Healthcare in the United States

Discussion in 'Politics, Etc.' started by keithburgun, Mar 9, 2017.

  1. keithburgun

    keithburgun Administrator, Lead Designer Staff Member

    Hi everyone! I would like to start a discussion about healthcare in the US. It seems to me that there are two distinct major paths that could be taken: some kind of market-based solution, and some kind of state-run solution.

    The ACA was basically a swing at a market-based solution (with an added expansion of medicaid and some other protections/regulations, and a mandate that made people pay a fine if they didn't get coverage (which was an attempt to get healthy people into the pool). The idea of the ACA was to create these healthcare "exchanges" where, hopefully, the free market forces of competition could bring prices down. It didn't really work all that well for a number of reasons, one of which was probably that we were forced to stick with ACA 1.0 because of Republican stonewalling.

    My position is, the absolute best thing would be to have a single-payer program like they have in Canada or the UK. As Bernie Sanders has suggested, a good way for us to do this is to expand Medicaid and/or Medicare by gradually reducing the requirements.

    I am okay with the idea of a market-based solution, assuming we can make such a thing work. I am not OK at all with the idea that "if you can't afford health insurance, you just die, or go horribly into debt". That seems totally immoral to me and any system that has that result will be rejected by me.

    Are there good market-based solutions that can guarantee that everyone has health coverage?

    Are there other solutions that haven't even been mentioned here?

    What is your ideal healthcare solution for the United States?
     
  2. Bucky

    Bucky Well-Known Member

    The ACA was a wrecking ball for market based solutions. It:
    (A) Kicked existing insurance providers in the business model really hard,
    (B) Mandated that various people cooperate with those insurance providers, with significant financial penalties for not doing so,
    (C) Added a bunch of regulations on top for what exactly constitutes 'coverage', rather than letting people buy what features they think they need, and
    (D) Took steps to insulate a significant minority of the market from any influence on health care prices, via subsidies.

    This has been a total disaster in parts of the country, with all providers in places exiting the market. In others, it's been only a partial disaster, leaving people paying several times as much as they were four years ago for similar coverage.

    ----

    The bar for market-based solutions shouldn't be "can it provide a perfect solution?" so much as "can it do better than the government?" We do have a parallel government run system for part of the population, the Veterans' Affairs network. It's generally viewed as much worse than the already-mediocre market.
     
  3. ALavaVatChild

    ALavaVatChild Well-Known Member

    So.. no?

    As an Australian it's just mind boggling to me that someone like you will complain that health insurance costs 100% of your income while arguing against government healthcare systems that work just fine elsewhere and provide consistent quality of care at a fraction of the price.

    Don't even get me started on worrying about millionaires 'wasting their money'. Health care is probably one of the best investments they'll ever make, and not just for themselves - they rely on a healthy workforce as much as anyone, and the ROI on health care is very high. Literally everyone in society benefits hugely from health care being affordable and accessible, yet the American narrative is about only paying for what 'you' need. It's completely myopic.
     
    Last edited: Mar 9, 2017
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  4. Erenan

    Erenan Well-Known Member

    Put me down in the column for suspecting that the free market would do a better job than government. Note that I used the word "suspect" and not "believe." I admit I don't know a lot about this stuff. All the same...

    I think... There are no solutions at all that can guarantee that everyone has what they need. We live in a world of scarcity. You can't just wave a magic wand and suddenly everyone has all of their needs met. Sorry to have to break it to you, but there's not actually enough to go around.

    Or if there is some way to get everyone access to health care, the health care will be terrible because we won't be able to afford good health care.

    Free market with strong social pressure in favor of private charity is my ideal health care system. I think this would result in the smallest amount of suffering. Government is too inefficient and divided to do a good job of regulating it.
     
  5. ALavaVatChild

    ALavaVatChild Well-Known Member

    [​IMG]
     
  6. Erenan

    Erenan Well-Known Member

    Is there a particular thing in my post you're responding to with that GIF? As it is, I get the impression you think everything I said is wrong. Is that accurate or inaccurate?

    Also please note the "suspect" and "I think." I'm trying to communicate that I don't think I have all the answers. I'm trying to signal significantly less than 100% confidence here.

    It sounds to me like Bucky is specifically arguing against the system we have in place in the US, not the systems of other countries. He's arguing that a free market would be better than the market with its hands tied behind its back by the government.
     
    Last edited: Mar 9, 2017
  7. Eji1700

    Eji1700 Well-Known Member

    Problem 1:

    Healthcare costs in the US are insane. Routine procedures that cost $200 in all the countries where healthcare systems work costs thousands if not tens of thousands of dollars in the US.

    I got hit driver side and spent less than 8 hours from the scene of the accident, to the trauma unit, to home. Probably less than 3 spent in the hospital. Bill? $60,000. Similar time spent in basically any other country costs nothing near that.

    Regardless HOW that's being paid for it cannot cost that much. ACA did not fix this. Making everyone get insurance will not fix this. Any system that does not fix this will fail as well.

    Problem 2:

    The US still does a majority of the medical research in the world. Other countries are finally gaining on us and we're dropping, but it doesn't change the fact that medical research is obscenely expensive and getting worse.

    http://csdd.tufts.edu/news/complete_story/pr_tufts_csdd_2014_cost_study

    This estimates it at over $2 billion per drug you bring to market.
     
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  8. -Y-

    -Y- Active Member

    Problem with single payer.

    Money going into healthcare must be than money going out. That means there needs to be less sick people than healthy people, to some degree, depending on tax and prices.

    If you experience negative demographic growth - You're going to have a bad time. And world is globally going towards such future, so you can't rely on immigration forever.
     
  9. Waterd

    Waterd Well-Known Member

    What's the argument Left argument against Singapore healthcare system which , I think its probably the best system right now if you only include countries with more than a million people. Though im not SUPER informed.

    https://en.wikipedia.org/wiki/Healthcare_in_Singapore
     
  10. deluks917

    deluks917 Well-Known Member

    I agree with this.
     
  11. Bucky

    Bucky Well-Known Member

    You're surprised that I stick by my principles even when they're personally inconvenient? I'll take that as a complement.

    ...which is why companies generally subsidize their employees' health care. But there's no good reason why people who can easily afford any reasonable level of health care without health insurance should be required to purchase insurance or face penalties more than 10x larger than the general public.


    A fair summary. I blame the difference between my current cost to insure (>100% of income) and my cost the last time we had this discussion (~40% of income) on side effects of government meddling.
     
  12. ALavaVatChild

    ALavaVatChild Well-Known Member

    I don't know a lot about it but it seems ok. It's functionally the government as a single insurer which is good, and private healthcare as a parallel system can be fine, most countries have that.

    It's a less redistributive than I'd like but that's Singaporean society in general I suppose. I wouldn't want to live there as a non-elite or an artistically inclined person, based on the experiences of Singaporeans I know.

    Sticking to principles that lead to worse outcomes for everyone is not a virtue.

    Health care is a public good. The idea that it operates more efficiently or effectively in the private sphere is false.

    40% of income is still outrageous, and I don't think you'll find anyone here arguing that the ACA is a good example of government intervention in health care.

    There's a difference between not having all the answers and saying things that can be disproven by looking at any number of real, functioning systems around the world (barring ridiculous definitions of 'good health care' etc.). It's not just inaccurate, it's factually incorrect and willingly so.

    Your post is just a bunch of deepities with no connection to the real world, like you emerged from a cave in which a first year economics text book was your only companion. It's possible the dumbest thing I've seen on this forum and that's really saying something.

    Why would anyone do this except to exclude working public systems from the argument?
     
    Last edited: Mar 9, 2017
  13. Erenan

    Erenan Well-Known Member

    :(
     
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  14. keithburgun

    keithburgun Administrator, Lead Designer Staff Member

    Looks okay to me. I'm surprised you like it though - Compulsory savings? <blood_dripping>PRICE CONTROLS</blood_dripping>??!

    Also worth noting that Singapore has 5 million people and ranked 3rd in GDP per capita. So this kind of a system might work better there than it would in the US. With that said, I'd definitely be down to try it here over what we are currently doing / what the Republicans are suggesting. Still seems worse than Berniecare though.
     
  15. Waterd

    Waterd Well-Known Member

    I didn't say I liked it, I said it was the best system implemented now in countries with more than a million people.
     
  16. Bob Shelline

    Bob Shelline Well-Known Member

    I think either direction would be better than this middle of the road thing we have going now. I definitely agree with the sentiment that health care is ridiculously overpriced, and I think insurance in general causes this by allowing health care providers to increase prices and still get paid by the insurance companies.

    I had the unfortunate experience of spending some time with my toddler in the hospital this week because of a case of rsv/pneumonia. There was a ridiculous amount of staff employed who were constantly checking up on us, introducing themselves, giving us biology lessons, making sure that I'm not an abusive husband, offering antidepressants, asking me to hold her down while they stick tubes through her nose and down her throat to suck out some mucus, trying random drug treatments on her while admitting that it probably wouldn't help... It was ridiculous. I wish I was exaggerating. Most of the time it was causing my daughter a lot of anxiety and I kept asking when we could go home. They were prepared to keep us there for several more days, but after about a 24 stay let us go with a home oxygen tank and some antibiotics (which are a hotbed of controversy in their own right.)
     
    Last edited: Mar 18, 2017 at 1:50 PM
  17. Bucky

    Bucky Well-Known Member

    The current mess of Medicare regulations itself appears to be a contributing factor to high costs, as does commercial insurance's bureaucracy. Currently fact-finding.

    In the meantime, y'all can get a preview by looking up the Surgery Center of Oklahoma.
     
  18. Bucky

    Bucky Well-Known Member

    Research complete.

    Issue 1: Inelastic Consumption. For a significant fraction of health care consumers, the person receiving the care, the person deciding what care is received and the person paying for the care are all different entities. The person receiving the care has a veto, but some people go with whatever their doctor prescribes, and the doctor and the person know the insurance company will pay for everything so they have no incentive to restrain themselves or shop around for lower prices.

    So no matter how expensive a health care option gets, someone will buy it. If there are too many of these consumers, ripping them off becomes more profitable than offering a reasonable price to the whole market. The ACA attempted to make this problem worse by eliminating the uninsured population.

    Issue 2: Nonprofit Care. Most hospitals in the USA are organized as tax-exempt entities. This means they can't take profits as an entity. In practice, it means profits are often extracted from some side-channel, spent on things that would be 'wasteful' for a for-profit company so that the hospital's for-profit affiliates and/or employees benefit. Conversely, as long as they're breaking even, they have no incentive to cut costs anywhere.

    Issue 3: Price Fixing. Insurance companies negotiate prices with suppliers. But they routinely do a worse job than consumers, overpaying significantly. Why? One part is that the costs can often be passed through to the consumer's employer or their deductible. Another, I suspect, is kickbacks from the provider to the insurance company.

    Issue 4: Local Regulation. A lot of places in the USA restrict building new hospitals to limit 'redundancy'. That leads to some local monopolies. Other places, such as New York, place unfair burdens on for-profit hospitals. Even where their hospitals are overpriced, and competition would drive those prices down dramatically, hospital companies can't enter the market.

    Issue 5: Federal Regulation. The electronic medical records mandates have proven expensive, costing most of a physician's salary to implement in exchange for a net loss in productivity. The costs of complying with Medicare and Medicaid are also substantial, essentially requiring one administrative employee per physician.


    The Surgery Center of Oklahoma is an experiment to sidestep all these issues. They built a for-profit facility in a place with light local regulation, do not accept insurance or federal medical benefits to avoid the associated bureaucracy and conflicts of interest, and display their prices up-front. The results are that (A) they generally cost 20% or less what other local hospitals do, (B) they get a lot of medical tourists and (C) they still earn a profit.
     
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  19. Bucky

    Bucky Well-Known Member

    Addendum - Costs related to malpractice lawsuits also appear to be significantly higher in the United States than elsewhere.
     
  20. SwiftSpear

    SwiftSpear Active Member

    As a citizen living in a first world country with single payer health care, I kind of hope the states continues to drag it's feet on single payer health care. We benefit greatly from the fact that there's an entirely competitive system in a world leader country. We get to adopt all your technological advancements you made because there's people willing to pay for experimental treatments, and people who are looking for the lowest price for care.

    It sucks for American poor people, but it sure is nice for the rest of the world.

    Maybe we could sort something out where charity organizations in Canada, the UK, Austrialia etc help offset the human costs so we can keep the system running as it is?
     

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