The 2020 Presidential Election Primary Thread

[beefytee]

First, Cardiac's pay will decrease under single payor. There's no question about that. This "argument" you make supports my position. Cardiac should be paid what a private market will bear. Do you think Cardiac is happy with his government mandated Medicare rates? I bet not. That is what he'll get under single payor. The result will be that few with Cardiac's abilities and drive will become surgeons, and we'll have shortages and declining care.

Second, it's hilarious that you say I'm on the wrong side of history because I don't get that socialism instead of capitalism can be a means to progress. That may be the most ignorant statement ever on this board (outside the religion forum, and Canadians are in thrall of a kind of religion). The problem of our age, maybe the ultimate human problem, is that capitalism, for all its faults (inequality, oppression of labor if unchecked by regulation, need for continual growth and consumption for resources), is the ONLY means to material progress and physical well-being.

Indeed, the "democratic socialist" countries like Denmark and Canada could not make their socialism work without the wealth and growth producing capitalist elements of their systems. It's the capitalism that pays for the "democratic socialism."

2 objections here.

There is very little capitalism associated with the US health care system. The free market, supply and demand, there is very little of that. When employers control your health care and costs are obfuscated, that is hardly free market.

Second, I would never characterize Canada as a "Democratic socialist" country unless you think that label applied to every developed country except the US. And it would be hard to exclude the US if the applications of the term is that liberal.

[tooblue]

First, Cardiac's pay will decrease under single payor. There's no question about that. This "argument" you make supports my position. Cardiac should be paid what a private market will bear. Do you think Cardiac is happy with his government mandated Medicare rates? I bet not. That is what he'll get under single payor. The result will be that few with Cardiac's abilities and drive will become surgeons, and we'll have shortages and declining care.

Second, it's hilarious that you say I'm on the wrong side of history because I don't get that socialism instead of capitalism can be a means to progress. That may be the most ignorant statement ever on this board (outside the religion forum, and Canadians are in thrall of a kind of religion). The problem of our age, maybe the ultimate human problem, is that capitalism, for all its faults (inequality, oppression of labor if unchecked by regulation, need for continual growth and consumption for resources), is the ONLY means to material progress and physical well-being.

Indeed, the "democratic socialist" countries like Denmark and Canada could not make their socialism work without the wealth and growth producing capitalist elements of their systems. It's the capitalism that pays for the "democratic socialism."

That's a great attempt at reframing the disputation Batman. There are no shortage of specialists, or surgeons in Canada. Specialist here do make less money, but a Cardiothoracic Surgeon for example still makes in excess of 400k a year. Further, quality of life in Canada is superior to the US, due in large part to universal health care. Your claims are false.

Canada benefits from a healthy capitalist economy. It shares a lot in common with the US due to remarkably similar economic, political and immigration policies. A principle difference between the two countries is Canada has found a way to make universal health care work in context to capitalist elements in its system, whereas the US has not. As for your assertion as to my ignorance, you were not even aware that there are more than two parities in Canada's parliamentary democracy.

I could continue, but usually this is the point where you make more half-baked claims and in particular derisive comments about my intellect before leaving the discussion like a tempestuous child. I will save you the trouble by agreeing with you that I am obviously just not as smart as you, and I am not worth your time.

[SeattleUte]

2 objections here.

There is very little capitalism associated with the US health care system. The free market, supply and demand, there is very little of that. When employers control your health care and costs are obfuscated, that is hardly free market.

Second, I would never characterize Canada as a "Democratic socialist" country unless you think that label applied to every developed country except the US. And it would be hard to exclude the US if the applications of the term is that liberal.

Well, as to your second point, there are two types of socialism--giving socialism the benefit of the doubt. Democratic socialism and totalitarian socialism. What socialism Canada has is democratic, and I am absolutely correct that the capitalist elements of its economy pay for that.

As to your first point, this issue--how capitalist is the US healthcare system--is an abstraction we need not trouble ourselves about. Few people argue the healthcare industry should be more capitalist than it is. But the capitalist elements are what distinguishes the US system from Denmark, Canada, the UK, etc.--private ownership of the means of production, competition, rates negotiated in a private market, etc. That's the key point. You personally may not be totally or much or at all involved in the health care market, but your employer is, as your proxy. There is stiff competition for the employer business among health insurers. Health insurers in turn are your proxy in negotiating rates with physician groups and hospitals, who compete with one another as to price and services. And it isn't true that you are totally shut out of this capitalist process. Your employer probably gives you choices among plans or maybe even companies. You make choices within the provider network available to you--which includes about 100% of hospitals and physicians. They compete for your business, and even try to upsell you--for example, encouraging you to be tested for sleep apnea.

So saying there's not much capitalism in the health care industry is a ridiculous comment for a lot of reasons, almost as bad as saying capitalism is on the wrong side of history.

[SeattleUte]

That's a great attempt at reframing the disputation Batman. There are no shortage of specialists, or surgeons in Canada. Specialist here do make less money, but a Cardiothoracic Surgeon for example still makes in excess of 400k a year. Further, quality of life in Canada is superior to the US, due in large part to universal health care. Your claims are false.

Canada benefits from a healthy capitalist economy. It shares a lot in common with the US due to remarkably similar economic, political and immigration policies. A principle difference between the two countries is Canada has found a way to make universal health care work in context to capitalist elements in its system, whereas the US has not. As for your assertion as to my ignorance, you were not even aware that there are more than two parities in Canada's parliamentary democracy.

I could continue, but usually this is the point where you make more half-baked claims and in particular derisive comments about my intellect before leaving the discussion like a tempestuous child. I will save you the trouble by agreeing with you that I am obviously just not as smart as you, and I am not worth your time.

I think you meant "a principal difference." But you're so dogmatic, maybe you think that Canada's difference is the more "principled."

As I noted, how many parties in Canada was irrelevant to my point about polarization in Canada.

As to quality of care, Canada is fine for regular stuff. But of course the US is superior for the big stuff and for innovation, which benefits Canada.

There may be cardiothoracic surgeons who make more than $400,00 in Canada, but there are a whole lot in the US who make a lot more. US physicians make a lot more money than Canadian ones. And it is only because of the capitalist elements in the US healthcare system.

[Jeff Lebowski]

Is it just me, or are the Bernie supporters a bunch of hyper-aggressive nutjobs? Good heavens, they are vicious when they attack fellow D candidates.

[SeattleUte]

There needs to be some type of coverage that is universal or at least an “opt out” system. People are too irresponsible. US health care in the event of a crisis like cancer, a car accident, or a heart attack is no doubt the best in the world. (US health care obviously sucks for routine primary care and preventive care.). But the amazing care provided in the event of these crises is just too freaking expensive.

This was one of the reasons the mandate in Obamacare was important.

If healthcare in the US is going to remain the best care in the world--amazing--for big stuff it's going to have to be paid for by the private sector on a needs basis. Sorry. But this will require filling out forms, even if required by law like tax returns.

[cowboy]

Cardiac is not part of the problem. He should get paid what he gets paid for the time he spent in school and in residency, and for the expertise with which he practices.

The problem is an irrational fear of progress that is not tied to profits. The US is on the wrong side of history on the issue of health care.

Agree with the first paragraph. Since 2004, physician salaries have doubled, outpacing GDP by less than .5%/year. The increased cost of healthcare is not the fault of physician greed. This is where I disagree with your second paragraph.

The problem with healthcare, and the real driver behind costs, is inefficiency that is an unintended consequence of our insurance-based decision. Specifically, while physician costs have increased 100 percent in 15 years, the cost of administration has increased 3300 percent. Yep, you read that right, administrative costs have risen 33 times faster than physician costs. The same phenomenon has occurred in education, and it is a direct result of institutions basing budgeting decisions on something other than efficiency.

We can complain about profit motives all we want, but when we compete on profits that are price-driven, we are motivated to become efficient and thus keep the cost of our goods and services from rising out of control. Instead, we make decisions in education and health-care based on our expected reimbursement for services rendered. Thus, we focus our budget less on efficiency and more on maximizing top-line revenue.

The good news for the rest of the world is that the life-saving technologies developed by profit-driven countries in the US have been exported all over the world. Not as good for the US, we are left to foot the bill for subsidizing single-payer systems.

In the United States, most people with full-time jobs are insured through their employers. Also, Cardiac is part of the problem. Most health insurers are non-profit and act as gatekeepers. As it is, through preferred provider networks they pay about 30% of billed charges. But health care providers react by continually raising their rates. Also, consumers in the US don't make thoughtful cost-effective decisions about medical care. Part of this is caused by a culture of throw every available weapon at a problem, and also medical malpractice suits. Finally, private interests, which drive the US's superior innovation, are motivated by profits.

I agree with what you said here, with the caveat that providers as I'd define them are the organizations and not the physicians. I've bolded what I believe is the biggest problem with healthcare. When we consider any purchase without considering its cost, we are bound to inflate the price of said service over time. The inefficiency that this type of service model breeds is what drives our healthcare prices out of control. One could argue that price control legislation is the answer, but that would hamper a lot of innovation.

The solution is not single payor, but expanding and improving the Affordable Care Act. Private markets, state regulation, choice remain undisturbed beneath an umbrella of federal regulation. The moderate democrats are right about that.

I adamantly disagree with this. The ACA has been a train wreck that has consolidated power of large insurers, drastically limited the choices of anyone who buys their own insurance, increased the price of insurance for those same people, and provided huge incentive for companies to restrict their growth to avoid providing health insurance for their employees. Insurers outside the exchange cannot issue policies for more than 3 months at a time, and every three months they can deny coverage to anyone who has developed a condition they don't want to cover. Coverage in states with smaller populations is incredibly expensive because both parties cowed to big insurance companies and refused to allow pooling across state lines. This has also driven insurers out of a lot of exchanges, so there is no competition in Wyoming, where Blue Cross was the only company big enough to hang in. Now they have a monopoly, and insurance with a $5,000 deductible for myself and 4 kids costs $3,000/month.

Ironically, the end result of the ACA is fewer people with incentive to buy insurance. As an example, hospitals are required by law to give uninsured patients the average facility discount, which is roughly 30%. With a $10,000 total out of pocket cost, that makes the indifference point me $60,000/per year. In other words, to make insurance worth it to me without a subsidy, I would have to expect gross healthcare costs for my family of at least $60,0000 EVERY YEAR. I understand it's not this bad in all states, but it's very bad in many. The medicaid expansion makes it even worse, but I don't have time for that.

IMO, the best thing that can happen immediately is to do away with exchanges, allow pooling across state lines, outlaw plans with deductibles less than $5,000 unless the insured meet income qualifications, and force every provider and facility to post total costs for every service rendered.

[tooblue]

I think you meant "a principal difference." But you're so dogmatic, maybe you think that Canada's difference is the more "principled."

As I noted, how many parties in Canada was irrelevant to my point about polarization in Canada.

As to quality of care, Canada is fine for regular stuff. But of course the US is superior for the big stuff and for innovation, which benefits Canada.

There may be cardiothoracic surgeons who make more than $400,00 in Canada, but there are a whole lot in the US who make a lot more. US physicians make a lot more money than Canadian ones. And it is only because of the capitalist elements in the US healthcare system.

Yes, I used the wrong word. Sorry. Again, one more point of evidence to suggest my intellect is inferior. Further, my tone is actually didactic, but I am not dogmatic. No system is perfect, but by the bar you set (your dogma), Canada has found a way to make universal health care work in context to capitalist elements in its system, and the US has not.

And what good is a cardiothoracic surgeon who makes well in excess of 400k if the average person of the requisite economy wherein he/she operates cannot pay for their services? So, exactly what service does the US health care system offer that is not available in the Canadian health Care system? Nothing, because even if there were superior services to be accessed, only a relative few could afford them. Bluntly, that is not demonstrative of a superior system.

[tooblue]

Well, as to your second point, there are two types of socialism--giving socialism the benefit of the doubt. Democratic socialism and totalitarian socialism. What socialism Canada has is democratic, and I am absolutely correct that the capitalist elements of its economy pay for that.

As to your first point, this issue--how capitalist is the US healthcare system--is an abstraction we need not trouble ourselves about. Few people argue the healthcare industry should be more capitalist than it is. But the capitalist elements are what distinguishes the US system from Denmark, Canada, the UK, etc.--private ownership of the means of production, competition, rates negotiated in a private market, etc. That's the key point. You personally may not be totally or much or at all involved in the health care market, but your employer is, as your proxy. There is stiff competition for the employer business among health insurers. Health insurers in turn are your proxy in negotiating rates with physician groups and hospitals, who compete with one another as to price and services. And it isn't true that you are totally shut out of this capitalist process. Your employer probably gives you choices among plans or maybe even companies. You make choices within the provider network available to you--which includes about 100% of hospitals and physicians. They compete for your business, and even try to upsell you--for example, encouraging you to be tested for sleep apnea.

So saying there's not much capitalism in the health care industry is a ridiculous comment for a lot of reasons, almost as bad as saying capitalism is on the wrong side of history.

Ahhh, in comes the boogey man. No one said capitalism is on the wrong side of history ... ... are you sure you do not work in the Trump administration?

Equating a lack of universal health care in the US, and thus the US political system of being on the wrong side of history as it relates to the issue of universal health care with "capitalism is on the wrong side of history" is a neat trick.

See Jeff, ya'll are truly irrational.

[SeattleUte]

Cowboy, requiring hospitals to treat uninsured and then expecting uninsured to suffer anxiety of huge bills and file for bankruptcy is not the answer. Nor is using emergency rooms as places for uninsured to camp out. That's barbaric. What you're saying is you don't want universal access to health care. You're on the wrong side of history, and the ACA was a good compromise, as evidenced by Republicans' inability to come up anything better than what you want.

[SeattleUte]

Is it just me, or are the Bernie supporters a bunch of hyper-aggressive nutjobs? Good heavens, they are vicious when they attack fellow D candidates.

Nobody ever tells me how the Bernie bros are going to take ownership and control of the means of production for our biggest industry. With guns, like the Bolsheviks? I bet a lot of Bernie Bros would be down for that. Nobody knows. It's all BS.

[cowboy]

Cowboy, requiring hospitals to treat uninsured and then expecting uninsured to suffer anxiety of huge bills and file for bankruptcy is not the answer. Nor is using emergency rooms as places for uninsured to camp out. That's barbaric. What you're saying is you don't want universal access to health care. You're on the wrong side of history, and the ACA was a good compromise, as evidenced by Republicans' inability to come up anything better than what you want.

It may differ by state, but I'm familiar with the billing policy of every hospital in Wyoming and half of Montana. They all write off charges for people who don't have to the ability to pay. Nobody in these communities files for bankruptcy over medical bills. Not saying it doesn't happen, but it's not a problem that can't be dealt with. Our charity care charge-offs run between 3% and 7%. Further, under the ACA there is more incentive to use the ER for primary care, because more people are on Medicaid and don't care where they're seen so they pick the fastest/easiest. The ACA wasn't a compromise at all, unless you are saying Democrats compromised with other Democrats. The effects I laid out above, and a host of others, make it one of the worst pieces of legislation in 40 years, and is replete with case studies in misaligned incentives and unintended consequences.

[old_gregg]

Not saying it doesn't happen, but it's not a problem that can't be dealt with.

2/3 (!!!!!!) of personal bk debtors cite medical debt as a driver

https://www.ncbi.nlm.nih.gov/m/pubmed/30726124/

[SeattleUte]

It may differ by state, but I'm familiar with the billing policy of every hospital in Wyoming and half of Montana. They all write off charges for people who don't have to the ability to pay. Nobody in these communities files for bankruptcy over medical bills. Not saying it doesn't happen, but it's not a problem that can't be dealt with. Our charity care charge-offs run between 3% and 7%. Further, under the ACA there is more incentive to use the ER for primary care, because more people are on Medicaid and don't care where they're seen so they pick the fastest/easiest. The ACA wasn't a compromise at all, unless you are saying Democrats compromised with other Democrats. The effects I laid out above, and a host of others, make it one of the worst pieces of legislation in 40 years, and is replete with case studies in misaligned incentives and unintended consequences.

What kind of world do you think we live in? Of course if there's no insurance, the bill usually gets written off. But not until after the health care provider tries to collect as much as possible, ultimately resorting to collection agencies or even suits. Physicians and hospitals are as money driven as any other business, that's for sure. Not everyone who can't pay a 100k bill is indigent. People with income and assets to protect are the ones who file for bankruptcy.

People who buy coverage through the ACA have coverage like you or I do. The ones with federal subsidies aren't stupid. They know how to find a primary care physician to fit their need.

[All-American]

The 2020 Presidential Election Primary Thread

You are welcome Canada, but we don't need any lectures from you. You are incredibly fortunate to have the US as neighbors and thereby simply neglect any meaningful military spending. Perhaps, when you pull your weight in protecting the security of our shared hemisphere, you can come on here and brag about how amazing your POS universal health care really is.

But thanks for Bob and Doug McKenzie!