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Thread: Serious Healthcare Thread

  1. #41

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    Quote Originally Posted by Alistair View Post
    Quote Originally Posted by Victoria Steckersaurus View Post
    If you start with a statement like this:

    How much do you make, ballpark, Victoria? How much of it are you willing to offer up to help them?

    50% perhaps? 75%?
    It looks like you're trying to argue. Just FYI.
    It's fair to ask what level of overall taxation you're personally comfortable with accepting to achieve the aims your promote, is it not?

    Do I think the Israeli system will scale perfectly from a country their size to ours? Probably not. But our current system spends 18% GDP on mediocre to poor healthcare, and theirs spends 8% on very good healthcare. That's such a massive gulf it's absurd.
    So, your position (if I understand it) is that we're going to add full coverage to something like ~100,000,000 new people (non- and underinsured currently) reaching 100% coverage, at a superior level of service to that enjoyed by the average privately insured person, with the same level of technology and pharmacopia access, the same level of investment in advancement, and we're going to save ~10% of our GDP doing it.

    And it's going to be run by the Federal Govt. and administered by the 50 States (following on Lall's quite astute point above).

    I have trouble believing that.

    So lets be objective. Can you provide an example of any other servidce that the Federal Government does that was taken away from the private sector competition where the Govt. service was a marked increase in service, at a marked descrease in costs, to the previous private version?

    As I am sure you understand, if you can promise me we can cover everyone, at current levels of service or better, and my paycheck will be bigger each week net take-home (higher taxes but no insurance costs), it would be a very difficult issue to oppose except from an ultra-libertarian individualist position (whcih is in truth a very small minority, most voters still vote out of personal self-interest above all else).

    The hurdle is showing that this is actually how it would work. Proof of concept here in the U.S. Do we have an example that could be used to prove it?
    You need to do a better job reading, please. I didn't say we were going to get down to 8%, I said right up front that it wouldn't scale perfectly. But the gulf is so large that I believe we would see significant savings.

    And see, those ~100m people without insurance? We already pay for them. Either they are covered by medicare, or we pay for them when they end up in emergency rooms (which can't refuse them service) because they couldn't get the vastly less expensive preventative care (which can refuse them service if they can't pay). So it's entirely possible that we won't see a large cost rise from them. We may even see savings from that.

    I won't deny that the lack of accountability tends to hurt efficiency when the Federal Gov does stuff, but that tends to be a bigger issue with bloated pet projects - Medicare isn't as bad, for example.

    You keep comparing it to the private sector, but in this instance, the private sector is the one that is horrifically ineffient and overpriced. By hiding pricing from both the people making decisions and the people paying (you and your employer, respectively), they've been able to steadily jack prices through the roof while eliminating competition. Even the (sometimes questionable) oversight that the government is subject to will prohibit such a degree of waste.

    So yes. I think it's possible to cover everyone and spend less overall meaning bigger paychecks (or smaller government deficits). The problem is convincing people of that. Such a system promises to take away from the profitability of the medical industry, which means they will be out in force to oppose it.

    Notice that here in America, people have been convinced that global climate change is a hoax (or at best is still controvertial) despite it actually being only a notch or two short of proven fact. People were convinced that Obamacare was a "Government Takeover" of healthcare, despite that being an utter lie. In this case we're talking about something much closer to a genuine government takeover, which will play nicely into the hands of anyone who wants to distort it a little and fear-monger a bit.

  2. #42
    Alistair's Avatar
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    Quote Originally Posted by Victoria Steckersaurus View Post
    I didn't say we were going to get down to 8%, I said right up front that it wouldn't scale perfectly. But the gulf is so large that I believe we would see significant savings.
    And see, those ~100m people without insurance? We already pay for them. So it's entirely possible that we won't see a large cost rise from them. We may even see savings from that.
    So we'll save, say, 5% to 6% of GDP in spending on Healthcare then? General Ballpark figures.

    I won't deny that the lack of accountability tends to hurt efficiency when the Federal Gov does stuff, but that tends to be a bigger issue with bloated pet projects - Medicare isn't as bad, for example.
    http://www.gao.gov/products/GAO-11-409T would seem, at first glance, to disagree with that claim.

    Googling "GAO medicare waste" makes for interesting reading. This for example: http://www.gao.gov/products/GAO-12-966

    So yes. I think it's possible to cover everyone and spend less overall meaning bigger paychecks (or smaller government deficits). The problem is convincing people of that. Such a system promises to take away from the profitability of the medical industry, which means they will be out in force to oppose it.
    Happily, the medical industry does not get a vote on election day.

    If the facts are so clearly in favor of such a system, as you and other say they are, it shouldn't be that hard to convince a majority of voters of how clearly in their own best interests such a choice is. Perhaps for a start, you may wish to stop calling them poor hated stupid people....thats generally a turnoff right from the start.

    Next, repeat ad neasuem "Everyone covered, bigger paychecks for all". Then show examples.

    Then (and this is the important part) when the Law passes finally.....you sure better have been right.

    Notice that here in America, people have been convinced that global climate change is a hoax (or at best is still controvertial) despite it actually being only a notch or two short of proven fact. People were convinced that Obamacare was a "Government Takeover" of healthcare, despite that being an utter lie. In this case we're talking about something much closer to a genuine government takeover, which will play nicely into the hands of anyone who wants to distort it a little and fear-monger a bit.
    Another serious topic, for another (seperate) serious thread.


  3. #43
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    I won't deny that the lack of accountability tends to hurt efficiency when the Federal Gov does stuff, but that tends to be a bigger issue with bloated pet projects - Medicare isn't as bad, for example.
    http://www.gao.gov/products/GAO-11-409T would seem, at first glance, to disagree with that claim.

    Googling "GAO medicare waste" makes for interesting reading. This for example: http://www.gao.gov/products/GAO-12-966
    Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
    I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.
    In short I agree it's bad, but I don't see how we're special.

    Edit: I guess another way to put it is, governments are frequently wasteful, but would they be "300% to 1000% above cost" wasteful? Because that's what our current system seems to be giving us with $250 bills for $50 operations.

    Even if government runs this setup at 100% waste above cost we'd be looking at 50-70% savings.

    So yes. I think it's possible to cover everyone and spend less overall meaning bigger paychecks (or smaller government deficits). The problem is convincing people of that. Such a system promises to take away from the profitability of the medical industry, which means they will be out in force to oppose it.
    Happily, the medical industry does not get a vote on election day.

    If the facts are so clearly in favor of such a system, as you and other say they are, it shouldn't be that hard to convince a majority of voters of how clearly in their own best interests such a choice is. Perhaps for a start, you may wish to stop calling them poor hated stupid people....thats generally a turnoff right from the start.

    Next, repeat ad neasuem "Everyone covered, bigger paychecks for all". Then show examples.

    Then (and this is the important part) when the Law passes finally.....you sure better have been right.
    Sadly, the healthcare industry gets a vote every other day of the year instead. We had numbers posted earlier showing they spend more lobbying than military contractors and investment banks combined.

    As for the posted strategy...I have no clue why we don't do this. I've been waiting to see it for a long time and have seen no evidence it couldnt be done just like that ("Everyone covered, lower costs"). My only hypothesis why this doesn't happen is that it's a politically suicidal option given the healthcare lobbying above.

    Notice that here in America, people have been convinced that global climate change is a hoax (or at best is still controvertial) despite it actually being only a notch or two short of proven fact. People were convinced that Obamacare was a "Government Takeover" of healthcare, despite that being an utter lie. In this case we're talking about something much closer to a genuine government takeover, which will play nicely into the hands of anyone who wants to distort it a little and fear-monger a bit.
    Another serious topic, for another (seperate) serious thread.
    Yes let's not discuss gullibility in America here. It could fill several threads.
    Last edited by Synapse; March 1 2013 at 09:18:46 PM.

  4. #44
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    TBH just passing regulation banning the practice of "evergreening" medication would likely be enough to drastically bring down the cost of medication & increase compition between pharma-corps.

    If you aren't familiar with what evergreening means, its the practice of a pharmaceutical company slightly altering the medication, usually the inactive ingrediants, as a way of extending the patents life time. If we were to introduce legislation that upon changing it, the company would recieve an entirely new patent for the altered medication, and that the previous makeup would have its patent voided, it would make companies vastly reconsider if the slight alterations are worth having the previous form of the drug made generic as they would have to compete against it. So it would push them to only alter the make-up when it actually offers tangible benefits to the consumer.

  5. #45
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    Quote Originally Posted by Synapse View Post
    Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
    I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.

    In short I agree it's bad, but I don't see how we're special.
    Each one of those State sized governments have a different method of doing it and complete control over it. The issue would have more in common if the EU cancelled all of those plans and issued their own universal plan and only the EU council controls it. Would the UK be fine if they had to use the Swedish version? Would the Dutch be fine with the Italian way of doing it? The States first have to get functioning systems run by them and balanced to their budgets in place before they can do a universal card like the EU and the US gov. doesn't want to have it that way.

  6. #46
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    Quote Originally Posted by Keorythe View Post
    Quote Originally Posted by Synapse View Post
    Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
    I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.

    In short I agree it's bad, but I don't see how we're special.
    Each one of those State sized governments have a different method of doing it and complete control over it. The issue would have more in common if the EU cancelled all of those plans and issued their own universal plan and only the EU council controls it. Would the UK be fine if they had to use the Swedish version? Would the Dutch be fine with the Italian way of doing it? The States first have to get functioning systems run by them and balanced to their budgets in place before they can do a universal card like the EU and the US gov. doesn't want to have it that way.
    Well, right now it seems that the US has done exactly that, then opted for the Albanian system. So I fail to see how that would be a worse situation then todays. And I'm pretty sure that the UK would be perfectly fine with the Swedish system and vice versa. And the same with the Dutch and Italian. (Italian is second rated after the French FYI according to the CIA World Factbook). The fact is that there are more similarities then there are differences in these systems, with the main focus being the patient, and not the wallet of the medical industry.

  7. #47
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    Quote Originally Posted by Keorythe View Post
    Quote Originally Posted by Synapse View Post
    Given that we have twenty other state-sized governments currently running these systems just fine, why discuss whether or not governments can do it?
    I don't see why our government is a special brand of retarded that makes it incapable of what (for example) french bureaucracy can do, and they are literally the poster children for wasteful bureaucracy.

    In short I agree it's bad, but I don't see how we're special.
    Each one of those State sized governments have a different method of doing it and complete control over it. The issue would have more in common if the EU cancelled all of those plans and issued their own universal plan and only the EU council controls it. Would the UK be fine if they had to use the Swedish version? Would the Dutch be fine with the Italian way of doing it? The States first have to get functioning systems run by them and balanced to their budgets in place before they can do a universal card like the EU and the US gov. doesn't want to have it that way.
    Even assuming your argument is correct that it doesn't scale (something not entirely settled). There's no reason it has to be a federally run system. Pretty unlikely that it would be anything greater than a federally mandated and supported set of systems, as we have discussed. So that point seems kind of moot.

    Furthermore, you're offering a false choice. It's not about whether the dutch would be happy with how the italians do it, its about whether either one would take the american system. (they wouldnt.)

    The dutch might not be fine with how the italians do it. But californians or dakotans would BOTH be happier with how either the dutch or the italians do it, compared to what they have now.
    Any US state would be so much better off that the comparative differences would just be washed out by improvements.

  8. #48
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    How the rest of the world sees the american healthcare discussion:


  9. #49
    Movember '12 Best Facial Hair Movember 2012Donor Lallante's Avatar
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    the problem, you see, is that USA is too awesome for healthcare

  10. #50
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    I have yet to hear a convincing argument against universal health care that does not fall flat on its face when faced with reality and economics. Most of the arguments against seems to be based on disprovable myths and misguided ideologies.

    And personally I must say that I prefer to get something back for the money I pay in taxes. And since I do I gladly pay them.

  11. #51

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    Let's move the focus a bit

    http://www.bbc.co.uk/news/health-21654536

    Interesting research released today. Despite commendable advances in primary and secondary medical care in the last 15-20 years, and a resulting boost to life expectancy, the UK is still one of the least healthy countries in the developed world. Does the combination of a state mandate for healthcare and the fact of a generally unhealthy lifestyle stand as justification for a government to enforce wide-ranging and intrusive health measures, like taxing low quality food, further limiting smoking (e.g. banning tobacco sales in all but a few licensed dispensaries) and combining health and social care into one, monolithic service with a strong focus on preventing rather than curing problems?

    Or should the approach be more education focused, based on the idea that many comparable countries achieve much healthier lifestyles without intrusive government control, the issue being self-managed through cultural attitudes to alcohol consumption and similar.

  12. #52
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    I think the problem lies a bit deeper then that. A lot of it is probably culturally based. If you can get people to eat healthier and exercise it will probably do more for public health then restricting tobacco sales. But as long as people don't move and eat low quality food, not just because it is cheap, but also because it requires no effort to prepare, you won't see much in the way of an improvement to general health.

    Must say that I'm generally for a tax on sugar and maybe even unhealthy food additives.

  13. #53
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    It should be pointed out that the U.S. does have something of a test-bed for a light-version of Universal Healthcare, in the form of the State of Mass. Albeit in the form of individual mandate + Social Welfare benefit, not a true Universal Single-Payer system.

    http://en.wikipedia.org/wiki/Massach...sal_healthcare

    Makes for interesting reading.


  14. #54
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    Move-on.org keeps sending me mails saying they want my money to help fight against Obama putting ANY CUTS up for negotiation in medicare, social security, or Medicaid.

    My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?

    Am I right that MoveOn is fighting a reactionary "don't touch my benefits" battle to the detriment of our national finances, or is Obama offering up the only lifeline left to America's poor in an attempt to meet the extreme right in the middle?

    ...or is it both?

  15. #55
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    Am I right that MoveOn is fighting a reactionary "don't touch my benefits" battle to the detriment of our national finances, or is Obama offering up the only lifeline left to America's poor in an attempt to meet the extreme right in the middle?
    A bit of both, but more the second than the first. It has happened so often that it's cliched now:

    1. The GOP says "let's meet in the middle"
    2. Obama moves a step closer.
    3. GOP moves a step further away.
    4. Goto step 1

    The last plan I saw to fix sequester was still firmly slanted towards everything the GOP wants, except a few bones thrown to Dem electorates with a large military presence, so I can understand the concern that moveon has.
    Contract stuff to Seraphina Amaranth.

    "You give me the awful impression - I hate to have to say - of someone who hasn't read any of the arguments against your position. Ever."


  16. #56
    Moderator Moderator F*** My Aunt Rita's Avatar
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    Quote Originally Posted by Synapse View Post
    My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?
    Where are you getting these numbers?

  17. #57
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    Quote Originally Posted by elmicker View Post
    Let's move the focus a bit

    http://www.bbc.co.uk/news/health-21654536

    Interesting research released today. Despite commendable advances in primary and secondary medical care in the last 15-20 years, and a resulting boost to life expectancy, the UK is still one of the least healthy countries in the developed world. Does the combination of a state mandate for healthcare and the fact of a generally unhealthy lifestyle stand as justification for a government to enforce wide-ranging and intrusive health measures, like taxing low quality food, further limiting smoking (e.g. banning tobacco sales in all but a few licensed dispensaries) and combining health and social care into one, monolithic service with a strong focus on preventing rather than curing problems?

    Or should the approach be more education focused, based on the idea that many comparable countries achieve much healthier lifestyles without intrusive government control, the issue being self-managed through cultural attitudes to alcohol consumption and similar.
    If you look at the statistics its clearly due to ciggarettes, alcohol and junk food, rather than health service.

    I think yes, the government should tax unhealthy products.

  18. #58
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    Quote Originally Posted by Lallante View Post
    Quote Originally Posted by elmicker View Post
    Let's move the focus a bit

    http://www.bbc.co.uk/news/health-21654536

    Interesting research released today. Despite commendable advances in primary and secondary medical care in the last 15-20 years, and a resulting boost to life expectancy, the UK is still one of the least healthy countries in the developed world. Does the combination of a state mandate for healthcare and the fact of a generally unhealthy lifestyle stand as justification for a government to enforce wide-ranging and intrusive health measures, like taxing low quality food, further limiting smoking (e.g. banning tobacco sales in all but a few licensed dispensaries) and combining health and social care into one, monolithic service with a strong focus on preventing rather than curing problems?

    Or should the approach be more education focused, based on the idea that many comparable countries achieve much healthier lifestyles without intrusive government control, the issue being self-managed through cultural attitudes to alcohol consumption and similar.
    If you look at the statistics its clearly due to ciggarettes, alcohol and junk food, rather than health service.

    I think yes, the government should tax unhealthy products.
    But doesnt the UK already have the highest taxation rates on booze + cigs out of any european country?

    (but im all for a tax on soda!)

  19. #59
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    Quote Originally Posted by F*** My Aunt Rita View Post
    Quote Originally Posted by Synapse View Post
    My understanding of these programs is that while nice, expansions in their cost are projected to overtake our entire budget in the next 30-40 years or so?
    Where are you getting these numbers?
    Honestly this is just coming from the gestalt of all I've heard on the subject over years from various sources, however this seems a representative sample below. I was wrong about 30-40 years, it was 75 years.
    The prodigious level of spending makes health care important, but it is the fearsome growth of health care costs that has put health care reform on the national agenda. Medicare spending has grown 2.4 percentage points per year faster than GDP over the past 30 years, more than tripling as a share of GDP since 1960. If costs continue to grow at current rates relative to GDP, then Medicare alone will account for 8 percent of GDP by 2030, 14 percent by 2050, and 31 percent by the end of the 75-year budget projection window. This would imply that Medicare would be more than 50 percent larger than the current size of the entire federal budget. While these numbers are absurdly large, a similar projection would forecast total health care spending to account for an impossible 99 percent of GDP by 2082 (Congressional Budget Office, 2007).
    (bolding mine)
    Source: http://www.ncbi.nlm.nih.gov/books/NBK52815/

    Moreover, the point is not how much that they will grow, but that the near term trajectory even through the next 15 years (~2030) is also an untenable amount of healthcare spending.

  20. #60
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    Quote Originally Posted by cheeba View Post
    But doesnt the UK already have the highest taxation rates on booze + cigs out of any european country?

    (but im all for a tax on soda!)
    Literally nowhere near.

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