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[McTraveller]

That's why it's a good idea to make healthcare single payer.

For the record, with private systems you're already subsidizing non-payers, except in a more expensive and less efficient manner.

"Single payer" is such a poor name. It's more accurately "millions of payers, with a monopolistic middleman who forces people to pay and forces providers to accept the terms".  I suppose that's all well and good, assuming the monopolistic middleman actually knows how to most efficiently set prices.

For health care what we really need is massive trust-busting. For a start, you could just choose to stop issuing patents for drugs. People will still invent drugs, because there will still be a demand for cures. If you really think that industry won't invest in drugs without "the profit motive" - then I'd rather see public labs set up to develop cures and sell them "at cost".  That would be a much more impressive use of my health care / tax dollar.

You could set up more flexible requirements for primary care and community physicians so you can meet most of that basic care (which has a huge influence on total health care cost) more easily - that is, you could have basic annual physicals or whatever and the license for that is only say a 4 year degree + 2 years of clinicals, instead of at least a 6 year degree plus other stuff. Reducing the amount of educational debt required would have an immediate and notable effect on costs, both in terms of reducing the required pay to repay the debt *and* increasing the number of available practitioners.

There are so many better ways to "fix" healthcare than simply making it possible for / requiring everyone to have insurance.

[EnigmaticHat]

Oddly it kind of helps everyone. Improves the quality of healthcare and decreases the overall drain on society.

That is the weird thing about collective responsibility.

"I will never use that road, so why should I pay taxes for its upkeep?" Or to put it in perspective "I don't want to force people to pay for roads they will never use"

Yet everyone benefits from those roads. regardless if they use it or not.

Yes absolutely - collective projects do "benefit everyone".  But I'd rather be in a society where a sufficient subset of the population would just pay for those collective things because they want them and would pay for them anyway even if they do benefit more than just the people paying for them.

After all, we already do live in a society where only a subset of the population effectively pays for all the infrastructure, etc. (This is looking at absolute dollars of taxes paid, not tax rate.)  It is sad that we only have the infrastructure we do have due to the compulsory nature of taxes though - that we don't have enough people willing to buy stuff "for everyone" otherwise.

We tried that kind of system with the articles of confederation.  Even a small number of wealthy agents (states rather than people) were unwilling to voluntarily fund things for the public good.  This includes a national military BTW.

And it really makes sense.  Would you pay $100, $1000, $10000 into a highway not knowing if anyone else was going to invest?  Of course not; its a huge amount of money for you and a meaningless amount of money for everyone else.  That's why kickstarter is a thing, no one wants to toss money into a pot without knowing if anyone else is.  Also why charities tend to be so superficial and theatrical.

But there's also the issue of stability.  Tangible infrastructure like highways and subways makes property values go up a great deal while bus lines don't.  Why is that?  Because bus lines can be moved.  If I'm investing in a business, and that business relies on a local high capacity road for its supply chain, I *need* that high capacity road to keep going without me putting an undue amount of money into it.  If the funding source for that road isn't compulsory, then that means it could be withdrawn on a whim by the funders.  Likewise, if I'm buying a residential building, I *need* local schools to continue being the same quality that they are now, or I might as well be playing slots.  Its not even a matter of whether the money is actually going to get pulled, the uncertainty itself is poison to any kind of investment.

[Helgoland]

Yes absolutely - collective projects do "benefit everyone".  But I'd rather be in a society where a sufficient subset of the population would just pay for those collective things because they want them and would pay for them anyway even if they do benefit more than just the people paying for them.

After all, we already do live in a society where only a subset of the population effectively pays for all the infrastructure, etc. (This is looking at absolute dollars of taxes paid, not tax rate.)  It is sad that we only have the infrastructure we do have due to the compulsory nature of taxes though - that we don't have enough people willing to buy stuff "for everyone" otherwise.

As someone who just found out that a group of less than thirty people less than half the time manages to put a buck in the box when they take a pack of cookies, I feel absolutely no remorse in calling you a bleeding-heart anarchist who should either change his opinions or be kept far away from any position of power.

That may just be the frustation about the cookies speaking, though.

[McTraveller]

As someone who just found out that a group of less than thirty people less than half the time manages to put a buck in the box when they take a pack of cookies, I feel absolutely no remorse in calling you a bleeding-heart anarchist who should either change his opinions or be kept far away from any position of power.

That may just be the frustation about the cookies speaking, though.

Hey, I was just saying what I wished would be possible, not what I think is possible. I do tend to revise my opinions over time - the trick is finding that balance between changing them too frequently and too infrequently, of course 

Would you pay $100, $1000, $10000 into a highway not knowing if anyone else was going to invest?  Of course not; its a huge amount of money for you and a meaningless amount of money for everyone else.  That's why kickstarter is a thing, no one wants to toss money into a pot without knowing if anyone else is.  Also why charities tend to be so superficial and theatrical.

I actually bet you could do bit infrastructure projects that way. And what I meant by "a few people putting their money in to (infrastructure) projects voluntarily" would probably much more look like kickstarter than it would just people randomly writing $1k checks to a fund, hoping work would get done.

[Reelya]

Yeah ... a subset of people pay for most of the infrastructure not because the other don't want to, but because the others can't afford to. That's what tax rates and the like are about.

Additionally, the people who can afford to, are the ones who make money off businesses, and businesses need customers, and those customers get to your business by road, rail, bridges, or if you deliver stuff to your customers, that also relies on road, rail, bridges. If we charged the full cost of the roads etc that are needed for all business transactions, then the price of doing business would shoot through the roof.

Also, businesses take for granted that their minimum-wage employees can get to work on public transport, and that literacy and numeracy are universal to the point that nobody values them as skills. Defund education and transport, and it'll hurt employees a bit, but it will hurt employers more because usually the employer is in control and getting more than 50% of the labor value of your work, thus they have more to lose.

We tax those who are making big money, because making big money in this society is heavily subsidized by infrastructure.

[Strife26]

That's why it's a good idea to make healthcare single payer.

For the record, with private systems you're already subsidizing non-payers, except in a more expensive and less efficient manner.

"Single payer" is such a poor name. It's more accurately "millions of payers, with a monopolistic middleman who forces people to pay and forces providers to accept the terms".  I suppose that's all well and good, assuming the monopolistic middleman actually knows how to most efficiently set prices.

For health care what we really need is massive trust-busting. For a start, you could just choose to stop issuing patents for drugs. People will still invent drugs, because there will still be a demand for cures. If you really think that industry won't invest in drugs without "the profit motive" - then I'd rather see public labs set up to develop cures and sell them "at cost".  That would be a much more impressive use of my health care / tax dollar.

Yeah, open fire pits of money are pretty impressive. Scariest words in the English language very much apply here.

[Reelya]

I suppose that's all well and good, assuming the monopolistic middleman actually knows how to most efficiently set prices.

This sort of logic about the hypothetical bogeyman of universal health care would work better if there weren't actually 200 different existing health systems in the world that we can check real patient data for.

The thing is, in a scientific sense we have 200 health care trials of alternate systems going on at any one time so we do in fact have ample information about what works and what doesn't and what is cost-effective. We don't have to "assume" anything.

You can in fact just copy how the best systems do their shit, and though we can say "in theory the market would be better here", that "theory" is trumped by actual lived experience. You can in fact just assume that the best-operating systems are the best systems, you don't need theory or assumptions other than that.

[Neonivek]

Well THAT and if we don't already see how "well" the US medical system is, how many people receive sufficient care, and how many people become poor or homeless from medical bills.

Still remember that mini-documentary where this couple was trying to see what it was like to be poor. He got a RSI in his hand and went to the emergency room and the bill for the service was so expensive (and not just because he went to the emergency room, even the bandages the hospital used were well over a hundred dollars) that he kind of realized how unstable his livelihood was... That people with low income are one accident away from absolute destitution.

Yet it isn't just the poor who sort of pay for the current system, they are just at the forefront.

[ChairmanPoo]

That's why it's a good idea to make healthcare single payer.

For the record, with private systems you're already subsidizing non-payers, except in a more expensive and less efficient manner.

"Single payer" is such a poor name. It's more accurately "millions of payers, with a monopolistic middleman who forces people to pay and forces providers to accept the terms".  I suppose that's all well and good, assuming the monopolistic middleman actually knows how to most efficiently set prices.

For health care what we really need is massive trust-busting. For a start, you could just choose to stop issuing patents for drugs. People will still invent drugs, because there will still be a demand for cures. If you really think that industry won't invest in drugs without "the profit motive" - then I'd rather see public labs set up to develop cures and sell them "at cost".  That would be a much more impressive use of my health care / tax dollar.

You could set up more flexible requirements for primary care and community physicians so you can meet most of that basic care (which has a huge influence on total health care cost) more easily - that is, you could have basic annual physicals or whatever and the license for that is only say a 4 year degree + 2 years of clinicals, instead of at least a 6 year degree plus other stuff. Reducing the amount of educational debt required would have an immediate and notable effect on costs, both in terms of reducing the required pay to repay the debt *and* increasing the number of available practitioners.

There are so many better ways to "fix" healthcare than simply making it possible for / requiring everyone to have insurance.

After the recent events in the Science thread I don't think I want to tackle this one. But I do want to let everyone know that I strongly disapprove of EVERYTHING in his post.

[McTraveller]

After the recent events in the Science thread I don't think I want to tackle this one. But I do want to let everyone know that I strongly disapprove of EVERYTHING in his post.

I'm curious - because the logic has massive problems, because it is naive thinking?  I'm honestly curious - I'm interested in fixing things*.  Can you show how pharma patent monopolies are better than not?  Can you show how having more first-line medical care with lower educational / certification requirements would reduce care and/or increase its cost?

*As if this was a technical problem in the first place...

[ChairmanPoo]

After the recent events in the Science thread I don't think I want to tackle this one. But I do want to let everyone know that I strongly disapprove of EVERYTHING in his post.

I'm curious - because the logic has massive problems, because it is naive thinking?  I'm honestly curious - I'm interested in fixing things*.  Can you show how pharma patent monopolies are better than not?  Can you show how having more first-line medical care with lower educational / certification requirements would reduce care and/or increase its cost?

*As if this was a technical problem in the first place...

Because you show a tremendous ignorance on how healthcare systems, drug development, and primary care work.

In the last category, I'm tempted to suggest that you should stay as a hospital intern for a couple of years and deal with all the consultations that come from primary care. That might help you understand firsthand why reducing either medical training or primary care training for GPs is a very bad idea.

[EnigmaticHat]

The thing is we already have most of the things your suggesting.  Becoming a GP takes less time than becoming a specialist and we do put public money into medical research.  AFAIK you can start seeing patients after 4 years depending on what your degree is, you just do it under someone else's supervision.  Apart from that, the incentive for big pharma to produce new drugs (which will become affordable in the long term) is pretty much the one good thing about the US medical system.  I'm not sure why you want to remove it if we're going to keep the insurance based funding.

Apart from that, ah, single payer works.  Poor developing nations bordering on failed states still provide cost efficient and decently fast healthcare to their citizens.  Everyone from tiny one city nations to China is doing it.  You can use scare arguments all you want but our system is more expensive and provides inferior access AND an inferior level of care.  The US system has (due to economic incentives) a high ratio of specialists compared to generalists.  The result is that someone who might have gotten caught up by a cancer screening in any other country in the world ends up getting chemo instead.

[Neonivek]

I admit EnigmaticHat, I forgot I have a faulty Sarcasm detector and had to reread that a few times to make sure there wasn't a typo.

[EnigmaticHat]

I admit EnigmaticHat, I forgot I have a faulty Sarcasm detector and had to reread that a few times to make sure there wasn't a typo.

That's a little rude.  Even if I said the dumbest thing ever you should at least say what your problem is.

[McTraveller]

Because you show a tremendous ignorance on how healthcare systems, drug development, and primary care work.

In the last category, I'm tempted to suggest that you should stay as a hospital intern for a couple of years and deal with all the consultations that come from primary care. That might help you understand firsthand why reducing either medical training or primary care training for GPs is a very bad idea.

Fair enough - I've not personally seen that side of things. (Although my wife is an RN who almost got her NP, our circle of friends includes lots of RNs, PAs, and MDs, and I have worked in healthcare IT.)

I was coming at it from the supply and demand side. If demand increases faster than supply, then prices will inevitably go up. And I know that in the US, regulations are only limiting supply (HIPAA, MU3, etc. are all really expensive). Things like expensive education limit supply, and I know that many states are increasing the requirements for some things like nurse practitioners from a master's to PhD program. The US pharma rules are all out in space, both in terms of cost to bring a drug to market and the patent environment. These things just don't inherently make good health care less expensive.

Our current political approach is only tackling the demand side, not the supply - and oddly enough it is increasing demand, not lowering it (at least in the short term; long-term I think perhaps demand would have dropped, but our "we want results now" generation missed it and now are chucking the whole thing. I think it's because health insurance is advertised as a cost, not as an investment; the general public is really bad about seeing a reduction in future costs as an investment compared to something that is a cash investment).

And as for "single payer Just Works" - you don't necessarily have to convince me personally. You have to give the general public arguments better than the ones we had with AHCA why they should ditch what we have for single payer.  And (for good or ill), in the US, saying "It works in other countries" is not a good enough argument...