24 February 2020

It's not "radical"


If you have the time, you can also watch John Oliver explain the process.

17 comments:

  1. The parties of the... RICH are are having fits about what to do with BERNIE!!!

    We finally got someone actually Left of Center who can get us things (like Universal Health Care) that have been standards in many European countries- and the RICH (on both sides) are finally revealing themselves for what they truly are...

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  2. I'm tired of this non-argument.

    The concerns about free healthcare in the States have already been brought up and ignored by the same people who think a John Oliver bit is a comprehensive plan for M4A. California considered it, and a state with single-party rule and the highest GDP in the union decided it was too expensive.

    You want a national plan for band-aids and basic physicals and check-ups? That could be workable. But the most sympathetic cost estimates put M4A in the tens of trillions, far in excess of what even 100% tax rates could generate.

    You're not getting this without a convincing plan to drastically reduce costs.

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    1. Here's an article published last week in The Lancet - a premier, peer-reviewed British medical journal - indicating that universal health care would result in a NET SAVINGS on medical costs:

      "Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households."

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    2. Again, no plan to reduce costs is present, just a presumption that it somehow will. You yourself put up a post about a $10 cough drop not too long ago. What makes that cough drop cost less with M4A?

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    3. I'm sure others here can answer your question more effectively than I can. It seems to me that the implicit but unspokken "plan to reduce costs" consists of not having an army of insurance staff advertising their health plans, sales people marketing those plans, clerks assessing a claim to see whether a cough drop is covered under the plan, pharmaceutical companies increasing the cost for some recipients to compensate for the inability of other recipients to pay etc etc.

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    4. Look at defense contracting and tell me that they don't have marketing or sales staff, even though the US government is their only/primary buyer. Clerks and administrators wouldn't go away either, you'd just shift them from private to public employees. Treatment still needs to be approved by someone, as is done in the UK and other free healthcare nations. And while "everyone" would technically be covering the costs through taxation, if it's anything like current taxation then that burden would fall primarily on the top third or so of tax payers who already fund most of everything. Only gouging billionaires is a fantasy that's impracticable and insufficient for the cost of the program.

      I'm not fearful of a well-designed social program that covers the basics of healthcare, and focuses on lifestyle health before it turns into something more expensive, but there are realities that are being ignored that cannot be.

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    5. So... you're unequivocally stating that every country listed above (not to mention shit poor Cuba) can somehow afford and implement a first class universal health care system, but... the Most Powerful country in the whole wide world is somehow completely impotent when it comes to achieving same said result. And we're supposed to take that seriously- at face value!

      UR $10 cough drop ends when we start to think... differently. eg-
      https://www.youtube.com/watch?v=fxYboVoiejM

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    6. Just found this supplemental info today: "Bernie doesn't golf. That's $334 million in savings right there."

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    7. You're not taking this seriously, and that's why no one wants to try it.

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  3. Electing Bernie Sanders may solve a lot of problems in the USA, and it will definitely improve the international image of the USA, even if the stain from the orange will remain for some time.
    I am able to comment here because of a health system that caters for all.
    If I lived in the USA and not New Zealand, I would have most likely been writing this posthumously.

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    1. This is off topic, but your comment got me to thinking about the term posthumous and if the antonym is prehumous. Anyway, I came across this amusing article on the origin of "posthumous."

      https://www.courant.com/hc-xpm-2010-07-12-hc-words-0712-20100712-story.html

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  4. An opinion article from Denmark surmises that cultural differences are the biggest barrier in providing Universal Health Care in the USA. Not a long read, and well worth a few minutes.

    I found this to be most telling: "My impression of Danish people, is that they do not necessarily think of life as a zero sum game whereby one must lose in order for another to gain. In the US on the other hand, it is commonplace to see Democrats and Republicans repeatedly describing each other’s plans in terms of “winning” or “losing.” Unlike Denmark, compromise in American politics is almost unheard of."

    "How does Denmark have better healthcare than the US for less money?"
    OPINION: Forget healthcare policy, it’s the culture.

    https://sciencenordic.com/culture-denmark-forskerzonen/how-does-denmark-have-better-healthcare-than-the-us-for-less-money/1451158

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  5. The funny thing is that the US has several partial health care systems. Medicare. Medicaid. Tricare. VA Health care. And most of them work pretty good, and where they don't there are clear reasons of political obstruction why they don't. It's just a matter of opening these systems up to people who aren't covered, merging them and taking away barriers for them working better.

    IMHO, the federal government should just keep kids in medicaid kill the upper age border. They can lower the medicare age every year. They can expand tricare to all members of military families. And then slowly integrate the systems until nobody wants private health care anymore. That would make the change gradual and prevent a shock to the existing system.

    As side-note, I often hear the argument that the US is too big to copy the systems of these 'small' European countries. That is a good point to note that the population of these 'small' countries coincides with the population of a lot of states in the US. Denmark has the same population as Colorado. Finland compares to Wisconsin. Sweden is like North Carolina.

    In the end, it does not matter a whole lot of doctors are employed by the government or not. It matters that everyone has equal access to health care. Until that is a common shared goal, not much will change here. Meanwhile the US is just burning money on health care inefficiency.

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    1. I worked in the VA health care system for the better part of 20 years. It had innumerable faults, but overall worked well during my years there, and could have been scaled out to more participants if there had been a political willingness to do so.

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  6. I'm a psychiatric social worker, and spend a lot of time in emergency rooms and the community trying to arrange care for people in psychiatric crisis. Part of this job is that I wind up on the phone with insurance companies trying to convince them that the care is required - and I get a lot of arguments.

    Now, I'm in Massachusetts, birthplace of American universal coverage (it's not universal, but that's another story). Even so, when someone with MassHealth needs treatment, I wind up on the phone with a person who works for a state contractor (which itself is essentially a private insurance company) and sometimes go back and forth with them for hours at a time. The state is paying for both of us (and our supervisors, and emergency room doctors, and nurses, and whomever brings the $10 cough drops) to have that argument.

    The person's coverage winds up paying for days of emergency room boarding just because the psychiatric payer won't pay for the psych treatment, and the person is too high-risk to discharge. If you think a day in a psychiatric hospital is expensive, the ER is staggering, and outcomes are affected because it's not actual treatment. We squander tens of thousands of dollars this way - sometimes on a single patient. Ironically, the state also pays for people to research this, and produce fancy charts illustrating it.

    This is the same ER where people come for primary care because they can't find or maintain a doctor, because the doctor's don't take their insurance. The same ER where homeless people come to tell me that they're going to kill themselves so that they have a warm place to sleep at night. There are ERs in California which are paying for apartments because it's cheaper than responding to the needs of the homeless and uninsured.

    I spend easily as much time and resources fighting the system as I do actually providing treatment and support to my clients. I am the enzyme of the system that is digesting itself. I am the cancer. I am a parasite slowly killing it's host.

    If we want to do math, let's ask why, in the USA, if we spend twice as much on healthcare as any other country, we can't have twice as good a healthcare system. To say that it costs too much is absurd. We're paying it already. People who want to shout about American exceptionalism should be behind single-payer all the way - but it's not about money, is it? It's about class, race, and those who believe that healthcare is a privilege that they've earned and others haven't.

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    1. I don't believe any of those things. I'm skeptical of universal healthcare because you just illustrated how a government run healthcare system is inefficient and ineffective. Why would I want to replicate this system across the country?

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    2. Respectfully, it's quite the opposite. What I described was a system in which private companies are contracted to control costs, and private hospitals and psychiatric providers all have to fight for survival. This is current Medicaid expansion, NOT single payer healthcare, and it fails us because it still pits multiple parties against each other for the largest slice of the pie - or sometimes ANY slice.

      I can understand how this appears as a failure on the part of government healthcare - and in a way it is. Yes, we've mandated coverage, but we haven't taken steps to assure that treatment is available AND that all the various private entities can turn individual profits. It's a half-measure, and one that was politically derived - with the love and support of lobbyists.

      When Governor Schwarzenegger (a fiscally conservative Republican) introduced the idea of universal coverage in California, it was because the state was rapidly losing emergency departments which couldn't afford to stay open. This was because people who were uninsured were using them for primary care, and EMTALA wouldn't allow the EDs to limit that. The governor said "we're paying for this treatment anyway," and he wasn't wrong. He knew that there were global cost controls that could be implemented, and that on a population-health level, we don't incur the same costs if people can access preventative care.

      Declaring "government bad" is not analysis, and it's not a solution. We have a choice to make. For my part, I believe that the America that I live in is more than capable of rising up to meet the challenge of caring for its citizens - all of its citizens. This is the country that launched the Civilian Conservation Corps. The country that could build ships faster than the Germans could sink them in order to keep Europe from going under - and THEN could fly enough planes into Berlin to keep the Germans themselves alive. We bring water to the desert, landed people on the moon, and we dug through the rubble of the World Trade Center to find strangers. We don't always get it right, and when we don't, people suffer, but we CAN get it right. The fact that we're still standing suggests that we have a reasonable average.

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