Who'd a thunk it? Obamacare not repealed

Should you squeeze the toothpaste tube in the middle or from the end?
shade-tree
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Re: Who'd a thunk it? Obamacare not repealed

Post by shade-tree » Wed Mar 29, 2017 11:02 pm

On this forum, I always hear folks (including comments above) telling us to take care of ourselves, that virtually all serious health problems are caused by unhealthy lifestyle and that exercise and diet can prevent them. That's dangerous, magical thinking and a threat to your early retirement.

Healthy youngish people get expensive to treat diseases that aren't self caused/ lifestyle diseases. i.e. autoimmune diseases, cancer (only about 40 percent is caused by environment, external stuff they say). Don't think it can't happen to you, kids.

Crazylemon
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Re: Who'd a thunk it? Obamacare not repealed

Post by Crazylemon » Thu Mar 30, 2017 1:31 am

@ classical_Liberal Some private health insurance does that here already. Not sure if it works particularly well though this paper seems to show some benefit of cash transfers for smoking cessation and vaccination: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3949711/ (disclosure - not done full literature search). Be the effect size is small and I suspect for getting people active/eating better even harder. Certainly not going to solve the problem on a population unless you are talking very big cash incentives.

Only other papers I have seen that show really good effects for the metabolic syndromes is to give people personal trainers for a few sessions a week. In perpetuity. Expensive solution for a problem that doesn't need to exist.

@Brute Fascism isn't the only way, you can still use cash incentives or a variety of 'nudges' (ok yes nudges can be viewed as 'fascism lite' if you really want to put the uber libertarian hat on)


@shade-tree of course right, but the odd are still on lifestyle diseases. Modify what you can and all...

EMJ
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Re: Who'd a thunk it? Obamacare not repealed

Post by EMJ » Thu Mar 30, 2017 2:55 am

Healthy youngish people get expensive to treat diseases that aren't self caused/ lifestyle diseases. i.e. autoimmune diseases, cancer (only about 40 percent is caused by environment, external stuff they say). Don't think it can't happen to you, kids
New Study Finds That Most Cancer Mutations are Due to Random DNA Copying ‘Mistakes’

http://www.hopkinsmedicine.org/news/media/releases

Johns Hopkins Kimmel Cancer Center scientists report data from a new study providing evidence that random, unpredictable DNA copying “mistakes” account for nearly two-thirds of the mutations that cause cancer. Their research is grounded on a novel mathematical model based on DNA sequencing and epidemiologic data from around the world.

/new_study_finds_that_most_cancer_mutations_are_due_to_random_dna_copying_mistakes

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BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE » Thu Mar 30, 2017 7:17 am

shade-tree wrote:
Wed Mar 29, 2017 11:02 pm
On this forum, I always hear folks (including comments above) telling us to take care of ourselves, that virtually all serious health problems are caused by unhealthy lifestyle and that exercise and diet can prevent them. That's dangerous, magical thinking and a threat to your early retirement.

Healthy youngish people get expensive to treat diseases that aren't self caused/ lifestyle diseases. i.e. autoimmune diseases, cancer (only about 40 percent is caused by environment, external stuff they say). Don't think it can't happen to you, kids.
brute isn't advocating not to carry insurance. but the majority of costs that make health care and health care system expensive in the west right now are lifestyle diseases. brute listed the top 10 causes of death in the US a few posts above, and about half of them are lifestyle diseases.

@Crazylemon

if "not weighing 500lbs" and "not going blind" and "not getting feet amputated" doesn't motivate some humans, neither will "nudging". this is a cultural problem, not a health care (system) problem.

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Dragline
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Re: Who'd a thunk it? Obamacare not repealed

Post by Dragline » Thu Mar 30, 2017 7:31 am

shade-tree wrote:
Wed Mar 29, 2017 11:02 pm
On this forum, I always hear folks (including comments above) telling us to take care of ourselves, that virtually all serious health problems are caused by unhealthy lifestyle and that exercise and diet can prevent them. That's dangerous, magical thinking and a threat to your early retirement.

Healthy youngish people get expensive to treat diseases that aren't self caused/ lifestyle diseases. i.e. autoimmune diseases, cancer (only about 40 percent is caused by environment, external stuff they say). Don't think it can't happen to you, kids.
It is quite true that outside substance abuse and other risky behaviors, most medical catastrophes that befall people under age 40-45 are fairly randomized or genetic in origin. I have known a number of people ages 15 - 40 who have suddenly contracted cancer or something similarly serious without any real connection to lifestyle.

The "lifestyle diseases" don't usually begin to creep up until sometime in the 40s or 50s for most people, even though that die may be cast much earlier by bad choices.

What this means is that lifestyle choices are not a substitute for catastrophic health insurance any more than "driving slowly and only in the daytime when it is not raining" would be a substitute for auto insurance. Improving your chances cannot eliminate risk entirely. These early efforts are more akin to a form of health "savings" that you will rely on 20 or 30 years down the road by preserving your organs.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Thu Mar 30, 2017 8:45 am

BRUTE wrote:
Wed Mar 29, 2017 7:50 pm

so while brute's "drop'em like they're hot" approach to pre-existing conditions might seem cruel, the alternative is really the state locking fat humans in cells until they're not fat any more.

thus, brute considers himself on the moral high ground with libertarian health care.
I don't necessarily agree with your outlook, but I'm increasingly convinced things will have to go to one extreme or the other:

-If you have the money buy your own insurance and/or pay for your medical bills yourself. If you can't pay for it, don't expect medical services, or

-complete taxpayer-funded "socialized" medicine.

I don't think we'll ever find a hybridized, half-measure system that works over time.

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Ego
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Re: Who'd a thunk it? Obamacare not repealed

Post by Ego » Thu Mar 30, 2017 8:52 am

Dragline wrote:
Thu Mar 30, 2017 7:31 am
The "lifestyle diseases" don't usually begin to creep up until sometime in the 40s or 50s for most people, even though that die may be cast much earlier by bad choices.
That is changing fast.

https://www.cdc.gov/pcd/issues/2013/12_0316.htm

Conclusion
The prevalence of having 1 or more or 2 or more of the leading lifestyle-related chronic conditions increased steadily from 2002 to 2009. If these increases continue, particularly among younger adults, managing patients with multiple chronic conditions in the aging population will continue to challenge public health and clinical practice.

More than 70.0% of deaths in the United States and about 75.0% of health care spending costs are attributable to chronic diseases. The 5 leading causes of death — heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease, and diabetes — accounted for more than half of all deaths in 2009 and represent a high percentage of the nation’s health care costs. Other chronic conditions exact a heavy toll in terms of disease, disability, quality of life, and economic costs.

Because the roots of the chronic conditions that are the leading causes of morbidity and mortality can be traced to lifestyle factors — principally smoking, diet, and physical activity — it is likely that, despite significant reductions in the prevalence of smoking, the continuing erosion of a low-risk lifestyle profile (9) could result in an increase in the incidence, prevalence, and co-occurrence of lifestyle-related chronic conditions.



I have no idea how to solve the problem other than to follow 7w's prescription of doing the work that is in front of me.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Thu Mar 30, 2017 9:04 am

Laura Ingalls wrote:
Wed Mar 29, 2017 4:04 pm
[quote=IlliniDave

My dad was 75 and had 15+ years of retirement. He also made some crappy lifestyle choices notably smoking for 30 years.

We declared ourselves FI on the lean side with the understand that if we "failed" we would go back to"real" jobs. As opposed to the low stress low pay gigs we have now.

So far so good.
If I had been younger when I started serious pursuit of "ER" I might have taken an approach similar to yours. Starting where I did, it didn't make sense. I also have a relatively high paying job that for me is low stress. I have sort of an inverted approach to yours--if down the road fate conspires against me, part-time low wage work is an option. In my profession it's very hard to get back in after a prolonged absence, especially if you are getting a bit long in the tooth. After one or maybe two years there's essentially no going back for me. Another of the several consideration that led to the belt plus suspenders approach.

Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire. That is in line with numbers I've heard in the past (for my employer, it's even shorter allegedly). Mind boggling to me. Certainly provides a sense of urgency to me that counterbalances my conservative (not in the political sense) nature.

ThisDinosaur
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Re: Who'd a thunk it? Obamacare not repealed

Post by ThisDinosaur » Thu Mar 30, 2017 10:37 am

IlliniDave wrote:
Thu Mar 30, 2017 9:04 am
Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire.
I heard a story from a coworker about a guy here who died of a heart attack in his car, in the work parking lot, with his key in the ignition, at the end of his last day of work before retirement. They got a full day's work out of him.

Laura Ingalls
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Re: Who'd a thunk it? Obamacare not repealed

Post by Laura Ingalls » Thu Mar 30, 2017 10:49 am

[quote=IlliniDave

We have chosen to work part-time now in part because we are currently teethered to the public school schedule anyway. We have both would work more pleasant when we have given ourselves permission to quit too.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Thu Mar 30, 2017 11:09 am

ThisDinosaur wrote:
Thu Mar 30, 2017 10:37 am
IlliniDave wrote:
Thu Mar 30, 2017 9:04 am
Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire.
I heard a story from a coworker about a guy here who died of a heart attack in his car, in the work parking lot, with his key in the ignition, at the end of his last day of work before retirement. They got a full day's work out of him.
That's truly unfortunate. Retirement is actually extremely stressful for many people.

I've known several people who have died shortly after retiring, but in all their cases either a terminal diagnosis or other grave health problems prompted the retirement. I'm sure folks like that skew the statistics a bit.

OTCW
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Re: Who'd a thunk it? Obamacare not repealed

Post by OTCW » Thu Mar 30, 2017 11:41 am

I don't think exercising and eating well are magic that can be used to forego insurance, but they definitely help greatly reduce the chances of developing lifestyle diseases. This is good if you want to reduce healthcare costs. (also good for quality of life in general). Insurance is still good (necessary?) to have for the rest of what may come your way like certain cancers, broken legs, etc.

My point is simply that if more people maintained healthy lifestyles, overall medical costs would go down, meaning health insurance costs would go down. How we get there is a harder discussion. Carrot approach? Stick approach? Carrot and stick approach? No approach is going to lead to disaster IMO.

My opinions are based on what I've seen happen to my premiums and deductibles/out of pocket limits the last 5 years of purcasing insurance as an individual (costs have ~ quadrupled in these three areas), based on not getting a subsidy, and based on watching the plan options in the ACA Marketplace in my area go from more than a dozen from 5 companies across all coverage levels (bronze, silver, gold, and platinum), down to only 2 this year from the same company (a bronze and a silver), and down to not a single plan available next year.

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BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE » Thu Mar 30, 2017 12:23 pm

OTCW got it exactly right.

brute didn't bring up the lifestyle diseases to argue against individuals getting insurance. lifestyle diseases are why health care costs are exploding. it doesn't really matter which system of (re)distribution is used, the costs are simply too high. the only way to make health care affordable for almost all humans it to make almost all humans not have lifestyle diseases - which is a cultural long-term issue, nothing a law could fix.

single payer for 30% diabetics is going to be as expensive as the ACA or AHCA or whatever for 30% diabetics. the system doesn't matter much if the cost is simply too high.

brute's argument is also not that a Libertarian Health Care Act would solve this cost issue - merely that it would allow brute and other somewhat healthy individuals to escape subsidizing the treatment of lifestyle diseases, while still getting insurance against low-risk, catastrophic events, which is actually extremely cheap. at the same time, this would prevent heavy-handed lifestyle controls that would certainly come up even more to get humans to have "skin in the game". examples are the soda taxes proposed in some parts of the US. brute isn't for soda, but the idiots in charge will likely go for fatty foods next, which brute very much enjoys.

thus, a single payer system would force brute to subsidize humans who don't care about their lifestyle diseases, while potentially enforcing ill-informed "health" laws unto him in the future.

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Ego
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Re: Who'd a thunk it? Obamacare not repealed

Post by Ego » Thu Mar 30, 2017 2:33 pm

BRUTE wrote:
Thu Mar 30, 2017 12:23 pm
lifestyle diseases are why health care costs are exploding. it doesn't really matter which system of (re)distribution is used, the costs are simply too high. the only way to make health care affordable for almost all humans it to make almost all humans not have lifestyle diseases - which is a cultural long-term issue, nothing a law could fix.
My thinking is changing somewhat on this. The more I learn about transgenerational epigenetic inheritance the more I realize that what we call lifestyle diseases are actually highly influenced by the lifestyle of parents, grandparents and great-grandparents. Hat tip to Jennypenny who has been saying a version of this for years.

http://www.radiolab.org/story/251885-yo ... ndpa-eats/

If your grandfather suffered famine from ages 9-12, you will have 1/4 the risk of heart disease than non-famine suffering grandchildren. Not only heart disease. The grandchildren show significantly lower incidence of all lifestyle diseases. So much so that on average the famine-grandchild lives thirty years longer than the grandchildren of those who did not suffer famine. Thirty years! Shit!

The more we learn the more of these intergenerational ghosts in the machine we discover. This shadow aspect is going to compound as we continue to live self-harming lifestyles. It will snowball.

Obviously, you are not responsible for the lifestyle of your grandparents. Is it fair that you'd be kicked off of your health insurance policy because your grandfather was pre-pubescent in a time of plenty? If not, then the only real solution is to influence those things that are within our control......
BRUTE wrote:
Thu Mar 30, 2017 12:23 pm
at the same time, this would prevent heavy-handed lifestyle controls that would certainly come up even more to get humans to have "skin in the game". examples are the soda taxes proposed in some parts of the US. brute isn't for soda, but the idiots in charge will likely go for fatty foods next, which brute very much enjoys.
You cannot change your grandparents. There is plenty you can control. We should be discouraging bad habits.... and maybe consider a policy of caging and starving pre-pubescent boys. :lol:

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vezkor
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Re: Who'd a thunk it? Obamacare not repealed

Post by vezkor » Thu Mar 30, 2017 2:37 pm

Tax fast food corporations the same way big polluters get hit, and for the same reasons ;) collateral damage

7Wannabe5
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Re: Who'd a thunk it? Obamacare not repealed

Post by 7Wannabe5 » Thu Mar 30, 2017 3:28 pm

Having your testes removed will also greatly extend lifespan and reduce other major health AND behavioral risks. So, given the ease, low-cost and safety of such a surgery under modern medical conditions, you could say that choosing to manifest an adult male hormone profile is a lifestyle disease. If, for selfish reasons, you don't choose to undergo surgery, probably your next best bet is to engage in vigorous sexual activity with great frequency so that your average levels are kept on the lower side.

If Ego will volunteer to work as personal trainer two days a week with the high risk/expense morbidly obese group, I will continue to "just do the work in front of me " towards reducing the poorly processed aging androgen burden on the healthcare system. No rest for the weary (sigh.)

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BRUTE
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Re: Who'd a thunk it? Obamacare not repealed

Post by BRUTE » Thu Mar 30, 2017 5:37 pm

Ego wrote:
Thu Mar 30, 2017 2:33 pm
Obviously, you are not responsible for the lifestyle of your grandparents. Is it fair that you'd be kicked off of your health insurance policy because your grandfather was pre-pubescent in a time of plenty?
this assumes the (false) null-hypothesis of "health insurance". is it fair that other humans have to pay for the effects that behavior of another human's grandfather had? no. having non-famished grandparents does not entitle to the money of other humans.

George the original one
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Re: Who'd a thunk it? Obamacare not repealed

Post by George the original one » Thu Mar 30, 2017 7:49 pm

IlliniDave wrote:
Thu Mar 30, 2017 9:04 am
Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire. That is in line with numbers I've heard in the past (for my employer, it's even shorter allegedly). Mind boggling to me. Certainly provides a sense of urgency to me that counterbalances my conservative (not in the political sense) nature.
Doesn't pass the sniff test when USA life expectancy is age 78.

OTCW
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Re: Who'd a thunk it? Obamacare not repealed

Post by OTCW » Thu Mar 30, 2017 9:01 pm

vezkor wrote:
Thu Mar 30, 2017 2:37 pm
Tax fast food corporations the same way big polluters get hit, and for the same reasons ;) collateral damage
Probably more effective to tax the end user. Using smoking as a comparison, high prices are the only thing that proved useful in getting people to stop that. $8 for a Route 64/Big Gulp would probably make a dent in consumption.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Fri Mar 31, 2017 4:31 am

George the original one wrote:
Thu Mar 30, 2017 7:49 pm
IlliniDave wrote:
Thu Mar 30, 2017 9:04 am
Was talking with a colleague today who cited a recent report he'd seen (can't give a reference, sorry, just don't remember), that on average Americans live 18 months after they retire. That is in line with numbers I've heard in the past (for my employer, it's even shorter allegedly). Mind boggling to me. Certainly provides a sense of urgency to me that counterbalances my conservative (not in the political sense) nature.
Doesn't pass the sniff test when USA life expectancy is age 78.
That's why I said it was mind boggling! Obviously they are not subtracting 65 from the average American's age at death.But I've heard those sorts of numbers enough times over the years that I'm mildly curious how they are arrived at. Not curious enough to expend any of my life energy pursuing it though. Just makes me disinclined to grind it out in the corporate world to age 67 or whatever and count on having a decade or more of vibrant retirement.

7Wannabe5
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Re: Who'd a thunk it? Obamacare not repealed

Post by 7Wannabe5 » Fri Mar 31, 2017 6:03 am

The reason the two statistics seem at odds is likely due to the fact that in the not so distant past many more men worked until retirement age than women, and the average life expectancy for men was only around 71, inclusive of a large clump of deaths of men in their 60s due to heart disease and cancer. So, if in 1989, you had a group of men in their 60s who were all working full-time at some establishment, their average life expectancy due to having already survived to 60 might have been around 75, but the smaller group of individuals who will survive into their 80s and 90s skew the results away from the fairly high number of deaths that will occur to members of this group in their 60s. So, if you include those who retire due to health necessity (most likely cancer), and those who were bound to topple over due to sudden infarction whether on the golf course or in the office, it is within the realm of possibility that slightly more than half will die within 18 months of retirement. Also, it is possible that this statistic includes retirement benefits paid to widows of men who died while still working.

I would also note that there are a variety of much more specific calculators and tables available with which to access your own personal risk. Throwing males and females together in health statistics is one of the most misguided gender neutral policies ever. A 52 year old man who has high-blood pressure and the same BMI as not-yet-post-menopausal me will very likely not be attending my 90th birthday party.

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Ego
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Re: Who'd a thunk it? Obamacare not repealed

Post by Ego » Fri Mar 31, 2017 8:38 am

IlliniDave wrote:
Fri Mar 31, 2017 4:31 am
That's why I said it was mind boggling!
Despite the fact that it happened to my father, those numbers seemed strange to me as well.

http://www.bbc.com/news/magazine-18952037

A paper attributed to the aircraft-maker Boeing shows that employees who retire at 55 live to, on average, 83. But those who retire at 65 only last, on average, another 18 months.

The "Boeing study" has been quoted by newspapers, magazines and pundits. It's circulated on the internet for years. The problem with it is that Boeing itself says it's simply not true.

IlliniDave
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Re: Who'd a thunk it? Obamacare not repealed

Post by IlliniDave » Fri Mar 31, 2017 8:42 am

Urban legend then. Well, I'm still not taking any chances! ;)

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Dragline
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Re: Who'd a thunk it? Obamacare not repealed

Post by Dragline » Fri Mar 31, 2017 12:36 pm

Yeah, that sounds more like data from when the U.S. social security system was first implemented as a reason why it wouldn't cost too much.

But even in 1940, a person who was 65 could expect to live about another 12-15 years. https://www.ssa.gov/history/lifeexpect.html

On the other hand, the average life expectancy itself (all people) was only about 60 in 1940, so a lot of people who paid into the system would never see a dime and would probably die within a short period of time after they stopped working, because they "retired" because they could not work anymore.

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BlueNote
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Re: Who'd a thunk it? Obamacare not repealed

Post by BlueNote » Sat Apr 01, 2017 1:32 pm

I think the following incentives in Universal (single payer) are strong enough that they overwhelm any minor incentive benefit provided by alternate systems:

1) Natural survival instinct.
2) "Free" preventative care like vaccines, advice etc. are much more helpful "carrots" then attempting to punish people with financial "sticks" when they don't comply. If they're already willing to knowingly do their health damage then I don't think throwing sand in their financial gears is going to help that much. I do however believe that when there's a resource shortage (doctors, organs etc.) that there should be a reasonably fair ranking system based on expected effectiveness and deservedness.
3) Almost nobody wants to go to the doctor or hospital. It's a lot like the fire department, few would call the fire department on a whim but it would suck (personally and to society in general) if you had to pay privately for the service. Imagine someone sets your house on fire and the fire department shows up and puts out the fire, but before they leave they give you an invoice and demand payment in 90 days. You don't have insurance so you end up going bankrupt dragging your whole innocent family into abject poverty with you, not a good outcome for society IMHO.

I've always been surprised that the US has been able to maintain it's archaic semi-private health care system for so long with all it's inefficiency and negative consequences to that society. A pure private system would be about as effective as a private fire department or a private road system, i.e. not a good fit for privatization and a detriment to society by imposing massive barriers on those least able to overcome them.


Single payer costs less and delivers great healthcare in many countries. People who take care of their health live longer , better lives than those who don't under single payer, that's probably a much better incentive than a bit of money. Maybe they pay slightly higher taxes then they would under a private system but I don't consider that to be anywhere near a good argument for private healthcare.

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