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For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible. Healthcare problems? Free he

For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible. Healthcare problems? Free healthcare for everyone, no forms required. No home? Everyone gets a free / low cost house. We aim to do much more than that (give control of the economy to the people), but a robust welfare state is a good start.

roenxi 7y ago
Those are compelling policy handwaves, but they really aren't going to the heart of the issue; which is someone in the broader conversation is basically misrepresenting reality to an astounding degree. The OECD reports that the US already spends more on healthcare per capita than any other nation by a substantial margin [0]. If it were believed that the ambitious left were going to implement free healthcare by bringing actual costs down into line with the rest of the world they could probably muster bipartisan support in a few years. But I bet their plans don't do that - eliminating means testing and more handouts are are just avoiding the real issues. [0] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...
- kazagistar 7y ago
  That's exactly what the left wants, but they are facing bipartisan opposition from both Republicans and the majorty of centrist Democracts, both of whom receive large donations from the massive insurance industry that stands to lose everything.
- pjc50 7y ago
  Giving it to everyone is the cost reduction. Leaving aside the question of old age and focusing on healthcare for people of working age, it is almost always cheaper to intervene earlier, and it helps people get back to work sooner. The case is even stronger in children where healthcare gets to determine if they get to live a decent life or not. Not to mention the benefits of time saved fighting back and forth over bills. A little bit of cost control pushing people onto the cheaper versions of insulin and things like that, in the manner of the UK National Institute for Clinical Excellence would help. This is also what every private insurer does, but people go bananas when contemplating the idea that the government might do it. Oh, and pharma marketing needs reining in. Some of the people who were marketing opiates should be jailed for the damage they've done.
  - vidarh 7y ago
    Medicare has for a long time been banned from negotiating drug prices in most instances, and that is a large part of the problem. They have a limited indirect ability by basically being able to contract with private healthcare plans to provide services, who in turn can negotiate, but it does in no way allow them to leverage their size to the full extent. Compare to e.g. the UK where the NHS does not just negotiate on generics, but also use the considerable value of their contracts for generics or drugs that can easily be substituted to drive down prices on other drugs by bargaining on combined contract values.
rjf72 7y ago
Imagine there was a button you could push that would give every single person everything you're mentioning - a free house, free healthcare, and all the things you're not mentioning - free education, free sustenance, free childcare, free longterm paid pa/maternal leave, guaranteed high paying jobs, etc. Who wouldn't push this button? I think every single individual, right/left/libertarian/liberal/conservative or whatever other identity would. The reason people are critical of ideas such as you are mentioning is not because they don't want them, but because they do not think they are economically viable. To get a ballpark for economic factors, let's try to figure out what the total value of absolutely all goods and services transacted, at market value, per year in the US and then divide that by the national population. I think if you asked the average person what they thought this figure would be, most would put it in the hundreds of thousands. Some might even put it in the millions. Fortunately it's really easy to figure out exactly what the answer is. It's precisely what the GDP/capita captures. It's about $62,000. And we're already chopping 27% of that in taxes to fund our current [generally underfunded] programs, so you can drop it down to $45k. That is, as hard as it is to believe, the entire economic product of the country. Our unimaginable achievements - both social and personal can make it hard to realize how little we actually have. So you need to fund all the grand ideas you have in proportion to this keeping in mind that it doesn't mean you have $45k per person to spend. That is the entire economic product of the country. This is why it's much easier to have a grand vision than to actually think about implementing it. Taxing the rich is hardly a solution because it again misses out on just how little we really have. If you go and just take 100% of Bezos' wealth from him, all $150 billion, that works out to about $470 per person - for one year. And he is exponentially richer than most rich. By the time you get to stripping the 20th richest person of all his wealth, you're down to $10s of dollars. Not too long after that, you're down to pennies per person. And that is, again, just money for a single year. These grand ideas need neverending annual funding. --- This is why even in places like Norway, which has extensive national wealth due to a mixture of a small population and large sums of nationalized oil money, it's not just free everything for everybody. Solving all of these issues requires much more than just a desire to solve them. The reason I mention this is because I think this shared desire is something that often gets lost in today's increasingly polarized world. We all want the same things; it's just we disagree on how to get there.
- 7y ago
Sharlin 7y ago
Oh my god, I just read news about some "centrist" Democrats arguing against universal single-payer healthcare on the grounds that some segment of the working population already gets a nice healthcare package as a benefit, and somehow it would be unfair to those people if everyone was eligible to reasonable medical care. I mean, with Democrats like that, why do you even need Republicans?
- Accipitriform 7y ago
  Right, of course we should want single-payer, just like Canada! Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait... There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier. The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!
  - Sharlin 7y ago
    Oh puh-lease. Even a trivial googling tells me that Canada has longer waiting times than most other comparable countries with single-payer healthcare. And those waiting times? About half of GP visits are same- or next day appointments, with 20% of Canadians having to wait for a week. As for specialists, the median waiting time is roughly four weeks. [1] So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company. Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost. [1] https://globalnews.ca/news/3251833/canada-has-some-of-the-longest-wait-times-to-see-doctors-specialists-report/ https://globalnews.ca/news/3251833/canada-has-some-of-the-lo... [2] https://www.cihi.ca/sites/default/files/document/text-alternative-version-2016-cmwf-en-web.pdf https://www.cihi.ca/sites/default/files/document/text-altern...
dragonwriter 7y ago
> For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible. No, it's not. There's a subset of the left that has that ambition, but there's a subset of the left that subscribes very hard to the idea that doing so is improperly aiding the wealthy (even though “eliminate means testing” mostly means “consolidate means testing into the tax system rather than duplicating the income verification function redundantly across various programs plus the tax system”.) Now, it's true that the thought leadership on the left is mostly in the former group, and the public figures talking up the latter position are mostly center-right neoliberals. But they are using the specific rhetoric they are using because it appeals to a wide swathe of the rank-and-file left and allows them to seem progressive when what they are actually doing is defending the ability of the rich to preserve advantages that exist for them in the status quo system while blocking progress to universal access. (And that's true whether it's healthcare or college funding or whatever else.)

roenxi 7y ago

Those are compelling policy handwaves, but they really aren't going to the heart of the issue; which is someone in the broader conversation is basically misrepresenting reality to an astounding degree. The OECD reports that the US already spends more on healthcare per capita than any other nation by a substantial margin [0]. If it were believed that the ambitious left were going to implement free healthcare by bringing actual costs down into line with the rest of the world they could probably muster bipartisan support in a few years. But I bet their plans don't do that - eliminating means testing and more handouts are are just avoiding the real issues. [0] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

kazagistar 7y ago
That's exactly what the left wants, but they are facing bipartisan opposition from both Republicans and the majorty of centrist Democracts, both of whom receive large donations from the massive insurance industry that stands to lose everything.
pjc50 7y ago
Giving it to everyone is the cost reduction. Leaving aside the question of old age and focusing on healthcare for people of working age, it is almost always cheaper to intervene earlier, and it helps people get back to work sooner. The case is even stronger in children where healthcare gets to determine if they get to live a decent life or not. Not to mention the benefits of time saved fighting back and forth over bills. A little bit of cost control pushing people onto the cheaper versions of insulin and things like that, in the manner of the UK National Institute for Clinical Excellence would help. This is also what every private insurer does, but people go bananas when contemplating the idea that the government might do it. Oh, and pharma marketing needs reining in. Some of the people who were marketing opiates should be jailed for the damage they've done.
- vidarh 7y ago
  Medicare has for a long time been banned from negotiating drug prices in most instances, and that is a large part of the problem. They have a limited indirect ability by basically being able to contract with private healthcare plans to provide services, who in turn can negotiate, but it does in no way allow them to leverage their size to the full extent. Compare to e.g. the UK where the NHS does not just negotiate on generics, but also use the considerable value of their contracts for generics or drugs that can easily be substituted to drive down prices on other drugs by bargaining on combined contract values.

rjf72 7y ago

Imagine there was a button you could push that would give every single person everything you're mentioning - a free house, free healthcare, and all the things you're not mentioning - free education, free sustenance, free childcare, free longterm paid pa/maternal leave, guaranteed high paying jobs, etc. Who wouldn't push this button? I think every single individual, right/left/libertarian/liberal/conservative or whatever other identity would. The reason people are critical of ideas such as you are mentioning is not because they don't want them, but because they do not think they are economically viable. To get a ballpark for economic factors, let's try to figure out what the total value of absolutely all goods and services transacted, at market value, per year in the US and then divide that by the national population. I think if you asked the average person what they thought this figure would be, most would put it in the hundreds of thousands. Some might even put it in the millions. Fortunately it's really easy to figure out exactly what the answer is. It's precisely what the GDP/capita captures. It's about $62,000. And we're already chopping 27% of that in taxes to fund our current [generally underfunded] programs, so you can drop it down to $45k. That is, as hard as it is to believe, the entire economic product of the country. Our unimaginable achievements - both social and personal can make it hard to realize how little we actually have. So you need to fund all the grand ideas you have in proportion to this keeping in mind that it doesn't mean you have $45k per person to spend. That is the entire economic product of the country. This is why it's much easier to have a grand vision than to actually think about implementing it. Taxing the rich is hardly a solution because it again misses out on just how little we really have. If you go and just take 100% of Bezos' wealth from him, all $150 billion, that works out to about $470 per person - for one year. And he is exponentially richer than most rich. By the time you get to stripping the 20th richest person of all his wealth, you're down to $10s of dollars. Not too long after that, you're down to pennies per person. And that is, again, just money for a single year. These grand ideas need neverending annual funding. --- This is why even in places like Norway, which has extensive national wealth due to a mixture of a small population and large sums of nationalized oil money, it's not just free everything for everybody. Solving all of these issues requires much more than just a desire to solve them. The reason I mention this is because I think this shared desire is something that often gets lost in today's increasingly polarized world. We all want the same things; it's just we disagree on how to get there.

7y ago

Sharlin 7y ago

Oh my god, I just read news about some "centrist" Democrats arguing against universal single-payer healthcare on the grounds that some segment of the working population already gets a nice healthcare package as a benefit, and somehow it would be unfair to those people if everyone was eligible to reasonable medical care. I mean, with Democrats like that, why do you even need Republicans?

Accipitriform 7y ago
Right, of course we should want single-payer, just like Canada! Never mind that the average wait time to see a doctor in Canada is almost 20 weeks, and that tens of thousands of Canadians cross the border to the US every year to avoid that wait... There are tradeoffs with everything. Personally I think people should proactively try to live healthier lives - the medical establishment is about making money, not making you healthier. The other major side benefit of that is our society might be able to afford the overall cost of healthcare - it's not looking too good at the moment!
- Sharlin 7y ago
  Oh puh-lease. Even a trivial googling tells me that Canada has longer waiting times than most other comparable countries with single-payer healthcare. And those waiting times? About half of GP visits are same- or next day appointments, with 20% of Canadians having to wait for a week. As for specialists, the median waiting time is roughly four weeks. [1] So those numbers are definitely not optimal compared to many other countries, but your claim about the average being almost 20 weeks is completely ridiculous. You're entitled to your own opinions, but you are not entitled to your own facts. And if your opinions are based on your own facts, don't expect to be taken seriously in any reasonably educated company. Now, according to [2], the US fares well on two metrics: waiting time to see a specialist and waiting time to elective surgeries. Unsurprisingly, both of these are conditional on already having gotten a referral and/or having decided to book the appointment or operation. That is, most of the time, if you have decided you can afford it! Indeed, cost barriers were by far the highest in the US, as measured by the fraction of people who skipped treatment or medication due to cost. [1] https://globalnews.ca/news/3251833/canada-has-some-of-the-longest-wait-times-to-see-doctors-specialists-report/ https://globalnews.ca/news/3251833/canada-has-some-of-the-lo... [2] https://www.cihi.ca/sites/default/files/document/text-alternative-version-2016-cmwf-en-web.pdf https://www.cihi.ca/sites/default/files/document/text-altern...

dragonwriter 7y ago

> For what it's worth, the ambition on the left over here (in the US) is to eliminate means testing for programs as much as possible. No, it's not. There's a subset of the left that has that ambition, but there's a subset of the left that subscribes very hard to the idea that doing so is improperly aiding the wealthy (even though “eliminate means testing” mostly means “consolidate means testing into the tax system rather than duplicating the income verification function redundantly across various programs plus the tax system”.) Now, it's true that the thought leadership on the left is mostly in the former group, and the public figures talking up the latter position are mostly center-right neoliberals. But they are using the specific rhetoric they are using because it appeals to a wide swathe of the rank-and-file left and allows them to seem progressive when what they are actually doing is defending the ability of the rich to preserve advantages that exist for them in the status quo system while blocking progress to universal access. (And that's true whether it's healthcare or college funding or whatever else.)