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Both in rich and poor countries, universal health care brings huge benefits

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Re: Both in rich and poor countries, universal health care brings huge benefits

#521
post #121

Earlier quoted context omitted.

Our spending on healthcare is grossly and immorally inefficient. A change is needed. One reason for the ineffiency is that public welfare is subordinate to special interests. All universal healthcare systems in the world are cheaper on a per capita basis than the American system. A change is needed. I’m not advocating for more money. I’m advocating for a change in perspective by our leaders.

>Our spending on healthcare is grossly and immorally inefficient. Yes, because it goes to treat chronic preventable (voluntary) conditions and to keep rich old people alive for a few hours or days longer. The way to handle those freeloading on the system is to abolish the system, not increase its scope.

I see that in the parable of the farm workers you would be the one hired at the beginning of the day.

Re: Both in rich and poor countries, universal health care brings huge benefits

#522

Earlier quoted context omitted.

> Medicare is the core of all regulatory and pricing issues in the healthcare space. I can't see a reasonable argument for that. > And if medicare were expanded to the entire population of the us, its expenditures could be 40-45% of gdp. Even with a naive covered-population-number based extrapolation that ignores that Medicare currently covers the elderly, who tend to have greater medical needs than average, that's n…

Medicare is the reason there is fee-for-service, which is the biggest administrative overhead design if there is one. Also all private insurance works based of of medicare in the rates they pay, the way they code themselves etc. On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare, as if the expansion of medicare were going to eliminate…

> On the extrapolation, of course they are all simplistic and wrong, both mine and yours. You are capping the NHE of GDP to cap medicare

No, I'm not, I'm using the current expenditures as the projection baseline. I'm clearly not using the current NHE share of GDP to cap Medicare because the projection (24% of GDP) is greater than the current NHE share of GDP.

> as if the expansion of medicare were going to eliminate out of pocket or private health.

No, you made a claim about Medicare expenditures being 40-50% of GDP if it covered the whole population, not other expenditures. Now you're moving the goalposts (and still not supporting your mutating guess with any actual concrete basis.)

> We cant know, its messy and even expert economists cannot get this right: but it has to be in the order of magnitude of 25 to 40% of gdp.

Well, that's a sudden drop in your estimate of what now seems to be total NHE from your earlier claim that Medicare expenditures alone would be 40-50% of GDP. Another round of this and you'll be conceding costs below the current 18% of GDP.

Re: Both in rich and poor countries, universal health care brings huge benefits

#523

Earlier quoted context omitted.

The inefficiency is in the private sector.

Medicare is just as expensive, and the government is what makes drugs, doctors, malpractice and opening facilities so expensive. So no.

Other governments don't have a problem making it cheaper.

Re: Both in rich and poor countries, universal health care brings huge benefits

#524

Earlier quoted context omitted.

> Uh, no. "Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans." [0] So although the Advantage plans are privately managed, the premiums are subsidized. I don't think this counts as "leaving" Medicare. By that logic, there's no way to leave Medicare, because you can't stop paying taxes for it or "disable" your eligibility for it (and all of the restrictions that Me…

> people using school vouchers for private schools is [not] a demonstration of their satisfaction with the public school system in their area It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts! The primary education system is a single- payer system, and the use of vouchers doesn't change that.

> It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts!

You're basically arguing a tautology: Because there's no legal way to fully opt out of the system if they dislike it, people can't leave it (by your definition), and you're then saying that, because people don't fully leave the system, that means they don't dislike it.

40% of people choose not to use Medicare, to the extent that's legally possible. The program that they choose to use instead outperforms Medicare on every key performance indicator (medical outcomes, cost, patient satisfaction), while also underperforming the same private insurers on those same indicators. It takes some real contortions to look at that data and use it as evidence in favor of a single-payer system, or even evidence that patients like Medicare, but if you're fully committed to interpreting available data in a way that supports that end goal, I guess that's all we can really say.

Re: Both in rich and poor countries, universal health care brings huge benefits

#525

Earlier quoted context omitted.

Causes of price inflation and the looming demographic crisis are not "abstract ideas." For literally decades the US did not open a single medical school due to lobbying from the medical industry. Even though we've tried to reverse the trend since the 90s, there are still fewer medical schools today than there were 100 years ago. When the government decides how many doctors there will be, it may get the number right o…

== And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.== That is a nice thought, fortunately NPR has done the actual reporting on this. It seems like the answer is government interference [1]: "But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts t…

>"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."

Yes, this supports my statement. I said the medical lobby has artificially constricted the supply of doctors. Limited supply means higher wages. I'm not familiar with the German system, they may have done other things such as price fixing to keep wages lower. Personally, I'd prefer having "too many" doctors. This would give me more personal choice to choose the one I like the most while simultaneously keeping prices reasonable.

>You have provided no evidence to back up this claim. What makes you so certain that it's true?

Here's the first article that came up when I googled the subject. https://www.newyorker.com/tech/elements/why-america-is-losin.... It talks about issues of poverty, adolescent pregnancy, etc.

===Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.====

>Why have you dismissed this potential outcome?

As noted above the majority of improved health outcomes are not the result of access to healthcare at all. Let's be generous and use the highest percentage in the stat provided above: 25%. So now we're only at 25% of healthcare gains at all, and the fraction of that that isn't actually affordable either by the individual themselves, through their insurance coverage, or provided by charity. We're talking a really tiny fraction of gains here.

Re: Both in rich and poor countries, universal health care brings huge benefits

#526

Earlier quoted context omitted.

Causes of price inflation and the looming demographic crisis are not "abstract ideas." For literally decades the US did not open a single medical school due to lobbying from the medical industry. Even though we've tried to reverse the trend since the 90s, there are still fewer medical schools today than there were 100 years ago. When the government decides how many doctors there will be, it may get the number right o…

Start with the data! > there are still fewer medical schools today than there were 100 years ago... it may get the number right or it may get the number wrong... And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make. http://www.nationmaster.com/country-info/stats/Health/Physic... > Most of the differences in outcomes between us and other wealthy nation…

>http://www.nationmaster.com/country-info/stats/Health/Physic....

By your link we're 52nd in doctors per capita. That's not great. Plus I'd already noted that we've made a concerted effort to undo the damage since the 90s. Are you suggesting that supply and demand has no impact whatsoever on the wages doctors are capable of demanding? Do you believe that artificially restricting the supply for decades has had no impact on wages whatsoever?

>https://obesity.procon.org/view.resource.php?resourceID=0043....

https://medicalxpress.com/news/2018-01-mortality-obesity-sta...

But obesity is not the only issue, general issues related to poverty are:

https://www.newyorker.com/tech/elements/why-america-is-losin...

Higher adolescent pregnancy rates, higher rates of HIV, etc.

=== Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.===

So best case scenario access and affordability to healthcare accounts for about 25% of improvements in life expectancy. Except the majority of people already have access to healthcare in the US. It's not as available and affordable as we'd like, and we're talking about how best to improve availability and affordability, but it's a tiny fraction of the problem of why US health outcomes are so bad.

Re: Both in rich and poor countries, universal health care brings huge benefits

#527

Earlier quoted context omitted.

I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death. Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?

>I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death. I don't think it's necessarily limited to that, but I do think all such situations are coercive. Whether someone is having a gun pointed at them, or being denied healthcare, they are being coerced. That said, I do think most coercion does ultimately amount to the threat of death or suffering, even i…

>And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.

Can you honestly not see the moral distinction between me intentionally shooting you with a gun and me not applying first aid after someone else has intentionally shot you with a gun?

Re: Both in rich and poor countries, universal health care brings huge benefits

#528

Earlier quoted context omitted.

> people using school vouchers for private schools is [not] a demonstration of their satisfaction with the public school system in their area It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts! The primary education system is a single- payer system, and the use of vouchers doesn't change that.

> It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts! You're basically arguing a tautology: Because there's no legal way to fully opt out of the system if they dislike it, people can't leave it (by your definition), and you're then saying that, because people don't fully leave the system, that means they don't dislike it. 40% of people choose not to…

In both cases — Medicare Advantage and vouchers — people are accepting a government subsidy in a form that allows them more choice than the default form. You're the one trying to make some kind of point based on that. I see it as evidence of nothing more than the fact that people like to have choices. I'm not arguing that it proves that they like the system as a whole; I'm just rejecting your claim that it somehow proves that they don't. I do tend to agree that a system that allows them those choices is better than one that doesn't.

> The program that they choose to use instead outperforms Medicare on every key performance indicator (medical outcomes, cost, patient satisfaction), while also underperforming the same private insurers on those same indicators.

Cost to whom? I don't see how Medicare Advantage can cost less to patients than Medicare; nor does it seem likely that the premiums for a private plan are less than the subsidized Medicare Advantage premiums. (Re the latter, I guess you didn't see my other reply to you: https://news.ycombinator.com/item?id=16979926)

Re: Both in rich and poor countries, universal health care brings huge benefits

#529

Earlier quoted context omitted.

> It certainly doesn't indicate dissatisfaction with the fact that the money for those vouchers comes out of tax receipts! You're basically arguing a tautology: Because there's no legal way to fully opt out of the system if they dislike it, people can't leave it (by your definition), and you're then saying that, because people don't fully leave the system, that means they don't dislike it. 40% of people choose not to…

In both cases — Medicare Advantage and vouchers — people are accepting a government subsidy in a form that allows them more choice than the default form. You're the one trying to make some kind of point based on that. I see it as evidence of nothing more than the fact that people like to have choices. I'm not arguing that it proves that they like the system as a whole; I'm just rejecting your claim that it somehow pr…

> Cost to whom? I don't see how Medicare Advantage can cost less to patients than Medicare

How do you think Medicare works? Do you think that, once you're covered by Medicare, you just show up at a doctor or hospital, flash your government-issued Medicare card, and receive free treatment for any covered services, without having to pay anything out of pocket?

(For the record, that is not how it works. Medicare is not free for patients. Premiums are neither your only nor your largest expense.)

Re: Both in rich and poor countries, universal health care brings huge benefits

#530
post #6

When a person gets a life threatening disease they ought not worry about whether or not their treatment will leave their family in penury. This is especially so in a nation as wealthy as the U.S. The American healthcare system is immoral and I hope it drastically changes. Americans need to change their underlying notions of what it means to be a society. An author was once made fun of for suggesting that it takes a v…

> Americans need to change their underlying notions of what it means to be a society. We want it ( https://www.pbs.org/newshour/health/62-percent-u-s-want-fede... )... Our politicians just aren't doing it.

I wonder what % of that 62% are actually net taxpayers?

http://www.taxpolicycenter.org/taxvox/closer-look-those-who-...

http://www.pewresearch.org/fact-tank/2017/10/06/a-closer-loo...

https://taxfoundation.org/distribution-tax-and-spending-poli...

>American’s lowest-income families receive $5.28 worth of government spending (federal, state, and local) for every $1 they pay in total taxes.

Can't be hard to find enough people willing to vote for more benefits, especially if they know they aren't the ones paying for anything.

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