Healthcare

Ahahahahah. Yes, brilliant.

@ de marquis

I don't remember arguing metrics being evil when did I do that?

@ Med.

I live in Britain! We don't use the silly Fahrenheit! No, it's actually 30 degrees Celsius in some parts of Canada.

@Breadloaf: https://tvtropes.org/pmwiki/posts.php?discussion=13031633370A38400100&page=9#217 You probably weren't being entirely serious.

Oh that, I think i was half-sarcastic. I was disagreeing with using metrics to base your pay/funding on.

edited 28th Jun '12 2:26:58 PM by breadloaf

I still really believe in that, you know. But the ACA is a good first step.

I think the next baby step would be to bring in a program to help states opt into a public option, as the liberal states will join into that right away. Canada didn't get universal healthcare all at once. It started off with a socialist party in Saskatchewan trying it out and became so ridiculously successful that everyone else followed suit to save money.

Those are effective steps to expand access to health care, but we desperately need some method of controlling health-related costs, since, unlike Canada or any other civilized country, healthcare here is primarily provided by for-profit entities. Cost control is almost entirely managed by the insurance companies, with all the well-known problems that creates.

If going full public sector is out (and it is, for political reasons) we really need to come up with a policy that creates incentives for cost-containment. Something like Accountable Care Organizations except for all insurance provided care, not just Medicare and Medicaid.

@ Partial Healthcare

I think that the US is divided between two kind of states with regards to how well healthcare funding is going to be regarded:

• Liberal States

The government can provide a co-op insurance corporation as a last option instead of private ones. It operates on a non-profit basis and thus provides premiums that reflect that (so it should be a lower premium to any equivalent private policy). Eventually this can become the market dominant business.

• Conservative States

You can institute a cooperation program between corporations/businesses and private insurers. I think that's the accountability thing mentioned above (I'll have to read the link) but "health accountable" plans for businesses supposedly can save upward to 70% of the premium cost and also requires people live healthier lifestyles, so everybody wins.

@ For full public healthcare

I point toward this crazy article:

http://en.wikipedia.org/wiki/US_Healthcare

It shows a chart that lists the rise of healthcare costs since the 1960s, and the US costs have been rising at a far higher rate than universal healthcare countries. Now, it certainly doesn't make sense for healthcare to make up an ever increasing amount of GDP but it looks like the US private solution is the worst idea of them all.

Let me also point toward http://www.oecd.org/document/60/0,3746,en_2649_33929_2085200_1_1_1_1,00.html

To show how the US private healthcare system is unsustainable and that the US must switch over to government-funded care or doom itself with a massive healthcare related budget problem.

Now if we compare Canada/US, two very similar countries in most respects (such as culture and language):

In 1960:

• Canada: 5.4% of GDP
• USA: 5.1% of GDP

In 2010

• Canada: 11.4% of GDP
• USA: 17.6% of GDP

At some point, universal healthcare system became more affordable and a superior method of organising the distribution of medical services. That gap in spending levels is only going to increase. Just to note, that difference in GDP spending is the entire US defence budget.

"Help, fix our health care, give us jobs, improve our infrastructure, stop firing police and firemen and teachers, fight the wars, stop illegal immigrants."

"What? You want tax money to do these things? I'm not giving you my money!"

I suppose this is a very semi-serious look at it, but a flight from NY-JFK to London Heathrow costs £300. A taxi from the airport to the nearest hospital is £10.

£310 in total.

So, if you got shot before your flight, as long as you can survive the flight and taxi ride, you can get free emergency care (because America is one of the nations the NHS allows free emergency care for) in an NHS hospital.

The altitude might be a bit trouble for the blood loss

edited 28th Jun '12 4:05:00 PM by 3of4

The government already gets more than enough money to all of those things. Except it squanders it on crap and then demands more money. If you need a trillion dollars to fix health care, you're doing it wrong.

edited 28th Jun '12 3:54:20 PM by Aethix

No it doesn't. Not with Republicans cutting all revenue earnings through taxes and increasing spending on shit like the military. Besides, a lot of that tax money goes to pay the workers that do those things. As in, taxes helps CREATE JOBS.

@ Aethix. Then its the problem with the government. Or the state. Remember, government =/= state. Obviously, if the US spends 18% of its GDP on health and yet is worse off than nations who spend barely half of that percentage, then it's most likely a problem with the government; for performing immobilisme (i.e what says), and a problem with the state; because it's not a very efficient delivery channel.

edited 28th Jun '12 4:05:57 PM by Inhopelessguy

@Aethix: Explain why my state is utterly destroying public jobs then? I thought we have enough money.

Well, duh! You gotta print more money! Obvs.

Actually, the talk about "accountability" and "pay for result not service" is not mutually exclusive with public healthcare systems. I think public healthcare systems have several issues with it:

• Flat fees for most diagnostic work no matter how much it actually cost (this is common but not universal to many socialised insurance plan countries)
• No health accountability, people do whatever, get themselves into dumb preventable situations and then require expensive healthcare afterwards (such as not exercising, which I must admit, I don't do properly because I'm lazy/overworked, I get home after a long day at work and my "exercising" is not drinking a beer)
• Lack of preventative care incentives other than angry taxpayers who demand higher efficiency
• Personally I think there's a lack of data on medical performance and wait times for services making it difficult to guide tax dollars to fund the right areas
• Canada lacks pharmacare

For private healthcare:

• Market forces and lack of unity of private insurers limits their ability to make healthcare providers more efficient
• Incentives for healthcare providers to choose the most awesome healthcare possible (rather than cost-effective strategies to provide the best care for the most people)
• Lost money due to marketing/advertising/sales of services
• Lower standards for pharmaceuticals due to higher chances of corruption
• Inability to bulk purchase drugs, lack of incentive to lower drug costs versus just raising premiums
• Profit margins for insurance providers necessitates claim denials or high premiums, investing collected money doesn't appear to be sufficient to maintain profit margins as logically expected (probably due to lack of seed money)
• Payment is based on services not results, thus insurance providers want to deny service while providers want to offer a lot of services, none of it is actually based on anything actually healing anybody or improving their healthiness

edited 28th Jun '12 4:51:58 PM by breadloaf

@Breadloaf: you mentioned previously that individual states should make their own single payer system. The ACA already has a provision for that, and as a result, Vermont is implementing their own Single Payer system before 2015.

Yeah I noticed, and also, even if the ACA did not have a provision for it, individual states could still go ahead with the implementation.

Are you saying that as a response to my particular point or were you expressing your disbelief at the response?

Government systems use clinical trials and empirical evidence to determine which pharmaceutical products are best. This isn't always done, but where it is, we get the best bang for buck because we figure out which products actually work best. Ad/marketing is a pamphlet given to a doctor (or conferences to which doctors are invited to) where some corporation extols the virtues of their latest sugar molecule additions to existing pharmaceutical products.

Running trials for effectiveness costs orders of magnitude less than doing ads and gets you effective results, whereas ads does not improve healthcare quality.

edited 28th Jun '12 7:23:36 PM by breadloaf

and the government knows about the new medicines so they can test it... how? psychic powers? invasion of privacy by having cameras set up in all buildings? someone from the pharmaceutical company shooting them an email (taking zero time to type said email) going "yo, we've got a thing, attached is a sample for testing that we conjured up at zero cost"?

Yes, there is a significant amount of money wasted on ineffective advertisement, but there is also a non-zero amount of money that must be spent for anyone to know something even exists.

You can't send a medical product out in the market without first having it checked by a government agency. At least, not in Europe, you can't.