# Why Obamacare will never work



## 32rollandrock

Here's the latest in an excellent series on the cost of health care:

https://www.nytimes.com/2014/07/03/...column-region&region=top-news&WT.nav=top-news

There are links provided to previous installments in the series. I think that it speaks for itself: Neither the current system nor Obamacare can ever work because neither gets to the root of the issue, which is costs that have skyrocketed beyond all reason. It is difficult to read this series and not get terribly angry at the waste and profiteering that permeates our health care system.


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## pleasehelp

Obamacare is complicated. There's a lot in that legislation, and I admit that I haven't read all of it yet. However, there are some parts that are very well-intended. Some of the components of Obamacare are aimed at trying to address the issue in that article. I'm hoping to have the chance to read up on Obamacare in more detail in the near future, and I'll form an opinion. I will say that parts of the legislation that I have read will take several years to run through the system and they can't really be judged until that occurs.

There are a lot of components to our healthcare system that are broken. For example, many of our doctors in the United States (particularly primary care doctors) are ridiculously underpaid. Future generations of smart people that we'd like to go to medical school will choose not to go because the economic incentives and lifestyle are unattractive. We need to fix that quickly.


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## SG_67

pleasehelp said:


> Obamacare is complicated. There's a lot in that legislation, and I admit that I haven't read all of it yet.


Neither have the people who crafted, voted on and signed into law that very same legislation.



> However, there are some parts that are very well-intended. Some of the components of Obamacare are aimed at trying to address the issue in that article. I'm hoping to have the chance to read up on Obamacare in more detail in the near future, and I'll form an opinion. I will say that parts of the legislation that I have read will take several years to run through the system and they can't really be judged until that occurs.
> 
> There are a lot of components to our healthcare system that are broken. For example, many of our doctors in the United States (particularly primary care doctors) are ridiculously underpaid. Future generations of smart people that we'd like to go to medical school will choose not to go because the economic incentives and lifestyle are unattractive. We need to fix that quickly.


I don't think we need to wait to judge it. Obamacare is basically publicly subsidized healthcare. The same as publicly subsidized labor, education or anything else where the true cost is hidden. Soon enough, the built in inefficiencies of such a system will come out in the form of higher prices and less access. Higher prices as more people will pour in and a disproportionate burden will be born by those producing vs. those consuming. Less access as reimbursements will be cut (as has been done with Medicare over the years) and fewer providers will opt into those networks.

There's nothing broken about our healthcare system. It is robust and the best in the world. Access is nearly universal as it is and wait times are minimal. Physicians are paid well and if anything its the cost of malpractice insurance that is gobbling into profits.


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## 32rollandrock

pleasehelp said:


> Obamacare is complicated. There's a lot in that legislation, and I admit that I haven't read all of it yet. However, there are some parts that are very well-intended. Some of the components of Obamacare are aimed at trying to address the issue in that article. I'm hoping to have the chance to read up on Obamacare in more detail in the near future, and I'll form an opinion. I will say that parts of the legislation that I have read will take several years to run through the system and they can't really be judged until that occurs.
> 
> There are a lot of components to our healthcare system that are broken. For example, many of our doctors in the United States (particularly primary care doctors) are ridiculously underpaid. Future generations of smart people that we'd like to go to medical school will choose not to go because the economic incentives and lifestyle are unattractive. We need to fix that quickly.


I'm not sure that I agree that doctors are underpaid--certainly, there seems to be no shortage of applications to med schools. But let's if we can, limit this to talking about skyrocketing costs, many of which accrue to drug companies and hospitals and insurance companies as opposed to physicians. My belief is that our health care system cannot be reformed unless and until we address these costs that do very little to affect the quality of care. Profiteering is an ugly word, but I think that it often applies in the world of health care.


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## WouldaShoulda

pleasehelp said:


> For example, many of our doctors in the United States (particularly primary care doctors) are ridiculously underpaid. Future generations of smart people that we'd like to go to medical school will choose not to go because the economic incentives and lifestyle are unattractive. We need to fix that quickly.


I believe that the waste and profiteering of primary care or any doctors will be the next targets.

They are nothing but 2%er Greedheads!!


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## Mike Petrik

pleasehelp said:


> Obamacare is complicated. There's a lot in that legislation, and I admit that I haven't read all of it yet. However, there are some parts that are very well-intended....


I will stipulate that most of it is well-intended. Pure intentions do not prevent odious consequences, however. Many of the social ills in the US are the result, at least in part, of well-intended social legislation. The incapability or the unwillingness of legislators to carefully consider how those affected by their legislation will actually respond to it is costly in both human and financial terms.


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## Chouan

SG_67 said:


> Neither have the people who crafted, voted on and signed into law that very same legislation.
> 
> I don't think we need to wait to judge it. Obamacare is basically publicly subsidized healthcare.* The same as publicly subsidized labor, education or anything else where the true cost is hidden. Soon enough, the built in inefficiencies of such a system will come out in the form of higher prices and less access.* Higher prices as more people will pour in and a disproportionate burden will be born by those producing vs. those consuming. Less access as reimbursements will be cut (as has been done with Medicare over the years) and fewer providers will opt into those networks.
> 
> There's nothing broken about our healthcare system. *It is robust and the best in the world.* Access is nearly universal as it is and wait times are minimal. Physicians are paid well and if anything its the cost of malpractice insurance that is gobbling into profits.


Really? And, really?
If the first is true, then how is it that the established National Health Services in western Europe are working very well? The only problems, in terms of medical care, have been through the involvement of "for profit" organisations, whose purpose is, of course, profit, not health care.
Your arguments appear to be the same as Doctors in Britain offered in 1947 against the NHS. Their self-interest was recognised then for what it was, and their arguments, which yours echo, were unfounded. One would hope that the commercial medical industry and interests in the US who are arguing for their own self-interest and profits will also be recognised for what they are, profit making organisations who see their opportunities for money-making being threatened.


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## Earl of Ormonde

Dear Americans, 
I'm sure you are aware that almost every European country has a National Health Service, paid for by small monthly contributions direct from a worker's wages. And the poor and unemployed get subsidised healthcare.


It seems to me that US medical institutions and medical stuff are so greedy/expensive and/or well paid and the state so uncompassionate that a national health service seems to be an insurmountable obstacle. 
Yet for the life of me I can't see why.


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## Earl of Ormonde

Chouan said:


> Really? And, really?
> If the first is true, then how is it that the established National Health Services in western Europe are working very well? The only problems, in terms of medical care, have been through the involvement of "for profit" organisations, whose purpose is, of course, profit, not health care.
> Your arguments appear to be the same as Doctors in Britain offered in 1947 against the NHS. Their self-interest was recognised then for what it was, and their arguments, which yours echo, were unfounded. One would hope that the commercial medical industry and interests in the US who are arguing for their own self-interest and profits will also be recognised for what they are, profit making organisations who see their opportunities for money-making being threatened.


EXACTLY. It is the self-interest/greed of the medical profession that I think must be what is getting in the way in the US as it did in the UK post-war.
Compare a UK or Swedish hospital nurse's wages with the same person in the US. Then do the same for a family doctor (GP), and a surgeon.
The US medical professionals earn way, way more than their European counterparts.


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## pleasehelp

SG_67 said:


> Neither have the people who crafted, voted on and signed into law that very same legislation.
> 
> I don't think we need to wait to judge it. Obamacare is basically publicly subsidized healthcare. The same as publicly subsidized labor, education or anything else where the true cost is hidden. Soon enough, the built in inefficiencies of such a system will come out in the form of higher prices and less access. Higher prices as more people will pour in and a disproportionate burden will be born by those producing vs. those consuming. Less access as reimbursements will be cut (as has been done with Medicare over the years) and fewer providers will opt into those networks.
> 
> There's nothing broken about our healthcare system. It is robust and the best in the world. Access is nearly universal as it is and wait times are minimal. Physicians are paid well and if anything its the cost of malpractice insurance that is gobbling into profits.


There's a lot to Obamacare that goes far beyond the insurance mandates. Whether or not people want to admit it, the US already had publically subsidized healthcare - parts of Obamacare are aimed at trying to improve upon it (and actually attempt to increase competition). I'm not defending it (as I need to read it before I can really comment on it fairly) but I find that people seem very fired up about it without having read it, and I think that it's worth digging into more before claiming it is terrible.

If you look at the income of primary care doctors relative to their peers with similar educations, class standing, etc., I think you'll find them underpaid by a large amount - you could argue that we don't want the people of that quality-level spending their careers as doctors, and I suspect that will be the eventual result.


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## pleasehelp

32rollandrock said:


> I'm not sure that I agree that doctors are underpaid--certainly, there seems to be no shortage of applications to med schools. But let's if we can, limit this to talking about skyrocketing costs, many of which accrue to drug companies and hospitals and insurance companies as opposed to physicians. My belief is that our health care system cannot be reformed unless and until we address these costs that do very little to affect the quality of care. Profiteering is an ugly word, but I think that it often applies in the world of health care.


I propose that you should be a proponent of legislation that improves competition in those sectors if you'd like to see the costs driven down.


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## justonemore

Earl of Ormonde said:


> EXACTLY. It is the self-interest/greed of the medical profession that I think must be what is getting in the way in the US as it did in the UK post-war.
> Compare a UK or Swedish hospital nurse's wages with the same person in the US. Then do the same for a family doctor (GP), and a surgeon.
> The US medical professionals earn way, way more than their European counterparts.


Indeed. But to be fair we also need to consider lawsuits & high insurance premiums for drs in the u.s. as part of the financial differences. I know very few mds out of europe that would be willing to practice in the u.s. due to such idiocy.

It is quite amazing to me that the u.s. hasn't come around to having a decent medical system that covers everyone when much of the world has already done so. It's quite 3rd world to have your citizens dropping dead due to lack of coverage.


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## Langham

^ Good point. The seemingly pervasive system of grotesque and punitive compensation in the US courts may be at the bottom of it all. 

That said, it is still surprising that such a wealthy country has no universal system of healthcare provision.


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## 32rollandrock

SG_67 said:


> Obamacare is basically publicly subsidized healthcare. The same as publicly subsidized labor, education or anything else where the true cost is hidden. Soon enough, the built in inefficiencies of such a system will come out in the form of higher prices and less access. Higher prices as more people will pour in and a disproportionate burden will be born by those producing vs. those consuming. Less access as reimbursements will be cut (as has been done with Medicare over the years) and fewer providers will opt into those networks.
> 
> There's nothing broken about our healthcare system. It is robust and the best in the world. Access is nearly universal as it is and wait times are minimal. Physicians are paid well and if anything its the cost of malpractice insurance that is gobbling into profits.


We most certainly do not have the best health care system in the world. I read (or try) a fair amount on this subject, and I have never seen any reputable source that states we have the world's best health care system as measured by such rubrics as infant mortality and life expectancy. At the same time, we do, indisputably, have the world's most expensive health care system. It is complicated, to be sure. I recall a very good Frontline report a few years ago that compared/contrasted various health care systems and none was perfect. But I do think that ours could be a lot better than it is right now.

You are right that Obamacare is subsidized health care, and I, personally, don't see anything inherently wrong with subsidized, even socialized, medicine (as we've discussed before, I favor Medicare for everyone, but we've already had that discussion). My problem is, we are subsidizing bloat, and that's why I like the NYT series so much. Without debating the merits or demerits of Obamacare, it says, factually and plainly, that we're spending a ton of money on medicine that isn't getting spent elsewhere for the same stuff--they've done it with colonoscopies, asthma drugs, emergency room care, artificial joints, child birth and now vaccines. Each and every one is a very common event in health care, which makes it even more relevant--we're not talking outlier stuff. You can do with these facts whatever you like, but I see them as unpleasant truths that make it impossible to create a system that is effective and efficient, no matter who pays.

As for malpractice insurance, I don't want to get bogged down in that debate, but I will say this. Malpractice insurance rates would, in my view, plummet if doctors didn't go to the lengths they do now to protect other doctors, regardless of whether the doctor in question is good or bad. Doctors who have no business practicing medicine are allowed to keep their licenses, often becoming someone else's problem as they move from one state to the next. You and I have talked about this, and we've discussed a certain physician who was allowed to keep practicing medicine despite a slew of lawsuits and malpractice settlements and discipline against his license and at least three deaths attributable to substandard care. It took more than a decade after the first death before that physician finally surrendered his license to practice--even after three deaths and an amputated leg caused by negligent care, they still didn't yank his license, they allowed him to voluntarily surrender it. Now, how he was able to keep getting malpractice insurance through all of this, I can't say. But I can say, with a fair amount of certainty, that malpractice premiums would go down if there were not as many bad doctors as there are now, and that's the responsibility of doctors who are in charge of the licensing/privileges system.

But let's, please, keep this to the cost of care. Thanks.


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## 32rollandrock

justonemore said:


> Indeed. But to be fair we also need to consider lawsuits & high insurance premiums for drs in the u.s. as part of the financial differences. I know very few mds out of europe that would be willing to practice in the u.s. due to such idiocy.
> 
> It is quite amazing to me that the u.s. hasn't come around to having a decent medical system that covers everyone when much of the world has already done so. It's quite 3rd world to have your citizens dropping dead due to lack of coverage.


Ack! It ain't idiocy. The U.S. allows more quacks to continue in practice than a flock of ducks. You want lower malpractice premiums? Start weeding out the bad doctors and the rates will go down. Or, perhaps, you would prefer caps on settlements/verdicts so that some poor soul gets just $50,000 even though he's a vegetable for the rest of his life because a quack who kept getting in trouble was allowed to keep practicing. Happens all the time.


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## 32rollandrock

Langham said:


> ^ Good point. The seemingly pervasive system of grotesque and punitive compensation in the US courts may be at the bottom of it all.
> 
> That said, it is still surprising that such a wealthy country has no universal system of healthcare provision.


It ain't grotesque or punitive if you are the widow or the person who'll never be able to walk because someone who had no business practicing medicine was allowed to keep practicing medicine.


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## Pentheos

Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):

https://www.forbes.com/sites/matthe...innovative-countries-in-biology-and-medicine/

Research costs money, some of which is passed on to the most immediate patients, i.e., Americans.


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## justonemore

Chouan said:


> Really? And, really?
> If the first is true, then how is it that the established National Health Services in western Europe are working very well? The only problems, in terms of medical care, have been through the involvement of "for profit" organisations, whose purpose is, of course, profit, not health care.
> Your arguments appear to be the same as Doctors in Britain offered in 1947 against the NHS. Their self-interest was recognised then for what it was, and their arguments, which yours echo, were unfounded. One would hope that the commercial medical industry and interests in the US who are arguing for their own self-interest and profits will also be recognised for what they are, profit making organisations who see their opportunities for money-making being threatened.


Agreed. Such claims are either baseless or good for the u.s. only. Much of the world has made education & medicine at a "federal" level work quite well. Here in Switzerland it is the private schools that are considered inferior. Private hospitals, while more comfortable as to meals & rooms), are for lower levels of care & anything serious gets transfered to the public hospitals (my wife dealt with this during her 2nd pregnancy).


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## 32rollandrock

pleasehelp said:


> I propose that you should be a proponent of legislation that improves competition in those sectors if you'd like to see the costs driven down.


Here is what I would do to drive down costs in at least one sector.

I would invent a drug that causes asthma attacks. Then I would administer that drug to every member of Congress and withhold Albuterol, a drug that's OTC in the rest of the world that brings instant relief, from these alleged public servants until they make Albuterol and a lot of other drugs, including birth control pills, available OTC like they are in other industrialized nations. I suspect the problem would be solved rather quickly. It is amazing what people will do in order to be able to breathe. In the United States, for instance, asthmatics will pay hundreds, even thousands, of dollars for drugs that will allow them to breathe.


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## 32rollandrock

Pentheos said:


> Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):
> 
> https://www.forbes.com/sites/matthe...innovative-countries-in-biology-and-medicine/
> 
> Research costs money, some of which is passed on to the most immediate patients, i.e., Americans.


I think that this is a good point.


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## Chouan

Pentheos said:


> Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):
> 
> https://www.forbes.com/sites/matthe...innovative-countries-in-biology-and-medicine/
> 
> Research costs money, some of which is passed on to the most immediate patients, i.e., Americans.


Which countries are they, that are "sucking off America"? The UK? Are you suggesting that places like Cambridge are "sucking off America"? Or is this more American chauvinism?

How about the asset stripping Pfizer trying to take-over and "suck off" the profits from the Anglo-Swedish Astrazeneca?

https://www.theguardian.com/business/2014/may/26/pfizer-abandons-attempt-astrazeneca-pharmaceutical
https://www.theguardian.com/business/2014/apr/20/pfizer-astrazeneca-takeover-rumours-jobs

Pfizer has a very poor record of research, being more concerned with profits, especially immediate and short-term profits than development.


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## Chouan

32rollandrock said:


> Here is what I would do to drive down costs in at least one sector.
> 
> I would invent a drug that causes asthma attacks. Then I would administer that drug to every member of Congress and withhold Albuterol, a drug that's OTC in the rest of the world that brings instant relief, from these alleged public servants until they make Albuterol and a lot of other drugs, including birth control pills, available OTC like they are in other industrialized nations. I suspect the problem would be solved rather quickly. It is amazing what people will do in order to be able to breathe. In the United States, for instance, asthmatics will pay hundreds, even thousands, of dollars for drugs that will allow them to breathe.


Yes, because it is the profit principle which always seems to trump the care principle. Yet people here seem to think that medical corporations' profit making is somehow able to maintain a more efficient care system than a care based system.


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## Langham

32rollandrock said:


> It ain't grotesque or punitive if you are the widow or the person who'll never be able to walk because someone who had no business practicing medicine was allowed to keep practicing medicine.


I'm not arguing against compensation per se. However, the amounts of compensation that are pursued frequently seem quite disproportionate to the loss suffered.


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## justonemore

Duplicate post deleted.


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## 32rollandrock

Chouan said:


> Which countries are they, that are "sucking off America"? The UK? Are you suggesting that places like Cambridge are "sucking off America"? Or is this more American chauvinism?
> 
> How about the asset stripping Pfizer trying to take-over and "suck off" the profits from the Anglo-Swedish Astrazeneca?
> 
> https://www.theguardian.com/business/2014/may/26/pfizer-abandons-attempt-astrazeneca-pharmaceutical
> https://www.theguardian.com/business/2014/apr/20/pfizer-astrazeneca-takeover-rumours-jobs
> 
> Pfizer has a very poor record of research, being more concerned with profits, especially immediate and short-term profits than development.


I had been struck by how much more pharmaceutical companies charge for drugs in the United States than they do for the exact same drugs in other countries. I am personally familiar with Advair. I am asthmatic and cannot breathe without it. A one-month supply in the United States is $400. It is one-third that cost, or less, in Europe--I believe that it may be sold over the counter in some countries. Even with insurance, I cannot afford to take it as prescribed and so skimp on the dose. Albuterol is another example. One inhaler costs around $50 here. In Mexico, the same inhaler costs $10 or so.


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## justonemore

Pentheos said:


> Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):
> 
> https://www.forbes.com/sites/matthe...innovative-countries-in-biology-and-medicine/
> 
> Research costs money, some of which is passed on to the most immediate patients, i.e., Americans.


funny that your example of europe sucking off of america's teet shows that it's actually a Swiss company funding American research in the mit/harvard area.


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## Pentheos

Chouan said:


> Which countries are they, that are "sucking off America"? The UK? Are you suggesting that places like Cambridge are "sucking off America"? Or is this more American chauvinism?
> 
> How about the asset stripping Pfizer trying to take-over and "suck off" the profits from the Anglo-Swedish Astrazeneca?
> 
> https://www.theguardian.com/business/2014/may/26/pfizer-abandons-attempt-astrazeneca-pharmaceutical
> https://www.theguardian.com/business/2014/apr/20/pfizer-astrazeneca-takeover-rumours-jobs
> 
> Pfizer has a very poor record of research, being more concerned with profits, especially immediate and short-term profits than development.


You really enjoy putting words in other people's mouths. I've been warned about you.

America leads the world in biomedical research. I presume that it also leads the world in expenditures on biomedical R&D. Those costs are passed on to consumers. Initially, I suspect that Americans pay the bulk of those costs.

What many forget is that developing new medicines is enormously expensive. I have a friend who works at a boutique pharmaceutical start-up. They are producing a single drug. They are pouring _billions_ into it. It will be expensive when they sell it. But it will save lives of people with cancers.

Meanwhile, most countries spend the bulk of their medical budget on patching up drunken soccer fans and mums on the dole, except Switzerland, where apparently everything is peachy.


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## Pentheos

justonemore said:


> funny that your example of europe sucking off of america's teet shows that it's actually a Swiss company funding American research in the mit/harvard area.


In before you edit.

I'm sure that the bulk of research in the area is supported by the universities. Harvard's endowment was, for a time, 1/10th of Switzerland's GDP.


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## justonemore

Pentheos said:


> You really enjoy putting words in other people's mouths. I've been warned about you.
> 
> America leads the world in biomedical research. I presume that it also leads the world in expenditures on biomedical R&D. Those costs are passed on to consumers. Initially, I suspect that Americans pay the bulk of those costs.
> 
> What many forget is that developing new medicines is enormously expensive. I have a friend who works at a boutique pharmaceutical start-up. They are producing a single drug. They are pouring _billions_ into it. It will be expensive when they sell it. But it will save lives of people with cancers.
> 
> Meanwhile, most countries spend the bulk of their medical budget on patching up drunken soccer fans and mums on the dole, except Switzerland, where apparently everything is peachy.


any examples of everything being peachy in switzerland or are you trolling?

Do you have any clue what you're saying? The bulk going to patching up soccer fans? Do you honestly think there are no problems with say cancer or heart disease here?

Oh. WARNING EDIT...EDIT...Just to let you know, in Switzerland we spend more of our medical resources on idiot American skiers than drunken soccer fans.


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## justonemore

Pentheos said:


> In before you edit.
> 
> I'm sure that the bulk of research in the area is supported by the universities. Harvard's endowment was, for a time, 1/10th of Switzerland's GDP.


Any proof or just your thoughts?


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## Pentheos

justonemore said:


> Any proof or just your thoughts?


I must prove that Novartis is the sole funding of biomedical research in Boston? You must be joking. Go read the article again. Novartis put up a lab there so that the Swiss could leech off of American ingenuity.


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## Mike Petrik

justonemore said:


> any examples of everything being peachy in switzerland or are you trolling?
> 
> Do you have any clue what you're saying? The bulk going to patching up soccer fans? Do you honestly think their are no problems with say cancer or heart disease here?


Pentheos can correct me if I'm mistaken, but I think he is saying that the enormous R&D costs to develop medicine and technology are concentrated in the US. To the extent countries have single-payer or monopsony markets, they can negotiate purchase prices for such medicine and technology that cover only marginal production costs plus a profit, leaving the market-based US to pay for the R&D. The US can remedy this only by also adopting a single-payer system, which would either (i) cause prices in Europe to increase dramatically or (ii) cause R&D to radically diminish, or (iii) both. Yes, it is true that there are some non-US drug and medical tech companies, but their continued existence is dependent on profits derived predominantly from the US.


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## justonemore

Pentheos said:


> I must prove that Novartis is the sole funding of biomedical research in Boston? You must be joking. Go read the article again. Novartis put up a lab there so that the Swiss could leech off of American ingenuity.


Yes. Yes. And I'm quite sure it was the Americans that invented the internet. One of your former vice presidents if memory serves correct. Lol. You're too funny hero. There are exchanges of information between education & business on a global scale. You think harvard funds its own research but they whored themselves out to private industry long ago. The proof I wanted was as to your claims that harvard funds most of its research


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## Tilton

I don't know what year he's referring to, but, for instance, in 2008, Harvard's endowment fund was worth about $38b and Switzerland's GDP was $450b. Not 10%, but not terribly far off at 8.4%.


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## Pentheos

Mike Petrik said:


> Pentheos can correct me if I'm mistaken, but I think he is saying that the enormous R&D costs to develop medicine and technology are concentrated in the US. To the extent countries have single-payer or monopsony markets, they can negotiate purchase prices for such medicine and technology that cover only marginal production costs plus a profit, leaving the market-based US to pay for the R&D. The US can remedy this only by also adopting a single-payer system, which would either (i) cause prices in Europe to increase dramatically or (ii) cause R&D to radically diminish, or (iii) both. Yes, it is true that there are some non-US drug and medical tech companies, but their continued existence is dependent on profits derived predominantly from the US.


Thank you, Mike. Delivered with a lawyer's precision. If I _ever_ get in trouble, I'm calling you.

Pardon my own laconic delivery. I'm neck-deep in a project, but I wanted to share my thoughts on this important matter.

(As an aside, can you imagine how high American high care costs would be if we had legions of rowdy soccer fans?)


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## Mike Petrik

justonemore said:


> Yes. Yes. And I'm quite sure it was the Americans that invented the internet. One of your former vice presidents if memory serves correct. Lol. You're too funny hero.


Al Gore is a self-important dope who as a US Senator supported the relaxation of certain laws that permitted Americans to more easily access the Internet, which fellow Americans Vint Cert and Robert Kahn did in fact invent. https://en.wikipedia.org/wiki/History_of_the_Internet


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## justonemore

Mike Petrik said:


> Al Gore is a self-important dope who as a US Senator supported the relaxation of certain laws that permitted Americans to more easily access the Internet, which fellow Americans Vint Cert and Robert Kahn did in fact invent. https://en.wikipedia.org/wiki/History_of_the_Internet


Hmmm. I-m not a tech geek. perhaps there is a difference between the web and the internet....but this seems to contradict such...

https://home.web.cern.ch/topics/birth-web


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## Mike Petrik

Pentheos said:


> Thank you, Mike. Delivered with a lawyer's precision. If I _ever_ get in trouble, I'm calling you.
> 
> Pardon my own laconic delivery. I'm neck-deep in a project, but I wanted to share my thoughts on this important matter.
> 
> (As an aside, can you imagine how high American high care costs would be if we had legions of rowdy soccer fans?)


Pentheos, the only trouble you are likely to get in is discipline from a forum moderator for having incorrect opinions. 
As for soccer, for a long time I just didn't get it, but the drama and athleticism displayed in the current games has captivated me. I'm now a fan. I don't get the rowdy hooliganism of course, but I suspect neither do most fans in these countries. It only takes a small percentage of knuckleheads to embarrass any group of people.


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## pleasehelp

I don't think high drug costs relate to whether you have a single-payor system v. multi-payors. Take a look at defense costs. Most nations have the functional equivalent of a single-payor system for high-end military equipment. Drug costs are a function of many different factors, including whether the nation enforces patent laws, regulation, alternatives to that drug, contract terms, etc.

If we want to encourage advances in medical care, in many ways we want there to be a high per-unit cost on drugs because it suggests that there is a market for those improvements.

I do find it frustrating that a discussion of healthcare systems becomes an issue of nation-bashing. It's a complicated issue with many factors. The US does need to improve its healthcare system, but hopefully we don't lose the parts of our healthcare system that are truly elite. While our statistics that are measured across the population are quite poor for a nation of such prosperity (e.g., infant morality), the US remains a destination point for medical innovation and the treatment of the most complicated cases.


----------



## Mike Petrik

justonemore said:


> Hmmm. I-m not a tech geek. perhaps there is a difference between the web and the internet....but this seems to contradict such...
> 
> https://home.web.cern.ch/topics/birth-web


Yes, there is a difference. The web is built on top of the Internet. https://www.webopedia.com/DidYouKnow/Internet/Web_vs_Internet.asp


----------



## Mike Petrik

pleasehelp said:


> I don't think high drug costs relate to whether you have a single-payor system v. multi-payors. Take a look at defense costs. Most nations have the functional equivalent of a single-payor system for high-end military equipment. Drug costs are a function of many different factors, including whether the nation enforces patent laws, regulation, alternatives to that drug, contract terms, etc.
> 
> If we want to encourage advances in medical care, in many ways we want there to be a high per-unit cost on drugs because it suggests that there is a market for those improvements.
> 
> I do find it frustrating that a discussion of healthcare systems becomes an issue of nation-bashing. It's a complicated issue with many factors. The US does need to improve its healthcare system, but hopefully we don't lose the parts of our healthcare system that are truly elite. While our statistics that are measured across the population are quite poor for a nation of such prosperity (e.g., infant morality), the US remains a destination point for medical innovation and the treatment of the most complicated cases.


I agree with much of this, but must point out that health outcomes cannot so easily be associated with health care. First, the unimpressive infant mortality data in the US is at least somewhat a function of more rigorous protocols for defining infant mortality than those used by many other nations (see link below). Second, affluence in the US has led to society that is both more obese and sedentary than its counterparts. These are exceedingly important risk factors for health, and while certainly a problem for the US are not a health *care* problem as such.

https://www.nationalreview.com/articles/276952/infant-mortality-deceptive-statistic-scott-w-atlas


----------



## justonemore

Mike Petrik said:


> Yes, there is a difference. The web is built on top of the Internet. https://www.webopedia.com/DidYouKnow/Internet/Web_vs_Internet.asp


Thanks Mike...I did like this quote from Wikipedia concerning Cerf...

Cerf is also known for his sartorial style, typically appearing in three-piece suit-a rarity in an industry known for its casual dress norms.[SUP][[/SUP]


----------



## pleasehelp

Mike Petrik said:


> I agree with much of this, but must point out that health outcomes cannot so easily be associated with health care. First, the unimpressive infant mortality data in the US is at least somewhat a function of more rigorous protocols for defining infant mortality than those used by many other nations (see link below). Second, affluence in the US has led to society that is both more obese and sedentary than its counterparts. These are exceedingly important risk factors for health, and while certainly a problem for the US are not a health *care* problem as such.
> 
> https://www.nationalreview.com/articles/276952/infant-mortality-deceptive-statistic-scott-w-atlas


Very good point on the infant morality issue, and I do agree that many of the population-wide metrics that are used are a function of factors that go beyond the healthcare system.


----------



## Mike Petrik

justonemore said:


> Thanks Mike...I did like this quote from Wikipedia concerning Cerf...
> 
> Cerf is also known for his sartorial style, typically appearing in three-piece suit-a rarity in an industry known for its casual dress norms.[SUP][[/SUP]


Hah! Outstanding catch -- I had not noticed that.


----------



## justonemore

Just a Wikipedia article concerning Swiss phamaceuticals and biotech... It hardly seems as if the Swiss are LEECHING off of the Americans as Pentheos states. It also seems to contradict a bit of what you were saying as well Mike. And no, it's not as a few have implied... drugs here are not cheap at all. They are in fact generally more expensive than in the U.S. ....as is most everything here....

https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_Switzerland


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## Mike Petrik

justonemore said:


> Just a Wikipedia article concerning Swiss phamaceuticals and biotech... It hardly seems as if the Swiss are LEECHING off of the Americans as Pentheos states.
> 
> https://en.wikipedia.org/wiki/Pharmaceutical_industry_in_Switzerland


Well, "leeching" strikes me as unnecessarily pejorative, but the more interesting question is where does it derive its profits. My hunch (and that is all it is) is that its profitability is dependent on the US market that allows it to recover its R&D costs through market prices.


----------



## justonemore

32rollandrock said:


> Ack! It ain't idiocy. The U.S. allows more quacks to continue in practice than a flock of ducks. You want lower malpractice premiums? Start weeding out the bad doctors and the rates will go down. Or, perhaps, you would prefer caps on settlements/verdicts so that some poor soul gets just $50,000 even though he's a vegetable for the rest of his life because a quack who kept getting in trouble was allowed to keep practicing. Happens all the time.


Perhaps this is a good reason to keep the drs. in the University/public system longer? Our drs must work for the University hospitals for at least 5years before they can open their own practice (and it used to be 10). Maybe I'm just missing it, but we don't seem to have these issues with drs mistakes and high cost lawsuits. It most certainly doesn't "happen all the time" here. What do you think the problem is there? Lack of training? Lack of regulation? Poorly informed clients? Lawyers seem to play a part as well don't they (i.e the famous "ambulance chasers")? It is/was pretty common for people to perhaps exagerate their claims a bit for a bit more money , wasn't it? This certainly doesn't help the cost of things either.


----------



## Earl of Ormonde

Pentheos said:


> Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):
> 
> https://www.forbes.com/sites/matthe...innovative-countries-in-biology-and-medicine/
> 
> Research costs money, some of which is passed on to the most immediate patients, i.e., Americans.


Absolute nonsense! UK, Sweden, Germany, France, India, Switzerland, Japan, Russia to name but a few all carry out extensive and useful medical and pharmaceutical research.

US companies haven't over the last few decades been buying up Swedish medical research & pharma-companies just for the fun of it.
Most medicines were created in Europe, just take the 4 main painkillers: Aspirin (German), Diclofenac (Swiss), Paracetamol (German), Ibuprofen (English)
Then of course Penicililin (English).


----------



## 32rollandrock

pleasehelp said:


> While our statistics that are measured across the population are quite poor for a nation of such prosperity (e.g., infant morality), the US remains a destination point for medical innovation and the treatment of the most complicated cases.


I think this is a good point but, frankly, I would trade the ability to deal with the most complicated cases for the ability to adequately and efficiently and economically take care of the bulk of the population, including me (I say this knowing full well that I might feel differently if I had a complicated case). Then again, I don't know or understand why we should have to make such a trade-off.


----------



## pleasehelp

justonemore said:


> Perhaps this is a good reason to keep the drs. in the University/public system longer? Our drs must work for the University hospitals for at least 5years before they can open their own practice (and it used to be 10). Maybe I'm just missing it, but we don't seem to have these issues with drs mistakes and high cost lawsuits. It most certainly doesn't "happen all the time" here. What do you think the problem is there? Lack of training? Lack of regulation? Poorly informed clients? Lawyers seem to play a part as well don't they (i.e the famous "ambulance chasers")? It is/was pretty common for people to perhaps exagerate their claims a bit for a bit more money , wasn't it? This certainly doesn't help the cost of things either.


Collecting real data on this issue would be very challenging, but I doubt that the issue relates to the actual proficiency of the doctors in the US.


----------



## Pentheos

Earl of Ormonde said:


> Absolute nonsense! UK, Sweden, Germany, France, India, Switzerland, Japan, Russia to name but a few all carry out extensive and useful medical and pharmaceutical research.
> 
> US companies haven't over the last few decades been buying up Swedish medical research & pharma-companies just for the fun of it.
> Most medicines were created in Europe, just take the 4 main painkillers: Aspirin (German), Diclofenac (Swiss), Paracetamol (German), Ibuprofen (English)
> Then of course Penicililin (English).


None of those medicines is younger than 41 years old, a few are over 100 years. The world is indebted to the many great discoveries of those who came before us.

But I'm taking about contemporary cutting-edge research, in which America leads the way, by a long shot. That, of course, is not to say that other countries do not conduct useful research; moreover, one can hardly say that each country's R&D truly exists independent of another's. The fact remains that America is the biotech leader. The huge costs of this industry are passed on to consumers, many of who are Americans. Another piece:

https://www.forbes.com/sites/matthe...-new-drugs-is-shaping-the-future-of-medicine/

Puts your health into perspective, doesn't it?

Why the high cost? Well, of course research chemists and MD/PhDs make the big bucks, but there are enormous costs associated with performing clinical trials and gaining FDA approval. Enormous.

This is not to say that the American health care system does not have its share of crooks, liars, and cheats. Lots of people have their hand in the till. All of this leads to increased costs. But we shouldn't pretend that it is a broken, ineffective system.


----------



## SG_67

32rollandrock said:


> I think this is a good point but, frankly, I* would trade the ability to deal with the most complicated cases for the ability to adequately and efficiently and economically take care of the bulk of the population*, including me (I say this knowing full well that I might feel differently if I had a complicated case). Then again, I don't know or understand why we should have to make such a trade-off.


The two aren't mutually exclusive. We do take care of the bulk of the population, be they covered by private insurance or public aid. Might I add that many providers see public aid patients because of the profit made from other payers. I can give quality, sophisticated and expedient yet appropriate care to a public aid patient because I can afford to take a hit now and then. There's no way the bulk of my practice could public aid, or medicare for that matter.

The U.S. medical system is the envy of the world. I get interns and students coming to train with me throughout the year and almost to a person they marvel at the sophistication of care, speed with which patients gain access to specialists and the variety of specialists in our medical centers and hospitals.

Just a note about access, let me offer two different models of access:

1) Young man injures his knee playing volleyball. He is referred within days to an orthopedic surgeon, get's an MRI the same day and is diagnosed with a meniscus tear or an ACL tear. He is scheduled for surgery within 2-3 weeks.

2) The same young man suffers the same injury. He sees his PCP, an x-ray rules out fracture. He is given a knee brace and a prescription for NSAIDs and told to schedule a follow up appointment 6-8 weeks from that date.

Both are examples of someone having access to the healthcare system. I would argue that access is not the end all, be all of quality medical care.


----------



## 32rollandrock

SG_67 said:


> The two aren't mutually exclusive. We do take care of the bulk of the population, be they covered by private insurance or public aid. Might I add that many providers see public aid patients because of the profit made from other payers. I can give quality, sophisticated and expedient yet appropriate care to a public aid patient because I can afford to take a hit now and then. There's no way the bulk of my practice could public aid, or medicare for that matter.
> 
> The U.S. medical system is the envy of the world. I get interns and students coming to train with me throughout the year and almost to a person they marvel at the sophistication of care, speed with which patients gain access to specialists and the variety of specialists in our medical centers and hospitals.
> 
> Just a note about access, let me offer two different models of access:
> 
> 1) Young man injures his knee playing volleyball. He is referred within days to an orthopedic surgeon, get's an MRI the same day and is diagnosed with a meniscus tear or an ACL tear. He is scheduled for surgery within 2-3 weeks.
> 
> 2) The same young man suffers the same injury. He sees his PCP, an x-ray rules out fracture. He is given a knee brace and a prescription for NSAIDs and told to schedule a follow up appointment 6-8 weeks from that date.
> 
> Both are examples of someone having access to the healthcare system. I would argue that access is not the end all, be all of quality medical care.


I agree that they should not be mutually exclusive. But, in fact, people often do not have real access to health care due to costs. Yes, you can get in to see a doctor, but at what price? Some friends had crappy insurance until they just couldn't afford the premiums any longer. They went without for nearly a year and kept their fingers crossed. They referred to health insurance as foreclosure insurance, because if they had had a major medical issue, they would have gone into bankruptcy and lost their home. That's really how it works for a lot of people. They now have Obamacare and, for them, it is a godsend. Unfortunately, you and I are subsidizing it. I have insurance, but I put off things that I should not because I do not have good insurance. This may be simplistic, but 20 years ago, I didn't worry about health care costs. Insurance pretty much took care of everything. Now, I have insurance and it does not. Far from it. I don't understand why things have deteriorated so much in the past couple decades.


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## Pentheos

It's great that we have an actual doctor participating in this thread.


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## 32rollandrock

Pentheos said:


> It's great that we have an actual doctor participating in this thread.


Thank you.


----------



## justonemore

Pentheos said:


> I must prove that Novartis is the sole funding of biomedical research in Boston? You must be joking. Go read the article again. Novartis put up a lab there so that the Swiss could leech off of American ingenuity.


I read the article again and paid a bit more attention, It seems that 2 countries with 1/50th of the population of the U.S. are used as Professional references more often than the U.S. As such (and the article states such as well), is the U.S. really ahead of said "Leechers" or are they just producing more with most of it having no credibility?

If I remember correctly, during the Bush era, a couple thousand global scientists claimed that u.s. research was biased towards u.s. politics and religion. Is there any merit in that or is everyone in the scientific community insane compared to you (or America in general)?

Ohh. As to leeching. I find it funny that Amrican and British Tobacco companies have saught refuge in Switzerland. What a bunch of cancer causing leeches taking advantage of Swiss laws.


----------



## justonemore

Mike Petrik said:


> Well, "leeching" strikes me as unnecessarily pejorative, but the more interesting question is where does it derive its profits. My hunch (and that is all it is) is that its profitability is dependent on the US market that allows it to recover its R&D costs through market prices.


I can see where you're coming from on this one Mike but if we were to take Novartis, which is #1 on a global basis, would you not think they would pull more money out of India or China compared to the U.S.? Out of sheer numbers alone, if they charged $1 per pill per person in India, they would make more than charging $2 per person per pill in the U.S.... Likewise, a $2 pill here wouldn't make them the same money as a $1 pill in the U.S.

I would think that if we ignored the "overall" total, and looked at research output/expenses per capita, then the U.S. is not quite as Advanced as Pentheos wanted to make it out to be. The wikipedia article I linked to earlier, seems to show that Switzerland hosts many companies of foreign origin. Several are indeed American. I find this to be a cooperative effort but perhaps it is indeed "leeching"?

Of course any drug company desiring to do anything useful is going to conduct global studies and research. What works in California may not work in Bern, which may not work in Moscow which may not work in Hong Kong.


----------



## Chouan

Pentheos said:


> You really enjoy putting words in other people's mouths.


Are you saying now that you didn't say the words "*Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):*" in post 17? I'm sure that you did, in which case they're your words, from your mouth. 



Pentheos said:


> I've been warned about you.


Have you indeed, how interesting. I'm sure that you're mature enough and intelligent enough to be able to make up your own mind. One would hope so, at least.


----------



## Chouan

Pentheos said:


> Thank you, Mike. Delivered with a lawyer's precision. If I _ever_ get in trouble, I'm calling you.
> 
> Pardon my own laconic delivery. I'm neck-deep in a project, but I wanted to share my thoughts on this important matter.
> 
> (As an aside, can you imagine how high American high care costs would be if we had legions of rowdy soccer fans?)


I'm not sure what you're talking about re the "legions of rowdy soccer fans", I'm assuming Russia. Just a thought, you weren't trying to stereotype and generalise were you? Just in case you were, here's an interesting generalisation in response.

Question _"Can you imagine how high American high care costs would be if we had legions of firearm victims?"
_Response_ "But we do, don't we."_


----------



## Chouan

Mike Petrik said:


> Well, "leeching" strikes me as unnecessarily pejorative, but the more interesting question is where does it derive its profits. My hunch (and that is all it is) is that its profitability is dependent on the US market that allows it to recover its R&D costs through market prices.


No, "_*sucking off*_" as another member put it is so much less pejorative, isn't it.


----------



## Chouan

32rollandrock said:


> I had been struck by how much more pharmaceutical companies charge for drugs in the United States than they do for the exact same drugs in other countries. I am personally familiar with Advair. I am asthmatic and cannot breathe without it. A one-month supply in the United States is $400. It is one-third that cost, or less, in Europe--I believe that it may be sold over the counter in some countries. Even with insurance, I cannot afford to take it as prescribed and so skimp on the dose. Albuterol is another example. One inhaler costs around $50 here. In Mexico, the same inhaler costs $10 or so.


An example of an alternative system. 
If in the UK you were prescribed Advair, or Albuterol, by your GP (General Practitioner) you would pay a fee of £8.05p for the item, whatever it was. So your monthly outgoing for your Advair would be £8.05. Your National Health Insurance would cover the rest. If you wanted to you could pay £104 for a prescription pre-payment certificate, which will cover *all* prescription costs for a year. The cost of the drug is comparable to that in the US, but to you, as the person in need, the cost is subsidised by the National Insurance scheme that you've paid into whilst earning.


----------



## justonemore

Chouan said:


> I'm not sure what you're talking about re the "legions of rowdy soccer fans", I'm assuming Russia. Just a thought, you weren't trying to stereotype and generalise were you? Just in case you were, here's an interesting generalisation in response.
> 
> Question _"Can you imagine how high American high care costs would be if we had legions of firearm victims?"
> _Response_ "But we do, don't we."_


I guess the "soccer fans" have somehow done more damage than all the riots in the U.S. when certain basketball teams win.


----------



## Chouan

pleasehelp said:


> I don't think high drug costs relate to whether you have a single-payor system v. multi-payors. Take a look at defense costs. Most nations have the functional equivalent of a single-payor system for high-end military equipment. Drug costs are a function of many different factors, including whether the nation enforces patent laws, regulation, alternatives to that drug, contract terms, etc.
> 
> If we want to encourage advances in medical care, in many ways we want there to be a high per-unit cost on drugs because it suggests that there is a market for those improvements.
> 
> I do find it frustrating that a discussion of healthcare systems becomes an issue of nation-bashing. It's a complicated issue with many factors. The US does need to improve its healthcare system,* but hopefully we don't lose the parts of our healthcare system that are truly elite.* While our statistics that are measured across the population are quite poor for a nation of such prosperity (e.g., infant morality), the US remains a destination point for medical innovation and the treatment of the most complicated cases.


If organised properly, you wouldn't. Most European healthcare organisations are as capable of top level medical work, yet work within a state controlled system. The only questions I'm asked if I attend a hospital are my name, address, and whether I am resident in the UK and have been for the previous year.


----------



## justonemore

Chouan said:


> Are you saying now that you didn't say the words "*Maybe medicine would cost more in other countries if they spent their own money on R&D instead of sucking off of America (as usual):*" in post 17? I'm sure that you did, in which case they're your words, from your mouth.
> 
> Have you indeed, how interesting. I'm sure that you're mature enough and intelligent enough to be able to make up your own mind. One would hope so, at least.


I find the "i've been warned" quote a bit odd coming from someone that has been on AAAC 18 months longer than you have. In fact, Pentheos has several hundred more posts than you as well. At such a point I have to Wonder if he's either playing a game or just being ignorant for a reason...


----------



## Earl of Ormonde

Pentheos said:


> contemporary cutting-edge research,_* in which America leads the way, by a long shot.*_


I bow to your greater knowledge, if it is correct of course.

Meanwhile, here's just a short list of names for you to mull over:

Marie Curie (Polish)
Joseph Lister - antisepctic surgery (Scottish)
Robert Koch - bacteriology (German)
Louis Pasteur - germ theory (French)
Alexander Fleming - penicillin (Scottish)
Karl Landsteiner - blood groups (Austrian)
Wilhelm Roentgen - X-rays (German)
Gerhard Domagk - sulfa drugs (German)
Frederick Hopkins - vitamins (English)
Edward Jenner - vaccination - (English)
Frederick Banting- insulin (Canadian)
Dmitri Ivanovsky - viruses (Russian)

Modern plastic surgery: Harold Gillies - (New Zealander in London), Morestin (French), Mcindoe (New Zealander in London),
Modern 20th century anesthesia: Hermann Fischer (German), Joseph von Mering (German). Magill (English) Gillies (NZ) and Rowbotham (English)


----------



## Earl of Ormonde

To those of you who do it, please stop with the name dropping of the type: "I have a friend who works here" and "I have a relative who works there"
It doesn't impress anyone. In fact, I think, it belittles your own knowledge if you are doing it just to discredit someone else's views and acquired knowledge.
It's akin to the school playground arguments of the type: "my dad drives a lorry, so he knows how to fix them" "oh yea, well my dad builds lorries, so he knows how to fix them better"

Really?


----------



## Earl of Ormonde

justonemore said:


> I find the "i've been warned" quote a bit odd coming from someone that has been on AAAC 18 months longer than you have. In fact, Pentheos has several hundred more posts than you as well. At such a point I have to Wonder if he's either playing a game or just being ignorant for a reason...


That is odd, isn't it.


----------



## justonemore

Chouan said:


> If organised properly, you wouldn't. Most European healthcare organisations are as capable of top level medical work, yet work within a state controlled system. The only questions I'm asked if I attend a hospital are my name, address, and whether I am resident in the UK and have been for the previous year.


I myself am asked what my medical problem is, and for my isnurance card. They do their little triage, and off to the Dr I go. No muss, no fuss...Just as in the U.S., my sprained ankle might hve to wait for the poor sap having a heart attack. We do pay more here, but everyone is covered. As someone holding many socialist ideas (which is not the same as communist for all those Americans that can't tell the difference), I am quite happy to pay my share not only for my health but for that of my Neighbors as well. I myself prefer to spend $10 a month for someone to stay healthy versus $1000 a month to raise their orphaned children (I also prefer to spend $1 for others birth control compared to $1000 for raising others kids).


----------



## SG_67

justonemore said:


> I myself am asked what my medical problem is, and for my isnurance card. They do their little triage, and off to the Dr I go. No muss, no fuss...Just as in the U.S., my sprained ankle might hve to wait for the poor sap having a heart attack. We do pay more here, but everyone is covered. As someone holding many socialist ideas (which is not the same as communist for all those Americans that can't tell the difference), I am quite happy to pay my share not only for my health but for that of my Neighbors as well. I myself prefer to spend $10 a month for someone to stay healthy versus $1000 a month to raise their orphaned children (I also prefer to spend $1 for others birth control compared to $1000 for raising others kids).


What does birth control and raising orphans have to so with healthcare?


----------



## justonemore

Earl of Ormonde said:


> I bow to your greater knowledge, if it is correct of course.
> 
> Meanwhile, here's just a short list of names for you to mull over:
> 
> Marie Curie (Polish)
> Joseph Lister - antisepctic surgery (Scottish)
> Robert Koch - bacteriology (German)
> Louis Pasteur - germ theory (French)
> Alexander Fleming - penicillin (Scottish)
> Karl Landsteiner - blood groups (Austrian)
> Wilhelm Roentgen - X-rays (German)
> Gerhard Domagk - sulfa drugs (German)
> Frederick Hopkins - vitamins (English)
> Edward Jenner - vaccination - (English)
> Frederick Banting- insulin (Canadian)
> Dmitri Ivanovsky - viruses (Russian)
> 
> Modern plastic surgery: Harold Gillies - (New Zealander in London), Morestin (French), Mcindoe (New Zealander in London),
> Modern 20th century anesthesia: Hermann Fischer (German), Joseph von Mering (German). Magill (English) Gillies (NZ) and Rowbotham (English)


Oh. But... Americans standing on the shoulders of such giants is what one must consider "cutting edge". As Eddie Murphy once put it..."what have you done for me lately?".....


----------



## justonemore

SG_67 said:


> What does birth control and raising orphans have to so with healthcare?


Are you really too much of a rightie to understand the benefits that birth control plays in society? If I have to pay 1'000 a month for trailer trash or a ghetto baby, then the $1 a month for birth control comes heavily into play as to costs. Or is the math off? To me, it's a $999 difference as to birth control or a unfunded baby.


----------



## justonemore

If a child's parents die early from having no health care, it is society that will pick up the bill. 1'000 a month to raise someone's kid is much more than $10 to pay for someone's healthcare... Or is math mistaken again? Who pays to raise orphans? The taxpayer, right? If papa can't be healthy and dies off due to lack of coverage, who is paying the bill? the taxpayer.. Paying papa $10 for health insurance is much cheaper than raising his kid... And it's much better for the kid to be raised by papa versus a Foster home...


----------



## SG_67

justonemore said:


> Are you really too much of a rightie to understand the benefits that birth control plays in society? If I have to pay 1'000 a month for trailer trash or a ghetto baby, then the $1 a month for birth control comes heavily into play as to costs. Or is the math off? To me, it's a $999 difference as to birth control or a unfunded baby.


Trailer trash and ghetto baby? What kind of socialist are you?

Are those the views you hold of your fellow human being? And you claim to be in the healthcare field?


----------



## justonemore

SG_67 said:


> Trailer trash and ghetto baby? What kind of socialist are you?
> 
> Are those the views you hold of your fellow human being? And you claim to be in the healthcare field?


I was using words you as a rightie might understand. We have no ghettos here, noir do we have trailer trash... Both are natural wonders mostly out of American society. If you can pretend that birth control and orphans aren't medical issues, I can pretend to be an uneducated American rightie... What's worse is that you seem to claim to be a health care pro and have no clue as to how wide ranging the field actually is.


----------



## justonemore

But again...You are pretending to be offended by words versus responding to the debate.... Just taking a bit of time to troll are you? Any response as to the debate concerning the costs of birth control over the costs of raising a child? The cost of parental health care over that of raising an orphan? or are you just going to cry about words my troll friend?


----------



## pleasehelp

A few thoughts and then I will probably step out of this conversation given the direction it has taken:

1) The nation-bashing that I'm seeing rarely leads to a productive discussion.

2) The laws under which an entity is formed and exists for existence purposes are relatively irrelevant with respect to the actual location of that entity for practical purposes, particularly if it is a publically traded entity with international operations. The more relevant factors are where the operations/transactions occur.

3) When measured across time and a large enough population, people (including doctors, potential doctors, patients, etc.) generally respond to economic incentives.


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## justonemore

You seem to have mistaken the meaning of socialism once again. Can you perhaps look it up in a dictionary or do you need to respond in such an ignorant manner everytime you post? being a socialist doesn't mean that I'm overly kind hearted any more than being a fan of democracy allows you to accept that the rich shouzldn't control u.s. politics.


----------



## justonemore

oh. I'm a jerk with whoever I want whenever I want. To include those that are paying my living. Any medical pro Worth their salt will not be kind just to be kind. Can you imagine a cardiologist stating that the American diet is just fine... Go ahead, eat as much fast food as you like...


----------



## SG_67

justonemore said:


> I was using words you as a rightie might understand. We have no ghettos here, noir do we have trailer trash... Both are natural wonders mostly out of American society. If you can pretend that birth control and orphans aren't medical issues, I can pretend to be an uneducated American rightie... What's worse is that you seem to claim to be a health care pro and have no clue as to how wide ranging the field actually is.


As much as I try to abide you and be cordial I simply can't seem to find the opening.

I'll say this and remain silent: you're disgusting, self righteous and someone I would likely stay away from in a social setting. You cannot reason and instead insult people with whom you share different opinions. In a nutshell, you're a creep.

As for whatever field of "healthcare" you're in, I'll guess you couldn't cut it here or you're what we call borderline quackery that running off to Europe where such alternative medical professions are more tolerated was you're only means of income.


----------



## Chouan

pleasehelp said:


> A few thoughts and then I will probably step out of this conversation given the direction it has taken:
> 
> 1) The nation-bashing that I'm seeing rarely leads to a productive discussion.
> 
> 2) The laws under which an entity is formed and exists for existence purposes are relatively irrelevant with respect to the actual location of that entity for practical purposes, particularly if it is a publically traded entity with international operations. The more relevant factors are where the operations/transactions occur.
> 
> 3) When measured across time and a large enough population, people (including doctors, potential doctors, patients, etc.) generally respond to economic incentives.


Yes, these threads that develop into "nation-bashing" generally start with a variety of an "America is best" assertion and then members from other countries respond and are then accused of anti-Americanism. You'll find the same pattern in lots of threads.


----------



## Chouan

SG_67 said:


> As much as I try to abide you and be cordial I simply can't seem to find the opening.
> 
> *I'll say this and remain silent*: you're disgusting, self righteous and someone I would likely stay away from in a social setting. You cannot reason and instead insult people with whom you share different opinions. In a nutshell, you're a creep.
> 
> As for whatever field of "healthcare" you're in, I'll guess you couldn't cut it here or you're what we call borderline quackery that running off to Europe where such alternative medical professions are more tolerated was you're only means of income.


Rather reminds me of the teenager who ends a row with their parents with a final shouted comment and then slams the door!


----------



## justonemore

SG_67 said:


> As much as I try to abide you and be cordial I simply can't seem to find the opening.
> 
> I'll say this and remain silent: you're disgusting, self righteous and someone I would likely stay away from in a social setting. You cannot reason and instead insult people with whom you share different opinions. In a nutshell, you're a creep.
> 
> As for whatever field of "healthcare" you're in, I'll guess you couldn't cut it here or you're what we call borderline quackery that running off to Europe where such alternative medical professions are more tolerated was you're only means of income.


Very nice. Another personal insult from SG. Not a single response as to comparative costs which I mentioned and you challenged... but of course...I'm a "creep"...As you've taken this approach several times with me, I think it's about time to file a complaint with the mods and Andy.


----------



## SG_67

Chouan said:


> Rather reminds me of the teenager who ends a row with their parents with a final shouted comment and then slams the door!


No I don't think so. The individual in question is not really with arguing or conversing with.

Do you consider children born into unfortunate circumstances to be ghetto babies and trailer trash?

I can't abide that regardless of any larger point he's trying to make.


----------



## justonemore

SG_67 said:


> No I don't think so. The individual in question is not really with arguing or conversing with.
> 
> Do you consider children born into unfortunate circumstances to be ghetto babies and trailer trash?
> 
> I can't abide that regardless of any larger point he's trying to make.


Boo hoo hoo. I am crying for you and your special form of humanity.... To you, It's ok for Israel to Knock off who they want in the name of some special power but god forbid anyone use terms you don't care for... Boo hoo hooo. The rich should control a democracy by your standards... Boo hoo hooo... Could you abide that prince Charles is a prince? Do you go by the title of Dr? Perhaps only higher titles please you? Are you really trying to deny that trailer trash exists in the U.S? Are there really no ghetto babies in the U.S.? Denial isn't only a river for the righties that think everything is "equal".... Boo hoo hoo... You claim to be educated but can't see the big picture over the minor détails... Boo hoo hoo.. You cry about general insults and then procede with personal insults. boo hoo hooo. I am now listening to "Don't cry for me Argentina" in your honor....

Oh by the way... Your lack of language skills in the first sentence means (according to your own past debates), that you aren't educated enough to argue with in a general public forum. To me, it seems that you've been here all of 3 months just in order to troll.


----------



## Earl of Ormonde

justonemore said:


> Oh. But... Americans standing on the shoulders of such giants is what one must consider "cutting edge". As Eddie Murphy once put it..."what have you done for me lately?".....


Well said!


----------



## Earl of Ormonde

Chouan said:


> Yes, these threads that develop into "nation-bashing" generally start with a variety of an "America is best" assertion and then members from other countries respond and are then accused of anti-Americanism. You'll find the same pattern in lots of threads.


+1

Odd, how it's only called "nation bashing" when a European responds to some bit of jingoistic American big-headedness e.g. America is best at cutting edge medical research, the rest of the word is doing stuff that might be useful but nowhere as good as what we Americans are doing! 
Yet we Europeans never accuse the Americans of "nation bashing" when some of the Americans here think that anything left-wing in Euorpe,no matter how good, is communistic.

America as a State really needs to get over itself, with its paranoid and ridiculous fear of social democracy and democratic socialism.
If the USA as a state can't look after its poor sick people without fleecing them for crazy sums of money for medical care, how can it possibly call itself a modern westernized civilized compassionate country? Fact is, it can't because a modern westernized civilized compassionate country doesn't have the death penalty, nor would it ignore the poor black population of a huge city devastated by a hurricane.


----------



## eagle2250

While it could be concluded from the referenced article in the OP, I don't think this point has been made in responses yet offered. Obamacare will never work because in the short time since it has been "rolled out," I have already absorbed two increases in my premiums and just a week or so back, received notice of a premium increase that will occur with the next policy year! In total, my healthcare premiums will have increased by just over 30% and there could be more increases yet to come! Sadly, the experience I report herein is not unique, but rather, pretty common. How much will the American public tolerate before they decide to restore some sense of reason to this fiasco?


----------



## justonemore

eagle2250 said:


> While it could be concluded from the referenced article in the OP, I don't think this point has been made in responses yet offered. Obamacare will never work because in the short time since it has been "rolled out," I have already absorbed two increases in my premiums and just a week or so back, received notice of a premium increase that will occur with the next policy year! In total, my healthcare premiums will have increased by just over 30% and there could be more increases yet to come! Sadly, the experience I report herein is not unique, but rather, pretty common. How much will the American public tolerate before they decide to restore some sense of reason to this fiasco?


Just curious...Didn't the same thing happen when everyone was forced to buy car insurance back in the 80's (or was it the 90's?)? Is mandatory universal car insurance coverage a problem in the U.S? are there as many complaints as to paying more to have everyone insured for an auto versus having everyone insured for their health? No one has to drive, but we all have a natural desire to live.


----------



## Earl of Ormonde

Good point Eagle, what in real money terms is the average salaried American paying straight out of his gross salary to healthcare? 
In Sweden, my total taxes & contributions (which include local and govt tax, national health and unemployment contributions) taken direct from my gross slary, total 34% of my gross.


----------



## justonemore

eagle2250 said:


> While it could be concluded from the referenced article in the OP, I don't think this point has been made in responses yet offered. Obamacare will never work because in the short time since it has been "rolled out," I have already absorbed two increases in my premiums and just a week or so back, received notice of a premium increase that will occur with the next policy year! In total, my healthcare premiums will have increased by just over 30% and there could be more increases yet to come! Sadly, the experience I report herein is not unique, but rather, pretty common. How much will the American public tolerate before they decide to restore some sense of reason to this fiasco?


Oh. just curious.. Is there a manner of filing a formal complaint against a new member with less than 4 months experience that resorts to personal insults against several senior members or is it a free for all here? I admit to not having read the rules recently...

To be exact, I have a problem with this guy calling me an "anti-semite" without backing it up and then following it up with this cr%p which is beyond the pale no matter any way you look at it...

"I'll say this and remain silent: you're disgusting, self righteous and someone I would likely stay away from in a social setting. In a nutshell, you're a creep.

As for whatever field of "healthcare" you're in, I'll guess you couldn't cut it here or you're what we call borderline quackery that running off to Europe where such alternative medical professions are more tolerated was you're only means of income."


----------



## SG_67

justonemore said:


> Oh. just curious.. Is there a manner of filing a formal complaint against a new member with less than 4 months experience that resorts to personal insults against several senior members or is it a free for all here? I admit to not having read the rules recently...
> 
> To be exact, I have a problem with this guy calling me an "anti-semite" without backing it up and then following it up with this cr%p which is beyond the pale no matter any way you look at it...
> 
> "I'll say this and remain silent: you're disgusting, self righteous and someone I would likely stay away from in a social setting. In a nutshell, you're a creep.
> 
> As for whatever field of "healthcare" you're in, I'll guess you couldn't cut it here or you're what we call borderline quackery that running off to Europe where such alternative medical professions are more tolerated was you're only means of income."


I'm quite certain you've suffered worse indignities.


----------



## pleasehelp

I know that I said that I would not participate in this thread anymore by I do feel compelled to make one final comment - I think we'd all be better off as a society if we reframed our thinking as to not devalue human life based upon someone's economic situation (as the terms trailer trash and ghetto babies seems to do).

I'd encourage everyone to let this thread die. While the original topic had merit for discussion, it has unfortunately decayed into a mud-slinging contest.


----------



## Pentheos

justonemore said:


> If a child's parents die early from having no health care, it is society that will pick up the bill. 1'000 a month to raise someone's kid is much more than $10 to pay for someone's healthcare... Or is math mistaken again? Who pays to raise orphans? The taxpayer, right? If papa can't be healthy and dies off due to lack of coverage, who is paying the bill? the taxpayer.. Paying papa $10 for health insurance is much cheaper than raising his kid... And it's much better for the kid to be raised by papa versus a Foster home...


Editing your post doesn't make the original message---or your true thoughts---any less offensive. Stay classy.


----------



## justonemore

Duplicate post.


----------



## justonemore

SG_67 said:


> I'm quite certain you've suffered worse indignities.


more insults? I guess that's all you got? And you're not a troll. Lol.


----------



## justonemore

Duplicate


----------



## justonemore

Duplicate post. Sorry folks


----------



## justonemore

Pentheos said:


> Editing your post doesn't make the original message---or your true thoughts---any less offensive. Stay classy.


what got edited that you're boo hooing about? I'll continue to use the teapublican slang as much as I desire. I edited nothing. Do you have anything logical to say or are you just crying & boo hooing as to the loss of U.S. status? What is classy? Doesn't that have to do with being superior due to finacial status?


----------



## justonemore

Pentheos said:


> Editing your post doesn't make the original message---or your true thoughts---any less offensive. Stay classy.


I notice you had no real response to the idea of the post. Just another boo hooer. Lol.


----------



## justonemore

SG_67 said:


> I'm quite certain you've suffered worse indignities.


only at the hands of god loving teapublicans like you . god bless america or at least the teapublicans while sending the others to hell. Ha. Perhaps I'll start calling you ned flanders


----------



## immanuelrx

justonemore said:


> only at the hands of god loving teapublicans like you . god bless america or at least the teapublicans while sending the others to hell. Ha. Perhaps I'll start calling you ned flanders


Man I have missed your posts J1M! Always entertaining. Happy 4th Sir. I hope you have the opportunity to fire off some fireworks in Switzerland.


----------



## SG_67

Pentheos said:


> Editing your post doesn't make the original message---or your true thoughts---any less offensive. Stay classy.


It doesn't matter when one engages in magical thinking....like a child.

Unfortunately for our friend when posts are quoted they stay true to the original wording and cannot be edited by the author.

J1M, why did you edit your post? I'm just curious.


----------



## Tilton

justonemore said:


> If I have to pay 1'000 a month for trailer trash or a ghetto baby, then the $1 a month for birth control comes heavily into play as to costs. Or is the math off? To me, it's a $999 difference as to birth control or a unfunded baby.


Holy **** you are a bigot.

People are people and falling on hard times or making what you personally deem to be a poor choice doesn't give you the right to name-call (you, who cries/holds grudges about every single personally offensive thing anyone on AAAC has ever said to or about you: hypocrisy at its finest) - who the hell are you to judge like that? What constitutes "trailer trash," anyway? Not being able to afford better housing than a single-wide trailer because you never had the right opportunities in life that would facilitate post-secondary education? Being born of sub-par intelligence and therefore unable to earn significantly more than minimum wage? Please explain...

No one was fooled by your BS backpedaling justification, either.


----------



## justonemore

As asked...which post post are you super heroes refering to? I edited nothing that changed the main meaning in any of my posts but perhaps you just have a hard time with reading comprehension?


----------



## justonemore

Tilton said:


> Holy **** you are a bigot.
> 
> People are people and falling on hard times or making what you personally deem to be a poor choice doesn't give you the right to name-call (you, who cries/holds grudges about every single personally offensive thing anyone on AAAC has ever said to or about you: hypocrisy at its finest) - who the hell are you to judge like that? What constitutes "trailer trash," anyway? Not being able to afford better housing than a single-wide trailer because you never had the right opportunities in life that would facilitate post-secondary education? Being born of sub-par intelligence and therefore unable to earn significantly more than minimum wage? Please explain...
> 
> No one was fooled by your BS backpedaling justification, either.


yes. Tilton you have always been the best judge of.others meanings. Had you any idea as to what you were claiming you wouldn't claim it.


----------



## Tilton

Earl of Ormonde said:


> Good point Eagle, what in real money terms is the average salaried American paying straight out of his gross salary to healthcare?
> In Sweden, my total taxes & contributions (which include local and govt tax, national health and unemployment contributions) taken direct from my gross slary, total 34% of my gross.


I think that I pay 28% federal tax, 5.75% state tax, 7.65% Medicaid + Social Security, so technically 41.4% (I say technically because my effective tax rate is a bit lower, I think around 35% after deductions, but I don't quite remember) and I still have to buy health insurance on top of that, which is approximately 8% of my gross monthly pay.


----------



## Tilton

justonemore said:


> yes. Tilton you have always been the best judge of.others meanings. Had you any idea as to what you were claiming you wouldn't claim it.


Intent is rather meaningless, pal. You're letting your true colors shine through and nobody is impressed.


----------



## justonemore

no. those that disagree with my point aren't impressed such as you and SG (and I don't care one wink what you and your buddies really think anyways as you're obviously not capable of following meaning throughout the conversation). I can't really blame you for your thin thinking as US politics are rife with such tactics. The fact is that your ghettos and trailer parks have been around for générations because us Policy has put them there for générations with no way to get ahead. If these people can't afford food, how are they going to afford education and health care in the us? Is simple math too difficult? Who picks up the final tab for these folks? You're offended by the term ghetto baby, but I am offended that your sh*thole society has allowed ghetto babies to exist generation upon generation without a solution. You have ghettos, you have babies in those those ghettos. it is an american sickness that most of the country refuses to even think about. You sir are the bigot. You allow such waste to happen all around you without demanding a solution.


----------



## justonemore

And the funniest thing is you and your fellow teapublicans cry over having to provide universal healthcare for these folks. Free or affordable university studies? Well not on the republican dime.


----------



## justonemore

How very decent of you to defend their honor however I'm not sure it means alot to them while they are forced to work at McDonalds for the minumum wage that the republicans don't want to set higher. I'm sure your kind words will be a comfort as their loved one lays dying due to lack of health insurance. These are American problems direct from American Policy. How can one "get ahead" when the choice is food or trying to save for higher education?


----------



## justonemore

Oh. Unless you're wiling to put some money into solving these situations...Then you're actually a much bigger bigot than you imagine me to be.


----------



## justonemore

Oh by the way "PAL"....Was the math wrong? Is birth control not less expensive than paying for a child from birth to 18 years of age? Is paying for someone's medical insurance not cheaper than paying for their operation? Is providing a a medical system that focuses on preventative care not cheaper than than dealing with issues at late stages and then having to pay to raise a persons family after they're dead? Hey, "PAL" these are all issues that could be solved if you and your teapbulican friends would close your mouth and open your wallets. "PAL".


----------



## justonemore

SG_67 said:


> It doesn't matter when one engages in magical thinking....like a child.
> 
> Unfortunately for our friend when posts are quoted they stay true to the original wording and cannot be edited by the author.
> 
> J1M, why did you edit your post? I'm just curious.




More name calling from the newbie troll. No shock there. Funny enough, it was your rant that just got you called a child by Choun but I guess we should all ignore that because you're such a good god fearing republican and by golly, that must mean you're such the great guy you pretend to be. I guess you couldn't find anything more original such as calling me a creep? lol. You just too funny. Take no responsibility for anything and then get offended. I understand why 32 said that there were quite a few poor quality drs in the us. With your quick thinking and solid logic, you're a prime example of a lawsuit waiting to happen. You don't want to pay for the ghetto babies to not be ghetto babies, but god forbid someone call them ghetto babies. It's quite a system of denial you and your republican friends have going on. As long as your taxes aren't raised, you couldn't give a flying f what happens to those kids. but. booo hooo. Someone came and reminded you of the problems you yourself refuse to fix. Talk about a child.



Again.. What did I edit that has you crying? My point remains and I'll state it again if it will stop you boo hooing. There is a "quote" button should you desire to quote my posts. Otherwise, I will continue to edit as I see fit. Sorry, it's not SG's rules here (no matter how much you'd think the idea to be "swell") and editing is acceptable. Be in punctuation, spelling mistakes, or rewriting what I said. But then again, the main point always remains and always has despite your babyish boohoooing everytime someone calls you out on your disgusting belief system. Whenver I picture you I see a fat bald guy sitting at the table and eating a whole turkey leg on the bone all the while mumbling complaints about taxes through his half filled mouth.


----------



## Pentheos

What sort of madman posts six comments in a row while editing and re-editing half of them? And what sort of madman posts bigoted, racist comments and pretends he never wrote them?

What is terrifying is that J1M is some sort of mental healthcare professional. God help the Swiss.


----------



## Pentheos

justonemore said:


> More name calling from the newbie troll. No shock there. Funny enough, it was your rant that just got you called a child by Choun but I guess we should all ignore that because you're such a good god fearing republican and by golly, that must mean you're such the great guy you pretend to be. I guess you couldn't find anything more original such as calling me a creep? lol. You just too funny. Take no responsibility for anything and then get offended. I understand why 32 said that there were quite a few poor quality drs in the us. With your quick thinking and solid logic, you're a prime example of a lawsuit waiting to happen. You don't want to pay for the ghetto babies to not be ghetto babies, but god forbid someone call them ghetto babies. It's quite a system of denial you and your republican friends have going on. As long as your taxes aren't raised, you couldn't give a flying f what happens to those kids. but. booo hooo. Someone came and reminded you of the problems you yourself refuse to fix. Talk about a child.
> 
> 
> 
> Again.. What did I edit that has you crying? My point remains and I'll state it again if it will stop you boo hooing. There is a "quote" button should you desire to quote my posts. Otherwise, I will continue to edit as I see fit. Sorry, it's not SG's rules here (no matter how much you'd think the idea to be "swell") and editing is acceptable. Be in punctuation, spelling mistakes, or rewriting what I said. But then again, the main point always remains and always has despite your babyish boohoooing everytime someone calls you out on your disgusting belief system. *Whenver I picture you I see a fat bald guy sitting at the table and eating a whole turkey leg on the bone all the while mumbling complaints about taxes through his half filled mouth*.


Quoted.


----------



## justonemore

immanuelrx said:


> Man I have missed your posts J1M! Always entertaining. Happy 4th Sir. I hope you have the opportunity to fire off some fireworks in Switzerland.


Well happy 4th to you as well. I hope you were careful with the fireworks. It's quite hard to type after blowing off a few fingers. I'm a bit shocked that fireworks aren't illegal in the whole of the U.S. by now. Back in my high school days they were already illegal in Illionis, and we had to go to Wisconsin or Indiana in order to obtain them (I do hope the statute of limitations for possessing illegal fireworks has run out after 25 years).

As for here, well we shoot off our fireworks on the 1st of August in honor of our "founding" in 1291. The fireworks guys come and set up their tents and we can get pretty much anything we want (even the big ones that sound like they could be used in démolitions).


----------



## justonemore

Pentheos said:


> Quoted.


And confirmed.....That is exactly the way I picture SG....


----------



## justonemore

Pentheos said:


> What sort of madman posts six comments in a row while editing and re-editing half of them? And what sort of madman posts bigoted, racist comments and pretends he never wrote them?
> 
> What is terrifying is that J1M is some sort of mental healthcare professional. God help the Swiss.


Just as you, I'll write what I want to write.

Ohh. and what have I denied? I certainly used the term ghetto baby... And will continue to do so. Are you trying to deny the u.s. has ghetto babies? Perhaps you have a hard time reading the past posts and putting more that 2 thoughts together? Is it too confusing for you perhaps?

Just curious, what term was racist? Is the term "ghetto" in and ofsitself somehow racist in your small minded world? Last time I looked, there were more poor white folks on welfare than there were any other race. Are you claiming that I'm against "******"?

Ahh. Well the Swiss certainly don't need help from some pretend god or the americans to fix their medical system. It works just fine especially compared to the U.S.


----------



## justonemore

Pentheos said:


> Quoted.


Ooof. I just remembered that you're the chap that thinks getting onto an airplane bound for the U.S. isn't part of entering the U.S. If I am indeed a madman, then this is a case of the kettle calling the pot black. I do hope you enjoy your weekend leave from whatever faclity you were released from.


----------



## justonemore

Hmmm. Something in this photo reminds me of a few posters here.....

https://imageshack.com/i/mvfpczj


----------



## justonemore

SG_67 said:


> Trailer trash and ghetto baby? What kind of socialist are you?
> 
> Are those the views you hold of your fellow human being? And you claim to be in the healthcare field?


Wasn't it you that was just crying over not making enough money off of public aid patients? But... you're such a wonderful kind hearted guy that you accept a few anyways just out of sheer goodness? Ha. Of course the American health sytem isn't broken. They have such fine folks as you.


----------



## Pentheos

Five posts to and from himself. Inner demons? Schizophrenia?

If we could diagnose a mental illness we could at least then understand his classicism, racism, and bigotry.


----------



## justonemore

Pentheos said:


> Five posts to and from himself. Inner demons? Schizophrenia?
> 
> If we could diagnose a mental illness we could at least then understand his classicism, racism, and bigotry.


Ha. More insults. You got nothing else hero? That's ok. As a self important American, I understand you want to feel important to the other self important inflated Americans posting here..... Perhaps you and SG can hold a little cry fest?

I'll try the questions again. Are you trying to deny that ghettos exist in the U.S.? Are you trying to deny, that the babies born in the ghetto are bound to stay in the ghetto due to American policies from the past several décades? That these are the people that will benefit from the universal health care that you and your fellow teapublicans are so against? Isn't that a more true definition of classicism? You can afford health care, you can afford education, you can afford food, you can afford decent housing. Will you pay for any of the same things to be given to those that have less? Of course not...You and your party are nothing if not practioners of classicism...Again, what are you defining as being racist? The term ghetto?


----------



## SG_67

Pentheos said:


> Five posts to and from himself. Inner demons? Schizophrenia?
> 
> If we could diagnose a mental illness we could at least then understand his classicism, racism, and bigotry.


Indeed! It almost makes me feel bad rattling his cage.


----------



## justonemore

SG_67 said:


> Indeed! It almost makes me feel bad rattling his cage.


What was your reasoning in using a pedophile known for sleeping with young boys for your forum photo? Talk about creepy...Perhaps it's a bit telling?


----------



## Pentheos

justonemore said:


> What was your reasoning in using a pedophile known for sleeping with young boys for your forum photo? Talk about creepy...Perhaps it's a bit telling?


Quoted after the first edit. Add homophobia to classicism, racism, and general bigotry.


----------



## Pentheos

justonemore said:


> Ha. More insults. You got nothing else hero? That's ok. As a self important American, I understand you want to feel important to the other self important inflated Americans posting here..... Perhaps you and SG can hold a little cry fest?
> 
> I'll try the questions again. Are you trying to deny that ghettos exist in the U.S.? Are you trying to deny, that the babies born in the ghetto are bound to stay in the ghetto due to American policies from the past several décades? That these are the people that will benefit from the universal health care that you and your fellow teapublicans are so against? Isn't that a more true definition of classicism? You can afford health care, you can afford education, you can afford food, you can afford decent housing. Will you pay for any of the same things to be given to those that have less? Of course not...You and your party are nothing if not practioners of classicism...Again, what are you defining as being racist? The term ghetto?


Consider where I live as a barometer of my political inclinations. I am comfortable here. Anyone who said "ghetto baby" would be rightly ostracized here.

You have shown your true colors. I pity you. You pretend to be other than what you are. For someone in the mental healthcare industry, that's deeply disturbing. It's a pity your patients can't read what you post here. If they could, I doubt you'd have much business. You are a sick man.


----------



## justonemore

Pentheos said:


> Quoted after the first edit. Add homophobia to classicism, racism, and general bigotry.


Oh. So to you a pedophile is the same as a homosexual. Geeesh. It must be hard being you.


----------



## justonemore

Pentheos said:


> Quoted after the first edit. Add homophobia to classicism, racism, and general bigotry.


 I'm quite certain the homosexual community would disagee with you classifying them with pedophiles. The person pictured slept with underage boys. He would be spending his life in jail in the current day & age. Are you really defending a pedophile & a person that likes to use a pedophile as their member photo.


----------



## justonemore

Pentheos said:


> Consider where I live as a barometer of my political inclinations. I am comfortable here. Anyone who said "ghetto baby" would be rightly ostracized here.
> 
> You have shown your true colors. I pity you. You pretend to be other than what you are. For someone in the mental healthcare industry, that's deeply disturbing. It's a pity your patients can't read what you post here. If they could, I doubt you'd have much business. You are a sick man.


So where you live, the political inclination is to support pedophiles . Talk about sick. You actually think it's ok to have sex with children and are willing to support others that do? & i'm "homophobic" for not defending a child rapist? You are disgusting beyond the pale as is your buddy that uses the photo to promote his name on this site.


----------



## Earl of Ormonde

justonemore said:


> What was your reasoning in using a pedophile known for sleeping with young boys for your forum photo? Talk about creepy...Perhaps it's a bit telling?


J1M, I'm not taking sides in this argument, at all. 
The only reason I'm responding is to defend my fellow Irishman and fellow Londoner Oscar Wilde, a fantastic writer and a loving father of two sons. He was not a paedophile, nor was he known for it, that is just a huge lie. He was very far from it in fact, and to suggest such I find disgusting and distasteful.

He was bisexual and as such by law a criminal - a ********, a bugger, a paederast (paederast is an old word for homosexual and in some languages is the same word used for paedophile unfortunately. The word homosexual was not used to describe such "criminals" in the 19th century ) in a time when homosexuality was illegal, when it was rarely spoken about.

*Wilde had sex with a 21 year old man (Bosie) not with young boys as you incorrectly put it. 
*
His very dear friend and lover, "Bosie" *Lord Alfred Bruce Douglas* (22 October 1870 - 20 March 1945) *was 21 years old when he first met Wilde*.
It was Bosie's father that took Wilde to court, where he was convicted of "gross indecency" (the less shocking term used then for buggery/ sodomy) in 1895, (*when Bosie was 24)* and sent to prison for 2 years, and so released in 1897.

Where do you get this idea that he had sex with young boys?


----------



## justonemore

Odd enough that I've seen sources claiming wilde was a pedophile & got into troubles for having steady boyfriends aged 15 & 17. I seem to remember him being accused of molesting a boy as young as 12. All 3 ages would get him labeled as a pedophile in the u.s. I'm out & about at the moment but I'll try to post sources later tonight.


----------



## SG_67

^ yes of course you will. I'm sure you'll be able to find a few children with whom he actually did this with. 

You're arguments, as well as your disposition and logic are moronic.


----------



## immanuelrx

justonemore said:


> Well happy 4th to you as well. I hope you were careful with the fireworks. It's quite hard to type after blowing off a few fingers. I'm a bit shocked that fireworks aren't illegal in the whole of the U.S. by now. Back in my high school days they were already illegal in Illionis, and we had to go to Wisconsin or Indiana in order to obtain them (I do hope the statute of limitations for possessing illegal fireworks has run out after 25 years).
> 
> As for here, well we shoot off our fireworks on the 1st of August in honor of our "founding" in 1291. The fireworks guys come and set up their tents and we can get pretty much anything we want (even the big ones that sound like they could be used in démolitions).


Yea, after I almost lost an eye I decided to stop purchasing fireworks and let the pros do all the work for me.


----------



## justonemore

SG_67 said:


> ^ yes of course you will. I'm sure you'll be able to find a few children with whom he actually did this with.
> 
> You're arguments, as well as your disposition and logic are moronic.


As are you in everything you say & do. If I post the sources will you admit to being a fan of pedophiles?


----------



## SG_67

justonemore said:


> As are you in everything you say & do. If I post the sources will you admit to being a fan of pedophiles?


Whoah! What happened? I thought you were out and about; searching high and low for evidence!

Sure, just make sure you don't edit them as you edit your posts to sanitize your contempt for those not as fortunate.

You may post away, sir! Post your little heart out big boy!


----------



## Hitch

If you insist on feeding a troll stay off the bridge.


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## justonemore

Out & about means I'm not at home & have no real inclination to find links right now. My contempt is quite low to your mighty reasoning of only treating a few public aid patients because they just can't afford to pay you what you want. Your entire thinking is pay me or go away (unless they're one of the "lucky" few of course. Still no answer as to your ideas that the wealthy shouldn't have to help support the poor? More denial & avoidance on your part.


----------



## 32rollandrock

eagle2250 said:


> While it could be concluded from the referenced article in the OP, I don't think this point has been made in responses yet offered. Obamacare will never work because in the short time since it has been "rolled out," I have already absorbed two increases in my premiums and just a week or so back, received notice of a premium increase that will occur with the next policy year! In total, my healthcare premiums will have increased by just over 30% and there could be more increases yet to come! Sadly, the experience I report herein is not unique, but rather, pretty common. How much will the American public tolerate before they decide to restore some sense of reason to this fiasco?


Thanks for staying on point, Eagle. Yours is the sort of point I was trying to drive at in my original post. My own healthcare premiums have also gone up, and rather dramatically, in recent years. Next month, I will have to calculate how much to set aside in a flexible spending account and it comes to more than $1,000 and no shortage of tomfoolery paperwork--as an aside, every time I get something done, be it an eye exam or a teeth cleaning (neither of which is covered) I have to fax (fax!) a paper invoice into the company that runs the FSA for my company so that they can be certain that neither my dentist nor my ophthalmologist is selling me beer instead of providing healthcare services.

Twenty years ago, my FSA cost was zero. In fact, I don't believe that FSAs even existed. We once had the world's best healthcare system. That is no longer the case, and yet we are spending so much more than we once did on healthcare. I think that access has improved for poor people as Medicaid has expanded, and the wealthy can afford to take the hit. People in the middle--people like me--are suffering. We are the ones who put off going to the doctor for stuff because we can't afford it due to ever-escalating co-pays and deductibles. A butt scope is a good example. I'm not going to do it because I don't want to pay the $200 or $300 it would cost me out of pocket. Now, I could come up with the money, but I have other priorities, and I am already paying more than $1,000 out of pocket for healthcare each year, plus $2,400 for bare bones medical insurance. I don't care to divulge what I make here, but it is a (un)healthy percentage of my salary. And I don't see it getting any better until the system is truly reformed. Obamacare is a Band-Aid on a spurting artery, and I am tired of bleeding. That is why I am in favor of Medicare for everyone. Everyone I know who has Medicare likes it. Medicare does an excellent job of controlling costs. In short, this wheel has already been invented. I have difficulty believing that costs would increase, or increase substantially, if we gave Medicare to everyone and eliminated insurance companies, tax-free status for hospitals, FSA's, Taj Mahal hospital lobbies and rooms and duplicative services (there are at least three places where I can get butt scoped in the town where I live that has a total population of less than 120,000, and there are other butt scoping stations within easy driving distance).

Capitalism is a good thing, but it has not proven so in the field of healthcare. Now, if someone can come up with a better system than Medicare for everyone, I'm all ears. But don't go defending the system that we have now, because it is too expensive and inefficient, and provably so. And if you want to troll each other and otherwise behave like children, please start a new thread for that.


----------



## Earl of Ormonde

The thing is though 32RnR and Eagle, and correct me if I'm wrong, I believe are you paying your monthly healthcare fees into a private healthcare system, which of course will be dearer. 

In most of Europe, national insurance contributions for healthcare are taken from our wages at source from everyone and for everyone i.e. so that everyone pays into the central national fund for everyone's healthcare. 

Fairer and simpler.

This means that when I go to hospital in Sweden either for a consultation or an operation I pay a flat fee of about £20, as my monthly contributions cover the real cost, and that is the same for everyone. And once I hit £100 in visit fees,(as I did last week) I get a year free of hospital/clinic charges.


----------



## eagle2250

^^(in response to post 139)Your mention of the "Taj Mahal" medical facilities raises an interesting point. A surprising number of providers do not accept Medicare patients and are only obligated to do so under extenuating emergency situations. The same is true with regard to healthcare for military retirees. While my wife and I are covered by military health care/Tricare insurance, but I would have to drive approximately two and a half hours to get to a VA facility or four hours to get to an active duty base to receive care on a space available basis and my wife had to drive close to 45 miles each way to find a provider that accepted Tricare insurance. Consequently, we maintained the health insurance we carried during my civilian employment with the government. The unwillingness of providers to accept Medicare coverage is an issue that would need to be addressed, for your suggestion of universal medicare coverage to work as well as it should.

PS: Another point to be considered is the premium costs for medicare coverage. For the wife and I those costs total (or would total) just under $650 per quarter. Could people unable to afford private health insurance be able to afford medicare premiums?

Earl: As members of the social security age crowd, the wife and my overall medical costs average 12% to 14% of our gross income, depending on the year you might choose to consider.


----------



## eagle2250

justonemore said:


> Oh. just curious.. Is there a manner of filing a formal complaint against a new member with less than 4 months experience that resorts to personal insults against several senior members or is it a free for all here? I admit to not having read the rules recently...
> 
> To be exact, I have a problem with this guy calling me an "anti-semite" without backing it up and then following it up with this cr%p which is beyond the pale no matter any way you look at it...
> 
> "I'll say this and remain silent: you're disgusting, self righteous and someone I would likely stay away from in a social setting. In a nutshell, you're a creep.
> 
> As for whatever field of "healthcare" you're in, I'll guess you couldn't cut it here or you're what we call borderline quackery that running off to Europe where such alternative medical professions are more tolerated was you're only means of income."


Every member has the ability to report any post that they perceive to violate forum rules for participation, by clicking on the appropriate icon at the bottom of the post in question. Such reports are looked at by all moderators and forum administrators, up to and including Andy, himself. While posts to threads in the Interchange are subject to the rules for user participation, there is much latitude allowed in considering such posts and only on rare occasions has it become absolutely necessary to intervene. The insults, the name calling, and unsupported accusations appear pretty regularly in Interchange postings, coming from all directions. While many may suffer bruised Cyber-egos, there are few, in any, innocents in these exchanges. Were it solely up to me, I would shut down the Interchange entirely, as we have proven repeatedly that, as a group, we do not demonstrate the requisite maturity to handle such responsibility for our personal conduct. At the very least, my recommendation would be to apply the same standards for rules compliance to the Interchange that are applied to the other fora comprising AAAC. However, if such should happen, very few of the recent threads appearing in the Interchange would be left standing. I am reminded of that old saw, "if you can't run with the big dogs, stay on the porch and frankly there have been many occasions on which I have personally chosen to do just that!

The bottom line is, if you feel it necessary, report the offending post(s), but be prepared to accept the consequences.


----------



## Hitch

> Medicare does an excellent job of controlling costs. In short, this wheel has already been invented. I have difficulty believing that costs would increase, or increase substantially, if we gave Medicare to everyone and eliminated insurance companies, tax-free status for hospitals, FSA's, Taj Mahal hospital lobbies and rooms and duplicative services (there are at least three places where I can get butt scoped in the town where I live that has a total population of less than 120,000, and there are other butt scoping stations within easy driving distance).
> 
> Capitalism is a good thing, but it has not proven so in the field of healthcare.


That nasty capitalism gives consumers too many choices . This is like some idiot standing in a lake complaining about the excess of water.


----------



## SG_67

32rollandrock said:


> Thanks for staying on point, Eagle. Yours is the sort of point I was trying to drive at in my original post. My own healthcare premiums have also gone up, and rather dramatically, in recent years. Next month, I will have to calculate how much to set aside in a flexible spending account and it comes to more than $1,000 and no shortage of tomfoolery paperwork--as an aside, every time I get something done, be it an eye exam or a teeth cleaning (neither of which is covered) I have to fax (fax!) a paper invoice into the company that runs the FSA for my company so that they can be certain that neither my dentist nor my ophthalmologist is selling me beer instead of providing healthcare services.
> 
> Twenty years ago, my FSA cost was zero. In fact, I don't believe that FSAs even existed. We once had the world's best healthcare system. That is no longer the case, and yet we are spending so much more than we once did on healthcare. I think that access has improved for poor people as Medicaid has expanded, and the wealthy can afford to take the hit. People in the middle--people like me--are suffering. We are the ones who put off going to the doctor for stuff because we can't afford it due to ever-escalating co-pays and deductibles. A butt scope is a good example. I'm not going to do it because I don't want to pay the $200 or $300 it would cost me out of pocket. Now, I could come up with the money, but I have other priorities, and I am already paying more than $1,000 out of pocket for healthcare each year, plus $2,400 for bare bones medical insurance. I don't care to divulge what I make here, but it is a (un)healthy percentage of my salary. And I don't see it getting any better until the system is truly reformed. Obamacare is a Band-Aid on a spurting artery, and I am tired of bleeding. That is why I am in favor of Medicare for everyone. Everyone I know who has Medicare likes it. Medicare does an excellent job of controlling costs. In short, this wheel has already been invented. I have difficulty believing that costs would increase, or increase substantially, if we gave Medicare to everyone and eliminated insurance companies, tax-free status for hospitals, FSA's, Taj Mahal hospital lobbies and rooms and duplicative services (there are at least three places where I can get butt scoped in the town where I live that has a total population of less than 120,000, and there are other butt scoping stations within easy driving distance).
> 
> Capitalism is a good thing, but it has not proven so in the field of healthcare. Now, if someone can come up with a better system than Medicare for everyone, I'm all ears. But don't go defending the system that we have now, because it is too expensive and inefficient, and provably so. And if you want to troll each other and otherwise behave like children, please start a new thread for that.


Everyone who has Medicare likes it because there's no other option for those who have Medicare. I'm not denying that it's not necessary as the older population has a disproportionate need for medical services vs. the young. Medicare is still only a small part of our healthcare system and the reason it controls costs is because it's reimbursement rates are woefully low.

Most physicians will accept it knowing that they are not really making much money off of it and knowing too that private payers are a bigger part of the mix. The paperwork and compliance costs alone eat into any monies that can be collected.

Expand a system like that and you'll drive people out of medicine. If you want to see a 2 tiered system just wait until everyone has Medicare. Many of my colleagues have gone into concierge medicine. Larger groups are merging with hospitals in order to achieve a measure of scale that will allow them to stay afloat.

Our medical system, with all it's flaws, is like any other economic system that has grown and adapted to a particular set of drivers. What obamacare has done is come in and without any thought as to the delicacy is the system, turned it upside down.

When you think of it, there are no large scale epidemics. Every child gets vaccinated regardless of background. There's no polio, typhoid or diphtheria. Children don't get small pox or measles. In the poorest communities people have access to public health. No one is dying in the streets.

Poor people with chronic health problems are covered through Medicaid and receive healthcare. Ate there people who may be healthier or richer? Certainly. Are people turned away from hospitals because of lack of funds? No.


----------



## Mike Petrik

justonemore said:


> As are you in everything you say & do. If I post the sources will you admit to being a fan of pedophiles?


I'm confident that SG is no more a fan of pedophiles than is the Swiss government. https://www.swissinfo.ch/eng/polanski-will-not-be-extradited-to-the-us/15389712

My point is that it would be dishonest to use Switzerland's protection of Polanski to slur Switzerland, since there is no evidence whatsoever to suggest that its treatment of the man had anything to do with affection for or support of pederasty. Similarly, it is dishonest to slur SG 67 when there is no evidence whatsoever that suggests that his use of Wilde as an avatar has anything to do with an affection for or support of pederasty. These kinds of things are just below the belt cheap shots that do not advance intelligent discourse.


----------



## justonemore

Mike Petrik said:


> I'm confident that SG is no more a fan of pedophiles than is the Swiss government. https://www.swissinfo.ch/eng/polanski-will-not-be-extradited-to-the-us/15389712
> 
> My point is that it would be dishonest to use Switzerland's protection of Polanski to slur Switzerland, since there is no evidence whatsoever to suggest that its treatment of the man had anything to do with affection for or support of pederasty. Similarly, it is dishonest to slur SG 67 when there is no evidence whatsoever that suggests that his use of Wilde as an avatar has anything to do with an affection for or support of pederasty. These kinds of things are just below the belt cheap shots that do not advance intelligent discourse.


Ah well cheap shots deserve cheap shots. Have you read some of the [email protected] coming from this guy? Creep. Anti-semite. And the list goes on from there. One personal insult after the other. I have come to the conclusion intelligent discourse isn't possible with the guy so why bother trying. I thought Hitch was bad until sg came along & heck hitch almost seems normal next to this guy. If fight fire with fire I must. Then so I will. If he can call me an anti-semite with no proof at all, then I can assume he's into pedophilia based on his avatar. He doesn't worry about the truth. Why should I when dealing with him?


----------



## 32rollandrock

eagle2250 said:


> ^^(in response to post 139)Your mention of the "Taj Mahal" medical facilities raises an interesting point. A surprising number of providers do not accept Medicare patients and are only obligated to do so under extenuating emergency situations. The same is true with regard to healthcare for military retirees. While my wife and I are covered by military health care/Tricare insurance, but I would have to drive approximately two and a half hours to get to a VA facility or four hours to get to an active duty base to receive care on a space available basis and my wife had to drive close to 45 miles each way to find a provider that accepted Tricare insurance. Consequently, we maintained the health insurance we carried during my civilian employment with the government. The unwillingness of providers to accept Medicare coverage is an issue that would need to be addressed, for your suggestion of universal medicare coverage to work as well as it should.
> 
> PS: Another point to be considered is the premium costs for medicare coverage. *For the wife and I those costs total (or would total) just under $650 per quarter*. Could people unable to afford private health insurance be able to afford medicare premiums?
> 
> Earl: As members of the social security age crowd, the wife and my overall medical costs average 12% to 14% of our gross income, depending on the year you might choose to consider.


You and I are paying the same amount in premiums, then. But your wife is also covered. Mine is not for the $2,400 a year that I pay in premiums, and she pays considerably more than I do in premiums. I am guessing that you, by virtue of being retired, are older than I am, yet your premiums are lower. How does that make any sense?

I do not understand why VA hospitals exist. I believe that veterans should get the highest possible quality of care at no charge if their health issues are service related and at a steep discount if they are not (and thank you for your service, Eagle). I cannot see why this needs to be accomplished at veterans-only hospitals. Where I live, the government pays for shuttles to VA facilities. They will also pay mileage to reimburse for transportation costs. I live in a city with two major hospitals and one major outpatient provider, yet veterans are forced to take short buses to facilities more than 50 miles away to receive care. In some cases, veterans in Springfield must travel to Indianapolis to receive care, and the closest VA hospital is 130 miles away. I don't think that's fair to either veterans who must travel for hours or to taxpayers like me who are paying for this.


----------



## SG_67

^ In theory I understand the purpose of VA hospitals; veterans often present with unique medical conditions and it is good to have specialty centers who deal with such injuries. Conditions such as amputations, PTSD, TBI and other conditions that a local or smaller medical center may not be equipped to deal with. 

But as is the case, in practice we get the system we have now. A lumbering bureaucracy that neither serves it's intended customers, and far worse, mistreats them as has been shown.


----------



## 32rollandrock

SG_67 said:


> Everyone who has Medicare likes it because there's no other option for those who have Medicare. I'm not denying that it's not necessary as the older population has a disproportionate need for medical services vs. the young. Medicare is still only a small part of our healthcare system and the reason it controls costs is because it's reimbursement rates are woefully low.
> 
> Most physicians will accept it knowing that they are not really making much money off of it and knowing too that private payers are a bigger part of the mix. The paperwork and compliance costs alone eat into any monies that can be collected.
> 
> Expand a system like that and you'll drive people out of medicine. If you want to see a 2 tiered system just wait until everyone has Medicare. Many of my colleagues have gone into concierge medicine. Larger groups are merging with hospitals in order to achieve a measure of scale that will allow them to stay afloat.
> 
> *Our medical system, with all it's flaws, is like any other economic system that has grown and adapted to a particular set of drivers*. What obamacare has done is come in and without any thought as to the delicacy is the system, turned it upside down.
> 
> When you think of it, there are no large scale epidemics. Every child gets vaccinated regardless of background. There's no polio, typhoid or diphtheria. Children don't get small pox or measles. In the poorest communities people have access to public health. No one is dying in the streets.
> 
> Poor people with chronic health problems are covered through Medicaid and receive healthcare. Ate there people who may be healthier or richer? Certainly. Are people turned away from hospitals because of lack of funds? No.


You make some good points here.

In my perfect system, physicians would be on salary. There would not be a lot of bureaucratic paperwork because procedure-based reimbursement wouldn't exist, nor would there be private insurance companies that must find ways to deliver profit for stockholders. Physicians would be doctors, not businessmen, and if they want to be businessmen, then they can set up concierge practices. In my system, doctors would be well compensated, with salaries tied to years of experience and cost of living wherever they choose to practice. In Chicago, where you live, I'm thinking that a minimum salary of $250,000 or so for a primary care physician, but don't get hung up on numbers--we can talk about that. In no case would a physician make more than $500,000 a year, regardless of whether you are a neurosurgeon or a dermatologist (and yes, some specialties would pay more than others). Again, don't get hung up on numbers--we can talk about those. I don't know, frankly, what a neurosurgeon makes--a quick check of Bureau of Labor Statistics shows the average for a primary care MD in the U.S. is $220,000 and the average specialist makes $396,000. It's my belief that doctor salaries are not driving the outrageous escalation in health costs, it is other things that have nothing to do with care providers.

I confess that I have not thoroughly thought out malpractice insurance, but the goal would be to lower premiums by creating incentives to rid the system of substandard physicians who are responsible for the lion's share of lawsuits and big payouts. One idea: Instead of making individual physicians pay for insurance, bill entire work groups so that groups of physicians would be motivated to get rid of incompetent colleagues who are driving up premiums.

Lower drug costs by making drugs available over the counter. From Albuterol to Viagra to birth control pills, I see no reason why so many drugs with no potential for abuse require prescriptions, which drives up costs.

This is by no means a comprehensive to-do list, just a few ideas--a starting point, as it were. Would this amount to socialized medicine? In my perfect world, yes, because taxes would pay for it. I believe in capitalism, but when it comes to health care, capitalism has not worked and so I think that it is time to blow up the model and start from scratch. As you say, our medical system is an economic system that has grown and adapted to a particular set of drivers. I think that it should be a health care system first and economic system second, and that isn't possible the way things are now.


----------



## MaxBuck

SG_67 said:


> There's nothing broken about our healthcare system. It is robust and the best in the world. Access is nearly universal as it is and wait times are minimal. Physicians are paid well and if anything its the cost of malpractice insurance that is gobbling into profits.


Too many misstatements here to go unchallenged.

1. Healthcare for the employed and insured in the USA can be the best in the world. For the uninsured it's barely above third world standards. Obamacare was an attempt to close the gap between poor and well-off, but it's unlikely to work very well.

2. Malpractice insurance is not a major element of *most* medical costs, though it certainly is for OB/GYN services. A bigger part of the cost picture is risk-avoidance practices by physicians who fear being sued (and their fear relates more to reputation harm than to the actual payout costs in most cases). Another bigger part is administrative requirements associated with insurance coding, HIPAA, and federal reimbursement. Finally, the ridiculous overbuilding of hospital and therapeutic facilities (these things were once regulated) has led to wasted expenditures on high-cost machines that are seldom used and hospital beds that are seldom occupied.

The original plan put forth by the Heritage Foundation more than 25 years ago was substantially superior to the ACA in cost containment and in reducing administrative burdens to healthcare providers. Unfortunately the GOP, rather than engaging in the legislative process, elected to play the "just say no" game and screwed us all by failing to get any of their good thinking into the ACA.


----------



## 32rollandrock

MaxBuck said:


> Too many misstatements here to go unchallenged.
> 
> 1. Healthcare for the employed and insured in the USA can be the best in the world. For the uninsured it's barely above third world standards. Obamacare was an attempt to close the gap between poor and well-off, but it's unlikely to work very well.
> 
> 2. Malpractice insurance is not a major element of *most* medical costs, though it certainly is for OB/GYN services. A bigger part of the cost picture is risk-avoidance practices by physicians who fear being sued (and their fear relates more to reputation harm than to the actual payout costs in most cases). Another bigger part is administrative requirements associated with insurance coding, HIPAA, and federal reimbursement. Finally, the ridiculous overbuilding of hospital and therapeutic facilities (these things were once regulated) has led to wasted expenditures on high-cost machines that are seldom used and hospital beds that are seldom occupied.
> 
> The original plan put forth by the Heritage Foundation more than 25 years ago was substantially superior to the ACA in cost containment and in reducing administrative burdens to healthcare providers. Unfortunately the GOP, rather than engaging in the legislative process, elected to play the "just say no" game and screwed us all by failing to get any of their good thinking into the ACA.


Amen.


----------



## MaxBuck

eagle2250 said:


> While it could be concluded from the referenced article in the OP, I don't think this point has been made in responses yet offered. Obamacare will never work because in the short time since it has been "rolled out," I have already absorbed two increases in my premiums and just a week or so back, received notice of a premium increase that will occur with the next policy year! In total, my healthcare premiums will have increased by just over 30% and there could be more increases yet to come! Sadly, the experience I report herein is not unique, but rather, pretty common. How much will the American public tolerate before they decide to restore some sense of reason to this fiasco?


Blaming insurance premium increases on the ACA, especially when reported by people of your age and mine, Eagle, may be attributing blame to the wrong cause. As we get older, our insurance gets *much* more expensive. It's been that way for a long, long time.

Generally, projections are that short-term premiums for the currently insured should remain relatively unchanged relative to what they'd be without the ACA. However, insurance execs I know say that males age 55 and older should actually do better initially under the ACA because of limitations on pre-existing coverage adders and other factors. Younger people are expected to pay higher premiums than they'd have paid without the ACA. If your rates went up 30%, I'd recommend doing some comparison shopping.


----------



## MaxBuck

justonemore said:


> Ah well cheap shots deserve cheap shots.


The inability of both sides of this unseemly insult-fest to just accept stupid accusations and in-print raspberries as the ravings of a lunatic (which is the way my wife regards any less-than-positive remarks I might offer to her) has led to many unnecessary, boring and off-topic posts. Think of all the energy you're wasting in storing this pointless nonsense on Andy's portion of the cloud! Please, think before you post! Save the lemmings!!


----------



## SG_67

MaxBuck said:


> Too many misstatements here to go unchallenged.
> 
> 1. Healthcare for the employed and insured in the USA can be the best in the world. For the uninsured it's barely above third world standards. Obamacare was an attempt to close the gap between poor and well-off, but it's unlikely to work very well.
> 
> 2. Malpractice insurance is not a major element of *most* medical costs, though it certainly is for OB/GYN services. A bigger part of the cost picture is risk-avoidance practices by physicians who fear being sued (and their fear relates more to reputation harm than to the actual payout costs in most cases). Another bigger part is administrative requirements associated with insurance coding, HIPAA, and federal reimbursement. Finally, the ridiculous overbuilding of hospital and therapeutic facilities (these things were once regulated) has led to wasted expenditures on high-cost machines that are seldom used and hospital beds that are seldom occupied.
> 
> The original plan put forth by the Heritage Foundation more than 25 years ago was substantially superior to the ACA in cost containment and in reducing administrative burdens to healthcare providers. Unfortunately the GOP, rather than engaging in the legislative process, elected to play the "just say no" game and screwed us all by failing to get any of their good thinking into the ACA.


Without going into specifics about my salary, let's just say my insurance premiums are in the 6 figures. Perhaps in aggregate it's not a big cost, but to individual providers it's huge, and it's regional.

As for the politics of the ACA, this is what happens when politicians try to fix something. The fix is usually worse than the original system because why? Politicians will always put politics and their own job security ahead of anything else.

As for the healthcare the poor receive, if we are talking about public aid, I'm sorry but it's nothing like 3rd world medicine. I've seen 3rd world medicine and I'll tell you and those here on public aid receive healthcare services far and above superior to that.


----------



## MaxBuck

SG_67 said:


> Without going into specifics about my salary, let's just say my insurance premiums are in the 6 figures. Perhaps in aggregate it's not a big cost, but to individual providers it's huge, and it's regional.
> 
> As for the politics of the ACA, this is what happens when politicians try to fix something. The fix is usually worse than the original system because why? Politicians will always put politics and their own job security ahead of anything else.
> 
> As for the healthcare the poor receive, if we are talking about public aid, I'm sorry but it's nothing like 3rd world medicine. I've seen 3rd world medicine and I'll tell you and those here on public aid receive healthcare services far and above superior to that.


First, I understand that malprac is an individual matter, and that many providers have very high premiums. My point was relative to the overall picture of healthcare costs. I don't mean to suggest that individual docs aren't getting soaked.

Second, poor folks in some areas can get pretty good healthcare; I suspect Chicago and New York are among the best places for such care. But in many other areas (examples: Appalachia and parts of the Deep South) they certainly do not. And even when good healthcare is available, many times the poor are so poorly informed as to how to get it, it may as well not be available. Is that a result of their own failure to look hard enough? Maybe yes, maybe no. And the worst situation for healthcare often applies to the working poor -- those whose incomes don't allow them to qualify for Medicaid.

I'm not going to dispute your comment about our political system, except to say we have too g-d many laws and regulations, and I don't have good suggestions on how we can remedy that situation.


----------



## 32rollandrock

SG_67 said:


> Without going into specifics about my salary, let's just say my insurance premiums are in the 6 figures. Perhaps in aggregate it's not a big cost, but to individual providers it's huge, and it's regional.
> 
> As for the politics of the ACA, this is what happens when politicians try to fix something. The fix is usually worse than the original system because why? Politicians will always put politics and their own job security ahead of anything else.
> 
> As for the healthcare the poor receive, if we are talking about public aid, I'm sorry but it's nothing like 3rd world medicine. I've seen 3rd world medicine and I'll tell you and those here on public aid receive healthcare services far and above superior to that.


So, what do you think? We know that you think malpractice premiums are too large, but, that aside, do you think the system really works for patients and the public as opposed to physicians? Do you think that it works for physicians? If you could change something about the system, what would you change, why and how?


----------



## 32rollandrock

MaxBuck said:


> Blaming insurance premium increases on the ACA, especially when reported by people of your age and mine, Eagle, may be attributing blame to the wrong cause. As we get older, our insurance gets *much* more expensive. It's been that way for a long, long time.
> 
> Generally, projections are that short-term premiums for the currently insured should remain relatively unchanged relative to what they'd be without the ACA. However, insurance execs I know say that males age 55 and older should actually do better initially under the ACA because of limitations on pre-existing coverage adders and other factors. Younger people are expected to pay higher premiums than they'd have paid without the ACA. If your rates went up 30%, I'd recommend doing some comparison shopping.


It may get more expensive as people age, but, in my experience, that cost is largely borne by payers other than the insured. Eagle should be paying more than me for insurance because he is older, but he pays less.


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## SG_67

32rollandrock said:


> So, what do you think? We know that you think malpractice premiums are too large, but, that aside, do you think the system really works for patients and the public as opposed to physicians? Do you think that it works for physicians? If you could change something about the system, what would you change, why and how?


I've said this before, professionally and perhaps not here, that to reduce healthcare costs we need to make the true cost known to the customer. I'm a big fan of HSAs and allowing people to buy their own insurance.

I'm not necessarily opposed to giving people subsidies to buy insurance, my issue is with the bells and whistles these policies have to carry that will drive costs up.


----------



## 32rollandrock

SG_67 said:


> I've said this before, professionally and perhaps not here, that to reduce healthcare costs *we need to make the true cost known to the customer. * I'm a big fan of HSAs and allowing people to buy their own insurance.
> 
> I'm not necessarily opposed to giving people subsidies to buy insurance, my issue is with the bells and whistles these policies have to carry that will drive costs up.


Interesting. In the linked NYT series (really, it should be required reading for anyone concerned about the escalating cost of health care), there is an example of a pregnant woman who called ahead to inquire about the cost of childbirth. It wasn't her first rodeo--she'd had one or two other kids. It's been awhile since I read the article, but IIRC she was, after meeting with some resistance, given a range: $5,000 to $40,000. That was the best they could do.

That is part of the problem with health care, I think. It is treated as a money-is-no-object thing when, really, money is, or should be, a consideration, at least at some point. Now, if myself or a loved one has a serious, life-threatening medical condition or emergency, then money is, in fact, no object. But a butt scope? Or a routine physical? Or a few stitches to close a kitchen knife accident? This is the stuff that costs way, way, way more than it should. How do we control those costs? The true cost cannot possibly be anything close to what patients are charged.


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## eagle2250

32rollandrock said:


> It may get more expensive as people age, but, in my experience, that cost is largely borne by payers other than the insured. Eagle should be paying more than me for insurance because he is older, but he pays less.


Whoa!!! Rein in those runaway conclusions and rest assured, Eagle pays plenty for his and the wife's health insurance. LOL. How did you conclude that you pay more? Paying 12 to 14% of our annual income on healthcare costs represents a pretty sizable chunk of change (the actual figure of which I will keep to myself), but trust me, it helps on the Schedule A deductions, come tax time. We do spend more for the convenience of patronizing local healthcare providers, but during each years open season for healthcare insurance reviews and changes sponsored by OPM, I do very closely study my options and make decisions that hopefully yield the best healthcare values for us. As it stands, be happy...none of your taxpayer dollars are being spent to provide medicare coverage for me!


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## eagle2250

MaxBuck said:


> Blaming insurance premium increases on the ACA, especially when reported by people of your age and mine, Eagle, may be attributing blame to the wrong cause. As we get older, our insurance gets *much* more expensive. It's been that way for a long, long time.
> ..............................
> ...


I am not by any means a healthcare insurance expert, MaxBuck, but by maintaining the heal insurance coverage I enjoyed as a federal employee into retirement, I don't think my age has an impact on today's premium increases. Group rates continue to apply to retirees. At least in my case they seem to have carried over.


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## 32rollandrock

eagle2250 said:


> Whoa!!! Rein in those runaway conclusions and rest assured, Eagle pays plenty for his and the wife's health insurance. LOL. How did you conclude that you pay more? Paying 12 to 14% of our annual income on healthcare costs represents a pretty sizable chunk of change (the actual figure of which I will keep to myself), but trust me, it helps on the Schedule A deductions, come tax time. We do spend more for the convenience of patronizing local healthcare providers, but during each years open season for healthcare insurance reviews and changes sponsored by OPM, I do very closely study my options and make decisions that hopefully yield the best healthcare values for us. As it stands, be happy...none of your taxpayer dollars are being spent to provide medicare coverage for me!


I based that on your statement that your premium costs $650 per quarter for yourself and your wife. My premium is $2,400 per year and does not cover my spouse. I also have a hefty co-pay and deductible. I have no history of any significant health issues. I get my teeth cleaned four times a year (I pay for all of that myself), I need Advair and Albuterol for my asthma and that's about it. I suffered a severe ankle sprain late last year, but the insurer for the business with the defective parking lot that caused the injury (I tripped on uneven pavement) picked up my out-of-pocket expenses.

I could also say that my father, who has Medicare, has this year supplemented his coverage with a plan that costs $187 per month, with the bonus being that it allows him free reign in choosing physicians (he can go to whomever he wants, wherever he wants). He will be 81 in September. He is paying less for health care than I am--a lot less--and he has more money than I do.

As for whether my tax dollars are subsidizing your care, didn't you say that you get a tax deduction? If so, isn't there a subsidy of some sort somewhere along the line? Now, I have an FSA which, I suppose, also involves a subsidy. The problem, in my view, is subsidizing bloat. I do not mind so much paying for health care. I do mind, very much, paying for bureaucracy and profits for insurance companies and Taj Mahal hospitals and advertising for health care ("Come to our emergency room--it's the best!") and a lot of other things that have nothing to do with providing care to people who need it. In my view, we are subsidizing capitalism when it comes to health care, and that is ridiculous. I don't begrudge a nickel that SG makes (I presume that he is an honest guy as opposed to a fraudster, and there are some of those in the health care biz). He earns it. He helps people. I resent every penny that goes to an HMO.

At the end of the day, your figure of 12-14 percent of income devoted to health care is about where I'm at, and I think that that is too much for me (I don't know about you) considering my income. I resent having to scrimp on asthma drugs. I resent having to discuss alternatives to butt scopes with my doctor due to economics. Obamacare has addressed health care for a lot of people, but not people like me, and I think that there are a lot of people like me who have worked their entire lives and done what we can to be self-sustaining and yet remain a fickle chance away from fiscal disaster if an unforeseen medical issue arises. I'm sorry that I keep going back to this, but health care cost a whole lot less two decades ago and the quality of the system was better. How could we have gotten ourselves into such a mess?


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## Tilton

MaxBuck said:


> Second, poor folks in some areas can get pretty good healthcare; I suspect Chicago and New York are among the best places for such care. But in many other areas (examples: Appalachia and parts of the Deep South) they certainly do not. And even when good healthcare is available, many times the poor are so poorly informed as to how to get it, it may as well not be available. Is that a result of their own failure to look hard enough? Maybe yes, maybe no. And the worst situation for healthcare often applies to the working poor -- those whose incomes don't allow them to qualify for Medicaid.


Having lived deep in the heart of Appalachia (unquestionably the poorest area of the US) for over a decade and having traveled to three third world countries on medical missionary trips, I can tell you first hand that there is still absolutely no comparison between the two.


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## 32rollandrock

Tilton said:


> Having lived deep in the* heart of Appalachia (unquestionably the poorest area of the US*) for over a decade and having traveled to three third world countries on medical missionary trips, I can tell you first hand that there is still absolutely no comparison between the two.


Have you ever been to Brooklyn, IL? Or Sauget, IL, for that matter?


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## Pentheos

Even the worst healthcare in the US is still healthcare. Elsewhere, it is something far less, far more degrading, and far less restorative. Say you break your arm in the poorest county in the US. You may wait in the ER for a long time, and you may pay thousands out of pocket, but, in the end, you're healed. In some other godforsaken part of the world, you don't get treatment, your broken bone leads to an infection, and you either die or lose your limb.

No one is the US is turned out the door. Everyone is treated. Health is expensive. Be prepared to pay up. People should stop pretending that you should have low expenses with high service. Nothing else works that way.


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## eagle2250

32rollandrock said:


> I based that on your statement that your premium costs $650 per quarter for yourself and your wife. My premium is $2,400 per year and does not cover my spouse. I also have a hefty co-pay and deductible. I have no history of any significant health issues. I get my teeth cleaned four times a year (I pay for all of that myself), I need Advair and Albuterol for my asthma and that's about it. I suffered a severe ankle sprain late last year, but the insurer for the business with the defective parking lot that caused the injury (I tripped on uneven pavement) picked up my out-of-pocket expenses.
> .......................................
> ................


The $650 per quarter figure is not what we pay, but rather what we would have paid in medicare premiums if we had elected to go that route. That would have limited the number of local, easily accessible doctors willing to provide for our needs, just as going the military/military dependent healthcare route (VA, Base medical facilities on a space available basis, and Tricare Insurance) would also have imposed limitations on healthcare service delivery for us. The point I was making is that Medicare is not free...there are premiums incurred by those who elect the coverage! The monthly private group healthcare insurance we maintain costs us substantially more than you assume and we too pay required deductibles and co-payments for service received. Most of our eyecare is not covered and our annual insurance limit for dental care is $200 per person, well below the actual costs incurred. It all becomes a trade-off. Added convenience and/or range of coverage generally equals added costs to the consumer. Alas. it seems we are all victims, as well as beneficiaries of the healthcare industry!


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## SG_67

32rollandrock said:


> Have you ever been to Brooklyn, IL? Or Sauget, IL, for that matter?


I was part of a medical mission once to Cambodia. Between locations we came upon a bus accident with many victims. We stopped to render help and most people who were gathered around were more interested in trying to loot our baggage train.

When an ambulance finally did arrive, they wouldn't transport anyone unless they got paid first. We ended up paying them out of our own pockets in order to get these folks to a hospital.

People in this country don't have to worry about that. Even in the poorest parts of the country there is emergency medicine available locally. There are local medical clinics run either by charities, government or some joint effort to that effect. Does everyone have access to cutting edge big city medicine? Perhaps not but it's pretty darned close.

No hospital will turn someone away due to the inability to pay. That doesn't happen. Private practitioners will accept a number of charity cases and it's especially in the poorest areas where many healthcare advocates are trying to reach out to people.


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## justonemore

SG_67 said:


> No hospital will turn someone away due to the inability to pay. That doesn't happen.


Odd. Unless the wonderful dr. on duty (such as yourself I'm sure) deems it an "emergency", private hospitals in the U.S. have every right to away patients that can't pay. Are you sure it doesn't happen? "No hospital" follows such practices?


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## justonemore

SG_67 said:


> I
> When an ambulance finally did arrive, they wouldn't transport anyone unless they got paid first. We ended up paying them out of our own pockets in order to get these folks to a hospital.
> 
> .


Did you and your fellow good hearted travelers end up paying out of Pocket the same as you would in Chicago?

Thje following is from ....https://www.cityofchicago.org/city/en/depts/fin/supp_info/revenue/ambulance_bills.html

If you are not covered by medical insurance, please pay the bill. Send check or money order with your account number to:

Or contact customer service at (877) 987-2083 to make payment arrangements:
*What are the fees for ambulance service?*
Basic life support: $900.00
Advanced life support: $1,050.00
Advanced life support II: $1,200.00
Oxygen: $25.00 (regardless of the amount)
Mileage*: $17.00 per mile
An additional fee of $100.00 shall be assessed for individuals who are not a resident of Chicago.


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## justonemore

SG_67 said:


> I was part of a medical mission once to Cambodia. Between locations we came upon a bus accident with many victims. We stopped to render help and most people who were gathered around were more interested in trying to loot our baggage train.
> 
> .


Is your disdain for the cambodians somewhat like this story out of the U.S.?

https://7online.com/archive/8647305/


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## Chouan

Pentheos said:


> Even the worst healthcare in the US is still healthcare. Elsewhere, it is something far less, far more degrading, and far less restorative. Say you break your arm in the poorest county in the US. You may wait in the ER for a long time, and you may pay thousands out of pocket, but, in the end, you're healed. In some other godforsaken part of the world, you don't get treatment, your broken bone leads to an infection, and you either die or lose your limb.
> 
> No one is the US is turned out the door. Everyone is treated. Health is expensive. Be prepared to pay up. People should stop pretending that you should have low expenses with high service. Nothing else works that way.


You seem to be generalising somewhat when you say "*elsewhere*". The fact is that in most Western European countries, state organised health care is both effective and affordable to all. Yet it seems that the majority of American members here seem to disregard that truth, seeming to think that there are only two alternatives, that of the American system, or that of the Third World. This appears as if the very efficient European Health Care systems funded by mandatory National Insurance payments taken, along with taxation, from source, doesn't exist in American eyes.
There have been some very bitter exchanges in this thread, but no acknowledgement at all that the various National Health schemes in Western Europe provide the kind of good quality health care that the title of this thread appears to suggest is impossible. The evidence is there in front of you all, yet the majority of you appear to be pretending that it doesn't exist!


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## justonemore

Pentheos said:


> No one is the US is turned out the door. Everyone is treated. Health is expensive. Be prepared to pay up. People should stop pretending that you should have low expenses with high service. Nothing else works that way.


Hmmm.. According to this article, your claim just isn't true... https://www.scu.edu/ethics/publications/iie/v1n4/healthy.html

"In Alameda County, a private hospital turned away a woman in labor because the hospital's computer showed that she didn't have insurance. Hours later, her baby was born dead in a county hospital.

In San Bernardino, a hospital surgeon sent a patient who had been stabbed in the heart to a county medical center after examining him and declaring his condition stable. The patient arrived at the county medical center moribund, suffered a cardiac arrest, and died. 
These two hospitals shifted these patients to county facilities not for medical reasons, but for economic ones -- the receiving hospitals feared they wouldn't be paid for treating the patient. These patients simply weren't "good business."


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## justonemore

Chouan said:


> You seem to be generalising somewhat when you say "*elsewhere*". The fact is that in most Western European countries, state organised health care is both effective and affordable to all. Yet it seems that the majority of American members here seem to disregard that truth, seeming to think that there are only two alternatives, that of the American system, or that of the Third World. This appears as if the very efficient European Health Care systems funded by mandatory National Insurance payments taken, along with taxation, from source, doesn't exist in American eyes.
> There have been some very bitter exchanges in this thread, but no acknowledgement at all that the various National Health schemes in Western Europe provide the kind of good quality health care that the title of this thread appears to suggest is impossible. The evidence is there in front of you all, yet the majority of you appear to be pretending that it doesn't exist!


Yep. It's quite often the American way. "If you don't like the U.S., you can move to Iraq (or North Korea, or Cambodia, or etc. etc)". There is never anything better or equal...It's always the U.S. or the worst case scenario...


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## Chouan

SG_67 said:


> There's nothing broken about our healthcare system. It is robust and the best in the world. Access is nearly universal as it is and wait times are minimal. Physicians are paid well and if anything its the cost of malpractice insurance that is gobbling into profits.


There is some interesting stuff here

especially regarding America's contribution to the development of science and technology

https://www.goodcountry.org/category/science-technology


----------



## justonemore

SG_67 said:


> I'm not necessarily opposed to giving people subsidies to buy insurance, my issue is with the bells and whistles these policies have to carry that will drive costs up.


(As a medical pro?) can you explain some of the "bells and whistles" that you mention? Especially when it comes down to the health and well being of a fellow American (or actually any person in general)?

"I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witness, that I will fulfill according to my ability and judgment this oath and this covenant...I will apply...(treatment) for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice."

-*Hippocratic oath

*Perhaps as you don't believe in "gods and goddesses" you feel this shouldn't actually be applied to the U.S. medical system?


----------



## justonemore

SG_67 said:


> .
> 
> No hospital will turn someone away due to the inability to pay. That doesn't happen. Private practitioners will accept a number of charity cases and it's especially in the poorest areas where many healthcare advocates are trying to reach out to people.


A bit more that seems to contradict your theory that turning away the poor doesn't happen in the U.S.....

Ohhh...As I find articles, I will add then add them into this post(edit them into the post) instead of starting a new one. I do hope you won't cry too much..........

https://www.medicalnewstoday.com/articles/248854.php

Edit to add this article....https://www.fiercehealthcare.com/story/3-hospitals-cited-turning-away-er-patients/2012-04-23

edit to add this article...

Edit to add this article....https://www.dailypaul.com/309216/ho...her-their-obamacare-insurance-plans-are-in-ef

Here's one close to home for you....

And another example....

Can you admit to faulty reasoning or are you still going to claim "it doesn't happen"? All that with 30 minutes of searching the internet.. Or do you need more to prove your ignorance?


----------



## justonemore

SG_67 said:


> .
> 
> When an ambulance finally did arrive, they wouldn't transport anyone unless they got paid first. We ended up paying them out of our own pockets in order to get these folks to a hospital. People in this country don't have to worry about that. .


Hmm. It seems that this article here contradicts you once again....

https://www.kaiserhealthnews.org/st...-demand-payment-upfront-from-er-patients.aspx


----------



## justonemore

And to add to all of this.... Several years ago I was studying in London. I had an emergency situation that forced me to go to one of the public hospitals... I was treated respectfully, within a reasonable time, and it cost me....Nothing. Nothing at all. I offered cash up front and after service but was denied each time. After the fact I donated money to the NHS beyond the costs, but it was quite an eye opener for an American. No questions asked, come in, get healthy, go home... And Americans have the B*lls to think they know best in all situations...


----------



## justonemore

SG_67 said:


> I've said this before, professionally and perhaps not here, that to reduce healthcare costs we need to make the true cost known to the customer. I'm a big fan of HSAs and allowing people to buy their own insurance.
> .


So knowing the cost will prevent me from using health services while having a heart attack? What exactly is your point here? To reduce costs to the national health service, you need univeral health care. Everyone is insured and therefore no one is denied treatment. The biggest costs in the American health care system come from those that are uninsured or indigent (is that a better term for you than what I used before? It does at least sound prettier compared to facing the reality that the ghettos and trailer parks need to be included equally in American society). You yourself have claimed that you refuse to treat more than a few "Lucky" poor patients due to profit.. What a great system you have...


----------



## justonemore

Chouan said:


> There is some interesting stuff here
> 
> especially regarding America's contribution to the development of science and technology


The U.S. ranked below # 20 once again? Really? What type of lies will Penteos and SG now make up in order to protect their prior assertions? Perhaps they can quote us a fox news article that proves otherwise??


----------



## SG_67

justonemore said:


> A bit more that seems to contradict your theory that turning away the poor doesn't happen in the U.S.....
> 
> Ohhh...As I find articles, I will add then add them into this post(edit them into the post) instead of starting a new one. I do hope you won't cry too much..........
> 
> https://www.medicalnewstoday.com/articles/248854.php
> 
> Edit to add this article....https://www.fiercehealthcare.com/story/3-hospitals-cited-turning-away-er-patients/2012-04-23
> 
> edit to add this article...
> 
> Edit to add this article....https://www.dailypaul.com/309216/ho...her-their-obamacare-insurance-plans-are-in-ef
> 
> Here's one close to home for you....
> 
> And another example....
> 
> Can you admit to faulty reasoning or are you still going to claim "it doesn't happen"? All that with 30 minutes of searching the internet.. Or do you need more to prove your ignorance?


You've cited a few examples where the institutions in question have been sued or fined.

In as large and complex a system as our healthcare system is, such things are going to happen. By the way, when when our current 1st lady was chief counsel of the UC medical center, she oversaw the hospitals patient dumping scheme.

Millions of people daily are admitted to ERs around our country. As for charging people for routine care at an ER, that makes sense since they should be utilized for emergent cases and not for routine care. Emergency rooms are not money makers for hospitals so the resources must be used for the intended purpose.

I'm sure if I had the time or inclination to do a search, I would find nightmares scenarios from countries with NHSs but I'm sitting in a park watching the squirrels frolic, and frankly it's more entertaining.

If you want a glimpse into how an NHS will fare in this country, just look at the VA. It can't be sued, it has no incentive to be efficient and it's understaffed and underfunded.

Your example of going into a London hospital is great! And I'm sure a vet can just as easily go into a VA hospital and get served and treated efficiently at no cost to him/her.

Since we're citing online sources, here are a few:
https://www.dailymail.co.uk/health/...ment-elderly-mans-chilling-story-reveals.html

And another:

https://www.dailymail.co.uk/news/ar...-patients-times-likely-operations-others.html

And another:

https://www.express.co.uk/life-styl...re-too-old-in-new-attack-on-Britain-s-elderly

https://www.ldascotland.org/index.p...denied-care-to-man-with-learning-disabilities

https://www.theguardian.com/society/2012/oct/15/nhs-cancer-joints-surgery-age-discrimination

We could go back and forth all day on this and in the end it's meaningless. Citing online sources does not substitute or relevant discussion and in my experience is used as a proxy for real analysis by those who haven't a clue as to what they're talking about.


----------



## justonemore

And so... Will Obamacare in the first draft work? heck no. What in the first iteration has ever worked? It takes time and fine tuning. You'll have plenty of crybabys that wish to ignore the extra expense to their pockets (at the expense of fellow citizens of course), you'll have pros that don't like that their income might be diminished a bit (medical school is expensive, too bad the teapubs don't advocate cheaper schooling over higher societal medical costs). Heck, it might take a few years to admit that someone with terminal cancer is going to die versus keeeping them on life support (at the expense of society) for 20 years. Anything new will take time to perfect, but it can indeed be done. Just look at Europe... They not spend $trillion per year on killing muslims, but they do support the people that reside there. The $billions per year spent on Israel could probably go to help your fellow citizens compared to helping Israel reverse engineer our technology and sell it to the Chinese at profit. Here in Switzerland, we have no concern as to "rich or poor"..We have mandatory universal health insurance. Our medical system is better and more regulated than anything coming out of the U.S. The true bigots deny health care to the poor for profit. "I don't want to pay, but I want to be paid"... As per SG's statements, Money is the only reason for practicing in the U.S. What type of a a racist, bigoted country in general would allow that only thew well off get the best health care? What type of racist and bigoted Dr. would support such a system? Certainly not one interested in profit over médicine itself...


----------



## justonemore

SG_67 said:


> You've cited a few examples where the institutions in question have been sued or fined.
> 
> In as large and complex a system as our healthcare system is, such things are going to happen. By the way, when when our current 1st lady was chief counsel of the UC medical center, she oversaw the hospitals patient dumping scheme.
> 
> Millions of people daily are admitted to ERs around our country. As for charging people for routine care at an ER, that makes sense since they should be utilized for emergent cases and not for routine care. Emergency rooms are not money makers for hospitals so the resources must be used for the intended purpose.
> 
> I'm sure if I had the time or inclination to do a search, I would find nightmares scenarios from countries with NHSs but I'm sitting in a park watching the squirrels frolic, and frankly it's more entertaining.
> 
> If you want a glimpse into how an NHS will fare in this country, just look at the VA. It can't be sued, it has no incentive to be efficient and it's understaffed and underfunded.
> 
> Your example of going into a London hospital is great! And I'm sure a vet can just as easily go into a VA hospital and get served and treated efficiently at no cost to him/her.
> 
> Since we're citing online sources, here are a few:
> https://www.dailymail.co.uk/health/...ment-elderly-mans-chilling-story-reveals.html
> 
> And another:
> 
> https://www.dailymail.co.uk/news/ar...-patients-times-likely-operations-others.html
> 
> And another:
> 
> https://www.express.co.uk/life-styl...re-too-old-in-new-attack-on-Britain-s-elderly
> 
> https://www.ldascotland.org/index.p...denied-care-to-man-with-learning-disabilities
> 
> https://www.theguardian.com/society/2012/oct/15/nhs-cancer-joints-surgery-age-discrimination
> 
> We could go back and forth all day on this and in the end it's meaningless. Citing online sources does not substitute or relevant discussion and in my experience is used as a proxy for real analysis by those who haven't a clue as to what they're talking about.


Ok.- Your quote was "0"... I gave at least 10 examples... I would hope you know that 10 is greater than 0.. Or no?

WARNING EDIT::: 
Do you deny your quote? 
"No hospital will turn someone away due to the inability to pay. That doesn't happen"..

From post #167 by SG


----------



## justonemore

MaxBuck said:


> It's unrealistic to think that economics won't enter into healthcare decisions, whether in the USA or in Switzerland.


Nope. Not here. People are treated as they come in. The public hospitals are the "FIRST" line of medical care, not the private. A private hospital will only move patients when they are not capable of handling the situation.


----------



## justonemore

MaxBuck said:


> You've conflated a good many different influences here. The fact that patients are moved to facilities where the management will actually be paid for their care is understandable. The pregnant woman could have contacted medical centers to determine where she could be treated, but elected instead to show up on a hospital's doorstep unannounced. She's culpable; it's not appropriate to let patients off the hook when they've failed to do any level of due diligence for themselves.
> 
> As for the unfortunate man who was stabbed, apparently his condition was such that he was deemed safe to transport. Sometimes such evaluations are imperfect, and sometimes things just change with respect to a patient's condition.
> 
> It's unrealistic to think that economics won't enter into healthcare decisions, whether in the USA or in Switzerland.


Oh. and the advatage of Universal health care here is that there are no economical décisions as to health care. We all have equal rights Under the law. The rich and the poor deserve the same Heath care. Private insurance allows that minor problems can be treated in a private hospital where there is less of a bed count, a nicer looking room, and better meals. Private insurance is considered more of a luxury compared to a health care mandate. As stated previously, my family carries "private" insurance". We can go have the enjoyment of a nice meal and a private (semi-private in my case compared to my wife and daughters) room. The medical care is decent but once again... Not in line with the the University hospitals. Just as an example. My wife had problrms during her pregnancy...She went to the private hospital... They quickly transfered her to the experts at the public level. Public meaning that all of Switzerland pays for the services. I am more than happy that such a system exists. I.E. I will pay $10'000 for the public system and another 5'000 for the private but I will always demand that anything serious be given to the public hospitals. This includes everyone. There is no boo hooing here as to "geesh..I'm such a great guy because I take 3 public aid patients". Everyone is covered and everyone has equal rights. The true bigots in my thoughts (and that was my point the other day) are those that whine about not making enough cash off of the poor while crying about supporting a sytem that covers everyone (thus eliminating the "ghetto babies and trailor trash". My point is that the whole U.S. system has been biased against these folks for décades and refuses to move beyond such.... Sorry but I don't buy into the..."ooohh. I treat a few public aid people a year and therefore I'm an American hero" line of BS.


----------



## justonemore

And the worst of it all is that people like SG support spending $billions per year giving welfare dollars to Irael over taking care of fellow Americans. What a bunch of Cr*p. This guy hst spent a perhaps a minute of his time to support his actual society in its medical needs compared to crying that some far off idiots deserve 500 times of such of our tax money. No doubt whatsoever that he never spent a minute thinking of his true compatriots over those that he desires to be so. American money should be spent on Americans and American problems. Lack of support of such ideologies shows nothing but contempt for those that you leech off of.

Warning edit... I don't care what the current first lady says. Nor do I care what the previous ones had to say. Reality is reality versus politics. I have been able to vote for the past 25 years and have found not a single politician Worth voting for. Their wives are just as worthless no matter the "political affiliation"


----------



## justonemore

SG... Can you actually respond to any of the questions? My main thought is.. Did you pay $2'000 in cash out of Pocket (as is standard in Chicago) for ambulance servis in Camobodia or was it more like $20??? Can you not perhaps put it in a better perspective?


----------



## Dmontez

Does anyone know if there is a way to have the Interchange, not show up, when I click on "whats new" I am sick and tired of seeing grown men fight like children.


----------



## justonemore

SG_67 said:


> You've cited a few examples where the institutions in question have been sued or fined.
> 
> In as large and complex a system as our healthcare system is, such things are going to happen. By the way, when when our current 1st lady was chief counsel of the UC medical center, she oversaw the hospitals patient dumping scheme.
> 
> Millions of people daily are admitted to ERs around our country. As for charging people for routine care at an ER, that makes sense since they should be utilized for emergent cases and not for routine care. Emergency rooms are not money makers for hospitals so the resources must be used for the intended purpose.
> 
> I'm sure if I had the time or inclination to do a search, I would find nightmares scenarios from countries with NHSs but I'm sitting in a park watching the squirrels frolic, and frankly it's more entertaining.
> 
> If you want a glimpse into how an NHS will fare in this country, just look at the VA. It can't be sued, it has no incentive to be efficient and it's understaffed and underfunded.
> 
> Your example of going into a London hospital is great! And I'm sure a vet can just as easily go into a VA hospital and get served and treated efficiently at no cost to him/her.
> 
> Since we're citing online sources, here are a few:
> https://www.dailymail.co.uk/health/...ment-elderly-mans-chilling-story-reveals.html
> 
> And another:
> 
> https://www.dailymail.co.uk/news/ar...-patients-times-likely-operations-others.html
> 
> And another:
> 
> https://www.express.co.uk/life-styl...re-too-old-in-new-attack-on-Britain-s-elderly
> 
> https://www.ldascotland.org/index.p...denied-care-to-man-with-learning-disabilities
> 
> https://www.theguardian.com/society/2012/oct/15/nhs-cancer-joints-surgery-age-discrimination
> 
> We could go back and forth all day on this and in the end it's meaningless. Citing online sources does not substitute or relevant discussion and in my experience is used as a proxy for real analysis by those who haven't a clue as to what they're talking about.


Ooofff. As as a vet... I needed to actually provide documentation as to such when going to a VA hospital. The process was quite prohibitive and denial was always there to remind me that my service was less respected compared to that of others. While I agree that the VA needs to change a bit, it still is there for those that have done more than you "leeches" that expect everyone to pay in "cash" value for your freeedom and that of sh*t countries that don't desreve U.S. taxpayer dollars


----------



## justonemore

Dmontez said:


> Does anyone know if there is a way to have the Interchange, not show up, when I click on "whats new" I am sick and tired of seeing grown men fight like children.


Ummm,. Not coming to the interchange might be a start. It seems that most people here are quite happy with an arguement. Should you fell different, it is simply a matter of staying in the "fasihon forum"... Go where you want and allow the rest of us to debate as we like...


----------



## Dmontez

justonemore said:


> Ummm,. Not coming to the interchange might be a start. It seems that most people here are quite happy with an arguement. Should you fell different, it is simply a matter of staying in the "fasihon forum"... Go where you want and allow the rest of us to debate as we like...


J1M, since I enjoy both the fashion, and trad forums, what I do is use the "whats new" button which shows me all new posts regardless of what forum its from. I was simply wondering if there is a way to exclude the interchange from that. When I use the "whats new" option on my computer it gives me the first few lines of whatever nonsense is going on in this part of the forum, so you see the only reason I came to the interchange was to ask the question, how do I keep from getting the interchange from showing up in my "feed"


----------



## justonemore

Dmontez said:


> J1M, since I enjoy both the fashion, and trad forums, what I do is use the "whats new" button which shows me all new posts regardless of what forum its from. I was simply wondering if there is a way to exclude the interchange from that. When I use the "whats new" option on my computer it gives me the first few lines of whatever nonsense is going on in this part of the forum, so you see the only reason I came to the interchange was to ask the question, how do I keep from getting the interchange from showing up in my "feed"


Umm. ignore what you don't like??? I despise many points of view here and have decided to counter them. No one has asked you to do the same. Take your point of view and explain it within anything considered as a reasonable circumstance.


----------



## MaxBuck

justonemore said:


> Nope. Not here.


If you believe that economics has no impact on Swiss healthcare, you're even more naive than I'd thought. Economics has an impact on *everything.* The impacts may not be evident to the outside observer, but they're there. I'm not going to dispute your commentary on quality of care in Switzerland; I have no direct knowledge of the situation there, but I'll accept your characterization of it as being excellent.

Look, we get that you have found your Nirvana in Switzerland, and I'm not here to try to burst your bubble. I'm glad you like the place so well. But your continual attempts to bash the USA are extremely tiresome and suggestive of a need for psychoanalysis to find the root cause of your hatred of your birthplace. I think you'd be happier if you could resolve those issues. And I mean that sincerely.


----------



## MaxBuck

justonemore said:


> Oh. and the advatage of Universal health care here is that there are no economical décisions as to health care. We all have equal rights Under the law. The rich and the poor deserve the same Heath care. Private insurance allows that minor problems can be treated in a private hospital where there is less of a bed count, a nicer looking room, and better meals. Private insurance is considered more of a luxury compared to a health care mandate. As stated previously, my family carries "private" insurance". We can go have the enjoyment of a nice meal and a private (semi-private in my case compared to my wife and daughters) room. The medical care is decent but once again... Not in line with the the University hospitals. Just as an example. My wife had problrms during her pregnancy...She went to the private hospital... They quickly transfered her to the experts at the public level. Public meaning that all of Switzerland pays for the services. I am more than happy that such a system exists. I.E. I will pay $10'000 for the public system and another 5'000 for the private but I will always demand that anything serious be given to the public hospitals. This includes everyone. There is no boo hooing here as to "geesh..I'm such a great guy because I take 3 public aid patients". Everyone is covered and everyone has equal rights. The true bigots in my thoughts (and that was my point the other day) are those that whine about not making enough cash off of the poor while crying about supporting a sytem that covers everyone (thus eliminating the "ghetto babies and trailor trash". My point is that the whole U.S. system has been biased against these folks for décades and refuses to move beyond such.... Sorry but I don't buy into the..."ooohh. I treat a few public aid people a year and therefore I'm an American hero" line of BS.


I deleted my post for a reason. Can this "refutation" similarly be removed by moderators?


----------



## SG_67

justonemore said:


> SG... Can you actually respond to any of the questions? My main thought is.. Did you pay $2'000 in cash out of Pocket (as is standard in Chicago) for ambulance servis in Camobodia or was it more like $20??? Can you not perhaps put it in a better perspective?


I would be glad to respond if you were somehow able to string together more than a few coherent thoughts.

As to your question regarding the cost of the ambulance, what does it matter?

And just so you know, no it wasn't $2000 but rather hundreds, which came out of the few dollars we had with us and our petty cash. When traveling in a 3rd world country I don't make it a habit of carrying large sums of hard currency. Especially seeing as how I'm not there to shop.


----------



## justonemore

MaxBuck said:


> If you believe that economics has no impact on Swiss healthcare, you're even more naive than I'd thought. Economics has an impact on *everything.* The impacts may not be evident to the outside observer, but they're there. I'm not going to dispute your commentary on quality of care in Switzerland; I have no direct knowledge of the situation there, but I'll accept your characterization of it as being excellent.
> 
> Look, we get that you have found your Nirvana in Switzerland, and I'm not here to try to burst your bubble. I'm glad you like the place so well. But your continual attempts to bash the USA are extremely tiresome and suggestive of a need for psychoanalysis to find the root cause of your hatred of your birthplace. I think you'd be happier if you could resolve those issues. And I mean that sincerely.


And as a true American patriot, I would love to think your thoughts as correct. I mean that much more than sincerely. Shouold the U.S ever be number 1, I would love it. I don't "bash" the U.S. over the U.S. bashing itself. I am an American. I have served in the American Army..I spent 5 years as a "public servant".. .Have you? Can you give an example as to your serving your society? I have no "hatred" as to my "birthpalce" and your assertion is less than realisticic compared to what I have done for the U.S. Not only do I have my Army service, but I was a firefighter for 3 years that was paid liittle to nothing for helping out those in trouble. Can you or any of your teapublicans friends claim likewise?


----------



## Hitch

Dmontez said:


> J1M, since I enjoy both the fashion, and trad forums, what I do is use the "whats new" button which shows me all new posts regardless of what forum its from. I was simply wondering if there is a way to exclude the interchange from that. When I use the "whats new" option on my computer it gives me the first few lines of whatever nonsense is going on in this part of the forum, so you see the only reason I came to the interchange was to ask the question, how do I keep from getting the interchange from showing up in my "feed"


Try the 'new posts' tab.


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## Hitch

Obama Care may very well work. If it does it will follow the principle the contrarian economic reality. The typical response to a failed government enterprise is ,after all, expansion.


----------



## justonemore

SG_67 said:


> I would be glad to respond if you were somehow able to string together more than a few coherent thoughts.
> 
> As to your question regarding the cost of the ambulance, what does it matter?
> 
> And just so you know, no it wasn't $2000 but rather hundreds, which came out of the few dollars we had with us and our petty cash. When traveling in a 3rd world country I don't make it a habit of carrying large sums of hard currency. Especially seeing as how I'm not there to shop.


Oh. so you're not quite the jésus figure you made youself out to be? a few hundred is not quite the figure you like compared to a few thousand for Chicago... Indeed you are quite the humanitarian. I still prefer medical care in Slovakia over anything you might be able to offer.


----------



## justonemore

justonemore said:


> Oh. so you're not quite the jésus figure you made youself out to be? a few hundred is not quite the figure you like compared to a few thousand for Chicago... Indeed you are quite the humanitarian. I still prefer medical care in Slovakia over anything you might be able to offer.


Oops sorry...You went on a trip to a 3rd worlsd country..Does that have anything to do with science or the medical community? Or is it more of a "feel good" religious trip?


----------



## justonemore

MaxBuck said:


> I deleted my post for a reason. Can this "refutation" similarly be removed by moderators?


OOps. Hoping to have the mods delete your biases? Why not just take responsibility for your viewpoints and continue in the arguement?


----------



## MaxBuck

justonemore said:


> OOps. Hoping to have the mods delete your biases? Why not just take responsibility for your viewpoints and continue in the arguement?


I've in the past encountered people as obsessive as you, but none who had yet to be institutionalized.


----------



## MaxBuck

Hitch said:


> Try the 'new posts' tab.


OT, but thanks! I hadn't tried that feature of the site before.


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## justonemore

Hitch said:


> Obama Care may very well work. If it does it will follow the principle the contrarian economic reality. The typical response to a failed government enterprise is ,after all, expansion.


Yes. It works for all of Europe but obviously it can't for those in the U.S. And your little buddies such as Hitch, SG, and Penteos, call me a bigot.... Pay into the system, admit that all are equal and I might start listening to your cryinging ...booo hoo...


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## SG_67

Does anyone have their copy of DSM V handy?


----------



## justonemore

SG_67 said:


> Does anyone have their copy of DSM V handy?


Which version do you prefer? I have several to include those that would consider you as being worthy of being hospitaliised.


----------



## justonemore

justonemore said:


> Which version do you prefer? I have several to include those that would consider you as being worthy of being hospitaliised.


Ooops . I just noticed the "v".. .What do you want me to look up?


----------



## justonemore

Can any of you teapublicans show any service to your country or are or only full of "words"? anything? just a bit of service? Beyond taking a few poor people as clients? Anything? Anything at all? or are you all just a bunch of talkers? Tilton...You liked to claim how great America is at serving immigrants compared to Switzerland... Any comment s to the 40'000 children forced into a small area in Texas? SG.. Can you claim anything more than the basics? MAxBuck..Can you provide anything more than basic insults? It seems to me that that you and your followers have nothing left but personal insults... Can you folks not provide any actual debate or should we dismiss you as needeed


----------



## justonemore

No logic over obvious personal insults.... Need I really show that SG favors child molestation due to his favored member photo? And his little Buddy Penteous has already shown that he thinks homosexuality as equal to being a pedpophile


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## justonemore

Oh. Just one article showing the pedophila that SG seems to take as herorism. (not to mention pentheous thinking it's ok).... I may be a socialist but I still don't take fake pedo heroes as my forum photo....


----------



## Mike Petrik

In the interest of truth and accuracy, perhaps justonemore should change his name to onetoomany.


----------



## 32rollandrock

justonemore said:


> Odd. Unless the wonderful dr. on duty (such as yourself I'm sure) deems it an "emergency", private hospitals in the U.S. have every right to away patients that can't pay. Are you sure it doesn't happen? "No hospital" follows such practices?


This is not true. Most hospitals in the United States enjoy tax-exempt status. They cannot turn away patients who have life-threatening conditions. That's part of the reason the Internal Revenue Service considers them charities. I do have some experience with this. An uninsured friend waited until the pain was unbearable before going to a hospital to find out that she needed gall bladder surgery. Still afraid of the bill, she was going to go home. They would not let her leave unless she signed a waiver absolving them of any responsibility if she left. I was summoned to the hospital to talk her into staying. This was 20 years back and the bill was astronomical--they couldn't operate for a week until the infection subsided, then they opened her up like a fish to remove the gall bladder. Had she gone in earlier, it would have been a relatively simple matter. The point, however, remains: Hospitals in the United States cannot turn away patients in true need. That's why the stories you cite were written--the hospitals were breaking the law by not providing care. It is bona fide news when they do that.


----------



## justonemore

Mike Petrik said:


> In the interest of truth and accuracy, perhaps justonemore should change his name to onetoomany.


Onetoomanyinsults? I would agree. Iwill not leave it alone from those that post thoughts that are easily proven as wrong. "no one is denied medical care" was easily shown with a 30 minute research as being false...While you have in the past shown a bit of respect as to the conversation, those thatI'm taking on have shown nothing but ignorance. I respect your right to take me to task for things that might be not quite correct, I would hope you would give me the same rights. SG and Penteous have given not a single reasoning as to there viewpoints, and I am taking them to task...Should you like to cover their mistakes, I will respond in kind. Personal insults on the other hand should be a bit beyond you as a senoir member.


----------



## Earl of Ormonde

Justonemore, I'm still waiting for the evidence that supports your claim that Oscare Wilde was "a pedophile well know for having sex with young boys"


----------



## justonemore

32rollandrock said:


> This is not true. Most hospitals in the United States enjoy tax-exempt status. They cannot turn away patients who have life-threatening conditions. That's part of the reason the Internal Revenue Service considers them charities. I do have some experience with this. An uninsured friend waited until the pain was unbearable before going to a hospital to find out that she needed gall bladder surgery. Still afraid of the bill, she was going to go home. They would not let her leave unless she signed a waiver absolving them of any responsibility if she left. I was summoned to the hospital to talk her into staying. This was 20 years back and the bill was astronomical--they couldn't operate for a week until the infection subsided, then they opened her up like a fish to remove the gall bladder. Had she gone in earlier, it would have been a relatively simple matter. The point, however, remains: Hospitals in the United States cannot turn away patients in true need. That's why the stories you cite were written--the hospitals were breaking the law by not providing care. It is bona fide news when they do thaat.


Did you bother to read any of the links I provided or are you just agreeing as an American practitioner?

EDIT::: The term "most" is quite telling compared to the many links I provided-......


----------



## justonemore

Earl of Ormonde said:


> Justonemore, I'm still waiting for the evidence that supports your claim that Oscare Wilde was "a pedophile well know for having sex with young boys"


I just provided a link above.. Do you want more?


----------



## 32rollandrock

For those of you still interested in the original premise of this thread, here is an interesting point:

https://www.nytimes.com/2014/07/06/...p-span-region&WT.nav=c-column-top-span-region

The Cliff Notes version: We in the United States wait for days, even weeks, if we have problems with our diabetes medication or issues with asthma that make breathing difficult. But, if we want Botox injections or cosmetic surgery, the wait is negligible. That is what a market-driven system has produced. The money-making procedures, i.e. elective surgeries and the like, are done promptly, but stuff that doesn't make as much money, i.e. basic health care to keep folks alive and feeling well, is delayed. Meanwhile, those who run the system complain about patients showing up in the emergency room for stuff that could have been handled in office visits. I find that both ironic and hypocritical.


----------



## 32rollandrock

justonemore said:


> Did you bother to read any of the links I provided or are you just agreeing as an American practitioner?


I said what I said because I know what I am talking about. Period. What you said is false, demonstrably false. It is as simple as that.


----------



## Earl of Ormonde

I saw the article, but I asked for evidence (i.e. proof from the day from witnesses and legal record) not the opinions of one biased journalist.

Oscar Wilde was NOT a paedophile. Can you prove that he was? No?
In which case then don't slander the dead!


----------



## SG_67

32rollandrock said:


> For those of you still interested in the original premise of this thread, here is an interesting point:
> 
> https://www.nytimes.com/2014/07/06/...p-span-region&WT.nav=c-column-top-span-region
> 
> The Cliff Notes version: We in the United States wait for days, even weeks, if we have problems with our diabetes medication or issues with asthma that make breathing difficult. But, if we want Botox injections or cosmetic surgery, the wait is negligible. That is what a market-driven system has produced. The money-making procedures, i.e. elective surgeries and the like, are done promptly, but stuff that doesn't make as much money, i.e. basic health care to keep folks alive and feeling well, is delayed. Meanwhile, those who run the system complain about patients showing up in the emergency room for stuff that could have been handled in office visits. I find that both ironic and hypocritical.


Your larger point is well taken and I think it goes to the lack of general practitioners in underserved communities.

There I think government can play a role. In my opinion, I think government can play a role in developing infrastructure, clinics, medical centers, etc. and help staff it with residents. Perhaps offer some type of tuition forgiveness?


----------



## justonemore

Earl of Ormonde said:


> I saw the article, but I asked for evidence (i.e. proof from the day from witnesses and legal record) not the opinions of one biased journalist.
> 
> Oscar Wilde was NOT a paedophile. Can you prove that he was? No?
> In which case then don't slander the dead!


Ok. you claim one thing while others claim another.... Pentheos claimed that homosexuality and pedophila were the same. Is there any excuse for such? I find the gent disgusting for even defending such... And the main problem is that he was defending a person that knows no difference as well... There is plenty of thought that Wilde is no different from the current child molesting pariah in England, Saville... They tore down his grave and statue as should be... Wilde should be no different unless you support his perverted ways... Having a photo of the guy as your foruzm photo is no less than disgusting until it is proven otherwise.


----------



## justonemore

32rollandrock said:


> I said what I said because I know what I am talking about. Period. What you said is false, demonstrably false. It is as simple as that.


Any proven examples or are you just giving wordplay as usual? A few links might be nice as well? Anything other than just you and your opinion?


----------



## Tilton

justonemore said:


> Can any of you teapublicans show any service to your country or are or only full of "words"? anything? just a bit of service? Beyond taking a few poor people as clients? Anything? Anything at all? or are you all just a bunch of talkers? Tilton...You liked to claim how great America is at serving immigrants compared to Switzerland... Any comment s to the 40'000 children forced into a small area in Texas? SG.. Can you claim anything more than the basics? MAxBuck..Can you provide anything more than basic insults? It seems to me that that you and your followers have nothing left but personal insults... Can you folks not provide any actual debate or should we dismiss you as needeed


Now that J1M is having to pull from months-old posts to try to pick fights with anyone and everyone who has posted an opinion in this discussion, the thread has fully run its course.

Just a thought - people might take you a bit more seriously if you sat down and gathered your thoughts into one coherent post instead of this weird stream of consciousness you do where you post 5-10 times in 20 minutes, making little sense and frantically lobbing insults.


----------



## justonemore

Tilton said:


> Now that J1M is having to pull from months-old posts to try to pick fights with anyone and everyone who has posted an opinion in this discussion, the thread has fully run its course.
> 
> Just a thought - people might take you a bit more seriously if you sat down and gathered your thoughts into one coherent post instead of this weird stream of consciousness you do where you post 5-10 times in 20 minutes, making little sense and frantically lobbing insults.


Opps. just another personal insult over logic??? Thanks tilton. You have just proven your Worth... Still...No comment on your false comments from a month ago... Nice.... The U.S treats children refugees much worse that Switzerland treats all of its refugees. Time to admit the truth over crying that that the U.S. is so much better, I made this point a mointh ago and you cried and cried that it wasn't true... Should I post the recent photos to prove you wrong???


----------



## 32rollandrock

SG_67 said:


> Your larger point is well taken and I think it goes to the lack of general practitioners in underserved communities.
> 
> There I think government can play a role. In my opinion, I think government can play a role in developing infrastructure, clinics, medical centers, etc. and help staff it with residents. Perhaps offer some type of tuition forgiveness?


I think that there might be some sort of tuition forgiveness for newly minted doctors who practice in under-served areas. Seems I've read about something along those lines, and if it's not being done, it should be done.

What say you to ending procedure-based compensation and putting doctors on salaries? Some might find that overly socialistic, but I think that could go a long way toward getting more primaries and other areas that are in short supply and ending whatever glut of plastic surgeons might exist. I do know that there is a critical shortage of forensic pathologists, and that's not good for society as a whole. I'm guessing that is because an anesthesiologist (to pick a specialty out of the air) makes more than a forensic pathologist.


----------



## Chouan

SG_67 said:


> You've cited a few examples where the institutions in question have been sued or fined.
> 
> In as large and complex a system as our healthcare system is, such things are going to happen. By the way, when when our current 1st lady was chief counsel of the UC medical center, she oversaw the hospitals patient dumping scheme.
> 
> Millions of people daily are admitted to ERs around our country. As for charging people for routine care at an ER, that makes sense since they should be utilized for emergent cases and not for routine care. Emergency rooms are not money makers for hospitals so the resources must be used for the intended purpose.
> 
> I'm sure if I had the time or inclination to do a search, I would find nightmares scenarios from countries with NHSs but I'm sitting in a park watching the squirrels frolic, and frankly it's more entertaining.
> 
> If you want a glimpse into how an NHS will fare in this country, just look at the VA. It can't be sued, it has no incentive to be efficient and it's understaffed and underfunded.
> 
> Your example of going into a London hospital is great! And I'm sure a vet can just as easily go into a VA hospital and get served and treated efficiently at no cost to him/her.
> 
> Since we're citing online sources, here are a few:
> https://www.dailymail.co.uk/health/...ment-elderly-mans-chilling-story-reveals.html
> 
> And another:
> 
> https://www.dailymail.co.uk/news/ar...-patients-times-likely-operations-others.html
> 
> And another:
> 
> https://www.express.co.uk/life-styl...re-too-old-in-new-attack-on-Britain-s-elderly
> 
> https://www.ldascotland.org/index.p...denied-care-to-man-with-learning-disabilities
> 
> https://www.theguardian.com/society/2012/oct/15/nhs-cancer-joints-surgery-age-discrimination
> 
> We could go back and forth all day on this and in the end it's meaningless. Citing online sources does not substitute or relevant discussion and in my experience is used as a proxy for real analysis by those who haven't a clue as to what they're talking about.


And you're quoting a Guardian article suggesting that things in the NHS could be better (things can *always* be better) and the usual alarmist articles from Britain's Right Wing press, which thrives on frightening the elderly with scare stories about the decline of the NHS, especially with regards to the elderly, immigration, house prices, extreme weather and the bad behaviour of young people. Not *quite* the same thing.


----------



## justonemore

Chouan said:


> And you're quoting a Guardian article suggesting that things in the NHS could be better (things can *always* be better) and the usual alarmist articles from Britain's Right Wing press, which thrives on frightening the elderly with scare stories about the decline of the NHS, especially with regards to the elderly, immigration, house prices, extreme weather and the bad behaviour of young people. Not *quite* the same thing.


oh my.. Did Sg's booo hooing not come to frutiion?


----------



## Chouan

MaxBuck said:


> If you believe that economics has no impact on Swiss healthcare, you're even more naive than I'd thought. Economics has an impact on *everything.* The impacts may not be evident to the outside observer, but they're there. I'm not going to dispute your commentary on quality of care in Switzerland; I have no direct knowledge of the situation there, but I'll accept your characterization of it as being excellent.
> 
> Look, we get that you have found your Nirvana in Switzerland, and I'm not here to try to burst your bubble. I'm glad you like the place so well. But your continual attempts to bash the USA are extremely tiresome and suggestive of a need for psychoanalysis to find the root cause of your hatred of your birthplace. I think you'd be happier if you could resolve those issues. And I mean that sincerely.


"Continual attempts to bash the USA"? There are a number of members who continually tell the rest of us that the US is better than the rest of the world. If another member argues with that they're told that they're anti-American. Hatred of his birthplace? I don't think so. Unhappiness with how the US is apparently run for the benefit of the rich doesn't mean that one has hatred for it.


----------



## Chouan

Hitch said:


> Obama Care may very well work. If it does it will follow the principle the contrarian economic reality. The typical response to a failed government enterprise is ,after all, expansion.


Sentence construction and us of grammar might make your comment make sense.


----------



## SG_67

Chouan said:


> And you're quoting a Guardian article suggesting that things in the NHS could be better (things can *always* be better) and the usual alarmist articles from Britain's Right Wing press, which thrives on frightening the elderly with scare stories about the decline of the NHS, especially with regards to the elderly, immigration, house prices, extreme weather and the bad behaviour of young people. Not *quite* the same thing.


Sorry, you misunderstood my intent. I simply wanted to illustrate how useless the citing of online sources as to the overall understanding of a complex economic system such as is healthcare.

My point is that this is typically done by those who haven't a clue as to what they are talking about.

As for Britain's NHS, that's for the Brits to decide and I don't have an opinion on it one way or another.


----------



## justonemore

Chouan said:


> "Continual attempts to bash the USA"? There are a number of members who continually tell the rest of us that the US is better than the rest of the world. If another member argues with that they're told that they're anti-American. Hatred of his birthplace? I don't think so. Unhappiness with how the US is apparently run for the benefit of the rich doesn't mean that one has hatred for it.


Indeed. Most of my detractors haven't bothered to serve their community at alll. Not a moment of volunteer service. Not a moment in the miltary. Yet.. They are somehow more patriotic than than myself and other that have done the the same. I have never posted anything against my fellow Americans... Not once... I have always supported them and their needs over spending trillions on overseas nonsense. Israelis have a much better socialist government than the U.S. yet we pay and pay for them to have a better life (and a more violent one at that). SG cries over the term Ghetto babies but can't seem to understand that it is he himself that supports such when compared to his supporting the billions in aid to Israel. My sarcastic comments may have been taken out of context, but it is exactly these same boo hooers that refuse to support their own community over that of a terrorist state (that supports killing everything in the way of it's "religious" ideolgy) that allows ghettos to exist... Perhaps instead of taking a few Ghetto babies because it makes SG feel good, the U.S. can come into a real universal healthcare system where SG has to take whoever comes into his office. Gaining a living is one thing, making a profit at the expense of the poor is an entirelly different matter.... But at least he takes a few "poor" patients...


----------



## Hitch

Chouan said:


> Sentence construction and us of grammar might make your comment make sense.


Suffering a slight cold ,I didnt know you were here.


----------



## justonemore

justonemore said:


> Oops sorry...You went on a trip to a 3rd worlsd country..Does that have anything to do with science or the medical community? Or is it more of a "feel good" religious trip?


Well as you to your thoughts i'm a "god hater" so religion obviously plays no part in my life. Did you have a valid point somewhere in your post or did I just miss it due to your inabilty to communicate clearly???


----------



## immanuelrx

justonemore said:


> Well as you to your thoughts i'm a "god hater" so religion obviously plays no part in my life. Did you have a valid point somewhere in your post or did I just miss it due to your inabilty to communicate clearly???


J1M, you are in rare form today. You have reached the point where you are commenting on your own comment. 
I all seriousness, quit with the pedophile talk. Not going into much detail, it if offensive and hits close to home. Loved ones have been effected and it is sickening. I don't agree with your, "fight fire with fire" tactics but if you must, please find another topic to discuss. It would be much appreciated.


----------



## Tilton

justonemore said:


> Opps. just another personal insult over logic??? Thanks tilton. You have just proven your Worth... Still...No comment on your false comments from a month ago... Nice.... The U.S treats children refugees much worse that Switzerland treats all of its refugees. Time to admit the truth over crying that that the U.S. is so much better, I made this point a mointh ago and you cried and cried that it wasn't true... Should I post the recent photos to prove you wrong???


Please point out in my post where I made a personal insult. I gave your posting habits a bit of criticism, but I wasn't anywhere close to making a personal insult. There is a pretty significant difference.

Second, please quote the posts in which I cried and cried. Disagreeing with you does not, at least to the rest of the world, equate to crying.


----------



## justonemore

immanuelrx said:


> J1M, you are in rare form today. You have reached the point where you are commenting on your own comment.
> I all seriousness, quit with the pedophile talk. Not going into much detail, it if offensive and hits close to home. Loved ones have been effected and it is sickening. I don't agree with your, "fight fire with fire" tactics but if you must, please find another topic to discuss. It would be much appreciated.


I will respect your thoughts and will leave it alone at your request but the fact that Pentheos compared Homophobia to those against pedophila is insulting as well.


----------



## immanuelrx

justonemore said:


> I will respect your thoughts and will leave it alone at your request but the fact that Pentheos compared Homophobia to those against pedophila is insulting as well.


Thank you Sir.


----------



## justonemore

ohh. and as to fireworks... I pretty much quit buying them back in high school. My "socialist" thinking was that the collective community can put on a much better display with less risk and less cost than I could do on my own & the whole community can come enjoy them versus me just annoying the heck out of the Neighbors (and their dogs). lol. As I age, I also have come to appreciate my fingers and eyes a bit more as well.

Oh. by the way. I thought I was responding to Hitch versus myself... Oh well. Not as if doing things correctly is going to change anyone's thoughts here anyways. lol


----------



## Tilton

justonemore said:


> ohh. and as to fireworks... I pretty much quit buying them back in high school. My "socialist" thinking was that the collective community can put on a much better display with less risk and less cost than I could do on my own & the whole community can come enjoy them versus me just annoying the heck out of the Neighbors (and their dogs). lol. As I age, I also have come to appreciate my fingers and eyes a bit more as well.
> 
> Oh. by the way. I thought I was responding to Hitch versus myself... Oh well. Not as if doing things correctly is going to change anyone's thoughts here anyways. lol


On the whole community thing - they not only do it much better, but much safer - firefighters there, steel plates to launch them off of, electronic controllers, etc. I say to heck with buying your own. I lit many as a kid, but these days I'd much rather sit back with a drink and watch, anyway. Apparently, on Friday night my across-the-alley neighbor lit himself on fire with a sparkler. Something about bug spray and/or polyester. He wasn't particularly injured, but still... I'd rather not.


----------



## immanuelrx

justonemore said:


> ohh. and as to fireworks... I pretty much quit buying them back in high school. My "socialist" thinking was that the collective community can put on a much better display with less risk and less cost than I could do on my own & the whole community can come enjoy them versus me just annoying the heck out of the Neighbors (and their dogs). lol. As I age, I also have come to appreciate my fingers and eyes a bit more as well.
> 
> Oh. by the way. I thought I was responding to Hitch versus myself... Oh well. Not as if doing things correctly is going to change anyone's thoughts here anyways. lol


It's all good. Everyone makes mistakes. Now if you were actually arguing with yourself, there would be an issue. 
I don't anyone here is trying to change people's thoughts. If they were, conversations would not be so aggressive. I am sure it is more for debate than anything else.


----------



## Chouan

SG_67 said:


> Sorry, you misunderstood my intent. I simply wanted to illustrate how useless the citing of online sources as to the overall understanding of a complex economic system such as is healthcare. .


Point taken.



SG_67 said:


> As for Britain's NHS, that's for the Brits to decide and I don't have an opinion on it one way or another.


But my point was that state organised and controlled health care systems exist and successfully operate in most of western Europe, so the arguments given as to why Obamacare can't be successful, in some form, in the US have already been discounted. As a person involved in health care you *should* have an opinion on the NHS, as the success of the NHS could easily be emulated in the US if the political will exists.


----------



## 32rollandrock

Chouan said:


> Point taken.
> 
> But my point was that state organised and controlled health care systems exist and successfully operate in most of western Europe, so the arguments given as to why Obamacare can't be successful, in some form, in the US have already been discounted. As a person involved in health care you *should* have an opinion on the NHS, as the success of the NHS could easily be emulated in the US if the political will exists.


I think that you are missing my original point, which is, neither Obamacare nor anything else cloaked as reform can succeed unless and until costs are contained. I don't know how European health care systems operate, but I do know that costs for any given procedure in the United States are so far above reason that any attempt to lessen the fiscal blow is merely an exercise in subsidizing waste. It is akin to subsidizing transportation by making taxpayers shell out $10 per gallon for gasoline.


----------



## Langham

Chouan said:


> ... As a person involved in health care you *should* have an opinion on the NHS, as the success of the NHS could easily be emulated in the US if the political will exists.


The NHS works moderately well in many respects but is far from perfect. The French I have noticed always try to get back to France, if they have a health problem, rather than risk treatment in English hospitals. Surprisingly, French doctors earn a lot less than English doctors. Well, perhaps not that surprising.


----------



## Chouan

Langham said:


> The NHS works moderately well in many respects but is far from perfect. The French I have noticed always try to get back to France, if they have a health problem, rather than risk treatment in English hospitals. Surprisingly, French doctors earn a lot less than English doctors. Well, perhaps not that surprising.


Of course its not perfect, no organisation is. Other options are, of course, available, if one can afford it. I would suggest that wealthy French people try to get back to France if they have a health problem rather than "the French". On the other hand, having been in hospital in Italy, which was an otherwise pleasant experience, I would rather be in Britain if I had a health problem. Not because our NHS is better than theirs, but because I would rather be at home, or close to it, if I was unwell. I'm sure that French people would feel the same.


----------



## justonemore

Chouan said:


> Of course its not perfect, no organisation is. Other options are, of course, available, if one can afford it. I would suggest that wealthy French people try to get back to France if they have a health problem rather than "the French". On the other hand, having been in hospital in Italy, which was an otherwise pleasant experience, I would rather be in Britain if I had a health problem. Not because our NHS is better than theirs, but because I would rather be at home, or close to it, if I was unwell. I'm sure that French people would feel the same.


As would most everyone. Unless I'm in the middle of a medical emergency, I would always prefer to be close to home. I would perhaps make the point that if my wealth or insurance allowed, I might go overseas to see a specialist that could provide a better/alternative treatment that I might not find in my current location. In the end, I would still prefer basic treatment close to home and when it comes time to close the final curtain, I would prefer it to be at home or at least a place that is familiar to me.


----------



## SG_67

Chouan said:


> Point taken.
> 
> But my point was that state organised and controlled health care systems exist and successfully operate in most of western Europe, so the arguments given as to why Obamacare can't be successful, in some form, in the US have already been discounted. As a person involved in health care you *should* have an opinion on the NHS, as the success of the NHS could easily be emulated in the US if the political will exists.


I appreciate your advocacy for the NHS, but I would argue your definition of success and successful.

You're correct assuming that no system is perfect, but is perfect defined as 100% universal coverage without question? Is that even possible?

In any system where resources are limited, and I know of no economic system where this is true, there are going to have to be controls placed on the allocation of those resources. The British NHS or the healthcare system of any country is no exception.

I am indeed interested in the NHS but I'm not about to comment on how a sovereign country should organize itself. I think the question we should ask ourselves is this; do we want bureaucrats deciding on the allocation of resources or do we want it to be market driven?

I'm not sure you're familiar with LASIK surgery, but it's a procedure not covered by most insurance plans. It's a cash business. Since LASIK first came about we've seen the price dramatically drop as providers have competed for patient's dollars. This is an example of market forces controlling the cost of a medical procedure.

I'm not suggesting it would work if someone came into an ER with a lacerated liver following an MVA, but it is an interesting example of one way of controlling costs.


----------



## Earl of Ormonde

justonemore said:


> Ok. you claim one thing while others claim another.... Having a photo of the guy as your foruzm photo is no less than disgusting until it is proven otherwise.


You are making excuses and not honouring what you previously wrote, you said Wilde was "known for having sex with young boys", that is not your opinion, that is something that you are claiming as a fact with the words "was known for"

*NOW, support that with EVIDENCE, not bias or opinion, or just be quiet and stop slandering people!
*
I am Irish and I grew up in London, I have studied English literature and Wilde and I have NEVER EVER before come across your disgusting so called "well known" suggestion, simply becasue it isn't true, it is simply a continuation of the slander Wilde suffered from the monied establishment during his life.

*Wilde was not a paedophile nor was he a pervert.*

There is absolutely nothing whatsoever wrong or disgusting with having a photo of Wilde or any other homosexual or bisexual as one's avatar on a forum.
I think this probably goes a lot deeper with you and your own prejudices than you are prepared to accept, let alone admit.

I may be a deeply religious Roman Catholic but one thing I am not is a homophobe nor do I hold any other prejudices based on the sexuality of other people. 
*And any attempt by ANYONE here or elsewhere to equate homosexuality with paedophilia is beyond disgusting, it is sick and twisted! 
*

*PROVE what you made up about Wilde or BE QUIET!*


----------



## justonemore

Earl of Ormonde said:


> You are making excuses and not honouring what you previously wrote, you said Wilde was "known for having sex with young boys", that is not your opinion, that is something that you are claiming as a fact with the words "was known for"
> 
> NOW, support that with EVIDENCE, not bias or opinion, or just be quiet and stop slandering people!
> 
> I am Irish and I grew up in London, I have studied English literature and Wilde and I have NEVER EVER before come across your disgusting so called "well known" suggestion, simply becasue it isn't true, it is simply a continuation of the slander Wilde suffered from the monied estalbishment during his life.
> 
> Wilde was not a paedophile nor was he a pervert.
> 
> There is absolutely nothing whatsoever wrong or disgusting with having a photo of Wilde or any other homosexual or bisexual as one's avatar on a forum.
> I think this probably goes a lot deeper with you and your own prejudices than you are prepared to accept, let alone admit.
> 
> I may be a deeply religious Roman Catholic but one thing I am not is a homophobe nor do I hold any other prejudices based on the sexuality of other people. And any attempt by ANYONE here or elsewhere to equate homosexuality with paedophilia is beyond disgusting, it is sick and twisted!
> 
> PROVE what you made up about Wilde or BE QUIET!


I promised a fellow member to drop the topic. As such, I will "be quiet" and admit that I am not willing to pursue the topic further. I provided a link. You didn't like it. Fine. But I will still not go further on the topic. Should I and my researches be wrong, I will make my apologies... I made nothing up and actually gave a link as to my ideas (accept it or not)

Still...It was Pentheos that claimed that homosexuality was the same as a pedophilia... Not me...


----------



## Langham

Chouan said:


> Of course its not perfect, no organisation is. Other options are, of course, available, if one can afford it. I would suggest that wealthy French people try to get back to France if they have a health problem rather than "the French". On the other hand, having been in hospital in Italy, which was an otherwise pleasant experience, I would rather be in Britain if I had a health problem. Not because our NHS is better than theirs, but because I would rather be at home, or close to it, if I was unwell. I'm sure that French people would feel the same.


No, I think it is because - as with certain other aspects of life in England - our hospitals disgust and puzzle them, in equal measure.


----------



## Earl of Ormonde

justonemore said:


> I promised a fellow member to drop the topic. As such, I will "be quiet" and admit that I am not willing to pursue the topic further. I provided a link. You didn't like it. Fine. But I will still not go further on the topic. Should I and my researches be wrong, I will make my apologies... I made nothing up and actually gave a link as to my ideas (accept it or not)
> 
> Still...It was Pentheos that claimed that homosexuality was the same as a pedophilia... Not me...


As I said before, you provided a biased article from ONE journalist, nothing from contemporary sources & as such nothing remotely resembling evidence.
Also I'm not suggesting for one second that you said homosexuality was the same as pedophilia, I was answering your comment & pointing out in agreement with you that such a suggestion is disgusting, as I said, "anyone".

But okay, I'll drop it too then.


----------



## Chouan

SG_67 said:


> I appreciate your advocacy for the NHS, but I would argue your definition of success and successful.
> 
> You're correct assuming that no system is perfect, but is perfect defined as 100% universal coverage without question? Is that even possible?
> 
> In any system where resources are limited, and I know of no economic system where this is true, there are going to have to be controls placed on the allocation of those resources. The British NHS or the healthcare system of any country is no exception.
> 
> I am indeed interested in the NHS but I'm not about to comment on how a sovereign country should organize itself. I think the question we should ask ourselves is this; do we want bureaucrats deciding on the allocation of resources or do we want it to be market driven?
> 
> I'm not sure you're familiar with LASIK surgery, but it's a procedure not covered by most insurance plans. It's a cash business. Since LASIK first came about we've seen the price dramatically drop as providers have competed for patient's dollars. This is an example of market forces controlling the cost of a medical procedure.
> 
> I'm not suggesting it would work if someone came into an ER with a lacerated liver following an MVA, but it is an interesting example of one way of controlling costs.


I suppose that successful means that if I go to my doctor with a medical complaint, I will be seen free of charge, will be referred to a specialist, if necessary, free of charge, will be treated free of charge, although about £8 will be charged per prescription, any scans, x-rays, ultra-sounds etc deemed necessary will be carried out free of charge, any necessary surgery, and post-surgical care, will be carried out free of charge, along with any necessary follow-up consultations.
Similarly, if I attend a A&E at a hospital following an accident, all of the treatments, scans etc, in fact any medical involvement of any kind, will be carried out or delivered free of charge. Indeed, all medical treatment in a hospital, including drugs, are supplied free of charge. Ambulances, both conventional and air, are also under the authority of the NHS and the Emergency Services and are also free of charge.
This is available anywhere and everywhere in the UK, for all citizens of EU member states. Obviously, in rather more remote areas one might need to be transported to a hospital that has the necessary facilities if a local hospital isn't able to deal with an individual problem, and there are specialist hospitals that focus on particular needs, Papworth for serious heart problems, for example, or Great Ormond Street for paediatric medicine. So I would argue that 100% coverage, in terms of the population, which what I assume you mean, is not only possible but is achieved.
The issue for allocation of resources that is currently most discussed is that of an aging population, where more people are older and in need of more medical care, which, obviously has an impact on resources. The other problem is of older people who aren't able to be looked after at home, either because there is nobody at home or because their family aren't able to provide the home care needed. A hospital can't discharge a patient into an environment in which the necessary care isn't available, so there is a tendency for some older patients to stay in hospital for longer than their medical need would demand, because of the lack of social care at home.

Of course the Right in British politics, especially those who favour a completely free market and privatisation of all services, will always condemn the NHS for its failings and perceived inefficiency, but their basis for their criticisms is their ideological view, rather than the reality. Hence the right wing media will always be far more critical of the NHS than the more left leaning view. The right will highlight failings in order to argue that the NHS should be stopped, whereas the left will highlight failings in order to argue that the NHS should be improved.
An example of the Right's view is this:


----------



## justonemore

Earl of Ormonde said:


> As I said before, you provided a biased article from ONE journalist, nothing from contemporary sources & as such nothing remotely resembling evidence.
> Also I'm not suggesting for one second that you said homosexuality was the same as pedophilia, I was answering your comment & pointing out in agreement with you that such a suggestion is disgusting, as I said, "anyone".
> 
> But okay, I'll drop it too then.


I'm more than Happy to agree to drop it. While his lifestyle might be in question for many, Wilde was by all means a great artist for his time and age.


----------



## Langham

Chouan said:


> I suppose that successful means that if I go to my doctor with a medical complaint, I will be seen free of charge, will be referred to a specialist, if necessary, free of charge, will be treated free of charge, although about £8 will be charged per prescription, any scans, x-rays, ultra-sounds etc deemed necessary will be carried out free of charge, any necessary surgery, and post-surgical care, will be carried out free of charge, along with any necessary follow-up consultations.
> Similarly, if I attend a A&E at a hospital following an accident, all of the treatments, scans etc, in fact any medical involvement of any kind, will be carried out or delivered free of charge. Indeed, all medical treatment in a hospital, including drugs, are supplied free of charge. Ambulances, both conventional and air, are also under the authority of the NHS and the Emergency Services and are also free of charge.
> This is available anywhere and everywhere in the UK, for all citizens of EU member states. Obviously, in rather more remote areas one might need to be transported to a hospital that has the necessary facilities if a local hospital isn't able to deal with an individual problem, and there are specialist hospitals that focus on particular needs, Papworth for serious heart problems, for example, or Great Ormond Street for paediatric medicine. So I would argue that 100% coverage, in terms of the population, which what I assume you mean, is not only possible but is achieved.
> The issue for allocation of resources that is currently most discussed is that of an aging population, where more people are older and in need of more medical care, which, obviously has an impact on resources. The other problem is of older people who aren't able to be looked after at home, either because there is nobody at home or because their family aren't able to provide the home care needed. A hospital can't discharge a patient into an environment in which the necessary care isn't available, so there is a tendency for some older patients to stay in hospital for longer than their medical need would demand, because of the lack of social care at home.
> 
> Of course the Right in British politics, especially those who favour a completely free market and privatisation of all services, will always condemn the NHS for its failings and perceived inefficiency, but their basis for their criticisms is their ideological view, rather than the reality. Hence the right wing media will always be far more critical of the NHS than the more left leaning view. The right will highlight failings in order to argue that the NHS should be stopped, whereas the left will highlight failings in order to argue that the NHS should be improved.
> An example of the Right's view is this:


Your definition of 'successful' omits any reference to the efficacy of the treatment received; in fact somewhat like some of the NHS's own performance metrics, though not all - when it is arm-wrestled into publishing performance tables, these reveal shocking disparities in performance from area to area - it can be a bit of a lottery.

However, I don't think it's necessary to approach the question of efficient healthcare with any great burden of political dogma, nor helpful in the debate at hand. Most people are strongly influenced in their opinion of the NHS by their personal experience. My own has been quite mixed - my late father was very well cared for during his last days, but when I was hospitalised a few years ago with broken ribs and kidney injury I was rather poorly treated - the surgeon's request that I be administered morphine was interpreted by the callous ward sister to mean a single aspirin tablet and a glass of water. The nurses all seem to think a bit of pain is good for you.


----------



## Earl of Ormonde

My view of a successful NHS is very simple, that EVERY person seeking medical treatment recieves SATISFACTORY treatment. 

NOT that the NHS must cover every person in a country all the time nor that the treatment is only sufficient.

However, a successful NHS MUST be available for everyone who seeks attention and they MUST receive treatment within a specified time period.


----------



## Langham

Earl of Ormonde said:


> My view of a successful NHS is very simple, that EVERY person seeking medical treatment recieves SATISFACTORY treatment.
> 
> NOT that the NHS must cover every person in a country all the time nor that the treatment is only sufficient.
> 
> However, a successful NHS MUST be available for everyone who seeks attention and they MUST receive treatment within a specified time period.


I think that, for many people, disenchantment with the NHS often starts with a visit to casualty, where very often they are kept waiting for hours in a room with varied psychotic drug addicts, retching and foul-mouthed drunks, people with quite serious injuries who are denied the immediate attention their condition clearly demands, and staff who too often betray staggering callousness and indifference.

Others, however, have happier experiences - some of the smaller hospitals are quite different to the above.


----------



## Chouan

My personal experiences have been universally good, at both large and small hospitals. One can't blame the NHS for the condition of the people who call upon them.
In any case, nobody is suggesting that the NHS is perfect or that it can't be improved, but it works and is certainly better than the alternative.


----------



## eagle2250

Chouan said:


> I suppose that successful means that if I go to my doctor with a medical complaint, I will be seen free of charge, will be referred to a specialist, if necessary, free of charge, will be treated free of charge, although about £8 will be charged per prescription, any scans, x-rays, ultra-sounds etc deemed necessary will be carried out free of charge, any necessary surgery, and post-surgical care, will be carried out free of charge, along with any necessary follow-up consultations..........................
> ....................


In far too many instances with public health systems, you could take the institutional straw man you propose, one step further in it's evolution. As you sit back and wait to see the "specialist" to which you refer, you could also die as has happened with so many of our veterans who have been victimized by our Veterans Administration in recent years (and unfortunately for as long as I can remember)...a public health system that perhaps needs substantial improvement before being thrust upon the innocents! It doesn't sound so idyllic when viewed from that perspective. Please note that there are many fine and well intended doctors, nurses and medical administrative employees, but as an institution, the VA fails!

Our Medicare system is another example of institutional failure. Providers are not required to accept medicare patients and of those who do, at one point (several years back) the system was estimating that more than 30% of the claims paid were fraudulent. Locally, in the past two years we have had three medical service providers convicted of submitting well over 10, plus million dollars, each, in medicare claims...just another public healthcare system that is way overdue for a badly needed fix and certainly not consistent with the healthcare utopia described in the quote above.


----------



## Chouan

eagle2250 said:


> In far too many instances with public health systems, you could take the institutional straw man you propose, one step further in it's evolution. As you sit back and wait to see the "specialist" to which you refer, you could also die as has happened with so many of our veterans who have been victimized by our Veterans Administration in recent years (and unfortunately for as long as I can remember)...a public health system that perhaps needs substantial improvement before being thrust upon the innocents! It doesn't sound so idyllic when viewed from that perspective. Please note that there are many fine and well intended doctors, nurses and medical administrative employees, but as an institution, the VA fails!
> 
> Our Medicare system is another example of institutional failure. Providers are not required to accept medicare patients and of those who do, at one point (several years back) the system was estimating that more than 30% of the claims paid were fraudulent. Locally, in the past two years we have had three medical service providers convicted of submitting well over 10, plus million dollars, each, in medicare claims...just another public healthcare system that is way overdue for a badly needed fix and certainly not consistent with *the healthcare utopia described in the quote above*.


Only it isn't a "health care utopia", it is the health care system that already exists in the UK and has done since 1947. There will always be problems and things will rarely be perfect, but the cost, to me for example, is considerably less than what you appear to be paying for your health insurance.


----------



## eagle2250

^^Chouan:
I am sure you are right in the comments/observations offered above. However, I am simply not confident that, at this point in our history, that we could create a bureaucracy that would provide the ease and range of access to medical care that I presently enjoy, absent the fatal flaws in the existing public healthcare programs that we claim to be currently available. I am sure some might consider me selfish for not wanting to accept a more limited range of services, that I would have to wait longer and travel farther to receive, but that would be universally available to all. However, having grown up dirt poor in the foothills of the Appalachian Mountains, raised by a single mother who quite literally worked her fingers to the bone, cleaning other peoples homes, doing other peoples laundry and ironing and watching other peoples kids to earn a hardscrabble living for herself, my brother, sister and myself, I am convinced that where there is a will to succeed, a way will be found. While I didn't realize we were poor until I began grammar school and the other kids enthusiastically pointed that out to me, my Mamma did teach us the value of hard work and sacrifice. One of the reasons I entered the military is the pathway from poverty to prosperity that it offered, in return for hard work and sacrifice! My life has been all about six and seven day work weeks, filled with 12 to 14 hour workdays and that life, while perhaps hard (military and civilian service), has been a blast and frankly I wouldn't want to change a thing. The opportunities are there for those willing to make the sacrifice! 

Some might consider me pretty generous with regard to our philanthropic giving. Jeez Louise, it even exceeds what I spend on clothing and shoes. I enjoy helping others to the extent that I can, but I would prefer not having the government plunder my finances to fund their wealth redistribution schemes. Until we figure out how to do it right, eliminating the previously cited shortfalls of the VA and medicare, we should probably move very cautiously in creating another fatally flawed welfare and/or public healthcare initiative.


----------



## 32rollandrock

eagle2250 said:


> ^^Chouan:
> I am sure you are right in the comments/observations offered above. However, I am simply not confident that, at this point in our history, that we could create a bureaucracy that would provide the ease and range of access to medical care that I presently enjoy, absent the fatal flaws in the existing public healthcare programs that we claim to be currently available. I am sure some might consider me selfish for not wanting to accept a more limited range of services, that I would have to wait longer and travel farther to receive, but that would be universally available to all. However, having grown up dirt poor in the foothills of the Appalachian Mountains, raised by a single mother who quite literally worked her fingers to the bone, cleaning other peoples homes, doing other peoples laundry and ironing and watching other peoples kids to earn a hardscrabble living for herself, my brother, sister and myself, I am convinced that where there is a will to succeed, a way will be found. While I didn't realize we were poor until I began grammar school and the other kids enthusiastically pointed that out to me, my Mamma did teach us the value of hard work and sacrifice. One of the reasons I entered the military is the pathway from poverty to prosperity that it offered, in return for hard work and sacrifice! My life has been all about six and seven day work weeks, filled with 12 to 14 hour workdays and that life, while perhaps hard (military and civilian service), has been a blast and frankly I wouldn't want to change a thing. The opportunities are there for those willing to make the sacrifice!
> 
> Some might consider me pretty generous with regard to our philanthropic giving. Jeez Louise, it even exceeds what I spend on clothing and shoes. I enjoy helping others to the extent that I can, but I would prefer not having the government plunder my finances to fund their wealth redistribution schemes. Until we figure out how to do it right, eliminating the previously cited shortfalls of the VA and medicare, we should probably move very cautiously in creating another fatally flawed welfare and/or public healthcare initiative.


You are fortunate in that your health care costs, if I understand this correctly, are largely borne by the government--and correct me if I'm wrong, because I might not be straight on this issue. I also understand that you earned this and that you likely made decisions on where to work and for whom based on benefits, including health coverage. As I recall, you had said that your Medicare premium is, or would be, the same as the premium that I am paying. My point is, people like me are subsidizing health care for people like you, and for people like my own father, who pays a tiny fraction of his medical costs. You can't get around it: There are all kinds of subsidies now in place when it comes to health care in the United States. We don't call it that, but they are subsidies nonetheless. Some people benefit while others pay. Since there are already subsidies in place, I would prefer a system where the subsidies are spread out more equally than they are now. I agree that we should move carefully to create a better system, but I am convinced that we can create a better system, and I do not think that it has to have the same problems as exist in Canada or England or any other given country. I truly believe that our health care system is broken. Maybe not for you, but it is broken for a lot of other people, particularly for whatever middle class still exists in this country. When people are forced to buy drugs from Canada (or India or Eastern Europe) and travel overseas for medical procedures because these things are not affordable in the United States, that is a huge problem, in my opinion.

Would you have to pay more for health care than you do now to fix this system? I suspect that you would. Would I pay less? Probably. Is that wealth redistribution? I don't think so. I think that it is simply assigning costs in a more equitable fashion than is currently the case. I also think that we would save a huge amount of money by eliminating private insurance companies that produce nothing of value and eliminate competition between hospitals that now spend an inordinate amount of money on marketing and fancy buildings and equipment that is already available in any given community. It's extraordinarily wasteful and inefficient, I think, and that is a direct result of trying to run a health care system based on free markets. I'm as capitalist as they come, but I do not think that capitalism has worked when it comes to health care.

I just looked up the financials for one of the hospitals where I live (501(c)3's are required to make this information public). According to the most recent figures available (for year ending 9/30/09--don't ask me why they're so behind with IRS filings), this hospital had more than a half-billion (with a "b") dollars in revenue for that fiscal year and had $32.8 million more in revenue than expenses. The prior year, it had nearly $63 million more in revenue than expenses. It is considered a charity under the federal tax code and so pays no taxes--beyond federal taxes, myself and other taxpayers in the city where I live have the honor of making up the difference in property and sales taxes that this hospital does not pay. That, in my opinion, is nuts and is just one example of the craziness of our health care system. There is another for-profit provider that operates on an outpatient basis. Their financials are not a matter of public record, but they spent between $20 million and $25 million on a new building a few years ago and didn't have to take out a loan. Cash flow covered it. This is also nuts. If a for-profit can thrive and generate this kind of money in the city where I live, why should two other hospitals (there is a second nonprofit hospital about the same size as the one I just looked up) enjoy tax-exempt status? Isn't this a form of wealth redistribution on a massive scale? Aren't tax exemptions subsidies?

All these millions of dollars in profit for nonprofits are coming out of my pocket, and I don't like it. One bit. And don't get me started on insurance companies.


----------



## Earl of Ormonde

The odd thing about this discussion is not just that the thread title suggests that the type of system in place in the UK could never work in the US but that some of our American friends here are having problems accepting that such a system does exist and work in the UK.

However, one thing I am TOTALLY against, which some people have mentioned is the fact, both in Sweden and the UK, that tax money intended for medical care in some counties and regions goes to private sector companies that are running NHS local health care i.e. taxes going towards profits for companies running what are supposed to be non-profit public sector entities.


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## Langham

Earl of Ormonde said:


> The odd thing about this discussion is not just that the thread title suggests that the type of system in place in the UK could never work in the US but that some of our American friends here are having problems accepting that such a system does exist and work in the UK.
> 
> However, one thing I am TOTALLY against, which some people have mentioned is the fact, both in Sweden and the UK, that tax money intended for medical care in some counties and regions goes to private sector companies that are running NHS local health care i.e. taxes going towards profits for companies running what are supposed to be non-profit public sector entities.


The involvement of private companies in the provision of public-sector services has been going on for decades, Earl - in fact many parts of the public sector - health, education, departments of state, the courts, even the prison service - would just grind to a halt without their involvement.


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## SG_67

Earl of Ormonde said:


> The odd thing about this discussion is not just that the thread title suggests that the type of system in place in the UK could never work in the US but that some of our American friends here are having problems accepting that such a system does exist and work in the UK.
> 
> However, one thing I am TOTALLY against, which some people have mentioned is the fact, both in Sweden and the UK, that tax money intended for medical care in some counties and regions goes to private sector companies that are running NHS local health care i.e. taxes going towards profits for companies running what are supposed to be non-profit public sector entities.


I understand the reflexive reaction to this, but one must ask if perhaps in the end money is being saved by having a more efficient system. I'm not suggesting it is, simply asking the question.

Then again, the government needs to get out of it all together.


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## Chouan

SG_67 said:


> I understand the reflexive reaction to this, but one must ask if perhaps in the end money is being saved by having a more efficient system. I'm not suggesting it is, simply asking the question.
> 
> *Then again, the government needs to get out of it all together.*


Why? So that health care can be run for the benefit of businesses in order to make profits and help their shareholders?


----------



## SG_67

Chouan said:


> Why? So that health care can be run for the benefit of businesses in order to make profits and help their shareholders?


That's a straw man argument and you know it.

I could easily counter that public healthcare is used as a political football by politicians looking to keep themselves in office by over promising and under delivering.

Anytime a system is based on public finding, it's viability will constantly be subject to the political winds.

This entire thread has, with the exception of a few distractions, been based on the argument is whether healthcare costs and delivery are better suited to the public vs. private sector.


----------



## 32rollandrock

SG_67 said:


> That's a straw man argument and you know it.
> 
> I could easily counter that public healthcare is used as a political football by politicians looking to keep themselves in office by over promising and under delivering.
> 
> Anytime a system is based on public finding, it's viability will constantly be subject to the political winds.
> 
> *This entire thread has, with the exception of a few distractions, been based on the argument is whether healthcare costs and delivery are better suited to the public vs. private sector.*


I'm not sure that I agree entirely with this, although you are correct in that there has been a lot of talk about public versus private sector. My original point was, health care in the United States, regardless of whether the public or private sector pays, costs too much, and so any attempt at reform without addressing underlying excessive costs is akin to lipstick on a pig. If someone can devise a way for the private sector to rein in costs, great. But when we've got an average $500-per-stitch charge for emergency care, doctors who cannot afford to keep vaccines in stock, wait times measured in weeks for routine medical care and hospitals disguised as charities that are raking in $32 million a year in tax-free after-expense revenue, there's an issue. It is true that any system based on public funding will be subject to political winds. It is equally true that any free-market system will be controlled by greed. Neither is a good thing when it comes to health care, in my view, and I suppose that I prefer politics to greed.


----------



## Mike Petrik

32rollandrock said:


> I'm not sure that I agree entirely with this, although you are correct in that there has been a lot of talk about public versus private sector. My original point was, health care in the United States, regardless of whether the public or private sector pays, costs too much, and so any attempt at reform without addressing underlying excessive costs is akin to lipstick on a pig. If someone can devise a way for the private sector to rein in costs, great. But when we've got an average $500-per-stitch charge for emergency care, doctors who cannot afford to keep vaccines in stock, wait times measured in weeks for routine medical care and hospitals disguised as charities that are raking in $32 million a year in tax-free after-expense revenue, there's an issue. It is true that any system based on public funding will be subject to political winds. It is equally true that any free-market system will be controlled by greed. Neither is a good thing when it comes to health care, in my view, and I suppose that I prefer politics to greed.


Greed does not disappear in the public sector. Prices are simply controlled by imperfect rules instead of imperfect competition, that's all. I'm no expert in health care economics, but my impression is that competition works poorly in the US system because it is primarily a 4 party system -- user, employer, provider, and insurer. The interests of the user and provider are aligned because they both desire the provision of as much service as possible: the provider because he will be paid for it and the user because he benefits from the service without paying for it. Insurers compete for the business of employers who bear the financial burden, and insurers reign in costs via a system of rules and protocols that are inevitably over-inclusive, under-inclusive, and clumsy -- yielding counter-intuitive outcomes and behaviors. Furthermore any system that can be gamed will be gamed, so the job of providers is to figure out how to legally game the governing insurance system to their benefit. Consumers typically have little skin in the game, so they have no incentive to price-shop or make cost-benefit decisions in their medical care. Instead they cooperate with providers in figuring out how to get as much medical care as possible as long as they don't pay. Examples are easy and abound, to wit -- Woman is playing tennis and notices a sharp pain in her knee. A couple weeks later her knee is still sore so she sees her doc. A couple scans later her doc tells her she has an injury to her ACL. She asks for a prognosis, and the doc says that if she just rests for a few months the pain will subside and she will be completely ambulatory. But, he emphasizes, if she wants to continue to play tennis thereafter surgery will be required. In a rational world the woman and her husband would compare the costs of the surgery to the benefits of tennis. In our world, no such discussion is necessary. The costs are already socialized through insurance so of course she gets the surgery.

Meanwhile hospitals price discriminate against insurers routinely. While the rack rates for uninsured services are always higher than those for insured services, no one pays the rack rates. Hospitals routinely cut deals with the uninsured based on ability to pay. This is especially true for anything resembling a necessary service. The stories one hears of hospitals bankrupting uninsured patients is true, but almost always related to especially catastrophic situations involving highly specialized care over many months or years.

It has always seemed to me that the key is to remove the income tax exclusion for employer-provided healthcare, which would allow the de-coupling of health care and health care insurance from employment. Once this is done consumers will not only shop for appropriate insurance, which means much more affordable insurance covering catastrophic care only, but also shop and make sensible decisions for ordinary care services as well.

The bottom line is that market forces work poorly in the US system due to the lack of transparency and normal incentives. These are fixable problems, but Obamacare doubled-down on this inefficient 4 party system instead of retreating from it.


----------



## eagle2250

32rollandrock said:


> You are fortunate in that your health care costs, if I understand this correctly, are largely borne by the government--and correct me if I'm wrong, because I might not be straight on this issue. I also understand that you earned this and that you likely made decisions on where to work and for whom based on benefits, including health coverage. As I recall, you had said that your Medicare premium is, or would be, the same as the premium that I am paying. My point is, people like me are subsidizing health care for people like you, and for people like my own father, who pays a tiny fraction of his medical costs. You can't get around it: There are all kinds of subsidies now in place when it comes to health care in the United States. We don't call it that, but they are subsidies nonetheless. Some people benefit while others pay. Since there are already subsidies in place, I would prefer a system where the subsidies are spread out more equally than they are now. I agree that we should move carefully to create a better system, but I am convinced that we can create a better system, and I do not think that it has to have the same problems as exist in Canada or England or any other given country. I truly believe that our health care system is broken. Maybe not for you, but it is broken for a lot of other people, particularly for whatever middle class still exists in this country. When people are forced to buy drugs from Canada (or India or Eastern Europe) and travel overseas for medical procedures because these things are not affordable in the United States, that is a huge problem, in my opinion.
> 
> Would you have to pay more for health care than you do now to fix this system? I suspect that you would. Would I pay less? Probably. Is that wealth redistribution? I don't think so. I think that it is simply assigning costs in a more equitable fashion than is currently the case. I also think that we would save a huge amount of money by eliminating private insurance companies that produce nothing of value and eliminate competition between hospitals that now spend an inordinate amount of money on marketing and fancy buildings and equipment that is already available in any given community. It's extraordinarily wasteful and inefficient, I think, and that is a direct result of trying to run a health care system based on free markets. I'm as capitalist as they come, but I do not think that capitalism has worked when it comes to health care.
> 
> I just looked up the financials for one of the hospitals where I live (501(c)3's are required to make this information public). According to the most recent figures available (for year ending 9/30/09--don't ask me why they're so behind with IRS filings), this hospital had more than a half-billion (with a "b") dollars in revenue for that fiscal year and had $32.8 million more in revenue than expenses. The prior year, it had nearly $63 million more in revenue than expenses. It is considered a charity under the federal tax code and so pays no taxes--beyond federal taxes, myself and other taxpayers in the city where I live have the honor of making up the difference in property and sales taxes that this hospital does not pay. That, in my opinion, is nuts and is just one example of the craziness of our health care system. There is another for-profit provider that operates on an outpatient basis. Their financials are not a matter of public record, but they spent between $20 million and $25 million on a new building a few years ago and didn't have to take out a loan. Cash flow covered it. This is also nuts. If a for-profit can thrive and generate this kind of money in the city where I live, why should two other hospitals (there is a second nonprofit hospital about the same size as the one I just looked up) enjoy tax-exempt status? Isn't this a form of wealth redistribution on a massive scale? Aren't tax exemptions subsidies?
> 
> All these millions of dollars in profit for nonprofits are coming out of my pocket, and I don't like it. One bit. And don't get me started on insurance companies.


As with all public employee healthcare insurance programs the govt pays a portion of the premiums and the employee retiree pays a share of the premium. I'm not sure, but think the govt/employee share of the premiums to be in the neighborhood of a 50%/50% split. If you want a better understanding of the actual cost of healthcare insurance to me, go to the Office of Personnel Management (OPM) website, Employee Healthcare Programs and check out monthly employee cost for the Blue Cross/Blue Shield, high option coverage for "self and family." That is just the insurance costs to me. Now add to that the deductibles and co-payments I must pay, as services are received and you come up with a total that I suspect is close to what you are paying.

However, what healthcare costs or does not cost me is not what drives my reluctance to see the US rush into an addition to the ever increasing list of public entitlement programs. What most concerns me is that I can not think of a single entitlement program sponsored by our Federal Government that has worked exactly as it was intended to work or cost anywhere near as little as the costs were originally projected to be. Instead, interference on the part of our federal entities just seems to muck things up, leading to reduced service levels for all of us and incur way overblown costs to be born by the ever besieged taxpayers. If we should ever prove ourselves able to properly manage such a program, then bring it on, but until then let's be cautious about biting off more that we can chew, lest we choke on our own bureaucratic ineptitude!


----------



## tocqueville

Eagle,

I understand your skepticism, largely because our political processes do not lend themselves to building effective institutions. We seem to specialize in building 'kluges,' and instead of replacing them, we add on more 'fixes' that probably make things worse. Thus, the ACA becomes something of a Rube Goldberg contraption. And then there are all the countless compromises that had to be built into ACA...

I'm an enthusiastic support of socialized medicine so long as instead of building atop Medicare (i.e. adding still more complexity and expense to the kluge) we wiped the slate clean and built anew. Is that even possible?

I also know that the British, French, Canadian, and German systems generally work better than ours and for less expense. I've been on the French system and was amazed. So, for me, the road ahead would be simple: We study the comparable systems in the rest of the G7, figure out which would be the best fit for us, and replicate it. But I suppose I might as well start dreaming of switching to the metric system....


----------



## 32rollandrock

Mike Petrik said:


> Greed does not disappear in the public sector. Prices are simply controlled by imperfect rules instead of imperfect competition, that's all. I'm no expert in health care economics, but my impression is that competition works poorly in the US system because it is primarily a 4 party system -- user, employer, provider, and insurer. The interests of the user and provider are aligned because they both desire the provision of as much service as possible: the provider because he will be paid for it and the user because he benefits from the service without paying for it. Insurers compete for the business of employers who bear the financial burden, and insurers reign in costs via a system of rules and protocols that are inevitably over-inclusive, under-inclusive, and clumsy -- yielding counter-intuitive outcomes and behaviors. Furthermore any system that can be gamed will be gamed, so the job of providers is to figure out how to legally game the governing insurance system to their benefit. Consumers typically have little skin in the game, so they have no incentive to price-shop or make cost-benefit decisions in their medical care. Instead they cooperate with providers in figuring out how to get as much medical care as possible as long as they don't pay. Examples are easy and abound, to wit -- Woman is playing tennis and notices a sharp pain in her knee. A couple weeks later her knee is still sore so she sees her doc. A couple scans later her doc tells her she has an injury to her ACL. She asks for a prognosis, and the doc says that if she just rests for a few months the pain will subside and she will be completely ambulatory. But, he emphasizes, if she wants to continue to play tennis thereafter surgery will be required. In a rational world the woman and her husband would compare the costs of the surgery to the benefits of tennis. In our world, no such discussion is necessary. The costs are already socialized through insurance so of course she gets the surgery.
> 
> Meanwhile hospitals price discriminate against insurers routinely. While the rack rates for uninsured services are always higher than those for insured services, no one pays the rack rates. Hospitals routinely cut deals with the uninsured based on ability to pay. This is especially true for anything resembling a necessary service. The stories one hears of hospitals bankrupting uninsured patients is true, but almost always related to especially catastrophic situations involving highly specialized care over many months or years.
> 
> It has always seemed to me that the key is to remove the income tax exclusion for employer-provided healthcare, which would allow the de-coupling of health care and health care insurance from employment. Once this is done consumers will not only shop for appropriate insurance, which means much more affordable insurance covering catastrophic care only, but also shop and make sensible decisions for ordinary care services as well.
> 
> The bottom line is that market forces work poorly in the US system due to the lack of transparency and normal incentives. These are fixable problems, but Obamacare doubled-down on this inefficient 4 party system instead of retreating from it.


As thought provoking and insightful as usual. Thanks.


----------



## 32rollandrock

tocqueville said:


> Eagle,
> 
> I understand your skepticism, largely because our political processes do not lend themselves to building effective institutions. We seem to specialize in building 'kluges,' and instead of replacing them, we add on more 'fixes' that probably make things worse. Thus, the ACA becomes something of a Rube Goldberg contraption. And then there are all the countless compromises that had to be built into ACA...
> 
> I'm an enthusiastic support of socialized medicine so long as instead of building atop Medicare (i.e. adding still more complexity and expense to the kluge) *we wiped the slate clean and built anew*. Is that even possible?
> 
> I also know that the British, French, Canadian, and German systems generally work better than ours and for less expense. I've been on the French system and was amazed. So, for me, the road ahead would be simple: We study the comparable systems in the rest of the G7, figure out which would be the best fit for us, and replicate it. But I suppose I might as well start dreaming of switching to the metric system....


I think that this is dead on. More change is coming, I think--given the trajectories, it's pretty much inevitable. We will see if we can wipe this slate. I think that we would have been better off if Obamacare had never been implemented. That, at least, would have hastened the collapse of a fatally flawed system.


----------



## Chouan

SG_67 said:


> That's a straw man argument and you know it.
> 
> I could easily counter that public healthcare is used as a political football by politicians looking to keep themselves in office by over promising and under delivering.
> 
> Anytime a system is based on public finding, it's viability will constantly be subject to the political winds.
> 
> This entire thread has, with the exception of a few distractions, been based on the argument is whether healthcare costs and delivery are better suited to the public vs. private sector.


Not at all. I asked a question and suggested an answer. Health Care is either run by the state, or by private enterprise. If the latter the motive is profit as businesses don't operate out of altruism. It can be one or other.


----------



## Mike Petrik

32rollandrock said:


> As thought provoking and insightful as usual. Thanks.


Thank you. That is very kind of you to say, and I appreciate it.


----------



## Chouan

tocqueville said:


> Eagle,
> 
> I understand your skepticism, largely because our political processes do not lend themselves to building effective institutions. We seem to specialize in building 'kluges,' and instead of replacing them, we add on more 'fixes' that probably make things worse. Thus, the ACA becomes something of a Rube Goldberg contraption. And then there are all the countless compromises that had to be built into ACA...
> 
> I'm an enthusiastic support of socialized medicine so long as instead of building atop Medicare (i.e. adding still more complexity and expense to the kluge) we wiped the slate clean and built anew. Is that even possible?
> 
> I also know that the British, French, Canadian, and German systems generally work better than ours and for less expense. I've been on the French system and was amazed. So, for me, the road ahead would be simple: We study the comparable systems in the rest of the G7, figure out which would be the best fit for us, and replicate it. But I suppose I might as well start dreaming of switching to the metric system....


Very well put. Rather than condemn state involvement as necessarily inefficient and the profit motive as necessarily efficient, look at what other countries are doing and learn from them.


----------



## MaxBuck

Mike Petrik said:


> It has always seemed to me that the key is to remove the income tax exclusion for employer-provided healthcare, which would allow the de-coupling of health care and health care insurance from employment. Once this is done consumers will not only shop for appropriate insurance, which means much more affordable insurance covering catastrophic care only, but also shop and make sensible decisions for ordinary care services as well.


With respect (and I have a great deal of it for you), I disagree to the extent I don't believe decoupling the tax break for health insurance premiums will have any influence on anything other than increasing federal income tax revenue. There is already a limit on deductibility for executive plans, which are typically the richest plans out there. I do agree that high deductibles are a great way to encourage price-shopping for routine care, but for high-cost procedures (which I can speak directly to, since I've been an expensive customer to my insurer) there still isn't much incentive to pick the low-cost surgeon. So even with a high-deductible plan the really high-cost items can mount up in a hurry. Nonetheless, I still have a high-deductible plan and would recommend one to most consumers.



Mike Petrik said:


> The bottom line is that market forces work poorly in the US system due to the lack of transparency and normal incentives. These are fixable problems, but Obamacare doubled-down on this inefficient 4 party system instead of retreating from it.


The ACA has unquestionably implemented some measures that should reduce costs, including outcome-based reimbursement in many areas. And it's been given inadequate credit for some of these innovations, though it's far from perfect.

Again, the problem is that had the GOP engaged in discussions of how best to configure the ACA, we'd have many more innovations and fewer of the remaining problems, ideally looking more like the system initially proposed by the Heritage Foundation. Instead they claimed we didn't have a national healthcare emergency (perhaps they were right), and counted on being able to defeat the law. We see how that strategy worked out.


----------



## Langham

Chouan said:


> Not at all. I asked a question and suggested an answer. Health Care is either run by the state, or by private enterprise. If the latter the motive is profit as businesses don't operate out of altruism. It can be one or other.


It can also be both - the state-funded healthcare need not be (nor is it) reliant purely on a public-sector provision of service. Any objection to such services being provided by private businesses (or even charities) - provided this can be done at least as efficiently - is just dogma. Some health authorities are already run in such a way for certain services.


----------



## MaxBuck

Chouan said:


> Why? So that health care can be run for the benefit of businesses in order to make profits and help their shareholders?


I recommend reviewing the performance of the agricultural, industrial and commercial sectors of the Soviet Union and its Eastern Bloc satellites for evidence that avoidance of the profit motive does not lead to increased efficiencies nor greater product availability. It's tempting to blame the ills of society on greed, but Gordon Gekko had at least one thing right: greed (modestly regulated) is in fact a good thing in an economy. To the extent western European nations have better healthcare efficiencies, the lack of economic competition is unlikely to be the reason.

Yeah, I'm a capitalist, and damn proud of it.


----------



## eagle2250

tocqueville said:


> Eagle,
> 
> I understand your skepticism, largely because our political processes do not lend themselves to building effective institutions. We seem to specialize in building 'kluges,' and instead of replacing them, we add on more 'fixes' that probably make things worse. Thus, the ACA becomes something of a Rube Goldberg contraption. And then there are all the countless compromises that had to be built into ACA...
> 
> I'm an enthusiastic support of socialized medicine so long as instead of building atop Medicare (i.e. adding still more complexity and expense to the kluge) we wiped the slate clean and built anew. Is that even possible?
> 
> I also know that the British, French, Canadian, and German systems generally work better than ours and for less expense. I've been on the French system and was amazed. So, for me, the road ahead would be simple: We study the comparable systems in the rest of the G7, figure out which would be the best fit for us, and replicate it. But I suppose I might as well start dreaming of switching to the metric system....


My friend, if we had people in office as responsible and realistic as yourself, I suspect I would not be as skeptical as to the potential for such a program to be successful. Why is it that our representatives in Washington cannot learn from the good examples of others? :icon_scratch:


----------



## Chouan

MaxBuck said:


> I recommend reviewing the performance of the agricultural, industrial and commercial sectors of the Soviet Union and its Eastern Bloc satellites for evidence that avoidance of the profit motive does not lead to increased efficiencies nor greater product availability. It's tempting to blame the ills of society on greed, but Gordon Gekko had at least one thing right: greed (modestly regulated) is in fact a good thing in an economy. To the extent western European nations have better healthcare efficiencies, the lack of economic competition is unlikely to be the reason.
> 
> Yeah, I'm a capitalist, and damn proud of it.


To repeat, for the hard of understanding, "Rather than condemn state involvement as necessarily inefficient and the profit motive as necessarily efficient, look at what other countries are doing and learn from them."


----------



## Mike Petrik

MaxBuck said:


> With respect (and I have a great deal of it for you), I disagree to the extent I don't believe decoupling the tax break for health insurance premiums will have any influence on anything other than increasing federal income tax revenue. There is already a limit on deductibility for executive plans, which are typically the richest plans out there. I do agree that high deductibles are a great way to encourage price-shopping for routine care, but for high-cost procedures (which I can speak directly to, since I've been an expensive customer to my insurer) there still isn't much incentive to pick the low-cost surgeon. So even with a high-deductible plan the really high-cost items can mount up in a hurry. Nonetheless, I still have a high-deductible plan and would recommend one to most consumers.


Thanks Max. The reason why I believe that the removal of the tax break is important is that it is the tax break that makes it advantageous for employers to offer insurance as non-taxable compensation. This has prevented the normal development of a mature consumer health insurance market (such as exists for property and casualty insurance). In order for market forces to operate efficiently, I think it is essential for individuals to purchase insurance directly rather than acquire it through employers, and I don't think that can happen as long as employers can offer insurance as tax-free compensation.


----------



## Mike Petrik

MaxBuck said:


> The ACA has unquestionably implemented some measures that should reduce costs, including outcome-based reimbursement in many areas. And it's been given inadequate credit for some of these innovations, though it's far from perfect.
> 
> Again, the problem is that had the GOP engaged in discussions of how best to configure the ACA, we'd have many more innovations and fewer of the remaining problems, ideally looking more like the system initially proposed by the Heritage Foundation. Instead they claimed we didn't have a national healthcare emergency (perhaps they were right), and counted on being able to defeat the law. We see how that strategy worked out.


I hope these innovations work, but I'm skeptical. They amount to rules rather than markets incenting people to make rational decisions. I'm not an expert on the Heritage Foundation proposal, but I've always thought its "mandate" proposal made policy sense in order to avoid "free riders," though only on a state rather than federal level (which would have avoided the knotty constitutional issue). States could have experimented with how rich a policy is mandated. A federal mandate is doomed to only get richer and therefore become unsustainable, I think. First figure out the level of care that no hospital can turn away, then mandate insurance for that level of care only. Many people will opt to pay for richer policies, but that would be up to them. The ACA doubles down on burdening employers with administering something that has nothing to do with their business, and perversely incents employers to offer more non-taxable insurance at the expense of taxable wages. Individuals should purchase health care just as they purchase housing and food, and insure only against costs that they determine to be catastrophic. Insuring against common ailments is like insuring against the dog knocking over your living room lamp.


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## SG_67

Chouan said:


> Not at all. I asked a question and suggested an answer. Health Care is either run by the state, or by private enterprise. If the latter the motive is profit as businesses don't operate out of altruism. It can be one or other.


I'm not denying profit is a motive in the private system, but you suggest that when it's run by the government that it is altruistic.

Are you suggesting that politicians aren't given to avarice, greed and the desire for political power? Look at how social security and Medicare are kicked about every 4 years when elections come about. Here are politicians using social programs to further their own careers and self interest.


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## 32rollandrock

SG_67 said:


> I'm not denying profit is a motive in the private system, but you suggest that when it's run by the government that it is altruistic.
> 
> *Are you suggesting that politicians aren't given to avarice, greed and the desire for political power? * Look at how social security and Medicare are kicked about every 4 years when elections come about. Here are politicians using social programs to further their own careers and self interest.


Not in Illinois. How dare you suggest such a thing!


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## SG_67

32rollandrock said:


> Not in Illinois. How dare you suggest such a thing!


Good one!


----------



## Chouan

SG_67 said:


> I'm not denying profit is a motive in the private system, but you suggest that when it's run by the government that it is altruistic.
> 
> Are you suggesting that politicians aren't given to avarice, greed and the desire for political power? Look at how social security and Medicare are kicked about every 4 years when elections come about. Here are politicians using social programs to further their own careers and self interest.


There's a difference between the government and the state. In the UK, for example, the NHS is run by the state, by civil servants, not by the government, by politicians. Although the government, the party in power at Westminster, has a Minister responsible for the NHS, their ability to do anything but change budgets is extremely limited. Even an attempt to cut the NHS budget would probably result in MPs of all Parties voting against such a measure. Essentially the NHS is self-running, with very little opportunity for politicians at any level to find any means of cashing in, either financially or politically.
The NHS was introduced for almost entirely altruistic reasons, with another, rather less obvious reason. There was considerable political unrest in the UK post-WW1, when those who had served didn't return to the "Land fit for Heroes" that they'd been promised. The government of 1945 knew that the UK would face more unrest if that promise wasn't kept, the Welfare State was both altruistic, in the sense of creating a "Land fit for Heroes", and to prevent post-war unrest. It has done the job, both jobs, ever since.


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## MaxBuck

Mike Petrik said:


> Thanks Max. The reason why I believe that the removal of the tax break is important is that it is the tax break that makes it advantageous for employers to offer insurance as non-taxable compensation. This has prevented the normal development of a mature consumer health insurance market (such as exists for property and casualty insurance). In order for market forces to operate efficiently, I think it is essential for individuals to purchase insurance directly rather than acquire it through employers, and I don't think that can happen as long as employers can offer insurance as tax-free compensation.


First, individuals buying insurance on the open market do not have the ability to risk-pool in the way that group-insurance allows for. Such a loss can make insurance unaffordable for those in the wrong demographic or with unfortunate personal health history. So I'm wary of a loss of risk pooling for that reason.

Second, I don't think deductability of insurance premiums need have anything to do with "individual purchase." As a self-employed professional I'm able to deduct my HI premiums even as I shop for and buy my own insurance (unfortunately with no risk pooling). Again, I don't see deductability and group purchase as necessarily being close-coupled the way you apparently do. Maybe that's a result of buying my own insurance on ehealthinsurance.com for the past 7 years.


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## MaxBuck

Chouan said:


> To repeat, for the hard of understanding, "Rather than condemn state involvement as necessarily inefficient and the profit motive as necessarily efficient, look at what other countries are doing and learn from them."


I was responding to your comment that appeared to depreciate the capitalist system, talking about healthcare benefiting shareholders, as though there were something fundamentally wrong with that. Repeated for the "hard of understanding."


----------



## MaxBuck

Mike Petrik said:


> I hope these innovations work, but I'm skeptical. They amount to rules rather than markets incenting people to make rational decisions. I'm not an expert on the Heritage Foundation proposal, but I've always thought its "mandate" proposal made policy sense in order to avoid "free riders," though only on a state rather than federal level (which would have avoided the knotty constitutional issue). States could have experimented with how rich a policy is mandated. A federal mandate is doomed to only get richer and therefore become unsustainable, I think. First figure out the level of care that no hospital can turn away, then mandate insurance for that level of care only. Many people will opt to pay for richer policies, but that would be up to them. The ACA doubles down on burdening employers with administering something that has nothing to do with their business, and perversely incents employers to offer more non-taxable insurance at the expense of taxable wages. Individuals should purchase health care just as they purchase housing and food, and insure only against costs that they determine to be catastrophic. Insuring against common ailments is like insuring against the dog knocking over your living room lamp.


I agree wholeheartedly that healthcare should be administered at the state level (along with a great many other things the federal government has put its grubby mitts into), and also that catastrophic coverage is the sensible approach. My wife and I deleted dental insurance coverage a few years ago when we realized what a silly concept it really was: paying 25% or more to administer reimbursement that we could as easily have just paid without the added fee.


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## 32rollandrock

MaxBuck said:


> I agree wholeheartedly that healthcare should be administered at the state level (along with a great many other things the federal government has put its grubby mitts into), and also that catastrophic coverage is the sensible approach. My wife and I deleted dental insurance coverage a few years ago when we realized what a silly concept it really was: paying 25% or more to administer reimbursement that we could as easily have just paid without the added fee.


I don't even know why they call it insurance. Same thing with vision plans. It should be called paying-on-installment plan.


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## Chouan

MaxBuck said:


> I was responding to your comment that appeared to depreciate the capitalist system, talking about healthcare benefiting shareholders, as though there were something fundamentally wrong with that. Repeated for the "hard of understanding."


Sorry. No deprecating of capitalism as such. There is room for capitalism as there is room for state control, neither excludes the other. However, that a profit motive should motivate health care provision is as wrong as the state controlling the price of copper.


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## SG_67

Chouan said:


> Sorry. No deprecating of capitalism as such. There is room for capitalism as there is room for state control, neither excludes the other. However, that a profit motive should motivate health care provision is as wrong as the state controlling the price of copper.


It's also wrong to equate a profit motive with the lack of any other motive. Healthcare practitioners are also able to apply moral agency and believe it or not, actually make decisions and give opinions which actually advocate for their patients welfare. We do have a fiduciary responsibility in what we do.

I think it's somewhat ridiculous to assert that as soon as profits enter into the equation, then all morality and good purpose flies out the window.

I'm not suggesting there aren't unethical practitioners out there but for the most part we go to work every day to try to help people.


----------



## SG_67

32rollandrock said:


> I don't even know why they call it insurance. Same thing with vision plans. It should be called paying-on-installment plan.


That's because the original intent of insurance has been lost. Car insurance really is the model; if stolen or wrecked, your car insurance helps you recover the cost.

Health insurance has gone from coverage for catastrophic illness or injury, to covering routines check ups, visits to the doctor for a sore throat, etc. This is what ends up driving up costs. Over utilization coupled with a relatively low cost to the consumer.

There's a place for preventative medicine and check ups to be sure, but the idea that medical insurance is there to cover major issues is out the door and many people view it as coverage for everything. You should see how people hem and haw at having to pay a $30-40 copay!

What's is interesting is seeing patients who come though the door with high deductible plans. They actually ask questions and want to know what something will cost and if this nor that test is necessary.

If you want to control the cost of healthcare, make the end consumer more financially liable.


----------



## eagle2250

Chouan said:


> There's a difference between the government and the state. In the UK, for example, the NHS is run by the state, by civil servants, not by the government, by politicians. Although the government, the party in power at Westminster, has a Minister responsible for the NHS, their ability to do anything but change budgets is extremely limited. Even an attempt to cut the NHS budget would probably result in MPs of all Parties voting against such a measure. Essentially the NHS is self-running, with very little opportunity for politicians at any level to find any means of cashing in, either financially or politically.
> The NHS was introduced for almost entirely altruistic reasons, with another, rather less obvious reason. There was considerable political unrest in the UK post-WW1, when those who had served didn't return to the "Land fit for Heroes" that they'd been promised. The government of 1945 knew that the UK would face more unrest if that promise wasn't kept, the Welfare State was both altruistic, in the sense of creating a "Land fit for Heroes", and to prevent post-war unrest. It has done the job, both jobs, ever since.


In the US such agencies are most often staffed by civil servants as well. However the executive level leadership in such agencies/organizations is provided by what are called, Schedule C political Appointments. These are people who have proven themselves to be the most adept at kissing the successful political candidates asses and in return are rewarded with what many perceive to be "plum appointments" to such positions. Some prove themselves capable, but alas, far to many prove themselves inept and/or so politically jaundiced, doing more harm to the agencies to which they have been appointed, than good! Pretty sad state of affairs isn't it?


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## MaxBuck

Chouan said:


> Sorry. No deprecating of capitalism as such. ... that a profit motive should motivate health care provision is as wrong as the state controlling the price of copper.


"No deprecating of capitalism," then a deprecation of capitalism. Got it. In other words, capitalism is OK upon your approval of the market sector in which it may operate.


----------



## Mike Petrik

SG_67 said:


> That's because the original intent of insurance has been lost. Car insurance really is the model; if stolen or wrecked, your car insurance helps you recover the cost.
> 
> Health insurance has gone from coverage for catastrophic illness or injury, to covering routines check ups, visits to the doctor for a sore throat, etc. This is what ends up driving up costs. Over utilization coupled with a relatively low cost to the consumer.
> 
> There's a place for preventative medicine and check ups to be sure, but the idea that medical insurance is there to cover major issues is out the door and many people view it as coverage for everything. You should see how people hem and haw at having to pay a $30-40 copay!
> 
> What's is interesting is seeing patients who come though the door with high deductible plans. They actually ask questions and want to know what something will cost and if this nor that test is necessary.
> 
> If you want to control the cost of healthcare, make the end consumer more financially liable.


This is exactly right in my view. It is true that consumers are not always rational and some will avoid preventative care unless it is fully paid for. The good news is that insurers are rational and they often voluntarily fully cover preventative care, even in some high deductible plans, precisely because they have determined that by preventing serious illnesses such care also serves to prevent serious expenditures.

I am not a libertarian. I do acknowledge a desireable role for government in providing a safety net to the extent a society can afford such. But prudence requires that we at least try to calibrate policy so that it avoids both indifference to suffering as well as a nanny state composed of citizen dependents. As a volunteer in many charities I have learned that in America most cases of economic hardship can be traced to poor decisions, and usually not just one. People are not perfectly rational, which explains not only why markets work imperfectly but also why people make decisions that are both self-indulgent and self-destructive. Responding to these hardships with indifference is unacceptably callous in my view. But responding too generously is also callous in that it serves to reward and therefore reinforce poor decision-making, thereby creating a dependent class. These questions emerge in many public policy decision-making. It is fair to ask whether a people who consider themselves self-governed should outlaw or regulate perfectly harmless soft drinks because some people choose to misuse. That may sound like a unfairly leading question, but I don't mean it to be. There may well be a role for government to protect us from our own decisions, but it should at least make a person who values personal freedom squeemish. Conservatives need to better appreciate the need for some dose of paternalism. Liberals need to better appreciate the virtues embedded in the lessons of hardship.


----------



## 32rollandrock

SG_67 said:


> That's because the original intent of insurance has been lost. Car insurance really is the model; if stolen or wrecked, your car insurance helps you recover the cost.
> 
> Health insurance has gone from coverage for catastrophic illness or injury, to covering routines check ups, visits to the doctor for a sore throat, etc. This is what ends up driving up costs. Over utilization coupled with a relatively low cost to the consumer.
> 
> There's a place for preventative medicine and check ups to be sure, but the idea that medical insurance is there to cover major issues is out the door and many people view it as coverage for everything. You should see how people hem and haw at having to pay a $30-40 copay!
> 
> What's is interesting is seeing patients who come though the door with high deductible plans. They actually ask questions and want to know what something will cost and if this nor that test is necessary.
> 
> If you want to control the cost of healthcare, make the end consumer more financially liable.


I think these are good points. No offense, but I loathe and distrust doctors (that is speaking generally, of course). I have experienced way more bad or mediocre physicians than good ones. I go to the doctor only when absolutely necessary, and I do not understand the concept of "wellness" care. I do not take my car in for an engine overhaul when it is running fine. I understand that I should lose weight, not eat so many fatty foods and not drink so much--I do not need anybody to tell me that, nor do I need anyone to tell me how to do these things. It offends me when I see hospitals promoting wellness care and how affordable it is. To me, wellness care should be a butt scope for $100 or so. That makes sense for my insurer, who reduces the odds of huge cost down the road, and it makes sense for me. But a butt scope costs a lot more than that, even though I am insured. Perhaps I should start a FundRazr campaign featuring a picture of my ass: Look at my butt. Help me keep it perfect.

When I have asked doctors about the cost of procedures, they look at me as if I have two heads,as if in shock that someone would go outside the price-is-no-object box. One in particular comes to mind. I was perfectly healthy, in the office to get some sort of drug (I can't remember what, exactly) and he insisted on a complete physical. Pretty much told me no physical, no drugs. I told him I saw no point in a complete physical in my early 40s when I had no health complaints other than I need drugs that, by all rights, should have been available without a prescription. He proceeded to boast that he had saved some guy's life just last week by performing a complete physical and finding some sort of rare, lingering disease that, left undiagnosed/untreated, would have had him six feet under before Christmas. I felt like I was dealing with an appliance salesman. The bill, even with insurance, came to $600, most of it for an array of lab tests that revealed nothing amiss.

But I digress.

I also know people who go to the doctor way too much. Perhaps the solution is to start metering visits. Someone like me, who sees a doctor once every three or four years or even longer (this isn't counting the quack who wouldn't renew Albuterol unless I paid him for $400 or so for an office visit once a year), should be charged less than the hypochondriac who rushes to the doctor if his hiccups don't cease after five minutes. Kind of like those car insurance policies where your deductible decreases the longer you go without making a claim. After three or four years with no costs aside from my asthma medicine, I think I should get a free, or steeply discounted, butt scope.


----------



## Chouan

MaxBuck said:


> "No deprecating of capitalism," then a deprecation of capitalism. Got it. In other words, capitalism is OK upon your approval of the market sector in which it may operate.


Exactly right. Capitalism is good for some things, state control is good for others.


----------



## 32rollandrock

Mike Petrik said:


> This is exactly right in my view. It is true that consumers are not always rational and some will avoid preventative care unless it is fully paid for. The good news is that insurers are rational and they often voluntarily fully cover preventative care, even in some high deductible plans, precisely because they have determined that by preventing serious illnesses such care also serves to prevent serious expenditures.
> 
> I am not a libertarian. I do acknowledge a desireable role for government in providing a safety net to the extent a society can afford such. But prudence requires that we at least try to calibrate policy so that it avoids both indifference to suffering as well as a nanny state composed of citizen dependents. As a volunteer in many charities I have learned that in America most cases of economic hardship can be traced to poor decisions, and usually not just one. People are not perfectly rational, which explains not only why markets work imperfectly but also why people make decisions that are both self-indulgent and self-destructive. Responding to these hardships with indifference is unacceptably callous in my view. But responding too generously is also callous in that it serves to reward and therefore reinforce poor decision-making, thereby creating a dependent class. These questions emerge in many public policy decision-making. It is fair to ask whether a people who consider themselves self-governed should outlaw or regulate perfectly harmless soft drinks because some people choose to misuse. That may sound like a unfairly leading question, but I don't mean it to be. There may well be a role for government to protect us from our own decisions, but it should at least make a person who values personal freedom squeemish. Conservatives need to better appreciate the need for some dose of paternalism. Liberals need to better appreciate the virtues embedded in the lessons of hardship.


Excellent points again. You are making a habit of this.


----------



## MaxBuck

Mike Petrik said:


> This is exactly right in my view. It is true that consumers are not always rational and some will avoid preventative care unless it is fully paid for. The good news is that insurers are rational and they often voluntarily fully cover preventative care, even in some high deductible plans, precisely because they have determined that by preventing serious illnesses such care also serves to prevent serious expenditures.
> 
> I am not a libertarian. I do acknowledge a desireable role for government in providing a safety net to the extent a society can afford such. But prudence requires that we at least try to calibrate policy so that it avoids both indifference to suffering as well as a nanny state composed of citizen dependents. As a volunteer in many charities I have learned that in America most cases of economic hardship can be traced to poor decisions, and usually not just one. People are not perfectly rational, which explains not only why markets work imperfectly but also why people make decisions that are both self-indulgent and self-destructive. Responding to these hardships with indifference is unacceptably callous in my view. But responding too generously is also callous in that it serves to reward and therefore reinforce poor decision-making, thereby creating a dependent class. These questions emerge in many public policy decision-making. It is fair to ask whether a people who consider themselves self-governed should outlaw or regulate perfectly harmless soft drinks because some people choose to misuse. That may sound like a unfairly leading question, but I don't mean it to be. There may well be a role for government to protect us from our own decisions, but it should at least make a person who values personal freedom squeemish. Conservatives need to better appreciate the need for some dose of paternalism. Liberals need to better appreciate the virtues embedded in the lessons of hardship.


Exceptionally well-stated. You've got my vote!


----------



## Chouan

MaxBuck said:


> "No deprecating of capitalism," then a deprecation of capitalism. Got it. In other words, capitalism is OK upon your approval of the market sector in which it may operate.


On further reflection, yes, absolutely. I really wouldn't be happy with the army operated as a commercial concern, for example. Although the Italian City States tended to use condottiere rather than a regular army, they didn't work out terribly well.


----------



## Langham

Chouan said:


> On further reflection, yes, absolutely. I really wouldn't be happy with the army operated as a commercial concern, for example. Although the Italian City States tended to use condottiere rather than a regular army, they didn't work out terribly well.


It's not necessary to use condotierre as an example of mercenary units. In fact our own army used mercenaries very extensively until nearly the 20th century - indeed there is little difference between the Swiss, German and Italian legions who fought for the British in South Africa, India, North America and the Crimea, and the present-day Gurkha Regiment. Very effective fighters, too, the Gurkhas.


----------



## 32rollandrock

Langham said:


> It's not necessary to use condotierre as an example of mercenary units. In fact our own army used mercenaries very extensively until nearly the 20th century - indeed there is little difference between the Swiss, German and Italian legions who fought for the British in South Africa, India, North America and the Crimea, and the present-day Gurkha Regiment. Very effective fighters, too, the Gurkhas.


Then there's Blackwater.


----------



## MaxBuck

Chouan said:


> Exactly right. Capitalism is good for some things, state control is good for others.


In the US, our experience with government-run healthcare currently is offered up by the Veterans Administration (VA). The care provided to our military veterans by that organization is terrible. So perhaps state control is good in some nations, not so good in others.

I'm eager to learn from the successes of other countries, but not so eager that I look forward to federal control of healthcare.


----------



## SG_67

Chouan said:


> On further reflection, yes, absolutely. I really wouldn't be happy with the army operated as a commercial concern, for example. Although the Italian City States tended to use condottiere rather than a regular army, they didn't work out terribly well.


A point made lucid by none other than Machiavelli himself.

No one is suggesting the privatization of the military or the police. Organized violence is something that should be the monopoly of the state, that way it is held accountable.

What we are talking about are enterprises that are best operated in a private sector. Of course there is a role for the state to play in ensuring public safety and the proper licensure and qualification of practitioners, but the actual form of payment and delivery of services should be regulated via the market.

This has been alluded to by others far more eloquently, but one of the reasons our healthcare system is "broken" is because there are too many players and those who are actually at the center are not assuming as much risk. Practitioners are going to get paid and the patient's risk is capped.

On the other hand we have to ask ourselves, what would medicine be like here if the profit motive were suspended?

Would specialist be plentiful? Would testing be available readily as it is now for elective procedures (MRI arthrogram for a rotator cuff tear, etc.).

I think all too often people think that if we socialize medicine the way it is done in other parts of the world that we get to have our cake and eat it too; we get to keep our access to readily available medical care and keep costs down.

This is just not realistic nor sustainable.


----------



## Chouan

SG_67 said:


> A point made lucid by none other than Machiavelli himself.
> 
> No one is suggesting the privatization of the military or the police. Organized violence is something that should be the monopoly of the state, that way it is held accountable.
> 
> What we are talking about are enterprises that are best operated in a private sector. Of course there is a role for the state to play in ensuring public safety and the proper licensure and qualification of practitioners, but the actual form of payment and delivery of services should be regulated via the market.
> 
> This has been alluded to by others far more eloquently, but one of the reasons our healthcare system is "broken" is because there are too many players and those who are actually at the center are not assuming as much risk. Practitioners are going to get paid and the patient's risk is capped.
> 
> On the other hand we have to ask ourselves, what would medicine be like here if the profit motive were suspended?
> 
> Would specialist be plentiful? Would testing be available readily as it is now for elective procedures (MRI arthrogram for a rotator cuff tear, etc.).
> 
> I think all too often people think that if we socialize medicine the way it is done in other parts of the world that we get to have our cake and eat it too; we get to keep our access to readily available medical care and keep costs down.
> 
> This is just not realistic nor sustainable.


So, in the way that I was accused, probably too strong a word, but I can't think of a better one, of being selective when it comes to capitalism, you are being selective when it comes to state control. 
The fact is medicine in most of Europe works well with no profit motive, so, unless Americans have a different moral compass to Europeans, it should work equally well in the US.


----------



## Chouan

Langham said:


> It's not necessary to use condotierre as an example of mercenary units. In fact our own army used mercenaries very extensively until nearly the 20th century - indeed there is little difference between the Swiss, German and Italian legions who fought for the British in South Africa, India, North America and the Crimea, and the present-day Gurkha Regiment. Very effective fighters, too, the Gurkhas.


The difference being that the Gurkhas are mercenaries fighting for the regular armed forces of a state. The Gurkhas aren't a commercial concern who *are* the armed forces of a state.


----------



## Chouan

SG_67 said:


> No one is suggesting the privatization of the military or the police. Organized violence is something that should be the monopoly of the state, that way it is held accountable.


Quite. So should health care.



SG_67 said:


> On the other hand we have to ask ourselves, what would medicine be like here if the profit motive were suspended?
> 
> Would specialist be plentiful? Would testing be available readily as it is now for elective procedures (MRI arthrogram for a rotator cuff tear, etc.).
> 
> I think all too often people think that if we socialize medicine the way it is done in other parts of the world that we get to have our cake and eat it too; we get to keep our access to readily available medical care and keep costs down.
> 
> This is just not realistic nor sustainable.


Yet the fact is that in countries where the state controls medicine specialists are available, whether they are plentiful would be hard to define, certainly testing is available when and as required. Why isn't it realistic or sustainable?


----------



## eagle2250

Firing up the computer this AM, the first headline I read on the Yahoo news feed was an AP article titled "US Reports 100 Billion Dollars Spent on Erroneous/Fraudulent Payments In 2013. The Medicare portion of the total was $36 billion and the Medicaid portion of those fraudulent payments was $12 billion, as I recall. Other entitlement programs accounted for the remainder of the fraudulent expenditures. Is it any wonder the taxpayers are fed up and are skeptical? :icon_scratch:


----------



## SG_67

Chouan said:


> Quite. So should health care.
> 
> Yet the fact is that in countries where the state controls medicine specialists are available, whether they are plentiful would be hard to define, certainly testing is available when and as required. Why isn't it realistic or sustainable?


Not to drone on about the NHS, but do you see an 18 week wait as reasonable for elective care?

This is the NHS goal. And what do you think this does? It makes 18 weeks the benchmark by which access is measured. Even this is difficult to achieve.

If I told a patient I could not get him in before 18 weeks, guess what would happen to my practice?


----------



## Chouan

SG_67 said:


> Not to drone on about the NHS, but do you see an 18 week wait as reasonable for elective care?
> 
> This is the NHS goal. And what do you think this does? It makes 18 weeks the benchmark by which access is measured. Even this is difficult to achieve.
> 
> If I told a patient I could not get him in before 18 weeks, guess what would happen to my practice?


But if the expectation is 18 weeks for a non-urgent operation what would be the problem? You would refer the patient for the procedure and it would be done. The patient would know that if they went to another practice the target would also be 18 weeks, so there would be no need for them to leave your practice. The only reason that I know of for people leaving one practice for another, apart from leaving the area, is if the GP either isn't very good, or isn't very pleasant.
There is also the going private option, in which the patient pays for the procedure themselves. Usually expensive, but no more expensive than seems to be the case in the US. Private Medical Insurance is also available in case one wishes to invest in such a scheme. Paying into the state scheme is compulsory, however.
Urgent procedures are carried out with urgency, however, dependent upon the degree of urgency.


----------



## Langham

^^The 18-week benchmark was actually introduced to speed things up. Patients now have the right to receive their treatment within 18 weeks. Non-urgent treatment that is, where presumably the delay is inconsequential to the prognosis.


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## justonemore

oooofff.... You missed the main term.... "Elective care"... Medical care that is not needed but the patient decides to have it anyways... Non emergencies...And in fact, secondary to treating patients with actual medical problems. While I undersatnd that strippers want bigger boobies "right away", I don't myself put them into the high priority category... Of course profit is profit so U.S. med pros want to make sure they can treat the wealthy before the poor. Over here,we have everyone insured. I can't buy a new jag every year but we do take 4 vacations a year. Imay not have a multi million doallr house, but basic math to me states that home ownership is a losing battle (taxes, property expenses, insurance, etc)...I myself find the "American dream"* of home ownership to be a scam.... A 30 year loan? 15? The American dream is actually the banker's dream. MY rent here is absurd, but it certainly doesn't reach the problems of U.S. property ownership. My health insurance (and all other forms of insurance) are equally absurd... But... They have worked welll from day one.


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## SG_67

Chouan said:


> But if the expectation is 18 weeks for a non-urgent operation what would be the problem? You would refer the patient for the procedure and it would be done. The patient would know that if they went to another practice the target would also be 18 weeks, so there would be no need for them to leave your practice. The only reason that I know of for people leaving one practice for another, apart from leaving the area, is if the GP either isn't very good, or isn't very pleasant.
> There is also the going private option, in which the patient pays for the procedure themselves. Usually expensive, but no more expensive than seems to be the case in the US. Private Medical Insurance is also available in case one wishes to invest in such a scheme. Paying into the state scheme is compulsory, however.
> Urgent procedures are carried out with urgency, however, dependent upon the degree of urgency.


18 weeks is a third of a year! Roughly 4 months to get treatment.

As for going private, you said it brother! Why should only those with money to go private or to fly to the U.S. have that option? As for medical insurance, it's such a small part of the equation over there, compared to the NHS that the risk pool is too small and premiums likely higher. All the while, the individual is still paying into a system that he does not like.

This is a choice that the Brits have made. If you tell someone here in the U.S. that they have to wait 18 weeks for a procedure, they would be appalled and quickly seek out another practitioner.

This is from the BBC, hardly a right wing group:

https://www.bbc.com/news/health-25845106

One could easily substitute the letters "NHS" for "VA" and you'd have a story very similar to what we're talking about here.

In the end, each society gets to determine for itself how to organize itself and to what extent the government intrudes upon personal freedoms and choices. There is a lot that is informed by the culture and by history. Socialism is a product of 19th century Europe and we see many remnants of this there. From publically funded social programs, schools and healthcare. Sometimes these things work well and at times they don't.

I'm not an education expert, but I somehow think that it is easier to budget for schools as the utilization is fairly predictable and the state is not responsible for cradle to grave education. Even factoring in public universities and colleges, the state is responsible for 22 years of the citizens life.

Healthcare is different. The costs for an individual are hardly known and if the state is going to be responsible for literally cradle to grave benefits, the costs can be considerably higher and unpredictable.

We face much the same problem here with Medicare. When MC was first enacted during the Johnson administration, the average life expectancy for a man was roughly 66 years and for a woman 73. Now the average life expectancy is about 76 and 78 respectively. Medicare covered an individual from 65 which means that it went from having to cover lives for 1-2 years to now covering lives for 12-13 years. Add to that the sophistication of modern medicine and the ability to extend life and you can see how costs can quickly run out of control. I see no reason why the UK's NHS is immune from this math.

There really is no way to control costs without sacrificing quality of care...period! Controlling costs means controlling access, rationing and paying less to providers. If you and your spouse sat down to figure out the budget and decided to control costs, it would come at some sacrifice. Socialized medicine is no different. Of course, another alternative would be to tax at a higher rate.

There really is no easy answer. Does the private sector hold the key? I don't know. Costs keep going up on patients in the form of higher deductibles and copays. Employers are feeling the pinch as well. Attempts to curb costs have failed to deliver and I can tell you right now that Obamacare is not going to be the answer as the bulk of those who have signed up have basically been shifted over from the Medicaid side.

I've mentioned this before but I believe part of the answer lies in making patients more financially responsible, therefore introducing true market reforms in the form of consumers seeking out and demanding cost effective medical care.


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## SG_67

Langham said:


> ^^The 18-week benchmark was actually introduced to speed things up. Patients now have the right to receive their treatment within 18 weeks. Non-urgent treatment that is, *where presumably the delay is inconsequential to the prognosis*.


You hit the nail on the head and perhaps intentionally or unintentionally, you've highlighted the problem. Who gets to decide the consequences? The bureaucracy or the individual with his/her doctor.

I would argue that waiting 4 months for a repair of a full thickness rotator cuff tear has long term functional sequela. It means a diminished quality of life.


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## eagle2250

Indeed, I will say from experience, a rotator cuff injury may not have the potential to kill the patient, but it sure puts you through a world of hurt! Having endured three shoulder surgeries, I can tell you I would not have wanted to wait four months to get the problem corrected. :crazy: However, after the surgery comes real pain...physical therapy! LOL. Never have I paid a woman so much to hurt me so badly.


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## Mike Petrik

eagle2250 said:


> Never have I paid a woman so much to hurt me so badly.


Next time try Craig's List.


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## 32rollandrock

eagle2250 said:


> Firing up the computer this AM, the first headline I read on the Yahoo news feed was an AP article titled "US Reports 100 Billion Dollars Spent on Erroneous/Fraudulent Payments In 2013. The Medicare portion of the total was $36 billion and the Medicaid portion of those fraudulent payments was $12 billion, as I recall. Other entitlement programs accounted for the remainder of the fraudulent expenditures. Is it any wonder the taxpayers are fed up and are skeptical? :icon_scratch:


The WSJ successfully convinced, contrary to the wishes of AMA, the government this spring to release figures on how much individual doctors received in Medicare payments in 2012 (I think that was the year). It was eye-opening. The AMA, rightly, pointed out that the information could be misused, but still. I ran a particular doctor who I thought was running a patient mill and, sure enough, his reimbursements were through the roof. I found it interesting that the American Medical Association was so opposed to making public how public money is being spent.


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## Langham

SG_67 said:


> You hit the nail on the head and perhaps intentionally or unintentionally, you've highlighted the problem. Who gets to decide the consequences? The bureaucracy or the individual with his/her doctor.
> 
> I would argue that waiting 4 months for a repair of a full thickness rotator cuff tear has long term functional sequela. It means a diminished quality of life.


You're right, delays in knee and hip operations are unacceptable. I should point out that I'm not a medico so I don't have my finger on all the numbers. Decisions on surgery are made by the patient's doctor or consultant, however, not some pen-pusher. I've had a few problems with joints and they were all taken care of within days, not weeks, and apart from issues with the nurses, the care I received was all quite satisfactory.

However there are plenty of dissatisfied patients who find fault with it. As you say, there is the issue of how to ration access to scarce resources. The average NHS patient consumes more resources during the last six months of life than for their entire life up to that point. There is the further issue of unhealthy lifestyles - obesity, alcoholism, substance abuse etc etc which means some patients are a disproportionate drain on resources. However, I dispute that these costs are unknown - it is more a matter of how much the state is prepared or can afford to pay.

Somehow healthcare has to be resourced whether the system is state-controlled or private - either that, or not funded at all, which might be a third alternative but scarcely acceptable. The issue of ageing populations is a problem that all developed countries face.


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## SG_67

Langham said:


> You're right, delays in knee and hip operations are unacceptable. I should point out that I'm not a medico so I don't have my finger on all the numbers. Decisions on surgery are made by the patient's doctor or consultant, however, not some pen-pusher. I've had a few problems with joints and they were all taken care of within days, not weeks, and apart from issues with the nurses, the care I received was all quite satisfactory.
> 
> However there are plenty of dissatisfied patients who find fault with it. As you say, there is the issue of how to ration access to scarce resources. The average NHS patient consumes more resources during the last six months of life than for their entire life up to that point. There is the further issue of unhealthy lifestyles - obesity, alcoholism, substance abuse etc etc which means some patients are a disproportionate drain on resources. However, I dispute that these costs are unknown - it is more a matter of how much the state is prepared or can afford to pay.
> 
> Somehow healthcare has to be resourced whether the system is state-controlled or private - either that, or not funded at all, which might be a third alternative but scarcely acceptable. The issue of ageing populations is a problem that all developed countries face.


When I suggest that the overall cost is somewhat unpredictable, I mean to suggest that there really is no way of knowing how much healthcare an individual may need over a life time. A person could live a relatively healthy life and die of natural causes without an extraordinary need for medical intervention at the end of life. Others may not. Still others may develop conditions which require decades of care and ongoing treatment. Couple this with the fact that our life spans are increasing adds an extra variable into the equation.

Then consider that the eligibility age for MC has not been raise for the nearly 50 years since the law was enacted! An increase in the eligibility age would go a long way in helping to curb some of the rising costs. There are many people working beyond 65, especially professionals. There's also the ever despised notion of means testing.

Now Medicare is only one part of the overall healthcare expenditure in the system, but it is a big one as it is precisely these folks who require medical services and ongoing treatment for chronic conditions, not to mention joint replacements as have been mentioned.

The current system is in fact unsustainable. We cannot continue to ask employers to shoulder the burden of providing healthcare coverage for employees, especially if we put mandates on employers (hourly employees working >30 hrs./week, health plans with bells and whistles and special interest mandates that vary from state to state, etc.).

I'm no lawyer but Congress seems to have a pretty expansive view of the commerce clause. Perhaps they should put this to the test to eliminate state mandates and make the purchase of health insurance open across state lines. Some of these solutions may not be politically palatable or popular, but they are examples of things that can be done to help curb the costs.


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## Earl of Ormonde

Let me make myself clear. I know it has been going on for decades BUT I don't think the private sector should be involved at all in healthcare or education.
But if they are they shouldn't be making a profit from the public funds they receive to perform public services.

BUT this whole discussion goes much deeper than this in my opinion. It should be within everyone's human nature to want to help any person in medical need without profiting from it. The private sector should want to help the health sector without taking public funds and then making a profit from extortionate fees and costs.


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## SG_67

Earl of Ormonde said:


> Let me make myself clear. I know it has been going on for decades BUT I don't think the private sector should be involved at all in healthcare or education.
> But if they are they shouldn't be making a profit from the public funds they receive to perform public services.
> 
> BUT this whole discussion goes much deeper than this in my opinion. It should be within everyone's human nature to want to help any person in medical need without profiting from it. The private sector should want to help the health sector without taking public funds and then making a profit from extortionate fees and costs.


Should farmers wake up every morning, till the soil and break their backs so that folks in the city can eat? Should they just volunteer their services in order to help their fellow man or do they deserve to make a profit?

The profit motive breeds efficiency, innovation and it's the reason why we enjoy the standard of living that we do. Without it, we'd be working on collective farms in order just to subsist.


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## Earl of Ormonde

1.Farmers aren't funded by public money.
2. There is a big difference between an individual medico earning a wage and their private sector medical service employer earning profits from public money


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## Tilton

Earl of Ormonde said:


> 1.Farmers aren't funded by public money.


:icon_scratch: You're obviously not familiar with America...


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## SG_67

Earl of Ormonde said:


> 1.Farmers aren't funded by public money.
> 2. There is a big difference between an individual medico earning a wage and their private sector medical service employer earning profits from public money


Who is the private sector employer in question? Hospitals? Most are non-profit medical centers operated by religious orders or affiliated with Universities. They may have a professional management team, but they're classified as non-profits. Physicians groups are largely independent with the exception of groups affiliated with the larger medical centers. In fact, the latter you would like as they are considered employees of the hospital and university and paid as such. Therefore, the incentive for profit is not as high.

Private companies make money off of tax payer dollars all the time. Who do you think builds roads and bridges? Where does the public sector purchase it's phones, computers, paper and other supplies from? Who builds the schools? Who supplies the public sector with cars and how do public sector employees fly about the country?



Tilton said:


> :icon_scratch: You're obviously not familiar with America...


Correct! Can anyone say Ethanol mandate?


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## Hitch

SG_67 said:


> Should farmers wake up every morning, till the soil and break their backs so that folks in the city can eat? Should they just volunteer their services in order to help their fellow man or do they deserve to make a profit?
> 
> The profit motive breeds efficiency, innovation and it's the reason why we enjoy the standard of living that we do. Without it, we'd be working on collective farms in order just to subsist.


It's the simplest thing in the world. In a free economy sellers compete against sellers and buyers and sellers both profit from every transaction. It builds wealth at astonishing rates.


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## SG_67

^ it really does force efficiency otherwise the goods and services delivered would cost more to cover the systemic inefficiency. 

The customer would look elsewhere and the void would be filled. It's not a perfect system, but one where inefficiency is ruthlessly stamped out in favor of the opposite. 

We can hold up many examples of government interdiction in private markets. In the soviet bloc, everything from cars, food, toilet paper and even the allocation of labor was controlled and planned. Goods and services were not free for price discovery and the consumer was without choice. Think of the long lines of people cued for toilet paper.

Without free enterprise, profit motive and competition, inefficiency runs amok. This is shown time and again in economic systems. Healthcare is no exception.


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## 32rollandrock

SG_67 said:


> Correct! Can anyone say Ethanol mandate?


It ain't just ethanol. The farm subsidy and crop insurance program is nothing short of scandalous. Makes food stamps look like petty cash.


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## vpkozel

What kills me is that the government really thinks that ethanol is helping. If every inch of arable land in the US was used to grow corn for ethanol, we still couldn't come close to satisfying our gas needs.


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## 32rollandrock

SG_67 said:


> ^ it really does force efficiency otherwise the goods and services delivered would cost more to cover the systemic inefficiency.
> 
> The customer would look elsewhere and the void would be filled. It's not a perfect system, but one where inefficiency is ruthlessly stamped out in favor of the opposite.
> 
> We can hold up many examples of government interdiction in private markets. In the soviet bloc, everything from cars, food, toilet paper and even the allocation of labor was controlled and planned. Goods and services were not free for price discovery and the consumer was without choice. Think of the long lines of people cued for toilet paper.
> 
> Without free enterprise, profit motive and competition, inefficiency runs amok. This is shown time and again in economic systems. Healthcare is no exception.


"Communism doesn't work because people like to own stuff."--Frank Zappa

I recently The Frank Zappa Book, which is as close as he came to writing an autobiography, and I think that he would fit in well here. Talk about a man ahead of his time. The book was published in 1989 and he talks about computer viruses and a day when no one will buy physical forms of recorded music anymore but will instead order it through the cable television company. Close enough.

He describes himself as a Practical Conservative, and he speaks from experience as a man who ran his own record label, had his band on salary and had to deal with the tax code and accountants and lawyers and unions (musician and stagehand, among others) and all other sorts of things that conservatives howl about. He saw through the absurdity that was Reagan while rightfully condemning the excesses of the left. He died of prostate cancer at 52, despite yearly preventative visits to his physician. "Always get a second opinion," he said. Amen.


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## Chouan

SG_67 said:


> ^ it really does force efficiency otherwise the goods and services delivered would cost more to cover the systemic inefficiency.
> 
> The customer would look elsewhere and the void would be filled. It's not a perfect system, but one where inefficiency is ruthlessly stamped out in favor of the opposite.
> 
> We can hold up many examples of government interdiction in private markets. In the soviet bloc, everything from cars, food, toilet paper and even the allocation of labor was controlled and planned. Goods and services were not free for price discovery and the consumer was without choice. Think of the long lines of people cued for toilet paper.
> 
> Without free enterprise, profit motive and competition, inefficiency runs amok.


Does it? The most efficient line in Britain's railway system is the East Coast Main Line, run by the state. It is the only line that runs for the purpose of transport rather than profit, and has the best record for efficiency! The French, German, Spanish, Dutch and Italian rail networks are all state run and are all efficient.



SG_67 said:


> This is shown time and again in economic systems. Healthcare is no exception.


Oh, and defence, and law enforcement. Private enterprise clearly works in the economic sector, but state systems work well in health care. And defence. And law enforcement. And transport.


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## Earl of Ormonde

Chouan said:


> Does it? The most efficient line in Britain's railway system is the East Coast Main Line, run by the state. It is the only line that runs for the purpose of transport rather than profit, and has the best record for efficiency! The French, German, Spanish, Dutch and Italian rail networks are all state run and are all efficient.
> 
> Oh, and defence, and law enforcement. Private enterprise clearly works in the economic sector, but state systems work well in health care. And defence. And law enforcement. And transport.


EXACTLY.

I think the experiences and knowledge of the Europeans here and the Americans here are too far apart for this discusison ever to come to a conclusion.
Simply because, using the very VERY broadest brush strokes, the USA is a centre to right of centre market economy that focuses on the individual, the private sector and the creation of wealth, whereas Europe is mostly a social democratic centre to left of centre continent with the focus on the public sector and what is best for each population.


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## SG_67

Chouan said:


> Does it? The most efficient line in Britain's railway system is the East Coast Main Line, run by the state. It is the only line that runs for the purpose of transport rather than profit, and has the best record for efficiency! The French, German, Spanish, Dutch and Italian rail networks are all state run and are all efficient.
> 
> Oh, and defence, and law enforcement. Private enterprise clearly works in the economic sector, but state systems work well in health care. And defence. And law enforcement. And transport.


You conflate efficiency with getting there on time and don't mention cost. I suppose if we threw enough money at something we could get the trains to run on time too. But at what cost, and could a similar system be developed privately, at less cost and still get there on time and provide proper service? I'm not suggesting I have the answer, I'm simply asking the question.

As for providing for defense, bridges and roads, I suppose it's easy to just start piling on. Defense has always been something that the state provides for. The same as infrastructure. It's one thing to build bridges and roads, but we don't see the government building the cars and trains that use them.

Let's take your argument to its reductio ad absurdum; why stop at healthcare? Why not run collective farms, factories and the like. Why not centrally plan the entire economy?

Certainly if healthcare is that important food production and distribution can't be far behind. What about clothing? Why should the bourgeois be able to afford Goodyear welter shoes and the rest wear sandals? Why not take over the production and distribution of clothing so that no one is cold in the winter.

Speaking of cold, energy production and distribution. I could go on and on.

Luckily we don't have to guess at how this turns out. We have evidence before us now and historically dating back to the last century.

Defense and infrastructure are one thing and as a society we've agreed that this is a proper role for government. The rest we have thankfully decided to leave in. The hands of private industry. Our good supply is plentiful and our supermarket shelves are fully stocked.

We have access to basic goods and services at the touch of a button, literally thanks to our phones! I can go out tonight and on a whim purchase a car and not wait to enter a lottery for the chance to own one.

I can go to a medical specialist tomorrow and ask for "the works" and get it (I've actually had a patient say that to me, he wanted a whole body MRI to make sure all his joints were healthy!).


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## SG_67

Earl of Ormonde said:


> EXACTLY.
> 
> I think the experiences and knowledge of the Europeans here and the Americans here are too far apart for this discusison ever to come to a conclusion.
> Simply because, using the very VERY broadest brush strokes, the USA is a centre to right of centre market economy that focuses on the individual, the private sector and the creation of wealth, whereas Europe is mostly a social democratic centre to left of centre continent with the focus on the public sector and what is best for each population.


You're exactly right on this. Governments form in accordance to the culture of the nation. European culture for all the commonalities it has with American culture differ in certain perspectives and our governments reflect this.

That's why I don't really comment on how European societies organize themselves and the distribution of goods and services, healthcare being among them.

Societies make choices for themselves and it's best to allow changes to these system to occur organically in response to market pressures.

So my European friends, stop trying to export your way of doing things here. We're aware of how you do things and we've decided it's not the direction we want to go in.


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## Earl of Ormonde

Well, the UK govt was subsidising the manufacture of cars as late as the 1980s. And that "yank" De Lorean still owes UK govt millions for the failure of his awful car that was being built in Northern Ireland.

The UK govt also subsidised the building of trains up to the 80s. As well as most of the energy sector until the total abortion of privatisation under Satan aka Maggie Thatcher. 

Collective farms, yea, why not? Ireland had soviet farms, soviet dairies, and soviet bakeries in the 1920s. 


ONCE UPON TIME, before extreme greed set in, the govt and the will of the people was able to cover everything in the public sector.

BUT greed in the private sector and in the upper echelons of the establishment and the public sector led to justified unrest, mistrust and displeasure amongst the lowest doing all the work. For example, why should the MD of Ford UK, sitting in an office, earn SEVEN times a week that of a factory machinist producing essential parts for the engine?

And why should the same MD get a golden handshake on retirement equivalent to the annual gross salary of TEN machinists? 

GREED! The private sector! Profit! Greed! I'm alright jack, fkcu you!


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## Earl of Ormonde

SG_67 said:


> So my European friends, stop trying to export your way of doing things here. We're aware of how you do things and we've decided it's not the direction we want to go in.


Well, you can't say fairer than that. BUT, speaking only for myself now, I wouldn't try to export the European NHS system to the USA, just pointing out that is DOES work in Europe and MIGHT work in the USA.....but as you say I don't think the US market or the US culture is ready for such well meaning social democracy


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## Chouan

SG_67 said:


> You're exactly right on this. Governments form in accordance to the culture of the nation. European culture for all the commonalities it has with American culture differ in certain perspectives and our governments reflect this.
> 
> That's why I don't really comment on how European societies organize themselves and the distribution of goods and services, healthcare being among them.
> 
> Societies make choices for themselves and it's best to allow changes to these system to occur organically in response to market pressures.
> 
> So my European friends, stop trying to export your way of doing things here. We're aware of how you do things and *we've decided* it's not the direction we want to go in.


Are you speaking for the entire population of the US?


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## SG_67

Perhaps not, but our current laws and the way we're organized does reflect our collective position. 

We're a representative republic. Not everyone agrees on everything, but we agree that this is our system. If a citizen wishes to change this, he/she is able to organize political support and try to change the system. 

Twenty years ago, the idea of same sex marriage was at the very margins of the margins of society, now it's being talked about as a fait accompli. Not everyone has to agree on everything in order to effect change.

edit: Does everyone in the UK agree on everything the government does with respect to social services/healthcare?


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## Earl of Ormonde

I agree with your points there SG, but let's not forget that the governing party is not always in the majority in the House or on the Hill etc. and as such doesn't always represent the majority of the population or indeed what the majority of the population voted for. Dubya knows dat!


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## 32rollandrock

SG_67 said:


> You're exactly right on this. Governments form in accordance to the culture of the nation. European culture for all the commonalities it has with American culture differ in certain perspectives and our governments reflect this.
> 
> That's why I don't really comment on how European societies organize themselves and the distribution of goods and services, healthcare being among them.
> 
> Societies make choices for themselves and it's best to allow changes to these system to occur organically in response to market pressures.
> 
> So my European friends, stop trying to export your way of doing things here. We're aware of how you do things and we've decided it's not the direction we want to go in.


One of my pet peeves are rail enthusiasts who point to France and Spain and Japan and say "They're doing it, we should too." Cultures aside, the nations are so different from the United States in terms of population density and geography that such comparisons are meaningless. Just because choo choo trains work in other countries (and it bears mentioning that they are almost always subsidized) does not mean that they would work here. There are problems, sure, but by and large, the U.S. transportation system is among the best, if not the best, in the world. We would be much wiser if we spent money maintaining existing infrastructure rather than building unnecessary choo choo systems. Some of our highways and bridges are in appalling condition. Let's fix those before we start spending zillions on choo choo's for which no meaningful market exists.


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## MaxBuck

32rollandrock said:


> One of my pet peeves are rail enthusiasts who point to France and Spain and Japan and say "They're doing it, we should too." Cultures aside, the nations are so different from the United States in terms of population density and geography that such comparisons are meaningless. Just because choo choo trains work in other countries (and it bears mentioning that they are almost always subsidized) does not mean that they would work here. There are problems, sure, but by and large, the U.S. transportation system is among the best, if not the best, in the world. We would be much wiser if we spent money maintaining existing infrastructure rather than building unnecessary choo choo systems. Some of our highways and bridges are in appalling condition. Let's fix those before we start spending zillions on choo choo's for which no meaningful market exists.


There are places (northeast US) where population densities are sufficiently high and centers of population sufficiently close that rail transit makes sense. And trains are there, and they work. Otherwise they don't, and I speak as one who spent several summers on long train trips as a youth with marvelous memories. Fresh-caught trout in the Rockies, char broiled aboard the train and devoured in the dining car: couldn't be beat! But it's not right for today's USA.

I think the Europeans here are missing a point -- policy-makers in the US have not ignored the successes of healthcare in Europe, they just don't quite know which of the policy measures that work overseas would translate well to the US. We're working hard on making things better here.


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## SG_67

^ And there are many who use the rail system on the East Coast. It works just fine for them and I've taken it myself when travelling east.


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## 32rollandrock

MaxBuck said:


> There are places (northeast US) where population densities are sufficiently high and centers of population sufficiently close that rail transit makes sense. And trains are there, and they work. Otherwise they don't, and I speak as one who spent several summers on long train trips as a youth with marvelous memories. Fresh-caught trout in the Rockies, char broiled aboard the train and devoured in the dining car: couldn't be beat! But it's not right for today's USA.
> 
> I think the Europeans here are missing a point -- policy-makers in the US have not ignored the successes of healthcare in Europe, they just don't quite know which of the policy measures that work overseas would translate well to the US. We're working hard on making things better here.


Yes, as I mentioned previously, the Northeast Corridor is the only passenger train system that operates without a subsidy, at least, it did a few years back. NYC subway is subsidized, but that's OK.


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## Tilton

32rollandrock said:


> It ain't just ethanol. The farm subsidy and crop insurance program is nothing short of scandalous. Makes food stamps look like petty cash.


Yes. When I first moved to DC, I had a roommate who was very high-ranking professional staff in the House Ag Committee. He was pretty much against every farm bill, but that obviously wasn't his decision to make. He was, however, very good at explaining exactly what each piece of new farm bills meant not only to tax payers, but also to farmers, how farmers can game the system, and how the payouts really work. It is really mind blowing how much is spent on farm subsidies and how they really work in practice.


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## SG_67

^ Scottie Pippen of the Chicago Bulls was receiving a farm subsidy for a time.

https://dailycaller.com/2011/11/14/...incy-jones-ted-turner-received-federal-funds/


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## 32rollandrock

SG_67 said:


> ^ Scottie Pippen of the Chicago Bulls was receiving a farm subsidy for a time.
> 
> https://dailycaller.com/2011/11/14/...incy-jones-ted-turner-received-federal-funds/


So was Paul Allen. The Environmental Working Group, an interest group opposed to farm subsidies (and rightly so, in my view) once had a database online (and still may have). You could plug in the name of any person and find out if they got a farm subsidy and how much. You could also do it by location. It is fascinating how many people in Manhattan (and not the one in Kansas) received farm subsidies. A lot of this was from a program that gave subsidies to land owners by virtue of them owning land, which did nothing except artificially increase the value of farmland. In Allen's case, he received a subsidy through the conservation reserve program, which pays landowners not to farm. It is, in theory at least, not necessarily a bad thing when considered in context of all the other subsidies. In Allen's case, he owned some land in Idaho that was in conservation reserve.

Most countries have farm subsidies, but New Zealand has done away with farm subsidies entirely and managed to survive. We should do the same thing, I think.


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## SG_67

32rollandrock said:


> So was Paul Allen. The Environmental Working Group, an interest group opposed to farm subsidies (and rightly so, in my view) once had a database online (and still may have). You could plug in the name of any person and find out if they got a farm subsidy and how much. You could also do it by location. It is fascinating how many people in Manhattan (and not the one in Kansas) received farm subsidies. A lot of this was from a program that gave subsidies to land owners by virtue of them owning land, which did nothing except artificially increase the value of farmland. In Allen's case, he received a subsidy through the conservation reserve program, which pays landowners not to farm. It is, in theory at least, not necessarily a bad thing when considered in context of all the other subsidies. In Allen's case, he owned some land in Idaho that was in conservation reserve.
> 
> Most countries have farm subsidies, but New Zealand has done away with farm subsidies entirely and managed to survive. We should do the same thing, I think.


Nothing stirs social unrest quite like a food shortage. The genesis of the French Revolution can be traced in part to the increase in the price of bread.

I'm not completely against farm subsidies; we have probably the most efficient farm system in the world and one acre of land can out produce any acre from any time in history. Keeping food prices down helps low end earners to eat well.

With that said, the system is completely broken and no one wants to touch it. The examples you've cited and the daily caller article are prime examples of this. I can see helping small farmers but rich individuals who just happen to own arable land? Like anything else, the governments well intentions become absurd in very short order.


----------



## Hitch

Clearly the need for a Federal DOA has long since past.


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## SG_67

Hitch said:


> Clearly the need for a Federal DOA has long since past.


I've always maintained that if the average person on the street doesn't know why a particular government agency or cabinet dept. exists, then perhaps it's time to look at whether it is really necessary.


----------



## 32rollandrock

SG_67 said:


> Nothing stirs social unrest quite like a food shortage. The genesis of the French Revolution can be traced in part to the increase in the price of bread.
> 
> I'm not completely against farm subsidies; we have probably the most efficient farm system in the world and one acre of land can out produce any acre from any time in history. Keeping food prices down helps low end earners to eat well.
> 
> With that said, the system is completely broken and no one wants to touch it. The examples you've cited and the daily caller article are prime examples of this. I can see helping small farmers but rich individuals who just happen to own arable land? Like anything else, the governments well intentions become absurd in very short order.


The problem is, there are, for all intents and purposes, no small farms anymore, at least here in the Midwest where the government is spending zillions subsidizing corporate farms. Now, some of these corporate farms may be owned by families, but they are run like corporations, with accountants and employees and all the rest. The argument can, and has, been made that subsidies have hastened the demise of the small family farm and with it much of the rural economy of the Midwest. To some extent, that is a good thing. Economies of scale have increased efficiency and lowered food prices.

Yes, ensuring the food supply is a legitimate national interest. I think that you can do that without subsidizing zillionaires.


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## bernoulli

I think it would really help most people discussing the topic if everybody understood the diferences between private goods (the Coase theorem guarantees that when property rights are properly defined, there is no need for government intervention), common resources (fishing), natural monopolies (water and sewerage, public transportation) and public goods (defence). In the last three cases society is better off by governments either regulating markets (with or without subsidies) or providing it directly. Food production is something in the middle (private goods with undefined property rights in terms of the externalities they generate). The US chooses to regulate it and does a bad job. Same as Europe. It can be done relatively efficiently (Brazil), but it is not easy.

Healthcare provision is clearly a Natural Monopoly (or a collective good) and hence should be either regulated or provided by the state. The idea that the US ever had or will have a private system is laughable. The choice is betweeen regulation (Obamacare or how the market was regulated before) and public provision. Obamacare is new and more pervasive regulation, but make no mistake, the market was heavily regulated in the past (see Emergency Room access). Europeans choose public provision. As expected, both have benefits (more innovation and better quality in the US, higher access in Europe) and costs (higher costs in the US, less choices and more waiting times in Europe). BTW, one neat positive externality for Europe is that European countries benefit from the innovation generated by the existence of the US system. If the US goes the public provision route, the whole world suffers. One is not better than the other, they are just different systems.

For a primer on these concepts (in ppt, as to optmize opportunity costs): cmbc.ucsd.edu/content/1/docs/*public*-*goods*.ppt



​


----------



## Hitch

> . BTW, one neat positive externality for Europe is that European countries benefit from the innovation generated by the existence of the US system. If the US goes the public provision route, the whole world suffers. One is not better than the other, they are just different systems.


 This is the logic that makes stirring pigeon milk with a frog feather reasonable.


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## Chouan

SG_67 said:


> Nothing stirs social unrest quite like a food shortage. *The genesis of the French Revolution can be traced in part to the increase in the price of bread. *
> 
> I'm not completely against farm subsidies; we have probably the most efficient farm system in the world and one acre of land can out produce any acre from any time in history. Keeping food prices down helps low end earners to eat well.
> 
> With that said, the system is completely broken and no one wants to touch it. The examples you've cited and the daily caller article are prime examples of this. I can see helping small farmers but rich individuals who just happen to own arable land? Like anything else, the governments well intentions become absurd in very short order.


Bread prices had fluctuated throughout the 17th and 18th centuries, so increased bread prices were nothing new, and had never led to anything beyond "bread riots", which occurred in most years in differing parts of France. It was the other factors, that were new, that led to Revolution, not bread prices. The Republic did attempt to prevent bread riots with the introduction of the "Maximum", but without understanding the economics.


----------



## SG_67

Chouan said:


> Bread prices had fluctuated throughout the 17th and 18th centuries, so increased bread prices were nothing new, and had never led to anything beyond "bread riots", which occurred in most years in differing parts of France. It was the other factors, that were new, that led to Revolution, not bread prices. The Republic did attempt to prevent bread riots with the introduction of the "Maximum", but without understanding the economics.


That's why I said "in part".


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## Chouan

SG_67 said:


> That's why I said "in part".


As implied in my post, no part.


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## tocqueville

Chouan said:


> As implied in my post, no part.


I think we really need a thread on the causes of the French Revolution!


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## bernoulli

Is basic economics that hard to follow?



Hitch said:


> This is the logic that makes stirring pigeon milk with a frog feather reasonable.


----------



## Chouan

tocqueville said:


> I think we really need a thread on the causes of the French Revolution!


Yes, I think that I'd like that!


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## SG_67

Chouan said:


> Yes, I think that I'd like that!


Obviously anyone with first hand knowledge of the French Revolution cannot contribute, however there are ample sources that identify grain and bread prices for at least *SOME PART* in the French Revolution:

https://www.ultimatehistoryproject.com/bread.html

https://mises.org/daily/1489/What-Brought-on-the-French-Revolution

I'd also urge everyone to read Simon Schama's "Citizens: A Chronicle of the French Revolution", not just to validate any point but for an excellent history of perhaps THE pivotal political event of the past 400 years.


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## bernoulli

Best quote about the French Revolution, apocryphal of course:

Zhou Enlai, a prominent Chinese leader, when asked in the mid XXth century about the repercussions of the French Revolution: "too soon to tell"...


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## Gurdon

tocqueville said:


> I think we really need a thread on the causes of the French Revolution!


I would very much like to read what the individuals here know and understand about the French Revolution. I have read about it over the years, but not enough nor with suffecient (any) rigor, to have formed a basis for understanding it.

Schama, according to a review by Hobbsbawm quoted in Wikipedia, apparently emphasizes the Terror. Others romantacize the Revolution, some see the French Revolution as part of an epoch of revolutionary transformation that is still going on. Oh, and some see it as a bourgeoise revolution. I am not so much interested in dueling interpretations, but rather in learning what happened and why.

I am also interested in how the nation evolved in the context of its ideals. I am rather pleased by France's institutionalized secularity, established in 1905 as a means of asserting the direct relationship of the state and each citizen and curtailing the authority of the Church. Now the French state owns the churches, but lets congregations use them. The state owns and maintains Notre Dame and many other edifices and maintains tham as part of the patrimony of the nation. They even built a national mosque in Paris with the intent of installing a housebroken clergy, which didn't work out. Public employees, including teachers, cannot wear religious stuff at work. (Small crosses, little hands of Fatima, etc., are OK.) I am curious as to how this fits in with national ideals and in what ways, if any, it is related to the Revolutionary underpinnings of the modern state.

So please, learned and informed forumites, please discuss the French Revolution.

Regards,
Gurdon


----------



## Gurdon

32rollandrock said:


> Yes, as I mentioned previously, the Northeast Corridor is the only passenger train system that operates without a subsidy, at least, it did a few years back. NYC subway is subsidized, but that's OK.


I believe much of the rail transport in the NE Corridor is subsidized. I know that millions of federal dollars have been spent upgrading the track and rights of way to accommodate high speed passenger service.

Roads in the US are generally built at public expense. The interstate highway system is built and maintained at public expense. This is a public subsidy, underwriting long distance trucking to the disadvantage of the railroads. Passenger trains for many years carried mail. Postal contracts underwrote the passenger service; an indirect public subsidy. When the post office switched to air transport the railroads dropped passenger transport. I haven't time nor inclination, nor resources, to write a term paper on this topic, but these examples at least suggest an alternative reality to that of the fable of rail transit being unsuitable for the US.

The air traffic control system is a public service, and a subsidy to the airline industry.

If anybody is really interested in the history of transit boondoggles, look into the authorization, financing and construction of The National Pike.

Gurdon


----------



## Chouan

SG_67 said:


> Obviously anyone with first hand knowledge of the French Revolution cannot contribute, however there are ample sources that identify grain and bread prices for at least *SOME PART* in the French Revolution:
> 
> https://www.ultimatehistoryproject.com/bread.html
> 
> https://mises.org/daily/1489/What-Brought-on-the-French-Revolution
> 
> I'd also urge everyone to read Simon Schama's "Citizens: A Chronicle of the French Revolution", not just to validate any point but for an excellent history of perhaps THE pivotal political event of the past 400 years.


When I have more time I'll contribute some more, but for now I'd just argue that bread prices had never brought about a Revolution in France before, and that the Revolution in France would have happened when it did even if bread prices hadn't been high. Of course, some historians will list high bread prices as a factor, but if the other factors had all existed, without high bread prices, there was still sufficient factors to cause Revolution.


----------



## Langham

^ It's along time since I studied the French revolution but my residual understanding was that is was brought about by a dysfunctional system of taxation, including a hugely bloated aristocracy that enjoyed great fiscal privileges. Just googling the term will give an outline e.g.:

https://www.britannica.com/EBchecked/topic/219315/French-Revolution

French politics and social relations have long been turbulent even to the present day. Before the revolution, other countries near and far (including North America and South Africa, also Great Britain and Switzerland) were all greatly enriched by France's persecution of its Protestant minorities, who then fled, taking with them certain valuable industries.


----------



## tocqueville

Gurdon said:


> I believe much of the rail transport in the NE Corridor is subsidized. I know that millions of federal dollars have been spent upgrading the track and rights of way to accommodate high speed passenger service.
> 
> Roads in the US are generally built at public expense. The interstate highway system is built and maintained at public expense. This is a public subsidy, underwriting long distance trucking to the disadvantage of the railroads. Passenger trains for many years carried mail. Postal contracts underwrote the passenger service; an indirect public subsidy. When the post office switched to air transport the railroads dropped passenger transport. I haven't time nor inclination, nor resources, to write a term paper on this topic, but these examples at least suggest an alternative reality to that of the fable of rail transit being unsuitable for the US.
> 
> The air traffic control system is a public service, and a subsidy to the airline industry.
> 
> If anybody is really interested in the history of transit boondoggles, look into the authorization, financing and construction of The National Pike.
> 
> Gurdon


I agree with all this, which is why I believe in developing high speed, modern rail, and don't care much about its profitability. The choice to have a car-based economy is shaped as much by public policy (and federal subsidies) as it is by anything else. So let's subsidies a rail system, even if only limited to the NE corridor. In the end, we'll all be pretty grateful, especially those of us who routinely have to rely on I-95.


----------



## tocqueville

Chouan said:


> When I have more time I'll contribute some more, but for now I'd just argue that bread prices had never brought about a Revolution in France before, and that the Revolution in France would have happened when it did even if bread prices hadn't been high. Of course, some historians will list high bread prices as a factor, but if the other factors had all existed, without high bread prices, there was still sufficient factors to cause Revolution.


It should be added that historians spend a lot of time pondering the difference between a bread riot and a revolution. Bread riots are a constant. Revolutions, and certainly revolutions on the scale of 1789, are extraordinarily rare.

At least in the 1980s-90s when I studied the stuff, the focus had turned from Marx-influenced arguments about social class conflict to purely linguistic and ideological arguments. There were currents within French political culture through the 18th century that had badly undermined the monarchy and changed many people's understanding of freedom, authority, legitimacy, etc. What Bastille had to do with this is hard to pin point, but it is clear that the street movements were led by more educated people than was thought (tradesmen, not illiterate peasants), and more to the point, the emergent movement managed to win legitimacy.

Schama is a good read, but I was schooled in François Furet.


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## SG_67

tocqueville said:


> I agree with all this, which is why I believe in developing high speed, modern rail, and don't care much about its profitability. The choice to have a car-based economy is shaped as much by public policy (and federal subsidies) as it is by anything else. So let's subsidies a rail system, even if only limited to the NE corridor. In the end, we'll all be pretty grateful, especially those of us who routinely have to rely on I-95.


This is much the same argument for healthcare and not caring about profitability.

Any enterprise, be it healthcare or rail and whether publicly, and certainly privately, funded needs to consider some measure of profitability.

If unprofitable, then it means that the demand is not high enough and it should be cancelled, I see absolutely no need for high speed rail in this country. If there was a demand for it, private industry would already have filled the void.

High speed rail, like universal healthcare, is a liberal fetish and under scrutiny fails to make sense economically.


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## MaxBuck

SG_67 said:


> This is much the same argument for healthcare and not caring about profitability.
> 
> Any enterprise, be it healthcare or rail and whether publicly, and certainly privately, funded needs to consider some measure of profitability.
> 
> If unprofitable, then it means that the demand is not high enough and it should be cancelled, I see absolutely no need for high speed rail in this country. If there was a demand for it, private industry would already have filled the void.
> 
> High speed rail, like universal healthcare, is a liberal fetish and under scrutiny fails to make sense economically.


SG, I'm as capitalist as they come, but even I have to take issue with the notion that if a good or service isn't profitable it shouldn't exist.


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## bernoulli

Neither healthcare or infrastrucure are private goods. Profitability is relevant, but those are natural monopolies (or collective goods). You can be a capitalist and still understand that some level of subsidy will always exist in the case of natural monopolies. But if properly regulated those should turn a profit.


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## Earl of Ormonde

Hitch said:


> This is the logic that makes stirring pigeon milk with a frog feather reasonable.


Hitch, can you tell me, who wrote that ridiculous untruth?


----------



## Langham

SG_67 said:


> This is much the same argument for healthcare and not caring about profitability.
> 
> Any enterprise, be it healthcare or rail and whether publicly, and certainly privately, funded needs to consider some measure of profitability.
> 
> If unprofitable, then it means that the demand is not high enough and it should be cancelled, I see absolutely no need for high speed rail in this country. If there was a demand for it, private industry would already have filled the void.
> 
> High speed rail, like universal healthcare, is a liberal fetish and under scrutiny fails to make sense economically.


Indeed private industry did exactly that in the 19th century; what makes sense economically will change over time. You can safely assume there will always be a demand for convenient transport, in terms of which the train has some advantages over both aircraft and cars. The price factors and for instance hidden subsidies in the form of roadbuilding, cheap gas etc, car parking, urban design etc all have to be looked at as they will vary over time.


----------



## SG_67

MaxBuck said:


> SG, I'm as capitalist as they come, but even I have to take issue with the notion that if a good or service isn't profitable it shouldn't exist.


There are certain government services such as national security and public safety where for obvious reasons profit cannot and is not a motivation.

But when it comes to services other than that, and I include high speed rail and healthcare in the mix, then some measure of profit needs to be considered. In the grossest sense, let us assume all healthcare services as of tomorrow are brought into the public domain. There will have to be a way of paying for these services and it will likely come in the form of taxes and fees on various aspects of our economy.

At some level, the expenditure in services must either equal or not exceed the tax revenue going to fund it. If it does exceed it, then taxes will need to be increased or the money borrowed. Private industry cannot exactly print money, government can. Sooner or later government run enterprises will collapse under their own weight.

The question then becomes, who is more efficient at maintaining and holding costs down and responding to market forces. In some ways, government transcends market forces and typically will define the market.


----------



## Hitch

Earl of Ormonde said:


> Hitch, can you tell me, who wrote that ridiculous untruth?


My grandmother used to say that when things got out of hand.


----------



## MaxBuck

SG_67 said:


> ... Sooner or later government run enterprises will collapse under their own weight.
> 
> The question then becomes, who is more efficient at maintaining and holding costs down and responding to market forces. In some ways, government transcends market forces and typically will define the market.


Has the US military collapsed under its own weight?

Are efficiency and holding down of costs the only parameters for healthcare system performance we ought to be concerned about?

I think your analysis is a bit too shallow here.


----------



## SG_67

MaxBuck said:


> Has the US military collapsed under its own weight?
> 
> Are efficiency and holding down of costs the only parameters for healthcare system performance we ought to be concerned about?
> 
> I think your analysis is a bit too shallow here.


There is a natural role for government and I think the military is the quintessence of what the state, or the government, is necessary for.

As for the parameters you've discussed, let's assume that there are two systems that provides equally good healthcare. What should be the deciding factor as to which system is preferred?

It's not shallow at all. We're not talking about better medicine, but making it more affordable and available which puts is squarely in the realm of economics. Therefore, the question of efficiency and cost containment is central.


----------



## MaxBuck

SG_67 said:


> There is a natural role for government and I think the military is the quintessence of what the state, or the government, is necessary for.
> 
> As for the parameters you've discussed, let's assume that there are two systems that provides equally good healthcare. What should be the deciding factor as to which system is preferred?
> 
> It's not shallow at all. We're not talking about better medicine, but making it more affordable and available which puts is squarely in the realm of economics. Therefore, the question of efficiency and cost containment is central.


Cost containment is obviously a goal of a healthcare system, but it's not certain that privatizing it further (right now we have an odd public-private mix, with the insurance industry adding yet more complexity) will advance cost containment. Further, it's not certain that freeing the market will either reduce costs or improve care.

Markets have somewhat limited value when consumers are information-limited, which most healthcare consumers certainly are. How else to explain the billions of dollars wasted in the USA on chiropractic (for non-skeletal issues), "supplements" and other snake oil? The average person has no clue how to make informed, rational decisions regarding their health.


----------



## Earl of Ormonde

Hitch said:


> My grandmother used to say that when things got out of hand.


No, not that. I mean who wrote the unnamed text that you quoted in post no.351?


----------



## bernoulli

That would be me. Post #350. Feel free to comment on Econ 101 "untruths" as you call them.



Earl of Ormonde said:


> No, not that. I mean who wrote the unnamed text that you quoted in post no.351?


----------



## SG_67

MaxBuck said:


> Cost containment is obviously a goal of a healthcare system, but it's not certain that privatizing it further (right now we have an odd public-private mix, with the insurance industry adding yet more complexity) will advance cost containment. Further, it's not certain that freeing the market will either reduce costs or improve care.
> 
> Markets have somewhat limited value when consumers are information-limited, which most healthcare consumers certainly are. How else to explain the billions of dollars wasted in the USA on chiropractic (for non-skeletal issues), "supplements" and other snake oil? The average person has no clue how to make informed, rational decisions regarding their health.


Your point about the wasted billions on snake oil is exactly spot on! The reason for this is that the consumer is not paying the true cost. If the consumer were in charge of his medical dollars then you'd see it dry up.

I've had many patients come in who have been prescribed orthotics by other providers. These damn things can cost upwards of $600-700 depending on the materials used. Why, I ask them. "Because he said I needed them" is the answer. I'm not in the business of second guessing other professionals but when I dig deeper and ask if they were having problems I'll often times get a response that amounts to "no, but he said I might without them." I these cases the patients responsibility was minuscule compared to the actual cost of the item, sometimes as little as 10-15%.

The reason our healthcare system is out of sorts is because the pricing structure is completely broken. Patients have non idea what the true cost is. Providers have a hard time even knowing. Patients just pay a company and that's all the cost they know.

With higher deductible plans, customers ask more questions. Why? The money is coming out of their pockets before insurance comes into play. Try getting some guy to fork over $700 for something that he might need but has no need for now.

In many ways, we don't have a free market right now because there is not the counter party risk as there is in a true free market. The costs are hidden and opaque to the end user.

So when I say "free the market" I mean make it truly free and let people shop and be responsible for more. People will ask more questions and competition for business will drive up quality and reduce prices.


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## Hitch

90% of the trouble with US Health Care, pre-Obama;

"Are you putting this on your insurance? Good then lets go ahead and do... " times 27,000,000 per day.


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## 32rollandrock

Hitch said:


> 90% of the trouble with US Health Care, pre-Obama;
> 
> "Are you putting this on your insurance? Good then lets go ahead and do... " times 27,000,000 per day.


Also part of the problem as we speak.


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## bernoulli

Do you understand the real implications of a free Market healthcare system? It means that if you are not willing to pay you get no care, including emergency care. If you don't have insurance or collateral hospitals can simply choose not to treat you. It means no emergency rooms other than for the insured (or those wtp). It means no preventive care or vaccines unless one is insured or willing to pay. Healthcare is far from a private good and a free Market would leave too many externalities unadressed, and I have not even begun to consider adverse selection and moral hazard. I don't think there is a single economist in the world who advocates a complete free market solution to the healthcare issues. There are more market friendly and less market friendly solutions, but no pure free market solution.

But yeah, if you are prepared to live in a truly survival of the fittest world, maybe it could work.



SG_67 said:


> So when I say "free the market" I mean make it truly free and let people shop and be responsible for more. People will ask more questions and competition for business will drive up quality and reduce prices.


----------



## SG_67

bernoulli said:


> Do you understand the real implications of a free Market healthcare system? It means that if you are not willing to pay you get no care, including emergency care. If you don't have insurance or collateral hospitals can simply choose not to treat you. It means no emergency rooms other than for the insured (or those wtp). It means no preventive care or vaccines unless one is insured or willing to pay. Healthcare is far from a private good and a free Market would leave too many externalities unadressed, and I have not even begun to consider adverse selection and moral hazard. I don't think there is a single economist in the world who advocates a complete free market solution to the healthcare issues. There are more market friendly and less market friendly solutions, but no pure free market solution.
> 
> But yeah, if you are prepared to live in a truly survival of the fittest world, maybe it could work.


All I am suggesting is that we even out the counter party risk. Insurance companies have incentive to pay for such things as vaccines and other appropriate tests if it means reducing their cost down the road. They do that now and sometimes under mandate and also because they realize this.

I'm not suggesting a survival of the fittest scenario where we eat what we kill, but the current system where someone plunks down $20 dollars and receives 20-30 fold in care related expenses is unsustainable. More and more employers are moving toward a model that makes the employee more responsible for expenditures. Higher deductible plans and HSAs are gaining traction and a win win for both sides. If one does not consume much healthcare then the monies are saved and put toward something more meaningful. If one is a bigger consumer of healthcare then they are still covered once the deductible has been met. It's just a larger deductible now.

Perhaps over time this will incentivize people to take better care of themselves; eat well, not smoke, exercise, etc. as they realize that a greater burden of the healthcare expenses down the road will be incumbent upon them.

Of course as a society we are not going to turn our backs on the truly needy and desperate. And I don't see hospitals turning away the truly unfortunate and emergent cases.


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## justonemore

SG_67 said:


> Of course as a society we are not going to turn our backs on the truly needy and desperate. And I don't see hospitals turning away the truly unfortunate and emergent cases.


Are your best ophthalmologists public or private? If private, who can afford the care needed to protect one of their most important assests? Just the Lucky few that the Dr. decided to take pity on? The private hospitals that carry the needed Equipment certainly won't take them, will they (even the the wealthiest private practice would have a problem providing the needed machinery and there is very little incentive to buy the newest and latest)? It appears that there is no equality whatsoever in the U.S. system. If you have the money you are served. If you are poor, you go blind... What a system...


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## justonemore

SG_67 said:


> Perhaps over time this will incentivize people to take better care of themselves; eat well, not smoke, exercise, etc. as they realize that a greater burden of the healthcare expenses down the road will be incumbent upon them.
> 
> .


Do accidents not happen in the U.S. or is it all down to the individual to "take better care of themselves"?


----------



## justonemore

SG_67 said:


> So when I say "free the market" I mean make it truly free and let people shop and be responsible for more. People will ask more questions and competition for business will drive up quality and reduce prices.


Or better yet.. Have universal health care and not rely on the ignorant masses to be informed as to high tech medical solutions. Are you an expert in engineering? Or do you rely on the experts? Are you an expert at the costs behind engineering? Do you think with a bit of study and a few questions you'lll be equal to a lawyer when it comes down to a lawsuit? Questions only go so far compared to expertise. Or are you trying to state that a lawyer asking questions will be able to compare medical care compared `to an engineer compared to any other expert that has studied and worked in the field?


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## justonemore

Once again.... 

My choice here for serious care will always be the public hospital. They have the most serious Equipment. They have the best trained staff. They have anything that one might need for serious medical care. And....They take everyone (not just drs, lawyers, etc)

If I want comfort, a private room, a well cooked meal, and nurses kissing my rear...I use my private insurance and go to a prvate facility but they certainly don't have what it takes to care for major cases and of course, you need private insurance in order to saty for more than "emergency" reasons......


----------



## SG_67

justonemore said:


> Once again....
> 
> My choice here for serious care will always be the public hospital. They have the most serious Equipment. They have the best trained staff. They have anything that one might need for serious medical care. And....They take everyone (not just drs, lawyers, etc)


----------



## justonemore

SG_67 said:


>


And funny enough you respond with a video that seems to contradict your reasoning. Did you bother reading my previous post where I stated that my wife was transfered from a private hospital to a public one due to lack of proper Equipment and knowledge? This was for both births. When the Sh*t hits the fan, it's time to rely on the federal system versus the blood sucking private sytstem that relies on good food and rear kissing nurses to make a buck... In a health care system, 7 million people giving $10 to a public medical system that includes all is better than 10 people giving 7 million to a private sytem that exludes all but the 10(especially when it comes down to the health of society in general).. Or is it all supposed to be about profit?


----------



## 32rollandrock

justonemore said:


> Once again....
> 
> My choice here for serious care will always be the public hospital. They have the most serious Equipment. They have the best trained staff. They have anything that one might need for serious medical care. And....They take everyone (not just drs, lawyers, etc)
> 
> If I want comfort, a private room, a well cooked meal, and nurses kissing my rear...I use my private insurance and go to a prvate facility but they certainly don't have what it takes to care for major cases and of course, you need private insurance in order to saty for more than "emergency" reasons......


Public hospitals in Europe must be a lot different than public hospitals in the states. Private hospitals, most organized as 501(c)3's, generally have better care, I think, than public hospitals that are often located in economically disadvantaged areas where alleged nonprofits can't bring in enough to have revenue left over after expenses , aka profit. The best doctors will go to the privates as opposed to the public's because that's where the money is.


----------



## SG_67

justonemore said:


> And funny enough you respond with a video that seems to contradict your reasoning. Did you bother reading my previous post where I stated that my wife was transfered from a private hospital to a public one due to lack of proper Equipment and knowledge? This was for both births. When the Sh*t hits the fan, it's time to rely on the federal system versus the blood sucking private sytstem that relies on good food and rear kissing nurses to make a buck... In a health care system, 7 million people giving $10 to a public medical system that includes all is better than 10 people giving 7 million to a private sytem that exludes all but the 10(especially when it comes down to the health of society in general).. Or is it all supposed to be about profit?


Press!


----------



## justonemore

32rollandrock said:


> Public hospitals in Europe must be a lot different than public hospitals in the states. Private hospitals, most organized as 501(c)3's, generally have better care, I think, than public hospitals that are often located in economically disadvantaged areas where alleged nonprofits can't bring in enough to have revenue left over after expenses , aka profit. The best doctors will go to the privates as opposed to the public's because that's where the money is.


Indeed.. Welcome to mandatory univeral health care. All are welcome and all are treated as equal. I had an accident the other day and my first choice was to go to public. Should I have required long term care, I would have had the primary care taken care of in the public clinic and be asked to transfer to the private clinic in order to have more "privacy" and better food. My first choice in medical care was not towards the "profit makers" (although I carry private insurance).


----------



## justonemore

SG_67 said:


> Press!


30 seconds of blurred nonsense means what? Can you put it into words a bit better?


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## justonemore

And yes. Universal care means added expenses for those that can afford it. Yes, Universal care means less profit for those greedy meds that wish only profit. Yes, Universal care means a greater expense due to a bit more bureaucracy (which I understand is hard for the u.s. to handle). But.. The major expense in the u.s. happens to be those that are unisured or indigent... Yet... The med pros still profit at extreme rates compared to the rest on a global basis.... Is it perhaps not time to learn from other cultures??? Or should we cry for those like SG that claim that they take few public aid patients just to be kind? I'll give my money for a better national healthcare over giving my money for the few "better classed" people to be treated. No one here is denied healthcare due to class, or wealth, or poverty, or "being better" versus being a member of our society. I may refer a patient due to lack of specialty, but never de to lack of funds (i.e. I'd take a recovering alcohloic of any economic staus that is sober and need continuing care but I would instantly refer a current drunk [of any economic staus] to the public alcoholic treatment center for detox).

EDIT WARNING for the ...(ADDED TEXT COMPARED TO A NEW POST)I'm not sure what Americans think universal healthcare really means but it seems that they have never bothered to think about better systems that are in place elsewhere. I understand that Switzerland doesn't have all the illegal immigrant problems. While we have plenty of immigrants, those that qualify for public assistance need to be here legally. We are a smaller (but 1 times 10 can still be equal). We are not as "profit" driven as the U.S. Sure, there are a few factors but in reality... The main factrors that drive a decent society (and its business) are education and healthcare. No one should go hungry. No one should be denied housing. No one should be denied healthcare. No one should be denied education. Most of Europe understands this.... Why not the U.S.? Is the U.S. not the "leader of the free world"?


----------



## justonemore

HAving spent my first 29 years in the u.s., and the last 12 in Europe, I just don't understand the problem here unless it is only under the idea of profit only. I disagree with patients being turned away for the almighty dollar. SG disgusts me on that factor alone. Any dr. worth their salt will treat all in my thoughts. A public health care sytem helps avoid the problems of cost versus profit. Perhaps Sg won't make $10'000 a patient, but what is the societal complaint if he makes $5'000? I understand that med school and time invested need to be compensated but my point has always been that U.S. education costs are idiotic compared to those of Europe and elsewhere. Drs are part of society, one need to give to the society they live in (versus expecting solely profit), Society helps pay for your education, and gives it time for you to do your studies, and therefore, you need to give back to the community. It is not "profit" driven over "society" driven. I live in a double dr. household, and while we are not the Superior drs that you have in the u.s, we are still a bit above the "masses".


----------



## Earl of Ormonde

bernoulli said:


> That would be me. Post #350. Feel free to comment on Econ 101 "untruths" as you call them.


I did not use the word "untruths". I referred to the unamed part of a sentence taken out of its context that Hitch posted as an untruth. Having now read your whole text, I still don't understand what you mean. By innovation do you mean that necessary medical research and working methods in the US have benefitted health services in Europe?


----------



## SG_67

Earl of Ormonde said:


> I did not use the word "untruths". I referred to the unamed part of a sentence taken out of its context that Hitch posted as an untruth. Having now read your whole text, I still don't understand what you mean. By innovation do you mean that necessary medical research and working methods in the US have benefitted health services in Europe?


There is a lot of cutting edge medicine going on around the world and everyone benefits from it.

I think the one area where the US excels at, and the rest of the world benefits, is medical devices.

When it comes to medical innovation I wish people would sometimes realize how much of an international effort it is. Just peruse the refereed journals and you'll see people from all over world collaborate with one another in order to advance the cause of healthcare.


----------



## bernoulli

Yes. Because market forces are stronger in the US, the system there brings about more innovation, which spills out to Europe, in which per capita expenditure on healthcare is lower than in the US. I am sorry if I was not clear. It was the whole point of my post: we need to agree on basic definitions so we can argue about healthcare systems. I tried to provide some basic Econ 101 definitions.



Earl of Ormonde said:


> I did not use the word "untruths". I referred to the unamed part of a sentence taken out of its context that Hitch posted as an untruth. Having now read your whole text, I still don't understand what you mean. By innovation do you mean that necessary medical research and working methods in the US have benefitted health services in Europe?


----------



## bernoulli

What you are suggesting is a regulated market in which regulation tries to unlock correct incentives. Which is fine. But in a previous post you were really pro-free market, which cannot really happen in the healthcare system, given it is a collective good (I prefer the neutral term natural monopoly).

In a completely free-market healthcare system hospitals would turn away clients that would be unable or unwilling to pay. Exclusion is a saliente feature of free markets, hence the need for regulation in healthcare systems. We can choose between public provision (Europe) or regulated markets (US). But we certainly cannot choose a free healthcare market. I do understand the fascination of Americans with free-market capitalism, but that only works for the provision of private goods (rival and excludable goods). For non-rival and/or non-excludable goods government certainly plays a role - in the US, Europe or pretty much anywhere else in the world.

BTW, I am an Economics professor. I do know capitalism (and can mathematically prove) provides efficient allocation of resources (for non-rival and non-excludable goods with well-defined property rights). I am just trying to be rigorous and to provide a blackboard so people can understand the ramifications of their arguments. Free-market capitalism is beautiful when it works, but it does not work for every single market.



SG_67 said:


> All I am suggesting is that we even out the counter party risk. Insurance companies have incentive to pay for such things as vaccines and other appropriate tests if it means reducing their cost down the road. They do that now and sometimes under mandate and also because they realize this.
> 
> I'm not suggesting a survival of the fittest scenario where we eat what we kill, but the current system where someone plunks down $20 dollars and receives 20-30 fold in care related expenses is unsustainable. More and more employers are moving toward a model that makes the employee more responsible for expenditures. Higher deductible plans and HSAs are gaining traction and a win win for both sides. If one does not consume much healthcare then the monies are saved and put toward something more meaningful. If one is a bigger consumer of healthcare then they are still covered once the deductible has been met. It's just a larger deductible now.
> 
> Perhaps over time this will incentivize people to take better care of themselves; eat well, not smoke, exercise, etc. as they realize that a greater burden of the healthcare expenses down the road will be incumbent upon them.
> 
> Of course as a society we are not going to turn our backs on the truly needy and desperate. And I don't see hospitals turning away the truly unfortunate and emergent cases.


----------



## Hitch

Econ 101; 

A provides a service

B provides roughly equal service.

A also provides far greater innovation and exploration.

A and B are different, A is more valuable.

Duh


----------



## Hitch

Earl of Ormonde said:


> I did not use the word "untruths". I referred to the unamed part of a sentence taken out of its context that Hitch posted as an untruth. Having now read your whole text, I still don't understand what you mean. By innovation do you mean that necessary medical research and working methods in the US have benefitted health services in Europe?


Care to explain what was taken out of context?


----------



## MaxBuck

SG_67 said:


> Of course as a society we are not going to turn our backs on the truly needy and desperate. And I don't see hospitals turning away the truly unfortunate and emergent cases.


I understand the Hippocratic oath constrains physicians in a manner that other professionals are not, but you've been trumpeting free markets, and in a completely free market there would be no incentive for hospitals *not* to turn their backs on those who cannot pay. And that problem is not addressed in the least by your proposed free-market solution.

I'm actually a good bit more callous and unfeeling than most people on this forum, and it wouldn't bother me particularly if poor folks went untreated for many ailments, but I doubt our society would accept such a solution -- but again, a completely free market really doesn't allow for anything else. So what's your solution to deal with this problem, assuming you're not equally callous as me?

(I'm emotionally callous by nature, but am aware that my God calls me to be less so. It's not very easy for me to care about others, actually, but I do try.)


----------



## Hitch

MaxBuck said:


> I understand the Hippocratic oath constrains physicians in a manner that other professionals are not, but you've been trumpeting free markets, and in a completely free market there would be no incentive for hospitals *not* to turn their backs on those who cannot pay. And that problem is not addressed in the least by your proposed free-market solution.
> 
> I'm actually a good bit more callous and unfeeling than most people on this forum, and it wouldn't bother me particularly if poor folks went untreated for many ailments, but I doubt our society would accept such a solution -- but again, a completely free market really doesn't allow for anything else. So what's your solution to deal with this problem, assuming you're not equally callous as me?
> 
> (I'm emotionally callous by nature, but am aware that my God calls me to be less so. It's not very easy for me to care about others, actually, but I do try.)


 A 'free market' in most conversations and certainly this one has no relation to anarchy. The reality of our society speaks directly to the contrary in that it is far easier to imagine if Tellburg Hospitial were to announce that it would ban any and all charity cases the public would ,rather than run to Tellburg in order to gain the results of its supposed greater efficiency, show its preference for a more traditional view of medical care and suppoort another facility and the force of the market would likely result in Tellburg's return to a more charitable practice.


----------



## SG_67

bernoulli said:


> What you are suggesting is a regulated market in which regulation tries to unlock correct incentives. Which is fine. But in a previous post you were really pro-free market, which cannot really happen in the healthcare system, given it is a collective good (I prefer the neutral term natural monopoly).
> 
> In a completely free-market healthcare system hospitals would turn away clients that would be unable or unwilling to pay. Exclusion is a saliente feature of free markets, hence the need for regulation in healthcare systems. We can choose between public provision (Europe) or regulated markets (US). But we certainly cannot choose a free healthcare market. I do understand the fascination of Americans with free-market capitalism, but that only works for the provision of private goods (rival and excludable goods). For non-rival and/or non-excludable goods government certainly plays a role - in the US, Europe or pretty much anywhere else in the world.
> 
> BTW, I am an Economics professor. I do know capitalism (and can mathematically prove) provides efficient allocation of resources (for non-rival and non-excludable goods with well-defined property rights). I am just trying to be rigorous and to provide a blackboard so people can understand the ramifications of their arguments. Free-market capitalism is beautiful when it works, but it does not work for every single market.





MaxBuck said:


> I understand the Hippocratic oath constrains physicians in a manner that other professionals are not, but you've been trumpeting free markets, and in a completely free market there would be no incentive for hospitals *not* to turn their backs on those who cannot pay. And that problem is not addressed in the least by your proposed free-market solution.
> 
> I'm actually a good bit more callous and unfeeling than most people on this forum, and it wouldn't bother me particularly if poor folks went untreated for many ailments, but I doubt our society would accept such a solution -- but again, a completely free market really doesn't allow for anything else. So what's your solution to deal with this problem, assuming you're not equally callous as me?
> 
> (I'm emotionally callous by nature, but am aware that my God calls me to be less so. It's not very easy for me to care about others, actually, but I do try.)


A free market does not necessarily mean one that is not without some measure of regulation. Perhaps a trained economist will define free market in more technical terms where there are no checks and balances. I'm not suggesting that nor do I want that.

There is a need for government intervention in setting standards for hospitals, credentialing of professionals and other areas where the public health and well being is at stake. Hospitals are of course paid for the services they provide. If someone without insurance shows up at the ER, they are cared for. If they don't have insurance, then public aid is used to pay for the services. There is nothing wrong with mandating hospitals to behave in a certain way for the privilege of operating in a particular city, county or state. As part of my licensure, I have to prove a certain level of CME every two year. I am mandated to report certain things to the state if I suspect abuse of minors, the elderly, etc. It's not an option; as part of the privilege and right to practice my craft, the citizens of the state of Illinois require me to behave in a certain way.

So at a practical level, I believe it's wrong to conflate a free market with one where there is no oversight and the law of the jungle prevails.

Insurance companies simply cannot cover everyone. There are people who are disabled or for other reasons cannot work or contribute financially to the economy, yet do require medical services. Government has a role to play in that. Government also has a role to cover the elderly as end of life care is incredibly expensive.

My suggestion has been to shift more of the cost to the consumer. I'm not saying that we should just let everyone fend for themselves. Right now, the cost is borne primarily by insurance companies and employers. Providers bill and payers write off part of those bills via contractual write offs. The end user, the patient, only sees a fraction of this and is responsible for only a fraction. The financial risk is not shared equitability. It is simple economics to suggest that when the end user shares more of the cost burden, then he/she will be more discriminate when choosing goods and services.

I've mentioned Lasik surgery before. If one looks at the cost curve of Lasik surgery, we see how the overall cost of the procedure has gone down. Can anyone here point to another medical procedure, a surgical procedure, which has gone down in price over the past 10 years? Why? Because Lasik is still a cash only business. Customers (patients) demand increased quality for decreased cost and the market adjusts to accommodate the demand.

So to my economist friend, if I am using the term "Free Market" incorrectly, my apologies. Call it a regulated free market, or whatever other term you deem appropriate.


----------



## SG_67

justonemore said:


> I may refer a patient due to lack of specialty, but never de to lack of funds (i.e. I'd take a recovering alcohloic of any economic staus that is sober and need continuing care but I would instantly refer a current drunk [of any economic staus] to the public alcoholic treatment center for detox).


Press!


----------



## MaxBuck

SG_67 said:


> So to my economist friend, if I am using the term "Free Market" incorrectly, my apologies. *Call it a regulated free market*, or whatever other term you deem appropriate.


Ah, but this is what we have right now. *It's the nature of the regulation that we're debating.*


----------



## SG_67

MaxBuck said:


> Ah, but this is what we have right now. *It's the nature of the regulation that we're debating.*


Not really. We're talking about the way we pay for healthcare. Regulation is part of that and factors into those costs. This entire debate at large has been about how we pay for and what is the most efficient and reliable way of covering as many people as possible.


----------



## Hitch

"_The existence of a free market does not of course eliminate the need for government. On the contrary, government is essential both as a forum for determining the "rule of the game" and as an umpire to interpret and enforce the rules decided on."_ 
― Milton Friedman


----------



## MaxBuck

SG_67 said:


> Not really. We're talking about the way we pay for healthcare. Regulation is part of that and factors into those costs. This entire debate at large has been about how we pay for and what is the most efficient and reliable way of covering as many people as possible.


So are you arguing that health insurance should not be the source of payment to providers? Or that only high-deductible plans be offered? Or that the regulation of healthcare (including insurance pools, etc.) should be on a state level rather than federal? Or that provision of insurance shall not be a perquisite provided by employers, but instead must be purchased by individuals? If so, how can individuals participate in risk pooling - or do you suggest they should not be able to?

Only if you define your own proposal in detail can we really start to discuss the benefits, risks and costs of each element. This is one of my pet peeves about the GOP opposition to the ACA, which they insist on referring to as "Obamacare;" they aren't specific. Their opposition is obviously political rather than policy-based, since if you asked each member his or her complaints they'd all come up with different ones, many of which would conflict. And many of those complaints would have sweet FA to do with the ACA itself.

I'm not trying to defend the ACA here, as I think it was overly broad and passed in haste. But claims that it's nothing but a big bag of crap are absurd; there's some good stuff in there like (as I said above) the emphasis on outcomes-based reimbursements.


----------



## MaxBuck

Hitch said:


> "_The existence of a free market does not of course eliminate the need for government. On the contrary, government is essential both as a forum for determining the "rule of the game" and as an umpire to interpret and enforce the rules decided on."_
> ― Milton Friedman


Yeah, that particular magnificent hypocrisy is one of the things that bothers me a lot about ol' Milt. He claimed that government was essential as an umpire, but then complained loudly whenever the government actually got down to calling balls and strikes. (I still think he was brilliant, though.)


----------



## Hitch

One more from Uncle Miltie;



> "A thoroughgoing paternalist who holds it cannot be dissuaded by being shown that he is making a mistake in logic. He is our opponent on grounds of principle, not simply a well-meaning but misguided friend. Basically, he believes in dictatorship, benevolent and maybe majoritarian, but dictatorship none the less. Those of us who believe in freedom must believe also in the freedom of individuals to make their own mistakes. If a man knowingly prefers to live for today, to use his resources for current enjoyment, deliberately choosing a penurious old age, by what right do we prevent him from doing so? We may argue with him, seek to persuade him that he is wrong, but are we entitled to use coercion to prevent him from doing what he chooses to do? Is there not always the possibility that he is right and that we are wrong? Humility is the distinguishing virtue of the believer in freedom; arrogance, of the paternalist."


:thumbs-up:


----------



## Hitch

MaxBuck said:


> Yeah, that particular magnificent hypocrisy is one of the things that bothers me a lot about ol' Milt. He claimed that government was essential as an umpire, but then complained loudly whenever the government actually got down to calling balls and strikes. (I still think he was brilliant, though.)


I think you've interposed what Miltie would support; Governemnt enforcement of private contracts, with the unsupported notion that government could/should decide what a good deal is, the umpire never tells the batter whether or not to swing and he never tells the pitcher to throw a curve or a fastball. The umpire does work on the presupposition that hitter and pitcher entered the game freely, with a working knowledge of the rules.


----------



## SG_67

MaxBuck said:


> So are you arguing that health insurance should not be the source of payment to providers? Or that only high-deductible plans be offered? Or that the regulation of healthcare (including insurance pools, etc.) should be on a state level rather than federal? Or that provision of insurance shall not be a perquisite provided by employers, but instead must be purchased by individuals? If so, how can individuals participate in risk pooling - or do you suggest they should not be able to?
> 
> Only if you define your own proposal in detail can we really start to discuss the benefits, risks and costs of each element. This is one of my pet peeves about the GOP opposition to the ACA, which they insist on referring to as "Obamacare;" they aren't specific. Their opposition is obviously political rather than policy-based, since if you asked each member his or her complaints they'd all come up with different ones, many of which would conflict. And many of those complaints would have sweet FA to do with the ACA itself.
> 
> I'm not trying to defend the ACA here, as I think it was overly broad and passed in haste. But claims that it's nothing but a big bag of crap are absurd; there's some good stuff in there like (as I said above) the emphasis on outcomes-based reimbursements.


I don't have the answers, but we already have a system where the costs of healthcare are somewhat opaque and with the ACA we're making it even more opaque. I realize you're not a fan of the ACA, but what's happening with the ACA is that we're moving further in a direction that has already been shown not to work vis a vie controlling costs.

Health insurance, any insurance, is a brilliant idea. The collective risk pool spreads risk across the many in the hopes of allowing the individual cost to be reduced. I believe in insurance and believe that it needs to be A source of payment, but not THE source.

Are high deductible plans the answer? Perhaps they are part of the answer, especially for those who do not consume as much healthcare. The shift toward higher deductible plans is having an interesting effect on healthcare but it's not yet at the scale necessary to manage costs.

Here is an interesting read:

I know some will dismiss this because of the source, but it's worth reading with an open mind.

As HSAs grow, the scale will reach a point where providers will start to pay attention.

As for individuals purchasing policies vs. employer provided, it is my opinion that it would be optimal for individuals to buy policies based on their and their families healthcare needs. If my wife and I have no plans on having children, then why should we be mandated to pay for fertilization services or child birth in our premiums. Allowing people to pick and choose the elements they feel they need in their policies is another option that should be considered.

As for state mandates, congress and the POTUS made a big deal about just how important healthcare was and how everyone should be covered. Congress seems to take a rather broad view of the commerce clause. Why should the purchase of insurance, with all that is at stake, be subject to state by state mandates that limits portability across state lines. Insurance companies in essence have monopolies in these states as anyone living within those borders is required to purchase their insurance from a handful of companies without outside options.

As for the GOP opposition, I agree. They need to come up with solutions. But this is the problem when we put something like this in the hands of politicians. The issue becomes politicized.


----------



## Mike Petrik

bernoulli said:


> In a completely free-market healthcare system hospitals would turn away clients that would be unable or unwilling to pay.


In a completely free market hospitals will choose whether to turn away clients who are unwilling or unable to pay. Free markets do not in any way exclude non-financial values, whether expressed by for-profit institutions or non-profit ones.


----------



## MaxBuck

Hitch said:


> I think you've interposed what Miltie would support; Governemnt enforcement of private contracts, with the unsupported notion that government could/should decide what a good deal is, the umpire never tells the batter whether or not to swing and he never tells the pitcher to throw a curve or a fastball. The umpire does work on the presupposition that hitter and pitcher entered the game freely, with a working knowledge of the rules.


I understand what you're saying here, but Friedman really did talk out of both sides of his mouth when it came to government regulation. Bottom line is that he thought government should regulate exactly what he thought it should regulate - in other words, that he should be the dictator in charge of regulation. Life doesn't really work that way, except in Soviet societies.


----------



## Hitch

MaxBuck said:


> I understand what you're saying here, but Friedman really did talk out of both sides of his mouth when it came to government regulation. Bottom line is that he thought government should regulate exactly what he thought it should regulate - in other words, that he should be the dictator in charge of regulation. Life doesn't really work that way, except in Soviet societies.


Well how about a quote or two Max?


----------



## bernoulli

Last time I answer to you, since you don't seem interested in a discussion. There are many errors in your assertions:

B provides more access, so B is not roughly equal to A.
Also, you forget missing statements between A and B that could tilt the relationship. Innovation is not the only externality generated by A or B.

This statement is better: For every complex problem there is a simple solution...that is wrong.

Thiking your simplistic reasoning can tackle such a complicated matter is just that, wrong. And that is not a normative statement.



Hitch said:


> Econ 101;
> 
> A provides a service
> 
> B provides roughly equal service.
> 
> A also provides far greater innovation and exploration.
> 
> A and B are different, A is more valuable.
> 
> Duh


----------



## bernoulli

Here is the difference you want:

It is one thing for the government to enforce standards and credentialing, it is another altogether to influence Output (the quantity of goods and services sold). Without the government the output generated by the healthcare system would be below the social optimal. Hence the government stepping in to guarantee "access", which just means forcing the Market to provide increased units of the good or service (in this care, more healthcare than the Market would produce by itself) or just providing the service itself (in the case of Europe). This is not the minimum state of government advocated by Friedman, this is the government intervening in a market to try to tackle a market failure (as often happens in the case of natural monopolies).

So here is a simple definition: if the government does not forcefully influence output decisions (it always does by measures of taxation, so here I mean no discriminatory taxation), it is a free market. Agents are free to maximize profit. Otherwise, we have either a regulated market (electricity, water, healthcare) or a public provision market (defence, some infrastructure).

And nothing to be sorry for, it is exactly the reason I provided some basic definitions, so we can discuss this complicated matter in an useful manner. We are indeed discussing the level of regulation, some people like less regulation and more market mechanisms, which is fine, while others would prefer public provision. Both systems have its merits. Right now I am in Scandinavia teaching and I can assure you that the lack of choice and waiting lines are problems here. But the fact everybody has access and the system is free is really appreciated. An american professor had to go to the hospital with an infection in his arm, was well treated and did not have to pay a dime. Which is nice, until you hear from a friend that his father is in a nursing home and could not choose which one to go to. Pros and cons.



SG_67 said:


> A free market does not necessarily mean one that is not without some measure of regulation. Perhaps a trained economist will define free market in more technical terms where there are no checks and balances. I'm not suggesting that nor do I want that.
> 
> There is a need for government intervention in setting standards for hospitals, credentialing of professionals and other areas where the public health and well being is at stake. Hospitals are of course paid for the services they provide. If someone without insurance shows up at the ER, they are cared for. If they don't have insurance, then public aid is used to pay for the services. There is nothing wrong with mandating hospitals to behave in a certain way for the privilege of operating in a particular city, county or state. As part of my licensure, I have to prove a certain level of CME every two year. I am mandated to report certain things to the state if I suspect abuse of minors, the elderly, etc. It's not an option; as part of the privilege and right to practice my craft, the citizens of the state of Illinois require me to behave in a certain way.
> 
> So at a practical level, I believe it's wrong to conflate a free market with one where there is no oversight and the law of the jungle prevails.
> 
> Insurance companies simply cannot cover everyone. There are people who are disabled or for other reasons cannot work or contribute financially to the economy, yet do require medical services. Government has a role to play in that. Government also has a role to cover the elderly as end of life care is incredibly expensive.
> 
> My suggestion has been to shift more of the cost to the consumer. I'm not saying that we should just let everyone fend for themselves. Right now, the cost is borne primarily by insurance companies and employers. Providers bill and payers write off part of those bills via contractual write offs. The end user, the patient, only sees a fraction of this and is responsible for only a fraction. The financial risk is not shared equitability. It is simple economics to suggest that when the end user shares more of the cost burden, then he/she will be more discriminate when choosing goods and services.
> 
> I've mentioned Lasik surgery before. If one looks at the cost curve of Lasik surgery, we see how the overall cost of the procedure has gone down. Can anyone here point to another medical procedure, a surgical procedure, which has gone down in price over the past 10 years? Why? Because Lasik is still a cash only business. Customers (patients) demand increased quality for decreased cost and the market adjusts to accommodate the demand.
> 
> So to my economist friend, if I am using the term "Free Market" incorrectly, my apologies. Call it a regulated free market, or whatever other term you deem appropriate.


----------



## SG_67

bernoulli said:


> Here is the difference you want:
> 
> It is one thing for the government to enforce standards and credentialing, it is another altogether to influence Output (the quantity of goods and services sold). Without the government the output generated by the healthcare system would be below the social optimal. Hence the government stepping in to guarantee "access", which just means forcing the Market to provide increased units of the good or service (in this care, more healthcare than the Market would produce by itself) or just providing the service itself (in the case of Europe). This is not the minimum state of government advocated by Friedman, this is the government intervening in a market to try to tackle a market failure (as often happens in the case of natural monopolies).
> 
> So here is a simple definition: if the government does not forcefully influence output decisions (it always does by measures of taxation, so here I mean no discriminatory taxation), it is a free market. Agents are free to maximize profit. Otherwise, we have either a regulated market (electricity, water, healthcare) or a public provision market (defence, some infrastructure).
> 
> And nothing to be sorry for, it is exactly the reason I provided some basic definitions, so we can discuss this complicated matter in an useful manner. We are indeed discussing the level of regulation, some people like less regulation and more market mechanisms, which is fine, while others would prefer public provision. Both systems have its merits. Right now I am in Scandinavia teaching and I can assure you that the lack of choice and waiting lines are problems here. But the fact everybody has access and the system is free is really appreciated. An american professor had to go to the hospital with an infection in his arm, was well treated and did not have to pay a dime. Which is nice, until you hear from a friend that his father is in a nursing home and could not choose which one to go to. Pros and cons.


Indeed any system will have pros and cons and society must weight those competing factors when settling on a system.

I think part of the problem with this entire discussion is that it is being framed as an all or nothing option. Either we go completely free market and let people fend for themselves or we go the Euro route. I don't believe massive systemic changes are either necessary or a good thing. It's as though we woke up one day and all of a sudden we were on the gold standard again. Think of the shock that would create.

By the way, for the sake of argument, let's assume we had a true free market in the economic theory sense. Do we know that insurance would go away? Do we know that people wouldn't be covered? I would argue that the system would change and adapt. Again, government would be there to look after the truly needy and the indigent.

But getting back to my original topic, I'm talking about minor tweaks and seeing how the system operates. And more importantly, giving the system time to adapt to those changes. Our healthcare sector, both in the actual delivery of services and from a broader economic sense is a product of the market forces that have pushed it in different directions for the last 100 years. Change takes time to work it's way through and to ultimately be reflected in the pricing structure and delivery of healthcare.

Giving people more control over healthcare expenditures and allowing them to have to make choices is a start. Decoupling of insurance from state by state mandate is another. Allowing people to choose the type of coverage yet another. These are all things worth looking at.

I mentioned LASIK before. While I understand that procedure is different from emergency surgery to repair a lacerated liver s/p MVA, it is nevertheless an example of how pricing responds when the only two players are the suppliers of a service and those who want it.


----------



## MaxBuck

SG_67 said:


> Giving people more control over healthcare expenditures and allowing them to have to make choices is a start. Decoupling of insurance from state by state mandate is another. Allowing people to choose the type of coverage yet another. These are all things worth looking at.


I'm not quite sure I understand what you mean by "decoupling insurance from state by state mandate," but I agree that giving people more control over their own healthcare expenditures and choosing the type of insurance coverage they want are great ideas. I also like HSAs; I have one myself and it's great.


----------



## SG_67

MaxBuck said:


> I'm not quite sure I understand what you mean by "decoupling insurance from state by state mandate," but I agree that giving people more control over their own healthcare expenditures and choosing the type of insurance coverage they want are great ideas. I also like HSAs; I have one myself and it's great.


Right now, each state controls the health insurance offered in said state. These controls involve many aspects but also include mandates such as coverage of services. For example, some states that mandated coverage for certain tests, fertility treatment, etc.

A person living in that particular state has no option than to purchase insurance from the providers in that state. I cannot, for example, purchase my insurance from another state if it is less expensive but does not offer coverage for services that I won't need, for example fertility treatment or coverage or childbirth, substance abuse, etc.

These mandates will have an impact on cost.

What I am suggesting is a decoupling of these state by state mandates from the policies being offered and allow people to pick and choose what kind of coverage and at what limits they want. There will, of course, need to be certain coverage guidelines such as emergency services. In the end though I believe that the cost of health insurance will decrease as the risk pool will widen drastically. Right now we have these small pockets of risk pools within the states. These are made even smaller given that the real choice most people have depends on what a particular employer has offered.


----------



## Hitch

bernoulli said:


> Last time I answer to you, since you don't seem interested in a discussion. There are many errors in your assertions:
> 
> B provides more access, so B is not roughly equal to A. (*the facts are contrary, adding that you made no such distinction in your post Edit correction He did make a distinction but went on to post *One is not better than the other )
> Also, you forget missing statements between A and B that could tilt the relationship. Innovation is not the only externality generated by A or B. *(It was the only difference you brought up*)
> 
> This statement is better: For every complex problem there is a simple solution...that is wrong. (*I think you will do much better asking and answering your own questions. Outside intervention is a problem for you )*
> 
> Thiking your simplistic reasoning can tackle such a complicated matter is just that, wrong. And that is not a normative statement.


In realty land A provides more access, and so goes the rest of your response. As for me I shall soldier on without your approval.

In the mean let's review your post;
https://askandyaboutclothes.com/community/member.php?203927-bernoullibernoulli 
*Member*

Join DateMarch 21st, 2011Posts449CountryBrazilStateRJCityRio de Janeiro​




> I think it would really help most people discussing the topic if everybody understood the diferences between private goods (the Coase theorem guarantees that when property rights are properly defined, there is no need for government intervention), common resources (fishing), natural monopolies (water and sewerage, public transportation) and public goods (defence). In the last three cases society is better off by governments either regulating markets (with or without subsidies) or providing it directly. Food production is something in the middle (private goods with undefined property rights in terms of the externalities they generate). The US chooses to regulate it and does a bad job. Same as Europe. It can be done relatively efficiently (Brazil), but it is not easy.
> 
> Healthcare provision is clearly a Natural Monopoly (or a collective good) and hence should be either regulated or provided by the state. The idea that the US ever had or will have a private system is laughable. The choice is betweeen regulation (Obamacare or how the market was regulated before) and public provision.​


Now that is simplistic


> Obamacare is new and more pervasive regulation, but make no mistake, the market was heavily regulated in the past (see Emergency Room access). Europeans choose public provision. As expected, both have benefits (more innovation and better quality in the US, higher access in Europe) and costs (higher costs in the US, less choices and more waiting times in Europe). /
> 
> 
> 
> Hmmmm it seemed to me at first reading ,although I assumed you would naturally favor the European model, that in this post you set the two as roughly even, saying one is not better than the other, and that turns out to be what you posted verbatim.
> 
> 
> 
> BTW, one neat positive externality for Europe is that European countries benefit from the innovation generated by the existence of the US system. If the US goes the public provision route, the whole world suffers. One is not better than the other, they are just different systems.
> 
> 
> 
> So from your post A/B are roughly equal and you gave the US the additional value associated as the provider of innovation, lacking this '_the whole world suffers_' . If A=B A+1 is greater than B .
> 
> Click to expand...
Click to expand...


----------



## bernoulli

Hitch, now that you are actually giving me arguments instead of one-liners, I think we can discuss on a nice level. 

I gave you ONE externality generated by the American system (and never implied that this was the only one). There are also externalities generated by the European system - given it is universal, ceteris paribus, it tends to attract more "health tourism" away from the US, which would make the US system even more expensive. 

But you are right, I stay away from normative statements. I don't necessarily favor one over the other. I think if well regulated the US system has the potential to be much better than the European system. And SG_67, you are right that such regulation would favor different incentives than we have today. Obamacare is a blunt solution to a complex issue, and is less than ideal (although better than the way it was before). There is enough space for market mechanisms to bring good incentives to people, but at the same time, we need regulation on how standardization can bring lower costs and other mechanisms (including pooling risks by making Young people buy insurance). 

I have published in the topic but I am by no means an expert. I do enjoy a spirited discussion, though I don't like being dismissed outright, as I think that writing 200.000 words a year on Economics and Finance and being respected in my field buys me at least the benefit of the doubt in whatever I write. I may still be wrong, but please don't try to use my words to prove your points. I am careful in what I write exactly because I don't favor simplistic answers.

To quote Mencken: for every complex problem there is a simple solution ... that is wrong.


----------



## Earl of Ormonde

Hitch said:


> Care to explain what was taken out of context?


Yes, you posted half a sentence from a very long answer, without providing the author's name. So it wasn't easy to understand what he meant removing just that part from the context of the whole answer. I asked you who wrote it but you didn't reply, which was why Bernoulli himself answered me & identified himself as the author. Then having read his entire answer, with the part you quoted in the context of the whole answer I was able to understand it.


----------



## bernoulli

Dear Earl,

I am sorry if I was blunt on my response to one of your posts. On post #369 you seem to indicate that what I wrote was a ridiculous untruth. If I got your meaning wrong, I apologize.



Earl of Ormonde said:


> Yes, you posted half a sentence from a very long answer, without providing the author's name. So it wasn't easy to understand what he meant removing just that part from the context of the whole answer. I asked you who wrote it but you didn't reply, which was why Bernoulli himself answered me & identified himself as the author. Then having read his entire answer, with the part you quoted in the context of the whole answer I was able to understand it.


----------



## Earl of Ormonde

No problem Bernoulli. I understand you & agree with what you wrote now. The way Hitch lifted that bit out of the text and unnamed gave it a different twist than that which you intended.


----------



## Hitch

bernoulli said:


> Hitch, now that you are actually giving me arguments instead of one-liners, I think we can discuss on a nice level.
> 
> I gave you ONE externality generated by the American system (and never implied that this was the only one). There are also externalities generated by the European system - given it is universal, ceteris paribus, it tends to attract more "health tourism" away from the US, which would make the US system even more expensive.
> 
> But you are right, I stay away from normative statements. I don't necessarily favor one over the other. I think if well regulated the US system has the potential to be much better than the European system. And SG_67, you are right that such regulation would favor different incentives than we have today. Obamacare is a blunt solution to a complex issue, and is less than ideal (although better than the way it was before). There is enough space for market mechanisms to bring good incentives to people, but at the same time, we need regulation on how standardization can bring lower costs and other mechanisms (including pooling risks by making Young people buy insurance).
> 
> I have published in the topic but I am by no means an expert. I do enjoy a spirited discussion, though I don't like being dismissed outright, as I think that writing 200.000 words a year on Economics and Finance and being respected in my field buys me at least the benefit of the doubt in whatever I write. I may still be wrong, but please don't try to use my words to prove your points. I am careful in what I write exactly because I don't favor simplistic answers.
> 
> To quote Mencken: for every complex problem there is a simple solution ... that is wrong.


 see above

_Obamacare is a blunt solution to a complex issue, and is less than ideal (although better than the way it was before)_ {Is this copy ok with you Earl? }

I m curious about how much of the ACA you have read personally. Im guessing less than 50%.


----------



## Hitch

Earl of Ormonde said:


> Yes, you posted half a sentence from a very long answer, without providing the author's name.


 Actually anyone reading the original (below copied lines in bold) can see that I copied the last two(correction 3) complete sentences of the post. Are you lying or mistaken, ?probably a combination of the two


> So it wasn't easy to understand what he meant removing just that part from the context of the whole answer.


 A it was copied and pasted in perfect context, B it was not 'named' because mine was the very next post


> I asked you who wrote it but you didn't reply,


 I did reply and you answered me . You are indeed a liar , I answered that it was a quote from my grandmother because I thought that is what you asked about, By the time I saw your follow up Burnoulii had already answered. So add whiner to liar and you get an earl See my #369 Your # 372


> which was why Bernoulli himself answered me & identified himself as the author. Then having read his entire answer, with the part you quoted in the context of the whole answer I was able to understand it.


 LOL You're just upset because I exposed what the Irish did to those brave enough to fight the NAZIs after you had denied the truth. Be sure and make it to confession this week

Healthcare provision is clearly a Natural Monopoly (or a collective good) and hence should be either regulated or provided by the state. The idea that the US ever had or will have a private system is laughable. The choice is betweeen regulation (Obamacare or how the market was regulated before) and public provision. Obamacare is new and more pervasive regulation, but make no mistake, the market was heavily regulated in the past (see Emergency Room access). Europeans choose public provision. As expected, both have benefits (more innovation and better quality in the US, higher access in Europe) and costs (higher costs in the US, less choices and more waiting times in Europe).* BTW, one neat positive externality for Europe is that European countries benefit from the innovation generated by the existence of the US system. If the US goes the public provision route, the whole world suffers. One is not better than the other, they are just different systems.*


----------



## MaxBuck

MaxBuck said:


> I'm not quite sure I understand what you mean by "decoupling insurance from state by state mandate," but I agree that giving people more control over their own healthcare expenditures and choosing the type of insurance coverage they want are great ideas. I also like HSAs; I have one myself and it's great.





SG_67 said:


> Right now, each state controls the health insurance offered in said state. These controls involve many aspects but also include mandates such as coverage of services. For example, some states that mandated coverage for certain tests, fertility treatment, etc.


So if I understand you correctly, you want to end state-by-state regulation of health insurance and open the national marketplace by instead regulating it only on the federal level. I agree that would provide more choice to the consumer, but more federal regulation makes me nervous. I doubt unregulated health insurance is ultimately what anyone would really be happy with, regardless of their political philosophies.


----------



## SG_67

MaxBuck said:


> So if I understand you correctly, you want to end state-by-state regulation of health insurance and open the national marketplace by instead regulating it only on the federal level. I agree that would provide more choice to the consumer, but more federal regulation makes me nervous. I doubt unregulated health insurance is ultimately what anyone would really be happy with, regardless of their political philosophies.


The way it works now, too many interest groups get a say in what types of mandates go into effect on a state by state basis. The chiro lobby pushes for chiro benefits, the mental health lobby pushes for a range of treatments and the list goes on and on.

There is going to be some measure of regulation imposed regardless. Something like health insurance is too tempting for politicians not to want to regulate. The question is how we want that regulation done and what kind of balance to strike. What I would like to see is the market being opened on an interstate level.

States can still regulate, but the consumer is also free to cross state lines in order to purchase insurance if he is getting a better deal. Right now, this is not possible.


----------



## Hitch

SG_67 said:


> The way it works now, too many interest groups get a say in what types of mandates go into effect on a state by state basis. The chiro lobby pushes for chiro benefits, the mental health lobby pushes for a range of treatments and the list goes on and on.
> 
> There is going to be some measure of regulation imposed regardless. Something like health insurance is too tempting for politicians not to want to regulate. The question is how we want that regulation done and what kind of balance to strike. What I would like to see is the market being opened on an interstate level.
> 
> States can still regulate, but the consumer is also free to cross state lines in order to purchase insurance if he is getting a better deal. Right now, this is not possible.


Adding there is already a system in place , we usually call it car insurance.


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## 32rollandrock

The "non-profit" 500-bed hospital in my city is looking to acquire a for-profit health care company that has 2,300 employees and $400 million in annual revenue. Meanwhile, just down the street, the other "non-profit" hospital in town is in the midst of a $145 million remodeling project that will include an artificial lake, surrounding picnic area and a lobby that would put the Ritz Carlton to shame. Still, there's enough money left in the advertising budget to put up billboards urging the public to patronize their emergency room which is held up as being better than any other.

I ran out of asthma medicine today and cannot get any more. The pharmacy says it needs doctor approval and the doctor hasn't responded to a fax (they are, apparently, still living in the 1990s when it comes to communicating with each other, perhaps because they are spending so much money on artificial lakes and billboards). If I lived in Mexico, I could just head down to the pharmacia and pick up what I need for less than $10. Instead, I'm thinking I'll soon know which emergency room is best because that's where I'm going to end up if I can't get my drugs, which cost me $15 and my insurance company an additional $35--for the same stuff sold over the counter in Mexico for less than $10. When I land in the ER, my problem will be instantly solved by the administration of the asthma drugs that I am now being denied, only I will have to pay hundreds and hundreds of dollars instead of $15. And some goofball is going to tell me that it is my fault for not thinking ahead and hoarding drugs as if they were cigarettes in Berlin at the close of World War II.

There is nothing wrong with the health care system in the United States that pure, old fashioned capitalism couldn't solve. Take away the non-profit protection. Make these bastards compete based on who can provide drugs and services at the lowest cost, and advertise those costs up front. But no. We'd rather pay for artificial lakes and billboards and mergers and private rooms with hardwood floors and granite counter tops in the crappers. Freaking disgusting.


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## WouldaShoulda

If we had a Trivago for hospitals I could compare rates and bathroom tile and decide if I want to pay more for amenities and the view!!


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## SG_67

Let's opt for a different pitchman though!


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## eagle2250

This past Sunday evening did anyone else watch the 60 Minute's segment on how the pharmaceutical companies are creating financial incentives to our doctors to jack up medicare and other medical insurance company payments that serve to further line the pharmaceutical company's pockets. Pretty discouraging really and certainly one more reason why Obamacare is doomed to failure. Sadly the schmuck left holding the dirty end of this stick is once again, the patient!

"We have met the enemy and he is us!"


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## 32rollandrock

And another thing.

The returns are in, and one of the "non-profit" hospitals here had $44 million in revenue above expenses on gross revenue of $592 million last year. Not bad.


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## SG_67

^ I am constantly being pitched new meds and new formulations and being invited to "educational" conferences in Florida, Hawaii and other very interesting locales. All, mind you, short on education and long on recreation. This has been standard practice for "big pharma" for quite some years. 

The business of pharmaceuticals is messy, borders on cheesy and quite low life. The science of pharmaceuticals, on the other hand, is nothing short of a miracle. Diseases and conditions we once used to dread are much better controlled and managed. Can we have one without the other in a free market? Maybe and maybe not. The government does subsidize pharma companies for what is known as "orphan diseases" where there is little to no profit motive to invest billions into R&D. I think this kind of partnership, where basic research and science is financed for some drugs, is a good model. 

In the end, each practitioner relies on his or her own judgment when prescribing meds. I'll usually go with things that I know have been successful and have achieved good outcomes and with minimal side effects. I'll rely on a combination of peer reviewed studies as well as patient feedback. I try to avoid the pharma pitch but if some guy or gal wants to buy my staff lunch, sure why not.


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## WouldaShoulda

Warning:

If you wear a suit anywhere near a Doctor's office, everyone will assume you are a Pharma-Rep and brought goodies!! 

(I was delivering monthly financial reports)


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## SG_67

^ I've noticed it's often a young, attractive woman in a tight suit, short skirt, high heels and toting a wheeled carryall.


----------



## 32rollandrock

SG_67 said:


> ^ I am constantly being pitched new meds and new formulations and being invited to "educational" conferences in Florida, Hawaii and other very interesting locales. All, mind you, short on education and long on recreation. This has been standard practice for "big pharma" for quite some years.
> 
> The business of pharmaceuticals is messy, borders on cheesy and quite low life. The science of pharmaceuticals, on the other hand, is nothing short of a miracle. Diseases and conditions we once used to dread are much better controlled and managed. Can we have one without the other in a free market? Maybe and maybe not. The government does subsidize pharma companies for what is known as "orphan diseases" where there is little to no profit motive to invest billions into R&D. I think this kind of partnership, where basic research and science is financed for some drugs, is a good model.
> 
> In the end, each practitioner relies on his or her own judgment when prescribing meds. I'll usually go with things that I know have been successful and have achieved good outcomes and with minimal side effects. I'll rely on a combination of peer reviewed studies as well as patient feedback. I try to avoid the pharma pitch but if some guy or gal wants to buy my staff lunch, sure why not.


There is no such thing as a free lunch.

All this stuff you are talking about--conferences and slick salesmen--has a cost. I don't have to look any further than thrift store shelves sagging with coffee mugs emblazoned with the names of various prescription drugs to know that there's a lot of swag being thrown at doctors by pharm reps. What I'd like to see are some ethics. No offense, but I don't think that it's ethical for doctors to receive things of value from pharm reps, and I think that the practice should stop. I also get ticked when I see ads for prescription drugs on television.


----------



## SG_67

^ There are actually rules and regulations governing such gifts believe it or not. Big pharma gets around the rule of outright gift giving by doing things such as paying a physician to be a "consultant" or speaker at an event, putting on aforementioned educational events and inviting docs to come with a reminder to not forget the golf clubs, etc.


----------



## 32rollandrock

SG_67 said:


> ^ There are actually rules and regulations governing such gifts believe it or not. Big pharma gets around the rule of outright gift giving by doing things such as paying a physician to be a "consultant" or speaker at an event, putting on aforementioned educational events and inviting docs to come with a reminder to not forget the golf clubs, etc.


Yes, I've read about that sort of thing. And let's not forget the doctors who are stockholders in the companies whose products they pitch, but don't mention the fact.


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## eagle2250

If the 60 Minutes report was accurate, why do US citizens passively accept the fact that the rest of the world pays as much as 70% less for essentially the same drug regimen with which we in the US are being treated? Why oh why are we always so quick to put the screws to ourselves? It would seem perhaps that our elected officials are just as much on the pharmaceutical companies payrolls, as the doctors were reported to be. How do you spell lobbyist?


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## SG_67

eagle2250 said:


> If the 60 Minutes report was accurate, why do US citizens passively accept the fact that the rest of the world pays as much as 70% less for essentially the same drug regimen with which we in the US are being treated? Why oh why are we always so quick to put the screws to ourselves? It would seem perhaps that our elected officials are just as much on the pharmaceutical companies payrolls, as the doctors were reported to be. How do you spell lobbyist?


They pay less because their governments subsidize it. The same way as insurance companies subsidize our purchase of drugs.


----------



## SG_67

32rollandrock said:


> Yes, I've read about that sort of thing. And let's not forget the doctors who are stockholders in the companies whose products they pitch, but don't mention the fact.


Through a mutual fund I see no problem. Even through owning individual stocks I don't see a problem.

I doubt I could prescribe enough celebrex to single handedly drive up the stock price.

What I see as a conflict is if the physician has a big dollar "consulting" contract with a device maker but even then, If the disclosure is made, as is obligatory, then the patients decisions are informed.


----------



## 32rollandrock

SG_67 said:


> They pay less because their governments subsidize it. The same way as insurance companies subsidize our purchase of drugs.


DON'T GET ME STARTED!!!!


----------



## 32rollandrock

You are correct on both counts. I should have been more clear. What I meant was, physicians who own very substantial amounts of stock and have arrangements with manufacturers to promote goods.



SG_67 said:


> Through a mutual fund I see no problem. Even through owning individual stocks I don't see a problem.
> 
> I doubt I could prescribe enough celebrex to single handedly drive up the stock price.
> 
> What I see as a conflict is if the physician has a big dollar "consulting" contract with a device maker but even then, If the disclosure is made, as is obligatory, then the patients decisions are informed.


----------



## SG_67

^ while not illegal nor unethical, if the physician is being paid by the drug company to promote a product (TV, print or at conferences) then that needs to be disclosed. That is, of course, if the physician is in a position to also prescribe and/or use said product. An ortho who does joint replacements paid by Zimmer for consulting is a clear conflict. A proctologist paid to pitch migraine mess, probably not. It begs the question, of course, why would I pay a proctologist for that, but I'm just citing it as an example.


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## 32rollandrock

Then there's this:

https://www.nytimes.com/2014/10/11/...column-region&region=top-news&WT.nav=top-news

The pertinent excerpt:

Gilead defended the price. "We believe the price of Harvoni reflects the value of the medicine," it said in a statement. "Unlike long-term or indefinite treatments for other chronic diseases, Harvoni offers a cure at a price that will significantly reduce hepatitis C treatment costs now and deliver significant health care savings to the health care system over the long term."

They also could have said this: "We believe the price of Harvoni reflects the value of the medicine. It is, after all, better to be alive than dead."


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## WouldaShoulda

32rollandrock said:


> They also could have said this: "We believe the price of Harvoni reflects the value of the medicine. It is, after all, better to be alive than dead."


...unless you are the one getting stuck with the bill!!


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## Chouan

I've probably said this, or things like this before. However, there is no reason why Obamacare *couldn't* work, if people wanted it to. There would be ways to make it work if the will was there. Instead, the vested interests, for want of a better expression, and those ideologically opposed to such government programmes will ensure that the difficulties are raised to such a level that it *won't* work. So, the premise that Obamacare will never work is true, predicated on the ideological opposition to it that will ensure its failure.


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## WouldaShoulda

Chouan said:


> ...the vested interests, for want of a better expression, and those ideologically opposed to such government programmes will ensure that the difficulties are raised to such a level that it *won't* work. So, the premise that Obamacare will never work is true, predicated on the ideological opposition to it that will ensure its failure.


False.

Obama said health insurance costs would decrease by $2,500.00 per family.

That numbers of covered citizens would increase while deficits decrease.

That an individual can keep their existing plan if they liked it.

He defined what success would be and by his standard he failed.


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## 32rollandrock

Chouan said:


> I've probably said this, or things like this before. However, there is no reason why Obamacare *couldn't* work, if people wanted it to. There would be ways to make it work if the will was there. Instead, the vested interests, for want of a better expression, and those ideologically opposed to such government programmes will ensure that the difficulties are raised to such a level that it *won't* work. So, the premise that Obamacare will never work is true, predicated on the ideological opposition to it that will ensure its failure.


It can't work for the reason for the reason first stated: Obamacare does nothing to address the unsustainable cost of health care in the United States, which is much higher than it is in many other industrialized nations. Until you get a handle on costs, it's a fool's mission. It is an inherently flawed model if only because it keeps private insurance companies, which do nothing but generate profits for shareholders, in business. At a minimum, you have to eliminate the insurance companies that create nothing of value. That's just my opinion, and I still favor Medicare for everyone.


----------



## Yodan731

Amen.



32rollandrock said:


> It can't work for the reason for the reason first stated: Obamacare does nothing to address the unsustainable cost of health care in the United States, which is much higher than it is in many other industrialized nations. Until you get a handle on costs, it's a fool's mission. It is an inherently flawed model if only because it keeps private insurance companies, which do nothing but generate profits for shareholders, in business. At a minimum, you have to eliminate the insurance companies that create nothing of value. That's just my opinion, and I still favor Medicare for everyone.


----------



## 32rollandrock

Apologies for reviving an old thread, but then there was this: https://www.nytimes.com/2015/01/06/...n-region&region=top-news&WT.nav=top-news&_r=0

My favorite part, straight from the ivory tower:

But Jerry R. Green, a professor of economics and a former provost who has been on the Harvard faculty for more than four decades, said the new out-of-pocket costs could lead people to defer medical care or diagnostic tests, causing more serious illnesses and costly complications in the future.
"It's equivalent to taxing the sick," Professor Green said. "I don't think there's any government in the world that would tax the sick."


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## SG_67

We can all thank Harvard and other academic and government elites for pointing out something that those of us working in healthcare were saying years ago.


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## WouldaShoulda

Did you know that recent studies indicate that men are different than women??


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## SG_67

^ I believe you'll find competing studies debunking this myth as well. 

Why can't we go back to meaningful studies like the mating habits of the North American gray squirrel.


----------



## 32rollandrock

SG_67 said:


> We can all thank Harvard and other academic and government elites for pointing out something that those of us working in healthcare were saying years ago.


Actually, I was thinking of what you had said on the topic when I first read this, vis-a-vis increasing consumer share of cost helps reign in costs. I still think Medicare for everyone is best, but that's a philosophical thing not worth beating to death again (and don't get me started on the recent decision of a local hospital, one of two major hospitals here, to hire six trauma physicians in order to recapture a bigger share of the trauma market, even though there have been no complaints regarding lack of access to care for folks who get in car accidents, gun fights, etc. To help lure business, they set up a room for ambulance drivers with free snacks.)

More than anything, the article, I think, underscores how amazingly stupid academics can be when it comes to living in the real world, and what cry babies they can be. I think Obamacare is somewhat beside the point. I know I'd wet my pants if I got a health care plan as generous as what these folks are complaining about. So would most everyone I know.


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## SG_67

^ 
That's correct! From a purely economic standpoint, the way to reign in costs is to shift the burden more onto the consumer.

The trouble is that in all the discourse surrounding "O" care between 2008-2010, and so well illuminated by Professor Gruber, that's not the way it was sold. The problem becomes when we discuss it purely academically it makes sense. But when we get sick we want every test to find out why we're sick and we want it now. We want to latest, most cutting edge medicine and we even want alternatives and other untested procedures that are considered "experimental"; if I had a nickel for everyone who has asked me about platelet rich plasma or stem cell therapy for tissue regeneration.......

Of course, the costs would go up for those whom the government deems can afford it, and the rest are then subsidized. But then how is that really different from what we have now. Instead of our employers subsidizing our healthcare we have government doing it. It's still subsidized and will present with the same economic model where those on the receiving end will have little to no understanding of the true cost. 

As for the Medicare for all model, it sounds good and I understand the appeal. But again, I would urge you and others to consider just what a small % of the population right now receives Medicare vs. the total population. Expand that to everyone and you will end up with a huge VA type situation. If you want to wait, if you want to have rationed healthcare and to muddle through bureaucracy of Byzantine proportions then I suppose we should have that debate. But let's at least be honest about it and not have people go into it blind and star struck as they were in 2008 when they voted for Obama and in the following 2 years when the public and the media didn't raise any concerns. 

Once again though, the Harvard faculty comes to rescue Western Civilization as we know it.


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## 32rollandrock

SG_67 said:


> ^
> That's correct! From a purely economic standpoint, the way to reign in costs is to shift the burden more onto the consumer.
> 
> The trouble is that in all the discourse surrounding "O" care between 2008-2010, and so well illuminated by Professor Gruber, that's not the way it was sold. The problem becomes when we discuss it purely academically it makes sense. But when we get sick we want every test to find out why we're sick and we want it now. We want to latest, most cutting edge medicine and we even want alternatives and other untested procedures that are considered "experimental"; if I had a nickel for everyone who has asked me about platelet rich plasma or stem cell therapy for tissue regeneration.......
> 
> Of course, the costs would go up for those whom the government deems can afford it, and the rest are then subsidized. But then how is that really different from what we have now. Instead of our employers subsidizing our healthcare we have government doing it. It's still subsidized and will present with the same economic model where those on the receiving end will have little to no understanding of the true cost.
> 
> As for the Medicare for all model, it sounds good and I understand the appeal. But again, I would urge you and others to consider just what a small % of the population right now receives Medicare vs. the total population. Expand that to everyone and you will end up with a huge VA type situation. If you want to wait, if you want to have rationed healthcare and to muddle through bureaucracy of Byzantine proportions then I suppose we should have that debate. But let's at least be honest about it and not have people go into it blind and star struck as they were in 2008 when they voted for Obama and in the following 2 years when the public and the media didn't raise any concerns.
> 
> Once again though, the Harvard faculty comes to rescue Western Civilization as we know it.


My problem is, I feel over-doctored, and it's against my will. We've had the discussion before. No reason why I should have to go see a doctor every year to get asthma drugs that are sold OTC in many countries when I am feeling perfectly healthy, but I have to go and it costs a fair amount of money.


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## SG_67

^ 
Perhaps it works for you but what about someone else who may not be aware that he/she has developed other health problems. The reason you see your MD annually for this is so that he/she can assess your overall health as well as the condition for which you are being treated. 

If that's not happening than I would consider that to be a failure on the part of the practitioner and the due diligence necessary before prescribing something. 

But again, you're speaking from your experience. If you started to develop another respiratory condition, trust me, you wouldn't be thinking you're over-doctored. You would want a team of physicians pouring over the physical findings to determine the diagnosis and proper treatment.


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## 32rollandrock

I get what you're saying. But, really, my health isn't being assessed at all. If they wanted to do that, they would give me a physical. Or they'd actually weigh me instead of asking "How much?" It's pretty much check the pulse, BP, a quick "How are you feeling?" and, ka-ching, I'm out the door. Not as bad as the last quack, who soaked me for unnecessary blood tests when I had no symptoms of anything amiss. Cost me $400, not sure about the insurer. It's my body and my health, but I very often feel like I'm not in control when I go to the doctor. I feel like I'm being extorted--no drugs for you unless you do what we say. While I understand due diligence, let's say that I do develop some serious issue that went undiagnosed. Is a doctor who gave me the most cursory of examinations--BP fine, no complaints, see you later, ka-ching--really going to escape liability if I sued (which I wouldn't do, but others might)?

Absolutely true, though--if I did develop something serious, I'd want a whole team of doctors poring over test results. Perhaps if doctors, at least the ones I've encountered, didn't waste time and money going through motions as described above, there would be a team with sufficient time and expertise to do that for me.



SG_67 said:


> ^
> Perhaps it works for you but what about someone else who may not be aware that he/she has developed other health problems. The reason you see your MD annually for this is so that he/she can assess your overall health as well as the condition for which you are being treated.
> 
> If that's not happening than I would consider that to be a failure on the part of the practitioner and the due diligence necessary before prescribing something.
> 
> But again, you're speaking from your experience. If you started to develop another respiratory condition, trust me, you wouldn't be thinking you're over-doctored. You would want a team of physicians pouring over the physical findings to determine the diagnosis and proper treatment.


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## Regillus

Hello to all. I haven't been on the site for over a year. Re Obamacare: Yes we need a single-payer system with cost controls like in other countries where medical care is cheaper. I know the vital necessity of having health insurance having had; last month; open-heart surgery to replace a heart valve and repair an aneurysm. I'm home now recovering which will take about 4 months.
Still experiencing occasional slight atrial fibrillation for which I take Amiodarone. So yes; everyone needs health insurance because you never know when you're going to need it.


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## SG_67

Regillus said:


> Hello to all. I haven't been on the site for over a year. Re Obamacare: Yes we need a single-payer system with cost controls like in other countries where medical care is cheaper. I know the vital necessity of having health insurance having had; last month; open-heart surgery to replace a heart valve and repair an aneurysm. I'm home now recovering which will take about 4 months.
> Still experiencing occasional slight atrial fibrillation for which I take Amiodarone. So yes; everyone needs health insurance because you never know when you're going to need it.


First off, I'm glad you're feeling better and got the care you needed.

Don't for a second think, however, that a single payer government system is going to give you access like you now enjoy. He healthcare system which we have will be a thing of the past under such a regime.

Folks, we can't have our cake and eat it too! It's a fact and I'm afraid it's been borne out time and time again.

By the way, that's exactly what health insurance is for; catastrophic health issues. When policies are festooned with give aways and little pet projects and other coverage lobbied for by special interests, that's when it gets out of control.


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## Regillus

SG_67 said:


> First off, I'm glad you're feeling better and got the care you needed.
> 
> Don't for a second think, however, that a single payer government system is going to give you access like you now enjoy. He healthcare system which we have will be a thing of the past under such a regime.
> 
> Folks, we can't have our cake and eat it too! It's a fact and I'm afraid it's been borne out time and time again.


If it can be done in other countries then it can be done here. Scotland's system is good.


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## SG_67

But it doesn't work in other countries. At least not in the way that it works in the states.

Max 18 week wait time!!!
https://www.nhs.uk/choiceintheNHS/Rightsandpledges/Waitingtimes/Pages/Guide to waiting times.aspx
https://www.telegraph.co.uk/news/po...ive-Scots-struggle-to-get-GP-appointment.html

This story ran on NPR this morning:
https://www.npr.org/2015/01/11/376384632/overcrowded-hospitals-overwhelm-uks-national-health-service


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## dmccardle

Hello, this is my first post on AAAC. Don't really know why I picked this (I guess it could be dangerously...divisive?), but I...sort of... always have the same two questions about this issue... 

1) Almost every other civilized country on Earth has Universal, Single Payer, Free or 'Government Supplied' healthcare. Why are we somehow 'better' than those others countries? 

2) Maybe I'm wrong, but isn't 'Obamacare' just a big insurance scam? Seems to me that this is the best thing that ever happened to the insurance industry? Doesn't 'Obamacare', essentially force, by threat of sanction, every American to become a customer of these companies? I bet the auto industry would love to get in on that action... 

And to those who suggest that it would be too costly... Sweden, Switzerland, Norway, France, Italy, Argentina, Brazil, Cuba, Canada, Denmark, Rwanda, Libya, Australia, Romania, and countless others all have some system of 'Free' healthcare. How come they can afford it? Maybe, just maybe, they don't have hugely subsidized industries like banking and finance, automobile manufacturing, farming, etc, etc. Maybe they don't spend 3.5+ times more than any other country on their military?

Maybe, just maybe, they recognize that their may, in fact, be a moral obligation to care for one's fellow man?


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## SG_67

^ let's say you snapped your fingers and it were so. How would you control costs?

P.s. Welcome by the way.


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## dmccardle

SG_67 said:


> ^ let's say you snapped your fingers and it were so. How would you control costs?
> 
> Thanks and...
> 
> I don't have a clue
> 
> I guess I'd ask France, Sweden, Rwanda, Italy, etc how they do it?


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## SG_67

dmccardle said:


> SG_67 said:
> 
> 
> 
> ^ let's say you snapped your fingers and it were so. How would you control costs?
> 
> Thanks and...
> 
> I don't have a clue
> 
> I guess I'd ask France, Sweden, Rwanda, Italy, etc how they do it?
> 
> 
> 
> I'll save you the trouble. They do it by restricting access and with price controls.
> 
> I said it before, those that want universal, single payer health system have to understand that the system we enjoy now will not be what's left when that transformation. Is over.
> 
> Rwanda?
Click to expand...


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## dmccardle

SG_67 said:


> dmccardle said:
> 
> 
> 
> Rwanda?
> 
> 
> 
> Yeah... kind of a joke
Click to expand...


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