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It was an anecdote about how complicated the US system is. Other countries figured out decades ago that adding competition to healthcare does not bring down the

It was an anecdote about how complicated the US system is. Other countries figured out decades ago that adding competition to healthcare does not bring down the price or lead to better life expectancy. It is not complicated. https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthres/health-spending.htm https://data.oecd.org/healthstat/life-expectancy-at-birth.htm https://data.oecd.org/healthstat/life-expectancy-at-birth.ht...

bumby 5y ago
But you’re missing a crucial point: The US is not starting from a blank slate. President Obama acknowledged this much when he proposed the Affordable Care Act. He said that he’d prefer a single payer system like other countries use, but that it’s not feasible in the US because we can’t just completely uproot the current system without a ton of unintended consequences. “Just do it like other countries” isn’t a real plan. So given the current state of the healthcare system, how do you propose it gets modified to mirror those other countries? Do you have a good handle on how those proposed steps (like drastic reductions in R&D spending) will affect the overall system? When people naively think there are simple solutions to extremely complex systems, it reminds me of the quote “For every problem there is a solution that is simple, straightforward, and wrong.”
- nicoffeine 5y ago
  Obama has also been endorsing Medicare For All since 2018. From an article about that subject: "The facts are undeniable. Citizens of developed countries with variations of single-payer systems — Britain, Germany, France, etc. — pay roughly half what Americans pay for health coverage and have better results to show for it (longer life spans, lower infant mortality). They accomplish this not through some exotic, foreign magic but by exploiting the economic benefits of large insurance pools that represent the entire population. This allows comprehensive coverage to be offered at affordable rates because everyone shares in the risks and rewards of the system. Let’s be real clear: This isn’t socialism. This isn’t communism. It’s simple risk management — the same economic principle that underlies all forms of insurance."[1] The bottom line is that nearly a third of America (over 100 million people) are already on Medicare or Medicaid. That is enough data to forecast any outcome there is. Billing, coding, everything is already at a federal standard. Hospitals, doctors, and clinics love Medicare/Medicaid because they know what they are going to be paid and they are paid. Anyone who claims that it can't work here is either unaware of these facts, or purposefully pretending they don't exist. [1] https://www.latimes.com/business/lazarus/la-fi-lazarus-obama-medicare-for-all-20180911-story.html https://www.latimes.com/business/lazarus/la-fi-lazarus-obama...
  - bumby 5y ago
    I think you are misunderstanding what I'm saying. I'm not arguing whether single payer is a good idea. I'm not arguing that it's tantamount to communism. I'm not arguing that there are many politicians (Obama, included) who are in favor of it. I'm arguing about the feasibility of it in light of naive statements. It's easy for a politician to endorse a policy, particularly a populist one like Medicare for All. It's entirely different to craft a policy, within the current system, that pragmatically implements it. My claim is that Obama endorsed the idea because he both thought it was good policy and populist idea that worked in the favor of his politics. But that's entirely different from crafting a pragmatic policy that actually can get passed into law. I think he's been on the record stating that he didn't like the ACA, but the goal was to pass something, even if it's broken, to try to force it into policy so that it would eventually be fixed into something better. So with so much support, why can't the U.S. implement it? That's central to my point. "President Obama was clear that – while he would have preferred single payer if we were starting from a clean slate – it would be too disruptive given our current system."[1] Point being, in many ways it is against the current system. So while you haven't directly addressed my questions, I get the impression you think "Just expand Medicare" is the answer. My point is that it's a bit naive because it really doesn't address the systemic effects that have kept single payer policy from already being implemented. Medicare/Medicaid is on track to be the largest proportion of the entitlement budget, before expanding it and it doesn't count the Dept. of Veterans Affairs budget (I don't think healthcare is a bad way to spend the budget btw). I know many people will say the Defense budget can be cut to pay for it. But how do you plan on getting that passed when nearly every senator wants to protect the DoD jobs in their state? I'm not even against that idea, I'm just not seeing you advocate a real strategy to implement it. The U.S. is perpetually running against the debt ceiling and your proposal will exacerbate that. This is just the beginning; how do you address the medical insurance industry, particularly when they are heavily lobbying Congress? If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy. So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system? [1]https://washingtonmonthly.com/2015/09/13/obama-the-negotiator/ https://washingtonmonthly.com/2015/09/13/obama-the-negotiato...

bumby 5y ago

But you’re missing a crucial point: The US is not starting from a blank slate. President Obama acknowledged this much when he proposed the Affordable Care Act. He said that he’d prefer a single payer system like other countries use, but that it’s not feasible in the US because we can’t just completely uproot the current system without a ton of unintended consequences. “Just do it like other countries” isn’t a real plan. So given the current state of the healthcare system, how do you propose it gets modified to mirror those other countries? Do you have a good handle on how those proposed steps (like drastic reductions in R&D spending) will affect the overall system? When people naively think there are simple solutions to extremely complex systems, it reminds me of the quote “For every problem there is a solution that is simple, straightforward, and wrong.”

nicoffeine 5y ago
Obama has also been endorsing Medicare For All since 2018. From an article about that subject: "The facts are undeniable. Citizens of developed countries with variations of single-payer systems — Britain, Germany, France, etc. — pay roughly half what Americans pay for health coverage and have better results to show for it (longer life spans, lower infant mortality). They accomplish this not through some exotic, foreign magic but by exploiting the economic benefits of large insurance pools that represent the entire population. This allows comprehensive coverage to be offered at affordable rates because everyone shares in the risks and rewards of the system. Let’s be real clear: This isn’t socialism. This isn’t communism. It’s simple risk management — the same economic principle that underlies all forms of insurance."[1] The bottom line is that nearly a third of America (over 100 million people) are already on Medicare or Medicaid. That is enough data to forecast any outcome there is. Billing, coding, everything is already at a federal standard. Hospitals, doctors, and clinics love Medicare/Medicaid because they know what they are going to be paid and they are paid. Anyone who claims that it can't work here is either unaware of these facts, or purposefully pretending they don't exist. [1] https://www.latimes.com/business/lazarus/la-fi-lazarus-obama-medicare-for-all-20180911-story.html https://www.latimes.com/business/lazarus/la-fi-lazarus-obama...
- bumby 5y ago
  I think you are misunderstanding what I'm saying. I'm not arguing whether single payer is a good idea. I'm not arguing that it's tantamount to communism. I'm not arguing that there are many politicians (Obama, included) who are in favor of it. I'm arguing about the feasibility of it in light of naive statements. It's easy for a politician to endorse a policy, particularly a populist one like Medicare for All. It's entirely different to craft a policy, within the current system, that pragmatically implements it. My claim is that Obama endorsed the idea because he both thought it was good policy and populist idea that worked in the favor of his politics. But that's entirely different from crafting a pragmatic policy that actually can get passed into law. I think he's been on the record stating that he didn't like the ACA, but the goal was to pass something, even if it's broken, to try to force it into policy so that it would eventually be fixed into something better. So with so much support, why can't the U.S. implement it? That's central to my point. "President Obama was clear that – while he would have preferred single payer if we were starting from a clean slate – it would be too disruptive given our current system."[1] Point being, in many ways it is against the current system. So while you haven't directly addressed my questions, I get the impression you think "Just expand Medicare" is the answer. My point is that it's a bit naive because it really doesn't address the systemic effects that have kept single payer policy from already being implemented. Medicare/Medicaid is on track to be the largest proportion of the entitlement budget, before expanding it and it doesn't count the Dept. of Veterans Affairs budget (I don't think healthcare is a bad way to spend the budget btw). I know many people will say the Defense budget can be cut to pay for it. But how do you plan on getting that passed when nearly every senator wants to protect the DoD jobs in their state? I'm not even against that idea, I'm just not seeing you advocate a real strategy to implement it. The U.S. is perpetually running against the debt ceiling and your proposal will exacerbate that. This is just the beginning; how do you address the medical insurance industry, particularly when they are heavily lobbying Congress? If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy. So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system? [1]https://washingtonmonthly.com/2015/09/13/obama-the-negotiator/ https://washingtonmonthly.com/2015/09/13/obama-the-negotiato...