Trumple down economics vs. entitlement state

[ThisDinosaur]

Dunning Kruger only applies if you don't acknowledge your ignorance. I freely admit my ignorance. I asked because I rarely hear complaints about Eurosocialism (with the exception of Brittain's NHS, maybe). The Bernie Left has been portraying the "Scandinavian Model" as a near-utopia. If nationalized social safety nets are universally good, is it ONLY special interest propaganda stopping US implementation? Or are there real reasons this sort of thing simply wouldn't work in the US? Alternatively, it could be that the costs are underreported (to me) because I don't know enough Europeans.

My current favored narrative is that a variety of government systems can work when resources are abundant. When there is perceived ongoing scarcity, the old guard is thrown out and replaced.

[BRUTE]

The Bernie Left has been portraying the "Scandinavian Model" as a near-utopia. [..] My current favored narrative is that a variety of government systems can work when resources are abundant. When there is perceived ongoing scarcity, the old guard is thrown out and replaced.

brute pretty much agrees. EVERYTHING works in a small, rich country with 5-10 million mostly homogenous humans in it. almost nothing will work for everybody in a huge country of 300 million humans of very different cultures and backgrounds.

[jacob]

@ThisDinosaur - Depends on what you mean by a "real" reason. US health care is substantially more "luxurious" or "bloated". E.g. each patient gets their own room which in turn requires more real estate, more monitoring equipment, etc. It would be quite expensive to write off such an [mis?-]"investment" and transition to a system where you have 4-8 patients in the same room and only need one nurse and less automated monitoring equipment. Another difference is that the US system has a much more litigious attitude towards, well, everything. So US doctors tend to overtest just in case. That kind of ROI benefits mainly labs and lawyers. Thirdly, the US is more technology oriented. E.g. if you bump your head and go to the ER in the US, you get a $10,000 trip through the MRI machine. In Denmark, the ER would just check your blood pressure by looking through your eyes or however that works. All that extra baggage means that the US spends about twice as much as the next leading country for results that aren't remarkable for a developed country in any way.

So, sure, the Scandinavian model would work in the US, but it would require a material change in public/legal/techmology attitude + writing off lost investments + re-investing. IOW, there's quite a gap to cross. Of course Obamacare didn't fix any of those problems as much as it forced everyone to experience them ... Also, I suppose one could argue whether bloated luxury costs are a bug or a feature.

Now, I wouldn't exactly call the health care system of any other developed country near Utopia, but I'd take any one of them any day over the US system. I say this based on personal experience with systems in three different developed countries. In the US I've had different plans going from gold-plated government to private bare bones. The non-US systems are much easier and less stressful to deal with. Put it another way, should some US state with a population of 5-10 million decide to implement a non-US style health care system in return for bumping state income taxes by 10%, I would strongly consider moving there.

[ThisDinosaur]

@Jacob
I see all that and I raise you the inefficient, bureaucracy-laden path money takes on its way from you to your providers.

Patient -> insurance company -> billing company -> healthcare management company -> hospitals/doctors/nurses.

The billing company exists solely to argue with insurance companies who make their money by refusing payment. The healthcare management companies exist solely to consolidate bargaining power for providers against insurance companies.

I see three competing ways to fix the system. 1)replace everything between patient and doctor with a Single Payer (Socialized medicine), 2)eliminate all of it and make it fee-for service (Free market), or 3)making it a fraudulent breach of contract for insurance companies to refuse payment.

My concern with (1) is that replacing a competition-rich insurance industry with a monolithic government system will destroy any hope for efficiency. The free market way could lead to only rich folks being able to afford quality healthcare. And if politicians theoretically work for the people, they shouldn't allow that to happen.

The third way is probably unworkable in the US UNTIL we eliminate insurance lobbyists from Washington. I think that's why Obamacare has turned out to be such a disappointment.

[7Wannabe5]

What working parents need are opportunities to engage in challenging, creative work that do not require a commitment of 40-plus hours/week. Childcare tax credits and similar initiatives are just throwing money at a problem that won't be solved with money.

https://www.newdream.org/programs/redef ... /plenitude

http://tech.co/study-work-three-days-week-2016-04

http://www.healthline.com/health-news/h ... workweek#1

[Lemon]

@THis Dinosaur

As someone who works in system 1) I can tell you it does work although without flaws. Actually in terms of efficiency it does pretty well. Why? All those scans are at best 1) an expensive waste and 2) directly harm a patient with radiation exposure/discovery of incedentalomas.

Example, Jacobs head injury. We have national protocols on head injury management for anyone who wants a read: https://www.nice.org.uk/guidance/cg176 This helps prevent people who don't need a brain scan getting one and coming to potential harm.

NICE also makes recommendation on affordable cost effective treatment. It isn't perfect, and can be controversial. If you want something that NICe doesn't think worth funding then you need to go private. A not insignificant proportion do, although for most for things that are 'cosmetic'

It is also cheaper as it brings down Doctors and other staff's wages. Which I am fine with. Could the US do it? You would need to change how Medschool is funded as the standard debt would be barely serviceable let alone repayable on UK doctor salaries. As well as getting over the sunk costs Jacob mentioned.

It isn't doing to hot now, but given that is with cuts on what was less than 50% on a GDP per capita basis it is pretty damn efficient, although getting in to 'negative return' territory these days.

Plus you get the benefit of no one stressing about healthcare costs, medical bankruptcy basically doesn't exist (other than medical issue leading to loss of income and then bankruptcy) and it allows people to thus take rather more risk with careers.

[BRUTE]

brute has experienced some more socialist health care systems, as well as cash payment when uninsured in some random country with relatively cheap health care.

thing seems to be, 98% of issues are not very expensive to fix. brute has gotten excellent consults from a doctor fluent in English in a shiny, brand new hospital with zero waiting time and walked out paying $25 (or approximately 99,999,999 dong) in Vietnam.

there are those 2% of things that are extremely expensive, but it seems the real cost of health care is either inefficiency (US system) or subsidizing/redistribution (socialist EU systems). young, healthy humans would spend $100-500/year in health care, yet they have to finance the old humans who can't afford to pay for what they consume.

[Dragline]

At least 40% of US health costs are for keeping people alive for an extra few months at the end of life. And, for better or for worse, that's largely cultural in the "never accept limitations" ethos. Doctors in other countries simply admit that there is nothing that can prevent death in a few weeks or months.

Atul Gawande has a good book about this: https://www.amazon.com/Being-Mortal-Med ... ul+gawande

[Dragline]

A good video by MMM, particularly around 15 - 16: "Even the life at the bottom of the US spending scale is still way more than enough to be happy. As long as you spend it on the right stuff."

This implies that "who get's elected and what the government does" is probably not of that much concern as long as it stays within modern Western democracy norms.

[Dragline]

Whoops, here's the video: https://vimeo.com/183016901