Who'd a thunk it? Obamacare not repealed

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 Obamacare not repealed

Post by Ego » Sat Apr 01, 2017 3:52 pm

BlueNote wrote:
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.
Hum. We've learned a lot from trying to get people to quit smoking. Probably the most striking lesson is that appealing to a person's natural survival instinct in early and mid-life does not work well at all. For the early and mid-life smoker, the consequences are too far away.

If universal healthcare provided smoking cessation programs worked then those countries with universal healthcare would rank low on smoking incidence. The reality is quite different.

https://en.wikipedia.org/wiki/Prevalenc ... onsumption

One thing that works well is social shaming through various second-hand smoke legislation. Light up in a park in California and you are likely to get doused with a drink.

Taxes also work well. The cigarette tax in New York is $4.35 per pack (15% of the population are smokers) vs Kentucky with a tax of 60 cents per pack (30% percent of the population are smokers).

It would be impossible to legislate social shaming for obesity, heart disease, and other lifestyle diseases so that leaves us with taxes.

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 Obamacare not repealed

Post by classical_Liberal » Sat Apr 01, 2017 5:57 pm

BRUTE wrote:
Wed Mar 29, 2017 7:50 pm
this is actually part of the reason why brute favors individual, privatized health care, instead of single payer.
The problem with such a system is that insurance companies would not insure high risk people at all, and many low risk people would opt to not have insurance. Then we are back to square one, unhealthy people showing up in the ER with no means to pay and young, healthy people having accidents and showing up in the ER with no means to pay. Who bears the cost? or do we deny service? Although, I see your concern with popular opinion beginning to sway government to outlaw an unhealthy and unpopular vise. Unhealthy and popular would likely remain just fine.

In the current environment I would argue no purely private health care insurance model will work, even a libertarian will except the need for government when private organizations are unable or unwilling to provide a needed service effectively. The hybridized system we have now is not working, I would be open to other suggestions. At least with single payer there will be clear lines in the sand for all, basic coverage with tax credits for good behavior. You want more, go to the (totally, not half assed) private market. Yes, some will subsidize others as with any government tax.
Crazylemon wrote:
Thu Mar 30, 2017 1:31 am
@ classical_Liberal Some private health insurance does that here already.
Yes, and many employer sponsored plans have options to pay for gym memberships, etc. The amount of compensation is low, because the vested interest is low. If an insurer knows with 100 percent certainty they will have to insure a smoker from age 20 - death, they have more reason to get that smoker to quit at age 20, rather than have a 70% chance of paying for a very expensive disease process decades down the road.
BRUTE wrote:
Thu Mar 30, 2017 7:17 am
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.
... But, limb amputations and dialysis are a decade away. A tax credit for losing weight can buy you a new TV now! Yes, I see the irony of that statement.
Ego wrote:
Sat Apr 01, 2017 3:52 pm
We've learned a lot from trying to get people to quit smoking.
From a public health standpoint, this has been an amazing achievement unparalleled in it's efficacy. This approached could be studied and then modeled. However, a large portion of this approach was to essentially make smoking illegal in almost all venues, which makes my more libertarian bones ache. Another large portion was to stigmatize the smoker. For some reason millennials and the younger Gen Z(?) think smoking is a choice and being fat is not. So it's uncouth to walk by a fat person and shake your head in disgust. Advertising and Hollywood already effectively portray skinny as "cool", I'm not sure how to change opinions on this subject.

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

Post by BRUTE » Sat Apr 01, 2017 6:24 pm

classical_Liberal wrote:
Sat Apr 01, 2017 5:57 pm
The problem with such a system is that insurance companies would not insure high risk people at all
uh - of course. why would insurance be provided for a very high-risk or pre-existing condition? that renders the concept of insurance absurd. what classical_Liberal is talking about is a subsidy - which is fine to talk about, but should not be confused with insurance. muddling of the terms is 1/2 the problem in the "health insurance" debate.

classical_Liberal wrote:
Sat Apr 01, 2017 5:57 pm
In the current environment I would argue no purely private health care insurance model will work, even a libertarian will except the need for government when private organizations are unable or unwilling to provide a needed service effectively.
brute agrees. as he posted above, he thinks the current system is "unfixable" - because of high-risk, high-cost conditions.

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

Post by BRUTE » 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.

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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 6:48 pm

Ego wrote:
Sat Apr 01, 2017 3:52 pm
BlueNote wrote:
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.


It would be impossible to legislate social shaming for obesity, heart disease, and other lifestyle diseases so that leaves us with taxes.
Sure there's special cases like addiction. However you'll never eliminate tobacco use with taxes anymore then you could eliminate Heroin, Cocaine or other addictive substances. It would simply move to the black market if you priced it high enough. Then you end up with a law enforcement problem for a non-violent drug crime and probably end up with yet more drug related prisoners costing even more tax money. It makes sense to tax the smokers so they pay their share of health care, hell that's basically how we do it in Canada. I think at this point you could even consider banning smokable tobacco products and favouring vapour products which are arguably much safer. However I wouldn't , for example, expect a reasonable single payer system to put such a person into an organ transplant program for new lungs unless they were proven to be a reformed non-smoker and I'd penalize them in the selection process for being a smoker in the first place.

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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 7:36 pm

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.

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

Post by Dragline » Sat Apr 01, 2017 8:41 pm

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.

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

Post by 7Wannabe5 » Sun Apr 02, 2017 9:53 am

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.

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

Post by IlliniDave » Sun Apr 02, 2017 11:04 am

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.

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

Post by Dragline » Sun Apr 02, 2017 11:15 am

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.

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

Post by Gilberto de Piento » 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?

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

Post by Dragline » 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.

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.

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

Post by RealPerson » 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?

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

Post by ThisDinosaur » Mon Apr 03, 2017 7:15 am

@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.

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

Post by 7Wannabe5 » Mon Apr 03, 2017 9:09 am

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.

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

Post by Dragline » Mon Apr 03, 2017 9:30 am

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

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

Post by BRUTE » 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.

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

Post by ThisDinosaur » Mon Apr 03, 2017 11:28 am

Brute, all insurance is a ponzi scheme.

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

Post by IlliniDave » Mon Apr 03, 2017 11:36 am

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.

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

Post by BRUTE » Mon Apr 03, 2017 4:21 pm

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 » Mon Apr 03, 2017 7:16 pm

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.

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

Post by BRUTE » Mon Apr 03, 2017 7:43 pm

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

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

Post by classical_Liberal » Mon Apr 03, 2017 8:09 pm

Laura Ingalls wrote:
Mon Apr 03, 2017 7:16 pm
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.
Your reasoning is probably sound for a minority only. My anecdotal, but very pertinent experience tells me these are mostly people who are eligible, but never apply for benefits due to lack of knowledge, lack of caring, or pure laziness. People who enter the ER and are broke have no intention of paying. Since you can't bleed a turnip, few attempts are made at collection. This has created an entire new field of RN's called "case managers", who are essentially social workers which try to get the "frequent flyers" into situations where they can apply for medicaid, hence improving revenue streams to hospitals.

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

Post by bryan » Tue Apr 04, 2017 1:36 am

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 » Sat Apr 15, 2017 1:32 am

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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