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affordable universal coverage

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below is a link and copy and paste i'm developing with basic information on the bigger picture issues in providing affordable universal care in the usa.


what are some other major issues that should be included in this? what in this do you feel is misrepresentative of the the truth of healthcare in the usa?

if you notice, i gave a spot to the free market types who are willing to argue for catostrophic care and something for the poor, with the free market for everything else.


Affordable Universal Care Information

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
-Martin Luther King Jr.

-Every other developed country besides the United States has affordable universal healthcare in some fashion. They have differing degrees of government involvement in the process along with private insurance to various degrees in some countries. 
-we spend 18 percent of our GDP on healthcare. every other developed country spends not much more than ten percent. if we ran healthcare like any of them, the difference amounts to over a trillion dollars a year. that's the equivalent of cutting people's income taxes in half. you can also look at the break down per capita and come to the same conclusions as bernie always does.
-Highlighting the need for reform: medicare and other government healthcare in the United States adds to our debt, despite the common thinking that our payroll and other income taxes pay for it all.  The problem is so big, that healthcare is the only thing that could potentially bankrupt the country. The debt clock shows that our current GDP and debt is around 20 trillion, but future unfunded liability from healthcare is around 120 trillion. 
-before obamacare, a commonly cited statistic was that over forty five thousand people died a year without healthcare. after obamacare, that number fell. the exact number is disputed by some, but the consensus is that the number is tens of thousands. for instance, there is no shortage of stories of insurance companies that deny or battle coverage while someone is dying of cancer.  
-Despite paying more than other countries, we have significantly worse health outcomes compared to them, even beyond high death rates. 
Fact One: The United States ranks 23rd in infant mortality, down from 12th in 1960 and 21st in 1990
Fact Two: The United States ranks 20th in life expectancy for women down from 1st in 1945 and 13th in 1960
Fact Three: The United States ranks 21st in life expectancy for men down from 1st in 1945 and 17th in 1960.
Fact Four: The United States ranks between 50th and 100th in immunizations depending on the immunization. Overall US is 67th, right behind Botswana
Fact Five: Outcome studies on a variety of diseases, such as coronary artery disease, and renal failure show the United States to rank below Canada and a wide variety of industrialized nations.
Conclusion: The United States ranks poorly relative to other industrialized nations in health care despite having the best trained health care providers and the best medical infrastructure of any industrialized nation
-The current healthcare industry causes people to go bankrupt. One in four of your grandparents will go bankrupt trying to pay for healthcare in this country.  Before Obamacare, half of bankruptcies were healthcare related. If an insurance company fights to pay for your cancer care, for instance, you will face not just the prospects of death, but won't receive any government assistance until you're lifetime saving from hard work, become depleted. 
-The primary way these countries save money is by negotiating and regulating costs (such as drug costs) but some also take out the insurance middleman to reduce administrative costs. 
-Medicare spends twenty percent less than insurance for any given procedure, and Medicaid reimburses a third less than Medicare. (consider the bigger picture. if we spent a third less than we do now overall, we would be much closer to other countries spending rates)
-Insurance companies spend thirty percent on the dollar on profit and administrative costs, while Medicare spends only three percent on administration.  For every doctor, it is not uncommon to see two staff people just to take care of billing. There is also the marketing and legal departments, other issues that are redundant among insurance companies that run up administrative costs. 
"We have 900 billing clerks at Duke (medical system, 900 bed hospital). I'm not sure we have a nurse per bed, but we have a billing clerk per bed... it's obscene." Reinhardt, Congressional Hearing on Healthcare Reform.
-The main reason we spend so much is because the healthcare industry charges so much for any given procedure.
-Hospitals are a bigger bad actor than insurance companies because they are prone to excessively charging simply because they can.
-Doctors and other healthcare professionals salaries are included to some extent in the excess.  There is an artificial restriction on the supply of doctors and they earn significantly more than their counterparts in other countries.  There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people — well below below the OECD average of 3.1.
-A, or 'the', major problem we have five percent of patients that cause half our healthcare expenses. this could potentially be regulated by creating a "high risk" category in the industry, where reimbursement is lower. If we reduced that category of expense by half, we should reduce the overall cost of healthcare by a quarter. (think of the GDP numbers, instead of 18 percent, we'd be closer to other countries) Think of the bigger picture- the average that is spent on each of those patients is $40,000 per year. You could hire a doctor to take car of just five of them and his salary would be paid for.  Trying to manage care like that is easier said than done though. So what happens is we end up having the healthcare industry milk each procedure and charge too much overall.   
-half of people get their insurance through their jobs. a lot of people are satisfied, but not all of them. and there is a general awareness of the waste involved.  
-here is a dude proposing public options through expanding medicaid and medicare. this sort of pragmatism hasn't been in the media a lot in recent years, but it's slowly becoming more mainstream.
-the above link shows a slight majority of americans support universal care. there is an even higher support when you raise the proposition that it can be cheaper that way too. 
-universal care doesn't have to be single payer or some form of a public option. switzerland does it like obamacare, yet it's affordable. the main way, as has been discussed, is because of regulating and negotiating with the health industry on costs. 
-If we keep health insurance to any extent, we need to make them non-profit organizations. Because health insurance in this country is for profit, they are going to do everything in their power to avoid paying your healthcare. Their main motivation is higher profits, not your well-being. Denying claims is just one clumsy way of saving money though; the main way is by avoiding unhealthy people altogether.  In other countries, any surplus funds are directed towards lowering premiums. Some of the countries have a health system like our current Medicare, where basic dental and eye health along with some luxurious arraignments are only covered through supplemental insurance beyond the government basic coverage. 
-none of the existing proposals are the only methods. some free market types have posited that we could have universal catastrophic care (covering care above a certainly yearly deductible), and something for the poor. the free market would drive down costs for everyone else on non-catastrophic issues that arise. A variation on this theme is they could outlaw non-catastrophic insurance and promote health savings accounts that already exist.  Another variation, if lawmakers wanted to play twisted with poor tax payers, they could give them subsidies before their catastrophic coverage kicks in that they can pocket if they don't use to discourage overuse. (this wouldn't be politically popular and has questionable ethics, too)
-France is rated number one by the world health organization and has an esteemed tort reformed system. (not that this is the major driver of costs)
-a universal system probably wouldn't be like the VA, especially in the USA. most countries aren't either. that is where the government is employer of healthcare workers. most universal care proposals only rely on the government at most as an insurer, not as taking over everything.  government as employer like the VA is only the case in the UK, but they don't have significant problems there anyway. the VA isn't as bad as it used to be either as most veterans are happy with their care.  

Would the USA suffer in the time we wait to see a Doctor?:
-the idea that we have to wait longer in a single payer system is mostly a myth. according to the Commowealth for most procedures the usa is well below average in wait times. for some specialized care, the usa is towards the top, but still not best.
-a libertarian who supports french healthcare: "For a dozen years now I’ve led a dual life, spending more than 90 percent of my time and money in the U.S. while receiving 90 percent of my health care in my wife’s native France. On a personal level the comparison is no contest: I’ll take the French experience any day. ObamaCare opponents often warn that a new system will lead to long waiting times, mountains of paperwork, and less choice among doctors. Yet on all three of those counts the French system is significantly better, not worse, than what the U.S. has now."
-the idea that canadians come here because of wait times is mostly a myth. only 20 for every 18,000 canadians come here on purpose for healthcare. it's not clear why they choose to do so (maybe there's a wait issue, maybe they respect the USA more given its reputation for quality in some areas of healthcare), but it's clear the numbers are miniscule. the atlantic article above does say canada is the only country worse in wait times, so there could be that, so a slight extent. the only reason canadians are worse, though, is because they choose to not fund healthcare as much as other countries or the usa does- a political decision that can be remedied here, and isn't a problem any where else. 

What can we conclude on wait times?:
-wait times is mostly a red herring- if we want decent access to doctors we shouldn't limit the supply of doctors like we have in the usa. let the free market work more in this regard.
-every other developed country is either single payer or has some sort of government involvement majorly. and they all are almost half as costly. most countries to save money by regulating costs. this is probably why specialized care wait times has been hurt some in other countries. but the fact that the usa is not the best in that regards, shows that it can be done better than here and with government involvement that covers everyone. and, all it means is we shouldn't be too gung ho on over regulating specialized care.
-other countries are like us. to the extent that there are wait times, it's mostly for people who dont need urgent care. the more urgent your situation, the faster you get seen. that's how it's done here too. any delay to the less urgent isn't significant enough to justify all the good points of single payer or a government involved method.
-there might be some limitation to access if we open up access to doctors to the remaining ten percent of uninsured just by demand going up some, but ten percent more people would not cause a significant shift in outcomes, and most states have less than that uninsured. There would be no lines under a universal health care system in the United States because we have about a 30% oversupply of medical equipment and surgeons, whereas demand would increase less than 10%. and, is it all that moral to make your own care better by denying it to someone else? especially when you can just find a way to take care of them that doesn't really affect you, but you simply choose not to?

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I think the only sensible program when looking at international systems of health care is a single-payer-like system. I think it should be a comprehensive no-cost equal-use service with ample social care given through a National Health Service (the institutional and infrastructure side) and a default Medicare for all service (for the financial side). This would likely over time replace much of the private market in the United States though likely not all. I would be okay with people getting vouchers to help get their own health insurance as long as it was reasonably adequate to their needs.

Health Care Triage actually has a series on the health care systems around the world:

Taiwan is really proof positive that reform and overhaul of a majorly broken system like the United States is possible. Even a rather rapid reform and fix.

And last, but not least, though not holding a candle to any of the previous:


Edited by GreenScapularedHuman

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The United States does not have the societal, economic,  cultural, or political culture that allows a rational, reasonable, and thoughtful discussion and development of ideas, policies, legislation, to reform the healthcare institutions.  

Obamacare did not result in any financial efficiencies or savings.  

The US has not had a rational and comprehensive fix to immigration in the over thirty years it’s been called a crisis. Everyone knows the solution is border security simultaneously with rational immigration policies to allow foreign workers with legal status and a clear path to citizenship while minimizing incentives to those who would come only for welfare benefits.   

Politics and news are committed to creating conflict as a self sustaining business model.    We’ve all become addicted and comfortable with supporting “our side’s” most strident partisan. 

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i truly think the problem is ignorant conservatives. we can provide healthcare to everyone that is just as cheap or cheaper, and with the same or better quality. if everyone knew this, things would change. but alas the premise for change will find many people beefing with it. i laid it all out in the opening post.... the facts speak for themselves. 

Edited by linate

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i dont see how you can say that. i mean it's a politically correct thing to say, but it's inaccurate. conservatives almost without fail will say universal care is too expensive, or there's long wait lines, or something like that. all things that can be easily dismissed once educated. i guess they may say things like we might overregulate and stifle innovation... that is a possibility but i have more faith in our system than that. but conservatives usually say things that have no basis in reality. 

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On 1/10/2019 at 1:15 PM, Anomaly said:

The problem rests entirely with the labeling of any disagreement as being ignorant.  


No.  Conservatives are the problem. Ignorant conservatives are a blight on our society. 

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On 1/12/2019 at 10:47 PM, FatWinchester said:

No.  Conservatives are the problem. Ignorant conservatives are a blight on our society. 

fiscal conservatives are the problem.  Just because the government is 27 trillion in debt is no reason the gov can’t provide healthcare


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