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What new or revised public policy/law would make it easier for people to maintain a healthy weight?
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It would certainly be a step in the right direction. Paying for preventative care, but if the person let something go on without getting the care, they would be on the hook for the difference.
But ultimately, a free people should never be obligated to pay.
They can volunteer to pay. But should never have the ability to force others to pay into such a system. Others may have different views on how to help those who cannot pay. A free person should never be forced to pay for another. They can do so voluntarily, but never by force of law.
Given that medical costs are much, much higher in the US than they are in countries with socialised healthcare systems, are you sure that you don't fix the problem by paying for people to get preventative healthcare...?
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Except that people are already trying to avoid incurring costs - by avoiding getting healthcare in the hope that the problem will go away / wait until they can get to a physician that will cost them less.
In other words, people trying to avoid incurring costs is actually the problem. You're not going to fix that by making it worse.
I see this argument brought up when attempting to pitch for socialized structures, but there isn't much truth to this.
By doing this you aren't addressing the root cause of unlimited demand and decreasing supply. In fact you are making the problem considerably worse.
If you actually want to help the healthcare problem you can either address the demand problem by reducing the need for care...or increase the number of practitioners.3 -
I see this argument brought up when attempting to pitch for socialized structures, but there isn't much truth to this.
By doing this you aren't addressing the root cause of unlimited demand and decreasing supply. In fact you are making the problem considerably worse.
If you actually want to help the healthcare problem you can either address the demand problem by reducing the need for care...or increase the number of practitioners.
So are you saying the reason health care is so expensive in the US is a supply/demand issue? Honest question, I know my opinions in this area involve a lot of emotion, so I try to keep my yapper shut and soak up info
Aren't the insurance companies a primary driver of the costs right now?5 -
Aren't the insurance companies a primary driver of the costs right now?
If insurance companies were the primary drivers of cost, wouldn't it be cheaper for people to just direct pay doctors and hospitals?
I doubt there is any one thing.
Cost shifting is one part of it.
Defensive medicine is another. No doctor or hospital wants to be sued because they missed something.
Tort reform is probably a part of it too. How much is malpractice insurance for this business. Daytime TV is full of law firms saying they will "get you what you deserve" from your doctor, hospital or whomever may have "harmed" you.
How much of the cost to treat me is to actually treat me, and how much is defense of the doctor or hospital from those who don't pay and those who sue?8 -
tbright1965 wrote: »I don't wish to bring back debtors prison.
If hospitals can just pass along the costs of those who don't pay to others, what is their incentive to keep costs low?
Don't allow them to pass those costs along to others.
If they are really losing money, they will have far more incentive to find a way to lower costs than if they can just pass them along.
Finally, nothing prevents those from believing something needs to be done to help those who cannot pay from opening their wallets and living out their values.
It's easy to say "the rich" or "the government" or some other group should pay. That's not generosity. Spending other people's money is never generosity or caring.
Generosity and caring is what you personally do with YOUR time, YOUR talent and YOUR treasure.
So what happens to people who actually can't afford to pay?3 -
So what happens to people who actually can't afford to pay?
Make the case to their family, neighbors, friends, community, church or other worship group they are affiliated with.
If those closest to them see they've been spending what would have been an insurance premium on toys as I've described above, they may not be so willing to fund their bill.
If their story is one that is truly one that is bad luck, such as they did have insurance until the plant closed, they were doing the right things, not being the grasshopper by living for today without regard to tomorrow, I can't imagine people would be so callous as to not help.
Having observed how people generously respond to natural disasters it's hard for me to buy the idea that people are not compassionate towards those who are really in need.9 -
One death is a tragedy. One million deaths are a statistic.
One person in need of a lifesaving operation they can't afford is a community fundraising project. Ten thousand people in a low-income area dealing with the rigors and ailments of aging, appealing to other communities dealing with their own issues... It's not a pretty picture. And going around appealing for aid can be a daunting prospect for people dealing with anxiety. Or people who always prided themselves on not needing charity. Or introverts.
It's one thing for me to send $25 for flood relief every year or so. It's another for me to be asked repeatedly to assist elderly relatives, friends and neighbors while trying to hang onto enough to cover my own medical needs and those of my family. It's not callousness. It's recognizing that there's only so many times I can contribute.
It's all well and good to say that healthcare providers will have an incentive to lower costs but people don't always agree to forgo lucrative income simply because "they no longer have to worry about other costs". They worry about what might be down the road. They think about increased cost of living. And some (not all, but let's agree that there are a fair number) are just plain greedy.
Government-funded healthcare may not be the best option. But what you're suggesting sounds a lot worse.
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tbright1965 wrote: »
Make the case to their family, neighbors, friends, community, church or other worship group they are affiliated with.
If those closest to them see they've been spending what would have been an insurance premium on toys as I've described above, they may not be so willing to fund their bill.
If their story is one that is truly one that is bad luck, such as they did have insurance until the plant closed, they were doing the right things, not being the grasshopper by living for today without regard to tomorrow, I can't imagine people would be so callous as to not help.
Having observed how people generously respond to natural disasters it's hard for me to buy the idea that people are not compassionate towards those who are really in need.
So basically, anyone who a) doesn't have connections wealthy enough to have tens of thousands spare, b) isn't well loved by those connections, or c) is insufficiently convincing about their own past decisions, just gets to die?
Presumably they need to raise the money prior to treatment; how do you expect them to do that if they're for example, unconscious?
If you're just going to hit them with a bill after treatment, how does that differ from today?
Even if wealthy and philanthropic connections were as plentiful as you imagine (which they're clearly not, or the US would have socialised healthcare by now), I don't see any practical way to implement this.9 -
So are you saying the reason health care is so expensive in the US is a supply/demand issue? Honest question, I know my opinions in this area involve a lot of emotion, so I try to keep my yapper shut and soak up info
Aren't the insurance companies a primary driver of the costs right now?
I agree and find that emotional response usually ends up badly. There are several issues at play and what is needed is a balanced approach.
The US system took on the worst points of both worlds. Heavily regulated on price (via insurance and government) and supply (regulations and education). The only thing keeping the system going is innovation, which is on the decline.
Insurance is a primary driver because it has too much control over the process. To address this you simply remove the influence on the system. ...but change brings fear and few people have the stomach to change even if it means things will likely be better.
Compare the cost of medical treatments outside of insurance coverage - eye correction and cosmetics/aesthetics medicine. These industries must evolve and adapt as they have no insurance or government safety net. The cost of goods is continually driven down via innovation and follows consumer price index. Medicine covered by insurance however exceeds this index by a monumental margin.1 -
So basically, anyone who a) doesn't have connections wealthy enough to have tens of thousands spare, b) isn't well loved by those connections, or c) is insufficiently convincing about their own past decisions, just gets to die?
News flash, we all die.
Why does someone get to reach into my pocket, without my permission and demand that I pay for everyone to get treatment because others have some form of guilt or other motivation to help using the fruits of my labor?
That's the real question. Because that happens far more frequently than does the person with no connections, etc.
At least here in the US, before the ACA, 85% of people already had insurance. The ACA increased that to 90% without the promised $2500/year savings for the average family.
So it missed 2/3rds of the population targeted and still didn't bring down costs for the typical family. Instead of the $2500 / year in savings, the typical family pays $2200/year MORE since the ACA was implemented.
Even NPR, not a right wing news source indicates all the ACA did was to shift costs. It did nothing to actually make care affordable.
Not sure we can afford any more government solutions to the problem.8 -
tbright1965 wrote: »
Make the case to their family, neighbors, friends, community, church or other worship group they are affiliated with.
If those closest to them see they've been spending what would have been an insurance premium on toys as I've described above, they may not be so willing to fund their bill.
If their story is one that is truly one that is bad luck, such as they did have insurance until the plant closed, they were doing the right things, not being the grasshopper by living for today without regard to tomorrow, I can't imagine people would be so callous as to not help.
Having observed how people generously respond to natural disasters it's hard for me to buy the idea that people are not compassionate towards those who are really in need.
Honestly I don't care if people spend money on toys. It's a non-issue and used for victim blaming. Hey sick person, did you take a vacation last year with your family? Did you buy your kids a video game system for Christmas? How dare you! Didn't you know you were going to have a horrible accident the next year and be on the hook for $300,000? You didn't save up for that? Why ever not?
And why aren't you willing to question the "bad luck" of having insurance until the plant closed. That's an argument for universal healthcare. If you're on unemployment that LAST thing you need is to fork out for medical expenses out of pocket with no insurance.
We have people doing GoFundMes for medical expenses to appeal to the goodness of others and what happens? Mostly bad things. Scammers show up in droves. People are hesitant to give because of those scammers. People give to others based on bigoted preconceptions, the same way young, pretty, white girls make the most in tips regardless of actual service level.
So instead of universal healthcare, you want people to "make the case" to guilt trip a bunch of people in their lives to help pay their medical bills, which also requires disclosing their personal medical issues to everyone. And their success will be highly dependent on their social circles. For example, I barely know my neighbors, most of my "coworkers" work for me, so it would be highly unethical to take their money, and I'm an atheist. I'm sure people will love getting calls from their cousin about a medical bill when they already have kids in daycare and aging parents dipping into their family resources.8 -
I agree and find that emotional response usually ends up badly. There are several issues at play and what is needed is a balanced approach.
The US system took on the worst points of both worlds. Heavily regulated on price (via insurance and government) and supply (regulations and education). The only thing keeping the system going is innovation, which is on the decline.
Insurance is a primary driver because it has too much control over the process. To address this you simply remove the influence on the system. ...but change brings fear and few people have the stomach to change even if it means things will likely be better.
Compare the cost of medical treatments outside of insurance coverage - eye correction and cosmetics/aesthetics medicine. These industries must evolve and adapt as they have no insurance or government safety net. The cost of goods is continually driven down via innovation and follows consumer price index. Medicine covered by insurance however exceeds this index by a monumental margin.
Thank you
This gives me more to think about. I do think generally everyone would get a better outcome if at least for "basic" care, people were dealing directly with doctors. This becomes more confusing when you are talking about a hospital stay where several different doctors and specialists are "checking in" but I suppose it could be up to the hospital to coordinate that.tbright1965 wrote: »
Make the case to their family, neighbors, friends, community, church or other worship group they are affiliated with.
If those closest to them see they've been spending what would have been an insurance premium on toys as I've described above, they may not be so willing to fund their bill.
If their story is one that is truly one that is bad luck, such as they did have insurance until the plant closed, they were doing the right things, not being the grasshopper by living for today without regard to tomorrow, I can't imagine people would be so callous as to not help.
Having observed how people generously respond to natural disasters it's hard for me to buy the idea that people are not compassionate towards those who are really in need.
I'm not sure it's any more realistic to assume that most people have a pipeline of folks with money available to them, than it is to assume the government would do a good job with universal healthcare. And I don't see how a society where people are desperately putting on a show to try to go viral so they can pay for their cancer treatment is a great idea either.4 -
I have no problem if universal healthcare is voluntary and optional.
My problem is when you FORCE people to participate or contribute.
Have whatever system you want, as long as it is not mandatory and is funded ONLY with money voluntarily given.
I have no problem with people helping one another. I have no problem with insurance.
My problem comes when participation is mandated. When the freedom to opt out is taken away by those acting in the name of their vision of "the greater good."
If something is a great idea, you don't need to FORCE them to do it by passing a law.
Like I've said before, I want people to have freedom. So the guy buying toys is always free to buy toys. If he didn't buy health insurance, why should he be able to demand a portion of my wages to pay his medical costs?
See, that's the difference. I'm willing to be in a voluntary insurance program with him. We are each putting the fruits of our labors into a mutual pool to protect one another.
Keyword is VOLUNTARY.
If the person voluntarily DOESN'T join the pool, why am I still expected to pay?
And none of my views prevent you or anyone else from cutting big checks to Uncle Sam if you think Uncle Sam is the best way to provide coverage for those who don't have it, for whatever reason.8 -
I'm not sure it's any more realistic to assume that most people have a pipeline of folks with money available to them, than it is to assume the government would do a good job with universal healthcare. And I don't see how a society where people are desperately putting on a show to try to go viral so they can pay for their cancer treatment is a great idea either.
So why assume anything? Let people decide for themselves. If they think Uncle Sam is the best choice, let them VOLUNTARILY sign up for a program with Uncle Sam and have that program pay for itself. No subsidies, no mandatory participation, etc.
If it's better than what other insurance companies are offering, for the money, people will flock to it.
Employers will flock to it if it provides their employees with better, lower cost health care.
But the last thing we need to do is FORCE people into something that may or may not work for them. Something that is mandatory has no incentive to get better. If someone is forced by law to be part of something, what is the incentive for it to get better?7 -
public policies regulating what food can be served in school cafeterias, and available in vending machines, plus a milk program can provide a good start out of the gate. I appreciate my school discouraging packing junk for the kiddos (I know some parents find this annoying but hey man if it gets my kid eating raw vegetables on purpose I am in).1
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FireOpalCO wrote: »
So instead of universal healthcare, you want people to "make the case" to guilt trip a bunch of people in their lives to help pay their medical bills, which also requires disclosing their personal medical issues to everyone. And their success will be highly dependent on their social circles. For example, I barely know my neighbors, most of my "coworkers" work for me, so it would be highly unethical to take their money, and I'm an atheist. I'm sure people will love getting calls from their cousin about a medical bill when they already have kids in daycare and aging parents dipping into their family resources.
Don't we already guilt trip people by making the false equivalency that if they are not in favor of single payer, that they must want grandma to die?
Single payer is nothing but a big guilt trip. You "should" feel "compassion" for these people, so support single payer. If you don't, then you must be "greedy" or "selfish" or "uncaring."
The primary argument for single payer is one long guilt trip.7 -
tbright1965 wrote: »I have no problem if universal healthcare is voluntary and optional.
My problem is when you FORCE people to participate or contribute.
Have whatever system you want, as long as it is not mandatory and is funded ONLY with money voluntarily given.
Why? Why does a single payer healthcare system need to be voluntary? What is unique to it that does not apply to everything else that is paid for by taxes? I don't decide how much I pay towards the military each year. Neither do I pick each year my contribution to roads, schools, or a myriad of other government provided services. Where on my tax form do I pick how much I want to contribute to our State Department?
Part of being a democracy is sometimes you pay for things that don't benefit you personally or that you don't value. At certain points in our history we decided that some items that weren't provided by the government should be paid for by tax dollars and funded by everyone, not just the "in the moment need" or the largess of the rich. Public schools, fire departments, police, judges, social workers, etc.12 -
tbright1965 wrote: »
Don't we already guilt trip people by making the false equivalency that if they are not in favor of single payer, that they must want grandma to die?
Single payer is nothing but a big guilt trip. You "should" feel "compassion" for these people, so support single payer. If you don't, then you must be "greedy" or "selfish" or "uncaring."
The primary argument for single payer is one long guilt trip.
No the argument for single payer is it guarantees a minimum level of care to all citizens, takes healthcare out of the employee & employer relationship, keeps hospitals open in low income or low population areas, reduces hospital waste on unnecessary equipment purchases to compete with neighboring hospitals even though the demand isn't there, and reduces inequities in life expectancy and outcomes due to geographic region & income level. It also has been repeatedly shown in studies to save people money and reduces the costs of providing quality healthcare. Which makes perfect sense when you realize it removes many middlemen (insurance companies, brokers, employers) and the idea of healthcare being for profit and beholden to shareholders.7 -
FireOpalCO wrote: »
No the argument for single payer is it guarantees a minimum level of care to all citizens, takes healthcare out of the employee & employer relationship, keeps hospitals open in low income or low population areas, reduces hospital waste on unnecessary equipment purchases to compete with neighboring hospitals even though the demand isn't there, and reduces inequities in life expectancy and outcomes due to geographic region & income level. It also has been repeatedly shown in studies to save people money and reduces the costs of providing quality healthcare. Which makes perfect sense when you realize it removes many middlemen (insurance companies, brokers, employers) and the idea of healthcare being for profit and beholden to shareholders.
If all of this is self-evident, why do we have to make it a law that people will participate?
Again, if it is as good as you say, why isn't it already happening? What prevents communities or states from creating their own form of this?
I am continually told how good it is. But then most of these things require mandatory participation. It's not an opt-in arrangment.
Yet if it provides better care for less money, one would imagine there would be no need to tax people for it, as they would sign up to pay less than they are now.
I'm not against such programs as I've repeatedly said. I'm against forced contributions to such programs. If they are such great deals, there is no need to coerce people to participate in the form of buying a policy.8 -
FireOpalCO wrote: »
Why? Why does a single payer healthcare system need to be voluntary? What is unique to it that does not apply to everything else that is paid for by taxes? I don't decide how much I pay towards the military each year. Neither do I pick each year my contribution to roads, schools, or a myriad of other government provided services. Where on my tax form do I pick how much I want to contribute to our State Department?
Part of being a democracy is sometimes you pay for things that don't benefit you personally or that you don't value. At certain points in our history we decided that some items that weren't provided by the government should be paid for by tax dollars and funded by everyone, not just the "in the moment need" or the largess of the rich. Public schools, fire departments, police, judges, social workers, etc.
Why not voluntary?
I'd argue many of the other things could be done for less if you take politicians out of it. Or at least they would be forced to earn their way.
One example, in my community, public transportation only collects 20% of costs from fares. The other 80% comes from taxpayers.
So people expecting their taxes to pay for the roads they pay taxes to drive on have their money diverted to pay 80% of the costs of public transit.
And if taxes on motor vehicles and their fuels isn't enough to build and maintain the roads, again, taxes are diverted from something else.
How do we know that this won't be like Social Security where the surplus FICA taxes were not invested to grow, but left as IOUs while the government in DC spent them on their pet projects back in their districts, including defense.
I agree, do we really need to spend as much as the next 10 nations on defense?
But we spend about 3x as much on Medicare, Medicaid and Social Security as we do defense. The only one that has gotten smaller over time has been defense. It's a smaller portion of GDP while the others are becoming larger and larger relative to GDP.
There is a track record that indicates I cannot really trust the same folks who are so willing to spend Social Security funds on funding Pork in their districts to have anyone's health care in mind when it comes to allocating the money.
VOLUNTARY is key, as it will act as a check on those making the choices. If the care doesn't meet the promises, people should be free to leave the program and not be locked in to endless contributions by law.
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http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/?fbclid=IwAR0Ar_moC2NR1sbjrt6-AkA2CGJSJjJUK9m9ystJtSdpRNrVJLQaZtbShTo
Given that medical costs are much, much higher in the US than they are in countries with socialised healthcare systems, are you sure that you don't fix the problem by paying for people to get preventative healthcare...?
To your point, medical costs in the U.S. are the highest by a factor of 1.8 and the worst quality of care in the developed world. I think there is something broken in a society that does not make the health of its people an affordable priority. Not every one of the other countries has socialized medicine either. But the fact remains they deliver higher quality of care at a substantially lower cost. Why can't the U.S. figure this out? We also have the highest rate of medical expense related bankruptcy. What is wrong with this picture?
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There's a law that says there must be a traffic jam on IT between Everett and Marysville at all times. And I pass through there on my way to a lot of hikes. Repealing that law would turn 2 hours of driving time into 2 more hours of hiking.1
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http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/?fbclid=IwAR0Ar_moC2NR1sbjrt6-AkA2CGJSJjJUK9m9ystJtSdpRNrVJLQaZtbShTo
To your point, medical costs in the U.S. are the highest by a factor of 1.8 and the worst quality of care in the developed world. I think there is something broken in a society that does not make the health of its people an affordable priority. Not every one of the other countries has socialized medicine either. But the fact remains they deliver higher quality of care at a substantially lower cost. Why can't the U.S. figure this out? We also have the highest rate of medical expense related bankruptcy. What is wrong with this picture?
The substantially lower cost originates from subsidies provided by the US.
We don't figure it out because there is no incentive for those in power to do so. They are making profit off of the existing system and will make more under single payer. All they have to do is promise to do something, do nothing, but hold the pretense of compassion. Verba non facta rules the day, but the same personalities and families remain in office.
Anyone else finding the irony of a debate advocating for collective control of health on a site where success is solely achieved through personal responsibility and accountability?
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Anyone else finding the irony of a debate advocating for collective control of health on a site where success is solely achieved through personal responsibility and accountability?
I have read too much history to be shocked by the contradiction. Too many believe they can be trusted to make the 'right' choice, but others cannot, so they better take charge and decide for them.
All in the name of the greater good, of course.
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I'm unclear exactly what you mean by the bolded. Are you saying the U.S. is subsidizing the healthcare of the other top industrialized nations? And if so, please substantiate this claim.
The substantially lower cost originates from subsidies provided by the US.
We don't figure it out because there is no incentive for those in power to do so. They are making profit off of the existing system and will make more under single payer. All they have to do is promise to do something, do nothing, but hold the pretense of compassion. Verba non facta rules the day, but the same personalities and families remain in office.
Anyone else finding the irony of a debate advocating for collective control of health on a site where success is solely achieved through personal responsibility and accountability?
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tbright1965 wrote: »
I have read too much history to be shocked by the contradiction. Too many believe they can be trusted to make the 'right' choice, but others cannot, so they better take charge and decide for them.
All in the name of the greater good, of course.
It's clear from your comment that you didn't read the article.2 -
I'm unclear exactly what you mean by the bolded. Are you saying the U.S. is subsidizing the healthcare of the other top industrialized nations? And if so, please substantiate this claim.
Governments other than the US set drug prices. The US does not. Through congressional action the US bargains with innovators in establishing price, so the ~2.6 B investment to bring a drug to market can be recomped, typically at a 5% industry margin.
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It's clear from your comment that you didn't read the article.
I didn't reply to the post about the article
I didn't even quote the article.
I doubt the article is going to change 50+ years of observing government and how it mismanages money.
I have no doubt business does the same.
The only difference is that I can fire a business if I don't like how they are doing things.
I cannot fire my government if they vote for a scheme where "they" provide something, but send the bill to others.
So unless the article called for voluntary insurance pools with no obligation to the taxpayer, it's not really going to change my mind.
What will change my mind is a few decades of a government that can operate without running deficits. Without fomenting race or class or gender divisions (to name a few.)
Words are largely meaningless when it comes to politicians. Action is all that matters.
Since any article is words, not action, it has little chance to sway my opinion.
Government has dug the hole themselves with respect to trust. Congress ranks down there with Used Car Dealers as far as being trustworthy.
Give them a generation or two of working on that, and proving by actions that they are trustworthy and perhaps words will actually have value.11 -
Governments other than the US set drug prices. The US does not. Through congressional action the US bargains with innovators in establishing price, so the ~2.6 B investment to bring a drug to market can be recomped, typically at a 5% industry margin.
Not all drug companies are located in the U.S. This doesn't represent a "subsidy" to other countries and there is much more that goes into the costs of healthcare delivery than just drug prices. Did you take time to read the article? It talks specifically about patient outcomes and satisfaction.5 -
Not all drug companies are located in the U.S. This doesn't represent a "subsidy" to other countries and there is much more that goes into the costs of healthcare delivery than just drug prices. Did you take time to read the article? It talks specifically about patient outcomes and satisfaction.
I'd like to see the same people polled 5 years later.
The study was done in 2014 (or at least published, then.)
Since the ACA went into effect, have the 85% of people who had insurance witnessed lower costs and better outcomes since the ACA? Are those who had coverage pre-ACA more satisfied now, post-ACA?
I do think The Commonwealth Fund has an agenda, so anything published should at least be viewed in light of the stated agenda.7
This discussion has been closed.
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