5 ms·

I see things like this that seem to me to imply that in order to deserve benefits, someone needs to work. I think a more productive line of debate would be: 1

by d4mi3n 5y ago

I see things like this that seem to me to imply that in order to deserve benefits, someone needs to work. I think a more productive line of debate would be: 1. Do we, as a society, believe we should only care for those who can be productive? 2. Do we, as a society, value things other than productivity? 3. Do we, as a society, believe it is the place of a governing body to ensure a standard quality of life (whatever that standard may be)? Putting barriers around who deserves what doesn't really serve to do much other than exclude people who don't know how to work the system, or those who are unable to work the system.

deleted 5y ago
[deleted]
manigandham 5y ago
I disagree. The better framing is around choice. In some countries these decisions are made for you and funded through taxes and fees. Other nations require you to plan your own way. The USA leans toward the individual over the state. Certain things like healthcare should be revamped to remove the ties to employers but it's important to keep the prevailing culture in mind. People overwhelmingly still want the ability to choose here - what they lack are the options to choose from.
- munk-a 5y ago
  I strongly disagree that people want to be able to choose healthcare - Americans value the ability to choose their healthcare merely because it's being dolled out by corporations (on all sides - not just the insurers) that are trying to squeeze as much profit as possible out. When you're denied choice in American healthcare you get bottom of the barrel service so asking someone to surrender that choice generates a kneejerk response. As an example my grandfather lost his leg to a blood clot due to being sent to an overwhelmed hospital that left him sitting undiagnosed for hours on end - it is easy to read that scenario as being forced into a lack of care, but choices wouldn't help things here. If he had a choice he would have advocated for going to his family doctor first which would have made the situation worse - in all honestly hospital overcrowding and underfunding is the only thing that led to him losing his leg. Healthcare is a sector of the market that most people here (even me - and I work in a company that deals specifically in the US healthcare market) don't have enough knowledge to make intelligent choices in because the knowledge needed to comprehend all the random crap that can go wrong with your body is intensely deep. I also don't think it's far to say the US favors individuals over the state - the US cares very little about individual health. And that's not precisely what you meant when you said it favors individuals over the state but I think it's important to highlight that the situation in the USA is quite detrimental to a lot of individuals.
  - manigandham 5y ago
    I literally explained that healthcare should be separated from corporations and that people are missing options to choose from in the first place. Hospital overcrowding is an entirely different issue. Did you reply just to argue? And yes, I do want to choose my healthcare. I want to select the plan that best fits my needs. If you want a larger simpler plan that covers everything then you can choose that. Me having choice does not take away from you, it only provides more for both of us.
    - deanCommie 5y ago
      As someone from a country with Universal Healthcare, I don't understand what "yes, I do want to choose my healthcare. I want to select the plan that best fits my life and needs. If you want a larger simpler plan that covers everything then you can choose that." means. And I especially don't understand how it doesn't lead to exactly the problematic outcome we are talking about which is that poor people can't afford access to quality healthcare. You don't "choose" what level of fire department protection you need. How is healthcare different? I suppose you can always hire your own private firefighter/doctor... So long as you give people the choice, and it's based on PERSONAL financial contributions rather than government-organized taxes, those with less means will have less access to a finite set of healthcare resources and result in systemic inequalities. I suppose I can imagine that there is some "ultra deluxe" version of healthcare where instead of crutches you get a wheelchair, and instead of a shared recovery room you get your own, and I do support those with the means to pay extra for something like that. But the baseline HEALTHCARE access part needs to remain the same...
      - manigandham 5y ago
        That's not how it works. America is a mix of several different systems. Everyone has access to care, and there are several public healthcare offerings; some specifically for seniors/low-income/single-parents/children/etc. The ACA already gives everyone an insurance option. The issue is that better coverage requires private insurance, mostly offered through corporations. Smaller companies can't compete, some people can't leave a bad job because of losing their plan, and others are limited to public options because they don't work. This is the overwhelming problem with USA healthcare. There aren't actually many choices because of this complex and outdated connection between jobs and benefits.
- mindslight 5y ago
  FWIW under current Medicare as it exists, you can choose between different private Medicare Advantage providers, or buy a private "supplement" that fills in where Medicare lacks. The same big insurance companies provide these plans, but have to actually conform to Medicare guidelines of not screwing people. To me the "prevailing culture" is more about the vibrancy of walking into a vendor and directly paying for services that you would like, rather than needing to appeal to some bureaucracy (whether "public" or "private") to convince it to agree that you "need" something. The medical system is currently so far from this, that I don't think it has much bearing on the practical reforms being discussed. Although I would love to see reforms in this direction as well - eg published price lists uniform for any payer, and a prohibition on arbitrary post-facto billing.
  - mattmcknight 5y ago
    > The same big insurance companies provide these plans, but have to actually conform to Medicare guidelines of not screwing people It's more like the providers have to conform to the Medicare pricing, instead of screwing the payers. This is why we need single pricer. Simply put into Medicare pricing agreements that the provider cannot charge anyone more than they charge Medicare or Medicaid. Not only does it avoid the price gouging of the uninsured and privately insured, it also ends the whole concept of out of network. Very few providers can survive without Medicare funds.
    - mindslight 5y ago
      Well it's both, although the aspect you point out is more important. That would solve a good deal of the most egregious problems. It still wouldn't fix the unexpected $5k hospital bill, but would prevent it from being a $15k fuck-you bill. And with a transparent cost structure, plans would actually be comparable financially, rather than having to guess at their "negotiated" rates or worrying whether they support your current doctors etc. Politically I wonder what's holding this back, as it seems like it would be more palatable than Medicare for all. Silent hospital lobby? Big insurers that don't actually want to make their market more efficient as they're effectively cost-plus entities?
ipaddr 5y ago
A negative production value society member needs to be carefully balanced against a positive production value society member. Not balancing this means society will go into decline one way or the other. Offering basic levels to society members is health if the society can afford it and allows the society to grow quickie because risk is removed.
- sethrin 5y ago
  > A negative production value society member needs to be carefully balanced against a positive production value society member. This is overly simplistic. Someone providing child or elder care is providing social value in a way which should not be measured against economic measures of production. Life is not an economic zero-sum game.

by d4mi3n 5y ago

deleted 5y ago

[deleted]

manigandham 5y ago

I disagree. The better framing is around choice. In some countries these decisions are made for you and funded through taxes and fees. Other nations require you to plan your own way. The USA leans toward the individual over the state. Certain things like healthcare should be revamped to remove the ties to employers but it's important to keep the prevailing culture in mind. People overwhelmingly still want the ability to choose here - what they lack are the options to choose from.

munk-a 5y ago
I strongly disagree that people want to be able to choose healthcare - Americans value the ability to choose their healthcare merely because it's being dolled out by corporations (on all sides - not just the insurers) that are trying to squeeze as much profit as possible out. When you're denied choice in American healthcare you get bottom of the barrel service so asking someone to surrender that choice generates a kneejerk response. As an example my grandfather lost his leg to a blood clot due to being sent to an overwhelmed hospital that left him sitting undiagnosed for hours on end - it is easy to read that scenario as being forced into a lack of care, but choices wouldn't help things here. If he had a choice he would have advocated for going to his family doctor first which would have made the situation worse - in all honestly hospital overcrowding and underfunding is the only thing that led to him losing his leg. Healthcare is a sector of the market that most people here (even me - and I work in a company that deals specifically in the US healthcare market) don't have enough knowledge to make intelligent choices in because the knowledge needed to comprehend all the random crap that can go wrong with your body is intensely deep. I also don't think it's far to say the US favors individuals over the state - the US cares very little about individual health. And that's not precisely what you meant when you said it favors individuals over the state but I think it's important to highlight that the situation in the USA is quite detrimental to a lot of individuals.
- manigandham 5y ago
  I literally explained that healthcare should be separated from corporations and that people are missing options to choose from in the first place. Hospital overcrowding is an entirely different issue. Did you reply just to argue? And yes, I do want to choose my healthcare. I want to select the plan that best fits my needs. If you want a larger simpler plan that covers everything then you can choose that. Me having choice does not take away from you, it only provides more for both of us.
  - deanCommie 5y ago
    As someone from a country with Universal Healthcare, I don't understand what "yes, I do want to choose my healthcare. I want to select the plan that best fits my life and needs. If you want a larger simpler plan that covers everything then you can choose that." means. And I especially don't understand how it doesn't lead to exactly the problematic outcome we are talking about which is that poor people can't afford access to quality healthcare. You don't "choose" what level of fire department protection you need. How is healthcare different? I suppose you can always hire your own private firefighter/doctor... So long as you give people the choice, and it's based on PERSONAL financial contributions rather than government-organized taxes, those with less means will have less access to a finite set of healthcare resources and result in systemic inequalities. I suppose I can imagine that there is some "ultra deluxe" version of healthcare where instead of crutches you get a wheelchair, and instead of a shared recovery room you get your own, and I do support those with the means to pay extra for something like that. But the baseline HEALTHCARE access part needs to remain the same...
    - manigandham 5y ago
      That's not how it works. America is a mix of several different systems. Everyone has access to care, and there are several public healthcare offerings; some specifically for seniors/low-income/single-parents/children/etc. The ACA already gives everyone an insurance option. The issue is that better coverage requires private insurance, mostly offered through corporations. Smaller companies can't compete, some people can't leave a bad job because of losing their plan, and others are limited to public options because they don't work. This is the overwhelming problem with USA healthcare. There aren't actually many choices because of this complex and outdated connection between jobs and benefits.
mindslight 5y ago
FWIW under current Medicare as it exists, you can choose between different private Medicare Advantage providers, or buy a private "supplement" that fills in where Medicare lacks. The same big insurance companies provide these plans, but have to actually conform to Medicare guidelines of not screwing people. To me the "prevailing culture" is more about the vibrancy of walking into a vendor and directly paying for services that you would like, rather than needing to appeal to some bureaucracy (whether "public" or "private") to convince it to agree that you "need" something. The medical system is currently so far from this, that I don't think it has much bearing on the practical reforms being discussed. Although I would love to see reforms in this direction as well - eg published price lists uniform for any payer, and a prohibition on arbitrary post-facto billing.
- mattmcknight 5y ago
  > The same big insurance companies provide these plans, but have to actually conform to Medicare guidelines of not screwing people It's more like the providers have to conform to the Medicare pricing, instead of screwing the payers. This is why we need single pricer. Simply put into Medicare pricing agreements that the provider cannot charge anyone more than they charge Medicare or Medicaid. Not only does it avoid the price gouging of the uninsured and privately insured, it also ends the whole concept of out of network. Very few providers can survive without Medicare funds.
  - mindslight 5y ago
    Well it's both, although the aspect you point out is more important. That would solve a good deal of the most egregious problems. It still wouldn't fix the unexpected $5k hospital bill, but would prevent it from being a $15k fuck-you bill. And with a transparent cost structure, plans would actually be comparable financially, rather than having to guess at their "negotiated" rates or worrying whether they support your current doctors etc. Politically I wonder what's holding this back, as it seems like it would be more palatable than Medicare for all. Silent hospital lobby? Big insurers that don't actually want to make their market more efficient as they're effectively cost-plus entities?

ipaddr 5y ago

A negative production value society member needs to be carefully balanced against a positive production value society member. Not balancing this means society will go into decline one way or the other. Offering basic levels to society members is health if the society can afford it and allows the society to grow quickie because risk is removed.

sethrin 5y ago
> A negative production value society member needs to be carefully balanced against a positive production value society member. This is overly simplistic. Someone providing child or elder care is providing social value in a way which should not be measured against economic measures of production. Life is not an economic zero-sum game.