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Post 06 May 2017, 12:33 pm

Hey, Diemo, nice to see you back.

I'm no longer a republican, but personally, I don't know who to trust to really find out the truth about anything anymore. The ACA itself was 10,000 pages. I don't doubt the AHCA is any different. But I know that, speaking of republicans, some moderates in the Senate have expressed their concerns over it (on CBS evening news). I very much doubt it will survive the Senate as is. And that's exactly why we have a bicameral legislature.

Ricky: correct me if I'm wrong, not to get off topic, but you don't really have a national health care system do you? It's all run provincially. I've been frequenting a Canadian political message board of late and we've had some interesting exchanges of information there.
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Post 06 May 2017, 5:39 pm

Canadian health insurance is the responsibility of the Provinces and Territories. Therefor there are 13 insurance programs. However they must meet the terms of the federal Canadian Health Act in order to receive the Federal Governments funding for their programs. Where the provinces have, in the past, failed to meet all of those terms funding from the Federal Government was withheld. (The federal government contribution is less than 10% in most jurisdictions, but its still a pretty big stick.)

So there are national standards but there are differences between the various provinces.(Pharma care and dental care vary the most).

https://www.canada.ca/en/health-canada/ ... ystem.html

Hospital care is delivered by publicly funded hospitals in Canada. Most of the public hospitals, each of which are independent institutions incorporated under provincial Corporations Acts, are required by law to operate within their budget.
Most care out of hospitals is provided by private practitioners (doctors or clinics) paid a fee for their service by the Insurance program.
About 30% of health care costs are borne by private citizens. Mostly drugs, and dental services that are not provided in hospital. And of course, some services not covered by the Insurance program. (Cosmetic surgery for instance.)
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Post 06 May 2017, 6:50 pm

OK, Thanks. Very interesting.
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Post 06 May 2017, 6:57 pm

Ok...so you guys got a better health care system and are better at hockey....and curling....and your prime minister is not crackers...what else ya' got?
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Post 07 May 2017, 8:06 am

freeman3 wrote:Ok...so you guys got a better health care system and are better at hockey....and curling....and your prime minister is not crackers...what else ya' got?


A sensible policy towards immigration.
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Post 07 May 2017, 8:10 am

Freeman:
We have been the free-market experiment in providing health care--how has that gone?


That's not right. We haven't had a free market in health care since the 30's. We've had a heavily government influenced health care market complete with tax shenanigans, crazy tort laws, various mandates, regulations (including regulatory capture), patent oddities, insurance requirements, and government funding under certain circumstances. Perhaps what you mean is that we have had a health care system ridden with profit motive. In which case I agree. We have profit motive without free markets.
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Post 07 May 2017, 8:28 am

As someone who is self employed in their 50's, I do get many sides of this. On the one hand health care insurance is incredibly expensive (north of $22,000 for a mediocre policy for a healthy family of 4). If I don't get health insurance I get penalized by both the Feds and Mass. for several thousands of dollars. Insurance rates went up over 25% this year, and we have several insurance companies in this state. Many states have just 1 provider.

Meanwhile friends who are of similar age get laid off or are underemployed without company provided health insurance. People are practically forced into Medicaid under this system. It provides another reason for companies to not hire anyone over 50. Close to 50% of Mass.'s budget is for health care, much of it subsidized by the feds. If this goes away the State will have to change policies, and there will be a lot of hurt out there. Other states with less funding and less health care will have even more hurt. No one under 65 without portable health insurance will be able to move state.

At the same time, a federal government cannot have a policy of paying for all health care for all people no matter what. Layer in the profit motive throughout the system including disallowed federal negotiation, mandated coverage for services one doesn't need, crazy tort laws that require doctors to request unnecessary procedures, and advertising laws that encourage patients to request them (since they don't pay), and you have continuing exploding costs, made worse, not better, by the ACA. A national economic policy that requires the country to run up massive debts (already exceeding 80% of GDP, and rapidly growing) to cover every needed (and sometimes unneeded) medical procedure is a policy doomed to fail. The fact that the Republican plan can save $1 trillion over 10 years tells you how expensive this all is. Will their be pain -- absolutely. Will we be ruined economically if we keep this up? -- yes.
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Post 07 May 2017, 8:48 am

Well, however you want to characterize it, we are the non-single payer experiment. And whatever it is now conservatives have no real ideas to make it better, certainly not competitive with health care systems in other western countries. It seems silly not to copy a way of doing things that has been proven to work better many times in the real world. There is something really wrong in our country if we cannot choose such an obvious solution to a problem because of ideology at odds with facts and money from insurance companies and pharmaceutical companies influencing the debate. I suspect, though, that without an individual mandate insurance companies may not mind that much going to single-payer.

Obamacare has not worked that well but it changed how people looked at health care. Before, we allowed insurance companies to cherry-pick who they insured, so health care was good for those with good jobs that provided health insurance and for the really poor and old. But for those who did not qualify for Medicaid, for those who were 50-65, for those with pre-existing conditions--for 45 million Americans who went without health care coverage--the system did not work. Obamacare exposed the immorality of a wealthy country not providing adequate health care to such a large group of people and the only health care system that can do so is single-payer. Most of us will have to get rid of our inner John Galt and sacrifice a little, so that some will not be sacrificed.
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Post 07 May 2017, 10:54 am

rayjay
We haven't had a free market in health care since the 30's.

Health care has never been a commodity that was subject to market conditions. ever. Anywhere.
People don't shop for the best price when they get appendicitis.

When the customers can't effectively respond to price conditions by either finding a competitive price or delaying purchase of the product or service .... then they are without power.
When the consumer of the product is almost powerless there is no free market.
Its really no different then recognizing that distribution of electricity needs to be a regulated monopoly because of the realities of the need and the method of supply.
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Post 07 May 2017, 11:03 am

freeman3
Ok...so you guys got a better health care system and are better at hockey....and curling....and your prime minister is not crackers...what else ya' got?

I kind of like the supply management approach to agriculture... Gets rid of the boom and bust that seems to happen in uncontrolled markets, meaning family farms have been maintained versus corporate farming...
But there's plenty to be embarrassed about too.
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Post 07 May 2017, 12:08 pm

freeman3 wrote:Well, however you want to characterize it, we are the non-single payer experiment. And whatever it is now conservatives have no real ideas to make it better, certainly not competitive with health care systems in other western countries.


Of course, that is hardly a fair assessment. Republicans are not starting from scratch. You can't have a "free-market" and mandate the coverage of "prior conditions" and "children up to the age of 26."

Covering existing conditions, while noble and good and all of that, are not "insurance." They hopelessly distort the insurance market.

It seems silly not to copy a way of doing things that has been proven to work better many times in the real world. There is something really wrong in our country if we cannot choose such an obvious solution to a problem because of ideology at odds with facts and money from insurance companies and pharmaceutical companies influencing the debate.


There is one other reason. Many people are satisfied with what they have. Socialized medicine will be a major step down for most people with healthcare insurance now. Sorry, but that's just true--more red tape, less options, less freedom.

For some, it will be great. But, that won't be the case for most.

I suspect, though, that without an individual mandate insurance companies may not mind that much going to single-payer.


Only if they're idiots. "Single-payer" will eventually evolve into "government-provided" as there will be no reason for insurance companies to exist.

Obamacare has not worked that well but it changed how people looked at health care. Before, we allowed insurance companies to cherry-pick who they insured, so health care was good for those with good jobs that provided health insurance and for the really poor and old. But for those who did not qualify for Medicaid, for those who were 50-65, for those with pre-existing conditions--for 45 million Americans who went without health care coverage--the system did not work. Obamacare exposed the immorality of a wealthy country not providing adequate health care to such a large group of people and the only health care system that can do so is single-payer. Most of us will have to get rid of our inner John Galt and sacrifice a little, so that some will not be sacrificed.


So many things wrong here. I'll stick with one: "sacrifice a little" is not correct. Many people are paying many thousands more a year than they used to before the ACA. That's not "a little."
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Post 08 May 2017, 6:18 am

fate
Socialized medicine will be a major step down for most people with healthcare insurance now. Sorry, but that's just true--more red tape, less options, less freedom.


You offer no evidence for this. Because, in fact, the opposite is true. (If indeed you have evidence please offer it..)
Doctors in private practice in the US struggle to get paid from insurance companies.
Patients of insurance companies struggle to get bills paid.
“U.S. doctors spend almost an hour on average each day, and $83,000 a year … with the paperwork of insurance companies.” And for every call coming from a doctor’s office or hospital to an insurance company, there is someone at that insurance company on the other end of the line to process the call.
In 2012, more than 460,000 people were working in the health insurance industry, and employment growth in health insurance is much higher than for the providers of actual health care. Of course, managing all these people is expensive—very expensive. In 2011, the CEO of Blue Shield of California made $4.6 million and the organization’s top 10 executives earned $14 million in total, although of course none of them did any medical research or delivered any care to real patients. The Affordable Care Act mandated that health insurers had to spend at least 80% of their collected premiums on medical care. The very inclusion of that provision implies that at least some health insurers had overhead rates in excess of 20%. All of this seems expensive and wasteful, and it is
.
http://fortune.com/2014/10/20/health-insurance-future/


Hospitals in the US have 10 times the employees in administration that are in Canadian hospitals because of the complexities of dealing with many insurance companies with many complex insurance plans.
If a Canadian or a French man goes to a hospital they are asked for the health card and after having given such they stop worrying about costs and payments. (Except for the parking or renting a television set. .)
The cost to parents having a baby in Canada or France? $0.
In the US the cost to parents depends on which insurance plan one has, its co-payments, coverage riders, which hospital, etc....
When you add insurance costs to taxes paid, Americans with decent health insurance invariably pay a greater percentage of their income for the two combined than most countries with universal coverage.

Fate
You can't have a "free-market" and mandate the coverage of "prior conditions" and "children up to the age of 26."

So you have to allow hospitals and doctors and insurance companies the freedom to turn down any customer, or charge any fee they require to be profitable ? So to have a free market, people who are too sick and poor must be left to die?
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Post 08 May 2017, 6:58 am

We spend far more on health care than other advanced western countries, we don't live as long, and we have more chronic disease. http://www.commonwealthfund.org/publica ... erspective

I don't know how you are going to do it but you need to show that this additional health care spending is doing something beneficial for the majority. Yes it would be selfish and sort of Darwinian for the majority to not want to change the system that costs so much because it confers a marginal advantage (albeit at the expense of those not covered), but you haven't even shown that. What does freedom and options matter here given the stakes involved? Are we getting better results or not? When people turn 65 here they somehow seem quite willing to forego options and freedom and seem willing to adapt to Medicare.

Twice as much spending for worse outcomes. Such a deal...
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Post 08 May 2017, 9:19 am

Ricky is making good arguments, but he uses terms so poorly and makes so many unsupported statements, that I feel a need to respond. Ricky:
rayjay
We haven't had a free market in health care since the 30's.

Health care has never been a commodity that was subject to market conditions. ever.


Who said anything about it being a commodity? There are lots of non-commodities that are subject to market conditions.

What's your source for health care never being subject to market conditions?


Ricky:
People don't shop for the best price when they get appendicitis.


What percentage of health care spending is for emergency medicine?

Ricky:
When the customers can't effectively respond to price conditions by either finding a competitive price or delaying purchase of the product or service .... then they are without power.


Why can't there be competition in health care? There are many doctors, hospitals, pharmaceuticals, etc. to choose from. We have competition in food and we often cannot delay that purchase.

Ricky:
Its really no different then recognizing that distribution of electricity needs to be a regulated monopoly because of the realities of the need and the method of supply.


Are you saying that the method of electricity supply and health care supply are similar? Electricity was (and largely is) provided by centralized power plants and piped into your home. What does that supply have to do with health care? Electricity is a commodity. Are you now arguing that health care is too? Oh good grief.

Also, are you now arguing that health care should be a regulated monopoly? Who should own the 18% of the US economy that provides health care?
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Post 08 May 2017, 9:47 am

rickyp wrote:fate
Socialized medicine will be a major step down for most people with healthcare insurance now. Sorry, but that's just true--more red tape, less options, less freedom.


You offer no evidence for this. Because, in fact, the opposite is true. (If indeed you have evidence please offer it..)
Doctors in private practice in the US struggle to get paid from insurance companies.
Patients of insurance companies struggle to get bills paid.


Thank you for refuting an argument I DID NOT MAKE. What I actually said, with emphasis to help the reading impaired.

Socialized medicine will be a major step down for most people with healthcare insurance now. Sorry, but that's just true--more red tape, less options, less freedom


So, if we scrap employer-provided healthcare and substitute Medicare, most people who lose their employer-provided plan will have a less satisfactory situation.

You want "proof?" Funny, you never provide it. Your "proof" has precious little to do with patient satisfaction.

Meanwhile, how about the joys of government healthcare?

http://freebeacon.com/issues/oig-report ... ngeles-va/

More than 100 veterans died while waiting for care at a Veterans Affairs hospital in Los Angeles, Calif., over a nine-month span ending in August 2015, according to a new government report.

The VA Office of Inspector General found in a recent healthcare inspection that 225 veterans at the VA Greater Los Angeles Healthcare System facility died with open or pending consults between Oct. 1, 2015 and Aug. 9, 2015. Nearly half—117—of those patients died while experiencing delays in receiving care.

The inspector general reported that 43 percent of the 371 consults scheduled for patients who ended up dying were not timely because of a failure by VA employees to follow proper procedure. The report was unable to substantiate claims that patients died as a result of the delayed consults.

Concerned Veterans for America, a D.C.-based nonprofit, cited the OIG findings as evidence that problems persist at the Department of Veterans Affairs despite a series of legislative reforms implemented after the 2014 wait time scandal in Phoenix, Ariz.


Oh, and even Canada is imperfect!

https://www.usnews.com/news/best-countr ... ealth-care

TORONTO — When Sharon Shamblaw was diagnosed last summer with a form of blood cancer that could only be treated with a particular stem cell transplant, the search for a donor began. A Toronto hospital, 100 miles east of her home in St. Mary's, Ontario, and one of three facilities in the province that could provide the life-saving treatment, had an eight-month waiting list for transplants.

Four months after her diagnosis, Shamblaw headed to Buffalo, New York, for treatment. But it was too late. She died at the age of 46, leaving behind a husband and three children, as detailed by the Toronto Star.



Fate
You can't have a "free-market" and mandate the coverage of "prior conditions" and "children up to the age of 26."

So you have to allow hospitals and doctors and insurance companies the freedom to turn down any customer, or charge any fee they require to be profitable ? So to have a free market, people who are too sick and poor must be left to die?


Nice strawman! Image

I didn't say any of that. I simply noted that you can't have a "free market" with those rather major stipulations.