2020 US Election

The thing with healthcare is that there really isn't a " like everywhere else in the world", or western world, or any selection of countries, really. There just isn't. There is no copy paste system for the us. Like for instance copy the british system to the entire us.

You're probably not going to believe me, but the medicare for all thing is really not the solution bernie is making it out to be. It's not the case of simply putting more people into that system and *poof* you've got a good national healthcare system for all. Not going to happen. Even if Bernie wins and gets everything through house/congress. It wouldn't drive costs down the way it is currently sold. You cant just grab billions of dollars from the economy like that without serious consequences. There is no infrastructure to manage the entire thing.

Any politician saying he's got a quick fix for the entire healthcare system is selling you snake oil. Which the medicare for all thing really is.

^ The elephant in the room with healthcare is that substantive change will have to involve the elimination of the healthcare insurance industry. The challenge isn't the idea of medicare for all or single-payer not being feasible but instead the behemoth of lobbying and propaganda and legal warfare the healthcare insurance industry will unleash. It will be exhausting, it will come at the cost of putting some people out of work initially, but these are people who work for an industry that LITERALLY makes money without actually contributing anything. They are a legalized mob that shakes payments out of both patients and hospitals. It's worse than the subsidies coal gets now. I mean, christ, could you imagine such absurd protectionism being applied to the steam engine industry back in the late 1800s / early 1900s.

The institutional stuff can be done, Bernie has pointed out that we rolled out the census, social security, and medicare before the internet, computer databases, and while much of country had no access to electricity. Likewise the people who work for the insurance industry could transition to an expanded government single-payer system instead of their current crushy yet completely soulless jobs or hawking overpriced medicine and grossly unfair premiums and coplay plans. Sanders and other simply can state that openly without being decimated in the mainstream liberal press or by their right-wing opponents. If a good number of people can be convinced our absolutely shitshow or a healthcare system was worth keeping the same back in 2009 and onward than they will certainly buy into any lies about single-payer and/or medicare for all. 

The us is simply too big to implement a single payer system for all. You'd basically end up institutionalising the entire healthcare industry. Not just the insurers. The entire thing.

No western country has done that, btw. The equivalent would be a single payer system for the entire EU. It would completely destroy the healthcare market. Driving prices up instead of down. And worse, making healthcare less accessible. Especially the innovative care. That market is really part of what drives innovation and helps making care accessible. 

Yes there are plenty players in the healthcare market making profit ( farma, medical devices, insurers, providers, health it, middle men,... the list goes on. and take note, it's not just about insurers and farma). There are many ways to improve that and anyone telling you single payer is the only option... again snake oil. 

My guess is, Warren is too sensible to not go for the easy "medicare for all" nonsense. I understand it would sell. It sounds catchy. And people hear what they want to hear and all that. But given the way Obama was slaughtered for having told 'lies' about the ACA ( this is another argument, but lets say I'd argue Obama was being as close to being honest as humanly possible on that one), I get the impression Warren doesnt want to make the same mistake.

Talking about insurers and the ACA: the ACA managed limit to profits of insurers by law by defining a max %. The biggest focus of the ACA was about getting insurers back in check. Was an important part of the puzzle. And the idea was good. The painful thing: it was just the beginning and only a part of the puzzle. Therefore imperfect. Which made it vulnerable to criticism and other "new" ideas (cough -snake oil -cough). Well, good luck with flushing this baby through the toilet and starting with medicare for all. 

Democracies stop functioning whenever the issues become too complex, I'm afraid. But I'll leave it there. Gotta respect peoples free speech and all. 

  On 9/10/2019 at 9:04 PM, goDel said:

The thing with healthcare is that there really isn't a " like everywhere else in the world", or western world, or any selection of countries, really. There just isn't. There is no copy paste system for the us.

what does this even mean? It just sounds like you work in the health system lol and dont want anything to change.

I said it's insane the US doesn't have a national healthcare system like the other countries in the developed world. I wasn't saying we need to copy /paste a system, like the uk's (please no)

https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care

This was about as general as I meant. Most of them involve a government controlled network of private insurers right? and then some have a public-private parnership? seems pretty fucking easy to do something like that especially when we already have national health insurance program called medicare. a believable approach to MCA would be to just lower the age... to... i dunno... 55 or something. And bring it maybe... from birth to 10. A small cut in our retardedly huge defense budget could probably handle this.
 

  On 9/10/2019 at 9:04 PM, goDel said:

You cant just grab billions of dollars from the economy like that without serious consequences.

lol. yeah it's way cooler to grab billions of dollars from sick people.

Have been working in the dutch healthcare system for i can't remember how long. Within various parts. And currently for the government.

If this tells you I don't want change... well I'm not sure even why you'd come to that conclusion. Apart from a poor attempt to dismiss my argument without any substance. Fyi: I don't get paid to keep the system the way it is. It's the other way around: i get paid to help improve it. Believe it or not. 

The us doesnt and cannot have a national healthcare system like other countries, because the us is not like those other countries. Most importantly because its size, like i mentioned earlier. And again, if you want to compare apples with apples, you'd have to compare the us to the entire EU. Which actually does have some specific functions for the entire eu market. But those are fairly limited. And mostly focusses and market access for medicines and medical devices. But has nothing to do with single payer or schemes to negotiate lower prices. And are fairly similar to what the us already has as well. 

That last lol about grabbing billions from sick people... not sure it even warrants a response. But yeah, if you have a basic understanding of how an economy works, youd know you just whiped out millions of jobs and made healthcare even less accessible and more expensive with your idea of solving this issue. Good luck with that. 

O, as a side note: there is no western country without continuous discussions on how to change and improve the healthcare system. All countries are struggling with affordability and sustainability of the system. Even though they tend to cost less than the us.

Although, even this point requires plenty of discussion as it's really not straightforward to distinguish between out of pocket costs of citizens and taxes/ government paying for care. 

  On 9/10/2019 at 9:58 PM, joshuatxuk said:

^ The elephant in the room with healthcare is that substantive change will have to involve the elimination of the healthcare insurance industry. The challenge isn't the idea of medicare for all or single-payer not being feasible but instead the behemoth of lobbying and propaganda and legal warfare the healthcare insurance industry will unleash. It will be exhausting, it will come at the cost of putting some people out of work initially, but these are people who work for an industry that LITERALLY makes money without actually contributing anything. They are a legalized mob that shakes payments out of both patients and hospitals. It's worse than the subsidies coal gets now. I mean, christ, could you imagine such absurd protectionism being applied to the steam engine industry back in the late 1800s / early 1900s.

The institutional stuff can be done, Bernie has pointed out that we rolled out the census, social security, and medicare before the internet, computer databases, and while much of country had no access to electricity. Likewise the people who work for the insurance industry could transition to an expanded government single-payer system instead of their current crushy yet completely soulless jobs or hawking overpriced medicine and grossly unfair premiums and coplay plans. Sanders and other simply can state that openly without being decimated in the mainstream liberal press or by their right-wing opponents. If a good number of people can be convinced our absolutely shitshow or a healthcare system was worth keeping the same back in 2009 and onward than they will certainly buy into any lies about single-payer and/or medicare for all. 

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j gets it. 

the US healthcare system is a racket, top to bottom, every fucking level, from the people who manufacture trash bags to the heads of the health insurance companies and big pharma. lots of wonderful and caring people in between who are there doing their best to aid the sick, disabled, and dying, but nonetheless, the whole system is rigged to funnel money away from the patients from before you're even born until the moment you're dead. it needs to be gutted and overhauled at every single fucking layer, which is absolutely mindboggling and honestly nearly impossible. it is absolutely staggering when you see the amount of money that goes in and out, unregulated and absolutely fucking wild, almost entirely on the backs of the average American. pretty sure if you stacked up the pennies of every petty theft, illegal drug deal, mob shakedown, pyramid scheme, etc in America all together it wouldn't make a fucking dent in the amount of money that the healthcare system is fucking out of the US citizenry. 

the concept of health insurance (and quite frankly even flood and hurricane insurance but that's unrelated) makes no sense since these are aimed to pay for catastrophic events which are unlikely to happen to an individual in a given year, but which are guaranteed to happen to some relatively predictable percentage of the population every year, or every decade.  thus the insurance aspect should be removed and replaced with healthcare.  it's really straightforward and it just requires nutting up and stop being a capitalist shill who wants to defend the profits of health insurance companies.  why should they have profits? they should be a net-zero profit industry, same for prisons and countless other shit

Please say "hi" to dunning kruger from me.

  On 9/11/2019 at 4:14 AM, goDel said:

Please say "hi" to dunning kruger from me.

just saw this. i guess warren is for medicare for all

  On 9/11/2019 at 4:08 AM, Zeffolia said:

the concept of health insurance (and quite frankly even flood and hurricane insurance but that's unrelated) makes no sense since these are aimed to pay for catastrophic events which are unlikely to happen to an individual in a given year, but which are guaranteed to happen to some relatively predictable percentage of the population every year, or every decade.  thus the insurance aspect should be removed and replaced with healthcare.  it's really straightforward and it just requires nutting up and stop being a capitalist shill who wants to defend the profits of health insurance companies.  why should they have profits? they should be a net-zero profit industry, same for prisons and countless other shit

it was inadvertent - this is a good rundown I heard years ago about that https://www.npr.org/templates/story/story.php?storyId=114045132

this fleshes it out some more - https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States#History - before the 20th century you simply paid the doctor upfront, also a lot of states and municipalities had public asylums, wards and ailment specific hospitals but they had their problems and issues stemming from the historical context of that era (lack of effective funding, institutional discrimination, now obsolete medical practices, etc) 

  On 9/10/2019 at 10:32 PM, goDel said:

The us is simply too big to implement a single payer system for all. You'd basically end up institutionalising the entire healthcare industry. Not just the insurers. The entire thing.

No western country has done that, btw. The equivalent would be a single payer system for the entire EU. It would completely destroy the healthcare market. Driving prices up instead of down. And worse, making healthcare less accessible. Especially the innovative care. That market is really part of what drives innovation and helps making care accessible. 

Yes there are plenty players in the healthcare market making profit ( farma, medical devices, insurers, providers, health it, middle men,... the list goes on. and take note, it's not just about insurers and farma). There are many ways to improve that and anyone telling you single payer is the only option... again snake oil. 

My guess is, Warren is too sensible to not go for the easy "medicare for all" nonsense. I understand it would sell. It sounds catchy. And people hear what they want to hear and all that. But given the way Obama was slaughtered for having told 'lies' about the ACA ( this is another argument, but lets say I'd argue Obama was being as close to being honest as humanly possible on that one), I get the impression Warren doesnt want to make the same mistake.

Talking about insurers and the ACA: the ACA managed limit to profits of insurers by law by defining a max %. The biggest focus of the ACA was about getting insurers back in check. Was an important part of the puzzle. And the idea was good. The painful thing: it was just the beginning and only a part of the puzzle. Therefore imperfect. Which made it vulnerable to criticism and other "new" ideas (cough -snake oil -cough). Well, good luck with flushing this baby through the toilet and starting with medicare for all. 

Democracies stop functioning whenever the issues become too complex, I'm afraid. But I'll leave it there. Gotta respect peoples free speech and all. 

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Thanks for all the details on real world roll out and the nuances and minutiae of systems currently in place and the challenges altering the status quo actually entails. I have my views on what I want done and what I think should be done but next to nothing in terms of details or knowledge about the actual systems in place.

I'd say in the US, it should be on state-by-state basis (cause really, as goDel says, the population is too big for it to be managed at a federal level), but there should be some federal regulations for at least baseline care. I know up here in commie Canada, our health care costs are eminently reasonable, and the model is somewhat like that (a mixture of provincial and federal government involvement).

Dental and pharmaceutical isn't covered by Medicare, but rather through insurance (mine is paid for by my employer). I bitch about some dental costs, but I'm not going bankrupt over them. Interestingly, expanding Medicaid into the insurance space could raise significant challenges through GATS and NAFTA as foreign investors in American health insurance could seek trade remedies if those business interests were diminished through health reform.

It's a complex issue, and there is no easy fix.

One general tip: look at population size of countries/regions when you're looking at different healthcare systems.

For instance, the Nordics. Lots of countries with nationalised healthcare have populations of about 6 mln. people. There are a couple big ones like the UK (although, as far as I can tell, Scotts and Irish have their own system so it's not the entire UK ), Germany, France and Canada perhaps. Still, nothing compared to the 300+mln in the US.

And realise it's a bit wishful thinking to look at Sweden and say "we should have that for the entire US". As you're basically looking at a system for a nation smaller than LA, in terms of population. It's a distinction that seems easily forgotten in discussions like these. You've got cities in the US with a bigger population than entire european countries.

A sidenote: arguably, the US has some interesting stuff happening like Kaiser Permanente, where the healthcare system is integrated. Ironically, the european countries are looking at those innovative US models for inspiration. (eg. http://www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf) So there's actually some good stuff happening in the US, believe it or not!

The reason why those innovations happen in the US and not, or less so, in socialised national healthcare systems, is that nationalised systems require a lot of rules and regulations to work. And therefore tend to be rigid and more fragmented (meaning the different kinds of care  - like general practitioners, paramedics, hospital, mental care, farma - tend to be managed independently in separate silos). One of the weaknesses is that such a system has difficulties learning and improving itself. As every change needs to be implemented through changing laws. And that takes a lot of time. It took roughly 30 years to come to a ACA, for example. Change in nationalised systems tend to be slow and inefficient. There's little to no room for experimentation, so change needs to be planned and perfect from the get go. And it rarely works out as planned when finally implemented (again, look at ACA). That's what happens when things are ruled from the top down, in a democracy.

So in order to have a nimble and adaptive healthcare system, you ideally want a minimal set of general rules and regulations for the big stuff and some flexibility/freedom for the rest. That could mean a regulated "free" market (dutch model, to a degree. it's a hybrid which was a model for the ACA, btw), or you could leave it to state or regional levels (which would imply potential differences between regions). Like chenGod mentioned about Canada.

Just remember, if you're seriously thinking about doing stuff on a national/federal level, you're about to bring an elephant into a porcelain shop. (and please realise I'm not a conservative or libertarian, or whatever kind of anti-government shill)

So what would be an example of something that works in, say, The Netherlands, with its 17 million inhabitants, that would not work if you scaled it up to 320 million US-ians?

Not snarky but genuinely curious.

we have a national health insurance program that is managed by federal agencies. we've had it for 50 years and it provides insurance and coverage for 60 million people or something around that number. that's greater than the entire population of england. if we're managing 60 million people we can manage more. the qualifying age range for medicare could be adjusted incrementally over a series of years to slowly give more and more americans insurance coverage from the government.

I'll be done talking about this - but this isn't the time where feasibility issues and minute speculations about implementation need to be discussed. That happens after Bernie is elected. Healthcare access is a moral and ethical issue, and anyone who tries to obfuscate the discussion otherwise (and those who do are usually in the health care industry) have been morally corrupted by capital. Everyone deserves equal access to healthcare. It's that simple. It's up to us to make it happen.

  On 9/11/2019 at 10:46 PM, rhmilo said:

So what would be an example of something that works in, say, The Netherlands, with its 17 million inhabitants, that would not work if you scaled it up to 320 million US-ians?

Not snarky but genuinely curious.

- a model where you have preferent drugs for the entire US in the generic drug market (probably needs some further explanation)

- similarly, when you want to negotiate drugs prices for innovative drugs (monopoly without alternatives). the question becomes how much power the entire US have wrt pharma companies. if access to the US market becomes an issue, that would have impact of the development of new drugs

- a national budget for hospital care, for instance. not sure how that could work for the entire US

- national registries with healthcare data. you can't simply build something like in sweden. (you'd need registries to monitor the effectiveness of treatments, for instance. and monitor quality of care)

  On 9/11/2019 at 10:50 PM, dr lopez said:

Healthcare access is a moral and ethical issue, and anyone who tries to obfuscate the discussion otherwise (and those who do are usually in the health care industry) have been morally corrupted by capital.

you're literally obfuscating the discussion with these kinds of statements, btw.

  On 9/11/2019 at 10:50 PM, dr lopez said:

 

we have a national health insurance program that is managed by federal agencies. we've had it for 50 years and it provides insurance and coverage for 60 million people or something around that number. that's greater than the entire population of england. if we're managing 60 million people we can manage more. the qualifying age range for medicare could be adjusted incrementally over a series of years to slowly give more and more americans insurance coverage from the government.

 

 

 

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All well and good, and Medicaid is a state/federal hybrid similar to what Canada has. The problem right now is that the federal government funds more than 90%, and expanding that to the remaining 300M people in the US will get very costly very quickly. 

I am not in the healthcare industry, don’t have much savings and certainly no large capital investments. I’m not arguing that health care isn’t a basic universal right. I’m saying that simply saying “healthcare for all!” with no plan in place for how to accomplish that will lead to a whole lot of wasted time and broken promises. 

I have other concerns regarding Bernie (his stance on free trade) but while MFA seems like a really simple thing to solve, it clearly isn’t. So you might want someone who is a bit pragmatic about the issue. Maybe that is Bernie, but maybe not:

https://www.vox.com/2019/4/10/18304448/bernie-sanders-medicare-for-all

  On 9/11/2019 at 10:59 PM, goDel said:

you're literally obfuscating the discussion with these kinds of statements, btw.

actually you're bikeshedding a correctly implemented system

it's not hard to figure out the solution, increase taxes on corporations and use them to pay for everything that health insurance companies and individual citizens used to pay for.  it may be hard to implement, but you're dancing around the real issue that our healthcare system is capitalist

I hate to break it to you, but health insurance companies in Canada are not charities. And because dental and prescription drugs are not covered by provincial insurance plans, private insurance is still an important part of the overall health care package. 

As well, there are limits (obviously) on what the provincial insurance seems reasonable for coverage, so for example, something like physiotherapy can be quite expensive. Because the provincial health insurance covers a limited amount of physio, many people take out additional insurance through private insurers. 

  On 9/12/2019 at 4:20 AM, Zeffolia said:

increase taxes on corporations and use them to pay for everything that health insurance companies and individual citizens used to pay for.

If it were truly that simple, don’t you think it would have been done by now?

  On 9/12/2019 at 5:23 AM, chenGOD said:

If it were truly that simple, don’t you think it would have been done by now?

when is now in particular, and why is it the special time where all of the simple fixes have been made?

"If it were truly as simple as just no longer enslaving people, don't you think it would have been done by now?"

  On 9/11/2019 at 10:55 PM, goDel said:

- a model where you have preferent drugs for the entire US in the generic drug market (probably needs some further explanation)

similarly, when you want to negotiate drugs prices for innovative drugs (monopoly without alternatives). the question becomes how much power the entire US have wrt pharma companies. if access to the US market becomes an issue, that would have impact of the development of new drugs

No, I think I understand what you mean. Yes, this would be a challenge, simply because the US is so big and therefore the stakes so high, but I’m not sure it precludes simply making everyone have some form of insurance.

  Quote

- a national budget for hospital care, for instance. not sure how that could work for the entire US

It would be really big ?

  Quote

- national registries with healthcare data. you can't simply build something like in sweden. (you'd need registries to monitor the effectiveness of treatments, for instance. and monitor quality of care)

Again, this would be really big. But given US citizens’ distaste for big government, they might not actually want to have something like this anyway.

Which would probably be ok. In the Netherlands we’ve had some form of health insurance for ages, even before there was a registry. So you could probably arrange for some basic form of universal health care without having a big complicated registry.

Which is probably the most important point anyway. Right now in the US basic care, where most of the quick wins in terms of health outcomes are to be had, is insanely ineffective and expensive. Simply insuring people for things like emergency rooms and GP care would solve so many problems - and that kind of care would not necessarily require dealing with innovative drugs and national health care registries.

The US is big, yes, but even the much poorer country of Indonesia managed to implement something like this - for 250 million people, so size apparently was not the biggest issue.

Anyway, thanks for your reply. It was very instructive and interesting to think about.