Who'd a thunk it? Obamacare not repealed

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 Obamacare not repealed

Post by BlueNote »

BRUTE wrote:
Sat Apr 01, 2017 6:26 pm
BlueNote wrote:
Sat Apr 01, 2017 1:32 pm
Single payer costs less and delivers great healthcare in many countries.
false. brute knows several single payer "customers" that pay way more for their health care than brute pays, yet their health care is inferior (in terms of doctor quality, waiting times, ..)

for the healthy, or the sick who can afford their doctors, single payer is a terrible deal in terms of cost for the former, and quality for the latter.
Single payer does seem to cost less overall (heck almost all countries seem to have a lower cost system then the US) and does deliver great healthcare in many countries. The issue is definitely not black and white and will vary by individual but on aggregate I stand by my argument and I don't think it is falsified by such a small personal sample.

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 Obamacare not repealed

Post by Dragline »

What people don't get is that we already have single payer health coverage in the US. Its just extremely badly managed single payer health coverage, because we don't want to admit that's what it is and we entertain pipe dreams of market solutions that never existed and never will, unless we are willing to just let people die by refusing admission to emergency rooms -- which we are not. Some people just need to stop dreaming that that will ever become a reality.

In the US system, everyone qualifies for single-payer if they are either old enough, broke enough or broken down enough. Its just a dumb, badly constructed system. That's why we pay more for inferior results overall.

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 Obamacare not repealed

Post by 7Wannabe5 »

Taxing junk food will likely prove to be very ineffective because it has been my observation that very obese people eat more of everything most people eat, not just more junk food. Also, unlike nicotine or caffeine, there are an almost infinite number of plants and animals from which sugar and/or fat can be fairly easily refined. We have all observed how as soon as one food is declared to be unhealthy, the industrial food complex will almost instantly come up with another cheap product to take its place. I mean, you can't make a cookie out of spinach, but nobody can survive on spinach. You can make a cookie out of rice and beets. Also, any component of taste that can be added to a recipe can also be simply bred into a species. A cup of juice pressed from a crop of HoneyCrisp apples is not likely to be more nutritious than some tart cherry juice sweetened with cane sugar, whether or not it is also rendered fizzy with carbonation.

I attended the funeral of a 90 year old woman yesterday. The slide show of pictures revealed that she had been quite slim as a young woman. Then she put on a bit of weight throughout the course of having and raising 5 children. In late mid-life she became quite chubby, and then as she became elderly she eventually slimmed back down to being quite thin when she died. I think this is what used to be "normal" for most humans, and so many young people being overweight is the main thing that has changed in our culture.

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

Post by IlliniDave »

Dragline wrote:
Sat Apr 01, 2017 8:41 pm
What people don't get is that we already have single payer health coverage in the US.
...
In the US system, everyone qualifies for single-payer if they are either old enough, broke enough or broken down enough. Its just a dumb, badly constructed system. That's why we pay more for inferior results overall.
In addition, we're all collectively paying medical expenses for the uninsured/can't pay portion of the population even when they are not on Medicaid. Providers simply pass along costs they cannot collect (and the cost of unsuccessful collections and costs associated with cash flow problems) by raising prices which ultimately wind up reflected in insurance premiums.

The healthcare system at present is far too regulated for any meaningful free market innovation.

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

Post by Dragline »

Correct. There cannot be a free market in health care unless we are willing to let people just die who can't afford it. Since that is a non-starter for about 80-90% of the voting population, even talking about it is a waste of time because its like pretending you have a sailboat and talking about how the magic free market wind will power you when you have a motorboat.

Gilberto de Piento
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Re: Who'd a thunk it? Obamacare not repealed

Post by Gilberto de Piento »

What innovations are being prevented by regulation? Like buying insurance across state lines and importing drugs from Canada or something more revolutionary?

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

Post by Dragline »

Innovations in the health care area in the US are typically not prevented by regulation, but protected as monopolies by regulation, first by the patent system and then by the FDA approval of generics system. There are many ways to game these systems and many very successful players.

But there are a lot of weird rules as well, for instance about what is a "supplement" vs a "drug" and what that means. Truly "experimental" treatments are often restricted. But a lot of those things are scams, too.

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

Post by RealPerson »

Dragline wrote:
Sun Apr 02, 2017 7:23 pm
Innovations in the health care area in the US are typically not prevented by regulation, but protected as monopolies by regulation, first by the patent system and then by the FDA approval of generics system. There are many ways to game these systems and many very successful players.
All other developed countries have patent laws for pharmaceuticals and regulation of generics as well, so they all create monopolies. How does that explain the huge price difference between the US and the rest of the developed world?

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

Post by ThisDinosaur »

@RealPerson
Marketing. US drug companies spend more on marketing than on research. To my knowledge, no other country with a large pharmaceutical industry markets directly to patients. And most of the substantial research is funded by the NIH anyway.

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

Post by 7Wannabe5 »

Don't forget about the recent immigrants with advanced degrees in pharmaceutical sciences who risk losing their resident status if they don't rubber stamp the result of drug trials for their employers. In blighted regions of rural and urban America it is extremely easy to find a clinic staffed by somebody who will write you a prescription for whatever you say you need. It is much more difficult to find a primary care physician who will straight-up tell you to go to Whole Foods and buy something over-the-counter rather than writing you a prescription in order to save you some money and side-effects. I drive 45 minutes in Zipcar, so I can keep seeing the one I did find.

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

Post by Dragline »

RealPerson wrote:
Sun Apr 02, 2017 11:05 pm
Dragline wrote:
Sun Apr 02, 2017 7:23 pm
Innovations in the health care area in the US are typically not prevented by regulation, but protected as monopolies by regulation, first by the patent system and then by the FDA approval of generics system. There are many ways to game these systems and many very successful players.
All other developed countries have patent laws for pharmaceuticals and regulation of generics as well, so they all create monopolies. How does that explain the huge price difference between the US and the rest of the developed world?
Those regs and protections are much stronger in the U.S. than elsewhere and US courts are more willing to enforce them. But the principal other difference is that the drug prices themselves are regulated in other countries much more so than in the U.S. A well-run single payer system has a lot of bargaining power and, frankly, just does not prescribe as many drugs as in the U.S. For example:

"The US consumes 80% of the world’s legal and illegal opioids; they are the country’s most abused prescription drug. Trends also indicate that the use of weak opioids is declining, while the use of strong, more easily abused opioids is increasing." http://www.pharmexec.com/us-opioid-mark ... ays-report

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

Post by BRUTE »

overprescription in the US is more of a cultural and litigation issue, brute would think, than single payer vs. whatever else.

@Dragline: again, yes, all humans like free money. pity that the "existing single payer system" doesn't work. Medicaid is so bad that 5 million Americans who are eligible for free health care (!) didn't get it. actual care provided is very sub-par for most on it. Medicare is popular because it's free money, but it's unsustainable, it'll run out pretty quickly unless young humans are made to pay more to finance the old. classic Ponzi scheme. and let brute not get started about the amazing single payer VA.

in fact, just the fact that the VA is single payer should tell humans all they need to know.

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

Post by ThisDinosaur »

Brute, all insurance is a ponzi scheme.

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

Post by IlliniDave »

Gilberto de Piento wrote:
Sun Apr 02, 2017 2:22 pm
What innovations are being prevented by regulation? Like buying insurance across state lines and importing drugs from Canada or something more revolutionary?
It depends on your state. I don't know that any of the stuff is revolutionary, but a small example I encountered: the small practice that my "family doctor" works in bought some blood analysis equipment a number of years back. For a token cost they could do standard blood work in minutes while the patient was there. But the insurance providers squawked (they don't like it when providers recommend services that the provider also provides) and lobbied the state gov't who threw up a mountain of red tape so essentially they'd have to gain state certification as a diagnostic laboratory to continue. That was cost prohibitive, so they got rid of their machine.

Now I have to make an appointment to go in and have blood drawn, then schedule a second appointment to go back and have them tell me about it. In the meantime they have to package up the blood and ship it somewhere to have a third party lab test it and send the results back. So now I miss part of two days work instead of just one, and between what the MD charges to take and process the blood, then what the outside lab charges for the analysis, and what the MD charges for me coming back for a second appointment, it's an increase in cost of more than 50%.

My MD tried a small innovation to help her patients get service faster and cheaper, and ran into the Borg. It's not just about people w/out money being refused service. The system is so bound up it's nearly immovable.

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

Post by BRUTE »

ThisDinosaur wrote:
Mon Apr 03, 2017 11:28 am
Brute, all insurance is a ponzi scheme.
brute disagrees. pooling of funds to guard against low-risk, high-cost incidents can be very useful. unfortunately, there's almost no "insurance" in "health insurance", it's 50% generational wealth transfer and 50% subsidies.

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

Post by Laura Ingalls »

BRUTE wrote:
Mon Apr 03, 2017 11:14 am
overprescription in the US is more of a cultural and litigation issue, brute would think, than single payer vs. whatever else.

@Dragline: again, yes, all humans like free money. pity that the "existing single payer system" doesn't work. Medicaid is so bad that 5 million Americans who are eligible for free health care (!) didn't get it. actual care provided is very sub-par for most on it. Medicare is popular because it's free money, but it's unsustainable, it'll run out pretty quickly unless young humans are made to pay more to finance the old. classic Ponzi scheme. and let brute not get started about the amazing single payer VA.

in fact, just the fact that the VA is single payer should tell humans all they need to know.
Who are these five million? People that never signed up for any coverage or people that were eligible and bought other coverage?

I think most people avoid Medicaid out of fear of looking or feeling "poor" not legitimate medical reasons.

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

Post by BRUTE »

brute has not met them. but avoiding medical care for fear of "looking or feeling poor" seems like.. uh... a whole different problem.

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

Post by classical_Liberal »

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

Post by bryan »

Dragline wrote:
Sat Apr 01, 2017 8:41 pm
In the US system, everyone qualifies for single-payer if they are either old enough, broke enough or broken down enough. Its just a dumb, badly constructed system. That's why we pay more for inferior results overall.
This reminds me of my GF's first use of her insurance (Medi-Cal) since being un-insured for a couple years. Basically she needed some antibiotics and a check-up but her PCP was booked up (but she could show up and see if anyone else didn't show up..) for weeks. So she called a few Urgent Care Clinics but they all said they don't accept Medi-Cal. She calls the 24/7 nurse who then tells her to just go to the ER and tell them she has Medi-Cal and needs some antibiotics. Hmmm.

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fiby41
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Re: Who'd a thunk it? Obamacare not repealed

Post by fiby41 »

7Wannabe5 wrote:
Tue Mar 28, 2017 1:19 pm
Also might consider having legal document refusing extreme treatment tattooed on to butt. Just brainstorming here.
That would be taking tramp stamps to whole another level.

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