single-payer system ... singled out

[Architect]

Actually, no. It's up to your government, who you elected.

 

[ddt]

If it's so easy, then there's no reason government shouldn't do that first. So I'll wait for them to actually, you know, do it before I lend my support to any expansion of the system.

Apparently, it is. But first, the clause in Medicare Plan D that Medicare is not allowed to negotiate the prices of drugs must get off the table. That's where you come in, Ziggy - write your Congreskritter! Tell your family, friends, neighbors to write them too.

You know why Medicare can't negotiate the price of medicines. You must unless you live under a rock. The pharmaceutical industry spends gobs of money in Washington to see that such a practice is prohibited. They spend hundreds of millions of dollars to safeguard their billion dollar profits and grotesque executive pay.

Of course, Ziggy knows. It astonishes me that he, and people like him who defend the current US system on ideological grounds, are wilfully "ignorant" of this, and must be told by a furriner.

 

[Ziggurat]

Of course, Ziggy knows. It astonishes me that he, and people like him who defend the current US system on ideological grounds, are wilfully "ignorant" of this, and must be told by a furriner.

What astonishes me is that people living outside of the US feel like they have a stake in what we do domestically, become emotionally attached to seeing their preferred outcome even though it will not affect them, and get offended when someone does not share their values.

Is this really the game you want to play, ddt?

 

[ddt]

And it is likewise on me to decide what healthcare system I want to live under, not you. But you aren't shy about voicing your opinion anyways.

Sure it is on you - with your fellow countrymen - to decide how you want to organize your society. It's just that I haven't seen any compelling arguments from you for the why you are happy with the current system.

You stated you though Medicare needed fixing; I just offered one avenue how you can fix it and cut down its costs. If you don't feel like that, fine, that's your choice. But I'm a bit amazed why you like paying three times for your drugs:

1) for your own drugs, through your own private insurance premiums
2) for the Medicare drugs, through your taxes
3) for the development of new drugs, through your taxes which fund the NIH.

 

[Architect]

The glaringly obvious.....

And we all know what that means when a politician says it. Right up there with "it goes without saying".

 

[Ziggurat]

Sure it is on you - with your fellow countrymen - to decide how you want to organize your society. It's just that I haven't seen any compelling arguments from you for the why you are happy with the current system.

Wonder of wonders: I haven't offered any compelling arguments because I'm not happy with the current system. You aren't under the mistaken impression that a government takeover of healthcare is the only possible alternative, are you?

You stated you though Medicare needed fixing; I just offered one avenue how you can fix it and cut down its costs.

And I'd like to see that happen, regardless of what we do after that. But until it does, I have no reason to trust politicians with even more power, and every reason to think that putting even more of the healthcare system under their charge would be a complete mess.

But I'm a bit amazed why you like paying three times for your drugs

And I'm a bit amazed that you're attributing to me a position which I never expressed.

 

[ddt]

What astonishes me is that people living outside of the US feel like they have a stake in what we do domestically, become emotionally attached to seeing their preferred outcome even though it will not affect them, and get offended when someone does not share their values.

Is this really the game you want to play, ddt?

"Emotionally attached"? How so?

As I said in my previous post, sure it is your choice how you want your country to be run. I feel sorry, though, for the tens of millions of your countrymen who have to go through life uninsured.

 

[Ziggurat]

"Emotionally attached"? How so?

The same way all my arguments are just ideological.

As I said in my previous post, sure it is your choice how you want your country to be run. I feel sorry, though, for the tens of millions of your countrymen who have to go through life uninsured.

A large fraction are only temporarily uninsured, many of them voluntarily (I've known a number), and a good portion of the long-term uninsured are illegal immigrants. The problem is not quite what you have evidently been led to believe.

 

[Architect]

Ah, I see. It's okay for them to catch something terminal and curl up their toes without healthcare if they're illegal immigrants........and of course if you're "only temporarily uninsured" (note no statistics supplied) you'll not fall ill until you get back in the system.

 

[Ziggurat]

Ah, I see. It's okay for them to catch something terminal and curl up their toes without healthcare if they're illegal immigrants

Did I say that? No, I do not believe I did. But we can decrease that contribution to the number of uninsured considerably even without reforming the health care system.

and of course if you're "only temporarily uninsured" (note no statistics supplied)

Note you didn't ask for statistics from ddt. Double standard much?

you'll not fall ill until you get back in the system.

A great many don't. Which is relevant to the scale of the problem under discussion.

 

[ddt]

Wonder of wonders: I haven't offered any compelling arguments because I'm not happy with the current system. You aren't under the mistaken impression that a government takeover of healthcare is the only possible alternative, are you?

No I'm not. I'd say, check out how health care is organized in the Netherlands. You're attributing to me a position I've never taken. We've had at least 30 years of public discussion on reform of the health care system, with lots of variants being discussed. However, the base line has always been: UHC - not necessarily government-run (it isn't now), but universal in its coverage.

And I'd like to see that happen, regardless of what we do after that. But until it does, I have no reason to trust politicians with even more power, and every reason to think that putting even more of the healthcare system under their charge would be a complete mess.

I keep being amazed that, according to (some) Americans, the politicians in Washington are so much worse than those in Ottawa, London, Paris or The Hague. Mind, a bit of distrust and disgust for politicians is universal.

And I'm a bit amazed that you're attributing to me a position which I never expressed.

Sorry. But what's your alternative? I haven't heard one yet.

A large fraction are only temporarily uninsured, many of them voluntarily (I've known a number), and a good portion of the long-term uninsured are illegal immigrants. The problem is not quite what you have evidently been led to believe.

Evidence? Wiki doesn't mention that. That page has a lot of links to reports. "The uninsured - a Primer" mentions that 75% of the uninsured are long-term (> 1 year) uninsured. Oh, and the latest numbers are around 45 million uninsured people. That comes close to the total population of Britain (playing to the gallery ).

And for the short-term uninsured: is it less bad when you catch a disease while in between jobs? And what effect does it have on their coverage in their next job?

Note you didn't ask for statistics from ddt. Double standard much?

I'm at a loss where Architect should have asked me for statistics.

 

[Ziggurat]

You're attributing to me a position I've never taken.

No, unlike you, I'm asking a question about what you think, not making a claim in that regards.

I keep being amazed that, according to (some) Americans, the politicians in Washington are so much worse than those in Ottawa, London, Paris or The Hague.

Really? Who said that? I didn't.

Sorry. But what's your alternative? I haven't heard one yet.

I've already mentioned a number of changes I'd like to see, starting with decoupling health insurance from employment.

Wiki doesn't mention that.

And if it's not on Wikipedia, it doesn't exist?

"The uninsured - a Primer" mentions that 75% of the uninsured are long-term (> 1 year) uninsured.

I wouldn't use that cutoff to define "long-term". In fact, neither does that report.

And for the short-term uninsured: is it less bad when you catch a disease while in between jobs? And what effect does it have on their coverage in their next job?

If you have been uninsured, then providers can deny coverage for pre-existing conditions for a period of time, but they still cover other things, and after that time period is up, they have to cover the pre-existing conditions too.

 

[Oliver]

What astonishes me is that people living outside of the US [insert random US-foe country] feel like they have a stake in what we do domestically, become emotionally attached to seeing their preferred outcome even though it will not affect them, and get offended when someone does not share their values

That post actually made me laugh out loud.

 

[mr rosewater]

That post actually made me laugh out loud.

Why?

 

[Oliver]

Why?

Because I know some of Ziggy's stances [and complaints] about foreign domestic issues.

 

[ddt]

No, unlike you, I'm asking a question about what you think, not making a claim in that regards.

Oh, it didn't seem like a question you really wanted an answer to. But I'll bite.

In my view, a health care system should be
1) universal, i.e., a uniform insurance system for the whole population. Whether it's like the Dutch system, with insurance companies, or like the British, state-run, then is secondary.
2) have a decent minimum coverage plan, government-mandated. When (private) insurers want to offer additional coverage (at a premium), fine with me.
3) be affordable to everyone. No exclusions for pre-existing conditions, flat premiums irrespective of age.

Then the particulars how it's implemented are secondary to me.

Really? Who said that? I didn't.

You implied it by claiming that your Washington politicians can't run an affordable health care system, whereas the politicians in the other countries I mentioned apparently can.

I've already mentioned a number of changes I'd like to see, starting with decoupling health insurance from employment.

OK, fair enough. And after that? What about the multitude of parallel systems existing in the US?

And if it's not on Wikipedia, it doesn't exist?

I'm still missing your evidence. I, at least, did some searching for your claims.

I wouldn't use that cutoff to define "long-term". In fact, neither does that report.

It doesn't define the words "long-term". I think going one year without health insurance is a pretty long term. To get back to your claims, two quotes from the report:

The large majority of the uninsured (78%) are native or naturalized U.S. citizens.

and

The majority of uninsured adults (75%) have gone without coverage for a period of at least one year.

So much for your claims about illegal immigrants and "temporarily uninsured".

If you have been uninsured, then providers can deny coverage for pre-existing conditions for a period of time, but they still cover other things, and after that time period is up, they have to cover the pre-existing conditions too.

That's the answer I expected. What period of time?

 

[ARubberChickenWithAPulley]

I'm told that in the USA, the insurance companies routinely negotiate the prices they pay right down to cut-throat levels. At the same time, hospitals will charge an inflated list price to the self-payer. And one way or another, the hospitals have to cover their costs for treating the emergency cases that show up on their doorstep with no insurance and no assets.

The one thing you're leaving out is that the government-run payers (i.e. Medicare and Medicaid) pay, on average, far less than private insurers do (I posted several links to this earlier in the thread). Private insurers may negotiate "cut-throat" prices, but the government programs don't even negotiate: they simply tell everyone what they will pay, and typically it is far lower than the private sector.

The "charging inflated prices to self-payers" is true, but I doubt hospitals make up much difference there. More often than not, the self-payers simply can't pay, and the hospital chalks it up as bad debt.

The bigger issue is with the market for individual insurance. Since those who want to buy individual insurance get underwritten as individuals, they don't benefit from risk pooling, can get rejected for prior conditions, etc.

Additionally, self-funded employer plans benefit from ERISA -- a Federal law that preempts most state mandates on insurance coverage. The individually insured (and also non-self-funded employers) don't fall under ERISA. This means that when a state places mandates on insurers (e.g. several states mandate that insurers cover alcoholism counseling and treatment, chiropractors, psychiatrists, therapeutic massages, etc.) , it is the individually insured who get hit hard: since the insurer is legally required to cover those mandates, the person buying an individual policy has to buy that coverage -- which is, of course, more expensive.

It's a bizarre situation, and is part of the reason why trying to buy individual insurance is such an ordeal. There is very little incentive for companies to offer a decent price or product to individuals. The system itself is pretty well rigged for employer-based insurance, to the detriment of anyone outside of that system.

 

[Ziggurat]

You implied it by claiming that your Washington politicians can't run an affordable health care system, whereas the politicians in the other countries I mentioned apparently can.

No, you read that into what I said. There are other possibilities. One is that since we're much larger than any individual European country, simple issues scale will exacerbate inefficiency problems we have compared to you (ie, a system twice as big will have more than twice the waste). Another is that Americans will simply demand other things from our health care system than what Europeans demand, even if these are not productive in terms of standard metrics (for example, extensive and expensive end-of-life treatments). There may be additional reasons beyond these. But regardless of the causes, there is simply no reason to believe that a major expansion of government coverage can occur without a major expansion of government costs. Has that ever happened in Europe? If so, nobody is pointing to it.

 

[Architect]

But our healthcare costs could double and still be no greater than yours.

Really, do you like paying through the nose for a system with no improvement in care?

 

[rwguinn]

Why is it that every time I see "Single Payer" in writing regarding Medical care, my brain insists on adding an "R" between the "P" and the "A"?