5 ms·

Weirdly, this kind of "freedom" is often freedom that's of zero or negative value to me. Take the "freedom" lost by switching to single payer healthcare or simi

Weirdly, this kind of "freedom" is often freedom that's of zero or negative value to me. Take the "freedom" lost by switching to single payer healthcare or similar: oh, no, I don't get to rely on private insurance and deal directly with private medical provider billing departments anymore, and spend tens of hours fixing their mistakes and attempts to screw me every time I use medical care, plus all the time trying to understand their deliberately-complicated policies to make any kind of mostly-useless attempt at comparison shopping, all while paying a premium for it, and instead I just pay taxes and get medical care when I need it. Like, OK, I'm losing some "freedom" of choice from a certain point of view, but damned if that wouldn't feel one hell of a lot more free.

booboolayla 7y ago
Do left-leaning Americans truly feel this way about single payer healthcare? Do you really not understand that SPH fixes only one problem - poor people getting substandard healthcare for free, at the taxpayer's expense? Do you really think you won't have to "spend tens of hours fixing their mistakes and attempts to screw me" when dealing with poorly paid doctors and staff that can't get laid off due to insane rules of SPH? Do you really not know about the dirty secret of places with SPH, which is that whoever has the means still goes to a private healthcare because the service is 1000x better?
big_chungus 7y ago
> Weirdly, this kind of "freedom" is often freedom that's of zero or negative value to me. As you said, _to you_. > Take the "freedom" lost by switching to single payer healthcare or similar: oh, no, I don't get to rely on private insurance and deal directly with private medical provider billing departments anymore, and spend tens of hours fixing their mistakes and attempts to screw me every time I use medical care, plus all the time trying to understand their deliberately-complicated policies to make any kind of mostly-useless attempt at comparison shopping, all while paying a premium for it, and instead I just pay taxes and get medical care when I need it. Well, this is a whole other can of worms, but here goes nothing. As a brief aside, possibly the only system more complicated than American medicine is the American tax code; both are horribly byzantine and have entire industries dedicated to wrangling the bureaucracy. Government involvement is what led to both being so messy. That aside, I oppose single-payer medicine for reasons out side of "which one costs more". I don't trust the government, and think it ought to stick to keeping the peace and enforcing property rights and contracts. There are a few other important things that can be done at the state and local level, and most things ought to be left up to the individual. I don't trust other people to run my life, be they union bureaucrats or federal ones, or even my fellow citizens. Leaving aside my concerns about the growth of federal government, why do you want everyone to use your government system instead of just offering it as an option? What business of yours is it if others choose to stay private?
- karatestomp 7y ago
  > As you said, _to you_. Yeah, I like policies that benefit me over ones that don't, typically. > Government involvement is what led to both being so messy. Well considering one of the two things that "both" signifies is the tax code... well, yes? More to the substance, that such systems under other states are, in both cases, significantly less messy leads me to believe "it's messy" does not follow simply from "government was involved", such that I would believe "get government out" is a necessary step in fixing either (again, one's the tax code, so...) > I don't trust other people to run my life, be they union bureaucrats or federal ones, or even my fellow citizens. Corporations on the same list, surely? Unless you're lumping those in with the government, which makes sense. > Leaving aside my concerns about the growth of federal government, why do you want everyone to use your government system instead of just offering it as an option? What business of yours is it if others choose to stay private? I don't really care what the new system looks like as long as I don't have to waste any more time or money enjoying the "benefits" of my "freedom" of "choice" under our current system. Any system I'm aware of from any other OECD state would be anywhere from somewhat to way better, from that perspective. Given those are proven in the real world I'd say just pick one of those. I'm pretty sure a few (e.g. Switzerland) do retain private insurance. All (AFAIK) employ price controls, strict pro-citizen rules about how insurance companies have to operate, and something like a "public option" so as long as those elements are present it's probably fine. Anything else is likely to be experimental or otherwise unproven so I'd rather avoid it, given a wealth of demonstrably-fine systems to choose among.
  - big_chungus 7y ago
    I do think we should "get government out of the tax code" to a serious extent in that it shouldn't be in the business of taxing income, payroll, capital gains, etc. Calculate expenses / adult population and send each adult a bill for that number. This would be about $15k/adult as of last year which will sting, but will quickly make people realize how much the free stuff they've been taking from others costs. > Corporations on the same list, surely? Unless you're lumping those in with the government, which makes sense. Yes, there is a deplorable amount of crony capitalism and regulatory recapture. Part of the reason why we need to starve the federal government: it will always be abused by the most powerful. I do, however, trust a market with a thousand participants motivated by profit more than a government that has changing motives every few years, or depending on what the media prints. > I don't really care what the new system looks like as long as I don't have to waste any more time or money enjoying the "benefits" of my "freedom" of "choice" under our current system. Okay, pay a medical concierge firm to handle the paperwork for you. I don't care what you do or how you do it so long as you don't tell me what to do and don't make me pay for your choices. With respect to my not-trusting-gov't point, here's why: https://news.sky.com/story/nhs-staff-can-refuse-to-treat-racist-or-sexist-patients-under-new-rules-11937175 https://news.sky.com/story/nhs-staff-can-refuse-to-treat-rac... The NHS just changed rules to allow refusal of "non-emergency" care to people who meet one of their non-PC criteria. This after people saying that it's a "human right".
sokoloff 7y ago
The other side of this is "Oh good, now I can get my health outcomes managed by the same people and with the same level of customer service/personal touch as my Department of Motor Vehicles and will have literally no alternative but to take it." Arguing the worst case of either system and representing it as the most common case is rarely productive.
- karatestomp 7y ago
  My description's the typical case for the US system, in my experience, not a worst-case, and I've not seen evidence that my experience is unusual—quite the opposite. At least we haven't been bankrupted by it yet, so there's that, but only because our family's pretty healthy.
  - sokoloff 7y ago
    As long as we’re sharing anecdotes and interpreting them as typical case outcomes: We’ve had two births, an uncomplicated broken arm, a complicated broken arm, another moderately complex issue that was many visits over a length of time, and countless pediatrics and adult GP visits and a few ER visits over the last decade with BCBS. I’d say that 95% of all visits go off with zero interactions beyond paying our part of the bill and waiting for paperwork to cycle around. The 5% cases are about half billing questions and half “just confirm that subscriber XYZ visited doctor D on date Q (so that we [as BCBS] know we’re not being scammed by the doc)”. We are nowhere near “tens of hours...every time [we] use medical care”. I doubt we’re even 10 hours per year on billing issues.
    - karatestomp 7y ago
      We've ended up with many bills, multiple EOB documents, et c., trickling in over a span of many months, coming from a bunch of different sources, each time we've had someone in the actual hospital (not just a doctor's visit), including three births. We've managed to miss some trivial bill and end up with it in collections because there's just so much damn paperwork and usually a few of them are in some state of error or dispute for some time. Seems to be normal. You in Kaiser or something? I understand that's smoother than... basically everything else, since it's all run by one entity (ahem).

booboolayla 7y ago

Do left-leaning Americans truly feel this way about single payer healthcare? Do you really not understand that SPH fixes only one problem - poor people getting substandard healthcare for free, at the taxpayer's expense? Do you really think you won't have to "spend tens of hours fixing their mistakes and attempts to screw me" when dealing with poorly paid doctors and staff that can't get laid off due to insane rules of SPH? Do you really not know about the dirty secret of places with SPH, which is that whoever has the means still goes to a private healthcare because the service is 1000x better?

big_chungus 7y ago

> Weirdly, this kind of "freedom" is often freedom that's of zero or negative value to me. As you said, _to you_. > Take the "freedom" lost by switching to single payer healthcare or similar: oh, no, I don't get to rely on private insurance and deal directly with private medical provider billing departments anymore, and spend tens of hours fixing their mistakes and attempts to screw me every time I use medical care, plus all the time trying to understand their deliberately-complicated policies to make any kind of mostly-useless attempt at comparison shopping, all while paying a premium for it, and instead I just pay taxes and get medical care when I need it. Well, this is a whole other can of worms, but here goes nothing. As a brief aside, possibly the only system more complicated than American medicine is the American tax code; both are horribly byzantine and have entire industries dedicated to wrangling the bureaucracy. Government involvement is what led to both being so messy. That aside, I oppose single-payer medicine for reasons out side of "which one costs more". I don't trust the government, and think it ought to stick to keeping the peace and enforcing property rights and contracts. There are a few other important things that can be done at the state and local level, and most things ought to be left up to the individual. I don't trust other people to run my life, be they union bureaucrats or federal ones, or even my fellow citizens. Leaving aside my concerns about the growth of federal government, why do you want everyone to use your government system instead of just offering it as an option? What business of yours is it if others choose to stay private?

karatestomp 7y ago
> As you said, _to you_. Yeah, I like policies that benefit me over ones that don't, typically. > Government involvement is what led to both being so messy. Well considering one of the two things that "both" signifies is the tax code... well, yes? More to the substance, that such systems under other states are, in both cases, significantly less messy leads me to believe "it's messy" does not follow simply from "government was involved", such that I would believe "get government out" is a necessary step in fixing either (again, one's the tax code, so...) > I don't trust other people to run my life, be they union bureaucrats or federal ones, or even my fellow citizens. Corporations on the same list, surely? Unless you're lumping those in with the government, which makes sense. > Leaving aside my concerns about the growth of federal government, why do you want everyone to use your government system instead of just offering it as an option? What business of yours is it if others choose to stay private? I don't really care what the new system looks like as long as I don't have to waste any more time or money enjoying the "benefits" of my "freedom" of "choice" under our current system. Any system I'm aware of from any other OECD state would be anywhere from somewhat to way better, from that perspective. Given those are proven in the real world I'd say just pick one of those. I'm pretty sure a few (e.g. Switzerland) do retain private insurance. All (AFAIK) employ price controls, strict pro-citizen rules about how insurance companies have to operate, and something like a "public option" so as long as those elements are present it's probably fine. Anything else is likely to be experimental or otherwise unproven so I'd rather avoid it, given a wealth of demonstrably-fine systems to choose among.
- big_chungus 7y ago
  I do think we should "get government out of the tax code" to a serious extent in that it shouldn't be in the business of taxing income, payroll, capital gains, etc. Calculate expenses / adult population and send each adult a bill for that number. This would be about $15k/adult as of last year which will sting, but will quickly make people realize how much the free stuff they've been taking from others costs. > Corporations on the same list, surely? Unless you're lumping those in with the government, which makes sense. Yes, there is a deplorable amount of crony capitalism and regulatory recapture. Part of the reason why we need to starve the federal government: it will always be abused by the most powerful. I do, however, trust a market with a thousand participants motivated by profit more than a government that has changing motives every few years, or depending on what the media prints. > I don't really care what the new system looks like as long as I don't have to waste any more time or money enjoying the "benefits" of my "freedom" of "choice" under our current system. Okay, pay a medical concierge firm to handle the paperwork for you. I don't care what you do or how you do it so long as you don't tell me what to do and don't make me pay for your choices. With respect to my not-trusting-gov't point, here's why: https://news.sky.com/story/nhs-staff-can-refuse-to-treat-racist-or-sexist-patients-under-new-rules-11937175 https://news.sky.com/story/nhs-staff-can-refuse-to-treat-rac... The NHS just changed rules to allow refusal of "non-emergency" care to people who meet one of their non-PC criteria. This after people saying that it's a "human right".

sokoloff 7y ago

The other side of this is "Oh good, now I can get my health outcomes managed by the same people and with the same level of customer service/personal touch as my Department of Motor Vehicles and will have literally no alternative but to take it." Arguing the worst case of either system and representing it as the most common case is rarely productive.

karatestomp 7y ago
My description's the typical case for the US system, in my experience, not a worst-case, and I've not seen evidence that my experience is unusual—quite the opposite. At least we haven't been bankrupted by it yet, so there's that, but only because our family's pretty healthy.
- sokoloff 7y ago
  As long as we’re sharing anecdotes and interpreting them as typical case outcomes: We’ve had two births, an uncomplicated broken arm, a complicated broken arm, another moderately complex issue that was many visits over a length of time, and countless pediatrics and adult GP visits and a few ER visits over the last decade with BCBS. I’d say that 95% of all visits go off with zero interactions beyond paying our part of the bill and waiting for paperwork to cycle around. The 5% cases are about half billing questions and half “just confirm that subscriber XYZ visited doctor D on date Q (so that we [as BCBS] know we’re not being scammed by the doc)”. We are nowhere near “tens of hours...every time [we] use medical care”. I doubt we’re even 10 hours per year on billing issues.
  - karatestomp 7y ago
    We've ended up with many bills, multiple EOB documents, et c., trickling in over a span of many months, coming from a bunch of different sources, each time we've had someone in the actual hospital (not just a doctor's visit), including three births. We've managed to miss some trivial bill and end up with it in collections because there's just so much damn paperwork and usually a few of them are in some state of error or dispute for some time. Seems to be normal. You in Kaiser or something? I understand that's smoother than... basically everything else, since it's all run by one entity (ahem).