5 ms·

Even if we just let the pesky poors die, the US healthcare system would still be more expensive on a per use basis than the rest of the world. Now sure, the ab

Even if we just let the pesky poors die, the US healthcare system would still be more expensive on a per use basis than the rest of the world. Now sure, the absolute amount spent would probably be lower if we just assumed that people that couldn't produce paperwork to prove they could fund their ER visit didn't deserve to live. If you prefer zero taxes and zero life expectancy for anyone unfortunate enough to need lifesaving treatment they can't afford, that's a perfectly valid preference. It's just intellectually dishonest to frame an argument that it's inefficient to let poor people live as an argument everyone would get more care if it wasn't for the pesky government paying for it.

mothballed 1y ago
Wait which is it. We have a "private" system where we save "the pesky" poor and regulate licensing, insurance, provide medicare/medicaid, have a quasi-public system for ER where private payers fund those who won't pay, or we don't? You just switched entirely to some soap box about why we actually do have a bastardized private-public system and then damned me for pointing out the very false basis that you presumed because it was "intellectually dishonest" for me to point out your argument was intellectually dishonest. Your premise was we have some kind of private system; my thesis is the uncovered poor would be better off with that than whatever it is we have now where they can maybe go to the ER "free" but otherwise pay a gazillion dollars in regulatory and other imposed costs if they actually try to get some prophylaxis. If you want to say universal healthcare could be better than whatever we have now -- sure I won't disagree with that. Right now we have about the worst imaginable public-private bastardized system replete with deep regulatory capture. >If you prefer zero taxes and zero life expectancy for anyone unfortunate enough to need lifesaving treatment they can't afford, that's a perfectly valid preference ... this is not my thesis at all, as you're relying on "can't afford" being at the level it is now where the poor are being billed for all manner of things they wouldn't be in an actually private free market and you're also relying an an absurd premise there will be no charity or any other options for them. For instance, in the Philippines I could just walk into a private pharmacy and buy penicillin essentially no questions asked to treat strep throat on the private market for ~half a day's local wages. (Yes Philippines have public healthcare and hospitals but you're not gonna get that meaningfully in some rural barangay). In USA it takes me 1-2 days wages to treat strep throat because I must go to a doctor to write me magic piece of paper that say I will not go in a cage for having a prescription drug, pay all his regulatory overhead, pay regulatory overhead for a lab, then go to a highly regulated pharmacist and then buy my antibiotics from probably the highest-barrier industry in the US through an anointed company and supply chain blessed by the government. I am much better off having cheap, but non-free antibiotics to treat strep than having to wait until it becomes Scarlet Fever and going to the ER for "free" or being taxed into oblivion to get "free" antibiotics that are then administered in the most bloated and uncompetitive way by government to the point I give up other necessities to pay the tax.
- notahacker 1y ago
  > Wait which is it. We have a "private" system where we save "the pesky" poor and regulate licensing, insurance, provide medicare/medicaid, have a quasi-public system for ER where private payers fund those who won't pay, or we don't? You have the fully private provision you insist is more efficient. It costs more for worse outcomes than every other developed country, who also have regulations. If your original claim that the private sector is so efficient it could deliver everything for a third of the tax cost of the current system, it's remarkable that you're actually paying a large multiple the cost of the fully socialised systems for many people to have no care or crippling copays. Sure, you can move the goalposts by claiming that true private provision requires there to be no medical regulations. But in order for that claim to be remotely credible you'd have to be able to point to all the countries that have great outcomes from having no medical regulations or public healthcare at all (the Philippines where the government is the main provider of healthcare but it doesn't have the time or inclination to enforce regulations on OTC antibiotics doesn't count, even if its health outcomes were excellent, which they're unsurprisingly not). Not gonna lie, if I'm suffering from the symptoms of a heart attack, I don't think antibiotics for half a day's pay are going to help, and literally the only efficiency argument for restrictions on ER rooms being allowed to employ extra admin staff to check insurance paperwork before deciding to administer treatment being an efficiency loss is that it's more efficient to let me die if I can't pay. As I've said, common argument but the complete opposite of your original setup where everyone gets the same outcomes for a third of the cost.
  - mothballed 1y ago
    It's an extremely strong indication you've no experience with the US ER system that you think the efficiency issues are checking insurance at the door of a MI patient vs the fact they're required to at least entertain the hordes of people coming in with self reported "STD" or "doctor note for flu" when that kind of stuff shouldn't be appearing at the ER unless a lower acuity clinic has suspicion it might actually require emergent care. But of course why go to a clinic that is much cheaper when you can just show up at the ER and claim the pseudonym Pedro Sanchez with no ID and let the clinic bill it to all the other patients (which you insanely claim makes our system 'private' despite the fact all this happens at the behest of government), whom of course won't show up unless they're about dead because they not only will have to pay for these abuses but actually having something to lose. [Oh and how would I know this, only working ~1 yr in an inner city ER and seeing all the cases] And you can argue that it would be better if those patients could get free urgent care instead of free ER to do the same thing at way higher cost, and I would agree that would be better than what we have now. But either way we're at an entirely different starting point. What you can't argue is we actually have a private system in the US (and somehow miss the elephant in the room that over 1/3 of healthcare spending in the US is public Medicare/Medicaid, then add VA on top that) and then allude it's no true Scotsman or a moved goalpost if I point this out. In fact every time I do point it out, you just go back to morally proselytizing about dead poor people because it's a great way to distract from the fact you've lied and knowingly lied.

mothballed 1y ago

Wait which is it. We have a "private" system where we save "the pesky" poor and regulate licensing, insurance, provide medicare/medicaid, have a quasi-public system for ER where private payers fund those who won't pay, or we don't? You just switched entirely to some soap box about why we actually do have a bastardized private-public system and then damned me for pointing out the very false basis that you presumed because it was "intellectually dishonest" for me to point out your argument was intellectually dishonest. Your premise was we have some kind of private system; my thesis is the uncovered poor would be better off with that than whatever it is we have now where they can maybe go to the ER "free" but otherwise pay a gazillion dollars in regulatory and other imposed costs if they actually try to get some prophylaxis. If you want to say universal healthcare could be better than whatever we have now -- sure I won't disagree with that. Right now we have about the worst imaginable public-private bastardized system replete with deep regulatory capture. >If you prefer zero taxes and zero life expectancy for anyone unfortunate enough to need lifesaving treatment they can't afford, that's a perfectly valid preference ... this is not my thesis at all, as you're relying on "can't afford" being at the level it is now where the poor are being billed for all manner of things they wouldn't be in an actually private free market and you're also relying an an absurd premise there will be no charity or any other options for them. For instance, in the Philippines I could just walk into a private pharmacy and buy penicillin essentially no questions asked to treat strep throat on the private market for ~half a day's local wages. (Yes Philippines have public healthcare and hospitals but you're not gonna get that meaningfully in some rural barangay). In USA it takes me 1-2 days wages to treat strep throat because I must go to a doctor to write me magic piece of paper that say I will not go in a cage for having a prescription drug, pay all his regulatory overhead, pay regulatory overhead for a lab, then go to a highly regulated pharmacist and then buy my antibiotics from probably the highest-barrier industry in the US through an anointed company and supply chain blessed by the government. I am much better off having cheap, but non-free antibiotics to treat strep than having to wait until it becomes Scarlet Fever and going to the ER for "free" or being taxed into oblivion to get "free" antibiotics that are then administered in the most bloated and uncompetitive way by government to the point I give up other necessities to pay the tax.

notahacker 1y ago
> Wait which is it. We have a "private" system where we save "the pesky" poor and regulate licensing, insurance, provide medicare/medicaid, have a quasi-public system for ER where private payers fund those who won't pay, or we don't? You have the fully private provision you insist is more efficient. It costs more for worse outcomes than every other developed country, who also have regulations. If your original claim that the private sector is so efficient it could deliver everything for a third of the tax cost of the current system, it's remarkable that you're actually paying a large multiple the cost of the fully socialised systems for many people to have no care or crippling copays. Sure, you can move the goalposts by claiming that true private provision requires there to be no medical regulations. But in order for that claim to be remotely credible you'd have to be able to point to all the countries that have great outcomes from having no medical regulations or public healthcare at all (the Philippines where the government is the main provider of healthcare but it doesn't have the time or inclination to enforce regulations on OTC antibiotics doesn't count, even if its health outcomes were excellent, which they're unsurprisingly not). Not gonna lie, if I'm suffering from the symptoms of a heart attack, I don't think antibiotics for half a day's pay are going to help, and literally the only efficiency argument for restrictions on ER rooms being allowed to employ extra admin staff to check insurance paperwork before deciding to administer treatment being an efficiency loss is that it's more efficient to let me die if I can't pay. As I've said, common argument but the complete opposite of your original setup where everyone gets the same outcomes for a third of the cost.
- mothballed 1y ago
  It's an extremely strong indication you've no experience with the US ER system that you think the efficiency issues are checking insurance at the door of a MI patient vs the fact they're required to at least entertain the hordes of people coming in with self reported "STD" or "doctor note for flu" when that kind of stuff shouldn't be appearing at the ER unless a lower acuity clinic has suspicion it might actually require emergent care. But of course why go to a clinic that is much cheaper when you can just show up at the ER and claim the pseudonym Pedro Sanchez with no ID and let the clinic bill it to all the other patients (which you insanely claim makes our system 'private' despite the fact all this happens at the behest of government), whom of course won't show up unless they're about dead because they not only will have to pay for these abuses but actually having something to lose. [Oh and how would I know this, only working ~1 yr in an inner city ER and seeing all the cases] And you can argue that it would be better if those patients could get free urgent care instead of free ER to do the same thing at way higher cost, and I would agree that would be better than what we have now. But either way we're at an entirely different starting point. What you can't argue is we actually have a private system in the US (and somehow miss the elephant in the room that over 1/3 of healthcare spending in the US is public Medicare/Medicaid, then add VA on top that) and then allude it's no true Scotsman or a moved goalpost if I point this out. In fact every time I do point it out, you just go back to morally proselytizing about dead poor people because it's a great way to distract from the fact you've lied and knowingly lied.