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Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully

Health insurance in the United States is a shit show. The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. I personally would prefer a market based approach to fixing the issues with obtaining medical care, but Congress can't do anything because there's just too much money and influence involved.

bluejekyll 8y ago
> The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this. I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.
- dd36 8y ago
  If Bernie wins running with it as his primary issue, it’s a lot easier to get Congress on board.
  - conanbatt 8y ago
    Its definitely a boon for the cause, but I would be surprised if it passed the senate. OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
- dv_dt 8y ago
  After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats. It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.
  - akhilcacharya 8y ago
    > as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, The problem being that none of their candidates won competitive seats. Now, some like Kara Eastman came close..but candidates closer to the Obama/Hillary mold, veterans, and pro-gun control candidates in suburbs made up the bulk of the wins in the midterms.
    - dv_dt 8y ago
      I doubt your data. Just one counter example, in Orange County CA, Katie Porter, a democrat, won a competitive seat in a district that has been Republican for a long time (maybe 30+ years?).
      - akhilcacharya 8y ago
        From what I understand, she wasn't endorsed by Our Revolution (I'm strictly talking about the Bernie-aligned groups). She was endorsed by lots of other progressive groups that are more effective at this sort of thing. On the other hand, people like Kendra Horn flipped deep-red Oklahoma 5th with help of Bloomberg's Independence PAC, and Sharice Davids beat Bernie-backed Brent Welder in the primary to win the general by 10 points in a swing district.
        dv_dt 8y ago
        Does it matter if it's a Bernie aligned group? In CA-25, Our revolution endorsed one candidate, Justice Democrats another candidate, and a third Democratic candidate actually won yet another historically Republican district. They were helped (but not endorsed) by also progressive, but not as closely aligned to Bernie, Indivisible, by loose Bernie inspired independents, etc. I think it's a mistake to only look at strict boundaries of support by candidate name. I would consider CA-25s win with Katie Hill another progressive win in an contentious district.
  - maxxxxx 8y ago
    "After Obama ran on hope and change and won," My theory is that presidents should try to make big changes only in their second term when they understand how the system works. Obama in his first term was a complete pushover with the banks after 2008 and also during the Obamacare debate. I think he would have done much better in his second term.
- JustSomeNobody 8y ago
  > ... inability of Congress to meaningfully fix the issue. They'll never fix it. As long as there is a mentality that the poor are poor because they make bad life choices and thus should receive as little support as possible as a punishment, nothing will change because any change that would give everyone basic healthcare would also mean helping the poor.
gorbachev 8y ago
The insurance companies have had years (decades?) to come up with one. Instead they've invested in lobbying to keep the status quo.
- conanbatt 8y ago
  One honest question: if you believe the system as it is, is broken because of lobbying, why would a socialized medicine system be immune to lobbying?
- lotsofpulp 8y ago
  It mostly benefits big businesses to have employer based insurance.
  - conanbatt 8y ago
    I'm not too sure about that. It has signficant costs for business to run these programs. And when companies get large enough they self-insure.
  - tareqak 8y ago
    He who pays the piper calls the tune [0]. [0] https://www.merriam-webster.com/dictionary/he%20who%20pays%20the%20piper%20calls%20the%20tune https://www.merriam-webster.com/dictionary/he%20who%20pays%2...
- maxxxxx 8y ago
  All the inefficiencies are either profit or jobs for them. US health insurance companies are the worst bureaucracies I have ever seen. They have power over people's lives and almost zero accountability. They can do pretty much whatever they want and you are helpless if you can't afford the time and money to constantly call them or hire lawyers.
dmead 8y ago
using the word 'inability' is obfuscating the issue. they are actively working against it.
davidw 8y ago
Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'. As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives. I mention Italy because 1) I lived there and 2) it's not some perfectly run place where everything works. It's not, and yet the health care is still better, overall, than in the US.
- conanbatt 8y ago
  > Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free' Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.
- dv_dt 8y ago
  All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the caveat that it looks like the more private companies are in the healthcare mix, the higher the costs seem to run).
  - aantix 8y ago
    Without the U.S. subsidizing the drug research R&D, who pays for it? You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding. But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed. The money has to come from somewhere. I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
    - 8y ago
luckydata 8y ago
There's no market based approach that can "fix" healthcare. Market self regulates around substitute goods, but healthcare is in the business of health and there's no substitute for that. Very few humans will say "all considered, the ROI/statistical likelhood of this procedure is not positive so I will pick death instead", it just doesn't happen. Single payer is the only way to go.
- conanbatt 8y ago
  > but healthcare is in the business of health and there's no substitute for that There's plenty of substitutes, and there are plenty of things that have little to no substitutes and don't have these issues (food, clothing..housing does have some of the same issues). Healthcare is a mess because it is the most regulated market there is.
  - luckydata 8y ago
    I don't think you understand what I said.
    - conanbatt 8y ago
      Correct me if I'm wrong: luckydata: there is no substitute to healthcare services, so whatever you need in healthcare, whoever provides service has absolute leverage to charge whatever they want. response: there are plenty of substitute effects in healthcare as you can deny getting treatment, or choose cheaper treatments. Moreover, even if you had no substitute effect possible, there are also other examples of markets with "no substitute effects" like food or clothing, but there is no gouging. It is a characteristic of the market but on itself is does not guarantee gouging unless other conditions are met, most typically mononopolies, and most typically gov. granted ones.
- specialist 8y ago
  Even with single payer, there's a large thriving market. Vendors, suppliers, manufacturers, contractors, auditors, etc. Bandages need to be made, hospitals need to be cleaned, nurses need to be trained, etc.
jimmy1 8y ago
I don't mean this to be snarky, but if what you are saying is true (Congress can't do anything), why do you think the governmental disfunction will not carry over to an expanded medicare-for-all program? Medicare is not without issue and is wrought with fraud that needs decisive congressional action to help fix, yet they have shown inability there as well.

bluejekyll 8y ago

> The Medicare for all that Bernie is proposing is a reaction to the inability of Congress to meaningfully fix the issue. Wouldn't expanding Medicare to all also require an act of Congress? Bernie will have the influence of the White House, which is important, but it doesn't change the fact that Congress is still the body that would need to fix this. I've always felt like the Affordable Care Act was a bandaid almost designed to point out the breaking points in the existing system, and force something like Medicare for All, to come along and "fix" the situation permanently.

dd36 8y ago
If Bernie wins running with it as his primary issue, it’s a lot easier to get Congress on board.
- conanbatt 8y ago
  Its definitely a boon for the cause, but I would be surprised if it passed the senate. OTOH I dont even get how it could be in the table to bankrupt an entire market without compensation. Can the state really just outlaw all private insurances?
dv_dt 8y ago
After Obama ran on hope and change and won, one thing he did was shut down his very capable campaign organization without transitioning it to something else. It was maybe one tactical reason that later midterms became a mess for Democrats. It's pretty clear the Bernie's organization, as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, will continue full bore to change congress as well as keep pressure on congress to make, well, progress.
- akhilcacharya 8y ago
  > as well as the loose independent collective of progressive organizations around similar national and local causes who have also sprung up, The problem being that none of their candidates won competitive seats. Now, some like Kara Eastman came close..but candidates closer to the Obama/Hillary mold, veterans, and pro-gun control candidates in suburbs made up the bulk of the wins in the midterms.
  - dv_dt 8y ago
    I doubt your data. Just one counter example, in Orange County CA, Katie Porter, a democrat, won a competitive seat in a district that has been Republican for a long time (maybe 30+ years?).
    - akhilcacharya 8y ago
      From what I understand, she wasn't endorsed by Our Revolution (I'm strictly talking about the Bernie-aligned groups). She was endorsed by lots of other progressive groups that are more effective at this sort of thing. On the other hand, people like Kendra Horn flipped deep-red Oklahoma 5th with help of Bloomberg's Independence PAC, and Sharice Davids beat Bernie-backed Brent Welder in the primary to win the general by 10 points in a swing district.
      - dv_dt 8y ago
        Does it matter if it's a Bernie aligned group? In CA-25, Our revolution endorsed one candidate, Justice Democrats another candidate, and a third Democratic candidate actually won yet another historically Republican district. They were helped (but not endorsed) by also progressive, but not as closely aligned to Bernie, Indivisible, by loose Bernie inspired independents, etc. I think it's a mistake to only look at strict boundaries of support by candidate name. I would consider CA-25s win with Katie Hill another progressive win in an contentious district.
- maxxxxx 8y ago
  "After Obama ran on hope and change and won," My theory is that presidents should try to make big changes only in their second term when they understand how the system works. Obama in his first term was a complete pushover with the banks after 2008 and also during the Obamacare debate. I think he would have done much better in his second term.
JustSomeNobody 8y ago
> ... inability of Congress to meaningfully fix the issue. They'll never fix it. As long as there is a mentality that the poor are poor because they make bad life choices and thus should receive as little support as possible as a punishment, nothing will change because any change that would give everyone basic healthcare would also mean helping the poor.

gorbachev 8y ago

The insurance companies have had years (decades?) to come up with one. Instead they've invested in lobbying to keep the status quo.

conanbatt 8y ago
One honest question: if you believe the system as it is, is broken because of lobbying, why would a socialized medicine system be immune to lobbying?
lotsofpulp 8y ago
It mostly benefits big businesses to have employer based insurance.
- conanbatt 8y ago
  I'm not too sure about that. It has signficant costs for business to run these programs. And when companies get large enough they self-insure.
- tareqak 8y ago
  He who pays the piper calls the tune [0]. [0] https://www.merriam-webster.com/dictionary/he%20who%20pays%20the%20piper%20calls%20the%20tune https://www.merriam-webster.com/dictionary/he%20who%20pays%2...
maxxxxx 8y ago
All the inefficiencies are either profit or jobs for them. US health insurance companies are the worst bureaucracies I have ever seen. They have power over people's lives and almost zero accountability. They can do pretty much whatever they want and you are helpless if you can't afford the time and money to constantly call them or hire lawyers.

dmead 8y ago

using the word 'inability' is obfuscating the issue. they are actively working against it.

davidw 8y ago

Italy has a thriving market based private health care industry. You can call in and get prices and everything. Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free'. As a % of GDP, Italy spends a lot less than the US in health care, and people live long and productive lives. I mention Italy because 1) I lived there and 2) it's not some perfectly run place where everything works. It's not, and yet the health care is still better, overall, than in the US.

conanbatt 8y ago
> Just that it's in addition to the single payer system, which means the private one is cheap because the competition is 'free' Eek. This is also called crowding out. It means expensive but efficient health services can't survive. It might be a decent compromise but I would call it a success.
dv_dt 8y ago
All other first world nations pay less. On average they pay less than half what the US pays. The fully socialized systems, like the UK, seem to trend lower in cost, as low as one third the cost of the US. But really, the takeaway should be you need universal healthcare with significant government cost controls on drugs and procedures, after that almost any arrangement of public/private administration works (but the caveat that it looks like the more private companies are in the healthcare mix, the higher the costs seem to run).
- aantix 8y ago
  Without the U.S. subsidizing the drug research R&D, who pays for it? You could fill notebooks with worthy, approachable hypotheses for any number of diseases that could show promise if given the funding. But if everyone makes it law to cap prices - fewer scientists, labs, studies are performed. The money has to come from somewhere. I think countries take for granted the progress we've made. No progress is made without incredible intellectual efforts and monetary backings.
  - 8y ago

luckydata 8y ago

There's no market based approach that can "fix" healthcare. Market self regulates around substitute goods, but healthcare is in the business of health and there's no substitute for that. Very few humans will say "all considered, the ROI/statistical likelhood of this procedure is not positive so I will pick death instead", it just doesn't happen. Single payer is the only way to go.

conanbatt 8y ago
> but healthcare is in the business of health and there's no substitute for that There's plenty of substitutes, and there are plenty of things that have little to no substitutes and don't have these issues (food, clothing..housing does have some of the same issues). Healthcare is a mess because it is the most regulated market there is.
- luckydata 8y ago
  I don't think you understand what I said.
  - conanbatt 8y ago
    Correct me if I'm wrong: luckydata: there is no substitute to healthcare services, so whatever you need in healthcare, whoever provides service has absolute leverage to charge whatever they want. response: there are plenty of substitute effects in healthcare as you can deny getting treatment, or choose cheaper treatments. Moreover, even if you had no substitute effect possible, there are also other examples of markets with "no substitute effects" like food or clothing, but there is no gouging. It is a characteristic of the market but on itself is does not guarantee gouging unless other conditions are met, most typically mononopolies, and most typically gov. granted ones.
specialist 8y ago
Even with single payer, there's a large thriving market. Vendors, suppliers, manufacturers, contractors, auditors, etc. Bandages need to be made, hospitals need to be cleaned, nurses need to be trained, etc.

jimmy1 8y ago

I don't mean this to be snarky, but if what you are saying is true (Congress can't do anything), why do you think the governmental disfunction will not carry over to an expanded medicare-for-all program? Medicare is not without issue and is wrought with fraud that needs decisive congressional action to help fix, yet they have shown inability there as well.