quote:

---

Originally posted by mousethief:
There are even cartoons about it. (The "expensive" part is of course applicable to America, where we still live in the 19th century as regards availability of medical care. Sigh.)

---

Apart from the enjoyable cartoon, this got me thinking on a constant question I have: Why are so many [not all, but many] opposed to a system of free healthcare for all [doctor's visit; hospital treatments/procedures] in the US?

Is it historical? Political, or does it cross the divide? Is it money-oriented: I'll pay for my heathcare myself not with increased taxes.

We here, supposedly, have free healthcare [I had a long consultation with a GP Monday who charges so I paid $160 and got back $105.55 instantly from the government; as would any citizen - not means tested], so I am obviously in my bubble...but what causes some Americans to be so anti-healthcare? And how does it get to the point that a simple hospital stay can cost 10s of 1000s, if not 100s of 1000s?
 

---

Posted by cliffdweller (# 13338) on :
 
The GOP has done an excellent job of spreading false info and sabotaging Obamacare by undercutting funding.

The insurers helped too. When premiums went up-- as they have done every year precisely because they can-- this time the insurers got to say "because Obama" and desperate people feeling pressed believed them
 

---

Posted by simontoad (# 18096) on :
 
Oh Ian. You may as well ask for a cure to the common cold.

I myself went to the Doctor's yesterday, and I will shortly go and get a few blood tests. All of this will cost me nothing as I use bulk-billing services. I live on the fringe of a big city. I also filled a script which cost me $12 I think, a generic brand.

Of course, we are oppressed by a socialist state and have no freedom, but I guess that's the price you pay for living well. Help! I'm being oppressed!
 

---

Posted by Og, King of Bashan (# 9562) on :
 
Planet Money ran this story on the history of the system in 2009. The whole thing was kind of thrown together over several decades through unrelated acts that drove demand. Now it's what we are used to, and the book on how to fight reform ("tax increases and socialist death panels") is well written.
 

---

Posted by Lamb Chopped (# 5528) on :
 
I think it's a combo of things, but fear we can't afford it as a country is a big part of it. Someone whose opinion I respect pointed out to me that we probably WOULD be able to afford it if we weren't largely responsible for financing the defense of half the world.... ah well.

Leaving that aside, there's the panicky feeling that some of us (those lucky enough to actually have health insurance) feel whenever we hear you-all in single-payer systems casually mention the long waits you have to be seen for things we routinely get seen for tomorrow--or the next day at most. And then there are the horror stories of things which should have been able to wait, but then you discover that it's ovarian cancer and you might have been cured if you'd been seen a few months earlier--oh, wait, that's my family.

But you can see how this makes us panic. We (some of us, we) fear being at the mercy of somebody else's ability to say "no, you can't see a doctor/get surgery/have tests until _____"--and then finding out that the decider, not being God, has made a bad mistake.

To be sure, we are already at the mercy of our &Y%^$&% insurance companies, who behave in much the same way even now; but they are the devil we know, and have lived with for so long...
 

---

Posted by Lamb Chopped (# 5528) on :
 
I should probably clarify that I am not at all in favor of repealing Obamacare, and I would probably breathe a sigh of relief if we could nationalize healthcare and not agonize over the prospect of possible medical bankruptcy anymore.

I do wonder, however, just how long we'd stay in the forefront of medical and pharmacological innovation if we took the extremely crass profit motive out of play. Low view of the human race? Why, whatever gave you that idea?
 

---

Posted by Ricardus (# 8757) on :
 

quote:

---

Originally posted by Lamb Chopped:
I think it's a combo of things, but fear we can't afford it as a country is a big part of it. Someone whose opinion I respect pointed out to me that we probably WOULD be able to afford it if we weren't largely responsible for financing the defense of half the world.... ah well.

---

I realise I'm probably preaching to the converted here, but is there no awareness of how ridiculously expensive the American system is? I don't have the figures to hand, but IIRC the US spends something like 15% of GDP on healthcare and not everyone is covered. The European average is more like 10% for near universal coverage and the health outcomes are similar.

IOW, if you lot switched to a German or French style system, you could afford to buy even pointier missiles with the savings ...
 

---

Posted by simontoad (# 18096) on :
 
You can buy private health insurance in Australia if you want. It gives you choice of Dr if you are lucky and the capacity to skip queues for elective procedures. Private health insurance is expensive and rarely if ever covers the entire cost of your health care. It also covers dental care, which is more or less not available under the public system.

There is definitely more than one basket in the Australian health care system. As someone without private health insurance, for my day-to-day health care I can choose to go to a medical practice that charges about $60 out of pocket per visit for an employed Doctor, about $100 for one of the owners of the business, or a free Dr who hung out her shingle about a year ago. These places are about a 10 min walk from my house.

I choose to go to a free Dr about 30 mins drive away, where I have been going for about 10 years. I really like the Dr who owns this place. He's a Sri Lankan migrant who invested heavily in an existing practice in a poor part of a relatively poor suburb of Melbourne. He expanded the premises about 4 or so years ago, and so now this area not only has a chemist and GP, but a dental surgery, a day surgery and plenty of space for visiting specialists across a range of fields. He also has people like physios, dietitians and the like practicing out of his rooms.

The guy is making an absolute mint providing free and comprehensive medical services to a poor locality. Incidentally, I avoid seeing him professionally like the plague. He's a terrible doctor, IMO, just rushes through the consultation without even pretending to listen. That's how you make money, see I tend to find the one employee Dr I like and just stick with them until they move on.

I have a diagnosis of bi-polar disorder. I have seen a psychiatrist for about 15 years now. It's rare to find one that doesn't charge a fee on top of the medicare schedule, but this bloke doesn't. So, that's free too. Last year I reacted to something in a way that disturbed me, so I'm also seeing a psychologist at the same place. Again I pay nothing. I think that has something to do with me having this chronic mental illness, but I'm not sure exactly how that works. I just go with the not paying for useful treatment thing.

But, you know, socialist oppression. Pity us.
 

---

Posted by mdijon (# 8520) on :
 

quote:

---

Originally posted by Lamb Chopped:
whenever we hear you-all in single-payer systems casually mention the long waits you have to be seen for things we routinely get seen for tomorrow--or the next day at most.

---

quote:

---

Originally posted by Og, King of Bashan:
Planet Money ran this story on the history of the system in 2009.

---

quote:

---

We (some of us, we) fear being at the mercy of somebody else's ability to say "no, you can't see a doctor/get surgery/have tests until _____"--and then finding out that the decider, not being God, has made a bad mistake.

---

quote:

---

Originally posted by simontoad:
Of course, we are oppressed by a socialist state and have no freedom, but I guess that's the price you pay for living well. Help! I'm being oppressed!

---

Well, you folks walk around upside-down there, so of *course* you all do things upside-down and backwards!

 

---

Posted by Doc Tor (# 9748) on :
 
Currently, on my facebook wall, I have three people trying to raise funds for medical treatment that would be free if they lived somewhere that had socialised medicine.

As it is, even if they make the rent and utilities bills on top of their care this month, they're probably going to die next month, homeless and broke.

I just have to conclude the US is, in general, happy with this situation, otherwise they'd have done something about it by now.
 

---

Posted by mdijon (# 8520) on :
 
Of course it is simplistic to talk about a state's view of a particular issue. The population elect representatives who are imperfect enactors and implementers of their will, and are often constrained by their choice of representatives, who are themselves constrained by political realities.

And then again they might elect a sociopathic, narcissistic, misogynist, racist nutcase bent on destroying everything. That would also not help.
 

---

Posted by Sioni Sais (# 5713) on :
 

quote:

---

Originally posted by mdijon:
Of course it is simplistic to talk about a state's view of a particular issue. The population elect representatives who are imperfect enactors and implementers of their will, and are often constrained by their choice of representatives, who are themselves constrained by political realities.

---

quote:

---

Originally posted by Ian Climacus:
Apart from the enjoyable cartoon, this got me thinking on a constant question I have: Why are so many [not all, but many] opposed to a system of free healthcare for all [doctor's visit; hospital treatments/procedures] in the US?

---

quote:

---

Originally posted by Amanda B. Reckondwythe:
If I have to see a specialist, though, I can wait several months before an appointment becomes available.

---

quote:

---

Originally posted by Amanda B. Reckondwythe:
Thank God for Medicare, though -- if we can only keep it. I'm of the age where I rely on it. I have no complaints regarding the level of care I receive from my primary care provider. I can always get an appointment in a reasonable amount of time. If I have to see a specialist, though, I can wait several months before an appointment becomes available.

---

quote:

---

Originally posted by mousethief:

quote:

---

Originally posted by Amanda B. Reckondwythe:
If I have to see a specialist, though, I can wait several months before an appointment becomes available.

---

This is true of many specialties, even for people with classical for-profit insurance plans. Just try getting a first appointment with a pediatric neurologist in most parts of the USA within 6 months.

---

quote:

---

Originally posted by Lamb Chopped:
I think it's a combo of things, but fear we can't afford it as a country is a big part of it. Someone whose opinion I respect pointed out to me that we probably WOULD be able to afford it if we weren't largely responsible for financing the defense of half the world.... ah well.

---

quote:

---

Originally posted by Amanda B. Reckondwythe:
Plus nationalized health care means higher taxes. The promise of lower taxes can always be a convenient carrot to fasten to the stick that leads voters down the road to subservience.

Everyone wants better health care, but no one wants to pay for it.

---

quote:

---

Plus it would mean decreased profits for the health care and pharmaceutical industries.

---

quote:

---

Originally posted by Crœsos:
They'll go to the mat to preserve Medicare for themselves but they're typically less concerned about providing a Medicare-like system for younger Americans. It's not so much that they don't want such a system, it's that it isn't a huge priority for them.

---

quote:

---

I take two prescription medications daily, one for blood pressure and the other for an underactive thyroid, and it so happens that the deductible (the amount the patient pays before Medicare kicks in) is higher than what the generic versions cost. And so I end up paying full price for both of them, which thankfully is cheap.

---

Most working-age people have to pay (a nominal charge) for prescriptions over here, but they're free for children, pensioners and anyone with a "medical exemption" - which covers drugs required for some chronic conditions such as diabetes and underactive thyroid.

[ 20. June 2017, 15:50: Message edited by: Jane R ]
 

---

Posted by Crœsos (# 238) on :
 

quote:

---

Originally posted by lilBuddha:
Side note: Teabag darling Ryan has tried to kill, and then maim, Medicare; so why does he remain a darling of the blue-haired?

---

quote:

---

Originally posted by lilBuddha:
Things like this, and Trump an Bexit, are enough to make one hate old people.
Except me, me, me, is not an age related thing, so then it is enough to hate the young for not adequately turning out to vote.
People suck.

---

quote:

---

Originally posted by mdijon:
2) Nevertheless believing that liberty matters more than healthcare, and that a society where individuals give up their freedom to be uninsured and spend their money as they want is one that sacrifices a principle and/or suffers consequences of the curtailed freedom and thin-end-of-the-wedge.

---

quote:

---

Originally posted by Lamb Chopped:
If any of you can suggest a realistic way of CHANGING this situation with any speed (given the current orange incumbent and various accomplices), I'm all ears.

---

quote:

---

Originally posted by Lamb Chopped:
Yeah, well, I live in a state that has the dubious honor of having actually chopped Medicaid already on a state level without waiting for Congress to justify their ways--and they never expanded it in the first place, either. So Mr. Lamb is coming home stressed out because he's trying to squeeze healthcare out of a stone for his very vulnerable old folks that he cares for. The stone that has taken the place of various legislators' hearts, I mean.

---

Oh, I thought you lived in Calif.-- my mistake. Agh, yeah, as noted above, that sucks.
 

---

Posted by cliffdweller (# 13338) on :
 
Although google tells me that even my progressive blue state has made some cuts to medicaid this year. Should the worst happen this week, more may be coming.
 

---

Posted by stonespring (# 15530) on :
 
The problems in the US are complicated, as many have said. It's not just the insurance companies that are worried about losing their profits. The pharmaceutical companies are as well. They more than any other interest group defend their massive profits by saying that it funds research and development of cutting-edge drugs. Quibbles about whether some drugs like Viagra really were so necessary for modern healthcare that they justified the high price of other drugs aside, there is a lot of research and development costs that go into merely producing similar chemicals to drugs that are already on the market and getting a new patent to sell a drug at a much higher price that does something a cheaper older generic drug already does. We need lots of R&D in healthcare, and pharmaceutical companies do often come up with remarkable breakthroughs - but we also need to have more funding for R&D in universities and in government labs - from funding sources other than the drug companies - that is directed towards helping humanity without the incentive to increase profits possibly directing research in other directions.

Hospitals (most of which, aside from the VA hospitals that provide free care to veterans, are private), whether for-profit or not-for-profit, are worried that a universal health insurance program would pay them less for the cost of care for people who are currently insured by private health insurance plans. Hospitals are very happy, though, with government policies that reduce the number of uninsured people (as opposed to a policy that would replace a person's private insurance with a government plan), because just about all hospitals have to treat anyone who comes to them with an emergency and when people are uninsured hospitals try to come after them for money but know that most of the time they likely will never be paid - the cost of treating the uninsured is written into higher costs charged by the hospital to insurers and in higher out-of-pocket costs to the insured for hospital care.

Doctors who work in private or group practice, as opposed to those who work in hospitals, are also worried about being paid less by a universal government plan that replaced private insurance. Some doctors in the US are paid much more than doctors in other countries, although giant student loan debts and huge premiums for malpractice insurance (the US is the most litigious society I know, and many states require malpractice insurance, which is very, very, very expensive) make doctors' take home pay less than it seems. Still, doctors in the US can often be among the wealthiest of professions, and many doctors are worried about losing not only pay but social status. There is also a deepening division among older, mostly male, mostly white doctors who became doctors when private practices were more common and university and medical school tuition was much lower, who stand the most to lose, and younger, increasingly female, increasingly people-of-color and/or immigrant doctors who because of changes in the healthcare system (among them consolidation due to the tremendous costs of paperwork required by the many different kinds of private and public insurance plans) have decided to become salaried employees of large hospital networks and other multi-speciality medical centers. Although doctors at hospitals often bill for services separately from the hospitals (and sometimes do not accept the same insurers that the hospital does - and the patient choosing a hospital often has no way of knowing if this is the case, but I digress), salaried doctors generally receive less payments directly from insurers (or none at all) than doctors in private or group practice, and are more likely to support reforms to the healthcare system that might result in reductions in reimbursements to healthcare providers for services - although this may indirectly result in lower doctor salaries.

Lastly, there is so much red tape in US healthcare - and so many good-intentioned people - not healthcare providers - whose jobs depend on helping people navigate this Byzantine system who would need to find new careers if the system were made sane. They are like the tax preparation companies in the US who lobby against simplifying the tax code or simplifying ways of filing your taxes.
 

---

Posted by simontoad (# 18096) on :
 
Someone mentioned funding family planning as a disincentive to supporting a universal health care system. I thought I'd post this instructional video funded by the Australian Government in 1995. As a result of this video, the worrying slump in child productivity no longer needed to be filled by child migrants.
 

---

Posted by Lamb Chopped (# 5528) on :
 
I'm a native Californian transplanted to the Midwest.
 

---

Posted by simontoad (# 18096) on :
 
Someone upthread suggested that some Americans don't want to have their taxes used to help poor people and other undesirables. After Universal Heathcare came out in 1975, Australians began to look at each other in a different way. Footage of this concert was widely used in an election campaign in 1976, with the slogan "Do you want to pay for these people's health care?".

The Government was smashed in the 1976 General Election, and major changes were made to the system to exclude bogans from the universal health care pledge.

However, after this interview was aired in late 1983, it was clear that universal healthcare had become a public safety issue, and the Government was forced to reinstate it.
 

---

Posted by stonespring (# 15530) on :
 

quote:

---

Originally posted by simontoad:
Someone upthread suggested that some Americans don't want to have their taxes used to help poor people and other undesirables. After Universal Heathcare came out in 1975, Australians began to look at each other in a different way. Footage of this concert was widely used in an election campaign in 1976, with the slogan "Do you want to pay for these people's health care?".

The Government was smashed in the 1976 General Election, and major changes were made to the system to exclude bogans from the universal health care pledge.

However, after this interview was aired in late 1983, it was clear that universal healthcare had become a public safety issue, and the Government was forced to reinstate it.

---

quote:

---

Originally posted by mdijon:
2) Nevertheless believing that liberty matters more than healthcare, and that a society where individuals give up their freedom to be uninsured and spend their money as they want is one that sacrifices a principle and/or suffers consequences of the curtailed freedom and thin-end-of-the-wedge.

---

quote:

---

Originally posted by Og, King of Bashan:
I see this quite a bit on Facebook, and I suspect I won't get a whole lot of push back around here for saying that it is an incredibly privileged position.

---

quote:

---

Originally posted by stonespring:

quote:

---

Originally posted by simontoad:
Someone upthread suggested that some Americans don't want to have their taxes used to help poor people and other undesirables. After Universal Heathcare came out in 1975, Australians began to look at each other in a different way. Footage of this concert was widely used in an election campaign in 1976, with the slogan "Do you want to pay for these people's health care?".

The Government was smashed in the 1976 General Election, and major changes were made to the system to exclude bogans from the universal health care pledge.

However, after this interview was aired in late 1983, it was clear that universal healthcare had become a public safety issue, and the Government was forced to reinstate it.

---

Sadly, there is not only a class and cultural aspect to the stigmatization of people receiving government benefits from the US (excluding benefits for veterans and the elderly, which people tend to not think of as "government" benefits because they are viewed as being earned) - there is also a racial component. The phrase "welfare queen" is a dog whistle term (i.e., a racial euphemism) that is most commonly associated with African-American single mothers - despite the vast majority of welfare recipients who are white.

---

quote:

---

Originally posted by mdijon:
Logically that's what I'd expect, but in fact it seems to me that many of the people who apparently value the liberty of an uninsured life are some of the most vulnerable in the US. The Republican demographic includes many poor older Americans doesn't it?

---

quote:

---

Originally posted by cliffdweller:

Of course everyone's individual mixed bag of needs/benefits is different. So the services you need will not be the services your neighbor needs-- which, if it's all configured in individual benefits, means they won't vote for the program you need.

---

quote:

---

Originally posted by simontoad:
It's like skanking (according to Wikileaks), and I find it highly risible.

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by mdijon:
Logically that's what I'd expect, but in fact it seems to me that many of the people who apparently value the liberty of an uninsured life are some of the most vulnerable in the US. The Republican demographic includes many poor older Americans doesn't it?

---

I've spoken to a number of poor Republican voters over the years, and they tend to share the opinion that they can't afford healthcare, and they are better off hoping that they remain reasonably healthy (when they can just about make ends meet and afford the occasional cheap luxury). They see a significant difference between having to spend a lot of money on insurance and not doing that, and assume that if they get sick, they're screwed anyway, so don't bother differentiating between degrees of screwedness.

They also don't have home insurance, for basically the same reason.

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by cliffdweller:

Of course everyone's individual mixed bag of needs/benefits is different. So the services you need will not be the services your neighbor needs-- which, if it's all configured in individual benefits, means they won't vote for the program you need.

---

But health insurance is about individual needs - it's about whether I think the odds of me getting sick are worth paying for healthcare. It's the kind of risk estimation that people are very, very bad at (we're not too bad at estimating "normal" risks, but completely suck at estimating rare risks.) And just like home insurance, preventative maintenance, and other precautionary spending, it's easy to kick it down the road in favour of immediate needs.

The thing that is not about individual needs is a taxation-funded single-payer system.

We don't buy "school insurance" to guard against the risk of having progeny that we can't educate ourselves. We don't buy "police insurance" to guard against requiring police services if we're the victims of crime, and we have long since realized that paying subscriptions to private fire brigades is a bad idea.

---

quote:

---

Originally posted by Lamb Chopped:

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by mdijon:
Logically that's what I'd expect, but in fact it seems to me that many of the people who apparently value the liberty of an uninsured life are some of the most vulnerable in the US. The Republican demographic includes many poor older Americans doesn't it?

---

I've spoken to a number of poor Republican voters over the years, and they tend to share the opinion that they can't afford healthcare, and they are better off hoping that they remain reasonably healthy (when they can just about make ends meet and afford the occasional cheap luxury). They see a significant difference between having to spend a lot of money on insurance and not doing that, and assume that if they get sick, they're screwed anyway, so don't bother differentiating between degrees of screwedness.

They also don't have home insurance, for basically the same reason.

---

This is actually quite a logical response from where they are standing. Suppose you're just meeting your needs financially (as a recent poll showed a lot of people are) but a 400$ expense would break you. You know perfectly well that if you get cancer the bill is going to be considerably more than 400$, but you also know that you have a high chance of NOT getting cancer (or other catastrophic illness) for the next few years anyway. This means that if you fork out for health insurance (say at a rate of $285 through what's on offer at your job), you are going to feel the pain each and every month, and if you get cancer, you're screwed anyway, because the copays and coinsurance are going to destroy you. On the other hand, if you take your chances, you manage to hang on to that $285 (or whatever it is) which allows you to do things like enrolling your kid in band (uniform costs etc) and you avoid the monthly pain. You may or may not get cancer--if you don't, hurray! but if you do, well, you would have been screwed even with insurance.

So all in all, the choice is between monthly pain and austerity which will not save you when the medical disaster comes; or running that same risk of medical and financial disaster but without the monthly pain.

Because it doesn't matter if you lose your home because you owe 10,000 or 100,000. You've still lost it.

The whole set up really does encourage an attitude of "eat, drink and be merry, for tomorrow we die." There simply is no reasonable option for avoiding the (financial) death no matter what you do. so why bother?

---

quote:

---

Originally posted by cliffdweller:
You don't seem to be following my point.

---

quote:

---

Health insurance IS precisely about pooled risk. ALL insurance-- auto, homeowners, etc.-- works precisely this way, as do many government services, including fire and police protection.

---

quote:

---

Originally posted by cliffdweller:
You don't seem to be following my point. Health insurance IS precisely about pooled risk. ALL insurance-- auto, homeowners, etc.-- works precisely this way,

---

quote:

---

as do many government services, including fire and police protection

---

quote:

---

Originally posted by lilBuddha:
Vaccinations aren't just whether Gran gets the flu because grandchild didn't get vaccinated, the flu killed more people than anything else during WWI because lack of vaccination. You know, like a threat to the public good.

---

quote:

---

Certainly it is true of things like vaccinations, which affect the whole society and not just the vaccinated individual, but it's also more weakly true about the general health of the populace.

---

quote:

---

Ala carte health care cost more for EVERYONE, this is against the public good.

---

quote:

---

Originally posted by Leorning Cniht:
<snip>

quote:

---

Ala carte health care cost more for EVERYONE, this is against the public good.

---

But this isn't true, which is why there is a debate. A la carte healthcare is cheaper for people who don't get sick. It's easy to tell a posteriori whether you are one of those people.

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by lilBuddha:

[QUOTE]Certainly it is true of things like vaccinations, which affect the whole society and not just the vaccinated individual, but it's also more weakly true about the general health of the populace.

---

quote:

---

[qb]Ala carte health care cost more for EVERYONE, this is against the public good.

---

But this isn't true, which is why there is a debate. A la carte healthcare is cheaper for people who don't get sick. It's easy to tell a posteriori whether you are one of those people.

---

quote:

---

Originally posted by Leorning Cniht:
But this isn't true, which is why there is a debate. A la carte healthcare is cheaper for people who don't get sick. It's easy to tell a posteriori whether you are one of those people.

---

quote:

---

Originally posted by Leorning Cniht:
But this isn't true, which is why there is a debate. A la carte healthcare is cheaper for people who don't get sick. It's easy to tell a posteriori whether you are one of those people.

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by lilBuddha:
Vaccinations aren't just whether Gran gets the flu because grandchild didn't get vaccinated, the flu killed more people than anything else during WWI because lack of vaccination. You know, like a threat to the public good.

---

It sounds like you're arguing with me, but this is equivalent to the statement that I made:

quote:

---

Certainly it is true of things like vaccinations, which affect the whole society and not just the vaccinated individual, but it's also more weakly true about the general health of the populace.

---

quote:

---

Ala carte health care cost more for EVERYONE, this is against the public good.

---

But this isn't true, which is why there is a debate. A la carte healthcare is cheaper for people who don't get sick. It's easy to tell a posteriori whether you are one of those people.

---

quote:

---

Originally posted by Lamb Chopped:
My point is simply that there is a very large chunk of people in America who don't have the ability to choose. Their financial circs are such that they have one realistic choice only, which is to go uninsured and hope for the best.

---

quote:

---

Originally posted by Doc Tor:

US spending per capita is over twice what it is in the UK. Would it true to say that it'd be actually cheaper for those who currently pay to pay for a UK-style NHS that covers everyone, as opposed to paying privately just for themselves?

---

quote:

---

There are foolish articles floating around pointing out that Medicare costs more per patient, and so is less efficient. (Medicare patients tend to be old and sick - they use on average much more healthcare than insurance company patients.)

---

quote:

---

Originally posted by lilBuddha:
You said weakly. My point is that it isn't weak. It only appears that way because enforcing policies For the public good have made the dangers smaller. But the potential for great danger is still there.

---

quote:

---

And taxes, dude. Part of the cost of treating the uninsured is payed in taxes.

---

quote:

---

Originally posted by simontoad:
How do those Americans who oppose universal health care defend themselves against the charge that they are selfish cockheads?

---

quote:

---

Originally posted by Leorning Cniht:
A public good is not quite the same as a thing that is good for the public. Having the public be generally healthier is obviously good for the public. It is less obvious that it is a public good, although I think it has at least an element of public good about it.

---

quote:

---

Originally posted by Crœsos:
if you're going to stipulate in advance that just letting people die untreated is an unacceptable option.

---

quote:

---

Originally posted by lilBuddha:

quote:

---

Originally posted by Crœsos:
if you're going to stipulate in advance that just letting people die untreated is an unacceptable option.

---

That is one of those things most people would say was unacceptable but act otherwise.

---

quote:

---

If a young person were to ask me what industry they should go into to insure a profitable future, I think I'd have to say "funeral services."

---

quote:

---

Originally posted by Soror Magna:
Why does the USA pay twice as much per capita for health care? Because a huge chunk of that money goes to insurance companies...

---

quote:

---

Originally posted by mdijon:
Then the level of bureaucracy required to approve and pay expenses is incredible. For all the bureaucracy of a Government system it's incredible what an insurance company requires in documentation in order to pay up to a hospital in the US, and all that costs money as well.

---

quote:

---

Originally posted by mdijon:
My impression is that in some setting in the US an administrator will have spent time on the phone getting insurance approval for the particular specialist referral

---

quote:

---

Originally posted by Leorning Cniht:
It didn't slow anything down very much, but it took two extra people.

---

quote:

---

Originally posted by mdijon:

Fictional numbers on a bill do not drop out of thin air - there has to be a lot of backing fictional calculation to get there and it all costs money.

---

quote:

---

Originally posted by Jane R:

The real tragedy of the British system is that Our Glorious Leaders want to make it more like the American system. [/QB]

---

quote:

---

Originally posted by Leorning Cniht:
... So when the doctor wanted to order tests A, B, C, and D, we asked whether his insurance would cover it, and the hospital sent us someone whose job was interfacing between patients and insurance companies, and they called the insurance company, and got approval for each specific test before they did anything.

It didn't slow anything down very much, but it took two extra people.

---

quote:

---

Originally posted by no prophet's flag is set so...:
I looked up the costs of some hospital procedures. Link to fee listing for my province. Link to Mayo Clinic cost estimate tool.
Here a cardiac pacemaker install is $1168.40. Mayo Clinic (Minnesota) cost is $31,475, using their cost estimator tool with no insurance.

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by mdijon:

Fictional numbers on a bill do not drop out of thin air - there has to be a lot of backing fictional calculation to get there and it all costs money.

---

Oh, yes.

My point with the "fictional" reference is that in a market where most people have insurance, and all the insurance companies negotiate the price that is to be paid for a particular procedure (and as I alluded to in my post, negotiated 90% discounts aren't uncommon), the headline price is completely I disconnected from any of the actual realities of the treatment.

---

quote:

---

Originally posted by Brenda Clough:
This is from the POST but is worth a clock if you can manage it. Because Senators have quit taking calls and emails, the parents of profoundly handicapped children bring their kids to Congress. It's heartbreaking.

---

quote:

---

Originally posted by Belle Ringer:
...
The disconnect between her searching for to meds free and her rejecting of free help left me speechless. To her there was no conflict. She needed the meds free. Free help is wrong, communist. What's the conflict?

As if these were two different topics.

I suspect she is not alone. And I cannot understand.

---

quote:

---

Originally posted by Brenda Clough:
you will see many ads for scooters <snip> and have the Federal government pay for it -- I believe they retail for $2K or so.

---

quote:

---

More perilously, once you quit walking and get onto one of these things you usually never get off.

---

quote:

---

Originally posted by cliffdweller:
The bastards had them forceably removed. The adults removed from their wheelchairs to be arrested

---

quote:

---

Originally posted by Amanda B. Reckondwythe:

quote:

---

Originally posted by Brenda Clough:More perilously, once you quit walking and get onto one of these things you usually never get off.

---

You're not implying, are you, that people use them unnecessarily?

---

quote:

---

Originally posted by Amanda B. Reckondwythe:
Time to seek the advice and assistance of an attorney, Gramps49.

---

quote:

---

Originally posted by lilBuddha:

quote:

---

Originally posted by Amanda B. Reckondwythe:

quote:

---

Originally posted by Brenda Clough:More perilously, once you quit walking and get onto one of these things you usually never get off.

---

You're not implying, are you, that people use them unnecessarily?

---

It is as ridiculous to say no one on benefits is a scrounger as to say all on benefits are scroungers.
However, I think Brenda might have been saying that using one when one can still walk might, in some cases, render the person unable to get along without one. Muscles atrophy quickly.

---

quote:

---

Originally posted by Crœsos:
Health care itself does not seem to fall under this classification but a health care risk pool might, if you're going to stipulate in advance that just letting people die untreated is an unacceptable option.

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by Crœsos:
Health care itself does not seem to fall under this classification but a health care risk pool might, if you're going to stipulate in advance that just letting people die untreated is an unacceptable option.

---

I know what a public good is. My case is that having a healthy population is a public good. This is obviously true for things like herd immunity in a vaccinated population, but I'm claiming that it's also weakly true for general population health. Consider the contrast between having fit, healthy neighbours who can lend a hand when needed, and sick ones who aren't capable.

Under the assumption that people are typically decent and will help out a neighbour in need (shoveling snow off the old lady next door's driveway, etc.), my claim is that a heathly population which is able to offer that help is a public good.

---

quote:

---

Originally posted by cliffdweller:
Even if your neighbor is a selfish jerk, you'll still benefit from having healthy neighbors because they'll be less of a drain on public services.

---

quote:

---

Originally posted by Brenda Clough:
Some pol in Virginia has proposed single-payer for our state. Doubt it'll go anywhere this cycle, but it's good to run the flag up the pole. In the meantime, I have one writer friend who has just been thrown off Medicare, and another who has started a Kickstarter campaign to fund her chemo, which she has to go to Mexico to get if she is able to afford it at all.

---

Sadly, they are just the canaries in the mine alerting us to what is to come if the replacement ACHA plan goes thru.
 

---

Posted by Brenda Clough (# 18061) on :
 
This is from the NY Times and so will cost you a click. In her inimitable style columnist Gail Collins points out why the current health care bill is poison for women.
 

---

Posted by Crœsos (# 238) on :
 

quote:

---

Originally posted by RuthW:
The Speaker of the House in California's Assembly has shelved the single-payer bill, saying it has too many flaws.

Then fix it, asshole, or write a better one. The majority of Californians support single-payer health care, so get it done. God, I am so angry.

---

quote:

---

Originally posted by Brenda Clough:
Some pol in Virginia has proposed single-payer for our state. Doubt it'll go anywhere this cycle, but it's good to run the flag up the pole.

---

quote:

---

Originally posted by Brenda Clough:
This should be a free click: it is possible that the current health insurance legislation could lose Rep. Scalise his coverage. This was the Congressman who was shot on a ballfield last week; if the caps on lifetime care go through he's going to be bankrupt before he dies. His care and rehab are going to cost millions of dollars.

---

quote:

---

Originally posted by Brenda Clough:
This should be a free click: it is possible that the current health insurance legislation could lose Rep. Scalise his coverage. This was the Congressman who was shot on a ballfield last week; if the caps on lifetime care go through he's going to be bankrupt before he dies. His care and rehab are going to cost millions of dollars.

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by RuthW:
The Speaker of the House in California's Assembly has shelved the single-payer bill, saying it has too many flaws.

Then fix it, asshole, or write a better one. The majority of Californians support single-payer health care, so get it done. God, I am so angry.

---

The main flaw with state-level single payer plans is that states have a very limited ability to engage in deficit spending. This tends to mean such plans collapse during economic downturns, when state revenues are down but demand for health care isn't. I'm not sure that's fixable within the scope of a health care bill.

---

quote:

---

Originally posted by Crœsos:
The main flaw with state-level single payer plans is that states have a very limited ability to engage in deficit spending.

---

quote:

---

Originally posted by Doublethink.:
Is there any way of changing those rules ?

---

quote:

---

Originally posted by lilBuddha:

quote:

---

Originally posted by Doublethink.:
Is there any way of changing those rules ?

---

I suppose they could vote to change them. But "Hey, let's go into debt" is unlikely to be popular.

---

quote:

---

Originally posted by mdijon:
I had no idea. That seems odd to me since I have thought of US States like quasi-countries, and borrowing seems an absolute necessity to most Countries. Is it generally thought to be an odd anachronism in the States themselves that is just too difficult to fix or is it part of a political stand taken by some or other group?

---

quote:

---

And many states run at a deficit anyway, they are continually bailed out by states with better economies. Most of their citizens do not appear to understand how this works.

---

quote:

---

Originally posted by RuthW:
If you're talking about states which are net takers from the federal government as opposed to net givers, that doesn't count as deficit spending -- federal dollars received by any state are just considered income for that state.

---

quote:

---

Originally posted by lilBuddha:

quote:

---

Originally posted by RuthW:
If you're talking about states which are net takers from the federal government as opposed to net givers, that doesn't count as deficit spending -- federal dollars received by any state are just considered income for that state.

---

Yes, it is to this I was referring. It is deficit spending, welfare, etc. whatever else people choose to call it.
This makes even more a mockery of the "balanced budget" amendments.

---

quote:

---

Originally posted by lilBuddha:

quote:

---

Originally posted by RuthW:
If you're talking about states which are net takers from the federal government as opposed to net givers, that doesn't count as deficit spending -- federal dollars received by any state are just considered income for that state.

---

Yes, it is to this I was referring. It is deficit spending, welfare, etc. whatever else people choose to call it.
This makes even more a mockery of the "balanced budget" amendments.

---

quote:

---

Originally posted by mdijon:
I had no idea. That seems odd to me since I have thought of US States like quasi-countries, and borrowing seems an absolute necessity to most Countries. Is it generally thought to be an odd anachronism in the States themselves that is just too difficult to fix or is it part of a political stand taken by some or other group?

---

quote:

---

As such their ability to repay those bonds is not as certain as the federal government, which has more monetary options at its disposal plus a section of the Fourteenth Amendment which forbids the feds from defaulting on their debts.

---

quote:

---

Originally posted by mark_in_manchester:

quote:

---

Originally posted by Crœsos:
The chief reason for this is that the individual states are forbidden from issuing their own currency. (Art. I, § 10 of the U.S. Constitution states, in part, that "No State shall . . . coin Money; emit Bills of Credit; . . .") As such their ability to repay those bonds is not as certain as the federal government, which has more monetary options at its disposal plus a section of the Fourteenth Amendment which forbids the feds from defaulting on their debts.

---

So if they print the money to pay them...they just have to watch out that internationally people don't lose confidence in the currency, which would generate 1930s Germany / Zimbabwe style inflation? (Sorry, I guess this is naive). Are there other issues?

---

quote:

---

Originally posted by Crœsos:
. . . <SNIP> if the states start printing their own money they have to watch out for the feds coming down hard on them for unconstitutional actions, possibly including sedition.

---

quote:

---

Originally posted by Belle Ringer:
That's the point. Its not a bill about health care. Its about taxes, giving lots of money to the rich.

---

quote:

---

Originally posted by Brenda Clough:
For those following along at home, here is a nice organized chart (and free!) delineating the winners and losers of the current legislation.

---

quote:

---

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood

---

quote:

---

States could request waivers to opt out of requiring essential health benefits.

---

quote:

---

States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether.

---

quote:

---

Originally posted by Golden Key:
Ian--

AFAIK, "yes" is the answer to the questions at the end of your post. It was the best that could be done, at the time. I cringed when I first heard that participation would be mandatory, because Americans don't like to be told what to do--especially by the gov't. And the punishing fines for non-compliance sure didn't help.

---

But of course there is no way for it to work financially without mandatory participation. And all sorts of other programs work precisely like that-- social security is not optional, paying taxes toward fire and police protection is not optional. But yes, getting past the mandatory part of it is a huge part of the problem.

The premium increases really didn't have anything to do with ACA, except the fact that ACA didn't go far enough. Premiums went up for the exact reason they have always gone up-- because they can. ACA didn't "make" them go up, but it did allow them to. ACA primarily fixed the access problem-- making it possible for everyone to get health insurance-- w/o addressing the cost. The best way to do that is some version of single-payer-- even more controversial than universal health care. Unfortunately, that doesn't seem to be the way the GOP is going.
 

---

Posted by Brenda Clough (# 18061) on :
 
Obama himself likened the ACA to your starter home. It was the best you could afford at the time. It is too small, in a less than charming area of town, and the kitchen is sadly lacking. The roof leaks and it needs some work. Nevertheless, it gets your foot into the door. The plan is for you to live in it for a while, amass your resources, and then move on up into a better house, hopefully before your children become so large that they drive you crazy and before the roof entire blows off into the street.
The ACA is acknowledged to be imperfect. The hope was to improve it. The intransigence of the GOP (not to mention their active malevolence sabotaging it) has made this impossible. But it is still better than what we had before.
 

---

Posted by Brenda Clough (# 18061) on :
 
Planned Parenthood is a separate whipping boy for the GOP. Keep in mind that the Hyde Act bars the government from funding abortions. PP truthfully affirms this, and supplies health and reproductive services to both genders across the nation. (The PP president went into their San Diego clinic earlier this year, and was astonished to see the waiting room full of men. Then she learned that it was Vasectomy Day, one of their most popular offerings. I envision it as an assembly line sort of operation...)
Nevertheless, the anti-abortion people have been demonizing it for years, and at this point it is clear that there is no reasoning with them.
I believe that the unspoken point of contention is not babies or abortion, but sex. You had, or intend to have, sex. BAD BAD BAD. This must be stopped. We need to control you and your sex, you slut. If you insist on having sex then you deserve all the bad things that can happen to you, and we will see to it that your misery is maximized.

[ 01. July 2017, 15:36: Message edited by: Brenda Clough ]
 

---

Posted by cliffdweller (# 13338) on :
 
spot on, Brenda (both posts).

Of all the ridiculous hypocrisy of the GOP, perhaps the most outrageous is the way they feign this "pro-life" position and get teary-eyed about "those precious babies"-- all the while putting forth the most cruelly pro-death legislation imaginable. And yes, babies-- both born and unborn-- will be among those lives lost due to the ACA repeal.
 

---

Posted by Brenda Clough (# 18061) on :
 
The moment that baby is born it is, by their design, without health care. The mother meanwhile had her pregnancy designated a pre-existing condition, and probably got no prenatal care. In this country a problem-free delivery probably cost her $20K.
So -- it's not the mother, not the fetus, not the infant. What is left, that they are so revering and protecting? Clearly the act itself, the p in the v that led to all this.
 

---

Posted by Ian Climacus (# 944) on :
 
Thanks for the explanations, all.
 

---

Posted by sabine (# 3861) on :
 
bumping. . .to report that the US Senate just voted 50-50 to bring forth the odious Repeal and Replace health care bill to the floor. Tie broken in favor of the ayes by Mike Pence (who always rates a from me).

sabine
 

---

Posted by sabine (# 3861) on :
 
Here is a link to the action, which is just a vote to debate the bill on the floor, not a vote to pass the bill

sabine
 

---

Posted by Brenda Clough (# 18061) on :
 
I have many friends who are thinking of emigrating.
 

---

Posted by sabine (# 3861) on :
 
A while back I typed "How do I..." into Google, and before I could type another word, the option popped up: "emigrate to Canada." Guess there have been a few searches on the subject.
sabine
 

---

Posted by Brenda Clough (# 18061) on :
 
A blog post I wrote on the subject three years ago.

And a follow-up, written last November.

This is now become a country that has set its face against the poor, the weak, and the old. We long ago of course lost pity for the prisoner and the outcast. Christ's gospel is dead here. The US is no longer a Christian nation.
 

---

Posted by Golden Key (# 1468) on :
 
Ummm, IMHO and that of many others, it never was a Christian nation--nor was it meant to be.
 

---

Posted by no prophet's flag is set so... (# 15560) on :
 
Yes slavery doesn't go well with Christianity. Southern Baptist and related racist organizations were't either. Lurched toward later. Lurched firmly away later-er. Oxymoron to consider reallt that any country is.
 

---

Posted by Brenda Clough (# 18061) on :
 
You would never know it, from the subset of Christians who loudly insist that it was Christian from its founding (never mind all those Deists, and you had better never read anything that Washington or Jefferson wrote). This frothing anxiety to impose their own version of religion, via legislation, onto the populace, springs from that belief.
I would mind less if their strictures actually had anything to do with what Jesus advocated. But no, their minds are all firmly fixed in their crotches. For example, today's POST headline: "Trump Calls for Ban on Transgender People Serving in Military."

[ 26. July 2017, 13:57: Message edited by: Brenda Clough ]
 

---

Posted by Penny S (# 14768) on :
 
So what does he want us not to look at this time?
 

---

Posted by Hedgehog (# 14125) on :
 
USA Today today is reporting:

quote:

---

The Senate voted Wednesday to defeat a bill that would have repealed Obamacare within two years without any immediate plan to replace the sweeping health care law.

Senators voted 45-55 in favor of the bill, falling six votes short of the 51 needed to pass it. Seven Republicans voted against it: John McCain of Arizona, Dean Heller of Nevada, Susan Collins of Maine, Rob Portman of Ohio, Lamar Alexander of Tennessee, Lisa Murkowski of Alaska and Shelley Moore Capito of West Virginia.

---

quote:

---

Senate plan with Cruz and Portman amendments
Vote failed 43-57 (required 60 votes)

Repeal and delay with Paul amendment
Vote failed 45-55 (required 50 votes)

Return to committee process
Vote failed 48-52 (required 50 votes)

---

quote:

---

From the Post:

• Repeal the individual and employer mandates, as well as the taxes on medical device companies
• Leave the Medicaid expansion, subsidies, and marketplace regulations such as preexisting conditions protections in place

The CBO has not scored the plan as a whole, but pieces have been scored in the past. Eliminating the individual mandate, for instance, would cause 15 million more people to become uninsured over the decade.

---

Eliminating the mandates will massively destabilize the individual market. Insurance companies will still be forced to cover anyone who buys insurance, but young and/or healthy people will exit the market, insurance premiums will go up, more people will exit the market, and the whole thing could completely come to pieces. This is the worst option that's been put forward. Naturally it has the greatest chance of passing.
 

---

Posted by Brenda Clough (# 18061) on :
 
Your third option "return to committee" was in fact advocated by John McCain in yesterday's speech. Alas, he didn't actually, you know, vote for it.
 

---

Posted by RuthW (# 13) on :
 
Because he doesn't actually believe all that bullshit about "the world's greatest deliberate body" and "regular order." He put party before country, just like the rest of the hyenas.
 

---

Posted by Dave W. (# 8765) on :
 

quote:

---

Originally posted by RuthW:
This [skinny repeal] is the worst option that's been put forward. Naturally it has the greatest chance of passing.

---

quote:

---

Originally posted by RuthW:
Because he doesn't actually believe all that bullshit about "the world's greatest deliberate body" and "regular order." He put party before country, just like the rest of the hyenas.

---

quote:

---

Originally posted by Dave W.:
The skinny repeal at least doesn't eliminate Medicaid expansion or cut its future spending, and although the individual market seems to draw more attention, Medicaid was where the ACA achieved most of its coverage increases and where the Republican plans would do the most damage.

---

quote:

---

“We just heard from the nonpartisan Congressional Budget Office that under such a plan, as reported in the press, 16 million Americans would lose their health insurance and millions more would pay a 20 percent increase in their premiums,” Sen. Chuck Schumer (D-NY) said on the Senate floor.

---

quote:

---

But from what I've read, skinny repeal isn't meant to be a final proposal anyway; it's just a way of getting 51 votes so McConnell, Ryan, and crew can cook up the real thing in the House-Senate conference committee. At that point they can switch their vote-cadging spiel from "don't worry that this is terrible policy, someone will fix it later" to "this is your last chance - vote for this horrific policy or be forever branded an Obamacare-loving traitor."

---

1. The American people, who spent a lot of time calling Congress and demonstrating in the streets. Nothing stiffens the spines of legislators like knowing people back home will definitely hold you accountable on this one.
   -
2. Congressional Democrats, who never wavered in preserving a signature accomplishment of their party. It takes a lot of party discipline to resist the beltway media's promise of accolades to reward bipartisanship simply for the sake of bipartisanship (and policy outcomes be damned).
   -
3. Senators Collins and Murkowski, who were willing to stand up for their constituents' interests from the start, against a lot of push-back from their fellow Republicans.
   -
4. John McCain, who seems to have felt that "someone should do something about this" and finally realized that he was "someone" who had a vote in the U.S. Senate.

quote:

---

Originally posted by Crœsos:
And so we now move on to the next Republican plan to get rid of the Affordable Care Act: sabotage by the executive branch.

---

quote:

---

Originally posted by Crœsos:
And so we now move on to the next Republican plan to get rid of the Affordable Care Act: sabotage by the executive branch.

---

quote:

---

Originally posted by Brenda Clough:
Let us not omit Senator Mazie Hirono (D-Hawaii), diagnosed with stage 4 liver cancer three months ago, who hauled herself to the Senate floor to vote NO, without any fanfare or backslapping from the media. So there's three recipients of the Iron Ovary right there.

---

quote:

---

Originally posted by Sober Preacher's Kid:
A free click, from the Globe and Mail, which isn't all that medicare-friendly, generally, but does have this gem:

Canadians watch Americans grapple with health care and it’s like we’re watching early man, standing frozen half to death in midwinter. We’re all like “Guys, just rub two sticks together!”

The Globe and Mail

---

quote:

---

But, no, 300 million Americans stand there, teeth chattering, each holding a stick, arguing day-in-day-out, “What is to be done?”

---

quote:

---

I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.

---

quote:

---

Originally posted by Brenda Clough:
Oh, that was Lyin' Don. A grain of salt the size of a Volkswagen would be about right.

The ACA is very imperfect. It can and should be improved, by wise legislation to stabilize the markets, patch holes, and so on. Hasn't happened. The populace is trapped in a rickety vehicle that doesn't really do the job, yet no better car is available.

---

quote:

---

Tangent: why exactly does health insurance need "open enrollment" periods? You can sign up for car, homeowners, earthquake, renters insurance pretty much any time you want. Why does health insurance need to be restricted to a few weeks a year? [/QB]

---

quote:

---

Originally posted by cliffdweller:
Tangent: why exactly does health insurance need "open enrollment" periods? You can sign up for car, homeowners, earthquake, renters insurance pretty much any time you want. Why does health insurance need to be restricted to a few weeks a year?

---

quote:

---

Originally posted by Brenda Clough:
Because it would otherwise be too tempting to simply wait, until you have that heart attack or break that leg. Then (the moment you can sit up) you sign up for health insurance.

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by cliffdweller:
Tangent: why exactly does health insurance need "open enrollment" periods? You can sign up for car, homeowners, earthquake, renters insurance pretty much any time you want. Why does health insurance need to be restricted to a few weeks a year?

---

If you stipulate that insurers are obligated to insure everyone at the same premium rate (the "community rating" stipulated by Obamacare/ACA) and that anyone applying for a policy is eligible ("must issue") then the obvious system exploit is to wait until you're sick and then sign up for insurance. This leads to a
death spiral where only sick (i.e. expensive) people sign up for insurance.

---

quote:

---

Originally posted by cliffdweller:
That's what the individual mandate/ penalties guards against

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by cliffdweller:
That's what the individual mandate/ penalties guards against

---

Except it really doesn't. There's still a wide range of ACA-legal insurance policies, so without the open enrollment period, it still might make sense to hold a cheaper policy and switch to a more expensive one when you want to use it.

Plus, you can't change your auto insurance after you have a crash, but you could change your health insurance if you were feeling sick, or thought you were pregnant, or thought you needed counselling that was offered by the more expensive plan or something, and before you consulted any kind of doctor.

---

quote:

---

Originally posted by cliffdweller:
But then why were there restricted open enrollment periods in decades before ACA, when pre-existing conditions weren't covered?

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by cliffdweller:
But then why were there restricted open enrollment periods in decades before ACA, when pre-existing conditions weren't covered?

---

A pre-existing condition is only "pre-existing" if it's been documented. So you take your pregnancy test, feel some unusual pains or whatever, quickly call up and change insurance, and then a couple of days later make an appointment to see your doctor with your new insurance.

---

quote:

---

Originally posted by Leorning Cniht:
A pre-existing condition is only "pre-existing" if it's been documented. So you take your pregnancy test, feel some unusual pains or whatever, quickly call up and change insurance, and then a couple of days later make an appointment to see your doctor with your new insurance.

---

quote:

---

Originally posted by Brenda Clough:
One of the root problems with the US system is that it is for-profit. The insurance companies, the doctors, the pharmaceutical firms, the ambulance drivers -- they're all out to maximize their profit. They have stockholders, to whom they answer to, and the patients are merely the cash cows, from which the funds must be milked. Thus these elaborate systems grow up, not to benefit the consumer or patient, but so as to maximize profit (or minimize payout) for the provider.

I know that a nationalized system (all of the entities above are employees of the Health Services or government or whatever) is open to abuses. But nothing is as pernicious, magnificently delivering mediocre care for maximal cost, as our current American system.

---

quote:

---

Originally posted by no prophet's flag is set so...:
Jesus didn't charge for healing.

---

Don't tell Benny Hinn.

sabine
 

---

Posted by Leorning Cniht (# 17564) on :
 

quote:

---

Originally posted by Boogie:
as I reckon I wouldn't put them through complicated operations at that age anyway. Not a choice we can make for humans

---

quote:

---

Originally posted by Leorning Cniht:

quote:

---

Originally posted by Boogie:
as I reckon I wouldn't put them through complicated operations at that age anyway. Not a choice we can make for humans

---

Of course it is. It's exactly what NICE does when it decides whether a particular treatment is cost-effective. Apparently according to NICE, a QALY is worth about £30,000.

---

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by cliffdweller:
Tangent: why exactly does health insurance need "open enrollment" periods? You can sign up for car, homeowners, earthquake, renters insurance pretty much any time you want. Why does health insurance need to be restricted to a few weeks a year?

---

If you stipulate that insurers are obligated to insure everyone at the same premium rate (the "community rating" stipulated by Obamacare/ACA) and that anyone applying for a policy is eligible ("must issue") then the obvious system exploit is to wait until you're sick and then sign up for insurance. This leads to a
death spiral where only sick (i.e. expensive) people sign up for insurance.

---

That's what the individual mandate/ penalties guards against-- just as it does if you ate caught driving around w/o auto insurance. Yet we don't need to restrict car insurance to an pope enrollment period. Health onsurance, otoh, had these limited enrollment periods decades before ACA or rules requiring coverage of preexisting conditions

---

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by cliffdweller:

quote:

---

Originally posted by Crœsos:

quote:

---

Originally posted by cliffdweller:
Tangent: why exactly does health insurance need "open enrollment" periods? You can sign up for car, homeowners, earthquake, renters insurance pretty much any time you want. Why does health insurance need to be restricted to a few weeks a year?

---

If you stipulate that insurers are obligated to insure everyone at the same premium rate (the "community rating" stipulated by Obamacare/ACA) and that anyone applying for a policy is eligible ("must issue") then the obvious system exploit is to wait until you're sick and then sign up for insurance. This leads to a
death spiral where only sick (i.e. expensive) people sign up for insurance.

---

That's what the individual mandate/ penalties guards against-- just as it does if you ate caught driving around w/o auto insurance. Yet we don't need to restrict car insurance to an pope enrollment period. Health onsurance, otoh, had these limited enrollment periods decades before ACA or rules requiring coverage of preexisting conditions

---

Car insurance differs from health insurance in several important ways. The biggest is that while we are generally willing to tell an uninsured motorist who's been in an accident that they'll just have to do without a car, we are less willing to simply let people without the means to pay for necessary medical care simply die. Most developed countries even have this standard enforced by law, in certain circumstances. In other words, someone willing to game the system with health insurance has more leeway than someone who does so with car insurance.

---

I think we established upthread the whole explanation re open enrollment periods so I've already dropped that line of argument.

However, let me remind you that prior to ACA we (US) were, in fact, quite willing to let people without health insurance die. Oh, sure, we'd let you in the ER so that you could spend your last few minutes of life surrounded by medical professionals going thru a desperate charade of trying to prevent the now-inevitable. And often they'd be able to forestall it a day or week or even month or two (at great cost). But the things that actually preserve life-- preventative care & screenings, access to chemotherapy or lifesaving pharmaceuticals? No, we were quite willing to deny that to all those poor (literally) uninsured suckers.
 

---

Posted by Brenda Clough (# 18061) on :
 
And we still are. You are entirely welcome in this land of the free and home of the brave to die from tooth decay. A little boy died that way in DC only a few years ago, I could find you the link -- the infection went upwards into his brain. A friend of mine, whose husband is fully employed, doesn't have dental insurance. To get the major dentistry she needs (extraction, implants, crowns) she's going to Poland. An extended medical vacation, still cheaper than paying out of pocket in Boston.
And consider that dying of toothache is probably one of the most agonizing ways to go.
 

---

Posted by sabine (# 3861) on :
 
Asthma is a pretty bad way to go, as well. Consider the uninsured folks (often children) who live in polluted* areas who die from asthma.

*polluted because, you know, "regulations are bad."

sabine

[ 24. September 2017, 18:26: Message edited by: sabine ]
 

---

Posted by Jane R (# 331) on :
 
Boogie:

quote:

---

There are only two market forces - fear and greed.

---

Three: you forgot envy. Plastic surgery, anyone?
 

---

Posted by RuthW (# 13) on :
 
I'd put that down to fear.
 

---

Posted by Jane R (# 331) on :
 
You could be right. Depends on the circumstances, though, don't you think?
 

---

Posted by Golden Key (# 1468) on :
 
Lots of people have legit reasons for plastic surgery: injuries, correcting physical problems (e.g., facial differences and structural problems, which can attract bullies), etc.

There are some people who seem to have...um...odd perspectives that they're driven to live out via plastic surgery. Like the woman who's had many, many surgeries, so she can look like a Barbie doll. Seriously. IMVHO, that's likely to be malpractice on the part of the surgeons, unless she is so disturbed about her looks that she was likely to kill herself.

And some people are under a lot of social pressure (from advertising, preferred stereotypes, and prejudice) that they change things about themselves they might otherwise keep. E.g., changing ethnic facial features.

And some people are under a lot of pressure from family and significant others.

Not as simple as envy.
 

---

Posted by Jane R (# 331) on :
 
I know all that... but ISTM that *some* of it is driven by envy. Plastic surgery with the aim of making perfectly passable features conform to whatever the current ideal of beauty may be, is an aspect of consumer culture. And consumer culture is definitely driven by envy.

As you say, it doesn't apply to all instances of plastic surgery, just as so-called 'designer babies' may be created for good medical reasons and not because Joe and Mary Bloggs want a child designed to their specifications.
 

---

Posted by Golden Key (# 1468) on :
 
Jane--

Your initial comment about envy and plastic surgery came across as flip and dismissive. That's why I listed counter-points.
 

---

Posted by Jane R (# 331) on :
 
Fair enough. Sorry I was a bit abrupt.
 

---

Posted by Golden Key (# 1468) on :
 
Thanks.
 

---

Posted by chris stiles (# 12641) on :
 

quote:

---

Originally posted by Jane R:
I know all that... but ISTM that *some* of it is driven by envy.

---

quote:

---

and some of it by a denial of the aging process.

---

quote:

---

Originally posted by Ohher:
A query for anyone who might know: since the Senate canceled this vote rather than holding it and securing the bill's defeat, is this bill really dead? Or does it slip unseen into some nightmare zombie state, lying poisonously around until some arcane Senate spell re-awakens it and calls it forth in blood and fire to threaten us once again?

---

quote:

---

Originally posted by Crœsos:

*I've been told that it's impolite to accurately describe the consequences of Republican "health care" bills, but I've never gotten a good explanation as to why this is so.

---

This.



 

---

Posted by Brenda Clough (# 18061) on :
 
I found the long detailed article from the Post about the availability of dental care in the US. Non-Americans, tell me if it's as bad where you are.
 

---

Posted by Boogie (# 13538) on :
 
This is the position in the UK.

Here is a longer fact sheet about charges for those not children or on low incomes.
 

---

Posted by Alan Cresswell (# 31) on :
 

quote:

---

Originally posted by Boogie:
This is the position in the UK.

---

quote:

---

Originally posted by Brenda Clough:
I found the long detailed article from the Post about the availability of dental care in the US. Non-Americans, tell me if it's as bad where you are.

---

© Ship of Fools 2016


UBB.classic^TM 6.5.0