ACA Repeal/Replace: Progressives Face Moral Dilemma

[SomeGuy]

(03-11-2017, 03:49 PM)Bob Butler 54 Wrote:

(03-11-2017, 03:27 PM)SomeGuy Wrote:

Quote:And if one believes that health care is a basic human right, letting each state decide who has that basic human right is kinda dubious morally.  As soon as the phrase 'human right' is in the mix, local solutions that deny such rights can seem questionable.

Which is probably why the term should not be continually expanded to include more and more policy preferences.  It makes governing a large and heterogenous country kinda difficult.

In abstract, I agree with you.  The Supreme Court has been more aggressive than I like in inventing new rights.

In specific, do you feel confident, seeing someone sick, in saying they shouldn't get access to health care?  UDHR 25 wasn't declared by five old men.  Eleanor Rosevelt somehow wrangled it out of the UN General Assembly.

Specifically, how do you feel about seeing a hungry person go without food?  Does your solution to this include nationalizing the nation's farms and restaurants?

[Bob Butler 54]

(03-11-2017, 03:55 PM)SomeGuy Wrote:

(03-11-2017, 03:49 PM)Bob Butler 54 Wrote: In specific, do you feel confident, seeing someone sick, in saying they shouldn't get access to health care?  UDHR 25 wasn't declared by five old men.  Eleanor Rosevelt somehow wrangled it out of the UN General Assembly.

Specifically, how do you feel about seeing a hungry person go without food?  Does your solution to this include nationalizing the nation's farms and restaurants?

One can have homeless shelters without nationalizing hotels. One can have soup kitchens without nationalizing restaurants. What makes you think differently?

[SomeGuy]

(03-11-2017, 05:23 PM)Bob Butler 54 Wrote:

(03-11-2017, 03:55 PM)SomeGuy Wrote:

(03-11-2017, 03:49 PM)Bob Butler 54 Wrote: In specific, do you feel confident, seeing someone sick, in saying they shouldn't get access to health care?  UDHR 25 wasn't declared by five old men.  Eleanor Rosevelt somehow wrangled it out of the UN General Assembly.

Specifically, how do you feel about seeing a hungry person go without food?  Does your solution to this include nationalizing the nation's farms and restaurants?

One can have homeless shelters without nationalizing hotels.  One can have soup kitchens without nationalizing restaurants.  What makes you think differently?

Likewise, one can provide healthcare to the needy without necessarily mandating single-payer.

[Bob Butler 54]

(03-11-2017, 05:25 PM)SomeGuy Wrote:

(03-11-2017, 05:23 PM)Bob Butler 54 Wrote:

(03-11-2017, 03:55 PM)SomeGuy Wrote:

(03-11-2017, 03:49 PM)Bob Butler 54 Wrote: In specific, do you feel confident, seeing someone sick, in saying they shouldn't get access to health care?  UDHR 25 wasn't declared by five old men.  Eleanor Rosevelt somehow wrangled it out of the UN General Assembly.

Specifically, how do you feel about seeing a hungry person go without food?  Does your solution to this include nationalizing the nation's farms and restaurants?

One can have homeless shelters without nationalizing hotels.  One can have soup kitchens without nationalizing restaurants.  What makes you think differently?

Likewise, one can provide healthcare to the needy without necessarily mandating single-payer.

Sure can.  Write up a bill saying how.  See if you can get it passed.

We've currently got a mix of employer, self and government payments.  There are a lot of self interested factions involved who care more about their own pockets than keeping everyone healthy.  There are enough plausible schemes that none of them are in a good place to attract a clear stable majority.

Single payer would be one clean simple approach.  Subsidizing those who can't afford or access the current mix of private, company and government sponsored systems is uglier, but could be made to work.  Lots of systems could be made to work if there was some sort of consensus on how to go about it.  Thing is, there are a lot of self interested folk who want to push costs away from their own demographic.  The GOP scheme favors the healthy and the wealthy, drifts away from UDHR 25, the notion that everyone should have some access.  

Lots of ideas being thrown around, but I don't have a magic scheme that will attract a clear stable majority.  The nation is too divided.  Lots more bickering to be endured.

[SomeGuy]

Quote:Sure can.  Write up a bill saying how.  See if you can get it passed.

It's very difficult to take you seriously when you substitute emotional appeals for rational argument on an issue like this.  It is impossible when you give every sign of not being able to tell the difference between the two.
We already provide healthcare for the needy.  There is Medicaid for the poor, there is Medicare for the elderly, there is the VA for veterans, we provide EMS stabilization and transport to the hospital at the dial of a phone, and if all else fails you can just show up at the emergency room.  This leaves out insurance for the middle classes, and charitable work by various non-profit groups.  The question is less one of care provision than it is of the price of care.  How much should be spent, by whom, on what.  That is the question, and it is not one that is answered by appeals to pathos.  

Quote:Single payer would be one clean simple approach.

That is an option, though to go beyond political rhetoric and on to implementation would require many more hard questions to be answered.

Quote:Subsidizing those who can't afford or access the current mix of private, company and government sponsored systems is uglier, but could be made to work.

That's more or less where we're at now, and it doesn't seem to be terribly effective, either in terms of price or quality.

Quote:Lots of systems could be made to work if there was some sort of consensus on how to go about it.

There's the rub.

Quote:Thing is, there are a lot of self interested folk who want to push costs away from their own demographic. 

You know, technically that is what poor people are doing as well when they demand that something be provided to them at the government's expense.  This is not necessarily an argument against it, just an observation.

Quote:Lots of ideas being thrown around, but I don't have a magic scheme that will attract a clear stable majority.  The nation is too divided.  Lots more bickering to be endured.

There does not yet seem to be an effective consensus, too many vested interests (the middle class, the insurance agencies, the existing burauecracies, the AMA, the pharmaceutical companies, etc.) In the absence of one, devolving this to the states is one option.

[Kinser79]

The tags are getting cluttered.

Bob Wrote:I don't know that the problem is size, or primarily size.  Most every civilized nation has found some sort of solution, most of which could be scaled up.

In my previous post I noted not only the size of the country (geographical area makes large areas harder to govern) but also the racial/ethnic, economic and political diversity of the nation.  Democracies function more readily in homogeneous societies (see most of Europe prior to the current Muslim Invasion) and Japan.  The US, and India are exceptions to this, but both have instituted a system of federalism to handle the problem.  India's federalism is stronger than the that of America.

Autocracies can expand theoretically infinitely but in so doing distance from the capital increases the corruption level.  An old Chinese saying is "The Emperor may be supreme but he is also far away". 

Quote:I just happen to take access to health care as being a basic human right, but somebody's got to pay for it.

We have to be clear here.  When you say health care you mean the actual provision of care.  That is to say going to the doctor.  I'm fine with viewing that as a right.  Honestly I want sick people to go to the doctor--mostly so they don't make me sick if their disease is infectious.  Enlightened self-interest there.

That being said if we're talking about the paying for the provision of health care then the answer is simple.  Make a deal.  When I was faced with the choice of making a deal with a private doctor or going to the VA I made the deal.  The VA fucking sucks, and not in the good way.  People went to doctors before insurance existed, they will go to doctors long after our civilization collapses (which I view as inevitable anyway).  I would not however, say that health care insurance is itself a human right.  People have no more right to insurance of any kind than they have a right to own stocks or bonds.

Quote:Letting the states handle it would break the problem into fifty parts.

And that is a bad thing how specifically?  When I'm fully dressed I wear 10 different articles of clothing (and no I'm not talking about a suit).  They are shoes (2), socks (2), drawers, trousers, undershirt, shirt, belt and hat.  I don't try to make my shirt cover my feet nor do I try to cover my head with my shoes.

Has it occurred to you that perhaps New York or Florida needs the shirt or trousers while Wyoming needs a sock?

Quote:If we keep trying to attack it at the federal level, and the dominant party keeps making the population unhappy, every four or eight years the whole health care system might get thrown upside down.  Not ideal.

It is worse than not ideal, it is unconstitutional and actively destructive.

Quote:And if one believes that health care is a basic human right, letting each state decide who has that basic human right is kinda dubious morally

Only if one takes Health Care is a human right to mean "health care insurance is a human right".  There is a difference between if you're sick go to the doctor figure out how to pay for it later, and everyone must either buy XYZ type of product.

If we take Health Care is a Human right to mean "when you're sick go to the doctor, he'll treat you" then it becomes a matter of mere provision of a service.  Strangely the private sector is really good at coming up with ways to provide services at prices nearly everyone can afford.  If a governmental entity is absolutely vital to the provision of some of this care, then the states can and should provide free/low cost clinics for the destitute/poor (so they aren't cluttering up the ERs).

That being said, every service provided by a government eventually turns into the DMV.  I strongly suggest you discuss going to the VA with a vet whose only source of health care provision is the VA.  I bet they have stories that would make your hair (or remaining hair) kink up tighter than mine.

Mostly Guy took care of the rest of my responses for you

[Mikebert]

(03-11-2017, 06:08 PM)Kinser79 Wrote: We have to be clear here.  When you say health care you mean the actual provision of care.  That is to say going to the doctor.  I'm fine with viewing that as a right.  Honestly I want sick people to go to the doctor--mostly so they don't make me sick if their disease is infectious.  Enlightened self-interest there.

That being said if we're talking about the paying for the provision of health care then the answer is simple.  Make a deal.  When I was faced with the choice of making a deal with a private doctor or going to the VA I made the deal. 

This is the view of a young person. He says just make a deal. For some things you can make a deal.  When I was young I went without insurance for some years during which time I received injections for allergies and had all four wisdom teeth extracted. Both of the treatments I received were simple things that have been done for a long time, since before the advent of widespread employer-paid insurance.  Thus when insurance came along there was a well-established price for these services and since insurance pays the "reasonable and customary" fees the amount this was set at was reasonable*.  So I paid cash--about a thousand bucks for each, out of my savings. 

But medicine has advanced since the forties.  And the treatments developed since then have big price tags. Had I developed cancer I would be SOL.  The typical initial treatment for cancer is surgical and they are going to want $50K for that, and if first line of attack doesn't work and you need chemo and/or other expensive treatments.  You can rack up a lot more in no time. 

And no, you can't just go to the emergency room.  They only have to treat you if you are at risk of imminent death. By that time you have long been a goner.  But once you show up in that state, the hospital duly provides tons of expensive care to a soon-to-be corpse. 
Makes no sense, but hell we are Americans and stupid is how we roll.    

Also Medicaid is a program for some poor people. Able-bodied guys in my state were not eligible for Medicaid before our Republican governor opted for the ACA Medicaid expansion against the wishes of the Republican legislature.  And when the expansion goes away under Trumpcare they will lose eligibility.  Kids get coverage, and I believe pregnant women and women with small children but I am not certain of this.

*This is why your primary care doctor's fees are so much more reasonable than what specialists charge. People did go to the doctor (i.e. a GP) back in the day.  They generally did not go to a specialist and had procedures done.

[Kinser79]

(03-12-2017, 04:01 PM)Mikebert Wrote:

(03-11-2017, 06:08 PM)Kinser79 Wrote: We have to be clear here.  When you say health care you mean the actual provision of care.  That is to say going to the doctor.  I'm fine with viewing that as a right.  Honestly I want sick people to go to the doctor--mostly so they don't make me sick if their disease is infectious.  Enlightened self-interest there.

That being said if we're talking about the paying for the provision of health care then the answer is simple.  Make a deal.  When I was faced with the choice of making a deal with a private doctor or going to the VA I made the deal. 

This is the view of a young person.

I'm no where near as young as I used to be. Granted I'm not old either but I have health problems of my own. Yes, already.

Quote: He says just make a deal. For some things you can make a deal.

Not true. Since when I spoke of making a deal we were talking about provision, the doctor doesn't get paid if he doesn't treat you. Therefore it is in his interests to treat you, even if he may have no obligation to legally or even morally speaking. As such it is almost always possible to make a deal.

My mother is already in her 60s but still too young for medicare. She goes to the doctor and has actually had to finance procedures before. Most recently was a surgery to repair a tear on her retina. Her so-called Cadillac plan wouldn't cover it. She needed it done or her other option was blindness in that eye. Amazingly the doctor made a deal. Seems he wanted to both treat his patient and get paid.

What I think you mean to say here is that one might not always be able to afford the deal offered. In which case there two options, find someone cheaper or do without. If we're talking about treating a cancer for example that has a high likelihood of being terminal then there is little point of spending anything on treatment.

 

Quote: When I was young I went without insurance for some years during which time I received injections for allergies and had all four wisdom teeth extracted. Both of the treatments I received were simple things that have been done for a long time, since before the advent of widespread employer-paid insurance.  Thus when insurance came along there was a well-established price for these services and since insurance pays the "reasonable and customary" fees the amount this was set at was reasonable*.  So I paid cash--about a thousand bucks for each, out of my savings. 

If you paid 250 dollars per tooth you got ripped off man, unless we're talking a bony impaction. I had my wisdom teeth removed prior to joining the Navy (they came in malformed rather than crooked as is usually the case). The price I got in 1998 was 250 and I'm assuming you didn't have your wisdom teeth removed when you were in your 40s (and I'm guessing you're about 15-20 years older than myself being a Boomer). Should have shopped around cause I know that 250 1978$ > 258 1998$ (cuz inflation).

Insurance or not, here's the thing. In a free market every good and every service will eventually reach it's equilibrium price.

Quote:But medicine has advanced since the forties.  And the treatments developed since then have big price tags.

They have big price tags because they are in the main being paid for by insurance companies rather than the patients. I assure you that were there not that layer of waste on top of the medical community the prices would decrease. Why? Cause Doctors that don't treat patients don't get paid.

Quote: Had I developed cancer I would be SOL.  The typical initial treatment for cancer is surgical and they are going to want $50K for that, and if first line of attack doesn't work and you need chemo and/or other expensive treatments.  You can rack up a lot more in no time. 

Depending on the cancer it might not even be worth it.

Quote:And no, you can't just go to the emergency room.  They only have to treat you if you are at risk of imminent death.

Not quite true. Reagan signed a law (passed by a Democrat congress no less) that stipulated that in order to get federal funds (IE Medicare) hospital ERs had to treat everyone regardless their ability to pay. If you're not at risk for imminent death, they'll take you, you'll just be in the waiting room for hours.

Bear in mind my mother is a ER nurse. I know how this system works Mike. I grew up in it. Ain't no body in the local hospital that doesn't know me cause my mother's worked there since Jesus was in diapers.

Quote: By that time you have long been a goner.  But once you show up in that state, the hospital duly provides tons of expensive care to a soon-to-be corpse. 
Makes no sense, but hell we are Americans and stupid is how we roll.    

While you're wrong on details, I agree. Which is why I've said repeatedly that if it is a case of provision then to obtain universal health care the best solution is for the States to open up free/low cost clinics for the poor and destitute. People who are rich or who have insurance really aren't the problem here.

Oh and these clinics would focus on preventative care.

Quote:Also Medicaid is a program for some poor people. Able-bodied guys in my state were not eligible for Medicaid before our Republican governor opted for the ACA Medicaid expansion against the wishes of the Republican legislature.  And when the expansion goes away under Trumpcare they will lose eligibility.  Kids get coverage, and I believe pregnant women and women with small children but I am not certain of this.

The expansion may or may not go away. Depends on if the state picks up the tab for it. Medicaid is administered by the state. Again I know because SCHIP Is covering my son now and is a part of Medicaid. (Well technically he's a ward of the state but the Department of Families and Children saw little reason to start moving a 16 [now 17] year old from foster care to foster care--more trouble than it's worth for them.)

Incidentally FL did not expand medicaid and the idea behind that was "what if they pull the funds? Then we're stuck with the tab and we don't have the money for that". And honestly Florida doesn't And wouldn't without massive increases on sales taxes and an imposition of income tax (which is political suicide down here).

Quote:*This is why your primary care doctor's fees are so much more reasonable than what specialists charge. People did go to the doctor (i.e. a GP) back in the day.  They generally did not go to a specialist and had procedures done.

Most people need a GP and not a specialist. The going to this specialist and that specialist isn't to increase the quality of care, it is rather a matter of C.Y.A. with the insurance companies. I blame lawyers for this issue. Also malpractice insurance is far too high and awards settlements of far too much. So tort reform has to be a vital part of any sort of real insurance reform.

[Bob Butler 54]

(03-12-2017, 04:01 PM)Mikebert Wrote:

(03-11-2017, 06:08 PM)Kinser79 Wrote: We have to be clear here.  When you say health care you mean the actual provision of care.  That is to say going to the doctor.  I'm fine with viewing that as a right.  Honestly I want sick people to go to the doctor--mostly so they don't make me sick if their disease is infectious.  Enlightened self-interest there.

That being said if we're talking about the paying for the provision of health care then the answer is simple.  Make a deal.  When I was faced with the choice of making a deal with a private doctor or going to the VA I made the deal. 

This is the view of a young person. He says just make a deal. For some things you can make a deal.  When I was young I went without insurance for some years during which time I received injections for allergies and had all four wisdom teeth extracted. Both of the treatments I received were simple things that have been done for a long time, since before the advent of widespread employer-paid insurance.  Thus when insurance came along there was a well-established price for these services and since insurance pays the "reasonable and customary" fees the amount this was set at was reasonable*.  So I paid cash--about a thousand bucks for each, out of my savings. 

But medicine has advanced since the forties.  And the treatments developed since then have big price tags. Had I developed cancer I would be SOL.  The typical initial treatment for cancer is surgical and they are going to want $50K for that, and if first line of attack doesn't work and you need chemo and/or other expensive treatments.  You can rack up a lot more in no time. 

And no, you can't just go to the emergency room.  They only have to treat you if you are at risk of imminent death. By that time you have long been a goner.  But once you show up in that state, the hospital duly provides tons of expensive care to a soon-to-be corpse. 
Makes no sense, but hell we are Americans and stupid is how we roll.    

Also Medicaid is a program for some poor people. Able-bodied guys in my state were not eligible for Medicaid before our Republican governor opted for the ACA Medicaid expansion against the wishes of the Republican legislature.  And when the expansion goes away under Trumpcare they will lose eligibility.  Kids get coverage, and I believe pregnant women and women with small children but I am not certain of this.

*This is why your primary care doctor's fees are so much more reasonable than what specialists charge. People did go to the doctor (i.e. a GP) back in the day.  They generally did not go to a specialist and had procedures done.

Kinser

My experience has been similar to Mikebert's.  As an example, I'm a diabetic.  For many years in my youth I had no health problems.  My company paid into the corporate insurance, which other than a hyperextended knee from playing ultimate frisbee, went essentially unused.  I got an X ray and a pair of crutches out of it.  These days, early in the year, before the deductibles have been paid off, I end up paying $1,000 plus for less than a month's worth of insulin.  The cost of these drugs has tripled in the last few years.  I don't anticipate making a deal with the big pharmacy companies.  They are too much into soaking lots of cash out of the ill.

I was once among the healthy and wealthy.  I remember that feeling of delusional immortality, and might have chosen an out of pocket approach if it was a choice.  It wasn't.  Given I had a full time engineering job, a good health plan came with it.  It wasn't an option to take risks and collect the cash.  I'm also too chicken.  Even then, I'd worry about such things as car crashes and out of the blue severe illness.  Out of pocket, to me, seems too large a risk.

I think one of Heinlein's favorite sayings applies.  "There is no such thing as a free lunch."  Expecting to go out and make a deal seems a silly expectation.  The GOP is optimizing their plans for the healthy and wealthy.  Their supporters are still buying into the "I've got mine, up yours" approach to health care.  I'm still thinking health care is a basic right, that politicians shouldn't look at less healthy parts of the population and proclaim 'drop dead'.  I'd as soon start with an assumption that most everybody should be covered, and try to find as even a way of paying for it as possible.  From my perspective, your father is going in the wrong direction.

[SomeGuy]

So basically, you aren't willing to go beyond vague rhetoric and anecdotes.  Nobody has said the present system is working great, they've just pointed out that, like college textbooks, the prices have gone to ludicrous levels because almost nobody is expected to pay for them themselves.

[Odin]

(03-13-2017, 06:55 AM)SomeGuy Wrote: Nobody has said the present system is working great, they've just pointed out that, like college textbooks, the prices have gone to ludicrous levels because almost nobody is expected to pay for them themselves.

On the flip side, various universal healthcare systems (single payer in Canada, whatever the term is for the German system is, and the regulated private system is Switzerland) work just fine, but conservatives either always have some excuse about why they supposedly can't work here, or spout complete bull about they are supposedly collapsing and failing. There are a shit-ton of different healthcare systems out there to use as a basis to fix the US healthcare system, but conservatives ignore them all because they are ideologically inconvenient and threaten the profits of a bunch of powerful people.

[SomeGuy]

(03-13-2017, 07:08 AM)Odin Wrote:

(03-13-2017, 06:55 AM)SomeGuy Wrote: Nobody has said the present system is working great, they've just pointed out that, like college textbooks, the prices have gone to ludicrous levels because almost nobody is expected to pay for them themselves.

On the flip side, various universal healthcare systems (single payer in Canada, whatever the term is for the German system is, and the regulated private system is Switzerland) work just fine, but conservatives either always have some excuse about why they supposedly can't work here, or spout complete bull about they are supposedly collapsing and failing. There are a shit-ton of different healthcare systems out there to use as a basis to fix the US healthcare system, but conservatives ignore them all because they are ideologically inconvenient and threaten the profits of a bunch of powerful people.

And, as I stated at the beginning of this thread, I have no real issue with most of those systems (trying to implement an NHS-style system here I would be skeptical of, as it would most likely end up looking like the VA).  They don't work perfectly, there are issues involved with all of them, but looking at them isn't a bad place to start.

But lets be honest, if it was just the "conservatives", the issue would have been addressed years ago.  It's all of the upper-middle class types and aging union workers with Cadillac plans, the major corporations and their bureaucracies, the lawyers, and all the others who benefit from the existing system who provide the electoral and financial power to block reform.  Prices have gotten to the point where some of them are starting to hurt, which is why it has become an electoral issue again, but not enough of them for a real political consensus to move forward.  We'll see how it plays out.

[Kinser79]

(03-13-2017, 03:25 AM)Bob Butler 54 Wrote:

(03-12-2017, 04:01 PM)Mikebert Wrote:

(03-11-2017, 06:08 PM)Kinser79 Wrote: We have to be clear here.  When you say health care you mean the actual provision of care.  That is to say going to the doctor.  I'm fine with viewing that as a right.  Honestly I want sick people to go to the doctor--mostly so they don't make me sick if their disease is infectious.  Enlightened self-interest there.

That being said if we're talking about the paying for the provision of health care then the answer is simple.  Make a deal.  When I was faced with the choice of making a deal with a private doctor or going to the VA I made the deal. 

This is the view of a young person. He says just make a deal. For some things you can make a deal.  When I was young I went without insurance for some years during which time I received injections for allergies and had all four wisdom teeth extracted. Both of the treatments I received were simple things that have been done for a long time, since before the advent of widespread employer-paid insurance.  Thus when insurance came along there was a well-established price for these services and since insurance pays the "reasonable and customary" fees the amount this was set at was reasonable*.  So I paid cash--about a thousand bucks for each, out of my savings. 

But medicine has advanced since the forties.  And the treatments developed since then have big price tags. Had I developed cancer I would be SOL.  The typical initial treatment for cancer is surgical and they are going to want $50K for that, and if first line of attack doesn't work and you need chemo and/or other expensive treatments.  You can rack up a lot more in no time. 

And no, you can't just go to the emergency room.  They only have to treat you if you are at risk of imminent death. By that time you have long been a goner.  But once you show up in that state, the hospital duly provides tons of expensive care to a soon-to-be corpse. 
Makes no sense, but hell we are Americans and stupid is how we roll.    

Also Medicaid is a program for some poor people. Able-bodied guys in my state were not eligible for Medicaid before our Republican governor opted for the ACA Medicaid expansion against the wishes of the Republican legislature.  And when the expansion goes away under Trumpcare they will lose eligibility.  Kids get coverage, and I believe pregnant women and women with small children but I am not certain of this.

*This is why your primary care doctor's fees are so much more reasonable than what specialists charge. People did go to the doctor (i.e. a GP) back in the day.  They generally did not go to a specialist and had procedures done.

Kinser

My experience has been similar to Mikebert's.  As an example, I'm a diabetic.  For many years in my youth I had no health problems.  My company paid into the corporate insurance, which other than a hyperextended knee from playing ultimate frisbee, went essentially unused.  I got an X ray and a pair of crutches out of it.  These days, early in the year, before the deductibles have been paid off, I end up paying $1,000 plus for less than a month's worth of insulin.  The cost of these drugs has tripled in the last few years.  I don't anticipate making a deal with the big pharmacy companies.  They are too much into soaking lots of cash out of the ill.

I was once among the healthy and wealthy.  I remember that feeling of delusional immortality, and might have chosen an out of pocket approach if it was a choice.  It wasn't.  Given I had a full time engineering job, a good health plan came with it.  It wasn't an option to take risks and collect the cash.  I'm also too chicken.  Even then, I'd worry about such things as car crashes and out of the blue severe illness.  Out of pocket, to me, seems too large a risk.

I think one of Heinlein's favorite sayings applies.  "There is no such thing as a free lunch."  Expecting to go out and make a deal seems a silly expectation.  The GOP is optimizing their plans for the healthy and wealthy.  Their supporters are still buying into the "I've got mine, up yours" approach to health care.  I'm still thinking health care is a basic right, that politicians shouldn't look at less healthy parts of the population and proclaim 'drop dead'.  I'd as soon start with an assumption that most everybody should be covered, and try to find as even a way of paying for it as possible.  From my perspective, your father is going in the wrong direction.

Bob.  I don't think anyone here is saying the current system is great.  I'm also certain that no one is saying the system prior to Obamacare was great either.  We didn't like that either.

What I've been consistent in though is that an attempt to create a one-size fits all policy for the US is impossible.  As such it should be sent to the States to deal with.  Considering that all the proposals that have ever come out of DC on this matter have pissed off at least one (and often more) large segments of the population it might be prudent to break it down and deal with it on a more local level?

I have also been consistent in my view that health care provision is a human right, while health care insurance is not a human right.  I'm sorry but I have a hard time viewing the owning of a financial instrument as being a fundamental human right.  Just like I don't view owning a house as a human right or owning stock in XYZ company as a human right.

Also I note you didn't even bother to tackle the points I counter posted to Mike.

[Kinser79]

(03-13-2017, 07:08 AM)Odin Wrote:

(03-13-2017, 06:55 AM)SomeGuy Wrote: Nobody has said the present system is working great, they've just pointed out that, like college textbooks, the prices have gone to ludicrous levels because almost nobody is expected to pay for them themselves.

On the flip side, various universal healthcare systems (single payer in Canada, whatever the term is for the German system is, and the regulated private system is Switzerland) work just fine, but conservatives either always have some excuse about why they supposedly can't work here, or spout complete bull about they are supposedly collapsing and failing. There are a shit-ton of different healthcare systems out there to use as a basis to fix the US healthcare system, but conservatives ignore them all because they are ideologically inconvenient and threaten the profits of a bunch of powerful people.

Actually Odin the NHS and Health Canada do not work great.  Sure you can get cheap drugs, and if you're deathly ill you're shoved to the front of the line.  However both suffer from near constant doctor shortages and both also have private practices and hospitals that deal with those who can afford it.

Canadians vacation down here and many given the choice get treatment here rather than Canada--so that should tell you something.

Furthermore we must examine the material realities of places like Canada, Germany, and the UK.

1.  Germany and the UK are small geographically which makes unitary rule. They are also both far more homogeneous than the US.  Canada is large but its population is small, and also more homogeneous than the US.

2.  Given that the vast majority of the countries with these various forms of universal health coverage are smaller than the US and more homogeneous than the US it might be more prudent to tackle this problem on a state level.  This would mean that California and Vermont could try an NHS type model, Florida could try a Swiss model, and Texas a German model.

3.  Trying to implement a model on a national level will result in the whole health care system being flipped over once every 4 to 8 years.  You have to take into consideration that we are not Britain or Canada--we have a presidential system rather than a Westminster system.

This constant change in a sector that comprises about 1/5th of the entire economy (we're talking trillions of dollars) every year will cause not only chaos in health care but in the economy and politics.  Which for me is an other reason to send it to the states.

4.  If we're going to have a welfare state at all like Europe we also have to shut down immigration totally.  It is my firm belief that one can have a welfare state, or one can have open boarders but one cannot have both.

But let me leave this here---

[Bob Butler 54]

Kinser

I perceive insurance programs as a risk sharing proposition.  I’ve paid a lot of money into home insurance.  I’ve never had the sort of disaster that has called for use of the policies.  If one is a gambler, one might think it cost effective to not buy the insurance.  Insurance companies are out to make a profit.  The odds they give you aren’t particularly advantageous.  On average, being uninsured is a financial win.

Except in a disaster, where it isn’t.  It seems prudent for me to share the burden, so those who have been lucky help out those who haven’t been.

For the healthy and wealthy, poor or no health coverage can similarly seem attractive.  One can convince one’s self that there is such a thing as a free lunch, and roll the dice.  I wouldn’t consider that prudent, but some are willing to live on the edge.

If one isn’t healthy and wealthy, the odds are much different.  Being uncovered is not by any means a good gamble.  If someone still young enough to think himself immortal wants to roll dice, I have no great desire to prevent him.  However, when the healthy and wealthy want to set up schemes to force those who are not healthy and wealthy to roll dice against absurd odds for deadly stakes, I get very dubious.

There is a lot to be said for letting the states trial and error a bunch of different schemes.  However, in the process they are going to force lots of impossible dice rolls with deadly stakes.  I am doubtful about that.  If past schemes have not been ideal, neither are many of the possible future schemes.

I have mixed feelings about letting the states each set their own policies.  Too many lives would be put at risk.  However, I’m not going to throw extreme partisan style hissy fits if it is attempted.

I feel more firm that health care should not be optimized for the benefit of the healthy and wealthy.  One should start with a goal of providing everyone coverage, and look for some way to share the burden reasonably.  Anyone moving in the opposite direction is moving in the wrong direction.

And, no, I don’t want to nitpick your experiences in Florida.  I’ve just have had very different experiences in Massachusetts.  Both your own feelings and Florida’s culture wish to avoid sharing the burden.  Both myself and Massachusetts culture lean the other way.  I don’t see much point in nitpicking details.

[Kinser79]

(03-13-2017, 12:24 PM)Bob Butler 54 Wrote: Kinser

I perceive insurance programs as a risk sharing proposition.  I’ve paid a lot of money into home insurance.  I’ve never had the sort of disaster that has called for use of the policies.  If one is a gambler, one might think it cost effective to not buy the insurance.  Insurance companies are out to make a profit.  The odds they give you aren’t particularly advantageous.  On average, being uninsured is a financial win.

Except in a disaster, where it isn’t.  It seems prudent for me to share the burden, so those who have been lucky help out those who haven’t been.

Agreed on all points. In fact there was never a point where we disagreed on this except perhaps on the fact that I don't think it moral for the state to force anyone into these "risk sharing pools". Most people who are smart would if offered (but they really can't due to the insistance on some of maintaining an ancient system that never really worked that well to start with) purchase individual health care insurance when they are young and healthy, lock in a lower premium and then they are covered.

This of course necessitates the abolition of employer based health care insurance. A particular generation seems to be hung up on keeping this insurance (probably because they are old) because the older set of the generation just younger than them wants to keep it too.

Quote:For the healthy and wealthy, poor or no health coverage can similarly seem attractive.  One can convince one’s self that there is such a thing as a free lunch, and roll the dice.  I wouldn’t consider that prudent, but some are willing to live on the edge.

Those who are rich are usually that way because they aren't stupid. Generally speaking wealthy people get personal coverage fairly quickly. Its a case of "in case shit". With the poor their problem is they cannot afford the insurance plans offered. I'd imagine because of a lack of competition in the market.

Since monopolies cannot exist without government collusion it seems to me that the last thing we want in such a market is governmental interference--and certainly not more of it where it already exists.

Quote:If one isn’t healthy and wealthy, the odds are much different.  Being uncovered is not by any means a good gamble.  If someone still young enough to think himself immortal wants to roll dice, I have no great desire to prevent him.  However, when the healthy and wealthy want to set up schemes to force those who are not healthy and wealthy to roll dice against absurd odds for deadly stakes, I get very dubious.

I see your point, it is valid, I'll grant you that. However, attempting to construct any system wherein you force the healthy and the wealthy to essentially pay the medical bills of the non-healthy and the non-wealthy it would never pass. Indeed had the Democrat Controlled house opened up the bill for debate in 2009 it would have never passed. The House and Senate (both Democrat Controlled at the time) used special rules to even pass the law.

In short the biggest problem with Obamacare is that it is primarily a give away to insurance companies, is terribly expensive, was not subject to debate on the floor of either house openly and simply does not work. I remember when Pelosi said "We have to vote for it to see what's in it." I told my mother and BF that day "This is going to be a disaster."

Turns out, I was right. I've never lost money betting that something that private enterprise does poorly government can't do less well.

Quote:There is a lot to be said for letting the states trial and error a bunch of different schemes.  However, in the process they are going to force lots of impossible dice rolls with deadly stakes.  I am doubtful about that.  If past schemes have not been ideal, neither are many of the possible future schemes.

Okay, great. Again a valid point. So your solution to that problem is to take 20% of the USA's economy and subject it to being overturned every 4-8 years? How you do not see that as worse is beyond me.

Quote:I have mixed feelings about letting the states each set their own policies.

Then you should consider moving to a country that isn't a federal republic or a confederation. So that means not only the US but also Germany, Mexico, Canada, Switzerland and India just to name a few.

 

Quote:Too many lives would be put at risk.

But lives aren't being put at risk as Obamacare collapses, exactly as was predicted would happen, from both Left and Right pundents and experts? We must have very different views as to what constitutes putting the lives of others at risk then.

Quote:However, I’m not going to throw extreme partisan style hissy fits if it is attempted.

You wouldn't have to...there will be plenty who share whatever your opinion is to scream and yell for you.

Quote:I feel more firm that health care should not be optimized for the benefit of the healthy and wealthy.  One should start with a goal of providing everyone coverage, and look for some way to share the burden reasonably.  Anyone moving in the opposite direction is moving in the wrong direction.

Health care needs to be optimized for maintaining health in those already healthy, wealthy or not. This means that preventative medicine must be looked at first. I would say the largest problem with health care itself, and by extension health care insurance (which are not the same thing) is that Americans tend to view health care as something you need when you get sick. This view is wrong. It is worse than wrong, it is wrong and stupid. It is also why costs are as high as they are.

Once the focus is switched to the preservation of health in those healthy and then treating as best we can the unhealthy costs for health care and health care insurance goes down. This is why Health Canada, the NSH and the European systems work at least moderately well.

Quote:And, no, I don’t want to nitpick your experiences in Florida.  I’ve just have had very different experiences in Massachusetts.  Both your own feelings and Florida’s culture wish to avoid sharing the burden.  Both myself and Massachusetts culture lean the other way.  I don’t see much point in nitpicking details.

I would submit that solutions that might work in MA wouldn't really work in FL and vise versa.

[Bob Butler 54]

(03-13-2017, 01:16 PM)Kinser79 Wrote:

(03-13-2017, 12:24 PM)Bob Butler 54 Wrote: Kinser

I perceive insurance programs as a risk sharing proposition.  I’ve paid a lot of money into home insurance.  I’ve never had the sort of disaster that has called for use of the policies.  If one is a gambler, one might think it cost effective to not buy the insurance.  Insurance companies are out to make a profit.  The odds they give you aren’t particularly advantageous.  On average, being uninsured is a financial win.

Except in a disaster, where it isn’t.  It seems prudent for me to share the burden, so those who have been lucky help out those who haven’t been.

Agreed on all points.  In fact there was never a point where we disagreed on this except perhaps on the fact that I don't think it moral for the state to force anyone into these "risk sharing pools".  Most people who are smart would if offered (but they really can't due to the insistance on some of maintaining an ancient system that never really worked that well to start with) purchase individual health care insurance when they are young and healthy, lock in a lower premium and then they are covered.

This of course necessitates the abolition of employer based health care insurance.  A particular generation seems to be hung up on keeping this insurance (probably because they are old) because the older set of the generation just younger than them wants to keep it too.

I do see a problem if those who have a particularly light burden don't want to share the burden.

And, yes, there are those who benefit from the old system, and those who don't want to risk a change to the system.  Part of the problem.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:For the healthy and wealthy, poor or no health coverage can similarly seem attractive.  One can convince one’s self that there is such a thing as a free lunch, and roll the dice.  I wouldn’t consider that prudent, but some are willing to live on the edge.

Those who are rich are usually that way because they aren't stupid.  Generally speaking wealthy people get personal coverage fairly quickly.  Its a case of "in case shit".  With the poor their problem is they cannot afford the insurance plans offered.  I'd imagine because of a lack of competition in the market.

Since monopolies cannot exist without government collusion it seems to me that the last thing we want in such a market is governmental interference--and certainly not more of it where it already exists.

Some don't trust the government.  Some don't trust corporations, including the insurance companies.  There is no lack of reasons for such distrust.  I'd note that which group is more distrusted has become a cultural and political thing.  You can state your particular prejudice, but take note that there are many with just a strong a distrust of big pharmacy and the insurance companies.  The proper goal might be to minimize bureaucracy all together, public or private.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:If one isn’t healthy and wealthy, the odds are much different.  Being uncovered is not by any means a good gamble.  If someone still young enough to think himself immortal wants to roll dice, I have no great desire to prevent him.  However, when the healthy and wealthy want to set up schemes to force those who are not healthy and wealthy to roll dice against absurd odds for deadly stakes, I get very dubious.

I see your point, it is valid, I'll grant you that.  However, attempting to construct any system wherein you force the healthy and the wealthy to essentially pay the medical bills of the non-healthy and the non-wealthy it would never pass.  Indeed had the Democrat Controlled house opened up the bill for debate in 2009 it would have never passed.  The House and Senate (both Democrat Controlled at the time) used special rules to even pass the law.

In short the biggest problem with Obamacare is that it is primarily a give away to insurance companies, is terribly expensive, was not subject to debate on the floor of either house openly and simply does not work.  I remember when Pelosi said "We have to vote for it to see what's in it." I told my mother and BF that day "This is going to be a disaster."

Turns out, I was right.  I've never lost money betting that something that private enterprise does poorly government can't do less well.

A disaster?  I'm doing all right.  Massachusetts seems quite ready to shift back to Romney Care.  It might be a disaster by the standards of Florida culture, but not all see it that way.  Some are ready to share burdens.

I have an equal dislike for how big pharmacy and the insurance companies meshed with the Republican desire to make Obama look bad.  Passing the ACA wasn't Congress's finest hour.  My current vaguely wistful hope is that the Republicans will be too divided to work without the Democrats.  The middle of both parties might have to work together for a change.

I can agree the Democrats didn't play their cards very well, but there is more than enough blame to go around.  That's water over the dam, though.  The question is whether the Republicans are united enough to push their own ideas on the country, or whether there will be some real give and take this time around.  So far, no such give and take.  It feels like the Democrats are waiting for the Republicans to discover they aren't united enough to railroad.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:There is a lot to be said for letting the states trial and error a bunch of different schemes.  However, in the process they are going to force lots of impossible dice rolls with deadly stakes.  I am doubtful about that.  If past schemes have not been ideal, neither are many of the possible future schemes.

Okay, great.  Again a valid point.  So your solution to that problem is to take 20% of the USA's economy and subject it to being overturned every 4-8 years?  How you do not see that as worse is beyond me.  

I am taking advantage of the fact that it is far easier to state displeasure of this plan or that's lack of perfection than it is to find a plan that is perfect.  I'm also not expecting the Republicans to let go.  They'll try to push their values on the entire country, as Obama did.  

It seems possible that if the two parties are forced to work together, the problem might get solved.  Fifty different solutions will leave it unsolved in parts of the country.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:I’m not going to throw extreme partisan style hissy fits if it is attempted.

You wouldn't have to...there will be plenty who share whatever your opinion is to scream and yell for you.

Here we're in total agreement.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:I feel more firm that health care should not be optimized for the benefit of the healthy and wealthy.  One should start with a goal of providing everyone coverage, and look for some way to share the burden reasonably.  Anyone moving in the opposite direction is moving in the wrong direction.

Health care needs to be optimized for maintaining health in those already healthy, wealthy or not.  This means that preventative medicine must be looked at first.  I would say the largest problem with health care itself, and by extension health care insurance (which are not the same thing) is that Americans tend to view health care as something you need when you get sick.  This view is wrong.  It is worse than wrong, it is wrong and stupid.  It is also why costs are as high as they are.

Once the focus is switched to the preservation of health in those healthy and then treating as best we can the unhealthy costs for health care and health care insurance goes down.  This is why Health Canada, the NSH and the European systems work at least moderately well.

This is one reason I oppose the approach of emergency rooms also becoming general practitioners for the poor.  Emergency rooms don't, can't and shouldn't do preventative maintenance without anyone paying for such services.

For a while, after I was young, healthy and immortal, but before Romney Care kicked in, I did out of pocket health care.  When I got insurance again, my health care provider started doing full preventative maintenance, something I'd never considered important when I was younger.  There was a skin specialist checking for surface cancers, a sleep specialist checking for apneas, a diabetic specialist, and someone who looks up people's rear ends for a living.  If one hasn't a solid form of coverage, one isn't going to get these things, certainly not in an emergency room.

(03-13-2017, 01:16 PM)Kinser79 Wrote:

Quote:And, no, I don’t want to nitpick your experiences in Florida.  I’ve just have had very different experiences in Massachusetts.  Both your own feelings and Florida’s culture wish to avoid sharing the burden.  Both myself and Massachusetts culture lean the other way.  I don’t see much point in nitpicking details.

I would submit that solutions that might work in MA wouldn't really work in FL and vise versa.

I'm doubtful that either region would even try the other's approach at this point.

[Kinser79]

Bob Wrote:I do see a problem if those who have a particularly light burden don't want to share the burden.

I don't.  I see a much larger problem with the initiation of force to make those who don't want to share the burden share it.  Given the choice between liberty and equality I'll always side with liberty.  Equality is always the equality of the lowest acceptable standard.

Bob Wrote:And, yes, there are those who benefit from the old system, and those who don't want to risk a change to the system.  Part of the problem.

Tradition has deep roots, so deep that often reason cannot dig them up.

Bob Wrote:Some don't trust the government.  Some don't trust corporations, including the insurance companies. There is no lack of reasons for such distrust.  I'd note that which group is more distrusted has become a cultural and political thing.  You can state your particular prejudice, but take note that there are many with just a strong a distrust of big pharmacy and the insurance companies. 

I trust neither.  But if the choice is between trusting one over trusting the other I'll pick the corporations every time.  A corporation without the compliance of the government cannot force me to buy my product, but the government compels me through force of arms to comply with their taxation.

Bob Wrote:The proper goal might be to minimize bureaucracy all together, public or private.

If that is the goal, and not one I necessarily agree with or disagree with (it depends on the context of this reduction), then the last thing to do is to have the government involved with it.  Bureaucracies have a nasty tendency to expand to fit the needs of the bureaucracy.

Bob Wrote:A disaster?  I'm doing all right.  Massachusetts seems quite ready to shift back to Romney Care.  It might be a disaster by the standards of Florida culture, but not all see it that way.  Some are ready to share burdens.

You missed my point.  Let me try to put this more simply.  When I learned the process by which it was passed--which was by bypassing the usual methods of law making (of which I'm very familiar, seriously the BF and I watch CSPAN for fun) I knew that the reason they were doing that is because using normal procedure they couldn't pass it at all.

Whenever the House and/or Senate leadership hides the bill and prevents debate to force an up or down vote it almost always ends up being terrible.  So yes it was, and is a disaster.

I will say that MA might fare better than FL due to having already implementing Romneycare.  You'd be going back to status quo ante, for FL things are more murky.

Bob Wrote:I have an equal dislike for how big pharmacy and the insurance companies meshed with the Republican desire to make Obama look bad.  Passing the ACA wasn't Congress's finest hour.  My current vaguely wistful hope is that the Republicans will be too divided to work without the Democrats.  The middle of both parties might have to work together for a change.

Possible, but unlikely.  The Democrats have no reason to work with Ryan on Obamacare 2.0.  The Freedom Caucus plus 30 other Reps are already actively opposing it.  Put simply Ryan lacks the 218 to pass it in the House, and Rand, Cruz and Collins say that it's DOA in the Senate.

When a Libertarian Senator, an Evangelical Senator and a North-East Moderate Conservative Senator all oppose a bill in a GOP dominated Senate...the bill is doomed.  Likewise in the Senate the Democrats have no reason to help the GOP leadership.

Bob Wrote:I can agree the Democrats didn't play their cards very well, but there is more than enough blame to go around.  That's water over the dam, though.  The question is whether the Republicans are united enough to push their own ideas on the country, or whether there will be some real give and take this time around.  So far, no such give and take.  It feels like the Democrats are waiting for the Republicans to discover they aren't united enough to railroad.

In the GOP the problem is the Replacement issue.  The Repeal would be passed, and signed by President Daddy within a week.  Rand has a repeal bill in committee now.  The issue is that Ryan either has to come up with a plan where he gets 218, or he needs to find someone with a plan who can get 218.  

I've already emailed Rep. DeSantis ® [FL-6], my Rep, my view that the perfect replacement to Obamacare is to simply mandate the states have to come up with a universal healthcare program for their residents and that the federal government bow out entirely.  Of course that proposal requires a full repeal of existing law.

Of course I didn't tell him that we're already lining up people to primary him should he vote for Obamacare 2.0.  In FL primary challenges coming like a bolt from the blue are not uncommon.

Bob Wrote:I am taking advantage of the fact that it is far easier to state displeasure of this plan or that's lack of perfection than it is to find a plan that is perfect.  I'm also not expecting the Republicans to let go.  They'll try to push their values on the entire country, as Obama did.  

It seems possible that if the two parties are forced to work together, the problem might get solved.  Fifty different solutions will leave it unsolved in parts of the country.

I expect the GOP to do what they were elected to do, which is repeal Obamacare.  If they don't they're going to face a lot of primaries in 2018.

I don't expect the Democrats to work with the GOP.  They have every reason not to--Obama already imposed their vision, and in their districts they are likely to be primaried if they get too friendly with even the moderate Republicans.  (Yes there still are some, not many but there still are some.)

Expecting the two parties to work together in DC is a pipe dream.  As for the states, I'm sure that if they are told they have to figure out a system to cover everyone, they will figure it out.  It may take a while to get it done, but I imagine that State Capitols are more responsive than the Hill.

Bob Wrote:This is one reason I oppose the approach of emergency rooms also becoming general practitioners for the poor.  Emergency rooms don't, can't and shouldn't do preventative maintenance without anyone paying for such services.

For a while, after I was young, healthy and immortal, but before Romney Care kicked in, I did out of pocket health care.  When I got insurance again, my health care provider started doing full preventative maintenance, something I'd never considered important when I was younger.  There was a skin specialist checking for surface cancers, a sleep specialist checking for apneas, a diabetic specialist, and someone who looks up people's rear ends for a living.  If one hasn't a solid form of coverage, one isn't going to get these things, certainly not in an emergency room.

I've always opposed it, but it was a law passed under Reagan back in 1986. I can't speak for MA, but outside of there, generally if you're too rich for Medicaid but too poor for insurance (or it isn't offered by your employer) everything from bronchitis to a bad cold is taken to the ER.  I've heard from my mother that during cold and flu season it isn't uncommon for her to administer up to 50 or 60 shots of common broad spectrum antibiotics to non-trauma patients.

I would say you're seeing too many specialists.  Really one needs to see a GP regularly, and see a specialist only if the GP detects something wrong beyond his pay grade.  I'd argue that the abundance of specialists actually results from lots of CYA in the insurance companies and naturally that drives up costs.

Bob Wrote:I'm doubtful that either region would even try the other's approach at this point.

I doubt either region ever would, not just now.  My state fought against your state a century and a half ago.  (Granted it was a backwater then and basically "South Georgia" but still.)

The proposal I've stated here several times of free/low cost clinics for the poor (to get them connected to GPs) along with patient centered personal insurance plans would probably work down here.  We have some advantages in such an approach, most employers down here don't offer health care, as such the people currently working have nothing to lose except perhaps medicaid if they make too much money, and apart from the elderly on Medicare (which isn't going to be repealed ever--its been too long) it is the working aged people that need to be looked at.

As such if the insurance follows the patient from job to job, he doesn't have worry about layoffs or the economy going bad, or not getting enough hours to be called "full time".  Indeed in FL a lot of people who would have theoretically gotten employer based health care insurance under Obamacare instead found that they had their hours cut to under the 30 hours per week threshold.  I hope I don't have to explain to you how being cut from full time to part time effected people.

[Odin]

(03-13-2017, 08:33 AM)SomeGuy Wrote: But lets be honest, if it was just the "conservatives", the issue would have been addressed years ago.  It's all of the upper-middle class types and aging union workers with Cadillac plans, the major corporations and their bureaucracies, the lawyers, and all the others who benefit from the existing system who provide the electoral and financial power to block reform.  Prices have gotten to the point where some of them are starting to hurt, which is why it has become an electoral issue again, but not enough of them for a real political consensus to move forward.  We'll see how it plays out.

That's true, I was oversimplifying there.

[Odin]

(03-13-2017, 10:21 AM)Kinser79 Wrote: Actually Odin the NHS and Health Canada do not work great.  Sure you can get cheap drugs, and if you're deathly ill you're shoved to the front of the line.  However both suffer from near constant doctor shortages and both also have private practices and hospitals that deal with those who can afford it.

Canadians vacation down here and many given the choice get treatment here rather than Canada--so that should tell you something.

Furthermore we must examine the material realities of places like Canada, Germany, and the UK.

1.  Germany and the UK are small geographically which makes unitary rule. They are also both far more homogeneous than the US.  Canada is large but its population is small, and also more homogeneous than the US.

2.  Given that the vast majority of the countries with these various forms of universal health coverage are smaller than the US and more homogeneous than the US it might be more prudent to tackle this problem on a state level.  This would mean that California and Vermont could try an NHS type model, Florida could try a Swiss model, and Texas a German model.

3.  Trying to implement a model on a national level will result in the whole health care system being flipped over once every 4 to 8 years.  You have to take into consideration that we are not Britain or Canada--we have a presidential system rather than a Westminster system.

This constant change in a sector that comprises about 1/5th of the entire economy (we're talking trillions of dollars) every year will cause not only chaos in health care but in the economy and politics.  Which for me is an other reason to send it to the states.

4.  If we're going to have a welfare state at all like Europe we also have to shut down immigration totally.  It is my firm belief that one can have a welfare state, or one can have open boarders but one cannot have both.

Thanks for proving my point with regards to excuses.