Explaining Why Federal Deficits Are Needed[W:5330]

[jaeger19]

Exactly...it's all about profits. Now what I'm not getting from you is why does that part of health care have to be for profit, and how does making it for profit improve outcomes when we have all the health metrics that show our outcomes consistently rank below other First World Nations. .

Well we have been over this.. first all the health metrics do not show our outcomes rank below first world nations. Our health system consistently ranks high on access, timeliness of care, and quality of care.. higher than almost all first world nations. We get docked on things like efficiency of care, and equality of care because not every person is insured in America.

We also score better on many metrics such as cancer outcomes. YET.. our demographics are much worse than most other nations if not all. higher rates of obesity, higher rates of sedentary lifestyles and stress. We have gone over this already.. you are wrong.. you have been proven wrong.. let it go.

How does having a for-profit tie to the administration of payments to providers improve outcomes? The answer is that it doesn't

The answer it does because if the insurance company pisses off their customers, then they leave for another company.

The care you receive DOES count on the insurance company.. no matter how many times you erroneously claim it does not. You have been shown how you are wrong.. you don't want to understand it.

In a single payer system, you can go see whatever doctor you wish because all doctors are reimbursed by the same entity. And that entity isn't taking 20% off the top for itself, wasting premium dollars that could otherwise be used on your care.

Yeah.. no you can't. In most single payer systems.. there are two systems.. one for the rich and upper middle class.. who have private doctors and another system for the poor and middle class who get the public system., And even within that public system in many single payer systems.. you don't have a choice of which doctor you go to.. you go where you are referred.

You sir are just flat out wrong on how the systems work.

 

[Moderate Right]

No, the solution is to have a single payer that reimburses all providers...which encourages doctors to produce better outcomes in order to compete for patients. Right now, you may think you have the best doctor, but you don't know that for sure. For all you know, your current doctor might not be that great compared to your neighbor's, who may have different insurance than you. Because there is no level playing field for providers, they have no incentive to produce better outcomes because they're not directly competing for your care. We hear over and over from Conservatives how competition leads to innovation. Single payer forces providers to compete for your care, which leads to innovation. Right now, providers aren't directly competing for your care. Instead, they are in the position where they can force insurers to compete for reimbursements. But that doesn't improve or enhance your care, or even guarantee better outcomes.

But if people are paying their own medical expenses now through premiums then we can get rid of the middleman insurance companies and everyone can just pay their own medical expenses.

 

[Critter7r]

Only for a very few years in those 20 years. So we are still at or above the average for revenue. And then add the deficit spending? On top of it. We have had way more than enough money available.

Uh ... deficit spending is the result of NOT having enough money available. If we had enough money available, we wouldn't be in a deficit.

 

[Critter7r]

But if people are paying their own medical expenses now through premiums then we can get rid of the middleman insurance companies and everyone can just pay their own medical expenses.

Amen.

Let's get back to catastrophic insurance only. None of this "insurance is supposed to pay for my $60 annual dental cleaning" BS. Pay for all your own stuff up to $xxxx.xx and then insurance kicks in.

I've been to a doctor 3 times in 10 years, never running up a tab of more than a few hundred bucks. Even my vasectomy was only about $800. And for that, I get to be forced to pay about $200 per month thru my employer. And my employer pays 75% of the policy!! $200/month/10 years = I want my $24,000 back. I'm sure my employer would love to have their $75,000 back too.

 

[Incisor]

But if people are paying their own medical expenses now through premiums then we can get rid of the middleman insurance companies and everyone can just pay their own medical expenses.

But people can't do that because the cost to treat cancer or have heart surgery is so high. All I'm saying is why not just pool everyone's premiums together into one payor and have that payor use its leverage as the only payor to negotiate for better fees and prices?

 

[Incisor]

first all the health metrics do not show our outcomes rank below first world nations.

Yes, they do. Infant mortality, life expectancy, maternal mortality, etc. We rank below most First World nations and you simply saying it isn't true doesn't make it so. I can point to the WHO. I can point to the NIH. I can point to pretty much any major health care-related body and they will all show us ranking below single-payer nations. Secondly, you say we rank high on access to care? Based on what? ~25,000,000 people in this country don't have health insurance right now. So already, access is not universal as it is in most single-payer first world nations. So if you compare us to say, Somalia, of course we are going to rank better. But if you compare us to Canada or Israel or Britain, we don't. Timeliness of care also relates to the first point as well. 25,000,000 people are not getting timely medical care because they can't get access to it, even though you claim we rank higher on access than (insert First World, single-payer nation here). As far as quality of care...that's purely subjective. You can't measure quality of care like you can measure life expectancy or infant mortality. And we can just look at outcomes and see how far behind we are from everyone else. Access, Timeliness, and quality are not outcomes. And of course, we spend more than double the next closest country.

We also score better on many metrics such as cancer outcomes.

Do we, though? We have the sixth-highest cancer rate in the world. And of course, outcomes for cancer are determined by access to health care, and in that regard we do not rank higher than other single-payer nations. So while our cancer outcome/survival rate may be tops, that's just on the people who have access to treatment. What about the 25,000,000 who don't? What's their cancer survival rate?

The answer it does because if the insurance company pisses off their customers, then they leave for another company.

How would they do that? The insurance company merely administers payment between the insurance company and the provider. You aren't in that equation.

The care you receive DOES count on the insurance company.. no matter how many times you erroneously claim it does not. You have been shown how you are wrong.. you don't want to understand it.

Access does. Actual care does not. So again, you are conflating access to health care with health care. They are two different things best articulated in how you couch your argument regarding cancer survival rates. Sure, the US may have the highest cancer survival rate of any other nation...but that's the survival rate for those who get cancer treatment. What about the 25,000,000 people who don't have access to cancer treatment because they don't have insurance? Are they included in your measurement? I don't think so.

Yeah.. no you can't. In most single payer systems.. there are two systems.. one for the rich and upper middle class.. who have private doctors and another system for the poor and middle class who get the public system.

Well, the wealthy have private doctors now, so that changes nothing. And didn't Margaret Thatcher go on Britain's national health service when she got sick and died? And the Public System seems to work out fine for single-payer nations, as we see in the most base health metrics.

 

[Winston]

Well we have been over this.. first all the health metrics do not show our outcomes rank below first world nations. Our health system consistently ranks high on access, timeliness of care, and quality of care.. higher than almost all first world nations. We get docked on things like efficiency of care, and equality of care because not every person is insured in America.

We also score better on many metrics such as cancer outcomes. YET.. our demographics are much worse than most other nations if not all. higher rates of obesity, higher rates of sedentary lifestyles and stress. We have gone over this already.. you are wrong.. you have been proven wrong.. let it go.

The answer it does because if the insurance company pisses off their customers, then they leave for another company.

The care you receive DOES count on the insurance company.. no matter how many times you erroneously claim it does not. You have been shown how you are wrong.. you don't want to understand it.



Yeah.. no you can't. In most single payer systems.. there are two systems.. one for the rich and upper middle class.. who have private doctors and another system for the poor and middle class who get the public system., And even within that public system in many single payer systems.. you don't have a choice of which doctor you go to.. you go where you are referred.

You sir are just flat out wrong on how the systems work.

So, the UK, Canada, Denmark, Sweden, Norway, Cuba, Germany, Belgium, Japan

they're all wrong.

And guys like Paul Ryan and Ted Cruz are right?

 

[jaeger19]

Yes, they do. Infant mortality, life expectancy, maternal mortality, etc. .

No we don't. and I've already posted those stats. Infant mortality, life expectancy, maternal mortality aren't how are healthcare system work.. they are things like demographics.. at what age do mothers have children.. what are the comorbidities with those mothers.. how many high risk problems etc.

We don't rank below first world countries on healthcare metrics.. and that's the facts.

Do we, though? We have the sixth-highest cancer rate in the world

yes.. and we do better than the UK.

What about the 25,000,000 who don't? What's their cancer survival rate?

Actually better than the UK. The studies don't tease out insurances. You are simply more likely to survive cancer if you live in the US.

How would they do that? The insurance company merely administers payment between the insurance company and the provider. You aren't in that equation.

I am in that equation.. all the time between the insurance, the patient and their care. You are wrong. its that simple.

Access does. Actual care does not.

Access is actual care. Whether you want to admit it or not.

Well, the wealthy have private doctors now, so that changes nothing

No.. not like in other countries. In this country the poor guy who is a janitor with blue cross blueshield from his company.. is in the same hospital receiving the same care as his boss with bluecross blueshield. In other countries.. the poor janitor waits on a waiting list to even get seen by a government physician.. while his boss just had surgery at a private surgery center with a surgeon of his choice.

If that's the kind of inequality you want in the US then keep pushing for single payer.

 

[jaeger19]

So, the UK, Canada, Denmark, Sweden, Norway, Cuba, Germany, Belgium, Japan

they're all wrong.

And guys like Paul Ryan and Ted Cruz are right?

Well it depends on what you mean by "they are all wrong". We rank higher than most of those country on quality of care, timeliness of care and effectiveness of care. If you have insurance in this country.. you will wait less for specialists, have more choice, have more treatments available than any of those countries. In fact.. in all those countries.. our Medicaid.. which is considered the worst insurance you can have in the US is better than being on the government insurance in those countries.

now.. if you are one of the 10-15% of americans that don't have health insurance or are choosing to go without it. The UK etc look pretty good.

But if you are the 85% or more of americans that have health insurance.. your insurance is far better than those countries you mentioned.

Paul Ryan and Ted Cruz are idiots when it comes to healthcare. As was Obama, and Saunders and Hillary. None of them understand the issues we have with healthcare and healthcare insurance in this country.

 

[Winston]

Well it depends on what you mean by "they are all wrong". We rank higher than most of those country on quality of care, timeliness of care and effectiveness of care. If you have insurance in this country.. you will wait less for specialists, have more choice, have more treatments available than any of those countries. In fact.. in all those countries.. our Medicaid.. which is considered the worst insurance you can have in the US is better than being on the government insurance in those countries.

now.. if you are one of the 10-15% of americans that don't have health insurance or are choosing to go without it. The UK etc look pretty good.

But if you are the 85% or more of americans that have health insurance.. your insurance is far better than those countries you mentioned.

Paul Ryan and Ted Cruz are idiots when it comes to healthcare. As was Obama, and Saunders and Hillary. None of them understand the issues we have with healthcare and healthcare insurance in this country.

You fault the single-payer system for waits on health care services ranging from routine checkups to elective surgery. Waits are prone to influence from variables. If the single-payer system itself was responsible for long waits.. you would have widespread reports of waits. There's too many variables in cases of long waits to make a case that waits are a symptom of single payer.

The take-away message is that both the United States and Canada do pretty poorly, compared to most other industrialized countries, on how long patients have to wait to get a regular appointment with a primary care physician or after-hours care, but the U.S. does better than most on having shorter wait times for diagnostic procedures, elective surgery, and specialty care. Each of these countries, though, with the exception of the United States, has universal health insurance coverage, funded and regulated in large part by the government, so it doesn't seem likely that government-subsidized health care, in itself, is the sole factor in determining how long patients are stuck in The Waiting Place. Other factors, like the numbers of primary care physicians and specialists in each country, may be more important.1.

Maybe a compromise is in order. Many governments use a two tier system. Everyone has basic health care. But, individuals are free to purchase extra care. 2.

1.The ACP Advocate Blog: Which countries have the longest waits for medical care?
2.https://en.wikipedia.org/wiki/Two-tier_healthcare

 

[jaeger19]

You fault the single-payer system for waits on health care services ranging from routine checkups to elective surgery. Waits are prone to influence from variables. If the single-payer system itself was responsible for long waits.. you would have widespread reports of waits. There's too many variables in cases of long waits to make a case that waits are a symptom of single payer.
B]

Well actually.. wait times for routine checkups in those countries are probably non existent.. and it would not surprise me if they are better in some cases than the US. And that's because in most single payer countries they front loan their care. In other words.. they make it easy for you to access your doctor for a cold, a sprain, a sniffle. Which does two things. First.. your populace loves it. Because most of the populace isn't really sick. So the ability to pop in.. see a doctor.. get some medicine for your headache, cold, etc and walk out without paying a cent (just flash your government healthcare card).. is extremely popular.

The second reason.. and we could learn from this is that front loading your doctor visits and making them easy helps prevent conditions that would worse from worsening. They pick up some medical savings from preventative medicine from catching the guy with diabetes before he has a wound, or is in the ER.

That's something we don't do in this country and it hurts us to a degree financially.

ON THE OTHER HAND... where single payer countries often pick up savings is by rationing EXPENSIVE care.. and they do that by controlling access to specialists, and specialized tests and procedures. and thus most of these countries have longer wait times for a variety of things. It depends on the country because what the single payer countries pay for tends to vary.. but for the most part they have significantly longer wait times for specialists, etc.

And if you bother to do some research.. you will find that these countries struggle with wait times.

Maybe a compromise is in order. Many governments use a two tier system. Everyone has basic health care. But, individuals are free to purchase extra care

Well you point out a reality in many of these countries. There are two systems.. one for the rich and upper middle class that can afford to go where they want... and another poorer system for everyone else not rich. That is a system we are heading to.. but for the vast majority of americans it will mean a dramatic decrease in what they have now.

 

[Moderate Right]

But people can't do that because the cost to treat cancer or have heart surgery is so high. All I'm saying is why not just pool everyone's premiums together into one payor and have that payor use its leverage as the only payor to negotiate for better fees and prices?

Now wait a minute. You said earlier that insurance companies don't pay medical bills, the people pay premiums to insurance companies, the insurance companies pocket a percentage for themselves, and then use the patient's own money to pay the medical bills. If that is true, then we can just get rid of the insurance companies altogether and pay our own medical bills without the insurance companies pocketing some of our money. It would be cheaper for us to do that than paying health insurance premiums to those greedy insurance companies. Please make up your mind. Which way is it?

 

[Moderate Right]

So, the UK, Canada, Denmark, Sweden, Norway, Cuba, Germany, Belgium, Japan

they're all wrong.

And guys like Paul Ryan and Ted Cruz are right?

Please reread jaeger's post.

 

[Winston]

Please reread jaeger's post.

I've read it plenty. I would trade "primo care" for universal coverage that saves everyone money.

 

[Moderate Right]

I've read it plenty. I would trade "primo care" for universal coverage that saves everyone money.

I have pre-existing conditions and have talked with many people the world over and I know of no other country I would trade places with when it comes to healthcare. Canada is spotty and there are some places there where overall health care is better than the US but there are also many parts of Canada that really suck when it comes to healthcare. Many people in these countries with nationalized health care have to buy separate health insurance policies if they want better care because the nationalized system sucks. The only real edge most of them have over the US is cost and the fact that people don't go bankrupt due to medical expenses. As far as overall health outcomes go, you read too many liberal statistics that don't give an accurate picture, as jaeger tried to explain but he couldn't break through the liberal brick walls. There are a million different variables and looking at a generalized picture that doesn't really break down how the statistics are compiled leaves a biased result.

 

[Incisor]

Now wait a minute. You said earlier that insurance companies don't pay medical bills, the people pay premiums to insurance companies, the insurance companies pocket a percentage for themselves, and then use the patient's own money to pay the medical bills. If that is true, then we can just get rid of the insurance companies altogether and pay our own medical bills without the insurance companies pocketing some of our money. It would be cheaper for us to do that than paying health insurance premiums to those greedy insurance companies. Please make up your mind. Which way is it?

By "our", I am speaking of the collective "we". I'm speaking in the plural.

 

[Incisor]

No we don't. and I've already posted those stats. Infant mortality, life expectancy, maternal mortality aren't how are healthcare system work.. they are things like demographics.. at what age do mothers have children.. what are the comorbidities with those mothers.. how many high risk problems etc.

Infant mortality, life expectancy, and maternal mortality are metric outcomes.

We don't rank below first world countries on healthcare metrics.. and that's the facts.

Yes, we do. One of the links you provided showed us ranked 11th out of 11 countries.

Actually better than the UK. The studies don't tease out insurances. You are simply more likely to survive cancer if you live in the US.

You sure about that? Because you didn't bother to cite the source. I am pretty sure that the cancer survival rate doesn't take those without health insurance into account. If it did, their survival rate would be 0% (because you can't survive cancer without treatment), which would drag down the US' overall average. You've excluded 8% of the population when you make your cancer survival rate claims. Also, cancer survival is also dependent on access to care. We already know that 25,000,000 people do not have access to health care because that many remain uninsured. Cancer survival means patients diagnosed and treated for cancer. How can you be diagnosed and treated for cancer if you have no insurance?

I am in that equation.. all the time between the insurance, the patient and their care. You are wrong. its that simple.

No, you are not in the equation when an insurer reimburses a provider. That part of the process is not a part that includes the patient. The patient has no say in how the insurer goes about processing and paying claims.

Access is actual care. Whether you want to admit it or not.

Access...lol....so you want to buy one of Donald Drumpf’s mansions? You have access to do that. Oh, you can’t afford $5 million for a house? Sorry. Access doesn’t mean a thing! What it means is whether people can afford it, and can get the health care that they need.. So by virtue of the fact that someone has access to it means that it is accessible for all? Hmmm...sounds suspiciously like "separate but equal" to me.

No.. not like in other countries. In this country the poor guy who is a janitor with blue cross blueshield from his company is in the same hospital receiving the same care as his boss with bluecross blueshield

If the poor guy is lucky enough to have an employer that provides coverage, and that coverage is comprehensive and affordable. And that's a big "if".That also doesn't count high deductibles, high co-pays and co-insurance, and drug costs. So unlike in other countries, the employee is not in control of their health care, but rather at the mercy of their employer who decides what plans they want to offer. And a single payer system does not mean that the government controls health care...such as, doctors don't suddenly become government employees. The only thing that changes for them is who reimburses them. That's it.

 

[Incisor]

but for the vast majority of americans it will mean a dramatic decrease in what they have now.

You can't make this claim. If Medicare is the standard, then the majority of Americans will see a dramatic increase in what they have now. Plus, there would no longer be premiums that change without warning, high deductibles, co-pays, co-insurance, or drug costs. So that's a trade-off I think most people would accept.

 

[jaeger19]

I've read it plenty. I would trade "primo care" for universal coverage that saves everyone money.

And most americans won't. Most americans don't want to have much worse insurance so everyone has crappy insurance. Most americans I would bet would rather find ways to get those without insurance to their level rather than make it worse for the majority.

 

[Moderate Right]

By "our", I am speaking of the collective "we". I'm speaking in the plural.

In other words, you are saying that all insurances have a purpose, from Auto to life to health insurance. Most people would find it cheaper to not have any insurance at all for anything. BUT, what if you have a car accident, what if you die at the age of 25 in that car accident, or what if you get sick and have to go to the hospital and incur tens of thousands of dollars in medical bills? You could get "lucky" and have the insurance companies pay out much more money than you paid in, in premiums. That's the way insurances work. You can only look at it collectively if you are being partisan.

 

[jaeger19]

You can't make this claim. If Medicare is the standard, then the majority of Americans will see a dramatic increase in what they have now. Plus, there would no longer be premiums that change without warning, high deductibles, co-pays, co-insurance, or drug costs. So that's a trade-off I think most people would accept.

no.. because medicare won't be the standard. Medicaid will be the standard or actually worse than Medicaid if we go by what other countries have.

Medicare is already in trouble financially. and you are talking about adding millions of people onto it that haven't paid into it. Medicare only works at all because you pay your whole life without taking out.. and only take out at the end.

 

[Incisor]

In other words, you are saying that all insurances have a purpose, from Auto to life to health insurance. Most people would find it cheaper to not have any insurance at all for anything. BUT, what if you have a car accident, what if you die at the age of 25 in that car accident, or what if you get sick and have to go to the hospital and incur tens of thousands of dollars in medical bills? You could get "lucky" and have the insurance companies pay out much more money than you paid in, in premiums. That's the way insurances work. You can only look at it collectively if you are being partisan.

Yes, collectively...so stay with me here. What benefits patients more? A system with multiple payors and varying levels of access dependent on income, or a system with a single payer that covers everything and provides universal access? The first option leads to fragmentation among payors which results in the bargaining power going to the providers and drug companies, whereas the second option creates a space where patients have the bargaining power because there is only one payor. So instead of insurers negotiating from an unfavorable position, the single payer negotiates from a position of strength because it's the single payor and is the sole source of demand.

 

[Incisor]

no.. because medicare won't be the standard. Medicaid will be the standard or actually worse than Medicaid if we go by what other countries have

Not sure why you think Medicaid would be the standard since Medicaid is a Federal Program administered by the states. Medicare is the national single-payer plan that already exists.

And "by what other countries has" means...what? Better outcomes and lower costs.

 

[Incisor]

Medicare is already in trouble financially. and you are talking about adding millions of people onto it that haven't paid into it. Medicare only works at all because you pay your whole life without taking out.. and only take out at the end.

Medicare is not in trouble financially. Thanks to Obamacare, Medicare's Trust Fund solvency was extended into the mid-late 2020's. And everyone pays into Medicare if they have a job via payroll taxes. Medicare is pay-go, meaning we are paying for the people who are currently using it. And when we retire, those working will be paying for us. Also, Medicare is funded right now with an all-in tax of just 2.9% (1.45% for individuals, 1.45% for business). That is extremely low. In fact, that is one of the lowest taxes Americans pay. But on top of that, we are also paying premiums to private insurance companies, deductibles, co-pays, co-insurance, drug costs, etc. So the out-of-pocket expense to the patient is much higher overall. Sanders' single-payer proposal set a payroll tax rate of 6.2% for workers and 6.2% for business. The average wage in this country is about $50K, and according to Kaiser the average worker spends about $5K a year in employer-provided coverage with the average business paying $12K a year. Under a single payer plan, the average worker would spend $3,100 on their health care and a business of 50 employees that clears $1M in profit a year would pay just $62,000 a year. That is decidedly less than the same company providing benefits to 50 employees at a cost of $12K per employee for a total cost of $600,000 a year. So that business is saving about $538,000 a year under a single-payer plan.

The single payer puts the bargaining power in the hands of the patients, rather than now where the power lies with providers and drug companies.

 

[jaeger19]

Infant mortality, life expectancy, and maternal mortality are metric outcomes.

.

No they are really not. If you smoke 10 packs of cigarettes a day, eat 3 hoagies a meal, wash it down with six pack of beer and sit on your butt 24/7. And you die at 47? I am not at fault.. you doctor is not at fault.

The metrics you are using have far more to do with lifestyle, culture and genetics, than they do with actual healthcare.

Yes, we do. One of the links you provided showed us ranked 11th out of 11 countries.

Yep.. and if you bothered to read it.. we actually scored 3rd in effective care, high in quality of care and high in timeliness in care. what pulled us to 11 was things like "equality of care, efficiency of care etc.. which has to do with the fact that we don't insure everyone. Not our healthcare system.

You sure about that? Because you didn't bother to cite the source. I am pretty sure that the cancer survival rate doesn't take those without health insurance into account.

I've cited it for you multiple times. and yes it doesn't take into account insurance.

No, you are not in the equation when an insurer reimburses a provider. That part of the process is not a part that includes the patient. The patient has no say in how the insurer goes about processing and paying claims.

yeah we have been over this.. how that insurer process and pays claims affects the care the patient receives.

Access...lol....so you want to buy one of Donald Drumpf’s mansions? You have access to do that. Oh, you can’t afford $5 million for a house? Sorry. Access doesn’t mean a thing! What it means is whether people can afford it, and can get the health care that they need.. So by virtue of the fact that someone has access to it means that it is accessible for all? Hmmm...sounds suspiciously like "separate but equal" to me

WTF? You just spouted a bunch of gobbledygook to hide the fact that I am right. If your insurance doesn't pay for something.. then it can effect your care. Whether government or private insurance.

If the poor guy is lucky enough to have an employer that provides coverage, and that coverage is comprehensive and affordable. And that's a big "if".

85% of americans if not more have healthcare coverage. So not such a big if.

And yes.. a single payer means the government is in control of your healthcare. And often with single payer systems the doctor is actually an employee of the government. You sir are so wrong.