US politics 2

[Former Lord of Winterfell]

Philosophically, government doesn't have any obligation to its citizens whatsoever. But we have made up a few obligations over the centuries, such as the US Constitution. Our rights are what we agree with the government that they are. If we agree healthcare is a right (as in most First World Countries), it's a right. If we don't, it isn't. If the Constitution is repealed, all those rights evaporate, too. It's a mind-bender, right?

No, it's not a mind-bender at all. The Constitution says nothing about healthcare being a right, nor have courts interpreting it. Other than that, we may each have our own opinions about what "rights" we should have separate from the Constitution, but that's hardly a mind-bender. Also, maybe I'm confusing you with someone else, but I thought you said you weren't American?

I think you are looking in the wrong direction. Healthcare is currently very expensive because it is so much better than it was. Many conditions that in the past were a death sentence are now an inconvenience (e.g. diabetes.) Conditions that doctors would have previously dealt with by calling a priest and telling the family to prepare for the worst can now be treated, usually with a lot of expensive medicine and pricy medical skills. This is why not providing health care at all worked for most governments before the '60s, because there was little to provide. Time marches on.

I don't disagree with your description, but I fail to see the relevance. Just because medical technology has improved doesn't mean that everyone should get all those improvement regardless of cost, paid for by someone other than themselves.

In the USA, drugs are marketed directly to consumers, so there is higher demand for pricey "miracle drugs" of dubious efficacy. The free market driving up costs? Shock!

I actually agree with you a lot on this. To some extent, health care is a luxury good, in that it is something on which we wish to spend more money when we have disposable income. Our costs are high because we want cutting edge care, which is incredibly expensive. Now, if private citizens want to spend their own money on that first-class care,, or have a large part of their wages taken up by insurance that provides such care, fine. Quit bitching about it, then. But to the extent we're talking about those who cannot afford that, I don't see why the rest of us should pay for it.

16% of the USA truly cannot get any health care at all.

Sure, they might be able to swing some free antibiotics from a friendly doctor, or queue for 7 hours at a charity clinic to have a tooth extracted. But if they got something serious, they'd be truly screwed without government support.

At current prices, under the current system, that is largely true.

I have pointed out to you before that for charity to cover the 16% already uninsured, Americans would have to switch all their charitable giving to health care, and increase it a little too. If medicare and medicaid were cancelled, they'd have to triple their charitable contributions. You don't seem interested in that.

Why should I be? Do you even read what I write, or just argue against what you see as a generic "conservative" POV? I specifically said that I was NOT in favor of ending Medicare or Medicaid as things now stand. So why should I be interested in you discussing what would happen if those programs were suddenly cancelled?

I can only assume you think the magic of the market would cover almost everyone instantly if all government controls were removed, which is fairy tale land.

No, you don't have to assume that at all. But seeing as you either do not read or cannot understand what I write, I suppose you'll have to be content with that assumption.

[WrathOfTinyKittens]

FLOW - you said something about this 80/20% ratio on paying for healthcare that made me want to go on a mini-rant.

Socialized healthcare is not about a few people paying so that tigers don't have to. It's about EVERYONE paying so that NOBODY has to. I realize that this sell would never work in America, but that's how I view it. We have freeloaders now and we'd have them under a single payer system, but society would be far healthier and incur dramatically less personal cost.

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[Former Lord of Winterfell]

It's about EVERYONE paying so that NOBODY has to.

This almost goes without saying, but even if that were true, it's a blatant contradiction on its face.

But it isn't true anyway. The real reason you have that system is that some people aren't paying anything, and they won't be paying anything even if you go "socialized".

[WrathOfTinyKittens]

Lol I just realized that autocorrect made me say something about tigers.

FLOW - I could have worded it better. I don't think that system exists because some people don't pay. I think it's because It controls costs relative to our current model and because societies have decided to "promote the general Welfare" and provide healthcare to their members.

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[Shryke]

Gingrich gets a much needed money injection:

http://www.nytimes.com/2012/01/10/us/politics/sheldon-adelson-a-billionaire-gives-gingrich-a-big-lift.html?hp

And here come more Romney attacks!

[Brienne the Beauty]

No, it's not a mind-bender at all. The Constitution says nothing about healthcare being a right, nor have courts interpreting it. Other than that, we may each have our own opinions about what "rights" we should have separate from the Constitution, but that's hardly a mind-bender. Also, maybe I'm confusing you with someone else, but I thought you said you weren't American?

I live in the USA but am British. I was using the Constitution as an example as a set of rights that are agreed but not universal. It's really no more eternal or sacred than any other right. We only have the rights we successfully demand. In this matter there is no difference between the right to healthcare, or the right to habeus corpus.

I say it's a mindbender, because when you realise that the rights you have come to think of as eternal are not eternal at all, but merely agreed, it is a mindbender, is it not? When I first heard that the USA had no universal healthcare system, I was shocked, because I regarded it as a universal right in all First World countries.

I don't disagree with your description, but I fail to see the relevance. Just because medical technology has improved doesn't mean that everyone should get all those improvement regardless of cost, paid for by someone other than themselves.

It would be paid for by everyone's taxes, just as the current (inefficient) US healthcare system is. And did I ever say everyone should get every treatment regardless of cost? In fact, I was defending the NHS's strategy of funding only cost-effective treatments. Denying people basic healthcare is what the problem is in the USA, not denying them the very latest super-duper million-dollar cancer drugs.

Why should I be? Do you even read what I write, or just argue against what you see as a generic "conservative" POV? I specifically said that I was NOT in favor of ending Medicare or Medicaid as things now stand. So why should I be interested in you discussing what would happen if those programs were suddenly cancelled?

Well, if you are for them, you are for government healthcare, and we are only arguing over the specifics of how it should be implemented. But I thought you were against your taxes paying for other people's healthcare? Because that's exactly what medicare and medicaid are. How inconsistent.

[The Progressive]

If you've been following economic news like I have the last few months, it has been quite a revelation about the strength and resilience of the US economy compared to pretty much everybody else.

Not only that, the US auto industry had the best year since 07, manufacturing is picking up, and unemployment is trending down. Even more mind-blowing, the US has been a net EXPORTER of gasoline and natural gas. That's right, EXPORTER!

This trend keeps up for another quarter or two and Obama is a guaranteed lock-in.

[Former Lord of Winterfell]

I think it's because It controls costs relative to our current model and because societies have decided to "promote the general Welfare" and provide healthcare to their members.

I don't disagree with that. But I think there also is an element of egalitarianism involved with this. When money is spent on health care, care can be allocated primarily on the basis of who provided the money, or on more of an objective "need-based", egalitarian basis. And I think the issue underlying that is the difficulty in defining exactly what level of care people must be provided. In a "socialized" system, the decision is essentially made that the level of care provided is going to be whatever the available funds can provide, allocated on the basis of need. And you set your level of taxation to support that at a higher level, so people have less income of their own to spend on health care as a consequence. So, the most common, default situation for the vast majority of people is that they're going to get whatever that "average" happens to be.

But I think that is different from a more individualized/non-socialist system. In such a system, you establish a lower level of a safety net, providing "second-tier" care at a lower cost, while the majority of people get improved care in the private sector at whatever level they're willing to pay.

Those two systems may sound the same if you describe them from 30,000, but as a practical matter, they look much different. And I think the fear on the part of a lot of people in the U.S. is that the move to a more socialized system with greatly benefit those who currently have little or nothing, but that boost will come at the cost of actually reducing what those who could afford to pay for it themselves would get as compared to the current system.

[Galactus]

This almost goes without saying, but even if that were true, it's a blatant contradiction on its face.

But it isn't true anyway. The real reason you have that system is that some people aren't paying anything, and they won't be paying anything even if you go "socialized".

What kind of person never pays any kind of taxes? Small children under the care of their parents I suppose. That's pretty much it.

[Galactus]

I don't disagree with that. But I think there also is an element of egalitarianism involved with this. When money is spent on health care, care can be allocated primarily on the basis of who provided the money, or on more of an objective "need-based", egalitarian basis. And I think the issue underlying that is the difficulty in defining exactly what level of care people must be provided. In a "socialized" system, the decision is essentially made that the level of care provided is going to be whatever the available funds can provide, allocated on the basis of need. And you set your level of taxation to support that at a higher level, so people have less income of their own to spend on health care as a consequence. So, the most common, default situation for the vast majority of people is that they're going to get whatever that "average" happens to be.

But I think that is different from a more individualized/non-socialist system. In such a system, you establish a lower level of a safety net, providing "second-tier" care at a lower cost, while the majority of people get improved care in the private sector at whatever level they're willing to pay.

Those two systems may sound the same if you describe them from 30,000, but as a practical matter, they look much different. And I think the fear on the part of a lot of people in the U.S. is that the move to a more socialized system with greatly benefit those who currently have little or nothing, but that boost will come at the cost of actually reducing what those who could afford to pay for it themselves would get as compared to the current system.

The thing is well... Economy of scale.

You can get a LOT of good effects simply by introducing mandatory (or even just free) early-stage preventative stuff. (Vaccinations of course being the most common, but there are other preparatory medecine as well)

[Former Lord of Winterfell]

In this matter there is no difference between the right to healthcare, or the right to habeus corpus.

I don't understand that.

I say it's a mindbender, because when you realise that the rights you have come to think of as eternal are not eternal at all, but merely agreed, it is a mindbender, is it not?

Honestly, it's not. I think most people understand that concept. The difference for us is that we have a written Constitution establishing rights much less transient than whatever the body politic might decide on a daily basis. For example, the "right" to healthcare can be something passed into law by a given Congress/President, but that "right" can just as easily be reversed by the same method. Changing the Constitution, however, is far more difficult.

Well, if you are for them, you are for government healthcare, and we are only arguing over the specifics of how it should be implemented.

No, that is not true. But I'm not going to repeat everything I wrote again.

But I thought you were against your taxes paying for other people's healthcare? Because that's exactly what medicare and medicaid are. How inconsistent.

Again, I went through this in some detail before. I do not approve of the concept if we were writing on a clean slate, but we're not. People rely in a government-created status quo that you can't reasonably reverse over night. So, the first step would have to be reform (including reduction) of the level of benefits provided under those programs, and repeal of a boatload of other healthcare-related legal requirements and mandates of which you may be unaware. Only after all that is done, and we see the effect on costs, do we look at further reductions or elimination of government-provided healthcare.

I also strongly suspect that the minimum level of support I would provide via government-sponsored care, as compared to whatever the state of the art is, would be a gap much greater than you would endorse.

[Former Lord of Winterfell]

What kind of person never pays any kind of taxes? Small children under the care of their parents I suppose. That's pretty much it.

A great many people pay absolutely no taxes to support Medicaid, the government program that provides health care for the poor. Since we're talking about taxes used to finance health care for the citizenry at large, that's the relevant metric.

[Shryke]

Why is it the relevant metric? Why does it matter where the taxes come from or go? It's all more or less an accounting trick anyway.

[Galactus]

A great many people pay absolutely no taxes to support Medicaid, the government program that provides health care for the poor. Since we're talking about taxes used to finance health care for the citizenry at large, that's the relevant metric.

I keep forgetting the US tendency to earmark taxes.

[lupis42]

Well, I was going to say that this guy is the reason I think people would benefit from doing some work for the government before they decide they know how the government works, but fuck if this kid doesn't get how the place he currently works at works either.

I'm sorry, I actually thought there was a lot of sense in the rest of your post, but where do you get off telling me you know how the company I work for now, the company I worked for previously, the law firms my immediate family have worked for or the government office I've done work for in the past function?

[Former Lord of Winterfell]

The thing is well... Economy of scale.

You can get a LOT of good effects simply by introducing mandatory (or even just free) early-stage preventative stuff. (Vaccinations of course being the most common, but there are other preparatory medecine as well)

Except it's not. The theoretical ability of preventative care to reduce costs is not something that has proven to have a measureable effect on those costs.

http://prescriptions...are-costs-more/

And second, the relatively low cost of vaccinations means that is the type of care most likely to be offered by even the most cut-rate government program or charitable work.

I keep forgetting the US tendency to earmark taxes.

That's not really the issue. For the most part, federal taxes are not earmarked. The real exception is payroll taxes, that everyone pays, that go to Social Security, Medicare, and unemployment. The problem is that people who pay no net income taxes don't contribute to all the programs financed by general revenues, including Medicare.

[WrathOfTinyKittens]

Lupis: because even if attorneys themselves don't get paid by billable hours, their firms almost always do. Which renders your argument (to which Raidne is responding) moot.

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[Brienne the Beauty]

And I think the fear on the part of a lot of people in the U.S. is that the move to a more socialized system with greatly benefit those who currently have little or nothing, but that boost will come at the cost of actually reducing what those who could afford to pay for it themselves would get as compared to the current system.

Yes, that's definitely the fear. It's not rational though. The NHS actually drives down the price of private health insurance in the UK, because it is such strong competition, so anyone who cares to (and is not really poor) can have both, or pay out of pocket if they want. In most social healthcare systems (Europe, not Cuba), people with money can make up for any deficiencies by paying privately. Most people in the UK choose not to, because the baseline service is fine.

I really have noticed no difference between the actual service in the UK and USA in terms of superficial patient experience - the doctors can see you in about the same time, the waiting rooms look much the same, the medicine is the same, the doctors treat you the same. The main difference is that US doctors seem to be very enthusiastic about pointless blood tests, and so are the veterinarians for some reason. I can only assume it's cultural.

People in the USA should more fear losing their jobs (and health insurance with it) in the present system because that's more likely by many orders of magnitude. I understand that people are not rational in this area, though. The risk of change is terrifying.

[Former Lord of Winterfell]

Yes, that's definitely the fear. It's not rational though. The NHS actually drives down the price of private health insurance in the UK, because it is such strong competition, so anyone who cares to (and is not really poor) can have both, or pay out of pocket if they want.

No, it is completely rational. If you're paying more in taxes to support the NHS then you'd be paying if NHS didn't exist (which is kind of hard to argue), then you have less disposable income left to buy a private market insurance policy.

If you want to argue that the level of care and access offered by the U.K's NHS is just as good as what you'd get in the U.S. with a good health insurance plan, we'll just have to disagree on that.

[WrathOfTinyKittens]

But if health insurance cost $50 a month out-of-pocket for advanced services, as is the case (roughly) in Germany, it's pretty much a wash compared to the potentially huge costs of private insurance, even when employer subsidized.

A point aside from the competition from govt healthcare is that private insurance no longer has to worry about paying for everything, because they can rely on the government system to pay for emergency care, so they can focus on providing higher-quality services than the basic for a very low cost.

Edit: I also wanted to add that at my first job out of college, I worked for a very small company that didn't have the leverage of a large firm to negotiate great group rates. It cost over $400 a month to insure a family and over $150 a month for an individual. A few extra percentage points of taxes wouldn't take this much from most people.

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