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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. |
Elizabeth Warren couldn't have scripted it any better if she tried.
Reading a letter from civil rights icon Coretta Scott King opposing Jeff Sessions for a federal judgeship in 1986, the Massachusetts liberal senator was reprimanded by Mitch McConnell, the Senate majority leader so loathed by Democrats. Warren was then gaveled down by Sen. Steve Daines (R-Mont.) and told to take her seat.
The visual of GOP men silencing Warren unleashed a flood of outrage on social media. Democrats quickly began fundraising off of the spectacle. And people tuned into C-SPAN for a late-night Senate session that otherwise would have been ignored, as Sen. Sessions of Alabama plodded toward confirmation despite near-unanimous Democratic opposition.
In an interview on Wednesday morning, Warren insisted she would have preferred continuing to read King's letter into the record and avoid the spectacular parliamentary fight that has consumed the Senate. Sessions, a longtime colleague of McConnell's in the Senate, is expected to be confirmed Wednesday as attorney general.
“I just wanted to read the letter, and I want everybody to read the letter. That’s how I see it. This debate is about Sen. Sessions nomination to serve as attorney general, the chief law enforcement official in the nation,” Warren said. “These facts are entirely relevant to Sen. Sessions' nomination.”
But there's no question the confrontation galvanized Warren's army of liberal fans. McConnell's rebuke — “She was warned. She was given an explanation. Nevertheless, she persisted” — became an instant meme on the left.
McConnell ignored a question about Warren on Wednesday morning, ducking into the chamber to defend Sessions as a “friend of many of us on both sides of the aisle.”
The Tuesday night showdown continued to resonate in the Senate a day later.
"I just find it amazing at a time when we're actually debating the U.S. attorney general, whose job it is to protect the rights and freedoms of all Americans, that a woman was called out reading the words of a black woman," said Sen. Patty Murray (D-Wash.). "It felt really wrong to all of us."
On the other side of the aisle, Majority Whip John Cornyn (R-Texas) said he heard Warren is "doing fundraising off it. I frankly don't think it's anything to be proud of."
Senators often come close to disrespecting their colleagues and breaking the arcane chamber's rule book barring personal insults of their peers. Most notably, McConnell and Senate Republicans ignored Ted Cruz's attacks on McConnell in 2015 for telling a "lie" about the Export-Import Bank, preferring not to elevate a political opponent. But elevating an opponent is precisely what McConnell did on Tuesday — and the Kentucky Republican is not prone to strategic missteps.
Source
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United Kingdom13775 Posts
On February 09 2017 04:36 KwarK wrote:Show nested quote +On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits.
Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country.
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On February 09 2017 05:04 LegalLord wrote:Show nested quote +On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country.
Which is why you need a public payment system for healthcare. That solves that problem, too.
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Here comes judicial review #2 lol
Homeland Security Secretary John Kelly said Tuesday that visa applicants may be asked to hand over their passwords for their social media accounts by U.S. embassies.
Kelly said the move could be part of the Trump administration’s extreme vetting effort for visitors from the seven Muslim-majority nations which has been the source of controversy since Trump’s executive order took effect.
Fox News
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United Kingdom13775 Posts
On February 09 2017 05:19 Simberto wrote:Show nested quote +On February 09 2017 05:04 LegalLord wrote:On February 09 2017 04:36 KwarK wrote:On February 09 2017 04:25 LegalLord wrote:On February 09 2017 04:19 Trainrunnef wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. The problem is that it isn't all that obvious that its the last year of death until they are dead. Some people do recover and live on for an extra few years after expensive medical intervention. I wouldn't want to be in the shoes of the person who makes the call on whether its this patient's last year or not. EDIT: Often that quality of life may not even be worth the cost but in some cases they are and without the privilege of hindsight how would you make that decision. Yes, that gets into the "death panel" issue. But often, it should be possible to see that the chance of a patient living a somewhat healthy life past a certain point is so small that it's better just to ease them towards death. To be fair, though, perhaps we could use a medical staff with more affinity towards mathematics towards that end. American MD's are notoriously bad at math. Death panels are a non issue. They're just a scare word for rationing. Nobody would expect their insurance coverage to outbid every other insurer to fly the best doctors in from around the world, and to hell with the cost. The insurance provider has already decided ahead of time which treatments they are willing to pay for and which they are not. Rationing is an inevitable part of any system in which demand outpaces supply, there is a finite supply of healthcare and, until people stop dying, an infinite demand for it. Your insurance provider has looked at how much money they get and has decided an appropriate ration of healthcare to provide you with. If you need more than your ration, well, you're shit out of luck there. It's the same thing that "death panels" do, only death panels are much better at resource allocation and aren't trying to maximize their profits. Which brings me to yet another issue: the way that certain emergency costs are left unpaid because of death or bankruptcy, which adds a further strain on the emergency medical facilities in the country. Which is why you need a public payment system for healthcare. That solves that problem, too.
I personally would like a universal healthcare system. But Americans would never get behind that because "socialism."
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On February 09 2017 05:03 Danglars wrote:Show nested quote +On February 09 2017 04:46 chocorush wrote:
On the insurance issues. What people think of as "insurance" isn't what they actually want. Insurance is a financial product meant to smooth costs over time (pay premiums + copay over a lifetime, rather than footing large spikes of medical costs). It's not meant to save you money, but make the spending manageable by spreading the total costs over your lifetime.
When the premiums no longer affect your own personal risk, that's what makes you feel like you're getting ripped off. On the other end of the spectrum, if you're one of those uninsurables, smoothing health costs over time does jack shit, because no amount of smoothing will make you not financially screwed because costs are already too high.
What people want, is actually just affordable healthcare, and I think disentangling the system with the insurance model is the only way we will be able to accept the realities of having to pay for it all one way or another. If we can manage that last bit with everything from regulatory to political will to business inertia, you'll be a miracle worker. I agree that it is absolutely the best goal for affordable health care.
by "that last bit" are you referring to disentangling the system from the insurance model? or something else? just trying to be sure which exact part you're referring to.
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Good Ole mitch being his awful self.
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On February 09 2017 05:02 Gorsameth wrote:Show nested quote +On February 09 2017 04:46 chocorush wrote:
On the insurance issues. What people think of as "insurance" isn't what they actually want. Insurance is a financial product meant to smooth costs over time (pay premiums + copay over a lifetime, rather than footing large spikes of medical costs). It's not meant to save you money, but make the spending manageable by spreading the total costs over your lifetime.
When the premiums no longer affect your own personal risk, that's what makes you feel like you're getting ripped off. On the other end of the spectrum, if you're one of those uninsurables, smoothing health costs over time does jack shit, because no amount of smoothing will make you not financially screwed because costs are already too high.
What people want, is actually just affordable healthcare, and I think disentangling the system with the insurance model is the only way we will be able to accept the realities of having to pay for it all one way or another. But because care is finite long term care is expensive. No amount of cost depression is going to make chronic treatment cheap enough for someone to pay during their lifetime. Esp if the illness stops them from being productive. Spreading the cost of sick people across healthy people is the only way available for the foreseeable future.
There are states in the US where school districts are cutting the amount of school days rather than pay taxes to pay for children's education.
Until you realize that half of americans would rather their own children lose opportunity rather than pay for other people's children then you'll never understand why there is resistance to socialized healthcare programs.
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United Kingdom13775 Posts
On February 09 2017 04:58 Gorsameth wrote:Show nested quote +On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. You lost Western society at the mention that we should let chronic people die so they stop being a drag on society and that it would be 'not bad'.
Statistically, it probably would not be that bad if people never died from simple, highly preventable diseases but that something like diabetes, cancer, etc., means that you die. It would certainly beat off all of the historical major killers.
Of course there is no reason people have to die from those diseases, but it does mean that focusing on those low-level problems would substantially decrease death, and that the expensive treatments should be a secondary concern to ensuring that everyone has access to the low level stuff.
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On February 09 2017 05:46 LegalLord wrote:Show nested quote +On February 09 2017 04:58 Gorsameth wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. You lost Western society at the mention that we should let chronic people die so they stop being a drag on society and that it would be 'not bad'. Statistically, it probably would not be that bad if people never died from simple, highly preventable diseases but that something like diabetes, cancer, etc., means that you die. It would certainly beat off all of the historical major killers. Of course there is no reason people have to die from those diseases, but it does mean that focusing on those low-level problems would substantially decrease death, and that the expensive treatments should be a secondary concern to ensuring that everyone has access to the low level stuff.
And that's why you either support everyone or no one. Who would like to be the one deciding who lives and who dies? What is the limit? The uproar would be massive looking at the fringe case which would go "ah you're illness is just a bit too expensive to treat, no cares for you". You can't make general tules on those situations.
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On February 09 2017 05:42 Thieving Magpie wrote:Show nested quote +On February 09 2017 05:02 Gorsameth wrote:On February 09 2017 04:46 chocorush wrote:
On the insurance issues. What people think of as "insurance" isn't what they actually want. Insurance is a financial product meant to smooth costs over time (pay premiums + copay over a lifetime, rather than footing large spikes of medical costs). It's not meant to save you money, but make the spending manageable by spreading the total costs over your lifetime.
When the premiums no longer affect your own personal risk, that's what makes you feel like you're getting ripped off. On the other end of the spectrum, if you're one of those uninsurables, smoothing health costs over time does jack shit, because no amount of smoothing will make you not financially screwed because costs are already too high.
What people want, is actually just affordable healthcare, and I think disentangling the system with the insurance model is the only way we will be able to accept the realities of having to pay for it all one way or another. But because care is finite long term care is expensive. No amount of cost depression is going to make chronic treatment cheap enough for someone to pay during their lifetime. Esp if the illness stops them from being productive. Spreading the cost of sick people across healthy people is the only way available for the foreseeable future. There are states in the US where school districts are cutting the amount of school days rather than pay taxes to pay for children's education. Until you realize that half of americans would rather their own children lose opportunity rather than pay for other people's children then you'll never understand why there is resistance to socialized healthcare programs.
I don't understand the resistance either. Healthcare is not a social welfare program,It is an insurance. A collective insurance when the government does offer it for everyone. When you pay for your healthcare insurance you are not paying for other people,you are paying for your own risk to get sick and be taken care of. In the end some people pay more then what they get in return and others pay less,just as with all other insurances that are there.
Making it a collective insurance has a few advantages,a stronger position to negotiate when you buy care for example.
Usa healthcare is about 2 to 4 times as expensive as healthcare in other developed countries like England and Europe,while the quality is arguably more or less equall. How can it be that it is 2 to 4 times as expensive per captiva?
It is even worse then this since quiet a few people in the usa get minimal care that does not cost much money,the high cost comes from a relatively small group of people.
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United Kingdom13775 Posts
On February 09 2017 06:03 nojok wrote:Show nested quote +On February 09 2017 05:46 LegalLord wrote:On February 09 2017 04:58 Gorsameth wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. You lost Western society at the mention that we should let chronic people die so they stop being a drag on society and that it would be 'not bad'. Statistically, it probably would not be that bad if people never died from simple, highly preventable diseases but that something like diabetes, cancer, etc., means that you die. It would certainly beat off all of the historical major killers. Of course there is no reason people have to die from those diseases, but it does mean that focusing on those low-level problems would substantially decrease death, and that the expensive treatments should be a secondary concern to ensuring that everyone has access to the low level stuff. And that's why you either support everyone or no one. Who would like to be the one deciding who lives and who dies? What is the limit? The uproar would be massive looking at the fringe case which would go "ah you're illness is just a bit too expensive to treat, no cares for you". You can't make general tules on those situations.
Making decisions on a budget is a reality of the real world. In some cases, yes, you have to let a fringe case of "your treatment for a disease you have a 10% chance of surviving is too expensive for us" end up being death, if it means that you can keep a system that saves many more people than that running. You can't save them all.
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On February 09 2017 05:40 Slaughter wrote:
Good Ole mitch being his awful self.
I have no idea what he was thinking when he did that. Or when he decided to issue a quote that would neatly fit on a bumper sticker or t-shirt. Maybe he feared that Curt Shilling might make it into the Senate after all and decided to give Warren a boost?
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United States42682 Posts
On February 09 2017 06:03 nojok wrote:Show nested quote +On February 09 2017 05:46 LegalLord wrote:On February 09 2017 04:58 Gorsameth wrote:On February 09 2017 04:14 LegalLord wrote:I think one small yet highly expensive piece of the puzzle that Kwark's analysis didn't address is that healthcare conditions that are resolved early on tend to be less expensive than ones that are put off until later. It would be an interesting experiment to see the general health of a society where simpler health goods and services - vaccinations, contraceptives, physicians, psychologists, general health advice, emergency services, dental care, and the like - are available free of charge for all citizens (and certain services like a yearly physical are mandatory), but no services of the more expensive kind are available (e.g. Chronic condition = death, no insulin injections are available). It would probably be about Cuba-like in its success rate, which is not that bad. Also, costs of healthcare in the last year of life. Perhaps it's better to just let particularly unhealthy people die a year early rather than keep them on life support for a fortune. Sounds callous, but I don't think the reality really is. You lost Western society at the mention that we should let chronic people die so they stop being a drag on society and that it would be 'not bad'. Statistically, it probably would not be that bad if people never died from simple, highly preventable diseases but that something like diabetes, cancer, etc., means that you die. It would certainly beat off all of the historical major killers. Of course there is no reason people have to die from those diseases, but it does mean that focusing on those low-level problems would substantially decrease death, and that the expensive treatments should be a secondary concern to ensuring that everyone has access to the low level stuff. And that's why you either support everyone or no one. Who would like to be the one deciding who lives and who dies? What is the limit? The uproar would be massive looking at the fringe case which would go "ah you're illness is just a bit too expensive to treat, no cares for you". You can't make general tules on those situations.
That's absurd. In every system there are people told their illness is too expensive. Say you had a disease that required daily injections that cost $1,000 from the only manufacturer of that treatment. If the insurance would pay for that, imagine a hypothetical of $1,001. And repeat until you get to the number where you say "sorry, you either pay for it yourself or you die".
Rationing is a reality of the system and the reality of rationing is that some people die because they're too expensive.
In the UK the organization who decides who lives and who dies is called NICE. Doctors, statisticians, actuaries etc working together to work out how much quality of life increase is worth the price.
Some drugs don't make the cut and the NHS won't provide them. You can still buy them privately but the NHS literally does say "your illness is too expensive to treat". But that's how it has to be. Because if you have a finite amount of money you have to try and allocate it as efficiently as possible.
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money.
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On February 09 2017 04:21 LegalLord wrote:
I also wanted to mention that it's kind of odd that Sanders was the one sent out to defend Obamacare in a debate. The first issue is that, as the establishment wing doesn't fail to point out, he isn't a party member. The second is that Obama blamed him for undermining support for the ACA from the left by supporting UHC. He definitely seemed to kind of distance himself from direct support of the ACA in favor of a more general support of improved, increased coverage for all.
Why not send out some beloved long-running darling of the status quo to make the case?
I think that CNN had more of a say in who to invite to the debate than the Democratic Party. This didn't seem like something where CNN approached the parties and said lets hold a debate on ACA who do you want to put forth as your champion. Remember that CNN is out for ratings and Sanders does have some amount of popularity coming out of the primary season. He also is passionate about UHC.
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United States42682 Posts
On February 09 2017 06:09 pmh wrote:Show nested quote +On February 09 2017 05:42 Thieving Magpie wrote:On February 09 2017 05:02 Gorsameth wrote:On February 09 2017 04:46 chocorush wrote:
On the insurance issues. What people think of as "insurance" isn't what they actually want. Insurance is a financial product meant to smooth costs over time (pay premiums + copay over a lifetime, rather than footing large spikes of medical costs). It's not meant to save you money, but make the spending manageable by spreading the total costs over your lifetime.
When the premiums no longer affect your own personal risk, that's what makes you feel like you're getting ripped off. On the other end of the spectrum, if you're one of those uninsurables, smoothing health costs over time does jack shit, because no amount of smoothing will make you not financially screwed because costs are already too high.
What people want, is actually just affordable healthcare, and I think disentangling the system with the insurance model is the only way we will be able to accept the realities of having to pay for it all one way or another. But because care is finite long term care is expensive. No amount of cost depression is going to make chronic treatment cheap enough for someone to pay during their lifetime. Esp if the illness stops them from being productive. Spreading the cost of sick people across healthy people is the only way available for the foreseeable future. There are states in the US where school districts are cutting the amount of school days rather than pay taxes to pay for children's education. Until you realize that half of americans would rather their own children lose opportunity rather than pay for other people's children then you'll never understand why there is resistance to socialized healthcare programs. I don't understand the resistance either. Healthcare is not a social welfare program,It is an insurance. A collective insurance when the government does offer it for everyone. When you pay for your healthcare insurance you are not paying for other people,you are paying for your own risk to get sick and be taken care of. In the end some people pay more then what they get in return and others pay less,just as with all other insurances that are there.
That's not accurate.
Individual insurance looks at your likely costs and gives you a premium that reflects your costs. With individual insurance there are no winners and losers, it's EV neutral, like betting $1 on a coinflip to win $2 if heads.
Collective insurance looks at the likely costs of the group. But individual members of that group paying their premiums may be healthier or less healthy than the average. The healthier members are paying for insurance against risks that do not apply to them, while the less healthy members are having their risks subsidized by that money. There are absolutely winners and losers. To return to the coinflip example, it's like three people each betting $1 on the outcome of two coinflips, one wins $3 if HH, one wins $3 if TT, one wins $3 if HT or TH.
Imagine if 100 people were made to buy flood insurance and only one of them lived on a floodplain. 99 of them are overpaying for insurance they don't need while the 100th is paying the same as the other 99 when he should be paying 100x that. That's collective insurance.
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On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money.
What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"?
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United Kingdom13775 Posts
On February 09 2017 06:31 cLutZ wrote:Show nested quote +On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money. What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"?
Everyone rides on the ass of the US's willingness to spend an absurd amount of money on their medicine.
Were that not the case, perhaps we would be forced to take waste more seriously in the industry.
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On February 09 2017 06:34 LegalLord wrote:Show nested quote +On February 09 2017 06:31 cLutZ wrote:On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money. What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"? Everyone rides on the ass of the US's willingness to spend an absurd amount of money on their medicine. Were that not the case, perhaps we would be forced to take waste more seriously in the industry.
There's other factors there too; like drug companies are allowed to spend money on marketing in the US. You could argue that each $1 they spend marketing they get >$1 back in new demand, but they could just as easily use the marketing to help support a higher price rather than drive a larger demand. Either way American people are paying for that marketing cost at some point either individually or collectively.
I don't really know what the right and ethical solutions are there, but pharma marketing is definitely an area to be looked at closely.
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United States42682 Posts
On February 09 2017 06:31 cLutZ wrote:Show nested quote +On February 09 2017 06:27 KwarK wrote:
One advantage though is that the NHS gets very different prices on drugs to US insurance companies. When you control access to 65,000,000 consumers and aren't afraid to say "no" drug companies will adjust accordingly because any price above the marginal price of each additional dose supplied (which is very different from price as calculated by the total cost of all doses(including all R&D) divided by the number of doses) is still profitable for them, even if it's below the amount they need to recover their money. What happens when all the countries have this model of "paying more than the marginal cost of a pill/treatment, but less than the cost needed to recover their money"?
Companies manufacture products that people will buy. With expensive healthcare drugs in order to have any chance at generating a profit they need to sell it to people who
A) Have that condition
B) Have $X to spend on the drug
those people*X = potential revenue
If potential revenue < cost of producing the drug then the drug won't get produced. And don't delude yourself into thinking that right now all potential treatments are being funded. This process happens, whether collective bargaining exists or not. Rare conditions that mostly afflict the poor aren't going to be top of the list for research in the US either because there's no money to be made.
The US insurance system increases X, I'll grant you, but it doesn't change the way this works. X still exists with collective bargaining, it's just calculated differently. The NHS would still represent a big customer for a potential drug that offered actual value for money. It's just for the purpose of the pharma company the population of the UK are all excluded from "Have $X to spend on the drug" if the price of the drug is higher than the NHS are willing to pay for it. For the purpose of how much the NHS has to spend on a drug, it's capped at whatever the value of the benefit is calculated to be. If you have a good drug at a good price you'll still be able to sell it at a premium.
Collective bargaining doesn't disincentivise drug research, no more than people just being poor does. Those customers never existed at the price the drug companies wanted. They were all too poor to afford it. Collective bargaining allows the manufacturer to generate additional profits by expanding their customer base into a group that previously had been disregarded as not being potential customers.
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