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Thread: The Heartland Institute’s Very Stupid New Medicare for All Report

  1. Top | #41
    Senior Member Canard DuJour's Avatar
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    Quote Originally Posted by southernhybrid View Post
    Not because I oppose it in principle, but because I find it very difficult to believe that the US would be able to provide decent care to all Americans if we adopted Medicare for All, I oppose it for practical reasons. No candidate so far seems to even understand the complexity involved in going from where we are now to a single payer system. Nobody has discussed how to deal with all of the fraud and abuse that exists in the current Medicare system. Nobody has discussed how hospitals will survive if they go from receiving the much higher payments that private insurance companies give them, to the much lower Medicare payments. Nobody has discussed where all of the money will come from to support such a system. It's insane to think the wealthy Americans have enough money to pay for it, even if they were taxed at 100 percent. Nobody has said how much more taxes the middle class would have pay to support such a system, or what percengage of doctors would simply become concierge providers. If you're not familiar that means doctors that only take cash for their services and sometimes charge a monthly fee for access. And, nobody had even mentioned that many other countries are having problems supporting their own UHC systems. Plus, nobody has discussed how to mange the insane cost of aggressive end of life care that many people expect and many doctors prescribe. That's just for starters. It's far more complicated than most people think. I did audits for Medicare patients, helped with billing and Medicare reviews etc. when I worked as a QA/UR nurse. It's very easy to abuse Medicare quide lines, by over or under utilizing based on how much profit would be made. I'm against health care for profit, but how the fuck do we get it out, when almost everything from hospice to hospitals, from drugs to long term care are based on profit. And, btw, in case you don't know, Medicare doesn't pay for long term care. There must be a better way to help more people get adequate care without causing chaos.

    The following is from an institution in Canada that describes itself as non partisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.

    Perhaps, as patients we expect too much. I know far too many people who run to their provider for every little sniffle, itch, or sore. I'm the extreme opposite, in that I put off medical exams until I'm sure I need one, and I refuse at least half of the tests and procedures ordered for me, at least in part because I don't want cause the system unnecessary expenses, but most people aren't like me. But, I digress.

    https://www.fraserinstitute.org/arti...gement-problem


    Government health spending is growing at unsustainable rates, while patients are facing shortages of medical resources and declining access to necessary medical care. The president of the Canadian Medical Association recently called on the federal government to become more involved in the management of provincial health systems in order to solve the serious problems plaguing Medicare. Unfortunately, the CMA president seriously misdiagnosed the cause of the health system’s ills.

    The Canadian health system has been run as a government monopoly since 1970. It doesn’t really matter which level of government tries to manage the system, our experience shows that political planning doesn’t work. Adding federal management would be as effective at averting disaster as rearranging the deck chairs on a sinking ship.

    The current health system does not have a “management” problem; it has an “economics” problem. The looming crisis in our system has three identifiable causes: the government’s monopoly over funding for medical care, the politically planned allocation of medical goods and services, and the lack of consumer exposure to the cost of using health care.

    Politically managed, 100 per cent redistributive financing produces a “pay more, get less” result: unsustainable cost growth and rationed access.

    According to a recent Fraser Institute study using provincial government data, total government spending on health grew at an average annual rate of 7.5 per cent across all provinces over the period from fiscal years 2000-2001 to 2009-2010. During the same period, total available provincial revenue from all sources, including federal transfers, grew at an average annual rate of only 5.7 per cent. At the same time the economy, measured by gross domestic product (GDP) grew by only 5.2 per cent.
    Do some of your own DD. Read articles from many sources. Many countries are having problems financing their health care programs. We need to be very careful before we adopt something that doesn't work. I'm not a political conservative in any way, but I am a realist. I want to see a realistic plan as to how we can go from the mess we have now to a better, more cost effective way of providing health care to all Americans. I haven't seen one yet from the candidates, although Biden's plan does sound a bit more rational than most of the others. Don't worry. I'm still going to vote for the Democratic nominee, regardless of who it is. Anybody else 2020!
    Look at Ray Dalio's suggestions which you've linked to in another thread :

    https://talkfreethought.org/showthre...hat-serves-all.

    As he suggests, healthcare spending - done properly - can pay for itself.

    How?

    Watch his video "How The Economic Machine Works". The key takeaway is that money is not consumed by spending, but circulates. The economy is not like a household. One man's spending is another's income. Healthcare (and education and infrastructure) spending have positive "fiscal multipliers", i.e. each dollar spent on them generates >$1 GDP, i.e. additional economic activity. Unless the economy is already running at capacity, in which case additional spending will compete for real resources, bid up their price and cause inflation.

    And, as Tom Sawyer points out, the Fraser Institute is anything but neutral. It's a Conservolibertarian think-tank funded by vested interests. For example, they cite an average annual 7.5% increase in healthcare costs in Canada against 5.2% increase in GDP as evidence of unsustainability. They neglect to mention that Canadian healthcare spending is 10% of its GDP, slighlty down recently.

    As the population ages and the productive capacity of current workers increases, healthcare spending as a %GDP should increase.

    The shatterproof heart of the matter is that almost every procedure and pharmaceutical costs more in the US than in UHC countries. If UHC isn't affordable, then the US model is even less affordable. But UHC is affordable. Most of the developed world has been affording it since nearly a century ago when GDP per capita was substantially lower despite increased ratio of retirees to current workers since then. That means it should be more affordable now.
    Last edited by Canard DuJour; 08-23-2019 at 04:03 PM.

  2. Top | #42
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    Quote Originally Posted by Tom Sawyer View Post
    Quote Originally Posted by dismal View Post

    I think you make the mistake of assuming everyone has the same priorities.

    But clearly if its not a priority to cut spending we can be pretty sure it won't be cut, so don't try to tell people it will cut spending. They don't believe you.
    You and I are clearly having two separate and unrelated conversations.
    No you're not. dismal is (again) dishoneslty throwing around a bunch of 'what about' and 'why not' bullshit with no intent to actually read your responses or glean anything from them.

    And you're responding as if he's being an honest interlocutor.

  3. Top | #43
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    Quote Originally Posted by Canard DuJour View Post
    Quote Originally Posted by southernhybrid View Post
    Not because I oppose it in principle, but because I find it very difficult to believe that the US would be able to provide decent care to all Americans if we adopted Medicare for All, I oppose it for practical reasons. No candidate so far seems to even understand the complexity involved in going from where we are now to a single payer system. Nobody has discussed how to deal with all of the fraud and abuse that exists in the current Medicare system. Nobody has discussed how hospitals will survive if they go from receiving the much higher payments that private insurance companies give them, to the much lower Medicare payments. Nobody has discussed where all of the money will come from to support such a system. It's insane to think the wealthy Americans have enough money to pay for it, even if they were taxed at 100 percent. Nobody has said how much more taxes the middle class would have pay to support such a system, or what percengage of doctors would simply become concierge providers. If you're not familiar that means doctors that only take cash for their services and sometimes charge a monthly fee for access. And, nobody had even mentioned that many other countries are having problems supporting their own UHC systems. Plus, nobody has discussed how to mange the insane cost of aggressive end of life care that many people expect and many doctors prescribe. That's just for starters. It's far more complicated than most people think. I did audits for Medicare patients, helped with billing and Medicare reviews etc. when I worked as a QA/UR nurse. It's very easy to abuse Medicare quide lines, by over or under utilizing based on how much profit would be made. I'm against health care for profit, but how the fuck do we get it out, when almost everything from hospice to hospitals, from drugs to long term care are based on profit. And, btw, in case you don't know, Medicare doesn't pay for long term care. There must be a better way to help more people get adequate care without causing chaos.

    The following is from an institution in Canada that describes itself as non partisan. Maybe our resident Canadian knows if it has any credibility. But, I have read many other articles about the problems with the British and the Canadian systems when it comes to financing. Considering the rabid increased costs of health care, I find these claims believable.

    Perhaps, as patients we expect too much. I know far too many people who run to their provider for every little sniffle, itch, or sore. I'm the extreme opposite, in that I put off medical exams until I'm sure I need one, and I refuse at least half of the tests and procedures ordered for me, at least in part because I don't want cause the system unnecessary expenses, but most people aren't like me. But, I digress.

    https://www.fraserinstitute.org/arti...gement-problem


    Government health spending is growing at unsustainable rates, while patients are facing shortages of medical resources and declining access to necessary medical care. The president of the Canadian Medical Association recently called on the federal government to become more involved in the management of provincial health systems in order to solve the serious problems plaguing Medicare. Unfortunately, the CMA president seriously misdiagnosed the cause of the health system’s ills.

    The Canadian health system has been run as a government monopoly since 1970. It doesn’t really matter which level of government tries to manage the system, our experience shows that political planning doesn’t work. Adding federal management would be as effective at averting disaster as rearranging the deck chairs on a sinking ship.

    The current health system does not have a “management” problem; it has an “economics” problem. The looming crisis in our system has three identifiable causes: the government’s monopoly over funding for medical care, the politically planned allocation of medical goods and services, and the lack of consumer exposure to the cost of using health care.

    Politically managed, 100 per cent redistributive financing produces a “pay more, get less” result: unsustainable cost growth and rationed access.

    According to a recent Fraser Institute study using provincial government data, total government spending on health grew at an average annual rate of 7.5 per cent across all provinces over the period from fiscal years 2000-2001 to 2009-2010. During the same period, total available provincial revenue from all sources, including federal transfers, grew at an average annual rate of only 5.7 per cent. At the same time the economy, measured by gross domestic product (GDP) grew by only 5.2 per cent.
    Do some of your own DD. Read articles from many sources. Many countries are having problems financing their health care programs. We need to be very careful before we adopt something that doesn't work. I'm not a political conservative in any way, but I am a realist. I want to see a realistic plan as to how we can go from the mess we have now to a better, more cost effective way of providing health care to all Americans. I haven't seen one yet from the candidates, although Biden's plan does sound a bit more rational than most of the others. Don't worry. I'm still going to vote for the Democratic nominee, regardless of who it is. Anybody else 2020!
    Look at Ray Dalio's suggestions which you've linked to in another thread :

    https://talkfreethought.org/showthre...hat-serves-all.

    As he suggests, healthcare spending - done properly - can pay for itself.

    How?

    Watch his video "How The Economic Machine Works". The key takeaway is that money is not consumed by spending, but circulates. The economy is not like a household. One man's spending is another's income. Healthcare (and education and infrastructure) spending have positive "fiscal multipliers", i.e. each dollar spent on them generates >$1 GDP, i.e. additional economic activity. Unless the economy is already running at capacity, in which case additional spending will compete for real resources, bid up their price and cause inflation.

    And, as Tom Sawyer points out, the Fraser Institute is anything but neutral. It's a Conservolibertarian think-tank funded by vested interests. For example, they cite an average annual 7.5% increase in healthcare costs in Canada against 5.2% increase in GDP as evidence of unsustainability. They neglect to mention that Canadian healthcare spending is 10% of its GDP, slighlty down recently.

    As the population ages and the productive capacity of current workers increases, healthcare spending as a %GDP should increase.

    The shatterproof heart of the matter is that almost every procedure and pharmaceutical costs more in the US than in UHC countries. If UHC isn't affordable, then the US model is even less affordable. But UHC is affordable. Most of the developed world has been affording it since nearly a century ago when GDP per capita was substantially lower despite increased ratio of retirees to current workers since then. That means it should be more affordable now.
    That really doesn't address the many complicated issues that I mentioned. Plus, I wasn't talking about UHC, as there are many ways to institute UHC. My problem is with Medicare for All, something that few people seem to understand. No politician has given a half way decent explanation as to how it would be implemented or financially supported.

    I see nothing wrong with expecting everyone to pay reasonable premium and copays, especially when you consider that lifestyle choices impact one's health to a large extent, yet most people make no attempt to change some of their unhealthy habits. The last I heard, even Medicaid recipients in my state are required to pay a 3 dollar copay. Medicare recipients pay 20% of out patient care, unless they purpose supplements which can be expensive. Those on the M of All bandwagon never mention copays or premiums.

    Anyway, I guess we will have to wait and see how things develop and whether or not it's possible to get enough support for some major changes after the next
    election. In the meantime, anyone else 2020 is my mantra.

  4. Top | #44
    Loony Running The Asylum ZiprHead's Avatar
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    Quote Originally Posted by southernhybrid View Post
    I see nothing wrong with expecting everyone to pay reasonable premium and copays, especially when you consider that lifestyle choices impact one's health to a large extent, yet most people make no attempt to change some of their unhealthy habits. The last I heard, even Medicaid recipients in my state are required to pay a 3 dollar copay. Medicare recipients pay 20% of out patient care, unless they purpose supplements which can be expensive. Those on the M of All bandwagon never mention copays or premiums.
    Sander's proposal is to eliminate most copays and deductibles.

    https://www.congress.gov/bill/116th-...bill/1129/text
    ITMFA

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  5. Top | #45
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    Quote Originally Posted by Canard DuJour View Post
    Watch his video "How The Economic Machine Works". The key takeaway is that money is not consumed by spending, but circulates. The economy is not like a household. One man's spending is another's income. Healthcare (and education and infrastructure) spending have positive "fiscal multipliers", i.e. each dollar spent on them generates >$1 GDP, i.e. additional economic activity. Unless the economy is already running at capacity, in which case additional spending will compete for real resources, bid up their price and cause inflation.
    Even if the economy isn't at 100% doesn't mean you won't get inflation--the economy isn't monolithic. Some real resources are already capacity-limited. (For example, look at what has happened to New York and San Francisco.)

    As the population ages and the productive capacity of current workers increases, healthcare spending as a %GDP should increase.
    And as healthcare technology improves spending should increase. When you save somebody rather than let them die because there's nothing you can do you still spent money.

    The shatterproof heart of the matter is that almost every procedure and pharmaceutical costs more in the US than in UHC countries. If UHC isn't affordable, then the US model is even less affordable. But UHC is affordable. Most of the developed world has been affording it since nearly a century ago when GDP per capita was substantially lower despite increased ratio of retirees to current workers since then. That means it should be more affordable now.
    I do agree we can afford it, but I don't think the current examples are adequate evidence. They all shortchange those who have expensive problems that can wait.

    My objection to is stems from the fact that it seems to universally have serious problems with inadequate capacity. I don't object to Medicare for all as an option, but I don't want to see it forced.

  6. Top | #46
    Senior Member Canard DuJour's Avatar
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    Quote Originally Posted by Loren Pechtel View Post

    Even if the economy isn't at 100% doesn't mean you won't get inflation--the economy isn't monolithic. Some real resources are already capacity-limited. (For example, look at what has happened to New York and San Francisco.)
    OK.

    And as healthcare technology improves spending should increase. When you save somebody rather than let them die because there's nothing you can do you still spent money.
    No idea what this is supposed to mean.

    The shatterproof heart of the matter is that almost every procedure and pharmaceutical costs more in the US than in UHC countries. If UHC isn't affordable, then the US model is even less affordable. But UHC is affordable. Most of the developed world has been affording it since nearly a century ago when GDP per capita was substantially lower despite increased ratio of retirees to current workers since then. That means it should be more affordable now.
    I do agree we can afford it, but I don't think the current examples are adequate evidence. They all shortchange those who have expensive problems that can wait.

    My objection to is stems from the fact that it seems to universally have serious problems with inadequate capacity. I don't object to Medicare for all as an option, but I don't want to see it forced.
    But then you have a long history of citing inadequate capacity stories which turn out to be nonsense. There's certainly some deliberate underfunding, but that's political.

  7. Top | #47
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    Quote Originally Posted by southernhybrid View Post
    I see nothing wrong with expecting everyone to pay reasonable premium and copays, especially when you consider that lifestyle choices impact one's health to a large extent, yet most people make no attempt to change some of their unhealthy habits.
    If I smoke or use tobacco should I have to pay an additional cost for my health insurance over and above what someone pays who does not smoke?

    If I am overweight should I have to pay an additional cost for my health insurance over and above what someone pays who is not overweight?

    If I have three speeding tickets on my record should I have to pay an additional cost for my auto insurance over and above what someone pays who does not have three speeding tickets?

    Should my auto insurance pay for my new engine because I did not check or ever change the oil?

    If I use tobacco, drink, am 80 pounds overweight and take diabetes medication, blood pressure medication, and cholesterol medication should I have to pay an additional cost for my health insurance and medications over and above what someone pays who does not smoke, is not overweight, does not smoke and does not need these medications?

    Should my auto insurer be allowed to deny my claim for a new engine simply because I never checked or changed the oil?

    Should there be any financial incentive of any kind in an insurance policy that would encourage a person to not need to make claims?

    I'll stop there for now.

  8. Top | #48
    Senior Member Alcoholic Actuary's Avatar
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    Quote Originally Posted by T.G.G. Moogly View Post
    Quote Originally Posted by southernhybrid View Post
    I see nothing wrong with expecting everyone to pay reasonable premium and copays, especially when you consider that lifestyle choices impact one's health to a large extent, yet most people make no attempt to change some of their unhealthy habits.
    If I smoke or use tobacco should I have to pay an additional cost for my health insurance over and above what someone pays who does not smoke?

    If I am overweight should I have to pay an additional cost for my health insurance over and above what someone pays who is not overweight?

    If I have three speeding tickets on my record should I have to pay an additional cost for my auto insurance over and above what someone pays who does not have three speeding tickets?

    Should my auto insurance pay for my new engine because I did not check or ever change the oil?

    If I use tobacco, drink, am 80 pounds overweight and take diabetes medication, blood pressure medication, and cholesterol medication should I have to pay an additional cost for my health insurance and medications over and above what someone pays who does not smoke, is not overweight, does not smoke and does not need these medications?

    Should my auto insurer be allowed to deny my claim for a new engine simply because I never checked or changed the oil?

    Should there be any financial incentive of any kind in an insurance policy that would encourage a person to not need to make claims?

    I'll stop there for now.
    Auto insurance doesn't pay for mechanical breakdown. That's what the warranty is for. If your engine breaks down and it causes the car to damage someone else's property, your BI/PD will cover that damage (3rd party and you're at fault), and if you have collision it will pay for repairs to your vehicle (but not the engine).

    aa

  9. Top | #49
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    Quote Originally Posted by Alcoholic Actuary View Post
    Quote Originally Posted by T.G.G. Moogly View Post
    Quote Originally Posted by southernhybrid View Post
    I see nothing wrong with expecting everyone to pay reasonable premium and copays, especially when you consider that lifestyle choices impact one's health to a large extent, yet most people make no attempt to change some of their unhealthy habits.
    If I smoke or use tobacco should I have to pay an additional cost for my health insurance over and above what someone pays who does not smoke?

    If I am overweight should I have to pay an additional cost for my health insurance over and above what someone pays who is not overweight?

    If I have three speeding tickets on my record should I have to pay an additional cost for my auto insurance over and above what someone pays who does not have three speeding tickets?

    Should my auto insurance pay for my new engine because I did not check or ever change the oil?

    If I use tobacco, drink, am 80 pounds overweight and take diabetes medication, blood pressure medication, and cholesterol medication should I have to pay an additional cost for my health insurance and medications over and above what someone pays who does not smoke, is not overweight, does not smoke and does not need these medications?

    Should my auto insurer be allowed to deny my claim for a new engine simply because I never checked or changed the oil?

    Should there be any financial incentive of any kind in an insurance policy that would encourage a person to not need to make claims?

    I'll stop there for now.
    Auto insurance doesn't pay for mechanical breakdown. That's what the warranty is for. If your engine breaks down and it causes the car to damage someone else's property, your BI/PD will cover that damage (3rd party and you're at fault), and if you have collision it will pay for repairs to your vehicle (but not the engine).

    aa
    Should my auto warranty have to pay to replace my engine, which failed, because I never checked or changed the oil?

    Should there be any financial incentive of any kind in an insurance policy that would encourage a person to not need to make claims?

  10. Top | #50
    Senior Member Alcoholic Actuary's Avatar
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    Quote Originally Posted by T.G.G. Moogly View Post
    Quote Originally Posted by Alcoholic Actuary View Post

    Auto insurance doesn't pay for mechanical breakdown. That's what the warranty is for. If your engine breaks down and it causes the car to damage someone else's property, your BI/PD will cover that damage (3rd party and you're at fault), and if you have collision it will pay for repairs to your vehicle (but not the engine).

    aa
    Should my auto warranty have to pay to replace my engine, which failed, because I never checked or changed the oil?
    Yes. That's what it's there for.
    Should there be any financial incentive of any kind in an insurance policy that would encourage a person to not need to make claims?
    Yes. Typically you can get 'well' visits to the doctor free and sometimes the insurer will offer a discount or other financial incentive. But standard rates cannot be based on any type of voluntary behavior - and claims arising under standard conditions still have to be paid.

    aa

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