8 ms·

There is a lot of abstraction in your statements culminating in an attempt to paint me as unethical. I wish we could just talk like friends who happen to disag

There is a lot of abstraction in your statements culminating in an attempt to paint me as unethical. I wish we could just talk like friends who happen to disagree on policy. I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system. > As far as I know, no presidential candidate is proposing to stop people from buying private medical insurance, so your worries seem entirely unfounded in fact. Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct.

foldr 7y ago
>I wish we could just talk like friends who happen to disagree on policy. I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue. That conception of things is part of the reason that it's been so hard to reform the system. > I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system. I've read through this a couple of times but can't really make any sense of it. As long as people have to pay for their own treatment, people with more money will be able to get better treatment. That's a form of rationing, and it wouldn't go away if the "market" were to get more "efficient". >Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct. If one of the candidates is proposing to ban private health insurance, it should be easy for you to reference a statement to this effect.
- EdSharkey 7y ago
  > I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue. Your passion is admirable, but no need to insult, friend. I'm not a policy wonk, I just disagree with you. I don't have the same faith in government's ability to deliver services as you do. America is especially bad at delivering services, given our tendency towards crony capitalism and a disengaged public. It is possible to make things worse than they are now with totally well-meaning, but flawed, economic and social policies. > it should be easy for you to reference a statement to this effect. I searched on DDG, got tons of good hits for "debate ban private health insurance" and I picked the first link. The socialists (who aren't looking too hopeless in the polls and actually stand a chance at being the nominee) want to run things soup to nuts, no surprise here. Harris walked it back afterward, Sanders stood his ground and beat her over the head for a lack of conviction. https://www.reuters.com/article/us-usa-election-harris-idUSKCN1TT1X6 https://www.reuters.com/article/us-usa-election-harris-idUSK... > Harris and U.S. Senate colleague Bernie Sanders were the only two candidates to raise their hands during Thursday night’s second Democratic debate when asked, "Who here would abolish their private health insurance in favor of a government-run plan?" > On Wednesday night, U.S. Senator Elizabeth Warren of Massachusetts and New York City Mayor Bill de Blasio were the only two candidates to raise their hands when asked if they would scrap private insurance. Please just watch the debates and don't give anyone a pass. I'm counting on you and others to not pick an unelectable wacko to run against Trump. Full disclosure, I didn't vote for Trump (or Hillary) in 2016.
  - foldr 7y ago
    Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry. You're really selling the US short if you think that it can't implement any one of the multitude of healthcare systems that exist in other first world countries - all of which are superior both in terms of outcomes and in terms of basic decency. This kind of pessimism is just a convenient excuse for doing nothing while people are dying. I believe there will come a time when the right to healthcare is no more up for debate than, say, women's right to vote (no longer a "policy" issue). But, clearly, we're not there yet. You still seem wedded to the idea that the system has to be set up in such a way that a person's access to health care is significantly limited by their wealth. Thus, only certain basic treatments will be "abundant and/or free" even in your ideal conception of how the system should work! And you talk about giving the "maximum possible" number of people in the US access to high quality care - as if this maximum were somehow obviously less than 100%! When you can't get care, it's "rationing". When 15% of the population can't get it because they're too poor, then, well, gee, that's just the market at work I guess. The bottom line here is that Americans still see healthcare as a job perk rather than as a right. That's ethically obscene, but it's still the mainstream point of view, so you're by no means alone. If you are happy with your own personal situation at present, then by all means sit out elections and float pie in the sky market-based schemes as alternatives to actionable policy proposals that would actually make a difference.
    - EdSharkey 7y ago
      Thank you for your detailed response, I'll try to honor it. > Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry. Yes, we do disagree. But, we have to go forward together by dealing with each other honorably and not operating from the default assumption that the other is below reproach or sub-human in their thinking. We need to hammer home that the perfect should not be the enemy of the good (myself included.) We have to make deals and compromise to implement any policies that will be durable and maintain their original spirit. Think Medicare and SS as examples of big compromise bills that lasted, and the ACA as a contra-example. If you don't believe in your bones that we need to compromise on the big stuff, then life will be full of disappointments. > superior both in terms of outcomes and in terms of basic decency What about our obesity epidemic, isn't that a factor contributing to our outcomes? Do all countries use the same measure when tallying outcomes? What are our comparative outcomes for health care at the extremes? Like, when your twins are born 2'10" and 2'11" respectively and still live and are healthy after 7 years? I'm sorry, but respectfully, that talking point is so cherry-picked, and ignores so many factors, that it is meaningless. It is only intended to shock and to shame. Reality is more complicated than just "outcomes are worse." Do not insult my intelligence. > I believe there will come a time when the right to healthcare ... Medicare turns people away all the time, it's actually hard to get them to pay a claim. A right is a only truly a right when it can't be denied. Just start asking simple questions, and the 'HC as a right' concept falls apart. Like, which health care procedures are a right and which are elective? Sex reassignment isn't a right ... this year ... maybe next year ... until the Republicans take power again ... see what I mean? A service like health care isn't so simple, nor black and white, as you paint it. I do not believe you can make your "100% covered" math work AND pay doctors and hospitals such that they will continue to work for you such that you don't wind up with a doctor shortage and induce rationing. I do believe that my "maximum possible" can reach an effective "100% covered". Think of how cheap technology and process changes can make things over time. The world is not a static system, it's dynamic and fluid! For example, Amazon.com, a recent phenomena, is being described as an anti-inflationary force across the entire economy because they are so effective at driving down costs and haggling on prices! > pie in the sky market-based schemes Come now... Consider there is no rationing of food. Food on store shelves regularly goes bad and we have to throw it out, we produce such an abundance. Consider the US manufactures 8x the amount of clothes that actually gets sold. If it weren't for Africa taking, basically for free, all of our excess clothes, we would be incinerating the excess at the end of each fashion season. Consider veterinary services and how much affordable they are relative to comparable human health care. Like, vet services paid out-of-pocket, no insurance at all affordable. Why? How?! Consider health care and student loans - both seeing spiraling cost increases. What's the connection? Heavy government involvement and crony influence. What I'm saying is ... Market forces perform! Pay people up to what the market will bear, and you'll never have a shortage of workers to provide a service. Then, encourage competition and allow people to shop based on price and quality. Next, the market will control for excess and will find a stable value for each service that will be as optimal as it can get. Finally, if you can ease up on regulations, then the cost of providing a service goes down further and businesses will reinvest in themselves, which can further lower the costs. It's economics. The model for how to unleash market forces and make services cheap and accessible exists in standard textbooks. The fact that health care is currently expensive and people's lives hang in the balance makes this discussion more than just economics. I think that's mainly what you are driving at. And I respect your passion in that regard. Honestly, I get you on that! Your whole paragraph there is full of bitterness for me, but why can't you get me, friend? I'm passionate too AND I don't want anyone to suffer! Like, no one normal wants other people to suffer. You know that, right? Finally, if it is true that I actually want to alleviate suffering just like you ...

foldr 7y ago

>I wish we could just talk like friends who happen to disagree on policy. I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue. That conception of things is part of the reason that it's been so hard to reform the system. > I don't believe a functional health care market where providers must compete on price and quality is as static as the system we have now. The "rationing" you describe that we have today is because we don't have a functional market or insurance system. I've read through this a couple of times but can't really make any sense of it. As long as people have to pay for their own treatment, people with more money will be able to get better treatment. That's a form of rationing, and it wouldn't go away if the "market" were to get more "efficient". >Rewatch the debates and listen to the policy statements and their implications, I don't think you're correct. If one of the candidates is proposing to ban private health insurance, it should be easy for you to reference a statement to this effect.

EdSharkey 7y ago
> I think it's a terrible mistake to treat this as a wonky policy issue rather than an urgent ethical issue. Your passion is admirable, but no need to insult, friend. I'm not a policy wonk, I just disagree with you. I don't have the same faith in government's ability to deliver services as you do. America is especially bad at delivering services, given our tendency towards crony capitalism and a disengaged public. It is possible to make things worse than they are now with totally well-meaning, but flawed, economic and social policies. > it should be easy for you to reference a statement to this effect. I searched on DDG, got tons of good hits for "debate ban private health insurance" and I picked the first link. The socialists (who aren't looking too hopeless in the polls and actually stand a chance at being the nominee) want to run things soup to nuts, no surprise here. Harris walked it back afterward, Sanders stood his ground and beat her over the head for a lack of conviction. https://www.reuters.com/article/us-usa-election-harris-idUSKCN1TT1X6 https://www.reuters.com/article/us-usa-election-harris-idUSK... > Harris and U.S. Senate colleague Bernie Sanders were the only two candidates to raise their hands during Thursday night’s second Democratic debate when asked, "Who here would abolish their private health insurance in favor of a government-run plan?" > On Wednesday night, U.S. Senator Elizabeth Warren of Massachusetts and New York City Mayor Bill de Blasio were the only two candidates to raise their hands when asked if they would scrap private insurance. Please just watch the debates and don't give anyone a pass. I'm counting on you and others to not pick an unelectable wacko to run against Trump. Full disclosure, I didn't vote for Trump (or Hillary) in 2016.
- foldr 7y ago
  Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry. You're really selling the US short if you think that it can't implement any one of the multitude of healthcare systems that exist in other first world countries - all of which are superior both in terms of outcomes and in terms of basic decency. This kind of pessimism is just a convenient excuse for doing nothing while people are dying. I believe there will come a time when the right to healthcare is no more up for debate than, say, women's right to vote (no longer a "policy" issue). But, clearly, we're not there yet. You still seem wedded to the idea that the system has to be set up in such a way that a person's access to health care is significantly limited by their wealth. Thus, only certain basic treatments will be "abundant and/or free" even in your ideal conception of how the system should work! And you talk about giving the "maximum possible" number of people in the US access to high quality care - as if this maximum were somehow obviously less than 100%! When you can't get care, it's "rationing". When 15% of the population can't get it because they're too poor, then, well, gee, that's just the market at work I guess. The bottom line here is that Americans still see healthcare as a job perk rather than as a right. That's ethically obscene, but it's still the mainstream point of view, so you're by no means alone. If you are happy with your own personal situation at present, then by all means sit out elections and float pie in the sky market-based schemes as alternatives to actionable policy proposals that would actually make a difference.
  - EdSharkey 7y ago
    Thank you for your detailed response, I'll try to honor it. > Ethical disagreements exist. You may not think that this is an urgent ethical issue, but I do. I'm not going to say that your position is ethically acceptable just because it would make you feel better - sorry. Yes, we do disagree. But, we have to go forward together by dealing with each other honorably and not operating from the default assumption that the other is below reproach or sub-human in their thinking. We need to hammer home that the perfect should not be the enemy of the good (myself included.) We have to make deals and compromise to implement any policies that will be durable and maintain their original spirit. Think Medicare and SS as examples of big compromise bills that lasted, and the ACA as a contra-example. If you don't believe in your bones that we need to compromise on the big stuff, then life will be full of disappointments. > superior both in terms of outcomes and in terms of basic decency What about our obesity epidemic, isn't that a factor contributing to our outcomes? Do all countries use the same measure when tallying outcomes? What are our comparative outcomes for health care at the extremes? Like, when your twins are born 2'10" and 2'11" respectively and still live and are healthy after 7 years? I'm sorry, but respectfully, that talking point is so cherry-picked, and ignores so many factors, that it is meaningless. It is only intended to shock and to shame. Reality is more complicated than just "outcomes are worse." Do not insult my intelligence. > I believe there will come a time when the right to healthcare ... Medicare turns people away all the time, it's actually hard to get them to pay a claim. A right is a only truly a right when it can't be denied. Just start asking simple questions, and the 'HC as a right' concept falls apart. Like, which health care procedures are a right and which are elective? Sex reassignment isn't a right ... this year ... maybe next year ... until the Republicans take power again ... see what I mean? A service like health care isn't so simple, nor black and white, as you paint it. I do not believe you can make your "100% covered" math work AND pay doctors and hospitals such that they will continue to work for you such that you don't wind up with a doctor shortage and induce rationing. I do believe that my "maximum possible" can reach an effective "100% covered". Think of how cheap technology and process changes can make things over time. The world is not a static system, it's dynamic and fluid! For example, Amazon.com, a recent phenomena, is being described as an anti-inflationary force across the entire economy because they are so effective at driving down costs and haggling on prices! > pie in the sky market-based schemes Come now... Consider there is no rationing of food. Food on store shelves regularly goes bad and we have to throw it out, we produce such an abundance. Consider the US manufactures 8x the amount of clothes that actually gets sold. If it weren't for Africa taking, basically for free, all of our excess clothes, we would be incinerating the excess at the end of each fashion season. Consider veterinary services and how much affordable they are relative to comparable human health care. Like, vet services paid out-of-pocket, no insurance at all affordable. Why? How?! Consider health care and student loans - both seeing spiraling cost increases. What's the connection? Heavy government involvement and crony influence. What I'm saying is ... Market forces perform! Pay people up to what the market will bear, and you'll never have a shortage of workers to provide a service. Then, encourage competition and allow people to shop based on price and quality. Next, the market will control for excess and will find a stable value for each service that will be as optimal as it can get. Finally, if you can ease up on regulations, then the cost of providing a service goes down further and businesses will reinvest in themselves, which can further lower the costs. It's economics. The model for how to unleash market forces and make services cheap and accessible exists in standard textbooks. The fact that health care is currently expensive and people's lives hang in the balance makes this discussion more than just economics. I think that's mainly what you are driving at. And I respect your passion in that regard. Honestly, I get you on that! Your whole paragraph there is full of bitterness for me, but why can't you get me, friend? I'm passionate too AND I don't want anyone to suffer! Like, no one normal wants other people to suffer. You know that, right? Finally, if it is true that I actually want to alleviate suffering just like you ...