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Preparing (FINANCIALLY) for the possibility of socialized medicine

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  • fatlittlepig fatlittlepig 
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    I think you’re missing a handful of things here.  First, we can’t afford any of those things you mention, as we are running hundreds-billions dollar deficits currently (in boom times).  These were still hundreds of billions even prior to the new tax law BTW.  So if the government wants to do something it’s not a matter of affording it because politicians have consistently shown a willingness to spend without an ability to pay for it (see $21T debt)

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    I think you’re missing a handful of things here.  First, we can’t afford any of those things you mention, as we are running hundreds-billions dollar deficits currently (in boom times).  These were still hundreds of billions even prior to the new tax law BTW.  So if the government wants to do something it’s not a matter of affording it because politicians have consistently shown a willingness to spend without an ability to pay for it (see $21T debt).

    FLP: already addressed…

    Second, no one has a right to anyone else’s labor.  I don’t have a right to yours and you don’t have the right to mine.  That is a fundamental concept of the free market, capitalism, and our founding documents, constructs that have enabled you to earn your vast sums of wealth and that have benefited even the poorest among us.

    FLP: I’m not sure I would equate the concept of free market capitalism to the right of a human being to receive medical care. To me it’s about human dignity, and taking care of our own citizens. 

    Third, it’s not common sense – it’s just your opinion, as these statements are mine.  If anything, common sense (IMO) would seem to be to support non-monopolistic systems sicne those systems have consistently delivered poor value for the consumer.  Competition and the free market drives value for the consumer.

    FLP: Competition is general is a good thing, but where it has led us in the health care sector is increased costs, inefficiency, fragmentation, and poorer outcomes than in countries with what you would call a monopolistic system..

    Fourth, you seem to misunderstand why drugs are priced the way they are and seem to misunderstand the nature of competition.  More drugs available are better.  More competition and options lowers cost.  You see this when trade names become generic.  What stalls this process and makes things more expensive is what the FDA allows in terms of patent protections and their criteria for what is approved as a “new drug”.  Look no further than the federal government here for the source of those problems.  The other issue here is that the rest of the world has been free-riding off our system that has allowed for R&D investment and innovation.  So we are charged higher prices while other countries sit back and enjoy a cheaper ride.  If we join them then bye-bye goes innovation for the next new medical problem or a better solution to ones we have currently.  Also, how would this work exactly?  A bunch of elected and non-elected government employees are going to wave a wand and determine which statins they will or will not approve, sending 8-9 companies into turmoil and 1-2 to sustained success?

    FLP: I disagree on this, we don’t need 7 statins. in a single payer system, we will give physicians the choice of one or two statins and only agree to pay $x (x being a very small amount). And no I don’t feel any sympathy for the drug companies. Costs need to come down for all pharmaceuticals and I think under a single payer, we can leverage power over the drug companies. 

    Fifth, you grossly underestimate the effects that a single payer shift would have upon the healthcare market and your salary.  Why would a monopolistic power care to offer physicians higher than Medicare wages?  Why would they seek to even sustain those payments?  Historical evidence would speak to a desire to reduce our wages in real terms.  Do you have evidence to the contrary?  Also, what makes you think the government will not make your life more debilitating, with more onerous work with no additional pay or value for patients?  You think burnout and the poor patient care that results from burnout will get better under this system?

    FLP: You may be right on this one, but I do know that there are many insurance company executives who would become superfluous. Again if as a result of true universal health coverage, physician salaries decrease, at least from my standpoint, so be it.

    And lastly, you still haven’t addressed the fundamental issue of individual liberty in that you are continuing to advocate for a system whereby people are conscripted into government service/payment against their will with no power to negotiate salary.  Last time I checked individual liberty was clearly outlined as a fundamental right in our founding documents.  Healthcare was not.

    FLP: Yes, all citizens of the US should have individual liberty to live a healthy life, and not worry about getting sick because they are uninsured, or going bankrupt from health care costs. 

    #240028 Reply
    ENT Doc ENT Doc 
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    Do you know how much treasure we are spending in Afghanistan per day, or how many bundles of cash we have given Afghanistan tribal leaders— and for what? Do you know we are building a drone base in the middle of Africa (Niger)- I happen to know a physician who was deployed there. Care to imagine how much money it takes to transport, feed, house troops, then to build hospitals, and drones in the middle of literally nowhere— and for what? I reject that we cannot afford to provide healthcare to our citizens. I’ll be happy to address your other concerns when I have more time.
    FLP

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    I’m not sure why you completely overlook the point I made on spending having nothing to do with this and try to ram home your off-based point again.  As for the other replies, I’ll wait.

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    To me, it has everything to do with it…a country (which happens to be the wealthiest country) which has the resources to pursue foreign misadventures surely has the resources to provide its own citizens healthcare…

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    Do you really think we have the resources to pursue foreign misadventures?  Perhaps you missed my point about our national debt and the fact that it’s doubled over the last 11 years.  Stop ignoring that point.  Also, even if we could afford it…see my other points.  I’ll wait.

    #240032 Reply
    ENT Doc ENT Doc 
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    FLP: already addressed…

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    Not really.  More like ignored.

    FLP: I’m not sure I would equate the concept of free market capitalism to the right of a human being to receive medical care. To me it’s about human dignity, and taking care of our own citizens.

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    There are plenty of other items that you could put up on the pedestal of human dignity and taking care of citizens.  The question is how best to do this efficiently while preserving individual liberty.  Advocating for government control is not only a lazy solution but also an inefficient one.

    FLP: Competition is general is a good thing, but where it has led us in the health care sector is increased costs, inefficiency, fragmentation, and poorer outcomes than in countries with what you would call a monopolistic system..

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    Competition has led to increased costs?  How exactly does that happen, FLP?  Please explain.  Competition has led to poorer outcomes?  Please explain.  You again reveal your ignorance about our healthcare system when saying that we are inferior to other monopolistic systems.  First, our populations are not comparable.  But let’s just say they are for this exercise.  I know you are simply repeating the tired talking points of our system being worse.  Because had you factored in and controlled for car deaths, homicide rates, suicide rates, obesity, etc. when you made the statement about health outcomes you wouldn’t have made it.  We are superior to other countries in cancer survival WITHOUT controlling for anything and then land #1 in life expectancy after those controls.  Also, when looking at birth statistics other countries don’t count infant mortality in the same way we do and they also give up on kids that we don’t give up on – we test the boundaries of what is possible to allow for their future kids to have the science and know-how to keep their future premature infants alive.  So spare me that we’re worse than other OECD countries.  We are better.

    FLP: I disagree on this, we don’t need 7 statins. in a single payer system, we will give physicians the choice of one or two statins and only agree to pay $x (x being a very small amount). And no I don’t feel any sympathy for the drug companies. Costs need to come down for all pharmaceuticals and I think under a single payer, we can leverage power over the drug companies.

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    Did you completely miss my point on R&D?  Or the FDA?  Sure, you CAN leverage power in a single payer system.  I don’t like drug companies any more than the next guy or gal.  But I realize their necessity.  And I also realize the inefficiency that’s been set up by the FDA – a branch of the very system that you want to give more decision making power to.  Huh?

    FLP: You may be right on this one, but I do know that there are many insurance company executives who would become superfluous. Again if as a result of true universal health coverage, physician salaries decrease, at least from my standpoint, so be it.

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    How many insurance company execs are you taking about here?  The number is dwarfed by the millions working in or attached to the healthcare sector who would be affected by a single payer system, at the very least with lost pay and/or lost jobs.

    FLP: Yes, all citizens of the US should have individual liberty to live a healthy life, and not worry about getting sick because they are uninsured, or going bankrupt from health care costs.

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    This isn’t what liberty means.  We can all choose to live healthy lives.  Some choose to, some don’t.  But what you don’t have the right to do is mandate that I work for X employer at Y salary to fulfill your needs.  You don’t have to stop at healthcare.  Why not food, water, shelter, transportation?  Certainly those are more essential than healthcare, yet none of those are guaranteed to all citizens through top down programs.  Also, your bankruptcy claim (pedaled by Warren…and yes, I’ve read her paper) ignores individual behavior and spending decisions prior to going into bankruptcy, other debt burdens held, and where medical debt fell on the margin.  You might be able to argue for a system that is more protective of people in this manner.  And you could argue for more market-based reforms that have a history of lowering costs to make bankruptcy less probable.  But instead you argue for a complete overhaul that would disrupt millions of lives and tank our economy.  That’s lazy thinking IMO when other, better options exist.  And BTW, do you think Medicare is cheap?  Do you think Medicare doesn’t bring with it OOP costs or remove the ability to go into bankruptcy as a result of required OOP costs?  Think again.

    #240037 Reply
    fatlittlepig fatlittlepig 
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    LOL, you won’t convince me that the current system doesn’t need a serious overhaul and I won’t convince you either. There are so many different proposals out there, to me any of them would be better than the current system.

    #240039 Reply
    uptoolate uptoolate 
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    Isn’t calling the U.S. Healthcare system a ‘free-market’ or ‘competitive’ just a bit of a stretch?  So many middlemen, so much bloat, so much obfuscation. Happy to not be burdened with your ‘system’ and be able to retire early with no worries about the quality of my or my family’s healthcare. No offense intended.

    #240041 Reply
    childay childay 
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    Fourth, you seem to misunderstand why drugs are priced the way they are and seem to misunderstand the nature of competition.  More drugs available are better.  More competition and options lowers cost.  You see this when trade names become generic.  What stalls this process and makes things more expensive is what the FDA allows in terms of patent protections and their criteria for what is approved as a “new drug”.  Look no further than the federal government here for the source of those problems.  The other issue here is that the rest of the world has been free-riding off our system that has allowed for R&D investment and innovation.  So we are charged higher prices while other countries sit back and enjoy a cheaper ride.  If we join them then bye-bye goes innovation for the next new medical problem or a better solution to ones we have currently.  Also, how would this work exactly?  A bunch of elected and non-elected government employees are going to wave a wand and determine which statins they will or will not approve, sending 8-9 companies into turmoil and 1-2 to sustained success?

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    While I agree with some of your other points, it is a bit one sided to blame the federal government for ridiculous FDA patent rules while ignoring the role of big pharma (in lobbying and creating those rules etc), the companies you are reluctant to wave a wand at and hurt the profits of.

    And lastly, you still haven’t addressed the fundamental issue of individual liberty in that you are continuing to advocate for a system whereby people are conscripted into government service/payment against their will with no power to negotiate salary.

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    Also to equate government health insurance to conscripted service is quite a stretch.  Though I agree the right to healthcare is very debatable.

    #240042 Reply
    Liked by Dusn, MPMD
    Avatar DEK 
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    Agee with ENT. Free market better. I have second hand experience with Socialism, married to Venezuelan for 20+ yrs. Not so good, Socialism that is.

    #239980 Reply
    Liked by ENT Doc
    Avatar Panscan 
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    Individual liberty to live a healthy life? How in the world are you going to guarantee that, and over and over we see Healthcare access has little to do with that. People just don’t care about their health. Are you next going to tell me obesity is due to lack of access to care? Hint, it’s not. People just don’t care.

    #240083 Reply
    fatlittlepig fatlittlepig 
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    Individual liberty to live a healthy life? How in the world are you going to guarantee that, and over and over we see Healthcare access has little to do with that. People just don’t care about their health. Are you next going to tell me obesity is due to lack of access to care? Hint, it’s not. People just don’t care.

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    ?? so it’s an individual choice not to get sick ?

     

    #240085 Reply
    Avatar Panscan 
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    in some illnesses yes, like majority of cirrhotics, that is a choice.

     

    A right is something you guarantee, IE you will have this and we will protect it. saying someone has a right to a healthy life? I have no idea how you make that proclamation. we cant guarantee health, especially to non-compliant patients who basically openly sabotage their own life. we could all have pancreatic masses churning or insert other insidious neoplasm here and there’s no way for the healthcare system to really stop that and guarantee a healthy life. our array of chronic disease as a population however, is mainly due to lifestyle choices, or should I say failure of choices.

    #240086 Reply
    Liked by med_phys
    fatlittlepig fatlittlepig 
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    in some illnesses yes, like majority of cirrhotics, that is a choice.

     

    A right is something you guarantee, IE you will have this and we will protect it. saying someone has a right to a healthy life? I have no idea how you make that proclamation. we cant guarantee health, especially to non-compliant patients who basically openly sabotage their own life. we could all have pancreatic masses churning or insert other insidious neoplasm here and there’s no way for the healthcare system to really stop that and guarantee a healthy life. our array of chronic disease as a population however, is mainly due to lifestyle choices, or should I say failure of choices.

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    LOL, Fatlittlepig never said we will guarantee a healthy life, that’s silly. We should guarantee health care access…

    this argument you are making is very unconvincing..

     

    #240087 Reply
    Liked by MPMD
    Avatar Dont_know_mind 
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    I find it hard to believe the world will fall back into the dark ages if the US didn’t “subsidise” worldwide tech R&D. This sort of argument is up there with the Olympics being an economic benefit for host countries.

    Anyway, who knows. US healthcare seems to be pretty inefficient with a lot free riders and ripe for disruption.

    Will Amazon Deliver a Single-Payer Health Care System for the U.S.?

    It will be interesting to see what happens.

    People who say the system can’t change due to X, Y, Z use a-priori arguments. I guess it’s easier to see if it happens.

    Let’s revisit this in 20 years.

    #240093 Reply
    Liked by q-school
    Avatar Null 
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    Earnest refinancing bonus

    Well, it turned into a political thread (guess I shouldn’t have been surprised!). I understand this is an important sociopolitical issue, but I don’t want to jump into a flamewar as a new poster, so…

    Guess the advice is: keep costs low, save money, and treat it like a possible illness, job loss, or divorce? I’m wondering about stuff like: I’m probably going to have more money coming in now than I will in the future, does that mean I should be more conservative than I otherwise would (more bonds relative to stocks)? Or should I put more in stocks to build capital while I’m able? Does the fact that I’d be paying lower tax rates later make tax-loss harvesting less useful? Stuff like that.

    #240106 Reply
    Lordosis Lordosis 
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    Guess the advice is: keep costs low, save money, and treat it like a possible illness, job loss, or divorce? I’m wondering about stuff like: I’m probably going to have more money coming in now than I will in the future, does that mean I should be more conservative than I otherwise would (more bonds relative to stocks)? Or should I put more in stocks to build capital while I’m able? Does the fact that I’d be paying lower tax rates later make tax-loss harvesting less useful? Stuff like that.

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    I do not think it would have much effect on your AA.  Just save as much ans you can and we can all adjust as we go along when more data is available.

    I find it hard to believe the world will fall back into the dark ages if the US didn’t “subsidise” worldwide tech R&D.

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    I think our innovation is doing the world a service.  Will the government keep the same level of funding to R&D new meds and vaccines?

    Same as how the space race advanced technology.  Now that we are out of that game things seemed to have slowed to a halt and are only picking up again 40-50 years later because of private industry.

    “Never let your sense of morals prevent you from doing what is right.”

    #240128 Reply
    MPMD MPMD 
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    Competition has led to increased costs?  How exactly does that happen, FLP?  Please explain.  Competition has led to poorer outcomes?  Please explain.  You again reveal your ignorance about our healthcare system when saying that we are inferior to other monopolistic systems.  First, our populations are not comparable.  But let’s just say they are for this exercise.  I know you are simply repeating the tired talking points of our system being worse.  Because had you factored in and controlled for car deaths, homicide rates, suicide rates, obesity, etc. when you made the statement about health outcomes you wouldn’t have made it.  We are superior to other countries in cancer survival WITHOUT controlling for anything and then land #1 in life expectancy after those controls.  Also, when looking at birth statistics other countries don’t count infant mortality in the same way we do and they also give up on kids that we don’t give up on – we test the boundaries of what is possible to allow for their future kids to have the science and know-how to keep their future premature infants alive.  So spare me that we’re worse than other OECD countries.  We are better.

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    I’m more watching this one that participating but a couple of questions.

    1. If you say our populations are not comparable (this is actually untrue but let’s assume it is for the sake of discussion) then how can you then go on to compare them in a way that supports the point you are making? If we cannot compare USA to say France for the purposes of most health stats then we can’t compare them on infant mortality either. I think you are trying to have this both ways. The argument that the USA is sui generis and therefore these systems that work very well (for less money) in our vacation destinations/staunchest allies is a common one that I find totally spurious, but if you’re going to voluntarily hoist yourself on that petard then I think you need to be consistent and just say that we are a completely unique case and eschew all comparison to other countries.

    2. This would be the first time that I’ve heard about vaguely defined allies “giv[ing] up on” neonates that we don’t. Do you have data for this? It seems that some of our NICU practices mirror some problematic practices at the end of life, namely massive expenditure for very marginal gains. That isn’t sustainable no matter who wins the policy argument. Everything I’ve read about infant mortality in the USA is an indictment of our system not a defense of it. Are you saying our stats are higher b/c we give more NICU babies a shot?

    3. Everyone thinks their country is better. What we resist as a nation is looking at best practices. Any interesting exercise here is to apply the philosophical principles of John Rawls and work behind the veil of ignorance.

    “Imagine that you have set for yourself the task of developing a totally new social contract for today’s society. How could you do so fairly? Although you could never actually eliminate all of your personal biases and prejudices, you would need to take steps at least to minimize them. Rawls suggests that you imagine yourself in an original position behind a veil of ignorance. Behind this veil, you know nothing of yourself and your natural abilities, or your position in society. You know nothing of your sex, race, nationality, or individual tastes. Behind such a veil of ignorance all individuals are simply specified as rational, free, and morally equal beings. You do know that in the “real world”, however, there will be a wide variety in the natural distribution of natural assets and abilities, and that there will be differences of sex, race, and culture that will distinguish groups of people from each other.”

    The interesting thing about Rawls is that you don’t get to be ENTDoc — an intelligent, well-spoken, well-read, and (I hope) relatively healthy professional. You are just “folks” as one of my college ethics profs put it. Any honest treatment of this exercise would not lead a rational actor to chose to be born in America. You would chose a Scandanavian nation, Japan, Switzerland, or perhaps Germany. Are we better?

    #240129 Reply

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