Trumpcare

[TotalInsanity4]

Definitely not an all-republican decision. There were some democratic hands on it as well.

Certainly not, but in reality, what party had the most incentive to hamstring a bill that would become Barack Obama's legacy?

 

[Xzi]

Definitely not an all-republican decision. There were some democratic hands on it as well. I'm not saying it wasn't torn apart by Republicans, just that it wasn't unanimously decided by the Republican party.

Of course not, but if it was decided unanimously by Democrats, we'd likely have single-payer and/or a public option right now. This discussion would be unnecessary.

 

[Kioku]

Certainly not, but in reality, what party had the most incentive to hamstring a bill that would become Barack Obama's legacy?

If we're seriously going to discuss ulterior motive here...

 

[TotalInsanity4]

If we're seriously going to discuss ulterior motive here...

I mean, we don't have to, but I also don't see why we wouldn't

 

[Xzi]

If we're seriously going to discuss ulterior motive here...

Then the clear winner is Trump, hands down. No other president has used the position as one big money making/money laundering operation. Hell, no other president has even kept control of their business once seated. Jimmy Carter gave up his peanut farm of all things, and Obama never had a business to begin with.

 

[SG854]

Speaking of hidden costs. I have seen many friends and associates take a spin in the US, or go there on a more permanent basis, both to rich states and to poor ones, as well as been there myself and find myself speaking to the unwashed masses. Without fail they and myself have seen some absolute horrors that people had not seen in decades, only seen in incredibly remote areas or only seen when various parts of Eastern Europe opened up and people dragged their sibling along with them. Similarly I have met plenty stuck in jobs they hate because insurance where they would instead have liked to have gone self employed, gone bankrupt/seriously debt laden from medical expenses, or find themselves living with things that are readily fixable and suffering the knock on effects to quality of life. Quality of care is right up there, and quite possibly class leading (not that there is a lot in it), if you can afford to pay for it but the key word is so often "if".

Similarly numbers paint a picture, outcomes another and you can also question if there are other ways (exercise based things in the case of heart conditions for instance). Similarly because of a bit of a suing culture there it is noted a lot more people get what you might call unnecessary CTs (which are still xrays and have the corresponding effects). The specifics here are not my forte though so I will have to pause that one for now and go do some reading.

Medical innovation wise then you can paint all sorts of pictures there. Quora I know but most things appear to be referenced so I will go it
https://www.quora.com/What-countrie...-during-the-time-period-between-1995-and-2014

That linked you sourced says that when you look a per million Switzerland comes out on top over the U.S. in terms of innovation, so more innovation in Switzerland than U.S. right?

Not really, it’s more complicated then that. For example Swiss Roche drug company is headquartered in Basil, but their top drugs were created in Genentech San Francisco USA. So is it U.S. made or Swiss made?

Pfizer has R&D in Connecticut USA, but has drugs originated in England. Sometimes companies in different countries merge, sometimes their tax status migrates to a different country. So is that link you gave me a reliable indicator of drug innovation from country to country?

A better look is to see how price controls shifted the change of R&D locations. Price controls have made it not profitable to fund R&D research, which can costs hundreds of millions of dollars and over 10 years to make one single drug, so many European countries shifted R&D to the United States where they now make 60% of their profits. Europeans were worried that low prices were killing the drug industry. There headquarters might by in Europe but R&D can be in the U.S.

Regulation of Drug Industry

Forbes Article - Sure, We’ll (Eventually) Beat Cancer. But Can We Afford to?

Which countries Excel in Creating New Drugs? It’s complicated.

--------------------- MERGED ---------------------------

I wouldn't go on CT Scanners or MRIs as a basis of degraded medical care inherently. Population density clearly isn't wholly an explanation. Nor is having an aging population, though I imagine that might heavily explain Japan.



As in the US. Black markets are common even in places where there's little regulation.



Nor the hidden costs of refusing to see a doctor until the situation is very bad and all the lost productivity as you work ineffectively through the pain. Definitely, hidden costs are very difficult to tabulate.



Uh, no. The numbers most frequently used are total cost per capita, so ineffective shorter doctor visits in Europe would if anything inflate the costs of Universal Healthcare meaning the US would look better.



Medical research funding is indirectly related to medical treatment costs. The part where there's any argument that the US improves medical research is in that US hospitals and insurers do not negotiate nearly as well so incur the guinea pig costs of new treatments so more companies can charge the sort of prices that allow to further such lines of research. Meanwhile, other countries do medical research but it is more heavily government funded (through universities and the like) and regular implementation into the medical field focuses on the benefit to cost ratio.

In the end, if you're rich enough, you can always find some doctor to do the procedure for the right price whether that means flying to the US, Thailand, or wherever. It's just that most common people don't get the treatment and so the effective per capita cost of treatment is often much lower. Obviously, that's still a gross oversimplification.

Japan is the odd-one-out as it has a system marginal like the US (required health insurance without a penalty) but health insurance is run by the government, hospitals are non-profit, and patients owe 30% of costs (0% if low income); the Japanese government also sets the rates for many (all?) procedures. And the result is lots of MRI/CT scanners and outcomes about the same as the US...which isn't saying much; I imagine Japan's general diet may have something to do with that more than their health care system, but it's hard to be sure about such hidden benefits.

PS - I was wrong. There is one area where the US isn't too crap in: cancer survival rates. The US is at least #1 in breast cancer survival (by a 1% margin to Australia and Canada). I imagine that too has more to do with awareness campaigns in the countries involved.

It depends on how you collect statistics. On a total per capita basis or a per visit cost basis. And yes U.S. would look better like you said. I was using per visit costs which is what some people use.

 

[kuwanger]

And yes U.S. would look better like you said. I was using per visit costs which is what some people use.

Because in part of the hidden statistic know as people don't go to the doctor. :/

--------------------- MERGED ---------------------------

Your argument is pretty poor when you're against reform that would cover millions more people and improve care because it saves money but it doesn't save enough. The fact that it saves any money at all shows how insanely broken the status quo is, and maintaining that is the only opposition plan proposed by Republicans.

It doesn't need to be enshrined in the constitution, that's just complicating things unnecessarily. Once we implement new social programs, we almost never repeal them, and that's why corporations oppose enacting them to begin with.

The end is precisely why I'm unsatisfied with the beginning. We implement new social programs, often very badly, and we spend 30+ years living with the consequences because Congress is too afraid of actually doing anything that could have a negative effect and possibly lose their job. Why do we have the broken mess that is Obamacare? Yes, the status quo (without or without Obamacare) is insanely broken. That "government does it better" cost wise is plainly obvious to anyone paying attention--health insurance takes a massive cut of premiums as profits so even run horribly a government program would be have to be absolutely terrible cost wise to be worse.

I'd rather live with 30+ years of substantial reform in our health care system, not merely adopting the relatively quick and easy. That's what got us Obamacare. There's too many system issues and it's not all something getting rid of health insurance for most people alone will fix. I'm not trying to downplay the advantage of having millions more people with health care. It's just plainly clear we can do a lot better, so we should.

 

[SG854]

The 4% reduction in cost is only a footnote to the fact that hundreds of millions more Americans would be covered and receive better care on average. There have been no better proposals thus far.

It's not "a plan" per se. It's the fact that the US spends an average of 100% more than other countries with Universal Healthcare. Looking at what they do and copying it would be "part of the plan". The actual $2 trillion/year is just sort of "out of the ass" figure as it'd mean we'd still be spending about 50% more than other countries with Universal Healthcare. Realistically, though, I don't think I've seen anyone actually draw up a plan to address the obvious issues with the US system that even curious reading tells you about.

So, sorry if I come across like I know of something complete. I think with all the resistance, basically no one with the experience has went through the effort of putting forth a whole Universal Healthcare plan that'd include all the necessary reform. I mean, people are gun-ho about Medicare-for-all probably precisely because it doesn't include reform. And as my first post pointed out, you'd basically need a Constitutional Amendment to have Universal Healthcare. It's not necessarily for the legality of it but because it indicates substantial buy-in.

They usually talk about GDP spending without giving reasons on why a high or lower number is bad.

 

[FAST6191]

That linked you sourced says that when you look a per million Switzerland comes out on top over the U.S. in terms of innovation, so more innovation in Switzerland than U.S. right?

Not really, it’s more complicated then that. For example Swiss Roche drug company is headquartered in Basil, but their top drugs were created in Genentech San Francisco USA. So is it U.S. made or Swiss made?

Pfizer has R&D in Connecticut USA, but has drugs originated in England. Sometimes companies in different countries merge, sometimes their tax status migrates to a different country. So is that link you gave me a reliable indicator of drug innovation from country to country?

A better look is to see how price controls shifted the change of R&D locations. Price controls have made it not profitable to fund R&D research, which can costs hundreds of millions of dollars and over 10 years to make one single drug, so many European countries shifted R&D to the United States where they now make 60% of their profits. Europeans were worried that low prices were killing the drug industry. There headquarters might by in Europe but R&D can be in the U.S.

Regulation of Drug Industry

Forbes Article - Sure, We’ll (Eventually) Beat Cancer. But Can We Afford to?

Which countries Excel in Creating New Drugs? It’s complicated.

--------------------- MERGED ---------------------------


It depends on how you collect statistics. On a total per capita basis or a per visit cost basis. And yes U.S. would look better like you said. I was using per visit costs which is what some people use.

I was more familiar with the east Asian + subsidiaries tax dodge done by such companies (of those waiting for one of those money outside the country "tax holidays" to happen they are one of the bigger ones) but yeah it is a complete mess. I don't know if I am supposed to add it all up and come out with US is the driving innovator though.

I would also have to consider how much is a minor patent workaround (see also basic organic chemistry and notions of pharmacology/functional groups, or even just "cocktails"), or indeed the result of patents on DNA being a thing (truly an abhorrence to me). The citations thing paints a reasonable picture but not a complete one.

I think in the end I will go with. People go into the US by any number of means and jump through any number of hoops (if I thought I could do something other than work I would have gone there years ago myself, trivially at that, and probably made a packet), and hoops the US likes to invent for reasons of their own amusement. Seldom is it that medical tourism though, and if it is it ain't from other first world countries, indeed "money for a ticket back home" is the higher end insurance policy of a lot of people I know from countries where it is rather more affordable. It is technologically driven chemical medicine, same as much of the rest of the world, and when it is done it is done as well as anything else. Going population wide though... not good.

 

[the_randomizer]

Can't we all just agree that our healthcare system sucks and that we don't have the infrastructure to support ~300 million people?

 

[Xzi]

The end is precisely why I'm unsatisfied with the beginning. We implement new social programs, often very badly, and we spend 30+ years living with the consequences

What "consequences?" Providing healthcare and a social safety net to people who need it are not "consequences," they're bi-products of a healthy country. The fact that you're conditioned to view everything from the prism of corporate profit is pretty sad.

Can't we all just agree that our healthcare system sucks and that we don't have the infrastructure to support ~300 million people?

We do have the resources to support everybody. We just siphon it all to the 1% instead and then pretend we have no idea where it all went.

 

[kuwanger]

They usually talk about GDP spending without giving reasons on why a high or lower number is bad.

Um, they who? I specifically talk about per capita spending precisely because it seems the most apples-to-apples comparison possible. It's not perfect for a lot of reasons, of course. The only part about GDP spending that comes up is showing that in many other countries their total health care expenditures are mostly covered by government and they're a manageable ratio compared to GDP; that should inherently be true based on per capita because of taxes. So, *shrug*. Just a rather indirect way of reference the same point.

Can't we all just agree that our healthcare system sucks and that we don't have the infrastructure to support ~300 million people?

I'd tend to argue we're using are infrastructure pretty inefficiently--the whole system of doctors, hospitals, and networks is such an absurd thing--, but in part I'd agree in that we have a shortage of doctors if you want to count that as part of "infrastructure". Other than that, I'd say everything else is pretty sufficiently built out in most areas (and possibly a bit more than really necessary). This is coming from a relatively rural area (where most bigger towns are 10,000 people or less). It might be different where you live.

What "consequences?" Providing healthcare and a social safety net to people who need it are not "consequences," they're bi-products of a healthy country.

Increasing the government debt which will fuel further efforts to cut other government programs, increased taxes which will upset basically everyone, and of course all this to be yet another way to funnel money to corporations (just not the health insurance companies).

 

[chrisrlink]

really i just used the ER for stuff like having a broken hdmi scrape causing skin to die/fall off in chunks (besides what doctor is open at 11pm at night? I had no choice) thing is cause of my pre existing condition and the ACA now dead all i have is medicaid part A (doctor visit coverage) i don't have part B or prescription coverage

 

[Xzi]

Increasing the government debt which will fuel further efforts to cut other government programs, increased taxes which will upset basically everyone, and of course all this to be yet another way to funnel money to corporations (just not the health insurance companies).

Again, the fact that Medicare-for-all saves money over the current system negates most of your arguments here. We can spend less and cover everybody, or spend more and keep covering a much smaller percentage of the population.

We're not going to reform capitalism no matter which healthcare system we end up going with, so the last part is a moot point. Corporations are going to profit from anything and everything in America, but what's important is that average citizens are still taken care of too.

 

[cots]

I mean youre not wrong, but thats not a democrat problem. Thats a problem with our entire nation, and republicans are just as guilty. Remember when the government was shut down because they wouldnt cooperate with the democrats? Both parties are shitty, dont try to act like its one party being insolent when the other just wants to get along.

I never said it was limited to one side of the coin. I was pointing out what is currently happening and what is likely to happen.

 

[TotalInsanity4]

Can't we all just agree that our healthcare system sucks and that we don't have the infrastructure to support ~300 million people?

We do have the resources to support everybody. We just siphon it all to the 1% instead and then pretend we have no idea where it all went.

Precisely this, I refuse to admit defeat like that simply because we do have the infrastructure. Just as an off-hand example: Insulin? It's a super cheap drug to synthesize, but there's a stupid markup SPECIFICALLY in American-based companies. They justify it literally by saying that it is a life-saving resource, so they have the right to sell it as a premium.

 

[the_randomizer]

Precisely this, I refuse to admit defeat like that simply because we do have the infrastructure. Just as an off-hand example: Insulin? It's a super cheap drug to synthesize, but there's a stupid markup SPECIFICALLY in American-based companies. They justify it literally by saying that it is a life-saving resource, so they have the right to sell it as a premium.

But what's it going to take? Wasn't 800 billion enough to send us further into debt?

 

[Xzi]

But what's it going to take? Wasn't 800 billion enough to send us further into debt?

We spent trillions (and climbing) on a corporate welfare tax cut just a year ago. Like I said, the resources are there, it's all about where we choose to allocate them.

 

[TotalInsanity4]

But what's it going to take? Wasn't 800 billion enough to send us further into debt?

I guess I don't see what you're saying?... Ideally we'd outlaw for-profit healthcare altogether, which isn't outlandish at all considering it's how the country was running pre-1970s. Obviously everyone else in the thread is saying Medicaid-for-all, which would redistribute costs of medical visits to people who can afford it through taxes. We could easily go the Australian model, for instance, where you can choose to have the tax credits go towards a private hospital if you so desire. We have options, the problem is that none of them make investors incredibly rich, and that's where we as a nation seem to be stuck right now at the expense of our population.

 

[SG854]

I was more familiar with the east Asian + subsidiaries tax dodge done by such companies (of those waiting for one of those money outside the country "tax holidays" to happen they are one of the bigger ones) but yeah it is a complete mess. I don't know if I am supposed to add it all up and come out with US is the driving innovator though.

I would also have to consider how much is a minor patent workaround (see also basic organic chemistry and notions of pharmacology/functional groups, or even just "cocktails"), or indeed the result of patents on DNA being a thing (truly an abhorrence to me). The citations thing paints a reasonable picture but not a complete one.

I think in the end I will go with. People go into the US by any number of means and jump through any number of hoops (if I thought I could do something other than work I would have gone there years ago myself, trivially at that, and probably made a packet), and hoops the US likes to invent for reasons of their own amusement. Seldom is it that medical tourism though, and if it is it ain't from other first world countries, indeed "money for a ticket back home" is the higher end insurance policy of a lot of people I know from countries where it is rather more affordable. It is technologically driven chemical medicine, same as much of the rest of the world, and when it is done it is done as well as anything else. Going population wide though... not good.

European countries are relocating R&D to the U.S. which means their current system isn’t enough to fund medical research. So if we imitate that system then we won’t get much innovation anymore.

Um, they who? I specifically talk about per capita spending precisely because it seems the most apples-to-apples comparison possible. It's not perfect for a lot of reasons, of course. The only part about GDP spending that comes up is showing that in many other countries their total health care expenditures are mostly covered by government and they're a manageable ratio compared to GDP; that should inherently be true based on per capita because of taxes. So, *shrug*. Just a rather indirect way of reference the same point.



I'd tend to argue we're using are infrastructure pretty inefficiently--the whole system of doctors, hospitals, and networks is such an absurd thing--, but in part I'd agree in that we have a shortage of doctors if you want to count that as part of "infrastructure". Other than that, I'd say everything else is pretty sufficiently built out in most areas (and possibly a bit more than really necessary). This is coming from a relatively rural area (where most bigger towns are 10,000 people or less). It might be different where you live.



Increasing the government debt which will fuel further efforts to cut other government programs, increased taxes which will upset basically everyone, and of course all this to be yet another way to funnel money to corporations (just not the health insurance companies).

U.S. is expensive because we aren’t running it as efficiently as we can from restrictive regulations.

A good comparison is X-Rays and Lasik Eye Surgery. There is no competition in the X-ray business. It’s regulated. You can’t look up a list and choose and X-Ray technician and find one for the lowest price. If you ask a doctor for price they won’t give it to you. They would have to check their system and call the insurance company. They won’t give a price till after you get the X-Ray. And you get the charge master problem.

Lasik Eye surgery is really unregulated. Insurance companies won’t cover it. It use to cost $20,000 an eye. Till the free market brought it down to $4,000 through competition. Lasik Eye surgery became cheap because of unregulated competition and not because government subsidized it.