we can choose to let them calculate everything automatically, and you only click one box that says "please send the money to my bank account #XXXX". There is no co-pay for the kids, so doctors visits are very easy with them.
I am seething with jealousy right now. I know you pay higher taxes than we do, but dammit, that's what taxes are for.
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Exactly. People get all up in arms about how "They'll have to raise taxes!!!1! OMG F-NO!!!" Well, last year my health insurance premiums cost $14,000 (that's how much it costs to insure my family of 6 with zero actual spending) and I spent $10,000 in out-of-pocket costs (because we have a special needs child who requires expensive care). That's more than a quarter of my annual income right there. The federal government could literally triple my effective tax rate and I'd still pay half as much for health care as I do right now. Oh, and don't even get me started on the numbers of hours my wife and I spend sorting, paying, and fighting for corrections to our medical bills. If the government actually tallied lost productivity due to our byzantine healthcare system, publicly-funded healthcare would look like a steal.
We still have to do the paperwork for some of the costs incurred out of system* that are covered by private insurance, but it is nothing like this.
*My pharmacy has my insurance information and I only do co-pay on prescriptions, I don't have to submit the bill to my insurance, they do. I have to handle my physiotherapy bills.
I don't have any paperwork for the medical part. Some of the welfare system runs on forms, but not the medical one. We have an annual maximal co-pay of about $200, and when we hit the limit, they automatically stop charging us at the doctors', physical therapists' and pharmacies. Even the transport refunds have been automated now. If I have to take the kids to a hospital in a different city, the state will cover the travel costs. It used to be a form to fill out, and you had to send in the receipts. Now we can choose to let them calculate everything automatically, and you only click one box that says "please send the money to my bank account #XXXX". There is no co-pay for the kids, so doctors visits are very easy with them.
I am seething with jealousy right now. I know you pay higher taxes than we do, but dammit, that's what taxes are for.
Do we? If you include the cost of the stuff that is covered by the taxes? Our total taxes ([all tax paid]/[all income]) have the last years been between 20 and 25 %. That is not the theoretical tax bracket, but the amount of our money we paid to the government. It includes state tax, municipal tax, property tax, social security (state pension + medical + "disability insurance"), etc. The only thing that comes in addition is taxes on stuff we buy, like 12 % on food, 25 % on stuff, 100% on petrol and alcohol, etc. Those are difficult to calculate, But based on last years consumption, a rough calculation is that we paid an additional 6 % in taxes that way. People who spend more than us will of course pay more purchase tax.
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The US has a "universal healthcare" system. It's called Medicare. How often do you year someone say "I just got to get to 65 so that I can be Medicare eligible."
I'm sure the system could use some improvements, but the above statement is a pretty good indicator that it works as well if not better than commercial insurance.
Just open Medicare up for everyone and we're done.
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The US has a "universal healthcare" system. It's called Medicare. How often do you year someone say "I just got to get to 65 so that I can be Medicare eligible."
I'm sure the system could use some improvements, but the above statement is a pretty good indicator that it works as well if not better than commercial insurance.
Just open Medicare up for everyone and we're done.
We could even just start phasing it in. Open up Medicare for people 60 and older, and up to age 18. Then to age 55 and up, and up to age 26. Etc.
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The US has a "universal healthcare" system. It's called Medicare. How often do you year someone say "I just got to get to 65 so that I can be Medicare eligible."
I'm sure the system could use some improvements, but the above statement is a pretty good indicator that it works as well if not better than commercial insurance.
Just open Medicare up for everyone and we're done.
We could even just start phasing it in. Open up Medicare for people 60 and older, and up to age 18. Then to age 55 and up, and up to age 26. Etc.
I think the math would support opening it up to everyone all at once. Working people are the lowest utilizers in any plan. The more employed young(ish) people you have in the risk pool the easier it is to fund the sicker members.
The answer is so completely obvious, but the there are too many lobbyists working against it.
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I think the math would support opening it up to everyone all at once. Working people are the lowest utilizers in any plan. The more employed young(ish) people you have in the risk pool the easier it is to fund the sicker members.
The answer is so completely obvious, but the there are too many lobbyists working against it.
This is partly why it works, everyone is covered, healthy and sick, so the costs in any one year are spread out. There are years when I have used it a lot, and years when I haven't used it at all, and most of us could say that.
US insurance companies would be huge losers if there were Medicare for everyone. We still have insurance companies that have health policies, but they cover the things that OHIP (in my case) doesn't cover.
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What tools are at the disposal of the insurance companies to maintain the status quo? I can think of a couple.
1) Have their bought politicians promise a big change down the road. Give the story that the big change will be introduced incrementally so that the economy doesn't get "shocked." Then throw the public some sort of very small bone to demonstrate progress. Continually kick the can down the road for the rest of the promised changes. They've started that already.
2) Lie to the public. Show pictures of dying Canadians and give the illusion that they wouldn't be dying with US health care. They wouldn't even have to be real Canadians. Just hire some emaciated third world actors to play the part. Investigative journalists would not be able to do further interviews with the dying people because, well, they died.
3) Obfuscate the facts. It is a complex issue and good looking people could be hired to sit around tables on news talk shows to give little pieces of the US health care story to make people feel good. One such BS thing they could bring up over and over would be to say that US pill prices are higher due to the research it is paying for. Not all BS, just mostly.
4) Link patriotism to the US health care system. We have a little more pain with our system and perhaps a little more sorrow, but it's our health care system. It's an American system. It's a system that was passed down along with the rest of our freedoms from our founding fathers. Then show pictures of gulags or something and note that we don't want the systems that they have in other countries. When Joseph Stalin ran Russia, a universal health care system was introduced. Than state Millions of people died after that. The fact that they died due to oppression, World War 2 and other horrible things need not be noted. Pictures of injured soldiers could be shown, followed by stern faced doctors proclaiming, "We want to help."
5) Use fear - If the health care system of this country is changed, are you sure it will be best for "your" children?
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The US has a "universal healthcare" system. It's called Medicare. How often do you year someone say "I just got to get to 65 so that I can be Medicare eligible."
I'm sure the system could use some improvements, but the above statement is a pretty good indicator that it works as well if not better than commercial insurance.
Just open Medicare up for everyone and we're done.
We could even just start phasing it in. Open up Medicare for people 60 and older, and up to age 18. Then to age 55 and up, and up to age 26. Etc.
I think the math would support opening it up to everyone all at once. Working people are the lowest utilizers in any plan. The more employed young(ish) people you have in the risk pool the easier it is to fund the sicker members.
I am aware, but I thought that politically it might be easier to phase it in. People get terrified by the thought of a huge change, but lowering the age for Medicare doesn't seem so radical.
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I do think we need to discourage people from crappy medical decisions so I would support a tax on unhealthy foods (e.g. junk food and fast food) as well as higher taxes on smoking and gambling and alcohol. Anything that encourages healthy lifestyles while punishing those who fail to improve their lifestyle choices. (I occasionally eat unhealthy food and I'd be happy for that consumption to be taxed, if it meant my overall income tax didn't go up to pay for people with no sense of their own health).
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If we are on the fat shaming bandwagon how would a fat tax work?
Actually my father inspired that. He developed a "two Whopper a day" habit while he worked as a farmer. And his diet hasn't improved much since he quit 20 years ago.
He had one knee replaced about 10 years ago. He was placed on social security disability while waiting to get the other knee replaced.
He will never get that other knee replaced though. He has good insurance through my mother. And my mother buys the groceries. Disability pays him and he can work small jobs though he has some paranoia regarding that.
This arrangement worked out decently because my grandmother started needing help at the same time. (She is a 103 now.)
So I see a man who won't get healthy for his family or to be an effective worker. The only leverage left on him is his wallet. The only way I figure someone can get through to him is if his accountant says "you're losing money because you are fat."
And, as things stand right now, it will fall on me to pay for his nursing home care when the time comes. (Alzheimer's runs in the family.)
Yes, I understand my situation is unique. Large bureaucracies are not know for handling uniqueness well. And it did color my previous opinions of healthcare.
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The easiest way we can reduce healthcare expenses is to get rid of commercial insurance. The insurers have layers of network teams to negotiate prices with providers which is passed on to you in your premium. And the providers (hospitals and physician groups) have teams of people that negotiate with the insurance companies and layers upon layers of people that work through all the precertification processes and billing with the insurance companies. And those costs are passed on to the patient through the providers rates. So we as members and patients are getting wacked on both sides by this ridiculous system.
And that's just one piece of it. There is layers and layers of administrative costs which could be done away with. Plus all the expense that's passed on to us for all the people who have NO insurance and their expense gets written off at ridiculous rates by the providers.
Oh, and lets not forget all the "non-profit" hospital systems that make $5B in revenue. THAT THEY DON'T PAY TAX ON. Start taxing them on a small portion of their net income and put that toward the Medicare system. Stop allowing them to build all kinds of capital investments as a way to not pay tax.
I could go on and on.
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Was chatting to my husband this morning about just this issue. You know who's going to suffer if single payer happens?
The dean of his medical center makes a $7 million salary plus perks you couldn't even know how to dream about, and has an entire building of well paid staff whose job it is to extract the most money from insurers and the government, including a dean whose sole function is to exhort university faculty to write more grants.
It reminds me of the following:
http://www.geoffwilkins.net/fragments/Adams.htm
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Was chatting to my husband this morning about just this issue. You know who's going to suffer if single payer happens?
The dean of his medical center makes a $7 million salary plus perks you couldn't even know how to dream about, and has an entire building of well paid staff whose job it is to extract the most money from insurers and the government, including a dean whose sole function is to exhort university faculty to write more grants.
It reminds me of the following:
http://www.geoffwilkins.net/fragments/Adams.htm
It is clear that the US cannot afford universal health care - your whole economy would collapse with all the jobs lost. ;-)
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You know how people on Facebook are constantly having GoFundMe campaigns due to medical bills and then their friends and relatives and other people they may not know donate to it? Universal Healthcare is basically that system except it's for the entire country and everybody has to give. By having a massive amount of people giving small amounts, the people who get sick can receive treatment. And that's pretty much it. It's not a perfect system but it's way better than losing your house because you get cancer.
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It is clear that the US cannot afford universal health care - your whole economy would collapse with all the jobs lost. ;-)
Not sure if you you were joking or not. What repercussions were felt to those other countries that have done it?
OR
Maybe you are a billionaire. Even if you are a Canadian, I'll bet your taxes would go up if the US instituted Universal Health Care. Being a billionaire, health care costs are a tiny increment of what you spend. Heck, its less than the maintenance cost on one of your yachts. It may be time to get together with your billionaire friends, go to the media outlets that you own and to start promulgating your message of how the US economy would collapse. Fear will work to sway people's minds.
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It is clear that the US cannot afford universal health care - your whole economy would collapse with all the jobs lost. ;-)
Not sure if you you were joking or not. What repercussions were felt to those other countries that have done it?
It was a joke. With universal healthcare all the "paper pushers" would be freed up to do meaningful work.
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If we are on the fat shaming bandwagon how would a fat tax work?
Actually my father inspired that. He developed a "two Whopper a day" habit while he worked as a farmer. And his diet hasn't improved much since he quit 20 years ago.
He had one knee replaced about 10 years ago. He was placed on social security disability while waiting to get the other knee replaced.
He will never get that other knee replaced though. He has good insurance through my mother. And my mother buys the groceries. Disability pays him and he can work small jobs though he has some paranoia regarding that.
This arrangement worked out decently because my grandmother started needing help at the same time. (She is a 103 now.)
So I see a man who won't get healthy for his family or to be an effective worker. The only leverage left on him is his wallet. The only way I figure someone can get through to him is if his accountant says "you're losing money because you are fat."
And, as things stand right now, it will fall on me to pay for his nursing home care when the time comes. (Alzheimer's runs in the family.)
Yes, I understand my situation is unique. Large bureaucracies are not know for handling uniqueness well. And it did color my previous opinions of healthcare.
So, tax the whoppers but that is not the same as taxing someone extra because they are overweight with no regard to how physically fit they are and what they eat. There are some slim people who eat total crap and have the high cholesterol, high blood pressure and heart disease to go along with it. Even if we as a country just stopped subsidizing corn for high fructose corn syrup and instead use that money to make veggies cheaper, that would go a long way.
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It is clear that the US cannot afford universal health care - your whole economy would collapse with all the jobs lost. ;-)
Not sure if you you were joking or not. What repercussions were felt to those other countries that have done it?
It was a joke. With universal healthcare all the "paper pushers" would be freed up to do meaningful work.
Actually this was an actual concern of Obama's when he was president and why he shied away from single payer in the Obamacare implementation. There are literally thousands upon thousands working in the insurance industry. It acts as a de facto wealth redistribution chain. Causing that many people to be unemployed overnight could have some pretty severe consequences.
Maybe providing those employees an expedited path to working on the gov. implementation would help ease that. But there would still be a lot of redundancies.
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Universal health care is an income redistribution scheme. It takes money away from people who make healthy lifestyle choices, and who live within their means and don't have a horde of children they can't afford, and gives that money over to people who often make unhealthy choices for themselves and the many children they pump out. It punishes the former and rewards the latter.
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Universal health care is an income redistribution scheme. It takes money away from people who make healthy lifestyle choices, and who live within their means and don't have a horde of children they can't afford, and gives that money over to people who often make unhealthy choices for themselves and the many children they pump out. It punishes the former and rewards the latter.
So many things to say here - but basically the most relevant is that per capita health costs are much lower in countries that have universal health care. We pay more taxes but we get more benefits from them. American health insurance premiums are incredibly high.
I know lots of people who live healthy lives and have still needed health care. Athletes often need health care, since they injure themselves a lot more than the general population. People get into car accidents. Those children you seem so concerned about - why? Giving birth is not expensive with universal systems. Pre-natal care, birth, post-natal care, all covered - when my DD was a few days old a public health nurse came to the house to see that we were doing OK, and do a urine test for PKU. All her vaccinations were covered, so she never got seriously ill as a child.
Do you also worry about the other costs of people making poor choices? About supporting public education so everyone gets a good start in life? About people working in poor health environments because they need the jobs? A lot of the manual labourers in my area (roofers, general constitutions) look 10-20 years older than they are because their jobs are physically hard on their bodies. Should they be denied health care?
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Universal health care is an income redistribution scheme. It takes money away from people who make healthy lifestyle choices, and who live within their means and don't have a horde of children they can't afford, and gives that money over to people who often make unhealthy choices for themselves and the many children they pump out. It punishes the former and rewards the latter.
No. It's not. Either make a real contribution to this thread or stop trolling.
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Universal health care is an income redistribution scheme. It takes money away from people who make healthy lifestyle choices, and who live within their means and don't have a horde of children they can't afford, and gives that money over to people who often make unhealthy choices for themselves and the many children they pump out. It punishes the former and rewards the latter.
No. It's not. Either make a real contribution to this thread or stop trolling.
Good repl;y, you were much calmer than I was. ;-)
But Canadians feel strongly about Universal Health Care, you will pry it from our cold dead clenched fists.
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What I've always seen as a huge short-coming of health care in general, whether it's my 'free' provincial health care, or employer offered health care, they will spend thousands on the disease, but little to nothing on prevention. ie $1000s on bypass surgery or prescription drugs, but nothing on cease smoking or heart healthy eating or exercise plans.
Maybe because prevention methods we have today (e.g. healthy eating courses, exercise plans) are not really effective?
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What I've always seen as a huge short-coming of health care in general, whether it's my 'free' provincial health care, or employer offered health care, they will spend thousands on the disease, but little to nothing on prevention. ie $1000s on bypass surgery or prescription drugs, but nothing on cease smoking or heart healthy eating or exercise plans.
Maybe because prevention methods we have today (e.g. healthy eating courses, exercise plans) are not really effective?
Our idea of healthy eating keeps changing. And sometimes I wonder. I look at my local sample of 5 friends (women my age, including me) and I am the only one who still has her gall bladder. And I have the highest fat consumption of us 5, which is against a lot of modern concepts of healthy eating.
We already have "sin" taxes on alcohol and tobacco, which makes the most obviously unhealthy habits harder to overdo.
I also look at our life styles, and physical activity (as opposed to formal exercise) has been planned out. When I was in elementary school we went home for lunch (because that was the 50's, and mothers were home, not pushing that part) and I walked 3.6 km every day, since the school was 0.9 km from my house. We had morning and afternoon recess, and gym at lest 3 days/week. Now most kids get bused for distances I think are ridiculous, because the streets are not designed for pedestrians and it is not safe. Adults walk less as well, because the walks are not as pleasant and there is TV. Everyone circles parking lots looking for a spot close to the entrance. We pay people to do our gardening and other activities that we used to do ourselves.
I know, I sound like Mr. MM (an older crankier Mr. MM), because yes, we have put too much time into our jobs and commutes and not enough time into our physical lives.
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If we are on the fat shaming bandwagon how would a fat tax work?
Actually my father inspired that. He developed a "two Whopper a day" habit while he worked as a farmer. And his diet hasn't improved much since he quit 20 years ago.
He had one knee replaced about 10 years ago. He was placed on social security disability while waiting to get the other knee replaced.
He will never get that other knee replaced though. He has good insurance through my mother. And my mother buys the groceries. Disability pays him and he can work small jobs though he has some paranoia regarding that.
This arrangement worked out decently because my grandmother started needing help at the same time. (She is a 103 now.)
So I see a man who won't get healthy for his family or to be an effective worker. The only leverage left on him is his wallet. The only way I figure someone can get through to him is if his accountant says "you're losing money because you are fat."
And, as things stand right now, it will fall on me to pay for his nursing home care when the time comes. (Alzheimer's runs in the family.)
Yes, I understand my situation is unique. Large bureaucracies are not know for handling uniqueness well. And it did color my previous opinions of healthcare.
So, tax the whoppers but that is not the same as taxing someone extra because they are overweight with no regard to how physically fit they are and what they eat. There are some slim people who eat total crap and have the high cholesterol, high blood pressure and heart disease to go along with it. Even if we as a country just stopped subsidizing corn for high fructose corn syrup and instead use that money to make veggies cheaper, that would go a long way.
I concede that taxing the food is a better idea.
My point had been that if are goal is to help the sickest among us, then everyone else needs to be striving towards healthy. But if some people are stubborn or insulated from punishment, society would have to consider a more direct intervention.
Fat or thin wouldn't have mattered. If you persist in an unhealthy lifestyle and have nothing seriously wrong with you, you would have a fine imposed upon you.
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What I've always seen as a huge short-coming of health care in general, whether it's my 'free' provincial health care, or employer offered health care, they will spend thousands on the disease, but little to nothing on prevention. ie $1000s on bypass surgery or prescription drugs, but nothing on cease smoking or heart healthy eating or exercise plans.
Maybe because prevention methods we have today (e.g. healthy eating courses, exercise plans) are not really effective?
Our idea of healthy eating keeps changing. And sometimes I wonder. I look at my local sample of 5 friends (women my age, including me) and I am the only one who still has her gall bladder. And I have the highest fat consumption of us 5, which is against a lot of modern concepts of healthy eating.
We already have "sin" taxes on alcohol and tobacco, which makes the most obviously unhealthy habits harder to overdo.
I also look at our life styles, and physical activity (as opposed to formal exercise) has been planned out. When I was in elementary school we went home for lunch (because that was the 50's, and mothers were home, not pushing that part) and I walked 3.6 km every day, since the school was 0.9 km from my house. We had morning and afternoon recess, and gym at lest 3 days/week. Now most kids get bused for distances I think are ridiculous, because the streets are not designed for pedestrians and it is not safe. Adults walk less as well, because the walks are not as pleasant and there is TV. Everyone circles parking lots looking for a spot close to the entrance. We pay people to do our gardening and other activities that we used to do ourselves.
I know, I sound like Mr. MM (an older crankier Mr. MM), because yes, we have put too much time into our jobs and commutes and not enough time into our physical lives.
This is why I would have liked to try "New Urbanism" because if we are physically and mentally unhealthy due to our isolation, then we are treating the symptoms of the disease, not the cause.
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Also visceral fat is actually a terrible measure of health. There is some connection between obesity and poor health outcomes, but actually ectopic fat is the actual predictor of bad health. Ectopic fat can be in both thin and fat patients. So a fat tax would be nothing more than a pointless punitive tax that wouldn't actually solve anything.
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People can be thin and not healthy. A fat tax is a nasty idea. Will we tax people who drink and smoke and take all sorts of drugs? Or don't floss and see a dentist regularly? Seriously, you should hear the stories my dental technician tells - and bad oral health can lead to all sorts of health problems.
Right now I would not want to go for a walk, Ottawa has had some snow and the streets are slippery and the sidewalks are a mess. Time for the plows! If municipalities put priority on designing for an active lifestyle (i.e. safe places to walk that actually go somewhere, so you are not just out for a stroll) and the same for bike paths, and realize that people will use them in winter if they are properly maintained, and basically quit giving cars massive consideration in design, then urban/suburban areas will invite more activity. Unfortunately we are so out of the habit of walking/biking that it will take a lot to reverse peoples' habits.
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It is clear that the US cannot afford universal health care - your whole economy would collapse with all the jobs lost. ;-)
Not sure if you you were joking or not. What repercussions were felt to those other countries that have done it?
It was a joke. With universal healthcare all the "paper pushers" would be freed up to do meaningful work.
Actually this was an actual concern of Obama's when he was president and why he shied away from single payer in the Obamacare implementation. There are literally thousands upon thousands working in the insurance industry. It acts as a de facto wealth redistribution chain. Causing that many people to be unemployed overnight could have some pretty severe consequences.
Maybe providing those employees an expedited path to working on the gov. implementation would help ease that. But there would still be a lot of redundancies.
What kinds of meaningful work require a lot of bureaucrats? We could invest more in the IRS and hire lots of people to catch tax evaders. We could hire caseworkers to look at immigration cases, to expedite asylum cases. The courts could hire more staff to expedite cases. We could hire more social workers. These ideas all involve government investment, but it seems like they might pay for themselves in some way. For instance, think about all the poor people in jail or detention waiting for their cases to come up, instead of doing meaningful work.
A little off topic I know, just some random thoughts.
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I come from a country with ”socialised medicine” and now live in another; but I’m married to a US citizen so have some experience of both sides of this. One thing that I find strange in all of these healthcare discussions is that Americans seem to spend a lot of time and mental energy worrying about the possibility of people getting health care that they don’t deserve - either because they don’t earn enough, or because they aren’t morally upstanding, or because they made lifestyle choices that we don’t agree with.
In countries with socliased healthcare systems (we just call it healthcare by the way) we don’t tend to worry too much about these things. Sure, the system isn’t entirely efficient, and some users cost more than others. But the overall cost of treatment is so much lower than it is in USA - and these edge cases people in the USA seem to worry about so much probably make up a tiny percentage of overall expenditure on health care. If we worry about avoidable health care costs at all it would be to worry about what we can do to avoid the cost of things like gunshot wounds and violence.
But rather than stress over the risk that someone somewhere is getting healthcare they “don’t deserve” we are far more worried by cases where someone was denied treatment they needed becuase they didn’t have cover. This seems to happen a lot in the states, and doesn’t seem to elicit nearly the level of concern that I would expect it to. To be honest though the reality is that we just don’t think about healthcare nearly as much as you guys do - for the most part its there when we need it, and its not something we have to stress about too much.
Sure there are some things that aren’t covered, but you’d probably be surprised as to how little. Where there are issues it tends to be longish waiting lists for elective surgery, or limited availability of extremely expensive experimental treatments. But under the current system in USA lots of people don’t get those anyway. One mistake people often seem to make is to compare a system like NHS that treats everyone, to the best possible healthcare in USA that very few people have.
This overlooks the fact that if I want to top up my NHS cover with insurance that will plug those gaps like waiting lists for non urgent surgery, I can buy very high quality insurance for something like £20 a month for an individual. Why so low? It doesn’t have to cover the cost of treating a road accident, or cancer, or any of the really expensive stuff, as the NHS deals with all of that. Heck, if I didn’t have private cover and really didn’t want to wait a year for say a joint surgery, I could pay out of pocket for private treatment and it would still cost a fraction of the cost it would in USA and would never get to the level of needing to sell my house to cover it, as I have known people in US have to do just to cover co-pays on a serious illness. That to me is unfathomable.
On the question of cost its worth pointing out that the US government alone currently spends more on healthcare than the UK government does - both per capita and as a percentage of gdp. Again, that is ignoring all expenditure on private healthcare, just the amount spent by govt - and we get universal cover for that price. That fact alone boggles my mind (see link below if you don’t believe this!) Of course there is so much inefficiency in the current system that you cant just remove all private spending at once without increasing govt spending, but it certainly shows what is possible and what you can aim for. FYI anecdotally I’d guess the three largest differences making up this gap are: 1. We don’t have all the bureaucracy of billing and insurance companies to cover; 2. Hospitals are usually a few years old and clean but slightly faded, no marble in sight but neither do we feel the need for it; and 3. Doctors are paid like middle class professionals, not rock stars. Think if all Drs got a salary in line with say a teacher or a CPA, instead of a hedge fund manager. But at the same time they don’t have to go into $500k of debt either.
Lastly as to the question of how do you judge the success of a healthcare system this is a problem that’s been pretty much solved. You guys go on about universal healthcare like its a really tough problem with no existing answer, like the Apollo landings. That’s just not true - pretty much every civilised country in the world already has some variation of it. Sure there will be particular difficulties in deciding the best approach for a country as large and diverse as USA, and in implementing it given the existing system and vested interests. But you could start by looking at WHO rankings, which try exactly to gauge the effectiveness of each country’s system and compare them. So there is an existing methodology there you can use to see how well the system works.
Honestly, I think it will be hard to do but once you have made the change you will look back and wonder how you could ever have coped without it, let alone why it seemed so controversial!
https://www.bbc.com/news/uk-42950587
https://en.m.wikipedia.org/wiki/World_Health_Organization_ranking_of_health_systems_in_2000
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^^^ This is the point of universal health care. Thank you, Doubleh for articulating it so clearly.
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Universal health care is an income redistribution scheme. It takes money away from people who make healthy lifestyle choices, and who live within their means and don't have a horde of children they can't afford, and gives that money over to people who often make unhealthy choices for themselves and the many children they pump out. It punishes the former and rewards the latter.
So... what you are saying is that you are in favor of infanticide, because it sounds like you want a whole bunch of helpless innocent children to die due to other people's choices.
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Interesting perspective Doubleh. US citizens are regularly exposed to the outrages of our health care system's inadequacies. People regularly die here as a result of financially unfortunate circumstances, and then we move on like it was a car crash on the freeway, doing 80 again after a mile. It's sad. Australia figured out banning guns was a good idea after Port Arthur. Canada figured out how to put together a universal health care system against major interests and strikes. How come America can't do the same? I figure it has to do with ego and fear. Fear that America as a country actually needs this thing, and what that amounts to is admitting we aren't all that great independent strong stand out that we make ourselves out to be. Like very poor people refusing assistance, we are too proud. It's sad, and it's costly in dollars, life expectancy, and lives.
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Interesting perspective Doubleh. US citizens are regularly exposed to the outrages of our health care system's inadequacies. People regularly die here as a result of financially unfortunate circumstances, and then we move on like it was a car crash on the freeway, doing 80 again after a mile. It's sad. Australia figured out banning guns was a good idea after Port Arthur. Canada figured out how to put together a universal health care system against major interests and strikes. How come America can't do the same? I figure it has to do with ego and fear. Fear that America as a country actually needs this thing, and what that amounts to is admitting we aren't all that great independent strong stand out that we make ourselves out to be. Like very poor people refusing assistance, we are too proud. It's sad, and it's costly in dollars, life expectancy, and lives.
Wow! Port Arthur disappeared and became a part of Thunder Bay, Ont about 1970. They must have had universal health care up there for a long time.
Doubleh - Those were good points backed up with financial facts.
Now - A lot of people are worried about overweight people getting health care and the rest of us paying the bill. A lot of people are worried about footing the bill for poor people. Well folks, I don't know how to break it to you but you are already paying for a lot of poor people's health care. They are on some form of government assistance already
Now - Here is how Universal Health Care would make it better for these people. I'll use a personal anecdote. I used to work with this very smart girl we'll call Sally. Sally and I had this discussion one day and she told me that she had a sister. I said that if your sister is half as smart as you she is probably doing well in this world. I was promptly informed that Sally's sister was a "welfare bitch." I was further informed that as her sister did not have any kind of specialized training that the best jobs she would be able to get would be minimum wage. She further offered that minimum wage jobs were not enough to pay for her and her two kids, did not offer the health benefits that she had and she would not be able to afford child care.
If we had universal health care, it may not be enough to enable or prompt Sally's sister to work, but it would be added incentive for many people. I am quite certain that there are many people who do not work because they will lose their taxpayer provided welfare health care. This is even somewhat true of Obamacare. If you have insurance with ACA (Obamacare) subsidies, you will lose said subsidies if you earn too much money. It is a disincentive to work.
Do we want to provide disincentives to work in the USA or do we want to provide added opportunities for people who want to work to be able to work?
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Interesting perspective Doubleh. US citizens are regularly exposed to the outrages of our health care system's inadequacies. People regularly die here as a result of financially unfortunate circumstances, and then we move on like it was a car crash on the freeway, doing 80 again after a mile. It's sad. Australia figured out banning guns was a good idea after Port Arthur. Canada figured out how to put together a universal health care system against major interests and strikes. How come America can't do the same? I figure it has to do with ego and fear. Fear that America as a country actually needs this thing, and what that amounts to is admitting we aren't all that great independent strong stand out that we make ourselves out to be. Like very poor people refusing assistance, we are too proud. It's sad, and it's costly in dollars, life expectancy, and lives.
Ego plays a part.
1. Americans don't trust each other. (http://freakonomics.com/podcast/trust-me/) Trust being a basic component of any social program.
I think this has something to do with the "Cult of Individuality" that runs through all economic strata but manifests in different ways.
Upper classes: "I built this business by myself."
Lower classes: "My individual actions won't effect the greater part of society."
The problem is niether is true. Upper classes had help from the government, lower classes create a culture of moral relativity. (I.e. "My friends are all liars, cheaters and thieves, why should I be surprised politicians are?"
2. Americans cannot communicate with each other due to over specialization. A friend of mine left customer service at an insurance company to work in a repair shop. He is finding difficulty explaining his job to his "white collar" friends because they can't imagine .001" of an inch, let alone why it is extremely important.
So when we are talking about healthcare, people may "understand" it, but not really have a frame of reference to actually understand it.
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So many things to say here - but basically the most relevant is that per capita health costs are much lower in countries that have universal health care. We pay more taxes but we get more benefits from them. American health insurance premiums are incredibly high.
Obamacare was passed with a mountain of lies, and I expect the same will be true of universal health care. We were told that we could keep our plans, that health care premiums would decline, and that it was not a tax, All lies. The architect of Obamacare admitted that it was written in a "tortured way" to prevent CBO from scoring it as a tax.
Many individuals will pay more, get less, and once again get screwed by our politicians with their empty broken promises. No more.
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I came into this thread really questioning Universal healthcare in the US. I'm moderate, socially liberal, but fiscally conservative so I occasionally agree with both major parties, but most of the time I think they are both extreme. Given that, I was hesitant to embrace universal healthcare, but this threat has opened my eyes to the benefits. Thank you fellow mustachians!
Thank you @Doubleh!
You answered a few questions I was going to ask. In order for the US to cost so much more than other countries while getting worse results, there are inefficiencies somewhere. An obvious inefficiency is the health insurance industry acting as middle men.
It appears the amounts we pay doctors is a big part of this. I've always wondered what the difference in pay was. On that note, our for profit health industry creates an incentive to do extra, often unnecessary procedures. I can't remember the poster now, but someone was talking about how in their country they used physical therapy first and surgery as a last resort for physical disabilities.
A few ideas to make this work in the US:
A fat 'product' tax: Instead of taxing people why don't we change how we tax products. For those of you who don't know, the US has a tax subsidy on corn, wheat, sugar, and meats. However it has very little incentive to farm fruits and vegetables. Let's switch that around! We also already tax tobacco and alcohol quite a bit. Let's extend that to soft drinks, and set it up so the tax revenue from all three has to go to medicare. Americans don't like extra taxes, especially if they consider the results to be waste, but I think a tax on unhealthy habits used to pay for future health expenses is something you could get acceptance for.
On the thought of not trusting people: The poor in the US already have free healthcare. It's called medicaid. Between that and medicaid the poor and the elderly are covered. It's just the young to middle age middle and upper class who are paying for their own healthcare.
In addition, the poor also get free food in the form of food stamps. Let's change how food stamps can be used and accomplish a few goals. Instead of X dollars and you can spend it however you want, let's set it up so the recipient gets a free allotment of healthy foods. What I'm getting at is that the recipient gets a lot of fruits, vegetables, rice, beans, lean meats, etc. but no processed chips and sodas. If they want to buy those things they can use their own money. This would in effect make our poor population much healthier, clear up some food deserts since there would be automatic added demand for these goods, and save a lot of money on public healthcare be it universal healthcare or medicaid. It would also create greater demand for these goods, which combined with fixing food subsidies, would give farmers incentive to farm a lot more healthy foods.
Thoughts?
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Right now I would not want to go for a walk, Ottawa has had some snow and the streets are slippery and the sidewalks are a mess. Time for the plows! If municipalities put priority on designing for an active lifestyle (i.e. safe places to walk that actually go somewhere, so you are not just out for a stroll) and the same for bike paths, and realize that people will use them in winter if they are properly maintained, and basically quit giving cars massive consideration in design, then urban/suburban areas will invite more activity. Unfortunately we are so out of the habit of walking/biking that it will take a lot to reverse peoples' habits.
It took decades for our current culture to form, it will take decades to change again(short some huge catastrophe.) So you have to start small, almost guerilla like.
1. Form a corporation with some fellow Mustachians.
2. Find a blighted neighborhood.
3. Buy houses at a "tax sale". (Homes that the county took for not paying taxes.
4. Restore the houses to original condition. (So people in the neighborhood can't say "They're going to change the neighborhood!")
5. Rent the houses. Thoroughly vet tenants, keep the yards neat, hire private snow plows to clean and salt the streets and sidewalks, possibly the bike trails too.
6. A few years down the line, buy more houses, convert them into two apartments.
7. Some years after that, try to build 4 unit apartment buildings.
That's my plan at least. Persuading people is more "a gentle curve" then a sudden 90 degree turn.
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So many things to say here - but basically the most relevant is that per capita health costs are much lower in countries that have universal health care. We pay more taxes but we get more benefits from them. American health insurance premiums are incredibly high.
Obamacare was passed with a mountain of lies, and I expect the same will be true of universal health care. We were told that we could keep our plans, that health care premiums would decline, and that it was not a tax, All lies. The architect of Obamacare admitted that it was written in a "tortured way" to prevent CBO from scoring it as a tax.
Many individuals will pay more, get less, and once again get screwed by our politicians with their empty broken promises. No more.
While I share your concerns about the government, I believe that we have to allow the experiment to proceed simply to move on to other issues.
Allow the people to try it. If it works, then we move on with our lives. If it fails, we repeal it. If we can't repeal it, people have the right to start putting heads on pikes.
I came into this thread really questioning Universal healthcare in the US. I'm moderate, socially liberal, but fiscally conservative so I occasionally agree with both major parties, but most of the time I think they are both extreme. Given that, I was hesitant to embrace universal healthcare, but this threat has opened my eyes to the benefits. Thank you fellow mustachians!
Thank you @Doubleh!
You answered a few questions I was going to ask. In order for the US to cost so much more than other countries while getting worse results, there are inefficiencies somewhere. An obvious inefficiency is the health insurance industry acting as middle men.
It appears the amounts we pay doctors is a big part of this. I've always wondered what the difference in pay was. On that note, our for profit health industry creates an incentive to do extra, often unnecessary procedures. I can't remember the poster now, but someone was talking about how in their country they used physical therapy first and surgery as a last resort for physical disabilities.
A few ideas to make this work in the US:
A fat 'product' tax: Instead of taxing people why don't we change how we tax products. For those of you who don't know, the US has a tax subsidy on corn, wheat, sugar, and meats. However it has very little incentive to farm fruits and vegetables. Let's switch that around! We also already tax tobacco and alcohol quite a bit. Let's extend that to soft drinks, and set it up so the tax revenue from all three has to go to medicare. Americans don't like extra taxes, especially if they consider the results to be waste, but I think a tax on unhealthy habits used to pay for future health expenses is something you could get acceptance for.
On the thought of not trusting people: The poor in the US already have free healthcare. It's called medicaid. Between that and medicaid the poor and the elderly are covered. It's just the young to middle age middle and upper class who are paying for their own healthcare.
In addition, the poor also get free food in the form of food stamps. Let's change how food stamps can be used and accomplish a few goals. Instead of X dollars and you can spend it however you want, let's set it up so the recipient gets a free allotment of healthy foods. What I'm getting at is that the recipient gets a lot of fruits, vegetables, rice, beans, lean meats, etc. but no processed chips and sodas. If they want to buy those things they can use their own money. This would in effect make our poor population much healthier, clear up some food deserts since there would be automatic added demand for these goods, and save a lot of money on public healthcare be it universal healthcare or medicaid. It would also create greater demand for these goods, which combined with fixing food subsidies, would give farmers incentive to farm a lot more healthy foods.
Thoughts?
I withdraw my suggestion of a fat tax. The thought was that some people will be too dense to realize they are being punished in a roundabout way.
I think people on food stamps can only buy "cold" food instead of "hot" food. My point is that there are restrictions in place on food stamps, we can take a better look at it.
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I came into this thread really questioning Universal healthcare in the US. I'm moderate, socially liberal, but fiscally conservative so I occasionally agree with both major parties, but most of the time I think they are both extreme. Given that, I was hesitant to embrace universal healthcare, but this threat has opened my eyes to the benefits. Thank you fellow mustachians!
Thank you @Doubleh!
You answered a few questions I was going to ask. In order for the US to cost so much more than other countries while getting worse results, there are inefficiencies somewhere. An obvious inefficiency is the health insurance industry acting as middle men.
It appears the amounts we pay doctors is a big part of this. I've always wondered what the difference in pay was. On that note, our for profit health industry creates an incentive to do extra, often unnecessary procedures. I can't remember the poster now, but someone was talking about how in their country they used physical therapy first and surgery as a last resort for physical disabilities.
A few ideas to make this work in the US:
A fat 'product' tax: Instead of taxing people why don't we change how we tax products. For those of you who don't know, the US has a tax subsidy on corn, wheat, sugar, and meats. However it has very little incentive to farm fruits and vegetables. Let's switch that around! We also already tax tobacco and alcohol quite a bit. Let's extend that to soft drinks, and set it up so the tax revenue from all three has to go to medicare. Americans don't like extra taxes, especially if they consider the results to be waste, but I think a tax on unhealthy habits used to pay for future health expenses is something you could get acceptance for.
On the thought of not trusting people: The poor in the US already have free healthcare. It's called medicaid. Between that and medicaid the poor and the elderly are covered. It's just the young to middle age middle and upper class who are paying for their own healthcare.
In addition, the poor also get free food in the form of food stamps. Let's change how food stamps can be used and accomplish a few goals. Instead of X dollars and you can spend it however you want, let's set it up so the recipient gets a free allotment of healthy foods. What I'm getting at is that the recipient gets a lot of fruits, vegetables, rice, beans, lean meats, etc. but no processed chips and sodas. If they want to buy those things they can use their own money. This would in effect make our poor population much healthier, clear up some food deserts since there would be automatic added demand for these goods, and save a lot of money on public healthcare be it universal healthcare or medicaid. It would also create greater demand for these goods, which combined with fixing food subsidies, would give farmers incentive to farm a lot more healthy foods.
Thoughts?
You have to be incredibly poor to qualify for Medicaid as a non-disabled adult in many states. My mother didn't qualify with zero assets and almost exactly $1200/month in income. In a state that expanded Medicaid under the ACA, I believe she would now qualify, but under our state's current rules she still would not. If all states would expand Medicaid, that would be a huge boost to the poor and a huge psychological burden lifted from them.
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Folks - It's not just you that is paying the high cost of insurance premiums. It's your employer.
How does your employer get the money to pay for their contribution to your expensive healthcare? It has to be derived from the income of the goods and services they provide. These goods and services may have to cost more than competitors. Some of which are domestic and some are abroad. Many of the competitors who are abroad do not have to buy health insurance for their employees. Health is done in a different way. These competitors can then pass the cost savings on to the consumer and thus increase their market share.
Universal Health Care costs the country less and may allow our businesses to be more competitive. Americas goods and services will prosper and the overall pie will be bigger. As right wing politicians are fond of saying, "A rising tide lifts all boats."
Think about Universal Health Care when you vote. It could give us better than the old cliche, "two chickens in every pot and a car in every garage."
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NYT had an article yesterday about the current political status of universal health care in the US.
https://www.nytimes.com/2019/02/02/us/politics/medicare-for-all-2020.html
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A fat 'product' tax: Instead of taxing people why don't we change how we tax products. For those of you who don't know, the US has a tax subsidy on corn, wheat, sugar, and meats. However it has very little incentive to farm fruits and vegetables. Let's switch that around! We also already tax tobacco and alcohol quite a bit. Let's extend that to soft drinks, and set it up so the tax revenue from all three has to go to medicare. Americans don't like extra taxes, especially if they consider the results to be waste, but I think a tax on unhealthy habits used to pay for future health expenses is something you could get acceptance for.
There are a few problems with this proposal.
One is the abstract issue of (further) complicating and bloating an already byzantine tax code. Another is that it rather runs against the principle of bodily autonomy, in that only an individual should decide what he/she puts in his/her own body, and a tax or fine or other state-imposed cost on the matter is a violation of bodily autonomy.
A third issue is that selecting which products to tax opens the door up to special interests and lobby groups to create exemptions for their own products and extra taxes on rival products. We can avert this risk is with extremely simple laws, or extremely honest politicians.
On the thought of not trusting people: The poor in the US already have free healthcare. It's called medicaid. Between that and medicaid the poor and the elderly are covered. It's just the young to middle age middle and upper class who are paying for their own healthcare.
Right, but the US government already spends a fortune on healthcare just for covering these select few. Unless there are price controls in some form (whether through law, competition, or something else) there is going to be a fiscal impact of covering more people.
In addition, the poor also get free food in the form of food stamps. Let's change how food stamps can be used and accomplish a few goals. Instead of X dollars and you can spend it however you want, let's set it up so the recipient gets a free allotment of healthy foods. What I'm getting at is that the recipient gets a lot of fruits, vegetables, rice, beans, lean meats, etc. but no processed chips and sodas. If they want to buy those things they can use their own money. This would in effect make our poor population much healthier, clear up some food deserts since there would be automatic added demand for these goods, and save a lot of money on public healthcare be it universal healthcare or medicaid. It would also create greater demand for these goods, which combined with fixing food subsidies, would give farmers incentive to farm a lot more healthy foods.
A free allotment of healthy foods sounds nice. It also sounds quite a lot like what Cuba does.
Subsidies indeed incentivize certain acts, but there are colossal second and third order effects that many not always be easy to see, and there's no guarantee whatsoever that they will result in intended first order effects at all. Take corn subsidies, for example... sure, they result in relatively cheap corn products, but there are also huge problems with them and they've resulted in the use of HFCS, which has its own issues.
Then there's the issue of who gets to decide what a "healthy" food is, along with the bodily autonomy issue... sure, the government wouldn't be forcing anyone to eat certain things per se, but it would steer you rather decisively towards certain personal lifestyle choices. That's a problem.
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NYT had an article yesterday about the current political status of universal health care in the US.
https://www.nytimes.com/2019/02/02/us/politics/medicare-for-all-2020.html
From the article:
"But Michael R. Bloomberg, the former New York City mayor who is considering a 2020 bid on a centrist Democratic platform, said it would be folly to even consider a single-payer system. “To replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time,” Mr. Bloomberg told reporters in New Hampshire on Tuesday."
Good use of fear.
The country is being pulled towards more Socialized medicine. I don't see how we would be bankrupt if all those companies no longer had that significant human resource cost. Overall the country would pay less. This is an example of economic efficiency. It would be good for business (other than insurance). It would be good for the average Joe as the overall cost would be less. I think most of the countries that offer medicine to their citizens are doing well. They are not bankrupt.
I think smart Republicans would pick this up and run with it. They could be offering Socialized medicine purely on economic justification. They would just have to call it something else, maybe "people's medicine." They would lose their health care lobbyist support, but they'd cut the legs off of the Democrats and it would benefit them with new voters for a generation. I am old enough to remember hearing a lot of old timers praise FDR.
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Then there's the issue of who gets to decide what a "healthy" food is, along with the bodily autonomy issue... sure, the government wouldn't be forcing anyone to eat certain things per se, but it would steer you rather decisively towards certain personal lifestyle choices. That's a problem.
Considering the personal lifestyle choices that "the market" has decided to steer people towards so far are you certain that it's a better driver than us? If so, when do you expect it to correct it's current course?
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Then there's the issue of who gets to decide what a "healthy" food is, along with the bodily autonomy issue... sure, the government wouldn't be forcing anyone to eat certain things per se, but it would steer you rather decisively towards certain personal lifestyle choices. That's a problem.
Considering the personal lifestyle choices that "the market" has decided to steer people towards so far are you certain that it's a better driver than us? If so, when do you expect it to correct it's current course?
+1.
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Also, corn and whatnot being subsidized and therefore super cheap, is already the government steering you rather decisively towards certain personal lifestyle choices.
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EVERYONE does something that is "self-destructive." It's only a matter of degree. Have you ever eaten junk food, drunk alcohol, did something foolish that could have gotten you injured, etc.? How many times? Who is going to judge the seriousness of your behaviour and decide whether you deserve to receive medical care as a result? I live in Canada and we spend a lot less on health care per person than the US does (don't have figures at hand, look it up if you're curious) for generally the same degree of health for the population. In fact, infant mortality is lower here than there. I don't think anyone can argue that universal health care is worse overall than a patient-paid system.
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A fat 'product' tax: Instead of taxing people why don't we change how we tax products. For those of you who don't know, the US has a tax subsidy on corn, wheat, sugar, and meats. However it has very little incentive to farm fruits and vegetables. Let's switch that around! We also already tax tobacco and alcohol quite a bit. Let's extend that to soft drinks, and set it up so the tax revenue from all three has to go to medicare. Americans don't like extra taxes, especially if they consider the results to be waste, but I think a tax on unhealthy habits used to pay for future health expenses is something you could get acceptance for.
There are a few problems with this proposal.
One is the abstract issue of (further) complicating and bloating an already byzantine tax code. Another is that it rather runs against the principle of bodily autonomy, in that only an individual should decide what he/she puts in his/her own body, and a tax or fine or other state-imposed cost on the matter is a violation of bodily autonomy.
A third issue is that selecting which products to tax opens the door up to special interests and lobby groups to create exemptions for their own products and extra taxes on rival products. We can avert this risk is with extremely simple laws, or extremely honest politicians.
On the thought of not trusting people: The poor in the US already have free healthcare. It's called medicaid. Between that and medicaid the poor and the elderly are covered. It's just the young to middle age middle and upper class who are paying for their own healthcare.
Right, but the US government already spends a fortune on healthcare just for covering these select few. Unless there are price controls in some form (whether through law, competition, or something else) there is going to be a fiscal impact of covering more people.
In addition, the poor also get free food in the form of food stamps. Let's change how food stamps can be used and accomplish a few goals. Instead of X dollars and you can spend it however you want, let's set it up so the recipient gets a free allotment of healthy foods. What I'm getting at is that the recipient gets a lot of fruits, vegetables, rice, beans, lean meats, etc. but no processed chips and sodas. If they want to buy those things they can use their own money. This would in effect make our poor population much healthier, clear up some food deserts since there would be automatic added demand for these goods, and save a lot of money on public healthcare be it universal healthcare or medicaid. It would also create greater demand for these goods, which combined with fixing food subsidies, would give farmers incentive to farm a lot more healthy foods.
A free allotment of healthy foods sounds nice. It also sounds quite a lot like what Cuba does.
Subsidies indeed incentivize certain acts, but there are colossal second and third order effects that many not always be easy to see, and there's no guarantee whatsoever that they will result in intended first order effects at all. Take corn subsidies, for example... sure, they result in relatively cheap corn products, but there are also huge problems with them and they've resulted in the use of HFCS, which has its own issues.
Then there's the issue of who gets to decide what a "healthy" food is, along with the bodily autonomy issue... sure, the government wouldn't be forcing anyone to eat certain things per se, but it would steer you rather decisively towards certain personal lifestyle choices. That's a problem.
I'm not suggesting we do anything drastically new. I'm suggesting we revamp what's already in place. There is already an alcohol tax and a tobacco tax, why not an 'excessive added sugar' tax now that we know that is just as bad for health as the former two? I agree a simpler tax system would be nice. Sales taxes do tend to be the simpler of our taxes which is why I thought to go there first. And don't get me wrong. I consume these products, but there is a difference between moderation and drinking liters of soda per day.
Price controls: Prices are a serious problem. My ideas were potential solutions to this that were less restrictive than price controls, which have just as many, if not more, unintended consequences as trying to incentive people eating healthier.
Allotment of food: We are already giving people free food. Currently, this money is used to buy foods that are unhealthy which comes back to bite us later in the form of higher healthcare costs. That's stupid and a waste of taxpayer money. In addition, we currently subsidize foods that are hurting our society and we don't subsidize foods that help our society, another waste of taxpayer money. I don't want to do this because it sounds nice. I like the idea because it takes two existing problems, and improves the situation. It isn't perfect, but it's better than the status quo.
Who gets to decide what 'healthy food' is? Nutritionists would be a good start. It also doesn't have to be just one option. It doesn't even have to be an allotment, that just seemed like a logistically easier option. It could be as simple as food stamp cards not paying for junk food, alcohol(already the case), soda, etc.
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Then there's the issue of who gets to decide what a "healthy" food is, along with the bodily autonomy issue... sure, the government wouldn't be forcing anyone to eat certain things per se, but it would steer you rather decisively towards certain personal lifestyle choices. That's a problem.
Considering the personal lifestyle choices that "the market" has decided to steer people towards so far are you certain that it's a better driver than us? If so, when do you expect it to correct it's current course?
I prefer the freedom to make your own decisions and live by them, and to potentially be harmed by them, over forced compliance. People are quite welcome to make good choices and I hope they do, but even if they make bad choices, I do respect their rights to do so.
How would you feel if you were "steered" away from doing things that you preferred to, or towards things that you preferred not to?
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How would you feel if you were "steered" away from doing things that you preferred to, or towards things that you preferred not to?
As has been mentioned above, we're already being steered into choices - like buying products packed with corn syrup due to agricultural subsidies - and hardly anyone notices and even fewer people complain.
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Well, there are certain things that are undoubtedly unhealthy. Start there. Friend foods, cigarettes, alcohol, refined sugar in products. I mean sure your best friend's uncle ate a Big Mac with Coke every lunch, smoked at work and drinks when he got home and is like 89 years old.......but 90%* of our health problems come from any of these habits in excess. To prevent people who have any number of easily treatable issues from getting decent health care at a decent price simply because others have bad habits is backwards thinking.
*100% not fake stat
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How would you feel if you were "steered" away from doing things that you preferred to, or towards things that you preferred not to?
As has been mentioned above, we're already being steered into choices - like buying products packed with corn syrup due to agricultural subsidies - and hardly anyone notices and even fewer people complain.
I try, when I can.
But this argument confuses me. We seem to agree that it's wrong to steer people, right? So, why is the fact that we are being steered even now an argument in favor of steering others?
To prevent people who have any number of easily treatable issues from getting decent health care at a decent price simply because others have bad habits is backwards thinking.
Who is saying that some people shouldn't get health care, because others have bad habits?
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While I share your concerns about the government, I believe that we have to allow the experiment to proceed simply to move on to other issues.
Statists pushing universal health care will not "move on to other issues" once it is implemented. When universal health care fails to deliver on its promises, statists will demand even more spending and regulation to "fix it". Sound familiar?
Getting rid of these failed social programs is very difficult, because the opposition party does not want to be subjected to the ensuing outcry. They would rather allow it to crash and burn on its own, rather than raise taxes to a stratospheric level in order to make it work financially. Again, sound familiar?
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While I share your concerns about the government, I believe that we have to allow the experiment to proceed simply to move on to other issues.
Statists pushing universal health care will not "move on to other issues" once it is implemented. When universal health care fails to deliver on its promises, statists will demand even more spending and regulation to "fix it". Sound familiar?
Getting rid of these failed social programs is very difficult, because the opposition party does not want to be subjected to the ensuing outcry. They would rather allow it to crash and burn on its own, rather than raise taxes to a stratospheric level in order to make it work financially. Again, sound familiar?
Again, do you have any reasoning to back up your claims or anything constructive to add?
Why will it fail to deliver? Do you have data, information to suggest this, a theory. At the very least you could give us a meaningless anecdote. Everyone has an anecdote.
If you take any real interest in this discussion, then give us something we can work with.
Universal health care is an income redistribution scheme. It takes money away from people who make healthy lifestyle choices, and who live within their means and don't have a horde of children they can't afford, and gives that money over to people who often make unhealthy choices for themselves and the many children they pump out. It punishes the former and rewards the latter.
No. It's not. Either make a real contribution to this thread or stop trolling.
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For heavens sake, just get a group of people with expertise in public health and health economics to pick over policies and practices from the rest of the developped world and be done with it.
Hard to see what could be worse than what you have now.
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For heavens sake, just get a group of people with expertise in public health and health economics to pick over policies and practices from the rest of the developped world and be done with it.
Hard to see what could be worse than what you have now.
Entirely agree. I live in Australia, and we got universal health care about 1974. In the run up to the 1972 Federal election, a workmate, who came from the Netherlands, said that if Australia gets universal healthcare, we will just be doing what Europe did 15 years earlier. I had to agree.
NZ got universal heath care about the same time, and Canada a decade later.
Learn from other rich countries. The road is open.
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For heavens sake, just get a group of people with expertise in public health and health economics to pick over policies and practices from the rest of the developped world and be done with it.
Hard to see what could be worse than what you have now.
Trusting specialists is so XX century...
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For heavens sake, just get a group of people with expertise in public health and health economics to pick over policies and practices from the rest of the developped world and be done with it.
Hard to see what could be worse than what you have now.
Trusting specialists is so XX century...
I find this quite interesting. People from other countries like England, Australia, New Zealand, etc are just saying, "do it."
USA people are not agreeing to just "do it." Instead they argue over a somewhat side issue as to whether fat people should be taxed.
I guess I trust the opinions of people who already have such systems successfully in place.
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I love how our ridiculous "defense" (spying, world policing, remote control bombing people, etc.) spending is never questioned, but talk about providing health care to the least expensive subset of the population and suddenly we're gonna go broke overnight.
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I love how our ridiculous "defense" (spying, world policing, remote control bombing people, etc.) spending is never questioned, but talk about providing health care to the least expensive subset of the population and suddenly we're gonna go broke overnight.
You can spend the money on stuff to kill people or on saving people's lives.
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How would you feel if you were "steered" away from doing things that you preferred to, or towards things that you preferred not to?
As has been mentioned above, we're already being steered into choices - like buying products packed with corn syrup due to agricultural subsidies - and hardly anyone notices and even fewer people complain.
I try, when I can.
But this argument confuses me. We seem to agree that it's wrong to steer people, right? So, why is the fact that we are being steered even now an argument in favor of steering others?
I'm 100% in favor of the government "steering" its population in ways that are beneficial for both individuals and society. I favor higher taxes on sugar, alcohol, cigarettes, and gas. I prefer automatic enrollment for choices like organ donation and retirement savings. I would like to see more infrastructure spending on public transit and intelligently designed bike paths and less on road widening.
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How would you feel if you were "steered" away from doing things that you preferred to, or towards things that you preferred not to?
As has been mentioned above, we're already being steered into choices - like buying products packed with corn syrup due to agricultural subsidies - and hardly anyone notices and even fewer people complain.
I try, when I can.
But this argument confuses me. We seem to agree that it's wrong to steer people, right? So, why is the fact that we are being steered even now an argument in favor of steering others?
I'm 100% in favor of the government "steering" its population in ways that are beneficial for both individuals and society. I favor higher taxes on sugar, alcohol, cigarettes, and gas. I prefer automatic enrollment for choices like organ donation and retirement savings. I would like to see more infrastructure spending on public transit and intelligently designed bike paths and less on road widening.
It's the 'Libertarian Paternalism' concept, and I am (mostly, with some big exceptions) in favor of it as well. Structure society so that the healthiest/smartest choices are easiest or cheapest to make, but consider keeping the other alternatives available so that people still have a choice.
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Then there's the issue of who gets to decide what a "healthy" food is, along with the bodily autonomy issue... sure, the government wouldn't be forcing anyone to eat certain things per se, but it would steer you rather decisively towards certain personal lifestyle choices. That's a problem.
Considering the personal lifestyle choices that "the market" has decided to steer people towards so far are you certain that it's a better driver than us? If so, when do you expect it to correct it's current course?
I prefer the freedom to make your own decisions and live by them, and to potentially be harmed by them, over forced compliance. People are quite welcome to make good choices and I hope they do, but even if they make bad choices, I do respect their rights to do so.
How would you feel if you were "steered" away from doing things that you preferred to, or towards things that you preferred not to?
I'm confused by your question. Are you trying to say that price differences do not influence your decisions unless those price differences are the result of taxes?
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While I share your concerns about the government, I believe that we have to allow the experiment to proceed simply to move on to other issues.
Statists pushing universal health care will not "move on to other issues" once it is implemented. When universal health care fails to deliver on its promises, statists will demand even more spending and regulation to "fix it". Sound familiar?
Getting rid of these failed social programs is very difficult, because the opposition party does not want to be subjected to the ensuing outcry. They would rather allow it to crash and burn on its own, rather than raise taxes to a stratospheric level in order to make it work financially. Again, sound familiar?
Actually, I was more afraid of "Brave New World" growing up than "1984".
Thankfully, I am sure that people will use their new found capabilities responsibly. (https://en.m.wiktionary.org/wiki/liberal_eugenics) I have also been assured by the finest scientific minds on this forum that Gene edited humans are decades away. (https://www.theguardian.com/science/2018/nov/26/worlds-first-gene-edited-babies-created-in-china-claims-scientist
) Nor will we ever have the capabilities to sustain an fetus outside of a womb. (https://nationalpost.com/health/artificial-wombs
)
Even if these miracle technologies existed, we have always been ruled by just and far seeing men. (https://en.m.wikipedia.org/wiki/Tuskegee_syphilis_experiment
https://en.m.wikipedia.org/wiki/Population_planning_in_Singapore
https://www.nature.com/articles/37848)
I have been assured that nothing can go wrong, to stop worrying and learn to love the bomb.
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Universal Health Care delivers just fine here in Canada, as literally any Canadian will tell you - excepting a few highly vocal companies and lobbyists who see dollar signs in a private system.
We had a wave of 'privatization' talk about 15 or 20 years ago, complete with constant talk about taxes being too high and our system being a disaster. Then we got a federal Conservative government- the supposed avatars of small government and private health care - and they quite smartly ran away screaming from the political suicide that ending the Canada Health Act would have involved.
Bottom line, it's a system that works well for acute care, and medical care. It isn't designed for prevention, and doesn't have the money to fund prevention efforts.
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For heavens sake, just get a group of people with expertise in public health and health economics to pick over policies and practices from the rest of the developped world and be done with it.
Hard to see what could be worse than what you have now.
Trusting specialists is so XX century...
I find this quite interesting. People from other countries like England, Australia, New Zealand, etc are just saying, "do it."
USA people are not agreeing to just "do it." Instead they argue over a somewhat side issue as to whether fat people should be taxed.
I guess I trust the opinions of people who already have such systems successfully in place.
Actually this was one of my primary concerns with a national system. We would get a system that works great for 7 out of 10 people and then get hung up on minor tweaks and changes that would improve the system overall.
I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
Americans seem to think throwing money at the issue will make it go away and that is the limit of their participation.
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- SNIP -
Actually this was one of my primary concerns with a national system. We would get a system that works great for 7 out of 10 people and then get hung up on minor tweaks and changes that would improve the system overall.
I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
Americans seem to think throwing money at the issue will make it go away and that is the limit of their participation.
I think you are right. There seems to be a large lack of empathy for the people who do not have any form of health care. The Spring before last our Congress was going to remove millions more from access to health care. It was called the American Health Care Act. It was only the actions of John McCain and a few others that stopped this. They just didn't care about these people. It was an eye opener to me.
It was different when I was a little kid. Those old folks from the depression were still around and they had tales to tell. They had a common experience which they had all been through and did not want it repeated for anyone.
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I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
How wrecked is "wrecked"? Canada, Australia and New Zealand were in WWII from the beginning, wit all the expected effects 6 years of war cause, but were not occupied territories with the degree of "wrecked" that implies.
There are certainly cultural differences. And of course the longer the US waits to shift, the harder the shift becomes, because the present systems become more and more entrenched.
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I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
How wrecked is "wrecked"? Canada, Australia and New Zealand were in WWII from the beginning, wit all the expected effects 6 years of war cause, but were not occupied territories with the degree of "wrecked" that implies.
There are certainly cultural differences. And of course the longer the US waits to shift, the harder the shift becomes, because the present systems become more and more entrenched.
I was thinking the London Blitz, France, Europe in general. As Canada and Australia were part of the empire, they were probably horrified by the toll on their countrymen.
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I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
How wrecked is "wrecked"? Canada, Australia and New Zealand were in WWII from the beginning, wit all the expected effects 6 years of war cause, but were not occupied territories with the degree of "wrecked" that implies.
There are certainly cultural differences. And of course the longer the US waits to shift, the harder the shift becomes, because the present systems become more and more entrenched.
I was thinking the London Blitz, France, Europe in general. As Canada and Australia were part of the empire, they were probably horrified by the toll on their countrymen.
Um, there are so many oddities in that last paragraph. I am sure we were horrified by what we saw in Europe and the Asian front, but they were not "our" countrymen. Of course we all had massive casualties, and massive war effort at home, but I am not thinking that is what you meant?
American GIs saw just as much war damage as we did, they were stationed in the UK and were part of D-Day and both the European and Asian fronts.
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I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
How wrecked is "wrecked"? Canada, Australia and New Zealand were in WWII from the beginning, wit all the expected effects 6 years of war cause, but were not occupied territories with the degree of "wrecked" that implies.
There are certainly cultural differences. And of course the longer the US waits to shift, the harder the shift becomes, because the present systems become more and more entrenched.
I was thinking the London Blitz, France, Europe in general. As Canada and Australia were part of the empire, they were probably horrified by the toll on their countrymen.
Tommy Douglas - The father of Canadian Medicare
Wikipedia
Tommy Clement Douglas was born in 1904 in Camelon, Falkirk, Scotland, the son of Annie (née Clement) and Thomas Douglas, an iron moulder who fought in the Boer War.[1] In 1910, his family immigrated to Canada, where they settled in Winnipeg.[2] Shortly before he left Scotland, Douglas fell and injured his right knee. Osteomyelitis set in and he underwent a number of operations in Scotland in an attempt to cure the condition. Later in Winnipeg, however, the osteomyelitis flared up again, and Douglas was sent to hospital. Doctors there told his parents his leg would have to be amputated. Fortunately, a well-known orthopedic surgeon took an interest in his case and agreed to treat the boy for free if his parents would allow medical students to observe. After several operations, Douglas's leg was saved. This experience convinced him that health care should be free to all.
All it takes is personal experience with being poor and needing treatment. That was 1910, how would he fare in the current US system?
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Exactly. People get all up in arms about how "They'll have to raise taxes!!!1! OMG F-NO!!!" Well, last year my health insurance premiums cost $14,000 (that's how much it costs to insure my family of 6 with zero actual spending) and I spent $10,000 in out-of-pocket costs (because we have a special needs child who requires expensive care). That's more than a quarter of my annual income right there. The federal government could literally triple my effective tax rate and I'd still pay half as much for health care as I do right now. Oh, and don't even get me started on the numbers of hours my wife and I spend sorting, paying, and fighting for corrections to our medical bills. If the government actually tallied lost productivity due to our byzantine healthcare system, publicly-funded healthcare would look like a steal.
We still have to do the paperwork for some of the costs incurred out of system* that are covered by private insurance, but it is nothing like this.
*My pharmacy has my insurance information and I only do co-pay on prescriptions, I don't have to submit the bill to my insurance, they do. I have to handle my physiotherapy bills.
I don't have any paperwork for the medical part. Some of the welfare system runs on forms, but not the medical one. We have an annual maximal co-pay of about $200, and when we hit the limit, they automatically stop charging us at the doctors', physical therapists' and pharmacies. Even the transport refunds have been automated now. If I have to take the kids to a hospital in a different city, the state will cover the travel costs. It used to be a form to fill out, and you had to send in the receipts. Now we can choose to let them calculate everything automatically, and you only click one box that says "please send the money to my bank account #XXXX". There is no co-pay for the kids, so doctors visits are very easy with them.
I am seething with jealousy right now. I know you pay higher taxes than we do, but dammit, that's what taxes are for.
Do we? If you include the cost of the stuff that is covered by the taxes? Our total taxes ([all tax paid]/[all income]) have the last years been between 20 and 25 %. That is not the theoretical tax bracket, but the amount of our money we paid to the government. It includes state tax, municipal tax, property tax, social security (state pension + medical + "disability insurance"), etc. The only thing that comes in addition is taxes on stuff we buy, like 12 % on food, 25 % on stuff, 100% on petrol and alcohol, etc. Those are difficult to calculate, But based on last years consumption, a rough calculation is that we paid an additional 6 % in taxes that way. People who spend more than us will of course pay more purchase tax.
Someone in Canada (Ontario) making $100k a year and maxing all tax advantaged investment opps (like any MMMer would), pays about $16k in fed and provincial income tax. Someone above from USA mentioned paying $14k for just medical insurance. !!!!!!!!
Adopting a Canadian healthcare method will not cost Americans more than the current system so long as you get rid of the middleman insurance companies who jack up the prices on everything. OF course, that's the problem, isn't it. Those insurance companies pay a lot of money to politicians so no one will ever run on getting rid of them. Another excuse is the lost jobs but there will be job needs to admin the new model so that won't be as bad as people think.
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I also figure that Americans don't have the underlying culture for the system. We didn't get wrecked during the World Wars. Every other country did, which I believe fostered the idea that "you are your brothers keeper."
How wrecked is "wrecked"? Canada, Australia and New Zealand were in WWII from the beginning, wit all the expected effects 6 years of war cause, but were not occupied territories with the degree of "wrecked" that implies.
There are certainly cultural differences. And of course the longer the US waits to shift, the harder the shift becomes, because the present systems become more and more entrenched.
I was thinking the London Blitz, France, Europe in general. As Canada and Australia were part of the empire, they were probably horrified by the toll on their countrymen.
Tommy Douglas - The father of Canadian Medicare
Wikipedia
Tommy Clement Douglas was born in 1904 in Camelon, Falkirk, Scotland, the son of Annie (née Clement) and Thomas Douglas, an iron moulder who fought in the Boer War.[1] In 1910, his family immigrated to Canada, where they settled in Winnipeg.[2] Shortly before he left Scotland, Douglas fell and injured his right knee. Osteomyelitis set in and he underwent a number of operations in Scotland in an attempt to cure the condition. Later in Winnipeg, however, the osteomyelitis flared up again, and Douglas was sent to hospital. Doctors there told his parents his leg would have to be amputated. Fortunately, a well-known orthopedic surgeon took an interest in his case and agreed to treat the boy for free if his parents would allow medical students to observe. After several operations, Douglas's leg was saved. This experience convinced him that health care should be free to all.
All it takes is personal experience with being poor and needing treatment. That was 1910, how would he fare in the current US system?
This is what I get for listening to Michael Moore. ("Sicko")
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
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All it takes is personal experience with being poor and needing treatment. That was 1910, how would he fare in the current US system?
If he lived in an Medicaid expansion state he would do alright in the US.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
I can see that perspective.
And I'd like to add to it.
We would have a moral responsibility to one another, as a society, to make sure that everyone had the potential to be healthy.
Meaning, we'd have a moral responsibility as a society to address problems such as food deserts, and things like the water in Flint, MI. Making sure people had reasonable access to healthy food. And reasonable access to ways to be physically active. And reasonable access to doctors. Things like that.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
Incorrect. See: many posts from Canadians (myself included) and folks from other countries. It works without worrying about any of that.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
Ironically, it's this exact line of thought that results in a lot of right-wing types not wanting government healthcare. It puts us on the road towards the government suddenly "having an interest" in many other aspects of our life, and we don't want that intrusion.
Yeah, it's easy to say "well maybe the government SHOULD regulate soda and fast food and candy" but how about another angle; what if the government decides broken legs from skiing is costing the health system too much money, so now there is going to be a skiing tax equal to, I dunno, 50% of your lift ticket if you go skiing, what would that do to most mountain resorts?
Single Payer healthcare systems is opens up Those Who Know Better Than Us all kinds of potential power to create new rules and laws all under the guise of "we pay for your healthcare so we have an interest in making sure you act in XXX way".
Yes in theory insurance companies can do the same thing, but as long as there is some choice (I can change jobs, I can push my employer to change insurance companies, I can elect to go on my spouse's benefits instead of mine) there is more potential freedom of choice than if the only answer is the government.
No thanks.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
Ironically, it's this exact line of thought that results in a lot of right-wing types not wanting government healthcare. It puts us on the road towards the government suddenly "having an interest" in many other aspects of our life, and we don't want that intrusion.
Yeah, it's easy to say "well maybe the government SHOULD regulate soda and fast food and candy" but how about another angle; what if the government decides broken legs from skiing is costing the health system too much money, so now there is going to be a skiing tax equal to, I dunno, 50% of your lift ticket if you go skiing, what would that do to most mountain resorts?
Single Payer healthcare systems is opens up Those Who Know Better Than Us all kinds of potential power to create new rules and laws all under the guise of "we pay for your healthcare so we have an interest in making sure you act in XXX way".
Yes in theory insurance companies can do the same thing, but as long as there is some choice (I can change jobs, I can push my employer to change insurance companies, I can elect to go on my spouse's benefits instead of mine) there is more potential freedom of choice than if the only answer is the government.
No thanks.
Wouldn't that actually make our decisions more free though? If you could include the implied healthcare risk of every activity as a tax, then you would no longer be worrying about what decisions people make.
A sugar tax equal in measure to how much sugar consumption increases medical costs. Don't eat sugar, don't pay the tax.
A ski tax that pays for all ski accidents? Don't ski.
This would basically be a fee-based model that conservative politicians love to implement. That way people who don't ski don't feel like they have to pay for the extreme risks of those who do.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
Ironically, it's this exact line of thought that results in a lot of right-wing types not wanting government healthcare. It puts us on the road towards the government suddenly "having an interest" in many other aspects of our life, and we don't want that intrusion.
Yeah, it's easy to say "well maybe the government SHOULD regulate soda and fast food and candy" but how about another angle; what if the government decides broken legs from skiing is costing the health system too much money, so now there is going to be a skiing tax equal to, I dunno, 50% of your lift ticket if you go skiing, what would that do to most mountain resorts?
Single Payer healthcare systems is opens up Those Who Know Better Than Us all kinds of potential power to create new rules and laws all under the guise of "we pay for your healthcare so we have an interest in making sure you act in XXX way".
Yes in theory insurance companies can do the same thing, but as long as there is some choice (I can change jobs, I can push my employer to change insurance companies, I can elect to go on my spouse's benefits instead of mine) there is more potential freedom of choice than if the only answer is the government.
No thanks.
Wouldn't that actually make our decisions more free though? If you could include the implied healthcare risk of every activity as a tax, then you would no longer be worrying about what decisions people make.
A sugar tax equal in measure to how much sugar consumption increases medical costs. Don't eat sugar, don't pay the tax.
A ski tax that pays for all ski accidents? Don't ski.
This would basically be a fee-based model that conservative politicians love to implement. That way people who don't ski don't feel like they have to pay for the extreme risks of those who do.
Orrrr you essentially legislate those industries out of existence. And then no one skiis. Supply/Demand tells us that if the price of something increases, demand goes down. Jack up the price of lift tickets, it's not unthinkable that all of the sudden you've killed enough demand to make skiing unprofitable (at least in the US, rich people could go to Canada or Europe or wherever).
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We do social risk mitigation - but Canadians seem to be more easygoing than Americans about agreeing to social rules that are of benefit. Things like seat-belts. Helmets. Speed limits. For example, we don't see seat-belts as an infringement on our freedom, we see them as a sensible way to stay safer in an accident. Those cars where the seat belt does up automatically? Those were invented for Americans - at the time, Canadian compliance was high, we didn't need them.
Quebec passed a law that a car has to have winter tires on starting mid-December, and apart from a bit of complaining everyone followed it - most were doing it anyway, but in November. Followup showed a decrease in winter accidents, because the people who thought all-seasons were OK then had to have the right tires. We see it as common sense - you have a car, you have it registered, you have a driver's license, you have the appropriate tires on the car.
We also don't do the moral judgement thing about health care - if you are sick, you get it (assuming you are eligible). They will do risk assessment - if there is a lung available for transplant and 3 people meet the immune system criteria, the person who smokes is least likely to get it. Simply because things are likely to go better for the person who does not smoke.
Skiiers/snowboarders and broken bones? Accidents happen. Is the hill design safe? No? Modify it? Are there accidents on the chair lift? Check it. In a resort area make sure there is a hospital with good trauma services. Seriously, Canada has the Laurentians and the Rockies, both big ski areas, and no-one is penalizing skiers who might break something. Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
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Those cars where the seat belt does up automatically? Those were invented for Americans - at the time, Canadian compliance was high, we didn't need them.
Sorta. Those seatbelts were created because the US had a law that after a certain date, all cars had to have a "passive restraint system" which contained unbelted passengers. This was generally understood to mean airbags, but those seatbelts counted as a passive system in cases where for whatever reason, airbags didn't make sense. For instance, the design of the car didn't allow for an airbag, the choice was to either discontinue sales until time when the car could be redesigned to allow airbags, or those seatbelts could be put in place as a stop-gap measure.
Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
Yes, and I for one do not want more, which is what I think Single-Payer health care will invite.
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Orrrr you essentially legislate those industries out of existence. And then no one skiis. Supply/Demand tells us that if the price of something increases, demand goes down. Jack up the price of lift tickets, it's not unthinkable that all of the sudden you've killed enough demand to make skiing unprofitable (at least in the US, rich people could go to Canada or Europe or wherever).
Hmm. Nope. Sounds like you're just talking without actually thinking. When was the last time an industry got taxed out of existence?
Let's do an estimate on this.
Let's assume a .5% injury rate per year. So out of 200 people that go skiing in a year 1 gets injured.
Each person goes an average of 3 times per year. So something like 1 injury per 600 rides.
The tax is applied to ski lift tickets. Let's make that a nice round $100.
The average cost of an injury is $10k.
600 * 100 / 10000 = 16%
I gave what I think is an upper bound to this idea. No a $7-15 surcharge for lift tickets to cover additional health risks would not "destroy" the ski industry.
Most states charge a 12-18% rental car tax and that industry seems to do just fine. If the ski industry were truly producing that many injuries and creating a large externality on the general populous, then it probably does deserve to go away. But it's not. So your fear seems unfounded to me.
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Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
Yes, and I for one do not want more, which is what I think Single-Payer health care will invite.
European countries with universal health care don't do this, the UK doesn't do this, Canada, Australia and New Zealand don't do this. Is the US so different that it will? So far you are the only American on here saying this, so I wonder if others think this too.
Also, your Medicaid and Medicare don't do this, why would it happen if there were universal health care for all? You as a country would be saving a huge amount of money with it, based on per capita costs. (shown below)
Total health expenditure per capita in PPP international U.S. dollars (not inflation-adjusted).[1][3][4] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Country 2013 2014 2015 2016
Australia 4,186 4,289 4,493 4,708
Austria 4,861 5,001 5,100 5,227
Belgium 4,505 4,656 4,778 4,840
Canada 4,461 4,502 4,613 4,753
Chile 1,646 1,737 1,877 1,977
Czech Republic 2,380 2,476 2,466 2,544
Denmark 4,772 4,906 5,058 5,205
Estonia 1,652 1,773 1,885 1,989
Finland 3,920 3,935 3,993 4,033
France 4,331 4,464 4,530 4,600
Germany 4,961 5,200 5,353 5,551
Greece 2,175 2,099 2,210 2,223
Hungary 1,776 1,821 1,913 2,101
Iceland 3,707 3,891 4,106 4,376
Ireland 5,033 5,082 5,276 5,528
Israel 2,423 2,595 2,713 2,822
Italy 3,235 3,271 3,352 3,391
Japan 4,207 4,269 4,436 4,519
Korea 2,252 2,396 2,535 2,729
Latvia 1,224 1,311 1,434 1,466
Luxembourg 6,693 6,850 6,818 7,463
Mexico 1,038 1,026 1,054 1,080
Netherlands 5,303 5,322 5,297 5,385
New Zealand 3,402 3,496 3,545 3,590
Norway 5,979 6,136 6,190 6,647
Poland 1,576 1,606 1,704 1,798
Portugal 2,536 2,599 2,664 2,734
Slovak Republic 2,100 2,009 2,059 2,150
Slovenia 2,586 2,647 2,731 2,835
Spain 2,941 3,057 3,180 3,248
Sweden 5,070 5,170 5,266 5,488
Switzerland 6,794 7,096 7,536 7,919
Turkey 978 1,003 997 1,088
United Kingdom 3,845 3,989 4,125 4,192
United States 8,616 9,036 9,507 9,892
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Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
Yes, and I for one do not want more, which is what I think Single-Payer health care will invite.
European countries with universal health care don't do this, the UK doesn't do this, Canada, Australia and New Zealand don't do this. Is the US so different that it will? So far you are the only American on here saying this, so I wonder if others think this too.
Also, your Medicaid and Medicare don't do this, why would it happen if there were universal health care for all? You as a country would be saving a huge amount of money with it, based on per capita costs. (shown below)
Total health expenditure per capita in PPP international U.S. dollars (not inflation-adjusted).[1][3][4] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
Country 2013 2014 2015 2016
Australia 4,186 4,289 4,493 4,708
Austria 4,861 5,001 5,100 5,227
Belgium 4,505 4,656 4,778 4,840
Canada 4,461 4,502 4,613 4,753
Chile 1,646 1,737 1,877 1,977
Czech Republic 2,380 2,476 2,466 2,544
Denmark 4,772 4,906 5,058 5,205
Estonia 1,652 1,773 1,885 1,989
Finland 3,920 3,935 3,993 4,033
France 4,331 4,464 4,530 4,600
Germany 4,961 5,200 5,353 5,551
Greece 2,175 2,099 2,210 2,223
Hungary 1,776 1,821 1,913 2,101
Iceland 3,707 3,891 4,106 4,376
Ireland 5,033 5,082 5,276 5,528
Israel 2,423 2,595 2,713 2,822
Italy 3,235 3,271 3,352 3,391
Japan 4,207 4,269 4,436 4,519
Korea 2,252 2,396 2,535 2,729
Latvia 1,224 1,311 1,434 1,466
Luxembourg 6,693 6,850 6,818 7,463
Mexico 1,038 1,026 1,054 1,080
Netherlands 5,303 5,322 5,297 5,385
New Zealand 3,402 3,496 3,545 3,590
Norway 5,979 6,136 6,190 6,647
Poland 1,576 1,606 1,704 1,798
Portugal 2,536 2,599 2,664 2,734
Slovak Republic 2,100 2,009 2,059 2,150
Slovenia 2,586 2,647 2,731 2,835
Spain 2,941 3,057 3,180 3,248
Sweden 5,070 5,170 5,266 5,488
Switzerland 6,794 7,096 7,536 7,919
Turkey 978 1,003 997 1,088
United Kingdom 3,845 3,989 4,125 4,192
United States 8,616 9,036 9,507 9,892
https://www.beveragedaily.com/Article/2017/12/20/Sugar-taxes-The-global-picture-in-2017 (https://www.beveragedaily.com/Article/2017/12/20/Sugar-taxes-The-global-picture-in-2017)
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Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
Yes, and I for one do not want more, which is what I think Single-Payer health care will invite.
European countries with universal health care don't do this, the UK doesn't do this, Canada, Australia and New Zealand don't do this. Is the US so different that it will? So far you are the only American on here saying this, so I wonder if others think this too.
Also, your Medicaid and Medicare don't do this, why would it happen if there were universal health care for all? You as a country would be saving a huge amount of money with it, based on per capita costs.
Probably the most effective strategy among conservatives for avoiding universal health care is pretending that dozens of other developed countries don't already implement it successfully, and at a lesser cost to taxpayers than American pay for their healthcare. This allows them free reign to imagine all sorts of freedom-constraining nightmare scenarios like "OMG what if universal health care kills the skiing industry??"
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Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
Yes, and I for one do not want more, which is what I think Single-Payer health care will invite.
European countries with universal health care don't do this, the UK doesn't do this, Canada, Australia and New Zealand don't do this. Is the US so different that it will? So far you are the only American on here saying this, so I wonder if others think this too.
The last two pages of this thread were people debating how best to tax fat people?
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Orrrr you essentially legislate those industries out of existence. And then no one skiis. Supply/Demand tells us that if the price of something increases, demand goes down. Jack up the price of lift tickets, it's not unthinkable that all of the sudden you've killed enough demand to make skiing unprofitable (at least in the US, rich people could go to Canada or Europe or wherever).
Hmm. Nope. Sounds like you're just talking without actually thinking. When was the last time an industry got taxed out of existence?
Luxury tax on the boat industry in the early 1990s damn near killed it.
Let's do an estimate on this.
Let's assume a .5% injury rate per year. So out of 200 people that go skiing in a year 1 gets injured.
Each person goes an average of 3 times per year. So something like 1 injury per 600 rides.
The tax is applied to ski lift tickets. Let's make that a nice round $100.
The average cost of an injury is $10k.
600 * 100 / 10000 = 16%
There are a lot of numbers there. Where do they come from? The average cost of a broken leg is $10k? Are you sure? What about surgery for a torn ACL? etc etc etc?
I gave what I think is an upper bound to this idea. No a $7-15 surcharge for lift tickets to cover additional health risks would not "destroy" the ski industry.
Most states charge a 12-18% rental car tax and that industry seems to do just fine. If the ski industry were truly producing that many injuries and creating a large externality on the general populous, then it probably does deserve to go away. But it's not. So your fear seems unfounded to me.
It was an example. Pick a different one, I don't care.
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I guess I should have expected a non-reply.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
What? I wasn't quibbling. I was agreeing with you.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
Perhaps, but I wish they'd meddle less. I am not interested in them meddling more. I don't see how them taking over healthcare results in them meddling less.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
What? I wasn't quibbling. I was agreeing with you.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
Perhaps, but I wish they'd meddle less. I am not interested in them meddling more. I don't see how them taking over healthcare results in them meddling less.
I would enjoy them meddling for people's good, for a change. Since they're going to be meddling anyway.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
What? I wasn't quibbling. I was agreeing with you.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
Perhaps, but I wish they'd meddle less. I am not interested in them meddling more. I don't see how them taking over healthcare results in them meddling less.
I would enjoy them meddling for people's good, for a change. Since they're going to be meddling anyway.
I would object to that. I would prefer to decrease meddling rather than just redirect.
-
I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
What? I wasn't quibbling. I was agreeing with you.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
Perhaps, but I wish they'd meddle less. I am not interested in them meddling more. I don't see how them taking over healthcare results in them meddling less.
I would enjoy them meddling for people's good, for a change. Since they're going to be meddling anyway.
I would object to that. I would prefer to decrease meddling rather than just redirect.
Yes. Well. I would say that there is a role for government to actually do some good in people's lives. I imagine that you and I are probably on different sides of that argument.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
What? I wasn't quibbling. I was agreeing with you.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
Perhaps, but I wish they'd meddle less. I am not interested in them meddling more. I don't see how them taking over healthcare results in them meddling less.
I would enjoy them meddling for people's good, for a change. Since they're going to be meddling anyway.
I would object to that. I would prefer to decrease meddling rather than just redirect.
Yes. Well. I would say that there is a role for government to actually do some good in people's lives. I imagine that you and I are probably on different sides of that argument.
There's some good, and there's regulating (for instance) how much soda someone can buy at a meal. That's way too paternalistic for me.
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I guess I should have expected a non-reply.
A non reply? You just spouted a bunch of numbers and then threw math at them. Are those numbers the right ones?
And again, you're quibbling with an example. We had NYC ban "oversized" drinks and Chicago tax soda/energy drinks. If you give healthcare over to the government does this become more or less prevalent?
And on the other hand, we have the federal government heavily subsidizing corn syrup. Which is what goes into those sodas/energy drinks (not to mention tons and tons of other foods and drinks that are incredibly bad for you).
If you give healthcare over to the government, does that become more or less prevalent?
Corn subsidies won't go away until we move the first primaries out of Iowa.
I wish we would, because I hate the E10/E15 requirement in gasoline.
You just accused FIPurpose of quibbling over an example. And now you are quibbling over an example.
What? I wasn't quibbling. I was agreeing with you.
The point is, you implied that giving healthcare over to the government will automatically make the government meddle more in people's food choices. My point is they already meddle so much that it's basically not worth arguing about.
Perhaps, but I wish they'd meddle less. I am not interested in them meddling more. I don't see how them taking over healthcare results in them meddling less.
I would enjoy them meddling for people's good, for a change. Since they're going to be meddling anyway.
I would object to that. I would prefer to decrease meddling rather than just redirect.
Yes. Well. I would say that there is a role for government to actually do some good in people's lives. I imagine that you and I are probably on different sides of that argument.
There's some good, and there's regulating (for instance) how much soda someone can buy at a meal. That's way too paternalistic for me.
For me, too.
That doesn’t mean I don’t think we should have universal health care.
And again, you are comparing a city regulation to the federal government. It’s not a particulary convincing argument.
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I think universal health care is an essential public service, not necessarily a right but essential nonetheless. I largely agree with BeanCounter's view so I don't have much to add on that front. However, a "universal health care" will be a lot more problematic than what most people here envision. Having seen variations of it in three different countries (lived and worked) I learned they mostly transformed problems from affordability to other types of issues.
Here are some common problems:
Wait time (ER, procedures queue, specialist appointments queue) can be exceedingly long; service "qualities" (in terms of crowded beds and time with care providers) tend to be less than satisfactory; and drug "varieties". It is true most of the time generic drugs will be enough but there are exceptions.
Also, keep in mind, prescription drugs are not "free" per se in both NHS and Canada. Australia PBS is indeed an exception but it acts more like a subsidy instead of "free" drugs.
Finally, on the cost front, I think if it were to be enacted, it'd would be part of the MMT (Modern Monetary Theory) policy package. In that framework, public spending is not constrained by tax revenues so the cost issue would be bypassed.
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I think universal health care is an essential public service, not necessarily a right but essential nonetheless. I largely agree with BeanCounter's view so I don't have much to add on that front. However, a "universal health care" will be a lot more problematic than what most people here envision. Having seen variations of it in three different countries (lived and worked) I learned they mostly transformed problems from affordability to other types of issues.
Here are some common problems:
Wait time (ER, procedures queue, specialist appointments queue) can be exceedingly long; service "qualities" (in terms of crowded beds and time with care providers) tend to be less than satisfactory; and drug "varieties". It is true most of the time generic drugs will be enough but there are exceptions.
Also, keep in mind, prescription drugs are not "free" per se in both NHS and Canada. Australia PBS is indeed an exception but it acts more like a subsidy instead of "free" drugs.
Finally, on the cost front, I think if it were to be enacted, it'd would be part of the MMT (Modern Monetary Theory) policy package. In that framework, public spending is not constrained by tax revenues so the cost issue would be bypassed.
Yes.
But don’t let the perfect be the enemy of the good.
Just because there will inevitably be problems does not mean it won’t be one hell of a lot better than what we have now.
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Yes.
But don’t let the perfect be the enemy of the good.
Just because there will inevitably be problems does not mean it won’t be one hell of a lot better than what we have now.
For the first time in forever (Disney song), we are in agreement.
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Yes.
But don’t let the perfect be the enemy of the good.
Just because there will inevitably be problems does not mean it won’t be one hell of a lot better than what we have now.
For the first time in forever (Disney song), we are in agreement.
Honestly, I never thought it would happen.
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Yes in theory insurance companies can do the same thing, but as long as there is some choice (I can change jobs, I can push my employer to change insurance companies, I can elect to go on my spouse's benefits instead of mine) there is more potential freedom of choice than if the only answer is the government.
No thanks.
Eh, good luck with that. Do you know how much my husband's employer cares about how much we hate UnitedHealthcare for gaming thousands of dollars out of us, because a doctor I never even met was considered "Tier 2" rather than "Tier 1"?
Almost less than zero.
We would still be able to purchase private insurance, although doubtless the selections would change. And other opportunities would open... changing jobs or starting their own small businesses would be easier for people, if they weren't afraid of losing healthcare.
Orrrr you essentially legislate those industries out of existence. And then no one skiis. Supply/Demand tells us that if the price of something increases, demand goes down. Jack up the price of lift tickets, it's not unthinkable that all of the sudden you've killed enough demand to make skiing unprofitable (at least in the US, rich people could go to Canada or Europe or wherever).
Canada or Europe, where skiing is dead because they have universal health care? And I haven't noticed (for better or worse) that they've managed to kill even smoking or alcohol consumption in these countries.
If you're worried about your big sodas, just don't vote for Bloomberg!
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All it takes is personal experience with being poor and needing treatment. That was 1910, how would he fare in the current US system?
If he lived in an Medicaid expansion state he would do alright in the US.
That was the same in Canada; Saskatchewan got health care before the rest of the country, it was controversial at the time. It was largely opposed by Doctors; apparently they feared they would lose the ability to bill as much. Its still a small problem in Canada, doctors heading south to make big money off american patients.
I suspect a lot of the funding opposed to healthcare is by people who make a lot of money off the current system. There's a lot of parallels in the arguments that Canadians made opposing healthcare, most of this thread could have been written in the 60's.
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So called Universal Health Care,......
It starts with the promise of "free" health care for all.
Like the threat of communism in the 1950s, it is an insidious plot to remove the freedoms of all Americans.
What comes after the "free" health care. Well, one thing may be a tax on sugar.
Do you want to take away every American's God given right to tooth decay, obesity and diabetes?
What could it lead to after that? What heinous things will "free" health care advocates force on the rest of us?
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Americans come up with more "for your own good" interference ideas than I can imagine, and they are supposed to be the "land of the free". Is it the Puritan influence still rearing its head?
Yes, and I for one do not want more, which is what I think Single-Payer health care will invite.
European countries with universal health care don't do this, the UK doesn't do this, Canada, Australia and New Zealand don't do this. Is the US so different that it will? So far you are the only American on here saying this, so I wonder if others think this too.
Also, your Medicaid and Medicare don't do this, why would it happen if there were universal health care for all? You as a country would be saving a huge amount of money with it, based on per capita costs. (shown below)
https://www.beveragedaily.com/Article/2017/12/20/Sugar-taxes-The-global-picture-in-2017 (https://www.beveragedaily.com/Article/2017/12/20/Sugar-taxes-The-global-picture-in-2017)
Interesting but I am not sure why you posted it as a reply to my post.
Most of this is so recent that the effects will not be known for a few years. Plus corn subsidies make high fructose corn syrup incredibly cheap. Food prices are affected by what gets subsidized and what does not, it is definitely not a level playing field now.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
I can see that perspective.
And I'd like to add to it.
We would have a moral responsibility to one another, as a society, to make sure that everyone had the potential to be healthy.
Meaning, we'd have a moral responsibility as a society to address problems such as food deserts, and things like the water in Flint, MI. Making sure people had reasonable access to healthy food. And reasonable access to ways to be physically active. And reasonable access to doctors. Things like that.
I agree. Those are all things that a comprehensive health Care system would have to help address. I have my doubts about those being addressed for a "top down" manner but that is the experiment.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
Incorrect. See: many posts from Canadians (myself included) and folks from other countries. It works without worrying about any of that.
That is because the system is working. No one worries when a system is working properly. They only worry when a system no longer works.
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That is because the system is working. No one worries when a system is working properly. They only worry when a system no longer works.
You seem to be assuming that for Americans it would not work. For no obvious reason. We have smokers, drinkers, druggies, couch potatoes, etc., and it still works. Not perfectly, I really wish dental were covered, and waits for non-emergencies can be longer than desired. But it works.
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I was looking for solutions for the "personal responsibility" issue. I would like any system that is created to have "safety relief valves" so self destructive people don't bring the whole system to a halt.
Ever heard of Banking crisis? Climate change? People driving drunken or too fast? People going skiing that have never done it before (Highest risk for broken leg or hip surgery in under 30s)? People getting into debt for luxuries? People getting booed for "not getting a job"?People...
You get it?
Self-caused medical problems are normally at the end of a row of self-caused or others-caused problems.
An generally the small amount of self destructive people is cheaper than the amount of money and work put into trying to prevent them (on what moral basis btw?) from services. Some is true for social transfers.
Just today I witnessed 4 people (or more) with at least 2 meetings involved in deciding about a payout of effectivly less than 240€ (travel costs for getting a job/work test).
The way I figured it, we came to the agreement to help heal the sick. We would all put money into a pool. That pool, while incomprehensibly huge, is still finite. The system would also have to make a "profit" in order to compensate for other factors. (Rising energy costs, national emergency, etc.)
Therefore it would be necessary for each of us to take what we need and not any more. I would have a moral responsibility to you to be healthy. You would have a moral responsibility to me to be healthy. We would have a moral responsibility to a third person to be healthy.
If a person persists in making bad decisions, they become drag on the system. Which causes problems.
Essentially everyone will have to lower their risk profile in order to make the system work.
Incorrect. See: many posts from Canadians (myself included) and folks from other countries. It works without worrying about any of that.
That is because the system is working. No one worries when a system is working properly. They only worry when a system no longer works.
"the system works everywhere else but I'm worried it won't work here"
What specifically will stop it from working in USA?
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That is because the system is working. No one worries when a system is working properly. They only worry when a system no longer works.
You seem to be assuming that for Americans it would not work. For no obvious reason. We have smokers, drinkers, druggies, couch potatoes, etc., and it still works. Not perfectly, I really wish dental were covered, and waits for non-emergencies can be longer than desired. But it works.
Canada has 1/10th our population. We would have to see if any in existence currently can scale like that. What works in one country may not work in another.
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Orrrr you essentially legislate those industries out of existence. And then no one skiis. Supply/Demand tells us that if the price of something increases, demand goes down. Jack up the price of lift tickets, it's not unthinkable that all of the sudden you've killed enough demand to make skiing unprofitable (at least in the US, rich people could go to Canada or Europe or wherever).
Canada or Europe, where skiing is dead because they have universal health care? And I haven't noticed (for better or worse) that they've managed to kill even smoking or alcohol consumption in these countries.
This skiing example is hilarious. You know where we see our family doctors most often? At the ski hill. Much more often than we see them for actual appointments in the office.
If skiing is so dangerous, why do so many Canadian doctors ski with their families? Why are they so thrilled when I tell them we also ski as a family. My GP seems to think skiing keeps me fit and healthy and that it's a good activity for my kids to be doing.
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That is because the system is working. No one worries when a system is working properly. They only worry when a system no longer works.
You seem to be assuming that for Americans it would not work. For no obvious reason. We have smokers, drinkers, druggies, couch potatoes, etc., and it still works. Not perfectly, I really wish dental were covered, and waits for non-emergencies can be longer than desired. But it works.
Canada has 1/10th our population. We would have to see if any in existence currently can scale like that. What works in one country may not work in another.
The UK has a lot more people and it works there. That is an excuse.
You have a perfectly adequate ratio of doctors and hospitals to population. You can decide to administer it federally or by state (Canada does it by province). There are lots of other countries with universal health care, you can cherry pick best practices from them.
What I am seeing from this discussion is a lack of will, a sense of "why should I have to pay for other people" and a sense of "why should I have to pay for people who have stupid/dangerous/unhealthy lifestyles". The old "pull myself up by my bootstraps and let the devil take the hindmost" and "I'm fine, screw you Jack" attitudes. Not all Americans, of course, but enough.
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Orrrr you essentially legislate those industries out of existence. And then no one skiis. Supply/Demand tells us that if the price of something increases, demand goes down. Jack up the price of lift tickets, it's not unthinkable that all of the sudden you've killed enough demand to make skiing unprofitable (at least in the US, rich people could go to Canada or Europe or wherever).
Canada or Europe, where skiing is dead because they have universal health care? And I haven't noticed (for better or worse) that they've managed to kill even smoking or alcohol consumption in these countries.
This skiing example is hilarious. You know where we see our family doctors most often? At the ski hill. Much more often than we see them for actual appointments in the office.
If skiing is so dangerous, why do so many Canadian doctors ski with their families? Why are they so thrilled when I tell them we also ski as a family. My GP seems to think skiing keeps me fit and healthy and that it's a good activity for my kids to be doing.
The weirdest part of the skiing example, is that it totally misses how the brains of the social economists works. In Norway, we have no fear of taxing stuff that is bad for your health, even when it might bankrupt businesses. The sugar tax of 2018, for instance, was a disaster for small breweries. But instead of taxing sports, we spend millions on subsidising them. One municipality on the west coast went as far as building their own ski lift, ending up with the largest municipal debt per inhabitant in the country. Why? Sure, for skiing there is also the issue of winning the olympics. But for other types of sports it is because we have calculations showing that the health benefits of acitivity greatly outnumbers the health costs of injuries. We were considering mandating helmets for bicyclists, but even that was vetoed by the economists. 10 people without diabetes saves us more than one brain injury costs us.
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We would have to see if any in existence currently can scale like that. What works in one country may not work in another.
That's true, countries have their own circumstances. Most Universal Health Care is not truly universal in terms of services provided. Dental, prescription drugs, physiotherapies, etc are not always covered in various systems. So it would be up to each country to decide what should be covered and what's not. The US is unique in terms of obesity and oxy addiction, so those are valid concerns that would need to be addressed.
I would like to bring up a nation that is more comparable to the US in terms of population and perhaps insurance: Japan.
Japan's insurance system bears some similarities with the US system, it is mandatory in name only, and it is not a single insurance system with over 3500 private health insurers. They fall into two categories (broadly speaking), Employee's health insurance and National Health Insurance.
The National Health Insurance (Kokumin-Kenkō-Hoken) might be relevant to the discussion here. It is similar to Medicare, but is open to all (almost all), including self-employed and students. This ties into what BeanCounter said previously and I think it has much merit, ie, expand Medicare. When the insured person uses a medical facility that accepts NHI, they will only need to pay part of the cost (~30%). And yes, there is a premium (income levy) that people pay for this insurance.
One big difference between Japan's "culture" and the States' is that Japan has a very different view on mental health. Some might call it outdated or even inhumane the way mental health patients are treated there. But on the quality of the "physical" health care side, Japan is doing quite well.
Here's an overview: https://transferwise.com/gb/blog/healthcare-system-in-japan
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That is because the system is working. No one worries when a system is working properly. They only worry when a system no longer works.
You seem to be assuming that for Americans it would not work. For no obvious reason. We have smokers, drinkers, druggies, couch potatoes, etc., and it still works. Not perfectly, I really wish dental were covered, and waits for non-emergencies can be longer than desired. But it works.
Canada has 1/10th our population. We would have to see if any in existence currently can scale like that. What works in one country may not work in another.
The UK has a lot more people and it works there. That is an excuse.
You have a perfectly adequate ratio of doctors and hospitals to population. You can decide to administer it federally or by state (Canada does it by province). There are lots of other countries with universal health care, you can cherry pick best practices from them.
What I am seeing from this discussion is a lack of will, a sense of "why should I have to pay for other people" and a sense of "why should I have to pay for people who have stupid/dangerous/unhealthy lifestyles". The old "pull myself up by my bootstraps and let the devil take the hindmost" and "I'm fine, screw you Jack" attitudes. Not all Americans, of course, but enough.
Okay let's back up a bit.
Systems are based on assumptions.
Universal Healthcare seems to assume that there will always be a "core" of healthy people producing enough excess value to treat the sick. A mathmatical ratio of healthy to sick, if you will.
A Canadian said "Canadians don't have to worry about that." Which means their ratio of healthy to sick is doing decently enough that the general population doesn't worry.
Now we have reached the theory part. Right now you have a plan on paper. How that plan translates to America is unknown. I am more than willing to give it a try at this point because as long as it is on the table for discussion, no one will consider any other options.
(With oil supplies dwindling, climate change accelerating and the health care crisis, New Urbanism seems like it would kill three birds with one stone. The public seems to believe that Universal Health Care will allow them to keep their current unsustainable lifestyles going.)
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gentmach
All the issues are there. But the thing is, the US as a country is paying about twice the per person cost for health care than the comparison countries are paying. Yes of course if a country's population is unhealthy (or aging, because let's face it, older people have more time to have had things go wrong) total costs may be Y instead of X. But that just means the US will be paying 2Y instead of 2X. Or what happens now, some people stay sick or die because they can't afford health care, or go bankrupt, or find job choices are dictated by the health insurance an employer does or does not offer.
I really started noticing the issue of American health care when I was planning my retirement and figuring out my post-work health insurance (and yes, I have insurance for the extras). Health care after retirement was such a big issue (and expense) for Americans, compared to my situation.
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It was noted that the United States has a "big" population and that could be a possible reason that universal health care wouldn't work. Apparently, the "economy of scale" may not apply to this huge number of people.
So, I got to wondering how do they do it in the "evil empire?" Russia has lots of people and they are spread out in a big big country. (144.5 million) With the fall of the Berlin wall years ago, it was an opportunity to embrace capitalistic medicine. Surely, folks over there shook off the Socialized medicine that had held them captive for so long.
Per Wikipedia, they kind of did for a while. Then they bounced back to having it covered by their government. Wikipedia says they pay 6.5 percent of their GDP for health care mainly by their government. This compares to about 18 percent of the GDP in the US. Maybe, you get what you pay for,.........maybe not.
https://en.wikipedia.org/wiki/Healthcare_in_Russia (https://en.wikipedia.org/wiki/Healthcare_in_Russia)
Perhaps the medical costs are kept low by sending poor and sick people to Gulags in Siberia where frozen corpses may lie in uncovered ditches hacked from the frozen tundra.
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I like @anisotropy ‘s mention of Japan’s healthcare since it is the most similar to ours in size and provides similar quality. Talking with friends and colleagues in Japan, the main differences that keep costs somewhat in check is the national government’s price control system, which sets maximum prices for all procedures and drugs. In addition, they have a lot fewer ICU beds than in the US, due to cultural aspects wherein it would be unusual for an elderly person with terminal diseases to be kept on prolonged, futile life support. Despite this, costs are starting to balloon anyway, mostly due to their population aging.
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Yes! The Japanese has a pretty tight price control system but the culture is definitely very different, Caveat Emptor!
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All Canadians reading this thread are staring at their screens with a confused-dog-head-tilt.
It's incredible, the mental gymnastics some people will do to justify continuing to spend an astronomical amount of money on a crazy system.
For those worrying about universal healthcare being a slippery slope to heavy handed government social intervention. Um...have you forgotten what country you live in? Any party attempting to do that would be eviscerated by their opposition, and there would probably be a government shut down.
You have mechanisms in place, very very strong mechanisms at that, to prevent your own government from doing things like that. Oh my...just think of the negative ad campaigns. Wow.
I mean, come on! Even in Canada there was severe backlash against a soda tax. Actually, the left was even aggressively against it, labeling it as an attack on the poor. Our opposition parties do a great job riling the public up about any and every social policy that could possibly piss people off. That shit is political gold. (We picked that up from you guys, btw)
Also, Canadians aren't protective of our universal health care because of some national sentiment of loving each other so sooooo much. It was a hard, ugly battle to get it, with tons of opposition. Also, we have plenty of vicious hate among ourselves, in some ways far worse than the US.
We're protective of it because we have it now.
We recognize how valuable it is, and we look down south, shudder, and kiss our healthcards.
There's a reason we voted Tommy Douglas as The Greatest Canadian. Yep, in 2004, our national television broadcaster had a multi-part, two level vote across the country, and the guy who brought us Universal Healthcare was voted The Greatest Canadian in our entire history. No one was surprised by the results.
Lastly, you know what's great about publicly funded healthcare?? It really doesn't promote weird social control policies over our food or skiing (???) or anything, but it DOES have a HUGE impact on the effectiveness of other major policies, like those regarding immigration, crime, welfare, etc.
Yep. Stuff like crime policies are always looked at through a lense of how they will affect the burden on our healthcare system. Drugs, violence, etc. That shit all costs healthcare dollars, so we are highly motivated to research and implement policies that lower the burden to the healthcare system, and y'know, actually work.
When those policies don't work, the government feels the cost of their own failure quite quickly, so they are highly motivated. There's still plenty of fuckery, but increases in healthcare spending that correlate with a new policy are hard to ignore.
Neat, huh?
Our system isn't perfect, our doctors are always angry, our nurses threaten to strike, our wait times can be prohibitive, our non-urban regions are painfully underserved, our drugs and dental aren't covered, and the debate about two-tiered-semi-privatization rages on and on and on and always will.
It's a cluster fuck for sure. But it's a hell of a lot less of a cluster fuck than the US system, and it's a hell of a lot cheaper.
Do you know how nice it is to have a medical emergency, rush to the nearest ER and not have to worry about anything other than the medical emergency you are having at that very moment. Not a single thought of some weird non-itemized bill showing up down the road.
It's nice. It's very nice.
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+1 to that!
It's not perfect, but there's no way in hell I'd ever trade it for the US system.
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+1 to that!
It's not perfect, but there's no way in hell I'd ever trade it for the US system.
It is definitely not perfect, but having the US for a neighbourly comparison makes it look amazing. And I was fascinated by the pragmatic calculations of an earlier poster (from Finland?) and how they find the universal health care is financially beneficial. I would guess that we reap the same national benefits. I'm just happy that my friends who have had major health crises were able to get care without going bankrupt.
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"It's incredible, the mental gymnastics some people will do to justify continuing to spend an astronomical amount of money on a crazy system."
These Canadians just don't understand that the Donald Trump tax cuts allow extra money to pay for health care. In the future, the money saved by the corporations will allow added investment to enable the benefits to trickle down to all enabling even more to be spent on health care.
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Lastly, you know what's great about publicly funded healthcare?? It really doesn't promote weird social control policies over our food or skiing (???) or anything, but it DOES have a HUGE impact on the effectiveness of other major policies, like those regarding immigration, crime, welfare, etc.
Yep. Stuff like crime policies are always looked at through a lense of how they will affect the burden on our healthcare system. Drugs, violence, etc. That shit all costs healthcare dollars, so we are highly motivated to research and implement policies that lower the burden to the healthcare system, and y'know, actually work.
When those policies don't work, the government feels the cost of their own failure quite quickly, so they are highly motivated. There's still plenty of fuckery, but increases in healthcare spending that correlate with a new policy are hard to ignore.
Neat, huh?
Wow. I was in favor of single-payer already, but wow. That's a brilliant alignment of incentives. I never thought about it that way.
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A friend of mine recently brought up a point in favor of universal health care that I hadn't even thought of (guess it should have been obvious)... savings to local government because health benefits will no longer have to be part of pension plans. Have the calculations of costs included savings on state and local taxes?
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A friend of mine recently brought up a point in favor of universal health care that I hadn't even thought of (guess it should have been obvious)... savings to local government because health benefits will no longer have to be part of pension plans. Have the calculations of costs included savings on state and local taxes?
No idea. My health plan in retirement was negotiated by my (para-public) union on behalf of all its retired members. But even if health insurance is part of a retirement package, it is a health plan that covers the extras, not the basics, so much less expensive.
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All Canadians reading this thread are staring at their screens with a confused-dog-head-tilt.
It's incredible, the mental gymnastics some people will do to justify continuing to spend an astronomical amount of money on a crazy system.
For those worrying about universal healthcare being a slippery slope to heavy handed government social intervention. Um...have you forgotten what country you live in? Any party attempting to do that would be eviscerated by their opposition, and there would probably be a government shut down.
You have mechanisms in place, very very strong mechanisms at that, to prevent your own government from doing things like that. Oh my...just think of the negative ad campaigns. Wow.
I mean, come on! Even in Canada there was severe backlash against a soda tax. Actually, the left was even aggressively against it, labeling it as an attack on the poor. Our opposition parties do a great job riling the public up about any and every social policy that could possibly piss people off. That shit is political gold. (We picked that up from you guys, btw)
Also, Canadians aren't protective of our universal health care because of some national sentiment of loving each other so sooooo much. It was a hard, ugly battle to get it, with tons of opposition. Also, we have plenty of vicious hate among ourselves, in some ways far worse than the US.
We're protective of it because we have it now.
We recognize how valuable it is, and we look down south, shudder, and kiss our healthcards.
There's a reason we voted Tommy Douglas as The Greatest Canadian. Yep, in 2004, our national television broadcaster had a multi-part, two level vote across the country, and the guy who brought us Universal Healthcare was voted The Greatest Canadian in our entire history. No one was surprised by the results.
Lastly, you know what's great about publicly funded healthcare?? It really doesn't promote weird social control policies over our food or skiing (???) or anything, but it DOES have a HUGE impact on the effectiveness of other major policies, like those regarding immigration, crime, welfare, etc.
Yep. Stuff like crime policies are always looked at through a lense of how they will affect the burden on our healthcare system. Drugs, violence, etc. That shit all costs healthcare dollars, so we are highly motivated to research and implement policies that lower the burden to the healthcare system, and y'know, actually work.
When those policies don't work, the government feels the cost of their own failure quite quickly, so they are highly motivated. There's still plenty of fuckery, but increases in healthcare spending that correlate with a new policy are hard to ignore.
Neat, huh?
Our system isn't perfect, our doctors are always angry, our nurses threaten to strike, our wait times can be prohibitive, our non-urban regions are painfully underserved, our drugs and dental aren't covered, and the debate about two-tiered-semi-privatization rages on and on and on and always will.
It's a cluster fuck for sure. But it's a hell of a lot less of a cluster fuck than the US system, and it's a hell of a lot cheaper.
Do you know how nice it is to have a medical emergency, rush to the nearest ER and not have to worry about anything other than the medical emergency you are having at that very moment. Not a single thought of some weird non-itemized bill showing up down the road.
It's nice. It's very nice.
I think we've entered that late stage of the debate that comes down to "what is human nature?" As a jaded, cynical person who has been dealing with borderline psychopaths most of his life, the idea that my healthcare is their hands is unsettling.
And before you say "get away from them", we will be linked by the healthcare system whether I wish it or not.
So let's give healthcare a try.
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I think we've entered that late stage of the debate that comes down to "what is human nature?" As a jaded, cynical person who has been dealing with borderline psychopaths most of his life, the idea that my healthcare is their hands is unsettling.
And before you say "get away from them", we will be linked by the healthcare system whether I wish it or not.
So let's give healthcare a try.
I am so confused...
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I think we've entered that late stage of the debate that comes down to "what is human nature?" As a jaded, cynical person who has been dealing with borderline psychopaths most of his life, the idea that my healthcare is their hands is unsettling.
And before you say "get away from them", we will be linked by the healthcare system whether I wish it or not.
So let's give healthcare a try.
I am so confused...
That is the only appropriate response here
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"It's incredible, the mental gymnastics some people will do to justify continuing to spend an astronomical amount of money on a crazy system."
These Canadians just don't understand that the Donald Trump tax cuts allow extra money to pay for health care. In the future, the money saved by the corporations will allow added investment to enable the benefits to trickle down to all enabling even more to be spent on health care.
Was that a bad try at irony?
Or is there still someone on the planet that didn't hear that "trickle down" is not only completely unlogical, but even also does not happen in reality?
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
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Frankly I'm surprised that a party so concerned with private activities of it's citizens (bedrooms, living rooms, AND bathrooms) does not jump at the chance to better guide it's citizens toward a more moral and responsible path. I'd have thought the "shared responsibility" that universal health care encourages would dovetail nicely with the principles taught in the good book.
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All you Canadian/ European liberals just don't understand. Our corporate masters have told us that their decisions are actually freedom! Our capitalist system never purposefully shuts down new innovations that might be cheaper or less profitable. And our brains can never be fooled into making poor decisions or drugged into unhealthy lifestyles.
In fact, we've decided that the decisions we make as a people are in actuality not decisions of our own free will. The freedom of our vote is not equal to freedom of our representatives' decisions. Actually, the vote of our dollars in purchasing decisions is our own free will. The power we hand over to corporations everyday is freedom. And when those corporations dangle medicine and my very life in front of my hands, I will gladly exchange my money for my "freedom".
Because when the government does something sinister or backhanded and I continue to vote for the same person, well that's just politics; it's the game of government that is messed up. However, when a corporation discovers that humans can be tricked into consuming more than is healthy or reasonable, when a corporation can mandate its will on its consumers, well then you're just a weak-minded consumer. It is good for corporations to learn and devise how to trick people out of more of their money. Any decisions made by the later upon the former is an exercise of free speech and an expression of American liberty. But any decision made by the former upon the later is an attack upon freedom itself.
Our forefathers gained our liberty at the expense of their own lives, should our freedom cost us our own indentured servitude, then so be it.
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Frankly I'm surprised that a party so concerned with private activities of it's citizens (bedrooms, living rooms, AND bathrooms) does not jump at the chance to better guide it's citizens toward a more moral and responsible path. I'd have thought the "shared responsibility" that universal health care encourages would dovetail nicely with the principles taught in the good book.
Jesus never had police, guns, and prisons to enforce his Commandments. You obeyed His commandments voluntarily, and never with a gun to your head. And He never really thought much of Earthly governments.
It is easy to spend other people's money. His way is much harder.
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+1 to that!
It's not perfect, but there's no way in hell I'd ever trade it for the US system.
Universal Health Care means that people are able to take risks like starting businesses or other ventures even when they have kids.
A year ago I left my adequate job with good benefits to buy a business and work on upgrading it. It did mean losing my 'extended health insurance'. If we were in the US there is NO WAY I could have done that with 2 kids at home (DW's job has no benefits either).
We will still pay for dental and I hope one of the kids doesn't knock his teeth out, but I don't worry about a bankruptcy inducing health crisis that is not covered (like when my 9 year old spent a week in hospital in November with pneumonia). I was able to take a risk, unlike a middle aged American in the same situation.
You can pry my health card from my cold dead hands. It is pro business, pro innovation and makes everything better. I am continually astonished at the bizarre pretzel logic that happens in the US debates on health care.
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+1 to that!
It's not perfect, but there's no way in hell I'd ever trade it for the US system.
Universal Health Care means that people are able to take risks like starting businesses or other ventures even when they have kids.
A year ago I left my adequate job with good benefits to buy a business and work on upgrading it. It did mean losing my 'extended health insurance'. If we were in the US there is NO WAY I could have done that with 2 kids at home (DW's job has no benefits either).
We will still pay for dental and I hope one of the kids doesn't knock his teeth out, but I don't worry about a bankruptcy inducing health crisis that is not covered (like when my 9 year old spent a week in hospital in November with pneumonia). I was able to take a risk, unlike a middle aged American in the same situation.
You can pry my health card from my cold dead hands. It is pro business, pro innovation and makes everything better. I am continually astonished at the bizarre pretzel logic that happens in the US debates on health care.
A lot of us are, too.
And it is freaking infuriating to be held hostage by it.
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Frankly I'm surprised that a party so concerned with private activities of it's citizens (bedrooms, living rooms, AND bathrooms) does not jump at the chance to better guide it's citizens toward a more moral and responsible path. I'd have thought the "shared responsibility" that universal health care encourages would dovetail nicely with the principles taught in the good book.
Jesus never had police, guns, and prisons to enforce his Commandments. You obeyed His commandments voluntarily, and never with a gun to your head. And He never really thought much of Earthly governments.
It is easy to spend other people's money. His way is much harder.
I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
I agree with the sentiment that we should not subsidize sugar, and that lowering the price of sugar will lead to worse health outcomes. But my point was that I don't think that there are any subsidies for sugar. I don't have encyclopedic knowledge of all the US farm subsidies, so was wondering if there exist any that I didn't know about.
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Isn't there anyone left out there that can make a cogent argument for sustaining the current US health care system? Isn't there pleasure in seeing odd little bills in the mail six months after a doctor visit for the big portion not covered by insurance? Don't you like the idea of paying the equivalent of a car payment of house payment every month for insurance that is "supposed" to cover you in the event of a catastrophic event?
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+1 to that!
It's not perfect, but there's no way in hell I'd ever trade it for the US system.
Universal Health Care means that people are able to take risks like starting businesses or other ventures even when they have kids.
A year ago I left my adequate job with good benefits to buy a business and work on upgrading it. It did mean losing my 'extended health insurance'. If we were in the US there is NO WAY I could have done that with 2 kids at home (DW's job has no benefits either).
We will still pay for dental and I hope one of the kids doesn't knock his teeth out, but I don't worry about a bankruptcy inducing health crisis that is not covered (like when my 9 year old spent a week in hospital in November with pneumonia). I was able to take a risk, unlike a middle aged American in the same situation.
You can pry my health card from my cold dead hands. It is pro business, pro innovation and makes everything better. I am continually astonished at the bizarre pretzel logic that happens in the US debates on health care.
Ah yes...
I forgot about the entrepreneurial benefits of universal healthcare in my previous diatribe.
It horrifies me how stifled US entrepreneurialism is by the current healthcare system. It makes no sense in such a pro-industry culture that people support a system that discourages people from taking business risks.
I read so many posts on here talking about life plans/goals/dreams and the weight of this ridiculous insurance issue is just so omnipresent. The concept is so foreign to us.
I can't even fathom a life where I have to think about that, where I have to balance the fear of a financially crippling hospital stay into my potential career plans.
I can just move jobs, drop to part time, and start businesses as I see fit. I can randomly take a year off. It's all good.
Another business aspect is that it's a lot easier to become an employer when you don't have to provide insurance (or 401K plans, ours are run centrally by the government as well) to attract quality staff, which makes growing a business a whole lot simpler here. I could hire a team tomorrow with minimal administrative set up or cost.
I know it's all ideologically supposed to be about having the "freedom" to choose through the markets, but on an individual scale, it actually really suppresses freedom.
You Americans have this terrifying axe hanging over your heads at all times, and it truly saddens us up north to see it. We genuinely feel really terrible for you.
It just seems so...uncivilized.
Truthfully, I wonder what will happen up here if you guys ever get a decent universal healthcare system, because your epically fucked up insurance system is a frequently cited reason why Canadians refuse to move south...even when it's so cold that our dogs refuse to pee outside.
It would be interesting to see what affect that would have on the "brain drain", because it's a frequent conversation up here:
-"Would you ever consider moving to the states? You could make so much more money, pay less taxes, and housing is cheaper in a lot of areas"
-"Yeah...but healthcare..."
-"Right...there's that. Better stay put in our arctic-fucking-polar-vortex-frozen-hellscape and pay 13% sales tax on everything, because there's no way we're putting up with that shit. My fingers might fall off from frostbite, but at least I don't have to worry about a 600K bill for sewing them back on!"
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
I agree with the sentiment that we should not subsidize sugar, and that lowering the price of sugar will lead to worse health outcomes. But my point was that I don't think that there are any subsidies for sugar. I don't have encyclopedic knowledge of all the US farm subsidies, so was wondering if there exist any that I didn't know about.
https://www.washingtonpost.com/news/business/wp/2018/05/17/house-defeats-divisive-sugar-amendment-that-threatened-to-sink-farm-bill/?utm_term=.4dcd760e779f
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@Even Steven found this interesting article. https://grist.org/article/farm-subsidies-bitter-and-sweet/
I can see the rationale for boosting production of staples like corn, sugar, and soy... they keep well, they can be used for many purposes. What is the answer to obesity? Taxing sweets on the consumer end? It seems like making communities more walkable would be the most desirable answer, but it is expensive (there are many barriers to putting sidewalks into my community, for instance.) But this is quite the sidetrack!
A friend of mine recently brought up a point in favor of universal health care that I hadn't even thought of (guess it should have been obvious)... savings to local government because health benefits will no longer have to be part of pension plans. Have the calculations of costs included savings on state and local taxes?
No idea. My health plan in retirement was negotiated by my (para-public) union on behalf of all its retired members. But even if health insurance is part of a retirement package, it is a health plan that covers the extras, not the basics, so much less expensive.
Oops, I meant to also include the health benefits that municipalities pay to active firefighters, police, teachers, and other civil workers as well as after retirement.
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- SNIP -
It would be interesting to see what affect that would have on the "brain drain", because it's a frequent conversation up here:
-"Would you ever consider moving to the states? You could make so much more money, pay less taxes, and housing is cheaper in a lot of areas"
-"Yeah...but healthcare..."
-"Right...there's that. Better stay put in our arctic-fucking-polar-vortex-frozen-hellscape and pay 13% sales tax on everything, because there's no way we're putting up with that shit. My fingers might fall off from frostbite, but at least I don't have to worry about a 600K bill for sewing them back on!"
In the event of US Socialist medicine, we might need another wall and the Canucks will pay for it.
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- SNIP -
It would be interesting to see what affect that would have on the "brain drain", because it's a frequent conversation up here:
-"Would you ever consider moving to the states? You could make so much more money, pay less taxes, and housing is cheaper in a lot of areas"
-"Yeah...but healthcare..."
-"Right...there's that. Better stay put in our arctic-fucking-polar-vortex-frozen-hellscape and pay 13% sales tax on everything, because there's no way we're putting up with that shit. My fingers might fall off from frostbite, but at least I don't have to worry about a 600K bill for sewing them back on!"
In the event of US Socialist medicine, we might need another wall and the Canucks will pay for it.
HAHAHAHAHA
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I think we've entered that late stage of the debate that comes down to "what is human nature?" As a jaded, cynical person who has been dealing with borderline psychopaths most of his life, the idea that my healthcare is their hands is unsettling.
And before you say "get away from them", we will be linked by the healthcare system whether I wish it or not.
So let's give healthcare a try.
I am so confused...
I was saying it was a "personal" problem. Right now I am dealing with people who have no empathy, respect or loyalty to anyone else. That they CAN take everything they want because they think the world OWES them. It has biased my thinking and caused problems.
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
I agree with the sentiment that we should not subsidize sugar, and that lowering the price of sugar will lead to worse health outcomes. But my point was that I don't think that there are any subsidies for sugar. I don't have encyclopedic knowledge of all the US farm subsidies, so was wondering if there exist any that I didn't know about.
https://www.washingtonpost.com/news/business/wp/2018/05/17/house-defeats-divisive-sugar-amendment-that-threatened-to-sink-farm-bill/?utm_term=.4dcd760e779f
Thanks, interesting article. But doesn't it say that there were amendments to the farm bill that, if passed, would lower the price of sugar? And that those amendments were defeated and not included in the farm bill? So the subsidies that go to sugar are all policies that raise the price of sugar, thus decreasing its consumption? If we were to end those, and lower the price of sugar, wouldn't that lead to more consumption and worse health outcomes?
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
I agree with the sentiment that we should not subsidize sugar, and that lowering the price of sugar will lead to worse health outcomes. But my point was that I don't think that there are any subsidies for sugar. I don't have encyclopedic knowledge of all the US farm subsidies, so was wondering if there exist any that I didn't know about.
https://www.washingtonpost.com/news/business/wp/2018/05/17/house-defeats-divisive-sugar-amendment-that-threatened-to-sink-farm-bill/?utm_term=.4dcd760e779f
Thanks, interesting article. But doesn't it say that there were amendments to the farm bill that, if passed, would lower the price of sugar? And that those amendments were defeated and not included in the farm bill? So the subsidies that go to sugar are all policies that raise the price of sugar, thus decreasing its consumption? If we were to end those, and lower the price of sugar, wouldn't that lead to more consumption and worse health outcomes?
Very doubtful. You are right, and I apologize, if I seemed to be implying that the subsidies are to lower the price of sugar for the consumer. The subsidies are to protect sugar farmers. As the corn syrup subsidies are to keep the corn farmers in business. My posting of that was just in answer to your question about whether sugar was subsidized, which it is.
That said, I highly doubt at this point that ending sugar subsidies, with the subsequent lowering of the price of sugar, would lead to more consumption at this point. Corn syrup is the biggest problem at this point, and it has so pervaded every aspect of our food industry in the US that it would be hard to pack more of it in than we already do. The cat is sort of out of the bag.
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I think we've entered that late stage of the debate that comes down to "what is human nature?" As a jaded, cynical person who has been dealing with borderline psychopaths most of his life, the idea that my healthcare is their hands is unsettling.
And before you say "get away from them", we will be linked by the healthcare system whether I wish it or not.
So let's give healthcare a try.
I am so confused...
I was saying it was a "personal" problem. Right now I am dealing with people who have no empathy, respect or loyalty to anyone else. That they CAN take everything they want because they think the world OWES them. It has biased my thinking and caused problems.
Still confused...
My post that you quoted was about national policy...not sure what that has to do with some people being assholes. Good policy accounts for assholes because they're a normal part of the population, so policy makers know to put integrity programs in place in their policy.
You can't make policy based on not having assholes in your system, that would be sloppy and ineffective.
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
I agree with the sentiment that we should not subsidize sugar, and that lowering the price of sugar will lead to worse health outcomes. But my point was that I don't think that there are any subsidies for sugar. I don't have encyclopedic knowledge of all the US farm subsidies, so was wondering if there exist any that I didn't know about.
https://www.washingtonpost.com/news/business/wp/2018/05/17/house-defeats-divisive-sugar-amendment-that-threatened-to-sink-farm-bill/?utm_term=.4dcd760e779f
Thanks, interesting article. But doesn't it say that there were amendments to the farm bill that, if passed, would lower the price of sugar? And that those amendments were defeated and not included in the farm bill? So the subsidies that go to sugar are all policies that raise the price of sugar, thus decreasing its consumption? If we were to end those, and lower the price of sugar, wouldn't that lead to more consumption and worse health outcomes?
The various price controls on sugar, such as domestic production limits and tariffs on imports, make substitutes (such as high fructose corn syrup) more economical. I'm not an expert on farm subsidies, but National Geographic does a nice, brief synopsis here. (https://www.nationalgeographic.com/people-and-culture/food/the-plate/2016/07/are-corn-subsidies-making-us-fat-/) The deficiency payments pioneered in the 70s definitely caused a glut of corn and other crops, so our intrepid scientists figured out how to use the excessive production to squeeze corn into everything from Coke to gasoline. But as the National Geographic article points out, corn is not really the only culprit - almost every subsidized crop in the U.S. is a commodity crop associated with worse health outcomes, while the fruits and vegetables that are associated with positive health outcomes go unsubsidized. The reasoning is obvious: Farm subsidies are intended to improve farm income, not public health.
I'm not opposed to reasonable farm subsidies, because farmers face a classic economic problem: Inelastic supply (they grow what they're able grow in any given year) combined with inelastic demand (the public eats what it needs to eat in any given year). It is a difficult problem to solve, and our politicians have "solved" it by forcing excess supplies of inexpensive nutrients into the supply chain. Intuitively, I would prefer an approach that places more weight on the demand side - subsidizing healthy foods for consumers, thus increasing demand for those products and encouraging more farmers to grow them. But I'm not a public policy expert, I simply believe that solving one problem (food shortages in year of inadequate productions & struggling farmers in years of excessive production) has led to another one (constant, excessive supplies of unhealthy foods) that has led to negative health consequences. I believe that the system has room to improve.
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Several people in this thread are wanting to get rid of subsidies to corn syrup. What subsidies exactly are you all talking about?
I can think of three that apply to corn.
1) Tariffs on sugar cane could be considered an indirect subsidy to corn in the US, but that would raise, not lower, the price of sugar.
2) Ethanol mandate for gasoline could also be considered an indirect subsidy to corn, but ethanol production uses the fermentable sugars.
3) Crop insurance subsidies that apply to all crops equally. These go disproportionally to corn and soy, but that is because the US grows a lot of corn and soy. This subsidy does not encourage the growing of any crop over another, because all crops can get it.
Are there any that I am missing?
I can't speak for everyone, but I listed a few things we have subsidies on including corn.
1. Why do we need a subsidy on sugar? Short of tobacco and alcohol, which are controlled and heavily taxed, excessive amounts of sugar likely contribute the most harm to health in western society.
2. That's a great point. Why do we need a subsidy or mandate for ethanol?
3. Makes sense.
I agree with the sentiment that we should not subsidize sugar, and that lowering the price of sugar will lead to worse health outcomes. But my point was that I don't think that there are any subsidies for sugar. I don't have encyclopedic knowledge of all the US farm subsidies, so was wondering if there exist any that I didn't know about.
https://www.washingtonpost.com/news/business/wp/2018/05/17/house-defeats-divisive-sugar-amendment-that-threatened-to-sink-farm-bill/?utm_term=.4dcd760e779f
Thanks, interesting article. But doesn't it say that there were amendments to the farm bill that, if passed, would lower the price of sugar? And that those amendments were defeated and not included in the farm bill? So the subsidies that go to sugar are all policies that raise the price of sugar, thus decreasing its consumption? If we were to end those, and lower the price of sugar, wouldn't that lead to more consumption and worse health outcomes?
The various price controls on sugar, such as domestic production limits and tariffs on imports, make substitutes (such as high fructose corn syrup) more economical. I'm not an expert on farm subsidies, but National Geographic does a nice, brief synopsis here. (https://www.nationalgeographic.com/people-and-culture/food/the-plate/2016/07/are-corn-subsidies-making-us-fat-/) The deficiency payments pioneered in the 70s definitely caused a glut of corn and other crops, so our intrepid scientists figured out how to use the excessive production to squeeze corn into everything from Coke to gasoline. But as the National Geographic article points out, corn is not really the only culprit - almost every subsidized crop in the U.S. is a commodity crop associated with worse health outcomes, while the fruits and vegetables that are associated with positive health outcomes go unsubsidized. The reasoning is obvious: Farm subsidies are intended to improve farm income, not public health.
I'm not opposed to reasonable farm subsidies, because farmers face a classic economic problem: Inelastic supply (they grow what they're able grow in any given year) combined with inelastic demand (the public eats what it needs to eat in any given year). It is a difficult problem to solve, and our politicians have "solved" it by forcing excess supplies of inexpensive nutrients into the supply chain. Intuitively, I would prefer an approach that places more weight on the demand side - subsidizing healthy foods for consumers, thus increasing demand for those products and encouraging more farmers to grow them. But I'm not a public policy expert, I simply believe that solving one problem (food shortages in year of inadequate productions & struggling farmers in years of excessive production) has led to another one (constant, excessive supplies of unhealthy foods) that has led to negative health consequences. I believe that the system has room to improve.
Exactly.
Which is, as someone said above, a good argument for universal health care: because it might actually prompt the government to factor in the cost of public health when they make choices on which crops to subsidize.
Instead of farm income, the fast food industry, etc., at the expense of the American people as a whole.
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Exactly.
Which is, as someone said above, a good argument for universal health care: because it might actually prompt the government to factor in the cost of public health when they make choices on which crops to subsidize.
Instead of farm income, the fast food industry, etc., at the expense of the American people as a whole.
Um, that would depend on how well the various government agencies involved do their homework. I have no idea what Canadian subsidies are on agricultural products, apart from the obvious policies on dairy. And so much seems to be driven by other agendas - the wheat boards are an example. Canada is not a lot better than the US re health and obesity and type 2 diabetes, but of course so much of our food is either from the US or from US subsidiaries in Canada (not to mention advertising for all these profitable barely-foods) that food-wise we might as well be part of US agricultural policy.
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Exactly.
Which is, as someone said above, a good argument for universal health care: because it might actually prompt the government to factor in the cost of public health when they make choices on which crops to subsidize.
Instead of farm income, the fast food industry, etc., at the expense of the American people as a whole.
Um, that would depend on how well the various government agencies involved do their homework. I have no idea what Canadian subsidies are on agricultural products, apart from the obvious policies on dairy. And so much seems to be driven by other agendas - the wheat boards are an example. Canada is not a lot better than the US re health and obesity and type 2 diabetes, but of course so much of our food is either from the US or from US subsidiaries in Canada (not to mention advertising for all these profitable barely-foods) that food-wise we might as well be part of US agricultural policy.
Yes, true. It would at least potentially prompt them to consider those things -- as I said above.
Then again, these days you would probably lose money if you bet on the US government making decisions that are in the best interests of its people, over corporate interests and powerful lobby groups.
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I think we've entered that late stage of the debate that comes down to "what is human nature?" As a jaded, cynical person who has been dealing with borderline psychopaths most of his life, the idea that my healthcare is their hands is unsettling.
And before you say "get away from them", we will be linked by the healthcare system whether I wish it or not.
So let's give healthcare a try.
I am so confused...
I was saying it was a "personal" problem. Right now I am dealing with people who have no empathy, respect or loyalty to anyone else. That they CAN take everything they want because they think the world OWES them. It has biased my thinking and caused problems.
Still confused...
My post that you quoted was about national policy...not sure what that has to do with some people being assholes. Good policy accounts for assholes because they're a normal part of the population, so policy makers know to put integrity programs in place in their policy.
You can't make policy based on not having assholes in your system, that would be sloppy and ineffective.
I'm extrapolating local conditions to a national scale. If the assholes outnumber the productive people, then the system operates at a deficit. Operating at a deficit is unsustainable in the long run because at some point all the accounts must balance.
Essentially my doubts stem from the idea that America is too big to police effectively, let alone tax effectively, leaving what integrity programs are created woefully inadequate, leading to a failing system.
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Essentially my doubts stem from the idea that America is too big to police effectively, let alone tax effectively, leaving what integrity programs are created woefully inadequate, leading to a failing system.
Run by the states? With general coordination by the feds? We do that, it works.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
That's literally the exact system we have in Canada.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
That's literally the exact system we have in Canada.
Does each province have its own law, or do they have to adapt a national law to work for them? Could a province choose not to offer universal care in its boundaries?
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
I think I would accept something like the federal government setting up incentives for states to adopt systems of universal coverage while allowing individual states to work out the details. But I don't think I trust red states to expand coverage without those incentives, and I don't believe the people in those states are any less deserving of basic healthcare because they don't live in the same state as me.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
I think I would accept something like the federal government setting up incentives for states to adopt systems of universal coverage while allowing individual states to work out the details. But I don't think I trust red states to expand coverage without those incentives, and I don't believe the people in those states are any less deserving of basic healthcare because they don't live in the same state as me.
However, then they would have more options. Our country was set up in such a way that each state could operate as its own sovereign government but still have a central government to address things that were not feasible on a state level, such as the military and a common currency. It also gave citizens the option to move between states if the policies of one better suited them. When we pass these laws on a federal level (violating the intent of the Constitution), it takes that ability away from citizens.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
I think I would accept something like the federal government setting up incentives for states to adopt systems of universal coverage while allowing individual states to work out the details. But I don't think I trust red states to expand coverage without those incentives, and I don't believe the people in those states are any less deserving of basic healthcare because they don't live in the same state as me.
However, then they would have more options. Our country was set up in such a way that each state could operate as its own sovereign government but still have a central government to address things that were not feasible on a state level, such as the military and a common currency. It also gave citizens the option to move between states if the policies of one better suited them. When we pass these laws on a federal level (violating the intent of the Constitution), it takes that ability away from citizens.
I feel that if that's the solution that you prefer, then you should be advocating for the federal government to implement policies that make it easier to move between states.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
I think I would accept something like the federal government setting up incentives for states to adopt systems of universal coverage while allowing individual states to work out the details. But I don't think I trust red states to expand coverage without those incentives, and I don't believe the people in those states are any less deserving of basic healthcare because they don't live in the same state as me.
However, then they would have more options. Our country was set up in such a way that each state could operate as its own sovereign government but still have a central government to address things that were not feasible on a state level, such as the military and a common currency. It also gave citizens the option to move between states if the policies of one better suited them. When we pass these laws on a federal level (violating the intent of the Constitution), it takes that ability away from citizens.
I feel that if that's the solution that you prefer, then you should be advocating for the federal government to implement policies that make it easier to move between states.
Or jobs, even.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
That's literally the exact system we have in Canada.
Does each province have its own law, or do they have to adapt a national law to work for them? Could a province choose not to offer universal care in its boundaries?
Each province is single payer, but yes, they run autonomously.
I suppose a province could go fully private, I suppose, but that would never happen, because as every Canadian has posted so far, you would have to rip our healthcards from our cold dead hands before we would give them up. Proposing that would be political suicide for any ruling party.
Various parties toss out the idea of incorporating a two-tier semi-private system into the mix in different provinces at different times, depending on what problems there are in their healthcare at a given point. It's a hiiiighly controversial proposal though.
Canada isn't a monoculture at all. Don't think that because we all value a non-broken medical system that doesn't bankrupt people that we're somehow all on the same page. We've got boat loads of hostility between us. This is like the ONE thing that Canadians seem to universally agree on. That's how big a deal it is.
So we are actually comparing apples to apples when you talk about one state being very different from another and requiring customized systems. The US is not unique in that respect.
I mean...you do realize we have Quebec, right? They literally operate in a completely different language, culture, ideology, etc. Then you have y'know the whole north, which is a totally different reality where many communities are so remote that everything needs to be flown in, etc, etc.
So no, it's not a case that it's so much easier because Canada is smaller population-wise because we're just as spread out as you guys are and perhaps even more different from one another.
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
That's literally the exact system we have in Canada.
Does each province have its own law, or do they have to adapt a national law to work for them? Could a province choose not to offer universal care in its boundaries?
Each province is single payer, but yes, they run autonomously.
I suppose a province could go fully private, I suppose, but that would never happen, because as every Canadian has posted so far, you would have to rip our healthcards from our cold dead hands before we would give them up. Proposing that would be political suicide for any ruling party.
Various parties toss out the idea of incorporating a two-tier semi-private system into the mix in different provinces at different times, depending on what problems there are in their healthcare at a given point. It's a hiiiighly controversial proposal though.
Canada isn't a monoculture at all. Don't think that because we all value a non-broken medical system that doesn't bankrupt people that we're somehow all on the same page. We've got boat loads of hostility between us. This is like the ONE thing that Canadians seem to universally agree on. That's how big a deal it is.
So we are actually comparing apples to apples when you talk about one state being very different from another and requiring customized systems. The US is not unique in that respect.
I mean...you do realize we have Quebec, right? They literally operate in a completely different language, culture, ideology, etc. Then you have y'know the whole north, which is a totally different reality where many communities are so remote that everything needs to be flown in, etc, etc.
So no, it's not a case that it's so much easier because Canada is smaller population-wise because we're just as spread out as you guys are and perhaps even more different from one another.
Thanks for the input. I certainly wasn't advocating for one province to get rid of the system or anything- just trying to get a better idea of it.
As for differences between the people, I remember seeing a hockey forum where Canadians were asked if there team couldn't win the Cup, which Canadian team would they want to win. A significant number would rather the Cup not go back to Canada than any other Canadian team win it first. So I get that.
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82 million people in Germany have (basically) one system of health care, not per state-level. And as far as I know, that is true for every other european country.
Which makes the EU bigger than the US with less states.
btw. in Germany the maximum you pay (after 7,X% right from your pay) is 2% of your income, for drugs. Heart surgery? Can't even say how much the one costs that my dad had. We have never seen the bill.
Yeah, there are some things you have to pay out of your pocket. Hearing aids better than the most basic one for example. But most things just happen. For everyone. I think that is worth the <10%
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For those that support universal healthcare, would you accept your individual state using a universal healthcare system instead?
I feel that the US is too big for a one-size-fits-all approach to most policies. What works in Massachusetts is not likely to work in Montana and vice-versa.
If you mean every state would have some form of basic universal healthcare but tailor the specifics to the state, then maybe. If you mean allowing states to opt out and maintain the status quo, then no. I can see a number of problems with that scenario but the first that comes to mind is that those who can't afford private insurance would move to a state with universal healthcare. The burden of low/no income earners would be shifted to states who will take care of them.
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I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
Americans don't live in a Socialist or Communist country. Individuals have rights under the US Constitution; "society" has no rights. And those individual rights should include the ability to opt out of any government-created health care scheme.
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I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
Americans don't live in a Socialist or Communist country. Individuals have rights under the US Constitution; "society" has no rights. And those individual rights should include the ability to opt out of any government-created health care scheme.
Only if you never use any hospital build with public money, never use an ambulance funded by public money rolling on a streeet build by public money and doctors trained at universities with public money. Oh, and of course never use any drugs or machines invented by public money research.
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As for differences between the people, I remember seeing a hockey forum where Canadians were asked if there team couldn't win the Cup, which Canadian team would they want to win. A significant number would rather the Cup not go back to Canada than any other Canadian team win it first. So I get that.
Most Canadians I know tend to hope for a descending series of Canadian teams. I will root for my team, then a few others, and won't start rooting for any American teams unless the last Canuck team is the Flames. At that point I usually root for a player (such as Crosby).
/thread diversion
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I think there is an issue that's being largely overlooked here. Effectively, the US pharma market is subsidizing countries like Australia, the UK, Canada, etc. If the US gets on the UHC bandwagon with some sort of meaningful drug plan, I wouldn't be surprised if drug prices in those countries go up by at least 50-100%. Actually, to maintain the sort of profit margins these companies currently have, i think the prices in these countries would need to go up almost 300%.
Which boggles my mind really, this is about as clear of an example of "other countries taking advantage of American generosity", shouldn't a drug plan be part of the MAGA platform? lol.
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I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
Americans don't live in a Socialist or Communist country. Individuals have rights under the US Constitution; "society" has no rights. And those individual rights should include the ability to opt out of any government-created health care scheme.
I find this stance to be intellectually dishonest unless you are also advocating for repealing EMTALA (https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act).
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As for differences between the people, I remember seeing a hockey forum where Canadians were asked if there team couldn't win the Cup, which Canadian team would they want to win. A significant number would rather the Cup not go back to Canada than any other Canadian team win it first. So I get that.
Most Canadians I know tend to hope for a descending series of Canadian teams. I will root for my team, then a few others, and won't start rooting for any American teams unless the last Canuck team is the Flames. At that point I usually root for a player (such as Crosby).
/thread diversion
Still diverted - same here, except substitute the Leafs. ;-)
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I think there is an issue that's being largely overlooked here. Effectively, the US pharma market is subsidizing countries like Australia, the UK, Canada, etc. If the US gets on the UHC bandwagon with some sort of meaningful drug plan, I wouldn't be surprised if drug prices in those countries go up by at least 50-100%. Actually, to maintain the sort of profit margins these companies currently have, i think the prices in these countries would need to go up almost 300%.
Which boggles my mind really, this is about as clear of an example of "other countries taking advantage of American generosity", shouldn't a drug plan be part of the MAGA platform? lol.
Um, drugs (except those administered in a hospital) are not covered under our health plan. Hospitals obviously save by buying in bulk.
Otherwise we buy our prescriptions at a pharmacy, just like in the US. If we have private insurance our insurance will pay for some % of the cost. So I fail to see how you are subsidizing us?
You don't seem to be following how we have described that some things (like prescriptions and dental work and various other things) are not covered by our health care.
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- KER SNIP -
Um, drugs (except those administered in a hospital) are not covered under our health plan. Hospitals obviously save by buying in bulk.
Otherwise we buy our prescriptions at a pharmacy, just like in the US. If we have private insurance our insurance will pay for some % of the cost. So I fail to see how you are subsidizing us?
You don't seem to be following how we have described that some things (like prescriptions and dental work and various other things) are not covered by our health care.
[/quote]
???? OK - I believe you. However, I remember those busloads of old folks that used to make the trek up to the Great White North to save money on prescriptions. If drugs are not part of your health plan, then why are they supposedly cheaper in Canada? I believe Congress even made a silly law that you couldn't import the drugs from Canada. The rationale was that the health standards couldn't be verified or some such. I think it was a very weak pseudo argument to protect the American pharmaceutical industry. ????
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As for differences between the people, I remember seeing a hockey forum where Canadians were asked if there team couldn't win the Cup, which Canadian team would they want to win. A significant number would rather the Cup not go back to Canada than any other Canadian team win it first. So I get that.
Most Canadians I know tend to hope for a descending series of Canadian teams. I will root for my team, then a few others, and won't start rooting for any American teams unless the last Canuck team is the Flames. At that point I usually root for a player (such as Crosby).
/thread diversion
Still diverted - same here, except substitute the Leafs. ;-)
Still diverting, because this is a much more important topic than healthcare (joking of course)- fuck the jets.
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- KER SNIP -
Um, drugs (except those administered in a hospital) are not covered under our health plan. Hospitals obviously save by buying in bulk.
Otherwise we buy our prescriptions at a pharmacy, just like in the US. If we have private insurance our insurance will pay for some % of the cost. So I fail to see how you are subsidizing us?
You don't seem to be following how we have described that some things (like prescriptions and dental work and various other things) are not covered by our health care.
???? OK - I believe you. However, I remember those busloads of old folks that used to make the trek up to the Great White North to save money on prescriptions. If drugs are not part of your health plan, then why are they supposedly cheaper in Canada? I believe Congress even made a silly law that you couldn't import the drugs from Canada. The rationale was that the health standards couldn't be verified or some such. I think it was a very weak pseudo argument to protect the American pharmaceutical industry. ????
[/quote]
In a word, price controls.
https://slate.com/news-and-politics/2000/05/why-do-drugs-cost-less-in-canada.html
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I think there is an issue that's being largely overlooked here. Effectively, the US pharma market is subsidizing countries like Australia, the UK, Canada, etc. If the US gets on the UHC bandwagon with some sort of meaningful drug plan, I wouldn't be surprised if drug prices in those countries go up by at least 50-100%. Actually, to maintain the sort of profit margins these companies currently have, i think the prices in these countries would need to go up almost 300%.
Which boggles my mind really, this is about as clear of an example of "other countries taking advantage of American generosity", shouldn't a drug plan be part of the MAGA platform? lol.
Um, drugs (except those administered in a hospital) are not covered under our health plan. Hospitals obviously save by buying in bulk.
Otherwise we buy our prescriptions at a pharmacy, just like in the US. If we have private insurance our insurance will pay for some % of the cost. So I fail to see how you are subsidizing us?
You don't seem to be following how we have described that some things (like prescriptions and dental work and various other things) are not covered by our health care.
Every province is different in various ways. In BC we have the 'Fair Pharmacare' plan, which basically means you are on the hook for the first couple of thousand dollars of drug costs but then the province will step in - for drugs that are on the list. There are some new drugs that haven't yet made it onto the list, or some other Shkreli drugs that are wildly overpriced. This does incentivize the province to approve generics, which is fine with me.
Drugs are cheaper here because pharmaceutical companies charge what the market will bear. In the US you have a non-unified array of bizarre HMOs, Medicaid and private payers where costs are wildly inflated and the companies get away with charging a ton. In Canada the primary buyer is a single entity that is willing to use a generic if the company is too greedy.
We are not subsidized in any way by the US, it's just that the American system is so screwed that pharma companies get away with outrageous things all the time and you guys think that is normal, or somehow 'capitalism' instead of just plain old corruption.
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Also for Canadian drug prices:
https://www.healthaffairs.org/doi/full/10.1377/hlthaff.20.3.92
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In NZ we have Pharmac, the govt national drug buying agency. Approved drugs are heavily subsidised to the patient. Drug prices are negotiated with various drug companies, and sometimes brands of particular funded medications change.
Unsubsidised drugs such as particular cancer drugs can still be purchased in many cases but with no subsidy.
Regular public debate about why isnt this or that drug funded. Regular lobbying by drug companies. But general acceptance that this model works well most of the time for most of the population.
I take a regular routine medication. It costs me $5 every 3 months. If I ever got to $100 in prescription drugs in a year, I would pay nothing more for that year.
I dont understand the preoccupation about " communist or socialist" medicine, why not just assess costs and outcomes objectively?
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We are not subsidized in any way by the US, it's just that the American system is so screwed that pharma companies get away with outrageous things all the time and you guys think that is normal, or somehow 'capitalism' instead of just plain old corruption.
Yes and No. The bigger picture is quite complicated, on one hand you have articles like this:
Debunking The Pharmaceutical Research ‘Free Rider’ Myth: A response To Yu, Helms, And Bach
https://www.healthaffairs.org/do/10.1377/hblog20170602.060376/full/
But they often neglect nuances such as this:
Reframing the Conversation on Drug Pricing
https://catalyst.nejm.org/reframing-conversation-drug-pricing/
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I dont understand the preoccupation about " communist or socialist" medicine, why not just assess costs and outcomes objectively?
It seems to be an outlook peculiar to some Americans - we are not seeing it on this thread from Europeans or Canadians either. We know it works, we discuss how the details will work, but we don't put much moral judgement into it. Some things are not covered here because they are not seen as medically necessary (i.e. plastic surgery for "vanity" reasons, compared to plastic surgery for medically necessary reasons) but basically the benefit of a healthy population is seen as worthwhile, just as an educated society is. Come to think of it, I would guess higher education costs in the countries that have universal health care are also lower than higher education costs in the US. Different approaches to how a society operates.
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I dont understand the preoccupation about " communist or socialist" medicine, why not just assess costs and outcomes objectively?
Here's the way it was described to me when I was about 12 years old:
Socialism: You have two cows. The government takes one and gives it to your neighbor.
Communism: You have two cows. You give them to the government, and the government then gives you some milk.
Fascism: You have two cows. You give them to the government, and the government then sells you some milk.
Capitalism: You have two cows. You sell one and buy a bull.
Nazism: You have two cows. The government takes both and shoots you.
This one is newer: Russian company: You have two cows. You drink some vodka and count them again. You have five cows. The Russian Mafia shows up and takes however many cows you have.
Besides the jokes, we had great comic books and movies where the bad guy was the "commie."
It was never referred to as brainwashing. That's what the commies did. It was (is) education. It's about learning about American Freedom. The freedom that must be retained until they pry your gun from your cold dead fingers.
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In NZ we have Pharmac, the govt national drug buying agency. Approved drugs are heavily subsidised to the patient. Drug prices are negotiated with various drug companies, and sometimes brands of particular funded medications change.
Unsubsidised drugs such as particular cancer drugs can still be purchased in many cases but with no subsidy.
Regular public debate about why isnt this or that drug funded. Regular lobbying by drug companies. But general acceptance that this model works well most of the time for most of the population.
I take a regular routine medication. It costs me $5 every 3 months. If I ever got to $100 in prescription drugs in a year, I would pay nothing more for that year.
I dont understand the preoccupation about " communist or socialist" medicine, why not just assess costs and outcomes objectively?
The cost of socialism is FREEDOM!
If you ask how it is more free to have the oligarchs in charge, you are an unAmerican elitist, both for questioning the efficiency of capitalism and using a big word.
If you ask how it considered free market if you can't find out the cost ahead of time and make an informed choice, you are a pinko.
If you ask what is wrong with countries like Sweden or Britain or Germany, you are an idiot who doesn't understand anything and should just move to Venezuela if you are such a commie.
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In NZ we have Pharmac, the govt national drug buying agency. Approved drugs are heavily subsidised to the patient. Drug prices are negotiated with various drug companies, and sometimes brands of particular funded medications change.
Unsubsidised drugs such as particular cancer drugs can still be purchased in many cases but with no subsidy.
Regular public debate about why isnt this or that drug funded. Regular lobbying by drug companies. But general acceptance that this model works well most of the time for most of the population.
I take a regular routine medication. It costs me $5 every 3 months. If I ever got to $100 in prescription drugs in a year, I would pay nothing more for that year.
I dont understand the preoccupation about " communist or socialist" medicine, why not just assess costs and outcomes objectively?
The cost of socialism is FREEDOM!
If you ask how it is more free to have the oligarchs in charge, you are an unAmerican elitist, both for questioning the efficiency of capitalism and using a big word.
If you ask how it considered free market if you can't find out the cost ahead of time and make an informed choice, you are a pinko.
If you ask what is wrong with countries like Sweden or Britain or Germany, you are an idiot who doesn't understand anything and should just move to Venezuela if you are such a commie.
Great patriotic words! It was written with feeling and not the logic to which the logic are attempting to blind us with.
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I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
Americans don't live in a Socialist or Communist country. Individuals have rights under the US Constitution; "society" has no rights. And those individual rights should include the ability to opt out of any government-created health care scheme.
I'd be all for that if doctors were also allowed to tell those individuals to fuck off and die unless they paid in full up front before getting sewn up in the ER.
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I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
Americans don't live in a Socialist or Communist country. Individuals have rights under the US Constitution; "society" has no rights. And those individual rights should include the ability to opt out of any government-created health care scheme.
I'd be all for that if doctors were also allowed to tell those individuals to fuck off and die unless they paid in full up front before getting sewn up in the ER.
Well - The problem with that one is that nobody in the medical business seems to be able to tell you what something costs. I guess they check if you have good insurance and then charge more. It looks to be far more lucrative than bank robbery.
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I apologize for invoking religion, I don't like using the bible *against* people. My point is that we are a society. Is it not for the benefit of the whole that each individual person be given complete and affordable access to health care regardless of their station in life? Our society, whether we know it or not, is interdependent on each other.
Americans don't live in a Socialist or Communist country. Individuals have rights under the US Constitution; "society" has no rights. And those individual rights should include the ability to opt out of any government-created health care scheme.
I'd be all for that if doctors were also allowed to tell those individuals to fuck off and die unless they paid in full up front before getting sewn up in the ER.
Well - The problem with that one is that nobody in the medical business seems to be able to tell you what something costs. I guess they check if you have good insurance and then charge more. It looks to be far more lucrative than bank robbery.
True, maybe a better solution would be to just ask how much you have, and then do that much of the work before the patient can come up with some more funds. "Sorry, your line of credit only covers taking half your appendix out - but I didn't tack on any extra for making sure it was the bad half!"
People get so worked up over the thought of some bum with no job eating themselves into a large healthcare bill. It's not like those people don't get care under the current system, so I'm not sure why changing who writes the check makes a difference.
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Things I would like to know and am not sure where to find out reliably:
How much does the average American pay from their own wages for healthcare every year and how much extra would the average American pay in taxes every year under universal healthcare?
What are the current American averages for key waiting times metrics as opposed to, say, the NHS four hour A&E target?
Never mind worrying about paying for other people's healthcare. I would be surprised if the average American wouldn't end up paying less for their own healthcare under a proper system.
And, is there any country in the world which repealed universal healthcare after it was introduced? Basically, is there any country that gave it a go and then reckoned the old private system was better?
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Regarding drug prices: most countries will negotiate prices with drug companies using their regulatory powers. For example, in the UK, the government has panels that evaluate the evidence of benefit of the drug, the economic analysis a company provides to support a given price, and then negotiates a price based on that analysis and a separate governmental analysis. This doesn’t result in $50,000 drugs costing $1,000 but does generally reduce the price by 25-50% depending on the drug’s utility. The benefit to the company is they will then be the preferred (or only) provider for a given drug for a period of several years (depending on what is negotiated, and if any new clearly more effective competitor drugs are developed). The risk is being shut out of the NHS market, but some drugs can be purchased privately if approved for prescribed use (a separate process) and patients really want it. That is fairly rare, however.
Regarding subsidizing or drugs by US consumers: this is a simplistic bumper-sticker summary of a complex system. Yes, companies will have more profits if one market pays much more than others. But three factors complicate this picture:
1. Manufacturing costs are much lower than drug development. Thus companies could likely maintain a profit without further drug development just on this basis alone, especially with the monopoly afforded to them after initial approval. Many generic drug manufacturers do this succesfully.
2. Most of the high-risk drug development is done by smaller companies that are then bought out if their preclinical data is promising. Most of this is high-risk, high-reward work is funded by venture capitalists, not your insurance company. The big company then has to buy the company at a valuation based on their estimates of future sales, but the idea that no research would be done without a huge payday for Merck, etc is simplistic.
2. For future drug development, much of the preclinical work is paid for by government grants. A significant fraction are from the US, but European countries contribute substantially also. It is rare for a company to develop a new drug without some level of government support. Yes, they then have to pay for the very expensive clinical trials, but the government will mitigate costs of running large trials by accelerating approval if there is a clear clinical benefit. If the benefit of a drug is not much more than a pre-existing competitor, it will cost more to show a statistical benefit. That is just a price of doing business: if your product isn’t that great, you have to do more work to convince people to buy it. Even then, don’t expect many buyers if you charge a lot.
Thus, Americans only “subsidize” drug development inasmuch as we buy marginally better drugs at extraordinary prices due to effective marketing campaigns. Other than a handful of drugs that are significant breakthroughs, the majority of new ones are basically competitors to existing ones, or reformulations designed to get around loss of monopoly due to expiring patents. There is no clear moral or economic reason why we should pay excess costs for these marginal products when cheaper alternatives are available.
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I'd be all for that if doctors were also allowed to tell those individuals to fuck off and die unless they paid in full up front before getting sewn up in the ER.
Too bad that is the opposite of what being a doctor is means. The old shithole Hippokrates...
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I'd be all for that if doctors were also allowed to tell those individuals to fuck off and die unless they paid in full up front before getting sewn up in the ER.
Too bad that is the opposite of what being a doctor is means. The old shithole Hippokrates...
But hospital administrators didn't take the oath, so...
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I'd be all for that if doctors were also allowed to tell those individuals to fuck off and die unless they paid in full up front before getting sewn up in the ER.
Too bad that is the opposite of what being a doctor is means. The old shithole Hippokrates...
But hospital administrators didn't take the oath, so...
Ahh, the old good cop-bad cop routine!
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Things I would like to know and am not sure where to find out reliably:
How much does the average American pay from their own wages for healthcare every year and how much extra would the average American pay in taxes every year under universal healthcare?
What are the current American averages for key waiting times metrics as opposed to, say, the NHS four hour A&E target?
Never mind worrying about paying for other people's healthcare. I would be surprised if the average American wouldn't end up paying less for their own healthcare under a proper system.
And, is there any country in the world which repealed universal healthcare after it was introduced? Basically, is there any country that gave it a go and then reckoned the old private system was better?
Well...considering that the US is literally the *only* highly developed country without universal healthcare...I think that answers a lot of your questions.
Also, there is boat loads of data out there showing that you guys spend WAY MORE per person on healthcare than Canadians do.
Here's a Harvard Public Health Review on universal healthcare
http://harvardpublichealthreview.org/universal-health-care-the-affordable-dream/
An article about per capita healthcare spending and how you guys spend the most and die the youngest.
https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.4823dd781fba
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@Abe That was a really good and concise summary while also capturing much of the nuances of the topic.
Are there reasons other than marketing to why we are paying excess costs for these marginal products when cheaper alternatives are available? Are the physicians to blame here?
I am under the assumption that if the US hops on the national drug plan wagon the companies would either open new lines of business or jack up prices (in negotiation) elsewhere to preserve both the top and bottom line. Do you think this thinking is valid or is it irrelevant and if it does happen the govt would just eat the cost regardless?
Also, in the national drug plan scenario, would the companies ask for more grants to make the clinical trials more cost-viable or would they change the way they do things to better adapt to the new paradigm? Thanks.
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"I am under the assumption that if the US hops on the national drug plan wagon the companies would either open new lines of business or jack up prices (in negotiation) elsewhere to preserve both the top and bottom line. Do you think this thinking is valid or is it irrelevant and if it does happen the govt would just eat the cost regardless?"
If the US bids, there should be at least one drug company that is greedy enough to want the business and undercut the others. If some of them go under,.......so what. Look at all the other companies that have gone under or are going under. Why should they be different than Enron, Lehman brothers, Texaco, Chrysler, etc. If we truly have a free market, there will be losers.
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If we truly have a free market, there will be losers.
lol wut? true free market in a "single payer" national healthcare system? *does not compute*
are you also a believer that "true free market" is possible under mmt? not intending to offend, just had way too much sugar and I am in a playful mood.
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@Abe That was a really good and concise summary while also capturing much of the nuances of the topic.
Are there reasons other than marketing to why we are paying excess costs for these marginal products when cheaper alternatives are available? Are the physicians to blame here?
I am under the assumption that if the US hops on the national drug plan wagon the companies would either open new lines of business or jack up prices (in negotiation) elsewhere to preserve both the top and bottom line. Do you think this thinking is valid or is it irrelevant and if it does happen the govt would just eat the cost regardless?
Also, in the national drug plan scenario, would the companies ask for more grants to make the clinical trials more cost-viable or would they change the way they do things to better adapt to the new paradigm? Thanks.
Thanks for the compliment. Regarding your first question:
I would say that when direct-to-patient advertising ramped up after a 1997 FDA ruling change, there was a fair amount of blame due to physicians. The typical scenario is company B created a competitor drug in the same class as company A's blockbuster drug. They sent out marketing reps to convince physicians why drug B is better than A (or at least different enough to use over A). Occasionally prices are mentioned, but the main reasons touted were lower side effects or more efficacy. they were required to have data to back up these claims, so it became a question of how much marginal benefit there was versus cost. In my training, for most drug classes this benefit was really minimal for the majority of scenarios. This creates a quandary for the drug companies, because it was really expensive to develop whole new classes of drugs. Solution 1: spend that money on advertising to patients. Solution 2: spend that money on "conferences" for physicians. The latter was eventually called out by the public, the FDA and other physicians. The former has not been addressed to any real extent.
In the last decade, insurance companies caught onto the drug companies' schemes and this resulted in "drug benefit managers" like ExpressScripts. These companies ostensibly negotiate with drug companies on behalf of a group of insurance companies to get one of two deals. Either the name brand, expensive drug is negotiated to be the preferred drug that insurance will cover if the drug company gives it at a discount, or one of several generic equivalents is negotiated for a substantially lower price. This would theoretically be good, except what happens is that who gets on the "preferred" list can change every few months, creating havoc for physicians and patients. The NY Times recently reported on this regarding insulin. Also, there is absolutely no transparency regarding what price the insurance company is paying, how much of the total cost is being covered by the patient, or how that deal was negotiated. Sometimes a drug company will throw in a steep discount for an older drug in one category if the insurance will make their new, super expensive drug preferred in another, more lucrative class. All kinds of fancy ways to negotiate, and hard to determine how much (if any) corruption is involved since these deals are almost always 'trade secrets' and confidential.
Long story short: there's plenty of blame to go around. Physicians for the most part have caught on to the bad optics of prescribing unnecessary brand-name drugs, so that has been fixed to a large extent. Also, insurance companies caught on to the drug companies' strategy. Now, use of marginally better drugs at higher costs is more driven by the game taking place between drug companies and insurance companies, rather than physicians' perceptions of their relative worth.
Regarding your second question:
In general, the cost of treatment for most chronic diseases is markedly cheaper than they were 20 years ago. This is mostly because the 1990s had a spurt of new cardiovascular, very effective drugs that are now all generic with multiple competitors. This includes statins for cholesterol, drugs for hypertension, and drugs for heart failure. All three conditions can be treated for fairly cheap ($5-15/month per condition). In addition, the standard, effective chemotherapy drugs used for most cancers were all developed in the 1970s-1980s and are far cheaper than newer, incrementally better chemotherapy agents. For example, colorectal cancer hasn't really had a significant chemotherapy breakthrough since 2004, using a drug developed in the 1980s. I'm citing these examples to point out that new lines of business are hard to develop.
Companies have responded by jacking up costs for other drugs that can have complicated formulations (since those are patent-worthy even if the underlying drug molecule is not new - best example are insulin variants, some of which are extremely cheap and others extremely expensive for no medical reason). This is where a lot of "drug discovery" is now going: trying to find more effective and targeted ways to deliver older drugs that are off-patent and cheap. If you can do this, then the cost of manufacturing is very low, but you get a brand new monopoly on a new medicine. Unfortunately, again, the marginal benefit is quite low.
If the US were to negotiate like other countries did, I think two things would happen:
Initially, pharmaceutical companies would drop out of less lucrative classes of drugs. This has happened with antibiotics since they are not very profitable. No significant breakthrough antibiotic has been developed since 2000, and most antibiotics we use today were developed in the 1970s! They may cut back on drug discovery in general since it is expensive and prone to failure (only 10% of drugs make it all the way to clinical use!). But, as is happening with antibiotics now, and with chemotherapy drugs in the past, governments will likely provide funding to promote drug discovery.
I doubt companies would drop out of an entire country-wide market because the manufacturing costs for current drugs are so low that they would still make a profit just selling them like any other normal business. I don't think European countries would budge on their price controls because they know the drug companies would still make a profit. The drug companies don't want to entirely drop drug discovery, because if development is funded entirely by governments they will have a weaker claim to the profits from its sale, and eventually there will be no reason for drug companies to exist other than manufacturing. Then, they will be destroyed by offshoring, just like every other non-technical manufacturing sector.
It is just really really hard to make major breakthroughs in medicines. Many of the low-hanging fruits have been picked. Now it is a hard, 20-year slog to get a historically significant drug class developed. Private companies are not driven by 20-year action plans, they are driven by quarterly and annual profits. The long-term result is a hybrid system that has informally existed for decades: some government or government-funded entity lays the groundwork, a company buys the patent for clinical development & marketing, and the profit is shared. The big question will be how regulated are the companies and how much profit they will be allowed to have.
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Things I would like to know and am not sure where to find out reliably:
How much does the average American pay from their own wages for healthcare every year and how much extra would the average American pay in taxes every year under universal healthcare?
What are the current American averages for key waiting times metrics as opposed to, say, the NHS four hour A&E target?
Never mind worrying about paying for other people's healthcare. I would be surprised if the average American wouldn't end up paying less for their own healthcare under a proper system.
And, is there any country in the world which repealed universal healthcare after it was introduced? Basically, is there any country that gave it a go and then reckoned the old private system was better?
Well...considering that the US is literally the *only* highly developed country without universal healthcare...I think that answers a lot of your questions.
Also, there is boat loads of data out there showing that you guys spend WAY MORE per person on healthcare than Canadians do.
Here's a Harvard Public Health Review on universal healthcare
http://harvardpublichealthreview.org/universal-health-care-the-affordable-dream/
An article about per capita healthcare spending and how you guys spend the most and die the youngest.
https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.4823dd781fba
The Brits spend much more than the Canadians? Really?
No, what I'd like to know is not total per capita spending but how much each American would pay personally - either via insurance and copays or via taxes. What would be the difference to their bottom line?
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If we truly have a free market, there will be losers.
lol wut? true free market in a "single payer" national healthcare system? *does not compute*
are you also a believer that "true free market" is possible under mmt? not intending to offend, just had way too much sugar and I am in a playful mood.
@pecunia I nearly quoted you out of context here too, because I hadn't read all of your original post.
If I may, for a moment, actually take your quote out of context, what I was going to say was that in a true free-market health care system, people will die for lack of being able to pay.
That is is an incredibly heartless and inhumane society to be a part of.
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It is not just the impovished who suffer if access to health measures such as immunisation and infection control is limited by income.
Like a dose of Hepatitis with your meal sir? Or how about that toddler with early whooping cough who came to look at your 2 month old baby in the playground?
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Interesting, thanks for the detailed reply. I think I have a new favorite forum member.
The big question will be how regulated are the companies and how much profit they will be allowed to have.
This is precisely what I am concerned about, personally I am quite leery of this sort of scenario. Has this sort of control been established somewhere in the world without severe adverse effect on innovation?
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Things I would like to know and am not sure where to find out reliably:
How much does the average American pay from their own wages for healthcare every year and how much extra would the average American pay in taxes every year under universal healthcare?
What are the current American averages for key waiting times metrics as opposed to, say, the NHS four hour A&E target?
Never mind worrying about paying for other people's healthcare. I would be surprised if the average American wouldn't end up paying less for their own healthcare under a proper system.
And, is there any country in the world which repealed universal healthcare after it was introduced? Basically, is there any country that gave it a go and then reckoned the old private system was better?
Well...considering that the US is literally the *only* highly developed country without universal healthcare...I think that answers a lot of your questions.
Also, there is boat loads of data out there showing that you guys spend WAY MORE per person on healthcare than Canadians do.
Here's a Harvard Public Health Review on universal healthcare
http://harvardpublichealthreview.org/universal-health-care-the-affordable-dream/
An article about per capita healthcare spending and how you guys spend the most and die the youngest.
https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.4823dd781fba
The Brits spend much more than the Canadians? Really?
No, what I'd like to know is not total per capita spending but how much each American would pay personally - either via insurance and copays or via taxes. What would be the difference to their bottom line?
You want an analysis of what individuals would pay???
Literally no one can answer that, but if the per capita spending drops, the answer will be: on average, everyone will pay less.
Some people will pay more in taxes compared to insurance and co-pays, some people much much much less.
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I said I had no idea how to find the numbers! And obviously not every individual, but surely there must be some ballpark figures one could use for an educated guess for the average person. Like, what the average person spends each year and what the average spend on Medicaid (the one that's not for old people is) per capita times population divided by taxpayers? I don't think it's so unreasonable to wonder this.
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The Brits spend much more than the Canadians? Really?
No, what I'd like to know is not total per capita spending but how much each American would pay personally - either via insurance and copays or via taxes. What would be the difference to their bottom line?
Wikipedia has per capita costs (US$) from the Organisation for Economic Co-operation and Development; if you click on the year you can sort by costs. The UK (4192) spent slightly less than Canada (4793) in 2016, but we both spent much less than the US (9892).
Since it is total cost per capita it would include what was spent both by public plans and private plans and then uninsured costs.
https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita
This also looks at breakdown between public and private spending (search term was per capita insurance health premiums by country)
https://www.finweb.com/insurance/average-health-insurance-cost-by-country.html
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Aside: As I look at these posts I note that many are from countries that already have universal health care and are relatively satisfied with it. It resembles the feeling of a car accident with many spectators. The car accident, in this case, is the US health care system. The spectators look on and proclaim, "I'm sure glad that isn't me."
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Things I would like to know and am not sure where to find out reliably:
How much does the average American pay from their own wages for healthcare every year and how much extra would the average American pay in taxes every year under universal healthcare?
What are the current American averages for key waiting times metrics as opposed to, say, the NHS four hour A&E target?
Never mind worrying about paying for other people's healthcare. I would be surprised if the average American wouldn't end up paying less for their own healthcare under a proper system.
And, is there any country in the world which repealed universal healthcare after it was introduced? Basically, is there any country that gave it a go and then reckoned the old private system was better?
Well...considering that the US is literally the *only* highly developed country without universal healthcare...I think that answers a lot of your questions.
Also, there is boat loads of data out there showing that you guys spend WAY MORE per person on healthcare than Canadians do.
Here's a Harvard Public Health Review on universal healthcare
http://harvardpublichealthreview.org/universal-health-care-the-affordable-dream/
An article about per capita healthcare spending and how you guys spend the most and die the youngest.
https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.4823dd781fba
The Brits spend much more than the Canadians? Really?
No, what I'd like to know is not total per capita spending but how much each American would pay personally - either via insurance and copays or via taxes. What would be the difference to their bottom line?
You want an analysis of what individuals would pay???
Literally no one can answer that, but if the per capita spending drops, the answer will be: on average, everyone will pay less.
Some people will pay more in taxes compared to insurance and co-pays, some people much much much less.
Well, we could speculate. For arguments sake I'll use the numbers in table 7.1.1 in this article posted above, https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.179bd5a88980 .
Since the US currently spends the most per capita of any country at $8508 and the next highest spending country is Norway at $5669, then the US could reasonably expect to save the difference. That's $2839 per person, per year. Not exactly chump change.
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Things I would like to know and am not sure where to find out reliably:
How much does the average American pay from their own wages for healthcare every year and how much extra would the average American pay in taxes every year under universal healthcare?
What are the current American averages for key waiting times metrics as opposed to, say, the NHS four hour A&E target?
Never mind worrying about paying for other people's healthcare. I would be surprised if the average American wouldn't end up paying less for their own healthcare under a proper system.
And, is there any country in the world which repealed universal healthcare after it was introduced? Basically, is there any country that gave it a go and then reckoned the old private system was better?
Well...considering that the US is literally the *only* highly developed country without universal healthcare...I think that answers a lot of your questions.
Also, there is boat loads of data out there showing that you guys spend WAY MORE per person on healthcare than Canadians do.
Here's a Harvard Public Health Review on universal healthcare
http://harvardpublichealthreview.org/universal-health-care-the-affordable-dream/
An article about per capita healthcare spending and how you guys spend the most and die the youngest.
https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.4823dd781fba
The Brits spend much more than the Canadians? Really?
No, what I'd like to know is not total per capita spending but how much each American would pay personally - either via insurance and copays or via taxes. What would be the difference to their bottom line?
You want an analysis of what individuals would pay???
Literally no one can answer that, but if the per capita spending drops, the answer will be: on average, everyone will pay less.
Some people will pay more in taxes compared to insurance and co-pays, some people much much much less.
Well, we could speculate. For arguments sake I'll use the numbers in table 7.1.1 in this article posted above, https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.179bd5a88980 .
Since the US currently spends the most per capita of any country at $8508 and the next highest spending country is Norway at $5669, then the US could reasonably expect to save the difference. That's $2839 per person, per year. Not exactly chump change.
The main reason for our high spending in Norway, is that everyone earns a decent wage. So unless you plan on doubling the wages of your cleaning staff (minimum wage ~$20), you should save more.
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
Decades of brainwashing.
And an extremely powerful for-profit system that spends millions of dollars lobbying every single year.
https://www.opensecrets.org/lobby/indusclient.php?id=F09
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
It's hard to say that there would be a net gain for "average" Americans. Right now, some people are out of pocket such enormous amounts, it's hard to say what the effect would be for a typical American, even if that's what the average is.
But yes, the average out of pocket would be less, simply because insurance companies make absolutely insane profits, so if the per capita spending is more, and the insurance companies are hugely profiting, then by definition, the difference has to come out of the pockets of the American public.
A public system isn't just cheaper in terms of administrative costs, which are astronomical, but also completely lacks the massive profit component as well.
So yeah, it's rather confusing why there's such resistance to it. There seems to be some kind of notion of freedom of choice, but from what I gather, your system actually drastically limits your actual real life options in very critical ways through limiting which doctors you can see, career options, retirement options, etc.
Why is it such a hard sell???
As PP said, decades of intense and strategic PR on behalf of a goddamn behemoth economic force.
The rest of the developed world is just lucky that we all cut the balls off that bull before it grew strong enough to start raging.
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Why is it such a hard sell???
As PP said, decades of intense and strategic PR on behalf of a goddamn behemoth economic force.
The rest of the developed world is just lucky that we all cut the balls off that bull before it grew strong enough to start raging.
There is a lot of smoke being blown out there by the mainstream press. The issue is obscured. These enormous economic forces that have purchased many American politicians also control the mainstream press. They control the press by being the advertisers or by direct ownership.
A little fear can go a long way to help maintain the status quo. We Americans do not travel like the folks of other countries. Many of us, myself included, are ignorant of many aspects of the broader world. We do not see that there are alternative methods of solving social problems.
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Aside: As I look at these posts I note that many are from countries that already have universal health care and are relatively satisfied with it. It resembles the feeling of a car accident with many spectators. The car accident, in this case, is the US health care system. The spectators look on and proclaim, "I'm sure glad that isn't me."
It's not so much that, and certainly not any schadenfreude either. It's that early on in this thread a lot of concerns and hypotheticals were postulated and those of us living in these types of systems weighed in as to how these things actually play out in a real life.
We're more like Mustachians weighing in on a conversation among people who are fearful and skeptical about frugality and we're saying "Guys, it's really not all suffering and deprivation, it actually has far reaching positive affects on your health, family life, and happiness."
Who better to contribute responses to concerns and questions than your neighbours who are extremely culturally similar, and have been living with the system through its ups and downs for decades?
We just happen to all think your system is insane. It might be a more interesting debate if various universal healthcare country people weighed in with varying opinions, but we just don't have many citizens who would give up universal healthcare...because they all moved to the US already. Lol.
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
Because lots of Americans would rather not get $2839 at all than have someone they consider undeserving get it too. Dumb and mean is a horrible combination.
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
Why is it such a hard sell???
As PP said, decades of intense and strategic PR on behalf of a goddamn behemoth economic force.
It's a matter of perspective.
"There are known knowns, known unknowns and unknown unknowns."
Outsiders looking in: "Take our system, adjust it to fit the data and your needs and your good to go."
Your data might be incomplete and missing nuance, leading to incorrect conclusions. That in turn leads to badly implemented plans. (Undersized programs for a given area being my worry. It cannot be adjusted because all resources have been used and must go through the political process.)
Additionally, Universal Health Care seems to treat symptoms of a problem, but not the underlying attitudes, behaviors, environmental and psychological issues. (A man over eats because of anxiety. He refuses to see a psychiatrist or a therapist because they are for "criminals and the insane.")
So I have the feeling that whatever is currently planned won't be enough and we would need something seemingly on the scale of Alexandria Ocasio Cortez's "Green New Deal". (I'm not saying that her plan was a good one, simply that saying the scale of the plan is what I think we need.)
Only one way to find out though.
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
Why is it such a hard sell???
As PP said, decades of intense and strategic PR on behalf of a goddamn behemoth economic force.
It's a matter of perspective.
"There are known knowns, known unknowns and unknown unknowns."
Outsiders looking in: "Take our system, adjust it to fit the data and your needs and your good to go."
Your data might be incomplete and missing nuance, leading to incorrect conclusions. That in turn leads to badly implemented plans. (Undersized programs for a given area being my worry. It cannot be adjusted because all resources have been used and must go through the political process.)
Additionally, Universal Health Care seems to treat symptoms of a problem, but not the underlying attitudes, behaviors, environmental and psychological issues. (A man over eats because of anxiety. He refuses to see a psychiatrist or a therapist because they are for "criminals and the insane.")
So I have the feeling that whatever is currently planned won't be enough and we would need something seemingly on the scale of Alexandria Ocasio Cortez's "Green New Deal". (I'm not saying that her plan was a good one, simply that saying the scale of the plan is what I think we need.)
Only one way to find out though.
You're right.
Universal healthcare is not a panacea or a solution to even most healthcare problems, nor is it designed to be. No one in a country like Canada would ever claim that it is.
As for what is currently planned??? Is anything currently planned? I'm not that up on my US politics in that much detail, but as far as I see, universal healthcare in the US is about as "planned" as Brexit was before the referendum.
Right now it just seems to be a growing vague acknowledgement that the current system is suboptimal and that change is complicated and heavily opposed by a lot of political and economic forces.
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I like how people in the most obese country think that universal healthcare leads to poor personal choices that don't treat the underlying issue.
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Additionally, Universal Health Care seems to treat symptoms of a problem, but not the underlying attitudes, behaviors, environmental and psychological issues.
And the current US system does that?
Actually UHC does try to treat the problems. Certainly more than greedy insurances. Simply because everyone is in it and shares the costs.
Just to take one example: In Germany you can get a lot of pre-emptive stuff. You get bonuses for regularily going to the dentist. A free trough-check starting at age 35 every 2 years. My local health insurer has regular "how to eat healthy" courses (okay, those cost a bit of money). Diverse Cancer checks.
And of course you don't pay for visiting the doctor. (We actually had a 10€ per 3 month thing running for a few years. It did not reduce the amount of visits by a meaningful measure. Surprise: Most people don't have fun sitting one hour or longer in a room with sick people!)
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Additionally, Universal Health Care seems to treat symptoms of a problem, but not the underlying attitudes, behaviors, environmental and psychological issues.
And the current US system does that?
Actually UHC does try to treat the problems. Certainly more than greedy insurances. Simply because everyone is in it and shares the costs.
Just to take one example: In Germany you can get a lot of pre-emptive stuff. You get bonuses for regularily going to the dentist. A free trough-check starting at age 35 every 2 years. My local health insurer has regular "how to eat healthy" courses (okay, those cost a bit of money). Diverse Cancer checks.
And of course you don't pay for visiting the doctor. (We actually had a 10€ per 3 month thing running for a few years. It did not reduce the amount of visits by a meaningful measure. Surprise: Most people don't have fun sitting one hour or longer in a room with sick people!)
OHIP (Ontario Health Insurance Plan) does a lot of obvious prevention stuff too - free vaccination for children, free flu vaccinations for everyone, free shingles vaccination if you are in a right age group, free mammograms and Pap smears and blood in stool sample testing (colon cancer) with reminders from your local hospital/clinic for the last 3. Free blood work if it is covered by OHIP and prescribed by your doctor, and a lot is - my Vitamin D levels test is covered because I have osteopenia, the x-rays that showed my bones are not quite as dense as they should be were also covered by OHIP. It is a lot cheaper to find out I need to take Vitamin D supplements and monitor my blood levels than it is for me to fall and break my pelvis. My local health unit also subsidizes pet rabies vaccines, since rabies is here but pretty well under control.
Not sure how a universal health plan can cover everything related to "underlying attitudes, behaviors, environmental and psychological issues." Those are all aspects of the broader society. For example, I can get my well water tested for pathogens for free, that is part of public health. Air quality - well that is part of pollution controls and emissions standards. Smoking? Clinics run stop smoking programs.
No-one expects a universal health plan to take care of everything any more than they expect private health insurance to cover everything. Some of it is up to us. I knew someone who died of breast cancer because she refused to go to a doctor, that is not something a health insurance plan, public or private, can deal with.
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So your average American would personally be $2839 better off under a proper system? I just don't see why that's such a hard sell.
Why is it such a hard sell???
As PP said, decades of intense and strategic PR on behalf of a goddamn behemoth economic force.
It's a matter of perspective.
"There are known knowns, known unknowns and unknown unknowns."
Outsiders looking in: "Take our system, adjust it to fit the data and your needs and your good to go."
Your data might be incomplete and missing nuance, leading to incorrect conclusions. That in turn leads to badly implemented plans. (Undersized programs for a given area being my worry. It cannot be adjusted because all resources have been used and must go through the political process.)
Additionally, Universal Health Care seems to treat symptoms of a problem, but not the underlying attitudes, behaviors, environmental and psychological issues. (A man over eats because of anxiety. He refuses to see a psychiatrist or a therapist because they are for "criminals and the insane.")
So I have the feeling that whatever is currently planned won't be enough and we would need something seemingly on the scale of Alexandria Ocasio Cortez's "Green New Deal". (I'm not saying that her plan was a good one, simply that saying the scale of the plan is what I think we need.)
Only one way to find out though.
You're right.
Universal healthcare is not a panacea or a solution to even most healthcare problems, nor is it designed to be. No one in a country like Canada would ever claim that it is.
As for what is currently planned??? Is anything currently planned? I'm not that up on my US politics in that much detail, but as far as I see, universal healthcare in the US is about as "planned" as Brexit was before the referendum.
Right now it just seems to be a growing vague acknowledgement that the current system is suboptimal and that change is complicated and heavily opposed by a lot of political and economic forces.
https://www.vox.com/2018/12/13/18103087/medicare-for-all-single-payer-democrats-sanders-jayapal
Plans and figures are being figured it seems. They sound like salesmen though. All talk about price, no talk about the cost of maintenance.
Additionally, Universal Health Care seems to treat symptoms of a problem, but not the underlying attitudes, behaviors, environmental and psychological issues.
And the current US system does that?
Actually UHC does try to treat the problems. Certainly more than greedy insurances. Simply because everyone is in it and shares the costs.
Just to take one example: In Germany you can get a lot of pre-emptive stuff. You get bonuses for regularily going to the dentist. A free trough-check starting at age 35 every 2 years. My local health insurer has regular "how to eat healthy" courses (okay, those cost a bit of money). Diverse Cancer checks.
And of course you don't pay for visiting the doctor. (We actually had a 10€ per 3 month thing running for a few years. It did not reduce the amount of visits by a meaningful measure. Surprise: Most people don't have fun sitting one hour or longer in a room with sick people!)
As I pointed out with the heroin addict example, she gets arrested, goes to "Drug Court", put in (state funded) rehab, comes out clean, moves in with her family, one month later she's on heroin again.
It sounds like something similar would happen under unversal health care. Constantly cycling people through the system seems wasteful and unsuccessful. It would be prudent for Americans to stop the drug war and open safe injection sites to supplement Universal Health Care. Or alternatively have people in rehab for longer stints to teach life skills.
I'm simply stating Americans will have to butcher quite a few "sacred cows" to make the system work, let alone be successful.
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No-one expects a universal health plan to take care of everything any more than they expect private health insurance to cover everything. Some of it is up to us. I knew someone who died of breast cancer because she refused to go to a doctor, that is not something a health insurance plan, public or private, can deal with.
I believe when I said "There is some personal responsibility" I was roasted because people thought I wanted to deny care.
Good to hear this.
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Well, we could speculate. For arguments sake I'll use the numbers in table 7.1.1 in this article posted above, https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.179bd5a88980 .
Since the US currently spends the most per capita of any country at $8508 and the next highest spending country is Norway at $5669, then the US could reasonably expect to save the difference. That's $2839 per person, per year. Not exactly chump change.
Your same source shows that the United States has the highest obesity rate among OECD countries, and Norway has one of the lowest obesity rates. The prevalence of diabetes in the USA is among the highest, and Norway has one of the lowest. It says that "Diabetes-related health expenditure was estimated to be USD 176 billion in the United States alone."
It shows that the USA has some of the best medical treatment outcomes in the world. For example, we have the highest breast cancer survival rates of any of the studied OECD countries. That's a better measure of quality of medical care than life expectancy.
The following source shows that Norway (and Canada) have some of the longest waiting times for elective surgery or to see a specialist; the USA has among the shortest waiting times:
https://expathealth.org/healthcare/global-patient-wait-time-statistics/
When you effectively ration health care by increasing waiting times, and have lower rates of obesity and diabetes, those factors will tend to reduce overall health care costs.
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When you effectively ration health care by increasing waiting times, and have lower rates of obesity and diabetes, those factors will tend to reduce overall health care costs.
And,.......everyone gets treated. This would drive the price up a bit.
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Well, we could speculate. For arguments sake I'll use the numbers in table 7.1.1 in this article posted above, https://www.washingtonpost.com/news/wonk/wp/2013/11/21/the-u-s-ranks-26th-for-life-expectancy-right-behind-slovenia/?noredirect=on&utm_term=.179bd5a88980 .
Since the US currently spends the most per capita of any country at $8508 and the next highest spending country is Norway at $5669, then the US could reasonably expect to save the difference. That's $2839 per person, per year. Not exactly chump change.
Your same source shows that the United States has the highest obesity rate among OECD countries, and Norway has one of the lowest obesity rates. The prevalence of diabetes in the USA is among the highest, and Norway has one of the lowest. It says that "Diabetes-related health expenditure was estimated to be USD 176 billion in the United States alone."
It shows that the USA has some of the best medical treatment outcomes in the world. For example, we have the highest breast cancer survival rates of any of the studied OECD countries. That's a better measure of quality of medical care than life expectancy.
The following source shows that Norway (and Canada) have some of the longest waiting times for elective surgery or to see a specialist; the USA has among the shortest waiting times:
https://expathealth.org/healthcare/global-patient-wait-time-statistics/
When you effectively ration health care by increasing waiting times, and have lower rates of obesity and diabetes, those factors will tend to reduce overall health care costs.
Regarding the cancer mortality rates:
Cervical cancer survival rates are similar to most European countries, if not slightly worse, despite much higher screening rates. This suggests failure to salvage rather than lack of access to screening. Breast cancer 5 year survival is comparable, maybe slightly better but within 5% of most countries. Regardless, 5 year overall survival is not a useful indicator in breast cancer since most deaths occur in years 5-10. This may be an indicator of poorer screening in Europe. Colorectal cancer we do have better survival than most countries and noticeably better than U.K. This is really interesting because colorectal cancer is cheap and effective to screen for, and treatment is also cheap and effective. Thus a socialized system should really knock this out of the park, unless people are not getting screened for non-financial reasons.
We also do much better at post-stroke and post- heart attack outcomes than most European countries, likely due to an overbuilt cardiovascular medicine infrastructure. Overall I say we do roughly equivalent, maybe slightly better than Europe as a whole for healthcare, but at considerably higher cost. More importantly, the reasons for disparities are unlikely to be entirely based on financial structure, and these reports are of limited utility in figuring out why there are differences.
Also as a surgeon I can assure you that the wait times listed for the US for elective surgery is grossly underestimated, and this is not a useful metric for quality, only number of ORs available.
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Also as a surgeon I can assure you that the wait times listed for the US for elective surgery is grossly underestimated, and this is not a useful metric for quality, only number of ORs available.
Side comment - this is so true. Often it is staffing shortages, not equipment. When more technicians were hired and appointments were made at odd hours, waits here for MRIs went way down. I had my MRI for my knees about 2 weeks after getting the doctor'sorder, not a long wait at all. My hospital Xrays were walk-in, I had the order, I just went and they fit me in.
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<snip> insurance companies make absolutely insane profits,
That's a myth in the United States.
The profitability of the health care insurance industry was ranked 46th out of 76 industries, in terms of profits as a percentage of revenue (median of 2.3%), according to the non-partisan Congressional Research Service (see Table 4):
https://www.ncsl.org/documents/health/MrktStrOfHlthIns.pdf
Hardly "insane" profits.
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Not the insurance companies?
Looks like the providers do OK.
https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html (https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html)
People pay a lot more than they do in the other countries. That money is going somewhere.
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+1 to that!
It's not perfect, but there's no way in hell I'd ever trade it for the US system.
Universal Health Care means that people are able to take risks like starting businesses or other ventures even when they have kids.
A year ago I left my adequate job with good benefits to buy a business and work on upgrading it. It did mean losing my 'extended health insurance'. If we were in the US there is NO WAY I could have done that with 2 kids at home (DW's job has no benefits either).
We will still pay for dental and I hope one of the kids doesn't knock his teeth out, but I don't worry about a bankruptcy inducing health crisis that is not covered (like when my 9 year old spent a week in hospital in November with pneumonia). I was able to take a risk, unlike a middle aged American in the same situation.
You can pry my health card from my cold dead hands. It is pro business, pro innovation and makes everything better. I am continually astonished at the bizarre pretzel logic that happens in the US debates on health care.
My husband switched jobs (excellent move!) but we now have to pay out of pocket for dental or eye care. You might want to double check the insurance you can purchase for your kids through school - it is super cheap - I think I paid around $300 for both kids for three years 24/7/365 for accidental care...I bought it for the dental. It even covers up to $10 000/tooth/ten years following accident. (my kids are sporty I was thinking knocking a few teeth out!) It also covers broken glasses!
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And here come the insurance and for-profit health care companies, mobilizing their lobbyists to make sure the American people don’t get in the way of their profits.
Non-US people, this is one large piece of why nothing changes.
https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html?smid=fb-nytimes&smtyp=cur
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Not the insurance companies?
Looks like the providers do OK.
https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html (https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html)
People pay a lot more than they do in the other countries. That money is going somewhere.
The article provides a spreadsheet summary of the profit data. Looking at this data, most of the highest-profit companies are pharmaceuticals, suppliers of hospital equipment, or REITs that own hospital real estate (weird thing I didn't even know existed!) So it isn't the providers who are profiting the most from healthcare, it's the above-listed sectors.
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Not the insurance companies?
Looks like the providers do OK.
https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html (https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html)
People pay a lot more than they do in the other countries. That money is going somewhere.
The article provides a spreadsheet summary of the profit data. Looking at this data, most of the highest-profit companies are pharmaceuticals, suppliers of hospital equipment, or REITs that own hospital real estate (weird thing I didn't even know existed!) So it isn't the providers who are profiting the most from healthcare, it's the above-listed sectors.
So there's a layer there that gives the hint of a way to disguise the money trail. Hospital real estate? Are hospitals rented like office buildings?
And here come the insurance and for-profit health care companies, mobilizing their lobbyists to make sure the American people don’t get in the way of their profits.
Non-US people, this is one large piece of why nothing changes.
https://www.nytimes.com/2019/02/23/us/politics/medicare-for-all-lobbyists.html?smid=fb-nytimes&smtyp=cur
You know - even the folks in the article who have been mobilized to stop the single payer thing are still edging the country closer to it. Per the article, it looks like they've given up on scrapping Obamacare. They say they want to improve it and cover everybody. That looks like they are compromising a bit and since they want everyone covered, it's an inch or two closer to Universal Health Care.
The money for universal Obamacare would have to come from tax subsidies. All that medical profit coming from taxes may not sit well with everyone. A better way of providing health care would be looked at.
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The following source shows that Norway (and Canada) have some of the longest waiting times for elective surgery or to see a specialist; the USA has among the shortest waiting times:
https://expathealth.org/healthcare/global-patient-wait-time-statistics/
When you effectively ration health care by increasing waiting times, and have lower rates of obesity and diabetes, those factors will tend to reduce overall health care costs.
Hard to generalize Canadian health care wait times as they vary significantly between provinces. I had an issue that required surgery from an ENT while living in BC that happened really quickly - I literally got walked over to the specialist's office from my GP in the same clinic, and had surgery the following Monday (for a non-life threatening issue).
I then moved to Ontario to go to grad school and discovered I had the same issue again and would need surgery. It took me a full year to get through the referral/specialist/surgery process, so long that one surgery was not enough to resolve the issue.
At the end of the year, two weeks after my surgery in Ontario, I moved back to BC. I went to my old GP, he again directed me to the ENT surgeon in the clinic and I had surgery 4 days later (resolving the issue for good).
The key difference between the two provinces at the time was funding for health care. At the time Ontario had been 'served' by a Conservative government for over a decade, and they had done the usual 'cut taxes and defund services' drill leaving the health system seriously stressed. In BC there had been an NDP government for a decade.
Note: taxes were roughly similar in the two provinces, though I can't remember the details. In that decade there was a well financed push to 'privatize' health care to look more like the US, led by many of the Conservative parties and politicians (and newspapers). Part of that process was to underfund public health care to make it look like it was in crisis and that the only 'solution' was to emulate the US and privatize everything.
Ultimately every politician in the country has learned that messing with public health care is electoral suicide, and the fools who thought the US system was something to emulate just ended up looking like morons - from the outside looking in nobody wants to live under that system (excluding possibly a few billionaires).
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Hard to generalize Canadian health care wait times as they vary significantly between provinces. I had an issue that required surgery from an ENT while living in BC that happened really quickly - I literally got walked over to the specialist's office from my GP in the same clinic, and had surgery the following Monday (for a non-life threatening issue).
"Since 2015, wait times to see a specialist has decreased in three provinces and stayed the same in one, but gone up in B.C., among other places. Waiting times from specialist consultation to treatment showed the same pattern: down in three provinces, the same in one, and up in B.C. and other areas.
In fact, B.C. had some of the longest specialist-to-treatment waits in the country, at 14.5 weeks, compared to 7.9 in Saskatchewan."
https://vancouversun.com/health/local-health/the-waiting-game-wait-times-are-on-the-rise-in-b-c
The BC government has a web site where you can check the surgical wait times for various procedures:
https://swt.hlth.gov.bc.ca/
If you care to name the specific procedure you had, we can look up the waiting time.
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Not the insurance companies?
Looks like the providers do OK.
https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html (https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html)
People pay a lot more than they do in the other countries. That money is going somewhere.
The article provides a spreadsheet summary of the profit data. Looking at this data, most of the highest-profit companies are pharmaceuticals, suppliers of hospital equipment, or REITs that own hospital real estate (weird thing I didn't even know existed!) So it isn't the providers who are profiting the most from healthcare, it's the above-listed sectors.
So there's a layer there that gives the hint of a way to disguise the money trail. Hospital real estate? Are hospitals rented like office buildings?
Most of the established large hospitals (university or large community ones) are not rented, so would not be part of this money trail. Private hospitals may have financed construction through these REITs. In addition, private medical groups often finance, possibly through these REITs. (I know they do finance, but always assumed it was through commercial real estate loans via banks. Guess not!)
Hospital/clinic margins are quite low (2-5%), and we actually have a crisis of rural hospitals shutting down due to net losses since most of their patients are medicare (which pays average) and medicaid (which pays very poorly). Also, the high-profit specialties have often gone off and built their own free-standing clinics, leaving even less money for hospitals. Theoretically, if we had a government-run system, then there would be no private clinics, and the profits would be 0%. This would potentially save 36-90 billion a year. ($1.8 trillion on hospital/clinic costs * 0.02 to 0.05). This amounts to 2.5% of total healthcare spending at the high end. Not chump change, but not a big dent either.
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Hospital/clinic margins are quite low (2-5%), and we actually have a crisis of rural hospitals shutting down due to net losses since most of their patients are medicare (which pays average) and medicaid (which pays very poorly). Also, the high-profit specialties have often gone off and built their own free-standing clinics, leaving even less money for hospitals. Theoretically, if we had a government-run system, then there would be no private clinics, and the profits would be 0%. This would potentially save 36-90 billion a year. ($1.8 trillion on hospital/clinic costs * 0.02 to 0.05). This amounts to 2.5% of total healthcare spending at the high end. Not chump change, but not a big dent either.
Maybe some of those rural hospitals would still be open? Not having a regional hospital is bad for everyone in the area no matter what their health coverage is.
Rural health care is still an issue here, simply because so many areas have huge land areas with low populations - how do you serve them adequately?
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Hard to generalize Canadian health care wait times as they vary significantly between provinces. I had an issue that required surgery from an ENT while living in BC that happened really quickly - I literally got walked over to the specialist's office from my GP in the same clinic, and had surgery the following Monday (for a non-life threatening issue).
"Since 2015, wait times to see a specialist has decreased in three provinces and stayed the same in one, but gone up in B.C., among other places. Waiting times from specialist consultation to treatment showed the same pattern: down in three provinces, the same in one, and up in B.C. and other areas.
In fact, B.C. had some of the longest specialist-to-treatment waits in the country, at 14.5 weeks, compared to 7.9 in Saskatchewan."
https://vancouversun.com/health/local-health/the-waiting-game-wait-times-are-on-the-rise-in-b-c
The BC government has a web site where you can check the surgical wait times for various procedures:
https://swt.hlth.gov.bc.ca/
If you care to name the specific procedure you had, we can look up the waiting time.
I have no doubt that wait times have changed since that experience (a multi-year process that ended around 2003). Official waiting times, in my experience, are somewhat different than actual waits as there are often changes and people move up the waiting list for various reasons.
The surgery was day surgery, so that is a different animal than more invasive experiences. I have little doubt that had I needed that treatment in the US and as a young person it would have bankrupted me at the time.
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Not the insurance companies?
Looks like the providers do OK.
https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html (https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html)
People pay a lot more than they do in the other countries. That money is going somewhere.
The article provides a spreadsheet summary of the profit data. Looking at this data, most of the highest-profit companies are pharmaceuticals, suppliers of hospital equipment, or REITs that own hospital real estate (weird thing I didn't even know existed!) So it isn't the providers who are profiting the most from healthcare, it's the above-listed sectors.
Health insurance companies generally have low profit margins, but look at the dollars. UnitedHealth made $2.5 billion in profit for pushing paper and payments. Insurance companies add nothing of value to the system. At least Pfizer's $2.8 billion is based on actually making something. (NOT that I think making 20% profit on people's health is reasonable.)
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So there's a layer there that gives the hint of a way to disguise the money trail. Hospital real estate? Are hospitals rented like office buildings?
I can't say about the US, but a bit about Germany.
Here the healthcare used to be "socialist" hospitals, run by the state. Single doctors mostly are on their own (dentists for example).
Than the "everything needs to be privatized" shit came round. Now my town's hospital belongs to a (Swiss?) group. The building is run by one company, the doctoring by another. The doctoring one rents from the building-owning company.
Did that safe money?
Maybe a bit. I can't say that for sure. What I can say for sure is that the care did not get better. The narcotics doctor I spoke to last was not really in the position to explain the risks (as would be his job) because he was from somewhere far away and likely only learned medical German.
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So there's a layer there that gives the hint of a way to disguise the money trail. Hospital real estate? Are hospitals rented like office buildings?
I can't say about the US, but a bit about Germany.
Here the healthcare used to be "socialist" hospitals, run by the state. Single doctors mostly are on their own (dentists for example).
Than the "everything needs to be privatized" shit came round. Now my town's hospital belongs to a (Swiss?) group. The building is run by one company, the doctoring by another. The doctoring one rents from the building-owning company.
Did that safe money?
Maybe a bit. I can't say that for sure. What I can say for sure is that the care did not get better. The narcotics doctor I spoke to last was not really in the position to explain the risks (as would be his job) because he was from somewhere far away and likely only learned medical German.
I agree with you on this privatization manure. I have seen it done for other things. The argument is made that it will cost less. It may initially, but people are in it for the profit motive. The people doing the work are often paid less when things become privatized and now have two bosses, the customer and those who wish to make a profit. if you are working and given a choice between the two, the man who holds the purse strings will win. If he wants more profit, something has to give. With some privatization, there is no real competition. With no competition, there are no forces to keep cost down and little accountability to a customer who has no real choice.
See link: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-average-wealthy-countries-spend-half-much-per-person-health-u-s-spends
US per capita - $10,224
Germany per capita - $5,729