4 ms·

Your argument is grounded in the idea that the US is somehow an exception to the economic behavior of other first world nations, due to size or diversity or wha

by beat 7y ago

Your argument is grounded in the idea that the US is somehow an exception to the economic behavior of other first world nations, due to size or diversity or whatever. But is that actually the case? Counter-argument... this isn't simply a question of "capitalism" vs "socialism". There are a wide variety of models in use out there, from the mostly-socialist (Sweden) to mostly-market (Japan). What they all have in common, though, is that all of them are producing better coverage and better outcomes at lower costs than the American system. We pay twice as much as the rest of the world, for the privilege of millions going without coverage, millions more trapped in jobs they hate for the sake of health insurance, and millions of families bankrupted by medical costs outside of what their insurance (or lack of insurance) covers. In other words, the existing American model that you're defending is uniquely bad. It's more expensive and less efficient than any other system in the industrialized world. It's not about whether we can do better. It's about whether we could possibly do any worse, at this point.

krupan 7y ago
"In other words, the existing American model that you're defending" Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here. I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more. EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.
- beat 7y ago
  Yes, but. Highly socialist systems are working well in other countries. Interestingly, they seem about as effective as highly capitalist systems in other countries (except, of course, for the American system). So I don't think "socialism" is the problem here, and I worry about the magical thinking of reactionary politics when I see that used as the argument against. Medicare is, in fact, the largest single payer system in the world, and it's a large chunk of the American system. Criticizing single payer would do well to start by criticizing the current Medicare system. But that means separating it logically from the privatized employer-based insurance model, and that's a very difficult knot.
  - krupan 7y ago
    "Criticizing single payer would do well to start by criticizing the current Medicare system." Will do. I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one. Think I'm making this up? I just did a quick web search and here's a quote from someone else: "Yet, thanks to the federal program’s low reimbursement rates, stringent rules and grueling paperwork process, many doctors are refusing to accept Medicare’s payment for services. Case in point: In 2000, nearly 80% of the Texas Medical Association’s doctors were taking new Medicare patients. By 2012, that number dropped to less than 60%. Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays. While a gap always existed, many physicians feel that in the past several years, Medicare reimbursements haven't kept pace with inflation (especially the costs of running a medical practice), while the rules and regulations keep getting more onerous, as do penalties for not complying with them." --https://www.investopedia.com/articles/personal-finance/100215/what-do-when-your-doctor-doesnt-take-medicare.asp https://www.investopedia.com/articles/personal-finance/10021... Here's another link a quick web search turned up: https://www.verywellhealth.com/doctors-accept-medicare-insurance-3976280 https://www.verywellhealth.com/doctors-accept-medicare-insur... So, if we all go only-medicare, how many doctors decide to retire early? <edit>How many potential doctors will decide to do something else instead?</edit> What quality of doctors and care are we left with?
    - arcticbull 7y ago
      > Also, criticizing socialism is not magical thinking. It's been a proven failure over and over. Yes, some tiny homogeneous countries have come together and made socialist medicine work, but I'd wager good money that that has more to do with their citizens having a general feeling of all being on the same team, avoiding freeloader problems by discouraging immigration, having larger more prosperous countries in the world to provide innovation and competition, and other factors that America is never going to be able to achieve. If by that you mean the entire OECD then yes, some tiny homogenous countries have tried it. And it works great. Also, diversity has nothing to do with medicine. > I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one. Lowering reimbursement rates reduces costs, that's how it's supposed to work. Did you think costs just go down while people get paid the same or more? Where did you think the money was to come from? Sorry, America's costs are 2X Canada's, those doctors do need to be paid less. > Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays. Great, now all programs will pay the same, much less than today. You do know doctors in Canada make $200-500K/yr right, they're not exactly starving. They don't need to make more, they're public servants. In the US the mean salary for a doctor is just shy of $300K (range $200-663K). In Canada the mean salary $225K, ranging from $232 to $676. I think they'll manage with the pay-cut. > So, if we all go only-medicare, how many doctors decide to retire early? Those who scrape by on $250-500K/yr and save, then retire, like the rest of the 1%.

by beat 7y ago

krupan 7y ago

"In other words, the existing American model that you're defending" Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here. I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more. EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.

beat 7y ago
Yes, but. Highly socialist systems are working well in other countries. Interestingly, they seem about as effective as highly capitalist systems in other countries (except, of course, for the American system). So I don't think "socialism" is the problem here, and I worry about the magical thinking of reactionary politics when I see that used as the argument against. Medicare is, in fact, the largest single payer system in the world, and it's a large chunk of the American system. Criticizing single payer would do well to start by criticizing the current Medicare system. But that means separating it logically from the privatized employer-based insurance model, and that's a very difficult knot.
- krupan 7y ago
  "Criticizing single payer would do well to start by criticizing the current Medicare system." Will do. I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one. Think I'm making this up? I just did a quick web search and here's a quote from someone else: "Yet, thanks to the federal program’s low reimbursement rates, stringent rules and grueling paperwork process, many doctors are refusing to accept Medicare’s payment for services. Case in point: In 2000, nearly 80% of the Texas Medical Association’s doctors were taking new Medicare patients. By 2012, that number dropped to less than 60%. Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays. While a gap always existed, many physicians feel that in the past several years, Medicare reimbursements haven't kept pace with inflation (especially the costs of running a medical practice), while the rules and regulations keep getting more onerous, as do penalties for not complying with them." --https://www.investopedia.com/articles/personal-finance/100215/what-do-when-your-doctor-doesnt-take-medicare.asp https://www.investopedia.com/articles/personal-finance/10021... Here's another link a quick web search turned up: https://www.verywellhealth.com/doctors-accept-medicare-insurance-3976280 https://www.verywellhealth.com/doctors-accept-medicare-insur... So, if we all go only-medicare, how many doctors decide to retire early? <edit>How many potential doctors will decide to do something else instead?</edit> What quality of doctors and care are we left with?
  - arcticbull 7y ago
    > Also, criticizing socialism is not magical thinking. It's been a proven failure over and over. Yes, some tiny homogeneous countries have come together and made socialist medicine work, but I'd wager good money that that has more to do with their citizens having a general feeling of all being on the same team, avoiding freeloader problems by discouraging immigration, having larger more prosperous countries in the world to provide innovation and competition, and other factors that America is never going to be able to achieve. If by that you mean the entire OECD then yes, some tiny homogenous countries have tried it. And it works great. Also, diversity has nothing to do with medicine. > I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one. Lowering reimbursement rates reduces costs, that's how it's supposed to work. Did you think costs just go down while people get paid the same or more? Where did you think the money was to come from? Sorry, America's costs are 2X Canada's, those doctors do need to be paid less. > Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays. Great, now all programs will pay the same, much less than today. You do know doctors in Canada make $200-500K/yr right, they're not exactly starving. They don't need to make more, they're public servants. In the US the mean salary for a doctor is just shy of $300K (range $200-663K). In Canada the mean salary $225K, ranging from $232 to $676. I think they'll manage with the pay-cut. > So, if we all go only-medicare, how many doctors decide to retire early? Those who scrape by on $250-500K/yr and save, then retire, like the rest of the 1%.