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Source: (consider it) Thread: The US and Health Care
Brenda Clough
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And then when there is a calamity -- hurricane, tower burning, terrorists -- the cry goes up from those same throats for help from the dadgum gummint. Why are they not here helping us, the taxpayers? Well, they would have, much more effectively and cheaply, if only they had been allowed to prepare and invest in advance.
The Grenfell tragedy could be a case in point. If you starve the local authorities for twenty years, gut the corps of building inspectors, and repeal all the regulations, then when the disaster happens naturally little can be done. The US is no better, cutting Coast Guard and EPA. We are sowing the wind, and guess what the harvest is going to be.

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cliffdweller
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Well said.

Really it's a product of excessive individualism-- especially in US. We have taught our citizens that individual freedom is the highest good, that any communal investment is a slippery slope to "godless communism". So no one wants to pay for anything that doesn't directly benefit them-- no investment in schools if you don't have kids, no investment in infrastructure if it's not roads you'll drive on, no investment in health care if you're (currently) healthy.

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.

When everything comes down to the individual investment we lose the ability to harness pooled risk to offset those tragedies that could be catastrophic-- a fire or natural disaster that wipes out your home and possessions; a devastating illness or injury such as the catastrophic heart defects my granddaughter was born with (estimated medical bill after 3 open heart surgeries: $2-3 million). You couldn't save for these sorts of tragedies in a dozen lifetimes. And it is inevitable that some of us will experience them at some point no matter how prudent and careful we might be. The good news is that they tend to be rare enough that pooled risk could allow all of us to be insured against these catastrophes. The bad news is the individualistic "me first" mood seems to be ruling against it.

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

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Leorning Cniht
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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.

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

Perhaps you find it risible because it isn't like skank.
I'm not much into drugs, but I particularly wish to avoid whatever causes that Australian "Style".

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So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

- A. N. Parsley, D. Mcvinni

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Lamb Chopped
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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?

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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 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.

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, as do many government services, including fire and police protection.

The problem is that voters are thinking individualistically in the terms you suggest-- "what are the odds I will get sick?"-- and willing to roll the dice they won't, therefore resenting having to pay for someone else who wasn't so fortunate. But no one thinks that way when your neighbor's house burns down or car gets stolen.

Thinking more globally about risk assessment is the key. All of us are at risk for some sort of catastrophe-- health, fire, natural disaster, criminal activity. Individually we cannot protect ourselves against all these threats, but we can, working together, pool the risk for all these things to provide a safety net. I've lived in parts of Africa where these sorts of safety nets aren't available-- no fire dept, very minimal police protection, minimal health care. Life is a lot lot harder and people are trapped in poverty because of the inability to bounce back from a catastrophe. That's precisely where our individualistic mindset is taking us.

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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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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?

Yes, this.

Of course, the results when the gamble doesn't pay off-- most particularly of course for the individual with the catastrophic illness, but to a lesser degree the taxpayers who end up covering the costs when the unfortunate uninsured person ends up (too late to help) in the ER-- are devastating. Which is why the price supports that were a part of ACA (and probably on the chopping block for the super-secret replacement plan) are essential to the difficult process of lurching toward universal health care.

[ 21. June 2017, 15:49: 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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no prophet's flag is set so...

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The arguments about single payer health care have led me to consider the wider question: what things should be "user pay" and what things should be "paid by taxation".

What is the rationale for, say, having highways paid for via taxation? I don't use most of the highways, and certainly don't use the ones I do use very often. Might it be a better idea to charge those who use the highways for both the costs of building them and the costs of maintaining? We could easily build the costs of highway use into all related uses: e.g., food transportation, consumer products.

Highways may not be the best example, others might be interesting too. Some parks cost for use (National and provincial parks have entry fees here), and some charge for some services, e.g., to use the showers, to burn firewood. Though I don't think the charges come anywhere near the costs of the services used.

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BroJames
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Historically in England* the beginning of fire fighting services was based in insurance. You paid your premiums, and they provided for a pump and crew to put out the fire in your property.

The move to a public service goes with the understanding that if your uninsured neighbour's house catches fire, you don't want the firefighters just to stand there waiting for the fire to get your property - you want them to stop it before it arrives.

There's a similar thing with some aspects of health provision as well, along with a humanitarian impulse (that in England, at least, has Christian roots) to care for the sick, and a realisation that that is not most effectively enabled by relatively small scale and/or local charitable efforts.

Before the NHS many hospitals had almoners, part of whose role was to ensure that those who could paid for their treatment. Of course, hospitals in areas of deprivation struggled to provide adequate services, and were usually supported by charitable foundations or bequests of one kind or another.

(*I'm confining myself to England because that's what I know a little about. I expect other parts of the UK may have operated on a similar basis)

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

I think I follow your point, but don't quite agree with it.

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.

Yes, of course insurance is about pooling risk. That's how it works.

The difference is that if I seek insurance for some risk, I make an assessment of the risk, and the costs associated with it happening. The insurance company has its actuaries make a similar assessment, and it offers to insure my risk at some premium. And then I choose whether it's worth it. In particular, I might not agree with the insurance company on what my risks are (perhaps I know things that it doesn't know about my personal circumstances.)

That's not how police and fire departments work. If I choose not to insure my house, and it burns down in a fire, I lose all my stuff. But if my city doesn't pay for a fire department, the whole block burns down. Same for police, same for garbage collection, and so on - these services do not just benefit the immediate "customer". Jailing a criminal doesn't actually help the person whose house was burgled, but it does help everyone else in the community, as it reduces the chances of future burglaries. Garbage collection means the streets aren't full of vermin. And so on.

At some level, the same is true of healthcare. 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.

All these things - police, fire departments, public health - are public goods. The benefits accrue to the society in general, and they should be funded from general taxation.

Things like whether I insure my personal possessions against theft are not public goods. The public does not benefit in any way from knowing that State Farm will buy me a new TV if someone steals mine, and equally it doesn't benefit if I decide that I'll risk losing the TV and not buy insurance. It doesn't care.

Insurance against catastrophic events gets imported into the public sphere when we choose, as a society, not to leave people destitute in the streets (and/or accept that people who are destitute in the streets end up costing us money). So therefore it is a public good that people have some kind of backstop (you can certainly include rare-but-expensive medical catastrophes in this category.)

Public goods should be paid for by taxation.

[ 21. June 2017, 16:14: Message edited by: Leorning Cniht ]

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lilBuddha
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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,

And it is cheaper than paying for individual coverage.
To be fair, the Republican'ts are pretty good at disguising it. You know, unless you pay attention to what they actually say.
quote:

as do many government services, including fire and police protection

Called taxes. Nobody like them, but they'd like even less the results of not having them.

--------------------
So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

- A. N. Parsley, D. Mcvinni

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cliffdweller
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Leorning Cniht:

I appreciate your distinction, but I would point out that both of those scenarios entail pooled risk. The difference is just in one case we allow that risk assessment to be made on an individual level (I get to decide whether or not I'll purchase renter's insurance) in other instances we assess that the risk assessment affects the entire community so it makes sense to approach it thru taxation rather than individual risk assessment. But in both cases you're talking about pooled risk.

[ 21. June 2017, 16:18: 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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lilBuddha
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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.
Ala carte health care cost more for EVERYONE, this is against the public good.

And how is excluding a significant part of the PUBLIC part of the public good?

--------------------
So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

- A. N. Parsley, D. Mcvinni

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Leorning Cniht
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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.
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BroJames
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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.
This is the one that's really tricky to be sure about. Certainly in direct money paid out of the pocket (in taxes or insurance premiums) this is true - provided you have some population wide provision for prevent the spread of serious diseases. But the hidden costs to the community at large of a lack of affordable health care are hard to quantify in terms of pounds or dollars in the pocket of an individual who doesn't get sick. In the US, it tends to be non-profit hospitals that carry the up front cost of uncompensated healthcare. One public purse contribution to that is their tax exempt status - and what they don't pay in taxes for other government services, the rest of the taxpayers do. But there are also wider economic costs to a community in which members of the community 'live with' conditions which they can't afford to treat.
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Brenda Clough
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And, even if at this precise moment you are not sick, you cannot guarantee, by any virtue, by any prayer, by any application of money, that you won't get sick in future. In fact the odds that you will become ill are pretty fairly high as you age. Sickness is almost -guaranteed- for ALL of us except for those very few people who are assumed up to Heaven body and bones like Elijah, or who drop dead without one previous symptom.
So it is not like you won't be needing that health insurance, some day soon. The odds are very good indeed that you will. And, even those young people who are currently healthy can be hit by a bus or bitten by a dog or something. A case could easily be made that universal health insurance is a social good, on this ground alone.

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cliffdweller
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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.

Only in the narrowest of terms. A la carte healthcare costs everyone more because it inevitably means people get sicker because they aren't getting routine screenings, ongoing monitoring of chronic conditions like diabetes, etc. which are much cheaper/easier to prevent/manage than to deal with when they become full-blown crisis (e.g. dealing w/ cancer at stage 1 much easier/cheaper/less deadly then at stage 4). And a la carte health care inevitably gets dealt with at the ER-- the most expensive means possible. Those factors are apt to ultimately fall on the taxpayers one way or 'nother-- either thru unpaid hospital (esp. ER) bills which cost everyone more, or thru bankruptcy (medical bills being #1 reason for bankruptcy in US).

And for those same reasons, a la carte health care is cheaper for the healthy only in the short-term. In the long run 100% of us will, given time, get older. And with age there is an almost 100% chance of a serious illness or injury of one sort or another, no matter how health-conscious you are. So health care, even for healthy seniors, is much, much more expensive. Yes, medicare helped-- but really it just pushed the problem down a decade-- insurers start doubling, tripling, and more premiums now at 50 rather than at 60.

In the long run, investing in a system of pooled risk for health care will benefit everyone and save $$ for everyone. It is only in the short run that it looks like a bargain. Of course, as Lamb pointed out, for the very poor, sometimes you HAVE to think in the short term because you're living so much on the edge-- something I'm constantly confronting with my work with the homeless. Which again, is why some government regulation and price supports is necessary to make this work for everyone.

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

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Crœsos
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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.

This is a bit of a fallacy. The well and the sick aren't two different groups of people, they're the same group at different points in their life.

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Humani nil a me alienum puto

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Doc Tor
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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.

I'm going to ask for a citation on this.

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?

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Get your arse to Mars

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mdijon
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It's obviously true to say in retrospect that if I live a charmed uninsured existence that's cheaper for me personally than a universal socialized system. It is only a useful point to reference if I am a seer with no relatives with vulnerable health.

In the prospective world where I or someone I care about could get sick then socialized medical cover is going to be cheaper for me.

It won't be cheaper if, in addition to my taxes, I want to take out private cover. But then that's a different comparison from the charmed-uninsured one.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Ricardus
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I thought Leorning Cniht's point was that healthy people imagine themselves to be 'people who don't get sick', and therefore state healthcare doesn't seem good value to them.

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Then the dog ran before, and coming as if he had brought the news, shewed his joy by his fawning and wagging his tail. -- Tobit 11:9 (Douai-Rheims)

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Brenda Clough
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Even if you yourself are healthy now, and plan to drop dead without one previous symptom at the end of your life -- do you care to bet that your son, your daughter, will be the same? Would you dare to send the kid off to walk to school, betting that she will not trip and fall, breaking her arm? At that moment you would have to have, oh, $8000 perhaps, in cash, ready to hand to the hospital.
There is also the point that there are many many activities that your child won't be permitted to participate in unless she is covered by health insurance. The soccer team does not want to be on the hook for that $8K, if she trips and falls on the soccer field.

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lilBuddha
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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.

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

--------------------
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If it's not here soon, I might be done
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Lamb Chopped
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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.

So the decision on what to do passes to the rest of us, who actually have options (because we have a little more money). Do we too go uninsured? Do we take care of ourselves and ignore our neighbor who can't pay for himself? Do we go whole hog and create a national system that will treat everyone including those without money?

I'd vote for the last. But I fear there are enough people who fear financial pain and would rather buy their heads in the sand that it would not pass.

I wonder if we'll reach a tipping point where the current system breaks down badly enough that even those folks will begin to opt for nationalization as the lesser of two pains.

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Er, this is what I've been up to (book).
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Jane R
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And if the uninsured wait until they have to go to A&E to get their conditions treated it works out far more expensive than it would have been if they'd seen a GP as soon as they felt sick. And more of them are likely to die because they left it too late to get treatment, although that doesn't seem to worry the Powers that Be.

Most of the work of the NHS is devoted to minimising the amount of time people have to spend in those expensive hospital beds.

[ 21. June 2017, 18:43: Message edited by: Jane R ]

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Crœsos
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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.

Thank you, John Roberts, for your inept judicial rewrite of the Affordable Care Act [PDF]. Judicial restraint, my ass!

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Brenda Clough
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# 18061

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The people who are too poor to have a choice would (one assumes) be OK with universal health care, and would accept it if offered. I can't prove this except anecdotally, but could find you news articles with thousands of people lined up to get care at free doctor clinics.
Of the people who can afford to pay for health insurance, some substantial fraction are OK with funding the costs of all those people who are too poor to pay; their argument is the good of society; love of others, Jesus's example, etc.
So the sticking point is that fraction remaining: those people who can afford to pay but do not want to pay for poor people. Their arguments may be summarized:
1. Poor people are lazy and unworthy of my support; let them get jobs with insurance.
2. Poor people get perfectly good health care at emergency rooms. (There is footage of congressmen saying this.)
Of these poor people, even the most diehard objectors usually exempt the elderly (you are 90, there is no point in expecting you to work), the disabled, and children (you are 2, ditto). Hence the existence of Medicare and Medicaid.
Do I summarize this correctly? Is there a third argument to add about poor people?

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Leorning Cniht
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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?

I strongly suspect that to be true, which is one reason that I am a supporter of single-payer healthcare. (Mostly, it's just the right thing to do.) The current US insurance system is inefficient on at least two fronts (huge administration overheads, and inefficient use of medical procedures). By comparison, Medicare does quite well.*

Plus you can eliminate the (large) cost of treating the uninsured at the ER when it would have been so very much better to see them weeks earlier in a doctor's office.

What the US largely does not have, is an a la carte system. In a system where the purchase of healthcare really was a la carte, healthy people would buy almost no healthcare, because they wouldn't need any. Perhaps you'd pay for an annual checkup. Sick people would mostly go bankrupt, and die.

This is the choice faced by a number of low-income people.

*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.) This argument is nonsense. It will obviously cost more to manage the healthcare of someone who has health issues, and will be almost exactly free to manage the healthcare of someone who is healthy, and only ever has an annual once-over from his doctor.

[ 21. June 2017, 19:24: Message edited by: Leorning Cniht ]

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Jane R
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Leorning Cniht:
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.)
Most of the money the NHS spends on me will be spent in the last few years of my life. This is true for just about everyone (except maybe Stephen Hawking).

There are equally foolish articles floating around on this side of the pond claiming that private healthcare is more efficient than the NHS. Any health service could be efficient if it were allowed to cherry-pick the easiest and most lucrative conditions to treat, and had the option of sending anyone with expensive complications on to a different provider (in the UK, that would be the NHS).

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Leorning Cniht
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# 17564

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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.

It is strongly true with regard to vaccinations the like. It is more weakly true that old ladies getting hip replacements, diabetics being able to manage their condition and so on convey a public good, but I think they still do.

(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:

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

Well, yes. And yes, it's very expensive to treat the uninsured in the ER, and the taxpayer would probably save money by providing some doctors' clinics for them (and the patients would be healthier.)
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simontoad
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# 18096

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

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Brenda Clough
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# 18061

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Oh, you need only look at the current US Senate. They invoke St. Ronald, who vowed to cut taxes on the rich. Since their patron saint also insisted on not racking up too much debt, the solution is to take away health care from the poor, so that the one percent may have their tax cuts. The Senators campaigns are funded by donations from that same one percent, so you can see how the milk gets into that coconut.
And then there is the persistent view that the poor are only poor because they have Bad Attitudes (per Ben Carson) or have otherwise not been scourged into thriftiness and hard work. In this view, health care will simply make them lazier and more feckless. Here is a POST article summarizing this viewpoint.

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Dafyd
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# 5549

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

Many of them have read Ayn Rand who literally thought we have a moral obligation to be selfish cockheads.
Fun fact: I assigned numbers to letters of the alphabet and added up the sum of the letters in Ayn Rand as you're supposed to do to discover the identity of the antichrist and got 666 on the first try.

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we remain, thanks to original sin, much in love with talking about, rather than with, one another. Rowan Williams

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Crœsos
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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.

In economic terminology a public good is usually defined as something which is both non-excludable (it is difficult or impossible to deny individual access) and non-rivalrous (use by one individual does not reduce availability to others). 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.

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lilBuddha
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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.

--------------------
So goodnight moon, I want the sun
If it's not here soon, I might be done
No it won't be too soon 'til I say goodnight moon

- A. N. Parsley, D. Mcvinni

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Soror Magna
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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.
And some Republicans have been known to cheer at the thought of uninsured people dying. They call it "personal responsibility". Besides, Americans know that if you get sick, God is clearly punishing you for something....

Seriously, though, let's look at those stats again. Why does the USA pay twice as much per capita for health care? Because a huge chunk of that money goes to insurance companies, not health-care providers, and they are not going to give that up without a fight. A single-payer system means billions of dollars of lost profits. Insurance companies have bought and paid for their Congresscritters, so they have no incentive to change the system either. That's what's really blocking a single payer system for the USA, not Cletus the no-socialized-medicine yokel.

Full disclosure: I was born in a Kaiser hospital in SFO, but I now enjoy Canadian health care.

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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mousethief

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I think it telling that the Religious Right believe the adjective "Christian" rightly applies to the nation itself when determining who should have equal rights or self-autonomy, but NOT when deciding how the nation as a whole should treat the uninsured. Then we're into every-man-for-himself territory.

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God has shown me that I should not call any man impure or unclean. --Acts 10:28

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cliffdweller
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Very similar to the way they call themselves "pro-life" while advocating policies that are most definitely pro-death. If I 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."

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

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Jane R
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cliffdweller:
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."
...or the IRS. Because taxing poor people is still OK, right? And nothing else is certain...

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

[ 22. June 2017, 07:45: Message edited by: Jane R ]

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mdijon
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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...

And a lot on inefficient delivery of care or on expensive treatments that aren't needed but are profitable for the health provider. 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.

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Doc Tor
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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.

This is one of the things that is boggling. When I was pitched off my bike and face-planted my glasses into the tarmac, that I needed a head x-ray and be seen by a surgical ophthalmologist was a decision for the A&E doctor.

"You need an x-ray, this porter will take you there now, and when you get back the on-call consultant will examine you," was literally all there was to it. The equipment was there, the expertise was there, and I was in clinical need.

(Admittedly, it was 8am on weekday morning, and I think they were all kicking their heels a bit.)

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Get your arse to Mars

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mdijon
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# 8520

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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, and although the X-ray will probably have been done straight-off, the forms required to claim back the cost of the film and the admission from the insurer will have needed non-trivial processing at both ends.

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mdijon nojidm uoɿıqɯ ɯqıɿou
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Leorning Cniht
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# 17564

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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

Whenever I have been to the ER in the US, everything has worked on the surface like Doc Tor describes. Doctor comes in, says "we need this, that, and the other" and it happened (and I knew my insurance would cover it).

(But the paperwork is absurd. It's not uncommon to get sent a bill after some minor procedure saying that the cost of your treatment is $10,000 (which will be itemized), that your insurer has negotiated a price of $1,500 for that procedure with the hospital, which again will be itemized, that the insurer has paid $1,400, the hospital is writing off $8,500, and you owe $100.

Basically all of those numbers are complete fiction.)

My father was taken ill whilst visiting from the UK, and went to the ER. He had taken out travel medical insurance, but nobody was very clear exactly what it would pay for and what it wouldn't. 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.

[ 22. June 2017, 12:28: Message edited by: Leorning Cniht ]

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

That's the point I was making. On the surface it looks like nothing much happened, behind the scenes lots of bureaucracy took place which costs time and effort for two people at least.

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.

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Leorning Cniht
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# 17564

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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 disconnected from any of the actual realities of the treatment.

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Brenda Clough
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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]

Jeez louise, Jane. DON'T DO THAT. Believe me, our system is -not- to be emulated. At the very minimum, have your pols wait to see it crash and sink later this year before they get onto the Titanic and settle into a deck chair.

In the US everything depends upon what health insurance you have. At the top tier, if you work for the government or big business, you have it all. The insurance card in your wallet gets you ER care; they know someone will pay and all the difficulties smooth out before you. Some years ago my husband had a gallstone attack; I took him to the ER and we glided in and out of scanning facilities and exam rooms on the wings of angels. (It may have helped that his ailment struck on a weekday morning early, so the ER was pretty empty.)

What gums up the works is if you're -not- top tier. If you are getting aid, or have minimal insurance or none. They're not allowed to just kick you to the curb to die. But they can drag things out for ages and drown you in forms. A refugee woman in our church recently died of lymphoma; she had no more insurance than your coffee cup. Herculean effort by many parishioners found her all the grants, aid, and so forth to pay for her chemotherapy. But the applications and forms was nearly a full-time job in and of itself, for a native English speaker who knew the ropes. (God raised up a woman who has a passion and charism for filling out forms correctly; it was a miracle.) The patient herself could never have done it.

[ 22. June 2017, 13:26: Message edited by: Brenda Clough ]

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Science fiction and fantasy writer with a Patreon page

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Jane R
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It's not my idea, and I will be campaigning (in my copious free time, cue bitter laughter) against it!

I don't think anyone outside the "top tier" thinks it's a good idea. But Jeremy Hunt is still Health Secretary, and Theresa May only seems to be listening to the voices in her head...

[ 22. June 2017, 13:46: Message edited by: Jane R ]

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Soror Magna
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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.

It also shows up another Republican lie - they claim they don't want to interfere with the doctor-patient relationship. They're always blabbing about how they don't want the government coming between doctors and patients, but they're ok with someone in a cube farm call centre making those decisions.

(Just as an aside, but also as an indication of how bad things are in the USA, I heard a talking head describe the federal government as "the ultimate outsider". Apparently "we the people" are toast. As Trump would say, "Sad!")

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

Posts: 5334 | From: Caprica City | Registered: Jul 2005  |  IP: Logged
no prophet's flag is set so...

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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.

Knee arthroscopy is $968.00 here (scope surgery of the knee. Mayo Clinic is $20,015.

The costs in Canada are to the provincial health plan, and not to patient. Unless I've got something messed with this, there is something significantly wrong with this picture.

[ 22. June 2017, 15:00: Message edited by: no prophet's flag is set so... ]

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Maybe I should stop to consider that I'm not worthy of an epiphany and just take what life has to offer
(formerly was just "no prophet") \_(ツ)_/

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chris stiles
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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.

I suspect they cost based both on gold plating, and by assuming service delivery has to make a profit when the unit of delivery is one.

And probably multiple levels of service delivery driving the cost up further, liability insurance at every stage of the process and so on.

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