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Increasing Numbers Of Americans Want Single-Payer Healthcare, But Do They Really
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Date: January 5th, 2019 1:06 AM Author: pea-brained sound barrier Increasing Numbers of Americans Want Single Payer, But Is That What They Want?
Joshua Cohen4:26 pm Healthcare I write about drug value, market access, and healthcare systems
People rally in favor of single-payer healthcare for all Californians as the US Senate prepares to vote on the Senate GOP health care bill, outside the office of California Assembly Speaker Anthony Rendon, June 27, 2017 in South Gate, California. Rendon announced last week that Senate Bill SB 562 – the high-profile effort to establish a single-payer healthcare system in California – would be shelved, saying it was ‘incomplete.’ / AFP PHOTO / Robyn Beck (Photo credit should read ROBYN BECK/AFP/Getty Images) A Washington Post/Kaiser Family Foundation poll asked: “Do you support or oppose having a national health plan – or a single-payer plan – in which all Americans would get their insurance from a single government plan?” A slight majority 51% of respondents was in favor of a single payer system.
As posed, however, the question and answer aren’t particularly meaningful. The poll question covers one aspect of a single-payer plan: There would be one government insurer that covers all Americans. But, there’s more to single payer systems that that. To gauge an at least somewhat informed opinion a vignette would need to be included describing key aspects of single payer, such as universal access, but also how such a system is funded through taxes and deploys explicit government budgeting and rationing.
It follows, however, from the polarized nature of the healthcare debate in the U.S., that the alternatives presented to Americans in polls like the one mentioned above may sometimes depict oversimplified scenarios that represent approaches on either end of the spectrum.
For decades, health reform efforts have been heavily politicized, with all sides resorting at times to misinformation and sloganeering. This appeared to come to a head in the run-up to passage of the Affordable Care Act. Opponents saw it as a government take-over of healthcare. Paradoxically, “hands off my Medicare” became an oft-repeated slogan by those who worried about government intrusiveness.
WASHINGTON, DC – OCTOBER 26: A woman holds a sign that reads ‘Hands Off Medicare’ during a news conference at the U.S. Capitol October 26, 2011 in Washington, DC. Members of Congress called on the Joint Deficit Reduction Committee to preserve Medicare, Medicaid, and Social Security benefits when making their decision on cutting the deficit. (Photo by Mark Wilson/Getty Images) Currently, the apparent popularity of the single payer approach among the general public and even doctors has produced a backlash. Critics of single payer cite wait times, rationing, and chronic under-funding, particularly of specialty care. But to then conclude that single payer is a “failure” is an inaccurate portrayal, especially when the system generally being referred to, the British National Health Service, is as cherished as it is by many Britons. It’s a flawed, not a failed system.
On the other side of the debate, critics of the U.S. healthcare system conveniently ignore positive aspects, such as cancer care (from diagnostics to health outcomes the U.S. does comparatively well), invention and use of cutting-edge technologies, and overall responsiveness (lack of delays in access to care, for example), while falsely proclaiming that single payer is free healthcare. While a single payer system is often free at point of service it is paid for by beneficiaries through taxes.
Both proponents and opponents of single payer also pit it against the U.S. healthcare system, creating a neat but patently false bifurcation of healthcare system approaches into the U.S. versus “European-style healthcare.” The fact is Europe is far from monolithic in terms of the structure of its healthcare systems. Single payer is not the typical approach to healthcare on the European continent. Unlike single payer systems, many of the hybrid systems on the continent have a substantial private component and are usually less budget-constrained. In the past two decades the private share in healthcare spending has edged up across Europe. This even includes traditional single payer systems. Interestingly, during this period, in the U.S. the public share of healthcare spending has increased to over 50%.
Let’s briefly review several salient features from each of four European healthcare systems. France requires all citizens and residents to purchase coverage from non-profit insurers. At regular intervals these insurers negotiate pharmacy, diagnostics, device, and medical care budgets with the national government. The majority of French citizens buy supplemental insurance from private carriers to cover co-payments and other items not included in the essential benefits package. This is comparable to MediGap coverage in the U.S., which is purchased by Medicare beneficiaries. Germany’s social health insurance system is the oldest in the world and contains elements that were later adopted by the American employer-sponsored model. Most citizens and residents are covered by statutory health insurance, which offers at a minimum a set of essential benefits provided by over 1000 public and private “sickness funds.” Insurance is funded by employee and employer contributions, as well as government subsidies for those with lower incomes. Some opt out of the statutory health insurance, choosing instead to purchase more comprehensive coverage from private insurers. The national government convenes an annual round table of sorts aimed at consensus building around healthcare goals, budgets, and resource allocation. The committee is made up of representatives from the corporate sector, labor, physicians, hospitals, and the drug and medical device industries. It provides recommendations to the sickness funds regarding healthcare expenditure targets, taking into account, for example, guidance issued by the Institute for Quality and Efficiency in Healthcare and the Federal Joint Committee on the comparative effectiveness of prescription drugs in specific therapeutic classes. In the Netherlands and Switzerland, all citizens and residents are required to purchase insurance from private health insurers. Most insurers are for-profit. Private insurers must offer a core set of medical and pharmacy benefits. While the Dutch healthcare system is funded by a combination of payroll taxes paid by employers and beneficiary premiums, the Swiss system is entirely funded by beneficiary premiums.
Common characteristics of all four systems include mandatory insurance, a government-defined minimum benefits package, community rating, the requirement that insurers take on all who apply for insurance, and national health technology assessment entities, each with distinct methods of calculating the cost-effectiveness of drugs and devices. With the exception of Germany, each system has a centrally approved formulary.
Single payer healthcare is gaining in popularity in recent polls conducted in the U.S. Nevertheless, as an approach to healthcare single payer is less translatable to the U.S. context than hybrid systems on the European continent. For example, from the experiences of the Swiss, Dutch, French, and Germans, important lessons could be drawn regarding design of a hybrid system – or its individual parts – that works towards universal access and containment of costs.
I'm an independent healthcare analyst with over 20 years of experience analyzing healthcare and pharmaceuticals. Specifically, I analyze the value (costs and benefits)…MORE Joshua P. Cohen |
Date: January 5th, 2019 1:41 AM Author: exciting sinister water buffalo psychic As a percentage of GDP, the U.S.'s public health care spending alone is about what other advanced countries spend in both public and private spending. Our private spending brings us to about double what other countries spend on a GDP basis.
And the retards in the U.S. excuse it with idiotic comments about fat Americans and paying for "innovation."
The problem isn't money. It's political will. |
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Date: January 5th, 2019 1:48 AM Author: Duck-like cuck milk No. The problem is money, (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530722) |
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Date: January 5th, 2019 1:52 AM Author: useless native (((money))) (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530728) |
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Date: January 5th, 2019 1:52 AM Author: exciting sinister water buffalo psychic Our peer countries manage on what we spend in public funds. We're simply wildly inefficient. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530730) |
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Date: January 5th, 2019 1:55 AM Author: Duck-like cuck milk So that means money isn’t a problem?
And we have no peer countries. We’re a polyglot confederation that isn’t nearly as centralized bureaucratically as European or Asian counties. And we have countless proles who libs would want to cover at the highest standard of care. |
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Date: January 5th, 2019 2:03 AM Author: exciting sinister water buffalo psychic There isn't any legal barrier to the federal government providing health care, so I'm not sure what problem you're thinking of.
And shitlibs are welcome to convince California to provide additional coverage. |
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Date: January 5th, 2019 2:05 AM Author: Stirring business firm jap every country has proles. the 'america is so unique' argument is just meaningless handwaving (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530763) |
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Date: January 5th, 2019 2:06 AM Author: zombie-like white striped hyena We pay more for the same drugs they get on the gubment. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530769) |
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Date: January 5th, 2019 4:04 AM Author: Bull headed parlour the problem is that the medical cartel owns our elites, just like the military complex owns our elites, and the tax return industry owns our elites, and silicon valley owns our elites, and the chamber of commerce owns our elites...and...you get the picture (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531078) |
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Date: January 5th, 2019 2:05 AM Author: Stirring business firm jap Yes. End of article. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530766) |
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Date: January 5th, 2019 2:21 AM Author: fragrant godawful stead Joshua Cohen4:26 pm (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530818) |
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Date: January 5th, 2019 2:22 AM Author: Electric Aggressive Death Wish (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530819) |
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Date: January 5th, 2019 2:25 AM Author: Stirring business firm jap (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530827) |
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Date: January 5th, 2019 2:25 AM Author: useless native (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530829) |
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Date: January 5th, 2019 2:08 AM Author: vibrant bat shit crazy dopamine No, I think its much better if people pay a random portion of their healthcare and then their employer pay another part and the prices are pulled more or less out of a hat based on choices people other than the patient made.
That's a great system and should be kept. |
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Date: January 5th, 2019 2:27 AM Author: anal affirmative action love of her life it's a better system because it's not really random. employers do change rates based on employees' health-related choices, such as smoking it's not ideal, but it is far superior to single payer why? because the goal with single payer is to provide everyone with equal healthcare. the goal with employee provided healthcare is to provide all employees with fair healthcare |
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Date: January 5th, 2019 2:28 AM Author: fragrant godawful stead (sealclubber) (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530838) |
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Date: January 5th, 2019 2:28 AM Author: Stirring business firm jap jfc (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530840) |
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Date: January 5th, 2019 2:29 AM Author: vibrant bat shit crazy dopamine So people are supposed to poll how many people at an employer smoke before accepting a job?
Holy fuck do free market people have stupid thoughts. |
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Date: January 5th, 2019 2:36 AM Author: anal affirmative action love of her life no. because an employer can charge smokers more than non-smokers for health insurance. just as employers do when it comes to family vs individual vs couple insurance |
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Date: January 5th, 2019 2:37 AM Author: Stirring business firm jap why wouldnt smokers just lie and say they dont smoke when signing up for insurance (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530866) |
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Date: January 5th, 2019 2:43 AM Author: anal affirmative action love of her life come on. this argument can be applied to everything and it wins zero arguments (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530884) |
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Date: January 5th, 2019 2:44 AM Author: Stirring business firm jap im serious, whats the enforcement mechanism here (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530891) |
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Date: January 5th, 2019 2:53 AM Author: anal affirmative action love of her life What’s wrong with lying about whether I smoke? The lie may be fraudulent, and the insurance benefits for you and your family may be at stake. After a federal judge found tobacco companies “guilty of lying about the health effects of smoking,” some cigarette users who lie on their policies may consider themselves excused from charges of insurance fraud, and the motivation for misrepresenting their own health risks may be even more significant. Cigarette users may be motivated to lie in order to obtain either (a) lower health insurance premiums or (b) maintain eligibility for life insurance policy or rates. In some states, lying about smoking for insurance purposes is a material misrepresentation, just like lying about health history. In others, the face amount of the policy may be adjusted downward if the policy holder misrepresents his smoking status. |
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Date: January 5th, 2019 2:41 AM Author: Cocky sandwich the insurers charge smokers more and pass it through. they're not allowed to deny coverage if you smoke but they are allowed to raise premiums for smokers. this is done for individual insurance too, not something unique to employer sponsored insurance.
it's also the insurers charging more to cover spouses and children, not something done as a result of employer sponsoring the insurance. |
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Date: January 5th, 2019 2:45 AM Author: anal affirmative action love of her life oh, so single payer means people who partake in potentially more expensive activities like smoking are going to pay more in insurance? of course not and that's why it is pure shit. |
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Date: January 5th, 2019 2:46 AM Author: Cocky sandwich im not sure if we should go to single payer but passing it through an employer is not why smokers and people covering spouses and children pay more. it's true for individual insurance purchase directly from insurer and employer is just a pass through. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530897) |
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Date: January 5th, 2019 2:57 AM Author: anal affirmative action love of her life let's back up. smokers and people covering spouses and/or children pay more because insurance companies know and require that they should. nothing is going to change the fact that they are more expensive to provide insurance to single payer ignores everything that matters to the cost of providing health insurance. it assumes all are identical. it assumes i'm cool with contributing the same amount as cancer carlos or smoking samantha |
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Date: January 5th, 2019 2:35 AM Author: exciting sinister water buffalo psychic "the goal with employee provided healthcare is to provide all employees with fair healthcare"
Says who?
And nothing you said justifies the massive amount we spend relative to other advanced countries. |
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Date: January 5th, 2019 2:42 AM Author: anal affirmative action love of her life says an employer who is looking to be fair ie all employers while all might not approach it that way, it is the endgame now you've shifted the converstation to wahhhh wahhh what does the usa spend on health care vs what do other "advanced" countries spend that is such a lame retort for many reaons. you, the whiner, gets to choose what countries are considered "advanced", and you, the whiner, ignore the negatives that these countries have because their health care provisions are supposedly better than ours. this really can be simplified by physics--every action has an equal opposite reaction
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Date: January 5th, 2019 2:43 AM Author: Stirring business firm jap "says an employer who is looking to be fair ie all employers"
what kind of koch brothers flame is this???? |
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Date: January 5th, 2019 2:51 AM Author: anal affirmative action love of her life am i correct that you don't have employees? work that tends to be important tends to have aspects where employees who can do that work are more valuable employers tend to reward those workers with more $ for many reasons workers who are fungible are not going to be treated the same, probably, because they don't need to be but when it comes to providing health insurance for these/all employees, you are looking to make it fair because there is little incentive to do otherwise
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Date: January 5th, 2019 3:04 AM Author: exciting sinister water buffalo psychic What the hell are you trying to say with private sector "fairness"?
Are you saying that "fairness" (whatever it means) justifies massive inefficiency? |
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Date: January 5th, 2019 3:05 AM Author: Stirring business firm jap whether i have employees or not is irrelevant (although in a sense, i do).
i disagree that employers are as fair minded as you seem to think, employers are profit seekers and operate to that end. even if they try to put together attractive compensation packages for valuable employees, the vast majority of employees are largely fungible, very few are truly valuable to the extent that employers will go above and beyond to provide health care tailored toward their needs. public policy on health care should address everyone, not just employees who employers deem to be valuable.
further, health care coverage is often opaque and will be unduly discounted by employees considering an offer in exchange for more immediate benefits (i.e. salary), thus there is incentive for employers to skimp on this end. it's a historic mistake that health care in america is typically tied to employment, and there is no reason to hang onto this failed system. |
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Date: January 5th, 2019 3:08 AM Author: Cocky sandwich other countries have single payer but still common for employers in those countries to offer healthcare benefits though. I'm thinking of HK and SG where there the single payer is for very basic care. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530955) |
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Date: January 5th, 2019 3:11 AM Author: zombie-like white striped hyena Those other countries don't pay for the R&D like the US does. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530963) |
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Date: January 5th, 2019 3:12 AM Author: Cocky sandwich i think it's worth pointing out that countries with a single payer layer are copying the US in having healthcare benefits as part of the overall benefits and compensation package. but for them the employer healthcare is an add-on to the basic government healthcare. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530970) |
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Date: January 5th, 2019 3:15 AM Author: zombie-like white striped hyena Not fighting your observation, just noting they aren't paying the piper when it comes to the research and payments at the discovery level.
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Date: January 5th, 2019 3:20 AM Author: exciting sinister water buffalo psychic http://www.xoxohth.com/thread.php?thread_id=4170609&forum_id=2#37530815 (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530996) |
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Date: January 5th, 2019 3:23 AM Author: zombie-like white striped hyena The United States bears the brunt for most Medical research worldwide. It's fucking ridiculous when they piggyback off of our R&D and wonder why it's expensive here. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531002) |
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Date: January 5th, 2019 3:31 AM Author: exciting sinister water buffalo psychic So what?
That doesn't come anywhere close to explaining our massively higher health care costs. |
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Date: January 5th, 2019 3:32 AM Author: zombie-like white striped hyena R&D doesn't factor into cost? Really? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531021) |
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Date: January 5th, 2019 3:36 AM Author: exciting sinister water buffalo psychic http://www.xoxohth.com/thread.php?thread_id=4170609&forum_id=2#37530815 |
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Date: January 5th, 2019 3:37 AM Author: zombie-like white striped hyena sure. Let China come up with the new innovations. Who gives a fuck about healthcare anyway? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531036) |
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Date: January 5th, 2019 3:41 AM Author: exciting sinister water buffalo psychic Flame or can't read? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531041) |
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Date: January 5th, 2019 3:42 AM Author: zombie-like white striped hyena sure, mister China. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531044) |
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Date: January 5th, 2019 3:28 AM Author: zombie-like white striped hyena https://en.wikipedia.org/wiki/List_of_countries_by_research_and_development_spending (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531011) |
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Date: January 5th, 2019 3:30 AM Author: exciting sinister water buffalo psychic And? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531015) |
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Date: January 5th, 2019 3:31 AM Author: zombie-like white striped hyena more than any other country. what is your point? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531019) |
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Date: January 5th, 2019 3:36 AM Author: exciting sinister water buffalo psychic http://www.xoxohth.com/thread.php?thread_id=4170609&forum_id=2#37530815 (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531031) |
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Date: January 5th, 2019 3:38 AM Author: zombie-like white striped hyena Let China give us dog food as medicine. yay! (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531037) |
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Date: January 5th, 2019 3:40 AM Author: exciting sinister water buffalo psychic What the fuck are you talking about? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531040) |
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Date: January 5th, 2019 3:41 AM Author: zombie-like white striped hyena Comrade Chinky..you know. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531043) |
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Date: January 5th, 2019 3:50 AM Author: exciting sinister water buffalo psychic I showed that we could maintain health care spending at levels similar to peer countries AND ALSO spend roughly half a trillion dollars PER YEAR on just medical research and still be way under our current total health care expenditures.
We're talking something like 20 complete Manhattan Projects PER YEAR in medical R&D, and you're responding with comments about *stopping* R&D.
Why would you do that? |
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Date: January 5th, 2019 3:51 AM Author: zombie-like white striped hyena Medicaid. There's your answer. It's out of control. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531063) |
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Date: January 5th, 2019 3:17 AM Author: Stirring business firm jap Yeah but its often easier and more economical to turn down the employer plan and get your own third party coverage in places like SG where the market for healthcare is very transparent
employer provided plans are not usually free, and often are pretty bad value |
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Date: January 5th, 2019 3:19 AM Author: Cocky sandwich Really? I don't have those observations from HK. Are you sure it's not unique to your employer. Then why does the employer offer it? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530991) |
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Date: January 5th, 2019 3:21 AM Author: Stirring business firm jap my observation is from a number of different employers/friends etc. there are different levels you can choose but if you want anything above the most basic shit, you typically have to pay (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530998) |
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Date: January 5th, 2019 3:22 AM Author: Cocky sandwich You generally have employee contributions for employer sponsored healthcare in the states too. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531000) |
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Date: January 5th, 2019 3:23 AM Author: Stirring business firm jap im not entirely sure what youre trying to get at (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531003) |
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Date: January 5th, 2019 3:26 AM Author: Cocky sandwich I lived in HK and only used employer sponsored healthcare. It was priced more favorably than if I were to go out and buy it individually. This is in a country with a single payer basic layer. I thought the situation is similar in SG cause I know our SG employees also had employer sponsored healthcare but I'm not sure how the price points compare to if they were to go out and buy it individually. I think it's worth noting there are countries that are copying the US health system in some ways. I mean, I functionally saw no difference because I never used the public system. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531007) |
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Date: January 5th, 2019 3:33 AM Author: zombie-like white striped hyena (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531024) |
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Date: January 5th, 2019 3:34 AM Author: Stirring business firm jap im not sure thats really a copy of the us system. SG has forced savings for medical care, subsidized government run hospitals/clinics/etc which provide better pricing for citizens and PRs and very transparent health care pricing generally. Employers may or may not provide their own health care package to employees but i think its all pretty easy to navigate as to whether that makes sense for the employee. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531030) |
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Date: January 5th, 2019 3:36 AM Author: zombie-like white striped hyena doesn't really provide new care if you're just relying on shit funding. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531033) |
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Date: January 5th, 2019 3:20 AM Author: anal affirmative action love of her life it's relevant because if you have employees, you'd know that you don't want them going to a different employer because you aren't being "fair" i'm assuming these employees are not fungible if you are just some profit seeking employer who treats all employees as being fungible, or you are discussing those types of employment situations, then it is the responsibility of the employee to look out for himself. if that employee is incapable of improving himself to the point of being distinctly valuable to his current or any employer, then wtf is an employer supposed to do but treat that employee as fungible? i will say this, though. an employee only has to show up reliably for work and not be a moron to have some non-fungible worth in today's workplace. moving on you posit that "public policy on health care should address everyone, not just employees who employers deem to be valuable". the easy response to that is why? present the reasoning behind that assertion and i or someone else will respond. (i'm getting ready to go to bed) your last paragraph is just an observation that people tend to fuck up and ignore caveat emptor. whether or not your point is true is irrelevant. it simply can be something kids are taught in school to be aware of. god forbid kids are taught something useful. |
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Date: January 5th, 2019 3:29 AM Author: exciting sinister water buffalo psychic "the easy response to that is why?"
- Employer-based health insurance discourages small business formation and reduces mobility.
- It adds a layer of complexity and opacity that reduces price pressure and increases inefficiency.
- Bonus: In a world in which the U.S. is a longtime, fucked up outlier, you don't get the conservative presumption in favor of the status quo. A liberal presumption requiring its defense is more appropriate. |
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Date: January 5th, 2019 3:42 AM Author: anal affirmative action love of her life point one. i don't give a fuck about employers providing health insurance. i'd actually prefer that people be responsible for obtaining and providing health insurance for themselves if they want it point two. providing health care for everyone is not about efficiency or price pressure. you bringing up these things as if they are relevant is disingenuous. providing healthcare for the homeless people on the corner is about charity, not efficiency. same for the 18 year old mother. same for her opioid addicted boyfriend who isn't working. i'm ignoring your bonus. the onus is on you to attack the status quo. that's how discussions go. |
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Date: January 5th, 2019 4:22 AM Author: exciting sinister water buffalo psychic "i don't give a fuck about employers"
You did in the prior post. I can't help it if you can't be consistent.
"providing healthcare for the homeless people on the corner is about charity"
Sure, to some significant degree. AND we have a dog shit system for everyone else.
"i'm ignoring your bonus."
Really?
"the onus is on you to attack the status quo."
Not if a liberal presumption applies.
"that's how discussions go."
If the conservative presumption applies. |
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Date: January 5th, 2019 4:31 AM Author: zombie-like white striped hyena go back to China. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531114) |
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Date: January 5th, 2019 4:34 AM Author: exciting sinister water buffalo psychic Ok. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531117) |
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Date: January 5th, 2019 3:32 AM Author: Stirring business firm jap it should be self evident that public policy should address the needs of the masses, not just the privileged few who are valued by employers. a government is meant to serve the people, not just the upper crust.
you can say 'caveat emptor' and all of that, but the fact of the matter is humans are flawed, and will continue to be, and that will feed into our health care outcomes. education is great, and should be pursued, but we should not be under the illusion that people will all of the sudden become rational actors with respect to health care even if we step up awareness on the importance of those choices. this feeds into the idea of employees leaving employers due to lack of 'fairness' on health care coverage. i think in reality, relatively few people are going to leave their jobs for another just to get better health care -- there are other factors at play and there are real costs involved in shifting jobs. its not an ideal way to police the way health care is provided and seems more likely to me to result in a race to the bottom where employers realize health care is undervalued by employees and continue to strip away benefits over time.
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Date: January 5th, 2019 3:49 AM Author: anal affirmative action love of her life the needs of the masses are addressed by encouraging the masses to be self reliant. that's what freedom, dignity, liberty, and our country is all about. giving things to people who do not deserve them is potentially problematic for many reasons. single payer in the us is based on the presumption that people deserve healthcare solely because they live here. that's a difficult position to support employees need to look out for themselves. that's freedom. that's liberty. healthcare provisions are just a piece of the puzzle. |
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Date: January 5th, 2019 3:05 AM Author: zombie-like white striped hyena What kind of flame are you fucking running? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530943) |
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Date: January 5th, 2019 3:07 AM Author: Stirring business firm jap why are you yosemite sam fuming in every thread today. relax. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530951) |
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Date: January 5th, 2019 3:09 AM Author: zombie-like white striped hyena just answer the fucking question. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530957) |
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Date: January 5th, 2019 3:20 AM Author: Stirring business firm jap im running 'flame' because my assumption is that employers are driven by profit rather than some abstract concept of 'fairness' toward employees? how dumb are you? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530995) |
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Date: January 5th, 2019 3:46 AM Author: zombie-like white striped hyena I work for a company that isn't jaded as you seem to be. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531049) |
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Date: January 5th, 2019 2:46 AM Author: provocative emerald rehab preventive strike Holy shit that physics part was as dumb as “it can be simplified by statistics it’s 50/50 either it is or it isn’t” (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530899) |
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Date: January 5th, 2019 2:58 AM Author: anal affirmative action love of her life you're a pumo so by default my opinion means more than yours try again, asshole |
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Date: January 5th, 2019 2:50 AM Author: provocative emerald rehab preventive strike I think the thing is people look at our healthcare system and say “that dog just won’t hunt.” it doesn’t work. Medical bills shouldn’t be so outrageous, and our country can’t spend as much as it does. Then they look at what works, which is single payer in other countries. And there you have it. It either is or it isnt (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530912) |
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Date: January 5th, 2019 3:06 AM Author: anal affirmative action love of her life our dog does hunt, it just doesn't hunt in a way that many people feel is "fair" medical bills are "outrageous" because because why? our country does spend what it spends. why? why can't it continue the way it is? what is unfair about how we do things now vs how others/you propose we do things? single payer in other countries "works" because it really isn't "working", but you choose to claim it is or because those countries have differences compared to us or because those countries have chosen to have policies that encroach upon some of their peoples' rights to help others or etc when you make x support y for no other reason than y exists, you are creating an inequity when you make x support y for some reason you think is justifiable, you are creating an inequity that might be justifiable, but might not be single payer is the first situation child support is the second.
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Date: January 5th, 2019 3:11 AM Author: exciting sinister water buffalo psychic "medical bills are "outrageous" because / because why?"
- bad and misaligned incentives
- price opacity and complexity
- artificial scarcity
- inefficient administration |
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Date: January 5th, 2019 3:23 AM Author: anal affirmative action love of her life i don't think any of these criticisms are relevant to single payer? are you suggesting the government take over all aspects of healthcare in order to address these things?
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Date: January 5th, 2019 3:32 AM Author: exciting sinister water buffalo psychic There's empirical evidence that it can be done. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531020) |
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Date: January 5th, 2019 3:34 AM Author: anal affirmative action love of her life durr durr see below and go on
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Date: January 5th, 2019 3:37 AM Author: provocative emerald rehab preventive strike (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531035) |
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Date: January 5th, 2019 3:11 AM Author: provocative emerald rehab preventive strike Everyone is paying too much for healthcare, friend (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530966) |
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Date: January 5th, 2019 3:23 AM Author: provocative emerald rehab preventive strike It’s not “fair” because it’s a shit market that’s creating a lot of rent for bigmed and is fucking everyone else. Thank god for shkreli pushing it to its garish extreme end otherwise people wouldn’t know and your red herring BS about wealth redistribution would be adequately distracting.
Do you also support the carried interest loophole? |
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Date: January 5th, 2019 3:31 AM Author: anal affirmative action love of her life wah wah wah, shit market people like shkreli are anomalies. no one likes what he did and i think it's unlikely that what he did can be duplicated in all that many places. what is my red herring about wealth redistribution?
i support flat taxes so that would avoid your loophole, i think, wouldn't it? |
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Date: January 5th, 2019 3:34 AM Author: provocative emerald rehab preventive strike Every pharma company is doing what he did just to a lesser degree. Ackman did a bunch of it too but it didn’t get as much press.
And carry is taxed as a capital gain even though it’s not connected to equity invested so not unless you don’t support a different rate for capital gains and ordinary income |
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Date: January 5th, 2019 3:47 AM Author: zombie-like white striped hyena "pharma" companies are fucking littered with random citizens. We all account for one another.
You honestly think we don't have compliance? It's probably more than some random tech startup when it comes to government regulation. |
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Date: January 5th, 2019 3:51 AM Author: provocative emerald rehab preventive strike what? they're literally comprised of random citizens. and together they're seeking rent at society's expense. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531062) |
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Date: January 5th, 2019 3:53 AM Author: zombie-like white striped hyena I work for a fortune 50 that would love not to be tied down with MedD and Medicaid compliance issues. Tell us how and you would be a billionaire. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531066) |
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Date: January 5th, 2019 3:58 AM Author: provocative emerald rehab preventive strike who said there wasn't regulation? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531071) |
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Date: January 5th, 2019 4:00 AM Author: zombie-like white striped hyena You seem to have the answers. Tell me. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531073) |
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Date: January 5th, 2019 4:09 AM Author: provocative emerald rehab preventive strike No idea what you’re getting at or trying to ask me. Would never say pharma companies aren’t regulated or shouldn’t be regulated. We need a system where there are controls on price for medical care and single payer is the only viable way to make that happen.
I sincerely HTH |
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Date: January 5th, 2019 4:12 AM Author: zombie-like white striped hyena Sure. So, our medical care should be through a government channel and we stop paying for R&D because...you want price control. Got it. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531094) |
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Date: January 5th, 2019 4:21 AM Author: provocative emerald rehab preventive strike No I just want to give med companies a staggering and increasing proportion of our wealth for the same outcomes because I fucking love science and so that we can have the BEST HEALTHCARE. I also want every 22 yr old to have 200k in debt so that we can have the BEST UNIVERSITIES in the WORLD (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531100) |
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Date: January 5th, 2019 4:24 AM Author: zombie-like white striped hyena You don't get the best healthcare by limiting profits on outcomes. You fucking retard. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531105) |
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Date: January 5th, 2019 4:28 AM Author: provocative emerald rehab preventive strike Wow you completely missed the point. The best healthcare is incredibly marginal and it’s not worth blowing all the money we spend on it. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531110) |
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Date: January 5th, 2019 4:33 AM Author: zombie-like white striped hyena you don't spend shit, JJC. I'm a US born citizen. I pay for you to be here. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531116) |
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Date: January 5th, 2019 4:36 AM Author: provocative emerald rehab preventive strike 👍 (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531118) |
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Date: January 5th, 2019 4:36 AM Author: exciting sinister water buffalo psychic "I'm a US born citizen."
I doubt that. |
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Date: January 5th, 2019 4:36 AM Author: zombie-like white striped hyena Try me, bitch (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531120) |
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Date: January 5th, 2019 4:38 AM Author: exciting sinister water buffalo psychic "give us your foresight and forward thinking resolution."
lulz |
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Date: January 5th, 2019 4:39 AM Author: zombie-like white striped hyena English words that are beyond you? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531124) |
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Date: January 5th, 2019 4:40 AM Author: exciting sinister water buffalo psychic Quite the opposite. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531127) |
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Date: January 5th, 2019 4:42 AM Author: zombie-like white striped hyena seems unlikely (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531129) |
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Date: January 5th, 2019 4:39 AM Author: exciting sinister water buffalo psychic "your rejoiner is what plan?" (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531123) |
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Date: January 5th, 2019 4:40 AM Author: zombie-like white striped hyena I live in Arizona, bitch. Yeah, I know words. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531126) |
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Date: January 5th, 2019 4:40 AM Author: exciting sinister water buffalo psychic "R&D doesn't factor into cost? Really?" (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531125) |
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Date: January 5th, 2019 4:43 AM Author: zombie-like white striped hyena And? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531130) |
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Date: January 5th, 2019 4:47 AM Author: exciting sinister water buffalo psychic You forgot already? (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531132) |
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Date: January 5th, 2019 4:48 AM Author: zombie-like white striped hyena don't know you, but you have zero points. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531133) |
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Date: January 5th, 2019 3:52 AM Author: anal affirmative action love of her life the "lesser degree" is exactly what can make it okay i don't support a different tax rate for capital gains and income. to any extent i can be convinced otherwise, it's important to remove any loopholes that aren't consistent with the different taxation levels.
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Date: January 5th, 2019 4:41 AM Author: zombie-like white striped hyena agreed! (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531128) |
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Date: January 5th, 2019 3:27 AM Author: provocative emerald rehab preventive strike Your argument is based on fairness more than pragmatism so idk why you’re putting fairness in quotes. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531009) |
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Date: January 5th, 2019 2:59 AM Author: exciting sinister water buffalo psychic "you, the whiner, gets to choose what countries are considered "advanced", and you, the whiner, ignore the negatives that these countries have because their health care provisions are supposedly better than ours."
You can pick the peer counties. Just be careful not to make yourself look like a window licker.
And if you want talk about "the negatives," no one is stopping you. |
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Date: January 5th, 2019 3:09 AM Author: anal affirmative action love of her life you're playing the whiner pick your country(ies) and argue why their system for providing healthcare is better than ours and while you're at it, you might as well point out why the obvious differences between our countries don't sufficiently refute your argument
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Date: January 5th, 2019 3:19 AM Author: exciting sinister water buffalo psychic You just bitched that I shouldn't be allowed to pick counties.
Which is it? |
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Date: January 5th, 2019 3:33 AM Author: anal affirmative action love of her life you pick, but you do the work. while you're at it, explain why you didn't pick the other possible single payer examples that will make my argument for me
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Date: January 5th, 2019 3:40 AM Author: exciting sinister water buffalo psychic "you pick, but you do the work."
We'll keep it simple.
Canada.
UK.
Much cheaper for similar or better health outcomes.
"while you're at it, explain why you didn't pick the other possible single payer examples"
I don't know what you're talking about.
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Date: January 5th, 2019 3:58 AM Author: anal affirmative action love of her life we spend 3.1% of gdp on military, canada spends 1.2 the uk? 1.8% it's not apples to apples on the obvious stuff even if we get a 3.1% comparison to the usa, i'll have other things to fall back on. but right now, i don't need to |
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Date: January 5th, 2019 4:02 AM Author: exciting sinister water buffalo psychic You're utterly incoherent. I have no clue what you're trying to say.
My best guess is you're saying we spend more on health care AND the military.
Uh. Ok. Yeah. That's true. But that doesn't help you. |
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Date: January 5th, 2019 4:06 AM Author: zombie-like white striped hyena give us your foresight and forward thinking resolution.
Until then, please STFU. |
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Date: January 5th, 2019 4:31 AM Author: exciting sinister water buffalo psychic I'm criticizing the status quo, advocating single-payer, and leaving the door open to protect R&D. That's pretty clear. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531113) |
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Date: January 5th, 2019 4:23 AM Author: zombie-like white striped hyena "better health outcomes"
On what planet do you live? |
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Date: January 5th, 2019 4:27 AM Author: exciting sinister water buffalo psychic Earth. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531108) |
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Date: January 5th, 2019 4:29 AM Author: zombie-like white striped hyena You are officially a retard. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531111) |
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Date: January 5th, 2019 4:32 AM Author: exciting sinister water buffalo psychic Yup. I was busted by the ESL genius. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531115) |
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Date: January 5th, 2019 4:44 AM Author: zombie-like white striped hyena most likely (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531131) |
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Date: January 5th, 2019 4:05 AM Author: zombie-like white striped hyena You have no answers. You just pick apart in hindsight.
When you have a resolution, feel free to post it here. |
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Date: January 5th, 2019 2:21 AM Author: exciting sinister water buffalo psychic The "innovation" angle is insane nonsense. R&D spending for the entire economy (not just medical and pharmaceutical) is between 2% and 2.5% of GDP.
If we maintained current public funding levels for health care and doubled R&D for the entire fucking economy by devoting the new spending to medical research, we should still be able to reduce total medical spending by something like 30% to 40%. |
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Date: January 5th, 2019 4:09 AM Author: zombie-like white striped hyena your rejoiner is what plan? You sound like a fuck up, no offense. But you seem lost. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531086) |
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Date: January 5th, 2019 2:27 AM Author: Bistre Buck-toothed French Chef Brethren Fuck healthcare I want single payer housing and a car. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530837) |
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Date: January 5th, 2019 2:50 AM Author: useless native Single payer Tesla (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37530908) |
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Date: January 5th, 2019 3:59 AM Author: blue jew I think people who pay for their healthcare deserve better healthcare with shorter wait times and the best doctors. I've found that illegals are demanding, suck up resources, are more likely to have self inflicted ailments, and have no appreciation for the manpower and $$ it takes to care for them (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531072) |
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Date: January 5th, 2019 4:10 AM Author: zombie-like white striped hyena Medicaid is in line before you and they don't pay shit. (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37531089) |
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Date: January 5th, 2019 2:38 PM Author: supple rebellious kitchen they complain endlessly about their self inflicted diseases and cause doctors to be late to appointments (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37532917) |
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Date: January 5th, 2019 12:56 PM Author: useless native (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37532413) |
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Date: January 5th, 2019 2:37 PM Author: fragrant godawful stead (http://www.autoadmit.com/thread.php?thread_id=4170609&forum_id=2#37532905) |