# Trumpcare



## kuwanger (Dec 16, 2018)

Dear Barack Obama,

Obamacare is a failure.  Obamacare was doomed to be a failure.  Obamacare made compulsory Health insurance a band-aid over Health Care, but Health Insurance is not Health Care.  The only system that would provide health care for all people in America is a system that specifically does something like that, like Universal Healthcare.  There's nothing wrong with admitting your mistakes; it's important to acknowledge them if your desire is for the people you care about, not attempting to fulfill a Legacy; Jimmy Carter has accomplished many good things since leaving the Presidency.

Join the Republicans, Democrats, and Trump to Repeal and Replace Obamacare with Universal Healthcare.  Make it clear that you'd joyously give Trump all the credit if he wants it if it means Universal Healthcare; Nixon passed many good laws.  Advocate making Universal Healthcare a Constitutional Amendment.  Stump for any Democrat or Republican will to support such legislation.  Call out other Democrats who refuse to work with Republicans.  Acknowledge criticism of not working well-enough with Republicans in the past, but make it clear you are putting the country first now and will work with anyone with the same goal.  Advocate merging Medicare/Medicaid into Universal Healthcare.  Make it clear that health care is an American responsibility, and it shouldn't be left up to individual States to control the flow of money to pay for health care nor to set requirements for licensing of doctors or nurses or restriction on services provided; yes, this means Universal Healthcare paying for abortions.  Make it clear that so long as abortion is a legal medical procedure and deemed necessary, it is appropriate for Universal Healthcare to fund it like any other necessary procedure.  Private hospitals and abortion clinics can continue to exist to allow for medical procedures deemed unnecessary or to expedite non-emergency care, to paid for by insurance or out of pocket.

Advocate to take steps to reduce the costs of health care by making more doctors available, bulk purchasing prescription, and other steps that other countries with Universal Healthcare engage in.  This could include things like complete Federal management of student loan forgiveness for doctors and nurses, lowering residency requirements for doctors from countries with comparable health systems, requiring all public hospitals to run residency programs, and seeing what regulations are unnecessary or overly expensive and should be reworked or removed.  Based on other Universal Healthcare systems, the money we spend on Medicare/Medicaid alone should be enough to cover nearly all the expenses of Universal Healthcare for all people in America; a slight tax increase may be necessary and the market correction will undoubtedly be painful, but it's a necessary step.

I believe fundamentally you are a pragmatist.  However, there is nothing pragmatic in merely doing what seems possible today if your goal is a better future.  What is pragmatic is to strive for the things that are really possible today and tomorrow.  There's definitely a lot about the cost of and organization of health care I am not well versed enough in to fully flesh out the idea.  It will take many people, both in the private and public sector to provide input.  There are many example countries to look at on what we're doing wrong on cost.  If there's one person's voice that will resonate the most, it will be yours to make clear that what matters more is not whether you have your name associated with something but whether what needs to be done is done.


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## Enkuler (Dec 16, 2018)

Well, Donald Trump and Hillary Clinton are famous Wii U hackers but I'm afraid Barack Obama is not on these forums.


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## Whole lotta love (Dec 16, 2018)

Trump just wants to make money dawg


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## kuwanger (Dec 16, 2018)

Enkuler said:


> Well, Donald Trump and Hillary Clinton are famous Wii U hackers but I'm afraid Barack Obama is not on these forums.



I do not believe Barack Obama would be any more likely to read what I wrote if I emailed him directly or if I put it here on a forum he does not read.  The real question is, do you agree or disagree, and do you think Barack Obama should read it?  Could you be part of the solution to make the latter happen?


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## SG854 (Dec 16, 2018)

Whole lotta love said:


> Trump just wants to make money dawg


Those are the homies Trump and Hillary. Trump got banned because he was too gangsta for GBAtemp.


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## tech3475 (Dec 16, 2018)

I expect the only thing to be passed/executive power in this administration is a law which the Democrats will say ‘doesn’t go far enough’ and the Republicans say ‘leaves the market alone’ with maybe just one or two additions like bans on pre-existing conditions.


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## cots (Dec 16, 2018)

kuwanger said:


> Dear Barack Obama.



I think you have the right idea. Liberals are busy trying to bash Trump when he is simply trying to implement something that benefits society more then the failed Obamacare did. Of course, you're asking Democrats to work with Republicans. Yeah right! They will refuse to compromise and then when nothing gets done they will blame Trump. Hell, I saw a stray cat today. Must be Trumps fault!


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## Captain_N (Dec 16, 2018)

With Universal Health care, you always have rationing of health care.


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## TotalInsanity4 (Dec 16, 2018)

kuwanger said:


> Make it clear that you'd joyously give Trump all the credit if he wants it if it means Universal Healthcare


https://www.independent.co.uk/news/...eal-replace-republican-democrat-a8423371.html



Captain_N said:


> With Universal Health care, you always have rationing of health care.


You say that as though healthcare is a somehow scarce resource?...


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## kuwanger (Dec 17, 2018)

Captain_N said:


> With Universal Health care, you always have rationing of health care.



With licensed doctors, you always have rationing of health care  With any sort of regulation on the safety, purity, or effectiveness of drugs, you always have rationing of health care.  I could go on, but I think you get the point.  The important thing isn't if health care is per se rationed but if it provides equal or better outcome and what such access costs.  By about every metric that can be used except peoples ability to expedite non-emergency care or to pay for much more expensive options--neither of which Universal Health care doesn't inherently remove--which have negligible statistical difference on outcome, the US system of public/private health insurance/health care is inferior to all other countries with Single Payer/Universal Health care.



TotalInsanity4 said:


> https://www.independent.co.uk/news/...eal-replace-republican-democrat-a8423371.html



The problem is Obama's comment was about renaming Obamacare, not actually replacing with something actually better.  The other part is it was a mocking joke under the belief that Trump is too incompetent to actually pass something better.  Again, I point out Nixon.  More importantly, with enough support you don't need the President to sign on, so it's fundamentally not about Trump.  It is fundamentally about getting enough people (especially in Congress and the States) behind a system that's been proven to work basically everywhere.


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## TotalInsanity4 (Dec 17, 2018)

kuwanger said:


> The problem is Obama's comment was about renaming Obamacare, not actually replacing with something actually better.


I mean... I'm not gonna say that the ACA was perfect by any means, because I'd so much rather have properly-implemented single-payer healthcare. _That said_, it's still LEAGUES better than the for-profit healthcare system we've been stuck with up to that point, especially for the people who wouldn't otherwise have been able to afford private insurance.



> The other part is it was a mocking joke under the belief that Trump is too incompetent to actually pass something better.  Again, I point out Nixon.


Well... yeah, but [insert low-hanging fruit joke here], y'know? I get what you're saying, but that's really kind of because that actually is the case. And the more important point here isn't that Obama thinks Trump is incompetent (although he'd never say that out loud, those were the days), it's that Obama clearly doesn't care about credit for himself, he genuinely wants what he thinks is best for the nation.



> More importantly, with enough support you don't need the President to sign on, so it's fundamentally not about Trump.  It is fundamentally about getting enough people (especially in Congress and the States) behind a system that's been proven to work basically everywhere.


That's... kinda shifting the topic of the conversation you started, but yes, you're right. There's really nothing that I disagree with here. And honestly that's what's going to HAVE to happen, because there's no plausible scenario in which I could see Donald Trump supporting universal single-payer healthcare


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## FAST6191 (Dec 17, 2018)

I am about as big a proponent of universal/nationalised healthcare as you will find, and find myself continually shocked by the US and its approach to things as well as the attitudes underpinning it, even more so when I consider its position in the world. Still I can see how the ACA ended up a rather neutered and ineffectual thing in the end. That said is repealing things the right move? It is generally noted as being far easier to amend things than make new things when it comes to matters legal and governmental. Trying to get such a thing introduced again would get all the "we tried it and look what happened" soundbites that skip over all the nuance.

Re: abortions. I know we already did that one, or we can go back to that thread if you like, but "necessary" immediately runs into the psychologically necessary quandary (as do many other things).


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## nando (Dec 17, 2018)

Enkuler said:


> Well, Donald Trump and Hillary Clinton are famous Wii U hackers but I'm afraid Barack Obama is not on these forums.




trump does come by, but he doesn't read anything, only looks for pictorial memes.


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## TotalInsanity4 (Dec 17, 2018)

nando said:


> trump does come by, but he doesn't read anything, only looks for pictorial memes.


That's very in-character of him


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## kuwanger (Dec 17, 2018)

FAST6191 said:


> That said is repealing things the right move? It is generally noted as being far easier to amend things than make new things when it comes to matters legal and governmental. Trying to get such a thing introduced again would get all the "we tried it and look what happened" soundbites that skip over all the nuance.



The truth is, the soundbites against it will be said regardless of it's replace or reform.  The truth is, Obamacare was about Health Insurance.  We need a law about Health Care.  So long as we keep following the path that think we can just reform a little here and there instead of directly addressing the issue, the more we're dooming ourselves to be mired into no real solution.



FAST6191 said:


> Re: abortions. I know we already did that one, or we can go back to that thread if you like, but "necessary" immediately runs into the psychologically necessary quandary (as do many other things).



The truth is, there will probably never be consensus on when people as a whole believe abortion or many other medical procedures are "necessary".  In the end, that means we are left to individual doctors who will make that call and likely many who will seek private abortion clinics.  I don't think the answer is to step forward and argue we codify it into law "pay for abortion" or "don't pay for abortion" because that's precisely the standstill no one is willing to give on.  Leave it to the individual and the doctor and promise that the procedure will be paid for if the doctor says it's medically necessary.  That's really the place we're already at, so that compromise (if you want to think of it as that) should be brought up and espoused upon as early and readily as possible so abortion isn't used to derail the whole thing.



TotalInsanity4 said:


> That's... kinda shifting the topic of the conversation you started, but yes, you're right. There's really nothing that I disagree with here. And honestly that's what's going to HAVE to happen, because there's no plausible scenario in which I could see Donald Trump supporting universal single-payer healthcare



I believe Donald Trump is fundamentally a sycophant.  If it's clear that playing to that base will result in him receiving credit and accolades to the point of calling it Trumpcare, he will gladly take up the honor.  That's why attacking Trump's ego is no approach to winning him over and why it's important that Obama specifically graciously concede to Trump's wisdom in Universal Healthcare.  But in the end, if it's clear he'll keep fighting against it anyways, the point is we can work around him.  He will go down as possibly the worst President for opposing health care.  That's not the goal.  That's him hanging himself.  Honestly, I don't want that.


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## x65943 (Dec 17, 2018)

No way Trump passes anything approaching universal health care. It's anathema to the GOP base.

And he probably won't be passing anything anytime soon. The impeachment is going to start this January when the Dems take the house - and although they need the Republicans in the Senate to convict, things are looking pretty damning now with Mueller implicating Trump in campaign finance violation in the Cohen case. Indictment soon I suspect.


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## SG854 (Dec 17, 2018)

Obama Care/Afordable Care Act does’t make overall Medical Care more affordable and doesn’t reduce GDP spending. It forced Young Healthy People to get Health Insurance. It redistributed the costs but costs were the same.

If people can’t afford medical care then they are unable to afford medical care and have government distribute it.

People complain that their paychecks are low and it’s because their money is taken from taxes and taken to pay for Business Supplied Health Insurance. Which also raises unemployment rates. It’s an added cost to employers.

Health Insurance adds to the total cost of medical care because instead of paying the doctor directly you now have to pay doctors and the health insurance companies making medical expenses even more expensive. More people involved more people to pay. It doesn’t reduce costs.


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## bitjacker (Dec 17, 2018)

If we learned anything, we would not authorize government to do anything to healthcare. How about we file a class action suit to reclaim money that was a fine for not having insurance, end the war on drugs, and pass an amendment granting citizens the right to self medicate/ force insurance companies to pay for care doctors prescribe. (any doctors caught working against patients in interest of insurance companies would have to be stripped of license). The government could loan its people money to get the higher costing cares done.


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## SG854 (Dec 17, 2018)

bitjacker said:


> If we learned anything, we would not authorize government to do anything to healthcare. How about we file a class action suit to reclaim money that was a fine for not having insurance, end the war on drugs, and pass an amendment granting citizens the right to self medicate/ force insurance companies to pay for care doctors prescribe. (any doctors caught working against patients in interest of insurance companies would have to be stripped of license). The government could loan its people money to get the higher costing cares done.


When people perceive something to be free they use more of that service as much as they want which leaves less for everyone else. 

More use of a service raises spending costs to the government which then is pased on to the people. And won’t lower GDP spending. GDP spending is high, people critisize high GDP spending, and this won’t lower it.

If people payed directly themselves then they would be more careful about their choices and how they use services. Which leaves more for people that really need it.


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## x65943 (Dec 17, 2018)

SG854 said:


> When people perceive something to be free they use more of that service as much as they want which leaves less for everyone else.
> 
> More use of a service raises spending costs to the government which then is pased on to the people. And won’t lower GDP spending. GDP spending is high, people critisize high GDP spending, and this won’t lower it.
> 
> If people payed directly themselves then they would be more careful about their choices and how they use services. Which leaves more for people that really need it.


Thing is the people who use the healthcare system the most are the poor who flock to the ER - which is the most expensive place to receive healthcare.

And guess what, they can't pay that huge bill - so it ends up being footed by everyone else anyway.

As someone who worked as an EMT let me tell you, they already treat emergency medicine like it's candy. People would call because they fell over and needed help up, or because they got stung by a bee.

At least with universal care they could treat regular visits like candy - which would cost less.


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## Captain_N (Dec 17, 2018)

so how are we gonna pay for said Universal health care?


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## SG854 (Dec 17, 2018)

x65943 said:


> Thing is the people who use the healthcare system the most are the poor who flock to the ER - which is the most expensive place to receive healthcare.
> 
> And guess what, they can't pay that huge bill - so it ends up being footed by everyone else anyway.
> 
> ...


It wouldn’t cost less if they are treating it like candy. It would cost more. Unless government refuses to pay for the costs then overall medical system would degrade like it has in Canada and Europe. And Canada treats it more like candy than the U.S.

The fact that the Primier of Quebec gets their medical care in the U.S. instead of their native Canadian country is telling. Or the huge amount of doctors from around the world that practices in the U.S. because of less constraining restrictions is another sign.

Many doctors in the U.K. are foreign born graduating from colleges that have less standards because they are unable to get native born doctors because people don’t see the benefit in the U.K. system. If you don’t incentivize doctors through competition then they won’t see  benifits in becoming a doctor.


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## SG854 (Dec 17, 2018)

We have more MRI’s and CT Scanners per million population in the U.S. then in Canada and U.K.

CT Scanners per million
7.5 in Britain
11.2 in Canada
32.2 in the United States

MRI’s per million
5.4 Britain
5.5 Canada
26.6 United States

This is just another sign of degraded medical care in Canada and Britain. They are unable to get latest tech.

Black markets are also common in U.K., Canada, Britain, Korea and Japan.

Hidden costs are also not counted in statistics. Like paying more to get ahead on the waiting lists. Since wait times are longer in those countries. And more money you loose if your out of work longer for waiting. Which is another hidden cost that is not counted in medical care statistics.

And it seems cheaper because they have more visits for half as long, then less visits for twice as long like U.S. does. So per visit costs appear cheaper in Europe since they spend less time with doctors. Less time cheaper costs. Longer time spent with doctor higher cost. But overall costs isn’t cheaper because of more repeated visits. Going for more visits then less to get the same work done I don’t think people would like that.

We also have more medical innovations compared to any other country in the world. U.S. is number 1 in this field. They are unable to fund research in other countries to the same level as U.S.


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## TotalInsanity4 (Dec 17, 2018)

Captain_N said:


> so how are we gonna pay for said Universal health care?


The same way any other countries do

Which is to say the same way _we_ already do, except instead of paying for private insurance you're paying more in taxes. In return, you're paying an institution that isn't trying to put profits before your welbeing


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## KingVamp (Dec 17, 2018)

If the people in power right now wanted to do Universal Healthcare, they would have already put effort in doing so rather than waste time repealing and messing up Obamacare before a better system was in place.


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## FAST6191 (Dec 17, 2018)

SG854 said:


> We have more MRI’s and CT Scanners per million population in the U.S. then in Canada and U.K.
> 
> CT Scanners per million
> 7.5 in Britain
> ...




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


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## Whole lotta love (Dec 17, 2018)

SG854 said:


> Those are the homies Trump and Hillary. Trump got banned because he was too gangsta for GBAtemp.


Trump got banned for asking for roms


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## kuwanger (Dec 17, 2018)

SG854 said:


> We have more MRI’s and CT Scanners per million population in the U.S. then in Canada and U.K.
> 
> CT Scanners per million
> 7.5 in Britain
> ...



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.



SG854 said:


> Black markets are also common in U.K., Canada, Britain, Korea and Japan.



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



SG854 said:


> Hidden costs are also not counted in statistics. Like paying more to get ahead on the waiting lists. Since wait times are longer in those countries. And more money you loose if your out of work longer for waiting. Which is another hidden cost that is not counted in medical care statistics.



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.



SG854 said:


> And it seems cheaper because they have more visits for half as long, then less visits for twice as long like U.S. does. So per visit costs appear cheaper in Europe since they spend less time with doctors. Less time cheaper costs. Longer time spent with doctor higher cost. But overall costs isn’t cheaper because of more repeated visits. Going for more visits then less to get the same work done I don’t think people would like that.



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.



SG854 said:


> We also have more medical innovations compared to any other country in the world. U.S. is number 1 in this field. They are unable to fund research in other countries to the same level as U.S.



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.


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## Xzi (Dec 17, 2018)

This is a joke, right?  When have Republicans ever made an honest attempt at passing any sort of healthcare reform?  They'll attack whatever ideas the Democrats have, like single payer or Medicare for all, but they never have any ideas of their own.  Republicans care far more about the _insurance_ aspect of healthcare than anything else, which is exactly how Obamacare ended up so watered-down from compromise in the first place.

The ruling against Obamacare is flimsy at best and probably won't hold up anyway, but I'm perfectly fine with discussing the future of healthcare, because obviously it still needs changes.  Just don't expect Trump to move on this at all before the next election.  Remember that he's only passed one bill as president, and that was while he controlled all three branches of government.


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## TotalInsanity4 (Dec 17, 2018)

Xzi said:


> This is a joke, right?  When have Republicans ever made an honest attempt at passing any sort of healthcare reform?  They'll attack whatever ideas the Democrats have, like single payer or Medicare for all, but they never have any ideas of their own.  Republicans care far more about the _insurance_ aspect of healthcare than anything else, which is exactly how Obamacare ended up so watered-down from compromise in the first place.
> 
> The ruling against Obamacare is flimsy at best and probably won't hold up anyway, but I'm perfectly fine with discussing the future of healthcare, because obviously it still needs changes.  Just don't expect Trump to move on this at all before the next election.  Remember that he's only passed one bill as president, and that was while he controlled all three branches of government.


To be fair, Mitt Romney actually did run on a platform of healthcare reform and did have a hand in authoring the ACA if I remember correctly (although it would have been partially due to him that it ended up as conservative as it did). I also wouldn't have been particularly surprised if John McCain would have supported some form of healthcare reform. They're both DEFINITELY exceptions to the rule, though


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## Xzi (Dec 17, 2018)

TotalInsanity4 said:


> To be fair, Mitt Romney actually did run on a platform of healthcare reform and did have a hand in authoring the ACA if I remember correctly (although it would have been partially due to him that it ended up as conservative as it did). I also wouldn't have been particularly surprised if John McCain would have supported some form of healthcare reform. They're both DEFINITELY exceptions to the rule, though


Yeah I remember his own party attacking Romney over that, and the party was definitely against McCain by the time he passed too.  Republicans shun anybody who doesn't prioritize corporate donors over all else.


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## Ratatattat (Dec 17, 2018)

kuwanger said:


> Dear Barack Obama,
> 
> Obamacare is a failure.  Obamacare was doomed to be a failure.  Obamacare made compulsory Health insurance a band-aid over Health Care, but Health Insurance is not Health Care.  The only system that would provide health care for all people in America is a system that specifically does something like that, like Universal Healthcare.  There's nothing wrong with admitting your mistakes; it's important to acknowledge them if your desire is for the people you care about, not attempting to fulfill a Legacy; Jimmy Carter has accomplished many good things since leaving the Presidency.
> 
> ...



Wow do I have a bridge for you


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## the_randomizer (Dec 17, 2018)

TotalInsanity4 said:


> I mean... I'm not gonna say that the ACA was perfect by any means, because I'd so much rather have properly-implemented single-payer healthcare. _That said_, it's still LEAGUES better than the for-profit healthcare system we've been stuck with up to that point, especially for the people who wouldn't otherwise have been able to afford private insurance.
> 
> 
> Well... yeah, but [insert low-hanging fruit joke here], y'know? I get what you're saying, but that's really kind of because that actually is the case. And the more important point here isn't that Obama thinks Trump is incompetent (although he'd never say that out loud, those were the days), it's that Obama clearly doesn't care about credit for himself, he genuinely wants what he thinks is best for the nation.
> ...



It was so perfect that low-income and jobless people like were totally unable to afford ACA and get penalized for not being able to get insurance, thanks, Obama!

Yeah, fuck Obamacare


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## Xzi (Dec 17, 2018)

the_randomizer said:


> It was so perfect that low-income and jobless people like were totally unable to afford ACA and get penalized for not being able to get insurance, thanks, Obama!
> 
> Yeah, fuck Obamacare


Have you seen the insurance rates lately, after the individual mandate was repealed?  They're way the fuck higher.  More importantly, pre-existing conditions were never covered before Obamacare, and they won't be again if it gets repealed.  The fate of Obamacare is literally a death panel being held by Republicans for hundreds of thousands of Americans.


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## kuwanger (Dec 17, 2018)

Ratatattat said:


> Wow do I have a bridge for you



Wow, I have two.  They're both very nice.



the_randomizer said:


> It was so perfect that low-income and jobless people like were totally unable to afford ACA and get penalized for not being able to get insurance, thanks, Obama!



Uh, yea, part of that was why Medicaid was expanded in scope but a bunch of States refused the money because in the long term they'd be put on the hook for the larger pool that'd be eligible.  Overall, I agree that such was an entirely stupid strategy because it relied upon State governments covering (a large part) of the poor and letting the market+insurers basically dictate the rates, which is fundamentally why all sorts of private+public systems in the US are so broken.  Markets that know they can keep jacking up the rates and the government will just pay for it are a gold mine.


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## the_randomizer (Dec 17, 2018)

kuwanger said:


> Wow, I have two.  They're both very nice.
> 
> 
> 
> Uh, yea, part of that was why Medicaid was expanded in scope but a bunch of States refused the money because in the long term they'd be put on the hook for the larger pool that'd be eligible.  Overall, I agree that such was an entirely stupid strategy because it relied upon State governments covering (a large part) of the poor and letting the market+insurers basically dictate the rates, which is fundamentally why all sorts of private+public systems in the US are so broken.  Markets that know they can keep jacking up the rates and the government will just pay for it are a gold mine.



Yeah, it was so good I couldn't afford jack shit, yay for BS socialized medicine.


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## Xzi (Dec 17, 2018)

the_randomizer said:


> Yeah, it was so good I couldn't afford jack shit, yay for BS socialized medicine.


Obamacare was never billed as socialized healthcare.  It started as single-payer and then slowly became watered down as Republicans complained about it not making them enough money.  We just need Medicare-for-all and be done with it.  It polls at like 70% approval, so obviously Republicans are against it in order to "own the libs."  Just another issue, like weed, where they can't get out of their own way and refuse to stand on the right side of history.


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## Kioku_Dreams (Dec 17, 2018)

Xzi said:


> Obamacare was never billed as socialized healthcare.  It started as single-payer and then slowly became watered down as Republicans complained about it not making them enough money.  We just need Medicare-for-all and be done with it.  It polls at like 70% approval, so obviously Republicans are against it in order to "own the libs."


I don't understand your bias against Republicans... However, it definitely is not just their fault Obamacare came to be the nightmare it is.


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## Xzi (Dec 17, 2018)

Memoir said:


> I don't understand your bias against Republicans... However, it definitely is not just their fault Obamacare came to be the nightmare it is.


It's not bias, I've simply accepted the fact that Republicans don't give a fuck about healthcare reforms of any kind.  They're perfectly fine with the entire system being a drain on the economy and rejecting treatment for needful individuals as long as it means the right corporations are making money.  They'll give it lip service and that's about it.

If Obamacare does get repealed and another Republican gets elected, we'll have a really fun time getting through the next recession with no healthcare options whatsoever.  Six years of worse healthcare than what third-world countries get.  Like I said though, Medicare-for-all polls really well across all demographics, so that should give Democrats an extra bump for 2020.


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## the_randomizer (Dec 17, 2018)

Xzi said:


> Obamacare was never billed as socialized healthcare.  It started as single-payer and then slowly became watered down as Republicans complained about it not making them enough money.  We just need Medicare-for-all and be done with it.  It polls at like 70% approval, so obviously Republicans are against it in order to "own the libs."  Just another issue, like weed, where they can't get out of their own way and refuse to stand on the right side of history.



No matter, it was useless to people who had zero income and/or couldn't afford it even with income. So yeah, forced medical insurance is bullshit.


----------



## TotalInsanity4 (Dec 17, 2018)

Memoir said:


> I don't understand your bias against Republicans... However, it definitely is not just their fault Obamacare came to be the nightmare it is.


No, it's pretty common knowledge (even on conservative talk shows, which is interesting to listen to them admit and think they're bragging) that Obamacare was neutered to the point where it was practically sabatoged. The success that it's had are in spite of all the odds against it, and the shortcomings aren't indicative of what proper single-payer would accommodate


----------



## Xzi (Dec 17, 2018)

the_randomizer said:


> No matter, it was useless to people who had zero income and/or couldn't afford it even with income. So yeah, forced medical insurance is bullshit.


_Nobody_ could afford that shit before Obamacare, the uninsured rate was through the roof and it was starting to have a clear impact.  The individual mandate brought prices down by quite a bit on average, just not nearly enough to get _everyone_ covered.  Which is precisely why Medicare-for-all is the better solution.  You're covered even if you can't afford it, and having to compete with that, private insurers would have to lower their rates to reasonable levels and/or include more incentives.

Not to mention it saves us $2 trillion over the current system in the long run.


----------



## kuwanger (Dec 17, 2018)

Xzi said:


> We just need Medicare-for-all and be done with it.



Uh, no.  Again, the money spent Medicare/Medicaid makes up ~30-50% of health care spending but only covers a fraction of the population.  If it were simply extended to everywhere, Medicare/Medicaid costs would simply balloon to the same scope of all health care costs (maybe 80-90%?).  That's ludicrous.  We don't have enough doctors (lack of required residencies at hospitals) with drives up their salaries.  We don't do enough benefit/cost analysis on treatment.  We don't do enough of a good job of loan forgiveness for doctors (which is part of the excuse used for their salary).

Those aren't the only things but if you go through all the per capita costs it's clear the US is just more expensive in a lot of areas and without good reason.  All that needs worked on as part of the process.  Medicare also still requires people make payments for services.  Prescriptions are a mess.  Really, it's a lot more than one simple "put everyone on medicare".


----------



## the_randomizer (Dec 17, 2018)

Xzi said:


> _Nobody_ could afford that shit before Obamacare, the uninsured rate was through the roof and it was starting to have a clear impact.  The individual mandate brought prices down by quite a bit on average, just not nearly enough to get _everyone_ covered.  Which is precisely why Medicare-for-all is the better solution.  You're covered even if you can't afford it, and having to compete with that, private insurers would have to lower their rates to reasonable levels and/or include more incentives.



Really, because when I went to the doctors, Obamacare didn't pay for jack squat, so yeah, it hasn't really helped me all that much. I was never covered when I've gone to ENT specialists and my physician, soooooo yeah. I'm glad that useless penalty is gone.


----------



## TotalInsanity4 (Dec 17, 2018)

the_randomizer said:


> No matter, it was useless to people who had zero income and/or couldn't afford it even with income. So yeah, forced medical insurance is bullshit.


So I'm looking at Utah's healtcare government page and so far as I can tell they actually do have a properly implemented Medicaid solution. Do you qualify for it, and if so did you ever _actually_ sign up for it?


----------



## Xzi (Dec 17, 2018)

the_randomizer said:


> Really, because when I went to the doctors, Obamacare didn't pay for jack squat, so yeah, it hasn't really helped me all that much. I was never covered when I've gone to ENT specialists and my physician, soooooo yeah. I'm glad that useless penalty is gone.


It depends entirely on the individual insurance plans available in your area.  A lot of states refused to implement Obamacare at all or accept any of the subsidies for it, and those states have been in a much harsher decline for the better part of a decade now.


----------



## the_randomizer (Dec 17, 2018)

TotalInsanity4 said:


> So I'm looking at Utah's healtcare government page and so far as I can tell they actually do have a properly implemented Medicaid solution. Do you qualify for it, and if so did you ever _actually_ sign up for it?



I honestly never found out what I was supposed to do or even how to get on it, wish someone would have told me, but it's too late as I owe $1100 in bills from visiting a doctor to get my ear nose and throat check. Well son of a bitch. Right now, I'm just full cynicism mode, I don't see the point in doing this now as it's not going to magically give me back the money I couldn've saved.   Damn our broken healthcare system.


----------



## Xzi (Dec 17, 2018)

kuwanger said:


> Uh, no.  Again, the money spent Medicare/Medicaid makes up ~30-50% of health care spending but only covers a fraction of the population.  If it were simply extended to everywhere, Medicare/Medicaid costs would simply balloon to the same scope of all health care costs (maybe 80-90%?).  That's ludicrous.  We don't have enough doctors (lack of required residencies at hospitals) with drives up their salaries.  We don't do enough benefit/cost analysis on treatment.  We don't do enough of a good job of loan forgiveness for doctors (which is part of the excuse used for their salary).
> 
> Those aren't the only things but if you go through all the per capita costs it's clear the US is just more expensive in a lot of areas and without good reason.  All that needs worked on as part of the process.  Medicare also still requires people make payments for services.  Prescriptions are a mess.  Really, it's a lot more than one simple "put everyone on medicare".


Obviously there are plenty of details to be worked out yet, but it's by far still the best option we have to bring our healthcare system in line with the rest of the civilized world.  If other large European countries can guarantee healthcare coverage to their citizens, then there's no good reason we can't.  Time to stop worrying about what the corporations might think about our progress and just start making progress.  The savings from fixing a broken system benefit them just as much as anyone else regardless.



			
				Business Insider said:
			
		

> According to the Mercatus model, total health spending would  actually come in about $303 billion lower in 2031 than under current projections, with $7.35 trillion going to healthcare that year versus $7.65 trillion expected now. Total national health spending would be $2 trillion lower from 2022 to 2031 under the plan, the report found.
> 
> While the price tag for the federal government would increase significantly, decreased spending by other groups would lower total healthcare spending over that 10-year period. Meanwhile, the model also assumes that 30 million more people would get access to healthcare, and many people would get more robust services.



https://www.businessinsider.com/bernie-sanders-medicare-for-all-plan-cost-save-money-2018-7


----------



## Lacius (Dec 17, 2018)

We need Medicare for All _and_ more regulations on pricing.


----------



## bi388 (Dec 17, 2018)

cots said:


> I think you have the right idea. Liberals are busy trying to bash Trump when he is simply trying to implement something that benefits society more then the failed Obamacare did. Of course, you're asking Democrats to work with Republicans. Yeah right! They will refuse to compromise and then when nothing gets done they will blame Trump. Hell, I saw a stray cat today. Must be Trumps fault!


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.


----------



## kuwanger (Dec 17, 2018)

"According to the Mercatus model, total health spending would actually come in about $303 billion lower in 2031 than under current projections, with $7.35 trillion going to healthcare that year versus $7.65 trillion expected now. "

So, less than a 4% reduction.  That's pretty horrible.  By 2031 with actual efforts to reduce costs, even without Medicare for all you'd see a lot larger than a 4% reduction.  Having to include 9 years to get a $2 trillion savings is horrible when a $2 trillion/year savings is possible.  So, yea, that's why Medicare-for-all seems like a joke. :/


----------



## Xzi (Dec 17, 2018)

kuwanger said:


> "According to the Mercatus model, total health spending would actually come in about $303 billion lower in 2031 than under current projections, with $7.35 trillion going to healthcare that year versus $7.65 trillion expected now. "
> 
> So, less than a 4% reduction.  That's pretty horrible.  By 2031 with actual efforts to reduce costs, even without Medicare for all you'd see a lot larger than a 4% reduction.  Having to include 9 years to get a $2 trillion savings is horrible when a $2 trillion/year savings is possible.  So, yea, that's why Medicare-for-all seems like a joke. :/


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.


----------



## TotalInsanity4 (Dec 17, 2018)

kuwanger said:


> Having to include 9 years to get a $2 trillion savings is horrible when a $2 trillion/year savings is possible.


Which plan are you referencing that gives a potential $2 trillion per year savings to taxpayers? I'd like to take a look at it at some point


----------



## Lacius (Dec 17, 2018)

cots said:


> I think you have the right idea. Liberals are busy trying to bash Trump when he is simply trying to implement something that benefits society more then the failed Obamacare did. Of course, you're asking Democrats to work with Republicans. Yeah right! They will refuse to compromise and then when nothing gets done they will blame Trump. Hell, I saw a stray cat today. Must be Trumps fault!





bi388 said:


> 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.


Democrats tried to pass bipartisan health care reform reform, which is one of the reasons we got Obamacare in its present form instead of something like Medicare for All. Obamacare is largely based on a free market Republican plan from the Heritage Foundation and is basically Romneycare. Republicans are the ones who decided to uniformly oppose the Democrats' plan no matter what because their number one priority was to "make Obama a one-term President." Trump and the Republicans ran on "Obamacare is bad" but couldn't repeal it because it actually does a lot of common sense good, despite being *far* from perfect. Now they don't know what to do, like a dog that chased a car. Republicans don't have a substantive health care policy aside from "Obamacare is bad."

It's fair to say both parties _can_ be bad, but it's unfair to say they're _equally_ bad.


----------



## bi388 (Dec 17, 2018)

Lacius said:


> Democrats tried to pass bipartisan health care reform reform, which is one of the reasons we got Obamacare in its present form instead of something like Medicare for All. Obamacare is largely based on a free market Republican plan from the Heritage Foundation and is basically Romneycare. Republicans are the ones who decided to uniformly oppose the Democrats' plan no matter what because their number one priority was to "make Obama a one-term President." Trump and the Republicans ran on "Obamacare is bad" but couldn't repeal it because it actually does a lot of common sense good, despite being *far* from perfect. Now they don't know what to do, like a dog that chased a car. Republicans don't have a substantive health care policy aside from "Obamacare is bad."
> 
> It's fair to say both parties _can_ be bad, but it's unfair to say they're _equally_ bad.


Oh yes Im not saying theyre equally bad. Im opposing the idea that democrats are always trying to be uncooperative and blame everything on trump (which they do sometimes do) but republicans only have the best interests of the people in mind and want to get along.


----------



## kuwanger (Dec 17, 2018)

TotalInsanity4 said:


> Which plan are you referencing that gives a potential $2 trillion per year savings to taxpayers? I



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.


----------



## Xzi (Dec 17, 2018)

kuwanger said:


> 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.


Not sure what you're on about...Medicare-for-all _is_ reform.  There's also absolutely nothing in the constitution that might prevent universal healthcare in the US, only some stipulations on how it can be billed.


----------



## kuwanger (Dec 17, 2018)

Xzi said:


> Not sure what you're on about...Medicare-for-all _is_ reform. There's also absolutely nothing in the constitution that might prevent universal healthcare in the US, only some stipulations on how it can be billed.



It's not any sort of substantial reform.  Substantial reform wouldn't show a sub 4% drop in costs after 10+ years.  And like I said, it's not necessarily about the legality*.  The point is that if enough of Congress and States are on board, they won't be trying to undermine what is passed in lawsuits.  The point then of making it into the Constitution is precisely to make it abundantly clear it's here to stay.  Put another way, the only way I see Universal Healthcare happening is if we're so behind it that it is put into the Constitution.  Everything will just be whittled away, including things like Medicare-for-all.

* Legislatures rarely pass things that don't need fixed because some of it is unconstitutional in some fashion (thanks to jurisdiction or precedent).  So, there's a need for Congress to be receptive to positive change to fix those things, not trying to dump the whole thing.


----------



## Kioku_Dreams (Dec 17, 2018)

TotalInsanity4 said:


> No, it's pretty common knowledge (even on conservative talk shows, which is interesting to listen to them admit and think they're bragging) that Obamacare was neutered to the point where it was practically sabatoged. The success that it's had are in spite of all the odds against it, and the shortcomings aren't indicative of what proper single-payer would accommodate


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.


----------



## Xzi (Dec 17, 2018)

kuwanger said:


> It's not any sort of substantial reform. Substantial reform wouldn't show a sub 4% drop in costs after 10+ years. And like I said, it's not necessarily about the legality*. The point is that if enough of Congress and States are on board, they won't be trying to undermine what is passed in lawsuits. The point then of making it into the Constitution is precisely to make it abundantly clear it's here to stay. Put another way, the only way I see Universal Healthcare happening is if we're so behind it that it is put into the Constitution. Everything will just be whittled away, including things like Medicare-for-all.


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.


----------



## TotalInsanity4 (Dec 17, 2018)

Memoir said:


> 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 (Dec 17, 2018)

Memoir said:


> 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.


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## Kioku_Dreams (Dec 17, 2018)

TotalInsanity4 said:


> 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...


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## TotalInsanity4 (Dec 17, 2018)

Memoir said:


> 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


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## Xzi (Dec 17, 2018)

Memoir said:


> 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 (Dec 17, 2018)

FAST6191 said:


> 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.
> 
> ...


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 ---------------------------



kuwanger said:


> 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.
> 
> 
> 
> ...


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.


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## kuwanger (Dec 18, 2018)

SG854 said:


> 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 ---------------------------



Xzi said:


> 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 (Dec 18, 2018)

Xzi said:


> 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.





kuwanger said:


> 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 (Dec 18, 2018)

SG854 said:


> 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?
> 
> ...


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.


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## the_randomizer (Dec 18, 2018)

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 (Dec 18, 2018)

kuwanger said:


> 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.



the_randomizer said:


> 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 (Dec 18, 2018)

SG854 said:


> 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.



the_randomizer said:


> 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.



Xzi said:


> 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 (Dec 18, 2018)

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


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## Xzi (Dec 18, 2018)

kuwanger said:


> 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 (Dec 18, 2018)

bi388 said:


> 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.


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## TotalInsanity4 (Dec 18, 2018)

the_randomizer said:


> 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 said:


> 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 (Dec 18, 2018)

TotalInsanity4 said:


> 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?


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## Xzi (Dec 18, 2018)

the_randomizer said:


> 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 (Dec 18, 2018)

the_randomizer said:


> 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 (Dec 18, 2018)

FAST6191 said:


> 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.



kuwanger said:


> 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.
> 
> 
> 
> ...


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.


----------



## TotalInsanity4 (Dec 18, 2018)

SG854 said:


> 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.


I'd argue (and honestly, even bet it's the case) that the only reason that happens is that the U.S. is also the only place where one can make viable capital off of drug research, so the contracted companies are getting a kickback. Which, I'm not going to blame them for, if they can make more money doing exactly what they would be in other countries then that makes a lot of sense. What I can't excuse is creating the backbone of a company on which said capital comes before treatment of patients.


----------



## Xzi (Dec 18, 2018)

TotalInsanity4 said:


> I'd argue (and honestly, even bet it's the case) that the only reason that happens is that the U.S. is also the only place where one can make viable capital off of drug research, so the contracted companies are getting a kickback. Which, I'm not going to blame them for, if they can make more money doing exactly what they would be in other countries then that makes a lot of sense. What I can't excuse is creating the backbone of a company on which said capital comes before treatment of patients.


The worst part being that treatment is obviously always going to be prioritized ahead of researching cures when it comes to the profit motive.


----------



## SG854 (Dec 18, 2018)

TotalInsanity4 said:


> I'd argue (and honestly, even bet it's the case) that the only reason that happens is that the U.S. is also the only place where one can make viable capital off of drug research, so the contracted companies are getting a kickback. Which, I'm not going to blame them for, if they can make more money doing exactly what they would be in other countries then that makes a lot of sense. What I can't excuse is creating the backbone of a company on which said capital comes before treatment of patients.


Drugs is very expensive to create. European countries and Canada usually pay for manufacturacting costs and not R&D. Which U.S. covers those costs. 

People look at how much it costs to produce a drug but don’t count the years and hundreds of millions of dollars for R&D development. Which sometimes European countries aren’t funded enough and have to shift locations to less restrictive conditions.


----------



## Xzi (Dec 18, 2018)

SG854 said:


> Drugs is very expensive to create.


So what?  Pharma companies probably make $1000 for every $1 they actually put into R&D.  Then a lot of that R&D effort is put into making the drugs as addictive as possible so they make more money, and we end up with an opioid epidemic.  Definitely not the good guys just because they're the ones putting up the capital.


----------



## JeepX87 (Dec 18, 2018)

Xzi said:


> Obviously there are plenty of details to be worked out yet, but it's by far still the best option we have to bring our healthcare system in line with the rest of the civilized world.  If other large European countries can guarantee healthcare coverage to their citizens, then there's no good reason we can't.  Time to stop worrying about what the corporations might think about our progress and just start making progress.  The savings from fixing a broken system benefit them just as much as anyone else regardless.
> 
> https://www.businessinsider.com/bernie-sanders-medicare-for-all-plan-cost-save-money-2018-7



Exactly, that why I support Medicare for all and it will work out to get everything resolved. I'm not fan of Obamacare but better than none, especially coverage for pre-existing, expand the coverage to 26 under parent's insurance and close the doughnut hole for Medicare Part D, so there is no doubt that Obamacare will be replaced eventually and there is no ETA because of divided political system, so up to voters to say about healthcare system.

Trumpcare is unlikely either so if Obamacare is gone so we will go back to older healthcare like before Obamacare.

I'm not into hurry to overhaul the healthcare and give voters more time to determine whichever is best for us and our country.



SG854 said:


> 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.



Unfortunately, LASIK is useless for anyone with cataract, including myself.


----------



## TotalInsanity4 (Dec 18, 2018)

SG854 said:


> Drugs is very expensive to create. European countries and Canada usually pay for manufacturacting costs and not R&D. Which U.S. covers those costs.


On top of what Xzi said, the statement "drugs are very expensive to create" is INCREDIBLY conditional, and oftentimes false. Again, I'll refer to insulin prices, which a study shows that if it weren't for an oligopoly that three companies have on the market (all of which reside in the U.S., by the way), diabetics could be paying nearly one tenth of what they pay a _month_ for a year's supply of insulin.

I'll challenge you to think "says who?" whenever you see something vaguely stating the synthesizing drugs is "expensive." The reason I say that is because these gigantic corporations have EXCELLENT PR teams that exist purely to make them look good.


----------



## SG854 (Dec 18, 2018)

TotalInsanity4 said:


> On top of what Xzi said, the statement "drugs are very expensive to create" is INCREDIBLY conditional, and oftentimes false. Again, I'll refer to insulin prices, which a study shows that if it weren't for an oligopoly that three companies have on the market (all of which reside in the U.S., by the way), diabetics could be paying nearly one tenth of what they pay a _month_ for a year's supply of insulin.
> 
> I'll challenge you to think "says who?" whenever you see something vaguely stating the synthesizing drugs is "expensive." The reason I say that is because these gigantic corporations have EXCELLENT PR teams that exist purely to make them look good.


I noticed 2 things in the article.

1) There is no competitive market. Which goes back to comparison I made about X-Rays and LASIK Eye surgery in an earlier post. The Insulin market isn’t entirely free and is regulated by government through patents which is a problem. No competition to drive down costs.

2) The article is about biosimilar generics not the originals. Originals costs way more in R&D development because the drugs don’t exist and they need a lot of trial and error to create the drug. While Generics can piggy back off the original discoveries, getting a free ride, to create at a fraction of the cost which can bring down prices. Originals need to make up the more expensive R&D then generics do. And you need originals to begin with or no generics available.

Generics also don’t have to be chemically identical to be considered bio equivalent. Sometimes they have side effects that the originals didn’t. They can produce blood levels up to 20% below or 25% above the original to still be considered bio equivalent.


----------



## TotalInsanity4 (Dec 18, 2018)

SG854 said:


> 1) There is no competitive market. Which goes back to comparison I made about X-Rays and LASIK Eye surgery in an earlier post. The Insulin market isn’t entirely free and is regulated by government through patents which is a problem. No competition to drive down costs.


There is, though, it's just not from within the U.S. And so far as I can tell, it's not due to restrictive regulations, it's due to patents and lawsuits preventing any startups from gaining traction. If anything, more regulation in this case would be better, as it would at least define a price that companies would need to hit to be able to work with Medicaid. Alternatively, patent laws on pharmaceuticals would need to be completely abolished (which would be _great_), but realistically what are chances of that actually happening?



> 2) The article is about biosimilar generics not the originals. Originals costs way more in R&D development because the drugs don’t exist and they need a lot of trial and error to create the drug. While Generics can piggy back off the original discoveries, getting a free ride, to create at a fraction of the cost which can bring down prices. Originals need to make up the more expensive R&D then generics do. And you need originals to begin with or no generics available.


I suppose I don't know how much of an argument that actually is. There are scientists that genuinely want to improve the quality of human life and aren't just in it for the money. Either way, though, pay is pay; if it comes from Big Pharma and they can do what they perceive is helping, then clearly that's where we're at now. Other countries have clearly shown that government employed biologists and chemists are clearly an effective option as well.



> Generics also don’t have to be chemically identical to be considered bio equivalent. Sometimes they have side effects that the originals didn’t. They can produce blood levels up to 20% below or 25% above the original to still be considered bio equivalent.


This is true, but also something that constraining regulatory definitions would fix


----------



## Captain_N (Dec 18, 2018)

TotalInsanity4 said:


> The same way any other countries do
> 
> Which is to say the same way _we_ already do, except instead of paying for private insurance you're paying more in taxes. In return, you're paying an institution that isn't trying to put profits before your welbeing



yeah, in a lot of socialist countries the tax rate is over 50%. All the us government wants if more money and they do less with it. Both the dems and the reps say "when we both get the house, the senate and the pres they will do something." Nothing ever happens but larger government that wastes more money then every company in existence. the price of health care is inflated in the US. Moving to Universal Health care will have to solve that problem. Also if doctors are only gonna make about $60k a year then i dont think they will be to happy and might cause a shortage. I dont know why people always look toward the government for the solutions. The government is the problem.

There needs to be personal responsibility/accountability and fiscal responsibility. That is the true problem. To many lazy asses looking to the government for salvation. Look how well that works in cuba north Korea, Venezuela and the tricoms in china.

If Universal Health care is going to work it cant be rationed, has to be paid for. Taxs cant be unreasonable. The health care has to be quality. 

Everyone pays into medicare and its not great. I work around alot of vets and more then 60% of them say the VA wont pay for the simplest of preventive procedures. The VA is a form of Socialized Health Care. Does not seem to work all that well. The government cant even fund the post office..... how the hell they gonna handle healthcare.....


----------



## the_randomizer (Dec 18, 2018)

Captain_N said:


> yeah, in a lot of socialist countries the tax rate is over 50%. All the us government wants if more money and they do less with it. Both the dems and the reps say "when we both get the house, the senate and the pres they will do something." Nothing ever happens but larger government that wastes more money then every company in existence. the price of health care is inflated in the US. Moving to Universal Health care will have to solve that problem. Also if doctors are only gonna make about $60k a year then i dont think they will be to happy and might cause a shortage. I dont know why people always look toward the government for the solutions. The government is the problem.
> 
> There needs to be personal responsibility/accountability and fiscal responsibility. That is the true problem. To many lazy asses looking to the government for salvation. Look how well that works in cuba north Korea, Venezuela and the tricoms in china.
> 
> ...



Venezuela, the country whose economy went to crap and where inflation has skyrocketed? Or Cuba, the country that just barely was able to grant smartphones to its citizens? I don't think we should be modeled after those places IMO.


----------



## TotalInsanity4 (Dec 18, 2018)

the_randomizer said:


> Venezuela, the country whose economy went to crap and where inflation has skyrocketed? Or Cuba, the country that just barely was able to grant smartphones to its citizens? I don't think we should be modeled after those places IMO.


Or, say, Finland, the current happiest country in the world


----------



## Captain_N (Dec 18, 2018)

the_randomizer said:


> Venezuela, the country whose economy went to crap and where inflation has skyrocketed? Or Cuba, the country that just barely was able to grant smartphones to its citizens? I don't think we should be modeled after those places IMO.



That's my point. People think large government control is great. They never mention when it fails. and it fails often. The United States system of rule is a grand experiment. Nothing has been tried like it. More people want to come to the unites states then any other country. The people wanting to come to the US are all escaping forms of government the jack ass liberals want to turn the US into. Does not make sense. In socialism you cant even own land.
I bet burnie sanders did not tell his voters that...



TotalInsanity4 said:


> Or, say, Finland, the current happiest country in the world



The tax rate in Finland is 51% would you like giving half your income to the government? I sure as hell dont.
You also realise for socialism to work everyone has to work. Actuly Finland is moving away from socialism.


----------



## the_randomizer (Dec 18, 2018)

TotalInsanity4 said:


> Or, say, Finland, the current happiest country in the world



Would rather follow in their footsteps than a country whose entire economic system has collapsed or is run by Communism *shrug* 



Captain_N said:


> That's my point. People think large government control is great. They never mention when it fails. and it fails often. The United States system of rule is a grand experiment. Nothing has been tried like it. More people want to come to the unites states then any other country. The people wanting to come to the US are all escaping forms of government the jack ass liberals want to turn the US into. Does not make sense. In socialism you cant even own land.
> I bet burnie sanders did not tell his voters that...



No system is perfect, some are better than others, but in the end, you pick your poison, essentially.


----------



## Captain_N (Dec 18, 2018)

TotalInsanity4 said:


> Or, say, Finland, the current happiest country in the world





the_randomizer said:


> Would rather follow in their footsteps than a country whose entire economic system has collapsed or is run by Communism *shrug*
> 
> No system is perfect, some are better than others, but in the end, you pick your poison, essentially.



Yep all systems have issues because Humans are greedy lol


----------



## JeepX87 (Dec 18, 2018)

Captain_N said:


> yeah, in a lot of socialist countries the tax rate is over 50%. All the us government wants if more money and they do less with it. Both the dems and the reps say "when we both get the house, the senate and the pres they will do something." Nothing ever happens but larger government that wastes more money then every company in existence. the price of health care is inflated in the US. Moving to Universal Health care will have to solve that problem. Also if doctors are only gonna make about $60k a year then i dont think they will be to happy and might cause a shortage. I dont know why people always look toward the government for the solutions. The government is the problem.
> 
> There needs to be personal responsibility/accountability and fiscal responsibility. That is the true problem. To many lazy asses looking to the government for salvation. Look how well that works in cuba north Korea, Venezuela and the tricoms in china.
> 
> ...



Honest with you, I'm not impressed with Medicare that I currently have one, so they only pay 80% of approved medical care, but 80% isn't actually real number anymore, so they actually paid 50% or less if both of approved and unapproved are taken in factor, so if your ER bill is $3,000 so your out of pocket expense after Medicare cover will be $600 to $1,800 after Medicare paid rest of approved care. The drug coverage under Medicare isn't good and you will pay more for higher tier, so they only pay 40%, so if one drug cost $600 per month so you have to pay $360 per month for drug. It is big deal if you are low to middle income. It is not unheard to see many patients have over thousand dollars of debt in medical bill after Medicare paid, so they end up in bankruptcy eventually due to subpar coverage and confusion.

Medicare can be very helpful if you have private medical insurance so usually cover 100%, otherwise it is totally useless for Americans with fixed income.

There is other way - get Medigap to cover 100% as possible but your premium on Medicare + Medigap could be $500 per month, not including the drug coverage, get Medicare Advantage so you will only pay based on fee for service, such as $30 copayment for doctor visit or $100 for emergency room, or relocate to state that offer generous Medicaid so they usually cover 100%, so it is helpful if you are on fixed income.

By the way, I'm disabled gamer due born with rare genetic disorder that limit my opportunity to find a job, so I never like Medicare.

Medicare needs to be revamped if want goes for all, so I want one that similar to Canada or Australia.


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## Localhorst86 (Dec 18, 2018)

SG854 said:


> 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.



Lasik eye surgery is not a medical necessity, it's a cosmetic operation because you don't want to wear glasses. And when people have to choose between a $100 pair of glasses and a $20.000 surgery (which, mind you, might not have permanent results*) it is clear that most people would not chose to pay such an ammount of money and either LASIK clinics have to drop their prices or be out of clients. It became cheap because it had to, otherwise no one would have wanted.

For the record, I had LASIK eye surgery about three years ago and it was 2.000€ (about $2.200 back then) for both eyes (mind you, I could have gotten it a lot cheaper in other countries like turkey, I know a few colleagues of mine who paid 800€ for both eyes over there, but I chose to do it localy where I live). I had to pay all by myself as even my additional private insurance (on top of our mandated health insurance) would not cover cosmetic operations like that and I understand that. They would have payed me glasses and they would have payed a majority of the costs for contact lenses if I chose that. If it hadn't been affordable for me to get the surgery, I'd just have lived with glasses or contact lenses.


*Your eyesight can always shift, that's why LASIK clinics recommend to only get surgery when your eyesight likely has settled in and not changed for at least three years. And even then, they'll let you know that as you get older, you might need to wear reading glasses.


----------



## JeepX87 (Dec 18, 2018)

Localhorst86 said:


> Lasik eye surgery is not a medical necessity, it's a cosmetic operation because you don't want to wear glasses. And when people have to choose between a $100 pair of glasses and a $20.000 surgery (which, mind you, might not have permanent results*) it is clear that most people would not chose to pay such an ammount of money and either LASIK clinics have to drop their prices or be out of clients. It became cheap because it had to, otherwise no one would have wanted.
> 
> For the record, I had LASIK eye surgery about three years ago and it was 2000€ for both eyes. I had to pay all by myself as even my additional private insurance (on top of our mandated health insurance) would not cover cosmetic operations like that and I understand that. They would have payed me glasses and they would have payed a majority of the costs for contact lenses if I chose that. If it hadn't been affordable for me to get the surgery, I'd just have lived with glasses or contact lenses.
> 
> ...



If you develop cataract so lenses will become useless and need to be replaced with artificial lenses via surgery.

The cataract is common if you are over 60 years old but it do occur in young adults if you have eye diseases.


----------



## Localhorst86 (Dec 18, 2018)

JeepX87 said:


> If you develop cataract so lenses will become useless and need to be replaced with artificial lenses via surgery.
> 
> The cataract is common if you are over 60 years old but it do occur in young adults if you have eye diseases.


Yes, I know. LASIK can't fix cataracts and it can't aleviate the risks of getting it. But at the same time, at least what I was told, it doesn't increase the risk either. So it's a risk you have with 20/20 vision, glasses, contact lenses or LASIK surgery either way.

My point was, though, that LASIK simply isn't a necessity and therefore a bad example to bring up as an example for regulation. It's just a thing people want and if they can't afford it, they wont get it.

It's not comparable to reliable diagnostic methods like X-Rays or medically necessary (life saving) operations/medication.

When people can't afford LASIK: LASIK clinics close. People are going to wear glasses or contact lenses. No one's going to die.
When people can't afford getting proper diagnostics: Serious illnesses or injuries get by undiscovered. People die.
When people can't afford life saving operations: People die.


----------



## JeepX87 (Dec 18, 2018)

Localhorst86 said:


> Yes, I know. LASIK can't fix cataracts and it can't aleviate the risks of getting it. But at the same time, at least what I was told, it doesn't increase the risk either. So it's a risk you have with 20/20 vision, glasses, contact lenses or LASIK surgery either way.
> 
> My point was, though, that LASIK simply isn't a necessity and therefore a bad example to bring up as an example for regulation. It's just a thing people want and if they can't afford it, they wont get it.
> 
> ...



Make sense for sure.

The cataract surgery could cause partial to full blindness as complication if have eye diseases so it is devastating for gamers who have to depends on vision to play video game, so that why my doctor told me to wait longer as possible.


----------



## Localhorst86 (Dec 18, 2018)

JeepX87 said:


> Make sense for sure.
> 
> The cataract surgery could cause partial to full blindness as complication if have eye diseases so it is devastating for gamers who have to depends on vision to play video game, so that why my doctor told me to wait longer as possible.


but a cataract surgery is not a LASIK operation. And I am almost certain healthcare would see it also as a medical necessity if you're affected to prevent blindness and it would be covered (at least over here) by the mandated insurance. It sounds to me like you're affected by this so I wish you well, hope you'll be fine.


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## KingVamp (Dec 18, 2018)

Just because you want to see naturally again, without glasses, doesn't make it "cosmetic surgery". It is another option to restore sight. Not some kind of eye color change. That said, if it cost too much even with universal healthcare or it isn't deemed safe enough, it is reasonable to wait until it gets safer and cheaper.

Someday, we are just going to be able to replace eyes with some equal, if not better, ones altogether. 

As for private businesses, I think they should still be around even if/when we get universal healthcare.


----------



## Viri (Dec 18, 2018)

KingVamp said:


> Just because you want to see naturally again, without glasses, doesn't make it "cosmetic surgery". It is another option to restore sight. Not some kind of eye color change. That said, if it cost too much even with universal healthcare or it isn't deemed safe enough, it is reasonable to wait until it gets safer and cheaper.
> 
> Someday, we are just going to be able to replace eyes with some equal, if not better, ones altogether.
> 
> As for private businesses, I think they should still be around even if/when we get universal healthcare.


You think that's bad? My medical card considers a root canal to be a "cosmetic surgery" I just wanted to save one of my poor molars.  I had to get it pulled, or fork up nearly 1 grand.


----------



## Localhorst86 (Dec 18, 2018)

KingVamp said:


> Just because you want to see naturally again, without glasses, doesn't make it "cosmetic surgery".



If you want to be able to see properly, healthcare will gladly pay you glasses without question. If you want to see without glasses, healthcare will gladly pay your contact lenses for the most part (the ammount is capped on a per year basis, depending on the lenses you choose, you might have to pay money on top from your own pocket). And let me re-iterate: I had LASIK eye surgery and insurances see it (rightfully, imho) as a cosmetic surgery (and yes, both the insurance company and the clinic called it that) which in turn means they are not going to pay for it and the doctor can not free you from work for the healing process* so you'll have to take vacation days if you want to not work during that time.

*(it takes about two weeks for your eyes to heal and while you could go to work, doctors recommend waiting at least three days and - now from experience - I can tell you that you might want to stay at home for about a week with seriously dark sunglasses)

EDIT: but let's no longer argue about LASIK eye surgery as it really seems to not be relevant or at least a bad example in the argument for/against universal healthcare or obamacare.


----------



## SG854 (Dec 18, 2018)

TotalInsanity4 said:


> There is, though, it's just not from within the U.S. And so far as I can tell, it's not due to restrictive regulations, it's due to patents and lawsuits preventing any startups from gaining traction. If anything, more regulation in this case would be better, as it would at least define a price that companies would need to hit to be able to work with Medicaid. Alternatively, patent laws on pharmaceuticals would need to be completely abolished (which would be _great_), but realistically what are chances of that actually happening?
> 
> 
> I suppose I don't know how much of an argument that actually is. There are scientists that genuinely want to improve the quality of human life and aren't just in it for the money. Either way, though, pay is pay; if it comes from Big Pharma and they can do what they perceive is helping, then clearly that's where we're at now. Other countries have clearly shown that government employed biologists and chemists are clearly an effective option as well.
> ...


I was talking about no competition in the U.S. which is what the article is about. That caused prices to be high.

Patents and lawsuits from patents are regulation. Patents are government administered, corporation can’t use patents without government, they use government to regulate what drugs people can sell and prevent new competition from coming in, restricting the market.

When people say they want a free market that means to get government and corporate interests out.

There are scientists that do want to help people and not do it for money, but they can’t do much if they don’t have the funds to pay for R&D.

And the U.K and Israel has a shortage of doctors, and have to import doctors from foreign countries that graduate from lower standard colleges. Medical school is a long excruciating process, if they see no benefit for going through hell to get little pay, when they can do something else that’s easier, they would do the easier thing. Their system does not reward doctors and it shows with the doctor shortage.

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



Localhorst86 said:


> Lasik eye surgery is not a medical necessity, it's a cosmetic operation because you don't want to wear glasses. And when people have to choose between a $100 pair of glasses and a $20.000 surgery (which, mind you, might not have permanent results*) it is clear that most people would not chose to pay such an ammount of money and either LASIK clinics have to drop their prices or be out of clients. It became cheap because it had to, otherwise no one would have wanted.
> 
> For the record, I had LASIK eye surgery about three years ago and it was 2.000€ (about $2.200 back then) for both eyes (mind you, I could have gotten it a lot cheaper in other countries like turkey, I know a few colleagues of mine who paid 800€ for both eyes over there, but I chose to do it localy where I live). I had to pay all by myself as even my additional private insurance (on top of our mandated health insurance) would not cover cosmetic operations like that and I understand that. They would have payed me glasses and they would have payed a majority of the costs for contact lenses if I chose that. If it hadn't been affordable for me to get the surgery, I'd just have lived with glasses or contact lenses.
> 
> ...


It’s not a medical necessity but it’s part of the medical field. The point I made was when you don’t regulate something and provide healthy competition it gets better and cheaper.

Compare communist countries with free market competition ones. The free market has lifted more people out of poverty then any other system in the world.

And what your describing is unregulated supply and demand. Which caused Lasik Eye surgery to be cheaper.


----------



## FAST6191 (Dec 18, 2018)

SG854 said:


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



I can't this being a this therefore that type of setup. Similarly we have stuff like https://www.theguardian.com/society...rials-other-countries-envious-getting-results to contemplate. I would refer back to the earlier numbers as well -- the US is doing well for it, no doubt there, but it is not streets and streets ahead of other places, and this for pharma which you can email to somewhere else in the world, unlike most other fields.



Is it the surgery or the equipment? Laser prices, especially high end laser prices, have fallen off a cliff in the last decade* and a bit whilst reliability, size and such have got far far better, to say nothing of control systems.
*the move from cooled pumped CO2 to solid state -- no need to have a ground/reinforced floor, no need for dedicated room to house it all (think old school valve computer vs transistors affair), no need to have a technician working at the levels they had to previously, I don't know if they would have used three phase power for the medical side of things but possible, fewer ongoing/just for existing costs (pumped CO2 static costs are far from nothing), lower initial outlay, lower disposal costs, control systems such that fewer people needed for oversight (plus probably a few more trained operators in the techniques)... that is going to drive costs down all day long.

Spin it the other way as well -- US prices for medicines are insane, many consider this owing to said small groups of 5-10 hospitals having way less collective bargaining power than a state. You say it is Europe does not pay R&D costs? What kind of accountant does not spread things out like that and I once again would point to the charts -- R&D is so very far from absent/token efforts in other regions.


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## TotalInsanity4 (Dec 18, 2018)

Captain_N said:


> The tax rate in Finland is 51% would you like giving half your income to the government?


If I didn't have to pay for any kind of medical services or higher education? And I could be guaranteed that public services are quality and on-demand? Hell yes I would. On top of that, I can't claim to know the intricacies of Finland's tax system, but if the US implemented a similar system then I guarantee the average person would NOT be paying over 50% of their income; that would be reserved for people in the higher tax brackets. And I'll remind you that we have American citizens making more in an hour than most anybody makes in a year; realistically speaking, they won't miss the increased tax dollars


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