The Trump Presidency - how I stopped worrying and learned to love the Hair

prizrak

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It's not only a question of choices, not only a question of costs, but also of social opportunity costs.
That's kind of where I am going with in general with my thinking on this. Even if people made some bad choices that caused them to be in a position where they are homeless or hurt, there is general opportunity cost to society. You can help a person get back on their feet and hopefully they become a contributing member of society or you can go with social darwinism. In the latter case the problem is that we still bear the cost of that person not working, directly through having to pay more in hospitals and emergency services and indirectly from that person not participating in the economy.
 

prizrak

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I'll counter your sob story: I know someone who works his behind off at a small business but still can't afford health insurance and is forced to pay penalty fees for not being able to afford health insurance by the ACA.
No one said ACA is a good idea, it was terrible from the get go and nothing but an extra layer of stupid.
I've said it before - I'd be willing to entertain the idea of single payer but only if we somehow got costs under control. Typically, anything the government controls has sky-high costs because there's no competition and seeing as we're starting off with high costs to begin with, I fear it would only get worse under single payer. In any case, I'm not going to support any plan that raises my tax burden because I already pay a ton.
That's my exact same problem, I don't trust the Feds to do anything right. Though I will say that in this particular case competition is largely irrelevant, rates that are paid out to healthcare providers are set/negotiated by the insurance companies and don't really reflect the price you as a beneficiary pay. Bigger companies with a larger network tend to get more favorable rates simply because they have the numbers behind them. In a case of single payer government is doing the negotiating on behalf of the entire country and they can more or less set rates as they please. Also single payer doesn't have to mean end of private insurance or cash only practice, there are still going to be elective procedures not covered by government and one can always differentiate with a higher standard of care. For example my previous physician left her normal practice and joined some special VIP program, if you want to see her you have to pay a certain membership fee into the program and she is limited to only having a certain number of patients. That means that she can space out appointments, spend more time with each patient and decrease wait times. She still takes insurance plans and still does the same care but just for fewer people. I don't see why something like that can't still exist under single payer. Don't wanna sit in a crowded hosptial room or an office? Welcome to our VIP service.

- - - Updated - - -

Shouldn't your friend just go get a new job then? /sarcasm
+vrtual rep
 
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PelicanHazard

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That's my exact same problem, I don't trust the Feds to do anything right. Though I will say that in this particular case competition is largely irrelevant, rates that are paid out to healthcare providers are set/negotiated by the insurance companies and don't really reflect the price you as a beneficiary pay. Bigger companies with a larger network tend to get more favorable rates simply because they have the numbers behind them. In a case of single payer government is doing the negotiating on behalf of the entire country and they can more or less set rates as they please. Also single payer doesn't have to mean end of private insurance or cash only practice, there are still going to be elective procedures not covered by government and one can always differentiate with a higher standard of care.
This is ideally how I'd see it implemented. It's not that I want single-payer to supplant all existing insurance and practices, it would just guarantee that every American can get an acceptable minimum of health care because there's social benefits to a relatively healthy populace. It shouldn't cover 'vanity' procedures like nose or boob jobs. Nor should it cover the higher end, less cost-effective alternatives of procedures. For example, there's many types of tooth fillings at many price points. Single payer shouldn't have to cover the higher end fillings if a cheaper one is as practically effective. If you want some cosmetic plastic surgery or higher quality fillings, you get private insurance or something else to cover it.

In a way, you could see it like education: there's more benefits than costs to an educated populace, so people generally agree that public schooling to a minimum standard is worth it. If you want better than that minimum standard, pay for private schooling; it has its own benefits over public schooling, but isn't for everyone.
 

PelicanHazard

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That minimum standard is abysmally low though. Our public schools are horrible, largely thanks to teachers unions. I'm quite nervous that government would completely screw up healthcare too (look at the VA).
Standards can be raised or lowered, often at the whims of legislature if Pennsylvania's schools are any indication, I was just illustrating the system I'd ideally like to see in single-payer. The VA is its own special ball of wax, what with the screwy transition from active-duty Tricare to the VA system, the 16 year war and counting, and a general American disregard for veterans. So while the fear of the government screwing up is quite real, I don't think it would get as bad as the VA.
 

prizrak

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That minimum standard is abysmally low though. Our public schools are horrible, largely thanks to teachers unions. I'm quite nervous that government would completely screw up healthcare too (look at the VA).
VA is different though, all of the people working there are government employees. We are talking basically medicaid for all.
 

prizrak

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I've seen private insurance controlled by government here in MA when I worked in auto insurance. It's a mess. The state has serious trouble figuring out what reasonable rates are both from the consumer's standpoint of not going broke and from the companies' need to make a buck. A lot of the time the comoanies are either able to bypass the state's attempts to reign in rates* or they spend years trying to convince the state that, for example, car parts are becoming more expensive and covered repairs necessitate higher premiums.

*MA has also attempted to get rid of "red-lining". Basically they are afraid that a single mother of two working three jobs in a shitty part of town and driving an old Honda wouldn't be able to get coverage because she's a huge risk. They've also declared that every single driver needs to be insured. At first we had a high risk ceded pool which immediately filled up with basically poor people in poor towns (i.e. people with vehicles most likely to be stolen, living in places where fraud and vandalism are widespread). Seeing how silly that idea was, they moved to an assigned risk plan, according to which drivers that can't find a company to write them voluntarily would be forcibly assigned to a company. All this did was create red-lining, the exact problem MA wanted to solve - for example, my rate dropped like a rock when I moved from Boston to the suburbs.

So fine. Not a VA example. But one much closer to what single payer healthcare would look like, with some personal experience with it. It's a g-ddamn regulatory mess, the rates are high, and poor people still get screwed.

Now compare the above story with our neighbor, NH, where insurance is not mandatory, 90+% still choose to get insurance, and rates are some of the lowest in the country.
All of the above is why I'm skeptical, though in case of a single payer you presumably wouldn't need an intermediate company to deal with rates. Just a point about NH, they don't have Bawstahn big cities tend to have high premiums. My insurance is literally the highest in the country, even moving to another borough would easily half my rate (currently moving is just not realistic before you ask) and even the lowest rate in the city itself would still be noticeably higher than the rest of the state even it's somewhere that directly borders it.
 

Dr_Grip

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The question about universal healthcare is a policy question first and an implementation question second. I can't remember a time during my life where "healthcare reform" wasn't on the agenda of either the opposition of the ruling parties in Germany. Just like a free market does not always produce perfect results*, a government-run or co-opted system will never work perfectly. But that holds true for any non-universal solution (for veterans, the elderly, those in need) as well: It boils down to whether universal healthcare is wanted politically or not. No matter how you decide, getting the resulting setup to work will be an ongoing project.
Now, one could argue that one scenario is easier to set up tham the other, but taking the easy way out is seldomly the politically wise choice....

*We have to keep in mind that even Adam Smith's legendary "invisible hand" metaphor originates from a chapter of "The Wealth of the Nations" where he explains where the free market does not work.
 
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Eye-Q

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I guess it's from the same WrestleMania as this clip. That said, a POTUS absolutely shouldn't post/tweet/whatever such a clip, that makes him a dick, but we already knew that long before he tweeted this clip...
 

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I've seen private insurance controlled by government here in MA when I worked in auto insurance. It's a mess. The state has serious trouble figuring out what reasonable rates are both from the consumer's standpoint of not going broke and from the companies' need to make a buck.
Well... healhtcare is an endless pit of money, nobody nowhere expects state funded health care to make a buck. It's just something you need, or someone you know will need, if not everyone, sooner or later, so you don't mind paying your due.

The problem here is the difference between health care, and health insurance.
Health insurance to me makes absolutely no sense. The way insurance companies make money is basically making educated bets on what will or will not happen. You can go from 0km to scrapyard with a car and have 0 accidents requiring your insurance to be involved in, or you can crash it taking it out of the showroom, that's why you need car insurance. But you know with the certainty that the sun rises in the east and sets in the west, some day in your life you will need a hospital and a doctor.
 

mpicco

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Insurance is all about spreading risk, which single-payer would not do.
Health should not be insured. I believe its one of the basic human rights as "all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."

You can't have life if you don't have health.
 
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