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Repeal of Obamacare (Page 10)
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Paco500
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May 16, 2017, 05:44 PM
 
Originally Posted by Snow-i View Post
Besson, those old people would still be paying for healthcare through a lifetime of higher taxes. You act as if the government's money just comes into existence. it comes from someone. All of it. Every cent. Actually, we lose a good size chunk of those cents to government inefficiency and overhead.
It would be difficult to calculate exactly, but given that your insurance costs $500/month, and my National Insurance contribution covers health care for me, my family, my state pension (equivalent to Social Security), and other benefits, I doubt it does cost me more out of pocket. Yes your employer pays most of your costs, but as you said above- the money comes from somewhere.

I would also challenge you to support your assertion that we would lose more to government inefficiency overhead than the US system loses to private sector inefficiency, overhead, and profit. As has been pointed out time and time again on these threads, other developed countries spend less on health care per capita with better outcomes via socialised medicine.

Originally Posted by Snow-i View Post
How would single-payer reduce costs in the United States? Are you suggesting we nationalize the pharma industries? That's actually one area that the US is exceedingly good at (which all those single payer countries benefit massively from).
All of the top 10 pharma companies not based in the US (there are six) are based in countries with nationalised systems yet remain private companies.

One last time- the rest of the developed world has shown that you can reduce the cost of healthcare and improve outcomes by going single-payer. Yes, your taxes would go up, but (most of) your out of pocket expenses and private insurance costs would disappear. This would be a net win.
     
Snow-i
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May 16, 2017, 05:45 PM
 
Besson:

Fundamental to my argument is the concept that we don't need "insurance" for literally every aspect of medical care. It's not insurance at that point, it's a subscription. There are huge costs associated with processing, regulating, and administrating that subscription that would otherwise be far cheaper if not for this process.

Also, the end-patient has no interest in price-shopping for services as they are completely disconnected from the pricing process. There's absolutely no incentive to seek out cheaper services, on top of the immense overhead required for processing those claims.

For instance - I go to the doctor for routine care. they quote me two prices.
1. Out of pocket. My last uninsured trip to the dermatologist was $48
2. Same doctor, same service, same everything save for my insurance card, $137 billed to my insurance company just last month on top of my $20 copay.

Why? The latter is far more expensive for the doctor's office. I saved $20, but cost the entire customer base of United healthcare $109 which is paid via premiums. $109 + whatever cost was associated with United processing that claim.

I'd be down for single payer if it were truly an insurance model, and not a subscription model. The government has proven in every industry to be just the worst at managing costs and maintaining high quality.
     
besson3c  (op)
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May 16, 2017, 05:52 PM
 
Originally Posted by Snow-i View Post
Besson:

Fundamental to my argument is the concept that we don't need "insurance" for literally every aspect of medical care. It's not insurance at that point, it's a subscription. There are huge costs associated with processing, regulating, and administrating that subscription that would otherwise be far cheaper if not for this process.

Also, the end-patient has no interest in price-shopping for services as they are completely disconnected from the pricing process. There's absolutely no incentive to seek out cheaper services, on top of the immense overhead required for processing those claims.

For instance - I go to the doctor for routine care. they quote me two prices.
1. Out of pocket. My last uninsured trip to the dermatologist was $48
2. Same doctor, same service, same everything save for my insurance card, $137 billed to my insurance company just last month on top of my $20 copay.

Why? The latter is far more expensive for the doctor's office. I saved $20, but cost the entire customer base of United healthcare $109 which is paid via premiums. $109 + whatever cost was associated with United processing that claim.

I'd be down for single payer if it were truly an insurance model, and not a subscription model. The government has proven in every industry to be just the worst at managing costs and maintaining high quality.

I think you've kind of made my argument for me.

Admin overhead is so high in the US because insurance is such a shit show. If you take out that admin overhead and allow medical practices to just focus on providing service rather than admin, with no admin overhead that gap between out-of-pocket and insurance cost goes away, or at least is reduced substantially (to just filing routine paperwork to the government and not having to haggle with multiple insurance companies).

My wife has done EMS work in the US and has seen the physical office presence of the admin/billing department (massive). We had the pleasure of a tour of the Toronto EMS head office, and I don't recall seeing any billing department - it was just dispatch stuff. It's no wonder this gap exists, somebody has to pay for all of that admin.

As I was trying to question in my other thread, when will Americans start to question whether the insurance thing is a dead-end not worth pursuing? I mean, most people seem to acknowledge it is a shit show, but why are we still hammering away at all of these creative ways to fix what might possibly be fundamentally broken?
     
Snow-i
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May 16, 2017, 05:53 PM
 
Originally Posted by besson3c View Post
What makes the US drastically different than other countries in this respect?

- large population: works in Japan. While obviously the populations aren't identical, I don't see a particularly compelling argument that the system couldn't scale further
Japan also has the highest population density in the world. Far easier to administer care when you don't need a helicopter to cover 100 or so miles to a trauma center.

- population density/clustering patterns: works in Canada. Obviously there are problems in rural areas, but this is likely the case with any sort of system?
Considering the majority of the country lives in rural areas, i don't think you can overlook this aspect.
- pharma profit motive, cutting edge sort of arguments: here is another indirect benefit. If you increase the pool of people that might potentially use your product, even if the per usage cost is lower, isn't this worth further analysis? There are still people in the US uncovered or who don't wish a treatment or drug because it is way overpriced. This is perhaps the most complicated factor in my mind, but I don't think it is unfair to say that there are no clear conclusions either way, and this is at least worthy of further not non-starter sort of discussion?
Take away the pharma profit motive, you take away the best system in the world for producing those drugs. Where will we get our drugs? Canada gets most of theirs from us at reduced cost.
- Americans are really unhealthy: isn't this kind of a circular argument in some sense?
Single payer won't address this - infact since it's all taken care of you further incentive unhealthy behavior as the person receiving the care has even less interest in preventing conditions from occurring
.
- lots of potential abuse: I think you'll find that in any country
Even worse when theirs no profit motive or other incentive for screeners to capture and mitigate this fraud and abuse.
- healthcare is currently really expensive and will remain so: another circular argument?
How does changing who pays have an effect on this? Where is that money coming from? Costs won't go down unless a market force brings them down. The government is not a market force. Read my posts up on this page as this is the single biggest problem we face today in the industry.
- malpractice lawsuits: maybe a thing, but as you acknowledged, just one factor among many?
Indeed. Covered above.
- Americans don't have an appetite for single payer politics: to me this is not a reason. It either works or it doesn't work, your ideological feelings (either way) don't change this. We need to start with finding what works.
I would argue that political appetites to have a tanglible effect on investment and R&D. If no one is investing in pharma for fear of bad returns, where are the new drugs and treatments going to come from? Canada?

I don't think the onus is on me to prove that this works, it works everywhere else. What makes the US special?
If you can't make a case other, the status quo or null hypothesis remains. If you're arguing for single payer, argue for single payer. Don't just say "it'll work!" then bow out as if somehow you've made a convincing argument.
     
Snow-i
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May 16, 2017, 06:00 PM
 
Originally Posted by besson3c View Post
I think you've kind of made my argument for me.

Admin overhead is so high in the US because insurance is such a shit show. If you take out that admin overhead and allow medical practices to just focus on providing service rather than admin, with no admin overhead that gap between out-of-pocket and insurance cost goes away, or at least is reduced substantially (to just filing routine paperwork to the government and not having to haggle with multiple insurance companies).
Are you really arguing the government, without a profit motive, would be better in this regard? Cite a US example of anything the government has been able to do better than private industry.

My wife has done EMS work in the US and has seen the physical office presence of the admin/billing department (massive). We had the pleasure of a tour of the Toronto EMS head office, and I don't recall seeing any billing department - it was just dispatch stuff. It's no wonder this gap exists, somebody has to pay for all of that admin.
So you think when the government does it, who has no profit motive, they do it better? That's a pretty large leap in logic.

As I was trying to question in my other thread, when will Americans start to question whether the insurance thing is a dead-end not worth pursuing? I mean, most people seem to acknowledge it is a shit show, but why are we still hammering away at all of these creative ways to fix what might possibly be fundamentally broken?
It is fundamentally broken, besson. Healthcare is not free, for anyone, anywhere. Someone has to pay. You can't get around that, no matter how much you wish it away. If you want it to be an indirect method - government taking money then paying out all at once, you need to describe how that is more efficient than a direct model where the end-user price shops for care.

Hence why my arguments are for measures that reduce costs, not shift who's paying, which is about all single payer will do for us aside the usual governmental innefficiencies.


Let me ask you this - do you believe medicare/medicaid works well today? It's essentially a single payer system within the larger industry. Do you think it would be fair to evaluate single-payer in the US extrapolating from medicare?
     
besson3c  (op)
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May 16, 2017, 06:05 PM
 
Originally Posted by Snow-i View Post
Japan also has the highest population density in the world. Far easier to administer care when you don't need a helicopter to cover 100 or so miles to a trauma center.


Considering the majority of the country lives in rural areas, i don't think you can overlook this aspect.
Okay, so this is where I question whether you are really open to this conversation. I kind of set a trap for you here to see if you would take this bait.

There is no comparable country in these respects, so I'm not going to find a perfect model. However, why does this mean that this whole conversation is now a non-starter? This, in my mind, just means that some extra analysis is required.

Take away the pharma profit motive, you take away the best system in the world for producing those drugs. Where will we get our drugs? Canada gets most of theirs from us at reduced cost.
Like I questioned, why would it remove the profit motive? Like I said, changing the pool size is possibly a thing, no?

Single payer won't address this - infact since it's all taken care of you further incentive unhealthy behavior as the person receiving the care has even less interest in preventing conditions from occurring
Maybe, but can we agree that this would possibly only be a case up to a point? I mean, do you think everybody is going to take up smoking just because their healthcare is "free" (note the quotation marks)? Maybe some will, but...

Even worse when theirs no profit motive or other incentive for screeners to capture and mitigate this fraud and abuse.
That argument works in the reverse direction too in the form of insurers trying to prevent payment because of pre-existing conditions and other profit-motivated sort of stuff. Do you acknowledge that this argument has a counter?

How does changing who pays have an effect on this? Where is that money coming from? Costs won't go down unless a market force brings them down. The government is not a market force. Read my posts up on this page as this is the single biggest problem we face today in the industry.
I think you are being ideological here. Do you really think that market forces are the only way to drive down costs? Why is health care cheaper in other countries?

I would argue that political appetites to have a tanglible effect on investment and R&D. If no one is investing in pharma for fear of bad returns, where are the new drugs and treatments going to come from? Canada?
You have not acknowledged my point about pool size. Prices relate to the size of the market and the potential for volume.

If you can't make a case other, the status quo or null hypothesis remains. If you're arguing for single payer, argue for single payer. Don't just say "it'll work!" then bow out as if somehow you've made a convincing argument.
I'm not sure I have an opportunity to make a case without the person I'm trying to make a case to being open-minded.

Can you say with complete honesty that you weren't anxious to shoot down my arguments line by line because of your existing ideological beliefs about market forces and your other conservative principles?
     
besson3c  (op)
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May 16, 2017, 06:07 PM
 
Originally Posted by Snow-i View Post
Let me ask you this - do you believe medicare/medicaid works well today? It's essentially a single payer system within the larger industry. Do you think it would be fair to evaluate single-payer in the US extrapolating from medicare?

No, because it co-exists with the private marketplace. A hybrid market is a complicated thing, which maybe could work, but you can't just look at one part of it in isolation.
     
Paco500
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May 16, 2017, 06:12 PM
 
Originally Posted by Snow-i View Post
Let me ask you this - do you believe medicare/medicaid works well today? It's essentially a single payer system within the larger industry. Do you think it would be fair to evaluate single-payer in the US extrapolating from medicare?
There is a lot you have said above that reads to me as ideological rather than evidence based, so I'm just going to leave it.

However, to hold up medicare a example of an actual single-payer system when it is administered via a collection of private (and profit driven) insurance companies is a bit disingenuous.

If we were to simplify medicare and make it a truly centralised and single-payer system, the evidence from around the world would lead me to believe it would work a lot better.
     
besson3c  (op)
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May 16, 2017, 06:31 PM
 
Originally Posted by Paco500 View Post
There is a lot you have said above that reads to me as ideological rather than evidence based, so I'm just going to leave it.

However, to hold up medicare a example of an actual single-payer system when it is administered via a collection of private (and profit driven) insurance companies is a bit disingenuous.

If we were to simplify medicare and make it a truly centralised and single-payer system, the evidence from around the world would lead me to believe it would work a lot better.

Why do you think that it is practically impossible to talk to US conservatives about this stuff without this same sort of ideological backlash?
     
The Final Dakar
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May 16, 2017, 07:25 PM
 
Is it worth pointing out we just expanded Medicaid and by all accounts people want to keep it?
     
subego
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May 18, 2017, 01:36 PM
 
Originally Posted by Paco500 View Post
I don't think I am seeing the numbers so differently because of ideology.

I will say flat out that my numbers are lacking some accuracy, because I am comparing healthcare per capita from 2015 and population from 2017, but the US already spends far more than the UK adjusting for population and currency. I was asserting that the US could save money and gain batter outcomes with a different system.

If the US spent the same on health care per capita as the UK it would save ~$1.788 Trillion. That would buy a lot of bombs.

The problem isn't the level of spending, but the system.
Originally Posted by Paco500 View Post
As an aside, I wouldn't necessarily put the UK forward as the best model- we can argue why the UK trails the rest of the EU in outcomes (my vote is that it has been hampered by creeping privatisation by both the Torries and Labour), so let's take Germany. If they US spent as much per capita as Germany, it would still save the economy ~$1.365 Trillion and Germany has MUCH better outcomes.
Sorry for the delay!

If Germany has the best system, or one of the best, those are the numbers I'd prefer to use.

To be clear though, my argument wasn't "a public option is too expensive", it's "this burden would need to get shifted off of employers into taxes".

Is the proposal also to force employers to increase salaries based on them no longer needing to pay for healthcare? I say "force" because the market likely won't do that on its own. These horses are notoriously difficult to stuff back in the barn.

Likewise, I'm not sure things like the U.S. having the top four pharma corps, or being responsible for about 40% of the research into biology and medicine can be simply explained away by considering Europe as a single market.
     
Paco500
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May 18, 2017, 03:19 PM
 
Originally Posted by subego View Post
Sorry for the delay!
Don't be.

Originally Posted by subego View Post
If Germany has the best system, or one of the best, those are the numbers I'd prefer to use.

To be clear though, my argument wasn't "a public option is too expensive", it's "this burden would need to get shifted off of employers into taxes".

Is the proposal also to force employers to increase salaries based on them no longer needing to pay for healthcare? I say "force" because the market likely won't do that on its own. These horses are notoriously difficult to stuff back in the barn.
How the taxes would be paid would obviously need to be looked at. Off the top of my head, I would imagine a big part would come from payroll taxes. Money that companies are currently giving to insurance companies, they would now pay in tax (except less!). This would have the side benefit of forcing companies like Walmart to actually pay their fare share rather than using public assistance to care for their employees.

I imagine the rest would fall to individual taxes- if there was a shortfall on the individual, the employers would either pick it up or they wouldn't. I would imagine the worst offenders are the ones that aren't providing health care to their employees now, so no big thing.

Of course this is all straight out of my ass because I'm not an economist or a tax expert or an employment expert. Just my musings.

Originally Posted by subego View Post
Likewise, I'm not sure things like the U.S. having the top four pharma corps, or being responsible for about 40% of the research into biology and medicine can be simply explained away by considering Europe as a single market.
Well, the single largest economy, depending on who is measuring, is either the European single market, or the US. So it makes perfect sense that the US has 40% of the top pharma companies, and the ESM has 50%. If America was such a paradise for pharma companies, their share should be higher.
( Last edited by reader50; May 18, 2017 at 03:32 PM. Reason: fixed quote tag position)
     
Snow-i
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May 18, 2017, 04:07 PM
 
Originally Posted by besson3c View Post
Okay, so this is where I question whether you are really open to this conversation. I kind of set a trap for you here to see if you would take this bait.
Being open to the conversation and abandoning my arguments are two seperate things, not to be conflated.

There is no comparable country in these respects, so I'm not going to find a perfect model. However, why does this mean that this whole conversation is now a non-starter? This, in my mind, just means that some extra analysis is required.
It doesn't mean the conversation is a non-starter, but given the lack of comparable countries this analysis falls on the argument for changing the status quo. Infact, we're having that conversation right now.


Like I questioned, why would it remove the profit motive? Like I said, changing the pool size is possibly a thing, no?
Changing the pool size simply changes the distribution of costs - it does nothing to change the realized costs themselves. You're simply increasing the variable that the total cost gets divided by.


Maybe, but can we agree that this would possibly only be a case up to a point? I mean, do you think everybody is going to take up smoking just because their healthcare is "free" (note the quotation marks)? Maybe some will, but...
Why would anyone price shop if it makes no difference to them personally? Why would anyone give a flying hoot about being in the hospital if it never directly costs them anything.

Of course its "up to a point", but that point, regardless of where it is in actuality, is not easily ignored in the context of "prices are already too high".


That argument works in the reverse direction too in the form of insurers trying to prevent payment because of pre-existing conditions and other profit-motivated sort of stuff. Do you acknowledge that this argument has a counter?
I'm not arguing for a free for all. Give the government already favors large incumbents in the marketplace, there will be no market forces to correct these kinds of issues. Regulation will be necessary regardless.


I think you are being ideological here. Do you really think that market forces are the only way to drive down costs? Why is health care cheaper in other countries?
And you are not being ideological?

Yes, I do believe market forces are the only mechanism by which to reduce costs. Is there anything else that possibly could, given the price is a function of the market?


You have not acknowledged my point about pool size. Prices relate to the size of the market and the potential for volume.
Pool size is strictly the distribution of costs, not the actual total realized costs.

Again, that's who's paying not how much

I'm not sure I have an opportunity to make a case without the person I'm trying to make a case to being open-minded.
You keep saying that, yet we still keep having the conversation. It's almost like if I'm not agreeing with you, we're not having the conversation at all. I am open minded, you just haven't presented a convincing case to change my beliefs. If I weren't open minded, I wouldn't even be responding to you.

Can you say with complete honesty that you weren't anxious to shoot down my arguments line by line because of your existing ideological beliefs about market forces and your other conservative principles?
Considering your ideological beliefs are what derailed the conversation to single payer in the first place, I think this is the pot calling the kettle black. My "ideological" beliefs are secondary to the reality of the situation we're in. Single payer is the hypothetical here - not private market healthcare.

Present a case for single-payer besson. Don't just tell me "it'll work! prove it won't!" and expect me to be convinced - calling me an ideologie in the process. You've already noted that the geographical aspects are not comparable to other countries, and that those issues present considerable costs to treatments - just how do we get around that? We can move down the issues list from there.
     
Snow-i
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May 18, 2017, 04:15 PM
 
Originally Posted by Paco500 View Post
There is a lot you have said above that reads to me as ideological rather than evidence based, so I'm just going to leave it.
Considering the arguments for single payer are equally ideological, I'm not sure i've done anything different than those I'm arguing against.

However, to hold up medicare a example of an actual single-payer system when it is administered via a collection of private (and profit driven) insurance companies is a bit disingenuous.
fair enough. Do you have another way we could accurately compare the US markets to those abroad? Definitely open to another approach.

If we were to simplify medicare and make it a truly centralised and single-payer system, the evidence from around the world would lead me to believe it would work a lot better.
Is this a gut feeling? I mean we haven't satisfactorily analyzed the differences between the US and those markets, so I'm not sure how your evidence could support that conclusion. I haven't even trotted out all my arguments in this regard - I'll wait to see how my current objections are addressed before doing so.
     
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May 18, 2017, 04:16 PM
 
To bessy being "open-minded" means agreement, not just having a discussion. I admire your attempts at diplomacy with him, you show great fortitude, but it's most likely a waste of time.
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Paco500
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May 18, 2017, 06:29 PM
 
Originally Posted by Snow-i View Post
Considering the arguments for single payer are equally ideological, I'm not sure i've done anything different than those I'm arguing against.
There are absolutely ideological arguments for single payer systems, I'm just not making them. I'm arguing that the best evidence we have is that these systems cost less and produce better outcomes. That's not an ideological argument.
Originally Posted by Snow-i View Post
Yes, I do believe market forces are the only mechanism by which to reduce costs. Is there anything else that possibly could, given the price is a function of the market?
^This is an ideological argument.^

Of course there are ways to reduce costs that are not driven by an open, profit driven, market in health care. Since the downturn in 2008, the NHS has achieved massive amounts of efficiency savings. They did this by being given less money by the government. The conservatives ran on, and were elected on, a platform of reducing the cost of government, including in the NHS. As for now, it's working out for them. If NHS quality continues to suffer, they may have to change course. But even if they do end up giving the NHS more money, many of the structural changes that the NHS has made which has taken cost out the system will remain.

The NHS has a budget that is set by the government. It is less than they'd like. They have one choice. Make efficiency savings and reduce costs. In the US, private insurers and healthcare providers have another choice. Raise the cost to patients. Based on the state of things- which have they chosen?

Originally Posted by Snow-i View Post
fair enough. Do you have another way we could accurately compare the US markets to those abroad? Definitely open to another approach.
Nope. No country is exactly like any other. There is no way to provide an exact comparison. All we can do is look at the available evidence without bias and hypothesize.

Perhaps it would be useful to investigate some of the reasons single-payer systems can provide superior outcomes at lower costs.

1. A much larger block to negotiate prices. The power of a national system to bargain with suppliers is dramatically superior than a massively balkanised system.
2. With universal cover, you have less sick people in the community, leading to better public health, leading lower cost to the system.
3. Health decisions and treatments are based on projected outcomes rather than profit. There is no incentive for needless tests or procedures.
4. A massive reduction in 'paperwork.' Claim forms, dealing with multiple insurers, different health systems. All gone.

I'm sure there are more, but that's all I can think of off the top of my head.

Then there are the massive benefits to individuals, beyond the fact that everyone now gets heath care. No more being stuck in a job you hate because you can't leave for fear of losing (affordable) coverage. Freedom to take a break in your career, or start your own company without the worry losing (affordable) coverage. As you keep saying, the money has to come from somewhere- be it from your employer, your pocket, or your taxes. But if as the evidence would predict, the overall cost to the economy goes down, that means more money for other things, more profits to businesses, more money in your pocket.

As for the objection that people would have no incentive to shop around for the lowest cost or people might abuse the system? Well, the shopping around thing is irrelevant if care is free at the point of delivery. You would choose your doctor based on effectiveness, personality, trust or convince rather than cost. This is a good thing for an individual. As for the abuse thing, I'd say, on the balance, it's the exact opposite. Sure there will be some abuse- the odd hypochondriac that clogs up the system. But in a private system, I go to my doctor, and I want a test or a treatment that the doctor doesn't believe is medically justified. What is his incentive to turn you down? Nothing. He makes more money, his employers make more money. With a national system, the doctor is not incentivised in ANY way to provide pointless care. The medical system is incentivised to provide the best care at the best cost.

Originally Posted by Snow-i View Post
Is this a gut feeling? I mean we haven't satisfactorily analyzed the differences between the US and those markets, so I'm not sure how your evidence could support that conclusion. I haven't even trotted out all my arguments in this regard - I'll wait to see how my current objections are addressed before doing so.
No, it's not a gut feeling, it's based on the evidence I see in front of me. The evidence shows, unquestionably, that single payer systems produce better outcomes at lower costs. There is not evidence I'm aware of to refute that. If you've got it, share it. The argument that the US is different than other countries is worth mentioning, but it's pretty weak if that's all there is. Every country is different than every other country. Japan is nothing like Germany, is nothing like Iceland, is nothing like France, etc. One of the few things they do have in common is that they provide better health care to their citizens for less money than the US does.

This isn't ideology.
     
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May 18, 2017, 08:37 PM
 
Originally Posted by Paco500 View Post
It would be difficult to calculate exactly, but given that your insurance costs $500/month, and my National Insurance contribution covers health care for me, my family, my state pension (equivalent to Social Security), and other benefits, I doubt it does cost me more out of pocket. Yes your employer pays most of your costs, but as you said above- the money comes from somewhere.
And what additional in taxes do you pay to cover those expenses? You can't ignore that increase in calculating your monthly cost.

I would also challenge you to support your assertion that we would lose more to government inefficiency overhead than the US system loses to private sector inefficiency, overhead, and profit.
We need to look at specific numbers to determine who is correct here.

. As has been pointed out time and time again on these threads, other developed countries spend less on health care per capita with better outcomes via socialised medicine.
That's because healthcare in those countries is cheaper than in the US.

I'm failing to connect how changing who pays in the US market is going to have any effect on the real, absolute costs of healthcare in the US. Sure, we can mess with the distributions of costs via risk pools, but you aren't actually reducing the real costs of healthcare, just how it's distributed among the US citizenry.

This is where you need to lead me to the light.

All of the top 10 pharma companies not based in the US (there are six) are based in countries with nationalised systems yet remain private companies.
And where does the revenue for those companies actually come from? They can be foreign owned and still getting most of their margins from the US.

One last time- the rest of the developed world has shown that you can reduce the cost of healthcare and improve outcomes by going single-payer.
You need to show how single payer reduces medical cost of services and goods, not just the per person expense via playing with how it's paid for.

Yes, your taxes would go up, but (most of) your out of pocket expenses and private insurance costs would disappear. This would be a net win.
Depends on how much my taxes go up vs what I (and my company) pay now for insurance.
     
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May 18, 2017, 09:16 PM
 
Originally Posted by Paco500 View Post
There are absolutely ideological arguments for single payer systems, I'm just not making them. I'm arguing that the best evidence we have is that these systems cost less and produce better outcomes. That's not an ideological argument.
^This is an ideological argument.^
Until you can demonstrate another method, besides a market force, to drive down price - it's simple reality regardless of my ideology. It's an economic inevitability - one that you cannot ignore if you're talking about costs.

Of course there are ways to reduce costs that are not driven by an open, profit driven, market in health care. Since the downturn in 2008, the NHS has achieved massive amounts of efficiency savings. They did this by being given less money by the government. The conservatives ran on, and were elected on, a platform of reducing the cost of government, including in the NHS. As for now, it's working out for them. If NHS quality continues to suffer, they may have to change course. But even if they do end up giving the NHS more money, many of the structural changes that the NHS has made which has taken cost out the system will remain.
I don't understand the argument here. The NHS got their budget cut, and it's quality began to suffer? But somehow, this is an argument for single payer because "structural changes" that could more easily be performed in a company than a government mandated by law? I don't follow how this is an argument in favor of single payer.

The NHS has a budget that is set by the government. It is less than they'd like. They have one choice. Make efficiency savings and reduce costs. In the US, private insurers and healthcare providers have another choice. Raise the cost to patients. Based on the state of things- which have they chosen?
Um, so you're basically saying "run the NHS at a deficit, and thats a long term solvent model". They actually don't have a choice - the costs are the costs, and their budget is their budget. Failing to reconcile that is simply punting the problem down the road in hopes that the real problems might be solved. The chickens will have to come home to roost, at some point.

Nope. No country is exactly like any other. There is no way to provide an exact comparison. All we can do is look at the available evidence without bias and hypothesize.
Then we can't make a comparison, right? No bias, but if the countries are not comparable, the evidence that "it works in other countries" is de facto non supportive of that conclusion, beyond guesswork and speculation.

Perhaps it would be useful to investigate some of the reasons single-payer systems can provide superior outcomes at lower costs.
How much do doctors get paid in comparison to the US?
How much does it cost to run a hospital, vs the US?
How much does medical school cost in those countries, vs the US?
How much do RNs get paid in those countries, compared to the US?

Our problem is in costs, not in who pays.

1. A much larger block to negotiate prices. The power of a national system to bargain with suppliers is dramatically superior than a massively balkanised system.
How so? The companies aggregately make up that same block, and negotiate against each other on those prices. Reducing the number of competing negotiators isn't going to reduce costs. You can legislate the prices, but the quality of care will be reduced naturally to just the level the government is paying to provide.

2. With universal cover, you have less sick people in the community, leading to better public health, leading lower cost to the system.
How does changing who pays reduce the number of people getting sick? That's a huge leap.

3. Health decisions and treatments are based on projected outcomes rather than profit. There is no incentive for needless tests or procedures.
That is only if you give the government immunity from malpractice. "Sorry, we killed your family member due to basic negligence....tough shit!"
4. A massive reduction in 'paperwork.' Claim forms, dealing with multiple insurers, different health systems. All gone.
We don't need single payer to reduce the overhead from the current "50 different systems" to just 1. Open up the companies to be able to sell across state lines would have the exact same effect, with the added benefit of a profit motive to reduce costs as much as possible. The government has no such motive, and will spend to and beyond their budget as is easily demonstrable from every other government endeavor the government makes into what should be private industry.

Postal service, example 1.
Obama's stimulus solar power, example 2.
The ACA website, example 3.

The list goes on literally forever, I can't see how changing the payer to the government will make them more efficient then profit driven companies. There's no incentives to spend under the budget.

Then there are the massive benefits to individuals, beyond the fact that everyone now gets heath care. No more being stuck in a job you hate because you can't leave for fear of losing (affordable) coverage. Freedom to take a break in your career, or start your own company without the worry losing (affordable) coverage. As you keep saying, the money has to come from somewhere- be it from your employer, your pocket, or your taxes. But if as the evidence would predict, the overall cost to the economy goes down, that means more money for other things, more profits to businesses, more money in your pocket.
This is another problem that doesn't need single payer to address. The problem here is the marriage of insurance to employment. I've articulated ways we can rid ourselves of this dependency without having single payer. If you want, I can rehash them, but i covered it earlier in this thread.

As for the objection that people would have no incentive to shop around for the lowest cost or people might abuse the system? Well, the shopping around thing is irrelevant if care is free at the point of delivery.
Precisely - nothing will keep the provider prices down if it's "free" to the person requesting the services.

You would choose your doctor based on effectiveness, personality, trust or convince rather than cost.
How does this reduce costs again?

This is a good thing for an individual. As for the abuse thing, I'd say, on the balance, it's the exact opposite.
Who pays for this dream of care whenever you want it, however you want it. How does having the government pay set up a paradise such as this?

Sure there will be some abuse- the odd hypochondriac that clogs up the system. But in a private system, I go to my doctor, and I want a test or a treatment that the doctor doesn't believe is medically justified. What is his incentive to turn you down? Nothing.
So you want the doctors to tell their patients "no" when they request services? That doesn't sound better - that sounds worse.

He makes more money, his employers make more money. With a national system, the doctor is not incentivised in ANY way to provide pointless care.
Or any care at all.

The medical system is incentivised to provide the best care at the best cost.
No, you just described how a doctor is not incentivized to provide any services, as they will drive up his costs and reflect poorly upon him as a doctor. That is not the kind of doctor i want to go to.

No, it's not a gut feeling, it's based on the evidence I see in front of me.
Evidence you admit in this post is not comparable to the US market.

The evidence shows, unquestionably, that single payer systems produce better outcomes at lower costs.
How do the costs in those countries compare to the US? How does changing who pays reduce the absolute costs?

Connect the dots.

There is not evidence I'm aware of to refute that. If you've got it, share it. The argument that the US is different than other countries is worth mentioning, but it's pretty weak if that's all there is. Every country is different than every other country. Japan is nothing like Germany, is nothing like Iceland, is nothing like France, etc. One of the few things they do have in common is that they provide better health care to their citizens for less money than the US does.

This isn't ideology.
It isn't self-consistent either. If you change who pays for the care, I'm not sure I understand how that will reduce costs overall. Lead me to the light.
     
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May 18, 2017, 10:37 PM
 
Originally Posted by Paco500 View Post
Don't be.

How the taxes would be paid would obviously need to be looked at. Off the top of my head, I would imagine a big part would come from payroll taxes. Money that companies are currently giving to insurance companies, they would now pay in tax (except less!). This would have the side benefit of forcing companies like Walmart to actually pay their fare share rather than using public assistance to care for their employees.

I imagine the rest would fall to individual taxes- if there was a shortfall on the individual, the employers would either pick it up or they wouldn't. I would imagine the worst offenders are the ones that aren't providing health care to their employees now, so no big thing.

Of course this is all straight out of my ass because I'm not an economist or a tax expert or an employment expert. Just my musings.

Well, the single largest economy, depending on who is measuring, is either the European single market, or the US. So it makes perfect sense that the US has 40% of the top pharma companies, and the ESM has 50%. If America was such a paradise for pharma companies, their share should be higher.
Honest question.

If Europe is a single market, why isn't the U.S. part of a "North American" market which includes Canada?
     
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May 18, 2017, 10:52 PM
 
     
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May 18, 2017, 10:54 PM
 
Little birdie tells me that may not exactly be legal.
     
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May 18, 2017, 10:55 PM
 
Originally Posted by subego View Post
Little birdie tells me that may not exactly be legal.
Believe it or not, that's not the part that bothers me.
     
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May 18, 2017, 11:08 PM
 
Go on.
     
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May 18, 2017, 11:11 PM
 
Not funding the CSRs is a great way to sabotage the market in general.
     
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May 18, 2017, 11:14 PM
 
Gotcha. Sounds plausible.

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May 18, 2017, 11:17 PM
 
The CSRs are the subsidies exchange users get. They're effectively saying they'll stiff the insurance companies on payments they owe. Which, if you've paid any attention to Trump, is one of his MOs
     
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May 19, 2017, 04:14 AM
 
Originally Posted by subego View Post
Honest question.

If Europe is a single market, why isn't the U.S. part of a "North American" market which includes Canada?
NAFTA is a free trade agreement between different countries, or 'markets.'

The European single market is much more than free trade. It includes free movement of goods, services, and people. There are common regulations and policies, and even, to a certain degree, laws. IE, any product legal to sell in the UK is legal to sell anywhere in the single market. This is not true of NAFTA. Were I an EU citizen, I could buy, sell, live, or work anywhere in the EU. NAFTA provides a subset of the integration of the European single market.

But if we were to count NAFTA as a single market, the position of US (or NAFTA) dominate in Pharma looks even worse.

But we shouldn't do that, because it's not correct.
     
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May 19, 2017, 09:19 AM
 
people have been getting mail order prescriptions from canada for ages under the table... would be great if there were a more easily accessible market.
     
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May 19, 2017, 11:25 AM
 
Originally Posted by Snow-i View Post
Until you can demonstrate another method, besides a market force, to drive down price - it's simple reality regardless of my ideology. It's an economic inevitability - one that you cannot ignore if you're talking about costs.
He already said it - a single entity negotiating prices for everyone can work better than a hundred different insurers negotiating with a thousand different clinics - think of the reduction in overhead.

How does changing who pays reduce the number of people getting sick? That's a huge leap.
No, it's a very commonly touted benefit of "free" healthcare. Right now, people don't get little problems treated because of the cost. Little problems become big problems that they eventually can't ignore, and now what could have been fixed with a couple stitches or some antibiotics or a little physical therapy has become a trip to the ER (the cost of which the hospital may have to absorb) and it's a hospital stay and a surgery or a whole regiment of drugs or something much more serious and costly.

Open up the companies to be able to sell across state lines would have the exact same effect, with the added benefit of a profit motive to reduce costs as much as possible.
Well, you'll need to show me a country identical to the US that has done this successfully for me to believe that it's possible. If you can't come up with a country identical to the US that has done this, I will dismiss the idea outright without considering its benefits.

See how ridiculous that sounds? Also, people don't (or can't) shop for healthcare like they do for cars or phones or bread.
     
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May 19, 2017, 12:14 PM
 
Originally Posted by Snow-i View Post
Until you can demonstrate another method, besides a market force, to drive down price - it's simple reality regardless of my ideology. It's an economic inevitability - one that you cannot ignore if you're talking about costs.
All other first-world countries have single payer health care and include caps on costs, so there already is plenty of proof out there. In business terms, these health care systems are more vertically integrated which does drive down costs. Apple has a business advantage because its chip division doesn't have to make a profit.
Originally Posted by Snow-i View Post
How does changing who pays reduce the number of people getting sick? That's a huge leap.
That's not a leap. Let's take just one factor here: If you only have “catastrophic coverage”, but do not pay for preventative health care, then statistically, people tend not to do cancer screenings and other preventative measures, so if they get sick (e. g. get breast cancer), it'll be much more expensive.
Originally Posted by Snow-i View Post
How do the costs in those countries compare to the US? How does changing who pays reduce the absolute costs?
The US does abysmal in comparison: health care spending accounts for 16.9 % of GDP in 2015 as compared to 12 % for the next country (the Netherlands) and 10.8 % for the average of other comparable countries. Single payer significantly outperforms the US system. In absolute numbers, the US does even worse (as the GDP per capita varies from country to country): the US spends $9,451 per person and year on average compared to the comparable country average $4,908. If you think the US has better health outcomes, also there you'll be disappointed.

There are many factors here, from the top of my head:
- Better preventative care.
- Better bargaining position over costs of procedures and medication.
- People get treated earlier, which makes things cheaper.
- In the US system every part of the health care chain has to make a profit. In more vertically integrated health care systems, fewer players do.
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May 19, 2017, 01:14 PM
 
OreoCookie: why do you think that these discussions are so difficult to have without dealing with the same 4 or 5 arguments that seem intractable?
     
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May 19, 2017, 01:46 PM
 
I feel like the question of if the government can do healthcare more efficiently misses the point. Government didn't get involved because the healthcare industry wasn't being efficient, it got involved because it was failing to cover a large swath of Americans. Because private industry failed, the government stepped in. The market had 30 years to implement a solution and failed, partly because there is little to no profit incentive. The notion is vaguely similar to the concept municipal broadband.
     
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May 19, 2017, 07:59 PM
 
Originally Posted by Laminar View Post
He already said it - a single entity negotiating prices for everyone can work better than a hundred different insurers negotiating with a thousand different clinics - think of the reduction in overhead.
How is one entity negotiating uncompetitively better than 50 competing on costs?

This does not follow.

No, it's a very commonly touted benefit of "free" healthcare. Right now, people don't get little problems treated because of the cost. Little problems become big problems that they eventually can't ignore, and now what could have been fixed with a couple stitches or some antibiotics or a little physical therapy has become a trip to the ER (the cost of which the hospital may have to absorb) and it's a hospital stay and a surgery or a whole regiment of drugs or something much more serious and costly.
So again the problem is in costs - disincentive people from going to the doctor because the costs are too high. You don't need single payer to address this problem - infact, single payer just hides the costs and adds costs to the backend that are unncessary. We will still have to pay for these services at the already too high for solvency prices.


Well, you'll need to show me a country identical to the US that has done this successfully for me to believe that it's possible. If you can't come up with a country identical to the US that has done this, I will dismiss the idea outright without considering its benefits.
The US - to the early 2000s, and despite it's flaws.

See how ridiculous that sounds? Also, people don't (or can't) shop for healthcare like they do for cars or phones or bread.
Because it's all through insurance, and they're disconnected from the buying process. Why can't routine care be cheap and not covered under the subscription model? Maybe if people did shop for care like they do those things, we'd see the costs come down just like we have in the phone market. Phones are getting cheaper and better all the time.
     
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May 19, 2017, 08:00 PM
 
Originally Posted by The Final Dakar View Post
I feel like the question of if the government can do healthcare more efficiently misses the point. Government didn't get involved because the healthcare industry wasn't being efficient, it got involved because it was failing to cover a large swath of Americans. Because private industry failed, the government stepped in. The market had 30 years to implement a solution and failed, partly because there is little to no profit incentive. The notion is vaguely similar to the concept municipal broadband.
Ehh considering blue cross blue shield is quasigovernmental and was a government sponsored monopoly for most of that time, this isn't exactly accurate to portray the government "just standing by". Their meddling got us into this situation in the first place, much as single payer would to a larger degree 30 years down the line.
     
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May 19, 2017, 08:10 PM
 
Originally Posted by OreoCookie View Post
All other first-world countries have single payer health care and include caps on costs, so there already is plenty of proof out there. In business terms, these health care systems are more vertically integrated which does drive down costs. Apple has a business advantage because its chip division doesn't have to make a profit.
Until you can articulate the mechanism for how changing who pays is going to affect how much medical services cost, you simply cannot make those comparisons.

Healthcare is cheaper in those nations, regardless of who pays. Infact, it's this disparity in costs that is exactly why single payer is viable in the first place.

That's not a leap. Let's take just one factor here: If you only have “catastrophic coverage”, but do not pay for preventative health care, then statistically, people tend not to do cancer screenings and other preventative measures, so if they get sick (e. g. get breast cancer), it'll be much more expensive.
I am all for setting up programs to target these - single payer is like taking a sledgehammer to put a nail in the wall to hang a picture.

The US does abysmal in comparison: health care spending accounts for 16.9 % of GDP in 2015 as compared to 12 % for the next country (the Netherlands) and 10.8 % for the average of other comparable countries. Single payer significantly outperforms the US system. In absolute numbers, the US does even worse (as the GDP per capita varies from country to country): the US spends $9,451 per person and year on average compared to the comparable country average $4,908. If you think the US has better health outcomes, also there you'll be disappointed.
How does changing who pays reduce the costs.

Your correlation does not factor in that the US costs considerably more in general, especially in wages for medical staff. You need to tell me how single payer would reduce those costs, not just "it works over there! trust me!"
There are many factors here, from the top of my head:
- Better preventative care.
So medical staff getting paid less under single payer are going to provide better care? The money for it has to come from somewhere. If that''s how you want to reduce costs, there will be consequences to it.

- Better bargaining position over costs of procedures and medication.
Uhh, the costs aren't going to reduce themselves simply because the government negotiates that. If they artificially set the prices too low, the quality of care and treatments will naturally fall to that level in short order. This is not ideal.

Negotiatons - more competition is lower prices. Less negotiators means higher prices. Your argument would have the exact opposite effect.

You want healthcare to look like the military industrial complex? Because that's exactly what we would get.
- People get treated earlier, which makes things cheaper.
Single payer isn't the only way to make this happen, nor the most effective.
- In the US system every part of the health care chain has to make a profit. In more vertically integrated health care systems, fewer players do.
Profit margins that are less than 3%. That 3% plus a whole lot more will be sacrificed in the government's inefficiencies - there's no motive to spend under the budget (infact, the government often runs on a "use it or lose it" style of budget planning. They will definitely go over, and will almost never come in under budget. The proof is all around you - just take a look at how the government is run today.
     
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May 20, 2017, 01:38 AM
 
Snow-i, this seems like a waste of time. Your approach with all of us here is "prove my preconceived notions wrong" rather than demonstrating a sense of openness and curiosity.

Your mind is clearly made up, and none of us are going to be able to change it.
     
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May 20, 2017, 02:24 AM
 
Yes, it is a waste of time. Your minds are made up, and he's not going to be able to change them. Your false front of "openness and curiosity" has been obvious for years, if a presented idea isn't purely "progressive" and socialist, you invariably pick and push at it until it fits within your agenda.
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May 20, 2017, 05:09 PM
 
Originally Posted by Snow-i View Post
Until you can articulate the mechanism for how changing who pays is going to affect how much medical services cost, you simply cannot make those comparisons.
Of course you can make those comparisons: consider how health care is being paid for as a black box, and compare different countries' health care systems according to costs and health outcomes. The US currently pays a lot more for, at best, mediocre health outcomes. So using purely economic arguments, it's clear which type of health care system is superior.
Originally Posted by Snow-i View Post
Healthcare is cheaper in those nations, regardless of who pays. Infact, it's this disparity in costs that is exactly why single payer is viable in the first place.
No, it's the other way around: health care is cheaper, because these countries have single payer systems.
Originally Posted by Snow-i View Post
Your correlation does not factor in that the US costs considerably more in general, especially in wages for medical staff. You need to tell me how single payer would reduce those costs, not just "it works over there! trust me!"
I gave you a few reasons, but you didn't reply to any of them.
Originally Posted by Snow-i View Post
So medical staff getting paid less under single payer are going to provide better care?
That's exactly what the statistics say, e. g. life expectancy is longer and infant mortality is also lower.
Originally Posted by Snow-i View Post
You want healthcare to look like the military industrial complex? Because that's exactly what we would get.
Health care systems in other countries look nothing like the military industrial complex.
Originally Posted by Snow-i View Post
Single payer isn't the only way to make this happen, nor the most effective.
Right now it is the most effective by a very large margin.
Originally Posted by Snow-i View Post
Profit margins that are less than 3%.
Every player wants 3 %, and that adds up. Hence my analogy to a vertically integrated company: Apple's chip division doesn't need a 30-40 % profit margin, it can “sell” its Ax chips at cost to itself. That's why Apple's competitors can't touch it on performance. Ditto here, lack of vertical integration makes the system more expensive.
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May 20, 2017, 06:14 PM
 
Originally Posted by Cap'n Tightpants View Post
Yes, it is a waste of time. Your minds are made up, and he's not going to be able to change them. Your false front of "openness and curiosity" has been obvious for years, if a presented idea isn't purely "progressive" and socialist, you invariably pick and push at it until it fits within your agenda.
It is a waste of time trying to promote a horseshit health care system to me, yes, you are quite right. However, I lived in the US for 15 years and was a dual citizen for part of that time, and am living in Canada now, and have been giving the US system a chance for years and years whether it is trying to engage in debate here, being optimistic about Obamacare, talking with Americans and Canadians about this subject which comes up a great deal when people learn about my background, etc.

How often are the merits of single payer or any other health care system really debated here? Hardly ever, it's a non-starter as Snow-i himself stated, so trying to paint a false equivalency here is not going to work.
     
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May 20, 2017, 08:47 PM
 
Originally Posted by Paco500 View Post
NAFTA is a free trade agreement between different countries, or 'markets.'

The European single market is much more than free trade. It includes free movement of goods, services, and people. There are common regulations and policies, and even, to a certain degree, laws. IE, any product legal to sell in the UK is legal to sell anywhere in the single market. This is not true of NAFTA. Were I an EU citizen, I could buy, sell, live, or work anywhere in the EU. NAFTA provides a subset of the integration of the European single market.

But if we were to count NAFTA as a single market, the position of US (or NAFTA) dominate in Pharma looks even worse.

But we shouldn't do that, because it's not correct.
I'm fine comparing the U.S. to the E.U.

According to the European federation of pharmaceutical Industries and Associations (I have no idea how legit they are) in terms of world sales of new medicines, the U.S. accounts for 55%, the E.U. accounts for 23%, and the rest of the world is the remaining 22%.

It of course should be noted we're talking about populations of 325 million (55%), 500 million (23%), and 6 billion (22%).

Would not shrinking the American market have a massive effect on worldwide pharmaceutical research? Is it not quite clearly the prime motivator of the industry?

It was noted earlier the amount of money which ends up in the coffers of European conglomerates. I'm a globalist. Why should that bother me if my country benefits from the research?
     
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May 20, 2017, 09:17 PM
 
Originally Posted by besson3c View Post
It is a waste of time trying to promote a horseshit health care system to me, yes, you are quite right. However, I lived in the US for 15 years and was a dual citizen for part of that time, and am living in Canada now, and have been giving the US system a chance for years and years whether it is trying to engage in debate here, being optimistic about Obamacare, talking with Americans and Canadians about this subject which comes up a great deal when people learn about my background, etc.

How often are the merits of single payer or any other health care system really debated here? Hardly ever, it's a non-starter as Snow-i himself stated, so trying to paint a false equivalency here is not going to work.
Canada's health care system is far worse than the USA's. Tens of thousands flock to the USA each year to have medical procedures that are either, virtually nonexistent in Canada, or so backed-up with waitlists that they might as well not exist. Otherwise, they could simply die. Socialism: "Free", yet much shittier, health care for all. I guess if you need a splint for a broken finger, Canada looks pretty decent, but **** you if you need an MRI within the next 2 weeks.
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besson3c  (op)
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May 21, 2017, 12:44 AM
 
Originally Posted by Cap'n Tightpants View Post
Canada's health care system is far worse than the USA's. Tens of thousands flock to the USA each year to have medical procedures that are either, virtually nonexistent in Canada, or so backed-up with waitlists that they might as well not exist. Otherwise, they could simply die. Socialism: "Free", yet much shittier, health care for all. I guess if you need a splint for a broken finger, Canada looks pretty decent, but **** you if you need an MRI within the next 2 weeks.

I think you're sore that I'm not impressed with your internet stature.
     
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May 21, 2017, 03:52 AM
 
Really? I think you're deflecting, and perpetually a disappointment to anyone who has the misfortune of encountering you.

When you have something substantive to add, LMK.
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but by the content of their character." - M.L.King Jr
     
Laminar
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May 22, 2017, 10:51 AM
 
Originally Posted by Snow-i View Post
How is one entity negotiating uncompetitively better than 50 competing on costs?

This does not follow.
"Your cost to do this procedure is X. We will pay you 10% over X. Negotiation over."

How much overhead gets cut out now that there aren't 50 different entities negotiating prices?

The US - to the early 2000s, and despite it's flaws.
Flaws like where insurance companies got to pick and choose who they covered and medical bills were the #1 cause of bankruptcy? Those are kind of big flaws to ignore.

Because it's all through insurance, and they're disconnected from the buying process. Why can't routine care be cheap and not covered under the subscription model?
Because even now, people won't go to the doctor and pay a $40 co-pay for a small thing that eventually turns into a big thing. No ****ing way are people going to fork over $200 cash for a yearly physical just because it's $20 cheaper than the clinic down the street.

Maybe if people did shop for care like they do those things, we'd see the costs come down just like we have in the phone market. Phones are getting cheaper and better all the time.
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Snow-i
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May 22, 2017, 11:29 AM
 
Originally Posted by Laminar View Post
"Your cost to do this procedure is X. We will pay you 10% over X. Negotiation over."
How much overhead gets cut out now that there aren't 50 different entities negotiating prices?

X is the problem, not the margin above it, considering as it currently stands that margin is less than 10%. Those 150 entities have a big motive to keep that overhead down to stay competitive and stay afloat. The government has no such motive, nor any competition as an economic market force.

"You can only do 10% over cost? Well, we're not going to invest in new tech then and you can find yourself another supplier".

Single payer will not reduce X, i.e. it will not fix our problem. This is my point and of the three of you arguing with me no one can explain how single payer would reduce X without the correlative drop in quality and access. "It works over there!"

"It's cheaper over there!". Well yeah, so is everything else - especially in wages, property, insurance, etc.

Flaws like where insurance companies got to pick and choose who they covered and medical bills were the #1 cause of bankruptcy? Those are kind of big flaws to ignore.
The fact that we're even having this conversation is evidence those flaws are not being ignored. Infact, I've already articulated ways we can mitigate these problems a few pages back.


Because even now, people won't go to the doctor and pay a $40 co-pay for a small thing that eventually turns into a big thing. No ****ing way are people going to fork over $200 cash for a yearly physical just because it's $20 cheaper than the clinic down the street.
Physicals are not and should not be $200. They can be when insurance pays

"Maybe if our country experienced a broad, unprecedented cultural shift unlike anything ever seen before, my idea would work."
Yes, because nationalizing over 10% of our economy would not represent a broad, unprecendented cultural AND economic shift.
     
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May 22, 2017, 11:49 AM
 
Originally Posted by OreoCookie View Post
Of course you can make those comparisons: consider how health care is being paid for as a black box, and compare different countries' health care systems according to costs and health outcomes. The US currently pays a lot more for, at best, mediocre health outcomes. So using purely economic arguments, it's clear which type of health care system is superior.
Right, and you think changing who's paying is going to affect how much is paid for those services? You need to explain the mechanism.


No, it's the other way around: health care is cheaper, because these countries have single payer systems.
[citation needed]

I gave you a few reasons, but you didn't reply to any of them.
Are the government dollars worth more than the private industry? How does the government paying reduce the costs of medical wages, facilities, equipment, etc?

That's exactly what the statistics say, e. g. life expectancy is longer and infant mortality is also lower.
Because the goods and services there are cheaper. I'm not sure how single payer does anything to address this, and you continually state your conclusion without stating the mechanism.

Health care systems in other countries look nothing like the military industrial complex.
Other countries are not the US.

Right now it is the most effective by a very large margin.
See subego's points about investment.

Every player wants 3 %, and that adds up.
It's still 3%, and the same aggregate market.

Hence my analogy to a vertically integrated company: Apple's chip division doesn't need a 30-40 % profit margin, it can “sell” its Ax chips at cost to itself. That's why Apple's competitors can't touch it on performance. Ditto here, lack of vertical integration makes the system more expensive.
Performance? Actually performance is an arms race to the top, thanks to the competition between Apple, Samsung, TMSC, etc. Imagine if the government bought everyone an iPhone, do you really think we'd have the same speeds and efficiency gains over the last 5 years?
     
subego
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May 22, 2017, 12:19 PM
 
Samsung does well, and my understanding is Korean "zaibatsus" aren't integrated. Samsung Mobile wants a chip from Samsung Semi, they don't get preferential treatment.
     
Laminar
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May 22, 2017, 12:38 PM
 
Originally Posted by Snow-i View Post
X is the problem, not the margin above it
I said "cost," not "price." Insurance companies currently pay whatever "price" they manage to negotiate.
     
Laminar
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May 22, 2017, 12:41 PM
 
Originally Posted by Snow-i View Post
Single payer will not reduce X, i.e. it will not fix our problem. This is my point and of the three of you arguing with me no one can explain how single payer would reduce X without the correlative drop in quality and access. "It works over there!"
Well then let me ask you this (you may have already answered it so sorry if I'm making you repeat yourself): How does every nation with single payer achieve A) lower costs per capita and B) better outcomes. The question has two parts, and sources must be cited.
     
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May 22, 2017, 01:38 PM
 
Doesn't the entire EU have single payer?

I can dig up the master WHO rankings of healthcare systems if you want, but if you're willing to take my word, we do better than a big hunk of Eastern Europe.
     
 
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