President Trump: The NEW one and only politics thread

Tarheel316 · Jul 26, 2017

typefitter said: ↑

To your last point, here's the thing about my gall bladder surgery that actually struck me the most.

This was, in the scheme of things, minor surgery. Keyhole surgery, one night in hospital. It cost $48,000. Okay, that's crazy. What's cancer cost? But because I have the great fortune of being Canadian, the Ontario government negotiated with the hospital. They got the bill down to $21,o00 and paid that instead.

Now, surely, the hospital was still making money at $21,000. They wouldn't agree to a fee that cost them money, right? Quite a markup.

That's first. Second, the government paid my now reduced bill and then told me: They will come after you for the rest. Don't pay it. They agreed to this reduction, but they're going to come after you as though they didn't. Tell them you're not paying.

Sure enough, collections agencies started calling me. $300 for this, $800 for this, a few thousand for this. Every time they called, I said, I'm not paying. They agreed to less. They got it. Now fuck off.

Eventually the calls stopped. But I remember thinking: These are people who are supposed to take care of sick people. And when, through no fault of my own, my gall bladder decided to pack it in, they tried to overcharge the shit out of me, and then they tried to shake me down for the rest of a ridiculous fee, even though they had agreed to a reduced payment.

Americans will never see it, and I will never understand why: Your healthcare system is the definition of sick, top to bottom. It is unique in the Western world in its moral deficiencies, in its costs, and in its elevation of misfortune into tragedy. And you will never, ever fix it. Because profit.
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Typefitter, you flat nailed it. Best synopsis of our broken system as I've ever seen. The price gouging is disgusting.

Alma · Jul 26, 2017

The Big Ragu said: ↑

Well, shit. It's different. Therefore, how can anyone possibly make an analogy to point out how people make decisions every day?

You can shut up any conversation with, "It's different!" It's how we end up with intentions getting confused with results, and the predictable consequences.
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I'm not merely saying it's different.

I'm saying it's unique. It's your life. It's your health. The thing you carry around with you every minute of every day. Doctors thus have an authority in our culture that almost no one has, certainly not mechanics. When a nurse or a doctor says the words "I'd hate to see you have a heart attack because we didn't get this test (that costs $2,500)" it's unique compared to a mechanic pontificating "boy, I'd sure replace that transmission before it goes out on ya."

It's death vs. a transmission.

Lemon health care kills people. Lemon cars are mostly irritating and inconvenient.

This free medical market paradise you envision will almost certainly harm and kill more people, because, in your example of mechanics...there are terrible, shitty, no good, cheap mechanics, just like there are shitty, no good, cheap pizza places.

Shitty, no good, cheap health care would be a disaster.

Michael_ Gee · Jul 26, 2017

Every other developed country has some means of getting as close to universal coverage as possible. That's because all of them put some limits, some much stricter than others, on profit-taking from the system. To expand coverage, either everyone, consumers and providers alike, has to be taxed more to do it, limits have to be placed on profit opportunities, or some combination of the two. It's not that complicated except politically.

Dick Whitman · Jul 26, 2017

Tarheel316 said: ↑

Typefitter, you flat nailed it. Best synopsis of our broken system as I've ever seen. The price gouging is disgusting.
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I wonder how many freelance paychecks Typefitter has negotiated down.

The Big Ragu · Jul 26, 2017

dirtybird said: ↑

I'd argue many people are incapable of synthesizing some of the more complex medical information coming at them. I'd also argue the things people most value are themselves and their family, and will thus be primed for acting irrationally.
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Most people don't have a medical degree, sure. If they did, they wouldn't have to trust in someone else's expertise. But the point is people don't have expertise in a lot of things, and they still have developed ways to navigate the world and make decisions about whose expertise and advise to trust. For example (cue, the "it's different! posts), you don't have legal expertise, but if you needed a lawyer how would you go about finding one? If you wanted to buy a fridge, would you consult consumer reports, read reviews, ask others, read up?

If the thing you value the most is your own health and your family's health, you are not acting irrationally if you make decisions that put a primacy on those things. It doesn't mean you are primed to act stupidly or against your own interests, though. When people don't bear the costs of their decisions directly, they behave differently than when they do. That is just empirically true.

Good health is not an entitlement. People who try to insist it is one, run into the fundamental problem of scarcity. People have unlimited wants and needs -- particularly when it comes to the thing that a lot of people value the most (their health). Health care is a limited resource. The notion that it is an entitlement has led to a lot of demagogic promises that ignore the fundamental scarcity. People have been sold intentions as results. It's how we come up with schemes like Medicare and Medicaid (which have grown into monsters that are bankrupting us and have driven up costs to extreme levels), the ACA, and a variety of other attempts to centrally plan the inherent scarcity away (which is a fairy tale). Worse, though, those attempts make things worse -- it creates greater scarcity due to higher costs. When you take a limited resource and separate the costs from the people who benefit from it, you are guaranteed to create inefficiencies, waste and drive up costs. Which is exactly what we have done. THAT is the irrationality. Not letting people bear the costs themselves, and make decisions accordingly based on their own utility.

dirtybird · Jul 26, 2017

doctorquant said: ↑

A health care organization faces fixed costs and variable costs. It answers to multiple stakeholders with varying perspectives and expectations. It requires revenues to ensure the continued inflows of the resources it needs. If, at the end of the day, it doesn't create value in excess of the value of those resources, some other entity will be given a chance with them.

You don't understand the comparison because you're unwilling to understand.
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It seems weird to accuse someone of being unwilling to understand as part of a relatively short post where the whole point was to willfully ignore the crux of someone's argument.

typefitter · Jul 26, 2017

Michael_ Gee said: ↑

Every other developed country has some means of getting as close to universal coverage as possible. That's because all of them put some limits, some much stricter than others, on profit-taking from the system. To expand coverage, either everyone, consumers and providers alike, has to be taxed more to do it, limits have to be placed on profit opportunities, or some combination of the two. It's not that complicated except politically.
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I don't even understand why it's complicated politically. Some large majority of Americans would benefit from a single-payer system. Once you switched (it's too late now, but you know what I mean), I sincerely believe you'd wonder why you ever tolerated the old system. Every time I hear of an American being forced into a worse job, or the military, because of benefits... I'm like, you really think you're free? Take that fear out of every American's life equation and you'd really know what it's like to be free.

dixiehack · Jul 26, 2017

Michael_ Gee said: ↑

Every other developed country has some means of getting as close to universal coverage as possible. That's because all of them put some limits, some much stricter than others, on profit-taking from the system. To expand coverage, either everyone, consumers and providers alike, has to be taxed more to do it, limits have to be placed on profit opportunities, or some combination of the two. It's not that complicated except politically.
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Whitman had a solid point about how a lot of the world benefits from American medical breakthroughs that come about because we're paying full freight on costs. Part of moving to single payer (and it will happen someday, even if many of us aren't around to see it) has to be accounting for putting money back into R&D, and it can't just be Uncle Sam carrying the load for the rest of the world.

BitterYoungMatador2 · Jul 26, 2017

typefitter said: ↑

I don't even understand why it's complicated politically. Some large majority of Americans would benefit from a single-payer system. Once you switched (it's too late now, but you know what I mean), I sincerely believe you'd wonder why you ever tolerated the old system. Every time I hear of an American being forced into a worse job, or the military, because of benefits... I'm like, you really think you're free? Take that fear out of every American's life equation and you'd really know what it's like to be free.
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They think they're free because a bunch of people told them they're free a long time ago and so now they believe they're free.

Tarheel316 · Jul 26, 2017

The Big Ragu said: ↑

Most people don't have a medical degree, sure. If they did, they wouldn't have to trust in someone else's expertise. But the point is people don't have expertise in a lot of things, and they still have developed ways to navigate the world and make decisions about whose expertise and advise to trust. For example (cue, the "it's different! posts), you don't have legal expertise, but if you needed a lawyer how would you go about finding one? If you wanted to buy a fridge, would you consult consumer reports, read reviews, ask others, read up?

If the thing you value the most is your own health and your family's health, you are not acting irrationally if you make decisions that put a primacy on those things. It doesn't mean you are primed to act stupidly or against your own interests, though. When people don't bear the costs of their decisions directly, they behave differently than when they do. That is just empirically true.

Good health is not an entitlement. People who try to insist it is one, run into the fundamental problem of scarcity. People have unlimited wants and needs -- particularly when it comes to the thing that a lot of people value the most (their health). Health care is a limited resource. The notion that it is an entitlement has led to a lot of demagogic promises that ignore the fundamental scarcity. People have been sold intentions as results. It's how we come up with schemes like Medicare and Medicaid (which have grown into monsters that are bankrupting us and have driven up costs to extreme levels), the ACA, and a variety of other attempts to centrally plan the inherent scarcity away (which is a fairy tale). Worse, though, those attempts make things worse -- it creates greater scarcity due to higher costs. When you take a limited resource and separate the costs from the people who benefit from it, you are guaranteed to create inefficiencies, waste and drive up costs. Which is exactly what we have done. THAT is the irrationality. Not letting people bear the costs themselves, and make decisions accordingly based on their own utility.
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So you're saying people who can't afford health care shouldn't get it?

dixiehack · Jul 26, 2017

Richard Shelby, noted millenial snowflake.

Sen. Richard Shelby backs transgender troops in military, breaks from new Trump policy

Iron_chet · Jul 26, 2017

YankeeFan said: ↑

Oh sure. But fawning over Trudeau is sort of cliche by now, isn't it?

And, not for nothing, but is there any evidence that he's some great leader? Does he have some record of success, or are we still just swooning over his looks?

The RS cover acts like it's saying what we're all thinking. Is Trudeau envy widespread in America? What percentage of Americans could identify him?
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If you want Trudeau you are more than welcome to have him (not that the alternatives up here are much better)

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President Trump: The NEW one and only politics thread

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President Trump: The NEW one and only politics thread

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