OT: Best Discussion yet on Obamacare IMO: Nixon

[ocrenter]

[quote=Jazzman]Good find CAR, ditto OCR. Here’s my take on the email:

Socialized (whatever that is supposed to mean) healthcare is not without its problems. I too lived under one for many years. They are a constant political bone of contention.

Obamacare is possibly not working as well as it could, because it’s a half-baked compromise that came about as a result of the usual legislative political deal-making.

I was very happy to see costs have been mentioned as “one of the biggest problems.” They are, I believe, the main problem.

I can confirm the exchanges are poorly represented by insurers here in Hawaii. But there are very few insurers anyway. Healthcare cover, however, is already mandated for employers for every employee.

Very interesting cost statistic regarding the last year of one’s life. I have a health care directive. It says. “If you find me injured and bleeding, kick me perfunctorily (hard) in the head. If you call an ambulance, don’t forget to leave your address so I can forward you the bill.”[/quote]

excellent point about Obamacare being the half baked compromise that it is. That’s why the future is so bleak. Obama had full control of congress and he was only able to pass a 15 year old Republican idea, with zero Republican support.

btw, not counting surgeries, over 90% of the hospital inpatient service at any given time is devoted to the 80+ population. lot’s of them frequent bounce backs.

[livinincali]

Obamacare is certainly the worst of all possible solutions. Doing nothing would likely have been better although those with pre-existing conditions do see a benefit under Obamacare. Obamacare is a throw more money at it solution to a problem that is being caused by exponentially growth in costs. Just removing some of the anti-competitive laws, like re-importation of drugs and opening up the licensing of more diagnostic testing centers (i.e. why does it cost so much more to have an MRI today than it did when the machine was invented, even though the technology is the same) would reduce costs more so than the ACA.

Let’s just say we do go with single payer and we limit costs to 10% of GDP which seems to be around many of the other socialized medicine country. So we decide we’re going to spend 1.5 trillion on health care. So then we need to decide what we’re going to tax to pay for that 1.5 trillion. Let’s say we use income tax to fund 2/3 of that 1.5 trillion or 1 trillion dollars. We’ll get the other 500 billion from corporate taxes, co-pays, and maybe some kind of wealth tax. What would that mean for your paycheck. Well there’s about 8 trillion dollars in income that subject to tax each year. So that would mean 1/8 = 12.5% tax rate to your paycheck to pay for single payer health care. That’ about 10% more than you’re currently paying for medicare/medicaid. You really think big corporation providing health care are going to bump your salary up the amount they used to contribute for health care or do you think they’ll keep most of that to pad their profits?

[Jazzman]

^^^The calculations and comparisons are going to difficult, but the money to pay for health care still has to come from the same place, whether it’s taxes or insurance premiums, so I don’t see how costs per capita increase under a universal system.

[CA renter]

[quote=Jazzman]^^^The calculations and comparisons are going to difficult, but the money to pay for health care still has to come from the same place, whether it’s taxes or insurance premiums, so I don’t see how costs per capita increase under a universal system.[/quote]

Exactly. We are **already** paying for the most expensive healthcare. If we go to a single-payer system, costs (whether paid via taxes or premiums) will likely go down, not up.

Again, we **already** pay for the most expensive patients in this country. The most expensive patients are covered by Medicare and Medicaid, while the most profitable are left to the private market — the privatization of profits, and the socialization of losses. The cost per capita in a “Medicare for all” scenario would go down drastically, relative to what we spend now, if we could incorporate the younger, healthier patients. We would probably be in line with other developed nations, if not better.

As I’ve said before many times, it doesn’t matter if your money is going to a public agency or a private agency, what matters is the value you get for the money. Studies have shown that, contrary to popular belief, public agencies tend to give more value for the money.

[joec]

The more I read about this stuff, the more I think we need some form of single payer/universal health care. The situation with Singapore and Sweden probably won’t work in the US due to a much larger population, probably less educated people to begin with and less overall healthy people. That said, I think a gov/public solution is the only thing which could help contain the costs as it’s been mentioned now already, the system we have now is crap. We pay the most for our health care and get the crappiest service.

This reminds me of that article in the UT about CA where we pay the most for education/tax/etc, but have the worst schools pretty much in all the US. It’s probably more complicated then that, but we certainly aren’t getting our money’s worth in health care now. If health care wasn’t something we had to have to protect against bankruptcy, most of us would just dump it.

I don’t know if the costs would actually be 12% of someone’s salary, but it seems like if EVERYONE working was forced to pay into the system, companies would be more than happy to just dump all their health care plans (they pay a TON) already and just find a percentage where it’s sustainable and still profitable for hospitals/doctors, etc…

Maybe that’s 12%, maybe 5%, but that seems a ton cheaper than what companies spend probably. I’ve heard companies would good benefits spend over 10k per employee. It could be taken from employee count, but that would make companies less likely to hire if it was a high per employee fee.

To make it palatable (sp?) to rich people, cap this tax at some income limit like SS and the multi millions don’t get taxed more. The ultra rich already have to pay that 3.2% medicare tax already. Remove that.

Make it sorta like in some countries, now, they FORCE you to contribute to your 401k. I think I heard it was Australia and forget which, but one in Europe as well.

Remember that these programs are used in nearly every industrialized nation other than the US and they provide coverage to far more people than here. Like with Maternity in pretty much EVERY country, the US has the worst help for new moms than every other advanced nation.

In the end, I don’t know if it’s due to American born people having an attitude that the US is the best and most of these people haven’t really lived/traveled outside the US, but plenty of other countries are doing more things right than people give credit for.

[CA renter]

[quote=joec]

In the end, I don’t know if it’s due to American born people having an attitude that the US is the best and most of these people haven’t really lived/traveled outside the US, but plenty of other countries are doing more things right than people give credit for.[/quote]

This. I cannot even begin to tell you how many times I’ve argued with people over the years (I’ve always been a fan of “socialized” medicine) about how the U.S. pays more for worse healthcare. Those who have never traveled or have little/no connection to the outside world have been lied to in so very many ways. They will swear up and down that the U.S. is #1 in everything, and that we can do no wrong. The level of ignorance out there is amazing.

[scaredyclassic]

i was in the uk as an exchange student, had some medical problems, got a bunch of free health care and i was just passin thru

[livinincali]

[quote=joec]
I don’t know if the costs would actually be 12% of someone’s salary, but it seems like if EVERYONE working was forced to pay into the system, companies would be more than happy to just dump all their health care plans (they pay a TON) already and just find a percentage where it’s sustainable and still profitable for hospitals/doctors, etc…

Maybe that’s 12%, maybe 5%, but that seems a ton cheaper than what companies spend probably. I’ve heard companies would good benefits spend over 10k per employee. It could be taken from employee count, but that would make companies less likely to hire if it was a high per employee fee.
[/quote]

Many companies offering health insurance probably do spend close to 10K per employee. The question is if we removed that burden from the employer and put in on the employee via some type of income tax would you expect the companies to give the employee the cost saving in wages or would the companies attempt to keep that cost savings in profits. Obviously if the companies keep that savings in profits all employees will be worse off.

The fundamental issue is there’s virtually unlimited demand for medical services and tests if you don’t have to pay for it. Single payer solves the rising costs of infinite demand problem via rationing. A free market system would solve that problem via competition of providers. Of course single payer does have the problem that you don’t necessarily attract the best and the brightest to become doctors because your single payer system has limited their compensation package. The best and brightest still might become doctors but they won’t be available to the users of the single payer system. They’ll exist outside of the system treating those that can afford to pay supplemental coverage.

[no_such_reality]

[quote=ocrenter]
btw, not counting surgeries, over 90% of the hospital inpatient service at any given time is devoted to the 80+ population. lot’s of them frequent bounce backs.[/quote]

How’s that compare to say, UK, France, Germany?

Also, what’s the split on surgery versus other visits?

There’s great irony that Americans scream about socialized medicine, yet scream bloody murder at the hint of touching medicare.

I don’t understand why Politicians simply don’t just look at someone screaming socialism and say, what do social security is? Medicare?

[Jazzman]

[quote=livinincali]
The fundamental issue is there’s virtually unlimited demand for medical services and tests if you don’t have to pay for it.
Under a universal system everyone contributes. If everyone abuses or over-uses, they’ll soon tire of the long lines.

Single payer solves the rising costs of infinite demand problem via rationing.
What rationing is that? It is the opposite; giving greater access to care as opposed to discriminatory, selective care.

A free market system would solve that problem via competition of providers.
Yes? Look where it has led.

Of course single payer does have the problem that you don’t necessarily attract the best and the brightest to become doctors because your single payer system has limited their compensation package. The best and brightest still might become doctors but they won’t be available to the users of the single payer system. They’ll exist outside of the system treating those that can afford to pay supplemental coverage.
This is a large assumption. Doctors in other countries are well remunerated and the profession does not attract the money-grubbing type. The extent to which it does, makes no commensurate guarantee of better care. No lines and slicker service maybe.

Placing healthcare systems under a theoretical framework comes unstuck pretty quickly. Far better to experience it for yourself to understand it.

[/quote]

[livinincali]

[quote=Jazzman]
Under a universal system everyone contributes. If everyone abuses or over-uses, they’ll soon tire of the long lines.

Single payer solves the rising costs of infinite demand problem via rationing.
What rationing is that? It is the opposite; giving greater access to care as opposed to discriminatory, selective care.

A free market system would solve that problem via competition of providers.
Yes? Look where it has led.
[/quote]

There’s a limited number of medical services available to everybody. Whether you decide to provide those services on the ability to pay, or waiting in line you still have a selective process in who gets the services when they want them.

The current medical system isn’t a free market. there’s plenty of anti competitive laws passed by congress to limit competition in providing medical services. Go try to open a MRI center in San Deigo and charge $500 a patient. You’ll never make it through the licensing and regulation process because those with existing MRI center lobbied to put up those barriers to entry in the name of safety. Go try to buy cheaper prescription drugs in Mexico and import them to the US.

All of these things make health care more expensive and single payer doesn’t do anything to solve those problems of higher costs here than anywhere else. Who opens a new hospital or clinic if the single payer doesn’t pay enough to keep the doors open. Do medical services providers open more facilities or less facilities under a single payer system. I see single payer pushing more providers out of the system and fewer services available to those in the single payer system. The next step will be to create government providers of services and/or forcing providers of medical services to accept single payer no matter what.

Why not focus of the problem of cost by encouraging more supply of medical services via competition. Why not force users of medical services to shop around for better prices and/or decide that some test/treatment isn’t worth it. That’s the way you address the cost problem.

[SK in CV]

[quote=livinincali]
Why not focus of the problem of cost by encouraging more supply of medical services via competition. Why not force users of medical services to shop around for better prices and/or decide that some test/treatment isn’t worth it. That’s the way you address the cost problem.[/quote]

The first part is being done. There were 5 new medical schools in the US between 1980 and 2000. There have been around 30 since then. (more than half DO schools.) Another 15 to 20 could be in operation within 5 years (mostly MD schools.)

I’m not sure what mechanisms can be put in place to “force” shopping around. The shift towards higher deductible plans along with both private and public insurance paying negotiated rates moves us in that direction.

[FlyerInHi]

There is a new medical school being built at UNLV, Las Vegas.

[joec]

There is some talk that doctors won’t be doctors if they changed to some single payer since they won’t be paid much, but I can bet nearly everything that if they balanced this with no/limited lawsuits and tort (is it?) reform, doctors will still make bank.

I come from a family of doctors actually and in these places that have low/cost FREE health care rated in the top in the world, the family people I know who are doctors are insanely wealthy. Maybe it was a mix of real estate or business as well, but no one was crying that they weren’t making much to be a doctor.

If anything, I’ve read numerous articles of US doctors having to file bk or hang it up.

That said, my dad was actually a doctor in the US and said if he stayed where we came from, he’d be making tons more bank than where he worked here (large hospital network).

He also never encouraged any of us to be doctors due to limited freedom/power, pay probably due to taxes, no power when under the insurance lobbies, etc…Just seems our system, as great as it sounds, probably isn’t…if people only knew how other people have it.

Also, how many people here would be actually willing to move to a foreign country to live? I think that’s what makes it hard for a lot of American born people to consider that else is out there since they just don’t know.

I know if I wasn’t settled and old now, I wouldn’t be against moving to asia for work since I think that’s where a lot more opportunity is.

The US is getting old/tired (like Europe). There were numerous funny videos on yahoo finance yesterday on how US politics is worst than China since in China, it’s actually a meritocracy where successful government people get more and more responsibility as they move up the leadership chain…Here, we’re left with people like Filner and all the lobbying where after getting elected, it all about raising money to keep your job.

If anyone saw the interview with the Baidu CEO on Bloomberg, it was funny how he said he/they don’t care what the US does anymore since the chinese market is huge already and it seems like they are doing less copying and more creating now.

Before someone say I should just move to China, no way the wife would go for that! so as a middle aged dude, I can just grumble and watch.

[Jazzman]

[quote=livinincali]
There’s a limited number of medical services available to everybody. Whether you decide to provide those services on the ability to pay, or waiting in line you still have a selective process in who gets the services when they want them.
Not sure if you are referring to all health care systems of just universal. Whatever, that holds true for most things.

The current medical system isn’t a free market. there’s plenty of anti competitive laws passed by congress to limit competition in providing medical services. Go try to open a MRI center in San Deigo and charge $500 a patient. You’ll never make it through the licensing and regulation process because those with existing MRI center lobbied to put up those barriers to entry in the name of safety. Go try to buy cheaper prescription drugs in Mexico and import them to the US. That still makes it a free market. It may wield more power than some of us would like, but the lobbying isn’t done in the name of socialism.

All of these things make health care more expensive and single payer doesn’t do anything to solve those problems of higher costs here than anywhere else. Who opens a new hospital or clinic if the single payer doesn’t pay enough to keep the doors open. Do medical services providers open more facilities or less facilities under a single payer system. I see single payer pushing more providers out of the system and fewer services available to those in the single payer system. The next step will be to create government providers of services and/or forcing providers of medical services to accept single payer no matter what. Nobody is saying universal (single payer) systems are without their faults, but no one is denied health care. Budgets are trimmed, waste is slashed, and taxes go up, but health care still remains a fundamental right. Under a free market system, you are at the mercy of a corporation. You have no guarantees so it is the policy holders who get pushed out of the system.

Why not focus of the problem of cost by encouraging more supply of medical services via competition. Why not force users of medical services to shop around for better prices and/or decide that some test/treatment isn’t worth it. That’s the way you address the cost problem.
I agree that costs are the core of the problem, but the current system encourages escalating costs, so it is time for the system to change.[/quote]

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