If you are still looking for inconsistencies in my position, then you haven't yet accepted that I want to find compromise solutions. I am ok with not getting everything I want. We're all walking inconsistencies anyway.
That said, you are right to call me out on that and student loans because I slipped into talking points mode, which was a futile attempt at one-upsmanship. I'm never going to convince you my opinion is the right one, and vice-versa. All that matters is we both have an accurate understanding of the other's worldview so we can discover where the give and take can happen.
> Why not just have a public option open to anyone, and let "the market" compete with that?
My answer is just another weak talking point regarding US states that have tried that and failed. The private market in those states predictably collapsed because employers took the opportunity to dump employees onto the state run plan. Which was, of course, the goal and no one is fooled.
The story ends sadly however, the state tax base couldn't support everyone dumped on the public option and virtually no one remained on the private plans to subsidize the public ones. So, the public options got scrapped. States can't run a debt like the Federal government can, so their plans have to square financially or the whole apple cart gets upturned. There's the harsh reality for ya! <mic drop>
And that was the most pathetic, cherry picked story with zero details that didn't include counter-stats about the thousands of mothers and children getting health care for the first time in those states, etc etc. You sank my battleship! Did I just change your mind about single payer? Of course not, and that's fine by me.
I just hope you are softening to the idea that someone who disagrees with you is not automatically an ogre, and can be well-meaning. There is far too much distrust driving factions in our society, when it is easy to find so much common ground if we just talk.
My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.
See, we both have solid points that the other must certainly agree with - the evidence is clear on both sides. What is not obvious is that one position does not negate the other. There is a right balance to be found between the two.
Here's how we balance as I see it: we don't dare make policy that wrecks the market so we keep the bounty -and- we don't dare leave people to suffer and die when we have all this bounty. BOTH! Not one at the expense of the other. Cautious, tuned, scientific, numbers based, avoid failures from history, and give ourselves grace that we're doing our best and we'll never reach Utopia.
> Poor people get crap healthcare while rich people get great healthcare
The world is not static. Today's crap healthcare and over the counter meds are impossible, miraculous health care if you compare with what people experienced historically. Caesar lived less healthfully than the American lower class. How can we get more good stuff into more people's hands more efficiently?
MRI's won't ever be as cheap as paper clips, but in twenty years TCFT hand scanner technology will make MRI's a blip in history and you will even be able to buy a consumer-grade scanner for a few hundred bucks at Walgreen's. Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.
>The world is not static. Today's crap healthcare and over the counter meds are impossible, miraculous health care if you compare with what people experienced historically.
Isn't this just a weaselly way of saying that you're perfectly fine with poor people getting much worse care than rich people? What does it matter that they're getting better care than rich people did 100 years ago?
>Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.
I'm sure that is a great comfort to uninsured patients with stage 3 cancer! We could just give them the care they need right now, but I guess it's better to wait some indeterminate amount of time till the market brings the cost of chemotherapy down to $100/month.
>My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.
As far as compromise is concerned, I don't really see any room for it here. There are many ways to provide universal health coverage. I have not insisted on a single payer system at any point in this discussion. However, it seems that what you want to compromise on is not the means of delivery, but the universality itself.
In all of your long and irrelevant discourse on various economic points, I don't detect any concrete statement of what it is about the current system in the US you don't like, and how you'd actually propose to change it. So it seems to me that you de facto support the current system.
No economic system has abolished status or privileges.
Not even Communism. To fight status itself is to fight human nature. People will always try to obtain benefits and pass them down to their children.
200 years ago, all medicine was hospice care. Allocating resources to an industry for which there is infinite demand for - staying alive - will be difficult.
>Allocating resources to an industry for which there is infinite demand for - staying alive - will be difficult.
Will it? The NHS does an ok job. Not perfect by any means, but much better than the US.
I don't demand perfection, just something significantly better than a situation where 15% of the population are uninsured. Do you think that is so terribly difficult?
> Isn't this just a weaselly way of saying that you're perfectly fine with poor people getting much worse care than rich people? What does it matter that they're getting better care than rich people did 100 years ago?
Why do you want to fight, friend? Maybe you perceive moral superiority such that it's easier to tear down than cooperate. Like I said before, that's a recipe for disappointment. Improvements in health care matters because that's a trend that is apparently still continuing. What am I missing?
And I'm not fine with cancer, another insult! Don't you get me yet, my friend?
I do know we're going to definitively cure cancer soon such that the treatment doesn't break the bank as it does today. Until that happens, let's work to bring down the costs AND help out people who can't afford what services are on offer today. Why not both?
> what it is about the current system in the US you don't like
I don't like how the health care insurance covers everything. The cheap stuff should be out of pocket so that individuals shop on price for those services and we build a competitive marketplace on the simple stuff.
I want up-front pricing for services in hospitals, and if I am of sound mind, I must opt into services before they are delivered. Finding out what services cost after I get them is one of the scammiest features of the current system.
I don't like how drug prices are artificially inflated in this country by Medicare and Washington cronies.
If I were a dictator, I'd mandate everyone who takes a salary must save some percentage (6-8%) of every paycheck in a personal medical savings account the way that Singapore does. If you get health services, you have to pay the full freight for the services out of your account, encouraging market forces. When that account runs out, you're screwed.
It's not taxed, and you can leave your account to your heirs. You can also buy catastrophic health insurance so you're not screwed in the event of a big event. The government offers low-income people additional catastrophic health insurance options and charities help pick up the rest of the slack.
We can't force that kind of mandatory savings in the US, it's unconstitutional. But, if we could go the mandatory MSA + catestrophic health insurance route, we would maximize market forces and yield results close to universal coverage that results-wise goes far beyond anything you can propose.
See? I've thought all about it.
I could just as easily say, "you have no realistic plans for controlling costs while delivering high quality service in abundance." But I suspect the life and death aspect of health care is an overriding priority for you, and delving into cost/waste/fraud/abuse is a non-starter. I believe that access to health-care in name only (a.k.a. government-induced rationing) is no health-care at all, though. Affordable, effective, abundant: pick 3.
So, no more insulting my intelligence, and please assume good faith, my friend!
You've written a lot without addressing the key point. It seems that you are fine with poor people getting much worse care than rich people. At least, you've declined several opportunities to indicate that you're not fine with this, and none of the suggestions that you're making would make things any better for Americans who currently lack insurance. Indeed, you're quite clear about what happens to people who can't pay up: "When that account runs out, you're screwed." Charming.
The fact that the cost of cancer treatment may go down in future is totally irrelevant to the question of how we pay for people's cancer treatment today. As far as I can see you only bring it up as a means of dodging the question of how poor people can get cancer treatment now. Rather than indicate how this might be possible now under the system you envisage, you talk about how it might be possible 100 years hence. You may whine about me taking the moral high ground, but can't you see how crass it is for you to play down people's present suffering on the grounds that people 100 years hence may be better off? What sort of reaction were you expecting to comments of that nature?
The concept of "catastrophic" health insurance transparently makes no sense. Any insurance plan that doesn't cover all the expensive treatments is next to useless. So obviously, no-one (either insurers or patients) can save very much money by nickel and diming patients for inessential treatments. Indeed, if these "catastrophic" plans don't cover screenings and other preventative measures, they'll probably end up increasing everyone's costs in the long run.
Bizarrely, you seem to think that the main problem with the current system is that people have too much coverage. This makes so little sense that I'm unable to engage you on that point. This is particularly so given that you are simultaneously so vague about the nature of the system that you favor and so unwaveringly certain that it would deliver better "results" (if, of course, we ignore all the poors).
The countries that pay less for drugs are the countries with a greater level of centralisation and government control. Drug companies are behemoths, and it takes another behemoth to negotiate a good deal.
>I could just as easily say, "you have no realistic plans for controlling costs while delivering high quality service in abundance."
I can point to plenty of existing systems that do this. E.g., the healthcare system of pretty much any European country.
Thank you for a respectful reply. I feel like we're finally talking.
> You've written a lot without addressing the key point. It seems that you are fine with poor people getting much worse care than rich people. At least, you've declined several opportunities to indicate that you're not fine with this, and none of the suggestions that you're making would make things any better for Americans who currently lack insurance. Indeed, you're quite clear about what happens to people who can't pay up: "When that account runs out, you're screwed." Charming.
I said that blunt thing on purpose, partly to draw you out and get you to express yourself, and partly to express my philosophy.
I am not fine with disparity, I just don't believe we can eliminate it through top-down, central planning or through collectivization. That's my bottom line; we probably won't ever bridge this philosophical chasm between us. But I appreciate having the opportunity to explain myself conversationally to you.
Expanding my thoughts a little, in my opinion government is particularly bad at addressing inequity because on the ground there is zero incentive for individuals in government to fully solve problems - that would put government workers out of a job. Yes, some people get aid, there's some salve for the hurt, but on the whole government spending on "programs" tends to be a racket for cronies.
I don't expect you to agree, just explaining my thoughts. If you want to provide contrary notions, and give some depth to your worldview, I'd like to hear it. I would like to know how we solve the problem of poor and rich getting the same quality services without also degrading the services.
Regarding the "screwed" comment - guilty as charged - that was too harsh. Here's the nagging concern that drives my thinking: when there is a natural disaster and community, family, and government structures are stripped away, people are forced to fend for themselves. If they haven't prepared for disaster mentally and with provisions, they can die needlessly.
So, I favor a government whose policies encourage self-sufficiency and resilience that will lead to a robust populace that can be free and happy in their own situation and not make themselves prostrate to others for their survival. Dependency, like debt, is slavery. Freedom is totally worth the trouble we put people through.
In my dictator scenario, I envisioned forced savings for routine medical bills, optional catastrophic health insurance for the unexpected huge claims, and freedom to shop for providers as the route to "well-nigh universal" health care.
You would need to be my advisor though, because there are always destitute people in any society that have no income and have no insurance. We'd would need to provide for them somehow. I'm open to haggling on various points. ;)
> The fact that the cost of cancer treatment may go down in future is totally irrelevant to the question of how we pay for people's cancer treatment today.
Yeah, it's an awful problem! You sound very fed up and in a rush to see action especially on cancer. What would you do as dictator to address this? Make me your trusted advisor!
I observe cancer treatments are at least improving and we're getting better outcomes. We should at least look for ways to lower costs to make treatments available to more patients. It's not a perfect solution, but it's a start.
> The concept of "catastrophic" health insurance transparently makes no sense.
We just see the utility of insurance differently than you do. I see it as a backstop, not a catch-all. I want people to pay out of pocket for the simple stuff so they search for and demand lower cost options. That lets the market deliver the goods.
> Bizarrely, you seem to think that the main problem with the current system is that people have too much coverage.
No, I don't think that. The US definitely has a dysfunctional way of covering the poor however (emergency rooms that take all comers.) I would love to see some fixes there, because the system we have now encourages the poor to suffer with easily treatable conditions and is very inefficient economically. It's easy to make rational arguments about delivering health care services to the indigent. Frankly, I think such arguments are unassailable.
My position is that health care in the US is overregulated and lacking market forces that could control costs. I don't believe a single-payer system in the US would be accompanied by deregulation, and therefore costs would continue to rise.
> The countries that pay less for drugs are the countries with a greater level of centralisation and government control. Drug companies are behemoths, and it takes another behemoth to negotiate a good deal.
I have heard this argument before and never understood why the blame isn't placed 100% on government. What you describe should have happened decades ago.
Medicare and Medicaid covered 37% of health care costs in the US in 2017.[1] That is HUGE buying power, they can set the worldwide prices for drugs. Noone who is in power at the federal level seems at all interested in negotiating.[2]
That's a very interesting article that takes years to get to the money quote:
> No Negotiation, the Price Is Set
> The major reason for the disparity in pricing is that the United States lacks any sort of central or universal healthcare system or agency that regulates across the board cost. In contrast, negotiations of drug prices between governments and pharmaceutical companies are routine in Canada, most European nations, and most countries in the Middle East and Far East. They have centralized authorities to negotiate more favorable prices with manufacturers, and some also have drug formularies and advisory boards that put restrictions on the use of new and expensive medications.
Wow, sounds good, what's the hold up?? From later on:
> However, by law, the federal government cannot negotiate for Medicare drug prices or obtain any sort of volume discounts.
It was Medicare Part D where the feds jumped deep into the prescription business and this mischief got started. High drug prices in the US is baked into the plan. And there's no incentive to fix the problem because everyone is on the take.
This is where you and I are, I hope, arm-in-arm. Medicare should negotiate with these drug companies such that all Americans get drugs at rates offered to comparable countries! Abolish that corrupt law. I'm not even talking about price controls, I just want the same or better deal that every other country negotiates.
But, Democratic and Republicans are attached like barnacles to the special interest money and that bad law is a worth a fortune. This isn't an abstract issue: people are suffering and dying today because of cronyism. Awful realities like this destroy my faith in government, especially federal. If I am wrong on this, I would love to have you explain it to me.
Thank you again for being so peaceable in your reply. I felt very relaxed replying to you this time.
If you are still looking for inconsistencies in my position, then you haven't yet accepted that I want to find compromise solutions. I am ok with not getting everything I want. We're all walking inconsistencies anyway.
That said, you are right to call me out on that and student loans because I slipped into talking points mode, which was a futile attempt at one-upsmanship. I'm never going to convince you my opinion is the right one, and vice-versa. All that matters is we both have an accurate understanding of the other's worldview so we can discover where the give and take can happen.
> Why not just have a public option open to anyone, and let "the market" compete with that?
My answer is just another weak talking point regarding US states that have tried that and failed. The private market in those states predictably collapsed because employers took the opportunity to dump employees onto the state run plan. Which was, of course, the goal and no one is fooled.
The story ends sadly however, the state tax base couldn't support everyone dumped on the public option and virtually no one remained on the private plans to subsidize the public ones. So, the public options got scrapped. States can't run a debt like the Federal government can, so their plans have to square financially or the whole apple cart gets upturned. There's the harsh reality for ya! <mic drop>
And that was the most pathetic, cherry picked story with zero details that didn't include counter-stats about the thousands of mothers and children getting health care for the first time in those states, etc etc. You sank my battleship! Did I just change your mind about single payer? Of course not, and that's fine by me.
I just hope you are softening to the idea that someone who disagrees with you is not automatically an ogre, and can be well-meaning. There is far too much distrust driving factions in our society, when it is easy to find so much common ground if we just talk.
My position is: the market left to do its thing produces goods/services that are cheap and plentiful. Yours is, I think: the market has no soul and there is corporate greed/corruption and the market will always have losers, so we need to intercede and level the playing field for people. Please correct me if I got you wrong.
See, we both have solid points that the other must certainly agree with - the evidence is clear on both sides. What is not obvious is that one position does not negate the other. There is a right balance to be found between the two.
Here's how we balance as I see it: we don't dare make policy that wrecks the market so we keep the bounty -and- we don't dare leave people to suffer and die when we have all this bounty. BOTH! Not one at the expense of the other. Cautious, tuned, scientific, numbers based, avoid failures from history, and give ourselves grace that we're doing our best and we'll never reach Utopia.
> Poor people get crap healthcare while rich people get great healthcare
The world is not static. Today's crap healthcare and over the counter meds are impossible, miraculous health care if you compare with what people experienced historically. Caesar lived less healthfully than the American lower class. How can we get more good stuff into more people's hands more efficiently?
MRI's won't ever be as cheap as paper clips, but in twenty years TCFT hand scanner technology will make MRI's a blip in history and you will even be able to buy a consumer-grade scanner for a few hundred bucks at Walgreen's. Ok, I made that up, but hopefully you get the point that greater things are coming than the things we have now.