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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.
Plansix
Profile Blog Joined April 2011
United States60190 Posts
November 10 2015 18:16 GMT
#50021
The claim is that the consumer gets to pick insurance based on cost monthly, deductible and network. But that is rarely the case and even if they do, they don't get to information on how much of the provider will cover for each service. So even if the consumer got to pick from 20 providers, the most important information would not be available.
I have the Honor to be your Obedient Servant, P.6
TL+ Member
oneofthem
Profile Blog Joined November 2005
Cayman Islands24199 Posts
November 10 2015 18:19 GMT
#50022
well that's still at the insurance level, whereas the actual incidents of consumption (going to the doc) are not under a market mechanism. so the general level of healthcare cost is still out of the patient's control. a lot of rent seekers on the supply side, no real choice with respect to general level of cost for patients.
We have fed the heart on fantasies, the heart's grown brutal from the fare, more substance in our enmities than in our love
cLutZ
Profile Joined November 2010
United States19574 Posts
November 10 2015 18:39 GMT
#50023
On November 11 2015 02:59 Toadesstern wrote:
Show nested quote +
On November 11 2015 02:50 Plansix wrote:
You can go more basic than that and avoid the moralistic argument. At the most basic level, the “free market” functions assuming that the consumer has reasonable information about what they are buying. The more information the consumer has, the better it functions. The converse is also true and lack of information can make it function poorly.

The healthcare market removes the consumer of the product from almost all of the decision making processes in the service. They can’t even find the prices for the services they are consuming. They can’t help set them with their insurance company or service provider. People going emergency rooms don’t shop around for the cheapest MRI.

The theory that a system with that structure can be directed to efficiency by free market mechanics has endless holes.

not to mention that at some points the consumer flat out has no option to deny the product (assuming enough cash is there), which is the principal upon which free market & capitalism works.

I can easily go on amazon and decide that I won't buy something because I think something's overpriced and that'll either lead to me finding it elsewhere cheaper or the realization that I'm a cheap fuck and it's just not viable any cheaper. Or I'll get rich making it myself for lots cheaper.

With healthcare that doesn't reall work that well because you can't reasonably expect someone to just die on the operation table to stick it to the man in protest of the high prices. You don't have the option to pick another "supplier" because you might reasonably die before you get to another hospital in some cases.


That isn't really the problem. Your insurance company would have pre-negotiated for an expense they anticipate they will likely incur (maybe not you on the operating table, but they know one of their insurees is going to be hit by a bus). This is also an event that makes perfect sense to insure. Its even plausible for the government to insure that expense for those who dont have insurance (which they did pre-Obamacare through Medicaid and EMPTALA). While this was a constant talking point pre-Obamacare, it really does not drive costs in America.

One thing that does drive costs is, yes, we don't have monopoly bargaining power against drug/medical device companies. Another is that because healthcare is tax advantaged companies often offer healthcare insurance and coverage that covers every imaginable expense, even those that are recurring (visits to an eye doctor to update your glasses) and those that could be subject to pre-negotiation like a hip replacement. All this is layered on a system that by regulation requires doctors to be a part of almost everything, but also imposes high costs on becoming a doctor, who thus requires high compensation. Also, the FDA has the most difficult approval scheme of the major markets.

Lastly, I will get to what I think is probably the real issue: what healthcare is everyone entitled to? Is it speedy access to state-of-the-art healthcare overseen by a university trained doctor? Because that is really what it seems like you are saying, which is not realistic, because no country does that. Most make decisions not to implement new, expensive, procedures until the costs come down and to skimp on end-of-life care.

^Thus, if we change all that, then we may get the American system at European costs. But, most proposals I've seen just get us the European system at American costs++
Freeeeeeedom
Danglars
Profile Blog Joined August 2010
United States12133 Posts
November 10 2015 19:29 GMT
#50024
On November 11 2015 03:39 cLutZ wrote:
Show nested quote +
On November 11 2015 02:59 Toadesstern wrote:
On November 11 2015 02:50 Plansix wrote:
You can go more basic than that and avoid the moralistic argument. At the most basic level, the “free market” functions assuming that the consumer has reasonable information about what they are buying. The more information the consumer has, the better it functions. The converse is also true and lack of information can make it function poorly.

The healthcare market removes the consumer of the product from almost all of the decision making processes in the service. They can’t even find the prices for the services they are consuming. They can’t help set them with their insurance company or service provider. People going emergency rooms don’t shop around for the cheapest MRI.

The theory that a system with that structure can be directed to efficiency by free market mechanics has endless holes.

not to mention that at some points the consumer flat out has no option to deny the product (assuming enough cash is there), which is the principal upon which free market & capitalism works.

I can easily go on amazon and decide that I won't buy something because I think something's overpriced and that'll either lead to me finding it elsewhere cheaper or the realization that I'm a cheap fuck and it's just not viable any cheaper. Or I'll get rich making it myself for lots cheaper.

With healthcare that doesn't reall work that well because you can't reasonably expect someone to just die on the operation table to stick it to the man in protest of the high prices. You don't have the option to pick another "supplier" because you might reasonably die before you get to another hospital in some cases.


That isn't really the problem. Your insurance company would have pre-negotiated for an expense they anticipate they will likely incur (maybe not you on the operating table, but they know one of their insurees is going to be hit by a bus). This is also an event that makes perfect sense to insure. Its even plausible for the government to insure that expense for those who dont have insurance (which they did pre-Obamacare through Medicaid and EMPTALA). While this was a constant talking point pre-Obamacare, it really does not drive costs in America.

One thing that does drive costs is, yes, we don't have monopoly bargaining power against drug/medical device companies. Another is that because healthcare is tax advantaged companies often offer healthcare insurance and coverage that covers every imaginable expense, even those that are recurring (visits to an eye doctor to update your glasses) and those that could be subject to pre-negotiation like a hip replacement. All this is layered on a system that by regulation requires doctors to be a part of almost everything, but also imposes high costs on becoming a doctor, who thus requires high compensation. Also, the FDA has the most difficult approval scheme of the major markets.

Lastly, I will get to what I think is probably the real issue: what healthcare is everyone entitled to? Is it speedy access to state-of-the-art healthcare overseen by a university trained doctor? Because that is really what it seems like you are saying, which is not realistic, because no country does that. Most make decisions not to implement new, expensive, procedures until the costs come down and to skimp on end-of-life care.

^Thus, if we change all that, then we may get the American system at European costs. But, most proposals I've seen just get us the European system at American costs++
You hit the nail on the head. Oh, and now mandating recurring expenses is the political talking point of preventative care. So go on and insure yourself against the risk of a sudden checkup, whose appointment eerily shows up at the worst times on the calendar.
Great armies come from happy zealots, and happy zealots come from California!
TL+ Member
KwarK
Profile Blog Joined July 2006
United States44203 Posts
November 10 2015 19:40 GMT
#50025
This idea that the quality of healthcare abroad is inferior does not match my experience of living both in the UK and the US. Admittedly my experience of the US system has been very soured by the inability to get generic drugs that are easily accessible in the rest of the world and the obscene bureaucracy involved in just getting an appointment but the actual care itself has been comparable. If someone threatened me with the NHS I'd be quite glad.
ModeratorThe angels have the phone box
BallinWitStalin
Profile Joined July 2008
1177 Posts
November 10 2015 20:18 GMT
#50026
Yeah for the record every time I go see a doctor in Canada he's university trained, too.

And if I need "state of the art" care I generally get it. My daughter just got a precautionary MRI (they didn't think there was anything wrong but just wanted to "make sure" because they don't take risks with young kids) like a month ago. Just to reiterate, the neurologist my daughter saw, for free, thought she was probably fine but, just to make sure, ordered a fucking MRI, for free.

Did i mention that all of this precautionary, state-of-the art healthcare, provided by a "university educated" neurologist, was free (for me)?

Honestly I don't understand what you guys think healthcare in other countries is like. I have only had awesome, positive experiences.
I await the reminiscent nerd chills I will get when I hear a Korean broadcaster yell "WEEAAAAVVVVVUUUHHH" while watching Dota
Jormundr
Profile Joined July 2011
United States1678 Posts
November 10 2015 20:21 GMT
#50027
Certain people in this thread like to combine american exceptionalism with their online republican economics degree to explain why our system is the way it is.
1. America spends the most on healthcare
2. If you buy something that is expensive that means its better.
3. Therefore we have the best healthcare in the world and everywhere else sucks.
Capitalism is beneficial for people who work harder than other people. Under capitalism the only way to make more money is to work harder then your competitors whether they be other companies or workers. ~ Vegetarian
Simberto
Profile Blog Joined July 2010
Germany11941 Posts
November 10 2015 20:24 GMT
#50028
Yeah, it's weird. I am sometimes wondering if a lot of americans simply never experienced an actually working healthcare system, so they can't imagine it exists and think that there is some major flaw that they are not being told about by people from other countries.

Of course, what you are getting isn't really "free" either, you pay for it with your taxes or healthcare insurance payments all your life. Still a much better deal than in the US.
Velr
Profile Blog Joined July 2008
Switzerland10929 Posts
Last Edited: 2015-11-10 20:40:12
November 10 2015 20:25 GMT
#50029
Yeah, clutz essay there is kinda comical.
As soon as he leaves US turf, its either just wrong or, in his bright moments, at least comically exaggerated.

And to everyones surprise, Danglars jumps right in and applauds him for his bs.
Plansix
Profile Blog Joined April 2011
United States60190 Posts
November 10 2015 20:28 GMT
#50030
The problem in the US people get very concerned the government will “control their healthcare”. And then believe if they can choose it themselves, they are in control. When in reality, they are just turning over control to a faceless company that controls their healthcare. They pay either way, but that tiny act of picking the provider provides this illusion of freedom and choice.
I have the Honor to be your Obedient Servant, P.6
TL+ Member
Jormundr
Profile Joined July 2011
United States1678 Posts
November 10 2015 20:28 GMT
#50031
The general working theory over here is that in single payer countries it takes two years to schedule a yearly appointment, when in reality it's pretty much the same wait times.
Capitalism is beneficial for people who work harder than other people. Under capitalism the only way to make more money is to work harder then your competitors whether they be other companies or workers. ~ Vegetarian
Simberto
Profile Blog Joined July 2010
Germany11941 Posts
November 10 2015 20:42 GMT
#50032
On November 11 2015 05:28 Plansix wrote:
The problem in the US people get very concerned the government will “control their healthcare”. And then believe if they can choose it themselves, they are in control. When in reality, they are just turning over control to a faceless company that controls their healthcare. They pay either way, but that tiny act of picking the provider provides this illusion of freedom and choice.


You could take a look at the german system. It is basically works more or less like single payer, but there are insurance companies you can choose from which are all basically the same (and all of them are nonprofits). They tend to barter collectively, and i honestly am not a 100% certain what exactly differantiates one from another (They all feel very much the same). But you can choose them
Plansix
Profile Blog Joined April 2011
United States60190 Posts
November 10 2015 20:48 GMT
#50033
hat is not the image many US citizens have. They picture endless lines at the hospital, which is a faceless gray box that says Gov. Health on the side. Inside is a copy of the RMV and more lines filled with sick, unhappy people. The darkest of fictional futures.
I have the Honor to be your Obedient Servant, P.6
TL+ Member
ticklishmusic
Profile Blog Joined August 2011
United States15977 Posts
November 10 2015 20:50 GMT
#50034
I am a Taiwanese dual citizen. Their healthcare is fucking great.
(╯°□°)╯︵ ┻━┻
Velr
Profile Blog Joined July 2008
Switzerland10929 Posts
November 10 2015 20:53 GMT
#50035
Here it works like this:
You are actually hurting/in trouble --> go to the doctor/hospital --> get treated immediatly.
You got some issue that should be looked at --> You make an appointment with your doctor and from there on he decides what will be done, you are not happy with your dcotors decision --> Feel free to visit another one.

So horrible... Health insurance companies are also 100% private but all have to cover the same treatments (which includes basically everything, including preemptive care, you'll ever really need and has proven to be effective).
CannonsNCarriers
Profile Joined April 2010
United States638 Posts
November 10 2015 21:06 GMT
#50036
We don't need to import full European systems in America. All we have to do is expand Medicare to cover everyone as a baseline of coverage, and liberalize the after market insurance industry. The ACA exchange system is largely a good idea, but we need ways to get more insurers onto it. Granted, this plan would require some stiff new taxes. But on net there would be significant cost savings over all of society.
Dun tuch my cheezbrgr
Toadesstern
Profile Blog Joined October 2008
Germany16350 Posts
November 10 2015 21:09 GMT
#50037
On November 11 2015 05:42 Simberto wrote:
Show nested quote +
On November 11 2015 05:28 Plansix wrote:
The problem in the US people get very concerned the government will “control their healthcare”. And then believe if they can choose it themselves, they are in control. When in reality, they are just turning over control to a faceless company that controls their healthcare. They pay either way, but that tiny act of picking the provider provides this illusion of freedom and choice.


You could take a look at the german system. It is basically works more or less like single payer, but there are insurance companies you can choose from which are all basically the same (and all of them are nonprofits). They tend to barter collectively, and i honestly am not a 100% certain what exactly differantiates one from another (They all feel very much the same). But you can choose them

unless some change happened that I somehow missed out on... we also have two different systems you can pick from if you want to. The "singleplayer" insurance you mentioned is one thing (you can pick a bunch of different but like you said they're essentially all the same) but we also have private insurance.
If you're running a company you in fact have to go for that because usually your employer is in the mix for who's paying what, which doesn't work if you're self-employed.

There was critique about it being a system of 2class healthcare since the private option ends up a bit more expensive but they (can) differ in that they cover more (thus more expensive) and you'll get appointments quicker on average.
<Elem> >toad in charge of judging lewdness <Elem> how bad can it be <Elem> also wew, that is actually p lewd.
Paljas
Profile Joined October 2011
Germany6926 Posts
Last Edited: 2015-11-10 21:30:52
November 10 2015 21:30 GMT
#50038
On November 11 2015 05:42 Simberto wrote:
Show nested quote +
On November 11 2015 05:28 Plansix wrote:
The problem in the US people get very concerned the government will “control their healthcare”. And then believe if they can choose it themselves, they are in control. When in reality, they are just turning over control to a faceless company that controls their healthcare. They pay either way, but that tiny act of picking the provider provides this illusion of freedom and choice.


You could take a look at the german system. It is basically works more or less like single payer, but there are insurance companies you can choose from which are all basically the same (and all of them are nonprofits). They tend to barter collectively, and i honestly am not a 100% certain what exactly differantiates one from another (They all feel very much the same). But you can choose them

Its also a two class system, which benefits the rich. (as toad pointed out)
TL+ Member
Plansix
Profile Blog Joined April 2011
United States60190 Posts
November 10 2015 21:31 GMT
#50039
On November 11 2015 06:30 Paljas wrote:
Show nested quote +
On November 11 2015 05:42 Simberto wrote:
On November 11 2015 05:28 Plansix wrote:
The problem in the US people get very concerned the government will “control their healthcare”. And then believe if they can choose it themselves, they are in control. When in reality, they are just turning over control to a faceless company that controls their healthcare. They pay either way, but that tiny act of picking the provider provides this illusion of freedom and choice.


You could take a look at the german system. It is basically works more or less like single payer, but there are insurance companies you can choose from which are all basically the same (and all of them are nonprofits). They tend to barter collectively, and i honestly am not a 100% certain what exactly differantiates one from another (They all feel very much the same). But you can choose them

Its also a two class system, which benefits the rich. (as toad pointed out)

From my understanding, it would be an upgrade from the garbage system in the US that already does that. No system is perfect, but some are better than others.
I have the Honor to be your Obedient Servant, P.6
TL+ Member
Velr
Profile Blog Joined July 2008
Switzerland10929 Posts
Last Edited: 2015-11-10 22:03:51
November 10 2015 22:02 GMT
#50040
On November 11 2015 06:30 Paljas wrote:
Show nested quote +
On November 11 2015 05:42 Simberto wrote:
On November 11 2015 05:28 Plansix wrote:
The problem in the US people get very concerned the government will “control their healthcare”. And then believe if they can choose it themselves, they are in control. When in reality, they are just turning over control to a faceless company that controls their healthcare. They pay either way, but that tiny act of picking the provider provides this illusion of freedom and choice.


You could take a look at the german system. It is basically works more or less like single payer, but there are insurance companies you can choose from which are all basically the same (and all of them are nonprofits). They tend to barter collectively, and i honestly am not a 100% certain what exactly differantiates one from another (They all feel very much the same). But you can choose them

Its also a two class system, which benefits the rich. (as toad pointed out)



Its impossible to not have a 2 (or actually way more) class system, no matter if there are private insurance plans or not. A person with more money to spend on his health will allways be able to get more/better care. To change this you would have to either prohibit doctors/hospitals from working privately or "overcome" () capitalism.

The job of a public health care system is not to get everyone the very best care that is avalaible. It is about granting people the best care that is proven to be effective and cost effective (weighted against the illness that is treated. If the very best treatment for the common cold costs 10'000$ public health care would and obviously should not pay for that).

And yes, this leads to pelnty of moral questions when it comes to very expensive treatments for dire conditions, but this is just unavoidable, having no general health care is not a viable option because that just means that many people won't get any decent treatment all.
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