Health Care Discussion

Feb 2011
16,343
5,684
Boise, ID
I admitted it wouldn't be simple, but pointed out it wouldn't be realistic to expect something simple given what a mess our system is. Yet every nation that has moved to something like Medicare for all has encountered similar issues and overcome them. And, even we have done it, with regard to Medicare itself, which has the same considerations, albeit only for a portion of the population.

Here's a little thought experiment for you. Let's say we have a time machine and travel back to the early 1960s, and you encounter a Reagan type, who is insisting the proposal for implementing Medicare just can't work. He presents a list very much like the one you presented (most of which items would work as well -- which is to say as badly-- in arguing against Medicare in the early 1960s). Would you believe him?
If I could bring my current mind and knowledge of the future with me? No, I wouldn't, because I would know that currently (as of the 1960s), health spending was 6% of GDP, and I would have the knowledge of the future that countries adopting single payer health care systems when their health spending was low would end up seeing markedly slower growth in spending than those that didn't.

As for your list:

1) Abolishing fee-for-service and replace it with federal global budgeting

With Medicare, there's still some fee-for-service, and there would be with Medicare-for-all.

2) Eliminating private insurance companies

With people age 65 and older, there's still private insurance, and there would be with Medicare-for-all. It would just be supplementary to the basic coverage through Medicare.

3) Elimination of all patient cost-sharing

With Medicare there is some patient cost-sharing, and there would be with Medicare for all.

4) Strong resistance from employees and unions with Cadillac employer- or union-sponsored insurance who really don't wish to lose it

You could allow such plans as supplementary, just as those with Medicare currently can get supplementary coverage. That's consistent with what happens in other Medicare-for-all-style systems... basic coverage is provided by the government, but people can get additional gold-plated coverage on top of that, with more conveniences and little luxuries, as well as additional procedures covered. With the money the employers and unions save on covering for basic insurance, they can provide even better supplemental coverage.

Explainer: why do Australians have private health insurance?
You're creating a stark contrast between your own vision for single payer and the versions actually being presented by our most prominent single-payer supporters in Congress. So it seems like step one to getting broader support for single payer is to first kill the plans that have been floated so far and come back with something that actually resembles what you would support. Plus you'd also have to defeat the Democrat skeptics of single payer who instead support multi-payer. And then you can work on convincing the Republicans/Conservatives not to undermine it.

5) Funding it with a huge list of the most aggressive tax increases proposals in American history.

There's a strong tendency among wingnuts and their enablers to treat every tax increase as catastrophic. Whenever I hear about the biggest or most aggressive tax increase proposals in American history, I'm reminded of Bob Dole's rhetoric, which described the Clinton tax hike of 1993 as the biggest tax hike in American history.
Are you aware of the tax increase proposals suggested in Sanders' plan? It isn't wingnut histrionics to look at that and very easily and objectively identify it as the biggest tax increase proposal in history. It really isn't even close.

I don't get terribly spooked about the whimpering about tax hikes. The US has radically low taxes by the standards of wealthy nations, and can stand to raise them a bit.
First of all, I find this funny coming from someone who was just whimpering a minute ago about not being taxed to support rural people. Shift gears and suddenly massive tax hikes (which very objectively speaking, these would be) are NBD. But that aside, I'm talking about the political reality of passing and maintaining these types of tax increases. Passing the benefit side of a Medicare For All policy would be easy relative to the types of tax hike proposals that have been floated by, for example, Sanders. Getting and keeping the funding side passed looks like a whole other battle. Republicans have always been able to knock the funding legs out from under government, they're doing it to the ACA right now, you don't think they'd undermine the tax hikes on which MFA funding would be based? Of course they would. And we'd end up funding a huge portion of our new single payer plan from federal deficit spending.

If we cut back on Medicare without an equally impactful increase in some other form of socialized medicine, it would be a move farther from other advanced nations. But, granted, if it was part of a move to something more like one of the well-tested multi-payer systems seen succeeding elsewhere, that could be good. I'm not married to single-payer or multi-payer. I think both can work.... and either would be better than what we have, much less what we had in the dark days before Obamacare.
I think the entire health insurance industry was on the verge of a death spiral when Obamacare was passed. The recession was about to push it over the edge.
 
Feb 2015
15,962
7,947
sadness
Oh, come off it, Syrenn! This is-not a Democratic/ Republican problem. It is about providing good health Care for the least expense. It is a national problem!

I edited my post because I read what you are referrring to. I have no problem with making able bodied people work. I think a system needs to have accountability. Just like limits on welfare and work rules.
i never said it was a political thing....

I said.... thoes on the dole dont give a rats ass how much services cost since they will never see a bill. The bumb passed out on the street will be transported to the ER. For you and me, that is going to cost a good 3k. For them all it will be is a nights sleep in a good bed, a shower, meal and out you go until next week. Yes, the system needs to have accountability. That starts with individuals not abusing the system.
 
Sep 2017
4,884
5,805
Massachusetts
.... I would have the knowledge of the future that countries adopting single payer health care systems when their health spending was low would end up seeing markedly slower growth in spending than those that didn't.
At the time they wouldn't have thought their health care spending low. That's hindsight. In the same sense, it's entirely possible that if we fail to seize this opportunity to move to single payer, in a few decades we'll look back and kick ourselves for not having made the transition to single payer back in 2019, when our healthcare costs were still so low.

You're creating a stark contrast between your own vision for single payer and the versions actually being presented by our most prominent single-payer supporters in Congress.
I'm not an expert on any particular proposal. I'm just a skeptic of the faux-skepticism that says single payer can't work in the US, despite it having worked in several other wealthy nations. The devil's in the details, it's true, and it's possible that some ideas being floated by liberals aren't realistic, in that they have untested structures that would lack things like copays that help to discourage frivolous access to "free" healthcare. But I think those details can be worked out in committee, so to speak. In fact, I think that if the GOP hadn't jumped headlong into wingnut madness, that's the kind of role they could be playing: working towards healthcare reform, but in a way that reined in the less sharp-minded notions of idealistic liberals. That's how conservatives in other countries chipped into the process of healthcare reform. But that kind of role is one the GOP has effectively abandoned as they embraced a crazed quasi-libertarian absolutism.

Are you aware of the tax increase proposals suggested in Sanders' plan? It isn't wingnut histrionics to look at that and very easily and objectively identify it as the biggest tax increase proposal in history. It really isn't even close.
Perhaps. But it remains true that the US is radically under-taxed by the standards of wealthy nations, so we can have the "biggest tax increase" in history and still wind up with normal-to-low tax levels. And, more to the point, if the record of other wealthy nations is anything to go by, we can do so while enjoying long-term net savings, in terms of what it costs, per capita, to buy quality healthcare for a nation.

First of all, I find this funny coming from someone who was just whimpering a minute ago about not being taxed to support rural people.
It's not whimpering to point out the absurdity of treating rural people as an aristocratic class that demands a higher standard of government support, in terms of net funding per capita. It's not whimpering to argue the logic of using our money to help transition people to more efficient settlement patterns, rather than to subsidize inefficient ones indefinitely. You seem to be having trouble squaring my approach to taxation (targeting taxes and spending efficiently for the greatest long-term good for the greatest number of people) with the two more simplistic paradigms you're used to hearing (a cartoonish liberal embrace of tax-and-spend without hard choices, and a cartoonish conservative embrace of the idea that taxes are always bad and thus lower taxes are always better). It's possible to think the liberal vision of using government for the benefit of the people is the right choice, without thinking that means any given tax must be a good thing.

But that aside, I'm talking about the political reality of passing and maintaining these types of tax increases.
As a practical political reality, just about every other wealthy nation has managed to pass and maintain taxes that are higher, in per GDP terms, than the US. There's no reason to think the US, alone, can't manage that political reality.

And we'd end up funding a huge portion of our new single payer plan from federal deficit spending.
That's certainly a perpetual fight with the Republicans -- they want our radically low taxes to be still lower, and yet aren't willing to look for any cuts to our biggest area of discretionary spending, the military, so they drive massive deficits. And that's a conscious strategy on their part -- drive deficits up very high so that they can then whine and claim we can't afford the basic government services that every other wealthy nation has. And the plutocrats laugh all the way to the bank. But we have, in fact, succeeded, even against such political saboteurs, in getting big moves in the right direction, including Social Security, Medicare, Medicaid, and Obamacare. The key is not to allow the dark-ages mindset of the GOP to dictate what we are willing to consider possibilities. We must fight back against that myopia, and continue to remind people that when you escape the airless echo chamber of conservative media and take a look out here in the real world , there are about three dozen countries that have managed to achieve universal healthcare systems that cost less than ours while producing better public health results. It can be done. And several accomplished that goal with something akin to Medicare-for-all, so there's no reason to rule that out from the start.
 
Feb 2011
16,343
5,684
Boise, ID
At the time they wouldn't have thought their health care spending low. That's hindsight.
I don't really see the point of asking such time travel questions then.
In the same sense, it's entirely possible that if we fail to seize this opportunity to move to single payer, in a few decades we'll look back and kick ourselves for not having made the transition to single payer back in 2019, when our healthcare costs were still so low.
I'm not an expert on any particular proposal. I'm just a skeptic of the faux-skepticism that says single payer can't work in the US
Mine isn't faux skepticism. It's skepticism of the specific examples of single payer that some legislators are currently proposing. I listed the problems with it, and you said "well it doesn't have to be that way." Well at this point they are that way, hence the skepticism.
despite it having worked in several other wealthy nations. The devil's in the details, it's true, and it's possible that some ideas being floated by liberals aren't realistic, in that they have untested structures that would lack things like copays that help to discourage frivolous access to "free" healthcare. But I think those details can be worked out in committee, so to speak.
Not these details. "If you like your plan, you can keep your plan" echoes through eternity, and that wasn't even that big of a lie, compared to what these would be. "No more cost-sharing, no more insurance companies!" (just kidding, here are your copays, any questions, call UnitedHealth Group) is definitely not going to fly. Those aren't the sort of selling points that can just be reneged away in committee.
In fact, I think that if the GOP hadn't jumped headlong into wingnut madness, that's the kind of role they could be playing: working towards healthcare reform, but in a way that reined in the less sharp-minded notions of idealistic liberals. That's how conservatives in other countries chipped into the process of healthcare reform. But that kind of role is one the GOP has effectively abandoned as they embraced a crazed quasi-libertarian absolutism.
Agree there.
It's not whimpering to point out the absurdity of treating rural people as an aristocratic class that demands a higher standard of government support
The only absurdity is that characterization of yours.
That's certainly a perpetual fight with the Republicans -- they want our radically low taxes to be still lower, and yet aren't willing to look for any cuts to our biggest area of discretionary spending, the military, so they drive massive deficits. And that's a conscious strategy on their part -- drive deficits up very high so that they can then whine and claim we can't afford the basic government services that every other wealthy nation has. And the plutocrats laugh all the way to the bank. But we have, in fact, succeeded, even against such political saboteurs, in getting big moves in the right direction, including Social Security, Medicare, Medicaid, and Obamacare. The key is not to allow the dark-ages mindset of the GOP to dictate what we are willing to consider possibilities. We must fight back against that myopia, and continue to remind people that when you escape the airless echo chamber of conservative media and take a look out here in the real world , there are about three dozen countries that have managed to achieve universal healthcare systems that cost less than ours while producing better public health results. It can be done. And several accomplished that goal with something akin to Medicare-for-all, so there's no reason to rule that out from the start.
Republicans bad, "the plutocrats" bad, bla bla.

As long as absurd, idealistic impracticaliteis are the central selling points of Medicare For All proposals, they're going to continue to be ruled out from the start. I press anyone on those and they immediately concede those things don't need to be part of it. It doesn't build support for MFA to propose absurdities as the policy's central principles that even a few minutes of critical thinking leads to the conclusion that that won't actually work.

You also don't build support for MFA by recommending government weaponize its health provision to intentionally create access problems for some people that will coerce them to relocate to what is deemed a more efficient configuration. It doesn't matter how logically you believe you are, people are not going to line up to support that kind of thing. Arguments like that sabotage the support for government's increasing role in moving us toward universal health care.
 
Sep 2017
4,884
5,805
Massachusetts
I don't really see the point of asking such time travel questions then.
The point is to call attention to the weakness attacks on the concept of implementing a single-payer system today. Many of the same attacks --and the same defeatist attitude-- would have been perfectly at home when it came to attacking the idea of implementing a single-payer system for the elderly, children, and the disabled. Yet, we know from history such a system was quite practical... becoming both highly successful and highly popular.

I listed the problems with it, and you said "well it doesn't have to be that way." Well at this point they are that way, hence the skepticism.
At this point, they aren't that way.... or any way at all. They're ideas. They haven't been fleshed out into concrete legislative proposals, with mechanisms specified.

"If you like your plan, you can keep your plan" echoes through eternity, and that wasn't even that big of a lie, compared to what these would be.
The big lie was the notion that Obama's claim wasn't accurate. The wingnuts and their enablers have tried to treat Obama's claim as dishonest, yet it was spot on. As Obama said, the Affordable Care act did not include provisions to force people off their current plans. That's not to say that Affordable Care included terms that, for the first time in history, would have required existing private plans to be extended to existing policyholders, unchanged, forever. But I have yet to meet a single real human being who thought that's what he was promising, and it's utterly foolish to imagine that's what he was trying to make people think was in ACA. We all knew that, as had always been the case, it was possible for private insurers to terminate plans or toss existing customers off them (or change their terms or pricing). We understood that Obama was merely saying that ACA didn't have provisions that would force people to change plans, which, as you know, was true.

The only absurdity is that characterization of yours.
The characterization is solid. Our current system disproportionately treats rural residents as a kind of aristocratic class, entitled to much higher average ratios between taxes paid and benefits enjoyed. And that includes our landed gentry (or, in Republicanese, "the noble American farmer.") Even those whose wealth far exceeds the national median have politicians falling all over themselves to make their lives easier with special tax breaks, subsidies, etc.

Republicans bad, "the plutocrats" bad....
Agreed. Some people are uncomfortable having it pointed out that starkly. It chafes with their self-image as being above the partisan fray. But I believe in stating things honestly and plainly.

As long as absurd, idealistic impracticaliteis are the central selling points of Medicare For All proposals, they're going to continue to be ruled out from the start.
The central selling points for Medicare for All are:

(1) It's an extension of an already-existing, wildly popular, and highly successful system, rather than some untested, hatched-in-a-plutocrat-funded-focus-group brain fart of an idea. So, we're building on solid ground.

(2) It's roughly in line with systems that are already in place across the entire populations of a number of other wealthy nations (right down to using the same name as some of them). So, there's reason to believe it can work across a whole population here.

(3) The other wealthy nations that have implemented something along those lines pay much less than us per capita for healthcare (about half as much, on average).

(4) The other wealthy nations that have implemented something along those lines tend to have markedly better overall public health outcomes than us (e.g., lower infant mortality, higher life expectancies, lower incidence rates of preventable and treatable diseases, etc.)

(5) From the patient's perspective, it is a simpler system that does not require shopping around for insurers and fighting the paperwork battle to get covered treatment paid for.

Those are strong arguments. The details, of course, need to be worked out -- but that was a caveat that applied every other time such a program was implemented (including when it was implemented for the elderly here). We have every reason to think we can iron out those details successfully.

You also don't build support for MFA by recommending government weaponize its health provision to intentionally create access problems for some people that will coerce them to relocate to what is deemed a more efficient configuration.
There is no intention to create access problems. If we stop disproportionately favoring rural residents with plus-sized subsidies and that doesn't create access problems, that's great. I'll cheer. But, we shouldn't be indefinitely shoveling good money after bad just to subsidize their rural lifestyle choice if it remains perpetually more expensive to meet the level of service to which they feel entitled. Better to spend that money helping them transition to a more efficient settlement pattern.

Arguments like that sabotage the support for government's increasing role in moving us toward universal health care.
Yes, that's probably true. If I were in a position where I had to appeal to the halfwits (e.g., if I were a politician or big-time pundit, rather than someone writing in a small forum), I'd refrain from making that argument at all. In the US, the only form of political correctness as strong as the pro-military bias is the pro-rural bias in our public discourse. People become outraged at the merest suggestion that it isn't the job of urban people to defray the costs of the rural aristocracy's lifestyle choices. We have been so long conditioned to think that the mooches in the sticks are the "real Americans" that rhetoric that runs afoul of that piety shocks and enrages people. Fortunately, I'm not a politician or pundit who has to hide the truth to keep the halfwits in line. I can speak plainly here.
 
Feb 2011
16,343
5,684
Boise, ID
The point is to call attention to the weakness attacks on the concept of implementing a single-payer system today. Many of the same attacks --and the same defeatist attitude-- would have been perfectly at home when it came to attacking the idea of implementing a single-payer system for the elderly, children, and the disabled. Yet, we know from history such a system was quite practical... becoming both highly successful and highly popular.

At this point, they aren't that way.... or any way at all. They're ideas. They haven't been fleshed out into concrete legislative proposals, with mechanisms specified.
They usually aren't, at least in this case, because their apparent purpose is merely to excite partisan voters, not be an actually workable policy. So when someone is criticizing a policy for being unworkable when our nationally prominent legislators are advancing policies that are unworkable, that's not defeatism, it's realism. The fact that you'd immediately concede on several almost certainly unworkable aspects of Sanders' proposal seems to confirm what I'm saying. Kamala Harris recently backpedaled on one of these (complete eradication of insurance companies). People are starting to catch on to the B.S. If anything resembling single payer is going to succeed, it's time to start sweating the details instead of lofting up silly fantasy promises to appeal to morons.
The big lie was the notion that Obama's claim wasn't accurate. The wingnuts and their enablers have tried to treat Obama's claim as dishonest, yet it was spot on. As Obama said, the Affordable Care act did not include provisions to force people off their current plans. That's not to say that Affordable Care included terms that, for the first time in history, would have required existing private plans to be extended to existing policyholders, unchanged, forever. But I have yet to meet a single real human being who thought that's what he was promising, and it's utterly foolish to imagine that's what he was trying to make people think was in ACA. We all knew that, as had always been the case, it was possible for private insurers to terminate plans or toss existing customers off them (or change their terms or pricing). We understood that Obama was merely saying that ACA didn't have provisions that would force people to change plans, which, as you know, was true.
You might be able to patch together some plausible deniability, nonetheless the perception that he lied on that point was a successful mountain made out of a molehill, which if that's any indication, can you imagine how damaging it would be if a policy was passed on a premise of no more cost-sharing and no more insurance companies and then the actual law that was passed required both of those things?
The characterization is solid. Our current system disproportionately treats rural residents as a kind of aristocratic class, entitled to much higher average ratios between taxes paid and benefits enjoyed.
The notion that people living in rural areas are treated as an "aristocratic class" is just absurd, the same as it's absurd to refer to welfare queens as having it so good at the public's expense. Rural America is an absolute mess in this country, as you previously acknowledged, so alleging they enjoy some sort of aristocratic privilege is just puerile.

The central selling points for Medicare for All are:

(1) It's an extension of an already-existing, wildly popular, and highly successful system, rather than some untested, hatched-in-a-plutocrat-funded-focus-group brain fart of an idea. So, we're building on solid ground.

(2) It's roughly in line with systems that are already in place across the entire populations of a number of other wealthy nations (right down to using the same name as some of them). So, there's reason to believe it can work across a whole population here.

(3) The other wealthy nations that have implemented something along those lines pay much less than us per capita for healthcare (about half as much, on average).

(4) The other wealthy nations that have implemented something along those lines tend to have markedly better overall public health outcomes than us (e.g., lower infant mortality, higher life expectancies, lower incidence rates of preventable and treatable diseases, etc.)

(5) From the patient's perspective, it is a simpler system that does not require shopping around for insurers and fighting the paperwork battle to get covered treatment paid for.

Those are strong arguments.
Strong attempts at persuasion, certainly, but they lack clear policy focus, and the celebrity legislators we're looking to to advance single payer are presenting fantasy iterations of what single payer would need to be in this country. They do this because they don't intend to present a workable policy, they intend to present fodder for excited voters to be inspired to vote.

There is no intention to create access problems. If we stop disproportionately favoring rural residents with plus-sized subsidies and that doesn't create access problems, that's great. I'll cheer. But, we shouldn't be indefinitely shoveling good money after bad just to subsidize their rural lifestyle choice if it remains perpetually more expensive to meet the level of service to which they feel entitled. Better to spend that money helping them transition to a more efficient settlement pattern.
It's disingenuous to suggest that money for rural health care should be cut off but then say there's no intention to create access problems.
 
Apr 2012
57,332
42,148
Englewood,Ohio
i never said it was a political thing....

I said.... thoes on the dole dont give a rats ass how much services cost since they will never see a bill. The bumb passed out on the street will be transported to the ER. For you and me, that is going to cost a good 3k. For them all it will be is a nights sleep in a good bed, a shower, meal and out you go until next week. Yes, the system needs to have accountability. That starts with individuals not abusing the system.
You are making up those numbers. People going to the ER were already abusing the system. Many on Medicaid are doing the same thing.
 
Apr 2012
57,332
42,148
Englewood,Ohio
They usually aren't, at least in this case, because their apparent purpose is merely to excite partisan voters, not be an actually workable policy. So when someone is criticizing a policy for being unworkable when our nationally prominent legislators are advancing policies that are unworkable, that's not defeatism, it's realism. The fact that you'd immediately concede on several almost certainly unworkable aspects of Sanders' proposal seems to confirm what I'm saying. Kamala Harris recently backpedaled on one of these (complete eradication of insurance companies). People are starting to catch on to the B.S. If anything resembling single payer is going to succeed, it's time to start sweating the details instead of lofting up silly fantasy promises to appeal to morons.


You might be able to patch together some plausible deniability, nonetheless the perception that he lied on that point was a successful mountain made out of a molehill, which if that's any indication, can you imagine how damaging it would be if a policy was passed on a premise of no more cost-sharing and no more insurance companies and then the actual law that was passed required both of those things?


The notion that people living in rural areas are treated as an "aristocratic class" is just absurd, the same as it's absurd to refer to welfare queens as having it so good at the public's expense. Rural America is an absolute mess in this country, as you previously acknowledged, so alleging they enjoy some sort of aristocratic privilege is just puerile.



Strong attempts at persuasion, certainly, but they lack clear policy focus, and the celebrity legislators we're looking to to advance single payer are presenting fantasy iterations of what single payer would need to be in this country. They do this because they don't intend to present a workable policy, they intend to present fodder for excited voters to be inspired to vote.



It's disingenuous to suggest that money for rural health care should be cut off but then say there's no intention to create access problems.
The people in rural areas are the ones going without health care. That is where the free clinics were going. Serving people that had never seen a Doctor.
 
Feb 2015
15,962
7,947
sadness
You are making up those numbers. People going to the ER were already abusing the system. Many on Medicaid are doing the same thing.
really... i am making up the numbers am i. It is obvious you have no idea how much a ambulance ride costs. How much just walking into the ER costs or how much a nights stay in the hospital costs. I am sure @HCProff could set you straight on how much the ER costs, how much a bed costs..... and who and who does not pay for it. Maybe you will believe her over me.

3K for a drunk or drugged up idiot to sleep it off is far more then they deserve. I know they have been abusing the system. Nothing new there.
 
Apr 2012
57,332
42,148
Englewood,Ohio
really... i am making up the numbers am i. It is obvious you have no idea how much a ambulance ride costs. How much just walking into the ER costs or how much a nights stay in the hospital costs. I am sure @HCProff could set you straight on how much the ER costs, how much a bed costs..... and who and who does not pay for it. Maybe you will believe her over me.

3K for a drunk or drugged up idiot to sleep it off is far more then they deserve. I know they have been abusing the system. Nothing new there.
Really? I had a trip to the ER in the Rescue squad my husband was once a part of. I didn’t get a break. $700.

I have enough experienc with health care to feel pretty qualified to know the costs.

I do not need anyone to tell me about costs.

But you are mixing apples and oranges. You seem not to understand why those costs are so high and who benefits from those high charges.

You act as if the drunk in ER creates the cost. Those drunks and people who go to the ER have driven many Hospitals out of business. If many of them had preventive care before theybecome deathly sick we would all w
Better off.

I am not sure where you came up with that $3000 business. You gave no chart to prove it. And we have no details yet.
 

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