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Thread: The Sandernistas Clear Hypocrisy

  1. #261
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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by Greenbeard View Post
    Vermont is a microcosm of exactly the phenomenon I'm talking about here...
    Except you're ignoring that Vermont is not California or any other state with a large economy and population, and therefore isn't a suitable/applicable microcosm because it's convenient for you. Economy of scale matters. Negotiating power matters, and you're essentially making the incredibly ridiculous and disingenuous argument that it doesn't.

    Do you really think a state with six hundred thousand people by itself can obtain nearly as favourable a rate as one of nearly 40 million in practice? Don't be ridiculous. The obstacles to singlepayer are variable by state, and in Vermont are particularly high and onerous as compared to many others, which is why it was turned down there, and, contrastingly, spiked by that traitor Rendon in California.

    GMCB has the authority right now to set rates, they just don't use it.... The current cost structure of U.S. health care providers can't be willed away with rate-setting schemes.
    #1: I agree, they can't; setting rates != those rates will be magically accepted by providers and is why negotiating, and negotiating power are both relevant: they determine the quality of the deal you'll get at a price point most providers are willing to take. Vermont as an SP doesn't have the volume on offer to support substantial price cuts due to its tiny size.

    #2: A substantial reduction in rates is possible with a large enough economy of scale at play without causing untold economic devastation as has been proven the developed world over, especially if these rates are phased in over time.

    You've offered a litany of reasons the pursuit of single-payer has failed repeatedly where taken up...
    Again, another absolutely disingenuous framing that glosses over the real reasons, and minimizes the relevant nuance.

    The issues I pointed out specifically are disparities of economy of scale which can make implementation too onerous on the state level, a politico that went in to a nomination process as an unknown and underfunded underdog, straight up corruption per Rendon, the issue of medical immigration in the event a minority of states pass SP and thus become attractive islands of sanity amidst an ocean of states reveling in healthcare for profit and perverse incentives (though this could be tackled by a legislated delay in coverage for newcomers), and a hastily drafted piece of legislation that was literally so badly put together a famous supporter and advocate of SP opposed it.

    And mind-bogglingly the lessons you take away are that (1) this will be easier at the federal level
    Yes, implementation, with perhaps the solitary exception of political corruption and the magnitude special interest forces leveled against it, would be easier at the federal level as compared to a highly variable state by state implementation; are you ****ing kidding me? Dealing with one legislative body and executive is far easier than dealing with fifty apiece, nevermind the highly variable obstacles to SP on a state by state level, which would result in highly variable quality and costs; standardization only makes sense. This is generally how SP is drafted in virtually every case where it has been done for good reason; provinces/states may be left to spend their federal subsidy as seen fit, but according to overall guidelines and minimum standards set by the federal level.

    and (2) the only reason a politician wouldn't be full-throatedly behind single-payer is because they're corrupt...
    Quote Originally Posted by Surrealistik View Post
    I'm not saying that corruption is the only thing holding it back in all places, but in the areas where majoritian support exists, that's pretty likely the case or at least a big part of the story.
    Wow you disingenuous ****, it's almost like there's some nuance to what I'm saying and you're strawmanning my positions as per usual, even after it's been explicitly clarified, because otherwise your bull**** arguments are fundamentally bankrupt.

    The point is that where it's economically viable due to the scales involved and has majoritarian support at the state level, it has generally been shot down by corrupt politicos by Rendon, or otherwise suffocated/blockaided from the legislature by the same.
    Last edited by Surrealistik; Yesterday at 02:58 PM.
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  2. #262
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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by Greenbeard View Post
    Perhaps what the people really want is a snake oil salesman ...
    I don't remember anyone saying there were no tradeoffs, that there would be no upheaval or short term pain for some sectors of the economy.

    Moreover, I don't recall blind allusions to Europe with no discussion as to how or why SP is so much more efficient than the American healthcare system, in fact this has been extensively covered. I think what you want politicians to do that support it is focus on/recognize the negatives in terms of industry/economic upheaval, which is fair, and they have with proposed transition periods spanning years.

    I don't think anyone who supports SP disagrees or shies away from the fact that there will be short term pain and upheaval, but they're not going to make that front and centre of their push because surprise, if you focus solely or predominantly on the negatives, you're going to have a hard sell on your hands; it's the same reason the right wing ****s who want to increase privatization in Canada don't want to talk about how ridiculously expensive their proposals will work out to be at the individual and societal level, or how ultimate health outcomes won't really improve while waxing on about the virtues of choice or decreased wait times, but at least SP advocates acknowledge that there will indeed be upfront issues and their proposals generally work towards minimizing those.

    Quote Originally Posted by Dirt Sands View Post
    Your "tiny state" theory isn't true. You seem to not be a believer in fixing problems "no matter what". There's an excuse as opposed to a reason. In Washington state, they have an agreement with Oregon to accept state insurance from the other state. Why can't a tiny state like Vermont do the same thing with neighboring states. You don't think politicians and medical administrators know this? Sure they do. Those tiny little northeastern states must not agree even though they're liberal.
    Except it is for reasons I've described; SP just doesn't work out so well at the small state level, and the challenges of implementation far outstrip those of an economy and population like California's.

    Perhaps smaller states could effect a viable SP solution if they were to pool resources and negotiating power, but the impractical bureaucracy of such a solution makes that much less than likely; there are way too many moving parts. Seriously, even if they could manage to hash out an agreement in the first place, they then have to upkeep that agreement regardless of changes of government from each party involved; it's a mess. Again, all the more argument for drafting SP at the federal level.

    By definition, for every problem there's a solution.
    Your saying all of these political problems has to be fixed first. That simply isn't the case. They can, in fact, fix healthcare today. The reason I assign to it is a lack of political will.
    I'm not saying that the political problems with corruption have to be fixed first, but their resolution would make drafting SP or a hybrid system orders of magnitude easier.

    Further, the lack of political will stems from said corruption.
    Last edited by Surrealistik; Yesterday at 02:49 PM.
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  3. #263
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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by FieldTheorist View Post
    You're treating the Left like they're intransigent and overly rigid, so they cannot accomplish anything.
    They have a tendency to cast aspersions on anyone who doesn't toe the party line exactly. Actual differences of opinion or perspective seem to have been ruled out as legitimate intellectual possibilities.

    Every year we are spending double or triple what we should in medical coverage for half of the positive outcomes of every other first world nation on the planet, and it's a colossal drain on the economy.
    This ignores the fundamental nature of the problem: health care increasingly is our economy. We don't make refrigerators, we make health care.

    Employment by major industry sector

    Where did the jobs grow most over the past decade? Health care. Where are they projected to grow most over the next decade? Health care. Which sector is the second (about to be first) largest source of employment? Health care.

    That's why cost control is hard. Our dollars are flowing into that sector because that's increasingly where the new white and blue collar job opportunities are concentrated. The "costs" in question are, to a large degree, people's paychecks. That's especially true in distressed areas:

    Hospitals are particularly important in high-poverty areas. In each of the largest twenty U.S. cities, a health system is among the top ten private employers; in high-poverty communities, a health system is almost always among the top five.
    You can find local articles coming at this same general point from every angle. E.g., As workforce bleeds men, health care jobs could be key to keeping them employed
    The rate of U.S. men participating in the labor force, meaning they're working or looking for work, has been declining for 50 years, a trend that could carry ramifications for economic growth as well as individual and family well-being. And more automation, particularly advancements in artificial intelligence, threatens to disproportionately hit traditionally male-dominated jobs going forward.

    Manufacturing, agriculture and utilities, all of which employ mostly men, are projected to lose jobs over the next decade, according to the Bureau of Labor Statistics.

    Meanwhile, nine of the 12 fastest-growing jobs in the U.S. are in health care, topped by occupational therapy assistants, physical therapy assistants and nurse practitioners, all positions that are held mostly by women.
    Cost control is fundamentally a project to reverse this. That's why it's so delicate. As a practical matter, an economic matter, and a political matter, there's no way to do this (i.e., re-balance the economy and divert labor into other sectors) other than through an evolutionary process. Single-payer could play a role in this process if adopted, but it doesn't change the nature of the project or the constraints on the pace of disruption.

    You're trying to draw a bright line between these industries and "the public" but that's not so easy to do.

    So what's your strategy?
    Continue on the trajectory that's been established over the last decade. Accelerate the movement to risk-based provider contracts, continue building out the infrastructure for incorporating an emphasis on value in purchasing decisions and insurance design, ramp up both demand-side and supply-side incentives for efficiency and the deployment of lower-cost innovations.

  4. #264
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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by Surrealistik View Post
    Except you're ignoring that Vermont is not California or any other state with a large economy and population, and therefore isn't a suitable/applicable microcosm because it's convenient for you. Economy of scale matters. Negotiating power matters, and you're essentially making the incredibly ridiculous and disingenuous argument that it doesn't.

    Do you really think a state with six hundred thousand people by itself can obtain nearly as favourable a rate as one of nearly 40 million in practice?
    The market situation is the same in either situation, it's a monopsony. The number of buyers has shrunk to one. The 40M and 600K numbers are extraneous to understanding the relative leverage of the parties. There's no fundamental difference between a hospital in California that only has one buyer and a hospital in Vermont that has only one buyer because most health care is local.

    More importantly, the number of payers doesn't inherently change the costs those hospitals need to cover (much of it fixed). What is supposed to be negotiated away in this scenario? The hospital's input costs? The GMCB already regulates now much revenue hospitals in Vermont can take in to cover their costs (you can go hospital-by-hospital to see the budgeted margins above cost--they're not particularly large). Under a single-payer scenario, presumably the state would assume responsibility for paying the hospital all of that revenue, as opposed to a multi-payer scenario where it's divvied up across payers who jockey with each other to pay a relatively smaller or larger share of it based on their market leverage.

  5. #265
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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by Greenbeard View Post
    The market situation is the same in either situation, it's a monopsony. The number of buyers has shrunk to one. The 40M and 600K numbers are extraneous to understanding the relative leverage of the parties. There's no fundamental difference between a hospital in California that only has one buyer and a hospital in Vermont that has only one buyer because most health care is local.

    More importantly, the number of payers doesn't inherently change the costs those hospitals need to cover (much of it fixed). What is supposed to be negotiated away in this scenario? The hospital's input costs? The GMCB already regulates now much revenue hospitals in Vermont can take in to cover their costs (you can go hospital-by-hospital to see the budgeted margins above cost--they're not particularly large). Under a single-payer scenario, presumably the state would assume responsibility for paying the hospital all of that revenue, as opposed to a multi-payer scenario where it's divvied up across payers who jockey with each other to pay a relatively smaller or larger share of it based on their market leverage.
    The problem is that, stateside monopoly or not, there are going to be consequences if you can't offer a combination of price and volume that is adequate to the provider, especially if you're surrounded by states that offer a better deal. In Vermont, the increase in volume that would accompany the reduction in cost per person covered is probably not going to be sufficiently enticing; your market size/expansion (because un/underinsured people are now fully covered) just won't be large enough to entice providers to take the kinds of cuts you might be able to leverage in California, even with the significantly reduction in administrative costs factored (since you don't have to deal with a labyrinthine maze of wasteful middle men that each want their cut/bloat) or cuts negotiated on the basis of payer/market stability and reliability and the fact that you're a monopoly (which can only take you so far before providers give up on your market for a more lucrative one), so your options are either accepting significantly compromised healthcare, or a relatively and likely substantively higher cost of care as compared to SP in other states with more economic largesse and larger populations, nevermind negotiations with suppliers. In the end, a small state takes on a substantial increase in operating costs by absorbing the responsibility of health insurers while securing perhaps significant, but ultimately inadequate reductions in cost.

    Again, stateside implementation is a bad idea (or at best, is a bad idea for a big subset of America, and inferior to a federal level implementation), and this is one of the key reasons; small States can't implement SP with nearly the same benefits as larger ones, and are especially vulnerable to provider flight/quality compromises if they try to.
    Last edited by Surrealistik; Yesterday at 05:16 PM.
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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by Dirt Sands View Post
    Whether you are right or wrong, you will lose the next election. Elections aren't about being right, they're about winning.

    I've seen this before. In college, in 1987, I went to a
    speech put on by Jesse Jackson. The auditirium sat 3000. I was one of three white guys. I'm a liberal who learned how to win. In 1992, after twelve years of republican presidencies. We elected a Democrat. He was still painted as a liberal though us Democrats new he wasn't.

    After Trump, you will be desperate for a Democrat, any Democrat. Only a minority of the population agrees with you.

    One day it'll make sense. You're just a future convert.

    Start the electoral college out with the entire south voting against right you off the top. Now begin your campaign. Being liberal isn't bad. You just can't let the rest of the country know it. Good luck.

    Its like playing Black Jack and you hit on every card till you catch 21. Sometimes you have to stand and let the dealer bust.

    It's the game and you have to learn how to play. Raw, crude politics, is simply the raw energy. It's only a small portion of the entirety of politics. Whether others get it isn't up to me. I've seen this before.
    If this were 1995, you'd be right; if this were even 2005, you might be right. But we are in a post-2008 world where people have really had a chance to think through the ramifications of a rigged economic system. That's what's created the "far Left" and the absurd far Right, and why moderates have begun to dwindle. You can give me sermons about what 80's and 90's politics was like, but at the end of the day the lessons of 30 years ago aren't applicable. Consider that when Reagan ran in 1980, he was considered an unserious ideologue who could never break the yolk of New Deal-era politics. He was given the exact advise you're giving me now --don't try to run on what you believe, the public will crucify you, and you'll never get what you want. Those Republicans in the 1980's learned the lessons of Republicans in the 1940's and 1950's --you have to bow your head to the New Deal. And at least in terms of victory, they were as wrong, just as you are wrong now.


    Over a dozen Democratic Socialist were elected to serve this month, including a Virginian who beat an incumbent Republican majority whip. Let that sink in. That's part of the South in a deep Red district, the kind you were just telling me cannot happen. But the thing about politics is that it is always subject to change. Reagan wouldn't have won in 1956; Bernie wouldn't have won in 1996; Trump wouldn't have won in 2008. Timing is everything.
    "The question is whether privileged elites should dominate mass-communication and should use this power, as they tell us they must [to] manipulate and deceive the 'stupid majority', and remove them from the public arena. The question, in brief, is whether Democracy and Freedom are values to be preserved or threats to be avoided." --Chomsky

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    Re: The Sandernistas Clear Hypocrisy

    Quote Originally Posted by Greenbeard View Post
    This ignores the fundamental nature of the problem: health care increasingly is our economy. We don't make refrigerators, we make health care.

    Employment by major industry sector

    Where did the jobs grow most over the past decade? Health care. Where are they projected to grow most over the next decade? Health care. Which sector is the second (about to be first) largest source of employment? Health care.

    That's why cost control is hard. Our dollars are flowing into that sector because that's increasingly where the new white and blue collar job opportunities are concentrated. The "costs" in question are, to a large degree, people's paychecks. That's especially true in distressed areas:



    You can find local articles coming at this same general point from every angle. E.g., As workforce bleeds men, health care jobs could be key to keeping them employed


    Cost control is fundamentally a project to reverse this. That's why it's so delicate. As a practical matter, an economic matter, and a political matter, there's no way to do this (i.e., re-balance the economy and divert labor into other sectors) other than through an evolutionary process. Single-payer could play a role in this process if adopted, but it doesn't change the nature of the project or the constraints on the pace of disruption.

    You're trying to draw a bright line between these industries and "the public" but that's not so easy to do.
    Firstly, you like to claim the fact that having 1/3 of our GDP come from health care shows that my views are problematic. Let me ask you, do you genuinely think that a health care-based economy is sustainable? Do you think that the US can be propped up by selling drugs and medical equipment to other countries? You do realize that what you are delineating right now is exactly what I was warning you before? A country where everyone is required to have health care, but as more and more people are employed in health care, the more and more expensive it becomes until no one can afford it. Everyone might be working in health care, but no one but the upper class can afford it. I assume you are conceding that all of these things are unsustainable, and saddle our economy with unbelievable opportunity costs.

    Secondly, and this gets to the crux of your criticism, it is really important for you to admit that no politician who supports Medicare-For-All (least of all Bernie Sanders) thinks that today we have PPACA, but tomorrow we will have Medicare-For-All. No one thinks that. The legislation that has been discussed involves a slow roll out over a decade or two, to allow for people to move out of the health care industry in an organic and controlled manner, and to allow for the adjustment to major overhauls of the US health care industry. Basically, it involves allowing Medicare to negotiate with pharmaceutical companies, providers and facilities, and then --in slow phases-- lower the age of Medicare eligibility. There's other issues to be discussed with regards to health care costs, but it does invalidate your point that those who support Medicare-For-All don't understand everything you just said and are clumsily failing to take these issues on board.

    Continue on the trajectory that's been established over the last decade. Accelerate the movement to risk-based provider contracts, continue building out the infrastructure for incorporating an emphasis on value in purchasing decisions and insurance design, ramp up both demand-side and supply-side incentives for efficiency and the deployment of lower-cost innovations.
    Some of this will certainly help, although I'm not certain about risk-based contracts and I haven't looked into the data on this one. But slowly removing the profit motive for private insurers is unquestionably another area where costs can be lowered, and allowing drugs from Canada is also an area that can positively impact a lot of low income Americans.
    Last edited by FieldTheorist; Yesterday at 07:25 PM.
    "The question is whether privileged elites should dominate mass-communication and should use this power, as they tell us they must [to] manipulate and deceive the 'stupid majority', and remove them from the public arena. The question, in brief, is whether Democracy and Freedom are values to be preserved or threats to be avoided." --Chomsky

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