Election 2020

[Sour Masher]

Lol, we’ll see.
You going to find jobs for the 500,000 private health insurance workers you just put out of business?

Job displacement is not a reason to keep an industry that is inefficient and an overall negative for society. If we thought that way, we'd still have blockbuster videos everywhere, pinsetters in our bowling allies, lectors in our factories, human computers, milkmen, switchboard operators, and lamplighters. Times change, society evolve. Ideally a society making such a radical change would consider ideas to help such a large number of people transition to new work, but it shouldn't keep society from making that transition.

[nots]

Job displacement is not a reason to keep an industry that is inefficient and an overall negative for society. If we thought that way, we'd still have blockbuster videos everywhere, pinsetters in our bowling allies, lectors in our factories, human computers, milkmen, switchboard operators, and lamplighters. Times change, society evolve. Ideally a society making such a radical change would consider ideas to help such a large number of people transition to new work, but it shouldn't keep society from making that transition.

Is it your contention that the federal government is efficient because I have several data points that indicate otherwise.

[Sour Masher]

Is it your contention that the federal government is efficient because I have several data points that indicate otherwise.

As I've said before, in my experience, there are factors not always accounted for in the data you have previously cited that are in favor of single payer from an efficiency standpoint. And there are many other benefits of single payer besides the efficiency such a system could have over our current set up.

I know you don't hold the government in high esteem in terms of efficiency, and I don't blame you. This is the one issue where I'm in favor of socialization, for a variety of reasons. Other things on the democratic socialist agenda, not so much. But I believe healthcare is a basic human right a wealthy society like ours should provide, I believe there are ample precedents that show it can work while also being more cost efficient, and I believe, on the whole, it will make for a better America. If done right, long term, it is overwhelmingly a net positive. Of course, the done right caveat is huge, and we'd have to ensure our politicians implement it correctly. I know you are skeptical that can happen, but that attitude would have left us without medicare and SS. Not sure your stance on those things, but I think they are positives.

[Sour Masher]

nots and others who are wary of universal medicare, would you be cool with a system that ensured every child under 18 in addition to senior citizens had medicare? Right now some states, like Florida, provide health care to children, but not all do. Federal expansion of coverage currently offered through Medicaid and CHIP may be a middle ground on universal coverage and concerns over the costs of it.

[gcstomp]

"You going to find jobs for the 500,000 private health insurance workers you just put out of business"

this cannot be the argument for keeping our byzantine machine that separates our population from affordable health care. again, why does our country pay more than other countries per capita in health care , when other developed countries have universal health care, but ours has millions of people without coverage. it is the thick layer of admin, healthcare coders, private insurance workers, a network of people designed to make money trail lining pockets of too many people unrelated to anything to do with your actual care. CEOs in some of the largest insurance companies -- Cigna, Humana, Health Systems, Aetna and Wellpoint, they need to earn 30 mill a year?

this system profits so many, i cannot see it replaced with one that has as its aim a population wide better health rather than profit in every dark pocket. so you are in luck, this system is probably with us for at least a couple more cycles of presidents.

[nots]

As I've said before, in my experience, there are factors not always accounted for in the data you have previously cited that are in favor of single payer from an efficiency standpoint. And there are many other benefits of single payer besides the efficiency such a system could have over our current set up.

I know you don't hold the government in high esteem in terms of efficiency, and I don't blame you. This is the one issue where I'm in favor of socialization, for a variety of reasons. Other things on the democratic socialist agenda, not so much. But I believe healthcare is a basic human right a wealthy society like ours should provide, I believe there are ample precedents that show it can work while also being more cost efficient, and I believe, on the whole, it will make for a better America. If done right, long term, it is overwhelmingly a net positive. Of course, the done right caveat is huge, and we'd have to ensure our politicians implement it correctly. I know you are skeptical that can happen, but that attitude would have left us without medicare and SS. Not sure your stance on those things, but I think they are positives.

Medicare works because private insurance pays more than the cost of the services they use. Medicare pays less. When you remove the private insurance, hospitals are going to close because they are going to lose money.

[nots]

"You going to find jobs for the 500,000 private health insurance workers you just put out of business"

this cannot be the argument for keeping our byzantine machine that separates our population from affordable health care. again, why does our country pay more than other countries per capita in health care , when other developed countries have universal health care, but ours has millions of people without coverage. it is the thick layer of admin, healthcare coders, private insurance workers, a network of people designed to make money trail lining pockets of too many people unrelated to anything to do with your actual care.

this system profits so many, i cannot see it replaced with one that has as its aim a population wide better health rather than profit in every dark pocket. so you are in luck, this system is probably with us for at least a couple more cycles of presidents.

It’s not THE argument, but it is certainly something that needs to be addressed if you are one of those 500,000 people. But yes, there are many, many more reasons why Medicare for all is a pipe dream, starting with the cost. Tell me how you are going to pay for it.

[Sour Masher]

"You going to find jobs for the 500,000 private health insurance workers you just put out of business"

this cannot be the argument for keeping our byzantine machine that separates our population from affordable health care. again, why does our country pay more than other countries per capita in health care , when other developed countries have universal health care, but ours has millions of people without coverage. it is the thick layer of admin, healthcare coders, private insurance workers, a network of people designed to make money trail lining pockets of too many people unrelated to anything to do with your actual care.

this system profits so many, i cannot see it replaced with one that has as its aim a population wide better health rather than profit in every dark pocket. so you are in luck, this system is probably with us for at least a couple more cycles of presidents.

This is clearly the case. I'm not touting the efficiency of the federal government, but it is almost impossible for them to be less efficient and more wasteful than our current set up. As you indicate, this is supported by our average health care costs as compared to countries with universal healthcare. It is also just logical and more humane.

[Sour Masher]

Medicare works because private insurance pays more than the cost of the services they use. Medicare pays less. When you remove the private insurance, hospitals are going to close because they are going to lose money.

As I addressed before, I believe those numbers are not entirely accurate, because they do not take into account reduced admin costs associated with single-payer done right. In my experience, hospitals would do just fine under medicare for all. The ones who would lose the most in such a system, at least if it is merely an expansion of what we currently do, would be high end specialists, and exceptional doctors in specialist fields that currently garner, and honestly probably deserve, higher rates of pay for their work than doctors who do easier surgeries. Even then, all doctors, including specialists, would still make exceptional pay. And this issue could be worked around by making doctor pay more complex and nuanced than medicare payments currently are.

ETA: Even allowing for the numbers are cite being completely accurate and accounting for everything (which I do not think they are), it is inaccurate to suggest those differences in pay are equal across all patients and all aspects of health costs. The area experiencing a great portion of that difference is, as I indicate above, highly paid specialists that make less with a standard pay rate per hour in surgery than they do in a free market system.

[nots]

As I addressed before, I believe those numbers are not entirely accurate, because they do not take into account reduced admin costs associated with single-payer done right. In my experience, hospitals would do just fine under medicare for all. The ones who would lose the most in such a system, at least if it is merely an expansion of what we currently do, would be high end specialists, and exceptional doctors in specialist fields that currently garner, and honestly probably deserve, higher rates of pay for their work than doctors who do easier surgeries. Even then, all doctors, including specialists, would still make exceptional pay. And this issue could be worked around by making doctor pay more complex and nuanced than medicare payments currently are.

ETA: Even allowing for the numbers are cite being completely accurate and accounting for everything (which I do not think they are), it is inaccurate to suggest those differences in pay are equal across all patients and all aspects of health costs. The area experiencing a great portion of that difference is, as I indicate above, highly paid specialists that make less with a standard pay rate per hour in surgery than they do in a free market system.

Putting aside your personal experience vs actual data, the federal government has never been shown to ‘reduce administrative costs’ in anything before. Even granting that they somehow would catch lightning in a bottle in this instance, how are you paying for it? I have seen numbers as high as 3.2T/yr. Let’s cut that in half due to hyperbole and call it 1.5T? Where is that coming from? Are you paying a doctor the same for an office visit in Manhattan as in Manhattan, KS? Is a hip replacement at the Cleveland Clinic the same as one in Pippa Passas, Ky?

[Sour Masher]

Putting aside your personal experience vs actual data, the federal government has never been shown to ‘reduce administrative costs’ in anything before. Even granting that they somehow would catch lightning in a bottle in this instance, how are you paying for it? I have seen numbers as high as 3.2T/yr. Let’s cut that in half due to hyperbole and call it 1.5T? Where is that coming from? Are you paying a doctor the same for an office visit in Manhattan as in Manhattan, KS? Is a hip replacement at the Cleveland Clinic the same as one in Pippa Passas, Ky?

These are all good questions, and highlight some of the current issues with payment that comes up in the data you have cited (not sure why you would allow for the fact that data may not account for admin costs, though, especially since the links you provide don't show that they do). But these are questions of how best to implement a single payer system, not questions about whether we should or not. I agree that to do it, we'd have to also agree on how best to pay for it, and how best to implement it. I've already suggested how I'd pay for it--cut military spending in half at least, and tax religions. I'd also make weed legal and tax it at the federal level. I'd favor other sin taxes on stuff that make America unhealthy to begin with. I know you would balk at that, and may even bring up how sin taxes are regressive, but I'm okay with charging poor people more for cigs and soda if it also gives everyone health care.

At the very least, I thought we'd agree on expanding universal coverage from old people to also include children.

ETA: I am glad we are getting into more specific examples of the differing payments between medicare and private insurance. You getting into differing costs in different areas is a big part of it, as is, as i indicated, differing costs for highly paid specialists. In many areas, and for most hospitals and many doctors, medicare doesn't pay less. But for some areas and doctors, it certainly does, and that should be addressed.

[baldgriff]

But I believe healthcare is a basic human right a wealthy society like ours should provide,

Here is where you lose me.... any skill or talent learned by another person to aid you is not something that you automatically have a right to. You pay people across a variety of industries and skill sets money for their expertise and experience. Why should this be any different because one person is a doctor vs. financial planner, mechanic, plumber or anyone else?

So this basic human right didnt exist during the dark ages because they didnt have doctors, but now it does because people spent their time and effort learning how to heal and cure illness and disease? Im just not so sure about that.

[Sour Masher]

Here is where you lose me.... any skill or talent learned by another person to aid you is not something that you automatically have a right to. You pay people across a variety of industries and skill sets money for their expertise and experience. Why should this be any different because one person is a doctor vs. financial planner, mechanic, plumber or anyone else?

So this basic human right didnt exist during the dark ages because they didnt have doctors, but now it does because people spent their time and effort learning how to heal and cure illness and disease? Im just not so sure about that.

Do you not think law enforcement or military or firefighters as having skills and talent learned by another person to aid you? We as a society all agree that is part of the basic package we pay for so that all society has access to those things. By your logic, we should go back to private police forces and fire stations that only serve those who can afford to pay them, and maybe privatize the military as well?

[nots]

These are all good questions, and highlight some of the current issues with payment that comes up in the data you have cited (not sure why you would allow for the fact that data may not account for admin costs, though, especially since the links you provide don't show that they do). But these are questions of how best to implement a single payer system, not questions about whether we should or not. I agree that to do it, we'd have to also agree on how best to pay for it, and how best to implement it. I've already suggested how I'd pay for it--cut military spending in half at least, and tax religions. I'd also make weed legal and tax it at the federal level. I'd favor other sin taxes on stuff that make America unhealthy to begin with. I know you would balk at that, and may even bring up how sin taxes are regressive, but I'm okay with charging poor people more for cigs and soda if it also gives everyone health care.

At the very least, I thought we'd agree on expanding universal coverage from old people to also include children.

ETA: I am glad we are getting into more specific examples of the differing payments between medicare and private insurance. You getting into differing costs in different areas is a big part of it, as is, as i indicated, differing costs for highly paid specialists. In many areas, and for most hospitals and many doctors, medicare doesn't pay less. But for some areas and doctors, it certainly does, and that should be addressed.

Taxing religions has been shot down by the SC twice, so I don’t think that’s a practical solution—certainly not one I have heard from anyone running for office on a Medicare for all platform. There are a lot of SC decisions I disagree with, but I find it’s useless to propose things that have already deemed to be unconstitutional. If you want this to happen, you’ll need to come up with something practical.

[baldgriff]

I'd favor other sin taxes on stuff that make America unhealthy to begin with. I know you would balk at that, and may even bring up how sin taxes are regressive, but I'm okay with charging poor people more for cigs and soda if it also gives everyone health care. .

Oh so as long as the "regressive tax" works to your advantage its ok. At least Im consistent about my thoughts on taxes. Why charge the sin tax - instead of collecting it upfront to pay for the medical insurance expense? Or is it just more comfortable to think that "well they use it, they should pay it". Lets be honest here poor people are statistically more likely to smoke and drink than the rich ones.