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Read the rules in the OP before posting, please.In order to ensure that this thread continues to meet TL standards and follows the proper guidelines, we will be enforcing the rules in the OP more strictly. Be sure to give them a re-read to refresh your memory! The vast majority of you are contributing in a healthy way, keep it up! NOTE: When providing a source, explain why you feel it is relevant and what purpose it adds to the discussion if it's not obvious. Also take note that unsubstantiated tweets/posts meant only to rekindle old arguments can result in a mod action. |
On April 14 2015 02:18 Sermokala wrote:
Basically Minnesota is better then your state.
(Because they gouge sick people and the healthcare system.)
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On April 14 2015 01:47 Simberto wrote:Show nested quote +On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. Regarding the incentives in the German system, unlike normal medical procedures a lot of the dental stuff is not totally covered (at least partially because good dental health is mostly reliant on you just taking care of your teeth daily). However, if you have been to the dentist at least yearly for checkups for the last 5 or 10 years, you have to pay less for fixing your teeth if there is some problem. The basic checkup is completely covered by your insurance and thus doesn't cost you a penny directly. And having to pay out of your own pocket for a preventive procedures (as some of the other US posters mentioned) is a pretty big disincentive to have these procedures done in my opinion. Same with having to pay for staying in a hospital for observation, and other things like that. I just find it weird that that is even a thing. Shouldn't your insurance company be happy if you that sort of thing, because it can prevent them from having to pay absurd bills if you actually do get cancer or whatever? In this case, in any reasonable system the well-being of the patient and the interests of the insurance company should coincide. And still it is mentioned so often that checkups and similar things aren't covered by US insurance rather often. I find that to be weird, but i must honestly say i also simply can not imagine living with a system where healthcare is not generally completely covered by your insurance.
That's really awesome. I'm glad my capitalist pessimism was misplaced. I think genuine welfare incentives like that are a great idea, and I think it's something we should look to replicate. As another poster mentioned, Obamacare isn't perfect. It really is just something better than before. It's still a starting point, though, and at least the wheels are beginning to turn in the right direction.
I think it's only prudent to observe other systems which are proven, to look for solutions within them and to replicate what they're doing right while steering away from what's not working so great. Many Americans, including myself, understand our healthcare system is a work in progress. Others believe we are appeasing the socialist pigs from across the pond and anything not in adherence to raw, unadulterated capitalism is unpatriotic filth.
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On April 14 2015 02:49 always_winter wrote:Show nested quote +On April 14 2015 01:47 Simberto wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. Regarding the incentives in the German system, unlike normal medical procedures a lot of the dental stuff is not totally covered (at least partially because good dental health is mostly reliant on you just taking care of your teeth daily). However, if you have been to the dentist at least yearly for checkups for the last 5 or 10 years, you have to pay less for fixing your teeth if there is some problem. The basic checkup is completely covered by your insurance and thus doesn't cost you a penny directly. And having to pay out of your own pocket for a preventive procedures (as some of the other US posters mentioned) is a pretty big disincentive to have these procedures done in my opinion. Same with having to pay for staying in a hospital for observation, and other things like that. I just find it weird that that is even a thing. Shouldn't your insurance company be happy if you that sort of thing, because it can prevent them from having to pay absurd bills if you actually do get cancer or whatever? In this case, in any reasonable system the well-being of the patient and the interests of the insurance company should coincide. And still it is mentioned so often that checkups and similar things aren't covered by US insurance rather often. I find that to be weird, but i must honestly say i also simply can not imagine living with a system where healthcare is not generally completely covered by your insurance. That's really awesome. I'm glad my capitalist pessimism was misplaced. I think genuine welfare incentives like that are a great idea, and I think it's something we should look to replicate. As another poster mentioned, Obamacare isn't perfect. It really is just something better than before. It's still a starting point, though, and at least the wheels are beginning to turn in the right direction.
Is it though, is it really? A very popular newcomer to the presidency controlling both houses of congress spent all of his political capital on this one thing, completely finishing him for any other legislative attempt, and he has this half-assed crapshow to show for it. I'm not sure it will be easier to move to single-payer, which really is or should be the point of healthcare reform. Do you really think the next president will use this to move on? I'd be ecstatic if they did, but I'm really not putting money on it.
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Florida Sen. Marco Rubio said Monday he will seek the Republican presidential nomination for the 2016 contest, multiple news sources are reporting.
Rubio made the remarks in a conference call with donors, The Associated Press and The New York Times reported. Separately, Rubio's adviser told CNN the senator was running for president.
A formal announcement is expected later today.
The news is another chapter in what's been a fast and meteoric rise for the senator in national politics. Rubio served at the state level beginning in 2000 and by 2010, he had been elected to the U.S. Senate.
Almost immediately, Rubio was seen as a Republican Party leader, who, as the son of Cuban immigrants, could help turnaround the demographic ills of the GOP.
As he was described in a 2013 Time Magazine profile, "the charismatic conservative" had suddenly become the Tea Party's answer to President Obama. So much so, that in 2013 Rubio was picked by the party to deliver the Republican response to President Obama's State of the Union speech.
Although Rubio's speech was somewhat overshadowed by him awkwardly reaching for a drink of water, it also introduced Rubio as a Hispanic Republican with moderate views on immigration and with a uniquely American story.
"My parents immigrated here in pursuit of the opportunity to improve their life and give their children the chance at an even better one," Rubio said. "They made it to the middle class, my dad working as a bartender and my mother as a cashier and a maid. I didn't inherit any money from them. But I inherited something far better — the real opportunity to accomplish my dreams."
As The Wall Street Journal reports, since that speech, Rubio has quietly moved into the upper tier of 2016 Republican contenders.
Source
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On April 14 2015 01:21 Millitron wrote:Show nested quote +On April 14 2015 01:13 Plansix wrote:On April 14 2015 01:06 Millitron wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. At least part of it is because well-visits are rarely covered. If you go to the doctor's for a routine check-up, and nothing is wrong, very few insurance plans will cover it, leaving you stuck with the whole bill. That bill is frequently hundreds of dollars, which is (rightfully) seen as ridiculous. I mean really, talking with your doctor for 5 minutes costs hundreds? All my regular check ups are covered by my very standard insurance. I just pay a co-pay. And the visit is normally a couple hundred, but its once-twice a year and takes about an hour. Its not really that much worse than an attorney+paralegal time for a full hour. Even a fully licensed plumber could cost you that much with both parts and labor. Many of the people who need preventative care the most cannot afford $200 twice a year. If you're living paycheck to paycheck, a single $200 fee is devastating. The poor typically are the ones who get screwed by easily-prevented illnesses. They generally eat less healthy food, because somehow junk food is cheaper than healthy food. They also often work more demanding jobs that are more likely to cause health problems. Poor neighborhoods are also often more polluted than wealthier neighborhoods. So basically, their lifestyle makes them more likely to suffer from easily prevented problems, and they do not have the money to prevent said problems.
This is all correct. Now I don't see how you, a self-proclaimed libertarian can look at that, and say "well, free market should take care of that". Any health insurance is gonna take one look at their lifestyle, classify them as high-risk and charge them MORE (making it less affordable). That is exactly the situation in which Obamacare (sort-of) works, by setting a bottom-line. Are there other systems that make (far) more sense? For sure. However, deregulation of heatlh care is going to make the problem far worse.
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On April 14 2015 02:52 Yoav wrote:Show nested quote +On April 14 2015 02:49 always_winter wrote:On April 14 2015 01:47 Simberto wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. Regarding the incentives in the German system, unlike normal medical procedures a lot of the dental stuff is not totally covered (at least partially because good dental health is mostly reliant on you just taking care of your teeth daily). However, if you have been to the dentist at least yearly for checkups for the last 5 or 10 years, you have to pay less for fixing your teeth if there is some problem. The basic checkup is completely covered by your insurance and thus doesn't cost you a penny directly. And having to pay out of your own pocket for a preventive procedures (as some of the other US posters mentioned) is a pretty big disincentive to have these procedures done in my opinion. Same with having to pay for staying in a hospital for observation, and other things like that. I just find it weird that that is even a thing. Shouldn't your insurance company be happy if you that sort of thing, because it can prevent them from having to pay absurd bills if you actually do get cancer or whatever? In this case, in any reasonable system the well-being of the patient and the interests of the insurance company should coincide. And still it is mentioned so often that checkups and similar things aren't covered by US insurance rather often. I find that to be weird, but i must honestly say i also simply can not imagine living with a system where healthcare is not generally completely covered by your insurance. That's really awesome. I'm glad my capitalist pessimism was misplaced. I think genuine welfare incentives like that are a great idea, and I think it's something we should look to replicate. As another poster mentioned, Obamacare isn't perfect. It really is just something better than before. It's still a starting point, though, and at least the wheels are beginning to turn in the right direction. Is it though, is it really? A very popular newcomer to the presidency controlling both houses of congress spent all of his political capital on this one thing, completely finishing him for any other legislative attempt, and he has this half-assed crapshow to show for it. I'm not sure it will be easier to move to single-payer, which really is or should be the point of healthcare reform. Do you really think the next president will use this to move on? I'd be ecstatic if they did, but I'm really not putting money on it.
From a political standpoint I can't disagree; I think that's a shrewd observation. He did expend most of his capital on Obamacare, and it's nowhere near the resounding success it was intended to be. But let's not forget prior to its implementation 20 million Americans were without health insurance, a monumental human catastrophe which was always at the forefront of rationale for change.
I honestly don't know if a Republican president would use Obamacare as a stepping stone to something greater. Everything in my body is telling me, emphatically, no. I think it's obvious Hillary would at least maintain the status-quo, likely even injecting her own corollary, but whether she'd win or whether she's even the right candidate for the oval office remains, in my opinion, unknown. What I do know is that nearly every current Republican contender has blindly vowed to dissolve it, simply for partisan affiliation rather than genuine ideology or concern for the American public, and I find that wholly disheartening and it's one of many reasons I perceive 2016 to be one of the most important and decisive elections of my generation.
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What issues are preventing a well-defined Republican plan from being made?
It doesn't seem like it should be THAT hard to take some Republican principles, and craft a system around that.
Too many internal disagreements over the parameters such a system would have? Political costs necessary to make the system sound?
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so is there a nice little check list somewhere of the views of the republican candidates thus far??
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On April 14 2015 03:06 Acrofales wrote:Show nested quote +On April 14 2015 01:21 Millitron wrote:On April 14 2015 01:13 Plansix wrote:On April 14 2015 01:06 Millitron wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. At least part of it is because well-visits are rarely covered. If you go to the doctor's for a routine check-up, and nothing is wrong, very few insurance plans will cover it, leaving you stuck with the whole bill. That bill is frequently hundreds of dollars, which is (rightfully) seen as ridiculous. I mean really, talking with your doctor for 5 minutes costs hundreds? All my regular check ups are covered by my very standard insurance. I just pay a co-pay. And the visit is normally a couple hundred, but its once-twice a year and takes about an hour. Its not really that much worse than an attorney+paralegal time for a full hour. Even a fully licensed plumber could cost you that much with both parts and labor. Many of the people who need preventative care the most cannot afford $200 twice a year. If you're living paycheck to paycheck, a single $200 fee is devastating. The poor typically are the ones who get screwed by easily-prevented illnesses. They generally eat less healthy food, because somehow junk food is cheaper than healthy food. They also often work more demanding jobs that are more likely to cause health problems. Poor neighborhoods are also often more polluted than wealthier neighborhoods. So basically, their lifestyle makes them more likely to suffer from easily prevented problems, and they do not have the money to prevent said problems. This is all correct. Now I don't see how you, a self-proclaimed libertarian can look at that, and say "well, free market should take care of that". Any health insurance is gonna take one look at their lifestyle, classify them as high-risk and charge them MORE (making it less affordable). That is exactly the situation in which Obamacare (sort-of) works, by setting a bottom-line. Are there other systems that make (far) more sense? For sure. However, deregulation of heatlh care is going to make the problem far worse.
Disincentivize insurance. If no one had insurance, the medical industry would have to charge less. How many people could afford any real treatment now without insurance? Not many. This is because Big Pharma knows most of the cost is covered by insurance, not their customers. Prices would fall without insurance artificially propping them up. Big Pharma's only options would be to either keep prices high and go out of business because they make exactly 0 sales, or lower prices, accept smaller profit margins, and continue making sales.
I'm not totally against regulation. I think there's a select few sectors of society that simply don't work on a for-profit model. The criminal justice system, the military, and infrastructure simply don't work satisfactorily if they're for-profit. For-profit models are fantastic for things you want to grow. They aren't so good for things you want to limit. In those cases, for-profit models cause a conflict of interest, which leads to shit like the prison industrial complex and the War on Drugs. I'm starting to come around to the idea that healthcare might be one of those sectors that shouldn't be a free market sector. At least not a totally free market. Not one that allows businesses to stifle competition.
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On April 13 2015 17:52 cLutZ wrote:Show nested quote +On April 13 2015 15:23 ticklishmusic wrote:
Right, vast socialist conspiracy got it No. Its the game plan of the Democratic party. Its not a conspiracy its just an effective propaganda technique that needs to be recognized if we are going to discuss policies implemented by that party. Show nested quote +On April 13 2015 16:36 Adreme wrote:On April 13 2015 15:05 cLutZ wrote:On April 13 2015 13:34 GreenHorizons wrote:On April 13 2015 13:07 Millitron wrote:On April 13 2015 12:14 GreenHorizons wrote:On April 13 2015 11:56 Millitron wrote:On April 13 2015 11:45 GreenHorizons wrote:On April 13 2015 10:36 Millitron wrote:On April 13 2015 10:11 zlefin wrote:
[quote]
I think what's he's talking about and what you're talking abotu are different.
One is about denying access to a policy at all and/or cancelling it. The other is not about the issue of an insurance policy in general, but about how it handled a specific coverage case.
These are his exact words: "...insurance companies could deny you to the insurance you paid for because you got more sick then they were willing to cover." The fact that he uses "could" instead of "can" implies that he believes that that's no longer the case. Clearly though, insurance companies still can deny you treatment because they didn't want to cover it. That's exactly what happened, even though Gorsameth said it no longer could. And sure, this is just one case. But it still happened. Gorsameth did not say it would happen less, he said it wouldn't happen, full stop. The larger point is "healthcare still sucks" is not a tenable position. It's long passed time for Republicans to shit or get off the pot on healthcare. That's fine. I'd be cool with Single Payer, assuming it's managed better than the VA. but Gorsameth doesn't seem to think healthcare still sucks. "Even with his 'bad' ACA plans which are not a thing" I don't know how a plan that denies routine treatment of a pretty common problem is not bad. I don't really like talking around Gorsameth without him responding. I'd rather not discuss Gorsameth's position any more without hearing from him first. Don't wanna put words in his mouth any more than I might already have. On April 13 2015 11:53 TheTenthDoc wrote:On April 13 2015 10:36 Millitron wrote:On April 13 2015 10:11 zlefin wrote:
[quote]
I think what's he's talking about and what you're talking abotu are different.
One is about denying access to a policy at all and/or cancelling it. The other is not about the issue of an insurance policy in general, but about how it handled a specific coverage case.
These are his exact words: "...insurance companies could deny you to the insurance you paid for because you got more sick then they were willing to cover." The fact that he uses "could" instead of "can" implies that he believes that that's no longer the case. Clearly though, insurance companies still can deny you treatment because they didn't want to cover it. That's exactly what happened, even though Gorsameth said it no longer could. And sure, this is just one case. But it still happened. Gorsameth did not say it would happen less, he said it wouldn't happen, full stop. That's not them refusing to pay because of a pre-existing condition or because you're sicker than they're willing to cover. That's them refusing to pay because the negotiated policy doesn't cover a product (in this case, a night of observation) that is not deemed essential by the ACA. Unfortunately, because of the incredibly opaque healthcare market, the price they (and the patient) end up paying in the cases where the observation is important is about as reliable as throwing darts while blindfolded after riding in a teacup ride for an hour. Edit: I mean, I'd love to have actual good healthcare that doesn't rely on actuarial tables and arcane black box negotiations to determine what's covered, but unfortunately that's not possible while having private insurance. Follow me here. I think a plan that does not cover basic, obvious things is a bad plan regardless of why the plan will not cover them. Gorsameth said bad plans no longer exist thanks to the ACA. Still, my dad's plan would not cover his basic, obvious treatment, meaning it's a bad plan. Ergo, Gorsameth is wrong, and bad plans do still exist. I think what you are missing is that the ACA doesn't have plans, insurers do. Your dad's insurance (may) meets the minimum requirements for his insurer to sell it to him. The ACA made it less likely for those types of scenarios to occur but most of the whining from the right was about having any mandates at all. Of course we don't know when your dad got his insurance so it's also possible the reason that happened is because his plan was grandfathered in (doesn't meet current requirements), and that a current ACA compliant plan would of handled it? An obvious question would be did he get new insurance after the ACA or was it the same insurance he had before the ACA? Same insurance he had before the ACA, as far as I know. The whole "bad plans still exist thing" isn't really disproven though. Gorsameth said bad plans don't exist anymore. He didn't make any qualifying statements like "bad plans don't exist unless they're grandfathered in." Anyways, I think we agree that the ACA is a shitty half-measure that doesn't really satisfy anyone, except maybe the insurance companies who now have millions of new customers. It probably has helped some people, but it's not the amazing success the White House press conferences would have you believe. Well obviously the ACA has 0 to do with your fathers case regardless. It doesn't really matter what you think Gor said as the point of "insurers still offer bad plans" would be opposed by no one. But he said "Even with his 'bad' ACA plans which are not a thing they are still better then the old situation" Seems pretty clear he was saying there is no such thing as an "ACA plan" just insurance plans that meet standards or don't. Yeah the ACA isn't perfect but it's a hell of a lot better than nothing. Not to mention the people who have literally had their life saved as a result of legislation (those who Republicans would have/simply have in essence done nothing for) would probably agree with the White House assessment. We know the ACA is worse than the Republican plans, there are just simply 6 or 7 of them, so its harder for people to attack "the one plan". The real scandal is that people pretend the ACA is some sort of reform of a free market, when its really just another layer of government regulation on one of the most highly regulated markets in the country. I would just like to point out that this gameplan has happened many times, which is why its not stupid to call these plans "Obamacare for XXX". Just recently, the ACA, Dodd-Frank, Net Neutrality, ahave all been sold and implemented using the same game plan: 1. Point out that there is a problem in a heavily regulated government sector (Healthcare, Banking, and Telecoms are probably 3 of the top 10, throw in Energy, Education, and Transit). 2. Blame the private entities operating for things that they have been incentivized by the government to do (Pricing, Risky Loans, Monopolization). 3. Propose a solution that is a band-aid on top of that broken system, that increases government control. The thing you do not seem to understand about Dodd/Frank is that while the markets are heavily regulated in some areas in many of the cases workarounds have already been found and thus new band aids to prevent the workarounds are needed. If you want to know why regulation has to be so tedious and specific and annoying its for the simple reason that every time a new rule is passed one of the most standard policies is to try and figure out a way to avoid having to do most of the things in question and oftentimes they succeed despite the very long worded attempts to stop them because its easier to find a single crack in a fresh wall then it is to build it perfectly and once that crack is found you can delay fixes to that crack for years. 1. That's an argument against regulation being effective in general. 2. It also doesn't rebut the idea that the things that they have, recently, railed against were incentivized by regulation. In a post WWII economy there is really no intellectually honest way to argue something is the "fault" of the free market.
It can be highly effective if you are able to be faster at closing the loopholes they find and if you are able to remove regulation that turns out to not be needed. However due to the current congressional state in which things move very slowly if at all and preventing corporate abuse is often blocked in congress by some people you have a situation where that can take years to manifest.
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On April 14 2015 04:59 Millitron wrote:Show nested quote +On April 14 2015 03:06 Acrofales wrote:On April 14 2015 01:21 Millitron wrote:On April 14 2015 01:13 Plansix wrote:On April 14 2015 01:06 Millitron wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. At least part of it is because well-visits are rarely covered. If you go to the doctor's for a routine check-up, and nothing is wrong, very few insurance plans will cover it, leaving you stuck with the whole bill. That bill is frequently hundreds of dollars, which is (rightfully) seen as ridiculous. I mean really, talking with your doctor for 5 minutes costs hundreds? All my regular check ups are covered by my very standard insurance. I just pay a co-pay. And the visit is normally a couple hundred, but its once-twice a year and takes about an hour. Its not really that much worse than an attorney+paralegal time for a full hour. Even a fully licensed plumber could cost you that much with both parts and labor. Many of the people who need preventative care the most cannot afford $200 twice a year. If you're living paycheck to paycheck, a single $200 fee is devastating. The poor typically are the ones who get screwed by easily-prevented illnesses. They generally eat less healthy food, because somehow junk food is cheaper than healthy food. They also often work more demanding jobs that are more likely to cause health problems. Poor neighborhoods are also often more polluted than wealthier neighborhoods. So basically, their lifestyle makes them more likely to suffer from easily prevented problems, and they do not have the money to prevent said problems. This is all correct. Now I don't see how you, a self-proclaimed libertarian can look at that, and say "well, free market should take care of that". Any health insurance is gonna take one look at their lifestyle, classify them as high-risk and charge them MORE (making it less affordable). That is exactly the situation in which Obamacare (sort-of) works, by setting a bottom-line. Are there other systems that make (far) more sense? For sure. However, deregulation of heatlh care is going to make the problem far worse. Disincentivize insurance. If no one had insurance, the medical industry would have to charge less. How many people could afford any real treatment now without insurance? Not many. This is because Big Pharma knows most of the cost is covered by insurance, not their customers. Prices would fall without insurance artificially propping them up. Big Pharma's only options would be to either keep prices high and go out of business because they make exactly 0 sales, or lower prices, accept smaller profit margins, and continue making sales. I'm not totally against regulation. I think there's a select few sectors of society that simply don't work on a for-profit model. The criminal justice system, the military, and infrastructure simply don't work satisfactorily if they're for-profit. For-profit models are fantastic for things you want to grow. They aren't so good for things you want to limit. In those cases, for-profit models cause a conflict of interest, which leads to shit like the prison industrial complex and the War on Drugs. I'm starting to come around to the idea that healthcare might be one of those sectors that shouldn't be a free market sector. At least not a totally free market. Not one that allows businesses to stifle competition.
You have a very different expectation of what would happen compared to me.
Let me tell you what i think is going to happen in that case:
People will die. You've got cancer? Well, better die quietly than putting your family a few hundred thousand dollars into debt. You've got some disease and are poor? Sucks to be you, should have been rich. Got hit by a car? Have fun paying shitloads of money fixing that. And don't say "Well people should just have 100k in the bank just in case. Because you know as well as i do that that is not going to happen for a vast majority of the population.
If you think off healthcare as off a privilege, not a right, than this position is ok. But that also means accepting that people won't get the treatment they need because they can't afford it. I do not think that is a position a civilized society should hold, and many countries that are not the US have shown that it is very much possible to have a reasonable universal healthcare system at a price that is much cheaper than what the US currently has.
Also, sick people have a really bad negotiating position. "Well, you can either buy our stuff at the price we set it up for, or die" is a pretty strong negotiating position.
Health insurance is one of the best things people have come up with. The US just has a really shitty system for health insurance.
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On April 14 2015 05:49 Simberto wrote:Show nested quote +On April 14 2015 04:59 Millitron wrote:On April 14 2015 03:06 Acrofales wrote:On April 14 2015 01:21 Millitron wrote:On April 14 2015 01:13 Plansix wrote:On April 14 2015 01:06 Millitron wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. At least part of it is because well-visits are rarely covered. If you go to the doctor's for a routine check-up, and nothing is wrong, very few insurance plans will cover it, leaving you stuck with the whole bill. That bill is frequently hundreds of dollars, which is (rightfully) seen as ridiculous. I mean really, talking with your doctor for 5 minutes costs hundreds? All my regular check ups are covered by my very standard insurance. I just pay a co-pay. And the visit is normally a couple hundred, but its once-twice a year and takes about an hour. Its not really that much worse than an attorney+paralegal time for a full hour. Even a fully licensed plumber could cost you that much with both parts and labor. Many of the people who need preventative care the most cannot afford $200 twice a year. If you're living paycheck to paycheck, a single $200 fee is devastating. The poor typically are the ones who get screwed by easily-prevented illnesses. They generally eat less healthy food, because somehow junk food is cheaper than healthy food. They also often work more demanding jobs that are more likely to cause health problems. Poor neighborhoods are also often more polluted than wealthier neighborhoods. So basically, their lifestyle makes them more likely to suffer from easily prevented problems, and they do not have the money to prevent said problems. This is all correct. Now I don't see how you, a self-proclaimed libertarian can look at that, and say "well, free market should take care of that". Any health insurance is gonna take one look at their lifestyle, classify them as high-risk and charge them MORE (making it less affordable). That is exactly the situation in which Obamacare (sort-of) works, by setting a bottom-line. Are there other systems that make (far) more sense? For sure. However, deregulation of heatlh care is going to make the problem far worse. Disincentivize insurance. If no one had insurance, the medical industry would have to charge less. How many people could afford any real treatment now without insurance? Not many. This is because Big Pharma knows most of the cost is covered by insurance, not their customers. Prices would fall without insurance artificially propping them up. Big Pharma's only options would be to either keep prices high and go out of business because they make exactly 0 sales, or lower prices, accept smaller profit margins, and continue making sales. I'm not totally against regulation. I think there's a select few sectors of society that simply don't work on a for-profit model. The criminal justice system, the military, and infrastructure simply don't work satisfactorily if they're for-profit. For-profit models are fantastic for things you want to grow. They aren't so good for things you want to limit. In those cases, for-profit models cause a conflict of interest, which leads to shit like the prison industrial complex and the War on Drugs. I'm starting to come around to the idea that healthcare might be one of those sectors that shouldn't be a free market sector. At least not a totally free market. Not one that allows businesses to stifle competition. You have a very different expectation of what would happen compared to me. Let me tell you what i think is going to happen in that case: People will die. You've got cancer? Well, better die quietly than putting your family a few hundred thousand dollars into debt. You've got some disease and are poor? Sucks to be you, should have been rich. Got hit by a car? Have fun paying shitloads of money fixing that. And don't say "Well people should just have 100k in the bank just in case. Because you know as well as i do that that is not going to happen for a vast majority of the population. If you think off healthcare as off a privilege, not a right, than this position is ok. But that also means accepting that people won't get the treatment they need because they can't afford it. I do not think that is a position a civilized society should hold, and many countries that are not the US have shown that it is very much possible to have a reasonable universal healthcare system at a price that is much cheaper than what the US currently has. Also, sick people have a really bad negotiating position. "Well, you can either buy our stuff at the price we set it up for, or die" is a pretty strong negotiating position. Health insurance is one of the best things people have come up with. The US just has a really shitty system for health insurance.
The problem with "pay whatever price we say or die" is that it is simply not possible to pay prices that high. It's not a bargaining issue, its basic arithmetic. People simply do not have that kind of money. So either prices fall, or the medical companies go out of business. Do you really believe there are enough wealthy people around to keep big pharma afloat given no insurance and current prices?
It doesn't matter how strong big pharma's negotiating position is when it is physically impossible for people to pay.
Imagine people desperately needed product X. And the company charged a billion dollars per unit, completely outside the purchasing power of the people who need it. The people may as well not even have been offered the deal because it's impossible to make. The product may as well have not even been for sale. So the company has two options. Lower the price so they can make some sales, or go out of business.
"Everything is worth what its purchaser will pay for it. " - some Roman guy I can't remember.
Things are not worth what a company tries to sell them for, they are worth what customers try to buy them for.
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Mill, you obviously haven't looked at the issues closely; or you'd know how often people go as deep into debt as they can in order to fund health expenditures. Removing insurance companies won't magically make prices drop, nor are insurance companies blindly overpaying by massive amounts if they could get away with paying less, they're businesses too ya know.
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On April 14 2015 06:18 zlefin wrote:
Mill, you obviously haven't looked at the issues closely; or you'd know how often people go as deep into debt as they can in order to fund health expenditures. Removing insurance companies won't magically make prices drop, nor are insurance companies blindly overpaying by massive amounts if they could get away with paying less, they're businesses too ya know.
Insurance companies have even less bargaining power than individuals though, specifically because they can afford to pay. I'm sure they'd love lower prices, but big pharma sets the prices, and the insurance companies are contractually bound to their customers. It's tough to argue with a pharmaceutical company when they've got a monopoly on the treatment a particular customer needs. They could charge an insurance company basically whatever they want, but they can only charge an individual what they'd actually be able to pay. It's simple math, they must cut prices or they lose almost every sale. And there's no way they can get by on the 1-2% of people who could afford current prices without insurance.
At the same time that you deincentivized insurance, you'd need to look at reworking intellectual property rights, to dismantle these monopolies.
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On April 14 2015 06:01 Millitron wrote:Show nested quote +On April 14 2015 05:49 Simberto wrote:On April 14 2015 04:59 Millitron wrote:On April 14 2015 03:06 Acrofales wrote:On April 14 2015 01:21 Millitron wrote:On April 14 2015 01:13 Plansix wrote:On April 14 2015 01:06 Millitron wrote:On April 14 2015 00:55 always_winter wrote:
Every dentist I've ever been to calls me twice a month to remind me to schedule my next check-up. My mother's side has a history of breast cancer, and during every regular appointment she is reminded by our family physician to schedule her next mammogram. I haven't read too far back, but I'm not sure how the idea emerged that preventative care is lackluster in the United States. Whether people choose to undergo preventive care is entirely up to them. As far as incentivizing, I'm not particularly knowledgeable with German healthcare, but unless your dentist is funded entirely by the state, then it's far less likely he's concerned about that cavity forming, and far more likely he's concerned with his own bottom line. At least part of it is because well-visits are rarely covered. If you go to the doctor's for a routine check-up, and nothing is wrong, very few insurance plans will cover it, leaving you stuck with the whole bill. That bill is frequently hundreds of dollars, which is (rightfully) seen as ridiculous. I mean really, talking with your doctor for 5 minutes costs hundreds? All my regular check ups are covered by my very standard insurance. I just pay a co-pay. And the visit is normally a couple hundred, but its once-twice a year and takes about an hour. Its not really that much worse than an attorney+paralegal time for a full hour. Even a fully licensed plumber could cost you that much with both parts and labor. Many of the people who need preventative care the most cannot afford $200 twice a year. If you're living paycheck to paycheck, a single $200 fee is devastating. The poor typically are the ones who get screwed by easily-prevented illnesses. They generally eat less healthy food, because somehow junk food is cheaper than healthy food. They also often work more demanding jobs that are more likely to cause health problems. Poor neighborhoods are also often more polluted than wealthier neighborhoods. So basically, their lifestyle makes them more likely to suffer from easily prevented problems, and they do not have the money to prevent said problems. This is all correct. Now I don't see how you, a self-proclaimed libertarian can look at that, and say "well, free market should take care of that". Any health insurance is gonna take one look at their lifestyle, classify them as high-risk and charge them MORE (making it less affordable). That is exactly the situation in which Obamacare (sort-of) works, by setting a bottom-line. Are there other systems that make (far) more sense? For sure. However, deregulation of heatlh care is going to make the problem far worse. Disincentivize insurance. If no one had insurance, the medical industry would have to charge less. How many people could afford any real treatment now without insurance? Not many. This is because Big Pharma knows most of the cost is covered by insurance, not their customers. Prices would fall without insurance artificially propping them up. Big Pharma's only options would be to either keep prices high and go out of business because they make exactly 0 sales, or lower prices, accept smaller profit margins, and continue making sales. I'm not totally against regulation. I think there's a select few sectors of society that simply don't work on a for-profit model. The criminal justice system, the military, and infrastructure simply don't work satisfactorily if they're for-profit. For-profit models are fantastic for things you want to grow. They aren't so good for things you want to limit. In those cases, for-profit models cause a conflict of interest, which leads to shit like the prison industrial complex and the War on Drugs. I'm starting to come around to the idea that healthcare might be one of those sectors that shouldn't be a free market sector. At least not a totally free market. Not one that allows businesses to stifle competition. You have a very different expectation of what would happen compared to me. Let me tell you what i think is going to happen in that case: People will die. You've got cancer? Well, better die quietly than putting your family a few hundred thousand dollars into debt. You've got some disease and are poor? Sucks to be you, should have been rich. Got hit by a car? Have fun paying shitloads of money fixing that. And don't say "Well people should just have 100k in the bank just in case. Because you know as well as i do that that is not going to happen for a vast majority of the population. If you think off healthcare as off a privilege, not a right, than this position is ok. But that also means accepting that people won't get the treatment they need because they can't afford it. I do not think that is a position a civilized society should hold, and many countries that are not the US have shown that it is very much possible to have a reasonable universal healthcare system at a price that is much cheaper than what the US currently has. Also, sick people have a really bad negotiating position. "Well, you can either buy our stuff at the price we set it up for, or die" is a pretty strong negotiating position. Health insurance is one of the best things people have come up with. The US just has a really shitty system for health insurance. The problem with "pay whatever price we say or die" is that it is simply not possible to pay prices that high. It's not a bargaining issue, its basic arithmetic. People simply do not have that kind of money. So either prices fall, or the medical companies go out of business. Do you really believe there are enough wealthy people around to keep big pharma afloat given no insurance and current prices? It doesn't matter how strong big pharma's negotiating position is when it is physically impossible for people to pay. Imagine people desperately needed product X. And the company charged a billion dollars per unit, completely outside the purchasing power of the people who need it. The people may as well not even have been offered the deal because it's impossible to make. The product may as well have not even been for sale. So the company has two options. Lower the price so they can make some sales, or go out of business. "Everything is worth what its purchaser will pay for it. " - some Roman guy I can't remember. Things are not worth what a company tries to sell them for, they are worth what customers try to buy them for.
While I understand your point, big farma is a necessary evil. It really is incredibly expensive to develop next generation medicine. Are there cases of big farma overstepping bounds? For sure. Repatenting the same medicine for a slightly different variation of the same disease is one of those. Similar for farmaceutical companies spending stupid amounts of money for direct advertising to doctors. However, in general, medicine is simply expensive.
You can't just say "you need an MRI?" "Sure, we will do that for 5 bucks", when simply buying an MRI machine costs in the millions of dollars, and on top of that, you need training to run the machine, and interpret the results, and it takes vast amounts of electricity to run. In general, somewhere in the thousands of dollars for an MRI scan is a fair price. And nothing is really going to make that cheaper. Philips, GE or Siemens aren't going to sell their MRI machines cheaper, because they are already selling them at a fair market price.
The same goes for most surgeries and medicines. Even if you discount the up-front cost of research (which runs in the 10s to 100s of millions of dollars), the synthesis of many drugs is highly specialized and complex. In addition, farmaceutical companies would simply stop doing research. That would need to be taken over by someone (government). While I don't disagree with restructuring farmaceutical research for government-funded agencies to do, I don't think that is what you had in mind when wanting to deregularize healthcare.
Also, surgeons spend a minimum of 10 years learning to do what they do at university. They build up expensive student loans for that, and now sell their highly specialized skills at a high price. Even if their cost can go down, you still need a team of about 4-10 people for the average surgery, doing complex, high-risk work, and that is also not cheap.
So your pipe dream of cheap medical help for everybody in a free market is simply not going to work: there will be expensive full care for the super rich. There will be medium care for the average joe who has put aside some savings. And there will be shit-all for everybody else: welcome to the 19th century (plus cheap antibiotics and basic hygiene, which in all fairness, is amazing in healthcare terms).
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re: millitron
so you want to remove the patent system? That will cut costs, it'll also lead to a lot less medical innovation.
It's still easier for an insurance corporation to bargain than for an individual who's sick. The individual has the option: pay or die. The corp can just accept some losses, say it costs too much, and to keep everyone's prices reasonable refuse to pay exorbitant sums. The risk of a sick customer cancelling their policy in anger isn't much of a risk.
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On April 14 2015 06:27 Millitron wrote:Show nested quote +On April 14 2015 06:18 zlefin wrote:
Mill, you obviously haven't looked at the issues closely; or you'd know how often people go as deep into debt as they can in order to fund health expenditures. Removing insurance companies won't magically make prices drop, nor are insurance companies blindly overpaying by massive amounts if they could get away with paying less, they're businesses too ya know. Insurance companies have even less bargaining power than individuals though, specifically because they can afford to pay. I'm sure they'd love lower prices, but big pharma sets the prices, and the insurance companies are contractually bound to their customers. It's tough to argue with a pharmaceutical company when they've got a monopoly on the treatment a particular customer needs. They could charge an insurance company basically whatever they want, but they can only charge an individual what they'd actually be able to pay. It's simple math, they must cut prices or they lose almost every sale. And there's no way they can get by on the 1-2% of people who could afford current prices without insurance. At the same time that you deincentivized insurance, you'd need to look at reworking intellectual property rights, to dismantle these monopolies.
insurances don't have to pay for the most expensive treatment. And cruel as it may sound they do have the chance to say no based on something being too expensive.
You can't expect a sick person to go "man, they're totally screwing me over with their prices. I'm just going to die so they don't get a cent! Serves them right. Maybe they'll learn from their mistakes" because he'll be dead.
That's the whole beauty of the free market and I'm sure you appreciate that very much. That's exactly why it doesn't work in every situation like when you don't have the option to say that.
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On April 14 2015 06:39 Toadesstern wrote:Show nested quote +On April 14 2015 06:27 Millitron wrote:On April 14 2015 06:18 zlefin wrote:
Mill, you obviously haven't looked at the issues closely; or you'd know how often people go as deep into debt as they can in order to fund health expenditures. Removing insurance companies won't magically make prices drop, nor are insurance companies blindly overpaying by massive amounts if they could get away with paying less, they're businesses too ya know. Insurance companies have even less bargaining power than individuals though, specifically because they can afford to pay. I'm sure they'd love lower prices, but big pharma sets the prices, and the insurance companies are contractually bound to their customers. It's tough to argue with a pharmaceutical company when they've got a monopoly on the treatment a particular customer needs. They could charge an insurance company basically whatever they want, but they can only charge an individual what they'd actually be able to pay. It's simple math, they must cut prices or they lose almost every sale. And there's no way they can get by on the 1-2% of people who could afford current prices without insurance. At the same time that you deincentivized insurance, you'd need to look at reworking intellectual property rights, to dismantle these monopolies. insurances don't have to pay for the most expensive treatment. And cruel as it may sound they do have the chance to say no based on something being too expensive. You can't expect a sick person to go "man, they're totally screwing me over with their prices. I'm just going to die so they don't get a cent! Serves them right. Maybe they'll learn from their mistakes" because he'll be dead. That's the whole beauty of the free market and I'm sure you appreciate that very much. That's exactly why it doesn't work in every situation like when you don't have the option to say that.
I'm not saying a person would forgo paying for expensive, life-saving treatment out of spite for big pharma. I'm saying he wouldn't have a choice. He would be completely unable to pay, it wouldn't be a choice. Big pharma would have to cut prices not because its customers refused to pay, but because they were unable to pay. There's no negotiations, no bargaining, its pure arithmetic.
If you're trying to sell a thing for $20, but all your possible customers only have $10, you've got no choice but to lower the price. Either you lower the price to $10, or you can't possibly make your sale. What you're saying is that your customers have the money, but don't have the negotiation strength to get a lower price. I'm saying they simply don't have the money.
On April 14 2015 06:30 zlefin wrote:
re: millitron
so you want to remove the patent system? That will cut costs, it'll also lead to a lot less medical innovation.
It's still easier for an insurance corporation to bargain than for an individual who's sick. The individual has the option: pay or die. The corp can just accept some losses, say it costs too much, and to keep everyone's prices reasonable refuse to pay exorbitant sums. The risk of a sick customer cancelling their policy in anger isn't much of a risk.
I want to reduce the power of monopolies. To do this we need better patent law. We need to not allow new patents for stupidly minor variations of a treatment.
We didn't have a truly free market before the ACA either. We had corporatism. There was no competition, and no market pressures.
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On April 14 2015 06:56 Millitron wrote:Show nested quote +On April 14 2015 06:39 Toadesstern wrote:On April 14 2015 06:27 Millitron wrote:On April 14 2015 06:18 zlefin wrote:
Mill, you obviously haven't looked at the issues closely; or you'd know how often people go as deep into debt as they can in order to fund health expenditures. Removing insurance companies won't magically make prices drop, nor are insurance companies blindly overpaying by massive amounts if they could get away with paying less, they're businesses too ya know. Insurance companies have even less bargaining power than individuals though, specifically because they can afford to pay. I'm sure they'd love lower prices, but big pharma sets the prices, and the insurance companies are contractually bound to their customers. It's tough to argue with a pharmaceutical company when they've got a monopoly on the treatment a particular customer needs. They could charge an insurance company basically whatever they want, but they can only charge an individual what they'd actually be able to pay. It's simple math, they must cut prices or they lose almost every sale. And there's no way they can get by on the 1-2% of people who could afford current prices without insurance. At the same time that you deincentivized insurance, you'd need to look at reworking intellectual property rights, to dismantle these monopolies. insurances don't have to pay for the most expensive treatment. And cruel as it may sound they do have the chance to say no based on something being too expensive. You can't expect a sick person to go "man, they're totally screwing me over with their prices. I'm just going to die so they don't get a cent! Serves them right. Maybe they'll learn from their mistakes" because he'll be dead. That's the whole beauty of the free market and I'm sure you appreciate that very much. That's exactly why it doesn't work in every situation like when you don't have the option to say that. I'm not saying a person would forgo paying for expensive, life-saving treatment out of spite for big pharma. I'm saying he wouldn't have a choice. He would be completely unable to pay, it wouldn't be a choice. Big pharma would have to cut prices not because its customers refused to pay, but because they were unable to pay. There's no negotiations, no bargaining, its pure arithmetic. If you're trying to sell a thing for $20, but all your possible customers only have $10, you've got no choice but to lower the price. Either you lower the price to $10, or you can't possibly make your sale. What you're saying is that your customers have the money, but don't have the negotiation strength to get a lower price. I'm saying they simply don't have the money. Show nested quote +On April 14 2015 06:30 zlefin wrote:
re: millitron
so you want to remove the patent system? That will cut costs, it'll also lead to a lot less medical innovation.
It's still easier for an insurance corporation to bargain than for an individual who's sick. The individual has the option: pay or die. The corp can just accept some losses, say it costs too much, and to keep everyone's prices reasonable refuse to pay exorbitant sums. The risk of a sick customer cancelling their policy in anger isn't much of a risk. I want to reduce the power of monopolies. To do this we need better patent law. We need to not allow new patents for stupidly minor variations of a treatment. We didn't have a truly free market before the ACA either. We had corporatism. There was no competition, and no market pressures.
what happens to stuff that is inherently expensive by itself? I can't imagine getting treatment for cancer being "reasonably" cheap no matter your negotiation strenght.
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Cayman Islands24199 Posts
i dont think insurance itself is the main culprit. the way patients are separated from market decisions is the main issue.
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EPT
