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Source: (consider it) Thread: The US and Health Care
Ian Climacus

Liturgical Slattern
# 944

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On another thread:
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?

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cliffdweller
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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

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simontoad
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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!

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Human

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Og, King of Bashan

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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.

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Lamb Chopped
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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. [Hot and Hormonal]

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...

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Er, this is what I've been up to (book).
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Lamb Chopped
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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?

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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!

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Ricardus
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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 ... [Razz]

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simontoad
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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 [Smile] 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.

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mdijon
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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.

Correction - that those who have insurance routinely get seen the next day for. Those who don't have insurance don't get seen until it becomes an emergency.

Those who want to pay for cover that produces next-day appointments for routine care are still free to do that in most healthcare systems I know about.

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Barnabas62
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@ Ricardus

Cherchez l'argent? (Look for the money). On this issue, as on climate change and gun control, there are big vested interests prepared to lobby and finance propaganda to counter the facts re international comparisons with "alternative facts" and arguments (constitutional, American way of life, etc.)

Where the truth lies is unfortunately smothered by what the powerful want.

BTW, although not I believe on the same scale, there are 'post fact' problems and distortions by vested interests here in the UK as well. The price of liberty is eternal vigilance, but not just that. The paradox of the information age is that there is a lot of bad information freely available and, I fear, less regard for the truth and a reducing capability to detect and discount BS. No easy answers to that issue.

[ 20. June 2017, 05:53: Message edited by: Barnabas62 ]

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Ian Climacus

Liturgical Slattern
# 944

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

That was helpful, thank you.

As have been all contributions here; thank you. Pondering.

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Jane R
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Lamb Chopped:
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.
But you already are; in your case the sentence reads 'until you can pay'.

The NHS is definitely getting worse as a result of cuts to its funding, but I'd still back it against the American system. It is very good at preventative medicine; my Other Half was diagnosed with early-stage cancer, several years ago now, after a set of tests his doctor ordered ("it's not likely to be cancer because of your age and lifestyle, but we'll do that one as well just to be sure"). He probably wouldn't have been diagnosed so soon if he'd had to pay for the tests himself (Scottish, you know).

You may be thinking of this tragic case? But even in Charlie Gard's case, the medical team are trying to do their best for him. And who do you think is keeping him alive on life support until the courts make their decision?

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mdijon
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Although for poor old Charlie the main factor cited by the hospital is "Specialists at Great Ormond Street believe he has no chance of survival". Not that they are skint.

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Jane R
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Yes. And even in America his chances of survival would be poor; the treatment his parents want to try is experimental. But in America they would already be bankrupt from having to pay for his life support...
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Golden Key
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simontoad--

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!
[Biased] [Two face]

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Doc Tor
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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.

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mdijon
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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.

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Sioni Sais
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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.

Does "political realities" translate to "what the business lobby will let us do"? It looks like many of those in Congress or Parliament represent oil firms and defence contractors rather than the electorate.

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mdijon
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Insurance companies and healthcare providers more than oil here, but yes that would be part of it.

I have heard what I'd call an "intelligent defence" of private healthcare as the state's plan for provision (not that I agree with it) that goes along the lines of;

1) Accepting that health outcomes for the population are better with socialized plans.

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.

3) Therefore reluctantly accepts that society will see worse outcomes for the poor and spiralling costs for the mediumly well-off and rich for the greater good of freedom.

I find this more honest than the attempt to pretend that the US healthcare system is actually doing an OK job or that socialized medicine leads to poorer outcomes and death panels.

Part of the challenge is the similarity with other areas where I personally do prize liberty over health outcomes. Europe would likely be healthier if the state took charge of the food industry and got rid of high-fat high-salt high-sugar foods. However I don't want to live in a society where that degree of control is exerted over citizens, even where it is for their own good.

There are differences of course, and I think it is consistent to say that the state should use its might to protect the poor from being uninsured, but at least it is an intelligent discussion.

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Crœsos
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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?

While the earlier cited NPR story is a pretty good summary of how the ad hoc American system arose, it doesn't cover one of the chief reasons efforts to reform the system generally fail. Namely that "a system of free healthcare for all" is "a system of free healthcare for all", including those people.

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Humani nil a me alienum puto

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Amanda B. Reckondwythe

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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.

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

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.

Pharmaceuticals are a different story. There are four (I think) different "tiers" that various drugs are classed under, with varying amounts of coverage for each. And there are some drugs that are not covered regardless.

Somehow it seems that the drugs that most people need, and so are prescribed most often, are the ones that coverage is the least for. 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.

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mousethief

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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.

[ 20. June 2017, 14:35: Message edited by: mousethief ]

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Crœsos
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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.

From a purely political perspective it could be argued that Medicare is one of the reasons the U.S. doesn't have some form of universal health care. Older Americans (a.k.a. Medicare recipients) are some of the most politically active Americans with some of the highest voter turnout rates and for them universal health care isn't a priority, largely because for them it already exists. 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.

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Humani nil a me alienum puto

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cliffdweller
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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.
Exactly. I'm not sure why a panel of not-for-profit medical professionals making decisions about access & pricing is more of a "death panel" than the decisions of a panel of for-profit accountants with a vested interest in denying coverage.

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Nicolemr
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Because the politicians are in the pocket of the insurance companies, and they have together brainwashed the majority of the population.

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Brenda Clough
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There are entire fundraising websites devoted to raising $ for Americans needing to pay for medical care. The chief cause of personal bankruptcy in this country is medical bills. I know writers who have died for want of care, and arts organizations (for instance the Science-Fiction & Fantasy Writers of America) have funding drives and foundations, to which you can donate to support members who need help with medical care.

The drive to have medical coverage distorts our entire culture in other pernicious ways. People stay in dead-end jobs, or abusive marriages, or pursue uncongenial careers, solely so as to have health insurance. You cannot dare to start a new venture, because one accident or illness would not only destroy the new business but your entire family as well. You cannot be an artist, a musician, an actor, unless you have inherited money or married wisely or have a day job. We will never know, the great things that have never been achieved because they had to be sacrificed upon the altar of health insurance.

I have friends, decent people, who insist that health insurance is but an optional accessory, like a bicycle. I can find you links of Congressmen assuring us that the poor could buy health insurance instead of a cell phone. These people are idiots.

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mdijon
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That was Jason Chaffetz.

Not such an intelligent argument.

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lilBuddha
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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.

But this is bullshit. When adjusted for GDP, America's spending on defence is roughly inline with the civilised world that has universal coverage. And still those countries pay less.
It is the same bullshit use of numbers that Cheato is suing against NATO. IIRC, the US actually pays [i[less[/i] when adjusted for GDP.
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.

This is the bullshit that is being sold, but it is a lie.
quote:

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

This is the reason it is so heavily marketed against.
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.

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.

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

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Jane R
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Amanda B. Reckondwythe:
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.
[Eek!] 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 ]

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Crœsos
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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?

Because he's just so charming! Seriously, it's because such efforts are always billed as "reforming" Medicare and the media is perfectly willing to play along. A more honest presentation of Ryan's goals might be less well received.

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Humani nil a me alienum puto

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cliffdweller
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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.

And young people are not off the hook either. They are pretty much the only group that ended up paying more for health care under Obamacare-- not a lot more, but more. Many were previously uninsured, which is a always an irresponsible gamble, but far less of a gamble at 20 then at 50 obviously. So some of the bellyaching comes from 20-somethings having to pony up more. And sure, I get that they are struggling financially and every extra dollar hurts. But if you could look down the road a minute and look at what healthcare costs for the 50-something set, and remember that, as unimaginable as it may be for you right now, someday you, too, will be 50 perhaps you can see why this is a good deal even for you.

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Og, King of Bashan

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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.

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. And I'm not looking down on folks by saying that- I held that position for many years before actually getting to know people who, unlike young(ish) healthy me, wouldn't be fine without health insurance. I often say that a trip to the social security office will either make you a raging libertarian or a raging socialist, depending on whether you spend your time whining about having to wait two hours to drop off one form, or if you look around and pay attention to the folks who are around you, who are pretty dependent on a disability check. And it sometimes takes life experience to convince young white males to see the second conclusion as a possibility.

There is also a dead horse-related argument that people frequently make against socialized medicine, which has proven to be a fairly effective rallying cry against Obamacare. There are a good number of people who believe that it is outrageous for them to have to pay money into a pool that might buy things that they consider to be immoral and which they never themselves imagine using- abortion services and contraception in particular. So along with the pharmaceutical companies and insurance companies using their money to rally against socialized medicine, you have religious groups who will tell you that it's a one-way street to a tax-subsidized Sodom and Gomorrah.

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"I like to eat crawfish and drink beer. That's despair?" ― Walker Percy

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cliffdweller
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But apparently it's only tax dollars that need that sort of moral purity-- and to some degree, consumer dollars. The same people who object to taxes being used to fund these things or will boycott a business that donates to Planned Parenthood have no problem with their health insurer funding abortion or contraception. They want the lowest rate possible, and any insurers who is trying to cut costs will absolutely be delighted to pay for your abortion or birth control bills rather than paying for labor & delivery followed by 25 years of pediatric bills.

And then, of course, when the topic switches to food stamps or welfare these same people will decry all the "welfare queens" having babies they can't afford...

[ 20. June 2017, 16:39: Message edited by: cliffdweller ]

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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Brenda Clough
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The entire system as it now stands bristles with ironies enough to fuel many a Shakespeare play. Rep. Scalise, shot last week by a nut, surely voted to strip people of health insurance. Nevertheless he has better insurance than just about all of us; you won't find him on GoFundMe to pay for his surgery. Most red states are very high in uninsured people, or persons on Medicaid, but none of those voters thought to vote their own self-interest. You can Google, and find the photos of protestors holding signs, "Keep your Government Hands off of My Medicaid."

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Science fiction and fantasy writer with a Patreon page

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Lamb Chopped
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Yo, folks, I think a few of you upstream believe I am defending the current set up. I'm not. It sucks. I was simply answering the question "Why?"

Why is a combination of fear and various perceptions of how things work, some of which may not be correct.

You wanted to know. That's why.

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. I happen to be in a state and age-range where, if (God forbid) I lose insurance coverage through my work, I'll have to go uninsured for at least 14 years. I won't be eligible even for Medicaid, which is the supposed safety net that catches the poorest of the poor. Except when they are under 65, not parents of minors, and not officially classed as disabled.

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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!

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Crœsos
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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.

Well, the House passed a bill to help relieve 24 million Americans of the burden of being able to afford health care and the Senate is working in secret on a bill that's even more draconian, so changes are definitely in the works.

Unless you meant "CHANGING this situation for the better", in which case things don't look so good.

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Humani nil a me alienum puto

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cliffdweller
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Lamb, I am clinging to the notion that our very blue state has had such great success with Covered California that the state will step in to continue the program even if the pro-death party manages to kill it on the federal level. There seems to be a strong state-wide will for that, as well as a strong movement to go for single-payer. Certainly it will cost more w/o the federal subsidies, but I think we will make it happen. My infant granddaughter's very life literally depends on the medicare expansion so the only way I'm able to sleep at night is to believe that is true.

The people that will really be s*****d are those in the red states, with GOP state government who will gleefully let ACA die in their states and then say (as they are even now): "see? we told you it was doomed". Of course, it was "doomed" by the very sabotage of the GOP who want it to fail for political motivations, but that won't be part of the explanation.

Most of the poor in red states haven't seen the benefits of ACA we've seen here in Calif.-- their Republican governors didn't invest in the medicare expansion or set up their own marketplace as we did here, so it's already been far less successful-- again, due to deliberate sabotage. Health outcomes for some demographic groups are already abysmal, so they won't see much difference.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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Lamb Chopped
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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.

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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!

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cliffdweller
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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.

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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cliffdweller
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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. [Hot and Hormonal]

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"Here is the world. Beautiful and terrible things will happen. Don't be afraid." -Frederick Buechner

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stonespring
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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.

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simontoad
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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.

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Human

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Lamb Chopped
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I'm a native Californian transplanted to the Midwest.

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Er, this is what I've been up to (book).
Oh, that you would rend the heavens and come down!

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simontoad
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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.

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Human

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stonespring
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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.
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mdijon
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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.

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?

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Doublethink.
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I had thought part of the argument of those who don't want healthcare provided by the state, is that the community will do it. So gofundme for healthcare is a feature not a bug.

Or in a different situation, in the Grenfell fire initial welfare response being overwhelmingly provided by private citizens and not the state would be seen as an example of how things ought to work in a healthy community.

(To me, the problem with this is that it is likely be very inefficient on a national scale, and relies on patronage so if you are unattractive for whatever reason - you die.)

[ 21. June 2017, 06:32: Message edited by: Doublethink. ]

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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mdijon
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The other weakness is that there is no negotiating muscle or technical competence to ensure certain standards on the industry. For instance, individuals clubbing together to fund an emergency healthcare need can't take a sober view on whether the treatment being provided is value for money, and whether the money would actually be better spent on hip operations rather than experimental gene therapy, or whether one should insist on providers using generic rather than branded drugs.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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simontoad
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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.
I had great fun with this post. I laughed so hard at the second video that I had tears in my eyes. Magda Subanski is a comic genius, and her 'husband' in that scene, Peter Moon, had a great run in the 1990's. The first video is actual footage from a concert with some kids doing a form of dancing unique to Melbourne sharpies in the 1970's. It's like skanking (according to Wikileaks), and I find it highly risible.

I have to confess that the sharpies video was not used in any election campaign, nor were Magda and Peter viewed with such fear and loathing that the entire country demanded the immediate reinstatement of universal healthcare.

A large part of me loves to hang shit on Americans over stuff that I reckon Australia does better. I am not alone in this country. We love sticking it to the Yanks. We like sticking it too the Brits too, but that's too easy. So, while I really do hope and pray that all Americans might one day enjoy the health outcomes that we in Australia consider our right, there is that bastard bit of me that hopes that doesn't happen for a few years yet.

One last comment: During the financial crisis, our dollar reached parity with the US dollar. That was a really bad thing for us. Nevertheless, at least one bloke wrote an opinion peace basically celebrating the fact that our dollar was just as bloody good as the American dollar. He was suggesting that every Australian with an American friend or associate should take the opportunity to ring them up and give them a friendly serve.

Sadly, it didn't work, as Americans tend to be immune to this sort of razzing.

Edit: Bogans were not excluded from coverage in 1976 or at any time.

[ 21. June 2017, 07:27: Message edited by: simontoad ]

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Human

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Leorning Cniht
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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.

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