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Should There Be Free Healthcare In The United States?
in United States

By joecavalryjoecavalry 396 Pts
Do you believe that there should be free health care?


  1. ?

    11 votes
    1. Yes
      36.36%
    2. No
      63.64%
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Arguments

  • I would rather see a system similar to Switzerland, where the government provides subsidies and tax exemptions for companies that comply with the recommended pricing and set of services on the offered medicare, while still relying on the private sector in this regard.

    Universal public healthcare tends to be very draining on the taxpayers and is only viable when the tax rates are considerably high, and such a situation has many other unpleasant economical effects that I personally do not want to have to deal with.
  • A more cash based system should lower costs. I received a 78 cent bill as part of my co-insurance for a test I had, makes no sense.  Insurance premiums, in general are interest free loans.  Consider this, taking those premiums and putting them in an interest earning account to be used for medical expenses with a catastrophic plan, just in case.  If you own a home or a vehicle and you incur a large expense not covered by insurance, what do you do?  You take out a loan to pay for it.  While I haven't done the math, would you be better off saving those insurance payments and earn some interest and then possibly have to take out a loan, or give those monthly payments to the insurance company?  Catastrophic plans are far cheaper and mostly to protect the hospital so they can recover some of their costs.  there is nothing to stop someone from incurring a huge bill and then filing bankruptcy which mostly hurts the hospital.  healthcare billing is a wasteful and expensive task which paying in cash could reduce and lower costs for everyone.  Private insurance doesn't pay for over the counter medications and certain tests and procedures which aren't need or considered cosmetic.  This is not true of medicaid type insurances, like any product or service the more you use the more it costs.  State and federal government doesn't do a very good job negotiating good prices because they really have no one who can hold them accountable.  The U.S. debt is glaring evidence of that as are the individual state debts.  And kind of single payer or socialized medicine would be terrible compared to what is currently in place, not that it couldn't be improved, but 'free" would send it backwards in the wrong direction.

    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • refugeerefugee 73 Pts
    @MayCaesar
    **I would rather see a system similar to Switzerland, where the government provides subsidies and tax exemptions for companies that comply with the recommended pricing and set of services on the offered medicare, while still relying on the private sector in this regard.

    Universal public healthcare tends to be very draining on the taxpayers and is only viable when the tax rates are considerably high, and such a situation has many other unpleasant economical effects that I personally do not want to have to deal with.**

    So taxes pay for your free healthcare 
    Agility_Dudewith_all_humility
  • What is the philosophical difference between a tax collector forcing you to give them money for something that's not yours or otherwise going to jail than a robber forcing you go give them money at gunpoint?
  • janesixjanesix 28 Pts
    yes, there should be free health care
    ApplesauceAgility_Dudewith_all_humility
  • janesix said:
    yes, there should be free health care
    so you are pro slavery then, only slaves are not paid and their master get free labor from them.  Or perhaps you didn't read any of the previous posts explaining how it would be impossible to have free health care?  Huge difference between "no cost to you" vs "free"  you should go back and read the posts so you'll be better informed.
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • janesixjanesix 28 Pts
    it would be easy. we can afford it. @Applesauce
    Applesauce
  • janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
  • Ampersand said:
    janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
    yes, it's not my burden to refute him when there's no evidence or argument presented.  It was an attempt to be helpful, perhaps in a stern and annoyed way, but still, this is a discussion and short one liners aren't conducive to that.  However after having said my piece, I would ignore future and similar posts by the same person once I have vented a bit <span>:smiley:</span>
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • Ampersand said:
    janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
    yes, it's not my burden to refute him when there's no evidence or argument presented.  It was an attempt to be helpful, perhaps in a stern and annoyed way, but still, this is a discussion and short one liners aren't conducive to that.  However after having said my piece, I would ignore future and similar posts by the same person once I have vented a bit <span>:smiley:</span>
    No, not just in your response, in your argument itself in your initial post. You just make a load of baseless claims. Your post is longer - because you make more baseless claims - but you don't back them up with evidence any more than janesix does. You're a complete hypocrite.
  • Ampersand said:
    Ampersand said:
    janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
    yes, it's not my burden to refute him when there's no evidence or argument presented.  It was an attempt to be helpful, perhaps in a stern and annoyed way, but still, this is a discussion and short one liners aren't conducive to that.  However after having said my piece, I would ignore future and similar posts by the same person once I have vented a bit <span>:smiley:</span>
    No, not just in your response, in your argument itself in your initial post. You just make a load of baseless claims. Your post is longer - because you make more baseless claims - but you don't back them up with evidence any more than janesix does. You're a complete hypocrite.
    did you watch the video? 
    Are you saying the statement about the U.S. being trillions in debt is a baseless claim?  Yes I made claims I didn't offer proof for, some don't need any and some was based on the video. Now compare that to the short one line posts that had exactly zero.  How about you get back on your white horse and ride off into the sunset and rescue some other damsel in distress.
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    A universal healthcare system system "is" cheaper than the current healthcare system we have: 

    "Universal Health Care would save the people of the United States about $600 billion for the same level of care they're receiving. We found it would require an additional $562 billion in taxation to cover the government spending, after savings and increases to demand. "

    https://decisiondata.org/news/how-much-single-payer-uhc-would-cost-usa/

    I don't know if i am fully on board to jump to a UHS, but what these private companies are doing is criminal in regards to premiums and drug prices. The biggest reason i would agree with UHS is to slash these cost in half and say goodbye to the raping these companies are doing to us. 

    Now, i think we can have other types of healthcare set up that isn't UHS, but ultimately i think UHS address all the problems i mentioned above and would be easiest to implement. 
    Agility_Dude
  • Outplayz said:
    @Applesauce

    A universal healthcare system system "is" cheaper than the current healthcare system we have: 

    "Universal Health Care would save the people of the United States about $600 billion for the same level of care they're receiving. We found it would require an additional $562 billion in taxation to cover the government spending, after savings and increases to demand. "

    https://decisiondata.org/news/how-much-single-payer-uhc-would-cost-usa/

    I don't know if i am fully on board to jump to a UHS, but what these private companies are doing is criminal in regards to premiums and drug prices. The biggest reason i would agree with UHS is to slash these cost in half and say goodbye to the raping these companies are doing to us. 

    Now, i think we can have other types of healthcare set up that isn't UHS, but ultimately i think UHS address all the problems i mentioned above and would be easiest to implement. 
    Even Canada has a "private" insurance as talked about in the video.  There's no dispute by me that the system needs a lot of fixing.  However I'm not convinced and see plenty of reasons why uhc is not the fix we need or want.
    "Sen. Bernie Sanders’ “Medicare for all” plan would boost government health spending by $32.6 trillion over 10 years, requiring historic tax hikes"
    http://time.com/5352950/medicare-trillions-bernie-sanders/

    I think health savings programs could be a good benefit.  There was talk about the inability and even illegality to buy health insurance from other states as well as forming a co-op to get better group rates.  Perhaps remove the "legal" barriers to prevent what is essentially collective bargaining capitalist approach shopping for the best deal.  You see the government is already neck deep in it and what's being proposed will put them in 100%.  I lack that kind of trust given the current and past ways they have managed it so far.  TBH I don't want healthcare like the V.A. has.  
    healthcare costs, medicare
    https://www.healthaffairs.org/do/10.1377/hblog20110809.012862/full/
    I'm no expert but have yet to see any real convincing reasons as to how a uhc system would be beneficial to the average person like myself.

    Agility_Dude
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • AmpersandAmpersand 471 Pts
    edited August 8
    Ampersand said:
    Ampersand said:
    janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
    yes, it's not my burden to refute him when there's no evidence or argument presented.  It was an attempt to be helpful, perhaps in a stern and annoyed way, but still, this is a discussion and short one liners aren't conducive to that.  However after having said my piece, I would ignore future and similar posts by the same person once I have vented a bit <span>:smiley:</span>
    No, not just in your response, in your argument itself in your initial post. You just make a load of baseless claims. Your post is longer - because you make more baseless claims - but you don't back them up with evidence any more than janesix does. You're a complete hypocrite.
    did you watch the video? 
    Are you saying the statement about the U.S. being trillions in debt is a baseless claim?  Yes I made claims I didn't offer proof for, some don't need any and some was based on the video. Now compare that to the short one line posts that had exactly zero.  How about you get back on your white horse and ride off into the sunset and rescue some other damsel in distress.
    Let's look at what you actually stated about the U.S being in debt:

    "State and federal government doesn't do a very good job negotiating good prices because they really have no one who can hold them accountable. The U.S. debt is glaring evidence of that as are the individual sta@Applesauce

    Oh look, what you were actually doing was making an absolutely baseless claim without a single iota of evidence to back it up. The existence of the U.S. debt is not evidence that "State and federal government doesn't do a very good job negotiating good prices" just because you say so. Stop arguing like a child and make a real@Applesauce

     And BTW, I flicked through the video and couldn't see it having any bearing on the argument and if you can't do the basic grunt-work to explain why and how video backs you up then I'm not going to make your arguments for you. Feel free to explain, for instance, how the video backs up your above claim about the existence of U.S debt showing that the government can't negotiate good prices.
  • ApplesauceApplesauce 92 Pts
    edited August 8
    Ampersand said:
    Ampersand said:
    Ampersand said:
    janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
    yes, it's not my burden to refute him when there's no evidence or argument presented.  It was an attempt to be helpful, perhaps in a stern and annoyed way, but still, this is a discussion and short one liners aren't conducive to that.  However after having said my piece, I would ignore future and similar posts by the same person once I have vented a bit <span>:smiley:</span>
    No, not just in your response, in your argument itself in your initial post. You just make a load of baseless claims. Your post is longer - because you make more baseless claims - but you don't back them up with evidence any more than janesix does. You're a complete hypocrite.
    did you watch the video? 
    Are you saying the statement about the U.S. being trillions in debt is a baseless claim?  Yes I made claims I didn't offer proof for, some don't need any and some was based on the video. Now compare that to the short one line posts that had exactly zero.  How about you get back on your white horse and ride off into the sunset and rescue some other damsel in distress.
    Let's look at what you actually stated about the U.S being in debt:

    "State and federal government doesn't do a very good job negotiating good prices because they really have no one who can hold them accountable. The U.S. debt is glaring evidence of that as are the individual sta@Applesauce

    Oh look, what you were actually doing was making an absolutely baseless claim without a single iota of evidence to back it up. The existence of the U.S. debt is not evidence that "State and federal government doesn't do a very good job negotiating good prices" just because you say so. Stop arguing like a child and make a real@Applesauce

     And BTW, I flicked through the video and couldn't see it having any bearing on the argument and if you can't do the basic grunt-work to explain why and how video backs you up then I'm not going to make your arguments for you. Feel free to explain, for instance, how the video backs up your above claim about the existence of U.S debt showing that the government can't negotiate good prices.
    the video is about healthcare, it's in the title, I'd rather you watch it w/o any of my bias or input so you can take from it what you will and reach your own conclusion w/o being lead there by me.  Canada is often touted as an example of how and why the U.S. should opt for a single payer system aka "free"  I thought that was common knowledge but at the risk of being pedantic I'll be more specific.
    toilet seats
    https://abcnews.go.com/US/senator-pentagon-investigate-air-forces-10000-toilet-seat/story?id=56488485

    50 Examples of Government Waste

    https://www.heritage.org/budget-and-spending/report/50-examples-government-waste

    but again the issue is healthcare
    Sen. Bernie Sanders’ “Medicare for all” plan would boost government health spending by $32.6 trillion over 10 years, requiring historic tax hikes, says a study released Monday by a university-based libertarian policy center.

    http://time.com/5352950/medicare-trillions-bernie-sanders/

    again i thought this was common knowledge, clearly it is not.
    those copied and pasted like that btw (shrug)
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • Ampersand said:
    Ampersand said:
    Ampersand said:
    janesix said:
    it would be easy. we can afford it. @Applesauce
    since you provide no evidence, there's little for me to respond do other than, you are wrong.  if you could be bothered to add a little substance to your posts we could have something to talk about, just a thought.
    You realise your posts have been exactly the same, right?
    yes, it's not my burden to refute him when there's no evidence or argument presented.  It was an attempt to be helpful, perhaps in a stern and annoyed way, but still, this is a discussion and short one liners aren't conducive to that.  However after having said my piece, I would ignore future and similar posts by the same person once I have vented a bit <span>:smiley:</span>
    No, not just in your response, in your argument itself in your initial post. You just make a load of baseless claims. Your post is longer - because you make more baseless claims - but you don't back them up with evidence any more than janesix does. You're a complete hypocrite.
    did you watch the video? 
    Are you saying the statement about the U.S. being trillions in debt is a baseless claim?  Yes I made claims I didn't offer proof for, some don't need any and some was based on the video. Now compare that to the short one line posts that had exactly zero.  How about you get back on your white horse and ride off into the sunset and rescue some other damsel in distress.
    Let's look at what you actually stated about the U.S being in debt:

    "State and federal government doesn't do a very good job negotiating good prices because they really have no one who can hold them accountable. The U.S. debt is glaring evidence of that as are the individual sta@Applesauce

    Oh look, what you were actually doing was making an absolutely baseless claim without a single iota of evidence to back it up. The existence of the U.S. debt is not evidence that "State and federal government doesn't do a very good job negotiating good prices" just because you say so. Stop arguing like a child and make a real@Applesauce

     And BTW, I flicked through the video and couldn't see it having any bearing on the argument and if you can't do the basic grunt-work to explain why and how video backs you up then I'm not going to make your arguments for you. Feel free to explain, for instance, how the video backs up your above claim about the existence of U.S debt showing that the government can't negotiate good prices.
    the video is about healthcare, it's in the title, I'd rather you watch it w/o any of my bias or input so you can take from it what you will and reach your own conclusion w/o being lead there by me.  Canada is often touted as an example of how and why the U.S. should opt for a single payer system aka "free"  I thought that was common knowledge but at the risk of being pedantic I'll be more specific.
    toilet seats
    https://abcnews.go.com/US/senator-pentagon-investigate-air-forces-10000-toilet-seat/story?id=56488485

    50 Examples of Government Waste

    https://www.heritage.org/budget-and-spending/report/50-examples-government-waste

    but again the issue is healthcare
    Sen. Bernie Sanders’ “Medicare for all” plan would boost government health spending by $32.6 trillion over 10 years, requiring historic tax hikes, says a study released Monday by a university-based libertarian policy center.

    http://time.com/5352950/medicare-trillions-bernie-sanders/

    again i thought this was common knowledge, clearly it is not.
    those copied and pasted like that btw (shrug)
    Wow, way to shoot yourself in the foot. Your first example is of the government finding large efficiency savings. Good job on showing the government works even though that's counter to your point.

    Your second example is a load of weird and random claims, with absolutely no argument that the public sector could do better and in some cases no indication given of what the government is doing wrong. That's of course the ones that aren't outright lies or misrepresentations. For instance number 7 on the list claims that "Washington will spend $2.6 million training Chinese prostitutes to drink more responsibly on the job". The link it provides as evidence for this doesn't work, but after doing some googling I've found that this actually refers to a study to find out ways to stop HIV spreading and alcohol addition: https://www.politifact.com/truth-o-meter/statements/2011/jul/29/judson-phillips/founder-tea-party-nation-claims-us-government-has-/

    Well done on being completely incredulous and accepting fake news as fact.

    The third one is a doozy though. It's a news article about a report from a libertarian policy centre funded by the far-right Koch brothers - about as biased as you would get. You'd think that would be a red flag, but let's look at what the report actually says because of course who goes off newspaper articles that can say anything rather than looking at studies first hand?

    https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf ;

    Although as it's incredibly biased it headlines the increase in federal spending up front, if you actually look at the findings you'll see that even the study admits (see the table on page 7) that medicare for All would SAVE people money. It increases federal taxes but it decreases personal spending by an even larger amount. In fact the overall change across 10 years would be a 2 TRILLION dollar SAVING to tax payers because the increase is tax is more than made up for the cost savings of no longer having to deal with insurance companies - and that's coming from right-wing, anti-government funded think tanks!

    You've managed to show that you are completely incapable of putting together an intelligent based argument. Two of your sources show the opposite of the point you were trying to make so you've well and truly shot yourself in the foot, the other is a poorly sourced and low quality list that show you're incredulous and will believe anything if it supports your world view rather than critically analysing it.

  • @janesix

    Can we afford it? Of course we can. Should we? That I am not so sure about.

    I have relatives and friends living in Canada, the UK and Australia, so I know something about their systems. They are far from how conspiracy theorist Moore draws them. ;) You generally get what you pay for, and those systems are no exception. Waiting in queues for months for even very simple examinations sometimes is hardly what you would call a modern healthcare system.

    In the US you have to pay a lot, but you usually get your money's worth. I enjoy calling to a dentistry for an urgent operation and having it scheduled for 2 hours later. Not something you generally can do in tax-funded systems.

    Switzerland is honestly the only universal healthcare-providing country which system I prefer over the US. But then, it is organized very differently from how most countries do it, and while the services are directed by the government, they are not really "funded" by the government. Not directly, at least.
  • MayCaesar said:
    @janesix

    Can we afford it? Of course we can. Should we? That I am not so sure about.

    I have relatives and friends living in Canada, the UK and Australia, so I know something about their systems. They are far from how conspiracy theorist Moore draws them. ;) You generally get what you pay for, and those systems are no exception. Waiting in queues for months for even very simple examinations sometimes is hardly what you would call a modern healthcare system.

    In the US you have to pay a lot, but you usually get your money's worth. I enjoy calling to a dentistry for an urgent operation and having it scheduled for 2 hours later. Not something you generally can do in tax-funded systems.

    Switzerland is honestly the only universal healthcare-providing country which system I prefer over the US. But then, it is organized very differently from how most countries do it, and while the services are directed by the government, they are not really "funded" by the government. Not directly, at least.
    Getting your money's worth? Lol.

    I could retort with anecdotes about great UK healthcare and awful USA healthcare, but anecdotes are irrelevant when we're talking on the scale of populations - anyone can find examples of something being good or bad and it doesn't tell you if the overall situation is good or bad.

    However when we actually look at the stats we find that the USA spends way more on healthcare than other countries:



    Yet comes between Costa Rica and Cuba in terms of life expectancy.

    Of course there will be other factors like how fat Americans are so that alone won't give you a true measure, but even when you look to peer reviewed academic studies you find that the USA has uniquely inefficient healthcare which is why USA healthcare expenditure is twice as high as it should be. 
  • MayCaesar said:
    @janesix

    Can we afford it? Of course we can. Should we? That I am not so sure about.

    I have relatives and friends living in Canada, the UK and Australia, so I know something about their systems. They are far from how conspiracy theorist Moore draws them. ;) You generally get what you pay for, and those systems are no exception. Waiting in queues for months for even very simple examinations sometimes is hardly what you would call a modern healthcare system.

    In the US you have to pay a lot, but you usually get your money's worth. I enjoy calling to a dentistry for an urgent operation and having it scheduled for 2 hours later. Not something you generally can do in tax-funded systems.

    Switzerland is honestly the only universal healthcare-providing country which system I prefer over the US. But then, it is organized very differently from how most countries do it, and while the services are directed by the government, they are not really "funded" by the government. Not directly, at least.
    government rationed healthcare might be fine for some countries but not the U.S.  You do get what you pay for.
    16 out of the 30 are in the U.S. including number 1, most other countries only have 1 in the top 30
    https://www.topmastersinhealthcare.com/30-most-technologically-advanced-hospitals-in-the-world/

    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • MayCaesar said:
    @janesix

    Can we afford it? Of course we can. Should we? That I am not so sure about.

    I have relatives and friends living in Canada, the UK and Australia, so I know something about their systems. They are far from how conspiracy theorist Moore draws them. ;) You generally get what you pay for, and those systems are no exception. Waiting in queues for months for even very simple examinations sometimes is hardly what you would call a modern healthcare system.

    In the US you have to pay a lot, but you usually get your money's worth. I enjoy calling to a dentistry for an urgent operation and having it scheduled for 2 hours later. Not something you generally can do in tax-funded systems.

    Switzerland is honestly the only universal healthcare-providing country which system I prefer over the US. But then, it is organized very differently from how most countries do it, and while the services are directed by the government, they are not really "funded" by the government. Not directly, at least.
    government rationed healthcare might be fine for some countries but not the U.S.  You do get what you pay for.
    16 out of the 30 are in the U.S. including number 1, most other countries only have 1 in the top 30
    https://www.topmastersinhealthcare.com/30-most-technologically-advanced-hospitals-in-the-world/

    Ah great, some random website I've heard of says things without evidence. That's obviously way better than trusted stats from world respected organisations like the OECD and peer reviewed scientific studies! Oh wait, no it isn't and I'm just being sarcastic!

    Your attempts to provide evidence are an embarrassment.
  • @Applesauce

    Well... i'm not really talking about Bernie Sander's proposal for healthcare. To be honest, i don't know what he is even saying other than everything should be free... which i disagree with him. What i know for sure as of right now is our healthcare system is broken. The first attempt to get healthcare to more people basically doubled our prices. This all comes down to should be let the company's take care of things or have the government get involved. That quote i put above is one of many that show UHC could be cheaper than our current system. I don't see how you could disagree with that bc anything would be cheaper than our current system. But is it good overall? I don't know... at first glance i don't think so. 

    So, UHC isn't my personal favorite choice. Turning it over to the government would be an easy step... so maybe i am being lazy. In truth, i personally think a mixture of government and private is where it's at. If people want it to be the healthcare from taxes it's mediocre but still healthcare. From there let private companies provide extra's or things like wait free plans, etc... Get creative. Then, you can have people with healthcare that just don't care... and, if someone wants something better... they can pay for it. 

    Ultimately we need to change our current healthcare. You don't get what you pay for like someone said. My mom pays $800 a month and she still has a 100 or 200 co-pay for an MRI scan. This is insane. I use to have to pay 60 a month for one medication...  until i found a plan i can afford that covered that specific med (thank goodness). Our healthcare is one huge part of American debt or pay-check to pay-check type savings. It's not good. But truly, i think the mixture of tax/pay type HC i said above could be an answer.     
  • Outplayz said:
    @Applesauce

    Well... i'm not really talking about Bernie Sander's proposal for healthcare. To be honest, i don't know what he is even saying other than everything should be free... which i disagree with him. What i know for sure as of right now is our healthcare system is broken. The first attempt to get healthcare to more people basically doubled our prices. This all comes down to should be let the company's take care of things or have the government get involved. That quote i put above is one of many that show UHC could be cheaper than our current system. I don't see how you could disagree with that bc anything would be cheaper than our current system. But is it good overall? I don't know... at first glance i don't think so. 

    So, UHC isn't my personal favorite choice. Turning it over to the government would be an easy step... so maybe i am being lazy. In truth, i personally think a mixture of government and private is where it's at. If people want it to be the healthcare from taxes it's mediocre but still healthcare. From there let private companies provide extra's or things like wait free plans, etc... Get creative. Then, you can have people with healthcare that just don't care... and, if someone wants something better... they can pay for it. 

    Ultimately we need to change our current healthcare. You don't get what you pay for like someone said. My mom pays $800 a month and she still has a 100 or 200 co-pay for an MRI scan. This is insane. I use to have to pay 60 a month for one medication...  until i found a plan i can afford that covered that specific med (thank goodness). Our healthcare is one huge part of American debt or pay-check to pay-check type savings. It's not good. But truly, i think the mixture of tax/pay type HC i said above could be an answer.     
    I agree the healthcare system is corrupt and broken.  Even so it's very good in many ways.  You don't have the government deciding on what you can have or rationing care.  Expensive copays for expensive testing makes sense in that you only want people who really need them to get them.  Long ago I worked near the Canadian border for an oncologist.  We often got calls from Canadian wanting to come over for cancer treatment, breast cancer mostly.  Back then the first line treatment for breast cancer was 2 agents (I don't recall which ones) because it improved outcomes, and the likely hood of progression on just one agent.  Canada was still only using one agent as first line treatment, only adding the 2nd when the cancer progressed.  Obviously just starting out with one is cheaper, but if adding a 2nd gave you at 10% chance that it wouldn't progress, wouldn't  you want it also?  Examine the lack of copay for Medicaid and as you might imagine people who have it are the most demanding and want every test under the sun, every scan and imaging because it costs them nothing, not a dime out of their pocket.  They will wait in a waiting room for an hour for a pregnancy test because they don't want to go to the store to buy one.  So this over use and misuse increases costs for everyone, how could it not?  Now consider that Medicaid and Medicare were essentially a single payer for their patients and then they started farming out the management of it.  Now there's a bunch of different medicaid and medicare plans ran but Blue cross, Aetna etc.  Why, if the governments were doing such a great job of running them and running them cost effectively?  How about the V.A.?  Good example of government run healthcare?
    several studies have found, is that many of Medicare's administrative costs do not show up in its budget
    http://thehill.com/blogs/pundits-blog/healthcare/337826-single-payer-healthcare-is-far-more-expensive-than-advocates
    Our system should be fixed until it's determined it can't be rather than doing something I consider too extreme.  To support this idea you have to trust and believe what you are told, "If you like your doctor you can keep your doctor"  There is no reason for that trust yet and there's plenty of counter arguments to make it not as clear as some think.
    "The biggest problem with Medicare for all, according to Bob Laszewski, an insurance-industry analyst, is that Medicare pays doctors and hospitals substantially less than employer-based plans do."
    https://www.theatlantic.com/health/archive/2017/08/are-you-sure-you-want-single-payer/537456/
    this is true of medicaid as well, and private offices (the better ones) only accept the number of medicare and medicaid patients as required by law.  Ever been to a medicaid office?  I worked in one for 11 years, the needless waste of resources is shocking and sad, because there are those who really need them but can't get them.  Just today someone needed a specialist appointment, first available....January, how will a single payer affect that?  I would think it would make it even longer.  Why do so many doctors from other countries come to the U.S. to practice?  Even when they still have to go through the residency program all over again.  Even a pediatric surgeon from China, yep they (she) starts at the very beginning no line jumping.  Yet it's worth it, why do you think that is?
    " if single payer did bring drug costs down, there might be less venture-capital money chasing drug development, which might mean fewer blockbuster cures down the line. "
    I do want a way for people to get the treatment they need (not just want)  But how do we do that?  Are you familiar with the brilliant idea of paying physicians according to patient satisfaction rather than actual outcomes?  How do you make sure someone is satisfied?  You give them whatever they want.  Still want the government heavily involved?
    https://newsatjama.jama.com/2015/06/17/jama-forum-does-linking-payment-to-patient-satisfaction-harm-or-help/
    https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108766?resultClick=3
    "In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.
    In addition, patients often request discretionary services that are of little or no medical benefit, and physicians frequently accede to these requests, which is associated with higher patient satisfaction.
    Physicians whose compensation is more strongly linked with patient satisfaction are more likely to deliver discretionary services, such as advanced imaging for acute low back pain."

    can you see my skepticism?  I'm not ready to reinvent the wheel just yet.  We haven't given a good faith effort to try and repair it first, we have been content for far too long to just spin the wheels.

    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    I agree here and there, but most of your concerns can be supplemented by good law. It all comes down to doing it right... which one could be skeptical of since we often times suck at implementing or enforcing laws. However, i think a mixed insurance system as i presented can work and cover most of your concerns. Now... if there is one group of people i am happy to have stay rich is doctors. They truly deserve it for not only saving lives, but going through a lot of work getting to their positions. That is why i don't believe in systems that would have them making less. And the reason many doctors come here from over sea's is bc we pay our doctors very well ... and i find that to be good too. It brings down smart doctors and it's better for our country. 

    So, it comes down to how do you keep doctors motivated to come here, from citizens wanting the position due to the rewards, and to continue innovations in medicine? The answer to that is to keep them rich and happy per se. Currently... they are too rich and too powerful. Getting rid of this power won't hinder innovation and won't keep people from being doctors. I still want them to be successful... just not to the level they are now. Bringing them down a little won't do anything bc they will still be wealthy and happy doing their job. 

    I can admit the problem is multi leveled. But i can't see any other way this can be fixed without government involvement. We aren't in a good place with healthcare right now. It is too expensive. It is like a lot of our problems here when it comes to greed. Greedy people wanting to stay powerful off the backs of others. In this sense i have always been left in my views. I am a market skeptic... i don't trust big corporations or people taking advantage just bc no one is telling them they can't. The nature of humankind is sadly this... and, i feel drug companies and certain doctors are taking advantage. So how do you fix this without more government reach? Maybe something like allowing more competition bw these companies and doctors could work. I'm not sure bc they are so use to over charging and their power. So i don't know. Sometimes the less government view puts too much trust in people... i don't trust people. More government puts more trust into government... i don't entirely trust government. But... the thing with government is that it also has good people looking out for our country. It isn't executives that only care about making more money... or a single doctor getting filthy rich. That kind of money corrupts... that is why i don't have much faith in these people fixing this problem. I can't see anyway around having to add more government into this conundrum. 
  • Outplayz said:
    @Applesauce

    I agree here and there, but most of your concerns can be supplemented by good law. It all comes down to doing it right... which one could be skeptical of since we often times suck at implementing or enforcing laws. However, i think a mixed insurance system as i presented can work and cover most of your concerns. Now... if there is one group of people i am happy to have stay rich is doctors. They truly deserve it for not only saving lives, but going through a lot of work getting to their positions. That is why i don't believe in systems that would have them making less. And the reason many doctors come here from over sea's is bc we pay our doctors very well ... and i find that to be good too. It brings down smart doctors and it's better for our country. 

    So, it comes down to how do you keep doctors motivated to come here, from citizens wanting the position due to the rewards, and to continue innovations in medicine? The answer to that is to keep them rich and happy per se. Currently... they are too rich and too powerful. Getting rid of this power won't hinder innovation and won't keep people from being doctors. I still want them to be successful... just not to the level they are now. Bringing them down a little won't do anything bc they will still be wealthy and happy doing their job. 

    I can admit the problem is multi leveled. But i can't see any other way this can be fixed without government involvement. We aren't in a good place with healthcare right now. It is too expensive. It is like a lot of our problems here when it comes to greed. Greedy people wanting to stay powerful off the backs of others. In this sense i have always been left in my views. I am a market skeptic... i don't trust big corporations or people taking advantage just bc no one is telling them they can't. The nature of humankind is sadly this... and, i feel drug companies and certain doctors are taking advantage. So how do you fix this without more government reach? Maybe something like allowing more competition bw these companies and doctors could work. I'm not sure bc they are so use to over charging and their power. So i don't know. Sometimes the less government view puts too much trust in people... i don't trust people. More government puts more trust into government... i don't entirely trust government. But... the thing with government is that it also has good people looking out for our country. It isn't executives that only care about making more money... or a single doctor getting filthy rich. That kind of money corrupts... that is why i don't have much faith in these people fixing this problem. I can't see anyway around having to add more government into this conundrum. 
    yes competition and allowing, empowering doctors to just say no w/o fear of being sued.  I believe a lot of what drives cost is use, which also causes shortages and wait times.  Why not address the current and fastest way we could address what's causing the increase in costs, instead of a new or additional system.
    https://www.investopedia.com/articles/personal-finance/080615/6-reasons-healthcare-so-expensive-us.asp
    "billing specialists are needed to determine how to bill to meet the varying requirements of multiple insurers."  certainly we can make it easier for hospitals etc to get paid, however if you make it difficult enough they will 'write" stuff off and the insurance won't have to pay it, it's an evil game if you really look into it.  Without reform to stop these practices no system you can come up with will be immune to it.
    "A Gallup survey estimated that $650 billion annually could be attributed to defensive medicine."
    overuse
    "U.S. medical practitioners also tend to use a more expensive mix of treatments." directly tied to defensive medicine and fear of being sued.
    “There is no such thing as a legitimate price for anything in healthcare,” 
    https://www.merckmanuals.com/home/fundamentals/financial-issues-in-health-care/causes-of-high-health-care-costs
    more of the same, but shows a trend of agreement on many of these issues.
    Here I'll even give you liberal fake news CNN LOL 
    https://www.cnn.com/2017/11/07/health/health-care-spending-study/index.html
    Diabetes was the condition with the greatest increase in spending
    The single most important risk factor for type 2 diabetes is obesity,
    (in other words totally preventable)
    the FDA drug approval process makes pharmaceuticals far more expensive than they ought to be.

    as you can see there's already so much that can be done, should have been done without trying to come up with a new system when the current one just needs to be fix, as does society.  there's a saying, only in America are the poor fat, there's a lot of truth to that.  It's the number 1 preventable disease which would reduce costs.  We can discuss that in a different thread if you like.  I've looked up a lot about it before. 
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    Two things real fast... make sure you hit reply to me and not just quote bc i am not getting a notification when you reply. Second, summarize your links a little, i often don't have enough time to read it all. 

    I don't know how much of these cost can be attributed to essentially, mistakes as you are putting it. The stuff i am talking about is clear over pricing by drug companies and doctors. It doesn't matter if everything runs smoothly or not... they are going to overcharge anyways. The concern i have is the human element of this. Now, doing what you said may save us some money, and/or fix some problems... but, i doubt it will put a dent in the problems. The main problem is overcharging bc 'they can.' What we are charged for health care is a crime. It seemed to get worse when obama care past... so that is why i am skeptical to future change other than UHC since that system is a sure guarantee to lower cost by not having costs. But i'm always in the camp of if it sounds too good it probably isn't... that is why i don't think it will be all rainbows by just passing that. 

    In any case, the problem i am addressing has to do with human greed. So, everything you put down can be fixed and should be fixed, but i don't think it will fix the issue regarding the over pricing etc. When you give humans free rain... they will look out for themselves and only for themselves while everyone else is screwed... At least in regards to this issue, do you not see why i think government involvement needs to happen?  
  • @Outplayz
    still learning this site.
    it's far more complex than simply saying we are being overcharged because they can.  That's actually not true.  The prices for services are negotiated as are 'allowable charges" "customary charges' all of which is based on medicare reimbursement rates, and who do you think sets those rates? 
    I see why you think the way you do.  Are you familiar with St. Jude's Children's Hospitals?
    There's no problem opening up the drug markets to purchase them from Canada or Mexico, competition lowers prices imo.
    Cash price is artificially high for a variety of reasons, but mostly because of the payment system and bureaucracy.  Let's say you provide x service, however group z will only pay you 80% if you wish to accept their contract.  Well 80% is below your costs so you raise x knowing you will only get 80%.  And if you want to make a contract with a huge group you might have to take even less.  And yet there needs to be profits so hospitals can afford to provide more services, especially in rural areas, to encourage innovation.
    In 2003 about 62 percent—were nonprofit. The rest included government hospitals (20 percent) and for-profit hospitals (18 percent).
    https://en.wikipedia.org/wiki/Non-profit_hospital
    so the greed isn't the hospitals I don't think.  I'm not sure how much can be blamed on the drug companies, there are many generic alternatives no a days.
    Hospital
    https://www.zerohedge.com/news/2017-11-28/obamacare-set-drive-new-wave-hospital-bankruptcies
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    Well... there is a law that people are trying to pass to allow government to create generic versions of drugs. This is currently something not allowed due to patent laws. But, if the drug companies won't lower prices... i believe in such a law. I personally feel a lot of it can be attributed to greed. Some hospitals may be good...  there are still good people out there, so some doctors, hospitals, etc... try to provide reasonable stuff. However, i don't think the "good" people are in the majority, and even them... i am sure companies think they can over charge these people for medical equipment etc., bc they think everyone is making so much money. I hear what you are saying, but don't overlook this greed part... it is def. there and part of the problem. I might be a bit pessimistic, but i can't help it... i have witnessed greed and am all too familiar with these type of people. You may be right that it isn't a big part of it.. i'm not exactly too confident to say i know for sure if it is a big part of the problem. But i do know for sure it is one part of the problem. It's in these type of cases that i am okay with government involvement. But if you are right and we fix these other problems and it is said and done fixed, okay sure... try it. I am skeptical that people can fix it by themselves however. If they could, it would have been done already for med costs is a huge issue and has been one since prices doubled on everyone. It seems like these companies are just trying to get as much as they can until the day government tells them they can't. That is what greedy people do.  
  • @Outplayz
    the drug companies have really been cut back in many way.  Back in the old days their reps were aggressive and threw lots of money around buying lunches, taking doctors out etc.  The system I work for now has cut all of that out and has go so far as to remove all samples (which is good and bad)  So no more samples or drug reps except for things that require patient teaching to use or administer.  The cost of r&d for these companies is huge and they want to recoup those costs and turn a profit before their patent runs out and others start making generics.  How do we determine what a reasonable amount of profit is for them to recoup their expenses and possible reinvest that profit into more or different research?  Let's be real there, money is the motivator and there's no replacement for it.  I guess this could be manipulated with taxes.  Companies don't hide their money under mattresses in fact there are tax advantages to reinvest profits rather than horde cash.  There needs to be a careful balance put in place and tossing out the current system and trying to replace it with something else I don't think is the best solution.  This also varies from state to state.  Perhaps we should examine states that are managing their healthcare very well and learn from what they do, I assume there must be at least one, I mean i hope so.
    Outplayz
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    Well i hope you are right and by the sound of it, you have more experience in this field than i do. My experience all boils down to being good at reading people and situations. My intuition is tell me i am right about the greed part, and i can find numbers showing ridiculous profits that in my opinion could be cut a little. But i don't know bc i am not an expert by any stretch of the imagination in this field. I had one medical type job and in that job it was all about abusing insurance companies to pay everything they can for rehab for others. So... i saw and took part in this greed. Not caring what the person needed, more so how much money can i get off them maxing out their policy. So... that is why i personally know there is greed going down but the big question is how do you fix that? You mentioned earlier to let the companies compete... maybe. I am actually in favor of that approach. See if the market can fix itself. All i am saying is that ultimately if it can't... government involvement is a must. Plus, the reason i favor UHC is that most of the left people i listen to say, for the same level of care, it would be cheaper overall. Not being an expert, i can't fact check that although my previous link also portrayed such a case. 

    Actually i'm curious to ask... why do you say that they are wrong in saying it would be cheaper?  
  • @Outplayz
    I'm not convinced it will be cheaper while still maintaining the level of healthcare and freedom that I have now.  This is based on what I have read and know about the Canadian and U.K. systems that everything loves to compare.  What they don't tell you is they have a secondary market for those who can afford it and don't want rationing or long wait times.  You can get private insurance in Canada either out of pocket or some employers offer it.  So the question is why would this even be a thing if the government program was so good, why is there a demand for it?  Insurance fraud, scams and greed are very real and should be kept as a low level as possible, and for the most part I think it is, always room for improvement, always.  There are Urgent Cares that don't accept any insurances and charge a flat fee of $50.  This cuts out much of their billing b.s. expenses with filings, rejections and the rest of the nightmare that is medical billing.  If you look at the different level of services and the amounts they are billed out at, what they actually receive, the cost that goes into just getting that amount actually collected, apparently this flat fee system is financially advantageous to the traditional, otherwise they wouldn't be in business long and no one would even attempt such a thing.  That's why i would say are more cash based system with insurance for catastrophic events, chronic issues and hospitalizations.  But along with that doctors should be trusted and allowed to order only want is really necessary to get away from practicing defensive medicine.
    In a UHC system how do you keep doctors from doing whatever the patient wants which drives costs out of control.  They have no real incentive to be financially responsible unless you threaten them with punishment.  I don't see a way to install safe guards in the UHC from over and un-need use.  The proponents admit usage will go up, partially because those who can't get treatment will receive it, but i think that's a pretty small %.  The rest will be because it's "free" doesn't cost me anything?  I want the works!
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    I'm... honestly a little lost on your perception of how a UHC system would work. As with any insurance-based system, UHC has specific restrictions on what kinds of care you can receive, largely based on established need. The simple fact that not everyone would pay into the system doesn't mean people would have carte blanche to take advantage of it - receiving something for free, particularly something regulated on multiple levels of bureaucracy, does not make what you receive a blank check. Unlimited access is not a feature of any UHC system I can find. Even if I agree that a UHC system would effectively render a large portion of the population no longer responsible for their medical costs (and I don't), that doesn't mean that financial responsibility disappears from the system the moment that UHC becomes policy. Just as a private health insurance company imposes limits on what people can seek for health care, the government can and does do the same. I also don't see why having a parallel system for obtaining private insurance in a UHC system is problematic. UHC is about providing a baseline of access to medical care. If people want to pay for more, they should be welcome to do so. No one is claiming that UHC would be a panacea - it's not meant to be a perfect system with free and clear access to all potential medical procedures.

    And I don't see how that's problematic. There are certainly potential issues involved in the negotiation of health care prices, particularly with regards to the pay that doctors and their staff receive within that system, but I don't think that's an insurmountable problem. There are many costs inherent to the system as it stands that disappear when the number of payers is consolidated. There are also potential issues involved with people seeking care earlier, since that will result in more visits to doctor's offices and thus affect wait times. However, I feel that that must be balanced against the number of people who use the emergency room as a form of health care in the status quo, leading the government to cover the much higher costs of their more debilitating circumstances. Tort reform and other measures would certainly have their benefits, and I support changing the way lawsuits affect their behaviors, but that won't be an easy or quick process, nor will it address a great deal of the costs inherent to the system. Other methods must be considered, and I think UHC warrants such consideration.
    someone234
  • @whiteflame
    it's like this, I don't want to take steps backwards.  Why would I want UHC?  What's in it for me?  Let's be real here, if it won't give me better or faster access and save me money why would I want it?  If it saves me money but I have wait times and rationing like Canada, I don't want it.  If it will save me money and all the services remain the same, then heck yeah sure give it to me.  There is been no real specifics on how I would benefit.  I'm not altruistic socialist, I'm mostly a capitalist libertarian.  Sell me on the idea and I may buy.
    Now explain why we should just work and fix our current system rather than scrap it for something new and most probably don't understand.  Remember how well the ACA worked out and how much was wasted on the failed website.  That was an epic fail and they want to try again?  Call me a skeptic but that money could have been better utilized don't you agree?
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    I'd say our system as it stands is already a pretty massive failure, so I don't know how you can characterize any shift as a clear step backwards, but that's just my perspective. Why would you want a UHC? Largely because it's a cost savings measure when it comes to pharmaceutical and medical device prices, which insurance providers can do nothing to keep in check due to a lack of ability to negotiate them down. Having a single payer system significantly increases the power of the insurer in these negotiations, and I frankly can't see why a government that would then be tasked with paying a great deal more health care bills would not take advantage of the opportunity to bring down those costs. Premiums would also be dramatically reduced since a large part of what contributes to them is the regularity of visits to the emergency room, paid for by the government. And in general, that seems an appropriate reason to see value in it for yourself. You pay for these people anyway because, like it or not, they receive medical care in the current system. And, at least from my perspective, it's quite a bit better to be able to ensure shorter wait times in the emergency room than to ensure shorter wait times for a primary care visit. 

    To some degree, you're right that there are some specifics we cannot know going into it, particularly as our system would likely differ quite a bit from Canada's or, perhaps, any other system currently in place. But that doesn't mean that there are absolutely "no real specifics on how" it would benefit people in this country, even from the perspective of "a capitalist libertarian." There is plenty that we do know and understand about how pretty much all UHC systems function, and we can apply a lot of the economics of those systems to a potential US system. 

    I stated in my previous post that working to fix the system as it stands through tort reforms isn't going to be quick, easy, or affect a great deal of the costs in the current system. There are numerous small fixes we could make, and they're worth making, but I don't think that any of them really solve for rampant health care cost inflation. I don't view my position as being one that pushes for "scrap[ping] it for something new". We're talking about expanding an existing program to broaden coverage. Medicare and Medicaid have been a part of our system for a long time now, and I do think people understand them to a great degree. Private insurance would still exist, so people could still purchase it to improve their health care coverage and experience. I don't see how comparing this to the ACA works, either, since that system is largely based on improving competition between private health insurers, which doesn't bear much resemblance to this. Maybe if the public option had been implemented, I could see your point, but that was excised before the policy was passed. The poor website experience doesn't apply here either because we're, again, not talking about a private health insurance market (though I would argue that those issues were resolved, that plenty of people still enrolled, and that what we learned from the experience could be applicable to any future efforts on the part of the government).
    someone234
  • @whiteflame
    I haven't experienced or witnessed many failures.  Certainly not enough to condemn the whole system.  Insurance companies have a tiered system for drugs and a preferred list so to say they can't do anything about the price just isn't true.  My emergency co-pay is much higher than for an office visit, hence I would only go to the e.r. if I really had to.  Medicaid has no such disincentive and you'd want everyone else to have the same?  So there's no way to curtail the abuse of emergency room visits paid by the government currently and you want to give them more control, this makes sense to you?  With regards to medical services they have control over and yet don't manage well at all, but you think giving it all to them, then they could do a good job with it?
    yes the ACA was an extremely expensive lesson, though I don't think we learn enough to get our moneys worth from that debacle.
    Perhaps UHC is too difficult to define and there's too many differing ideas for it.  One said it would medicare for all which is what I'm most familiar with.  What you describe about expansion isn't what I would call UHC because medicaid is state run and state specific.  And again I would ask you how well you think medicare and the V.A. has been ran and why I should trust the same agencies/government that run those to run even more.  If you don't handle your responsibility very well, why should I give you a lot more?  I'm not really following the logic here.  This seems to be a bunch of wishful thinking when history and reality has already shown us what is and what will probably happen.
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    You really haven’t experienced any failures? Not massively ballooning health care costs, widespread difficulties getting coverage (particularly for “preexisting conditions” before the ACA), or expansive wait times, all in a system that costs our country more per capita than any UHC that exists today? I can understand the argument that UHC might not fix these problems, but the notion that these aren’t systemic failures of the current medical system is honestly baffling. By the way, just to be clear, the tiered system for drugs is entirely separate from insurance providers - there are specific companies like Medco that make those lists. The problem is that they only work by comparing various treatments for the same problems, which means they only work (and barely at that - introducing a means of ranking is not much of a cost control measure when everyone’s prices are soaring) when multiple companies have treatments for the same illness that all work to roughly the same degree. It doesn’t  control prices if one drug is clearly better or the sole available option.

    The reason why you don’t see Medicare patients getting regular care in the ER is two-fold: one, ERs prioritize emergency cases, meaning that anyone who shows up with a minor problem will probably be forced to wait hours to receive care and whatever they receive will usually be minimal, and two, having access to an actual doctor who knows you and can address your specific case with attention and time is usually what people prefer. I don’t see why a UHC system would suffer from more ER visits when more people have access to appointments with doctors in the hospital. You don’t need a cost disincentive to keep people out of the ER, though even a government-run program could easily bill people for non-emergency visits to the emergency room. It honestly doesn't seem that difficult - if a private insurer can do it, why can't a government insurer?

    It's fine if you have problems with the ACA. Frankly, so do I, though my problems probably differ from yours substantially. The roll-out might have been problematic, but it seems to me that the price increases we see throughout the health care system would still plague the ACA, regardless of how well-run it is. The public option would have been a means of reducing that cost, but as I said, it got removed before the ACA was passed into law. It might not be the best of lessons, but since that is already a sunk cost, we might as well learn from it.

    I don't think UHC is all that difficult to define, and we can use specific systems as examples to start to figure out how such a system would play out, like Medicare for All. I'm not sure I understand your explanation for why a Medicare for All system isn't an expansion of Medicare. Medicare is a federally-run system, that system is expanding to cover more people, ergo it's an expansion of Medicare. You're correct that Medicaid is state-run (though funding for Medicaid does often come, in large part, from the federal government), but the two are separate programs. I would say that, on the whole, Medicare has been run pretty well. There are certainly problems with the VA as well, though again, I don't think that applies to a Medicare for All system. They're both far from perfect, but then I don't think any health insurance system has been run perfectly. And that's where the line "why should I trust" them doesn't really make sense to me. I haven't heard of a single health insurance provider that hasn't made substantial mistakes, and particularly in the case of private health insurers, actively sought to ensure that many aren't covered for their care in order to bring down costs. The responsibility to address issues with health care coverage exists in society, regardless. If fewer people receive coverage, then the responsibility lies with emergency rooms across the country to manage emergency cases and then bill the government. If more people receive coverage, then the responsibility lies with the government to decide how much coverage is afforded and cover those costs. Both of those systems have their problems, but in either case, the government is involved in a great deal of our health care. I don't think that private health insurers are being exceptionally responsible with their efforts either, so if this is a matter of who should bear the responsibility, I'd rather delegate it to a body that we can vote in and out of office rather than one that practically maintains monopolies on coverage in each and every state in the country.
  • in 25 years of working in the field I have not and don't know anyone who has experience "ballooning costs" (except because of the ACA and mandate)  or enough failures that couldn't be attributed to individual, specific instances, corruption and greed, nothing is immune from those not even UHC.  Wait times?  Not in the states and places I have worked.  We do pay more per capita but get more from it in terms of service and availability.  Sole option is a direct result of innovation and capitalism, would you rather not have that option at all?  Why spend the money and resources for r&d if you can't benefit from it?  What motivates new and better products, socialist altruism?  I don't think so.

    ER:  So let me tell you a little bit about ER's first hand.  Offices are generally closed on the weekends so the scumbum welfare queens go to the ER for a pregnancy test instead of the drug store.  Or they have a little cold and yes sometimes they will wait for hours, one, 8 hours, then got tired of waiting and left.  Now this person was still registered, vitals taken and documents created none of which can be billed for.  This person was also take up room and a slot make other people wait who should probably go a head of this one.  Do you think they quietly and patiently wait or constantly bother the staff to see how much long it's going to be?  Time is money right?  If they stay they are seen for non emergency conditions because they can't be turned away.  If medicaid says we aren't going to pay that bill because it's not an emergency who eats that cost do you think?  You can't garnish someone's wages if they don't have any.

    Access: More people have access to appointments with doctors is what you said, if there is already wait times and limited access, what is adding more people going to do to that?  If you are able to hire more doctors and staff that increases the costs again.  You can't bill medicaid patients, even if you do, there's no point and you will never collect.  Medicare has restrictions on when you can bill the patient etc as well, neither works like private insurance as they are much more restrictive.  There's a reason doctors don't want to accept medicaid and medicare.

    Who is in favor of UNC people already on the taxpayer's dime and those who don't have any insurance though an employer.  So isn't that the real issue?  Is there a large number of people with private insurance so unhappy they want to government to take over?  if there is I'm not aware of any such group.

    V.A.:  I think the V.A. is a great example of federally ran healthcare and I certainly can't think of one better.  In that system they virtually control and own everything.  Now when compared to private insurance who gets better care?  I would also say their piece of the healthcare pie is pretty small wouldn't you agree?  Give the problems that have plagued the V.A. for many years, you think they should get a bigger slice of pie?  Now ask yourself why are there so many Medicare supplements? 

    Medicare:  As I said before many of the Medicaids and Medicares have been farmed out to private insurances for them to manage because it was cheaper.  Think about that for a moment, it's cheaper to let someone else do it than to run it yourself......... There is roughly about 57 million people on medicare (2016 figure)  1. UnitedHealthcare Group, 70 million members     2. Anthem, 39.4 million members  3. Aetna, 23 million members.  So they already have far more negotiating power, or should than every private insurance except the number 1 spot based on number of people in the plans.  People on medicare tend to need more expensive and frequent services which is expensive over all compared to a pool of healthy people.  This goes back to what I have said that keeping people healthy is how you reduce costs because it reduces utilization and obesity is number 1 preventable health problem that can be fixed.  Controlling spending should be the first priority and yet UHC doesn't seem to address that and it can be addressed today.  UHC just masks and swaps problems for a different set, it's a distraction like a shiny object.  Maybe they should merge Medicare and the state Medicaids (about 73 million people)  V.A. about 10 million.  So now ask why do the government employees and politicians not have a government insurance?  Wouldn't it make sense these employees, politicians and military all be under some part of Medicare?  If it's not good enough for them why should it be good enough for me?

    All these things and many more that I haven't even mentioned or know about could have been done long ago but wasn't.  And you want to delegate more responsibility to those who aren't even responsible with what they have?  Call me a cynic but that doesn't make sense to me.

     I will leave you with this story for more context.  The not so great state of N.Y. after many decades finally realized it was a good idea and cheaper to give people on welfare cab vouchers.  Person on Medicaid/Medicare and poor was not feeling well, makes appointment with their doctor.  Can't get a ride to the appointment so they call an ambulance who will only take them to the hospital.  That means there's an ambulance tied up and not able to be used for oh something minor like a horrific traffic accident, you know a true emergency.  Last I knew as soon as you go inside the ambulance it's $900, then add in the E.R. costs etc, now if you call one and don't get in there's no charge to you, but it does take it out of service, driving back and forth as well as the team that comes with it.  This was easily solved with cab vouchers, why it took so long to figure that out I'll never understand other than to say that's how government operates (notice I didn't say works).  My criticism and skepticism is well earned.  I can delight you more horrible stories similar to this if you like, but I think you'll get my point.

    Don't fall for the fancy phrases, catching acronyms, fake and hollow promises, it's just smoke and mirrors, keep you eye on the real ball.


    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce

    Regarding increasing health care costs, I would say the regular increase in the cost of health care year-on-year in the US shows that those costs have ballooned. The fact that these cost increases far exceed inflation rates, and consistently have for several decades (since well before the ACA) is also an indication that something is clearly wrong. Whatever your personal experience is, costs are and have been ramping up, and there's no sign that they will go back down.
    https://www.kff.org/report-section/health-care-costs-a-primer-2012-report/

    Regarding wait times, I also think the data shows this rather convincingly. In three years, wait times increased by 30%.
    https://www.forbes.com/sites/brucejapsen/2017/03/19/doctor-wait-times-soar-amid-trumpcare-debate/

    It seems like a lot of your argument functions from a place of personal experience, and while I respect the fact that you have a great deal of experience in this field, anecdotes based on what you've seen and understood don't appear to reflect the reality across the country. If we're getting more service and availability, then why are wait times increasing? Why is the quality of care such a mixed bag, depending on the type of care and the location in which that care is received?
    https://www.ajmc.com/contributor/julie-potyraj/2016/02/the-quality-of-us-healthcare-compared-with-the-world
    https://www.ahrq.gov/research/findings/nhqrdr/nhqdr16/overview.html
    What, exactly, are we getting more of for the funds we're paying out as a nation? I don't doubt that those who can afford it get better care here than pretty much everywhere else in the world, but an assessment of health care quality has to take into account all people receiving care. 

    I'm not at all clear what you're talking about regarding "innovation and capitalism". It seems to me that companies would still benefit from pursuing R&D to develop new drugs and medical devices. I don't think that's going to stop in a world where an insurer can effectively negotiate with them. Companies still have a clear means to benefit by coming out with newer and better drugs or devices. Just because the scale would no longer be ever-increasing doesn't mean that the incentive goes away.

    Regarding the ER, I keep coming back to this, but your argument takes place... right now. It's status quo, and most of those that do don't have insurance. They come to the ER for everyday care, and they wait because they know that the government will cover what they cannot pay for. That's right now. It seems to me that an improvement would be providing those people with the means to make an appointment so that they aren't sitting there bothering ER staff and taking up their valuable time, particularly when they face a great deal of emergency cases. I honestly don't see how that's made worse by providing them a means to receive care from a primary care physician instead of an ER nurse.

    Regarding access, I don't doubt that there will be increased wait times to see primary physicians. That comes with the territory. But, and I'll say this again, these people are receiving care in the status quo. They are simply receiving it from ER docs. It seems to me that transitioning those wait times from the ER to the general hospital, where cases generally are not emergencies, is a positive impact. 

    Regarding interest in UHC, I'm currently on my employer's health insurance, and I'd favor having it. In many ways, that insurance has been incredibly restrictive to my wife and I, though I won't make this about my personal experience. I'm quite certain I'm not alone - most of the polls have read on the matter don't exactly present a public happy with either their health care or their access to that care through their insurers. Just because you haven't seen such a group doesn't mean it doesn't exist. You're right that those most in favor of UHC are the most in need of it (though I don't see how people already on the taxpayer dime stand to gain), but I don't see how that undercuts the argument. Recognizing that this population exists, that they're in need, and that they currently cost the US quite a bit via their receipt of care in the status quo is part of the argument for UHC.

    I'm not arguing for a system similar to the VA, nor do I claim to understand that system well. If you want to argue specifically against the VA, you'll have to do that with someone else.

    Now, regarding Medicare, I will discuss specifics. I honestly don't see how the argument that running them through private insurers showcases a problem with Medicare. The fact that private insurers have the structures and personnel in place to effectively run their portion of this program doesn't seem particularly jarring to me, nor does the fact that medical offices have established relationships with these companies. It's simply easier to function through a smaller number of bureaucracies, particularly ones you already know. If anything, this is an argument for collapsing those bureaucracies down further, as doctors offices often have to deal with multiple health insurers and negotiate with them back and forth to get coverage for their patients, particularly after procedures are done. Medicare does already employ a great deal of negotiating power, and employs it, though they are somewhat limited in that utilization. There's little doubt that their negotiating power increases if they take on more of the population (and, just a note, your numbers include the entirety of Medicaid, which as you said, is state-run so it does not factor into this negotiating power).
    https://www.healthleadersmedia.com/innovation/medicare-advantage-plans-given-negotiating-power-part-b-drug-prices
    As for the rest of your argument, it seems to function on the basis that Medicare recipients, simply by virtue of being Medicare recipients, are more expensive. Of course, that ignores the fact that all current Medicare recipients are over the age of 65, making them more medically fragile and increasing their costs. You talk about "keeping people healthy", but it's not at all clear how you'd manage that. Sure, it would be great if we could improve the health of the country, and I think a UHC system would improve that by providing preventative care services to people who otherwise would not receive them, but I don't see how you manage to improve health in general by other means. You say obesity can be fixed, but you don't say how.

    And just because you find it interesting that government employees aren't all covered under a single government insurance provider doesn't erase the realities of how it benefits the people who are on it. I'm not sure what the reasons are for how the government chooses to cover its employees, but pointing out that that's the case doesn't show how government insurance is bad. You keep talking about how the government is irresponsible, but you also keep ignoring how private insurers have caused their own set of harms. None of them seem particularly responsible to me, though the latter certainly seems more concerned about their shareholders.

    I have no doubt that your concerns regarding the government are earned by your experiences. My views are also largely based on my experiences, particularly with private health insurers. I wont regale you with stories of my experience, however, because they are just that: my experience. I'm not doubting that your experience is more broadly applicable and that the various inadequacies in the system have led you to doubt that the government should ever be engaged in anything akin to UHC, but my problems with the case you're making come down to two essential points.

    First, your points always seem to focus in on what you experience, and by doing so, you essentially dismiss the broader issues affecting people beyond your sphere. Maybe that's not your goal, but by focusing in on even NYC, you're limiting your evaluation of what makes a good or bad system to your region of the world and leaving the majority of experiences out. Even with the NYC system, I see it differently from you: the government had a clear and outstanding deficiency in how they addressed a health care issue within the city, and, much as it took them a long time to address, they found a meaningful way to attack it. Government is certainly not quick to address issues (not that private health insurers are the vision of speed and efficiency), but that doesn't mean they don't or can't address them, and if a UHC system was to become a reality, it would certainly be after the implementation of changes to the existing system to make it work for such a large group of people being added. I don't doubt that there would be missteps and difficulties, but that's probably going to result from any substantial change. You talked about tort reform, but if we really wanted to make big changes to that system, we risk the possibility that patients could be harmed by their doctors with little to no repercussions. I don't pretend to know all of the issues that we could face if we implemented UHC, but it seems like it addresses a great deal of the problems we face right now.

    Second, it seems as though your focus is largely on what the government does wrong without examining how that differs from the current system. I think a large part of how you see me (especially based on that last line) is as a bleeding heart liberal who just wants everyone to be covered. I'm not sitting here talking about a system I haven't researched myself. I'm not bought by "fancy phrases, catching acronyms" or any of the other things you listed. I'm reading the financial data surrounding it, trying to understand the issue inside and out, and I'm comparing the glaring problems with the system we have today with a potential UHC system. If I'm being perfectly honest, I'm not sure I'd support a UHC system. There are others I'd be more than willing to consider, and I think that there are plenty of potential pitfalls that need to be addressed before I'm comfortable with any promise of broader insurance coverage through the government. But I can't help but see where the system we've had is failing us as a nation, and that's from a purely financial perspective. Maybe smaller fixes would be enough, but I can't see how they resolve the vast majority of problems plaguing us today.
  • @whiteflame
    do you honestly believe the protections of UHC is accurate and not biased?  How far off were the projections and promises of the ACA?  Are you denying that what we currently have couldn't be improved and fixed?  Explain why you think it would be cheaper not to fix or work on the current system.  It should be obvious why I talk about my situation and experience being pro libertarian and capitalism.  Let's be real people care about what affect them and benefits them.  Yes I focus on what the government does wrong as they are largely unaccountable, yet we should give them a bigger part of the pie, makes no sense.  Do you give chronic under performers and screw ups more and more important responsibility?  These some of the same clowns that give you the projects that you believe, I mean come on.  Convince me why I should believe they are speaking the truth this time.  The closest thing to a UHC is the ACA, if that was a great and honest effort to show their ability to provide healthcare, I'll pass tvm.
    "I'm just a soul whose intentions are good
    Oh Lord, please don't let me be misunderstood"
    The Animals
  • @Applesauce ;

    Projections are always going to be subject to some uncertainty, and there may be some bias involved, but I see it coming from several sources and some of those sources I trust. If you don't trust them, then I ask you to explain where the faults are in their analysis instead of just stating that all of them are biased and inaccurate. The ACA was a system that hadn't been tried before and is completely unlike any UHC system, so I don't see how difficulties involved in the ACA are relevant, though I would say that many of the promises of the ACA were met (however, that is a separate conversation). 

    I never said we couldn't work on the current system. I said that any changes we make, particularly to areas like torts that have the potential to reduce costs in a meaningful way, are going to be time intensive, careful, and difficult. The idea that one comes at the cost of the other sounds strange to me, mainly because so many of the small changes that could improve on the system as it stands are applicable to a UHC system. The problem is that I don't think any of the small changes, no matter how well-made, will actually resolve the problems in the current system. If you have other ideas, we could go through them, but I'm not going to list off possibilities. The fundamental problems would still exist - namely, that there's a clear profit motive behind deciding who gets care through normal means and who doesn't. In the end, everyone gets care, but a great deal more people are receiving that care through the ER. That doesn't seem like a reparable problem. If you have ideas, I'd be more than happy to discuss them.

    From my perspective, the situation is already bad. I don't view the government as perfect, I don't think they'll do anywhere near a perfect job, and they will probably make many mistakes in the process of making a UHC system a reality, but I view the current system as so problematic that it's worth the risk. You talk about unaccountability, yet private health insurers are barely accountable to those they insure. They maintain veritable monopolies in each state, and can charge exorbitant prices for plans that cover less and less. To me, that's chronic under-performance. That's a set of problems that have been allowed to persist for far too long.

    Clearly, you disagree. I'm not here to get you to believe in what I'm saying, I'm just explaining why I think the way I do, providing the support I've seen for my position, and letting you decide what matters. If it doesn't matter to you, I can't make it matter, and if you don't believe it because you can't believe any data that supports this position, then I can't make you believe it. I will say that the ACA is about as different from a UHC as any other system of health care can be, since it largely reinforces a private health care system with government backing, but if you want to believe they're that similar on no basis whatsoever, I can't stop you. It's up to you if you're willing to consider the evidence and weigh the options. That's what I'm doing. I'm not sure I want a UHC, even after all I've said about it, because there are inherent problems that concern me. But that won't stop me from considering it and balancing the data about such a system against other potential options. From my perspective, there is no incorruptible entity that could run a health insurance program. Everyone's got their problems, I'm just looking for the best of the worst.
  • @whiteflame

    I'm a tad bit on your side but i am really hesitant in saying turn this over to the government. Letting competition be the deciding factor with maybe some regulations on prices can be one way. I just am not seeing why everyone should pay for everyone to have healthcare when essentially now, everyone does have health care. ER's can't turn you away, there are free clinics, etc. I don't know. I hear your points and i hear his. Everything sounds good on paper, but i'm afraid a switch so drastically to a new system is a pretty big risk. Since no one has really done it right... i have a hard time believing we can do it right.  
    Applesauce
  • @Outplayz

    I'd say my issue is that the current system is functioning poorly enough that we need to consider other options, even drastic ones. I don't think the continued crowding of ERs is something we should accept, and there are numerous issues with available free clinics that prevent them from being sufficient to address the issues faced by people who cannot afford insurance.

    I'm not clear on how you'd go about increasing competition within the system, but simply removing the barriers that prevent companies from selling across state lines wouldn't do it. Competition is great in theory, but difficult to implement in any meaningful way because companies that do currently have monopolies in their states have massive head starts on advertising and network associations. Personally, I'd probably favor a system where the government is an active competitor in the market over one where everyone is under a government system, largely because I think it's likely to control costs pretty well by creating said competition. I think that's a much less dramatic shift, and it would provide an opportunity to directly compare a government-run insurance system (and improve on it) that people could actually buy into to the privatized insurance system. It wouldn't be the end goal, but it would be a step in the right direction.
  • @whiteflame

    I am more inclined to agree with a government/private owner type of solution. It doesn't look like companies care that they are harming the American society with their greed, so some kind of government involvement seems inevitable at this point. I just don't like the idea of having to pay more taxes for health care that will most likely be abused by those that are like... "well it's free." Having good law to circumvent that i think would be the trick to a successful platform... besides the fact that there really should be options to pay out of pocket for extra perks. The only problem with that would be to make sure it doesn't only benefit the rich. 
  • @Outplayz

    It's the "well it's free" part that I honestly don't find very convincing. If people have regular access to free health care via the ER and free clinics today, then the problem of people taking advantage of that system is already a problem. I don't see how that substantially changes in a UHC system, since their access to care simply shifts from being the equivalent of drop-ins to an appointment-based system. Abuses seem like a non-unique problem.

    I agree with the rest of your post. I think the notion of having a supplemental parallel private system is clearly beneficial, and that the government needs to be involved in the process of improving health care, at least to some degree, given how far private insurance has gone out of their way to make things more difficult. There will always be substantial health care disparities based on income, it's really just a matter of ensuring that everyone has a basic level of access.
  • It's amazing how in countries with free healthcare this "abuse" doesn't seem to happen. How are people even imagining this will happen. People go and get treatment for illnesses they don't have? Because they enjoy sitting round in a doctor's surgery for no reason?
  • @Ampersand

    It has to do with the culture. Places like Japan and Norway are high trust societies. It's like a big community of friends. You can have free food in a market only for people that need it and people that don't need it would find it immoral or wrong to take it. This isn't the case with America. We aren't the worst, yet we are def. not a high trust society. This is bc we have people from all types of cultures. For instance, cultures like the middle east find it to be witty or smart to cheat the system. Bc they live somewhere cheating the system is a good thing. Bc of this type of lifestyle they don't find cheating the system to be a bad thing. This is why you can't compare United States with any other place bc we truly are diverse and different. And, when it comes to implementing anything you should always look at the problem of cheating the system first... bc here, people will at a larger scale than any other place.. especially when comparing a homogeneous society to ours.    
  • @whiteflame

    Well.. i don't know. I think the people abusing it now are just smarter. I mean, a lot of people aren't smart enough to know there is free health care, er's can't turn them away, etc. But.. putting "free" next to it announces to everyone that it's free. So, now everyone knows. Yes it is a problem now... but i assure you i am confident it will be more of a problem with a free system. However, again, it all comes down to how you set this new system up. If you have laws and regulations not allowing this abuse by some kind of penalty or restrictions we should be fine.    
  • @Outplayz

    Doesn't seem to me that people would have to be all that smart to know that ERs are required to provide care to anyone, and free clinics have "free" in the name. I agree that laws and regulations can effectively prevent abuse, I just don't think that a UHC is more prone to abuses.
  • @whiteflame

    We can agree to disagree on this one. Really... no one knows until it's all said and done. I just know things sound good on paper but implementing them and how they play out is something totally different - i guess i'm just a bit of a pessimist when it comes to trusting people will behave. I hope we can figure it out bc i know people close to me that our current system is letting down... i'm sure everyone knows someone... which is a clear sign that our health care system is failing the people.

    Btw, would you also say that "greed" is one of the main reasons for the state of our health care?
  • @Outplayz

    Well, greed plays a role in a lot of enterprises, both private and public, causing harm. I'd say this is one of those instances, though I think it's an inherent issue for companies that have stakeholders that expect a certain return on their investment. That desire must, at some point, butt heads with the aim of ensuring good care for patients - they simply can't do both continuously. Public enterprises have their own sets of competing interests, but my impression is that seeking a profitable company fundamentally comes at odds with providing affordable health care to those who need it.
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