2017

PeterZ wrote:The rest of the world may get it about socialized medicine. What they don't get is just how massively corrupting control over government expenditures are because of its massive size. Now you propose to massively increase the amount those corrupt a$$hats play with? Are you INSANE?

Are you?

No, seriously, are you insane? Because none of that rant of yours is in any way supported by the experience those of us fortunate enough to live in countries with proper public health have had. Furthermore, while you are ranting about how evil governments are, you are a) hoping for governments to step in when a health service provider steps over the line and b) not addressing any of the very basic points gcomeau made about the economical incentives of commercial enterprises not being aligned with the incentives a health service provider needs to operate under.

noblehunter wrote:

PeterZ wrote:Yes, we get it.
Socialized medicine places MORE actors between a patient and service provider. Each layer of actor is motivated by incentives that are different than service providers and patients. Worse, those layers will be highly politicized. Politicized means subject to bribes.....er....lobbyists' donations. Those lobbyists will structure the system with inefficiencies that will benefit them.

In Ontario, if the care is covered under the provincial plan, the only person between me and my health care providers is the secretary. Do private doctors do their own scheduling in the US?

Not to mention politicians and bureaucrats have a strong preference to providing proper health care since denying coverage or excessive CYA testing are both recipes for PR troubles.

Really? Do you pay for the doctor visit? No? Who does?
If the doctor prescribes a treatment, does whoever pays your doctor get a chance to reject treatment if deemed unnecessary?

If you participate in socialized medicine, then your government DOES get between you and the services your docotr may prescibe to you. Glad you guys are a small enough nation to allow your socialized health system to be responsive.

PeterZ wrote:

noblehunter wrote:In Ontario, if the care is covered under the provincial plan, the only person between me and my health care providers is the secretary. Do private doctors do their own scheduling in the US?

Not to mention politicians and bureaucrats have a strong preference to providing proper health care since denying coverage or excessive CYA testing are both recipes for PR troubles.

Really? Do you pay for the doctor visit? No? Who does?
If the doctor prescribes a treatment, does whoever pays your doctor get a chance to reject treatment if deemed unnecessary?

I'm assuming he pays taxes, so yeah, he pays for it.

And a hell of a lot less than you have to pay for it in the incredibly inefficient US system that throws all your money away on private sector waste.

(And yes, when it comes to health insurance the private sector is ABSURDLY more wasteful than the public sector)

If you participate in socialized medicine, then your government DOES get between you and the services your docotr may prescibe to you. Glad you guys are a small enough nation to allow your socialized health system to be responsive.

Umm, no. No they do not. Not beyond the basic regulatory oversight it applies to any industry at least, same as in the U.S.

It's just that in the US you then have many added layers of bureaucratic interference from the insurance companies that are far more burdensome than the government regulation is. I've lived multiple decades in the US and Canada. There is NO comparison here. None. The US system is a trainwreck.

Daryl wrote:The alt right approach to providing services to citizens misses the whole point that governments are not businesses. They should be there to protect and support all regardless of individual situations. Businesses quite properly produce goods and services, sell them, make a profit, then pay tax (unless they are Apple, Amazon, IKEA & co), the government then should distribute that tax sensibly.

Exactly.

The purpose of a business is to make money and they need to provide goods/services to do that. The purpose of a government is to provide services (defense, etc) and they need to take in money to do that. Someone who is used to the business "profit above all" perspective might not be good at dealing with what they provide being the more important piece.

PeterZ wrote:

gcomeau wrote:Etc... etc... etc...

And now here is the Econ 101 explanation of why everything you said *does not apply to health insurance*.

Let's take a look at that profit motive of which you speak in any regular marketplace for a good or service. Let's say I'm selling apples...

Do I want as a customer:

A: A person who needs truckloads of apples for their cider business.

B: Some guy who is allergic to apples.

???

Where is the profit motive going to push me to direct my apple supplying efforts? To the person who ACTUALLY NEEDS my product? Or the person who doesn't need it at all?


Now let's say I'm selling health insurance.

Do I want as a customer:

A: The patient with a really nasty brain tumor.

B: The healthy 20 year old with a low risk lifestyle.

???

Where is the profit motive going to push me to direct my health insurance supplying efforts? To the person who ACTUALLY NEEDS my product? Or the person who doesn't need it at all?



In case you haven't caught on yet, that profit motive drives efficient provision of goods and services to where they are needed in society in most markets. It drives them AWAY from where they are needed in society in a health insurance market.


Every developped nation on earth gets this, because it's really freaking obvious... to everyone except about half of America.

Yes, we get it.

Then why did "we" not address a single point I wrote?

Didn't even so much as mention the content of my post in anything you replied with, just changed the subject to make more totally baseless claims about how public sector insurance works.

The solution is to reduce the actors between the service providers and the patients as was the case prior to the 1980's.

You know how you do that? By CUTTING OUT THE INSURANCE COMPANIES.

Socialized medicine places MORE actors between a patient and service provider.

Spoken like someone who has never once encountered a socialized health insurance system.

I lived my entire young life in Canada. Many doctor visits. Know how many times I ever had to interact with anyone besides my doctor and the receptionist? Directly OR indirectly?

Zero.

Know how often I have to constantly be checking with some freaking insurance company bean counter every damn time I need anything done in the US.... either myself or by waiting around while the doctor's office goes back and forth with them trying to figure out what will and will not be covered and what my out of pocket portion is and blah blah blah blah? All the while wasting time and money that ultimately ends up coming out of MY pocket?

EVERY FREAKING TIME I NEED ANYTHING DONE.

How do you not understand this? Seriously?

I saw someone put it like this once, they were comparing the billing departments of two similarly sized major hospitals, one in the US and one in Canada.

The hospital in the US had it's own multi story building that had nothing in it but people dealing with insurance paperwork and billing and talking to insurance companies day in and day out figuring out what every individual plan did and didn't cover about any given procedure the hospital had performed and fighting with them over this procedure and this prescription and on and on and on and one... a giant black hole of bureaucratic waste the money of the patients of that hospital was disappearing into that exists only because the US is under the bizarre impression that the private sector is better at everything when it is only better at some things.

The hospital in Canada... of the same size, that saw the same number of patients and did the same number of procedures... had a one room office with 3 people on staff. Because that is ALL THEY NEEDED.

I agree. Cut out the insurance companies. I get it. Most of us against socialized medicine get it too.

I don't agree that replacing it with government will improve the situation.

I believe direct payments work best. That addresses all your points to my way of thinking.

If we have to have some player between the doctor and patient I believe a private sector entity is best. That way government can act to ensure compliance with the law.

Want to offer assistance? Give the assistance directly to the patient. Let him/her use it to pay the provider. I am ok with that assistance coming from government. I am just NOT ok with government running healthcare because they would be worse than insurance companies.

Those that don't recognize the qualitative difference between the size of the US bureaucracy and that of the other countries in the world should really consider it. The sheer volume of cash flows our government copntrols distorts any comparison with what works in your countries. The massive corruption this size generates will distort any system the government runs into a shambling, inefficient mess.

PeterZ wrote:I agree. Cut out the insurance companies. I get it. Most of us against socialized medicine get it too.

I don't agree that replacing it with government will improve the situation.

So you don't agree with the objective empiracal data that contradicts that statement from basically the entire rest of the world.

You offer no justification for rejecting that data except that you don't believe it based on ideological grounds. You don't think it SHOULD work if your economic ideology is correct, so the fact that is DOES work and contradicts those economic beliefs is just filtered out of your brain somehow.

I believe direct payments work best. That addresses all your points to my way of thinking.

If we have to have some player between the doctor and patient I believe a private sector entity is best.

You JUST SAID you agreed that cutting out the insurance companies was best.

Do you know what you call a private sector entity between you and your doctor in the payment structure? An insurance company.

Want to offer assistance? Give the assistance directly to the patient. Let him/her use it to pay the provider.I am ok with that assistance coming from government. I am just NOT ok with government running healthcare because they would be worse than insurance companies.

You do understand that in socialized health insurance nations the system works EXACTLY LIKE YOU JUST SAID YOU ARE OK WITH?

In Canada the government manages the insurance structure. Extremely efficiently because the entire system is so simplified by being a single payer entity.

The doctors, hospitals, etc.... are private sector businesses or non profits. They just bill the government insurance plan for procedures. And they always know they aren't going to have to spend half their time arguing with them about whether anything is covered or not because EVERYONE knows what is covered up front except in some possible very rare edge cases.

So basically, you just said you want single payer. Congratulations, welcome to the socialized health insurance team.

PeterZ wrote:I believe direct payments work best. That addresses all your points to my way of thinking.

Except the point where medical infrastructure is incredibly costly to maintain. The cost of any given procedure, even under socialized care, is likely to exceed the amount of money people are actually able to save and put on layaway, so introducing an insurance scheme where a large pool of people not requiring procedures subsidizes a small pool of people who do makes sense, since such pools keep individual costs down to a manageable level.

Of course, such an insurance can't be run on a profit-oriented basis, which means that turning it into a state-run or state-owned institution makes a lot of sense (since states don't care about profitability, by design).

But that's something you can't handle, isn't it? After all, it means that healthy you is paying for sick people to get better, and since you're never going to get sick or injured, that's just money you're throwing away.

If we have to have some player between the doctor and patient I believe a private sector entity is best. That way government can act to ensure compliance with the law.

Coming from someone who is always crying about there being too many rules and regulations and that government is too large, this is hilarious.

Tell me, how do you run a private sector entity in a way that benefits patients, not shareholders? How do you ensure that it stays that way over generations?

Want to offer assistance? Give the assistance directly to the patient. Let him/her use it to pay the provider. I am ok with that assistance coming from government. I am just NOT ok with government running healthcare because they would be worse than insurance companies.

There's a bunch of ways to make this work, but the key ingredient here is that health care providers must not be run on for-profit lines. Which a private entity invariably will be.

Those that don't recognize the qualitative difference between the size of the US bureaucracy and that of the other countries in the world should really consider it. The sheer volume of cash flows our government copntrols distorts any comparison with what works in your countries. The massive corruption this size generates will distort any system the government runs into a shambling, inefficient mess.

That you choose to put kleptocrats into office because they agree with you that government is too large and too inefficient who then proceed to make government larger and more inefficient is an interesting dynamic that you, unfortunately, are too ideologically blinded to perceive.

No, not what I think should work, but has worked before and will again.

Yes, cutting out insurance companies without replacing it with government is best. Cutting out insurance companies and replacing it with government is worse. Having government to offset insurance companies is better than having nothing to offset total government control.

Back to the size of the US government and what adding socialized healthcare means for it.

The US GDP is 18.04 trillion (2015), Canada is $1.55TR and Australia is $1.34TR. We spend about $3.0TR in the US in healthcare. 2015 government outlays are $3.68TR. Socialized medicine will add approximately $3.0TR to those outlays. Government outlays of $6.68TR-$7.0TR will result in a feeding frenzy of lobbyists and special interest groups seeking a share of that windfall.

In context Australia's and Canada's TOTAL GDPs are between 20%-22% of that expanded US government outlays. Not US GDP, but government expenditures. Our corruption is bad enough now, adding to the available pool for the pols to play with is a bad idea.

PeterZ wrote:No, not what I think should work, but has worked before and will again.

Ahem.

It has *never* worked. Ever.

Yes, cutting out insurance companies without replacing it with government is best.

So, just have everyone be UNinsured.

You get how that would cause a lot of people some rather serious problems right?

Back to the size of the US government and what adding socialized healthcare means for it.

The US GDP is 18.04 trillion (2015), Canada is $1.55TR and Australia is $1.34TR. We spend about $3.0TR in the US in healthcare.

Speaking in terms of absolute dollar numbers is meaningless as a comparison between nations. Which I'm pretty sure you know.

THIS is the comparison that matters:

https://pbs.twimg.com/media/DP5_t7KU8AAnbjZ.jpg

THAT is what trying to make the private sector handle the bulk of the health insurance load in the US gets you.

THAT.