Trump Tweets (no more)

[Vallen Chaos Valiant]

Originally Posted by Ithekro

A lot of it is the idea that the Federal Government has too much power and the States not enough. Others think these things should be handled by the hospitals and churches, without government interference. Others by the corporate business structure that was the free market.

Hospitals and Charities can't handle the sick without government, this had been the case since forever, and anyone who didn't know this is ignorant.

While Free Market had made it clear that insuring old people is unprofitable. The Free Market only wants to insure those who are healthy and don't need it, and will let the sick and old die when they needed help. The Free Market never ever works when the customers only have death as the alternative. This is KNOWN. This is no secret. To believe otherwise only works if those involved think they will never get sick.

Your arguments just don't add up. There is no belief that Free Market will work better. The belief is that Free Market will make the most money out of sick people. And that letting people die is profitable. Assuming you just want money and don't care about people dying, you get the American population.

[Ithekro]

Not adding up doesn't stop people from believing it, which is what I was voicing. Some of the various reasoning for Americans not wanting health care by the Federal Government.

That is why there is no real full effective healthcare system in the United States. People don't believe that it should be a right, nor something the government does, because they trust our government less than they trust corporation.

[frivolity]

Editing done. My next post, if I do write one, will need to be left in point form because writing it out in full is taking way too much time!

Originally Posted by Reckoner

You're ignoring something really important. Before ACA insurance companies dropped people all the time once a "preexisting" condition showed up. The system before ACA was really, really screwed up and only benefited rich people. I know of this firsthand because I've seen it, and we saw countless stories of this out there.

None of that remotely suggests that the solution is to force people to buy insurance and force insurers to pay the claims of people who have never bought insurance in their lives until their pre-existing conditions started showing up. There have been several good ideas regarding changes to the system pre-Obamacare, such as the suggestion for health insurance policies to be offered for life once the application is accepted, and be renewed without further underwriting so long as the premiums continued to be paid. This is the system that's already in place for life insurance, and it can be applied to health insurance as well. If this suggestion were implemented, I would be willing to support a transition arrangement where people who did hold health insurance in the past were now allowed to reapply without underwriting. Heck, I'd even support a policy of one-time subsidies specifically for this transition.

What Obamacare did, however, was force insurers to accept applications even from those who never had any insurance in their lives. As a result, many of those who did hold insurance for practically all their lives ended up losing it. You can't have a system that allows people with pre-existing conditions to get insurance policies and cash out on claims, since everyone would only sign up specifically to get paid out for treatment and then immediately cancel their policies. Such a system is bound to collapse.

At the end of the day one must ask how beneficial it is to put something like people's healthcare on the marketplace. Like I said before, no one WANTS to pay for healthcare, but you sure as hell are you going to want it if god forbid you need it. There are benefits in theory to paying for a more expensive private insurance system because the US arguably is propping up the rest of the world by paying more for everything which goes into good R&D for drugs that would never get made otherwise without a profit motive in the end. The argument that we should pay more is a hard one though for voters. [emphasis added by me]

If the market is more efficient at running the healthcare system than government is, then why shouldn't we leave healthcare to the market? You're taking for granted the notion that government will automatically do a better job when that notion is clearly untrue. There has been no mechanism so far discovered that has been able to achieve outcomes that are superior to the marketplace, because in spite of all the technological advances, we still can't find the all-knowing angels who know other people better than those other people know themselves. For every market failure there is even greater government failure, and even modern regulation of natural monopolies has the aim of mimicking the outcomes that would have been achieved in a competitive market.

The argument that nobody wants to pay for healthcare isn't saying anything at all. Nobody WANTS to pay for anything. I'd get everything for free if I could! The point is that we don't live in the Garden of Eden with infinite resources. There's no such thing as a free good - someone has to supply it at the end of the day and someone has to pay for it. The marketplace serves the function of matching people who want to buy things with those who want to sell them. Prices aggregate all of the little bits of information that are each held by all of the individuals in the marketplace. And if you believe, as I do, that society as a whole has superior information to the knowledge of a select few, then you would agree that the marketplace - which reflects the aggregated assessments of everyone - generates superior outcomes to the decisions of the subset of people in government.

There are lots of things that people do that they end up regretting later. There are lots of people who smoke, eat unhealthy food, and live life as couch potatoes. And of course there are people who are foolish enough to not buy insurance when they are young and healthy. Regardless of that, the one person who best knows an individual is the individual himself. I for one don't smoke, I walk at least 8 km a day, and I hold extremely comprehensive health and life insurance policies (though I do eat unhealthy food every now and then ). I do not for one second, however, profess to be all-knowing enough to make another person's decision for him, and neither does anyone else have that information either.

The part that I bolded in your quote FINALLY gets to what I've been talking about all this while. The only way to lower healthcare prices is by increasing SUPPLY. For that matter, intellectual property law was designed by government and the current framework is clearly inadequate. This is the number one aspect that should be discussed when talking about healthcare costs in the US, alongside the whole "lawsuit culture" that forces up the cost of insuring a medical practice. All of this talk about health insurance only serves to rearrange demand, which ultimately does nothing to lower prices.

Yes, the healthy and rich essentially are subsidizing the poor and sick in the system. What a terrible idea. There are problems still in the system (health care is complicated yo), no one denies that, but to me the system doesn't go far enough.

From a purely economic perspective, your libertarian fantasy only works in a world where we let people die in the streets. Yes, if someone shows up at the ER without means to pay for care you HAVE to turn them away. Otherwise our tax dollars end up paying their bills and the system ends up more costly overall than before. Is that something you are prepared to do with your hyper individualist worldview? Economically speaking, it's better to get these people treated for perfectly treatable conditions before they truly become costly in our system and I morally cannot support the idea of letting people die in the streets.

The ones who ultimately lost the most as a result of Obamacare are those who have held insurance from the very beginning and paid all the premiums all these years. Many of them either lost their health insurance or ended up facing massive increases to co-payments and deductibles due to the influx of claims from people who never held insurance in their lives.

Not everyone who has held insurance and paid premiums all these years were rich. Many of them were middle class folks who chose to give up spending on other things so that they could set aside some part of their budget to pay the premiums. I myself am not rich (though I hope to be in the future), and I buy way more insurance than I need as a personal choice, sacrificing a lot of short-term enjoyment in the process. Is it any surprise that those regions that were the hardest hit by Obamacare all flipped red in 2016? I know I would certainly change my vote here in Australia if government interference caused me to lose my insurance policies.

There are privately run charities that serve the role of helping precisely those hard cases you're referring to. Private charities have historically been a lot more efficient at channelling donations to the communities they help than government departments have been, because the latter inevitably start running up enormously bloated overheads that cannot be undone. The other side of the equation is that Americans are a very generous lot, and even we Aussies know it! If there's one thing that libertarianism can't explain, it's precisely this.

*By the way, I'm a conservative, not a libertarian. Libertarianism cannot explain people's propensity for voluntarily giving to charity with such a high level of generosity. Conservatism can.

Your argument is using people's lives in a free market capitalist system, which to me is morally repugnant on so many levels. There's a reason I started this discussion with you with asking about basic moral principles and not any of the economic stuff. Do you fundamentally believe society has a responsibility to care for its citizens health in this day and age? I believe your answer is no, even if I'm not sure you're fully committed to what that means.

That's a fundamental disagreement as a human being that cannot be bridged and any further discussion beyond that operates on a flawed premise here. It's what many Republicans on capital hill like Paul Ryan believe as well although they are too chicken shit to not lie to their constituents about it.

The reason why I go to economic stuff is because moral arguments help no one. We don't live in the Garden of Eden. Someone must still produce the goods that people want to buy. Your question is as misdirected as the question about whether society has a responsibility to care for its citizens' housing needs, which as we all know culminated in the housing crisis that ended up causing even greater harm to society. Regardless of whatever the moral answer is (and there are indeed moral arguments both ways), it doesn't change the fact that morality does nothing if it's not grounded on economic principles. What can you protect if your only weapons are your emotions? The individuals who have done the most damage to humanity are precisely those who believed they had the moral high ground and ended up forcing their will on everyone else, while having no knowledge of the economics needed to achieve particular outcomes.
(Bonus points for anyone who gets the ironic reference)

The right question to ask at the end of the day is what's the best way for society to serve its citizens, keeping in mind the various trade-offs and the inherent flaws of human nature? This still leads back to the question that I wrote as part of my first response to you: Do you believe that the knowledge of a select few is superior to the knowledge held by society at large? I don't. I consider that society at large has superior knowledge, particularly on sociological issues, which is why I believe that the solution that minimises harm is to let each person makes his/her own choice, and pay for whatever services he/she values. This is the mechanism that incentivises suppliers to enter industries that society values most and leave industries that society values least, thus maximising the benefits for society.

One man cannot set the prices, the task is simply too great for a single individual. But together, we can do it.
*Bonus points again, for whoever gets the reference

Originally Posted by Solace

Venezuela is facing problems because it has been run as a de facto dictatorship for decades. It has nothing to do with socialism or price controls, and everything to do with the lack of a properly functioning government. It has been under constant human rights watch as a result and the country is on the verge of collapse because Maduro's desire for power threatens what little order is left in the country.

Of course it doesn't have a functioning market. Who the fuck would want to deal with that, even without price controls? The very existence of the country is under question, that doesn't exactly scream "we're open for business". Using Venezuela for your example is a complete strawman and you know it.

There is one dictatorship that was successful for about 40-50 years, and that's Singapore. What a coincidence that it's largely used a free market system and ended up greatly benefiting the lives of its citizens. The point is that big government creates a lot more scope for corruption because it concentrates power in the hands of the few. Limited government was designed precisely to prevent such power hungry people from taking over.

Venezuela does in fact have one market that's functioning - the black market. Dealing in it is even more dangerous than not dealing in it, and yet people still do it. Locals do buy food on the black market where prices are high as a result of the price controls that cause suppliers to incur more costs in order to avoid getting caught by officials, and because the number of suppliers is lowered due to people not wanting to break the law. You think these people trading on the black market will stop trading if the price controls are removed and they're allowed to trade in an open market? Of course not, they'd be happy to carry on trading without having to worry about the shroud of illegality hanging over their heads, and even more suppliers would be willing to join in, resulting in lower prices.

I stand by my statement. You're being extracted regardless of you having insurance, and having insurance might mean less expensive but it doesn't mean affordable. If you can't afford health care even if you have insurance then what is the point of insurance?

Health care is something that everyone needs in their life at some point, and even if people can't afford to pay into the system, they deserve the best possible care because they should be treated just as human as the rest of us.

If you had read and understood my earlier post, you would see that I agreed with your statement, and I was pointing out why things are that way.

The second paragraph is pure fallacy and acts as though we live in the Garden of Eden where there's unlimited resources to allocate to unlimited needs and wants. Consider a scenario where the best possible form of treatment costs $1 million and it can cure the afflictions of 1 million people. Should the state then pay for it? If it did, then it would divert resources away from other forms of spending, which will impoverish the country and cause even more deaths.

Health care at the end of the day is a commodity. Someone has to supply it and someone has to pay for it. There's been no mechanism discovered so far that's better at allocating scarce resources than the free market, and even modern natural monopoly regulation aims to mimic the outcomes of a competitive market. Diverting expenditure away from market outcomes does even more harm than good in the long run.

Covering prexisting conditions is one of the best aspects of the law. Losing some parcels on a boat is not the same as discovering you have cancer...or that it came back. I understand your point about risk and costs, but the reason insurance companies used to exclude preexisting conditions was because it helped them save money. It turns out that when people require an expensive treatment, there's a good chance they might need it more than once. Why insure a risk? There's a reason insurance companies love you when you're young and healthy.

Let's not pretend either the health care or insurance industries are angels. They're profit driven, and if the cost benefit analysis says it's better to screw you for more profit, they'll do exactly that.

The principles of insurance remain the same regardless of the item being insured, be it parcels or healthcare. There is no way to insure a loss if the insurer is made to pay out people who didn't buy insurance before their losses show up, because the system will still collapse regardless of whether it's maritime goods or healthcare that's lost.

Nobody said anything about the insurance industry being angels. The reason why a market is needed is precisely because none of us are angels. Everyone wants to get ahead and maximise their lot in life. As Adam Smith argued eloquently in The Wealth of Nations, individuals who act in their own self interests are led by an invisible hand to create the outcome that is of most value to society, even though they never intended to do so. The whole point is to harness the flaws of human nature - the greed and the competitive spirit - in a manner that creates the most good for everyone, (or to reduce the damage caused by the flaws of human nature depending on whether you see the glass as half empty or half full). Letting competition and profit motives drive insurers is what induces them to offer the best deals for everyone in an attempt to steal market share from their competitors.

I'm no fan of the ACA, but the insurance system is busted and I stand by that. I'm not saying universal health care is some magic cure either, but the current systems of health care and insurance in America are patchworked together from different parts and it's now this massive untenable mass of shit that's on the verge of collapsing. We've danced around this issue for nearly a century and we're still pretending it just needs some "tweaks" and things will be fine.

And don't bother feeding me the "free market would fix it if the government would let it" line. The line between private and public institutions is practically incestuous and almost always has been.

I agree that insurance needs reform and that the current system is an abominable hodge-podge that's the worst of both worlds. At least we agree on something!

Originally Posted by Vallen Chaos Valiant

I went to a "Conservative" forum the other day, and noticed that some of them have openly admitted that they consider it a necessary evil to let sick people die, in order to save money/cut taxes.

Not all the people present there made that argument. But I noted that no one actually disagreed or opposed it.

But in the end, that's really unique to America. That there is a belief that everyone is living on a homestead fending for themselves with no law or order, and that it is normal to just die if you get in trouble. That's of course, assuming that the people who die are other people. That if it was anyone they know instead, then suddenly survival matters.

Well here's a thought experiment: there's an essential treatment that costs $1 million and 1 million people need it, so should the state pay for it the total $1 trillion bill is equal to 100% of the budget? They certainly can pay for it, but the costs will be so catastrophic that even more people will die.

Look, we don't live in the Garden of Eden. Things have costs. Someone has to pay for them. Simply saying something along the lines that lives are infinitely valuable is really not saying anything at all when there are infinite wants and needs but finite resources. No perfect solution exists, and all that can be done is to minimise the damage caused by all these limitations.

The whole point is that the free market allocates goods in a manner that generates the most benefit for society. Capitalism has saved millions of lives by elevating millions of people out of poverty. The places on earth where the masses are worst off are exactly the kind of societies that depart from that.

Originally Posted by MeoTwister5

The mere premise of needing healthcare as an "if" is itself flawed.

If my clinical experience amounts for anything here, needing healthcare is a matter of when, not a matter of if.

Everyone here, everyone reading this even me, will guaranteed need healthcare at some point in their life. It is an eventuality. Some people are probably far too ignorant or in denial to realize this. The sad iront is that those who do probably cannot even afford it.

Thus it should be an inalienable right even if you have to force people to have the foresight to be prepared for it. The mere fact that this right is given almost entirely to the command of the private sector more concerned with the health of their bank accounts is an atrocity.

If that means one less patient who goes into cardiac arrest while we figure out how to treat and diagnose, well, I would be ecstatic.

I can't say this enough, thank you very much for your service.

On to the content of your post, I agree that healthcare is a matter of when, not if. This is why I am always perplexed when people look at me like I've grown two heads when I tell them that they need to buy insurance while they're young and healthy. That does not mean, however, that we should force people to buy insurance against their will.

Should we ban cigarettes? Should we force people to exercise at least an hour a week? Force people to eat only healthy food? I recently read an article about someone who was a vegan and lived to 120+. When he was interviewed about what's one thing that he would have done differently, he said that he would rather have eaten meat and accepted dying a few years younger. He told the interviewer that one lesson he wanted to tell others was to enjoy life a little more. In the end, all of these are personal choices that people make, and I seriously doubt that we possess the divine knowledge to overwrite their decisions without causing further harm.

Note as well that the private sector has historically been more efficient than the public sector, since competition is what drives companies to innovation and improvement.

That aside, regardless of my disagreement, thank you for your service. お疲れ様です

[Ithekro]

Effectively, the way out of these problems is a post-scarcity economy (talking Star Trek, 24th century style Federation economy). But such a thing is highly unlikely without a form of highly advanced energy production with an infinite for the purposes of the human species theoretical existence on this planet, supply that is effectively cheap or free due to its cost being absorbed over an extreme period of time, or being absorbed by a generation or two to benefit later generations.

Such an effective source of energy on the scale neared for our species is presently not possible even with use of solar power as the energy requirements of our technology likely outstrips the usable surface area for solar panels on our planet. Fusion power is hoped for a possible way, as is more advanced versions of fission power, but these are not yet up to the task, plus humans are afraid of them.

[MeoTwister5]

Another odd thing people forget about health care is that it is not entirely a completely limited resource.

In many cases, at least in my area of practice, there's enough diagnostic and therapeutic resources to go around for the people who need it. They just can't afford it.

Case in point: Last night while I was on duty I had a patient who I found had CT scan findings of a LOT of metastases to the calvarial bones. I brought it up with the internist in charge and told him that the findings were a giveaway, and it would be prudent of him to find out where the primary was. He couldn't, because the patient could not afford follow up scans that night.

The entire night we had few patients. Half the time the machine wasn't even running. I could have scanned that patient 3 times over. If he had the money.

We also had a fresh batch of chemo drugs that the patient could have used, just sitting in the pharmacy, because patients could not afford. The damn things would just expire.

Another case in point: Dengue Fever season starts in a few months here. Dengue Fever can easily be treated (self limiting viral infection) if detected early and given IV fluid promptly. We have a LOT of reagents for the lab test, and you can make a swimming pool out of all the bottles of IV fluid available for use. But patients cannot afford them. A bottle of IV fluid here is barely $1.50 and they cannot afford it. There are a ton of easily treatable diseases with enough resources to go around for diagnosis and treatment for everyone who needs them, but without the funds for them. They may be readily available, but they still need to be paid for.

The 1 million dollar treatment analogy is blatantly stupid because it is a rare outlier for a treatment to cost as much, exists in only extreme disease scenarios, and often entail cutting edge tech that are either unproven by clinical trials or themselves come with poorly investigated risks. This is a possibility that exists for an extreme minority of patients.

That is why letting market forces decide who or what should be treated makes a mockery of human life. And as a physician, letting the "guiding hand" of an economic system make those decisions indirectly, whatever it may be, is nothing short of dehumanizing. There are certain things humanity should have to fight for and take control of, even against the ignorant will of some of its members, for the betterment of the species. History has shown that sometimes, letting the general population make those decisions for themselves ends in disaster. Sometimes a few people can make better choices than the majority. Letting people go crazy with what little information we have is the reason why we're having ridiculous levels of antibiotic resistance and doctor litigations in the first place.

Healthcare is one of them. If that weren't the case, hell, I need a new career path. One of the reasons I chose medicine is specifically BECAUSE not everyone CAN make the right decisions for themselves.

[Vallen Chaos Valiant]

It still fascinates me that Americans can still argue the government can't afford to pay for decent healthcare, when no one else in the developed world agrees.

You have the money, Americans. No one is being fooled. You are the only ones lying to yourselves, the rest of us are not impressed.

The only reason the bill seems too high is because Americans wanted it to be. Because someone is making money off sick people while delivering less care. And Americans rather that money gets made even if it means dead and dying citizens.

[Eisdrache]

Originally Posted by frivolity

Paying for health and life insurance does stop me from being able to buy a car and going to holidays in exotic places due to income constraints, duh .

Like I said, perhaps it takes you more time to save up for what you desire but in return you enable others to be able to pay for their health care. I call this a fair trade whereas you call it obtrusion of free will.

Originally Posted by frivolity

Sorry, I'm going to have to call BS on that. One parent with cancer before 50, grandfather with diabetes, hereditary thalassemia minor, eczema since young, recent complaints of RSI-like wrist pain, and a slightly positive result on a blood test cancer marker. Still got life insurance with no premium loading and no exclusions.

The percentage of people at the age of 20 who would get rejected by insurance companies is VERY low. Majority of those who can't get insurance are those who left it until too late and end up trying to get insurance only after the pre-existing conditions show up.

Under the ACA insurance companies will have to accept people without taking their condition into account. The republican 'plan' however replaces this with continuous coverage. What this means is that as long as someone regularly pays their premiums there is no problem, in other words it's a boon for the healthy. On the other side of the coin there are the sickly with gaps in their coverage due to health issues. Insurers would still have to offer them a plan - but it doesn't have to be affordable. Under the AHCA insurers would also be able to take eventual conditions into account like the mentioned health issues in the family and charge more for them. Whether the person is able to afford them or not is highly unclear.

Originally Posted by frivolity

Saying that America had the worst health care system in the developed world is pure nonsense. Bernie Sanders' own home state of Montana has Canadian flags on its medical centres as a signal that it welcomed Canadians who were flying in for healthcare. America's 5-year cancer survival rate is among the best in the world.

The facts disagree with you.
WHO ranking (2000)
Bloomberg (2014)
Commonwealthfund (2010)
Commonwealthfund (2014)

A quick search reveals a number of sources who all rank the overall US health care low to very low. Additionally since you brought up cancer rates, let's take a look at some other aspects shall we. According to the U.S. HEALTH in international perspective (2013) it also has

• The highest rate of death by violence, by a stunning margin
• The highest rate of death by car accident, also dramatically so
• The highest chance that a child will die before age 5
• The second-highest rate of death by coronary heart disease
• The second-highest rate of death by lung disease
• The highest teen pregnancy rate
• The highest rate of women dying due to complications of pregnancy and childbirth

Originally Posted by frivolity

The ACA was a step in the wrong direction. Premiums and deductibles both went up, people who have been periodically paying for insurance from the time when they were young and healthy ended up suffering too, and the states that suffered the most from Obamacare rightly voted against the Democrats in the latest election. The reason why the Republicans' recent healthcare proposal is trash is precisely because it didn't rip Obamacare apart from the foundations. They need to do a full repeal.

Originally Posted by frivolity

Your argument is based on a misunderstanding of economics and the probability foundations of insurance.

Profit is increased whenever the insurer sells a policy that is at least equal to its marginal cost [1]. To do this, the insurer needs to cater to as many consumer preferences as it can, at least until the point where administrative costs become too prohibitive, but this is still a fairly high ceiling. Low-risk customers are attracted to cheap skimpy plans, medium-risk customers are attracted to medium-price medium-coverage plans, and high-risk customers are attracted to high-price high-coverage plans (a bit of a simplification here, since there's a whole spectrum of risk profiles). If an insurer only sells skimpy plans and full coverage plans with no medium coverage ones, then those customers will simply go to competitors who do, which causes that insurer to lose potential profits. In this way, every insurer has the incentive to offer as broad a range of policies as it can, including medium-priced ones, and multiple firms will focus on various niches such that the industry as a whole offers a wide degree of choice for consumers.

This was precisely what I observed while poring through the life insurance disclosure statements of the 10 different firms that I evaluated.

[1] This refers to economic profit and not accounting profit.

In a similar vein to above, premiums might go down for the young but up for the old. And unfortunately it is predicted that they will go up more for the old than they will go down for the young. The numbers will stay the same if you replace a sickly old 60 year old with a healthy 25 year one but the quality of the system drops. Several million people might lose their coverage if the AHCA goes through and the one who will have to cover their costs that they can't afford to pay themselves will be the state, therefore massively increasing the costs the AHCA wanted to reduce in the first place.

Premiums might go down but they will also cover less than under the ACA. People who are unfortunate to have a health issue that is not covered will cause higher costs if they or respectively the state will have to cover their treatment. It is so economically backwards to think that a medium average for everyone is worse than paying slightly less for lower coverage while increasing the cost for everyone.

Originally Posted by frivolity

You missed the forest for the trees. The principle that I'm getting at is that an inter-generational transfer of wealth shifts the burden away from the current generation to future generations. This is true because the additional money that is spent on the first generation must still be paid by someone. There is no such thing as a free good. My example holds true provided one assumption is met: that the population cannot keep growing forever.

[Bernie Madoff yadda yadda]

Now, "changes to pension age" is where you're finally getting the point. Governments overspent on earlier generations and later generations end up paying for it, be it through higher taxes than the earlier generations, austerity measures, etc.

Or you could, you know, have each generation pay for their own healthcare costs, which keeps the system sustainable for every single generation down the line.

There are simply no similarities to Bernie Madoff. You're wearing blinders for your obsession with increasing population further and further as if that were the only possibility while completely ignoring the fact that every factor can lead to a more sustainable age pyramid. The reason you're seeing a ponzi scheme is because you're making it into one. An infinitely larger number isn't necessary for a healthy demographic.

As for pension age it is important to note that many retirement provisions were created when life expectancy was much lower than it is now. Thanks to medical advances it has steadily increased and we now face completely different circumstances than we did back then. It is necessary not to be stuck too hard in the past and be open for possibilities, one of them being an increase to pension age.

[mangamuscle]

Originally Posted by Ithekro

Not adding up doesn't stop people from believing it ...

IMO 'murricans have been led to believe (euphemism for "have been had for fools") that healthcare is not a government responsibility, in the same vein most are thoroughly convinced that not adopting metric units is better (aka misdirected nationalism). Meanwhile the 1% keeps getting richer everyday, just the other day I heard some politician say in CNN that the USA had the highest corporate tax in the world, which is a big fat lie and no one said nothing, no doubt rich people are still salivating at the prospect of getting (another round of) tax cuts (oh, and make them permanent) from the trumpo administration.

[frivolity]

Finished editing. Less coherent than my previous post though, since today's particularly busy for me.

Originally Posted by MeoTwister5

Another odd thing people forget about health care is that it is not entirely a completely limited resource.

In many cases, at least in my area of practice, there's enough diagnostic and therapeutic resources to go around for the people who need it. They just can't afford it.

Case in point: Last night while I was on duty I had a patient who I found had CT scan findings of a LOT of metastases to the calvarial bones. I brought it up with the internist in charge and told him that the findings were a giveaway, and it would be prudent of him to find out where the primary was. He couldn't, because the patient could not afford follow up scans that night.

The entire night we had few patients. Half the time the machine wasn't even running. I could have scanned that patient 3 times over. If he had the money.

We also had a fresh batch of chemo drugs that the patient could have used, just sitting in the pharmacy, because patients could not afford. The damn things would just expire.

Another case in point: Dengue Fever season starts in a few months here. Dengue Fever can easily be treated (self limiting viral infection) if detected early and given IV fluid promptly. We have a LOT of reagents for the lab test, and you can make a swimming pool out of all the bottles of IV fluid available for use. But patients cannot afford them. A bottle of IV fluid here is barely $1.50 and they cannot afford it. There are a ton of easily treatable diseases with enough resources to go around for diagnosis and treatment for everyone who needs them, but without the funds for them. They may be readily available, but they still need to be paid for.

The 1 million dollar treatment analogy is blatantly stupid because it is a rare outlier for a treatment to cost as much, exists in only extreme disease scenarios, and often entail cutting edge tech that are either unproven by clinical trials or themselves come with poorly investigated risks. This is a possibility that exists for an extreme minority of patients.

That is why letting market forces decide who or what should be treated makes a mockery of human life. And as a physician, letting the "guiding hand" of an economic system make those decisions indirectly, whatever it may be, is nothing short of dehumanizing. There are certain things humanity should have to fight for and take control of, even against the ignorant will of some of its members, for the betterment of the species. History has shown that sometimes, letting the general population make those decisions for themselves ends in disaster. Sometimes a few people can make better choices than the majority. Letting people go crazy with what little information we have is the reason why we're having ridiculous levels of antibiotic resistance and doctor litigations in the first place.

Healthcare is one of them. If that weren't the case, hell, I need a new career path. One of the reasons I chose medicine is specifically BECAUSE not everyone CAN make the right decisions for themselves.

It's hard for me to comment about the healthcare system in your specific case without knowing which country you're practising in, so I'll reserve my comments on that unless you prefer to reveal it. My guess from your description is Singapore (very unlikely), Malaysia or Philippines (most likely)?

What I can say, however, is that when it comes to the level of poverty that you're talking about, where many people really cannot afford an item that costs $1.50, the best way forward is to implement economic measures that raise the wealth of the whole country so that people can be productive enough to work for wages that enable them to pay for the basic necessities. And so far, the vast majority of recorded cases in which the masses have actually escaped from this kind of grinding poverty is in places where there has been capitalism and largely free trade. I can't really say much more without knowing the specifics.

The point of the $1 million example is to illustrate the fact that there are limited resources and unlimited wants. There have been at least two other posts in this thread (maybe more) asserting that not giving all people the best healthcare possible is equivalent to treating them in an inhumane manner. This is an assertion that is patently false, because the so-called best healthcare is going to be so expensive that it will divert too much of society's resources away from other uses, which will end up costing even more lives. The appropriate question is therefore about how best to allocate the resources, and the best method that's been discovered so far is through a market where people engage in voluntary transactions.

There are indeed situations where decisions should be left in the hands of a few. The ones that I particularly consider as falling in this category are national defence, the establishment of a framework for setting up and enforcing contracts and property rights, and measures that protect third parties from harm caused by transactions that they are not a party to and where property rights are difficult to enforce. Vaccines, for example, would fall under the third category. If we're going to expand from these issues, however, then the question is who gets to decide which are the cases where the minority knows more than society as a whole? After all, those who are in the minority will clearly have every incentive to call every case a special case in which they know best.

Aside from that, the issue you're talking about with antibiotic resistance has to do with the question of, "What is the right medical procedure for this scenario?" That's a very different issue from the question of how resources should be allocated for healthcare issues.

As a side comment, my own mantra when it comes to my personal healthcare is to choose a doctor that I trust and then follow his instructions all the way.

Originally Posted by Eisdrache

Like I said, perhaps it takes you more time to save up for what you desire but in return you enable others to be able to pay for their health care. I call this a fair trade whereas you call it obtrusion of free will.

And how exactly is this a fair trade?

Under the ACA insurance companies will have to accept people without taking their condition into account. The republican 'plan' however replaces this with continuous coverage. What this means is that as long as someone regularly pays their premiums there is no problem, in other words it's a boon for the healthy. On the other side of the coin there are the sickly with gaps in their coverage due to health issues. Insurers would still have to offer them a plan - but it doesn't have to be affordable. Under the AHCA insurers would also be able to take eventual conditions into account like the mentioned health issues in the family and charge more for them. Whether the person is able to afford them or not is highly unclear.

How is this relevant to what I said? Again, the proportion of people who will be rejected for insurance at the age of 20 is very low. Majority of those people who developed symptoms that made them uninsurable were once young and healthy but chose not to buy insurance while they could.

What's missing from your analysis is the cost of side of things. If you force insurance companies to accept people without taking their conditions into account, then the payouts will always exceed the total premiums collected, which causes the system to collapse. This is indeed what's been happening, with another two insurers leaving the Obamacare exchanges a couple of days ago. Explain to me with some numbers how your system is going to remain solvent.

The facts disagree with you.
WHO ranking (2000)
Bloomberg (2014)
Commonwealthfund (2010)
Commonwealthfund (2014)

A quick search reveals a number of sources who all rank the overall US health care low to very low. Additionally since you brought up cancer rates, let's take a look at some other aspects shall we. According to the U.S. HEALTH in international perspective (2013) it also has

• The highest rate of death by violence, by a stunning margin
• The highest rate of death by car accident, also dramatically so
• The highest chance that a child will die before age 5
• The second-highest rate of death by coronary heart disease
• The second-highest rate of death by lung disease
• The highest teen pregnancy rate
• The highest rate of women dying due to complications of pregnancy and childbirth

All of the measures that you're putting up are highly affected by factors that have nothing to do with the healthcare system. The Bloomberg ranking, for example, is highly affected by life expectancy, which is a very broad category that is heavily influenced by factors such as crime. Lung disease is more a reflection of how widespread smoking is, as compared to the healthcare system. Cancer survival rate, however, is almost purely due to healthcare, because people generally don't recover without treatment.

In a similar vein to above, premiums might go down for the young but up for the old. And unfortunately it is predicted that they will go up more for the old than they will go down for the young. The numbers will stay the same if you replace a sickly old 60 year old with a healthy 25 year one but the quality of the system drops. Several million people might lose their coverage if the AHCA goes through and the one who will have to cover their costs that they can't afford to pay themselves will be the state, therefore massively increasing the costs the AHCA wanted to reduce in the first place.

Premiums might go down but they will also cover less than under the ACA. People who are unfortunate to have a health issue that is not covered will cause higher costs if they or respectively the state will have to cover their treatment. It is so economically backwards to think that a medium average for everyone is worse than paying slightly less for lower coverage while increasing the cost for everyone.

This is precisely why insurance must be bought when you're young and healthy, and not when you're old and showing symptoms of disease. There is simply no way to make the numbers work if you have a system where people are allowed to buy insurance after they've shown symptoms and then claim for that. How else do you explain the massive losses by insurance firms as a result of the ACA, leading to many of them leaving the Obamacare exchanges?

There are simply no similarities to Bernie Madoff. You're wearing blinders for your obsession with increasing population further and further as if that were the only possibility while completely ignoring the fact that every factor can lead to a more sustainable age pyramid. The reason you're seeing a ponzi scheme is because you're making it into one. An infinitely larger number isn't necessary for a healthy demographic.

As for pension age it is important to note that many retirement provisions were created when life expectancy was much lower than it is now. Thanks to medical advances it has steadily increased and we now face completely different circumstances than we did back then. It is necessary not to be stuck too hard in the past and be open for possibilities, one of them being an increase to pension age.

Ok, give me your definition of what a ponzi scheme means, and give me a set of illustrative numbers that demonstrate that allowing one or more generations to spend more on healthcare than they contribute will not be detrimental to future generations.

[Ithekro]

A basic question would be, is each generation actually spending more than they contribute on healthcare? Or will medical advances make it so that the cost will become less as time goes onwards, thus mitigating the high cost for the first two generations (due to adding people in late in life and covering costs that would not need to be covered if the generation had been covered its entire existence) that have to set up the system, while the third forwards have a stabilized system?


One problem with they system today is that it is new. The living generation were not, nor could not have been covered by it for their entire existence, therefore inflating the costs. However future generations would be covered for their whole lives and thus have contributed to the system as soon as they gain employment and start getting taxed. Any new system would have a high startup cost, but could smooth out over time as it standardizes.

Combine that with lowering health costs due to technology and hopefully healthier people in general, the costs should balance out at some point by the third or fourth generation if the system is stable and not hit with to much greed on the parts of the insurance companies, the medical community, the pharmaceutical companies, or the Federal Government.

[frivolity]

Originally Posted by Ithekro

A basic question would be, is each generation actually spending more than they contribute on healthcare? Or will medical advances make it so that the cost will become less as time goes onwards, thus mitigating the high cost for the first two generations (due to adding people in late in life and covering costs that would not need to be covered if the generation had been covered its entire existence) that have to set up the system, while the third forwards have a stabilized system?

That is a very good question that should indeed be discussed when healthcare policies are evaluated. What really disappoints me, not just with the US Congress but with the Australian parliament too, is that the healthcare debates always focus more on the demand side of things such as how much taxes to allocate to Medicare and the like, while debating less about the supply side.

The historical experience of most countries is that medical costs have generally gone up as the economy develops, since healthcare is a normal good where people demand more as their incomes increase (positive income elasticity of demand). Medical advancement can eventually turn the less sophisticated treatment into an inferior good that becomes cheaper over time, but the more sophisticated treatment has generally always gone up in real price over time.

It is certainly possible that we'll end up with some sort of revolutionary technology that drastically lowers the prices of all medical treatment, but I think that technology is still very far away. The reason is that a high proportion of the cost of medical treatment goes towards paying for patents, and until we manage to create robots that are capable of intelligent and creative design of drugs and medical equipment, then the prices are likely to keep increasing.

It might be easier to just redesign the framework of intellectual property law instead - been a long time since I studied the TRIPS agreement back when I was still a student!

One problem with they system today is that it is new. The living generation were not, nor could not have been covered by it for their entire existence, therefore inflating the costs. However future generations would be covered for their whole lives and thus have contributed to the system as soon as they gain employment and start getting taxed. Any new system would have a high startup cost, but could smooth out over time as it standardizes.

Combine that with lowering health costs due to technology and hopefully healthier people in general, the costs should balance out at some point by the third or fourth generation if the system is stable and not hit with to much greed on the parts of the insurance companies, the medical community, the pharmaceutical companies, or the Federal Government.

The only way to pay back the one-off costs incurred by the first generation is for the money to be taken away from future generations. There is no way around that because the money has to come from somewhere. In essence, the first generation made a windfall gain and that same gain has to be recouped from future generations.

Leaving that aside, one major problem with such a system still lies in the tremendous informational constraints involved. There are a lot of forecasts that need to be made for the system to work, such as forecasts of life expectancy, trends in healthcare costs, and the evolution of social demographics. Get one forecast wrong or go through an unexpected event such as an epidemic and you could have an entire generation completely deep in the red.

[GDB]

https://twitter.com/realdonaldtrump/...84560904773633

This really puts into question the real motive behind bombing Syria.

[Akito Kinomoto]

Should someone be allowed to go bankrupt after being treated from an automobile accident? Should an asthmatic have to suffer the consequences of not being able to afford their medication? Can anyone confidently tell me, that they'd be willing to live in America, working full-time on minimum wage, and still be able to afford healthcare? Would you still talk about personal responsibility and objectivism if you were suddenly diagnosed with cancer, or someone walked into your theater and shot you? If you answered no to any of these, you're in favor of universal, government-run healthcare; you just haven't been forced to admit it yet

This might also be relevant

[Archon_Wing]

Originally Posted by Akuma Kousaka

Should someone be allowed to go bankrupt after being treated from an automobile accident? Should an asthmatic have to suffer the consequences of not being able to afford their medication? Can anyone confidently tell me, that they'd be willing to live in America, working full-time on minimum wage, and still be able to afford healthcare? Would you still talk about personal responsibility and objectivism if you were suddenly diagnosed with cancer, or someone walked into your theater and shot you? If you answered no to any of these, you're in favor of universal, government-run healthcare; you just haven't been forced to admit it yet

This might also be relevant

https://www.youtube.com/watch?v=K2U4pssEqHY

I thought that was quite relevant to this issue.

[monir]

Originally Posted by GDB

https://twitter.com/realdonaldtrump/...84560904773633

This really puts into question the real motive behind bombing Syria.

Hah! Whatever his motif is I still supported the strike. One of the few issues that I had with Obama was he talked a bit too much at times. He should have struck when the "red line" was crossed. Those three chemical attack had even bigger number of civilian casualties.

Either way, the shoe is on the other foot for Trump so this attack should not sway any investigation toward whether there is a link between the Donald and Russia. It might, however, boost his national standings. I think he thinks so too cause he's in a congratulatory mood:

"Congratulations to our great military men and women for representing the United States, and the world, so well in the Syria attack. "

[Reckoner]

Obama wasn't all talk, he went to congress to give him the authority to conduct the strike you know because acting unilaterally is unconstitutional. They just covered their ears and did nothing.

[monir]

Originally Posted by Reckoner

Obama wasn't all talk, he went to congress to give him the authority to conduct the strike you know because acting unilaterally is unconstitutional. They just covered their ears and did nothing.

Obama did not need congress's authority to strike as the Commander in Chief of the United States Armed Forces. The only time a US President needs approval from Congress is when US wants to declare war. A US president can still authorize military action without congressional approval.

Obama did not want to be involved in Syria so it was a shrewd political move by Obama to get congress involved just because how anti-Obama congress was and most constituent around the country is still very leery of US getting involved with middle east problem so congress wasn't going to authorize the strike. It was well played by Obama.

[Reckoner]

Originally Posted by monir

Obama did not need congress's authority to strike as the Commander in Chief of the United States Armed Forces. The only time a US President needs approval from Congress is when US wants to declare war. A US president can still authorize military action without congressional approval.

Obama did not want to be involved in Syria so it was a shrewd political move by Obama to get congress involved just because how anti-Obama congress was and most constituent around the country is still very leery of US getting involved with middle east problem so congress wasn't going to authorize the strike. It was well played by Obama.

How is launching tons of tomahawk missiles into a foreign country not an act of "war?" Only congress has the authority to do so.

[Ithekro]

US Presidents have a latitude of issuing military action via the Constitution. These actions can be issued without requiring Congress to declare war, nor does it actually require interaction with Congress if the action is less that I believe 60 days.

Congress wrote up some rules for what the Presidents can and cannot do with the military during the Nixon Administration, and got it passed despite a veto. The thing is, no President has acknowledge it as it constitutes a conflict in Constitutional powers between the Executive Branch and the Legislative Branch. Congress holds the money and the right to declare war. The President is Commander in Chief of the military and can order what they do or where they go. The separation of powers is the debate, and the reason Presidents give lip service to Congress, at best, over these matters. To do any more would take away the Presidential Constitutional powers without an amendment to the Constitution.

[monir]

Originally Posted by Reckoner

How is launching tons of tomahawk missiles into a foreign country not an act of "war?" Only congress has the authority to do so.

Refresh your memory on the power of the Executive branch.