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[wierd]

The point I was making is that it need not be self funding itself, it can receive subsidization from the state level government, just that the state level government cannot itself be subsidized by the federal government should it fail to deliver its promises. My own state is suffering terribly because it cannot manage its books or politics. (Seriously if you want a poster child for IMPROPER state management, look at how Sam Brownback runs Kansas.)

The point of subsidizing at the state level is that the money collected for the subsidy has direct local impact on local economy and politics-- people get to directly observe the impact and results of the taxes, and are more organically involved in the process.  Increasing state autonomy in this way increases the importance of active political engagement of citizens with their state government, which results in (theoretically) better policing of the state government by the electorate, and a better running system, that better understands and accommodates local hazards and benefits, while avoiding the "We wont be giving Greece any more of our money! Fuck those Greek pigs!" problem. (that problem being, "why should I support somebody I dont know, and get nothing of tangible value from?")

If the state decides to use the system you mentioned, then and only then would it apply to my suggestion. Otherwise, I again state that it is a strawman, and has no brearing or applicable position for invocation against what I suggested. Sarcasm or not.

[EnigmaticHat]

"We need 132 more cancer patients to get black figures this year. Could you distribute the polonium tea to ward 6 please, nurse?"

"We're going to build a hospital and we're going to make the terminally ill pay for it!"

That is pretty much the system tho.

Sure you don't literally give people cancer.  You just de-emphasize and discourage preventative care.  And defund a major source of cancer screenings for US citizens.

I mean seriously I know people who haven't had a routine dental checkup/cleaning in 2 years because they don't have the money.  That simply *is* going to put them in a position where they experience personal discomfort and economic burden, but if you don't have money you don't have money and its not like the oral surgeon is going to complain.

US doctors would probably be willing to work pro bono (like lawyers) if not for how ridiculously hard and competitive getting a degree is.  So even tho the country is full of kids that are like "I want to be a doctor so I can make a difference" the system actively pushes those people away.  Instead what you get are work hard party hard types that want to ruin their health and finances getting the degree, drink hard liquor on the weekends to forget, and then make a shit-ton of money once they graduate to make up for it.  So what you end up with is a healthcare system run by the people that didn't get the degrees.  Receptionists, nurses and assistants do most of the work and spend most of the time with each patient only for the MD to show up at the end and spend 10 minutes dealing with the patient.  But they need the MD to be able to have a practice.  You can't run a doctor's office with nothing but undergraduate degrees.

And so you're left with the weird case where medical professionals *must* gouge their clients for money.  This is before insurance.  With insurance what happens is the insurance only pays X% of each procedure, so the hospital or practice bumps up the price to compensate expecting to get paid the same amount as before.  This leads to hospitals handing ordinary people 100K medical bills for relatively routine surgery.  They don't actually expect to see the money, its pretty much just politics so they can stay in business.  So even if a doctor believes in preventative care they can't just hand out blood tests and cancer screenings and STD tests, they really have to be in it for the money and there isn't money there.

The US government spends so much money on healthcare.  Between social security, medicare, and medicaid, we spent 1.877 trillion dollars.  Not US citizens, the government.  I don't even want to think of how much US citizens spent on top of that.  If they just divided that up to everyone who has a social security number, that would be ~6K a year.  I don't actually believe we should do that but that's still more money than the spending saves the average American anyway.  Also note that we spend half of our budget on welfare, benefits, and healthcare.  Yet our social safety net sucks balls.  We spend more on helping needy Americans get healthcare than we do on our military, by almost 2x, even tho our military is the most expensive in the world by a mile.  Governments with literal socialized medicine allot a smaller portion of their budget to handouts than our "private" system.

[Reelya]

Yeah, for example, Australia's Medicare covers 100% of the population, and the spending on the insurance part of that is $23 billion, or $1000 per citizen. Sure, there's some other spending on hosipitals and other health care related things, which brings the total up to around $4500 per citizen. But that covers everyone for pretty much anything up to open heart surgery and the like. And remember, it's in Australian dollars, not American, so it's effectively < $4000 per citizen to provide universal health care.

e.g. here's something from NSW hospitals "costs of operations":
http://www.health.nsw.gov.au/Hospitals/Going_To_hospital/cost-of-care/Pages/default.aspx

Here you will find the cost of some of the more common operations and tests undertaken in a hospital.

It is important to know that if you elect to be a public patient when admitted to a public hospital, you will not be required to pay for your treatment and hospital stay

Just to give you an idea of the things that are covered by universal health care you can get heat transplants, liver transplants and lung transplants for free.

[wierd]

Our problem is the middle men.  When the government is the insurer, at cost, there is no premium. Cost of healthcare reflects actual costs of providing care.

With private insurers, there has to be profit and growth. That means shorting hospitals, who then have to inflate prices, and booya. here we are.

There are two possible solutions to that:

1) tell hospitals that they must give actual cost values for procedures and supplies. Tell insurers that they *WILL* pay the full amount, and cannot balk on the costs, or be forcibly closed by the government as a result of RICO enforcement.

2) Eliminate private insurance totally, and do state run healthcare management.

[Reelya]

Which is why Medicaid is really the frontline in this battle. Expanding Medicaid eligibility, and in the end e.g. abolishing means tests for Medicaid for all but the wealthiest is in fact a clear route to America having a European style health system.

A good system would be national basic health insurance through Medicaid, but with states responsible for more of the hospital administration. There could be a mix of state owned hospitals and private ones, competing for the state dollars. Then, states could choose to spend their own money boosting things up, but with Medicaid covering citizens so they can move around and still be covered.

[Starver]

I'm sorry, but I find that hard to believe--my only experience with that is that a friend of the family's mother simply got stuck behind red tape for over a year whilst waiting to receive treatment for some kind of back problem. She's English for reference.

English as she is, you're likely talking about the NHS (and specifically NHS England).

The NHS is famously worse at care than Europe-in-general, mostly because of our government messing it about and (certain governments) seemingly wanting to convert it towards a US style system. But it works, at the moment. There are problems, but you're never too poor to even try to get treatment.

[wierd]

Try to avoid adding additional agencies and systems together. It creates red tape, and increased admin costs, which means people waiting to get care, and having avoidable complications while the issue of who pays the bill gets settled.

Fed level medicaid, coupled with state level healthcare is such a beast.

Rather, I would much prefer to see the Fed issue minimum care universal mandates, with each state possibly providing better care than that.

EG, Fed says "You will provide, at the least, this level of healthcare" which covers routine dental, routine cancer screening, routine surgery, etc. You can be assured that anywhere in the US, you will get that level of care. The state itself still foots the bill. It will eat a little when people from out of state get injured and treated in-state, but a properly balanced healthcare system can absorb that, by planning for it.

In addition to this minimum level of care, individual states might offer better service than the fed required minimum. Say, they might also cover psychiatric and psychotherapy services, in addition to mental health medication providence, or whatever. Maybe you can get state funded sex changes. Whatever. Things that are outside of the minimum requirement, but make the state a better place to live in, (and thus encourage migration to the state, bringing useful skills and other resources with them, and increasing the wealth and prosperity of the state.)

That means that if you went to California, you might get better healthcare than if you wen to Arkansas, but regardless of which state you were in, you would still get dental, life saving surgery, etc-- subsidized by the state govt, who gets it provided at cost.

[smjjames]

@Reelya: Heat transplants? Heh, just poking at your typo.

Still, the problem is that the Republicans keep trying to bring something that just amounts to a tax cut and isn't a healthcare system at all.

Given thought from this article, what do the conservatives around here want healthcare to be? The concept of universial healthcare is actually a popular idea on both sides of the political spectrum, all the way to the ends.

[redwallzyl]

@Reelya: Heat transplants? Heh, just poking at your typo.

Still, the problem is that the Republicans keep trying to bring something that just amounts to a tax cut and isn't a healthcare system at all.

Given thought from this article, what do the conservatives around here want healthcare to be? The concept of universial healthcare is actually a popular idea on both sides of the political spectrum, all the way to the ends.

they want to kill it becasue Obama and they are incapable of coming up with a working compromise health care bill because that was the ACA. they have long ago stopped doing what people want them to do and are instead trying to make people conform to their stupid ideology.

[Sheb]

I'm sorry, but I find that hard to believe--my only experience with that is that a friend of the family's mother simply got stuck behind red tape for over a year whilst waiting to receive treatment for some kind of back problem. She's English for reference.

English as she is, you're likely talking about the NHS (and specifically NHS England).

The NHS is famously worse at care than Europe-in-general, mostly because of our government messing it about and (certain governments) seemingly wanting to convert it towards a US style system. But it works, at the moment. There are problems, but you're never too poor to even try to get treatment.

Not really, it's almost opposite to a US system. However, it's currently starved for cash after years of austerity. They spend way less than your average EU country, and about a third of the US's spending.

[wierd]

I believe I already skirted that with a tongue in cheek slight earlier, when I said that the nature for people to shout "I dont want to pay for THEM!!" is being EXPLOITED by congress critters.

When a person says "I dont want to pay for THEM!", it really means this: "That person is outside of my local scope, so far in fact, that there is no tangible benefit to balance my expenditure. It is NOT in MY interests to do so."

This happens when that person lives way outside of their state, or is so far removed from their daily activities that no real tangible is there to justify it. It is just a net drain on one group, (Group A) , to the benefit of another group. (Group B).

Saucy politicians will exploit this negative sentiment in people constituent to group A, and will prey on this mental anguish, promising to stop the drain, when in fact they just want to prolong it as long as possible, to continue to extort control over group A. (See current GOP mode of operations.)

It is important to note that people in group A are not against helping other people inside group A. They can directly see benefits of assisting people inside group A. They just dont want to finance group B, because group B consistently takes resources, and returns no practical return. They are not innately "selfish, insufferable bastards." They are perfectly OK with setting up subsidized support and assistance within their immediate sphere, and often will just fine with limited collectivism to perform that civic function-- they just want group B to pay for its own needs.

Pundits from Group B will assert that people in group A are rich, insufferable assholes, withholding what is rightful and essential to group B-- constituents of group B, who get benefits from group A without cost, will naturally support this. In this way, group B can be controlled.

Actually getting group B self sufficient, and thriving-- and getting group A self-sufficient, and thriving, and assuring basic parity between groups A and B, is NOT in the interests of either set of congress critter, as people who are not over a barrel are people who are not being controlled, and will not accept concessions that result in the congress critter's personal financial, or other tangible gain.


THAT is the fundamental breakdown in the US right now as I see it.

[ChairmanPoo]

I'm sorry, but I find that hard to believe--my only experience with that is that a friend of the family's mother simply got stuck behind red tape for over a year whilst waiting to receive treatment for some kind of back problem. She's English for reference.

English as she is, you're likely talking about the NHS (and specifically NHS England).

The NHS is famously worse at care than Europe-in-general, mostly because of our government messing it about and (certain governments) seemingly wanting to convert it towards a US style system. But it works, at the moment. There are problems, but you're never too poor to even try to get treatment.

Not really, it's almost opposite to a US system. However, it's currently starved for cash after years of austerity. They spend way less than your average EU country, and about a third of the US's spending.

Yeah... I've heard about really weird  treatment restrictions in the UK.

[smjjames]

I wonder how other countries got around that problem to get their awesome healthcare? Besides compromising and working with the other party obviously.

[Lord Shonus]

The NHS is (I think) one of the oldest extant collective medicine systems, being introduced shortly after WWII because the war exposed how shockingly bad (current US healthcare problems aren't even in the same league) the UK's health was. Most other countries were able to learn from the NHS's errors.

[Reelya]

I'm sorry, but I find that hard to believe--my only experience with that is that a friend of the family's mother simply got stuck behind red tape for over a year whilst waiting to receive treatment for some kind of back problem. She's English for reference.

English as she is, you're likely talking about the NHS (and specifically NHS England).

The NHS is famously worse at care than Europe-in-general, mostly because of our government messing it about and (certain governments) seemingly wanting to convert it towards a US style system. But it works, at the moment. There are problems, but you're never too poor to even try to get treatment.

There's also another thing. In virtually any national health country, you can in fact get private treatment - if you wish to pay for it out of pocket like you probably would in the USA or if you decide to buy private insurance.

So ... if you have the bucks in the UK to get private coverage you ... don't have to wait for treatment. But ... if you can't afford private cover or don't want to spend the money, or if your insurer refuses to fund a treatment, you'll still get treated no matter what. Fat chance of getting that in the USA. Plus the amount of taxes the spend in UK is lower than USA. So the "but they pay more taxes" argument fails as well.