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Source: (consider it) Thread: The US and Health Care
Sober Preacher's Kid

Presbymethegationalist
# 12699

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A free click, from the Globe and Mail, which isn't all that medicare-friendly, generally, but does have this gem:

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

The Globe and Mail

Lest you think this is sanctimony, two huge reasons why health care is public in Canadda, aside from its massive popularity, is that

1) Corporate Canada knows, in its heart of hearts, that Medicare is the biggest subsidy to business going.

2) In the days before public health care, physicians in Canada, on average, never collected on 30% of their accounts. Their patients were either dead, or deadbeat. Medicare changed all that. It both stabilized physician incomes and in fact raised them.

And finally, I for one and sick and tired of Canada's actually not so comprehensive public health coverage debates being perverted by the fact that we live next to a nation with the wackiest, most perverse and downright insane health policies on the planet. In some things like pharmaceuticals Canada is downright terrible, but every time its gets pointed out, the US is raised, and the sanctimony begins.

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Brenda Clough
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In the US, if you throw the phrase "how do I ..." into Google, the current top hit is "How do I emigrate to Canada?"
A free click, Slate points out that strengthening Medicare is the secret.

And this is from the POST but very sad: disabled people call out Christians for their lack of support.

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

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

The Globe and Mail

That quote is the kind of reaction I would expect of a Canadian who had paid almost no attention to what's actually been going on in the US for the last eight years, particularly when followed up with
quote:
But, no, 300 million Americans stand there, teeth chattering, each holding a stick, arguing day-in-day-out, “What is to be done?”
Perceptive commentary this is not.
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sabine
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Bumping this thread to say that John McCain has just announced that he will not vote for the latest Republican attempt to repeal and replace the ACA. Rand Paul has also said no, and Susan Collins probably won't vote for it as well.

sabine

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Brenda Clough
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I won't believe it until I see it.

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Crœsos
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For those who are interested, here is Senator McCain's statement on the matter.

The key paragraph:

quote:
I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.
John McCain is 81 years old, has a very aggressive form of cancer, and was just re-elected last fall. Threats to mount a primary challenge against him in 2024 (the typical threat used to keep Congressional Republicans in line) would seem particularly ineffective in his case.

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Humani nil a me alienum puto

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Ian Climacus

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Does the ACA just tick over, or does it need to be (re-)funded if a replacement is not agreed to? I seem to recall something about "letting it fail", but I may be wrong.
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Brenda Clough
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Oh, that was Lyin' Don. A grain of salt the size of a Volkswagen would be about right.

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

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

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

Agreed. There is much that could be done to improve it, were Congress sufficiently motivated to do so.

Conversely, there is much they can do to make it far worse-- even w/o repealing it. Taking away funding for low-income subsidies, taking away clinics that help people navigate registration (especially those w/o internet access, narrowing the open enrollment period, defunding advertising about how to sign up and when. Oops, they already did most of that. That's exactly what they mean by "letting it fail"

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

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

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Science fiction and fantasy writer with a Patreon page

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Ian Climacus

Liturgical Slattern
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Thank Brenda and cliffdweller.

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

Was this some sort of compromise to get the ACA through? My mind boggles as to why health care in particularly, as cliffdweller wrote, is treated this way.

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

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

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Humani nil a me alienum puto

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

Insurance doesn't work retroactively. Otherwise people would wait til the had an accident or a fire to get car or homeowners insurance

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

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

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

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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:
That's what the individual mandate/ penalties guards against

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

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

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Ian Climacus

Liturgical Slattern
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Are there waiting periods for health insurance? We have anywhere from 2 to 12 months (maybe more...) for private health insurance here.
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cliffdweller
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quote:
Originally posted by Leorning Cniht:
quote:
Originally posted by cliffdweller:
That's what the individual mandate/ penalties guards against

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

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

OK, that makes sense of the current ACA system. But then why were there restricted open enrollment periods in decades before ACA, when pre-existing conditions weren't covered?

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

A pre-existing condition is only "pre-existing" if it's been documented. So you take your pregnancy test, feel some unusual pains or whatever, quickly call up and change insurance, and then a couple of days later make an appointment to see your doctor with your new insurance.
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cliffdweller
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quote:
Originally posted by Leorning Cniht:
quote:
Originally posted by cliffdweller:
But then why were there restricted open enrollment periods in decades before ACA, when pre-existing conditions weren't covered?

A pre-existing condition is only "pre-existing" if it's been documented. So you take your pregnancy test, feel some unusual pains or whatever, quickly call up and change insurance, and then a couple of days later make an appointment to see your doctor with your new insurance.
Oh, it NEVER worked like that. If you gave birth less than 9 months after your insurance policy you had BETTER be able to prove premature labor. Before ACA, the burden of proof was always, always on the patient to prove the condition was not pre-existing (not previously unknown, but actually not pre-existing). All sorts of people were denied coverage on the flimsiest of evidence they "should have known" they were going to have a heart attack, stroke, whatever.

Not saying you aren't right re why there were open enrollment periods, but in reality, it never ever worked like that.

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

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

Not the US, I know, and US law might be quite different, but that would invalidate an insurance policy under the law here. When you apply for any sort of insurance, you are obliged to disclose to the insurer anything you know that might affect the risk you are asking them to cover.

If you don't, and the insurer finds out, it can repudiate your cover. That applies just as much to making any claim, whether it has anything to do with what you didn't tell them or not. So if your house insurance form asks 'has your house been broken into at any time?', and you say 'No' when it has, you're not covered against subsidence either.

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

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

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Boogie

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Sounds a lot like pet insurance over here in the UK.

It costs a fortune and you have to be careful about pre-existing conditions, as the animal gets older it becomes more difficult and crazy-expensive. All is about profit and not care for animals, although the marketing would have you think otherwise. When my dogs reach 13 I stop insuring them and put the money away in savings to pay for medications, as I reckon I wouldn't put them through complicated operations at that age anyway. Not a choice we can make for humans

For all its faults (which are all caused by silly politics imo) thank goodness for the NHS.

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

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

Yes. For-profit enterprises are not inherently problematic, of course-- it works just fine for all sorts of things-- consumer goods and services like automobiles and shoes and so forth. But having a for-profit system is problematic because health care is not like other consumer products-- you can't walk away from the bargaining table like you can for a new pair of shoes if you think the price is too high. At the point you find yourself in the ER having a heart attack there's no chance of shopping around to see who's offering a sale on bypass surgery. If you have a disease that can only be treated with one particular patented drug, they can charge anything they want, no matter what the mark-up-- as we've seen many, many times. Beyond that, even in the few non-emergency situations where you could comparison shop, the US health care system is set up to make that sort of pricing impossible. While you may be able to compare a surgeon's charge or even the charge for an OR at a particular hospital, you will have no way of knowing if your anesthesiologist will be in or out of network and how much s/he will charge compared to the anesthesiologist at the hospital across town. There are 100s of obscure charges like that piled onto each and every hospital bill, each different from the hospital across town, making it impossible to comparison shop.

It simply does not fit well in a free market, but we have a whole political party that is wedded to the idea that each and every societal problem can be solved by the magical free market.

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

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Boogie

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There are only two market forces - fear and greed.

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Garden. Room. Walk

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no prophet's flag is set so...

Proceed to see sea
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There's something about morality in here too, but the message appears flipped upside down in the discussions which relayed here from the religious mouthpieces there. Jesus didn't charge for healing.
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sabine
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quote:
Originally posted by no prophet's flag is set so...:
Jesus didn't charge for healing.

Don't tell Benny Hinn. [Smile]

sabine

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

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

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

Of course it is. It's exactly what NICE does when it decides whether a particular treatment is cost-effective. Apparently according to NICE, a QALY is worth about £30,000.
No it isn't. If a dog is very old and suffering and you don't want him/her to suffer an operation and recovery you have the choice of euthanasia.

My lovely 19 year old (Boogie, who I name myself after) dog's legs gave in, we had him put to sleep with many tears. My 16 year old Cavalier needed heart surgery - not fair at his age so the same decision.

That's what I meant.

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Garden. Room. Walk

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

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

That's what the individual mandate/ penalties guards against-- just as it does if you ate caught driving around w/o auto insurance. Yet we don't need to restrict car insurance to an pope enrollment period. Health onsurance, otoh, had these limited enrollment periods decades before ACA or rules requiring coverage of preexisting conditions
Car insurance differs from health insurance in several important ways. The biggest is that while we are generally willing to tell an uninsured motorist who's been in an accident that they'll just have to do without a car, we are less willing to simply let people without the means to pay for necessary medical care simply die. Most developed countries even have this standard enforced by law, in certain circumstances. In other words, someone willing to game the system with health insurance has more leeway than someone who does so with car insurance.

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Humani nil a me alienum puto

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cliffdweller
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# 13338

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

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

That's what the individual mandate/ penalties guards against-- just as it does if you ate caught driving around w/o auto insurance. Yet we don't need to restrict car insurance to an pope enrollment period. Health onsurance, otoh, had these limited enrollment periods decades before ACA or rules requiring coverage of preexisting conditions
Car insurance differs from health insurance in several important ways. The biggest is that while we are generally willing to tell an uninsured motorist who's been in an accident that they'll just have to do without a car, we are less willing to simply let people without the means to pay for necessary medical care simply die. Most developed countries even have this standard enforced by law, in certain circumstances. In other words, someone willing to game the system with health insurance has more leeway than someone who does so with car insurance.
I think we established upthread the whole explanation re open enrollment periods so I've already dropped that line of argument.

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

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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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# 18061

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

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Science fiction and fantasy writer with a Patreon page

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sabine
Shipmate
# 3861

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

*polluted because, you know, "regulations are bad." [Disappointed]

sabine

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

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"Hunger looks like the man that hunger is killing." Eduardo Galeano

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Jane R
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# 331

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Boogie:
quote:
There are only two market forces - fear and greed.
Three: you forgot envy. Plastic surgery, anyone?
Posts: 3954 | From: Jorvik | Registered: May 2001  |  IP: Logged
RuthW

liberal "peace first" hankie squeezer
# 13

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I'd put that down to fear.
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Jane R
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# 331

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You could be right. Depends on the circumstances, though, don't you think?
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Golden Key
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# 1468

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

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

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

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

Not as simple as envy.

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?" (Dragon, "Jane & the Dragon")
--"Oh, Peace Train, save this country!" (Yusuf/Cat Stevens, "Peace Train")

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Jane R
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# 331

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

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

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Golden Key
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# 1468

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Jane--

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

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?" (Dragon, "Jane & the Dragon")
--"Oh, Peace Train, save this country!" (Yusuf/Cat Stevens, "Peace Train")

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Jane R
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# 331

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Fair enough. Sorry I was a bit abrupt.
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Golden Key
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# 1468

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Thanks. [Smile]

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Blessed Gator, pray for us!
--"Oh bat bladders, do you have to bring common sense into this?" (Dragon, "Jane & the Dragon")
--"Oh, Peace Train, save this country!" (Yusuf/Cat Stevens, "Peace Train")

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chris stiles
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# 12641

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

and some of it by a denial of the aging process.
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Jane R
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# 331

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chris stiles:
quote:
and some of it by a denial of the aging process.
That's fear. If you've been exposed to a popular culture that views older women (= anyone who looks like she's over 30) as essentially worthless, and you're a woman, you want to avoid looking old for as long as possible. Men are not subjected to this kind of pressure, because older men are 'distinguished'. Unless they have orange hair, that is.
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Boogie

Boogie on down!
# 13538

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Is it greed or envy to get a new car because your neighbour did?

Peer pressure?

OK, I concede, there are more than two market forces, but I can't think of any that are forces for good.

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Garden. Room. Walk

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Brenda Clough
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# 18061

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It's not very difficult for insurers to filter out the purely vanity procedures. Even we laymen can distinguish between a woman who wants breast-reconstruction surgery after a double mastectomy is different from a healthy 22-year-old who wants silicone added so that she can star in porn videos. They already do this -- no health insurer in the US will pay for your nose job or liposuction. If you want bigger boobs, you pay for the work yourself.

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Science fiction and fantasy writer with a Patreon page

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Jane R
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# 331

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That's how it works in the UK as well - cosmetic surgery for medical reasons is covered by the NHS, but anything else has to be paid for by the punter.

Complications arising from cosmetic surgery, on the other hand, may be treated free of charge by the NHS if they qualify as life-threatening emergencies... the NHS usually gets to pick up the pieces after the private healthcare sector screws up.

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Ohher
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# 18607

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

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From the Land of the Native American Brave and the Home of the Buy-One-Get-One-Free

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Gwai
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# 11076

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My guess is that it's dead, but I'm not going to trust it until October first. Even then, I imagine they'll try again next year.

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A master of men was the Goodly Fere,
A mate of the wind and sea.
If they think they ha’ slain our Goodly Fere
They are fools eternally.


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Brenda Clough
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# 18061

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The doltish Lindsay Graham says it's not dead and he's hoping it'll come back after they deal with tax reform, which they plan to pass before the year is out. Of course they planned to pass Obamacare repeal the first day Crooked Don was in office, so there's that.

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Science fiction and fantasy writer with a Patreon page

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Crœsos
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# 238

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

The Grassidy bill is almost certainly dead. On the other hand, the Republican desire to take affordable health care away from millions of Americans (and kill* thousands of Americans) remains as strong as ever. The opportunity to repeal the Affordable Care Act through reconciliation during this fiscal year (October 1, 2016 to September 30, 2017) is gone, but other attempts will definitely be made.


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

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Humani nil a me alienum puto

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Brenda Clough
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# 18061

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A larger and more hopeful reflection is, Obamacare has been the law for several years only. Already Americans have discovered that yes, they really like having health insurance. It's so much more fun, not to die in an emergency room waiting room!
If the GOP continues in its dysfunction and dissension, there is every possibility that Obamacare will hang on for yet longer. By the end of this decade it'll have a host of rabid fans. It's a truism in American politics that it's easy to award a benefit and nearly impossible to take it away. May it be so in this case.

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Science fiction and fantasy writer with a Patreon page

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