why medicare for all makes sense

Author: linate

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Greyparrot
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@linate
giving people healthcare similar to food stamps? or, in other words give them subsidies but keep our current structure? or in other words, obamacare minus the mandate and regulations?  i never took you for an obamacare type of person. 
Obamacare isn't for poor people only, like food stamps are.

Outplayz
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@Greyparrot
There's not a single example in this country, or any other country, where the government took over the management aspects of an industry and lowered costs without lowering the supply.

Yeah... I guess we can only cross our fingers that we are good enough to do it right. That is why i am not a fan of government involvement as a whole. I think we should try everything before bring them into the mix. 
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@Outplayz
Yeah... I guess we can only cross our fingers that we are good enough to do it right. That is why i am not a fan of government involvement as a whole. I think we should try everything before bring them into the mix. 
Why believe blindly? We already know monopolies are bad for economies, and the government is the ultimate monopoly....

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@Greyparrot
government is the ultimate monopoly.

Yes, absolutely. But, what if we can find a way to make them a competitor with the private companies? I am absolutely against giving it over to government... i'm just trying to think of a way to integrate them into the mix that would split up the current monopolies and give them an actual competitor.  
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@Buddamoose

whatever your points might be can be remedied by us having more doctors, simple as that. we need to stop limiting the supply. 

but as to your numbers. 
only ten percent of people are uninsured. most states have less than that uninsured. that means the actual number is around ten percent more patients who will need to be seen. that means to use your numbers two hundred more patients per doctor per year would need seen. if you do the math, that's less than one more patient per day to be looked at. so yes it's completely doable. i'm not one to tell them if they have to see more patients, but i would decrease what is paid for the existing patient set, and use the money to cover the rest. such that, they can just see some more patients to get the same amount of money. 
as far as the special v generalist point you made, i think you are making that too complicated. everyone who is a medial person we would assume will get ten percent more people if they are willing to take the increased numbers. i dont think it will be a problem, as when obamacare was passed the increased numbers just got absorbed into the system, so i dont know why five percent more in most states would break the bank. 



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@linate
whatever your points might be can be remedied by us having more doctors, simple as that.

Ah yes, such clever thinking around needing to mandate price. So, who pays? Government? My guess is that 32. 6 trillion price tag over 10 years[1] didn't say anything about costs of educating new medical professionals to meet the increased demand.

And thus Alice dives down into the Rabbit hole of indirect costs 🙃. 

What exactly do you think a GDP is anyways? Do you think GDP is all taxable or something? That if you taxed 100% there would be 18trillion in revenue? Considering that since WW2 tax revenue as a percentage of GDP has always floated around 19% on average, that's very questionable.[2]. So again, who pays? Because somebody has to pay the piper and tax revenue won't cover that + everything else. After all, federal revenues for 2019 are projected to be 3.44 trillion.[3] 👏👏. 

32.6/10= 3.26 trillion per year. 

Federal Budget for 2019[4] is going to be 4.4 trillion. Thats already a deficit of 1 trillion. Not good, but not disastrous. But consider that, Medicare/Medicaid account for 1.37 trillion. So that is 3.03 trillion in other spending to tack onto that 3.26 trillion a year.

All for a total budget of 6.29 trillion.

In fairness, 1 trillion in a deficit is not good, but not disastrous, it isn't a crisis in other words. A deficit of almost 3 trillion though? That is a crisis to the extreme in the economic ramifications that result from that. 

But yeah sure, let's add even more expense on that by paying to educate tens to hundreds of thousands of new general practitioners. Im sure there is nooooooooooo way that goes horribly wrong. 



TheDredPriateRoberts
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@Outplayz
nope, Applesauce!  :)
Outplayz
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@Greyparrot
Because what they are charging is theft.  It's bs.  How else can we have them lower it without regulations, etc.? 
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@TheDredPriateRoberts
Oh cool! Now i know so it doesn't get confusing when i reply to you there lol. 
Greyparrot
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@Outplayz
There was a time when regulation dropped pretty low in the healthcare industry, and HMO's had these insanely affordable bargain health packages where you could buy catastrophic health coverage for ...crumbs... this was like 25 years ago.

You can't get anything like that today with the current regulations. They are not allowed to sell it to you.
linate
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@Buddamoose

every other country keeps costs under control so why wouldn't we? they all spend not much more than ten percent GDP on healthcare, whereas we spend 18 percent. the difference amounts to over a trillion dollars a year, enough savings to balance our budget too, if we wanted, if we taxed the potential revenue. but that's not the main point i'm trying to make right now. i'm trying to say we can marginally add ten percent more people for the costs we currently have, and prevent people from going bankrupt and ruining their lives too. personally id think we should be more like every other country in what we spend, but a lot of people think innovation will suffer. if we keep spending eighteen percent GDP there's no way innovation will suffer. and my bottom line point is true.... covering everyone and stopping medical bankruptcies is all a matter of an accounting issue
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@Greyparrot
I remember my parents insurance before HMO required a 20% co insurance for everything.  People tend to be more concerned about price and complain about it when what you have to pay is based on a % of the it.  Who cares about rapid price increases if your flat fee doesn't?
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@linate
"every other country keeps cost under control"

Here is a fun exercise, take an western nation with socialized healthcare. Now, starting today, those countries have to pay for 100% of their own defense and securement of trade routes. GO! 🙃

Not to mention the benefit of piggybacking off of US healthcare innovation. For which the US blows every other nation by far out of the water in R&D spending and academic studies/papers. So much so you can combine alot of subsequent ones together and still not come close. 🤔

"If we keep spending 18% of GDP" 

Again, GDP =\= potential taxable revenue. Its not money that government can just appropriate control of on whim, its mostly not even currency itself, its a representation through currency of wealth(currency, commodity, or otherwise) produced 🤔.

>US with 350 million pop.
>China with 1 billion+ pop.

Again, blowing them and other socialistic healthcare nations out of the water on innovation. Administrative costs are not the only healthcare costs, nor is actual medical care/medication. Much of that spending is in R&D of new healthcare drugs, tools, and methodology.

R&D is so expensive *because* its so highly regulated. Dropping regulatory measures would again, reduce these costs dramatically. And again

"If we keep spending 18% of GDP"

This isnt the primary concern/area for healthcare spending. The concern is federal debts and deficits. Its in the $$ the government spends/the revenue it recieves through tax. 

How long into running at deficits of at least 3 trillion before the US government drops down the tubes in credit rating? How long before people start dumping dollar investments and the dollar becomes the dumpster fire tinder of currency? 

How effective is the system really gonna be at that point? How adequately will it address inequal practical access to healthcare? 

"Stopping medical bankruptcies is all a matter of an accounting issue" 

You know fudging accounting so as to nullify expenses through technicality does not mean those expenses magically dissapear? There is no such thing as a free lunch, and somebody or multiple some bodies along that line still foot the bill. In the same way, mandating X thing to have Y price to purchase, does not mean X actually has a cost of Y in totality. 

The more you speak, the more im starting to get the impression you are very misguided when it comes to economics 

Buddamoose
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 Cost isn't a matter of waving a magic wand and going "you have the price of $10 dollars" and oh wow, magically its actual cost is now 10 dollars 🙊

Price v Cost

You can mandate price, you cant mandate cost, cost gets paid at some point regardless of whether or one buries their head in the sand, as would 
be the equivalent actions for a mandating of price. 
linate
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@Buddamoose

if we keep our spending at 18 percent of GDP, however you want to view that number it's still a lot of money that can cover everyone. even if all the expenses don't go away, it's still a simple accounting issue where we lower the price on costs to get everyone covered for the same price. or, do you propose getting rid of the cost regulations on medicaid and meeicare? medicare spends a fifth what insurance does, and medicaid spends a third what imedicare does. to get into the actual numbers, obamacare's medicaid expansion costs five grand per person, whereas spending in general costs closer to eight nine or ten thousand dollars. in other words, we cover more people at a fraction of the going rate. 
you harp on us being the big innovators but i'm not sayin we necessarily spend like the rest of the world.... we spend ten grand per person, they spend five grand.... or you can break it down with GDP numbers. 

you wrote a big wave of text but didn't really say anything- the biggest impediment to progress isn't ignorance, it's the illusion of knowledge. 
linate
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also you may have been missing the basic point that if we have medicare for all or something, we would obviously increase taxes to pay for it. the main point being, it will still cost if not the same than less than we pay now, overall. spending ten grand in premiums isn't magically better just because it's a premium and not a tax, than spending eight grand in taxes. 
linate
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if a doctor makes twice as much as doctors in other countries, that doesn't have anything to do with research or anything. most procedures don't have anything to do with research in why they cost so much.... they charge more simply because they can, compared to other countries. it's a bloated system where the open checkbooks of insurance competes with the open checkbook of government spending, to cause inflated costs. i dont know if you ever looked into what percent of our helathcare is actually spent on research but it's just  small fraction. 

i think your biggest problem isn't so much that you lack the ability to engage in big picture thinking.... it's just that you don't know enough factual information to base educated decisions on. 
linate
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this article talks about how research and innovation wouldn't necessarily die becaue of universal care.


it says that we spend around a hundred bilion per year on reseach and development. you can see it's just a fraction of what we spend on our trillions in healhcare. we could double our R and D spending and still cover everyone. 

TheDredPriateRoberts
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@Buddamoose
#43

brilliant, which is why he largely ignored it.
linate
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@TheDredPriateRoberts
the only way you could think i ignored it, is if you ignored what i replied with. i replied with how his idea of runaway deficits was illogical, and his idea of crushing innovation was misinformed and gave him some numbers for perspective. 
Buddamoose
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if a doctor makes twice as much as doctors in other countries, that doesn't have anything to do with research or anything. 
 
Wow, a few spicy takes here:

1) that the economies of nations are seperate from one another even if heavily intertwined in trade
2) that cost of medical research doesn' factor in cost of medical care

For the first.... LMAO. Your entire argument is presupposed on this predication and its about time you made it blatantly obvious. 

Say X company produces Y product for Z cost. They wish to sell it for A(>Z) price across the board. 

However country G mandates prices at B(<Z).

Country H does not. 

Company X then  choose to accept the sale of that drug at a less than desires price(to gain valuable indirect benefits of further access within a market), and sell in Country H that product for D(A+C. Wherein C is A-B) price. 

Now imagine this extrapolated out across all aspects of medical care that price is mandated in relation to the scope of *trillions* of dollars of spending. 🙃

we would obviously increase taxes to pay for it

As stated before, GDP is not a representation of taxable revenue.

Regardless of tax rate federal revenues have escaped the average range of 19% GDP (Hauslers Law) since WW2. This from the high average tax rates post WW2 to the low corporate tax rates of the Reagan era, and onward. 

At best we are talking maybe federal revenues of 4 trillion maximially.

That still leaves a deficit of 2.29 trillion. 1 trillion roughly higher than currently. And this before any necessary increases to cost in total, or indirect but necessary expenditures such as encountered previously, specifically the added cost of education and training for tens to hundreds of thousands of new medical care professionals to meet the necessary increase to demand. This just in the realm of Primary Care alone





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@Greyparrot
I'm old enough to remember when it wasn't too bad... so you have a point. I imagine the only thing that has changed is more regulations.  
Buddamoose
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*that economies of nations are seperate and do not affect one another even if intertwined as global commerce is at this point🔥. 

"The price of tea in china" matters now, shocking 😮

linate
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@Buddamoose

you keep saying there would be deficits but dont say how? our spending of government revenue stays pretty much the same, but if we increased taxes we'd be swapping out premiums for taxes. i dont know how this is so hard to understand. if we spend nineteen percent now in general spending and got the rest of that healthcare revenue we currently spend at 18 percent, we'd be spending thirty seven percent in total. no one is proposing deficit spending to pay for healthcare... they all propose tax increases. 

i showed you that R and D accounts for a hundred billion a year. even if we assume they are trying to make a profit, can't we also assume the profit is within a certain range of the investments? maybe they need three times as much profit on that investment, i dont know. but it is still a small portion of our healthcare costs. in your example, companies are accepting less from other countries, only because they make profit from them too, and can charge us exorbitant amounts simply because they can. 

you act like the supply and demand for healthcare acts the way it's suppose to based on some complex factors. healthcare providers charge a lot simply because they can. not because there's some complex cost factor that they need to cover. people don't shop for healthcare, they just go. it's called 'inelastic demand'. innovation is a small amount of costs. 
https://www.healthcare-economist.com/2009/07/22/is-health-care-demand-elastic/


Buddamoose
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As for R&D not factoring into research costs... hrmmm turns out healthcare professionals need specialized equipment that requires *research* to *develop*. The costs of this equipment would consequentially incorporate the aforementioned R&D, and in turn consequentially affect what the medical professional, then charges for their medical care. Equipment costs and maintenance thereof being a factor of price 🤔

TheDredPriateRoberts
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@linate
no you ignored the question of how well their systems would be if they didn't benefit and take advantage of the U.S. which currently costs them zero.  Since you want to compare other countries who greatly benefit from the U.S. with no cost to them how can you make an honest comparison with health systems?  If the U.S. didn't protect them, bleed foreign aid all over the world, trade deficits, share innovations etc, how good would they systems be then?
would you be in favor of cutting off foreign aid and other foreign entitlements and a zero trade tax world wide and that money is used to fix our current system?
Buddamoose
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you act like the supply and demand for healthcare acts the way it's suppose to based on some complex factors. healthcare providers charge a lot simply because they can.

Im acting like it doesn't operate the way its supposed to. My previous example equation is not how "its supposed to act", thats a perversion, but one that is nonetheless how things *currently* operate. 

Perhaps you ignored where I pointed out that doing away with many arbitrary regulations and oversight on medical care, and reforming tort regarding malpractice would also reduce administrative cost/waste. 

Or that doing away with abritrary regulations on Medical R&D would both boost innovation, and reduce spending. 

"Healthcare providers charge alot simply because they can"

No, they don't. What about *price* in relation to economics ever gave you the impression price was entirely arbitrary? 

Let's get down to brass tacks here, you at a fundamental level take issue with the profit motive in medicine. You consider *price* arbitrary, as *profit* is included in *price*, and *profit* is in itself, *arbitrary*

This is true, but how does that make *price* arbitrary in whole, as *price* includes *cost* a non-arbitrary metric. 



TheDredPriateRoberts
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@Buddamoose
@linate
can't think of any products or updates to, that the manufacturer/creator doesn't increase costs to recoup those costs or replenish their profits (though i would imagine most of it is done on debt)

The research and development (R&D) expenditures of this industry are staggering—and since they are matters of public record there is no way and no need to exaggerate them.
Only about 10 cents of every U.S. health-care dollar is spent on retail prescription medicines—which is the same share that was spent on prescriptions in 1960. 
 nearly nine out of 10 U.S. prescriptions are filled with generic medicines 
if we equalized drug prices with those countries tomorrow, we would further reduce the economic incentives for new-drug innovation—but we would do essentially nothing to lower the cost of health care.

can we now agree prescriptions and the drug companies are not the problem?

top 10 pharmaceutical companies

10.  U.S.
9     U.K.
8     U.S.
7     U.S.
6     Switzerland
5     U.S.
4     U.S.
3     France
2     Switzerland
1     U.S.

I think all the U.S. companies should charge exactly what they charge in the other countries. so the U.S. citizens don't have to subsidize the rest of the world.  We need to stop the companies from making profits or most of from the U.S. citizens which allows companies to sell the same things much cheaper in other countries.  I'm all for an equal playing field.  What do you think other countries would think of that idea?
Buddamoose
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his idea of runaway deficits was illogical, and his idea of crushing innovation was misinformed 
"we'll raise taxes"

Does not solve the runaway deficit issue. Again, 1 trillion isnt good, but not a crisis. Turns out, when you start getting near a deficit that matches maximal revenue ranges of 3 trillion from direct expenses, let alone indirect necessary costs, is actually a crisis.

And Yes, illogical to point out that currently

"It's a bloated system where the open checkbooks of insurance competes with the open checkbook of government spending, to cause inflated costs"
And a solution of "let's open up that checkbook even more and see if that helps"

Is rather absurd 

if we keep our spending at 18 percent of GDP, however you want to view that number it's still a lot of money
Newsflash, its not money(currency).

, it's still a simple accounting issue where we lower the price on costs to get everyone covered for the same price

"Lower the price on costs"

This is unintelligible, costs are a factor of price. Do you mean lower price *to* cost, as I supposed earlier was your main objective. 

"Get everyone covered for the same price"

*Covered by insurance* as established earlier, does not equate to equal practical access to medical care. As I originally established the primary goal of such legislation is equal practical access. These systems only heighten practical access disparities(ex. increased and oft extreme average wait times), particularly if private medicine is still allowed to practice. 


Buddamoose
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I think all the U.S. companies should charge exactly what they charge in the other countries. so the U.S. citizens don't have to subsidize the rest of the world.
This assumes other countries would not see corresponding rises to price themselves. 

  We need to stop the companies from making profits or most of from the U.S. citizens which allows companies to sell the same things much cheaper in other countries.

I can see you trying so hard to hold onto single-payer. You really think stating all this is an out and would be advantageous to healthcare and equal practical access thereof to people. 

You cant think of how these countries would pay for exigent necessities like defense and trade, (without favorable trade agreement), and are recognizing that the US subsidizes the existence of these systems. 

However, you don't see this as damning of your idea.

But, if these countries require extensive indirect subsidization to survive, and you want to implement this kind of system everywhere, where does this necessary subsidization come from at that point? 

K

F for respects






  I'm all for an equal playing field.  What do you think other countries would think of that idea?
Lmao, lets see how well that plays out being that this would signal the end of these systems being propped up significantly.