There are a lot of people making a lot of money on the inefficiencies of the US system. They won’t give
up their revenue streams without a fight, and they are filthy rich on the backs of sick people. You better believe they will play dirty.
Last I heard healthcare is like the only employment sector that's seeing real growth right now.
Note that this is a Good Thing.
The issue with US (and privatized) healthcare delivery is that there is an incentive (by insurers) to deny treatment, as well as an incentive for healthcare suppliers (hospitals, doctors) to over-deliver treatment, as well as incentives to use more expensive solutions.
Demand in healthcare is inelastic, no one is ever "too healthy".
Supply is always insufficient, so there needs to be a mechanism to resolve that.
In the US, that mechanism is money, or the cost of insurance etc to provide a restriction on demand.
In universal healthcare, that mechanism is a combination of subsidizing medications based on results and waiting lists for limited supplies, prioritized by need (eg surgeries).
But you will lose endless billing departments at general/specialist practices, hospitals etc, because actual consumers would not engage. Hospital administrations will be driven by the government setting reimbursement rates for services that are transparent, so the argy-bargy between someone paying cash, someone getting insurance etc will disappear (mostly).
I'm in Australia, and the billing departments, even at private hospitals are minimal. Ditto at general practices. Reimbursements for GP/specialists that are not "bulk billed" (ie paid at the government rate) are automated into a nominated bank account and are usually instant.
Medicare for All in the US would move the 2/3rds that are not covered by Medicare, VA, etc into the same systems, with the reduction in overhead from 10-20% to the 2-5% of the current government run health systems.
Allowing Medicare to negotiate both drug prices (as a large purchaser) and health services will also dramatically reduce costs, because the government has the purchasing power to drive hard bargains.
You can't just conjure up a medical school out of nowhere though. That's extremely hard and expensive. You can do it if you relax your standards. Maybe by making the "hospital" part of the school optional or something. Students won't see patients but what does it matter.
Medicare, Medicaid and Tricare are all basically universal systems for segments of the population. None work well. And all are subsidized from what people with private insurance pay. And the UHC proponents rely on a stacked deck--UHC is "better" in a system that makes 20% of the score "fairness". That is, UHC. And one of the other yardsticks is life expectancy. Sounds fine--but dig deeper. A big factor in lowering life expectancy is infant mortality. Again, sounds fine--except you see a big difference in infant mortality across the developed world that is not reasonably explained by differences in their medical systems. But you see an inverse relationship between infant mortality and stillbirths. Most of what you're really seeing is whether the doctors consider it a live birth that promptly died, or consider it a stillbirth. (And, yes, we are still an outlier--but by only 1/3 of the amount claimed.)
Show me it's better without your thumb on the scale!
(A lot of people are going to be very mad at me about this comment, without having the awareness to understand that this is the inevitable conclusion to, "You wanna play rough, ah?!"ing people's access to life-saving treatment. Please grok that we can preclude any more assassinations by cutting profits and letting people get the care they need.)
Congress is our only hope, along with a president who signs reform.
Obama had a generational mandate and couldn't even pass a public option which, is far more moderate than a single payer approach. Even the abomination of the ACA that actually got signed into law was subsequently gutted to the bone in the following years.
There is room for more tweaking, but the system we're living with now is pretty close to what most voters prefer.
1) In the immediate aftermath of Thompson being shot, policies were deliberately briefly softened. Anecdotally, people were helped to live longer by this. It didn’t last long.
2) The response to Thompson’s assassination was the closest I’ve seen to a class consciousness almost forming in the US, as people from across the political divide who had suffered at the hands of the healthcare insurance companies found common ground.
The reaction was short lived while the insurance companies figured out how to bolster security and return to the usual.
Look at what's happening in California with the proposed wealth tax.
>Page’s co-founder, Sergey Brin, has poured at least $45 million into the Building a Better California Super PAC specifically dedicated to blocking the tax
The reason more CEOs getting shot might make a difference is that many CEOs care about status and being able to mention it in the right places. Historically many people love it so much that they call themselves CEOs and Presidents of companies that are small businesses.
If these same people can no longer be open about their role and status, which they value, there will be some kind of change. I'm not sure what it is, but security guards don't restore their freedom to feel thoughtless about their role and lifestyle.
Whereas with taxes... Maybe some people brag about dodging them or their suspect filings that get them big refunds. But they're mostly not public and not tied to identity the same way. And even the wealth tax isn't remotely the same as the public being vocal at large.
For it to be comparable we'd have to have modern highwaymen and Robin Hoods somehow stripping the wealth, not the tax man.
Because the weight of any changes or perceived need to change come from the social burden that public violence would create in the shooting case.
And that doesn't seem to exist near at all with the wealth tax.
This is still a possitive outcome brought from the presence of a threat to their lives. Not as positive as the healthcare thing, but it's still jobs and a "tax" in that they are forced to purchase the vehicles which do have to be built and driven by someone not in their tax bracket.
The solution is to have both a) mandatory voting and b) a voting holiday. This is done in many other democracies around the world, and it works. Personally I would prefer term limits and age limits for congress, the president, and federal judges. Diane Feinstein, Ruth Bater Ginsberg died in office. Mitch McConnell is working on it. We have age limits for lots of professions that require high performance - political leadership should not be an exception. But of course to make any of these changes young people have to vote, but they're mostly busy being poor and doomscrolling to block out the pain.
-The US has had a lot of success by letting businesses run pretty free. This has produced some of the largest and most powerful companies on the planet.
-The conservative party traditionally has been suspicious of a powerful, centralized government
-In the US, there is a common thread of "government workers are impossible to fire" as well as a common thread of "government moves at a snail's pace".
In light of just that, there are many people who would prefer that healthcare is run by a private industry, as private insurers are enormous companies in the US. Everyone knows Blue Cross Blue Shield, Aetna, or Kaiser Permanente. Many people give a benefit of the doubt that companies are doing things efficiently. Additionally, health insurance companies in the US have a requirement to spend a certain % of their revenue each year on medical care, and will sometimes send out small refunds when they simply cannot suppress costs in certain other regions of the company enough to keep their spending at the right rates.
Beyond this, states may provide additional benefits, and many do (some with the help of federal funding, even). You may find someone in one state where they are suffering greatly, while someone in an identical economic situation in another state is not suffering at all. It's easy to convince the first man to vote for a better healthcare situation. It's hard to convince the latter.
I could go on for ages, but this is getting long. There are like a billion reasons.
The grammar is a little ambiguous around this, but you seem to be claiming that this is a majority position. It isn't. Single payer polls over 50% basically every time it's tested (the exception being some spun partisan reframings you occasionally see pushed), and has for decades.
Sorry, that's ridiculous. Universal Health Care policies are an almost 100% partisan issue. I can literally count on one hand the number of federal lawmakers who cross party lines here.
The real problem is people like you refusing to vote for the people with the policy you want, as often as not as part of a bothsidesist stance designed to get more upvote in peer forums like HN.
The two party system may be flawed and unjust, sure. But people who want single payer are still democrats.
That's a lot of words they didn't say. It is a true statement that Congress did not give the USA single-payer healthcare nor even a public option.
Nothing about that says anything about who voted for whom, where anyone even lives for that matter, or anything about political parties.
To say this is the fault of "people like you" is out of line.
But that is what they didn't say! They said it wasn't "votable", in the sense I took that means that this isn't an issue you can get by voting. And it is, clearly. And was, in 2010, when they were within one senate vote for a "public option" in the ACA. It 100% boggles my mind that you'd look at that once again incredibly partisan voting result and decide "Oh well, I might as well vote republican" (instead of "damn Joe Lieberman").
Who said any of this? "I" said nothing of the sort
I don't think you're going to convince anyone of anything this way. If anything you'll probably end up turning people off who otherwise would have agreed with you
You quite clearly came in to defend someone who did, though. This is the second time you've tried this end-around strawman. Please engage with the discussion as it is.
> "I already have universal healthcare here in Canada"
I don't think I'm the one misreading the discussion as it is.
If you take a deep breath and re-read, maybe you'll understand the point I've been trying to make is you're jumping down people's throats that aren't disagreeing with you, which at best does your own arguments a disservice. To put words in someone's mouth and say this is the fault of 'people like you' is out of line.
Have a good one
But I'm very happy you agree that health care policy in the USA is among the most directly partisan issues and know who to vote for given those priorities.
Edit: and even now you still put words in my mouth with your edit (so that's every message in this thread that does so). Best of luck to you
You just don't think I shouldn't have engaged with advocacy around the issue or taken offense that you and upthread commenters feel that this isn't something that can be... I guess "achieved by voting"[1]. I think that's a weird thing to troll a discussion this deep about, but OK.
[1] Does that match your understanding of the point? Genuine question! I think it's bonkers and wrong, but you seem attached to it and I'd like the opportunity to convince you.
In the 2020 debate, Joe Biden said he would veto Medicare for all*. Just this week, Hakeem Jeffries said he did not support Medicare for all and wouldn't vote for it. You already mentioned Joe Lieberman
None of what I just said implies "it's not partisan" nor does it imply "both sides are the same" -- multiple things can be true at the same time
It sure does, however, reinforce the original, plain statement: "The issue is that the people in Washington won’t make it a 'votable' decision."
*By April 8, 2020, Biden was the "presumptive Democratic nominee" -- at that time, 22 states still hadn't yet held their primary elections. As such, for those 22 states it was quite literally not a votable decision
As the joke goes, "how did God create the universe in 7 days? No installed base"
Oh for... Joe Biden was literally the tiebreaker vote in the senate when the public option was still part of Obamacare and was stumping for it like crazy. MfA is one particular proposal from one particular faction of the party. We aren't talking about MfA specifically, and that's quite clear all the way upthread.
This kind of dissembling and trickery is what's driving me crazy in this thread. You just don't seem to be arguing in good faith. No, Joseph Biden Jr. is very clearly not opposed to government-provided health care, nor is any democrat in office right now that I'm aware of.
"Mostly" partisan. Good grief.
Public option is not single-payer/universal healthcare. Medicare for All is generally used as a synonym for single-payer healthcare in the US. The article stated it models the results of implementing a plan like Medicare for All
"Public option" still results in a vast bureaucracy of "paying for healthcare machinery", and so is scarcely comparable. Note: that does not mean a public option would be a bad thing. But it is not the same thing
I've already wasted way too much time on this, against my better judgement. I tried to leave twice, but third time will be the charm. Be well
Indeed you've wasted too much time on this. And I still have no idea what it is you really are trying to argue about. You agree with me on everything I've tried to pin you down on, and want to dither over tone and jargon when challenged.
There would still be the option of people and businesses to buy 3rd party "extras" like private hospital rooms, vision care etc. on top the state plan, but some level of basic health care would be provided to all people paying into the state plan.
Would that work?
Probably important to point out here that leftists are looking to see a threat to a corporation's leadership change the behavior of a corporation, whereas right-wingers are looking to see a threat to a government's leadership change everyone's behavior ("overreaching government" in a democracy being the will of voters). They're not the same thing.
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It's a n-tuple-whammy. Co-pays and deductibles discourage early diagnoses by preventing most people from visiting doctors for issues that aren't serious. The painful process of claiming the small amounts that would cover preventive care discourage people from getting it even if they've seen a doctor and been told to. Preventable conditions balloon into things that are very expensive and unpleasant. This process takes years though, and there are many, many insurance companies, plus people change jobs and coverage frequently. Odds are, the company denying preventive care won't be on the hook for the heavy costs down the road. If they are, they have ways to wriggle out of it. Also, with more people waiting until conditions get bad before seeking treatment, the whole system consumes more resources to keep people less healthy, on average, than if the system pushed preventive care effectively.
When governments assume responsibility for medical coverage, incentives start to be much less perverse. You pay taxes while you work. You work while you're healthy. So, the government wants you healthy. The government wants to do that as cheaply as possible, so they're incentivized, not just to provide preventive care, but to make sure you take advantage of it. I live in Canada. I have a genetic condition that could cause me problems if I don't get preventive care. One of my relations had those problems, so they tested her and found the problem gene. The government then tasked a genetic counsellor to seek out everyone related to her. I had the gene, so they now book me for the care I need to manage it. I don't have to pay for this. I don't have to fight insurance companies to prove I need preventive care. I just do what they ask me to do and I get to live longer. This is the kind of stuff that happens when the incentives are right.
Insurance companies need to be cut out of the loop entirely. They know they're what's wrong, so they employ expensive lobbyists. Americans need to realize this and start making it an election issue.
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EDIT: TIL that preventative and preventive are used interchangeably in the context of medicine, so I changed my very inconsistent use of them to just one.
Most of the things that are predictable and lead to long-term bad outcomes are behavioral (i.e. diet and exercise; smoking cessation; quitting drugs), and therefore both largely unaffected by medical care, and heavily confounded with socioeconomic status. Your doctor cannot make you eat better and exercise and quit smoking.
In the developed world, if you don’t die at birth or succumb to diseases of lifestyle (diabetes, heart disease, addiction) or accidents, you basically then die of cancer. The lifestyle diseases cannot be prevented by a doctor, and we have essentially no ability to prevent cancer. It’s all just acute treatment.
North Americans in particular hate to hear this, because they have an almost religious faith in doctors based on decades of bad TV. Honestly, though, doctors are pretty impotent when it comes to prevention of illness, and it is ironically this desire for treatment that is helping to balloon costs.
You've also included vaccines (which I explicitly mentioned) and "taxes" (which are not medical interventions), so you've completely missed the point.
[1] The NordICC trial found an impact of 0.03% on risk of death from colorectal cancer, which was insignificant. It did find an 18% risk reduction for getting colorectal cancer, but this didn't translate into a survival benefit.
I'm one of the 20% with the lipoprotein A gene. Mimics high cholesterol. Diet and exercise still help but that just slows the clogging.
GLP-1 drugs do seem to help people change their diet (or at least intake), even in this environment of unhealthy, hyperpalatable foods that we have created.
https://www.miamiherald.com/news/politics-government/article...
Funny thing is: if you tell the hospital that you do not have an insurance they will charge you a price that actually sounds reasonable, say $700 for a CT scan (which is still like 2x more than in my home country, but then the US is a high cost of living place), but if you do have insurance they will try to extort as much money as possible from your insurer: initial bill will be like $10k, and then they will settle for, say, $6k.
That has not been my experience. Insurance negotiates lower rates and without insurance, the full fare price suggested price has always been higher.
Also, for beyond that, unspend premiums have to be refunded, which also cuts into the potential admin spend bucket, so it's best to always ensure your paying as much as possible in claims.
Plus, patients hate denied claims, because typically your forced to sign paperwork saying your responsible for anything insurance refuses to pay.
And with most health insurance spending being locked to employer benefits, the big market is the group market, which means your stuck with either getting your job's option(s), finding a new job, or not getting insurance basically.
In other words, you don't have a price choice as an individual in a group.
Now that is some sick shit. Making every doctor's visit a gamble you might lose, discouraging people from seeing a doctor.
Alot of insurers the past few years have actually gone bankrupt from ballooning costs and claims.
So, they want costs to go up, so the next year they can up the premiums, so they can then up their admin spend, but the costs still need to below the premium. And they can't just up the premium without an associated rise in cost, because groups are owed their premium money back if it isn't paid out.
All for profit insurance must by definition bring in more than it pays out. From cars to homes to health to pets.
If instead of paying all your premiums, you'd be far more likely to be able to afford the services that the insurers are supposedly paying for. Like, yeah, there's a chance you need a new engine, and a small chance that all of your monthly car insurance totals up to less than the cost of the engine, but the entire point of the company is that they know that it is far more likely that you will end up paying more for their service than you'd have actually payed for turns out the only thing that ever went wrong was a small crack in your windshield.
Why can't they just charge higher rates to more risky people. If you are a risky driver you pay more, and if you have a risky body you should also pay more.
Well yes, but you are paying for reduced variance, which itself has a value.
And the PE firms getting in to healthcare delivery space will take up that fight too, so they can keep more of what they make.
And, there’s also a lot of people who actually believe we have a superior system because M’urica and Europe is communist or something
Reliable details are hard to come by, but some estimations are that more people in the industry are doing admin tasks than instead of providing care, admin tasks that will be reduced drastically once the industry is streamlined.
Once we get affordable care there will be less people who can... afford.
This just plainly isn't true. The US is unique in the way it doesn't have affordable public healthcare, but the rest of the western world doesn't have an affordability problem because of less bean counters scamming patients.
Feels like their job is mostly to enrich the corporations profiteering from these inefficiencies, they're doing admin fighting the sick and dying who also gained the job of admin of fighting them (a job thrown at them to - in a lot of cases - literally save their lives, financially and physically).