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[mainiac]

Nenjin, Obama can't pass legislation on his own, he is not a dictator.  This is all he could get.  And it took months.  And it passed by a zero vote margin.

And this can evolve over time into something better.  When social security started out it was deliberately racist.  Never let the perfect be the enemy of the good.

Palau, healthcare does not operate like the market for sneakers or other widgets.  Market forces will NOT keep costs down.  It's not the government that's creating the perverse incentives, it's inherent to what's being delivered.  Government programs have a track record of being vastly better at providing both quality and efficiency in the healthcare sector.

[nenjin]

Nenjin, Obama can't pass legislation on his own, he is not a dictator.

He's got executive privilege, signing statements and a few other tricks. In reality, he can do what he wants and the rest of the country has to try to stop him. We've seen plenty of that behavior in the last decade. Granted, those tools alone wouldn't build an entire functioning healthcare system.....but Obama could have used them to break deadlocks or amend what he needed to until it came up for a challenge in the courts. And he has chosen not to do that. And here we are anyways. In the courts.

When social security started out it was deliberately racist.  Never let the perfect be the enemy of the good.

It's a fair point. But to the same token, hoping business will actually do it's part in this and not grind us down, or that it even can evolve into something better sounds a little like hoping for the perfect as well. If we declare that the health insurance industry as it stands is vital to the national interest, we're likely to end up in the same place as banks which were viewed the same way: a highly lucrative and successful industry that can't ultimately fail because we made it part of the system, so it just goes fucking bonkers.

If Obama wins re-election, and the Republicans get dialed back in the House and Senate, then maybe a fresh start is exactly what is called for, rather than the compromise we had to live with. I honestly feel like, in the arenas Obama has had to act with Congress, he hasn't gotten a rational shake by legislators. Even some from his own party. I don't want to use that as an excuse to plunge down the rabbit hole though. If he gets elected, he'll have 4 more years to do it better. The amount of time spent on this thing isn't an absolute figure, even though politics tend to treat legislation of this scale that way.

[Mr. Palau]

Palau, healthcare does not operate like the market for sneakers or other widgets.  Market forces will NOT keep costs down.  It's not the government that's creating the perverse incentives, it's inherent to what's being delivered.  Government programs have a track record of being vastly better at providing both quality and efficiency in the healthcare sector.

I never said government is raising the cost, I said it was the insurance based healthcare system in general that raises costs. Insurance insulates you from the price of the product you are buying and stops competion in healthcare providers for lower costs. Insurance is the biggest reason that healthcare doesn't work like a market.

The main reason health care doesn't work like a normal market is that it is both an investment and a consumer good, you invest in your health by making you healthier and you consume drugs to protect you investment. However if we are talking about Healthcare providers then for the most part you can treat health care as a consumerable good, because many of the investment parts of healthcare like surgery to solve a chronic illness can also be assesed as cures for the disease instead of an investment in your future health.

In China and India, where due to the lack of government healthcare there is downward pressure on healthcare prices, you can get a quality MRI for 10% of the cost in America*, in terms of Purchasing Power Parity which doesn't accout for currency exchange rates. Which is appropriate in this case because you would ahve to bring thos emodels to America in order to recieve health care at that cost.
*http://www.economist.com/node/17961922
Leting people see what they are really paying for their healthcare, while still recieving almost all the healthcare they would normally get, would drive down costs drasticly. You are correct, currently market forces do not keep costs down, they drive them up, because people believe that a more expensive doctor must be a better doctor and better treatments always cost more,  and they are largely insulated from the costs by their insurance, which allows and almost encourages doctorss to raise costs.

[mainiac]

Palau, healthcare does not operate like the market for sneakers or other widgets.  Market forces will NOT keep costs down.  It's not the government that's creating the perverse incentives, it's inherent to what's being delivered.  Government programs have a track record of being vastly better at providing both quality and efficiency in the healthcare sector.

I never said government is raising the cost, I said it was the insurance based healthcare system in general that raises costs. Insurance insulates you from the price of the product you are buying and stops competion in healthcare providers for lower costs. Insurance is the biggest reason that healthcare doesn't work like a market.

The main reason health care doesn't work like a normal market is that it is both an investment and a consumer good, you invest in your health by making you healthier and you consume drugs to protect you investment. However if we are talking about Healthcare providers then for the most part you can treat health care as a consumerable good, because many of the investment parts of healthcare like surgery to solve a chronic illness can also be assesed as cures for the disease instead of an investment in your future health.

In China and India, where due to the lack of government healthcare there is downward pressure on healthcare prices, you can get a quality MRI for 10% of the cost in America*, in terms of Purchasing Power Parity which doesn't accout for currency exchange rates. Which is appropriate in this case because you would ahve to bring thos emodels to America in order to recieve health care at that cost.
*http://www.economist.com/node/17961922
Leting people see what they are really paying for their healthcare, while still recieving almost all the healthcare they would normally get, would drive down costs drasticly. You are correct, currently market forces do not keep costs down, they drive them up, because people believe that a more expensive doctor must be a better doctor and better treatments always cost more,  and they are largely insulated from the costs by their insurance, which allows and almost encourages doctorss to raise costs.

If this were true then the uninsured would have more efficient healthcare.  But they don't.  And they don't in China either.  Healthcare is not a normal good.

Consider for instance if I was paying for an unconscious loved one to get an MRI out of pocket.  Exactly how am I going to control costs here?  Shrug and let them die?  Travel back in time and encourage the hospital to get another MRI machine?  Travel to another hospital which faces the exact same market pressures?  Healthcare is made up of a million little "market" interactions like this and in the vast majority of spending I as a consumer am virtually powerless.  Consumers in aggregate are virtually powerless.  That's why we need to government to act as our collective mechanism.

Market forces are great where there are channels for them to control costs.  Those channels do not exist in healthcare and have never existed in healthcare.  Free markets are nice but they don't operate on magic.  They have to deliver the results through real life transactions.

Where people do have efficient healthcare is where the government nationalizes the whole damn thing and only mandates for healthcare services that are effective while taking advantages of economies of scale.  This is not speculative thinking.  Look at the damn real world results and the conclusion is inescapable.

[Bauglir]

The free market is absolutely awful, from a moral perspective, when lives are on the line. Ask any of the dozens of species humans have hunted to extinction. More generally, any evolutionary strategy (which, yes, is the concept that underlies how the free market is supposed to work) is morally unacceptable when you have the opportunity to implement an alternative, and the failure condition is the death of a person, as it is here.

Those strategies only help the winners, not the statistical majority of losers who get to go right ahead and die. I can't really be any clearer about why I don't think healthcare should be a market.

[Mr. Palau]

Where people do have efficient healthcare is where the government nationalizes the whole damn thing and only mandates for healthcare services that are effective while taking advantages of economies of scale.  This is not speculative thinking.  Look at the damn real world results and the conclusion is inescapable.

Oh yeah because Switzerland doesn't exist, I forgot, I am sorry. 
http://www.forbes.com/sites/aroy/2011/04/29/why-switzerland-has-the-worlds-best-health-care-system/
Oh yeah I forgot that Switzerland has had less healthcare cost growth than the UK even though the UK has the NHS, but that’s not possible because Switzerland clearly doesn't exist.
Oh and it has a fully private system, but Norway pays more even though the government controls their healthcare.
Not to mention that cost of healthcare in the Swiss system is accelerating less than the OCED median, and accelerating less than that of Canada.
But I'm sorry because obviously free markets don't work, cost controls in a private system don't work, only the government works, clearly. 

If this were true then the uninsured would have more efficient healthcare.  But they don't.  And they don't in China either.  Healthcare is not a normal good.

Consider for instance if I was paying for an unconscious loved one to get an MRI out of pocket.  Exactly how am I going to control costs here?  Shrug and let them die?  Travel back in time and encourage the hospital to get another MRI machine?  Travel to another hospital which faces the exact same market pressures?  Healthcare is made up of a million little "market" interactions like this and in the vast majority of spending I as a consumer am virtually powerless.  Consumers in aggregate are virtually powerless.  That's why we need to government to act as our collective mechanism.

The uninsured don't have more efficient care because what service they do receive comes from a system that is used to dealing with patients who have insurance, and I never said that the uninsured in America would have more efficient healthcare you attempted to extrapolate to that conclusion based on my premises without taking into account the difference in the markers.

You would control costs by finding the cheapest MRI, those people in China and India didn't let their loved ones die, nor did they go to an expensive MRI, at least in the case of the ones that could afford an MRI scan as the governments don't provide universal coverage I only use this as an example as it is the only market that really has cost cutting forces at work.

Yes in terms of individual interactions you don't make a difference in any kin of market, your sole decision only hurts a company’s profits by a few thousand dollars at most, unless you are a millionaire out there buying yachts. If you create a market where it is possible for the consumer to accurately judge the quality and cost of a procedure, or at least the cost as the quality of healthcare is very hard to judge, then you create a system that will naturally drive costs down due to normal consumer behavior.

Market forces are great where there are channels for them to control costs.  Those channels do not exist in healthcare and have never existed in healthcare.  Free markets are nice but they don't operate on magic.  They have to deliver the results through real life transactions.

Which is why there are proposals to create channels instead of just use the blunt force of monopoly power to crush costs, which is ultimately only a short term solution as it discourages medical innovation that would ultimately lower costs further or develop new treatments or drugs due to the lack of profit in the market. Monopoly power curbs doctors salaries, leading to less qualified doctors and thereby lesser quality healthcare.

The free market is absolutely awful, from a moral perspective, when lives are on the line. Ask any of the dozens of species humans have hunted to extinction. More generally, any evolutionary strategy (which, yes, is the concept that underlies how the free market is supposed to work) is morally unacceptable when you have the opportunity to implement an alternative, and the failure condition is the death of a person, as it is here.

Those strategies only help the winners, not the statistical majority of losers who get to go right ahead and die. I can't really be any clearer about why I don't think healthcare should be a market.

Where the hell are you guys pulling death from? The only thing we are talking about is the ability to decide how much you are going to pay for care through consumer choice! You will get your care in any of the proposal I put forth!  I mentioned the government would cover expensive procedures, Ideally, which includes most life threating ones! The cost savings will help the poor more than the rich, who already have enough money to buy all the care they want!

Oh and by the way humans hunted species out of existence before the free market was even a concept in the mind of Adam Smith.

Oh and Singaporeans live longer, have healthier children, pay much much less on healthcare than Americans do.
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model
One sweet model.

[MetalSlimeHunt]

Oh and by the way humans hunted species out of existence before the free market was even a concept in the mind of Adam Smith.

Adam Smith didn't invent free market capitalism; he just quantified it's existence.

Anyway, humans hunt species to extinction because we're a species of high endurance, sapient, superpredators with a vast population spread across the entire planet and weaponry that can take down anything under the sun. Hence why things like hunting seasons and license limits are needed; lest we kill everything in a single year. My point is that nothing can survive us in a fair competition, and thus we have to choose to let them live if we want to make sure that they do. Not even the microorganisms are safe, as shown by the now eradicated Smallpox and Rinderpest.

[Mr. Palau]

Oh and by the way humans hunted species out of existence before the free market was even a concept in the mind of Adam Smith.

Adam Smith didn't invent free market capitalism; he just quantified it's existence.

Anyway, humans hunt species to extinction because we're a species of high endurance, sapient, superpredators with a vast population spread across the entire planet and weaponry that can take down anything under the sun. Hence why things like hunting seasons and license limits are needed; lest we kill everything in a single year. My point is that nothing can survive us in a fair competition, and thus we have to choose to let them live if we want to make sure that they do. Not even the microorganisms are safe, as shown by the now eradicated Smallpox and Rinderpest.

Well technicly it is his concept, although the system did exist before he came along. Just like pluto existed before man but onyl man would be able to see pluto. For eath life that is. Personally I don't mind if we kill a bunch of species that weren't usefull to us. We are intelligent enough to maintain a stable ecosystem if we really try.

[Bauglir]

Hospitals, even now, aren't required to treat every terminal condition. Just immediate life-threatening symptoms. If you have cancer, and you can't pay for chemotherapy if you need it, you are, as far as I know, doomed. If you do not get treated, you will die. That is where I'm getting death from, even though there's still a large burden of people who get treatments they can't pay for that drags down the current system. Chronic conditions are expensive to treat and can't be taken care of by a simple walk-in. If you support a public health care system, funded by taxes, that covers every condition that could conceivably be lethal (which is every condition with surprisingly few exceptions), I don't disagree with you. I'm arguing against the status quo, and against the existence of private insurance, which robs those people of choice just as much as an alternative would.

Also, you're missing the point entirely on the evolution/capitalism thing. Both concepts functioned before they were formally described. It isn't that humans hunted creatures to extinction for economic reasons born of capitalist reasoning, so much as that that those species were out-competed into oblivion, and there is an analogy between those species and people who can't afford health insurance without a tax-funded option, and between humans in that example and people who can afford health insurance.

More generally, the point is that any system designed to evolutionarily reach a goal necessarily promotes the misery of those elements that cannot make the cut, and that's unacceptable, particularly given the significant impact of luck on monetary success. You can't run a humane society on that kind of system.

EDIT:

We are intelligent enough to maintain a stable ecosystem if we really try.

A significant tangent, but while we may be intelligent enough, we're certainly not knowledgeable enough.

[MetalSlimeHunt]

Personally I don't mind if we kill a bunch of species that weren't usefull to us. We are intelligent enough to maintain a stable ecosystem if we really try.

Then we aren't really trying, given the number of species currently in the process of being reduced to extinction or near-extinction levels. You can't really quantify the "usefulness" of a particular species. Furthermore, the value of a living thing is not purely based on how useful it is to humans. We intentionally destroyed Smallpox because it uses humans as a reproductive vector (much to our detriment) and Rinderpest because it can annihilate entire herds of cattle in days, but outside of microorganisms there isn't much justification for intentionally allowing a species to go extinct because of human action.

[mainiac]

Where people do have efficient healthcare is where the government nationalizes the whole damn thing and only mandates for healthcare services that are effective while taking advantages of economies of scale.  This is not speculative thinking.  Look at the damn real world results and the conclusion is inescapable.

Oh yeah because Switzerland doesn't exist, I forgot, I am sorry. 

Switzerland does exist.  They just don't do a great job controlling healthcare costs:

http://www.who.int/countries/che/en/
http://www.who.int/countries/gbr/en/

AFAIK they spend the second most per capita.

And the Singapore model is government health insurance!  The government sets the prices.  The government provides the funding.  It's not strictly single payer but it resembles it very much.

As I said before if you look at the actual data the conclusions are inescapable.  But if you are getting your information from Forbes then you have only yourself to blame.

[Mr. Palau]

quote author=mainiac link=topic=105423.msg3143823#msg3143823 date=1333111324]
Switzerland does exist.  They just don't do a great job controlling healthcare costs:

http://www.who.int/countries/che/en/
http://www.who.int/countries/gbr/en/

AFAIK they spend the second most per capita.
[/quote]
If we are talking about a comparison to England that because the Swiss GDP per capita is 7,000$ higher at PPP per person than English GDP. Richer people spend more on healthcare than poorer people do. Switzerland's Healthcare costs are inflating at a slower rate than GB, as you can see in Forbes if you didn't just shoot the messenger. 
https://www.cia.gov/library/publications/the-world-factbook/geos/uk.html
https://www.cia.gov/library/publications/the-world-factbook/geos/sz.html
Oh and Luxembourg and Norway spend more per capita, WHO has data on that too.
http://apps.who.int/ghodata/?vid=1901

And the Singapore model is government health insurance!  The government sets the prices.  The government provides the funding.  It's not strictly single payer but it resembles it very much.

As I said before if you look at the actual data the conclusions are inescapable.  But if you are getting your information from Forbes then you have only yourself to blame.

No it's a government mandated savings account, which since it is only your own savings account is not insurance. The government sets the prices much, much less than countries with socialized medicine or single payer do. The government mandates YOU fund your savings account, and only tops off the savings accounts of the population when it comes to catastrophic care and 10% of the population for primary care.  It is not a single payer system, as there is no insurance system it is based off a savings account.

This system allows consumers to drive costs controls. The government publishes the price of common medical services and you take a look at the common price, and then find the hospital that offers the best mixture of quality and price. You are not insulated from the costs of your decisions because it comes out of your medical savings account. However if you have a heart attack the price of care doesn't matter because the government will cover that. That doesn't reduce the cost of catastrophic care but it puts great down-ward pressure on the price of primary care.

If you look at the actual data Singapore has one of the best healthcare systems in the world, as the World Bank summarized much more elegantly than I could:
"The World Bank, in a paper assessing Singapore’s health system, says the results of 3M, with its supplementary programs to protect the poor and to address potential market failures in health financing, “have been impressive, with excellent health outcomes, low costs and full consumer choice of providers and quality of care.”
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model

Sorry about the tone in the last post, you just sounded so patronizing I couldn't help but be sarcastic.

[Nadaka]

My issue with the bill isn't that people will no longer be too poor to go to the hospital, my issue is that the government is forcing me to buy a product that I do not want and do not need. If you haven't noticed, I'm alright with people getting healthcare. I'm not alright with the government forcing me to buy stuff, even if it's for something good. Pay taxes? Sure. Be forced to pay a for-profit company for something I probably won't need? Not so much.

I still want to hear Knight of Fools explain how Obamacare made him lose his insurance...

Then just ask.

As a child benefiting from my father's military insurance, under the new healthcare law, I can only receive healthcare from my parents after 18 by being a student. I was serving as a missionary in another country at the time, so I couldn't become a student when that part went into effect. The specifics weren't available to me, but my parents were unable to get me under their insurance until I proved that I was studying at a college.

Now you know as much as I do.

That is, not much.

I also have a problem with the individual mandate. But enriching the coffers of industry by giving handouts to the insurance company was the only compromise that conservative republicans would accept.

[mainiac]

Singapore is 80% government paid, 20% copay.  It's about as freemarket as Medicare.

And apparently the metric for the success in switzerland is that the fail but not as hard as they should?  Wow, way to go free market?

[MetalSlimeHunt]

Singapore is also very small, where as the United States is....not.