The failure of single-payer in Vermont

[George S]

Basically the doctors all got together and said lets make a better system. The Doctors are still in private practice, but they pool all payments (from whatever source). They share info on what works better and costs less. Everyone can get care. My Mother and her Husband, who has an expensive terminal illness, moved there partially for the healthcare system.

But what they are doing is something that can be done in either a for profit or a non-profit system. It is not something that can only be done in a for profit system, correct?

What I am saying is that there is no reason to believe that health care delivered by a for profit system will be anything but more expensive than a non-profit system, a single payer system for example. This video gives us no reason to doubt this.

The difference is in administration as I said before. With government single-payer it is legislators and their appointed agents who control health care. The government is endowed with the reverse-Midas-touch. Everything the government touches turns to excrement.

 

[laughing dog]

But what they are doing is something that can be done in either a for profit or a non-profit system. It is not something that can only be done in a for profit system, correct?

What I am saying is that there is no reason to believe that health care delivered by a for profit system will be anything but more expensive than a non-profit system, a single payer system for example. This video gives us no reason to doubt this.

The difference is in administration as I said before. With government single-payer it is legislators and their appointed agents who control health care. The government is endowed with the reverse-Midas-touch. Everything the government touches turns to excrement.

What planet do you live on? The interstate highway system, and the lock and dam systems are but two counter-examples of your claim. Health care is a service and it will be "rationed" whether there is single payer or a free-market or any other system. The question is what is the most acceptable form of rationing. None of the choices about rationing are perfect - every single one of them has advantages and disadvantages. Rational discussions involve weighing the actual and expected advantages and costs, not flinging ideological and false memes.

 

[fromderinside]

The difference is in administration as I said before. With government single-payer it is legislators and their appointed agents who control health care. The government is endowed with the reverse-Midas-touch. Everything the government touches turns to excrement.

What planet do you live on? The interstate highway system, and the lock and dam systems are but two counter-examples of your claim. Health care is a service and it will be "rationed" whether there is single payer or a free-market or any other system. The question is what is the most acceptable form of rationing. None of the choices about rationing are perfect - every single one of them has advantages and disadvantages. Rational discussions involve weighing the actual and expected advantages and costs, not flinging ideological and false memes.

Maybe George S was being ironic by attributing national feeling to be as those whining in the Tea Party league?

 

[George S]

The difference is in administration as I said before. With government single-payer it is legislators and their appointed agents who control health care. The government is endowed with the reverse-Midas-touch. Everything the government touches turns to excrement.

What planet do you live on? The interstate highway system, and the lock and dam systems are but two counter-examples of your claim. Health care is a service and it will be "rationed" whether there is single payer or a free-market or any other system. The question is what is the most acceptable form of rationing. None of the choices about rationing are perfect - every single one of them has advantages and disadvantages. Rational discussions involve weighing the actual and expected advantages and costs, not flinging ideological and false memes.

Remarkably, Grand Junction, CO, there is no rationing. All -- even the dead broke -- get medical service.



I don't know much about the dam system. Hoover dam was built by private Six Companies, Inc. and paid for by tax money. (Wiki)

Electricity from the dam's powerhouse was originally sold pursuant to a fifty-year contract, authorized by Congress in 1934, which ran from 1937 to 1987. In 1984, Congress passed a new statute which set power allocations from the dam from 1987 to 2017.[90] The powerhouse was run under the original authorization by the Los Angeles Department of Water and Power and Southern California Edison; in 1987, the Bureau of Reclamation assumed control.[91] In 2011, Congress enacted legislation extending the current contracts until 2067, after setting aside 5% of Hoover Dam's power for sale to Native American tribes, electric cooperatives, and other entities. The new arrangement will begin in 2017.[90] The Bureau of Reclamation reports that the energy generated is allocated as follows:[2]

Area Percentage
Metropolitan Water District of Southern California 28.53%
State of Nevada 23.37%
State of Arizona 18.95%
Los Angeles, California 15.42%
Southern California Edison Company 5.54%
Boulder City, Nevada 1.77%
Glendale, California 1.59%
Pasadena, California 1.36%
Anaheim, California 1.15%
Riverside, California 0.86%
Vernon, California 0.62%
Burbank, California 0.59%
Azusa, California 0.11%
Colton, California 0.09%
Banning, California 0.05%

From all US taxpayers, to Arizona(19%) , Nevada (23%) and California (52%). It is an asset of the government. It helps 3 states. Yep great example of government. Help those who are politically favored.

I am familiar with the activities of the Corps of Engineers who do things to the Mississippi. It dredges the channel. If the Corps did not do that those who ship up and down river would have to. They provide pilots (like my father-in-law) who ride each big boat through their section of the river. It is the Army Corps of Engineers who does this for Army reasons, not to help shipping. The interstate highway system was envisioned by General Eisenhower after he observed that had their been roads all over Germany the Nazi's would have won the war. It was for military vehicles during time of invasion, only incidentally for trucks to move goods on.

But these do not respond to my post. The experiment has been run. It is possible to treat every single ill person, practice preventive medicine, and provide pre-natal care to every pregnant person, bar none. At lower cost than the average expense across the US. And you are against this on cost-benefit analysis? Your analytical skills need work.

 

[T.G.G. Moogly]

You guys are obviously talking past each other because it sounds to me like you both want the same thing by the same means.

 

[George S]

You guys are obviously talking past each other because it sounds to me like you both want the same thing by the same means.

Close. He wants gobermunt run healthcare. Government poisons everything in my opinion. Different means. How can private 100% coverage at lower cost be bad and should be run by the same people who give us Obamacare.

 

[laughing dog]

Remarkably, Grand Junction, CO, there is no rationing. All -- even the dead broke -- get medical service.

You know for a fact that no one is denied any medical service for any reason whatsover?

I don't know much about the dam system. Hoover dam was built by private Six Companies, Inc. and paid for by tax money. (Wiki)

The gov't touched that. And it hasn't turned to shit.

From all US taxpayers, to Arizona(19%) , Nevada (23%) and California (52%). It is an asset of the government. It helps 3 states. Yep great example of government. Help those who are politically favored.

That is non-responsive to your claim about everything the gov't touches turns to shit.

I am familiar with the activities of the Corps of Engineers who do things to the Mississippi. It dredges the channel. If the Corps did not do that those who ship up and down river would have to.

Why do you think they would "have to"? Why do you thin they would dredge the Mississippi (something they do not own nor can they charge people to use) and let their competitors use it at no cost?

They provide pilots (like my father-in-law) who ride each big boat through their section of the river. It is the Army Corps of Engineers who does this for Army reasons, not to help shipping. The interstate highway system was envisioned by General Eisenhower after he observed that had their been roads all over Germany the Nazi's would have won the war. It was for military vehicles during time of invasion, only incidentally for trucks to move goods on.

Is there an actual point to this? The gov't touched this, and regardless of the original intent, it has not turned to shit.

But these do not respond to my post. The experiment has been run. It is possible to treat every single ill person, practice preventive medicine, and provide pre-natal care to every pregnant person, bar none. At lower cost than the average expense across the US. And you are against this on cost-benefit analysis? Your analytical skills need work.

Your logic needs work. Grand Junction has a number of hospitals and the Va, so your claims about treating every single ill person are truly unsubstantiated. If you are basing your hopes on doctors and everyone else who works in health care to get "religion", then you have abandoned whatever analystic skills you ever had.

- - - Updated - - -

You guys are obviously talking past each other because it sounds to me like you both want the same thing by the same means.

Close. He wants gobermunt run healthcare. Government poisons everything in my opinion. Different means. How can private 100% coverage at lower cost be bad and should be run by the same people who give us Obamacare.

It cannot be bad or good, because it is a delusion.

 

[George S]

You know for a fact that no one is denied any medical service for any reason whatsover?

But these do not respond to my post. The experiment has been run. It is possible to treat every single ill person, practice preventive medicine, and provide pre-natal care to every pregnant person, bar none. At lower cost than the average expense across the US. And you are against this on cost-benefit analysis? Your analytical skills need work.

Your logic needs work. Grand Junction has a number of hospitals and the Va, so your claims about treating every single ill person are truly unsubstantiated. If you are basing your hopes on doctors and everyone else who works in health care to get "religion", then you have abandoned whatever analystic skills you ever had.

I am quoting the video. In it we find 100% coverage for everyone. Perhaps they lied.

 

[SimpleDon]

Private insurers cover their population (i.e. their customers). The principle of "insurer covers their population" is the same, just the scale is different.

I think that you need to look up the meaning of the word "tautology."

You think wrong.

Saying that we have had single payer is not a tautology.

I agree because it is a factually incorrect statement: the US has never had a single payer as it is normally understand. Under your definition, all insurers are single payers which makes your claim inconsequential.

I don't use two words that mean the same thing in the same sentence.

Good for you.

"Half is not a whole" is a repeat of your nonsense.

I see the problem. You think factually correct statements (half is not a whole) are nonsense. I think you need to look up the meaning of the term "nonsense".

I don't know why I keep getting sucked in to these childish, pointless, semantic pissing contests. Possibly because it is the only kind of discussions some people are capable of.

Okay, you know, you are right. In fact you are always right.

Because you are always right you can define any word to mean anything that you want it to. You don't even have to tell us what you think that it means. Because you are always right.

Having a common, mutually understood meaning for a word would only be a help in a world where we would need to discuss problems to come to conclusions about solutions. In other words, a world without you. Because you are always right.

Because you are right all of the time we just have to accept it when you tell us that we are wrong. You don't have to explain why. You just have to keep repeating, "no, you are wrong." Because you are always right.

Because you are always right I realize that your statements that "half is not the whole" and "euthanasia is euthanasia" are brilliant insights that propelled the discussion along and showed me the errors of my ways. I am truly in your debt. Because you are always right.

Because you are always right I realize now that there are so many reasons for vetereninarians* to euthanize pets that it is useless to try to generalize about a single reason.

* The new spelling for what we used to call "veterinarians," because you are always right.

Because you are always right we now know that single payer insurance is only a true single payer insurance if the single payer provides all of the insurance for everyone because it is much easier to force a literal meaning on the concept based on three words of the description rather than to do the work to understand the concept behind the words. Because you are always right.

Because you are always right we all now know that there is no difference between a for profit health care insurance company and and what we use to call a single payer provider like Medicare. They are virtually the same in how they deliver health care. What I thought were significant differences, such as way that they acquire their customers, who those customers are, how they set their rates, the way that they are paid or the more than 20% cost differences are trivial, especially when you say something incredibly stupid but your ego can't let you admit it. Because you are always right.

I don't want you to be confused, I am making fun of you. I am mocking you. I am being impolite on purpose in the fond hope that you will leave.

But you can do what you always do, you can ignore most of my post. Especially the parts that you don't have any answer for. You can edit down my post and prove to yourself that everyone here acknowledges that you are always right. Because you are always right.

Now you have had your say.

Now let the adults talk among themselves.

 

[SimpleDon]

The insurance companies' direct costs and profits are pure additions to our medical costs.

But even greater than these costs are the indirect costs that having hundreds of private insurance companies with different rules about what they will cover and how they will pay. A Kinsey Group Study that I got in about 2007 estimated that this cost was about 400 billion dollars in the entire health care system. This is additional costs above what a single payer system would impose. This is pure waste imposed by having the for profit companies.

Also, we have so many regulations covering the health care system not because the evil government wants to increase the costs of health care, but because we depend so much on for profit companies to deliver our health care. Companies who exist to make profits, not to deliver what we need, low cost, high quality health care.

Excellent points. The problem in the US really is the insurance companies. I have fought them tooth and nail in car accident cases and can not imagine having to do that for every little medical expense in day to day life. I just pop out my OHIP card and *KAZAM* medical expense paid for. I know that I probably pay just as much into taxes as I would have paid for that procedure, but I have the convenience of not having to wade through red tape, the comfort of knowing that I am taken care of if I am unfortunate to need a really expensive procedure, and the pride of knowing that my entire province, and nation, is covered, even those who have no other means of paying. Universal Single Payer Health Care is one reason I am proud to be Canadian.

And I think the true litmus test. Even die hard conservatives that I know here in Ontario would balk if you took OHIP away. And I think the same is true in the USA, if you put the system in, and had it there for a few years, I think it would become political suicide to seek to undo it. Maybe that is why US conservatives freak over it.

Yes, they fear that any entitlement becomes ingrained into the body politic and can't be removed because it becomes popular. Especially things like people having health care or people having enough to eat, especially children and seniors who should in the natural order of things have to work to support themselves. I think that they view it as a failure of representative democracy, one that they are working hard to correct by turning government over to the corporations and the wealthy.

 

[laughing dog]

****string of straw men mixed into...mini meltdown****... Now let the adults talk among themselves.

An adult would recognize that rant as meta-ironic to say the least. So, why not calm down and post like the adult we all know you can be?

For example, there is nothing incompatible with a single payer and for-profit insurance: a system could be single payer that earns a profit. Yes, there are significant differences how Medicare and for-profit insurance works and there are significant similarities. If you wish to claim the US has had (or has) single payer health insurance because of Medicare, go ahead. Just realize that most people are probably going to view that claim as counterfactual. When they do, there is no need to have conniption - life is much too short to worry about it.

 

[SimpleDon]

The video doesn't have closed captioning so I can watch it but can't decipher the audio. Can you tell me how many of the cost cutting ideas that they came up with with depend on the private enterprise system? In other words cost cutting ideas that can only be done in a for profit environment, but not in a non-profit one?

I, myself, use closed captioning when available. Sorry you haven't listened to the video.

There is almost nothing that could, in theory, work in a not-for-profit environment. I worked for Blue Cross one summer when I was 17. It was a not-for-profit corporation at the time. Since then legislation has forced them to be a for-profit company.

Marxism could work in theory. Take from society only a standard uniform amount, and give to society all that you are able. From each according to his ability; to each according to his need. It doesn't work.

People feel they should have more wealth than they have. They want to live in better housing. They want health. They want successful children. People want. Want more.

The logic of these physicians in Mesa County was to treat the patient population as "us." They are in the family. No one denies care to family. The physicians own/are the insurance company. They take a salary, not fee for services. They are true physicians who put the needs of their population first. It is similar to the ancient Chinese physician who was paid only when the patient was healthy. When healthy those who can afford it pay premiums. All collect (how Marxist) when ill. One important point is that preventive care (especially pre-natal) is done because it saves on net cost to the health insurance company. Especially important for those who cannot afford it because any later illness will be paid by everyone else.

The advantage of private enterprise over public policy is that policy is immutable or can be changed only slowly. Private enterprise allows for experiment. Mesa County Colorado is a successful experiment. Also in the video was one of the failures.

The same thing can work in a socialist environment, of course. Make all the physicians employees of the state on a fixed salary. The government the only insurer. Politicians the only controllers of health care.

I have severe tinnitus, ringing in my ears. I can usually understand people in the room but TV is hit and miss. Thank you for your explanation.

My admittedly belabored point was that no one had provided an example of a cost cutting or quality improving measure that can only be provided in a for profit environment. In fact, there is no one who has pointed to any advantage to converting health care into a for profit businesses except the obvious one to the people who collect the profits.

I understand that people are reluctant to trust the government to do anything. I don't understand why. In this case in not trusting the government they are instead turning health care over to companies whose only interest is to make profits, not to keep people healthy.

Ironically it is the slow conversion of the health care industry into a for profit industry that has forced the government into ever deeper involvement in health care. Every innovation that the for profits come up with forces the government to write a regulation to force the for profits back to providing health care, not to increase profits and to increase costs.

What we need, as a country, is high quality, low cost and widely available health care. It is that simple. But this doesn't produce the highest profits. In fact, the highest profits are produced by high cost medical care for those who can afford it. If you are going to turn the businesses into a for profit business then the government is going to be forced increasingly in to the business in order to force the for profits into providing what we the health care that we need.

The health care for profits naturally oppose the government involvement. But because they see government involvement as reducing their profits. The private enterprise verses government discussion is about profits, not health care.

As I think that this video says that the proper place in health care for decisions and innovation is with the health care professionals, not with business executives, not with politicians. The general public doesn't in my experience, understand the concept of professionalism. That we have people who are charged with a greater duty than to make profits.

I was a professional engineer. I had a duty to society to provide safe and useful installations. I was personally liable for the work that I did, not the corporation as a person that I worked for. The corporation as a person that allows executives of corporations to escape liability when they make criminal decisions.

Yes, doctors will spare no cost usually to save someone. But I haven't seen anyone who is sick or injured argue against this position.

So yes, if you characterize the discussion as business verses government people are going to respond based on how they feel about government. I personally would pick a democratically elected government against for profit business any day.

But the major accomplishment of so-called movement conservatism and its propaganda has been to undermined the standing of the government that got us through the Great Depression and that defeated fascism. Instead shifting the trust of large numbers of the population to an unobtainable fantasy of a self-regulating free market. All by lies.

 

[SimpleDon]

But what they are doing is something that can be done in either a for profit or a non-profit system. It is not something that can only be done in a for profit system, correct?

It would depend on the rules. If the government system says you can't work outside the system, then no they couldn't do it.

What I am saying is that there is no reason to believe that health care delivered by a for profit system will be anything but more expensive than a non-profit system, a single payer system for example. This video gives us no reason to doubt this.

The video really doesn't address that question and I don't want to go down that rabbit hole.

Unfortunately that is the only reasonable thing to discuss, costs. That is the failure of the US's health care system, it costs too much.

It destroys our competitiveness in foreign trade. We spend twice as much as the average developed nation on health care.

It wasn't always that way. Someone posted graphs of the health care costs of the developed countries from 1980 on. You can look at the graphs and see that if you project the curves back to 1970 that they converge. The US spent about the same as the other developed countries on health care.

In 1970 we had a largely non-profit health care sector. Hospitals were owned largely by charities and local government. Insurance was provided by the large, non-profit, community rate based companies, primarily Blue Cross-Blue Shield or by the government, indigent care, Medicare, Medicaid, the VA and the military health care system.

You have to look at what changed. It was the ever increasing conversion of health care into a for profit business. Hospitals were the first, for profit businesses bought the hospitals from the charities and from the local governments.

Then they broke up Blue Cross-Blue Shield and for the most part turned them into profit making enterprises. Before Congress broke up Blue Cross-Blue Shield Only about 5% of the health care insurance was issued by for profit insurance companies where they were at risk. Their main business was administrating the health care for large corporations, where the corporation was at risk, not the insurance company.

And no the increase in cost wasn't because of the huge increase in government regulations. The huge increase in government regulations was because of the increase in the penetration of the profit model into the health care industry. Who needs more regulation, the Sisters of Mercy running a hospital or a for profit business running one?

 

[George S]

****string of straw men mixed into...mini meltdown****... Now let the adults talk among themselves.

An adult would recognize that rant as meta-ironic to say the least. So, why not calm down and post like the adult we all know you can be?

For example, there is nothing incompatible with a single payer and for-profit insurance: a system could be single payer that earns a profit. Yes, there are significant differences how Medicare and for-profit insurance works and there are significant similarities. If you wish to claim the US has had (or has) single payer health insurance because of Medicare, go ahead. Just realize that most people are probably going to view that claim as counterfactual. When they do, there is no need to have conniption - life is much too short to worry about it.

I use medicare today. My first health insurer was a not-for-profit. It was mine and portable. The doctor did not know nor care about it. I filed my own claims. Next came employer-provided group insurance at half the cost and more benefits. Non-portable, it expired when I left the group. Later I worked for a major pharma manufacturer who self-insured. They hired an insurance provider to administer the plan, but they decided what would be covered and to what degree. All preventive medicine was done at an on-site free-to-employees clinic. Dental care and all drugs covered, period. Doctor visits were just like medicare: an 80/20 plan.

With medicare we find the government in the same role as a self-insured-for-employee-healthcare company. They decide what is to be covered and to what degree.

The problem with all government programs is scale. What works in the small does not, in general, work in the large. Families find it easy to be Marxist -- from each according to his abilities, to each according to his needs. Small communes work, but national communism does not.

A single-payer system is a large system with rules that are applicable to all. One size fits all, but is ideal for no one.

The system in Grand Junction, Colorado could be used in any city of similar size. It may not scale up well. It may not even scale down well. In my hometown of 4,000 fine folks the doctor I used to see has a sign: Annual physical: $65. See the doctor: $35. See the nurse practitioner $20. (cash prices when no insurance involved)

 

[SimpleDon]

And I think the true litmus test. Even die hard conservatives that I know here in Ontario would balk if you took OHIP away. And I think the same is true in the USA, if you put the system in, and had it there for a few years, I think it would become political suicide to seek to undo it. Maybe that is why US conservatives freak over it.

I've come to the conclusion that conservative opposition to social spending is just a manifestation of the Dunning Kruger effect. In essence, they only oppose it when it's for someone else.

The article states that Obamacare is unlikely to be repealed because insurance companies, many who make big contributions to conservative lawmakers, are enjoying record profits. This came as a surprise to me and I'm not sure if this is a bit of liberal genius or just dumb luck. But Obamacare seems here to stay for that reason and because there are millions of people who now depend on it for their healthcare.

Yes, this the ultimate insult waiting for the opponents of ObamaCare. They will find the for profit insurance companies lined up against them.

But it shouldn't have surprised you. That was the guiding principle of the proposal as far back as when it was first formulated by the Heritage Foundation. to hand the insurance side over to the for profit insurance companies, a business that they had largely been priced out of. The proposal that became ObamaCare protects the for profit insurance companies from the competition that they can't meet. Specifically from the community rate based companies like Blue Cross-Blue Shield was when costs were reasonable, before Congress broke them up at the bequest of the for profit insurance companies. The so-called community option offered competition to the for profits that they couldn't match. As did Medicare for all.

 

[SimpleDon]

I've come to the conclusion that conservative opposition to social spending is just a manifestation of the Dunning Kruger effect. In essence, they only oppose it when it's for someone else.

The article states that Obamacare is unlikely to be repealed because insurance companies, many who make big contributions to conservative lawmakers, are enjoying record profits. This came as a surprise to me and I'm not sure if this is a bit of liberal genius or just dumb luck. But Obamacare seems here to stay for that reason and because there are millions of people who now depend on it for their healthcare.

And once the framework is in place we can work on cutting costs.

I opposed ObamaCare because it was by far the most expensive way to try to increase health care coverage. It carried the lowest bang for the buck. But it has at least slowed the increases in costs.

 

[Horatio Parker]

It would depend on the rules. If the government system says you can't work outside the system, then no they couldn't do it.

What I am saying is that there is no reason to believe that health care delivered by a for profit system will be anything but more expensive than a non-profit system, a single payer system for example. This video gives us no reason to doubt this.

The video really doesn't address that question and I don't want to go down that rabbit hole.

Unfortunately that is the only reasonable thing to discuss, costs. That is the failure of the US's health care system, it costs too much.

It destroys our competitiveness in foreign trade. We spend twice as much as the average developed nation on health care.

It wasn't always that way. Someone posted graphs of the health care costs of the developed countries from 1980 on. You can look at the graphs and see that if you project the curves back to 1970 that they converge. The US spent about the same as the other developed countries on health care.

In 1970 we had a largely non-profit health care sector. Hospitals were owned largely by charities and local government. Insurance was provided by the large, non-profit, community rate based companies, primarily Blue Cross-Blue Shield or by the government, indigent care, Medicare, Medicaid, the VA and the military health care system.

You have to look at what changed. It was the ever increasing conversion of health care into a for profit business. Hospitals were the first, for profit businesses bought the hospitals from the charities and from the local governments.

Then they broke up Blue Cross-Blue Shield and for the most part turned them into profit making enterprises. Before Congress broke up Blue Cross-Blue Shield Only about 5% of the health care insurance was issued by for profit insurance companies where they were at risk. Their main business was administrating the health care for large corporations, where the corporation was at risk, not the insurance company.

And no the increase in cost wasn't because of the huge increase in government regulations. The huge increase in government regulations was because of the increase in the penetration of the profit model into the health care industry. Who needs more regulation, the Sisters of Mercy running a hospital or a for profit business running one?

My understanding is that costs took off after the expansion of Medicare in the 80s. Doctors, in return for supporting what many saw as socialized medicine, through a special committee, were allowed to set rates for procedures. This is why the specialities became so lucrative; they were constantly creating new procedures whereas something like a physical exam hasn't changed much.

 

[T.G.G. Moogly]

[With medicare we find the government in the same role as a self-insured-for-employee-healthcare company. They decide what is to be covered and to what degree.

That is a cost issue as I see it, if I understand you correctly. Maybe call it a quality/cost issue. It is not unique to healthcare nor to government provided anything.

Because healthcare has such a personal connection I believe people perceive it very differently than other government services or services generally. But I don't know if the problem has a solution.

It's one thing for the road in front of my house to have potholes and be in need of repair. I can still navigate it and still use it. I can even apply a band-aid solution, maybe skim the surface and repave so it gets by for another couple years. But not so healthcare. Issues are immediate and expensive in many cases. Healthcare really is quite different.

Now don't get me wrong. You can have healthcare or you can have flotillas of nuclear powered aircraft carriers prowling the seas. It seems the U.S. has made its choice. Shame on its voters for being so stupid.

 

[NobleSavage]

It would depend on the rules. If the government system says you can't work outside the system, then no they couldn't do it.

What I am saying is that there is no reason to believe that health care delivered by a for profit system will be anything but more expensive than a non-profit system, a single payer system for example. This video gives us no reason to doubt this.

The video really doesn't address that question and I don't want to go down that rabbit hole.

Unfortunately that is the only reasonable thing to discuss, costs. That is the failure of the US's health care system, it costs too much.

It destroys our competitiveness in foreign trade. We spend twice as much as the average developed nation on health care.

It wasn't always that way. Someone posted graphs of the health care costs of the developed countries from 1980 on. You can look at the graphs and see that if you project the curves back to 1970 that they converge. The US spent about the same as the other developed countries on health care.

In 1970 we had a largely non-profit health care sector. Hospitals were owned largely by charities and local government. Insurance was provided by the large, non-profit, community rate based companies, primarily Blue Cross-Blue Shield or by the government, indigent care, Medicare, Medicaid, the VA and the military health care system.

You have to look at what changed. It was the ever increasing conversion of health care into a for profit business. Hospitals were the first, for profit businesses bought the hospitals from the charities and from the local governments.

Then they broke up Blue Cross-Blue Shield and for the most part turned them into profit making enterprises. Before Congress broke up Blue Cross-Blue Shield Only about 5% of the health care insurance was issued by for profit insurance companies where they were at risk. Their main business was administrating the health care for large corporations, where the corporation was at risk, not the insurance company.

And no the increase in cost wasn't because of the huge increase in government regulations. The huge increase in government regulations was because of the increase in the penetration of the profit model into the health care industry. Who needs more regulation, the Sisters of Mercy running a hospital or a for profit business running one?

Yeah, I'm aware of all that. If you want to talk about ways to cut costs that are politically feasible great. I'm not gonna get into a non-profit vs for-profit debate. We have the ACA and it doesn't look like the Republicans are going to be able to kill it. So what kind of bills can be introduced to make the system better?

 

[T.G.G. Moogly]

My understanding is that costs took off after the expansion of Medicare in the 80s. Doctors, in return for supporting what many saw as socialized medicine, through a special committee, were allowed to set rates for procedures. This is why the specialities became so lucrative; they were constantly creating new procedures whereas something like a physical exam hasn't changed much.

I remember being young and having several stays in the hospital of several days each in the 1960s. In hindsight there was much milking of the system, even if the costs were in fact much lower. What effect breaking up blue cross/blue shield had I don't really know.

I've always attributed the soaring increase in healthcare costs as being the result of new and more expensive procedures becoming available, and also the proliferation of litigation.

It would be interesting to know what an individual and a family of four would have paid for top of the line healthcare in 1965, and compare that to today. Would it equate in today's dollars? And of course I don't know how pre-existing conditions were treated back then. Does anyone have a good source?