[arcticbull]

Right, I don’t disagree. I’m still not sure how the utility of the health system isn’t health outcomes. You can make a case that they are interlinked, smoking and health, but that doesn’t really answer my question. If anything, to me, you're making the case that (abuse of) substances such as alcohol, cigarettes and all 'illicit' narcotics should be under the full control of the health system and not the criminal justice system. Similar to how Portugal handles it.

FWIW the big issue is that private companies don't want to compete with the state because the goal of the state is to provide quality care, not to maximize profit. None of the private insurers are lobbying for two-tier universal healthcare so they can show off their sheer superiority are they? You'd think if they were actually superior they'd love, or at least be neutral to, the introduction of an inferior competitor.

If you're so sure private cover is better why push back against the introduction of a public option at all? Welcome all comers with open arms.

[conanbatt]

Insurance companies should abhor any kind of state competition, regardless of the case for it, its in their interest. But being an interested party does not make you evil.

Government also has an interest, in fact a huge interest. If healthcare were socialized entirely, dollar-per-dollar it would increase the federal government's size by ~ 10% of GDP. Currently its 21%! It would mean 50% bigger government!!

And that means HUGE cash, and HUGE political boons. Sanders could become president by promising people a healthcare service he does not pay for or he is not responsible for its failure. And the government now will have some omnipotent ways to levvy taxes and then short-change constitutents by cutting health spending or quality.

The government is also an interested party, and it's stands to gain more power than ever with such a ploy.

I also urge not to believe that the state "does thing for the people" because it either fails to do so or it just is plain false. Please look at the real results of public education: it has terrible results even though "its in the interest of the state to provide quality education".

[arcticbull]

The idea that this is going to be more expensive/isn’t paid for is ridiculous because it eliminates all of the money spent by private corporations on what should be a public service. It’s crazy that the government was able to shirk it’s responsibility to look after people and place that unfair burden on businesses. That makes it harder to run a business, harder to start a business, and increases your total cost of doing business in America. It’s time to relieve businesses of the burden of dealing with their employees health. The money they were paying to provide that service is going to pay for it. Isn’t that what America is all about — small business?

It doesn’t increase the size of government, those are flow-through dollars, they go in one side and out the other. A huge amount of American healthcare is already socialized between Medicare and Medicaid. If anything consolidating these disparate services should represent an administrative efficiency. And even if, so what?

Yes the government can then change health policy, that’s the point. If they cut it, deal with it at the ballot box. Right now there’s zero transparency and accountability with private insurers, so it’s strictly worse. In other countries the government treats health programs as sacred just like Medicare.

The data shows it works everywhere else, it can work here too. Government works in other countries, it can work here too. I’m curious as a free market health aficionado why not pitch privatizing Medicare? How’d you think that’d go over?

[GabrielBen]

> The idea that this is going to be more expensive/isn’t paid for is ridiculous because it eliminates all of the money spent by private corporations on what should be a public service

This is just a plain criticism of capitalism in general. Does this logic apply to everything else? Like food? Housing? In practice we have a great example with public education: an expensive, unequal base level that americans avoid if they have the money to.

> It’s crazy that the government was able to shirk it’s responsibility to look after people and place that unfair burden on businesses. > . It’s time to relieve businesses of the burden of dealing with their employees health

I agree, although I would like to note that historically this made sense from an administrative standpoint. Back in the 20's, administrative work of insurance was like half the cost. It wouldn't be so expensive today with electronic payments and all. Its the same logic behind payroll taxes (those that work pay it) mostly because its easy to do, not because its fair or good.

Its true that businesses would love not to manage training people about healthcare, but then the government will have to do it and that won't come cheap. That will be an interesting challenge. The M4A plan of no copays no nothing, that would eliminate that instruction is a pipe dream.

> It doesn’t increase the size of government, those are flow-through dollars, they go in one side and out the other.

Hey come in.

<They are in a federal bank account.>

<They are processed by a claims office that decides what to pay and what not to pay> They come out.

Whatever claims are not paid, its money leftover for spending in whatever initiative the government wants. In fact advocates for socialized medicine like Sarah Kliff want that to happen so the government can set prices. Since its your only employer (no competition with private insurance) you say you accept it or you close down.

> If anything consolidating these disparate services should represent an administrative efficiency

And if it doesn't, whats the way out?

> Yes the government can then change health policy, that’s the point.

Maybe thats your point, but I don't want in on that. I dont want the government deciding for me.

So I dont want to go thing by thing: we disagree, you envision a government administration to be great and fantastic, and I see it as unfair and oppressive. Lets compromise on our different of beliefs: lets advocate for a public option. Government offers something, insurance offers theirs, they compete in the open market, you get what you want and I dont need to confront.

I do want some other things though!

[arcticbull]

One last point of interest: it's not an open market right now. Medicaid pays for the poor, Medicare pays for the old and sick. In any other insurance system, the young and healthy pay for the old, sick and poor. However, literally all the worst customers in US healthcare have been socialized away. This is probably the biggest cash giveaway to private enterprise in history.

It's like offering government fire insurance only to buildings already on fire, in high-risk areas and below-code, leaving all the not-on-fire up-to-code buildings for the "free market." It's insane.

[conanbatt]

This is a common criticism but I don't think it checks out:

Medicare is funded by payroll taxes. So it already works as in "the young pay for the old". Its true insurances have incentives not to have diseases before patients to go medicare (for example, if they knew something has high risks at old age, but low risks before, they have an incentive to do that). Working in the industry I have yet to see an example of this, so I think its a greatly exaggerated claim.

OTOH, hospitals are forced to take medicare patients, and the reimbursement rate is up to half of what regular insurance pays. It is often below cost of care. This implies a cross-subsidy from private to medicare.

I think the final math on this topic is ambiguous. I would not make a claim either way without some stronger analysis.

[arcticbull]

> This is just a plain criticism of capitalism in general. Does this logic apply to everything else? Like food? Housing? In practice we have a great example with public education: an expensive, unequal base level that americans avoid if they have the money to.

The reason public education is bad is because Americans have decided to hate their government (which is an extension of themselves) and not invest in services in the public interest. It's not inherent to the system, it's a product of what you put into it: apathy and distrust. The same just isn't true in other countries.

In your criticism of public education you actually make a case for two-tier healthcare: I'd rather have a base level of schooling I can buy my way to "better quality" than leave anyone who can't afford private school out on the street with no education.

Not everything needs a profit motive. Some things, the ones that lay a foundation for a free and fair society, such as police, fire, roads, railways, water, education and health, should be provided. This allows individuals to rise to the level of their abilities and merits without relying on the largesse of their family. This is the meritocratic American dream, in a lot of ways. There are plenty -- and I do mean plenty of ways to make money out there, it's not like socializing this eliminates capitalism. If anything, it bolsters it by allowing more people to pursue entrepreneurship.

> Its true that businesses would love not to manage training people about healthcare, but then the government will have to do it and that won't come cheap.

It is cheaper in every other country, and there's no reason it wouldn't be cheaper here. Analysis in a Koch-backed study showed it would be +/- 10% (either 10% cheaper or 10% more expensive depending on ability to control costs while covering 12% more people) -- so less per capita no matter what. [1]

> Whatever claims are not paid, its money leftover for spending in whatever initiative the government wants.

That's not how governments work, that's how private companies work. Private companies take left over money and distribute it to their shareholders. Whenever a private insurer denies a claim someone makes money. Governments distribute it back to the people. Their goal is not to make money, to have money left over, it's to provide service. If they can do it for less, they'll lower their budget.

Not that it matters, single payer setting prices works just fine in Canada. You know that price transparency everyone in America is demanding? Here's Ontario's entire list of prices: http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser... PET scan? That's $237.50 (vs. $5000 in the US).

> And if it doesn't, whats the way out?

Voting?

> Maybe thats your point, but I don't want in on that. I dont want the government deciding for me.

By voting you decide. That's government. It's an extension of the people's will. You are in fact deciding. I'm sorry you feel like that doesn't work here, and that in fact you'd rather a faceless, un-accountable corporation with an interest in making a profit decide than a transparent, public good service you can control the leadership of. The government "decides" for you in so many other ways, it's ridiculous to draw the line here but even if you were to, offering a public plan strictly increases your options.

[1] https://www.nytimes.com/interactive/2019/04/10/upshot/medica...

[conanbatt]

> The reason public education is bad is because Americans have decided to hate their government...

Thats not going to change with socialized medicine. So shouldn't you be against it? Because americans still "hate government" and if that breaks government programs, it will break socialized medicine as well.

> In your criticism of public education you actually make a case for two-tier healthcare

US already has this. Namely Medicaid.

> It is cheaper in every other country,

We have had this argument before. Making it socialized will not make it cheaper, it will fundamentally change the way its funded. I haven't seen the details of the Koch study, but there are things that won't change: the shortage of doctors, the cost of pharma, the amount of hospitals, malpractice insurance costs etc. The cost of administration is exaggerated because that administration also provides value: it checks expenditures, medical reasearch etc.

In any case, again, if gov will be so efficient, it can start with a public option and see how that goes.

> By voting you decide. That's government.

I dont want to vote to see if I can see the doctor I want to see or pick the service I want to use. If you wish to vote your treatments go your own way, and you don't need me to achieve that. Advocate for a public option you can opt-in, and if it is truly better and cheaper and all that, now we know. I believe it will be worse and more expensive and I don't want to be locked in to that.

> The government "decides" for you in so many other ways,

That doesn't make me feel any better.

[arcticbull]

> Thats not going to change with socialized medicine. So shouldn't you be against it? Because americans still "hate government" and if that breaks government programs, it will break socialized medicine as well.

Maybe I'm just optimistic but I hope that this could be the thin edge that changes it. When in a democracy, attacking the government is attacking yourself and your country. It hurts you and your fellow citizens to approach social services like this, IMO.

That said I'd rather a low-quality baseline everyone gets that people can buy out of as necessary than leaving 10% of Americans un-insured and fending for themselves. Now ideally, I'd like a high-quality baseline everyone gets but even a low-quality program is better than the bupkis we have today.

> US already has this. Namely Medicaid.

Well, if private cover is the be-all and end-all why do we need this? Why don't we just privatize Medicare and Medicaid if they're so much worse? That plan enjoys little support, even from Republicans. Turns out the aged are all about socialized medicine for themselves, just not for anyone under 65.

You know that Medicaid may put a lien on your house for the amount of money spent on your care right? It's not socialized cover for the poor, it's death-prevention for the destitute.

> We have had this argument before. Making it socialized will not make it cheaper...

It does, though. Accessible preventative care is cheaper than dealing with problems down the line. You don't have huge marketing budgets, you don't have CEO compensation, you don't have claims denial departments, you have simple, stream-lined payout processes and pricing structures. You drive down drug prices because the states form bulk buying groups and negotiate. That's what makes drugs in Canada so much cheaper even though unless administered at a hospital, you have to pay out of pocket -- negotiation. Your incentive as the government is to make people well to drive down the cost of healthcare. Just axing coverage will not get you re-elected. (Imagine the optics of being the politician that cut spending on healthcare causing their constituents to die publicly?)

You send everyone through a primary care physician so they're not wasting the time of specialists via self-referrals. The list goes on and on. Medicare is objectively more efficient than private care. [1]

Then if you go all-in you can do what Canada does and socialize malpractice insurance too. It costs a fraction there of what it does here.

> In any case, again, if gov will be so efficient, it can start with a public option and see how that goes.

I'm down.

> By voting you decide. That's government. I dont want to vote to see if I can see the doctor I want to see or pick the service I want to use.

You don't get it. It's the other way around. In a public system 100% of doctors are in-network. You can go see anyone you need. In the US you either go to the ones your employer has in-network or you go bankrupt trying to see someone else. Change jobs? You may well have to change doctors. This whole narrative represents a false choice.

It's the other way around: Socialized cover represents a large cluster of freedoms: The freedom to pursue self-employment or liberal arts or stay-at-home parenting without fear of death or bankruptcy. The freedom to pick any job regardless of medical coverage. The freedom from worry about dying in the streets. The freedom from fighting your insurer over legitimate claims. The freedom to pick your own doctor regardless of what your boss wants -- and keep them if you change jobs! The freedom from having to pay more than you can afford for medical coverage. It's the freedom from having to be required to create profits for the insurance companies, by law (the individual mandate).

> The government "decides" for you in so many other ways, That doesn't make me feel any better.

Fair.

[1] https://www.modernhealthcare.com/article/20190211/NEWS/19021...