[Discussion] Health Policies and ACA Reform/Repeal

The existing health thread is for discussion on how changes to current policy will/have personally affected you or those you know. This thread is for more general discussion of the subject.

Aetius wrote:
Yonder wrote:

Isn't saying that single payer can't be paid for in flagrant violation of the (dozens of?) examples of countries having a single payer system and paying for it?

Not at all. Most of those countries don't pay for it - they just keep going further and further into debt. In places where the debt runs out, like Greece, the system simply falls apart.

The first rule of economics - economics always wins. Always. You can vote and talk and scheme all you want, but eventually, economics will catch up with you. You can't get something for nothing forever.

This is kind of starting to remind me of Social Security is a Ponzi scheme of nothing arguments... that largely only have clout because somone (oh look, the people who keep talking about Free Market and how the government is corrupt when in power) keeps raiding the accounts.

Singlepayer can work where it is correctly funded through taxes. If you make something contingent upon taxes then give out tax breaks so everyone can do what they want with their money which will somehow bring about a utopia of consumerism while still offering the services that the taxes were paying for previously, then of course it falls apart.

Also doesn't help that we have a country with so few poor people and so many "temporarily inconvenienced millionaires" who would rather keep pushing for tax cuts for millionaires (you know, when they get back to where they're supposed to be) than... you know, having healthy lives where they don't have to worry about a single hospital visit costing them more than their home, car, and next two of each of those combined.

I believe Aetius is referencing the notion that, absent any economic disincentives, people will overconsume healthcare.

I'm not sure I've seen research either way, but would be interested in data about health care usage in single-payer systems and whether its implementation led to over utilization.

Aetius wrote:
Yonder wrote:

Isn't saying that single payer can't be paid for in flagrant violation of the (dozens of?) examples of countries having a single payer system and paying for it?

Not at all. Most of those countries don't pay for it - they just keep going further and further into debt. In places where the debt runs out, like Greece, the system simply falls apart.

The first rule of economics - economics always wins. Always. You can vote and talk and scheme all you want, but eventually, economics will catch up with you. You can't get something for nothing forever.

That 2.45 billion pound deficit => $3.06 billion deficit => 0.11% of their gdp. That doesn't seem like a systemic failing. It seems like the system just isn't quite funded enough, as your article states:

Hopson pointed out that Britain spent a lower percentage of its national wealth on health than France, Germany, Sweden or Greece, and that investment as a proportion of overall public spending would fall even further over the next few years to less than 7% by 2020.

“This is simply not enough and we need to stop pretending it will be,” he said. “In the end you get what you pay for. There is now a clear gap between the quality of health service we all want the NHS to provide and the funding available. What we can’t keep doing is passing that gap to NHS trusts – asking them to deliver the impossible and chastising them when they fall short.”

Considering that the UK spends 9.1% of their GDP on their system, and the US spends 17.1% on their healthcare, that means that UK notching up their spending to 9.2% would fix everything?

I also don't appreciate the (all too common Libertarian) idea that anyone that disagrees with you just hasn't looked at any numbers and is being hopelessly ignorant. Try to keep in mind that people can have an understanding of economics and disagree with you.

Aetius wrote:

Not at all. Most of those countries don't pay for it - they just keep going further and further into debt. In places where the debt runs out, like Greece, the system simply falls apart.

The first rule of economics - economics always wins. Always. You can vote and talk and scheme all you want, but eventually, economics will catch up with you. You can't get something for nothing forever.

Most of those countries don't pay for it? Really? The link you provided is evidence of a decades-long campaign to piecemeal dismantle one single-payer system by the right-wing who've been privatizing or under-funding public services that whole time. Yes, they haven't been paying for it, because it's been politically advantageous for them to do so, not because they can't.

What about the rest of the single-payer countries? Canada? France? Australia?

Republican Plans for The Affordable Care Act

Jonman wrote:
Aetius wrote:

Not at all. Most of those countries don't pay for it - they just keep going further and further into debt. In places where the debt runs out, like Greece, the system simply falls apart.

The first rule of economics - economics always wins. Always. You can vote and talk and scheme all you want, but eventually, economics will catch up with you. You can't get something for nothing forever.

Most of those countries don't pay for it? Really? The link you provided is evidence of a decades-long campaign to piecemeal dismantle one single-payer system by the right-wing who've been privatizing or under-funding public services that whole time. Yes, they haven't been paying for it, because it's been politically advantageous for them to do so, not because they can't.

What about the rest of the single-payer countries? Canada? France? Australia?

I mean, to be fair, that's likely a good preview of what will happen in the US after the Republicans rise to power again post-implementation of WarrenCare.

Considering that the UK spends 9.1% of their GDP on their system, and the US spends 17.1% on their healthcare, that means that UK notching up their spending to 9.2% would fix everything?

Unfortunately no, because the UK is already over 90% of their GDP in debt, so a significant portion of that would have to be cut in order to be fiscally sound. Also to be fiscally sound, that increase would have to be supported by new taxes, which isn't politically feasible. Alternatively, that money would have to transferred from elsewhere in the budget, which also is unlikely to be politically feasible. The involvement of politics, the defining feature of a single-payer system, is thus also its greatest flaw.

Further, the NHS real budget (inflation-adjusted) has increased every year in the last 50, except for three. It's extraordinarily hard to argue that the NHS is underfunded when NHS spending, both real and as a percentage of GDP, has more than doubled over the last 50 years, against a population growth of about 20%.

The systems in the UK and the US are not directly comparable. The US system is significantly worse in terms of expenditures, and especially expenditures versus outcomes, because it was designed pretty much from the ground up as a tax-looting engine for government-friendly healthcare businesses.

Yonder wrote:

I also don't appreciate the (all too common Libertarian) idea that anyone that disagrees with you just hasn't looked at any numbers and is being hopelessly ignorant. Try to keep in mind that people can have an understanding of economics and disagree with you.

Huh?

Aetius wrote:

Further, the NHS real budget (inflation-adjusted) has increased every year in the last 50, except for three. It's extraordinarily hard to argue that the NHS is underfunded when NHS spending, both real and as a percentage of GDP, has more than doubled over the last 50 years, against a population growth of about 20%.

The practice of medicine today is unrecognizable to a doctor from 50 years ago. There are capabilities and treatments that simply didn't exist then, by the tens of thousands. The cost of that should outpace population growth, because we are doing a lot more medicine per person than 50 years ago, as evidenced by much better mortality rates.

Jonman wrote:
Aetius wrote:

Further, the NHS real budget (inflation-adjusted) has increased every year in the last 50, except for three. It's extraordinarily hard to argue that the NHS is underfunded when NHS spending, both real and as a percentage of GDP, has more than doubled over the last 50 years, against a population growth of about 20%.

The practice of medicine today is unrecognizable to a doctor from 50 years ago. There are capabilities and treatments that simply didn't exist then, by the tens of thousands. The cost of that should outpace population growth, because we are doing a lot more medicine per person than 50 years ago, as evidenced by much better mortality rates.

Population increased by 20%, cost of leeches increased by 10%, you really can't justify anything other than a 32% cost increase. That extra 68% is just lining the pockets of Big Leech.

Jonman wrote:

What about the rest of the single-payer countries? Canada? France? Australia?

Canada:

National debt of 66% of GDP

http://www.huffingtonpost.ca/nadeem-...

And it gets worse. Changing demographics mean Canada's health care system has a funding gap of $537 billion. While health care is costly and underperforming today, in the absence of reform the future will either hold large increases in taxes, further reductions in the availability of medical services, further erosion of non-health care government services, or all of the above.

France:

National debt of 95% of GDP

https://www.bloomberg.com/news/artic...

The government projects the health-care system’s 2013 shortfall will be about €5.1 billion, down from €11.6 billion in 2010. Yet that forecast may be optimistic, since it’s based on the assumption that the economy will grow 0.8 percent—double the European Commission’s estimate. France’s system “is simply unaffordable, unsustainable, and the manner in which it’s financed is a huge burden on the economy,” says Nicholas Spiro, managing director of Spiro Sovereign Strategy in London. “The French are not being realistic.”

Australia:

National debt of 17% of GDP

http://www.adelaidenow.com.au/news/n...

Hospital spending has been growing at two and a half times the inflation rate, it’s outstripping population growth and is rising even faster than the ageing of the population.

If nothing was done NSW had predicted its entire state budget would be spent on healthcare alone by 2033.

Yonder wrote:

Big Leech.

I used to play bass for them.

***

Good research work, Aetius.

So, would you say this a weird supply and demand problem? Where the demand is essentially infinite, and the supply has been limited by the capabilities of medicine? With technological advances, we're increasing the supply substantially, and that genie isn't getting back in the bottle anytime soon.

Aetius wrote:
Considering that the UK spends 9.1% of their GDP on their system, and the US spends 17.1% on their healthcare, that means that UK notching up their spending to 9.2% would fix everything?

Unfortunately no, because the UK is already over 90% of their GDP in debt, so a significant portion of that would have to be cut in order to be fiscally sound. Also to be fiscally sound, that increase would have to be supported by new taxes, which isn't politically feasible. Alternatively, that money would have to transferred from elsewhere in the budget, which also is unlikely to be politically feasible. The involvement of politics, the defining feature of a single-payer system, is thus also its greatest flaw.

None of that is at all important. The financial health of the country itself is entirely parallel to the amount of money this specific facet costs. Even if you believed that increasing the healthcare spending by 1.2% is going to be the straw that breaks the UK's fiscal back, that's not relevant. That's like saying "oh, well the UK has a 90% GDP debt, so if they spent more money on law enforcement then they will go bankrupt, thus governments shouldn't pay for law enforcement". The pertinent question is "does single payer healthcare lead to a better or cheaper health care system, or both". If you think that the 1.2% price increase would bankrupt the UK certainly the 188% price increase of switching to the American system would also bankrupt them.

The reason that "how would we pay for single payer" isn't as pressing of a question as other implementation details, is because evidence shows that the system would be far, far cheaper than what we pay now. When you have the same job and are moving from a $900 a month to a $1710 a month rental then "How on Earth am I going to pay for this" is a really pressing question. When you are moving from the $1710 apartment to the $900 apartment then spending too much time worrying about which checking account you're going to use, or whether you will pay cash, or drop a check off, or do a direct deposit... not negligible, but not as important either. Spend your time making sure to look for hidden costs and make sure you are accounting for everything, rather than getting distracted by trivia.

Yonder wrote:

I also don't appreciate the (all too common Libertarian) idea that anyone that disagrees with you just hasn't looked at any numbers and is being hopelessly ignorant. Try to keep in mind that people can have an understanding of economics and disagree with you.

Huh?

I thought that

The first rule of economics - economics always wins. Always. You can vote and talk and scheme all you want, but eventually, economics will catch up with you. You can't get something for nothing forever.

was pretty condescending, and implied that costs and money have been something that we (on this forum) have been ignoring while talking about healthcare policies. Rather than the absolutely, all-important, central overriding concern that it has been, frequently heavily sourced with examples.

oops

oops

Jonman wrote:

So, would you say this a weird supply and demand problem? Where the demand is essentially infinite, and the supply has been limited by the capabilities of medicine? With technological advances, we're increasing the supply substantially, and that genie isn't getting back in the bottle anytime soon.

Not a weird supply and demand problem, but a fairly standard one. Technological advances in nearly all other markets have reduced costs and increased capability, and that should be happening in healthcare as well. The fact that it's not is directly attributable to the vast market distortions that are currently in place in many countries.

Yonder wrote:

The financial health of the country itself is entirely parallel to the amount of money this specific facet costs. The pertinent question is "does single payer healthcare lead to a better or cheaper health care system, or both". If you think that the 1.2% price increase would bankrupt the UK certainly the 188% price increase of switching to the American system would also bankrupt them.

I would say the pertinent question is "is this system sustainable in the long term?" If the system is continually overspending, and adding to government debt - despite getting funding increases every year - then the answer is clearly no. Systems that are economically unsustainable are ... economically unsustainable.

Yonder wrote:

was pretty condescending, and implied that costs and money have been something that we (on this forum) have been ignoring while talking about healthcare policies. Rather than the absolutely, all-important, central overriding concern that it has been, frequently heavily sourced with examples.

I'm sorry - that's not what I meant at all. I meant, specifically, that single-payer systems promise free healthcare for everyone, and then expect to be able to control costs. It can't be done, and eventually, like in Greece, the economics catch up to you. And to be fair, the American system is also unsustainable, and for many of the same reasons, and is certainly facing the same fate.

Aetius wrote:

I meant, specifically, that single-payer systems promise free healthcare for everyone, and then expect to be able to control costs. It can't be done, and eventually, like in Greece, the economics catch up to you. And to be fair, the American system is also unsustainable, and for many of the same reasons, and is certainly facing the same fate.

That's not a fair characterization. Single-payer systems promise a free-at-the-point-of-delivery defined-level-of-healthcare. No single payer system allows whatever healthcare the patient wants - it's not an all-you-can-eat buffet, it's far more like a ration. The delivery is often (based on my long experience with the NHS) heavily throttled. I liken it to a "crap-to-mediocre insurance plan for everyone".

Jonman wrote:
Aetius wrote:

I meant, specifically, that single-payer systems promise free healthcare for everyone, and then expect to be able to control costs. It can't be done, and eventually, like in Greece, the economics catch up to you. And to be fair, the American system is also unsustainable, and for many of the same reasons, and is certainly facing the same fate.

That's not a fair characterization. Single-payer systems promise a free-at-the-point-of-delivery defined-level-of-healthcare. No single payer system allows whatever healthcare the patient wants - it's not an all-you-can-eat buffet, it's far more like a ration. The delivery is often (based on my long experience with the NHS) heavily throttled. I liken it to a "crap-to-mediocre insurance plan for everyone".

But if you take away his straw-man, what will the Libertarian argue against?

There's also a problem here, in that the idea that national debt is always, inevitably bad is strongly contested by accomplished economists, like Paul Krugman.

Rand Paul said something funny the other day. No, really — although of course it wasn’t intentional. On his Twitter account he decried the irresponsibility of American fiscal policy, declaring, “The last time the United States was debt free was 1835.”

Wags quickly noted that the U.S. economy has, on the whole, done pretty well these past 180 years, suggesting that having the government owe the private sector money might not be all that bad a thing. The British government, by the way, has been in debt for more than three centuries, an era spanning the Industrial Revolution, victory over Napoleon, and more.

There's more to it than that, but the libertarian fascination with austerity economics at the national level is not well-grounded in history these days. It often seems to me that libertarians simply neglect to consider the overwhelming successes of most countries since the Gold Standard went away, and use the few examples of fiscal policy mistakes to argue that the whole system will come crashing down, inevitably. But folks, we've had more than a hundred years of operating in this economic mode; it's time to acknowledge that the old way of doing economics represented to us by libertarians as the best way is simply not as good as what we have now, for the size and complexity of markets and nations today. And because going back would impose the old pains and weaknesses on us once again, it's probably not advisable.

The idea that all countries must remain debt-free is not mainstream economic thought today. Nor does it account with history. Libertarians must somehow explain within their theoretical framework how the British maintained government debt for three hundred years without crashing their government or economy before they can be taken seriously. It's clear that that success stands up to simple claims that national debt is always bad.

That's definitely a derail from this thread. If you want to talk about debt itself, rather than Health Spending in particular, can you go to the Libertarian thread?

Jonman wrote:
Aetius wrote:

I meant, specifically, that single-payer systems promise free healthcare for everyone, and then expect to be able to control costs. It can't be done, and eventually, like in Greece, the economics catch up to you. And to be fair, the American system is also unsustainable, and for many of the same reasons, and is certainly facing the same fate.

That's not a fair characterization. Single-payer systems promise a free-at-the-point-of-delivery defined-level-of-healthcare. No single payer system allows whatever healthcare the patient wants - it's not an all-you-can-eat buffet, it's far more like a ration. The delivery is often (based on my long experience with the NHS) heavily throttled. I liken it to a "crap-to-mediocre insurance plan for everyone".

Does it not also come back to demographics, namely you are better off with more people contributing rather than drawing on the system.

Put another way if you can maintain say three people working (and paying into the system via taxes) for every one person using the system who is not paying into it (be it due to retirement or what have you) it will remain much more viable.

OTOH there certainly will be demand side cost pressure related to how readily anyone can get expensive care on demand, a counter to which is essentially quotas.

I think that a large part of it comes down to personal attitudes.

Canadians (and those who live in places with single payer health care) are, on average, more accepting of "I am willing to pay more taxes, even if I never use the health system, so those that do aren't forced to choose between health care or their house." (to use one example) We do not want people to go into debt because they have to get treated for cancer or give birth. Society is, for us, better if you can get basic levels of health care for free.*

*yes, I know it is not for free. I pay for it with my taxes.

Great description and detail about the Republican "replacement" plan in comic form, illustrated by Ian Akin the same guy that created a similar set of comics explaining the ACA years ago.

http://economixcomix.com/home/trumpc...

mudbunny wrote:

I think that a large part of it comes down to personal attitudes.

Canadians (and those who live in places with single payer health care) are, on average, more accepting of "I am willing to pay more taxes, even if I never use the health system, so those that do aren't forced to choose between health care or their house." (to use one example) We do not want people to go into debt because they have to get treated for cancer or give birth. Society is, for us, better if you can get basic levels of health care for free.*

*yes, I know it is not for free. I pay for it with my taxes.

I often think that many people in the U.S. have no clue what taxes are actually for and just think it's just "the government" stealing money from them for...reasons.

But we do have some precedent for paying taxes on things that we don't use such as in the case of public schools. Many of us without children pay taxes for other people's children to be able to get an education, but that's perfectly fine with me. Even though I'm not directly benefiting, I'm enjoying things like less crime in my neighborhood as well as other community benefits of a better educated population.

I think exactly the same way about healthcare. If less people are sick, the less they are making *me* sick. The economy is better too when people have money to spend rather than going bankrupt. When, heaven forbid, I have a real health emergency, the emergency room wouldn't be packed with people getting treated for non-emergencies or may have even been able to prevent a health problem to begin with had they actually had access to preventative healthcare.

But sure, let's use our taxes to build a stupid wall that benefits no one.

bekkilyn wrote:

But we do have some precedent for paying taxes on things that we don't use such as in the case of public schools. Many of us without children pay taxes for other people's children to be able to get an education, but that's perfectly fine with me. Even though I'm not directly benefiting, I'm enjoying things like less crime in my neighborhood as well as other community benefits of a better educated population.

I may have commented on this before but during my childhood my aunt and uncle, who didn't have kids, raged against increases in public school funding, voted against it every chance they got. And years later they raged about how they couldn't find qualified employees for their business. Somehow never making the connection that working to destroy schools got the situation where youth were unqualified!

There's more to it than that, but the libertarian fascination with austerity economics at the national level is not well-grounded in history these days. It often seems to me that libertarians simply neglect to consider the overwhelming successes of most countries since the Gold Standard went away,

Robear, the middle class is being destroyed, and the primary reason is the lack of sound money. It's preventing price signaling from working, so that we aren't correctly adjusting to relative scarcities and surpluses. Instead, we issue fountains of debt to fuel basic consumption items. We're not living within our means, and the only reason we've maintained even the standard of living we have is because of the incredible levels of debt we've issued.

The thing about debt? It has a cost to carry, and it has to be paid back. People only lend you money if you're going to give them more money back. Issing debt is not free, and no matter how big and wealthy you are, you can choke yourself that way. Any entity, no matter how large, can make promises it can't afford to keep.

The path we're on is the one Venezuela is following. The middle class is being wrecked here, in a very similar way, because the fountains of money-from-nothing all go to the elites, while the people actually doing the work are starved. It's just taking a lot longer, because other countries are following our lead and printing money to hold theirs at parity with ours. Eventually, they're going to figure out this is a bad idea, and when things fall apart, they're going to do so catastophically and very, very quickly.

There's a reason why personal income peaked right when we went off the gold standard, you know. After the 1970s, we've steadily lost 2 or 3% real income per year, on average. It should have been growing, and instead it's been shrinking. Do that long enough, and people start to die.

The only reason people think it's better is because it's better for the elites, and the elites are the ones commissioning the studies and determining policy.

"Flyover America" had its say this election, and they're telling you this is a country in very severe economic distress, no matter what the economists tell you. Prosperous, happy people don't vote for clownshoes candidates.

Malor wrote:
Some stuff about austerity and the gold standard

Some stuff about the mechanics of debt and consumption. Contains the phrase "living within our means".

Is there a better thread to take this comment to? I don't feel it's particularly relevant to the Affordable Care Act but I'd be interested to talk about it. Debt and money supply is pretty fundamental to the structure of an economy and therefore how we live as a society. It also doesn't feel like this is a Libertarian issue (though Malor is presenting a fairly Libertarian point of view above).

I was politely asked not to continue this line of discussion in this thread, and I didn't.

The 31st is the last day to sign up for Obamacare or ACA.

Rep. Dave Brat, R-7th, is feeling some political pressure as Republicans in Congress move to repeal the Affordable Care Act.

“Since Obamacare and these issues have come up, the women are in my grill no matter where I go,” Brat told an audience Saturday at a meeting of conservative groups at Hanover Tavern.

“They come up — ‘When is your next town hall?’ And believe me, it’s not to give positive input.”

Brat, R-7th, asked the GOP-friendly audience to get organized.

“Help us write newspaper articles. We’re getting hammered,” he said.

...

Brat said Saturday that he was concerned the Senate wouldn’t pass a free market alternative to the Affordable Care Act, the 2010 law that became a signature of the Obama administration.

“We need activists coming out on everything,” he said.

In a phone interview Monday, Brat said he thinks many of the people protesting the Trump administration are paid activists from outside their area of protest.

“I had one woman on my Facebook say she was going to get up in my grill,” he said. “There’s paid protesters ... paid activists on the far left, not my Democratic friends I go to church with.

“They’re being paid to go around and raise havoc.”

Brat’s comments on “paid activists” were met with surprise from some constituents on Monday.

Karen Conley of Henrico County said she recently called Brat’s office in support of the Affordable Care Act, which insures her family.

She said she’s encountered numerous other constituents of the 7th District concerned about representation, and groups of people are finding each other.

“Nobody is being paid or put up to this by an outside organization,” she said. “Everybody is putting in their time and effort because they’re dissatisfied with the representation. They feel dismissed, and that their concerns aren’t valid because they’re not being responded to.”

People disagree with me? Must be paid to do so!