4 ms·

> The public rhetoric frustrates me as someone who favors universal healthcare. Demonizing corporations and rich people is red meat for partisans, but it’s not

> The public rhetoric frustrates me as someone who favors universal healthcare. Demonizing corporations and rich people is red meat for partisans, but it’s not a solution. How do we pay for this system? How do we cut costs? There are already two pieces of legislation, the Jayapal and Sanders bills, they account for their costs. Tim Faust’s new book likewise walks through all of these concerns in detail: https://www.mhpbooks.com/books/health-justice-now/ https://www.mhpbooks.com/books/health-justice-now/ And I don’t think people are “demonizing” corporations, so much as they are being more and more exposed to fundamental cruelty and parasitism of the American healthcare system. As costs spiral out of control and inequality compounds in the US, a far greater swathe of people are finding themselves on the receiving end of its violence and deprivation. I’d suggest you look at the work of disability activists like Ady Barkan to get a better picture.

rayiner 7y ago
The Sanders bill plans to pay for Medicare for All with taxes that are much lower than the social insurance taxes in France or Germany. That is pure fantasy. That gives me little comfort that its accurately accounting for costs.
- dragonwriter 7y ago
  > The Sanders bill plans to pay for Medicare for All with taxes that are much lower than the social insurance taxes in France or Germany. The US has much weaker non-healthcare social insurance than France or Germany, and a much larger per-capita economic activity to tax, so lower social insurance taxes for equivalent healthcare seems to be expected rather than suspicious.
  - rayiner 7y ago
    France’s healthcare tax is 20%. Sanders’ proposal is about 14.4%. As to per capita economic activity—the assumption is that we’ll be as cost efficient as France in absolute dollar terms, not even just percentage of GDP terms? When we spend 30% more on primary education per student than France?
tptacek 7y ago
You're using "account for their costs" in a different sense than I think Rayiner meant. When Sanders "accounts for his costs", he means that they've added up the total projected costs of their plan and then accounted for it with tax revenue. That's fine, but it doesn't address the fundamental problem of US health care costs, which is --- regardless of "who pays" --- "why does it cost so fucking much". If all we do is move our exorbitant costs off customer bills and invoices and into our tax code, we haven't actually solved anything; in fact, in some sense, we've provided cover to the inefficiencies and incompetencies in the system that are overcharging us. Single payer or private system or something in between, I don't much care, but I'd like to see a proposal about US health care that is serious about reducing cost, not about accounting for existing costs differently.
- claudeganon 7y ago
  As I mentioned to Raiyner, you should really read Tim Faust’s book to understand how single-payer can drive down costs, but I’ll highlight this from one of his articles: “ As the sole purchaser, the federal government is immediately able to set just prices for health care services (for example, by negotiating the cost of drugs). With the weight of the full cost of health care falling squarely on its shoulders, it has an incentive to develop infrastructure and provide accessible primary care for all people, diverting money from low-frequency crisis care to high-frequency primary and preventive medicine. It can also create evidence-driven guidelines for how to handle episodes of complex care and adjust payments based on adherence to these guidelines. This promotes good care for all patients and respects providers’ agency to provide the best care they can, instead of the current mess, where payment per-service can incentivize unscrupulous providers to bilk payers by either ratcheting up individual unnecessary services (when paid per-service) or providing less care (when paid per-patient).” https://www.jacobinmag.com/2017/10/single-payer-medicare-for-all-bernie-sanders https://www.jacobinmag.com/2017/10/single-payer-medicare-for...
  - tptacek 7y ago
    I'm very familiar with this argument, but it's unpersuasive, because we already have a national health insurance system for the (huge) most expensive cohort of Americans, and it has been unable to contain these costs, despite playing a powerful role in the structure of the system itself. Why aren't private health insurance systems incentivized to create evidence-based care plans? Wouldn't they, if anything, be more incentivized to do that?

rayiner 7y ago

The Sanders bill plans to pay for Medicare for All with taxes that are much lower than the social insurance taxes in France or Germany. That is pure fantasy. That gives me little comfort that its accurately accounting for costs.

dragonwriter 7y ago
> The Sanders bill plans to pay for Medicare for All with taxes that are much lower than the social insurance taxes in France or Germany. The US has much weaker non-healthcare social insurance than France or Germany, and a much larger per-capita economic activity to tax, so lower social insurance taxes for equivalent healthcare seems to be expected rather than suspicious.
- rayiner 7y ago
  France’s healthcare tax is 20%. Sanders’ proposal is about 14.4%. As to per capita economic activity—the assumption is that we’ll be as cost efficient as France in absolute dollar terms, not even just percentage of GDP terms? When we spend 30% more on primary education per student than France?

tptacek 7y ago

You're using "account for their costs" in a different sense than I think Rayiner meant. When Sanders "accounts for his costs", he means that they've added up the total projected costs of their plan and then accounted for it with tax revenue. That's fine, but it doesn't address the fundamental problem of US health care costs, which is --- regardless of "who pays" --- "why does it cost so fucking much". If all we do is move our exorbitant costs off customer bills and invoices and into our tax code, we haven't actually solved anything; in fact, in some sense, we've provided cover to the inefficiencies and incompetencies in the system that are overcharging us. Single payer or private system or something in between, I don't much care, but I'd like to see a proposal about US health care that is serious about reducing cost, not about accounting for existing costs differently.

claudeganon 7y ago
As I mentioned to Raiyner, you should really read Tim Faust’s book to understand how single-payer can drive down costs, but I’ll highlight this from one of his articles: “ As the sole purchaser, the federal government is immediately able to set just prices for health care services (for example, by negotiating the cost of drugs). With the weight of the full cost of health care falling squarely on its shoulders, it has an incentive to develop infrastructure and provide accessible primary care for all people, diverting money from low-frequency crisis care to high-frequency primary and preventive medicine. It can also create evidence-driven guidelines for how to handle episodes of complex care and adjust payments based on adherence to these guidelines. This promotes good care for all patients and respects providers’ agency to provide the best care they can, instead of the current mess, where payment per-service can incentivize unscrupulous providers to bilk payers by either ratcheting up individual unnecessary services (when paid per-service) or providing less care (when paid per-patient).” https://www.jacobinmag.com/2017/10/single-payer-medicare-for-all-bernie-sanders https://www.jacobinmag.com/2017/10/single-payer-medicare-for...
- tptacek 7y ago
  I'm very familiar with this argument, but it's unpersuasive, because we already have a national health insurance system for the (huge) most expensive cohort of Americans, and it has been unable to contain these costs, despite playing a powerful role in the structure of the system itself. Why aren't private health insurance systems incentivized to create evidence-based care plans? Wouldn't they, if anything, be more incentivized to do that?