Medicare For All

[henkeli]

Imagine in the current year 2020 not voting for Trump.

 

[JerryLove]

 

[JerryLove]

I've not pointed this out, because it was false pretense, but I suddenly realize this underscores the compartmentalization required.

We have people simultaneously arguing that we can't to Medicare for all because it will cost us more money (we will spend more on healthcare) and because it will cause layoffs and pay reductions in healthcare (we will spend less on healthcare).

Literally two opposite positions being argued to both be true in order to attack a proposal for which no alternative has any real backing.

 

[killdozzer]

I must say I really, really disliked the "woman card" (as it was dubbed in some news shows) Warren played on Sanders.

Saying this as someone who might see Warren as a Lady President.

 

[highfigh]

It's not Sanders that is claiming things are free. That's a straw-man propped up but the opposition and even believed, at least when commented on without thought, by some supporters.

What is bullshit is your claim.

I have a sneaking suspicion you don't object to building a wall with our tax dollars, even though it does naught but harm; but you seem to clearly oppose that our tax dollars go to making lifesaving healthcare available and affordable.

Did you know that the US government (Federal and State combined) spends more on healthcare (adjusted for population) than any country in the world... and somehow we manage to still only actually provide healthcare to a small percentage of the population (Those one Tricare, Medicare, Medicaid, and subsidized ACA care).

Do you know what would happen if we could magically mirror Germany's healthcare system today?

Everyone in the US would have access to healthcare.
Taxes would go *down*.
The average American would also save $5000/year in insurance expenses.
Not to mention what we'd save in personal outpayments to medical.
And we'd eliminate more than half of all bankruptcies in the US.

We'd also end up with more hospitals in rural areas, lower infant mortality, and you'd be more likely the be able to get the doctor of your choice (since basically all doctors will be in the one network), etc.

Single payer would also reduce the administrative costs of doctor's offices by 80%.

Again: all using *fewer* tax dollars than we do now.

I wonder why anyone would oppose it.

But the right is *forced* to prop straw-men. Otherwise they have to say things like.
"We oppose affordable college"
"We think people shouldn't be able to get needed healthcare"
"We want healthcare prices to be the highest in the world, and without giving the best care in exchange".

"Medicare for all" isn't the best solution.. partially because (in a mostly partisan vote) the right wing outlawed Medicare from bargaining for better prices like every other country does... but it is a solution that we can assert as a step in the right direction and one that avoids the gridlock of letting the perfect be the enemy of the good.

Care to show how taxes would drop, everyone would have health care and hospitals would magically appear in rural areas, considering the extremely high cost to build them? Taxes can't drop AND result in all of these claims. Health care costs about $3.5 Trillion per year in the US, which comes to almost $10,800/year for each person, if a population of 325 million is used. That doesn't account for whether everyone can afford to pay a single penny for it, either. If one third of the population can't pay one cent, it shoots up to over $16,500 per person.

Please show your math.

 

[highfigh]

Patents exist for the public good. That's why they expire. If the patent isn't serving the public good, it should expire.

Patents exist to prevent others making some thing or using a process that is the same or extremely similar to what another person or entity developed, often at considerable expense. It gives the patent holder rights to the manufacture of said item or use of the process, without regard to public good. Once the patent expires, it can become public domain or the patent holder can reapply before it expires. Depending on the item or process, it can be considered a 'lifetime' patent.

One thing that could be done with patents, whether limited or lifetime- donate them to health care facilities, research centers and programs as a way to defray the cost. Corporations donate patents to colleges and universities, I see no reason they couldn't do the same for health care (and I would hope they already do this).

 

[JerryLove]

Care to show how taxes would drop, everyone would have health care

The Federal government spent about $1.1 trillion in healthcare. That's $3,363/person.
State governments spent about $605 billion (in 2016, which is the first year I found). That's $1,850/person

Combined: that's $5,213/person

Germany's total expenditure (not just government expenditure) is $5,182; but as has been pointed out, not everyone gets everything free; so actual tax spending is lower than that.

$5,182 <5,213

and hospitals would magically appear in rural areas, considering the extremely high cost to build them?

Yea. nothing prejudicial in the "magically appear" language. That's certainly my claim /s

The only thing I asserted as magical was if we could magically switch to an exact copy of Germany; because I know there are differences in an incredibly complex system (some to advantage and some to disadvantage) but I needed to pick somewhere to make my argument by example.

The way rural hospitals stay afloat is multi-pronged.
1) an 80% reduction in administrative costs (I've already cited source in a previous post).
2) the elimination of people who don't pay (because universal healthcare covers everyone)
3) A government payer system with a "public trust" incentive to keep the hospitals open (much like how the rural Telco fund got phones to rural areas)

Taxes can't drop AND result in all of these claims. Health care costs about $3.5 Trillion per year in the US, which comes to almost $10,800/year for each person, if a population of 325 million is used. That doesn't account for whether everyone can afford to pay a single penny for it, either. If one third of the population can't pay one cent, it shoots up to over $16,500 per person.

Universal healthcare in Germany costs $5,182 per person.

That's less than $10,800 and less than $16,500.

Patents exist to prevent others making some thing or using a process that is the same or extremely similar to what another person or entity developed, often at considerable expense.

That's what they do. That's not why they exist.

Just like copyright, they exist to encourage the creation of new work for the public good.

The goal is always the public good. If they are not serving the public good, then they are not valid.

Do you support what has happened with insulin prices in the US? There are a number of life-saving drug that are still under patent. Are you actually OK with companies pricing those at "market bear" to maximize profit even if that results in, say, ten million unnecessary deaths?

Because if you aren't. Tell me what you are proposing to prevent it.

Funny note: there's actually an insurance company in...I want to say Nevada. If you'll agree to it, they will pay to fly you to SoCal, drive you into Mexico (where your prescription will be waiting for you), drive you back, fly you back, and pay you $500 in cash... because it's cheaper than paying the price for the same medication in the US. That seems reasonable, right?

 

[JerryLove]

The absurdity of the "people will lose jobs" argument still lingers in my brain.

The Polio vaccine cost jobs as lost of children weren't being crippled any more and requiring a lifetime of care. Are people actually arguing that they think the polio vaccine was a bad thing?

And the analogy is correct. Should we do "X". "X" will save lives, reduce human suffering, and remove some jobs from the economy (in this case:healthcare administrative ones).

How many deaths is your job worth?

 

[Irvrobinson]

We have people simultaneously arguing that we can't to Medicare for all because it will cost us more money (we will spend more on healthcare) and because it will cause layoffs and pay reductions in healthcare (we will spend less on healthcare).

You're twisting around the arguments. The Sanders bill will indeed cost more because it promises universal unlimited healthcare for everyone on American soil without premiums or co-pays. (I can't call it Medicare For All anymore, because I won't promote Sanders' deception that it has any resemblance to Medicare.) There is nothing in the bill about how it gets paid for. While I have no doubt that administrative costs will go down, and healthcare insurance industry profits will be saved, the increase in expenditures due to covering premium revenue and co-pay revenue will far exceed the savings. The net profits of the entire healthcare insurance industry are in the range of $25B, or less than the net profit of Apple.

https://naic.org/documents/topic_insurance_industry_snapshots_2018_health_ins_ind_report.pdf

Assuming we discount the layoff of the entire healthcare insurance industry as just roadkill, the 25% average compensation reduction will certainly introduce turmoil into the provider industry just when demand dramatically increases. Your argument is simply that these factors are less relevant than saving lives at any cost, and mine is that disruption of the healthcare system by flipping a switch one day is a profoundly dumb idea for the majority of us, and will put additional lives at risk for some unknown period while a new equilibrium is established. Also, as I've pointed before, the Sanders bill doesn't make participation by providers mandatory, so the "concierge" healthcare industry, which operates outside of insurance of all types, will probably expand to provide services to those wealthy enough to avoid the disruption, and may attract the best professionals to join and leave the chaos of the nationalized system.

...no alternative has any real backing.

No alternative has been proposed, because the Republican position is that the status quo is just fine, and the remnants of the ACA must be eliminated, with the exception of the ACA taxes, coverage for dependents until age 26, and elimination of pre-existing conditions as a measure of insurability. As an independent I am in favor of numerous changes to the healthcare and pharma laws, but if all I have to choose between is the dumbness of the Sanders bill and the status quo of the Republicans, I choose the latter.

 

[Irvrobinson]

Once the patent expires, it can become public domain or the patent holder can reapply before it expires. Depending on the item or process, it can be considered a 'lifetime' patent.

Extending a patent beyond its normal life takes an act of Congress. Drug patents can be extended to include the delays due to regulatory approval (the Hatch-Waxman Act), but in general there's no such thing as a lifetime patent.

 

[Irvrobinson]

That's what they do. That's not why they exist.

Just like copyright, they exist to encourage the creation of new work for the public good.

The goal is always the public good. If they are not serving the public good, then they are not valid.

Do you support what has happened with insulin prices in the US? There are a number of life-saving drug that are still under patent. Are you actually OK with companies pricing those at "market bear" to maximize profit even if that results in, say, ten million unnecessary deaths?

Because if you aren't. Tell me what you are proposing to prevent it.

Funny note: there's actually an insurance company in...I want to say Nevada. If you'll agree to it, they will pay to fly you to SoCal, drive you into Mexico (where your prescription will be waiting for you), drive you back, fly you back, and pay you $500 in cash... because it's cheaper than paying the price for the same medication in the US. That seems reasonable, right?

Actually, patents are the creation of a government-enforced monopoly for the purpose of increasing innovation by providing the incentive of monopoly profits for the term of the patent.

The patents on insulin have run out. Even the pharma industry can't come up with reasons why insulin prices have risen so much over time. This is probably the most blatant case of sheer greed in healthcare. Personally, I don't consider pharma companies investable any longer, because of their goading both parties into constraining regulations increasing investment risks. Admittedly, middleman companies also take part of the blame, but if there was ever a case for drug industry regulation it is insulin. So dumb.

 

[JerryLove]

You're twisting around the arguments. The Sanders bill will indeed cost more because it promises universal unlimited healthcare for everyone on American soil without premiums or co-pays. (I can't call it Medicare For All anymore, because I won't promote Sanders' deception that it has any resemblance to Medicare.) There is nothing in the bill about how it gets paid for. While I have no doubt that administrative costs will go down, and healthcare insurance industry profits will be saved, the increase in expenditures due to covering premium revenue and co-pay revenue will far exceed the savings. The net profits of the entire healthcare insurance industry are in the range of $25B, or less than the net profit of Apple.

We literally cannot know. There is nothing resembling consensus among leading economists. There are values from "large saving" to "huge increase".

Assuming we discount the layoff of the entire healthcare insurance industry as just roadkill, the 25% average compensation reduction will certainly introduce turmoil into the provider industry just when demand dramatically increases.

You can't seem to decide which it is. Will costs go up as we send much more money to healthcare providers? Or will we be sending much less money to healthcare provides as their pay gets cut?

Perhaps you can explain how we are going to spend more money (your claim), give it to fewer people (your claim: as of all those lay-offs you keep mentioning) and yet each of those fewer people pulling from a larger pool of money will get less (your claim). Because I'm not familiar with math that allows that.

 

[Irvrobinson]

You can't seem to decide which it is. Will costs go up as we send much more money to healthcare providers? Or will we be sending much less money to healthcare provides as their pay gets cut?

Perhaps you can explain how we are going to spend more money (your claim), give it to fewer people (your claim: as of all those lay-offs you keep mentioning) and yet each of those fewer people pulling from a larger pool of money will get less (your claim). Because I'm not familiar with math that allows that.

Costs go up because a much greater number of people have unlimited access to services with no premiums or co-pays. The 25% (on average) reimbursement cut, in conjunction with the loss of private insurance subsidization of Medicare pricing will result in either reduced services available (fewer hospitals and providers) or a reset to a new pricing equilibrium where the 25% reimbursement cut has to be significantly reduced or eliminated. The rest of your argument and math is confused.

 

[GO-NAD!]

Costs go up because a much greater number of people have unlimited access to services with no premiums or co-pays. The 25% (on average) reimbursement cut, in conjunction with the loss of private insurance subsidization of Medicare pricing will result in either reduced services available (fewer hospitals and providers) or a reset to a new pricing equilibrium where the 25% reimbursement cut has to be significantly reduced or eliminated. The rest of your argument and math is confused.

The math isn't quite that simple though. Sure, you will see a greater demand for services, likely for primary care. If a person is able to obtain treatment for a health condition at an early stage, it could preclude far more costly ER visits and treatment. So, while initially costing more, wider access could lead to long term savings.

 

[Irvrobinson]

The math isn't quite that simple though. Sure, you will see a greater demand for services, likely for primary care. If a person is able to obtain treatment for a health condition at an early stage, it could preclude far more costly ER visits and treatment. So, while initially costing more, wider access could lead to long term savings.

Agreed, and I am in favor of expanded coverage (perhaps not universal, as including illegal aliens), I'm just not supporter of the Sanders bill.

 

[JerryLove]

Costs go up because a much greater number of people have unlimited access to services with no premiums or co-pays. The 25% (on average) reimbursement cut, in conjunction with the loss of private insurance subsidization of Medicare pricing will result in either reduced services available (fewer hospitals and providers) or a reset to a new pricing equilibrium where the 25% reimbursement cut has to be significantly reduced or eliminated. The rest of your argument and math is confused.

So since consumption is up (as you just said), there are more jobs (you said less jobs)
And since consumption is going up, hospitals that might suffer in rural areas from lack of paying business will get the help of more paying customers (you said rural hospitals would do worse).

Perhaps basic questions would make this easier.

Is more (economic boost) or less (economic saving) money going from the population at large into the medical workers?

 

[Irvrobinson]

Perhaps basic questions would make this easier.

Is more (economic boost) or less (economic saving) money going from the population at large into the medical workers?

Less, for more work, at least in the initial implementation, assuming the Sanders bill is passed as-is. (Passing as-is seems as unlikely as me growing my hair back, but we can only discuss what we can see.) If it was passed as-is medical providers would get about 25% less revenue, but are assumed to get some administrative cost savings. The increase costs from the bill would be in the elimination of premiums and co-pays, universal coverage, and the creation of a massive bureaucracy to manage the program, which would probably be farmed out to private companies (as Medicare is) who would have no incentive to be efficient, as profit-making companies do. There would, IMO, also be a flight of professionals from the general system to independent concierge medicine only for the well-off, and to biotech companies getting funding for labor-reduction strategies to offset the lower pay-outs. (This is already occurring. The biotech industry employs a large number of MDs who, obviously, are no longer servicing patients.)

I doubt very much that the answers you're looking for are anything like as simple as you want them to be. I think the assumptions made by the Sanders bill for medical providers are unsustainable, and will either result in higher prices than the bill assumes, a less functional healthcare system with lower service levels and longer wait times, or a massive increase in government funding for provider training and employment.

And none of this discussion has included the potential negative impact on the drug industry from fleeing investment due to the IP confiscation threat.

 

[JerryLove]

If it was passed as-is medical providers would get about 25% less revenue, but are assumed to get some administrative cost savings.

Using some made up numbers.

Right now we are spending $1000 (cost) to pay 10 people (workers). Ignoring pay disparity, each person makes $100.

You are saying this new plan will pay $1500 (costs go up) to 5 people (jobs go down) giving each of them $75 (pay goes down).

You realize that's mathematically impossible, right?

$75 x 5 = $375 (costs would go down)
$1500 / 5 = $300 (pay would go up).

There's no way to do both. And it's not the numbers I've chosen; but the direction. You can insert any values you want as long as they move in the direction you said they would, the math fails.

And none of this discussion has included

We've established a pattern where you throw an assertion then, rather than defend it, throw another assertion. I've been familiar with this tactic for decades and my approach to it is to force one topic at a time in response.

So I'm happy to discuss any aspect you want to discuss; but I'm not going to respond to one assertion after another when you won't follow through. That's not a discussion: that's a rhetorical argument (also known as propiganda)

So again: Please show math that allows more money to go into fewer hands resulting in less per-person money. It's not possible.

 

[Irvrobinson]

Using some made up numbers.

Right now we are spending $1000 (cost) to pay 10 people (workers). Ignoring pay disparity, each person makes $100.

You are saying this new plan will pay $1500 (costs go up) to 5 people (jobs go down) giving each of them $75 (pay goes down).

You realize that's mathematically impossible, right?

$75 x 5 = $375 (costs would go down)
$1500 / 5 = $300 (pay would go up).

There's no way to do both. And it's not the numbers I've chosen; but the direction. You can insert any values you want as long as they move in the direction you said they would, the math fails.

We've established a pattern where you throw an assertion then, rather than defend it, throw another assertion. I've been familiar with this tactic for decades and my approach to it is to force one topic at a time in response.

So I'm happy to discuss any aspect you want to discuss; but I'm not going to respond to one assertion after another when you won't follow through. That's not a discussion: that's a rhetorical argument (also known as propiganda)

So again: Please show math that allows more money to go into fewer hands resulting in less per-person money. It's not possible.

Jerry, you've worn me out with your derivative and incorrect conclusions, and your style of discussion makes me feel like I'm arguing with a Stairmaster. I did not say more money goes into fewer hands, but this discussion is not entertaining me anymore.

 

[JerryLove]

Jerry, you've worn me out with your derivative and incorrect conclusions, and your style of discussion makes me feel like I'm arguing with a Stairmaster. I did not say more money goes into fewer hands, but this discussion is not entertaining me anymore.

OK.

But you did say that. I will quote you.

You said more money "Costs go up"
You said fewer hands "healthcare insurance industry workers (~500,000 of them) who will just be out of work."
You did say less income "healthcare workers (they'll have to take a ~25% pay cut)"

It's not possible to give more money to fewer people while paying individuals less.