Who'd a thunk it? Obamacare not repealed

[bryan]

BRUTE, looks like your home-boy is for universal national healthcare: https://mobile.twitter.com/GreatDismal/ ... 6722054144

[IlliniDave]

specifically, brute was thinking about a culture of over-diagnosing, over-prescribing, over-litigating, undervaluing lifestyle, a tendency for pill-popping and silver bullet solutions... all these things will be demanded by US health care consumers under single payer, and they'll be done by US medical professionals and US lawyers.

That certainly is another discussion that needs to be undertaken, but I don't think current legislation will come into it, and what we've been discussing is legislation. Also, the "culture of over-diagnosing, over-prescribing, over-litigating, undervaluing lifestyle, a tendency for pill-popping and silver bullet solutions" is exactly the "free market solution". It is the optimally profitable point in the business landscape. The people that receive the treatment aren't really the customers: it's the regulators, insurance companies, and shareholders that providers and others in the system ultimately answer to. There's no money in improving lifestyle, curbing "sales"/consumption, and such.

The whole system would have to be torn down and rebuilt (something legislation could address), and the only way to achieve a different outcome would be to eliminate the existing conflicts of interest in the rebuilt system. The welfare of medical care recipients would have to be installed as the ultimate priority and profits therefore unseated (sort of like how Vanguard operates in the investment world). I suppose a limited free market could exist under that, ultimately answering to the "medical fiduciary". That still would be far from perfect, but without it the only thing we really have to talk about is how we're going pay for what we've got, and how much actionable compassion we have towards our neighbors.

[Spartan_Warrior]

@Brute:

"does jacob really want the humans who run the USPS operating on him?"

Sorry, but this kind of nonsensical fearmongering rhetoric just shows a total, foundational ignorance as to what single payer, or insurance itself, even is. Like conservatives who don't understand how marginal tax rates work claiming people won't want to earn more money if it puts them in a higher bracket. No. It doesn't work like that. At all. Not even a little bit. It's insurance, guy. Think about this carefully. Is your current surgeon an employee of the insurance companies he accepts? Right, I didn't think so. Why would that change under single payer? Right, it wouldn't. Providers paid under single payer care would be no more employees of the government insurer than they are currently employees of Aetna... or Medicare.

"there are cultural differences between the US and other western nations that will likely be exacerbated by a single payer system."

Right, it's those damn cultural differences. If you meant what you claim you meant by this, you may want to consider your words more carefully in the future, as "cultural differences" in this context is typically a cliche right-wing dog whistle used to suggest public services can't work in America because of blacks and single moms sucking up the resources, thus the need for more racial purity and Eurocentric Christian hegemony.

"in general, government solutions seem to be good at arresting development."

Tell it to NASA.

[Chad]

"in general, government solutions seem to be good at arresting development."

Tell it to NASA.

And, almost every industry that relies on tech of some sort or the other.

The current lack of basic research just for the sake of science is a potential future problem for the US, as this research has historically been the foundation many US companies built on. This type of research is usually too big of a hurdle for private investors to get past, as it cost too much with no clear way to make money.

[BRUTE]

BRUTE, looks like your home-boy is for universal national healthcare: https://mobile.twitter.com/GreatDismal/ ... 6722054144

health care is here, it's just not evenly distributed.

[BRUTE]

@Brute:

"does jacob really want the humans who run the USPS operating on him?"

Sorry, but this kind of nonsensical fearmongering rhetoric just shows a total, foundational ignorance as to what single payer, or insurance itself, even is.

so is jacob's example of "who would build the roads" in the quoted post. it's misinformed rhetoric. that's why brute countered with his own piece of misinformed rhetoric. something something pig wrestling.

Right, it's those damn cultural differences. If you meant what you claim you meant by this, you may want to consider your words more carefully in the future, as "cultural differences" in this context is typically a cliche right-wing dog whistle used to suggest public services can't work in America because of blacks and single moms sucking up the resources, thus the need for more racial purity and Eurocentric Christian hegemony.

sure, because the only reason to disagree with X is literally being a racist. and that's how Trump got elected - Democrats scared away many reasonable voters with extreme tribalism. not that Republicans are better.

"in general, government solutions seem to be good at arresting development."

Tell it to NASA.

that place that's being outcompeted by Elon Musk's part time job?

[Chad]

"in general, government solutions seem to be good at arresting development."

Tell it to NASA.

that place that's being outcompeted by Elon Musk's part time job?

Who do you think is paying for the majority of Musk's part time job? NASA. The companies hiring Spaxe X to put satellites in orbit built their satellite tech off of whose research and effort? NASA's. Whose research did Musk build Space X off of? NASA's.

Broad statements like this are always incorrect. The world is more complicated than. Gov't sucks! Or, corporations suck!

[BRUTE]

that's why brute would favor an actual, complex solution to health care, not the wishful thinking for the miracle of single payer.

[Chad]

Then why make those simple statements or simple solutions?

[Lemon]

*warning - non American who works in socialised healthcare*

Single payer is not a magic bullet and to suggest it solves everything is madness. But what it does do is get everyone covered and in one risk pool, which makes sense unless you are happy with denying some people access/only with heavy crippling costs. Which you either disagree or agree with, Obamacare superficially looks to have done a good job of moving the overton window on that issue.

It means medical bankruptcy basically doesn't exist here other than the 'I couldn't work and ran out of money' variety.

Private additional insurance isn't banned, opt 'up' if you want to.

We get better outcomes per $, the data has already been shown. Now, yes there is less healthcare avaliable if you think MRIs all the time are great...The culture you describe of over investigation starts to melt away when the answer is 'not funded unless you go private'. Ok maybe that would be a bumpy road, if you are suggesting that Americans would find it culturally unacceptable for a £500,000 a year medicine that grants one extra year of life to be not funded, to me that just makes sense...

[Chad]

No one is suggesting it's a magic bullet. Everyone knows there would still be issues.

[jennypenny]

I think crazylemon makes an important point about US healthcare. Americans (overgeneralizing here) don't just want basic healthcare, they want heroic healthcare. In a single-payer system, that kind of all-in treatment would have to come from private insurance or OOP. That fuels the fear that single-payer would actually lead to a wider gap between rich and poor in healthcare coverage than there is now.

Scenes like those on the news from VA hospitals showing just how mismanaged 'government run' healthcare can be aren't helping. I've always wondered why proponents of universal coverage don't overhaul that system so they could hold it up as an example of how it can work for people. Seems like an obvious place to try out a new system, especially since most people would agree that they couldn't make it worse.

[BRUTE]

The culture you describe of over investigation starts to melt away when the answer is 'not funded unless you go private'.

this is the part brute doesn't buy.

@Chad: once again, reaction to simple solutions on pro single payer side. simply yelling "single payer" isn't going to solve any problems, yet any critique of it immediately makes brute a racist.

Scenes like those on the news from VA hospitals showing just how mismanaged 'government run' healthcare can be aren't helping. I've always wondered why proponents of universal coverage don't overhaul that system so they could hold it up as an example of how it can work for people. Seems like an obvious place to try out a new system, especially since most people would agree that they couldn't make it worse.

that's probably racist.

in seriousness, exactly this. the VA is single payer. it demonstrates why single payer in the health care sector in the US doesn't necessarily solve any of the problems. supporting the troops is probably the single most bi-partisan thing in this country, and every republican would donate a kidney to the VA if it helped at all. yet even that mess can't seem to get fixed. why would it be different if this system got expanded dramatically?

[IlliniDave]

Scenes like those on the news from VA hospitals showing just how mismanaged 'government run' healthcare can be aren't helping. I've always wondered why proponents of universal coverage don't overhaul that system so they could hold it up as an example of how it can work for people. Seems like an obvious place to try out a new system, especially since most people would agree that they couldn't make it worse.

That's true, but what, nearly a quarter of the country is on Medicare now, and by age it is the least healthy demographic. They manage to make it work and I don't think there are huge rich vs poor gaps. We're all headed there if we live long enough, and I don't here many people panic when they are 64 about to turn 65.

The VA is an example of a system that not everyone participates in (so not enough people have a stake to ensure a good outcome), and it is the best predictor of the outcome of "high risk pools" I believe. Medicare works because essentially everyone has skin in the game.

I think one of the difficulties is many of us (me included) live in the bubble of employer-provided/managed medical insurance. Even though it's becoming an anachronism, some of us don't really know what it like to be out there without insurance or faced with only prohibitively expensive options. But we do as a group tend to be the strongest critics of anything that begins to sound like socialized medicine.

Right now my emerging plan is to stop seeking medical care altogether so I don't risk getting a chronic diagnosis before I get into the new system in some state. If something does happen, I'll probably have to scrap ER and keep working. I have a pretty good stash, but not enough to manage a chronic condition solo for 10 years throwing retirement on top.

[C40]

supporting the troops is probably the single most bi-partisan thing in this country, and every republican would donate a kidney to the VA if it helped at all. yet even that mess can't seem to get fixed. why would it be different if this system got expanded dramatically?

ehh... "Supporting Troops" is, IMO, just some fake patriotism bullshit where people say something or stand up and clap or put a sticker on their car, but 99.9% of them don't actually do anything beneficial. Republicans are the worst with this fake patriotism. A lot of them will talk and clap and insult people who don't, but believe me, they aren't giving up their kidneys.

I do know what you mean and agree with you about the opportunity for good publicity for politicians to make improvements, and I suppose I'm a bit surprised that opportunity hasn't been fully exploited.

[ThisDinosaur]

Medicare may be the same sort of ponzi scheme that social security is. Meaning, it depends on a majority of nonusers contributing to a minority of users. As the age demographics shift older, we may either have to raise the benefits age, or reduce thw available benefits. Countries with universal coverage tend to have much less expenditure on the elderly than the US does. AKA , rationing.

[George the original one]

supporting the troops is probably the single most bi-partisan thing in this country, and every republican would donate a kidney to the VA if it helped at all. yet even that mess can't seem to get fixed. why would it be different if this system got expanded dramatically?

ehh... "Supporting Troops" is, IMO, just some fake patriotism bullshit where people say something or stand up and clap or put a sticker on their car, but 99.9% of them don't actually do anything beneficial. Republicans are the worst with this fake patriotism. A lot of them will talk and clap and insult people who don't, but believe me, they aren't giving up their kidneys.

I do know what you mean and agree with you about the opportunity for good publicity for politicians to make improvements, and I suppose I'm a bit surprised that opportunity hasn't been fully exploited.

I worked for the VA 25 years ago. The problems are a combination of the client base (heavily psychiatric care-oriented, homeless, drug abuse, old folks home), legislative (the further a medical center is from Washington, D.C., the more likely things go right), the ties to research & teaching medical schools (medical researchers aren't caregivers), and extra veterans preference rule for hiring (less qualified candidates have priority in hiring).

Now, I highly doubt the public version of a single-payer healthcare system would look like the VA because we're unlikely to have those same requirements.

[classical_Liberal]

...

[Dragline]

Charlie Munger is saying single-payer like Canada is the answer and the future, although not until he is dead:

https://finance.yahoo.com/news/charlie- ... 04021.html

[IlliniDave]

They (Medicare) manage to make it work and I don't think there are huge rich vs poor gaps.

This is not at all true. The already existing rationing of cares has very large wealth inequality gaps in the realm of "outpatient" care. Outpt care often has expensive copays or no coverage at all if it is not deemed "medically necessary". This results in many elderly going with out rehabilitation which would be very beneficial to outcomes. This is particularly true of the elderly who do not have local family with enough free time to care for them when they are weak from mild to moderate illness or injury (which is much more common than one who does not work in healthcare would assume). In fact, "swing bed" or "rehab" facilities often only accept medicare payments (those deemed "medically necessary") or demand full payment up front since so many older adults can not afford the services independently. Out patient follow ups for serious conditions along with physical/occupational therapy are often missed because copays are not affordable. While this may not immediately and directly lead to demise, its does lead to a positive feedback cycle of poorer and poorer health, with less and less quality of life. One which could have been avoided altogether with financial means.

Not included in the above is the fact many elder couples live independently in a very delicate symbiosis. If one becomes weak or injured, even with a condition completely covered by Medicare, then other quickly finds him/herself in a dangerous situation alone and becomes another participant in the feedback loop. There is no coverage for this eventuality built into the system.

Bottom line, have children locally with the means, time, compassion, and intelligence to help or have the financial means to allow for outside help when needed, otherwise you will be on the wrong side of this very apparent disparity

I too believed Medicare was a horror show--based on complaints about it from people I know in the medical industry--until people I knew got over 65 and began relying on it significant medical conditions. None of them have complaints. Some of them have very serious conditions (my mom and my aunt) and only typical low middle class financial resources (no actual financial wealth, only a fixed monthly income). Medicare isn't really intended to be free healthcare for the lowest income people. That's the purview of Medicaid. Medicare is a a medical plan and isn't intended to solve the social issue of elderly living alone (something I agree is a gap in out social safety net system). The only reason I mentioned it was that is an example of a taxpayer funded medical that by-in-large works pretty well. If we want it to pay every nickel of every service every person might desire, medically necessary or not, and include non-medical in-home care for the elderly, well, it's going to cost us a bit more than a 2.9% nick in our paychecks.

Of course wealthier people will always have fancier and more convenient options. What I was getting at is that Medicare doesn't look at someone like my mother and say, "Yep, you're old, you're Stage 4, bummer for you, here's a bottle of oxy to ease you out and the number for the hospice people," where a wealthy person could write a check and get the surgeries, radiation, chemo, and advance approval cancer drugs that can be used to manage it. Mom gets all that too.


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