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phaedrus
It's been a good long while since I posted here but there is something bothering me and the other board I post to seems uninterested, thought I would try here. I'm just going to throw out some thoughts on the subject and see where it leads. The subject is the Affordable Healthcare Act and how it gets repealed and replaced. This is going to happen in a few months and I'm sure anyone watching this unfold has seen the protestors yelling, 'do your job', well honestly it's a difficult job.

Consider the fact that the number of people uninsured is at an all time low? In 2010 it spiked at 18.2%, it was 10.5% in 2015. (KFF Org).
In the first quarter of 2016, there were 8.6 percent of Americans — or about 27.3 million people — who were uninsured, the first time in history that the nation's uninsured rate fell below 9 percent. (CNBC)

I remember Hilary Clinton in the West Wing working on universal health care, the President holding up a plastic card that gives all the same healthcare all the members of Congress enjoy. The obvious question emerges how on earth could we pay for this, Daniel Patrick Moynihan, a solid Democrat, said the financing for this proposed legislation was fantasy, accurate fantasy since it came our of their computer in this way. Well, I suppose the idea of savings from Medicaid and Medicare wasn't the answer. New revenue Obama said was the only way, how did that work out for us?
In reviewing some IRS stats for 2014 returns, I was surprised to see that two taxes added by the Affordable Care Act (Obamacare), generated more revenue in 2014 than was generated from the individual AMT. Here are the stats:

Net Investment Income Tax (NIIT)
(3.8% §1411 tax)

$22.5 billion
Additional .09% Medicare tax
$7.3 billion
Total
$29.8 billion
Alternative Minimum Tax (AMT)
$28.6 billion

For 2013 returns, the AMT generated $4.6 billion more than the two ACA taxes. (ACA taxes generate more revenue than AMT 21st Century Taxation)

I was never all that good at political math but that does seem like a lot of money to me. The Republicans think they have a much better idea, maybe they think they can get the Mexicans to pay for it. I know there were and are a lot of illegal immigrants who draw benefits from it. The numbers again are tricky, but then again they always are:
"Illegal immigration costs our country more than $113 billion a year. And this is what we get," Trump, the Republican presidential nominee, said. "For the money we are going to spend on illegal immigration over the next 10 years, we could provide 1 million at-risk students with a school voucher, which so many people are wanting." (Donald Trump says illegal immigration costs $113 billion a year, Politafact)

I see, we are just going to save money we are just wasting on desperately poor people, why didn't we think of that before. I know, let's take the oil away from the Iraqis, or many we could put the bite on our most important allies in the NATO countries cause they don't have any problems of their own. Or better yet let's raid the existing tax revenue from Social Security, there was a lock box on that at one time, unfortunately they spent that on unilateral action in Iraq. Maybe we could use the $2.5 trillion is held by the Federal Reserve' (CNN Money). It's our own money, that we owe to ourselves, there's nothing confusing or absurd about that is there?

My feeling on this after a mentally and emotionally exhausting campaign and a mildly disturbing first month of Trump. If your not confused, your not paying attention.

An NPR statistic tells us that, '14 percent favor repeal without a replacement plan' (NPR). Perhaps that's how Trump is going to make America great again, repeal ACA and replace it with something terrific!, or maybe nothing at all. As a Democrat I would enjoy the interim elections managed to elect a majority in the Senate or maybe the House again. There is just this one nagging question that is bothering me, how do they intend to pay for all of this.

Bottom line, this is important and well underway. I don't care about Trump's tweets, I care about where this legislation might be taking us.

So, question for debate: What, given the imminent repeal of ACA, aka Obamacare, is the replacement going to be, if any?
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Mrs. Pigpen
So, question for debate: What, given the imminent repeal of ACA, aka Obamacare, is the replacement going to be, if any?

We recently had a visiting Congressman. He was a surgeon and (according to what he said) fixing the ACA is his main priority right now. Even he couldn't answer this question in full so I doubt anyone here will be able to.
An interesting tidbit that I did not know:
Congressmen are required to use Obamacare. So, heh, I guess that's one way to "give all the same healthcare all the members of Congress enjoy!" laugh.gif

He confirmed what I have mentioned before about high rates and ridiculously high deductibles. With the ACA his deductible is 13,000 and payments went up 400 a month (that's 400 a month MORE than he was paying when he didn't have Obamacare).
kimpossible
There has been a replacement that has recently been floating around. The NYT reports on it here and here.

From the Upshot (the Times' 'data blog'):

QUOTE
The Republican plan would alter both of those programs, changing the winners and losers. It would substantially cut funding for states in providing free insurance to low-income adults through Medicaid. And it would change how tax credits are distributed by giving all Americans not covered through work a flat credit by age, regardless of income.

That means that the biggest financial benefits would go to older Americans, like, say, Secretary of State Rex Tillerson. If he didn’t have a job in the Trump cabinet and access to government coverage, a 64-year-old multimillionaire like him would get the same amount of financial assistance as someone his age, living in poverty, and he would get substantially more money than a poor, young person.

The idea of matching tax credits to age makes some sense. Older people tend to have higher medical bills, and insurers, even under Affordable Care Act rules, charge them substantially higher prices. The new plan would also simplify the current system, which requires verifying every applicant’s income and then giving just the right amount of financial assistance. It would also eliminate incentives for low-income people to avoid earning more (higher earners can face a reduction in benefits).

But the current system is set up to ensure that low and middle-income Americans can afford the cost of their premiums. The Republican plan would not do that, and would result in many more low-income people losing out on coverage if they couldn’t find the money to pay the gap between their fixed tax credit and the cost of a health plan.

Older people without employer-based insurance typically earn more than young people, who tend to be starting out in their careers. It’s hard to know precisely how many people would lose coverage under this proposal because it’s missing some numbers. But similar tax credit plans from House Speaker Paul Ryan and Tom Price, the new secretary of health and human services, would result in millions losing coverage, according to independent estimates. (Mr. Ryan said Thursday in a news conference that the Congressional Budget Office was evaluating the new proposal, which means that we may see firm coverage estimates in the coming weeks.)

The plan includes additional features that redistribute resources from the poor to the rich. It would allow Americans to sock more money away for health spending in special tax-free health savings accounts. The benefits of such accounts fall largely to higher income-people who pay more in taxes, and a recent analysis of current health savings accounts found that they are held disproportionately by families with high earnings. (The white paper is silent on two Obamacare taxes that target wealthier Americans, but other Republican plans have proposed eliminating them. It does eliminate a number of taxes on the health care industry.)

What the plan doesn’t do, currently, is change any of the Obamacare regulations on health insurance that Republicans say drive up the cost. Those rules, including requirements that every plan cover a standard package of benefits, and those requiring companies to charge the same prices to healthy and sick Americans, would stay on the books, because they can’t be easily changed through the budget process.

There’s still a lot subject to change, of course. Congressional leadership has said the bill, once completed, will proceed through committee hearings and amendments. And the politics of passing such legislation, even with Republican control of both houses of Congress, will be a challenge. But this proposal, with the imprint of every major committee working on health care, seems likely to set the terms of the discussion.
akaCG
So, question for debate: What, given the imminent repeal of ACA, aka Obamacare, is the replacement going to be, if any?

Answer #1 (serious):
As of this very day (i.e. only about 36 days into President Trump's administration), ... nobody really knows.

Answer #2 (semi-humorous):
As ex-Speaker of the House Nancy Pelosi famously said, ... https://www.youtube.com/watch?v=hV-05TLiiLU
Gray Seal
I am one of those one of those uninsured. It is my choice and I do not want health insurance. I am appalled that I am being penalized for my choice.

The call to replace the ACA is a crock. The problem with the ACA is that the federal government is controlling your healthcare spending. The problem with replacing the ACA means the federal government will continue to control healthcare spending. That is no solution at all but a continuation of the problem.

The call to replace the ACA is political fool you language. We should not fall for it. We should be controlling our healtcare spending. We should not have government barriers to finding the healthcare we want and can afford.

The reason no can/will describe the replacement is explained by it being nothing more than "new boss same as the old boss". Politicians do not want you to be cognitive about this reality.
AuthorMusician
So, question for debate: What, given the imminent repeal of ACA, aka Obamacare, is the replacement going to be, if any?

The ACA won't be repealed simply because the Republicans in Congress want to keep their jobs. Now that people in places like Kentucky are aware that Obamacare = ACA, they want to keep it while making it better.

Which will eventually mean getting the profit motive out of health care and healthcare insurance.

That will really suck for those who want to get rich or remain rich off of health care, but at least as they head back into the dreaded muck of humanity, they'll get to live longer than they would without health care. It may not be primo Mayo-Clinic care, but someone will be there to clean up the messes and bring the food, medications, water & etc.

But say in a mass career suicide attempt, the Republicans do repeal the ACA. What then?

Well, if you can afford it, healthcare insurance will still be available to you. It might be entirely worthless, but at least you can say you've got insurance when bleeding out in an ER or more slowly checking out in a clinic. And you'll be able to save, tax-free, for the hundreds of thousands of dollars that'll be billed to you after getting care.

Those are the Republican ideas. They won't work. People are coming to realize it, and the 2018 election season looms. Sanders is still in the fight; the Obamas both have book deals; the Democratic Party is motivated to get moving ahead on social issues.

But hey, if the Republicans in Congress are stupid enough to force ACA repeal, I'll be happy to play a dirge for them. It's too bad that they'll take a lot of lives with them, but like Trump, it could be something we have to go through.

Mrs. P, has that Congressman dropped his insurance? No? Then he can afford it. Maybe his premiums are tax-deductible:

http://blog.turbotax.intuit.com/health-car...nsurance-17419/

But if he thinks it's just too much, he might want to check out France and GB and Canada and Sweden and . . . well, you know. It's far from impossible to ensure health care for every citizen.

As for penalties when a citizen does drop insurance, it's commonly understood to be pretty small. Now what if everyone contributed via taxes to healthcare coverage while gainfully employed (better than starvation wages)? What if opioid pushers were put out of business? What if artificially jacking up prices were to be punishable by 20-life hard time?

Well, point is that the ACA can be made to work better, and it's not that difficult with all the functioning examples in the world. The worst thing to do is repeal it without trying to improve it, so I'm allowing for Republican stupidity to win that steaming pile of prize. However, not all voting Republicans are stupid, so there's that to consider. And they either do or will need health care.
Mrs. Pigpen
QUOTE(AuthorMusician @ Mar 1 2017, 10:38 AM) *
Mrs. P, has that Congressman dropped his insurance? No? Then he can afford it.


AM, that is a really, really poor argument. ermm.gif
I guess healthcare isn't too expensive either...because hey! People keep going to the doctor.
I guess taxes aren't high because, hey! people keep paying them.
I guess housing and food aren't too expensive because...hey! People keep on eating and most of them live with a roof over their heads.

QUOTE
But if he thinks it's just too much, he might want to check out France and GB and Canada and Sweden and . . . well, you know. It's far from impossible to ensure health care for every citizen.


I'm sure he has. France and GB and Canada and Sweden do not have 13,000 dollar annual deductibles before their coverage kicks in. If they did, they wouldn't consider it to be universal healthcare.

Supposn
Affordable care act dilemma:

Almost all Republican leadership will, (if they haven’t already) concluded that
enactment of federal healthcare insurance policy changes passed within
president Trump’s administration, (for the best interests of the Republican
Party), should be delayed beyond the 2020 presidential elections.

I’m among the populists realizing the federal budgetary limitations upon our
goal of adequate and affordable medical insurance for everyone within our
nation.
Republicans’ now or soon will realize they must try to evade responsibility for
their changes’ reductions of insured medical services, and/or the increased
costs of medical insurance, and/or reduced proportions of our population’s that
are adequately medically insured.

I expect that Republicans fear passing any health insurance bill UNLESS the detriments do not “kick-in” until 2021.

Democrats would be fools to enable such Republican evasions.

Respectfully, Supposn
entspeak
QUOTE(Mrs. Pigpen @ Feb 25 2017, 07:19 AM) *
He confirmed what I have mentioned before about high rates and ridiculously high deductibles. With the ACA his deductible is 13,000 and payments went up 400 a month (that's 400 a month MORE than he was paying when he didn't have Obamacare).

Well, considering his premiums before the ACA were $0 a month, he's now paying $400 a month - I'm assuming this is for his entire family.. Prior to the ACA, we paid for Congressional healthcare with our taxes. That changed under the ACA, but they do get a massive subsidy (the same subsidy the poorest get from the ACA.)

The Republicans spent many years refusing to help fix the ACA (because they were more interested in Obama failing than in the health of citizens.) Now, some Republicans are asking Democrats to come up with an alternative to their stupid plan. The marketing push for the AHCA would be hilarious if die-hard TrumpChumps weren't so gullible. Pay 15 to 20% higher premiums now in the hope that ten years from now, you'll get a 10% drop. Yay! Plus kicking millions off insurance, and recreating the mandate in the form of requiring private businesses to assess a 30% hike in premiums for a year if you drop (or lose) your coverage. Bonus!!
Mrs. Pigpen
QUOTE(entspeak @ Mar 15 2017, 04:31 PM) *
QUOTE(Mrs. Pigpen @ Feb 25 2017, 07:19 AM) *
He confirmed what I have mentioned before about high rates and ridiculously high deductibles. With the ACA his deductible is 13,000 and payments went up 400 a month (that's 400 a month MORE than he was paying when he didn't have Obamacare).

Well, considering his premiums before the ACA were $0 a month, he's now paying $400 a month - I'm assuming this is for his entire family.. Prior to the ACA, we paid for Congressional healthcare with our taxes. That changed under the ACA, but they do get a massive subsidy (the same subsidy the poorest get from the ACA.)


I'm pretty certain that Congressmen had the same healthcare insurance as other civilian government employees before ACA.
Here is a link to compare federal employee healthcare plans.
They aren't "no premium" plans.
He is a new Congressman though, and I'm not certain if he was referring to a prior government plan or the previous insurance plan he had with his medical practice.
Either way, he was definitely NOT referring to a "I didn't have to pay premiums before but now I do" plan.

ACA premiums are far higher than 400 a month for a family. Higher than 400 a month in every state...some more than others. Again, I direct you to the gianormous deductible. So, let's do the math. This family pays (let's go with the cheapest of cheap state premiums on that chart, 600 a month for a family of four)...7200 a year in premiums, and unless they have medical bills in excess of 13000 dollars receive not one dollar's worth of coverage. That's 20,200 a year for a catastrophic cap. That isn't medical coverage, that's more like a tax. A huge tax.

QUOTE
The Republicans spent many years refusing to help fix the ACA (because they were more interested in Obama failing than in the health of citizens.) Now, some Republicans are asking Democrats to come up with an alternative to their stupid plan. The marketing push for the AHCA would be hilarious if die-hard TrumpChumps weren't so gullible. Pay 15 to 20% higher premiums now in the hope that ten years from now, you'll get a 10% drop. Yay! Plus kicking millions off insurance, and recreating the mandate in the form of requiring private businesses to assess a 30% hike in premiums for a year if you drop (or lose) your coverage. Bonus!!


I know a person who owed 4,000 dollars in penalty fees for no coverage, because her family couldn't afford the plan (she owns a business).
That's a fee amounting to almost 400 dollars a month for no coverage at all.
The whole point of ACA was to offer affordable healthcare to those without coverage. A deductible-with-premium-charges of 20,000+ completely eradicates that....heck, a deductible of half that would be outrageous.

A little over a year ago:
QUOTE
So, my family now has no health insurance, we’re now in debt because of massive medical bills we’ve never had before, and we’re paying fines for not having health insurance. It’s not that we “chose” to not have insurance, it’s that we simply don’t have that kind of money laying around the house. To make life even more fun, the deductables would actually exceed our income before our Affordable Care would even kick in.


More recently:
QUOTE
It’s been tough the last few years, medical bills mostly, fines, fees, permits, all this government stuff crushing down on our heads and the harder we work, the more backwards we go. The other day I came home to more bills and notices of impending doom, what amounted to several thousand dollars we just haven’t got, including what is now more than 4 grand in Obamacare fines for not having insurance. *snip*
... but we soon got the news that President Trump had just signed the relief act for Obamacare fines. Four thousand dollars of our family’s stress gone with the stroke of a pen.


Hyperbole won't solve this problem. Republicans aren't little green evil beings crawling from the ground hoping to take coverage away from people and leave them to die in the streets. Having a healthy population is in everyone's interest, and everyone knows it. The ACA is a tax that does nothing to ameliorate this problem, if anything it exacerbates it. ESPECIALLY for private business owners, if they are your particular point of interest (I'm assuming from what you wrote above).
I lived in the keys for four years and know a LOT of private business owners, and every single one, upon inquiry, told me Obamacare was crushing them.
They said their insurance skyrocketed after the ACA was passed.
Google
entspeak
QUOTE(Mrs. Pigpen @ Mar 16 2017, 07:00 AM) *
QUOTE(entspeak @ Mar 15 2017, 04:31 PM) *
QUOTE(Mrs. Pigpen @ Feb 25 2017, 07:19 AM) *
He confirmed what I have mentioned before about high rates and ridiculously high deductibles. With the ACA his deductible is 13,000 and payments went up 400 a month (that's 400 a month MORE than he was paying when he didn't have Obamacare).

Well, considering his premiums before the ACA were $0 a month, he's now paying $400 a month - I'm assuming this is for his entire family.. Prior to the ACA, we paid for Congressional healthcare with our taxes. That changed under the ACA, but they do get a massive subsidy (the same subsidy the poorest get from the ACA.)


I'm pretty certain that Congressmen had the same healthcare insurance as other civilian government employees before ACA.
Here is a link to compare federal employee healthcare plans.
They aren't "no premium" plans.
He is a new Congressman though, and I'm not certain if he was referring to a prior government plan or the previous insurance plan he had with his medical practice.
Either way, he was definitely NOT referring to a "I didn't have to pay premiums before but now I do" plan.

ACA premiums are far higher than 400 a month for a family. Higher than 400 a month in every state...some more than others. Again, I direct you to the gianormous deductible. So, let's do the math. This family pays (let's go with the cheapest of cheap state premiums on that chart, 600 a month for a family of four)...7200 a year in premiums, and unless they have medical bills in excess of 13000 dollars receive not one dollar's worth of coverage. That's 20,200 a year for a catastrophic cap. That isn't medical coverage, that's more like a tax. A huge tax.

QUOTE
The Republicans spent many years refusing to help fix the ACA (because they were more interested in Obama failing than in the health of citizens.) Now, some Republicans are asking Democrats to come up with an alternative to their stupid plan. The marketing push for the AHCA would be hilarious if die-hard TrumpChumps weren't so gullible. Pay 15 to 20% higher premiums now in the hope that ten years from now, you'll get a 10% drop. Yay! Plus kicking millions off insurance, and recreating the mandate in the form of requiring private businesses to assess a 30% hike in premiums for a year if you drop (or lose) your coverage. Bonus!!


I know a person who owed 4,000 dollars in penalty fees for no coverage, because her family couldn't afford the plan (she owns a business).
That's a fee amounting to almost 400 dollars a month for no coverage at all.
The whole point of ACA was to offer affordable healthcare to those without coverage. A deductible-with-premium-charges of 20,000+ completely eradicates that....heck, a deductible of half that would be outrageous.

A little over a year ago:
QUOTE
So, my family now has no health insurance, we’re now in debt because of massive medical bills we’ve never had before, and we’re paying fines for not having health insurance. It’s not that we “chose” to not have insurance, it’s that we simply don’t have that kind of money laying around the house. To make life even more fun, the deductables would actually exceed our income before our Affordable Care would even kick in.


More recently:
QUOTE
It’s been tough the last few years, medical bills mostly, fines, fees, permits, all this government stuff crushing down on our heads and the harder we work, the more backwards we go. The other day I came home to more bills and notices of impending doom, what amounted to several thousand dollars we just haven’t got, including what is now more than 4 grand in Obamacare fines for not having insurance. *snip*
... but we soon got the news that President Trump had just signed the relief act for Obamacare fines. Four thousand dollars of our family’s stress gone with the stroke of a pen.


Hyperbole won't solve this problem. Republicans aren't little green evil beings crawling from the ground hoping to take coverage away from people and leave them to die in the streets. Having a healthy population is in everyone's interest, and everyone knows it. The ACA is a tax that does nothing to ameliorate this problem, if anything it exacerbates it. ESPECIALLY for private business owners, if they are your particular point of interest (I'm assuming from what you wrote above).
I lived in the keys for four years and know a LOT of private business owners, and every single one, upon inquiry, told me Obamacare was crushing them.
They said their insurance skyrocketed after the ACA was passed.


You are correct. Prior to the ACA and, now even under the ACA, members of Congress receive a 72% subsidy for healthcare paid for by us. So, they pay 28% of their premium as a pre-tax payroll deduction, and the rest is covered by tax dollars. I can't speak to the deductibles, but since Congressional plans tend to be the gold standard, I find it difficult to believe it's as high as he claims... but, obviously, I can't disprove the anecdote.

What did I say that was hyperbolic? Republican lawmakers are giving insurance CEO's a tax break, giving billionaire investors a tax break, and, basically, cutting off affordable access to healthcare for millions in middle America (people who largely voted for Trump). That's a fact. Their "incentive" is actually worse than the ACA penalty. I work in an industry where continuous coverage is difficult because there is no single employer and my insurance is provided by my union based on weeks worked. In the entertainment industry, you don't work all the time, so, occasionally, there are gaps in coverage. Under the ACA, so long as that gap didn't last more than 6 months, I was fine and didn't have to pay a penalty. And, even if I ended up having to pay, it wold be tiny compared to the 30% hike in premiums for failing to have coverage for just over 2 months under the AHCA.

Republicans also blocked any attempt to fix the ACA... they refused to participate. That isn't hyperbole, that is a fact. Perhaps, your friend's issues could have been resolved years ago had the Republicans been more interested in representing the interests of their constituents rather than being obstructionist for the sake of being obstructionist.

Not every small business is required to provide health insurance. People need health insurance - I get that this is difficult for small businesses, but that's the problem when you're trying to get everyone covered in a for-profit insurance environment. You either have to either increase the cost of goods/services to cover the fact that you are providing insurance or increase it to cover the penalty.

The biggest problem with health insurance in this country is that access to it is a for-profit enterprise. That simply shouldn't be the case. The bottom line for insurance companies is making money... that means having the healthiest people on the rolls and keeping deductibles high. This will always be the case. That isn't the ACA doing this... the ACA didn't mandate an increase in deductibles - that's the insurance companies trying to keep a profit margin. So long as insurance is a for-profit endeavor, getting everyone covered will mean it's expensive (either high deductibles, higher premiums, or both.)

Add to this the fact that healthcare itself is expensive in this country and we have corporations gouging us for the cost of medicine and medical devices.
Mrs. Pigpen
QUOTE(entspeak @ Mar 16 2017, 11:11 AM) *
The biggest problem with health insurance in this country is that access to it is a for-profit enterprise. That simply shouldn't be the case. The bottom line for insurance companies is making money... that means having the healthiest people on the rolls and keeping deductibles high. This will always be the case. That isn't the ACA doing this... the ACA didn't mandate an increase in deductibles - that's the insurance companies trying to keep a profit margin. So long as insurance is a for-profit endeavor, getting everyone covered will mean it's expensive (either high deductibles, higher premiums, or both.)

Add to this the fact that healthcare itself is expensive in this country and we have corporations gouging us for the cost of medicine and medical devices.


I'm not going to argue with you there. But I think the problem is multi-causal.
Lots of reasons for increasing healthcare expenses (defensive medical practices from fear of lawsuits, inefficiencies in the system due to multi-payer systems and regulations, and yes insurance companies too)
Very interesting analysis of "cost disease" here.
The blogger is a physician.
(the above link mentions several "cost disease" examples, but healthcare is one of the primary ones)

QUOTE
Imagine if tomorrow, the price of water dectupled. Suddenly people have to choose between drinking and washing dishes. Activists argue that taking a shower is a basic human right, and grumpy talk show hosts point out that in their day, parents taught their children not to waste water. A coalition promotes laws ensuring government-subsidized free water for poor families; a Fox News investigative report shows that some people receiving water on the government dime are taking long luxurious showers. Everyone gets really angry and there’s lots of talk about basic compassion and personal responsibility and whatever but all of this is secondary to why does water costs ten times what it used to?

I think this is the basic intuition behind so many people, even those who genuinely want to help the poor, are afraid of “tax and spend” policies. In the context of cost disease, these look like industries constantly doubling, tripling, or dectupling their price, and the government saying “Okay, fine,” and increasing taxes however much it costs to pay for whatever they’re demanding now.
(snip)

I’m not sure how many people currently opposed to paying for free health care, or free college, or whatever, would be happy to pay for health care that cost less, that was less wasteful and more efficient, and whose price we expected to go down rather than up with every passing year. I expect it would be a lot.

And if it isn’t, who cares? The people who want to help the poor have enough political capital to spend eg $500 billion on Medicaid; if that were to go ten times further, then everyone could get the health care they need without any more political action needed. If some government program found a way to give poor people good health insurance for a few hundred dollars a year, college tuition for about a thousand, and housing for only two-thirds what it costs now, that would be the greatest anti-poverty advance in history. That program is called “having things be as efficient as they were a few decades ago”.
(snip)
I’m more worried about the part where the cost of basic human needs goes up faster than wages do. Even if you’re making twice as much money, if your health care and education and so on cost ten times as much, you’re going to start falling behind. Right now the standard of living isn’t just stagnant, it’s at risk of declining, and a lot of that is student loans and health insurance costs and so on.

What’s happening? I don’t know and I find it really scary.



AuthorMusician
Consumer Reports on why health care is so expensive in the USA:

http://www.consumerreports.org/cro/magazin...-care/index.htm

It's an article from 2014. The ACA was passed in 2010.

Here's a fairly comprehensive rundown on how health care in the USA developed:

http://www.post-gazette.com/healthypgh/201...version=pgevoke

This article is also from 2014, back before Trump, so it concludes with hope that things were improving. Now that the evil version of Michael Scott (The Office USA) is running things, that hope is pretty much gone.

Will it be restored in 2018? Beats me. I want to believe it'll happen, but my optimism has worn pretty darn thin. I've still got music and scribbling, and that is probably what Trumpcare will look like -- heal thyself. Don't get sick. If you're not wealthy enough for health care, you don't deserve to live.
Mrs. Pigpen
QUOTE(AuthorMusician @ Mar 16 2017, 10:49 PM) *
http://www.post-gazette.com/healthypgh/201...version=pgevoke

This article is also from 2014, back before Trump, so it concludes with hope that things were improving.


This is the "high note":

QUOTE
Some of these new cost-sharing concepts “are old ideas that get recycled and buffed up” once a generation, Mr. Brown said. Others may have more lasting impact. If the program promoted by President Barack Obama works as advertised, the government will pay for more and more care, but the levers of control are increasingly in the hands of private companies, since many Medicare plans and almost all Medicaid HMOs are administered by commercial insurance companies.


This is the problem I mentioned before (from my former-flight-doc-now-pathologist-aspiring-to-have-a-private practice friend). The insurance companies are buying out the clinics and creating an ipso-facto monopoly. This is inherently anti-competition...the private practices can't even get set up, let alone compete.

Sure, in the very short term that might lower cost a small percentage, but they do it by controlling the primary care providers who make the referrals.
The goal is to turn physicians into employees, beholden to their employers
(employers who are also the insurance companies...and they count up the number of referrals they make, too many and their employment is in jeopardy).
It's pretty easy to see where that one goes:
Came in with blood in your stool? Meh, probably a hemorrhoid...some back next month.

If you read that post, i also mentioned the only way he could establish a practice was to join a physician conglomerate that had already paid the many many millions and spent many years in court for the chance to set up a practice and compete with the insurance companies. Think that might have an impact on the price?

The one thing I know for certain from my experience watching the privatization of the military...socializing cost and privatizing gains is inherently about the most inefficient way possible to do things.
entspeak
QUOTE(Mrs. Pigpen @ Mar 17 2017, 07:04 AM) *
QUOTE(AuthorMusician @ Mar 16 2017, 10:49 PM) *
http://www.post-gazette.com/healthypgh/201...version=pgevoke

This article is also from 2014, back before Trump, so it concludes with hope that things were improving.


This is the "high note":

QUOTE
Some of these new cost-sharing concepts “are old ideas that get recycled and buffed up” once a generation, Mr. Brown said. Others may have more lasting impact. If the program promoted by President Barack Obama works as advertised, the government will pay for more and more care, but the levers of control are increasingly in the hands of private companies, since many Medicare plans and almost all Medicaid HMOs are administered by commercial insurance companies.


This is the problem I mentioned before (from my former-flight-doc-now-pathologist-aspiring-to-have-a-private practice friend). The insurance companies are buying out the clinics and creating an ipso-facto monopoly. This is inherently anti-competition...the private practices can't even get set up, let alone compete.

Sure, in the very short term that might lower cost a small percentage, but they do it by controlling the primary care providers who make the referrals.
The goal is to turn physicians into employees, beholden to their employers
(employers who are also the insurance companies...and they count up the number of referrals they make, too many and their employment is in jeopardy).
It's pretty easy to see where that one goes:
Came in with blood in your stool? Meh, probably a hemorrhoid...some back next month.

If you read that post, i also mentioned the only way he could establish a practice was to join a physician conglomerate that had already paid the many many millions and spent many years in court for the chance to set up a practice and compete with the insurance companies. Think that might have an impact on the price of things?

The one thing I know for certain from my experience watching the privatization of the military...socializing cost and privatizing gains is inherently about the most inefficient way possible to do things.

I think the only way to do this is to remove profit from the equation when it comes to insurance - a single payer system. Yes, taxes go up, but will they go up more than the cost of insurance premiums? Not likely, because there is no profit margin. Then the cost of healthcare itself can go down because you have a non-profit monopoly (the government) negotiating the cost of medicine and devices. It kills the insurance industry, but, there will be a need for people to administer the system all over the country, and who better to do that than the folks who currently work for insurance companies. The big losers would be insurance CEO's, but... hey, I'm sure they could retire and do just fine. Or, we could have a parallel private system like they do in the UK.

Will it be perfect? No. But will it be better than what we have? Absolutely. Despite paying more for healthcare in the US, we have higher mortality rates and poorer overall health than places that have public insurance.

This replacement is going to kill a lot of old people who will not be able to afford their insurance. (Of course, the administration seems bent on helping to kill a lot of things considering the new budget).
Mrs. Pigpen
QUOTE(entspeak @ Mar 17 2017, 08:00 AM) *
I think the only way to do this is to remove profit from the equation when it comes to insurance - a single payer system.


I agree. Not only for the "profit" equation, but just pure efficiency. Rather than thousands of tiered price ranges per individual determined by insurance type, there would be one price for the good/service. I remember long long ago I asked Victoria Silverwolf the price of a single medication. I thought this would be easy...she's a pharmacist, after all, and made hundreds of these transactions on a regular basis over the years. She said it was almost impossible to tell me...even for a person paying out of pocket. That's a single medication. No hard to imagine the ginormous bureaucracy surrounding the bargaining price of each and every medication/medical service depending on payer. If she couldn't determine the price how on earth could the average consumer?

Not sure if you read the piece I linked to, but I found this portion, from a link particularly interesting. Veterinary expenses are (apparently) rising even faster than human medical expenses.

A lot of this just comes down to a population that is far less healthy...with all the accompanying comorbidities. Same is happening to animals.

Edited to add: Thought it would be interesting to find a medical cost comparison of some countries in the ME (the richer ones in particular, like Qatar and Kuwait and the UAE, but also Egypt if memory serves). They're now leading the world in obesity rates...a very very recent population change, probably due in large part to KFC.
But I don't think those figures would provide and accurate assessment.
I know that when Kuwaitis have a major health issue, they typically go elsewhere for treatment.
I think it's safe to assume it's likely similar in the UAE and Qatar.
akaCG
QUOTE(entspeak @ Mar 17 2017, 08:00 AM) *
...
... I think the only way to do this is to remove profit from the equation when it comes to insurance - a single payer system. ...
...

Chances of dying after a month without food, on average: about 100%. Chances of dying after a month without health insurance, on average: about 0%.

Yet, amazingly, no one of any note has proposed removing "profit from the equation" in regards to the former industry.

Could it possibly be that the problems with our country's health system (be they of the health insurance type or the health care type; the two are quite different, after all, though they get conflated a lot) have absolutely diddly squat to do with the "profit motive"?

Could it possibly be that said problems actually have to do with, say, the kind of increasingly byzantine ... regulations ... that, over the course of the last 20/30 years or so, have resulted in so many of our nation's "best and brightest" minds "needing" to devote their talents/skills to navigating said increasingly byzantine system that, at the end of said last 20/30 years, 5 of the 10 wealthiest counties in our country are now neighboring ... Washington, D.C.?

ps:

Profit ≠ Graft

entspeak
QUOTE(akaCG @ Mar 17 2017, 10:39 PM) *
QUOTE(entspeak @ Mar 17 2017, 08:00 AM) *
...
... I think the only way to do this is to remove profit from the equation when it comes to insurance - a single payer system. ...
...

Chances of dying after a month without food, on average: about 100%. Chances of dying after a month without health insurance, on average: about 0%.

Yet, amazingly, no one of any note has proposed removing "profit from the equation" in regards to the former industry.

Could it possibly be that the problems with our country's health system (be they of the health insurance type or the health care type; the two are quite different, after all, though they get conflated a lot) have absolutely diddly squat to do with the "profit motive"?

Could it possibly be that said problems actually have to do with, say, the kind of increasingly byzantine ... regulations ... that, over the course of the last 20/30 years or so, have resulted in so many of our nation's "best and brightest" minds "needing" to devote their talents/skills to navigating said increasingly byzantine system that, at the end of said last 20/30 years, 5 of the 10 wealthiest counties in our country are now neighboring ... Washington, D.C.?

ps:

Profit ≠ Graft


You're clearly joking, right?

An item of food is significantly less expensive than the cost of a drug that one might need to keep one alive. If you can't afford the drug, you die. So, chance of dying without insurance is not 0%. The analogy is preposterous. Which regulations are the problem, exactly?

Never made the general statement that Profit = Graft. So, you can put that straw man away.
Mrs. Pigpen
QUOTE(entspeak @ Mar 18 2017, 06:32 AM) *
Which regulations are the problem, exactly?


Regulations create a huge administrative layer that is very inefficient.
And the regulations are burdensome,and the administrators very very well paid (same thing is happening in higher education...different regulations, same dynamic).
Imagine for a moment that you were performing in a play and at that exact time you were also required to be in the basement of the theatre checking to make sure everyone was (still) wearing socks every two hours...or you'll lose your job or license to be an actor. Imagine if you're also required NOT to leave your post...you must stay in the play at all times too.
Add about ten other impossible conflicts and you have the rough equivalent of what it is like to be a floor nurse.

Different example, but still regulation-related: In most of the rest of the world (at least the parts I've lived in in Europe and Asia), a person can go to a pharmacist, fill out a form and tell the pharmacist their symptoms, and get a drug that would require a doctor's visit and prescription here).

Regulations are part of the equation, but they're not the only factor (see Veterinarian costs, a far less regulated industry).
entspeak
QUOTE(Mrs. Pigpen @ Mar 18 2017, 07:58 AM) *
QUOTE(entspeak @ Mar 18 2017, 06:32 AM) *
Which regulations are the problem, exactly?


Regulations create a huge administrative layer that is very inefficient.
And the regulations are burdensome,and the administrators very very well paid (same thing is happening in higher education...different regulations, same dynamic).
Imagine for a moment that you were performing in a play and at that exact time you were also required to be in the basement of the theatre checking to make sure everyone was (still) wearing socks every two hours...or you'll lose your job or license to be an actor. Imagine if you're also required NOT to leave your post...you must stay in the play at all times too.
Add about ten other impossible conflicts and you have the rough equivalent of what it is like to be a floor nurse.

Are these government regulations dictating this?

QUOTE
Different example, but still regulation-related: In most of the rest of the world (at least the parts I've lived in in Europe and Asia), a person can go to a pharmacist, fill out a form and tell the pharmacist their symptoms, and get a drug that would require a doctor's visit and prescription here).


And we're talking about places with public insurance, right?

QUOTE
Regulations are part of the equation, but they're not the only factor (see Veterinarian costs, a far less regulated industry).

For profit industries need to be regulated and virtually every one is in some way, shape, or form. What people fail to be learning from history is that, given the opportunity, many for-profit industries will put an interest in profit over the interest of the customer/client. In many industries that may not be too much of a problem, I just don't think that healthcare should be a for-profit industry. I was watching Secretary Price answer questions in the recent town hall and that was what struck me primarily. The problem is less about the government and more about the fact that insurance companies, understandably, need to make a profit. Giving everyone coverage in a private insurance system is counter to that... it is not in the interest of an insurance company to cover someone who is high risk. That means less profit. Which means they raise premiums. Obamacare didn't solve this dilemma and the AHCA won't solve it either.
akaCG
QUOTE(Mrs. Pigpen @ Mar 18 2017, 08:58 AM) *
QUOTE(entspeak @ Mar 18 2017, 06:32 AM) *
Which regulations are the problem, exactly?


Regulations create a huge administrative layer that is very inefficient.
And the regulations are burdensome,and the administrators very very well paid (same thing is happening in higher education...different regulations, same dynamic).
...

The above point, starkly illustrated:

http://isaacmorehouse.com/2016/04/30/every...-gets-involved/

And you're absolutely right about the similar dynamics that have been in play in higher education:

http://www.the-american-interest.com/2014/...strative-bloat/

EDITED TO ADD:

QUOTE(entspeak @ Mar 18 2017, 07:32 AM) *
QUOTE(akaCG @ Mar 17 2017, 10:39 PM) *
QUOTE(entspeak @ Mar 17 2017, 08:00 AM) *
...
... I think the only way to do this is to remove profit from the equation when it comes to insurance - a single payer system. ...
...

Chances of dying after a month without food, on average: about 100%. Chances of dying after a month without health insurance, on average: about 0%.

Yet, amazingly, no one of any note has proposed removing "profit from the equation" in regards to the former industry.

Could it possibly be that the problems with our country's health system (be they of the health insurance type or the health care type; the two are quite different, after all, though they get conflated a lot) have absolutely diddly squat to do with the "profit motive"?

Could it possibly be that said problems actually have to do with, say, the kind of increasingly byzantine ... regulations ... that, over the course of the last 20/30 years or so, have resulted in so many of our nation's "best and brightest" minds "needing" to devote their talents/skills to navigating said increasingly byzantine system that, at the end of said last 20/30 years, 5 of the 10 wealthiest counties in our country are now neighboring ... Washington, D.C.?

ps:

Profit ≠ Graft


You're clearly joking, right?

An item of food is significantly less expensive than the cost of a drug that one might need to keep one alive. If you can't afford the drug, you die. So, chance of dying without insurance is not 0%. The analogy is preposterous. ...
...

Please note my use of the term "on average" above (now highlighted). It's important.

QUOTE(entspeak @ Mar 18 2017, 07:32 AM) *
...
Never made the general statement that Profit = Graft. So, you can put that straw man away.

1.
The statement I made is Profit "does NOT equal" Graft.

Nonetheless, ...

2.
I'm sorry, "entspeak". I should have provided at least some elaboration on that bit of my post, so that it would have been clear that I wasn't addressing anything you had said. My bad and, therefore, my apologies.

What I meant to convey is that ...

Our health insurance system(as well as health care system; again, they are not to be conflated) does not have "profit" problem. It has a "rent seeking" problem. Hence, for instance, my reference to the 5 counties neighboring ... Washington, D.C..

ps:

Capitalism ≠ Crony Capitalism

EDITED TO ADD:

ps2:

An interesting example of the "rent seeking" problem I mentioned above involves ... the EpiPen.

QUOTE
...
Americans throw away unused epinephrine auto-injectors worth more than $1 billion annually. Or maybe it would be more accurate to say that Americans waste more than $1 billion annually on $50 million worth of epinephrine auto-injectors that are discarded unused. The devices should only cost $20 a pair. So, why do they cost $608 instead? ...
...
Why is a 40-year old technology still so expensive? Much of the blame is due to the U.S. Food and Drug Administration and the way drugs are regulated in the United States. The backlog of generic drug applications awaiting the FDA’s approval is nearly 4,000 applications. Thus, competitors who want to enter the market cannot do so for several years. In addition, safety improvements made to the design of the EpiPen over the years can be patented. Although the initial patent (or patents) likely expired in the 1990s, a new patent was issued on some aspect of the EpiPen in 2005, which will not expire until 2025. The FDA will not approve a generic based on an earlier model, say a 1975 auto-injector design, if the currently patent holder has identified potential problems in the earlier design and incorporated safety features that boost efficacy or safety. ...
...
Drug maker Mylan bought the rights to the (then) 30-year old epinephrine auto-injector in 2007. At the time, one pen sold for about $57. By August 2016, Mylan had jacked up the price to more than $300. A generic EpiPen that was to be sold by Israeli drug maker, Teva, suffered setbacks that will delay their product by a year. The FDA recently declined to approve Teva’s version until it resolved some concerns. A talking epinephrine auto-injector made by French drug maker Sanofi was recalled because a couple dozen of its units supposedly administered inaccurate doses. There is speculation that Sanofi may never return its Auvi-Q to the market.

To make matters worse, in 2010 the government decided one dose of epinephrine is not enough that for about 10 percent of anaphylaxis patients and advised people with serious allergies to have two EpiPens available at all times. Mylan took advantage of the government recommendation and now the only way to buy EpiPens is a twin-pack with a list price of $608. Families with serious allergies or asthma often have two EpiPens at work or school and two more for at home in case of emergency. A significant affordability problem is that epinephrine is unstable when exposed to heat and light. Thus, EpiPens expire after an expected life of only one year. Of course, most are never used before expiring. To not experience a life threatening allergic reaction is a good thing. But that also means patients are expected to throw out $1,200 worth of unused EpiPens every year and purchase new ones annually.
...
Doctors like to only prescribe what they trust. Many may not even know about the competing epinephrine auto-injector, Adrenaclick. According to Consumer Reports, a twin-pack can be purchased a Walmart for $145 with a GoodRx coupon. Unfortunately, regulations in most states prevent pharmacists from substituting the $145 Adrenaclick for the $608 EpiPen. Schools may not want parents to send their kids to class with an Adrenaclick because teachers and school nurses are used to the EpiPen. These are all reasons Mylan’s EpiPen enjoys an 85 percent market share. To get the cheaper version, patients must ask their doctors to prescribe the Adrenaclick or a “generic epinephrine auto-injector.”

Twenty dollars. That’s probably about how much a generic EpiPen twin-pack would cost if the FDA approved an over-the-counter version or a version pharmacists could dispense to patients without a doctor’s prescription. Greater access could potentially save lives by making epinephrine more widely available. An OTC version would also save Americans nearly $1 billion a year.
...

Link: http://healthblog.ncpa.org/epipen-a-case-s...h.sYpAssAK.dpbs

More:
QUOTE
...
the government made a couple of interventions in the market that allowed the manufacturer to raise prices above the free-market level. The federal government changed its guidelines such that the EpiPens have to be sold in packages of two (while customers might prefer just one, or at least an odd number). Also, the federal government gave public-emergency grants to states on condition they stockpile EpiPens.

Further, the Food and Drug Administration has hindered other manufacturers’ ability to compete. Those with differentiated products (which do not infringe the patents) have struggled for market access. A competing device which entered the market in 2013 had to withdraw in 2015 after 26 potential malfunctions in the U.S. and Canada, in which it delivered the wrong dose. However, according to the FDA’s own report of the recall:

None of these device malfunction reports have been confirmed. ...
...
... By creating an environment in which EpiPen prices are higher than otherwise, the federal government may have made them unaffordable to many families. That will cause more harm than 26 unconfirmed cases of bad dosing by its now unavailable competitor.
...

Link: http://healthblog.ncpa.org/epipen-a-case-s...h.aFuVvgtk.dpbs

Yet more:
QUOTE
...
According to a report in the Washington Examiner, drug maker Mylan lobbied the U.S. Preventive Services Task Force to require insurers to pay the full price of EpiPens by deeming the drug delivery device a preventative measure. Under the Affordable Care Act, health plans must cover preventive services 100% without cost-sharing regardless of whether deductibles have been met. EpiPens are used by people with severe allergies who go into anaphylactic shock. They are not used to prevent anaphylaxis, they treat the symptoms once it occurs. For example, under ACA regulations, a flu shot is a preventive medicine. Once you have the flu, seeing your doctor for Tamiflu would be a treatment, not a prevention.
...

Link: http://healthblog.ncpa.org/epipen-maker-lo...h.eg7yicGV.dpbs

ps3:

The more complex a regulatory system is, the more it benefits individuals/institutions who have the resources to navigate it. Good for Big Capital, Big Labor and ... of course ... Big Government. Not so good for the rest of us "peons".
Mrs. Pigpen
QUOTE(entspeak @ Mar 17 2017, 08:00 AM) *
QUOTE(Mrs. Pigpen @ Mar 18 2017, 07:58 AM) *

Regulations create a huge administrative layer that is very inefficient.
And the regulations are burdensome,and the administrators very very well paid (same thing is happening in higher education...different regulations, same dynamic).
Imagine for a moment that you were performing in a play and at that exact time you were also required to be in the basement of the theatre checking to make sure everyone was (still) wearing socks every two hours...or you'll lose your job or license to be an actor. Imagine if you're also required NOT to leave your post...you must stay in the play at all times too.
Add about ten other impossible conflicts and you have the rough equivalent of what it is like to be a floor nurse.

Are these government regulations dictating this?


Yes, government creates the regulations and then there's an administrative layer (both government and private) that interprets, negotiates, enforces, develops the standards around the regulations. Often the private orgs have a hand in creating the regulations (not ALL regulations are bad, obviously, and that's the rub...everyone wants safety in medical practice). I've found interpretation of standards, and regulations, differ with the type of facility too (also, individual facilities differ).

QUOTE
QUOTE
Different example, but still regulation-related: In most of the rest of the world (at least the parts I've lived in in Europe and Asia), a person can go to a pharmacist, fill out a form and tell the pharmacist their symptoms, and get a drug that would require a doctor's visit and prescription here).


And we're talking about places with public insurance, right?


Yes. But their regulations are different from ours (and their pharmacists had a different level of responsibility). In areas I was familiar with, South Korea and Italy (unless things have changed a lot since then, which is possible) the pharmacies were privately owned and operated. No chains or large franchises. A person could go to the counter, describe their symptoms to the pharmacist, and pay cash for the medicine (though not if it was a controlled substance of course). I'm ignorant of the exact medication allowed to be administered and exact policy regulating them...of course they had regulations, just different ones.

AkaCG is right about the FDA.
One thing I'd like to see is medical reciprocity with Europe and other First World countries. Currently and pharma company that wants their medication approved in both the US and Europe has to spend a billion or so dollars getting it approved by the FDA, and then another billion or so dollars getting it approved by the Europeans. A lot of pharma companies don’t want to bother, with the end result that Europe has many good medications that America doesn’t, and vice versa.
From that blogger I linked to earlier:
QUOTE
Burdensome approval process for generic medications (SSC, more SSC). How come Martin Shkreli can hike the dose of an off-patent toxoplasma drug 5000%, and everyone just has to take it lying down even though the drug itself is so easy to produce that high school chemistry classes make it just to show they can? The reason is that every new company that makes a drug, even a widely-used generic drug that’s already been proven safe, has to go through a separate approval process that costs millions of dollars and takes two to three years – and which other companies in the market constantly try to sabotage through legal action. Shkreli can get away with his price hike because he knows that by the time the FDA gives anyone permission to compete with him, he’ll have made his fortune and moved on to his next nefarious scheme. If the FDA allowed reputable pharmaceutical companies in good standing to produce whatever generic drugs they wanted, the same as every other company is allowed to make whatever products they want, scandals like Daraprim and EpiPens would be a thing of the past, and the price of many medications could decrease by an order of magnitude.


QUOTE(akaCG @ Mar 18 2017, 07:30 PM) *


Yep, picture is worth a million words.

To tie it in with education, from Professor Doom's blog

QUOTE
Let’s take a look at snippets from this 2012 report, and the gentle reader should realize our government, which supposedly was formed to protect us from something-or-other, does nothing of the sort. I’m not saying we shouldn't have a government to protect us, by the way…but I’m certain we don’t need a government to provide gigantic flows of tax dollars via the student loan scam to well known and quite documented frauds.

Unlike traditional non-profit and public colleges, virtually all of the revenues of for-profit colleges come directly from taxpayers, and significant portions of their expenses are dedicated to marketing and recruiting and to profit.


While in the “public” higher education system the primary expense is to support a bloated administrative class, the for-profit system spends a great deal of money on marketing. Google’s biggest advertiser is University of Phoenix, for example, which used to spend hundreds of thousands of dollars day on Google ads. There’s big, big money in higher ed thanks to the student loan scam, but first you have to find the suckers willing to check a box qualifying the loans.

Federal taxpayers are investing billions of dollars a year, $32 billion in the most recent year, in companies that operate for-profit colleges. Yet, more than half of the students who enrolled in (sic) in those colleges in 2008-9 left without a degree or diploma within a median of 4 months.


There’s no accountability in this system. Students are pulled in, sucked dry of loan money as quickly as possible, then spit out deep in debt. Now, I grant the public colleges do much the same, but since they’re paid via tax dollars and the “butts in seats” model, the students get trapped in the system much longer.

The for-profit system is simply more efficient at looting that loan money, plundering in a few months what takes our public college plundering system years to accomplish. I guess this is a bad thing, though I hope someday the Federal government will take a more careful look at what’s going on in public colleges.
entspeak
I certainly agree that the FDA is part of the problem. One of the reasons we don't get generic versions is that the foxes have the keys to the chicken coop. There are many conflicts of interest because of the financial ties many involved with the FDA have to pharmaceutical companies. I don't know if this also plays a role in delaying approval.
Hobbes
QUOTE(entspeak @ Mar 19 2017, 10:00 AM) *
I certainly agree that the FDA is part of the problem. One of the reasons we don't get generic versions is that the foxes have the keys to the chicken coop. There are many conflicts of interest because of the financial ties many involved with the FDA have to pharmaceutical companies. I don't know if this also plays a role in delaying approval.


I have to chuckle, sadly, when I listen to most advertisements for drugs on air these days. You listen to all the KNOWN potential side effects, which seem to include DEATH in increasing numbers, and then you think 'and these are the drugs that got approved?'

I totally get that drugs are going to have side effects, but if we are going to allow drugs like these on the market, it certainly should NOT take years and years and years to get them approved. Because given the list of serious side effects allowed, why should it take so long?

I suspect part of the answer to that gets back to one of most important drivers of health care costs in the U.S.--litigation, and litigation insurance. Doctors pay sometimes more than half of their income towards malpractice insurance. You don't need to look any farther than that to see why health care costs so much here. And that's not even including the excess of tests that are run not for medical necessity, but to cover the doctor in case of litigation. It is a HUGE burden, and one that clearly doesn't lead to any health benefit. We get nothing for all this extra money we pay...no better coverage, no better care, no lower costs..nothing. A lot of the FDA approval process strikes me as something along these lines...extensive additional testing designed to cover litigation, rather than improve health care. Otherwise...why do we have the longest approval process, with no better quality coming out the other end?
akaCG
QUOTE(entspeak @ Mar 17 2017, 09:00 AM) *
...
... Despite paying more for healthcare in the US, we have higher mortality rates and poorer overall health than places that have public insurance.
...

International comparisons have long been recognized as less than useful for practical purposes. Reason being that countries vary in how (and even whether) they account for the various factors involved. In recognition of that, the OECD began a project to harmonize matters more than 10 years ago. Last I checked (3 or 4 years ago, IIRC), they're not quite there yet.

1. "Despite paying more for healthcare in the US, ...":
QUOTE
...
... normal market forces have been so suppressed throughout the developed world that purchasers rarely see a real price for any medical service. As a result, summing over all transactions produces aggregate numbers in which one can have little confidence. In addition, other countries more aggressively disguise costs, especially by suppressing provider incomes.

Economists have long known that international health care spending comparisons are fraught with potential error. Even for uncomplicated dental fillings, reimbursement data underestimate total costs by 50% in nine European countries.3 Countries account for long term care and out-of-pocket spending differently. The accounting treatment of overhead and capital costs also varies.4 An OECD project to harmonize national accounting methods began in 2000, but even when methods are harmonized, the choice of a price adjustment method can alter hospital cost estimates by as much as 400%.5
...


2. "... we have higher mortality rates ...":
QUOTE
...
... Comparing cancer outcomes, the largest international study to date found that the five-year survival rate for all types of cancer among both men and women was higher in the US than in Europe.18 US women have a 63% chance of living at least five years after a cancer diagnosis, compared with 56% for European women. Survival after diagnosis of breast cancer was 90% and 79%, respectively. Men in the US have a five-year survival rate of 66%, compared to only 47% for European men. Survival after diagnosis of prostate cancer was 99% and 78%, respectively.19
...
... The rate of adverse events in US hospitals is only about half that in England, Australia, and New Zealand.22 ... Fewer health and disability related problems occur among US spinal cord injury patients than among Canadian and British patients.24

The US has better relative survival rates than Norway for colorectal and breast cancer, lower rates of vaccine-preventable pertussis, measles, and Hepatitis B, and shorter waiting lists.25 ...
...
... the mortality rate in Canada is 25% higher for breast cancer, 18% higher for prostate cancer, and 13% higher for colorectal cancer.31
...


Source: http://www.ncpa.org/pdfs/sp_Do_Other_Count...the_Answers.pdf


3. "... and poorer overall health than places that have public insurance.":

Interestingly, but not at all surprisingly, overall health does not correlate very well at all with accessibility to health insurance or health care. What it does seem to correlate very well with is one's lifestyle choices/habits, particularly ... one's diet. Which goes a long way toward explaining why ... the overall health and life expectancy of Americans of Japanese descent are remarkably similar to those of Japanese in Japan, ... the overall health and life expectancy of Americans of Scandinavian descent are remarkably similar to those of Scandinavians in Scandinavia, ... the overall health and life expectancy of Americans of Mexican descent are remarkably similar to those of Mexicans in Mexico (after adjusting for the fact that murder has overtaken diabetes as the top cause of Mexican mens' mortality, and such), ... etc.
Hobbes
QUOTE(akaCG @ Mar 19 2017, 05:58 PM) *
QUOTE(entspeak @ Mar 17 2017, 09:00 AM) *
...
3. "... and poorer overall health than places that have public insurance.":


Interestingly, but not at all surprisingly, overall health does not correlate very well at all with accessibility to health insurance or health care. What it does seem to correlate very well with is one's lifestyle choices/habits, particularly ... one's diet. Which goes a long way toward explaining why ... the overall health and life expectancy of Americans of Japanese descent are remarkably similar to those of Japanese in Japan, ... the overall health and life expectancy of Americans of Scandinavian descent are remarkably similar to those of Scandinavians in Scandinavia, ... the overall health and life expectancy of Americans of Mexican descent are remarkably similar to those of Mexicans in Mexico (after adjusting for the fact that murder has overtaken diabetes as the top cause of Mexican mens' mortality, and such), ... etc.


Exactly. This was the huge flaw in the approach that Obamacare took...it addressed the wrong problem. The problem in the U.S. is not lack of health insurance. That is a SYMPTOM. The problem is that health care costs too much. And until we fix that, we can't afford health coverage for everyone. Look at the already projected UNFUNDED deficits for Medicaid and Medicare running tens of trillions of dollars. We have unfunded liabilities right now that are 3 times the WORLD GDP. Is extending health care coverage going to solve that??? NO!


QUOTE
life expectancy of Americans of Mexican descent are remarkably similar to those of Mexicans in Mexico (after adjusting for the fact that murder has overtaken diabetes as the top cause of Mexican mens' mortality, and such), ... etc.


To further elaborate on this point, assuming health coverage were the cause, one could only lament all those murder victims...if only they had health insurance, they somehow wouldn't.... be dead?
entspeak
QUOTE(akaCG @ Mar 19 2017, 05:58 PM) *
International comparisons have long been recognized as less than useful for practical purposes. Reason being that countries vary in how (and even whether) they account for the various factors involved. In recognition of that, the OECD began a project to harmonize matters more than 10 years ago. Last I checked (3 or 4 years ago, IIRC), they're not quite there yet.

And, even according to the OECD, as of the latest numbers, we spend more on healthcare per capita in the US, than in the U.K, and we have a lower life expectancy.

First, one disease is not all diseases. Second, it has been argued that US cancer survival rates are artificially inflated by overdiagnosis of cancers that weren't going to end up killing someone in the first place. So, there's a lot of overdiagnosis going on. And, despite this amazing survival rate in the US, deaths from cancer are not significantly lower in the US compared to other countries.

According to the OECD's latest figures for death by cancer per 100,000 people: US - 190; UK 222; Norway 200... out of 100,000. That's 0.19%, 0.22%, and 0.20%. Now, relative to cost per capita, is this a better result?

There is no doubt that lifestyle choices have the greatest impact on health, but we, as a nation, also have little interest in promoting healthier lifestyle choices.

But, when it comes to healthcare itself, we don't negotiate the cost of healthcare, the insurance companies do. And prices for services vary from plan to plan... there is no fixed cost for a service... it is, basically, get the maximum possible. But, we, as the insured don't even know what that price will be. The cost of a lab test can vary wildly... for the same test, depending on who the patient is (not what their illness is, but whether or not they are insured, what insurance they have, and whether or not it is in-network or out-of-network.) That's ridiculous.

In a single-payer system, you'd have one price negotiator, you'd have one price for everyone.
akaCG
QUOTE(entspeak @ Mar 20 2017, 11:56 AM) *
QUOTE(akaCG @ Mar 19 2017, 05:58 PM) *
International comparisons have long been recognized as less than useful for practical purposes. Reason being that countries vary in how (and even whether) they account for the various factors involved. In recognition of that, the OECD began a project to harmonize matters more than 10 years ago. Last I checked (3 or 4 years ago, IIRC), they're not quite there yet.

And, even according to the OECD, as of the latest numbers, we spend more on healthcare per capita in the US, than in the U.K, and we have a lower life expectancy.
...

1.
As I mentioned earlier, the OECD hasn't yet managed to solve the problems that render international comparisons less than useful for practical purposes. IOW, even its latest numbers don't paint a sufficiently accurate picture.

For an idea of just how intractable this problem is, consider the following, which involves two developed countries that could hardly be more similar in all sorts of respects (bolding and coloring mine):
QUOTE
...
Why is there such a gap between health expenditures and outcomes in Norway compared to Finland?

According to the OECD Norway spends 47% more on health care per capita compared to Finland and about 30% more than the other Nordic countries. At the same time indicators of health status show that Norway is not better on important indicators of health. This raises the question of why there is such a gap between spending and outcome in Norway compared to the other Nordic countries. This paper lists a number of possible explanations and quantifies their importance. The conclusion is that higher wages may explain up to 38% of the difference between Norway and Finland and differences in staff levels explain about 25%. Data errors are difficult to quantify, but the data on in long term care suggests that it accounts for at least 20% of the difference. ...
...

Link: https://www.researchgate.net/publication/46...ared_to_Finland

Related (bolding mine):
QUOTE
...
Countries are often ranked based on health spending per capita. The ranking is sometimes used to argue in favor of more health spending if the country is low on the list or as an indicator of inefficiency when a country is ranked high in spending but low on indicators of health. For instance, Jacobs and Skocpol (2010) use the OECD figures to argue that "other nations get hugely more bang for the bucks than the United States Does." Similarly Cutler and Ly (2011) argue that the gap between spending and outcome in the US compared to other countries "raises the possibility of substantial waste." The OECD spending figures are also used in regressions that explore the relationship between spending and health status across time and countries (See Nixon and Ulmann, 2006, for a review of 38 papers using spending as an independent variable). All this makes the reliability of health spending figures important. If it turns out that the comparison differ because of accounting standards and adjustment methods, then we should be cautious when trying to draw analytical or policy implications from the rankings.

This article will investigate the extent to which spending and rankings vary depending on different adjustment methods based on information from the OECD Health Data. The analysis shows, first, that health spending figures differ significantly because of different accounting standards. More specifically, long term nursing care spending is not treated the same way in all the countries. Some countries classify it as a health expense, others classify it as social spending. Next, the rankings differ depending on whether spending is adjusted for purchasing power parity or not. This is to be expected. There is a reason one uses PPP adjustment – to adjust for price differences - and this reason implies that there should be some change after applying the adjustment. The true problem is that general PPP adjustment is misleading because the conclusions change if we use health specific purchasing power adjustment instead of using the general consumer price index. Finally, the paper examines the problem of how to quantify the degree to which an adjustment method changes the outcome of a comparison.
...
The OECD data on health spending is based on the system of health accounts (SHA). Total spending on health is defined as the sum of all private and public expenditure and investments in a set of sub- categories. One of these sub-categories is spending on long term nursing care (LTNC). This is an important category and for some countries it constitutes about 25% of all health care spending. However, as shown in Table 1, the reported numbers differ greatly between countries. Some report very little spending on long term nursing care. Even countries that are geographically and institutionally similar, such as the Nordic countries, report very different numbers. This raises the suspicion that a major component of total spending is mismeasured.1 To what extent this is a problem depends on whether the missing spending is simply classified in another sub-category that is included in the total, or whether it is excluded from health spending overall. If countries just differ in terms of which sub-category they use to report their expenses, the total will still be comparable.

Data and documentation from the OECD itself indicate that the problem is not just differences in sub- classification among health expenses. The guidelines for how to treat spending on long term nursing care is vague about whether long term care is a social expense or a health expense. This vagueness has led to different practices in different countries. As shown in Table 1, countries which report little spending on long term nursing care, tend to report more spending on long term social care (LTSC). Since spending on long term social care by definition is not health spending, this difference implies that the figures for total health spending are misleading because of differences in accounting standards.
...
The fact that international comparisons of health spending is sensitive to accounting differences and adjustment methods is not new. This paper has contributed with some new examples of how large the problem is, but the underlying issues have been known for a long time. For instance, Gerdtham and Jönsson described many of the same problems and conducted similar calculations more than 20 years ago. Despite several on- (and long-) going projects by the OECD and the WHO, the problem remains. This raises the question of whether the empirical and conceptual problems are too large to conduct useful international comparisons of health expenditure. The usefulness of a specific adjustment and comparison depends on the aim. If the aim is simply to say something about the volume of health services, then it may be better to stick to natural units in a multidimensional measure. It seems cumbersome and, given the limitations in data and method, unreliable to measure volume in money and then to adjust it for differences in prices in order to get back to a volume measure. Advances in data collection and method may make it more reliable and in some cases perfect precision is not needed to draw conclusions.5 At the very least one should be aware of the problems. Knowing that the comparison can give almost any result depending on the methods used, is important knowledge in itself since it may vaccinate against unguarded policy conclusions based on an isolated and misleading comparison.
...

Link: https://www.researchgate.net/publication/25...of_the_problems


2.
Life expectancy is the statistic most frequently trotted out during these discussions/debates, yet ...
QUOTE
...
Life expectancy is a poor statistic for determining the efficacy of a health care system because it fails the first criterion of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die "in their sleep," in a car accident or of some medical ailment before an ambulance ever arrives. If an individual dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic.

Life expectancy also largely violates the second criterion - a health care system has, at most, minimal impact on longevity. One way to see this is to reexamine the table constructed by the Center for Economic and Policy Research. The interpretation that the Center for Economic and Policy Research wants readers to derive from Table 1 is that the United States would be better off with a system of universal health care. However, a careful examination of that table yields a more accurate interpretation: There is no relationship between life expectancy and spending on health care. Greece, the country that spends the least per capita on health care, has higher life expectancy than seven other countries, including Belgium, Denmark, Finland, Germany, Netherlands, the United Kingdom and the United States. Spain, which spends the second least per capita on health care, has higher life expectancy than ten other countries that spend more.
...
... Studies of multiple countries using regression analysis found no significant relationship between life expectancy and the number of physicians and hospital beds per 100,000 population or health care expenditures as a percentage of GDP. Rather, life expectancy was associated with factors such as sanitation, clean water, income, and literacy rate.8 A recent study examined cross-national data from 1980 to 1998. Although the regression model used initially found an association between health care expenditure and life expectancy, that association was no longer significant when gross domestic product (GDP) per capita was added to the model.9 Indeed, GDP per capita is one of the more consistent predictors of life expectancy.
...
... Yet the United States has the highest GDP per capita in the world, so why does it have a life expectancy lower than most of the industrialized world? The primary reason is that the U.S. is ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds - culture, diet, etc. - can have a substantial impact on life expectancy. Comparisons of distinct ethnic populations in the U.S. with their country of origin find similar rates of life expectancy. For example, Japanese-Americans have an average life expectancy similar to that of Japanese.10

A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years.11 What accounts for the difference? Numerous scholars have investigated this question.12 The most prevalent explanations are differences in income and personal risk factors. One study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.13 Another study found that much of the disparity was due to higher rates of HIV, diabetes and hypertension among African Americans.14 Even studies that suggest the health care system may have some effect on the disparity still emphasize the importance of factors such as income, education, and social environment.15

A plethora of factors influence life expectancy, including genetics, lifestyle, diet, income and educational levels. A health care system has, at best, minimal impact. Thus, life expectancy is not a statistic that should be used to inform the public policy debate on health care.
...

Link: http://www.nationalcenter.org/NPA547ComparativeHealth.html

QUOTE(entspeak @ Mar 20 2017, 11:56 AM) *
...
First, one disease is not all diseases. ...
...

Cancer is the second leading cause of death in the OECD countries, so it's a biggie. But, by all means, please provide non-cancer based comparisons. Looking forward to them.

QUOTE(entspeak @ Mar 20 2017, 11:56 AM) *
...
Second, it has been argued that US cancer survival rates are artificially inflated by overdiagnosis of cancers that weren't going to end up killing someone in the first place. So, there's a lot of overdiagnosis going on. ...
...

I hope you're not under the impression that the U.S. is alone in terms of suffering from what you (interestingly) characterize as "artificially inflated" cancer diagnoses. 'Cause it most certainly isn't. Australia, for instance: "Overdiagnosis from mammography screening"

QUOTE(entspeak @ Mar 20 2017, 11:56 AM) *
...
... And, despite this amazing survival rate in the US, deaths from cancer are not significantly lower in the US compared to other countries.

According to the OECD's latest figures for death by cancer per 100,000 people: US - 190; UK 222; Norway 200... out of 100,000. That's 0.19%, 0.22%, and 0.20%. Now, relative to cost per capita, is this a better result?
...

Let me get this straight:

On the one hand, right above, you are downplaying the fact that the UK death-by-cancer rate is about 17% higher than the US rate thereof, ...

... while, earlier in this very post, ...

You were touting the fact that UK life expectancy (about 81 years) is higher than that in the US (about 79), a difference that happens to amount to about ... 3%.

Really?

QUOTE(entspeak @ Mar 20 2017, 11:56 AM) *
...
There is no doubt that lifestyle choices have the greatest impact on health, ...
...

Yup. There isn't any doubt about that. Very, very glad to see that you and I agree on that.

QUOTE(entspeak @ Mar 20 2017, 11:56 AM) *
...
... but we, as a nation, also have little interest in promoting healthier lifestyle choices.
...

Which particular dietary plan would you like to see the 300,000,000+ of "[us], as a nation" be collectively promoted into following? Atkins? WeightWatchers? South Beach? NutriSystem? Other(s)?

Which particular exercise activities would you like to see the 300,000,000+ of "[us], as a nation" be collectively promoted into following? Jazzercise? CrossFit? P90X? Yoga? Tai Chi? Other(s)?

And, most importantly, who would be in charge of getting the 300,000,000+ of "[us], as a nation" to adopt said "healthier lifestyle choices"?

Reason I ask the last question, btw, is because ...

The timing of the last major, comprehensive, widely trumpeted effort on the part of our government to provide the rest of "[us], as a nation" with guidance regarding dietary matters (i.e. the "Food Pyramid" back in 1990 or so) happens to have coincided with the timing of the beginning of the acceleration in our nation's obesity rate toward its current state.
QUOTE
...
In 1990, obese adults made up less than 15 percent of the population in most U.S. states. By 2010, 36 states had obesity rates of 25 percent or higher, and 12 of those had obesity rates of 30 percent or higher. (1)

Today, nationwide, roughly two out of three U.S. adults are overweight or obese (69 percent) and one out of three is obese (36 percent). (2) ...
...

Link: https://www.hsph.harvard.edu/nutritionsourc...mic-of-obesity/

entspeak
It isn't 17% higher, it's 15% higher, but the figures themselves are not much different when you put them in context. It's like saying eating 25% more of a single apple means something significant in an apple orchard with thousands of apples.

Why are you linking to a 2009 article to refute the accuracy of 2013 data?

Cancer is the only area where he US has lower mortality rates. http://kff.org/slideshow/mortality-rates-i...ries-slideshow/

Again, considering the significant difference in the cost of care for individuals, the results don't seem worth the expense.
akaCG
QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
It isn't 17% higher, it's 15% higher, ...
...

It's both, as it happens. It just depends on whether you divide the difference (32) into the UK rate (222), or into the US rate (190). The former yields 14.4%, the latter 16.8%. Let's split the difference and agree on ... 15.6%.

QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
... but the figures themselves are not much different when you put them in context. It's like saying eating 25% more of a single apple means something significant in an apple orchard with thousands of apples.
...

Yet, you pointed to life expectancy comparisons in support of the "U.S. health care sux by comparison" argument, despite the fact that your analogy above would be about 5 times more applicable to it.

QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
Why are you linking to a 2009 article to refute the accuracy of 2013 data?
...

Because the problems that plagued international comparisons back then have yet to be resolved (to my knowledge; if you find evidence to the contrary, please share). As such, for purposes of our discussion/debate here, the only thing that can be said about 2013 OECD data versus 2009 OECD data is that the former is ... more recent.

QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
Cancer is the only area where he US has lower mortality rates. http://kff.org/slideshow/mortality-rates-i...ries-slideshow/
...

That's a mighty important area to be good at, wouldn't you say? It is, after all, the second leading cause of death in our and the other OECD countries.

QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
Again, considering the significant difference in the cost of care for individuals, the results don't seem worth the expense.

Simple solution:

Find a way to reduce the U.S. income per capita (about $56,000) down to, say, the U.K. income per capita (about $41,000). That way, we here in the U.S. won't have any of that extra per capita $15,000 to play with, in terms of deciding which portion of it to spend on a knee or hip replacement/gastric bypass procedure/etc./etc./etc..

Point being:

Much of the reason why we in the U.S. spend more money on health care related stuff than other countries is because, ... we have more money to do so with. Just like, in the example I cited earlier, ...

Much of the reason why Norwegians spend more money on health care related stuff than their Finn neighbors is because, ... they have more money to do so with.

entspeak
QUOTE(akaCG @ Mar 21 2017, 06:45 PM) *
QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
... but the figures themselves are not much different when you put them in context. It's like saying eating 25% more of a single apple means something significant in an apple orchard with thousands of apples.
...

Yet, you pointed to life expectancy comparisons in support of the "U.S. health care sux by comparison" argument, despite the fact that your analogy above would be about 5 times more applicable to it.

If there is a flaw in my argument, it doesn't excuse a flaw in yours.

QUOTE
QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
Why are you linking to a 2009 article to refute the accuracy of 2013 data?
...

Because the problems that plagued international comparisons back then have yet to be resolved (to my knowledge; if you find evidence to the contrary, please share). As such, for purposes of our discussion/debate here, the only thing that can be said about 2013 OECD data versus 2009 OECD data is that the former is ... more recent.

No, no, no. The onus isn't on me to prove that the current OECD data doesn't suffer from the same problems, the onus is on you to show that it does.

QUOTE
QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
Cancer is the only area where he US has lower mortality rates. http://kff.org/slideshow/mortality-rates-i...ries-slideshow/
...

That's a mighty important area to be good at, wouldn't you say? It is, after all, the second leading cause of death in our and the other OECD countries.

If you can find some connection between private insurance and cancer survivability, then this might mean something. As it stands, cancer survival rates do not serve as a good indicator as to whether or not private or public insurance is better.

http://www.factcheck.org/2009/08/cancer-ra...ed-conclusions/

QUOTE
QUOTE(entspeak @ Mar 20 2017, 11:35 PM) *
...
Again, considering the significant difference in the cost of care for individuals, the results don't seem worth the expense.

Simple solution:

Find a way to reduce the U.S. income per capita (about $56,000) down to, say, the U.K. income per capita (about $41,000). That way, we here in the U.S. won't have any of that extra per capita $15,000 to play with, in terms of deciding which portion of it to spend on a knee or hip replacement/gastric bypass procedure/etc./etc./etc..

Point being:

Much of the reason why we in the U.S. spend more money on health care related stuff than other countries is because, ... we have more money to do so with. Just like, in the example I cited earlier, ...

Much of the reason why Norwegians spend more money on health care related stuff than their Finn neighbors is because, ... they have more money to do so with.


No, Norwegians spend more than Finns because Norwegians must first pay a deductible each year before becoming eligible for coverage - Finns don't have that. Where are you getting the information that higher income means higher healthcare costs in countries with public insurance.
akaCG
QUOTE(entspeak @ Mar 22 2017, 10:38 AM) *
...
... Where are you getting the information that higher income means higher healthcare costs in countries with public insurance.

GDP per capita (descending order):

1. Norway ($69000)
2. Sweden ($48000)
3. Germany ($47000)
4. Denmark ($46000)
5. Iceland ($46000)
6. Finland ($41000)
7. France ($41000)
8. U.K. ($41000)
9. Italy ($36000)
10. Portugal ($28,000)

Health expenditures per capita (descending order):

1. Norway ($6600)
2. Germany ($5300)
3. Sweden ($5200)
4. Denmark ($4900)
5. France ($4400)
6. Iceland ($4000)
7. Finland ($4000)
8. U.K. ($4000)
9. Italy ($3300)
10. Portugal ($2600)

See the ranking correlation?

Sources:
https://en.wikipedia.org/wiki/List_of_count...nd_dependencies
https://en.wikipedia.org/wiki/List_of_count...and_Development

entspeak
QUOTE(akaCG @ Mar 22 2017, 12:13 PM) *
QUOTE(entspeak @ Mar 22 2017, 10:38 AM) *
...
... Where are you getting the information that higher income means higher healthcare costs in countries with public insurance.

GDP per capita (descending order):

1. Norway ($69000)
2. Sweden ($48000)
3. Germany ($47000)
4. Denmark ($46000)
5. Iceland ($46000)
6. Finland ($41000)
7. France ($41000)
8. U.K. ($41000)
9. Italy ($36000)
10. Portugal ($28,000)

Health expenditures per capita (descending order):

1. Norway ($6600)
2. Germany ($5300)
3. Sweden ($5200)
4. Denmark ($4900)
5. France ($4400)
6. Iceland ($4000)
7. Finland ($4000)
8. U.K. ($4000)
9. Italy ($3300)
10. Portugal ($2600)

See the ranking correlation?

Sources:
https://en.wikipedia.org/wiki/List_of_count...nd_dependencies
https://en.wikipedia.org/wiki/List_of_count...and_Development


I see this:

GDP may help gauge per capital income, but it isn't income in and of itself, and it is a gauge of mean income - which doesn't account for wealth inequality. And, even then... Norway, for example has significant wealth inequality, but, unlike in the US, financial assets aren't necessary for higher education or healthcare, so the impact of wealth inequality isn't nearly as big. Wealth inequality doesn't impact people's access to healthcare in Norway.

Also, total health expenditures doesn't reflect how those expenditures are paid, or distributed among the population - it doesn't reflect how much people actually pay.
akaCG
QUOTE(entspeak @ Mar 22 2017, 03:47 PM) *
QUOTE(akaCG @ Mar 22 2017, 12:13 PM) *
QUOTE(entspeak @ Mar 22 2017, 10:38 AM) *
...
... Where are you getting the information that higher income means higher healthcare costs in countries with public insurance.

GDP per capita (descending order):

1. Norway ($69000)
2. Sweden ($48000)
3. Germany ($47000)
4. Denmark ($46000)
5. Iceland ($46000)
6. Finland ($41000)
7. France ($41000)
8. U.K. ($41000)
9. Italy ($36000)
10. Portugal ($28,000)

Health expenditures per capita (descending order):

1. Norway ($6600)
2. Germany ($5300)
3. Sweden ($5200)
4. Denmark ($4900)
5. France ($4400)
6. Iceland ($4000)
7. Finland ($4000)
8. U.K. ($4000)
9. Italy ($3300)
10. Portugal ($2600)

See the ranking correlation?

Sources:
https://en.wikipedia.org/wiki/List_of_count...nd_dependencies
https://en.wikipedia.org/wiki/List_of_count...and_Development


I see this:

GDP may help gauge per capital income, but it isn't income in and of itself, and it is a gauge of mean income - which doesn't account for wealth inequality. And, even then... Norway, for example has significant wealth inequality, but, unlike in the US, financial assets aren't necessary for higher education or healthcare, so the impact of wealth inequality isn't nearly as big. Wealth inequality doesn't impact people's access to healthcare in Norway.

Also, total health expenditures doesn't reflect how those expenditures are paid, or distributed among the population - it doesn't reflect how much people actually pay.

Wealth/income inequality within a country and the particular degree of progressiveness of its health care system are irrelevant in terms of the question of whether a country's aggregate wealth/income correlates with its aggregate health care expenditure levels. As you can see from the data I presented above, even in countries with universal health care/public insurance, not only is there a correlation, but it's quite a strong one.

Which, of course, makes perfect sense. After all, there's no such thing as "free health care". Each and every health care good/service costs something. And the more wealth/income a country generates, the more its average/mean citizens (one way or another; directly or indirectly) can afford to pay for health care goods/services.


ps (not directed specifically to you, "entspeak", but to the ad.gif population in general):

Isn't it wonderfully reassuring to know that one can continue to rely on the fact that the laws of supply and demand continue to be so reliably inviolable that they work even in countries with ... cough ... "free" health care?

entspeak
QUOTE(akaCG @ Mar 22 2017, 08:40 PM) *
QUOTE(entspeak @ Mar 22 2017, 03:47 PM) *
QUOTE(akaCG @ Mar 22 2017, 12:13 PM) *
QUOTE(entspeak @ Mar 22 2017, 10:38 AM) *
...
... Where are you getting the information that higher income means higher healthcare costs in countries with public insurance.

GDP per capita (descending order):

1. Norway ($69000)
2. Sweden ($48000)
3. Germany ($47000)
4. Denmark ($46000)
5. Iceland ($46000)
6. Finland ($41000)
7. France ($41000)
8. U.K. ($41000)
9. Italy ($36000)
10. Portugal ($28,000)

Health expenditures per capita (descending order):

1. Norway ($6600)
2. Germany ($5300)
3. Sweden ($5200)
4. Denmark ($4900)
5. France ($4400)
6. Iceland ($4000)
7. Finland ($4000)
8. U.K. ($4000)
9. Italy ($3300)
10. Portugal ($2600)

See the ranking correlation?

Sources:
https://en.wikipedia.org/wiki/List_of_count...nd_dependencies
https://en.wikipedia.org/wiki/List_of_count...and_Development


I see this:

GDP may help gauge per capital income, but it isn't income in and of itself, and it is a gauge of mean income - which doesn't account for wealth inequality. And, even then... Norway, for example has significant wealth inequality, but, unlike in the US, financial assets aren't necessary for higher education or healthcare, so the impact of wealth inequality isn't nearly as big. Wealth inequality doesn't impact people's access to healthcare in Norway.

Also, total health expenditures doesn't reflect how those expenditures are paid, or distributed among the population - it doesn't reflect how much people actually pay.

Wealth/income inequality within a country and the particular degree of progressiveness of its health care system are irrelevant in terms of the question of whether a country's aggregate wealth/income correlates with its aggregate health care expenditure levels. As you can see from the data I presented above, even in countries with universal health care/public insurance, not only is there a correlation, but it's quite a strong one.

Which, of course, makes perfect sense. After all, there's no such thing as "free health care". Each and every health care good/service costs something. And the more wealth/income a country generates, the more its average/mean citizens (one way or another; directly or indirectly) can afford to pay for health care goods/services.


ps (not directed specifically to you, "entspeak", but to the ad.gif population in general):

Isn't it wonderfully reassuring to know that one can continue to rely on the fact that the laws of supply and demand continue to be so reliably inviolable that they work even in countries with ... cough ... "free" health care?


I know that people end up paying for healthcare in some way shape or form. You're talking about something completely different than what is the issue faced by many in this country. The concern for your average American is not the nation's healthcare expenditures averaged per capita. That's not useful information. The are concerned about how much is coming out of their pockets - that's usually gauged as a percentage of income spent on healthcare. Pretty much everyone in Norway spends roughly 8% of their annual income on healthcare in the form of a national insurance tax that is taken out of their paycheck - like social security is here.
akaCG
QUOTE(entspeak @ Mar 23 2017, 01:06 PM) *
...
... You're talking about something completely different than what is the issue faced by many in this country. The concern for your average American is not the nation's healthcare expenditures averaged per capita. That's not useful information. The are concerned about how much is coming out of their pockets - that's usually gauged as a percentage of income spent on healthcare. ...
...

OK, let's take a look at how things pan out from that perspective:

Average annual wage:

U.S.A.: $59,000
Norway: $51,000

Denmark: $50,000
Germany: $45,000
France: $41,000
Sweden: $41,000
U.K.: $41,000
Italy: $34,000


Out-of-pocket health care expenditures per capita:

U.S.A.: $1,100
Norway: $900

Sweden: $726
Italy: $666
Germany: $649
Denmark: $625
U.K.: $321
France: $277


Resulting in, …

Percent of average wage devoted to out-of-pocket health care expenditures:

Italy: 2.0%
U.S.A.: 1.9%
Norway: 1.8%
.
Sweden: 1.8%
Germany: 1.4%
Denmark: 1.3%
France: 0.7%
U.K.: 0.7%

QUOTE(entspeak @ Mar 23 2017, 01:06 PM) *
...
... Pretty much everyone in Norway spends roughly 8% of their annual income on healthcare in the form of a national insurance tax that is taken out of their paycheck - like social security is here.

Not quite. The average (mean?) Norwegian ends up spending a total of roughly 12.9% of his average (mean?) annual wage income on health care ($6,600/$51,000). In comparison, the average (mean?) American ends up spending a total of roughly 16.1% of his average (mean?) annual wage on health care ($9,500/$59,000).

Summarized:

The average (mean?) American spends about 23% more of his average (mean?) paycheck on health care than the average (mean?) Norwegian. Meanwhile, the average (mean?) American's annual paycheck is about 15% higher than that of the average (mean?) Norwegian.

Personally, I don't find that juxtaposition to be anywhere near being problematic enough to justify a wholesale overhaul of our country's health care system, such that it would be like Norway's. If you think it does, please explain why.


Sources:
https://en.wikipedia.org/wiki/List_of_count...OECD_statistics
http://international.commonwealthfund.org/...ocket_spending/
https://en.wikipedia.org/wiki/List_of_count...and_Development
entspeak
QUOTE(akaCG @ Mar 23 2017, 05:43 PM) *
QUOTE(entspeak @ Mar 23 2017, 01:06 PM) *
...
... You're talking about something completely different than what is the issue faced by many in this country. The concern for your average American is not the nation's healthcare expenditures averaged per capita. That's not useful information. The are concerned about how much is coming out of their pockets - that's usually gauged as a percentage of income spent on healthcare. ...
...

OK, let's take a look at how things pan out from that perspective:

Average annual wage:

U.S.A.: $59,000
Norway: $51,000

Denmark: $50,000
Germany: $45,000
France: $41,000
Sweden: $41,000
U.K.: $41,000
Italy: $34,000


Out-of-pocket health care expenditures per capita:

U.S.A.: $1,100
Norway: $900

Sweden: $726
Italy: $666
Germany: $649
Denmark: $625
U.K.: $321
France: $277


Resulting in, …

Percent of average wage devoted to out-of-pocket health care expenditures:

Italy: 2.0%
U.S.A.: 1.9%
Norway: 1.8%
.
Sweden: 1.8%
Germany: 1.4%
Denmark: 1.3%
France: 0.7%
U.K.: 0.7%

QUOTE(entspeak @ Mar 23 2017, 01:06 PM) *
...
... Pretty much everyone in Norway spends roughly 8% of their annual income on healthcare in the form of a national insurance tax that is taken out of their paycheck - like social security is here.

Not quite. The average (mean?) Norwegian ends up spending a total of roughly 12.9% of his average (mean?) annual wage income on health care ($6,600/$51,000). In comparison, the average (mean?) American ends up spending a total of roughly 16.1% of his average (mean?) annual wage on health care ($9,500/$59,000).

Summarized:

The average (mean?) American spends about 23% more of his average (mean?) paycheck on health care than the average (mean?) Norwegian. Meanwhile, the average (mean?) American's annual paycheck is about 15% higher than that of the average (mean?) Norwegian.

Personally, I don't find that juxtaposition to be anywhere near being problematic enough to justify a wholesale overhaul of our country's health care system, such that it would be like Norway's. If you think it does, please explain why.


Sources:
https://en.wikipedia.org/wiki/List_of_count...OECD_statistics
http://international.commonwealthfund.org/...ocket_spending/
https://en.wikipedia.org/wiki/List_of_count...and_Development


When I said "out of their pockets," I wasn't referring solely to the term "out-of-pocket" costs (which doesn't include premiums or how much comes out of your paycheck.)

The tax for health insurance is 8.1% in Norway (10.7% for self-employed), this is deducted from paychecks. But, it is fixed. https://www.nav.no/en/Home/Rules+and+regula...e+contributions

In the US, the percentage of your income that goes to healthcare varies from place to place and plan to plan. We wish that only 1.9% of our income went to healthcare.

So, I don't know what you believe the figures your citing actually refer to or what they are based on (the links provide no guidance.)
akaCG
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
When I said "out of their pockets," I wasn't referring solely to the term "out-of-pocket" costs (which doesn't include premiums or how much comes out of your paycheck.)
...

Ah, OK.

QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
The tax for health insurance is 8.1% in Norway (10.7% for self-employed), this is deducted from paychecks. But, it is fixed. https://www.nav.no/en/Home/Rules+and+regula...e+contributions
...

Yes, the percentage is fixed. But the amounts, obviously, vary with income. So, people making 250K end up paying 5 times more for the very same insurance coverage than people making the average wage (about 50K). Can you imagine the voters' uproar if our government pushed for a policy to do that here?

QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
In the US, the percentage of your income that goes to healthcare varies from place to place and plan to plan. ...
...

Yes, it does. So? What's the problem with different people making different choices regarding what proportion of their income to devote to health care, just like they do regarding what proportion of their income to devote to housing, eating out, transportation, vacation travel, etc.?

QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
... We wish that only 1.9% of our income went to healthcare.
...

As do the Norwegians, obviously.


QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
So, I don't know what you believe the figures your citing actually refer to or what they are based on (the links provide no guidance.)

What they refer to, as I hope is clear now, are the amounts that are universally defined as "out of pocket", i.e. what people pay on top of their health care related insurance premiums and taxes (in whatever combination).

One of the many difficulties with cross-country comparisons is precisely that. In Norway, insurance premiums are (mostly) a public sector item. In the U.S., they're (mostly) a private sector matter. And there's a bewildering degree of variation among countries in regards to which proportion thereof is public vs private sector.

That's why cross-country analyses are done at the aggregate level (e.g. looking at PPP-adjusted GDP per capita, dividing total health spending per capita into it, etc.). Like it or not, it's simply not really feasible to do it any other way.

ps:
Some illuminating reading (warning:really long, and it gets really statistical analysis-heavy, really fast):

"High US health care spending is quite well explained by its high material standard of living"

I found it via this article, which also makes for interesting reading:
QUOTE
...
"America spends more on health care than other rich nations, but has lower life expectancy." If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system.

As with many political memes, its usefulness to policy wonks is inversely proportional to the weight that its casual proponents place on it. As stated, this meme is true enough: America does have higher health-care costs than anywhere else, and we do indeed have shorter life expectancies than some nations. But of course people are not introducing these facts as a fun bit of trivia, like “Babe Ruth used to wear a cabbage leaf under his baseball cap to keep cool.” What they are actually interested in communicating is the implication that America could switch to a single-payer health-care system and thereby enjoy longer life expectancies at lower cost. And that implication is considerably more dubious.
...
... When you actually look at our spending, you see that even before Obamacare, America spent more on its government systems as a percentage of GDP than many of the comparison countries we’re supposed to emulate -- this to cover a fraction of the population. Somehow, getting the government involved did not make American health care cheap.

That’s because policy is path dependent: What you did yesterday determines what you can do today. No government system in the world has actually lowered health-care costs on any sustained basis, absent something like the Greek financial crisis that forces a sudden and drastic reduction in government spending. Lowering health-care spending means denying treatments, closing hospitals, and cutting provider salaries. Politically, this has proven impossible.
...
... We aren’t a nation that has a cost-growth problem; we’re a nation that had a problem a couple of decades ago, when we failed to keep costs from outpacing the hog-wild inflation of the 1970s. Which means that we can’t even hope to get our costs down in the future, relative to other countries, by switching to a more government-driven system now, as many people have suggested when I pointed this out.

Why are memes like this so compelling? Because they’re easy. But the whole truth is not so easy. And solutions for Americans' health-care complaints? Those are really hard.
...

Link: https://www.bloomberg.com/view/articles/201...care-not-really

EDITED TO ADD ...

Another item for comparison purposes: waiting times, which also carry costs, be it in terms of money, general well being and, occasionally, lives. From the 2016 Commonwealth Survey (from worst to best):

Q:"Last time you were sick or needed medical attention, how quickly could you get a same- or next-day appointment to see a doctor or a nurse?"

Norway: 43%
U.S.A.: 51%


Q:"[Did you have to wait] 4 or more hours last time [you] went to the hospital emergency department[?]"

Norway: 13%
U.S.A.: 11%

Q:"[Did you have to wait] 4 weeks or longer to see a specialist after [you] were advised or decided to see one in the last 2 years?"

Norway: 52%
U.S.A.: 24%

Q:"[Did you have to wait] 4 months or longer for elective surgery in the last 2 years?"

Norway: 15%
U.S.A.: 3%

Link (click on the "How Canada Compares: ..." link on the right hand side of the page; PDF file): https://www.cihi.ca/en/commonwealth-fund-survey-2016

entspeak
QUOTE(akaCG @ Mar 24 2017, 01:29 PM) *
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
When I said "out of their pockets," I wasn't referring solely to the term "out-of-pocket" costs (which doesn't include premiums or how much comes out of your paycheck.)
...

Ah, OK.

QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
The tax for health insurance is 8.1% in Norway (10.7% for self-employed), this is deducted from paychecks. But, it is fixed. https://www.nav.no/en/Home/Rules+and+regula...e+contributions
...

Yes, the percentage is fixed. But the amounts, obviously, vary with income. So, people making 250K end up paying 5 times more for the very same insurance coverage than people making the average wage (about 50K). Can you imagine the voters' uproar if our government pushed for a policy to do that here?

I know, I know... for all the talk of Christian values, the US doesn't quite have the spirit. People in these other countries tend to have a different view of their role in society. But, it's really the only way to get everyone covered.

QUOTE
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
In the US, the percentage of your income that goes to healthcare varies from place to place and plan to plan. ...
...

Yes, it does. So? What's the problem with different people making different choices regarding what proportion of their income to devote to health care, just like they do regarding what proportion of their income to devote to housing, eating out, transportation, vacation travel, etc.?

You think people "decide" the percentage of their income that will be spent on healthcare like they do these other things? It's not like going to the Aldi instead of Whole Foods. Going out to dinner or eating in, walking or driving a car, going Euro-hopping or to Branson, MO. Is it? The choice is, do I get knee replacement surgery or live in pain for the rest of my life.

QUOTE
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
So, I don't know what you believe the figures your citing actually refer to or what they are based on (the links provide no guidance.)

What they refer to, as I hope is clear now, are the amounts that are universally defined as "out of pocket", i.e. what people pay on top of their health care related insurance premiums and taxes (in whatever combination).

One of the many difficulties with cross-country comparisons is precisely that. In Norway, insurance premiums are (mostly) a public sector item. In the U.S., they're (mostly) a private sector matter. And there's a bewildering degree of variation among countries in regards to which proportion thereof is public vs private sector.

That's why cross-country analyses are done at the aggregate level (e.g. looking at PPP-adjusted GDP per capita, dividing total health spending per capita into it, etc.). Like it or not, it's simply not really feasible to do it any other way.

ps:
Some illuminating reading (warning:really long, and it gets really statistical analysis-heavy, really fast):

"High US health care spending is quite well explained by its high material standard of living"

I found it via this article, which also makes for interesting reading:
QUOTE
...
"America spends more on health care than other rich nations, but has lower life expectancy." If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system.

As with many political memes, its usefulness to policy wonks is inversely proportional to the weight that its casual proponents place on it. As stated, this meme is true enough: America does have higher health-care costs than anywhere else, and we do indeed have shorter life expectancies than some nations. But of course people are not introducing these facts as a fun bit of trivia, like “Babe Ruth used to wear a cabbage leaf under his baseball cap to keep cool.” What they are actually interested in communicating is the implication that America could switch to a single-payer health-care system and thereby enjoy longer life expectancies at lower cost. And that implication is considerably more dubious.
...
... When you actually look at our spending, you see that even before Obamacare, America spent more on its government systems as a percentage of GDP than many of the comparison countries we’re supposed to emulate -- this to cover a fraction of the population. Somehow, getting the government involved did not make American health care cheap.

That’s because policy is path dependent: What you did yesterday determines what you can do today. No government system in the world has actually lowered health-care costs on any sustained basis, absent something like the Greek financial crisis that forces a sudden and drastic reduction in government spending. Lowering health-care spending means denying treatments, closing hospitals, and cutting provider salaries. Politically, this has proven impossible.
...
... We aren’t a nation that has a cost-growth problem; we’re a nation that had a problem a couple of decades ago, when we failed to keep costs from outpacing the hog-wild inflation of the 1970s. Which means that we can’t even hope to get our costs down in the future, relative to other countries, by switching to a more government-driven system now, as many people have suggested when I pointed this out.

Why are memes like this so compelling? Because they’re easy. But the whole truth is not so easy. And solutions for Americans' health-care complaints? Those are really hard.
...

Link: https://www.bloomberg.com/view/articles/201...care-not-really


Yes, it's hard. Other countries have managed to do it, though and with substantial approval from the population.


QUOTE
EDITED TO ADD ...

Another item for comparison purposes: waiting times, which also carry costs, be it in terms of money, general well being and, occasionally, lives. From the 2016 Commonwealth Survey (from worst to best):

Q:"Last time you were sick or needed medical attention, how quickly could you get a same- or next-day appointment to see a doctor or a nurse?"

Norway: 43%
U.S.A.: 51%


Q:"[Did you have to wait] 4 or more hours last time [you] went to the hospital emergency department[?]"

Norway: 13%
U.S.A.: 11%

Q:"[Did you have to wait] 4 weeks or longer to see a specialist after [you] were advised or decided to see one in the last 2 years?"

Norway: 52%
U.S.A.: 24%

Q:"[Did you have to wait] 4 months or longer for elective surgery in the last 2 years?"

Norway: 15%
U.S.A.: 3%

Link (click on the "How Canada Compares: ..." link on the right hand side of the page; PDF file): https://www.cihi.ca/en/commonwealth-fund-survey-2016


Do these questions address the severity of the illnesses? They don't seem to. Of course, if you go to the ED and you don't actually have an emergency, you're going to wait. In Canada, despite the wait times, 75% are happy with their health care system.

Look at the site you mention: https://www.cihi.ca/sites/default/files/doc...ble-en-web.xlsx

It is quite telling with regard to how bad our healthcare system is. Check out cost barriers to care. The difference between Norway and the US is pretty stark.

Look at the overview of the quality of care. The US has the lowest. So, yes, people wait longer... do they really care? With 75% of people believing their medical care was good or better, I'd say not. In the US... not so much.

So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.
AuthorMusician
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

But not as badly as the Republican replacement would have been, and most of us know it.

The very recent retreat from repeal/replace has a lot of ramifications, but the most obvious one is that the ACA, even with all its problems, is a whole lot better than what we had before. A much more subtle thing is that the ACA can be improved via future legislation. Since Republicans can't get their poo together on this, the improvements will have to come from somewhere else. You know, from some other party that's on the same page regarding health care, one that understands how insurance works, and one that doesn't have a huge faction of ideologues way, way, way over there beyond the edge.

https://www.youtube.com/watch?v=Gq_bjaI0NTo
entspeak
QUOTE(AuthorMusician @ Mar 25 2017, 09:57 AM) *
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

But not as badly as the Republican replacement would have been, and most of us know it.

The very recent retreat from repeal/replace has a lot of ramifications, but the most obvious one is that the ACA, even with all its problems, is a whole lot better than what we had before. A much more subtle thing is that the ACA can be improved via future legislation. Since Republicans can't get their poo together on this, the improvements will have to come from somewhere else. You know, from some other party that's on the same page regarding health care, one that understands how insurance works, and one that doesn't have a huge faction of ideologues way, way, way over there beyond the edge.

https://www.youtube.com/watch?v=Gq_bjaI0NTo

When that party comes into existence, let me know.
akaCG
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
QUOTE(akaCG @ Mar 24 2017, 01:29 PM) *

...
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
The tax for health insurance is 8.1% in Norway (10.7% for self-employed), this is deducted from paychecks. But, it is fixed. https://www.nav.no/en/Home/Rules+and+regula...e+contributions
...

Yes, the percentage is fixed. But the amounts, obviously, vary with income. So, people making 250K end up paying 5 times more for the very same insurance coverage than people making the average wage (about 50K). Can you imagine the voters' uproar if our government pushed for a policy to do that here?

I know, I know... for all the talk of Christian values, the US doesn't quite have the spirit. ...
...

It would be interesting to test Norwegians' Christian values by way of making their health insurance tax rate progressive, as opposed to flat. I'm guessing such a policy would elicit a response along the lines of "Hell NO!".

QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
QUOTE(akaCG @ Mar 24 2017, 01:29 PM) *

...
QUOTE(entspeak @ Mar 24 2017, 01:33 AM) *
...
In the US, the percentage of your income that goes to healthcare varies from place to place and plan to plan. ...
...

Yes, it does. So? What's the problem with different people making different choices regarding what proportion of their income to devote to health care, just like they do regarding what proportion of their income to devote to housing, eating out, transportation, vacation travel, etc.?

You think people "decide" the percentage of their income that will be spent on healthcare like they do these other things? ...
...

I don't think so. I know so. I've been making those choices all of my adult life. So have tens of millions of our fellow citizens, year in year out, month in month out, day in day out. You've never heard of people comparing one plan's premium/deductible combination to another's and picking the one that best fits their needs/wants? You've never heard of people choosing to fill their prescription at Walmart instead of Costco, or CVS instead of Walgreens, etc.? You've never heard of people choosing one Lasik surgeon over another based on cost? You've never heard of people engaging in "medical tourism", whereby they, say, get on a plane to, say, Costa Rica to get their hip replacement on the basis that, even after flight and hotel costs, it's still cheaper for them to do so than getting it done locally? Etc., etc., etc., etc.?

QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
...
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

Interestingly, ...

From the spreadsheet you linked (bolding and coloring mine):

Q3 Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor’s practice/GP’s practice or clinic?

Excellent:

U.S.A: 41.0
Norway: 34.9

Very good:

U.S.A.: 32.0
Norway: 28.5

Good:

U.S.A.: 17.5
Norway: 19.4

Total Good through Excellent:

U.S.A.: 90.5
Norway: 82.8

And, for good measure, ...

Poor:

U.S.A.: 1.6
Norway: 2.6
entspeak
QUOTE(akaCG @ Mar 25 2017, 12:47 PM) *
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
...
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

Interestingly, ...

From the spreadsheet you linked (bolding and coloring mine):

Q3 Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor’s practice/GP’s practice or clinic?

Excellent:

U.S.A: 41.0
Norway: 34.9

Very good:

U.S.A.: 32.0
Norway: 28.5

Good:

U.S.A.: 17.5
Norway: 19.4

Total Good through Excellent:

U.S.A.: 90.5
Norway: 82.8

And, for good measure, ...

Poor:

U.S.A.: 1.6
Norway: 2.6


And, of course, there is no question asking the people who are uninsured in America this question because... oh, right... they don't have regular doctors. So, grain of salt on this one as a measure of satisfaction with the US healthcare system. I've never said that medical care in the US isn't good when you can afford it - that's not the issue here.

As for the system overall, if they didn't think it worked for them, they would go to a progressive system. It's just a different set of values. No reason for them to "test" anything.

I get insurance through my union... not much choice for me. When I have coverage, it's amazing and I don't need to shop.
akaCG
QUOTE(entspeak @ Mar 25 2017, 05:26 PM) *
QUOTE(akaCG @ Mar 25 2017, 12:47 PM) *
QUOTE(entspeak @ Mar 25 2017, 02:02 AM) *
...
So, we can talk numbers and how difficult it is to gauge cost, but the proof of the pudding is in the eating. By and large, the people in Canada, the U.K., and Norway like their healthcare systems despite the flaws. Ours is failing us.

Interestingly, ...

From the spreadsheet you linked (bolding and coloring mine):

Q3 Overall, how do you rate the medical care that you have received in the past 12 months from your regular doctor’s practice/GP’s practice or clinic?

Excellent:

U.S.A: 41.0
Norway: 34.9

Very good:

U.S.A.: 32.0
Norway: 28.5

Good:

U.S.A.: 17.5
Norway: 19.4

Total Good through Excellent:

U.S.A.: 90.5
Norway: 82.8

And, for good measure, ...

Poor:

U.S.A.: 1.6
Norway: 2.6


And, of course, there is no question asking the people who are uninsured in America this question because... oh, right... they don't have regular doctors. ...
...

I have a regular doctor. I have a regular dentist. I have a regular pharmacy where I get my prescription filled. Yet, ... I have no health insurance. I chose to go the "self-pay" route about 6 years ago, because my yearly out-of-pocket expenses are less than what I'd be paying out in premiums. There are millions like me, who've made the same choice for exactly the same reasons, yet who ("amazingly" enough) do indeed have a regular doctor, a regular dentist, and a regular pharmacy. Reason: doing it that way turns out to be more ... AFFORDABLE ... for us. That's especially true (see link below) of people who are younger than I am (mid-50s). We wouldn't mind at all being able to buy what used to not only be known as a "catastrophic" plan (high deductible in return for low premiums), but actually "behaved" like one. Alas, the Affordable Care Act (i.e. Obamacare) has resulted in such plans quickly becoming LESS AFFORDABLE than going "self-pay". Just another one o' dem "unintended" consequences of "feel good"/"do something" type policies./

Aforepromised link:

"Aetna CEO: Young people pick beer over Obamacare"

QUOTE(entspeak @ Mar 25 2017, 05:26 PM) *
...
As for the system overall, if they didn't think it worked for them, they would go to a progressive system. It's just a different set of values. No reason for them to "test" anything.
...

Nope. They (meaning Norwegians) would not. For the simple reason that they don't have much room left, in terms of the total (25% income tax + 8% health insurance tax + 25% VAT, etc.) tax burden that their average citizen could endure yet more of. If their government dared to propose that their health insurance tax rate should be made progressive instead of flat, even they (who you obviously think of as more Christian-like than your fellow U.S. citizens) would quickly get busy forming a, say, Taxed Enough Already type movement.

Even people who truly think of themselves as "egalitarians", let alone people who just "preen" that way, have a breaking point of the "Are you f***ing serious!!??!!??" type.
entspeak
QUOTE(akaCG @ Mar 25 2017, 08:40 PM) *
Nope. They (meaning Norwegians) would not. For the simple reason that they don't have much room left, in terms of the total (25% income tax + 8% health insurance tax + 25% VAT, etc.) tax burden that their average citizen could endure yet more of. If their government dared to propose that their health insurance tax rate should be made progressive instead of flat, even they (who you obviously think of as more Christian-like than your fellow U.S. citizens) would quickly get busy forming a, say, Taxed Enough Already type movement.

Even people who truly think of themselves as "egalitarians", let alone people who just "preen" that way, have a breaking point of the "Are you f***ing serious!!??!!??" type.


I owe no allegiance to my "fellow U.S. citizens" when it comes to the hypocrisy of their "Christian" values. I am more patriotic than nationalistic. The thing you are failing to grasp here is that Norwegians view inequality differently than you do. They are willing to pay more to help those less fortunate than themselves. I understand that this may be a difficult concept to grasp.

https://www.citylab.com/work/2017/01/how-no...erently/512852/



akaCG
QUOTE(entspeak @ Mar 26 2017, 01:01 PM) *
...
... The thing you are failing to grasp here is that Norwegians view inequality differently than you do. They are willing to pay more to help those less fortunate than themselves. I understand that this may be a difficult concept to grasp.

https://www.citylab.com/work/2017/01/how-no...erently/512852/

1.
Let's see now, ...

In Norway, bank senior executives and neurosurgeons have the same income tax rate and health insurance tax rate as bank clerks and nurses, and they pay no more for their childrens' education than bank clerks and nurses pay for theirs'. And ... there is no inheritance tax.

Yet ... it's the Norwegian system that's supposed to be viewed as the more "Christian" one???

I'm very impressed, I must say. How in the world did the rich in Norway manage to sell that notion to the rest of their fellow citizens, as well as to "egalitarians" elsewhere???

I mean, any time anyone in our country so much as suggests that the federal government should tax everyone's income at the same rate, the howls and screams of the "You hate poor people! You want to throw grandma off the cliff! Your health care policy is just to have people die early! And you call yourself a Christian??!!??" variety, from the very same people who extol the "Christian" virtues of, say, the Norwegian way of going about things, ... oh, boy!

2.
As far as the matter of "help[ing] those less fortunate than themselves" goes, it never ceases to amaze me that oh so many among us judge the generosity of a country's people solely on the basis of what proportion of its citizens' income that country's government takes and then redistributes. Which, of course, is only one part of the story. The other part of the story, courtesy of the Charities Aid Foundation 2015 Global Giving Index Survey, being ..

CAF World Giving Index Ranking:

1. Myanmar, with a score of 66
2. U.S.A., with a score of 61
3. New Zealand, with a score of 61
4. Canada, with a score of 60
5. Australia, with a score of 59
6. U.K., with a score of 57
...
...
...
...
...
...
...
14. United Arab Emirates, with a score of 50
15. Norway, with a score of 49
16. Guatemala, with a score of 49
17. Bhutan, with a score of 49
18. Kyrgyzstan, with a score of 49
19. Thailand, with a score of 48
20. Germany, with a score of 47

Link (Table 1, page 10; PDF): http://www.cafamerica.org/wp-content/uploa...EB_V2_FINAL.pdf
entspeak
As I said, I get how it would be difficult concept for you to grasp.
LoneWisdom
QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.


Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? Norway also has a 'Dutch disease' dependency on oil exports while attempting to hedge a downturn in oil with investments in the stock market, weighted toward a growing Chinese economy. A false prosperity will not benefit Norway when it suddenly loses its foundation combined with high young adult unemployment. Socialists depend heavily on others doing the heavy lifting. It has already been forced to withdraw from its investments to sustain its overly generous socialist safety net due to oil prices falling to $30 a barrel in 2016.

Norway seeks to diversify its economy as oil earnings plunge

Norway's Oil Shock

Risks Mount for World's Biggest Wealth Fund


Repeal ACA, don't replace. Have AMA doctors commit to pro bono work for those that can't afford health care. Insurance is for catastrophes, not for preexisting conditions. Cooperatives will provide better health care than creating multiple layers of collectors and claims 'managers.' Unwind other agencies that lead the U.S. down these unsustainable socialist tendencies. Stop depending on others to do the heavy lifting. It's unrealistic.


akaCG
QUOTE(LoneWisdom @ Mar 27 2017, 06:19 AM) *
QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.

Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? ...
...

Unfortunately, the answer to your question, I'm afraid, is: Nope.

On either side of the ideological/political/such "isle", it bears mentioning.

Both "Look at Norway!" type advocates, as well as "Look at Singapore!" type advocates shall, alas, always be with us.

entspeak
QUOTE(akaCG @ Mar 28 2017, 08:00 PM) *
QUOTE(LoneWisdom @ Mar 27 2017, 06:19 AM) *
QUOTE(entspeak @ Mar 26 2017, 11:44 PM) *
As I said, I get how it would be difficult concept for you to grasp.

Is there ever going to be an end to those attempting to scale economies based on populations the size of Metro Atlanta to the entire U.S. economy? ...
...

Unfortunately, the answer to your question, I'm afraid, is: Nope.

On either side of the ideological/political/such "isle", it bears mentioning.

Both "Look at Norway!" type advocates, as well as "Look at Singapore!" type advocates shall, alas, always be with us.

You were the one who said "Look at Norway!"
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