8 ms·

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is

• bbarn 9y ago
  We all know it's bad. We pay hundreds a month to insurance companies because it's a law that we have to, and our employers pay even more. The health care industry is massively profitable. There's simply nothing we can do about it, or many of the issues plaguing this country. Before anyone says so, the illusion that we can change it by voting is not helpful. We can all elect a representative who will say they are going to change it, and they don't have to do a damn thing we want them to. Our system of government is broken, not just our health care system.
  • maxerickson 9y ago
    The individual mandate was repealed. With the explicit goal of causing the individual marketplaces to implode. In the meantime it's increased the cost to taxpayers of subsidizing marketplace plans!
    • humanrebar 9y ago
      The individual markets were already a mess.
      • ivraatiems 9y ago
        That was the talking point, and may have been true in a couple of places (especially those states that refused to expand Medicaid or only did the minimum to comply with the law), but I'm aware of no evidence that was true overall.
        • emodendroket 9y ago
          Costs in Massachusetts did not go down when an analogous plan was enacted. Obamacare may have been better than nothing but it was not good.
      • ceejayoz 9y ago
        They were briefly a mess, while insurers worked out the numbers - what to charge, how many young healthy folks would take the penalty, etc. https://www.cnbc.com/2018/01/04/obamacare-health-insurers-see-improved-financial-performance-in-2017.html https://www.cnbc.com/2018/01/04/obamacare-health-insurers-se... > That report instead finds that the Obamacare market has continued "stabilizing," and that insurers are "regaining profitability" despite continued political uncertainty over the health-care law. For a bit of anecdotal data, my premiums went up 2% last year, after 17% the previous year. I also got a $500 refund as they'd exceeded the 20% non-medical costs cap.
      • maxerickson 9y ago
        That doesn't really excuse the political cowardice of undermining the system while leaving most of it in place. I guess we are pretty screwed though, there's no willingness to prop up the buy side of the market and no willingness to make regulatory changes that would negatively impact incumbents on the sell side. (the fair, "market based" approach to decreasing medical costs in the US is to dramatically increase the number of doctors and mid-level providers).
• charlesdm 9y ago
  I will bring up one point. The wages medical practitioners make are generally higher in the US. So the cost of medical care is higher. I live in Belgium, mostly good and free healthcare (barring payment of a few euros here and there). I have 3 cousins who are (or are studying to become) doctors and while specialised doctors can make decent money (€75 -> 450k), they don't come anywhere close to what a US based doctor might be making. Someone making between $1 to 2m in the US (e.g. certain surgeons) might "only" be making $300 - 400k here. And the quality level is exactly the same.
  • titzer 9y ago
    That's a good point, but not the only reason. The insurance industry extracts a big profit margin by just moving money from one risk pool to another, and that profit has to come from somewhere, so, costs go up. It's inevitable.
    • travoc 9y ago
      U.S. health insurers have an average profit rate of 3.1%. Does that sound massive to you?
      • titzer 9y ago
        That's their profit. We are all paying for their operating costs as well.
      • beguiledfoil 9y ago
        The whole healthcare provider<->insurer interface is hugely expensive. http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs http://www.commonwealthfund.org/publications/in-the-literatu...
      • falsedan 9y ago
        That's the same as Amazon's!
      • malnourish 9y ago
• avs733 9y ago
  >How do lawmakers in the USA convince people that this is acceptable? One side of government is intent on breaking government and then using that dysfunction as a justification to create more dysfunction. The American political environment relies entirely on fear and creating fear using misinformation.
  • mfoy_ 9y ago
    "There's profit in confusion."
  • arcbyte 9y ago
    I agree completely, although I highly suspect we would refer to different "sides" as the ones intent on "breaking government".
    • pavel_lishin 9y ago
      I think one side has explicitly stated it as their goal, hasn't it?
    • avs733 9y ago
      No...this isn't a 'both sides' thing. It is a defined political strategy that one side is committed to[0]. There is a difference between a group of people doing things that you think will break government and a group of people doing things with the intent of breaking government. This type of 'counter argument' is a symptom of exactly what I'm talking about. [0] https://en.wikipedia.org/wiki/Starve_the_beast https://en.wikipedia.org/wiki/Starve_the_beast
• 3princip 9y ago
  I understand where you're coming from, I too live in a country where healthcare is free at the point of use, but your claim is ludicrous. If you've ever payed any taxes then you have payed for the services you've received.
  • sjg007 9y ago
    In America you pay for health insurance and Medicaid and Medicare taxes. So we are already paying for universal healthcare we just don’t get it until we are 65 or poor or disabled.
• slantedview 9y ago
  > The argument that I pay for my healthcare in my taxes doesn't hold water either Indeed. Americans spend more per capita on healthcare than any country in the world, and needless to say, for all that spending we don't even cover everyone. To put it another way, we _already_ spend enough on healthcare to cover everyone. That we don't cover everyone is a political problem (allowing for the existence of a for profit system with no public alternative), not a spending problem.
• towndrunk 9y ago
  What about Alfie Evens? UK said he must die. Parents were prevented from taking him to another country for care.
  • drunken-serval 9y ago
    https://en.wikipedia.org/wiki/Whataboutism https://en.wikipedia.org/wiki/Whataboutism
  • nicktelford 9y ago
    This isn't at all accurate. There was no treatment for his condition beyond palliative care. He was on life support for the rest of his life, no matter what anyone did. His doctors, whose duty is to the patient, determined that it was more harmful to artificially keep him "alive" (he was in a semi-vegetative state due to serious brain damage) than to disconnect his life support and allow him to die. The offer of "care" in another country (the Vatican) was simply palliative care: they intended to simply keep him alive on life support indefinitely. There was no treatment for his condition. His doctors, quite rightly, concluded that transport to another country would do him no good and would instead cause more harm. The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it.
    • humanrebar 9y ago
      > The court case was between his doctors and his parents. The UK government had absolutely nothing to do with it. Is there a difference in terminology here? The courts are part of the government in my mind. And they have the ability to overrule unjust law.
      • deleted 9y ago
        [deleted]
      • nicktelford 9y ago
        An independent judiciary is a foundation of all true democracies. The government may make the laws, but the judiciary are fully independent when making judgements about a case. IANAL but I believe in this case, the point of law it came down to was largely about deciding what was best for the patient, not the parents.
• nickjj 9y ago
  It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario. Meanwhile they are still losing ~40% of their income to taxes if they own a small business with no insurance applied. The messed up thing is, the US also offers "catastrophic" insurance for about $150 / month but they only allow people under the age of 30 to apply for it. But at the same time I'm pretty sure hospitals are forced by law to perform emergency surgery on you regardless of whether or not you have insurance (don't quote me on this). In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!
  • chapium 9y ago
    “Brainwashed” is a bit harsh. We put up with this because it’s necessary to work within the constraints of the system.
    • avs733 9y ago
      I grew up on the coasts and for a long time would have believed that. People might hate the system but they will comply and work within it. Living in the midwest has changed my mind, here people need the system to be true because it is the basis for their entire way of seeing the world. They listen to Rush adn to Fox News...and they accept it at a philisophical level. They rely on being told it because otherwise they would have to confront a lot of realities all at once. I don't see brainwashed as a slight, I see it as said with compassion and sadness.
      • deleted 9y ago
        [deleted]
      • chapium 9y ago
        “It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario.” What are the other options? Most dont choose their health insurance based on belief in one system or another. I agree there are plenty in the midwest, with conservative views, who believe in conservatism to unhealthy levels, no thanks to the crack pots they listen to on the radio. The only person I’ve heard who felt the american healthcare system was the best in te world was in a speech by GW Bush. His speech was answered with silence because the audience was in such shock.
• chapium 9y ago
  Why should stitches be free? Of course they arent, its being paid for under your country’s healthcare model. The cost is harder to see to the individual but its there. I’m all for universal healthcare but comparisons like this are deceiving.
  • falsedan 9y ago
    The advantage of the single-payer model is this: if some clinic decides to mark-up one patient's treatment by 4,453%, the single payer can not only refuse to pay for that treatment, but also refuse to pay all other treatments performed at that clinic. This keeps the cost for treatment in a much more reasonable range, since the health care budget is debated and scrutinised as part of government spending. The Australian model is that health care providers can charge what they like, but Medicare only pays a predetermined amount for every kind of treatment. Providers are free to charge more, but have to capture the difference as a 'copay' or by billing the patient's private health insurance.
    • chapium 9y ago
      That makes sense. Medicare works in a similar way in the US.
  • lstamour 9y ago
    I disagree. It’s a universal form of insurance that everyone contributes too. It’s free in the same way a public library or road is free to use. It just becomes another societal cost which frankly, no one notices. It’s not perfect either, if you want something unusual or not common, it’s possible you’ll have to pay for it if it can’t be arranged at the right price. Certain vaccines for example. So there’s still a need for health benefits but without a system charging high prices by default, even those costs tend to be more reasonable.
  • danmaz74 9y ago
    Yes, the cost is there, but it's much lower per treatment. Mainly because the medical/insurance complex makes less money off healthcare.
• mikeash 9y ago
  Nobody thinks this is good, but half of our voters think government is the problem, and these problems would disappear if the government would stop messing everything up and let businesses provide health care how they want.
  • mfoy_ 9y ago
    I'm pretty sure "how they want" looks exactly like it does right now, with the only change being the option to refuse treating uninsured emergency cases.
    • beguiledfoil 9y ago
      They also don't want to be "forced" to buy insurance.
    • mikeash 9y ago
      You don’t have to convince me! I think socialized medicine is the way to go. But I see enough from the other side to have an idea of the thinking there. Part of the reasoning is that prices are high because of excessive regulation, like that requirement to treat all emergency cases. Get rid of those and prices will become affordable, the theory goes. I don’t think that would help nearly enough to make it work, but others clearly disagree.
• Quarrelsome 9y ago
  I don't understand the logic of "it will cost too much to save my ear so I'll get plastic surgery instead". That's fucking mad.
  • falsedan 9y ago
    A plastic surgeon can do cosmetic surgery, but they aren't cosmetic surgeons: their specialty covers many less-well-known but far more important treatments. A plastic surgeon specialises in repairing or reconstructing damaged body parts: in this case, the treatment is clearly reconstructive surgery on the patient's ear in the hospital. The patient was weighing the cost of that surgery against living with a damaged ear… Plastic surgeons also do cosmetic alterations of body parts, such as removing moles, etc. Some platic surgeons work privately to only do these kinds of procedures for celebrities etc., so you may be more familiar with this minority & their work rather than their primary specialty.
• OnMyPhone 9y ago
  I hate it all, and would rather pay much more taxes if we had universal healthcare. That aside, I had a few different people give me the following reason why this is acceptable to them. "Why should we pay any of our hard earned money to the government so some drug addict can get their fix?" "Why should I pay for single mothers who made bad decisions?" It is almost always other people making poor decisions or getting into poor situations that justify their choices on this type of stuff. When you ask about parents who's kids can't get surgery, they reply in a similar fashion, "there's government programs for them, so I don't need to pay anymore taxes." They have never had to use one of these "wonderful" government programs. That's key to their thinking. Try to tell them that it could be their kids that need a surgery they can't afford and it'll go something like, "well that's why we pay for insurance out of our pocket." They never stop to think about people who are in a bad situation. There is NO getting through to some of these people until they need the help they refuse to pay for. I have seen one couple change their minds once their insurance refused to cover something for their kid. Immediately they were "raising awareness" for this type of stuff... but whatever at least they eventually came to. So to answer your question, they aren't blind per se, as they see how stupid it is. They are however selfish as shit and don't care about anyone outside of their initial friends and family.
  • emodendroket 9y ago
    In addition to being cruel, this kind of penny-pinching is often penny-wise and pound-foolish. It's easy to lose more money verifying that people are not shiftless than you save by denying them benefits.
    • ceejayoz 9y ago
      For example: https://www.nytimes.com/2012/04/18/us/no-savings-found-in-florida-welfare-drug-tests.html https://www.nytimes.com/2012/04/18/us/no-savings-found-in-fl... > Because the Florida law requires that applicants who pass the test be reimbursed for the cost, an average of $30, the cost to the state was $118,140. This is more than would have been paid out in benefits to the people who failed the test, Mr. Newton said. As a result, the testing cost the government an extra $45,780, he said.
• emodendroket 9y ago
  People who have insurance good enough for all the medical care they've ever had are afraid of being denied care, basically.
• okreallywtf 9y ago
  We do it for the illusion of freedom which is used to trick unfortunately ignorant people out of services that would cost the wealthy a bigger percentage of their income. "Choose what X is right for you and your family" This allows the wealthy the chance to choose a better level of healthcare, schools, and basically everything else leaving the rest of the nation to choose only what they can afford (guess what, its not much). By patronizing the nation by saying "You're so smart, you know better what you need than a stupid Washington bureaucrat like me!", they stroke our ego's just enough to convince people that they are able to get a better deal (ie, beat the system). It infuriates me that the people who ran for office and chose to "represent" us in a lot of cases completely abdicate their responsibility to do anything. Not to be partisan, but one party is a lot worse about this than another, to me if you go through all the trouble to put yourself in government and enrich yourself handsomely while you are there, at least fucking pretend you are going to try and solve something rather than this self-deprecation that comes out of the Republican party.
• gambiting 9y ago
  I've literally had someone on reddit tell me that (and I quote) "the only reason why you have free healthcare is that we[USA] subsidize it by protecting your country so that you are free to spend your budget on healthcare". And I mean....maybe there is a little bit of truth to that, but what sort of attitude is this? It was almost pride as in "yeah we're paying through the nose so you don't have to"?
  • jahvo 9y ago
    It's funny that guy would say that because, because of the wars the USA and its greatest ally begin, we have to deal with millions of economic immigrants now, which are seriously hamstringing our system. So I'd say it's kinda the opposite
    • assblaster 9y ago
      Trump had made it pretty clear he was against the Iraq war, and plans on closing military bases overseas to reduce military costs. Keeping our military in European bases certainly does cost the United States significant resources to counter the Russian threat to Europe. While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance. If European countries actually spent what they ought to, they absolutely would have less money to spend on their welfare systems.
      • gambiting 9y ago
        >>While NATO countries don't pay their fair share of costs of maintaining their security, the United States has to pay the balance. The counterpoint here is that US keeps American bases in Europe because US wants to keep their bases here and it serves their interests first and foremost, any defensive goals are secondary, if not tertiary. All Nato nations could contribute exactly ZERO to the budget and US would still be getting the best deal out of everyone here.
        • assblaster 9y ago
• gcb0 9y ago
  its not about laws or health. it's the american dream. hospitals and doctors are in it for the money. so anything that forces you to pay, they will make you pay, because they will get money and that's the American dream. the incentives are all wrong. remember the news about a bank telling drug companies to straight out quit researching cures and only go for treatments because those generate more money? its all the same problem
• jbb67 9y ago
  Yes, prices in the USA seem totally out of control. I pay a significant amount in the UK in tax towards the NHS ( I think about £7500 a year of my tax goes towards it) but that's nothing like what I'd pay in the USA. It's not just the system there that is poor, it's how expensive it is in addition.
• dragonwriter 9y ago
  > How do lawmakers in the USA convince people that this is acceptable? They don't; it's a lot easier to channel blame for the problem in the wrong direction than to sell the system as acceptable, so that's what they do.
• Meekro 9y ago
  I've never met anyone (of either party) who thinks that stories like this are acceptable. The issue, as always, is how do we fix it? Pointing to European democracies merely shows that it can be done, it doesn't necessarily offer a blueprint for how to make it happen in a country with very different size and culture. Bernie Sanders' "medicare for all" is the plan I've seen get the most support. If we got single payer healthcare, it would probably happen that way. It would cost $1.4 trillion per year[1], which is more than everything the government currently spends outside of entitlement programs. Adding this much spending without raising revenue would more than double the annual deficit. "Tax the rich to pay for it," Bernie says! Okay, sounds good. His supporters will point to how the top marginal tax rate in the 1950s was 91%[2], and everything was great during that post-war boom. Here's the problem: regardless of the tax laws or rates, the US federal tax revenue has always been 15-20% of GDP[3] (we are currently at 17.3% of GDP). This figure has not changed since 1945, even as the tax law has been wildly changed many times over. That's not to say that nothing can ever change this figure -- it is different in other countries after all. But numerous attempts to change it by manipulating marginal tax rates have failed, and there's no reason to think that Bernie's tax-the-rich plan will do any better. [1] http://money.cnn.com/2017/09/12/news/economy/sanders-medicare-for-all/index.html http://money.cnn.com/2017/09/12/news/economy/sanders-medicar... [2] http://www.politifact.com/truth-o-meter/statements/2015/nov/15/bernie-s/income-tax-rates-were-90-percent-under-eisenhower-/ http://www.politifact.com/truth-o-meter/statements/2015/nov/... [3] https://en.wikipedia.org/wiki/Hauser%27s_law https://en.wikipedia.org/wiki/Hauser%27s_law
  • corpMaverick 9y ago
    ... and it is easy to do gradually. i.e. Lower the age two years every year. In ten years people born in 1983 would be covered.
  • brewdad 9y ago
    We are on pace to run a $1 trillion deficit this year thanks to the Republican tax cuts. Simply rescinding the cuts and putting things back they way they were in 2017 gets us about 2/3 of the way to paying the cost of Medicare for all. It can be done, we the people need to stand up and demand it while voting in leaders who will make it happen.
• politics531 9y ago
  The thing that is often hard to understand about the United States is that many Americans hate each other, and many hate the non-Americans that live here even more. We aren't so much a melting-pot, where a single culture emerges from disparate ones living together, as we are an arena with enclaves of very separate, very antagonistic cultures that happen to live in the same country. It is often very difficult to convince these groups, especially the economically prosperous ones, to contribute to a system that helps the others, even to their own detriment. The rich don't want to pay for healthcare for the poor, the conservatives don't want to pay for healthcare for illegal immigrants, the mid-westerners don't want to capitulate to the coastal-elite agenda, progressives have zero respect for the values of conservatives and on and on. There are cultural lines drawn, and crossing those lines is nearly unthinkable to many Americans, even if it costs them their health. American culture is broken and divided, most people can see that but they think that the other groups are the problem, and I'm not sure we will make much progress on our massive problems unless something changes with it.
• psychometry 9y ago
  Tens of millions of Americans thought it was smart to elect Donald Fucking Trump president. We're paying the price for decades of underfunding and ignoring our educational system with an astoundingly ignorant electorate.
  • ddingus 9y ago
    Universal Health Care / Medicare For All --> "That will never happen." Candidate for President Hilary Clinton Trump being elected is not actually germane to this discussion.
• slantedview 9y ago
  > Are people just so blind to how extortionate healthcare is in the USA? Yes, Americans are utterly blind to this. It's amazing. But it has taken no small amount of effort on the part of specially interested parties to create and maintain that blindness.
• tzs 9y ago
  > How do lawmakers in the USA convince people that this is acceptable? When comparing different health care systems there are dozens, probably even hundreds, of points they can be compared on. If a US politician or party advocating universal, affordable, effective healthcare uses Australia, or Canada, or the UK, or Germany, or any other specific system as a model, or even just as an example to compare to, their opponents can find for that specific system something that it does not handle as well as the US currently does. They use those to convince their constituents that the current US system is better than the proposed replacement. If the politician advocating change does not reference specific other systems, then their opponents say they are pushing for a government takeover of healthcare using an untried, untested system based just on theory and speculation. Another thing they like to do is label every other system as "socialized medicine", and paint a picture of adopting such a system meaning we will have to go to government assigned doctors who work in government owned hospitals and deal with a giant, intrusive, inefficient bureaucracy for every medical thing we do no matter how minor.