Ryusei the Morning Star Posted February 9, 2017 Report Share Posted February 9, 2017 We have a lot of Bernie folks on this forum who have fallen for the whole universal healthcare nonsense. Most of these systems cost less but on the other hand make it up through rationing and under serviced quality of healthcare. Furthermore as their quality deteriorates they continuously increase costs everywhere to the tax payer or end up being broke. Canada :http://www.cbsnews.com/news/canadian-health-care-in-crisis/http://www.huffingtonpost.ca/saqib-qureshi/health-care-costs_b_9317386.html Sweden:http://www.nationalcenter.org/NPA555_Sweden_Health_Care.html UK:http://www.telegraph.co.uk/news/nhs/11853029/The-NHS-is-broken.-What-should-replace-it.htmlhttps://www.theguardian.com/politics/2015/apr/30/nhs-gps-are-exhausted-ae-is-overrun-and-hospitals-are-broke-what-went-wrong France:https://www.bloomberg.com/news/articles/2013-01-03/frances-health-care-system-is-going-broke So this brings us to the other side. Why can't conservatives come up with a better system? Well America is generally a very isolationist country, as are western countries. Conservatives don't do their research and therefore are constantly caught off guard. There also seems to be a belief of western supremacy of education which is rarely reflected in policy. So people stay in their bubble getting screwed by crony capitalism of both Dems and Republicans causing Commie Sanders to offer simpleton solutions. So this brings us to Asia: Contrary to popular belief America is not the bastion of free market capitalism that title goes to usually one of two countries Hong Kong or Singapore - although HK is an SAR which is irrelevant to the convo. http://www.heritage.org/index/ranking US tax to GDP : 27.5 % Singapore : 15%. So this leads us to healthcare which is the most efficient healthcare and best healthcare system in the world. It's a little island in Asia called Singapore which not only has the most efficient govt in the world but the most efficient healthcare system in the world Clearly neither Rand Paul nor Ron Paul would know free market capitalism if it hit them in the face. That title goes to a gentlemen called John J Cowperwaithe who is the so called father of the systems followed in Hk nd then Singapore and after that tiger economies like Taiwan. Or as Milton Friedman said want to see free markets in action go to Hong Kong. Singapore: https://www.bloomberg.com/graphics/infographics/most-efficient-health-care-around-the-world.htmlhttps://www.bloomberg.com/news/articles/2014-09-18/singapore-beats-hong-kong-in-health-efficiency-southeast-asia Singapore the cost of healthcare is 5% of GDP. US the cost is 17.5%. The so called universal healthcare countries? 10%.But this affect outcomes? No. http://www.straitstimes.com/singapore/health/singapore-ranked-worlds-no-2-for-health-care-outcomes-eiu So how do they do it? Well firstly their system is run by well paid non idealogical technocrats who actually care for the people. Which leads to a mix of private and public healthcare creating cross compeition between public and private sector and YOU have the choice what you want. Milton Friedman realised long ago Healthcare had an agency problem where there was no price discovery in order to overcome this he realised people should be able to contribute into a savings account so you can choose who your provider is. In Singapore it's called the Medisave account which is much larger than the medical savings accounts the US has and it' compulsory. It primarily separates 'primary' healthcare, from 'secondary' significantly reducing the costs of basic healthcare. http://dollarsandsense.sg/what-is-medisave-why-it-is-important-in-singapore/ This removes the agency problem. Solution: increase medical savings and separate primary from secondary healthcare by making health insurance only for secondary healthcare. Singapore has a caveat if your primary medisave account runs out of money your healthcare insurance kicks in. Insurance companies it's important to have choice; governments can contain costs through central power and the private market can provide efficiency through innovation. So in reality a customer should be able to get both. http://theconversation.com/creating-a-better-health-system-lessons-from-singapore-30607 The insurance is separated into a single payer which constantly competes with the private market insurance. Private market offers innovation efficiency and sometimes even lower cost, government controls the costs. Most of the health insurance is used only in private market. Furthermore you can use your health insurance in either private hospitals or public hospitals. Solution to US: https://www.brookings.edu/blog/up-front/2013/05/06/singapores-health-care-lessons-for-the-u-s/ The governments role is provide the best service at the best price. This done by aligning the free market principles with individual objectives. Setting BROAD guidelines on costs NOT controlling costs. Secondly offering a public sector insurance offer to compete against market cartels and offering incentives to make sure insurance companies keep their cost under control.Furthermore insurance should be both portable and you should be allowed to cross state lines to sell insurance which the republicans recognition. Finally people can choose private or public insurance and use them it in either public or private hospitals. This creates optimum competition. It also insures those who can't afford insurance can get it to buy govt insurance without forcing those who can afford it to come into single payer. Singapore also has broad guidelines for hospitals. It uses public hospitals to break the cartel power of private hospitals. It's key to note these hospitals which are 'public' are not run by government but by independent boards and technocrats. So what's the difference? Well government set's broad guidelines on costs and minimum service availability. The rest the hospital decides and competes with private hospitals. This again allows choice and drives down the cost. Private efficiency and service vs govt cost controls. Of course private hospitals offer better services than public, but public hospitals run by technocrats are of high quality and affordable to everyone, furthermore they are subsidised when necessary without interference so cost inefficiencies are reduced. https://www.theguardian.com/healthcare-network/2016/mar/01/worlds-most-efficient-health-systems Separating primary healthcare from secondary. It's important to desperate primary healthcare from secondary healthcare. https://www.moh.gov.sg/content/moh_web/home/our_healthcare_system/Healthcare_/Primary_Care.html Primary healthcare costs sometimes something as simple as simple as getting stitches can cost thousands of dollars in America. Sometimes as much as $17000 : http://www.nbcnewyork.com/news/local/Hospital-Cost-Emergency-Finger-Injury-17000-Dollars-Bill-Bandage-United-Healthcare-Insurance-Medical-Investigation-360940291.html Wide availability of polyclinics which offer basic primary services like getting stitches costs can be $100 USD. Which is then paid through medical savings accounts. Solution : public private partnerships to create thousands of primary healthcare polyclinics where government sets guidelines and private market provides the service. This allows patients choice of where they wish to go, which removes price gouging and broad based guidelines mean minimum service choice/ quality is insured. Bottom line : Competition and choice. I'll put up a more detailed part 2 on problems of American healthcare later. Link to comment Share on other sites More sharing options...
Sunshine Jesse Posted February 9, 2017 Report Share Posted February 9, 2017 How does this system still not throw the poor and unemployed under the bus? You say "affordable," but as long as obtaining income is still effectively up to chance, it won't be affordable to some people. And those people will still die in droves because they can't afford it, which is the actual problem to begin with, not efficiency, quality, or any other free-market buzzwords you might want to use. Link to comment Share on other sites More sharing options...
~~~~ Posted February 9, 2017 Report Share Posted February 9, 2017 free healthcare should be a human right. If you get into an accident or have health problems, you shouldn't be financially punished for your misfortune. The rich have more money than they need, so let's see some proper financial equality and tax the billionaires until they have a few hundred thousand left. That's enough for a really decent house. Meanwhile, the billions we have raised in tax can give everyone what they deserve: free healthcare and free internet. Link to comment Share on other sites More sharing options...
Sunshine Jesse Posted February 9, 2017 Report Share Posted February 9, 2017 free healthcare should be a human right. If you get into an accident or have health problems, you shouldn't be financially punished for your misfortune. The rich have more money than they need, so let's see some proper financial equality and tax the billionaires until they have a few hundred thousand left. That's enough for a really decent house. Meanwhile, the billions we have raised in tax can give everyone what they deserve: free healthcare and free internet. It isn't about what we "deserve" tbh It's about taking power out of the hands of the corporations (that have robbed, cheated, and failed us time and time again) and putting it back into the hands of the working class. Link to comment Share on other sites More sharing options...
VCR_CAT Posted February 9, 2017 Report Share Posted February 9, 2017 Your first article on Canada was written in 2005. It's old as hell; Paul Martin was the PM at the time, and then we had Stephen Harper for 9 years after him, and now we've had Justin Trudeau for a year and a half. A LOT has changed in 12 years. Please pick more relevant pieces. As well, the second article you posted is looking purely at spending and cost without any actualy citations of what it's being compared to other than "better systems" and when it cites the quality of our healthcare system, it cites statistics from the turn of the millennium (2000). You also might recall my post from the Democrat thread: https://forum.yugiohcardmaker.net/topic/360465-radicalization-of-the-democratic-party/page-2 that lays down some things about Canadian healthcare, such as the overwhelming approval of nationally-funded healthcare, especially over the US's system, and the overall better health of Canadian citizens. Privatized just, honestly, doesn't have a place in healthcare. The Canadian system may not be perfect, but a purely public system can be tuned to fit a good balance of funding and quality, and while Singapore might have one system, I'm hesitant to see how that system would not only work on a larger scale, but work in an objectively better manner than a public system. There's also the issue where you bring up that the technocrats care for the people; and what if they don't? This might be a what-if argument, but the rich and wealthy of western society have a long, long history of not giving a single crap for the little guy. A public system may not be perfect, but what countries like Canada have achieved with their's have worked very, very well for what they are, and it's a system that's worth developing further. Link to comment Share on other sites More sharing options...
mido9 Posted February 9, 2017 Report Share Posted February 9, 2017 How does this system still not throw the poor and unemployed under the bus? You say "affordable," but as long as obtaining income is still effectively up to chance, it won't be affordable to some people. And those people will still die in droves because they can't afford it, which is the actual problem to begin with, not efficiency, quality, or any other free-market buzzwords you might want to use.When the cost of healthcare goes down heavily, Charity Care or smaller government programs like medicare becomes a lot bigger and able to buy more with less and I mean something like 75% of all doctors gave some form of free healthcare in 1999, and a lot of people really care about people not dying so donations go up so the sort of "people dying the streets" thing really doesn't happen as much. I mean yeah there's still the 5'8' morbidly obese ebola+cancer+mental illness guy but it's so much better for the other 99.999% that it's honestly worth it. Link to comment Share on other sites More sharing options...
~ P O L A R I S ~ Posted February 9, 2017 Report Share Posted February 9, 2017 I think it's sad that the US doesn't have universal healthcare in terms of at least symbolism if not efficacy. Sure people need their incentives to achieve, but punishing those who don't with physical harm is not on. In terms of efficacy, the WHO consistently has Canada's system higher than the US's including now (Canada's is 30th US's is 37th). The best in the world right now is apparently France's. Link to comment Share on other sites More sharing options...
Sunshine Jesse Posted February 9, 2017 Report Share Posted February 9, 2017 When the cost of healthcare goes down heavily, Charity Care or smaller government programs like medicare becomes a lot bigger and able to buy more with less and I mean something like 75% of all doctors gave some form of free healthcare in 1999, and a lot of people really care about people not dying so donations go up so the sort of "people dying the streets" thing really doesn't happen as much. I mean yeah there's still the 5'8' morbidly obese ebola+cancer+mental illness guy but it's so much better for the other 99.999% that it's honestly worth it.That seems more like a Libertarian pipe dream than reality. Link to comment Share on other sites More sharing options...
Ryusei the Morning Star Posted February 12, 2017 Author Report Share Posted February 12, 2017 Your first article on Canada was written in 2005. It's old as hell; Paul Martin was the PM at the time, and then we had Stephen Harper for 9 years after him, and now we've had Justin Trudeau for a year and a half. A LOT has changed in 12 years. Please pick more relevant pieces. As well, the second article you posted is looking purely at spending and cost without any actualy citations of what it's being compared to other than "better systems" and when it cites the quality of our healthcare system, it cites statistics from the turn of the millennium (2000). You also might recall my post from the Democrat thread: https://forum.yugiohcardmaker.net/topic/360465-radicalization-of-the-democratic-party/page-2 that lays down some things about Canadian healthcare, such as the overwhelming approval of nationally-funded healthcare, especially over the US's system, and the overall better health of Canadian citizens. Privatized just, honestly, doesn't have a place in healthcare. The Canadian system may not be perfect, but a purely public system can be tuned to fit a good balance of funding and quality, and while Singapore might have one system, I'm hesitant to see how that system would not only work on a larger scale, but work in an objectively better manner than a public system. There's also the issue where you bring up that the technocrats care for the people; and what if they don't? This might be a what-if argument, but the rich and wealthy of western society have a long, long history of not giving a single crap for the little guy. A public system may not be perfect, but what countries like Canada have achieved with their's have worked very, very well for what they are, and it's a system that's worth developing further.And I'd like you to show me where a single-payer system worked on the scale of the US. The US is considerably larger than Canada or any other single payer nation. To quote a wise person "I'm hesitant to see how that system would not only work on a larger scale" The likelihood of people with more serious conditions increases with a large population, and that's going to drive the cost up fairly significantly. Innovation requires profit. You'd be driving away both researchers and doctors with a pure public system that's revenue neutral. That being said, I agree that the insurance agencies as they currently stand are making a profit off people's blood and that's not OK. Selling across state lines would help alleviate that to some degree since some states literally sell at 2-3 times the price of other states. The Rand Paul plan creates unions of people with a certain condition that can lobby for rates as a group based on their specific pre-existing condition. The Better Way plan has high risk pools that you you can isolate and subsidize. All in all, nobody is going to be thrown under the bus, but at the same time I won't be having to pay for cervical cancer risk. There aren't enough options today VCR (under Obama care). I suggest you listen to this debate. And/or listen to https://www.youtube.com/watch?v=MHwyca_IAKw https://www.youtube.com/watch?v=yPVkqlkT_S0 https://www.youtube.com/watch?v=pD5w42NPgyw https://www.youtube.com/watch?v=EuhOSOYHBjg https://www.youtube.com/watch?v=VffeUN-rkCU Anyway both POTUS and HFC look like they're gonna give their blessings to the Rand Paul Plan http://www.politico.com/tipsheets/politico-pulse/2017/02/obamacare-repeal-replace-effort-begins-to-come-together-218642 https://thefederalist.com/2017/02/09/3-key-problems-rand-pauls-obamacare-replacement-act/ Conservative Critique of it Moderate explanation of it http://www.decisiondeskhq.com/2017/01/26/obamacare-alternatives-the-paul-plan/ As for Canada being better than America in healthcare http://www.usnews.com/news/best-countries/articles/2016-08-03/canadians-increasingly-come-to-us-for-health-care Hmmm Link to comment Share on other sites More sharing options...
VCR_CAT Posted February 12, 2017 Report Share Posted February 12, 2017 Innovation requires profit. You'd be driving away both researchers and doctors with a pure public system that's revenue neutral. No it doesn't, and no it's not. Profit is simply the surplus of money over expenses. Assuming that the money going to doctors is somehow going to the researchers and not at all in a separate budget (how the frick would a privatized system give more money to the researchers; the money is going to the doctors) you're ignoring that IF the research is included in the medical budget in a public system, then they get the money. It's not driving away anyways, and profit is not required. Non-profit just means they need to use all the money they receive and they only charge to break-even on expenses. Research would be included in those expenses, and they would be receiving the money they need to research. The only thing that would drive away researchers and doctors is inadequate funding; something Canada hasn't been doing for years. Regarding applying the Canadian system to the size of the US, no I would say it's do-able. I mean, anything is possible if a disproportionate amount of your budget isn't being put towards only military. Our healthcare spending is a percentage of our GDP, and assuming the US isn't proportionately more poor than Canada is (I'm pretty sure it's the opposite), then a public healthcare system should be possible. So far as I can tell, the main reason the US spends more on their healthcare is because it's privatized and doctors and specialists are charging to make a profit rather than to break even. Also, if profit is required to make healthcare better, then why is US healthcare consistently worse than Canada's? Food for thought. Also: As for Canada being better than America in healthcare http://www.usnews.com/news/best-countries/articles/2016-08-03/canadians-increasingly-come-to-us-for-health-care Hmmm So about 0.15% of our population. Big whoop. As for Canada, you need to be a Canadian citizen to take advantage of our healthcare, which makes it harder for an American to hop the border to take advantage of our healthcare, but that hasn't stopped you guys now has it http://www.nytimes.com/1993/12/20/world/americans-filching-free-health-care-in-canada.html?pagewanted=all Link to comment Share on other sites More sharing options...
Ryusei the Morning Star Posted February 28, 2017 Author Report Share Posted February 28, 2017 The United States has a population of 314 million individuals. That's more than twice as large as any other modern country with a single-payer healthcare system. In economics there's a concept called diseconomies of scale. I'm sure you've heard of economies of scale, or the notion that as you scale up production, the production of an individual unit becomes progressively more efficient. Economies of scale is why it is cheaper for you (per unit) to buy toilet paper in packages of thirty than per individual roll.But at the same time there's also diseconomies of scale, where an entity becomes so huge that it then becomes progressively more inefficient. Due to factors such as the Ringlemann effect and increasingly complex bureaucracy the cost of something so large as a government entity overseeing our entire healthcare system could balloon out of what we initially thought possible. The United States in general does not efficiently allocate finances by any stretch of the imagination; despite not having a single-payer system, the US already spends more public dollars per capita on healthcare expenses than all but two other countries. If you look at the funding of our other programs, from social security to the military, it becomes easy to grow cynical over the US's capability to keep the size of programs and their costs in check.Another barrier is the structure of the current US healthcare system. The US system is complicated and is composed of not just hospitals but also thousands of private care clinics spread across the country employing half a million Americans. Under a single-payer plan similar to the one Bernie Sander is proposing, we'd see the dissolution of our private healthcare industry, putting 500,000 doctors and nurses out of work. Thing is, including these 500,000 workers, we already don't have enough doctors and nurses for the demand. Under single payer, our demand would increase while the workforce remains the same, if not shrinks. I don't think we'd lose these 500k healthcare professionals, but it would take a long time to reallocate them to public institutions.The United States also pays their doctors and nurses more than other countries; roughly 20% of US healthcare spending goes to doctors, nurses, and other professionals. In order to keep costs in-line for a single-payer system, the salaries of healthcare workers would have to fall. For doctors this would be bad news.Yes, doctors are paid a lot, but that is also because of the (average) 229,000 dollar investment they make into their education. Paying off those loans is difficult even under their high salaries, and yes, you could make an argument to reform our education system as well, but that's outside of the scope of this discussion.Lowering pay is also a problem because, as I said earlier, we are already understaffed with healthcare professionals. Assuming switching to a single-payer increases demand, which is extremely likely, we would then be even more understaffed. If we can't get enough doctors, nurses, and APNs for our patients at current pay rates, lowering pay for a profession while simultaneously increasing demand won't produce great results.Then there are also grand cultural problems that would come with any attempt to implement such a system. Citizens in the US are generally not wanting to raise their taxes for any program and even with prodigious tax hikes it is not certain that a system like Bernie Sander's could be funded; a study by Ken Thrope, a doctor at Emory University who actually advocates for single payer, found that Sander's proposal may be underfunded by as much as $1 trillion dollars annually. To put that into perspective, our entire 2015 FY budget defect was 638 billion dollars. Our unpaid bill for medical expenses could be nearly twice as much as our entire current defect. As time goes on the program would be increasingly underfunded as our population ages and less and less people are working.Also, I'd like to note that I'm only focusing on Bernie's plan because it's currently the most popular proposal and is the easiest one to get info for so it's a convenient example.In addition to all of this there are powerful groups lobbying against healthcare reform and one of our major political parties hates the idea so much that they have fought Obama's relatively limp-wristed program dozens of times in court.And as a final note, one dangerous aspect of implementing such a huge program is that it would be very difficult to roll-back or reform. Even if we were to implement it and the cost began to explode it would be extremely difficult to roll-back.These are all the reasons why someone could argue that single-payer healthcare in the United States is a risky proposition when compared to implementation in much smaller Scandinavian countries with vastly different cultures and healthcare systems.Again, these do no necessarily reflect my views. Personally I think our current system is as inefficient as they come and I'm increasingly convinced of that with every patient charged $100 for an IV bag. I'd personally advocate using our states to test-run some solutions like Massachusetts did in 2006. The United States is a federal system composed of 50 relatively independently acting states. It's a very powerful system and I think we should use it more when it comes to questions such as these.Regardless of your stance, reform of some kind is needed, of that I think we all can agree.Sources:http://www.economist.com/news/united-states/21692895-health-care-costs-and-high-taxes-would-sink-sanders-economic-plan-vote-whathttp://www.economicsonline.co.uk/Business_economics/Diseconomies_of_scale.htmlhttp://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspectivehttp://www.bestmedicaldegrees.com/is-medical-school-worth-it-financially/http://www.scribd.com/doc/296831690/Kenneth-Thorpe-s-analysis-of-Bernie-Sanders-s-single-payer-proposalhttp://www.usgovernmentspending.com/federal_deficit_chart.html Link to comment Share on other sites More sharing options...
~ P O L A R I S ~ Posted March 18, 2017 Report Share Posted March 18, 2017 ^This post is the best I've ever seen in Debates considering how researched, fair, comprehensive and thought-provoking it is, though in terms of America's national debt it's reached such an absurd, unfathomable number (~19 trillon) that it begs questions as to how it could have any meaning at all, why it can't just spiral trillions upon trillions further into the reds, and when or if anyone will ever collect on it. Link to comment Share on other sites More sharing options...
Ryusei the Morning Star Posted March 18, 2017 Author Report Share Posted March 18, 2017 ^This post is the best I've ever seen in Debates considering how researched, fair, comprehensive and thought-provoking it is, though in terms of America's national debt it's reached such an absurd, unfathomable number (~19 trillon) that it begs questions as to how it could have any meaning at all, why it can't just spiral trillions upon trillions further into the reds, and when or if anyone will ever collect on it.It's scary since the US debt to GDP ratio has crossed one in the Obama years and the Trump years don't seem like they're going to cut down on the debt either. We're in a problem if people ever attempt a bankrun Link to comment Share on other sites More sharing options...
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