[b9a2cab5]

> Healthcare is the great equalizer

By income redistribution I mean most progressive proposals aim to heavily tax high earners to fund healthcare for lower income individuals. That money would otherwise be used by those earners to buy their first home, build retirement wealth, etc. Ever heard of HENRYs?

> MediCal is set up to be punitive to the poors like all Medicaid programs. A Medicare system isn't.

Citation is needed here. A lot of good doctors in my area won't take Medicare patients because Medicare reimbursements are too low. We also know from European systems that because everything is triaged based on need that wait times end up being very long if you don't have a life threatening condition. You also need to consider that American doctors make substantially more than European ones. If you compare the pay of specialty doctors in the NHS to ones in the US the difference is something like 5x.

> What getting everyone on the system does is it makes the political class beholden to the needs of the individuals

That is your perspective, and I think it's a naive one. I think it would prevent reforms that drive efficiency. Think of what happens when anyone talks about making Medicare more efficient: they get attacked as anti-elderly and portrayed as wanting to cut benefits. Or the same for military spending. At least the free market (which healthcare is not right now, but it could be) is ruthless about creating efficiency.

> Socialized medicine is no more a partisan issue in most countries than a socialized fire department or sidewalks.

Funny that the UK argues about NHS funding a lot then.

[arcticbull]

> By income redistribution I mean most progressive proposals aim to heavily tax high earners to fund healthcare for lower income individuals.

As someone who would be on the giving end of that, I'm fine with it, honestly. I won't always be on top.

> We also know from European systems that because everything is triaged based on need that wait times end up being very long if you don't have a life threatening condition.

We don't know that at all. Triaging based on need is a feature, not a bug - and a super easy way to save a ton of money! All of these criticisms were made up by the marketing department at insurers to fleece Americans. That's not hyperbole, and don't take my word for it. Here's an interview with one of the Cigna guys admitting to doing it, and apologizing. [1]

  "Here's the truth. Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border"

> You also need to consider that American doctors make substantially more than European ones. If you compare the pay of specialty doctors in the NHS to ones in the US the difference is something like 5x.

Ok, and they shouldn't. I'm sorry. It's not sustainable, it's not affordable. They're taking pay cuts. Nobody is entitled to a certain salary, standard or lifestyle in perpetuity no matter how unsustainable. BMWs for doctors while 10% of Americans are told to die or pick their favorite finger after an accent is unconscionable. America pays more than anyone else anyways, and would still after cuts, where would they go?

However, this is also simply not true for every system. Most similar countries socialize malpractice insurance which is a huge cost for US doctors. US OBGYNs pay up to $200,000 per year in malpractice insurance. In Canada, $40,000CAD. In the UK I think it's 0GBP handled by the CNST. That goes a long way to balancing out pay differentials.

In the US anesthesiologists make 400K USD median, in Canada 335K CAD median.

> Funny that the UK argues about NHS funding a lot then.

They argue about funding and prioritization and all sorts of stuff, sure, but it's not a partisan matter that the NHS should exist and be the status quo. The NHS was literally in the opening ceremonies of the 2012 olympics. 87% of British folks are proud of the NHS. [2]

Canada's Conservatives support single-payer medicine too.

[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...

[2] https://yougov.co.uk/topics/politics/articles-reports/2018/0...

[b9a2cab5]

> As someone who would be on the giving end of that, I'm fine with it, honestly. I won't always be on top.

And I and many others are not. You should recognize that this is a _political_ issue where there is no objectively better outcome. Higher taxation has long run drags on innovation and wealth building. The tradeoff is yes, we don't have universal healthcare. I'm okay with that if it means I have more job opportunities and ability to build my wealth.

> In the US anesthesiologists make 400K USD median, in Canada 335K CAD median

Just because the gap isn't 5x doesn't mean there still isn't a huge gap. $335K CAD is $235K USD. And Canada has comparable CoL to major US cities so you're losing real purchasing power there.

> That's not hyperbole, and don't take my word for it

Take a look for yourself at the data in Table 4 [1] sourced directly from each country's government reporting infrastructure and decide for yourself whether you would accept those wait times. I wouldn't accept a 2 month average wait time for something as simple as cataract removal, that's for sure. The quality of life loss in that time is immense.

> Ok, and they shouldn't. I'm sorry. It's not sustainable, it's not affordable. They're taking pay cuts.

Good luck passing any legislation over the lobbying of the AMA then. You're suggesting fundamentally untenable legislation that will never pass in the US. Aka bikeshedding. This is exactly the reason progressives can't get any legislation passed in Congress.

[1]: https://www.sciencedirect.com/science/article/pii/S016885101...

[arcticbull]

> And I and many others are not. You should recognize that this is a _political_ issue where there is no objectively better outcome

Luckily the rich are a minority and this is a majority rule system :)

There is 100% an objectively better outcome. Better care for more people, fewer people falling through the cracks is objectively better. There are objective rankings of healthcare system quality.

> Higher taxation has long run drags on innovation and wealth building.

And not dying if a small business owner gets sick has a long run boost to the economy. Individuals being able to take risks without fear of death and pestilence has a long run boost to the economy. A carpenter having all their fingers re-attached instead of just some of them has a long-run boost to the economy. Small and mid-size businesses not having to administer health plans is a boost to the economy.

> I'm okay with that if it means I have more job opportunities and ability to build my wealth.

You'll still have your chance lol.

> I wouldn't accept a 2 month average wait time for something as simple as cataract removal, that's for sure.

Cataracts develops slowly over a period of years. It's explicitly one of the lowest priority surgeries you can get for that reason. It took you 10 years to develop you don't need it out by Monday, late February is fine. (NOTE: In some provinces your data shows you can get it out in 2 days in Canada). It's nuts to think that you should be able to pay more to get your decades old cataract out by Monday so that someone who was in a car accident can get in line lol.

So yeah you absolutely would, and you wouldn't care at all.

Either way, America will almost certainly land on a two-tier system where you can still get your way.

> The quality of life loss in that time is immense. This is exactly the reason progressives can't get any legislation passed in Congress.

It's simply not. Sorry. Data and satisfaction surveys disagree, but also - only for the few who can afford to jump the queue. There's very few of those so they're not really represented in surveys.

> Good luck passing any legislation over the lobbying of the AMA then.

Single payer in Canada passed explicitly against the wishes of the entire North American medical establishment. "The organized medical establishment was not nearly so reticent and mounted a ferocious propaganda campaign fronted by the local College of Physicians and Surgeons with the support of the Canadian Medical Association (CMA), the AMA, the local economic elite and most of the media in the province." [1]

We got it done before, we'll get it done again.

You've been fed a crock. Sorry.

[1] https://canadiandimension.com/articles/view/the-birth-of-med...

[b9a2cab5]

> Luckily the rich are a minority and this is a majority rule system

Hmm, is that why the Build Back Better Act got killed in part by House Democrats wanting a SALT cap repeal? "The rich" you're thinking of excludes a large percentage of high earners who live in high CoL areas but are not wealthy. I'll remind you 20% of California earns more than $162k [1]. That's a lot considering the win margin of the general election and most CA state propositions. Enough to tip elections.

> And not dying if a small business owner gets sick has a long run boost to the economy

"Small business owner dying because they got sick without insurance" just doesn't happen. This is a strawman.

> You'll still have your chance lol

Average house price in Frankfurt is 7200 euro/sqm [2]. Tell me again how you can pay for a 200sqm house (=1.4M euro) when European software engineers make less than half of what American engineers make and get taxed more? A new grad at Uber in Europe makes 87k EUR [3]. A new grad in the US at any big name tech company makes more in the range of $180-200k. So your pay is more than double and you get taxed less, meaning you build wealth in the range of 3x as quickly.

[1]: https://www.thecentersquare.com/california/california-househ... [2]: https://www.ft.com/content/3e4f8c40-1dca-447e-a3c4-69911cfc1... [3]: https://blog.pragmaticengineer.com/software-engineering-sala...

[arcticbull]

> Hmm, is that why the Build Back Better Act got killed in part by House Democrats wanting a SALT cap repeal?

This could not be less relevant, but yes, I do think this likely represented the majority position. I think as much as we grumble Manchin represents his people. By the way 70% of Americans support Medicare for All so I'm not really worried about the popularity of the position. [1]

> "Small business owner dying because they got sick without insurance" just doesn't happen. This is a strawman.

18,000 Americans die each year due to insufficient medical coverage. You willing to bet not a single one is a small business owner? [2]

> Average house price in Frankfurt is 7200 euro/sqm [2]. Tell me again how you can pay for a 200sqm house (=1.4M euro) when European software engineers make less than half of what American engineers make and get taxed more?

Speaking of straw men, this is all attributable to the fact the Germans manage to cover 100% of their population for $5,595 per capita, vs America's covering 40% via a socialized program and 60% via private cover for $11,000 per capita?

> A new grad in the US at any big name tech company makes more in the range of $180-200k. So your pay is more than double and you get taxed less, meaning you build wealth in the range of 3x as quickly.

This argument doesn't hold water. You won't get that salary, broadly speaking, unless you live in SF, NY or SEA. There, your cost of living is so high your net take-home pay may well be lower than the German engineer. Certainly not after you adjust for PPP. But of course this has nothing to do with healthcare.

[1] https://www.cnbc.com/2018/08/28/most-americans-now-support-m...

[2] https://policyadvice.net/insurance/insights/how-many-uninsur...

[arcticbull]

At this point much of your argument has devolved into Gish gallop, so let's take a step back.

If private cover is so good - so clearly superior - would you advocate for eliminating Medicare and Medicaid? If not, why not? Why is socialized medicine the bees knees once you turn 65 but utterly unworkable if you're younger? Why do 75% of those covered by Medicare think the system is working very well - significantly more than those with private cover - and why would that not extend to everyone?

[b9a2cab5]

My argument is simple: Medicare for All entails higher taxes on high earners, which stunts wealth building and economic mobility, especially for high earners who grew up in poverty. This can be easily seen by comparing, for example, salaries of software engineers in Europe and the United States. Medicare and Medicaid are intended to take care of those that _can't work_, but Medicare for All is intended to take care of people that _choose not to work in a higher paying field they dislike_.

> private cover is so good

I would pay for a single payer option if everyone paid a flat fee for insurance that wasn't income based. I'm against the income redistribution part of Medicare for All, for aforementioned reasons.

> Why do 75% of those covered by Medicare think the system is working very well

Once again, polls are incredibly misleading and dependent on the wording used in the survey. You need only look at surveys of Obamacare vs. the ACA to see this effect.

You continually try to engage in asking the same questions by claiming to not understand all the statistics I've given you and I don't believe you're conversing in good faith anymore. Goodbye.

[arcticbull]

> My argument is simple: Medicare for All entails higher taxes on high earners, which stunts wealth building and economic mobility, especially for high earners who grew up in poverty.

This is an absolutely tiny fraction because most poor people can't afford the healthcare necessary to actually thrive in the economy. Ditto the education. What we need is equality of opportunity, and that requires social services.

> I'm against the income redistribution part of Medicare for All, for aforementioned reasons.

I'm completely uninterested in this. Unless tied to income it's a regressive tax that punishes the poor disproportionately along the axis of marginal utility of money.

> Once again, polls are incredibly misleading and dependent on the wording used in the survey. You need only look at surveys of Obamacare vs. the ACA to see this effect.

This is a different subject and so not relevant. Everyone knows what Medicare is. The only thing most right-wingers know about Obamacare is that Obama created Obamacare. Really it's more like Romneycare for All as it's essentially a Republican policy. There's not a single left-leaning thing about making every individual pay a private company for healthcare. You're not showing a skew in reality, just marketing.

I suspect Americans would feel differently if they knew that Obamacare single handedly dropped the rate of people dying from lack of cover by almost 50% per annum.

> You continually try to engage in asking the same questions by claiming to not understand all the statistics I've given you and I don't believe you're conversing in good faith anymore. Goodbye.

Respectfully disagree. I've successfully refuted every concrete point you've made up to and including whether "the left can pass such a bill" and whether you really need cataract surgery tomorrow.

I wish you the best. Medicare for all is coming. It's just a matter of time.

However, you have failed to answer my core question. Do you think that Medicare should be abolished? Should Medicaid? If so, why? And in what concrete ways do you think that would make America a better place? More efficient? And why is 65 the magic age at which "socialism" finally starts to make sense?

[b9a2cab5]

> This could not be less relevant

It shows you that the "rich" you're discounting wield substantial political influence. Manchin wasn't the only one that killed the bill, House democrats also said they'd kill the bill during the merging of Senate/House versions if there wasn't a SALT repeal.

> By the way 70% of Americans support Medicare for All so I'm not really worried about the popularity of the position

Do you know how these surveys work? They literally just ask people how much they support "Medicare for All". They don't present any concrete policy or implications of implementing M4A. That's why "Obamacare" got way less support than "Affordable Care Act" in polls. Please understand the stats you're quoting at the very least.

> 26,000 Americans die each year due to insufficient medical coverage. You willing to bet not a single one is a small business owner?

And hundreds of thousands of people die from benign illnesses like the common cold and the flu each year. What's your point? I bet we can find someone in Germany who died because of wait times too, that doesn't mean we can use that to generalize to everyone.

> Speaking of straw men, this is all attributable to the fact the Germans manage to cover 100% of their population for $5,595 per capita, vs America's covering 40% via a socialized program and 60% via private cover for $11,000 per capita?

This has no relation to the impact of universal healthcare's higher taxes on wealth building. It is a fact that it is harder for working professionals in Europe to build wealth compared to the US.

> This argument doesn't hold water

Cost of living is not so high in NY and SEA. You can rent a luxury apartment in SEA for less than $2000/mo, which is comparable to Frankfurt. Only SF is insane. And German cost of goods is around the same or more than US, so I don't know where you're going with your PPP idea. You need only look at the cost of electronics, gasoline, food, etc. to see they are about the same.

> But of course this has nothing to do with healthcare

Yes it does. Implementing M4A would require heavily taxing high earners. I'm giving you an example of how a high earner would be unable to build wealth under European-like taxation. But it seems like you are unable to understand the idea that high taxes unfairly penalize high earners who came from poor families. I.e. implementing M4A's taxes would penalize economic mobility. Perhaps you came from a family with wealth already.

[Talanes]

> By income redistribution I mean most progressive proposals aim to heavily tax high earners to fund healthcare for lower income individuals. That money would otherwise be used by those earners to buy their first home, build retirement wealth, etc.

This is the most transparently selfish thing I've read in a while. Congratulations.