Single payer healthcare system discussion

dculberson said:

aircooled said:

How to discourage excessive profiteering?  Well, that's another hard one to deal with without killing motivation.  I am suspicious the primary reason why much of excessive profiteering exist is from simple (or complex) corruption.  That corruption is of course in the government.

 

I don't see why that "of course" follows. There's plenty of corruption in the private sector.

We agree about corruption both in the public and private sector.  In the private sector there is an incentive for rooting it out,  Banking for example deals with fraud.  They hire very expensive lawyers to put the perpetrators in Jail or otherwise punish them. 

In the public sector the people made a choice Our politicians are corrupted by the election process.  Politicians have long expensive campaigns to be elected. Private citizens can't afford to pay for those so they allow politicians to accept bribes  to pay for those campaigns.

In turn Gold rules,  the company or person who made the donation tells the politician which way to vote or what laws to make that benefit the contributor. 
Tax laws are written to benefit the wealthy who have the money to make the contributions. Look at where the big donations come from. Defense, Gun lobby, Pharmaceuticals, for profit prison owners etc etc etc. 

Curtis said:

engiekev said:

There's going to need to be a massive cultural shift in order for the US to adopt better healthcare policy, just like Gun Control, and it won't happen overnight.

The big difference between the US and societies that care for their fellow citizens is that they aren't so fearful of losing $1 that they will kill someone.  Seriously, read this article.  A guy in a Mercedes shot someone at a McDonalds over french fries.  We have become so ridiculously fearful of losing our "inalienable right" to protect ourselves from the mortal danger of LOSING FRENCH FRIES?

The sad thing is, I started typing that example, THEN searched google for a story, and dozens of french fry shootings popped up.

Cultural shift?  We need a complete berkeleying reboot.  We live in a society that actively supports legislation that favors the rich and rips money from our pockets with the specific intent of skewing wealth, but we shoot people over one dollar's worth of fried potatoes.

You're damn right, short of a new age revolution the status quo of profit over people will continue.

frenchyd said:

In reply to aircooled :

Welfare isn't some choice lazy people take when they don't want to work.  It's desperation time.  It's the cupboard is empty and the children are Hungry. 
 
Disincentive? What hogwash, it's living as cheaply as can be done, barely.  
 

You are aware that welfare money comes from property taxes aren't you ?  It's not some big federal program that erects giant apartment buildings that are eyesores for generations before they're torn down and replaced.  ( That's housing and urban development). 
Anyway since it's local they are constantly looking for people to serve on the boards.  You clearly have ideas about welfare, why not get on those boards and share your ideas?  You'll find several like minded people and maybe you guys can figure out how to come up with the extra money it would cost to end welfare.  Or just welfare for lazy good for nothings. 
 Hint; it costs a lot more to not have welfare than to have welfare.  
Let me repeat that.  It costs more not to have welfare than to have welfare.    More! A lot more!  
 

Having many constructive dealings with people below the poverty line, I can say with some authority that it is absolutely a disincentive to work. I am absolutely not saying that it should not exist, but simply that there are income levels where staying home makes more sense financially than trying to get a low paying job. This does not condemn people on welfare, but the system itself is not built properly. I do believe that we ought to have a social safety net. I do not believe the current welfare system serves that role very well.

In reply to tuna55 :

This.

In the first half of 1990s not much was getting built in the private sector, so as an architect one of our revenue-generating specialties was renovating public housing projects.  We spent a lot of time touring and surveying typical taxpayer-funded public housing.

In about 1993 or so we were renovating a development of housing authority townhouses in southeastern Pennsylvania.  The residents were always extremely interested in what was going on, of course, so we would talk to them a little.

I met an older woman who was considered the 'queen' of this particular housing project, because she had lived there since it was built.

In 1967.  So tell me again about how the average stay is 13 months?.  Now, this woman was maybe in her mid-60s.  Which meant she had moved into this taxpayer-funded complex at about age 40... and never left.  She had no full time job I ever saw because she was always there during the week with her nose in our business.  Maybe she worked nights or weekends - but I have no reason to believe it.

She was also getting other public assistance because I saw her food stamp books all over the dining room.  This was back in the day when they were actual coupons.  I can only assume that she had been doing so since 1967 as well.

I can tell you a hundred stories about things I saw in public housing units all around the PA / DE / MD area, which I'm sure are typical of those in the other 47 states.

Most units were pretty shabby, and shabbily kept by their tenants; unclean and a bit crowded with junk.  About 2 in 10 looked like a 'normal' lower-middle-income household, reasonably clean and taken care of.  About 2 in 10 were jammed full of expensive rental furniture, big TVs and stereos, gaming systems, etc.  Way more stuff than we had as a young double-income professional couple.  Funny how those units always seemed to be smokers, too.

And about 1 in 10 was scrupulously clean, neat as a pin, and furnished with maybe an obvious thrift store sofa, a couple milk crates, and a small old TV.  I never minded helping those folks.  The others, not so much.

pheller said:

So maybe there is answer in that: is there some of limiting what can be charged to insurance, forcing the general public to shop around? Could we have some sort of law in place that says "unless you're putting something into your body (other than shots/vaccines/medication) or being cut open, you can't use insurance." 

That would mean ER visits, urgent care, normal checkups would all be cash-only transactions. Doctors could run offices without staff. You'd pay for their time, not for insurance codes of various billing rates. We have car insurance for major damage, but we see service shops and pay out of pocket regularly. We don't use insurance for oil changes and spark plug swaps. Why do we need insurance for primary care?

The thing is, even having an HSA an essentially paying cash, I need to use insurance in order for it to be registered against my deductible. I don't get any discount because it has to pass through the insurance company, even if I pay the whole cost of the visit/procedure. 

I think what would happen if we limited what insurance could be used for is that insurance companies would partner with providers to figure out ways of getting more people into the operating room or having serious (ie costly) procedures. 

In my opinion, forcing people to shop around for medical care is worse than third-world.  In fact, many 3rd world countries have already figured out universal healthcare and/or single payer.  If I'm in the middle of a heart attack, bleeding out from a severed femoral artery, or have a gunshot wound in the stomach, I don't think that shopping around is the key to saving a few dollars.

The trouble with your suggestion is also that it further skews the income bias and hurts the lower income segment disproportionately.  Rich guy goes to the doctor for stomach pain, doctor says you have colitis, that will be $100 for the visit and $100 for the Flagil Rx.  Rich guy says, "worth every friggin penny."  Poor guy goes for the same reason and realizes that $200 means he can't feed his family for two weeks if he does, so instead he buys some Kaopectate and Gatorade and suffers through it, risking colon cancer, IBS, and hemorrhoids.

The disproportionate skewing of healthcare costs kills poor people.  Period.  I can understand that income is SOMETIMES a choice.  I choose to make $35k a year because it's all I need and I love my job.  But there was a time that I could not work.  Period.  If it weren't for the free healthcare I received, I would be dead.  Buried.  Decomposed.  No longer of this realm.  Do I deserve to die because I don't make enough money to pay for treatment?  It wasn't my fault that I couldn't work.

I can understand.  If you do something dumb like just decide to be lazy, you're going to drive a 91 Saturn and eat Ramen noodles.  If you're skilled/lucky enough to have a high paying job, you'll drive a Lambo.  That is where the choice comes in.  I don't feel like access to healthcare is any different than access to air.  The poor guy breathes just as much as the rich guy.  I don't feel like someone should be punished with death, discomfort, or bankruptcy just because he/she has the same ailment that a rich person does.. 

In reply to Duke :

My only input on this thread is to agree with you. About 10 years ago I was maintenance guy at a 200 unit 4 building apartment complex. About 3/4 of it was HUD, because the state paid double the rent that a private person would pay. 

Of those 150 HUD units, I'd say 30 were retirees or at least at that age, the rest were junkies or people working the system. 

I have to hand it to the people who were working the system there though, they worked a hell of a lot harder trying to not work than I did actually working. What killed me though was they were making more than I was with my actual job taking care of their E36 M3. Had to laugh when we evicted them though for not making their $30/month rent payments. 

In reply to Duke :

Reminds me of working for Quik Trip in high school and college. I worked in "urban" stores the entire time I worked there. Urban = the crime rate within X radius of the store = hazard pay. Wasn't much but didn't hurt.

I have one specific instance that stands out in my mind to this day. 

Super sharp dressed gentleman comes into the store, buys some cigars and gas for his new ESCALADE, then proceeded to buy his kids and partner tons of ridiculously overpriced, unhealthy snacks on his EBT card.

In reply to Curtis :

Except that breathing air doesn't require others to provide you with their goods, services, or knowledge. 
 

Maybe they should do single payer healthcare with a government enforced diet and exercise plan for everyone. Do body mass measurements regularly to make sure that everyone is meeting the government determined standards. Does that sound overly opressive and intrusive? Oh, wait... I already lived under that system for a career in the U.S. military. Regular day-to-day healthcare was terrible in most cases. Think you have the flu? You're going to have to go to sick call and wait in line for a few hours with all the people who 'just don't feel good' and don't want to go to work on time. I don't think that U.S. federal government single payer healthcare will fix anything. At best, it will just make different problems at great expense.

I'll just leave this here...

Medicare works pretty well for us old folks.   Could it be expanded.

The way it works, pays for a bunch of stuff and the I have "Advantage" plan that pays fo the rest, this funded by Medicare but administered through an independent company that offers different plans .

My current plan I pay nothing.  This also cover medicine with a co pay.

Yesterday , my semi-annual check up cost me $15.oo in co pay at the doctors.

Tomorrow I am getting an ultrasound on my carotid artery, this has been a recurring thing .

Later I am getting an annual blood test.

These cost me nothing.   I may get a small bill from the hospital, maybe $ 25.oo.

 So I wonder if this could just be expanded.    It works pretty well .

Nah, the politicians will screw it up.

Reading some of these responses is great entertainment.

I get the argument from some people because we have what I think are similar issues now with the likes of universal dental and pharmacare, which has really become a popular platform with some parties in recent elections. I have, and always have had, excellent coverage from work for both and was initially dead set against it. But I realized how hypocritical I was being and at the same time can't help but consider things like the world happiness report where the happiest countries all seem to be quite socialized.

Is there anything more important than happiness? (if there is please let me know)

Article

Report

Wikipedia ranking

Duke said:

In reply to Curtis :

Except that breathing air doesn't require others to provide you with their goods, services, or knowledge. 
 

I'm not saying doctors should work for free, I'm saying that healthcare should be as accessible monetarily as air to those receiving it.

Or, perhaps you would appreciate a scaled approach?  Let's make it that a checkup with your practitioner costs 0.2% of your net worth?  A splenectomy costs 9%?  Brain surgery costs 20%?  As long as the government is supporting profiteering by the insurance and drug companies, why not treat it like a tax? (yes, I'm being facetious)

If I had to pay out of pocket for a splenectomy right now, it would probably cost me about 4000% of my net worth, but for a 1%er it would be less than they spent on lunch yesterday.

AAZCD said:

Maybe they should do single payer healthcare with a government enforced diet and exercise plan for everyone. Do body mass measurements regularly to make sure that everyone is meeting the government determined standards. Does that sound overly opressive and intrusive? Oh, wait... I already lived under that system for a career in the U.S. military. Regular day-to-day healthcare was terrible in most cases. Think you have the flu? You're going to have to go to sick call and wait in line for a few hours with all the people who 'just don't feel good' and don't want to go to work on time. I don't think that U.S. federal government single payer healthcare will fix anything. At best, it will just make different problems at great expense.

You're comparing the military and its society to general population. You're talking about a microcosm of "free" healthcare that operates within a national construct of for-profit health, operated by a government who spends more money on a single fighter jet than it does on the entire agriculture budget.

Universal healthcare and single payer have proven to be incredibly successful everywhere it is implimented.

I always get a kick out of people (no one in specific here) who claim lazy people who just want a hand-out are ruining the country, and yet they support a system of healthcare where they are stripped of their meager wealth so that every other country can benefit from the 10 times more we pay for healthcare.

Curtis said:

Duke said:

In reply to Curtis :

Except that breathing air doesn't require others to provide you with their goods, services, or knowledge.

I'm not saying doctors should work for free, I'm saying that healthcare should be as accessible monetarily as air to those receiving it.

So what you're saying is that even though breathing air does not cost anyone anything at all, you're equating that with simply outsourcing the cost of medical care to an undefined someone else and pretending it's the same.

 Strictly on a self centred note I’d like the current American healthcare system to stay just the way it is or even become more exclusive. 

I work for a company that has great medical, drug and dental coverage. Part of this coverage includes access to care outside of Canada. It can be used in case of a critical illness that either has a long wait time or if there’s new treatment not yet available in Canada. No one has had to use it yet and I hope not to be the first but it’s nice to know I have options.

Wayslow said:

I work for a company that has great medical, drug and dental coverage. Part of this coverage includes access to care outside of Canada. It can be used in case of a critical illness that either has a long wait time or if there’s new treatment not yet available in Canada. No one has had to use it yet and I hope not to be the first but it’s nice to know I have options.

At the risk of sounding like a douche: Why does that type of coverage even exist?  I thought national health care was the bestest thing ever.

OK, maybe the point of that was to sound like a douche.  I think I'll leave this thread before I get even more pissed off.

Duke said:

Curtis said:

Duke said:

In reply to Curtis :

Except that breathing air doesn't require others to provide you with their goods, services, or knowledge.

I'm not saying doctors should work for free, I'm saying that healthcare should be as accessible monetarily as air to those receiving it.

So what you're saying is that even though breathing air does not cost anyone anything at all, you're equating that with simply outsourcing the cost of medical care to an undefined someone else and pretending it's the same.

 

Nope, simply making an analogy to compare the ease of access that I believe people SHOULD have access to healthcare.  People always assume that it has to be "something for nothing" or "taxpayer burden."  Neither needs to be true.  The money is there, and it doesn't have to come from your pocket or from the end of a rainbow.  There is (2015 numbers, source: US treasury website) $1.22T sitting on the table that our legislators have given away to top corporations and 1 percenters.  We are left to carry much of the burden, so we blame those less ambitious than we, and label them as lazy or incompetent.  In many ways, we middle class folks who blame the "lazies" are no better than the big corporations getting tax handouts from the middle class.  We're basically asking for the lower income people to work more so we don't have to carry their butts... which is exactly what our legislators did for us by giving out free money to bigwigs.  The Waltons, while they are earning over $25k per minute (each), only paid Social Security tax on 132,900 dollars of income, so they were taxed (2018) for social security on the first 6 minutes of their work year.  The list continues ad nauseum.  Basically, WalMart avoided $2.6B in taxes in 2014 and they continue to dodge taxes by about $200M per year by using the very tax code that our legislators wrote.  GSK pharmaceuticals dodged an estimated $34B in taxes the same way.  So just with those two examples (legal or otherwise) there is nearly $40B of uncollected tax revenue.  From just two companies. (sources: qz, WaPo, HuffPo, WSJ, Forbes).

It isn't "free."  There is no "undefined someone else."  The "someone else" is Walmart, Apple, KP, BP, and the thousands of other corporations that paid good money to buy our tax code.

How about we get rid of all forms of welfare, corporate and individual?  Cut the tax code back to a single page like frenchy suggests and quit socio-economic engineering with it since socio-economic engineering sucks out loud?  That puts those $40B back into circulation so people can do what they want with it.

That works for me.

Duke said:

Wayslow said:

I work for a company that has great medical, drug and dental coverage. Part of this coverage includes access to care outside of Canada. It can be used in case of a critical illness that either has a long wait time or if there’s new treatment not yet available in Canada. No one has had to use it yet and I hope not to be the first but it’s nice to know I have options.

 

At the risk of sounding like a douche: Why does that type of coverage even exist?  I thought national health care was the bestest thing ever.

 

OK, maybe the point of that was to sound like a douche.  I think I'll leave this thread before I get even more pissed off.

 

Canada's healthcare system works pretty well, but it has several flaws. One of which is the US health system.  Canada lacks the GDP and industry that we have per capita, therefore more of the tax burden falls to individuals to provide that healthcare.  In order to keep it affordable, it has to be kept modest.

Doctors get a relatively inexpensive education, then move down here because our broken system pays WAY better.  In many ways, fixing our healthcare system will fix that flaw with theirs.

The thing that always amazes me about the majority of Canadians I know (which is significant because I spend about 1/4 of my life there) is that regardless of the taxation it requires, they are happy to pay it.  They have recognized the success of the fact that healthcare doesn't have to be only for the wealthy, and the benefits to a healthy nation are palpable and tangible.

So, if you're going to criticize the Canadian HC system, you must first understand that they don't have the resources we do, more of the burden falls to the individual, AND they still prefer it and are happy to give their tax dollars for it.  Compare that to us:  We give away our tax dollars to people who make billions of dollars per year, then tell the poor people who work for those corporations to suck it up and stop being a burden.  Interesting juxtaposition.

In reply to Duke :

I didn’t say nationalized healthcare was the best thing ever. I’m encouraging you to leave your system as it is or even make it more exclusive.

As far as why the coverage exists. It’s a cheap way for employers to attract people in a highly competitive market. 

Duke said:

How about we get rid of all forms of welfare, corporate and individual?  Cut the tax code back to a single page like frenchy suggests and quit socio-economic engineering with it since socio-economic engineering sucks out loud?  That puts those $40B back into circulation so people can do what they want with it.

That works for me.

 

If you support that most of the poor, injured, mentally ill, and compromised citizens of your country die, then great.  C'mon, Duke.  Even goats look out for the welfare of the herd   Socio-economic engineering (as you call it) is something that got us out of the cave and into huts, then got us out of monarchy and into a representative republic.  But, if people prefer plagues and rats and just tossing our turds into the street, I suppose that is their choice.

But I would LOVE to start from scratch on the tax code.

Much respect for you and the debate, by the way.

Wayslow said:

In reply to Duke :

I didn’t say nationalized healthcare was the best thing ever. I’m encouraging you to leave your system as it is or even make it more exclusive.

As far as why the coverage exists. It’s a cheap way for employers to attract people in a highly competitive market. 

Sorry, it was a rhetorical question aimed at supporters of nationalized health care, not at you.  My apologies to you.

I am continually bombarded by people insisting how much better and more effective socialized medicine is, and frequently told how much better Canada's system is than the US's.  Based on that propaganda, I am questioning why insurance coverage that makes it possible to get healthcare outside of Canada should ever be necessary.

But again, I will try leaving this thread before I just get bitter(er).

Duke said:

OK, maybe the point of that was to sound like a douche.  I think I'll leave this thread before I get even more pissed off.

This has become (if not from the start) political in nature. It's an arguement with the internet. The only way to 'win' is to make the other guys go ALL CAPS and storm away from their computers.We should all just let it go.

Curtis said:

Duke said:

How about we get rid of all forms of welfare, corporate and individual?  Cut the tax code back to a single page like frenchy suggests and quit socio-economic engineering with it since socio-economic engineering sucks out loud?  That puts those $40B back into circulation so people can do what they want with it.

If you support that most of the poor, injured, mentally ill, and compromised citizens of your country die, then great.  C'mon, Duke.  Even goats look out for the welfare of the herd   Socio-economic engineering (as you call it) is something that got us out of the cave and into huts, then got us out of monarchy and into a representative republic.  But, if people prefer plagues and rats and just tossing our turds into the street, I suppose that is their choice.

But I would LOVE to start from scratch on the tax code.

Much respect for you and the debate, by the way.

Even with my curmudgeonly ways, I fully support socialized care for those who are so mentally or physically handicapped that self-support is out of the question, be it from birth defect, injury, or disease.

But I also think that threshold needs to be set at a fairly high level.

And the respect flows both ways, my friend.  I tried to stay out of this one but I couldn't.  I'm just never going to be a Utilitarian philosopher.