Your thoughts on The US Healthcare System

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Seanchaidh:

Ryotknife:
It is an issue that is immensely complicated. People thinking that there is a silver bullet are oversimplifying the problem.

No.

Medicare for all, and allow it to actually negotiate drug prices instead of just taking it on the chin. Single payer works, look at countries that use it if you doubt. Medicare works, take a look at that if you doubt.

The way we've structured healthcare is immensely complicated. Solving it is easy: kill the health insurance companies. Stop worrying about a parasitic industry which adds no value but makes billions in profits on human misery. In the face of single payer, health insurance is obsolete.

There is a simple solution to this problem-- or at least one we've already mapped out pretty well in providing medicare-- it's just opposed by some very wealthy people who would rather make lots of money than solve the problem.

1. and the 2.5 million people employed by health insurance companies?

2. Government does not do things cheaper. Anyone with any experience knows this.

3. those other countries have different factors to take into consideration. for example, doctors in US get paid a lot more. Also, doctors in US have on average 183,000 in student debt once they graduate, much more than other countries. Also, malpractice insurance is much more (anywhere from 10,000 to almost 200,000). Medical fraud of up to 272 billion dollars. Also, most other countries have punishments for frivalous lawsuits or make it more difficult to sue government entities, we dont have any of those. In fact, it is way too easy to sue the government or anyone else. Look at what happend to jim sterling. You are glazing over dozens of variables.

Dont get me wrong, i would love to support public healthcare. I really would. But you are oversimplifying the problem.

Ryotknife:

Seanchaidh:

Ryotknife:
It is an issue that is immensely complicated. People thinking that there is a silver bullet are oversimplifying the problem.

No.

Medicare for all, and allow it to actually negotiate drug prices instead of just taking it on the chin. Single payer works, look at countries that use it if you doubt. Medicare works, take a look at that if you doubt.

The way we've structured healthcare is immensely complicated. Solving it is easy: kill the health insurance companies. Stop worrying about a parasitic industry which adds no value but makes billions in profits on human misery. In the face of single payer, health insurance is obsolete.

There is a simple solution to this problem-- or at least one we've already mapped out pretty well in providing medicare-- it's just opposed by some very wealthy people who would rather make lots of money than solve the problem.

1. and the 2.5 million people employed by health insurance companies?

Shouldn't be shielded by Luddite reasoning.

Ryotknife:
2. Government does not do things cheaper. Anyone with any experience knows this.

These people don't have experience, then?

That took two seconds of changing tabs and Google search. Also, knowing what the word "monopsony" means, I know why the government is more efficient than private health insurance.

Ryotknife:
3. those other countries have different factors to take into consideration. for example, doctors in US get paid a lot more. Also, doctors in US have on average 183,000 in student debt once they graduate, much more than other countries.

We should do something about student debt, but it hardly presents an incredible problem for medicare for all.

Ryotknife:
Also, malpractice insurance is much more (anywhere from 10,000 to almost 200,000). Medical fraud of up to 272 billion dollars. Also, most other countries have punishments for frivalous lawsuits or make it more difficult to sue government entities, we dont have any of those. In fact, it is way too easy to sue the government or anyone else. Look at what happend to jim sterling.

Dont get me wrong, i would love to support public healthcare. I really would. But you are oversimplifying the problem and not thinking things through.

You're not raising any terrifically important or difficult objections. Yes, there are dollar costs. No, they aren't a big problem.

Seanchaidh:

Ryotknife:

Seanchaidh:

No.

Medicare for all, and allow it to actually negotiate drug prices instead of just taking it on the chin. Single payer works, look at countries that use it if you doubt. Medicare works, take a look at that if you doubt.

The way we've structured healthcare is immensely complicated. Solving it is easy: kill the health insurance companies. Stop worrying about a parasitic industry which adds no value but makes billions in profits on human misery. In the face of single payer, health insurance is obsolete.

There is a simple solution to this problem-- or at least one we've already mapped out pretty well in providing medicare-- it's just opposed by some very wealthy people who would rather make lots of money than solve the problem.

1. and the 2.5 million people employed by health insurance companies?

Shouldn't be shielded by Luddite reasoning.

Ryotknife:
2. Government does not do things cheaper. Anyone with any experience knows this.

These people don't have experience, then?

That took two seconds of changing tabs and Google search. Also, knowing what the word "monopsony" means, I know why the government is more efficient than private health insurance.

Ryotknife:
3. those other countries have different factors to take into consideration. for example, doctors in US get paid a lot more. Also, doctors in US have on average 183,000 in student debt once they graduate, much more than other countries.

We should do something about student debt, but it hardly presents an incredible problem for medicare for all.

Ryotknife:
Also, malpractice insurance is much more (anywhere from 10,000 to almost 200,000). Medical fraud of up to 272 billion dollars. Also, most other countries have punishments for frivalous lawsuits or make it more difficult to sue government entities, we dont have any of those. In fact, it is way too easy to sue the government or anyone else. Look at what happend to jim sterling.

Dont get me wrong, i would love to support public healthcare. I really would. But you are oversimplifying the problem and not thinking things through.

You're not raising any terrifically important or difficult objections. Yes, there are dollar costs. No, they aren't a big problem.

http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than-private-insurance/

from the same blog site as yours.

You cant handwave away variables and call them irrelevant just because you dont like them. Although i know im basically talking to a wall at this point and this is a debate that has been hashed out over a dozen times.

Ryotknife:

Seanchaidh:

Ryotknife:

1. and the 2.5 million people employed by health insurance companies?

Shouldn't be shielded by Luddite reasoning.

Ryotknife:
2. Government does not do things cheaper. Anyone with any experience knows this.

These people don't have experience, then?

That took two seconds of changing tabs and Google search. Also, knowing what the word "monopsony" means, I know why the government is more efficient than private health insurance.

Ryotknife:
3. those other countries have different factors to take into consideration. for example, doctors in US get paid a lot more. Also, doctors in US have on average 183,000 in student debt once they graduate, much more than other countries.

We should do something about student debt, but it hardly presents an incredible problem for medicare for all.

Ryotknife:
Also, malpractice insurance is much more (anywhere from 10,000 to almost 200,000). Medical fraud of up to 272 billion dollars. Also, most other countries have punishments for frivalous lawsuits or make it more difficult to sue government entities, we dont have any of those. In fact, it is way too easy to sue the government or anyone else. Look at what happend to jim sterling.

Dont get me wrong, i would love to support public healthcare. I really would. But you are oversimplifying the problem and not thinking things through.

You're not raising any terrifically important or difficult objections. Yes, there are dollar costs. No, they aren't a big problem.

http://healthaffairs.org/blog/2011/08/09/is-medicare-more-efficient-than-private-insurance/

from the same blog site as yours.

Let's look at their first point:

What about the claim that Medicare?s administrative costs are only 2 percent, compared to 10 percent to 15 percent for private insurers? The problem with this comparison is that it includes the cost of marketing and selling insurance as well as the costs of collecting premiums on the private side, but ignores the cost of collecting taxes on the public side.

Collecting taxes is something we do anyway. So, this is an extraordinarily weak point. Also, what I linked was a direct response to what you did.

You cant handwave away variables and call them irrelevant just because you dont like them. Although i know im basically talking to a wall at this point and this is a debate that has been hashed out over a dozen times.

I can call them irrelevant because we easily have enough to pay for them. Like, you can throw money at this problem if you use the medicare template. It's not complicated.

A disaster, certainly, and getting more disastrous, but many people seem to be cheerful about this, which seems strange.

Thaluikhain:
A disaster, certainly, and getting more disastrous, but many people seem to be cheerful about this, which seems strange.

I dunno man. Humans are weird as fuck. We cheer disasters but boo success. There is one important message here many many people need to know.

*clears throat*

CORPORATIONS DO NOT GIVE A FUCK ABOUT YOU.

The US healthcare serves as a warning for other developed nations not to privatise their healthcare. I used to worry ACA would remove the worst failures of US healthcare but I'm glad the Republican party managed to weaken that. US healthcare still remains a source of cheap amusement as well as political warning.

Ryotknife:
1. and the 2.5 million people employed by health insurance companies?

If the US switched to a single-payer system tomorrow, it would by necessity probably end up employing a large portion of those people, because someone still needs to run the insurance system. Experienced actuaries and claims processors would probably still be able to get a job; they'd just be employed by a government-run entity instead of an insurance company.

That said...

Seanchaidh:

Ryotknife:

1. and the 2.5 million people employed by health insurance companies?

Shouldn't be shielded by Luddite reasoning.

...you are glossing over the problem here. We're talking two and a half million jobs tied up in the insurance system in one way or another. A government-run single-payer system would be vastly more efficient - to be honest, a fifth grader could design a system that's more efficient than the current US healthcare system - but that also means it would employ less people.

You need to acknowledge the scale here. Those lost coal jobs that everyone raises a stink about amount to about 70,000 workers in total. The US loses 70,000 jobs in a dying energy industry, and the political backlash is strong enough to get Trump elected. Transferring to a single-payer system would be that, but ten times larger. It's these obstacles that killed the Clinton plan in 1993.

I'm not saying you couldn't do it, just that you'd have to wean people off it, probably over ten to fifteen years, with a lot of federal support along the way. It'd require a long-term effort from multiple different presidents who could agree to pursue the same policy.

bastardofmelbourne:
...you are glossing over the problem here. We're talking two and a half million jobs tied up in the insurance system in one way or another. A government-run single-payer system would be vastly more efficient - to be honest, a fifth grader could design a system that's more efficient than the current US healthcare system - but that also means it would employ less people.

You need to acknowledge the scale here. Those lost coal jobs that everyone raises a stink about amount to about 70,000 workers in total. The US loses 70,000 jobs in a dying energy industry, and the political backlash is strong enough to get Trump elected. Transferring to a single-payer system would be that, but ten times larger. It's these obstacles that killed the Clinton plan in 1993.

I'm not saying you couldn't do it, just that you'd have to wean people off it, probably over ten to fifteen years, with a lot of federal support along the way. It'd require a long-term effort from multiple different presidents who could agree to pursue the same policy.

Totally different situation. Often entire towns or even cities are built around coal mining. If 10,000 miners get fired in one single small area that can be enough to send an entire city into a downward spiral because everyone, from restaurateurs to the betting office to the butchers feels the impact.

I'm not aware of any towns or cities in the US which are built around health care to that degree. Maybe theres a MediCity somewhere in the south west I've never heard of which flies in people from all around the country so the 5000 medical specialists can take a look at them. But if not you're comparing apples and oranges here.

In an act of supreme irony, while meeting with Malcolm Turnbull, Trump praised Australia for having "better health care than we do." Australia has a publicly funded universal health care system. Bernie Sanders found this hilarious.

I, for one, would like to thank Mr. Trump for recognising the intrinsic bettererness of Australia. Make Australia Betterer Again!

bastardofmelbourne:
In an act of supreme irony, while meeting with Malcolm Turnbull, Trump praised Australia for having "better health care than we do." Australia has a publicly funded universal health care system. Bernie Sanders found this hilarious.

I, for one, would like to thank Mr. Trump for recognising the intrinsic bettererness of Australia. Make Australia Betterer Again!

And Turnbull returned the favour, praising Trump for attacking the ACA

http://www.9news.com.au/national/2017/05/05/11/14/malcolm-turnbull-praises-donald-trump-on-successful-vote-to-repeal-obamacare

RiseOfTheWhiteWolf:
Totally different situation. Often entire towns or even cities are built around coal mining. If 10,000 miners get fired in one single small area that can be enough to send an entire city into a downward spiral because everyone, from restaurateurs to the betting office to the butchers feels the impact.

I'm not aware of any towns or cities in the US which are built around health care to that degree. Maybe theres a MediCity somewhere in the south west I've never heard of which flies in people from all around the country so the 5000 medical specialists can take a look at them. But if not you're comparing apples and oranges here.

That's a good point, actually. It hadn't occurred to me.

Thaluikhain:
And Turnbull returned the favour, praising Trump for attacking the ACA

A...charitable interpretation of those words would lead me to believe that Turnbull is referring to the general euphoria one feels when successfully passing a piece of keystone legislation, rather than the specifics of what the AHCA does.

Alternately, Turnbull got all buttered up and felt he had to slather some butter in return. That's...okay, that's in my head. That's an image in my head that I'm seeing right now, and it is not pretty. I am never getting rid of this. Oh God.

bastardofmelbourne:

RiseOfTheWhiteWolf:
Totally different situation. Often entire towns or even cities are built around coal mining. If 10,000 miners get fired in one single small area that can be enough to send an entire city into a downward spiral because everyone, from restaurateurs to the betting office to the butchers feels the impact.

I'm not aware of any towns or cities in the US which are built around health care to that degree. Maybe theres a MediCity somewhere in the south west I've never heard of which flies in people from all around the country so the 5000 medical specialists can take a look at them. But if not you're comparing apples and oranges here.

That's a good point, actually. It hadn't occurred to me.

To be fair it might not have to me either if I wasn't in the Ruhrgebiet and didn't have the example of what I'm talking about literally a 10 minutes walk away. I can see the tower thingy what you call it from my flat. Problem for this bit of the country is its essentially just one clusterfuck of cities which were all built on coal and steel. Now that all of it has disappeared we're royally boned.

BeetleManiac:

inu-kun:
I'm not saying it's my opinion. But regardless, it's not outlandish to demand that if a person intentionally does something that gets him ill he should pay for the treatment out of his own money. No one "decides" he will die, just owe money.

Unless you say it's someone else's opinion, it's yours. Own it.

https://en.wikipedia.org/wiki/Devil%27s_advocate

Socialized health insurance has the problems of needing tax payer money and not needing to actually be efficient like businesses are. It's not a black and white scenario where one is inherently superior to the other and needing to get your own insurance at a higher price can be said to be superior to waiting 6 months for an important surgery.

Did you just say that businesses are efficient? Is that why over 90% go bankrupt within the first 12 months? Is it efficient for corporate executives to rack up lavish expenses for their own luxury and give themselves bonuses because they want one? Is it efficient to concentrate wealth and power into an elite, privileged minority? Is Trump's habit of marketing bargain bin crap as luxury items for outrageous markups efficient?

I am far less concerned with efficiency than I am with effectiveness. They are entirely separate things and most businesses are neither. Efficiency simply seeks to remove the perception of over-complication, and the reality of most business efficiency models only ends up creating an even more broken system that's even more complicated than when it started, the boss just has to learn fewer people's names. Effectiveness on the other hand focuses on results, not appearances.

And in regards to "paying more for your own insurance," not only I can not do that, but under Trumpcare my mother, who is a cancer survivor who gave birth to me through a C-section would be denied all coverage because those would be pre-existing conditions and the Republicans think it's okay to discriminate against people.

Society doesn't work when everyone's only out for themselves.

But they at least have a reason to be efficient unlike government owned business that would function regardless of quality. As for the pre-existing conditions, this is not a necessary part of non-socialized healthcare (and can depend on the case and how different the price for that case).

Society also doesn't work when everyone pays for everyone else without choice in the matter.

inu-kun:
https://en.wikipedia.org/wiki/Devil%27s_advocate

Devil's advocate is a bullshit idea that doesn't help anything because it's being contrary for the sake of it. It doesn't require thought, principles or even good faith.

But they at least have a reason to be efficient

So they have a reason to be efficient, but they still don't do it anyway? Then what's the difference?

unlike government owned business that would function regardless of quality.

You do know that the roads you drive on are government-run, right? As are your public schools, your courts, your treasury, national banks, law enforcement, national defense, emergency services, and any government benefits you directly enjoy. Please, spare me the Ronald Reagan talking points. They don't refute anything I'm saying and only serve to make you look thoughtless.

As for the pre-existing conditions, this is not a necessary part of non-socialized healthcare (and can depend on the case and how different the price for that case).

Do you not believe that access to health care is a human right?

Society also doesn't work when everyone pays for everyone else without choice in the matter.

You mean I could have skipped out on paying all of my taxes all these years? Why didn't anyone tell me?!

inu-kun:

BeetleManiac:

inu-kun:
I'm not saying it's my opinion. But regardless, it's not outlandish to demand that if a person intentionally does something that gets him ill he should pay for the treatment out of his own money. No one "decides" he will die, just owe money.

Unless you say it's someone else's opinion, it's yours. Own it.

https://en.wikipedia.org/wiki/Devil%27s_advocate

It's in the best interest of one wishing to be a devil's advocate to say that they are being a devil's advocate from the start. That way it doesn't appear to be a cop-out.

But they at least have a reason to be efficient unlike government owned business that would function regardless of quality.

Actually, as far as healthcare goes, the exact opposite is true. The reason the base cost of medicines and medical procedures in the US is so expensive is because normal free market rules do not apply to something like medicine. Remember when the price of an EpiPen went up 400% for no good reason? That happened because, unlike other products, there is no price people won't pay for a life-saving medicine or medical procedure. If the price of Cheetos were to suddenly go up 400%, I'd stop buying Cheetos. If the price of an emergency medical device I use to save my life when I have an allergic reaction goes up 400%, I will spend all the money I have plus quite a bit that I don't in order to get it. In economics this is called inelastic demand, because no matter what happens to the cost the demand remains the same.

Socialized healthcare systems fix this problem by setting up the government as a price negotiator. With free market healthcare, while customers are subject to whatever prices pharmaceutical companies offer, they are not in a position to negotiate that price or drive competition for pricing. However with socialized healthcare, the government is in a position of power to cause pharmaceutical companies to compete with one another to be "the one" to provide medicine or medical equipment for that entire country. And the government DOES have incentive to make sure the things covered by their plan are both affordable and safe, because if people get sicker from what services they are provided, that only costs them MORE to fix.

As for the pre-existing conditions, this is not a necessary part of non-socialized healthcare (and can depend on the case and how different the price for that case).

Maybe coverage for pre-existing conditions necessary for non-socialized healthcare, but it's certainly necessary for the people who fall in that category to remain alive.

Society also doesn't work when everyone pays for everyone else without choice in the matter.

Oh yes, it's a miracle Canada, the UK, Australia, Germany, Finland, Denmark, Austria, Switzerland, the Netherlands, Sweden, Iceland, Norway, Italy, Portugal, Romania, and Spain have made it this long. Each and every one of them are on the verge of breaking into riots with how much they hate their healthcare systems.

inu-kun:

Society also doesn't work when everyone pays for everyone else without choice in the matter.

To what degree?

Any society that features taxation involves everyone paying for everyone else without choice in the matter to an extent. This is something people have no problem with fundamentally; it is the extent that we disagree about. That's why it's unhelpful to imagine that the above stance is universally applicable. It's definitely, clearly not.

Ryotknife:

2. Government does not do things cheaper. Anyone with any experience knows this.

Really? That must be why the US spends inordinately more proportionally on its healthcare system than does the UK, while the latter performs better.

bastardofmelbourne:

Ryotknife:
1. and the 2.5 million people employed by health insurance companies?

If the US switched to a single-payer system tomorrow, it would by necessity probably end up employing a large portion of those people, because someone still needs to run the insurance system. Experienced actuaries and claims processors would probably still be able to get a job; they'd just be employed by a government-run entity instead of an insurance company.

That said...

Seanchaidh:

Ryotknife:

1. and the 2.5 million people employed by health insurance companies?

Shouldn't be shielded by Luddite reasoning.

...you are glossing over the problem here. We're talking two and a half million jobs tied up in the insurance system in one way or another. A government-run single-payer system would be vastly more efficient - to be honest, a fifth grader could design a system that's more efficient than the current US healthcare system - but that also means it would employ less people.

Yes. This is what we call progress.

bastardofmelbourne:
You need to acknowledge the scale here. Those lost coal jobs that everyone raises a stink about amount to about 70,000 workers in total. The US loses 70,000 jobs in a dying energy industry, and the political backlash is strong enough to get Trump elected.

Eh? Trump wasn't just a coal candidate. Christ, if the collapse of the coal industry was our only economic problem worthy of anger at the establishment, Trump's candidacy wouldn't have been more than a greasy fart in the wind.

bastardofmelbourne:
Transferring to a single-payer system would be that, but ten times larger. It's these obstacles that killed the Clinton plan in 1993.

A bit oversimplified, and spread out over the country as you've already acknowledged.

bastardofmelbourne:
I'm not saying you couldn't do it, just that you'd have to wean people off it, probably over ten to fifteen years, with a lot of federal support along the way. It'd require a long-term effort from multiple different presidents who could agree to pursue the same policy.

If you're really worried about it, implement an employer of last resort plan at the same time, then. Estimates put such a program at around $600B per year to start, and then less over time (because of macroeconomic effects-- more demand for goods and services because people at the bottom actually consume with extra income).

Either one of these programs are something we should just do. Both together, even better.

People need to understand that health insurance and health care are two different things. Health insurance(America) and universal coverage(Europe) are not health care, they are different methods of paying for health care. The one you prefer depends on whether you are in favor of the healthy taking care of the sick. The vast majority of healthcare is accrued by a small percent of the population. If you think those lucky enough to not have serious illness should help out those who do, you support universal coverage. If you think people should be left to chance, you support health insurance.

Universal coverage is better for those seeking to avoid the worst possible outcome. The American system is better if you are more willing to take a risk. Overall, the American system is better for most people, but it really sucks if you are one of the unlucky few. It's a bet you are very likely to win, but God help you if you dont.

cthulhuspawn82:
Overall, the American system is better for most people

It's really not. It doesn't cover everyone, it drives up costs, places a well between people and receiving care, and practically necessitates cheating the system if you aren't rich. A person's value as a human being should not be tied to the size of their bank account.

As a personal example, I went most of my adult life without health insurance because I couldn't afford it until my state accepted the Medicaid expansion. So yeah, I'm totally in favor of universal coverage. As a society, we have a responsibility to look out for each other.

God help you if you dont.

There is no god, so let's not depend on that, shall we?

Seanchaidh:
Yes. This is what we call progress.

I'm not saying it's bad. Progress is inevitable. But it's also disruptive, and that disruption needs to be accounted for if you're going to keep people happy - and, more importantly, keep them voting for you.

Seanchaidh:
If you're really worried about it, implement an employer of last resort plan at the same time, then. Estimates put such a program at around $600B per year to start, and then less over time (because of macroeconomic effects-- more demand for goods and services because people at the bottom actually consume with extra income).

Either one of these programs are something we should just do. Both together, even better.

It's a good solution. For health insurance specifically, the federal government could just hire everyone working in the health insurance industry and then let attrition whittle the workforce down to something more efficiently-sized over time.

The problem then is convincing people to pay for it, but all of these policies exist in a hypothetical scenario where there isn't a solid majority in government dedicated to cutting taxes for rich people.

http://www.smh.com.au/world/donald-trump-backs-down-on-comment-praising-australias-health-care-20170505-gvzhk7.html

Nobody should be too surprised at this.

(Unless they got the Sanderses mixed up, like I did the first time I read about this)

cthulhuspawn82:
People need to understand that health insurance and health care are two different things. Health insurance(America) and universal coverage(Europe) are not health care, they are different methods of paying for health care. The one you prefer depends on whether you are in favor of the healthy taking care of the sick. The vast majority of healthcare is accrued by a small percent of the population. If you think those lucky enough to not have serious illness should help out those who do, you support universal coverage. If you think people should be left to chance, you support health insurance.

Well, that's not actually true..

The amount of government spending on healthcare relative to GDP in the US is comparable to much of Europe (including the UK). Health insurance in the US is heavily subsidized, most notably through medicare. The difference is that in the US private interests also spend a similar ammount on healthcare in addition to the amount spent by the federal government, whereas in Europe private spending on healthcare is much, much smaller.

In essence, in the American system costs twice as much overall as the European system, and everyone pays just as much towards it through federal taxation in addition to the fees they actually spend.

The cause of this difference is essentially that the US system encourages a very different model of healthcare which is less economical.

1) Primary care/specialist care

Countries with universal health care tend to rely more on primary healthcare providers, which are compratively cheaper than specialists. The ratio of general practitioners to specialists is far lower in the US than elsewhere and the use of doctors follows suit. This means it is much quicker easier to be referred to a specialist, but it also means that many people who end up being referred to specialists don't actually need to be.

2) Hospitalization

Patients in the US are more likely to receive in-patient hospital treatment for longer, which is more expensive than out-patient alternatives, although it may be more comfortable for patients and less stressful for their families.

3) (Over)use of expensive equipment

Things like CAT and MRI scans are expensive, and yet patients are far more likely to be referred to these (and other expensive services) in the US without clear evidence that they are necessary. This can be justified in the sense that very occasionally you will catch a condition early, but the cost of this widespread use of expensive scanning and diagnostic equipment is generally considered disproportionately high in a universal healthcare system.

In short, the problem with an insurance based healthcare system is that it removes much of the responsibility on doctors themselves to lower operating costs by avoiding things like excessive referrals. Instead, the focus shifts to providing as many treatments and services to the user as possible in order to maximize profits. It's worth noting that even with infamously bad rates of obesity, Americans on average live slightly longer than Europeans largely because the healthcare system is better from a treatment standpoint, and in that sense it can be justified, but it's better to quite a negligible degree for the immense cost it incurs (both to the taxpayer and the service user, the latter of which is effecively double-charged).

4) Insurance companies

As mentioned, a lot of government spending on healthcare in the US is through subsidies given to private insurers. This means there is no accountability among doctors for their own spending practices beyond their ability to recoup expenses from insurers or patients themselves, but it also means that some money spent on healthcare will be used to cover the operating cost of insurers, rather than being spent directly on patient care, which lowers the overall cost/effectiveness of government spending.

I think it'saaahahaHAHAHAHAHAHAHAHAHHAHAhahahahaaaa... yeah.

Let me offer some perspective from the hellish, socialist, oversized collective farm that is Australia. Our last medicare controversy was the government trying to implement a co-payment adjustment that would result in people paying $7 more for visits to a doctor. Yes, that's seven dollars, I'm not missing any zeroes. Concerns were raised that this would discourage poor people from seeking medical treatment. Now you might think that's justified or silly or whatever. My point is that over here a price hike of $7 is cause for controversy.

Meanwhile you guys are getting willingly skullfucked by private insurance companies out to profit on the fact that people pay anything for healthcare because the alternative is, yknow, dying from preventable causes. And now your fearless leaders are pushing changes that will, at a lowball estimate, remove coverage from more Americans than the entire population of Australia and make it more expensive for the people who are most likely to need medical cover to actually get it. And many Americans are cheering for this because they somehow can't see that there is something fundamentally fucked up about a health coverage system that doesn't exist to provide health coverage to people, but rather to make a profit by providing health coverage to those who can afford it.

We have what Americans call a 'single-payer-system'. We call it 'common-bloody-sense-what-kind-of-gibbering-fool-trusts-healthcare-to-for-profit-companies?' It's by no means a perfect system but any politician who tried to suggest we do things US-style here would be spat on in the street, if not fucking shanked.

Zhukov:
We have what Americans call a 'single-payer-system'.

Technically, healthcare in Australia is a public/private mix, like in the UK. We have a universal healthcare system, but not a single-payer healthcare system.

One of the biggest sins committed by Republican healthcare rhetoric was implying that single-payer healthcare, where the government is the only health insurer, was the same as universal healthcare, where everyone gets some level of health insurance regardless of their income.

In reality, only Taiwan and (I think?) Canada have "pure" single-payer healthcare systems. Everywhere else, healthcare is a mix of universally available, low-cost public health plans that serve as a "safety net" for low-income citizens, and more expensive private plans that give greater coverage at greater cost for those willing to afford it.

If the US passed Sander's Medicare-for-all plan, they would likely end up building something like that, where every citizen can get access to basic health care for free through Medicare, but the private health insurance industry is otherwise left intact so as not to cause economic disruption. One of the biggest reforms the ACA did was increasing enrollment in Medicaid - which I believe had previously been only for the elderly - to low-income households, in an attempt to try and build that publicly-funded safety net. Naturally, the Republicans want to gut that, as well; the AHCA freezes new Medicaid enrollments and cuts its budget by $800 billion.

As a Briton I could be misunderstanding this but one of the things I find amusing is how Republicans espouse the mechanisms and virtues of free market economics yet insist on a health insurance model that isn't free market. Insurance, as we all know, is a free market mechanism to pay for occasional, catastrophic costs. If an insurer raises their premiums, a free market means customers can switch insurers. If a house insurance customer makes a claim, he receives a payment and can switch insurers without loss. If a healthcare customer makes a claim, undergoes continuing treatment then switches, payment is stopped. That is, the customer no longer has free market choice and the insurer can raise premiums with impunity.

I can understand that many Americans advocate a free market but they seem oblivious that they don't have it in private healthcare.

warmachine:
As a Briton I could be misunderstanding this but one of the things I find amusing is how Republicans espouse the mechanisms and virtues of free market economics yet insist on a health insurance model that isn't free market. Insurance, as we all know, is a free market mechanism to pay for occasional, catastrophic costs. If an insurer raises their premiums, a free market means customers can switch insurers. If a house insurance customer makes a claim, he receives a payment and can switch insurers without loss. If a healthcare customer makes a claim, undergoes continuing treatment then switches, payment is stopped. That is, the customer no longer has free market choice and the insurer can raise premiums with impunity.

I can understand that many Americans advocate a free market but they seem oblivious that they don't have it in private healthcare.

that's because they don't know what the free market is. it's basically just a slogan nowadays. it's like the reverse of the red scare just like how people back then only knew that communism was bad they only know today that the free market is good.

lionsprey:

warmachine:
As a Briton I could be misunderstanding this but one of the things I find amusing is how Republicans espouse the mechanisms and virtues of free market economics yet insist on a health insurance model that isn't free market. Insurance, as we all know, is a free market mechanism to pay for occasional, catastrophic costs. If an insurer raises their premiums, a free market means customers can switch insurers. If a house insurance customer makes a claim, he receives a payment and can switch insurers without loss. If a healthcare customer makes a claim, undergoes continuing treatment then switches, payment is stopped. That is, the customer no longer has free market choice and the insurer can raise premiums with impunity.

I can understand that many Americans advocate a free market but they seem oblivious that they don't have it in private healthcare.

that's because they don't know what the free market is. it's basically just a slogan nowadays. it's like the reverse of the red scare just like how people back then only knew that communism was bad they only know today that the free market is good.

This is why US healthcare is a source of cheap amusement for me. You must not laugh at a victim but you can laugh at someone who chooses to be ignorant, especially half a nation.

My take is that it's a mess because it's obligatory, when many people, especially if they're young, don't want to pay for healthcare they'll barely use. Also, the lack of competition in the market doesn't give people much options.

I just learned something! According to the CFPB (via alternet), 59% of Americans contacted by debt collectors said it was for medical debt.

So single payer healthcare not only puts health insurers out of business, it also threatens the livelihoods of hard-working debt collection agencies. Heaven forbid.

In all seriousness, debt collection is another of those industries which we should all prefer not to be in demand at all: nothing is produced by debt collection, its effect is entirely redistributive. So that's another reason to extend medicare to everyone. And if we really need makework, raise taxes (or just deficit spend) and institute a job guarantee.

bastardofmelbourne:

Zhukov:
We have what Americans call a 'single-payer-system'.

Technically, healthcare in Australia is a public/private mix, like in the UK. We have a universal healthcare system, but not a single-payer healthcare system.

This. While Zhukov was correct that people bitterly opposed the concept of co-payments, the government has also been forcing co-payments by stealth for years by freezing and not indexing rebates for General Practitioners. GP clinics have to decide whether they bulk-bill and make profits based on sheer volume of patients seen in a time period, leading to worse care. Or to charge people additional out of pocket costs to make up for the longer time spent.

Pretty easy really.

The US Healthcare system is a shambles.

But then again, I live in Denmark, where I can just march into the ER (or any other applicable service) and get my appendix fixed for sodall, because it's been financed by taxes.

Parasondox:
Why do many shun the idea of something affordable for those sick and poor?

Maybe because sometimes, the "affordable" cure is worse than the disease. Especially when a healthcare bill lacks sufficient quality control and regulation to ensure that those lovely "affordable" generic medications actually work and are sufficiently safe.

https://epha.org/press-release-antibiotic-factories-compounding-superbug-spread/
http://raps.org/Regulatory-Focus/News/2016/10/18/26027/FDA-Proposes-to-Withdraw-Two-Generic-Versions-of-ADHD-Drug-Concerta/
https://www.forbes.com/sites/davidmaris/2012/10/10/fda-recall-points-to-serious-problems-at-the-fda/#2f057c6367cb
http://www.caddac.ca/cms/video/player.html?dfile=05-06.flv

And these are just a few examples that have actually been caught and addressed. A lot of cases are likely still flying under the radar. Just how many patients do you suppose, right now, are finding themselves no longer receiving effective treatment because their pharmacy switched them to a different generic brand? And just how many pharmacists do you suppose would dismiss any of these issues patients are claiming? And then what is a patient supposed to do when they can't even order for a specific brand that they've previously found does work, either because the pharmacy isn't legally obligated or because the patient's insurance only copays for medication from some brand out in Derkaderkastan?

The poor are going to get screwed one way or another. The narrative may change, the players might swap seats, but in the end it's going to play out the same. Because those in power have no obligation to care.

I would prefer that not a single penny from the government goes to the health insurance companies, thus forcing them to rely on the free market capitalist system forcing them to actually compete by means of providing good service for cheap when compared to the other company. By doing this we have competition in health insurance providers, something desperately needed. But then again what do I know, I'm just someone that supports free market capitalism.

kiri3tsubasa:
I would prefer that not a single penny from the government goes to the health insurance companies, thus forcing them to rely on the free market capitalist system forcing them to actually compete by means of providing good service for cheap when compared to the other company. By doing this we have competition in health insurance providers, something desperately needed. But then again what do I know, I'm just someone that supports free market capitalism.

The problem with relying on the free market capitalist system is that health insurance providers are still businesses with profits first on mind. Unless they are heavily regularized, people with no means to pay insurance will be left with none. But hey, what do I know? I'm just someone who isn't afraid of having some empathy for people who need it. And you, what are you afraid of?

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