Serious question.

Post #413,851 by mmoffitt 9/23/16 1:21:04 PM 9/23/16 1:21:04 PM Reply	Serious question. Whenever the topic of "Single Payer" comes up, you (or perhaps Rand or perhaps both or perhaps others) draw analogies to unicorns and rainbows and/or ponies. Clearly, a Single Payer system can replace a for-profit health insurance system. All one need do is look a little north of here and/or observe health care delivery systems in most Western Democracies and/or around the world. So, what is it really that makes a "Single Payer" solution here a fantasy? Do you hold that we are just plain too stupid to do it or that our government is just plain too corrupt to do it? It's got to be one of those two as far as I can tell.
Post #413,853 by drook 9/23/16 1:40:51 PM 9/23/16 1:40:51 PM Reply	Serious answer Because every time someone gets close to taking a real step in that direction the purity ponies who want a giant leap give a big "fuck you" to the pragmatists and leave the vandals in charge for another round. -- Drew
Post #413,855 by mmoffitt 9/23/16 2:13:07 PM 9/23/16 2:13:07 PM Reply	By "Pragmatists" you mean capitulators, right? Follow up question. Canada didn't need a baby step, why do we? Pick (1) or (2) from previous question.
Post #413,857 by Another Scott 9/23/16 3:18:48 PM 9/23/16 3:18:48 PM Reply	Canada's system started in a few provinces then went national. It took decades. http://www.hc-sc.gc.ca/hcs-sss/pubs/system-regime/2011-hcs-sss/index-eng.php Before World War II, health care in Canada was, for the most part, privately delivered and funded. In 1947, the government of Saskatchewan introduced a province-wide, universal hospital care plan. By 1950, both British Columbia and Alberta had similar plans. The federal government passed the Hospital Insurance and Diagnostic Services Act in 1957, which offered to reimburse, or cost share, one-half of provincial and territorial costs for specified hospital and diagnostic services. This Act provided for publicly administered universal coverage for a specific set of services under uniform terms and conditions. Four years later, all the provinces and territories had agreed to provide publicly funded inpatient hospital and diagnostic services. Saskatchewan introduced a universal, provincial medical insurance plan to provide doctors' services to all its residents in 1962. The federal government passed the Medical Care Act in 1966, which offered to reimburse, or cost share, one-half of provincial and territorial costs for medical services provided by a doctor outside hospitals. Within six years, all the provinces and territories had universal physician services insurance plans. From 1957 to 1977, the federal government's financial contribution in support of health care was determined as a percentage (one-half) of provincial and territorial expenditure on insured hospital and physician services. In 1977, under the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, cost sharing was replaced with a block fund, in this case, a combination of cash payments and tax points. A block fund is a sum of money provided from one level of government to another for a specific purpose. With a transfer of tax points, the federal government reduces its tax rates and provincial and territorial governments simultaneously raise their tax rates by an equivalent amount. This new funding arrangement meant that the provincial and territorial governments had the flexibility to invest health care funding according to their needs and priorities. Federal transfers for post-secondary education were also added to the health transfer. In 1984, federal legislation, the Canada Health Act, was passed. This legislation replaced the federal hospital and medical insurance acts, and consolidated their principles by establishing criteria on portability, accessibility, universality, comprehensiveness, and public administration. The Act also added provisions that prohibited extra billing and user fees for insured services (see this brochure's section on the federal government for further details). Federal legislation passed in 1995 consolidated federal cash and tax transfers in support of health care and post-secondary education with federal transfers in support of social services and social assistance into a single block funding mechanism, the Canada Health and Social Transfer (CHST), beginning in fiscal year 1996-1997. HTH. Cheers, Scott.
Post #413,856 by Another Scott 9/23/16 3:15:14 PM 9/23/16 3:15:14 PM Reply	You didn't say "Single Payer". You said "Medicare for All" Medicare isn't "Single Payer" the way people think of what SP means. Medicare doesn't pay for everything. People on Medicare usually have supplemental insurance (A,B,D, private, etc.). People pay Medicare premiums, and have to pay more for more coverage. J's parents had Medicare and BCBS. Canada isn't "Single-Payer". You can buy BC insurance up there. I don't have much patience for "let's throw it all away and start over with something that will obviously be perfect because reasons" type of arguments. What Medicare/Single-Payer system are you advocating that has been demonstrated to work in a large modern country, and cover everyone, and not have a significant private management/gatekeeper element (since that's what's so Evil about the PPACA, amirite)? Please be specific. And tell me how you're going to get the House, Senate, and President to go along and pass/sign it. Thanks. Cheers, Scott. (Who is all for expanding Medicare but who doesn't claim that that would address all the things that the PPACA does so we should throw it away.)
Post #413,908 by mmoffitt 9/26/16 8:22:02 AM 9/26/16 8:22:02 AM Reply	Re: What Medicare system are you advocating ... Yes. That one. Premium Billing: Handled. Benefit Definition: Handled (Although not being completely familiar with Medicare benefits at this point, I believe they'll probably need to be extended to cover things like pregnancies, childhood immunizations, pre-natal care, and so on.) I'm advocating for a national plan that is essentially a hybrid of the existing Medicare and Medicaid programs. Claims Payment: Handled and vastly more efficient than private health insurers. Everyone covered: Yes. It's merely an extension of everyone being covered once they turn 65 or are living below the poverty line now. This isn't hard. Every other country has done it. We pay more and get less because we're idiotically paying people in our system that have nothing to do with the delivery of healthcare. In fact, some of those people we're paying are people who have a monetary interest in denying healthcare. The combined total of healthcare expenditures by the government (State programs and Federal) already amount to 2/3 of all healthcare expenditures (see here: http://www.pnhp.org/news/2016/january/government-funds-nearly-two-thirds-of-us-health-care-costs-american-journal-of-pub ) The balance is paid for by private health insurance. The private health insurance only pays medical claims for the most healthy of us. That leaves a "margin" absent in the public system. But that margin is money people pay for healthcare services that they are not going to receive. Instead that money is diverted to shareholder and corporate profit. And tell me how you're going to get the House, Senate, and President to go along and pass/sign it. Thanks. You answered my question. Our government is too corrupt to represent the people.
Post #413,910 by Another Scott 9/26/16 8:30:59 AM 9/26/16 8:30:59 AM Reply	Our government isn't going to change unless people vote sensibly. Which means voting D.
Post #413,913 by mmoffitt 9/26/16 8:39:22 AM 9/26/16 8:39:22 AM Reply	The last D put private insurers in our system by law. How'd that help?
Post #413,914 by Another Scott 9/26/16 8:43:54 AM 9/26/16 8:43:54 AM Reply	"Put" isn't the word you're looking for there.
Post #413,923 by mmoffitt 9/26/16 11:06:35 AM 9/26/16 11:06:35 AM Reply	Really? Private Insurers were in the system by federal law before?
Post #413,928 by Another Scott 9/26/16 11:42:44 AM 9/26/16 11:42:44 AM Reply	Define "the system" that you're talking about for me. "Medicare Advantage" ring a bell?
Post #413,931 by mmoffitt 9/26/16 11:54:07 AM 9/26/16 11:54:07 AM Reply	Part C is redundant coverage that could have been placed in part B.
Post #413,933 by Another Scott 9/26/16 12:05:48 PM 9/26/16 12:05:48 PM Reply	Shoulda woulda coulda. The law and the system has to deal with reality. ;-)
Post #413,917 by drook 9/26/16 10:09:51 AM 9/26/16 10:09:51 AM Reply	Action first, payment second Most of us prefer that people get healthcare first and worry about how it's paid second. You've been very clear that payment is your first, last and only consideration. -- Drew
Post #413,924 by mmoffitt 9/26/16 11:08:03 AM 9/26/16 11:08:03 AM Reply	Not at all. My first concern is that all people receive healthcare as a right. The second is that people get the healthcare they actually pay for.
Post #413,927 by drook 9/26/16 11:34:34 AM 9/26/16 11:34:34 AM Reply	What does "as a right" mean? If it includes "without having to pay for it individually" then yes, payment is your first priority. -- Drew
Post #413,932 by mmoffitt 9/26/16 11:56:19 AM 9/26/16 11:56:19 AM Reply	In America, you get the healthcare you can pay for and nothing else. That's wrong. Physicans can refuse to take Medicaid patients. Even pediatricians. No system is worth anything that allows a situation where a child can be legally denied care based upon their parents ability to pay.
Post #413,934 by Another Scott 9/26/16 12:10:31 PM 9/26/16 12:10:32 PM Reply	In Canada... http://www.canadian-healthcare.org/page4.html Private Health Insurance While the health care system in Canada covers basic services, including primary care physicians and hospitals, there are many services that are not covered. These include things like dental services, optometrists, and prescription medications. Private health insurance plans are usually offered as part of employee benefit packages in many companies. Incentives usually include vision and dental care. Alternatively, Canadians can purchase insurance packages from private insurance providers. The main reason many choose to purchase private insurance is to supplement primary health coverage. For those requiring services that may not be covered under provincial health insurance such as corrective lenses, medications, or home care, a private insurance plan offsets such medical expenses. AFAIK, please correct me if you know otherwise, there is no national health care system that covers everything. There is always going to need to be other supplementary systems, which often involve separate private insurance. Cheers, Scott.
Post #413,942 by mmoffitt 9/26/16 2:29:39 PM 9/26/16 2:29:39 PM Reply	Well, there was one once. I know because I personally benefited from being mistaken for a Russian child in the Soviet Union. ;0)
Post #413,951 by Another Scott 9/26/16 3:25:07 PM 9/26/16 3:25:07 PM Reply	Re: Well, there was one once. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025801/ Reliable information about the system of health care pertaining to the average Soviet citizen is difficult to come by. The health care offered important officials, artists and foreigners who become ill is at a much more sophisticated level than that available to the general Soviet community. Anectodal reports [1-5] depict the personal encounters of Western travelers with the health care system and reflect the preferential treatment given sick foreigners. ;-p Cheers, Scott.
Post #413,955 by a6l6e6x 9/26/16 3:38:09 PM 9/26/16 3:38:09 PM Reply	So, Mike was privileged even as a youth! :) Alex "There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge." -- Isaac Asimov
Post #413,960 by mmoffitt 9/26/16 4:01:53 PM 9/26/16 4:01:53 PM Reply	So, you know my own experiences better than I? The point is they did not know I was a foreigner until after they'd treated me because that was the point at which my father told them and asked how a fee for treatment could be made. My father and I spoke Russian only when we went into the office. It wasn't until after I was treated that they knew I was a foreigner. That's when they panicked. If they'd known before treatment, I'd have probably been sent to (at least) the embassy. Being a local clinic, I doubt seriously the practitioner would have wanted to chance an international incident by treating a US citizen and having something go wrong. So you can fsck-off telling me what my own experiences were and the reasons for them. No one better than I knows how well (and differently) U.S. citizens were treated in the Soviet Union than Soviets. We were the "Golden Children" everywhere we went and we'd been raised to reject that "special treatment" for ourselves. Which is why, in public, neither my brother nor I ever spoke a word of English and it is also why we wore our school uniforms almost everywhere we went because we knew our Western clothes would make us stand out. We intentionally always tried to pass for Soviet children. We were often successful, as we were the first and only time I was treated by Soviet clinicians. Quoting some US government propaganda site and suggesting that trumps my own, real-life experiences is beneath you.
Post #413,963 by Another Scott 9/26/16 4:06:16 PM 9/26/16 4:06:16 PM Reply	Point is, you were a sample of one. That is all. :-)
Post #413,964 by mmoffitt 9/26/16 4:09:21 PM 9/26/16 4:09:21 PM Reply	Okay, Twas not the thrust anyway. :0)
Post #413,940 by drook 9/26/16 1:55:51 PM 9/26/16 1:55:52 PM Reply	Thanks for confirming No system is worth anything that allows a situation where a child can be legally denied care based upon their parents ability to pay. So a system that demonstrably leads to more people being covered on a per-capita basis than any time in the history of the country is worth nothing because there are still cases where care depends on ability to pay. Like I said, finances are your first and only criteria. Doesn't matter who actually gets (or doesn't get) care. -- Drew
Post #413,943 by mmoffitt 9/26/16 2:30:28 PM 9/26/16 2:30:28 PM Reply	You've got a strange definition of equality embedded in that statement.
Post #413,945 by drook 9/26/16 2:34:08 PM 9/26/16 2:34:08 PM Reply	More words, please? -- Drew
Post #413,947 by mmoffitt 9/26/16 2:40:25 PM 9/26/16 2:40:25 PM Reply	Re: More words, please? I'm saying, "Everyone should get treatment who needs it without regard to whether they can pay for it." My position is that a system that treats people unequally is not a system worth having. You are arguing my position is ill advised. This suggests you don't care if some people go without care because unequal treatment with regard to healthcare is insufficient grounds to toss a system. IOW, some people are more equal than others and you're good with that.
Post #413,949 by drook 9/26/16 2:52:17 PM 9/26/16 2:52:17 PM Reply	You don't seem to understand your own words No system is worth anything that allows a situation where a child can be legally denied care based upon their parents ability to pay. I'm saying that the ACA is better than what it replaced because more people receive care than before. It could be still better if more were covered, and without regard to what they could pay, but it's *BETTER*. That's the word that doesn't exist in your world. It's not up to your standards, so it shouldn't exist. -- Drew
Post #413,961 by mmoffitt 9/26/16 4:03:17 PM 9/26/16 4:03:17 PM Reply	Simpler summary of my view: An unequal system is not a defensible system.
Post #413,967 by drook 9/26/16 5:00:41 PM 9/26/16 5:00:41 PM Reply	Do you prefer no system? There will be a system, even if that system is anarchy. If you don't choose something else you are choosing anarchy. Is that defensible? -- Drew

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